Safe Injection, Crystal Meth & HIV

1. B.C.'s Top Health Officer Appeals for Safe Drug Site

April 1, 2008

Victoria - British Columbia's top health official says Victoria should become Canada's second city to permit safe injection drug sites, even though the future of the first site is still up in the air.

Vancouver has been operating its safe-injection drug site in the notorious downtown Eastside neighbourhood for almost five years on a trial basis. Now it's time to expand to Victoria, said Dr. Perry Kendall, B.C.'s provincial health officer.

Kendall and Dr. Benedikt Fischer, of the University of Victoria's school of addictions research, are publishing a joint editorial in the B.C. Medical Journal on Tuesday calling for a second safe injection site in Victoria.

"The Health Act specifically states that if I am able, (I) must speak out on issues of policy or practice that I think affect the health of the population of British Columbia, and do it in any way that I think most appropriate," said Kendall.

"So, I think a journal editorial co-written with a drug policy researcher in a medical journal is an appropriate way of bringing the issue to attention."

Vancouver's safe-injection site, called Insite, allows addicts to inject their own heroin and cocaine under the supervision of a nurse.

Studies published in medical journals such as the Lancet have suggested Insite, the only facility of its kind in North America, has reduced overdoses and blood-borne infections such as HIV because addicts are given clean needles.

Fischer and Kendall contend a supervised consumption drug site in Victoria will offer the city's 1,500 to 2,500 hard-drug users a location other than alleyways and open parking lots to inject drugs.

And a second site in an urban environment smaller than Vancouver's will allow the federal government to further study the benefits of supervised drug sites, said Fischer.

The federal Conservative government has extended the Vancouver site's trial period, but has not committed to making permanent the exemption from drug laws that allows the site to operate.

The government also appears cool to expansion, Fischer said.

"The (federal) health minister has repeatedly called for additional evidence on whether these programs work or not," said Fischer.

"We think Victoria would be an ideal environment to produce such additional evidence and that the kind of safe consumption site program we would advocate for here in Victoria would be a model that would be quite distinct from what's going on in Vancouver."

Fischer said the Vancouver site is located in a permanent downtown location and the environment is highly clinical.

The Victoria model plans to include several smaller sites that are integrated with other services that could help drug users. It could include a mobile unit to reach out to injection drug users who are not being reached through conventional ways, he said.

It is estimated about 70 per cent of Victoria's intravenous drug users are infected with the Hepatitis C virus and 15 per cent are HIV positive.

Kendall said Victoria needs to file a joint city council, police and health authority application for a safe consumption pilot project to the federal government in order for a second project to be considered by Ottawa.

Victoria's city council and police department are in support of harm reduction strategies.

Victoria's health authority has not declared support for safe consumption drug sites, but it has been involved in several innovative drug projects in the Victoria area, including moves to distribute safe crack kits to users on Vancouver Island.

"I have to hope that the federal government would be guided by the evidence and the desires of the local health-care providers, the local police forces and the local city council who are elected by the electors of Victoria," Kendall said.

Victoria is currently in the midst of a wrenching local debate over the location of a needle exchange. The location of the old needle exchange upset residents and business operators, and the proposed new location is drawing similar concerns.

Residents and businesses in the surrounding area said the neighbourhood became a haven for drug dealers and open drug use was rampant.

"Clearly, if those people weren't injecting in the streets, but were to inject inside in a sterile environment, they would not only be in contact with health services, but they'd also be out of view of the public," Kendall said.

Earlier this month, a United Nations monitoring body said it wanted the Canadian government to close Vancouver's safe injection site and end the distribution of safe crack kits in Toronto, Ottawa and on Vancouver Island.

The International Narcotics Control Board's annual report said the distribution of crack kits in some Canadian jurisdictions contravened part of the UN's Convention against Illicit Traffic in Narcotic Drugs.

Proponents of Canada's harm-reduction approach said the board's policies are irrelevant.

The Canadian Press.  www.CTV.ca


2. Needle Sharing Prompts Renewed Calls For In-Prison Exchange Programs
 
April 06, 2008

Vancouver - Up to 15 per cent of incarcerated drug users report injecting heroin and cocaine while behind bars, according to one of two new studies that say Canadian prisons are contributing to the spread of the virus that causes AIDS.

The findings are so worrisome the researchers at the B.C. Centre for Excellence in HIV/AIDS, who conducted the studies, have renewed calls for in-prison needle exchanges to reduce the risk of dirty syringes spreading HIV and Hepatitis C infections, which are common among inmates.

The sharing of used needles in prisons is "a recipe for disaster," says Dr. Evan Wood, a principal investigator on both studies.

The first, in this week's advance online edition of the Journal of Public Health published by Oxford University, followed 1,247 intravenous drug users, half of whom spent time in jails at some point during the six-year study. Almost 15 per cent of those incarcerated reported injecting heroin or cocaine in prison, most of them with used syringes.

The second study, published in the Drug and Alcohol Review this week, followed another group - 902 injection drug users at Insite, Vancouver's controversial supervised injection facility. Approximately one-third reported spending time behind bars at each six-month follow-up in the two-year-long study and five per cent reported injecting drugs while incarcerated.

"People who had been incarcerated were more likely to report syringe sharing and more likely to be infected with HIV and hepatitis C as compared to non-incarcerated injection drug users," the researchers say.

Wood said in an interview the studies likely underestimate the rate of syringe sharing, which many people are reluctant to admit.

He says a "co-ordinated public health response" is needed to address the risk of disease transmission from prisons to not only protect inmates, but the "home communities" they return to.

"We're doing everything we can to try and stop people from sharing syringes," Wood said, referring to community-based addiction treatment programs and needle exchanges across the country. "Then, you follow drug users over time to see where we are falling short and prison jumps out as a reason people are lending and borrowing syringes. It's very worrisome."

The drug users in the studies were incarcerated in B.C. correctional facilities.

But Wood and his colleagues suspect syringe sharing is common in jails across Canada.

They say the findings underline the "urgent need" to expand harm-reduction programs in Canada's municipal, provincial and federal correctional institutions.

They would like to see prison-based needle exchanges, which have been called for by several groups in the past, piloted so inmates can exchange used syringes for sterile ones.

Officials at Correctional Service Canada say "continuing risk behaviour by inmates during incarceration presents a public health challenge."

Guy Campeau, the department's director of media relations, said the agency is addressing the problem with "a comprehensive" infectious disease program.

It includes methadone maintenance to try help inmates kick heroin addiction. "As well, condoms, dental dams, water-based lubricant and bleach are made available as harm reduction measures to help reduce the spread of disease within institutions," Campeau said by e-mail when asked to comment on the B.C. research findings and the call for more action.

