AIDS Rises Sharply in African Officials, Flash-Heat Inactivation of HIV in Breast Milk

AIDS Seen as New Threat to African Democracy
A new study suggests that HIV/AIDS is hitting elected officials hard in southern Africa, thus posing a new threat to democracy and governance (Felix B. Reuters. June 4, 2007). The report was released in advance of South Africa's biannual AIDS conference in Durban.

"Our findings have shown there has been a sharp rise in the number of elected leaders that have died prematurely of illness," Kondwani Chirambo, head of AIDS programs at the Institute for Democracy in South Africa (IDASA), said at a recent Cape Town conference. "If you compare the trends before the onset of the pandemic and after, we do see that patterns of death mimic the mortality pattern of the general population."

The IDASA said its study shows that HIV/AIDS is responsible for political power shifts and burdens treasuries with additional vacancy-related special elections. HIV/AIDS stigma throughout Africa means that few elected leaders' deaths are attributed to the disease.

Between 1994 and 2006 in Malawi, 42 members of parliament (MPs) died. By 2000, the national assembly speaker officially declared 28 MPs had died as a result of HIV/AIDS, Chirambo said. In Zambia, only 14 of 46 special elections between 1964 and 1984, when the country's first AIDS case was recorded, were held as a result of death. Between 1985 and 2003, however, 39 of 102 special elections were held because the officials died in office.

"HIV/AIDS is having an impact not just on electoral institutions, but also on government and governance, and we have underestimated this impact," said Alan Whiteside, director of health economics at the HIV/AIDS research division of the University of KwaZulu-Natal. [CDC HIV/Hepatitis/STD/TB Prevention News Update, Monday, June 4, 2007]

A Potential Method to Reduce Postnatal Transmission of HIV in Developing Countries
"Up to 40% of all mother-to-child transmission of HIV occurs by means of breast-feeding; yet, in developing countries, infant formula may not be a safe option," according to researchers (Israel-Ballard K, Donovan R, Chantry C, et al. J Acquir Immune Defic Syndr. doi: 10.1097/QAI.0b013e318074eeca. May 17, 2007). Noting that the World Health Organization recommends heat-treated breast milk as an infant-feeding alternative, they investigated the ability of flash-heat to inactivate HIV in breast milk from HIV-positive mothers.

The researchers collected 98 breast milk samples from 84 HIV-positive mothers in a periurban settlement in South Africa. The samples were aliquoted to flash-heating or unheated (control). To differentiate between active and inactivated cell-free HIV in the samples, reverse transcriptase assays (lower detection limit, 400 HIV RNA copies/mL) were performed.

Detectable HIV was found in the milk of 26 (31%) of 84 mothers. Multivariate logistic regression, after adjusting for covariates, showed a statistically significant negative association between detectable virus in breast milk and maternal CD4⁺ T-lymphocyte count (P = .045) and volume of breast milk expressed (P = .01) and a positive association with use of multivitamins (P = .03). In the reverse transcriptase assay, all the flash-heated samples showed undetectable levels of cell-free HIV-1 (P < .00001).

"Flash-heat can inactivate HIV in naturally infected breast milk from HIV-positive women," the investigators concluded. "Field studies are urgently needed to determine the feasibility of in-home flash-heating breast milk to improve infant health while reducing postnatal transmission of HIV in developing countries." [CDC HIV/Hepatitis/STD/TB Prevention News Update, Monday, June 4, 2007]

Targeting HIV Better Than Broad Screening
According to a study by David Holtgrave (Holtgrave DR. PloS Med. 2007;4(6);e194. doi:10.371/journal.pmed. 0040194), a program targeting persons at high risk for HIV that offers counseling would be more effective than routine testing of those ages 13 to 64 regardless of risk, as recommended by the CDC (Steenhuysen, J. Reuters. June 11, 2007).

The study said that implementing the CDC's plan, which does not require counseling and allows patients to refuse to be tested, would cost $864 million a year. Holtgrave maintains that for the same price, a plan targeting those at high risk that offers counseling could detect more than 3 times as many HIV-positive persons and prevent 4 times as many new infections.

Holtgrave's analysis found that the CDC's testing strategy could diagnose about 57,000 HIV cases in a 1-year period. However, a strategy that focuses on likely HIV-infected patients––by geography, health care setting, or risk behavior––would identify 188,000 persons with HIV infection out of the estimated 250,000 to 300,000 persons in the United States who are infected but do not know it, according to Holtgrave.

Holtgrave said the targeted approach would focus testing mainly on clinics and emergency departments that treat the uninsured, on areas with a higher-than-normal percentage of HIV infection, or on physicians' assessments of risky behavior. It would use counseling as a means of preventing the spread of HIV.

The CDC's 1993 guidelines called for routine testing of high-risk patients and of patients in settings in which the prevalence of HIV infection was greater than 1%. Its updated regulations, announced in September, are designed to simplify the testing process and remove barriers to screening in an effort to make HIV testing a part of routine care for pregnant women.

"Our point of view is this is not a question of either-or," said Bernard Branson of the CDC's division of HIV/AIDS prevention. "You really do need both approaches. You need targeted risk-based testing, and you need broader screening. Risk-based screening misses about half of HIV-infected people in the health care setting. Providers are often unwilling to do risk assessments, and patients are often unwilling to be labeled as at high risk for HIV," Branson said in a telephone interview. "Those features have told us that risk-based screening will be insufficient to find all of the people that will be HIV-infected." [CDC HIV/Hepatitis/STD/TB Prevention News Update, Monday, June 18, 2007]

Experimental HIV Vaccines Offer Only Limited Immunity
Just ahead of HIV Vaccine Awareness Day in May, US government scientists said that although the most promising vaccine candidates offer only limited immunity against infection, they could delay the onset of AIDS (Daly L. Agence France Presse. May 16, 2007). In addition, these first-generation HIV vaccines might reduce viral loads during acute infection, which would, in turn, reduce onward HIV transmission––a worthy goal in battling the global pandemic.

"There is optimism that even a less-than-perfect vaccine could benefit both individual recipients and the at-risk community," wrote Drs Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), and Margaret Johnston, director of NIAID's vaccine research program, in a New England Journal of Medicine review (Johnston MI, Fauci AS. N Engl J Med. 2007;356:2073-2081).

It is uncertain when first-generation vaccines would become available, but stage 1 and 2 clinical trials are "well into their execution," said Fauci. "Large numbers of people are being vaccinated."

In studies of nonhuman primates, those inoculated by vaccines that targeted T cells had peak simian immunodeficiency viral loads reduced by a factor of 10. Such vaccines are designed to induce a cellular immune response, to reduce viral loads, and to preserve the immune system. The inoculations also "dramatically" slowed disease progression in many of the infected animals, said Fauci.

The aim of such first-generation T-cell vaccines might be to improve the lives of those who contract HIV infection and postpone the day when they need to begin daily treatment of AIDS. Computer modeling suggests that an even partially effective HIV vaccine could alter the course of the epidemic, said Fauci and Johnston. Further studies will be needed to test that hypothesis, they noted. [CDC HIV/Hepatitis/STD/TB Prevention News Update, Friday, May 18, 2007]