Aids Discussion

Medicare To Pay For HIV Testing

admin — Fri, 19 Mar 2010 11:00:29 +0000

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Reuters: “Americans enrolled in the U.S. government-run AIDS will be covered for Medicare beneficiaries who are at increased risk for the infection, including pregnant women, CMS said, but it added that Medicare participants of any age who voluntarily request the service will also be covered” (Berkrot, 12/8).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

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Obama Administration Releases Five-Year PEPFAR Strategy, Avoids Abortion, Abstinence Issues

admin — Fri, 19 Mar 2010 09:00:44 +0000

The Obama administration last week released a 74-page outline of its new President’s Emergency Plan for AIDS Relief implementation strategy, which includes slowing expansion of antiretroviral drug distribution in favor of prevention and fighting other deadly diseases, the New York Times reports. The strategy emphasizes prevention, curtailing mother-to-child transmission and focusing on treatment of the sickest people, pregnant women and individuals with tuberculosis. In addition to HIV/AIDS, funding would be used to battle diseases that cost less to fight, including diarrhea, fatal birth complications, malaria and pneumonia. Since its 2004 inception under President George W. Bush, PEPFAR has provided antiretroviral access to a total of 2.4 million people, with an average of nearly 500,000 new people beginning to take the drugs annually. The new strategy aims to increase the number of individuals receiving antiretrovirals by about 320,000 each year for the next five years, bringing total recipients to four million people by 2014, according to the Times.

According to the Times, the strategy “is nearly silent” on controversial issues like abstinence and distribution of condoms through missionary hospitals that oppose their use. The proposal also does not specify whether funding would be cut off for groups that support abortion rights, groups that work with sex workers but do not condone prostitution or countries that criminalize homosexual sex (McNeil, New York Times, 12/9).

In addition, more of the day-to-day management of the program will be shifted to the 15 countries that have received the bulk of PEPFAR funding to date. According to the Washington Post, the goal is to make prevention and treatments services — such as the provision of antiretroviral drugs, HIV counseling and testing, prevention advice and condoms, and palliative care for people at advanced stages of the disease — a routine part of those countries’ health offerings.

Over the next five years, the Obama administration’s goal is for PEPFAR to provide care for 12 million people and double the number of infants born without HIV. While the U.S. will continue to contribute most of the funding, additional money would come from foreign donors and the Global Fund To Fight AIDS, Tuberculosis and Malaria. According to the Post, the exact amount of money slated to be spent through the program is unclear (Brown, Washington Post, 12/8). The Times reports that President Obama, during the presidential campaign, pledged to increase PEPFAR’s budget by $1 billion annually, though his first budget proposal included a $165 million increase (New York Times, 12/8).

On Monday, administrators of the program also released three supplements that describe how nations’ health ministers would take on the tasks of delivering services — as many already do — managing the programs and gauging their effects, the Post reports. Eric Goosby, the Obama administration’s global AIDS coordinator and chief administrator of PEPFAR, said, “It is our honest belief that these programs are in a fragile period,” adding, “We need to transition them into being more embedded in the countries’ infrastructure and for the countries to have true ownership of them” (Washington Post, 12/8).

The Obama administration has drawn the criticism of some HIV/AIDS advocates who believe that the administration is trying to save money by shifting emphasis from providing antiretrovirals to encouraging preventive measures, according to the Times. Gregg Gonsalves — a longtime HIV/AIDS campaigner — said, “I’m holding my nose as I say this, but I miss George W. Bush,” adding, “On AIDS, he really stepped up. He did a tremendous thing. Now, to have this happen under Obama is really depressing.”

