News (Updated August 23, 2009)

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Richmond trials part of elusive hunt for HIV vaccine

By Tammie Smith

Published: August 23, 2009

The Richmond AIDS Consortium, based at Virginia Commonwealth University , has more than a dozen clinical trials under way studying different aspects of HIV/AIDS care, with more studies in the pipeline.

At the University of Virginia , a researcher is investigating a technique that might make developing an HIV vaccine easier.

Billions of dollars have been spent in the past two decades on HIV research. One result: drugs that have added years to the life expectancy of people infected with HIV.

But efforts to find a way to rid the body of the virus permanently or a vaccine to prevent infection in the first place have fallen way short of expectations.

"What makes it so hard to develop a vaccine is that HIV has so many tricks to fool the immune system," said Dr. Daniel Nixon, director of the VCU HIV/AIDS Center.

But Nixon said the National Institutes of Health, which has funded much of the research on HIV and AIDS, hasn't given up.

"About a year or so ago they realized they needed to go back to the drawing board a little bit and more carefully study things in the pre-clinical testing phase. Go back to bench science and animal models and have more understanding of how these problems could be dealt with before moving to the big vaccine trials. So there was a bit of a readjustment," said Nixon, a physician and molecular virologist.

. . .

HIV, the virus that causes AIDS, destroys a type of white blood cell critical to fighting off infections.

In the past decade, there have been failures of two promising HIV vaccines in human clinical trials -- VaxGen's AIDSVax in 2003, studied in a trial that enrolled 5,403 people; and Merck's STEP HIV trial vaccine study that enrolled 3,000 people.

Those failures are partly what prompted the shift back to the lab to do more basic research to better understand the virus.

"HIV is always making itself different," said Nixon, explaining one of the virus's tricks. HIV also changes some of its proteins to look like the body's own, and in that way avoids being attacked.

"It's not just one strain of the virus. In the body, the virus is so diverse. It's millions of different strains," said Nixon. "Just because you have HIV doesn't mean you can't get a more aggressive form or a drug-resistant form."

The lack of a vaccine makes research on better disease management for HIV that much more important.

Nixon said a trial that the Richmond AIDS Consortium hopes to start soon will look at whether statin drugs can help reduce HIV inflammation associated with heart disease and mortality. Another study is looking at what T-cell count level is best for starting an HIV-infected person on antiretroviral drugs. That study, which is enrolling people worldwide, will eventually have 4,000 patients.

Guy Bernard Jean of Richmond has volunteered for two HIV-related studies, though not vaccine trials. Jean, 45, has been HIV-positive since 1991.

It's important to be part of clinical trials, Jean said. "The virus treats everybody differently. We have to find a common denominator to find a better treatment."

In the United States , an estimated 1.1 million people are infected with HIV, with about one-fourth unaware they are infected. Since the epidemic began in the early 1980s, more than 500,000 people in the United States have died from AIDS.

"We haven't given up on a cure," Nixon said. "As a matter of fact, we have learned an amazing amount about the virus."

 

KENYA : HIV testing crucial in TB vaccine programme

21 Aug 2009 08:20:30 GMT

NAIROBI, 21 August 2009 (IRIN) - New research showing that the tuberculosis vaccine Bacille Calmette Guerin (BCG) can be deadly to HIV-positive infants means Kenya's health ministry will have to redouble its efforts to test pregnant mothers and their infants for HIV, senior health officials say.   The South African study found that HIV-positive babies who receive the BCG vaccine were three times more likely to contract TB from the vaccine than previously thought. The authors recommended delaying vaccination until an infant's HIV status is known.   "The new revelations will be challenging to us in regards to the treatment of children, especially given that diagnosis of both HIV and TB in children is not easy and takes a long time to determine," Joseph Sitienei, the director of the National Leprosy and TB Programme at the Ministry of Health, told IRIN/PlusNews.   An estimated 80 percent of children born in Kenya 's health facilities receive the TB vaccine, whether or not they have been tested for HIV.   "We must strengthen prevention of mother to child transmission [and] encourage mothers to embrace delivery in health facilities for adequate antenatal and post-natal care to save infants," Sitienei said.   Just 40 percent of Kenyan mothers have their babies in health facilities, with most rural women and up to one in four women in the slums of the capital, Nairobi , opting to have their babies at home with traditional birth attendants.   The government now plans to incorporate traditional birth attendants into the national drive to bring women to antenatal clinics and boost immunization.   "The government will use them as a link between the community and health facilities... this will have the double benefit for the mothers and the children in terms of both vaccination against TB and prevention of mother to child transmission in the case of HIV," Sitienei added.   To encourage women to come to antenatal clinics, it would also be important to reduce the costs associated with obtaining maternity services, including medical fees and expensive transportation.  

"The biggest challenge, however, will be to ensure that our healthcare system is strengthened to deal with these new findings on the dangers and efficacy of the BCG vaccine vis-à-vis children born infected with HIV," he said.   According to the National Leprosy and TB Programme, children account for about 11 percent of new TB infections per year. Kenya is ranked 13 out of the 22 high burden countries worldwide and had 140,000 new TB cases in 2008.   ko/kr/mw

 

Gel could block HIV like a condom

Emma Quilligan

Website: http://www.scidev.net

Scientists have created a gel that could prevent the transmission of HIV by physically stopping the virus in its tracks.

The 'molecular condom' was designed by scientists at the University of Utah in the United States . If it passes clinical trials, it will enable women to protect themselves against HIV without approval from their partners.

Patrick Kiser, assistant professor of bioengineering at the University of Utah , says the gel would act in a similar way to a condom. Women would insert it before intercourse and the acidic conditions of the vagina would ensure it remained liquid, allowing it to coat the vaginal walls and therefore the cells vulnerable to HIV infection.

The presence of semen makes the vagina less acidic, and it is expected that this change in pH will cause the molecules within the gel to interact and turn semisolid. The resulting mesh would be so small, virus particles would be unable to penetrate.

Unlike existing microbicides, Kiser's molecular condom appears not to be affected by high temperatures, making it potentially suitable for use in hot developing countries.

A paper describing the HIV-blocking properties of the gel was published in Advanced Functional Materials last week (10 August).

"We have shown that the gel prevents the movement of HIV," Kiser told SciDev.Net. He added, however, that the gel's ability to trap HIV has only been shown in the laboratory and clinical trials are at least three years away.

Kiser hopes the gel will eventually work in conjunction with existing technologies. "We would want to put an antiretroviral agent in the gel, to act as another level of protection," he says.

Salim Karim, director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), says he likes the idea of a "smart" material that responds to pH.

But he adds that Kiser's team will need to demonstrate the gel's genuine effectiveness as a barrier to HIV and ability to withstand the force applied during sex. He adds that Kiser's team may benefit from seeking advice from others with experience in microbicide research.

Karim says that if the gel proves effective against the spread of HIV in humans, it could have a substantial impact on women's ability to protect themselves against infection. This would be particularly welcome in those developing countries where women are unable to discuss preventative measures with their partners.

Kiser aims to develop the gel into a product that remains active for 20-24 hours after a single application.

 


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