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HIV

HIV the worst possible STD

Dec 3rd 2018

Christmas charity appeal for worldwide HIV testing

Andrew Williams had never heard of the word HIV when he tested positive. It was his mother who had forced him to go to the doctor where he got the diagnosis that he thought was a death sentence.

At that time he was in a wheelchair. It was the unbearable itching of his back that finally got him to get medical help but, he discovered, he not only had HIV but diabetes, high blood pressure and kidney disease.

That was two years ago. This week, as the 31-year-old joined Sir Elton John and Evening Standard and The Independent owner Evgeny Lebedev in Atlanta to witness the revolutionary new breakthroughs against the disease at the city’s Grady Ponce De Leon Centre, there was no need for a wheelchair. Nor, he now knew, was there any need for fear.

Within two months of starting the latest antiretroviral drugs, the virus in his body had become undetectable in his blood. Not only is he now healthy, partly due to the drugs and partly due to the healthy lifestyle adopted for his other illnesses, but he can virtually not pass the infection to other people.

He feels, he says, “reborn”. “I have a reason to live,” he explained, “and that is to help people who were like me – and to show you’re going to be OK.”

It was a message so stark in its optimism that it reduced Sir Elton to tears. He knows first-hand the realities of what, in the past, an HIV diagnosis can mean. When he started his Elton John AIDS Foundation in the US in 1992, it was because his friends were dying and he wanted to do what he could, anything that he could, to help.

“When we set up the Elton John AIDS Foundation we were delivering meals to people’s doors,” he said. “[The stigma meant] they would not go outside. We have come a long way.”

But part of the reason for his tears was not only happiness at Andrew’s story. It was also the knowledge that, despite all the advances that have been made, the fight is far from won – indeed, in some parts of the world, things are getting worse.

It is why he and Mr Lebedev had come to Atlanta to mark the first day of our Christmas Appeal, for that city, sadly, is one place where the situation is not only getting worse but, as those at the centre made clear, dramatically so.

In Atlanta, one of America’s richest cities and the home of such international corporate giants as Coca-Cola and CNN, if you are a gay black man in 2018 then, unbelievably, you still have a one in two chance of being diagnosed as HIV positive during your lifetime.

In the last few weeks alone, three people the centre were trying to help died because of Aids. The reason is that, not knowing their HIV status and terrified of the stigma that HIV can still bring in the city, they came to get treatment too late. 

The latest figures show black Americans in the US accounted for 44 per cent of HIV diagnoses, although they are only 12 per cent the population. As many as 54 per cent of gay black men who are HIV positive are believed to not receive the right treatment. Three decades after the first antiretroviral drug was licensed to help in the fight against HIV and Aids, for some it remains an epidemic.

Sir Elton made clear his shock. “It started off as a disease of young gay men in the 1980s, affluent people in in New York, LA and San Francisco,” he said. “Now it’s a disease of the poor all across America, but especially in the South. People are being forgotten. That is a disgrace.”

It is why Atlanta is one of the cities being focused on as a recipient of this year’s Christmas Appeal. The money it raises will pay for those at risk to be able to get tested, and then will make sure they have access to the treatment they need.

At the centre, Sir Elton and Mr Lebedev tried out one of the most recent developments in testing. A simple swab, wiped around the mouth, that people can do for themselves without even needing to go to a medical facility. Sir Elton’s Foundation is in some parts of the world planning to make it available for free in supermarkets so there is no barrier to anyone getting a test when they want it.

“The simple fact is that in 2018 no one should be dying because of Aids,” Mr Lebedev said. “We have the drugs to control HIV. It is treatable. Today, any person, anywhere, dying because of Aids is a tragedy.

“That is why I am so proud that this Christmas the Evening Standard will raise money to combat this epidemic. It is a time of year for helping others, and our appeal will do exactly that.

“Over the next few weeks, we will campaign to help those at risk of infection to access treatment. We will tell the stories of the people who have been forgotten. We will fight to make sure governments give the disease the attention it requires.

“Today I saw first-hand the damage HIV can cause. I spoke with people who had lost loved ones; I heard from others struggling to receive treatment. I want this appeal to prevent more people suffering so needlessly. That would be a real Christmas miracle.”

