This Week in HIV/AIDS News

U.K., Gates Foundation Award Grant Money for Microbicide Research

The British government and the Bill & Melinda Gates Foundation recently awarded more than 90 million British pounds — almost $130 million — in grant money to continue development on microbicides for HIV prevention, London’s Times reports. The grant follows the results from a clinical trial of an experimental microbicide, called PRO 2000 and developed by Indevus Pharmaceuticals (Lister, Times, 2/23). Research presented earlier this month suggests that the vaginal gel is 30% effective in preventing HIV infection, though the findings were not statistically significant. A second, larger clinical trial — involving 9,000 women and led by teams in Tanzania, South Africa and Uganda — is expected to finish in August, with results reported by November (Kaiser Daily HIV/AIDS Report, 2/10).

The grant money — about 20 million pounds from the U.K.’s Department for International Development and 70 million pounds from the Gates Foundation — will be given to the International Partnership for Microbicides, according to the Times. The funding will then be dispersed to several research teams, including those at Imperial College London, which is leading the second PRO 2000 trial; the University of London; St. George University; and the Medical Research Council. Ten new clinical trials will be supported over the next five years with the grant money to investigate new and more advanced versions of PRO 2000, including longer-lasting gels and those with specific antiretroviral drugs.

According to the Times, a microbicide gel “shares many of the same advantages of a vaccine,” such as being undetectable when used by women who might be unable to persuade their partners to use condoms. However, one “problem” is that the toxicity in many chemicals that can kill HIV is “such that they risk causing tissue damage that actually hastens any infection,” the Times reports.

Renee Ridzon, senior program officer in global health for the Gates Foundation, said that the foundation recognizes the potential contribution microbicides can make, especially the “next generation” of more targeted drugs. Zeda Rosenberg, the chief executive of the International Partnership for Microbicides, said the PRO 2000 trial is an “important milestone.” She added that the support of the British government and the Gates Foundation adds “crucial momentum to delivering on the promise of microbicides.” Sheena McCormack — a clinical epidemiologist at MRC’s Clinical Trials Unit, which coordinated the PRO 2000 trials — said that researchers involved with microbicides “have come together as an international community in a more coherent way (recently) and we are starting to see the results,” adding that the results “should now come in quick succession.” McCormack said that researchers “have given PRO 2000 the best chance,” adding that if the product works, “it will be statistically significant in our trial and obviously a very, very exciting development.” U.K. International Development Minister Ivan Lewis said the increased funding for the research is crucial to ensure the greatest possibility of success and that new research is “vital” to curbing the HIV/AIDS pandemic. He said the development of an effective microbicide “will enable women to protect themselves against infection and could be available long before a vaccine for HIV is found” (Times, 2/23).

Related Opinion Piece
The “holy grail of AIDS research remains elusive” as almost 25 years of research still has not resulted in an HIV/AIDS vaccine, Sam Lister, health editor for the Times, writes in an opinion piece. “The world’s leading scientists have stopped talking of vaccine targets, instead favoring terms such as ‘incremental advances,’” Lister writes. The finding from the PRO 2000 trial “suggests that it may not be a conventional vaccine that provides a breakthrough in AIDS control,” he writes, adding, “But that does not mean that the quest for a vaccine, and the funding it requires, should be diverted in any way.”

Although microbicides could be the “key” in the fight against HIV/AIDS, “they will never have the blanket disease-eradication power of a vaccine,” Lister writes. “A medication that relies on repeat applications by an individual remains open to considerable human error,” while a vaccine can “generate herd immunity to the point where, with a single jab, whole populations can live free of the condition,” he writes, concluding that is “may take another 20 years, but it will be worth the wait. Let us hope that, in the meantime, microbicides step up to the plate” (Lister, Times, 2/23).

“Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report , search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.”

