Researchers have used the cutting-edge CRISPR/Cas9 gene-editing
technology to identify five potential targets for HIV treatments,
including three new discoveries. Because these targets are all human
genes, treatments that go after them are likely less likely to give rise
to drug resistance compared with existing antiretrovirals (ARVs) that
target proteins crucial to the rapidly mutating virus’s life cycle. Publishing
their findings in the journal Nature Genetics, researchers used CRISPR
to screen a cell line taken from human CD4 cells, which HIV targets.
They found five human genes that when switched off, protected the CD4
cells from infection with the virus without affecting the cells’
survival. The two previously identified genes were the
CCR5 gene, responsible for the coreceptor on the surface of CD4 cells
to which most HIV attaches in order to infect the cell, as well as the
CD4 gene itself. The researchers also identified two
enzymes, known as TPST2 and SLC35B2, that modify the CCR5 coreceptor in
order to facilitate the virus’s effort to bind to it. The other new gene
they identified is known as ALCAM, which helps CD4 cells stick to one
another, which facilitates the transmission of HIV from cell to cell. To read a press release about the study, click here. To read the study abstract, click here.
The newly established Evergreen Fund is awarding a total of $1
million to eight projects focused on accelerating research in cancer and
HIV, according to a press release from the Fred Hutchinson Cancer Research Center, which launched the fund. “The
Evergreen Fund is an innovative, bold initiative by the Hutch to
promote commercialization of its latest research into lifesaving
therapies for cancer and other diseases,” said Gary Gilliland, PhD,
president and director of Fred Hutch. “We firmly believe it will lead to
new ventures and partnerships that will significantly improve outcomes
in the battle to defeat cancer and other diseases. It’s a new chapter in
our ongoing commitment to creating enterprises that will be
game-changers for global health.” Among the grantees
is Andrew McGuire, PhD, who “is working on a novel approach to elicit
broadly neutralizing antibodies to trigger an immune response that will
ultimately lead to development of an effective HIV-1 vaccine,” according
to the press release. Also related to HIV is the work
of Hans-Peter Kiem, MD, PhD, whose research involves a method to purify
and gene-modify stem cells for therapeutic use. The press release
states: “Worldwide millions of people suffer from malignant, genetic or
infectious blood diseases such as leukemia and HIV/AIDS. The Kiem lab
has identified a stem cell population using preclinical small and large
animal models to demonstrate this population of cells can quantitatively
predict engraftment and repopulation of blood cells. The goal of the
proposal is to translate this into clinical practice and overcome major
barriers that limit the broad utilization of gene-modified hematopoietic
stem cell transplants.” Other grant recipients are
studying the enhancement of T-cell immunotherapy and ways to measure
components of the immune system. For a complete list, click here. In related news, HIV has been officially listed as a cancer hazard to humans.
Volunteers from the Andrey Rylkov Foundation distributing free needles, condoms and other supplies from a truck in Moscow.Credit
Max Avdeev for The New York Times
ST. PETERSBURG, Russia — Quietly, the number of Russians who have received a positive H.I.V.
diagnosis passed the one million mark this year. There is, however,
little indication that the government will commit adequate resources to
stem the acceleration of the virus from high-risk groups into the
general population.
About
850,000 Russians carry H.I.V. and an additional 220,000 have died since
the late 1980s, said Vadim Pokrovsky, the longtime head of the
Moscow-based Federal AIDS Center, who estimated that at least another
500,000 cases of H.I.V. have gone undiagnosed.
Although
the label “epidemic” prompts denials from some senior officials,
experts on the front lines like Mr. Pokrovsky are calling it just that.
The overall estimate of victims constitutes about 1 percent of Russia’s
population of 143 million, enough to be considered an epidemic, they
argued. Beyond that, they said that heterosexual sex would soon top
intravenous drug use as the main means of infection.
“This
can already be considered a threat to the entire nation,” Mr. Pokrovsky
said, noting that the caseload is increasing by about 10 percent a
year. In 2016, 100,000 new infections are anticipated, about 275 daily.
It is the largest H.I.V. epidemic in Europe and among the highest rates
of infection globally.
Despite
the grim milestone, experts do not expect much change in Russia, where
victims still face the kind of stigma prevalent in the 1980s in the West
and where continuing trench warfare between the Kremlin and independent
nongovernmental organizations saps collective efforts. In addition,
some prominent voices push “family values” as the ideal prevention
program.
