Young people with innovative ideas to reduce HIV infections among adolescents will receive cash incentives to showcase best practices to fight the deadly virus during an international conference in Kisumu.

At least 600 youthful delegates from Eastern and Southern Africa are expected to submit proposals at the conference dubbed ‘30 Under 30 Awards.’

This comes at a time when most new HIV infections occur among adolescents and young people aged between 15and 24 years.

HIV PREVENTION

The young people will present their practices and innovation in HIV prevention, care and treatment during the first ever international Conference of reducing HIV in adolescents and youth set to be held on June 14-19 in the Lakeside City.

The youth, whose presentation will win, will receive a seed funding of Sh500,000.

The conference is the brain child of Impact Research and Development Organisation (IRDO), the Kenya Medical Research Institute (Kemri) and Nyanza Initiatives for Girls Education and Empowerment (Nigee).

Speaking to the Nation IRDO Director Kawango Agot said half of the presenters at the Kisumu conference will be adolescents and young people under 30 years.

INNOVATIVE IDEAS

“Youth under 30 years with innovative ideas on reducing HIV, especially among adolescent girls and young women, will receive seed funding and mentorship to implement their projects,” said Dr Agot.

She urged young people to submit proposals and share their work with other youth from Kenya and Eastern and Southern Africa to reduce the burden of the disease among their peers.

However, she said youth above 30 years can also submit their abstracts which must be based on data from adolescents and young people of the age bracket of 10-24 years.

At the same time, Dr Agot announced that youth whose abstracts and proposals will be selected, will not pay registration fee.

 “We are also encouraging organisations with youth led best practices on HIV and reproductive health programmes to apply before February 28 deadline,” said Dr Agot.

Dr Agot, who has been in the frontline in the fight against HIV in Nyanza region, appealed to well-wishers including county governments, managers of the National Government Constituency Development Fund (NG-CDF) to sponsor young people from their respective regions  to attend the conference.

“The fight against HIV among the youth must not be left to government and non-governmental organisations alone. All the actors from the grassroots must join hands to reduce the burden that is still a threat to the future and prosperity of this country,” said Dr Agot.

NASCOP

A recent report by national Aids and Sexually Transmitted Infections Control Programme revealed that at least eight counties account for 50 per cent of all new HIV infections.

Six of the counties that experts have raised red flag over the increasing new infections are in Western and Nyanza. Other cases have been reported in Nairobi and Rift Valley.

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Researchers working to overcome the reservoir of dormant HIV within CD4 T cells have discovered two methods with which to stimulate HIV to re-emerge from latency into the blood stream. Two separate papers, both published in Nature, detail the differing techniques which could lead to a cure for HIV in future.

The research papers, both funded by the US National Institutes of Health (NIH), show promising results disrupting viral latency. While not a cure, the researchers claim combining this therapy with existing antiretrovirals could be the future of HIV treatment.

Both approaches were tested at Yerkes National Primate Research Center of Emory University in monkeys infected with SIV, the primate form of HIV and treated with antiretroviral drugs. At the University of North Carolina at Chapel Hill (UNC), tests were also conducted in mice transplanted with human immune cells.

One paper describes how AZD5582 activates an intracellular pathway that leads to HIV and SIV reactivation. The drug showed minimal toxicity in non-human primates – just one of twelve treated monkeys experienced a temporary fever and loss of appetite.

“AZD5582 was remarkable in its ability to reactivate latent SIV from resting CD4+ T cells and to induce continued virus production in the blood when monkeys were still receiving daily antiretroviral therapy,” said Dr Ann Chahroudi, co-senior author on both papers, associate professor of paediatrics and director of the Center for Childhood Infections & Vaccines at Emory and Children’s Healthcare of Atlanta.

In the other study, researchers stimulated the cells that are the main viral hosts (CD4+ T cells) while depleting CD8+ T cells, which normally fight the virus.

This combination was especially potent according to the study; however, both components were necessary to see SIV re-emerge.

“The old paradigm is that you need CD8 cells to clear other infected cells,” said Dr Guido Silvestri, paper senior author, interim chair of pathology and laboratory medicine at Emory University School of Medicine and chief of microbiology and immunology at Yerkes National Primate Research Center. “We’re showing that CD8 cells are also involved in repressing latency reversal.”

The main obstacle to a cure for HIV infection is the immune cell reservoir of the dormant virus following treatment with antiretroviral drugs. No interventions have been proven to reduce the size of the reservoir, because once the animals were taken off antiretroviral drugs, viral levels rebounded. The scientists think that post re-emergence, the virus needs to be treated with other targeted modes of treatment, such as antibodies.

