A newborn immune system responds to HIV infection less effectively than a more mature one, so an HIV-positive baby should be started on antiretroviral therapy as soon after birth as possible, new research suggests.

Although treatment early in life was known to be advantageous, the study, published Wednesday in Science Translational Medicine, shows the immune system’s response in detail for the first time. The study could energize efforts to treat newborns with HIV, several experts say, and it may help pave the way for an eventual long-lasting treatment or even a cure.

In the study, 10 HIV-positive newborns in Botswana were started on antiretroviral therapy—the gold-standard treatment for HIV—within hours or days of birth instead of the more typical four months. If an HIV-positive pregnant woman is receiving treatment, and the amount of virus in her body is well controlled, she will not pass the disease on to her baby, although the infant will have antibodies to HIV in his or her bloodstream. If the mother’s disease is not well controlled, the baby may be born with HIV.

To look for HIV-positive babies, the team screened more than 10,000 newborns using very small amounts of blood. The researchers identified 40 who were HIV-positive and began treating them with a three-drug cocktail within days of birth. The study reported on 10 of those babies, who are now almost two years old, and compared them with HIV-positive babies who did not receive treatment until four months of age.

The early treated babies fared much better in measures of viral levels in their bloodstream and lower levels of immune activity, which predicts the course of the disease, according to the study, which was conducted by a research team at the Ragon Institute of Massachusetts General Hospital, the Massachusetts Institute of Technology and Harvard University, Brigham and Women’s Hospital, and the Botswana Harvard AIDS Institute Partnership in Botswana. The babies coped well with the drug regimen, with only one having to discontinue therapy because of side effects, said Roger Shapiro, a senior author of the paper and an immunologist at the Harvard T. H. Chan School of Public Health, in a news conference on Tuesday.

The stakes are high for getting these babies treated, says Pat Flynn, an infectious disease specialist at St. Jude Children’s Research Hospital in Memphis, Tenn., who was not involved in the new study. HIV infection can have devastating neurological consequences, likely because of ongoing inflammation in the brain.

Every day, between 300 and 500 babies in sub-Saharan Africa are infected with HIV, according to the study’s authors, who cite data from the Joint United Nations Program on HIV/AIDS (UNAIDS).  Up to half of them will die by age two if they do not receive antiretroviral therapy. Infants infected in utero face even worse outcomes than those infected during birth or breastfeeding, said Mathias Lichterfeld, a co-author and an infectious disease specialist at the Ragon Institute and Brigham and Women’s in the news conference. Putting all HIV-positive pregnant women on antiretroviral therapy is the best way to prevent them passing the virus to their babies, but many such women face barriers to accessing treatment, Shapiro said.

Scientists have known since a study published in 2008 that treating HIV-positive babies as early as possible leads to better outcomes, but the new paper provides a “very comprehensive scientific rationale for why that is the case,” says Sten Vermund, dean of the Yale School of Public Health and a pediatrician and infectious disease epidemiologist, who was not involved in the new research. “As soon as possible might be too late. We really would be better treating right at birth.”

Compared with the immune system of an older baby or an adult, Vermund says, the newborn immune system is much more immature but “developing at a breakneck pace.” That’s why infants are particularly vulnerable to intrauterine infections, which include toxoplasmosis, rubella, syphilis and Zika. And, he says, “HIV can be added to that list, given the findings of this study.”

Unfortunately, Vermund says, it is unrealistic to think that most HIV-positive babies born in sub-Saharan Africa could be treated soon after birth. “The science is terrific,” he says of the new paper, but it may not have much effect in the real world. “The clinical relevance in Africa is not at all obvious to me,” Vermund adds.

In most countries in sub-Saharan Africa, infants are tested for HIV at four to six weeks of age, Shapiro said in the conference. This practice enables doctors to catch babies who are infected during pregnancy, at delivery or very early in life, but it misses the chance to start treatment immediately if the child is infected at birth.  Adding a second test at birth—as South Africa now does—would be complicated and expensive, he conceded, but “that’s really the direction that the rest of the world should be following.”

