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HATIP #70, 14th July, 2006

Published: 14 July 2006

News headlines

PEPFAR: PMTCT improving but services only reaching small percentage of women in need
The past few years have seen improvements in the treatment options for the prevention of mother-to-child transmission (PMTCT), according Dr Dorothy Mbori-Ngacha, who is the Chief of the PMTCT Section of the US Centers for Disease Control in Kenya. But despite the expansion of programmes under PEPFAR, PMTCT services are reaching less than 10% of HIV-infected women in most countries.

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PEPFAR: Unexpected and unwanted pregnancies in women on ART highlights family planning gap
A number of antitroviral treatment (ART) programmes supported by the US have observed a large number of unexpected pregnancies in women on ART, according to reports made at the 2006 PEPFAR Implementers meeting held in June in Durban, South Africa. According to one report, the results were disastrous for some women on ART in Uganda, who did not want any more children. As a result, teams have concluded that PEPFAR may need to invest more in supporting family planning services in these countries.

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Circumcision could avert three million AIDS deaths over next 20 years in Africa
The widespread adoption of male circumcision throughout Africa could avert up to 5.7 million HIV infections by 2026, according to a scientific modelling study published this week in Public Library of Science Medicine.

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Russia admits HIV drug shortage
Russia’s chief epidemiologist admitted yesterday that supplies of antiretroviral drugs are running short in the country, and that people with HIV in regions such as Siberia are experiencing interruptions in treatment because of badly managed drug supply.

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PEPFAR: Early weaning to avoid mother-to-child transmission of HIV could endanger infant’s health
Early weaning to prevent mother-to-child transmission (PMTCT) of HIV can pose considerable challenges in resource-limited settings — and could put HIV-exposed infant’s health in serious jeopardy —according to reports presented at the 2006 PEPFAR Implementers meeting in Durban this June.

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Ukraine: many pregnant women with HIV were infected by partners, unaware of drug use history
Women diagnosed with HIV during pregnancy in Ukraine are now more likely to have acquired HIV through sexual transmission than through injecting drug use, and by 2004 the majority of women who acquired HIV through sexual transmission were not aware of any direct sexual contact with injecting drug–using partners, according to findings from a pan-European comparison of mother-to-child HIV transmission rates published in the June 26th edition of the journal AIDS.

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85% of rural Chinese HIV-positives also have hepatitis C
Rural Chinese villagers with HIV have high rates of undetected hepatitis C (HCV) infection, and are potentially compromising treatment with antiretroviral drugs, according to a study published in the journal AIDS last month.

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Nevirapine-based triple-drug combinations safe for use in pregnant African women
Triple-drug combinations containing nevirapine (Viramune) are safe and effective for most pregnant women in resource-limited settings, according to a review of medical notes from over 700 women in Africa. The study’s findings were published in the July edition of HIV Medicine.

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Monthly sulfadoxine-pyrimethamine might protect HIV-positive African pregnant women against placental malaria
Monthly treatment with sulfadoxine-pyrimethamine (SP) is significantly more effective in preventing malaria in pregnant women than the current practice of giving two doses of SP during pregnancy, according to a US-sponsored study carried out in Malawi, published in the August 1st edition of the Journal of Infectious Diseases.

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15th HIV Resistance Workshop: tenofovir resistance in Africans may be quicker, more frequent
New antiretrovirals with novel mutational profiles allow physicians and patients to sequence drugs without overlapping resistance – that’s the theory. A somewhat disconcerting report from Botswana conducted by a Botswana-Harvard-McGill coalition and reported by Florence Doualla-Bell from McGill University in Montreal lent further credence to the view that some drug resistance mutations emerge at different frequencies and speeds in different viral subtypes. In particular the findings have serious implications for the eventual use of tenofovir in countries with subtype C HIV epidemics.

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FDA approves first three-drug fixed-dose tablet for PEPFAR use
The US Food and Drug Administration (FDA) this week issued the first tentative approval for a three drug, fixed dose tablet for use as a stand-alone antiretroviral treatment for HIV infection in adults. The product (lamivudine-zidovudine-nevirapine tablet) contains the active ingredients in the widely used antiretroviral drugs Epivir (lamivudine), Retrovir (zidovudine), and Viramune (nevirapine).

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Zimbabwe observes a reduction in HIV prevalence, but why?
In 2005, a substantial reduction in national HIV prevalence during the previous year was observed in Zimbabwe. This has been heralded by some as evidence that HIV prevention efforts, particularly strategies based upon Abstinence, Be Faithful and use Condoms (ABC), are having an impact.

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Kaletra receives EU marketing approval; developing countries registration 'moving forward'
The Meltrex tablet formulation of Kaletra (lopinavir/ritonavir) has now received full marketing approval from the European Medicines Agency (EMEA), according to a statement from the drug's manufacturer, Abbott, who says this now allows them to register the new formulation in countries eligible for its access programme, which offers the drug at a steeply discounted price in more than 60 least developed countries.

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Modelling study predicts efficacy and cost-effectiveness of HIV treatment after single-dose nevirapine
South African women exposed to single-dose nevirapine (Viramune) are likely to gain the most benefit from antiretroviral therapy based on ritonavir-boosted lopinavir (Kaletra) followed by a nevirapine-based combination. This is also a ‘very cost-effective’ strategy, according to the results of a study presented in the 15th June edition of Clinical Infectious Diseases.

