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HIV & AIDS Treatment in Practice #18, November 24 2003
A regular electronic newsletter for health care workers and community-based organisations on HIV treatment in resource-limited settings. It is supported by and produced in collaboration with St Stephen's AIDS Trust and the International HIV/AIDS Alliance.

Its publication is also supported by Positive Action of GlaxoSmithKline, Boehringer Ingelheim and the Access 4 Trust.
   Last updated: 18.06.04
 
A selection of news stories which have appeared since November 6 2003.

US and UK announce `Joint Special Task Force` on HIV/AIDS

  • The British and US governments are to set up a Special Joint Task Force on HIV, Downing Street announced yesterday, following a roundtable meeting on HIV/AIDS hosted by Tony Blair and attended by representatives from Ethiopia, Kenya, Nigeria, Uganda and Zambia. President Bush also took part in the meeting, which was the only significant diversion from talks on the war in Iraq and international terrorism during his three and half day visit to the UK.



South Africa announces treatment roll out - and begins search for health care workers

  • Today people with HIV, treatment advocates and health care providers across South Africa were celebrating as news spread that the South African government has finally approved a plan that promises eventually to deliver comprehensive care to the five million HIV-positive people in the country, including providing antiretroviral treatment to those patients who need it. “We’re ecstatic,” said Nathan Geffen of the Treatment Action Campaign (TAC). “This is what we have been working so hard for.”


Cost of care shown to be primary barrier to adherence in African study

  • Financial constraints, including though not limited to the cost of antiretrovirals, were reported to be the most significant barrier to antiretroviral adherence in patients living with HIV infection and AIDS in Botswana prior to the introduction of free treatment. The study, published in the Nov. 1st issue of the Journal of Acquired Immune Deficiency Syndromes reported that though 54% of the patients reported that they took their drugs as prescribed, if cost were removed as a barrier, 74% would have been adherent, which is comparable to rates of adherence in the developed world.


High rates of AIDS and death in first year of life argue for universal ART for kids with HIV

  • In developed countries, with broadly accepted efforts to prevent mother to child transmission (MTCT) of the virus, the incidence of HIV-infected newborns has become rare. But in the rest of the world, and despite the initial deployment of some simplified protocols to prevent MTCT, several hundred thousand HIV-infected infants continue to be born each year. It has been recognised that the greatest risk of mortality for an infant infected at birth is during the first year of life, as viral load soars during primary infection and the immature immune system is still developing.



Brazil wins 75% discount on new HIV drug

  • The Brazilian government has announced that it has negotiated a 75% discount on the top US price of the new protease inhibitor atazanavir (Reyataz). Brazil will pay $3.25 per capsule for the drug, compared with a US price of up to $13.80 per capsule. This represents a daily price of $6.50 a day ($2372.50 a year).



Total lymphocyte count predicts risk of death in children

  • A total lymphocyte count and serum albumin levels may predict disease progression in HIV-positive children where CD4 and viral load testing are not affordable, according to US research published today in The Lancet.



How will AZT and nevirapine use for MTCT affect future treatment? Two studies provide clues

  • Two studies in the November 1st edition of the Journal of Acquired Immune Deficiency Syndromes address the issue of drug resistance in women taking drug prophylaxis to prevent mother to child transmission of HIV. One found an increased risk of transmission in mothers infected with phenotypic AZT-resistant virus. The other reported that efavirenz-based regimens were as effective in patients exposed to short courses of nevirapine as in patients with no prior nevirapine exposure.



Cheap multivitamin pill increases survival in those with low CD4 counts

  • A multivitamin and mineral supplement with a local cost of about 60p a month has been found to enhance survival of HIV-positive people with less than 200 CD4 cells unable to access HAART, according to a Thai study published in the latest issue of the journal, AIDS.





Vaxgen announces second phase III trial failure in its AIDSVAX programme

  • The US vaccine developer VaxGen today announced that a phase III study of AIDSVAX adapted for Thailand has failed to show that the vaccine protected against HIV infection during three years of follow-up.



HIV/malaria coinfection increases morbidity and mother to child HIV transmission

  • HIV and malaria can independently cause serious complications during pregnancy, endangering the health and survival of both the pregnant woman and her infant. But when the two diseases occur together, the dangers are compounded, according to two recent studies from Africa.



Old TB vaccine can improve immune response to TB in HIV patients

  • An old form of vaccine against tuberculosis has shown promise in people with HIV, researchers from Dartmouth Medical School and the National Public Health Institute of Finland report in the November 7th issue of the journal AIDS.


Alternative to viral load flops in West African field trial

  • It’s been noted that the impact of highly active antiretroviral therapy (HAART) in 1995 might not have been so dramatic had it not been accompanied by a simultaneous breakthrough in assay technology called HIV-1 RNA PCR, which allowed the drop in viral load caused by the new drugs to be rapidly detected. The HIV RNA viral load test is now used routinely to monitor the initial response the HAART and to give an early warning when viral suppression starts to falter so that regimen changes can be made before drug-resistant mutations get out of control. The other main assay in the clinician’s toolkit, the CD4 test, tracks a person’s immune status, telling when it’s time to start therapy and reporting on the slow process of immune recovery after successful viral suppression has been achieved. But both of these tests involve sending blood to qualified laboratories where trained technicians use sophisticated equipment to obtain reliable and reproducible results. The cost of these tests can range from $60 to well over $100 each.



Chest X-ray may not be needed before TB preventive therapy

  • A chest X-ray may not be needed in resource-limited settings before administering a course of isoniazid to prevent the development of active tuberculosis, according to doctors from Botswana writing this week in The Lancet.




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