A debate has been raging on social media since the release of an op-ed last week in which Dr. Max Pemberton, a noted U.K.-based physician and author, stated that he'd "rather have HIV than diabetes."
While some might argue that the ensuing controversy has been something of a tempest in a teacup, several of our leading HIV/AIDS researchers have thrown themselves head-first into the fray.
On the one side, Dr. Kenneth Mayer of Harvard University believed that Pemberton's statement did a disservice to both diseases, particularly since HIV is transmittable disease with its own set of issues, while diabetes is not. Furthermore, Mayer argued that Pemberton, a mental health specialist, based his assertions on U.K. prevalence rates, where HIV affects around 77,000 people versus 1.1 million in the U.S.
On the other side, Dr. Joel Gallant of the HIV Medical Association believed that Pemberton didn't necessarily mean to diminish HIV as a "non-issue," but rather highlight the effectiveness of modern HIV therapy when compared to drugs used to treat diabetes.
Both sides are right.
As further evidence that Sovaldi (sofusbuvir) is a real game changer in treating hepatitis C (HCV) infection, early research from the U.S. National Institute of Allergy and Infectious Diseases (NIAID) has demonstrated that the combination of Sovaldi and the experimental HCV drug ledipasvir has resulted in a 100% cure rate in patients co-infected with HIV and HCV genotype 1.
Traditionally, people coinfected with HIV have not responded as well to interferon-based HCV therapies, so it has been considered vital to develop interferon-free therapies for this and other hard-to-treat groups.
The NIAID study was comprised of 50 HIV-positive individual, most of whom were in infected with HCV genotype 1a (considered one of the more difficult HCV types to treat). Participants were either on antiretroviral therapy (ART) or untreated with stable CD4 counts and low HIV viral loads. While 25% had advanced liver fibrosis, none had cirrhosis.
All participants were treated with Sovaldi/ledipasvir for a period of 12 weeks. By week four, 100% of both the treated and untreated group reached an undetectable HCV load, with continuing undetectable levels four weeks after termination of therapy (the definition of an HCV "cure").
At a time when many are a proclaiming that we, as a society, are overcoming the stigma and social barriers related to HIV, a new study from the University of Chicago suggests that we may still have some way to go.
According to the research published in the March 17th issue of Journal of the American Medical Association Internal Medicine, 49% of 1,351 Americans surveyed suspect that HIV was an intentional act of conspiracy linked to the U.S. Central Intelligence Agency (CIA). The study, which looked at medical conspiracy theories relating to HIV and other diseases, was part of an online survey conducted from August to September 2013.
The selection of participants was weighed to best represent the U.S. population by age, ethnic group, income and gender, while the results were correlated to determine how and if any of the beliefs affected a person's health behavior.
Among the findings:
- 49% either strongly believe or question whether the CIA deliberately infected a large number of African Americans under the guise of hepatitis vaccinations.
There has inarguably been no bigger turnaround in HIV public health policy than in South Africa, which emerged from the rampant AIDS denialism of former-President Thabo Mbeki to become what is today the world's largest and most ambitious public antiretroviral (ARV) initiative.
So profound has this turnaround been that the perception among some is that the South African HIV epidemic is largely under control or that we, as an international community, are somehow approaching the proverbial "end of the tunnel." And why shouldn't anyone believe this, given that many -- including Luis Loures of the Joint United Nations Programme on HIV/AIDS (UNAIDS) -- are now predicting that the end of the epidemic in nigh?
To be fair, many of the statistics support the argument. Since the start of the ARV roll-out in 2003, South Africa has made some incredible inroads, with the latest CDC data indicating an overall 25% drop in new infections and a 50% reduction in child HIV infections (the latter of which is largely due to highly effective mother-to-child interventions).
But that paints only a part of the picture. The fact is that, here in South Africa, the country remains at a critical crossroads, with not only the largest HIV population in the world (6.4 million), but massive obstacles yet to overcome.
Chief among these are the rising HIV prevalence rate which, according to the country's Human Science Research Council (HSRC), has increased from 10.6% in 2008 to 12.2% in 2012. While this figure is, in part, due to the increased longevity of those living with HIV, underlying it is the astonishing number of new infections each year. In 2012 alone, the HSRC reported 470,000 new diagnoses -- or nearly 1,100 new infections every day. That's 100,000 more than was seen just one year earlier in 2011.
