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Kaisernetwork / HIV/AIDS


Online resource for timely and in-depth coverage of health policy news, debates and discussions.

Conference Addresses Universal Access to Antiretroviral Drugs, Health Systems
08 08 2008 Although antiretroviral drugs have become "so effective" that a 20-year-old HIV-positive person in a wealthy country can now expect to live another 43 years on average -- "close to a normal lifespan" -- the "near-miraculous effects" of the drugs highlight the need to treat as many people as possible worldwide, advocates and researchers said on Wednesday at the XVII International AIDS Conference in Mexico City, Toronto's Globe and Mail reports.

About three million people in the developing world have access to antiretrovirals -- an estimated 31% of those in need. About as many people again with HIV/AIDS are taking the drugs in wealthy nations, where treatment is virtually universal, according to the Globe and Mail. "I ran out of fingers and toes to count the inequalities," Anton Pozniak, executive director of HIV research at the Chelsea and Westminster Hospital, said.

While the United Nations' goal of achieving universal access to antiretroviral drugs by 2010 likely will not be reached, continuing to work toward the objective is essential, according to Gregg Gonsalves, program coordinator at the AIDS and Rights Alliance for Southern Africa. Speaking at the conference, Gonsalves said, "The scale-up of antiretroviral therapy is the most ambitious public health undertaking of our lifetimes."

According to Gonsalves, although the lives of millions of HIV-positive people worldwide depend on antiretrovirals, the world should understand the difficulty of providing the drugs to a vast number of people. "We've already accomplished the impossible in the last 10 years," he said, adding, "We can succeed, but our future is precarious. The technical challenges are formidable, and the political ones are brutal."

One of the most "contentious" debates at the conference this week has been over when it is best to start HIV-positive people on antiretroviral treatment (Picard, Globe and Mail, 8/8). Despite research showing the benefits of early treatment, Gonsalves cautioned that widening access to treatment in countries with weak health systems could undermine drug programs. Although Gonsalves said access to antiretrovirals during the early stages of the virus may be "clinically beneficial for individual patients," more patients in public health settings may weaken antiretroviral programs by "creating longer queues in already saturated national programs using relatively temporary facilities, where even now the sickest patients still have trouble accessing medicines."

He added that beginning antiretroviral regimens earlier "without assessing the effectiveness and indeed the feasibility of this intervention at a population level in low- and middle-income countries may end up doing more harm than good." Gonsalves called for research into when to start antiretroviral treatment in resource-limited settings and urged delegates at the conference to set firm global targets and deadlines to make sense out of "the definition of universal access" to antiretrovirals, which "is now irresponsibly vague." Gonsalves said, "Approximately 10-million people need antiretroviral therapy today. Perhaps we can't reach that goal by the next time we gather in 2010 in Vienna, but let's not leave Mexico City without attaching a firm deadline nonetheless" (Cullinan, The Star, 8/8). Gonsalves also said that well-managed HIV/AIDS programs require training of health workers and construction of clinics and laboratories (Chase, "Health Blog," Wall Street Journal, 8/7).

In related coverage, Tierramerica on Thursday included a discussion with Pedro Cahn, head of the International AIDS Society, on universal access to antiretrovirals, the conference and the worldwide fight against HIV/AIDS (Valente, Tierramerica, 8/4).

Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference. Webcasts of a plenary session and press conference featuring Gonsalves and Pozniak are available online.

Antibodies Could Prevent HIV Transmission, Research Indicates
08 08 2008 Antibodies that prevent some HIV-positive people from progressing to AIDS could be used to develop microbicides or a vaccine to prevent HIV-negative people from contracting the virus, according to research presented Thursday at the XVII International AIDS Conference in Mexico City, the Washington Post reports.

