Daily HIV Prevention Pill (PrEP): Why It’s Urged for Healthy People at Risk

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You may have heard the saying, ‘If all you have is a hammer, everything looks like a nail’.  As a nutritionist I will admit that I am a bit of a hammer. If someone asks, ‘How do I get more energy?’ I will likely respond, ‘Eat clean and stay hydrated’. ‘What about having better brain function?’someone asks. ‘Watch those blood sugar highs and low’ might likely be my response.

But what about this COVID -19 epidemic, could nutrition play a role in its outcome? Would it make a difference if we were equally focussed on our diet and immune system as much as preventing contracting the virus with social distancing, hygiene, and masks?

Statistics

Thailand’s mortality rate from COVID-19 stands at one of the lowest in the world at 1.7% (global average was estimated at around 6%). However, among the deceased 41% had diabetes, 36% had high blood pressure, 18% had hyperlipidemia, and 14% had heart diseases.

When divided by age group, those who are over 70 had the highest mortality rate at 12.1%, followed by those aged 50-59 (4%) and 60-69 (3.7%), while the group with the lowest risk is 20-29 years old at 0.2%.

Among the deceased, 41% had diabetes, 36% had high blood pressure, 18% had hyperlipidemia, 14% had heart diseases. 

The CDC also recently released statistics that 94% of those who died had more than one underlying medical condition. When this figure is connected with the statistic that those people over 70 have the highest rates of mortality it stands out that health is a key player in COVID Mortality for those under 70 years of age.  

COVID-19 and metabolic syndrome

So I was thrilled to read a recent editorial from Dr Maryanne Demasi in the British Medical Journal titled; ‘COVID-19 and metabolic syndrome: could diet be the key?’

Dr Demasi starts by sharing the now-familiar statistics of the vast majority of people hospitalised and dying from COVID-19 as having pre-existing conditions including:

• Two-thirds of the people in the UK have fallen seriously are with COVID, who are overweight or obese. 
• 99% of deaths in Italy have been in patients with pre-existing conditions such as hypertension, diabetes and heart disease.

These conditions make up what is known as metabolic syndrome, and include high blood pressure, low good cholesterol, high blood sugar, high waist circumference.

Perhaps this may help to explain Thailand’s lower rate of mortality as Thailand has about half the Metabolic Syndrome cases of the US and UK – about 16% compared to the US and UK with over 32%.

What causes Metabolic Syndrome

Dr Demasi goes on to say metabolic syndrome is related to insulin resistance. The most significant factor that determines blood glucose levels is the consumption of carbohydrates, refined carbs, starches and simple sugars. 

She believes one of the problems facing people now is that people who are confined to nursing homes, hospitals and self-isolating are stockpiling non-perishable staple foods which are generally high carbohydrate like pasta, bread, rice and cereals and increasing their mortality risk.

Are you at risk of Metabolic Syndrome?

I highly recommend every year people doing an annual health check-up and getting your labs done. We are blessed when it comes to medical tourism in Phuket. With International Hospitals offering health checks along with many walk-in clinics. Here are some of the tests related to metabolic syndrome:

Fasting Blood Sugar, HBA1c (long term blood sugar), Full lipid (Cholesterol markers), Fasting Insulin along with getting your waist circumference measured (men should be under 90cm, women under 85cm) and blood pressure taken.

What do you do if these markers are high?

Naturally, talk to your doctor about solutions but here are 3 strategies to help using diet (regular exercise and good sleep naturally also help):

1. Reduce as much sugar as possible – so cut down or ideally eliminate the soft drinks, reduce adding sugar to meals or drinks and consuming confectionary.
2. Go lower Carb – especially lowering the refined grains like white bread, pasta, potatoes and rice. Try to replace these with more vegetables. As Doctor Demasi rightly says, even most diabetic associations now agree that restriction of dietary carbohydrates is a safe and effective way to achieve good balance between blood sugar and weight loss.
3. Try Intermittent Fasting (I.F.). I.F. is not for everyone (especially not for kids, pregnant women, and those with low blood sugar issues). But for those with metabolic syndrome not eating frequently and having longer gaps between meals has considerable research supporting its efficacy in blood sugar balance. The 5:2 diet is one style that recommends twice a week eating just 1 meal. Another strategy recommends eating only during an eight-hour window eg. 10am to 6pm and fasting the remainder. 

The key to long-term health success comes from firstly ownership of your health, so I highly recommend to get your labs done. If the results are not in your favour then make it very clear why health is important. Then comes the plan. Find the strategies that will work long term and become healthy habits. Finally, you need to make yourself accountable to follow through – maybe also share your goals with a friend, partner or coach and make those strategies become life-long habits. Good health to you!

Craig Burton (BSc, NASM, CISSN) is a practicing Clinical and Sports Nutritionist with over 20 years’ experience as a health practitioner. He holds an array of qualifications in nutrition, as well as in health, fitness, mental and lifestyle coaching. To find out more about Craig or contact him go to www.craigburtoncoaching.com

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THERE’S the temptation to think that — despite the masks and face shields — things are heading back to normal. Restaurants have now been given the go-signal for 24 hour operation, barbershops and salons are allowed to increase the number of customers that can step inside, and buses are back to plying EDSA (though commuters are reportedly struggling with the tap cards).

