TB vaccine candidate hits proof of concept trials among HIV positives, pregnancy doubles HIV transmission risk, and more…

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The following “What We’re Reading” selection is a compilation of recent articles and reports making headlines in HIV and TB news.

Aeras TB vaccine trial among HIV positives hits Phase IIb: On Thursday Aeras and the Oxford-Emergent Tuberculosis Consortium announced the launch of a proof-of-concept Phase IIb study utilizing the MVA85A investigational tuberculosis (TB) vaccine – touted as the most clinically advanced of a new generation of vaccines under development to combat TB and the TB/HIV co-epidemic. The first among HIV infected people, the trial will test the vaccine candidate among approximately 1,400 participants ages 18 to 50 at research sites in Senegal and South Africa.  The same candidate TB vaccine is being studied for proof-of-concept among nearly 3,000 infants in South Africa. 

Antiretrovirals for HIV prevention - translating promise into praxis:  In a commentary that appeared in the Lancet Infectious Diseases, Kenneth H. Mayer, MD, co-chair of the Center for Global Health Policy’s Scientific Advisory Committee, addresses the tension in the activist and scientific communities between treatment as prevention and pre-exposure prophylaxis (PrEP). “In a severe economic downturn, with less than a third of people infected with HIV who need antiretroviral treatment (based on WHO criteria) accessing drugs, concerns regarding how best to use scarce resources loom large. The conclusions from HPTN 052 would suggest that earlier initiation of treatment could yield a substantial prevention benefit, but it is important to consider that a significant proportion of new HIV infections do not occur in the context of stable discordant couples,” Mayer said in the article.
 
WHO releases 2011 update to guidelines for programmatic management of drug-resistant TB: Last updated in 2008, the World Health Organization (WHO) released updated guidelines to manage multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (MDR-TB), including a call for more research to guide the management of the condition. Wider use of rapid drug-susceptibility testing with molecular techniques to detect TB with rifampicin resistance and provide adequate treatment, continued use of culture for the early detection of failure during treatment, and early use of antiretroviral agents for TB patients with HIV infection who also receive medication with second-line anti-TB regimens are among the 11 key recommendations the WHO encourages in the document.

Treatment as prevention – we urgently need policy guidance: In a PLoS One blog post, Dr. Nathan Ford, medical coordinator for Medecins Sans Frontieres’ International Campaign for Access to Essential Medicines, makes the case for much-needed policy guidance for discordant couples from the World Health Organization on the use of treatment as prevention since the release of the HPTN 052 trial results in May. Ford suggests the delay was in part due to the challenge of balancing funding between treatment as prevention and pre-exposure prophylaxis (PrEP), which also has shown great prevention benefits in scientific trials of late, and offered pointed reasoning as to “why such a trade off is wrong.”

Pregnancy doubled risk of female-to-male HIV transmission in Partners in Prevention study: According to an article by Nelly R. Mugo and colleagues in the journal AIDS entitled, “Increased risk of HIV-1 transmission in pregnancy: a prospective study among African HIV-1 serodiscordant couples,” pregnancy increased the risks of female-to-male HIV transmission twofold among the more than 3300 couples from seven African countries. “Pregnancy brings biological and behavioral changes that may make a woman more susceptible to getting HIV, as well as making her more infectious, so increasing the risks of transmission,” according to an article in Aidsmap. The Partners in Prevention HSV-2/HIV transmission study – a randomized, controlled trial looking at acyclovir as herpes simplex virus-2 (HSV-2) suppressive therapy for the prevention of HIV transmission – involved 3,408 couples from Bostwana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia between November 2004 and April 2007.

Modern Legislation: Moving from Policy to Practice: House Foreign Affairs Committee Ranking Member Howard Berman (D-CA) proposes “modernizing” the Foreign Assistance Act of 1961 in a Modernizing Foreign Assistance Network blog post, a process he has undertaken with his staff and plans to release in draft discussion form in September. “We need to develop strategic planning processes that set clear goals and measurable indicators of success; work with partner governments and local communities to make sure they have the will and the ability to keep projects going with their own resources; coordinate our activities with those of other donors and focus on the areas where we have a comparative advantage; and institute robust mechanisms for transparency, monitoring, and evaluation,” Berman said in his post, making clear that the draft does not authorize or set any funding targets.

HIV/AIDS At 30 – A Public Opinion Perspective: The Kaiser Family Foundation conducted a survey recently on Americans’ opinions on HIV/AIDS. One of the key findings, more than half of Americans continue to support increased funding for HIV/AIDS, and fewer than one in ten say the federal government spends too much in this area. “Young adults express even higher levels of support for government spending on HIV, and are more optimistic than older adults that spending on prevention and treatment will lead to meaningful progress,” according to the report.

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