What’s the News: A daily dose of anti-HIV drugs can significantly reduce the likelihood that straight men and women will contract HIV from an infected partner, according to two new clinical studies. These studies add strong evidence to earlier findings that taking HIV drugs can prevent healthy people from contracting the disease, and are the first to show that the drugs reliably lower transmission risk in heterosexuals.

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What’s the News: A much-anticipated trial in African women of an HIV drug found to be effective in preventing infection in men has washed out—researchers announced today that women taking Truvada were no more likely to evade HIV infection than women taking a placebo.

The result is especially disappointing because Truvada, which is an oral pill combining two drugs, emtricitabine and tenofovir disoproxil fumarate, has been shown to be 90% effective in preventing infection in gay men who took it religiously. (more…)

Earlier this week at a scientific conference in Boston, HIV researchers announced a remarkable success in countering the virus’ drain on the immune system. But this early step is far from a cure.

Why it’s exciting:

Carl June and colleagues tested six male patients who already had HIV and were taking a standard antiviral regimen. Like many HIV patients, the drugs helped them, but their counts of immune cells stayed low. June’s team tested a therapy created by Sangamo BioSciences in Richmond, California, that alters a patient’s actual white blood cells to make them more HIV-resistant.

Researchers removed a sample of CD4⁺ T cells, the type of immune cells affected by HIV, from each man and used Sangamo’s enzyme to disrupt the CCR5 gene, which encodes a protein that HIV uses to enter CD4⁺ cells. The engineered cells were then infused back into the patients. Immune-cell counts subsequently rose for five of the six patients who received the therapy. “It’s very exciting,” says John Rossi, a molecular biologist at the City of Hope’s Beckman Research Institute in Duarte, California. “If they did this several times in a given patient, you could establish a high percentage of resistant cells.” [Nature]

The idea came from the “Berlin Patient,” who we’ve written about before at 80beats. He became famous after receiving a donation of bone marrow from someone who carried a mutation in CCR5 that made them resistant to HIV.

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Perhaps you’ve seen the story of the 44-year-old American man reportedly “cured” of HIV in Germany–it’s been making the rounds over the past week. What’s actually happening here?

The Procedure

This is a story that dates back a few years; in fact, 80beats blogged about this case years ago when it first made the news. Back in 2007, the man—Timothy Ray Brown—was an HIV-positive patient suffering from acute myeloid leukemia. When standard chemotherapy couldn’t help him, his docs in Germany turned to a bone marrow transplant, with one twist.

Brown’s oncologist decided to look for a bone marrow donor who had a had a special genetic mutation that made the stem cells in it naturally resistant to HIV infection. His physician, Dr. Gero Huetter, was able to find this rare match and Brown got the bone marrow transplant.  He needed a second stem cell transplant because the cancer came back. Today, he appears to be cancer free and doctors can’t find traces of the virus that causes AIDS either. [CNN]

Brown’s treatment made a splash in the news in 2008, when the doctors first reported on it. It has resurfaced this month because the researchers published a new study in the journal Blood updating his condition.

The researchers confirmed that Brown seems to have maintained his resistance to HIV for three years, confounding their expectation that he would become reinfected. They concluded that a “cure of HIV has been achieved in this patient.” [New Scientist]

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A neuroscientist who has spoken out in support of animal testing is in the news again after a militant animal rights group sent razor blades and a threatening note to his house. The group claims that the razor blades were contaminated with HIV-infected blood.

The researcher, J. David Jentsch, who studies addiction and schizophrenia at UCLA, explains the incident:

“About a week ago I was going through my mail in my kitchen and I opened a letter and razor blades spilled out on the floor. It was the first sign something was nefarious,” he said. “The letter inside contained quite specific and heinous acts of violence to kill me.” [CNN]

Jentsch made headlines last year when he staged a pro-test rally in support of (humane) animal research after an animal rights group fire-bombed his car in his driveway. The threats and harassment of Jentsch and other department employees have continued, but Jentsch seems undaunted and undeterred.

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A drug called Truvada seems to be able to prevent HIV infection from taking hold in the body when taken regularly. The once-a-day pill combines two anti-retroviral drugs, and was found to reduce new HIV infections in a study of 2,500 gay men. But there are two big issues: compliance and cost.

In the study, which was published in the New England Journal of Medicine, men who took the pill were 44 percent less likely to contract the disease than those on placebo. But when the researchers looked only at the men who took the pill faithfully, the number jumped to 90 percent.

“These results represent a major advance in HIV-prevention research,” says physician Kevin Fenton of the Centers for Disease Control and Prevention in Atlanta. “For the first time, we have evidence that a daily pill used to treat HIV is partially effective for preventing HIV among gay and bisexual men at high risk of infection.” Fenton cautions, however, that the results don’t warrant abandoning other proven prevention techniques. [Science News]

While the results are certainly promising, it remains to be seen if at-risk people would take a pill every day.