Majority of Ex-Inmates in Texas Delay HIV Treatment, Study Finds

A majority of HIV-positive prison inmates in Texas do not fill their prescriptions in an appropriate amount of time after release, creating a threat to public health, according to a study published Wednesday in the Journal of the American Medical Association, the Houston Chronicle reports. According to researchers from the University of Texas Medical Branch-Galveston, Baylor College of Medicine, and other universities in Texas and other states, the study is the first to track people living with HIV from prison release to care on the outside. Researchers studied 2,115 inmates living with HIV in the Texas Department of Criminal Justice prison system between 2004 and 2007. They found that 5.4% filled their prescriptions within 10 days of release, while 15.5% did so within 30 days and 30% within 60 days (Ackerman, Houston Chronicle, 2/24). According to the researchers, 90% or more of the inmates did not fill a prescription soon enough to avoid interruptions in their treatment regimens. The study also found that black and Hispanic inmates were 60% less likely than white inmates to fill a prescription within 10 days of release, and 30% less likely to do so within 30 days, according to Reuters.

Jacques Baillargeon, one of the study’s investigators from UTMB-Galveston, said the “remarkably high rates of lengthy HIV treatment interruptions are troublesome from a public health perspective.” He said that studies have suggested that “many released inmates who discontinue antiretroviral therapy also resume high-risk behaviors, such as injection drug use or unsafe sex.” Baillargeon added that “this combination may result not only in poor clinical outcomes for these individuals but also in the creation of drug-resistant HIV reservoirs in the general community” (Reuters, 2/24).

In the study, researchers said the prison system has become “an important front” in efforts to treat and control the spread of HIV/AIDS, as many people are offered HIV testing for the first time while incarcerated (Houston Chronicle, 2/24). They concluded, “Adequately addressing a public health crisis of this scale and complexity will require carefully coordinated efforts between academic institutions, the criminal justice system and public health agencies” (Reuters, 2/24).

An abstract of the study is available online.

“Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report , search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.”

HIV’s Mutations To Avoid Immune Defenses Can Be Passed to Wider Population, Study Says

HIV can adapt rapidly to evade immune system responses, and these mutations can be passed on in the wider population, according to a study published Thursday in the journal Nature, Reuters reports. Although researchers have known that HIV constantly mutates within an individual person, the new study indicates that these mutations that help the virus attack immune cells are increasingly passed to large groups in the population. According to the researchers, the virus’ ability to mutate rapidly likely will pose significant challenges for the development of an HIV vaccine (Kahn, Reuters, 2/25).

For the study, Philip Goulder of Oxford University and colleagues analyzed genetic codes and viral strains among 2,800 HIV-positive people in Australia, the Caribbean, Europe, Japan, North America and sub-Saharan Africa. The team focused on human leukocyte antigen, or HLA, genes, which control specialized proteins that signal CD4+ T cells about the presence of HIV. Previous research has demonstrated that people with certain variants of HLA have more effective immune responses to HIV and do not develop AIDS as quickly as others without the variation. However, Goulder’s study found that HIV can mutate to avoid the immune responses of the more effective HLA variants. In addition, the virus can spread this adaptation, also called an “escape mutation,” if it is transmitted to another person.

According to AFP/Google.com, populations with a high prevalence of a certain HLA variant also have a high prevalence of the “escape mutation” that allows HIV to evade the HLA. For example, Japan has a high prevalence of the HLA-B*51 variant, and as a result about two-thirds of HIV-positive people in the country have a strain of HIV with the “escape mutation” for this variant. However, only about 15% to 25% of HIV-positive people in Britain and Africa have a virus with this mutation. Rodney Phillips, co-author of the study, in a press release said, “Where a favorable HLA gene is present at high levels in a given population, we see high levels of the mutation that enable HIV to resist this particular gene effect.” He added, “The virus is outrunning human variation, you might say.”

