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A Wilmington News Journal editorial discussed the potential lifting of the ban on using federal funding for needle exchange programs. The editorial notes recent Congressional action and the restrictions in a House bill that prohibit needle exchanges to operate “within a 1,000 feet of day care centers, schools, parks, playgrounds, pools and youth centers.” According to the News Journal, “This rule wipes out much of the flexibility many cities need in their fight to prevent the spread of HIV among intravenous drug users. The nation’s capital, where the rates of HIV and AIDS cases are considered epidemic, would be hit the hardest because no part of the District of Columbia would be eligible for the funding according to AIDS Action.” The editorial adds, “Vans patrolling near vulnerable populations - specifically young, impressionable children - are an issue that must be addressed. But well-intentioned limits should not be allowed to hold up the rest of the program,” according to the News Journal (8/1).

This information was reprinted from dailyreports.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily U.S. HIV/AIDS Report, search the archives and sign up for email delivery at dailyreports.kff.org.

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The Cincinnati Enquirer examines how STOP AIDS - a local organization providing cash assistance, HIV education, tests and treatment - has “had to dig into reserve funds to continue to provide” some of its services to clients. According to the Enquirer, “Delays in reimbursement of federal funds by the state forced [STOP AIDS] to scramble for the past six weeks to serve its 1,000 clients.” The Enquirer reports that “[f]unds from the Ryan White HIV/AIDS Program distributed by the Ohio Department of Health were held up when lawmakers and Gov. Ted Strickland [D] failed to reach a budget compromise in July”; officials contend that the funds “could arrive late this week.” The Cincinnati-based organization “conducts about 3,000 HIV tests a year and provides education programs to 20,000 people a year in schools and prisons,” according to the article (Curnutte, 8/19).

This information was reprinted from dailyreports.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily U.S. HIV/AIDS Report, search the archives and sign up for email delivery at dailyreports.kff.org.

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Former National Basketball Association player Earvin “Magic” Johnson gave the opening address of the CDC’s 2009 HIV Prevention Conference in Atlanta, the Southern Voice blog “The Latest” reports. He “spoke frankly about being HIV positive for nearly 20 years,” and discussed the impact black religious leaders have on addressing HIV/AIDS in the black community, according to the blog. Johnson said, “We now have a major problem in urban America, in inner cities - the face of AIDS has changed from a gay white man’s disease to a black and [Hispanic] disease. And if we don’t get the black church involved, there is no way we can bring these numbers (of new HIV cases) down.” The Magic Johnson Foundation “is working to partner with black churches … because African-Americans are disproportionately impacted by the disease,” according to the blog. Johnson said, “We all have to get black churches involved. If we do, we will see change quickly. One constant in the black community is the church” (Bagby, 8/24).

This information was reprinted from dailyreports.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily U.S. HIV/AIDS Report, search the archives and sign up for email delivery at dailyreports.kff.org.

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TIME examines the debate over the Ugandan government’s recent decision to use money from the U.N. Population Fund to purchase and distribute 100,000 female condoms to stop the spread of HIV/AIDS. Supporters of the government’s plan say female condoms increase a woman’s ability to negotiate with her partner. “The main issue was the desire for women to be able to say, ‘OK, you’re not going to use yours, then let’s use mine,’” Serra Sippel, president of the Center for Health and Gender Equity, said.

“Many experts, however, disagree,” fearing instead, “that by offering yet another choice, the government’s move may only distract from other drug and condom programs,” the magazine writes. Also, as the article notes, the female condom, which is more expensive than the male condom, has been slow to catch on since its introduction in the 1990s.

“Uganda sees the female condom as one way to regain the success the nation had in the fight against HIV/AIDS in the 1990s. After slashing its AIDS rate from more than 20% in the late ’80s to about 6% in 2000, Uganda saw a leveling off of AIDS cases and then a slight rise,” according to the magazine.

Beginning this year, the government will distribute the condoms in two regions in Uganda and will consider extending the program with the support of donors, according to TIME. However, the magazine writes, “[m]ajor donors including PEPFAR say they are not likely to back the female condom in Uganda.” Mike Strong, coordinator for PEPFAR in Uganda, suggested the government focus on the programs already in progress rather than starting from scratch with new programs (Wadhams, 8/30).