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Fatty liver prevalence high with HIV/HCV coinfection: 'use ddI or d4T cautiously'
Individuals coinfected with HIV and hepatitis C virus (HCV) should use ddI (didanosine, Videx/Videx EC) and d4T (stavudine, Zerit) with caution, according to an editorial commenting on the results of the largest study so far to report on factors associated with hepatic steatosis, or fatty liver - the accumulation of fatty acids in the liver - in coinfected patients. The study, to be published in the August 1st issue of Clinical Infectious Diseases, found that 69% had steatosis and that the use of ddI or d4T increased the risk of steatosis almost fivefold.

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Two generic HIV drugs approved for children by FDA
The US Food and Drug Administration announced this week that it has approved liquid formulations of two antiretroviral drugs, lamivudine (3TC) and abacavir, for use in the treatment of children with HIV.

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Malnourishment at time HIV treatment is started equals much poorer survival
Malnutrition at the time antiretroviral therapy is started is associated with significantly poorer survival, according to a study published in the July edition of HIV Medicine. In a retrospective study conducted in Singapore, investigators found that patients who were malnourished when they initiated potent HIV therapy had a six-fold increase in the risk of death compared to patients with good nutritional status. However, CD4 cell recovery was comparable between malnourished and well-nourished patients, and the investigators speculate that the increased mortality seen in patients with malnourishment could have been due to factors such as poorer drug absorption, inability to tolerate treatment, or lower physical functioning. They recommend that nutritional support should be provided to malnourished patients when anti-HIV treatment is started to reducing the risk of death.

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Mortality and causes of death amongst people taking HIV treatment in Senegal examined
A study conducted in Senegal suggests that individuals who die after commencing anti-HIV therapy are most likely to do so in the first year of antiretroviral therapy, largely because antiretroviral therapy was only initiated when they were already very ill because of HIV. The study, published in the May edition of AIDS, also found that mycobacterial infections, particularly tuberculosis (TB), cause a significant number of deaths, and the investigators also speculate that some of the TB-associated deaths could have been caused by immune reconstitution inflammatory syndrome (IRIS).

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AZT/3TC/tenofovir regimen effective first-line therapy in resource-limited settings
The combination of AZT (zidovudine, Retrovir), 3TC (lamivudine, Epivir) and tenofovir (Viread) is an effective first-line regimen in adult HIV patients in Africa, according to a cohort study published in the 26th June edition of AIDS. The study found that most patients starting HIV treatment with this combination achieve viral suppression over the first year of therapy, supporting its use as first-line therapy in resource-limited settings.

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Grey nails help predict need to start anti-HIV therapy in Malawians
Grey nails accurately predict if asymptomatic HIV-positive Malawians have a low CD4 cell count and need to commence antiretroviral therapy, according to a study published in the June edition of AIDS. The investigators believe that monitoring patients for nail discolouration could provide a useful tool for clinicians working in southern Africa who do not have access to CD4 cell count testing.

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PEPFAR: HIV prevention for injection drug users in Africa a growing issue
While sexual transmission is the leading driver behind the spread of HIV, it has been estimated that globally, injection drug use accounts for at least 10% of new infections globally. In some countries injection drug users (IDUs) are at the centre of the epidemic. Preventing the spread of HIV in this (and from this) marginalised population will be necessary to reverse the epidemic in Eastern Europe and southeast Asia.

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PEPFAR project reports reduction in the number of partners among Zambian truck drivers
Prevention work among truck drivers in Africa appear to be leading to reductions in sexual risk taking behaviour according to one presentation at the 2006 HIV/AIDS Implementers Meeting of the President’s Emergency Plan for AIDS Relief held from June 12-15 in Durban, South Africa.

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Cigarette smoking may undermine benefits of potent antiretroviral therapy
Cigarette smokers are more likely to be diagnosed with an AIDS-defining condition or to die, negating some of the benefits of potent antiretroviral therapy, according to a large prospective observational study of HIV-positive women from the United States. The study, published in the June issue of the American Journal of Public Health, is the first to find a relationship between smoking and HIV disease progression in women.

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Is PEPFAR competing or cooperating in treatment scale-up?
Given the political climate in which the PEPFAR Implementers meeting and the UN High Level meeting took place, it would be only natural for some working in the respective funding organisations to become a bit competitive — and yet publicly at least both appear to be striving for closer cooperation.

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Casting the first stone: the US Christian right’s war on the Global Fund
When he first announced PEPFAR, President Bush pledged to allocate $1 billion dollars to the Global Fund over the next five years, and recent PEPFAR promotional materials proudly announce that the US Congress has seen fit to increase that funding to an aggregate closer to $2 billion dollars. Earlier this year politicians from both parties in Congress sponsored an amendment to the Global AIDS Bill that would boost next year’s US donation to $866 million.

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PEPFAR and Global Fund both highly effective, but is the funding sustainable?
At the 2006 Annual Implementers’ Meeting of the US President’s Emergency Plan for AIDS Relief (PEPFAR), last week in Durban, South Africa, the “implementers” (the teams working on the ground in PEPFAR’s focus countries) reported success after success and gave numerous examples of just how rapidly effective smart and strategic investments in AIDS care and treatment can be. In a little over two years since disbursements began, PEPFAR has supported antiretroviral treatment (ART) for hundreds of thousands and care for literally millions of people infected or affected by HIV in resource-constrained settings.

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Fat loss beginning to trigger treatment changes in South African patients
Fat loss caused by the d4T (stavudine) component of triple antiretroviral therapy is beginning to trigger treatment changes among people receiving HIV treatment in South Africa, doctors from Durban’s McCord Hospital reported at last week’s 2006 Implementers Meeting of the President’s Emergency Plan for AIDS Relief in Durban, South Africa.

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.