A
'universal' vaccine that could revolutionise the treatment of cancer could be
available in just two years.News (Updated April
17, 2011)
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By Peter Loftus, Of DOW
JONES NEWSWIRES
"We don't see ... a
product vaccine that we could make at this point," Roger Pomerantz, who
leads infectious disease research at Merck, said at a conference of the
Association of Health Care Journalists here. He cited limits on scientific
understanding of how best to combat such a complex virus.
Merck, however, continues
to conduct basic research aimed at coming up with a vaccine, and it's monitoring
outside research efforts, he said. Also, Merck continues to work on improving
treatments for people infected with HIV, the virus that causes AIDS.
In September 2007, a
clinical trial of a Merck vaccine was halted because it didn't reduce the rate
of HIV infections compared with a placebo--a major disappointment for
researchers and patients who had seen promise in Merck's approach.
Pomerantz said Merck, of
A separate attempt to develop an HIV vaccine, funded by the federal government, showed some promise in reducing HIV infection in a clinical trial in 2009, but there has been scientific debate about the trial results, casting doubt on the potential for the vaccine.
by: Claire Bates I Daily Mail (UK)
AN HIV vaccine that could
outwit the deadly virus could undergo human trials in as little as a year's
time, scientists say.
The 'mosaic vaccine',
which is being designed by an international team of investigators, works by
being able to adapt to the virus as it mutates.
HIV's ability to evolve
rapidly is what lets it dodge current drugs.
Bette Korber from Los
Alamos National Laboratory in
She said: 'We're in
the evolutionary fast lane studying HIV.
'If you give just
one drug, HIV evolves away from it. That why treatments involve three or four
drugs at once.'
The HIV virus, which is
largely made up of proteins, causes AIDS - a disease that destroys the body's
immune system leaving sufferers vulnerable to infections and tumours. The
disease killed 1.8million people worldwide in 2009.
Traditional HIV vaccines
are designed to stimulate the body’s immune system to recognize naturally
occurring stretches of specific amino acids in the virus’ proteins.
However, a mosaic vaccine
is composed of many sets of synthetic, computer-generated sequences of proteins.
These can cue the body's immune system to respond to a variety of HIV mutations.
It is put together using a
huge database created by Korber and her colleagues at LANL, which contains
information from hundreds of thousands of HIV fragments.
Such a vaccine could break
a 25-year stalemate in the search for a cure of a disease that infects 7,500
people a day and kills two million a year. All previous vaccine trials
have ended in failure.
Early computer models
predicted that mosaic vaccines would perform better than natural HIV genes.
This was partly confirmed
last year, when results published in Nature Medicine found mosaic vaccines
provoked powerful immune responses in both mice and monkeys.
Now a consortium of
researchers, supported by the Bill & Melinda Gates Foundation and National
Institutes of Health, hope to launch human trials of a mosaic vaccine by late
2012.
Dr Korber, who has
lost a couple of friends to Aids, said she had high hopes for the novel
approach.
'It has been the focus of
my life to make a vaccine happen,' she said.
'At this point, because of
the results in animal studies, I'm confident this is a good approach that merits
testing in humans.'
If the early phase safety
trial shows the vaccine is safe to use on humans, scientists can move on to a
phase two trial where the vaccine would be tested on larger groups to assess how
well it works.
An estimated 1,6 million
Zimbabweans have HIV.
13 Apr 2011
Source: Content partner //
IRIN
Some common reasons for
failing to stick to ARV regimens include: side-effects; insufficient food; long
distances and high transport costs to and from drug collection points;
forgetting to take them; stigma and fear of disclosure of one's status and
spending time away from home.
Adherence is crucial to
preventing the huge expense of putting patients on second- and third-line HIV
treatment. Here are some ways HIV programmes can improve adherence:
Continuous counselling -
Crucial to ensure patients understand the importance of strictly adhering to
their medication and make healthy lifestyle choices. Many HIV programmes offer
counselling at the initiation of ART, after which patients merely collect their
drugs from the pharmacy monthly, being seen a few times a year or only when they
have other health conditions.
