Compassion from carers make HIV patients seek life-saving treatments

A new study has highlighted that if HIV patients are attended with compassion and unconditional empathy, they're more likely to continue longer, life-saving treatments.

The study showed that patients need help in understanding their illness and care needs through an understandable or easy language to translate complex information.

Today, HIV is considered a chronic, treatable condition. However, this study found that many patients continue to view it as a death sentence, said the lead author.

The author added that their challenge is to reach those people diagnosed with HIV and who are retained or engaged in ongoing care.

For the study, researchers included 41 studies published between 1997 and 2017.

The sample populations included adults with HIV and their healthcare providers. All adults with HIV were between the ages of 18 and 65, represented diverse races and ethnicities, sexual orientations and gender identities.

Whereas, their healthcare providers included physicians, nurse practitioner, physician assistants, pharmacists, social workers and others, making a total of 1597 participants.

Findings from the study indicated that many patients experienced stigma and a lack of compassion that is often grounded in primary care provider's ignorance about HIV and transmission risks.

The poor communication between providers and patients results in many patients' failure to seek or remain in care and adhere to antiretroviral therapy medications.

Patients reported feeling grilled by providers who often assumed they're not taking medications.
Researchers found that patients were more inclined to adhere to HIV treatment when their primary care providers showed empathy, true listening, trust, consideration of the whole person and involvement in decision making.

Providers should use common language, not medical jargon, to educate patients about HIV, medications and how they can live a healthy life, he said.

They should thoroughly teach them about the disease, the medications and side-effects and the meaning of the tests, he added.

The researchers noted that providers who help patients navigate the health system, offer, one-stop location of services and provide connections to psychological support, health insurance, medicine, transportation and other services, can help their patients stay engaged in care.

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Cure for HIV moves closer as scientists find potential genetic switch

A genetic switch that causes HIV hidden inside the cells to replicate can be manipulated to completely eradicate the virus from the human body, a study has found.

Cells harbouring latent HIV are "invisible" to the natural defences of the immune system, said researchers.

During infection, the DNA of HIV makes its way into the host cell's nucleus and integrates itself into the host genome.

The Tat gene circuit is a key piece of HIV DNA that controls the HIV gene transcription and activation, according to the study.

When activated, it initiates a takeover of the cell's machinery to churn out new copies of the HIV virus, which eventually burst from the cell and infect neighbouring cells.

HIV-specific immune effector cells kill cells infected with HIV, but only when the cells are being used to produce more of the virus, meaning that the Tat gene circuit is switched on.

In cells that are latently infected, the Tat gene circuit is off, and the cell goes about its normal business all the while harbouring quiescent HIV.

"By targeting the Tat gene circuit with drugs or small molecules to activate it, we would be able to cause latently-infected cells to start producing more virus, and then they can be destroyed by the immune system," said a researcher.

So far, there are no drugs successfully targeting this circuit, researchers said.

People infected with the HIV virus can live relatively normal lives with exceedingly low or even undetectable viral loads thanks to powerful antiretroviral therapies that work to suppress viral replication.

However, even in people where the virus is undetectable, it doesn't mean it's completely absent.

The HIV virus can hide in cells in an inactivated state, meaning it isn't actively replicating.

This is a dire situation and makes life-long antiretroviral therapy the only option for HIV infected patients.

"It is extremely difficult to flush latently-infected cells out of their latency," he said.

Techniques developed to reactivate latent HIV-infected cells so that they become susceptible to the body's natural immune response or to drug therapies have had mixed results.

This is mostly because the technique, known as "shock and kill," relies on a class of drugs called HDAC inhibitors that come with severe adverse effects, researchers said.

"We need to better understand the mechanisms that regulate HIV latency so we can identify new opportunities for intervention and develop better drugs that can either lock viral particles in a latent state, or kill latent cells, or both,"he said.

