Posts tagged ‘HIV’
Kits allowing people to test themselves for HIV at home can be bought over the counter in the UK for the first time – but no kits exist yet in Britain.
The change in the law means it is now legal for people to test and diagnose themselves at home.
Previously, people could carry out tests they ordered online at home and send away their results, but were diagnosed over the phone.
It is hoped the move will help the UK’s 25,000 undiagnosed HIV-positive people.
No tests have yet been developed that pass European guidelines, said the government’s health regulator.
Home testing for HIV was approved by the government last September but the law only came into effect on Sunday.
The Terrence Higgins Trust HIV charity said the tests could be introduced into the UK this year or in early 2015.
The UK is leading Europe in making the kits available over the counter, but they were introduced to the US in 2012.
Testing could involve taking a small drop of blood from a finger, or a swab from the inside of the mouth.
‘Key strut’ of HIV prevention
Dr Michael Brady, medical director at the Terrence Higgins Trust, said it was a “shame” the change in the law was coming into effect when no viable tests were available.
The charity recently ran a scheme where participants were able to test themselves at home, send the results away by post and then receive a diagnosis over the phone, or by text message, if negative.
Dr Brady said: “What we had not anticipated was just how popular the scheme would be, with demand very nearly outstripping supply on more than one occasion.”
The trust found that 97% of 915 users in its study said they would use the HIV self-sampling again. The charity said that in one weekend it received 3,000 orders for the test.
He said such feedback indicated home testing would form a “key strut” of the charity’s prevention work in the UK.
But Dr Brady added: “It [home testing] is not for everyone, which is why it is important to have a range of options available.”
He said it was important for users to access NHS facilities such as counselling and treatment if they found out at home they were HIV-positive.
‘Convenient and discreet’
A spokesperson for the Department for Health said: “The stigma surrounding HIV may mean that some people are afraid or reluctant to go to a clinic to be tested.
“The change in the law will mean self-test kits are now legal to buy, making the test process more convenient and discreet.”
She said although no kits meeting European standards were available in the UK, the government “expected this to change” in the next year.
“HIV testing remains free on the NHS – anybody with concerns can visit their GUM Clinic, GP or contact the Terrence Higgins Trust’s confidential helpline. Self-sampling kits are also available to buy,” she added.
Online tests ‘unreliable’
Heather Leake Date, HIV specialist pharmacist and spokesperson for the Royal Pharmaceutical Society, said the tests would help reduce the risk of new HIV infections.
She said: “HIV self-testing kits may help increase diagnosis by providing more choice for people who have been at risk but are reluctant to get a test in person from existing services.”
Ms Leake Date said kits currently available online could be unreliable and give “false results”.
She added: “When kits become available, people should buy from a trusted source and check for the CE mark, which means it will have been assessed for quality and safety.”
Fifteen-year-old Tadisa was never expected to live. Her mother Grace was HIV-positive and passed the virus on to Tadisa at birth.
In the 1990s, thousands of babies born with HIV in Zimbabwe died in infancy, as today’s cheap life-saving drugs were not available in sub-Saharan Africa.
But to the great surprise of doctors, there are thousands of teenagers like Tadisa who have lived with HIV for more than a decade.
When Dr Rashida Ferrand wanted to research these young survivors, she was told none were still alive.
“Five years ago people would shake their heads in disbelief and say: ‘Well, no, nobody survives,'” said the HIV expert from the London School of Hygiene and Tropical Medicine.
“Survival beyond five years is considered absolutely exceptional.”
No-one knows exactly why people like Tadisa survived childhood with untreated HIV.
But while they have lived longer than expected, their lives have not been straightforward.
Many suffer chronic health complications, including disfigurement, and as a result are socially ostracised.
Dr Ferrand now treats these teenagers in Zimbabwe and is a passionate advocate for them.
“These children are more likely to be poor and to have lost their parents to Aids,” she said. “They’ve been shifted around amongst guardians and missed education, so the odds are stacked against them.”
‘Untreated HIV infection’
Sub-Saharan Africa accounts for 69% of the world’s HIV cases. Today, nearly one in 20 adults live with the condition.