Goosby stressed that more people would be given the treatments each year. “We’re honoring our commitment, we’re increasing our commitment, we will not veer from that commitment,” he said. Ezekiel Emanuel — a bioethicist at the National Institutes of Health and a health care adviser to the White House Office of Management and Budget, who also is the brother of White House Chief of Staff Rahm Emanuel — rejected rumors that he and Goosby have sparred over the number of people that should be treated. “This is [Obama's] policy and the way he wants to approach it, and no individual counselor stands in his way” (New York Times, 12/8).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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FY2010 State And Foreign Ops Bill Expected To Move On The Hill This Month

admin — Fri, 19 Mar 2010 07:00:58 +0000

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The fiscal year 2010 State and Foreign Operations Appropriations bill, which includes funding for global health-related measures, “is moving on the Hill as part of a mammoth catch-all spending bill that’s expected to move through both chambers this month,” Foreign Policy’s blog, “The Cable,” reports. “It’s been more than a month since the new fiscal year started and several federal agencies are operating under a stop-gap funding measure called a ‘continuing resolution’ that keeps the government humming but doesn’t allow for new funding initiatives to begin. That expires on Dec. 18, giving a semi-firm deadline for Congress to pass the real funding bills,” the blog notes (Rogin, 12/9).

A Committees on Appropriations summary document (.pdf) from the House and Senate chairs highlights some funding allocations in the consolidated bill. The items related to global health and food security are:

“Global Health and Child Survival: $7.779 billion, $440 million above 2009 and $184 million above the request, to strengthen global public health infrastructure and surveillance to save lives overseas and protect the health of Americans from infectious diseases. It is estimated that U.S. investment in bilateral HIV/AIDS programs has provided life-saving treatment for 2.4 million people and the Global Fund to Fight AIDS, Tuberculosis, and Malaria has saved millions more. Specific investments include:

HIV/AIDS: $5.709 billion (including $350 million for AUSAID HIV/AIDS programs), $200 million above 2009 and $100 million above the request, for international HIV/AIDS prevention, treatment and care programs including $750 million for multilateral programs through the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.
USAID Global Health and Child Survival Programs: $2.42 billion to USAID, including for HIV/AIDS, which when combined with $50 million for global pandemic programs in the FY 2009 supplemental is $134 million above the request and $440 million above 2009, for other global health programs. This includes increases of nearly $54 million for maternal and child health programs, $202.5 million to fight malaria, $62 million to fight tuberculosis, and $103 million for international family planning.”

“Development Assistance: $2.520 billion, $720 million above 2009 and $214 million below the request, including for agricultural development, climate change, micro-credit, democracy and governance, and education in countries that face a complex range of long-term development challenges.”

“Agriculture and Food Security Programs: $1.170 billion, $698 million above 2009 and $193 million below the request, to provide agricultural assistance and improve food security. More than one billion people suffer from chronic hunger.”

“Improving Access to Safe Drinking Water: $315 million, $15 million above 2009 and $160 million above the request, for safe water programs, including increasing access to safe drinking water (such as pumps and wells); building water systems; and expanding safe hygiene programs. Over a billion people around the globe lack access to safe drinking water and two and a half billion lack access to basic sanitation.”

“Humanitarian Assistance:

Refugee Assistance: $1.730 billion, $19 million above 2009 and $175 million above the request, to help displaced people around the world with food, water, shelter and other basic needs. According to the UN High Commissioner for Refugees, as of early 2009, there are approximately 10.5 million refugees of concern worldwide, and many more internally displaced persons.
Disaster Assistance: $845 million, $25 million above 2009 and $35 million below the request, to avert famines and provide life-saving assistance during natural disasters and for internally displaced people in Africa, Afghanistan, Pakistan, Iraq and elsewhere around the world.”

“Millennium Challenge Corporation (MCC): $1.105 billion, $230 million above 2009 and $320 million below the request, for bilateral assistance to developing nations. MCC compacts have supported agriculture, transportation, education, health, and financial development projects” (Committees On Appropriations, 12/8).

This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.

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Drinks Industry Supplanting Government Role In Alcohol Policies In Sub-Saharan Africa

admin — Thu, 18 Mar 2010 11:00:31 +0000

A recent comparison of proposed national alcohol policies in Lesotho, Malawi, Uganda, and Botswana shows that the drinks industry has assumed a significant and detrimental role in designing national alcohol policies in Sub-Saharan Africa. The policy drafts point to the alcohol industry’s preferred version of a national alcohol policy, which includes letting the industry regulate its own marketing activities.

