The Future of HIV: Novel Treatment Options & A Possible Cure

As the medical community and those it serves welcomed in a new year, it brought with it the hope of scientific advancements that will alter the course of certain disease states. These advancements include the use of stem cells to treat to treat macular degeneration, novel microscopic techniques to capture images of the brain, the continued observed effectiveness of the experimental Ebola vaccine, and countless other interventions aimed at creating a healthier global society. Included in these optimisms for 2019 is the possibility for novel treatment options and a possible cure for one of the world’s leading causes of death, HIV. The stories of Timothy Brown – the only individual ever to be cured of HIV, the Mississippi baby and Clark Hawley – both having an extended period of time with undetectable HIV viral load with an interruption of Antiretroviral Therapy (ART), and the Boston patients/Mayo Clinic patient – all three having undetectable HIV viral loads for an extended period of time after a stem cell transplant, have brought much sanguinity to health care professionals and patients alike. However, these exciting results have been unable to be replicated in the majority of the population suffering from HIV and remain unique in their respective occurrences. Although ART has been vital to the HIV community in terms of longevity and quality life, there are still certain populations that are seeking other mechanisms to treat this infectious disease – and, of course, always coveting the idea of a cure. The following is a brief glimpse at the vast pipeline that awaits 2019 and the anticipations of the global healthcare community.  

Combination Approaches

  1. The AIDS Clinical Trial Group (ACTG) is currently exploring the option of combining vorinostat, a HDAC inhibitor along with tamoxifen, which is an FDA approved medication the treatment of breast cancer for postmenopausal women. Utilizing this approach is thought to prevent the reactivation of HIV in CD4+ cells that are latent in addition to increasing the latency-reversal effect of vorinostat through tamoxifen.
  2. Researchers from the USA, France, Germany, Italy, Spain, Switzerland, and the UK are collaborating for a trial testing the combination of two HIV vaccine candidates alongside a monoclonal antibody called vedolizumab. This method of treatment is thought to target a certain protein in the body, α4β7 integrin, that plays a role in transmission of HIV into CD4+ cells. In a macaque model, this combination has shown the control of SIV (HIV but in simians) after discontinuing ART.
  3. At the University of Minnesota, researchers are testing infusions of natural killer (NK) cells with the administration of cytokine interleukin-2 (IL-2). The researchers are hoping to add to the evidence of NK cells being able to exhaust HIV reservoirs and to control virus replication.
  4. In a version of the “kick & kill” method of curing HIV, researchers in Oxford and Barcelona are using a medication to active the latent HIV reservoir while boosting the immune response 1000 times stronger than the usual to rid the body of the virus. Preliminary results showed that 5/15 patients had undetectable viral loads for seven months without ART.

Immunotherapy Approaches

  1. Immunocore, a company founded in Oxford with heavy investment by Bill Gates, has designed T cell receptors that seek out and bind with the HIV virus. These receptors then instruct immune T cells to eliminate any HIV-infected cells, even when the levels happen to be extremely low. Since levels can be rather low in the reservoir of HIV virus that exists in an infected individual, this is a promising lead to completely remove this retrovirus from the body. This immunotherapy has shown to be effective in human tissue samples, but no results being tested in humans have been released.
  2. In France, a company known as InnaVirVax has established a vaccine, VAC-3S, that allows the body to stimulate a production of antibodies against the HIV protein 3S. This, in turn, causes T cells to attack the virus. This is considered a novel approach because it encourages the immune system to recover while equipping it with the tools to continue fighting off the virus. VAC-3S has completed Phase 2a trials, and is partnered with a DNA-based vaccine from FIT Biotech, a Finnish company, that both parties believe can lead to a functional cure.  
  3. In a recently initiated trial, IMPAACT 2008, held in the USA, Botswana, Brazil, and Zimbabwe, a broadly neutralizing antibody termed VRC01 is being investigated for its effectiveness in infants with HIV who are also started on ART within 12 weeks of birth. Although the study aims at establishing the safety profile for VRC01, it is also observing the difference in the HIV reservoir compared with only ART.