Life-saving antiretroviral therapy (ART) has been available for free since 2004 in the region and has transformed the outlook of those with the virus.
But children like Tadisa who survived unexpectedly have often gone untreated, and the complications of untreated HIV – such as damage to the lungs and heart – are debilitating.
“There’s also some brain damage leading to them not being able to perform in school,” said Dr Ferrand. “There are some obvious visible signs of longstanding untreated HIV infection, such as stunting and skin disfigurement.
Part of the problem is a lack of awareness: four out of five children with HIV do not know that they have the virus.
Their medical problems are often put down to normal childhood illnesses and they do not get tested for HIV until they are in their teens.
‘Culture of silence’
Dr Ferrand described a “culture of silence” and said the “most shocking” aspect of her research was that nearly all the older children and adolescents who have tested positive could have been diagnosed earlier.
Two-thirds had been to a primary health care clinic in the previous six months, a quarter had been in hospital at some point in their lives, and more than half had a parent or sibling with HIV.
Despite this, no-one had thought to test them for HIV.
Once tested, there was no standard way for young people to be told of their status, according to research at Harare’s Parirenyatwa Ol Clinic by Dr Ferrand and her colleagues.
They asked 31 patients aged between 16 and 20 how they discovered they were HIV-positive.
Although the advice was for their parents or guardians to tell them, the adolescents preferred to hear the news for themselves.
“I wanted to be told at the clinic just so I know that it’s really true, that I’ve been tested, and it’s true”, said one 17 year-old girl.
Some children had guessed, such as one 17-year-old boy who told the researchers: “My mother was lying to me saying I have a heart problem, I have a hole in my heart. So I decided to say, ‘Okay.’
“But I knew. I knew that when I was coming here I was HIV-positive.”
And sometimes the news was given in an abrupt manner.
“My grandmother told me at home,” said one 18-year-old boy. “I was watching TV. My grandmother came up to me and said: ‘Hey, A, do you know that you’re HIV-positive?’ I said, ‘Okay.’ She said it twice: ‘You’re HIV-positive.’ I just said, ‘Okay.'”
The adolescents learn most about their condition from each other rather than their parents and guardians, the researchers found.
Once diagnosed, they can keep the virus at bay with the free ARTs.
But one reason their guardians did not bring them for diagnosis and treatment was to protect them and their families.
“They fear that if the child is disclosed to, he will go about in the streets or at school telling others and other relatives that don’t know that the parents are positive,” said a counsellor at Parirenyatwa Ol Clinic. “So they will be stigmatized or discriminated against as a family.”
In 2013 a UNICEF report stated that only about a third of children with HIV were receiving ARTs, compared with around two-thirds of adults.
New WHO guidelines say testing should be offered to all adolescents living in areas of the world where HIV is common, particularly sub-Saharan Africa.
Dr Ferrand believes it is an issue of child rights that the young people learn about their HIV status and receive treatment.
Potent antibodies were able to wipe a hybrid of human and monkey immunodeficiency viruses from the bloodstream of monkeys within days.
The findings could “revolutionise” the search for an HIV cure, say experts.
The US researchers said trials in patients with HIV now needed to take place.
The immune system produces precisely targeted antibodies to take out HIV, but the virus is able to rapidly mutate to evade the immune assault.
The effect with these potent antibodies is profound and unprecedented. It’s probably as large an antiviral therapeutic effect as has ever been seen”
Prof Dan BarouchHarvard Medical School
However, some antibodies have been discovered that target the “conserved” parts of HIV – those that the virus struggles to change because they are vital for it to function.
Two groups, from Harvard Medical School and the National Institute of Allergy and Infectious Diseases, performed the first trials of these antibodies.
They used rhesus macaques that had been infected with simian-human immunodeficiency virus (SHIV), a blend of HIV and the monkey equivalent.
Data from the Harvard team showed that injection of the antibodies drove SHIV from the bloodstream until it reached undetectable levels after three to seven days.
The effect lasted for one to three months, but in three monkeys the virus did not return to the blood during the 250-day study.
Prof Dan Barouch told the BBC: “The effect with these potent antibodies is profound and unprecedented. It’s probably as large an antiviral therapeutic effect as has ever been seen.
