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Saturday, September 10, 2011

NO FIXED PATH TO HIV PREVENTION

NO FIXED PATH TO HIV PREVENTION

Erle Frayne D. Argonza

Could there be a single, most acceptable path to HIV prevention? This is the guide question posed upon those biomedical specialists and experts who are into HIV research & development as well as to the practitioners.

Long before the biomedical disciplines found the pharmacologic panacea to HIV, alternative health practitioners in Asia already found the cure to ailment which they tried on many patients in the 70s and 80s. Whether the biomedical fields will come to accept these non-conventional solution remains to be seen.

One thing is clear though at this juncture: that biomedical experts are now of the consensus that there is not a single megalithic path to HIV prevention. This is a welcome departure from the extremely positivist premise of biomedical paradigm which sought to reduce disease treatment to a single active ingredient from drug-based medication.

Below is an update report on relevant developments from the International AIDS Society or IAS.

[Philippines, 09 September 2011]

Source: http://www.scidev.net/en/opinions/biomed-analysis-no-single-path-to-hiv-prevention-1.html

Biomed Analysis: No single path to HIV prevention

Priya Shetty

22 July 2011

Excitement about new drug treatment for HIV prevention does not mean we should lose sight of other methods, cautions Priya Shetty.

Scientists trying to prevent people from becoming infected with HIV are on a roll. After a huge leap forward last year in AIDS vaccine research, when powerful sequencing uncovered potent anti-HIV antibodies, new research shows convincingly that treatment with antiretroviral drugs can also be used to prevent infection.

The latest results on the effectiveness of drugs for pre-exposure prophylaxis (PrEP), presented at the International AIDS Society conference (IAS 2011) in Rome this week, were released just a couple of weeks before. The finding that PrEP could reduce new HIV infections by up to 73 per cent was so compelling that the trial was halted early.

With such excitement over a preventive approach that we have available right here, right now, suddenly a vaccine might not seem like the holy grail of HIV prevention after all.

But the early days of HIV vaccine research are a cautionary tale. The assumption that a vaccine was just around the corner seemed to lead, initially, to complacency that might explain why it is only relatively recently that other approaches to prevention have been high on the agenda.

And at IAS 2011, there was a broad consensus that pursuing one approach does not render the others redundant — and indeed that it would be impossible to tackle a disease such as HIV/AIDS without several approaches.

Vaccine research gets a boost…

For years, HIV prevention has relied on non-biomedical, behavioural interventions such as condom use and safe-sex counselling. Since behaviour is difficult to change, such tactics are notoriously difficult to implement. Yet, for several years, they were the only weapons in the fight to prevent the spread of HIV.

Once scientists knew that HIV was the cause of AIDS, they were confident that a vaccine would soon be developed for the virus. But they had not bargained for its complexity — and AIDS vaccine research has been problematic from the beginning.

Most disease-causing viruses come in a few different strains; HIV has hundreds of them. Not only that, the virus is capable of changing its surface proteins to evade antibodies. Devising a vaccine against HIV is a huge challenge.

Speaking at IAS 2011, Gary Nabel, head of the US National Institutes of Health's Vaccine Research Center, which was set up in 1999 to find an HIV vaccine, described most of the time spent hunting for it as "the dark ages".

But last year, everything changed, said Nabel. The discovery of antibodies that worked against 90 per cent of HIV strains (compared with 40 per cent for previously found antibodies) has made the prospect of an HIV vaccine real again.

…but existing tools show promise

Even before the resurgence in vaccine research, male circumcision and microbiocide (disinfecting) gels had shown great promise in preventing infection. The WHO now says "there is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60 per cent".

Early clinical trials had hinted at the promise of treatment for prevention. And in the past few months, studies have shown that combination antiretroviral treatment (tenofovir/emtricitabine) reduced the risk of HIV-negative people becoming infected by 44 per cent in men who have sex with men, and by up to 73 per cent in heterosexual couples.