Money raised from public donations through the AIDSfree appeal will be used to support the Elton John AIDS Foundation projects in six key cities around the world (London, Nairobi, Atlanta, Kiev, Delhi and Maputo).

Dec 2nd 2018

World Aids Day 2018 Five women share their stories of living with HIV

Despite the medical advancements that have been made in recent years in the crusade to improve treatment for people living with HIV, stigma still surrounds HIV and Aids in today’s society.

Women are particularly marginalised, often only making up a fraction of HIV clinical research, as Positively UK founder Silvia Petretti explains. “Clinical research on HIV has historically failed to focus on women, unless they are pregnant,” she says.

“This means that women are put on medications that haven’t been studied on their bodies, which can lead to more side effects and long term toxicities.”

Audrey Nosenga, a leading HIV campaigner, recently spoke at the ENDAIDS2030 festival about the need to ensure that all those living with HIV are given the opportunity to live their lives to the fullest.

“As the global response to HIV continues through the fourth decade, a good quality of life for people living with HIV is a fundamental right and a critical challenge,” she says.

To mark World Aids Day 2018, The Independent has spoken with five inspirational women with HIV who’ve each shared their personal accounts of what it’s like to live with the condition and the stigmas that they face today.

In the space of a year and a half, Lizzie’s entire world was turned upside down when she gave birth to her child, experienced the tragedy of her partner passing away and discovered that she’s HIV positive. Following her diagnosis, Lizzie founded Think2Speak, a social enterprise that provides schools, charities, and organisations with tools to help make people feel empowered and confident in life. Lizzie is now 37 and lives in Lincolnshire.

Prior to her HIV diagnosis, Lizzie’s only knowledge of HIV came from the 1991 storyline in EastEnders in which character Mark Fowler contracts the virus. She was also aware of Freddie Mercury’s life story.

All that changed however, when she was informed that she was HIV positive during an especially trialling period of her life.

“In 18 months I’d become a mum, a widow and was diagnosed with HIV,” she says.

After being informed that her partner had died of an Aids-related infection, Lizzie’s first instinct when getting tested for the virus was that if her results came back negative, she would keep the truth of her partner’s HIV status a secret.

In retrospect, Lizzie feels sad that she ever thought that way about HIV and the stigma commonly associated with it.

“Being HIV positive is not shameful. HIV is one possible outcome of condom-less sex,” she says.

“I believe in the power of conversation as prevention”

After confirming that her child was HIV negative, Lizzie took it upon herself to learn all that she could about the virus and has since become an outspoken advocate of HIV awareness.

On World Aids Day 2017, Lizzie spoke with the Duke and Duchess of Sussex at an event, with the couple recognising Lizzie from a BBC1 documentary.

Lizzie explains that HIV is still highly stigmatised, and appreciates that she comes from a position of privilege in comparison to others who may be living with the condition.

“I am privileged and I have to acknowledge that,” she says.

“I’m a white, heterosexual female, who is securely employed; I’m educated and fairly articulate, and this means that I am able to challenge stigma when I’ve experienced it.

“I believe in the power of conversation as prevention.”

Following her work with HIV charity Positive East, LeaSuwanna discovered that she was HIV positive while pregnant with her second child. She’s now a part of the Changing Perceptions campaign, an initiative that aims to educate people about those living with HIV and their experiences. LeaSuwanna is 39 and lives in east London.

Before she became aware of her HIV status, LeaSuwanna worked in childcare for Positive East, a charity that provides care and support for children and families affected by HIV.

She was then informed, while pregnant with a baby girl, that she’d been diagnosed with the virus.

LeaSuwanna and her partner of two years had stopped using condoms so that they could conceive.

While she would always go for check-ups at sexual health clinics when starting a new relationship, she hadn’t asked her partner to do the same thing.

“I cried a bit but mostly asked questions about my child being safe,” LeaSuwanna remembers about her response to her HIV diagnosis.

“I gather knowledge on HIV so I can help others”

“This is what kept me going; knowing I could have a life with both my kids and that she was going to be born HIV negative.”