However, experts recommend
sustained ART adherence counselling to achieve the best results. A randomized
controlled study [http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000422;jsessionid=168D48D3BB44EBB49E84F177506DB5DA.ambra02
] published in 2011 and conducted in the Kenyan capital,
Additional lifestyle
counselling, such as alcohol counselling [ http://www.plusnews.org/report.aspx?ReportID=86043
] for heavy drinkers, can also improve adherence.
Community support - Visits
by community members to encourage patients to adhere to their medication,
home-based care by community health workers or people visiting the clinic with
the patient and keeping tabs on them between visits, can all help.
Some programmes are using
community drug distribution to bring health services closer to remote villages.
One Tanzanian project [ http://www.irinnews.org/report.aspx?ReportId=89757 ]
uses community-based volunteers - many of them HIV-positive - and trained
medical workers to drive around villages refilling prescriptions and providing
counselling and support to patients.
A 2011 South African study
[ http://www.ncbi.nlm.nih.gov/pubmed/21259136 ] found community-based adherence
to be crucial in ensuring that patients remained in care, regularly picked up
their treatment and retained low viral loads.
Task-shifting - Patients
do not waste precious working hours and lose money waiting for medical care.
Many African countries lack medical staff [ http://www.irinnews.org/report.aspx?ReportID=89186
]; overburdened health workers are unable to provide the proper attention to
patients. Task-shifting - the use of mid- to low-level health workers rather
than doctors to prescribe ART - helps ease the burden on doctors and saves
patients’ time.
As more [ http://www.plusnews.org/Report.aspx?ReportID=91383
] HIV programmes take on task-shifting, experts warn that ongoing training and
monitoring [ http://www.plusnews.org/Report.aspx?ReportId=85979 ] are necessary
to ensure the quality of care is not compromised.
Technology - Many health
centres provide patients with devices such as pill boxes, medical calendars and
alarms to help them to remember to take their drugs at the appropriate time.
The use of text messages [
http://www.irinnews.org/report.aspx?ReportID=88653 ] to remind patients to take
their medicines and to report health issues to medical personnel is proving
popular and effective. A 2011 study [ http://www.ncbi.nlm.nih.gov/pubmed/21252632
] of 431 patients at a rural Kenyan clinic found that 53 percent receiving
weekly SMS reminders achieved adherence of at least 90 percent during the 48
weeks of the study, compared with 40 percent of participants who did not.
Social assistance -
Patients often abandon their HIV medication due to hunger [ http://www.plusnews.org/Report.aspx?ReportID=92406
]; for others, the costs associated with travelling long distances [ http://www.plusnews.org/report.aspx?ReportID=82881
] to seek treatment are simply too high.
According to a 2010 study
[ http://www.aidsrestherapy.com/content/7/1/33 ] in Haiti, food assistance was
associated with improved clinic attendance and adherence to ART, while a 2010
Ugandan study [ http://retroconference.org/2010/PDFs/831.pdf ] found that cash
transfers of between US$5 and $8 for transport costs resulted in improved ART
adherence and retention in care.
Researchers [http://www.google.co.ke/url?sa=t&source=web&cd=1&ved=0CB4QFjAA&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F20048268&ei=bIalTbCFCKTu0gG_lPHoCA&usg=AFQjCNFt0u9qhKSIvsLAaJJIJOGNoM6ZXQ
] argue that the cost of food assistance and transportation is dwarfed by the
potential costs - including hospitalization and additional medication -
associated with failure to adhere.
kr/mw
Neil Osterweil
April 13, 2011 —
Although incidence rates of AIDS-defining cancers such as Kaposi's sarcoma have
plummeted since the introduction of highly active antiretroviral therapy (HAART)
in the 1990s, other more common cancers are filling the void, report
investigators from the National Cancer Institute (NCI) in
From 1991 to 1997, as the
number of Americans with AIDS increased, the number of AIDS-defining cancers
showed a sharp decline, and continued to decrease more gradually in subsequent
years. However, at the same time, in people with either HIV or AIDS, the number
of non-AIDS-defining cancers — particularly anal, liver, prostate, and lung
cancers — increased about 3-fold, according to Meredith S. Shiels, PhD,
MHS, from the Infections and Immunoepidemiology Branch of the NCI's Division of
Cancer Epidemiology and Genetics, and colleagues. Their study was published
online April 11 in the Journal of the National Cancer Institute.
