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Meklit G.Michael

Meklit G.Michael

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....Continued

She was now helping her mother financially. Her life had changed. Although she hadn't stopped going to school, she was missing classes and her grades were going down.

One day, out of the blue, he asked her to buy a dress fit for a great occasion and invite her closest friends to the city hall. The reason, he said, he was going to be featured in a theatre act at the city hall.

Nardos and her friends were excited. They went to Mercato to buy dresses when she saw pictures of her boyfriend on posters all over music shops. Why was he famous? She didn't understand. What was his job? She didn't know. She didn't care much.

At the city hall, he was wearing a suit and waiting for them with some of his friends. He told her right then and there that he wanted to tie the knot with her and that was the reason he had called them to be there. Nardos was surprised but happy with the proposal. She agreed to marry him. Nardos officially got married.

That day she returned home to her mother. He had not prepared a home for them yet. Nardos was not happy to be living with her mother after marriage. She thought it was not customary and wanted something of her own.

It was after some time, that he surprised her with a fully furnished rented house. Nardos felt loved, she thought she had the best husband ever.

Now that they were living together, her husband's friends also came to work with him in a room he had prepared for this purpose. The room was furnished with mattresses fit for chewing chat and writing songs. All kinds of people came, famous singers, songwriters, pretty women.

When the women came, they hugged him and kissed him affectionately. She was jealous. She wanted to dress like them and look like them. But her husband always reassured her saying that it was artists' character to act the way they do. He encouraged her to stay the same.

As time went by, however, the women who came to visit her husband were beginning to openly display their affections for him. And this was bothering her. They went into the room where they worked and spent hours laughing with her husband. The women sometimes called at night and talked to her husband. His responses over the phone, although vague, were playing on Nardos' imagination. It seemed they were telling him they loved him. It was unbearable.

When she confronted her husband about it, he was always dismissive. He told her they meant nothing to him and that she was the love of his life. He kept on telling her that it was their character to be so flamboyant. She was nonetheless uncomfortable by their visits and asked him to shift his work place somewhere else. He agreed.

When they were together, he poured all his attention on her. At those times all things seemed unimportant. She stayed with him. There was no one else she knew anyway. He was the one who showed her the good life. He was her real first love. Her house was full, they had everything. When she went shopping, he always encouraged her to shop for her mother too. He would give her extra money to give to her mother. All these caused her to trust him and to stay with him.

One day, when she was pregnant with her second child, as she was returning home she finds him on the bed with one of his girl friends. Shocked by what she saw, she ran away to her friend's house and told her what had happened. Her friend was not helpful. She was not telling her what Nardos wanted to hear. She kept on telling her that it was normal for husbands to cheat on their wives. She told her to also do the same. Nardos was angry. She was not happy to have left her home.

The next day, his male friends looked for her and found her. They begged her to return home. They told her that it was her eyes and that he had not committed anything with the woman. They convinced her. She believed them.

After her return, her husband was giving her a lot of attention. Her due date was near and so she gave birth. He would not leave her side. He was very caring. She thought, she really must have been wrong to think that her husband would cheat on her. Nardos was glad that she had returned home. And to think that she was going to leave him, she thought it was laughable.

As time went by, though, things with her husband were getting worse. He was coming home late. There were even days when he spent the night out. He said it was for work. Nardos' imagination was going wild. They were always fighting. She was growing extremely unhappy. She didn't know what was happening to them.

They were in this condition when the final blow came.

She had gone to church as usual. This time though, she decided to return home after a short prayer. Her return was unexpected. When she returned home, the maid was not there and the gate was open. Nardos entered into the house and went into the room where her husband worked without much thought. This was when she found him with another woman. It was an unforgettable and heart-wrenching encounter for Nardos. That was it. Her husband was cheating on her.

Nardos left home.

This is an audio excerpt from Nardos Debebe's (not her real name) radio diary transmitted on Betengna radio diaries in thirty nine episodes on Sheger FM 102. 1. Her real life story had captivated many listeners. Besides the ones who tuned in to the radio transmission, thousands had downloaded the episodes from the Betengna website.

According to Sosina, the producer, Nardos changed her name and did not disclose most of the names in her story for fear of being stigmatized. Nardos was HIV positive and her husband who had grown to be a famous songwriter had died of AIDS leaving her with three children. She was telling her story not only because it was cathartic, but also because she wanted to be inspirational to many who were in and were passing through similar situations.

Chuchu, one of Betengna's avid listeners, got introduced to the radio program in 2005 through its unique captivating radio format. He says "since then I've learned from it and have taught many through it".

When he was listening to Nardos' story, he was able to learn about HIV in detail. He said "I went for HIV testing for the second time".