“The exciting thing about these papers being published together are the concordance of the results in two animal models with both approaches and the opening up of new avenues for research towards the goal of an HIV cure,” said Chahroudi.

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While the rate of increase of new HIV infections in India has been dropping over the last decade, it appears the National Aids Control Organisation’s (NACO’s) targeted interventions have been skipping over important vulnerable groups at higher risk of contracting HIV. Part of the problem appears to be that high-risk groups have been using apps, such as Grindr and Blued, and voice-calling services on their mobile phones to find sexual partners, and in the process slip off NACO’s radar.

The last available census of female sex workers and homosexual men happened in 2009-2011, and estimated the size of these two groups to be 11.58 lakh and 4.27 lakh people, respectively.

Maharashtra, Telangana, Karnataka and Andhra Pradesh are the top four states that receive NACO’s targeted interventions. Female sex workers in these states have some of the country’s highest prevalence of HIV. Similarly, Andhra Pradesh, Karnataka and Maharashtra, along with Gujarat, have the most number of identified homosexual men, and HIV prevalence among them is higher than the national average.

Since 2014, NACO claims to have conducted site revalidation exercises once every three, six or 12 months in areas where it implements its interventions, reexamines previously established hotspots, identifies new hotspots, and updates its data pertaining to high-risk groups. However, its own annual reports show that NACO hasn’t revised these groups’ population estimates since the 2009-2011 census.

According to Purnima Parmar, a team leader with the targeted interventions group at the Indian Health Actions Trust (IHAT), Bengaluru, “Plans for conducting a new estimation exercise are already under process in NACO.”

Need for better mapping and estimation

But as more conversations happen within apps designed (rightly) to protect people’s identities, more potential cases of HIV infection disappear from NACO’s radar, and more people are denied its targeted interventions. All together, these gaps increase the risk of HIV entering the bridge and then the general populations.

The 2009-2011 census was restricted to venue-based solicitation, such as at brothels and certain parts of the streets that female sex workers had been known to frequent. So unless the new exercise – the plans for which are already in the works, according to IHAT’s Parmar – is able to account for the rising popularity of mobile phones, it will underestimate the amount of work NACO has left to do, which in turn will postpone the day India can be HIV-free by years.

That said, NACO has been aware of this blindspot – as it indicated in its IBBS report – but hasn’t been doing enough to cover it. Multiple studies, both independent and sponsored, conducted since 2015 have reported the same gaps in its estimation process. A midterm review of NACP 4 published in 2016 recommended upgrading the methods, tools and guidelines used in population estimation and mapping exercises vis-à-vis high-risk groups.

In 2019, NACO published a whitepaper acknowledging that virtual spaces have emerged as a new risk environment for HIV transmission. The paper discussed one pilot density-mapping survey of homosexual men who used one, some or all of Grindr, Hornet, Scruff and Blued in Pune, Mumbai and Vijayawada. Based on its outcomes, NACO members have been deliberating the use of two methods to address the blindspot: a census-based mapping procedure and a capture-recapture method.

However, no one knows when and how the organisation plans to roll the procedure out nor how it will modify its targeted interventions. NACO had not responded to requests for comment at the time of publication.

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Newswise — DALLAS – Jan. 8, 2020 – Providing multidisciplinary team consults for HIV patients while they are hospitalized to help address social and medical barriers reduces future infection rates and boosts participation in follow-up care, results from a study on how to reengage patients show.

A multidisciplinary inpatient team of HIV medical specialists, HIV case managers, and transitional care nurses assigned to help patients overcome care gaps improved viral suppression rates by 30 percent and increased engagement in care after discharge by 30 percent compared with those without interventions (for whom viral suppression increased 7 percent and engagement 11 percent), researchers at UT Southwestern Medical Center report in the journal AIDS Care.

Ank Nijhawan, M.D., M.P.H., associate professor of internal medicine, and of population and data sciences

“As we focus on national initiatives to Ending the HIV Epidemic: A Plan for America, it is important to remember that many people living with HIV continue to struggle with staying engaged in care – particularly youth, minorities, and people who live in the South. Solutions to this problem require a collaborative and adaptable approach,” says clinical researcher Ank Nijhawan, M.D., M.P.H., an associate professor of internal medicine, and of population and data sciences at UT Southwestern. “Our multidisciplinary approach of matching the type and intensity of intervention to the level of need resulted in significant improvement in the outcomes of patients with HIV.”