After confirming that she hadn’t passed the virus onto her baby and coming to terms with her HIV status, LeaSuwanna now uses her knowledge of the virus to help others.

“I gather knowledge like it’s going to run out on HIV so I can pay forward for others who may be in my situation,” she says.

“The best thing to know about HIV is as long as I or anyone who is positive takes their medication as prescribed, they will become undetectable.

“This is massive news that should be celebrated and made widely spread to the public.

“It is not the people aware of their status causing the continued issues – it’s the people who are not testing that are.”

Despite being born with HIV, Sasha was only made aware of her diagnosis as a young girl when a doctor mentioned that she was HIV positive. She was forced to leave school without any qualifications due to the bullying that she endured when her classmates became aware of her condition. Sasha is now an activist, is 30 years old and lives in Buckingham.

Throughout her childhood, Sasha experienced several bouts of illness with no explanation why.

After a doctor revealed by chance that she was HIV positive while in A&E, Sasha felt intense anger towards her mother, who eventually passed away from HIV when Sasha was 20.

“I was furious with my mum and went home and shouted at her because I didn’t understand what she was going through,” she says. “I was a young girl and I just blamed her at the time.”

When Sasha confided in a friend at school that she was HIV positive, she never anticipated how quickly the news would spread or the abuse that she would receive from her classmates.

Faced with the prospect of having to endure constant bullying, Sasha left school without any academic qualifications and without the financial means of finishing her education in the future.

As a teenager, Sasha became embroiled in an abusive relationship with a man with whom she had a son and who made her question her self-worth.

“People think that HIV people are dirty and it’s not true, however someone gets it”

Her mental health reached such a low point eight years ago that she attempted to take her own life.

Two years later, Sasha left her ex and met her current partner, with whom she has a four-year-old daughter.

She now works as an HIV activist with Positively UK and believes strongly in breaking down the stigmas associated with HIV.

“People react with shock and horror when I tell them that I’m HIV positive, English, white and have children,” she says.

“People think that HIV people are dirty and it’s not true, however someone gets it.”

When Charity was told that she was HIV positive, fears over whether she was going to die or ever be able to have children occupied her mind. She recently spoke with Terrence Higgins Trust about her involvement with the Catwalk for Power, an event that helps women living with HIV from all walks of life by making them feel confident and empowered. Charity is 48 and lives in London.

Charity is no stranger to the taboos associated with HIV, having had an unfavourable opinion of the virus prior to her positive diagnosis.

“I didn’t particularly know a lot about HIV before I was diagnosed and I am ashamed to say the views I had on HIV weren’t very pleasant,” she says.

When she was informed that she was HIV positive, Charity was distraught, feeling as though “it was the end of my life”.

Various questions, including whether she was going to die, whether she’d be able to have sex and whether she’d become infertile raced through Charity’s mind.

Having been made aware that she’d be able to live a long and healthy life, have sex and have HIV-negative children, Charity now has a positive outlook with regards to her condition.

“I really don’t think attitudes have changed that much”

“To be honest, now HIV is a very small part of my life and most days, after taking my pills, I forget about it,” she says.

One of the biggest misconceptions about HIV that Charity has experienced is the way in which many people assume that HIV and Aids are the same thing.

While there may be greater awareness and more advanced medical treatments for those living with HIV, Charity isn’t convinced that the stigma surrounding the condition has lessened over the years.

“I really don’t think attitudes have changed that much, people are still scared of us,” she says.

She urges anyone who’s been newly diagnosed with HIV to learn as much as they can about the virus.

“Education is power when it comes to surviving without discrimination,” she says. “But you will need thick skin.”

A few days before her 30th birthday, Silvia received the news that she was HIV positive. With her mother having passed away a decade before and a father with Alzheimer’s, she felt desolate and alone when coming to grips with her diagnosis. Meeting other women living with HIV through a support group gave her the boost that she needed to accept herself and her HIV status. Now 52 and living in south London, Silvia is joint CEO of HIV charity Positively UK.

In 1997, 29-year-old Silvia was residing in Italy when she received the news that she was HIV positive.

It was particularly shocking for Silvia considering the fact that she’d always followed a healthy lifestyle.

