HIV pandemic's origins located: It may have emerged in Congo in 1920s

 Scanning electron micrograph of an HIV-infected H9 T cell. Credit: NIAID

 http://medicalxpress.com/

The HIV pandemic with us today is almost certain to have begun its global spread from Kinshasa, the capital of the Democratic Republic of the Congo (DRC), according to a new study.
An international team, led by Oxford University and University of Leuven scientists, has reconstructed the genetic history of the HIV-1 group M pandemic, the event that saw HIV spread across the African continent and around the world, and concluded that it originated in Kinshasa. The team's analysis suggests that the common ancestor of group M is highly likely to have emerged in Kinshasa around 1920 (with 95% of estimated dates between 1909 and 1930).
HIV is known to have been transmitted from primates and apes to humans at least 13 times but only one of these transmission events has led to a human pandemic. It was only with the event that led to HIV-1 group M that a pandemic occurred, resulting in almost 75 million infections to date. The team's analysis suggests that, between the 1920s and 1950s, a 'perfect storm' of factors, including urban growth, strong railway links during Belgian colonial rule, and changes to the sex trade, combined to see HIV emerge from Kinshasa and spread across the globe.
A report of the research is published in this week's Science.
'Until now most studies have taken a piecemeal approach to HIV's genetic history, looking at particular HIV genomes in particular locations,' said Professor Oliver Pybus of Oxford University's Department of Zoology, a senior author of the paper. 'For the first time we have analysed all the available evidence using the latest phylogeographic techniques, which enable us to statistically estimate where a virus comes from. This means we can say with a high degree of certainty where and when the HIV pandemic originated. It seems a combination of factors in Kinshasa in the early 20th Century created a 'perfect storm' for the emergence of HIV, leading to a generalised epidemic with unstoppable momentum that unrolled across sub-Saharan Africa.'
'Our study required the development of a statistical framework for reconstructing the spread of viruses through space and time from their genome sequences,' said Professor Philippe Lemey of the University of Leuven's Rega Institute, another senior author of the paper. 'Once the pandemic's spatiotemporal origins were clear they could be compared with historical data and it became evident that the early spread of HIV-1 from Kinshasa to other population centres followed predictable patterns.'
One of the factors the team's analysis suggests was key to the HIV pandemic's origins was the DRC's transport links, in particular its railways, that made Kinshasa one of the best connected of all central African cities.
'Data from colonial archives tells us that by the end of 1940s over one million people were travelling through Kinshasa on the railways each year,' said Dr Nuno Faria of Oxford University's Department of Zoology, first author of the paper. 'Our genetic data tells us that HIV very quickly spread across the Democratic Republic of the Congo (a country the size of Western Europe), travelling with people along railways and waterways to reach Mbuji-Mayi and Lubumbashi in the extreme South and Kisangani in the far North by the end of the 1930s and early 1950s. This helped establishing early secondary foci of HIV-1 transmission in regions that were well connected to southern and eastern African countries. We think it is likely that the social changes around the independence in 1960 saw the virus 'break out' from small groups of infected people to infect the wider population and eventually the world.'
It had been suggested that demographic growth or genetic differences between HIV-1 group M and other strains might be major factors in the establishment of the HIV pandemic. However the team's evidence suggests that, alongside transport, social changes such as the changing behaviour of sex workers, and public health initiatives against other diseases that led to the unsafe use of needles may have contributed to turning HIV into a full-blown epidemic – supporting ideas originally put forward by study co-author Jacques Pepin from the Université de Sherbrooke, Canada.
Professor Oliver Pybus said: 'Our research suggests that following the original animal to human transmission of the virus (probably through the hunting or handling of bush meat) there was only a small 'window' during the Belgian colonial era for this particular strain of HIV to emerge and spread into a pandemic. By the 1960s transport systems, such as the railways, that enabled the virus to spread vast distances were less active, but by that time the seeds of the pandemic were already sown across Africa and beyond.'
The team says that more research is needed to understand the role different social factors may have played in the origins of the HIV pandemic; in particular research on archival specimens to study the origins and evolution of HIV, and research into the relationship between the spread of Hepatitis C and the use of unsafe needles as part of public health initiatives may give further insights into the conditions that helped HIV to spread so widely.
More information: The early spread and epidemic ignition of HIV-1 in human populations, Science, 2014. www.sciencemag.org/lookup/doi/… 1126/science.1256739

HIV establishes viral reservoirs with surprising speed

 http://www.latimes.com/science

 

 

 

 

 

 

 

 

 

 

 

Scanning electron micrograph of HIV particles infecting a human T cell. (NIAID / NIH)

By Monte Morin contact the reporter

 

Medical ResearchScientific ResearchHIV - AIDSHarvard Medical SchoolJohns Hopkins University

Early treatment may not be enough to prevent formation of HIV reservoirs, study says

Study suggests HIV virus can establish persistent reservoirs in just three days

In a sobering discovery, researchers say that rapid treatment of HIV-like infections in monkeys failed to prevent the establishment of persistent viral reservoirs in as little as three days.

Related story: Girl who was declared 'functionally cured' of HIV now has active virus

Monte Morin

The study, published Sunday in the journal Nature, comes on the heels of news that the so-called Mississippi Baby -- a child once considered functionally cured of HIV due to antiretroviral drug treatment hours after her birth -- had in fact been infected with the virus all along.
While researchers had begun to hope that there was a window in which the virus could be prevented from establishing a permanent foothold within its host, that possibility now seems much less likely.
"We show that the viral reservoir can be seeded substantially earlier than previously recognized," wrote lead study author and Harvard Medical School virologist James Whitney, and colleagues.

 

HIV attacks CD4 white blood cells -- critical components of the body's immune system. The virus then uses the cells to manufacture copies of itself, destroying the blood cell in the process and steadily eroding the body's internal defenses.
However, in some cases, the virus will lay dormant within a white blood cell, only to begin reproducing itself at a later date. The virus cannot be killed in this dormant state -- either by the body's immune system or by antiretroviral drugs -- and this latent reservoir of infection has proved to be the biggest obstacle to finding a cure.

Related story: HIV infection causes immune cells to self-destruct, study says

Monte Morin

In the latest study, researchers infected 20 adult rhesus monkeys with simian immunodeficiency virus, or SIV, the simian equivalent of HIV, the disease that causes AIDS.
Some of the monkeys were treated with a cocktail of antiretroviral drugs three days after infection, yet prior to when the virus could be detected in the monkeys' bloodstream. Other monkeys received the drug treatment at seven, 10 and 14 days after infection, when evidence of the illness could be detected.

In each case, antiretroviral therapy was stopped after 24 weeks. While researchers had hoped the virus would not reappear in the monkeys that were treated in three days, it in fact rebounded in all of the animals.
The researchers, however, did note that it took about three weeks for the virus to rebound in the monkeys that received drug treatment after three days, where it took only one or two weeks in the other monkeys.
In an accompanying News & Views article, Kai Deng and Dr. Robert Siliciano, both HIV researchers at Johns Hopkins University Medical School, noted that further research was needed to confirm the study's results.
"Substantial differences exist between SIV infection in rhesus macaques and HIV-1 infection in humans," the pair wrote.
Nonetheless, they called the paper's findings "striking," as they argued that still newer medical approaches are needed to eradicate HIV.