A key randomised clinical trial that was also presented at IAS 2011, called HPTN 052, showed conclusively for the first time that putting infected people on antiretroviral therapy early can reduce their chance of passing on the infection by 96 per cent.

Many paths to prevention

As thrilled as HIV researchers have been with the results of preventive drug trials, the implementation of treatment programmes will be far from simple. Developing countries have too few healthcare workers, and rolling out antiretroviral treatment can be logistically difficult — so adding treatment for prevention will add to already heavy burdens.

Deciding which groups are eligible for drug treatment, which means putting otherwise healthy people on powerful drugs, also raises ethical questions that are not easily solved.

Given these complexities, it would be short sighted not to pursue aggressively a vaccine that would confer lifetime immunity in one shot. Nor should the public health community abandon non-biomedical strategies such as condom use and reducing risky behaviour.

Safe sex is not just about HIV, after all — prevalence rates of other sexually transmitted diseases are on the rise in many developing countries, and rates of unwanted pregnancy remain high.

The take-home message from IAS 2011 is crystal clear. After years of struggle, we can now contemplate moving towards ending the epidemic. But we should not threaten the chances of success by playing off one approach against another.

Journalist Priya Shetty specialises in developing world issues including health, climate change and human rights. She writes a blog, Science Safari, on these issues. She has worked as an editor at New Scientist, The Lancet and SciDev.Net.

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Friday, August 12, 2011

MALARIA D’APES & MONKEYS

Erle Frayne D. Argonza

We have a new alarming development concerning malaria spread. Gorillas and monkeys might just happen to be the dreaded carriers of the disease, a news that could cause chagrin on the legendary Tarzan.

This analyst has no fondness for Tarzan philosophy, but is more focused on highlighting risks to communities caused by a diversity of factors such as diseases. Being a development worker for long, I contracted malaria while doing field work and almost died of the falciparum disease in 1982.

We have no evidence yet of malaria being transmitted to humans by monkeys even though we do have species of monkeys among our diverse fauna. But Africa has shown less resiliency to that possibility, as shown in the report below.

[Philippines, 18 July 2011]

Source: http://www.scidev.net/en/news/primate-malaria-in-africa-may-be-jumping-species.html

Primate malaria in Africa may be jumping species

Rachel Mundy

7 July 2011

A malaria parasite from gorillas has been found in an African monkey, suggesting it has jumped species and may be able to transfer to humans.

The finding has led some malaria experts to suggest that if transfer between monkeys and apes has occurred then monkey-to-human malaria transmission may already be happening. They have called for more research to quantify the risks.

"The evidence is sufficient to warrant further investigation into the possibility that these parasites may also jump to humans," said Beatrice Hahn, a professor of medicine at the University of Alabama at Birmingham, United States. "We need to screen humans who live in flying range of mosquitoes that also bite primates, to establish whether they are susceptible to the primate parasites."

Wild forest-living gorilla populations are known to harbour a parasite strain that is closely related to the human malaria parasite Plasmodium falciparum. And macaque monkeys in South-East Asia carry another malaria parasite, Plasmodium knowlesi — a potential threat to humans.

But this is the first time that a P. falciparum strain similar to the one that causes human malaria has been found in an African monkey — the spot-nosed guenon from Gabon (Cercopithecus nictitans).

The fact that "the genetic differences from the human strain are so slight" raises the possibility that monkey and ape malaria may be transmitted to humans, said François Renaud, a researcher at the French National Centre for Scientific Research, in Montpelier, and co-author of the study published in the Proceedings of the National Academy of Sciences (5 July).

As humans come into closer contact with apes and monkeys as a result of deforestation, commercial hunting and population growth, the opportunity for the parasites to be transmitted to humans will increase.

"One single successful cross-species transmission event has the potential to result in a major human pandemic," Hahn, who was not involved in the study, told SciDev.Net.  