He said the department has drawn the line at handing out sterile syringes to inmates. "There are no plans to implement a needle exchange program," Campeau says.

By Margaret Munro, Canwest News Service


3. Street Kids Using Crystal Meth At 'Alarming' Rate
'I don't think anybody knew it was that pervasive in that population,' says one author of large-scale survey

April 2, 2008

Injection drug use is on the rise among street youth in Vancouver, fuelled by alarming rates of crystal methamphetamine use, a new study has found.

The federally funded study, written by medical researchers with the B.C. Centre for Excellence in HIV/AIDS, found that crystal meth users surveyed were four times more likely to inject drugs, compared to drug users who didn't use crystal meth.

It's the first time a large-scale survey of crystal meth use among street youth has been undertaken in Canada.

And researchers were shocked by some of its findings, particularly around the sheer prevalence of the drug.

About 75 per cent of participating street youth reported crystal meth use -- a number one of the study authors described as "highly alarming."

"I don't think anybody knew it was that pervasive in that population," said Dr. Evan Wood.

"We're dealing with a crystal methamphetamine epidemic here."

By comparison, only about 15 per cent of addicts on Vancouver's drug-hardened Downtown Eastside reported crystal meth use.

According to Wood, the study raises serious concerns that this highly addictive and dangerous street drug is creating a whole new generation of injection drug users. With it comes widespread health care implications linked to increased drug overdoses and HIV/AIDS and hepatitis C infection rates.

Already both HIV and hepatitis C have been detected among local street youth, Wood said.

The study findings also raise questions around crystal meth injection rates among youth outside the street culture, given the widespread prevalence of the drug in small towns and suburban neighbourhoods across the country.

Nearly 500 Vancouver street youth between the ages of 14 and 26 years took part in the study, which spanned September 2005 to October 2006. Most of the participants said they were either living on the streets or spent a significant portion of their day out on the streets.

"They are people living on the margins of society," Wood said.

The findings will be published this May in the Australia-based journal, The Drug and Alcohol Review.

Among other critical findings, the study found that 95 per cent of the youth who reported crystal meth use said it was "very easy" to obtain the drug, while the remaining five per cent said it was "easy" to get.

"It's out there," Wood said.

Eighty per cent of first-time crystal meth users said they were given the drug as a "gift" at a party with friends, and most were sober when they used it.

The study also found that 25 per cent of first-time crystal meth users injected the drug, while the majority either smoked, snorted or swallowed it.

However, said Wood, the rate of injection goes up steadily among those who continue to use the drug.

"Even when we adjusted for all kinds of variables, there seems to be this link between crystal methamphetamine and injection drug use," Wood said.

Wood said the study did not address why users choose to inject crystal meth. That question will be among the many yet to be answered as researchers continue to probe the issue over the next five years.

"What leads people to pick up a needle and begin injecting is really a mystery," he said. Researchers are hoping the current study results will catch the interest of federal drug policy makers in Canada, whose current focus is on supply reduction.

"I do think we need to really start to consider where we are putting our efforts and our resources," Wood said. "Given what we are facing with drugs in society, we really need to start looking at the scientific evidence and modifying what we are doing to address these issues."

By Darah Hansen, The Vancouver Sun

First New NNRTI in Nearly a Decade to Benefit Canadians with HIV/AIDS
INTELENCE™ (etravirine) for HIV combination therapy is the first new NNRTI to work for patients who have developed NNRTI-resistance

April 2, 2008

Toronto, ON - Canadians living with HIV/AIDS now have a new prescription treatment option, with the recent approval of INTELENCE*(etravirine, also known as TMC125) from Tibotec, a division of Janssen-Ortho Inc. INTELENCE is the newest member of the family of AIDS-fighting drugs known as non-nucleoside reverse transcriptase inhibitors (NNRTI), and is the first new NNRTI to be introduced in nearly 10 years. Prior to approval, INTELENCE was granted priority review status by Health Canada. Health Canada applies priority status to New Drug Submission (NDS) for a serious, life-threatening or severely debilitating disease or condition for which a new drug demonstrates the potential to address an unmet medical need.

"It is important for me to share the benefits that a new therapy can bring to the lives of HIV/AIDS patients who are often faced with complicating side effects and deteriorating health" says Yves Brunet, a Canadian living with HIV/AIDS. "Since my diagnosis in 1986, I have developed various resistances to drug regimens. The last time this happened, my physician added a drug which is now called INTELENCE to my treatment regimen and it has greatly improved my health and sense of well-being"

INTELENCE is the first NNRTI to show antiviral activity (viral load (VL) decreases) in treatment-experienced adult patients with HIV who have failed prior therapies.2,3 "The approval of INTELENCE is an important development, as it is common for patients, like me, to build resistance to existing HIV medicines" says Yves. "It is comforting to know that there are still options available"

INTELENCE, in combination with other antiretroviral agents, is indicated for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in treatment-experienced adult patients who have failed prior therapy and have HIV-1 strains resistant to multiple antiretroviral agents, including NNRTIs.

As part of a combination therapy, INTELENCE must be taken with other anti-HIV medicines in patients who have already taken anti-HIV medicine that did not control their HIV infection. When used with other anti-HIV medicines, INTELENCE works to reduce a patient’s VL and increase the number of white blood cells known as CD4 cells that help fight off other infections. Reducing the amount of HIV and increasing the CD4 cell count may improve a patient’s immune system, leading to improved health.4

The NNRTI Class

NNRTIs block reverse transcriptase, a key enzyme the HIV virus uses to replicate. NNRTI drug resistance occurs when HIV develops mutations that partially or completely stop the NNRTI from binding to the reverse transcriptase enzyme, causing the drug to lose effectiveness.

DUET-1 and -2 Study Design2,3

The approval of INTELENCE is based on the 24-week analysis of HIV viral load and CD4+ cell counts from the pooled analysis of the Phase 3 DUET-1 and -2 studies. The DUET-1 and –2 studies, identical in design but conducted in different regions, assessed the 24-week efficacy and safety of INTELENCE in combination with a background regimen (BR), which included PREZISTA* (darunavir), in treatment-experienced adult HIV-1 patients with documented evidence of NNRTI and protease inhibitor (PI) resistance. They were large randomized, controlled studies with a primary endpoint of VL less than 50 copies/mL (known as undetectable viral load). IAS-USA treatment guidelines define VL less than 50 copies/mL as the goal of therapy for treatment-experienced patients when two or more potent drugs are used in the treatment regimen.

