HIV : Early ART: A Stitch in Time...

posting this in here whilst my suggestion for a Health forum is debated ..........:)


HEALTH-AFRICA: Early ART: A Stitch in Time...
By Miriam Mannak

https://teakdoor.com/images/imported/2009/08/15.jpg
Youth run testing centre in Chad: poor infrastructure and a severe shortage of health workers mean millions of Africans who should be receiving antiretrovirals are not.

Credit: UNFPA

CAPE TOWN, Jul 31 (IPS) - A global call to put people living with HIV on antiretroviral therapy (ART) at an earlier stage of their illness is intensifying, but most developing countries, especially in Africa, are struggling to meet the current recommendations.

Formulated by the World Health Organisation (WHO), the guidelines state that HIV positive people should begin ART before their CD4 count - a measure of immunity strength - drops below the 250 level.

This is in line with the notion that someone living with HIV is technically considered to have AIDS when his or her CD4 count dips below 200 white blood cells per microlitre of blood. At this stage of their illness, the patient’s immune system is often too weakened by the virus to respond to ART rapidly and effectively - hence the recommendation to commence therapy before the CD4 count dips to this level.

Various scientists and members of civil society, however, are now urging governments around the world to make provisions to allow patients to start treatment even earlier, before their CD4 count drops below 350.

The main argument is that the stronger someone’s immune system when starting treatment, the greater the chance ARV treatment has of having a long term positive effect, but there are other reasons.

"ARVs reduce the viral load in people living with HIV, which means they become less infectious," said Pedro Cahn, president and cofounder of the Huésped Foundation, one of Argentina’s major AIDS organisations. "If more people living with HIV become less infectious, this will lead to less new cases of HIV."

IPS spoke to Cahn during the 5th IAS conference on HIV pathogenesis, treatment and prevention, which took place in South Africa’s coastal city of Cape Town from July 19-22, 2009. The event drew thousands of HIV experts, scientists and members of civil society from around the world.

Reuben Granich, Medical Officer for HIV/TB in the HIV/AIDS department of WHO, shares Cahn’s views.

"Someone’s viral load is the single greatest risk factor for HIV transmission, and if started with ARVs at an early stage of the illness, the viral load can be reduced to undetectable levels," he said.

"A study conducted in the United States and Canada in 2003-2005 among 17,517 patients showed a 69 percent increase in mortality for those who started treatment at a CD4 count below 350 compared to people who started at an earlier stage of the disease."

Few in the South get ART in time

The problem is that many developing countries that bear the brunt of HIV are not able to meet the current stipulations.

"The median CD4 count of patients in (the Southern Africa) region who started their treatment in 2001 was 87," said Catherine Hankins, senior scientific adviser at the Joint United Nations HIV/AIDS Programme (UNAIDS).

"This means that it is unlikely that they will be able to meet the new guidelines," said professor Hoosen Coovadia, director of the centre for HIV/AIDS at the University of KwaZulu-Natal in South Africa.

"The new recommendations mean more people should get access to ARVs, and this costs more money. Most governments in Africa do not have the budget for this."

Poor infrastructure and a severe shortage of health care workers is another important reason why millions of Africans who should be receiving antiretrovirals are not on treatment.

According to WHO, sub-Saharan Africa is the region in the world that faces the greatest challenges - harbouring 11 percent of the world’s population, carrying 24 percent of the global disease burden, and having only three percent of the world's health workers.

"In Africa, we require an additional one million doctors, nurses and midwives to meet the needs of the people," said Jacqueline Bataringaya, senior policy advisor at the IAS.

"We have to scale it up, as these serious deficiencies in our healthcare systems disable - among other things - people from accessing ARVs."

The shortage of healthcare workers is partially caused by the fact that thousands of African nurses and doctors are working abroad, said Coovadia.

According to 'New Data on African Health Professionals Abroad', a study that was published by the online journal Human Resources for Health in January, 65,000 African-born physicians and 70,000 nurses were working overseas in developed countries by the year 2000. According to the researchers this amounts to one fifth of African physicians and one tenth of nurses.

"People are leaving for a reason, including low salaries, massive work loads and poor working conditions," said Coovadia. "This is sad, of course, but we cannot stop them. The only way to prevent people from seeking greener pastures is to improve working conditions in African clinics and hospitals."

Political will is therefore important, as a shortage of healthcare workers impacts the distribution of ARVs among people who need it, Coovadia underlined.

"South Africa for instance, is one of the countries that can afford to put more people on ARVs, but in order to do so, the government will have to commit itself to do that. It is all about political will. This means it has to make a choice between purchasing state-of-the-art fighter jets and submarines, or investing in fighting HIV/AIDS and saving its people," he explained.

