New York: HIV patients lose immunity to smallpox even though they were vaccinated against the disease as children and have had much of their immune system restored with anti-retroviral therapy, says a new study.

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. It helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission.

The study, published in the Journal of Infectious Diseases on HIV-associated immune amnesia could explain why people living with HIV still tend to have shorter lives on average than their HIV-negative counterparts despite being on antiretroviral therapy.

The study follows other research recently published in the journals Science and Science Immunology that found the immune systems of children who contracted measles similarly ‘forgot’ their immunity against other illnesses such as influenza.

For the study, lead researcher Mark K. Slifka from Oregon Health and Science University in US, and his colleagues compared the T-cell and antibody responses of a total of 100 HIV-positive and HIV-negative women who were vaccinated against smallpox in their youth.

The research team chose smallpox because its last known US case was in 1949, meaning study participants haven’t recently been exposed to its virus, which would have triggered new T-cell and antibody responses.

They found the immune systems of HIV-positive women who were on antiretroviral therapy had a limited response when their blood was exposed to the vaccina virus, which is used in the smallpox vaccine.

Normally, those vaccinated against smallpox have CD4 T cells that remember the virus and respond in large numbers when they’re exposed again.

Previous research has shown smallpox virus-specific CD4 T cells are maintained for up to 75 years after vaccination.

This finding happened despite the fact that antiretroviral therapy works by boosting CD4 T cell counts in HIV-positive patients.

This indicates that while antiretroviral therapy may boost total T cell counts overall, it can’t recover virus-specific T cells generated from prior childhood vaccinations.

The research team plans to evaluate whether the same phenomenon occurs in HIV-infected men, and if people living with HIV also lose immune memory to other diseases.

Researchers from SUNY Downstate, Georgetown University, Cornell University, University of Southern California and John Hopkins University, also contributed to this study.

The post HIV patients lose smallpox immunity despite vaccine: Study appeared first on MyMedicPlus.

Bengaluru: Over 320 children and adolescents died every day from AIDS and AIDS-related causes in 2018, states a recent report released by the UN International Children’s Emergency Fund (UNICEF).

To take care of the health needs of such children, Desire Society was set up in 2005 in Hyderabad. The NGO now has presence in five states, including in Karnataka (Bengaluru), and an overseas office in the United States. It focuses on disadvantaged children, with special emphasis on HIV-positive victims, children abandoned by one or both parents, children of sex workers, truck drivers, and kids who have been abused and those belonging to vulnerable socio-economic sections.

The NGO wants to ensure that no children in the country lives life as a HIV-positive. “We have been providing medical, nutritional and educational needs of our children. We have not lost a single child under our care. This year, we will focus on holistic development of our children,” said Shubash, co-founder and vice-president, Desire Society.

The NGO runs four programmes – Supply of supplementary nutrition through health camps, ICH (Institutional Care Homes), IEC (Information, Education, Counselling) – Knowledge-building and empowerment of infected children – and summer camps as an annual social event which are fun-based gatherings meant exclusively for children with HIV/AIDS.

Desire focuses on educating these children, helping them get employed, get married and start a family. Since HIV transmission from the parent to a child can be prevented, the organisation believes that children supported by it are eligible to get married. Desire boasts of taking care of next generation kids as well if their parents don’t survive.

One of the major impediments HIV-infected children face is the social stigma, which deprives them of school education. Once children are taken under its wings, Desire puts them under the medical observation of its healthcare team.

The children are made to take drugs regularly and on time as unless a patient takes antiretroviral therapy (ART), there are no results.

Regular counselling sessions are conducted to inculcate positive thinking in young minds. “Our aim is to work towards ensuring that no children in the country will be living a life of a HIV-positive. One of our present challenges is that we do not have our own land for the care centre. We have to pay a high rent so we are in need of funds to build a separate building for boys’ accommodation,” Mr Shubash said.

The post Desire Society: No child should live life of a HIV-positive appeared first on MyMedicPlus.

