Black AIDS Institute and Merck Launch BTAN
HIV/AIDS Patients Say Doctors Need to Pay More Attention to Co-Morbidities
Congressional Democrats Still Silent on AIDS Legislation
Crucell, Harvard, IAVI Team Up to Test Experimental AIDS Vaccine
Black AIDS Institute and Merck Launch BTAN
On August 12, the Black AIDS Institute (The Institute), with support from Merck, announced the launch of the Black Treatment Advocates Network (BTAN). BTAN will be the first collaborative network of its kind, and will train and mobilize treatment advocates who will work to link HIV-positive African Americans into care and treatment; strengthen local and national leadership; raise HIV science and treatment literacy in black communities; and advocate for policy change and research priorities.
"We are at an important juncture in the trajectory of the AIDS epidemic in Black communities. Improving HIV literacy, increasing the number of trained Black treatment educators, and expanding the level of treatment advocacy in Black communities is critical to our efforts to end the AIDS epidemic in Black communities," said Phill Wilson, president and CEO of the Black AIDS Institute. "The Institute is pleased to partner with Merck, people living with HIV/AIDS, and community organizations to launch BTAN. Their support, leadership, and dedication will help to lay the foundation for a new era in Black HIV/AIDS treatment education and advocacy."
BTAN will enable advocates to learn together through national web-based trainings, regional programs around the U.S., and the Network’s website, which will serve as a portal to connect members and provide resources to support them and their efforts in the field.
"We are proud to support BTAN and partner with the Black AIDS Institute, AIDS service organizations (ASOs) and advocates across the country to launch this important initiative," said Patrick Bergstedt, senior vice president and general manager, Merck Infectious Disease Franchise. "Merck is committed to helping reduce healthcare disparities and improve access to HIV/AIDS care and treatment for Black Americans through collaborative efforts such as BTAN."
As its first major initiative, BTAN will partner with Merck & Co., Inc. and local ASOs in a small number of high prevalence, resource-limited "pilot" communities across the country to hold intensive science and advocacy trainings to address local critical needs. The pilot launch cities for 2010 are Philadelphia, Pennsylvania; Houston, Texas; and Jackson, Mississippi. The pilot partners will be introduced at a BTAN program at September's U.S. Conference on AIDS (USCA) in Orlando, Florida.
HIV/AIDS Patients Say Doctors Need to Pay More Attention to Co-Morbidities
In a report in the Chicago Tribune, the AIDS Treatment for Life International Study (ATLIS 2010), revealed that HIV-positive patients, while expressing “widespread satisfaction with their physicians overall,” also said that discussion of other conditions (co-morbidities) that can be exacerbated by HIV or the drugs used to treat it was lacking in their communications with their doctors.
ATLIS 2010 was an international study of 2,000 patients that two Chicago-area health providers were instrumental in carrying out. The study, funded by Merck & Co., found that “two-thirds of patients said they had a co-morbid condition and 26 percent reported three or more, but only one-third remembered talking to their doctors about heart disease, for example, while 38 percent recalled a discussion about the health implications of smoking as it relates to HIV.”
“That's a big oversight,” said Renslow Sherer, professor of medicine at the University of Chicago and member of the ATLIS team who helped present the study's findings at the 18th International AIDS Conference in Vienna. “We have to remind physicians that these are critical issues.”According to the researchers, people with HIV have a greater risk of lung cancer, heart attacks, and strokes, and communication with providers needs to focus on the whole person, not just suppressing the virus. Moreover, they said, there needs to be more discussion around adherence and side effects.
The ATLIS 2010 study found that another barrier to treatment for HIV is that “stigma around the disease persists. In North America, 42 percent of respondents reported feelings of isolation due to their disease, less than in Asia (52 percent) but more than in Africa (24 percent).”
“If people can be treated with respect and dignity, they're much more likely to be treated, and to turn their lives around,” said Sherer. “It's the same in Chicago as it is in Nairobi or Bangladesh.”
Congressional Democrats Still Silent on AIDS Legislation
In a story in Congressional Quarterly, it was reported that when the National HIV/AIDS Strategy was announced last month, many AIDS activists were skeptical, some even angry. It was pointed out that with over 2,300 people on ADAP (AIDS Drug Assistance Programs) waiting lists in 13 states due to budgetary crises, it seemed ironic at best that President Obama—who is the first president to establish an Office of National AIDS Policy and, as a candidate, voluntarily got tested for HIV—would roll out a strategy that seems to have no funding foundation to support it.
