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Study details how dengue infection hits harder second time around
http://newscenter.berkeley.edu/2011/12/21/dengue/
The Affordable Care Act and People Living with HIV/AIDS
http://blog.aids.gov/2012/01/the-affordable-care-act-and-people-living-with-hivaids.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+aids%2Fgov+%28Blog.AIDS.gov%29&utm_content=Yahoo%21+Mail
kismetkid,
Thank you for that post - Great Find. It is a good thing that the co. has put this out - it answers a lot of questions from many angles.
Aethlon Medical Announces Biotech Showcase™ 2012 Presentation
http://finance.yahoo.com/news/Aethlon-Medical-Announces-prnews-1826182329.html?x=0
NEF
HIV Nef is secreted in exosomes and triggers apoptosis in bystander CD4+ T cells.
Lenassi M, Cagney G, Liao M, Vaupotic T, Bartholomeeusen K, Cheng Y, Krogan NJ, Plemenitas A, Peterlin BM.
Source
Departments of Medicine, Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94143, USA.
Abstract
The HIV accessory protein negative factor (Nef) is one of the earliest and most abundantly expressed viral proteins. It is also found in the serum of infected individuals (Caby MP, Lankar D, Vincendeau-Scherrer C, Raposo G, Bonnerot C. Exosomal-like vesicles are present in human blood plasma. Int Immunol 2005;17:879-887). Extracellular Nef protein has deleterious effects on CD4(+) T cells (James CO, Huang MB, Khan M, Garcia-Barrio M, Powell MD, Bond VC. Extracellular Nef protein targets CD4(+) T cells for apoptosis by interacting with CXCR4 surface receptors. J Virol 2004;78:3099-3109), the primary targets of HIV, and can suppress immunoglobulin class switching in bystander B cells (Qiao X, He B, Chiu A, Knowles DM, Chadburn A, Cerutti A. Human immunodeficiency virus 1 Nef suppresses CD40-dependent immunoglobulin class switching in bystander B cells. Nat Immunol 2006;7:302-310). Nevertheless, the mode of exit of Nef from infected cells remains a conundrum. We found that Nef stimulates its own export via the release of exosomes from all cells examined. Depending on its intracellular location, these Nef exosomes form at the plasma membrane, late endosomes or both compartments in Jurkat, SupT1 and primary T cells, respectively. Nef release through exosomes is conserved also during HIV-1 infection of peripheral blood lymphocytes (PBLs). Released Nef exosomes cause activation-induced cell death of resting PBLs in vitro. Thus, HIV-infected cells export Nef in bioactive vesicles, which facilitate the depletion of CD4(+) T cells that is a hallmark of acquired immunodeficiency syndrome (AIDS).
Nef
Curr HIV Res. 2011 Nov 18. [Epub ahead of print]
ONE PROTEIN TO RULE THEM ALL: MODULATION OF CELL SURFACE RECEPTORS AND MOLECULES BY HIV NEF.
Landi A, Iannucci V, Nuffel AV, Meuwissen P, Verhasselt B.
Source
Department of Clinical Biology, Immunology and Microbiology, 3Blok A UZ Gent, B-9000 Gent, Belgium. bruno.verhasselt@ugent.be.
Abstract
The HIV-1, HIV-2 and SIV Nef protein is known to modulate the expression of several cell surface receptors and molecules to escape the immune system, to alter T cell activation, to enhance viral replication, infectivity and transmission and overall to ensure the optimal environment for the outcome of infection. Consistent and continuous efforts have been made during the years to characterize the down-regulation of each of these molecules, in the hope that a better understanding of these processes essential for HIV infection and/or pathogenesis will eventually highlight new therapeutic targets. In this article we provide an extensive review of the knowledge gained so far on this important and evolving topic.
Nef
Microbes Infect. 2010 Jan;12(1):65-70. Epub 2009 Sep 19.
Role of HIV-1 Nef protein for virus replication in vitro.
Jere A, Fujita M, Adachi A, Nomaguchi M.
Source
Department of Microbiology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
Abstract
The Nef protein of primate lentiviruses (simian and human immunodeficiency viruses; SIV/HIVs) appears to be multi-functional and plays a pivotal role in viral persistence and pathogenesis in vivo. Of its numerous functions reported to date, the ability to enhance virion infectivity in indicator cell lines and to augment viral replication in peripheral blood mononuclear cells (PBMCs) and lymphocytes (PBLs) is very well conserved among various SIV/HIVs. This review summarizes and organizes current knowledge of HIV-1 Nef with respect to this particularly virological activity for understanding the basis of its in vivo function.
Nef
Adv Virus Res. 2011;80:103-27.
HIV immune evasion disruption of antigen presentation by the HIV Nef protein.
Wonderlich ER, Leonard JA, Collins KL.
Source
Graduate Program in Cellular and Molecular Biology, University of Michigan, Ann Arbor, Michigan, USA.
Abstract
The Human Immunodeficiency Virus (HIV) Nef protein is necessary for high viral loads and for timely progression to AIDS. Nef plays a number of roles, but its effect on antigen presentation and immune evasion are among the best characterized. Cytotoxic T lymphocytes (CTLs) recognize and lyse virally infected cells by detecting viral antigens in complex with host major histocompatibility complex class I (MHC-I) molecules on the infected cell surface. The HIV Nef protein disrupts antigen presentation at the cell surface by interfering with the normal trafficking pathway of MHC-I and thus reduces CTL recognition and lysis of infected cells. The molecular mechanism by which Nef causes MHC-I downmodulation is becoming more clear, but some questions remain. A better understanding of how Nef disrupts antigen presentation may lead to the development of drugs that enhance the ability of the anti-HIV CTLs to control HIV disease.
Nef
. Trends Microbiol. 2011 Sep;19(9):435-40. Epub 2011 Jul 25.
HIV-Nef and AIDS pathogenesis: are we barking up the wrong tree?
Baur AS.
Source
Department of Dermatology, University of Erlangen/Nürnberg, D-91052 Erlangen, Germany. Andreas.Baur@uk-erlangen.de
Abstract
After two decades of research the Nef protein of human immunodeficiency virus (HIV) remains a mysterious protein with an indisputable role in HIV pathogenesis. The ability to downregulate CD4 and major histocompatibility complex class I (MHC-I) was the first ascribed function of Nef and, whereas the number of downmodulated receptors by Nef is rising, so are the explanations for how their downregulation could contribute to HIV pathogenesis. At the same time there is increasing evidence that Nef not only induces endocytosis but also exocytosis, namely of cytokines and microvesicles that contain Nef itself. Because endocytosis and exocytosis are connected events, this is not surprising - and raises the intriguing possibility that HIV aims at secretion rather than ingestion. Have we therefore barked up the wrong tree over the past two decades? In this opinion article I argue that Nef-induced secretion is most probably the pathogenesis-relevant function behind this elusive viral effector.
Copyright © 2011 Elsevier Ltd. All rights reserved.
Nef
1. Ethn Dis. 2008 Spring;18(2 Suppl 2):S2-14-9.
HIV-1 Nef protein is secreted into vesicles that can fuse with target cells and virions.
