HIV / AIDS NEWS
Part 2 of this report is abstracted from published reports from the 17th International AIDS Conference in Mexico City, August 3-8, 2008, and other sources.
Questions? Write to Mark Behar mpbehar@wisc.edu.
AIDS Vaccine Blueprint Described: The pendulum is swinging towards the scientific belief that an AIDS/HIV vaccination is now likely, and a "blueprint" has been developed that will help researchers better focus on the challenges and obstacles that need to be overcome.
Although researchers have identified "neutralizing" antibodies against HIV, and an AIDS vaccination will focus on this feature, by designing non-infectious immunogens to generate similar antibodies.
Many individuals infected with HIV, thankfully don't progress to clinical illness for many decades. The mechanisms of this unique "cell-mediated immunity (CMI)" need further exploration. The simian (monkey) equivalent of HIV does respond to animals given live, but weakened (attenuated) forms of simian immunodeficiency virus. Because these weakened strains of virus can replicate ("replicating vectors"), risk-benefit questions must be addressed when thinking about a human model.
Vaccine researchers need to be able to compare and prioritize the tested vaccines, and throw out those that aren't up to par, and resources reallocated to more promising candidates. Pre-defined and mutually-agreed upon criteria need to be developed, so that candidate vaccines can rapidly progress into more conventional large scale effectiveness trials.
AIDS vaccination efforts must be sustained, as this may be one of medical sciences greatest challenges and triumphs of this century. This means providing incentives for innovation, training the next generations of researchers, and obtaining long term, stable, and flexible financial support.
Hope for the Future & Adopting Realistic Plans For HIV Survival: How many of us have some sort of plan for or hope for the future? Do you have a vision for your own future, say in 5, or 10, or 20 years from now? The association between HIV transmission and the ability to plan for the future (i.e., have hope), have been overlooked in HIV prevention around the world. Perhaps its time to once again critically review the traditional ABCs to prevention that has made policy makers apoplectic: “Abstain, Be faithful, and Condomize.” How could a person with little hope for the future (economic and social success) consider the benefit of HIV risk reduction strategies?
HIV as "Treatable Chronic Disease" Called One of Several Misplaced
Citing flashbacks to earlier patterns of the HIV epidemic in men who have sex with men, experts are concerned that the mindset of "HIV as a treatable chronic disease" may be the reason for rising HIV prevalence especially among men who have sex with men (MSM), and men of color, where there remains a cultural stigma against homosexuality. In addition, fatigue and boredom of the usual safer sex prevention messages, confidence in new antiretroviral therapies, the use of "designer" drugs including methamphetamine, and the coming of age of a new generation of gay men who did not personally experience the ravages of the 1980s, is also contributing to the situation. Many MSMs practice "serosorting" whereby they screen partners based on the presumed HIV status, and adjust their prevention strategies based on their own and their partner's status. Attempts to limit one's partners to those who are "d/d free" - drug & disease free, are deceptive and contribute to disease spread. Many men may not know that they are HIV infected, because they haven't been tested recently, or the test was performed too early to be accurate, or they may lie, or are fearful of rejection. In many countries, increased HIV among MSM may be related to societal and cultural institutionalization of homophobia.
"Homophobia Still Kills," According to UNAIDS Executive Director:
Countries that criminalize sexual activity between men, discourage MSM to seek HIV testing and treatment. Eighty-five countries have laws criminalizing sexual activity in MSM, and 7 countries have the death penalty. In fact, according to Am-FAR (American Foundation for AIDS Research), in spite of a unanimous commitment of all UN member countries to monitor HIV among high-risk groups, 44% failed to provide HIV data on MSM. [ED NOTE: Even countries that do not criminalize sexual activity inbetween men still have institutional and cultural homophobia that prohibit honest communications among men who wish to have real intimacy with each other.]
Antiretroviral medications have been able to stop HIV from replicating, the first of three key steps needed to eradicate HIV from the body. Progress is still needed in identifying where viral reservoirs persist, and how to destroy HIV in those hiding areas. One such reservoir is the immune system's CD4 memory T-cells; these CD4s concentrate in the lymph nodes and spleen, as well as adult stem cells and progenitor cells. Trace amounts of virus that occasionally appear ("blips") in otherwise HIV positive people with undetectable viral loads on HAART, are probably due to their release from these viral reservoirs, rather than from newly replicating virus.
The "Swiss Statement" was a widely distributed position by the Swiss Commission on AIDS-related issues suggesting that physicians could inform their patients that the sexual transmission risk of HIV to an uninfected partner is negligibly low if three conditions were met: 1) HIV-infected patient is under a physician controlled antiretroviral therapy with excellent adherence; 2) Blood viral load has consistently been undetectable; and 3) no STDs are present in neither of the partners. The statement also made clear, that it is only the HIV negative partner who can decide for himself whether he wants to stop using condoms with the treated partner. [It did NOT address the potential for re-infection with drug resistant or just other strains of HIV among two partners already infected.]
Contact: Mark Behar, 414-550-0026, mpbehar@wisc.edu
Posted: modified by:Del Korte Modify date:2009-03-23 15:35:28