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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A bill proposed by Washington, D.C., council member Marion Barry (D), which “has been stalled in committee since July,” would mandate HIV testing and counseling for all district jail inmates upon admission, the Washington Post reports. Since 2006, the district has administered “voluntary HIV tests to all inmates upon admission, although they can opt out,” and “99 percent, or more than 27,000, inmates have opted to take the test, according to the Department of Corrections,” the newspaper reports. Walter Smith, executive director of D.C. Appleseed Center for Law and Justice, Corrections Director Devon Brown and HIV/AIDS Administration Director Shannon Hader all oppose mandatory testing, according to the article. “Twenty-one states test inmates for HIV when they are admitted to prison, according to the Department of Justice’s Bureau of Justice Statistics. But most states test only with an inmate’s consent or upon court order” (Ricard, 8/30).

This information was reprinted from dailyreports.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily U.S. HIV/AIDS Report, search the archives and sign up for email delivery at dailyreports.kff.org.

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Researchers at and associated with the International AIDS Vaccine Initiative (IAVI), at The Scripps Research Institute, and at the biotechnology companies Theraclone Sciences and Monogram Biosciences have discovered two powerful new antibodies to HIV that reveal what may be an Achilles heel on the virus. They published their work in Science this week.

Researchers will now try to exploit the newfound vulnerability on the virus to craft novel approaches to designing an AIDS vaccine. Moreover, the global collaboration and process that led to the discovery of the two new broadly neutralizing antibodies (bNAbs) are likely to produce more such antibodies, which may in turn reveal additional vulnerabilities of HIV, adding still more vitality to the effort to develop a vaccine against AIDS.

“The findings themselves are an exciting advance toward the goal of an effective AIDS vaccine because now we’ve got a new, potentially better target on HIV to focus our efforts for vaccine design,” said Wayne Koff, senior vice president of research and development at IAVI. “And having identified this one, we’re set up to find more, which should further accelerate global efforts in AIDS vaccine development.”

Broadly neutralizing antibodies to HIV are produced by a minority of HIV-infected individuals and are distinct from other antibodies to HIV in that they neutralize a high percentage of the many types of HIV in circulation worldwide. It is widely believed that to prevent HIV infection an AIDS vaccine would need to teach the body to produce these powerful antibodies before exposure to the virus. Animal experiments suggest that conceptually such a vaccine would work. Before this finding only four antibodies to HIV had been discovered that were widely agreed to be broadly neutralizing.

The two newly discovered bNAbs, called PG9 and PG16, are the first to have been identified in more than a decade and are the first to have been isolated from donors in developing countries, where the majority of new HIV infections occur. Moreover, previously identified bNAbs against HIV have functioned by binding to places on HIV that have proven difficult to exploit by means of vaccine design.

“These new antibodies, which are more potent than other antibodies described to date while maintaining great breadth, attach to a novel, and potentially more accessible site on HIV to facilitate vaccine design,” said Dennis Burton, professor of immunology and microbial science and scientific director of the IAVI Neutralizing Antibody Center at The Scripps Research Institute in La Jolla, California. Professor Burton is also a member of the newly established Ragon Institute of MGH, MIT and Harvard. “So now we may have a better chance of designing a vaccine that will elicit such broadly neutralizing antibodies, which we think are key to successful vaccine development.”

Breadth of neutralization is important because any effective AIDS vaccine must provide protection from a diverse range of the most prevalent types of HIV circulating worldwide. High potency suggests that such antibodies will not have to be produced by the body in very large quantities to confer protection.

The two new antibodies target a region of the viral spike used by HIV to infect cells. The viral spike glycoproteins, termed gp120 and gp41, are highly variable and have evolved to thwart immune attack. But biochemical studies suggest that PG9 and PG16 target regions of gp120 that do not change, which probably accounts for their breadth of neutralization. Now researchers at the IAVI-organized Neutralizing Antibody Consortium (NAC), a scientific network focused on designing vaccines capable of eliciting broadly neutralizing antibodies, will turn their attention to studying the molecular structure of PG9 and PG16 and that of the region they target on the HIV spike. They will use this information to try to devise immunogens - the active ingredients of vaccines - that elicit similar antibodies.

How they were discovered

The methods by which PG9 and PG16 were isolated are themselves proving instructive. Their identification represents the first success of an ongoing global hunt launched by IAVI in 2006 to find new bNAbs to support the rational design of novel AIDS vaccine candidates. The effort, named Protocol G, is unprecedented in scale and distinguished by its emphasis on identifying antibodies that neutralize subtypes of HIV circulating primarily in developing countries. IAVI’s clinical research partners have collected blood specimens from upward of 1,800 HIV-infected volunteers from IAVI-supported clinical research centers in seven sub-Saharan countries as well as from centers in Thailand, Australia, the United Kingdom and the United States.