Campbell TD, Khan M, Huang MB, Bond VC, Powell MD.
Source
Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia 30310, USA.
Abstract
HIV-1 Nef is a major determinant in HIV-1 pathogenicity. However, its properties have mainly been associated with its biochemical activities within the producer cell. Nef is also secreted from infected and transfected cells. Our primary objective was to determine the nature of secreted Nef protein and its effect on target cells. We determined that HIV-1 Nef is secreted in the form of exosome-like vesicles. Nef protein present in these vesicles is largely protected from protease digestion, which suggests that most of the protein is present on the lumenal side of the vesicles. We observed that HEK293 cells, transfected with a Nef-GFP expression vector, can secrete vesicles containing Nef-GFP fusion protein into the extracellular medium. When the conditioned medium was used to treat Jurkat cells, we found that the cells can take up the Nef fusion protein. The pattern of distribution of the Nef-GFP fusion protein within the target cells is mainly cytoplasmic and results in a punctate staining pattern. We also observed that Nef (-) virions treated with Nef-conditioned medium have their infectivity restored to near wild-type levels. This implies that the Nef contained within vesicles has the ability to fuse with HIV-1 virions and deliver functional Nef to these virions. It also demonstrates that Nef protein delivered in trans can restore infectivity even after virion maturation has occurred. These studies suggest that secreted Nef could play a role in HIV-1 pathogenesis by inducing effects in noninfected bystander cells.
Recapping the 2011 mHealth Conference
http://blog.aids.gov/2011/12/reccaping-the-2011-mhealth-conference.html
AIDS Funders Release NHAS Toolkit for Philanthropic Sector
http://blog.aids.gov/2011/12/aids-funders-release-nhas-toolkit-for-philanthropic-sector.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+aids%2Fgov+%28Blog.AIDS.gov%29&utm_content=Yahoo%21+Mail
AHRQ Awards $34 Million To Expand Fight Against Healthcare-Associated Infections
http://www.ahrq.gov/news/press/pr2011/haify11pr.htm
Tiny Magnets Could Clear Diseases from the Blood
Researchers make magnetic nanoparticles that can latch on to harmful molecules and purge them from the blood.
http://www.technologyreview.com/biomedicine/39181/page1/
New Sepsis Test Promises To Save Limbs, Lives
Test Developed By Massachusetts Company
Read more: http://www.thebostonchannel.com/health/29879185/detail.html#ixzz1gC5OUd53
Recognizing blood poisoning quickly
01/12/2011 08:26:00
http://www.healthcanal.com/public-health-safety/24017-Recognizing-blood-poisoning-quickly.html
Speed can save lives – especially in the case of blood poisoning. The more quickly and directly doctors recognize and treat sepsis, the greater the patient’s chances of survival. With the help of a new biochip, physicians will now be able to analyze blood within their own practice.
Is the patient suffering from blood poisoning? To answer this question, the doctor draws a blood sample and sends it to a central laboratory for testing. This takes up valuable time, which could cost the patient his life. In future, physicians will be able to analyze blood there and then and have the results within twenty minutes. This is made possible by a biochip, developed by scientists at the Fraunhofer Institute for Physical Measurement Techniques IPM in Freiburg. “To analyze the biochip we have also designed a fully automatic device to carry out all the examination steps,” explains Dr. Albrecht Brandenburg, group manager at the IPM. “All the doctor has to do is place the sample in the apparatus and wait for the results.”
Meanwhile, within the device there’s plenty going on: it starts by preparing the blood sample. Red blood cells are separated from the blood and the plasma that remains is guided onto the biochip. When patients are suffering from sepsis, their immune system reacts by producing certain proteins. The biochip uses these in its diagnosis: there are antibodies positioned on the chip which fit these proteins like a key fits a lock. If the proteins are present in the blood, the antibodies fish them out of the fluid and bind them to the chip. But how does the apparatus know if proteins have been caught? “The chip is rinsed with a solution containing the appropriate antibodies, which have in turn been marked with a fluorescent dye,” explains IPM scientist Dr. Manuel Kemmler. “These bind to the proteins – meaning antibodies, protein and marked antibodies are all firmly linked to each other and to the chip’s surface. When the chip is illuminated, the dye lights up.” The apparatus sees lots of little illuminated dots that show the protein was in the blood. If the patient is healthy, however, the chip remains dark.
The researchers can even test for different proteins at the same time in one cycle. This is done by placing various different catcher molecules on the chip, to which specific molecules in the blood attach themselves. A cunning selection of proven protein markers allows the scientists to obtain additional important information about the severity and cause of the illness.
Together with colleagues from a university hospital, the researchers have already successfully tested prototypes of the device and biochip. Each biochip can only be used once – so they have to be affordable. “We predict that in the long run, with production on a large enough scale, each chip will cost no more than one euro,” says Brandenburg. There are various possible applications: other conditions such as heart attacks or cancers can also be investigated this way. What’s more, the chip facilitates doping and urine testing as well as the quality assessment of foodstuffs.
Protean Therapeutics
http://www.proteontherapeutics.com/docs/science.php
Technology
Elastin and collagen fibers are the major extracellular components of the blood vessel wall. Collagen fibers provide strength to the vessel while elastin fibers determine vessel diameter, provide elasticity and regulate cellular proliferation and migration. Proteon has developed a method of degrading elastin fibers in treated segments, while leaving the collagen fibers intact and preserving structural integrity.
Non-clinical studies by Proteon suggest that elastin degradation may result in vessel dilation and reduced neointimal hyperplasia in the vessel lumen. An increase in cross sectional lumen area would reduce the impact of vessel stenosis, potentially prolonging vessel patency (function). PRT-201 treatment is administered as a single dose that can be applied topically to the external surface of exposed vessels during surgery or injected into the wall of blood vessels using drug delivery catheters during an endovascular procedure. Thus, the drug could potentially be used in a variety of surgical and endovascular procedures to improve the patency of treated vessels.
Clinical Development Programs
Proteon Therapeutics is currently pursuing clinical development programs for PRT-201 in two hemodialysis vascular access indications: arteriovenous fistulas and arteriovenous grafts.
Vascular Access for Hemodialysis
Most patients whose kidneys no longer function adequately undergo chronic hemodialysis, a blood purification process in which blood is passed through a dialysis machine that removes substances normally excreted by the kidney. Hemodialysis requires surgical creation of a vascular access so blood can be efficiently drawn through the dialysis machine. There are two main types of permanent vascular access sites: arteriovenous fistulas (AVFs), where a vein is surgically connected to an artery, and arteriovenous grafts (AVGs), where a vein is connected to an artery via a segment of artificial tubing.
Once functional for hemodialysis, AVFs and AVGs are at risk of losing patency over the subsequent months and years. Patency loss manifests as thrombosis (blood clotting) or diminished blood flow, resulting in inadequate dialysis and increased morbidity and mortality. Currently available treatments to restore blood flow fail to provide a durable benefit, and patients may thus endure repeated interventions and surgical procedures associated with complications, poor outcomes and higher cost of care.