Novel Antiretroviral Agents

  1. The manufacturer, ABIVAX, believes it has developed a compound that may help the immune system recognize cells infected with HIV by allowing an increased presentation of HIV antigens on the cell’s service. This would lead to an augmented immune response to abolish these infected cells. This compound has been labelled ABX464 and targets the HIV protein Rev, which is responsible for the transcription of HIV RNA. Reductions of measured HIV DNA have been reported from 25% to 50% in eight of the fifteen patients participating in the study; however, no delay in viral load rebound was found when compared with placebo.
  2. Gilead has created a novel mechanism of targeting the HIV virus through the capsid inhibitors class. Capsids are involved in protecting HIV RNA and related proteins, and capsids also breaks down to release the viral contents into CD4 cells which enable reverse transcription to take place. The novel agent by Gilead, GS-CA1, blocks both the assembly and disassembly of capsids that create non-infectious and defective viruses.

Gene Therapy

  1. Chimeric antigen receptor (CAR) T therapy has been re-initiated in the first cure related clinical trial of this approach in people living with HIV who are on ART. CAR T cell therapy involves the modification of an individual’s T cells that can target antigens of interest. The specific cells modified by the initiative in China, called VC-CAR-T cells, have been modified to target HIV gp120. These modified cells were able to induce the destruction of HIV-infected cells, including latently infected cells exposed to latency-reversing agents, in the laboratory setting.  
  2. With the knowledge of knowing that about 1% of the world’s population is immune to HIV due to a genetic mutation on the gene that encodes for CCR5, US-based Sangamo has begun to edit DNA to introduce the aforementioned mutation. The CCR5 protein is attached to the surface of CD4 cells that allows HIV to enter and infect the cell; with the mutation, it would be impossible for HIV to enter cells. This company extracts patient’s CD4 cells in order to use zinc finger nucleases to edit patient’s DNA to make them resistant to HIV.
  3. Although a highly controversial topic amid the recent publication of the use of CRISPER in twin daughters in China, scientists believe that this tool can lead to a cure for HIV as it is believed to be a much easier, faster, and effective approach than other gene-editing methods. However, the majority of the global health community is in agreement that years of laboratory research and ethical standards need to be established before human trials are properly started.

With the HIV virus adapting and mutating to evade treatments almost as rapidly as the world is producing novel approaches to treating this infectious disease, the drive for continued research and testing should be relentless. These aforementioned examples of novel treatments and possible cures display the creative and diverse thought processes the medical community has put forth to tackle one of the most stigmatized diseases on this earth. However, the ethics behind these trials need to be sound and forthcoming for all of humanity. The trials that occur need to ensure an assortment of demographics including individuals from both developed and developing nations – a subtle form of medical colonialism has no place in the global health community. In addition, trials that enroll patients who willingly accept the benefits and risks associated with the experimental therapy have the moral obligation to supply lifetime treatment if it happens to be effective. The researchers and medical professionals who monitor these participants need to take extreme caution in ART interruptions/discontinuations and certify that the patients realize what complications could transpire due to them. Finally, and most importantly, the interventions that show promise of novel ways to approach HIV or even a cure have to be accessible, affordable, and available to all humans who suffer from HIV. The health inequalities that plague this fragile planet have already been clearly highlighted in this ailment throughout history; the global health community is in debt to humanity for a cure for all when discovered.  

With the global health community’s commitment, the future of the HIV virus continues to transition from infectious disease to chronic disease. While the step that will advance the chronic disease to a cure is still thought to be unknown, the excitement behind the aforementioned gene editing therapy is substantial. The ability to safely, effectively and ethically modify human cells to prevent the entry of the virus into the immune system is certainly the most promising option recently and possibly from this disease’s initial appearance; although, health care professionals haven’t quite figured out how to combine these aspects yet. A cure or even functional cure may be years away, but the global health community needs to continue to accompany those inflicted by this chronic infectious disease to meet the hopes and expectations of alleviating the burdens of HIV.