Butwe should always be reminded that there’s still a dangerous virus lurking in the air.

Multiple studies have shown that people with the most risk from COVID-19 are the people with so-called “comorbidities” — hypertension, diabetes, and the like.

These comorbidities are often lumped together under the term “lifestyle diseases.”

“Lifestyle diseases such as diabetes, obesity and heart disease are closely linked with the way people live their life,” said Dr. Michael Villa to SPIN Life. Villa is a member of the Philippine Society of Endocrinology and Metabolism.

He continued: “These noncommunicable diseases are associated with smoking, too much alcohol, lack of physical exercises, and too many calories or unhealthy eating habits.”

It’s the c-word that’s important here. (And no, we’re not talking about calories, though we’ll get to that a little later.) The SARS-CoV-2 virus is communicable; diabetes is not. We don’t catch the latter from other people — we only do it to ourselves.

And when it’s paired with something like COVID-19, well. Let’s just put it this way. A review of over 33 studies published late July found that comorbidities were present in 74.37 percent of fatal COVID-19 cases. Almost a quarter (24.89 percent) of these fatal cases also had diabetes.

But with or without COVID-19, “diabetes can become a serious medical condition if not properly addressed,” continued Villa. “If you have diabetes, you need to manage your blood sugars and regularly monitor blood sugar to stay within their target range.”

For those suffering from diabetes, you’ll need to keep your eye on the data. As you eat, the level of your glucose — or blood sugar — changes, and you need to know how and why these changes happen. Self-management of this disease can be aided by tools like flash glucose monitoring (sometimes called a patch glucose meter).

“[These] can help track fluctuations in the daily glucose levels of people with diabetes,” Villa said.

In addition, these diagnostic tools will also give real-time information to your doctor so they can cook up a better care plan.

But even so, nothing beats a lifestyle disease than some lifestyle changes. It bears repeating, but Villa also dished out some common sense advice for managing your blood sugar — and keeping yourself even better protected from COVID-19.

Eat the right amount of calories and cut too much refined sugars from your diet. “Eating foods high in refined carbs and sugar increases blood sugar and insulin levels which may lead to diabetes over time.”

Work out regularly. “Performing physical activity on a regular basis has shown to slow or help prevent heart disease, stroke, high blood pressure, high cholesterol, type 2 diabetes, arthritis, osteoporosis (bone loss), and loss of muscle mass.”

Keep hydrated with water. “Drinking water instead of other beverages may help control blood sugar and insulin levels.”

Lose weight. “Even a small amount (about 5 percent) of weight loss can give you health benefits.”

Quit smoking. “Smoking can accelerate the development of diabetic complication and make it worse.”

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Today’s 10 big news of corona – lockdown, virus PM Modi breaking news dls news 4 october news Today’s 10 big news of corona – lockdown, virus PM Modi breaking news dls news 4 october news 4 october 2020 today breaking news dls news corona news . 10/4/2020 DLS News Today Breaking News | DLS News aaj ki taja khabar 1. NCB deputy director KPS Malhotra who questioned Deepika Padukone in drugs case tests Covid-19 positive – NCB officer Corona positive who questioned Deepika Padukone in drugs case 2. Officer KPS Malhotra interrogating Deepika, Sara and Shraddha gets corona infection | Deepika, Sara and Shraddha are interrogated by the officer being coronated. Hindi News, Country 3. Coronavirus Outbreak India Cases LIVE Updates; Maharashtra Pune Madhya Pradesh Indore Rajasthan Uttar Pradesh Punjab Bihar Novel Corona (COVID 19) Death Toll India Today 04 October Mumbai Delhi Coronavirus News | In 7 states including Punjab, Maharashtra and Gujarat, the death rate is around 2-3%, higher than the national rate, in 14 states it is less than 1%; 65.47 lakh cases so far – Dainik Bhaskar 4. Coronavirus: More Than 70 Million People Tested in the Country So Far, Falling Infection Rate | Corona virus: More than 70 million people have been tested in the country so far, the rate of falling infection is 5. Coronavirus Novel Corona Covid 19 3 oct | Coronavirus Novel Corona Covid 19 News World Cases Novel Corona Covid 19 | The next 48 hours are crucial to improving Corona positive Trump’s health; 3.49 crore cases in the world so far – Dainik Bhaskar 6. Mamta Banerjee admitted, Corona reached the level of community transmission in Bengal – West Bengal Chief Minister Mamata Banerjee admits corona reached stage of community transmission durga puja – AajTak 7. mamata-banerjee- sixteen_nine.jpg (1200 × 675) 8. Coronavirus: Corona Figures in Country Exceed 65 Lakhs | Corona virus: 75,829 new cases reported in 24 hours in the country, corona infects exceed 65 lakhs 9. COVID-19 Analytics Center, COVID-19 Data Center: Interactive coronavirus tracker (corona virus tracker) of cases in India and the world | Kovid-19 Analytics Center 10. Corona Infected Nepals Prime Minister KP Oli, Prime Ministers Residence Sanitized | Corona infected Nepal’s Prime Minister KP Oli, Prime Minister’s residence sanitized 11. 5 tips for older person know how to stop ageing in older person in coronavirus pandemic | The elderly are most at risk of infection from corona, by making these 5 changes in diet, the effect of increasing age can be reduced and can avoid major diseases – Dainik Bhaskar.

