TAG: "AIDS/HIV"

Community-based HIV prevention can boost testing


Prevention efforts also can help reduce new infections, study shows.

Thomas Coates, UCLA

Communities in Africa and Thailand that worked together on HIV-prevention efforts saw not only a rise in HIV screening but a drop in new infections, according to a new study in the peer-reviewed journal The Lancet Global Health.

The U.S. National Institute of Mental Health’s Project Accept — a trial conducted by the HIV Prevention Trials Network to test a combination of social, behavioral and structural HIV-prevention interventions — demonstrated that a series of community efforts boosted the number of people tested for HIV and resulted in a 14 percent reduction in new HIV infections, compared with control communities.

Much of the research was conducted in sub-Saharan Africa, which has particularly high rates of HIV. The researchers were interested not just in how the clinical trial participants’ behavior changed, but also in how these efforts affected the community as a whole, said Thomas Coates, Project Accept’s overall principal investigator and director of UCLA’s Center for World Health.

“The study clearly demonstrates that high rates of testing can be achieved by going into communities and that this strategy can result in increased HIV detection, which makes referral to care possible,” said Coates, who also is an associate director of the UCLA AIDS Institute. “This has major public health benefit implications — not only suggesting how to link infected individuals to care, but also encouraging testing in entire communities and therefore also reducing further HIV transmission.”

These findings were previously presented at the 2013 Conference on Retroviruses and Opportunistic Infections in Atlanta.

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Twitter ‘big data’ can be used to monitor HIV and drug-related behavior


Studying link between HIV, drug use could help prevention, detection efforts.

Sean Young, UCLA

Real-time social media like Twitter could be used to track HIV incidence and drug-related behaviors with the aim of detecting and potentially preventing outbreaks, a new UCLA-led study shows.

The study, published in the peer-reviewed journal Preventive Medicine, suggests it may be possible to predict sexual risk and drug use behaviors by monitoring tweets, mapping where those messages come from and linking them with data on the geographical distribution of HIV cases. The use of various drugs had been associated in previous studies with HIV sexual risk behaviors and transmission of infectious disease.

“Ultimately, these methods suggest that we can use ‘big data’ from social media for remote monitoring and surveillance of HIV risk behaviors and potential outbreaks,” said Sean Young, assistant professor of family medicine at the David Geffen School of Medicine at UCLA and co-director of the Center for Digital Behavior at UCLA.

Founded by Young, the new interdisciplinary center brings together academic researchers and private sector companies to study how social media and mobile technologies can be used to predict and change behavior. (See the center’s Twitter account.)

Other studies have examined how Twitter can be used to predict outbreaks of infections like influenza, said Young, who is also a member of the UCLA Center for Behavioral and Addiction Medicine; UCLA’s Center for HIV Identification, Prevention and Treatment Services; and the UCLA AIDS Institute. “But this is the first to suggest that Twitter can be used to predict people’s health-related behaviors and as a method for monitoring HIV risk behaviors and drug use,” he said.

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Venice Family Clinic, Common Ground merge


The merger will provide enhanced HIV/AIDS care.

The UCLA-affiliated Venice Family Clinic and the nonprofit Common Ground, two pre-eminent health care and service providers for those in need on Los Angeles’ Westside, have merged, bringing their respective HIV services under a single umbrella — the Common Ground program of Venice Family Clinic.

As the Westside’s only provider of comprehensive HIV services for low-income and homeless patients, the Common Ground facility in Santa Monica will continue to offer critical support to those living with HIV and AIDS.

With recent changes to federal funding reimbursements for service providers mandated under the Affordable Care Act, Common Ground realized it would not be able to keep its doors open. Venice Family Clinic, one of Common Ground’s longtime community partners, acted quickly to ensure that the organization’s important contributions to this vulnerable community would continue.

For the last 20 years, Common Ground and Venice Family Clinic, which receives support from UCLA Health System and other medical centers, have collaborated to provide the only continuum of HIV care on the Westside to thousands of people living with HIV.

