Aids Prevention

30 May 2013
Last updated at 10:19 ET

By Jane Dreaper
Health correspondent, BBC News

Scientists handle thousands of blood samples every year at the HIV vaccine laboratory in London

A fresh effort to find a vaccine for HIV is beginning at laboratories in a London hospital and two centres in Africa.

Scientists are recruiting 64 healthy adult volunteers for the trial, which is expected to take up to two years.

The work will be split equally between London, the Rwandan capital Kigali and Nairobi in Kenya.

This early trial is being run by the International Aids Vaccine Initiative (IAVI), a non-profit organisation.

The principal investigator, Dr Jill Gilmour, who has worked at the laboratory at Chelsea and Westminster Hospital since its founding in 2001, says she is optimistic that the Aids virus can eventually be tackled with a vaccine.

‘Formidable beast’

The virus is now 30 years old, and the search for a vaccine has proved elusive so far.

Continue reading the main story

“Start Quote

I believe it’s not if, it’s when we will have an effective HIV vaccine”

End Quote
Dr Jill Gilmour
IAVI human immunology laboratory

However, an American-backed trial in Thailand found in 2009 that a combination of two vaccine prototypes was 30% effective in preventing HIV infection.

Follow-up trials are being planned with the aim of improving those initial results.

In the IAVI trial, volunteers who are free of HIV and not at risk of catching the infection will receive a combination of two vaccines.

One of them is derived from a weakened version of Sendai, a flu-like virus that infects rodents. It will be administered through nasal drops.

This is because in the early stages of infection, both HIV and Sendai affect the mucosal tissues, which are found in the nose and also in the genital area.

Dr Gilmour said: “I believe it’s not if, it’s when we will have an effective HIV vaccine. There is now strong scientific data to support that position.

Dr Jill Gilmour is a founding member of the laboratory, which began work in 2001

“We will get there but vaccine development takes time. It’s not for the faint-hearted.

“Bear in mind that with polio, it was 45 years from discovering the virus to getting an effective vaccine.

“HIV is a formidable beast with sneaky tricks. It changes every time it divides, so it’s highly variable. And it can integrate into your own cells, so your immune system can’t see it.”

The trial is early work known as Phase I, meaning that the aim is to ensure the vaccine is safe and induces an immune response.

Dr Gilmour added: “Delivering the vaccine into the nose has public health benefits, because we’re not using needles.

“If we see strong immune responses, we go into the larger second phase of testing whether the vaccine is effective in reducing transmission or lowering the load of the virus.

“The Sendai product is modified from a virus which affects rodents, including hamsters. From our perspective, it’s a bonus that this virus has lived in the human environment without causing us harm.”

The hospital laboratory in London freezes and analyses many thousands of blood samples

The IAVI laboratory at Chelsea and Westminster handles almost 100,000 blood samples a year and has supported more than 20 other vaccine trials.

Its work includes sending test kits to sub-Saharan African countries at the heart of the Aids epidemic, carefully tracking the thousands of blood samples that it holds and ships elsewhere, and ensuring the data and paperwork from trials is rigorously monitored, so the results from different sets of tests can be pooled.

Jason Warriner, clinical director at the Terrence Higgins Trust, said: “We welcome investment in the search for a vaccine against HIV. This research is in its very earliest stages. Clinical trials take several years to complete and, even if the vaccine passes this first stage of tests, more research will be needed over the course of many years.

“Although an HIV vaccine has so far remained stubbornly out of reach, we now understand how to prevent transmission better than ever before.

“A combination of widespread condom use, regular testing for HIV, and getting those with the virus onto the right treatment, could drastically reduce HIV within a generation.”

Article source: http://www.bbc.co.uk/news/health-22719391#sa-ns_mchannel=rss&ns_source=PublicRSS20-sa

Related MedlinePlus Page

By Julie Steenhuysen

CHICAGO (Reuters) – The National Institutes of Health on Thursday halted a study testing an experimental HIV vaccine after an independent review board found the vaccine did not prevent HIV infection and did not reduce the amount of HIV in the blood.

The trial, started in 2009, is the latest in a series of failed HIV vaccine trials. The study, called HVTN 505, had enrolled 2,504 volunteers in 19 U.S. cities, and was looking at men who have sex with men and transgender people who have sex with men.

“This trial has provided a clear, swift answer about a specific vaccine strategy. It’s not the answer we hoped for, but the search doesn’t end here,” Mitchell Warren, executive director of the nonprofit group AVAC: Global Advocacy for HIV Prevention, said in a statement.

“Researchers need to unpack the data from this trial to understand more about why this strategy didn’t prevent infection,” he said.

The review board has recommended that no further vaccinations be given. The National Institutes of Allergy and Infectious Disease, which sponsored the study, said it would continue to follow study participants to further evaluate the trial data.

The HVTN 505 trial tested a two-part vaccine strategy designed to first prime the immune system and then provide a vaccine “boost.”

The vaccine itself was based on a common cold virus that was used to sneak HIV genes into the body and grab the attention of the immune system.