Silvia had to take 18 pills a day when first diagnosed, leading to her experiencing a barrage of side effects.

When her doctor attempted to prescribe her with antidepressants to no avail, he then suggested that she go to a women’s support group called Positively Women, now called Positively UK.

“The first time I went, I couldn’t believe the women in the group had HIV,” she says.

“They looked fabulous, joking and laughing, and there were children running around.

“Enabling people to live well with HIV is a powerful tool”

“Meeting other women with HIV lead me to finally have hope it was possible to live a normal life with HIV. I found self-acceptance and new friends.”

A few years after discovering that she was HIV positive, Silvia became involved with Positively UK as a volunteer.

This then resulted in a job in the peer support team answering the helpline and managing support groups, which eventually led to Silvia becoming joint CEO of the entire organisation.

“I know what a powerful tool it is enabling people to live well with HIV,” she says.

“I would never be where I am without the role models I have had, and the incredible support of other women with HIV.”

Positively UK runs a national programme called Project 100 that trains people living with HIV so that they can become involved in peer support groups.

Gallery: 5 Things to Know About HIV/AIDS Around the World (U.S. News & World Report)

In 2017, approximately 37 million people around the world were living with HIV, a small increase from the previous year, according to data from UNAIDS, the U.N. agency advocating for a coordinated global response to treating HIV and AIDS.

 

Despite the number of people living with the HIV steadily climbing over time, the global health community has made significant strides in treating and managing the virus and AIDS: In 2017, 21.7 million people accessed antiretroviral therapy, a number that has skyrocketed since 2000, when just 611,000 people were receiving the therapy.

 

Deaths from HIV and AIDS have also plunged since its peak in 2004, when nearly 2 million people died from the disease. In 2017, 940,000 people died from an AIDS-related cause.

 

Nov 29th 2018

What People Still Get Wrong About HIV – From 3 Women Who Live With It

“A lot of people still believe the old messages.      

By Sophie Gallagher

On a cold November day, 27-year-old Winnie Sseruma received the news she had been dreading – her HIV test had come back positive. It was 1988, she was living in the US, and her doctor had become so accustomed to delivering this diagnosis, so de-sensitised, that he didn’t even sit down in his chair before he told her, she remembers. Instead he opened her file and listed off medications. 

“Nobody expected me to live,” she tells me over the phone from her home in London, almost 30 years to the day after that diagnosis. It wasn’t just her doctor. Sseruma was so unable to see light at the end of the tunnel that by the summer of 1994, she had booked herself a one-way flight back to her homeland of Uganda. “I just thought: let me die where I want to die.”

But Sseruma, now 57, has defied the early odds. She doesn’t remember the last time she went to a hospital (she only sees her doctor once a year) and no longer tortures herself by replaying the day she believes she contracted it. “I’m choosing to live my life well with HIV,” she says. “I love it.” 

Amanda Mammadova’s diagnosis came in January 2010, when she was 30, and she still hasn’t quite come to terms with the way it was delivered: by a medical receptionist, over the phone, while Mammadova was standing in the middle of her office on her lunchbreak.

The 38-year-old personal trainer from Milton Keynes had only taken the test as a box-ticking exercise – she was trying to join the RAF after a stint in the territorial army and knew her application would involve some element of medical testing, so she preemptively had one done to speed up the process. She never anticipated she might actually be HIV positive.

“My initial thought was: am I going to die? And am I going to die alone? Who is going to want me,” she says. “I’m going to be single forever I need to go and buy 100 cats from somewhere and a cardigan. Within 10 years I’ll be dead.”

Eight years later she has three children, has been through a marriage (and a divorce) and says she couldn’t be in a better place. 

This narrative, this story of the doom and gloom of diagnosis giving way to genuine positivity about a life with HIV, is familiar to Angelina Namiba, a 51-year-old who is originally from Kenya but has lived in London for 27 years.

Namiba was so terrified of finding out her status that when, in 1993, her GP suggested she get tested for HIV (because she already had hepatitis B), she hid the form for the clinic under her bed for six months. 

When, eventually, she took the test and got the results, she moved out of her family home there and then, renting a bedsit alone in Chingford so she could keep her diagnosis secret from her mother. She also took a new job in the belief it would keep her busy while she waited to die. “I can’t be sitting in the house looking at the four walls,” she remembers thinking at the time.