Patients with HIV-1 who were eligible for the DUET studies had a VL of greater than 5,000 copies/mL, while on a stable antiretroviral therapy regimen for at least eight weeks and had evidence of at least one NNRTI resistance-associated mutation, either at screening or from prior resistance tests, as well as evidence of three or more primary PI mutations at screening.

In treatment-experienced patients with NNRTI-resistance, treatment with INTELENCE achieved greater VL reductions at week 24 than did placebo. The most commonly reported adverse drug reactions with INTELENCE identified from the pooled DUET 1 and 2 trials were rash (all types), diarrhea and nausea.5

INTELENCE does not cure HIV infection or AIDS, and does not prevent passing HIV to others.

About HIV/AIDS

Canada’s first diagnosed AIDS case occurred in 1982, and the first death due to the disease occurred in 1983. Since then, 21,000 Canadians infected with HIV/AIDS have died6 however, the number of positive AIDS diagnoses reported in 2006 have decreased from 498 in 2000 to 255.7 Given this decline, it’s important to reflect just how far treatment advancements have come in managing the disease.

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) were introduced in 1987 as the first type of antiretroviral drug available to treat HIV infection. NRTIs interfere with the action of reverse transcriptase (an HIV protein) which the virus needs to make new copies of itself.8From 1988 to the early 1990’s, drug advancements focused on treating various HIV/AIDS complications, such as infections and weight loss.9 Significant breakthroughs occurred in the late 1990’s, with the introduction

of a new class of treatments called protease inhibitors (PI). PIs inhibit HIV-1 protease thereby preventing the formation of mature infectious virus particles.10

Approved in 1997, was the first of another class of antiretroviral drugs known as Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), which stop HIV from replicating within cells by inhibiting the reverse transcriptase protein.11

http://www.webwire.com

Man Convicted of Spreading HIV Sentenced to 18 Years In Prison

April 4, 2008

Windsor, Ontario - A man convicted of knowingly spreading the virus that causes AIDS was handed an 18-year prison sentence Friday after a judge declined to declare him a dangerous offender.

Carl Leone pleaded guilty last year to 15 counts of aggravated sexual assault after failing to inform his sexual partners of his HIV status. Five of the 15 are now HIV-positive.

On Friday, Superior Court Justice Joseph Quinn handed Leone 15 consecutive sentences totalling 49 years _ a number Quinn reduced to 18 years to better reflect sentencing guidelines laid out in the Criminal Code.

In passing sentence, Quinn said Leone committed a ``despicable and selfish crime for five to 10 minutes of sexual gratification.''

Leone, 32, will have to surrender a DNA sample, and his name will be added to Ontario's sex offender registry.

He will be eligible for parole in six years.

Defence lawyer Andrew Brady, who noted he hadn't spoken with his client, said outside court the sentence was fair and that he would not appeal.

Leone's mother left the courthouse with tears in her eyes, accompanied by Leone's father and sister. The family did not comment.

Quinn told the court that Leone's age, his lack of a criminal record and the fact he pleaded guilty to spare his victims the trauma of testifying were factors in his sentence.

At his dangerous offender hearing in February, Leone expressed remorse and said he hopes he can be forgiven and one day return to the community.

A dangerous offender designation would have jailed Leone indefinitely.

Leone, who helped run his wealthy parents' music store, was told in 1997 by Windsor Essex County Health Unit workers that he was HIV-positive, seven years before his arrest on June 6, 2004.

Court has heard that Leone lived in a ``sex-drenched, drug-drenched environment'' that included frequenting strip clubs and having casual sex.

The Canadian Press, www.365Gay.com

House Approves Global AIDS Package

April 2, 2008

Washington - The House voted Wednesday to triple to more than $10 billion a year U.S. humanitarian spending on fighting AIDS, malaria and tuberculosis in Africa and other stricken areas of the world.

About $41 billion of the $50 billion over five years would be devoted to AIDS, significantly expanding a program credited with saving more than 1 million lives in Africa alone in the largest U.S. investment ever against a single disease.

Every day another 6,000 people are infected with the HIV virus, said House Foreign Affairs Committee Chairman Howard Berman, D-Calif. "We have a moral imperative to act and to act decisively," he said.

The House voted 308-116 to extend and broaden the scope of the $15 billion President's Emergency Plan for AIDS Relief that President Bush promoted and Congress enacted in 2003. It has been hailed as a noteworthy foreign policy success of the Bush presidency.

The White House, which backs the House bill, said the program is supporting anti-retroviral treatment for about 1.45 million people and is on track to meet its goals of backing treatment for 2 million, preventing 7 million new infections and providing care for 10 million, including orphans and vulnerable children.

In 2007, 33 million people worldwide were living with HIV and AIDS, according to the United Nations.

Rep. Ileana Ros-Lehtinen of Florida, top Republican on the Foreign Affairs Committee, added that while the program is based on altruism, it has strengthened U.S. security.

Without addressing the AIDS pandemic, she said, it "will continue to spread its mix of death, poverty and despondency that is further destabilizing governments and societies, and undermining the security of entire regions."

The compromise bill was one of the last endeavors of the former Foreign Affairs Committee chairman, Tom Lantos, D-Calif., who died of cancer in February. The measure is named after Lantos and his predecessor as Foreign Affairs chairman, the late Rep. Henry Hyde, R-Ill., who worked together on the 2003 act.

The Senate Foreign Relations Committee has approved a similar $50 billion bill, and the legislation is seen as having a good chance of passing in an election year in which few major bills will reach the president's desk.

To advance the legislation, conservatives had to give up a provision in the 2003 act requiring that one-third of all HIV prevention funds be spent on abstinence programs. Instead it directs the administration to promote "balanced funding for prevention activities" in target countries.

Liberals, in turn, had to accept some restrictions on family planning groups participating in AIDS programs. Conservatives, concerned that money might be diverted to abortion promotion, pushed for a provision that allows the use of funds for HIV/AIDS testing and counseling services in those family planning programs supported by the U.S. government.

By The Associated Press, www.365Gay.com

MEP's Campaign Against US Policy On HIV Travellers

April 4, 2008

London, England - Liberal Democrat MEP Baroness Sarah Ludford has launched an online campaign to end an American policy which effectively bars HIV positive people from entering the country.

Under current US immigration law, any foreign national who tests positive for HIV is "inadmissible," meaning he is barred from permanent residence and even short-term travel in the United States.

There are waivers available to this rule, but obtaining them has always been difficult.

The ban originates from 1987, when fear about the spread of the disease led US officials to require anyone with HIV to declare their status and apply for a special visa.

