March 08, 2014 (Aidsmap) - An oral combination therapy of two antiretroviral drugs, the non-nucleoside rilpivirine (Edurant, also in Eviplera/Complera) and the new integrase inhibitor GSK1265744 (744), was at least as effective as a standard nucleosides-plus-efavirenz triple combination in keeping viral load undetectable in people taking it, the 21st Conference on Retroviruses and Opportunistic Infections (CROI) heard on Wednesday.
The dual combination was a maintenance therapy. This means patients did not start on it as their first treatment combination, but switched to it after six months on an NRTI-plus-744 combination, as long as they had a viral load under 50 copies/ml. The reason for this is that there has been a raised risk of early failure in rilpivirine-based combinations in people with high viral loads (over 100,000 copes/ml) in some drug trials, so the idea was not to start the two-drug combination until participants in the study had already achieved virological suppression.
The point of doing this study is explained in its title – the Long-Acting antiretroviral Treatment Enabling study, or LATTE for short. Rilpivirine and 744 remain so long in the body that the potential exists for them to be used as injectable formulations that could be administered once a month instead of taking pills. Now we know they are safe to use together as an oral maintenance therapy, there will be a new trial of them as an injected maintenance therapy. The conference heard on Tuesday how an injectable formulation of 744 was being developed for pre-exposure prophylaxis (PrEP).
In the LATTE study, participants were divided into four groups and for the first six months all the groups took triple combination therapy. The four groups took two NRTIs (either tenofovir/FTC, the drugs co-formulated as Truvada; or abacavir/3TC, the drugs co-formulated as Kivexa/Epzicom) and the third drug was either the NNRTI efavirenz or one of three different doses of 744 (10, 30 or 60 milligrams).
If, after six months, participants on this starting therapy had viral loads under 50 copies/ml, then those on 744 exchanged their NRTIs for rilpivirine (25mg). Those taking efavirenz continued taking the two NRTIs.
These results are for the first 48 weeks of the study, i.e. 24 weeks each on the starting and maintenance combinations. The full 96-week results will be presented next year.
There were 243 participants in the study, all but ten of them (96%) men. Thirty-eight per cent were non-white and 16% had an initial viral load over 100,000 copies/ml. Baseline CD4 count averaged 410 copies/mm3. The choice of NRTIs was up to doctor and patient: 69% were taking Truvada and 31% were taking Kivexa/Epzicom.
At week 24 (after six months), 87% of study participants taking 744 plus-two-NRTIs had a viral load under 50 copies/ml, with virtually identical viral suppression rates between the three doses, compared to 74% of people taking efavirenz. The 87% taking 744 (160 out of 181 starting) switched their NRTIs to rilpivirine. Adding in 47 participants taking efavirenz, this meant that there were 207 participants in the maintenance phase of the study.
At week 48, 82% of all participants who started taking 744 (including 24-week dropouts) had a viral load under 50 copies/ml and 71% of participants taking efavirenz. This 11% difference was not statistically significant due to relatively small numbers. The difference was driven entirely by the lower efavirenz viral-suppression results in the first 24 weeks: the proportion of participants who had undetectable viral loads at 48 weeks who continued into the maintenance phase was 94% for efavirenz and 93% for 744.
The lower rates of success for efavirenz in the first 24 weeks were largely driven by discontinuations due to toxicity, particularly this drug's well-known neuropsychiatric side-effects; 13% dropped out of the efavirenz arm in the first 24 weeks due to toxicity compared with 3% in the 744 arms, and combined with drop-outs due to viral failure, 21% on efavirenz discontinued compared to 8% on 744. The only side-effect that was significantly more common with 744 was headache, which was mainly mild (22% of people taking 744 had headaches compared with 11% taking efavirenz: no participants withdrew from the study for this reason).
These results support a trial of the injectable formulations of rilpivirine and 744 as maintenance therapy (as in LATTE, participants will start on six months of oral therapy).
Feb 05, 2014 (MNT)- While a number of strategies can prevent and control HIV transmission and spread, their effective use depends on understanding the sexual networks within and between communities. A paper published in PLOS Medicine reports a detailed analysis with surprising results from the Rakai district in Uganda, one of the most studied areas of the HIV/AIDS epidemic in Africa.
