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HIV/AIDS, Image of the Week

Image of the Week: Glass sculpture of an HIV virus

Artist Luke Jerram has created a remarkable collection of glass sculptures depicting some of the most notorious microbes. This image illustrates the HIV virus and, as noted on Jerram’s website, was made as an object “to hold, to contemplate the impact of the disease upon humanity.”

One HIV-positive patient who viewed a photo of the sculpture at an exhibit in 2009 wrote to Jerram saying:

I just saw a photo of your glass sculpture of HIV. I can’t stop looking at it. Knowing that millions of those guys are in me, and will be a part of me for the rest of my life. Your sculpture, even as a photo, has made HIV much more real for me than any photo or illustration I’ve ever seen. It’s a very odd feeling seeing my enemy, and the eventual likely cause of my death, and finding it so beautiful. Thank you.

Jerram’s glass microbiology sculptures are currently on display at New York City’s Museum of Art and Design.

Previously: Engineering immune cells to resist HIV and Stanford expert discusses recommendation for universal HIV screening
Via Fast Company
Photo by Luke Jerram

Genetics, HIV/AIDS, Immunology, Research, Stanford News

Engineering immune cells to resist HIV

Engineering immune cells to resist HIV

People with HIV have to take a cocktail of drugs daily to keep the lethal virus in check. But a novel gene therapy approach, now under development at Stanford, could make patients resistant to the virus and free them from this lifelong dependence on drugs, which have adverse side-effects.

In a new study, the researchers describe their technique of using “genome editing” to make T cells, key cells of the immune system, resistant to the virus. In studies done in the lab, the technique effectively blocked the virus from entering the cells through one of two receptors, known as CCR5 and CXCR4. These are the two common entry points for the virus.

In one instance, the researchers used genetic manipulation to deactivate the CCR5 receptor gene. And for added protection, they were able to introduce three known anti-HIV genes into the receptor genes. This blocked both CCR5 and CXCR4. These modified T cells had more than 1,200-fold protection, and in some instances more than 1,700-fold protection, against HIV; unmodified cells succumbed to infection in a matter of weeks, the researchers reported.

The research is still in the early stages and has to go through animal testing, as well as clinical trials. But it is a very encouraging step forward in the field of gene therapy for HIV, Matt Porteus, MD, the lead investigator told me.

“I feel this is a significant improvement in the first generation application. So I’m very excited,” he said.

Interestingly, as I left Porteus’ lab, located in the Lorry I. Lokey Stem Cell Research Building, I ran into another HIV researcher and mentioned the work, which was entirely new to him. That’s how innovative this technique is.

Porteus, a pediatrician, is interested is using the approach to treat other diseases as well. A hematologist and cancer biologist, he treats children at Lucile Packard Children’s Hospital and is hoping some of his patients, such as those with sickle cell anemia, might someday benefit from a gene therapy approach along these lines.

Health Policy, HIV/AIDS, Podcasts, Public Health, Sexual Health, Stanford News

Stanford expert discusses recommendation for universal HIV screening

Stanford expert discusses recommendation for universal HIV screening

Yesterday my colleague wrote about a task force’s draft recommendation for universal HIV screening. Today, in a 1:2:1 podcast, task force member Douglas K. Owens, MD, discussed the proposed guidelines and the importance of screening. He believes the recommendation, if implemented, could have a substantial impact on the course of the epidemic in the United States.

Previously: Task force issues draft recommendation for universal HIV screening

Health Policy, HIV/AIDS, Public Health, Stanford News

Task force issues draft recommendation for universal HIV screening

Task force issues draft recommendation for universal HIV screening

When the International AIDS Conference was held in Washington, D.C. this summer, it cast a spotlight on the U.S. epidemic, which continues apace. Every year, there are some 50,000 Americans newly diagnosed with HIV – a figure Anthony Fauci, MD, the nation’s top AIDS doctor, has called “embarrassing.”

