The Heavy Co$T Of AIDS – With Global Funds To Dry Up, Jamaica In Peril

Prepared by Byron Buckley

CARIBBEAN AIDS prevention advocates fear that crucial funding to sustain hard-won gains over the last decade could dry up by year end. Financial support from the Geneva-based Global Fund could cease because Jamaica and other Caribbean states, having been classified as ‘middle-income’ countries, no longer qualify as recipients of funding.

Dr Edward Greene - File

In addition, a South-South agreement between the Organisation of Eastern Caribbean States (OECS) and Brazil, which facilitates universal access to antiretroviral drugs to treat HIV/AIDS, comes up for renegotiation later this year.

Faced with this spectre, Dr Edward Greene, United Nations special envoy for HIV in the Caribbean, says the world body will be working with Jamaica and other countries in the region to protest the ‘middle-income’ designation and secure its reversal.

Warns Greene: “With Jamaica experiencing its current level of financial constraints and renegotiating its debt with the International Monetary Fund, we are concerned about the possibility of the country being forced to suspend its social programmes. It would be catastrophic, in particular, for people living with HIV (PLHIV), if a withdrawal of support were to take place.”

The UN envoy flays the World Bank’s flawed study, based on income, which resulted in Jamaica’s reclassification. He notes: “Income does not tell you the burden of debt nor disease.”

It is the easing of the burden of HIV/AIDS on Caribbean societies that Greene and fellow advocates wish to sustain. A cessation of funding would threaten the fragile gains made in the Caribbean over the last decade. From 2001-2009:

The number of AIDS-related deaths declined by 9,000;
The number of new HIV infections decreased by 3,000;
The number of PLHIV in Haiti and Guyana declined;
The number of PLHIV in Jamaica remained the same;
Adult HIV prevalence rate declined in Jamaica, Haiti and Guyana;
Adult HIV prevalence remained stable in Suriname, the Dominican Republic, and The Bahamas.
In addition to these positive trends, Greene has high praise for Jamaica’s efforts to ramp up its HIV response. “It is obvious that Jamaica is on the path to the elimination of mother-to-child transmission by 2015, and that the Caribbean, as a whole, can aim to be the first region in the world to achieve this goal,” he says.

The OECS could eliminate mother-child HIV infection by 2015. Fifty per cent of people in the Caribbean have access to antiretroviral treatment (ART) drugs, 70 per cent in Guyana, and universal in Barbados.

Challenges remain

But challenges remain in the regional efforts to control the spread of HIV/AIDS. Overall, between 2001 and 2009, the number of PLHIV increased by four per cent, including in Cuba, Jamaica’s nearest neighbour. During the same period, the HIV adult prevalence rate increased in four Caribbean countries: Barbados, Belize, Trinidad and Tobago, and Cuba.

One area of grave concern in Jamaica is the 30 per cent HIV prevalence among gay men. This is among the highest in global terms, and is followed in the region by Trinidad and Tobago (20 per cent), Dominican Republic (11 per cent), and The Bahamas (10 per cent). Overall, the Caribbean, with an adult HIV prevalence rate of one per cent, is ranked second to Africa (five per cent). This makes the Caribbean anomalous in the Americas, where the adult/HIV prevalence is 0.5 per cent in both Central/South America and North America/Mexico.

Indeed, any reversal of the gains from the Caribbean’s HIV/AIDS prevention programme would give a black eye to the optimism that characterises the global outlook on the status of the epidemic. Over the last 10 years, there has been a decline in mortality rates for HIV/AIDS across the globe. The mortality rate is down because more people have access to medication.

Greene explains: “Having access to antiretroviral drugs is a lifesaver because it allows people to live a very active and normal life. In the Caribbean, we can almost safely say we can eliminate the disease. I think we are in a more optimistic position than we were 10 years ago.”

His optimism is also based on developments in medical science of formulas to eventually eliminate HIV/AIDS, just like what occurred with smallpox and polio in the 1980s. This upbeat posture, perhaps overblown, is also reflected in UNAIDS’s goals of getting to zero by 2015:

Zero AIDS infection
Zero AIDS-related deaths
Zero discrimination
Eliminating discrimination
Lifting the burden of the disease, importantly, involves the elimination of discrimination against PLHIV. Discrimination is considered an important driver of HIV infection rate, according to health advocates, because people refuse to be tested. Studies carried out in the OECS by the Caribbean HIV/AIDS Alliance found that even among medical practitioners, there was the perception of stigma. This often leads to some form of discrimination, – giving more legs to the disease because people don’t want to go to the clinic.

Commenting on the hot-button issue in Jamaica of repealing the buggery law, the UN envoy says it is secondary to addressing discrimination and promoting human rights in general.

“For me, that (repealing the buggery law) is not the main problem. The main problem we are dealing with is the human rights, generally speaking,” he reasons. “People are entitled to access care, because if they don’t, that could affect society on a whole.”

Greene believes the State has an obligation to protect citizens on a whole to ensure that people with communicable diseases have access to care and treatment.

He reasons: “If I put the accent on reducing stigma and discrimination and human rights, I am ensuring that there is no overt discrimination for PLHIV in the workplace and in the school. This is because I don’t want to exclude one per cent of the population, or 30 per cent of men who have sex with men (MSM), from having access to those things that other people have. Just like how I would not exclude people from certain services because of their race, gender or where they live – as happens to job applicants living in inner-city communities.”

According to the UN envoy, it is important that PLHIV have certain responsibilities – to go and get tested, to adhere to their regime of treatment, to ensure that they educate their family and friends.