Mary K. Grabowski, from Johns Hopkins Bloomberg School of Public Health, led an international group of scientists in an effort to test the hypothesis that most people who contract HIV outside their household are infected through sex with someone from their local community. However, studying 46 communities within the Rakai district in Uganda, the researchers found that introductions of HIV from outside the community are frequent and seem to contribute substantially to sustaining the HIV epidemic within the community. While the largest fraction of new infections take place within a household, the majority of new infections outside of the household appear to be contracted by sexual contact with partners from outside the community.
Some of the data rely on the accuracy of self-reported sexual partnerships, but the findings were consistent between three different approaches the scientists used to examine the question. And while it is not known whether the situation in communities outside of Rakai is similar, these results suggest that HIV infections by sexual partners from outside the community are common, and that HIV prevention campaigns need to look beyond communities.
March 04, 2014 (VOA) - In what's being hailed as a breakthrough in HIV prevention, researchers have developed a slow-release version of an antiretroviral medication that offers long-lasting protection against the AIDS virus.
Injections of long-lasting AIDS drugs protected monkeys against infection for weeks, and researchers hope that it could lead to an important step forward in preventing the disease in humans.
In experiments with rhesus macaques, researchers at the Aaron Diamond AIDS Research Center in New York gave two injections of the slow-release drug to eight monkeys. The animals were protected against repeated attempts to infect them with a hybrid human and monkey immunodeficiency virus, called SHIV. Macaques that received a placebo became infected.
Next, investigators wanted to see how long the drug worked. They injected 12 macaques, trying once a week to infect them. On the 10th try, the animals developed SHIV. Because macaques clear the drug from their system more quickly than people do, researchers think it could offer humans protection against HIV for up to three months.
Robert Grant, a virologist at the University of California, San Francisco, led trials of so-called pre-exposure prophylaxis or PreP using the anti-AIDS pill Truvada.
The study showed the procedure was effective if people took the oral medication daily. Many do not, so Grant said oral PreP does not work for everyone who is at risk.
He thinks an injectable drug that provides three months' protection against the virus is a breakthrough.
"This is a very exciting approach, especially for people who have had difficulty taking pills in the past. These are younger people who are not taking medications for other reasons and whose daily life is not highly organized in a way that allows them to build a habit of taking a pill a day," said Grant.
In the United States, young people account for an estimated 40 percent of new HIV infections.
The drug, called dolutegravir, is already being used by thousands of HIV-positive individuals. Researchers say it is safe. In its injectable form, dolutegravir is embedded in nanoparticles that slowly release the drug over a long period of time.
Large scale clinical trials are already being planned. Experts say the injectable drug would be of great benefit in countries with high HIV rates and where adherence to daily oral prophylaxis is poor.
Feb 26, 2014 (allAfrica) - Eligible countries will develop their proposals in line with requirements under the new funding model
The list of countries eligible to apply for Global Fund support for up to four components -- HIV, TB, malaria and health system strengthening -- was released in February, timed to coincide with the imminent roll-out of the new funding model (NFM) allocating greater resources to those countries with high disease burdens and modest financial resources.
Each country may develop and submit concept notes for any or all of the components they are eligible for.
A number of countries with high incidence of co-morbidity of HIV and TB will be required to submit an integrated concept note. The World Health Organization has identified 41 countries as priorities for integration of HIV/TB activities; two of them -- China and Brazil -- are not, however, eligible for Global Fund support due to their income classification. A third ineligible country, Russia, is only able to apply for Global Fund funding under an exceptional rule that allows HIV proposals to be developed by non-governmental organizations.
Countries included in the 2014 eligibility list will be allocated a proportional share of the more than $12 billion raised during the fourth replenishment, launched in December 2013, for the period 2014-2016, based on disease burden and ability to pay.
The Global Fund Secretariat has estimated that countries will be preparing and submitting 321 proposals for financial support for activities in each of the four components during the cycle.
