The Microbicide Trials Network (MTN) have announced that Tenofovir gel will no longer be used in the current VOICE trial (Vaginal and Oral Interventions to Control the Epidemic) shortly after the same decision was made about the oral version. Both arms of the trial have been stopped for the same reason; neither are any more effective than a placebo. Trials of Truvada, a combination of tenofovir and emtricitabine, will continue for the moment.Incidence, the rate of new infections, was extremely high, at 6%. I wonder if the trial has got any closer to figuring out just why HIVTransmission is so high among study participants? For instance, were sexual partners tested and were their HIV types matched? Were possible non-sexual HIV exposures investigated, for example, through unsafe healthcare, traditional healthcare, cosmetic practices, or any others?All the talk about 'fast-tracking' approval of tenofovir by the US Food and Drugs Advisory for possible production by 2014 that we heard so much of just a year ago has been replaced by the kind of silence we've come to expect from results that can't even be dressed up to look a little bit positive. With viable gels and PrEP pills so far in the future, it might be a good idea to put into effect some low technology (though far less lucrative) HIV prevention programs.The full results of VOICE are unlikely to be available for some time, perhaps another year or two. But if good data is collected on non-sexual transmission, the thousands of participants will not have wasted their time completely. It won't be much consolation for the hundreds of people whose infections were not prevented, nor the hundreds of thousands of new infections that will occur elsewhere in the meantime, but everyone will benefit if a little less attention is paid to their sex lives, which may not be as relevant as orthodox HIV theory suggests.Mitchell Warren, the Executive Director of the AIDS Vaccine Advocacy Coalition (AVAC, a front group for the HIV pharmaceutical industry), has expressed disappointment. One researcher is reported to have said "the failure of one method in one trial did not mean that the trial, or the idea of microbicides, had failed." Which is quite true. The failure could be for entirely different reasons, incorrect and unwarrented assumptions about the relative contribution of sexual transmission in serious epidemics being just one.Pre-exposure prophylaxis (PrEP) involves putting HIV negative people on antiretroviral drugs (ARV) with the aim of protecting them from Hiv Infection. read more..
Saturday, 3 March 2012
Hiv Prevention Programs-Sexual Transmission-Hiv Transmission-Hiv Infection
Wednesday, 29 February 2012
Pharmaceutical Industry-African Countries-Hiv Infection-Avac-HIV
Pharmaceutical industry front group AVAC is blowing the usual trumpet for PrEP because some recent trial results have been encouraging. They said predictably little about results which were not so encouraging.The problem with PrEP still remains: no high prevalence country has managed to put all HIV positive people on antiretrovirals, not even all those who are at the stage of disease progression where it is a serious threat to their health. Why does anyone think they can roll out a drug for people who are not infected with HIV on the grounds that it might give them 'up to' 73% protection?If 20% of sexually active people are infected with HIV and most of the other 80% are considered to be at risk of infection, will they all be given PrEP? Think of the cost, the logistics, the high levels of resistance, the side effects, things instititutions like AVAC and UNAIDS don't seem to be willing to discuss sensibly.It also seems like a humiliating climbdown for UNAIDS and all the others who maintained that HIV is almost always spread through unsafe heterosexual sex in African countries (though hardly ever in non-African countries, however unintuitive that may sound). Are all 'risk reduction' strategies now to cease?Will we instead just give out drugs and ignore the things we appeared to deplore for the last thirty years, promiscuous men, survival sex, commercial sex work, exploitation, early and unplanned pregnancies, early marriage, concurrent relationships, large numbers of partners, low use of condoms, lack of family planning and whatever other issues we have spent so long bemoaning?Warren Mitchell from AVAC remembered to thank the trial volunteers, presumably mostly guinea pigs who, if they are African, will never be able to afford the drugs and for whom the money to pay for them may never be raised. I don't suppose he was being ironic, either.Another move which looks suspiciously like a way to vastly increase the volume of ARV drug sales, and thereby increase dependency on drugs and funding, is a strategy called test and treat (or various other names). This involves testing the whole population of a country regularly, perhaps every year, and putting everyone found positive on treatment.Testing even a reasonable percentage of people in a population once has remained elusive, let alone the whole population or the whole population every year. But even testing once a year is not thought to be enough, so test and treat is still just a theory. And it is well known that early treatment carries a lot of risks that have not yet been adequately explored.It is to be wondered if people will be obliged to take the drugs by law or if they will face stigma if they refuse. UNAIDS has many years of experience in the use of stigma as a weapon with which to threaten people and punish them for being African so perhaps they have some plans in this area. No disease has ever been beaten by drugs alone so it seems hard to believe that HIV will be the first. But it is great news for the pharmaceutical industry.[For more about PrEP and HIV issues in Africa, see my other blog, HIV in Kenya.]Pre-exposure prophylaxis (PrEP) involves putting HIV negative people on antiretroviral drugs (ARV) with the aim of protecting them from Hiv Infection. read more..