Proteon believes there is potential for using PRT-201 as a therapy to improve the outcomes associated with surgical creation of AVFs and AVGs. Proteon commenced enrollment in its AVF Phase 1/2 clinical trial in late 2008, and in its AVG Phase 1/2 clinical trial in 2009. Proteon is currently identifying clinical sites to participate in upcoming Phase 2 AVF and AVG clinical trials expected to commence in 2011.
Other Potential Indications
The Company believes that PRT-201 may be useful to treat other vascular diseases in which reduced blood flow impairs clinical function, including peripheral arterial disease (PAD) and coronary artery disease (CAD).
MIT/HARVARD BROAD INSTITUTE SCIENTIST
JOINS SEMPRUS BIOSCIENCES
Roger Smith, Ph.D. Appointed Microbiology Team Leader
http://www.semprusbio.com/documents/MIT_HARVARD_BROAD_INSTITUTE_SCIENTIST_JOINS_SEMPRUS_BIOSCIENCES.pdf
CAMBRIDGE, MA – (February 09, 2011) – Semprus BioSciences today announced the appointment of
Roger Smith, Ph.D., as the company’s new microbiology team leader. In this role, Dr. Smith will direct
Semprus’ team of microbiology researchers as they investigate antifouling surface-modified technologies
on biofilm and bacterial adhesion.
Semprus BioSciences is a venture-funded biomedical company designing new tools for clinicians and
patients to reduce the 56,000 annual U.S. deaths and $11.2 billion cost of infection- and thrombus-related
complications1 that arise when vascular access products are implanted in the body. These products are
components of the Semprus Platform, a single-surface modification designed to reduce the attachment of
bacteria, fungus, platelets and blood proteins to an implanted medical device. The company spun out of the
labs of biomedical researcher and Massachusetts Institute of Technology (MIT) Professor Robert Langer,
Sc.D., in 2007.
Immediately prior to joining Semprus, Dr. Smith served as Research Scientist II, head of microbial genetics
at the Broad Institute of MIT and Harvard. While at the Institute, he managed a group of six scientists in
creating genomic tools for functional analyses and antimicrobial screening.
Dr. Smith also served as a post-doctoral fellow with Dr. Stephen Lory at Harvard Medical School’s
Department of Microbiology and Molecular Genetics. Prior to this, he completed graduate research at the
University of Rochester’s Department of Microbiology and Immunology in Rochester, NY, where he studied
under the tutelage of esteemed Pathogenic Microbiology expert Dr. Barbara Iglewski.
“As we begin the clinical development of our transformative Semprus Platform technology, Roger’s
impressive experience and leadership skills will be invaluable to Semprus BioSciences,” said Chief Executive
Officer David L. Lucchino. “We are delighted to have Roger on our team, and look forward to his many
contributions.”
Dr. Smith received a Ph.D. and M.S. in Microbiology and Immunology from Rochester University, and a B.S.
in Biology from Eastern University in Harrisonburg, VA.
About Semprus BioSciences
Semprus BioSciences is a venture-backed biomedical company headquartered in Cambridge, Massachusetts.
Our innovative, multi-faceted Semprus technology signifies a breakthrough in medical device technology.
Our current focus is to develop a vascular access catheter with the first single surface modification that is
designed to simultaneously reduce microbial adherence and thrombus accumulation over the life of the
device. In December 2010, the company completed an $18 million Series B financing co-led by SR One, the
corporate venture capital arm of GlaxoSmithKline, and Foundation Medical Partners (FMP), a national
healthcare venture capital investment firm with a strategic relationship with Cleveland Clinic. Combined
with previous financing rounds, Semprus has raised a total of $28.5 million in equity.
PATHOGEN AND INFLAMMATORY COMPONENTS REMOVAL FROM
BLOOD USING CELL MARGINATION (Looks like this is partially financed by the DARPA DLT grant - I am not entirely sure)
http://www.rsc.org/images/LOC/2011/PDFs/Papers/638_0255.pdf
PoemStone
Thank you!
However,I think the biggest jackpot would be carrying out the DARPA sepsis project without a hitch - if it pans out as intended i.e the hemopurifier becomes effective in preventing sepsis (even a part of it) then this will be a major medical breakthrough.
Bristol-Myers, J&J team up against hepatitis C
Reuters – Fri, Dec 2, 2011
NEW YORK (Reuters) - Bristol-Myers Squibb Co and Johnson & Johnson plan to jointly develop experimental treatments for hepatitis C in a market worth billions of dollars.
The drugs being developed by the two companies work by blocking different proteins than those attacked by traditional treatments for the serious liver disease, which is caused by infection with the hepatitis C virus.
Bristol-Myers said on Friday its drugs daclatasir (BMS-790052) and its NS5A replication complex inhibitor would be tested in combination with a NS3 protease inhibitor called TMC435 being developed by J&J's Tibotec pharmaceuticals unit.
Beginning in the first half of 2012, the medicines will be tested in various combinations in patients with genotype 1, the most common and most difficult-to-treat viral strain of hepatitis C.
J&J currently has the European rights to distribute Incivo (telaprevir), one of the most promising new hepatitis C treatments on the market. The recently approved drug, which can nearly double prior cure rates, was developed and is sold in the United States by Vertex Pharmaceuticals under the brand name Incivek.
Any drug that comes out of the Bristol/J&J collaboration would likely be a rival to the Vertex medicine, which is taken in combination with the older drugs ribavirin and pegylated interferon.
Several companies are racing to develop hepatitis C treatment regimens that do not include interferon, which causes severe flu-like symptoms and leads many patients to discontinue or avoid treatment.
Pharmasset Inc, which is being acquired by Gilead Sciences Inc and Abbott Laboratories, are among the companies developing promising all oral, interferon-free treatments for hepatitis C, a market some analysts have said could be worth $20 billion by 2020.
(Reporting by Ransdell Pierson and Bill Berkrot; Editing by Derek Caney)
@yahoonews on Twitter, become a fan on Facebook
NYC recommends AIDS drugs for any person with HIV (NYC and San Francisco DOH need to be educated about the HP and how it can be cost effective for AIDS and HCV)
NEW YORK (AP) — Health officials in the nation's largest city are recommending that any residents living with HIV be offered AIDS drugs as soon as the virus is diagnosed, an aggressive move that has been shown to prolong life and stem the spread of the disease.
Standard practice has been to have patients put off the expensive pill regimen — which can cost up to $15,000 a year in the United States — until the immune system weakens.
But New York City Health Commissioner Thomas Farley said recent studies have shown that the benefits of early treatment, combined with education and testing, appear to be a promising strategy for countering the epidemic.
"I'm more optimistic now than I've ever been about this epidemic that we can drive our new rates down to zero or close to it — eventually. I don't know how soon. But I'm very optimistic of the direction that it's going to take the epidemic to," Farley said Wednesday.
More than 110,000 people in New York City are infected with HIV, more than in any other U.S. city and about 75 percent of all cases in the state. San Francisco, which had more than 18,000 people living with HIV, is believed to be the only other major city to have made a similar recommendation, in 2010.
