The Obama Administration has often been criticized for not doing enough in the global fight against HIV/AIDS, particularly when compared to the aggressive strides made by his predecessor, George W. Bush. In some ways, the criticisms carry weight as funding for HIV/AIDS programs has remained largely stagnant in recent years, with greater focus placed on either "repurposing " or optimizing funds already in place.
Yet despite these criticisms, one fact remains clear: the U.S. continues to contribute the lion's share of funding to the global HIV/AIDS initiatives -- as much as two-thirds, according to Anthony Fauci of the National Institute of Allergies and Infectious Diseases (NIAID).
The Obama administration recently highlighted this disparity by offering to commit up to $5 billion over three years to the UN-led Global Fund to Fight AIDS, Tuberculosis and Malaria if partner countries contributed two dollars for every one dollar the U.S. sends.
The men, who were both suffering from lymphoma and had undergone experimental stem cell transplants in October 2012, had been declared clear of the virus in July 2013. However, latest reports show that the virus reappeared in one of the men in August, while the second experienced rebound in November.
The news scuttled hopes that the procedure might open new doors to the eradication of HIV from the so-called "latent reservoirs" of the body. In this state, HIV lies dormant within a host cell, invisible to the body's immune defenses and little affected by antiretroviral therapy.
South Africans awakened this morning to the news that Nelson Rolihlahla Mandela, former-president and beloved human rights icon, has died at the age of 95. The hours since his passing at 8:50pm on Thursday, December 4 have been one of somber reflection for many, both here in South Africa and abroad, who have long held Mandela as a symbol of hope, freedom, dignity and tolerance.
His contributions to HIV/AIDS, most notably the founding of the Nelson Mandela Children's Fund and his 46664 charity, helped usher the country out of an era of deep governmental denialism into one that today operates the largest free antiretroviral program in the world.
What is being felt here on the ground is not so much a sense of grim resignation or despair, but rather a feeling of shared gratitude for helping lead the country to a place where it can move forward, positively and productively, well after his death.
A tribute to Mandela if ever there was one.
In what can only be described as an unprecedented blunder, the World Health Organization (WHO) apologized for reporting that half of new HIV infections in Greece were self-inflicted by those wanting to obtain a $1000 per month governmental benefit.
The WHO has since claimed that an editorial error in the 184-page report -- entitled the Review of Social Determinants and the Health Divide in the WHO European Region -- was the cause for the gaffe, and insists that they meant to say that half of all new infections were "self-inflicted" through intravenous drug use.
Neurocognitive impairment is frequently associated with long-term HIV infection, affecting more than 50% of HIV-infected people, with conditions ranging from mild memory loss and deterioration of fine motor skills to more serious disorders like AIDS dementia complex.
While the mechanism for this impairment remains less than certain, it has long been postulated that neurotoxins secreted by HIV-infected cells may cause nerve cell death, gradually (and sometimes profoundly) deteriorating synaptic pathways in the brain.
A new study from the University of Minnesota Medical School suggests that this may not be the case. According to research published in the Journal of Neuroscience, a specific protein called Tat (or transactivator of transcription) is actively shed by HIV-infected brain cells and, rather than killing nerve cells, causes an over-stimulation of the neural network as the protein binds with and effectively alters synaptic connections in the brain.
Since 1988, December 1 has been designated as World AIDS Day, and in keeping with this year's theme, "Shared Responsibility: Strengthening Results for an AIDS-Free Generation," we'd like to offer a few suggestions on what you can do to help move forward this global HIV/AIDS initiative:
1. Educate and protect yourself. Start by learning the facts and by doing a personal risk assessment to better understand your personal vulnerabilities to HIV infection.
2. Get tested. With advances in therapy now affording people near-normal life expectancy and good quality of life, it's more important than ever to get tested. Find your nearest testing center (many of which offer free, anonymous, rapid HIV testing) through the AIDS.gov Service Locator.