New regulations purport to speed up the waiver application process because consular officers would be empowered to make decisions on waiver applications without seeking Department of Homeland Security (DHS) sign off.

However, by using this "streamlined" application process, waiver applicants would have to agree to give up the ability to apply for any change in status while in the US, including applying for legal permanent residence.

Deborah Jack of the National AIDS Trust said: "People in the UK should no longer be subjected to discriminatory laws that restrict their travel to the US based on HIV status.

"Such a law only breeds stigma and discrimination."

Currently the EU is involved in visa negotiations with the US authorities to secure visa-free travel (visa waiver) for EU citizens from all of its 27 member states.

Baroness Ludford has called for action to use this opportunity to get genuine equality for all EU citizens including those with HIV or AIDS currently refused the right to travel freely across then Atlantic.

"The greater the number of people who support the call to end this unfair discrimination, the less the problem can be ignored by European policy-makers," she told PinkNews.co.uk.

"The persistence of the travel ban just feeds prejudice and ignorance.

"EU equalities laws will be meaningless if the Commission and Council fail to insist that the US treat all EU citizens fairly.

"They can only redeem their 15-year tolerance of this gross discrimination by taking a firm line in the new negotiations."

The United States is one of 13 countries in the world, including Iraq, Saudi Arabia, and Sudan, that bans travel for individuals who are HIV-positive.

In July 2007 the European Commission quietly approved an agreement which gives the DHS unprecedented access to the personal information of anyone on a transatlantic flight, including details of their sexual orientation.

The DHS insists on the right to use the information for disease control, and there are fears that gay passengers may be singled out as possible HIV risks.

The plans involve upgrading information which is already sent by airlines to the DHS on the 4-million-plus Britons who visit the US every year, including payment details, home address and the passengers in-flight meal choice.

The agreement adds 19 possible new categories, including information on ethnic origin, political and philosophical opinions, credit card numbers, trade union membership, sex life and details of the passengers' health.

The information will be provided by passengers when making bookings.

The US is not required to provide this information about its citizens.

By Tony Grew, http://www.pinknews.co.uk

Genetic Profile Governs Immune System Recovery on HAART

March 31, 2008

The speed and duration of immune system recovery after starting highly active antiretroviral therapy (HAART) appear to be governed by human genetic differences, raising the prospect that genetic testing may soon help to determine when to start treatment and drugs given specifically to influence the expression of genes that promote immune reconstitution.

The findings, published online on March 30th by Nature Medicine, are derived from a study of participants in a number of large US cohorts.

Two genes appear to be critical - CCR5, an HIV-1 co-receptor or portal of entry for the virus into CD4+ T cells, and CCL3L1, an HIV-suppressing molecule that binds to CCR5. Both are strongly implicated in HIV disease progression in untreated people.

The new study, led by Dr Sunil Ahuja, Professor of Medicine at the University of Texas in San Antonio, found a strong correlation between a genetic pattern associated with slower CD4 cell loss in untreated people and stronger CD4 cell gains after starting treatment, suggesting that these genes regulate the pathway determining the extent to which HIV damages the immune system.

Dr Mike McCune, chief of the Division of Experimental Medicine at the University of California, San Francisco, said the study has potentially important practical applications. "By showing that the same genetic makeup increases susceptibility to immune depletion and impaired immune recovery, the authors provide novel tools that may allow us to predict both those who will progress faster after HIV infection as well as those who might benefit from earlier initiation of HAART," he said.

The researchers categorised the copy number of the CCL3L1 gene and variations in the CCR5 gene into three groups designated as high, moderate and low genetic risk groups. Those with a higher level of the CCL3L1 gene and a CCR5 genotype not associated with fast disease progression were classified as low risk. This corresponds to a higher level of circulating CCL3L1 and less expression of the CCR5 receptor on CD4+ T-cells.

"Those HIV-positive persons categorised into the low genetic risk group did the best on HAART. In contrast, those categorised into the high genetic risk group initially did fine during the first two years of therapy, but then their immune reconstitution failed and their CD4 cell counts began to decline," Dr. Matthew Dolan of the Uniformed Services University, Bethesda, said.

The researchers also looked at the interaction between genetic profile and CD4 cell count at the time treatment started. In those who started treatment with a CD4 cell count below 350, even a genetic profile classified as `moderate` risk resulted in a diminished CD4 cell recovery rate.

Every 50-cell decrease in the CD4 level at which treatment was initiated resulted in a correspondingly poorer recovery rate in the `moderate` and `high risk` groups. The same was not true in those who started treatment at a CD4 count above 350.

"The current debate about when to initiate antiretroviral therapy might need to be redirected toward first assessing who should be considered for therapy, on the basis of the host genetic endowment," Dr. Ahuja commented.

Capt. Gregory Martin, programme director for the Infectious Diseases Clinical Research Program at the Uniformed Services University, said, "The finding that CCL3L1-CCR5 genetic makeup has its greatest impact on immune recovery when persons were started on therapy with CD4 counts of less than 350 cells/mm3 highlights the importance of starting persons on therapy earlier rather than later."

The CD4 cell restoration was more closely associated with number of copies of CCL3L1 than with CCR5 status. "This suggests that drugs that mimic or amplify the activity of CCL3L1 could be effective for HIV treatment," Dr. Dolan said.

Reference
Ahuja SK et al. CCL3L1-CCR5 genotype influences durability of immune recovery during antiretroviral therapy of HIV-1-infected individuals. Nature Medicine, advance online publication, March 30 2008.

By Keith Alcorn, www.aidsmap.com

TB Survival Mechanism Uncovered

April 1, 2008

Many tuberculosis bacteria shield themselves in protective fat, which may keep them safe as they pass from person to person, research shows.

The UK finding may eventually lead to new treatments for the disease, which currently requires a six-month course of antibiotics.

It may also shed light on why efforts to combat TB, are increasingly being undermined by drug resistance.

The study appears in the journal Public Library of Science Medicine.

TB kills two million people around the world each year, and efforts to combat the disease have been stymied by the fact that scientists know very little about the life cycle of the bacterium which causes it.

The bacterium which causes the disease is also mutating to neutralise current drug therapies.

Researchers at the University of Leicester and St Georges, University of London, analysed all the genes active in TB samples taken from infected patients.

The researchers found that, unlike TB bacteria growing in test tubes, many of the bugs in sputum are loaded with fat droplets.

They appear to be an inert, non-growing state, which might help them better to survive the adverse conditions they are likely to encounter during person-to-person transmission.

The discovery may explain why TB patients require a long course of treatment before they cease to pose an infection risk to others.