Earlier in March, we explored the impact of the Uganda's Anti-Homosexual Act of 2014, suggesting that the widening of the government's anti-gay laws was directly linked to the rise of HIV infections within the country. It seemed a fair assumption, given that Uganda is today the only country in all of Central and East Africa to see a rise in infections, with Health Cabinet Minister James Macharia reporting that many of the clinics servicing gay men and other at-risk populations have been closed.
Just this Friday, the Associated Press (AP) reported that Ugandan police raided the U.S.-funded Makerere University Walter Reed Project (MUWRP) building in the capital of Kampala. The facility, which provides antiretroviral therapy (ART) to gay men, among others, was targeted for "training youths in homosexuality" -- this according to Ofwono Opondo (pictured), the deputized head of the government's Uganda Media Centre.
We've reported recently on efforts to activate so-called "latent HIV reservoirs," considered essential to what many had hoped would be an eventual cure. By providing shelter to latent forms of HIV, these cellular reservoirs enable the virus to quietly replicate along with the host cell, shielded from immune detection.
It has long been postulated that by activating these reservoirs, the viruses would be forced out into the open to where they could be eradicated with currently available antiretroviral drugs and other techniques. Without the ability to do so, many believe that an eradicating cure (as opposed to a functional cure) cannot be achieved.
In recent years, a class of drugs called HDAC inhibitors have shown much promise in achieving activation, including one Danish study which appeared so positive as to elicit claims that a cure would be seen "within months."
A new study from John Hopkins University has largely dashed those hopes.
We have to admit that it gives us a moment's pause whenever we hear someone dismiss HIV stigma as being a thing of the past, suggesting that we, as a society, have somehow moved beyond the judgments or derision regularly directed at people living with HIV.
Admittedly, in many regards, things have improved. The near-hysterical fear and "blame game" associated with the disease back in the 1980s and 90s have diminished significantly with the increased public awareness about HIV. At the same time, efforts to provide HIV legal protections have improved vastly in recent years (including the ending of U.S. ban on HIV-positive immigration in 2011 and the extension of the Americans with Disabilities Act to people with HIV).
But does this necessarily mean that attitudes have changed, or that those infected with the disease no longer have anything to fear but fear itself?
A new survey published by the Public Religion Research Institute (PRRI) suggests that we still have a long way to go in dismantling the stigmas related to HIV, particularly in some key church-going populations.
While the research is still early, a recent study conducted by investigators at the Centers for Disease Control and Prevention (CDC) demonstrates a possible, new approach to preventing HIV in women after sexual exposure.
In the March 12 issue of Science Translational Medicine, the CDC team led by Dr. Walid Heneine showed a single application of vaginal microcidal gel was able to prevent infection in five of six macaque monkeys exposed to a virulent strain of SHIV (a combined form of HIV and simian HIV). The 1% ratelgravir gel was applied vaginally three hours after sexual exposure and demonstrated rapid action in significantly reducing the vaginal viral load.
On Thursday, the Centers for Disease Control and Prevention (CDC) reported that a 46-year-old Texas woman had "likely acquired" HIV through sex with her 43-year-old, HIV-positive female partner. Genetic testing of the woman's virus showed a 98% match to that of her partner, while a number of risk factors that could have contributed to infection (e.g., injecting drug use, multiple partners) have been largely excluded.
If further investigation supports these findings, the case will be one the rare instances whereby HIV transmission has been linked directly to sex between two women.
In the aftermath of the report, some in the social media have begun to asked whether we've been underestimating the risk of woman-to-woman HIV infection, and if the rules of HIV prevention have now somehow changed.
By now, many people will have read about the second case of an HIV baby "cure," wherein an HIV-infected baby born in Los Angeles was reportedly cleared of the virus after receiving three-drug combination antiretroviral therapy (cART). This latest case appears, at least on the surface, to replicate a similar event last year in which a Mississippi baby given cART within 30 hours of birth and now appears virus-free without the use of HIV medications.
Within hours of the news brief at last week's Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, many in the media were quick to suggest that the latest case proves beyond a shadow of a doubt that cART at the time of birth can "functionally cure" HIV-infected babies.
But is this necessarily what the study tells us, or are we perhaps jumping the gun a bit?