Fingers to Ashes: The Millennial Disconnect with HIV

Tyler Curry Become a fan Freelance columnist and fiction writer; creator, The Needle Prick Project

Posted: 06/11/2014 5:17 pm EDT Updated: 06/11/2014 5:59 pm EDT 

http://www.huffingtonpost.com/the-blog

It is hard to imagine that it was only 34 years ago when the first case of HIV was first documented in the United States. Shortly after, the virus seemed to spread like wildfire, burning a path of hysteria, frustration and sadness across the U.S. and throughout the world. In a short period of time, and thanks to a series of political blunders from the Reagan administration and many other political figures across the nation, HIV went from hundreds to millions and became the closest we have ever come to a modern plague.

Although there is still no cure for the virus, this plague is now classified as a chronic illness with those who are HIV positive living long and healthy lives. So the obscene terror that lived in the hearts of every gay man in the world merely three decades ago has all but been erased in the mines of the millennial age. In its place now lives a vague but often-impenetrable fear of those who carry HIV and a diluted sense of safety based on the idea that the transmission of HIV is related to a character flaw of promiscuity. This blind faith that the virus is relinquished to "other" types of people has allowed for this disease to continue affecting the millennial generation at staggering rates.
According to the Center for Disease Control's National Progress Report of 2013, an estimated 1.1 million people are living with HIV in the United States with 50,000 more becoming infected each year. One out of every six people living with the virus are unaware that they are infected, thus continuing the cycle of transmission. And worse, one out of every five gay men are living with HIV, yet the millennial generation often treats the disease as if it is only reserved for the history books.
But beyond the numbers, just what exactly does it mean to live HIV in today's world? For starters, HIV is now officially classified as a chronic disease. Although most people assume that treatment involves a series of toxic cocktails that HIV positive men and women take throughout the day, a person diagnosed today will most likely be on one daily pill to manage the virus. And reports suggest that, given a person is compliant with their medication; they can expect the same estimated lifespan as they did when they were HIV negative.
"A person who is 20-years-old and diagnosed today can expect to live into their 70s, roughly the same lifespan they would expect prior to being diagnosed," says Dr. Gary Blick, HIV Specialist and Founder of World Health Clinicians, an international HIV treatment organization.
However, it isn't all good news. The span of your life may be the same, but your worries certainly are not. People living with the virus run an increased risk of developing other life-threatening diseases such as cancer, heart attack and stroke. Combined with other STI's, these risks are even bigger, making it even more important for a person living with HIV to manage all aspects of their health, not just their pillboxes. However, an HIV positive diagnosis is merely a charge to be drastically more responsible with a person's health instead of an order to make arrangements for a pending funeral.
To many of the people living with the disease, it is also a scarlet branding that induces emotional and psychological symptoms that far outweigh the side effects listed on the side of their medication bottles.
The organizations charged with delivering the message of HIV awareness and prevention have grappled with advancing their messaging with the advancements of modern medicine. Managing HIV is a drastically different animal than it was merely a decade ago, but many still view the virus with the same gravity that they did in the 1990s. The few organizations who have tried to modernize the approach to HIV education have been lambasted for "making light" of the disease, trying to "make HIV cool," or downplaying the severity of living with the virus.
This struggle over messaging has never been more contentious then in the present as institutional juggernauts like the AIDS Healthcare Foundation (AHF) battles with more progressive activists and organizations over the promotion of PrEP, or pre-exposure prophylaxis. This new drug, nicknamed the birth control pill for HIV, now personifies the crux in HIV treatment debate.
PrEP is an Antiretroviral Therapy drug that, if taken correctly by an HIV negative individual, has a 99 percent efficacy rate in preventing the transmission of HIV from someone who is HIV positive. This drug has been on the market since 2012, but several prominent organizations such as AHF, the largest HIV treatment provider in the U.S., have taken an active stance against the HIV prevention pill.
Michael Weinstein, the Executive Director of AHF, has publicly referred to PrEP as a party drug and suggested that the "people who would be taking the drug" could not be trusted to be compliant with their dosage. This stigmatizing rhetoric, combined with the pharmaceutical company, Gilead's, unwillingness to advertise the drug to at-risk populations, has led to a virtual standstill in people seeking a prescription for the prevention pill.
People like J Nick Shirley, a 24-year-old gay man from Dallas, represent the most at risk demographics for HIV transmission, and yet has never heard of PrEP. When asked about the new form of prevention, he was shocked that this was the first time he was hearing about it.
"I just can't believe that we have such a ground-breaking tool at our disposal and so many people don't know about [PrEP]," Shirley said. "I am pretty sure none of my friends know about it. We have never talked about it before."
Long term HIV survivor, activist and former reality T.V star, Jack Mackenroth, is mortified that organizations like AHF have taken on such a damaging approach to PrEP.
"If this were the '90s, people would be lining up down the streets to take PrEP," says Mackenroth. "It is so sad that the fear that we went through has given way to the judgment and stigma from gay men onto other gay men. HIV isn't going anywhere if we don't wake up and realize that condom-only messages don't work."
Which leads us to the use of the problem; organizations using worn out methods of education and prevention, further stigmatizing others looking for prevention methods beyond condoms and leaving the vast majority of millennial, at-risk individuals to believe that HIV is a virus that "other" people get.
Movies like The Normal Heart serve as history lessons, leading young gay men to cry, "Never forget," while failing to realize the dangers they face. LGBT youth are left grappling for connection, because most of the visible reminders of the risk of HIV are only ashes, while the living, more relevant examples prefer to remain in silence for fear of public ridicule and castigation. Sadly, the community that was once unified under the call to fight the virus is now complacent in a pseudo-class system of HIV status that only serves to perpetuate transmission.
But change is on the horizon. Grassroots campaigns such as HIV Equal, The Stigma Project, The Needle Prick and several others have worked to change the climate of HIV stigma for those living with the virus and educate the public on the real vs. perceived danger of HIV transmission. A new wave of young, HIV positive faces, such as Josh Robbins, Cory Lee Frederick and Jake Forth are making their presence known in the public eye, humanizing the virus for the millennial generation while serving as living examples that HIV is still an issue for their age group. And this year, as the Obama Administration unveiled the HIV Care Continuum at the third annual HIV/AIDS Strategy, President Obama's HIV prevention policy recognized Antiretroviral treatment as a valid form of prevention, giving authority to the fact that HIV positive men who achieve undetectable viral load levels are actively preventing the spread of HIV.
While the level of danger has waned over the past three decades, the threat of HIV still remains. Unlike the generations first affected by the virus, the millennial age is now armed a wealth of information and a variety of prevention tools to change the course of HIV for good. And this young generation should take note that these tools came at a very heavy cost.
If you have had sex even once since your last HIV test without a condom, it is worth it educate yourself on PrEP and determine if it is right for you. It only takes one time to transmit the virus, and it only takes one pill a day to stop it. The millennial generation no longer has to face a multitude of limitations when concerning HIV, so there is no excuse to get tested, know your status and pick up the slack in the fight against HIV. After all, most of the heavy lifting has already been done.

