Gene Hope from HIV Controllers

posted: 05/11/2010

Scientists are closer to understanding why a tiny proportion of people with HIV can live for many years without treatment and without developing AIDS. New scientific insights could boost HIV vaccine and treatment prospects by exploiting natural immunity to the virus. But a UK HIV expert said there is still a "long way" to go before a vaccine or any new drug for HIV can be developed.

Natural immunity

About one in 300 people with HIV do not develop AIDS because of natural immunity. Their immune systems keep the virus in check, preventing HIV from overwhelming the body's immune system defences, and reducing the risk of passing on HIV.
 

People who stay healthy are described as "HIV controllers". Their bodies are able to control HIV by suppressing it so far that the viral load can be undetectable.
 

Genes of 1000 compared with 2,600

The latest study involved an exhaustive genome-wide genetic scan involving a million measurements of the DNA of 1000 HIV controllers from around the world. These were compared with the genomes of 2,600 other people with HIV. The comparison revealed significant differences in the DNA responsible for one of the immune system's vital proteins, called HLA-B. This is already known for defending the body against viruses.
 

Small differences
The study found that the ‘Controllers’ version of this protein has differences in only five of the amino acids – the building blocks of proteins. These differences are at the "binding pocket," which locks on to invading viruses, before warning the immune system that it is under attack.
 

HLA-B is part of the process by which the immune system recognises and destroys virus-infected cells. Part of the protein called a binding pocket "drags and drops" peptides from inside the virus onto the cell membrane. These then mark out the cell for destruction by CD8 "killer" T cells of the immune system.
 

"We found that, of the three billion nucleotides in the human genome, just a handful make the difference between those who can stay healthy in spite of HIV infection and those who, without treatment, will develop AIDS," said Bruce Walker, director of the Ragon Institute at the Massachusetts General Hospital in Boston.
 

Paul de Bakker of the Broad Institute in Cambridge, Massachusetts, said: "Earlier studies showed that certain genes involved with the HLA system were important for HIV control. But they couldn't tell us exactly which genes were involved and how they produced this difference. Our findings take us not only to specific protein, but to a part of that protein essential to its function."
 

One step closer

Dr Walker emphasised that the discovery just one of the major differences that increase people’s chance of living healthily with HIV.
"We've not identified the precise mechanism to explain HIV controllers, but we know that of all the genetic influences involved, this is by far the most important," Dr Walker said.
 

Doug tells us why he's involved
Doug Robinson, 46, from Truro, Massachusetts, is one of hundreds enrolled in the study of "HIV controllers". He was diagnosed in November 2003 but is still healthy and well. Normally by this stage of HIV infection, and without anti-HIV drugs, Mr Robinson would be expected to have a high level of HIV in his bloodstream – a "viral load" of about 50,000 copies of HIV. Instead, Mr Robinson has under 50 copies, which is undetectable.
 

"After my diagnosis, a friend told me that I am here for a purpose, that I could be a link to something that could be beneficial, and I felt like I had a responsibility to put myself out there," Mr Robinson said. "I feel it's my responsibility, no matter what I do, to put that to use. When I'm long gone, and the dust has blown over me, I hope to leave something, a positive contribution."

Hope but a long road
Gus Cairns, editor of HIV Treatment Update of the UK's National Aids Manual, said: "This research opens the door to the development of a vaccine that could encourage the body to mimic the most effective kind of immune response, or to drugs that could interfere with HIV's ability to infect cells and derange the immune system.
"Nonetheless there is still a lot we don't know about why some genetic variants provide a much less welcoming environment for HIV than others and, although we are becoming clearer about what kinds of specific immune response are effective against HIV, we are a long way from being able to make them happen, or even knowing what we must do to make them happen."
 

Sources and reference
Independent
BBC
HIV Controllers study

Science article (pay to view)

Good for Treatment-Experienced Youngsters

posted: 10/11/2009

More excellent news from France, this time for children and young people people with drug-resistant HIV due to taking many HIV drugs – you can reach an undetectable viral load with a new three drug combination - the results are almost as good as starting treatment for the first time.
 

At the end of October news of the same combination's success with adults appeared.

The French study involved twelve children taking a combination of HIV treatment that included darunavir / ritonavir (Prezista), etravirine (Intelence), and raltegravir (Isentress). All twelve children had extensive resistance to anti-HIV drugs.