“So homosexuals have the right to health care,” Greene argues, “but they also have to behave in particular ways to conform to the norms of the communities. If they expect to be treated a certain way, they can’t behave in ways that are subversive to the community.” For example, he notes, members of the homosexual community should not “prey on young, vulnerable boys”. They must act responsibly, thus balancing the human rights structure.

Faith-based organisations

The goals of zero infection, deaths and discrimination require the involvement of the faith-based community. Greene is hopeful that after recent consultations with local church leaders, they will be able to adopt a message of abstinence, faithfulness to one’s partner and condom use. He points to the role played by faith-based organisations in East Asian societies in producing the lowest HIV/AIDS prevalence rate of 0.1 per cent per population.

“Notwithstanding its religious tenets, East Asia promoted safe sex as a practice for a fairly long time. It has not allowed its religious precepts to get into the way of practical sexuality.

“This is one reason we are seeing the very low prevalence rate, overall,” Greene observes.

The situation in East Asia contrasts with what obtains in the Caribbean where family life is breaking down; sexual promiscuity is rampant; and communities foster a culture of fear that leaves young girls vulnerable to sexual predators.

Of course, per capita income is quite high in East Asia, and the level of poverty there does not compare with prevalence rates in India and South/Southeast Asia.

Greene points out: “We have to see AIDS also as a development issue. Enhancing development could impact positively on AIDS outcome.”

He was in Jamaica to discuss a number of issues with governmental and non-governmental organisations, particularly surrounding human rights and HIV, as well as the financial sustainability of HIV programmes. As a result of these discussions, it has been agreed that Jamaica will hold a national consultation on human rights and the reduction of stigma and discrimination on World AIDS Day, December 1, 2012.

Byron Buckley is associate editor at The Gleaner. Email feedback to and
Low HIV prevalence in East Asia linked to:

Religious and family patterns;
Historical cultural mores, spiritualism;
Less multiple partners in sex;
Greater degree of abstinence before marriage;
Higher degree of faithfulness to partners

Rectal Formulation of Tenofovir Gel Found Safe and Acceptable in Early Phase Clinical Study

Follow-up study planned to further assess gel’s potential as a rectal microbicide to prevent HIV
March 5, 2012 – A gel formulation of the antiretroviral drug tenofovir designed specifically for rectal use was found safe and acceptable, according to a Phase I clinical study led by the U.S. National Institutes of Health (NIH)-funded Microbicide Trials Network (MTN), and presented today at the 19th Conference on Retroviruses and Opportunistic Infections (CROI). The results of the study, which included HIV-negative men and women who used the gel rectally once a day for one week, serve as an important step toward the development and testing of arectal microbicide to prevent HIV from anal sex. 
Microbicides, products applied on the inside of the rectum or vagina, are being studied as an approach for preventing or reducing the sexual transmission of HIV. The majority of microbicide research has focused on products to prevent HIV through vaginal sex, yet the risk of becoming infected with HIV from unprotected anal sex may be 20 times greater than unprotected vaginal sex. Developed as a vaginal microbicide, tenofovir gel was reformulated with less glycerin, a common additive found in many gel-like products, in the hopes of making it more appropriate for rectal use. 
The study, known as MTN-007, began in October 2010 and enrolled 65 men and women at three sites – the University of Pittsburgh, University of Alabama at Birmingham and Fenway Health in Boston. It is a follow-up trial to an earlier study, RMP-02/MTN-006, which assessed the rectal use of the vaginal formulation of tenofovir gel. That study found the gel produced a significant antiviral effect when used in the rectum, but gastrointestinal side effects were problematic.
In MTN-007, study participants were randomly assigned to one of four study groups. Three of these groups were assigned to use one of the following products for a one-week period: a rectal formulation of tenofovir gel; a placebo gel containing no active ingredient; or a gel containing the spermicide nonoxynol-9. A fourth group did not use any gel but took part in all of the study-related procedures and tests, including physical and rectal exams.
Study results indicated no significant differences in side effects among the three gel groups. Eighty percent of participants reported only minor side effects related to the use of study products, while 18 percent reported moderate side effects. (Two study participants reported severe adverse events, but they were not deemed to be related to use of the study products.) Participants’ adherence to the use of their assigned study products was high, with 94 percent using the products daily as directed. When asked about the likelihood that they would use the gel in the future, 87 percent of the participants who used the rectal formulation of tenofovir gel indicated they would likely use the gel again, compared to 93 percent of the placebo gel group, and 63 percent of the nonoxynol-9 gel group. In addition to assessing safety and acceptability, researchers also conducted preliminary gene expression testing, and noted changes in the activation of some genes in the tenofovir gel group, which they are continuing to evaluate to understand more fully.
“These findings tell us that the ‘rectal-friendly’ version of tenofovir gel was much better tolerated than the vaginal formulation of the gel when used in the rectum,” said Ian McGowan, M.D., Ph.D., co-principal investigator of the MTN and professor of medicine, Division of Gastroenterology, Hepatology and Nutrition and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine. “We are very encouraged that the rectal gel was quite safe, and that most people who used it said they would be willing to use it in the future.”
As follow-up to MTN-007, researchers are now planning a Phase II, multi-site trial called MTN-017that will involve186 men who have sex with men and transgender women at clinical sites in Peru, South Africa, Thailand, and the U.S. Participants will cycle through three study regimens: rectal tenofovir gel used daily, rectal tenofovir gel used before and after anal sex, and daily use of the antiretroviral tablet Truvada®. MTN-017 will allow researchers to collect additional information about the gel’s safety and acceptability in the rectum, and compare it to the use of Truvada.                                         
In addition to Dr. McGowan, other authors of MTN-007 are Craig Hoesley, M.D., University of Alabama; Ross Cranston, M.D., University of Pittsburgh; Philip Andrew, FHI 360; Laura Janocko, Ph.D., MTN and Magee-Womens Research Institute; James Dai, Fred Hutchinson Cancer Research Center; Alex Carballo-Dieguez, Ph.D., Columbia University; Ratiya Kunjara Na Ayudhya, BSMT, MTN; Jeanna Piper, M.D., Division of AIDS, National Institute of Allergy and Infectious Diseases; and Ken Mayer, M.D., Fenway Health.
MTN-007 is funded by the National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) and the National Institute of Mental Health, both components of the NIH. Tenofovir gel was developed by Gilead Sciences, Inc., of Foster City, Calif., which assigned the rights for tenofovir gel to CONRAD, of Arlington, Va ., and the International Partnership for Microbicides of Silver Spring, Md., in December 2006. 
The reduced glycerin formulation of tenofovir gel that was evaluated in MTN-007 is not the same formulation developed for vaginal use. The vaginal formulation of tenofovir gel was found safe and effective in reducing the risk of HIV in women who used it before and after vaginal sex in a study called CAPRISA 004. More recently, however, MTN researchers conducting the VOICE Studyclosed the tenofovir gel arm of the trial after a routine review of study data determined that the gel, while safe, was not effective in preventing HIV among the women in that study group, who were asked to apply it vaginally every day. In the meantime, a Phase III trial called FACTS 001 is currently evaluating the vaginal formulation of tenofovir gel using the same regimen as CAPRISA 004, with results expected in 2014. 