“My brother was already very ill with AIDS-related illnesses and the only images of people I’d seen were dying. I’d seen what living with HIV looked like and I was scared,” she says.

Today Namiba has survived 25 years, has a 19-year-old daughter, a career as a charity project manager and is open about her status.

Each of these women have been through unique experiences, but they all agree that HIV does not have to be the death sentence it is often portrayed as in the media. “The stigma has not caught up with the science,” says Namiba. 

One of the biggest misconceptions these women lived with was believing they were alone in their diagnosis. “I thought I was the only woman in London with HIV,” says Namiba. “All the images I saw were men.”

Sseruma agrees: “I was hearing a lot about it but not from women’s perspective, it was all about gay men. It came as a shock that as a woman I was being affected by HIV and there was no precedent set.” 

Even though she was diagnosed 20 years later, Mammadova says she felt exactly the same. “It’s all well and good being told [by your doctor] there are around 300 people living in Milton Keynes with HIV but I don’t know any of them. I felt very alone.”

She wasn’t. Around 25 per cent of people diagnosed with HIV in the UK are women. The latest Public Health England data shows 4,363 people (3,236 male and 1,125 female) were newly diagnosed in 2017. With 40 per cent of all HIV patients, London continues to have the highest prevalence in the country.

Another myth the women grappled with was believing their positive status meant they faced imminent death – especially for Sseruma who faced a very different prognosis and treatment plan in 1988 to anyone diagnosed today.

“When I was first diagnosed I used to go to a funeral every week,” recalls Namiba. “Friends who hadn’t survived. [I felt] there was no hope for me either.”

“I’d seen the tombstone adverts,” says Mammadova. “I thought I’m going to spend the rest of my life in fear and will be kicked out of society.”

But together these three women have survived a combined 63 years.

They’re not only surviving, but thriving. Science has developed to the point where antiretroviral drugs can now lower the virus to undetectable levels in the blood (less than 40 copies per millilitre). At this point the disease is known as ‘undetectable equals untransmittable’ or U=U. 

In short, if the virus is being kept suppressed by medication, you cannot pass it on – either to a sexual partner or to a child in the womb. This advance is what allowed Mammadova and Namiba to give birth to negative status children and all three women to live healthy, successful lives and jobs. 

“I always wanted four daughters, and here I am. I was able to realise my dream,” says Namiba. “A lot of people still believe the old messages. If I want to have a relationship or children I can.” 

The bigger problem, all three women say, is stigma: people getting HIV wrong and believing a diagnosis means a life of misery – or a life cut short. And it’s a stigma that exists around HIV in a way that it doesn’t around other illnesses.

“Nobody scowls at someone for having breast cancer,” says Mammadova. “But people are still fearful. They think they’ll contract it if I sneeze or share a fork with them. They won’t sit on the same sofa as me.”

“The stigma hurts more than the side effects of the drugs or anything medical. It makes you feel like a leper. I got told by a stranger that anyone with HIV should have it tattooed on their head so people can stay away,” she adds. 

Sseruma goes further, saying: “The stigma is what is killing people, the HIV-related stigma. They don’t get tested because they are afraid of being tested.”

What they want you to know is this: a positive diagnosis is not the end of the story. “There is nothing HIV could stop you doing,” says Mammadova. “It used to be the case, but not anymore. People will love you regardless of HIV.”

All three women appear in ‘A Life Beyond’ - a short film about living with HIV, created with support from the Bloomsbury Network at The Bloomsbury Clinic, Mortimer Market Centre, London. 

Whether you’re living with HIV, know someone who is, or think you might have put yourself at risk of HIV and need support, you can contact an adviser at the Terrence Higgins Trust to talk. Ring 0808 802 1221. 

June 25th 2018

Vaccine for HIV to begin tests on humans next year

An experimental vaccine for HIV is set to be tried on humans in 2019.

Scientists from the US have recently made significant steps with a new vaccine that attacks vulnerable parts of HIV by drawing out powerful antibodies.

