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A study [...]]]> Editor’s Choice
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Main Category: HIV / AIDS
Also Included In: Neurology / Neuroscience
Article Date: 22 Feb 2012 – 5:00 PST

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A study published in the print issue of Neurology®, the medical journal of the American Academy of Neurology, suggests that a larger waistline may be associated with a greater risk of decreased mental functioning in HIV-positive individuals.

J. Allen McCutchan, M.D., MSc, of the University of California, San Diego, and lead researcher of the study, explained:

“Interestingly, bigger waistlines were linked to decreased mental functioning more than was general obesity. This is important because certain anti-HIV drugs cause weight gain in the center of the body that is most dramatic in the abdomen, neck, chest, and breasts.”

The researchers enrolled 130 HIV-positive individuals, approximately 46 years of age, with HIV infection for an average of 13 years from six clinics to participate in the study. The majority of participants were taking combinations of anti-HIV medications called antiretroviral therapy. 40% of study participants were diagnosed with impaired mental functions, such as poor memory and concentration, called neurocognitive impairment (NCI).

Compared to participants without memory difficulties, they found that those with NCI had larger waist circumferences (average of 35 inches vs. 39 inches, respectively). In addition, NCI was associated to diabetes in individuals aged 55+, older age, and a longer time living with HIV. For instance, 15% of people with memory problems also had diabetes compared with 3% of individuals with no memory problems.

McCutchan, explained:

“Avoiding those HIV drugs that cause larger waistlines might protect or help reverse NCI. We don’t know if central obesity is causing NCI directly or is just a marker for exposure to a more direct cause such as anti-HIV drugs. People with HIV should talk to their doctors before considering changes in their anti-HIV medications.”

The National Institutes of Health funded the investigation.

To learn more about cognitive impairment, click here.

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A recent study [...]]]> Editor’s Choice
Main Category: HIV / AIDS
Also Included In: Aid / Disasters
Article Date: 17 Feb 2012 – 13:00 PST

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A recent study published by The Lancet, indicates that an effective way of reducing the prevalence of HIV and HSV-2 infections among young women, is through providing financial aid to them and their families. The study was led by Dr Berk-zler, The World Bank; Prof Richard Garfein and Dr Craig McIntosh, University of California at San Diego; and Dr Sarah Baird, George Washington University, USA.

Some of the principal risk factors for HIV infection among women are lack of education and economic dependence on men; these gender inequalities are suggested to be a main cause of their sexual decision-making. This study analyzed the effectiveness of a crash transfer program in reducing HIV infection rates among a population of never-married women aged 13-22 years, in the Zomba district of Malawi.

A total of 1289 schoolgirls from 176 enumeration areas in the Zomba disctrict were included. The areas were randomly divided into three different groups based on the terms of the financial aid given; one intervention area offered unconditional cash payments, another offered conditional cash payments (school attendance required), and the control area did not give any financial support whatsoever. Those receiving cash transfers (conditional or unconditional), were randomly assigned to be given any amount from US$1 to $5 each month, with their families receiving an additional range of $4-10 each month as well. The researchers conducted behavioral risk assessments of the participants at baseline and 12 months later, and a serology test after 18 months. They measured and compared the prevalence of HIV and herpes simplex virus 2 in the groups.

A total of 88 areas received the financial aid intervention – conditional or not – with the other 88 as controls. The rate of HIV in the intervention groups was far lower than the control group, with only 1·2% (seven of 490 participants) developing the infection compared to 3·0% (17 of 799 participants). In terms of HSV-2 prevalence, the intervention groups also had a far lower rate, of only 0·7% (5 of 488 participants) compared to 3·0% (27 of 796 participants). They found that there was hardly – if any- notable difference of HIV and HSV-2 prevalence between the conditional versus unconditional intervention groups.

 
The authors say:

“Poor education, poverty, and gender inequalities are postulated to be important determinants of young women’s vulnerability to HIV infection. However, to date, no randomised controlled trial of a structural intervention has shown a significant effect on HIV incidence. The Zomba cash transfer programme reduced the prevalence of HIV and HSV-2 infection at 18 month follow-up in school-age girls who were enrolled in school at baseline. These effects are supported by changes in self-reported sexual behaviour. The findings suggest that financially empowering school-age girls and their families can have substantial effects on their sexual and reproductive health.”