To help contain the epidemic, which affects an estimated 1.2 million Americans, the U.S. Preventive Services Task Force today issued a new draft recommendation that urges everyone in the country – adolescents and adults between 15 and 65 – to get an HIV test.  The task force has recommended screening in the past but only among those considered at increased risk. And the federal Centers for Disease Control also has advised routine voluntary screening, but has allowed people to opt out.

We think it’s important for everyone to screen once because treatment helps people live longer, healthier lives and also prevents transmission to others

Doctors and patients may be reluctant to test because they don’t see a reason to do so or are afraid to broach a topic that still carries a lot of stigma. But there are as many as 250,000 people in this country who are HIV-positive and don’t even know it. They could benefit from treatment – and so could the rest of the population, if this epidemic is to be brought under control.

“We think it’s important for everyone to screen once because treatment helps people live longer, healthier lives and also prevents transmission to others,” task force member Douglas K. Owens, MD, a professor of medicine at Stanford, told me.

In recent years, the science of AIDS has advanced to the point where it’s clear that early testing and treatment can make a big difference. People who are diagnosed early – even before symptoms show up – and then receive antiretroviral treatment can reduce their odds of getting serious AIDS-related complications. And a landmark study also has shown that treatment drives down the amount of circulating virus in a person’s blood to the point where the infected person is significantly less likely to pass the virus on to others.

Also, once people know their HIV status, they are more likely to take steps to reduce the risks of transmission, such as using condoms, studies have shown. All these factors, taken together, point to the need for a universal testing program, Owens says.

Previously: International AIDS conference ends on an optimistic note and National HIV screening and testing could be very cost-effective

HIV/AIDS, Infectious Disease, Stanford News

International AIDS conference ends on an optimistic note

International AIDS conference ends on an optimistic note

Last week, some 24,000 people from 183 countries attended the International AIDS Conference in Washington D.C., including my colleague and Scope contributor Ruthann Richter who posted periodic updates from the biannual gathering. (You can read her past updates in our HIV/AIDS category.)

The conference ended Friday and acknowledged a turning point in the fight against the epidemic. As Richter explains in a news story today, scientists and policy makers are optimistic about achieving the goal of an “AIDS-free generation” in the future despite a multitude of economic, social and scientific challenges. She writes:

The world is gaining ground against AIDS, with more people now on treatment (8 million) than those who need it (7 million), said Michel Sidibe, executive director of the Joint United Nations Program on HIV/AIDS, also known as UNAIDS. Worldwide infections have declined 20 percent since 2011, and in hard-hit Africa, AIDS-related deaths have fallen from 1.8 million in 2005 to 1.2 million today, he said.

Still, there are 34 million people living today with HIV, and for every person on treatment, two more become infected, highlighting the need for stepped-up prevention efforts, speakers said. And though 100,000 fewer babies were born HIV-positive in 2010, there were still some 330,000 infants who became infected at birth or through breastfeeding in 2011. [Secretary of State Hillary Clinton], who announced an $80 million initiative to prevent mother-to-child transmission, said the goal is to reduce this number to zero by 2015.

The advancing science of AIDS, meanwhile, has produced a plethora of new treatments and prevention strategies that could help drive down AIDS prevalence. These include voluntary male circumcision, use of anti-AIDS drugs in infected individuals to reduce their chance of passing on the virus to others, as well as use of these drugs as preventives in uninfected people.

Previously: International AIDS Conference Day Four: Focusing on a vaccine, International AIDS Conference Day Three: Daring to talk about a cure, International AIDS Conference Day Two: Sir Elton John calls for compassion, International AIDS Conference Day Two: Hillary Clinton envisions AIDS-free generation and International AIDS Conference: Day One
Photo by Paula Bailey

Global Health, HIV/AIDS, Pregnancy, Research, Sexual Health, Stanford News

Using family planning counseling to reduce number of HIV-positive children in Africa

Using family planning counseling to reduce number of HIV-positive children in Africa

