A medical trial has revealed what could be the most significant development yet in the search for an effective HIV vaccine.

Researchers in Thailand say the results of a vaccine trial conducted over the past six years are the most promising to date - actually preventing some people from becoming infected with the virus.

But it is still a long way from being a useable vaccine.

For decades researchers have been seeking an effective vaccine for the human immunodeficiency virus, HIV.

The latest study in Thailand involved more than 16,000 healthy men and women aged from 18 to 30.

The trials were conducted in areas of high HIV risk, in the provinces of Chonburi and Rayon, home to the city of Pattaya, Thailand's sleaze capital.

The region is also a hotspot for migration to and from Cambodia.

The trial began in October 2003 and wrapped up just a few months ago.

The results revealed the risk of getting HIV fell by almost a third for those who were vaccinated versus those who were not given the vaccine.

Dr Supachai Rerks-Ngarm from Thailand's Ministry of Public Health says it is not exactly known what makes the so-called prime-boost combination of two vaccines work, but they say it is a breakthrough.

"This is the first project in the world where the design of the vaccine is not only safe, but it can also help reduce the chance of infection. It gives hope that an HIV vaccine can be developed," he said.

'Too low to risk'

This study will be used in further research but Don Baxter from the Australian Federation of AIDS Organisations says it is unlikely that the vaccine will be made available to the general public.

"Well it's the first vaccine that I think that's really shown any efficacy," he said.

"But 30 per cent is far too low to risk putting it out into a general population because condom use would drop and we'd actually end up with more infections."

If an effective vaccine can be developed it would help the estimated 650,000 Thais who have the virus, among them close to 15,000 children.

The trials were funded and assisted by the US Army, which has spent $140 million in this trial alone to ensure that its troops are protected from the infection as they travel the world and to assist in the global fight against the virus.

The United States Ambassador to Thailand, Eric G John, says the trial brings scientists closer to finding an effective vaccine for the virus.

"This trial will be recognised as a testament to Thailand's ability to successfully execute a complicated vaccine trial, the largest ever attempted that ended with a credible conclusion and that brought us one step closer to an HIV vaccine," he said.

The United Nations has welcomed the results, saying they offer new hope to the estimated 40 million people worldwide who have contracted the virus.

Source: http://www.abc.net.au/news/stories/2009/09/24/2695951.htm

Researchers have developed a new "assassin cell" therapy for treating HIV which involves engineering the patient's own immune system to fight the virus more effectively.

The therapy – which has proved effective in laboratory tests using human cell cultures – will be tested in a clinical trial of 35 patients with advanced HIV infection that is due to start next summer.

I got an email this morning from Amfar alerting me to a case study published in February that I had missed. An American living in Germany has apparently been cured of HIV with a stem-cell transplant from a donor with the delta32 CCR5 mutation. This is more of a proof-of-concept than an actual course of therapy for most of us though. Stem-cell transplants are even harder to get than antiretrovirals for most of the world's HIV infected, and they aren't going to be rolling them out in Kwazulu-Natal any time soon. But from the proof of concept, maybe these geniuses can come up with something for the rest of the world.

In an attempt to cure the leukemia, he underwent a course of radiation therapy and chemotherapy in preparation for a stem cell transplant. But in his case, rather than simply using the best match among available stem cell donors, his physicians did something very clever. They also screened potential donors for a natural mutation known as delta32 CCR5. CCR5 is the primary means by which most types of HIV infect cells. Individuals lacking this CCR5 receptor—the 1.5 percent of the Caucasian population in America and Europe with the delta32 mutation—are completely resistant to infection by the most common forms of HIV.

The patient’s stem cell transplant was a success, although relapse of his leukemia required a second transplant using the same donor. Now off all anti-HIV drugs for almost two years, the patient continues to show no detectable signs of HIV in his blood, bone marrow, lymph nodes, intestines, or brain. To the limits of our ability to detect HIV, it appears that the virus has been eradicated from his body. At the very least this patient represents a functional cure: he is off all anti-HIV meds, has a normal T-cell count, and exhibits no evidence of virus.

amfAR, The Foundation for AIDS Research Research

They are slowly getting closer to a vaccine and each of these little discoveries brings us one day closer ...

MedlinePlus: Scientists Break Into HIV 'Hideout'

The Sydney Symphony conducted by Sir Charles McKerras playing Richard Strauss' Thus Sprach Zarathustra. And the second half of the program is Mozart's C minor Mass.

It may seem remarkable that, 23 years after the identification of the human immunodeficiency virus (HIV), there is still denial that the virus is the cause of acquired immune deficiency syndrome (AIDS). ...

HIV denial has taken root in the general population and has shown its potential to frustrate public education efforts and adversely affect public funding for AIDS research and prevention programs.

PLoS Medicine - HIV Denial in the Internet Era

Part of the reason that these stupid opinions get any airplay is that people like Act-Up San Francisco and the Foo Fighters (!) actively promote the idea among gullible people. In Australia, a prominent court case in 2006 was forced to weigh the evidence when a man charged with the reckless endangerment of his sexual partners used AIDS denial as a key plank in his defense. The court came down on the side of mainstream science, and he was finally jailed last month after an appeal failed.

Man jailed for spreading HIV

Although I'm no fan of jailing people for diseases (were his sex partners jailed for taking part in unprotected sex as well? No.), I'm glad that the court, with no vested interest in the scientific status quo, found in favour of HIV as the cause of AIDS.

Surprise, surprise. Valproic acid makes no difference to latent viral reservoirs, and moreover, seems to have some incredibly toxic side effects. So NOT a cure ....