The US Department of Health and Human Services (HHS)-led Ending the HIV Epidemic initiative aims to end the HIV epidemic in the United States by 2030. An analysis published in the US Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report suggests that substantial challenges lie ahead in the effort.

The authors of the report used National HIV Surveillance System data to estimate the annual number of new infections, estimate the percentage of infections which led to an HIV diagnosis, and evaluate the percentage of individuals with viral load suppression.

Pre-exposure prophylaxis (PrEP) coverage was estimated by analyzing national pharmacy data from the IQVIA Real World Data-Longitudinal Prescriptions database. The estimation was calculated as the number of persons who were prescribed PrEP divided by the estimated number of persons who had indications for PrEP.

The report highlighted a variety of barriers including the underutilization of pre-exposure prophylaxis (PrEP) and groups of Americans living with HIV who either don’t know it or aren’t accessing effective treatment.

Among the estimated 1.2 million people living with HIV in the United States in 2017, 14.2% had not received a laboratory-confirmed diagnosis. Of the 854,206 people with diagnosed infections, 62.7% had a suppressed viral load.

The lowest percentages of viral suppression were found among those aged 13-24 years, black individuals, and heterosexual males.

Report authors pointed to health care coverage, homelessness, and incarceration as potential drivers of lower medication adherence or viral suppression, particularly among at-risk black individuals.

“Since 2012, prompt treatment with antiretroviral therapy after diagnosis of HIV infection, regardless of stage of disease, has been recommended,” report authors wrote.

At the state level, low viral suppression rates within 6 months of HIV diagnosis (59%) were concentrated in the South, which authors noted is already disproportionately impacted by HIV.

Areas for improvement were also found in analysis of PrEP coverage.

Approximately 1.2 million people were estimated to have indications for PrEP in the United States. Of these individuals, 12.6% were prescribed PrEP in 2017 and 18.1% were prescribed PrEP in 2018.

PrEP coverage was 5.9% for blacks, 10.9% for Hispanics/Latinos, and 42.1% for whites. This indicates a racial disparity relative to coverage which is itself suboptimal among whites.

The United States is not alone in underutilization of PrEP. Europe’s PrEP gap of 500,000 MSM who need PrEP but can’t access it points to a global issue.

The report also discussed overall progress in terms of reducing HIV infections from the 2013 to 2018 period, noting that the number of annual infections has remained stable rather than decreased.

“Since 2013, progress in reducing the number of new HIV infections has stalled at approximately 38,000 new infections occurring each year,” authors of the report wrote.

“Accelerated efforts to diagnose, treat, and prevent HIV infection are urgently needed,” the authors concluded.

The post The State of HIV Treatment and Prevention in the United States appeared first on MyMedicPlus.

Every day, as many as 500 babies in sub-Saharan Africa are born with HIV. Standard practice in many of these countries is to give them treatment if they test positive, but not for weeks or even months after they’re born. The concern is that newborns can’t tolerate the powerful drugs.

In the last few years, researchers have suspected that treating right at birth is better. Dr. Deborah Persaud, a virologist at Johns Hopkins Children’s Center, co-wrote a paper six years ago about a baby girl in Mississippi with HIV who was treated 30 hours after birth.

“That baby was known to be infected and went off drugs,” she says. At 18 months, the girl’s family took her off antiretroviral drugs. For infected individuals who stop treatment, it usually takes two to four weeks for the virus to resurge, but “for 27 months, there were no signs of HIV.” The girl later relapsed and went back on antiretroviral drugs around age 4.

Still, doctors thought the “Mississippi baby’s” two years of drug-free healthy living were the result of getting treatment so early. Since then, it has become standard practice in the U.S. to treat babies at high risk of being born with HIV soon after birth — but doctors think more clinical evidence is needed that the treatment can be safe and more effective than delaying treatment.

Now, results from a clinical trial in Botswana support that hunch. In Science Translational Medicine, researchers report on 10 HIV-positive babies who were started on a drinkable three-drug cocktail of conventional antiretrovirals within their first days. After they had two years of antiretroviral drugs, the virus was almost undetectable in their bodies. By contrast, kids who started antiretroviral therapy a few months after birth had 200 times more virus in their blood.

