The American Medical Association recently updated its HIV testing policy to include guidelines supporting routine HIV testing, while continuing to advocate for the protection of patient privacy and autonomy, the AP/Google.com reports (AP/Google.com, 5/14).
"Understanding and treatment of HIV has grown substantially over the past few decades," Ardis Hoven, an AMA board member, said, adding, "new policy calls on physicians to routinely test consenting adult patients for HIV and reflects the reality that if HIV is detected early patients can lead full and productive lives" (AMA release, 11/13).
CDC in September 2006 released revised recommendations on HIV testing in the U.S. The recommendations advise that HIV tests become a routine part of medical care for residents ages 13 to 64 and that requirements for written consent and pretest counseling be dropped. According to a study published last month in PLoS One, more than 30 states have laws that hamper doctors from implementing the recommendations (Kaiser Daily HIV/AIDS Report, 10/11).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Tuesday, November 20, 2007
Virus Used In HIV Vaccines Weakens Immune System
A new US study has shown that some of the viruses used as carriers in clinical trials for HIV-1 vaccines weaken the immune system and may do more harm than good.
Researchers primed the immune systems of laboratory mice by exposing them to fragments of HIV carried by rAAV (recombinant adeno-associated virus (rAAV) vector), a type that has been used recently in human trials. This resulted in the anticipated creation of special T cells against HIV, but they didn't work properly. They couldn't fight against infection, they didn't release enough cytokines to activate an appropriate immune response, and they didn't reproduce when exposed to HIV in a booster.
The study is the work of Dr Hildegund C.J. Ertl, director of the Wistar Institute Vaccine Center, an independent nonprofit biomedical research institute based in Philadelphia, Pennsylvania, and colleagues, and is published in the November 16th online issue of the Journal of Clinical Investigation.
Leading efforts in human trials to develop an HIV vaccine have depended on the use of viruses to carry scraps of HIV virus as a way to get the patient's immune system to make antibodies against HIV.
However, more recently, evidence has been coming forward that some of these viral "vectors" may weaken the immune system and should not be used.
This study from Ertl and colleagues gives further evidence of this, and suggests that some viral vectors could do more harm than good.
Ertl and colleagues found that while the rAAV based vaccine managed to stimulate the immune system to produce T cells specifically against HIV, as intended, those same T cells also undermined the immune system in various ways.
"Put simply", said Ertl, these results "mean that AAV vaccines against HIV may potentially cause harm and that, without additional pre-clinical studies, they should not be used in humans".
Using laboratory mice, Ertl and colleagues primed the immune system against HIV with an experimental rAAV based vaccine. Then, as would be done in a typical vaccine regimen, they followed this with a booster immunization using a vaccine based on another viral vector, adenovirus (Ad). They also carried out some booster immunizations using other viral vectors.
When they looked at the resulting immune response using follow up assays, they found that in all booster immunization cases, the HIV specific T cells induced by the rAAV vector were ineffective at preventing infection, regardless of time between prime and booster. The T cells protected poorly against HIV, they failed to secrete sufficient levels of cytokines, chemicals that stimulate the immume response, and they did not replicate sufficiently in response to the booster.
The results indicate a condition known as "T cell exhaustion", something that has been observed before with HIV, hepatitis B and hepatitis C, and some cancers like melanomas, said the researchers.
The researchers concluded that:
"Our data suggest that rAAV vectors induce functionally impaired T cells and could dampen the immune response to a natural infection."
Ertl questioned the rationale for injecting people with "a vaccine that's going to have a detrimental effect".
"AAV vaccines against HIV may do more harm than good by robbing people of their natural immune response to HIV," she warned.
Researchers primed the immune systems of laboratory mice by exposing them to fragments of HIV carried by rAAV (recombinant adeno-associated virus (rAAV) vector), a type that has been used recently in human trials. This resulted in the anticipated creation of special T cells against HIV, but they didn't work properly. They couldn't fight against infection, they didn't release enough cytokines to activate an appropriate immune response, and they didn't reproduce when exposed to HIV in a booster.
The study is the work of Dr Hildegund C.J. Ertl, director of the Wistar Institute Vaccine Center, an independent nonprofit biomedical research institute based in Philadelphia, Pennsylvania, and colleagues, and is published in the November 16th online issue of the Journal of Clinical Investigation.
Leading efforts in human trials to develop an HIV vaccine have depended on the use of viruses to carry scraps of HIV virus as a way to get the patient's immune system to make antibodies against HIV.