In earlier trials on small animals, scientists found that some strains of HIV were neutralised after the vaccine successfully targeted and latched on to a vulnerable part of the virus.

Scientists now plan to expand into human trials next year, following these successful results.

The research was conducted by the National Institute of Allergy and Infectious Diseases (NIAID), as a part of the government agency the National Institutes of Health (NIH).

The results of the tests were published in the peer-reviewed journal Nature Medicine on June 4.

NIAID Director Anthony S. Fauci welcomed the results, saying that this could be a highly important step towards creating a virus.

Fauci said: “NIH scientists have used their detailed knowledge of the structure of HIV to find an unusual site of vulnerability on the virus and design a novel and potentially powerful vaccine.

“This elegant study is a potentially important step forward in the ongoing quest to develop a safe and effective HIV vaccine.”

This vaccine has been made possible by the recent discovery of a specific part of the HIV virus called an epitope.

An epitope is the part of an antigen – a virus or toxin that makes you sick – that an antibody can bind with.

In 2016, the epitope for HIV targeted by the vaccine was discovered, allowing researchers to attempt new ways of battling the virus.

Around 35 million people have died of AIDS since the epidemic began, while 36.7 million are still living with HIV, according to the World Health Organisation.

In 2017, scientists at the University of Nebraska-Lincoln successfully engineered an ‘on/off switch’ onto a weakened strain of HIV.

If successful in humans, this would allow scientists to spread the virus throughout someone’s body, before deactivating the strain after it has immunised the host.

A weakened virus is generally preferred by scientists because it has the potential to produce a stronger and longer-lasting immunity in patients.

In spite of recent progress in treatments and several awareness campaigns about HIV, only 37 percent of people said they were “well informed” on the illness and 40 percent said they had moderate knowledge on it in a recent survey.

According to a survey by charity HIV Scotland in May, 21 percent of people still believe HIV can be transmitted through kissing or saliva exchanges, while 14 percent think it can be transmitted by coughing, sneezing and spitting.

June 7th 2018

Syphilis and gonorrhoea surge in London with thousands of new STIs diagnosed

Syphilis and gonorrhoea are on the rise in London with thousands more people contracting the infections, new data shows.

Research by Public Health England found the capital still has the highest rate of sexually transmitted infections (STIs) in the UK despite a 1 per cent reduction from 2016.

But rates of syphilis and gonorrhoea have increased by 16 per cent and 23 per cent respectively, with London accounting for almost half of the cases of the two infections in England.

Overall, more than 117,000 London residents were diagnosed with new STIs during 2017.

Dr Yvonne Doyle, regional director for PHE London, said: “Poor sexual health is still a problem in London with some infections like syphilis and gonorrhoea increasing significantly.

“London is disproportionately affected by STIs compared to other parts of the country and this is why public health interventions must remain a top priority if we are to get numbers of new infections down.”

Syphilis cases have been steadily increasing for a decade, with 78 per cent of those diagnosed being men who have sex with other men.

Public Health England is working with other organisations to develop a plan to tackle the rise in syphilis, including more frequent tests for high risk people.

The data also found that London’s rate of STI diagnoses is 83 per cent higher than any other region in England, while 17 of the 20 local authorities with the highest rates of STIs are in the capital.

Paul Steinberg, Lead Commissioner of the London HIV Prevention Programme, said lessons could be learnt from the “huge progress” made in reducing the number of HIV cases.

“Lessons can be learnt for behaviour change related to wider sexual health and STI prevention, as we continue to work across the system with shrinking resources, to safeguard the sexual health of our residents,” he said.

 

Sept 23rd 2017

Scientists have designed a drug to attack nearly all HIV strains and prevent the infection in monkeys.

The International Aids Society has called it an 'exciting breakthrough'. Human trials will start in 2018 to see if it can offer the same protection in people.

What makes it so difficult for our bodies to fight HIV is the virus's incredible ability to mutate and become a different strain.

But after years of infection, a tiny number of patients develop powerful weapons (called broadly neutralising antibodies) that attack the majority of HIV strains. Scientists have been trying to engineer these antibodies to both treat HIV and prevent infection in the first place.