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Individuals with pre-existing conditions, such as type 2 diabetes, have a demonstrated higher risk for developing more severe cases of coronavirus disease 2019 (COVID-19) infection, leading to higher morbidity and mortality. A new study sheds light on improving outcomes for patients with type 2 diabetes who are infected with the virus, suggesting that a focus on blood glucose (BG) control may be key. 

For the study, which was published in Cell Metabolism, investigators performed a retrospective, multi-centered analysis of 7337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing type 2 diabetes.

The results showed that patients with type 2 diabetes required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than those without diabetes. Patients with diabetes registered a higher need for antibiotics, antifungal drugs, systemic corticosteroids, immunoglobin, anti-hypertensive drugs, and even vasoactive drugs, according to the data. Oxygen inhalation, noninvasive ventilation, and invasive ventilation was also more common in those with type 2 diabetes compared with those without.

However, the study showed that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared with individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization.

Patients from the well-controlled BR group also received less medical interventions, such as supplemental oxygen and/or ventilation, and had significantly lower incidences of lymphopenia, lower rates of increase counts of leukocyte and neutrophil, and elevated serum CRP and procalcitonin.

“We were surprised to see such favorable outcomes in well-controlled blood glucose group among patients with COVID-19 and pre-existing type 2 diabetes,” senior author Hongliang Li of Renmin Hospital of Wuhan University, said in a press release. “Considering that people with diabetes had much higher risk for death and various complications, and there are no specific drugs for COVID-19, our findings indicate that controlling blood glucose well may act as an effective auxiliary approach to improve the prognosis of patients with COVID-19 and pre-existing diabetes.”

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La Jolla, California (January 18, 2020). A new study published in the Journal of Clinical Investigation enrolled people with HIV who also happened to have a terminal illness to study where HIV hides in the human body so doctors can better treat and maybe even cure HIV.

Selfless Terminally Ill Persons Join Doctors To Study HIV

Despite understanding that HIV exists throughout the human body, researchers working toward a cure of HIV do not understand how HIV populates deep tissues. “Unfortunately, we simply cannot know the answer until a person is deceased and subject to an autopsy. Delays between death and when tissues are collected means the virus degrades, obscuring where HIV really hides,” said Davey Smith, MD, the senior author and Chief of Infectious Diseases and Global Public Health at UC San Diego.

To fill this gap, the team turned to terminally ill persons who happened to have HIV, and with their consent, the team serially collected blood while the person was alive, and then performed a rapid autopsy at the time of their death. “This donation at the end of one’s life is the first of its kind in HIV research, and allowed us to discover all the places HIV hides, even during treatment where the virus is difficult to detect in standard blood tests.”

Terminally ill volunteers were eager to support this groundbreaking work. “Our participants have HIV but are dying of something else, like cancer. They are going through a lot, but they still want to leave a larger legacy behind and help find a cure for HIV,” said Sara Gianella, MD, assistant professor at UC San Diego Health and study coauthor. Study participants were either self-referred from hearing about the study or referred from their primary HIV providers. “Only one potential volunteer decided ultimately not to participate,” added Dr. Gianella.”It is an amazing gift from both the participants and their families.”

Where does HIV hide?

Study investigators found HIV in every one of the 30 organ sites they studied, even when the deceased participant was taking modern HIV therapy . When the virus was sequenced, some of the virus had genetic defects, which meant that it was nonfunctional or likely ‘dead’, but most of the virus seemed to be intact and able to grow.

“As expected, most of the HIV was in the blood, gut and lymph nodes,” said Antoine Chaillon, MD, PhD, assistant professor in the Division of Infectious Diseases and Global Public Health at UC San Diego and the study’s lead author. “But, intact HIV was also found in the brain, liver, spleen, kidney, basically everywhere.”

It seems that having HIV in all these tissues can cause problems, even when someone is taking HIV therapy, and active HIV growth is ‘undetectable’ in blood. Being ‘undetectable’ in blood means that a person’s HIV therapy has basically stopped the growth of HIV in the blood. Although antiretroviral therapy can keep HIV from replicating, it does not stop all of the problems associated with HIV. Persons with HIV have more inflammation-related diseases, like heart attacks, stroke and cancer, than people who do not have HIV. “We do not fully know why,” Dr. Gianella said. “We think that when HIV tries to regrow in each of these tissues where it was lying dormant, it can cause an inflammatory response. Even though the antiretroviral therapy keeps it from fully replicating, it still causes local damage.”

“Yes,” Dr. Smith added. “For example, half of persons with HIV have neurocognitive impairment even when taking the very best HIV therapy. How HIV causes local inflammation in the brain, even during therapy, may explain this.”

“Further improving the health of people with HIV likely means we need to figure out how to clear HIV from its hiding places,” Dr. Chaillon said. “This means new therapies.”

How HIV moves in the body?