Fewer than half of people living with HIV receive consistent, ongoing medical care, while vulnerable populations such as African Americans, Hispanics, and uninsured patients are at an even higher risk of disengagement and uncontrolled HIV infection, researchers say.

In this study, the UT Southwestern infectious disease researchers reviewed electronic health records for 1,056 people living with HIV in the Parkland Health and Hospital System between September 2013 and December 2015 – a year prior to and after the multidisciplinary intervention team launched its program. The intervention program initiated in October 2014. Hospitalized patients with HIV received one of the following: (a) an HIV medical consultation (as requested by primary treatment team), (b) an HIV medical consultation plus transitional care nursing (based on readmission risk), or (c) no specialized intervention beyond care coordination from the HIV case manager. Of the patients who were studied, 68 percent were male, 55 percent were African American, 23 percent were Hispanic, 77 percent were single, and 38 percent had AIDs.

In addition, 85 percent who were seen by the transitional care nurse reported at least one barrier to continuity of care – most commonly mental health and substance use disorders – and more than a third (39 percent) reported three or more such barriers. Many had poor engagement in outpatient HIV care and low virologic suppression rates.

The success of the team’s multidisciplinary approach reinforced the importance not just of specialized medical care, but also the critical role of social determinants of health such as transportation, housing instability, and substance use disorders, the researchers say.

The study was funded by the National Institute of Allergy and Infectious Diseases (NIAID), National Institute on Drug Abuse (NIDA), and the Agency for Healthcare Research and Quality (AHRQ). The multidisciplinary teams were partially funded through a Centers for Medicare and Medicaid Services (CMS) 1115 waiver program. Other study authors include Mitu Bhattatiry, Matthieu Chansard, Song Zhang, Ph.D., and Ethan Halm, M.D., M.P.H., MBA, all of UT Southwestern. No conflicts of interest were reported.

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HIV/AIDS is one of the deadliest diseases in the world, and a permanent cure has yet to be developed. As countries all over the globe face this problem, The United Nations Program on HIV/AIDS or UNAIDS announced their approach to getting rid of the disease in a span of 10 years.

The Geek Herald reports that the organization announced its 90-90-90 approach for 2020. 90-90-90 meaning having 90 percent of individuals who are infected properly diagnosed, 90 percent of those diagnosed treated, and 90 percent of those who are treated receiving viral suppression. Come 2030, UNAIDS plans to increase that rate to 95-95-95, with the hopes of ending the epidemic once and for all since then.

While the United States has achieved a goal close to UNAIDS, with a 79-78-86 rating, other countries where the disease is prevalent still have a long way to go. With those countries in mind, it is important that the disease should be made treatable and a solid cure found to get rid of the disease for good. This is why the organization plans to support those countries with very limited resources by providing HIV/AIDS testing and treatment programs that are not only accessible but also affordable.

If technological breakthroughs over the past hundred years are able to get rid of once-deadly diseases like the plague and smallpox, then the future is bright for further research into developing a cure for the disease. Scientists are all on a united front when it comes to beating this disease as more and more progress is made in terms of properly treating HIV/AIDS. A new study as reported by Medical Xpress, reveals that while research has gone on mainly on killing off infected cells, it may not be as necessary.

Explaining further, the researchers focused on the individuals who are HIV-positive but are also able to live without treatment. They found that these individuals had lymphocytes that only suppress the virus but do not kill the infected cells. Analyzing blood samples from these individuals, the researchers saw that they had HIV-specific CD8-T cells in their lymphoid tissue, and these specific cells were able to suppress the virus by an enhanced ribosomal function, and thus were better at determining proteins from amino acids.

This resulted in producing more varieties of cytokines, which are small protein molecules that play a big role in cell communication, and promoted the polyfunctionality of the cells.

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A new study provides insight into how HIV may increase the risk of cardiac death in infected individuals.

The findings, which were published in Circulation and presented at the annual American Heart Association Scientific Sessions, indicated that those with HIV have more QT interval variability, a marker of ventricular repolarization compared with individuals who do not have HIV.

Although the increase in sudden cardiac death in those with HIV has been previously established, the biological roots of this increase has been unclear, the study authors wrote.

HIV-associated heart disease has more than tripled over the past 20 years and individuals with HIV are twice as likely to develop cardiovascular disease than their healthy counterparts. A 4.5-fold higher than expected rate of sudden cardiac death, accounting for 86% of cardiac mortality, was reported among patients with HIV attending a public clinic in San Francisco in 2012, according to the authors. This evidence, compounded with an aging HIV population, indicates the need for more preventive interventions for cardiovascular health in those with HIV.