City health officials said the new recommendation could initially help about 3,000 people get on medications. About 66,000 New Yorkers living with HIV that the Health Department tracks are being effectively treated with AIDS drugs, they said. But they said it was difficult to estimate how many people would eventually need the medications.
Some doctors agree with the Department of Health that it is time to update the guidelines for initiating AIDS drug treatment.
"The New York City health department is a little bit ahead of the curve. In my opinion, the rest of the country will follow, and I think it will be pretty quick," said Dr. Michael Saag of the University of Alabama at Birmingham and past chairman of the HIV Medicine Association.
The standard measure of the CD4 count — a way to measure the strength of the immune system — is an outdated trigger for therapy, a relic from research on early antiretroviral drugs, Saag said.
"It's an anachronism. It's old school. It's yesterday," Saag said. "I agree completely with the New York City health department."
Dr. Joel Gallant of Johns Hopkins University School of Medicine and vice chair of the HIV Medicine Association also agrees with the New York recommendation for offering early treatment. He recommends early treatment for his own patients.
"Nobody I know who is an HIV expert feels that it's a bad idea to treat HIV at high CD4 counts from a medical or scientific standpoint," Gallant said. "If there are objections, they'd usually be based on cost or feasibility."
Saag said the cost questions are very important because brand-name drugs can retail for $1,200 to $1,600 per month.
"For sure, they're very expensive drugs and we should be careful about that," he said, though he added that the medications are going generic so costs should come down.
City health officials said they anticipated that the cost for expanding the use of AIDS drugs would be covered by private insurance or by the AIDS Drug Assistance Program, a $270 million program for the uninsured or underinsured that is partially funded through federal dollars. The health officials said they expect the benefits over the long term would far outweigh the initial costs because there would be fewer hospitalizations and new HIV cases.
"There will be some increasing costs over the short term," Farley said. "But over the long term, it's absolutely the right thing for the epidemic."
HIV experts are split about whether early therapy should be recommended or optional. Besides the high costs, the pills have side effects from nausea to liver damage. Patients unwilling to take them religiously for life could develop drug resistance.
A panel that recently updated U.S. guidelines was divided evenly, with half favoring starting therapy early for everyone and half regarding an early start as elective.
But there's growing evidence that untreated HIV can lead to cancers and heart disease. What's more, antiretroviral drugs are safer, have fewer side effects and work better than they did in the past. New research also indicates that people live better, healthier lives and their sex partners are less likely to get infected.
The new research cited by the city's Health Department in making its recommendations includes a nine-nation study whose preliminary results were announced earlier this year and showed that earlier treatment meant patients were 96 percent less likely to spread the virus to their uninfected partners.
Dr. Moupali Das, the director of research at the San Francisco Department of Health HIV Prevention Section, said its surveillance data indicated that physicians were treating their HIV patients early even before the city recommended doing so. She said the average amount of time from diagnosis to having no virus in the blood went from 32 months in 2004 to eight months in 2008.
"That reflects that the newer medications are more potent and efficacious, and the doctors were likely initiating them earlier," she said.
She said they are currently analyzing what has happened since the recommendations went into effect. But, anecdotally, she said that there has been a change among patients seeking treatment. "It's changed the dialogue and empowered our patient population," she said.
Public health experts predict the guidelines for starting AIDS drugs treatment will shift toward a clear recommendation for early treatment.
But New York City's health commissioner said officials there could not wait to respond.
"What we're doing here is we're making a really clear and unequivocal statement that we think this is good for the health of the patient, good for the health of the entire population, good for the response to the epidemic," Farley said.
___
AP Medical Writer Carla K. Johnson in Chicago contributed to this report.
Vital Signs: HIV Prevention Through Care and Treatment — United States
Weekly
December 2, 2011 / 60(47);1618-1623
Key Points
About 1.2 million persons in the United States are infected with HIV; 80% are aware of their infection, and 20% have not been diagnosed.
After diagnosis, 77% of HIV-infected adults are linked to HIV medical care, but only 51% of diagnosed persons stay in medical care; fewer than half of the patients getting care receive prevention counseling from their health-care provider.
A suppressed HIV viral load can lead to better health outcomes and a much lower chance of passing HIV on to partners; however, only 28% of all persons with HIV have a suppressed viral load because the best possible levels have not been reached for 1) testing, 2) ongoing HIV medical care, and 3) adherence to medicine.
Additional information is available at http://www.cdc.gov/vitalsigns.
On November 29, 2011, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr).
Abstract
Background: An estimated 1.2 million persons in the United States were living with human immunodeficiency virus (HIV) infection in 2008. Improving survival of persons with HIV and reducing transmission involve a continuum of services that includes diagnosis (HIV testing), linkage to and retention in HIV medical care, and ongoing HIV prevention interventions, including appropriately timed antiretroviral therapy (ART).
Methods: CDC used three surveillance datasets to estimate recent HIV testing and HIV prevalence among U.S. adults by state, and the percentages of HIV-infected adults receiving HIV care for whom ART was prescribed, who achieved viral suppression, and who received prevention counseling from health-care providers. Published data were used to estimate the numbers of persons in the United States living with and diagnosed with HIV and, based on viral load and CD4 laboratory reports, linked to and retained in HIV care.
Results: In 2010, 9.6% of adults had been tested for HIV during the preceding 12 months (range by state: 4.9%–29.8%). Of the estimated 942,000 persons with HIV who were aware of their infection, approximately 77% were linked to care, and 51% remained in care. Among HIV-infected adults in care, 45% received prevention counseling, and 89% were prescribed ART, of whom 77% had viral suppression. Thus, an estimated 28% of all HIV-infected persons in the United States have a suppressed viral load.
Conclusions: Prevalence of HIV testing and linkage to care are high but warrant continued effort. Increasing the percentages of HIV-infected persons who remain in HIV care, achieve viral suppression, and receive prevention counseling requires additional effort.
Implications for Public Health Practice: Public health officials and HIV care providers should improve engagement at each step in the continuum of HIV care and monitor progress in every community using laboratory reports of viral load and CD4 test results.
Introduction
Human immunodeficiency virus (HIV) causes a chronic infection that leads to a progressive disease. Without treatment, most persons with HIV develop acquired immunodeficiency syndrome (AIDS) within 10 years of infection, which results in substantial morbidity and premature death (1). Approximately 50,000 persons in the United States were infected with HIV annually during 2006–2009 (2). Approximately 16,000 persons with AIDS die each year (3). A consistently suppressed HIV viral load is associated with reduced morbidity and mortality and a lower probability of transmitting HIV to sex partners (4). Testing identifies infected persons and is the entry point to a continuum of HIV health-care and social services that improve health outcomes, including survival. This continuum includes diagnosis (HIV testing), linkage to and retention in continuous medical care for HIV, prevention counseling and other services that reduce transmission, and appropriately timed and consistent antiretroviral therapy (ART) for viral suppression. This report estimates the number of HIV-infected persons who received selected services along the continuum of HIV care in the United States and the overall percentage of persons with HIV who had a suppressed viral load.