In a study published in the January issue of the journal Addiction, researchers Øystein Bakke and Dag Endal found that that alcohol policy documents from the four African countries were almost identical, and were likely based on a single source document that reflects alcohol industry interests. That source document originates from a series of alcohol policy initiatives in Sub-Saharan countries sponsored by multinational brewer SABMiller and the International Center on Alcohol Policies (ICAP), an alcohol industry-funded organisation.

The proposed national alcohol policies emphasise the economic benefits of the alcohol trade and the positive health impacts from alcohol consumption. Three of the drafts cite “self-regulation by the alcohol beverage industry as the most suitable way to manage marketing and promotions.” All four proposed policies prescribe “active participation of all levels of the beverage alcohol industry as a key partner in the policy formulation and implementation process.”

When approached for comment, SABMiller said that workshops which took place prior to the policies being drafted included significant discussion about population-based measures and references to relevant World Health Organisation (WHO) sponsored research. However, the draft policies contain few of the best-practice policy recommendations developed by independent researchers working on behalf of the WHO. They also fail to address alcohol’s role in key development issues such as HIV/AIDS, gender-based violence, child rights, and social and economic deprivation.

The authors observe that the timing of the policy initiative suggests that it was spurred by the 2005 WHO alcohol initiative, and may represent an attempt to establish policies in Africa before WHO recommendations have a chance to influence their content.

Authors Bakke and Endal state: “Few, if any, would accept Philip Morris as the designer of the tobacco policy for a national government. The alcohol industry’s current policy proposals in several Southern African states can hardly be viewed any differently.”

Bakke Ø. and Endal D. Alcohol policies out of context: Drinks industry supplanting government role in alcohol policies in Sub-Saharan Africa. Addiction 2010; 105: 22-28

Discussion of a Global Strategy to Reduce the Harmful Use of Alcohol is planned for the WHO Executive Board meeting in January 2010 and at the World Health Assembly in May 2010.

Source: Amy Molnar

Wiley-Blackwell

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admin — Thu, 18 Mar 2010 09:00:36 +0000

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Further Progress Toward AIDS Vaccine

admin — Thu, 18 Mar 2010 07:00:46 +0000

Researchers from Thomas Jefferson University are one step closer to developing a vaccine against the AIDS disease.

Led by Matthias J. Schnell, Ph.D., director of the Jefferson Vaccine Center, the researchers found that a rabies virus-based vaccine administered to monkeys protected against the simian equivalent of the HIV virus (SIV). The data were published in the journal Vaccine.

The researchers previously showed that a rabies-based vaccine expressing HIV and SIV antigens protective against a chimeric HIV/SIV virus in monkeys. In this study, they used highly attenuated rabies virus vaccine vectors to protect against challenge with the highly pathogenic SIVmac251. This type of SIV virus causes a more similar disease in monkeys compared to human infection with HIV-1. In addition, it is difficult to protect monkeys against AIDS-like disease after challenge with SIVmac251.

Two vaccine strategies were used: immunization with a recombinant rabies virus expressing SIVmac239GagPol, or a combination of that and a rabies virus expressing SIVmac239Env. Both strategies induced neutralizing antibody production, CD8+ T cell responses, and increased protection. Although the combination with Env helped immediately following the infection, the long-term benefits were minimal. However, it was surprising that the rabies-based vaccine was able to induce such potent anti-SIV humoral responses.

“Although we can’t yet block the infection, we showed that we can protect against disease,” said Dr. Schnell. “We also saw significant antibody activity against the virus, which is promising. In addition, this is a very simple approach that only took two immunizations.”

Source: Emily Shafer

Thomas Jefferson University

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Induction Of Antibodies That Block HIV Prevented By Biological Catch-22

admin — Wed, 17 Mar 2010 17:00:23 +0000

Scientists seeking to understand how to make an AIDS vaccine have found the cause of a major roadblock. It turns out that the immune system can indeed produce cells with the potential to manufacture powerful HIV-blocking antibodies - but at the same time, the immune system works equally hard to make sure these cells are eliminated before they have a chance to mature.

