Sustainable HIV prevention possibilities present choices, challenges

via Science Speaks, by Antigone Barton

When he looks at what biomedical science can do in the next decade to prevent HIV transmission, Jim Turpin of the National Institutes of Health said, he thinks of the lyrics of a Timbuk3 song: “The future’s so bright I gotta wear shades.”

By, which, actually, he means — don’t get blinded by the light; the search for answers will require focus.
“The challenge is not the lack of options,” he said, “but prioritizing the best options.”

Turpin, program officer and branch chief in the Prevention Sciences Program in the Division of AIDS at NIH”s  National Institute of Allergy and Infection Disease spoke this morning in webinar titled “The HIV Prevention Pipeline: A Future of Possibilities.” The webinar was sponsored by the International Rectal Microbicide Advocates (IRMA) and AVAC Global Advocacy for HIV Prevention.

After a series of disappointments in the quest for a vaccine or microbicide to prevent HIV transmission, the last two years offered hope, in strategies using antiretroviral medicine to prevent acquiring HIV, organizers point out. But, with a diversity of prevention needs and challenges among women and men worldwide still demanding answers, is that all there is?

Or, as Turpin put it, “Do we currently have what it takes to create a sustainable prevention pipeline?”

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Policy Implications of The Lancet MSM & HIV Series

via Center for Strategic & International Studies

In light of the need to address key populations in the HIV epidemic, the Center for Strategic and International Studies is convening several authors to discuss a special issue of The Lancet focused on the global HIV epidemic among men who have sex with men (MSM).

Thursday, September 6th
3:00pm—5:00pm (EST)
B1 Conference Room
Center for Strategic and International Studies
1800 K Street NW, Washington, D.C.

CSIS will host a dialogue focusing on the domestic and global policy implications of the new research and modeling presented in this special issue. Articles examine the subject from a variety of perspectives, including epidemiology, biological and behavioral factors in HIV transmission, the success of various interventions, costing a comprehensive response, and HIV among black MSM in the United States and elsewhere. Authors will discuss why current programs are failing and HIV epidemics among MSM are still increasing. Sharon Stash, CSIS Global Health Policy Center Senior Advisor, will moderate the discussion with authors Chris Beyrer, Kenneth H. Mayer, Greg A. Millett, and Patrick S. Sullivan, and discussant Chris Collins. The session will open with concise presentations of the key findings and policy recommendations, with the majority of the time reserved for questions and discussion.

Please RSVP at: http://SmartGlobalHealth.org/Lancet

Thank you,

J. Stephen Morrison
Senior Vice President and Director, Global Health Policy Center
Center for Strategic and International Studies

Access the webcast here.


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U.S. Preventive Services Task Force May Soon Make HIV Testing Routine

via the Huffington Post, by Salimah Ebrahim

WASHINGTON, Aug 20 (Reuters) - A U.S. health panel may soon make HIV testing as standard a practice as checking cholesterol levels, a move that would fundamentally change how the virus is detected and treated.

The U.S. Preventive Services Task force, a government-backed group of clinicians and scientists, is expected to make a new recommendation on HIV screening available for public comment before the end of the year.

Health officials close to the panel, speaking on condition of anonymity, see it making a positive recommendation for routine screening, updating their current position, issued in 2005, which leaves the decision up to doctors.

Under President Barack Obama's healthcare law, passed in 2010, insurers are required to cover preventive services that are recommended by the task force.

"This would be one of those major sea changes ... moving away from what has been somewhat the segmentation of HIV - either by population, by geography," said Michael Kharfen, chief of community outreach for the Washington, D.C., Department of Health. Kharfen, who worked on the frontlines of the HIV epidemic in New York in the 1980s, recalls when the prognosis for the disease was "practically certain you were going to die.

"It still will take culture change for medical providers, but this will be a tremendous leap," he said

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Three-quarters of clinicians in the US willing to prescribe early HIV treatment for the purpose of prevention

via aidsmap.com, by Michael Carter

There is an overwhelming consensus among clinicians who prescribe HIV treatment in the US that people who are taking antiretroviral therapy are less likely to transmit HIV to their sexual partners, according to results of a study published in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Results also showed that over three-quarters of care providers would be willing to prescribe early therapy to people with an HIV-negative partner for the purposes of prevention.