It had been thought that all bacteria contained in infected sputum was released from infected areas of the lungs, and while highly infectious, might also be vulnerable to attack by drugs.

Lead researcher Professor Barer said: "These surprising findings have opened the door for us to develop new ways to stop TB from spreading and to treat it more effectively.

"We hope that our new ability to monitor these sleepy and resistant bacteria in sputum will enable us to treat the disease more quickly."

Professor Philip Butcher, from St George's, said: "This work forms the foundation to develop a new drug that works effectively against these fat and lazy bacteria."

Dr John Moore-Gillon, of the British Lung Foundation, which co-funded the study, said: "This research helps us understand just why the TB bug is an extremely tough cookie built to survive.

"It adds to our knowledge of why TB bacteria are so difficult to eradicate from the body and why drug resistant strains develop."

Professor Peter Ormerod, a respiratory expert at Blackburn Royal Infirmary, agreed the research raised the prospect of new drugs which could combat TB more quickly.

He said some TB bacteria were already known to be latent, but they tended to remain in the body's tissues, often within specialised immune system cells, rather than be coughed out in the sputum.

http://news.bbc.co.uk

Evolutionary Accident Makes HIV Deadly

April 1, 2008

HIV may have "accidentally" evolved to become deadly, rather than benign, like similar viruses in monkeys, say researchers at a presentation at the General Microbiology’s 162nd Meeting today in Edinburgh, Scotland. These new data may help explain why HIV damages the immune system in most humans, whereas its close cousin, simian immunodeficiency virus (SIV), doesn’t harm most monkeys.

While most people would intuitively assume that an active immune system response to the virus is a good thing, researchers have actually shown that an overactive response in people with HIV causes great harm to the immune system. What remained unknown, however, was why human immune systems react so powerfully to HIV, when monkey immune systems barely respond to SIV.

Building on previous studies, researchers today presented data showing that differences in the viruses’ NEF proteins may explain this discrepancy. The NEF protein in both SIV and HIV helps the viruses evade detection by the immune system. SIV’s NEF protein, however, also removes a receptor called CD3 from the surface of T cells, which allows them to become active. HIV’s NEF protein does not remove this molecule, thus resulting in the hyperstimulation of the immune system and, eventually, its destruction.

The researchers stated that their next step is to genetically alter SIV in such a way that it makes NEF proteins that, like HIV, don’t remove CD3 receptors and see if this will cause SIV to become deadly in monkeys. Should those experiments confirm that NEF plays such a key role, it may be possible to develop treatments for HIV that play off the unique immune-dampening quality of SIV’s version of NEF.

http://www.poz.com

Spring Awakening: HIV, Allergies and Sinusitis

April 1, 2008

In much of the United States, spring is well underway. Though nature’s green glory is a welcome change, springtime can also bring misery to those of us susceptible to allergies. Those beautiful budding trees and blossoming flowers harbor a menace—pollen—that can condemn many of us to weeks of sneezing, runny noses, red eyes and, if we’re not vigilant, sinus infections.

Untreated allergies are one of the leading causes of sinus infections, or sinusitis. Though sinusitis is rarely a life-and-death matter—thanks to potent antiretrovirals that keep immune systems healthy and harmful bacteria from spreading—it does diminish the quality of life for large numbers of people.

Experts disagree about whether allergies and sinusitis are more common, have a worse course or need to be treated differently in people living with HIV. They all agree, however, that no one—HIV positive or negative—should suffer needlessly. Douglas Ward, MD, a longtime HIV treater from the Dupont Circle Physicians Group in Washington, DC, says, "[Sinusitis] is the No. 2 diagnosis [in my practice]."

For those with minor or brief seasonal allergies, a little information and over-the-counter (OTC) self-care will probably be sufficient. For those with more severe problems—such as fever, sinus pain or a bad cough—or those with respiratory diseases like asthma or chronic bronchitis, a health care provider’s care and guidance could mean the difference between enduring a short stretch of symptoms and never-ending days of head-splitting sinus pain, difficulty breathing and major discomfort. Ward says, "If you’re coughing up green phlegm, you’ve got an infection. Don’t think, ‘Oh, it’s just allergies.’ Get it looked at and treated."

Sinus Science

Our nasal sinuses are pockets of air-filled mucus membranes that are connected to the nose by small passages called ostia. Though scientists argue about their primary purpose, these hollow cavities protect our eyes and the roots of our teeth from rapid temperature fluctuations and help cushion our brains if suffering a blow to the face.

The air-filled nasal sinuses can become infected when clogged with mucus from allergies, leading to facial pain and pressure, nasal blockage, greenish-yellow discharge and sometimes fever.

But the ostia are easily clogged by mucus in our noses and the swelling of the mucus membranes caused by allergies or cold and flu viruses. According to Rona Vail, MD, an HIV specialist at Callen-Lorde Community Health Center in New York City, when the ostia become clogged, "The mucus just sits there without the ability to drain and then the bacteria, or fungus or [viruses trapped in the sinuses] multiply and end up causing a problem."

Vail says that there’s some controversy among primary care physicians about whether sinusitis is over treated, particularly with antibiotics, and so they’ve developed criteria to properly diagnose it. She says, "The kind of symptoms that [doctors look for] are facial pain and pressure, nasal blockage…and also nasal discharge that is greenish-yellowish, loss of smell sometimes, and fever…. Other things that people [experience] are headaches, bad breath, pain in the teeth, sometimes pain in the ears."

Before the era of combination antiretroviral (ARV) treatment began in 1996, sinusitis was a serious problem. Chronic sinusitis, lasting 12 weeks or more, or recurrent sinusitis, was all too common. Though ARV therapy preserves many people’s immune systems, protecting them from the most severe and lingering forms of sinusitis, expert opinion is mixed about whether sinusitis remains worse or more common among people living with HIV.

Vail and Ward say that sinusitis is about equally common in their HIV-positive and HIV-negative patients. Antonio Urbina, MD, medical director of HIV/AIDS education and training at St. Vincent Catholic Medical Center in New York City, on the other hand says that the incidence of sinusitis "is still higher [in people with HIV] than persons who are HIV negative, but less now in the era of [ARV therapy]."

Whether or not sinusitis is more common in people with HIV, all support treating its underlying causes. To guard against cold and influenza virus infections, experts recommend that people get their flu shot each year and wash their hands thoroughly many times throughout the day. For allergies, Vail and Urbina recommend a combination approach that may include steroid-based nasal inhalants and oral antihistamines and decongestants. The steroids and the antihistamines calm down the immune system’s response to whatever you may be allergic to. The decongestants simply block the production of mucus.