Yet even something that is simple in the U.S.—such as drawing blood from a newborn, taking the blood to a lab, and getting results back to the clinic and the family—remains “a major barrier to identifying those babies who are infected very early on,” Flynn says. Instead it may make sense to determine women who are at high risk for transmitting HIV and put their infants on therapy even before the test results can be returned. But even then, maintaining stocks of antiretroviral drugs continues to be an issue in sub-Saharan Africa, she says, with funding streams to pay for medications being uncertain.

In the U.S., no more than about 50 babies are born each year to mothers who did not know they were HIV-positive, and they are generally identified at birth, Vermund says. The new study should “stimulate obstetricians and pediatricians to be especially aggressive” in promptly diagnosing and treating those newborns, Vermund says.

The research team plans to follow the babies and track how much viral “reservoir” they continue to carry. In a natural experiment in the U.S., the so-called Mississippi Baby was thought to be cured when her HIV remained undetectable for two years after stopping therapy. But then the disease rebounded, suggesting that early aggressive therapy is not a cure.

To improve long-term treatment of HIV-positive children, the researchers hope to put some of the babies on so-called broadly neutralizing antibodies—which can recognize and block many types of HIV from entering healthy cells. They want to see if, long-term, these antibodies can substitute for the antiretroviral regimen, which is costly and cumbersome and comes with significant side effects.

Yvonne Maldonado, an expert in pediatric infectious diseases and epidemiology at Stanford University, who was not part of the new study, says the real benefit of the new study may not be in how it impacts the care of newborns with HIV but rather in the insights it offers into the HIV reservoirs that remain in the body even during treatment. “This is really geared toward ‘How do you get to the cure?’ rather than ‘How do you treat babies?’” she says.

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The rapid increase in HIV infection among the gay population in China has been brought primarily under control due to improved education and intervention measures in recent years, a leading expert at the Chinese Center for Disease Control and Prevention said.

However, Wu Zunyou, chief epidemiologist at the center, said the number of new HIV cases among heterosexuals is still rising rapidly, posing a major threat to overall HIV/AIDS prevention and control in China.

About 6.9 percent of gay men who received tests through the National Sentinel Surveillance Program last year were HIV positive, down from a peak of about 8 percent in 2015.

In 2005 the rate was less than 2 percent, he said.

“We can draw the conclusion that the HIV epidemic among the MSM (men who have sex with men) group has initially been brought under control,” Wu said, adding that risks of HIV transmission in the group may continue to fall.

Although most new HIV cases reported each year in China are still heterosexual, the rapidly rising number of HIV cases among the MSM population in many big cities in China has worried health authorities and experts in the past few years.

In Beijing, for example, MSM has been responsible for the majority of newly reported HIV/AIDS cases in recent years. Of the more than 2,800 cases reported between January and October last year in the capital, nearly 70 percent were transmitted through sex between men, according to the city’s health authority.

Compared with other groups, MSM have much higher chances of HIV transmission.

It is estimated that 1.25 million people were living with HIV in China by the end of last year, though about 30 percent of them were not diagnosed and therefore unaware they had the virus, according to the National Health Commission.

The commission estimates that every year about 80,000 people in China are infected with HIV.

Wu, from the Chinese CDC, said constant publicity and education efforts targeting the MSM group in recent years, especially improved community-based services, have played a key role in containing HIV transmission.

In addition, recent advances in early diagnosis have contributed to improved HIV prevention and control in communities, he said.

“The number of HIV/AIDS cases among heterosexuals in China is still rising,” he said. “The group will be a key for HIV/AIDS prevention and control in the long run.”

Last year, heterosexuals accounted for 71 percent of the total number of new HIV/AIDS cases in China, up from 69.6 percent in the previous year, he said.

Improved diagnosis is urgent for effective control and prevention so new cases can be identified in a timely manner, Wu said.

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Nov. 16 through to Nov. 22 marks National HIV Testing Week 2019. Charities like the Terrence Higgins Trust have spent decades destigmatising HIV, supporting people who live with it, and educating people to practice safe sex. In 2019 getting diagnosed with HIV is not what it was a few decades ago. People live happy full lives with a positive diagnosis. So, here’s how you can get involved this National HIV Testing Week. Getting a HIV test is a super simple step in getting an STI test and is over within seconds. However, knowing your status is so important when it comes to your sex life.