The newly engineered vaccine combines three of these antibodies into an even more powerful defense against HIV. The work is a collaboration between the US National Institutes of Health and the pharmaceutical company Sanofi.

Dr Gary Nabel, the chief scientific officer at Sanofi and one of the report authors, told BBC News: "They are more potent and have greater breadth than any single naturally occurring antibody that's been discovered."

Researchers tested the antibody on 24 monkeys. None of them developed HIV when they were later injected with the virus.

The study is published in the journal Science.

Related: Hunt wants NHS to treat a million more by 2021 (provided by ITN News)

June 3rd 2017

Despite extensive efforts, there’s still no cure for HIV. Since the virus often lives dormant in cells, it’s difficult for doctors to deem a person is cured. But, a newly developed test may be sensitive enough to identify “hidden” HIV, according to research published in Nature Medicine.

The scientists at the University of Pittsburgh who developed the test, also found that the amount of people who are thought to be nearly cured of HIV, is much larger than previous estimates.

"Globally there are substantial efforts to cure people of HIV by finding ways to eradicate this latent reservoir of virus that stubbornly persists in patients, despite our best therapies," said senior author Phalguni Gupta, in a statement. "But those efforts aren't going to progress if we don't have tests that are sensitive and practical enough to tell doctors if someone is truly cured."

Thanks to the development of antiretroviral therapies, or ART, people with the virus have been able to live significantly longer and healthier lives. Despite the therapy being successful, it’s key to know if the present HIV infected cells have the ability to replicate. Currently, the best available test to detect this is called Q-VOA, which stands for quantitative viral outgrowth assay.

Disadvantages of Q-VOA is that it’s costly, requires a large amount of blood, and is time-consuming. Typical costs can be around $1,200 (‎£931.80), according to Johns Hopkins University.

Gupta and his colleagues have developed TZA - a test that’s quicker, cheaper, requires less blood, and is less labour-extensive than Q-VOA. TZA works by detecting a gene that is activated only when replicating HIV is present.

"Using this test, we demonstrated that asymptomatic patients on antiretroviral therapy carry a much larger HIV reservoir than previous estimates—as much as 70 times what the Q-VOA test was detecting," Gupta said. "Because these tests have different ways to measure HIV that is capable of replicating, it is likely beneficial to have both available as scientists strive toward a cure."

In the United States, about 1.2 million people are living with HIV, according to the Centers for Disease Control and Prevention. It’s estimated about 1 in 8 of them don’t know it. People who are most affected include young African American gay and bisexual men.

May 20th

HIV cure a step closer after scientists remove virus's DNA from living tissue

Scientists have managed to remove DNA of the HIV virus from living tissue for the first time in a breakthrough that could lead to an outright cure.

At the moment, treating the disease involves the use of drugs that suppress levels of the virus so the body’s immune system can cope.

Now researchers in the US have revealed they used gene-editing technology to remove DNA of the commonest HIV-1 strain from several organs of infected mice and rats.

In April, the same team reported that they had successfully eliminated the virus from human cells in the laboratory, but a paper in the journal Nature Gene Editing revealed they had managed to do the same thing in live animals for the first time.

The researchers’ team leader, Professor Kamel Khalili, of Temple University, said: “In a proof-of-concept study, we show[ed] that our gene-editing technology can be effectively delivered to many organs of two small animal models and excise large fragments of viral DNAfrom the host cell genome.”

The current antiretroviral drugs for HIV are not able to eliminate HIV-1 from the infected cells.

And if treatment is interrupted, the virus can start replicating quickly, putting patients of risk of getting full-blow AIDS.

This is because it is able to persist in immune system T-cells and other places where it is not actually active and is unaffected by the current treatments.

The researchers used a specially adapted virus to deliver the gene-editing system into the cells.

“The ability of the rAAV delivery system to enter many organs containing the HIV-1 genome and edit the viral DNA is an important indication that this strategy can also overcome viral reactivation from latently infected cells and potentially serve as a curative approach for patients with HIV,” Professor Khalili said.

In a statement, Temple University said the implications of the new study were "far-reaching".

"The gene-editing platform by itself may be able to eradicate HIV-1 DNA from patients, but it is also highly flexible and potentially could be used in combination with existing antiretroviral drugs to further suppress viral RNA. It also could be adapted to target mutated strains of HIV-1," it added.