Daniel Kuritzkes, a study co-author and chief of the Division of Infectious Diseases at Brigham and Women’s Hospital in Boston, says the early-treated kids aren’t cured yet, “but it’s likely that we may have set them up for the possibility of long-term remission of their HIV.”

Kuritzkes thinks there are two main reasons that treating so early is helpful. First, in people of any age, treating as soon as someone becomes infected helps keep the virus from taking firm hold in their bodies. And second, in babies, their immune system is just beginning to develop.

“By intervening very early, we’re able to protect the immune system much more effectively from any damage from HIV,” he says.

Kuritzkes says his study adds evidence that very early treatment is safe and tolerated well by babies.

Persaud, who was not involved in the Botswana study, says that when HIV first infects someone, it establishes itself in certain cells where it can hide out for years. Current HIV drugs can’t get at these reservoirs. Very early treatment, which prevents the virus from replicating when babies’ immune systems are just developing, seems to work by keeping the hidden stock of HIV very small.

The Botswana trial is one of three major ongoing clinical trials looking at very early treatment of HIV in infants — and the first to publish some results, says Ted Ruel, an infectious disease pediatrician at UCSF Benioff Children’s Hospital. A second study is ongoing in South Africa, and a third, called the P1115 study (which Ruel and Persaud are both involved with), has multiple sites around the world, including in Brazil, India and Thailand. The ultimate goal of this work, Ruel says, “is to get it so that people with HIV can forget about it, so they can not [have to] take medicine every day and not worry about infecting other people and not feel any side effects from it.”

According to Kuritzkes, the next step in the Botswana trial is to introduce an experimental treatment using broadly neutralizing antibodies, which have been promising in adults, to children.

“The idea is to replace daily or twice daily oral dosing with antibody infusions that might be administered every three months or less frequently,” he wrote in an email. Persaud says that the P1115 study plans, with the consent of the families, to stop antiretroviral treatment in healthy-seeming children and to see if their bodies will continue to suppress the virus on their own.

While treating HIV very early looks promising, one of the biggest hurdles will be getting drugs to babies who need them.

“You really need the kind of infrastructure that exists in Botswana or in a country like the United States in order to be able to identify and rapidly intervene in these children,” says Kuritzkes. Faced with one of the world’s highest HIV rates, Botswana developed a nationwide treatment plan — the first in eastern and southern Africa to give free access to HIV drugs for anyone who needs them.

Last year, 160,000 kids worldwide were infected with HIV through pregnancy, birth or breastfeeding. Almost 90% of them live in sub-Saharan Africa, and half of them don’t have access to antiretroviral drugs. Obstacles to treatment abound. The parents might not know their children have HIV, the drugs can be hard to get or there’s often stigma around being an HIV carrier in their communities.

Researchers involved in these studies agree that preventing kids from getting HIV in the first place is key. But for those who fall through the cracks, they say that giving treatment very early offers a second chance for good health.

The post For HIV-Positive Babies, New Evidence Favors Starting Drug Treatment Just After Birth appeared first on MyMedicPlus.

Yet it remains an enduring problem: a disease rooted in poverty and inequality, it’s an epidemic that disproportionately affects women and young girls, health workers say. 

Last year, 1.7 million people were newly infected with HIV, according to the Joint United Nations Programme on HIV/AIDS, known as UNAIDS.

But the prevalence is twice as high among young women aged 15 to 24 compared to men of the same age group.

In Gambia, South Africa, the Congo, and Gabon, HIV prevalence is three times higher among young women. In Angola, it is four times. And in eSwatini, a country with one of the highest prevalence rates in the world, young girls and women are five times more likely to be living with HIV compared to boys and young men.

There is concern that the HIV epidemic is falling from global public health agendas and, with it, financial investment.

Between 2017 and 2018, there was a $900 million decrease in HIV funding in low- and middle-income countries.

Jose Izazola, UNAIDS special adviser on resource tracking and finances, told The New Humanitarian this was driven primarily by: reduced disbursements from The Global Fund, a multilateral non-profit; reductions in contributions from donor governments such as the UK; and a stagnation in funding from the world’s largest donor – the United States.

