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PrEP is safe and effective for widespread use, research shows

Worldwide, there are only 300,000 people estimated to be taking PrEP. This is far too small a number to prevent 1.8 million new HIV infections.

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New research shows that pre-exposure prophylaxis (PrEP) could be given to millions of people worldwide with no increased risk of safety issues during treatment. 

PrEP is a combination of two drugs that people can take before sex to prevent HIV infection. Existing evidence shows that people who take tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) as PrEP have a 90% lower chance of being infected with HIV than people not taking it.

However, widespread use of TDF/FTC can be justified only if its preventative benefits outweigh potential risks of safety issues. These new results, presented today, show that PrEP is safe to use.

The researchers undertook a meta-analysis of 13 randomized trials with 15,678 participants. People at risk of HIV infection were given either TDF/FTC as PrEP or no treatment (the control, or placebo). There was no significant difference in risk of high grade or serious adverse events comparing PrEP with control. The risk of serious adverse events was almost the same for both groups: 9.4% for those on PrEP and 10.1% for those on placebo. There was also no significant difference in risk of renal or bone adverse outcomes. The risk of bone fractures was 3.7% on PrEP versus 3.3% on no treatment. The risk of significant renal dysfunction was 0.1% on PrEP and 0.1% for no treatment.

“In 2016, there were 1.8 million new HIV infections worldwide and the same number again in 2017,” International AIDS Society President Anton Pozniak said. “Across a range of studies, men who have sex with men have one in 30 chance of contracting HIV in a year. Other particularly vulnerable populations’, such as people who inject drugs or sex workers, have a one in 50 chance of being infected with HIV.

READ:  False positive

“Worldwide, there are only 300,000 people estimated to be taking PrEP. This is far too small a number to prevent 1.8 million new HIV infections. Clearly, to have a significant effect on the HIV epidemic, we need to scale up PrEP to reach tens of millions of people worldwide.”

Other PrEP modalities, such as long-acting injectable drugs and antibodies, are being tested in order to offer more choices of how PrEP could be taken.

“Globally, there is a new HIV infection every 18 seconds,” study co-author Dr Andrew Hill, from Liverpool University, said. “Every person newly infected will then need to be treated for life, and could transmit HIV to others. We need radical changes in our prevention strategy to cut new HIV infections down to zero.”

The most widely used PrEP, a combination of TDF and FTC, costs only £40 per year to make. A generic TDF/FTC course is available in the UK for £300 per year and £50 in sub-Saharan Africa. With recent legal rulings, low-cost, generic PrEP is becoming more available. This provides an opportunity, with the decreasing costs making it increasingly feasible to provide PrEP to millions of people at risk of HIV worldwide.

“The World Health Organization updated its official guidelines in 2015 to include the use of PrEP as a prevention method,” Dr. Pozniak commented. “The data is clear and it’s time to globally implement this recommendation.”

These results are supported by another recent analysis, which showed no difference in adverse events between TDF/FTC and a combination of tenofovir alafenamide (TAF) and FTC when taken for treatment with an additional antiviral drug.

READ:  Jake: Learning lessons

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42 Filipinos now infected with HIV daily; 1,249 new HIV cases reported in January

More male Filipinos are still getting infected, with 95% of the newly diagnosed cases in January. The median age was 27 years old; and almost half of the cases (49%) were 25-34 years old and 32% were 15-24 years old at the time of testing. Sexual contact remained as the predominant mode of transmission (98%).

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The year started with a worrying bang.

In January 2019, there were 1,249 newly confirmed HIV vases reported to the HIV/AIDS & ART Registry of the Philippines (HARP), which just released its most recent HIV data. This figure is already higher compared to the prior month (in December) when DOH released its HIV data, with 877 cases reported.

For 2019, the DOH already averaged the number of people who get infected with HIV on a daily basis to 42. This is 10 more than the number (32) in 2018.