Betengna radio diaries goes back in time into the lives of the diarists to show that those who are infected with HIV are ordinary people like everybody else. It portrays the ordinariness of their day-to-day lives and what elements exposed them to HIV. By so doing it evoked empathy and understanding. The program is also educational. In addition to the real life stories, the follow-up programs discussed many social and health issues.

The radio diaries program, a project of the Johns Hopkins School of public health – Center for Communication programs, began its operation in 2005 in Amharic for Addis Ababans and soon broadened its scope into four of the major regions: Oromia, SNNPR, Amhara and Tigray regional states. Betengna programs were being broadcast in Afan Oromo, Amharic and Tigrigna using region specific tones by diarists who lived in the respective regions.

Unfortunately however, AIDS Resource Center's Betengna program which was designed to present a unique insight into what it means to be HIV positive in Ethiopia was forced to close its doors due to funding re-alignment.

The impact that Betengna had on people living with HIV and those uninfected was enormous. Sosena says that many had found solace through the radio program. Many had felt like their stories were being told. And still others were learning a great deal about living with HIV, the benefits of adhering to their antiretroviral treatment, how to tell their children their HIV status etc.

Betengna radio diaries gave hope to people living with HIV, taught and informed the general public, forged camaraderie among people who were uninfected and those living with HIV.
Sosena, who sees the impact Betengna has on people decided to look for funding and continue the program.

Although, Betengna will no longer be produced under AIDS Resource Center, the Betengna program transmitted in Addis Ababa has continued to air its programs under a different funder and umbrella.

For past Betengna radio diaries go to: http://betengna.etharc.org/listenin

June 27, 2014 (MNT) - While bringing new drugs to market is important for increasing life expectancy in younger people with HIV, lowering the toxicity of those drugs may have an even greater health impact on all HIV patients, a University of Pittsburgh Graduate School of Public Health analysis reveals.

The research, supported by the National Science Foundation (NSF) and National Institutes of Health (NIH), and published in the journal PLOS ONE, used a computer simulation to examine what would happen if guidelines for starting HIV treatment took into account the rate of new drug development and the toxicity of those drugs.

"The side effects of treatment remain one of the primary reasons that HIV drug regimens are discontinued," said senior author Mark Roberts, M.D., M.P.P., professor and chair of Pitt Public Health's Department of Health Policy and Management. "By decreasing the toxicity and side effects of HIV drugs, you increase the amount of time that patients can stay on that life-saving treatment regimen. Some side effects, such as increased cardiovascular risk, also cause problems that directly contribute to premature mortality."

The simulation, which built upon a model developed at New York University School of Medicine, found that if the toxicity of new HIV drugs is reduced compared to existing drugs, those new drugs will increase the patient's quality-adjusted life expectancy by as much as 11 percent, or more than 3 years.

"Quality-adjusted life years" and "quality-adjusted life expectancy" are measures that analysts use to determine the value of different medical actions. For example, a potentially life-saving drug that was highly toxic and left a patient debilitated would have a lower value than a life-saving drug that didn't have such side effects.

New HIV drugs are approved for market nearly twice a year and recently revised World Health Organization guidelines on the initiation of HIV treatment recommend that, with this rate of drug development, all HIV patients start treatment before their immune system is significantly compromised.

Pitt Public Health's simulation backed this recommendation, finding that, even at current drug toxicity levels, young people with HIV add nearly two years to their lives by initiating HIV treatment regimens soon after infection.
Antiretroviral therapy for HIV typically consists of the combination of at least three drugs that help control HIV. However, over time, these drugs become less effective.

In younger patients, doctors have tended to wait longer to start antiretroviral therapy because those patients will have to be on the drugs the longest in order to live an average lifespan. As such, they'll need the drugs to be effective longer and have fewer side effects.

"This availability of new drugs means that as the drugs a patient is on become less effective, doctors can adjust the therapy to use a new, more effective drug," said Dr. Roberts. "And if that new drug has a low toxicity and is well-tolerated by the patient, then they are more likely to take it regularly so that it is as effective as possible."

Source: http://www.medicalnewstoday.com/releases/278828.php

Nardos, one of Betengna's diarists, was one of twelve children for her mother. She grew up in much poverty. Her mother, grandmother, two of her older brothers, Nardos and two of her younger siblings lived in their one-room home.

Betenga radio diaries is an exceptional radio program in that true life stories of peope living with HIV are told by the diarists themselves, in their own voice, expressing their emotions. 

Nardos' mom, who was the bread winner, made her living by making enjera and cooking for other people. The family barely had anything to eat. They often times skipped meals because there was nothing to eat.