For the study, the authors used data collected from the National Institutes of Health Multicenter AIDS Cohort Study (MACS), an ongoing 30-year study that follows the health of gay and bisexual men from 4 US cities. The study, which is the largest of QT variability to date, included 1123 men: 589 of whom are HIV-positive and 534 of whom are HIV-negative. Of the men with HIV in the study, 83% had undetectable levels of the virus in their blood as a result of antiretroviral therapy (ART). Approximately 61% of men identified themselves as white, 25% as African American, and 14% as Hispanic or other. On average, individuals with HIV had been treated for approximately 13 years.

To collect data on their QT intervals, the participants wore a portable electrocardiogram (ECG) patch device to measure heart rhythms. The authors analyzed 3 to 4 days of data on the intervals between beats.

According to the results, those with HIV had higher QT interval variability [adjusted difference of +0.077 (95% CI: +0.032 to 0.123)] compared with men without HIV. Variability was also associated with detectable viral load, as measured with a blood test. On average, men with HIV who had an undetectable viral load had a QT interval of just 0.064 greater than men without HIV. However, men with higher levels of the virus had an average of 0.150 greater QT interval variability, according to the study.

Additionally, the authors compared information to determine how strongly the HIV link is to the QT interval variation compared with other risk factors for cardiovascular disease, such as high blood pressure, opioid use, high cholesterol levels, obesity, smoking, and diabetes.

The results suggest that the extent of abnormal QT variation in men living with HIV was comparable to that of 8 years of aging in those without detectable virus in the blood and close to 20 years in those with detectable virus. They also separately collected blood samples to analyze for inflammatory molecules, finding that men with HIV had 14% more of the inflammation marker IL-6 and 22% more sCD163 compared with men who didn’t have HIV, according to the study. Higher levels of inflammation were associated with more QT variability and arrhythmia risk, the authors noted.

“HIV puts people in a state of chronic heightened inflammation and that might be a major contributor to why the heart is prone to abnormal rhythms,” lead author Amir Heravi, a medical student at the Johns Hopkins University School of Medicine, said in a press release. “However, inflammation would only partly explain our findings and our results showed even after adjusting for effects of inflammation, HIV infection was associated with higher QT variability. We think it may be a combination of the virus and the body’s reaction to the virus via inflammation that ultimately contributes to an increased risk of sudden cardiac death.”

According to Heravi, the findings implicate the importance of treating and controlling HIV infection early on with ART, maintaining adherence to therapy, and continuing to monitor virus levels.

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The incidence of HIV infections has held steady for most of the decade, but experts say the number of new infections could drop dramatically if currently available medications reached those who are most at risk, particularly black and Hispanic gay and bisexual men. Some are even putting “end” and “AIDS epidemic” in the same sentence. “We essentially have tools to end the epidemic at this point even without a cure,” says Carlos Malvestutto, MD, the medical director of the Family AIDS Clinic and Education Services program at Nationwide Children’s Hospital in Columbus, Ohio.

For people who are already infected with HIV, antiretroviral therapy can suppress the virus to such a low level that it can’t be passed on. But government and public health officials and the pharmaceutical industry are talking up pre-exposure prophylaxis (PrEP) as perhaps the most potent weapon against ending the spread of HIV/AIDS. It consists of a daily pill that combines antiviral medications and prevents infection with HIV in those who are exposed to the virus. In this country, Gilead’s Truvada, a combination of two antivirals, emtricitabine and tenofovir disoproxil fumarate, has had the PrEP market to itself. In October, the FDA approved another Gilead product, Descovy, for PrEP. Descovy swaps out tenofovir disoproxil fumarate for tenofovir alafenamide and may have advantages over Truvada for people with kidney disease or osteoporosis.

There’s no question that PrEP can prevent HIV infection. Access to PrEP has already helped cut the rate of new infections significantly in big cities. However, “PrEP is not reaching the population who needs it most. We haven’t been able to scale up proven interventions,” says Greg Millett, vice president and director of public policy for amfAR, the Foundation for AIDS Research, a high-profile HIV/AIDS advocacy organization that also funds research. Part of the problem, Malvestutto says, is the stigma still associated with the disease, particularly among the highest-risk population groups and in parts of the South, which has the highest rate of new infections. While people may be offered HIV testing, “they would rather not know,” he says. They are often concerned about what it would mean if the word got out that they were HIV positive. Bridget Calhoun, associate dean of health sciences at Duquesne University in Pittsburgh, says that some health care providers resist prescribing PrEP because “they don’t want to encourage risky behavior.” 