 
Dr Nancy Padian, School of Public Health, University of California, Berkeley, CA, USA and colleagues comment:

“These results add to the increasing evidence suggesting that economic development and anti-poverty programmes can alter the context of sexual decision making and, thus, HIV infection risk. These findings also warrant more collaboration with economists and those who work in development to more completely test the effects of social protection…livelihood-based and economic development programmes, on the sexual and reproductive health of young people.”

Written by Joseph Nordqvist

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Bohdan Nosyk and Julio Montaner of [...]]]> Main Category: HIV / AIDS
Article Date: 16 Feb 2012 – 0:00 PST

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Bohdan Nosyk and Julio Montaner of the British Columbia Centre for Excellence in HIV/AIDS in Vancouver, Canada argue in an Essay published in this week’s PLoS Medicine that the cost-effectiveness of HAART roll out has been significantly underestimated, because economic analyses have not yet taken into account the beneficial impact of HAART on prevention of HIV transmission.

The authors comment: “the strategic value of expanded HIV testing and expansion of HAART coverage has dramatically increased. We believe this should open the door for wide-scale implementation of ”Seek, Test, Treat and Retain” programs as a means to control HIV and AIDS-related morbidity, mortality, and transmission at once.”

Funding: No specific funding was received for writing this article.

Competing Interests: BN is a Canadian Institutes of Health Research (CIHR) Bisby Fellow, and also supported by a postdoctoral fellowship from the Michael Smith Foundation for Health Research. Since 2011, JSGM has received grants from antiretroviral manufacturers Abbott, Biolytical, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare. JSGM is also supported by the Ministry of Health Services and the Ministry of Healthy Living and Sport, Province of British Columbia, Canada (2009); by a Knowledge Translation Award from the Canadian Institutes of Health Research (CIHR-2010); and through an Avant-Garde Award (No. 1DP1DA026182-01) from the National Institute of Drug Abuse at the US National Institutes of Health (2008-2013). During 2011 to present, JSGM has received support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institute on Drug Abuse, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief (PEPfAR), Bill Melinda Gates Foundation, French National Agency for Research on AIDS Viral Hepatitis (ANRS), and Public Health Agency of Canada.

Citation: Nosyk B, Montaner JSG (2012) The Evolving Landscape of the Economics of HIV Treatment and Prevention. PLoS Med 9(2): e1001174. doi:10.1371/journal.pmed.1001174

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Main Category: HIV / AIDS
Also Included In: Immune System / Vaccines;  Blood / Hematology
Article Date: 15 Feb 2012 – 0:00 PST

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Scientists from the Antwerp Institute of Tropical Medicine, Antwerp University Hospital and Antwerp University have tested a new ‘therapeutic vaccine’ against HIV on volunteers. The participants were ‘so to say’ vaccinated with their own cells. The researchers filtered certain white blood cells out of the volunteer’s blood, ‘loaded’ them outside the body and then gave them back. The immune system of the testees was better than before in attacking and suppressing the virus, the scientists reported in the top journal AIDS. But they still cannot cure the disease.

Actually, medical science can control an HIV-infection quite well, with a medicine cocktail. ‘Seropositive’ people (people who are infected with the HIV virus) now can lead a reasonably normal life, but their virus is not exterminated. When they stop the treatment it immediately rebounds.

Science knows what the problem is: the ‘special forces’ in our blood (the CD8 cells, in medical lingo) get not enough support from the general staff (the dendritic cells, that show the combat units what to attack). Dendritic cells exhibit on their exterior typical parts of the virus to be attacked. But human dendritic cells are not that good in getting the right information on the HIV virus and to transform it into good examples for the CD8 battle cells.

The virologists and HIV-physicians of the Institute of Tropical Medicine and the haematologists of Antwerp University Hospital have cooperated for years on that problem. Together they succeeded to ‘load’ dendritic cells of seropositive volunteers in the lab with the building instructions (genetic information in the form of so-called messenger RNA) for HIV proteins. They could make the dendritic cells to execute the instructions and to exhibit the resulting typical part of the HIV virus on their surface. Subsequent research in test tubes demonstrated that the ‘loaded’ dendritic cells were able to activate battle cells.