All samples were sent to Monogram Biosciences, which, working with researchers at IAVI’s AIDS Vaccine Design and Development Laboratory in New York City and the IAVI Neutralizing Antibody Center at The Scripps Research Institute, screened the sera for broadly neutralizing activity. Researchers historically have sought bNAbs in serum by testing whether antibodies from such samples bind to soluble versions of gp120 and gp41. It turns out that PG9 and PG16, however, bind to soluble forms of the proteins very weakly, if at all. The antibodies were detected only because a micro-neutralization assay developed by Monogram in partnership with IAVI measuring their ability to block HIV infection of target cells was run in parallel with the standard binding assays used for screening. This has significant implications for the future screening of bNAbs.

“If you think of it as a fishing expedition,” said Christos Petropoulos, chief scientific officer and vice president of virology research and development at Monogram Biosciences, “we and the rest of the field were previously using the wrong bait in the search for HIV-specific broadly neutralizing antibodies. Together with colleagues at IAVI, we reasoned that the best approach to identifying antibodies with the most potent and broad neutralizing activity was to screen directly for their ability to block HIV infection. To do this we developed a new, specialized test known as the micro-neutralization assay, which has opened up new avenues for exploration of additional donors for similar antibodies.”

Once the researchers had ranked the top 10% of serum samples in terms of breadth of neutralization, they needed to isolate the actual bNAbs. This can be painstaking work. But Theraclone Sciences, a company that had been working outside the HIV field, had a relevant and unique high-throughput process that it adapted to HIV work with financing from IAVI’s Innovation Fund, which is co-funded by the Bill & Melinda Gates Foundation. The Theraclone team used a system designed to expose the entire repertoire of antibodies from a blood sample obtained from an HIV-infected individual. Antibodies with broadly neutralizing potential were identified from this pool and traced to their corresponding antibody-forming cells. Using recombinant DNA technology, bNAb genes were then isolated from these cells to enable the production of unlimited quantities of the antibody clones for research.

“It is exciting that we were able to use our technology to identify and isolate these new bNAbs, which may offer important clues that could help create an effective AIDS vaccine. Through this strong scientific partnership, we have rapidly delivered promising results,” said Matthew Moyle, chief scientific officer and senior vice president of Theraclone Sciences. “This project has been a useful demonstration of Theraclone’s antibody discovery platform in infectious disease, and we highly value IAVI’s collaborative approach to solving the AIDS vaccine challenge,” said David Fanning, president and CEO of Theraclone Sciences.

With a large pool of HIV-positive donors from Protocol G now identified whose serum contains HIV-specific broadly neutralizing antibodies, it is likely that this global collaboration will generate more bNAbs that will benefit the vital enterprise of accelerating AIDS vaccine development.

“The story of the discovery of these two new antibodies demonstrates the challenges of AIDS vaccine research but also the power of the collaboration that formed to produce this advance. This is what can happen when you have researchers from the global North and South, from academia and industry, from within and outside the HIV field, working together in a framework to speed innovation,” said Seth Berkley, president and CEO of IAVI. “By working in this manner, I am confident we will continue to move toward solving the AIDS vaccine challenge, one of the greatest scientific and public health challenges of our time.”

The published study on the two new bNAbs is available online at http://www.sciencemag.org.

Source:
Keith McKeown

Scripps Research Institute

The National Institutes of Health (NIH) has awarded a consortium of Chicago-based institutions, led by Rush University Medical Center, a five-year, $3.75-million grant to establish a Developmental Center for AIDS Research, creating a comprehensive research infrastructure to spur basic science, clinical studies and translational research in the prevention, detection and treatment of HIV infection and AIDS.

The new center is one of only two in the Midwest - the other is in Cleveland, Ohio - and was the only developmental center funded this year. NIH has funded 20 such centers at major academic institutions across the country.

The center in Chicago involves investigators from Rush, the University of Illinois at Chicago (UIC) and Cook County Health and Hospitals System, who will collaborate across disciplines and institutions to advance HIV/AIDS research. Chicago ranks sixth among U.S. cities in the number of HIV cases, with approximately 21,000 known infections and another 5,000 presumed infections.