In
many ways, Russia’s fight against H.I.V. is a case study in the
constant tension between civil society and a Kremlin under President
Vladimir V. Putin; public activity outside government control is
considered inherently suspect. Tensions heightened this year after the
Justice Ministry blackballed a number of bantam N.G.O.s involved in
combating H.I.V./AIDS as “foreign agents” because they received grants
from abroad.
Anton Krasovsky, a prominent talk show host fired in January 2013 after coming out as gay on air, says he has spent his personal savings building an N.G.O. that tries to bridge that divide.
“Since
we are not talking about fighting Putin, but fighting a virus, people
have to understand that they can fight this virus only if they are on
the same side as Putin,” Mr. Krasovsky said. “It is impossible to change
the situation without coming to some kind of an agreement.”
Volunteers for the Andrey Rylkov Foundation must attach the label “foreign agent” to the plastic bags they distribute.Credit
Max Avdeev for The New York Times
The
president has remained largely silent on H.I.V. Over all, activists
said, the combination of indifference toward victims, government
financial austerity, hostility toward foreign funds and a powerful camp
of AIDS deniers all amounts to the lack of a coherent national effort.
Experts
criticized a new, rather vague Russian government strategy on fighting
H.I.V. that was released in October for lacking a plan of execution or
any new money.
Despite
that, both sides in the H.I.V. battle agree that Russia has made some
progress. The fact that a national strategy exists — as well as an
advertising program promoting H.I.V. tests backed by Svetlana Medvedeva,
the wife of the prime minister — at least implies some high-level
interest.
In
St. Petersburg, one married couple, Dr. Tatiana N. Vinogradova and
Andrei Skvortsov, straddles the government-N.G.O. divide on the issue.
Dr.
Vinogradova, slim beneath her white coat, with bobbed brown hair and
beige stilettos, is a third-generation H.I.V. warrior. Her grandmother,
an infectious-diseases specialist, treated one of the first patients in
St. Petersburg in the late 1980s and pushed the city to establish an
AIDS Center. Dr. Vinogradova’s mother ran it, and she herself is now its
deputy head of scientific research.
Mr. Skvortsov, wiry, scrappy and H.I.V. positive — a reformed drug addict and ex-convict — runs a small N.G.O. called Patients in Control.
It was founded in 2010 to try to cajole, pressure and embarrass both
federal and local governments into providing government-guaranteed
treatment.
At the St. Petersburg AIDS Center, Dr. Vinogradova, 41, has seen the prevalence among drug addicts shrink while cases among heterosexual couples soar.
“Calling
it an epidemic would be akin to admitting that the government let the
problem get out of control over the past 30 years,” she said, explaining
why the government avoids the term. But she uses the national strategy
and any official statements she can find to try to wring more money out
of politicians. “This is Russia, so everything has to be top down to get
anything done.”
The
couple has tried to use their marriage to help break the stigma that
the disease is an untreatable plague limited to drug addicts,
homosexuals or others likely to die anyway.
Dr. Tatiana N. Vinogradova
and Andrei Skvortsov, who is H.I.V. positive, have used their marriage
to help break the image of H.I.V. as untreatable.Credit
Max Avdeev for The New York Times
“I
watch people jump back a meter when he says he is living with H.I.V.,”
Dr. Vinogradova said, with older medical professionals particularly
still fearful despite the raft of evidence that anyone taking antiviral
drugs is not infectious. “Now whenever I hear about H.I.V.
discrimination, I take it as a personal offense.”
When
her husband needed an operation last year to repair with a metal
implant a collarbone broken in a motorcycle accident, the surgeon
refused after discovering his H.I.V. status. Mr. Skvortsov, 37, recently
appeared on a talk show with Evgeniya Prokhoda, an H.I.V. activist in
the southern city of Krasnodar, and one of the first Russians to speak
about carrying the virus on national television without hiding her face.
She
detailed the gantlet of fear and discrimination she had faced,
including when authorities put her son in an orphanage for about a year
after her own mother sued to have him removed from home. The day after
she appeared on television, Mrs. Prokhoda was fired.
Activists and experts always come back to the lack of government support as the root problem.
Under World Health Organization guidelines, to reduce the spread of the disease, at least 90 percent of H.I.V.-positive patients should receive antiviral drugs.
In
Russia, a little more than 37 percent receive such treatment, according
to government statistics. “The prevention programs are not working, the
coverage is not sufficient to break the curve,” said Vinay P. Saldanha,
the Unaids regional director for Eastern Europe and Central Asia.
