News (Updated August 16, 2009)

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Huge challenges ahead in fight against AIDS: experts

Mon Aug 10, 2009 5:29am EDT

By Tan Ee Lyn

BALI, Indonesia (Reuters) - Leading health experts on Monday called for repeal of outdated laws criminalizing prostitution and homosexuality so that people suffering from HIV/AIDS or at risk from the disease could get medical treatment.

"The main challenge is overcoming the whole issue of stigma and discrimination, repealing of outdated laws and legislation that countries have got," Prasada Rao, director of UNAIDS Asia Pacific regional support team, said on the margins of an HIV/AIDS conference.

Rao and other experts, kicking off a four-day meeting, said that while progress has been made in research and getting people treated for AIDS, huge challenges lie ahead and much more needs to be done.

"All this progress is not meaningful if we don't address the stigma and discrimination in this region. Young children (whether infected themselves or have family members who are infected) or are still being evicted from schools," Rao told the conference.

"This must change. Without this, progress is not possible," he added.

After HIV/AIDS was first identified in the early 1980s it unleashed fear and a strong wave of prejudice against high-risk groups such as gay and bisexual men and prostitutes, but little appears to have changed after more than 20 years.

Everywhere around the world, criminalization of behavior involving illicit drug use, sex work and sex between men is seriously hampering effective prevention and support programs, according to experts working to help these people.

"For gay men, we need to reach out to these people but if their behavior is criminalized, they are not going to come to you and say hey I need help. This is a classic case of a clash between public health and public security," said Loretta Wong, who heads the Hong Kong-based help group AIDS Concern.

"If they don't get access to services and treatment, their health cant be monitored, they wont get tested. They will instead be driven underground and there will be the risk of infections increasing," she added.

MORE TREATMENT, MONEY NEEDED

The conference also heard strong calls for more access to treatment. Women and children were particularly left out of the loop, experts said.

"We are supposed to be achieving universal access by 2010. We are not going to make these goals particularly in treatment, said David Cooper, professor of medicine and director at the National Center in HIV Epidemiology and Clinical Research in Sydney .

Although about 3 million people were receiving drugs to control HIV by the end of 2007, or nearly 950,000 more compared with the end of 2006, only 31 percent of people who were in need of drugs were getting them.

Cooper said children and pregnant women in low and middle-income countries need better and adequate drugs.

"There is incontrovertible new evidence that treating women with antiretroviral therapy in pregnancy and during their breastfeeding period will almost eliminate HIV infection in their infants."

"But we are not getting access to these women and we are not treating them with proper antiretroviral therapy. We are just giving them single-dose drugs," Cooper said.

(Editing by Sanjeev Miglani)

Battle Erupts Over Plan For HIV Vaccine Test

County Health Officials Turned Down Proposal Last Week

CHICAGO (CBS) ― (6/10/2009)

A plan to test a possible new HIV vaccine in Cook County has run into a roadblock.

In June, Cook County Board President Todd Stroger signed an agreement with GeoVax Labs Inc. to discuss a plan to bring a trial HIV vaccine test to the county, according to the Chicago Free Press. The tests called for GeoVax to hold the tests at the Ruth M. Rothstein CORE Center an organization founded by the county Bureau of Health Services and Rush University Medical Center that runs an HIV/AIDS clinic on the city's West Side , the article said.

The tests would have been held at the Gift House, a testing facility at 1309 S. Kedzie Ave.

But the CORE Foundation,turned the proposal down.

Foundation officials do not want the vaccine trials at the CORE Center . This was in part due to a concern that patients would go off their HIV medications while taking the vaccine, as well as the fact that "there is no example to date of a therapeutic vaccine that has been successful," the Free Press reported.

But Stroger and his deputies suggest politics played a big role in the decision to reject the vaccine test.

"I think that politics is at issue with everything that happens in the county," he told CBS 2 Political Editor Mike Flannery. "That's just a sad fact of life."