AP WAS THERE: Probable cause of AIDS found

By WARREN E. LEARY 23 hours ago

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FILE - This combination made from file photos provided by the National Institute of Health, Pasteur Institute …

WASHINGTON (AP) — EDITOR'S NOTE: In 1981, the U.S. Centers for Disease Control and Prevention reported the first cases of a rare pneumonia that had sickened five Los Angeles gay men. The AIDS epidemic had begun.

Over the next three years, the CDC formally named the condition and announced that sexual contact and infected blood were the major ways the disease spread.

On April 23, 1984, the Department of Health and Human Services held a press conference to announce that the probable cause of the disease had been found — a virus that was eventually called the human immunodeficiency virus, or HIV. At the meeting, government scientists said the discovery could spur work on a preventive vaccine, which could be ready for testing within two or three years.

There is still no cure or vaccine. But drugs emerged in the mid-1990s that have turned HIV from a death sentence into a manageable chronic disease for people who stick with them.
An estimated 36 million people have died of AIDS since 1981, according to the World Health Organization.
Thirty years after its publication, the AP is making its original report on the announcement available.
___
Government scientists have found the virus that probably causes AIDS, a discovery that has led to a blood test for the deadly disease and the possibility of developing a preventive vaccine within two or three years, federal health officials announced Monday.
"The probable cause of AIDS has been found," Health and Human Services Secretary Margaret M. Heckler told a news conference.
Isolating the virus and developing a process to mass-produce it led to a test that should detect AIDS — acquired immune deficiency syndrome — in victims even before symptoms arise and tell if donated blood supplies are contaminated with the virus.
By identifying those carrying the virus and its presence in blood, "we should be able to assure that blood for transfusion is free from AIDS," Mrs. Heckler said.
"With the blood test, we can now identify AIDS victims with essentially 100 percent certainty," Mrs. Heckler said.
Dr. Edward N. Brandt, assistant HHS secretary for health, said the test should be widely available within six months to screen donated blood, suspected to be a source of the agent that causes the disease that destroys the body's immune system.
Brandt said that having quantities of the elusive virus should spur work on a preventive vaccine, which could be ready for testing within two or three years.

"What we have at the moment is not of particularly great benefit to those with the disease right now," Brandt said. However, he continued, the blood test should help researchers define the early courses of the incurable disease and possibly find a way to intervene at an earlier stage.

Scientists at the National Institutes of Health, and particularly Dr. Robert Gallo of the National Cancer Institute, were given most of the credit for isolating the virus and devising the system to routinely detect and grow it, a major step for future research.

The officials said they are so sure about the strength of the U.S. findings, which closely parallel work by French scientists reported last week, that they can declare an AIDS breakthrough after years of research.

"The NCI work provides the proof we need that the cause of AIDS has been found," Mrs. Heckler said.

Four papers describing the work of Gallo and his many colleagues will be published this week in the journal Science.

According to Gallo and the papers, the causative virus appears to be a member of a family of viruses called human T-cell leukemia virus (HTLV) previously suspected of having a role in AIDS.

The researchers said the new virus, called HTLV-3, shares so many characteristics with other HTLV viruses that it has to belong to this family despite some structural differences.

Scientists said they suspect HTLV-3 is very closely related, if not identical, to the recently publicized AIDS candidate virus called lymphadenopathy associated virus (LAV), which was discovered last year by French researchers at the Pasteur Institute in Paris.

Gallo told the news briefing that his group has worked closely with the French researchers and, despite some recent "miscommunications and misunderstandings," still is collaborating with them. And, he said, the Americans are not trying to steal credit for finding the virus.

To his knowledge, Gallo said, the French virus has yet to be truly isolated and grown in quantity to determine its structure. If it proves the same as HTLV-3, Gallo said, he will make sure the world knows of the French contribution.

"If the viruses prove to be the same, I will say so in collaboration with the French," Gallo said.

Both viruses attack and grow in the same white blood cells that are defective or missing in AIDS patients.

About 90 percent of blood serum samples from American AIDS patients show evidence of previous infection by HTLV-3, said Gallo. However, similar samples sent to Paris also showed about the same percentage of infection by LAV, according to French researchers.

Although it is unclear if HTLV-3 and LAV are the same viruses, it appears that scientists have identified, isolated, grown and taken electron microscope pictures of a virus or viruses that may cause AIDS.

Other experts say more work is needed to positively prove that HTLV-3 causes AIDS since victims of the disease become infected with many viruses because of their decimated immune systems.

AIDS results in the collapse of the immune system, which defends the body against disease. Victims become susceptible to rare cancers, pneumonia and other infections that lead to disability and death.

The federal Centers for Disease Control in Atlanta say that more than 4,000 AIDS cases have been reported in the United States since 1981 and that more than 1,700 patients have died of the incurable disease.

The majority of victims have been promiscuous male homosexuals, but other high-risk groups are intravenous drug abusers, Haitian immigrants and hemophiliacs who are treated with blood products. Scientists think AIDS is transmitted through contact with bodily fluids such as blood or semen.

The NIH studies said HTLV-3 viruses themselves, and not just indirect evidence of their presence, were isolated from 48 individuals. No virus was isolated from 115 normal people who were not members of groups at increased risk of AIDS.

Those in whom the virus was found included 26 of 72 patients with AIDS; 18 of 21 patients with a pre-AIDS syndrome manifested by depressed immune systems, and three of four clinically normal mothers of children infected with AIDS who may have acquired the infection before birth or through nursing.

The reports said the virus also was found in one of 22 samples from clinically normal, non-promiscuous homosexual males believed to be at only moderate risk of AIDS. However, six months after the tests, the man with the virus developed AIDS.

Ryan Lewis's Mom Opens Up on Living Decades With HIV, Wants to Help Others

By ABC News | ABC News Blogs – 6 hours ago

Musician Ryan Lewis is spearheading a fundraising effort to build medical centers around the world to provide comprehensive health care and specialized HIV/AIDS treatment for the needy, and it's all because of one case that hits very close to home.

Lewis, who is one half of the hit rap duo, Macklemore and Ryan Lewis, says his mother, Julie Lewis, has been HIV positive since she gave birth to her first child 30 years ago.
After giving birth to her daughter, Teresa, in 1984, Julie Lewis needed a blood transfusion.
"In that moment without anyone knowing it, (she) had HIV positive blood put into her body," Ryan Lewis said. "At age 25, one year younger than I am right now, her life would change forever."
She had two other children - Laura and Ryan - before being diagnosed as HIV positive in the summer of 1990.
"I was 32 years old, and I had three young children, ages 6, 4, and 2. I'd never thought about dying," an emotional Julie Lewis said, speaking in a YouTube video about the initiative.
Scientists Find Aggressive New HIV Strain
Each of her younger children had a 25 percent chance of being born with HIV, but they were both born free of the virus.
Julie Lewis herself was given only a few years to live.
"But you know what's amazing? My mom never died. She lived," her son said.
Julie Lewis founded the 30/30 Project to allow people all over the world access to the same high-quality healthcare that she received. The project is raising funds on the website IndieGoGo. As of Tuesday night, the campaign had collected $19,238 of a stated goal of $100,000.
UK Doctor: 'I'd Rather Have HIV Than Diabetes'
"Life-threatening diseases like HIV/AIDS can be managed," Julie Lewis said. "What people need is access … I was infected with HIV 30 years ago. And I never thought I'd be sitting here, 30 years later, talking to you."
The announcement is timed to coincide with the 30 th anniversary of the scientific discovery that AIDS is caused by HIV.
Macklemore voiced his support for the project.
"Healthcare is a human right. That is what we believe. We want to see this idea put into action," he said.
An estimated 34 million people globally have been diagnosed with HIV, according to the World Health Organization. Since the epidemic began in the early 1980s, the infection has claimed more than 33 million lives, according to CDC estimates.

