In a bid to reduce levels of undiagnosed HIV in Cardiff, HIV and sexual health charity Terrence Higgins Trust (THT) is encouraging people who may have been at risk to attend a local service offering one-hour HIV testing. One in four people who have HIV in the UK are undiagnosed, and there are now more people living with the condition than ever before.

THT’s ‘Fastest’ service is free and confidential, and involves taking a finger-prick blood test which is analysed straight away, with the results provided within one hour. Those who attend the clinic will be given information and support before and after the test, and anyone who tests positive will be given full support in choosing a treatment centre. They will also be given information on the range of support services available, including counselling and peer support.

Gavin Mooney, Centre Manager for THT in Cardiff, said: “With recent medical advances, it’s now possible for people with HIV to live long and healthy lives. However, if they leave it too late to get tested, they’re setting themselves up for serious health problems and the risk of early death. In the UK, gay men and Africans are the groups most at risk of contracting HIV, but if you’ve had unprotected sex you may have put yourself at risk, so we’d urge you to get tested as soon as possible.”

THT clinics and workers also offer information and advice on STIs and safer sex, as well as giving out free condoms.

The Fast Test service takes place at THT’s Cardiff centre at 435-451 Cowbridge Road East. Each week, there are sessions on Tuesdays from 6.00pm to 8.00pm. The number of tests that can be done at each session are limited, so people are advised to arrive early.

Source
Terrence Higgins Trust

AIDS Vaccine Day, May 18, marks the occasion in 1997 when U.S. President Bill Clinton challenged researchers to come up with an AIDS vaccine within the following decade, stating that such a vaccine was the only way to eliminate the threat of AIDS. Twelve years later, the goal of an effective HIV vaccine remains unfulfilled, but the need for one remains urgent. AIDS is the number four killer in the world and number one in sub-Saharan Africa. Despite education and prevention campaigns, every day 7,500 people become infected with HIV. Antiretroviral drugs can prolong the lives of those who are infected, but they are not cures, and because of their cost and logistical difficulties, they reach only a minority of those who need them. And for every two individuals who go on antiretroviral treatment, five become HIV infected. As with any major viral pandemic, a vaccine remains the best hope of ending, and not just mitigating, AIDS.

Development of an effective AIDS vaccine will require time and perseverance. Many of today’s licensed vaccines took decades to develop and were the product of many failed attempts. That’s how science works. With each miss, or near hit, researchers learn something-if only what not to do-that advances their progress.

As a result of this kind of incremental learning, we are facing an exciting time in AIDS vaccine science. AIDS vaccine research and development has focused on two arms of the immune system: the arm that dispatches T-cells to seek and destroy human cells that have become HIV infected, and the arm that stimulates the production of antibodies to block HIV from infecting cells in the first place. Today, there are promising new advances on both fronts.

In the past decade, most HIV vaccine development has focused on the T-cell arm, also called cellular immunity. Although vaccine candidates of this type, in the absence of an antibody response, are unlikely to fully prevent HIV infection, in animal studies they have been shown to reduce the amount of virus circulating in the body of the animals that become infected after vaccination. Thus, such a vaccine might keep HIV in check, slowing or preventing progression to AIDS and, perhaps, reducing the chances of transmitting HIV to another person. The only AIDS vaccine candidate of this type to reach efficacy testing failed to show efficacy in the STEP trial in 2007. However, for the first time, researchers have shown in animal studies that a handful of new T-cell vaccine strategies under development can control the amount of virus in infected animals better than approaches previously tested in clinical trials. A subset of these improved T-cell approaches are in early development, heading toward clinical trials.

The greatest scientific challenge impeding AIDS vaccine development is the antibody problem: how to design a vaccine that elicits antibodies that neutralize the many types of HIV in circulation so that the vaccine is protected from infection. But here, too, there is progress to report. Scientists have identified new antibodies capable of neutralizing a wide spectrum of HIV types circulating worldwide. These antibodies may now provide the keys to new vulnerable targets on the surface of HIV, which can be exploited for vaccine design.

There is also an interesting concept now in preclinical testing that aims to use vector-mediated gene transfer to maintain in the body large amounts of broadly neutralizing antibodies against HIV over long periods of time.

Of course, these developments will not lead us directly to an AIDS vaccine. There is much work to do, and more failure ahead, certainly. But the point is, despite disappointments, overall, AIDS vaccine science is progressing.

It does so because of a wide array of participants in the HIV vaccine effort, among them: researchers and technicians who devote themselves to the mission, study and trial participants who make the selfless contribution of volunteering for research, community workers who lend their voices and ears, political leaders who pave the way and donors who make the whole enterprise happen. On the occasion of World AIDS Vaccine Day, we at IAVI salute these individuals and our many partners for their dedication to making an AIDS vaccine a reality.

Source
IAVI

HIV-positive patients who don’t seek medical attention until they have a serious AIDS-related condition can reduce their risk of death or other complications by half if they get antiretroviral treatment early on, according to a new multicenter trial led by researchers at the Stanford University School of Medicine.

The study results could lead to widespread changes in treatment for HIV patients, particularly those diagnosed at an advanced stage, experts say.

“Even in San Francisco, one of the first epicenters of HIV in the United States, we still find that many people still present late in the course of their illness with an opportunistic infection,” said Mitch Katz, MD, San Francisco’s director of health, who was not involved in the study. “This study shows that it is life-saving to treat those persons with antiretroviral drugs while they are still in the hospital. The results of this study will change practices throughout the world.”

