Compiled by Gus Cairns
A trial to see if sex workers could avoid catching HIV by taking antiretrovirals has been halted following protests.
The California Center for Aids Prevention Studies planned to give a daily dose of tenofovir to 960 Cambodian women working in Phnom Penh. But the Women's Network for Unity representing the sex workers said women were being told they could stop using condoms and would not be adequately compensated for drug side-effects or if they contracted HIV. WNU President Kao Tha said: “If they fall ill, who will look after their mothers, children, sisters or brothers?"
Protests peaked at the Bangkok World Aids conference and the trial was halted after the network demanded a guaranteed 30 years' insurance against long-term side effects. The centre refused, saying it would amount to an ‘undue inducement' to get women to join the trial.
Cambodian Prime Minister, Hung Sen said: “If a trial is needed, please do it on animals, and don't use Cambodians." The trial's collapse has caused soul-searching among prevention activists. Many saw so-called Pre-Exposure Prophylaxis (PREP) as one of the few ways to stop HIV, in the absence of a vaccine, among vulnerable people not always able to use condoms.
Veteran activist John S James of the US magazine Aids Treatment News said: "This is a serious setback to controlling the epidemic. The new prevention method being tested could save millions of lives if it works."
But others disagree. Global Fund board member, Philippa Lawson, a woman living with HIV, said: "I know trials for tenofovir are important and other trials in the future will be important, including microbicide trials. Yet, at the same time they must involve the local target group in the design and review of the trials."
Internet ‘does not cause unsafe sex’
Meets between gay men arranged online are no more likely to result in unsafe sex that transmits HIV than meets in bars and saunas, a study suggests.
Professor Jonathan Elford told the 10th Autumn Conference of the British HIV Association the latest findings from the two-year 'Sex Health and the Internet' study showed gay men who used the internet did have more sex with partners of unknown HIV status than men who didn't. However, they were just as likely to have met those partners in gay venues as on the net.
Ten per cent of men attending an HIV clinic said they'd had unprotected sex with partners they'd met online compared with 11 per cent who had met partners at gay venues.
This puts the internet in context. It is a new place that men use to meet casual partners - but it is not the only place
However, one in eight positive men had used the internet to arrange same-status unprotected sex compared with just one in 20 who had checked out their partner's status at a gay venue.
"It seems that HIV positive men use the internet as a safe environment in which to disclose their status," Elford said.
Call for better tracking of migrants with HIV
European experts on the spread of diseases have called for better documentation of migrants with HIV.
Epidemiologists from Spain, the Netherlands, France and the UK say the EU should document the country of origin and ethnicity of people with HIV better, to see how much HIV crosses borders.
Writing in the journal AIDS, the group, which includes Kevin Fenton of the UK's Health Protection Agency (HPA), said politics had prevented standardised data collection to track the international movement of positive people.
In France, data on race cannot be collected without patients' consent. In the UK, the HPA asks people their ethnic origin and asks heterosexuals (but not gay men) where they think they caught HIV. Many countries collect nationality data on people diagnosed with Aids, but not HIV.
Heterosexual contact is now the dominant mode for HIV transmission in Western Europe, accounting for 44 per cent of cases.
Recent cases of Aids in people from Africa vary from 29 per cent in Spain to 39 per cent in Germany.
The writers urged agreed minimum standards for monitoring country of origin among people with HIV.
Doctors’ warning as T-20 scoops award
Drug company Roche Products has won a top prize for its anti-HIV drug Fuzeon (T-20, enfuvirtide).
This is the second time Roche has won the Prix Galien for Innovation in Medicine, an award for venturing into new areas of research. In1998, the drug company picked up the same prize for saquinavir (Invirase), the first licensed protease inhibitor.
Professor Sir Michael Rawlins, chair of the judging panel, said: “We were impressed, not only with the results of the clinical trials for [T-20], but also the extraordinarily complex manufacturing issues that had to be solved.”
However, HIV clinicians predicted T-20 would have a very limited life as an HIV medicine.
Industry analyst Thomas Wei predicted the numbers of patients using T-20 would start to decrease from mid-2005.
T-20 has to be injected twice a day and this can cause lumps under the skin called injection site reactions in a majority of patients.
The take-up for T-20 has been lower than expected, partly because it costs around £13,000 a year, more than four times the cost of other HIV drugs.
But, for other doctors, the low take up is also due to the drug industry's failure to co-ordinate production of innovative medicines.
T-20 will only work if patients have other HIV drugs to which they are not resistant. In a recent letter to The Lancet, four HIV doctors said they were unable to make up combinations for some patients because new drugs appeared one at a time. Patients end up taking only one active drug (monotherapy) and develop resistance to it quickly.