More male Filipinos are still getting infected, with 95% (or 1,190) of the newly diagnosed cases in January. The median age was 27 years old (age range: 1 – 72 years old); and almost half of the cases (49%, 610) were 25-34 years old and 32% (395) were 15-24 years old at the time of testing.

Almost a third (32%, 402) were from the National Capital Region (NCR). Region 4A (18%, 228 cases), Region 3 (9%, 114), Region 7 (8%, 97), and Region 6 (7%, 92), comprised the top five regions with the most number of newly diagnosed cases for the month, together accounting for 74% of the total.

Sexual contact remained as the predominant mode of transmission (98%, 1,223). Among the newly diagnosed, 62% (780) were males having sex with males, 25% (306) males who having sex with males and females, and 11% were infected through male to female sex. Other modes of transmission were sharing of infected needles (1%, 9) and mother-to-child transmission (<1%, 4).

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YOUTH AND HIV

In January, 395 (32%) cases were among youth 15-24 years old; 96% were male. Almost all (98%, 390) were infected through sexual contact (31 male-female sex, 266 male-male sex, 93 sex with both males and females). Two cases were infected through sharing of needles; while three cases had no data on mode of transmission.

There were 53 newly diagnosed adolescents 10-19 years old at the time of diagnosis. Further, seven cases were 15-17 years old and 46 cases were 18-19 years old. All were infected through sexual contact (three male-female sex, 45 male-male sex, and five had sex with both males and females).

In addition, there were four diagnosed cases less than 10 years old in this reporting period and all were infected through vertical (formerly mother-to-child) transmission.

WOMEN AND HIV

Among the newly diagnosed females in January, eight were pregnant at the time of diagnosis. Four cases were from NCR and one case each from Regions 1, 6, 7, and 8. The age of diagnosis ranged from 15 to 39 (median age: 24).

Reporting of pregnancy status at the time of testing was included in the HARP from the year 2011. Since 2011, a total of 301 diagnosed pregnant cases were reported. More than half (56%, 168) were 15-24 years old at the time of diagnosis, and 38% (113) were 25-34 years old. The regions with highest number of diagnosed pregnant cases with HIV were NCR (49%), Region 7 (24%), Region 4A (9%), and Region 3 (6%).

READ:  False positive

TRANSACTIONAL SEX AND HIV

In January, 12% (148) of the newly diagnosed engaged in transactional sex. Ninety-seven percent (143) were male and aged from 18 to 72 years old (median: 30 years). Majority of the males (62%, 89) reported paying for sex only, 22% (32) reported accepting payment for sex only and 16% (22) engaged in both. All of the female cases were reported to have accepted payment for sex.

People who engage in transactional sex are those who reported that they either pay for sex, regularly accept payment for sex, or do both. Reporting of transactional sex was included in the HARP starting December 2012.

DEATH AMONG PLHIVs

In January, there were 22 reported deaths due to any cause among people with HIV, and 91% (20) were males. Four cases (18%) were 15-24 years old at the time of death, 13 cases (59%) were 25-34 years old, four cases (18%) were 35-49 years old and one was older than 50 years. Almost all of the cases were reported to have acquired the infection through sexual contact: five of them through male-female sex, 11 through male-male sex, and five through sex with both males and females. One reported death had no data on mode of transmission.

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HIV-positive man from Britain becomes world’s second AIDS cure hope

Diagnosed with HIV infection in 2003 and began antiretroviral therapy in 2012. He was diagnosed with advanced Hodgkin’s lymphoma. After chemotherapy, he underwent a stem cell transplant in 2016 and remained on antiretroviral therapy for 16 months. But the “London patient” has been in remission for 18 months since he stopped taking antiretroviral drugs.

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A second person experienced sustained remission from HIV-1; meaning that, effectively, a person with HIV has been cured of the viral infection.

The case – published Tuesday in the Nature journal – comes over 10 years after a somewhat similar (and first) case that involved the “Berlin patient” (later identified as Timothy Ray Brown, 52, who now lives in Palm Springs, California). Both patients were treated with stem cell transplants from donors who carried a rare genetic mutation, known as CCR5-delta 32, that made them resistant to HIV.

