Human Immunodeficiency Virus Response Research Articles

Warga Peduli AIDS’: Community Participation in the HIV and AIDS Response in Bandung

Human immuno deficiency virus (HIV) becomes the global epidemic. It attacks human immune system; and if left untreated it leads to AIDS (acquired immunodeficiency syndrome). Indonesian governmental and non-governmental institutions are the main actors in the response to this epidemic since late 80s; while community participation has newly emerged. This study discusses ‘Warga Peduli AIDS’ (local residents concerned about AIDS) in Bandung; which is one of the rare forms of community participation in the HIV and AIDS response in Indonesia. Using ethnographic method, this study examines the main actions by Warga Peduli AIDS, such as attendance in HIV related meetings, events, and workshops; dissemination of information; and provision of support and companionship for neighbours living with HIV. This study finds that members of the community actively participate in the HIV and AIDS response through their actions as Warga Peduli AIDS; and their actions has contributed significantly to the national strategies to respond the HIV and AIDS in Indonesia

IL-21 Therapy Controls Immune Activation and Maintains Antiviral CD8+ T Cell Responses in Acute Simian Immunodeficiency Virus Infection.

Human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV) replicate during acute infection in lymphocytes of the gastrointestinal tract, before disseminating systemically. Localized replication and associated loss of gut-resident CD4+ T cells occur regardless of the portal of entry of the virus (e.g., intravenous vs. rectal). Thus, HIV and SIV are tropic for gut tissue, and their pathogenesis requires the special environment of the intestine. T helper 17 (Th17) cells are important contributors to microbial defense in the gut that are vulnerable to HIV infection and whose loss is associated with translocation of microbial products to the systemic circulation, leading to chronic immune activation and disease progression. Interleukin (IL)-21 promotes differentiation and survival of Th17 cells and stimulates CD8+ T cell function. By promoting Th17 cell survival, IL-21 could limit bacterial translocation and immune activation in the setting of acute or rebounding HIV/SIV disease. In this study, we tested the effect of recombinant IL-21-IgFc treatment, given at the time of infection, on SIVmac251 infection. We found that rIL-21-IgFc decreases immune activation and maintains effective antiviral responses by CD8+ T cells in blood, but this maintenance is not associated with lower viral loads. rIL-21-IgFc treatment also did not generally support Th17 cell populations, but Th17 cells remained strongly and independently associated with control of plasma viremia. For example, the single animal exhibiting greatest control over viremia in our study also manifested the highest levels of IL-21 in plasma, Th17 cell maintenance in blood, and Th17 cells in intestinal tissue. These findings provide rationale for further exploration of IL-21 treatment as a support for host CD8+ T cell responses in HIV cure strategies.

Key populations and human rights in the context of HIV services rendition in Ghana

BackgroundIn line with its half century old penal code, Ghana currently criminalizes and penalizes behaviors of some key populations – populations deemed to be at higher risk of acquiring or transmitting Human Immunodeficiency Virus (HIV). Men who have sex with men (MSM), and sex workers (SWs) fit into this categorization. This paper provides an analysis of how enactment and implementation of rights-limiting laws not only limit rights, but also amplify risk and vulnerability to HIV in key and general populations. The paper derives from a project that assessed the ethics sensitivity of key documents guiding Ghana’s response to its HIV epidemic. Assessment was guided by leading frameworks from public health ethics, and relevant articles from the international bill of rights.DiscussionGhana’s response to her HIV epidemic does not adequately address the rights and needs of key populations. Even though the national response has achieved some public health successes, palpable efforts to address rights issues remain nascent. Ghana’s guiding documents for HIV response include no advocacy for decriminalization, depenalization or harm reduction approaches for these key populations. The impact of rights-restricting codes on the nation’s HIV epidemic is real: criminalization impedes key populations’ access to HIV prevention and treatment services. Given that they are bridging populations, whatever affects the Ghanaian key populations directly, affects the general population indirectly.SummaryThe right to the highest attainable standard of health, without qualification, is generally acknowledged as a fundamental human right. Unfortunately, this right currently eludes the Ghanaian SW and MSM. The paper endorses decriminalization as a means of promoting this right. In the face of opposition to decriminalization, the paper proposes specific harm reduction strategies as approaches to promote health and uplift the diminished rights of key populations. Thus the authors call on Ghana to remove impediments to public health services provision to these populations. Doing so will require political will and sufficient planning toward prioritizing HIV prevention, care and treatment programming for key populations.