The Tat gene circuit has a random probability of being active or inactive, and the switch from inactive to active can happen spontaneously.

"In HIV-infected cells, reactivation of the Tat gene circuit is still a very rare event," he said.

The researchers developed advanced computational algorithms to study the Tat gene circuit under different conditions.

"Using different models and algorithms, we were able to accurately map a 'probability landscape' of the cellular reactions that can impact Tat gene circuit reactivation, and our results suggest new ways of targeting latent cells that may lead to the eradication of the HIV virus from a host," he said.

Researchers identified ways to manipulate the Tat gene circuit so that the "shock and kill" technique would be more effective.

They also looked at a "block and lock" strategy, where latent viral particles are locked into latency by permanently blocking activation of the Tat gene circuit.

"Our results suggest that by controlling HIV latency through manipulation of the Tat gene circuit, effective therapeutic strategies can be identified that would one day provide a cure for HIV," he said.

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A 'safe' immunotherapy offers hope for cancer patients with HIV

A new category of immunotherapies, called checkpoint inhibitors, appears safe to use in patients with both advanced malignancies and HIV, according to a recent study.

"During the development of these drugs, people with HIV were routinely excluded from studies due to concerns that they would not tolerate these medications or perhaps not benefit from them because of their underlying HIV and associated immune dysfunction," he said. "The most important first step was to show that this class of drug would be safe in cancer patients with HIV."

Study participants, who were on standard antiretroviral therapy to control their HIV infections and had various cancers that had failed to respond to standard therapies, received pembrolizumab (Keytruda), known since 2015 as "the Jimmy Carter drug" after it swiftly beat back melanoma that had spread to the former president's brain and liver.

"These drugs are the backbone of cancer immunotherapy at present and have been shown to be effective in subsets of virtually every different kind of cancer," said senior author. "For patients with HIV who are using effective antiretroviral therapy and have cancers for which these drugs are approved, there's no reason not to consider these drugs as standard therapy."

From the earliest days of the AIDS pandemic, Kaposi sarcoma -- a rarely seen cancer until then -- was one of a trio of cancers known as AIDS-defining malignancies. It, non-Hodgkin lymphoma and, in women, cervical cancer, often signaled that a person's HIV infection had progressed to full-blown AIDS. People did not die of AIDS, per se. They died of one of these cancers or of infections like pneumocystis pneumonia and toxoplasmosis that took advantage of a weakened immune system.
The ongoing study will enroll up to 36 patients, and there are plans to include more patients with Kaposi sarcoma, a cancer for which checkpoint inhibitors have not been studied. It is one of the leading causes of cancer deaths in sub-Saharan Africa -- where HIV rates are high -- and new treatments are sorely needed.

Also to be presented Friday is the death of one patient later in the study who had Kaposi sarcoma. The death is still being evaluated but was likely due to dissemination of KSHV. Uldrick and Cheever said review of the case suggests the patient had a history of symptomatic KSHV viremia, and the study has been changed to exclude such patients in the future and provide specific guidelines for management should new symptomatic KSHV viremia be observed.

Six other study participants with Kaposi sarcoma or primary effusion lymphoma have been treated on this study. None has experienced similar problems, and some have benefitted from therapy, Dr. said.

"We do not believe that this takes away from the safety message in patients with HIV and other, better studied cancers," Dr. said. "However, more experience is clearly needed in treating KSHV-associated diseases with checkpoint inhibitors."
 

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Breast milk, bee venom and bone marrow transplants – the different things that could cure HIV/AIDS!

Scientists have for the first time identified a protein in breast milk that neutralises HIV and may protect babies from acquiring the virus from their infected mothers. The protein, called Tenascin-C or TNC, had previously been recognised as playing a role in wound healing, but had not been known to have antimicrobial properties. The discovery could lead to potential new HIV-prevention strategies. Researchers found the TNC protein in breast milk binds to and neutralises the HIV virus, protecting exposed infants who might otherwise become infected from repeated exposures to the virus.

