Kaisernetwork.org (Washington, DC)
23 July 2007
Global Challenges
World Must Act To Achieve Commitments To Provide Universal Access to HIV/AIDS Treatment, Conference Delegates Say
[Jul 23, 2007]
The world cannot celebrate advances in HIV diagnosis and treatment until global commitments to provide HIV-positive people in developing countries with universal access to treatment by 2010 are reached, delegates attending the opening of the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention in Sydney, Australia, said on Sunday, the AP/Washington Post reports (Foley, AP/Washington Post, 7/22).
Delegates attending the conference, which will end on Wednesday, are expected to present studies and discuss advances in HIV/AIDS prevention and treatment. The conference aims to improve understanding of HIV/AIDS, treatments for the disease and methods to prevent it from spreading worldwide.
David Cooper, director of Australia's National Centre for HIV Epidemiology and Clinical Research and conference co-chair, said studies scheduled to be presented at the conference will highlight research into new vaccines and classes of antiretroviral drugs, as well as research on male circumcision and lubricant gels as methods to curb the spread of HIV. He added that integrase inhibitors, a new class of antiretrovirals, will be discussed at the conference. According to Cooper, another major topic at the conference will be making the latest drugs available in developing countries.
The International AIDS Society ahead of the conference released the Sydney Declaration, which calls for increased research funding to fight HIV/AIDS worldwide. The declaration proposes that donors allocate 10% of their HIV resources to research and states that "although funding remains insufficient to meet the increasing need for services, it is imperative that the global community does not lose sight of the future while responding to the immediate crisis" (Kaiser Daily HIV/AIDS Report, 7/20).
Opening Statements
IAS President Pedro Cahn at the opening of the conference said that although antiretrovirals are easily accessible in Western nations, most people in developing countries do not have access to the drugs they need. "With fewer than one-third of people living with HIV in low- and middle-income countries having access to lifesaving medications and still fewer with access to proven prevention services, such as condoms and sterile syringes, the goal of universal access by 2010 must remain a priority," he said (McLean, AAP/News.co.au, 7/22). Cahn also said that the world is "dealing with a preventable disease, and 11,000 people are contracting HIV/AIDS every day," adding, "We are dealing with a treatable disease and more than three million people are dying" of AIDS-related illnesses annually (AP/Washington Post, 7/22). According to Cahn, "Science has given us the tools to prevent and treat HIV effectively." He added, "The fact that we have not yet translated this science into practice ... is a shameful failure" on the part of the global community (AAP/News.co.au, 7/22).
According to Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, about 2.2 million people living with HIV/AIDS in developing countries received antiretroviral access last year. "However, for every one person that you put in therapy, six new people get infected," Fauci said, adding, "So we're losing that game, the numbers game." The "proven prevention modalities are not accessible to any substantial proportion of the people who need them," Fauci said. "Although we are making major improvements in the access to drugs, clearly, prevention must be addressed in a very forceful way," he added (Foley, AP/Forbes, 7/23). According to Fauci, of the estimated 60 million HIV cases that will occur by 2015, "already known and proven prevention methods" are projected to be able to have prevented about half of them (AP/Washington Post, 7/22). He added that the research community has "incredibly potent treatments on the horizon, possible vaccines in the pipeline and new options for using these things in ways we haven't before. But as for a cure, let's just stop talking about it" (AAP/Taipei Times, 7/23).
According to Fauci, an additional obstacle to HIV/AIDS control efforts is that women in many developing countries cannot negotiate condom use with their husbands or regular sex partners, leaving them "at the mercy of a situation over which they have very little control" (Australian Associated Press, 7/22).
Michel Kazatchkine -- executive director of the Global Fund To Fight AIDS, Tuberculosis and Malaria -- said that 2.2 million lives had been saved because of recent increases in drug access in Africa, Asia, eastern Europe, Latin America and Russia. However, more funding is needed to provide antiretrovirals to the more than 70% of HIV-positive people in developing countries who do not have access. According to United Nations estimates, $18 billion will be needed next year for global HIV/AIDS programs and more than $22 billion will be needed annually by 2010. According to Kazatchkine, these figures are a small fraction of the $2 trillion of new wealth generated worldwide annually. "Don't tell me this is unaffordable," Kazatchkine said, adding, "Yes, everyone needs to put more money on the table" to provide universal access, "but the message is we should be able to win the battle" (Williams, Sydney Morning Herald, 7/23).
