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Posts tagged ‘AIDS’

Addressing HIV issues

Françoise Barré-Sinoussi: “HIV comorbidity is one of the most pressing issues that we need to address in HIV.”

RESEARCHERS speaking on the final day of the 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) have focused on HIV epidemic trends in Asia and the Pacific, new vaccine insights and HIV and Hepatitis C co-morbidity.

The presentations reflected the breadth of expertise among more than 5,200 researchers, clinicians and community leaders attending the conference, which runs from June 30 to July 3 in Kuala Lumpur, Malaysia.

“Thanks to tremendous efforts, in the last few years most countries in the Asia and the Pacific region have registered a reduction of new HIV infections,” said IAS 2013 local co-chair Adeeba Kamarulzaman, director of the Centre of Excellence for Research in AIDS (CERiA) and Dean of the Faculty of Medicine at Universiti Malaya in Kuala Lumpur.

“HIV comorbidity is one of the most pressing issues that we need to address in HIV,” said Françoise Barré-Sinoussi, IAS 2013 International Chair and International AIDS Society President. “There is no doubt that new studies on tuberculosis and hepatitis C (HCV) will contribute to better integrate research and improve multidisciplinary coordination. In the case of HCV, injecting drug use is the main driver of infection, and we face similar challenges in terms of stigma and discrimination towards infected people.”

Tracking the HIV epidemic in Asia and the Pacific

In his plenary presentation, J.V.R. Prasada Rao, UN Secretary-General’s special envoy for AIDS in Asia and in the Pacific, described how Asian AIDS epidemics are characterised by high levels of HIV prevalence among key populations, including sex workers and their clients, injecting drug users (IDUs), men who have sex with men (MSM), and transgender women.

As a region, Asia witnessed the highest HIV incidence from 1990 to 2000, which plateaued and reversed during the next decade in a number of countries.

Asian countries have conducted systematic surveillance, data collection and analysis, helping them to monitor the progress of the epidemic with a fair degree of accuracy.

Rates of new HIV infections are decreasing or stable, except in a few countries, and mortality rates peaked from 2000 to 2005.

Mortality among children, however, has not reduced that appreciably, largely due to low coverage of prevention of mother-to-child transmission (PMTCT) programmes. There is high coverage of interventions among sex workers and their clients, but coverage levels of interventions for IDUs, MSM, and transgender women continue to be low – largely due to political apathy and criminalisation.

High levels of stigma persist because of the prevailing adverse legal environment and criminalisation of key populations.

Looking beyond 2015, the situation remains hopeful, but uncertain, with a great opportunity for progress at the UN General Assembly in September 2013 where countries will meet to deliberate the reports of the Intergovernmental Working Group (IMG) of Rio + 20 Conference and a high level panel appointed by the UN Secretary General to define post-2015 development agenda.

Vaccine: new developments in protecting antibodies

Dennis Burton (United States), professor of immunology and microbiology, Scripps Research Institute, noted that many now consider that in order to be successful, an HIV vaccine will need to induce broadly neutralising antibodies capable of neutralising many different strains of virus.

Induction of such antibodies by classical vaccination strategies, such as live attenuated virus and killed virus, has not been successful.

An alternative approach is a rational one based on understanding, at the molecular level, the structure of the HIV envelope spike at the surface of the virus, and how broadly neutralising antibodies interact with this spike. It is the binding of antibodies to the spike that makes virus non-infectious.

Great progress has been made in recent years in isolating broadly neutralising antibodies and understanding how these antibodies interact with the envelope spike.

The next stage, which is to take this knowledge and design proteins that may be capable of inducing broadly neutralising antibodies, has begun. With examination of more and more of the broadly neutralising antibodies, some of the hurdles to inducing them through vaccination become clearer.

At this moment, many insights are being obtained and many vaccine candidates are being designed and tested. It is hoped that this rational design approach will begin to give signs of success within the near future.