Friday, 24 February 2012
Dar Es Salaam-Hiv Infection
[Citizen] Dar es Salaam - Tina Pius, 31, realised that she had an Hiv Infection when she was pregnant with her second child, three years ago.When receiving the results from a counselor at a voluntary counseling and testing centre (VCT), her first thought was whether that was a death sentence to both of them. But she would despair easily and declared: "Neither me nor my child will die." read more..
Thursday, 23 February 2012
World Health Organization-Treatment Of Hiv-Hiv Prevention-HIV Infections-Effectiveness
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Pre-exposure prophylaxis (PrEP) is an experimental method of HIV prevention. It involves a doctor prescribing antiretroviral HIV/AIDS drugs to a healthy person in order to prevent that person from possibly getting infected with HIV. So far, clinical trials have failed to prove PrEP’s effectiveness… (Click below to read more.)The 2007 iPrEX study found that PrEP reduced the risk of HIV infection among men who have sex with men (MSM) by only 44%. A part of the 2009 Vaginal and Oral Interventions to Control the Epidemic (VOICE) study was discontinued two years later because tenofovir (branded as Viread by Gilead Sciences) tablets were no better than a placebo in protecting HIV-negative women from HIV. Researchers stopped another trial in 2011, called Fem-PrEP, after they concluded that Truvada (Gilead’s combination tablet of tenofovir DF and emtricitabine) was unlikely to prevent HIV infection in women. Partners PrEP, a study of sero-discordant couples in Africa, showed an efficacy rate of 62%-73%. However it is imprudent to extrapolate the overall effectiveness of PrEP based of this study since the researchers reported an adherence rate of 95% among the study participants — a figure that would likely be much lower under non-clinical trial conditions and as a result, would likely lead to a lower overall efficacy rate.Questionable clinical efficacy aside, a surge in the interest around PrEP is puzzling given that 14.6 million HIV positive people around the world in need of ART right now are not receiving it. Expanding the permitted use of a lifesaving antiretroviral therapy—which is currently unavailable to those 14.6 million individuals still in need of treatment—as a sanctioned form of HIV prevention for use by uninfected individuals presents both a practical and moral dilemma for both Gilead and society at large.In the United States, the Centers for Disease Control and the Federal Drug Administration (FDA) have expressed interest in establishing guidelines for the use of PrEP. Under the current regulations, a medical provider is allowed to prescribe ART to a HIV negative person. This is called ‘off-label use’ – use of an HIV/AIDS medication for purposes other than treatment of HIV— effectively constitutes PrEP. However, as long as PrEP is not officially sanctioned by the FDA, drug companies cannot market ARTs as a preventative measure to the public. If PrEP is eventually approved by the FDA, pharmaceutical companies stand to make a lot of money catering to a new market in the developed world instead of providing cheaper—and much needed—drugs in the developing world.Internationally, PrEP has also received attention from the EU, the World Health Organization and various civil society organizations and advocates in the global health arena. The fact that PrEP is being considered as an evidence-based HIV prevention approach is incomprehensible at a time when the world cannot treat all people with HIV who are already ill.With the continued assault on generic drug manufacturers by Big Pharma and a stagnating commitment by the rich countries to contribute more money to the global AIDS fight, PrEP looks more like a pharmaceutical cash cow in the making, than a viable or prudent public health initiative. In the United States, one year of ART can cost upwards of $10,000 USD. Currently, there are waiting lists in the US for HIV-positive low-income people in need of treatment. In Eastern Europe, Central Asia and Africa ART coverage remains unacceptably low and far behind the Universal Access target of 80% for all who need it. Is it possible to justify giving PrEP to healthy people while the sick and dying are waiting for treatment?The legitimization of PrEP is detrimental because it could lead to a false sense of security among people who are currently using condoms to protect themselves. To achieve even a modest level of protection, PrEP requires strict adherence to a daily ART regime read more..