Nevertheless, after a year of treatment, all but one had a viral load below 400 copies/ml, and average CD4 cell count had increased from 124 cells/mm3 to over 500 cells/mm3.

None of the children developed a serious HIV-related illness or died, and only one stopped treatment because of side-effects.
 

The researchers describe these results as “remarkable”.

Source

Good Results for Treatment-Experienced

posted: 29/10/2009

Excellent news from France for people with drug-resistant HIV due to taking many HIV drugs - people can reach an undetectable viral load with a new three drug combination - the results are almost as good as starting treatment for the first time. 

Treatment with a combination of three newer anti-HIV drugs – darunavir/ritonavir (Prezista), etravirine (Intelence) and raltegravir (Isentress) – means that the viral load of patients who’ve taken a lot of anti-HIV drugs in the past and have drug-resistant virus can become undetectable. 

French researchers looked at how effective this combination was for 90 people. All had resistance to protease inhibitors and NRTIs. Some patients also took additional drugs in their combination – either two NRTIs or the fusion inhibitor T-20 (enfuvirtide, Fuzeon). These additional drugs were selected after resistance testing and were called the ‘optimised background’.
 

Results similar to people first starting treatment

After a year of treatment, 83% of people on the new-drug combination had an undetectable viral load. This outcome is similar to that seen in people starting HIV treatment for the first time. It didn’t matter if a person was taking these drugs with an optimised background of other drugs – the results were equally impressive.
 

People also had good increases in CD4 cell count, and there were no HIV-related deaths. And only one person had to change treatment because of side-effects.

Source

Prescriptions, HIV and Charges

posted: 10/03/2009

The British Medical Association has branded as pointless the Department of Health's consultation on making everyone with a long-term condition exempt from prescription charges. 

It says this is a waste of time and energy and the government should just make all remaining prescriptions free once more. Just 1 in 10 prescriptions are now paid for and this will fall even more because cancer patients will get free prescriptions from 1 April.

In Wales and Scotland all prescription charges have either already been abolished or are about to be abolished.

HIV treatment costs

Since the start of this year Greater Manchester HIV clinics (among other HIV clinics) have stopped prescribing any drugs except those for HIV and their treatment side effects. People must now turn to a GP for prescriptions for all other healthcare needs, such as depression amd anxiety, and sexual dysfunction. 

For some people with HIV this means paying for these prescriptions - some people are exempt, some are exempt because of low income, and some people can buy a discount card. Find out what help is available with English prescription charges here.

The charging review

The Prescription Charges Review will consider how to implement prime minister Brown's commitment to exempt patients with long-term conditions (LTCs) from prescription charges over the next few years following the exemption for cancer patients.

It will consider:

• how to define the range of long term conditions affecting patients that should be exempted from prescription charges;
• how exemption from charging can best be phased in, with due regard to:
  - what is in the best interests of patients
  - the potential impact on the wider health care system
  - implications for existing policies on management of long term conditions
  - implications for public expenditure

The review will report to the Minister for Public Health and the Secretary of State for Health in Summer 2009.

It would be good to have your say on exempting HIV as a longterm condition from prescription charges but it seems the Deaprtment of Health doesn't want to hear - there is no way to feed your views to the department at the consultation page.

Last September Gordon Brown announced that “as over the next few years the NHS generates cash savings in its drugs budget we will plough savings back into abolishing charges for all patients with long-term conditions”.  The Department of Health has established the Prescription Charges Review, chaired by Sir Ian Gilmore, to make recommendations on how this policy will be implemented. 

Charging by diagnosis or disability

The idea that we should discriminate in levels of charges according to diagnosis or disability is fundamentally misconceived. Herpes is a chronic condition. So are HIV and ME.

TB and syphilis are perhaps not chronic conditions because they can be treated and people cured, but it is in the interest of the rest of the population that people take their treatments properly and become clear of infections.

Continuing to restrict help with prescription charges to save money is a false economy. Despite the help available, the simple existence of charges is enough of a barrier to put off some of the poorest and most vulnerable. 

George House Trust supports the BMA argument, prescription charging has reached the point where the income from charging isn't worth the administrative and other costs of collection. Scotland and Wales are already seeing the benefits of free prescriptions. We don't need a review, we need prescription charges in England scrapped.

Department of Health Consultation

source