Showing posts with label HIV/Undetectable. Show all posts
Showing posts with label HIV/Undetectable. Show all posts

March 7, 2019

Details of The Second HIV-Free Patient With Stem Cell Treatment



Before I start with this report who made headlines yesterday and today, let me say there is nothing new here. It is good that they are trying ways which might have worked in the past but stem cell treatment is no panacea. If a person do not want to suffer from HIV and not transmit it to their sex partner(s) they need to follow Doctors instructions in becoming "UNDETECTABLE". If you have no HIV being detected there is no HIV to transmit to a sex partneer. Everytime you get news like this you run the danger to make people feel there is something else coing next month from what we have today. Why should I go through the trouble of stying undetectable?
Actually injections to be taken once a month so people don't forget their pills which many times is just one or two pill max would be an advance. A vaccine is needed really and it haas nothing to do with a trsansfer of Stem cells.
Getting excited about this particular news does not make a lot of sence since you have only two patients with decades between the two. Yet the case to get excited about is that undetectable is untransmitable. But both the person who came positive and friends and partners need to to teach people about that, just like people have been taught that gays don't all like lipstick and you have more straight men using ladies underwear than gay men unless they are performers or 'Drag-queens'. Most gay men , you can't tell they are gay and is not because they are acting straight, is just the way they are. We also owe a lot of gratitute to those who could be identified as gay beacuse of mannerism or closthes because they are the ones that got the death penalty and beatings first.
{ Page 6} HIV Where are we in HIV?
 HIV being very active in the lymphatic system which they find very cozy. (You can bring the picture to all dark.)

BBC News
A UK patient's HIV has become "undetectable" following a stem cell transplant - in only the second case of its kind, doctors report in Nature.
The London patient, who was being treated for cancer, has now been in remission from HIV for 18 months and is no longer taking HIV drugs.
The researchers say it is too early to say the patient is "cured" of HIV.
Experts say the approach is not practical for treating most people with HIV but may one day help find a cure.
The male London patient, who has not been named, was diagnosed with HIV in 2003 and advanced Hodgkin's lymphoma in 2012. 
He had chemotherapy to treat the Hodgkin's cancer and, in addition, stem cells were implanted into the patient from a donor resistant to HIV, leading to both his cancer and HIV going into remission.
Researchers from University College London, Imperial College London, Cambridge and Oxford Universities were all involved in the case.

'Not an anomaly'

This is the second time a patient treated this way has ended up in remission from HIV.
Ten years ago, another patient in Berlin received a bone-marrow transplant from a donor with natural immunity to the virus.
Timothy Brown, said to be the first person to "beat" HIV/Aids, was given two transplants and total body irradiation (radiotherapy) for leukaemia - a much more aggressive treatment.
"By achieving remission in a second patient using a similar approach, we have shown that the Berlin patient was not an anomaly and that it really was the treatment approaches that eliminated HIV in these two people," said lead study author Prof Ravindra Gupta, from UCL.

Hope of a cure?

By BBC Online Health Editor, Michelle Roberts
Although the finding is exciting, it is not offering up a new treatment for the millions of people around the world living with HIV.
The aggressive therapy was primarily used to treat the patient's cancer, not his HIV. 
Current HIV therapies are really effective, meaning people with the virus can live long and healthy lives. 
But the reason this case is so significant is that it could help experts who are looking for new ways to tackle HIV and achieve a cure. 
Understanding how the body can naturally resist the infection does offer up hope of this, even if it is still a long way off.

Prof Eduardo Olavarria, also involved in the research, from Imperial College London, said the success of stem cell transplantation offered hope that new strategies could be developed to tackle the virus. 
But he added: "The treatment is not appropriate as a standard HIV treatment because of the toxicity of chemotherapy, which in this case was required to treat the lymphoma."

Anti retroviral therapy for HIVImage copyrightGETTY IMAGES
Image captionThe patient was able to stop taking antiretroviral therapy drugs to control his HIV

How does it work?