Eligibility was calculated on a methodology that assesses disease burden and gross national income per capita. Classification into income bands is based on a methodology created by the World Bank and used by organizations including the Global Fund.
An announcement about the amount of money available to each of the eligible countries based on the new allocations formula under the NFM is expected following the Global Fund Board meetings opening on 5 March in Jakarta. Countries will first be assigned to a band and then provided with a funding allocation envelope with a suggested disease split reflecting burden.
The list includes 125 countries eligible to apply for funding for at least one component, with some caveats. Countries including Belarus, Romania and Russia are eligible for HIV funding only under the NGO rule, which requires proposals to be submitted not by a country's coordination mechanism (CCM) but by a non-governmental organization that has identified itself as an independent implementing entity (see articles here about the NGO rule).
Other countries such as Iraq and Fiji are only eligible for TB funding under the transitional provisions of the new eligibility policy.
An analysis of the list by Aidspan reveals only minor changes in eligibility since 2013. The changes are:
• Belarus, Bulgaria and Kazakhstan are newly eligible for HSS
• Chile, Latvia, Lithuania and Uruguay are no longer eligible for Fund support
• Belize's eligibility is restricted to HIV and TB
• Peru is no longer be eligible for HSS funding but remains eligible for HIV and TB
• Seychelles has been included among eligible countries, but only for HIV
• Tonga is no longer be eligible for HSS funding
Specific components in some individual countries included in the eligibility list are also shown as being subject to 'pre-defined maximums'. Aidspan understands from consultations with the Secretariat that allocations subject to these 'pre-defined maximums' will be applied as a fixed amount based on population size, to a small number of upper middle income countries with high burdens of one or more disease components and small island economies.
Countries affected by this pre-defined maximum include: Algeria, Azerbaijan, Belarus, Belize, Botswana, Bulgaria, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, Grenada, Iran, Jamaica, Malaysia, the Maldives, Mauritius, Panama, Peru, Romania, Russia, the Seychelles, St Lucia, St Vincent and Grenadines, Suriname, Tonga, Tunisia, Turkmenistan and Tuvalu.
Feb 24, 2014 (MNT) - Researchers want to help HIV-positive patients live better by understanding why their essentially dormant infection is still wreaking havoc in their mouth.
Even with meticulous dental hygiene, tooth decay and gum disease, as well as infections by yeast, bacteria, and viruses such as human papillomavirus, continue to plague many patients, said Dr. Josѐ A.Vazquez, Chief of the Section of Infectious Diseases at the Medical College of Georgia at Georgia Regents University.
"If we can improve the oral health of these patients, we believe it will further improve their overall health," Vazquez said.
He and Dr. Scott S. De Rossi, Chairman of the Department of Oral Health and Diagnostic Sciences at the GRU College of Dental Medicine, are investigators on a new National Institutes of Health-funded study that will better determine whether the problem is the HIV infection, the antiretroviral therapy or both.
They have joined researchers at Louisiana State University and Ohio State University in collecting samples from the mouths of 440 HIV-positive patients. They are performing sophisticated molecular tests on the samples that should provide a census of the living organisms in the mouth as well as a T-cell count - an indicator of the activity level of the immune system - then comparing those findings with uninfected individuals.
They also are looking at whether antiretroviral therapy changes the community of oral organisms, called microbiota, by taking a census both before and after therapy starts and by comparing the populations in patients who have oral complications like HPV and yeast, with those who don't.
They are assessing the general health of the teeth and gums as well. "Another big question is, why do these patients have such really bad gum disease and tooth decay," said Vazquez, a principal investigator on the new study that brings $1.5 million in NIH funding to the university.
While even a healthy mouth is full of bacteria - in fact, more than 600 species play a role in keeping the mouth healthy - Vazquez and De Rossi suspect a different set of bacteria set up shop in these patients.
Vazquez's lab also will be analyzing the different types of yeast recovered from study patients to determine if HIV patients have more aggressive or treatment-resistant strains.
