Category Archives: Uncategorized

Time for Australia to catch up – Health workers with HIV cleared for dental and surgical work

It’s time for Australia to review its protocols once again and come inline with worlds best practice. C’mon Australasian Society of HIV Medicine continue to drive the change to scientific best practice.

UK health care workers with HIV to be cleared for dental and surgical work

Health care workers on treatment, with undetectable viral load, will carry out `exposure-prone` procedures

Keith Alcorn
Published: 15 August 2013

Health care workers in the United Kingdom living with HIV will be permitted to carry out exposure-prone surgical and dental procedures from April 2014, the Department of Health announced today, if they are on antiretroviral treatment, receive regular medical monitoring and have an undetectable viral load.

The decision follows a public consultation in 2012 and a review of the evidence by the Expert Advisory Group on AIDS.

An exposure-prone procedure is any medical or dental procedure which carries a risk of injury to the health care worker that might result in bleeding into the patient’s open tissues. These might occur in surgery, dentistry and during obstetric and gynaecological procedures.

HIV testing is compulsory for all health care workers who carry out exposure-prone procedures, and previous regulations banned any HIV-positive health care worker from carrying out these procedures. This is despite extremely limited evidence of transmission from health care workers to patients.

The recent consultation and review of the policy concluded that the risk of transmission from health care workers during exposure-prone procedures was extremely low.

Based both on the lack of evidence of transmission and the accumulating evidence regarding the lack of onward transmission in people with fully suppressed viral load, the Department of Health has recommended a new procedure that will allow health care workers with HIV to practice while protecting patient safety.

  • All health care workers with HIV who wish to practice exposure-prone procedures should be notified by occupational health physicians to the UK Advisory Panel for Healthcare Workers Infected with Blood-Borne Viruses (UKAP) for the first two years after revision of the guidance.
  • Health care workers should be on antiretroviral therapy, have viral load below 50 copies/ml (undetectable) and undergo three-monthly viral load testing.
  • If viral load is below 50 copies/ml health care workers may continue to practice exposure-prone procedures.
  • If viral load is between 50 copies/ml and 200 copies/ml re-testing should be carried out and the case should be reviewed on an individual basis if viral load is found to be between 50 copies/ml and 200 copies/ml.
  • Review of safety to practice will be carried out by the patient’s treating physician and occupational health physician.
  • If viral load is above 200 copies/ml the health care workers should cease to practice exposure-prone procedures until viral load falls below 200 copies/ml again.

Formal guidance for the NHS on implementation is being prepared by Public Health England.

“Today’s announcement brings England into line with nations including Sweden, France, Canada and New Zealand, and is good news for patients and HIV-positive dentists alike. We look forward to seeing its implementation,” said Professor Damien Walmesley, scientific advisor to the British Dental Association.

http://www.aidsmap.com/UK-health-care-workers-with-HIV-to-be-cleared-for-dental-and-surgical-work/page/2731599/

Time To Scale Up Stem-cell Therapy

 

It appears that we now have a cure for HIV (yipeee!!!!), which at this stage requires further research so that its not so toxic that it kills people on the way (either through the chemo or graft versus host disease), and scaled up so that it becomes affordable and sustainable to perform for many. Very excited at how close we now are :-).
Four people have now been cured of HIV, the “Berlin Patient”, “Mississippi Baby” and the “Boston Two” described below. I am very hopeful we are at the beginning of the end for HIV. Below an article posted by the ABC

 

Bone marrow stem-cell therapy appears to have eradicated HIV in two patients

 

Updated Thu Jul 4, 2013 1:17pm AEST

 

American doctors have revealed that two patients appear to have become HIV-free after having bone marrow stem cell transplants to treat cancer.

Both patients, who were treated in Boston and had been on long-term drug therapy to control HIV, received stem-cell transplants after developing lymphoma, a type of blood cancer.

Timothy Henrich from the Harvard Medical School says doctors have been unable to find any evidence of the HIV infection in the men since the transplants.