Mississippi Baby Born With HIV 'Functionally Cured,' Doctors Say

More than 1.1 million people in the U.S. are living with the infection but nearly one in six is unaware they are infected.
When AIDS was a relatively new disease, patients could expect to develop full blown AIDS within 10 years and live only a year or two longer.
Now, with better HIV treatments, patients who start them before their immune system declines significantly have a much longer life expectancy.
ABC News' Liz Neporent contributed to this report.

S.African HIV prevalence rises on soaring new infections

9 hours ago

Nandi Makhele, 25, poses for a portrait while wearing a T-shirt indicating that she is HIV-positive, …

JOHANNESBURG (Reuters) - The prevalence of HIV/AIDS in South Africa is rising due to the world's fastest growth in new infections and a higher patient survival rate, according to a new health study.

An estimated 12.2 percent of South Africa's population was infected with the HIV virus in 2012, compared with 10.6 percent in 2008, according to a survey of 38,000 people carried out by the country's Human Sciences Research Council.
The percentage rise was partly due to 400,000 new HIV cases in the year studied, the highest in the world, taking the total number of people infected in South Africa to 6.4 million.
Young black African women were the worst affected, with 23.2 percent of females aged 15-49 infected, compared with 18.8 percent of men, the study showed.
Treatment of the virus is increasing, with around 2 million people on an expanded antiretroviral treatment plan.
However, the study found the overall knowledge about how HIV is transmitted and can be prevented fell to 26.8 percent in 2012, from 30.3 pct in 2008.

Three-quarters of those surveyed believed they were at low risk of contracting HIV, even though one-in-ten of those tested were found to be already infected.

South Africans under fifty were having increasing numbers of sexual partners and using condoms less.

"The increases in some risky sexual behaviours are disappointing, as this partly accounts for why there are so many new infections still occurring," said Professor Leickness Simbayi, an investigator on the study.

Despite a government push to spread the treatment of HIV, medical charities warned last year that many clinics were running short of life-saving HIV/AIDs drugs. [ID:nL5N0JD2Q0]

South Africa awarded a $667 million two-year contract in 2012 to pharmaceutical firms, including Aspen Pharmacare, Abbott Laboratories and Adcock Ingram, to supply HIV/AIDS medication.

US reports rare case of woman-to-woman HIV transmission

March 13, 2014 2:06 PM

A rare case of suspected HIV transmission from one woman to another was reported Thursday by US health authorities (AFP Photo/Manjunath Kiran)

Washington (AFP) - A rare case of suspected HIV transmission from one woman to another was reported Thursday by US health authorities.

The 46-year-old woman "likely acquired" human immunodeficiency virus while in a monogamous relationship with an HIV-positive female partner in Texas, said the Centers for Disease Control and Prevention.

The woman, whose name was not released, had engaged in heterosexual relationships in the past, but not in the 10 years prior to her HIV infection.

Her HIV-positive partner, a 43-year-old woman who first tested positive in 2008, was her only sexual partner in the six months leading up to the test that came back positive for HIV.

She did not report any other risk factors for acquiring the virus that causes AIDS, such as injection drug use, organ transplant, tattoos, acupuncture or unprotected sex with multiple partners.

The strain of HIV with which she was infected was a 98 percent genetic match to her partner's, said the CDC in its weekly report.

Authorities first learned of the case in August 2012 from the Houston Department of Health.

The couple said they had not received any counseling about safe sex practices, and reported that they routinely had sex without barrier methods.

"They described their sexual contact as at times rough to the point of inducing bleeding in either woman," said the CDC report.

"They also reported having unprotected sexual contact during the menses of either partner."

The partner who was infected since 2008 had been prescribed antiretroviral drugs in 2009 but stopped taking them in November 2010, and was lost to follow up in January 2011.

The CDC warned that although such cases are rare, "female-to-female transmission is possible because HIV can be found in vaginal fluid and menstrual blood."

People with HIV should be under the care of a doctor and take their prescribed medicines to keep their viral load down and reduce the risk of infecting a partner, the CDC said.

Very few cases of this kind have been documented, and confirmation "has been difficult because other risk factors almost always are present or cannot be ruled out," said the report.

One survey of 960,000 female blood donors found 144 who tested positive for HIV and were therefore blocked from donating.

Of 106 of those women who agreed to interviews, none described female-to-female sexual contact as their only risk factor.

The CDC also described one case of a woman in the Philippines who tested positive for HIV and said she had sex only with women and did not inject drugs, though no source of infection could be confirmed.

One other case is known of a 20-year-old woman who was diagnosed with HIV after a two-year monogamous relationship with a female partner who was HIV positive. While both women had the same drug-resistant HIV mutations, no tests were done to identify if their HIV strains were a genetic match.

What the New HIV Breakthroughs Mean for the Future of the Disease

By Sarah B. Weir, Shine Senior Writer | Healthy Living – 16 hours ago

 

Photo: Getty Images 

There was exciting news this week in the battle against HIV/AIDS, much of it coming out of the annual Conference on Retroviruses and Opportunistic Infections (CROI), which took place in Boston. But perhaps the biggest story was that, for the second time in history, a baby born with HIV has been declared free of the virus after early, aggressive treatment.

While “baby cured of HIV” is, for sure, a thrilling headline, scientists are more cautiously hopeful than some media outlets would suggest. “That case is definitely intriguing,” Reilly O’Neal, editor of the San Francisco AIDS Foundation’s blog BETA, who attended the conference, tells Yahoo Shine. “The baby was tested with incredibly sensitive tests. The case supports the idea that very early treatment has the potential to dramatically reduce HIV reservoirs [the genetic code of the virus that 'hides' in the body], which are a major obstacle in curing HIV.”

More on Yahoo: Doctors Hope for Cure in a 2nd Baby Born with HIV

The now-famous "second baby" was treated in Los Angeles after being born last year to an HIV-positive mother who had received no prenatal care. (Treating pregnant mothers reduces the transmission of the virus to their babies.) Only four hours after the baby was born, doctors began administering an antiretroviral cocktail, the same one that had successfully led to remission in an HIV-infected newborn in Mississippi three years ago. Now, nine months later, there is no detectable trace of the virus in the second baby’s cells and she continues to undergo treatment.