Russia
is among five countries that account for almost half the new infections
globally; the others are South Africa, Nigeria, India and Uganda,
according to Unaids figures, although in some of them, a much higher percentage of the overall population is infected.
Most
of the $338 million annual Russian federal H.I.V. budget is spent on
medicine, and almost nothing goes to preventive education. Veronika
Skvortsova, the health minister, has repeatedly called expanding
treatment programs a government priority. (The minister is not related
to Andrei Skvortsov.) After a deep recession, however, little new money
has materialized.
At the same time, the Russian Orthodox Church and some politicians promote “conservative values” as the best way to combat H.I.V.
Patriarch
Kirill called for “moral education,” stressing that the “establishment
of family values, ideals of chastity and marital fidelity” should be at
the forefront of curbing the virus.
A poster of Dr. Vinogradova
and Mr. Skvortso in St. Petersburg encouraging people to get tested for
H.I.V. “I know that there are no barriers to my love,” the poster reads.Credit
Max Avdeev for The New York Times
Both
the government and the church staunchly oppose sex education for
children. One senior government official stated that classical
literature was the best teacher.
The
state also adamantly opposes methadone for drug addicts, sometimes
denigrated as a “narcoliberal” scheme. In other countries, methadone
programs are used both to treat and to monitor patients infected by
intravenous needles.
The
emphasis on traditional values dismays those fighting the disease.
“Traditional values just means leaving everything as it is,” Mr.
Pokrovsky said. “If we have traditional values and do nothing, the
epidemic will keep spreading.”
Compounding
the problems, the federal government has tried to silence organizations
that challenged its policies, labeling them “foreign agents” for
receiving grants from abroad, forcing some to close.
The Andrey Rylkov Foundation for Health and Social Justice, which hands out free needles and condoms
in southern Moscow, now has to staple a small label to its plastic bags
saying “Foreign Agent” as required by law. Recipients said they could
not care less, but it means that the foundation cannot work with
government organizations.
“H.I.V.
is not a personal problem, it is a social problem, and it should be
solved as a social problem,” Elena Plotnikova, who works for the
foundation, said as she handed out supplies. “The basic attitude of the
government is: You made a bad decision and we are not going to help
you.”
N.G.O.s
are considered crucial to reaching populations that avoid government
contact, including drug addicts, prostitutes and gay men. Help varies
widely from city to city. St. Petersburg is perhaps the most
enlightened, treating all comers to its clinic and sponsoring an advertising campaign.
Dr.
Vinogradova and Mr. Skvortsov appear together on one poster encouraging
people to get tested. The couple is startlingly open about their sex
life, stressing that his being on antiviral drugs means that she remains
H.I.V. negative even though they do not use condoms.
In
the poster, wearing navy blue shirts, they stare into each other’s
eyes. “I know that there are no barriers to my love,” reads the text.
“H.I.V. is not an obstacle to creating a family; it’s possible to live a
long life with H.I.V.”
____________
Oleg Matsnev contributed reporting from St. Petersburg, and Sophia Kishkovsky from Moscow.
Sovaldi (sofosbuvir)-based hepatitis C virus (HCV) regimens may
negatively affect the body’s ability to process the commonly prescribed
HIV antiretroviral (ARV), Viread (tenofovir disoproxil fumarate, or
TDF), Healio reports.
Sovaldi is included in the
fixed-dose combination hep C regimens Harvoni (ledipasvir/sofosbuvir)
and Epclusa (sofosbuvir/velpatasvir) and is also used in combination
with other stand-alone tablets such as Daklinza (daclatasvir) and Olysio
(simeprevir).
Viread (tenofovir disoproxil fumarate,
or TDF) is included in Truvada (TDF/emtricitabine), Atripla
(efavirenz/TDF/emtricitabine), Stribild
(elvitegravir/cobicistat/emtricitabine/TDF) and Complera
(rilpivirine/TDF/emtricitabine).
Publishing their
findings in the Journal of Hepatology, researchers studied small
portions of cells known as microsomes taken from the liver cells of 20
people and the kidney cells of 12 people. They found that Sovaldi
inhibited the chemical breakdown, or hydrolysis, of both liver and
kidney microsomes and that the drug inhibited the enzyme
carboxylesterase-2 (CES-2).
CES-2 is known for its
detoxification effects and is found in great quantities in the liver and
kidney. It normally breaks down through hydrolysis and activates
Viread.