The National Institute of Allergy and Infectious Diseases (NIAID) supported a 2010 clinical trial called iPrEx, which was the first to establish the effectiveness of PrEP. It found that daily use of Truvada reduced the risk of acquiring HIV infection among men who had sex with men. For those who took the drug on a daily basis, the risk of acquiring HIV was 92% lower than those in the placebo group. But the main challenge was getting participants to take the medication daily. Overall, the risk was reduced by 44% because many failed to take the drug regularly. Because of the adherence challenges, NIAID is supporting research to find a longer-acting form of PrEP.

Patients resist PrEP—both sticking with it and refusing to start it in the first place—for a raft of interconnected reasons, ranging from distrust of health care providers to lack of health insurance coverage to marginalization of at-risk groups. “Without stable access to health insurance, access to PrEP is lost,” Millett says. And prophylaxis of any kind is a hard sell: You are asking people to do something—in the case of PrEP, taking a pill daily—to prevent an infection or disease that may not happen. 

Meanwhile, the opioid epidemic has created a new wave of people who are injecting drugs, says Millett, and intravenous drug use and the sharing of needles is one of the primary ways that HIV is transmitted. A recent outbreak of HIV infections in rural West Virginia has been linked to drug users sharing contaminated needles. PrEP is not routinely offered to IV drug users, notes Malvestutto.

Large racial disparity

Expense is also an obstacle for PrEP acceptance. Truvada’s list price is more than $20,000 per year, although payers often pay far less because of discounts and rebates. Gilead has come under fire because generic versions of the drug sell for about $60 a year in Africa. Several companies have tried to introduce generic versions of Truvada in the United States and Gilead has sued. Every case has ended in a settlement that has been kept secret.

This spring, Gilead announced a generic version of Truvada will be available next year. The company also announced it was donating up to 2.4 million bottles, each containing a month’s supply of Truvada, to the CDC annually for those who lack insurance. Some have criticized Gilead because Descovy has not been tested for those who have vaginal intercourse. 

Last year, CDC researchers reported research findings that showed that only 7% of the 1.1 million Americans who were at high risk of HIV infection in 2016 were prescribed PrEP. Presumably that percentage has increased, and earlier this year, Gilead said 200,000 Americans were taking Truvada for PrEP purposes. Still, the vast majority of Americans who might benefit from PrEP are not taking it.

The CDC researchers also highlighted another problem with PrEP: the glaring racial disparity of the prescription patterns. Although black men and women accounted for about 40% of the Americans for whom PrEP might be indicated, just 11% of the prescriptions were written for black Americans.

Government action at the federal and state levels may spur wider acceptance of PrEP. In June, the U.S. Preventive Services Task Force recommended HIV screening for everyone between the ages of 15 and 65. Part of that recommendation is that PrEP be prescribed for those who are at high risk of contracting HIV. Because it is a USPSTF recommendation, under the ACA, private health plans must start covering PrEP without copay beginning no later than 2021. This won’t help Americans without insurance coverage, but for those who do, it will remove one more barrier to PrEP. In California, Gov. Gavin Newsom signed a bill last month that allows specially trained pharmacists to dispense PrEP without a prescription. 

During this year’s State of the Union address, President Donald Trump announced a goal to eliminate the HIV epidemic within 10 years. This effort includes using PrEP to prevent new infections. The initial phase focuses on the areas of the country that account for more than half of new diagnoses, particularly urban areas and the South, which has a disproportionate number of cases in rural areas.

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HIV is a virus that infects humans. It attacks your immune system causing it to malfunction and makes you very ill. HIV stands for human immunodeficiency virus, the virus that causes AIDS.

AIDS is a serious medical condition comprising of a variety of diseases that occur because HIV interferes with your body’s ability to fight off other infections. AIDS stands for acquired immunodeficiency syndrome. 

How HIV affects your body ?

A virus is a small infectious organism that can only replicate inside living cells of other organisms; in HIV’s case, human immune cells. In order to understand how HIV and AIDS are connected, we need to take a closer look at how the immune system works. Your immune system is a complex network of organs, tissues, and cells, called white blood cells. The white blood cells are made in the bone marrow, migrate to other parts of the immune system such as the lymph nodes, spleen, and thymus and float around in the bloodstream. The components of your immune system work together to prevent germs from entering, growing, and multiplying inside your body.