As reported previously in Positively Aware e-updates, and in an article in the upcoming September/October issue, conservative Republicans have been the only ones so far to introduce legislation (S.3401) that would solve the ADAP crisis, at least temporarily, and allow access to treatment for all those currently on waiting lists, as well as supporting failing ADAPs so that the establishment of more waiting lists would be unnecessary.
Activists say the $126 million proposed by Richard Burr and Tom Coburn (and co-sponsored by Senators Enzi, Lemieux, and Grassley) would meet the demand for this fiscal year (ending March 31, 2011). Though the money would come from unobligated discretionary funds from the stimulus package passed in 2009, House Speaker Nancy Pelosi, whose San Francisco district has one of the largest HIV-positive populations, nonetheless opposes diverting money from other programs designed to spur job creation and speed the economic recovery, as do other Democrats in both chambers.
In addition to co-sponsoring S.3401, Senator Coburn, also a physician, recently introduced a bill (S.3627) that would re-focus current federal funding for global AIDS programs, not adding any money, but boosting the amount earmarked directly for treatment from 50% to 75%.
However, neither bill has much chance of being passed in the final months of the 111th Congress, especially without any Democratic support.
Crucell, Harvard, IAVI Team Up to Test Experimental AIDS Vaccine
In an August 11 press release, Dutch biopharmaceutical company Crucell N.V. announced its intention to “participate in an international Phase 1 clinical trial in the United States and Africa of a combination of two AIDS vaccine candidates, Ad26.ENVA.01 and Ad35-ENV, in healthy adults who are not infected with HIV. The clinical trial, which will be led by the International AIDS Vaccine Initiative (IAVI), represents a collaboration between IAVI, Crucell, the Ragon Institute, and Beth Israel Deaconess Medical Center (BIDMC), a major teaching hospital of Harvard Medical School.”
The planned Phase 1 trial of the vaccine combination represents a key step towards proof of concept studies to evaluate the safety and efficacy of the vaccine combination in humans, as well as the candidate vaccines’ ability to provoke an immune response when administered in a prime-boost regimen.
"We are very happy that IAVI has decided to support the NIAID-sponsored Crucell-Harvard AIDS vaccine program, making it possible to advance this vaccine candidate further towards proof of concept Phase 2b efficacy trials in humans," said Jaap Goudsmit, Chief Scientific Officer at Crucell. "A different prime-boost AIDS vaccine approach has been shown in the RV144 trial (Thai Trial) to protect against HIV in humans, for the first time in the history of AIDS vaccine development. Our program to develop this combination vaccine represents one of the most advanced AIDS vaccine programs in the world and is based on the best science available today. We have the obligation as vaccine producers to do everything in our power to bring an effective AIDS vaccine to all people in need."
A large study of African heterosexual couples showed that going on HIV therapy reduced transmission to a primary partner by 92%. Doctors seized on the fact that this study provided HIV treatment to people who wouldn’t otherwise be eligible for it under the therapy guidelines of their country.
Of the 3,381 couples involved, all of whom had one HIV-positive partner and one negative, 349 individuals were put on treatment, mostly because of pregnancy or low CD4 T-cell count. As expected, those with a low CD4 count (less than 200) were shown to have a higher risk of transmission; however, there was also an increased risk with the people who had more than 200 T-cells along with a viral load of greater than 50,000 copies per mL.
“Obviously, the concept of treating people with a CD4 count [of less than] 200 cells/mm³ is not new, but the idea of using viral load to prioritize ART initiation among people with CD4 counts [greater than] 200 cells/mm³ is provocative,” wrote Atlanta HIV specialist Carlos del Rio, MD, in Journal Watch. He summarized the post hoc analysis of the study published in the June 12 issue of The Lancet.
Also of note: 70% of the individuals going on HIV therapy achieved a viral load of less than 251 copies per mL; further, there were 104 genetically-linked (both partners had genetically similar virus) infections in the non-therapy group and one in the treatment group, which occurred within one month of the partner’s initiation of treatment with anti-viral medication. Results from the study were presented last February in Abstract 136 at the 2010 CROI (Conference on Retroviruses and Opportunistic Infections) in San Francisco.
The Senate is currently in recess, so no action has been taken on S.3401, Access to ADAP Act; S.3627 Save Lives First Act; or S.3680, Family and Medical Leave Inclusion Act.
The House was recalled by Speaker Nancy Pelosi and met on August 9 and 10. Though no HIV/AIDS legislation was acted upon, a resolution was proposed expressing disapproval of Judge Walker’s decision overturning Proposition 8. To read the text and find out which representatives signed onto it, go to http://thomas.loc.gov/cgi-bin/query/z?c111:H+Res.+1607:
Watch for reports of progress when Congress reconvenes on September 13. Your elected officials can be contacted at their home district offices until then.