[M]any men in the study failed to take all their pills, and some clearly lied about it. For example, some who claimed to take them 90 percent of the time had little or no drug in their bloodstreams. Although the pills caused no major side effects in the study, some men disliked the relatively minor ones, like nausea and headaches. [New York Times]

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Anthony Eugene Whitfield is currently serving a 178-year prison sentence for, among other things, knowingly infecting several sexual partners with HIV. But how do you prove that the women in question contracted the virus from him?

From Ed Yong:

To demonstrate Whitfield’s guilt, the prosecution had to show that he had wilfully exposed women to HIV, that his five HIV-positive partners contracted their infections from him. Fortunately, David Hillis from the University of Texas and Michael Metzker from Baylor College of Medicine knew exactly how to do that. They had evolutionary biology on their side.

Hillis and Metzker knew that HIV is a hotbed of evolution. The bodies of HIV carriers produce around a billion new virus particles every day, and their genomes change and shuffle at furious speeds. But when infections pass from one person to another, this viral variety plummets. Thousands of genetically distinct viruses might jump into a new host, but usually, only one of these managed to gain a foothold and set up a new infection. Every time it moves from host to host, HIV passes through a genetic bottleneck and that provides a massive clue about who passed an infection to whom.

For great detail on how the scientists built these HIV trees and used them in the case against Whitfield, as well as what it means for the future of prosecution, read the rest of this post at Not Exactly Rocket Science.

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Image: Scaduto et. al / PNAS

From Ed Yong:

The vast majority of people who are infected with HIV go on to develop AIDS. Their bodies become riddled with the virus, their immune systems falter, and they are besieged by life-threatening infections. But not everyone shares the same fate. Around 1 in every 300 people infected with HIV carry genetic trump cards that allow them to resist and control the virus. These “HIV controllers” can live with the virus for years. They never develop AIDS and they live long, healthy lives, even if they never take any medication. Their genetic secrets are slowly being revealed.

Researchers studying thousands of people with HIV, some with the controllers and some without, found something surprising:

Amazingly, every single one of these variants sits within a specific part of our sixth chromosome, among a set of genes called class I HLA genes. The proteins they produce form part of the internal security checks that defend us from infections. They grab small pieces of other proteins from inside our cells and display them on the outside, waving them under the noses of passing T-cells. If the T-cells recognise these pieces as parts of bacteria, viruses or other foreign invaders, they tell the infected cell to self-destruct and set the immune system on red alert.

Check out the rest of this post at DISCOVER blog Not Exactly Rocket Science.

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Image: Wikimedia / HIV Budding

During an unusual bureaucratic meeting yesterday, members of California’s Occupational Safety and Health Administration sat down with representatives of California’s porn industry to talk about safe sex.

Last year, the AIDS Healthcare Foundation filed a petition asking Cal/OSHA to tighten health regulations on the porn industry. And the issue was brought to the fore this month when an adult-film performer tested positive for HIV, which brought several porn production studios to a halt while the industry scrambled to determine the source of the infection and to test the performer’s partners.

At yesterday’s meeting, Cal/OSHA officials went over the existing rules, which were originally written to protect health care workers and were only later applied to porn performers. The rules require employers to protect their employees against blood-borne pathogens via “barrier protection,” which in the hospital world probably means rubber gloves, face masks, and the like. In the porn industry, the obvious protective measure would be requiring male performers to wear condoms, but in straight films that hasn’t come to pass (in gay films, condoms are standard).

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HIV became an epidemic in the human population just in the 20th century. Its precursor found in primates, called simian immunodeficiency virus or SIV, could be not just hundreds of years old, but tens of thousands of years old, according to a study out in Science.

Preston Marx and colleagues studied the monkeys of Bioko, an island off West Africa that has been cut off from the mainland for 10,000 years. By studying the way SIV evolved in that isolated population, the team calculated that the virus is at least 32,000 years old, and possibly much, much older. Says Marx:

“The biology and geography of SIV is such that it goes from the Atlantic Ocean to the Indian Ocean all the way to the tip of Africa. … It would take many, many thousands of years to spread that far and couldn’t have happened in a couple of hundred years.” [AFP]

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There was a big step forward this week in the struggle to contain the spread of HIV and AIDS in sub-Saharan Africa. Reporting on a three-year study in the journal Science, scientists at the Centre for the Aids Programme of Research in South Africa (CAPRISA) say that a microbicidal gel reduced HIV infection rates in women who used it by 39 percent over the course of the study. It would be the first time such a gel has proven so effective.

The researchers gathered nearly 900 women for the study who were HIV-free but demographically at risk for infection. Half received the gel, half a similar-looking but inactive substance. Among those given the gel, a vaginally-administered substance that contained an antiretroviral medication called tenofovir, infection rate fell by half after a year, and were reduced by 39 percent over two and a half years.

“This is very encouraging,” said Dr. Michel Sidibe, executive director of Unaids, the United Nations AIDS-fighting agency. “It can be controlled by women, and put in 12 hours earlier, and that is empowering. They do not have to ask the man for permission to use it. And the cost of the gel is not high” [The New York Times].