“As longtime partners of Common Ground, we know how many people rely on the critical, high-quality services they provide,” said Elizabeth Benson Forer, CEO of Venice Family Clinic. “This merger will ensure there will be no gap in service by bringing together two renowned teams committed to working in partnership to address the health care and service needs of those living with HIV.”

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Researchers open door to new HIV therapy


UC Berkeley researchers focus on a fourth protein, Nef.

The AIDS virus enters immune cells by binding to CD4 receptors embedded in the membrane (parallel lines) of the cell. But once a virus enters the cell, it makes a protein, Nef, that binds to the protein complex underlying CD4, tagging it for the waste bin. Potential anti-HIV drugs would disable one of the proteins (colored blobs) to which Nef binds, interfering with HIV’s strategy for spreading through the body. (Image by James Hurley, UC Berkeley)

The AIDS virus enters immune cells by binding to CD4 receptors embedded in the membrane (parallel lines) of the cell. But once a virus enters the cell, it makes a protein, Nef, that binds to the protein complex underlying CD4, tagging it for the waste bin. Potential anti-HIV drugs would disable one of the proteins (colored blobs) to which Nef binds, interfering with HIV’s strategy for spreading through the body.

People infected with the Human Immunodeficiency Virus (HIV) can stave off the symptoms of AIDS thanks to drug cocktails that mainly target three enzymes produced by the virus, but resistant strains pop up periodically that threaten to thwart these drug combos.

Researchers at the University of California, Berkeley, and the National Institutes of Health have instead focused on a fourth protein, Nef, that hijacks host proteins and is essential to HIV’s lethality. The researchers have captured a high-resolution snapshot of Nef bound with a main host protein, and discovered a portion of the host protein that will make a promising target for the next-generation of anti-HIV drugs. By blocking the part of a key host protein to which Nef binds, it may be possible to slow or stop HIV.

“We have imaged the molecular details for the first time,” said structural biologist James H. Hurley, UC Berkeley professor of molecular and cell biology. “Having these details in hand puts us in striking distance of designing drugs to block the binding site and, in doing so, block HIV infectivity.”

Hurley, cell biologist Juan Bonifacino of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health and their colleagues report their findings in a paper published today (Jan. 28) by the open-access, online journal eLife.

The report comes a month after President Barack Obama pledged to redirect $100 million in the NIH budget to accelerate development of a cure for AIDS, though therapies to halt the symptoms of AIDS will remain necessary for the immediate future, Bonifacino said.

“For many patients, current drug therapies have transformed HIV infection into a chronic condition that doesn’t lead to AIDS, but anything we can develop to further interfere with replication and propagation of the virus would help keep it in check until we find a way to completely eliminate the virus from the body,” he said.

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No link found between HIV-prevention pill, higher sexual risk behavior


Biological markers confirm behavioral data, underscore Truvada’s effectiveness.

Robert Grant

Robert Grant

In 2012, the HIV antiretroviral drug Truvada became the first and only medication approved by the FDA for HIV prevention. Led by Gladstone Institutes’ investigator Robert Grant, M.D., M.P.H., this research was hailed as an important step towards reducing the worldwide HIV/AIDS epidemic. Now, a new study provides further proof that regular Truvada use can reduce one’s risk for contracting HIV – without increasing sexual risk behavior.

This research, published today (Dec. 18) in the online journal PLOS ONE, builds on the 2010 Global iPrEx clinical study, which reported that Truvada, an FDA-approved drug used for years to treat HIV-positive patients, could also prevent new infections in people likely to come in contact with the virus. Lending further support to Truvada’s efficacy, a 2012 follow-up study found that taking Truvada regularly reduced risk of HIV infection by more than 90 percent.

Questions about the drug’s real-world effectiveness remained, however, particularly concerning the issue of whether taking the drug could lead to a behavioral effect called risk compensation. Risk compensation is the notion that individuals adjust their behavior in response to a change in their perceived level of risk—such as increasing exposure to the sun in response to sunscreen use. While iPrEx participants did self-report decreases in sexual risk behavior over the course of the study, Grant and his team decided to examine those findings more closely, by studying biological markers of risk behavior.

