From ABC News online…
Some doctors have been reluctant to prescribe the drug, Truvada, on the premise that it might encourage high-risk, unprotected sexual behavior. However, its preventive use has been endorsed by the Centers for Disease Control and Prevention, the World Health Organization, and many HIV/AIDS advocacy groups
The Human Rights Campaign, which recently has been focusing its gay-rights advocacy on same-sex marriage and anti-discrimination issues, joined those ranks with the release of a policy paper strongly supporting the preventive use of Truvada. It depicted the drug as “a critically important tool” in combatting HIV, the virus that causes AIDS. “HRC does not take this position lightly,” the policy paper said. “We recognize there is still ongoing debate … and that there are those out there who will disagree with our stance.”
Truvada has been around for a decade, serving as one of the key drugs used in combination with others as the basic treatment for people with HIV. In 2012, the Food and Drug Administration approved it for pre-exposure prophylaxis, or PrEP — in other words, for use to prevent people from getting sexually transmitted HIV in the first place. “Today, there is an unprecedented chance to end the HIV/AIDS epidemic, in part through PrEP’s aggressive prevention of new HIV infections,” said Chad Griffin, president of the Human Rights Campaign. “There is no reason — medical or otherwise — to discourage individuals from taking control of their sexual health and talking to their doctor about PrEP.”
The CDC says studies have shown that Truvada, when taken diligently, can reduce the risk of getting HIV by 90 percent or more. Research discussed at the International AIDS Conference in July found that use of the drug does not encourage risky sex and is effective even if people skip some doses.
As part of its announcement, the Human Rights Campaign called on insurers, regulators and Truvada’s manufacturer to take steps to reduce costs, raise public awareness, and make the option available to all medically qualified individuals who could benefit from it, regardless of ability to pay.
The cost of Truvada varies widely; a New York State Health Department fact sheet gives a range of $8,000 to $14,000 per year. The manufacturer, California-based Gilead Sciences Inc., has a program that provides assistance to some people who are eligible to use Truvada but cannot afford it.
The Human Rights Campaign urged all states to emulate Washington state, which implemented a program earlier this year offering assistance in paying for PrEP. The preventive option also was endorsed by New York Gov. Andrew Cuomo when he announced initiatives in June aimed at ending the state’s AIDS epidemic by 2020.
The HRC called on state insurance regulators to take action against any insurers who deny legitimate claims from patients who’ve been prescribed PrEP by their doctors.
A prominent provider of services to HIV-positive people, the Los Angeles-based AIDS Healthcare Foundation, remains a vocal critic of the preventive use of Truvada. In an ad campaign launched in August, the foundation says many gay men fail to adhere to Truvada’s once-a-day regimen and describes government promotion of the drug as “a public health disaster in the making.”
From U.S. News and World Report …
Even though Hispanics in the United States become infected with HIV at rates triple those of whites, less than half of Hispanics with the virus are receiving adequate treatment, a new report finds. The report, based on 2010 U.S. government health data, finds that while 80 percent of HIV-infected Hispanics do receive care soon after their diagnosis, only about 54 percent continue that care and only about 44 percent receive the virus-suppressing drugs they need to stay healthy.
From the New York Times…
The medical school at the University of California, San Francisco, has opened a free telephone consulting service for doctors who are not H.I.V. specialists and want help prescribing the right AIDS drugs for preventing infection in healthy patients.The service, known as PrEPline for pre-exposure prophylaxis line, was announced last week.
In pre-exposure prophylaxis, patients at high risk for H.I.V., such as gay men who frequently have unprotected sex with strangers, ward off infection by taking Truvada, a pill containing two antiretroviral drugs. Uninfected men, if they have doctors at all, usually see general practitioners, who rarely prescribe antiretrovirals. By contrast, doctors at U.C.S.F. have decades of experience in treating H.I.V. because San Francisco was an early center of the outbreak.
The new hotline is aimed at American doctors, but if PrEP is rolled out around the world, it could be a model for other countries, said Dr. Ronald H. Goldschmidt, the director of the school’s clinical consultation center. Since 1993, he said, the center has fielded phone calls from doctors seeking help. Typically, they are obstetricians treating pregnant women infected with H.I.V.; emergency-room doctors treating nurses who have had a needle injury; or patients who had sex with someone they suspect is infected.
South Africa and Ethiopia have sent doctors for training to offer similar services at home, he said; prophylaxis is still rare in poor countries because they are struggling to pay for medicine even for those with advanced AIDS.