Only about two percent of global funding for HIV is earmarked specifically for key populations such as girls and women – but that is changing.

An example is the DREAMs programme, a partnership with the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Bill and Melinda Gates Foundation, among other funders, to reduce new HIV infections in adolescent girls and young women in 10 sub-Saharan African countries. 

“For the first time, we do have comprehensive programmes,” Chewe Luo, the associate director of UNICEF’s HIV/AIDS section, told TNH. “The DREAMs programme of PEPFAR is attempting to address exactly what we are talking about.”

The problem in eSwatini

There are particular reasons why the small southern African country formerly known as Swaziland, now officially the Kingdom of eSwatini, has so many women with HIV.

“The first thing to know is eSwatini is a patriarchal society. Women are considered children,” Albertina Zodwa Nyatsi, director of Swazi’s Africa Coalition on Tuberculosis chapter, told TNH on a trip around the northwestern countryside.

“Women have limited decision-making when it comes to family planning. Women cannot advocate for condom usage or they risk being viewed by their partner as a prostitute or as diseased,” said Nyatsi, who also founded Positive Women Together in Action, a support group for HIV-positive women.

“The first thing to know is eSwatini is a patriarchal society. Women are considered children.”

Swazi women cannot take steps to prevent the spread of HIV, and when they receive their diagnosis, they are often blamed, socially isolated, or face stigma and violence.

As a result of gender inequality and cultural practices, an estimated 16 percent of Swazi girls and young women were living with HIV in 2018, a reflection of the broader burden of HIV on girls and women.

Early sexual debut and child marriage – cultural practices that are normalised in many countries across sub-Saharan Africa – put girls at high risk of contracting HIV.

In some countries, it is estimated that 25 percent of adolescents are sexually active before the age of 15, and 12 million girls under the age of 18 are married each year.

“Many of those gender inequalities mean that women have less power. Girls have less power,” said Sarah Hand, CEO of Avert, a UK-based charity focused on spreading information about HIV. 

“The cultural practices often mean that young girls, very young girls, are having sex early with male partners who are often themselves then in concurrent sexual partnerships.”

Lack of opportunities

Many challenges that young girls and women face stem from a lack of education and economic opportunities.

“We realise now, in terms of challenges among girls and young women, they go through multiple vulnerabilities as they grow,” said Luo.

“For example, we know that not keeping a girl in school increases risk of HIV acquisition because she is not empowered to negotiate for safer sex.”

“They go through multiple vulnerabilities as they grow.”

In eSwatini, only about 30 percent of adult women received some secondary education between 2010 and 2017. Limited education combined with widespread poverty creates an environment where transactional sex, often with multiple concurrent partners, and intergenerational sex are commonplace.

On top of that, gender-based violence, which is linked to higher rates of HIV transmission, is common. An estimated 48 percent of Swazi women experience sexual violence in their lifetime.

Harmful cultural practices such as polygamy and wife inheritance also persist and are frequently cited as factors contributing to high HIV rates.

In KaKhoza Township, an impoverished slum-like community in Manzini, eSwatini’s second largest city, TNH met with a support group for girls and young women living with HIV. Nearly every young woman was diagnosed with HIV in her late teens or early twenties – and only after seeking health services for pregnancy.

Gender-based violence

Stories of stigma and violence reverberated around the group.

“I was diagnosed with HIV when I went to the doctor for my pregnancy,” one girl, who asked not to be named, said. “When I told my partner, he beat me and forced me out of the home.

Today, she lives with her mother and her child in a one-room hut; she makes a small living selling fruits and vegetables in her town, but said her meagre income doesn’t even cover the medication for her baby.

“When the HIV came, my husband didn’t want to associate with me,” Dudu Manana, the support group’s leader said through a translator. “He sends a bit of money each month but doesn’t come to see me.” Like many HIV-positive women, Manana lives alone, socially isolated from her family and friends.

