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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NIH to test maraviroc-based drug regimens for HIV prevention

via National Institute of Health

Scientists are launching the first clinical trial to test whether drug regimens containing maraviroc, a medication currently approved to treat HIV infection, are also safe and tolerable when taken once daily by HIV-uninfected individuals at increased risk for acquiring HIV infection.

The eventual goal is to see if the drug regimens can reduce the risk of infection.

The trial involves a strategy known as pre-exposure prophylaxis, or PrEP, in which HIV-uninfected individuals who are at risk for contracting the virus take one or two HIV drugs routinely in an effort to prevent infection. Called Novel Exploration of Therapeutics for PrEP, or NEXT-PrEP, the two-year study is sponsored and funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

"The NEXT-PrEP study will examine whether maraviroc-based PrEP is safe and well-tolerated. It is a necessary first step before we can test the effectiveness of maraviroc-based PrEP, and in the future, potentially expand the selection of drugs that may be used in this emerging HIV prevention strategy," said NIAID Director Anthony S. Fauci, M.D.

Led by principal investigator Roy M. Gulick, M.D., M.P.H., chief of the Division of Infectious Diseases and professor of medicine at Weill Cornell Medical College of Cornell University, the study team will enroll 400 HIV-uninfected men who have sex with men (MSM) ages 18 and older in 12 cities in the United States and Puerto Rico.

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Investigating the Impact of Treatment on New HIV Infections

via PLoS Collections

The HIV Modelling Consortium aims to strengthen the support that mathematical modelling and related quantitative disciplines can provide to global decision-making in HIV. In November 2011 the HIV Modelling Consortium held a meeting in South Africa to focus on the cross-cutting issues of the impact of new scientific findings about HIV treatment preventing new infections. The group considered the feasibility of interventions, potential epidemiological impact, affordability, and new scientific observational studies and community trials. The nine reviews and one research article which comprise this collection arose from that meeting and provide insights into the factors which will support evidence-based decision-making in HIV prevention, with a focus on the use of antiretroviral treatment to prevent HIV transmission.

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World Health Organization Encourages Antiretroviral Drug Use for HIV Prevention

via aidsmap.com, by Keith Alcorn

The number of people eligible for antiretroviral treatment will grow by around six million as a result of recent World Health Organization recommendations on the use of antiretroviral drugs to prevent HIV transmission, Dr Gottfried Hirnschall, head of the WHO’s HIV department told the IAPAC Controlling the HIV Pandemic with Antiretrovirals:Treatment as Prevention and Pre-Exposure Prophylaxis Evidence Summit in London.

The new recommendations almost double the number of people judged to be in need of antiretroviral therapy –  calculated at 7.4 million people with CD4 counts below 350 and therefore in need of treatment at the end of 2010. In 2010, antiretroviral coverage reached 47% of those eligible, he said.

His remarks coincided with the release by WHO of a Programmatic Update on Antiretroviral Treatment for Prevention of HIV and TB, which sets out the organisation’s plans to galvanise greater use of antiretroviral treatment in order to limit new infections.

The summit, organised by the International Association of Physicians in AIDS Care, is designed to review recent advances in the use of antiretroviral drugs as a means of preventing HIV transmission, and to discuss the practical implications of the new data for treatment and prevention programmes.

Speaking on the first day of the two-day summit, Dr Hirnschall pointed out that, for every person placed on treatment, 2.5 people are still becoming infected every year, amounting to approximately 2.7 million infections a year in 2010.

Scale-up of a combination of effective prevention interventions remains urgent, and antiretroviral treatment must play a central role in the prevention of new infections, he said, following last year’s release of the results of the HPTN 052 study, which showed that early antiretroviral therapy for the HIV-positive partner reduced the risk of HIV transmission by 96% in serodiscordant partnerships.

