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EPIDEMICS
AIDS: Circumcision campaign lifted by new evidence
by Staff Writers
Melbourne (AFP) July 21, 2014


Monkey study dampens hopes for AIDS cure
Paris (AFP) July 20, 2014 - The monkey version of HIV can take refuge from anti-AIDS drugs within days of entering the body, a study said Sunday, dampening hopes for a human cure.

If the same holds true for human beings, treatment may have to start "extremely early" after a person is infected with the virus that causes AIDS, according to researchers publishing in the journal Nature.

The findings come just days after the disappointing announcement that a Mississippi baby thought to have been cleared of HIV through a potent dose of antivirals administered 30 hours after birth and continued for 18 months, has tested positive for the virus after two drug-free years.

"The unfortunate clinical findings of viral rebound in the Mississippi baby appear to be concordant with the monkey data," study co-author Dan Barouch of the Beth Israel Deaconess Medical Centre (BIDMC) in Massachusetts told AFP.

"These data certainly raise important challenges for HIV eradication efforts."

A key challenge for curing HIV infection is the presence of viral reservoirs -- infected immune cells in which virus DNA can lie dormant for years, undisturbed by antiretroviral treatment (ART) or the immune system.

In the vast majority of people, the virus starts proliferating as soon as treatment is stopped, which means the drugs have to be taken for life.

Little is known about when and where these reservoir cells are established during HIV infection.

Some had assumed the reservoirs are "seeded" by virus DNA during acute HIV infection -- when the presence of virus in the blood had already risen to a high level.

But the new study found that in rhesus monkeys infected with simian HIV, or SIV, the reservoir was established "strikingly early" after infection.

"The reservoir was established in tissues during the first days of infection, before the virus was even detected in the blood," said Barouch.

The monkeys were started on antiretroviral treatment at three, seven, 10 and 14 days after SIV infection.

Once the drugs were stopped, the virus replicated in all groups, though slower in the monkeys treated earliest.

"The strikingly early seeding of the viral reservoir within the first few days of infection is sobering and presents new challenges to HIV-1 eradication efforts," the authors wrote.

- New game plan required -

"Taken together, our data suggest that extremely early initiation of ART, extended ART duration and probably additional interventions that activate the viral reservoir will be required."

Scientists in Melbourne, Australia, are experimenting with an anti-cancer drug to flush the virus out of its hiding place, then to be killed.

The authors of the Nature paper stressed their findings have yet to be confirmed in humans, as there are important differences between SIV and HIV infection.

But if in humans the virus can also enter the reservoir even before it is detectable in the blood, it may be "very difficult" to start treatment early enough, as a blood test is required to diagnose HIV infection, said the team.

There is no cure for AIDS, and antiviral drugs merely control the virus' replication, thus halting its spread.

Last week, US scientists said the Mississippi baby, who had had no detectable level of HIV for more than two years after stopping treatment, had tested positive for the virus.

Her case had raised hopes that doctors may have found a way to cure children born HIV-positive, simply by treating them early.

The new study was published as experts and policy makers from around the world gathered in Melbourne for the 20th International AIDS Conference, which will discuss advances in prevention and treatment.

A campaign to encourage circumcision among men in sub-Saharan Africa to help protect them against the AIDS virus was backed by new research on Monday showing that men who have had the operation are unlikely to engage in unprotected sex.

Three major trials have previously shown that, for heterosexual men, male circumcision reduces the risk of contracting HIV by as much as 60 percent -- a finding that has prompted the UN's World Health Organization (WHO) to recommend it as a voluntary prevention option, to be used along with the condom.

But some experts have warned that circumcised men, believing themselves to be shielded, are likely to become more promiscuous after the operation, and less likely to wear a condom.

The new study, coinciding with the 20th International AIDS Conference in Melbourne, took a long look at this argument yet found no evidence to support it.

University of Illinois at Chicago researchers questioned more than 3,000 men aged 18-35 in Kenya's Nyanza province who had just been briefed about the option of circumcision and advised on safe sex and testing for HIV.

At the start of the study, half of those enrolled decided to be circumcised, while the others chose to remain uncircumcised. They were asked about their sex life, with followup questions every six months over the following two years.

During this period, sexual activity increased in both groups, especially among those aged 18-24, the investigators found.

But risky sex -- such as having multiple partners or having intercourse in exchange for providing money or gifts -- declined, while use of condoms rose.

Just as revealing was self-perception.

Men who were circumcised often believed they had lessened their risk of acquiring HIV. Thirty percent considered themselves high-risk before circumcision, while just 14 percent considered themselves so after.

Among those who decided not to be circumcised, 24 percent considered themselves high-risk at the study's start, and 21 percent still did at the end.

But the different perceptions did not translate into different behaviour, sex-wise.

"Countries that have been holding back on implementing medical circumcision programs due to a lack of evidence regarding risk compensation should have no concerns about scaling-up programs," said lead scientist Nelli Westercamp in a press release issued by the university.

The research appears online in a specialist journal, AIDS and Behavior.

- Food voucher incentive -

Separately, a presentation at the Melbourne conference said that offering men compensation in the form of food vouchers worth around $9 or $15 (6.5 or 11 euros) was a useful incentive for the circumcision campaign.

The WHO and UNAIDS recommend voluntary circumcision in 14 countries in eastern and southern Africa where HIV is highly prevalent.

But most countries remain far short of reaching their targeted numbers -- and investigators have found that many men are deterred by the loss of wages from time off work to have the operation, and the cost of travelling to and from the clinic to have it carried out.

Harsha Thirumurthy of the University of North Carolina at Chapel Hill led a team who studied 1,504 uncircumcised men in Nyanza aged 25-49 who were randomly assigned to groups where they were offered food vouchers of varying amounts to offset the cost of the operation or offered no compensation at all.

Nine percent who were offered the equivalent of $15 decided to get circumcised within the next two months, while 6.6 percent did so if offered $8.75.

Among those offered $2.50, the takeup was only 1.9 percent.

In the "control" group, where no compensation was offered, just 1.6 per cent got circumcised within the following two months.

The increase was "modest" overall but much higher among married and older men, a group that had been harder to persuade, according to the scientists.

"The interventions also significantly increased the likelihood of circumcision uptake among participants at higher risk of acquiring HIV. This latter result is especially promising from an HIV prevention standpoint," according to the study, published in the Journal of the American Medical Association (JAMA).

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