HIV patients

Modern drugs give HIV patients in Europe and US extra 10 years of life expectancy

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The HIV virus targets immune cells in the bloodstream
The HIV virus targets immune cells in the bloodstream

Life expectancy for young HIV-positive adults has risen by 10 years in the United States and Europe thanks to improvements in AIDS drugs known as antiretroviral therapy, researchers said on Thursday.

This meant many patients can expect to live as long as those without HIV, according to their study published in The Lancet medical journal.

The scientists said the improvements were likely to be largely due to the transition to less toxic medicine combinations, with more drug options for people infected with drug-resistant HIV strains, and better adherence to treatment.

“Our research illustrates a success story of how improved HIV treatments coupled with screening, prevention and treatment of health problems associated with HIV infection can extend the lifespan,” said Adam Trickey, who led the research at Britain’s University of Bristol.

Antiretroviral therapy, or ART, first became widely used in the mid 1990s. It involves a combination of three or more drugs that block the HIV virus’ replication. This helps prevent and repair damage to the immune system caused by the HIV, and also prevents onward spread of the disease.

The World Health Organisation (WHO) now recommends ART should be given as soon as possible after diagnosis to everyone with HIV.

The researchers analysed 18 European and North American studies involving 88,504 people with HIV who started ART between 1996 and 2010.

Fewer people who started treatment between 2008-2010 died during their first three years of treatment than those who started treatment between 1996-2007.

Trickey’s team said when they looked specifically at deaths due to AIDS, the number during treatment declined over time between 1996 and 2010, probably because more modern drugs are more effective in restoring the immune system.

 As a result, the researchers said that between 1996 and 2013, the life expectancy of 20-year-olds treated for HIV increased by nine years for women and 10 years for men in the European Union and North America.

This suggests that life expectancy of a 20-year-old who began ART from 2008 onwards and responded well to it would get close to a life expectancy of the general population – 78 years.

But the improvements were not seen in all people with HIV. Life expectancy of those infected through injecting drugs, for example, did not increase as much as in other groups.

Mr Trickey said this underlined the need for prevention and treatment efforts to be focused on high-risk groups.

 

Meet Nigeria’s curious Cupid – matchmaking for HIV patients looking for love

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Sitting in his dimly-lit office in the Nigerian capital of Abuja, surrounded by files and boxes of condoms, matchmaker Ugochukwu Michael talks passionately about the part he has played in the marriages of around 100 couples in recent years.

While the popularity of dating apps and websites may make Michael’s efforts to play Cupid seem old-fashioned, his matchmaking service stands out from the rest.

All of his clients are living with HIV.

“Sometimes, I spend days without sleeping,” he said, his phone ringing non-stop as he explained how most calls come in the middle of the night when it is cheaper to call.

The 45-year-old started his service in 2012 with the desire to help those he describes as Nigeria’s “rejects” after becoming disillusioned with widespread stigma toward people with HIV.

Michael says he has some 7,000 clients on the books, ranging in age from 19 to 72. Six in seven of them are women.

He charges a one-off fee of 2,000 naira ($6) for people who work, but his service is free for the unemployed.

“You will see a lot of improvement,” Michael tells one caller. “Let’s see how it will be before the end of the month.”

The prevalence of HIV among adults in Nigeria is relatively low for sub-Saharan Africa, around one in 30 compared to one in five in South Africa, said the U.N. AIDS program UNAIDS.

Yet discrimination toward Nigeria’s some 3.5 million HIV-positive people is rife, and many struggle to enter university or find work, health experts and human rights activists say.

“Stigma is the obstacle to achieving the 90-90-90 agenda,” John Idoko, director general of Nigeria’s National Agency for the Control of AIDS (NACA), told the Thomson Reuters Foundation.

By 2020, UNAIDS wants 90 percent of people with HIV to know their status, 90 percent of diagnosed people to be on treatment, and 90 percent of those on treatment to have suppressed levels of the virus in their bodies.

“HIV-POSITIVE SUGAR MUMMY”

After a failed attempt to migrate to Europe six years ago and the loss of his life savings from his job as a technician, Michael decided to volunteer with a Catholic organization.

Helping out at a state hospital where nurses were reluctant to get too close to HIV-positive patients made Michael aware of the discrimination they faced daily.

“I encouraged the patients to help one another do things, like go to the toilet, since they all had one thing in common.”

When the threat of Boko Haram forced him to move from the northeastern city of Damaturu to Abuja in 2012, Michael decided the time was right to launch his HIV matchmaking service.

Weary of trying to persuade government agencies to invest in his idea, he headed out into the streets of Abuja at night, hanging up around 100 banners to advertise his project.

“By the following morning, my phone started ringing – so many people were calling me,” Michael said, scrolling through the dozens of texts he receives from his clients each day.

Some of the texts ask for medical or fertility advice, while one comes from a man looking for an “HIV-positive sugar mummy”.

Yet not everyone approves of Michael’s matchmaking efforts.

When people started tearing the banners down, Michael turned to bright red spray paint. Signs reading: “HIV positive? Need husband/wife?” can be seen alongside many major roads in Abuja.