Two of the study’s participants had stopped taking their HIV therapy, leading to even more new insights. “Sometimes when people have a terminal illness they don’t want to keep taking their medicines anymore,” Dr. Gianella explained. “This gave us a unique opportunity to study how the virus replicated and moved in the body while the virus was untreated. We collected the participant’s blood before and after stopping their therapy, while they were alive, and then we collected all the tissues after they died. Since HIV evolves quickly within a person, we were able to identify the same viruses that restarted replicating in the blood after the person stopped their therapy in all their tissues after death.”

“We expected the replicating virus to seed blood cells and cells in the gut and lymph nodes,” added Dr. Chaillon, “but we were surprised at how quickly the virus was everywhere!” The team used new analytical methods, to find that the virus moved between tissues in the body. Cells in the blood and the gut seemed to be the source of most HIV in the rest of the body, and most HIV was trafficked through the body by the blood.

What does this mean for curing HIV?

Developing a way to keep HIV from replicating when therapy is stopped, often called ‘therapy free remission’, is a major goal for HIV researchers. Two people seem to have achieved this goal through treatments with special bone marrow transplants. “But even in these patients they still have intact virus throughout their body, even if it cannot get to the bloodstream,” said Dr. Smith. “Our study found that HIV was mainly trafficked through the body in the blood. This might explain why we saw therapy-free remission in the two persons with bone marrow transplants,” Dr. Smith explained. “After the transplants, their blood cells were protected and could no longer carry HIV. They still have intact virus throughout their body, but it can’t get to the bloodstream to start replicating.”

“But, HIV in these tissues still likely cause local inflammation and damage,” Dr. Chaillon added. “We need new ways to clear those places and extensions of our work can some day answer how.”

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As of last year, an estimated 1.4 million Ugandans were living with HIV/Aids while another 23,000 died of HIV/Aids-related illnesses. As of 2018, Unaids estimated HIV/Aids prevalence among adults aged 15 to 49 at 5.7 per cent.

The judiciary isn’t spared in all this and in an effort, ostensibly, to mitigate effects of the pandemic in the sector, it set up a committee to sensitize and create awareness. But as DERRICK KIYONGA writes, power struggles in the institution are putting the fight against HIV/Aids at risk. 

In July 2019, a six-man judicial committee on HIV/Aids assembled at the High court in Jinja to evaluate its effort so far to create awareness on the scourge.

Chaired by the then Judiciary’s undersecretary Aggrey Wunyi, the committee comprised of the then inspector of courts Immaculate Busingye, who was appointed a judge recently. Others were the registrar in charge of planning Fred Waninda, principal human resource officer Apophia Tumwine Namutamba as well as communications officer Rehemah Nasuuna. 

The committee was in line with the Public Service Orders and President Museveni’s project dubbed ‘Presidential Fast-Track Initiative on Ending Aids in Uganda by 2030.’

It is also important to note that the president instructed all ministries to set aside 2.5 percent of their budgets to fighting HIV/Aids. So, the committee had an estimated annual budget of about Shs 250m.

In Jinja, they were armed with questionnaires and the intention was get reaction on how the committee can improve the services, going forward. “What would you love to know about HIV/Aids?” went one question; “What would you want us to improve?” went another question.

Unknown to this committee, Jinja would be their Waterloo. As the committee was going about its duties, things were falling apart; Expedito Kagole Kivumbi, the then secretary to the Judiciary, who was the brains behind the committee, was facing off with the Public Accounts Committee over illegal expenditure of Shs 34 billion in the financial year 2017/18.

Events unraveled quickly and on July 26, 2019, President Museveni sent Kivumbi on forced leave before replacing him with Pius Bigirimana.

From then onwards, The Observer understands that this critical committee has never done any more activities as they had envisioned due to lack of funds. When prodded about the fate of the committee, various officers of the judiciary either give contradictory responses or they simply have no ready answer.

Solomon Muyita, the judiciary’s senior communication officer, said such activities now fall under the institution’s human resource office. “I need to check the work plans of that office in order to ascertain if they have activities in respect to HIV/Aids,” Muyita said.    

Namutamba,  who also doubles as the acting commissioner, Human Resource, offered that the judiciary now holds a health camp at the judiciary’s headquarters at the Criminal division of the High court.

“People were told about non-communicable diseases.  HIV/Aids counseling was done. And also other diseases such as hypertension were treated,” she offered.

Though this health camp indeed happened in the middle of last year, judiciary staff interviewed for this story dismissed the effort as a one-off that can’t replace the works of the HIV/AIDS committee work – which emanates from a presidential order.    

“The HIV/Aids committee traversed the whole country,” a judiciary staffer explained, “You can’t say that it was replaced by a one-off event  …” the female staffer said.        

Meanwhile, a judiciary technocrat who sought anonymity since he isn’t authorized to speak to the media told The Observer: “Every regime comes with its own agenda and that committee and its work were not in the agenda of the current one.”

The source adds that the committee members were seen as Kivumbi’s favorites and thus a new regime couldn’t trust them. “It happens all the time.  When you look at that committee critically, all members were close to the previous permanent secretary [Kivumbi]. It was easy for the new regime to deal away with them,” the source said.

When contacted, Kivumbi declined to comment on the issue, saying that he was on leave and he prefers the current administration to execute its agenda. “I’m still in my leave,” he said, “You will have to seek an explanation from the people in charge now.”    

