Friday, March 29, 2013

Researchers Identify New Approach for an Effective HIV Vaccine Read more: Researchers Identify New Approach for an Effective HIV Vaccine | Medindia http://www.medindia.net/news/researchers-identify-new-approach-for-an-effective-hiv-vaccine-




Researchers Identify New Approach for an Effective HIV Vaccine





American researchers have come up with a new approach to vaccine design that could help them overcome the difficulties faced in developing an effective HIV vaccine due to the rapidly changing structure of the HIV virus.


 Researchers Identify New Approach for an Effective HIV Vaccine


Now, a researcher team led by an Indian origin scientist has developed a new approach to vaccine design that may allow them to cut off those evolutionary escape routes. 

The researchers from the Ragon Institute of MGH, MIT and Harvard University have developed and experimentally validated a computational method that can analyze viral protein sequences to determine how well different viral strains can reproduce in the body. That knowledge gives researchers an unprecedented guide for identifying viral vulnerabilities that could be exploited to design successful vaccine targets. 

The team, led by Arup Chakraborty, the Robert T. Haslam Professor of Chemical Engineering, Chemistry, Physics and Biological Engineering at MIT, has designed protein fragments (peptides) that would target these weaknesses. 

Ragon Institute researchers are now developing ways to deliver the peptides so they can be tested in animals. 

"We think that, if it continues to be validated against laboratory and clinical data, this method could be quite useful for rational design of the active component of a vaccine for diverse viruses. Furthermore, if delivered properly, the peptides we have designed may be able to mount potent responses against HIV across a population," said Chakraborty, who is also the director of MIT's Institute for Medical Engineering and Science. 

Typically when a vaccine for a disease such as smallpox or polio is given, exposure to viral fragments primes the body's immune system to respond powerfully if it encounters the real virus. With HIV, it appears that when immune cells in a vaccinated person attack viral peptides that they recognize, the virus quickly mutates its protein sequences so immune cells no longer recognize them. 

To overcome this, scientists have tried analyzing viral proteins to find amino acids that don't often mutate, which would suggest that they are critical to the virus's survival. However, this approach ignores the fact that mutations elsewhere in the protein can compensate when those seemingly critical amino acids are forced to evolve, Chakraborty said. 

The Ragon Institute team focused on defining how the virus's ability to survive depends on the sequences of its proteins, if they have multiple mutations. This knowledge could enable identification of combinations of amino acid mutations that are harmful to the virus. Vaccines that target those amino acids would force the virus to make mutations that weaken it. 

With existing HIV protein sequence data as input, the researchers created a computer model that can predict the fitness of any possible sequence, enabling prediction of how specific mutations would affect the virus. 

In their study, the researchers focused on an HIV polyprotein called Gag, which is made up of several proteins that together are 500 amino acids long. The proteins derived from Gag are important structural elements of the virus. For example, a protein called p24 makes up the capsid that surrounds the virus's genetic material. 

Each position in HIV proteins can be occupied by one of 20 possible amino acids. Sequence data from thousands of different HIV strains contain information on the likelihood of mutations at each position and each pair of positions, as well as for triplets and larger groups. The researchers then developed a computer model based on spin glass models, originally developed in physics, to translate this information into predictions for the prevalence of any mutant. 

Using this model, the researchers can enter any possible sequence of Gag proteins and determine how prevalent it will be. That prevalence correlates with the fitness of a virus carrying that particular protein sequence, a relationship that the researchers demonstrated by using the model to predict the fitness of a few dozen Gag protein sequences, and verified by engineering those sequences into HIV viruses and testing their ability to replicate in cells grown in the lab. They also tested their predictions against human clinical data. 

The model also allows the researchers to visualize viral fitness using "fitness landscapes" - topographical maps that show how fit the virus is for different possible amino-acid sequences for the Gag proteins. In these landscapes, each hill represents sequences that are very fit; valleys represent sequences that are not. 

Ideally, vaccine-induced immune responses would target viral proteins in such a way that mutant strains that escape the immune response correspond to the fitness valleys. Thus, the virus would either be destroyed by the immune response or forced to mutate to strains that cannot replicate well and are less able to infect more cells. 

This would mimic the immune response mounted by people known as "elite controllers," who are exposed to the virus but able to control it without medication. Immune cells in those people target the same peptide sequences that the model predicted would produce the biggest loss of fitness when mutated. 