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Challenges Accessing PrEP for HIV Prevention in England

The successful integration of HIV prevention programs that increase testing and offer early treatment for infected individuals is contributing to reductions in new HIV infections. By 2016, the 5,164 HIV diagnoses in gay and bisexual men living in England represented an 18% decline compared to the 6,286 diagnosis in 2015.  Secure integration of pre-exposure prophylaxis (PrEP) will continue to reduce infections. HIV prevention programs need to address persistent barriers and doubts however, including limited access of PrEP in England. Continue reading “Challenges Accessing PrEP for HIV Prevention in England”

IH News Global Health Weekly News Round-Up

Politics and Policies:

  • Burundi is introducing the second dose of measles vaccine in its vaccination campaign in order to strengthen its efforts to fight preventable diseases.
  • China has stated that it will assist Cameroon in its fight against malaria as well as to strengthen health policies.
  • Angola parliament approves main lines of 2013 budget bill. A third of it will be spent on education, health, social welfare and housing.
  • African government’s will implement a health scorecard to reduce child deaths. This monitoring system publicly collects and reports health data.
  • Ghana is planning to establish its Health Insurance Learning Center to provide expertise and training on health insurance to many countries and institutions across the world.
  • China plans emergency measures to control Beijing air pollution. The rules will formalize previous ad-hoc measures including shutting down factories, cutting back on burning coal and taking certain vehicle classes off the roads on days when pollution hits unacceptable levels.
  • Negotiations on the Minamata Convention on Mercury (in Switzerland) among the delegates of 140 United Nations member states state that mercury added products like batteries, switches, thermometers etc. may not be manufactured, imported or exported no later than 2020. Mercury-added dental amalgams are also to be phased out. But certain mercury-added products are to be exempted from ban- like products for military and civil protection, products used in religious practices and some vaccines (with thimerosal) etc.
  • The Food and Drug Administration (FDA) has approved a new type of flu vaccine which is made with a process that does not require the virus to be grown in chicken eggs. This will make it available weeks earlier in the event of a pandemic.

Programs:

  • In order to prevent, strengthen, and mobilize the society on HIV/AIDS risks, a project “Proactive” was presented in Angola by the Population Services International (PSI). It will target prostitutes, lorry drivers and gays.
  • In collaboration with UNAIDS, Tango organized a two-day workshop on combating stigma and discrimination in HIV/AIDS for Civil Society Organizations.
  • To provide treatment to the needy heart patients mainly children and elderly, the Emirates Heart Group has launched humanitarian missions in Sudan, Egypt and Bosnia.
  • Guinea worm eradication program is coming to its completion. The reports show that the cases of the parasitic disease were reduced by nearly half in 2012.
  • For increasing awareness on road traffic safety the Riders for Health-the Gambia (RFH) and the British High Commission have established a Training-cum Resource Center in Gambia.

Research:

  • According to a study done by the researchers of UK, US and Germany, eating with seven servings a day is linked to peak mental well-being.
  • A study states that the HIV infection rate has declined among the pregnant females in the Republic of Congo from 3.4 percent in 2009 to 2.8 percent in 2012.
  • According to the World Health Organization, the cases of measles have fallen by 75 percent since 2000 but the rate of vaccination is still quite low to progress towards its complete eradication.
  • A study states that the HIV infection rate has declined among the pregnant females in the Republic of Congo from 3.4 percent in 2009 to 2.8 percent in 2012.
  • A report states that the Somali women living in Minnesota for 20 years or more have their cultural traditions about pregnancy and birth. They continue to resist cesarean sections, prenatal care and family planning.
  • A study published in PloS One states that South Africa pays a high cost to treat both drug-resistant and drug-sensitive tuberculosis. It states that drug resistant tuberculosis in South Africa consumed about 32% of the total estimated 2011 national TB budget of $218 million.
  • A simple radiographic scoring system has been suggested as it is found to reliably rule out active pulmonary tuberculosis in smear negative HIV – uninfected patients. It will potentially reduce the need for further testing in high burden settings.
  • A study published in the New England Journal of Medicine states that a 48-week course of antiretroviral medication taken in early stages of HIV infection slows the damage to immune system and delays the need for long term treatment.
  • According to a study bats are reservoirs for Ebola virus in Bangladesh.
  • Studies have shown that the cactus fruit could treat diabetes, help to lower cholesterol and have high levels of vitamin C.
  • A study published in Plos One states that majority of the high risk population in a setting in rural China have been diagnosed with a Cardiovascular Disease related disease. Majority of them did not take any cardiovascular disease drugs and very few of them took some drugs to prevent the diseases.
  • A study done in University of Gothenburg, Sweden, states that amputations among people with diabetes can be reduced by 50%. They stated that simple interventions like shoe inserts, podiatry, regular check-ups and other simple interventions can help to reduce it.
  • A new infection caused by ticks similar to Lyme disease has been found in 18 people in southern New England and upstate New York. According to the study published in the New England Journal of Medicine, this sickness could be infecting more than 4,300 Americans a year with flu-like symptoms and relapsing fevers.
  • According to a study vitamin D3 supplements are as effective as influenza vaccine. The study published in the American Journal of Clinical Nutrition states that those school children who took vitamin D3 supplements were 64 % less likely to contract seasonal influenza A viral infection.