From the Advocate online…
Despite recommendation by the Centers for Disease Control and Prevention, and studies that indicate that PrEP can reduce HIV transmission by 96 and up to 99 percent, there are still relatively few gay and bisexual men on the drug.
It can be hard to find anyone among your friends to ask about it. And what makes a person decide they want to go on the once-daily pill varies a lot. The Advocate reached out to gay and bi men, as well as serodiscordant couples, who use the drug to hear their reasons. They offered advice for those on the fence about it. Read their stories in their own words.
People living with HIV in the United States who receive their care through the Ryan White HIV/AIDS Program have good rates of retention and virological suppression, investigators report in the online edition of Clinical Infectious Diseases. Of the patients seen at least once in 2011, some 82% were retained in care and 73% achieved virological suppression.
These outcomes dwarf those seen for most people living with HIV in the US – previous reports have estimated that as few as 40% were retained in care and 19% had achieved virological suppression.
A second new report focuses on gay, bisexual and other men who have sex with men, demonstrating that outcomes continue to be unacceptably poor in this group. Of those who have ever been diagnosed with HIV, 51% were retained in care and 42% achieved virological suppression.
However, both new studies found that outcomes were poorer in younger people, African American people and some other ethnic groups.
Continue reading on aidsmap.com
Posted on Reuters...
Bustling transport networks, migrant labor and changes to the sex trade in early 20th-century Congo created a “perfect storm” that gave rise to an HIV pandemic that has now infected 75 million people worldwide, researchers said on Thursday. In an analysis of the genetic history of the human immunodeficiency virus (HIV) that causes AIDS, the scientists said the global pandemic almost certainly began its global spread in the 1920s in Kinshasa in Democratic Republic of Congo (DRC).
Here, a confluence of factors including urban growth, extensive railway links during Belgian colonial rule and changes in sexual behavior combined to see HIV emerge in Congo’s capital and spread across the globe. Oliver Pybus, a professor at Oxford University’s zoology department who co-led the research, said that until now most studies have taken a piecemeal approach to HIV’s genetic history and looked only at certain HIV genomes in particular locations. “For the first time, we have analyzed all the available evidence using the latest phylogeographic techniques, which enable us to statistically estimate where a virus comes from,” he said. “This means we can say with a high degree of certainty where and when the HIV pandemic originated.”
United Nations AIDS agency (UNAIDS) data show that more than 35 million people worldwide are currently infected with HIV, and some 1.5 million people died of AIDS-related illness in 2013. Since the HIV/AIDS pandemic began, it has killed up to 40 million people worldwide. The disease is spread in blood, semen and breast milk. No cure exists, but AIDS can be kept at bay for many years in people with HIV who take cocktails of antiretroviral drugs.Various strains of HIV are known to have been transmitted from primates and apes to humans at least 13 times in history, but only one of those transmissions – of a strain known as HIV-1 Group M – led to the current human pandemic.
Pybus said the key questions centered on how this happened.”Why did most of (the HIV strains) die out, and why did some of them — like HIV-2 — go on to generate local epidemics in Africa, and why did only one go to become a global pandemic?” he said in a telephone interview. “To answer that, we needed to try to reconstruct the spread through space and time of the global pandemic strain.”
Pybus and an international team of researchers analyzed HIV-1 group M sequences from a major HIV sequence database and then combining these analyses with spatial and epidemiological data. Their study will be published in the journal “Science” on Thursday. Philippe Lemey, a professor at Belgium’s University of Leuven who worked on the study, explained that genetic analysis had helped establish the time and place of the pandemic’s origins. The team then compared that with historical data “and it became evident that the early spread of HIV-1 from Kinshasa to other population centers followed predictable patterns.”
A key factor, the analysis suggests, was the DRC’s transport networks, particularly its railways, which made Kinshasa one of the best-connected of all central African cities. “Data from colonial archives tells us that by the end of 1940s over one million people were traveling through Kinshasa on the railways each year,” said Nuno Faria of Oxford University, who also worked on the team. He said the genetic data showed that HIV rapidly spread across the DRC — a country the size of Western Europe — traveling with people along railways and waterways to reach Mbuji-Mayi and Lubumbashi in the extreme south and Kisangani in the far north between the end of the 1930s and early 1950s.
The team’s findings also suggest that along with transport, social changes such as the changing behavior of sex workers and public health initiatives against other diseases that led to the unsafe use of needles may have contributed to turning HIV into a full-blown epidemic. “We think it is likely that the social changes around the independence in 1960 saw the virus break out from small groups of infected people to infect the wider population and eventually the world,” said Faria.