National HIV Testing Week was created to encourage people to get tested and normalise conversations around HIV and sexual health. Getting tested and prioritising your sexual health should be second nature and this includes being tested for HIV. Treatments have developed so much that they work by reducing the amount of the virus in the blood to undetectable levels. This means that the levels of HIV become so low that the virus cannot be passed on.

This National HIV Testing week a number of famous faces have joined forces with the Terrence Higgins Trust to raise awareness for what happens when you go for a HIV test and how easy it actually is. E4’s The Sex Clinic nurse Sarah Mulindwa and This Mornings Dr Ranj are among the people raising awareness. Dr Ranj said in a statement, “getting tested is nothing to be worried about – I’ve been tested in the past and it’s quick and easy. You’ll be in a better situation knowing your status than not knowing. With effective treatment, people living with HIV can not only live long healthy lives but they can’t pass it on to others.”

According to Public Health England and estimated one in 14 people in the UK with HIV are living with it and remain undiagnosed. The Terrence Higgins Trust recommends that you go and get tested at least once a year, if not more.

Charities, campaigners, and celebrities have fought tirelessly to open up conversations on HIV and showing how easy it is to get tested. Former Welsh Rugby Captain Gareth Thomas has been praised by so many people, including Prince Harry, after speaking so openly about his own HIV diagnosis. The pair sat down for a chat in a video made by the Terrence Higgins Trust and Thomas said, “we do so much around our health – going to the dentist, going to the doctor. But when it comes to sexual health testing there’s the stigma and fear around it.” He continued:

“We need to re-educate people to know that where we are now with HIV it is not a death sentence, it’s not and I am living proof.”

Taking control of your sexual health is so important. Knowing your HIV status is crucial and there’s absolutely nothing to be embarrassed about when you go to get tested. If you want to get tested you can either book to see your GP, or go to a walk in-centre. Alternatively, the Terence Higgins Thrust offers HIV self-testing kit for those most at risk of HIV.

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Bernie Sanders became the first 2020 presidential candidate to come out in support of finding a global cure for AIDS. Scientists and researchers have been working toward a cure, but they insist that full support and additional resources from the government is necessary to find the solution. With his announcement, Sanders told the Research Foundation to Cure AIDS that “the U.S. can lead the world in finding the global cure for AIDS,” Block Toro reported.

Since Sanders’ announcement, almost every other presidential hopeful followed suit, supporting a cure for HIV/AIDS.

“We have all of the technology needed to end AIDS-related deaths and stop HIV transmission and develop a working cure for AIDS,” Sanders said. “All we need now is the political will to do it.”

In a series of questions asked by the Research Foundation to Cure AIDS (RFTCA), Sanders said that as president he would form a team of the top U.S. scientists, researchers and doctors to find a cure for HIV/AIDS, make sure every citizen had access to affordable treatment, work with the international community to help find a cure, as well as provide affordable medicine and hold Big Pharma accountable.

Sanders’ leadership and support of the cause won him praise by Kambiz Shekdar, Ph.D., RFTCA president.

“The cure for HIV/AIDS has been proven possible but the main struggle is to raise the funds needed to make it happen in real life,” Shekdar said. “We would need a presidential leadership like Bernie’s for developing the cure for all the patients in need.”

According to a transcript, Sanders “introduced curing AIDS as a new pillar” to his comprehensive AIDS address.

“Bernie believes that we can and we must end the AIDS epidemic in the United States and abroad, and we can lead the world by developing a cure for AIDS. Bernie will invest significant federal resources and convene experts, advocates, scientists, and researchers to ensure this goal is met. The United States has before come together to achieve things once thought impossible. What we need is a grassroots political movement that will stand up to the greed of the pharmaceutical industry and take the steps necessary to ensure we end the AIDS epidemic by 2025 and ensure no person in America dies because they cannot afford medication or health care. Bernie is proud to say he will, alongside a political movement, rise to this challenge.”

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Last year I marked 10 years since I became HIV positive. It has been a long journey, from the fear of acceptance and today, advocacy, knowing that my treatment keeps me healthy and prevents HIV being passed on to any partner.

