Vienna — A successful microbicide trial and the promise of HIV treatment as prevention have dominated the scientific breakthroughs making headlines at the International AIDS Conference in Vienna, but scientists working on a cure for HIV say they are making slow but significant headway in finding a permanent solution to the epidemic.
The main focus of current research is how to find and tackle "reservoirs" - cells, organs or tissue in the body where the virus could remain latent - and eventually become active again.
"Cells harbour HIV for long periods of time, and there are so many different types of cells that move all over the body; these reservoirs can be located anywhere these cells can reach," said Maureen Goodenow, a professor of pathology at the University of Florida.
Current research is seeking a "functional cure", which would not eliminate the virus from the body but would allow a patient's immune system to control the virus without the need for lifelong medicine by using antiretroviral (ARV) drugs and medications for a limited period to target these reservoirs. At least two clinical trials are underway in France to test such products.
"[HIV] treatment can reduce the viral load in the blood but it cannot eliminate it; it's life-long and can have many side effects after long-term use," said Prof Francoise Barré-Sinoussi, who earned a Nobel Laureate in Medicine for her role in the discovery of HIV.
"We are trying to find a treatment that is more efficient, causes fewer complications, and can be stopped after a while; one that would improve a patient's quality of life," she told IRIN/PlusNews.
Stem cell research
In terms of funding, the search for a cure is the poor relation to HIV prevention research. Scepticism about the possibility of finding a cure for such a complex virus, and a lack of significant strides in the field over the last 30 years, have made donors reluctant to support this arm of research.
In 2009 the National Institute of Allergy and Infectious Diseases (NIAID) at the United States National Institutes of Health (NIH), one of the largest donors to global HIV research, spent just over US$40 million - about three percent of its total AIDS spending - on the search for a cure.
"For many years there was a staleness in the field, but now there are a number of breakthroughs, including stem-cell technology, that make it feasible to address the issue," said Carl Dieffenbach, director of the AIDS division at NIAID. "The NIH now plans to ramp up its efforts to find a cure."
The excitement over stem-cell research was caused by a case known as "the Berlin patient". In 2007 Dr Gero Hütter, the doctor treating the Berlin patient - an HIV-positive American leukaemia patient who lived in Berlin - replaced the patient's bone marrow cells with those from a donor with a naturally occurring genetic mutation that rendered his cells immune to HIV.
To date the Berlin patient, who is no longer on ARVs, shows no evidence of having the HI virus.
Researchers in the US are using the same genetic mutation to do stem-cell research in mice in the hope that, eventually, it could provide immunity to HIV-infected patients. Recent positive results have increased interest in this line of research.
Back to basics
But scientists believe that they also need to do more fundamental research into exactly how the virus works. "There is a dearth of information on the basic immunological system, on the molecular interaction between the virus and cells," Goodenow said.
Dieffenbach noted that Hütter, the Berlin patient's doctor, was a haematologist and not an HIV specialist, and said there was a need to collaborate more closely with scientists from diverse fields, from immunologists and virologists to basic scientists and drug developers.
Jean-Francois Delfraissy, director of France's National Agency for AIDS Research, commented: "The real cure - the total eradication of HIV from the body - is a very big task, but we are hopeful that we are taking baby steps towards controlling the virus in infected patients."
[ This report does not necessarily reflect the views of the United Nations ]
Comments 1 to 5 of 5 Post a comment
We have to really sit down and wonder what is being promoted here.
UNAIDS Head Michel Sidibe and Deputy President of South Africa Kgalema Motlanthe are very heavily promoting genital mutilation as HIV "prevention" and no one at the conference seems to be raising an eyebrow?
Has the whole world gone MAD???
First of all, the VERY idea. Would the WHO, UNAIDS etc. ever recommend FEMALE circumcision as a way to curb AIDS, if it were shown in "studies" that it "might" prevent HIV transmission by 60%? What about 100%?
The answer is, no, they wouldn't. Forcefully circumcising a girl or woman would be immediately recognized as a basic human rights violation. When something is a basic human rights violation, it doesn't matter how many studies are written for it. All the "studies" in the world would not be enough to promote female circumcision. How is it that we have allowed this to happen with male circumcision?
Why can't researchers seem to focus on something else? What research is being done to move past circumcision? What studies are being made on alternative medicine? Usually, medicine tries to ABOLISH the use of surgery, not seek its preservation. This "lets circumcise everybody" idea is MADNESS. I'm surprised no opposition was raised at the conference.
But secondly, the claim that circumcision prevents HIV isn't entirely solid. There are a few realities that "researchers" have failed to explain.
