Treating to Prevent HIV

posted: 03/03/2011

Could people who do not have HIV use HIV treatment drugs (PrEP) to stop themselves from getting HIV? The detailed results just out for gay and bi men are better than the early findings. This means PrEP could be approved for use in the USA by the end of the 2011.

Last year, the first results from a study of gay and bisexual men appeared. Taking PrEP cuts gay and bi men’s risk of getting HIV. But there were worries because many of the men did not take all the tablets. Some men got HIV.

HIV infection
Much better updated results were announced at the CROI conference in Boston, USA, that has just ended.

In the different places where the trial took place, including South Africa, the taking of PrEP (HIV drugs to prevent HIV infection) varied a lot.

Gay and bi men in the two USA cities (Boston and San Francisco) of the international iPrEx study of tenofovir/FTC (Truvada) had near-perfect HIV-prevention drug taking, compared with 50% tablet taking at the other sites.
 

And the men taking the greatest sexual risks for HIV, by having unprotected receptive anal sex, were taking the prevention treatment better than men taking less HIV risks – which is good to know.
 

USA approval within a year?
Lead investigator Bob Grant announced that the US Food and Drug Administration (FDA) had agreed that the trial results were good enough for the FDA to consider allowing the use of Truvada to prevent HIV. PrEP, as a result, might be approved in the USA by the end of this year.
 

First USA Guidelines for gay men published

Interim Guidance: Pre-exposure Prophylaxis for the Prevention of HIV Infection in Men Who Have Sex with Men from USA Centers for Disease Control and Prevention. 

2500 men and the results

There were almost 2500 men in this trial and 130 of them got HIV by the end. Like most drug trials men were randomly split into two groups and told they would either get Truvada, or a dummy pill, but no-one would know who was taking what, until the end. The men were therefore warned they should still use condoms, because half were using the dummy pill.
 

48 of the men who got HIV took the Truvada and 82 of the men who were taking the dummy pills, a HIV infection rate of 2.6% a year. Another 10 other men have HIV, but they already had the symptoms of HIV infection when they joined the study.
 

This means that the final ‘how well does it work’ rate in the ‘modified intent to treat’ analysis, (this leaves out the 10 men who started the study with HIV, and ignores things like different rates of tablet-taking and the men’s level of sexual risk-taking), was 42%.
 

PrEP worked better when men were over 25 (56%), among men who took more than 9 out of 10 of the tablets (68%), and among the men who were circumcised (76%).
 

Would PrEP be cost effective? 

Other new studies have now looked at the value for money of treating people to prevent HIV in South Africa. The answer is mixed. 

It is usually cheaper to treat the person with HIV than treating one or more HIV negative people with PrEP. Treating the person with HIV should reduce their viral load so it becomes undetectable and their chance of passing on HIV then becomes very small. In mixed status couples, that may be enough protection for many. But PrEP would help protect negative partners who have unsafe sex outside the main relationship and who don't use condoms.  

Source and more details

African Pastor preaches 'Jesus had HIV'

posted: 26/08/2010

A pastor led 100 in his congregation to take HIV tests and preached a sermon called "Jesus was HIV-positive," in an attempt to break the conspiracy of silence by the South African church.     
 

Xola Skosana said that HIV is stigmatised as evil and a sin in the country that has the world's largest number of people with HIV. Pastor Skosana, 43, took a HIV test in front of his congregation last Sunday at the non-denominational Way of Life church in Khayelitsha, Cape Town. The test was also taken by 100 young people from the township.
 

The pastor said he chose the title "Jesus was HIV-positive" for his sermon to draw attention to "a very serious issue". “In many parts of the Bible, God put himself in the position of the destitute, the sick, the marginalised," he said. "When we attend to those who are sick, we are attending to Him. When we ignore people who are sick, we are ignoring Him."
 

Jesus’s words
Skosana cited a passage in the Bible where Jesus says: "I was sick and you visited me, I was in prison and you came to me." But he has had a hostile reaction in some quarters.
"The scathing attacks I've received from Christians are unbelievable," he said. "They're saying you can't reconcile Jesus and AIDS. They assume it means Jesus was promiscuous and had a louche lifestyle with many sexual partners."
 

Skosana has two sisters died from HIV. One died last month at the age of 44. The other died in 2003 in her early 20s.
 

South African church condemned
He condemned the national church for failing to tackle the issue when nearly 1,000 people are dying from HIV-related causes every day. The South African government had been accused of AIDS "denialism" but has more recently been praised for its prevention and treatment programmes.
"It baffles me why in the church this is the most untalked-about subject," Skosana said. "If I went to church and never heard the pastor talk about this, I would assume I must go home and die in silence. The message is that it's an unpardonable sin and we must just forget about HIV/AIDS.
 

God cares
"My responsibility as a pastor is to open a Bible and paint a picture of a God who cares for people and wants the best for them, not who judges them and is ashamed of them."
He called on other churches to be more open about the subject. "I hope this will change the paradigm, especially in the Pentecostal background. I come from the Pentecostal background and I know this discussion is totally alien there."
 

HIV information and advice
Skosana will not disclose the result of his public HIV test in case it puts pressure on the churchgoers who followed his example. They had heard him explain the virus, possible treatments and the importance of knowing their status and were given professional counselling.
 

Praise for example
Skosana's stance was praised by South Africa's National AIDS Council. Mark Heywood, its deputy chairperson, said: "I applaud his actions. It's very important that church leaders set an example, destigmatising HIV and encouraging testing so people know their status. There are many churches that have done a lot to combat HIV. The problem is that the church as a whole has not been vocal enough. It's often been left to individual church leaders and organisations. We would like to hear a clearer message."
 

