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HATIP #71, 27th July, 2006

Published: 27 July 2006

News headlines

Gilead will license tenofovir to Indian companies; Merck to take Atripla to Africa
Gilead is negotiating voluntary licenses with `seven or eight` Indian manufacturers to make the anti-HIV drug tenofovir within the next year, after obtaining a patent on tenofovir in India. The company hopes that by granting voluntary licenses it will be able to increase production capacity.

Cotrimoxazole prophylaxis is feasible and effective in HIV-1 infected adult Ugandans but resistance concerns persist
Preventive treatment with cotrimoxazole (CTX), a cheap, easily available antibiotic, reduced death rates by a quarter in Ugandan people with HIV who had no access to antiretroviral therapy, Ugandan researchers report in the July edition of the Journal of Acquired Immune Deficiency Syndromes. However the treatment was poorly adhered to, was associated with significant and unexplained side-effects and led to a substantial increase in bacterial resistance to cotrimoxazole, the study found.

People with history of depression more likely to stop efavirenz due to mental health problems
HIV-positive patients with a history of depression who receive treatment with the antiretroviral drug efavirenz (Sustiva) are significantly more likely to experience mental health problems during the first four weeks of therapy and to discontinue treatment with the drug than individuals who have not previously been diagnosed with depression, according to a retrospective American study published in the August 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The investigators note that many of the patients stopping efavirenz because of depressive symptoms had well-controlled viral load and argue that although HIV therapy may be virologically “successful” it may be “failing” the patient in other ways.

PEPFAR: Epidemiologist presents a scientific rationale for focusing on Abstinence & Being Faithful in sub-Saharan Africa
“The high prevalence HIV epidemic in sub-Saharan Africa is characterised by close-knit sexual networks that allow the propagation of the virus to large numbers of individuals” said epidemiologist David Stanton, who believes that Abstinence, Being Faithful and Condoms-based (ABC) interventions, but especially the A & B parts, are the means to disrupt these networks. Stanton, who serves as the Chief of the Division of Technical Research in the Office of HIV/AIDS at USAID, made a scientific case in support of PEPFAR’s emphasis on A & B, at the 2006 Implementers meeting in Durban last month.

Study finds why circumcision reduces female-to-male HIV transmission
An Australian study has found that male HIV infection may occur through infection of cells on the inner surface of the foreskin and the fraenulum of uncircumcised men. These areas contain HIV-susceptible Langerhans’ cells close to the skin surface of the skin, and are protected with only a thin layer of keratin. The study’s findings were published in the 13th July edition of AIDS.
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Traditional risk factors and use of some anti-HIV drugs increase uric acid levels in HIV-positive patients
A significant number of HIV-positive individuals have elevated levels of uric acid in their blood, German researchers report in the July 13th edition of AIDS. High levels of uric acid are a risk factor for the development of gout, a very painful condition that some other studies have shown to occur with increased frequency in HIV-positive patients. High levels of uric acid can also lead to uric kidney stones. The German investigators found in their observational study that traditional risk factors such as male sex, being overweight and kidney dysfunction were associated with elevations in uric acid as well as the use of certain antiretroviral drugs.

Oral and anogenital shedding of HSV-2 occurs more frequently in HIV-positive men, often without symptoms
Men who are infected with herpes simplex virus-2 (HSV-2) anally or on their genitals, often shed the virus orally without any symptoms, investigators from the University of Washington conclude in an observational study published in the August 15th edition of The Journal of Infectious Diseases. The investigators found that HSV-2 was frequently shed orally at the same time that it was shed anogenitally, and that HIV-infected men shed HSV-2 more frequently from all sites than HIV-negative men.

Routine HIV testing widely supported in Botswana
Botswana’s policy of routinely offering an HIV test to all who seek medical care is widely supported by people in that country, and the majority of people believe that the policy will help to reduce stigma and violence against women, researchers from the University of California report this week in Public Library of Science Medicine.

Gates Foundation gives $287 million to HIV vaccine research
Substantial new money for HIV vaccine research has been made available by the Bill & Melinda Gates Foundation. A total of $287 million will be disbursed in grants to investigators in 19 different countries. The grants will be known as the Collaboration for AIDS Vaccine Discovery and will be targeted at research priorities identified by the Global HIV Vaccine Enterprise, a consortium of researchers, funders and advocates working towards the development of an effective HIV vaccine.
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Steep decline in the incidence of nearly all opportunistic infections in HIV-positive children after introduction of HAART
The incidence of most opportunistic infections has fallen significantly in American HIV-positive children, thanks to the use of potent antiretroviral therapy, according to the results of a large prospective study published in the July 19th edition of the Journal of the American Medical Association. Significant reductions were seen in the incidence of infections common in the era before effective antiretroviral therapy became available, such as bacterial pneumonia, shingles and oral candida. However, 14% of children developed an opportunistic infection in the period of the study, and some infections, including urinary tract infections, molluscum and viral hepatitis predominantly occurred when children had healthy immune systems.

Low CD4 cell count and hepatitis C coinfection risk factors for acute kidney failure in HIV-infected patients
HIV-positive individuals who are receiving treatment with potent antiretroviral therapy have an increased risk of experiencing acute kidney failure if they have a low CD4 cell count, US investigators report in the July edition of the Journal of Acquired Immune Deficiency Syndromes. The investigators further found that patients who were coinfected with hepatitis C virus had particularly elevated rates of acute kidney failure.
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G8 leaders call for end to tariffs on medicines
Leaders of the Group of Eight (G8) wealthy nations have called on governments worldwide to abolish tariffs, import duties and other taxes on medicines, following their annual meeting in St Petersburg, Russia, this weekend.

Russia to step up AIDS funding, will cover Global Fund grants in country
Russia has pledged that it will reimburse $270 million in aid allocated by the Global Fund to Fight AIDS for HIV prevention and treatment programmes between now and 2010.

HIV-positive patients with 'dead bone' usually have other risk factors
The majority of HIV-positive patients who develop the painful bone disease osteonecrosis have pre-existing risk factors for the condition, Spanish researchers report in an article published in the July edition of the Journal of Acquired Immune Deficiency Syndromes. The investigators conducted a retrospective review of the medical records of over 10,000 HIV-positive individuals and found that among the 54 individuals developed the condition progression of the condition most commonly occurred when it involved the hip.

Spanish study confirms that tenofovir-related kidney problems are rare and linked to other risk factors
An observational study of almost 1300 HIV-positive patients has confirmed that kidney problems related to tenofovir (Viread) are rare and usually occur in patients with other risk factors. These findings were published in the July edition of The Journal of Acquired Immune Deficiency Syndromes.

What's happening in HIV vaccine research?
Three doctors from Seattle have written a review article in the 15th August edition of Clinical Infectious Diseases, summarising the state of play in HIV vaccine research. They explain that while HIV has thrown up a number of challenges to vaccine researchers, a number of studies are planned or underway that could lead the way to a vaccine in the future.
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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.