Showing posts with label HIV Aids. Show all posts
Showing posts with label HIV Aids. Show all posts

March 12, 2019

Little by Little Scientist Have Been Gaining Ground on HIV/AIDS~Let Me Tell You~












The unnamed “London patient” the second person apparently cured of H.I.V. — earned all the headlines. But other research released this week at the Conference on Retroviruses and Opportunistic Infections showed that scientists are making slow but steady progress on the tactics and medicines needed to fight the epidemic, especially in Africa.

Monthly injections of long-acting H.I.V. drugs proved as good as daily pills at suppressing the virus, according to two trials involving more than 1,000 patients. In another study, Descovy, a new formulation of the H.I.V. treatment Truvada, proved just as effective at suppressing the virus and may have fewer — or at least different — side effects.

                                

A study of the “test and treat” strategy in one million people in South Africa and Zambia — the largest H.I.V. prevention study ever conducted — produced mixed results.

Offering widespread home testing plus treatment to the sickest patients did reduce the number of new infections. But offering immediate treatment to all did not help as much as had been expected. 

And a study of pregnant women in Uganda and South Africa showed that a relatively new drug, dolutegravir, was better than the standard treatment for women about to give birth.

The results of those trials were revealed at the C.R.O.I. meeting in Seattle, a scientific conference held each year in the United States. It tends to offer more research and fewer theatrics than the International AIDS Society conferences that move to new cities around the globe every two years.

Proving that injectable H.I.V. drugs work is important because many people forget to take their daily pills or cannot keep pills in their homes.

The success of the two injectable-drug studies — named Atlas and Flair — raised hopes among H.I.V. experts that these shots may eventually be used to protect the uninfected. (Trials testing that idea are underway now, but results are not expected for about three years.)
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Doctors working in poor countries are eager for injections or implants that will release small daily doses of antiretroviral drugs because the devices can be used in secrecy. Providing injections may be harder than handing out pills, but the option may attract patients with H.I.V. who would otherwise stay away.
A study of pregnant women in Uganda and South Africa found dolutegravir to be more effective in fighting H.I.V. than the standard treatment. 

A study of pregnant women in Uganda and South Africa found dolutegravir to be more effective in fighting H.I.V. than the standard treatment.CreditBaz Ratner/Reuters
African women often say they cannot be caught with pills, microbicides, vaginal rings or other anti-H.I.V. measures because they fear that their husbands, lovers, family members or neighbors will mistakenly assume they are infected.

Long-lasting contraceptive injections like Depo-Provera are much more popular in Africa than in the United States because many women must conceal birth control from their partners, who may get angry that they do not want more children.

Similarly, many gay or bisexual men would welcome a discreet way to take H.I.V. drugs because they are hiding from their spouses or families that they have sex with men.

Both studies tested monthly injections of cabotegravir and rilpivirine deep into the buttocks. The shots worked, and only a handful of participants dropped out complaining they were too painful. Post-trial surveys found that 98 percent of the subjects preferred injections to pills.

In poor countries, cabotegravir may be especially useful because it does not need to be refrigerated.

The clinical trial involving Descovy, a new pill from Gilead Sciences containing a form of tenofovir known as TAF — instead of TDF, the form in Truvada — showed that it suppressed the virus just as well as Truvada did.

People who take Truvada every day as PrEP, or pre-exposure prophylaxis, are almost 100 percent protected against getting H.I.V., whether from unprotected sex or drug injection.

The trial, known as Discover, found that Descovy was slightly less likely than Truvada to harm kidneys or bone density, but other studies have suggested that Descovy is more likely to raise cholesterol.

Gilead said it will soon ask the Food and Drug Administration to let it market Descovy as PrEP. Some AIDS activists worry that people at risk will be urged to switch to Descovy just as low-cost generic versions of Truvada become available.

Truvada has been very safe for most patients, but its high price — now about $20,000 a year — and the red tape needed to help the uninsured pay for it have become major obstacles to ending the AIDS epidemic in the United States.

Gilead has already sold $33 billion worth of tenofovir; it is now shifting its new H.I.V. drug cocktails to TAF, which will remain patented — and, presumably, expensive — for many more years.

The trial in 21 neighborhoods in Zambia and South Africa — a region where H.I.V. infection rates are the world’s highest — was designed to see whether infection rates could be dramatically cut if teams of counselors went door-to-door, testing anyone who agreed and offering pills to anyone testing positive. Counselors also offered advice, condoms, circumcisions, tuberculosis tests and other incentives to lower infection rates during the trial, which is known as PopArt and ran from 2013 to 2018.