The increase in
non-AIDS-related cancer among people with HIV infection is a byproduct of the
success of HAART. Namely, people are living with HIV and AIDS far longer than in
the early days of the epidemic, and developing cancers that rise in incidence
with age, according to the authors.
"The growing burden
of non-AIDS-defining cancers highlights the need for cancer prevention and early
detection among HIV-infected people. In particular, programs focusing on smoking
cessation (to prevent lung and other cancers) and the prevention and treatment
of hepatitis B and C viral infections (to prevent liver cancer) should be
targeted toward HIV-infected people," they write.
An oncologist with
expertise in AIDS-related cancers told Medscape Medical News that the findings
confirm what she and her colleagues have seen in recent years.
"What we were seeing
clinically is that cancers such as lung cancer and anal cancer were increasing
in this population. I think this article validates that and I think it's
important because it points out that half the cancers currently are things that
are non-AIDS-defining," said
AIDS Population Grows,
Ages
The NCI investigators
obtained incidence rates for individual cancer types from the ongoing HIV/AIDS
Cancer Match Study, which links 15 American population-based HIV and cancer
registries. They used surveillance data from the US Centers for Disease Control
and Prevention to estimate the population living with HIV and AIDS.
To estimate the incidence
of AIDS-defining cancers (Kaposi's sarcoma, non-Hodgkin's lymphoma, and cervical
cancer) and non-AIDS-defining cancers from 1991 to 2005, they multiplied cancer
incidence rates and AIDS population counts stratified by year, age, sex,
race/ethnicity, transmission category, and AIDS-relative time (time since onset
of AIDS).
There was a more than
4-fold increase in the number of people living with AIDS in the
Comparing the 5 years from
1991 to 1995 with the 5 years from 2001 to 2005, the authors saw that the
estimated number of AIDS-defining cancers fell from 34,587 to 10,325 — a more
than 3-fold decline (P for trend < .001). During the same time period,
non-AIDS-defining cancers increased slightly more than 3-fold — from 3,193 to
10,059 (P for trend < .001).
Changes Over Time in
Non-AIDS-Defining Cancers
|
Cancer Type |
1991 to 1995 |
2001 to 2005 |
|
Anal |
206 |
1564 |
|
Liver |
116 |
583 |
|
Prostate |
87 |
759 |
|
Lung |
875 |
1882 |
|
Hodgkin's Lymphoma |
426 |
897 |
The investigators also looked at a more limited set of data from 34 American
states that tracked HIV-infected people who had not yet developed AIDS (946,936
person-years from 2004 to 2007). They estimated an incidence of 2191
non-AIDS-defining cancers during that period, including 154 anal cancers, 454
lung cancers, and 166 breast cancers.
Their findings suggest
that people living with HIV should be screened for common cancers on the basis
of age-specific recommendations and included in clinical trials of cancer
therapies.
Dr. Noy told Medscape
Medical News that the AIDS Malignancy Consortium is involved in clinical trials
of therapies for cancers that are disproportionately prevalent in patients with
HIV-infection, including anal and liver cancer and Hodgkin's lymphoma. In
addition, an intergroup study of advanced Hodgkin's lymphoma, led by the
Southwest Oncology Group, has enrolled patients living with HIV.
The study was funded by
the Intramural Research Program of the NCI. The authors are NCI employees. The
AIDS Malignancy Consortium receives NCI funding.
J Natl Cancer Inst.
Published online April 11, 2011.
Neurological and cognitive
problems
Gus
Published: 11 April 2011
Two studies presented at
the17th British HIV Association (BHIVA) conference last week suggest that the
proportion of people who have subtle brain impairment due to HIV may not be as
high as previously thought, and may in fact be little higher than in the general
population.
Several studies measuring
neurocognitive impairment (deficits in memory, thinking and movement) in people
with HIV in the last few years have concluded that a high proportion of people
with HIV have subtle impairments. These may not cause symptoms that interfere
with daily life, but can be detected by psychological tests.