"One of the earliest signs of HIV can be a yeast infection in the mouth," said Vazquez. In the worst case scenario, this fungal infection can quickly spread into and block the esophagus. "They can't swallow, they can't drink, they can't eat, and so they dehydrate," he said. In fact, when De Rossi sees a patient with an oral yeast infection, he may suggest an HIV test, after ruling out more common causes such as taking an antibiotic for an upper respiratory infection.
While mostly responsive to antifungal drugs, a few missed doses can give the fungus the opportunity to develop a protective film of sugar, called a biofilm, and become treatment resistant. "To successfully treat a yeast infection, you need a combination of some kind of host immune response and the antifungal medication," Vazquez noted.
HPV, more commonly known as a cause of cervical cancer, was actually not a significant problem in HIV patients until the advent of highly-active antiretroviral therapy, said De Rossi, a study co-investigator. But once it has found a home, the virus can move quickly throughout the mouth and beyond as patients inadvertently bite the area enabling its spread.
Treatment tends to work marginally and the virus often resurfaces, spreads, and can cause head and neck cancer.
"We don't know a lot about the evolution of HPV in the mouth of anybody," Vazquez added. "We have to characterize this HPV infection and how it advances in HIV patients from a state of colonization to a tiny lesion, to a little wart, to maybe head and neck cancer that requires major surgery."
The researchers note that anyone whose immune system is compromised by disease or treatment, such as cancer patients receiving chemotherapy or radiation, may experience similar oral health concerns.
Antiretroviral, or cocktail therapies, which have been in use about a decade, have dramatically improved patient survival by inhibiting replication of HIV in all cells so that levels of infection-fighting T-cells can normalize. However, the researchers suspect it does not restore normal microbiota composition in the mouths of these patients.
Georgia Regents Health System follows about 1,800 HIV-positive patients and is adding approximately 15 newly diagnosed patients per month.
Feb 18, 2014 (MNT) - HIV pre-exposure prophylaxis (PrEP) with FTC/tenofovir (Truvada) is associated with only mild disturbances in kidney function, investigators report in the online edition of AIDS.
Creatinine clearance declined slightly but significantly four weeks after starting therapy with Truvada and this decline persisted for the duration of treatment. However, kidney function returned to normal after treatment was stopped.
The authors believe their findings support recommendations for the routine monitoring of creatinine clearance among people taking Truvada PrEP.
Results of the iPrEx study involving 2499 HIV-negative men who have sex with men and transgender women showed that daily Truvada PrEP reduced the risk of HIV infection by 44% compared to placebo. Truvada was approved for use as PrEP by the US Food and Drug Administration in July 2012 and interim guidance about its use has been issued by the Centers for Disease Control and Surveillance (CDC) and the World Health Organization (WHO).
Tenofovir is generally a safe and well-tolerated drug. However, when used by people living with HIV it has been associated with kidney dysfunction. In most cases, this is mild and resolves after treatment is stopped. But some more serious cases involving Fanconi syndrome have been observed.
Investigators from the iPrEx study wished to see if tenofovir-containing PrEP was also associated with a risk of kidney dysfunction in HIV-negative individuals.
Participants enrolled in the placebo-controlled study had a series of tests at regular intervals to monitor their renal function. These included creatinine clearance, serum phosphorus, and urine dipstick tests to detect protein (proteinuria) and glucose (glucosuria). A subset of participants was also assessed for proximal renal tubulopathy.
Approximately half the participants were aged between 18 and 24 years, 5% were black/African American, 5% had a body mass index (BMI) above 30 kg/m2 and 5% had a history of hypertension (high blood pressure).
There was a small but significant decrease in creatinine clearance from baseline among people taking Truvada compared to the placebo arms (-2.4 vs -1.1 ml/min; p = 0.02). This difference emerged after four weeks of therapy and persisted until the end of treatment (p = 0.02). However, creatinine clearance normalised after the cessation of therapy (-0.0 vs 0.0 ml/min).
The effect of Truvada on creatinine clearance was unaffected by known risk factors for kidney dysfunction, including hypertension, race, age and higher body BMI.
There was a non-significant trend for a greater decrease in serum phosphorus levels among the participants taking Truvada compared to placebo (week 4 = -0.06 vs -0.01 mg/dl; p = 0.06).
