Questions about ARVs as HIV Prevention

Earlier this week, we published a video of Dr Myron Cohen talking about his research study that showed how ARVs can prevent the spread of HIV in couples. Science magazine went as far as to call it the ‘Breakthrough of the Year,’ and there is no question that the trial was one of the most discussed in 2011. However, some have raised concerns about the trial design, the results and what this means for future HIV treatment.

A reader pointed out that USAID’s Dr. James D Shelton wrote an article that appeared in the very same edition of Science Magazine raising questions about the study. He questions if patients will be able to adhere to the protocols of the medication or if drug resistance will develop.

For ARVs as prevention to have a substantial impact, very large numbers of those persons testing positive—most symptom-free—would need to take them voluntarily and consistently for a lifetime. Even now, adherence is far from perfect, and some patients discontinue for a variety of reasons, including drug side effects ( 10).

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Ask Nick Kristof and Melinda Gates a Question

Melinda Gates is visiting Bangladesh this month on a maternal and child health fact-finding tour. On the Impatient Optimists blog, Melinda Gates explains why she’s going and invites people to ask her questions during the trip.

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Healthy Dose January 6, 2012

Life Expectancy in Zambia Up by 6 Years

Ministry of Health spokesperson Kamoto Mbewe says that TB infections are down and life expectancy has risen from 37 to 43 years. The Lusaka Times reports:

Dr Mbewe said the improvement was mainly due to the many milestones his ministry has made in fighting pandemics such as HIV and AIDS which had previously reduced the life expectancy in Zambia.

In response to a press query on Tuesday, Dr Mbewe said the infection rate of TB has drastically dropped.

“The main reason for the reduction in the TB infection rate is the introduction of the National TB Control Programme, which focuses on addressing the problem and implementation of the TB control strategy in a consistent and effective manner,” Dr Mbewe said.

He said other factors that have led to a decline in the number of TB cases, include a good monitoring and evaluation system, quality assured drugs for patient management and care as well as availability of effective treatment.

Dr Mbewe said global health initiatives such as the Global Fund have also helped to reduce the prevalence rate of TB, as more resources for treating the disease are readily available.

He also said good programme management has led to a rise in the successful treatment of TB patients which in 2000 stood at 66 percent but rose to 86 percent in 2010.

Dr Mbewe said this is because many cases were identified early and treated successfully. The transmission rate of TB has also reduced in the communities.

He said because of the current interventions the Ministry of Health has embarked on combating TB, HIV and AIDS and other related illnesses.

He however said the burden of TB is still high despite the strides made so far, adding that there is need for more efforts in dealing with TB in children and prisons.

Dr Mbewe said laboratories should be well equipped so that many TB, HIV and AIDS cases can be detected early.

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Jonah Hill Gets Serious for Nothing But Nets

Jonah Hill is is a hilarious. Who else would make a video playing around like a kitten?

When not trying to make people laugh, Jonah is supporting the “Nothing But Nets” campaign. He decided, “I’m hustling to win $25,000 in the Mozilla Firefox Challenge.” To do so, he needs to raise the most money on the website Crowdrise.

I think that Nothing But Nets is doing a kick ass job at helping those suffering in Somalia, Kenya, Ethiopia, and other countries. Those in the Horn of Africa are already suffering due to the severe drought, famine and conflict in that region, but the leading cause of death right now is from malaria.

A simple net that costs no more than a movie ticket could save thousands more from dying. It’s so simple, it’s stupid not to help. Nothing But Nets is set on sending 150,000 nets to the Horn of Africa and I want to do everything I can to aid them. You need to help too.

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How a South African Pop Star Became an HIV “Idol”

Tender Mavundla became a household name in South Africa not when she took part in the contest ‘Idols,’ but when she publicly revealed her HIV positive status. She told the South African TV Authority, while still a contestent, “I found out I was HIV positive in 2001 and ever since then I’ve just tried to make things as comfortable for myself and my family because there’s a stigma – there was a stigma – ‘cos now I don’t think there’s a stigma anymore because – and I say this a lot – every household in South Africa’s affected or infected by it. There’s no ways you’re gonna laugh at your neighbour, tomorrow it’s you. So the stigma part’s gone, forgotten really – as far as I’m concerned people need to get used to it ‘cos it’s not gonna change anytime soon.”

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Healthy Dose January 5, 2012

Researchers on the Verge of Hepatitis C Vaccine

Researchers who conducted a small trial of a Hepatitis C vaccine in the UK are optimistic about the early results. The BBC reports:

Writing in Science Translational Medicine, researchers say their trial on 41 patients shows it is possible.

The Hepatitis C Trust said the findings were very promising.

The virus can go unnoticed for years, but during this time it can cause considerable liver damage.

In the UK, up to 500,000 people may be infected with the virus. The World Health Organization believes the global figure could be as high as 170 million people.

It spreads through blood-to-blood contact such as sharing needles. While infection can be controlled with antiviral drugs, the Oxford University researchers say a vaccine “would be a major step forward”.

They attempted to target the inner workings of the virus, rather than the variable surface markings.

One of the researchers, Prof Paul Klenerman, said: “That’s where the engine of the virus is, where we may be able to successfully target many of the crucial pieces of machinery.”