More on Yahoo: Studies Show Big Promise For HIV Prevention Drug

So does that mean we've now found a cure for HIV? Well, not yet. On Wednesday, one of the baby's physicians, Yvonne Bryson, an infectious disease specialist at Mattel Children's Hospital UCLA, told the audience at CROI, "We don't know if the baby is in remission, but it looks like that." According to O’Neal, Dr. Deborah Persaud of Johns Hopkins University, who tested the baby and also spoke at CROI, was careful not to refer to the infant as “cured.”

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), explains to Yahoo Shine, “The only real proof is if you stop therapy and the virus doesn’t bounce back.”

That search for proof, of course, begs the question: When is it ethical to withdraw treatment to test for remission? Five months after the mother of the Mississippi baby ceased giving the girl her medications at 18 months old, her doctors were shocked when a blood test revealed that she was still HIV-free. Fauci says that both of these cases suggest the promise of early intervention in the prevention of HIV transmission to newborns. (Right now, about 200 babies are born with HIV in the United States annually.)  In April, NIAID will be funding a series of trials in which babies will be treated for the virus and carefully withdrawn from treatment under highly controlled conditions.

And there's more good news: A limited but hopeful pilot study presented at CROI and published in the New England Journal of Medicine on Wednesday focused on gene editing — the process of removing genetic material from a person, altering it to make cells become HIV-resistant, and replacing it in the body. Genetic modification has the potential to both prevent and reverse HIV. The goal of the study was to test the safety of the technique.

A small percentage of people are actually resistant to HIV because their immune cells lack CCR5, a protein that acts as a gateway to the virus. In 2008, a man named Timothy Brown, known as the “Berlin Patient,” was cleared of HIV after receiving a bone marrow transplant for leukemia from a donor who happened to have the CCR5 mutation. In the current study, which built on that case, researchers removed blood from 12 HIV-positive men to disable CCR5 in their immune cells. The cells were returned to their bloodstreams through a transfusion. Researchers found that the modified cells did increase in vivo, and when patients went off their medication as part of the study, the modified immune cells remained more resistant to HIV than regular cells. “It was an important conceptual advance, but not the end of the game,” says Fauci.

Rowena Johnston, PhD, the vice president and director of research at amfAR, says she’s optimistic about the future of gene therapy. “Some people think it's pie in the sky, especially for poorer countries with fewer resources,” she tells Yahoo Shine. “But if you had a potential to cure 34 million people, someone’s going to figure out a way to do it.”

Another compelling line of research that was published this week involved two related studies that looked at the efficacy of long-term antiviral injections in monkeys. In one study, by the CDC, six monkeys were given a monthly injection of an experimental antiretroviral drug, and six were given a placebo. All were exposed to HIV twice a week. After four exposures, the six monkeys on a placebo tested HIV-positive, but after 20 weeks, the other six remained virus-free. The second study, by the Aaron Diamond AIDS Research Center at Rockefeller University, had similar results. Previous research has shown that taking a daily antiretroviral pill has a strong protective effect, but some researchers believe that a monthly or quarterly injection might be more practical and an easier regimen for some people to stick with.

And finally, one more intriguing study presented at CROI was the PARTNER study. “Some of the most exciting news this week comes from this study,” O’Neal says. Researchers analyzed data from more than 750 mixed HIV-status couples who were having sex without condoms. It found that no cases of HIV transmission took place when the positive partner was adhering to effective antiretroviral therapy. “The real-world implications are huge,” she shares. “Researchers could not rule out that HIV infections might happen over the long term … but people in mixed-HIV status couples can use these data to make their own informed decisions.” The final results of the PARTNER study will be published in 2017.

While we may still be years away from a cure for HIV, from treatment to prevention, we’ve come a long way from the dark days when a diagnosis was a death sentence.  And that's good news now.

Study Gives Hope of Altering Genes to Repel H.I.V.

The idea of genetically altering people’s cells to make them resist the virus that causes AIDS may seem like a pipe dream, but a new report suggests it can be done.

The research involves the first use in humans of “gene editing,” a treatment that zeros in on a particular gene and disables it.

In 12 people infected with H.I.V., scientists used the technique to get rid of a protein on the patients’ immune cells that the virus must latch onto to invade the cells. Cells were removed from the patients, treated and then dripped back into their bloodstreams through an intravenous line.

In theory, if enough cells could be engineered to repel the virus, patients might no longer need antiviral drugs, and might in effect be cured.

The experiment was a pilot study, meant to test safety, not efficacy. It found that immune cells could be altered, and that doing so did not harm patients. The gene editing also seemed to help fight the infection in some cases, but the findings are preliminary and researchers cautioned that widespread use of the technique is a long way off.

“It’s a great strategy,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, who was not involved in the research. “It’s exciting, interesting, elegant science. But a lot of ‘ifs’ need to be addressed before you can say ‘Wow, this could really work.’ ”

Dr. Fauci also questioned whether patients would want this relatively complex treatment when many people can keep the infection under control with just one to a few pills a day.

An article about the study is being published on Wednesday in The New England Journal of Medicine, by researchers from the University of Pennsylvania, the Albert Einstein College of Medicine in New York and Sangamo BioSciences, a company in Richmond, Calif., that makes the gene-editing product.

The study has its roots in something that scientists discovered in the 1990s: A small percentage of people are resistant to H.I.V. thanks to a lucky mutation that causes their immune cells to lack CCR5, a protein that gives the virus a foothold. In people with one copy of the mutated gene, the infection progresses more slowly than in those who have normal CCR5. People who have inherited two copies of the mutated gene, one from each parent, are highly resistant to H.I.V. and may never become infected despite repeated exposure.

One man, known as “the Berlin patient,” was apparently cured of AIDS after he developed leukemia and had bone-marrow transplants in 2007 and 2008. As luck would have it, his bone-marrow donor had two copies of the mutated gene for CCR5. His immune system rebounded, the virus disappeared and he was able to stop taking antiviral drugs. But bone-marrow transplants are too arduous, risky and expensive to be used as a treatment for H.I.V.

Dr. Carl June, the senior author of the study and an expert in AIDS and cancer at the University of Pennsylvania, said gene editing may offer another way to achieve the same result.

He said the approach was worth considering because many patients dislike the antiviral drugs and experience side effects, and because lifelong treatment can cost $1 million in the United States. Gene editing could be cheaper, he said.

One scientific advance had a big role in making researchers consider even trying to engineer H.I.V. resistance: the development of a powerful molecular tool, zinc-finger nucleases, enzymes that can cut DNA at specific sites. When the cell tries to repair such a cut, it often makes mistakes, disabling that particular gene.

At first, he doubted that the technology would ever be useful for humans, but he began trying it out in mice, and was surprised by how well it worked.

“It’s incredible,” Dr. June said. “This tool can target any gene you desire.”

He and his team began testing the technique in people with H.I.V. in 2009. The 12 patients were given infusions of about 10 billion of their own CD4 T-cells, which had been treated to disable the CCR5 gene. The technique disabled the gene in 11 percent to 28 percent of the treated cells.