The researchers believe that the
Sovaldi-prompted inhibition of the enzyme may have implications for
Viread-related kidney toxicity. They recommend that people take these
two drugs at different times or administer them in different ways, i.e.,
not both as oral drugs, until clinical trials can fully analyze the
risks of combining them.
By offering free self-serve water, gay bars may reduce drunkenness
among their patrons and in turn men’s risk of contracting HIV, SF Weekly
reports. Alcohol intake may impair an individual’s judgment and lead to
sex that poses a greater risk of HIV transmission. Researchers
from the University of California, San Francisco and the San Francisco
AIDS Foundation conducted a study in which they placed cups and water
pitchers at two gay bars in San Francisco. They conducted Breathalyzer
tests on patrons leaving these bars as well as on those departing two
control gay bars that did not have free water stations. The
investigators found that the men in the two bars with the water
stations left the establishments less intoxicated than those who left
the control bars. There’s no word yet on whether bar owners would be keen on a scheme that would reduce the number of drinks patrons order. To read the SF Weekly article, click here.
Truvada, the other "little blue pill," is taken daily to prevent HIV and has been touted as a miracle drug responsible for lowering HIV rates
across the United States. But soon, the daily pill may be overshadowed
by an even simpler method—a single flu shot-like injection at the
doctor's office, once every two months.
The National Institutes of Health (NIH) announced
last week that it was entering the first-ever global clinical trial of
an injectable HIV-prevention drug called cabotegravir. The trial is
taking place in eight countries across three world regions—the Americas,
Africa and Asia—and researchers are enrolling 4,500 gay and bisexual
men along with transgender women, pulling from groups with the highest
rates of new infections.
"The annual number of new HIV infections among young people,
especially young men who have sex with men and transgender women who
have sex with men, has been on the rise despite nearly flat HIV
incidence among adults worldwide," said Raphael J. Landovitz, the
Protocol Chair for the study.
In the U.S., the Centers for Disease Control reported new HIV diagnoses have declined
by nearly 20 percent—mostly among white gay and bisexual men. But HIV
rates are on the rise for men of color and transgender women, as well as
youth. Data suggests the disparity might be due to Truvada itself: A
2016 study found 74 percent of Truvada users were white, and the number
of black users dropped between 2012 and 2015.
RELATED: Black Gay, Bisexual Men Have 50 Percent Risk of HIV Patients participating in the new study will be
randomly assigned to receive Truvada pills or cabotegravir injections,
to compare the injectible drug's efficacy with the established PrEP
pill. Currently, Truvada is the only commercially available pre-exposure
prophylaxis (PrEP) medication, and the only FDA-approved HIV-prevention
method, period.
Bottles of antiretroviral drug Truvada are displayed at Jack's Pharmacy on November 23, 2010 in San Anselmo, California. Justin Sullivan / Getty Images
Dr. Anthony Fauci, director of the National Institute of Allergy and
Infectious Diseases at the NIH, told NBC Out the hope is the injectable
PrEP drug will work as well as Truvada—which currently has a roughly 99 percent rate of success in preventing transmission of the HIV virus. "The ultimate reason for the trial is that many
people who take Truvada have difficulty with having to take a pill every
single day," Fauci said. "That really becomes prohibitive, and
sometimes people don't adhere really well."
Fauci explained that while it would be ideal for
patients to only have a shot once a year, for example, the 8-week
period is how long cabotegravir stays in the system inhibiting the virus
from taking hold. If the current trial is successful, he predicted,
researchers will likely begin to tweak the drug's chemical makeup in an
effort to make it last longer.
Full results of the trial are expected by 2021
but could come even sooner. A related trial testing the injections on
cisgender young women is slated to begin in 2017.
RELATED: New Study Shows HIV Epidemic in New York in 1970 The stunning efficacy rates of Truvada have
launched a race to expand the market. Researchers are currently studying
an HIV vaccine that uses antibody injections, a microbicide gel that
can be used as a sort of HIV-prevention lube and a slew of other HIV
drugs for treatment and prevention. Damon Jacobs, an HIV-prevention specialist who moderates the 15,000-member Facebook group PrEP Facts: Rethinking HIV Prevention and Sex, told NBC Out the plethora of future prevention methods looming on the horizon is "wonderful."
"It's not going to be one size fits all," he
said. "Just like with birth control: some women take the pill, some get
an IUD. I'm glad we're going in that direction for PrEP as well."