HCV in HIV patients: cure and beyond

Around 25% of HIV-infected patients are also chronic carriers of hepatitis C virus (HCV) and because of the intricate and deleterious influence both viruses have upon one another, liver-related morbidity and mortality have been lately increasing in the co-infected population.

Karine Lacombe (France), associate professor of the Infectious and Tropical Diseases Department, Saint-Antoine Hospital, Paris, France, reviewed the latest data regarding the evolving epidemics of co-infection around the world and gave some insights on the physiopathological pathways by which both viruses may lead to end-stage liver disease.

HCV cure is becoming a reality thanks to the major changes occurring in the treatment paradigms: care is shifting from a long course of Peg-Interferon – ribavirin-based bitherapy with major side effects and low response rate to well-tolerated and short courses based on two, three or four-drug regimens with a very high rate of success. But this reality may stay out of touch for the most parts of the HIV-HCV infected world because of cost and human resources constraints.

In her address, Lacombe advocated for an easier access to innovative therapies for those most at need. — IAS

via Addressing HIV issues – Health | The Star Online.

WHO | WHO issues new HIV recommendations calling for earlier treatment

30 JUNE 2013 | GENEVA – New HIV treatment guidelines by WHO recommend offering antiretroviral therapy (ART) earlier. Recent evidence indicates that earlier ART will help people with HIV to live longer, healthier lives, and substantially reduce the risk of transmitting HIV to others. The move could avert an additional 3 million deaths and prevent 3.5 million more new HIV infections between now and 2025.

The new recommendations are presented in WHO’s “Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection”, as new data reveal a total of 9.7 million people were taking these lifesaving drugs at the end of 2012.

“These guidelines represent another leap ahead in a trend of ever-higher goals and ever-greater achievements,” says WHO Director-General Dr Margaret Chan. “With nearly 10 million people now on antiretroviral therapy, we see that such prospects – unthinkable just a few years ago – can now fuel the momentum needed to push the HIV epidemic into irreversible decline.”

Call to initiate treatment at 500 CD4 cells/mm³ or less

The new recommendations encourage all countries to initiate treatment in adults living with HIV when their CD4 cell count falls to 500 cells/mm³ or less – when their immune systems are still strong. The previous WHO recommendation, set in 2010, was to offer treatment at 350 CD4 cells/mm³ or less. 90% of all countries have adopted the 2010 recommendation. A few, such as Algeria, Argentina and Brazil, are already offering treatment at 500 cells/mm3.

WHO has based its recommendation on evidence that treating people with HIV earlier, with safe, affordable, and easier-to-manage medicines can both keep them healthy and lower the amount of virus in the blood, which reduces the risk of passing it to someone else. If countries can integrate these changes within their national HIV policies, and back them up with the necessary resources, they will see significant health benefits at the public health and individual level, the report notes.

Further recommendations

The new recommendations also include providing antiretroviral therapy – irrespective of their CD4 count – to all children with HIV under 5 years of age, all pregnant and breastfeeding women with HIV, and to all HIV-positive partners where one partner in the relationship is uninfected. The Organization continues to recommend that all people with HIV with active tuberculosis or with hepatitis B disease receive antiretroviral therapy.

Another new recommendation is to offer all adults starting to take ART the same daily single fixed-dose combination pill. This combination is easier to take and safer than alternative combinations previously recommended and can be used in adults, pregnant women, adolescents and older children.

“Advances like these allow children and pregnant women to access treatment earlier and more safely, and move us closer to our goal of an AIDS-free generation,” said UNICEF Executive Director, Anthony Lake. “Now, we must accelerate our efforts, investing in innovations that allow us to test new born babies faster and giving them the appropriate treatment so that they enjoy the best possible start in life.”

The Organization is further encouraging countries to enhance the ways they deliver HIV services, for example by linking them more closely with other health services, such as those for tuberculosis, maternal and child health, sexual and reproductive health, and treatment for drug dependence.

