Flu Vaccines Good with HIV

posted: 12/01/2011

People with HIV are strongly recommended to have an annual flu jab, following a recent study. Swine flu (or H1N1 flu) hasn’t gone away, and the flu vaccine being given to people this winter protects against this.

Some new studies have shown that vaccination against flu works well and is safe for people with HIV.
 

The studies show

• vaccination produces protective antibodies against flu
• better levels of protection come if you have a booster dose
• rates of flu were much lower among people vaccinated
• CD4 cell count is not affected
• viral load stays stable.

Flu jab : Strongly recommended with HIV 
The research results show recommending vaccination of people with HIV is “justified” and they strongly recommend that people should contact their GP and ask for the vaccination.
 

In the UK flu jabs are available from GPs. HIV clinics can provide advice on dealing with swine flu and being vaccinated.

The NHS Choices website allows you to search the database of all GPs.

Source

New Treatments Pipeline

posted: 10/09/2010

If you want to know about all the future treatments, tests, and prevention for HIV, hepatitis, and TB, the Treatment Action Group (TAG) have produced a new guide. It deals with

• future HIV antiretroviral treatments
• future ways of diagnosing HIV
• future HIV antiretroviral treatments for babies, children and young people
• future immune-based therapies and preventive technologies - like vaccines and pre-exposure prophylaxis (which means treatment to prevent HIV infection)
• future hepatitis B treatments
• future hepatitis C treatments
• future diagnosis, treatments and vaccines for tuberculosis (TB)

It's not an easy booklet to read, but there are 150 pages of information about new HIV treatments in the development 'pipeline.' That is a lot of new developments that should continue to steadily improve the quality and length of life people with HIV can expect.

TAG 2010 Pipeline Report from i-BASE

Treatment Action Group (TAG)

HIV Damages and Sneaks Through

posted: 14/04/2010

HIV damages the cell walls of the genitals’ mucous membrane, and this lets HIV slip through to infect the vulnerable cells below, we have now learnt from a study. Most experts thought that HIV got through the mucous membrane itself, where these already had surface damage. This new scientific finding steers scientists who are creating microbicides and vaccines, to design these so they block contact between a very specific HIV protein and those in genital mucous membranes.

Microbicide hopes raised
This is an example of basic laboratory research into learning exactly how HIV attacks and works that may help solve a big HIV prevention problem. Women lack a HIV prevention method that they can control. Microbicides and vaccines are the best hope, but none have succeeded. This research gives microbicide and vaccine researchers a clear target to focus on. A few years down the line, we may see more hopeful signs of workable microbicides and vaccines appearing.

All sexual transmission of HIV occurs through mucous membranes. These researchers have basically found out that HIV has a protein that makes genital mucous membranes easier to pass through and cause infection. Previously researchers into HIV transmission had thought that transmission was most likely to occur either when the mucous membrane was damaged (for example through trauma or ulcers), or when many activated immune cells were present (such as during a sexually transmitted infection like gonorrhoea).

Disease progression?
The same ‘damage the cell walls and then sneak past’ strategy used by HIV for infecting people is thought by some experts to also help explain HIV disease progression and the development of some serious conditions, such as atherosclerosis (hardening and narrowing of the arteries).

How HIV does it
This study found that HIV weakens the integrity of surface cells, even when they are undamaged.

"It makes the electrical barrier resistance of epithelial cells decrease. By doing that, the virus can cross the barrier," said lead researcher Charu Kaushic, associate professor in the Centre for Gene Therapeutics at McMaster University, Ontario, Canada.

How does HIV actually get underneath epithelial cells to infect other cells that are susceptible to HIV? "It's not the cells on top," Kaushic said. "It is the immune cells underneath that have all the receptors that HIV likes to latch on to and that allow the virus to replicate and establish infection. But it has to cross the epithelial barrier first!"

Aisha Nazli, a researcher in Kaushic's laboratory, noticed every time she put HIV on epithelial cells, their electrical resistance went down significantly. It happened every time she tried this.

Protein break through

Kaushic said the surface protein of the virus (the gp120 surface protein) causes the epithelial barrier to break. "The surface protein signals to the inside of the epithelial cells by binding to it", she said. "The epithelial cells start making inflammatory proteins which cause these cells to go on their self-destructive pathway."