The frequency of creatinine elevations did not differ between the treatment and placebo arms (n = 37 vs 25; p = 0.28).
Analysis of urine dipstick results showed no difference in the proportion of people with proteinuria (Truvada = 21% vs placebo = 20%) or glucosuria (3% for both groups).
After the discontinuation of therapy, two participants – both in the placebo arm – had proximal tubulopathy.
The investigators acknowledge a number of limitations. The mean duration of therapy was 81 weeks, thus limiting their ability to determine the longer-term effects of Truvada PrEP. Low adherence to therapy was another limitation, and the authors note "stratifying the analysis according to FTC/TDF drug detection in the active arm indicated a dose response that was significant at some time points."
They conclude their findings support CDC guidance that "oral FTC/TDF PrEP should include monitoring of serum creatinine...we advise repeating the abnormal serum creatinine measurements on a separate specimen before discontinuing FTC/TDF because the majority of elevations are self-limited."
Feb 17, 2014 (NY Times) - Patients who have multi-drug-resistant tuberculosis and AIDS are more likely to live if they get simultaneous treatment for both diseases rather than waiting weeks to start the AIDS treatment, a new study has found.
Although the study was small — it included only 23 South African patients with drug-resistant TB — its results concurred with those of three major studies of people with regular TB and the virus that causes AIDS.
Those three studies, said Dr. Gerald Friedland, a tuberculosis specialist at the Yale School of Public Health, overturned an old belief that it was safer to treat TB first and H.I.V. afterward.
The new study was published in The International Journal of Tuberculosis and Lung Disease.
The old fear was that weak TB patients would be killed by the inflammation and fluids released into their lungs when antiretroviral drugs jump-started their immune systems.
But "immune reconstitution" can usually be managed with anti-inflammatory drugs, Dr. Friedland said, and far fewer patients in the studies died when they received both therapies promptly.
The idea that waiting was best "goes back historically quite a ways," he said, to the early days of AIDS, when tuberculosis treatment was a long-established specialty and its practitioners were unfamiliar with the new disease. Also, early H.I.V. drugs were more toxic, and patients had to take many pills every day. Since TB patients typically take a four-drug cocktail, pill regimens could become very complicated, and patients often quit.
Feb 17, 2014 (aidsmap) - HIV incidence and prevalence are declining in Kenya, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. They compared results of large cross-sectional surveillance surveys conducted in 2007 and again in 2012. HIV prevalence fell from 7.2 to 5.6% and the incidence rate from 0.7 to 0.4%. The authors attribute the deceleration of the HIV epidemic in Kenya to improvements in linkage to care and the roll-out of antiretroviral therapy.
"Our data confirm a significant decline in HIV prevalence," comment the authors. "Declining incidence in Kenya coincides with similar declines in new HIV infections reported by at least 26 countries in Africa, Asia, and the Caribbean between 2001 and 2012."
Kenya has the fourth-largest HIV epidemic in the world: in 2012, out of a population of 40 million, an estimated 1.6 million individuals were living with HIV and there were approximately 98,000 new infections.
Strategies to control the country's epidemic are reliant upon reliable surveillance data.
In 2007, the Kenya AIDS Indicator Survey (KAIS) showed that HIV prevalence in adults was over 7% and the adult HIV incidence rate was 0.7%.
KAIS was repeated in 2012 with the aim of establishing revised prevalence and incidence rates and also the factors associated with undiagnosed HIV infection.
KAIS 2012 was a cross-section household survey of individuals aged between 18 months and 64 years living in nine Kenyan regions. The investigators restricted their present analysis to adolescents and adults aged between 15 and 64 years.
Study participants answered questionnaires concerning their demographics and HIV risk behaviour. Blood samples were obtained and tested for HIV.
A total of 11,626 individuals were included in the investigators' analyses. Just over half (51%) were women and the median age was 33 years. The majority (64%) resided in rural areas. Most (85%) were sexually experienced and 72% reported sex in the previous twelve months. A fifth of men and 3% of women reported two or more sexual partners in the past year. Anal sex was reported by 2% of men and 2% of women. Symptoms of a sexually transmitted infection in the previous twelve months were reported by 3% of men and 9% of women. Most men (91%) were circumcised and 71% of women said their male partner was circumcised. The majority of participants (85%) reported a low self-perceived risk of HIV infection.
