• UNAIDS said it had surveyed over 1,000 HIV people in China and found that the coronavirus outbreak is having a ‘major impact’ on their lives
• HIV patients in China risk running out of life-saving AIDS drugs because quarantines, lockdowns mean they cannot replenish vital medicine stocks

• LONDON/BEIJING : HIV patients in China risk running out of life-saving AIDS drugs because quarantines and lockdowns aimed at containing the coronavirus disease outbreak mean they cannot replenish vital medicine stocks, United Nations AIDS agency said on Wednesday.

  UNAIDS said it had surveyed more than 1,000 people with HIV in China and found that the outbreak of the coronavirus, now known as COVID-19, is having a “major impact” on their lives.

  The outbreak so far infected more than 74,000 in China, and killed 2,004 of them. Outside China, five deaths and 827 cases have been reported so far.

  Nearly a third of the HIV positive people surveyed by UNAIDS said lockdowns and restrictions on movement in China meant they were at risk of running out of their HIV treatment in the coming days.

  Of these, almost half – or 48.6% – said they did not know where to collect their next antiretroviral therapy refill from.

  “People living with HIV must continue to get the HIV medicines they need to keep them alive,” UNAIDS Executive Director Winnie Byanyima said in a statement. “We must ensure that everyone who needs HIV treatment gets it, no matter where they are.”

  UNAIDS says that according to Chinese government sources there were an estimated 1.25 million people with HIV in China at the end of 2018.

  One HIV-positive volunteer AIDS campaigner in China told Reuters he has set up a group chat that includes more than 100 HIV patients, mostly in Hubei province – epicentre of the COVID-19 outbreak – where he is helping patients to share limited stocks of medicines between them.

  Some HIV patients are scared of letting other people know why they are desperate to get out of the cities.

  “(Patients are) very panicked, very panicked, and in the group chat I have to comfort them constantly,” said the campaigner, who did not want to give his name. “For patients, medicine is important, treatment is important. This could be as important as front-line relief supplies.”

  Adding to the problem of potential shortages is an emerging practice of people not infeGcted with HIV appealing to patients with the AIDS-causing virus to share their medicine as potential experimental treatment against the new coronavirus.

  Although there is no evidence from clinical trials, China’s National Health Commission said the HIV drug lopinavir/ritonavir could be tried in COVID-19 patients.

  That triggered a rush for drugs such as Kaletra, also known as Aluvia, which is drugmaker AbbVie’s off-patent version of lopinavir/ritonavir.

  UNAIDS said lockdowns in various cities have also meant that people with HIV who had travelled away from their home towns have not been able to return home and access HIV services, including treatment, from their usual providers.

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Vitamin E Safe For Fatty Liver In HIV Patients: Study

Toronto: A type of fatty liver disease that commonly affects patients with HIV can be safely treated with vitamin E, researchers have found.

Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD) and is characterised by liver inflammation and cell damage.

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People living with HIV in the UK have high levels of GP registration and about two-thirds of these individuals have good experiences of using a GP, according to research recently published in BJGP Open. In-depth interviews showed that a “good” GP took time to get to know their HIV-positive patients, accept them without judgement and offered continuity of care.

The researchers suggest that GPs (general practitioners) could improve the care they provide to individuals living with HIV by deploying skills – especially those relating to empathy and person-centredness – developed when looking after people with other long-term conditions. They make several other suggestions for how primary care services can improve their care for people with HIV.

“Some of the issues faced by people living with HIV are similar for patients with other long-term conditions; an NHS England report on improving health outcomes for people with long-term conditions identified lack of care coordination, lack of emotional and psychological support, fragmentation of care, lack of informational continuity, and poor care planning consultation as key problems,” comment the authors. “The solutions to these problems are also likely to be similar.”

Dr Tanvi Rai and colleagues at Imperial College, London, undertook the research. A particular strength was that it combined the findings of a nationally representative survey of and in-depth qualitative interviews with people living with HIV. This allowed them to fill gaps in knowledge about the use of GP services, especially regarding rates of registration, disclosure and satisfaction and to identify the practical steps GPs could take to improve their services for people with HIV.

The Positive Voices survey conducted in 2017 involving 4422 nationally representative people attending HIV clinics provided the investigators with information regarding rates of GP registration, HIV disclosure and experiences of using GP services. Interviews conducted with 52 people with HIV recruited in London in 2014-2015 were used to explore individuals’ opinions regarding GP registration; HIV disclosure, confidentiality and stigma; and empathy and support.

Results from the national survey showed that 98% of individuals were registered with a GP. Rates were consistently high across demographic groups. The vast majority of those registered with a GP had disclosed their HIV status to them (94%). Disclosure rates were above 85% for all demographic groups, with the lower rates of disclosure seen in younger adults, people with more education, people who rated their health as good or very good, people with fewer health complaints and individuals who reported avoiding health care due to their HIV.

Over half (58%) had consulted their GP in the previous three months. Recent use of a GP was associated with poor self-rated health and a higher number of non-HIV-related health problems.

About two-thirds of participants thought their GP had sufficient knowledge of HIV (65%), had an appropriate level of involvement in HIV care (65%) and that specialist HIV services and GPs communicated well (64%). Slightly fewer felt comfortable asking their GP HIV-related questions (59%). Factors associated with higher levels of satisfaction with GP services and competence were older age, lower educational attainment, being in employment, and good or very good health.