Similarly, evidence from the South African province of KwaZulu-Natal demonstrates that, at the population level, antiretroviral therapy is already having an impact on one of the most severe epidemics in sub-Saharan Africa. Every 1% increase in antiretroviral coverage among adults in rural communities between 2004 and 2011 was associated with a 1.7% reduction in the risk of HIV acquisition, suggesting the potential for large reductions in HIV incidence if greater progress towards universal access to antiretroviral treatment can be achieved.

However, Dr Hirnschall noted that current coverage in low- and middle-income countries – 47% in 2010 – “is not giving us the prevention gain we want to see”.

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Discordancy in sexual partnerships in Sub-Saharan Africa

via Sexually Transmitted Infections, by Hiam Chemaitelly, Ide Cremin, Jim Shelton, Timothy B Hallett, Laith J Abu-Raddad

Objective

To describe patterns of HIV infection among stable sexual partnerships across sub-Saharan Africa (SSA).

Methods

The authors defined measures of HIV discordancy and conducted a comprehensive quantitative assessment of discordancy among stable partnerships in 20 countries in SSA through an analysis of the Demographic and Health Survey data.

Results

HIV prevalence explained at least 50% of the variation in HIV discordancy, with two distinct patterns of discordancy emerging based on HIV prevalence being roughly smaller or larger than 10%. In low-prevalence countries, approximately 75% of partnerships affected by HIV are discordant, while only about half of these are discordant in high-prevalence countries. Out of each 10 HIV infected persons, two to five are engaged in discordant partnerships in low-prevalence countries compared with one to three in high-prevalence countries. Among every 100 partnerships in the population, one to nine are affected by HIV and zero to six are discordant in low-prevalence countries compared with 16–45 and 9–17, respectively, in high-prevalence countries. Finally, zero to four of every 100 sexually active adults are engaged in a discordant partnership in low-prevalence countries compared with six to eight in high-prevalence countries.

Conclusions

In high-prevalence countries, a large fraction of stable partnerships were affected by HIV and half were discordant, whereas in low-prevalence countries, fewer stable partnerships were affected by HIV but a higher proportion of them were discordant. The findings provide a global view of HIV infection among stable partnerships in SSA but imply complex considerations for rolling out prevention interventions targeting discordant partnerships.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

An AIDS Free Generation: Running Toward the Dream of a Lifetime

via The Chicago Tribune, by David Ernesto Munar

When I tested positive for HIV in 1994, I never would have imagined an AIDS-free generation to be possible in my lifetime.

I also didn't think I would live past 35.

And yet, I am 42 years old today and we have arrived at the precipice of that dream. With recent medical advances, and the promise of more soon to come, an AIDS-free generation is possible. Achieving this goal, as eloquently outlined by Secretary of State Hillary Clinton earlier this month, would save millions of American dollars and countless lives around the world.

The question is whether we have the political and social will to make it a reality.

No one is talking about what the deficit-reduction talks or the attempts to dismantle health care reform mean for stopping AIDS in this country. Now is the time for that conversation. Cutting funding for HIV/AIDS services, treatment and research would be devastating to our progress in defeating this 30-year-old epidemic.

And the full implementation of the Affordable Care Act is necessary to provide access to treatment for the thousands in our country who are on waiting lists because they cannot afford life-saving medications.
We need our political leaders to lead. We stand at the precipice of the AIDS-free dream but we're stuck. If HIV/AIDS funding is cut through the deficit reductions, our progress could, in the haunting words of poet Langston Hughes, "dry up like a raisin in the sun."

Backing up, why have the AIDS conversation now?

HIV/AIDS is no longer a death sentence. The drugs are better and those who take them are living longer, relatively normal lives. So, what's the problem?

The reality is that more than 1 million people still live with HIV in the United States, and more than half of them do not receive regular medical care that could save their lives and curb new infections. The rate of infections remains unchanged. The cost for antiretroviral drugs is exorbitant, ranging from $1,500 to $3,000 a month.