Some 60,000 to 70,000 newly HIV-infected individuals are identified every year in the United States, according to recently revised figures from the federal Centers for Disease Control and Prevention. A growing number of these patients, particularly minorities, youth, injection-drug users and those in poor rural areas, are being diagnosed late in the disease process when they’ve already developed life-threatening conditions, said Andrew Zolopa, MD, associate professor of infectious diseases and geographic medicine at Stanford and first author of the study. When these patients come for treatment of these complications, doctors are often reluctant to give them anti-AIDS drugs at the same time, fearing the two therapies could interfere with one another.

“A lot of people wait, thinking, ‘Let’s get the patient out of acute crisis, and then we’ll deal with the underlying HIV infection later,’” said Zolopa. “But that answer is wrong. If we’re more aggressive with HIV drugs, we can reduce AIDS-related complications and death by 50 percent. It’s a substantial clinical benefit.”

The study was conducted by the AIDS Clinical Trials Group, the world’s largest clinical trial organization. Results will be published May 18 in the online journal PLoS-ONE.

William Powderly, MD, dean of medicine at the University College Dublin School of Medicine, said the study addresses one of the last, longstanding unknowns in the management of AIDS.

“Clinicians have long grappled with the question of whether or not early treatment with antiviral drugs will help people who come to the hospital with advanced infections, such as pneumonia,” said Powderly, MD, the study’s senior author. “The answer is clearly yes. Early antiviral treatment for HIV improves the clinical outcome, including the likelihood of surviving in the next few months. It probably does so by improving the immune system and therefore adds to the ability to resist these infections.”

The study findings, presented in abstract form at an earlier scientific meeting, are already starting to change clinical practices. The International AIDS Society, the CDC and the British AIDS Society all have adopted guidelines that recommend that early antiretroviral treatment be considered in patients with an opportunistic infection, Zolopa noted.

The study involved 262 patients at 39 sites across the United States, from Puerto Rico to Seattle. An additional 20 patients were enrolled in a hospital in Johannesburg, South Africa. Eighty-five percent of the patients were men whose median age was 28. They were an ethnically diverse group: 37 percent were black, 36 percent Hispanic, 23 percent white and 5 percent Asian.

The patients all had one or more opportunistic infection, with the most common ones being pneumocystis jirovecii pneumonia, cryptococcal meningitis and serious bacterial infections. Patients with tuberculosis were excluded from the study because it was unclear what the optimal antiviral treatment was for these patients, Zolopa said.

The patients, who were enrolled between May 2003 and August 2006, were separated into two groups: those who got antiretroviral treatment early and those for whom this treatment was delayed until their opportunistic infections had been dealt with. The patients were all offered antiretroviral drugs free of charge. The drugs for the study were supplied by Abbott Laboratories (lopinavir/ritonavir), Gilead Sciences (tenofovir and emtricitabine) and Bristol-Myers Squibb (stavudine).

The patients in the early intervention arm of the study were treated with ARVs within an average of 12 days, while those in the deferred group received the treatment within an average of 45 days after the start of treatment for the opportunistic infection. Among the patients treated early, there were 20 (14.2 percent) who died or developed another significant AIDS-related complication. That compared with 34 patients (24.1 percent) in the deferred group who died or suffered a new complication.

In addition, the patients in the early treatment group saw a much swifter recovery of their immune systems. The early group patients saw their T-cell counts, a measure of the immune cells destroyed by the AIDS virus, increase to more than 100 within four weeks. In the deferred treatment group, it took 12 weeks for the patients’ T cells to reach that same level, the researchers reported.

“I was quite impressed at how rapidly these T cells could rise in these patients,” Zolopa said. “By starting ARVs early you can effectively reduce the window of vulnerability where another AIDS-related complication could develop.”
Zolopa said there was no difference between the two sets of patients in their adherence to their prescribed regimens. One concern in treating patients with ARVs soon after being diagnosed with AIDS is that they might not stick to their treatments and could then develop drug resistance. But adherence did not prove to be an issue, he noted.

“Starting the therapies early didn’t scare people off,” he said.

According to Zolopa, the study results probably provide some guidance for patients in developing countries, though each country would have to determine its own strategy for initiating ARVs in patients with advanced AIDS.

“These results do have important implications across the globe,” he said.

Although the study did not include patients with tuberculosis, the most common AIDS-related complication among patients in sub-Saharan Africa, early ARV treatment has been shown in other, more recent studies to be of value in those patients with TB, Powderly said.

Zolopa said implementing the study findings could entail some logistical challenges, as hospitals will have to develop interdisciplinary teams, including pulmonary specialists, emergency physicians, pharmacists and others, in coordinating early treatment for these critically ill patients as they come into the system.

Other researchers in the study are Janet Andersen, ScD, and Lauren Komarow, both with Harvard School of Public Health; Ian Sanne, MD, of the South African College of Physicians; Alejandro Sanchez, MD, of the USC Keck School of Medicine; Evelyn Hogg with Social & Scientific Systems, Inc.; and Carol Suckow with the Frontier Science and Technology Research Foundation.

The study was funded by the National Institutes of Health through the Division of AIDS.

Source
The Stanford University School of Medicine