CCR5 is the most commonly used receptor by HIV-1 - the virus strain of HIV that dominates around the world - to enter cells.
But a very small number of people who are resistant to HIV have two mutated copies of the CCR5 receptor.
This means the virus cannot penetrate cells in the body that it normally infects.
The London patient received stem cells from a donor with this specific genetic mutation, which made him resistant to HIV as well.
But a reservoir of cells carrying HIV can still remain in the body, in a resting state, for many years.
The UK researchers say it may be possible to use gene therapy to target the CCR5 receptor in people with HIV, now they know the Berlin patient's recovery was not a one-off. 
Prof Graham Cooke, National Institute for Health Research research professor and reader in infectious diseases from Imperial College London, said the results were "encouraging".
"If we can understand better why the procedure works in some patients and not others, we will be closer to our ultimate goal of curing HIV. 
"At the moment the procedure still carries too much risk to be used in patients who are otherwise well."

'Potentially significant'

Dr Andrew Freedman, reader in infectious diseases and honorary consultant physician at Cardiff University, said it was an "interesting and potentially significant report". 
But he said much longer follow-up would be needed to ensure the virus did not re-emerge at a later stage.
"While this type of treatment is clearly not practical to treat the millions of people around the world living with HIV, reports such as these may help in the ultimate development of a cure for HIV."
In the meantime, he said the focus needed to be on diagnosing HIV promptly and starting patients on lifelong combination antiretroviral therapy (cART).
This can prevent the virus being transmitted to others and give people with HIV a near-normal life expectancy.

January 24, 2019

Undetectable=Untrabnsmittable ( If By now You don’t know it, you are Ignorant and Condoms don’t cum into this!)




U=U
For almost four decades, researchers have worked tirelessly to find a cure for the human immunodeficiency virus (HIV), which causes AIDS. There’s still more work to do, but a recent commentary published in JAMA [1] by Anthony Fauci, director of NIH’s National Institute of Allergy and Infectious Diseases, and his colleagues serves as a reminder of just how far we’ve come. Today, thanks to scientific advances, especially the development of effective antiretroviral therapy (ART), most people living with HIV can live full and productive lives. These developments have started to change how our society views HIV infection. 
In their commentary, the NIH scientists describe the painstaking research that has now firmly established that people who take ART daily as prescribed, and who achieve and maintain an undetectable viral load (the amount of HIV in the blood), cannot sexually transmit the virus to others. To put it simply: Undetectable = Untransmittable (U=U). 
The U=U message was introduced in 2016 by the Prevention Access Campaign, an international health equity initiative that aims to help end the HIV epidemic and HIV-related social stigma. The major breakthrough in combination ART regimens, which successfully reduced viral loads for many HIV patients, came over 20 years ago. But their importance for HIV prevention wasn’t immediately apparent. 
There’d been some hints of U=U, but it was the results of the NIH-funded HIV Prevention Trials Network (HPTN) 052, published in The New England Journal of Medicine [2] in 2011, that offered the first rigorous clinical evidence. Among heterosexual couples in the randomized clinical trial, no HIV transmissions to an uninfected partner were observed when ART consistently, durably suppressed the virus in the partner living with HIV. 
The data provided convincing evidence that ART not only treats HIV but also prevents the sexual transmission of HIV infection. The public health implications of what’s sometimes referred to as “treatment as prevention” were obvious and exciting. In fact, the discovery made Science’s 2011 list of top 10 Breakthroughs of the Year 
Three subsequent studies, known as PARTNER 1 and 2 and Opposites Attract, confirmed and extended the findings of the HPTN 052 study. All three showed that people with HIV taking ART, who had undetectable HIV levels in their blood, had essentially no risk of passing the virus on to their HIV-negative partners. 
Of course, the success of U=U depends on people with HIV having the needed access to health care and taking their medications as prescribed every day of their lives [3]. ART works by preventing the virus from making more copies of itself. It’s important to note that achieving an undetectable viral load with treatment can take time—up to 6 months. Viral load testing should be performed on a regular basis to ensure that the virus remains at undetectable levels. If treatment is stopped, the virus typically rebounds within a matter of weeks. So, strict adherence to ART over the long term is absolutely essential.
Practically speaking, though, ART alone won’t be enough to end the spread of HIV, and other methods of HIV prevention are still needed. In fact, we’re now at a critical juncture in HIV research as work continues on preventive vaccines that could one day bring about a durable end to the pandemic. 
But for now, there are more than 35 million people worldwide who are HIV positive [4]. With currently available interventions, experts have predicted that about 50 million people around the world will become HIV positive from 2015 to 2035 [5]. Work is proceeding actively on the vaccine, and also on ways to totally eradicate the virus from infected individuals (a “cure”), but that is proving to be extremely challenging. 
Meanwhile, with continued advances, including improved accessibility to testing, adherence to existing medications, and use of pre-exposure prophylaxis (PrEP) in high risk individuals, the goal is to reduce greatly the number of new cases of HIV/AIDS.
References:
[1] HIV Viral Load and Transmissibility of HIV Infection: Undetectable Equals Untransmittable. Eisinger RW, Dieffenbach CW, Fauci AS. JAMA. 2019 Jan 10. 
[2] Prevention of HIV-1 infection with early antiretroviral therapy. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JH, Godbole SV, Mehendale S, Chariyalertsak S, Santos BR, Mayer KH, Hoffman IF, Eshleman SH, Piwowar-Manning E, Wang L, Makhema J, Mills LA, de Bruyn G, Sanne I, Eron J, Gallant J, Havlir D, Swindells S, Ribaudo H, Elharrar V, Burns D, Taha TE, Nielsen-Saines K, Celentano D, Essex M, Fleming TR; HPTN 052 Study Team. N Engl J Med. 2011 Aug 11;365(6):493-505.
[3] HIV Treatment (U.S. Department of Health and Human Services) 
[4] HIV/AIDS  (World Health Organization)
[5] Effectiveness of UNAIDS targets and HIV vaccination across 127 countries. Medlock J, Pandey A, Parpia AS, Tang A, Skrip LA, Galvani AP. Proc Natl Acad Sci U S A. 2017 Apr 11;114(15):4017-4022.
Links:
HIV/AIDS (National Institute of Allergy and Infectious Diseases/NIH)