Stroger's once-close ally, County Commissioner John Daley, chairs the panel that made the decision. In a phone conversation, Daley ridiculed Stroger's complaint about political motivation.

Robert Weinstein, the chief operating officer of the CORE Center , said it was strictly based on science. He said medical officials there discussed it with health experts, board members and researchers.

"None of these individuals gave us any encouragement to move ahead on the therapeutic vaccine," Weinstein said.

Stroger said he's undeterred.

"I think that the public ought to have more information about this, and they should let the foundation and the board know what they think," Stroger said.

The Cook County Health and Hospitals system could overrule CORE and force it to accept the proposal, but the chairman, Warren Baits, usually listens to his board, Stroger's office told the Free Press.

CBS 2 Political Editor Mike Flannery contributed to this report.

Is HIV progression sex-linked?

13th August 2009

A genetic variant on the X chromosome may explain why some HIV-infected women are slower to develop full-blown AIDS than men.

Although several human genetic variants have been implicated in the control and spread of HIV within a host, this is the first time that a sex chromosome has been found to harbor a suspect stretch of genome related to the disease.

"I think it's a fascinating piece of work," Sunil Ahuja, an infectious disease geneticist at the University of Texas Health Science Center in San Antonio , told The Scientist. "It allows us to begin to probe some of those rather tantalizing reports that [HIV-infected] women generally do better than men," added Ahuja, who was not involved with the study.

German researchers identified a single-nucleotide polymorphism (SNP) located on the X chromosome of 16, or 17%, of 93 HIV-infected women of European descent, according to research published in this month's issue of The American Journal of Human Genetics. HIV infection in most women with the SNP, which is nestled into a highly conserved region between two genes, progressed almost four times slower than it did both in women who lacked the variant and in men, some of whom also carried the SNP. Those women displayed a significantly reduced rate of CD4 cell loss throughout the disease's progression and a lower viral load. Strangely, none of the women had the SNP on both X chromosomes.

Roman Siddiqui, a geneticist at the Leibniz Institute for Primate Research in Germany and one of the lead authors on the AJHG paper, told The Scientist that finding the SNP on the X chromosome was a complete surprise. "We never expected to find this," he said.

Siddiqui and his colleagues first focused on the X chromosomal region after combing the genomes of rhesus macaques infected with SIV (the non-human primate equivalent of HIV) for genetic factors influencing the progression of the disease. Through its microsatellite-based genome-wide association study (GWAS) on the monkeys, the German team keyed in on a locus on the X chromosome located between two genes, one thought to be involved in cell signaling and proliferation, and the other thought to be involved in sperm head cytoskeletal construction.

To investigate whether or not the region of the X chromosome was also involved in the progression of HIV in humans, Siddiqui turned to human GWAS data generated by American colleagues at the Center for HIV/AIDS Vaccine Immunology (CHAVI), a sprawling collaboration headquartered at Duke University . That phenotypic and X chromosomal SNP genotype data from 93 HIV-positive women and 210 HIV-positive men led them to the finding that the SNP rs5968255 on the X chromosome of female patients corresponded to slower disease progression.

"They have used a very logical and innovative approach by probing non-human primates before moving into humans," said Ahuja.

"The rhesus monkey work was something like a magnifying glass," Siddiqui said. "It showed us the region we should look at [in humans]."

Because all of the patients contained in the CHAVI data were Americans of European decent, Siddiqui decided to comb through the wider HapMap database for the SNP's prevalence in people of other ethnicities. He found that the SNP was four or five times more common in Asian females from Japan or mainland China compared to women of European or African descent. Siddiqui and his team also noted that there were Japanese and Chinese women in the HapMap database that did carry the SNP on both X chromosomes. "[The SNP] is very, very rare among African women," he added.