Time had come to proceed to humans. Flemish, Belgian and French research foundations provided grants. Six seropositive persons who for a long time already used the drug cocktails, were prepared to volunteer. The scientists filtered the dendritic cells from a large volume of their blood, cultivated them in test tubes in the cell-therapy unit of the Antwerp University Hospital and provided them with the genetic instructions of an HIV virus. They then froze the loaded cells.

The volunteers received four times, with four-week intervals, a small quantity of their own reworked dendritic cells. And indeed, after each vaccination the CD8 battle cells in their bodies recognised the virus better and better, while the vaccination had virtually no side effects. The most important result was that the vaccine-activated battle cells became better and better in suppressing the virus, in test tubes for the moment. But HIV remains a disguise artist; it still succeeds in changing its proteins sufficiently fast and often to let at least a few viruses escape the attack.

So it remains impossible to cure AIDS, but the results are encouraging: the vaccine, made of the participant’s own dendritic cells, is safe and has some therapeutic effect, be it a limited one. But sufficiently strong for a publication in the most renowned journal for HIV researchers, AIDS. And more than sufficient to enthuse and motivate the Antwerp scientists.

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According to [...]]]> Editor’s Choice
Main Category: HIV / AIDS
Article Date: 15 Feb 2012 – 8:00 PST

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According to a new study, HIV-resistant sex workers in Africa have a weak inflammatory response in their vaginas. The researchers, led by Dr. Michel Roger of the University of Montreal Hospital Centre and the university’s Department of Microbiology and Immunology, were surprised by this finding, as they expected the opposite, due to the women’s high exposure to the virus.

Roger explained:

“In this part of the world, women represent over 60% of HIV cases, and this proportion continues to increase. Studying women who are naturally resistant to the virus enables researchers to identify interesting information in terms of developing vaccinations or microbid gels that could prevent transmission of HIV.”

The word microbid refers to something that is able to destroy microbes.

In order to get a clearer picture of the immune and molecular mechanisms involved in the transmission of HIV, Roger has been working with women from Zimbabwe and Benin for the past decade and a half. The researchers targeted Benin and Zimbabwe, due to the high incidence of HIV-infected women and that some of them were naturally HIV-resistant.

The team discovered that the immune system cells in the vaginas of HIV-infected women generated more inflammatory molecules (cytokines and chemokines) than the same cells in HIV-resistant women.

Cytokines and chemokines help to activate and recruit “lymphocyte T-cells” that usually attack and destroy viruses. However, HIV uses the T-cell to attack the body. Roger said: “Fewer T-cells means fewer target cells available for the virus to use.”

Results from the study showed that the immune response was extremely different in the women’s blood than in their vaginal mucous membrane. According to the findings, it would be more effective to produce vaccinations that would obstruct the virus at entry point of the body, instead of attempting to fight it after the virus is already established within the body’s system.

Roger explained:

“AIDS vaccination research has entirely focused on the blood stream and this approach has been a failure. Our research shows that the immune response is different at the site of the infection, and that we should turn to the entry points in order to find a means for blocking the virus.”

This type of vaccination would immunize all mucus membranes in the body and could be administered via the nose.

The researchers will continue their research in order to get a clearer picture of the molecular mechanisms involved in the vaginal immune response. According to scientists, genetic factors may play a role as they have found that sisters living in similar circumstances have the same HIV-resistant profile.

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Main Category: HIV / AIDS
Also Included In: Urology / Nephrology
Article Date: 14 Feb 2012 – 2:00 PST

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Tenofovir, one of the most effective and commonly prescribed antiretroviral medications for HIV/AIDS, is associated with a significant risk of kidney damage and chronic kidney disease that increases over time, according to a study of more than 10,000 patients led by researchers at the San Francisco VA Medical Center (SFVAMC) and the University of California, San Francisco (UCSF).

The researchers call for increased screening for kidney damage in patients taking the drug, especially those with other risk factors for kidney disease.

