By KEVIN FREKING, Associated Press WriterThu
Jul 24, 2:01 PM ET
Scientists will have to take "enormous intellectual leaps" to
develop an AIDS vaccine in the coming years, say researchers clearly
frustrated by the failure of a once-promising shot.
The researchers, including a top National Institutes of Health official,
want new people with new ideas to step up and join the search. They say the
focus of their research should be on discovering a vaccine rather than on
clinical trials for evaluating medicines that may or may not work.
"Design of a vaccine that blocks HIV infection will require enormous
intellectual leaps beyond present day knowledge," concluded a broad
team of researchers writing in Friday's edition of the journal Science.
More than 6,500 new HIV infections occur daily worldwide. A recent
high-profile trial of a potential vaccine not only failed to prevent
infection, but those who got the inoculation appeared at increased risk of
infection compared with those who were given a placebo.
After the disappointing results, the National Institute of Allergy and
Infectious Diseases held a summit in March on how to reinvigorate vaccine
research.
The institute will still support studies in people — but it is raising
the bar that candidate vaccines need to pass to get federal support. NIH is
looking for fresh ideas on how to approach HIV vaccine discovery, and
emphasizing basic laboratory research to fill in key gaps in knowledge.
Among the priorities will be increased research in chimpanzees, the Science
article says.
The recent failed vaccine study showed "we were maybe on the wrong
track a bit," Dr. Anthony Fauci, the institute's director, told a
Science podcast. "We will be turning the knob, as I like to say, more
preferentially toward answering some of the fundamental questions that have
gone unanswered," he said.
When contractors don't meet milestones, or when initiatives don't attract
the highest quality of applications, money will be redirected to more
promising research activities, Fauci's team wrote. Unfortunately, the need
for more resources aimed at discovering a vaccine comes at a time when the
National Institutes of Health's budget remains flat, the officials said.
"Should growth in the NIH budget be reinstated in future years, one
of the highest priorities will be to target those additional resources to
HIV vaccine programs, particularly vaccine discovery research," the
health officials wrote.
WASHINGTON, July 22 (Reuters) - The U.S. Centers for Disease Control and
Prevention said on Tuesday it will soon release long-awaited revised estimates
of how many Americans become infected with the AIDS virus every year.
Activists have been saying
the numbers are sharply higher and have been urging the CDC to release the
numbers.
In June, Dr. Anthony Fauci,
director of the National Institute of Allergy and Infectious Diseases, said he
believed the numbers had risen from 40,000 to 50,000 a year, although the CDC
denied he had seen the new estimates.
Late on Tuesday, the CDC
said it would release the new estimates on Aug. 3 in the Journal of the American
Medical Association.
"These new incidence
estimates are based on direct measurement of new HIV infections and will provide
the clearest picture to date of incidence (or the number of new HIV infections
in a given year)," it said in a "Dear Colleague" letter.
"These more precise
estimates are possible now only because of breakthrough technology developed by
CDC that can distinguish recent from long-standing HIV infections."
Because the system was new,
it had to "receive rigorous scientific review," the CDC said.
"This process took
longer than we anticipated, but, in the end, it has produced estimates that are
more reliable and scientifically sound than would have occurred without the
independent review."
In June, Fauci said the new
counting methods were not changing the overall picture of AIDS in
America
, but reflected the long-standing rate of new infections.
In the
United States
, with a population of about 300 million, 1.1 million people are infected with
HIV, of which 25 percent do not know it.
Globally, an estimated 33.2
million people are infected with the human immunodeficiency virus that causes
AIDS and 25 million have died so far. It is mainly transmitted through
heterosexual sex but also mother to child and via needles.
Knowing the precise number
of new infections is key to better funding for clinics, public education and
drug programs. HIV has no cure and there is no vaccine, but treatment with drugs
can keep the infection under control and people who know they are infected can
take steps to avoid infecting others.