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Entrez PubMed

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PLoS Medicine: Modelling the Impact of Antiretroviral Use in Resource-Poor Settings

 

There is no doubt that ARV is really important as a part of the control of the impact of HIV, but for too long now, we have been looking to treatments to somehow take the brunt of prevention. This study hopefully puts a nail in the coffin of the arguments that drugs can do what behaviour change can't. As the authors say, "Our analysis found that ART cannot be seen as a direct transmission prevention measure, regardless of the degree of coverage. Counselling of patients to promote safe sexual practices is essential and must aim to effect long-term change."

Treatment IS NOT prevention.

But neither is counselling positive people to achieve bevaiour change enough either. Putting the onus onto positive people means that newly infected people, who have not yet been diagnosed, can carry on as if they are not infected. Given the infeciousness of the newly positive, this is a serious flaw in any prevention strategy.

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Potential new way to fight HIV

Pardon my cynicism, but why do they always announce these things prior to a stock float, rather than prior to the release of the actual miracle cure.

 With no apologies to catholics anywhere, is there any doubt that Ratzinger is a Kunt with a capital c. We should listen even less to the Catholic church on moral or health issues even less than we take the advice of the us senate on these issues.. 

Pope faces controversy on gay priests and HIV/AIDS - news from ekklesia

I think it has been clear to most of us in Australia, and to thoughtful people in the rest of the world that in general people with HIV behave better in relation to spreading their infection if they know they're infected. Some Americans have now proved it with a meta analysis.

"The analysis integrating all 11 findings indicated that the prevalence of UAV with any partner was on average 53 percent lower (95 percent confidence interval [CI]: 45 percent-60 percent) in HIV+ aware patients compared to HIV+ unaware patients. After adjusting the data to focus on UAV with partners who were not already HIV+, the researchers found a 68 percent reduction (95 percent CI: 59 percent-76 percent). ?

Again, it seems that a really effective contribution to prevention efforts is encouraging testing - letting people know their status so they can behave appropriately.

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UNITED STATES: Meta-Analysis of High-Risk Sexual Behavior in Persons Aware and Unaware They Are Infected with HIV

 Here's one I missed from last week's Lancet - a new treatment (vaproic acid) that attacks latent T-cells, and has shown promising results in a (huge!) trial of 4 patients, one of whom developed serious anaemia in less than four weeks on the treatment. Cynical aside: this reminds me of the kind of claims that were being made in the mid-90s about HAART - some period - say 2 years - on HAART + vaproic acid and HIV might be wiped out. At least these guys aren't peddling mathematical models this time. They are about to start a somewhat larger trial.

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New HIV Therapy Clears Out Hidden Virus - HIV: health and medical information about HIV and AIDS

Another view of the same material is at: http://www.wired.com/news/medtech/0,1286,68521,00.html?tw=rss.TEK

Another great idea from the UK - maps that show STD hotspots in London - soon to be published in the International Journal of Health Geographics. I don't think we pay enough attention to space as a dimension in STD surveillance - it is certainly an idea that might shed some light on what is happening with syphilis in Melbourne and Sydney (although maybe it's a technique that needs a few more incident cases to be useful). Maybe chlamydia in Victoria might provide a better case for testing the usefullness of it. Worth cheking out anyway...  

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STD "hotspot map" to improve treatment? | Headlines | News | Gay.com UK

Update: It was actually already published when I wrote this.

See: http://www.ij-healthgeographics.com/content/4/1/4

More news about HPV and anal cancer in gay men ... 

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New trial focuses on HPV protection for gay men | Headlines | News | Gay.com UK

 

Trials of a new vaccine intended to protect gay men from human papillomavirus (HPV) - and subsequently reduce the rates of anal cancer - are being undertaken in Australia.

The clinical trials will include gay men aged between 18-23, according to the country's Associated Press, with a view to eventually designing a vaccine that could be available for gay men at risk of the virus.

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http://www.docguide.com/news/content.nsf/news/8525697700573E188525705B0049EE38

The ongoing uproar about syphilis in gay Australia (a storm in an epidemiologist's teacup if you ask me) should perhaps look to the success factors in California's recent decline in syphilis cases in an equivalent population (http://www.aegis.org/channel/s/AD051641.html). Although the scattergun approach may be what is yielding results, I'm curious about how this decline fits into the model Nature recently presented on syphilis as a geographically periodic disease - is it declining because of the public health measures as Klausner claims, or because this periodic bump in syphilis is over?

Dr. Jeffrey Klausner, director of San Francisco's department of STD prevention and control, cited as reasons for the declines more people testing for syphilis; the launch of Magnet, a gay health center in Castro; medical care providers' awareness of the need to screen patients for STDs; increased partner testing and treatment; and Inspot, an online system for informing partners they may have an STD.

Though HIV cases have also recently declined, HIV-positive men accounted for nearly 60 percent of syphilis cases. Gay HIV- positive men may be serosorting, but also eschewing condom use, which can lead to STD transmission, health officials hypothesized. In the meantime, HIV-negative men who comprised the majority of rectal infections at City Clinic are not serosorters, but an unrepresentative higher-risk population, said Klausner.

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UNITED STATES: Cultural Challenge; Conference Addresses Meth, HIV Among Gay Latinos

 

Nice to see an American quote on HIV that mentions culture:

 

Understanding the impact of culture and family on sexual behaviors and attitudes is key to forming effective HIV/AIDS prevention messages to Latinos. "Gender scripts can impact on how you promote HIV testing and prevention," said deLeon. "Family scripts impact a whole range of drug use and sexual behaviors. For Latino men who have sex with men [MSM], sexual silence imposed by the family is an important factor in HIV. The silence built of fear of disclosure leads drug-using Latino men and women and Latino [MSM] to engage in more risky sexual behavior in unsafe venues."