More news from the International AIDS Conference: Stanford researchers have presented findings showing that family planning counseling could be a cost-effective way to help minimize the number of children born HIV-positive in sub-Saharan Africa. The study involved 98 HIV-positive women – two-thirds of whom attended three 90-minute group courses on family planning, sexual negotiation, and self-esteem building. My colleague Ruthann Richter, who has been reporting from the conference, writes:

According to [Clea Sarnquist, DrPH, MPH, a senior research scholar in pediatrics] and her colleagues, about 40 percent of pregnancies in sub-Saharan Africa are unplanned. Such unwanted pregnancies could be prevented if women relied on long-acting forms of contraception — such as the intra-uterine device, or IUD, or hormonal implants — rather than birth control pills or diaphragms. Indeed, the researchers found that [three months] after receiving group counseling almost 90 percent of the HIV-positive women in the study chose a long-acting form of contraception.

The women in the study, which was conducted in a suburban region of Zimbabwe, also said they felt a greater sense of power in negotiating sexual activity, including condom use, and were more open with their partners about their HIV status, the researchers reported.

Sarnquist, who is hoping to expand the study to a larger population of women who could be followed over a longer period of time, said of the significance of this work, “If you can help prevent HIV-positive women from having unplanned children, obviously you’re going to prevent unnecessary HIV transmission.”

Previously: International AIDS Conference Day Four: Focusing on a vaccineInternational AIDS Conference Day Three: Daring to talk about a cure, International AIDS Conference Day Two: Hillary Clinton envisions AIDS-free generationInternational AIDS Conference: Day OneWHO’s new recommendations on contraceptive use and HIV and New book shows the pain and hope of AIDS orphans

Global Health, HIV/AIDS

International AIDS Conference Day Four: Focusing on a vaccine

Less than 10 years ago, I remember hearing French virologist Francoise Barre-Sinoussi, PhD, winner of a Nobel Prize for co-discovering the virus, express deep pessimism about whether it would be possible to develop an AIDS vaccine, the holy grail of the epidemic.

But as Barton Haynes, MD, director of the Duke Human Vaccine Institute, said at the International AIDS Conference today, the field of vaccine research is enjoying a revival, with hopes renewed, thanks to a series of new developments in just the last few years.

“I can assure you the HIV vaccine field is invigorated. We are treating this problem as a global emergency,” said Haynes, who has been working in the field for 27 years and leads the NIH’s Center for HIV/AIDS Vaccine Immunology.

One of the challenges of vaccine development is that HIV is an extraordinarily diverse virus, changing its character every time it replicates. An infected person may harbor hundreds of thousands or millions of different variations of the virus. So a vaccine needs to generate an immune reaction that is clever enough to recognize all of these variants.

I can assure you the HIV vaccine field is invigorated.

Vaccine researchers were encouraged in their quest by the results of a trial among 16,000 people in Thailand, reported in 2010, which showed a 31 percent reduction in infections. The vaccine was all too limited in its effectiveness, but it nonetheless pointed the way forward.

Since then, researchers have been following some of the trial participants and identified some immune “correlates” – clues on what it is about the immune response that can help predict whether a vaccinated person will be protected or not, Haynes said.

At the same time, scientists have identified several potent new neutralizing antibodies with broad ability to recognize different viral strains, Haynes said. These can be combined with so-called adjuvants, which boost the immune response, to form the basis for new clinical trials.

Haynes likened the struggle for a vaccine to the global arms race: Every time a weapon is introduced, a new, more powerful one is built. In HIV, every time an antibody attacks a virus in the body, a new “escape” virus is created, and HIV wins.

Now, he said, “We hope to create the human HIV arms race with a vaccine and a strong adjuvant so the vaccinee wins.”

Ruthann Richter is a Scope contributor and writer in the medical school’s communication office. She is attending the International AIDS Conference in Washington, D.C. and is posting periodic updates on the happenings there. You can see all of her updates in our HIV/AIDS category.

