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Professor David Serwadda spoke at the 5th SA AIDS Conference this morning
HIV/AIDS studies conducted in Africa are making a significant contribution to understanding the disease, a leading public health expert Dr David Serwadda said today.
The importance of the viral load in HIV transmission, the preventative value of medical male circumcision, the efficacy of mother-to-child-HIV prevention and other breakthroughs in research have been proven in trials conducted in African countries said Serwadda.
Dean of the Makerere University School of Public Health in Uganda, Srwadda said major international funding had played a role in boosting research and science capacity in countries like Uganda, South Africa and Kenya over the past 25 years.
For example, 37% of HIV funding by the NIH in the US, has been directed to Africa.
Serwadda said the funding had improved training, infrastructure and service provision to patients.
He said HIV had impacted severely on health systems, for instance, leading to overcrowding in hospitals and had taken its toll on healthworkers.
“We need to increase investment and resources for health systems,” Serwadda said.
He also called for greater leadership and accountability.
Serwadda spoke at the plenary session this morning of the 5th SA AIDS Conference in Durban
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.
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.
'Seek, test and treat to slow HIV'
“Studies in several nations show that treating people before they fall ill can curb the spread of disease,” writes Erika Check Hayden, in an article in the journal Nature this week.
Research in Africa, the US and Canada seems to provide more evidence in favour of “treatment as prevention”, Hayden reports.
* The African research involving seven countries and data from 3 408 discordant couples (Deborah Donnell) showed that “HIV-positive individuals who were receiving treatment almost never passed the virus on to their partner, whereas many untreated individuals did”.
* The American study found that “as ‘community viral load’ — the amount of virus in the blood of all HIV-infected individuals tested in San Francisco (Moupali Das) — declined from 2005 to 2008 because of drug treatment and increased awareness, the number of new infections in the city also dropped”.
* The Canadian study involving intravenous drug users had similar results, with new HIV infections dropping by around 50% when treatment was expanded to intravenous drug users with HIV throughout British Columbia(Julio Montaner).
But the results – presented at the annual Conference on Retroviruses and Opportunistic Infections in San Francisco, California – do not prove that antiretroviral treatment itself reduces the spread of HIV as there were many confounding factors.
Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, said in the article: “Rather than saying it’s an all-or-nothing phenomenon — that we’re going to eliminate the epidemic without anything else but test and treat — what I argue for is, why don’t we let test and treat be part of a more aggressive prevention armamentarium.”
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.
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.
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.”
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.”
