Wednesday, April 04, 2007

HIV/AIDS findings

While looking for a different paper in the Journal of Infectious Diseases, I came across an article and a editiorial commentry that I found interesting, especially when combined.

The editorial commentry takes a look at the effects of highly active antiretroviral therapy (HAART) for HIV on HIV infections, while the paper takes a more general look at the dynamics of the spreading of HIV in Quebec.

The editorial, Primary HIV Infection, Phylogenetics, and Antiretroviral Prevention, makes clear that while HAART has been effective in prolonging the lives of HIV-infected people, it has done nothing to stop the spreading of HIV at all.

Over the past 10 years, the world has witnessed one of the most significant chronic disease interventions ever seen—that of highly active antiretroviral therapy (HAART) for HIV infection. Morbidity and mortality have plummeted in those areas of the world with unrestricted access to these drugs [1], and HIV/AIDS has been transformed from an almost certain death sentence to, for those receiving treatment, a long-term, manageable disease, with a potentially normal life expectancy. By contrast, this success has not been matched by reductions in HIV transmissions over the same period. Indeed, current surveillance data suggest that transmissions are increasing in resource-rich communities—particularly among men who have sex with men (MSM) [2], in addition to the large epidemics ongoing within the resource-poor world. Such increases represent a public health failure. The inevitable outcome of widespread HAART use in the midst of increasing HIV transmission—namely, transmission of drug-resistant viruses—has now become a worldwide reality [3–5].

The suboptimal impact of safe sex messages over the past 20 years suggests that more innovative and effective preventive strategies are required. More research is necessary to uncover the dynamics and drivers of transmission within different communities and risk groups, to inform an evidence base for such interventions.

As the editorial makes clear, to do this, we have to know something about the dynamics of the spreading of HIV, which leads us to the paper, High Rates of Forward Transmission Events after Acute/Early HIV-1 Infection by Brenner et al, which describes the pattern of the spreading of HIV in Quebec, with a focus on how large a part of it happens by people who are newly infected. And the paper reaches a pretty important conclusion.

Early infection accounts for approximately half of onward transmissions in this urban North American study. Therapy at early stages of disease may prevent onward HIV transmission.

In other words, if we can stop the infection at its early stage, half of the spreading can be stopped (if Quebec is representative in that aspect). That's pretty important, since most of the focus has been on preserving the health of infected people, and find a complete cure. None of these aspects should be ignored, but there should certainly be a focus on stopping the spreading of the virus as well.

The paper I was looking for was this one: Highly Attenuated Rabies Virus–Based Vaccine Vectors Expressing Simian-Human Immunodeficiency Virus89.6P Env and Simian Immunodeficiency Virusmac239 Gag Are Safe in Rhesus Macaques and Protect from an AIDS-Like Disease by McKenna et al.

It basicly describes how an rabies vaccination seemed to protect four test animals against an AIDS-like disease. ScienceDaily described it here.

Obviously a lot more research has to go into this, before it can even be considered for human trials, but the findings are interesting, and has the potential for being a major break-through in combating HIV/AIDS.

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