Jul 28, 2010
The Mixed Messages of AIDS 2010
If the world economic outlook were brighter, AIDS 2010 might be viewed as a turning point in the global HIV response. The conference, which wrapped up last Friday, was the stage for the announcement of the promising potential of the CAPRISA 004 trials on a vaginal microbicide. If the initial results are successfully replicated, the microbicide could offer women partial protection against HIV and herpes simplex II infections down the road. A successful microbicide would be a much-welcomed and desperately needed addition to the arsenal of women-initiated HIV protection, in which the female condom is now alone and greatly underfunded.
Other good news came out of the discussion on antiretroviral therapy (ARVs) as both HIV prevention and treatment and the discussion on the potential for vaccines and other mechanisms to stop HIV transmission by targeting the “mucosal bottleneck,” as described by Dr. Anthony Fauci, head of the United States National Institute of Allergies and Infectious Disease.
But tomorrow’s potential good news was overshadowed by today’s pressing concerns. In Russia, 2,000 people have been forced to stop treatment, and it may be 14,000 people soon if something isn’t done quickly. May other countries are facing a similar situation. Dr. Peter Mugenyi, director of Uganda’s Joint Clinical Research Center, spoke passionately about Ugandans living with HIV who are being turned away from treatment. He warned of “the carnage” of HIV-related deaths if we don’t continue to fund HIV adequately and offer life-saving ARVs.
The World Health Organization has released new guidelines that will require putting more people on treatment. Real questions linger not just about how to pay for it but also about who will do this work in a world where we are desperately short of qualified health workers. This is exactly the question my colleague, Karen Blyth, IntraHealth’s director of HIV/AIDS programs, raised at a session on the human resources requirements for achieving universal access. The term “task-shifting” refers to the delegation of some health care tasks to less specialized health workers when appropriate, and it’s a term that engenders mixed reactions. When done well, task-shifting can offer a viable solution for making health care more available and making more efficient use of existing health workers, especially if task-shifting is supported by health worker training and retention programs. Increasingly, we are seeing solid evidence of the benefits of task-shifting in HIV/AIDS work, notably the Lancet’s recent study on using nurses to monitor patients on ARVs. Task-shifting can offer an innovative way of doing things “faster, better, cheaper,” as former President Bill Clinton urged.
I want to share with you one example I heard about at AIDS 2010 of a type of de facto task-shifting to the patients themselves from a largely unheralded program in Mozambique. This Medecins Sans Frontieres-supported program in Mozambique (see abstract) has succeeded in forming community-based “patient groups,” groups of people living with HIV who monitor each other for adherence to treatment, side effects, and other problems. Every month, one group member goes to the clinic to pick up prescriptions for the entire group. When one member isn’t feeling well, another member will seek a refill on their behalf or see that the person is referred to immediate care if the situation is more serious. Every six months, the entire group goes together to the health facility to be seen by medical professionals. This model reduces the amount of money patients spend on transportation and reduces the amount of time they spend in health facilities as well as the burden on health facilities. Perhaps, just as importantly, these patient groups cultivate a community of support for people living with HIV. It is this kind of innovation that we need to promote if we are going to learn to do more with less while continuing to move towards making universal access to and use of HIV prevention services, counseling and testing, and treatment and care a reality.
—Chris Penders, Senior Program Manager
3 Comment(s)
Great work done by the World Health Organization which will help more number of HIV patients to have treatment.
Thanks for this review, Chris. It's tragic that having medications for HIV disease and making them available to those most in need are two completely different challenges. And that includes the USA, where the ADAP program is wilting on the vine, as patients join waiting lists because of State budget shortfalls.
I must mention that my feature-oriented video blogs from Vienna do manage to include segments on the female condom (for gay men), rectal microbicides, and even attendees from Malawi and the Congo. You might find them of interest!
Mark S. King
MyFabulousDisease.com
DEFEATING INFECTIOUS DISORDERS BY STIMULATING IMMUNE FUNCTION
A scientific paradox, as defined by Geoffrey W. Hoffmann, Julia G. Levy, and Gerald T. Nepom in “Paradoxes in Immunology”, exists when there is a conflict between some well-supported and widely accepted theoretical dogma or framework. The new data is a paradox within the prevailing framework of experimental or observational data. According to these writers, "Paradoxes play a pivotal role in the advancement of science.” Many major breakthroughs in science were preceded by the emergence of one or more paradoxes; the prelude to what Thomas Kuhn called a "paradigm shift." Einstein's theory of relativity, Plank's quantum theory, and Darwin's natural selection were all scientific paradoxes.
Stimulating immune function to perform efficiently is the logical approach to defeating pathogens. Such stimulation is propagandized as unavailable, when Shenkman documented the potent immunostimulating and antibacterial properties of lithium in 1980, and I in 1981 the first of nine review articles on the remarkable immunostimulating and antimicrobial properties of lithium and antidepressants. My “Stimulating immune function to kill viruses” was recently released (Amazon), and applies also to bacteria, parasites, and fungi. A therapeutic claim is reinforced when the mechanism is known. In this case, minute molecules known as prostaglandins, when produced excessively, depress every component of immune function, and induce microbial replication. In the early nineteen seventies, my late colleague David Horrobin and others showed that antidepressants and lithium inhibit prostaglandins.
Lithium has immunostimulating, antiviral and antibacterial properties, antidepressants immunostimulating, antiviral, antibacterial, antiparasite, and fungicidal properties. Lithium is often effective for paronychia, chalazions, bacterial skin infections, urinary tract infections, canker sores, cold sores and genital herpes, antidepressants for canker sores, cold sores, genital herpes, and probably T.B, malaria, and HIV. A recent study has shown that antidepressants frequently reduce HIV viral load to undetectable. Both lithium and antidepressants prevent recurrences of flu’ like colds, thus both could be effective for HINI. Lithium has untapped potential in methicillin-resistant staphylococcal infections, (MRSA) hospital acquired infections (HAIs) septicemia, and pressure ulcers (bed sores).
With the threats posed by resistant T.B, HIV, and bacteria, and the emerging resistance of the malaria parasite to artemisin, the availability of immunostimulation becomes all the more crucial. Government and private laboratories are pursuing immunostimulation in the context of infection and cancer; they are unlikely to succeed. In a review published in 1983, I proposed that to stimulate immune function, an agent must have mood elevating properties. Over the past quarter of a century, I appealed to innumerable individuals or institutions to support the advance, none of whom obliged. Financial and nonfinancial conflicts of interest were surely involved. Immunostimulation was available as early as 1980, the consequences of its suppression a catastrophe.
Lieb, J.”The immunostimulating and antimicrobial properties of lithium and antidepressants.” J Infection (2004) 49 88-93
A complete bibliography is available in Lieb, J. “Stimulating immune function to kill viruses.” (And bacteria, parasites, and fungi). (2009) Amazon
These comments are intended for education only. All treatment decisions should be made with a physician.
I m a semi-retired, former Yale medical school psychiatry professor, and author or coauthor of forty- eight articles and eleven books.
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