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  1. #1
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    HIV / AIDS update

    HIV infection still can’t be cured, but it can be treated. Earliest possible treatment preserves immune function, prevents infection and cancers, and prevents sexual transmission of HIV. Most HIV treatment guidelines now recommend treatment at the time of diagnosis.


    Testing for HIV may be performed on blood samples either in clinics or with " home - sampling " kits.


    At least 100,000 people are living with HIV in the UK ( over half heterosexual ; 2/5 gay or bisexual men ) ; perhaps a fifth may be undiagnosed.


    Worldwide, about 40 million are living with HIV, less than half on treatment, with over a million AIDS-related deaths in 2014.


    We’re well past the peak of the global HIV/AIDS epidemic, reached over a decade ago, because of success in prevention, diagnosis and treatment.


    However, the Philippines has been struggling with what now appears to be the fastest growing epidemic in the world. For decades the country described its HIV epidemic as " low and slow ". To be fair, 6 years ago some health workers warned of an " impending epidemic " ready to emerge in the country - due to the lowest rates of condom use in South-East Asia ; growing rates of casual sex ; returning oversea Filipino workers from areas with high HIV rates ; widespread misconceptions about HIV/AIDS ; and high needle-sharing rates among injecting drug users.


    This dire prediction seems to be coming true - a REAL increase, rather than apparent due to better diagnosis / reporting ( as I had previously suggested / hoped ).


    Of 30,000 HIV infections recorded, most have been reported since 2010 ; usually by sexual contact, especially men who have sex with men ( MSM ) ; condom use by MSM may be only 40% ; also transgender women who have sex with men.


    Several regions have HIV frequency among MSM and transgender women of over 5% - a " tipping point " beyond which the epidemic is likely to worsen. Increasingly young adults are being diagnosed.


    Co-existing undiagnosed TB infection is another concern. Sexual health education is needed to correct misinformation about HIV, how it is spread, and who is at risk. Consistent condom use, and reduced sharing of needles ( if injecting drugs can’t be stopped ) would clearly help. At present, HIV testing for minors is prohibited without parental consent, and the Reproductive Health Law prohibits condoms and other contraceptives for minors.


    Urgent action is needed, as the cost to individuals’ health and to the Philippines health budget is increasing alarmingly.



  2. #2
    Trusted Member mickcant's Avatar
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    Thankfully I seem to have escaped any of these problems, thanks for another good report Doc
    Mick.


  3. #3
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    Quote Originally Posted by mickcant View Post
    Thankfully I seem to have escaped any of these problems, thanks for another good report Doc
    Mick.
    Thank you in turn Mick ; I never doubted you would have avoided such problems


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    This may not be a topic of great interest to Forum members ( 31 views and 1 response so far ), but I did consider it worth posting.

    Concern about the " Philippine epidemic " prompted an editorial this month in the UK medical journal " The Lancet ". Itís worth repeating that it canít be cured. Treatment increases life expectancy and reduces the risk of complications. However, itís not only expensive and lifelong, but the antiretroviral drugs needed may also have serious side-effects. Prevention is better than cure in any case !


  5. #5
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    Education and protection. That is the main issue IMHO


  6. #6
    Respected Member Michael Parnham's Avatar
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    Another great read Alan


  7. #7
    Moderator fred's Avatar
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    Scientists managed to eliminate HIV-1 DNA from T cell genomes in human lab cultures. It will take time for advanced use in humans, but it is a remarkable accomplishment.

    http://futurism.com/scientists-just-...-gene-editing/


  8. #8
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    Eliminating HIV genomes from human T lymphoid cells is indeed a " remarkable accomplishment ".


    Gene - editing technology is literally " cutting edge " - the " CRISPR " technique uses an enzyme ( " Cas9 " ) which guides an RNA molecule to " home in " on DNA which it then " edits " ; either disrupting genes or inserting desired sequences. It’s actually a bacterial defense system ( CRISPR = Clustered Regularly Interspaced Short Palindromic Repeats ).



    For interested members, it’s worth reading the personal account by Jennifer Doudna, pioneer of this revolutionary gene-editing technology, and how it’s affected her life as a biochemist ( http://bit.ly/1mxCeLu ).




    Antiretroviral treatment can’t eradicate HIV from infected patients, so they need life-long treatment - costly, and with serious side effects. Eliminating HIV from infected cells and making uninfected cells resistant to further infection may be promising for the future - but it would STILL need pre-treatment to reduce the number of infected cells, each patient then requiring " personalised CRISPR " , tailored to their individual HIV-infected T cells.



    What is of vital importance in the next decade or so is for more infected people to be AWARE of their HIV status ; more to then be able to receive TREATMENT ; and more to continue with LIFELONG effective treatment. Major barriers to these aims continue to be stigma ; discrimination ; fear, with low awareness of benefits of testing / early treatment ; or complacency ( " AIDS can be treated these days " ! ).


