AIDS Compendium

Issue: December 2007

Four organ transplant patients contracted HIV and the virus for hepatitis C in January at three Chicago hospitals. The infected patients did not learn of their status until November, when the staff of the transplantation program at the University of Chicago Hospitals first found out about the problem, officials said.

Initial tests on the organs for HIV, hepatitis and other conditions were negative. Officials believe this is because the donor had acquired the infections in the last three weeks before death. Physicians at Northwestern Memorial Hospital, Rush University Medical Center and the University of Chicago Medical Center went ahead with transplants after receiving the negative result.

This is the first transmission of HIV via organ transplant since 1985, when three patients contracted the virus from organs donated by a Virginia man. From 1985 to present, physicians have transplanted more than 400,000 organs in the United States without a reported case of HIV transmission. Officials from the transplantation program at the University of Chicago Hospitals believe the screening process can be improved, but may never be completely fail proof with current technology.

Experimental HIV vaccine may increase HIV risk

Pre-existing immunity to a common cold virus in some people who participated in an experimental HIV vaccination trial may increase their susceptibility to HIV infections, researchers said at an HIV Vaccine Trials Network conference.

Among the 778 male participants with a pre-existing immunity to the common cold virus adenovirus type five, 21 became HIV positive, compared with nine who received a placebo.

Phase-2 trials for the experimental HIV vaccine ended in September after it failed to prevent HIV infection in 3,000 HIV-negative volunteers and did not delay the progression of the virus to AIDS.

Trial data suggests that participants in the vaccine group were becoming HIV-positive at similar rates to those in the placebo group—49 participants compared to 33 participants.

Possible causes for these infection rates may have to do with behavioral factors unrelated to the biology of the vaccine. These possible reasons include: circumcision rates among participants, variations in the strain of HIV that infected the participants, and chance.

Researchers hoped the experimental vaccine would simulate a CD4+ T-cell response that could control HIV/AIDS based on the theory that people who have HIV and stronger T-cell responses tend to fight the virus better. The vaccine was made from a weakened version of adenovirus type five, which served as a model to provide three synthetically produced genes from HIV.

Participants in this study were enrolled from the United States and Latin America. In a separate trial of the same vaccine, researchers in South Africa have told the 801 participants whether they received the vaccine. According to information from the conference, there is insufficient data for researchers to determine the full implications of the trials, and the findings may be statistical coincidences.

Misconceptions about HIV/AIDS remain common

More than 40% of people in a multinational survey did not understand that AIDS is always a fatal disease. A recent nine-country survey concerning HIV/AIDS beliefs, conducted by the MAC AIDS Fund, a philanthropic organization set up by MAC cosmetics, found that misconceptions about HIV/AIDS are still widespread.

Although most respondents believed that AIDS is a fatal illness, many wrongly believed that a cure for HIV infection is available. Responses seem to be influenced by demographic variables. For instance, 59% of Indians believed that a cure is available. In France, older adults were more likely than younger people to believe that the disease is curable. In the United States, blacks were more likely than whites to think that there is a cure.

According to the survey, other misconceptions exist about the availability of AIDS treatment. Almost 50% of respondents believed that most patients with HIV were receiving treatment, when in reality the figure is closer to one in five, based on 2006 data.

Also, prejudice, fear and stigma still surround the disease. Nearly 50% of respondents said they felt uncomfortable walking next to a person with HIV, 52% did not want to live in the same house and 79% did not want to date someone harboring the virus.

Survey results also suggest that gender roles and difficulty in discussing safe sex practices may also be key contributors to the pandemic, with 73% of respondents indicating that they believe the spread of HIV is partially fueled by women who are uncomfortable discussing safe sex practices with their partners.

Overall, health care officials believe that current HIV/AIDS education programs may not be effective enough. Data from the survey support this belief, namely the fact that in the United Kingdom, people with a higher education were more likely than those lacking a college degree to believe that most people with HIV go untreated. In light of setbacks in the most promising AIDS vaccine trial, philanthropists stress the need to focus funding efforts on the most basic and effective HIV prevention programs, particularly those that effectively address gender, age and race differences.

The survey encompassed 4,510 interviews conducted in Brazil, China, India, France, Mexico, Russia, South Africa, the United Kingdom and the United States.

UNAIDS lowers global HIV prevalence estimates

Global HIV prevalence has leveled off, and the number of new infections has decreased, according to a UNAIDS report released Nov. 20.

The new estimate of 33.2 million people living with HIV replaces the 2006 estimate of 39.5 million. The main reason for the reduction in global HIV prevalence figures in the past year is the recent revision of estimates in India combined with the revision of estimates in five sub-Saharan countries. The combination accounts for 70% of the reduction in HIV prevalence compared with 2006 estimates.

Although global prevalence of HIV infection has leveled, the total number of people living with HIV has increased because of ongoing acquisition of HIV infection, longer survival times and the continuously growing global population.

“These improved data present us with a clearer picture of the AIDS epidemic, one that reveals both challenges and opportunities,” said Peter Piot, MD, UNAIDS executive director. “Unquestionably, we are beginning to see a return on investment: new infections and mortality are declining and the prevalence of HIV leveling.”

By UNAIDS estimates, 33.2 million people were living with HIV, 2.5 million people were newly-infected with HIV and 2.1 million people died of AIDS in 2007.

Brazil’s AIDS treatment programs face escalating long term costs

The long-term costs associated with providing drugs to people with AIDS in developing countries were examined by researchers at the Harvard School of Public Health. The results were published in PLOS Medicine.

fThe researchers analyzed cost trends in Brazil, a country that has one of the developing world’s oldest, largest and most successful AIDS treatment programs, and has been in operation for more than a decade. Health officials regard Brazil as a model for other countries scaling up AIDS treatment due to the country’s success at providing free and universal access to AIDS drugs.

Since 2001, Brazil has been able to obtain lower prices for patented antiretroviral drugs by threatening to produce AIDS drugs locally. Although the price negotiations with multinational pharmaceutical companies initially prompted major declines in AIDS drug spending, drug costs doubled between 2004 and 2005. Research shows the increase is caused by the fact that more people with HIV/AIDS are living longer due to treatment, and also by the need to develop costly second and third line treatments as these individuals develop resistance to first line drugs.

Researchers believe that developing countries currently working to provide free and universal AIDS treatment will experience challenges similar to those of Brazil as their programs mature. The U.S. Departments of Education and State, along with the National Institute on Aging and the Bill and Melinda Gates Foundation provided financial backing for the study.

HIV cases increasing in Australia

HIV is on the rise in Australia. Results of a study conducted by the National Centre in HIV Epidemiology and Clinical Research demonstrated a one-third increase of newly diagnosed HIV cases in Australia between 2000 and 2006. Cases rose from 763 in 2000 to 998 in 2006, after a steady decline that began in the 1980s. Health officials attribute the rise in HIV to a decrease in funding for HIV prevention programs. New South Wales, the only state that has continued to invest in education programs, is the only state in Australia to report a decrease in HIV incidence.

In response to these figures, the Australian government has announced the inclusion of 9.8 million Australian dollars in the federal budget for the development of a national HIV prevention and education campaign. Funds will go toward creating resources for doctors, sexual health workers, schools, and a new media campaign. The program will target at risk populations, particularly young people and men who have sex with men.

— compiled by Nicole Blazek