Tweet
The Lancet Infectious Diseases 2006; 6:624
DOI:10.1016/S1473-3099(06)70593-X
XVI International AIDS Conference
Pam Das
Click to enlarge image
Lise Beaudry/IAS
The XVI International AIDS Conference ?Time to Deliver? took place in Toronto, Canada from Aug 13?18, 2006. It provided an opportunity for clinicians, researchers, and policy makers to review current strategies, explore new approaches, and identify the many barriers that are keeping effective HIV/AIDS prevention and treatment from reaching the most vulnerable. Here we report a few of the highlights.
Integrase inhibitors
Click to enlarge image
Lise Beaudry/IAS
Click to enlarge image
Lise Beaudry/IAS
Merck's experimental integrase inhibitor MK-0518 might control HIV more effectively in some HIV-positive people than other drugs on the market, according to studies. Integrase inhibitors stop HIV from inserting its genes into uninfected DNA. The company's decision to expand access to the MK-0518 comes after a 24-week study that found 90% of the HIV-positive people in the trial who took 100 mg to 600 mg of the drug in combination with tenofovir and lamivudine twice daily reduced HIV viral loads to undetectable levels. Most of the viral load reduction took place in the first 4?8 weeks of taking the drug. Furthermore, the MK-0518 combination in all doses reduced the viral load faster than the control group, which was taking tenofovir, lamivudine, and efavirenz. The expanded access programme allows the company to provide the drug internationally to HIV-positive people resistant to current antiretrovirals and is supported by regulatory agencies. Merck will begin enrolling people in the programme in the next few months. The company plans to begin phase III trials, which are expected to involve 700 people.
Drug-resistant tuberculosis
A virulent strain of tuberculosis otherwise known as extensively drug-resistant (XDR) tuberculosis has killed 52 of 53 patients in a rural district in KwaZulu Natal, South Africa. Sputum samples were collected between January 2005 and March 2006. Of the 544 patients studied, researchers found that 221 (41%) of the study participants had multidrug resistant (MDR) tuberculosis, and of these, 53 had XDR-tuberculosis. All of the people with XDR-tuberculosis were HIV-positive, most of whom were carrying a genetically similar strain, and they all failed to respond to first and second-line drugs. According to the study, most deaths occurred within 30 days of individuals having their sputum collected. Most of the participants who died had progressed to AIDS, and about half contracted the XDR tuberculosis at hospitals or clinics. The origins of the South African outbreak are unknown, but misuse of antituberculosis drugs is thought to be one explanation. The emergence of this strain could undermine the efforts to control both these diseases.
Pre-exposure prophylaxis
Pre-exposure prophylaxis (PREP) is intended to prevent HIV infection before exposure to HIV, and involves giving broad spectrum compounds as well as antiretroviral drugs to people at risk. Studies have shown PREP prevents HIV infection in animals. Human trials are underway that investigate the potential of Gilead's Viread (tenofovir) and their combination pill Truvada for PREP use. However, four trials have ended prematurely because of ethical concerns about how the trials are conducted. One study presented at the conference involved 400 HIV-negative women in Ghana, half of whom took tenofovir for 1 year. Half of the women took a placebo. Two study participants taking tenofovir tested HIV-positive at the end of the trial, compared with six women taking the placebo pill. Although the trial was powered to examine efficacy, the results are not statistically significant. Tenofovir was found to be safe despite previous concerns about potential drug toxicity to the kidney, liver, or bones. Futhermore, the women in the study did not have an increased amount of sex and continued to use condoms so PREP did not alter their behaviour. Researchers are conducting studies in Botswana, Peru, and Thailand. These studies are expected to involve about 4600 people, which could solve the question of whether tenofovir and Truvada are effective as PREP.
Entry inhibitors
Schering-Plough reported early data on their experimental drug vicriviroc. In the study, people taking vicriviroc experienced more ?durable drops? in HIV viral levels and rises in CD4+ T cells, compared with a group of people taking a placebo. Five of 90 people taking vicriviroc developed cancer during the study, compared with two of 28 people in the placebo group, which raises concerns about the treatment's link to malignancy. The treatment is in a class known as chemokine receptor 5 (CCR5) blockers, which are known only to block one type of HIV, the R5 virus, which occurs early on in the course of the infection. CCR5 blockers do not attack the X4 virus, a more aggressive virus that occurs later in the infection cycle.
Insite remains open
The legal exemption that allow's North America's only government-sanctioned supervised injection site to operate in Vancouver, Canada, was granted for only another 18 months, and research funding appears to have been cut off. Evaluation of the facility, known as Insite, has shown that it is not associated with increased drug trafficking or crimes commonly linked to drug use. But despite these results, opposition to the site by the Canadian Police Association threatens the potential public-health gains of keeping the site open.
