Abstract
HIV
HIV Epidemic Looming in Arab World?
Among the global populations with the fastest growing HIV epidemics is the Arab world of the Middle East and North Africa, according to the UN Population Fund (UNFPA). The evidence points to rising rates of HIV and AIDS-related deaths in this region. Contributing to this is the secrecy, social stigma, and discrimination associated with being HIV-positive; government inaction; and inadequate access to medical care. Adding to the secretive atmosphere is the risk of arrest for same-sex relationships and premarital sex, which may be viewed as criminal behavior in some countries. UNFPA has worked with the health ministries in some of the more liberal countries in the region, such as Egypt and Lebanon, to launch the media outreach campaign “Let's Talk,” which encourages HIV screening and provides information where free and anonymous HIV testing is available.
Source: Agence France Presse, December 7, 2011.
New CDC Campaign to Increase HIV Testing
The Centers for Disease Control and Prevention (CDC, Atlanta, GA) released data showing that nearly 3 out of 4 Americans living with HIV do not have the infection under control. In fact, only an estimated 28% of the nearly 1.2 million Americans living with HIV have a viral load of less than 200 copies/mL, which is indicative of viral suppression. In fact, according to the CDC, 1 in 5 HIV-infected people do not even realize they are infected. Furthermore, only 51% of those who are aware they are HIV-positive receive ongoing medical care and treatment. Of the Americans living with HIV who are receiving ongoing care and antiretroviral treatment, about 77% are achieving viral suppression.
In response to these trends, the CDC launched a new awareness campaign—“Testing Makes Us Stronger”—aimed at increasing HIV testing rates and targeting in particular black gay and bisexual men, a group disproportionately affected by HIV. The campaign includes national print and online advertising, a website and Facebook page, ads placed in targeted urban communities, and promotions at black gay pride events.
Source: Centers for Disease Control and Prevention;
Making Progress Against HIV/AIDS
Speaking at New York Presbyterian Hospital-Cornell Medical Grand Rounds, Kevin Fenton, M.D., Ph.D., Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, of the Centers for Disease Control and Prevention (Atlanta, GA), provided data on the impact of antiretroviral therapy in the resource-poor world. In delivering the Arthur Ashe Endowment Christopher I. Barley, M.D. Lecture, entitled “Thirty Years of HIV/AIDS: What Have We Achieved? Where Are We Headed,” Dr. Fenton noted that for every 1,000 patient years of antiretroviral therapy in the resource-poor world 228 deaths are averted, 449 children are not orphaned, 61 HIV sexual transmissions are prevented, 26 mother-to-fetus transmissions are averted, 9 cases of tuberculosis are prevented, and 2,200 life-years are gained.
HIV Transmission Risk Per Coital Act
The design of interventions aimed at preventing HIV transmission and the process of modeling HIV spread can both benefit from knowledge of factors that affect the infectivity of HIV per coital act. Data from a prospective study of HIV-serodiscordant couples reveal an unadjusted per-act risk of unprotected male-to-female transmission of 0.0019, compared to 0.0010 for female-to-male transmission. When adjusted for plasma HIV RNA levels in the infected partner, and herpes simplex virus serostatus and age of the uninfected partner, the relative risk is 1.03 for male-to-female versus female-to-male transmission. The study authors report a 2.9-fold increase in the per-act risk of transmission for each log10 increase in plasma HIV RNA. The per-act risk dropped by 78% with self-reported condom use. Other modifiable risk factors for viral transmission were HSV2 infection, genital ulcers, Trichomonas vaginalis, vaginitis or cervicitis, and male circumcision in the HIV-uninfected partner.
Source: Hughes JP, Baeten JM, Lingappa JR, et al. Determinants of per-coital-act HIV-1 infectivity among African HIV-1-serodiscordant couples. J infect Dis 2012;205:356–365.