But David Conway, professor of biology at the London School of Hygiene & Tropical Medicine, United Kingdom, said the reservoir of malaria in African monkeys must be very small, given the low prevalence found in this study.

"Hopefully, monkey malaria will start to be recognised as an important area of research, but when examining the public health significance for humans, it is important to put the risk into context. Normal human malaria has a much higher prevalence, except in parts of South-East Asia where this has been reduced and the importance of malaria from monkeys has become more noticeable," Conway said.

Looking for human infections with monkey malaria is "like looking for a needle in a haystack", he said, adding that "there is every chance that human infections are occurring occasionally in the forest".

"In this particular case, the vector of malaria is the key determinant in determining any public-health risk," Conway said. "Identifying which species of mosquitoes transmits each parasite strain is a neglected area of research that needs additional funding."

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Wednesday, August 10, 2011

VACCINE FEARS

Erle Frayne D. Argonza

How far do vaccines work? Is vaccination an opportunity or a threat to communities suffering from epidemic and pandemic outbursts?

Vaccination has generated its own level of fear responses, as cases of vaccination failures have led to fatalities on the parts of poor patients. Let it be stressed that pandemics, such as those that struck Africa, often than not strike down the poor classes, thus generating toxic fears that the vaccines coming from the West are meant as genocide bacteriological warfare weaponry.

Devising ways & means to track vaccine fears is a challenge to healthcare stakeholders across the globe. Below is one reportorial discussion on the subject.

[Philippines, 17 July 2011]

Source: http://www.scidev.net/en/news/system-tracks-vaccine-fears-around-the-globe.html

System tracks vaccine fears around the globe

Smriti Mallapaty

4 July 2011

[LONDON] Fears of a growing mistrust of vaccinations in developing countries have led academics to set up a 'listening station' that monitors local responses to new immunisation campaigns.

Researchers at the UK-based London School of Hygiene and Tropical Medicine (LSHTM) are hoping their system will alert them when concerns have passed thresholds beyond which there may be a risk to the smooth implementation of a programme.

"I have been seeing an increasing number of episodes of communities, governments and individuals questioning vaccines and refusing them, even in some of the poorest countries," said Heidi Larson, senior lecturer at LSHTM and principal investigator for the project.

"After several years of fire-fighting, I started to see patterns where early intervention could have prevented boycotts," she said.

The project started in November 2009. Data are collected from local media, official and local observer reports and categorised by country, source, type of disease, vaccine and issue raised.

Risk is allocated to three categories, ranging from a potential problem requiring more data-gathering, to immediate action being needed to prevent vaccine refusal.

In Kenya, the researchers are piloting a 'listening system' model that documents local opinion as it emerges following the launch of the pneumococcal vaccine last February.

Today, mobile phones, the Internet and social media are providing new methods of self-organisation for those on all sides of vaccine debates.

Larson and colleagues recently published a case study in The Lancet examining the suggested link between the tetanus vaccine and sterility that disrupted immunisation campaigns across the world and led to a 45 per cent drop in coverage in the Philippines between 1994 and 1995.

They found that the Internet had been crucial in allowing the pro-life Catholic group Human Life International to communicate these fears to its members in over 60 countries, including Mexico, Nicaragua and the Philippines.

The eruption of fear usually results from underlying social and political issues, said the researchers. When fears arose in Uttar Pradesh in India that the polio vaccine might induce sterility, analysts found that mistrust revolved around the person administering the vaccine — often non-local men.

"When you have a group that is marginalised and is very conscious of its marginalisation, it is not a surprise that they would be more suspicious of government-driven initiatives," said Larson.

Thomas Abraham, director of the public health communication programme at the University of Hong Kong, said: "I think that any tool that tells you that there is a problem is useful".

"The question then becomes, what are you going to do about these rumours?"

He said that communication needed to be the starting point for any public health programme. "Health communication, especially around vaccines, is still very much in the dark ages."

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