This general approach could also be used to identify vaccine targets for other viruses, Chakraborty added. 

The researchers have described their findings in latest issue of the journal Immunity.

Source-AN
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Tuesday, March 26, 2013

Early HIV drugs 'slow virus down'


Early HIV drugs 'slow virus down'

HIVThe human immunodeficiency virus (HIV) attacks the immune system

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Giving a patient HIV drugs as soon as they are diagnosed could be the future of treatment, say researchers.
Currently, antiretroviral therapy is given only once the immune system has been seriously weakened by infection.
A trial, in the New England Journal of Medicine, showed that a year-long course of therapy after diagnosis helped preserve the immune system and keep the virus in check.
It is thought that early treatment may also reduce the spread of HIV.
The virus is no longer a death sentence for patients who get the best care and drugs. Treatment is given once their CD4 T-cell count, a part of the immune system, falls below 350 cells per cubic millimetre of blood.
However, there has been some speculation that starting as soon as a patient is diagnosed may be more beneficial.
The Spartac study, which involved 366 patients from eight countries around the world, tested the theory.

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Questions remain about whether a longer course at an early stage could be more beneficial or whether early treatment should be continued for life”
Dr Jimmy WhitworthWellcome Trust
Some patients were given 12 weeks of drugs after being diagnosed, another group had drugs for 48 weeks after diagnosis and a third group were given no drugs until they reached the 350 level.
Prof Jonathan Weber, from Imperial College London, said those on the 48-week regime "end up with much higher CD4 cell count and a much lower viral load".
"Also, the benefit persists after you've stopped treatment," he added.
Who pays?
Keeping a strong immune system is important for preventing other "opportunistic" infections, such as tuberculosis, taking hold.
Prof Weber acknowledged that cost was a "massive question" that would represent "a real problem" in poorer parts of the world.
However, in richer countries if would mean "only a few extra years" on a lifetime of medication.
Dr Sarah Fidler, also from Imperial, pointed to the benefit of keeping levels of the virus low.
"This could be very important for helping reduce the risk of passing on the virus to a sexual partner," she said.
Dr Jimmy Whitworth, from the Wellcome Trust, which funded the study, said: "This study adds to increasing evidence that early initiation of HIV treatment is of benefit to the individual in preventing severe disease and in reducing infectiousness to his or her partners.
"Questions remain about whether a longer course at an early stage could be more beneficial or whether early treatment should be continued for life."
However, one of the biggest problems remains identifying people who have been infected. In the UK, one in four people with HIV are thought to be completely unaware they have the infection.

Thursday, March 21, 2013

Centres run out of anti-HIV drugs


Centres run out of anti-HIV drugs

         People battling the human immunodeficiency virus (HIV) in the city are having a tough time finding drugs for opportunistic infections, which can be life-threatening. Most centres providing anti-retroviral therapy (ART) have run out of drugs for opportunistic infections since last year, despite repeated requests to the Mumbai District Aids Control Society (MDACS).

The virus primarily targets the immune system, causing a gradual decline in the immunological response of patients. This makes the patient highly susceptible to tuberculosis, pneumonia, diarrhoea and meningitis blindness. Most of those infected come from middle and lower-middle classes.


People living with HIV are extremely susceptible to infection, which can prove fatal if not treated on time. At least 30% patients develop opportunistic infection(s), with 8% getting tuberculosis, th e most common infection in HIV cases. The mortality in HIV patients due to TB hovers around 5% for Mumbai.

A medical officer from an ART centre in a civic hospital told TOI that even medicines to treat common symptoms have not been supplied for over six months. "The symptoms hint at the presence of infections like tuberculosis, cryptosporidial diarrhoea, serious meningitis or pneumonia," said the doctor, adding that several requests have been made to higher-ups to arrange for medication.

Another medical officer from a centre in a suburban hospital said medicines prescribed to patients with low CD4 counts (indicates stage of HIV) have also been out of stock for over two months. "We tell patients to buy them from chemist shops but most cannot afford them. Patients are reluctant to collect medications from civic hospitals," he said. 
The National Aids Control Organization (NACO) attaches significant importance to the control of opportunistic infections as they can push up morbidity and mortality. The unavailability of medicines can push up mortality from HIV, which is on a steady decline.