“These studies show that a potentially protective neutralizing antibody against a viral disease is under the control of immunological tolerance,” said Barton Haynes, M.D., director of the Center for HIV/AIDS Vaccine Immunology (CHAVI) at Duke University Medical Center and senior author of the study appearing in the online early edition of the Proceedings of the National Academy of Sciences. “This represents a new insight into the way HIV effectively evades detection by the B cell arm of the immune system and may offer new directions for vaccine design.”

Over the years, scientists have assumed that B cells - one of the first lines of defense against infection - are simply not able to “see” the HIV virus. HIV has the ability to hide its most vulnerable parts from immune system surveillance, and researchers generally assumed that helped explain why B cells often took weeks and even months to arise following infection.

But several years ago, Duke researchers hypothesized that the antibodies required to broadly neutralize HIV may not be produced in the first place because the immune system “sees” them as a potential threat - due to their similarity to antibodies that promote autoimmune disease - and destroys them.

To see if this is indeed what happens, Laurent Verkoczy, Ph.D., assistant professor of medicine at Duke and the lead author of the study, and Haynes genetically engineered a mouse that could only produce B cells containing a rare but potent broadly neutralizing human antibody that is able to block HIV infection.

Researchers found that the mouse’s immune system produced plenty of early stage B cells bearing this human neutralizing antibody on their surface but eliminated most of them before they had a chance to fully evolve into more mature B cells capable of secreting the antibody.

“This work may mean that we need to think and act very differently in envisioning how a successful vaccine may work,” said Verkoczy. “The good news is that while about 85 percent of the “right” kind of B cells are eliminated, about 15 percent survive and wind up in circulating blood, but are turned off. One goal in vaccine design may be to figure out how to wake them up so they can go to work.”

“We have now unveiled a major reason why members of this class of neutralizing antibodies are not routinely made: Our own immune systems block their production because they are perceived as potentially harmful, when in reality, they are not,” said Haynes. “This is a very unusual way the virus has developed to evade the immune system.”

Haynes says researchers plan on using the new mouse model to test ways to teach the immune system to enable the production of powerful neutralizing antibodies capable of blocking HIV.

The research was supported by the Bill and Melinda Gates Foundation, the Duke Center for AIDS Research, and grants from the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

Duke colleagues who contributed to the research include T. Matt Holl, Hilary Bouton-Verville, S. Munir Alam, Hua-Xin Liao and Garnett Kelsoe. Additional co-authors include Marilyn Diaz, from the National Institute of Environmental Health Sciences and Ying-Bin Ouyang, of Xenogen Biosciences.

Source: Michelle Gailiun

Duke University Medical Center

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Research On Leishmaniasis In Ethiopia Benefits From $5 Million Grant To Hebrew U.

admin — Wed, 17 Mar 2010 16:34:26 +0000

The Hebrew University of Jerusalem Kuvin Center for the Study of Infectious and Tropical Diseases has received a $5 million grant from the Bill & Melinda Gates Foundation for research into visceral leishmaniasis in Ethiopia.

The project will be led by Prof. Alon Warburg, a vector biologist working at the Institute of Medical Research Israel-Canada at the Hebrew University’s Faculty of Medicine.

The project, entitled ‘Studies on the ecology and transmission dynamics of visceral leishmaniasis in Ethiopia’, will comprise thorough investigations to determine the drivers of transmission of Kala-Azar in endemic foci. The ecology of the sand fly vectors and their larval breeding habitats will be characterized and putative reservoir hosts will be incriminated. In parallel, genotypes and drug sensitivities of the Leishmania parasites will be studied in depth. The data gathered will be rigorously analyzed and utilized to identify the weak links in the transmission cycle in order to devise methods for control of the disease.

According to Prof. Warburg, “Visceral leishmaniasis is transmitted by small, mosquito-like insects known as sand flies. Sand flies become infected with Leishmania while sucking blood from an infected person or animal and transmit the disease during subsequent blood meals. Sand fly control is problematic because the breeding sites of their immature stages are unknown, making larval source reduction all but impossible.”