“But we have to make sure we don’t overhype and the limitation is the study is in animals, not humans.”
The antibodies were also able to attack the virus in some tissues. Drugs can assault the virus in the blood during normal HIV treatment, but the virus can hide in other parts of the body.
These early findings raise the prospect of using antibodies to clear these tissues as well.
Similar results were produced by the team at the National Institute of Allergy and Infectious Diseases
HIV infection is incurable, although taking a daily dose of medication can keep the virus in check, giving patients a near-normal life expectancy.
The antibodies will be tested in human clinical trials and if successful they could be used alongside antiretroviral drugs as a treatment.
It may also be possible to devise a vaccine that could train the immune system to produce these antibodies.
However, both these ideas are dependent on human trials being successful.
Commenting on the findings, Prof Louis Picker and Prof Steven Deeks said: “The findings of these two papers could revolutionise efforts to cure HIV.”
However, they warned that HIV was so prone to mutation that it was “likely that some people will harbour viruses that are resistant to one or more” of the antibodies.
Death rates fell from 2.3 million during its peak in 2005 to 1.6 million last year, says UNAIDS.
The number of new HIV infections fell by a third since 2001 to 2.3 million.
Among children, the drop was even steeper. In 2001 there were more than half a million new infections. By 2012 the figure had halved to just over a quarter of a million.
The authors put the fall in deaths and infection rates in children down to better access to antiretroviral drugs which help suppress the virus.
Without treatment, people with HIV can go on to develop Aids which makes simple infections deadly.
By the end of 2012 almost 10m people in low and middle income countries, including South Africa, Uganda and India, were accessing antiretroviral therapy, according to the report.
The improved access is being attributed to drugs being more affordable and available in communities, as well as more people coming forward for help.
Way to go
According to UNAIDS, the world is “closing in” on its Millennium Development Goals to stop and reverse the Aids epidemic by 2015.
But it says the world can go beyond its target of getting 15m people on HIV treatment by 2015. The World Health Organization has now revised its guidelines making even more people eligible for treatment.
The report also found that progress has been slow in providing HIV services to people who are most at risk of infection, like those who inject drugs.
And it highlights the need to do more to deal with sexual violence against women and girls. They make up a key group of people vulnerable to infection.
Bev Collins, Health Policy Advisor at Doctors without Borders said: “Huge leaps forward have been made to make sure that millions of people – especially in the developing world – can access lifesaving HIV treatment at an affordable price.
“But this is no time for complacency. We need to keep on rolling out access to better treatment strategies, expanding access to accurate, cost-effective testing, and to care”
The Science Hour, Bone marrow ‘frees men of HIV drugs’; Self-cleaning seabird eggs; New tests for liver disease
Bone marrow ‘frees men of HIV drugs’
Doctors in the United States say two patients have been taken off their HIV drugs after they were given bone marrow transplants for blood cancers. Dr Daniel Kuritzkes is part of the medical team behind the research and says “we’ve learnt something very important about the mechanisms by which HIV infected cells could be eliminated”.
Self-cleaning seabird eggs
Guillemots – highly social, cliff-nesting seabirds – lay eggs that are self-cleaning. Scientists studying guillemot eggs accidentally spilled water on a batch. When the accident happened, the researchers noticed that the water stood in droplets on the eggs’ surface, similar to the droplets that are seen on lotus leaves or other hydrophobic, water-repellent, self-cleaning surfaces. BBC Science reporter Victoria Gill heard the scientists’ story at the Society for Experimental Biology Conference in Valencia, Spain.
Liver disease is on the increase worldwide, due to the rise in hepatitis C in some countries and increasing alcohol use in others. Researchers from the University of Nottingham are exhibiting how new tests, including a technique borrowed from the cheese industry and the use of unique MRI protocols, are being used to diagnose liver disease at an earlier stage. Dr Neil Guha, a liver specialist, and Dr Susan Francis, a physicist, are from the NIHR Nottingham Digestive Diseases Biomedical Research Unit in the UK.
via BBC World Service – The Science Hour, Bone marrow ‘frees men of HIV drugs’; Self-cleaning seabird eggs; New tests for liver disease.