People with concerns about stigma and discrimination had the most negative experiences of GPs. Individuals who had avoided using healthcare services in the past year because of their HIV status were less likely to feel comfortable consulting their GP. Similarly, they were unlikely to agree that their GP had good knowledge of HIV, were adequately involved in their HIV care, or had adequate communication with HIV services. 

Findings from the in-depth interviews largely supported the results of the national survey and also provided important insights into individuals’ experiences of using GP services.

People were unlikely to visit their GP instead of their HIV clinic unless they had other chronic non-HIV-related illnesses that needed regular follow-up. Most participants felt obliged to register with a GP because this was recommended by their HIV clinic. People with long-term conditions in addition to HIV thought it was in their best interest to have a GP especially because their HIV clinic no longer provided services such as statins, flu vaccines or smear tests.

While rates of HIV disclosure were high, reasons for not disclosing included a fear that this would mean that HIV care would be transferred to the GP and also a concern that disclosure could jeopardise employment opportunities.

But concerns about confidentiality were widespread. “I was a bit sacred about telling my GP because I didn’t want my job and health insurance and all those kind of things to know,” said one 35-year-old gay man.

Another individual was surprised that their HIV status was flagged on their electronic patient records and that the GP told him “it was put there because of the health and safety of his staff.”

Participants had a deep sense of trust in their HIV clinic. This was fostered by consistent medical and psychological support from the moment of diagnosis. For GPs to be similarly trusted they had to be willing to listen, take health problems seriously and show kindness.

A 50-year-old gay man recalled the response of his GP when he disclosed his HIV: “that’s okay,” said the GP, “let me see what I can do to make life easier.”

However, some people thought their GPs placed an excessive emphasis on HIV as a cause of health problems. “Everyone sees me as walking HIV,” said a 53-year-old heterosexual woman.

Consistency of care helped establish confidence in GP services. “I’ve got somebody there that if there is something a bit more personal, I can talk to him,” said a 39-year-old gay man.

However, in some instances, participants were much more comfortable talking to HIV clinic staff rather than a ‘family doctor’ about issues such as drugs, alcohol and sex.

Factors making a ‘good GP’ included seeing the same person at each consultation, and a doctor that came to know and accept their patients without judgement.

Occasionally, concern was expressed about GPs lack of knowledge or confidence when dealing with people with HIV.

A 45-year-old gay man recalled his GP saying, “I think you should ask your consultant.” This left him feeling “in limbo.”

The researchers believe their findings have important implications for the provision of primary care by GPs to PLHIV:

• GPs should draw on their experience of caring for individuals with other long-term health conditions.
• Receiving regular updates about HIV (for instance on treatment as prevention) will keep GPs abreast of important developments in the treatment and care of people with HIV.
• GP practices which care for several people with HIV could consider identifying a ‘champion’ who proactively shares their knowledge of HIV with colleagues.
• Confidentiality obligations to all patients should be stated and explicit consent should be sought each time a GP needs to share information about a patient.
• Proactively displaying information about HIV, for instance encouraging testing or U = U messages, would help allay fears regarding stigma.

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Tuberculosis and HIV—two of the world’s deadliest infectious diseases—are far worse when they occur together. Now, Texas Biomedical Research Institute researchers have pinpointed an important mechanism at work in this troubling health problem. And, their discovery could lead to a new mode of treatment for people at risk. The results were published in the Journal of Clinical Investigation, a top-tier venue for critical advances in biomedical research.

“We were a little surprised at the extent of clarity in our data,” Professor and Southwest National Primate Research Center Director Deepak Kaushal, Ph.D., said. “I am actually very excited to move forward trying different treatment approaches on co-infected monkeys.”

The scientific community has long assumed the reason people with HIV are more likely to develop TB is a depletion of immune cells called CD4+ T cells. However, Dr. Kaushal’s team was able to show that other effects of viral co-infection play a crucial role in this process.

Using about 40 rhesus macaques, researchers determined that lung-specific chronic immune activation is responsible for the progression of disease. Chronic immune activation is a dysfunction of immune pathways that generate molecules (cytokines and chemokines) which fight off pathogens like bacteria, viruses and fungi.

Dr. Kaushal used an analogy to explain what this dysfunction caused by HIV infection does in the body. “It’s like all the taps and faucets in your house are turned on full blast all the time,” he said. “You are going to lose a lot of water. With this dysfunction, all cytokines ad chemokines are constantly being produced to the highest levels. This dysregulates the body’s ability to fight off other infections.”

Even with the gold standard antiretroviral therapy (ART) for people with HIV, chronic immune activation still persists. Dr. Kaushal said his study shows “we need to develop approaches to target chronic immune activation,” perhaps with a drug that would be an additional therapy along with ART.

Dr. Kaushal said the implications of a new method of treatment are enormous. Up to a fourth of the world’s population is infected with tuberculosis. Most of the time, the bacterial disease remains latent (dormant). In otherwise healthy people with latent TB, only 5% will go on to develop active tuberculosis. In HIV/AIDS patients, the risk of developing active TB increases ten-fold to 50%. TB and HIV co-infection is considered a global syndemic, meaning the diseases are pandemics infecting people all around the world, and they promote each other. In parts of Sub-Saharan Africa, the rate of TB/HIV co-infection is “astronomically high,” according to Dr. Kaushal, citing statistics that show it’s 100 times higher than the rest of the world.

This discovery was 12 years in the making, starting with the creation of a nonhuman primate model for TB/HIV co-infection. Dr. Kaushal said he is hopeful new treatment strategies could reach the clinic within a decade.

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