People with asthma or other obstructive respiratory problems, such as emphysema or chronic bronchitis, should also monitor their allergy symptoms with the help of a health care provider, as seasonal allergies can sometimes trigger serious flare-ups of these diseases.

Why Call My MD When There’s OTC?

It’s hard to say whether people living with HIV are better than their HIV-negative peers about turning to a health care provider when allergies or sinus infections arise. Some may be concerned that their allergy symptoms are HIV med side effects or signs of an AIDS-defining opportunistic infection, prompting a call to their doctors. Others, however, may feel silly calling their doctor about sniffles, sneezes and wheezes while undergoing care for a potentially life-threatening disease like HIV.

One reason to consult a health care professional about allergies is to pick and choose OTC medications wisely.

Another reason to seek professional guidance is when allergies may have possibly crossed the line into sinusitis. Though Urbina says that many sources of sinus infections are viral, bacteria can also cause them, and prescription antibiotics are often used to treat bacterial sinus infections. Catching infections early often results in a faster recovery and less time feeling ill. Vail cautions, however, that "antibiotics are great for the initial relief of the infection and the pain, but they’re not enough."

Vail is an advocate of a do-it-yourself method that’s low cost—saline nasal irrigation. She admits that "people often don’t want to do it, because it gets kind of messy. You know, irrigating saline up your own nose," but says, "It’s actually pretty easy to get used to and incredibly effective."


Nasal irrigation, with a properly mixed warm saline solution, doesn’t burn. In a Neti Pot (pictured above), or rubber ear syringe, mix 1⁄2 teaspoon kosher salt with 8 ounces of warm water (first timers may wish to reduce salt and water amounts by half). Lean over the sink—or stand in the shower—and rotate your head to the side so that one nostril is directly above the other, with your forehead remaining level with the chin, or slightly higher. Gently insert the Neti Pot spout into the upper nostril, forming a comfortable seal. Keep your mouth open and raise the handle of the Neti Pot, so that the solution enters the upper nostril and drains out through the lower. Repeat with another 4- to 8-ounce saline mix in the other nostril. 

Other OTC options include nasal sprays, although Vail warns against the use of brands that contain oxymetazoline hydrochloride (found in Afrin, Zicam, etc.). She uses the word addiction to describe some people’s attachment to these nasal sprays, explaining, "I know why people get hooked on Afrin, because they immediately feel better. But in the long run it causes rebound inflammation and swelling and the problem just gets worse and worse."

Antihistamines, which include over-the-counter drugs like Benadryl (diphenhydramine), Claritin (loratadine) and most recently Zyrtec (cetirizine), may be used regularly throughout a bout with allergies. About decongestants, which include pseudoephedrine (Contac Non-Drowsy, Sudafed, etc.) and phenylephrine (Sudafed PE), Vail says, "[They] are fine for short-term use, just for symptom relief."

Prescription options, such as inhaled corticosteroids like Nasarel (flunisolide) and Nasonex (mometasone), can be particularly effective if people start using them at the first sign of symptoms, as the drugs can take a while to start working. People with HIV should beware, however, of potential interactions between many HIV drugs and the corticosteroid fluticasone (found in Advair, Flovent or Flonase). Norvir (ritonavir), especially, can substantially raise blood levels of fluticasone, leading to an increased risk of Cushing’s syndrome, an endocrine disorder that can result in obesity, water retention and puffiness, diabetes, high blood pressure, thin skin, aches and pains, and mood swings. 

Immunotherapy: Hope For Long-Term Allergy Relief

Another allergy remedy that can work when allergies are persistent and don’t respond well to other treatments is allergy desensitization immunotherapy, also known as allergy shots. Desensitization involves injecting a person with small but increasing amounts of the substance they are allergic to, known as an allergen, so that the immune system develops a tolerance for that specific allergen. When it works well, some people are able to do away with a daily regimen of pills and inhalers, and even when a person can’t stop allergy meds altogether, they often find they have to take them less often.

When it comes to desensitization for people living with HIV, official recommendations and actual practice are not necessarily in agreement. According to Roger Emert, MD, a specialist in allergies and immunology from the Weill Cornell Medical School of New York Presbyterian Hospital, "The recommendations from the American Academy of Allergy, Asthma and Immunology are that if someone is HIV positive they should not get allergy desensitization immunotherapy."

Recommendations like these were often issued when having HIV almost invariably meant having AIDS and a compromised immune system. Aside from the fact that desensitization probably wouldn’t work as well in people with CD4 cells in the single digits, experts feared it could also do harm. Times have changed, however, and now plenty of people have good CD4 counts and undetectable virus. Emert is willing to buck the official recommendations for these individuals. He says, "I have done [desensitization] with HIV-positive patients successfully without any problems. If your HIV viral load is undetectable, there’s no reason that I know of that it would adversely affect the immune system."

Still, people wishing to undergo allergy desensitization should probably ensure that their primary HIV care provider work closely with the allergy specialist to guard against any problems.

If treated early and appropriately, allergies can be reduced to a mere nuisance. If left untreated or mistreated, however, minor symptoms can literally turn into a major headache. And while everyone else is outside enjoying the sunny days of springtime, you may find yourself in bed with sinusitis, too sick to smell the flowers.

Image sources: (sinuses) A.D.A.M., Inc., (Neti Pot) himalayainstitute.org

By David Evans, http://www.aidsmeds.com

GSK Says Its Abacavir Trials Show No Heart Attack Risk

April 2, 2008

GlaxoSmithKline – the manufacturer of abacavir (Ziagen) – says its own data on the drug show no suggestion of any increased risk of myocardial infarction (heart attack), in contrast to findings from a recent large international cohort study.

The data have received advance online publication as a letter on The Lancet website - alongside the D:A:D study (Data Collection on Adverse Events of Anti-HIV Drugs), and will appear in a future edition of The Lancet.

That study suggest abacavir increases the risk of MI by 90% and didanosine (Videx) by 49% and was presented in February 2008 at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston and reported here

The findings were unexpected - although the increased risk due to both abacavir and didanosine disappeared within six months of the drugs being discontinued, and no similar effect was seen with the other drugs studied in D:A:D – zidovudine (AZT) and stavudine (Zerit).

The letter from GSK says its own analysis of data pooled from 54 clinical trials did not suggest an increased risk of MI with abacavir.

Dr Didier Lapierre from GSK said: "We did not find a result consistent with that of D:A:D. Nonetheless GSK takes the D:A:D finding seriously and is committed to understanding these data more fully and to communicating openly with treating physicians and regulatory agencies globally."