In America, for example, 80% of men are already circumcised from birth. The rates of infant circumcision are dropping, but at large, the population remains circumcised. These rates are at their highest in the East Coast, where cities such as Philadelphia and Washington DC rival HIV hotspots in South Africa. In the 1980s, when the AIDS epidemic first hit, the rate of circumcised men in America was at 90%. One needs to question how something that never worked here in our own country is suddenly going to start working wonders in Africa.
In other countries, the "protection" remains to be seen as well. AIDS is a rising problem in Israel, where the majority of the male population is already circumcised. On Wednesday, July 7th, two weeks ago, Malaysian AIDS Council vice-president Datuk Zaman Khan announced that than 70% of the 87,710 HIV/AIDS sufferers in the country are Muslims (in other words CIRCUMCISED). The Muslim, circumcised population accounts for 70% of the incidence of HIV, but only 60% of the population, which would mean that the circumcised population is getting HIV at a much higher rate than the non-circumcised population.
Millions are being spent on a "prevention method" with dubious benefits, when they could be spent on other modes of prevention that have been conclusively proven to work. Condoms and education for example. Some people say "that hasn't worked," but that's not the reality. In some parts of Africa, it has worked so well that people wanting to "study" circumcision there have no cases to work with.
Circumcision is going to COST more money in the long run. A recent issue of the WHO Bulletin noted that African ritual circumcisions have a 35% complication rate, while clinical circumcisions have an 18% complication rate. A neonatal circumcision complication rate of 20.2% was found in Nigeria. As you may know, Annie, funds for the fight against AIDS are scarce. Dealing with these complications is going to divert resources away from other more-needed programs, such as mother-to-child transmission reduction, and treatment of people who are already infected.
Not to mention that men are using their circumcisions as an excuse not to wear condoms, putting themselves and their partners in danger. That's MORE money, because now you have more people infected, and more people on drugs. But that's what this whole thing in Vienna was about, wasn't it; drugs.
Tribal groups are using the WHO's stance to go ahead with traditional circumcision rituals, where men, if they want to be called "real men," are ostracised if they want to go to a hospital to have a "safe" circumcision. 47 men have already died this year, and a lot more have lost their penises to gangrene.
This is already being used to carry out circumcisions in healthy, non-consenting CHILDREN. "Rights here, right now" was the slogan at this year's conference. Where is human rights HERE? How is it that circumcision is being pushed on children who aren't even sexually active and therefore at ZERO risk? Shouldn't circumcision be for those who WANT it, and they KNOW they're going to be engaging in risky behavior? Why are men being coerced in KwaZulu Natal? This is MADNESS.
This is an UNACCEPTABLE form of "prevention." Leaders need to find something else.
I cannot get behind a movement that endorses genital mutilation as "prevention." They'll just have to get their money and my signature for their precious "Vienna Declaration" from elsewhere. And I'm notifying all my friends too. As long as this madness continues, UNAIDS, UNICEF etc. should NOT be getting our money. This is absolute MADNESS.
IntactAmerica were at Vienna to raise opposition, but the people in charge of spending the funds don't seem to want to listen.
Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".
The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.
ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
Somehow, I don't think these "studies" were "randomised."
Controlled?
Yes.
"Random?"
I have reason to think the UN is hornswaggling Africa.
There is a video that I think all Africans should see.
http://www.youtube.com/watch?v=4AfPajxmfbE
The volunteers for circumcision (not a random sample of the population, or even the at-risk population) were randomly assigned to be circumcised at the beginning of the trial or the end. About 5,400 in total were in each group. The trials were cut short "for benefit" after less than two years. It is known that studies cut short "for benefit" are more likely to seem to show benefit where there is none. 64 of the circumcised men had HIV and 137 of the control group had HIV. The difference, 73 men out of 5,400 (who may well have HIV by now) is the WHOLE basis of the claim that "millions could be saved". 327 circumcised men and a similar number dropped out, their HIV status unknown. Circumcision advocates assume that they dropped out in equal ratios from the two groups, but circumcised men would be much more likely to dtrop out because they found they had HIV and the trials had failed them. (Control group men would drop out because they had changed their mind about getting circumcised.)
These mass campaigns are pressing ahead with hysterical fervour, when no field trials of the effect of mass circumcision in real-world conditions have been held, only these rather artificial trials. If (when) mass circumcision fails to have any effect on the AIDS disaster, is there any plan to halt the lemming-like rush?
I don't know where you guys are taking circumcision and HIV to; or do you guys think that Africa is still leaving in colonial time and do not have intelligent and intellectual Africans??? You guys that keep thinking negatively about Africa are still leaving in the dark ages or other wise blatantly Ignorant.