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Teenagers born with HIV need attention now

By Claire Keeton | 4 days, 12 hours ago
Babies, children and adolescents get HIV care from ECHO's services

Babies, children and adolescents get HIV care from ECHO services

Nearly half the teenagers admitted to two hospitals in Harare in Zimbabwe were infected with HIV and the virus was the most common cause of in-hospital death among them, a new study shows.

Adult opportunistic infections and chronic paediatric HIV/AIDS complications were the most common cause for their admission.

Many of them were likely to have a mother who was HIV-positive or who had died of AIDS but they had survived into older childhood.

Now they need “better recognition” and care, Rashida Ferrand and his co-authors stated.

Wits HIV expert, Professor Glenda Gray, supported this call, stating in the same journal: “There is an urgent need for services that will be able to provide accessible and appropriate HIV testing, counselling, and support, as well as facilitate access to ART and appropriate sexual risk-reduction interventions.

“The adolescents admitted to hospitals in Harare could have benefited from early diagnosis and concomitant initiation of ART, and this absence of treatment should not continue to be the plight of similar adolescents in our region.”

In South Africa as many as half a million children are estimated to have HIV.

Dr Marnie Vujovic, a clinical psychologist for Wits Paediatric HIV Clinics, said that sensitive and age-appropriate disclosure to adolescents born with HIV was critical to their physical, mental and social wellbeing – and to avoid them finding out by accident.

“Disclosure to children is the biggest issue in our caregiver support groups and a problem at all sites,” she said.

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Scientific breakthrough could lead to better AIDS drugs

By Claire Keeton | 1 week ago
Cracking the integrase crystal mystery after 20 years

Cracking the integrase crystal mystery after 20 years

Scientists have succeeded in growing a crystal that reveals the structure of the enzyme, integrase, and this could improve the design of the integrase inhibiting drugs commonly used for AIDS treatment.

Integrase – an enzyme found in retroviruses like HIV – plays a key role in HIV infection.

“When HIV infects someone, it uses integrase to paste a copy of its genetic information into their DNA,” the researchers from Imperial College in London stated.

“Availability of the integrase structure means that researchers can begin to fully understand how existing drugs that inhibit integrase are working, how they might be improved, and how to stop HIV developing resistance to them.”

Many researchers had tried and failed for more than 20 years “to work out the three-dimensional structure of integrase bound to viral DNA”, prior to this study, they stated.

To grow a crystal of “sufficient quality to allow determination of the three-dimensional structure”, the scientists from Imperial College in London and Harvard University in Boston conducted more than 40 000 trials.

These results in seven kinds of crystals, only one of which was of high enough quality for their study.

Lead author Dr Peter Cherepanov said: “We went back to square one and started by looking for a better model of HIV integrase, which could be more amenable for crystallization.

“Despite initially painstakingly slow progress and very many failed attempts, we did not give up and our effort was finally rewarded.”

Their findings are published this week in the journal Nature.

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HIV spreading among middle-aged population

By Claire Keeton | 2 weeks, 6 days ago

Everyone knows young adults are at risk for HIIV. What’s less well known is how HIV is becoming more common among “middle-aged” populations.

Men over 50 were found to be among the “most at risk populations” in the latest Human Science Research Council survey on HIV released last year.

Prevalence was also high among men and women in the ’40s ranging from 8% to 19%.

“More than a third of adults 50+ years are not reached by any national programme, and even for adults aged 25–49 more than one in nine (16.4%) have no exposure to HIV/AIDS communication programmes,” the study showed.

Ignorance is also allowing HIV to make inroads among older people in the US, an American sociologist has declared.

HIV prevalence has risen from 10% to 19% among people more than 50 years old, and more than half the women over 50 know nothing about HIV, her research shows.

Diane Zablotsky, an associate professor of sociology at the University of North Carolina Charlotte, stated: She said: “When I first started my work, when we were trying to explore the situation with HIV generally, our first approach was to alert people that this [HIV/AIDS] was something that people across the life course need to know about.”

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Examining the early and late costs of ARV treatment

By Claire Keeton | 3 weeks, 1 day ago

An important new study on AIDS treatment in the private sector in Southern Africa examines what drives up costs in HIV management – and many of these findings also apply to the public sector.

The researchers analysed the direct costs in treating more than 10 000 “HIV-infected adults are enrolled in managed care programmes” from three years before ARV initiation up to five years afterwards and the results are published in the current issue of PLos Medicine.

They found: “There was a peak in costs in the period around ART initiation (from 4 months before until 4 months after starting ART) driven largely by hospitalisation, following which costs plateaued for 5 years.”