Coovadia referred to a controversial 1999 arms deal, in which South Africa purchased weaponry worth 4.8 billion dollars, including three submarines, 40-odd light utility helicopters, and three dozen advanced light fighter aircraft.

Putting more people on ARV treatment might seem expensive, but at the end of the day it is a cost-effective way of fighting the disease, Coovadia added.

"It will mean less hospitalisations due to for instance tuberculosis, a major cause of death among people living with HIV. It will also contribute to a more productive workforce, and thus more revenue which you’d otherwise had to spend on people dying."

(END/2009)

ipsnews.net

right then , we already have a health forum , so would a kind mod move this please ?

https://teakdoor.com/health-fitness-a...s-in-thailand/

Breakthrough in search for HIV cure leaves researchers ‘overwhelmed’

Exclusive: Melbourne team demonstrates way to make the virus visible within white blood cells, paving the way to fully clear it from the body

A cure for HIV could be a step closer after researchers found a new way to force the virus out of hiding inside human cells.

The virus’s ability to conceal itself inside certain white blood cells has been one of the main challenges for scientists looking for a cure. It means there is a reservoir of the HIV in the body, capable of reactivation, that neither the immune system nor drugs can tackle.

Now researchers from the Peter Doherty Institute for Infection and Immunity in Melbourne, have demonstrated a way to make the virus visible, paving the way to fully clear it from the body.

It is based on mRNA technology, which came to prominence during the Covid-19 pandemic when it was used in vaccines made by Moderna and Pfizer/BioNTech.

In a paper published in Nature Communications, the researchers have shown for the first time that mRNA can be delivered into the cells where HIV is hiding, by encasing it in a tiny, specially formulated fat bubble. The mRNA then instructs the cells to reveal the virus.

Globally, there are almost 40 million people living with HIV, who must take medication for the rest of their lives in order to suppress the virus and ensure they do not develop symptoms or transmit it. For many it remains deadly, with UNAids figures suggesting one person died of HIV every minute in 2023.

It was “previously thought impossible” to deliver mRNA to the type of white blood cell that is home to HIV, said Dr Paula Cevaal, research fellow at the Doherty Institute and co-first author of the study, because those cells did not take up the fat bubbles, or lipid nanoparticles (LNPs), used to carry it.

The team have developed a new type of LNP that those cells will accept, known as LNP X. She said: “Our hope is that this new nanoparticle design could be a new pathway to an HIV cure.”

When a colleague first presented test results at the lab’s weekly meeting, Cevaal said, they seemed too good to be true.

“We sent her back into the lab to repeat it, and she came back the next week with results that were equally good. So we had to believe it. And of course, since then, we’ve repeated it many, many, many more times.

“We were overwhelmed by how [much of a] night and day difference it was – from not working before, and then all of a sudden it was working. And all of us were just sitting gasping like, ‘wow’.”

Further research will be needed to determine whether revealing the virus is enough to allow the body’s immune system to deal with it, or whether the technology will need to be combined with other therapies to eliminate HIV from the body.

The study is laboratory based and was carried out in cells donated by HIV patients. The path to using the technology as part of a cure for patients is long, and would require successful tests in animals followed by safety trials in humans, likely to take years, before efficacy trials could even begin.

“In the field of biomedicine, many things eventually don’t make it into the clinic – that is the unfortunate truth; I don’t want to paint a prettier picture than what is the reality,” stressed Cevaal. “But in terms of specifically the field of HIV cure, we have never seen anything close to as good as what we are seeing, in terms of how well we are able to reveal this virus.

“So from that point of view, we’re very hopeful that we are also able to see this type of response in an animal, and that we could eventually do this in humans.”

Dr Michael Roche of the University of Melbourne and co-senior author of the research, said the discovery could have broader implications beyond HIV, with the relevant white blood cells also involved in other diseases including cancers.

Dr Jonathan Stoye, a retrovirologist and emeritus scientist at the Francis Crick Institute, who was not involved in the study, said the approach taken by the Melbourne team appeared be a major advance on existing strategies to force the virus out of hiding, but further studies would be needed to determine how best to kill it after that.

He added: “Ultimately, one big unknown remains. Do you need to eliminate the entire reservoir for success or just the major part? If just 10% of the latent reservoir survives will that be sufficient to seed new infection? Only time will tell.

“However, that does not detract from the significance of the current study, which represents a major potential advance in delivery of mRNA for therapeutic purposes to blood cells.”

Prof Tomáš Hanke of the Jenner Institute, University of Oxford, disputed the idea that getting RNA into white blood cells had been a significant challenge. He said the hope that all cells in the body where HIV was hiding could be reached in this way was “merely a dream”.

Good one Aussies. Way ahead of the game. Making whooring great again. Great news for those that still participate