The new case, with the patient now referred to as the “London patient”, has been in remission for 18 months since he stopped taking antiretroviral drugs. A male resident of the UK was diagnosed with HIV infection in 2003 and began antiretroviral therapy in 2012. Later, he was diagnosed with advanced Hodgkin’s lymphoma. After chemotherapy, he underwent a stem cell transplant in 2016 and remained on antiretroviral therapy for 16 months.

The London patient quit taking anti-HIV drugs in September 2017. He has now been in remission for 18 months, and regular testing has confirmed that his HIV viral load remains undetectable. This makes him the first patient since Berlin patient/Brown to remain virus-free for more than a year after stopping.

In both cases, the stem cell transplant procedure worked about as well, with the transplant destroying the cancer without harmful side effects. The transplanted immune cells, now resistant to HIV, seem to have fully replaced the vulnerable cells.

READ:  False positive

Thus far, most people with the HIV-resistant mutation, called delta 32, are of Northern European descent. IciStem maintains a database of about 22,000 such donors.

The International AIDS Society (IAS) welcomed the announcement.

“This is the second reported case of prolonged remission off antiretroviral therapy (ART) post bone marrow transplantation from a CCR5 negative donor,” IAS President Anton Pozniak said. “Although it is not a viable large-scale strategy for a cure, it does represent a critical moment in the search for an HIV cure. These new findings reaffirm our belief that there exists a proof of concept that HIV is curable. The hope is that this will eventually lead to a safe, cost-effective and easy strategy to achieve these results using gene technology or antibody techniques.”

Mark Dybul, co-chair of the Towards an HIV Cure initiative, said: “Despite the great success of ART, there remains a high need for a cure for HIV, especially in low-income settings. This case is as important as it is exciting. There is still more to discover.”

UNAIDS seconded the sentiment, saying that it is greatly encouraged by the news that an HIV-positive man has been functionally cured of HIV.

“To find a cure for HIV is the ultimate dream,” said Michel Sidibé, Executive Director of UNAIDS. “Although this breakthrough is complicated and much more work is needed, it gives us great hope for the future that we could potentially end AIDS with science, through a vaccine or a cure. However, it also shows how far away we are from that point and of the absolute importance of continuing to focus HIV prevention and treatment efforts.”

READ:  Jake: Learning lessons

Stem cell transplants are highly complex, intensive and costly procedures with substantial side-effects and are not a viable way of treating large numbers of people living with HIV. However, the results do offer a greater insight for researchers working on HIV cure strategies and highlight the continuing importance of investing in scientific research and innovation.

In 2017, there were 36.9 million people living with HIV and 1.8 million people became newly infected with the virus. In the same year, almost one million people died of AIDS-related illnesses and 21.7 million people had access to treatment.

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67% of gay men want to ‘make PrEP free’

88% of gay, bi males or trans members feel that they are (well)-informed about safer sex and sexually transmitted infections (STIs). But participants indicate that the rise in the spread of STIs is a major concern.

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Only 16% of gay men surveyed use PrEP; and 67% said that PrEP should be covered by national health agencies and/or other health insurance.

This is according to gay dating app ROMEO, which held a worldwide survey among its members about safer sex. ROMEO was interested in getting an idea of sexual behavior and opinions about condoms, PrEP use, and sexually transmitted infections (STIs). There were 69,551 respondents.

The ROMEO survey showed that 88% of gay, bi males or trans members feel that they are (well)-informed about safer sex and sexually transmitted infections (STIs). But participants indicate that the rise in the spread of STIs is a major concern.

PrEP use was only 16%; though among PrEP users, 91% indicated that they also are willing to use condoms.

“The introduction of PrEP in 2012, a medication that prevents HIV infection, has been a game changer in the gay dating world. At the same time, there is a big discussion about its benefits and risks. With this survey we want to help to find answers,” said Jens Schmidt, founder of ROMEO.

