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5th SA AIDS Conference chairman Professor Francois Venter opens the conference
The 5th SA AIDS conference started in Durban today with a call to prioritise young people in the next HIV/AIDS National Strategic Plan.
Young people have a high rate of HIV infection, too many of them confront violence every day and many of the youth urgently need access to education Mark Heywood, deputy chairman of the SA National AIDS Council, said at the opening session.
“The bottom line is that the lives of young people have not improved,” he said.
Heywood shared the platform with a courageous young woman Mandisa Dlamini, whose mother Gugu was killed in 1998 for publicly disclosing she had HIV.
“I saw my mother dying but I nearly became infected with HIV. Two years later I was pregnant,” said Dlamini, talking about how young women can make wrong decisions and get into destructive cycles simply to survive.
The vulnerability and exploitation of young women is visible in any South African city. Leaving the International Conference Centre at 10pm tonight, I saw young female sex workers hanging out on street corners only a few blocks away looking for business.
One measure of the success of this conference and the next five-year National Strategic Plan (NSP) will the difference it makes the lives of women like them.
Conference chairman Professor Francois Venter reported on what great progress has been made on tackling HIV/AIDS in South Africa since the first conferences were held in Durban in 2000 and 2003.
But Venter, also president of the HIV Clinicians Society of Southern Africa, warned against being complacent, particularly in gains made around access to antiretroviral treatment.
“Antiretrovirals are magic muti. You go from zero to 100,” said Venter, commenting on how he has seen skeletal children and adults recover from near death to lead healthy lives again.
He warned that if funding for treatment runs out doctors could be telling patients, as they were back in the ‘80s in the US: “We have what it takes to keep you alive but we won’t pay for it”.
About 1.4 million South Africans — 100 000 of them children — are now on ARV medicines but still roughly 50% of people who need the life-saving drugs do not have them.
HIV prevention needs to be prioritised, Venter said, but not at the expense of cutting back on treatment.
The HIV Prevention Trials Network conducted this research in 9 countries with 1763 serodiscordant couples
HIV doctors, scientists and activists are not surprised at the results of a major clinical trial that has found early antiretroviral therapy hugely reduces HIV transmission.
“This breakthrough is a serious game changer and will drive the prevention revolution forward. It makes HIV treatment a new priority prevention option,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).
“Now we need to make sure that couples have the option to choose Treatment for Prevention and have access to it.”
The results of the trial are good, so good in fact that the researchers have suspended the study four years ahead of schedule to allow all participants and their sexual partners to benefit from early treatment.
“The study (HPTN 052) was designed to evaluate whether antiretroviral drugs can prevent sexual transmission of HIV infection among couples in which one partner is HIV-infected and the other is not. The results are the first of their kind from a major randomized clinical trial,” according to the lead researcher Dr Myron Cohen from the University of North Carolina.
“The research found that treating HIV-infected individuals with antiretroviral therapy (ART) when their immune systems are still relatively healthy led to a 96 percent reduction in HIV transmission to their partners.
“This critical new finding convincingly demonstrates that early treatment of infected individuals can have a major impact on the spread of the epidemic.”
Of the 1763 couples from nine countries who volunteered for the study, only one new infection took place among the couples in the “immediate treatment” group.
This contrasts significantly to the 27 infections that took place in the group who waited until a later stage of the disease – as the current guidelines recommend – to start ARVs.
The new HIV infections were linked through genetic analysis to the infected partners in the study.
“This breakthrough is a serious game changer and will drive the prevention revolution forward. It makes HIV treatment a new priority prevention option,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).
“Now we need to make sure that couples have the option to choose Treatment for Prevention and have access to it.”
South Africa, Kenya, Thailand, India, Brazil, Botswana, Malawi and Zimbabwe were the countries involved in the trial.
Early ARV therapy also helped prevent a type of TB found outside the lungs.
“HPTN 052 shows a prevention benefit that must be translated into programmatic reality. If deployed effectively, efficiently and ethically, early initiation of treatment will be fundamental to turning the tide of the epidemic,” says Mitchell Warren, executive director of AVAC: Global Advocacy for HIV Prevention.
The HIV Prevention Trials Network – largely funded by the National Institute of Allergy and Infectious Diseases (NIAID) – conducted the trial.
More than a million South Africans are now on antiretroviral drugs
The Treatment Action Campaign and Section 27 today congratulated Health Minister Dr Aaron Motsoaledi and his team for securing antiretroviral drugs for South Africa at the best global prices for the next two years.
“It is my pleasure to announce the massive reduction in the prices of antiretroviral drugs which has resulted in the 53,1% reduction in the cost of the total tender which translates to a R4,7 billion savings,” Motsoaledi said yesterday.
Section 27 activist Jonathan Berger responded today: “This is in stark contrast to the previous tender, which resulted in South Africa paying significantly more than necessary for ARV medicines.
“For example, South Africa will now be paying – on average – about R115 per patient per month for the standard triple combination of tenofovir (TDF), lamivudine (3TC) and efavirenz (EFV). Under the previous tender, the country committed to pay about R110 for EFV alone – just a few rands less for only one drug.”