One day, a neighbor, who had observed the dire situation at Nardos' house, informs the family of an opportunity to give some of the children to the government to be raised in an institution and go to school.

It was after much reluctance that the mother agreed. Nardos, along with her two younger brothers, were shipped to the institution.


At the institution, Nardos was for the first time having three meals a day. She could eat her favorite food – Siga wot. She was going to school, wore clothes that were not torn and slept on a bed with bed sheets and a blanket.

Although her brothers were put in a separate housing, they saw each other on Saturdays during TV hours. The seven-year old Nardos was very happy.

As she lay on her comfortable bed with her dorm mates, she couldn't help but remember the family she had left behind. The way they used to sleep huddled on the floor, the water that flooded them through the door and poured upon them from the roof when it rained. "Do they have food to eat", "are they alive" were some of the thoughts that kept her awake at night. She always dreamt of the day when she could support her mother.

Years had passed without seeing her family. Nardos was fourteen years old. Would she find them alive? This was her first visit since her departure to the institution. She's taking all the things she's hoarded over the years. Bed sheets, shirts, jackets for her family she had left behind.

When she arrived at her old home, everything was the same. The neighborhood had changed a bit but not her home. It was the same old house, small and dingy. She was so used to the comfort at the institution that Nardos was already beginning to regret her visit.

 

She looked around at the house, the bed where her grandmother used to sleep was empty. Where were her older siblings, she didn't ask. She was afraid to. It was only Nardos, her mother and her youngest brother in the house. They went to bed.

In the morning, neighbors gathered at their house. Nardos thought they were entertaining guests. But, No, they had come to tell her bad news. News about her grandmother's death, then her older sister's then her two brothers. This was too much for Nardos to take. The pain was too much for her to bear. Nardos regretted her visit.

All those expected to support their mother had died. Now the burden, she felt, had fallen on her. But what could she do to help. Her heart was no longer on her education, she felt she must quickly get a job and support her mother.

After her return to the institution, however, she was beginning to forget her grief. Things were getting back to normal.

A couple of years had gone by. Nardos was now acting like a typical teenager. She loved to hang out with her friends, participate in sports and try new things. Sometimes Nardos and her friends would make fake cigarettes and fake smoke after lights-out in their dormitories.

Nardos had one best friend that she particularly liked to hang out with. She and her best friend had much in common. They were both from a poor family and they both had another family member in the institution. Nardos had two of her younger brothers and her friend had one older brother.

Although Nardos' brothers were not that known, her friend's brother was a well known, up-and-coming soccer player in the institution.

One day, her friend's brother asked his sister to wash his clothes for him as there was no water at the boys' dormitory. His younger sister complied and she together with Nardos took on the job. After the clothes were washed and dried, Nardos' friend begged her to drop the clothes off at her brother's dormitory. Nardos agreed and went to the boys' dormitory.

There was no one at the dormitory except the boy. He quickly rose up from his bed and received the clothes from Nardos. When she was about to leave, he quickly grabbed her hand and kissed her. For Nardos this was completely unexpected. Scared and confused, she pushed him away and ran out of the dormitory.

After her return to her own room, furious, she told her best friend, the boy's sister, what had happened. She called him names and declared she didn't want to lay eyes on him again. But deep down within she knew she was beginning to have feelings for him.

This was the beginning of a relationship with the soccer player.

The soccer player brought Nardos gifts whenever he went to Addis. He would sometimes treat her for meals. She felt they were going steady.

He was becoming more and more famous. He was even featured on a local newspaper. Nardos was very happy to be associated with him, to be his girlfriend.

Nardos was seventeen years old and feeling very restless. She wanted to get a job. It was during this time that Nardos got word through a friend that the soccer player was calling her to come to Addis. She thought this was her ticket out. They were going to be together. He was going to take care of her.

Nardos along with a few of her friends decided to lie to the institution's governor. They told him that their parents who were abroad had returned. They had sent letters asking for forgiveness and want to have their children back. Of course, the governor did not believe it but reluctantly agreed to sign their release.

Now Nardos, her best friend and other two girls were free, they thought.

Once in Addis, Nardos and her best friend went to the soccer player to meet him. Happy to see them, he asked how they were able to get out. Nardos told him the whole story.
The soccer player could not believe it. He had only asked them to come for a visit. He had no intention of having them leave the institution. Nardos was disappointed.

Nardos was now forced to live with his family in a shack, much like her own home which she had left behind. She helped out his mother who made her living by selling tella and looked forward to his visits on Sundays.

Nardos loved that she was his girlfriend. Whenever they were left alone, they would be in each other's arms, kissing for hours. He would take her out sometimes and buy her gifts. But still Nardos was a virgin.

Months had passed before Nardos' mother heard what had happened and came to get her. One of Nardos' friends had given her the direction to the house.