Diseases and Disasters:

  • A recently introduced five-in-one vaccine against diphtheria, pneumonia, tetanus, hepatitis B and Hib meningitis have raised health concerns among the doctors in India.
  • The Public Health Laboratory Services Branch (PHLSB) of the Center for Health Protection (CHP) of the Department of Health Hong Kong, has confirmed a case of New Delhi metallo-β – lacatamase-1 (NDM-1) Carbapenemase-producing Enterobacteriaceae in a 26 year old female.
  • The Department of Health (Hong Kong) has released a warning on a oral product named ‘Chashoot’. They say that it may contain undeclared Western drug ingredients that are dangerous to health.

Global Health Weekly News Round-Up

Politics and Policies:

  • Supreme Court upholds President Obama’s health-care law.
  • South Africa adopts 2.5 micron meter (PM 2.5) ambient air quality standards to maintain public health.
  • Indian government proposes new health mission with a focus on the health challenges of people in towns and cities.
  • For uninsured in Texas, Supreme Court ruling adds to uncertainty.
  • Some GOP-led states plan to resist health care law, as ruling reins in Medicaid expansion.
  • Ottawa earmarks $238M for health data research.

Programs

  • The Bank Windhoek Cancer Apple Project sold a total of 87400 apples and raised N$1.3 million for the Cancer Association of Namibia (CAN).
  • Swim across America raises $400K for cancer research.
  • The Prem Rawat (TPRF) Foundation has awarded US$20,000 to cover the costs of a garden-installation program in challenged Niger. These gardens provide fresh produce for the school children lunch.
  • The Primate’s World Relief and Development Fund (PWRDF), with financial support of the government of Canada begins 5-year $2million healthcare program that will focus on preventing HIV/AIDS and tuberculosis among pregnant women in the Ngqushwa district of the Eastern Cape, South Africa.
  • The International Youth Fellowship (IYF) has launched 2012 World Youth Camp in Accra. The aim behind it is make the youth stay away from acts that might lead to violence and conflicts during the coming elections. It will include free medical screening and lectures.
  • A polio campaign from June 29 to July 1 in Lunda Norte Province (Angola) is estimated to vaccinate about 250,000 children from ages 0 to 5.
  • Looking at the health and safety problems of the children, Nestle, Africa vows action on coca child labor in Ivory Coast.
  • Equatorial Guinea offers food aid to Somali famine victims.
  • Workshop on malaria control under way in Ethiopia. This year’s National Malaria Control Programme (NMCP) Best Practice Sharing Workshop will acknowledge the progress made in managing malaria (particularly at community level).
  • Global action for healthy communities without illicit drugs theme marked the celebrations of International Day against drug abuse and illicit drug trafficking in Gambia.
  • ‘Love the Gambia foundation’ donated medical equipment’s worth £150,000 to the Ministry of Health and Social Welfare of Gambia.
  • A team of IBM experts presented a plan to the Kenyan Ministry of Health and the United States Embassy in Kenya to encourage more women to request screening for cervical cancer.
  • Ghana to give USD1m to tackle neglected endemic tropical diseases in order to protect the gains made by the country in Guinea Worm eradication and the elimination of trachoma.
  • Uganda Red Cross Society seeks Sh4.5 Billion for Budada district to provide the people with sanitation kits, hygiene kits, latrine slabs, and safe clean water and sanitize them to prevent any disease outbreaks like diarrhea and dysentery.
  • “Neighbors’ eye” program in Rwanda to help eradicating drug abuse.
  • Hong Kong’s first anti-cancer drug (for liver cancer) granted with US FDA IND.
  • Nepal gets $8 million from UN peace building fund. This funding will used for the activities such as mobile health camps, health services inside the cantonments.
  • Cordillera (Philippines) administrative region children to receive free rotavirus vaccination.
  • Canadian Institutes of Health Research (CIHR) and Children with Intestinal and Liver Disorders (CH.I.L.D) create Canadian Children Inflammatory Bowel Disease Network.