“With this grant, we have an unparalleled opportunity to make Chicago an epicenter for AIDS research, focusing on translational research that takes investigations from bench to bedside, and out to the community, to make a truly significant impact,” said Alan Landay, PhD, chairman of immunology and microbiology at Rush, director of the new center, and an internationally recognized expert in immunology and HIV pathogenesis.

The NIH funding will be used to create shared “core” facilities that provide expertise and services to participating laboratories at all three institutions.

Rush will head the administrative and developmental cores, with responsibility for strategic planning and operational management. It will oversee scientific communications and funding for important new areas of research and launch a special outreach effort to share advances with the affected community in Chicago.

The University of Illinois at Chicago will direct the basic science and the social and behavioral sciences cores. The basic science core will provide access to, and training in, state-of-the-art technologies for laboratory investigations in virology, molecular biology, immunology and other areas. The social and behavioral sciences core will support research involving social, behavioral and psychosocial issues and facilitate studies and interventions in local, national and international communities.

“Numerous scientists and community activists in our three institutions have been working largely independently to reduce the scourge of HIV/AIDS. This research initiative will provide opportunities for us to share and build upon our varied expertise and perspectives. I fully expect new prevention and treatment strategies to arise from this exciting collaboration,” said Robert Bailey, PhD, professor of epidemiology at the UIC School of Public Health and co-director of the new AIDS research center.

Cook County Health and Hospitals System will direct the clinical core, assisting investigators with clinical and epidemiologic research and facilitating translation of basic science discoveries into the patient care realm. The Ruth M. Rothstein CORE Center for the Prevention, Care and Research of Infectious Diseases, a partnership between Rush and Cook County, sees more than 5,000 HIV-infected individuals each year from diverse communities and has extensive expertise in HIV clinical care and clinical research.

“By including Cook County Health and Hospitals System, the outstanding research team brought together by this grant will be able to address issues that increase HIV-associated morbidity and mortality among the disadvantaged minority populations we serve. That is an extremely important mission for the new center,” said Dr. Audrey French, director of the clinical core and director of research at Cook County’s CORE Center.

The Developmental Center for AIDS Research in Chicago will concentrate its investigations around three themes: HIV and women, with an emphasis on behavior and viral pathogenesis; HIV and aging, including studies of behavioral, cardiovascular, immune system and neurocognitive issues; and HIV and drug abuse, focusing on behavioral questions and neuropharmacology.

Source:
Sharon Butler

Rush University Medical Center

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Concluding his recent trip to Zimbabwe, the Global AIDS Coordinator for PEPFAR Eric Goosby said the country can rebuild and strengthen its health care delivery systems, the Zimbabwean reports. “I have seen fatigue in health care delivery in the country. A fatigue that that has come out of sustaining the response (to HIV and AIDS) with diminishing resources, but at the same time a feeling of hope and anticipation that they have hit bottom and are now on the return,” Goosby said (9/4).

As part of his trip, Goosby toured PEPFAR-sponsored programs in Zimbabwe, including a hospital clinic that provides treatment and other programs for HIV-positive patients on antiretroviral therapy (ART) and a male circumcision site, the Standard/allAfrica.com reports. “We are anxious to engage with ministries at both the national, provincial and district levels to develop these systems of care that allow for the movement of patients into the system and for those that need more specialised care,” Goosby said (Shoko, 9/5).

In related news, Al Jazeera examines the lack of access to antiretroviral drugs for HIV/AIDS patients in Zimbabwe. The video report is part of a series on the stigma of HIV/AIDS (Mutasa, 9/5).

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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South Africa’s shortage of health professionals combined with a budget shortfall of over $130 million for the government’s HIV programs could keep the country from reaching its goal of providing 80 percent of the people living with HIV/AIDS in need of treatment with antiretroviral drugs (ARVs) by 2011, South African Health Minister Aaron Motsoaledi said on Tuesday, Reuters reports. Motsoaledi said of the funding, “We have discussed it with Treasury, calculated the costs and I have already met international funders. We are waiting and hoping that there is no chance of the actual shortfall happening.”

According to Motsoaledi, an estimated 700,000 HIV-positive South African’s currently receive ARVs. “Unfortunately it is only 50 percent of the number that has been targeted,” he told Reuters. The article examines the factors contributing to the shortage of health professionals in South Africa, including trained professionals leaving the country for positions that offer higher pay and better conditions, and the low number of doctors being trained in the country compared to those needed annually.