In their analysis of comprehensive VA electronic health records, the study authors found that for each year of exposure to tenofovir, risk of protein in urine – a marker of kidney damage – rose 34 percent, risk of rapid decline in kidney function rose 11 percent and risk of developing chronic kidney disease (CKD) rose 33 percent. The risks remained after the researchers controlled for other kidney disease risk factors such as age, race, diabetes, hypertension, smoking and HIV-related factors.

For individual patients, the differences in risk between users and non-users of tenofovir for each year of use were 13 percent vs. 8 percent for protein in urine, 9 percent vs. 5 percent for rapidly declining kidney function and 2 percent vs. 1 percent for CKD. “However, these numbers are based on the average risks in our study population, and patients with more risk factors for kidney disease would be put at proportionately higher risk,” said principal investigator Michael G. Shlipak, MD, MPH, chief of general internal medicine at SFVAMC and professor of medicine and epidemiology and biostatistics at UCSF.

Patients were tracked for an average of 1.2 years after they stopped taking tenofovir. They remained at elevated risk for at least six months to one year compared with those who never took the drug, suggesting that the damage is not quickly reversible, said Shlipak. “We do not know the long-term prognosis for these patients who stop tenofovir after developing kidney disease,” he cautioned.

The implications for patients already on or starting antiretroviral therapy are “mixed,” said Shlipak. “The best strategy right now is to work with your health care provider to continually monitor for kidney damage. Early detection is the best way to determine when the risks of tenofovir begin to outweigh the benefits.”

Shlipak noted that HIV, itself, increases the risk of kidney damage, while modern antiretroviral treatments clearly reduce that overall risk. “Patients need to be aware of their kidney disease risks before they start therapy, and this should influence the medications that they choose in consultation with their doctor,” he said. “For an otherwise healthy patient, the benefits of tenofovir are likely to exceed the risks, but for a patient with a combination of risk factors for kidney disease, tenofovir may not be the right medication.”

Tenofovir is used to decrease viral load and increase immune cell count in people infected with the virus. It is currently considered the preferred first line treatment for HIV because of its potency, overall low toxicity, and convenience of dosing. It is sold under a variety of names, by itself and in combination with other medications.

The study examined the medical records of 10,841 HIV-positive veterans in the national VA health care system who were new users of antiretroviral therapy from 1997 to 2007. It was published electronically in the journal /iAIDS.

Lead author Rebecca Scherzer, PhD, a researcher and statistician at SFVAMC and UCSF, said that the observational study was the largest and most conclusive indication so far of tenofovir’s association with kidney damage. “There have been a number of previous, smaller studies suggesting that this drug might be associated with kidney disease, but the results were mixed,” she said. “Those studies may have missed this association because they were too small, lacked appropriate lab data or excluded subjects with pre-existing renal impairment or risk factors for kidney disease.”

To be sure that tenofovir was the culprit, Scherzer and her colleagues looked for associations between 18 other antiretroviral medications and the same three measures of kidney disease: protein in urine, rapid decline in function and progression to CKD. None were associated with higher risk.

Shlipak noted that the study results are particularly strong because two of the risk factors – decline in function and CKD – indicate kidney function, while protein in urine indicates physical damage to the kidney. “These are independent markers,” he said. “To see the same drug cause both types of kidney disease gives you a very objective signal that something real is happening here.”

Shlipak emphasized that, despite tenofovir’s association with progressive kidney disease, it is an important component of effective antiretroviral therapy that may be required in many patients to control viral load.

The VA is the largest provider of HIV care in the United States, said Shlipak. “We could not have done this work without access to the VA’s system of electronic medical records,” he said. “In particular, the data kept by the VA Clinical Care Registry, located at the VA Palo Alto Health Care System, were essential to this study.”

Co-authors of the study are Michelle Estrella, MD, of Johns Hopkins School of Medicine; the late Andy I. Choi, MD, MAS, of SFVAMC and UCSF; Steven G. Deeks, MD, of San Francisco General Hospital; and Carl Grunfeld, MD, PhD, of SFVAMC and UCSF.

The study was supported by funds from the National Institutes of Health, the National Center for Research Resources, the American Heart Association and the Department of Veterans Affairs, some of which were administered by the Northern California Institute for Research and Education.
University of California – San Francisco

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