In fact, government programs to help HIV-positive people obtain lifesaving HIV medications are hamstrung by dangerous, growing waiting lists across the country. As of earlier this month, more than 6,000 people in 12 states were on the waiting lists for the AIDS Drug Assistance Program. Illinois does not have a waiting list, but state legislators recently approved a change in the program that will make fewer people eligible for assistance.

And stigma and systemic injustices also fuel new HIV infections.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Ribbons Without Rights Don't Save Lives

via The Huffington Post, by Serra Sippel

Last month, the President's Emergency Plan for AIDS Relief (PEPFAR), in partnership with George W. Bush Institute, Susan G. Komen for the Cure, and UNAIDS, launched the global "Pink Ribbon Red Ribbon" campaign, an initiative that integrates cervical and breast cancer education, screening, and treatment with HIV services. It's a move that has the potential to reduce the number of cancer deaths among women living with HIV and improve their overall health. Given that women living with HIV are at an increased risk of developing cervical cancer, it makes sense. It's a logical and critical part of what PEPFAR is calling care and support services.

What doesn't make sense is that planning a family and preventing further HIV transmission is not part of what PEPFAR is calling care and support. HIV was responsible for 60,000 maternal deaths in 2008, and pregnancy alone could put women at higher risk of transmitting and acquiring HIV. Integrating and linking voluntary family planning, HIV, and cervical cancer prevention saves lives, improves access to quality care and promotes human rights. Including family planning in Pink Ribbon Red Ribbon would help women manage childbearing and protect themselves and their partners from infection or re-infection (think female condoms) and should be automatic.

UNAIDS has stated as much. "We must take AIDS out of isolation and provide young girls with opportunities to negotiate their sexual relationships and receive sexuality education so that they can protect themselves from infection," said UNAIDS Executive Director Michel Sidibé at this year's Commission on the Status of Women. "If we don't do this, our vision of zero new infections will remain a dream."

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Hormonal Contraception and HIV: A New Study Rekindles the Debate

* Original content from our Mapping Pathways blog team

Earlier this month, the Lancet published the results of a study conducted in Africa, which seemed to suggest that hormonal methods of contraception could lead to increased risk of HIV infection. The New York Times published a story on the study soon after, one that many HIV/AIDS experts are calling “alarmist”. There has been a great deal of press coverage on the study since then. As Dr. Adolfus Muyoti from the George Washington University said in a discussion on the IRMA (International Rectal Microbicide Advocates) listserv, “The news is all over Africa.”

The study, supported by the US National Institutes of Health and the Bill & Melinda Gates Foundation, followed 3,790 heterosexual HIV-1-serodiscordant couples across seven African countries. According to the Lancet, the aim of the study was to determine if hormonal contraceptive use had any effect on the risk of HIV acquisition by women as well as the risk of transmission from HIV-infected women to their male partners. As the below diagram used in The New York Times article illustrates, at first glance the results looks fairly disturbing.

However, as Heather Boonstra, Senior Public Policy Associate at the Guttmacher Institute, points out on the IRMA discussion listserv, “The study is less conclusive than at first appears, and leading experts in the field agree that, by itself, it does not warrant changes to current programs on the ground.”

Isobel Coleman from the Council of Foreign Relations echoes similar sentiments, “The study … adds urgency to a long-simmering debate over whether there is a link between hormonal contraception and HIV … no conclusive work has been done. The Lancet study is also not conclusive due to small sample sizes, and because the study was not specifically designed to examine contraception use.”  She does, however, add that, “The doubts raised are sufficient that a full-blown, conclusive study should be launched as soon as possible.”[1] (To read the complete write-up on the Council of Foreign relations website, click here.)

In Sub-Saharan Africa, where more than 60% of HIV infections occur in women, the ramifications of this link, if confirmed, would be huge. A hormonal shot every three months is the most popular contraceptive method in the region – about 12 million women between 15-49 years of age use these injectable hormones. If hormonal contraception suddenly became less acceptable, Africa would have to deal with the problems of affordability and access that surround other contraceptive methods.

