How useful is pre-exposure prophylaxis (PrEP)? The Partners PrEP randomized control study of daily pre-exposure prophylaxis among HIV-uninfected partners of heterosexual HIV-discordant couples in Uganda and Kenya has indicated that, given adequate adherence, PrEP has high biologic efficacy. The study itself (Baeten & Celum) demonstrates levels of risk reduction of 75%; while a spin-off sub-study […]
Category: HIV infection
UNAIDS assesses progress towards #HIV Millennium Development Goal
In the run-up to the 2013 General Assembly of the UN in New York, a new report from the Joint United National Program on HIV/AIDS seeks to give an overview of progress to date towards Millenium Goal 6 – the goal of halting and beginning to reverse the HIV/AIDS epidemic by 2015 (UNAIDS Report 2013). […]
HIV+ mothers without ART: when and how should they wean?
Without antiretrovirals, breastfeeding contributes 28% to the risk of mother-to-child HIV transmission (MTCT) (http://sti.bmj.com/content/88/Suppl_2/i44.abstract?sid=fcfaeecc-767f-4db8-b644-77db5aa8db63). Antiretroviral drugs make achieving he WHO goal of near elimination of MTCT imaginable (http://sti.bmj.com/content/87/3/261.full; http://sti.bmj.com/content/86/Suppl_2/ii48.abstract?sid=fcfaeecc-767f-4db8-b644-77db5aa8db63). But, in the meantime, what advice should be given to HIV+ mothers in those low-resource settings where antiretrovirals are still not available? In this context, the […]
The dapivirine ring: success at last for a vaginal microbicide?
The International Partnership for Microbicides (IPM) has just announced the launch of a trial (IPM 027) to evaluate the effectiveness of the antiretroviral (ARV) drug dapivirine delivered by means of a monthly replaceable vaginal ring (http://www.ipmglobal.org/node/670). The IPM study, which has enrolled 1,650 women at four sites in South Africa, is part of a broader […]
HIV and breastfeeding in Africa: balancing the risks
One area in which the recent wide scale deployment of ARV could have the greatest impact is that of mother-to-child HIV transmission (PMTCT). The UNAIDS goal is for total elimination of PMTCT by 2015 – though this is scarcely feasible (STI 2010:86 Suppl.II – especially M. Mahy et al. (http://sti.bmj.com/content/86/Suppl_2/ii48.full?sid=50f44956-1266-4dd0-bed1-08ebd39bb60a)). A component of the PMTCT […]
Putting Rectal Microbicides “On the Map”
17th April saw the launch of the report: On the Map: Assuring Africa’s Place in Rectal Microbicide Research and Advocacy by the International Rectal Microbicide Advocates (IRMA) On the Map: Ensuring Africa’s Place in Rectal Microbicide Research and Advocacy . The report has been developed by African advocates and researchers on the basis of an […]
How infectious are HIV+ MSM on ART?
How effective is HAART (highly active antiretroviral therapy) in preventing HIV transmission among MSM (men who have sex with men)? The recent HPTN (HIV Prevention Trials Network) 052 clinical trial demonstrated, to great acclaim, that with heterosexual sero-discordant couples early initiation of HAART is associated with 96% reduction in HIV transmission. Yet there are reasons […]
Desperation over withdrawn HIV program funding in Myanmar
At 120,000 cases in a population of 42m, the prevalence of HIV in Myanmar is not enormous by global standards. Yet with ART coverage among the lowest in the world, the death rate from HIV is estimated at 15,000-20,000 per year. Add to this an epidemic of multi-drug resistant (MDR) TB of three times the […]
Modelling ART impact on HIV prevention within discordant couples
The HPTN 052 study, discussed in an earlier blog, appears to offer a godsend: a demonstrated 96% reduction in HIV transmission in discordant couples using antiretroviral therapy (ART). Apparently, the extension of ART conveys an additional, and unexpected, benefit in its potential impact on prevention. But how do we quantify the additional benefit? A recent […]
Costing the scale-up of voluntary medical male circumcision
The end of November saw the first in a series of nine new articles produced by researchers associated with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United States President’s Emergency Plan of AIDS Relief (PEPFAR). This article proposes a rapid (five-year) scale-up of voluntary medical male circumcision (VMMC) in 13 priority sub-Saharan […]