Designing Human Immunodeficiency Virus Counselling and Testing Services to Maximize Uptake Among High School Learners in South Africa: What Matters?

Increasing human immunodeficiency virus (HIV) testing in South Africa is vital for the HIV response. Targeting young people is important as they become sexually active and because HIV risk rapidly increases as youth enter their 20s. This study aims to increase the understanding of high school learners' preferences regarding the characteristics of HIV testing service delivery models and to inform policy makers and implementers regarding potential barriers to and facilitators of HIV testing. An attitudinal survey was used to examine HIV testing preferences among 248 high school learners in KwaZulu-Natal. Statistical tests were used to identify the most favored characteristics of testing service delivery models and examine key differences in preferences based on demographic characteristics and testing history. Most learners were found to prefer testing offered at a clinic on a Saturday (43%), using a finger prick test (59%), conducted by a doctor (61%) who also provides individual counselling (60%). Shorter testing times were preferred, as well as a monetary incentive to cover any associated expenses. Time, location, the type of test, and who conducts the test were most important. However, stratified analysis suggests that preferences diverge, particularly around gender, grade, but also sexual history and previous testing experience. Human immunodeficiency virus testing services can be improved in line with preferences, but there is no single optimal design that caters to the preferences of all learners. It is unlikely that a "one-size-fits-all" approach will be effective to reach HIV testing targets. A range of options may be required to maximize coverage.

Measuring Sexual Behavior Stigma to Inform Effective HIV Prevention and Treatment Programs for Key Populations

BackgroundThe levels of coverage of human immunodeficiency virus (HIV) treatment and prevention services needed to change the trajectory of the HIV epidemic among key populations, including gay men and other men who have sex with men (MSM) and sex workers, have consistently been shown to be limited by stigma.ObjectiveThe aim of this study was to propose an agenda for the goals and approaches of a sexual behavior stigma surveillance effort for key populations, with a focus on collecting surveillance data from 4 groups: (1) members of key population groups themselves (regardless of HIV status), (2) people living with HIV (PLHIV) who are also members of key populations, (3) members of nonkey populations, and (4) health workers.MethodsWe discuss strengths and weaknesses of measuring multiple different types of stigma including perceived, anticipated, experienced, perpetrated, internalized, and intersecting stigma as measured among key populations themselves, as well as attitudes or beliefs about key populations as measured among other groups.ResultsWith the increasing recognition of the importance of stigma, consistent and validated stigma metrics for key populations are needed to monitor trends and guide immediate action. Evidence-based stigma interventions may ultimately be the key to overcoming the barriers to coverage and retention in life-saving antiretroviral-based HIV prevention and treatment programs for key populations.ConclusionsMoving forward necessitates the integration of validated stigma scales in routine HIV surveillance efforts, as well as HIV epidemiologic and intervention studies focused on key populations, as a means of tracking progress toward a more efficient and impactful HIV response.

Improving HIV and STI responses through media and community engagement

HIV (Human Immunodeficiency Virus) and other sexually transmitted infections (STIs) in Western Australia are at their highest in 20 years. In response to this worrying escalation and the public need for accurate and balanced information about these diseases, the journalism department at Edith Cowan University, in partnership with the WA AIDS Council (WAAC), developed a pilot project that consisted of a series of media training and education programmes to enable WAAC staff to share information and stories with the media on HIV and STIs in a more confident and proactive way. The project offers a model framework for media and community engagement that can be applied to a broader range of health promotion and disease prevention issues.

Charting a path to end the AIDS epidemic.