However, more recently, evidence has been coming forward that some of these viral "vectors" may weaken the immune system and should not be used.
This study from Ertl and colleagues gives further evidence of this, and suggests that some viral vectors could do more harm than good.
Ertl and colleagues found that while the rAAV based vaccine managed to stimulate the immune system to produce T cells specifically against HIV, as intended, those same T cells also undermined the immune system in various ways.
"Put simply", said Ertl, these results "mean that AAV vaccines against HIV may potentially cause harm and that, without additional pre-clinical studies, they should not be used in humans".
Using laboratory mice, Ertl and colleagues primed the immune system against HIV with an experimental rAAV based vaccine. Then, as would be done in a typical vaccine regimen, they followed this with a booster immunization using a vaccine based on another viral vector, adenovirus (Ad). They also carried out some booster immunizations using other viral vectors.
When they looked at the resulting immune response using follow up assays, they found that in all booster immunization cases, the HIV specific T cells induced by the rAAV vector were ineffective at preventing infection, regardless of time between prime and booster. The T cells protected poorly against HIV, they failed to secrete sufficient levels of cytokines, chemicals that stimulate the immume response, and they did not replicate sufficiently in response to the booster.
The results indicate a condition known as "T cell exhaustion", something that has been observed before with HIV, hepatitis B and hepatitis C, and some cancers like melanomas, said the researchers.
The researchers concluded that:
"Our data suggest that rAAV vectors induce functionally impaired T cells and could dampen the immune response to a natural infection."
Ertl questioned the rationale for injecting people with "a vaccine that's going to have a detrimental effect".
"AAV vaccines against HIV may do more harm than good by robbing people of their natural immune response to HIV," she warned.
Mozambique To Revise National HIV/AIDS Prevention Strategy, Health Minister Says
The Mozambican government has decided to revise its national HIV/AIDS prevention strategy after finding that the current efforts have not been effective in controlling the disease, Health Minister Ivo Garrido, recently said, AIM/AllAfrica.com reports. Garrido, who also serves as the spokesperson for the Steering Council of the country's National AIDS Council, said a meeting of the council held on Monday highlighted 10 areas that should guide the revision.
He said that the AIDS council will seek to increase coordination between HIV/AIDS advocacy groups in the country; develop a mechanism for gauging the effectiveness of HIV prevention strategies; and improve HIV counseling and testing programs. The review also will address the definition of "high-risk groups," Garrido said. He said that he believes "almost everybody" is at risk but added that a task group was established to investigate this issue.
Garrido said the Steering Council hopes to have "proposals on coordination" by early next year. The country in 2004 had an estimated HIV prevalence of 16.2% among adults ages 15 to 49 (AIM/AllAfrica.com, 11/14).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
He said that the AIDS council will seek to increase coordination between HIV/AIDS advocacy groups in the country; develop a mechanism for gauging the effectiveness of HIV prevention strategies; and improve HIV counseling and testing programs. The review also will address the definition of "high-risk groups," Garrido said. He said that he believes "almost everybody" is at risk but added that a task group was established to investigate this issue.
Garrido said the Steering Council hopes to have "proposals on coordination" by early next year. The country in 2004 had an estimated HIV prevalence of 16.2% among adults ages 15 to 49 (AIM/AllAfrica.com, 11/14).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Opinion Piece Examines HIV/AIDS Policy Views Of Giuliani Adviser
A recent opinion piece by Sally Pipes -- president and CEO of the Pacific Research Institute, a think tank that receives some funding from drug companies -- about intellectual property rights and compulsory licenses for patented antiretroviral drugs is "frightening," Andrew Green, a publishing fellow, writes in the American Prospect. If Pipes were "just running a think tank with pharmaceutical funding, it could be read as a shill piece and dismissed. But there's more to Pipes' biography: She is also a health care adviser to Rudy Giuliani," the former New York City mayor who is running for the Republican presidential nomination, Green adds (Green, American Prospect, 11/15).
In her opinion piece, Pipes says it was a "staggering display of cluelessness" for Rep. Tom Allen (D-Maine) and Sen. Sherrod Brown (D-Ohio) to sponsor a resolution that praises the Thai government for its decision to issue compulsory licenses to make generic versions of patented antiretroviral drugs. She adds that Thailand's actions "threaten to upset the economic incentives that allow Western firms to produce novel cures," saying, "Without patent protections, the drug industry as we know it would collapse, and development of new drugs would be significantly curtailed" (Kaiser Daily HIV/AIDS Report, 10/18).