Nardos' mother was furious; she even threatened to sue the family for having an underage girl in their home without her parents' consent. Nardos' heart sank. She knew she was never going to see the soccer player or the family again. This was it.

Nardos went back to her home with her mother. There was now a man living with them. He provided for them and her mother gave him whatever he wanted.

The man wasn't too happy about Nardos' return, so he picked on her often. To avoid him, Nardos would spend most of her time at neighbors' houses.

There was particularly one older girl she had befriended who was living with her aunt. Unfortunately for Nardos, their friendship was cut short when the girl had to move out of her aunt's house due to some disagreement. This girl was now staying in a hostel.

One day Nardos found an opportunity to go to the hostel her friend was staying in. This friend of hers had bought some goods from a merchant on credit and Nardos had to take this man to where her friend was staying so he could collect his money.

The hostel was lively. There were people coming and going. Everyone knew Nardos' friend. The men who came in hugged and kissed her. Nardos thought her friend was lucky to live in such a place.

Her friend was busy taking care of all the gentlemen coming in. Nardos was waiting for her to finish. As she waited Nardos sat by the bar counter sipping her soda.

Suddenly she catches someone eyeing her. She looks at him and thinks he's ugly. She was disgusted that he was looking at her.

It was getting dark outside and her friend had still not finished her work. Nardos decided to leave. She bade her friend farewell and left the hostel.

As she was waiting for the bus, the guy from the bar caught up with her and asked to ride with her. Nardos reluctantly agreed. He was well dressed and seemed well off.

On her ride back home, this guy was asking Nardos many questions. She told him about herself but sometimes told him lies because she didn't want to seem poor. When she was about to reach home, he asked for her phone number. Nardos' family didn't have a phone. But she didn't want to tell him that, so she gave him her neighbor's number pretending it was theirs. She thought he wouldn't call her anyway.

Days had passed when suddenly she was summoned by their neighbor for a phone call. It was the guy she had met at the bar. He asked to meet with her and they set a date.
For her date, Nardos had nothing fancy to wear. So she took a shower and combed her hair and put on her ordinary clothing and flip-flops.

On their first date, he looked at the way she was dressed and decided to take her shopping. On that day, he bought her clothes and shoes. He even gave her money. Nardos was thrilled. She thought, now this one will take care of her and she's going to help her mother. This was something she had always dreamt about.

On their second date, he bought some chat, took her to a hostel room and ordered drinks for her. Then he proceeded to ask about her previous relationships. She told him about her previous boyfriend, how she had loved him and all the things they used to do. Surprised by the detail she was telling him, he asked her if she had had sex with him. She told him she never had. He was very surprised.

He hugged her and told her that she was created for him and him for her. He told her to be wary of men who could trick her into having sex. He advised her not to trust any man and not to go to a hotel room with any other man.

From then onwards they started going steady. He bought her clothes, gave her money and made her very happy. They would usually go to a motel room and spend time alone. They even spent days in a motel room. He did his work of song writing from the motel room and sometimes went out to meet his friends while she stayed at the motel waiting for him.

To be continued.....

June 25, 2014 (NewsRx) - By a News Reporter-Staff News Editor at AIDS Weekly -- Data detailed on Immune System Diseases and Conditions have been presented. According to news reporting out of Jeddah, Saudi Arabia, by NewsRx editors, research stated, "Arthralgic disorders involving various rheumatic manifestations are commonly observed in HIV patients. Available therapies for HIV-associated rheumatic syndromes include non-steroidal anti-inflammatory drugs for pain management, disease-modifying antirheumatic drugs (e.g., methotrexate), and antitumor necrosis factor-alpha therapies."

Our news journalists obtained a quote from the research from the College of Medicine, "However, treatment of HIV-associated arthritis can be challenging, particularly in patients with co-infections like hepatitis viruses, and therapeutic strategies are not well defined. Here, we present three case reports on the use of antitumor necrosis factor-alpha agents for HIV-associated arthritis. We managed three cases of HIV-associated arthritis following initial presentation. All patients were on highly active antiretroviral therapy with stable HIV loads and CD4(+) cell counts. Data were reported for treatment of inflammatory arthritis using 5 months of etanercept followed by adalimumab for case 1, and 12 months of etanercept for case 2. In case 3, reactive arthritis was treated with 5 months of etanercept followed by adalimumab. In all three cases, significant improvement or resolution of arthritis was achieved following treatment with antitumor necrosis factor-alpha therapies. Moreover, these case studies demonstrated the safe and effective use of antitumor necrosis factor-alpha agents in HIV patients with hepatitis B and/or C virus co-infection."