Dr Henrich, who made the announcement at an international AIDS Society conference in Kuala Lumpur, said it is too early to say for sure that the virus has disappeared from their bodies altogether.

 

However, he reported that one patient has now been off antiretroviral drug treatment for 15 weeks and the other for seven weeks.

 

Dr Henrich first reported last July that the two men had undetectable levels of HIV in their blood after their stem-cell treatment, but at that time they were still taking medicines to suppress HIV.

“Dr Henrich is charting new territory in HIV eradication research,” said Kevin Robert Frost, the chief executive officer of the Foundation for AIDS Research, which funded the study

The revelation has raised hopes for a cure of the virus, which infects about 34 million people worldwide, but experts in the field are urging caution until more work is done.

Using stem-cell therapy is not seen as a viable option for widespread use, since it is extremely expensive, but the latest cases could open new avenues for fighting the disease.

The latest cases resemble that of Timothy Ray Brown, known as “the Berlin patient”, who became the first person to be cured of HIV after receiving a bone marrow transplant for leukaemia in 2007. There are, however, important differences between the cases.

While Mr Brown’s doctor used stem cells from a donor with a rare genetic mutation, known as CCR5 delta 32, which renders people virtually resistant to HIV, the two Boston patients received cells without this mutation.

Scientific advances since HIV was first discovered more than 30 years ago mean the virus is no longer a death sentence and the latest antiretroviral AIDS drugs can control the virus for decades.

But many people do not get therapy early enough, prompting the World Health Organisation to call for faster roll-out of medicines after patients test positive.

In the meantime, Australian scientists said they are optimistic they have discovered a way for millions more people to get access to crucial antiretroviral drugs.

They have found a lower daily dose of one drug is just as effective, yet far cheaper, than the current dosage.

Danish Breakthrough for HIV cure expected ‘within months’

The story was published by The Sydney Morning Hearld , it was also published by many others. I believe that the Danes are on the right track. Finding a way to release/flush out the hidden reservoirs (insert HDAC inhibitors) of HIV from our DNA and then having other drugs or our own boosted immune system (or a combination of both) eliminate them/inhibit future replication, sounds like a strong plausible basis for a cure. Wearing my optimists hat, I wish the Danish researchers and their collaborators speed and efficiency in their endeavor.

After posting this page I received some valid criticism from Gus Cains re hype. The original article has been resubmitted   Scientists’ hope for HIV cure

Below the original article.

Danish breakthrough for HIV cure expected ‘within months’

Jake Wallis-Simons
Published: April 29, 2013 – 3:00AM

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A breakthrough in the search for a cure for HIV will come ”within months”, researchers believe.

Danish scientists are expecting results showing that it will be possible to find a cure that is both affordable and can be provided to a large number of people.

They are running clinical trials to test a ”novel strategy” in which the HIV virus, which causes AIDS, is stripped from human DNA and destroyed by the immune system.

It has already been found to work in laboratory tests and the scientists are now running human trials.

The technique involves releasing the HIV virus from ”reservoirs” it forms in DNA cells, bringing it to the surface of the cells. Once it comes to the surface, the body’s immune system can kill the virus through being boosted by a ”vaccine”.

In vitro studies – those that use human cells in a laboratory – of the new technique proved so successful that in January the Danish Research Council awarded the team 12 million kroner ($2 million) to pursue clinical trials with human subjects.

Ole Sogaard, a senior researcher at the Aarhus University Hospital in Denmark who is leading the study, said: ”I am almost certain we will be successful in releasing the reservoirs of HIV.

”The challenge will be getting the immune system to recognise the virus and destroy it. This depends on the strength and sensitivity of individual immune systems.”

Fifteen patients are taking part in the trials, and if they are found to have been cured of HIV, the process will be tested on a wider scale.

The technique uses drugs called HDAC inhibitors, more commonly employed in treating cancer.

It is also being researched in Britain, but studies have not yet moved on to the clinical trial stage.

Telegraph, London

This story was found at: http://www.smh.com.au/national/health/danish-breakthrough-for-hiv-cure-expected-within-months-20130428-2imnp.htm

For some more hope read the article below

University of Minnesota doctors try to cure boy of HIV, cancer in risky operation

HIV is not a crime!

