News (Updated July 29, 2007)
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SYDNEY, July 25 (Reuters) - The world's biggest AIDS conference closed on Wednesday with a call for the development of child-specific drugs to ensure millions of HIV-infected children not only survive to adulthood, but also live without damaging side effects from their treatment.
"We must do more to protect our future, finding better ways to treat the youngest among us...," said International AIDS Society (IAS) President Dr Pedro Cahn.
An estimated 2.3 million children are HIV infected, with around 600,000 new infections each year. Without treatment half of all babies infected will die before their second birthday.
Yet only 15 percent of children who need treatment are currently receiving antiretroviral drugs, the IAS conference in Sydney was told on Wednesday.
"The goal of treatment in children must be balanced between halting the effects of the HIV disease and the long-term effects of antiretroviral on a developing child," said Dr Annette Sohn from the Division of Paediatric Infectious Diseases at the University of California in San Francisco.
Sohn said HIV-infected children on antiretrovirals risk HIV encephalopathy, where the brain swells and damages tissues over time, reduced neurocognitive development and lower bone density.
The conference was told that early treatment of children increased survival rates, but Sohn said some children who have been on early treatment have been forced onto second and third line drugs as the virus quickly builds resistance.
"It's clear that response to treatment is better when children are started before they develop severe immune deficiency," she said. "What is the future for those children already on second line drugs at the age of 5?"
ADULT-DESIGNED DRUGS
Those lucky enough to receive antiretroviral treatment are usually administered adult-designed drugs, cut into smaller and sometimes inaccurate doses which may mean treatment failure.
"Most of the world has been forced to split adult tablets into child size pieces. However splitting tablets into anything less than one half risks under or over dosing," said Sohn.
"It means children that require smaller sized pieces may be under dosed, leading to inadequate drug levels and risk of treatment failure."
Sohn said there was a need for generic paediatric drugs which would be cheaply shipped, stored and administered.
"We still need more paediatric antiretroviral formulations. Children clearly need a wider range of drugs in dual and triple combinations," she said.
The United Nations says close to 40 million people are infected with the AIDS virus and that treatment had dramatically expanded from 240,000 people in 2001 to 1.3 million by 2005.
In June, world powers at the Group of Eight (G8) summit in Germany set a target of providing AIDS drugs over the next few years to approximately 5 million people.
The three-day IAS conference, attended by 5,000 delegates from more than 130 countries, urged governments to allocate 10 percent of HIV funding to research, both medical and operational, to ensure treatment reached those in the world's poorest nations.
"HIV presents one of the greatest and most complex scientific challenges of our time," said Professor David Cooper, co-chair of the 2007 IAS conference.
"Confronting this challenge will require sustained political will and increased resources dedicated to AIDS research."
Wed Jul 25, 2007 2:19 PM BST
By Michael Perry
SYDNEY (Reuters) - HIV-infected babies have a greater chance of survival if they receive treatment before they show signs of illness or a weakened immune system, the International AIDS Society (IAS) was told on Tuesday.
A study of infants in Cape Town and Soweto in South Africa found that infants given immediate drug treatment had a 96 percent survival rate compared with 84 percent for children where treatment was deferred.
The study, sponsored by the U.S. National Institute of Allergy and Infectious Diseases (NIAID), was so successful that it was amended in 2007, ending enrolments for the deferred treatment group and evaluating those in the group for treatment.
An estimated 2.3 million children are currently HIV infected, with around 600,000 new HIV infections in children each year. Without treatment half of all babies infected with HIV die before their second birthday.
"Children with HIV infection frequently show rapid disease progression within the first year of life due to their developing immune systems and susceptibility to other serious infections," said Dr Elias Zerhouni, director of the U.S. National Institute of Health, in a statement on the study at an IAS conference.
"This is the first randomized clinical trial that shows that infants treated before 3 months of age will do better than infants who have their treatment delayed," Zerhouni said.
The study of 337 babies aged 6 to 12 weeks was initially aimed at examining whether early antiretroviral drug therapy over a limited period would delay HIV progression.
Doctors had hoped that early treatment would allow a child's immune system to develop and possibly allow the child to stop treatment for a period of time and avoid continuous therapy.
A review in 2007 found such a significant difference in survival rates and the interim results forwarded to the World Health Organisation.
"The results of this trial could have significant public health implications worldwide because these findings will cause experts to consider changes in standards of care in many parts of the world," said NIAID director Dr Anthony Fauci.
IMMUNE SYSTEMS
Caring for HIV-infected children is complicated by the fact that their immune systems are not fully developed in the first year of life, which makes them especially susceptible to rapid the disease progression and death.