According to the news editors, the research concluded: "Our results indicate that antitumor necrosis factor-alpha therapies can be successfully used for HIV-infected patients with stable HIV loads and CD4(+) lymphocyte counts."

For more information on this research see: Successful use of antitumor necrosis factor-alpha biological therapy in managing human immunodeficiency virus-associated arthritis: three case studies from Saudi Arabia. Joint, Bone, Spine, 2013;80(4):426-8.

Source: http://health.einnews.com/article/210980332/VdAFdbGrHtMB18XV

June 25, 2014 (PRNewswire) -- Today, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) welcomed health, government, and NGO experts at a policy roundtable. The event, held at the Pew Charitable Trusts, was a discussion on current advancements, investment opportunities, and future innovations in pediatric AIDS treatment.

Michael Gerson, op-ed columnist for The Washington Post and Policy Fellow at the ONE campaign, moderated the roundtable, and special guests included Ambassador Deborah Birx, M.D., U.S. Global AIDS Coordinator, Rajiv Shah, M.D., Administrator of the U.S. Agency for International Development (USAID) and Deborah Persaud, M.D. of the Johns Hopkins Children's Center, who led the investigation that developed the first functional cure of HIV in two infants in Mississippi and California.

"If one group is stigmatized, everyone feels unsafe. Our partners and our patients feel unsafe. We need to approach the HIV epidemic as a human rights issue, and we can't wait 20 or 30 years for this to reverse. This stigma is a threat to public health," said Ambassador Deborah Birx, M.D.

She also addressed the need to take joint action to increase pediatric treatment access, share data and success stories across the global community so that countries that still suffer from high infection rates may learn from those who have made great strides in preventing and treating pediatric AIDS.

"The Mississippi baby case provided proof that a cure is possible. But we need more than one case, we need long term follow-up," said Deborah Persaud, M.D. "[The case] represented collaboration and investment in the field of pediatric AIDS treatment."

In addition to reflecting on the successes of the Mississippi baby case, Dr. Persaud examined how this work may inform the broader delivery of maternal and pediatric care in both the United States and around the globe.

The morning's panels also addressed programmatic investments to accelerate progress towards ending AIDS in children, and explored future innovations in pediatric AIDS prevention, treatment and cure research.

"We have made tremendous progress, but there are still major challenges ahead," said Charles Lyons, EGPAF president and CEO. "It's unacceptable that only a third of children living with HIV are getting treatment. There is an urgency that is missing. Knowing the status of more kids and finding the incentives for them to return to care will result in a dramatic uptake in the care and treatment of these children."

Other speakers included: Shaffiq Essajee, M.D., Clinton Health Access Initiative; Jose G Esparaza Bracho, M.D., Ph.D., University of Maryland; Lynne Mofenson, M.D., National Institute of Child Health; Douglas F. Nixon, M.D., Ph.D., George Washington University; Peter McDermott, Children's Investment Fund Foundation; and Gwynn Stevens, Ph.D., Cepheid.

Later this evening, EGPAF will celebrate 25 years of research and innovation to end pediatric AIDS by honoring Democratic Leader Nancy Pelosi with its Congressional Global Champion Award at the Newseum in Washington, D.C. at 6:30 p.m.

Source: http://health.einnews.com/article/210986291/k2Lo97xpbtSKJjFS

June 25, 2014 (MNT) - Human Immunodeficiency Virus (HIV) screening for emergency patients at an institution with a large number of ethnic minority, underinsured and uninsured people reveals few are HIV positive, but of those who are, nearly one-quarter are in the acute phase and more than one-quarter have infections that have already advanced to Acquired Immune Deficiency Syndrome (AIDS). The results of the study were reported online in Annals of Emergency Medicine ("Identification of Acute HIV Infection Using Fourth Generation Testing in an Opt-Out Emergency Department Screening Program").

"People may believe that HIV and AIDS are diseases of the 20th century, but our results show that many people continue to be infected without being aware of it," said lead study author Kara Iskyan Geren, MD, MPH, of Maricopa Integrated Health System in Phoenix, Ariz. "Proper diagnosis before HIV progresses to AIDS allows for interventions that can extend life as well as minimize the risk of transmission to other people. Of the patients with confirmed HIV diagnosis, we were able to connect 72 percent with HIV care within 90 days."

Of 22,468 patients who were tested for HIV, 78 (0.28 percent) had new HIV diagnoses. Of those, 23 percent had acute HIV infections and 28 percent had a T-cell count below 200 or an opportunistic infection (in other words, had AIDS). Eight-two percent of patients with confirmed HIV did not have health insurance. Patients excluded from testing included those who had an altered level of consciousness and had higher risk profiles, such as prison inmates.

