Children Living With HIV/AIDS Need Access To Specialized Antiretrovirals

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Children Living With HIV/AIDS

Children living with HIV/AIDS in developing countries need access tospecialized antiretroviral drugs and other treatments, Annette Sohn, anassistant professor at the University of California-San Francisco's pediatric infectious disease division, said on Wednesday at the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention in Sydney, Australia, AFP/iafrica.com reports (Sands, AFP/iafrica.com, 7/25).

Delegatesattending the conference, which ends on Wednesday, presented studiesand discussed advances in HIV/AIDS prevention and treatment. Theconference aims to improve understanding of HIV/AIDS, treatments forthe disease and methods to prevent it from spreading worldwide (Kaiser Daily HIV/AIDS Report, 7/24).

Accordingto Sohn, about 780,000 HIV-positive children worldwide needantiretroviral drugs but only 15% have access to them. Sohn urgedpharmaceutical companies to focus on designing specializedantiretrovirals for children after a study -- which was conducted by NIH's National Institute of Allergy and Infectious Diseasesand found that HIV-positive infants have a greater chance of survivalif they are given immediate treatment -- was presented at theconference on Wednesday (AFP/iafrica.com, 7/25).

The NIAID studybegan in 2005 and was conducted in Cape Town and Soweto, South Africa.It examined 337 infants ages six to 12 weeks and initially aimed todetermine whether early antiretroviral drug therapy over a limited timeperiod would postpone HIV progression, Reutersreports. The study found that 96% of infants given immediate drugtreatment were alive two years after birth, compared with 84% of thechildren given treatment later (Perry, Reuters, 7/24). Anindependent safety and monitoring board in London last month said thatthe study's results were so convincing that the study should be changedto allow all the infants to receive treatment and that the earlyresults should be released (Foley, AP/South Florida Sun-Sentinel, 7/25).

Kevin De Cock, director of the HIV/AIDS Department at the World Health Organization,at the conference said the study is "obviously immensely important inits insight into pediatric treatment strategies," adding, "But the datawill need to be looked at more before we really say what theimplications are for treatment policy." Current WHO policy says thatdrugs should be administered only after children demonstrate signs of aweakening immune system. According to De Cock, "You can't scale uptherapy or provide appropriate treatment to people if they don't knowtheir HIV status." He added, "There's a need across the board to scaleup HIV testing" (Foley, Associated Press 7/25).

Comments

"Children with HIV infection frequently show rapid disease progressionwithin the first year of life due to their developing immune system andsusceptibility to other serious infections," NIH Director EliasZerhouni said Wednesday when releasing the study at the conference. Headded, "This is the first randomized clinical trial that shows thatinfants treated before three months of age will do better than infantswho have their treatment delayed."

Anthony Fauci, director ofNIAID, said, "The results of this trial could have significant publichealth implications worldwide because these findings will cause expertsto consider changes in standards of care in many parts of the world" (Reuters, 7/24).

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Sohnon Wednesday said, "These findings have implications for guidelines ontiming of antiretroviral therapy in early infancy and support the needfor enhanced early diagnosis of infants and early effective transitioninto care." She added, "Research presented at this and otherconferences have increasingly proven that we are waiting too long totreat HIV-positive children" in developing countries. According toSohn, "Better generic pediatric antiretrovirals that are both potentenough to achieve sustained clinical and virological improvement andhave limited long-term metabolic side effects are urgently needed."

Betterdiagnostic tools for health care workers working on pediatric HIV alsoare needed, Sohn added. "We are not identifying more HIV-positive womenduring pregnancy, and we lack the ability to diagnose their infants, sowe don't know they're infected until they're already very sick," shesaid, adding, "By that time, it's often too late to preventopportunistic infections and maximize the treatment benefits ofantiretroviral therapy" (AFP/iafrica.com, 7/25).

Citric Juice, Microbicide Studies

Roger Short, a reproductive biologist at the University of Melbourne,at the conference Tuesday presented a study that found vaginal douchingwith citrus juice has no effect on the spread of sexually transmittedinfections, including HIV, Australia's The Age reports (Leung, The Age, 7/24).

Short in 2002 told the Australian Broadcasting Corporationthat a "few drops" of lemon or lime juice could protect women from HIVinfection and unplanned pregnancies. He said he thought HIV, inaddition to sperm, also might be affected by lemon juice because thevirus is "extremely susceptible" to acidity. According to Short,laboratory tests, which did not include tests on humans or animals,indicated that the citrus juice killed HIV and sperm (Kaiser Daily HIV/AIDS Report, 10/11/02).

Therecent study, conducted in collaboration with clinicians in the U.S.and Nigeria, examined the sexual health of almost 400 commercial sexworkers in Jos, Nigeria. About one-fifth used lemon or lime juice toprevent STIs while the others did not. Tests for STIs -- including HIV,syphilis and hepatitis B and C -- found that there were nostatistically significant differences in incidence between the groups, The Age reports. "Unfortunately, [lemon and lime juice] doesn't appear to have worked" in preventing STIs, Short said (The Age, 7/24).

Also at the conference, Jeremy Paull, a researcher at the Australian pharmaceutical company Starpharma, presented data from recent trials of an experimental microbicide, called VivaGel, that has been found to prevent the sexual transmission of HIV and genital herpes, the AAP/Sydney Morning Herald reports.

Accordingto Paull, recent trials on animals have shown the gel to be between 85%and 100% effective at preventing the transmission of HIV and genitalherpes. He added that the active ingredient in the gel is dendrimer,which is a molecule that binds to both viruses and prevents them frominfecting healthy cells. Safety trials of the gel are under way amonghumans, the AAP/Morning Herald reports. According toPaull, the gel will be used by men who apply it before sex with women.Initial data presented at the conference indicate that the gel is safeand well-tolerated by healthy men whether or not they are circumcised (AAP/Sydney Morning Herald, 7/25).

Inrelated news, conference delegates also discussed the risks peopleliving with HIV/AIDS face as their lives are extended by the use ofantiretrovirals, Business Day/AllAfrica.comreports. Physicians speaking at the conference warned that whileHIV-positive people are living longer, they face a higher risk ofage-related illnesses, including cardiovascular disease, osteoporosisand dementia (Kahn, Business Day/AllAfrica.com, 7/24).

BMS Launches New Approach to Expanding HIV Treatment Model

Bristol-Myers Squibb at the conference on Monday announced a new approach to expanding its Secure the Futureinitiative in developing countries. The new approach will replicate theinitiative's HIV/AIDS treatment support programs in conjunction withgovernments, community groups and other funders. Secure the Future atthe conference released a manual on establishing antiretroviraltreatment programs that include community support to ensure thatHIV-positive people receive assistance at home and in the community, aswell as in clinics. The manual includes experiences from Botswana,Lesotho, Namibia, Swaziland and South Africa (BMS release, 7/23).
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Reprinted with permission fromkaisernetwork.org.You can view the entire KaiserDaily HIV/AIDS Report, search the archives, and signup for email delivery at kaisernetwork.org/email. The Kaiser Daily HIV/AIDS Report is published forkaisernetwork.org,a free service of The Henry J. Kaiser Family Foundation.

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