What next?

It remains to be seen whether the committee will be revived. Before its disbandment, it had traversed virtually the whole of Uganda since the judiciary essentially touches every part of the country through magistrate courts. Workshops were organized as far as Karamoja sub-region, West Nile, Kasese and Kabale, among others 

According to records that were seen by The Observer, the committee tapped into the knowhow of Dr Stephen Watiti, a doctor and counselor living with HIV/Aids, Tom Etii, a facilitator from Uganda Aids Commission, and Moses Nsubuga who is popularly known as Supercharger, an entertainer and motivational speaker living positively with HIV/Aids.

Watiti and Superchargers’ testimonies about living a productive life with HIV/Aids have moved millions and the committee felt that the same trick would work with the conservative judiciary staff – and seems it worked.     

“We were not coercing anybody to come out. We talked to staff and support staff about the advantages of coming out and many came out,” one of the members of the committee said, adding that each month staff who had come out as HIV/Aids positive would be given Shs 150,000. 

The key catchword for this committee was creating awareness because it seemed there was lack of knowledge among the staff. “We had to fight stigma,” one of the female members of the committee said, “Those who come out shouldn’t be stigmatized at work. They shouldn’t be laughed at it.”

That was not all the committee was offering at these workshops- testing and counseling, for HIV/Aids, testing for hypertension, hepatitis B and also treatment of tuberculosis.

“We had a lot to offer even in terms of food. Those who came out as HIV-positive were given nutritious food. I believe we were making a positive contribution,” a committee member opined. 

As the committee was doing its work of financing of HIV/Aids activities according to documents seen by The Observer, the amounts allocated varied depending on the moods of the judiciary’s finance committee – in total denunciation of the  presidential order. Over the years the figures have oscillated from Shs 60 million, 45 million to 25 million, depending on who seats on the sought-after finance committee.   

HIV/AIDS POLICY

Another issue under sharp contestation is a document called: ‘The judiciary’s policy on HIV/Aids. Before it was disbanded, the committee had come up with an HIV/Aids policy, records obtained by this paper indicate.  In a nutshell, the policy was hinged on issues such as non-discrimination, confidentiality, HIV testing at the workplace and promotion of prevention, support and care, among others.

Essentially, it spelt out how staff living HIV/Aids shouldn’t be sent to work in hard to reach areas, how they have a right to get sick leave with pay without any conditions or threats and the policy also institutionalized the HIV/Aids committee.

Those who drafted the policy insist that during their time in office it was validated by the Judiciary’s top honchos and all that remained was for it to be launched. Namutamba, who seems now to be in charge, when asked about the policy, had different narrative, “The policy isn’t ready,” she said, “There are a number of changes that have been made.

And we are still looking at it before it is launched.  I can’t give you a document which isn’t ready.”   

In its strategic plan that will be revisited this year, the judiciary had laid out plans of addressing HIV/Aids issues in the delivery of justice but as we speak now the committee that is supposed to do that work is grounded and future looks no so rosy.

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Cure for HIV/AIDS is under research for so many years and in meanwhile antiretroviral therapy (ART) treatments are discovered which could suppress the virus to a very low level and let infected people live a prolonged life. However, it has been more than two decades since the year 1996 when ART meds were developed and we still don’t have any permanent cure for HIV and AIDS.

While the modern drugs have been able to limit the virus growth and suppress it to a very low level, some of the dormant virus can sleep for years in cells and can come out and re-infect the patient and cause damage. It is why we need a permanent cure that can kill the virus for once and all, curing the HIV-AIDS disease permanently.

Cure for HIV by Smoking Out the Virus

Antiretroviral and the other modern drugs are only temporary solutions and we need to create an actual cure that would remove the viruses from our body completely. It is because the infected people after entering middle age show side effects including inflammation caused by the tiny amounts of HIV present in the blood, which is why doctors are looking for a viable cure.

Norwegian University of Science and Technology’s (NTNU) Center of Molecular Inflammation Research (CEMIR) had found a new way to flush out the HIV virus. The method involves activating the virus so that it can start to replicate, hence making it visible to the immune system and thereby providing a way to kill it for permanent.

Research for Curing HIV holds Promise

Hany Zakaria Meås, a postdoc at CEMIR said, “It is the current idea for a cure. We are planning to activate the cells which are hiding away so that we can kill them by giving medicine that protects cells from infection. There will be more virus produced making it easier to spot them and kill them at the source.”

Although the initial research didn’t succeed in the trials, there is still promise to the cure. The scientists and researchers are working on other methods and new mechanisms to reverse HIV latency and cure the epidemic.

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A single dose of an antibody-based treatment can prevent human immunodeficiency virus (HIV) transmission from mother to baby, according to new nonhuman primate research. The findings (“Single-dose bNAb cocktail or abbreviated ART post-exposure regimens achieve tight SHIV control without adaptive immunity”) were recently published in Nature Communications. When that single dose is given is key, however. The study found rhesus macaque newborns did not develop the monkey form of HIV, called SHIV, when they received a combination of two antibodies 30 hours after being exposed to the virus.