Global Health, HIV/AIDS, Public Health

No clowning around: How clown-educators are increasing HIV awareness in Guatemala

When I first heard that a group of Guatemalan clowns were staying with some of my relatives on the East Coast, my interest was piqued. A few Facebook messages later I learned that the clowns weren’t the Ronald McDonald type but instead were professional health educators – part of a non-profit organization aiming to increase awareness of HIV and other sexual-health issues among vulnerable populations. Several members (i.e. clowns) of the Asociacion Payasos Atz’anem K’oj have come to Washington D.C. to present at the International AIDS Conference, and – still intrigued – I recently spoke with project coordinator Anthony Savdie about their work.

Who first identified a need to address sexual health and human rights in vulnerable communities? And what led to the establishment of Asociacion Payasos Atz’anem K’oj in 2001?

The need to shift the focus to the rural poor was first identified in a report from the Food and Agricultural Organization and UNAIDS, called Sustainable Agriculture: Rural Development and Vulnerability to the AIDS Epidemic, which was published very quietly in 1999. It outlined a series of vulnerability criteria for communities where statistics don’t yet exist. Paul Farmer, MD, PhD, has also written about HIV, in Haiti and elsewhere, and he persuasively argues for a public-health effort that uses an analysis of poverty as the lens through which sexual health is examined. We in Guatemala – and by we, I mean the original team of Proyecto Payaso, a group that included an HIV educator, several performers and others interested in developing a project to address the issue – recognized a situation in the indigenous majority of the Western Highlands that clearly put large segments of the population at risk. Migration, poverty, and a lack of access to condoms, testing and basic information all seemed to point at the region as the next epidemiological time bomb.

The Atz’anem K’oj Collective formed in early 2001 to propose a communications project based on organic, face-to-face exposure to accurate, up-to-date and scientifically proven information formulated in a way as to be intelligible to people with little Spanish and little exposure to formal education.

What is the current state of sexual health and HIV awareness in the Guatemala? Who has the biggest need for accurate information?

The pandemic has exhibited worldwide tendencies over the last decade that have been very well documented: HIV is affecting, increasingly, women and the poor, and it is shifting disproportionately to rural areas. Indigenous women in Guatemala fall under all three categories; it is therefore logical that they should be the most vulnerable both to the spread and to the impact of HIV. Cultural mores that dictate women’s subservience and ignorance of their bodies, health and rights have conspired with centuries of structural violence and historical neglect that have kept an estimated 85 percent of indigenous women in Guatemala from basic services such as education. We know, then – with or without hard epidemiological statistics – that women are under-resourced in terms of sexual health.

If we look at reproductive health statistics, which actually do exist, we have an indication of the general state of women’s health in Guatemala. It is, as you may guess, not very good. Maternal mortality is almost the highest in the hemisphere, second only to Haiti, and the only reason, in our view, that HIV statistics among indigenous women are not through the roof is that testing and counseling services are nonexistent in areas of indigenous majority.

Your clown-educators – who, I understand, perform in big shoes and red noses – use games, workshops and theater to increase access to information and resources on HIV. Can you provide a few examples of how this is done?

A board game gathers twelve people around a 50-square circuit, and it’s a race to the end with the roll of one or two dice. If you roll a six, for instance, you land on a square where you are asked to put a condom on [an object] following the correct steps. If you roll a five you are instructed to pick from a stack of hypothetical situations and asked to determine whether you are in fact in a risky situation – whether the described behavior could end up causing a new infection, either HIV or some other STD. Another square announces that your HIV test has come back positive and asks you to discuss whom you might tell first and why, another square asks you to name three bodily fluids capable of transmitting HIV from one person to another, another tells you to roll again because you went to the health post and asked for condoms and they gave them to you. You get the drift.

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Global Health, HIV/AIDS

International AIDS Conference Day Three: Daring to talk about a cure

AIDS researchers today are talking about something almost unthinkable a few years ago: a cure. At the International AIDS Conference, research to eradicate the virus took center stage with a major presentation by a Spanish scientist on efforts to understand how the virus persists in the body and to find ways to flush it out and eliminate it entirely. The International AIDS Society, which has convened a group of experts to lead the effort, also unveiled a roadmap for priorities in cure research in the coming years.