It was assumed that communities, where patients were offered treatment immediately, would have by far the lowest rates of new infection. But they did not, even though tests suggested that more people there were taking their pills; further analysis of that quandary will be done, the investigators said.

“PopArt is a head-scratcher,” Mitchell J. Warren, executive director of A.V.A.C., an advocacy group for H.I.V. prevention, said in an email. 

Combining the results of the two main subgroups — those offered pills immediately and those offered pills only when they showed early signs of illness — showed that these strategies lowered new infections by about 20 percent.

Therefore, Mr. Warren said, offering treatment without offering PrEP at the same time “is not the way to epidemic control. Frustrating!”

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The pregnancy trial, called Dolphin-2, showed that 74 percent of women who got dolutegravir-based drug cocktails in their third trimester had no H.I.V. in their blood when they gave birth. Only 43 percent of the women who got older efavirenz-based combinations reached that benchmark.

That was a “highly significant” difference in how fast each drug drove the virus out of the blood, said Dr. Saye Khoo, an H.I.V. specialist at the University of Liverpool who led the trial.

That is important because many women in Africa find out they are infected late in pregnancy, and it can be hard to prevent them from infecting their babies.

Some babies in each test group died, and a few were born infected anyway. The investigators believed the deaths were from unrelated causes like sepsis or pneumonia, and that the rare H.I.V. infections occurred early in the pregnancies before either drug regimen could kick in.
Donald G. McNeil Jr. is a science reporter covering epidemics and diseases of the world’s poor. He joined The Times in 1976 and has reported from 60 countries.

Don't be shy with questions!~~~~~~~

December 3, 2018

Mile Pence Seems to Hate AIDS and The One Affected By It {There Was a President Who Would Not Mention AIDS and delay Treatment for a Year

YES PAPI GIVE ME YOUR LOVE and show me your empty heart full of dogma and ideas of Christ who Love us and gives you love to love us. In The Case of the of the Catholic church and contrary to it who hates the Sin but not the Sinner, Pence hates AIDS and the Homosexual but how about the one with AIDS and Heterosexual?? Adam🦊

Yesterday, in a speech given in advance of World AIDS Day, Vice President Mike Pence didn’t bother mentioning LGBTQ victims of the epidemic. Given what we know of Pence and his anti-gay Christian values, we can’t even call that hypocrisy, much less an oversight. It’s right in line with his character.
The neglect, however, is worth bringing up since conservatives and faith-based groups were the ones who looked the other way while LGBTQ people suffered.
Pink News reports:
Thousands of men who have sex with men lost their lives in the AIDS crisis, with homophobic stigma fuelling social and political rejection on the issue.
Pence failed to wear an AIDS ribbon for the speech and also failed to mention gay people or homophobia.
Instead, Pence recalled stories of straight people who contracted HIV/AIDS from contaminated blood and other sources.
Pence also pledged new funding to “faith-based organisations” who he claims are on “the frontline against HIV/AIDS.”
That makes as much sense as a future headline all about how evangelicals led the way in the struggle to achieve civil rights for LGBTQ people. They were, historically speaking, the obstacle, no matter what they’re doing about it now. 
It’s not the first time that Pence has made a mess of HIV prevention activism: As a congressman back in 2002, Pence condemned condom use as a means to prevent STDs, claiming they were in fact “poor protection,” a statement that contradicts virtually every study on the subject. He also insisted that abstinence was the best means of HIV prevention… which, while technically true, avoided reality. (You can also avoid gun violence by never leaving your bedroom. That doesn’t make it good advice.)
As governor of Indiana, Pence also cut funding for HIV testing and banned needle exchanges, resulting in a predictable — and highly preventable — HIV/AIDS outbreak: the largest in the state’s history.
But what else would you expect when toxic ideology is held to be more important than the facts?
(Image via Shutterstock)

By Patheos



This Angel Doctor is Responsible For Lowering HIV Rates/Deaths in NYC, Young and Gay He Was in The Middle of It



 On a brisk November afternoon at Mount Sinai Comprehensive Care Clinic in Manhattan, Dr. Demetre Daskalakis sat in a brightly lit exam room, clicking away on a keyboard as his next patient walked in. The patient was in his 50s, and his first question was about his mental health. He felt depressed, but he didn’t know why. The patient recently stopped smoking and drinking, and an abdominal pain had him worried. He said his libido was nonexistent, even though he had a regular partner.