“The new WHO guidelines are very timely in view of the rapid progress we have made in expanding programmes for prevention and treatment,” says Dr Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “This is an example of how the Global Fund and the WHO work together to support countries as we move towards removing HIV as a threat to public health.” Since its creation in 2002, the Global Fund has supported more than 1,000 programmes in 151 countries, providing HIV treatment for 4.2 million people.

Challenges remain

Challenges still remain. Alongside the new treatment guidelines, a treatment progress update by WHO, UNAIDS, UNICEF identified areas in need of attention.

While the number of all eligible children on ART has increased by 10% between 2011 and 2012, this is still too slow compared to the 20% increase in adults. A further complication is that many key populations such as people who inject drugs, men who have sex with men, transgender people and sex workers, continue to face legal and cultural barriers that prevent them getting treatment that otherwise would be more easily available. Another factor that needs to be addressed is the significant proportion of people who, for many reasons, ‘drop out’ of treatment.

Data reinforces feasibility of recommendations

Despite this, the Global update on HIV treatment: results, impact and opportunities contains encouraging data that reinforces the feasibility of the new WHO recommendation on earlier ART, which would expand the global number of people eligible for antiretroviral therapy to 26 million.

Between 2011 and 2012, the largest acceleration ever of people enrolled on ART was achieved, with an extra 1.6 million people benefitting from antiretroviral therapy, increasing the total to 9.7 million people. Furthermore, increased coverage of treatment occurred in every region of the world, with Africa leading. Four out of 5 people who started treatment in 2012 were living in sub-Saharan Africa.

“Today nearly 10 million people have access to lifesaving treatment. This is a true development triumph,” says Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “But we now have a new challenge – ensuring that all 26 million people eligible for treatment have access – not one person less. Any new HIV infection or AIDS-related death due to lack of access to antiretroviral therapy is unacceptable.”

Today’s recommendations were released by WHO on the opening day of the International AIDS Society 2013 conference in Kuala Lumpur. Among those endorsing the recommendations at the launch were representatives from countries, where such earlier ART intervention is already national policy, along with development agencies who are providing technical and financial support.

The International AIDS Society conference is held every two years and attracts leading scientists, clinicians, public health experts and community leaders to examine the latest developments in HIV-related research, and to explore how scientific advances can inform the global response to HIV/AIDS.

via WHO | WHO issues new HIV recommendations calling for earlier treatment.

National program to raise awareness, treat HIV cases

A National program to combat HIV and AIDS will strive to provide   free anti-retroviral (ARV) and other medicines to 70 percent infected persons during the period 2012-2015, according to the Ministry of Health.

The Ministry will run the program for the period 2012-2015, which has been approved by the Prime Minister. Vietnam has successfully reduced the number of new HIV-infected cases and AIDS patients as well as deaths. Many measures have been taken, including anti-retroviral (ARV) and methadone treatment methods.

The target of the program for the period 2012-2015 is to provide better understanding of the disease to at least 60 percent of the population from 15 to 49-years-of-age.

The program will educate people on the ways the disease can be transmitted and how it can be prevented. Any previous misconceptions on HIV and AIDS will be cleared so as to avoid discrimination of children and adults infected from the disease.

The program will endeavor to reduce infection in the general public by 15 percent and in sex workers to below 5 percent and in homosexuals to below 10 percent.

The government has agreed to provide VND3,700 billion (US$178 million) for the program.

By K. Nguyen – Translated by Uyen Phuong

Championing our women’s healthcare

Datuk Dr Raj Karim had a life-altering moment when she came across an incest case


DOCTOR ON A MISSION: Datuk Dr Raj Karim is a recognisable game-changer in ensuring the health and well-being of women, children and families in Malaysia. She has yet more challenges ahead as the newly-appointed Malaysian AIDS Council president, writes Eunice Au

WITNESSING incest was the turning point for Datuk Dr Raj Karim in her efforts to improve maternal and child healthcare services in the country.

Assigned to improve rural healthcare nationwide as a Health Ministry officer in the 1970s, she visited a home in Terengganu where she saw a mother holding her baby whilst her daughter was cradling another.