Six of the patients then stopped taking antiviral drugs. In most, their H.I.V. levels went up and their immune cells diminished. But the modified immune cells declined significantly less than the patients’ untreated cells, suggesting that the gene editing was protective. The altered cells persisted, at least for a while. On average, half were still present after 48 weeks.

Jay Johnson, 53, who lives in Philadelphia, took part in the study and was treated in 2010. He was the only patient who had an adverse reaction: a brief bout with fever, chills and joint and back pain.

For three months, he went off antiviral drugs. Initially, his virus levels were undetectable, but they began to rise, and he went back on the drugs.

A few months ago, doctors told him that he still had some of the altered cells, Mr. Johnson said, adding that he hopes the cells will keep multiplying, take over and eventually leave him virus free. He would gladly go through the treatment again, he said.

“If this works, it will be just such an overwhelming joy to say that I’m H.I.V. negative,” he said.

As the studies move ahead, Dr. June said, researchers will be trying to find ways to increase the proportion of edited cells and to make them persist in the body. It remains to be seen whether the treatment can be made practical for large numbers of patients. Because the test patients have received a treatment that alters their DNA, the Food and Drug Administration requires 15 years of follow-up to check for adverse effects. One concern is that the treatment could disable the wrong genes, though no evidence of that has been seen so far.

A version of this article appears in print on March 6, 2014, on page A4 of the New York edition with the headline: Study Gives Hope of Altering Genes to Repel H.I.V.

Second US baby is HIV-free after early treatment

By Kerry Sheridan 4 hours ago

Washington (AFP) - A baby treated for HIV within hours of birth is free of the virus nearly a year later, in the second case that has raised hopes about early treatment, doctors said.

The approach mirrored that taken for a Mississippi baby, who has been off treatment for 21 months and still has no detectable virus in her system.
The latest research on the two young girls was presented at the annual Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.
The newest case involves a Los Angeles baby who was born to a mother infected with HIV and who had not been taking her medications, making her at high risk for transmission, said Yvonne Bryson, chief of pediatric infectious diseases at the David Geffen School of Medicine at the University of California, Los Angeles.
Audra Deveikis, a pediatric infectious disease specialist at Miller Children's Hospital Long Beach, where the baby was born, tested the infant and gave her high, treatment-level doses of antiretroviral drugs before even knowing if she was HIV-positive, Bryson told AFP by phone from the conference.

"The way it works is you test and you treat before you know the results because it takes several days to get the results," explained Bryson, a consultant on the case.

 

A baby treated for HIV within hours of birth is free of the virus nearly a year later, in the second …

 

Treatment started at four hours of age, even earlier than the Mississippi child.

Eventually, the tests came back positive for HIV.

But by six days of age, the virus was undetectable.

"The remarkable thing about this particular baby is that the virus disappeared so quickly," said Bryson.

- Not a 'cure' yet -

The baby is still being treated with antiretroviral drugs, and researchers are cautious not to utter the world "cure" or even "remission" just yet.
Now aged 11 months, the child is doing well and continues to see doctors while under the care of a foster family.
She has "no detectable viral load, nothing since six days of age. That is the earliest ever," said Bryson.

Once she turns two, doctors may decide to stop suppressive therapy to see if she is in remission, or if the virus would rebound.

"The only way we would know if the baby is in remission is to stop therapy," explained Bryson.

Also at the conference, Deborah Persaud of Johns Hopkins University presented the latest on the Mississippi baby, who was given ART at 31 hours of age.

Now, the three-year-old is considered in remission from HIV, after drug treatment was stopped 21 months ago and no viral rebound has been observed.

Bryson said the Los Angeles team is optimistic that their baby will do just as well.

"The fact that it was a very fast reduction in the virus to undetectable levels makes us very hopeful that this baby might follow in the footsteps of the Mississippi which is still being followed," said Bryson.

"We are learning a lot now and it is exciting for the future."

There is no known cure for AIDS, which has infected some 70 million people around the world and killed 35 million, according to the World Health Organization.

HIV Prevention Shot May Replace Pills

http://www.webpronews.com/

By Jasmine Allen · 16 hours ago · 30 Comments

Two separate HIV studies on macaque monkeys show very promising results.
Researchers from Aaron Diamond AIDS Research Center at Rockefeller University in New York presented their findings on Tuesday at the Conference on Retroviruses and Opportunistic Infections in Boston, Mass.
They determined that a newly designed shot routinely taken four times a year could possibly protect people from the HIV virus.
One San Francisco doctor from Gladstone Institute, which is affiliated with the University of California, told the Associated Press that two studies were “showing 100 percent protection” from the virus.
“This is the most exciting innovation in the field of HIV prevention that I’ve heard recently,” said Dr. Robert Grant. “If it works and proves to be safe, it would allow for HIV to be prevented with periodic injections, perhaps every three months.”
The GSK1265744 drug was the experimental medicine used in the latest research study. The drug company GlaxoSmithKline makes the potent drug.
The Centers for Disease Control and Prevention was the first to test the effectiveness of the new drug.
Two recent studies by the Aaron Diamond AIDS Research Center provided further validation.
In the first study, 16 monkeys were exposed to the virus once a week for eight weeks. Eight of the monkeys were given two treatments within that time frame, whereas the remaining was given a placebo shot. In a second study, six out of 12 monkeys were given the shot.
The end results for both experiments determined that those given GSK1265744 injections were protected from the virus for at least 5 to 10 weeks.
Watch The Doctors cover a segment on monkeys used as a cure for HIV virus:
Truvada, a HIV preventive pill already available to the public, may soon be replaced. Experts say that injections may prove to be a better option for people who are reluctant to taking pills.
According to Bloomberg:
“If successful, the injection may provide an alternative to Gilead Sciences Inc. (GILD)’s Truvada pill, which won U.S. approval in 2012 to lower the chance of infection for people who don’t have the virus but are at risk of catching it.”
Researchers from the Aaron Diamond AIDS Research Center have established that the next steps involve testing the shot on humans as a treatment first, and then as a preventive medication.
Image via Wikimedia Commons

Scientists Discover How HIV Becomes Drug Resistant

By David Heitz
Wed, Feb 19, 2014

For the first time, scientists have determined how HIV is able to duck a commonly used drug.
Researchers from the University of Pittsburgh School of Medicine presented their findings today at the Biophysical Society annual meeting in San Francisco. Cell biologist Sanford Leuba and colleagues studied the molecular activity of efavirenz, an antiretroviral drug that is one of a class of drugs called non-nucleoside reverse transcriptase inhibitors, or NNRTIs. Efavirenz is sold under the brand name Sustiva, or Atripla when used in combination with another drug.
NNRTIs work by keeping HIV from piercing CD4+ “helper” cells and hijacking their genetic material to turn them into machines used for copying the virus. But the virus has found ways to adapt to NNRTIs and become resistant to them in some patients.
Leuber told Healthline that his team made the discovery by studying a “tour de force of expressions” previously found by their colleague Nicolas Sluis-Cremer. Sluis-Cremer is an internationally recognized expert on reverse transcription who also studies HIV drug resistance.
The Future of HIV Prevention: Truvada for PrEP
NNRTIs normally create a tiny “salt bridge” that keeps HIV from performing reverse transcription on cells. Reverse transcription is required for HIV to enter and corrupt the CD4+ cell with its genetic information. The salt bridge prevents HIV from fully grasping the cell, much like a hand that cannot close to fully clench an object.
Instead, the viral cell slides against the healthy cell, and this sliding keeps it from replicating. But Leuber and his colleagues now know that the sliding sometimes continues until the salt bridge eventually breaks, or is unable to form, allowing HIV to get inside the cell.