“How much of it do you think is because of your brain, and how much of it is because of your penis?” Daskalakis asked. He peppered his patient with questions about the nature of his erectile dysfunction. 

Eventually, Daskalakis discussed the patient’s HIV viral load and CD4 count, markers of the progress of his HIV infection. The patient’s blood tests indicated his viral load remains undetectable — meaning the amount of HIV in his blood is so low, thanks to HIV medications, that he can’t transmit the virus sexually.

                                                                        Demetre Daskalakis speaks at the formal dedication ceremony of New York City AIDS Memorial Park at St. Vincent's Triangle on Dec. 1, 2016.

Daskalakis, 45, updated his patient’s cholesterol medication and wrote him prescriptions for six Viagra tablets and a flu shot. He gave the man a hug goodbye and, before he walked out, said “Text me.”

Daskalakis still sees patients, as he has since the late 1990s, but today he’s just moonlighting as a clinician. The infectious disease specialist squeezes his patients in around the busy schedule of his main job: deputy commissioner for the Division of Disease Control at the New York City Department of Health and Mental Hygiene, one of the world’s largest public health agencies.

                                                                   


Demetre Daskalakis speaks at the formal dedication ceremony of New York City AIDS Memorial Park at St. Vincent's Triangle on Dec. 1, 2016.Erik McGregor / Sipa USA via AP 

Since joining the city’s health department in 2013, Daskalakis has promoted a framework for treatment and prevention strategy that he calls “status-neutral care,” which uses the same approach to initial patient care regardless of one’s HIV status. This type of care is intended to reduce HIV stigma and encourage frank discussions about sexual health, HIV risk and prevention options.

Today, the results of “status-neutral care” are beginning to be seen in public health data. On Thursday, the city released its annual raw data on diagnoses, which showed a record low 2,157 new HIV diagnoses in 2017, a 5.4 percent drop from 2016. The decline is most dramatic among men who have sex with men, whose rate of new infections is estimated to be 35 percent lower than 2013.

‘RADICAL GAY DOCTOR’

Before entering the municipal public health world, Daskalakis earned a reputation as “a progressive, radical gay doctor,” according to Mark Harrington, the executive director of Treatment Action Group, an HIV/AIDS organization.

During a 2012-2013 meningitis outbreak in New York City, Daskalakis went straight to those most at risk — including men who have sex with men, patrons of commercial sex venues and weekenders in Fire Island — and set up a popup vaccine clinic, occasionally dressed in drag as a nurse to take the edge off the injection. The effort was so successful that by August 2013, the outbreak was contained, and officials credited this aggressive vaccination campaign with halting it, according to The New York Times. Shortly after the meningitis campaign, a position opened at the NYC Department of Health for assistant commissioner of the Bureau of HIV/AIDS Prevention and Control. Daskalakis said his “email sort of exploded with people saying, ‘Hey, you should apply for this.’” He threw his hat in the ring and was offered the job, and as he was deciding whether to accept the offer, he said his mind was made up after he received an email from Mark Harrington, saying, “History’s calling. Are you going to answer?”

Harrington recalled telling Daskalakis, “This kind of opportunity won’t come around again, and you’ve got a new [mayoral] administration, you’ve got a governor committed to ending the AIDS epidemic.”

Daskalakis said this made him realized the job offer came at an “opportune moment in the history of HIV in New York City.”

“There was an effort that was motivated by the community to look at New York City and New York State as a place where we could prove that we could end an epidemic of HIV,” he explained.

NEW WAVE OF ACTIVISM

Around 2012, Harrington said it became clear that “we had the tools to bring down the rate of new HIV infections so drastically that it was possible — even without a cure or vaccine — that we could essentially end the epidemic in places where there was access to high-quality treatment and prevention.”

Part of the reason it was possible, he added, was the passage of the Affordable Care Act in 2010, which meant more young people and poor people were eligible for health insurance than ever before.

                                                                               Bottles of antiretroviral drug Truvada.

The way to end the HIV epidemic without a cure or a vaccine, according to Harrington, is by scaling up the use of two novel prevention tools: PrEP and TasP.

PrEP means “pre-exposure prophylaxis,” and it involves taking a daily Truvada pill to prevent HIV infection. Studies proving PrEP works were published in 2011. Since then, the government has recommended that more and more people consider the drug. This November, the U.S. Preventive Services Task Force recommended that doctors assess all Americans’ HIV risk, and counsel patients to take PrEP if they are at risk, including women who recently had any sexually transmitted infection, vastly increasing the number of people recommended to take the drug.