An estimated 500,000 cases of visceral leishmaniasis - also known as Kala-azar - occur annually. More than 90 percent of the cases are concentrated in the Indian sub-continent, East Africa and Brazil. The worst affected region in Africa is southern Sudan and northwest Ethiopia. Kala Azar is considered an emerging disease in Ethiopia where it is frequently associated with HIV/AIDS, a leading cause of adult illness and death. Leishmania donovani parasites multiply inside cells of the immune system producing symptoms that include an enlarged spleen and fevers. If treated with a 30-day course of intra-muscular injections, the cure rate is 95 percent. However, if left untreated, Kala-azar kills 95 percent of its victims.

Co-infection with HIV makes treatment much more complex. Because the immune system is suppressed in HIV-positive patients, Kala-azar relapses are common and patients have to be treated multiple times. Given the difficulties of treating large populations in remote areas and the bleak prospects for co-infected patients, efforts must be made to protect people living in HIV/AIDS-endemic areas from contracting Kala-azar.

This is a collaborative project with Prof. Asrat Hailu from the Faculty of Medicine and Prof. Teshome Gebre-Michael of the Aklilu Lemma Institute of Pathobiology in Addis Ababa University. Additional collaborating institutions include the Hebrew University’s Robert H. Smith Faculty of Agriculture, Food and Environment, Charles University in Prague, the Volcani Center and the Gertner Institute for Trauma and Emergency Medicine Research.

Source: Jerry Barach

The Hebrew University of Jerusalem

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UAB Aids Center Director Installed As Chair Of HIV Medicine Association

admin — Wed, 17 Mar 2010 16:33:12 +0000

Michael Saag, M.D., director of the University of Alabama at Birmingham (UAB) Center for AIDS Research and a renowned leader in the establishment of best practices for human immunodeficiency virus (HIV) treatment, has been installed as chair of the board of directors of the HIV Medicine Association (HIVMA).

HIVMA is the largest professional society of physicians, scientists and health-care professionals dedicated to the field of HIV and AIDS. The organization actively promotes quality in HIV care and advocates for policies that ensure a science-based, comprehensive and humane response to the AIDS pandemic, including adequate funding for HIV research, prevention, care and provider training and resources.

A professor of medicine, Saag also directs UAB’s Division of Infectious Diseases. He is on the board of directors of the International AIDS Society-USA, and he helped author U.S. Department of Health and Human Services guidelines for antiretroviral treatments and edits the Sanford Guide to HIV/AIDS Therapy. Saag will serve a one-year term with HIVMA that ends November 2010.

Saag is credited with being the first to demonstrate the value of viral-load testing in a clinical practice. This test allows physicians to follow the response to antiretroviral treatment, just as they follow the blood-sugar response to insulin when treating diabetics. He also is among the first to perform clinical trials of several antiretroviral drugs that are approved worldwide.

Saag helped establish UAB’s 1917 Clinic, a comprehensive HIV outpatient clinic devoted to patient care and clinical-trial coordination. Opened in 1988, the clinic has grown into a hub for HIV basic science and treatment-outcomes research at UAB.

He has authored dozens of scientific manuscripts, contributed more than 50 chapters to medical textbooks and served on the editorial board of the journal AIDS Research and Human Retrovir uses. He also has served on subspecialty committees of the American Board of Internal Medicine and the American College of Physicians.

Saag earned his medical degree from the University of Louisville in Kentucky and completed a postdoctoral fellowship at UAB. He is the Jim Straley Chair in AIDS Research and an active member of the American Society of Clinical Investigation.

About the HIV Medicine Association

The HIV Medicine Association (HIVMA) is the professional home for more than 3,600 physicians, scientists and other health-care professionals dedicated to the field of HIV/AIDS. A part of the Infectious Diseases Society of America, HIVMA promotes quality in HIV care and advocates policies that ensure a comprehensive and humane response to the AIDS pandemic informed by science and social justice. For more information, visit http://www.hivma.org.