Cold viruses were modified with genetic material from the hepatitis C virus in order to prime the immune system to attack the hepatitis C virus.

The aim of the Phase I trial was to determine whether the treatment was safe and to help plan future trials.

Forty-one healthy patients were given the vaccine. Scientists said it produced a “very strong” immune response which lasted for at least a year and had no major side-effects.

Prof Klenerman said: “The immune responses we’ve seen are exciting and we are beginning the next stage of trials. While we are hopeful, it could be a long road to any vaccine that protects people against hepatitis C.”

The next step will be to give the vaccine to people at-risk of hepatitis C infection to see whether it protects against the virus.

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Dr. Myron Cohen on 2011’s Biggest Global Health Breakthrough

The discovery that the sexual transmission can be virtually stopped when the infected person is treated with ARVs this year was heralded as the ‘Breakthrough of the Year’ by Science magazine. The team of researchers who completed the study was lead by University of North Carolina’s Dr. Myron Cohen. In the above video, Dr. Cohen shares how he and his team set about testing the idea. Additionally, he speaks to his motivations as a scientist searching for a way to end AIDS.

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Why 2011 Was A Pivotal Year for Global Sexual and Reproductive Health

Helen Marsden of Marie Stopes International writes a review of accomplishments in sexual and reproductive health in 2011.  She illustrates important events in each month of what she called a “pivotal year in sexual and reproductive health.”  Here are highlights from her blog post on the Huffington Post:

January

A wonder drug – the new one
A good month for women in Malawi as misoprostol – a crucial drug to treat post-partum haemorrhage and other reproductive health issues – was registered in the country for the first time. Post-partum haemorrhage (severe blood loss after giving birth) causes 25% of the 358,000 global maternal deaths each year, reaching up to 60% in some countries in the developing world.

The World Health Organisation recognises misoprostol as a crucial intervention in the prevention and treatment of post-partum haemorrhage, as it can both be given to women in their third trimester to decrease their risk, and immediately after birth if haemorrhage occurs. Registering the drug in as many countries as possible should be a priority, so women across the world can benefit like those in Malawi
.

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Healthy Dose January 4, 2012

UNICEF Plans Huge Expansion of Vaccine Programs

The UN agency has big ambitions for 2012 and beyond:

UNICEF is preparing ambitious plans to update, strengthen and vastly expand its global vaccination programme.

Vaccination has always been at the heart of UNICEF’s mission. Protecting children from life-threatening diseases is one of the most effective ways to ensure they have the chance to reach their full potential.

UNICEF is an influential part of the world vaccine market. In 2010, it supplied vaccines worth $757 million.

Nevertheless, it is taking a critical look at its role in immunization, and is gearing up to triple its capacity over the next five years.

“We need to strengthen what we do, so that the role that we and governments play in delivering immunization is much more solid,” said UNICEF Chief of Immunization Jos Vandelaer.

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GAVI Head Joins Blogosphere

Dr. Seth Berkley, the CEO of the GAVI Alliance, is now a global health blogger! It’s exciting to see more global health leaders joining a medium that encourages greater accessibility and deeper discussion on issues for which we are all so passionate.

Before Christmas, he shared his personal reflections on what 2011 has been like for the GAVI Alliance. And it was a good year! His organization shored up some serious financial backing from the international community which helps brings vaccines to people all around the world.   He reflects:

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Healthy Dose January 3, 2012

India Taking Lead in Polio Fight

India is drawing closer to polio eradication thanks to support from Muslim clerics and a new vaccination campaign.

Ending polio in IndiaThe World Health Organisation (WHO) stipulates that three years must pass without any cases of polio occurring before a region can be declared polio-free.

Moradabad, which only recently had 60-80 cases a year, is expected to qualify in 2012.

“This will be a wonderful thing – for us, for India, for the people of Moradabad,” said Dr Mohammed Arif, a public health specialist and organiser of anti-polio campaigns in the area.

There is a bigger national milestone on the horizon. If in India as a whole there are no more confirmed cases before 13 January, the country will have completed its first year without a new victim.

And if polio is gone from India, the only countries where the disease is still endemic would be Nigeria, Afghanistan and Pakistan.

India’s likely achievement would be a big step towards the eradication of a global disease – the second after smallpox, which was officially defeated worldwide in 1979.

“That would really be something to be happy about,” said Arif.

It would also be a boost to a global effort which has been flagging in recent years, with key milestones repeatedly missed.

Last year, Sir Liam Donaldson, the UK’s former chief medical officer who now chairs the independent monitoring board of the Global Polio Eradication Initiative, said the final success of the eradication campaign, which has seen cases reduced by 99% in 20 years, was “on a knife-edge”. In some places, particularly sub-Saharan Africa, polio has even made a comeback.

In India, a mass vaccination campaign involving more than a million volunteers reduced cases nationally by 94% between 2009 and 2010, from 741 to 42, and down to the single case last year.

The success is due to a combination of highly motivated local workers, philanthropy, the involvement of international health bodies and the sometimes inefficient but nonetheless essential support of local government.

Equally important in overcoming the last bastions of the disease, as in many parts of the world, has been the consent of local religious figures.

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