Methods
Data reported through June 2010 to the National HIV Surveillance System were used to calculate rates* by state per 100,000 population among persons aged 18–64 years living with diagnosed HIV infection (prevalence) at the end of 2008. Behavioral Risk Factor Surveillance System† data from 2010 were used to estimate percentages by state of persons aged 18–64 years who reported testing for HIV during the 12 months preceding the interview. Medical Monitoring Project (MMP)§ data were used to estimate numbers and nationally representative percentages of adults aged =18 years receiving medical care who reported receiving prevention counseling in a clinical setting¶ during the 12 months preceding the interview, and whose medical record documented that they 1) were prescribed ART during the 12 months preceding the interview and 2) had a suppressed viral load (defined as =200 copies/mL) at their most recent test.
Using these surveillance data and published information, CDC assessed the estimated number of persons with HIV infection (7) and the numbers and percentages of persons who were 1) aware of their infection (7), 2) linked to care (8,9), 3) retained in care (8–11), 4) prescribed ART, and 5) virally suppressed. From these analyses, CDC developed a national estimate of the percentage of all HIV-infected persons with viral suppression.
Results
In 2008, an estimated 1.2 million persons were living with HIV in the United States, of whom 80% had been diagnosed (7). The prevalence rate for persons aged 18–64 years with an HIV diagnosis ranged by state from 40.1 to 3,365.2 per 100,000 population (Figure 1). In 2010, an estimated 9.6% of persons aged 18–64 years reported recent HIV testing (range by state: 4.9%–29.8%) (Figure 2). In general, recent HIV testing percentages were higher in states with higher HIV prevalence rates.
According to published studies, approximately 77% of persons diagnosed with HIV were linked to care within 3–4 months of diagnosis (8,9), and 51% were retained in ongoing care (8–11). Among adults aged =18 years in MMP representing persons receiving HIV medical care, 89% had been prescribed ART. Of these, 77% had a suppressed viral load at their most recent test (Table). CDC synthesized these findings to determine the number of persons in selected categories of the continuum of HIV care (Figure 3), and estimated that 328,475 (35%) of 941,950 persons diagnosed with HIV (or 28% of all 1,178,350 persons with HIV) in the United States are virally suppressed.
The percentages of patients in MMP who were prescribed ART, had documented viral suppression, and received prevention counseling from a health-care provider during the preceding 12 months varied by age group, race/ethnicity, and reported sexual behavior (Table). Prescription of ART ranged from 76% for patients aged 18–24 years to 92% for those aged =55 years; of those prescribed ART, viral suppression was lowest among patients aged 25–34 years (69%) and highest in those aged =55 years (85%). Among the 92% of whites, 89% of Hispanics or Latinos, and 86% of blacks or African Americans who were prescribed ART, 84% of whites and 79% of Hispanics or Latinos had documented viral suppression, compared with 70% of blacks or African Americans. ART prescriptions were documented for 91% of men who have sex with women only (MSW), 89% of men who have sex with men (MSM), and 86% of women who have sex with men (WSM). By sex, 79% of males (81% of MSM and 75% of MSW) had viral suppression, compared with 71% of females.
Among persons in MMP, 45% had received prevention counseling during the preceding year, ranging from 36% among persons aged =55 years to 73% among persons aged 18–24 years. By race/ethnicity, 54% of blacks or African Americans and 52% of Hispanics or Latinos received prevention counseling, compared with 29% of whites. Prevention counseling was received by 50% of MSW and WSM, but only 39% of MSM.
Conclusions and Comment
Among MMP participants (representing adults aged =18 years receiving medical care for HIV infection), 89% had been prescribed ART, of whom 77% had a suppressed viral load. However, only 28% of all persons living with HIV infection in the United States are estimated to be virally suppressed, in large part because only approximately 41% are both aware of their infection and receiving ongoing HIV care.
The observed higher percentages of persons who were recently tested in areas with higher HIV prevalence are encouraging. These findings are consistent with the recommendations of the 2010 National HIV/AIDS Strategy to intensify efforts in communities where HIV is concentrated most heavily, but continued effort is necessary to achieve the goal of increasing the proportion of persons aware of their infection from 80% to 90% (12). CDC's comprehensive HIV testing strategy includes 1) routine HIV screening in health-care settings with prevalence of undiagnosed infection =0.1%, 2) targeted testing of persons with risk factors associated with increased HIV prevalence, and 3) retesting at least annually for HIV-negative persons at increased risk for HIV (13).
Although the percentage of persons with HIV who are linked to care after diagnosis is 77%, more effort is needed to ensure that those patients remain in care and to eliminate disparities among subgroups who are prescribed ART and subsequently achieve viral suppression. In MMP, compared with whites, smaller percentages of blacks or African Americans and Hispanics or Latinos were prescribed ART and were virally suppressed. Differences in rates of ART prescription and viral suppression might reflect differences in insurance coverage, prescription drug costs, health-care providers' perceptions of patients' probability of adherence, or other factors associated with adherence.
Ongoing prevention interventions for persons with HIV infection are key components to reduce HIV transmission. Prevention counseling is recommended as an ongoing part of HIV care for all patients (14), but fewer than half of patients in MMP had received prevention counseling from their health-care provider during the preceding year. These low percentages, especially among MSM, who account for the most new HIV infections in the United States (2), indicate a need for health-care providers to deliver HIV prevention services more consistently.
The findings in this report are subject to at least two limitations. First, documentation of a recent suppressed viral load might not be indicative of consistent viral suppression. Second, the percentage of persons with viral suppression might be overestimated or underestimated and not representative of all persons with HIV in the United States because 1) not all states have implemented routine reporting of CD4 and viral load test results, so estimates of percentages of persons retained in care are based on a limited number of states; 2) MMP data might include persons more likely to be retained in care or adhere to ART; and 3) the estimate assumed no viral suppression among persons not in care, although a small percentage of persons demonstrate viral suppression without taking ART.
CDC's estimate that 28% of all HIV-infected persons are virally suppressed is higher than the 19% reported in a recent review (15). CDC used more recent data and different methods that did not depend on estimates of the proportion of persons in care who need ART. The previous estimate calculated that 80% of persons in care need ART, of whom 75% receive it (15).
The 2010 National HIV/AIDS Strategy goals of reducing HIV incidence, increasing access to care and improving health outcomes for persons living with HIV, and reducing HIV-related disparities and health inequities are interdependent. Reducing national HIV incidence and improving individual health outcomes require increased access to care and elimination of disparities in the quality of care received. To meet these goals and break the cycle of HIV transmission in the United States, achieving high levels of engagement at every stage in the continuum of care is essential. Currently, a substantial proportion of HIV-infected persons have been tested and initially linked to care, and of those retained in care, 89% are prescribed ART, and 77% achieve viral suppression. However, only an estimated 28% of all HIV-infected persons in the United States are virally suppressed, largely because even among those with diagnosed infection, only 51% are receiving regular HIV care (8–11). Without substantial improvement in these percentages, 1.2 million new HIV infections would be expected to occur in the United States over the next 20 years (16). Based on estimated lifetime HIV treatment costs of $367,000 per person (2009 dollars) (17) caring for persons who become infected could cost as much as $450 billion in health-care expenditures (16).