Abbott Drops Suit Against French HIV/AIDS Group for Launching Attack on Company's Web Site
Abbott Laboratories at the conference on Sunday announced that it has agreed to drop its lawsuit against the French HIV/AIDS group Act Up-Paris, according to IAS (IAS release, 7/22). Abbott in May filed the suit in French criminal court against Act Up-Paris for launching an attack on the company's Web server. Act Up-Paris on April 26 organized the attack in response to a call from Thai HIV/AIDS groups to protest Abbott's recent actions regarding its antiretroviral drugs Aluvia and Kaletra in Thailand. The group encouraged between 500 and 1,000 HIV/AIDS advocates from Canada, France, India, Thailand and the U.S. to click on a link posted on Act Up-Paris' Web site that caused Abbott's server to become overloaded.
In the suit, Abbott claimed that the attack interrupted some of its business activities, such as online sales of nutritional products. Abbott also alleged that the group violated two articles of the French penal code that prohibit disrupting a Web site and providing the means to do so (Kaiser Daily HIV/AIDS Report, 6/18).
According to the release, Abbott and Act Up-Paris agreed to hold future discussions on the issue. They also agreed that their primary goal is to promote HIV prevention, treatment and care access worldwide and that access to information, including through Web sites and other media, is important (IAS release, 7/22). According to a joint release from Act Up-Paris and the Thai Network of People Living With HIV/AIDS, Abbott while meeting with the groups at the IAS conference did not agree to introduce Aluvia into the Thai market (Act Up-Paris/Thai Network of P+ release, 7/22).
Kaisernetwork.org will serve as the official webcaster of the IAS conference. Individuals can sign up for a free daily update e-mail and find more information about conference webcasts online.
Video of the opening session is available online. An interview with Cahn also is available online.
"National Nine News" on Monday included a discussion with Kevin De Cock, director of the HIV/AIDS Department at the World Health Organization, about male circumcision and HIV prevention ("National Nine News," 7/23). Video of the segment is available online. A kaisernetwork.org interview with De Cock also is available online.
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HIV/AIDS Advocates in Swaziland Call for Expansion of Antiretroviral Program, Warn of Limited Drug Access Among Women
[Jul 23, 2007]
Some HIV/AIDS advocates are calling on Swaziland to expand and strengthen its national antiretroviral program, IRIN News reports. The advocates also say that the country faces serious challenges, particularly in preventing and treating HIV/AIDS among women.
The Ministry of Health and Welfare last week at a conference in Manzini, Swaziland, said that about 15,000 people receive antiretroviral access through the government-sponsored treatment program and that the number is expected to double by the end of the year. However, advocates said the drugs are reaching only a fraction of those in need and targets should be dramatically increased, IRIN News reports. According to IRIN News, the Swazi government has allotted 43 million rand, or $6.25 million, to the national antiretroviral program. Thembi Nkambule, national coordinator for the Swaziland National Network of People Living With HIV and AIDS, said, "There is a need to make antiretrovirals more available to children and to develop a national antiretroviral literacy curriculum and an urgent need to scale up community awareness around the accessibility" of the drugs.
Officials at the conference also discussed ensuring the availability and affordability of drug supplies, as well as the finalization of national nutritional guidelines for people living with HIV/AIDS, IRIN News reports. According to Albertina Nyatsi, head of the Manzini-based Positive Women Together, uncertainty over whether people are adhering to their treatment regimens has been an obstacle to the success of the program. She added that "transportation is a significant hindering factor for access" to treatment.
A report compiled by the National Emergency Response Council on HIV/AIDS, which was based on a similar conference held in Swaziland in May, said that some church leaders and traditional medicine practitioners are giving parishioners and clients inaccurate information about HIV/AIDS. "Some traditional healers are making concoctions that are mixed with [antiretrovirals], and these remedies are taken by people living with HIV/AIDS, heightening the risk of drug resistance and reversal of progress gained" by the national program, the report said.
The NERCHA report, distributed at the Manzini conference, also said that hospital and health clinic nurses who provide prenatal care are advising some HIV-positive women against having children or to have an abortion if they are pregnant and have significantly low CD4+ T cell counts, IRIN News reports. Nyatsi said that information on antiretrovirals "still remains inaccessible for many Swazi women living positively," adding, "Most information is generalized and needs to be tailored for women-specific needs." She also said that in addition to "living with the stigma of being HIV-positive, most women are restricted by family members and husbands from going on [antiretrovirals] because of the expense," Nyatsi said. The United Nations estimates that 33.4% of Swazis between ages 15 and 49 are HIV-positive (IRIN News, 7/19).
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Indonesia To Increase HIV/AIDS Funding by 75% During Next Three Years, Minister Says
[Jul 23, 2007]
Indonesia plans to increase the amount of money it spends on controlling HIV/AIDS by 75% during the next three years and will focus on fighting the disease in the Papua province, Welfare Minister Aburizal Bakrie said on Thursday, the AP/International Herald Tribune reports. According to Bakrie, the government will increase spending on HIV/AIDS to $263 million by 2010 -- up from $67 million in 2006. The government also wants to reduce its dependency on international donors, which contribute up to 70% of the national HIV/AIDS budget, Bakrie said. Papua receives 4% of money budgeted for HIV/AIDS spending, according to the AP/Herald Tribune (AP/International Herald Tribune, 7/20).