Stigma, violence, and the cultural expectation that Swazi women receive permission from their spouse or partner to access health services can prevent young girls and women from receiving proper medical treatment and social support.

“When you are diagnosed with HIV, you are seen as useless, depleted,” Tebeguni Nxumalo, a member of the Kakhoza support group said. “It is harder to become employed and you have to leave school.”

A grim employment outlook forces many young girls into the sex industry, said Florence, an HIV-positive sex worker living in Mbanane, the capital. “And then clients pay double for sex without a condom even when they know your HIV status,” she added.

Sex workers in eSwatini have the highest prevalence rate of HIV in the world, with 60 percent of sex workers living with the disease.

In eSwatini, antiretrovirals that suppress the virus are provided free of charge, but medications and diagnostic tests for illness caused by opportunistic pathogens are not, which drives up deaths from diseases such as tuberculosis and cryptococcal meningitis.

Food insecurity has been found to lower adherence to antiretroviral therapy.

“The [HIV] medicine makes you hungry, but there is no food,” said Hobsile Malambe, a resident in Mvembili, in the far north of eSwatini. “I wish they provided food, too.”

The post How the neglected AIDS epidemic hits women and girls hardest appeared first on MyMedicPlus.

 An American man who leaked confidential details of thousands of HIV-positive people in Singapore, most of them foreigners, has been jailed in the United States for two years.

Combination HIV interventions in HIV-hyperendemic fishing communities in Uganda resulted in increased testing, male circumcision and ART coverage, as well as increased population HIV viral load suppression, according to findings from a prospective cohort study published in The Lancet HIV.

“Decreases in HIV incidence with combination HIV intervention scale-up have been reported in some lowerrisk populations, but to our knowledge this is the first report of prospectively observed declines in overall HIV incidence with rapid scale-up of combination HIV interventions in HIV-hyperendemic communities,” Joseph Kagaayi, MBChB, director of the Institute of Public Health at Makerere University in Kampala, Uganda, and colleagues wrote.

HIV-hyperendemic geographical areas have specific social-behavioral, demographic and structural characteristics — including high levels of mobility, transactional sex and large proportions of men — that may hinder interventions.

The researchers conducted a prospective cohort study from 2011 to 2017 to determine the effect of combination HIV interventions on HIV incidence and evaluate trends in coverage of combination HIV interventions. They administered five surveys to collect self-reported demographic, behavioral and service-uptake data from patients aged 15 to 49 years who lived in four HIV-hyperendemic fishing communities in Uganda. They provided free HIV testing at each interview and offered referrals to combination HIV intervention services when appropriate. implemented Interventions that included establishing a new community-based HIV clinic in the largest of the four fishing communities, providing male circumcision through mobile camps and initiating ART in these communities.

A total of 8,942 patients contributed data, of 52% were . The researchers reported an HIV prevalence of 41% in the 2011-2012 baseline survey, which declined to 37% at the final survey in 2016-2017 (< .0001). From the first to the last survey, HIV testing coverage increased from 68% to 96%. Male circumcision coverage increased from 35% to 65% and ART coverage increased from 16% to 82%. They noted that population HIV viral load suppression in all HIV-positive patients increased from 34% to 80%. However, risky sexual behaviors did not decrease over the study period.

According to Kagaayi and colleagues, HIV incidence decreased from 3.43 per 100 person-years (95% CI, 2.45-4.67) at the first survey to 1.59 per 100 person-years (95% CI, 1.19-2.07) at the final survey for an adjusted incidence rate ratio (IRR) of 0.52 (95% CI, 0.34-0.79). They noted that declines in incidence were similar for men (IRR = 0.53; 95% CI, 0.3-0.93) and women (IRR = 0.51; 95% CI, 0.27-0.96). Circumcised men had a lower risk of incident HIV infection than uncircumcised men (IRR = 0.46; 95% CI, 0.32-0.67).

“Despite surpassing 90-90-90 goals and almost reaching 95-95-95 goals of around 86% population viral suppression, HIV incidence in the Ugandan fishing communities remained 15times higher than the suggested incidence required for HIV epidemic control (ie, 0.1 per 100 person-years) from previous modeling studies,” the researchers wrote.