But GSK’s analysis has come in for criticism in an accompanying Lancet editorial, written by cardiologist Dr James Stein of the University of Wisconsin School of Medicine and Public Health and HIV physician researcher Dr Judith Currier of the University of California David Geffen School of Medicine.

They say the findings from D:A:D were observational – that is the trial was not designed to specifically look at this effect – and should therefore be treated with caution.

But the magnitude of the effect among those people at highest risk of heart disease is so great it cannot be ignored, they insist.

‘In these individuals – about 6% of the D:A:D cohort – one additional MI would be expected for every 11 treated with abacavir or every 20 treated with didanosine for five years,’ they say.

‘On [this] basis, alternatives to abacavir and didanosine in high-risk patients should be considered [but] the decision to switch antiretroviral therapy must be made cautiously.’

Those deemed at high risk would be those with high cholesterol or blood pressure, diabetes, smokers or those with a family history of heart disease.

Commenting on GSK’s analysis they say: "Although the low overall rates of MI are somewhat reassuring [the] analysis is not powered to detect meaningful differences.

‘It was based on only 18 MIs and the limitations of summaries of pooled data for uncommon events in studies not designed to detect them are well known."

They add that any available data on heart disease from antiretroviral clinical trials should be submitted for peer review so the trial design and analysis can be described in detail and their conclusions fully interpreted.

Reference
D:A:D study group. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. The Lancet. Published online 2nd April 2008.

Stein JH and Currier JS. Risk of myocardial infarction and nucleoside analogues. The Lancet. Published online 2nd April 2008.

Cutrell A et al. Abacavir and the potential risk of myocardial infarction. The Lancet. Published online 2nd April 2008.

By Adam Legge, www.aidsmap.com

Even Failing Treatment Reduces HIV in the Brain

April 2, 2008

Despite having similar levels of HIV in the blood, people who continue taking a failing antiretroviral (ARV) regimen have lower levels of HIV and reduced immune activation in the brain compared with people not on treatment, according to a study published in the April 15 issue of the Journal of Acquired Immune Deficiency Syndromes. This is potentially good news for people who may be at risk for HIV-related brain disorders like AIDS dementia complex (ADC).

To protect the central nervous system, our bodies have a series of membranes—called the blood-brain barrier (BBB)—that filter blood and fluids entering the brain and cerebrospinal fluid (CSF) from the rest of the body. Scientists have noted that HIV replication sometimes differs between the blood and distinct compartments like the brain or the genital tract. It is also clear that, in addition to directly infecting and killing CD4 cells, HIV causes damage to the immune system by causing it to be in a chronically activated state. Because of this, and the fact that not all HIV drugs make it through the BBB, there has been concern that HIV replication and immune activation may be worse in the brain than in the blood, potentially leaving HIV-positive people on ARV therapy for ADC and other cognitive disorders.

Elizabeth Sinclair, PhD, of the University of California San Francisco, and her colleagues examined the results of HIV viral load tests and immune cell tests in the blood and CSF of 123 people with HIV and 14 HIV-negative volunteers. The study participants were similar in terms of age and gender and none had any evidence of neurological diseases. Sinclair’s team divided the HIV-positive patients into three groups: The first group included people not taking antiretrovirals, called "offs"; the second group included people taking antiretrovirals, but with virus levels over 500 copies, called "failures"; and the third group included people taking antiretrovirals with virus levels below 500 copies, called "successes."

Though the offs and failures had similar levels of HIV in blood, levels of HIV in the CSF were significantly lower in the failures than the offs. When Sinclair’s team looked for signs of immune activation, specifically the presence of a CD38 receptor on the surface CD8 immune cells, they found that remaining on a failing regimen reduced the amount of activation in both the blood and the brain. The offs had activation levels in both blood and CSF that were roughly double that of the HIV negatives. Immune activation was significantly lower in the failures and lower still in the successes. As would be expected, the HIV-negative group had the lowest levels of immune activation of all the groups.

Sinclair and her team conclude that while the results of their study are promising, similar research should be carried out in people with varying levels of neurological impairment to determine how much of a role immune activation and HIV levels in CSF play in brain disorders.

http://www.poz.com

Immune Response in Genital Tract May Explain Why Some Exposed Women Not Infected with HIV

April 3, 2008

Women who are repeatedly exposed to HIV but do not become infected may be protected by HIV antibody and virus-specific cellular responses produced in their genital tract, say the authors of a study in Kenyan sex workers published in the March 30th edition of AIDS. The study’s authors are hopeful that their finding may help in the search for an HIV vaccine.

The researchers studied women who had taken part in a trial from 1998 to 2002 in which high-risk Kenyan female sex workers were given monthly antibiotics (Kaul, 2004). In that trial, the antibiotic reduced the risk of a sexually transmitted infection, but not of infection with HIV.

After the trial finished, 24 women who had become infected with HIV were matched with 89 women who had remained HIV-negative despite repeated exposure to the virus. The researchers studied cervicovaginal secretions (CVS) in both groups of women.

Crucially, the samples were taken at the beginning of the original trial, allowing the researchers to see if there were any protective factors present at the start.

They found that highly exposed, persistently negative (HEPS) women were far more likely to have vaginal secretions containing a type of antibody called immunoglobulin A (IgA) that was active against HIV.

These women were also more likely to have evidence of HIV-specific T-cell proliferation in their cervicovaginal tract than those who had become infected with HIV.

Several potential immune defences have been described in HEPS individuals, including HIV-specific CD8+ and CD4+ T cells, CD8+ antiviral factors and HIV neutralising IgA.

But this is study is the first to show an association between reduced HIV transmission and prior detection of both genital HIV-neutralising IgA and HIV-specific cellular proliferation.

In fact, HIV acquisition was lowest in those women with both these immune responses present at the start of the study- suggesting the responses have an additive effect.

The HIV-neutralising activity was more common against certain HIV-1 types – termed clades – than others in this study. Activity was more common against clade C than clade A – even though clade A is the most common in Kenya.

But the authors say different HIV isolates vary hugely in how sensitive they are to neutralisation. Therefore a much broader panel of clade A and C isolates would need to be tested before firm conclusions could be drawn.

They add that they cannot prove that these immune responses were the reason women did not become infected but that these data suggest the induction of these responses could be an important target for HIV vaccine development.

Reference

Hirbod TY et al. HIV-neutralizing immunoglobulin A and HIV-specific proliferation are independently associated with reduced HIV acquisition in Kenyan sex workers. AIDS 22: 727-735, 2008.