About the UAB Center for AIDS Research

The UAB Center for AIDS Research (CFAR) is one of the seven original centers established in 1988 by the federal government to stimulate research and advances in fighting AIDS and HIV. CFAR supports prevention and HIV-patient care at the 1917 Clinic and in Africa through a partnership with the Center for Infectious Disease Research in Zambia.

Source
University of Alabama at Birmingham

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African Scientist Wins Award For HIV And TB Co-infection Research

admin — Fri, 06 Nov 2009 10:00:34 +0000

A scientist who is helping to treat thousands of people living with HIV and tuberculosis (TB) in South Africa was awarded the Royal Society Pfizer Award at a ceremony last night (27 October). Dr Linda-Gail Bekker’s research looks at how TB epidemiology has changed in the HIV era. Researchers estimate that more than one in ten of all South Africans over 2 years old were living with HIV in 2008. South Africa has also seen a six fold increase in tuberculosis rates in the last 20 years.

The Royal Society Pfizer Award includes a £60,000 award grant which aims to encourage medical research in Africa by supporting young scientists. Pfizer, the world’s leading research-based pharmaceutical company has been supporting the awards for the last four years and has so far granted £240,000 core funding for research work in Africa.

Dr Bekker is deputy director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town and chief operating officer of the Desmond Tutu HIV Foundation. Her doctoral work focused on the host response to TB both with and in the absence of HIV co-infection. Subsequently her research interests have expanded to include programmatic and action research around antiretroviral roll out, TB integration and prevention of HIV.

The funding provided by this award will help with research being carried out at Nyanga Primary Health Clinic in Cape Town. Bekker’s team will collect positive tuberculosis cultures obtained from sputum samples in the clinic with the specific aim of describing the diversity of TB strains among HIV-positive individuals receiving Highly Active Anti-Retrovir al Treatment (HAART), HIV- positive individuals not receiving HAART and HIV negative individuals. They will also explore healthcare-associated transmission of tuberculosis in the clinic and test drug sensitivities of all cultures. It is hoped the research will have lessons for how TB/HIV and ART services are designed and run in southern Africa as well as giving further information on host susceptibility and organism virulence.

Dr Bekker said of her award:

“In 2005, the World Health Organization declared a regional emergency and called for extraordinary measures to be implemented to curb the unprecedented increase in HIV/TB currently occurring in South and southern Africa. I am so honoured to be a recipient of the Royal Society Pfizer Award this year- it will help me and the great team I work with to do our part in investigating urgently what those extraordinary measures should be. More than ever before this public health crisis requires innovative thought and research to find novel answers and effective strategies to turn these numbers around.”

Professor Ralph Kirsch, a colleague of Dr Bekker’s at the University of Cape Town, said:

“Linda Gail marries science and humanity in her approach to patients with HIVAIDS. She is constantly looking at how to provide better care and how to make compliance easier. Her relationship with her patients and with those recruited into her various studies is an important role model to us all.”

Professor Lorna Casselton, Foreign Secretary of the Royal Society, said:

“The Royal Society Pfizer Award recognises the valuable research already taking place in Africa, whilst aiming to expand research capacity. We hope that this award will continue to boost the careers of its winners and the individuals working around them. This year’s winner, Dr Linda-Gail Bekker, has done outstanding research into tuberculosis and HIV co-infections in Africa. Her contribution to several innovative and successful health delivery platforms and capacity building opportunities has been invaluable. We congratulate her and hope that this funding will help her continue her research to its full potential.”

Dr Freda Lewis-Hall, Chief Medical Officer of Pfizer Inc, said:

“Defeating infectious disease means making advances in both prevention and treatment. Pfizer is proud to be a partner with the Royal Society in creating this award, which recognizes essential and inspiring medical and public health research from a new generation of African scientists. Support like this translates into new knowledge, lives extended and saved, and less human pain and suffering.”

The award grant and a £5,000 personal prize were presented to Dr Bekker at a ceremony at the Royal Society in London last night.

Source
The Royal Society

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