TasP means “treatment as prevention” and is a moniker given to the realization that HIV positive people can’t transmit the virus through sex if they are undetectable. Until 2015, treatment guidelines had HIV patients wait until their immune systems began to weaken before starting medication. Studies proving that starting treatment early helps HIV patients and also blocks transmission were published between 2008 and 2015.

“We were treating people late, and in many cases too late, to block transmission,” Harrington explained. When studies were published proving PrEP and TasP were both safe and beneficial, health bodies around the world overhauled their HIV guidelines and recommended that many millions more people begin taking antiretroviral drugs in order to control the HIV epidemic.

Harrington said this realization drove a “new wave of activism” at the 2012 International AIDS Conference in Washington, D.C. Activists began to talk about an idea that had been abandoned after the failure of HIV vaccine and cure trials: ending the epidemic.

In 2014, soon after Daskalakis joined the NYC Department of Health, New York Governor Andrew Cuomo announced the formation of “Ending the Epidemic,” a task force that would be responsible for devising a plan to use these new tools to draw down the state’s historically high HIV incidence. Daskalakis sat on the panel and was instrumental in developing the state’s robust PrEP program.

‘ENDING THE EPIDEMIC’

“The definition of ending HIV is a mathematical one,” Daskalakis explained. If New York City could get new infections down below 750 a year by 2020, he said new "transmission would no longer be fueling the epidemic."

When Daskalakis started work at the NYC Department of Health, he did so at a moment when it was suddenly possible, with proper inputs of political will and cold hard cash, to use antiretroviral drugs to engineer an end to HIV transmission in the city. The political will of Mayor Bill de Blasio and Governor Andrew Cuomo, he explained, helped secure the funding needed to scale up the distribution of expensive medications like Truvada.

                                                                                          

Some of the language in this new HIV/AIDS prevention paradigm was coined by Daskalakis himself: “status-neutral care.” In an article in Open Forum Infectious Diseases, a medical publication, Daskalakis described status-neutral care as a “multidirectional continuum [that] begins with an HIV test and offers 2 divergent paths depending on the results; these paths end at a common final state,” which is the prevention of HIV transmission.

Daskalakis overhauled the city’s sexual health programs to make them status-neutral. STD clinics were renovated, streamlined and rebranded as “sexual health clinics.”

“All the services had to look alike, whether you're HIV-positive or negative, and the idea was that if you come in and you are newly diagnosed with HIV you get started on meds on the same day of your diagnosis,” he explained. “If you are at risk for HIV, and you test HIV-negative, we don't dilly dally and wait. We start you PrEP that same day.”

Ad campaigns that had attempted to shame people out of contracting HIV instead distilled prevention down to a simple formula: “New boo? Get tested!” That’s because in the status-neutral-care continuum, getting tested is the first step to getting a patient enrolled in PrEP or TasP.

An advertisement from the New York City Department of Health and Mental Hygiene.NYC Dept. of Health and Mental Hygiene / NYC DOHMH

Gone were the scare-tactic campaigns of the Bloomberg administration (one infamous YouTube ad showed a close up view of anal cancer). They were replaced by joyful, brightly colored ads that encouraged people to come in for STD testing. Joining those ads were public awareness campaigns aimed at underserved communities with higher-than-average HIV incidence, like Spanish speakers, transgender women and heterosexual women of color. For the past several years, New York City subways and buses have been plastered with health department PrEP ads.

'REAPING THE BENEFITS'

The success of New York City’s revolutionary HIV prevention program is seen in the city’s declining rate of new HIV infections, but its success stark when compared to jurisdictions that haven’t implemented status-neutral care, or scaled up access to health care. The hotspots of HIV transmission today are in some of the poorest states that have refused to expand Medicaid, like Mississippi.

Daskalakis said his efforts prove the concept works, but he points to the challenges inherent in a model based on the distribution of expensive medications. “A lot of people doing this work are going from, ‘So now we can do it, we know we can,’ to 'How do you create sustainability?'”

Daskalakis describes the city’s new status-neutral-care regime as “the steam engine that's rolling through HIV in New York City and mowing it down in a pretty aggressive way.”

“We're reaping the benefits by consistently seeing HIV incidence decrease,” he said. Last week, in an announcement of the record low HIV incidence, the City of New York said the new data shows it is on target to meet its Ending the Epidemic goals by 2020.

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