The study involved 165 prescribing clinicians working at HIV clinics in the Bronx, New York, and Washington DC. It was conducted in 2010 and 2011, well before the publication of the results of the HPTN 052 study in the summer of 2012, which showed that virologically suppressive HIV treatment reduced the risk of transmission by 96%. US HIV treatment guidelines were updated in 2012 to endorse early treatment to reduce the risk of transmission.

“This survey of HIV clinicians in two US cities found most clinicians believe that ART [antiretroviral therapy] can reduce HIV transmission, even before the results of HPTN 052 demonstrated ART to be effective for this purpose, and before 2012 treatment guideline changes recommending ART for patients at risk for HIV transmission,” write the authors.

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Cipla launches HIV/AIDS treatment kit at Rs 158

via IBN Live

New Delhi: Drug major Cipla on Tuesday said it has launched 'Qvir', a four-drug kit priced at Rs 158 per kit to be used for treating HIV/AIDS. The kit consists of two tablets packaged together in one strip which represents a single day's treatment, Cipla said in a statement.

Commenting on the introduction Cipla Chairman and Managing Director YK Hamied said: "While we are committed to making drugs affordable and accessible, we also endeavour to have more options for HIV infected patients, which are potent, effective, patient-friendly and easy to take".

As the tablets are packaged together in one strip, the patient does not have to remember which tablet he took, and cannot mistakenly take two of the same tablet, the company said.

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Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial

via The Lancet, by Lara Fairall et al.

Background

Robust evidence of the effectiveness of task shifting of antiretroviral therapy (ART) from doctors to other health workers is scarce. We aimed to assess the effects on mortality, viral suppression, and other health outcomes and quality indicators of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) programme, which provides educational outreach training of nurses to initiate and represcribe ART, and to decentralise care.

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Newly infected individuals sustaining HIV epidemic in Geneva

via aidsmap, by Michael Carter

Individuals with recent HIV infection are sustaining the epidemic, a Swiss study published in the online edition of AIDS suggest. The investigators believe that their results further support the use of antiretroviral therapy as prevention, but also show that its impact on the epidemic will be blunted because of the high number of transmissions which can be attributed to individuals who have been recently infected with HIV and who are not yet taking treatment.

Phylogenetic analysis showed that only a handful of infections in individual diagnosed between 2008 and 2010 could be attributed to patients diagnosed before 2000. Patients with longer-term HIV infection were the group most likely to be taking antiretroviral therapy and to have an undetectable viral load.

“Recent HIV infections were a significant source of HIV spread,” comment the authors. “By contrast, HIV individuals diagnosed before 2000 were rarely the source of new infections before 2008.”

It is now widely accepted that patients who are taking HIV therapy that suppresses their viral load to undetectable levels are highly unlikely to transmit the virus to their sex partners.

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CDC Issues Interim Guidance for Clinicians Considering the Use of Preexposure Prophylaxis for the Prevention of HIV Infection in Heterosexually Active Adults

via Morbidity and Mortality Weekly Report

In the United States, an estimated 48,100 new human immunodeficiency virus (HIV) infections occurred in 2009 (1). Of these, 27% were in heterosexual men and women who did not inject drugs, and 64% were in men who have sex with men (MSM), including 3% in MSM who inject drugs. In January 2011, following publication of evidence of safety and efficacy of daily oral tenofovir disoproxil fumarate 300 mg (TDF)/emtricitabine 200 mg (FTC) (Truvada, Gilead Sciences) as antiretroviral preexposure prophylaxis (PrEP) to reduce the risk for HIV acquisition among MSM in the iPrEx trial, CDC issued interim guidance to make available information and important initial cautions on the use of PrEP in this population.