Source
YouTube

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Pastors guide to HIV ministry
Other Religions and HIV guides in our Information Bank 
 

Test and Treat to End HIV in 40 Years

posted: 22/02/2010

A global public health strategy for testing and treating everyone with HIV is now being considered.
Health officials are considering a radical shift in the strategy against HIV that would see everyone tested for the virus and people with HIV then put on a lifetime course of drugs. The strategy, which would involve testing most of the world's population for HIV, aims to reduce the transmission so much that HIV would die out completely over the next 40 years.
 

Brian Williams, professor of epidemiology at the South African Centre for Epidemiological Modelling and Analysis in Stellenbosch, said that HIV transmission could be stopped within five years with the use of antiretroviral drugs (ARVs). "The epidemic of HIV is really one of the worst plagues of human history," Williams told the American Association for the Advancement of Science meeting in San Diego. "I hope we can get to the starting line in one to two years and get complete coverage of patients in five years. Maybe that's being optimistic, but we're facing Armageddon."
 

Two years of trials now
Major trials of this universal test and treat strategy are planned in Africa and the USA and will affect whether this becomes part of global public health policy in the next two years.
More than 30 million people are infected with HIV globally and two million die of the disease each year. But across the globe only 12% of those living with HIV get the treatment they need. The disease is overwhelmingly prevalent in sub-Saharan Africa, which accounts for a quarter of all HIV cases globally. Half of these are in South Africa.
 

Broadly the epidemic calculations are that a person with HIV may pass on HIV to between five to 10 others in their time with HIV. Treating people within a year of becoming infected can reduce transmission tenfold, enough to cause the HIV epidemic to die out.
 

Trials plans
In the trials, people will be offered HIV tests once a year, either as routine when they visit their GP, or through mobile clinics in more remote regions. Those testing positive will be put on a lifetime course of ARVs.
"Over the past 25 years we have saved the lives of probably two to three million people using antiretroviral drugs, but almost nothing we have done has had any impact on transmission of the disease," Williams said. "We have stopped people dying but we haven't stopped the epidemic."
If patients take ARVs when they should, the amount of virus in their bodies should fall so low that it becomes undetectable, and they are then extremely unlikely to pass the virus on.

Five years to see the results but worth the price
"The question is, can we use these drugs not only to keep people alive, but also to stop transmission and I believe that we can. We could effectively stop transmission of HIV in five years." Scientists estimate that the cost of implementing the strategy in South Africa alone will be $3bn-$4bn a year. The world currently spends $30bn (£19.4bn) a year on HIV research and treatment, a figure that some experts believe will double over the next decade.
 

Sub-Saharan Africa has seen a dramatic rise in cases of tuberculosis among HIV patients, who are also susceptible to other infections because their immune systems are weakened.
"If you factor in all of the costs, in my opinion, doing this would be cost saving from day one, because the cost of the drugs would be more than balanced by the cost of treating people for all of these other diseases and then letting them die," Williams said. "We're killing probably half a million young adults every year in the prime of their life just at the point where they should be contributing to society and the cost of that to society is enormous," he added. "The only thing that's more expensive than doing this is not doing this."
 

HIV patients in southern Africa are more likely to take ARVs when they should than people living in developed countries, according to health officials. The finding gives doctors hope that the blanket administering of drugs might suppress the virus enough that it dies out naturally.

George House Trust comment 

This assumes a great deal. We are still a long way from providing treatment to all the millions of people in sub-Saharan Africa who need it. This strategy would require us to deliver HIV treatment for vastly more people, reliably, day after day, for decades.

The computer prediction of the epidemic will be correct as long as every African does get tested for HIV every year, everyone who tests positive then starts taking antiretrovirals immediately and 98 out of 100 do not miss a dose. How would people in the UK respond if outsiders decided all adults in the UK must have a HIV test every year?

We know gay men in rich countries use condoms far less now than before effective treatment became available in the mid 1990s, but somehow it's assumed heterosexuals in Africa won't also use condoms less.  

Source

 

Sign Up for Conference News

posted: 15/07/2009

International AIDS Society is holding one of the major HIV conferences in Cape Town, South Africa this year. The Conference runs from 19 - 22 July.

The IAS conference focuses on expanding treatment and prevention in resource-limited settings. It covers basic, clinical and prevention science and 'operations research' will look at how people are developing evidence-based prevention, treatment and care programmes and policy.

You can get daily news updates from aidsmap.com from the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention.

You can sign up here for the aidsmap.com conference bulletin. 

Harmed by Vitamin Claims

posted: 20/04/2009

The lives of tens of thousands of people, especially in South Africa, were needlessly shortened by unscientific claims to cure HIV simply with vitamins.
 

Dr Ben Goldacre wrote a best seller called Bad Science and now you can read, free, the chapter about falsely peddling vitamins as if they are a cure for HIV.

This chapter couldn't be included when the book first came out because the vitamin pill plugger, Matthias Rath, was still suing the author and the Guardian newspaper.

Maathias Rath lost, has already paid almost a quarter million pounds in compensation and legal costs, and still owes another £300,000.  He is a man who claimed vitamins cure cancer, cardio-vascular heart disease as well as HIV. Worse, he tells people the conventional treatments for these various conditions are harmful and must be replaced with vitamins. He makes a great deal of money from selling vitamins to the vulnerable and credulous.

In the case of HIV he got the president of S Africa and the health minister on his side. Thabo Mbeki gave Rath's ideas credence and support, and Mbeki and his minister bear a heavy responsibility for the deaths of thousands of people living with HIV.

This chapter - The Doctor Will Sue You Now - is free and shared on a Creative Commons Licence.

Bad Science