According to the research, conducted by researchers at the University of Texas Medical School, some long-term survivors of HIV have antibodies against an HIV protein called gp120. The antibodies, called "catalytic antibodies," attack an area on the outer shell of HIV where the virus binds to immune system cells, preventing the virus from entering the cells. According to the researchers, the antibodies are present in people with lupus, and "researchers noticed years ago that HIV infection rarely occurred in them," according to the Post. "One hypothesis is that they mount an immune response that protected them," Stephanie Planque, a student at UTMS who presented the research at the AIDS conference, said. Lupus patients' immune systems malfunction and produce a number of "unusual" antibodies, the Post reports.

HIV-positive people make separate antibodies against gp120, but they usually are not strong enough to stop or slow the progression of the virus, according to the Post. Previous research on a vaccine using the protein did not stop or slow HIV progression.

The researchers, led by Sudhir Paul at UTMS, found that gp120 is part of a 13-unit stretch of proteins located where the virus attaches to immune cells. Gp120 is hidden by the other proteins, making it more difficult for the immune system to make antibodies against it, according to the research.

Planque screened antibodies made by lupus patients to determine if any produced catalytic activity against HIV's 13-unit protein stretch, which includes gp120. She found that antibodies derived from the lupus patients killed five strains of HIV.

According to the researchers, the findings could be used to find a way to prompt the immune system to make its own supply of antibodies against gp120 before being exposed to the virus. However, the "road is long before we reach that point," Planque said. The researchers are currently researching strategies to "presen[t]" the protein stretch to the immune system that stimulates catalytic antibodies more effectively than what happens naturally. If such an approach proves successful, it could produce a useful vaccine, the Post reports.

Although drugs containing antibodies are expensive, a microbicide containing catalytic antibodies might be affordable for people in developing countries because only a small quantity would be needed to prevent HIV transmission during sexual contact, the researchers said. In addition, the protective benefit would only need to last hours, not days or weeks. According to the Post, the "broad effect" of catalytic antibodies is "important" and any microbicide or vaccine developed from the antibodies would need to prevent all HIV strains to be "useful" (Brown, Washington Post, 8/8).

An abstract of the study is available online.

Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference.

About 40% of U.S. Adults Have Received HIV Tests, Study Finds
08 08 2008 About 40% of adults in the U.S. have ever been tested for HIV, according to a study published Friday in CDC's Morbidity and Mortality Weekly Report to coincide with the XVII International AIDS Conference in Mexico City, the Los Angeles Times reports (Maugh, Los Angeles Times, 8/8). "In 2006, 40.4% (an estimated 71.5 million persons) of U.S. adults aged 18 to 64 years reported ever being tested for HIV infection," the study said, adding, "In addition, 10.4% (an estimated 17.8 million persons) reported being tested in the preceding 12 months, and 23% of persons who acknowledged having HIV risk factors reported being tested in the preceding 12 months."

The study, as well as an earlier report from CDC about annual new HIV infections in the U.S., "show that testing efforts are falling far short," with one-fourth of the approximately one million HIV-positive people in the U.S. unaware of their status, according to Reuters. "The data in this report suggest that progress in HIV testing stalled in the mid- to late-1990s and new strategies such as expanded screening in health care settings appear to be warranted," CDC said in the study.

The agency two years ago released new guidelines recommending routine HIV screening for people ages 13 to 64. Early HIV diagnosis "enables infected persons to obtain medical care that can improve the quality and length of their lives and adopt behaviors to prevent further HIV transmission," CDC said (Fox, Reuters, 8/7). An HIV-positive person who is unaware of his or her status is three times as likely to transmit HIV to others than a person who knows his or her status, according to CDC (Los Angeles Times, 8/8).

According to the agency, among all people diagnosed with HIV in 2005, 38% received an AIDS diagnosis within one year of their first positive HIV test (Reuters, 8/7).

The study is available online.

Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference. A webcast on HIV testing and counseling is available online.

In addition, a kaisernetwork.org interview in Mexico City with Kevin Fenton, Director of the CDC's Director, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention is available online.

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