HONG KONG (Reuters) - HIV infections could quadruple over
10 years if HIV-positive people who are taking antiretroviraldrugs become
complacent and stop using condoms, researchers in Australia warned.
The warning, published in The Lancet, comes after the Swiss Federal
Commission for HIV/AIDS said in a controversial statement earlier this
year that HIV-positive people on effective treatment were sexually
non-infectious.
But the Australian researchers stressed that while the risk of
transmission from people on effective therapy was low, it was unlikely to
be zero.
"Factors such as incomplete adherence to therapy or the presence
of other sexually transmitted infections could increase the risk of HIV
transmission," they wrote.
"A false sense of security might lead to reductions in condom use,
as was documented in a behavioural study among men who have sex with men
in Australia."
HIV infections have been rising among homosexual men in a number of
countries in recent years despite high treatment rates -- something often
attributed to reductions in condom use.
Using mathematical models, the team at the National Centre in HIV
Epidemiology and Clinical Research in Sydney showed that, while the risk
of HIV transmission by people on treatment was fairly small for each
sexual contact, that risk would be substantial over large numbers of
sexual contacts.
They based their calculations on 10,000 couples -- one partner being
HIV-positive -- having 100 unprotected sexual encounters a year over 10
years.
"The expected number of HIV infections would be 215 for
female-to-male transmissions, 425 for male-to-female transmission, and
3,524 for male-to-male transmission, corresponding to an increase in
incidence of four times compared with incidence under current rates of
condom use," they wrote.
Jonathan Anderson, president of the Australasian Society for HIV
Medicine, said the Swiss advice was misleading.
"When the viral load goes down in the blood due to antiretrovirals,
it might not go down in the semen or vaginal and anal fluids," said
Anderson, who did not participate in the study.
"Antiretrovirals can complement consistent condom use but
replacing condom use with medications may end in disaster."
(Reporting by Tan Ee Lyn; Editing by Alex Richardson)
Page last updated by BBC at 23:11 GMT,
Tuesday, 22 July 2008 00:11 UK
Symptoms can be missed
HIV is being spread because doctors overlook symptoms
which could reveal the infection, a charity claims.
The National Aids Trust said as many as half of all early-stage
infections, often marked by severe flu-like symptoms, are being missed.
Spotting them and carrying out an HIV test would prevent further
infections, it said.
A GP specialising in sexual health said doctors should always be
open-minded to the possibility their patients had HIV.
Doctors need to always be alive to the possibility that the
person in front of them may have HIV
Dr Christian Jessen
GP
There are approximately 7,000 new HIV infections in the UK every year,
and as many as 50% are estimated to be passed on by people who are in the
early stages of their own infection.
In the first few weeks after infection, there are massive levels of the
virus in the blood, and in most cases, this causes symptoms such as sore
throats, fever and rashes. A person with HIV is at their most infectious
at this point.
However, after six weeks, these symptoms generally recede and the
infected person will feel back to normal, even though they still have HIV.
However, the National Aids Trust (NAT) said that people visiting a
doctor, either their GP or in A&E, complaining of these symptoms were
often told it was a trivial viral infection, and to return if it did not
improve.
A study in Brighton found that 48% of HIV patients who had sought
medical advice with their early symptoms had not been diagnosed.
'Stereotype'
Deborah Jack, the chief executive of NAT, said: "It is very
worrying that GPs and other healthcare professionals are often missing the
signs and symptoms of HIV infection.
"This can mean they become seriously ill in the longer term and
respond less well to treatment.
"It also means they are likely to be putting partners at risk of
infection as they may live undiagnosed for a number of years."
Dr Martin Fisher, a consultant in HIV medicine, said that this brief
period was a "golden opportunity" to spot new cases.
He said: "HIV testing needs to be more widespread and routine.
It's reasonable to expect doctors to be able to make this diagnosis."
Dr Christian Jessen, a GP specialising in sexual health medicine, said
that doctors were still guilty of being influenced by the stereotypical
notion of the "gay man with HIV".