Those recommendations remain valid for MSM, including MSM who also have sex with women (2). Since January 2011, data from studies of PrEP among heterosexual men and women have become available, and on July 16, 2012, the Food and Drug Administration (FDA) approved a label indication for reduction of risk for sexual acquisition of HIV infection among adults, including both heterosexuals and MSM.* This interim guidance includes consideration of the new information and addresses pregnancy and safety issues for heterosexually active adults at very high risk for sexual HIV acquisition that were not discussed in the previous interim guidance for the use of PrEP in MSM.

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The battle against HIV and AIDS, selling sex in India, and what next for Ghana

via the Guardian, by Liz Ford

Funding for HIV and Aids treatment and prevention, and the barriers to receiving it, were the focus of two conferences last week.

World leaders and celebrities gathered at the International Aids Conference in Washington DC to discuss the issues. Among the attendees was the president of the World Bank, Jim Yong Kim, who told Global development that the long-term sustainable response to the Aids crisis needed to include discussions on how to spur growth in the private sector. He also talked about his mission to end poverty.

On another continent, sex workers from more than 40 countries held an alternative HIV summit to urge the case for their rights and protest at US visa restrictions barring them from attending the Washington conference. The week-long summit in Kolkata, India, highlighted the ways in which the fight against HIV has forced governments to talk to marginalised groups.

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Changing the way HIV prevention is delivered – a roadmap

via aidsmap, by Roger Pebody

In the last few years there has been a wealth of dramatic data on the efficacy of new HIV prevention methods, including male circumcision, pre-exposure prophylaxis and treatment as prevention. While last week’s 19th International AIDS Conference (AIDS 2012) didn’t deliver similar headline-grabbing studies, there were important discussions about how policy makers can implement effective HIV prevention strategies.

“We need to start thinking about the populations who are most at risk for targeted interventions,” Nelly Mugo of the University of Nairobi told a plenary session. “Then we will need to prioritize those interventions that work within those populations, and deliver them in combination with high coverage for us to get high impact.”

Speakers at other sessions gave numerous examples of the choices and dilemmas involved at each stage, drawing upon experience in the United States and in African countries.

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Helen Epstein's wrong about SA's response to AIDS

via politicsweb, by Nathan Geffen

Helen Epstein is an influential journalist and regular contributor to one of the world's most prestigious literary journals, the New York Review of Books (NYRB). It is therefore unsettling that she has written an article on the NYRB blog that contains serious errors about the South African HIV epidemic and the important prevention benefits of antiretroviral treatment (ART) (see here).

In her first sentence Epstein writes, "When I first visited South Africa in 2000 to report on the AIDS epidemic there, one adult in five was HIV positive, and a million children had lost one or both parents to the disease." These numbers are simply wrong. UNAIDS estimates that by 2001 there were 580,000 children who had lost one or both parents to AIDS. This is a horrific figure, but substantially less than Epstein's. 2 The Actuarial Society of South Africa estimates the number of children who had lost a mother or both parents to AIDS by mid-2000 and they reach a considerably lower estimate of about 120,000. 3 Epstein also overstates the percentage of adults infected with HIV in 2000.

Epstein writes, "Although the HIV infection rate has finally begun to fall in neighboring countries like Botswana and Zimbabwe, it remains stubbornly high in South Africa. After studying the African epidemic for two decades, I've come to believe that shame and silence are the primary reasons ..."

She is wrong that South Africa's infection rate is not falling. Also wrong is her implication that shame and silence make the South African epidemic signally different from those in Botswana and Zimbabwe.

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The Value Of HIV Treatment In Couples

via NPR, by Richard Knox

Dr. Rochelle Walensky thinks the 19th International AIDS Conference will be remembered as the moment when the world began to mobilize to end the pandemic.

The Harvard researcher probably speaks for many of the 23,000 scientists, activists and policy mavens who came to the Washington conference. But they're going home with a big question on their minds: Can the world afford it?

Walensky and her colleagues provided the beginning of an answer with a presentation on the final day of the conference. They looked at the cost implications of expanding anti-retroviral treatment to all HIV-positive people in couples where one partner is not infected.

"Is it worth paying for? The answer is yes, it's very cost-effective," Walensky told Shots. At least that's the case in South Africa and India, which the researchers chose for their analysis, and for the limited situation of these so-called discordant couples.

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