"I think that now we have a clear genetic aspect that must be looked at in the future," Siddiqui said. He is planning a project that involves screening Asian women infected with HIV for the SNP, as well as searching for other genetic host factors lurking in the sex chromosomes that may affect HIV infection and progression. "I'm pretty sure that there are more sex-specific genetic variations which need to now be found." (from thescientist.com)

Most drug-resistant TB cases go untested-Global Fund expert

By Tan Ee Lyn

BALI, Indonesia, Aug 10, 2009 (Reuters) - Cases of multi-drug resistant tuberculosis are underdiagnosed around the world and even among those who have been diagnosed, only a fraction are being treated, a Global Fund official said on Monday.

"The Global Fund is funding about 25,000 to 30,000 patients but the estimated total number of cases is 500,000," Michel Kazatchkine, executive director of the Global Fund's effort to fight HIV/AIDS, TB and malaria, told an HIV/AIDS conference.

"So we are very far off. It is a dangerous epidemic that is spreading," he told the conference in Bali . "There is an underdiagnosis of MDR-TB."

The Asia-Pacific region has the highest number of multi-drug resistant TB (MDR-TB), but only one percent of the cases are being treated, he added.

Most cases of TB can be cured with a drug regimen of 6 to 8 months. Multi-drug resistant TB emerges when there is improper use of antibiotics in fighting regular TB, such as failure to complete the whole course of treatment.

People with HIV/AIDS are especially susceptible to falling ill with TB because their immune systems are compromised. An estimated one-third of people living with HIV are co-infected with TB, and TB continues to be the leading cause of death among people living with HIV.

The emergence of multi-drug resistant TB and extensively drug-resistant TB in recent years poses a significant public health threat, especially for countries with high HIV prevalence. Multi-drug resistant TB is resistant to two of the most powerful TB drugs, isoniazid and rifampicin.

Kazatchkine said treatment for someone with multi-drug resistant TB costs US$7,000 a year, about 100 times the cost of treating regular TB.

"The best way to prevent resistant TB is to get people to take the whole course of standard TB drugs," he said. He stressed, however, there was still an urgency to allocate more money to treat people with multi-drug resistant TB.

"If we can do it for H1N1, we can do it for TB. These epidemics have been at (pandemic) level 6 plus plus plus plus for years," he said.

(Editing by Sugita Katyal)

Dynavax announces European development strategy for investigational adult hepatitis B vaccine in Europe

12. August 2009 19:20

Dynavax Technologies Corporation (Nasdaq:DVAX) today announced that it has met with the European Medicines Evaluation Agency (EMEA) to discuss its plans for continued clinical development of HEPLISAV Phase 3 investigational adult hepatitis B vaccine in Europe.

In a Scientific Advice letter, EMEA expressed a general agreement with Dynavax’s proposed plan to develop HEPLISAV for adult populations that are less responsive to current licensed hepatitis B vaccines, including adults over 40 years of age, individuals with chronic kidney disease, and other groups. In addition, EMEA suggested that Dynavax consider the development of HEPLISAV for adults under 40 years of age who need rapid protection, a group that includes emergency personnel, healthcare workers and international travelers.

“As we advance our development plans for HEPLISAV, EMEA’s scientific advice supports expansion of our targeted population in Europe to include subjects who need rapid protection against hepatitis B infection,” commented Dino Dina, M.D., President and Chief Executive Officer of Dynavax. “A vaccine that demonstrates potential to provide faster and better protection than current vaccines could transform vaccination regimens and outcomes, particularly for individuals with increased risk of infection.”

About HEPLISAV

HEPLISAV is a Phase 3 investigational adult hepatitis B vaccine designed to provide more rapid and increased protection with fewer doses than current licensed vaccines. Over 2,500 individuals have been vaccinated with HEPLISAV to date.