Rory Leisegang, from UCT’s Clinical Pharmacology division in the Department of Medicine, and his co-authors concluded: “Starting ART at higher CD4 counts or longer pre-ART care should reduce early costs.

“Monitoring ART adherence and interventions to improve it should reduce later costs.”

President of the HIV Clinicians Society of Southern Africa, Dr Francois Venter, commented: “$2400 annually in direct costs, once accounting for the early hospital; costs, is a bit over double that in the state sector.

“The hospitalization rates were similar, but that probably is because of a higher bar to hospitalization for state patients (which also again drives cost). As expected, poor adherence impact on costs.”

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Time to applaud Professor Jimmie Earl Perry

By Claire Keeton | 3 weeks, 5 days ago

Prof Jimmie Earl Perry (right), creative director for the Afri Centre of HIV/AIDS Management

Prof Jimmie Earl Perry (right), creative director for the Centre of HIV/AIDS Management


Acclaimed performer Professor Jimmie Earl Perry, the first UNAIDS Goodwill Ambassador for South Africa to be appointed, will be publicly introduced at the Cape Town Waterfront next week.

UNAIDS and the Africa Centre for HIV/AIDS Management are hosting a cocktail function for invited guests to meet Perry, director of the centre’s education theatre and creative arts programme.

A musician, dancer and actor, Perry will join eight international and three national goodwill ambassadors in promoting HIV/AIDS awareness and stopping the epidemic.

UNAIDS executive director Michel Sidibe announced Perry’s appointment at the centre’s World AIDS Day gala concert.

The US-born Perry, whose recent CD “Power of the Dream” was self produced, stays in Stellenbosch now.

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Having a relationship with an HIV-negative partner

By Claire Keeton | 3 weeks, 6 days ago

Sharing common experiences of relationships

Sharing common experiences of relationships


“Many people with HIV are in loving, supportive and intimate relationships. And many of these are with a partner who is HIV-negative,” a new page about relationships on the HIV website, namlife.org, proclaims.

“All relationships go through ups and downs and the presence of HIV in a relationship can exaggerate the routine stresses,” namlife.org advises.

“This section provides information on some of the more common problems that arise in relationships where one partner is HIV-positive and the other HIV-negative.”

This section on relationships goes way beyond traditional “Agony Aunt” columns since readers share their personal experiences on namlife.org, an award-winning organisation based in the UK.

Research in African countries has shown about one out of five relationships in Zambia and one out of eight relationships in Rwanda are between serodiscordant couples (one partner HIV positive, one partner HIV negative).

Dr Eric Hunter is driving the research to find out how HIV is transmitted from one partner to the other.

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HIV Clinicians condemn Uganda’s ‘Anti-Homosexuality Bill’

By Claire Keeton | 8 January 2010

Protestors standing up for gay rights in Uganda

Protestors standing up for gay rights in Uganda


Today the HIV Clinicians Society of Southern Africa added its voice to a powerful lobby against the proposed Anti-Homosexuality Bill in Uganda.

The bill, submitted last October, proposes the death penalty for some “homosexual acts”, while other acts incur a steep penalties up to life imprisonment.

In an open letter to the Parliament of Uganda, the society’s president Dr Francois Venter, said its 16 000 members were gravely concerned at the 2009 bill.

“Our concern regarding the Anti-Homosexuality Bill stems from the fact that it proposes draconian measures which will further criminalize same-sex relations between consenting adults.

“We are particularly concerned that the Bill proposes the introduction of the death penalty for, inter alia, people living with HIV who engage in same-sex sexual activities.”

“Encouraging openness and combating stigma are widely recognized as key components of Uganda’s successful campaign to reduce HIV infection,” said Venter, warning that the bill threatened to have a “profoundly negative impact on Uganda’s efforts to combat HIV”.

Addressed to the speaker of Parliament and CC’d to President Yowera Kaguta Museveni, the letter called on all MPs “committed to public health and human rights” to stop the bill being passed in any form.

Meanwhile AFP reported today that Ugandan Investment Minister, Aston Kajara, opposed the bill and said the country had enough legislation against homosexuality.

“The government’s position is that the existing provisions in our penal code against homosexuality are strong enough and that this new bill is not necessary,” Kajara told AFP.

But the Ethics Minister James Nsaba Buturo said Kajara was not representing the government. AFP reports that Buturo is “a staunch supporter of the bill”.