“Strangers call me to express disdain for my work … they accuse me of encouraging promiscuity,” said the husband and father-of five, who declined to disclose if he has HIV or not.

HEALTH BEFORE LOVE

After an initial telephone conversation, most of Michael’s clients insist on coming to see him in person to talk further.

“When they come, we just sit and chat,” he said, adding that many of his patients are suicidal because of their HIV status.

Beyond setting up dates, Michael also ensures that every person he works with is registered with a specific hospital and that they are regularly taking their antiretroviral drugs.

“I cannot match-make anyone who is not on drugs – it is a lot of risk,” Michael said, sitting in his office in front of a decorative wall hanging that reads: ‘May hope encourage you’.

Michael also provides his clients with free condoms and booklets about HIV, and teaches them about safe sex. For people seeking medical advice, he refers them to a doctor.

Although based in Abuja, a photo of his advert posted on Facebook means people stretching from Rivers state in the south to the Borno in the northeast have signed up looking for love.

Flicking through several folders, Michael explains how he has a separate file for clients who have started seeing each other, another for those who have graduated to a serious relationship, and a different one for those who have married.

“I never attend weddings, he said, explaining how he was once embarrassed by the recognition he received at the marriage ceremony of one of the couples who met through his matchmaking.

In March this year, the Nigerian government signed into law a new version of the HIV/AIDS Anti-Discrimination Act, which is designed to make it easier to understand.

Yet Michael said the law has had no impact on his service, or the thousands of HIV-positive people that he works with.

“Many people don’t even know where to access drugs,” he said. “They hear about these things but have no information.

“The enlightenment is not there – it is just not there.”

Phase II Trial Offers ‘Proof of Concept’ for Therapeutic HIV Vaccine.

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A peptide-based vaccine against HIV-1 reduces viral load set-point after combination antiretroviral therapy (cART), a new phase II trial demonstrates.

However, there was no difference between the vaccine and placebo groups in the study’s two primary endpoints, the proportion of patients who resumed treatment after cART interruption or CD4 cell count.

“We believe the study reported here provides initial proof of concept to support a role for therapeutic HIV vaccines, since the finding that Vacc-4x is immunogenic and capable of changing plasma viral load setpoint after an analytical treatment interruption of cART,” Dr. Richard Pollard of U.C. Davis Medical Center in Sacramento and colleagues stated in The Lancet Infectious Disease, in a paper online February 11.

Vacc-4x (Bachem AG, Bubendorf, Switzerland) targets domains on the HIV-1 core protein, p24Gag. The study, at 18 sites in the U.S. and Europe, enrolled 137 patients who were virologically controlled on cART, with data available for 135 patients.

Patients were given a dose of the vaccine weekly for the first four weeks of the study, and then booster immunizations at week 16 and week 18. Patients continued on cART for an additional 10 weeks, and then cART was stopped in individuals with a CD4 count above 350 x 1,000,000/L who were under virologic control. Patients resumed cART if their CD4 counts dropped below this level or fell to more than half of their levels at week 28; if their viral load went above 300,000 copies per mL on two consecutive measurements; or if they developed HIV- or AIDS-related events. The study ended at week 52, and patients were followed to week 104.

Thirty patients (34%) given Vacc-4x began taking cART again between week 28 and week 52, versus 11 patients (29%) on placebo (p=0.89). Time to resuming cART was a median 198 days in the vaccine group and 175 days in the placebo group (p=0.77).

At week 48, patients in the vaccine group had a viral load of 23,100 copies per mL, vs 71,800 copies per mL in the patients on placebo (p=0.025).

At week 52, median viral load was 19,550 in the vaccine group and 51,000 in the placebo group (p=0.041).

The vaccine was well tolerated, with most adverse events involving injection site reactions. Nine patients, including five in the vaccine group, had serious events.

“It is recognized that because of the smaller number of recruited participants than originally planned (137 vs. 345) and the use of additional analyses, done on a subgroup of participants who achieved a 52 week off-ART period, these data need to be considered as exploratory,” Dr. Pollard and colleagues write.

“It’s an encouraging first step,” Dr. Merlin Robb, of the US Military HIV Research Program at the Walter Reed Army Institute of Research in Silver Spring, Maryland, told Reuters Health. Dr. Robb co-wrote an editorial on the new study. “If we could arm the immune system to better control the virus after a period of suppression under drugs, then we might have an important avenue to improve treatment outcomes and possibly achieve a cure.”

He and his colleagues are currently conducting clinical trials of HIV vaccine in individuals in the acute phase of HIV infection, when it may be easier to reduce the reservoir of infected T cells, he added.

The SMART trial, which looked at the effect of interrupting cART in HIV patients, found that patients who interrupted cART therapy were actually at greater risk of side effects than those who continued on cART, Dr. Robb noted. Dr. Pollard and his colleagues attributed the difficulty they had recruiting patients to the current trial to the “climate after the release of the SMART data.”

But studies like the current investigation, which are seeking curative treatments, are different from SMART, which looked at management of HIV, Dr. Robb said. “We need to brace ourselves to do these treatment interruptions safely and carefully, because we don’t want to do any harm, but we also want to see if these interventions have any impact.”