Dynavax has worldwide commercial rights to HEPLISAV, which combines hepatitis B surface antigen (HBsAg) with a proprietary Toll-like Receptor 9 agonist to enhance the immune response.  (www.dynavax.com)

FDA Regulations To Improve Access To Investigational Drugs For People With HIV/AIDS, Other Illnesses

14 Aug 2009   

The FDA on Wednesday posted on its Web site "new regulations … designed to provide broader access to experimental drugs for seriously ill people who have exhausted all other commercially available treatments," the Wall Street Journal reports (Corbett Dooren, 8/12). "The regulations spell out more clearly which patients are eligible for special access to experimental medicines, the [FDA] said. They also clarify when manufacturers can charge patients for the drugs," Reuters reports. According to the article, "Experimental medicines have been available to patients outside clinical trials under certain circumstances since the 1970s. Tens of thousands of patients with AIDS, cancer and other conditions have used medicines through those programs, the FDA said" (Reuters, Richwine, 8/12). Lynda Dee, a patient representative for the FDA's Antiviral Drugs Advisory Committee and a founding member of the AIDS Treatment Activist Coalition in Baltimore, said, "Anything FDA does to promote transparency is good for us," adding, "This will go far in helping people who need these new treatments" (Gardner, HealthDay/U.S. News & World Report, 8/12).

Experts gather in Bali to discuss AIDS fight

Sun Aug 9, 7:11 am ET

NUSA DUA, Indonesia (AFP) – Experts from 65 nations gathered in Indonesia Sunday to assess progress in the battle against HIV/AIDS in Asia and the Pacific, amid concern that only a quarter of those in need in the region were getting treatment.

The ninth International Congress on AIDS in Asia and the Pacific (ICAAP), to be opened by Indonesia 's President Susilo Bambang Yudhoyono on the resort island of Bali , will look at how to ensure "universal access" to antiretroviral treatment, congress chairman Zubairi Djoerban said.

He said that only 25 percent of the 1.7 million of people with HIV/AIDS in the Asia-Pacific region who needed the treatment were receiving it.

"We're still far away from our target," he said.

"We're not talking 100 percent, which is the ideal. If Latin America can treat 62 percent of sufferers there, we should strive towards that."

UNAIDS regional director Prasada Rao said that countries such as Thailand, Cambodia and Laos have been able to treat 80 percent of HIV-positive people there but about 10 countries managed to cover only 10 to 15 percent, due to geographical limitations and lack of funding.

An estimated five million Asians are living with HIV, especially in southeastern countries such as Thailand , Cambodia , the Philippines and Indonesia , according to a UN report released last year.

The congress, which runs until Thursday, will also demand commitment from governments to tackle a disease that killed 380,000 people across Asia in 2007, Djoerban said.

"We ask for commitment from the countries to achieve the targets they have set and if they say they can't, we'll discuss new efforts to help them reach their goals," he added.

"We can discuss prevention and treatment but with no leadership and commitment from countries and the community, we won't achieve much."

The congress also aims to put pressure on governments to change policies that "just keep on discriminating people because of their sexual behaviour such as males who have sex with males and commercial sex workers," Rao told reporters.

While there are some bright spots in the region, such as Cambodia , where HIV prevalence has declined through condom use, new infections are growing in populous countries such as Bangladesh and China , the UN report said.

In Indonesia and South Asia , Djoerban said, the biggest threat was the lethal combination of dirty needles and unprotected sex.

"We're concerned about India , Indonesia and Pakistan , where there is overlapping of drug injecting and unprotected sex... this includes sex workers taking drugs and drug users not using condoms," he said.

"New infections are offsetting positive results from preventive actions."

In Indonesia , where HIV/AIDS cases have tripled since 2005 to 26,632, according to official figures, prisoners and prostitutes have joined injecting drug users to become among the groups most at risk.

A third of 254 prison deaths in the country in May this year were due to HIV/AIDS.

Meanwhile, one of the worst HIV epidemics outside of Africa is under way in Indonesia 's remote eastern province of Papua , where 2.4 out of every 100 people are infected due to an influx of migrants workers and a booming sex industry.

However, HIV prevalence in the region is still low compared with Africa .

"In South and Southeast Asia , the HIV prevalence is 0.3 percent. In sub-Saharan Africa , it's five percent," Djoerban said.

The Bali congress will also cover topics ranging from HIV risks among transgenders and migrant workers to biomolecular advances in HIV treatment and the impact of the financial crisis on those with HIV/AIDS.

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