Kaul R et al. Monthly antibiotics chemoprophylaxis and incidence of sexually transmitted infections and HIV-1 infection in Kenyan sex workers: a randomized controlled trial. JAMA 291: 2555-2562, 2004.

By Adam Legge, www.aidsmap.com

New HIV/AIDS Vaccine Phase 1 Trial Begins In Boston

April 4, 2008  

A phase 1 clinical trial to test a novel HIV/AIDS vaccine has begun at Brigham and Women's Hospital (BWH). This new vaccine aims to overcome the problem of preexisting immunity to common vaccine vectors, which is thought to be a major problem in the developing world.

"This study will involve 48 healthy volunteers who will receive either two or three immunizations and who will be followed to assess the safety and immunogenicity of the vaccine," explains Lindsey R. Baden, MD, Assistant Professor of Medicine at BWH and Harvard Medical School and Protocol Chair for the study.

The vaccine consists of a replication-incompetent, recombinant adenovirus serotype 26 (rAd26) vector encoding an HIV-1 envelope gene.

"The rAd26 vaccine vector was selected for its particularly low seroprevalence in human populations and for its potent immunogenicity and protective efficacy in preclinical studies," explains Dan H. Barouch, MD, PhD, Associate Professor of Medicine at Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School and Principal Investigator of the Integrated Preclinical/Clinical AIDS Vaccine Development (IPCAVD) program that developed the vaccine. This program is sponsored by the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health.

Manufactured by the Dutch biotechnology company Crucell Holland BV, the rAd26 vaccine is the first HIV-1 vaccine candidate to emerge from the IPCAVD initiative, which brings together investigators from academia and industry in an effort to accelerate the development of promising HIV/AIDS vaccine candidates. The novel strategy used in developing this vaccine enables researchers to circumvent preexisting immunity to the adenovirus serotype 5, the virus responsible for the common cold, which has recently shown limitations as an HIV-1 vaccine vector.

"The rAd26 vector does not regularly occur in the human population and human antibodies to this vector are rare," explains Jaap Goudsmit, Chief Scientific Officer at Crucell. "The rAd26 vector therefore is efficacious in eliciting good T and B cell responses."

AIDS remains one of the world's most devastating health problems, with an estimated 33.2 million people living with HIV/AIDS and 2.5 million new infections reported in 2007 alone.

Article adapted by Medical News Today from original press release.

Superbug Detection Technique Found

April, 4, 2008

Scientists have discovered a technique for the early detection of a deadly superbug.

A research team, led by the University of Sunderland, has announced that it has found a way of detecting the potentially fatal bacterium pseudomonas aeruginosa within 24 to 48 hours of infection.

Patients with cystic fibrosis are particularly susceptible to the infection, but patients with immune defects are also at risk, such as those with Aids, cancer or severe burns.

According to the Centre for Disease Control and Prevention in the USA, pseudomonas aeruginosa accounts for 10.1% of all hospital infections.

The superbug is highly resistant to antibiotics, making it difficult to cure, but the scientists said early detection greatly increases a patient's chances of survival.

Professor Paul Groundwater, who led the research, said: "This superbug has a massive impact on people who are immunocompromised, for example patients with severe burns, cancer and AIDS.

"It is calculated that 28% of people who have undergone transplant surgery are infected by pseudomonas aeruginosa. We hope our research will make a big difference in the survival rate of many thousands of vulnerable people throughout the world.

"The bacteria infect the fluid on the lungs of cystic fibrosis sufferers. It also infects patients in intensive care units. It is really difficult to treat, and hospital staff need to know very quickly if someone has been infected by it."

Prof Groundwater explained that with their new diagnostic method, a non-coloured compound reacts with an enzyme in pseudomonas aeruginosa, which then produces a very distinctive purple colour to indicate the presence of the bacteria.

PA News, www.cdc.gov

Measles Virus Slows Progression of HIV Infection

April 3, 2008

HIV/AIDS is one of the most pressing public health concerns today. Hopkins researchers have made a potentially important and surprising advance in the treatment of the disease. They found that the virus that causes measles could reduce the effects of HIV.

The group, led by William Moss from the Bloomberg School of Public Health, studied the effects of the measles virus on HIV-infected cells. Measles, a viral disease like AIDS, used to be a major problem until the late 20th century when a vaccine was discovered.

Measles is now almost eradicated in the developed world, but continues to be a major cause of death in underdeveloped areas.

Moss's group found that the measles virus blocks the proliferation or production of white blood cells, which host the HIV virus in the bloodstream.

When HIV enters the body, it finds shelter in CD+4 cells, a specific type of white blood cells, in the lymph tissue. Lymph is responsible for keeping the body clean and defending it against pathogens. HIV/AIDS is deadly because it kills white blood cells, leaving the body vulnerable to infection.

Without the antibodies produced by the body to counter the invasion, a small infection can get out of hand and kill the host.

The measles virus also infects lymph tissue once it enters the body. The virus kills cells by fusing multiple cells together.

Measles causes rashes, severe cold-like symptoms and sometimes diarrhea. If no other complications arise, the disease will run a two-week course, by which time the body will have caught up and treated itself.

In this study, it was found that a cell once infected by the measles virus will have a sort of immunity to the HIV: The virus can enter the cell, but its multiplication is blocked.

Three types of cells were studied: CD+4 cells infected with measles virus only, cells infected with HIV only and cells co-infected with both viruses. The cell cultures were prepared for two different analyses that measured protein levels and the production of RNA, the genetic material used by the HIV virus.

RNA is an effective indicator of the growth of the viruses in the cells because both the measles virus and HIV are retroviruses, meaning they use RNA to transmit genetic information into their hosts' cells, rather than DNA.

It was found that in cells that were infected with the measles virus first, and then with HIV, reproduction of HIV was blocked. The measles virus induces white blood cells to produce proteins that restrict lymphoproliferation, or the reproduction of infected lymphatic cells. The virus did not cause cells to die, but simply prevented cell growth.

The same phenomenon was noticed in HIV-infected cells that were infused with the measles virus later. Possible mechanistic pathways were investigated to determine the reason for this phenomenon.

It was concluded that the measles virus hinders RNA synthesis in HIV-infected cells, and it reduces levels of a critical class of proteins required for the rapid cell replication typical of HIV-infected cells.

The practical application of this experiment is clear and crucial: A method to prevent HIV/AIDS could be devised from these findings.

Infecting a person with measles is out of the question, but a new type of vaccine could be created that would give immunity to measles as well as HIV.

The researchers are already well underway with further research, exploring other interactions of the HIV virus.

By Apurva Yeluru, http://www.jhunewsletter.com