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).
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]
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].
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.
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]
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].
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.
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].
DISCOVER: Whatever Happened to… Smallpox?
DISCOVER: 20 Things You Didn’t Know About… Lab Accidents
DISCOVER: Killer Pox in the Congo
80beats: Researchers Track the HIV Virus to a Hideout in the Bone Marrow
80beats: S. African HIV Plan: Universal Testing & Treatment Could End the Epidemic
For a study this week in the journal Nature Medicine, Kathleen Collins and her team have uncovered another of HIV’s dirty tricks: the virus can hide out in bone marrow cells and lie in wait for the right time to strike.
In recent years, drugs have reduced AIDS deaths sharply, but patients need to keep taking the medicines for life or the infection comes back, she said. That’s an indication that while the drugs battle the active virus, some of the disease remains hidden away to flare up once the therapy is stopped [AP]. One place the researchers already knew HIV could hide was inside resting T cells. However, Collins says, she thought T cells alone didn’t offer a complete picture of the virus’ ability to play hide-and-seek.
It’s a big year for South Africa: Less than four months remain until the first matches of the World Cup, when much of the planet’s attention will turn to the country. But being under the spotlight of international sport makes it difficult to hide a country’s less glamorous bits, as China and Canada have found out trying to shield pollution and addiction problems from the glare of the last couple Olympiads. In June, the microscope will turn to South Africa and its ongoing AIDS crisis.
This month one of the country’s health leaders has renewed his call for blanket HIV testing and anti-retroviral drug dispersal to all patients, which he says can stop the AIDS epidemic once and for all–without having to find a vaccine against the virus or a cure for the disease.
Brian Williams’s idea isn’t new. The former World Health Organization figure, who is now one of South Africa’s top health officials, came out with a paper more than a year ago explaining his model for how effective universal testing and immediate therapy could be. But this week at the American Association for the Advancement of Science meeting in San Diego he expounded on his proposal: “The epidemic of HIV is really one of the worst plagues of human history…. I hope we can get to the starting line in one to two years and get complete coverage of patients in five years. Maybe that’s being optimistic, but we’re facing Armageddon” [The Guardian].
The United States will end its long-standing ban that prevents foreigners with HIV from entering the country. President Obama announced the change on Friday, saying that the exclusionary rule had been “rooted in fear rather than fact.” The policy has been in place for 22 years, and was enacted at a time when people still wondered whether HIV could be transmitted through physical or respiratory contact. It will officially be repealed at the start of 2010.
The ban applied both to tourists wishing to visit the United States and to foreigners who hoped to live and work here. Only about a dozen other countries still bar people with HIV or AIDS from entering. “If we want to be a global leader in combating H.I.V./AIDS, we need to act like it,” Mr. Obama said. “Now, we talk about reducing the stigma of this disease, yet we’ve treated a visitor living with it as a threat” [The New York Times].
Gay advocates said the ban also discouraged travelers and some foreigners already living in the United States from seeking testing and medical care for H.I.V. infection. “The connection between immigration and H.I.V. has frightened people away from testing and treatment” [The New York Times], said Rachel Tiven of the advocacy group Immigration Equality.
80beats: CDC Officials Consider Promoting Circumcision to Prevent HIV’s Spread
80beats: During Africa Visit, Pope Knocks Condoms for HIV Prevention
80beats: If Everyone Got an Annual AIDS Test, Could We Beat Back the Epidemic?
80beats: South African Health Minister Breaks With Past, Says HIV Causes AIDS
Image: flickr / Doug Letterman