The post Combination HIV interventions decrease incidence, increase coverage in hyperendemic Ugandan regions appeared first on MyMedicPlus.

The baby girl of the 23-year-old woman, who became affected with HIV after a blood transfusion, has not been affected by the virus, according to the dean of the Madurai Government Rajaji Hospital K Vanitha.

The woman, pregnant with her second child, was found to be anemic and she was given HIV positive blood without screening the blood properly. The incident happened at a government hospital in Sattur of Sivakasi district in December 2018. After delivering agirl child, she was neglected by her husband, a daily-wage worker.

The donor came to know about his condition when he underwent a medical check-up some days after donating the blood. He committed suicide by consuming poison. 

Three workers of the government hospital at Sivakasi had been suspended as they had failed to screen the blood properly.

The Madurai bench of the Madras High Court had recently ordered the government to pay a compensation of Rs 25 lakh to the woman. Hearing a PIL that the woman got the infection as the blood transfused was not properly screened, a division bench of the court comprising Justices N Kirubakaran and S S Sundar directed that Rs 10 lakh be deposited in the name of the 23-year-old woman and the remaining Rs 15 lakh in the name of her two children. The court has also ordered the government to give her a suitable permanent job  and a house measuring not less than 450 sq feet. The court directed the state government to implement its order by January 11.

The judge said nurses, counsellors and blood bank technicians should be recruited as per the conditions of the National AIDS Control Organisation, and the government should monitor the blood banks, ART (antiretroviral therapy) centres and medical documents.

Besides, they should check if the equipment are maintained properly and inspected frequently by authorised people, the judges said. An expert committee should be formed to make blood donation and transfusion safe, the court added.  

The post ‘Baby of pregnant woman given HIV-positive blood tested HIV-free’ appeared first on MyMedicPlus.

The Madras High Court has ordered the Tamil Nadu government to give Rs. 25 lakh as compensation to a woman from Sattur in Virudhunagar, who has transfused with HIV-positive blood at a government hospital. This is in addition to a previous order from the High Court which directed authorities to construct a house and provide a permanent job for the victim.

In December 2018, the 23-year-old pregnant woman had undergone a blood transfusion at the Sattur government hospital, only to discover that the donated blood carried the HIV virus. It was alleged that the blood bank staff failed to properly screen the donated blood. Following this, multiple public interest litigations (PILs) were filed in court demanding compensation for the victim’s physical and mental trauma. The order was finally passed by a division bench of Justice N Kirubakaran and Justice SS Sundar. A batch of three cases related to the issue were clubbed together by the court.

In their order, the judges said, “The State shall pay a sum of Rs.25 lakhs by way of compensation to the victim, Tmt.Muthu. Out of the said sum of Rs.25 lakhs, a sum of Rs.10 lakhs shall be deposited in an interest bearing fixed deposit for a period of three years in any Nationalised bank in the name of the victim. The remaining sum of Rs.15 lakha shall be deposited in the joint name of her two minor children and the said sum will be in fixed deposit till the minors attain majority. The victim is entitled to withdraw interest accrued only out of the amount deposited in her account.”

The court then reiterated its previous order from April 2019, and directed the government to allocate additional funds to construct a house for the victim.

The court further set guidelines for recruitment of blood bank employees and for tests conducted on samples.

“All the posts, particularly, the post of Counselor, Lab Technicians, Blood Bank Technicians, Supervisors and Staff Nurses shall be filled up by TANSACS or SBTC in connection with Blood Banks, and AIDS Control programme in the State shall be filled up by following the recruitment process recommended by NACO, particularly, with regard to the educational qualification and other eligibility criteria,” ordered the bench.

In addition to this, the government has been directed to constitute an expert body for the purpose of evolving a foolproof mechanism/procedure to collect, test and preserve blood units. This is to prevent recurrence of transfusion of infected blood at private and government hospitals in the future.

The post Madras HC orders Rs 25 lakh compensation for woman transfused with HIV-positive blood appeared first on MyMedicPlus.