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NEWSMAKERS

Condom use pushed to deal with HIV

For “Love Walk”, PAFPI’s workers/volunteers distributed condoms and lubricants in different areas in the cities of Manila and Pasay, with the approach hoping to “educate (particularly men) and to try to change their attitudes, their outlook, and their (sex) behaviors.”

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ALL PHOTOS BY LUWELA RODRIGO

In December 2018, the HIV/AIDS & ART Registry of the Philippines (HARP) reported 877 new HIV cases in the Philippines, with the country now registering 32 new HIV cases every day. And of that figure, 98% (or 861 of the cases) were from sexual contact, which remains the main mode of HIV transmission in the country.

This is the backdrop of the push for condom use of the Positive Action Foundation Philippines Inc. (PAFPI), a non-government organization serving the PLHIV community, via its “Love Walk” advocacy.

Now in its seventh year, “Love Walk” is basically “an HIV awareness campaign” that brings together people to “directly respond to the HIV epidemic affecting the Philippines.”

According to Moses Ayuha, from PAFPI, there are other lessons that may continue to be taught to deal with HIV, including teaching people to abstain from sex to avoid possible HIV infection. However, he said that there is also a need for a more realistic look approach at the situation because “not everybody abstains anyway.”

For Ayuha, and in a gist, there are people who – even if they are already aware of (other) ways to supposedly avoid getting infected with HIV – still have unprotected sex. “These are the people we need to reach.”

For “Love Walk”, PAFPI’s workers/volunteers distributed condoms and lubricants in different areas in the cities of Manila and Pasay, with the approach hoping to “educate (particularly men) and to try to change their attitudes, their outlook, and their (sex) behaviors.”

READ:  Living with HIV at 7 years old

Ayuha admitted that efforts like the “Love Walk” continue to be challenging, particularly since bringing the sex educating straight to the streets means teaching people about HIV off the bat. “The challenge ay kung paano ipaliliwanag sa mga tao ang HIV sa kalsada at paano rin maiintindhan ng tao ang kahalagahan ng pagpapa-test (The challenge is how to explain HIV to people on the sreets, and how to tell people about the importance of getting tested for HIV),” he said.

It is also not uncomoon to encounter unwanted responses from people who may not support efforts like “Love Walk.”

Sinasabi namin na hindi naman pag namigay ng condom, (we already) promote sex,” Ayuha said. “It’s just one of the preventive measures. And because – nowadays, people are having sex – we just encourage people to be responsible.” 

In the end, for Ayuha, efforts like the “Love Walk” will continue to be relevant until “we’ve finally properly dealt with HIV.” – ARTICLE FILED WITH LUWELA RODRIGO

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‘Change minds to deal with HIV’

An interview with a person living with HIV, who believes that it’s stigma that kills, not the virus. And so there is a need to change minds if we are to successfully deal with HIV.

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This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”.
More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

Like others who test HIV-positive, Ron, 36, was “shocked” when he found out his HIV-positive status in April 2018. But he admitted that he was only “a little bit shocked” because he sort of anticipated testing positive because he knew he engaged in risky sexual behaviors in the past. He still couldn’t help but feel some “lungkot (sadness)” because “I let it happen.”

Interestingly, “my family found out about my HIV status before I did,” he recalled. This was because his sister knew the medical practitioners in the hospital where he was tested; and they disclosed his status to her.

Ron said he didn’t want to “break down” in front of family members, particularly since he’s the only boy in the family (and following the stereotypical male expectation that males shouldn’t show weakness by crying/breaking down). However, he realized that his family’s members were apparently also showing the same “strength”, not wanting to show their sadness and even disappointment with him.

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Ron was, therefore, “lucky” that his family showed him “good things; and support”.

When he tested HIV-positive, Ron’s CD4 count was 202, at “the brink of AIDS stage”, he said. And so he had to immediately start his antiretroviral treatment (ART). Immediately becoming healthier was one of the more immediate effects of testing HIV-positive. Another was “turning my life around”, he said – i.e. he rediscovered his faith, which he said he “lost” a few years back, and which may have led to him getting infected with HIV. “I shifted to following the right path,” he said.