"I have seen so many cases come to me which have been missed, and
people with HIV are not just gay men, they are heterosexual men and women
as well.
"Doctors need to always be alive to the possibility that the
person in front of them may have HIV."
Lisa Power, of the HIV charity Terrence Higgins Trust, said it was
important that those of particular risk of HIV, and those who give them
healthcare, needed to know the signs of early infection.
"Sore throat, fever and a rash? Go and get it checked out, and
make sure the various checks includes an HIV test."
NEW YORK (AP) -- Shares of biotechnology company Gilead Sciences Inc. rose
Wednesday after the company said it started a late-stage study of a new HIV
treatment candidate.
The stock rose $1.60, or 3.1 percent, to close at $52.70 on heavier than
average volume. Shares have traded between $35.22 and $56.95 over the last 52
weeks.
The Phase III clinical trial will compare Gilead's once-daily drug
candidate elvitegravir with Merck & Co.'s twice-daily Isentress. The
program will involve about 700 HIV-infected people, with the goal of assessing
whether Gilead's new drug is just as effective as Isentress.
Gilead already dominates the HIV therapy market with Truvada and the
three-in-one, once-daily drug Atripla.
HIV patients often remain on one treatment for a long time, eventually
growing resistant to the drug. If Gilead's elvitegravir proves just as
effective as Isentress, then it would become both a new treatment on the
market and an option for patients who have grown a resistant to their current
therapy.
If it works equally well, elvitegravir would also be desirable because of
its once-daily dosing regimen, said Leerink Swann analyst William Tanner, in a
note to investors. But, the drug needs a boost from the antiretroviral
treatment Ritonavir in order to achieve the once-daily dosing.
That could possibly cut out approval of the drug as an initial HIV
treatment, leaving it only as a secondary therapy, Tanner said. But, Gilead is
currently developing its own boosting agent, called GS 9350, which doesn't
have antiviral activity. That could increase elvitegravir's potential to be
approved as an initial therapy.
Tanner and several other analysts have been maintaining that the company
has a strong market position, following what was perceived by some investors
to be a weak second-quarter profit report last week.
Robert W. Baird analyst Thomas Russo reaffirmed a "Neutral"
rating and $57 price target, urging patience after the earnings report. He
said it showed that positive earnings surprises are no longer certain from
Gilead.
"That said, this is by no means a broken story, and we retain
sufficient confidence in estimates," he said.
Deutsche Bank-North America's Mark Schoenebaum reaffirmed a "Buy"
rating.
WASHINGTON, July 22
(Reuters) - People infected with parasitic worms may be much more susceptible to
the AIDS virus, according to a study published on Tuesday that may help explain
why HIV has hit sub-Saharan Africa particularly hard.
The study involving monkeys
demonstrated how a type of parasitic worm that causes schistosomiasis, which
affects 200 million people globally, may make HIV infection more likely.
Much lower amounts of the
AIDS virus -- 17 times lower -- were needed to cause infection in monkeys who
had the parasitic worms than in the parasite-free monkeys, the researchers said.
"The presence of the
worm is like adding fuel to the fire -- it creates more fertile ground for the
virus to take hold," Dr. Ruth Ruprecht of
Harvard
Medical
School
, one of the researchers, said in a telephone interview.
Evan Secor of the U.S.
Centers for Disease Control and Prevention, another of the researchers, said the
findings likely apply to people as well. This may confirm suspicions that
parasitic worm infections like those common in parts of sub-Saharan
Africa
with unsanitary water supplies make people more vulnerable to HIV, Secor said.
"Sub-Saharan
Africa
has only like 10 percent of the world's population but almost two-thirds of the
world's HIV/AIDS," Secor said in a telephone interview.
"So there's an
apparent disproportionate amount of HIV/AIDS there, and it's very severe. So the
hypothesis is that one of the things that may contribute to the more intense
nature of HIV/AIDS in sub-Saharan
Africa
is the presence of these parasitic worms," Secor added.