December 10, 2018

The Black Gay HIV Community Are Reclaiming Their HIV by Celebrating Being Cer0


Larry Scott-Walker and Daniel Driffin can rattle off the date they tested positive for HIV as easily as their birthdays. So can Alfonso Mills.
In fact, so can most of the 1,000-odd members of the group they run in Atlanta to help gay men living with the virus. But they do not simply remember the date – they celebrate it.
In an act of empowerment that may initially make little sense to an outsider, many choose to mark the day that altered their lives with reflection and festivity. In the same way many in the LGBT+ community reclaimed the power of slurs such as “queer,” so too have these men taken control of the day that a generation ago would have meant something much darker. 

They mark their so-called “seroversaries” in different ways – a drink with friends, or a quiet dinner. A woman they know in New Orleans is this year marking her 25th seroversary with a blow-out bash for more than 100 guests.
The name seroversarsy takes its inspiration from several words that have their root in “sero”, which refers to blood serum. Serology is the scientific study of such serum, while the medical and HIV communities use the word serostatus in relation to whether someone is positive or negative.
“Once you’re a person living with HIV, no amount of shame is going to change it, so celebrate it,” says Scott-Walker, 39, one of the group’s three co-founders and the man credited with inventing the word. “Celebrate the way your life has changed since you were tested. I go to the doctor more than ever. A lot of amazing things have happened to me since I admitted I had HIV.”


Mills, 27, the group’s story telling project manager, added: “Mentally, it is so important. It’s a complete change in life. By calling it a seroversary, I focus on the point my life changed.”
The three men – gay, black and living with the HIV virus – are members of Transforming HIV Resentment into Victories Everlasting Support Services, or Thrive SS. It is one of the organisations supported by the Elton John AIDS Foundation, which The Independent and Evening Standard are raising money for this Christmas.
Sir Elton and Evgeny Lebedev, the owner of the newspapers, recently heard from groups such as Thrive after travelling to Atlanta, the Georgia city often touted as the shining example of the so-called new south, but which has HIV infection rates comparable to a number of cities in southern Africa. 