How do you get HIV?

The most common way to get HIV is by having sex with an HIV infected person.

HIV spreads from one person to another when certain body fluids (blood, semen, vaginal secretions, rectal fluids, and breast milk) from an HIV infected person come into contact with a mucous membrane in the nose, mouth, rectum, vagina, or penis of an uninfected person. Vaginal, anal, and oral sex all set the scene for HIV to spread from one person to another.

The 2nd most common way to get HIV is by injecting HIV directly into your body.

This most commonly happens when HIV contaminated needles or syringes, or other drug injecting equipment is shared by injection drug users.

How to avoid getting infected with HIV

To avoid getting HIV, you must prevent any contaminated body fluids from entering your body through your nose or mouth, vagina, anus, penis, or breaks in your skin. This can be done by practicing safe sex and safe drug use, which means:

Always use a condom

Get tested regularly – this is a must if you are having sex with someone you know has HIV, or if you are worried you might have been exposed to HIV, and

Never share intravenous needles, syringes, cookers, cotton, cocaine spoons, or eye droppers if you use drugs.

There are other ways you can catch HIV, although it very rarely happens. It is possible to become infected through a needle stick injury or blood transfusion, or by getting bitten by an HIV infected person. HIV can also be passed on from an infected mother to a baby during pregnancy, labor, and birth or via breast milk, but with proper medical treatment during pregnancy, this is also rare.

How do you treat HIV/AIDS?

Antiretroviral therapy or ART is the medicine used to treat HIV infection. It is a combination of three different medicines that are often taken as a single tablet and must be taken every day to be of maximum benefit. ART is recommended for everyone infected with HIV. Although it is not a cure, if you have HIV, it lets you live a longer, healthier life, and reduces the chances you will spread the virus to someone else.

HIV medicines work by preventing HIV from multiplying, which lowers the amount of virus in your bloodstream (viral load). Although the medicine does not get rid of HIV entirely, it gives your CD4 cells a chance to recover so that they can fight off opportunistic infections and cancers. If you don’t take ART, you are likely to die within 12 years from the time you first got infected. On the other hand, if you do take ART, you can have a life expectancy equal to or even higher than the general population.

HIV is managed with prescription viral suppression medications called Highly Active Antiretroviral Therapy (HAART). Taking Viraday has become much easier over the past few years. New treatments include two or three medicines combined in one pill. Many people living with HIV are treated with just one or two pills a day.

If you test positive for HIV infection, your doctor will take a medical history, conduct a physical exam, and order some more tests to find out how HIV is affecting your immune system. There are more than 20 HIV medicines available like Tenvir EM, Tenvir L Tablet, Tenvir and several different ART combinations that may be suitable, depending on your individual needs. Three important tests that help your doctor decide which medicines will work best for you are:

CD4 tests that measure your CD4 cell count.

Viral load tests that measure the number of viruses in your bloodstream, and Drug resistance tests that find out whether or not the HIV you are infected with is resistant to any of the anti-HIV medicines that are available.

As HIV medicines are known to interact badly with some other medicines, the choice of therapy will also depend on what else you are taking. Later, your HIV medicine may need to be changed if you have unpleasant side effects, or if your HIV becomes resistant to the medicine. Prep pill is not for everyone. Doctors guide PrEP for some sufferers who have a very high risk of getting in touch with HIV by not using a condom when they have sex with a personality who has HIV infection.

Consider the following:

You might be one of the millions of people who use a lubricant during sex. If you are using latex condoms, you can have safer sex if you use a water-based lubricant rather than an oil-based lubricant. Why would that be? Oil-based lubricants like Vaseline can weaken latex, making it more likely to break. So, only choose an oil-based lubricant if you are using polyurethane condoms. 

You might think that forgetting to take your HIV medicine now and then is not a big deal, but it is! Why would that be? HIV can multiply very quickly, and sometimes it mutates, meaning it evolves into a new form. Forgetting to take your HIV medicine increases the chances that your HIV will multiply and mutate into a drug-resistant form. If this happens, your HIV medicine will no longer work very well, and HIV will do more damage to your immune system.

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A new peer-reviewed commentary published in the January issue of the American Journal of Public Health argues for new metrics to evaluate the public health response to HIV in the United States. The U.S. Department of Health and Human Services (HHS) has announced plans to reduce the number of new HIV infections by 75 percent in the next five years and 90 percent in the next 10 years. “Ending the HIV Epidemic” (EtHE) efforts will focus initially on 48 high burden counties; Washington, DC; San Juan, Puerto Rico; and seven states with substantial rural HIV burdens, before moving on to all U.S. counties.