Most healthcare professionals and researchers working in the field agree on the importance waiting for the results to be confirmed and not spreading large-scale panic. Says Mary Lyn Gaffield, an epidemiologist in the World Health Organization’s department of reproductive health and research, “We want to make sure that we warn when there is a real need to warn, but at the same time we don’t want to come up with a hasty judgment that would have far-reaching severe consequences for the sexual and reproductive health of women.”[2]

Perhaps it is Dr. Muyoti sums up the issue best and most succinctly: “This has the makings of a problem that will be highly contentious and will not be resolved in the short term.”

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[1] http://blogs.cfr.org/coleman/2011/10/04/long-lasting-hormonal-contraception-and-the-hiv-epidemic/ 

[2] http://www.nytimes.com/2011/10/04/health/04hiv.html?_r=1&pagewanted=all

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Uganda Needs to Re-Discover its Prevention Success of the 1990s

via AllAfrica.com, by Henry Zakumumpa

"The trouble for us in Uganda is that we are falling behind in global efforts to rein in new HIV infection rates an endeavor we were renowned for in the 1990s.

What is troubling is that many more people in Uganda are going to need AIDS treatment because of the spike in new HIV infections, driven primarily by married couples, but also because people with HIV/AIDS are now living longer, at a time when western donor countries are actually cutting AIDS funding.

Many AIDS treatment centres in Uganda are already turning away new patients due to donor funding caps, with some centres tragically sharing drugs amongst their patients. What is going to happen when thousands of Ugandans newly require AIDS treatment and they are turned away at treatment centres?

Sadly, Uganda's losing HIV prevention effort is out of step with the rest of the world where prevalence is actually going down. Even the worse- hit Southern African countries have registered a 25% reduction in HIV prevalence according to UNAIDS."

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Hunger and HIV in the Horn of Africa: Famine Exacerbates the Epidemic

An estimated 11.6 million people are struggling for basic nutrition and sanitation in the humanitarian crisis in the Horn of Africa – and experts have warned that this situation could have a serious effect on the health of people undergoing HIV treatment. The United Nations has said that 750,000 people could die if global assistance fails to meet the required target (so far, only 62% of the total has been contributed).

The worst drought in 60 years has led to large-scale food scarcity, which is a well-known barrier to antiretroviral (ARV) effectiveness. ARVs increase the appetite and a lack of food has been known to worsen the side-effects. Additionally, HIV-positive mothers may have to feed their children with a mixture of solid food and breast milk, thereby increasing the risk of transmission.

The number of sexual assault and rape cases also increases in refugee camps as regular societal and legal protection systems break down. With that, the risk of new HIV infections also rises. While post-exposure prophylaxis (PEP) may be available at some places, most rapes go unreported and HIV prevention awareness is low. Many women are also forced to turn to sex work to survive and procure food for their families, and the lack of condoms increases the chances of HIV infection.

Thousands of migrants will also face problems with adherence – the stigma attached to HIV makes it hard for them to approach unknown healthcare providers for services. Additionally, the already-limited health services are dealing with the ongoing starvation crisis and HIV treatment services are often not prioritized at such times.

You can read a UNAIDS feature story on this situation as well as an article on the IRIN website. The issue was also mentioned as one of the stories to follow during UN week in a blog post written by Mark Leon Goldberg, managing editor of the UN Dispatch blog.

Tell us – what do you think needs to be done to tackle a crisis such as this one? Africa has seen millions of people die from HIV infection, and the numbers are often exacerbated due to socio-political tumult in the region. How can we work towards a long-term solution to this problem, to try and limit the impact ofthe HIV epidemic? (Note: The Horn of Africa Initiative is one such effort, which has been working to “halt and reverse the spread and address the impact of HIV and AIDS in the Horn of Africa region.”)

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]