According to Goulder, the study indicates that “[e]ven in the short time that HIV has been in the human population, it is doing an effective job of evading our best efforts at natural immune control of the virus.” He added, “This is high-speed evolution that we’re seeing in the space of just a couple of decades.” In addition, the virus’ ability to mutate rapidly indicates that a successful HIV vaccine would have to account for both “escape mutations” and geographical differences in HIV and HLA variants (AFP/Google.com, 2/26). Keith Alcorn of the HIV information service NAM said the study’s findings “indicate the enormous challenge involved in developing a vaccine against HIV.” Jo Robinson of the not-for-profit group Terrence Higgins Trust added that the research “suggests that if we’re able to create a vaccine that works against HIV, the virus will always be one step ahead.” According to Goulder, the study suggests that “once we have found an effective vaccine, it would need to be changed on a frequent basis to catch up with the evolving virus, much like we do today with the flu vaccine” (BBC News, 2/26).

An abstract of the study is available online.

“Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report , search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.”

Obama Names Director for Office of National AIDS Policy

President Obama on Thursday named Jeffrey Crowley — a senior research scholar at Georgetown University’s Health Policy Institute and former deputy executive director for programs at the National Association of People with AIDS — as the director of the Office of National AIDS Policy, the Washington Post‘s “Cast of Characters” reports. As director, Crowley will be responsible for coordinating the federal government’s efforts in curbing the spread of HIV through education programs, in addition to coordinating treatment efforts for people living with the virus. He also will serve on the president’s Domestic Policy Council and help guide the Obama Administration’s disability policies. Obama said, “Crowley brings the experience and expertise that will help our nation address the ongoing HIV/AIDS crisis and help my administration develop policies that will serve Americans with disabilities” (Stein, “Cast of Characters,” Washington Post, 2/26).

During his time at NAPWA, Crowley helped implement major initiatives, including National HIV Testing Day and the Ryan White National Youth Conference. Crowley has expertise in Medicaid policy, including Medicaid prescription drug policies, and Medicare policy. He also has experience in consumer education and training. Crowley has spent the last fourteen years in efforts to improve access to health and social services for people living with HIV/AIDS, people with physical and mental disabilities, low-income individuals and other groups (Rhee, “Political Intelligence,” Boston Globe, 2/26). Rep. Barbara Lee (D-Calif.) — chair of the Congressional Black Caucus — welcomed Crowley’s appointment and said, “We need a national AIDS strategy to better coordinate and guide our response to this devastating disease” (AP/Google.com, 2/26).

“Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report , search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.”

Obama’s FY 2010 Budget Emphasizes Commitment to PEPFAR, Increases Resources for Domestic HIV/AIDS Prevention, Treatment

President Obama on Thursday released his $3.55 trillion budget proposal for fiscal year 2010, the San Francisco Chronicle reports. According to the Chronicle, the proposal emphasizes the commitment to the President’s Emergency Plan for AIDS Relief and other global health programs (Coile, San Francisco Chronicle, 2/27).

According to the New York Times, the $51.7 billion allocated in the budget for the State Department and foreign assistance is “purposely vague” because the administration is working to “figure out its overseas spending priorities during an economic crisis at home,” some experts said. Obama’s proposal for the department and foreign assistance is an almost 10% increase over the FY 2009 budget of $47.2 billion, which the White House says places the U.S. “on a path to double foreign assistance,” although the budget does not provide a timeframe. The Times reports that the Obama administration might be “rethinking” some international issues, such as global health. According to Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, this could include PEPFAR. According to Morrison, he expects the Obama administration will continue to provide antiretroviral drugs to those already receiving them from the U.S. “on ethical and moral grounds.” However, he added that Obama might shift funding to other infectious diseases, such as malaria and tuberculosis, or other health issues such as family planning or clean water. Morrison added that promoting foreign aid in the U.S. could be difficult because of the current economic situation. “There’s going to have to be a strong case made,” he said, adding that “these investments have concrete, verifiable impacts on people’s lives” (Gay Stolberg, New York Times, 2/27).

The AP/Google.com reports that Obama’s budget proposal pledges to increase resources to domestic HIV/AIDS prevention and treatment, although a specific amount was not included (AP/Google.com, 2/26). The budget also notes the increased resources for domestic HIV/AIDS efforts will have a particular focus on underserved populations (FY 2010 budget, 2/26).

“Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report , search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.”