In May, the Bush administration with great reluctance and under extensive pressure agreed to contribute $200 million to the UN’s global health fund. That fund’s goal is to spend $10 billion annually on AIDS, malaria and TB. In contrast, the administration had no trouble asking for $20 billion to fight terrorism in the aftermath of the September 11 attacks.
In much of the world, the stork is regarded as a symbol of fertility, a welcome bearer of the good news that a baby is on the way, gently carried along in the stork’s beak. Not so in the capital of Uganda, where the giant marabou stork with its huge black wings and pink gullet is viewed more as a Grim Reaper, a symbol of death and decay, not life and prosperity.
The latest South African projections on the spread of AIDS are appalling: The country's Medical Research Council (MRC) estimates that AIDS was the cause of a quarter of all South African deaths last year. Without effective treatment or prevention, AIDS will account for more than double the number of deaths due to all other causes by 2010.
Finally, the first anti-HIV drug of the year: On October 3, the FDA Antiviral Drug Products Advisory Committee members unanimously agreed to recommend FDA approval of Gilead Sciences’ tenofovir disoproxil (Viread). Tenofovir inhibits reverse transcriptase in the same manner as ddI, but requires less intracellular processing.
Last July a National Institute of Allergy and Infectious Diseases committee issued a report reviewing what is known about condom efficacy in blocking disease transmission. Entitled "Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention," the report summarized the results of a workshop held in July, 2000 at the request of then-Representative Tom Coburn . . . .
Thirty years ago, the paved highway leading from Port-au-Prince to Haiti's high, forested interior was a winding feat of engineering. Today, it would be generous to call what remains of it a road, especially during the summer rains.
Clinical experience, the art of treating AIDS learned through years of trial and error, along with recent research findings about unfit virus, have converged to create today’s model for treating patients with moderate to high levels of multidrug-resistant HIV.
Not only do the potent HIV drugs cause myriad side effects, but HIV can mutate to become resistant to all the existing medications. A growing number of multidrug-resistant HIV strains (MDR HIV) have emerged following the introduction of more complex and active regimens.
Ritonavir’s function is to increase the blood levels of the second PI – and thereby decrease pill burden, simplify dosing schedules, and improve adherence to dosing schedules.
The June 7 announcement that Bristol-Myers Squibb was purchasing DuPont Pharmaceuticals heralded a further concentration of HIV drug development and marketing. Especially at stake are agents to treat the multidrug-resistant HIV that is the focus of this issue of the Treatment Insider.
The biggest challenge now facing this nation of 40 million is one that collectively encompasses economic, social, political, and health issues: HIV/AIDS currently affects nearly every citizen either directly or indirectly, with 1,500 to 1,800 new cases diagnosed every day.
Depending on how you look at it, malaria has either a lot or very little in common with HIV. Both diseases kill millions of people each year, and both diseases are scourges of developing nations in Africa, India, Southeast Asia and South America.
Research into microbicides, which could be topically applied to vagina or rectum to prevent HIV transmission, continues to make slow headway. At Keystone, James Hildreth of the Johns Hopkins University School of Medicine presented preliminary findings of a promising microbicide called b-cyclodextrin .
This year's annual Keystone Symposium on HIV, held March 28 to April 3 in Keystone, Colorado, featured concurrent sessions on "AIDS Vaccines in the New Millennium" and "HIV Pathogenesis" (how the microbe causes disease). Previous meetings on pathogenesis have emphasized the adaptive immune response: antibodies and CD8+ cytotoxic T lymphocytes (CTLs).
Two ambitious new gender-specific research agendas at the National Institutes of Health (NIH) could launch a major new initiative to study HIV disease and treatment in women. Within two weeks last April, the Office of AIDS Research (OAR) and the Women's Health Committee of the AIDS Clinical Trials Group (ACTG) both produced near-final versions of comprehensive gender-specific agendas.
Twentieth anniversaries usually are cause for celebration, but this one obviously is not: On June 5, 1981, the CDC's Morbidity and Mortality Weekly Report carried a curious but otherwise unremarkable account from Los Angeles that in the past eight months, "5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia."
Tenofovir, Gilead Sciences' candidate reverse transcriptor inhibitor, is on the way to the market. In an unexpected move, the company announced May 1 that it had filed a New Drug Application with the FDA.
The annual Conference on Retroviruses and Opportunistic Infections, held this year on February 4-8 in Chicago, is supposed to be the premier event for reporting HIV treatment innovations. Though widely discussed in the halls, the biggest story this year did not went unmentioned in the official program.
The FDA is taking its most active role to date in encouraging drug companies to address the needs of persons with HIV who have exhausted all their treatment options. Due to a long history of drug failures, these people require innovative salvage therapies that are unaffected by the drug resistance their HIV has built up.
At the 8th Conference on Retroviruses and Opportunistic Infections, there were few breakthroughs for scientists bent on unscrambling the causes of lipodystrophy, bone disease and other metabolic changes.
The new drug is enhanced by "pegylation" - the attachment of a polyethylene glycol (PEG) tail to interferon. The PEG molecule makes the interferon more soluble in water and shields it from degradation by blood enzymes and antibodies.
The XIII International AIDS Conference's sessions on HIV vaccines took place in an atmosphere of greater urgency than ever before. Durban, the conference's locale, has an HIV prevalence that exceeds one in five, and treatment for HIV is unaffordable there for all but a tiny elite.
A small group of community advocates, a divided research community, huge sums of money, and urgent questions that threaten to break the mold of conventional trial designs. All of these elements are at play in what may be one of the least publicized and most critical fields in HIV research today: long-term trial design.
In the wake of the XIII International AIDS Conference, the concept of "best practices" in HIV management has become a touchstone. The "best practices" concept implies drawing on local capacity and experience to create a practical high-quality standard of care.
"I'm an old Ugandan right now," says David Serwadda, "I'm not that enthusiastic about treating with HAART." As he speaks, Serwadda looks out the window of the white four-by-four that is bouncing at high speed along the road to Rakai, a southern district that shares a border with Tanzania.
Large-scale phase III trials of vaccine efficacy are likely to take place in poor countries that are hardest hit by the epidemic. These areas have the high-incidence populations best suited for testing new vaccine candidates. Where HIV infection rates are high, it takes a smaller study to determine whether or not a vaccine is effective.
Adding to the uncertainty about Kaletra's contribution in salvage therapy that also includes an NNRTI like efavirenz is evidence that HIV mutations conferring resistance to nucleoside analogs at the same time make the virus more susceptible to NNRTIs like efavirenz (Sustiva).
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Disclaimer: The editors have taken all such care as they consider reasonable in preparing this database, but they cannot be held responsible for any inaccuracies or mis-statements of fact contained herein. Inclusion in this database of any information on any treatment, therapy, or clinical trial in no way represents an endorsement of that treatment, therapy, or trial by ÆGiS or any of its sponsors. This data should always be used in conjunction with professional medical advice.