About 16% of the general
population has some degree of neurocognitive deficit. It therefore caused a lot
of concern when in 2010 the large CHARTER trial in the
A quarter of these people
had other conditions that were probably the major cause of their brain
impairment, but that still meant that 39% of all HIV-positive patients had brain
impairment without any other obvious cause, and 36% of patients who had never
had an HIV-related illness. Of these 71%, or 28% of the entire group, had no
obvious neurological symptoms. CHARTER, therefore, suggested that HIV more than
doubled the risk of brain impairment in otherwise healthy people, raising
concerns that it might become even more common with age.
One study presented at
BHIVA, however, found a rate of asymptomatic neurocognitive impairment of only
19% in a group of patients with suppressed viral loads, very little in excess of
the general population rate. Another study found that young people who had been
born with HIV had rates of neurocognitive impairment no higher than their
HIV-negative siblings. This study, and a third study that looked at rates of
neurocognitive impairment in the over-50s, found some evidence that some
psychological tests that rely on self-report might not be detecting actual
difficulties in thinking and memory, but rather people’s fear of them.
The St Mary’s Study
Dr Lucy Garvey from St
Mary’s and
The study subjects were
given two types of psychological test, a 20-minute computerised cognitive
assessment test called Cogstate, and the International HIV Dementia Scale (IHDS),
a short, validated screening test for dementia employing three simple memory and
motor tasks.
Neurocognitive impairment
was defined as scores more than one standard deviation below the mean
age-matched population data in at least two areas of functioning – roughly
within the lowest one-sixth of performance scores.
The median age of the
subjects was 53, and the majority (77%) were white men. They had been
HIV-positive for an average of 14 years, with a mean CD4 count of 559 and
lowest-ever CD4 count (nadir) of 185. A high proportion – 25% – had
hepatitis C, which is also associated with neurocognitive disorders.
The overall rate of
neurocognitive impairment was 19% in this group, only 3% above the rate in the
general population. The pattern of domains affected was familiar from other
studies of people with HIV, in that fine muscular movement, multitasking and
executive function (prioritising and planning) were particularly impaired, and
CD4 nadir was associated with a high IHDS score, but nonetheless the impairments
seen were slight.
“Many cohorts have
reported HIV-associated neurological disorder, but their antiretroviral therapy
status and health have been widely variable,” commented Dr Garvey. “This is
one of the first studies to look at neurocognitive impairment only in stable
HIV-asymptomatic patients on suppressive antiretroviral therapy.”
The St Mary’s team will
now conduct further studies to look at neurocognitive disorder in drug-naive
patients with unsuppressed HIV.
Young people and brain
impairment
The results from this
study were echoed by another study from St Mary’s that looked at
neurocognitive function in young people who had been born with HIV. It studied
31 young people aged 16-25 (mean age 20) and compared their performance with 14
of their HIV-negative siblings. The two groups were matched for age, ethnicity
(both 85% black African) and gender (33% and 29% respectively were male in the
positive and negative groups). Seventy-nine per cent of the positive subjects
were on antiretrovirals of whom 70% were virally suppressed (55% of the whole
group).
These subjects were given
the Cogstate computerised tests and the IHDS, and were also given the
prospective and retrospective memory scale (PRMQ) questionnaire, a self-reported
rating of problems with recall and retention of information. A minority of both
groups were also given an MRI brain scan to detect signs of inflammation.
The positive and negative
group had identical scores on the IHDS and on the Cogstate test in all domains.
The PRMQ score was significantly worse (p=0.023) for the HIV-positive young
people, and there were also high levels of activity of certain neurotransmitters
in the basal ganglia area of the brain, a finding seen in other studies.
However presenter Jane
Ashby commented that the PRMQ questionnaire, as a self-report, could measure
subjects’ concern about memory problems as much as actual ones, and so far no
study in HIV has established whether the inflammation seen in MRI scans is
actually associated with neurocognitive performance.
Screening for brain
impairment
The idea that some
psychological tools might be reporting HIV-positive people’s fears of dementia
rather than actual impairment, and might over-report neurological problems, has
led London’s first dedicated HIV clinic for people over 50, at the Chelsea and
Westminster Hospital, to include two ten-minute psychological questionnaires for
generalised anxiety disorder and depression as standard first steps in
psychological assessment of patients, only proceeding to tests for neurological
function once these are eliminated.
