Conference Focuses on Hope Against HIV, AIDS

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Method of Estimating Infection Rate in India May Overstate Problem

August 18, 2006

TORONTO, Aug. 17 -- The AIDS epidemic in India, good news and bad news out of Africa, and novel drugs on the horizon were topics of research presented in the "late-breaker" sessions of the 16th International AIDS Conference on Thursday.

Here is a brief summary:

The most common way of estimating HIV infection rates in the developing world is to test pregnant women in public clinics and men at venereal-disease clinics for the virus. These are accessible samples of reproductive-age adults. Epidemiologists use those rates, after certain adjustments, to calculate a population-wide estimate.

But how accurate is this method? A team of Indian researchers tried to answer that for one district of Andhra Pradesh, a state in south India.

They tested a random sample of about 14,000 people ages 15 to 49. They adjusted for certain high-risk groups that were under-sampled (such as prisoners) and came up with an estimate of about 47,000 HIV-infected people in the district. The previous estimate was about 113,000 -- almost 2 1/2 times as high.

The "population-based" method found higher HIV prevalence in lower socioeconomic groups. The 25 percent of pregnant women who used public prenatal clinics were more likely to come from lower-income households. That was also true of the men who were treated for venereal infections at the "sentinel" clinics. Together, those samples produced inflated estimates for the whole population.

India has been thought to have 5.2 million infected people (out of 40 million worldwide). Based on the new study, this estimate "needs substantial downward revision," said Lalit Dandona of the Administrative Staff College of India in Hyderabad, who headed the new survey.

Whether that is true of Africa, where researchers also rely heavily on prenatal clinics for data, is unknown. But several countries there that have introduced slightly more representative sampling have come up with lower prevalence estimates in the past two years.



When American AIDS patients began taking a cocktail of antiretroviral drugs in 1996, death rates plummeted.

Now, that is happening in Africa.

Researchers have been following a sample of HIV-infected people in Entebbe, Uganda, since 1995. In 2003, the drugs became available.

The mortality rate before the drugs was estimated at 577 per year per 1,000 people. It is now 34. The probability that a person newly enrolled in the study group would be alive in two years has risen from 28 percent to 94 percent.

A study from northern Tanzania, however, found that in 32 percent of people on antiretrovirals, the virus eventually becomes resistant and reappears in their bloodstream.

The single biggest predictor of this problem was whether a person had to pay for the medicine. The longer they had to, the more their risk of "virological failure" increased.

The researchers believe that people who had to buy the drugs themselves skipped doses or went on and off treatment as their income varied. This adds to mounting evidence that people who get free AIDS drugs have much better outcomes.



There was also disturbing news out of Uganda, which for years has been the African model of a winning battle against AIDS.

HIV infection rates at a sample of 24 prenatal clinics fell from 1992 to 2000. In seven, the fall has continued, and in seven it has leveled off, but in 10 it is rising. In a rural population sample, HIV prevalence in men rose from 5.6 to 6.5 percent in the past four years and in women from 6.9 to 8.8 percent.

The precise reason for this is unknown, but the researchers said it shows that prevention efforts must not let up.



The pipeline of new AIDS drugs has numerous promising candidates.

Researchers reported very positive results for MK-0518, a drug developed by Merck that is an "integrase inhibitor." It is unlike any of the 25 antiretrovirals in use.

When added to two drugs commonly in use (tenofovir and 3TC, a brand of lamivudine), it knocked back HIV in the bloodstream just as well -- and more quickly -- as those same two drugs taken with efavirenz, another highly successful and popular medicine.

MK-0518 could eventually add one more option to the many now available to AIDS patients.

Another study showed promising laboratory results for a substance called TAT0002, the first in a new class known as "telomerase activators" that may help prolong the lives of HIV-fighting cells that use the protein CD8.



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