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AIDS 2010 Studies, Releases: Treating HIV-Positive Patients With ARVs Drove Down Number of New HIV Infections, Study Finds

July 19, 2010

"Treating HIV patients with cocktails of AIDS drugs helps to stop them spreading the infection further and more than halved the number of new HIV diagnoses in a study in Canada, scientists said on Sunday," Reuters reports.

The study, which was published on Sunday in the journal Lancet and presented during AIDS 2010, "found that since the introduction of a treatment plan called highly active antiretroviral therapy (HAART) for HIV patients in the Canadian province of British Columbia in 1996, the number of new HIV diagnoses has fallen by 52 percent," Reuters writes. For every 100 people who started taking HAART, new HIV diagnoses dropped by three percent in the region, according to the study (Kelland, 7/18).

"Previous research had suggested that increased HAART coverage reduced the spread of HIV in the general population. The findings in this study applied not only to the general population, but also to the subset of individuals with a history of injection drug use," according to a press release by the National Institute on Drug Abuse (NIDA) (7/18).

For the study, which was funded, in part, by the U.S. government, researchers led by Julio Montaner, director of the British Columbia Centre for Excellence in HIV/AIDS and the co-chair of AIDS 2010, conducted an epidemiological analysis using "patient registries from British Columbia's universal health care system to track HIV tests, new cases, treatments and virus levels since 1996, when modern AIDS drugs became available," the Associated Press reports (Marchione, 7/18).

"During three distinct time periods, researchers saw that the number of individuals actively receiving HAART had a strong impact on viral load and new diagnoses in the community," NIDA notes. "As HAART coverage increased sharply, new HIV diagnoses decreased sharply. As HAART coverage stabilized, so did viral load and new HIV diagnoses."

"The trends were largely driven by more treatment and fewer new cases among injection drug users, as sharing needles raises the risk of spreading HIV. ... Rates of other sexually spread diseases rose during the study period, suggesting that safer sex behaviors were not responsible for the drop in new HIV infections -- treatment was," the AP adds (Marchione, 7/18).

"This study strengthens the evidence that maximizing HAART coverage within current medical guidelines will help to curb the spread of HIV," NIDA Director Nora Volkow said in a statement, according to the Los Angeles Times' "Booster Shots" blog. "These findings are especially important since new HIV cases have remained stubbornly steady in the United States at a rate of about 56,000 per year for the past 10 years," she added (Maugh, 7/18).

"While waiting for an effective vaccine, experiences such as those reported today should be strongly considered by clinicians, national and international agencies, policy makers, and all parties involved in the development of treatment guidelines, because the population-based dimension of HAART might play an important part in the future control of the HIV epidemic," write the authors of an accompanying Lancet editorial (Maggiolo/Leone, 7/18).

The AP article includes comments by National Institute of Allergy and Infectious Diseases' Anthony Fauci, the CDC's Jonathan Mermin and the AIDS Vaccine Advocacy Coalition's Mitchell Warren (7/18).

UNICEF Study Highlights How HIV Prevention, Treatment Programs Are Skipping Over Youth in E. Europe, Central Asia

"An underground HIV epidemic in Eastern Europe and Central Asia is building at an alarming pace, fuelled by drug use, risky sex and severe social stigma that stops people asking for help," according to a report (.pdf) released Monday at AIDS 2010 by UNICEF that explores the issues faced by young people in the region, Reuters reports (Kelland, 7/19).

"Marginalized young people are exposed on a daily basis to multiple risks, including drug use, commercial sex and other exploitation and abuse, putting them at higher risk of contracting HIV," according to a UNICEF press release. "The trends are especially troubling, as the region is home to 3.7 million injecting drug users -- almost a quarter of the world total. For many, initiation into drug use begins in adolescence," the release states (7/19).

"According to UNAIDS, the prevalence of HIV in the region has risen by 66 percent since 2001, bringing the number of people living there with HIV to 1.5 million in 2008," Reuters adds. "UNICEF said it had had reports of increases in HIV prevalence of up to 700 percent in five regions of Russia. In Ukraine HIV rates of 1.6 percent of the general population are the highest in Europe and experts say Central Asian countries are the new hot-spots of rapidly increasing HIV transmission," the news service notes (7/19).