From 8 to 10 June 2016, heads and representatives of states and governments, along with other key stakeholders, will assemble at the United Nations (UN) in New York, for the High-Level Meeting on Ending AIDS. There are three reasons why this meeting is an important milestone for the global response against human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). First, the meeting will provide an opportunity to reflect on the extent of progress and unprecedented achievements that have been made in responding to the AIDS epidemic, as described in the UN Secretary-General’s report.1 Globally, between 2000 and 2014, the number of people newly infected with HIV each year dropped by more than one-third, from 3 million to 2 million. In the same period, new paediatric HIV infections fell by 58%. Eighty-five countries are close to eliminating mother-to-child transmission of HIV. The global target of millennium development goal 6 of having 15 million people on HIV treatment by 2015 was met nine months ahead of schedule.2 Second, the meeting serves as an occasion to galvanize support from the global community to scale up the AIDS response. The 90–90–90 treatment target calls for 90% of people living with HIV to know their status, 90% of people who know their HIV status to have access to treatment and 90% of people on treatment to achieve suppressed viral loads by 2020.3 We need to focus on specific populations and locations where investments will have the greatest impact to ensure that no one is being left behind. Of the estimated 2 million people newly infected with HIV in 2014, nearly half live in eastern and southern Africa, where adolescent girls and young women are disproportionately at risk.3 The number of people acquiring HIV infections is increasing in several countries. Incident infections are also increasing in some cities in North America and western Europe. These increases in new infections are primarily seen in men who have sex with men, transgender people, sex workers and their clients and people who inject drugs. Across Latin America and the Caribbean, most cases occur in men who have sex with men.1 We have less than five years to step up investments in HIV prevention, treatment and care to reach this target. Third, the meeting will be an opportunity to reflect on specific challenges that need to be addressed as we move forward. Among them is a treatment gap and inadequate global investments in prevention.4 Other challenges include how to increase access to diagnostic tests and eliminate HIV-related discrimination. Around half of all people living with HIV are unaware of their HIV status.1 While there is a general decline in discriminatory attitudes towards people living with HIV, in about 40% of countries where studies have been conducted, more than half of adults surveyed reported discriminatory attitudes towards people living with HIV.5 Laws, policies and practices that are fuelling vulnerability to HIV and hindering access to services will need to be addressed as a priority. The UNAIDS 2016–2021 Strategy integrated efforts towards ending the AIDS epidemic fully into Transforming our world: the 2030 agenda for sustainable development. The strategy sets out the links between the HIV response and several sustainable development goals (SDGs), from SDG 1 on ending poverty to SDG 16 on promoting inclusive societies.3 Building on the SDGs, we need a global approach to ending the AIDS epidemic, underpinned by universal principles of social equity and an unwavering commitment to human rights. We must pledge to invest at least 26 billion United States dollars a year in low- and middle-income countries by 2020. Diverse sources of funding, innovative forms of financing and increases in both domestic public expenditure and international assistance are all needed. Let us make history at the high-level meeting. Let us commit to charting a path forward that will secure the end of the AIDS epidemic as a public health threat in one generation.

Antibody Responses After Analytic Treatment Interruption in Human Immunodeficiency Virus-1-Infected Individuals on Early Initiated Antiretroviral Therapy

The examination of antibody responses in human immunodeficiency virus (HIV)-1-infected individuals in the setting of antiretroviral treatment (ART) interruption can provide insight into the evolution of antibody responses during viral rebound. In this study, we assessed antibody responses in 20 subjects in AIDS Clinical Trials Group A5187, wherein subjects were treated with antiretroviral therapy during acute/early HIV-1 infection, underwent analytic treatment interruption, and subsequently demonstrated viral rebound. Our data suggest that early initiation of ART arrests the maturation of HIV-1-specific antibody responses, preventing epitope diversification of antibody binding and the development of functional neutralizing capacity. Antibody responses do not appear permanently blunted, however, because viral rebound triggered the resumption of antibody maturation in our study. We also found that antibody responses measured by these assays did not predict imminent viral rebound. These data have important implications for the HIV-1 vaccine and eradication fields.

Critical considerations for adopting the HIV 'treat all' approach in Zimbabwe: is the nation poised?

While the advent of antiretroviral therapy (ART) has increased survival and reduced the number of acquired immune-deficiency syndrome (AIDS) related deaths among people living with the human immunodeficiency virus (HIV) virus (PLHIV), HIV/AIDS remains a global health problem and sub-Saharan Africa continues to bear the greatest burden of disease. There are also major challenges in the HIV response: as of December 2013, only 36% of PLHIV globally were on ART, and for every individual started on ART there were two new PLHIV diagnosed. This has led to considerable debate around adopting an HIV 'treat all' approach aimed at greatly escalating the number of PLHIV initiated and retained on ART, regardless of CD4 cell count or World Health Organization (WHO) clinical stage, with the intended goal of achieving viral suppression which should in turn reduce HIV transmission, morbidity and mortality in affected individuals. This paper examines the issues being discussed in Zimbabwe, a low-income country with a high burden of HIV/AIDS, about the implications and opportunities of adopting an HIV 'treat all' approach, along with pertinent operational research questions that need to be answered to move the agenda forward. These discussions are timely, given the recent WHO recommendations advising ART for all PLHIV, regardless of CD4 cell count.

CD4 Cell Count: Declining Value for Antiretroviral Therapy Eligibility.