Research

  • A study published in Lancet describes a treatment option for the people living with HIV/AIDS. The quad pill includes an integrase inhibitor, which is meant to stop the virus from replicating.
  • A study published in the Journal of AIDS confirms that the Shang Ring is safe to use and demonstrates that men should exceed the recommended timing for removing the device. This requires only one visit for the procedure and it stays in place for 7 days after the procedure.
  • According to a recent study the pregnant women in Lilongwe and Malawi need to be informed of their increased risk for HIV and the importance of using condoms throughout pregnancy and the postpartum.
  • A study conducted by the New Zealand’s Ministry of Agriculture and Forestry (MAF) has found that children’s intake of iodine has significantly improved since the mandatory bread fortification policy.
  • A team of scientists from the National University of Singapore’s (NUS) Department of Biological Sciences and Mechanobiology Institute have discovered how a drug – Lead compound- can deprive cancer cells of energy and stop them from growing tumor. This drug-lead compound is named BPTES.
  • According to a study, expectant mothers who dealt with the strain of a hurricane or major tropical storm passing nearby during their pregnancy had children who were at elevated risk of abnormal health conditions at birth.

Diseases & Disasters

  • Strong earthquake (of magnitude 6.6) rocks China’s far-western frontier. About 34 people are reported to be injured.
  • Earthquake of 3.4 magnitude strikes Morgan Hill about 12 miles from San Martin and 15 miles from San Jose City Hall.
  • Household air pollution in Laos fuels pneumonia. A report by the World Health Organization (WHO) and the UN Development Programme (UNDP) noted that 1,200 of the 1,777 deaths could be directly attributed to solid fuel use.
  • Floods by the water of river Brahmaputra in the state of Assam (India) has caused death of 35 people. 11 lakh people are left stranded.
  • 350,000 marooned in flooding of river Brahmaputra in Bangladesh.
  • The Ministry of Health (Singapore) said microspordial spores are common in Singapore soil.

 

 

 

Global Health Weekly News Round-Up

  • April 7th is celebrated every year as World Health Day to mark the founding anniversary of World Health Organization (WHO).

Politics and Policies:

  • Food and Drug Administration (FDA) warns against Japanese weight loss pills. The product contains a suspected cancer-causing agent – Phenolphthalein.
  • Indonesia has won a tobacco dispute with the United States after the World Trade Organization (WTO) ruled in its favor saying that the US ban on clove cigarettes was discriminatory.
  • The 126th Inter-Parliamentary Union (IPU) Assembly in Kampala, Uganda, adopts Resolution on “Access to Health as Basic Right”.
  • World politicians meeting in the capital of Uganda, Kampala, have agreed on the need to repeal laws discriminating against HIV/AIDS which they say have contributed to an increase in the rate of new infections.
  • Dharamsala (in India) based Central Tibetan Administration (CTA) has launched a Medicare system for Tibetans in Exile.
  • The Department of Health (DH) of Hong Kong has appealed the public not to buy or consume an oral product called “Ling Zhi She Xiang Tong Mai Dan”.
  • The Chilean Senate has rejected three bills that would have eased the country’s absolute ban on abortions.