For Immediate Release                          Contact

December 15, 2011                                  Mark Aurigemma;

                        Pedro Goicochea;                                                                                                      




An application from Gilead Sciences, Inc. has been filed with the U.S. Food and Drug Administration toapprove an HIV antiretroviral therapy to reduce the risk of HIV infection among uninfected men who have sex with men (MSM) and heterosexual women and men. The application to approve the new HIV prevention method called pre-exposure prophylaxis, or PrEP, is based partly on data from the Global iPrEx study, the first human efficacy study to prove that PrEP reduces HIV infection risk inpeople (


The PrEP drug is a single-tablet once-daily combination of emtricitabine (FTC 200 mg) and tenofovir (TDF 300 mg), marketed under the brand name Truvada®. The iPrEx study found that MSM who were prescribed a single daily FTC/TDF tablet experienced an average of44% fewer HIV infections than those who received a placebo pill. Among a study sub-set those who took the tablet frequently enough for drug to be detected in their bodies, the rate of protection against HIVinfection was more than 90%. All participants in the iPrEx study received condoms and comprehensive HIV prevention support. The HIV prevention benefits of PrEP were in addition to the benefits obtained from other prevention methods.


iPrEx study results were first reported in the New England Journal of Medicine in November, 2010 (


Data supporting the use of PrEP to reduce HIV infection risk in heterosexual men and women were provided by the Partners PrEP study, which involved 4758 HIV serodiscordant couples (couples in which one partner is HIV-infected and the other is not) at nine trial sites in Kenya and Uganda. Both the iPrEx and Partners PrEP studies found that PrEP is safe, with very low levels of sideeffects and limited risk of HIV drug resistance.


“With 2.6 million new HIV infections occurring each year, and fewer than half of people with HIV receiving treatment, the world needs new and effective HIV prevention strategies,” said iPrEx Protocol Chair Robert Grant, MD, MPH of the Gladstone Institutes and the University of California at San Francisco. “Men who have sex with men have borne an enormous burden in this epidemic, and have also beenconsistently at the head of efforts to help reverse it. The 2,499 men and transgender women who participated in the iPrEx study Brazil, Ecuador, Peru, South Africa, Thailand and the United States have made an historic contribution to the effort to help end this epidemic.”


“The data are clearly strong enough to warrant FDA approval of Truvada for HIV prevention,” said Dana Van Gorder, Executive Director of the AIDS advocacy group Project Inform. “The decision about whether to approve Truvada for prevention should be made with compassion, based on science rather than ideology, and without judgment regarding the behaviors of people at risk for HIV. We firmly believe in the right of people at risk of becoming infected with HIV to choose PrEP, which has been shown to be effective when used with condoms, as an additional method of HIV prevention.”

An Open Label Extension of the iPrEx study (iPrEx OLE; is currently underway at 11 clinical trials sites in the United States, Peru, Ecuador, Brazil, South Africa and Thailand. iPrEx OLE is designed to provide additional information about the safety of PrEP and the behavior of people taking PrEP over a longer term.


The iPrEx study was sponsored by the U.S. National Institutes of Health (NIH) through a grant to the Gladstone Institutes, a non-profit independent research organization affiliated with the University of California at San Francisco. Additional support for iPrEx was provided by the Bill & Melinda Gates Foundation.

# # #


Mark Aurigemma
212.600.1960 (office)
646.270.9451 (mobile)

Scripps Research scientists reveal surprising picture of how powerful antibody neutralizes HIV

PGT 128

Caption: This is the PGT 128 antibody in action.

Credit: Image courtesy of the Wilson lab, The Scripps Research Institute

Usage Restrictions: None

LA JOLLA, CA, October 13, 2011 – Researchers at The Scripps Research Institute have uncovered the surprising details of how a powerful anti-HIV antibody grabs hold of the virus. The findings, published in Science Express on October 13, 2011, highlight a major vulnerability of HIV and suggest a new target for vaccine development.

“What’s unexpected and unique about this antibody is that it not only attaches to the sugar coating of the virus but also reaches through to grab part of the virus’s envelope protein,” said the report’s co-senior author Dennis Burton, a professor at The Scripps Research Institute and scientific director of the International AIDS Vaccine Initiative’s (IAVI) Neutralizing Antibody Center, based on the Scripps Research La Jolla campus.