A 'Eureka' Moment

Leuber told Healthline there was “a screaming moment” when this mutation was first observed in the laboratory. “My interests are watching proteins move in real time on nucleic acid,” he said, adding that he did not know this could be done with HIV reverse transcription until now.
Dr. Daniel Kuritzkes, a professor of virology at Harvard University who also studies how HIV develops resistance to antiretroviral medications, told Healthline that Leuber's research is “interesting, but not earth-shattering.”
Kuritzkes said that the discovery has greater implications for the field of biochemistry than for advancing patient treatment. “But the truth is that the more we understand about the mechanisms of action for drug resistance, the better we may be able to design molecules that can overcome those mechanisms," he said.
"What people would ideally want are molecules that anticipate the mechanism of resistance and have patterns of escape.”
45 HIV/AIDS Terms You Should Know 

One in Six Carry Drug Resistant HIV Strain

More than 16 percent of Americans with HIV carry a strain of the virus that is resistant to certain drugs, according to research presented in March 2013 at the Conference on Retroviruses and Opportunistic Infections in Atlanta, Ga. In half of those cases, the virus is resistant to NNRTIs.
Although the majority of patients taking antiretroviral drugs do well, “for a significant subgroup of patients who have trouble taking their medications regularly, these people can get into trouble with resistance,” Kuritzkes said. “Resistance to non-nucleosides is a problem.”
Read this article at Healthline.com

Truvada for PrEP: Experts Weigh In on the Newest Way to Prevent HIV/AIDS

By Sandra Levy
Sat, Feb 08, 2014

Truvada (emtricitabine and tenofovir disoproxil fumarate), manufactured by Gilead Sciences, is the first drug approved to reduce the risk of HIV infection. In a pre-exposure prophylaxis, or PrEP, regimen, HIV-negative people who are at high risk may take a daily dose of Truvada, which has been proven to lower their infection risk if they are exposed to the virus.
PrEP treatment is meant to be employed alongside other prevention methods, such as safer sex practices, risk-reduction counseling, and regular HIV testing.
In giving the green light to Truvada on July 16, 2012, FDA Commissioner Dr. Margaret A. Hamburg said, "Every year, about 50,000 U.S. adults and adolescents are diagnosed with HIV infection, despite the availability of prevention methods and strategies to educate, test, and care for people living with the disease. New treatments as well as prevention methods are needed to fight the HIV epidemic in this country."
See the Infographic: Truvada PrEP for Men Who Sleep with Men

A Work in Progress

Dr. Kenneth Mayer, a visiting professor at Harvard Medical School and the medical research director at Boston’s Fenway Institute (a research center dedicated to providing medical services to LGBT communities), expressed a favorable opinion about Truvada for HIV prevention—while emphasizing that the drug’s use for this purpose is in its infancy.
“It has potential to help people,” he told Healthline. “Several randomized control trials show that it decreases HIV incidence, but it’s not a simple matter. It’s in its early days, and it’s very analogous to the early days of hormonal contraception. The initial hormonal contraception was only progestin. It was a very high dose, and that had more side effects … people got smarter about how to give it less frequently and to modulate the chemicals.”
In trials, Truvada has proved, overall, to be safe and well tolerated, though a small minority of people did show some side effects. And many medical experts and HIV experts have raised serious concerns about the ability of high-risk patients to consistently take a pill every day—if it’s not taken daily, it loses efficacy, and there are fears that poor adherence to a daily schedule could lead to HIV infections and Truvada-resistant strains of HIV.
Dr. Mayer said that it is important for healthcare providers to determine patients’ motivations and their willingness to be monitored: “It’s not a vaccine," he explained. "It’s a commitment to taking pills on a regular basis."
Thomas D. Chiampas, Pharm.D., BCPS, AAHIVP, a clinical assistant professor and clinical pharmacist at the University of Illinois College of Pharmacy, was initially skeptical about the use of Truvada for PrEP. But after reading the results of studies and talking to preceptors and students, he echoed Dr. Mayer’s sentiments.
“I do think Truvada for PrEP, when safe for the patient and taken appropriately with 100 percent medication adherence, does have the potential to diminish HIV transmission and thus AIDS infections. At our clinics we only see HIV-positive individuals; therefore, we do not prescribe Truvada for PrEP," he said. "I do believe more education is needed about Truvada for PrEP—in particular, appropriate prescribing duration, assessment of risk factors, assessment of adherence, and lab monitoring,” he said.

A Numbers Game

According to several accounts, 1,774 people filled prescriptions for Truvada for PrEP between January 2011 and March 2013. But while those numbers may seem low, many others are receiving the medication through ongoing clinical trials.
Get the Inside Story: Q&A with PrEP Patient Michael Rubio
And at about $13,000 a year, Truvada for PrEP does not come cheap. While most insurance companies in the U.S. cover Truvada, affordability can be an issue if a person has a high-copay insurance plan. “For many people, it’s not necessarily expensive, but it does involve people being motivated consumers, since a physician might have to get prior approval with some insurance companies,” said Dr. Mayer.

Education Is Key

There is some agreement among the medical community that riskier sexual behavior is on the rise, and that more education about HIV and AIDS prevention is crucial.
Fenway Health is one of several groups that have received non-restricted educational and research grants from Gilead Sciences, according to Dr. Mayer. “We’ve used some of the funding to convene a conference about best practices in HIV prevention and have developed some educational materials for people in the community, so they can be informed consumers. Their goal is not to push people to use PrEP, but [to let them] know about it. Obviously, it’s not the answer for some people,” he said.
Fenway has also conducted research on whether people are starting to use the medication, what people know about it, and what concerns they have.
One eye-opening finding of the focus group is that some people are not comfortable talking about their sexual behavior with their doctors, according to Dr. Mayer.
“This medication is not something that you would give to everybody,” said Dr. Mayer. “It is individuals who are having unprotected sexual behavior with any regularity, particularly if they have a known HIV-infected partner, who are the key targets for using PrEP. There are a number of people who said, ‘Well, I wouldn’t be comfortable divulging my behavior to my doctor, so I don’t know how I would ask for it.’ That was one concern.”
“The focus group findings also revealed that even though the drugs’ side effect profile is quite low, some individuals felt that any risk of any side effect was unacceptable if they were otherwise healthy,” he added.

What Are the Side Effects?