"This report is a call to protect the rights and dignity of all people living with or at risk of exposure to HIV, but especially vulnerable children and young people. We need to build an environment of trust and care, not one of judgment and exclusion," UNICEF Executive Director Anthony Lake said in the press release. "Only by reversing discrimination against people living with HIV, can Eastern Europe and Central Asia begin to reverse the spread of the epidemic" (7/19). A Reuters factbox notes how HIV/AIDS has impacted Eastern Europe and Central Asia (7/19).

Panel Issues ARV Therapy Guidelines Panel

The International AIDS Society-USA Antiretroviral Therapy Guidelines Panel "recommended earlier treatment for HIV infections in an effort to prevent the development not only of full-blown AIDS, but of other complications of infection as well," the Los Angeles Times reports.

"In an article Sunday in the Journal of the American Medical Assn. and a presentation at the International AIDS Conference in Vienna, the group said it is now recommending that treatment begin when levels fall below 500," according to the newspaper (Maugh, 7/18). The WHO's 2006 guidelines "advised doctors to begin therapy when the patient's count of CD4 cells ... reaches 200 cells or less per microlitre of blood," Agence France-Presse writes. "This figure was raised by the WHO last year to 350 CD4 cells per microlitre of blood, but may still be too cautious, the panel implies."

HIV-positive individuals should begin treatment when they reach a threshold of 500 CD4 cells per microlitre or less, according to the panel's recommendations. "Therapy 'should be considered' for non-symptomatic patients with more than 500 cells per microlitre, it said, adding: 'There is no CD4 cell count threshold at which initiating therapy is contra-indicated,' or inadvisable. Therapy is also recommended for patients who are pregnant, older than 60, are co-infected by hepatitis B or C and at high risk for cardiovascular disease," the news service reports (7/18).

Two World Bank Studies Hail Cash Payments as HIV, STD Prevention

AFP reports on two studies released by the World Bank "linking cash payments to Malawian and Tanzanian youths with 'significantly lower' rates of HIV and other sexually transmitted infections." The first study looked at a program that rewarded young Malawian girls with cash for regular school attendance (Ogle, 7/18). According to the World Bank, the young women who received up to $15 per month over 18 months had a "60% lower prevalence" of HIV compared with a control group.

In the second study adults in Tanzania who practiced safe sex, measured by testing negative "for half a dozen curable sexually-transmitted diseases," received cash payments of "up to $60 per person over 12 months." Participants also "received free treatment, such as antibiotics and counseling." Among the 2,399 enrollees "9% of participants eligible for the $60 award tested positive for the infections. By comparison, the rate was 12% for a control group who didn't receive payments" (7/18).

Berk Ozler, a senior economist with the Bank told AFP that "the findings suggest that 'empowering girls financially can lead to reduced risk -- not just by reducing their sexual activity or practicing safer sex, but also by enabling them to choose partners who are less likely to be infected with HIV in the first place'" (7/19). The Financial Times adds, "new applications of so-called conditional cash transfers already used to change human behavior in line with different social policies, signal a potential new approach to preventing the spread of HIV" (Jack, 7/19).

Glaxo/Pfizer Venture to Open AIDS Treatment Portfolios to Generic Manufacturers In Developing World

"ViiV Healthcare, a joint venture between GlaxoSmithKline and Pfizer to develop and market their AIDS treatment portfolios, will open its entire drug lineup to generic manufacturers in the world's poorest countries," the Triangle Business Journal reports (Gallagher, 7/16).

"To address the evolving treatment needs in [the poorest] countries ... ViiV Healthcare is expanding the number of countries that this relates to, to include all least developed countries, all low income countries and all of sub-Saharan Africa," the company said in a press release on Friday that lists the 69 countries that will ViiV's drug lineup (7/16).

The move will allow companies to "obtain royalty-free voluntary licenses for all current ViiV products, as well as products still in development," Reuters writes. The decision will help reduce the cost of second-line HIV treatment, which becomes necessary as increasing numbers of people develop resistance to first-line drugs, Dominique Limet, the company's CEO said. "As more people have access to treatment, there is an increased need for second- and third-line treatment options once initial treatment failure occurs," he said (7/16).

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