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Prior to joining KQED, Amel worked at Al Jazeera America, Al Jazeera English, Democracy Now! and Punched Productions. She also helped produce \u003cem>Changing Face of Harlem\u003c/em>, a documentary that tracked gentrification in Harlem over a period of ten years. 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Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS.[contextly_sidebar id=\"lO0syDiO3AlElegX7fRdQulfH7k681UG\"]\u003c/p>\n\u003cp class=\"danger-zone\">And yet, today, the struggle against HIV may be undergoing a sea change.\u003c/p>\n\u003cp class=\"danger-zone\">U.S. health officials and HIV experts are beginning to talk about a future \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">in which transmission in the United States could be halted\u003c/a>. And that future, they say, could come not within a generation, but in the span of just a few years.\u003c/p>\n\u003cp class=\"\">“We have the science to solve the AIDS epidemic,” Dr. Robert Redfield, the director of the CDC, himself a longtime HIV researcher and clinician, told STAT in a recent interview. “We’ve invested in it. Let’s put it into action.‘’\u003c/p>\n\u003cp class=\"\">Other leaders in the HIV field have been musing about the idea, buoyed by the astonishing impact effective HIV medications have wrought, both on the lives of people infected with or at risk of contracting the virus, and on the trajectory of the epidemic.\u003c/p>\n\u003cp class=\"\">“It’s certainly doable in the United States,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a researcher whose study focused on HIV from the earliest days of the AIDS epidemic.\u003c/p>\n\u003cp>Fauci and other health experts are quick to point out that the goal of stopping transmission entirely is largely theoretical. There will always be some new cases, and the barriers to providing treatment to existing cases remain significant. There are still just under 40,000 people in the U.S. each year contracting HIV. As Fauci put it: “We live in a real world, we don’t live in a theoretical world.”\u003c/p>\n\u003cp>But “if we implement all the tools that we have and if we can theoretically, conceptually, get everybody who’s HIV infected on antiretroviral drug so that they will not transmit the infection to anyone else, theoretically you could end the epidemic tomorrow by doing that,” he added.[contextly_sidebar id=\"wauS1YFripUOWbpsTIa7lXm8j8pGcJjw\"]\u003c/p>\n\u003cp>In the absence of a highly effective vaccine — and likely, even, in the presence of one — consigning the global HIV/AIDS epidemic to the history books would be impossible. And at the moment, that’s moot: Despite decades of research on HIV vaccines, the holy grail of HIV control remains an unmet goal.\u003c/p>\n\u003cp>Still, even without a vaccine, experts believe transmission could be largely stopped in this country — a goal that until the past few years would have been unthinkable.\u003c/p>\n\u003cp>In March, Redfield told CDC staff that he believed HIV transmission in the United States \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">could be halted over the next three to seven years\u003c/a>.\u003c/p>\n\u003cp>The foundation of the dream is the realization that, if taken correctly, today’s potent antiretroviral drugs will drive down the amount of virus in an HIV-infected person’s system to undetectable levels. People who reach that state, known as viral suppression, are not contagious — even, it seems, if they have unprotected sex.\u003c/p>\n\u003cp>Accumulated data from several studies show that in nearly 80,000 condomless sex acts between pairs of men who had discordant HIV status — one was negative, the other was positive, but virally suppressed — not a single new infection occurred.\u003c/p>\n\u003cp>In the HIV world, that finding has given rise to a slogan: U = U, or undetectable equals untransmissible. To maximize the benefits of viral suppression, though, people must know their HIV status and start treatment if they are infected. Currently the CDC estimates that 15 percent of infected Americans are unaware they are HIV positive.\u003c/p>\n\u003cp>“People with HIV infection need to be diagnosed, getting care, stay in care, get on antiretrovirals, and get their viral load down to undetectable,” Redfield said.\u003c/p>\n\u003cp>Pairing the power of viral suppression with another tool further increases the chances of stopping spread of the virus. That other tool is \u003ca href=\"https://www.statnews.com/2018/07/24/digital-pill-prep-truvada/\">PrEP\u003c/a>, pre-exposure prophylaxis — antiretroviral drugs used to prevent infection in people who are at high risk of contracting the virus.\u003c/p>\n\u003cp>Taken correctly, PrEP reduces the risk of contracting HIV from an infected partner by 95 percent. If the infected partner is virally suppressed, the risk is lower still.