    Clearly, even better would be PREVENTION in the first place - more responsible behaviour ; use of condoms ; and even " prophylactic " / protective drug treatment in advance for those most at risk.


  9. #9
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    Just think, cures for this and many cancers should happen in our lifetime. Awesome

    Now what does mother nature have planned for us next ...


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    Quote Originally Posted by Trefor View Post
    Just think, cures for this and many cancers should happen in our lifetime. Awesome

    Now what does mother nature have planned for us next ...
    Two very interesting comments .


    HIV infection may well be cured in our lifetime. It’s also likely at least one vaccine will become available. A very occasional patient may have naturally occurring antibodies against HIV - such antibodies are good for studying experimental vaccines.



    As for " cures for many cancers " and " what mother nature may have planned for us next ", those are topics for a whole new thread ( see http://bit.ly/1XVcXqM ).


  11. #11
    Moderator fred's Avatar
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    It’s also likely at least one vaccine will become available. A very occasional patient may have naturally occurring antibodies against HIV - such antibodies are good for studying experimental vaccines.
    Problem is....How would they ever know they had it in the first place?
    Do you mean those that have been tested HIV + but then a year later they were tested again and no trace of it??


  12. #12
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    Quote Originally Posted by fred View Post
    Problem is....How would they ever know they had it in the first place?
    Do you mean those that have been tested HIV + but then a year later they were tested again and no trace of it??

    The only way to confirm HIV infection is by testing body fluids ( usually blood ) for antibodies, and ideally also for antigens ( viral proteins ) ; there may be no symptoms ( or only nonspecific " ‘flu-like " symptoms ), and AIDS only results months or years after undetected - therefore untreated - infection.


    For reasons given already, many people living with HIV infection are either undiagnosed, or diagnosed late.


    However, those who ARE tested include sex workers, homosexual or heterosexual subjects who have a history of possible infection through their sexual behaviour, children borne to HIV positive mothers, intravenous drug users, and healthcare workers who may have been accidentally exposed to the virus. These people who consent to testing are helping not only themselves but also others to receive better treatment, and ultimately cure for this terrible infection.


    The immune system generates many responses - both antibody formation and T cell responses - to different viral antigens. Not all antibodies and T cell functions are routinely tested.


    Immunology is a complicated topic, and individual responses vary from none detectable ( these patients have HIV virus and are likely to die from AIDS ) to " broadly neutralising antibodies " ( giving protection against different strains of HIV ). Since HIV, like other viruses, keeps mutating, it’s these uncommon broadly neutralising antibodies which will probably be the best hope for developing future vaccines.

    http://bit.ly/22EFKH1


  13. #13
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    Worldwide, AIDS-related deaths almost halved since 2005, to around a million last year *. This is mainly because more people with HIV are being treated. Both sexes have similar rates of infection.

    The rate of new infections is also falling, less than 2 million in 2016.


    Antiretroviral drugs can keep symptoms at bay indefinitely, although there is as yet no cure - no medication will clear viruses from someone’s body completely, nor is there a vaccine.


    " UNAID ", United Nations body charged with combating HIV and AIDS, has set a goal for 2020 which seems realistic - that 90% of those who are infected will know their HIV status, 90% of those will be on treatment, and in 90% of those ( ~3/4 of the total ), treatment will be effective.


    The UK already reaches this goal. It’s recently been suggested that screening for HIV in primary care should be promoted in areas where it’s known to be relatively common. Early diagnosis and treatment has advantages, but more work for GPs. Most testing is still in sexual health and antenatal clinics. More hospital HIV testing - obviously with informed consent - has also been suggested. The stigma and fear of a positive test for HIV * could be reduced further.


    There’s been good progress in the world’s most affected areas ( eastern and southern Africa ), but less positive elsewhere, such as Russia and Ukraine.


    There appears to have been a genuine increase in the number of new HIV infections in the Philippines * over the past few years. It’s said to be the fastest growing epidemic in southeast Asia. While 10 years ago one new case was diagnosed every day, last year 26 Filipinos contracted HIV daily. New infections are said to be concentrated in key populations - men who have sex with men, transgender women, and injection drug users. President Duterte’s war on drugs - while widely supported in the country - may well have had the unintended consequence of increasing HIV infections. Lack of promotion of condoms - and lack of awareness of their effectiveness - are other factors. Funding on HIV/AIDS control was less than $15 million in 2015 - mostly from international sources.


    There is no room for complacency, either in the Philippines; or worldwide, where just over half of people living with HIV are on treatment … but 17 million are not.

    ( * Left click on underlined text to read links )


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