Second Patient Achieves Hiv Remission After Stem Cell Transplant
In March 2019, University College London and Imperial College London announced that a patient known as the London patient had also been cleared of HIV following a stem cell transplant to treat Hodgkins lymphoma.
The donor, like the donor in the first, Berlin patient case, had two copies of the CCR5-delta32 genetic mutation. The patient stopped ART 16 months following the transplant and his blood viral load remained undetectable 18 months later.
University of Cambridge Professor Ravindra Gupta, who led the study while working at UCL, said: 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.
Hiv Education And Approach To Sex Education
In 2013, 20 countries in the region committed to improving sexual and reproductive education for young people. In 2016 governments reaffirmed this commitment and agreed on a roadmap that would enable 95% of adolescents and young people to have comprehensive HIV prevention knowledge by 2020.81
As of July 2019, 14 countries had achieved one of the key indicators providing comprehensive sexuality education and life skills in at least 40% of primary and secondary schools. All were implementing CSE training programmes for teachers.82However, there are questions surrounding the quality of information, teaching and training in some contexts.83
People Who Inject Drugs
Kenya, Madagascar, Mauritius, Mozambique, South Africa, Tanzania and Uganda are all home to significant populations of people who inject drugs . Although regional data is limited, country surveys among people who inject drugs suggest high HIV prevalence.44 Overall, just under a third of people who inject drugs in the region are estimated to be living with HIV.45 It is estimated that this population group accounted for 8% of new HIV infections in the region in 2018.46
In Kenya, HIV prevalence among people who inject drugs was 18% in 2011, compared to 5.6% among the general population.47 In Tanzania it is estimated that 15.5% of people who inject drugs are living with HIV48, with HIV prevalence among women who inject drugs thought to be higher than among their male counterparts.49
In 2018, an estimated 21.8% of people who inject drugs in South Africa were living with HIV.50 A 2015 study in five South African cities found 32% of men and 26% of women who inject drugs regularly shared syringes and other injecting equipment and nearly half reused needles.51
Evidence from Kenya, Mauritius, Seychelles and Tanzania suggests many people who inject drugs acquire HIV before the age of 25.52
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World Aids Day: Progress Made But More Needed
The 1st of December marks World Aids Day and this years theme is Know Your Status. UNAIDS estimates that more than 9.4 million people living with HIV still do not know their status. This year also marks the 30th anniversary of the day which was initiated by the World Health Organization in 1988. So, what strides have been made in treating the virus? One person who has worked for many years on the issue of HIV/AIDS is Monsignor Robert Vitillo.
The First Drug To Treat Hiv Is Approved
The FDA approves the first medication for the treatment of HIV, an antiretroviral that was first developed in the 1960s to treat cancer. Its approval launches a new era of drug development.
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Category : Clients Who Face Ongoing Daily Challenges
The seventh category consisted of art therapy with clients who face ongoing daily challenges that do not fall into one diagnostic category .7). Three studies have been conducted since 2008, two of which address issues such as stress, distress, and burnout of individuals working in various health professions . These studies were carried out without randomization in one study there was a control group , whereas in the other there was not . The sample size ranged from 20 to 60 participants. The therapeutic process lasted 913 sessions in a group art therapy setting. These studies suggest that art therapy can help healthcare professionals reduce levels of stress, anxiety, and burnout connected to their work.
Prisoners And Hiv In East And Southern Africa
Although data is limited, East and Southern Africa is thought to have one of the highest rates of HIV prevalence among prisoners in the world at just under 30%.53 This is reflective of high HIV prevalence in the general population and the continued criminalisation of key population groups. It is also due to the fact that prisons are high risk environments for HIV transmission, fuelled by over-crowding, limited access to health care, drug use, unsafe injecting practices, sexual violence, unprotected sex and tattooing.54
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Longer Lives For Those With Hiv
People with HIV in high-income Western countries are now living longer and healthier lives, thanks to the effective antiretroviral drugs introduced in the 1990s. However, its important to note that the death rate among HIV-positive people continues to be higher than HIV-negative people. Most deaths in HIV-positive individuals are connected to late detection of the disease.
Induce And Reduce: Our Approach To Hiv Cure
HIV is a sneaky virus that can persist in a small population of cells even while its spread to new cells is being suppressed by ARVs. Unless we can find a way to expose hidden HIV and selectively target these cells, well continue to require chronic treatments to keep the virus at bay. Thats why cure research currently underway by Qura Therapeutics and ViiV Healthcare targets these pockets of virus through the concept of induce and reduce.
This strategy is first focused on driving HIV hidden in human immune cells to make viral proteins that allow the cells with HIV to be recognised . Once cells harbouring HIV are exposed, drugs can then tag these reservoir cells for elimination by the host immune system . The Induce and Reduce agents will all be given while people are on suppressive ARV therapy to protect healthy cells from the virus. While it may sound straight forward, it has been a major challenge to reactivate the virus in animals or people in an effective and safe way.
The research required to develop an HIV cure is complex and requires a commitment to the long-term. As we look ahead to the future, were optimistic that the initial steps weve taken towards establishing our approach to HIV cure will move from the laboratory into clinical studies in people, big steps in the long journey to finding a cure for HIV. It is our lifes work to end the HIV epidemic, and we will be here until HIV isnt.