Wednesday, 22 February 2012
HIV Infections-Hiv Prevention-Hiv Prevalence-Hiv Infection
Why do so manyHIV-positive children in Africa have HIV-negative mothers?Forexample, approximately 30% of HIV-positive kids aged 0-11 years haveHIV-negative mothers in Mozambique (see pp. 177-181 in:http://www.measuredhs.com/pubs/pdf/AIS8/AIS8.pdf).Why are so manyvirgin men and women found with HIV? In the Republic of Congo,for example, virgin women aged 15-49 years have higher HIV prevalencethan all women, 4.2% vs 4.1% (see p. 101 in:http://www.measuredhs.com/pubs/pdf/AIS7/AIS7.pdf).The personal storiesbehind these statistics are hard to fit with the common view thatalmost all infections are from sex. Why has there been so littleattention and response to Africans with unexplained infections?THE PURPOSE OFTHIS NOTE IS TO INITIATE DEBATE ABOUT WHETHER TO CONTINUE TO IGNORENON-SEXUAL HIV Infections IN AFRICA. To do so, this note presentsfour arguments for AIDS activists, both in Africa and elsewhere, torecognize and respond to HIV from skin-piercing procedures in Africanhealth care and cosmetic services.1.DE-STIGMATIZING HIV/AIDS: Programsfor HIV prevention in Africa – including especially foreign-fundedprograms -- focus almost exclusively on sex. With all attention onsex, the emotions, prejudices, and controversies around sex naturallyspill over into HIV programs. Thus, it is not only wrong to thinkthat all African HIV comes from sex (see points 3 and 4, below), butalso confusing and distracting. Currently, stigma against HIV is sogreat that most people with unexplained infections keep silent, so asnot to be accused of sexual behaviors that some people don’t like.When the public discourse is corrected to recognize blood-borne aswell as sexual HIV (see: http://dontgetstuck.wordpress.com),people with HIV from blood risks will be able to speak out withoutfacing stigma compounded by charges they are lying. And they willthen be able to contribute to public efforts to make health care andcosmetic services safe. 2. PREVENTING HIVINFECTIONS: Ensuring that medical facilities are safe willnot only prevent HIV infection but also the transmission of otherblood borne pathogens. Across Africa, HIV prevalence is lower incountries where more people are aware of blood-borne risks for HIV;see: http://dontgetstuck.wordpress.com/africans-aware-of/3. SEX ALONECAN’T EXPLAIN AFRICA’s HIV EPIDEMICS: Allattempts to explain Africa’s epidemics as exclusively sexual havefailed to find anything that is so different about sex in Africa thatcould account for Africa’s high rates of HIV prevalence.Studies find that Africans have fewer partners and use condoms morethan Americans and Europeans. Circumcision is lesscommon in Europethan Africa. Sex can’t explain how HIV prevalence is lower afterlong term wars, and among people living further from health clinics.Sex is a risk for HIV because so many Africans are infected – buthow are so many infected? 4. EVIDENCE THATAFRICANS GET HIV FROM SKIN-PIERCING EVENTS: Alot of evidence shows HIV transmission through skin-piercingprocedures in Africa.Evidence is both old and new. For example:(a) In 1985, ProjectSIDA in Kinshasa,Zaire(now the Democratic Republic of Congo), tested inpatient andoutpatient children aged 1-24 months and their mothers for HIV.Seventeen (39%) of 44 HIV-positive children had HIV-negative mothers.Among children with HIV-negative mothers, “medical injectionsseemed to be the most important risk factor for HIV…” The studyteam noted, “Injections are often administered in dispensarieswhich reuse needles and syringes yet may not adequatelysterilize them” (Mannet al, Riskfactors for human immunodeficiency virus seropositivity amongchildren 1-24 months old in Kinshasa, Zaire. Lancet1986, ii: 654-7. p. 656.)(b) Around 1990,WHO’s Global Programme on AIDS coordinated a study in Rwanda,Uganda,Tanzania,and Zambiato test in-patient children 6-59 months old and their mothers forHIV. Sixty-one (1.1%) of 5, read more..
Friday, 17 February 2012
American Heart Association-Federal Health Officials-Cardiovascular Disease-Heart Patients
THURSDAY, Jan. 19 (Healthday News) -- The number of Americans who practice behaviors that put them at risk for HIV infection has declined significantly, federal health officials reported Thursday. read more..
Sex OK for Many Heart Patients, Docs Say
THURSDAY, Jan. 19 (Healthday News) -- Sexual activity generally isn't hazardous for people with cardiovascular disease, the American Heart Association says in a new statement. read more..