Prevention, vaccines addressed at IAS conference

Jul 22 2009

During the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention meeting in Cape Town, South Africa, scientists "renewed the call for more immediate and urgent effort to be directed towards HIV prevention amid the dominance of treatment interventions and the world-wide search for a quick fix vaccine, which many agree, is years away," Health-e/allAfrica.com reports (Thom, 7/22).

Data was presented from ongoing trials of microbicides and Pre-Exposure Prophylaxis trials, including a Phase III trial on the microbicide Pro2000 involving more than 9,389 women and an "adherence and drug absorption study" that looks at "whether antiretrovirals (ARVs) can be used effectively for HIV prevention in the form of a applicator gel or a pill that can be taken orally once a day - also known as PrEP," Health-e/allAfrica.com reports (Langa, 7/22).

The Times of Zambia/allAfrica.com examines the announcement by scientists representing the Microbicide Trials Network at the conference about plans for a large-scale microbicide clinical trial involving about 5,000 women from Zambia, Uganda, Malawi, Zimbabwe and South Africa. The trial is expected to take about three and half years, with results available in 2012, a co-chair of the study said, according to the news service (7/22).

François Venter, president of the Southern African Clinicians Society, "said though the research shows promise there are numerous issues that need to be addressed," the Health-e/allAfrica.com writes, including accessibility of products and the "uncertainty on whether developing countries will be able to afford providing PrEP to patients not yet infected when they are currently struggling to provide treatment to those already infected," the news service reports (Langa, 7/22).

According to Health-e/allAfrica.com, Stefano Bertozzi, executive director at the Center for Evaluation Research and Surveys at the National Institute of Public Health in Mexico, "said greater emphasis needed to be placed on getting value from investments," which would require "a shift in thinking from a short-term emergency response to a more efficient, long-term approach." An analysis of 28 "completed biomedical prevention trials" revealed "only four, including three trials of male circumcision, have reported significant efficacy," according to Robert Gray of Johns Hopkins, who "argued for conducting fewer trials, but with a greater investment in rigor and quality," the news service writes (Thom, 7/22).

Prolonged HIV Treatment For Breastfeeding Women Reduces Mother-To-Child Transmission, Study Finds

"HIV infection rates among babies are significantly cut when mothers are given prolonged ARV [antiretroviral] treatment during breastfeeding," according to findings released at the conference on Wednesday, Reuters reports. Tim Farley, project leader for the "Kesho Bora" study - which was conducted by the WHO in partnership with several other international agencies - "said the results suggest that giving mothers [a] combination of ARVs during pregnancy, delivery and breastfeeding cut HIV infections in infants by 42 percent compared to current WHO recommendations," the article states.

Study participants will "be monitored to see if there were any long-term health side-effects," according to Farley, with results anticipated in a year. Farley said as a result of the findings WHO might consider revising its recommended short-course ARV regimen for breastfeeding women. The WHO "is reviewing its 2006 recommendations on the use of ARVs in pregnant women, including during the breastfeeding period. New guidelines are expected to be published by the end of 2009 and will take into account emerging data," Reuters reports (Roelf, 7/21).

Vaccine Research Funding

A report released on Monday (pdf) at the conference says that a "shift in priorities is blamed for the first ever decline in funding for AIDS vaccine research," VOA News reports. The report finds that funding for AIDS vaccine research has declined from around $930 million to $870 million. The report was released by the HIV Vaccine and Microbicide Resource Tracking Working Group, which includes the AIDS Vaccine Advocacy Coalition (AVAC), the International AIDS Vaccine Initiative (IAVI), UNAIDS and other organizations.

The group has been tracking investment in AIDS vaccines for the last eights years and observed that 2008 was the first time there was an investment drop, specifically in preventive HIV vaccines, according to Mitchell Warren, the head of AVAC. He said, "The biggest decline actually comes from the pharmaceutical sector, the commercial investment." VOA News writes: "Warren says there has been an increase in funding for microbicides and the use of anti-retroviral drugs as preventive measures" (DeCapua, 7/20).

Speaking of the overall vaccine effort, Paula Akugizibwe of the AIDS and Rights Alliance for Southern Africa said, "The world is jumping into a flurry of excitement about a possible solution many years down the line - nobody seems to be in a similar flurry about the fact that, right now, two out of three people who need antiretrovirals to stay alive aren't receiving it. But we should not let efforts to find a magic bullet distract us from the immediate need to save lives," News24.com reports (Pillay, 7/22). 