A study funded by the World Bank, the U.S. government and Family Health International found that 48% of Papuans are unaware of HIV/AIDS, and the number of AIDS cases per 100,000 people in the province is almost 20 times the national average. In addition, the percentage of people who reported being unaware of HIV/AIDS increased to 74% among uneducated populations in the region. The study, which was released last month, called for increased funding for sex education and condom-distribution programs. Health authorities have said that if steps are not taken to reduce the spread of the virus in Papua and other high-prevalence regions, Indonesia could have one million HIV-positive people by 2010 (Kaiser Daily HIV/AIDS Report, 6/20).
Indonesia has one of Asia's fastest-growing HIV epidemics, and up to 290,000 people are living with HIV out of the total population of 235 million, the AP/Herald Tribune reports. HIV in the country primarily is spread by injection drug use and commercial sex work, according to the AP/Herald Tribune (AP/International Herald Tribune, 7/20).
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Drug Access
European Advisory Panel Recommends Approval of Pfizer's Antiretroviral Maraviroc, Company Says
[Jul 23, 2007]
Pfizer on Thursday announced that the European Committee for Human Medicinal Products -- an advisory panel of the European Medicines Agency -- has recommended the sale and marketing of its antiretroviral drug maraviroc in the European Union, the AP/Houston Chronicle reports (AP/Houston Chronicle, 7/19).
Pfizer has proposed using the drug to treat people with advanced HIV or AIDS who have not responded to other medications. Maraviroc works by blocking a protein, called CCR5, on human immune system cells that HIV uses as a portal to enter and infect the cell. Pfizer plans to offer the drug with a test developed by Monogram Biosciences that determines if people are likely to respond to the treatment. Pfizer has proposed selling maraviroc under the brand name Celsentri. FDA last month issued an approval letter for maraviroc. An approvable letter means that FDA believes the drug is worth approving but needs additional information before doing so. The company is in discussions with the agency to address outstanding questions and finalize the product labeling as soon as possible (Kaiser Daily HIV/AIDS Report, 6/21). CHMP said it recommended approval of maraviroc for use with other antiretrovirals among adults. EMA will make its final decision in the coming months, Reuters reports (Reuters, 7/19).
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Science & Medicine
Genetic Variations Might Help HIV-Positive People Control Viral Loads, Study Says
[Jul 23, 2007]
Variations in three genes might help people newly diagnosed with HIV control their viral loads, according to a study published Thursday in the online edition of the journal Science, the San Francisco Chronicle reports. For the study, a group of international researchers from the Center for HIV/AIDS Vaccine Immunology, led by David Goldstein of Duke University, pooled information about 486 HIV-positive people from a group of 30,000 to determine if genetic variations are linked to the disease, the Chronicle reports.
The researchers scanned the genes of the participants using gene-reading machines produced by Illumina and Affymetrix to determine if they carried any of the 550,000 gene variants commonly found in the general population. They then analyzed the data to determine if there was an association between the genetic differences and a different ability to control HIV.
The researchers found that two genes, called HLA-B and HLA-C, accounted for 15% of the differences in the participants' viral set-points -- a level at which the concentration of HIV in a person's blood becomes stable. According to the Chronicle, HLA-B helps white blood cells destroy other cells that have been compromised by conditions such as HIV. In previous studies, HLA-B was detected in a few hundred HIV-positive people, known as "elite controllers," who are able to control their viral loads without antiretroviral drugs, the Chronicle reports. HLA-C produces a protein that resides on the surface of white blood cells. Participants with the variant form of the gene seemed to be able to produce more of the protein, which might explain why they had lower viral loads. The researchers also discovered a third variant gene, called ZNRD1, which might inhibit the ability of HIV to replicate (Russell, San Francisco Chronicle, 7/20).
The study's findings might aid in the development of HIV/AIDS vaccines that bolster natural immunity to the disease, according to the Raleigh News & Observer. Researchers plan to confirm that the genes are vital to immune system responses and, if they are, discover how they improve resistance to HIV, according to the News & Observer. Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said, "I'm expecting very important things from" this study (Clabby, Raleigh News & Observer, 7/20). "What we are seeing here transcends the study of HIV," Fauci said, adding that these "genome-wide association studies" probably will create insights into how to treat and prevent diseases (San Francisco Chronicle, 7/20). Mark Connors, a scientist at NIH who was not involved in the study, said that even if the three genes do not prove useful for a vaccine, the technique of searching for biological differences in people's DNA might discover genes that could (Raleigh News & Observer, 7/20).
An abstract of the study is available online.
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