Category: Uncategorized

Use a condom for Valentine Day

HIV/TB care association has launched a Twiter-Facebook campaign in Cape Town to encourage condom use. Under slogan is Love=Condom and with Valentine Day as a prop, the campaign aims to address the rising rates of HIV – especially.

In the UK the relentless rise in HIV in men who have sex with men to record levels in 2012 has also raised concern that the safe sex message is not getting through. The Healthe Protection Agency which provides annual report on rates of HIV and other sexually transmitted infections has made a number of recommendations for controlling the HIV epidemic.

  • Implementing safer sex programmes promoting condom use and HIV testing are a priority, particular for higher risk groups, including men who have sex with men and black African communities.
  • In areas with high HIV prevalence (prevalence greater than 2 per 1,000 people aged between 15 and 59 years old), routine HIV testing should be performed for all general medical admissions and people registering at GP practices. GPs should offer and recommend HIV testing.
  • HIV testing should be offered to people with tuberculosis and people with HIV should be screened for tuberculosis.
  • The benefits of treatment with antiretroviral drug treatments should be discussed with all people receiving HIV care.
  • HIV care needs to be continually monitored to ensure it continues to be of high quality.

Maybe we should take a leaf out of the South African TB/HIV Care Association.

Current HPV vaccines miss half of the carcinogenic types found in London women

Vaccination against human papillomavirus (HPV) types 16 and 18 protects women against cervical cancer associated with these two common phenotypes.

A recent study by Oakshott and her colleagues from the UK has found that 18.5% (95% CI 17-20%) of nearly 2,200 women attending a sexually transmitted infection (genitourinary medicine) clinic were positive for HPV types associated with cervical cancer in samples taken from vaginal swabs. These included 327 women (15%) who were positive for HPV genotypes not covered by the current vaccines currently in use.

By sampling twice a median of 16 months apart the authors were able to provide an annual estimate of new infections (incidence) of nearly 13% of carcinogenic genotypes. Reporting two or more sexual partners in the previous year and concurrent Chlamydia trachomatis or bacterial vaginosis were independent risk factors for prevalent vaginal HPV infection.

Of the 143 women with baseline carcinogenic HPV that provided samples later 14% were infeceted by the same HPV genotype.

The study was performed before the introduction of immunisation against HPV types 16 and 18 for schoolgirls. It highlights the continued need to screen women for cervical cancer.

HIV highly homogeneous in early infection

Current findings suggest that the mucosal barrier is the major site of viral selection in sexual transmission of human immunodeficiency virus type 1 (HIV-1), transforming the complex inoculum to a small, homogeneous founder virus population. In a recent study from Zurich the authors analyzed HIV-1 viral seqiuences in the C2-V3-C3 region in 145 patients with characteristics  primary HIV-1 infection. They found that  the meedian viral diversity within env was 0.39% (range 0.04%–3.23%). Viral diversity did not correlate with viral load, but it was slightly correlated with the duration of infection.

They also found that  neither transmission mode, gender, nor STI predicted transmission of more heterogeneous founder virus populations. Only 2 patients (1.4%) were infected with CXCR4-tropic HIV-1 with a duakl-tropic R5/X4-tropic–mixed population. The other patients were infecetd by the CCR5-trophic virus which targets the macrophage series.

The authors concluded that transmission of multiple HIV-1 variants might be a complex process that is not dependent on mucosal factors alone. CXCR4-tropic viruses can be sexually transmitted in rare instances, but their clinical relevance remains to be determined. These results have imprtant implications for vaccine development.

An alternative explanation for these results, not discussed by the authors, is that the individuals were infected by a small number or even a single CCR5-trophic virus which subseqeuntly mutates to the complex virus soup that is seen in long-term infected subjects.

Lack of funding causes Global Fund to suspend funding for projects on AIDS, Tuberculosis and Malaria until 2014

On the eve of World AIDS Day on December 1, the Global Fund to Fight AIDS, Tuberculosis and Malaria has for the first time in its decade-long existence suspended all new grants because of lack of funding. According to the fund director Christoph Benn the Fund has to date distributed US$8.5 bn (6.4 bn Euros, 5.5 bn GBP) on projects worldwide, and promised a further US$1.5 for the next two years.

the Fund is also concerned that it might not be able to meet its target of increasing funding to scale up services in poorer countries. Thus the fund will attempt to guarantee continued funding for those already on treatment but will not provide funding for treating new cases. This is a major setback for the millennium project to have 3.5 million people with advanced HIV receiving anti-retroviral drugs by 2015. Mike Mandelbaum, executive of the charity TB Allert, talking to the BMJ, spoke of ‘catastrophic effect’ of reduced funding leading to ‘many avoidable deaths’. Similar concerns were raised by Awa Marie Coll-Seck of the Roll Back Malaria partnership who warned of losing ‘the tremendous gains made in malaria control in recent years’. Malaria remains the top cause of death globally.

BMJ 2011:343:d7755

US Committee recommends HPV vaccine for men

Human papilloma virus (HPV) causes warts but also is the underlying cause of various cancers, particularly cervical cancer in women.  HPV vaccines are now available and recommended for young women to prevent cervical cancer, and in the case of quadrivalent vaccine also genital warts. [see our news item: Quadrivalent wart vaccine would prevent high cost of care for genital warts ] The vaccine is more effective if administered to children aged 11-12 years, before they become sexually active

Now a study published in the New England Journal of Medicine showed that the quadrivalent vaccine can prevent intraepithelial neoplasia, a precursor of anal cancer, in young gay men. anal intraepithelial neoplasia associated with the HPV types linked to cervical cancer (HPV 16 and 18) were reduced by 55% in the vaccinated group. Consequently the US Advisory Committee on Immunisation Practice has recommended the roll out of vaccination to all children aged 11-12, regardless of sex.