Schistosomiasis, seen
primarily in developing countries, is caused by tiny flatworms that live in
snail-infested freshwater like rivers and lakes.
When people wade, swim or
bathe in contaminated water, worms bore through the skin and travel in the
blood, causing anemia, diarrhea, internal bleeding, organ damage and death.
Secor said the parasitic
worm infection may undercut the immune system's ability to fight off HIV
infection and may make it easier for HIV to get into white blood cells.
HIV MORE LIKELY TO SPREAD
The researchers conducted
experiments with rhesus monkeys, some of which had an acute infection with the
Schistosoma mansoni parasitic worm and some of which were parasite-free, normal
and healthy.
They then exposed the
monkeys to a hybrid AIDS virus -- a genetically engineered version that combined
elements of the monkey AIDS virus and the human immunodeficiency virus that
causes AIDS in people.
Ruprecht said having
parasitic worms not only made a monkey more susceptible to AIDS virus infection,
but once infected they had far higher concentrations of the virus in their
bloodstream, meaning they became more likely to infect others.
"If the virus is
extremely high in the blood, then the chances are that the virus is also going
to be high in the genital fluids. And therefore such a host would be more likely
to be spreading the infection to others," Ruprecht said.
Ruprecht said the findings
emphasized the need for public health measures to control parasitic worm
infections in regions where HIV infection is common. A drug called praziquantel
is available to treat schistosomiasis.
The study, published in the
Public Library of Science journal PLoS Neglected Tropical Diseases, can be read
at http://www.plosntds.org/doi/pntd.0000265.
Anti-HIV
drugs have slashed death rates among people with the AIDS virus by nearly 40
percent since combination therapy was introduced in 1996, boosting their
life expectancy by some 13 years, a study says.
It is the biggest-ever assessment into the effectiveness of highly active
antiretroviral therapy -- the triple cocktail of drugs that suppress, but do
not eradicate, the human immunodeficiency virus (HIV).
Publishing on Friday in the British weekly medical journal The Lancet,
researchers report on 14 ongoing studies into more than 33,000 HIV-infected
people living in Europe, Canada and the United States.
These people started antiretrovirals in one of three phases -- from
1996-1999; from 2000-2002; and from 2003-2005.
From 1996 to 2005, 2,056 patients died, but mortality fell by around 40
percent in the course of this period. Life expectancy at the start was 36.1
years but rose to 49.4 years at the end.
"These advances have transformed HIV from being a fatal disease,
which was the reality for patients before the advent of combination
treatment, into a long-term chronic condition," says the paper.
The team is headed by Robert Hogg, a professor at Simon Fraser University
in Vancouver, Canada.
The study found that people who were treated earlier after infection and
had a higher number of CD4 immune cells at the start of the therapy had a
better life expectancy.
Despite the greater overall survival chances, there remained a big gap in
life expectancy between people on antiretrovirals and the general
population, the authors found.
In a rich country, an HIV-positive person starting the drugs at the age
of 20 will on average live another 43 years, to the age of 63, while a
non-infected person will survive to around 80, according to this data.
The mortality figures culled in the study are not detailed enough to
explain this discrepancy, the authors admit.
Nor -- given most people with HIV are under 50 - are there yet any
figures to compare survival among older HIV-infected people compare with
non-infected counterparts.
In high-income economies, a disproportionately high number of injecting
drug users have HIV, where there is a higher risk of suicide or a fatal
overdose.
Australian AIDS expert David Cooper at the University of South Wales,
near Sydney, said that the study was a useful pointer to people with HIV as
to how long they could expect to live if they had access to the
antiretroviral lifeline.
Since AIDS emerged in 1981, the disease has claimed around 25 million
lives and another 33 million are infected, some two-thirds of whom live in
sub-Saharan Africa.
CAPE TOWN, July 22 (Reuters) - Researchers in South Africa are investigating
whether taking AIDS drugs daily will prevent infections among gay and bisexual
men, in the latest effort to combat the epidemic.
