HIV ALIVE - AIDS Conference EXTRA - August 8, 2008

We won't just survive; we'll thrive - as we eradicate the virus.

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|  Mexico City AIDS Conference is a First for Latin America

World leaders joined 25,000 attendees of the XVII International AIDS Conference, which began Sunday August 3, 2008 and ends today in Mexico City. Prominent speakers included Secretary General of the United Nations Ban Ki-Moon, and Mexican President Felipe Calderon Hinojosa.

Former American President Bill Clinton gave the keynote address. "AIDS is a very big dragon. The mythological dragon was slain by Saint George, the original knight in shining armor, but this dragon must be slain by millions and millions of foot soldiers," Clinton told the gathered activists.

Health professionals included Margaret Chan, MD Director General of the World Health Organization, Pedro Cahn, MD, President of the International AIDS Society, and Peter Schick of The Peter Schick Foundation

"Universal action now," was the theme of the conference. The resources to fight HIV are at now an all time high, thanks increased help from the Bill and Melinda Gates Foundation, the Global Fund, and the President's Plan for Emergency AIDS Relief, PEPFAR, which was signed into law by President George W. Bush on July 30th. Still, new infections keep outpacing the number of people beginning first time treatment.

AIDS has already killed 30 million people. 2.7 million people were newly infected with HIV / AIDS last year, a disease that is entirely preventable. The Global HIV Prevention Working Group claimed that many of these infections occurred because governments are ignoring solid science showing that changing behavior works. The most effective behavior modifications include engaging in safer sex by delaying the onset of intercourse, using condoms, and circumcising males. Intravenous drug users should cut back while needle exchange programs should increase. . Myron Cohen, MD of the University of North Carolina stressed that we can not treat our way out of the epidemic. Prevention and treatment efforts "need to get married today."

The conference didn't shy from contentious issues. One session bluntly asked in this overwhelmingly Catholic country if religion were a barrier to HIV prevention. Another looked at changing gender norms for girls and women Other discussions explored the unique problems of Black Americans dealing with AIDS and the role of prisons and detention centers in propagating the disease. One defined the continued travel ban on HIV+ patients by a dozen of the world's countries, as a human rights issue.

Finally the conference did a bit of prognostication, looking at where the epidemic would be in 2031.

For anybody coping with HIV, a number of promising avenues of new research were brought to view, which will be highlighting in this and future issues of HIV Alive. As Peter Schick put it, "The Mexican conference is gigantic. It will take a long time to catch up with the thousands of treatment abstracts presented."

With vaccine and microbicide trials yet to show promise, researchers are now focusing on pharmaceutical prophylaxis as a way to fight AIDS, according to a report issued by the AIDS Vaccine Advocacy Coalition. The use of antiretroviral drugs for infection prevention, called PrEP, comes out of the success such efforts have had in cutting transmission rates of HIV to fetuses from infected mothers. In 2007, Family Health International studied the antiretroviral drug tenofovir as away of preventing HIV infection in Ghanan women. Although the study showed that the drug was safe and tolerated in uninfected users, it did not produce definitive proof of its effectiveness in preventing the spread of HIV. By 2009 15,000 people are expected to partake in the new PrEP studies worldwide.

Results of the studies would ultimately be hard to interpret, because participants in this unproven method would be more likely than others to engage in lower risk behavior. Since typical anti-viral cocktails for HIV positive patients run more than $20,000 a year, cost becomes an issue. How much preventive pharmeceutical intervention to prevent HIVis justified? If pharmaceutical prophylaxis catches on, just in the ares of foreign funding, AIDS costs to the US taxpayer are projected to climb from $2 billion a year today to $12 billion in just eight years. Some candidates for daily pills question whether simply taking doses before sex would be as effective in preventing infection with HIV. If the virus dismebarks into a hazardous environment it might be killed quickly and cleanly.

According to activists, like Laurie Garrett, a senior health fellow at the Council on Foreign Relations, daily pharmaceutical prophylaxis is the wrong way to fight AIDS because the initiative's true aim is to create a multibillion dollar AIDS treatment industry with a vested interested in maintaining the status quo. She says that medicine’s ultimate goal should be the eradication of the virus.