According to Jacobs, the PrEP race in medicine
is happening because of Truvada's runaway success. While the studies
showed Truvada prevents HIV transmission at near-total rates, it's only
over the course of the past couple years that the wider effects have
been seen. Truvada was introduced commercially in the U.S. after its FDA
approval in 2012—since then, New York City has announced new HIV rates fell below 2,500 for the first time since the epidemic exploded in 1981. Jacobs said PrEP was largely responsible for the decline.
"We're seeing how well it works for communities when there's wider
implementation and access," Jacobs added. "We're looking at areas where
the use of PrEP is being validated by local governments—subway ads,
newspaper ads, doctors being supportive of it."
There are still kinks to be worked out when it comes to PrEP. Truvada is expensive, and some communities—particularly gay and bisexual black men, who are at the highest risk for new infections—report frustrating experiences with doctors reluctant to offer PrEP medication.
And within the gay community, critics suggest some men may be overly
reliant on PrEP alone, rather than using condoms in addition to the
drug.
RELATED: AIDS Activists Still Fight Stigma But Jacobs said condoms and PrEP aren't an
either-or scenario. Truvada, he said, is filling the space that was left
empty years ago in terms of HIV prevention.
"Even when the consequences of not using condoms
was death, people weren't using them," he said. "Why would you think
they're going to start using them now?"
New drugs like cabotegravir are poised to fill even more gaps. One early study of Truvada (the "iPrex"
trial) showed that while 93 percent of study subjects reported taking
the daily pill, only 51 percent actually kept up the regimen. For
patients who don't adhere well to daily medication, a shot every two
months is a highly desirable alternative.
For Jacobs, who works as a marriage and family
therapist in addition to educating people about PrEP, the expansion of
HIV-prevention methods is a boon not only to the health of Americans,
but also to their emotional and sexual wellness.
"People are having sex for pleasure, to
experience intimacy and connection with a partner," Jacobs said. "These
studies are beautiful, because they will allow more people to connect in
meaningful ways."
The Bill & Melinda Gates Foundation is investing up to $140
million to support development of a tiny implantable drug pump it
believes could help prevent people in sub-Saharan Africa and elsewhere
from becoming infected with HIV, the virus that causes AIDS.
The
matchstick-size pump is being developed by Intarcia Therapeutics Inc., a
closely held Boston-based biotechnology company. It can hold six or 12
months’ supply of medicine and is designed to deliver micro doses
continuously to patients, ensuring they stay on the treatment for up to a
year.
The new investment, which Intarcia is announcing Thursday,
comes amid a flurry of fresh efforts to develop HIV prevention
strategies.
Last week, for instance, the National Institute of Allergy and
Infectious Diseases announced the launch of a global 4,500-patient
clinical trial to test whether injections every eight weeks of an
experimental HIV drug, cabotegravir, from U.K.-based ViiV Healthcare is
effective in preventing HIV infection. Last month, the first efficacy
study of an HIV vaccine in seven years was launched in South Africa.
This is “one of the most exciting years ever in HIV prevention,” said Mitchell Warren, executive director of AVAC, a global HIV advocacy organization supported by the Gates Foundation.
Progress
is needed. Despite major gains against HIV and AIDS in the past two
decades, some 1.9 million people become infected with the virus each
year, the Joint United Nations Programme on HIV/AIDS estimates. The
majority are in resource-poor regions such as sub-Saharan Africa, where
the epidemic’s toll has been especially severe.
Experts worry
that without effective prevention efforts, an emerging generation of
young people are at risk of becoming infected.
“If we don’t find a
way to prevent infection, we’re going to wind up with more people
infected in that part of the world than we have now,” said Emilio Emini, director of the HIV program at the Gates Foundation.
Using the pump in this manner would fit a prevention strategy called pre-exposure prophylaxis, or PrEP.
Gilead Sciences Inc.’s
daily pill Truvada, the only drug regulators have approved for PrEP,
has been shown in clinical trials to reduce risk of HIV infection by
more than 90%. It is becoming available in generic versions in some
African countries.
Bill and Melinda Gates in February. Mr. Gates visited Intarcia’s Boston headquarters in June.
Photo:
Shannon Stapleton/Reuters
But “its real-world effectiveness is much lower than that because you
have to take a pill” every day and getting healthy people to do so is
difficult, Dr. Emini said. That’s what makes Intarcia’s pump so
attractive, he said. “You put it in and you forget it,” he said,
likening it to long-acting forms of contraception. “You can immediately
imagine how it could be applicable.”