In a study launched on
Tuesday, researchers want to find out whether antiretroviral drugs normally used
by people already carrying the HIV virus could protect those at higher risk of
infection, a concept referred to as pre-exposure prophylaxis (PrEP).
"It's early days but
very exciting. It's another strategy, it gives us hope that maybe we can beat
this epidemic," researcher Linda-Gail Bekker told Reuters at the sidelines
of the launch of the study.
The study targets men who
have sex with other men because they have been found to be at higher risk of HIV
infection than other sexual groups.
South Africa has one of the world's highest incidences of
the HIV virus which can lead to AIDS, with an estimated 500,000 people infected
each year. About 1,000 die every day from AIDS-related illnesses.
"In terms of concept
... it (PrEP) looks like it has a chance of working," Bekker said, likening
it to oral contraceptives used to help prevent pregnancy.
"I'm not sure that
it's going to be the silver bullet, I doubt that. I think its going to be,
hopefully, another strategy in our armour," she added.
South Africa is the only African country selected to
participate in the international study, which includes
Brazil
,
Ecuador
,
Peru
,
Thailand
and the
United States
.
Results from the global
PrEP study, which will enrol 3,000 high risk men who have sex with men, is
expected towards the end of 2010. (Reporting by Wendell Roelf; Editing by Mariam
Karouny)
By Maggie Fox, Health and Science Editor Reuters - Friday,
July 25 01:13 am
WASHINGTON (Reuters) - Meditation may slow the worsening
of AIDS in just a few weeks, perhaps by affecting the immune system, U.S.
researchers reported on Thursday.
If the findings are borne out in larger studies, it could offer a cheap
and pleasant way to help people battle the incurable and often fatal
condition, the team at the University of California Los Angeles said.
They tested a stress-lowering program called mindfulness meditation,
defined as practicing an open and receptive awareness of the present
moment, avoiding thinking of the past or worrying about the future.
The more often the volunteers meditated, the higher their CD4 T-cell
counts -- a standard measure of how well the immune system is fighting the
AIDS virus. The CD4 counts were measured before and after the two-month
program.
"This study provides the first indication that mindfulness
meditation stress-management training can have a direct impact on slowing
HIV disease progression," David Creswell, who led the study, said in
a statement.
His team tested 67 HIV-positive adults from the Los Angeles area, 48 of
whom did some or all of the meditation. Most were likely to have highly
stressful lives, Creswell said.
"The average participant in the study was male, African American,
homosexual, unemployed and not on ARV (antiretroviral) medication,"
they wrote in the journal Brain, Behaviour, and Immunity.
The meditation classes included eight weekly two-hour sessions, a
day-long retreat and daily home practice. "The people that were in
this class really responded and just really enjoyed the program,"
Creswell said.
"The mindfulness program is a group-based and low-cost treatment,
and if this initial finding is replicated in larger samples, it's possible
that such training can be used as a powerful complementary treatment for
HIV disease, alongside medications," he added.
QUALITY OF LIFE
About 30 percent of the volunteers were taking HIV drug cocktails,
which can help suppress the virus.
"Even when we controlled for ARV use, we still saw these effects.
Whether you are on or off the drugs you are going to see these
benefits," Creswell said in a telephone interview.
Creswell said it was unclear how the stress-reducing effects of
meditation work. It may directly boost CD4 T-cell levels, or suppress the
virus, he said.
"We know that stress has direct effects on viral load," he
said.
Creswell said he believes the program can help people infected with a
variety of viruses and from all walks of life. HIV patients are especially
highly stressed, he noted.
"These marginalized folks typically are experiencing the highest
stress levels," he said.
But middle-class workers also experience stress. "Most people do
report a lot of daily stress," Creswell said.
And for AIDS patients, HIV drug cocktails are known to have a variety
of side effects, from weight gain to nausea.
"One of the main side-effects of this particular treatment was an
increase in their quality of life," Creswell said.
Doctors need to always be alive to the possibility that the
person in front of them may have HIV 