Elton John launches The Independent’s AIDSfree campaign

In the US today, a gay black man has a 50 per cent chance of being diagnosed as HIV positive. In Atlanta, the figure is closer to 60 per cent. Racism, homophobia, poverty and lack of education about HIV are all contributory factors.
Scott-Walker (whose seroversary is 5 June, 2007) says the group, which also has chapters in Washington DC, Oakland, California and Charleston in South Carolina, said Thrive SS was different to many other groups working in the field.
Firstly, the members placed their own experiences – of being gay, black men living in the south and living with HIV – at the heart of the organisation. By doing this, they “prioritise the experiences of our community”. Secondly, they offer 24/7 online support, unlike many government-supported groups that shut up shop at 5pm. 


Daniel Driffin, Larry Scott-Walker and Alfonso Mills’ group stresses authenticity and flexibility

Then, there is the twist that they allow alcohol at their meetings – the third co-founder, Dwain Bridges, describes the atmosphere as being “like a fraternity”. Core aims of the meetings are flexibility and authenticity.
Driffin (19 June, 2008) said the decision to take control of the day they tested positive was because for many, the experience was utterly traumatic. Staff can come across as unsympathetic – in that intense, vulnerable moment, many people feel they are being blamed for what happened.
Driffin, one of the co-founders, said when he was tested, a nurse pushed a piece of paper across the table to him, saying: “You know what that means.”
He said he refused to show any emotion in front of the nurse and walked out and telephoned a close university friend. It turned out she had just learned she was pregnant – something she was not expecting. “I said, ‘I’ve got one on you – I just found out I have HIV’.”
While he was able to share the news with his closest friends, Driffin felt unable to tell his mother for five years. She found out by accident when he posted a public Facebook message that he thought was in a private group. When he saw her three days later, his mother Jeanine offered her support and love. “She said: ‘Why did you not tell me before, so that I could have helped’?”


Scott-Walker said his husband Derrick had been told by the doctor: “I thought we had talked about this”, the inference being – whether the doctor intended it to be or not – that he had somehow done something wrong.
Miller (15 September, 2012) got tested by himself. The nurse told him the results had come back positive. He managed to limit his emotions in the clinic to a single tear, before heading outside, feeling stunned. To try to pretend it was just like any other day, he bought a pet turtle. “I just did not want to think about it,” he said.
The group believes that by focusing on the experiences of the people they are trying to help, they can provide an essential network of support.
Two years ago, Driffin was invited to speak at a Democrat national convention in Philadelphia. 
“I’m living with HIV, and so many others are,” he told the audience. “Who is most at risk? Young, gay black men. Men like me. In fact, one in two black gay men will be diagnosed in their lifetime if the current rates continue. I’m sure black transgender women are more at risk, too.”
He said to beat the disease, it was essential to to ensure “the meaningful involvement of young gay black men at every level”.
“So what do we do to fight HIV/Aids today?” he challenged the crowd.
“As an organiser, as an advocate, as a black man, as a gay man, as a man living with HIV, I ask you: go get tested, and then go vote.”
Money raised from public donations through the AIDSfree appeal will be used to support the Elton John AIDS Foundation projects in six key cities around the world (London, Nairobi, Atlanta, Kiev, Delhi and Maputo). Through UK Aid Match the UK government will double public donations up to £2m to be spent across projects in Maputo and Nairobi.

July 25, 2018

AGAIN: U=U {If You Are Undetectable You are NOT Transmissible} This Is True Anywhere in The Planet

Slide from John Blandford's presentation on Vietnam's K=K campaign
Roger Pebody 

Being Undetectable does not kills you nor your sex partner but the stigma could

In Guatemala, the slogan is “Indetectable = Intransmisible” (I=I); in the Netherlands, it’s “Niet meetbaar = Niet overdraagbaar” (N=N); and in Turkey, “Belirlenemeyen = Bulaştırmayan” (B=B). One of the most striking aspects of yesterday’s pre-conference on “Undetectable = Untransmittable” (U=U), held in advance of the 22nd International AIDS Conference (AIDS 2018) in Amsterdam, was the extent to which the campaign has energized advocates around the world.

“U=U is a fact that every person with HIV around the world should know about,” said Jesús Aguais of AID for AIDS International, an organization working in six Latin American countries. “People have the right to be informed and it is our responsibility to disseminate this information.”