Programs

  • An emergency funding of $26 million has been authorized by President Barack Obama to the United Nations High Commissioner for the Sudanese refugees. This will help to respond to the crisis of health, water and food.
  • Bill Gates- Backed Alliance prepares to fight cervical cancer in the developing world. This program is planned to protect 20 million women in thirty countries by the end of decade.
  • Palmcroft Church of Arizona is organizing a campaign to raise thousands of dollars to bring clean water to the poorest of poor in Haiti and Ethiopia.
  • United States Fund for UNICEF President and CEO, Ceryl Stern joins Royal delegation to UNICEF emergency center.
  • The Kenya Aids Vaccination Initiative (KAVI) is collaborating with Uganda, Rwanda, Zambia, Tanzania, South Africa and Gambia to carry out its research to develop biological marker for understanding the diseases among the people in Africa.
  • The Arab bank for Economic Development in Africa (BADEA) has signed loan agreements worth US$ 10 million to improve health services and expanding its coverage in West African region.
  • A meeting organized by the interest groups together for a Stakeholders Consultation on Tuberculosis in the mining sector under the auspices of the South African Development Community (SADC), with the World Bank support.
  • The Primate’s World Relief and Development Fund (PWRF) and the Canadian International Development Agency (CIDA) will together begin US$ 10.8 million health care program that will focus on maternal and child health in fifty nine villages in Burundi, Mozambique and Tanzania.
  • The HIV Early Infant Diagnosis Project funded by the Clinton Foundation and Mozambique’s Ministry of Health has saved an estimated 20,000 babies from infection in the first six months of its launch. Sequoia Technology and Telit Wireless Solutions- providers of technology for this project- has developed a way for the rural medical clinics in Africa to wirelessly receive HIV test results of the expectant mothers within days of testing.
  • The UK government is planning to develop a smartphone natural disaster application, to help victims of flood, famines and earthquake.
  • The first Czech clinic of addictology, focused on the treatment and prevention of alcohol and illegal drug addictions and research into them was opened in Prague.

Research

  • Researchers say that fish along the Orange County coast may have been affected by radioactivity that fell in California in the days after Japan’s 2011 nuclear disaster. They also say that small levels of radioactive isotope have accumulated in seaweed along the local shoreline.
  • A research suggests link between an injectable form of progestin-only birth control and an increased risk of breast cancer.
  • A universal cancer vaccine has been developed by a group of researchers. The early clinical trial has shown that it triggers an immune response and targets a molecule found in 90% of all cancers.
  • A remedy consisting of phytonutrients extracted from eggplant have been confirmed to treat and basal cell and squamous cell carcinoma.
  • A study on females in China revealed that the vegetables like mustard and turnip greens, bok choy, cauliflower and green cabbage are protective against breast cancer.
  • According to a study malaria stain resistant to the most effective drug used to treat the disease has spread along the Thai-Myanmar border. If ways are not found to contain it, it might reach India and Africa.
  • According to a recent survey Delhi (in India) has the highest number of corporate employees afflicted with insomnia due to high stress level and demanding schedules in offices. This city is followed by Mumbai, Ahmedabad, Chandigarh, Hyderabad, Pune and Chennai.
  • Type 2 diabetes rising sharply in China. About 30 percent increase in cases in only seven years.
  • Data from 2010 Basic Health Research (Riskesdas) shows that 27.1% of obese people above the age of eighteen years with BMI greater than 27.The same data shows obesity among kids below five years olds has increased to 14% from 11% in 2007.
  • Scientists from Duke-NUS Graduate Medical School in Singapore and the National Cancer Center Singapore have identified more than 600 genes that are mutated in stomach cancer, the second most lethal cancer in the world.
  • The blood-pressure medication prazosin was found to be an effective treatment to curb nightmares related to post-traumatic stress disorder (PTSD).
  • A study shows that most of the fat people think they are not fat.
  • Researchers have demonstrated the effectiveness of hypnotism in reducing severe symptoms of Irritable Bowel Syndrome.
  • A new study suggests a link between obesity during pregnancy and autism.
  • The dengue virus may make mosquitoes even thirstier for human blood according to a study conducted at the John Hopkins Bloomberg School of Public Health.
  • According to a new study, waist size helps to predict heart disease risk in teenagers.

Diseases & Disasters

  • The eastern horn of Africa is in famine crisis. About 750,000 people are at a risk of death.
  • H1N1 was detected in a Hong Kong’s slaughter house during regular influenza virus surveillance for pigs.
  • Avalanche in Siachen glacier region claims life of people in India and Pakistan.
  • Nine miners trapped in collapsed mine in Peru.