Dr. Geren and her team used a fourth generation antigen/antibody HIV test with rapid results which has only been available since 2009. The relatively new test allows for earlier and easier detection of HIV.

"In 2006, the Centers for Disease Control and Prevention (CDC) suggested universal screenings for patients in populations with a prevalence of undiagnosed infections greater than 0.1 percent, which would include our patient population" said Dr. Geren. "However, it is difficult to ask an already overburdened, underfunded emergency department and its staff to perform a public health function. The reality is that the lack of organizational support and upfront costs will likely be major barrier to implementing this type of testing in many emergency departments across the country."

Source: http://www.medicalnewstoday.com/releases/278696.php

June 23, 2014 (MNT) - HIV-1, the virus responsible for most cases of AIDS, is a very selective virus. It does not readily infect species other than its usual hosts - humans and chimpanzees. While this would qualify as good news for most mammals, for humans this fact has made the search for effective treatments and vaccines for AIDS that much more difficult; without an accurate animal model of the disease, researchers have had few options for clinical studies of the virus.

New work from Paul Bieniasz's Laboratory of Retrovirology at The Rockefeller University and the Aaron Diamond AIDS Research Center and Theodora Hatziioannou's Laboratory, also at Aaron Diamond, may help fill this gap. In research described today in Science, they announce that they have coaxed a slightly modified form of the HIV-1 virus to not only infect pigtailed macaques, a species of monkey, but to cause full blown AIDS in the primates, a first.

"HIV-1 only causes AIDS in humans and chimpanzees, but the latter are not a practical model and are no longer used for HIV/AIDS research. Our goal has been to figure out how HIV-1 could cause disease in a new host," Bieniasz says. "By accomplishing this with macaques, we have taken a step toward establishing a new model for AIDS that can be used universally in prevention and treatment research."

Although pigtailed macaques have fewer defenses against HIV-1 than most other primates - they lack an antiviral protein that fights off the virus - the researchers still had to alter both the virus and the macaque immune system in order to induce AIDS.

They bolstered the virus with a defense-disabling protein made by Simian Immunodeficiency Virus (SIV), a relative of HIV-1. Then they encouraged the modified HIV strain to adapt to its new host by passing it from one monkey to another, resulting in six generations of infected monkeys and an adapted virus. Even so, the monkeys' immune systems were still able to control the HIV-1 infection. So, the researchers temporarily weakened their immune systems by depleting a type of white blood cell, known as a CD8 T-cell, that destroys virus-infected cells.

"When we depleted their CD8 cells, the infected monkeys developed disease closely mirroring that of human patients. For example they contracted AIDS-defining conditions including pneumocystis pneumonia, a textbook example of an opportunistic infection in AIDS," says Hatziioannou.

"Because it replicates what happens when HIV-1 compromises a human patient's immune system, our approach could potentially be used in the development of therapies and preventative measures for human patients."

In fact, if fully developed, the macaque model will offer a substantial improvement for research. Often, HIV therapy and prevention research relies on SIV, a viral relative of HIV-1, since SIV can cause AIDS-like disease in nonhuman primates. However, SIV doesn't always behave the same way HIV-1 does. "We still have one major hurdle to overcome: If we could get HIV-1 to cause AIDS without depleting the CD8 cells, we could replace models that make use of SIV for this research."

This work and previous research in the lab has also illuminated the process by which HIV-1 and other members of the lentivirus family can colonize a new host like the macaques. It turns out that evading or fighting off the antiviral proteins produced by the new host's cells is key.

"This new model for HIV-1 infection is the result of years spent exploring scientific questions about how the virus interacts with a host's antiviral defenses. These kinds of basic insights will enable us to continue to improve this model," Hatziioannou says.

Source: http://www.medicalnewstoday.com/releases/278552.php

June 23, 2014 (MNT) - HIV-1, the virus responsible for most cases of AIDS, is a very selective virus. It does not readily infect species other than its usual hosts - humans and chimpanzees. While this would qualify as good news for most mammals, for humans this fact has made the search for effective treatments and vaccines for AIDS that much more difficult; without an accurate animal model of the disease, researchers have had few options for clinical studies of the virus.

New work from Paul Bieniasz's Laboratory of Retrovirology at The Rockefeller University and the Aaron Diamond AIDS Research Center and Theodora Hatziioannou's Laboratory, also at Aaron Diamond, may help fill this gap. In research described today in Science, they announce that they have coaxed a slightly modified form of the HIV-1 virus to not only infect pigtailed macaques, a species of monkey, but to cause full blown AIDS in the primates, a first.