“We can now start to think about constructing mimics of these viral structures to use in candidate vaccines,” said co-senior author Ian Wilson, who is Hansen Professor of Structural Biology and member of the Skaggs Institute for Chemical Biology at Scripps Research.

Other institutions in the United States, United Kingdom, Japan, and the Netherlands contributed to the research as part of an ongoing global HIV vaccine development effort.

Getting a Better Grip on HIV

Researchers from the current team recently isolated the new antibody and 16 others from the blood of HIV-infected volunteers, in work they reported online in the journal Nature on August 17, 2011. Since the 1990s, Burton, Wilson, and other researchers have been searching for such “broadly neutralizing” antibodies against HIV—antibodies that work against many of the various strains of the fast-mutating virus—and by now have found more than a dozen. PGT 128, the antibody described in the new report, can neutralize about 70 percent of globally circulating HIV strains by blocking their ability to infect cells. It also can do so much more potently—in other words, in smaller concentrations of antibody molecules—than any previously reported broadly neutralizing anti-HIV antibody.

The new report illuminates why PGT 128 is so effective at neutralizing HIV. Using the Wilson lab’s expertise in X-ray crystallography, Robert Pejchal, a research associate in the Wilson lab, determined the structure of PGT 128 joined to its binding site on molecular mockups of the virus, designed in part by Robyn Stanfield and Pejchal in the Wilson group and Bill Schief, now an IAVI principal scientist and associate professor at Scripps Research, and his group. With these structural data, and by experimentally mutating and altering the viral target site, they could see that PGT 128 works in part by binding to glycans on the viral surface.

Thickets of these sugars normally surround HIV’s envelope protein, gp120, largely shielding it from attack by the immune system. Nevertheless, PGT 128 manages to bind to two closely spaced glycans, and at the same time reaches through the rest of the “glycan shield” to take hold of a small part of structure on gp120 known as the V3 loop. This penetration of the glycan shield by PGT 128 was also visualized by electron microscopy with a trimeric form of the gp120/gp41 envelope protein of HIV-1 by Reza Kayat and Andrew Ward of Scripps Research; this revealed that the PGT 128 epitope appears to be readily accessible on the virus.

“Both of these glycans appear in most HIV strains, which helps explain why PGT 128 is so broadly neutralizing,” said Katie J. Doores, a research associate in the Burton lab who was one of the report’s lead authors. PGT 128 also engages V3 by its backbone structure, which doesn’t vary as much as other parts of the virus because it is required for infection.

PGT 128’s extreme potency is harder to explain. The antibody binds to gp120 in a way that presumably disrupts its ability to lock onto human cells and infect them. Yet it doesn’t bind to gp120 many times more tightly than other anti-HIV antibodies. The team’s analysis hints that PGT 128 may be extraordinarily potent because it also binds two separate gp120 molecules, thus tying up not one but two cell-infecting structures. Other mechanisms may also be at work.

Toward an AIDS Vaccine

Researchers hope to use the knowledge of these antibodies’ binding sites on HIV to develop vaccines that stimulate a long-term—perhaps lifetime—protective antibody response against those same vulnerable sites.

“We’ll probably need multiple targets on the virus for a successful vaccine, but certainly PGT 128 shows us a very good target,” said Burton.

Intriguingly, the basic motif of PGT 128’s target may mark a general vulnerability for HIV. “Other research is also starting to suggest that you can grab onto two glycans and a beta strand and get very potent and broad neutralizing antibodies against HIV,” Wilson said.




In addition to Pejchal, Doores, and Khayat, Laura M. Walker of Scripps Research and Po-Ssu Huang of University of Washington at Seattle were co-first authors of the study, “A potent and broad neutralizing antibody recognizes and penetrates the HIV glycan shield.” Along with Wilson, Burton, and Ward, additional contributors were Sheng-Kai Wang, Chi-Huey Wong, Robyn L. Stanfield, Jean-Philippe Julien, Alejandra Ramos, Ryan McBride, and James C. Paulson of Scripps Research, and Pascal Poignard, and William R. Schief of Scripps Research, IAVI and University of Washington at Seattle; Max Crispin and Christopher N. Scanlan of the University of Oxford; Rafael Depetris and John P. Moore of Weill Medical College of Cornell University; Umesh Katpally, Andre Marozsan, Albert Cupo, and William C. Olson of Progenics Pharmaceuticals; Sebastien Maloveste of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health; Yan Liu and Ten Feizi of Imperial College, London; Yukishige Ito of the RIKEN Advanced Science Institute in Japan; and Cassandra Ogohara of University of Washington at Seattle.

The research was supported by the International AIDS Vaccine Initiative, National Institutes of Health, the U.S. Department of Energy, the Canadian Institutes of Health Research, the UK Research Councils, the Ragon Institute, and other organizations.

Contact: Mika Ono
Scripps Research Institute

Campaigners ‘disappointed’ with Lorna Golding’s speech on HIV/AIDS



HIV/AIDS campaigners said they were disappointed by Jamaica’s presentation as the spouses of government and state leaders spoke on a UNAIDS programme to eliminate new infections of the disease, now passing its 30-year milestone.

Lorna Golding, wife of Prime Minister Bruce Golding, was among 30 ‘First Ladies’ from the Caribbean, Latin America, Africa and Asia who gathered at the United Nations in New York last week to mobilise support around achieving the Joint United Nations Programme on HIV/AIDS’ (UNAIDS) vision of zero new HIV infections among children by 2015. The event was held while their spouses and diplomats met for a UN high-level meeting on AIDS.