The researchers say if viral load and exposure time are enough, HIV can probably disrupt any mucosal barrier in the body, although infection may not necessarily occur every time.

"This is a significant step forward in defining where prevention strategies, such as microbicides and vaccines, need to focus. Instead of trying to stop HIV from infecting the target cells underneath the epithelium, we need to think about ways to stop the virus from attaching to epithelial cells themselves," said Charu Kaushic.

Source

Nazli A et al. Exposure to HIV-1 directly impairs mucosal epithelial barrier integrity allowing microbial translocation. PLoS Pathogens 6 (4): e1000852, 2010. (full article, free access)

Vaccine – No breakthrough

posted: 28/10/2009

At the end of September people got rather excited about HIV vaccines. For the first time ever we had some hopeful vaccine trial results. They seemed to show the risk of HIV transmission in Thailand was cut by just under one third, using a combination of two vaccines.

But these bright hopes were dashed when the full results were published at the HIV vaccine conference that has just ended in Paris.

Full results shows the vaccine is only modestly effective and does not protect those at highest risk of HIV.
 

Surprised

The news in September that the controversial $105m (£64m) trial was an unexpected success took experts by surprise and sparked excitement around the world. However, it is now clear that there is little to cheer.
 

Dashing Hopes in Results

The full results published online by the New England Journal of Medicine show

• The vaccine did not protect those at high risk of HIV infection, such as sex workers and intravenous drug users
• The vaccine’s protection fell after 12 months
• If you remove the results of the people who didn’t have all the vaccine shots, the apparent protection provided by the vaccine seems to vanish – it is not statistically trustworthy.

Hopeful

Some scientists and campaigners in Paris nevertheless continued to hail the results, if not as a triumph, then as a beacon of hope. Dr Nelson Michael of the US army – the US military had invested in and run the research programme with the Thai government – said scientists would now look for clues for future HIV vaccine trials. "It is a signpost for vaccine development," he said. "This was a yes-we-can moment: the opportunity to become enthusiastic. The door has cracked open. We are all going to try to collectively crash through it."
 

End of line for old goods
But Seth Berkley, president of the International Aids Vaccine Initiative, which evaluates and channels funds into trials, said he thought the regime tested in Thailand would be taken no further. The vaccines involved – AidsVax, which previously failed in a trial in Thailand on its own, and Alvac – were 15 years old.
"That's why there was scientific controversy about starting this trial," he said. "If you were going to start again, you might use one of the more robust vaccines we have [in the lab] today.
 

No new hopes on horizon
"We don't have a vaccine on the horizon. It isn't the Thai one or one of the others. That's why we have to have the patience for this marathon rather than a sprint."
 

Wasted investment?
The Thai trial, given the name RV144, was controversial from the start because it involved two vaccines given together, one of which had previously failed to protect people from HIV while the other had not been tested alone. Many people felt the $105m it cost could be better spent.
More than 16,400 Thai men and women aged 18 to 30 who did not have HIV were recruited and randomly assigned to receive the vaccine or a placebo. They were given six shots over six months: two of Alvac followed by two more sessions where they were injected with both vaccines. They were tested for HIV every six months, and counselled on how to avoid it for the next three years.
By the end of the trial only 125 people had become infected with HIV. In the announcement of the headline results last month, it was said that 51 of those given the vaccine had become HIV positive compared with 74 in the placebo group, which gives a statistically significant efficacy of 31%.
 

1 in 4 missed doses
But many volunteers did not get all six vaccinations, taking the numbers down from around 8,000 in each group to around 6,000. Among those people, there were 50 infections on placebo and 36 on the vaccine, which gives an efficacy of 26% but is not statistically significant, meaning it could happen by chance.

based on Source

Aidsmap has a very detailed analysis and sees more hope

New Scientist has a brief clear analysis and useful links to the journal and scientific analysis

This has a very clear plain English explanation of 'statistical significance' and how this affects how you interpret these vaccine trial results.

George House Trust comment
 

The before-conference hyping of ‘results’ which were hardly statistically meaningful has done none of us any favours. 
 

The technical difficulties of designing a vaccine to penetrate HIV’s defences and rapid evolution remain. We are 20 years long into the search and are a little nearer but still a vast distance from real success. We wouldn’t put any money on finding a decent working HIV vaccine in the next decade, and some think we will have an even longer wait than that. But we really hope we are wrong about this.