With the developments in pre-exposure prophylaxis (PrEP), a daily tablet which can stop a person from getting HIV, we have a real chance of ending HIV transmissions.

Robust scientific evidence has shown that PrEP is highly effective at preventing HIV. Yet, England is the only place in the UK where access to PrEP is restricted. Organisations including Terrence Higgins Trust and the British HIV Association are clear that this needs to change. England has lagged behind on PrEP for far too long

The PrEP Impact Trial was launched across England in October 2017 with 10,000 places available. Due to soaring demand, the trial places were increased by an extra 3,000 in September last year.

In January, the secretary of state Matt Hancock committed the UK Government to end new HIV transmissions by 2030. To assist this aim he promised to double the number of places on the PrEP Impact Trial, with NHS England agreeing to fund the cost of the drug for these extra places.

The trial comes to an end in September 2020. Demand remains high, and we must ensure that while the trial remains in place no one is turned away from accessing PrEP.

The Government must also now turn their efforts to ensuring that PrEP has a permanent home within sexual health services. In the past few months NHS England, Public Health England, local authorities and even the Department of Health and Social Care have said there must be a smooth transition between the trial and routine commissioning of PrEP.

A national PrEP programme needs to be introduced by April 2020 to ensure that those currently on the trial don’t face a cliff edge in September 2020.

We all are aware of the budgetary pressures faced by councils as a result of continued cuts to public health budgets. The tension around funding is tricky. The reality is that NHS England are funding the PrEP drug, but it’s local authorities that fund sexual health clinics.

When the Impact Trial started, only the branded PrEP drugs were available. Now it’s available as the generic version – at a fraction of the price. But the reality of creating more sexual health appointments when the funding has been cut is a very real challenge. However, this cannot justify the withholding of a tool that we know can prevent HIV.

We now know that at least 15 men have contracted HIV while waiting for a place on the trial. And this is likely to be the tip of the iceberg. This is the reason why I am urging the Department of Health and Social Care, NHS England, Public Health England and local authorities to work together to find a viable and stable future for PrEP as a national programme.

If we are to have a smooth transition, the challenges facing routine commissioning must be ironed out and resolved sooner rather than later.

As Phil Samba, a PrEP activist puts it: “PrEP means that I can finally feel completely in control of my sexual health for the first time. No one should be turned away from this HIV game-changer and it must be routinely available.”

PrEP works. PrEP saves the NHS money in treatment costs. PrEP will help us end HIV transmissions. PrEP transforms the lives of people at risk of HIV. So why the hell are we still waiting for full access to this game-changing drug?

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David Austin was diagnosed with HIV while living in London in 1993.

In a television interview, the journalist talks about how her family was unable to bring his body back home for burial because of his condition.

Her story is part of a new documentary in which County Antrim actor Matthew Cavan talks about living with HIV and the abuse he endured.

True North: Cherrie, Me and HIV is narrated by Matthew, who also talks about living as a gay man in Northern Ireland and the prejudices he encountered.

He was diagnosed as HIV positive 10 years ago – something he says changed his life and had a huge impact on those closest to him.

The documentary focuses on what has changed since the Aids epidemic first came to the public’s attention in the 1980s and how close scientists are to finding a cure, if at all.

During the programme, Matthew visits Wendy Austin and her daughter Kerry.

The veteran broadcaster said her brother broke the news of his illness to her during a visit to London.

“He [David] got in touch with me one day and said: ‘I’ve got some really bad news for you – I’m an alcoholic and I’m HIV positive’.

“He did start to go downhill very quickly and the next time I saw him in London I thought that, really, mum and dad needed to come over.

‘Sad journey’

“So we went over for the weekend, the three of us, and we saw him then. I have to say he looked beyond dreadful.

“Actually, I think that was the last time I saw him and the last time mum and dad saw him.”

She spoke about how the family had to make the “sad journey” to London for his funeral.

“One of the things that we discovered was there was no question of being able to bring his body back here because he had died from Aids, ” she said.

“He was zipped up in a bag and taken away and that was that. He had to be cremated.

“People would stop me in the street and say: ‘I’m sorry to have read that about your brother, but good for you for talking about it.'”