Dr Mike Youle and colleagues wrote: “The successful outcome of future combination therapy will be determined by the number of new drugs used... planned co-development of investigational agents has not occurred, and patients continue to be offered serial monotherapy.”
Vaccine conference brings disappointment
A recent conference devoted to the search for an HIV vaccine brought mainly bad news.
The conference in Switzerland, heard that several vaccine candidates which tested well in animals failed to produce an immune response to HIV in humans.
The biggest disappointment was news that the International Aids Vaccine Initiative had dropped its lead candidate after it produced an immune response in only 10-20 per cent of the 119 people who received it in the UK and East Africa.
One researcher, Stephen Kent, suggested the amount of vaccine needed to produce an immune response in humans wasn’t practical as an injection. A family of viruses used as ‘vectors’ may also be part of the problem.
Vaccines that gave disappointing results used viruses from the smallpox family as vectors.
Better results have been seen using adenoviruses. These, however, are common cold viruses and might not work because a lot of people have pre-existing immunity to them.
Drug company Merck has produced an adenovirus-based vaccine that produces responses in 50 per cent of people, and 75 per cent without adenovirus immunity. They plan to start large-scale trials in 2008.
HIV drugs fail to improve women’s lives
Quality of life for women with HIV in the US has failed to improve since the mid-'90s, despite the availability of HIV treatment, two new studies show.
Women in New York taking HIV therapy were asked about their psychological state and ability to cope with everyday life. Their levels of depression, anxiety and ability to cope were compared to those in a similar group of HIV positive women studied in 1995-6. Investigators found the women on HIV treatment were no less depressed or anxious than the women from the mid ’90s, and were actually more likely to report difficulties in coping with everyday life.
Trial investigator Karolynn Siegel said HIV/Aids was still very stigmatising. Meanwhile, a US-wide study has found 43 per cent of women who needed HIV treatment weren't taking it.
Being a crack/cocaine user, being black, and being a survivor of sexual or physical abuse were all found to be closely associated with failure to use HIV treatment.
Nelfinavir lower in pregnancy
A study has found pregnancy affects blood levels of a widely used protease inhibitor. Scientists found levels of nelfinavir were a third lower in pregnant women than ones not pregnant, possibly due to their more active liver enzymes. Nelfinavir is widely used in pregnant women as it has lowtoxicity to mother and baby. Scientists said increasing doses in pregnancy should be considered.
HIV fails to rise with Syphilis
US public health officials are puzzled that large rises in sexually transmitted infections among gay men have not translated into increases in HIV cases. In New York, syphilis increased fivefold over the last three years, but new HIV cases among gay men remained static. The same was observed in Seattle and San Francisco. Experts think HIV treatment has made the average positive gay man less infectious and that more are having sex with men with the same HIV status
Subtle brain damage in people with HIV
Another study has found evidence of subtle brain changes in people with HIV. Researchers found parts of the brain used when concentrating, showed reduced blood flow and oxygen usage in HIV positive people. In contrast, parts of the brain bordering these areas which are normally inactive in such tasks showed activation, suggesting that the brain was attempting to compensate for cell damage.
Moderate viral load does not mean 'failure'
US researchers have found staying on an apparently 'failing' HIV treatment can keep patients well for over four years. Patients who had a detectable viral load of less than 20,000 were no more likely to die or develop Aids than patients who were undetectable. Patients with a viral load higher than this were over three times more likely to get ill. Since stopping treatment often results in viral loads increasing rapidly, the researchers concluded it was better to keep patients on their treatment than stop, if no
other drugs were available.
Non-nukes last longer than PIs
A Canadian study has found patients starting treatment on combinations including non-nucleoside (NNRTI) drugs are 25 per cent less likely to have to change even one drug in their regime than patients on protease inhibitors. On average, those taking NNRTIs lasted 25 months before having to change a drug, compared with 19 months on PIs. Patients on NNRTIs mainly changed due to
toxicity, while patients on PIs were more likely to have an HIV 'rebound'. But patients on PIs were less likely to develop resistance.
Japan 'grossly underestimating' HIV problem
Japan could be significantly underestimating its HIV cases, a local expert warns. In 2003 the Japanese government reported 640 new HIV cases and 336 cases of Aids, about one-twelfth the UK rate. But due to HIV treatment, the number of people with HIV should be about 10 times the number with Aids, as in other developed countries. Clinician Tsuneo Akaeda said stigma was responsible for a gross underestimate of the number of people with HIV.