CDC supports state and local health department programs to expand and monitor HIV testing and linkage to medical care, especially in high prevalence areas. Because ensuring that persons with HIV infection receive continuous medical care is important, CDC is working with health departments throughout the nation to expand their efforts to collect laboratory reports on all CD4 and viral load test results for persons diagnosed with HIV. Local programs can use these data (in accordance with privacy and confidentiality policies, laws, and regulations) to identify persons not in care and to facilitate efforts to ensure they receive appropriate care. CDC will continue using MMP to monitor receipt of ART and prevention services among persons in care and identify opportunities for improvement. CDC will share this information with grantees, partners, health-care providers, and other federal agencies (e.g., the Health Resources and Services Administration) to improve the delivery of care, treatment, and prevention services for all persons with HIV infection.
The results in this report indicate that progress has been made; however, continued and intensified efforts are needed. Only with success at each step in the continuum of HIV care (i.e., identifying those with HIV, linking them to and retaining them in care, and ensuring they receive optimal treatment and prevention services) can the ultimate goals of improving health, extending lives, and preventing further HIV transmission be achieved.
Reported by
Stacy M. Cohen, MPH, Michelle M. Van Handel, MPH, Bernard M. Branson, MD, Janet M. Blair, PhD, H. Irene Hall, PhD, Xiaohong Hu, MS, Linda J. Koenig, PhD, Jacek Skarbinski, MD, Angie Tracey, Jonathan Mermin, MD, Linda A. Valleroy, PhD, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Corresponding contributor: Stacy M. Cohen, scohen@cdc.gov, 404-639-4493.
References
Hall HI, McDavid K, Ling Q, Sloggett A. Determinants of progression to AIDS or death after HIV diagnosis, United States, 1996 to 2001. Ann Epidemiol 2006;16:824–33.
Prejean J, Song R, Hernandez A, et al. Estimated HIV incidence in the United States, 2006–2009. PLoS One 2011;6:e17502.
CDC. Diagnoses of HIV infection and AIDS in the United States and dependent areas, 2009. HIV surveillance report, Volume 21. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. Available at http://www.cdc.gov/hiv/surveillance/resources/reports/2009report/index.htm. Accessed October 25, 2011.
Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011;365:493–505.
CDC. Behavioral Risk Factor Surveillance System Survey. Atlanta, GA: US Department of Health and Human Services, CDC; 2010. Available at http://www.cdc.gov/brfss. Accessed October 25, 2011.
CDC. Clinical and behavioral characteristics of adults receiving medical care for HIV infection: Medical Monitoring Project, United States, 2007. MMWR 2011;60(No. SS-11).
CDC. HIV surveillance—United States, 1981–2008. MMWR 2011;60:689–93.
Marks G, Gardner LI, Craw J, Crepaz N. Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis. AIDS 2010;24:2665–78.
Torian LV, Wiewel EW. Continuity of HIV-related medical care, New York City, 2005–2009: do patients who initiate care stay in care? AIDS Patient Care STDS 2011;25:79–88.
Hall IH, Mahle KC, Tang T, Li J, Johnson AS, Shouse L. Retention in care of HIV-infected adults and adolescents in 13 U.S. areas. Presented at the National HIV Prevention Conference, Atlanta, GA, August 14–17, 2011.
Tripathi A, Youmans E, Gibson JJ, Duffus WA. The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study. AIDS Res Hum Retroviruses 2011;27:751–8.
White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. Washington, DC: White House Office of National AIDS Policy; 2010. Available at http://www.aids.gov/federal-resources/policies/national-hiv-aids-strategy/nhas.pdf . Accessed October 25, 2011.
CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(No. RR-14).
CDC. Incorporating HIV prevention into the medical care of persons living with HIV: recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR 2003;52(No. RR-12).
Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 2011;52: 793–800.
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Schackman BR, Gebo KA, Walensky RP, et al. The lifetime cost of current human immunodeficiency virus care in the United States. Med Care 2006;44:990–7.
* Diagnosed HIV prevalence rates were not adjusted for reporting delays to allow inclusion of all 50 states and the District of Columbia. By June 2010, only 40 states had implemented confidential name-based HIV infection reporting for long enough (since at least January 2006) to allow for stabilization of data collection and adjustment for reporting delays.
† The Behavioral Risk Factor Surveillance System is a state-based, random-digit-dialed telephone survey of the civilian, noninstitutionalized adult population that collects information on preventive health practices and risk behaviors in the United States (5).
§ MMP collects behavioral and clinical information from a nationally representative sample of adults receiving medical care for HIV infection in outpatient facilities in the United States and Puerto Rico (6). A total of 23 project areas were funded to conduct data collection activities for the 2009–2010 MMP data collection cycle: California; Chicago, Illinois; Delaware; Florida; Georgia; Houston, Texas; Illinois; Indiana; Los Angeles County, California; Michigan; Mississippi; New Jersey; the state of New York; New York City, New York; North Carolina; Oregon; Pennsylvania; Philadelphia, Pennsylvania; Puerto Rico; San Francisco, California; Texas; Virginia; and Washington. Patients who received medical care during January–April 2009 at an MMP participating facility were interviewed once during June 2009–April 2010 regarding all medical visits during the 12 months preceding the interview. In addition, patients' medical records were abstracted for documentation of medical care (including prescription of ART and HIV viral load) for the 12 months preceding the interview. All percentages were weighted for the probability of selection and adjusted for nonresponse bias.
¶ Based on self-reported information from the patient interview about discussions with a physician, nurse, or other health-care worker. Topics might have included condom negotiation, how to practice safer sexual behavior or injection use, or how to talk with partners about safe sex. Discussion occurring during sessions that were part of HIV testing and counseling encounters were not included.
Obama Raises Domestic HIV Treatment Funding by $50 Million
Details Category: HIV Policy & Advocacy Published on Friday, 02 December 2011 00:00 Written by Press Release
Barack Obama (Photo: White House)
President Barack Obama recognized World Aids Day on December 1 by announcing a $50 million increase in funding for HIV care and treatment in the U.S. The bulk of the money -- $35 million -- will supplement state AIDS Drug Assistance Programs (ADAPs), with the remainder going to community clinics funded by the Ryan White CARE Act.
The increase comes a day after the Centers for Disease Control and Prevention released data showing that only about half of people with HIV in the U.S. are receiving ongoing treatment and just 28% maintain an undetectable viral load.
"Today President Obama made a bold and important move in combating HIV disease by announcing a new initiative that commits to putting six million people with HIV on treatment globally by 2013 and investing much needed new resources in HIV care and treatment through the Ryan White Program," said HIV Medicine Association Chair Judith Aberg. "We now turn to the U.S. Congress to do their part by ensuring that the Affordable Care Act is fully implemented and funded, investing in HIV care and treatment through the Ryan White AIDS Drug Assistance Program and Part C, and sustaining funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria."
Below is an edited excerpt from a Department of Health and Human Services press release describing the new funding.