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Does This All Mean We Will See An Hiv Cure In 2021
Well, this September, the FDA approved the first human trial investigating CRISPR gene editing as an HIV cure. And while this doesnt mean we will see a cure immediately, this showcases the progress researchers and scientists have made towards ending HIV as a global health threat.
Excision BioTherapeutics will begin trials, a first-in-human Phase I/II trial, to evaluate the safety, tolerability, and efficacy of EBT-101 as a potential functional cure in healthy individuals living with HIV. EBT-101 uses CRISPR to excise HIV wrapped around DNA in cells, which has been challenging to treat and is primarily why past curative efforts have not succeeded. Harnessing adeno-associated virus at a relatively low rate, this therapy uses one dose to deliver treatment.
It is great to see that both a vaccine and a cure are possible and even likely in our futures with these advancements.
Category : Trauma Victims
The fourth category included art therapy with clients coping with trauma .4). In this category, two studies have been conducted since 2004, both with randomization . The first study was composed of a sample of 45 students who participated in two art therapy sessions. These students had dealt with a traumatic event, which could occur at different levels of intensity and at various stages in their lives. In addition, the comparison was made between an art-therapy group and two comparison groups where one underwent writing therapy and the other experimented with artwork, regardless of the traumatic event. Despite the attempt to use a wide range of indices, including symptom reporting and emotional and health assessments, and perhaps because of the short duration of therapy, this study failed to find significant results.
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People With Diagnosed Hiv In The Us And Dependent Areas By Region Of Residence 2019*
*Rates per 100,000 people.
a American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.b In the 50 states and the District of Columbia.c The term male-to-male sexual contact is used in CDC surveillance systems. It indicates a behavior that transmits HIV infection, not how individuals self-identify in terms of their sexuality.d Includes infections attributed to male-to-male sexual contact and injection drug use .
The Future Of Hiv And Aids In East And Southern Africa
Tackling the HIV epidemic in East and Southern Africa is a long-term task that requires sustained effort and planning from both domestic governments and the international community.
In order to meet UNAIDS 2020 targets, between 2019 and 2020 the region must diagnose 1.1 million people living with HIV who did not previously know their HIV status, start an additional 3 million people on ART, and ensure an additional 3 million people living with HIV achieve viral suppression.140
Girls and young women must be placed at the centre of the response if the region is to drastically reduce HIV. This means meaningfully addressing gender inequality and inequity, tackling harmful traditional practices such as child marriage, and increasing educational opportunities.141
Insufficient financial resources, combined with the lack of strategic information, has led to many high-impact HIV prevention programmes not being implemented to the necessary standard or scale in the region. These systems must be strengthened to enable the regions HIV response to be evidence-based, and ultimately more effective.
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Hiv/aids Still A Real Concern
Monsignor Vitillo, who serves as the attaché on health for the Permanent Observer Mission of the Holy See to the UN in Geneva says, we still need to maintain our concern certainly, a lot of progress has been made in terms of helping people who know that theyre infected get access to anti-retroviral treatment, which means that they can live in a more healthy way and for much longer, so thats good progress. But, he goes on to say, we still have an elevated number of new infections in the world, and points out that more people need to be tested and diagnosed and therefore, be put on treatment.
Treatment Toxicity And Regimen Simplification
With the success of modern cART and the trend towards earlier initiation of treatment, long-term treatment toxicities, including psychiatric, metabolic, renal, bone and cardiovascular issues, are increasingly being recognized as important contributors to discontinuation of treatment and/or increased morbidity, especially in the ageing HIV population. The search for safer and better-tolerated ART options continues. One agent in late-stage development is tenofovir alafenamide, which is a prodrug of tenofovir disoproxil fumarate. Tenofovir alafenamide at a dose of 25mg provides enhanced delivery of tenofovir to lymphatic tissues, which results in significantly enhanced concentrations of tenofovir diphosphate in peripheral blood mononuclear cells and 90% lower circulating tenofovir compared with administration of a standard 300mg dose of tenofovir disoproxil . When single-tablet regimens of elvitegravir, cobicistat, emtricitabine and either tenofovir disoproxil or tenofovir alafenamide were compared in treatment-naïve subjects, the tenofovir alafenamide treatment arm showed similar rates of viral suppression at week 48 and significantly lower bone mineral density change and lesser increase in serum creatinine in comparison to the tenofovir disoproxil-containing STR arm .
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Continuing The Quest For An Hiv Vaccine
Despite all the progress in HIV treatment, development of an effective HIV vaccine has proved to be elusive. But vaccine research continues. Janssens late-stage, mosaic-based vaccine candidate, which is expected to see initial results from the phase 2b Imbokodo study as early as this year. As of July last year, all 2,600 patients in the study have been fully vaccinated.
