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EPIDEMICS
AIDS: Anger flares at homophobic laws
by Staff Writers
Melbourne (AFP) July 21, 2014


Monkey study dampens hopes for AIDS cure
Paris (AFP) July 20, 2014 - The monkey version of HIV can take refuge from anti-AIDS drugs within days of entering the body, a study said Sunday, dampening hopes for a human cure.

If the same holds true for human beings, treatment may have to start "extremely early" after a person is infected with the virus that causes AIDS, according to researchers publishing in the journal Nature.

The findings come just days after the disappointing announcement that a Mississippi baby thought to have been cleared of HIV through a potent dose of antivirals administered 30 hours after birth and continued for 18 months, has tested positive for the virus after two drug-free years.

"The unfortunate clinical findings of viral rebound in the Mississippi baby appear to be concordant with the monkey data," study co-author Dan Barouch of the Beth Israel Deaconess Medical Centre (BIDMC) in Massachusetts told AFP.

"These data certainly raise important challenges for HIV eradication efforts."

A key challenge for curing HIV infection is the presence of viral reservoirs -- infected immune cells in which virus DNA can lie dormant for years, undisturbed by antiretroviral treatment (ART) or the immune system.

In the vast majority of people, the virus starts proliferating as soon as treatment is stopped, which means the drugs have to be taken for life.

Little is known about when and where these reservoir cells are established during HIV infection.

Some had assumed the reservoirs are "seeded" by virus DNA during acute HIV infection -- when the presence of virus in the blood had already risen to a high level.

But the new study found that in rhesus monkeys infected with simian HIV, or SIV, the reservoir was established "strikingly early" after infection.

"The reservoir was established in tissues during the first days of infection, before the virus was even detected in the blood," said Barouch.

The monkeys were started on antiretroviral treatment at three, seven, 10 and 14 days after SIV infection.

Once the drugs were stopped, the virus replicated in all groups, though slower in the monkeys treated earliest.

"The strikingly early seeding of the viral reservoir within the first few days of infection is sobering and presents new challenges to HIV-1 eradication efforts," the authors wrote.

- New game plan required -

"Taken together, our data suggest that extremely early initiation of ART, extended ART duration and probably additional interventions that activate the viral reservoir will be required."

Scientists in Melbourne, Australia, are experimenting with an anti-cancer drug to flush the virus out of its hiding place, then to be killed.

The authors of the Nature paper stressed their findings have yet to be confirmed in humans, as there are important differences between SIV and HIV infection.

But if in humans the virus can also enter the reservoir even before it is detectable in the blood, it may be "very difficult" to start treatment early enough, as a blood test is required to diagnose HIV infection, said the team.

There is no cure for AIDS, and antiviral drugs merely control the virus' replication, thus halting its spread.

Last week, US scientists said the Mississippi baby, who had had no detectable level of HIV for more than two years after stopping treatment, had tested positive for the virus.

Her case had raised hopes that doctors may have found a way to cure children born HIV-positive, simply by treating them early.

The new study was published as experts and policy makers from around the world gathered in Melbourne for the 20th International AIDS Conference, which will discuss advances in prevention and treatment.

Campaigners at the world AIDS conference are taking aim at countries with anti-gay laws, accusing them of creating conditions that let HIV spread like poison.

Powerfully mixing concerns over human rights and health, the issue threatens to divide western donor countries where gay equality is making strides from poor beneficiary nations where anti-gay laws persist or have been newly passed, say some.

Nobel laureate Francoise Barre-Sinoussi, who co-discovered HIV and co-chairs the six-day conference, seized Sunday's opening ceremony to lay down a barrage of fire at laws targeting minorities who bear a disproportionate share of the global pandemic.

"The cruel reality is that in every region of the world, stigma and discrimination continue to be the main barriers to effective access to health," she said.

"We need again to shout out loud that we will not stand idly by when governments, in violation of all human rights principles, are enforcing monstrous laws that only marginalise populations that are already the most vulnerable in society."

Experts point to bitterly-won experience in the war on AIDS, which has claimed 39 million lives in 33 years: HIV spreads stealthily from stigmatised minorities and into the mainstream population, where it then can spread like wildfire.

If gays or bisexuals are jailed or persecuted, this discourages them from taking an HIV test or seeking treatment if they are infected. It creates a toxic atmosphere of silence and fear -- a perfect breeding ground for HIV.

The scenario is similar, say specialists, when sex workers and intravenous drug users are criminalised.

The 12,000 delegates attending the 20th International AIDS Conference are being urged to sign a "Melbourne Declaration" which insists that all gay, lesbian and transgender people "are entitled to equal rights and to equal access to HIV prevention, care and treatment information and services".

But just as more and more western countries have passed laws enshrining equal rights to marriage, health care and pensions for gays, other countries have pushed through legislation to prosecute them.

According to a report issued last week by the UN agency UNAIDS, 79 countries have laws that criminalise same-sex practices, and seven of them have the death penalty for it.

Recent adopters of anti-gay legislation include Uganda and Nigeria. India has restored colonial-era anti-sodomy laws. Russia has passed legislation banning even the distribution of information about homosexual orientation.

Kene Esom, a Nigerian who works in South Africa for a gay campaign group, the African Men for Sexual Health and Rights, said these laws sometimes crippled efforts to spread the word about safe sex and expand access to life-saving HIV drugs.

"Some laws ban freedom of assembly and freedom of association" for gays, he said. "That means groups can't meet or even receive funds."

- Donor anger -

In a keynote speech, former Australian high court justice and human rights advocate Michael Kirby said patience was wearing thin among western countries which donated roughly half of the $19 billion (14 billion euros) in funds to fight AIDS in developing economies last year.

Most of the money is spent buying drugs that keep millions of infected people alive.

"Someone must tell those who will not act the practical facts of life in our world," Kirby said acidly.

"They cannot expect taxpayers in other countries to shell out, indefinitely, huge funds for antiretroviral drugs if they simply refuse to reform their own laws and policies to help their own citizens."

Jean-Francois Delfraissy, head of France's National Agency for AIDS Research (ANRS), said he feared the medical consequences if the money stopped flowing.

Donor frustrations at repressive laws were best voiced through the Global Fund to Fight AIDS, TB and Malaria to avoid charges of interference by rich countries in the domestic politics of poor ones, he told AFP.

"I'm a doctor, so my reflex is to think that these countries need antiretrovirals like everyone, and we should not be punishing patients in the hope of getting a government to shift its position.

"However, the Fund is not just a bank, it's a moral entity," he said. "It can set general lines (for disbursement), so funding can be conditional."

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