Under terms of the
agreement, the foundation will take a $50 million equity stake in the
company and provide up to $90 million more in grants, pegged to certain
research milestones toward development of the device.
The money
comes from a $1.5 billion fund the foundation has set aside apart from
its larger grant-funding operation to make investments in technologies
being developed in the private sector. The goal of the fund isn’t to
generate a financial return but to back ideas with equity, loans and
other financing that advance the foundation’s charitable mission, Andrew Farnum, the foundation’s director of program-related investments, said in an interview.
The
Intarcia deal is one of about 50 such investments the foundation has
made since 2009. The pump would likely find a market in the U.S. and
other wealthy countries, but “the ultimate goal is developing an HIV
prophylaxis device that will save lives in the developing world,” Mr.
Farnum said.
Intarcia has already developed a version of the pump
loaded with the diabetes drug exenatide as a treatment for patients
with Type 2 diabetes. The company filed an application with the U.S.
Food and Drug Administration last month to market the device, called the
ITCA650. If all goes well, it could be on the market by the end of
2017.
It took a decade to develop. The challenge the company
faced was to come up with a formulation of exenatide that would remain
stable at body temperature for at least a year and that was potent
enough to be effective at the micro doses delivered by the pump. The
company mounted several phase 3 clinical trials, which demonstrated its
efficacy in controlling blood sugar.
“We’re going to basically take that same approach” with an HIV drug, said Kurt Graves, Intarcia’s chairman, president and chief executive officer.
The $50 million in equity is part of a larger round of new financing for Intarcia totaling $206 million, Mr. Graves said.
The
foundation, which considers prevention a critical component of its
efforts to combat HIV, first heard about the Intarcia pump about a year
ago while searching for technologies with the potential to provide
long-term protection against the virus.
As part of the due diligence, Bill Gates visited Intarcia’s Boston headquarters in June, where he and Mr. Graves discussed the technology for nearly two hours.
The
company and the foundation haven’t decided which HIV drug to put in the
pump, but Mr. Graves said initial tests indicate “we have a very good
probability of success” in coming up with an effective formulation. It
will likely take several years before the pump reaches the market. If
they are successful, the agreement is intended to make sure the pump
available and affordable to poor populations in the developing world.
Even when people’s HIV is well treated with antiretrovirals (ARVs),
their risk of heart attack is apparently nearly double that of the
general population. This risk is likely driven by the
chronic inflammatory state to which HIV gives rise, even when the virus
is suppressed to undetectable levels. Lifestyle factors such as smoking,
which is more common among the HIV population, also likely play a role. Researchers
also found that a standard calculator for estimating the risk of heart
attack and stroke underestimates the risk for those living with HIV. Publishing
their findings in JAMA Cardiology, researchers studied a multicenter
clinical cohort of people receiving care at one of five Centers for AIDS
Research Network of Integrated Clinical Systems sites in the United
States. The scientists looked at data on 19,829 people
who had received inpatient and outpatient care since 1995. Ultimately,
they narrowed the cohort to 11,288 people with sufficient data. The
study authors found that even when members of the cohort had an
undetectable viral load, they still had about a 1.5- to 2-fold increased
risk of heart attack or stroke compared with the general population.
The risk of heart attack and stroke was also about 50 percent higher
than predicted by a common algorithm used to predict such risk in the
general population. The researchers believe that
scientists should develop a new cardiovascular disease–predicting
algorithm specifically for HIV-positive people. Among
the HIV-positive cohort, the rate of heart attack per cumulative 1,000
years of follow-up was higher for black men (6.9) and black women (7.2)
compared with white men (4.4) and white women (3.3). The rates per
cumulative 1,000 years of follow-up were also higher for people age 40
and older (7.5) compared with those younger than 40 (2.2) and for those
who were not virally suppressed (6.3) compared with those who were
virally suppressed (4.7). To read the study abstract, click here. To read a press release about the study, click here.
We write frequently about our commitments to following the
science, tracking data, gathering user feedback, and responding to the
community’s needs—and our name change honors those commitments. We want
our program to reflect today’s science, as well as the terms most of our
visitors use to tell their stories about HIV or to search for information about HIV and AIDS on our website.
As we prepare for this name change, we’ll share updates and
feedback we receive. After the changeover, our program, which is funded
through the Secretary’s Minority AIDS Initiative Fund, will automatically redirect users who search for “AIDS.gov” to the new URL (or web address). We look forward to sharing more with you soon! For more
details about our name change, read below. And we look forward to your
feedback.
What factors are driving the change?