The current standard of HIV care in many parts of the world is to treat infants with antiretroviral therapy, but only after they show signs of illness or a weakened immune system.
Medecins Sans Frontieres (MSF) said children were the "silent victims" of the global AIDS epidemic, with 9 out of 10 child sufferers infected through mother-to-child transmission during pregnancy, childbirth or breastfeeding.
About 87 percent of children with HIV live in sub-Saharan Africa, with the vast majority beyond health services. Of the 540,000 children newly infected in 2006, 470,000 live in Africa and only 700 in either Europe or North America, said MSF.
MSF said "vertical transmission" of HIV from mother to child had been almost been wiped out in wealthy countries because antiretroviral drug therapy was given to pregnant mothers and babies within a few hours of birth.
The mother-to-child transmission rate in wealthy nations was below 1 percent, compared with rates as high as 25 to 45 percent in poorer nations in Africa, said MSF.
The United Nations says close to 40 million people are infected with the AIDS virus and that treatment had dramatically expanded from 240,000 people in 2001 to 1.3 million by 2005.
In June, world powers at the Group of Eight (G8) summit in Germany set a target of providing AIDS drugs over the next few years to approximately 5 million people.
Tue Jul 24, 2007 11:05 AM ET
By Michael Perry
SYDNEY (Reuters) - The emergence of new and improved drugs, genetic engineering and the ancient surgical practice of circumcision are the latest weapons in the fight against AIDS, the International AIDS Society conference was told on Tuesday.
A new batch of drugs that slow the progress of HIV in patients and genetically modified cells that prevent further infections are about to become available or trialed, doctors told the world's largest AIDS conference.
"It's an extremely exciting time in terms of drug development. We have better drugs in existing classes, as well as whole new classes of drugs," said Professor David Cooper, co-chairman of the 2007 IAS conference in Sydney.
"Patients and their clinicians now have a much wider choice of drug combinations than ever before," said Cooper, director of Australia's National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales.
But the biggest breakthrough for the world's poorest nations, which will not initially be able to afford these new drugs and which carry the heaviest AIDS burden, lies in a procedure dating back to at least 2,300 B.C. in Egypt -- circumcision.
African studies have shown that male circumcision can reduce HIV transmission from women to men by about 60 percent, said Professor Robert Bailey at the School of Public Health at the University of Illinois at Chicago.
Universal circumcision could avert two million new infections and 300,000 deaths in sub-Saharan Africa over 10 years, he said.
Africa is the epicenter of the AIDS epidemic. South Africa has an estimated 5.5 million people with HIV and is struggling to stem the spread of the disease in the general population.
Bailey said that while the World Health Organisation (WHO) had now endorsed circumcision as a preventative measure, encouraging the widespread use of circumcision would not be easy.
"Circumcision is not just simply a surgical procedure. It's tied up in a complex web of cultural and religious practices and beliefs," he said.
NEW DRUGS
New drugs and improved second-generation drugs will not only be more effective in fighting HIV, the IAS conference was told, but could offer treatment to patients whose disease had become immune to earlier drugs.
Recent research has shown that new classes of anti-retroviral drugs, which include various inhibitors, provide superior benefit to patients with highly resistant HIV, said Joseph Eron, professor of medicine at the University of North Carolina.
"I think that while it will take some time, some of these new agents will also be very useful in the developing world were we are seeing the emergence of resistant virus," said Eron in detailing the new drugs.
At the cutting edge of the AIDS battle is genetic engineering, with human trials about to start on genetically modifying a HIV patient's blood stem cells and T cells and reintroducing them into the body to better fight the disease.
"This is a permanent modification of the cells. As long as the cells persist in the patient they will be resistant to further infection," said Professor John Rossi, head of biological sciences at the U.S. Beckman Research Institute.
"We realize that this is not a treatment that will be applied universally," said Rossi, adding the treatment should allow patients to reduce drug dosage.
Rossi and Eron called on drug companies to make new drugs available to the world's poorer nations.
Medecins Sans Frontieres (MSF) told the IAS conference on Monday said that while there had been dramatic price reductions in some HIV drugs, the newer, less toxic drugs recommended by the WHO had become more expensive. An MSF report said some new drugs had risen in price by nearly 500 percent from $99 to up to $487.
The United Nations says close to 40 million people are infected with HIV and that treatment had dramatically expanded from 240,000 people in 2001 to 1.3 million by 2005.
In June, world powers at the Group of Eight (G8) summit in Germany set a target of providing AIDS drugs over the next few years to approximately 5 million people.
Tue Jul 24, 2007 8:47 AM BST
By Jane Lee
SYDNEY (Reuters) - Millions of new HIV infections in Africa could be avoided if more men were circumcised, an International AIDS Society conference was told on Tuesday.