Former head of JJ Hospital's ART centre, Dr Alaka Deshpande, said early diagnosis and treatment of opportunistic infections are imperative to improve expectancy and quality of a patient's life. The programme is grappling with compliance issues and unavailability of drugs will only compound the situation, she said.

"At least 15-30% patients stop taking ART treatment and it weakens their immune system. At least one-third of these patients have very high chances of developing opportunistic infections," she said.

Deshpande busted the myth that patients on ART usually have a healthy CD4 count and thereby may not get opportunistic infections. She said in the last one month she has treated three cases of cryptococcal meningitis, a serious fungal infection, in patients who were regular with ART medication. She cautioned that the authorities cannot take chances with resistance to tuberculosis medicines on the rise.

MDACS additional project director Dr Balkrishna Adsul said, "We will float a tender for the drugs and make them available to patients. They can always take drugs from medical college dispensaries." 

Tuesday, March 19, 2013


Preventing HIV Infection With Anti-HIV Drugs In People At Risk Is Cost-Effective



An HIV prevention strategy in which people at risk of becoming exposed to HIV take antiretroviral drugs to reduce their chance of becoming infected (often referred to as pre-exposure prophylaxis or PrEP), may be a cost-effective method of preventing HIV in some settings, according to a study by international researchers published in this week's PLOS Medicine

In an analysis of 13 modelling studies led by Gabriela Gomez from the Department of Global Health, Academic Medical Centre, University of Amsterdam/AIGHD in The Netherlands, the authors evaluated the impact of pre-exposure prophylaxis in different populations (heterosexual couples, men who have sex with men, and people who inject drugs) in different regions and countries, such as southern Africa, Ukraine, the US, and Peru. 

They found that in every setting, the cost of antiretroviral drugs was an important factor influencing the affordability of effective prevention programmes but delivery of pre-exposure prophylaxis to populations at higher risk of HIV exposure appeared to be the most cost-effective strategy. The authors also found that both behavioural changes and adherence to the pre-exposure prophylaxis drug regimens affected programme effectiveness. 

The authors say: "Our findings show that pre-exposure prophylaxis has the potential to be a cost-effective addition to HIV prevention programmes in some settings." 

They continue: "However, the cost-effectiveness of pre-exposure prophylaxis is likely to depend on considerations such as cost, the epidemic context, pre-exposure prophylaxis programme coverage and prioritisation strategies, as well as individual adherence levels and pre-exposure prophylaxis efficacy estimates." 

The authors add: "Given that our review shows that both the setting and which population is prioritised for pre-exposure prophylaxis are critical drivers of cost-effectiveness, the next step is to conduct context-specific demonstration studies, including comprehensive cost analyses, of different prioritisation and adherence promotion strategies to ensure that the maximum benefit from the introduction of pre-exposure prophylaxis is realised within combination HIV prevention programmes." 

Monday, March 18, 2013

Government moots anti-AIDS measures in 8 districts


Government moots anti-AIDS measures in 8 districts



The State Government has identified eight districts where it plans to involve corporate houses to address the issues of HIV and AIDS. Mineral rich and industrial hubs, these districts have different sets of vulnerabilities to the dreaded infection which prompted the Health and Family Welfare Department to seek help of its Industries counterpart for a joint initiative.
The Health Department had asked the Odisha State AIDS Control Society (OSACS) to flag the major issues faced by the eight districts where mining and industrial activities are intensive leading to prevalence of high risk groups such as migrants, transporters, alcoholics and drug users.
In its report, the OSACS pointed out the concerned areas in each of the districts which included Angul, Jharsuguda, Jajpur, Keonjhar, Sundargarh, Rayagada, Koraput and Jagatsinghpur. It also suggested that massive IEC campaigns, health camps, counselling-cum-therapy centres could be set up in the districts basing on their needs with support from the corporate social responsibility (CSR) wings of the industrial houses. Industries Department will hold a meet with the corporate houses so that an action plan can be charted out for giving the plan a working shape.