According to Reuters, “[d]espite his overstretched budget, Motsoaledi is exploring providing ARVs to patients” earlier than when currently dispensed by public hospitals. “Waiting for people to go to a CD4 count of 200 is too low too late, maybe we should start them at 350,” Motsoaledi said (Govender, 9/15).

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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A retreat from international funding commitments for AIDS threatens to undermine the dramatic gains made in reducing AIDS-related illness and death in recent years, according to a new report released today by the international medical humanitarian organization Doctors Without Borders/Medecins Sans Frontières (MSF).

International support to combat HIV/AIDS is faltering, as reflected in significant shortfalls among two of the world’s main funding mechanisms for HIV/AIDS. The board of directors of the Global Fund, a key financer of AIDS programs in poor countries, is unable to respond to countries’ needs. The board will vote next week in Addis Ababa whether or not to suspend all new funding proposals in 2010. The US President’s Emergency Plan for Aids Relief (PEPFAR), the American government’s AIDS program, is capping funding for two more years. This means that new patients will be turned away for treatment.

Report: Punishing Success: Early Signs of a Retreat from Commitment to HIV Care and Treatment.

The MSF report highlights how expanding access to HIV treatment has not only saved the lives of people living with AIDS but has been central to reducing overall mortality in a number of high HIV burden countries in southern Africa in recent years.

In Malawi and South Africa, MSF observed significant decreases in overall mortality in areas with high antiretroviral therapy (ART) coverage. Increased treatment coverage has also had an impact on the burden of other diseases. For example, tuberculosis cases have been significantly reduced in Thyolo, Malawi and Western Cape Province, South Africa.

“After almost a decade of progress in rolling out AIDS treatment we have seen substantial improvements, both for patients and public health,” said Dr. Tido von Schoen-Angerer, director of MSF’s Access to Essential Medicines Campaign. “Recent funding cuts mean doctors and nurses are being forced to turn HIV patients away from clinics, as if we were back in the 1990s before treatment was available.”

“The Global Fund must not cover up the deficit caused by its funders,” said von Schoen-Angerer. “The proposed cancellation of the 2010 funding round and other measures to slow the pace of treatment scale-up are punishing the successes of the past years and preventing countries from saving more lives.”

PEPFAR has had a huge impact on increasing the number of people on AIDS care and treatment in poor countries since 2003, supporting more than two million people on treatment with a commitment to increase treatment to at least three million by 2013. But U.S. government HIV/AIDS funding has remained the same for 2009 and 2010 and early signs indicate there will be no increase in funds for 2011 either. The proportion of PEPFAR’s budged dedicated to treatment has actually decreased. Only a handful of countries will be able to increase the number of new patients at a pace similar to what PEPFAR has supported in the past.

In 2005, world leaders promised to support universal AIDS coverage by 2010, a promise that encouraged many African governments to launch ambitious treatment programs.

“What about the promise made to people with AIDS?” said Olesi Ellemani Pasulani, MSF clinical officer in Thyolo District Hospital in Malawi. “We gave them hope and life. We have to be there for them. We all knew from the beginning that this treatment was for life. Passing on the bill for treating AIDS to very poor countries would be a colossal betrayal.”

Reducing funding at this time will leave people in urgent need of treatment to die prematurely, and can lead to dangerous interruption of treatment.

In Uganda, cuts have already begun to hit home, with some facilities forced to stop treating new patients with HIV. Other countries are backing away from their earlier treatment coverage targets. In Free State, South Africa, past funding problems-since resolved-led to disruption of treatment and a moratorium on treating new patients, which resulted in an estimated 3,000 deaths.

The report provides evidence that treating AIDS, particularly in high prevalence settings, has a positive impact on other important health goals, in particular maternal and child health.

“A stronger commitment to other health priorities must happen, but this should be in addition to, not instead of, continued, increased commitment to HIV/AIDS,” said von Schoen-Angerer.

At present, over four million people living with HIV/AIDS in the developing world receive antiretroviral therapy. An estimated six million people who are in need of life-saving treatment are still waiting for access. MSF operates HIV/AIDS programs in approximately 30 countries and provides antiretroviral treatment to more than 140,000 HIV-positive adults and children.

Source
Doctors Without Borders/Medecins Sans Frontières

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