Remember the dark days when TAC fought the government on issues like access to antiretrovirals? South Africa has come a long way since then and Motsoaledi is leading from the front.
While welcoming the antiretroviral tender gains, TAC and Section 27 still raise the following concerns:
* First, the rules under which the tender was conducted do not make provision for price reductions in the event that input costs (such as the costs of active pharmaceutical ingredients) decline.
* Second, as was the case with the 2008 ARV tender, the published documents do not explain how the points awarded to winning bidders were allocated.
* Third, the 2010 tender did not include any TDF-containing three-in-one fixed dose combinations (FDCs). We believe that the DoH should continue to strive to include such FDCs in future procurement processes, as their use will greatly improve patient adherence.
* Fourth, the extent to which the DoH was able to take control of the tender process remains unclear – in our view, the National Treasury appears to have retained undue influence.
Antiretroviral drugs can be used to prevent HIV infection the results of the global iPrEx clinical trial, released today, show.
This is the first study to test the concept of oral pre-prophylaxis exposure (PrEP) among HIV-negative participants – and these promising results could change the field of HIV prevention.
Taking a daily dose of Truvada (TDF/FTC) 50% of the time offered roughly 50% protection to the gay men who took part in the trial, which was conducted across five countries.
The efficacy rose above 70% among participants who took the ARVs more than 90% of the time.
The findings are the third promising trial result since last year.
Last year the Thai RV144 vaccine showed modest protection of 31%.
The CAPRISA 004 tenofovir gel results, released in July, showed 39% protection for women in the microbicide trial.
And the iPrEx study shows a 43.8% efficacy overall among the 2499 participants.
The full report is published in the New England Medical Journal today.
HIV rates among pregnant women are stable
The survey was conducted among more than 33 000 pregnant women aged 15-49 years old in some 1500 public health clinics in October last year.
The HIV prevalence rate among pregnant women in 2009 was estimated to be virtually the same as 2008: 29.4% compared to 29.3% the previous year.
Major findings of the report include:
* Pregnant women 30-34 years have the highest HIV prevalence at 41%;
* HIV rates have risen the most in women aged 35-39, from 29% in 2006 to 35% in 2009;
* Kwazulu-Natal is still the province with the highest prevalence, estimated at 39%; and
* Syphilis prevalence remains unchanged at 1.9%.
Releasing the survey on Thursday November 11, Health Minister Aaron Motsoaledi said that an extra R5.4 billion had been allocated for expanding ARV treatment, in the 2010-11 financial year.
An estimated 1.584 million South Africans older than 15 years need ARVs and 158 000 children, the report states.
Lipodystrophy changes fat distribution. Pic from: nature.com
Approved this week by the US Food and Drug Administration, Egrifta (tesamorelin) reduces abdominal fat as measured by CT scan.
Lipodystrophy is “a condition in which excess fat develops in different areas of the body, most notably around the liver, stomach, and other abdominal organs” the FDA said in a press release yesterday.
“The condition is associated with many antiretroviral drugs used to treat HIV.”
The Treatment Action Campaign explains that lipodystrophy can lead to fat gain around the stomach, breasts or shoulders and fat loss from the face, arms, legs and buttocks.
TAC says that it usually, but not always, develops slowly over months or years – and can “occur rarely in HIV positive people who are not on treatment”.
This visible side effect can impact on people’s self image and qualify of life.
Lipodystrophy is linked to stavudine, or d4T, which was first line therapy in South Africa until 1 April 1 2010 when updated clinical management guidelines were released.
“The updated guidelines will begin to phase out the use of stavudine (d4T) and start replacing it with tenofovir (TDF)… all patients experiencing side effects on d4T or zidovudine (AZT) will be switched to TDF,” the SA National AIDS Council announced at the time.
The FDA explained that Egrifta is a growth hormone releasing factor (GRF) drug that is administered in a once-daily injection.
Dr Curtis Rosebraugh from the FDA’s Center for Drug Evaluation and Research said: “The presence of excess fat with this condition may contribute to other health problems as well as affect a patient’s quality of life, so treatments that demonstrate they are safe and effective at treating these symptoms are important.”
The FDA reported that: “Egrifta was evaluated in two clinical trials involving 816 HIV-infected adult men and women with lipodystrophy and excess abdominal fat.
“Of these, 543 patients received Egrifta during a 26-week, placebo-controlled period. In both studies, patients treated with Egrifta experienced greater reductions in abdominal fat as measured by CT scan, compared with patients receiving another injectable solution (placebo). Some patients reported improvements in their self image.
“The most commonly reported side effects in the studies included joint pain (arthralgia), skin redness and rash at the injection site (erythema and pruritis), stomach pain, swelling, and muscle pain (myalgia). Worsening blood sugar control occurred more often in patients treated with Egrifta than with placebo.
“Whether Egrifta decreases the risk of cardiovascular disease or improves compliance with antiretroviral drugs has not been studied.”
Antiretroviral drugs save lives
An additional 30%-50% of HIV-positive people are eligible to take life-saving ARVs immediately under the new WHO treatment guidelines.