Congratulations to AIDS ACTION NOW, for showing us what active advocacy can look like. I have reproduced their article below. Applying pressure onto Doctors may well become a winning strategy for finally overcoming the inappropriate criminalisation of HIV in 2013.

HIV is not a crime! Accountability demanded for scientists who provide ‘expert’ testimony supporting HIV criminalization

Could clearing HIV from its hiding place, make way for a cure?

Potential New Treatment for HIV, staff writers at the Star Observer, report on a trial, BIT225, conducted by Biotron limited. The potential new agent is reported to treat HIV infection hidden in reservoir precursor cells. I found this article to be exciting. Imagine if in the near future they are able to combine several agents to eliminate HIV hiding in the body. As an optimist again we are another step closer to a cure. 🙂

Could successfully suppressed HIV viral load be a defence against HIV criminalisation?

The HIV Justice Network reported on the German National AIDS Council production of a consensus statement on HIV criminalisation while having consensual sex. I liked the article, so I’ve decided to copy it to my blog.

Germany: National AIDS Council releases powerful policy statement on HIV criminalisation

March 13, 2013

The German National AIDS Council – an independent advisory body of the Ministry of Health consisting of experts from the fields of research, medical care, public health services, ethics, law, social sciences, as well as people from the civil society – has produced a consensus statement on HIV criminalisation during consensual sex.

A press release issued yesterday by the Federal Ministry of Health states (unnofficial translation from German)

HIV infection has become a treatable chronic disease. In Germany, life expectancy with appropriate medical care is nearly normal. However, people with HIV still experience limitations, especially in everyday social life. They are often stigmatised and discriminated against in both the workplace and in the home environment. Criminal court judgments and their public perception play in a crucial role in this context.

  1. The National AIDS Council points out that the following medical factors should be assessed in criminal proceedings: HIV is difficult infection to transmit compared to other sexually transmitted diseases. The transmissibility of HIV is primarily related to viral load. In the first weeks after infection this is particularly high, and can amount to several million viral copies per milliliter of blood. After a few weeks or months, however, the immune system, usually controls the infection. Once viral load drops the body can keep viral load low for months or years before medication needs to be taken. During this time, the risk of infection is much lower than in the early phase of infection. Once the immune system weakens, generally antiretroviral therapy commences. With effective treatment, the viral load falls below the detection limit (viral load less than 50 viral copies / ml blood). If viral replication is permanently suppressed completely, according to current medical knowledge, HIV is not sexually transmitted. The risk reduction of successful antiretroviral therapy is at least comparable to the correct use of condoms. It is assumed that a large proportion of HIV transmission takes place during the early stages of HIV infection, i.e. at a time, when those who are infected are not aware of their infection, because an HIV antibody test can only show infection after a few weeks.
  2. Against this background, the National AIDS Council emphasisesA criminal examination of HIV exposure or transmission related to consensual sexual intercourse must be consistent with the medical facts. The decision whether or not the criminal liability of onward transmission can be assigned to the person with HIV cannot be made as a matter of routine. In fact, the determining factor are the circumstances of each individual case, especially the legitimate expectations of both sexual partners. In any case, in a short-term, consensual sexual encounter both partners are responsible for the application of protective measures, regardless of the knowledge or the acceptance of one’s own status and the status of the other person. Attributing either partner as perpetrator or victim is not appropriate.
    Criminal proceedings regarding the transmission of HIV from consensual sexual intercourse do not contribute to HIV prevention. They can even be counterproductive in terms of the willingness of an individual to take an HIV test and in terms of open communication of sexual partners. In contrast, it is in the interest of the individual and society to increase willingness to take an HIV test.”

The evidence continues to accumulate

The study from Uganda below continues to build the strong evidence that people successfully on HIV treatments are in the translated words of the Swiss “non-infectious” (Search Swiss Statement for caveats and conditions).

Couples study in Uganda finds no HIV infections from partners on antiretroviral therapy.

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