Dr. Denis Nash, Distinguished Professor of Epidemiology at the CUNY Graduate School of Public Health and Executive Director of the CUNY Institute for Implementation Science in Population Health, notes that because ending the public health threat of HIV requires intensification and more focused targeting of implementation, there is a need for new metrics to inform and evaluate EtHE initiatives. Nash argues that newer metrics should complement the current metrics that focus on new HIV infections, individuals successfully being treated for HIV, and coverage of pre-Exposure Prophylaxis (PrEP), a drug which can prevent HIV infection.

The HHS plan should develop metrics that track the deployment and uptake of specific intervention delivery strategies, which would provide data regarding plan goals. Nash contends that HIV-related health disparities in both implementation outcomes and health outcomes require special attention.

Finally, Nash underscores the need for HHS to develop a public facing web-based dashboard system that more rapidly disseminates actionable information based on the new metrics needed to inform the implementation of the HHS plan.

“We have made substantial strides in getting useful data into the hands of those that are in a position to act in support of New York’s Ending the Epidemic initiative,” he said, referring to New York’s Ending the Epidemic Dashboard system. “The national EtHE Plan needs a timely dissemination system like the one we have here in New York in order to accelerate impact and share lessons learned within and across those jurisdictions aiming to end HIV as a local public health threat.”

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LONDON (Reuters) – British drugmaker GSK applied on Friday for a license to market its HIV drug dolutegravir in a formulation designed to be easier for babies and children who are living with the virus to swallow.

About 1.7 million children have HIV, most of them in sub-Saharan Africa, the United Nations agency UNAIDS says.

If approved by regulators, the medicine will be the first new generation HIV medicine available in baby-friendly form.

Doctors wanting to use dolutegravir in children with HIV have had no licensed child formulations, meaning they often have to prescribe older HIV medicines that can be less potent, harder for children to take, and have more side effects.

“Children in today’s world, still have fewer options in terms of HIV therapies compared to adults,” said Harmony Garges, chief medical officer for ViiV Healthcare, GSK’s HIV drugs division. She said she hoped the license application would “enable approval of dolutegravir across the pediatric spectrum”.

ViiV’s CEO Deborah Waterhouse added in a statement: “For parents living in resource-poor countries, the ability to give medicine to children in a format that they can swallow and tolerate can mean the difference between life and death.”

Dolutegravir is a so-called integrase inhibitor and was originally developed by ViiV, in which Pfizer Inc and Shionogi & Co have small stakes. For the adult formulation, ViiV has already agreed licensing deals with generic companies to sell low-cost versions in poor countries.

New HIV infections among children have fallen by 41% since 2010, but there were 160,000 new cases in babies and children in 2018, and 100,000 children died of AIDS last year, partly due to lack of access to HIV medicines.

Helen McDowell, ViiV’s head of government affairs and global public health, said that subject to licenses being granted by U.S. and European drug regulators, the company was planning for an initial roll-out in sub-Saharan Africa next year.

ViiV’s version of the child formulation will be priced at “cost of production” she said but declined to give more detail.

ViiV is planning licensing agreements with two generic drugmakers, Mylan Laboratories and Macleods Pharmaceuticals, who aim to make cheaper generic versions of the dispersible pill available within months of ViiV’s coming to market, she added.

Indian generic drugmaker Cipla said last month it was seeking regulatory approval for a four-in-one HIV drug combination called Quadimmune, which it promised to price at below $1 a day.

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Ever since the AIDS epidemic erupted nearly 40 years ago, researchers have tried to make a vaccine.

The efforts typically end up like this: “Failure Of Latest HIV Vaccine Test: A ‘Huge Disappointment.’ “

Now researchers have come up with a new blueprint.

The method behind their potential vaccine mimics a rare process detected in the immune systems of some people with HIV — a process the reduces the amount of virus in the body.

The team from Duke and Harvard behind the work, which appears this month in the journal Science, says there is still a long road ahead before an actual vaccine is ready for large-scale field trials. But scientists in the field are more optimistic than they’ve been for some time.

“For the first 20 years after the virus was discovered, the field tried to make a vaccine using the techniques that all the successful measles, mumps, rubella, polio vaccines had been made with in the past. And none of those worked,” says Barton Haynes, director of the Duke Human Vaccine Institute and a lead author of the new research. But with a virus that’s constantly mutating to evade the immune system, the antibodies generated weren’t strong enough to fight it off.