“Both babies were a few months apart and the mother insisted she gave birth to both children, but the midwives revealed otherwise,” said Dr Raj.

From that encounter, she witnessed the fear, trauma and powerlessness experienced by the mother and her daughter because in those days, she said, “people don’t talk about incest”.

Since then, Dr Raj has been an impetus for change and progress in maternal and child healthcare as well as in the reproductive and sexual health field in the state.

Her appointment as Malaysian AIDS Council president on May 26, she felt, would be a challenge — to take stock of the former presidents’ and council’s work and to discover and strengthen the gaps.

Prevention of HIV and AIDS was part of the whole gamut of maternal and child healthcare and reproductive and sexual health, she explained, adding that the issues were all integrated.

“The AIDS epidemic is not stagnant. It moves with the times. At one time, we concentrated on injecting drug users, but now we need to focus more on other factors such as sexual transmission as more young people and women are getting AIDS.”

One of the tasks she is most anticipating is to have more integration of HIV and AIDS education into the schools’ reproductive and sexual health modules.

Soft-spoken and unpretentious, Dr Raj was the first female to be awarded the United Nations Malaysia Person of the Year Award for her contributions in promoting gender equality and women’s empowerment.

Modestly downplaying her outstanding achievement, she credited the award to the people who had supported her along the way, including Tun Dr Siti Hasmah Mohd Ali, the wife of former prime minister Tun Dr Mahathir Mohamad.

“She (Dr Siti Hasmah) is a person I have worked closely with all my career and she is definitely my inspiration in the professional field.”

While she had been inspired by Dr Siti Hasmah and other bosses during her career, Dr Raj’s initiation to rural healthcare stemmed from her mother’s lifelong involvement in social work.

She recalled seeing villagers eating monkeys as a source of protein when her mother brought her to visit kampungs.

“My mother showed me how privileged I was to have a house, shelter, clothes, shoes, good food and water because so many people do not have those basic needs,” the mother of five said.

Dr Raj further grew into her role as an advocate for good maternal and child health services as the Public Health Institute director in 1989 and later tackled the sensitive issue of reproductive and sexual health when she was appointed National Population and Family Development Board director-general in 1992.

So dedicated was she that subsequently, she continued her efforts in the international arena as the regional director of the International Planned Parenthood Federation, East and Southeast Asia and Oceania Region (IPPF) after retiring from government service in 1999.

Eager to incorporate her 10-year IPPF experience in Malaysia, Dr Raj spoke about a project in Can Tho province in Vietnam.

The foundation had collaborated with the Vietnam Family Planning Association and Bank of Japan to provide HIV and AIDS prevention and support for the construction workers at a thermal power plant project there.

“It was very successful and it should be done here because we have huge local construction projects, but have yet to take care of the workers in these areas.”

The industrious 68-year-old has met her share of impediments and her surefire solution was always “not to despair”.

“When one road closes, another opens. If one strategy does not work, look at another.”

She also emphasised that one had to find good people in important positions to help move issues ahead.

“Getting the hearts of people who matter is important,” she said, with a knowing smile and confessed that one of her bravest moments was an encounter with Dr Mahathir.

She and her colleagues had travelled around the country capturing images of malnourished children living in poverty, compiled them into an album and handed it to the then prime minister with a note, stating: “These are your children, what will you do for them?”.

“He (Dr Mahathir) was silent at first, but later he asked for a cabinet hearing on the issue,” she said excitedly, evidently still pumped with the sense of achievement.

Perhaps her different approach — collecting proof and getting the right listening ear — was why people rarely labelled her as an activist, but called her an “internal lobbyist” instead.

The other secret to the success of her struggles, she pointed out, was evidence.

“To me, evidence is most important. To fight for any issue, you need to show what you want to do, why it is a problem, what happens when you do not address the issue and what happens if you do.

“I’m now shooting a documentary on trafficking in the country because people think this is only happening to foreign girls and not our local women.”

Read more: NST

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