During the programme, Matthew Cavan also returns to his family home.

In a poignant discussion, he explores with his parents how his sexuality and diagnosis impacted on them and their strong religious faith.

He also meets people who are helping prevent further cases of the condition and talks to those who understand the stigma around HIV.

Matthew also speaks to the doctors who treat his condition and finds out more about how, with the right medical help and support, men and women with HIV can expect to live a healthy, happy life.

During the documentary, Matthew introduces his colourful drag alter-ego, Cherrie Ontop, who brings sparkle and fun into his life and helps him cope with the pressure of living with HIV.

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SAMBALPUR: HIV positive people under the banner of ‘Network of Positive People, Sambalpur’ have come out in support of VIMSAR dental surgeon PK Swain, accused of performing surgery on an afflicted patient without following protocol. The people on Saturday submitted a memorandum to the District Collector, addressed to Chief Minister Naveen Patnaik demanding to end the inquiry going on against Swain. 

On October 28, Swain had conducted the surgery of an HIV positive patient at the dental wing of the hospital. However, he was accused of not following set protocols for the surgery. Following the incident, on October 30, a five-member team was formed to probe the alleged violations. Hospital sources informed that the inquiry is in progress and the team is yet to submit is report.

Founder member and secretary of ‘Network of Positive People, Sambalpur’ Amarendra Behera said, “I have been witnessing cases where HIV positive patients are denied any kind of surgery in VIMSAR. The doctors here usually refer such patients to other hospitals. The HIV positive patients are also being subjected to discrimination since they are afraid to disclose their identity owing to social stigma associated with the disease.” 

Under such circumstances, the surgeon, who performed surgery on an HIV positive patient on humanitarian grounds, deserves to be commended for his act. But instead, some people are trying to malign his image and the hospital authorities have initiated an inquiry against him which is unjust, he said.

Behera said the surgeon had taken all precautions while operating upon the patient. Besides demanding termination of inquiry against the doctor, the organisation asked the government to act against those who hatched a conspiracy to blame the surgeon. Moreover, they have urged the Chief Minister to take steps to felicitate the surgeon at the state capital on World AIDS Day for his noble act.

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She is one of about 20 children aged 18 and under living in Wales with the disease.

Jessica – not her real name – told BBC Wales Live she wept as jokes about the condition went unchallenged.

Campaigners said there should be a new education drive about HIV and how medicine has revolutionised treatments.

Jessica said myths about the disease persist – that touching or sharing a cup or even a hat can pass on the virus, and people with HIV will die of AIDS.

But drugs introduced more than 20 years ago mean those living with HIV can control the infection so effectively it is undetectable and cannot be passed on to another person, even through sexual activity.

Antiviral treatments used since 1996 also mean those with the virus will enjoy the same life expectancy as those without the condition.

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Jessica said she sat through lessons in school where incorrect information was shared with other pupils and jokes about the illness were allowed.

“I was sat at the back of that classroom and I cried my eyes out. But I had to hide it at the same time, because these were people that I wanted to potentially tell,” she said.

“I’ve never been so shocked and ashamed of myself in my entire life – I shouldn’t have been upset in that way.”

Consultant pediatrician Dr Jennifer Evans said this was not a surprise.

“If people have a serious diagnosis of cancer there’s huge amount of sympathy – this diagnosis is still met with a lot of suspicion,” she said.

“That transmits itself into feeling bad about yourself.”

Jessica agreed: “If there was less stigma, I would 100% be the person out there talking to all my friends.

“I feel like those conversations would’ve been a lot easier if in school it was educated properly.”

Abi Carter, an participation officer with the charity Chiva – Children’s HIV Association – said the lack of education about the disease could hold people back.

“We need another public information campaign about HIV, which is updated with all the revolutions that have happened in medicine over the last 20 to 30 years. There’s a lot of misinformed people out there.

“It’s time that we really busted some of these myths.”

A Welsh Government official said the new education curriculum included guidance on learning how to find information from trusted sources to inform decisions and “challenging harmful social influences”, including stigma.

“We recognise how HIV has changed in terms of risk and disease profile in the last decade and think it is important that teachers should have the most up-to-date information on HIV available to them.”

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