In related news, Elise Levendal - the director of the South African AIDS Vaccine Initiative (SAAVI) -- the organization conducting the clinical trials of an HIV vaccine launched this week - "said she wanted to set the record straight after reports that the government had cut funding on research on the AIDS vaccines," SAPA/News24.com reports. She said, "We are signing a new agreement with the department of health. They have notified us of further funding of 35 million rand [$4.5 million] for next three years." Levendal said South Africa's Department of Science and Technology [DST] had not renewed its funding of the project. "The DST informed us that it would no longer fund HIV research and development through SAAVI, but through a platform known as Lifelab," she said (7/20).

The lead scientist working on the trial stated earlier that government funding of the project has "been halted," the AP/Globe and Mail reports. "Anna-Lise Williamson, an AIDS researcher at the University of Cape Town, said the clinical trial would continue with U.S. money. But she said the … DST … had pulled its funding in March, while the project's other sponsor, the state electricity utility Eskom, did not renew its contract when it expired last year," according to the article (Faul, 7/21).

Calls For Continued Commitment To International Fight Against HIV/AIDS Despite Economic Crisis 'Increasing In Volume'

"Voices warning against moves to decrease and limit spending on health - blaming the financial crisis - are increasing in volume at the [IAS] Conference," Health-e/allAfrica.com reports. The article highlights a Tuesday press conference, where Eric Goemaere, of Medecins Sans Frontieres, presented data on funding cuts to HIV/AIDS programs in African countries and Robin Wood, of the University of Cape Town, shared data on antiretroviral coverage and declines in tuberculosis rates. "'What message are we sending to patients who have been told about adherence and the lifetime commitment to treatment when we inform them we no longer have drugs?' Wood asked, cautioning that interrupting people's treatment would lead to viral suppression and the need to move patients to second line treatment at six times the cost," the news service writes (Thom [2], 7/22).

ABS-CBN News also reports on conference leaders speaking out about "looming threats of possible cuts in funding for AIDS research and prevention" caused by the global economic crisis: "Stephen Lewis, the former U.N. Secretary-General's envoy on AIDS to Africa, said scientists should become forceful advocates for AIDS funding and for greater resources for global health. 'When the Global Fund faces a shortfall of several billion, you would do the world a tremendous service by finding a way, from your positions of authority, to remind the political leadership of how they used precious public money to bail out the banks, so that Goldman Sachs could make a profit of $3.4 billion in the second quarter of 2009, JP Morgan Chase could make a profit of $2.7 billion in the same period,' he said" (Dizon, 7/21).

Conference Attendees Discuss Health Worker Shortages

Health worker shortages were also a topic of discussion at the IAS conference, Inter Press Service reports. The article examines suggestions to help overcome the workforce gaps, such as the concept of taxing "governments or companies in developed countries who employ health workers from developing countries to balance out the skills loss occurring in those countries" and "task-shifting" -- when nurses and lay health workers are trained to perform tasks traditionally performed by doctors. According to Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, "[a] quarter of all Global Fund resources go to support the health workforce, for example towards training, task-shifting and so on. We have invested $4 billion in the last six years" (Palitza, 7/21).

Container Labs Provide High-Tech HIV Diagnostics In Basic Settings

Scientists attending the IAS Conference on Tuesday had the opportunity to see "how state-of-the-art HIV laboratory services could be delivered in the most basic settings," Health-e/allAfrica.com reports. Toga Labs container facility located in Gugulethu, South Africa  -- the first of its kind -- currently serves 4,500 patients, providing such services "as CD4 testing (measure of the patient's immunity), viral load detection as well as identifying toxicity (drug side-effect) signs in patients who are already on treatment," the news service writes (Langa, 7/22).

"A lack of quality laboratory services in the world's poorest continent hampers the battle against HIV/AIDS, with the sub-Saharan Africa region hardest hit by the global pandemic which kills millions each year," Reuters writes. "You can't have antiretroviral programs without laboratory support, it's dangerous," Des Martin, a director at Toga, said. "We believe this is a model for the developing world in resource constrained settings," he added. "The U.S. President's Emergency Plan for Aids Relief was supporting another five planned container labs in South Africa, two in Malawi, two in Zambia and one in Liberia, Martin said. Each fully equipped lab costs in the region of $250,000," the news service writes (Roelf, 7/21).

The International AIDS Society is providing regular updates on the latest conference developments and resources along with featured guest posts on the IAS 2009 Live blog.