"HIV-1 only causes AIDS in humans and chimpanzees, but the latter are not a practical model and are no longer used for HIV/AIDS research. Our goal has been to figure out how HIV-1 could cause disease in a new host," Bieniasz says. "By accomplishing this with macaques, we have taken a step toward establishing a new model for AIDS that can be used universally in prevention and treatment research."

Although pigtailed macaques have fewer defenses against HIV-1 than most other primates - they lack an antiviral protein that fights off the virus - the researchers still had to alter both the virus and the macaque immune system in order to induce AIDS.

They bolstered the virus with a defense-disabling protein made by Simian Immunodeficiency Virus (SIV), a relative of HIV-1. Then they encouraged the modified HIV strain to adapt to its new host by passing it from one monkey to another, resulting in six generations of infected monkeys and an adapted virus. Even so, the monkeys' immune systems were still able to control the HIV-1 infection. So, the researchers temporarily weakened their immune systems by depleting a type of white blood cell, known as a CD8 T-cell, that destroys virus-infected cells.

"When we depleted their CD8 cells, the infected monkeys developed disease closely mirroring that of human patients. For example they contracted AIDS-defining conditions including pneumocystis pneumonia, a textbook example of an opportunistic infection in AIDS," says Hatziioannou.

"Because it replicates what happens when HIV-1 compromises a human patient's immune system, our approach could potentially be used in the development of therapies and preventative measures for human patients."

In fact, if fully developed, the macaque model will offer a substantial improvement for research. Often, HIV therapy and prevention research relies on SIV, a viral relative of HIV-1, since SIV can cause AIDS-like disease in nonhuman primates. However, SIV doesn't always behave the same way HIV-1 does. "We still have one major hurdle to overcome: If we could get HIV-1 to cause AIDS without depleting the CD8 cells, we could replace models that make use of SIV for this research."

This work and previous research in the lab has also illuminated the process by which HIV-1 and other members of the lentivirus family can colonize a new host like the macaques. It turns out that evading or fighting off the antiviral proteins produced by the new host's cells is key.

"This new model for HIV-1 infection is the result of years spent exploring scientific questions about how the virus interacts with a host's antiviral defenses. These kinds of basic insights will enable us to continue to improve this model," Hatziioannou says.

Source: http://www.medicalnewstoday.com/releases/278552.php

June 20, 2014 (MNT) - HIV epidemics are emerging among people who inject drugs in several countries in the Middle East and North Africa. Though HIV infection levels were historically very low in the Middle East and North Africa, substantial levels of HIV transmission and emerging HIV epidemics have been documented among people who inject drugs in at least one-third of the countries of this region, according to findings published in PLOS Medicine.

The HIV epidemics among people who inject drugs (PWID) are recent overall, starting largely around 2003 and continuing to grow in most countries. However, they vary across the region. In countries such as Afghanistan, Bahrain, Egypt, Iran, Morocco, Oman, and Pakistan, on average between 10 and 15 percent of PWID are HIV-positive. The HIV epidemics in these countries appear to be growing; in Pakistan, for example, the fraction of PWID who are HIV-infected increased from 11 percent in 2005 to 25 percent in 2011. In Iran, the HIV epidemic among PWID has stabilized at about 15 percent. There are, however, other countries where limited HIV transmission was found among PWID, such as in Jordan, Lebanon, Palestine and Syria.

"Not only have we found a pattern of new HIV epidemics among PWID in the region, but we found also indications that there could be hidden HIV epidemics among this marginalized population in several countries with still-limited data," said Ghina Mumtaz, lead author of the study and senior epidemiologist at the Infectious Disease Epidemiology Group at Weill Cornell Medical College-Qatar. "For example in Libya, the first study among people who inject drugs was conducted only recently and unveiled alarmingly high levels of HIV infection, suggesting that the virus has been propagating, unnoticed, among this population for at least a decade. Eighty-seven percent of PWID in Tripoli, the capital of Libya, were infected with HIV, one of the highest levels reported among PWID globally."

The study estimated that there are about 626,000 people who inject drugs in the Middle East and North Africa. This translates into 24 people who inject drugs for every 1,000 adults in this part of the world. These individuals are typically involved in several types of behavior that expose them to HIV infection, such as sharing of needles or syringes, a behavior reported by 18 to 28 percent of injecting drug users during their last injection across these countries.

"The levels of HIV infection among people who inject drugs tell only half of the story. We also see high levels of risky practices that will likely expose this population to further HIV transmission in the coming years," said Dr. Laith Abu-Raddad, principal investigator of the study and associate professor of public health in the Infectious Disease Epidemiology Group at Weill Cornell Medical College-Qatar. "We found that nearly half of people who inject drugs are infected with hepatitis C virus, another infection of concern that is also transmitted though sharing of needles and syringes."