But this is a dream unless resources – which are flatlining or declining – are increased substantially.
The scale-up in ARV treatment has been slowing down since last year.
By 2009, 5.2 million people were on ARVs – compared to only half a million in 2003 – following consistently increased funding from 2001 to 2008.
The International AIDS Society released a report this week that warns “universal access cannot and will not be achieved without a substantial increase in resources for AIDS”.
IAS President Elly Katabira says: “At this critical juncture in the international AIDS response, we should not be talking about doing more with less, but doing more with more.”
The IAS report Universal Access: Right Here, Right Now reflects “the principal debates around universal access during the XVIII International AIDS Conference (AIDS 2010) in July.
“The report also takes stock of progress to date and reveals the scale of the future challenge for HIV treatment and prevention at a time when new infections are outstripping those receiving treatment by five to two.”
UNAIDS reports today that new HIV infections dropped by more than a quarter (25%) in 22 of the most affected countries in sub-Saharan Africa between 2001 and 2009.
UNAIDS Executive Director Michel Sidibé states: “For the first time change is happening at the heart of the epidemic. In places where HIV was stealing away dreams, we now have hope.”
“The data shows that countries with the largest epidemics in Africa—Côte d’Ivoire, Ethiopia, Nigeria, South Africa, Zambia and Zimbabwe—are leading the drop in new HIV infections,” the organisation states in a press release.
“The number of new HIV infections is steadily falling or stabilising in most parts of the world.”
The number of people on AIDS treatment has increased 12 times in the past six years, with an estimated 5.2 million people now on the life-saving drugs.
“There were 200,000 fewer deaths in 2008 than in 2004,” UNAIDS declares.
The global HIV/AIDS body observes that “South Africa is rapidly accelerating efforts to achieve universal access to HIV prevention, treatment, care and support.”
“New HIV infections among adults and young people have dropped by more than 25% and record numbers of women are accessing treatment to prevent mother-to-child transmission of HIV from previous years.
“The country has also significantly increased its domestic investments for the AIDS response in the current fiscal year.”
But the organisation warns the lack of resources in many low- and middle-income countries is obstructing the expansion of HIV/AIDS programmes.
UNAIDS released this progress report ahead of the UN Summit on the Millennium Development Goals on 20-22 September 2010.
Helping hands mural at a Johannesburg children's hospital. Pic: Sulucas
Children who were exposed to nevirapine (to prevent mother-to-child-transmission of HIV) benefit from switching back to a nevirapine regimen after they have achieved viral suppression using a protease inhibitor, an important study shows.
Protease inhibitor (PI) therapy is recommended initally to achieve viral suppression for infants with HIV who have been exposed to nevirapine for PMTCT.
This randomised controlled trial tests whether young children switched back to nevirapine can maintain viral suppression.
The new study published this week in JAMA (Journal of the American Medical Association) – with Dr Ashraf Coovadia the lead author and Dr Louise Kuhn the corresponding author – demonstrates the “many advantages” of putting these children back onto nevirapine.
The trial was conducted at a Johannesburg Hospital from April 2005 to May 2009 among 195 children who had achieved viral suppression, from a cohort of 323 nevirapine-exposed children who initiated PI-based therapy before 24 months of age.
The results showed that the children switched back to nevirapine achieved lower rates of virus in the blood (lower viremia) compared to the children who stayed on ritonavir-boosted lopinavir.
Coovadia listed the limitations PI-regimens (based on ritonavir-boosted lopinavir) for children as:
- unpleasant taste which makes long-term adherence difficult for young children
- concerns about metabolic toxicities during children’s development and
- more expensive than nevirapine and thus a barrier in low-resource settings
The researchers said their results “suggest that a majority of nevirapine-exposed children who are successfully treated with initial regimens…could benefit from the switch strategy.”
The switch group also had a better CD4 cell response.
The South African Medical Association, SAMA, today blamed the public sector strike on the “government’s failure to take workers’ demands seriously”.
The medical body supported employee demands for adequate pay as well as their right to take industrial action.
“Government has, for years, refused to negotiate and conclude a Minimum Service Level Agreement, which would have gone a long way to preventing the current chaos prevailing in our public hospitals,” the chairman Dr Norman Mabasa, said in a statement.
“It is clear that the Department of Health has no contingency plan to deal with the strike … using the military is completely inadequate”.
Doctors are picking up the pieces and this is an “unacceptable abuse of our members”, the medical body stated. But SAMA called on members to deliver appropriate care to patients.
The association also condemned “all acts of violence and intimidation from both the State and striking workers”, while urging its members to join peaceful picketing, marches and public demonstrations.
“SAMA calls on Government to concede to the reasonable demands of public sector workers and immediately sign a Minimum Service Level Agreement,” Mabasa stated.
As reported on this blog yesterday, patients experiencing problems accessing chronic medicines during the strike can contact the SA National AIDS Council Nerve Centre for assistance at (012) 395 9078/9, (012) 395 9081/7/8/9 or (012) 395 9090 or e-mail: sanacnervecentre@gmail.com.