Delaying treatment until 48 hours, on the other hand, resulted in half of the baby macaques developing SHIV when they were given four smaller doses of the same antibody cocktail. In comparison, the study found macaques that received the current standard HIV treatment—antiretroviral drugs—remained SHIV-free when they started a three-week regimen of that therapy 48 hours after exposure.

Vertical transmission accounts for most HIV infection in children, and treatments for newborns are needed to abrogate infection or limit disease progression. “We showed previously that short-term broadly neutralizing antibody (bNAb) therapy given 24 h after oral exposure cleared simian-human immunodeficiency virus (SHIV) in a macaque model of perinatal infection. Here, we report that all infants given either a single dose of bNAbs at 30 h, or a 21-day triple-drug ART regimen at 48 h, are aviremic with almost no virus in tissues. In contrast, bNAb treatment beginning at 48 h leads to tight control without adaptive immune responses in half of the animals. We conclude that both bNAbs and ART mediate effective post-exposure prophylaxis in infant macaques within 30–48 h of oral SHIV exposure. Our findings suggest that optimizing the treatment regimen may extend the window of opportunity for preventing perinatal HIV infection when treatment is delayed,” the investigators wrote.

“These promising findings could mean babies born to HIV-positive mothers can still beat HIV with less treatment,” said the study’s corresponding’s author, Nancy Haigwood, PhD, a professor of pathobiology and immunology in the Oregon Health & Science University (OHSU) School of Medicine, as well as the director at the Oregon National Primate Research Center at OHSU.

This is the first time a single dose of broadly neutralizing antibodies given after viral exposure has been found to prevent SHIV infection in nonhuman primate newborns, noted the scientists. Previous research by Haigwood, Ann Hessell, PhD, a research associate professor at OHSU, and others showed four doses of antibodies started 24 hours after exposure prevented SHIV infection, with all 10 of the baby primates in that study not having any SHIV virus for six months. Both studies used a combination of two antibodies called PGT121 and VRC07-523.

The new study also suggests a much shorter course of antiretroviral therapy given after virus exposure could prevent HIV transmission to newborns. Human babies born from HIV-positive mothers typically take the drug cocktail—a personalized regimen of multiple drugs taken daily—for about six weeks before being re-tested. If the tests are then positive, they likely need to take HIV drugs for the rest of their lives. But this study showed nonhuman primate newborns didn’t have SHIV after undergoing antiretroviral therapy for just three weeks starting 48 hours after exposure.

HIV-positive women typically take antiretroviral therapy drugs during pregnancy for their own health, as well as to prevent passing the virus onto their developing child. But mother-to-baby transmission sometimes still happens. Children born to HIV-positive mothers also are given antiretroviral therapy to further prevent infection. However, this drug cocktail can have many negative side effects, involves making special liquid formulations for newborns, and researchers worry about antiretroviral therapy’s long-term consequences for development.

Antibodies, however, generally aren’t toxic and can be modified to last a long time in the body, which reduces treatment frequency. This has led researchers to explore their potential to replace or supplement antiretroviral therapy for newborns with HIV-positive mothers as well as for HIV-positive adults.

Next, Haigwood and colleagues plan to see if different antibodies, or a combination of antibodies and antiretroviral therapy, could be even more effective. They also want to determine if the antibodies they evaluate actually eliminate HIV, or only prevent it from replicating. The research team has regularly shared their primate research findings with the scientific community, including those involved in the International Maternal Pediatric Adolescent AIDS Clinical Trials Network, which is currently leading two trials evaluating a single antibody to treat HIV-exposed newborns.

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A discovery by Florida State University College of Medicine researchers is expected to open the door for new and more potent treatment options for many of the more than 36 million people worldwide infected with the HIV virus and for others chronically ill with hepatitis B.

Their work has established for the first time the mechanism responsible for how two widely used antiviral drugs inhibit viruses.

In a paper published by Communications Biology, an open-access journal from Nature Research, Professor Zucai Suo and colleagues also provide the key to understanding how a single HIV-1 mutation can inactivate the anti-HIV drugs emtricitabine and lamivudine. Those drugs are worth billions in annual sales for the companies that make them, and the frequency of patients who develop resistance creates serious and dangerous obstacles to controlling the disease.

Emtricitabine also is approved for use in patients with hepatitis B, which afflicts 270 million people worldwide, according to the World Health Organization.

The paper suggests new pathways for developing drugs able to avoid specific virus mutations that can render these two blockbuster L-nucleoside drug treatments ineffective for many patients.

It’s not unusual for patients undergoing treatment to develop a resistance to their prescribed anti-HIV medications, leaving physicians with three options: adjust the treatment regimen, temporarily interrupt therapy or continue with an only partially effective regimen.

For patients who have failed their first treatment regimen, or even a second, doctors typically try to salvage the current course of treatment by adjusting the combination of drugs. But for patients who have failed multiple treatment regimens, there are limited options to suppress the incurable virus.

The number of drug choices available when one combination fails is limited. More than a million of those infected with HIV live in the U.S.

“In our paper, we suggest new chemical possibilities for more potent L-nucleoside analog drugs, which may possess different drug-resistance mutation profiles from the most widely used current anti-HIV drugs,” said Suo, the study’s co-lead author, and an Eminent Professor and the Dorian and John Blackmon Chair in Biomedical Science at the FSU College of Medicine. Eric Lansdon of Gilead Sciences Inc. is the co-lead author.