Antiretroviral therapy (ART) policy for people living with human immunodeficiency virus (HIV) has historically been based on clinical indications, such as opportunistic infections and CD4 cell counts. Studies suggest that CD4 counts early in HIV infection do not predict relevant public health outcomes such as disease progression, mortality, and HIV transmission in people living with HIV. CD4 counts also vary widely within individuals and among populations, leading to imprecise measurements and arbitrary ART initiation. To capture the clinical and preventive benefits of treatment, the global HIV response now focuses on increasing HIV diagnosis and ART coverage. CD4 counts for ART initiation were necessary when medications were expensive and had severe side effects, and when the impact of early ART initiation was unclear. However, current evidence suggests that although CD4 counts may still play a role in guiding clinical care to start prophylaxis for opportunistic infections, CD4 counts should cease to be required for ART initiation.

PD-L1 Blockade Differentially Impacts Regulatory T Cells from HIV-Infected Individuals Depending on Plasma Viremia.

Blocking the PD-1/PD-L1 pathway has emerged as a potential therapy to restore impaired immune responses in human immunodeficiency virus (HIV)-infected individuals. Most reports have studied the impact of the PD-L1 blockade on effector cells and neglected possible effects on regulatory T cells (Treg cells), which play an essential role in balancing immunopathology and antiviral effector responses. The aim of this study was to define the consequences of ex vivo PD-L1 blockade on Treg cells from HIV-infected individuals. We observed that HIV infection led to an increase in PD-1+ and PD-L1+ Treg cells. This upregulation correlated with disease progression and decreased under antiretroviral treatment. Treg cells from viremic individuals had a particularly high PD-1 expression and impaired proliferative capacity in comparison with Treg cells from individuals under antiretroviral treatment. PD-L1 blockade restored the proliferative capacity of Treg cells from viremic individuals but had no effect on its suppressive capacity. Moreover, it increased the viral production in cell cultures from viremic individuals. This increase in viral production correlated with an increase in Treg cell percentage and a reduction in the CD4/Treg and CD8/Treg cell ratios. In contrast to the effect of the PD-L1 blockade on Treg cells from viremic individuals, we did not observe a significant effect on the proliferative capacity of Treg cells from individuals in whom viremia was controlled (either spontaneously or by antiretroviral treatment). However, PD-L1 blockade resulted in an increased proliferative capacity of HIV-specific-CD8 T cells in all subjects. Taken together, our findings suggest that manipulating PD-L1 in vivo can be expected to influence the net gain of effector function depending on the subject’s plasma viremia.

The road to eliminate mother-to-child HIV transmission

The World Health Organization’s Global Health Observatory estimates that 78 million people have been infected with the human immunodeficiency virus (HIV) during the course of the epidemic, and that 39 million men, women, and children have died.1 Nearly 1 in 20 adults in sub-Saharan Africa are currently living with the infection. HIV represents one of the world’s most serious health problems. The WHO global health sector strategy on HIV/acquired immunodeficiency syndrome (AIDS) has identified four strategic directions to guide countries’ HIV response to achieve the United Nations’ Millennium Development Goal of halting the spread of HIV/AIDS. A core element of strategic direction one was the elimination of new HIV infections in children.2 It is encouraging that the number of new HIV infections in children is decreasing in most parts of the world. In 2011, there were approximately 330,000 new childhood infections, and while this is a reduction of 43% since 2003, it remains unacceptably high.3 Unfortunately, increased childhood infection rates were observed in Angola, Congo, Equatorial Guinea, and Guinea-Bissau. While a small proportion of childhood infections result from blood transfusions, sexual abuse, or unsafe injecting practices, the main cause is mother-to-child transmission

Vaccination for 2009 pandemic H1N1 influenza A did not induce conserved epitope-specific memory CD8 T cell responses in HIV+ northern Thai children

The influenza virus causes severe illness in susceptible populations, including children and people living with human immunodeficiency virus (HIV). Here, we investigated cell-mediated immune responses (CMI) against influenza CD8 T cell conserved epitopes in HIV-infected (HIV+) northern Thai children following the 2009 pandemic H1N1 influenza A vaccination. Sixty HIV+ children were vaccinated with two doses of the 2009 pandemic influenza vaccine and their CD8T cell responses were assessed. We found no significant differences in the increase of cytokines-producing and CD107a-expressing CD8+ T cells or CD8+ memory T cells in response to pooled conserved epitopes stimulation in vitro between children with different serologic responses to the vaccine at all time points of the study. Our results suggest that the 2009 pandemic H1N1 vaccine did not induce the conserved epitope-specific immune responses in HIV+ children. Vaccine design and vaccination strategy against influenza in these populations warrant further studies.