‘Even though we have antiretroviral drugs that can work to prevent mother-to-child transmission, not every pregnant woman is being tested for HIV, and less than 60 per cent are receiving the prevention drugs, particularly in countries with few resources,’ said senior study author. ‘So there is still a need for alternative strategies to prevent mother-to-child transmission, which is why this work is important,’ she said.

In their study, the team screened mature milk samples from uninfected women for neutralising activity against a panel of HIV strains, confirming that all of the detectable HIV-neutralisation activity was contained in the high molecular weight portion. Using a multi-step protein separation process, the researchers narrowed the detectable HIV-neutralisation activity to a single protein, and identified it as TNC.

Should we be optimistic or cautious? This isn’t the first time that we’ve been presented with tales that an HIV cure is on its way. The most famous of them are: 

 The Berlin Patient Case – Leukaemia

For a long time researchers believed there was no cure. Even five years ago, a scientist who wanted to work on HIV cure research was laughed at. But all that changed with the Berlin Patient. He – an HIV-positive man who developed leukaemia. After first-line cancer treatments failed, a bone marrow transplant procedure was done. Two transplants later, not only was his leukaemia in remission, his immune system actually managed to ward off HIV. He no longer takes antiretroviral drugs or tests positive for HIV. Essentially, he was cured.  

Bee venom to cure HIV?

A study suggested that bee venom might have the potency to kill the human immunodeficiency virus (HIV). Researchers had demonstrated that a toxin called melittin which is found in bee venom is the reason for this. The researchers used nanoparticle technology to target the virus. Particles smaller than HIV were infused with bee venom and since HIV cells are smaller than normal body cells the nanoparticles only targeted HIV.

‘Melittin on the nanoparticles fuses with the viral envelope,’ said research instructor. ‘The melittin forms little pore-like attack complexes and ruptures the envelope, stripping it off the virus.’ Adding, ‘We are attacking an inherent physical property of HIV. Theoretically, there isn’t any way for the virus to adapt to that. The virus has to have a protective coat, a double-layered membrane that covers the virus.’

Stem cell therapy to overcome HIV?

In a path-breaking breakthrough two people were believed to have overcome HIV after undergoing stem-cell therapy! The news has met with widespread elation with experts believing that a cure might be on the cards. Doctors announced  that two previously HIV-positive patients no longer had detectable virus levels in their blood or tissue after having bone marrow stem-cell transplants to treat cancer between two and four years ago.

Aggressive antiretroviral treatment 

There were reports in March 2013 of a toddler who was completely cured of the virus after being born of it. She has been cured of the disease after following an aggressive regime of drugs. This was the second documented case of a person being completely cured of the virus after an adult known as the Berlin Patient was cured as a result of bone-marrow transplant. This startling piece of information was discovered when the baby’s mother stopped treatment and doctors lost track of the baby who was given a bout of heavy drugs (current procedure suggests only a modest daily dose of antiretroviral treatment) about 30 hours after she was born at a rural hospital, doctors said at a medical meeting. However, a doctor poured cold water on cold water on what was termed ‘the greatest medical breakthrough of the century’.  

In his piece, the Dr.   pointed out in his column, exposure to HIV doesn’t mean that the baby will have HIV. ‘We will likely never know if those cells were from the child or maternal cell that has been transmitted during pregnancy or birth.’ When a child is born, he or she has some maternal cells in his system so it’s impossible to tell whether the child actually had HIV or not, or the tests detected the maternal HIV positive cells.

The MX2 gene

According to a study published , scientists have discovered a new gene which can inhibit the HIV virus from spreading after it has entered the body.  It was conducted by introducing the virus to two separate lines of human cells. On one line, they introduced the MX2 gene along with the virus, while on the other they didn’t. The line on which the MX2 gene was introduced, it was seen that the virus had stopped replicating. 

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