What Are The Types Of Hiv/aids Medicines
There are several different types of HIV/AIDS medicines. Some work by blocking or changing enzymes that HIV needs to make copies of itself. This prevents HIV from copying itself, which reduces the amount of HIV in the body. Several medicines do this:
- Nucleoside reverse transcriptase inhibitors block an enzyme called reverse transcriptase
- Non-nucleoside reverse transcriptase inhibitors bind to and later change reverse transcriptase
- Integrase inhibitors block an enzyme called integrase
- Protease inhibitors block an enzyme called protease
Some HIV/AIDS medicines interfere with HIV’s ability to infect CD4 immune system cells:
- Fusion inhibitors block HIV from entering the cells
- CCR5 antagonists and post-attachment inhibitors block different molecules on the CD4 cells. To infect a cell, HIV has to bind to two types of molecules on the cell’s surface. Blocking either of these molecules prevents HIV from entering the cells.
- Attachment inhibitors bind to a specific protein on the outer surface of HIV. This prevents HIV from entering the cell.
In some cases, people take more than one medicine:
- Pharmacokinetic enhancers boost the effectiveness of certain HIV/AIDS medicines. A pharmacokinetic enhancer slows the breakdown of the other medicine. This allows that medicine to stay in the body longer at a higher concentration.
- Multidrug combinations include a combination of two or more different HIV/AIDS medicines
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B Inching Closer To A Twice
Gilead is expected to complete regulatory filings this year for their long-acting self-injectable HIV treatment lenacapavir. Gileads long-acting injectable only has to be injected once every six months, a far cry from the daily oral treatments.
If approved, the HIV-1 capsid inhibitor will be the first approved treatment of its kind and is meant for heavily treated patients who have become resistant to multiple drugsa particularly difficult-to-treat group of patientsin combination with other treatments.
The anticipated regulatory filings will come on the heels of Gilead releasing topline results from the phase 2/3 CAPELLA trial of 36 patients. The data showed that patients receiving lenacapavir were significantly more likely to meet the studys primary endpoint of a 0.5 log10 or greater reduction in viral loada marker chosen to measure a relevant change in the amount of virus a patient hascompared with placebo.
Condom Availability And Use
Condom availability varies widely by country, with only five countries meeting the United Nations Population Fund regional benchmark of 30 male condoms distributed per man per year between 2011 and 2014.76 Overall in 2015 in sub-Saharan Africa , the estimated condom need was six billion male condoms, but only about 2.7 billion condoms were distributed.77
Condom use at last sex among adults with more than one sexual partner in the past 12 months is low, estimated at 23% among men and 33% among women in 2015. 78 However, condom use varies substantially among countries. In 2018, it ranged from 13% among men in Madagascar to 85% among men in Zimbabwe. Among women, it ranged from 5% in Madagascar to 76% in Lesotho.79 Condom use among men who pay for sex is generally higher, at about 60%.80
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Pharmacogenomics To Identify/minimize Toxicity
A hypersensitivity syndrome associated with the NRTI abacavir was first described in the premarketing phase of drug development and was characterized by fever, malaise, gastrointestinal symptoms and later rash on first exposure, with severe hypotension and shock on rechallenge ,. The discovery of an association between abacavir hypersensitivity and the human leukocyte antigen class I allele HLA-B& 57:01 and its translation into routine HIV clinical practice as a guideline-endorsed preventive screening strategy has created a roadmap for pharmacogenomic translation ,. Since the introduction of routine HLA-B& 57:01 screening prior to abacavir prescription, true immunologically mediated abacavir hypersensitivity has disappeared . Other ART toxicitypharmacogenomic relationships that have been explored in detail and reproduced amongst different groups include CYP2B6 and uridine diphosphate glucuronyltransferases polymorphisms and efavirenz exposure/pharmacokinetics and atazanavir-associated unconjugated hyperbilirubinaemia, respectively . Some studies have suggested relationships between genetic polymorphisms and discontinuation related to ART-related adverse events . One small study successfully reduced the dose of efavirenz in patients with the CYP2B6 516GT polymorphism using adjunctive TDM . The CYP2B6 516GT polymorphism is particularly prevalent in Black African and African American populations , and PK studies have demonstrated higher exposure in these populations .
How It Could Be Done For Others
Brown and Castillejos cures, as transplants, were so-called allogenic, meaning that the HIV-resistant cells came from another person. Better would be autogenic transplants, in which immune system cells are taken from a person with HIV, genetically altered in the lab dish to make them resistant to HIV, and then re-introduced. This type of procedure by treatment advocate Matt Sharp, who underwent one.
The repertoire of gene therapies is not restricted to CCR5 deletion. Gene therapy is immensely versatile, and could be used in a number of ways.
Instead of using gene therapy to make cells resistant to HIV, it could directly repair defective genes in cells by means of cut-and-paste technology such as CRISPR/Cas9. This is already being used in trials for some genetic conditions such as cystic fibrosis and sickle-cell anaemia. Given that HIV-infected cells are also defective in the sense that they contain lengths of foreign DNA that shouldnt be there, they are amenable to the same molecular editing. Early trials have produced promising results but the challenge, as it has been in a lot of gene therapy, is to ensure that the cells containing DNA are almost entirely eliminated.
“Timothy Ray Brown and Adam Castillejo were both given bone marrow transplants from donors whose T-cells lacked the gene for the CCR5 receptor.”
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