So far, there are no vaccines approved to prevent infection with the human immunodeficiency virus or HIV, the virus that causes AIDS.

Several HIV trials are still in the works or in planning stages, including a follow-up to a Thai trial which in 2009 showed a vaccine combination cut HIV infections by 31.2 percent. Although the finding was not strong enough to approve the vaccine, it offered the first glimpse that a vaccine could work.

Both of these vaccines – the one in the Thai study and the HVTN 505 study – are largely designed to train immune system cells known as T-cells to recognize and kill cells already infected with HIV.

Researchers are studying other approaches, including vaccines that activate powerful antibodies to prevent HIV from infecting cells in the first place.

Matthew Rose, a vaccine advocate for AVAC who participated in the HVTN 505 study, said he remains hopeful in the search for a vaccine.

“These results do not change the fundamental view that an AIDS vaccine remains critical to any long-term strategy to end the AIDS epidemic,” Rose said.

(Reporting by Julie Steenhuysen; Editing by Cynthia Osterman and Vicki Allen)

Article source: http://www.nlm.nih.gov/medlineplus/news/fullstory_136274.html

Results likely due to very low levels of product use with young, single women least likely to use strategies

Three antiretroviral-based strategies intended to prevent HIV infection among women did not prove effective in a major clinical trial in Africa. For reasons that are unclear, a majority of study participants — particularly young, single women — were unable to use their assigned approaches daily as directed, according to findings presented today by one of the study’s co-leaders at the Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta.

The Vaginal and Oral Interventions to Control the Epidemic (VOICE) study, or MTN 003, was designed to evaluate the safety and efficacy of three HIV prevention strategies compared to placebo. The trial tested an investigational vaginal gel containing the antiretroviral drug tenofovir, a pill form of tenofovir (brand name Viread), and a pill containing a combination of tenofovir and emtricitabine (brand name Truvada). The study was sponsored and largely funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

In the trial, the three strategies were tested among 5,029 sexually active women 18 to 45 years of age at 15 sites in South Africa, Uganda and Zimbabwe. Nearly half of the study participants were under the age of 25, and most were unmarried (79 percent).
Participants in each of the three groups were counseled to use their assigned pill or gel once daily and received free condoms, ongoing counseling on how to reduce their HIV risk, and testing and treatment for sexually transmitted infections. Prior to enrollment, all potential study participants engaged in an oral and written consent process explaining the details of the study.

Study results presented today indicate that most VOICE participants did not adhere to the daily use schedule. Moreover, single women 25 years of age and younger were the least likely to use the investigational products and the most likely to become infected with HIV. The rate of new HIV infections among these young women was nearly 10 percent at some of the study sites in South Africa, reflecting a very high incidence of HIV infection among young women in these communities.

“We do not know why many participants in the VOICE study did not adhere to daily use of these HIV prevention strategies,” said NIAID Director Anthony S. Fauci, M.D. “We must continue to conduct research to find additional HIV prevention tools that women will find acceptable and use consistently to protect themselves against infection.”

In other HIV prevention studies involving different study populations, including men and women, both oral Truvada and oral tenofovir have demonstrated an ability to reduce the risk of HIV infection when used consistently. However, the VOICE study results are consistent with another clinical trial known as the FEM-PrEP study, which tested daily use of oral Truvada among a similar population of women. Like the VOICE study, researchers found that the majority of FEM-PrEP participants did not follow the daily regimen.

The VOICE study, which launched in 2009, was led by co-investigators Zvavahera Mike Chirenje, M.D., of the University of Zimbabwe in Harare, and Jeanne Marrazzo, M.D., M.P.H., from the University of Washington, Seattle. In fall 2011, oral tenofovir and tenofovir vaginal gel were dropped from the VOICE trial after separate routine reviews of the study data by an independent data and safety monitoring board determined that while each product was safe, neither was effective in preventing HIV compared with placebo. Researchers continued to evaluate oral Truvada until the study’s scheduled conclusion in August 2012. Results presented today at the CROI meeting by Dr. Marazzo provided an analysis for each of the study’s three product arms.

Of the 5,029 women who enrolled in the VOICE study, 312 became infected with HIV for an overall 5.7 percent rate of new HIV infections — reflecting a very high overall rate of infection among women in these areas. Twenty-two women were found to be HIV-infected at time of enrollment; therefore, the study’s primary analysis was based on 5,007 participants.

There was no statistically significant difference in the rate of new infections between women assigned to the three investigational products and women using placebo. Among the 994 women who were assigned to daily use of Truvada, 61 women became infected with HIV (4.7 percent rate of new infections) compared with 60 of 1,008 women who became infected in the oral placebo group (4.6 percent rate of new infections). Of the 1,002 participants in the daily oral tenofovir group, 60 women acquired HIV. However, the rate of new HIV infections was calculated to reflect what had occurred up until Oct. 3, 2011, when study sites began informing participants that testing of oral tenofovir would end. At this time, 52 women acquired HIV (6.3 percent rate of new infections) compared with 35 of 1,008 women who became infected in the placebo arm (4.2 percent rate of new infections). Of the 1,003 women assigned to use daily tenofovir gel, 61 became infected with HIV (5.9 percent rate of new infections), and 70 infections occurred among the 1,000 women in the placebo gel group (6.8 percent rate of new infections). Women who became infected with HIV during the VOICE study were referred to local sites for appropriate medical care and treatment.

