Delaying need for HIV treatment by preventing other disease

Recipients of a long-lasting insecticide-treated mosquito net. 

Image © Vestergaard Frandsen/Georgina Goodwin

The need for antiretroviral therapy can be significantly delayed by the prevention of malaria and diarrhoea, Kenyan research shows.

Both malaria and water-borne diseases that can cause diarrhoea are thought to be major factors affecting HIV disease progression.

Researchers wanted to see if the distribution of long-lasting insecticide-treated mosquito nets and water filters, used to prevent malaria and diarrhoea, delayed the need for HIV therapy.

About 600 HIV-positive people not yet eligible for HIV treatment (i.e., they had a CD4 cell count above 350 and no serious symptoms) were recruited to their study.

Approximately half of the study group was given the treated mosquito nets and water filters.

The use of these nets and filters was associated with a 27% reduction in the need to start HIV treatment.

The strategy was highly cost-effective. A mathematical model showed that if it was employed across sub-Saharan Africa, it would save US$400 million per year in HIV treatment costs.

Hillary Clinton announces funding for key HIV projects

US Secretary of State Hillary Rodham Clinton. 

©IAS/Ryan Rayburn - Commercialimage.net

The US Secretary of State, Hillary Clinton, made a number of important funding pledges in her address to the International AIDS Conference.

These included:

• $37 million for projects working with injecting drug users and gay men in countries with expanding HIV epidemics.

• $40 million for the roll-out of male circumcision in Africa.

• $80 for the prevention of mother-to-child transmission.

• $90 million for research into microbicides.

The Secretary of State used her address to reaffirm the Obama administration’s support for the reproductive rights of women.

"Every woman should be able to decide when and whether to have children. This should be whether she is HIV positive or not. There should be no controversy about this. Women need and deserve a voice in the decisions that affect their lives."

New TB drug shows excellent promise - AIDS Conference 2012

A new drug for the treatment of tuberculosis (TB) has performed very well in a clinical trial.
The drug, PA-824, was taken in combination with the antibiotic moxifloxacin and the anti-TB drug pyrazinamide.
In a randomised study lasting 14 days, the PA-824-containing regimen had better antibacterial activity than five other arms, one of which involved therapy with standard TB treatment.
The PA-824-containing regimen is expected to work against both drug-sensitive and drug-resistant TB. It is hoped that use of the drug could reduce the length of treatment for multidrug-resistant TB (MDR-TB) by up to a year.
Importantly, the combination is unlikely to have any significant interactions with HIV therapy.
“The regimen of PA-824 plus moxifloxacin plus pyrazinamide has really very dramatic improvement over a number of other combinations,” said researchers.

During two weeks of treatment, the combination killed 99% of TB bacteria.

Promising results for a new treatment combination

A new treatment combination of maraviroc (Celsentri/Selzentry) plus ritonavir-boosted atazanavir (Reyataz) produced good results, it was reported to AIDS 2012. 

The study compared this combination with tenofovir/emtricitabine (Truvada), and both arms also took atazanavir boosted with ritonavir. The new combination is unusual in that it doesn’t contain a drug from the NRTI class. 

After 96 weeks, 67.8% of people taking maraviroc and 82.0% of those on Truvada had undetectable viral loads – the goal of HIV treatment. Using a less sensitive test, 78.0% and 83.6%, respectively, had a viral load below 400.

Rises in CD4 cell count were similar on both the treatment combinations. 

More people taking maraviroc had serious side-effects than those on Truvada (22 vs 18%). These included jaundice because of raised bilirubin, a known side-effect of atazanavir.

But fewer people on maraviroc had indicators of reduced kidney function or of bone problems (tenofovir is known to cause kidney and bone problems in some people). 

A new trial is now underway testing maraviroc with a different protease inhibitor, darunavir (Prezista).

Sex work, HIV risk and human rights

A major theme for AIDS 2012 is turning the tide for key populations, and one of these groups is sex workers.

The Sex Worker Freedom Festival in Kolkata – 

an alternative conference hub for sex workers denied entry to the United States. 

Image courtesy of Luca Stevenson, Sex Worker Open University 

www.sexworkeropenuniversity.com and ICRSE www.sexworkeurope.org

Sex work is illegal in many countries, creating its own problems for sex workers trying to protect themselves against HIV. Now there seems to be a global trend of criminalising condom possession, with police claiming it provides ‘evidence’ that sex work is taking place.

Research was presented at the Washington conference on the impact these new laws are having: condom use by sex workers has reduced significantly, increasing the risk of HIV transmission.

The session called for an end to this trend of new police powers, but – more importantly – for the decriminalisation of sex work for both the workers and their clients. This would have clear benefits for both public health and human rights.

Hillary Clinton mentioned sex workers specifically in her address to the conference, pledging money for prevention programmes for this at-risk group.

The US has been criticised this week for denying sex workers visas to enter the country and attend AIDS 2012. A Sex Worker Freedom Festival is taking place in Kolkata, India, as an alternative conference hub for sex workers denied entry to the United States. (You can follow events at the Kolkata conference through the HIVandhumanrights blog.)