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EPIDEMICS
HIV epidemic 'smaller' than UN estimates: report
by Staff Writers
Paris (AFP) July 22, 2014


New drug regimen speeds TB treatment
Melbourne (AFP) July 21, 2014 - An experimental cocktail of three drugs can dramatically shorten the time it takes to treat patients infected with TB strains that are hard to cure with conventional antibiotics, according to research presented Monday at the world AIDS forum.

Dubbed the PaMZ regimen, the drugs killed more TB bacteria than standard therapy and at a faster rate in a so-called Phase IIb trial, usually the penultimate step in vetting new treatments for safety and effectiveness, investigators said.

If funding is found, PaMZ will move to Phase III tests by the end of the year, their backers, TB Alliance, said.

Doctors are deeply worried by the emergence of tuberculosis bacteria that fail to respond to frontline antibiotics.

These resistant strains are especially dangerous for people co-infected with the human immunodeficiency virus (HIV), which causes AIDS. HIV attacks CD4 immune cells, leaving the body exposed to opportunistic microbes.

PaMZ comprises two candidate drugs that are not yet licensed for use against TB, called Pa-824 and moxifloxacin, deployed with an existing treatment, pyrazinamide.

The treatment, which is administered as tablets, was formulated specifically for patients believed to have TB strains that can be targeted by these drugs.

The trial reported at the 20th International AIDS Conference in Melbourne entailed testing PaMZ against standard drugs -- isoniazid, rifampicin, pyrazinamide and ethambutol -- among 207 volunteers in South Africa, a fifth of whom were co-infected with HIV.

Of these, 181 were sensitive to the PaMZ drugs while 26 were multidrug-resistant (MDR), meaning that they had failed to respond to conventional antibiotics.

It found that 71 percent of people treated with PaMZ were cleared of TB bacteria in their sputum within two months. By comparison, only 38 percent of those on standard therapy were clear at eight weeks.

The MDR patients all took PaMZ and were treated within four to six months, compared to two years for standard treatment. This should translate into cost savings of more than 90 percent in some countries, as MDR therapy is complex and labour-intensive.

Another boon was that PaMZ showed no signs of interfering with commonly-used antiretrovial treatments to suppress HIV.

"TB remains the largest killer of people with AIDS, causing one in five HIV-related deaths globally. Yet often TB and HIV therapies cannot be given together because of side effects, making it difficult to treat both diseases simultaneously," TB Alliance said.

At least a third of the roughly 35 million people living within HIV worldwide are infected with TB in its latent form, meaning that they have the Mycobacterium tuberculosis germ that causes the disease but do not yet have any symptoms of illness, according to the UN's World Health Organization (WHO).

But people co-infected with TB and HIV are nearly 30 times likelier to develop active TB than those without HIV. In 2012, around 320,000 people died of HIV-associated TB, the WHO said.

Anti-AIDS drugs have helped save 19 million years of human life since 1996, said an analysis Tuesday which also slashed UN estimates for HIV deaths and disease by a quarter.

"The HIV epidemic is smaller than estimated by UNAIDS", wrote the team which had reviewed data contained in the Global Burden of Disease Study 2013.

"The overall amount of ill-health and premature death resulting from HIV (is) roughly 25 percent lower than the latest estimate provided by UNAIDS in 2012," added a statement carried by The Lancet medical journal, which published the results of the probe.

The analysis by a team of international researchers tracked the rate of new infections, deaths and numbers of people living with HIV, tuberculosis and malaria in 188 countries over the period 1990 to 2013.

They found the world's malaria burden, while shrinking, was probably larger than World Health Organisation (WHO) estimates, while new tuberculosis infections continued their decline.

The UN seeks to halt the spread of the three diseases by 2015 under its Millennium Development Goals, designed to improve the lot of the world's poor.

"Slow but important progress" had been made, the study found.

There were 1.8 million new HIV infections in 2013, compared to the highest-ever 2.8 million recorded in 1997, and 1.3 million HIV deaths compared to 1.7 million at the epidemic's mortality peak in 2005.

- Each extra year 'a bargain' -

"Cumulatively, 19.1 million years of life have been saved since 1996" -- 13.4 million in developing countries, said the authors.

These are calculated as the total number of years that people lived instead of dying from HIV/AIDS thanks to prevention measures and virus-suppressing drugs.

The cost was calculated at $4,498 (3,327 euros) per year of life added, "which we think is a bargain," study co-author William Heisel of the University of Washington's Institue for Health Metrics and Evaluation, told AFP.

Donors spent $7.7 billion (5.7 billion euros) on HIV/AIDS prevention and treatment in 2011.

With ever-better access to drugs, the number of people living with HIV rose steadily to about 29 million in 2012, said the review.

The global rate of new HIV infections among children was down 62.4 percent from its highest level in 2002.

The team's HIV mortality estimates were 27 percent lower than those of UNAIDS for 2005 and 14.5 percent for 2012, they wrote.

Prevalence estimates were 17.1 percent lower than the agency's in 2005 and 18.7 percent lower in 2012.

"We gathered more data than had ever been analysed before and we took a different approach than UNAIDS has in previous reports," Heisel explained by email.

The discrepancies also illustrated the dearth of data in many countries.

The review found new malaria cases and deaths declined steadily from 2004 as funding for treatment rose to $11.3 billion (8.4 billion euros) between 2000 and 2011.

There were 165 million new malaria cases and 855,000 deaths in 2013, down from a peak of 232 million new cases in 2003 and 1.2 million deaths in 2004.

The new number was higher than the 627,000 deaths estimated by the WHO in 2013, said the authors.

The number of tuberculosis deaths fell from 1.6 million in 2000 to 1.4 million in 2013.

There were 7.5 million new TB infections in 2013 and 12 million people living with the disease.

The authors said the interventions were clearly working, but had to be scaled up.

The findings are to be presented Tuesday at the 20th International AIDS conference taking place in Melbourne.

.


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