“After the initial iPrEx study, there was concern that self-reported behavior may not tell the whole story,” said Grant, who is also a professor at the UC San Francisco, with which Gladstone is affiliated. “Here, we not only gathered behavioral data, but we also tested each participant for both HIV and syphilis — allowing us to map over time how reported changes in overall behavior correlated with actual changes in infection rates.”

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Scientists ID potential drug to block AIDS


Gladstone plans to launch Phase 2 trial with existing anti-inflammatory.

Warner Greene

Warner Greene

Research led by scientists at the UC San Francisco-affiliated Gladstone Institutes has identified the precise chain of molecular events in the human body that drives the death of most of the immune system’s CD4 T cells as an HIV infection leads to AIDS. Further, they have identified an existing anti-inflammatory drug that in laboratory tests blocks the death of these cells — and now are planning a Phase 2 clinical trial to determine if this drug or a similar drug can prevent HIV-infected people from developing AIDS and related conditions.

Two separate journal articles, published simultaneously today (Dec. 18) in Nature and Science, detail the research from the laboratory of Warner C. Greene, M.D., Ph.D., who directs virology and immunology research at Gladstone, an independent biomedical-research nonprofit. His lab’s Science paper reveals how, during an HIV infection, a protein known as IFI16 senses fragments of HIV DNA in abortively infected immune cells. This triggers the activation of the human enzyme caspase-1 and leads to pyroptosis, a fiery and highly inflammatory form of cell death. As revealed in the Nature paper, this repetitive cycle of abortive infection, cell death, inflammation and recruitment of additional CD4 T cells to the infection “hot zone” ultimately destroys the immune system and causes AIDS. The Nature paper further describes laboratory tests in which an existing anti-inflammatory inhibits caspase-1, thereby preventing pyroptosis and breaking the cycle of cell death and inflammation.

“Gladstone has made two important discoveries, first by showing how the body’s own immune response to HIV causes CD4 T cell death via a pathway triggering inflammation, and secondly by identifying the host DNA sensor that detects the viral DNA and triggers this death response,” said Robert F. Siliciano, M.D., Ph.D., a professor of medicine at Johns Hopkins University and a Howard Hughes Medical Institute investigator. “This one-two punch of discoveries underscores the critical value of basic science — by uncovering the major cause of CD4 T cell depletion in AIDS, Dr. Greene’s lab has been able to identify a potential new therapy for blocking the disease’s progression and improving on current antiretroviral medications.”

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Sustainable science to promote health in Africa


UCSF establishes regional headquarters in East Africa to anchor research, train local scientists.

When someone is diagnosed with HIV in western Kenya, chances are he will get help from FACES, a network of clinics that takes a family-focused approach to prevention, care and treatment of the virus.

Likewise, a villager in Uganda who wants to know her HIV status is likely to get tested at a traveling clinic from SEARCH, a community-based trial with the goal of stopping the spread of HIV through a strategy known as “test and treat.”

Both projects were launched in collaboration with African scientists by researchers from UC San Francisco, which has been working in East Africa for more than two decades. UCSF scientists and clinicians have provided AIDS, tuberculosis and malaria-related treatment to tens of thousands of people, researched the causes and trajectories of the diseases and trained scientists and physicians throughout the region.\

Now, UCSF’s many and varied efforts – which are spread throughout the African continent, but are most concentrated in Uganda, Kenya and Tanzania – finally have a regional headquarters in Nairobi, Kenya, sponsored by the UCSF/Gladstone Center for AIDS Research (CFAR). CFAR also is supporting the expansion of a core immunology lab at the Infectious Diseases Institute (IDI) at Makerere University College of Health Sciences in Kampala, Uganda.

“This will increase the opportunity for UCSF researchers to get involved in collaborative programs in East Africa,” said Phil Rosenthal, M.D., a professor in the Division of Infectious Diseases at San Francisco General Hospital and Trauma Center (SFGH) and a malaria expert who has been training scientists in Uganda for more than a dozen years.

Like others at UCSF, Rosenthal has approached his scientific work with a dual aim: treat disease while sustainably building up the local health care system. These researchers have been at the forefront of a push toward more sustainable work that was embraced as national policy under the leadership of Ambassador Eric Goosby, M.D., who recently returned to UCSF after serving as Obama’s global AIDS coordinator and head of PEPFAR, the President’s Emergency Plan for AIDS Relief.