The researchers comment
that “high levels of anxiety, depression and concern about cognitive
function” are common in older patients and that “memory loss, mental slowing
and psychomotor disorder are common manifestations of these conditions” and
should therefore be assessed and treated first.
References
Garvey L et al. Features
of neurocognitive performance in over 100 neurologically-asymptomatic
HIV-infected adults receiving combination antiretroviral therapy (cART).
Seventeenth BHIVA Conference,
Ashby J et al. Cerebral
function in perinatally HIV-infected young adults and their HIV-uninfected
sibling controls. Seventeenth BHIVA Conference,
De Silva S et al. Over 50
Clinic: how to screen for neurocognitive disorders? Seventeenth BHIVA
Conference,
Published April 14, 2011 |
FoxNews.com
A group of children who
received flu shots at a
It happed at the Med Peds
Clinic in
Unlike adults, kids are
supposed to receive two doses of the pediatric flu vaccine. With that
understanding, officials at the clinic said the assistant removed the needles
from the half-full syringe – assuming it was the adult dose – and replaced
it with a sterile needle, but not a new syringe.
The syringes were then
placed in a box marked “second doses.”
As a result, the clinic
said some of the half-used vaccines were used on children who returned for their
second influenza shot.
"Apparently, somebody
wasn't following policy and procedure and it puts infants in danger, so [I'm]
not a big fan of them right now," Cary Bergeron, whose infant was
vaccinated at Med Peds, told the news station. "She was born flawless, and
now, by someone else's mistake, something bad could happen."
The clinic said the
assistant has since been fired and they are taking precautions to make sure this
doesn’t happen again.
By Fiona Macrae
15th April 2011
A
'universal' vaccine that could revolutionise the treatment of cancer could be
available in just two years.
The TeloVac jab is part of
a new generation of drugs that use the body’s own defences to fight the
disease, stopping tumours in their tracks.
TeloVac has already been
given to hundreds of Britons with pancreatic cancer, one of the deadliest forms
of the disease.
Fight: The TeloVac jab
uses the body's own defences to fight cancer, stopping tumours in their tracks
But it is hoped it will be
effective against many other tumours, including those of the skin, lung and
liver. Breast and prostate cancers may also be within its grasp.
Together, the six forms of
the disease claim more 70,000 lives a year in the
In the case of pancreatic
cancer, which killed actor Patrick Swayze, survival rates have barely improved
in the past 40 years, and patients typically die within six months of diagnosis.
Just 3 per cent survive
five years, and it is the fifth biggest cancer killer in the
Rather than attacking the
cancer cells, like many existing drugs, it harnesses the power of the immune
system to fight the tumours.
It works by encouraging
the immune system to seek out and destroy an enzyme called telomerase. Found at
high levels in many cancer cells, telomerase effectively makes them immortal,
allowing them to live on when healthy cells would die – easing the growth and
spread of the tumour.
In the largest trial of
its kind in the
The results from the 53
hospitals taking part will not be available until next year but, anecdotally,
some patients credit their participation in the trial with giving them an extra
year or two of life. In earlier, smaller trials, the vaccine gave those in the
late stages of the disease an average of an extra three months.
John Neoptolemos, who is
co-ordinating the large-scale British trial, said: ‘When you have got
pancreatic cancer, it is like a timebomb in people.’
Pancreatic cancer cells
are normally invisible to the immune system but the vaccine ‘spots’ the
telomerase spilling out from them and kick-starts the fight back.
Professor Neoptolemos, of
Healthy cells escape the
attack because their levels of telomerase are too low to bother the immune
system. This cuts the risk of side-effects such as nausea and hair loss normally
seen with cancer drugs.
If the latest study, which
is funded by Cancer Research
Dr Jay Sangjae Kim, the
founder of GemVax, the Korean company developing the TeloVac vaccine, said:
‘We strongly believe this has the potential to overcome the limits of other
current cancer vaccines and become part of the standard of care not only for
pancreatic cancer but for various other types of cancers.
‘In other words, a truly
“universal” vaccine will be available in the near future.’
Professor Peter Johnson,
of Cancer Research