Key Link Between Neglected Tropical Diseases and HIV
Responding with praise to a review article on the HIV prevention research agenda previously published in The Lancet, researchers from the Harvard School of Public Health, Boston University School of Medicine, Harvard Medical School, and Broad Institute (Boston and Cambridge, MA) propose an additional approach for HIV prevention that would involve linking delivery of HIV/AIDS prevention strategies to treatment for neglected tropical diseases (NTDs). The authors describe the established link between NTDs and HIV risk as “a rare and substantial opportunity for efficiency and savings.” They cite evidence that NTDs such as female urogenital schistosomiasis (FUS) and helminthiases increase the risk of HIV infection and negatively impact disease progression. Women with FUS-related genital ulcers, for example, have a threefold increase in HIV-AIDS incidence. Furthermore, deworming has been associated with reduced HIV viral load.
Source: Manne J, Maclog K. Neglected tropical diseases and the HIV prevention agenda. The Lancet 2011;378:2069–2070.
Executive Director of Global Fund Steps Down
Michel Kazatchkine, a founder of the Global Fund to Fight AIDS, Tuberculosis and Malaria, has resigned his position after serving for 5 years as the Fund's Executive Director. This action follows a decision last fall by the Fund's Board to change operating policies in response to the economic downturn. In November the Global Fund Board announced that it would appoint a General Manager to oversee implementation of the Consolidated Transformation Plan, and this person would report directly to the Board. In a message penned on his resignation, Kazatchkine writes, “I respect this decision and trust that it was made in the best interests of the Global Fund. I have reflected long and hard on the implications of this decision for me and for the organization. While
The Global Fund “stands at a cross-road,” says Kazatchkine. “The prevailing economic climate poses new and formidable challenges to all international development efforts. In the international political economy, power-balances are shifting and new alignments of countries and decision-making institutions are emerging or will have to be developed to achieve global goals.”
Source: The Global Fund;
Hepatitis C Virus
Promising Results with Adenovirus-Based HCV Vaccines
Hepatitis C virus (HCV) infects an estimated 170 million people worldwide. The results of a phase I trial in healthy human volunteers of a recombinant adenoviral vector-based vaccine containing HCV proteins suggests that this strategy can induce a sustained T- cell response that may be sufficient to provide protective immunity against HCV. The two adenoviral vectors tested carried NS proteins from HCV genotype 1B. Both vectors elicited both CD4+ and CD8+ T-cell responses against multiple HCV proteins and were able to recognize heterologous HCV strains. The responses were sustained for longer than a year after boosting. Studies showed long-lived, functional central and effector memory pools capable of proliferation.
Source: Barnes E, Folgori A, Capone S, et al. Novel adenovirus-based vaccines induce broad and sustained T cell responses to HCV in man. Sci Transl Med 2012;4:115.
Human Papilloma Virus
Education is Important Component of HPV Vaccination
Most adolescent girls recognize the need for safer sexual behaviors after receiving the first in a series of three immunizations against human papilloma virus (HPV), according to a study of 13- to 21-year-olds. However, the girls' perception of risk following the initial vaccination appeared to be influenced by their level of knowledge about HPV and HPV vaccination and that of their mothers, as well as the extent of maternal communication about the HPV vaccine. By providing education on HPV vaccines to adolescent girls and their mothers, and encouraging mothers to communicate about the vaccine to their daughters, physicians can help prevent misperceptions about the vaccine and about HPV risk following immunization. The study found that after the first HPV vaccination a significant proportion of the girls surveyed perceived themselves to be at less risk for HPV than for other sexually transmitted infections.
Source: Kowalczyk Mullins TL, Zimet GD, Rosenthal SL, et al. Adolescent perceptions of risk and need for safer sexual behaviors after first human papillomavirus vaccination. Arch Pediatr Adolesc Med 2012;166:82–88.
Cost Effectiveness Analysis of HPV Vaccination and Cervical Screening
In the setting of universal HPV immunization of preadolescent girls, a Canadian study assessed the cost effectiveness of catch-up HPV immunization in older females and of a delay in the timing of the first Pap smear. The results suggest that a catch-up immunization program administered through schools or clinics would be cost effective, saving about $19 million (USD$18.8 million) and 240 years of life. Furthermore, delaying initial cervical screening from 18 to 25 years of age would not have a negative effect on health and would also offer cost savings.
Source: Tully SP, Anonychuk AM, Sanchez DM, et al. Time for change? An economic evaluation of integrated cervical screening and HPV immunization programs in Canada. Vaccine 2012;30:425–435.