“I can’t believe this information has been known for ten years and I’ve only heard about in the past six months,” commented Lucy Wanjiku-Njenga of Positive Young Women’s Voices. She said that not many of her peer group in Kenya know what U=U means. Those who do know about it heard about it from a friend or on social media, rather than from a doctor or care provider.

The quotes she presented from other young women testified to the impact the U=U message can have:

“This is a message of hope to those living positively. It is the success that comes along with adherence. The victory after all those days you feel like the drugs were a burden. With this, young women can lead a life without worry of infecting their partners.”

“U=U gives young people who acquired HIV through vertical transmission like me a sense of ‘normalness’. For the first time, I see I am not afraid of infecting someone else because I am virally suppressed! I can finally have a fear-free relationship. I am the safest relationship any guy can have!”

Alex Schneider’s organisation Life4me+ works across Eastern Europe and Central Asia. For him, the Russian language slogan “НЕОПРЕДЕЛЯЕМЫЙ = НЕ ПЕРЕДАЮЩИЙ” (Н=Н) is a new tool for advocacy. It can help raise broader public awareness of HIV, reduce stigma towards people living with HIV, undermine self-stigma, increase HIV testing, motivate early initiation of treatment and improve treatment adherence. So far, 60 organisations, including eleven state organisations, have signed on to the statement in the 14 countries of the region.

Nonetheless, there are very real barriers to treatment in the region, including frequent stock-outs of medication. In terms of the 90-90-90 targets, currently 63% of people with HIV are diagnosed, 28% of those diagnosed are on treatment, and 22% of those on treatment are virally suppressed.

In many low- and middle-income countries, viral load monitoring is not routinely available, making it impossible for an individual to be confident that they really are undetectable. U=U provides an additional argument for increasing access to viral load monitoring.

In Vietnam, the Centers for Disease Control and Prevention (CDC) has promoted the slogan “Không phát hiện = Không lây truyền” (K=K). John Blandford of the CDC said that the campaign was conceived as an intervention that would both support changes in HIV care and reduce stigma. The information has been shared via social media, in community meetings and through press coverage.

The community advocacy has helped build support among people with HIV and healthcare practitioners for a switch from CD4 to viral load monitoring. The country’s treatment guidelines are now aligned with K=K, so that a key marker of success is two consecutive viral load test results of less than 200 copies/ml. The proportion of people having their viral load monitored increased from 21% to 73% in a year, with 93% of those on treatment now being virally suppressed.

Science

The pre-conference opened with Anthony Fauci, probably the United States’ most senior HIV research scientist, reviewing the evidence that underpins U=U. Since the mid 1990s, data showing the inverse relationship between the level of virus and the rate of HIV transmission have been accumulating. The introduction of combination therapy “was the definitive moment of U=U and we didn’t even realise it then,” he said.

The research studies HPTN 052, PARTNER 1 and Opposites Attract have provided the strongest evidence. Tomorrow the final results of PARTNER 2, the study which more precisely quantifies the potential for HIV transmission during anal sex, will be presented at AIDS 2018. It is likely to be the most discussed study at this year’s conference.

Nonetheless, Fauci did not feel he needed to wait for these results to state: “The evidence that undetectable equals untransmittable is overwhelming.”

Pietro Vernazza was presented with a lifetime achievement award for the 2008 Swiss Statement he co-authored and other work which has laid the basis for U=U. Clearly moved by the advocates’ response to his work, he went back to the philosophy of science to explain why he felt that the accusation of the Swiss Statement not being founded on evidence was unfair.

If the hypothesis is that HIV can be transmitted when a person is taking effective antiretroviral therapy, then the null hypothesis is that HIV cannot be transmitted in these circumstances. In science, it is the null hypothesis which a researcher aims to disprove or falsify.

He said that the position of the ‘HIV establishment’ had always been the former, that there remains some transmission risk when a person has an undetectable viral load. He said it was up to those who hold that position to find a single documented case of transmission from a person with a durably suppressed viral load.

Vernazza quoted the logical philosopher Irving Copi: “In some circumstances it can be safely assumed that if a certain event had occurred, evidence of it could be discovered by qualified investigators. In such circumstances it is perfectly reasonable to take the absence of proof of its occurrence as positive proof of its non-occurrence.”