President Obama Announces New Efforts to End the AIDS Epidemic in the United States
December 1, 2011 -- President Barack Obama today announced accelerated efforts to increase the availability of treatment to people living with HIV/AIDS in the United States in conjunction with World AIDS Day 2011. The president directed the U.S. Department of Health and Human Services (HHS) to invest approximately $50 million in new funding to support AIDS Drug Assistance Programs in states and increase access to HIV/AIDS care services.
“President Obama has laid out a compelling vision that has the power to change the course of the epidemic,” said HHS Secretary Kathleen Sebelius. “Now it’s up to all of us to make our National HIV/AIDS Strategy real. Treatment not only improves and extends the lives of people living with HIV, but it also drastically reduces their risk of spreading the virus. Today we have a unique opportunity to significantly alter the course of the AIDS epidemic in the United States.”
The president emphasized that critical HHS resources will help ensure that HIV-positive Americans get the best care and treatment possible. HHS will commit approximately $35 million in new funding and enhanced technical assistance through the Health Resources and Services Administration (HRSA) to support state AIDS Drug Assistance Programs so that approximately 3,000 people living with HIV/AIDS will have access to life-saving medications. In addition, HHS will provide $15 million in new funding to support experienced community-based providers of care for individuals with HIV/AIDS.
As part of today’s announcement, HHS will sponsor new activities focused on improving adherence to medications and encouraging consistent access to HIV care. The Centers for Disease Control and Prevention (CDC) estimates that 34 percent of HIV/AIDS patients do not receive consistent care and only 28 percent of HIV/AIDS patients have their HIV under control. Consequently, HHS will help providers improve quality of health care delivered and states monitor and improve the continuum of HIV care for patients.
Today’s announcement builds upon the Obama Administration’s new testing initiatives to help the estimated 240,000 Americans living with HIV who are not aware that they are infected. For example, CDC has launched a new campaign to encourage testing among one of the hardest hit populations in the United States, black men who have sex with men. Testing Makes Us Stronger is part of Act Against AIDS, CDC’s national campaign to bring attention to the importance of HIV prevention and testing. In 2012, CDC will also be working with partners to expand its successful campaign for African American women.
Recognizing that the federal government’s efforts are only part of the solution, President Obama also applauded commitments by other public and private sector partners to expand and improve HIV/AIDS care services. The National Alliance of State and Territorial AIDS Directors announced a new agreement with Gilead Sciences to extend additional voluntary discounts and rebates for most Gilead medications purchased by state AIDS Drug Assistance Programs, as well as a continued price freeze through 2013.
12/2/11
Sources
U.S. Department of Health and Human Services. President Obama announces new efforts to end the AIDS epidemic in the United States. Press release. December 1, 2011.
HIV Medicine Association. President Obama Sets Course for Dramatically Reducing the Impact of HIV Disease. Press release. December 1, 2011.
Health GAP. AIDS Activists Applaud Obama Announcement To Double Global AIDS Treatment By 2013. Press release. December 1, 2011.
Health Care Innovation Challenge
http://innovations.cms.gov/initiatives/innovation-challenge/index.html
New Hope of a Cure for H.I.V (from the NYT)
http://www.nytimes.com/2011/11/29/health/new-hope-of-a-cure-for-hiv.html?_r=3&ref=health
Mass Spectometry-Based Protein Patterns in the Diagnosis of Sepsis/Systemic Inflammatory Response Syndrome
http://journals.lww.com/shockjournal/Abstract/2011/12000/Mass_Spectometry_Based_Protein_Patterns_in_the.6.aspx
HIV and Viral Hepatitis (From the CDC)
http://www.cdc.gov/hiv/resources/factsheets/hepatitis.htm
Clinton Aims for ‘AIDS-Free Generation’
http://www.nytimes.com/2011/11/09/health/policy/hillary-rodham-clinton-aims-for-aids-free-generation.html?ref=world
Access to HIV Treatment Must Speed Up to Match Political Promises
http://access%20to%20hiv%20treatment%20must%20speed%20up%20to%20match%20political%20promises/
UNAIDS World AIdS dAy report | 2011
http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/JC2216_WorldAIDSday_report_2011_en.pdf
Prompt Effective Treatment Maximizes Life Expectancy for People with HIV (This can also apply to the HP - which we know can bring the viral load down faster then any other means available.)
DetailsCategory: HIV Treatment Published on Tuesday, 22 November 2011 00:00 Written by Liz Highleyman .. .
HIV positive people who receive a timely diagnosis and start treatment with suppressive antiretroviral therapy (ART) are likely to lose less than a decade of life expectancy -- comparable to the effect of cigarette smoking -- according to a mathematical model described in the November 14, 2011, advance online edition of AIDS.
Effective combination ART dramatically reduced AIDS-related mortality starting in the mid-1990s. But people with HIV still have higher rates of non-AIDS-related chronic conditions such as cardiovascular disease and cancer, for reasons that are not yet fully understood.
HIV positive people who sustained severe immune suppression before achieving undetectable viral load on ART -- whether due to infection early in the epidemic when effective drugs were not yet available, or due to late diagnosis and poor access to care -- may have lingering health problems that contribute to increased mortality. But outcomes among people who are diagnosed promptly and start early treatment with today's state-of-the-art drugs have yet to be determined.
Fumiyo Nakagawa from the HIV Epidemiology and Biostatistics Group at University College London and colleagues form the U.K. and Denmark used a computer simulation to estimate life expectancy in a high-income industrialized country with good access to ART and healthcare in general. The model patient was an HIV positive gay man who was infected with drug-sensitive HIV in 2010 at the age of 30 and is not coinfected with hepatitis C.
Results
Assuming prompt HIV diagnosis -- a median 2.8 years after infection, with a median CD4 T-cell count of 432?cells/mm3 -- the projected median age at death was 75.0 years.This reflects a loss of 7.0 years of life due to HIV, on average, relative to a similar HIV negative man -- comparable to the effect of diabetes or cigarette smoking.
A promptly diagnosed man was estimated to start ART an average of 5.9 years after infection and remain on therapy for 39.1 years, with an 85% probability of at least 1 treatment interruption.
Such a person would spend an average of 18.8 years on a first-line regimen, 7.2 years on a second-line regimen (required by 60%) and 6.0 years on third-line and subsequent regimens (required by 32%).
A man with no ART interruptions gained an additional 1.5 years of life expectancy.
The cumulative risk of death for such a person at 5 years after HIV infection was 2.3%, rising to 5.2% at 10 years.
A promptly diagnosed man would have a 41% probability of developing at least 1 AIDS-related condition in his lifetime, but only 14% of deaths were due to AIDS-related causes.
Assuming late HIV diagnosis -- with a median CD4 count of 140?cells/mm3, usually occurring after an individual develops symptoms -- life expectancy was 71.5 years.This reflects an average loss of 10.5 years of life due to HIV.
"If low rates of virologic failure observed in treated patients continue, predicted life expectancy is relatively high in people with HIV who can access a wide range of antiretrovirals," the study authors concluded. "The greatest risk of excess mortality is due to delays in HIV diagnosis."