Though he is still not open/out about his HIV status, Ron believes that – eventually – one should not hide one’s status. “Being HIV-positive is not an issue,” he said, “so long as you’re focusing on your treatment. You’re just like everybody else; nadagdagan ka lang ng isang pill, or two (you just happen to need to take a pill or two).”

For those afraid to get tested for HIV, Ron said that “if you love yourself and your family, undergo testing. Being HIV-positive isn’t a death sentence; and you may even find your purpose.”

In the end, Ron believes there is a need to deal with stigma. “People are scared about the virus. They just link this mostly with sex, so they look down on this. But if they find out that there’s life – and love – after diagnosis, then it may change their minds.” – WITH STEPHEN CHRISTIAN QUILACIO

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Faulty immune receptor may be why many face HIV complications

Patients with malfunctioning receptors can’t shut off their immune systems, which can put the body in a chronic proinflammatory state. This constant activation can negatively affect other organs and tissues.

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Photo used for illustration purpose only. Photo by Vittore Buzzi from Unsplash.com.

HIV treatments that control the infection have come a long way, but many still struggle with a host of other disease-related complications, such as neurocognitive disorders, cardiovascular issues, diabetes and chronic inflammation.

Why these complications occur isn’t exactly known, but many indicators point to an overactive immune system, something HIV patients are all too familiar with.

Michigan State University scientists discovered SLAMF7, an immune receptor that has the ability to tone down the body’s immune response when activated on certain white blood cells, called “monocytes.” The finding was made after studying both healthy and HIV-infected patients. Yet, for certain HIV patients who experience a myriad of health issues, the researchers found that these patients’ receptors don’t work properly.

They also discovered that SLAMF7 made the monocytes more resistant to HIV by increasing the level of a protein, called “CCL3L1,” which is known to make it harder for the HIV virus to get inside cells.

The federally funded study is published in the Journal of Immunology.

“SLAMF7 can act like a seesaw and keep the balance of the immune system in check,” said Patrick O’Connell, a fourth-year doctoral student who led the project with Yasser Aldhamen, an assistant professor of microbiology and molecular genetics in the College of Osteopathic Medicine. “When receptors need to turn immune cells on because of an infection, they bind to the cells and work with fellow receptors to activate the immune system. When signs of infection or inflammation go away, the receptors switch gears and turn off the immune response.”

READ:  Living with HIV at 7 years old

O’Connell explained that for HIV patients, their inability to fight infections stems from chronic immune activation, which exhausts certain cells, such as T-cells, that are needed to help the body ward off diseases.

Patients with malfunctioning receptors can’t shut off their immune systems, which can put the body in a chronic proinflammatory state. This constant activation can negatively affect other organs and tissues.

“If you have too much activation, you see autoimmune disorders where the body attacks its own tissues and if there’s not enough activation, you see cases where the body can’t fight off infections,” O’Connell said. “HIV patients are different because they can experience both, which can lead to all sorts of health issues and make treatment difficult.”

O’Connell and the team tested the blood of study participants, isolated their white blood cells and stimulated them with interferon alpha, a protein that boosts the immune system’s response to infections, sometimes to an unhealthy level. They then investigated how the SLAMF7 receptor responded, and found that it was unresponsive in certain HIV patients who struggled more with complications and often times had a worse prognosis.

Understanding the molecular mechanism of the SLAMF7 receptor and how it works could lead to new drug treatments that target immune activation. This could make SLAMF7 a functioning team player again in the immune system – something Aldhamen and O’Connell are looking at in their next phase of research.

“There’s always a need to get new drugs that can target different mechanisms related to a disease,” O’Connell said. “Most HIV drugs target the virus itself. Our work comes at it from a different angle – to potentially modify the immune system so we can fight the virus. Finding a drug that does this is our ultimate goal.”

READ:  NCCP's message on World AIDS Day 2016: 'God's love encompasses all'

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