Pipes opinion piece "can be read both as a signal that her role is expanding and as a preview of the HIV/AIDS policy she is encouraging Giuliani to adopt, specifically one without regard for the immediate need for as many cheap generic antiretrovirals as possible," Green writes. According to Green, while this is "cause for concern," the "real crisis" is that "Giuliani might actually be receptive to her arguments."
Giuliani has "expressed an interest in continuing and possibly expanding the President's Emergency Plan for AIDS Relief," but it is "apparent" he has "thought little about what that actually means," Green says. In addition, Giuliani has not described his HIV prevention strategy or whether he would expand treatment options, according to Green. "His lack of investment or concern about the issue leaves him vulnerable to insiders like Pipes, whose business-first agendas are prepackaged," Green writes. He adds that it is "not outlandish to think that [Giuliani] might make AIDS relief contingent on buying brand-name antiretrovirals" or "levy trade restrictions and financial penalties on countries, like Thailand, that determine the best way to immediately reach the most HIV/AIDS patients is to produce their own antiretrovirals."
Green suggests that all presidential candidates "study the AIDS policy Democrat John Edwards has introduced," adding that the "first move Giuliani should make, though, is to send Pipes back to the sideline and hire some advisers whose values aren't predicated on profit margins" (American Prospect, 11/15).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
In her opinion piece, Pipes says it was a "staggering display of cluelessness" for Rep. Tom Allen (D-Maine) and Sen. Sherrod Brown (D-Ohio) to sponsor a resolution that praises the Thai government for its decision to issue compulsory licenses to make generic versions of patented antiretroviral drugs. She adds that Thailand's actions "threaten to upset the economic incentives that allow Western firms to produce novel cures," saying, "Without patent protections, the drug industry as we know it would collapse, and development of new drugs would be significantly curtailed" (Kaiser Daily HIV/AIDS Report, 10/18).
Pipes opinion piece "can be read both as a signal that her role is expanding and as a preview of the HIV/AIDS policy she is encouraging Giuliani to adopt, specifically one without regard for the immediate need for as many cheap generic antiretrovirals as possible," Green writes. According to Green, while this is "cause for concern," the "real crisis" is that "Giuliani might actually be receptive to her arguments."
Giuliani has "expressed an interest in continuing and possibly expanding the President's Emergency Plan for AIDS Relief," but it is "apparent" he has "thought little about what that actually means," Green says. In addition, Giuliani has not described his HIV prevention strategy or whether he would expand treatment options, according to Green. "His lack of investment or concern about the issue leaves him vulnerable to insiders like Pipes, whose business-first agendas are prepackaged," Green writes. He adds that it is "not outlandish to think that [Giuliani] might make AIDS relief contingent on buying brand-name antiretrovirals" or "levy trade restrictions and financial penalties on countries, like Thailand, that determine the best way to immediately reach the most HIV/AIDS patients is to produce their own antiretrovirals."
Green suggests that all presidential candidates "study the AIDS policy Democrat John Edwards has introduced," adding that the "first move Giuliani should make, though, is to send Pipes back to the sideline and hire some advisers whose values aren't predicated on profit margins" (American Prospect, 11/15).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Wednesday, September 12, 2007
New Guide on 'Unseen' Disabilities for Small Businesses
To help small businesses avoid unintentionally discriminating against people living with long-term conditions, such as HIV and cancer, the National AIDS Trust has produced 'You can't always tell- a guide to 'unseen' disabilities for small businesses'. The free guide provides clear, practical advice to help small business owners ensure that they are providing a fair and equal working environment for employees who may be living with one of these conditions and that they are not breaking the law.
No Increase in HIV Prevention Spend Despite Massive Increase in Need
The results of a survey by the National AIDS Trust suggest that investment in HIV prevention in England has stagnated, and probably decreased, over the last ten years, despite the fact that the potential for HIV transmission in the UK is greater than it has ever previously been.more...
New Issue of Impact Examines HIV and the Law
The National AIDS Trust has launched the latest issue of Impact, its policy bulletin which stimulates debate on key HIV policy topics. This issue focuses on HIV and the law and aims to give an overview of both the current legal developments that can affect the lives of people living with HIV and the work that the National AIDS Trust and other organisations are doing to ensure that the law protects, rather than infringes, the rights of people living with HIV.
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