The death penalty could be imposed for “aggravated homosexuality” – applicable in cases of rape of a minor by a person of the same sex, or where one partner is HIV positive, AFP stated.

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After 10 years Pholokgolo gets ready for ARVs

By Claire Keeton | 6 January 2010
"The reality is that my time of living with HIV without treatment is up"

2010 is a significant year for HIV activist and media specialist Pholokgolo Ramothwala.

He has lived with the virus for more than a decade without needing to take antiretroviral drugs.

But his CD4 count has been dropping, viral load rising and Pholokgolo has been developing opportunistic infections, like oral thrush, more often.

His doctor has advised him that now it is time to initiate treatment.

Despite his initial reluctance, Pholo writes: “I have always known that one day my health will deteriorate and I will have to start taking antiretrovirals (ARVs) to manage my HIV.

His online diary will be focused on this journey for the next six months.

He writes: “I must now accept that this virus has progressed and my fighting strategy must also change. I must prepare myself for the challenge.

“I am not afraid of taking ARVs. I just don’t know if I have the discipline to take them every day for the rest of my life.”

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HIV tests no longer required for US visa

By Claire Keeton | 5 January 2010

HIV ban was rooted in fear, not fact, Obama stated

HIV ban was rooted in fear, not fact, Obama stated


The lifting of the US travel ban on people with HIV came into effect yesterday and two Dutch visitors, Clemens Ruland and Hugo Bausch, are expected to touch down in New York this week.

For more than 20 years an American HIV Travel and Immigration Ban has fuelled stigma, discrimination and misinformation.

But on 30 October last year President Barack Obama cancelled this ban, as he had promised to do.

“HIV infection will no longer be an ineligibility when foreign citizens apply for a visa to travel to the United States. Additionally, HIV testing will no longer be required for medical examinations for visa purposes,” the American diplomatic mission in SA announced on its website.

The US ban was shared by countries like Saudi Arabia and Libya. When it was repealed, US Department of Health and Human Services Secretary Kathleen Sebelius said: “When it comes to ending the stigma of HIV/AIDS, we’ve been one of only 12 countries who, by their policies, still enable the myth that HIV/AIDS is a threat.

“Lifting the HIV “entry ban” represents… a blow against stigma.”

The entry restrictions on foreigners with HIV have disqualified the US from hosting prestigious international AIDS conferences for more than two decades. The last conference was held in San Francisco in 1990.

The same month the restrictions were lifted, the International AIDS Society announced that Washington DC will host the XIX International AIDS Conference in July 2012.

DC is the headquarters of the US Global AIDS Coordinator (which directs PEPFAR – President’s Emergency Plan for AIDS Relief) and the National Institutes of Health.

IAS president Dr Julio Montaner stated at the time: “We are extremely pleased that the United States’ new entry policy for people living with HIV reflects its key role in global efforts to combat AIDS.”

The biennial AIDS conference this year will be held in Vienna in Austria.

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HIV drug resistance alert

By Claire Keeton | 30 December 2009
HIV drug resistance at about 5% in Sub-Saharan Africa

HIV drug resistance at about 5% in Sub-Saharan Africa

South Africa has initiated more than 700 000 people with HIV on antiretroviral drugs and – along with scaling up the rollout of treatment – a major challenge for 2010 and beyond will be containing drug resistance.

A presentation at the HIV Clinicians Society of Southern Africa this year outlined the increasing number of patients failing treatment, and the steps required to avert the widespread development of drug resistance.

The human cost of drug failure is vividly illustrated in an Associated Press feature from South Africa published today.

The Associated Press did a six-month investigation into soaring drug resistance to a range of diseases worldwide.

Among the key points this excellent story highlights are:
* HIV drug resistance ranges from 5% to 30% across the world, up from about 1% to 5% 10 years ago;
* HIV drug resistance is increasingly common in South Africa;
* Monitoring for HIV drug resistance is scarce in Sub-Saharan Africa, where the highest number of people have the virus;
* HIV drug resistance “mirrors the rise worldwide of new and more deadly forms of killer infections, such as tuberculosis and malaria. These diseases have mutated in response to the misuse of the (drugs),” the story says;
* “In some high-risk populations worldwide, HIV drug resistance rates soar as high as 80 percent”, according to studies published in the journal AIDS;
* Drug resistant strains could cost $44 billion to treat by 2010;
* Every year more drug resistant strains are detected: in 2008 there were 93, up from 80 different documented strains in 2007, according to Stanford University’s HIV Drug Resistance Database; and
* Adherence among children is difficult “because they depend on someone else to make sure the meds are swallowed”.

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