Early HIV drugs 'functionally cure about one in 10'




Boston: Rapid treatment after HIV infection may be enough to "functionally cure" about a 10th of those diagnosed early, say researchers in France.
They have been analysing 14 people who stopped therapy, but have since shown no signs of the virus resurging.
It follows reports of a baby girl being effectively cured after very early treatment in the US.
However, most people infected with HIV do not find out until the virus has fully infiltrated the body.
The group of patients, known as the Visconti cohort, all started treatment within 10 weeks of being infected. The patients were caught early as they turned up in hospital with other conditions and HIV was found in their blood.
They stuck to a course of antiretroviral drugs for three years, on average, but then stopped.
The drugs keep the virus only in check, they cannot eradicate it from its hiding places inside the immune system.
There have been two stories about HIV 'cures' in two weeks now - yet the latest developments offer little to the majority of people living with HIV.
In the Mississippi baby case and in the Visconti cohort the infection was caught very early, within weeks, at a vulnerable stage.
This suggests that by hitting the virus hard when it first infects the body, it might be possible to live for years without needing treatment - a functional cure.
However, these patients were the lucky few who were detected in the days and weeks after infection. Most cases are detected years later. For these patients a cure looks, at best, distant.
The hope is that by investigating how patients treated early, and a group of people who are genetically resistant to HIV, can combat the virus - it will give scientists clues for developing cures for everyone else.
End.

Thursday, March 14, 2013

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Pre-marital HIV testing is a shortcut to nowhere

Pre-marital HIV testing is a shortcut to nowhere

(The Maharashtra government's proposal is aimed at shielding women but it could end up adding to their vulnerability)

THE MAHARASHTRA government is considering a proposal to make HIV test mandatory before marriage. The proposal is seemingly an attempt to protect women from contracting HIV from their husbands. However, evidence shows that such testing is ineffective in preventing transmission.

The proposal is not new. It has been considered in Kerala (2011), Jharkhand (2010), Goa (2006), Andhra Pradesh (2002) and in Maharashtra itself in 2008. Each time, the proposal was abandoned or rejected for manifold reasons.

First and foremost, the National HIV/AIDS Control Programme, implemented by the health ministry's National AIDS Control Organisation (NACO), is founded on a rights-based approach. It is based on the understanding that the epidemic can be addressed only by respecting the rights of people living with HIV and those vulnerable.

Three fundamental aspects of this approach are informed consent, confidentiality and non-discrimination. When rights are violated, people lose confidence in the public health system, causing the epidemic to go underground.

Mandatory testing is antithetical to the rights-based approach. It overrides an individual's right to make decisions about their body and thereby violates their right to informed consent. There is also a serious risk of the HIV status of a person becoming public, violating their right to confidentiality. A large number of marriages in India are arranged with the participation of the prospective spouses' families. If a person tests positive, the results would be shared with everyone involved, thus making it public, with grave repercussions. There is also a risk of false positive results.

Persons who may not have contracted HIV may test positive, which could have a serious negative impact on their future.

Mandatory testing is also ineffective in preventing HIV transmission. It is based on a fundamentally flawed assumption that an HIV test prior to marriage guarantees protection from HIV subsequently as well.

It does not address the fact that HIV can be contracted during marriage, by either spouse, through extra-marital sex, blood transfusion or sharing needles. In fact, the test would lure spouses into a false sense of security of being protected from HIV.

This could increase complacency regarding health risks associated with sex and increase risky sexual activity. It would also reduce the ability of women to negotiate safe sex.

The public health system currently uses the antibody test to detect HIV. However, the limitation of the test is that there is a window period, of up to three months, during which antibodies remain below detection levels. During this period, an HIV positive person would test negative for HIV. As a result, HIV transmission would not be prevented when a person is tested during the window period.

Experience shows that mandatory pre-marital testing is easily subverted. When it was implemented in Illinois, US, people travelled to other states to get married. The law was later repealed. In Louisiana and Utah, similar laws were found to be wasteful and ineffective and eventually removed. In India, it is also possible that instituting such a policy could open a racket of obtaining false certificates.

It's possible that instituting such a policy could open a racket of obtaining false certificates

That women are more vulnerable to HIV than men is well-established. Part of this is biological, but a large part of this vulnerability can be traced to the socio-economic and cultural disadvantages that women face. Most women have little or no control over decisions about sex, including condom use.

It would be far better if NACO introduced the HIV/AIDS Bill in Parliament immediately. The Bill espouses the rights-based approach in general. It contains a number of specific provisions, seeking to ensure that women have access to information regarding, and able to take decisions relating to sex. These include the provision of sexuality education to adolescents and couple counselling before marriage. NACO must champion the cause of the Bill and put to bed all debate about policies such as mandatory pre-marital testing, which are contrary to the rights-based approach and deleterious to public health