Panos Caribbean, the information and communication non-governmental organisation, reported on reaction to the session involving Golding and her counterparts which was focussed on first spouses’ role in eliminating new HIV infections in children.

In a brief presentation that invoked the Jamaica national pledge, Golding announced that Jamaica has successfully reduced HIV transmission from mother to child since the inception of its Prevention of Mother-to-Child Transmission programme in 2004, Panos said.

“The number of HIV-positive pregnant women receiving antiretroviral medication has increased significantly from 47 per cent in 2004 to 83 per cent in 2009. This has led to a dramatic reduction in mother-to-child transmission of HIV from 25 per cent in 2002 to below five per cent since,” she said.

HIV/AIDS campaigners representing civil society who attended the session told Panos Caribbean they felt Golding’s presentation was disappointing and lacked clarity in what her plans were for eliminating vertical transmission of HIV.

“I’m disappointed that there were no specific commitments made by the First Spouse on this very critical issue. She only quoted from our national prayer that ‘under God’ Jamaica will play her part in advancing the welfare of the whole human race. I’m surprised she didn’t seize the opportunity to seek specific assistance from the international community to support prevention of vertical transmission in Jamaica,” legal advisor, Marginalised Groups AIDS-Free World, Maurice Tomlinson, told Panos Caribbean.

“She gave no indication as to what she or the Government plans to do. This makes it palpably clear she and the Government failed to understand the issue of vertical transmission which is not going away but is festering and threatens to explode in our high-sex and multiple/concurrent partners’ context,” Tomlinson added.

Director of programmes and training at Eve for Life, Joy Crawford, also told Panos Caribbean that Golding’s contribution lacked specifics or any clear action plan, strategies or projects that she would undertake.

“In her promise to play her part in upholding the national pledge ‘Before God and all mankind’ we anticipate she will develop clear advocacy and interventions that will reduce the current societal, familial and moral stigma and discrimination faced by the young pregnant adolescent female especially those identified as HIV positive,” Crawford said.

Sophia Martelly, the wife of Haiti’s newly inaugurated President Michel Martelly, committed to working to involve more Haitian men in reducing the rate of mother-to-child transmission of HIV. She also pledged to improve sex education for teens and to support programmes that empower women and improve their economic status.

Around 1,000 babies worldwide are infected with HIV every day, UNAIDS estimates, 90 per cent of whom are in sub-Saharan Africa. HIV is also the leading cause of maternal deaths in developing countries.

The spouses agreed to advocate for comprehensive and integrated access to maternal and child health services. They also committed themselves to pressing for an end to gender inequality, gender violence, discrimination and unfair laws that prevent pregnant women from accessing HIV testing and counselling, prevention, treatment and support services.

Vitamin D Deficiencies Linked to Diabetes in People With HIV

HIV-positive people with vitamin D deficiency were far more likely to also have type 2 diabetes than people who were not vitamin D deficient, according to a study published online December 20 in the journal AIDS.

Poor vitamin D levels in people with HIV have become a prominent concern among AIDS researchers in recent years. Vitamin D deficiency has been linked to a number of health conditions in HIV-negative people, including: poor bone strength and density, type 2 diabetes, metabolic syndrome and cardiovascular disease (CVD).

A number of recent studies have also consistently found that vitamin D levels are deficient in a significant number of people living with HIV in the Northern Hemisphere. What remains unclear, however, is whether HIV and its treatment are solely responsible for the increase in diseases such as diabetes and CVD seen in HIV-positive people, or whether low vitamin D levels also contribute in a meaningful way.

To begin answering these questions, Zsofia Szep, MD, from the University of Pennsylvania Medical School in Philadelphia, and her colleagues tested vitamin D levels in participants enrolled in the Modena HIV Metabolic Clinic Cohort in Italy. Their aim was to determine whether vitamin D deficiency was linked to either type 2 diabetes or metabolic syndrome.

Metabolic syndrome involves having a large waist circumference and problems with cholesterol and triglycerides and blood sugar control, and it is a significant risk factor for diabetes, heart attacks and strokes.
Among the 1,405 participants in the study, most were male and the average age was 44. About 45 percent were also infected with hepatitis C virus (HCV), but few were taking vitamin D supplements.

Overall, Szep and her colleagues found that 62 percent of the study participants had vitamin D deficiency—defined as blood levels of 25-hydroxyvitamin D less than 20 nanograms per milliliter (ng/ml). An additional 20 percent had vitamin D insufficiency—blood levels of vitamin D of at least 20 ng/ml but less than 30 ng/ml.

When Szep’s team accounted for a number of factors that can contribute to type 2 diabetes—such as sex, age, body mass index and HCV coinfection—vitamin D deficiency remained strongly associated with type 2 diabetes. In fact, vitamin D deficiency predicted the presence of type 2 diabetes more than any other factor, and people with vitamin D deficiency were 85 percent more likely to have diabetes than people who weren’t deficient.

As far as metabolic syndrome, there was a trend toward association—people with vitamin D deficiency were 32 percent more likely to have metabolic syndrome—but this did not reach statistical significance. This means that the difference was small enough that it could have occurred by chance.

The authors acknowledge that the study design, which involved a snapshot of people’s health at a single point in time, can’t establish whether vitamin D deficiency causes diabetes or whether the link is coincidental. However, they note that maintaining good vitamin D levels is associated with reducing blood vessel inflammation in HIV-negative people. Given that HIV itself significantly increases inflammation—a precursor to diabetes and CVD—it is possible that HIV levels and vitamin D levels are synergistically contributing to these health problems.

“Future studies should examine whether vitamin D supplementation can prevent or treat type 2 diabetes mellitus in HIV and possibly reduce complications associated with HIV infection and its treatment,” the authors conclude.


