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HATIP #33, 3rd September 2004

Published: 03 September 2004

News from the AIDS Vaccine 2004 meeting

There is wide consensus among AIDS vaccine researchers that we need an HIV vaccine to induce high levels of neutralising antibodies against a wide range of HIV strains, of the kind that are actually transmitted from person to person. Beyond this, even moderate levels of imperfect antibodies could be enough to change the course of disease and allow other immune mechanisms to take effect. The bad news from the AIDS Vaccine 04 meeting which has now concluded in Lausanne is that we still have no such vaccine; the good news is that methods to develop one are available and beginning to show results.

A vaccine developed by Merck is likely to be the first adenovirus-based vaccine to be put into a large scale clinical trial, it emerged this week at the AIDS Vaccine 2004 meeting in Lausanne, Switzerland.

In two separate presentations at the AIDS Vaccine 04 meeting in Lausanne, Dr Frederic Tangy from the Agence Nationale de Recherches sur le Sida (ANRS) in Paris advocated the use of a licensed live attenuated measles vaccine the very same one used in the measles, mumps and rubella (MMR) system given to millions of children as a vehicle to deliver an HIV vaccine for future generations.

The International AIDS Vaccine Initiative (IAVI) has announced that it does not plan to carry out further trials of its lead HIV vaccine candidate, following the presentation of disappointing results at this week's AIDS Vaccine 2004 meeting in Lausanne.

AIDS Vaccine 04 opened on Monday 30 August 2004 in Lausanne, Switzerland, a city which never loses an opportunity to remind the visitor of its status as the Capitale Olympique. The most relevant Olympic event is probably the competition to host the Games in 2012, since the arrival of an effective HIV vaccine is at least equally distant.

Treatment news

Measuring viral load a month after starting highly-active antiretroviral therapy (HAART) can strongly predict which individuals will have a viral below 50 copies/ml after six months of treatment, according to a joint UK and German study published in the September 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The early identification of patients who are not virologically responding to treatment can, the investigators suggest, allow the possible causes of poor virological suppression to be identified and addressed.

Plasma levels of the protease inhibitor nelfinavir (Viracept) were 34% lower in HIV-positive pregnant women than HIV-positive women taking the drug who were not pregnant, according to a Dutch study published in the September 1st edition of Clinical Infectious Diseases. Nevertheless, all but one of the pregnant women maintained an undetectable viral load, and none of the womens babies was infected with HIV.

Incremental new data from the landmark DAD (Data collection on Adverse event of anti-HIV Drugs) trial, which last year reported a 26% increased risk in the frequency of heart attacks (myocardial infarctions, or MI) per year of antiretroviral drug exposure, has found that HAART also increases the risk of stroke and other cardiovascular or cerebrovascular events (CCVEs) by the same amount. The results appear in the September 3rd issue of the journal AIDS.

Gilead Sciences has revealed that a preliminary 24 week analysis of a study comparing tenofovir/FTC/efavirenz to AZT/3TC/efavirenz shows a significant advantage to the tenofovir/FTC arm, with a higher proportion of patients in this arm achieving and maintaining a viral load below 400 copies/ml at week 24. The results are likely to give a major impetus to the marketing of a new pill containing tenofovir and FTC, called Truvada, that was approved in the United States on August 2nd.

The British government is to tighten regulations on employment of health care workers from developing countries in order to stop draining key staff from nations hard hit by AIDS, Health Minister John Hutton announced this week during a visit to South Africa.

Hepatitis C and opportunistic infection news

Treatment with pegylated interferon alpha-2b (PegIntron) and ribavirin can cause serious eye problems in individuals coinfected with HIV and hepatitis C virus according to an article published in the September 3rd edition of AIDS.The US investigators recommend that patients coinfected with HIV and hepatitis C and treated with pegylated interferon and ribarvirin receive regular ophthalmic monitoring.

Spanish researchers have reported the best ever response to pegylated interferon and ribavirin in people coinfected with HIV and hepatitis C genotype 1 (the most difficult to treat variant). In a randomised study given fast track publication in the September 3rd edition of AIDS, the Barcelona group report that almost half the genotype 1 patients who received pegylated interferon showed a sustained response to treatment.

Advanced cirrhosis and concurrent treatment with ddI (didanosine) are the key risk factors for the development of decompensated cirrhosis (a marked and sometimes irreversible decline in liver function) during treatment of hepatitis C with pegylated interferon and ribavirin, according to an analysis of the APRICOT study published in the September 3rd edition of AIDS.

Individuals with moderate or advanced Kaposis sarcoma (KS) have much higher rates of partial or complete remission of lesions when highly active antiretroviral therapy (HAART) is combined with the liposomal chemotherapeutic agent, pegylated liposomal doxorubicin (PLD; Caelyx) than with HAART alone, according to a letter by Spanish researchers in the most recent issue of the journal AIDS. This is the first randomised study to assess the direct effect of HAART on HIV-related KS regression, and suggests that, unlike previous studies, HAART alone is not sufficient when KS is moderate or severe.

Mother-to-child transmission news

Breastfeeding of infants by multiple women may be contributing to the spread of HIV in Africa even when the childs mother is not HIV-positive, according to research carried out in Gabon by German and Dutch researchers.

The risk of transmission of HIV-1 from mother to child in the womb may be dependent on the viral subtype. A higher proportion of HIV-1 subtype C was transmitted in utero than subtypes A and D, according to a new study published in the August 20th edition of AIDS.

Transmission news

More evidence was presented this week by researchers from London regarding the strong link between infection with herpes simplex virus-2 (HSV-2) and the transmission of HIV, this time from an epidemiological perspective. The results of a cross-sectional study of 1000 married heterosexual couples in four cities in sub-Saharan Africa, published in the latest issue of the journal AIDS, suggest that HSV-2 is the key risk factor in promoting HIV transmission.

Other news

HATIP #33, 3rd September 2004

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.