Acknowledging that tenofovir has been associated with kidney problems in HIV-infected people, Dr. Mayer believes that this side effect is not a major drawback if patients are monitored.
“The kidney problems that people are monitored for tend to be self-limited. You stop the medication, and the creatinine [which is evidence of kidney dysfunction] goes back to normal, so it’s not as if people automatically go into irreversible kidney failure," Dr. Mayer explained. "But what it means is, particularly if they have preexisting kidney disease, or, for example, untreated hypertension for a long time, if they go on the medication, they need to be carefully monitored. We do kidney function within a month after people start the medication, and then if it looks good, we do quarterly monitoring of kidney function. So that’s an important side effect. It’s uncommon though; it was in the 1 percent to 2 percent range that people had to stop the medication because of kidney problems in the course of the trials.”
Other side effects reported in trials include weight loss (2 percent), nausea (2 percent), and headache (4 percent), according to Fenway Medical.

Complacent Attitudes and Risky Behaviors?

Many medical professionals agree that the current generation of sexually active young adults is more complacent about HIV and AIDS than the generation before it.
For much of the 1980s and early 1990s, the lack of effective treatments for AIDS made the disease more frightening. But current therapies are so effective that HIV/AIDS is widely seen as a manageable health condition, not the death sentence it once was. And this may lead to young people being lax when it comes to safe sex practices.
Dr. Mayer explains, “Young people may feel invulnerable and the epidemic may be quieter for them, because they don’t know people with AIDS. Years ago, the drugs had more side effects and people were sicker. In many cities, you could spot people that you had the sense might have AIDS … and that’s not the case anymore.”
As such, one major concern for medical professionals is whether using Truvada will lead to riskier sexual practices—and thereby increase people’s risk for other STDs.
Maurizio Bonacini, M.D., is an associate clinical professor at the University of California, San Francisco, and the director of the HIV-Liver program at California Pacific Medical Center. He is adamantly opposed to Truvada for AIDS prevention: “I found it appalling that Truvada was approved to prevent HIV. So now we will have people that have high risk sex taking a tablet with questionable adherence, and placing themselves at risk for HBV [hepatitis B], HCV [hepatitis C], HAV [hepatitis A], HSV [herpes simplex virus], HPV [human papillomavirus], and whatever other acronym that will spell health trouble,” he said
Fred Mayer, R.Ph., the president of Pharmacists Planning Service Inc. (PPSI), a California non-profit corporation that offers a large number of health-awareness programs to promote public health and education, gave a thumbs-up to Truvada for prevention, but feels that there is not enough of a promotional push for using the drug in conjunction with condoms and other safer sex practices.
“I think any new development in prescription drugs, especially for AIDS, is great as a consumer advocate," Mayer said. "The only downside I see as a consumer advocate with a public health pharmacy organization is they are promoting this drug as an AIDS preventative and should be promoting this drug with the use of condoms, for prevention of STDs, STIs, chlamydia, et cetera,” he said.
Chiampas agrees: “People think, ‘OK, it’s a pill I can take.’ But adherence counseling, follow-up for labs and assessments, pregnancy tests, hepatitis tests, sexually transmitted diseases, HIV—all of those tests need to be drawn every two to three months to six months out for safety concerns.”

New Avenues for Education and Counseling

In terms of public health initiatives, social media presents new opportunities and new challenges. In the recent past, materials for people who are at high risk for AIDS were provided at places where they congregated. “For example, [if] gay men meet in a bar or club, you can do lot of education, you can have materials in the club—people would know where to go to recruit people for trials and studies,” said Dr. Mayer.
But as more and more people are socializing and finding sexual partners on their handheld devices, outreach can be more difficult.
“We’ve learned to be creative,” said Dr. Mayer. “The challenge is that organizations that in the past helped instill a sense of community… are not as strong anymore, because people are meeting partners online. On the other hand, with the Internet you can also offer a lot of education materials and you can educate people in the privacy of their home. It’s a matter of figuring out creative ways.”
Josh Robbins, an HIV activist and patient advocate and blogger, has recently launched a digital LGBT PrEP Guide for HIV Prevention at I'm Still Josh. “I fall short of endorsing PrEP because I don’t believe that’s the best place for our voice,” said Robbins. "What I believe in is giving people the power to be informed and then to make an educated decision with their physician or healthcare provider."
Robbins explained, "I’m not saying PrEP is right for everybody, but I’m not saying you should ignore PrEP. It is important, maybe, for me to say that, because the FDA has neither tested nor approved a condom for anal sex. PrEP is the only FDA-approved prevention method. It is the only one in the arsenal when we talk about what do we have for the prevention of HIV… as long as you have an educated discussion with a physician or whoever is the stakeholder in helping you make a decision, then, whether I agree with your decision or not, at the end of the day I’m glad that you had that discussion.”
Chiampas and one of his colleagues are planning to conduct a survey for general practitioners to see how comfortable they feel about Truvada. “Our concerns are the appropriate monitoring and follow-up, as well as counseling," he said.
He added that people on a PrEP regimen should be seen by a healthcare provider every two to three months, to be tested for HIV, kidney function, pregnancy, and other things. “The adherence issue cannot be stressed enough,” he said. “But when taken with 100 percent adherence, Truvada for PrEP was very effective in preventing HIV transmission between homosexual, heterosexual, and injection drug-use populations.”
And all the experts stress that although PrEP is an effective option, there is no 100 percent guaranteed way to prevent sexually transmitted HIV infection.

The Future of HIV/AIDS Prevention

Now that the darkest days of the AIDS crisis have passed, what does the future of treatment and prevention of HIV look like?
Dr. Mayer sees the glass as half full. “We are at an interesting point, a watershed moment where we have proof-of-concept that treating people earlier will make them less infectious, and we have proof-of-concept that for high-risk people, taking medication on a daily basis before and after high-risk behavior will make them less likely to become infected. We have new tools in the last few years, but they are not being implemented as quickly as many of us would like. It is going to take time. A lot of it is professional education in the media, a lot of it is public education, continuing the discussion.”
He adds, “None of us who work in this area think that we are going to necessarily give the same medication the same way over the next decade. There are a number of different studies looking at: Can you give less drug? Should you give different drugs that have different side effect profiles? Can you give the medication in different ways ... such as gels, vaginal rings, and injectables? It’s a very interesting time.”
Chiampas sums up the future in these words: “We think a lot of patients … will be going to their general family medicine provider and they might say, ‘I’m not positive, but I’m not in a monogamous relationship, so can I get this drug?’ or ‘My partner is HIV positive and his provider only deals with HIV patients, so can I get it through you?’ That’s where a lot of the education might be targeted.”
Finally, Dr. Mayer points out that the Centers for Disease Control and Prevention’s (CDC) guidance on the use of PrEP addresses heterosexual couples as well as women who want to conceive a child.
“One study in Africa enrolled [HIV-status] discordant heterosexual couples," he said. "It was quite a large study with almost 5,000 participants. Part of the package insert and CDC guidance is for heterosexual couples using this medication. It’s part of a larger piece. There are also studies that show that people who are infected who go on treatment become less infectious. The whole idea now is using antiretrovirals for prevention. Part of this is treating infected people earlier and working with them to maintain adherence so they are less likely to transmit."
"The other part of the equation is to identify the riskiest uninfected people and to offer them PrEP so they don’t become infected in the first place.”