News (Updated November 29, 2009)

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New HIV infections reduced by 17% over the past eight years

24 Nov 2009 Source: WHO

According to new data in the 2009 AIDS epidemic update, new HIV infections have been reduced by 17% over the past eight years. Since 2001, when the United Nations Declaration of Commitment on HIV/AIDS was signed, the number of new infections in sub-Saharan Africa is approximately 15% lower, which is about 400 000 fewer infections in 2008. In East Asia HIV incidence has declined by nearly 25% and in South and South East Asia by 10% in the same time period. In Eastern Europe , after a dramatic increase in new infections among injecting drug users, the epidemic has leveled off considerably. However, in some countries there are signs that HIV incidence is rising again.

The report, released today by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), highlights that beyond the peak and natural course of the epidemic - HIV prevention programmes are making a difference.

"The good news is that we have evidence that the declines we are seeing are due, at least in part, to HIV prevention," said Michel Sidibé, Executive Director of UNAIDS. "However, the findings also show that prevention programming is often off the mark and that if we do a better job of getting resources and programmes to where they will make most impact, quicker progress can be made and more lives saved."

In this first double issue, the UNAIDS Outlook report further explores how “modes of transmission� studies are changing the approach of HIV prevention efforts. The new magazine-style report looks at new ideas and ways to use the data collected in the companion epidemiological report.

Data from the AIDS Epidemic Update also show that at 33.4 million, [31.1 millionâ€"35.8 million] there are more people living with HIV than ever before as people are living longer due to the beneficial effects of antiretroviral therapy and population growth. However the number of AIDS-related deaths has declined by over 10% over the past five years as more people gained to access to the life saving treatment. UNAIDS and WHO estimate that since the availability of effective treatment in 1996, some 2.9 million lives have been saved.

Dr Margaret Chan, Director- General of WHO said: "International and national investment in HIV treatment scale-up has yielded concrete and measurable results. We cannot let this momentum wane. Now is the time to redouble our efforts, and save many more lives."

Antiretroviral therapy has also made a significant impact in preventing new infections in children as more HIV-positive mothers gain access to treatment preventing them from transmitting the virus to their children. Around 200 000 new infections among children have been prevented since 2001.

In Botswana , where treatment coverage is 80%, AIDS-related deaths have fallen by over 50% over the past five years and the number of children newly orphaned is also coming down as parents are living longer.

One of the significant findings of the report is that the impact of the AIDS response is high where HIV prevention and treatment programmes have been integrated with other health and social welfare services. Early evidence shows that HIV may have a significant impact on maternal mortality. Research models using South African data estimate that about 50 000 maternal deaths were associated with HIV in 2008.

"AIDS isolation must end," said Mr Sidibé. "Already research models are showing that HIV may have a significant impact on maternal mortality. Half of all maternal deaths in Botswana and South Africa are due to HIV. This tells us that we must work for a unified health approach bringing maternal and child health and HIV programmes as well as tuberculosis programmes together to work to achieve their common goal."

The double report also shows that the face of the epidemic is changing and that prevention efforts are not keeping pace with this shift. For example the epidemic in Eastern Europe and Central Asia once characterized by injecting drug use is now spreading to the sexual partners of people who inject drugs. Similarly in parts of Asia an epidemic once characterized by transmission through sex work and injecting drug use is now increasingly affecting heterosexual couples.

Data show that few HIV prevention programmes exist for people over 25, married couples or people in stable relationships, widowers and divorcees. These are the same groups in which HIV prevalence has been found to be high in many sub-Saharan countries. For example in Swaziland people over the age of 25 accounted for more than two thirds of adult infections yet very few HIV prevention programmes are designed for older people.

Funding for HIV prevention has become the smallest percentage of the HIV budgets of many countries. For example in Swaziland , just 17% of the country’s total budget for AIDS was spent on prevention despite a national HIV prevalence rate of 26%. In Ghana , the prevention budget was cut in 2007 by 43% from 2005 levels.

Building on the need to maximize results and to better connect the 33.4 million people living with HIV and the millions of people who are part of the AIDS response, UNAIDS has launched AIDSspace.org. This social networking site is open to the community and is free.

AIDSspace.org aims to expand informal and established networks to include more people interested in HIV to maximize resources for a stronger AIDS response. The premise behind AIDSspace is simple: if hundreds of millions of people can connect on some of the most popular social networking sites (e.g. Facebook, LinkedIn, MySpace, Twitter, YouTube) to connect, exchange ideas, post and share HIV-related content, they can do the same for HIV related content - including key policies, case studies, multimedia materials, conference posters, reports and other essential resources. Users can also find and post jobs and reviews on service providers on AIDSspace.org.

Sophie Barton-Knott
Telephone: +41 22 791 1697
E-mail: bartonknotts@unaids.org

FDA grants full approval to J&J's HIV drug

Wed Nov 25, 2009

BRIDGEWATER , N.J. – A division of Johnson & Johnson said Wednesday that federal regulators granted full approval to an HIV drug designed to treat patients who have stopped responding to other treatments.

The Food and Drug Administration gave Intelence preliminary approval in January 2008 under its accelerated approval program, which allowed J&J to market the drug. In order to gain full approval, FDA required the company to submit follow-up data on the drug's effectiveness.

More recent data submitted by J&J's Tibotec unit showed that 60 percent of patients taking the drug for 48 weeks had undetectable levels of HIV in their blood compared with 38 percent of patients taking a placebo.

Intelence is a non-nucleoside reverse transcriptase inhibitor, or NNRTI, that blocks the enzyme HIV needs to multiply. The twice-daily tablet is already approved for use in 50 countries around the world.

Tibotec Therapeutics is a division of Ortho Biotech Products LP, a Johnson & Johnson company based in Bridgewater , N.J.

Timely and continuous HIV care extends survival

Thu Nov 26, 2009

By Megan Brooks

NEW YORK (Reuters Health) - In people infected with human immunodeficiency virus (HIV), the virus that causes AIDS, high-risk behavior, HIV infection itself, as well as late initiation and early discontinuation of anti-HIV therapy all contribute to substantial decreases in life expectancy, United States researchers report.

Using a comprehensive computer model of HIV disease, the researchers simulated cohorts of HIV-infected individuals and compared them with uninfected individuals who had similar demographic characteristics.

"We estimated that for people in the United States living without HIV, life expectancy beginning at age 33 is an additional 43 years," first author Dr. Elena Losina, of Massachusetts General Hospital, Boston, told Reuters Health.

"High risk behavior, such as substance abuse, on average, accounts for an 8 year reduction in life expectancy," Losina added.

HIV infection itself reduces life expectancy by an additional 12 years and a late start or premature discontinuation of HIV treatment further reduces life expectancy to a total of 23 years, she and colleagues report in the journal Clinical Infectious Diseases.

"The current therapy for HIV is very effective," Losina commented, "but unless HIV-infected patients initiate treatment on time and stay on treatment, the treatment benefits would be truncated substantially."

Minorities, especially minority women, tend to initiate therapy later and are more likely to drop off from care, and this "leads to disproportional losses in life expectancy in these population groups," she said.

"There is a critical need for people with HIV to begin care in a timely way and to remain in care," senior investigator Dr. Kenneth A. Freedberg, also from the Massachusetts General Hospital , said in a statement. "HIV testing for all adults in the United States , as currently recommended, with effective linkage to care, will have important survival benefits."

SOURCE: Clinical Infectious Diseases, November 15, 2009.

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