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HIV plus HPV leads to increased anal cancer risk in men


Researchers also report that smoking increases risk of infection with specific types of HPV.

Dorothy Wiley, UCLA

Dorothy Wiley, UCLA

Human papillomavirus, or HPV, which can cause cervical cancer in women, is also known to cause anal cancer in both women and men. Now, a study led by researchers at the UCLA School of Nursing has found that older HIV-positive men who have sex with men are at higher risk of becoming infected with the HPVs that most often cause anal cancer.

The researchers also report that smoking increases the risk of infection with specific types of HPV among both HIV-infected and uninfected older men by up to 20 percent. This is the first large U.S. study of a group of HIV-infected and uninfected men between the ages of 40 and 69 who have sex with men. Study participants were examined twice a year for up to 25 years.

“Invasive anal cancer is a health crisis for gay, bisexual and other men who have sex with men,” said Dorothy J. Wiley, associate professor at the UCLA School of Nursing and lead author of the study, which was published Nov. 20 in the journal PLOS ONE. “Right now, invasive anal cancer rates among HIV-infected men who have sex with men surpass rates for seven of the top 10 cancers in men.”

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Taming the global AIDS epidemic


Eric Goosby returns to UCSF intent on applying lessons learned as global AIDS ambassador.

Eric Goosby

Eric Goosby

When Eric Goosby, M.D., arrived in Washington, D.C., to lead the Obama administration’s global effort on AIDS in 2009, the world economy was in free fall. Foreign aid budgets were contracting, and many feared the President’s Emergency Plan for AIDS Relief (PEPFAR), begun by President George W. Bush in 2003, might lose the fight against a disease that had already wiped out a generation in Africa.

Four years later, despite funding cuts, the number of HIV-positive people that PEPFAR has put on life-saving antiretroviral therapy has grown fivefold – to 6.5 million. Since treatment stops transmission of HIV, many now speak hopefully about containing the spread of AIDS.

This month, Goosby returns to UC San Francisco, where he earned his medical degree and completed his residency. He’s intent on applying the lessons he learned as head of the largest public health endeavor in history – with $48 billion invested over 10 years – as resources began to shrink.

At UCSF’s Global Health Sciences, Goosby will lead a new center on implementation sciences, a hot, new field in public health and an emerging specialty at UCSF. It examines the practicalities of running public health programs, applying business-world efficiencies to improve them.

Goosby also will return to Ward 86, the AIDS unit at San Francisco General Hospital and Trauma Center where he worked in the early days of the epidemic, when everyone died for lack of effective treatment.

“We are thrilled that Eric is coming back to UCSF and joining Global Health Sciences,” said Jaime Sepulveda, executive director of UCSF Global Health Sciences. “Eric’s experience at the highest levels of international and domestic HIV/AIDS policy and implementation, and his early career as a doctor on the AIDS ward at UCSF, give him unique insights on what works, from both a local and global perspective.”

Read a Q&A, where Goosby discusses the challenges he faced as U.S. Global AIDS Ambassador and what lies ahead in a world where 35 million people – nearly the population of California – are infected with HIV.

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Collaborators in nursing, public health tackle AIDS in China


Part of international effort to limit spread of disease, improve care of those already infected.

Ann Williams (left) and Roger Detels began to collaborate on AIDS research and treatment in China 15 years ago — around the same time that World AIDS Day, every year on Dec. 1, was established to unite people around the globe in the fight against HIV.

Ann Williams (left) and Roger Detels began to collaborate on AIDS research and treatment in China 15 years ago — around the same time that World AIDS Day, every year on Dec. 1, was established to unite people around the globe in the fight against HIV.

Ann Williams, associate dean for research at the UCLA School of Nursing, has traveled the world for nearly 30 years caring for people with HIV/AIDS and conducting research to improve treatment outcomes. Over that same period, Dr. Roger Detels, professor and chair of epidemiology at the UCLA Fielding School of Public Health has taken a similar route, conducting AIDS research and training epidemiologists.