Background: Metabolic complications, including type 2 diabetes mellitus and metabolic syndrome, are increasingly recognized among HIV-infected individuals. Low vitamin D levels increase the risk of type 2 diabetes mellitus, and vitamin D supplementation has been shown to decrease the risk of type 2 diabetes mellitus in patients without HIV infection.

Objectives: The primary objective was to determine whether vitamin D deficiency (serum 25-hyrdoxyvitamin D <20 ng/ml) was associated with type 2 diabetes mellitus among HIV-infected patients. Our secondary objective was to determine whether vitamin D deficiency was associated with metabolic syndrome in HIV.

Methods: We conducted a cross-sectional study among participants enrolled in the prospective Modena (Italy) HIV Metabolic Clinic Cohort. Clinical and laboratory data, including history of type 2 diabetes mellitus, fasting blood glucose, components of metabolic syndrome, and 25-hydroxyvitamin D levels, were obtained for all participants.

Results: After adjusting for vitamin D supplementation, sex, age, body mass index, and hepatitis C virus co-infection, vitamin D deficiency was associated with type 2 diabetes mellitus [adjusted odds ratio (OR) 1.85; 95% confidence interval (CI) 1.03-3.32; P = 0.038]. The association between vitamin D deficiency and metabolic syndrome was not significant after adjusting for vitamin D supplementation, sex, age and body mass index (adjusted OR 1.32; 95% CI 1.00-1.75; P = 0.053).

Conclusions: Our study demonstrates an association between vitamin D deficiency and type 2 diabetes mellitus. Clinical trials are needed to better characterize the association between vitamin D deficiency and type 2 diabetes mellitus in HIV infection and to evaluate whether vitamin D is able to prevent or delay the onset of type 2 diabetes mellitus.

(C) 2011 Lippincott Williams & Wilkins, Inc.

Bad news for HIV in Jamaica: HIV/AIDS Programme Hit By Funding Woes

Anastasia Cunningham, Senior Gleaner Writer

Dr Karen Hilliard (centre), mission director, United States Agency for International Development, responds to President of the Jamaica Chamber of Commerce, Milton Samuda (right), during a meeting of private sector leaders to discuss establishing a foundation to ensure the financial sustainability of Jamaica’s HIV programme, at the Wyndham Kingston hotel, New Kingston, Tuesday. At left is chief consultant at the Jamaica Business Council

The announcement by the World Bank that due to the global financial crisis, within the next four years, they will stop external funding of Jamaica’s HIV/AIDS programme has thrown the business community into a crisis mode.

With the core productivity age group, 20-44, at the greatest risk, it has hit home that the economy could be in serious trouble and the productivity level of the country greatly affected if left unchecked.

This reality has caused the Jamaica Business Council on HIV/AIDS (JaBCHA), to seek to establish a J$1 billion foundation to support the national treatment and prevention programme. As the council’s chief fundraiser Earle Moore puts it, “A strong hurricane is heading our way and we have ample time to prepare for it.”

Human resources

Moore added, “If we don’t control the HIV epidemic, it will lead to reduced market sizes for businesses. There will be a decline in the total number of human resources available for production and investment, and managing human resources within our companies will become more difficult and complicated.”

JaBCHA has the strong backing of the Ministry of Health, Jamaica Employers’ Federation (JEF), Private Sector of Jamaica, Jamaica Chamber of Commerce (JCC), Jamaica Hotel and Tourist Association (JHTA) and USAID/ Jamaica. Several key organisations are already onboard, among them Jamaica National, LIME, GraceKennedy, Supreme Ventures, LASCO, Bank of Nova Scotia, Jamaica Broilers and Digicel.

Speaking at JaBCHA’s launch, on Tuesday, JEF President Wayne Chen said: “We are concerned about the increasing number of employees with HIV/AIDS, so we now have to take an enlightened approach to deal with it.”

JCC President Milton Samuda said, “if it is left unchecked, Jamaica will be faced with a crisis, so the private sector has to put heart and soul into it to prevent it. We need to do more for ourselves, instead of depending on others. We have to clean up our own mess. We have to fund the things that are of national importance.”

Wayne Cummings, JHTA president, said he wanted the private sector to take it one step further and “make a bold move. Remove HIV/AIDS persons from the list of persons who cannot get insurance.”

Mission Director of USAID/Jamaica, Dr Karen Hilliard said she was proud to see the greater business community come together to commit funding to fight an epidemic that threatened the productivity sector.

Dr Kevin Harvey, HIV/STI senior medical officer in the Ministry of Health, announced that there is a 2007-2012 National Strategic Plan in place to deal with the epidemic, which is estimated to cost over US$200 million.


Jamaica has relied heavily on external funding to support its HIV/AIDS programme. Over the last two years, the national HIV programme was funded largely by global donors to the tune of US$80.4 million, with treatment and prevention receiving 33 per cent and 38 per cent, respectively. Only one per cent of Jamaica’s National Capital Expenditure was allocated to the health service.

On the other hand, countries like Trinidad and Tobago, Barbados and St Kitts & Nevis finance their HIV/AIDS programmes primarily from domestic revenue. While The Bahamas’ programme is solely financed by the private sector.

Between 1982 and 2009, approxi-mately 1.6 per cent or some 27,000 Jamaicans had HIV, 14,354 of which had AIDS, 7,772 of that number have died. Men and women age 20-44, the labour force’s most productive years, accounted for 65 per cent of the reported AIDS cases. Kingston, St Andrew and St James had the majority of cases. Last year, 378 persons died of AIDS, a decline of 43 per cent, when compared to 665 persons who died in 2004.