“Right now, there are a limited number of FDA-approved drugs available,” Suo said. “New drugs need to be developed if doctors are to have other options when treating so many patients who may have developed resistance to most of the FDA-approved anti-HIV drugs.”

The drugs remain highly effective in keeping the disease under control for most patients, but some patients develop a resistance due to mutations within the HIV virus.

Suo’s paper explains how the class of HIV drugs known as L-nucleoside reverse transcriptase inhibitors (L-NRTIs) work. L-NRTIs block an enzyme that HIV needs to replicate, but they were discovered through blind trials. Important details about the underlying mechanism triggering L-NRTIs have remained a mystery, as well as a source of controversy among the scientists who study them.

“The enzyme has a unique pocket and supposedly recognizes NRTIs, but not their structural mirror images—L-NRTIs,” said Suo, who grew curious about the mechanism behind L-NRTI drugs as a graduate student. He’s been motivated since then to understand and explain the mechanism involved, which he does in his paper—one of six he has published involving L-NRTI research.

Suo’s current paper also explains how a mutation found in some patient populations leads to developing resistance to antiviral L-NRTI drugs.

“Patients, HIV scientists and medical doctors all will benefit from this,” Suo said. “HIV scientists and drug companies will now know how it works and will be able to design better drugs in the same class of medications. They will be able to build on the mechanism described in this paper to make slight adjustments for better and more powerful treatment options.”

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Bisnis.com, GUNUNGKIDUL –  The Gunungkidul District Health Office recorded that as of November 2019 there were 64 new cases of people infected with HIV / AIDS in Gunungkidul. Compared to 2018, the number of cases in 2019 has increased.

“For December 2019 there were several people affected, but not included in the accumulation. Overall, the number of cases increased compared to 2018,” said the head of the Gunungkidul Health Office, Dewi Irawaty, when met by Jogja Daily , Tuesday (1/7/2020).

If accumulated from 2006 to November 2019, there are 663 cases that are still being monitored and given care by the health team. The number is divided from the positive people infected with the HIV virus as many as 399 people, while positively infected by AIDS as many as 264 people in which there are 13 affected children.

Dewi said that HIV / AIDS can be contagious, but its transmission is not as easy as other communicable diseases. According to him, transmission of HIV / AIDS is only through four fluids namely blood transfusion fluid, vaginal fluid, sperm fluid and breast milk. Outside of this method, germs of HIV / AIDS cannot live and develop. “Out of these four modes of transmission, germs will die,” he said.

According to Dewi, the most important thing for the community is not to discriminate against sufferers. Until 2018, there was still this incident in Gunungkidul. He gave an example that children with HIV were not accepted at one school. According to Dewi, that has violated human rights.

Deputy Chairperson of Commission D of Gunungkidul DPRD, Ari Siswanto, said the need for massive socialization to the public in order to provide a clearer understanding related to HIV / AIDS, ranging from the way it is transmitted to handling it.

Ari explained the most important thing was that the community needed to understand that there were victims and perpetrators of HIV / AIDS. Victims who do not know the cause of transmission need to be protected, not shunned. “Victims such as children must be protected because there is no mistake whatsoever, because they do not know anything, maybe because of the parents, but sometimes people consider the treatment the same as the perpetrators,” he said.

Ari said that the perpetrators also should not be isolated. They must continue to gain understanding so that transmission does not continue. One of them is with spiritual reinforcement.

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KUALA LUMPUR: THE human immunodeficiency virus (HIV), which can cause Acquired Immune Deficiency Syndrome (AIDS), was first detected in Malaysia in 1986.

More than 33 years on, the country is ranked the seventh highest in adult prevalence of HIV/AIDS in Asia after Thailand, Papua New Guinea, Myanmar, Cambodia, Vietnam and Indonesia, with a 0.45 per cent prevalence rate.

Data from the Health Ministry showed that every day, an average of nine new HIV cases and two AIDS-related deaths were reported to the health authorities.

According to the United Nations, Malaysia is one of 10 countries that together account for more than 95 per cent of new HIV infections in the Asia-Pacific region.

In an interview with the New Straits Times, PT Foundation chief operating officer Raymond Tai made an observation on the World Health Organisation’s theme for World AIDS Day, “Communities Make the Difference”.

“HIV is preventable and treatable. It isn’t a death sentence. It’s social stigma and ignorance that drives key populations underground, restricting their access to prevention, testing and treatment.”

He said unless there was strong will among the public to normalise conversations about safe sex to break down social stigma and discrimination, Malaysia would not be able bring down the rate of new HIV infections.

He said social stigma drove internalised stigma, which often result in psychological and emotional struggles for those who do not fit into “social norms”.

In Malaysia, social norms dictate that sex only between a man and a woman married to each other is legitimate. Monogamy is held up as the ideal, and outside of it, only abstinence is promoted.

Therefore, anyone who does not conform to these ideals tend to be regarded as morally undesirable. They include single men and women who engage in pre-marital sex, gay and lesbian couples whose relationships are not recognised, as well as transgender people.

Even if teenagers are curious and are aware of the basic use of condoms for HIV/AIDS prevention, it takes courage for people to buy condoms at convenience stores, discuss safe sex with their partner and use the protective barrier properly.

