UN Sees Progress Inadequate on Children and AIDS, Los Alamos Lab Suggests HIV Spreads Faster Than Thought, Regular Laboratory Testing May Not Be Needed During Antiretroviral Therapy

UN Sees Progress Inadequate on Children and AIDS
UNICEF has reported that there have been some improvements for children facing AIDS, but progress is still far short of goals set for 2010 (Worsnip P. Reuters. April 3, 2008). Three years ago, UNICEF established targets for reducing mother-to-child (MTC) HIV transmission, supplying pediatric AIDS drugs, preventing HIV among adolescents, and caring for children with HIV/AIDS.

In 2006, the number of HIV-positive pregnant women in middle- to low-income countries who received treatment to prevent MTC transmission increased to 350,000, up 60% from 2005. In those countries, the proportion of infected women receiving drugs to reduce the HIV risk to their babies grew from 10% in 2004 to 23% in 2006, still much lower than UNICEF’s 80% target for coverage by 2010. In 2006, there were 1.5 million births to HIV-positive women in low- and middle-income countries. UNICEF noted “steady progress” in eastern and southern Africa, home to the majority of newly infected children.

More than 125,000 children with HIV infection were receiving treatment in 2006, UNICEF said, a 70% increase from 2005. “Yet, with millions of children and women not being reached, these results are in no way satisfactory” the report said. Government-provided services are still reaching only a low percentage of those in need, it added.

“Poor geographical service reach, aggravated by weak health systems, and the fear, stigma, and denial that discourage many women from being tested for HIV are significant barriers to wider coverage,” the report said. “Community mobilization and family support, especially from men, for women who are HIV-positive remain urgent priorities.” [CDC HIV/Hepatitis/STD/TB Prevention News Update, Friday, April 4, 2008].

Los Alamos Lab Suggests HIV Spreads Faster Than Thought
New research from scientists at the Los Alamos National Laboratory in New Mexico suggests that HIV replicates at a much faster rate than previously thought (Associated Press. April 14, 2008).

Previous estimates of a cell at a single point in time suggested that 100 to 200 viruses might be made in each HIV-infected cell, explained Alan Perelson. That figure was later raised to 1000 to 2000, he said. But when studying SIV-the simian version of HIV-in rhesus monkeys, the Los Alamos team found a much faster rate. “When we looked at a cell over its life span, we found each cell was making approximately 50,000 viruses and it looks like that’s the minimum,” said Perelson.

Given that HIV and SIV act similarly, it is reasonable to believe that HIV could duplicate in the same way, Perelson said.

The SIV strain engineered by researchers could infect 1 cell and produce offspring; however, the offspring were defective and could not infect other cells. This allowed the team to count the virus reproduced from the 1 cell.

Performing similar tests on humans is difficult, since the subjects must be dead before scientists can count how much the virus replicated. Still, the conclusions are similar, said Perelson.

“Overall, though, this tells us the infection is a lot tougher to combat,” Perelson noted. “Early in the infection, sharing needles, blood, [even] if a small number of cells are transferred, the disease has a larger chance of spreading through the body quickly.”

“This lets us know more what we’re up against,” said Bette Korber, a fellow HIV expert at Los Alamos. “Maybe it tells us something about the efficacy of a vaccine. Maybe you can’t protect against infection, but you could try to find a way to stop the progression of HIV.” [CDC HIV/Hepatitis/STD/TB Prevention News Update, Tuesday, April 22, 2008].

Study Highlights the Need for Continuity of Care for Persons Who Are HIV-Infected and Were Recently Released From Jail
Dr Kristen Clements-Nolle and colleagues evaluated highly active antiretroviral therapy use and risk behaviors among 177 inmates who were HIV-infected and were released and then reincarcerated in San Francisco jails during a 12-month period. A quarter of the adults who are HIV-infected in the United States pass through correctional facilities annually.

Interviews with study participants assessed sociodemographics, incarceration history, and use of supportive services the month preceding reincarceration. Participants were also screened for depression and were questioned about past or present alcohol dependence and sexual and drug use behaviors. They were given a pill card with pictures to determine antiretroviral use during the preceding month and asked about doses missed.

In general, participants were economically disadvantaged and repeated incarceration was common. A majority were homeless the month preceding incarceration. Risk-taking behavior included serodiscordant unprotected sexual intercourse (27% to 38%) and syringe sharing (17%). Although almost two-thirds had a history of antiretroviral use, 59% (n = 64) of this group did not use antiretroviral therapy the month preceding incarceration. Among antiretroviral therapy users, 52% missed medication doses once a week or more.

The discontinuation of antiretroviral therapy was independently associated with homelessness, marijuana use, injection drug use, and the lack of community medical care.

According to the authors: “Suboptimal [antiretroviral therapy] use while in the community compromises the personal health of ex-offenders and may increase HIV transmission, including transmission of drug-resistant strains. This is particularly troubling given the rates of serodiscordant unprotected sexual intercourse and distributive syringe sharing we observed and others have reported.”

The authors concluded that the study results “highlight the need for coordinated public health interventions that begin during incarceration and continue post-release. Such interventions are critical to improving health outcomes for inmates who are HIV-infected and preventing further HIV transmission in the community.” Results of the study were published in the American Journal of Public Health (Clements-Nolle K, Marx R, Pendo M, et al. Highly active antiretroviral therapy use and HIV transmission risk behaviors among individuals who are HIV infected and were recently released from jail. Am J Public Health. 2008;98:661-666). [CDC HIV/Hepatitis/STD/TB Prevention News Update, Tuesday, April 29, 2008].

HIV Patients May Not Need Regular Lab Tests While Taking Antiretroviral Drugs, Study Says
According to a new study, the survival rates of HIV-infected patients who were monitored with laboratory tests were almost the same as those of patients who were not monitored. Although the results must still be verified, they could influence how HIV-infected patients in developing countries are treated (Cheng M. Associated Press. April 25, 2008).

The research was based on computer modeling and used simulated patient details based on HIV’s progress in real patients. The scientists then projected patient survival under monitored or unmonitored scenarios for up to 20 years. Data from actual patients are not yet available.

The researchers, Dr Andrew Phillips and his Royal Free and University College Medical School colleagues, found that 83% of patients who were monitored with laboratory tests survived 5 years, compared with 82% for those who were not monitored. Through 2 decades, 67% of patients who were monitored with laboratory testing were still alive versus 64% for those not monitored.

“Laboratory monitoring shouldn’t be the priority while we’ve got less than half of people who need treatment still waiting for it,” Phillips said.

In Western countries, HIV patients undergo routine laboratory tests about every 6 months, while in poorer countries, most patients are simply monitored by a doctor or nurse.

“In an ideal world, you would want lab support everywhere,” said Dr Charlie Gilks, one of the study’s authors. “But right now we need to continue to roll out the medicines because that is what’s going to save lives.”

Results of the study were published in The Lancet (Phillips AN, Pillay D, Miners AH, et al. Outcomes from monitoring of patients on antiretroviral therapy in resource-limited settings with viral load, CD4 cell count, or clinical observation alone: a computer simulation model. Lancet. 2008;371:1443-1451). [CDC HIV/Hepatitis/STD/TB Prevention News Update, Wednesday, April 30, 2008].