Studies in Africa have found that male circumcision, the world's oldest surgical procedure dating back to 2300 BC, reduces HIV transmission from females to males by 60 percent.
Universal circumcision could avert 2 million new infections and 300,000 deaths in sub-Saharan Africa over 10 years, said Professor Robert Bailey from the School of Public Health at the University of Illinois in Chicago.
"If we had a vaccine that was 60 percent protective we would be very happy and rolling it out as fast as possible," Bailey told the IAS conference in Sydney.
"But no one stands to profit from male circumcision -- no one but the 4,000 in Africa who will be infected tomorrow."
Africa is the epicenter of the AIDS epidemic. South Africa has an estimated 5.5 million people with HIV and is struggling to stem the spread of the disease in the general population.
But African nations such as Cameroon and Nigeria, where circumcision is common, have a much lower rate of HIV infection than Zimbabwe and Swaziland where there is little circumcision.
The idea of using circumcision as a weapon against AIDS emerged after studies in Uganda, Kenya, Malawi, Zambia and the United States found the potential to significantly reduce infections, said Bailey, adding the World Health Organisation has now endorsed circumcision as a disease prevention method.
"The challenge ahead for us is how to roll out circumcision safely ... and to persuade leaders in countries that it is going to help their populations," Bailey told a news conference.
"Circumcision is not just simply a surgical procedure. Its tied up in a complex web of cultural and religious practices and beliefs," he added.
"It's not easy for politicians and ministers of health to quickly come out in favor of circumcision in countries where circumcision is not traditionally practiced."
Bailey said aid organizations would not offer the service until local governments endorsed it, for fear of being seen as culturally insensitive.
WOMEN BACK CIRCUMCISION
Women in African nations are expected to be the drivers behind using circumcision to stop HIV infection as they are traditionally associated with ensuring hygiene in communities.
"Women, more than men, equate circumcision with improved hygiene," said Bailey.
"It's often up to women to provide the water, the soap and the materials for men to bathe and cleanse themselves. Many of the women complain the men are not as clean as they could be."
Circumcision should not be seen by men as their only preventative measure against HIV and must still be combined with safe sex practices. Condom use should still be encouraged.
"It's very important not to view this as a standalone surgical procedure," said Bailey.
Many Africans were already seeking circumcision to try and stop the spread of HIV, but many were suffering medical complications because of poor procedures.
There also was some evidence that circumcision may help prevent infection between homosexual men, with one study in Uganda showing a 30 percent reduction in infection.
SYDNEY (AFP) - Scientists have begun human trials of a revolutionary HIV treatment that genetically modifies people's cells to halt the virus, a conference of international experts in Sydney was told Tuesday.
US professor John Rossi said the world-first trials began recently at the City of Hope hospital in California, the culmination of research that began in the early 1990s.
"We have already enrolled our first patient, who will be infused with his own genetically modified blood stem cells and we will enrol four more patients after him," said Rossi, the head of the hospital's molecular biology division.
The process, known as intra-cellular immunity, involves changing the genetic information in the human cells, known as T-cells, that the HIV virus normally locks into and infects before replicating and spreading.
A piece of genetic material is introduced into the cells that makes then recognise HIV as a threat, stimulating the body's natural cellular defence mechanism to prevent the HIV cell from replicating.
"Our approach has been to take blood stem cells and T-cells out of patients that are HIV infected and introduce into these cells genes that produce products that inhibit HIV replication," Rossi told the International Aids Society conference in Sydney.
"This would be long-term, this is a permanent modification of these cells, so that as long as these cells persist in the patient, they will have resistance to the HIV infection."
Rossi said the ultimate goal of the research was to either completely control the HIV virus or reduce its presence in patients to such an extent that they needed fewer drugs to survive.
"It's a landmark trial in many ways and we're very excited about being the first people in the world to do this," he said.
The conference also heard that a US study showed a link between HIV infection in gay men and increased use of drugs such as methamphetamines.
Researcher Christopher Hurt from the University of North Carolina said the study showed that between 2000 and 2005, the proportion of HIV-positive US men under 30 who also took club drugs almost tripled from 1.7 to five percent.
Hurt said research confirmed that gay sex and club drugs were a dangerous combination.
"Gay men were already at risk and now they're becoming even more vulnerable," he said.
Hurt said increased use of drugs such as methamphetamine had the potential to dramatically lift HIV infection rates among gay men.
"The libido is stimulated on methamphetamine and we also know that if you stay awake for hours and hours and hours you're more likely to have marathon sessions of sex," he said.
"And more sex equals more risk for this group."