Investigating the Impact of Climate Change on HIV Management

Climate change is a reality and its effects are felt differently in different regions and times. There is evidence of marked increase in mean global temperature in the 21st century and resultant increase in intensity, severity, distributions and occurrence of climate sensitive diseases in areas they never used to be. Consequently there is more change in ecosystems, productivity and lifestyles and as such impact on the human health as well as ecosystem on which human kind relies for sustenance. Infection with Human Immuno-deficiency Virus (HIV), an immune compromising virus, on the other hand has great implications on the health of individual’s and that of the community. Globally more than 33 million people are living with HIV with more than two-thirds of the infected living in Sub-Saharan Africa. In Kenya, significant progress has been made in HIV interventions, with 2013 data indicating that the national HIV prevalence stands at 5.6%, 1.6 million people are living with HIV, about 98,000 new infections occur amongst adults, and 11,000 amongst children annually and the AIDS related deaths stand at about 58,465. Information on climate change and variability is inevitable in managing the overall burden of climate sensitive diseases in Kenya and dealing with challenges in opportunistic infections associated with HIV which introduce a new dynamic. This desktop research sought to investigate the implications of climate change on HIV management in Kenya. The research established that the impact of climate change on HIV management in Kenya are real, people are predisposed to infections and vulnerable to disease progression due to climate change impacts posing a risk of increased mortality rate. This research informs policy makers and implementers at all levels and recommends an HIV and AIDS response in the Country, both National and County levels, that is cognizant and responsive to climate change implications.

Humoral Immune Responses to Pneumocystis jirovecii Antigens in HIV-Infected and Uninfected Young Children with Pneumocystis Pneumonia

BackgroundHumoral immune responses in human immunodeficiency virus (HIV)-infected and uninfected children with Pneumocystis pneumonia (PcP) are poorly understood. MethodsConsecutive children hospitalized with acute pneumonia, tachypnea, and hypoxia in South Africa were investigated for PcP, which was diagnosed by real-time polymerase chain reaction on lower respiratory tract specimens. Serum antibody responses to recombinant fragments of the carboxyl terminus of Pneumocystis jirovecii major surface glycoprotein (MsgC) were analyzed. Results149 children were enrolled of whom 96 (64%) were HIV-infected. PcP occurred in 69 (72%) of HIV-infected and 14 (26%) of HIV-uninfected children. HIV-infected children with PcP had significantly decreased IgG antibodies to MsgC compared to HIV-infected patients without PcP, but had similar IgM antibodies. In contrast, HIV-uninfected children with PcP showed no change in IgG antibodies to MsgC, but had significantly increased IgM antibodies compared to HIV-uninfected children without PCP. Age was an independent predictor of high IgG antibodies, whereas PcP was a predictor of low IgG antibodies and high IgM antibodies. IgG and IgM antibody levels to the most closely related MsgC fragments were predictors of survival from PcP. ConclusionsYoung HIV-infected children with PcP have significantly impaired humoral immune responses to MsgC, whereas HIV-uninfected children with PcP can develop active humoral immune responses. The children also exhibit a complex relationship between specific host factors and antibody levels to MsgC fragments that may be related to survival from PcP.

Sexual behaviors among men who have sex with men: a quantitative cross sectional study in Kathmandu Valley, Nepal

Unprotected sexual transmission is the cause of approximately 70%–80% of human immunodeficiency virus (HIV) infections worldwide. Prevalence of HIV infection in 2011 was more than ten fold higher (3.8%) among men who have sex with men (MSM) than in the general population (0.33%) in Nepal. This study aimed to explore sexual behaviors, and social and demographic characteristics of MSM in Kathmandu Valley, Nepal. A quantitative cross sectional study was conducted among 113 MSM. MSM is a hidden population in Nepalese society, therefore, it was difficult to construct a sample frame for this research so, respondent driven sampling was used which gives unbiased estimates of population parameters and has the potential to reach MSM, who are not easily accessible. A structured interview was used to obtain the information. The majority of respondents were above 20 years old (mean = 27.9 years, SD = 7.4 years). Most respondents were receptive, 43.4% identified themselves as Meti. Forty six percent of respondents were married. The majority had sex with males which was predominantly anal. MSM had an average number of 74 sex partners (last three months). Nearly 95% had used a condom, and 92% had used lubricant during their last sex act. Thirty eight percent perceived themselves as at risk of HIV. The majority knew of a place for confidential HIV testing in Kathmandu. This study highlights the importance of partner tracing during HIV counseling and testing, the importance of drop-in centers to increase access to condoms, and supports the need to increase comprehensive health services and peer led participatory behavioral change communication activities to this population in the national HIV response.