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You can’t defeat what you can’t identify. That’s part of the human body’s problem with HIV–a virus that mutates constantly. Most antibodies can identify, latch onto, and neutralize only certain variants of the virus, or none at all. But two new studies published in Science yesterday point to two antibodies that almost always hits their targets--neutralizing some 90 percent of the most common HIV strains.

Scientists hope to eventually use their knowledge of these antibodies to develop a vaccine, but this is not an easy task.

“The path forward isn’t as clear as we’d like it to be, but we are turning a corner, I think,” says David Montefiori, a viral immunologist at Duke University Medical Center in Durham, N.C., who was not involved in the research. [Science News]

But first, how did they find these antibodies?

Step 1: Learning from a Survivor

Researchers at the National Institute of Allergy and Infectious Diseases looked at the blood of a 60-year-old African American man who had survived with HIV for 20 years.

The HIV antibodies were discovered in the cells of a 60-year-old African-American gay man, known in the scientific literature as Donor 45, whose body made the antibodies naturally…. Donor 45′s antibodies didn’t protect him from contracting HIV. That is likely because the virus had already taken hold before his body produced the antibodies. He is still alive, and when his blood was drawn, he had been living with HIV for 20 years. [Wall Street Journal]

Something about Donor 45′s antibodies were keeping the virus at bay or, more specifically, keeping it from binding with certain white blood cells to infect and destroy them.

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When it comes to research on HIV and AIDS treatments, it can be hard to know when to celebrate a small advance–everyone wants to see progress, but so many experimental avenues that seemed promising have turned out to be dead ends. Still, a new study that tried a sophisticated form of gene therapy as an HIV treatment seems cause for cautious optimism. If it bears out under further testing, the technique could lead to a one-shot, long-lasting treatment that could replace the punishing regimen of daily medications.

Treating HIV currently comes down to managing the viral load with a mixture antiretroviral drugs. Researcher John Rossi and his colleagues tried to craft a more direct treatment by genetically modifying the HIV-infected patients’ own blood stem cells and increasing the cells’ ability to fight off the virus. The researchers weren’t able to truly combat the virus in this experiment–the patients’ viral loads remained the same–but their work moved beyond previous attempts in two ways: They successfully modified blood stem cells by giving them anti-HIV genes, and those cells survived for two years in patients.

Earlier clinical studies the group conducted with the same strategy made little headway, but now the researchers have overcome two key obstacles, says Rossi, a molecular geneticist. One is that they managed to stitch the anti-HIV genes into a high percentage of the appropriate stem cells. The other is that the cells lived for a long time. “If we could increase the number of modified cells by 10- or 100-fold, we might be able to stop the virus itself,” says Rossi. [ScienceNow]

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Blood donation is fraught with arcane restrictions and a mess of complex requirements meant to keep the blood supply as safe as possible (I can’t give, for instance, because I lived in England in the early 1990s. Thanks a lot, mad cow scare.) But one of its most controversial—a lifetime ban on donation by men who’ve had sex with other men—may finally be coming to an end.

Massachusetts lawmakers like Senator John Kerry are pushing an overturn of the ban. The Red Cross, American Medical Association, and American Association of Blood Banks all want the lifetime ban to go away, though the Red Cross supports in its stead a single-year donation ban dating back to the last sexual encounter.

The lifetime ban was enacted in 1983 before AIDS was widely understood and has long infuriated gay rights groups since it applies to all gay men regardless of their HIV status. Heterosexuals who engage in risky behavior, like having sex with prostitutes or HIV-positive partners, are only banned from giving blood for a year [Boston Globe].

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With smallpox largely eradicated around the world, health organizations phased out the smallpox vaccine between the 1950s and 1970s (the last natural case of the disease was seen in 1977, in Somalia). During that span, Raymond Weinstein says, the AIDS crisis broke out in force. And in a study in BMC Immunology, he argues those two events could be connected.

Supposing that smallpox vaccination could have some effect on a person’s susceptibility to HIV, researchers led by Weinstein tested the idea on cells in a lab. They took immune cells from 10 people recently vaccinated against smallpox and 10 people never vaccinated. HIV, they found, was five times less successful at replicating with the cells of vaccinated people.

Why?

The researchers believe vaccination may offer some protection against HIV by producing long-term alterations in the immune system, possibly including the expression of a receptor called CCR5 on the surface of white blood cells, which is exploited by the smallpox virus and HIV [BBC News].

Any finding that expands knowledge of how HIV replicates could be an important one. And while this small study can’t prove Weinstein’s assertion is correct, the argument is, at the very least, plausible. Says Weinstein:

“There have been several proposed explanations for the rapid spread of HIV in Africa, including wars, the reuse of unsterilised needles and the contamination of early batches of polio vaccine. However, all of these have been either disproved or do not sufficiently explain the behaviour of the HIV pandemic” [Press Association].

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Image: CDC