HIV prevalence was 5.6% and HIV incidence was 0.4% – an annual HIV transmission rate of 7.1 per 100 HIV-positive people. Women had significantly higher HIV prevalence than men (6.9 vs 4.4%; p < 0.001). Prevalence increased with age, peaking in the 35 to 39 age group for women (12.3%) and 45 to 54 age group for men (7.2%).
Comparison with the KAIS 2007 data showed that overall HIV prevalence had fallen significantly from 7.2 to 5.6% in 2012 (p = 0.002). Significant decreases were seen in both women (2007 = 8.5% vs 2012 = 6.9%; p = 0.006) and men (2007 = 5.5% vs 2007 = 4.4%; p = 0.031).
Analysis of the factors associated with undiagnosed HIV infection (vs HIV-negative status) was restricted to the approximately 10,000 individuals who reported ever having sex.
Overall HIV prevalence was 6.3% and 52% of these infections were undiagnosed.
Factors associated with undiagnosed HIV infection in men were widowhood (AOR = 8.1; 95% CI, 1.9-34.6; p = 0.005) and condom use (AOR = 3.3; 95% CI, 1.8-6.2; p < 0.001). Circumcision was associated with a lower risk of undiagnosed HIV infection (AOR = 0.3; 95% CI, 0.1-0.5; p < 0.001).
Risk factors for undiagnosed HIV infection among women included being aged 35 to 39 years (AOR = 4.5; 95% CI, 1.1-18.3; p = 0.037), being separated or divorced (AOR = 2.3; 95% CI, 1.1-5.0; p = 0.033), condom use (AOR = 2.3%; 95% CI, 1.2-4.2; p< 0.09) and reporting four or more lifetime sexual partners (AOR = 1.9; 95% CI, 1.1-3.4; p = 0.026).
Why the reported falls in prevalence and incidence? The investigators believe increased access to HIV therapy has an important role.
They explain: "Over the past five years, Kenya has experienced substantial progress in linking HIV-infected persons into care and placing those who require antiretroviral therapy (ART) on treatment. Increased coverage of ART and high levels of viral suppression on ART have led to reductions in HIV mortality and transmission on a population level."
But the authors are concerned that over half of HIV infections are still undiagnosed, and believe this is "a major barrier to achieving greater reductions in HIV transmission."
Feb 16, 2014 (MNT) - People receiving mental health care are up to four times more likely to be infected with HIV than the general population, according to a new study published in the American Journal of Public Health from researchers at Penn Medicine and other institutions who tested over 1,000 patients in care in Philadelphia and Baltimore. Of that group, several new HIV cases were detected, suggesting that not all patients are getting tested in mental health care settings, despite recommendations to do so from the CDC and the Institute of Medicine.
The study is one of the largest studies to date to estimate HIV prevalence and risk factors among persons receiving treatment in mental health settings and included researchers from the Centers for Disease Control and Prevention (CDC), as well as the University of Maryland and Columbia University Medical Center.
"These findings paint a recent picture of HIV infection rates in the community, and reinforce how important it is to identify patients and get them into appropriate infectious disease care in a timely manner while being treated for mental illness," said lead author Michael B. Blank, PhD, associate professor in Psychiatry at the Perelman School of Medicine. "With such a high-risk group, it's imperative to be routinely testing patients to improve care and reduce transmissions to others. Historically, though, HIV testing is often not implemented in mental health care."
For the study, researchers provided rapid HIV testing to 1,061 individuals (621 men and 436 women) seeking treatment for symptoms, including depression, psychosis, and substance abuse, at university-based inpatient psychiatry units, intensive case-management programs, and community mental health centers from January 2009 to August 2011. About 0.3 percent of the general population is HIV infected, and CDC estimates a much higher prevalence of 1.4 percent in Philadelphia and 1.3 percent in Baltimore, since both cities are HIV epicenters.