Professor Khalili said a clinical trial could happen within the next few years, but he first planned to carry out a similar study involving a larger group of animals.

The hottest news in AIDS in the last year was the partial success in a South African clinical trial of a microbicide — a gel women can put in their vaginas to kill the virus before it can infect them with HIV.

The whole field of protection before sex is “red-hot cool right now,” said Sharon L. Hillier, a gynecology professor at the University of Pittsburgh’s medical school and principal investigator of the Microbicide trials network . “People are really energized.”

Although the gel offered only about 40 percent protection against the virus, it was the first form of protection that women could use without men knowing, which is crucial because so many men around the world absolutely refuse — sometimes violently — to wear condoms when having sex with their wives or girlfriends.

Other clinical trials will report their results in 2011 and 2012 and, if all goes well, researchers hope to have a product or two ready to enter the market by 2013.

The first may not be a gel, however.

In the next few months, said Mitchell Warren, executive director of AVAC, an advocacy group for AIDS prevention, “we’re going to see a cascade of results” from trials of what is called “oral pre-exposure prophylaxis,” or “oral prep” for short. In them, men and women who are not infected with the AIDS virus but who regularly engage in high-risk sex, like anal sex without condoms or sex for money with strangers, take a daily dose of one or two of the antiretroviral drugs normally taken by infected people. If many fewer of those subjects become infected than subjects taking a placebo, a second breakthrough will have been achieved.

Should that happen, regulatory authorities may approve pills faster than a gel, because they have already been found safe and effective for treatment.

But that doesn’t mean a gel isn’t still worth pursuing, said Dr. Salim Abdool Karim, a professor of epidemiology at the University of KwaZulu-Natal in South Africa and a leader of the microbicide trial for which results were released in July.

Gels have advantages. The drug in them stays in the vaginal tissue, so it is unlikely that anyone who gets infected anyway would develop a drug-resistant form of the virus. And unlike pills, gels also protect against herpes.

Also, as several experts pointed out, women like having choices in birth control: some prefer a daily pill, some prefer condoms, or IUDs, or shots that last three months, or skin implants that last three years. Presumably, they will also want choices in AIDS prevention.

“The simple truth is: one size does not fit all,” Dr. Karim said.

Because 95 percent of gay American men and 40 percent of heterosexual American women have had anal sex at least once during their lifetimes, according to surveys, rectal versions of the gel are being developed. Tests of new, less viscous formulations that are less likely to draw water into the rectum, making use unpleasant, will begin soon, said Dr. Ian McGowan, another leader of microbicide trials at the University of Pittsburgh’s medical school.

Gay and bisexual black and Hispanic men, who are now the highest AIDS risk groups in the United States, will be recruited soon in Boston, Pittsburgh and Puerto Rico to see if they find the gels acceptable, he said.

But first it is crucial to make sure gels don’t inflame the rectal lining, which is more fragile than the vagina’s. Since H.I.V. zeros in on activated immune cells, inflammation increases infection risk. Brief tests of irritation and acceptability will be done on people advised to remain celibate during the tests, he added. Larger trials, in which thousands of men and women regularly practicing anal sex are given gel or placebo will not begin for two to three more years.

“The rectal microbicide field is about 10 years behind the vaginal one,” Dr. McGowan said.

That is partly due to misconceptions.

“When you mention rectal microbicides, a lot of people say ‘Oh, come on,’ because they think you have to protect the whole colon, and it’s meters long,” Dr. McGowan said. In fact, researchers believe protecting only the last six to eight inches will suffice.

A 2008 British study showed that rectal tenofovir gel was very protective in monkeys that were then given anal doses of the virus that causes simian AIDS.

Farther over the horizon, another method is being tested for possible deployment by 2015 or so. Next year, a trial will begin of a vaginal ring containing a new antiretroviral drug, dapivirine. Dapivirine was never approved as a pill because the body doesn’t absorb it well, but it can build up in vaginal tissue. Also, it is so concentrated that a month’s worth fits in a ring that allows a tiny amount to trickle out each day.

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