For more than a year, we’ve been listening to how people
talk about HIV and AIDS, and we asked our partners and users for their
input on the name change. We’ve also been watching how the terms are
used on other websites and social media, and we assessed how they’re
used on our site. Here’s what we found:
Science is advancing: In the
beginning of the epidemic, the term “AIDS” became implanted in the
public’s mind because it was used in the popular press before
researchers identified the cause of AIDS and an international committee
of scientists named it the Human Immunodeficiency Virus (HIV).
Today, people with HIV who are diagnosed early, linked to
care, start antiretroviral therapy (ART), and take it as prescribed, can
achieve life-long viral suppression that prevents HIV infection from
progressing to AIDS. Viral suppression improves health outcomes for
people living with HIV (PLWH), reduces HIV-related deaths, and prevents
transmission of the virus to others. AIDS has not gone away. People in
the United States and around the world still develop AIDS and die from
its complications. But as our ability to treat HIV infection has
improved again and again over the years, AIDS is no longer an expected
outcome of having HIV. Today, stopping the progression of the disease
before AIDS develops by suppressing the virus to very low or undetectable levels
is the primary aim of HIV medical care. Effective ART means that almost
everyone living with HIV can achieve viral suppression, including many
of those who had been diagnosed with AIDS in the past.
There are other reasons for focusing now on HIV rather than
AIDS. Since 2010, a string of major scientific advances have
dramatically improved our ability to prevent HIV transmission. Key
studies showed that early treatment of PLWH could reduce transmission of
the virus to HIV-negative partners by 93 percent over extended
follow-up [through TasP] (HPTN 052), and that taking a daily pill containing HIV drugs [PrEP] significantly lowered the risk of an HIV-negative person contracting the virus (iPrEx study, the TDF2 Study, and the Partners PrEP trial ).
Searches are changing: Today, twice
the number of people who come to our website from internet searches use
the term “HIV” rather than “AIDS.” In addition, the majority of the
social media conversations we participate in focus on the term “#HIV.”
Changing our name to HIV.gov will improve our ability to help our users
find the information they need.
Stories are evolving: In the early
days of the epidemic, the public often referred to “AIDS victims.” But
many people living with AIDS pushed back against that [phrase] because
they did not see themselves as “victims.” They asked to be called
“people with AIDS,” and this marked the beginning of a movement by those
with HIV to define themselves on their own terms.
Now many of the people living with HIV with whom we work
across the nation use the term “HIV” more often than “AIDS” to discuss
themselves and the wider HIV community.
We see this in the personal stories shared by those who are HIV-positive in our Positive Spin digital storytelling initiative and in our Black Voices blog series, as well as in other resources by and for the community.
What did our partners say?
Our partners tell us that the pending name change reflects
the progress we’ve made over 35 years of the epidemic and reinforces
that it’s now possible for individuals to live long and healthy lives
with HIV.
Our partners also noted that the term “AIDS” continues to
make it difficult to serve key populations at risk for/living with HIV
infection. “A big reason youth from communities of color and the LGBT
community don’t come into the healthcare system is because they
experience more stigma associated with AIDS. Talking about HIV in its
current state and that it’s not a death sentence helps people come into
my clinic, get on treatment, and be able to live life. I think other
physicians would also welcome the chance to get out of the AIDS mindset
and help people live,” said Michelle Collins Ogle, at the Warren-Vance
Community Health Center, Inc.
“So many people have worked so hard and fought for so long
to get us to this place. I started doing this work in 1985 when the
reality of living with HIV was so very different than it is today. I
cannot tell you how happy I am about the progress that has been made,
but our work is far from over,” said Dr. Richard Wolitski, director of
the Health and Human Services Office of HIV/AIDS and Infectious Disease Policy.
“Now people with HIV can live just as long as their HIV-negative peers.
I’ve been living with HIV for more than 20 years, and I don’t expect to
ever develop AIDS.”
Wolitski noted: “This change focuses all of us more clearly
on ending HIV, whether that’s stopping transmission or preventing the
destructive effects of HIV on the body. It represents all of us who are
dedicated to stopping HIV transmission and improving HIV care, as well
as those of us who are living with HIV, regardless of whether we have
been diagnosed with AIDS. We will continue working to address the needs
of all people who are at risk for, or living with, HIV. We understand
that the experiences and needs of people living with AIDS can be
different from those of other people living with HIV and that we all
need to take this into account in the work that we do. Together we’ll
continue to work toward our dream of seeing the end of this epidemic. It
is within our grasp, but our work is not over yet.”