The work has important implications: People on antiretroviral therapy may suffer serious side-effects, including cancer, liver disease and heart disease, that can shorten their lives, said Javier Martinez-Picado, PhD, a senior investigator at IrsiCaixa AIDS Research Institute in Barcelona. Moreover, the cost of maintaining people on the therapy could reach $22 billion by 2015, he said.

But work on the cure is proceeding cautiously, as scientists have gone down this path and been disappointed before, researchers Steven G. Deeks, MD, and Francoise Barre-Sinoussi, PhD, leaders of the effort, discuss in the latest issue of Nature Reviews Immunology.

“The barriers to curing HIV are real, and they may prove to be insurmountable,” they write.

What makes viral eradication so challenging is the fact that the virus integrates itself into the DNA of specialized immune system cells and can remain there indefinitely without detection. Scientists are just starting to develop tests to measure these latent cells not only in the blood, but in other body tissues, such as the lymph nodes or genital tract, where they may be hiding out, Martinez-Picado said.

The next few years also will see the development of animal models to better understand viral latency, as well some small clinical trials with several drugs that work through different mechanisms. The first preliminary results emerged in March of this year, when David Margolis, MD, of the University of North Carolina at Chapel Hill, reported that the cancer drug Vorinostat could flush out latent cells. In theory, antiretrovirals then could be used to mop them up.

“Certainly, this is promising,” Martinez-Picado said at today’s meeting.

One patient already stands as proof of the possibility of cure. He is the so-called Berlin Patient, an HIV-infected man who received a bone marrow transplant for leukemia from an HIV-resistant donor. Five years have passed, and today he remains entirely free of HIV.

Ruthann Richter is a Scope contributor and writer in the medical school’s communication office. She is attending the International AIDS Conference in Washington, D.C. and is posting periodic updates on the happenings there. You can see all of her updates in our HIV/AIDS category.

Global Health, HIV/AIDS

International AIDS Conference Day Two: Sir Elton John calls for compassion

By all rights, he should be dead today. He was a self-destructive, angry young man who got mixed up in drugs and alcohol and took a lot of sexual risks in the free-wheeling, AIDS-ridden 1980s.

“I should have died of AIDS… I shouldn’t be here today,” British singer Sir Elton John told some 5,000 people at the International AIDS Conference today.

But he was saved by the love and compassion of complete strangers, who cared for him during his dark days of drug rehabilitation. And that’s the message he’s preaching today – that with all the best science in the world, people won’t be saved from HIV/AIDS as long as there is hatred, discrimination, stigma and lack of compassion for marginalized groups affected by the epidemic.

We need to put our arms around people who are HIV-positive and celebrate those who go to be tested.

John founded the Elton John AIDS Foundation in 1992 after he came to know Ryan White, the Indiana teenager who contracted AIDS through a blood transfusion. After White’s death in 1990, he began to take stock of his own life. He writes about his experiences in his new book, “Love is the Cure.”

In his talk at the conference, where he appeared in an uncharacteristically conservative black suit and blue shirt, he said he experienced the shame of a drug addict, and it’s the same shame that keeps many at-risk people from emerging into the mainstream to seek HIV testing and care today.

“They feel subhuman, worthless, like they don’t matter at all,” he said. “It prevents them from getting treatment.”

The AIDS epidemic has led people to be ostracized by families, for African men to be subject to stoning, for orphaned children to be abandoned in the streets, and for injection drug users to be considered lawless citizens in some parts of the world. But all this does is push people further into the shadows, causing needless suffering and further contributing to the spread of AIDS.

“We need to put our arms around people who are HIV-positive and celebrate those who go to be tested,” John said.

Compassion, he said, “doesn’t cost anything, but it’s the most precious thing in the world… When we find it, I promise you we will wake up from this 30-year nightmare into a brand new day.”

Ruthann Richter is a Scope contributor and writer in the medical school’s communication office. She is attending the International AIDS Conference in Washington, D.C. and is posting periodic updates on the happenings there. You can see all of her updates in our HIV/AIDS category.

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