Anthony Fauci, MD, head of the National Institute of Allergy and Infectious Diseases, NIAID, told the conference that the only way to stop HIV pandemic is through biomedical research.  Despite medicine’s success in managing HIV, nobody has been cured yet. “This is because HIV is unlike virtually any other virus in its ability to hide from the immune system in protected cellular sanctuaries that we call ‘latent reservoirs.’… Our best hope for eradicating HIV from the reservoirs may be to diagnose and treat people aggressively very early in infection, before the reservoirs have become too large.” Fauci stressed that such early treatment might not totally eradicate the virus, but by keeping the reservoirs low, allow the immune system to better handle infection so a patient could ultimately come off anti-viral therapy. He described this as a "functional cure." This approach is at the heart of The Peter Schick Foundation's early treatment protocols. Despite recent setbacks, Dr. Fauci also held out hope for a vaccine.

- Edited by Paul M. J. Suchecki

|  News Briefs

The AIDS epidemic in the United States is 40% worse than previously thought, according to a paper published August 6th in the Journal of the American Medical Association. The new data comes from more precise monitoring from the Centers for Disease Control. In the US, gay and bisexual men represent 53% of all new infections. Blacks are now infected at a rate that is seven times higher than whites, and three times more often than Hispanics, a combination of biological suscepitbility and cultural stigma.. The data translates into nearly a quarter of a million more cases of HIV infection in the United States than estimated. The revisions is due to a new lab test called BED that can differentiate between recent and older HIV infection coupled with changes in official statistical extrapolation. _____________________________

Texas Doctors might have found a way to kill HIV. HIV mutates so quickly that it ultimately foils immune system produced anti-bodies as well as all conventional anti viral therapy. However, Sudhir Paul, Ph.D. of the University of Texas Medical School at Houston has discovered that the point of attachment that HIV's uses to infect T-cells does not mutate. Normally the body makes antigens that target the virus' changeable areas which means that the antigens only target a single virus at a time. Dr. Paul, looks at the point of attachment that the virus uses to take over a T-cell as HIV's Achilles Heel. Paul's research group has designed antibodies with enzymatic activity, known as abzymes, which can attack the point of attachment precisely, fragmenting it and destroying its function so HIV can't enter a T-cell. Because the abzymes target the one part shared by all HIV, each abzyme can inactivate thousands of virus particles. Lab results are promising. Human clinical trials are next.

"Homophobia continues to fuel the spread of HIV," according to International AIDS Society Executive Director Craig McClure. Men who have sex with men, MSM, have 19 times greater chance of being infected with HIV than other adult males in low to moderate income countries, yet in these areas only 5% have access to prevention programs. Activists reminded attendees that diminishing anti-gay prejudice in the developed west, is not reflected in emerging societies. Most Asian countries spend 1% of their AIDS prevention budget on MSM, yet that behavior there is responsible for up to 20% of new infections. Homophobia was tackled by an AIDS Action Now Testing Prevention and Treatment Rally at Mexico City's Angel of Independence. The goal of the march was to fight HIV stigma and discrimination. _____________________________

2.1 million children under the age of 17 are estimated to be living with HIV, mostly in sub-Saharan Africa. 90% were infected through transmission from their mothers. The prophylactic method of choice has been administering anti-viral medication to pregnant HIV positive women, a practice that had increased from just 10% of all HIV pregnancies just four years ago to 30% today. HIV transmission to newborns has slowed dramatically in developed countries. In the emerging world many mothers still don't get the help they need. _____________________________

About 40% of males and 16% of females who take AIDS cocktails develop abnormal fat deposits, known as lipodystrophy which increases the risk of cardiovascular disease. Stephen Grinspoon, MD of the Harvard Medical School, in the Journal of the American Medical Association said that light doses of human growth hormone given to HIV patients significantly reduced the fat deposits. The treatment is not recommended for diabetics because it also raised blood sugar.


President Bill Clinton
© International AIDS Society / Mondaphoto 

UN Secretary General
Ban Ki- Moon
© International AIDS Society / Mondaphoto 
© International AIDS Society / Mondaphoto

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