"Since the HIV epidemics among people who inject drugs in the Middle East and North Africa are still overall in an early phase, there is a window of opportunity to prevent these epidemics from further growth. This will also limit the potential for HIV transmission to be bridged to other population groups," Mumtaz said.

Although the region overall lags behind in responding to the emerging HIV epidemics among PWID, several countries have made significant progress in building and expanding harm-reduction programs and integrating them within the socio-cultural fabric of the region. These programs refer to policies and strategies aimed at reducing the harmful consequences of injecting drug use, including needle- and syringe-exchange programs and opioid-substitution therapies.

"It is of priority that countries in the region expand HIV surveillance systems among PWID to detect and monitor these budding and growing HIV epidemics. About half of the countries of the region still lack sufficient data to assess the levels of HIV infection among this population, and we continue to discover these epidemics several years after their onset. We need to be ahead of the epidemic to prevent a public health burden that this region is largely not prepared to handle," Dr. Abu-Raddad said.

Source: http://www.medicalnewstoday.com/releases/278508.php

June 19, 2014 (aidsmap) - Antiretroviral therapy started soon after birth can suppress HIV to extremely low levels and severely restrict the size of the reservoir of HIV-infected cells in peripheral blood, Canadian researchers report in the online edition of Clinical Infectious Diseases.

The findings raise the hope that early suppressive antiretroviral therapy can achieve a "functional cure" for HIV-infected babies. However, the authors caution that the only way to determine this would be to discontinue HIV treatment, a strategy that is not without risks.

An HIV-infected baby who started antiretroviral therapy within 30 hours of birth was recently reported to have no detectable virus after treatment was stopped. The case of the so-called "Mississippi Bay" raised the prospect of a "functional cure" for HIV – control of viral replication after with withdrawal of antiretroviral drugs.

Doctors from three hospitals in Canada therefore investigated the impact of early antiretroviral treatment on HIV replication and various measures of the HIV reservoir size in children infected with HIV at birth who achieved sustained virologic suppression with triple antiretroviral therapy.

HIV-exposed infants were eligible for inclusion if they started treatment within 72 hours of life because of incomplete maternal HIV suppression at delivery, the absence of viral load results, or a history of poor adherence.

The eligible infants all had confirmed HIV infection and achieved sustained HIV suppression with antiretroviral therapy consisting of zidovudine, lamivudine and nevirapine.

Follow-up was undertaken after 2.5-7.5 years. Assessments included HIV antibody testing, viral load testing with a lower limit of detection of 1.5 copies/ml, monitoring of cell-associated HIV DNA and RNA, tests for the presence of replication-competent HIV and HLA genotype.

A total of 136 infants started combination antiretroviral therapy soon after birth; twelve (9%) were HIV infected and four achieved sustained viral suppression. Analysis focused on these four patients. All received their fist dose of therapy within 24 hours of birth. Virological suppression was first documented between 66 and 189 days of life. All four infants remained on the same regime until follow-up and at this time were in good health with normal CD4 counts.

At follow-up, all four infants were HIV-negative using both ELISA and Western blot tests. Viral load was undetectable using the ultra-sensitive assay. No detectable cell-associated HIV DNA (below2.6 copies/106 CD4 T-cells) was found in the peripheral blood of any of the children. However, low levels of cell-associated HIV RNA (19.5-130 copies/1.5 μg RNA) were detected in all four. No virion-associated HIV RNA was detected in the patients' CD4 cells. Culture detected replication competent virus in one child at a concentration of 0.1 infectious units per 106 CD4 cells.

All four children had wild-type CCR5 virus. Three had HLA B*58. The HLA-B sequence has previously been associated with better HIV control.

"The findings in the four children with sustained virologic suppression show that early initiation of cART [combination antiretroviral therapy] in infants can dramatically reduce the level of proviral HIV-1 DNA and replication competent virus in peripheral blood CD4+ T-cells," comment the authors. "Given that it is not possible to examine every cell in each infant, a structured treatment interruption may be the only practical way to determine if HIV-1 eradication or functional cure can be achieved in such treatment."

The investigators urge that the pros and cons of this strategy should be carefully assessed.

"If virologic rebound were to occur following cART discontinuation it would likely to accompanied by expansion of the HIV-1 reservoir, potentially making future HIV-1 reservoir eradication more difficult," they conclude.

"Therefore, a thorough discussion of the risks and benefits of stopping cART with patients and caregivers is imperative and, if undertaken, will require long-term follow-up."

Source: http://www.aidsmap.com/ART-soon-after-birth-for-HIV-infected-babies-can-achieve-sustained-viral-suppression-and-reduce-pool-of-HIV-infected-cells/page/2861067/

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