MIGUEL GOMEZ (pictured above), is the director of AIDS.gov,
and senior communications advisor of the Office of HIV/AIDS and
Infectious Disease Policy, U.S. Department of Health and Human Services.
This piece previously ran on AIDS.gov.
When President-elect Donald Trump tapped physician and U.S. Rep. Tom
Price as secretary of the Department of Health and Human Services (HHS),
the selection earned a speedy endorsement from the American Medical
Association. But apparently, the AMA does not speak for most doctors—not
even those in its organization. As The New York Times reports, thousands of doctors oppose Price in that role. For
Price to lead the HHS, he will have to be confirmed after a Senate
hearing, which will take place in January. The Times says the growing
dissent among doctors is not likely to harm Price’s confirmation. What is the controversy? Price wants to dismantle the Affordable Care Act,
or ACA (a.k.a. Obamacare), and transform Medicare and Medicaid,
programs for older Americans and low-income people, respectively. Doing
so, one doctor told the Times, would mean that vulnerable patients would
lose insurance benefits and be put at risk. Other doctors criticized
Price’s record on women’s health (he wants to cut off funds for Planned
Parenthood). So why would the AMA, which boasts about
235,000 members, endorse Price? As one doctor told the Times:
“Pocketbook issues—the economic well-being of physicians—may well be a
factor contributing to the AMA’s endorsement.” The Times writes that
“physicians have long been a focus of Mr. Price’s legislative efforts.
He led the push to fix widely recognized flaws in Medicare’s formula for
paying doctors and supported changes in malpractice laws that could
make it easier for doctors to defend themselves. He supported changes in
Medicare that would allow doctors to get around fee limits by signing
contracts with patients. He has also backed changes in antitrust law
that would enhance doctors’ bargaining power in negotiations with
insurance companies.” Other doctors remain staunch
supporters. Patricia Harris, AMA chairwoman, said that Price is “a
longtime member, he’s a delegate. For us, he has always been accessible.
He listens, and he really knows how policies impact the delivery of
care and the physician-patient relationship.”
Gay pop star George Michael has passed away at the age of 53, BBC reports. Michael, who found fame in the 1980s as the lead singer of Wham! later launched a successful solo career, becoming one
of the biggest pop stars of the late 20th-century, selling over 100
million albums. Michael He came out in 1998 after being arrested for
soliciting sex with an undercover police officer in Beverly Hills,
California.
It's not clear the cause of Michael's death, but the BBC says he "passed away peacefully at home." As
rumors began about whether his death was related to HIV, fans took to
social media to condem the idea as "ugly," homophobic, and biased. As Heavy notes, one of Michael's partners, the designer Anselmo
Feleppa, passed away from AIDS-related complications. The British
singer’s song “Jesus to a Child” was reportedly a tribute to Feleppa.
Michael had been an active
supporter of those with HIV since the early days of the AIDS epidemic
and contributed widely to charities. According to the Elton John AIDS Foundation, Michael donated over £1 million from his tour for the album Symphonica to
EJAF which, "enabled the Foundation to set up a special fund
commemorating the AIDS-fighting work of Elizabeth Taylor." The singer
also performed in numerous fundraising concerts like Live
Aid, and the World Aids Day concert. And, "In recent years, he staged a
charity performance at the Palais Garnier Opera House for France’s
biggest AIDS charity Sidaction."
Born in London, Michael would pair up with childhood friend
Andrew Ridgeley to form Wham!. The band broke through with their second
album, Make It Big, released in 1984 and featuring hits like "Wake Me Up Before You Go-Go" and "Careless Whisper."
His 1987 solo album, Faith, was a phenomenon,
featuring the hit title track, along with the controversial, "I Want
Your Sex." The album won numerous accolades, including Album of the Year
at the Grammys. His follow-up, Listen Without Prejudice, Vol. 1,
was a more somber affair. Eschewing his past image as a sex symbol,
Michael released videos like the iconic "Freedom! '90" that didn't
feature him.
Though he continued to release albums and participate in
philanthropic efforts throughout the 1990s, Michael's career was in
decline when he was arrested in Beverly Hills. He would soon come out
and even mock the bathroom incident in his video for the single
"Outside."
Michael struggled with drugs during the past decade and was arrested
several times for possession or driving under the influence. The
singer's health was also suffering; he had a severe case of pneumonia in
2011 and suffered a head injury after falling out of his car in 2013.