The increased risk of death in the late diagnosis scenario was mainly due to a high death rate within the first 10 years after diagnosis, they elaborated in their discussion.
"[T]he effect on life expectancy after this period was more modest," they wrote. "This is due to the durable effects of ART, even in those who start ART when their CD4 count is low. However, late diagnoses can and should be prevented by increased access and uptake of HIV testing."
The researchers noted that they assumed a lifelong 1.5-fold increased risk of non-AIDS death compared with the general population, due to the presence of HIV infection itself. "Bearing in mind that most people are predicted to have viral suppression and high CD4 counts for most of their lives, this may well be a pessimistic assumption, resulting in underestimation of life expectancy," they suggested.
Investigator affiliations: HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, UCL Medical School, London, UK; Health Protection Agency, Colindale, London, UK; Copenhagen HIV Programme, University of Copenhagen, Panum Institute, Copenhagen, Denmark; Centre for Viral Diseases at Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark.
11/22/11
Reference
F Nakagawa, RK Lodwick, CJ Smith, et al. Projectedlife expectancy of people with HIV according to timing of diagnosis. AIDS (abstract). November 14, 2011 (Epub ahead of print).
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yield - thank you for the post. There is a ton of strong information and evidence which would point towards using the HP in a significant chunk of patients with HIV/HCV. I hope we can help AEMD out in some way by posting new info. here, both for investors and also for the people who run the company. I say this humbly as I know AEMD is streched in terms of manpower.
New biosensor benefits from melding of carbon nanotubes, DNA
DNAhttp://www.purdue.edu/newsroom/research/2011/111114PorterfieldDNA.html
Researchers Discover New Way To Form Extracellular Vesicles
Article Date: 18 Nov 2011 - 2:00 PST
Researchers at NYU Langone Medical Center have discovered a protein called TAT-5 that affects the production of extracellular vesicles, small sacs of membrane released from the surface of cells, capable of sending signals to other cells. When released extracellular vesicles can affect tumor spread, blood clotting and inflammation. Their discovery gives new insight into how extracellular vesicles form, and reveals new potential strategies to manipulate diseases such as cancer. The study was published online November 17, 2011 in Current Biology.
"Very little is known about how cells release extracellular vesicles from their surfaces, so the discovery of TAT-5 opens the door to learning how to manipulate their numbers and thus affect cell communication," said Jeremy Nance, PhD, associate professor of Cell Biology at NYU School of Medicine and a member of the Developmental Genetics Program at the Skirball Institute of Biomolecular Medicine.
Researchers at NYU Langone studied the embryo of the worm C. elegans and discovered that TAT-5 inhibits the budding of extracellular vesicles from the surface of cells. Several types of tumors produce extracellular vesicles that can induce tumor cell invasion or metastasis. Researchers found they can use tat-5 mutants as a tool to study how extracellular vesicles are formed, enabling the design of strategies to regulate their formation. In the study, researchers also discovered that two proteins that regulate viral budding are involved in extracellular vesicle release, suggesting that budding of viruses and release of extracellular vesicles might occur through similar mechanisms, and that this research may reveal new strategies to inhibit viral spread.
ASN: HCV Infection Virtually Untreated in Dialysis Patients
By Todd Neale, Senior Staff Writer, MedPage Today
Published: November 12, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Action Points
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
PHILADELPHIA -- Hepatitis C virus (HCV) infection is associated with an increase in mortality in patients on hemodialysis, but treatment is rare in that population, researchers found.
In a large, international cohort study of patients on hemodialysis, only one in every 100 of those who were HCV-positive received antiviral treatment, according to David Goodkin, MD, of the Arbor Research Collaborative for Health in Ann Arbor, Mich.
Treatment of HCV infection was associated a 73% lower risk of dying during follow-up, even after accounting for numerous potential confounders (HR 0.27, 95% CI 0.08 to 0.92), he reported at the American Society of Nephrology meeting here.
"We may be doing a disservice to our hemodialysis patients by not treating HCV, particularly those who are awaiting transplantation," Goodkin said.
A randomized trial examining the effect of treating HCV infection in patients on hemodialysis has not been done, and Goodkin said such a trial is unlikely because all previous trials of HCV treatments have excluded patients with renal failure.
But even if such a trial is undertaken, it would be years before conclusions could be drawn, he said.
"In the interim, clinicians are going to go on rounds, 10% of the patients are HCV-positive, and I really hope, at least for the transplant waiting list patients, [clinicians will] think again about whether [the patients] should be treated or not."
The findings came from a data analysis of the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective cohort study of patients at 382 randomly selected hemodialysis clinics in 12 countries.
The current study included information on 47,004 patients participating in the study between 1996 and 2011. Median follow up ranged from 0.94 to 1.76 years.
The overall prevalence of HCV infection -- determined by a diagnosis of HCV infection in the medical record or a positive test for HCV antibodies at baseline or during follow-up -- was 9.6%, indicating that "this is not a trivial problem," according to Goodkin.
Overall, only 47 patients in the study (1.1% of those who were HCV-positive) were receiving antiviral medications. For patients on the kidney transplant waiting list who were HCV-positive, 3.8% were receiving antivirals.
Goodkin acknowledged that it is possible the use of antiviral medications was underestimated, but said that after calling some of the hemodialysis centers, he trusted the figures.
"Even if we were off by a factor of three, it's still almost no one is being treated," he said.
That is particularly important because HCV infection is associated with a 22% increased risk of mortality after adjustment for patient characteristics (HR 1.22, 95% CI 1.11 to 1.33), Goodkin said, noting that the hazards of death associated with congestive heart failure and diabetes are of similar magnitude.
HCV infection has also been shown to be associated with increased allograft loss, new-onset diabetes, serious infections, and death among untreated HCV-positive patients who had undergone a kidney transplant.
Treating HCV infection in patients on hemodialysis does work, Goodkin said, pointing to a systematic review that showed a 40% sustained virological response to interferon in those patients, which is comparable to or better than in the general population.
But antiviral therapy can be difficult for patients, which could account for the low treatment rates in patients on hemodialysis, who already have impaired quality of life, he noted.
Interferon is associated with flu-like symptoms, fatigue, depression, and neurological and cardiovascular complications. And ribavirin carries a risk of severe anemia.
Even so, Goodkin said guidelines from KDIGO (Kidney Disease: Improving Global Outcomes) addressed the issue correctly. Those recommendations state that HCV-positive patients who are awaiting a kidney transplant should receive antiviral treatment, whereas treatment in other patients should be considered on a case-by-case basis.
An Inspiring Vision: Creating an AIDS-Free Generation
http://blogs.state.gov/index.php/site/entry/goosby_creating_an_aids_free_generation
Records Show Deaths Associated With Hepatitis C Have Overtaken Deaths Caused by HIV
http://www.prnewswire.com/news-releases/records-show-deaths-associated-with-hepatitis-c-have-overtaken-deaths-caused-by-hiv-133428598.html
Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS
http://www.cdc.gov/hiv/strategy/echpp/index.htm