HIV Vaccine - Hopes and Fears

posted: 28/09/2009

Combining two HIV vaccines into one vaccine cut the risk of HIV infection by almost one-third in a large trial in Thailand, the trial sponsor announced today. It is the first proof that a vaccine against HIV can protect against infection, but scientists say a lot more research will be needed before a vaccine can be given to large numbers of people.

“This is a historic day in the 26-year quest to develop an AIDS vaccine,” said Dr Alan Bernstein, executive director of the Global HIV Vaccine Enterprise.

"This is the first HIV vaccine candidate to successfully reduce the risk of HIV infection in humans. We are very excited and pleased with the outcome of this trial and congratulate all those who participated in it," said Lieutenant General Eric Schoomaker, Surgeon General, U.S. Army, the trial sponsor.

The trial involving 16,000 people since 2003 was called RV 144, and compared vaccinating people with two products against vaccinating people with a dummy, inactive substance.

The study recruited adults in the community in two provinces of Thailand with high HIV prevalence (Chon Buri and Rayong), but did not specifically target individuals at high risk of HIV infection. Volunteers for the study were adults aged 18-30 who gave informed consent to participate in the trial.

Participants were randomly assigned to receive an initial set of vaccinations with ALVAC, and follow-up booster vaccinations with AIDSVAX, a product previously tested in large trials without evidence of it working, or the placebo vaccination.

The inclusion of AIDSVAX in the vaccination meant many vaccine experts had expected the trial to fail.

31% surprise

In the event, the prime-boost combination of ALVAC(R) HIV and AIDSVAX(R) B/E lowered the rate of HIV infection by 31.2% compared with placebo. This reduction was statistically significant, meaning that the possibility that the possibility of the result being due to chance is very low, but the confidence intervals for the estimate in the reduction in risk were wide (p=0.039, 95% confidence interval 1.1% - 51.1%).

In the final analysis, 74 placebo recipients became infected with HIV compared to 51 in the vaccine regimen arm. The vaccine regimen had no effect on the amount of virus in the blood of volunteers who became HIV-infected during the study.

More detailed results of this study will be presented next month at the AIDS Vaccine Conference, October 19 - 22 in Paris, France.

The vaccine products used in the study will not go forward for immediate licensing. Instead, the results from the study, which was considered to be a `proof of concept` trial, will be used to inform the design of future vaccine trials.

Long wait for Africa

The vaccine was designed for HIV found in Thailand, which has a particular type of HIV. Africa is where a HIV vaccine is most urgently needed because 2 out of 3 of the world's population living with HIV live on the continent. The trial of this vaccine won't protect against HIV in Africa. African's will probably be last in the queue for HIV vaccines but have by far the greatest need. The African market is huge but there is no profit in it for the global drug companies.

Some protection but more risk taking?

It is exciting that something has finally been shown to work, even a bit. But a vaccine that reduces the risk of infection by a third presents an sharp public health dilemma, as the HIV commentator Elizabeth Pisani notes here:

With most infectious diseases, reducing everyone’s risk by a third would make quite a difference across a whole population. But the problem with HIV is that it is both an infectious disease and a behavioural one. I can get it by sharing needles with other drug injectors, I can avoid it by using condoms every time I have sex. If I know I have been vaccinated, will that make me more likely to share needles, or less likely to use condoms? And if it does, will that change outweigh the 30 per cent reduction in risk that comes with the vaccine?

The question came up in 2005, when studies showed that circumcising men reduced their risk of getting HIV through heterosexual sex by 60 per cent. A stunning result, especially for the hyperepidemics of Southern Africa, but one that health authorities didn’t act on for years because they worried that circumcised men would enjoy what the wonks call “behavioural disinhibition” — that “I’ve been snipped, so I can toss the condoms” thinking.

Large circumcision programmes are just beginning, so we do not know what effect they will have on behaviour. We do know that after HIV treatment became universally available in this country, condom use in the gay community fell and new HIV infections rose, even though treatment greatly reduces the risk of passing the virus on. Could the same thing happen if people feel protected by a vaccine? Probably.

I think we should develop a vaccine even at “modest” effectiveness; for people who do not have any safe behaviour to undo, a 30 per cent reduction in risk is better than none. But I’ll be curious to see if the public heath nannies agree.

Source and Source2