But in about 20% of people who get infected with HIV, their immune systems will make special proteins called “broadly neutralizing antibodies.” These antibodies live up to their name by wiping out many different strains of HIV by attacking the parts of the virus that stay constant, even as it evolves.

These proteins tend to develop several years after infection and can stop the virus from replicating for a while — although they don’t cure people of HIV because there’s always a reservoir of the virus hiding out in cells where antibodies can’t reach them.

But earlier tests in animals showed a powerful way forward: When they were infused with these antibodies before exposure to HIV, infections were prevented.

But there was a problem: The protection was short-lived.

In the new research, Haynes and his colleagues use computer modeling and lab testing on mice and monkeys to figure out how to train an immune system that’s not been compromised by HIV to create these special antibodies — and then continue to make new, stronger generations.

“We show a new way to design the HIV vaccine to guide the broadly neutralizing antibodies to go down paths they rarely go down on their own,” Haynes says. The vaccine would also train the immune system to make these antibodies in months instead of the natural timetable of years after human exposure to the virus.

The approach looks promising to Rowena Johnston, research director at the nonprofit Foundation for AIDS Research, or amfAR, who was not involved with the study. “Nature is the best engineer when it comes to working out what our immune system should do,” she says.

A vaccine based on these antibodies also has the potential to be far more effective than others in development. There currently are three HIV vaccine candidates in the final stages of human testing, and they’ll be considered successful if they protect just half the exposed population from getting HIV. The benefit of this new method is that because it’s introducing more powerful antibodies than the other vaccine candidates, it could lead to a vaccine that is 80-90% effective, says Dr. John Mascola, director of the Vaccine Research Center at the National Institutes of Health (NIH), who was not involved with the study.

Haynes’ team is a third of the way through developing several of these antibodies, and they’ll need more types to make an effective vaccine, something they say they’re confident they’ll be able to do.

Mascola estimates that it will take at least another five years for an HIV vaccine based on this research to get to large-scale clinical trials.

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We seem to have hit a wall when it comes to slowing the rate of new HIV infections, according to the US Centers for Disease Control and Prevention (CDC). “Since 2013, progress in reducing the number of new human immunodeficiency virus (HIV) infections has stalled at approximately 38,000 new infections occurring each year,” CDC investigators say in a study out this week in the agency’s Morbidity and Mortality Weekly Report.Using data from theNational HIV Surveillance System (NHSS), the CDC measured rates of new HIV infections from 2013 to 2017.

The CDC wants to practically eliminate the occurrence new HIV infections by 2030. “Accelerated efforts to diagnose, treat, and prevent HIV infection are needed to achieve the US goal of at least 90% reduction in the number of new HIV infections by 2030,” the study states. 

Reaching this goal will mean getting at least 95% of people with HIV diagnosed, getting 95% of those diagnosed to viral suppression, and getting 50% of those at increased risk for acquiring HIV on pre-exposure prophylaxis (PrEP), the daily pill that prevents HIV. 

Jonathan Mermin, MD, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, and STD Prevention, said in a statement that “the number of people who acquire HIV each year is unacceptably high. Ending this epidemic would be one of the greatest public health triumphs in our nation’s history.”

In 2017, about 154,000 people with HIV (14%) did not know that they had it and so couldn’t take advantage of HIV treatment. The CDC says that people ages 13 to 24 are less likely to know their HIV status than people 25 years or older. About two-thirds (63%) of those who knew that they had HIV were receiving effective treatment for it. 

In 2018, according to CDC data, 219,700 of the 1.2 million people who could benefit from PrEP had gotten a prescription from a retail pharmacy for the medication. PrEP coverage was likely higher than that, however, because CDC’s data did not include prescriptions from the military or managed care organizations. “Coverage was especially low among young people, African Americans, and Latinos who could benefit from PrEP,” the CDC states. 

In addition to looking at the number of new infections from 2013 to 2017, the CDC used 2017 data to determine the percentage of people with diagnosed HIV infection with viral load suppression. The agency also looked at surveillance and pharmacy data to estimate PrEP coverage—the number of people prescribed PrEP divided by number of people who should be taking it.  

The CDC has recommended since 2012 that prompt treatment with antiretroviral therapy be initiated for people diagnosed with HIV, yet only 61.5% of people diagnosed in 2017 had a suppressed viral load 6 months after diagnosis. 

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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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