Fifteen years ago, their paths intersected in China, when Detels was looking to include nursing as part of a training program in HIV research for Chinese health care professionals. A professor, Williams signed on, and they have been collaborating ever since as part of an international effort to limit the spread of HIV-AIDS and improve the care of those already infected.

Recently, each received HIV research training grants from the Fogerty International Center at the National Institutes of Health to help scientists and clinicians in developing countries build much-needed research infrastructure.

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UCSF scientist wins $89M grant to study anal cancer


Study will focus on HIV-infected people.

Joel Palefsky, UC San Francisco

Joel Palefsky, UC San Francisco

A UC San Francisco investigator has won an eight-year grant from the National Cancer Institute for a major investigation into anal cancer, a debilitating and sometimes fatal disease largely concentrated among people with HIV.

The total amount of the award over the life of the grant is projected to be approximately $89 million.

Anal cancer disproportionately affects HIV-infected men and women, but the rate of infection is rising among people who do not have HIV and without active intervention, and the number of cases is expected to continue to grow in the general population.

Like cervical cancer and some oral cancers, most cases of anal cancer are associated with human papillomavirus (HPV). Vaccination has been shown to reduce the risk, but the majority of HIV-infected individuals currently at risk for anal cancer are older than age 26, do not qualify for vaccination, and may already have been exposed to the form of HPV known to cause anal cancer.

“Given these strong biological similarities, it is very possible that biomarkers and treatments identified in the study will be applicable to cervical and HPV-associated oral cancer as well,” said Joel Palefsky, M.D., a UCSF professor of medicine and principal investigator of the anal cancer project.

The study will focus on determining the effectiveness of treating anal high-grade squamous intraepithelial lesions (HSIL), which are caused by chronic HPV infection, in reducing the incidence of anal cancer in HIV-infected men and women.

Combined with the possibility that anal cancer is preventable, the incidence of anal cancer is unacceptably high and calls for urgent intervention, Palefsky said.

“Compared with the general population, the incidence of anal cancer is increased more than 100-fold among some risk groups of HIV-infected persons, including many who are successfully treated with combination antiretroviral therapy,” Palefsky said. “There is evidence that anal HSIL is the precursor to invasive anal cancer, which makes it a great target for prevention.”

Palefsky is founder and president of the International Anal Neoplasia Society, which will hold its inaugural annual meeting Nov. 22- 24 in San Francisco.

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UCLA gets $7M to study links between substance abuse, HIV


Study will focus on minority men who have sex with men.

Pamina Gorbach, UCLA

Pamina Gorbach, UCLA

The National Institute on Drug Abuse has awarded UCLA a $7 million grant to investigate the links between substance abuse and HIV among Latino and African-American men who have sex with men.

Researchers will examine how non-injected drugs and alcohol can directly interact with the virus and other infectious diseases, to damage these men’s health. Enrollment in the study begins in January.

Called MASCULINE (MSM and Substances Cohort at UCLA Linking Infections Noting Effects), the study will be led by Pamina Gorbach, a professor of epidemiology at UCLA’s Fielding School of Public Health and a professor of infectious diseases at the David Geffen School of Medicine at UCLA, and Steven Shoptaw, a professor of family medicine at the Geffen School and director of the UCLA Center for Behavioral and Addiction Medicine.

For the study, researchers will establish and maintain an extensive repository of tissue, blood and fluid samples. This repository will be headed by Dr. Peter Anton, a professor of digestive diseases at the Geffen School. Anton, Gorbach and Shoptaw are also members of the UCLA AIDS Institute.

“Alcohol, non-injection use of cocaine and methamphetamine are linked to HIV sexual risk behaviors and transmission of infectious disease,” Gorbach said. “But little is known about how these substances can affect biology to produce health threats among those living with or at risk for HIV — especially among minority men who have sex with men.”

MASCULINE will be a companion study to the Multisite AIDS Cohort Study, the first and largest study specifically created to examine the natural history of AIDS. It will be conducted through the Fielding School’s Behavioral Epidemiology Research Group.

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