Despite impressive strides made in recent years to reduce the number of HIV transmissions worldwide, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reports that a number of key targets are likely to be missed as donor funding continues to stall, while at-risk populations remain ever-vulnerable to HIV infection and illness.
In a report released on November 20, UNAIDS officials cite troubling signs in regions where access to essential HIV services is lagging -- most specifically in Eastern Europe and Central Asia, where infection rates have increased by 13% since 2006; and in the Middle East and North Africa, where HIV infections have nearly doubled since 2001.
Investment in these regions have simply not kept pace, say officials, particularly when instituting programs targeted to stigmatized populations such as men who have sex with men (MSM), injection drug users (IDUs), transgendered people, or commercial sex workers (CSWs).
In fact, according the report, many of these groups continue to be blocked from accessing HIV services, despite a staggering increase in the number of new infections each year.
Injection drug users (IDUs) have long been considered a group at increased risk for HIV acquisition, particularly in parts of Eastern Europe and Russia where injection drugs continue to be the major route of transmission.
By and large, we tend to associate injection drug use with heroin (or a combination of crack and heroin). And while these drugs continue to be the most commonly injected substances, there has been a concerning shift in drug use patterns among IDUs in recent years.
According to a report published by Public Health England (PHE), the use of image and performance-enhancing drugs (IPEDs) like anabolic steroids and psychoactive substances like crystal methamphetamine is on the rise, with the risk of transmission equal to that of heroin users who share needles.
In fact, in some region, users of IPEDs now represent the single, largest group of individuals accessing needle exchange programs, with nearly one in 10 having been exposed to either HIV, hepatitis B or hepatitis C. Meanwhile, the report indicates an alarming, three-fold increase in the use of injectable amphetamines or amphetamine-like substances such as mephedrone among IDUs.
It will take more than an increased coverage of antiretrovirals to bring an end to the AIDS pandemic, said a panel of experts at the inaugural Lancet/Cell Translational Medicine Conference on HIV Research in San Francisco.
"For us to achieve a truly 'AIDS-free' world requires only one thing," said Bruce Walker of the Ragon Institute of MGH, MIT and Harvard, "the development of an HIV vaccine."
Despite a growing perception among some that an end to the epidemic is within reach -- a view conveyed by Luis Loures of UNAIDS back in September -- the panel of vaccine researchers were adamant that only a protective vaccine could fully reverse global HIV infection rates.
While annual HIV transmissions have fallen by some 50% in recent years, 2.5 million people are still being infected each year, with rates increasing in parts of Eastern Europe and Central Asia, as well as among vulnerable men who have sex with men (MSM), injection drug use (IDU), and migrant populations.
"The need for an HIV vaccine is urgent," said Julie McElrath, Director of the HVTN Laboratory Program and Seattle Vaccine Trials Unit. "Antivirals are only an interim strategy. They can slow the epidemic, but they cannot stop it."
"Finally" was the first word that came to mind when it was announced yesterday that the U.S. House of Representatives approved the HIV Organ Policy Equity Act, which had been authorized by the Senate way back in June.
The bill allows for the transplant of otherwise healthy organs between HIV-positive donors and HIV-positive recipients only. The bill will also provide funding for further research into potential complications from such transplants, including any changes to viral dynamics (such as the potential for superinfection or viral rebound) or the effects of post-operative immunosuppressive therapy on individuals with already-compromised immune systems.
However, early research from South Africa seems promising. A paper published in 2012 showed that, among 26 positive-to-positive kidney transplants at Groot Schuur Hospital in Cape Town, results have been incredibly good, with patients showing few post-operative complications while sustaining complete viral suppression for up to four years.
Currently, there is a backlog of 121,000 people awaiting organ transplant in the U.S. The bill could potentially curb that demand by providing 500 or more additional transplants each year. And with high incidence of HIV/hepatitis C co-infection in the U.S., the need for liver transplants ranks high among people living with HIV.
The bill awaits final approval from President Obama before being officially signed into law.
Photograph from Official U.S. Navy Imagery is in the public domain at http://www.flickr.com/photos/usnavy/5765456097.