Jamaica Gleaner Company

Discordant HIV Levels in the Brain and Blood Are More Common Than Expected says US study


Up to 10 percent of people on antiretroviral (ARV) therapy have active HIV replication in the brain and spinal fluid despite having undetectable HIV levels in the blood, according to a study published online November 4 in The Journal of Infectious Diseases. This could explain why low-level inflammation and cognitive decline persist in people being successfully treated with HIV drugs. It may also have implications for treatment recommendations and the ongoing study of different treatment strategies.
A number of studies in recent years have documented two key findings about HIV in the brains of people taking ARVs. First, that HIV reproduction in the brain and central spinal fluid (CSF) is sometimes different from what occurs in the blood; and second, that immune inflammation and cognitive decline are frequently detected in people who otherwise have very good control of their HIV on ARV therapy.

Another key factor that some researchers believe can significantly affect HIV’s activity in the brain and CSF is the ability of individual drugs to cross the blood-brain barrier. Some ARVs cross easily, while others have poor penetration into these compartments.

In an effort to explore the interaction of these three factors—differences in viral replication in blood and brain, signs of immune inflammation, and the brain penetration potential of a person’s regimen—Arvid Edén, MD, from the Sahlgrenska Academy at the University of Gothenburg, in Sweden, and his colleagues examined blood and CSF samples from 69 HIV-positive people taking ARV therapy.

The blood and brain samples were taken between 2002 and 2010. To be included in the study, in which CSF levels were obtained by a lumbar puncture, a person needed to have been on ARVs for at least six months and to have had undetectable HIV levels in the blood for at least three months.

All of the people were taking either Sustiva (efavirenz), Norvir (ritonavir)-boosted Reyataz (atazanavir) or Kaletra (ritonavir plus lopinavir). These drugs were combined with either Viread (tenofovir), Ziagen (abacavir) or Retrovir (zidovudine), plus either Emtriva (emtricitabine) or Epivir (lamivudine).

Edén and his colleagues found that 10 percent of the participants had detectable HIV levels in CSF, many more than they expected. When the team compared the characteristics of those with measurable virus in CSF with those who did not have measurable virus in CSF, they found that people with measurable CSF levels were more likely to have been on ARVs longer, to have had periodic increases in HIV in the blood (blips), and to have taken a treatment interruption.

Edén’s team also found that people with measurable CSF HIV levels were more likely to have high levels of brain inflammation, as determined by measuring neopterin levels.

The makeup of the ARV regimen was not statistically meaningful in regards to discordant viral load responses in the blood and brain. However, there was a trend toward an increased risk of HIV replication in the brains of those who took either Viread or Ziagen compared with those who took Retrovir.

Interestingly, a new method of calculating the likelihood of good ARV control of HIV in the brain, called the central nervous system penetration effectiveness (CPE) rank, was not a good predictor of neither discordant blood and brain HIV levels nor the likelihood of brain inflammation.

Though the brain penetration of the regimens did not significantly affect the likelihood of having discordant HIV levels in the blood and brain, other studies have found that it does. In an accompanying editorial, David Clifford, MD, from Washington University in St. Louis, said this issue needs critical attention, as the most commonly used ARVs today often have only minimal to moderate brain penetration. “If these findings are replicated by others, suggesting 10 percent failure rate of current therapy in the critical CNS compartment, this would be a serious shortcoming for present therapy,” he warned.

“This topic also touches on the interaction of HIV with aging, particularly as it affects the brain and cognitive status,” he continued, noting that cognitive decline from HIV replication and activation could hasten or worsen age-related cognitive problems.

“If control of virus in the brain becomes increasingly difficult to maintain over time,” he concluded, “this implies that increasing neurologic symptoms associated with the virus might augment the cognitive decline of aging, resulting in much more serious late-life neurological issues for HIV-infected patients.”

Ultimately, both doctors, along with Edén’s colleagues, emphasize that this is a very important area of exploration that demands larger studies going forward.

See also:

“Cerebrospinal fluid”

Inter-American Commission on Human Rights Heightens Commitment to LGBT Rights at Hearing on Punitive Measures & Discrimination in the Caribbean

Georgetown, Guyana, November 9, 2010 – Courtesy of

SASOD - GuyanaSASOD is a group based in Guyana which is committed to eradicating discrimination on the grounds of sexual orientation. It started work in 2003 with the campaign to include sexual orientation as one of the fundamental rights in the Guyana constitution, and has since been working on promotion of rights for gay and lesbian people.