The research team found that 4.8 percent of the mental health patients receiving care (51 individuals) were infected with HIV, which is about four times the base rate in each city and about 16 times the base rate for the United States population. Thirteen of the 51 infected patients reported that they did not know they were HIV positive, which represents an important failure in our public health system since they were already receiving ongoing mental health care. These results suggest that even in areas in the U.S. where prevalence is lower those with mental illness may be at substantially higher risk and should be routinely tested.
Results of the study also showed that persons with more severe symptoms of mental illness were at higher risk for being HIV-infected. HIV prevalence was also higher among the groups most likely to be infected in the general population, including African American, gay or bisexual men, and those infected with Hepatitis C, which is often an indicator of past injection drug use.
Previous studies have found that people with serious mental illness are at an increased risk for being infected with HIV, but many were from the 1990s and early 2000s and produced wide variations in risk, most likely because of small sample sizes, differences in sampling frames, and inadequate adjustment for confounding effects of factors associated with the disease. What's more, the demographics of the HIV epidemic have shifted in the past decade, and the degree to which HIV prevalence among persons with mental illness has changed remains unclear.
Both the CDC and the Institute of Medicine recommend routine HIV screening be conducted in all clinical settings, including mental health settings, to increase identification of those infected and strengthen access to care. However, little progress has been made toward integrating HIV testing into mental health care, said Blank.
"There are barriers to testing, be it funding, system-level barriers or access to rapid HIV testing, that need to be addressed in order to have a wider adoption," said Blank, who also serves as the co-director of the recently-established Penn Mental Health AIDS Research Center, alongside co-author David S. Metzger, PhD, director of the HIV/AIDS Prevention Research Division at Penn Medicine, and chair of Psychiatry Dwight L. Evans, MD.
"The results of this important study highlight the need for research into integrated treatments for people with complex, co-occurring conditions like HIV and mental illness," said Dr. Evans.
The health care system's approach to these patients may also play a role in the health disparities that are observed in them. Mental illness and HIV often times go hand in hand; however, today's system is not fully equipped to treat these co-morbidities in tandem. In order to achieve optimal outcomes, patients would be better served with a more integrated approach, rather than today's fragmented one.
Better integration of HIV testing in mental health settings is one example, the authors assert, that can help to relieve significant health burdens and even economic costs associated with these chronic illnesses. More specifically, it will help identify those who do not know they are HIV-positive, as well as improve linkage to and, presumably, retention in HIV medical care.
Feb 13, 2014 (MNT) - NIH-funded scientists have shown that boosting the production of certain broadly neutralizing antibodies can protect humanized mice from both intravenous and vaginal infection with HIV. Humanized mice have immune systems genetically modified to resemble those of humans, making it possible for them to become HIV-infected.
Led by David Baltimore, Ph.D., of the California Institute of Technology, the investigators inserted the genes encoding the NIH-discovered broadly HIV neutralizing antibody VRC01 into a vector, a virus that infects mice but does not cause disease. In a unique technique known as vectored immunoprophylaxis (VIP), the researchers infected laboratory mice with this altered virus, enabling certain of their cells to produce the antibodies for extended periods. To test the applicability of this approach to human infections, the researchers used a novel method of repeatedly exposing these mice to low doses of HIV in a manner that mimics human sexual intercourse. In two separate experiments, the investigators assessed protection from infection with two strains of HIV: a standard laboratory strain as well as one that is commonly transmitted among humans.
Two of the 10 mice expressing VRC01 antibodies became infected with the laboratory strain of HIV after 13 to 15 exposures to the virus. In contrast, all nine mice without the antibodies were infected with HIV within six exposures. In the second experiment, researchers used a modified form of the VRC01 antibody, known as VRC07, and challenged the mice with an HIV strain known to be heterosexually transmitted among people. The mice expressing the VRC07 antibody were completely resistant to infection during repeated intravaginal challenge. Taken together, these results indicate that VIP can protect mice from infection with strains of HIV that cause human disease and suggest that a similar strategy could be developed to reduce transmission in people, the authors write.