DOI:10.1016/S1473-3099(06)70593-X
XVI International AIDS Conference
Pam Das
Click to enlarge image
Lise Beaudry/IAS
The XVI International AIDS Conference ?Time to Deliver? took place in Toronto, Canada from Aug 13?18, 2006. It provided an opportunity for clinicians, researchers, and policy makers to review current strategies, explore new approaches, and identify the many barriers that are keeping effective HIV/AIDS prevention and treatment from reaching the most vulnerable. Here we report a few of the highlights.
Integrase inhibitors
Click to enlarge image
Lise Beaudry/IAS
Click to enlarge image
Lise Beaudry/IAS
Merck's experimental integrase inhibitor MK-0518 might control HIV more effectively in some HIV-positive people than other drugs on the market, according to studies. Integrase inhibitors stop HIV from inserting its genes into uninfected DNA. The company's decision to expand access to the MK-0518 comes after a 24-week study that found 90% of the HIV-positive people in the trial who took 100 mg to 600 mg of the drug in combination with tenofovir and lamivudine twice daily reduced HIV viral loads to undetectable levels. Most of the viral load reduction took place in the first 4?8 weeks of taking the drug. Furthermore, the MK-0518 combination in all doses reduced the viral load faster than the control group, which was taking tenofovir, lamivudine, and efavirenz. The expanded access programme allows the company to provide the drug internationally to HIV-positive people resistant to current antiretrovirals and is supported by regulatory agencies. Merck will begin enrolling people in the programme in the next few months. The company plans to begin phase III trials, which are expected to involve 700 people.
Drug-resistant tuberculosis
A virulent strain of tuberculosis otherwise known as extensively drug-resistant (XDR) tuberculosis has killed 52 of 53 patients in a rural district in KwaZulu Natal, South Africa. Sputum samples were collected between January 2005 and March 2006. Of the 544 patients studied, researchers found that 221 (41%) of the study participants had multidrug resistant (MDR) tuberculosis, and of these, 53 had XDR-tuberculosis. All of the people with XDR-tuberculosis were HIV-positive, most of whom were carrying a genetically similar strain, and they all failed to respond to first and second-line drugs. According to the study, most deaths occurred within 30 days of individuals having their sputum collected. Most of the participants who died had progressed to AIDS, and about half contracted the XDR tuberculosis at hospitals or clinics. The origins of the South African outbreak are unknown, but misuse of antituberculosis drugs is thought to be one explanation. The emergence of this strain could undermine the efforts to control both these diseases.
Pre-exposure prophylaxis
Pre-exposure prophylaxis (PREP) is intended to prevent HIV infection before exposure to HIV, and involves giving broad spectrum compounds as well as antiretroviral drugs to people at risk. Studies have shown PREP prevents HIV infection in animals. Human trials are underway that investigate the potential of Gilead's Viread (tenofovir) and their combination pill Truvada for PREP use. However, four trials have ended prematurely because of ethical concerns about how the trials are conducted. One study presented at the conference involved 400 HIV-negative women in Ghana, half of whom took tenofovir for 1 year. Half of the women took a placebo. Two study participants taking tenofovir tested HIV-positive at the end of the trial, compared with six women taking the placebo pill. Although the trial was powered to examine efficacy, the results are not statistically significant. Tenofovir was found to be safe despite previous concerns about potential drug toxicity to the kidney, liver, or bones. Futhermore, the women in the study did not have an increased amount of sex and continued to use condoms so PREP did not alter their behaviour. Researchers are conducting studies in Botswana, Peru, and Thailand. These studies are expected to involve about 4600 people, which could solve the question of whether tenofovir and Truvada are effective as PREP.
Entry inhibitors
Schering-Plough reported early data on their experimental drug vicriviroc. In the study, people taking vicriviroc experienced more ?durable drops? in HIV viral levels and rises in CD4+ T cells, compared with a group of people taking a placebo. Five of 90 people taking vicriviroc developed cancer during the study, compared with two of 28 people in the placebo group, which raises concerns about the treatment's link to malignancy. The treatment is in a class known as chemokine receptor 5 (CCR5) blockers, which are known only to block one type of HIV, the R5 virus, which occurs early on in the course of the infection. CCR5 blockers do not attack the X4 virus, a more aggressive virus that occurs later in the infection cycle.
Insite remains open
The legal exemption that allow's North America's only government-sanctioned supervised injection site to operate in Vancouver, Canada, was granted for only another 18 months, and research funding appears to have been cut off. Evaluation of the facility, known as Insite, has shown that it is not associated with increased drug trafficking or crimes commonly linked to drug use. But despite these results, opposition to the site by the Canadian Police Association threatens the potential public-health gains of keeping the site open.