“The challenge to openly buy condoms at supermarkets and ask for advice on proper use of the rubber is compounded if the person is a school dropout, a gay man or a transgender woman,” Tai said.

He said government-funded reproductive health education often leaves out people from such groups.

He said awareness on HIV/AIDS preventive methods and how to gain access to them were not readily available to marginalised groups, who tend to be low-income earners and those with low education.

“It tends to be left to non-governmental organisations (NGOs), like PT Foundation, to reach out to these marginalised groups,” he said, adding that with scant resources, as well as restrictions on access to mainstream media, NGOs could reach out to only small segments of people in cities.

Today, there are more effective means of protection aside from condoms, such as Pre-Exposure Prophylaxis (PrEP), a pill taken daily to prevent the spread of HIV infection.

“PrEP has been proven to be more reliable than condoms in HIV/AIDS prevention. Yet, it is not accessible at government clinics and available at
only selected private clinics at high prices,” Tai said.

He said many people living with AIDS go to considerable lengths to hide their anti-retroviral drugs from family members and colleagues to ensure that their HIV status remained a secret.

“They are driven by fear of the way others will treat them if their HIV status is revealed.”

Established more than 30 years ago, PT Foundation runs sexual health programmes focusing on key affected populations.

Its flagship programmes include the Community Health Care Centre Clinic (CHCC); MSMPOZ, which is a Treatment Adherence and Support Programme for men who have sex with men who are living with HIV; 2nd Chance Programme, which provides psycho-social mentoring and support for urban poor children infected with or affected by HIV; and, Take Charge Today, an online campaign to promote safer sex practices, HIV and sexually transmitted infections testing, as well as access to community-friendly clinics throughout Malaysia.

Tai said CHCC was being managed as a social enterprise, where beneficiaries pay a small fee for sexually-transmitted disease tests and counselling services.

“Some make donations, which enable CHCC to conduct HIV tests for those who cannot afford them.

“Its fees are kept low because selected test kits are sponsored by the Health Ministry, while more expensive fourth generation test kits are offered to CHCC at a discounted price.”

CHCC, based on this business model, is recognised by the Malaysian Global Innovation Centre as a sustainable social enterprise.

Recently, the World Health Organisation declared that AIDS can globally end by 2030 if all nations were able to get at least 90 per cent of those who were at high risk of HIV infection to be tested, and if the results were HIV positive, they were provided access to treatment and they must follow through with their treatment.

Tai said current HIV medication was effective to a point where a HIV positive patient who has been on treatment for more than six months could become “virally undetectable”.

At this stage, he said, the person could no longer infect another person during sex even if a condom was not worn.

In view of such medical advances, the government had reportedly committed to end AIDS by an even earlier date — 2023.

“While we have the (means in terms of) medical advances to end AIDS, the battle in Malaysia is to eliminate stigma and discrimination,” Tai said.

This, he said, involved a shift in how soon Malaysia could move from a conservative and judgemental society to one that embraced diversity, irrespective of one’s race, religion and sexual orientation.

For this to happen, Tai urged the government to lead the way in being more inclusive.

“We need more ‘enabling laws and policies’.

“There has to be more political will in channelling more funding and efforts into HIV/AIDS prevention as a matter of public health and community development.”

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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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New research has shown that focussing on ways to eradicate infected cells may not be necessary for a functional cure for AIDS. In a study focusing on a subset of HIV-positive individuals who can live with the virus without needing treatment, the researchers found that these people’s lymphocytes suppress the virus but do not kill off infected cells.

The study was conducted by researchers at the Karolinska Institutet, Sweden and the University of Pennsylvania, US.

HIV infection typically leads to a loss of CD4+ T cells, a type of white blood cells that together with the CD8+ T cells attack and destroy infections. The fewer CD4+ T cells a person has, the worse the symptoms. But fewer than 1 percent of HIV-positive people have stable CD4+ T cell counts and undetectable HIV viremia and are thus able to live with the virus without therapy. This group, known as elite controllers, has more effective CD8+ T cells than most HIV-positive people.

To find out how the CD8+ T cells of elite controllers keep the HIV virus from replicating and progressing to AIDS, the researchers collected blood samples and lymph node tissue biopsies of 51 HIV-positive individuals, including 12 elite controllers.

Using single-cell RNA sequencing analyses, the researchers found that elite controllers had more HIV-specific CD8+ T cells in their lymphoid tissue than the others but that these were so-called non-cytolytic cells, meaning they didn’t kill off infected cells.

Instead, these CD8+ T cells of elite controllers had a distinct transcriptional profile and were able to suppress HIV replication through an enhanced ribosomal function, meaning they were better at translating proteins from amino acids. This led to the production of more and a greater variety of cytokines (small protein molecules that are important in cell communication) and boosted the cells’ polyfunctionality.

“These findings go against the paradigm of HIV control that focuses on killing off infected cells to find a cure,” says Marcus Buggert, Assistant Professor at the Department of Medicine, Huddinge, at Karolinska Institutet. “While these strategies may still work, our research supports a model in which viral suppression rather than viral eradication can, in fact, serve as a functional cure.”

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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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