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AIDSInfo-at-a-glance

Issue No. 30 | July 23, 2010
A Service of the U.S. Department of Health and Human ServicesView HTML version
News and Features 

Study Suggests Starting HAART Early During TB Treatment in People Co-Infected with HIV and TB Improves Survival Rate

“A clinical trial in Cambodia has found it possible to prolong the survival of untreated HIV-infected adults with very weak immune systems and newly diagnosed tuberculosis (TB) by starting anti-HIV therapy two weeks after beginning TB treatment, rather than waiting eight weeks, as has been standard. This finding by scientists co-funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the French National Agency for Research on AIDS and Viral Hepatitis, brings physicians closer to optimizing the treatment of severely immunosuppressed individuals with HIV-TB co-infection. The findings were presented … at the XVIII International AIDS Conference in Vienna by principal investigators Francois-Xavier Blanc, M.D., Anne E. Goldfeld, M.D., and Sok Thim, M.D. ...

“The clinical trial, called the Cambodian Early versus Late Introduction of Antiretroviral Drugs (CAMELIA), or ANRS 1295 … enrolled 661 volunteers ages 18 and older with newly diagnosed HIV-TB co-infection and very weak immune systems (measured as fewer than 200 CD4+ T cells per cubic millimeter of blood). The participants all began receiving treatment for TB and were assigned at random to begin antiretroviral therapy for HIV either two weeks later or eight weeks later. …
 
“By the end of the follow-up period, 59 out of 332 participants who had started HAART two weeks after beginning TB treatment had died, while 90 out of 329 participants who started HAART eight weeks after beginning TB treatment had died. This 33 percent difference was statistically significant, leading the principal investigators to conclude that starting HAART two weeks after beginning TB treatment, rather than waiting eight weeks, boosts the chance of survival for people with HIV-TB co-infection and severely damaged immune systems.”

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NIAID Director Fauci Issues Statement About CAPRISA 004 Microbicide Study Results

“[W]e congratulate the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and the people of South Africa on the positive findings from the CAPRISA 004 microbicide study, which marks a significant milestone both for the microbicide research field and HIV prevention as a whole.

“For years, antiretroviral medicines have been effectively used to treat HIV infection. Through the successful conduct of the CAPRISA 004 study, we now have proof that an antiretroviral drug, in this case tenofovir, can be formulated into a vaginal gel that can protect women against HIV infection. Given that women make up the majority of new HIV infections throughout the world this finding is an important step toward empowering an at-risk population with a safe and effective HIV prevention tool. …

“Now we must build upon the CAPRISA research and identify a highly effective and acceptable microbicide for women and other groups at high-risk for HIV infection. The NIAID-sponsored VOICE study which launched last fall and is expected to enroll 5,000 women in four south African countries, will provide additional safety and effectiveness data for a tenofovir-based vaginal gel as an HIV prevention method. The study also will offer some insight as to the gel’s acceptability as a product used once a day rather than one that is used before and after sexual intercourse. Additionally, the VOICE study is examining oral antiretroviral tablets (tenofovir alone or tenofovir plus emtricitabine) as an HIV prevention method. This approach is known as pre-exposure prophylaxis, or PrEP. NIAID and other research organizations are exploring PrEP strategies in studies involving a number of at-risk populations with the first results expected early next year.”

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Study Suggests HAART Reduces Spread of HIV Among Injection Drug Users

“Highly active antiretroviral therapy (HAART), currently known for its therapeutic benefits against HIV, also reduced the spread of the virus among people with a history of injection drug use, according to a population-based study funded by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health. The study was published … in the [Lancet]. … 

“Previous research had suggested that increased HAART coverage reduced the spread of HIV in the general population. The findings in this study applied not only to the general population, but also to the subset of individuals with a history of injection drug use. …

“Researchers analyzed information from two databases that provide information on HAART use, looking at viral load, new HIV diagnoses, and HIV and viral load testing information in British Columbia, where residents are provided free access to HIV care. During three distinct time periods, researchers saw that the number of individuals actively receiving HAART had a strong impact on viral load and new diagnoses in the community. As HAART coverage increased sharply, new HIV diagnoses decreased sharply. As HAART coverage stabilized, so did viral load and new HIV diagnoses.

“‘Our results clearly demonstrate that there is a connection between treatment and prevention not just among the general population, but among injection drug users as well,’ said Dr. Julio Montaner, the study’s lead author and director of the BC Centre for Excellence in HIV/AIDS. ‘Expanding HAART coverage within current medical guidelines will prevent disease progression and decrease new HIV infections.’”

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