A Study of Biological Markers in HIV Disease Progression and Management in yhe Highly Active Antiretroviral Therapy (HAART) Era

Human Immunodeficiency Virus (HIV), the causative agent in AIDS has been a challenge to medical fraternity from the time since it was first discovered in 1983. About 40 million people are living with HIV infection globally and 99% of the infected people are in south East Asia (SEA). With inception of highly active antiretroviral therapy (HAART), the quality of life of HIV infected individuals is gradually improving. The number of people contracting new infections has been on decline globally and those having access to HAART are increasing. Close monitoring of HIV infected patients is essential in reducing the morbidity and mortality of HIV patients. Monitoring HIV disease progression, deciding the time to initiate HAART requires evaluation of TCD4+ cell counts and HIV/RNA viral load at regular intervals. Considering the fact that it is the resource restrained developing countries that carry most of the burden of HIV, studies recently have been carried out to evaluate the utility of low cost, easily performed alternate biomarkers that can be used for HIV disease management and response to HAART therapy. Very few studies are available that have demonstrated the role of alternate biomarkers to monitor HIV disease progression and assessing response to HAART.

Association of Polymorphisms of the Mu Opioid Receptor Gene with the Severity of HIV Infection and Response to HIV Treatment

Mu opioid receptor (OPRM1) ligands may alter expression of chemokines and chemokine receptors involved in penetration of human immunodeficiency virus (HIV) type 1 into the cell. We suggest that OPRM1 variants may affect the pathophysiology of HIV infection. DNA samples from 1031 eligible African Americans, Hispanics, and whites from the Women's Interagency HIV Study (WIHS) who were alive as of April 2006 were analyzed. We performed regression analysis of association of 18 OPRM1 variants with a change of viral load and CD4 cell count during 2 periods: between admission to WIHS and the start of highly active antiretroviral therapy (HAART) (interval X) and between the start of HAART and the most recent WIHS visit (interval Y), and examined the association of these variants with HIV status. Regardless of genotype, a significant decrease in viral load during interval X was found for each ethnicity. Whites with allele G of the functional polymorphism 118A > G (reference sequence rs1799971) showed a smaller decrease in viral load; those bearing minor alleles IVS1 + 1050A, IVS1 + 14123A, and IVS2 + 31A showed a larger decrease in viral load over interval X (0.01 < P < .05). Hispanics with the same alleles showed a greater increase in CD4 cell count over interval Y (0.01 < P < .05). We found an association between OPRM1 variants and HIV status in African Americans and whites. OPRM1 polymorphisms may alter the severity of HIV infection before and after HAART.

Response of Human Immunodeficiency Virus–Associated Oral Plasmablastic Lymphoma to Highly Active Antiretroviral Therapy Without Chemotherapy

Response of Human Immunodeficiency Virus–Associated Oral Plasmablastic Lymphoma to Highly Active Antiretroviral Therapy Without Chemotherapy

Antiretroviral therapy in prevention of HIV and TB: update on current research efforts.

There is considerable scientific evidence supporting the use of antiretroviral therapy (ART) in prevention of human immunodeficiency virus (HIV) and tuberculosis (TB) infections. The complex nature of the HIV and TB prevention responses, resource constraints, remaining questions about cost and feasibility, and the need to use a solid evidence base to make policy decisions, and the implementation challenges to translating trial data to operational settings require a well-organised and coordinated response to research in this area. To this end, we aimed to catalogue the ongoing and planned research activities that evaluate the impact of ART plus other interventions on HIV- and/or TB-related morbidity, mortality, risk behaviour, HIV incidence and transmission. Using a limited search methodology, 50 projects were identified examining ART as prevention, representing 5 regions and 52 countries with a global distribution. There are 24 randomised controlled clinical trials with at least 12 large randomised individual or community cluster trials in resource-constrained settings that are in the planning or early implementation stages. There is considerable heterogeneity between studies in terms of methodology, interventions and geographical location. While the identified studies will undoubtedly advance our understanding of the efficacy and effectiveness of ART for prevention, some key questions may remain unanswered or only partially answered. The large number and wide variety of research projects emphasise the importance of this research issue and clearly demonstrate the potential for synergies, partnerships and coordination across funding agencies.