During the course of the study, adherence to each of the three approaches was anticipated to be roughly 90 percent based on what study participants reported to clinic site staff and monthly counts of unused gel applicators and leftover study pills that were returned to the sites. However, in a blood sample analysis of 773 participants, including 185 participants who became HIV-infected, it became clear that adherence was low across each of the study’s three investigational product groups. Drug was detected in the blood of 29 percent of the women in the Truvada group, 28 percent in the oral tenofovir group and 23 percent among those in the tenofovir gel group. When examining the data by age, young, single women were less likely to use their assigned treatment strategy. For example, among the women assigned to use oral Truvada, drug was detected in the blood of only 21 percent of young, single women compared to 54 percent of those married and over the age of 25.

“Based on our findings, it is clear that young, single women in Africa continue to be at very high risk for HIV infection and may need the greatest assistance with using prevention strategies consistently,” said Dr. Marrazzo. Among VOICE study participants, the rate of new HIV infections was nearly 9 percent among unmarried women under the age of 25 compared to 0.8 percent for older married women, a statistically significant difference.

Through two ongoing behavioral studies involving VOICE participants, researchers are hoping to gain insight as to why the women did or did not use the investigational products. Results from those two studies are expected later this year.

NIAID funded the VOICE study with co-funding from the National Institute of Mental Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, also part of the NIH. The trial was conducted by the NIH-funded Microbicide Trials Network (MTN). Gilead Sciences, Inc., of Foster City, Calif., donated the tenofovir and Truvada tablets. CONRAD of Arlington, Va., provided the tenofovir gel and applicators used to insert the product.

For more information about the VOICE study, see the MTN site .

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

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Article source: http://www.nih.gov/news/health/mar2013/niaid-04a.htm

News from HPA (Health Protection Agency) has disclosed that almost 100,000 people have the human immunodeficiency virus (HIV) in the UK. Also it is believed that as many 25% more are unaware that they are HIV positive. This is the highest that it has ever been since it was highlighted in the early 80’s.
In 2011 HIV was diagnosed in 6,280 people. It was also said that over half of the cases were infected whilst in the UK, whereas nine years before it was only 27%. Results also showed that homosexual males acquiring the virus had increased as well, 3,010 were recorded. As many as 1 in 20 males that have same sex encounters in the UK have HIV, with the number rising alarmingly to 1 in 12 amongst those in the London area. This said almost half the cases were from heterosexual relationships.

HIV does cause erectile dysfunction problems as the HIV infection can affect sexual activity; this also includes some of the antiretroviral medication. Viagra and Cialis tablets are able to help with ED suffered by HIV patients with advice sought from a health practitioner.

Dr Valerie Delpech works for the HPA in her capacity as a consultant epidemiologist, monitoring HIV cases in UK. The increase in HIV cases is a marker that people still need to be reminded about safe sex regimes and that programmes that are in place are still upheld.

‘The good news is that with the excellent services and treatments available nowadays, if diagnosed and treated early someone with HIV can look forward to a normal lifespan, as well as protecting their sexual partners from infection. That’s why it is vitally important that anyone who has been at risk gets an HIV test, and that those in higher risk groups get screened regularly.’ said Dr Delpech.

It is not only those at risk that need to be educated still on the importance of how to avoid acquiring HIV, but also Doctors, so that screening tests and advice is offered to patients.

National HIV testing week was held between 23-30 November this year in a precursor to World AIDs Day that falls on the 1st December each year. It was the first time that a week has been dedicated to getting anyone that wanted the test to come forward and have it done.

There are certain groups of people that carry a higher chance of getting HIV; this tends to be from the African community, bisexual and homosexual men. Also more than 25% of these groups are not aware that they have HIV, so they could be spreading the infection unknowingly.

This is a preventable disease and those unfortunate enough to acquire it, can with early detection and medication lead a long and normal life. Regular testing is the main way to ensure that you have not got it and that you are not passing it on, also protecting yourself against it being transmitted.
It is the recent rise of cases amongst the heterosexual population that is more worrying, as it has been thirty years almost since the hugely publicised scare stories of epidemics pointed at the gay sector of society. It has been mainly this community that has done the most good to educate, fund research and help stem its progress.

Written by Frances Cerulean

Uk-Med are an online clinic registered with the Care Quality Commission in the United Kingdom. They diagnose and treat ED (Erectile Dysfunction) problems and can prescribe treatments Please see http://www.uk-med.co.uk/Drug-Info/Viagra for more details or http://www.uk-med.co.uk/Drug-Info/Cialis

Article Source: http://www.uk-med.co.uk/Health/People-In-The-UK-Living-With-HIV-Reaches-A-Record-High