Breastfeeding

One remaining area of scientific uncertainty concerns breastfeeding. Eliane Becks Nininahazwe, a woman from Burundi living in the Netherlands, said that many women were waiting for the day when they could feel confident that U=U applies to breastfeeding. “Please people who are doing the science, hurry up!” she said.

Linda-Gail Bekker of the Desmond Tutu HIV Centre said that there are still gaps in the data, but there is clearly a strong relationship between viral load and the potential for transmission.

She pointed to two African cohorts (from Tanzania and Malawi) with a total of 477 infant-mother pairs in which no HIV transmissions have occurred from mothers with a plasma viral load below 100 copies/ml. However, some transmissions occurred in the latter study from women whose viral load would be described as ‘undetectable’ using a higher cut-off. This could be due to viral load being detectable between the (relatively few) occasions when it was measured, or due to reservoirs of virus in breastmilk that can’t be eliminated by antiretroviral therapy.

Even if she could not be definitive, Bekker said that her take-home message was that women taking HIV treatment who have an undetectable viral load have shown very little risk of HIV transmission. Weighing up the multiple benefits of breastfeeding for the infant with this low transmission risk, she said that it was appropriate that women in low- and middle-income countries continue to be recommended to exclusively breastfeed for six months after birth.

Pietro Vernazza said he had reviewed the same body of evidence to consider recommendations for the high-income setting of Switzerland. For an optimal scenario of a woman who was adherent to her medication and had a suppressed viral load of below 50 copies/ml throughout pregnancy and breastfeeding, his group had not been able to identify any confirmed cases of HIV transmission. While there are still gaps in the data, this risk needs to be considered alongside the proven benefits for all infants, such as fostering contact between mother and child, the anti-inflammatory and antimicrobial substances contained in breastmilk, and the development of the gut microbiota.

Given clinicians’ uncertainty about the balance of potential harms and benefits, he suggested that a shared decision-making approach was appropriate. Breastfeeding should not be actively promoted to women living with HIV in Switzerland, but women who choose to breastfeed should be supported by their clinical teams, in particular with adherence support and regular viral load monitoring.

Messaging

How can organisations describe U=U in a way which is meaningful to people living with HIV, their sexual partners and the general public? Whereas the concepts of ‘treatment as prevention’ (TasP) and ‘universal test and treat’ (UTT) are rooted in public health and describe the impact of widespread treatment in a population, ‘undetectable = untransmittable’ focuses on the individual. The slogan has already reached far more people living with HIV than the idea of TasP ever did, but the language used is complex and may not reach the widest audience.

Michael Brady said that it was in 2016, after the second release of data from the PARTNER study, that the UK organisation the Terrence Higgins Trust decided it had a responsibility to share the information in a clear and definitive way. They would have to evolve the language, so that it would be clear, concise and easily understood, he said.

A number of slogans were tested, including “Yes we are sure”, “This changes everything”, “Won’t pass it on” and “Can’t be passed”. Two made it to the shortlist – “I’m not a risk” (which resonated most with people living with HIV) and “Can’t pass it on” (which had greater purchase with the wider public).

It was the latter slogan which has been taken forward. Without a larger than usual budget, it has been one of Terrence Higgins Trust’s most successful campaigns in terms of reach and exposure, especially on social media. Brady attributed this to the simplicity and definitiveness of the message, as well as the support of community advocates.

Nic Holas of the Australian online organisation the Institute of Many said that having people with HIV understand U=U was only half the battle. They needed their sexual partners and potential sexual partners to understand it as well. A particularly important audience are pre-exposure prophylaxis (PrEP) users and his organisation has developed a series of videos in collaboration with Dynamix International, one of the main companies importing generic PrEP medication to Australia, the UK and elsewhere.

While PrEP and U=U are often described as having synergies, he pointed to tensions between the two approaches. Some PrEP users remain fearful of and stigmatising towards people with HIV, he suggested. They prioritise their new found freedom but ignore the fact that PrEP could only be developed “after people with AIDS put their bodies on the line”.

“In the age of PrEP, people living with HIV must not shy away from taking up space and ensuring our voices are heard,” he said. “It is not enough to end the HIV epidemic with PrEP and leave us isolated, criminalised and stigmatised.”

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