On Tuesday, October 26, 2010, four representatives of the Lesbian, Gay Bisexual and Transgender (LGBT) communities in the English-speaking Caribbean participated in a thematic hearing before five of the seven Commissioners of the Inter-American Commission on Human Rights (IACHR) in Washington, DC. The Commissioners who sat for the hearing were Paulo Sérgio Pinheiro (First Vice Chair); Dinah Shelton (Second Vice Chair); Rodrigo Escobar Gil; Luz Patricia Mejía Guerrero and María Silvia Guillén.
The IACHR is the body of the Organization of American States (OAS) responsible for the promotion and protection of human rights in the Inter-American system and the hearing was facilitated in accordance with OAS resolution 2600 ‘Human Rights, Sexual Orientation and Gender Identity’ which mandated the IACHR to report on the status of human rights of LGBT at the next General Assembly of the OAS in June 2011.
The petitioners, representing organizations from Barbados, Guyana, Jamaica, and Trinidad and Tobago, presented a 72-page report detailing the situation of LGBT people in the region and requested the assistance of the IACHR in helping to repeal the laws that criminalize same-sex sexual behaviors, expression and identities in the Anglophone Caribbean.
One of the key points made in the hearing, was that the existence of the laws that criminalize same-sex sexual behaviors, expression and identities result in widespread societal stigma and discrimination on the basis of sexual orientation, significantly restricting LGBT people’s ability to live safe, happy and fulfilling lives.
Maurice Tomlinson, of AIDS-Free World (Jamaica), reviewed the various laws and their penalties, and gave examples of how they affected gay men in the region; Patsy Grannum of MOVADAC- Movement Against Discrimination Action Committee (Barbados), spoke about how the laws impacted lesbian women; Ashily Dior of CAISO- Coalition Advocating Inclusion of Sexual Orientation (Trinidad and Tobago) advocated for the rights of transgender individuals and Sherlina Nageer of SASOD- the Society Against Sexual Orientation Discrimination (Guyana) discussed the deleterious effect of the laws on the response to HIV in the region.
The petitioners urged the Commissioners to consider that the Caribbean countries which retain these colonial-era laws against homosexuality foster an environment in which real and perceived homosexuals are regularly threatened, harassed, raped, murdered, and otherwise ill-treated. Because their sexual identity has been criminalized, LGBT people in these countries often feel unable to seek legal remedies when their human rights are violated.
Finally, the petitioners called for the repeal of these discriminatory laws as an essential step in winning the Caribbean’s response to HIV, since stigma and discrimination often prevents LGBT people from seeking vital HIV prevention, treatment, care and support services.
The Commissioners acknowledged the seriousness of this issue and pledged their full support to LGBT individuals and organizations in the Anglophone Caribbean that are working on these issues. The Commissioners also urged affected individuals and organizations to continue to inform and involve them about the status of LGBT human rights in accordance with the OAS resolution, and to utilize all the tools and mechanisms available through the Inter-American human rights system in their efforts. In its release reporting at the conclusion of the 140th period on November 5, the Commission affirmed its commitment to intensify its efforts to defend the rights of LGBT persons and prepare a hemispheric report on this issue.
The participation of the petitioners at the hearing and the preparation of the report was made possible through support from the United Nations Development Programme (UNDP), the Joint United Nations Programme on HIV and AIDS (UNAIDS), the Open Society Institute (OSI), AIDS-Free World, Global Rights and the International Gay and Lesbian Human Rights Commission (IGLHRC).

Related Information:
IACHR Press Release on the 140th Period of Sessions:
Audio File of the Thematic Hearing on the Punitive Measures and Discrimination on the Basis of Sexual Identity in Caribbean Countries at the 140th Period of Sessions of the IACHR:

Photo Caption:

LGBT Panelists at the IACHR Thematic Hearing on October 26, 2010, during the 140th Period of Sessions (from left to right): Patsy Grannum (MOVADOC – Barbados), Stefano Fabeni (Global Rights), Maurice Tomlinson (AIDS-Free World – Jamaica), Sherlina Nageer (SASOD – Guyana), Marcelo Ferreyra (IGLHRC) and Ashily Dior (CAISO – Trinidad and Tobago).

Some People Control HIV Without Drugs Due To 5 Amino Acids In A Protein

Medical News Today

Tiny differences in five amino acids in HLA-B, a protein, are linked to whether people can control levels of HIV (human immunodeficiency virus) with just their immune systems, an international team of researchers wrote in the journal Science. These small variants in the protein appear to alert the immune system that there is an infection.

Co-senior author Bruce Walker, MD, director of the Ragon Institute, said:


We found that, of the three billion nucleotides in the human genome, just a handful make the difference between those who can stay healthy in spite of HIV infection and those who, without treatment, will develop AIDS. Understanding where this difference occurs allows us to sharpen the focus of our efforts to ultimately harness the immune system to defend against HIV.


Co-senior author, Paul de Bakker, PhD, of the Broad Institute and Brigham and Women’s Hospital, said:

Earlier studies had showed that certain genes involved with the HLA system were important for HIV control. But they couldn’t tell us exactly which genes were involved and how they produced this difference. Our findings take us not only to a specific protein, but to a part of that protein that is essential to its function.

The authors explain that approximately 1 in every 300 patients infected with HIV is naturally able to undermine viral replication just with their immune system, resulting in permanent very low viral loads.

Such people are known as HIV Controllers, or simply Controllers.

Florencia Pereyra, MD, at the Ragon Institute, set up the International HIV Controllers Study in 2006, in order to determine what genetic features drove this unique ability to keep viral loads down naturally. Their aim was to enroll 1,000 HIV controllers from clinics and centers of research worldwide. So far, 1,500 controllers have been enrolled and the goal was upped to 2,000 of them.

This study started with a GWAS (genome-wide association study) of nearly 1,000 controllers and 2,600 patients with progressive HIV infection, provided through a collaboration with the AIDS Clinical Trials Group.

The GWAS located about 300 sites that were statistically linked to HIV immune control – all 300 sites were in chromosome 6, in the regions that code for HLA proteins. The scientists eventually pinned down the gene sites to four, but could not tell whether they were just located close to casual variants or really had an impact on viral control.

They could not fully sequence that genome region in all participants. They used a process developed by Sherman Jia to identify specific amino acids – directly testing those sites linked 5 amino acids within the HLA-B protein with variations in viral control. Sherman Jia is a medical student in the Harvard-MIT Health Sciences and Technology program.


Overcome HIV infection and AIDS Regain your health and strength

HLA-B plays a vital role in the immune system’s process of identifying and destroying cells which are infected by virus. HLA-B usually attaches onto viral peptides (protein segments) inside the cell and carries them to the cell’s membrane where CD8 “killer” T cells are flagged to destroy the infected cell.

All the 5 identified amino acid sites are in the lining of the binding pocket – the part of the HLA-B protein that grabs and displays the viral peptides.