\u003c/p>\n\u003cp>But the benefits of PrEP can only be reaped if people use it. Currently too few do. The CDC estimates that about 1.1 million people in the U.S. should be taking PrEP, including men who have sex with men, sex workers, and transgender women, a population with a highly elevated risk of contracting HIV. But only about 200,000 are actually using it, Redfield said.[contextly_sidebar id=\"cMA1JnuuPTnJDbxO5uh5Kz0WejZJ8v2u\"]\u003c/p>\n\u003cp>Paradoxically, doctors bear part of the blame for that gap.\u003c/p>\n\u003cp>“There is a large number of people who are not comfortable prescribing PrEP or have not been taught how to prescribe PrEP, whether it be in their residency, fellowship, or post-graduate training,” said Dr. Robert Goldstein, medical director of the transgender health program at Massachusetts General Hospital and an instructor at Harvard Medical School.\u003c/p>\n\u003cp>“We’re limited by stigma within the medical community and within the LGBT community. We’re limited by lack of provider knowledge. We’re limited by awareness among those at highest risk of HIV infection,” Goldstein said. “And those limitations result in rising rates of new HIV infections in men who have sex with men while we see across the country actually dropping rates of new HIV infections year after year.”\u003c/p>\n\u003cp>In some cases, the problem of too little PrEP prescribing is due to a lack of training, and in other cases, something else may be at play, suggested Dr. Demetre Daskalakis, the New York Department of Health’s deputy commissioner of disease control.\u003c/p>\n\u003cp>“We still have to sell this to [clinicians] who are like, ‘Why would I be offering people PrEP, if it’s going to encourage them to have condomless sex?’” he said. “And our answer tends to be, ‘They’re already having condomless sex and this prevents HIV.’”\u003c/p>\n\u003cp>New York is one of several cities — San Francisco and Washington, D.C., among them — that have moved aggressively to harness the power of the treatment and prevention, working to actively identify people who are HIV-positive but who haven’t yet been tested, or haven’t yet started taking antiretroviral drugs, as well as people who should be using PrEP, but are not.\u003c/p>\n\u003cp>New York has expanded the remit of its sexual health clinics to help identify these patients and get them into treatment, said Daskalakis, who explained it’s about “snagging” the people most at risk “where they come for service.”\u003c/p>\n\u003cp>Anyone who is newly diagnosed with HIV is offered antiretroviral drugs immediately. No waiting for a follow-up appointment, which increases the possibility the patient won’t return. And it’s working “with just staggering success,” said Daskalakis.\u003c/p>\n\u003cp>“What we’re finding is that they get virally suppressed faster,” he said. “It’s sort of the dream, that when you start people on medicines for infections they have on the day of their diagnosis, all of a sudden you see that they’re interested in connecting to care and actually follow through.”\u003c/p>\n\u003cp>Likewise, people who test negative for HIV but who are deemed at risk of becoming infected are offered a starter pack of PrEP. The efforts led to a sharp upswing in the number of people taking PrEP — and a swift decline in the number of new HIV diagnoses. In 2016, new infections dropped 10 percent overall, and 15 percent among men who have sex with men, Daskalakis said.\u003c/p>\n\u003cp>The cost of PrEP is steep — $1,500 a month without insurance or assistance from the manufacturer. But New York state has an assistance program that helps with the cost of the medical care PrEP use requires, and there’s a patient assistance program for those who can’t pay for the drug. At the end of the day, Daskalakis said, with a combination of programs, most patients can access PrEP.\u003c/p>\n\u003cp>“In New York, the answer is yes. But I would be more worried about talking to someone in Mississippi,” he said.\u003c/p>\n\u003cp>That isn’t an insignificant consideration. The epidemic in the United States is currently being driven, in large part, by infections among African-American and Latino men who have sex with men in several Southern states.\u003c/p>\n\u003cp>Fauci is a believer in the active style of HIV interventions New York and other cities are employing. “You can’t do business as usual,” he said. “You’ve got to have an aggressive approach.”\u003c/p>\n\u003cp>But he’s always cognizant that translating the successes of Washington or New York to less urban settings — where access to care is more limited and stigma may be greater — likely won’t be as simple as changing some wording on some brochures.\u003c/p>\n\u003cp>“Is that going to work in Alabama? In Georgia? In Mississippi and Louisiana? That’s where we’ve got to put the focus on,” Fauci said.\u003c/p>\n\u003cp>Another challenge that likely won’t be easily overcome relates to the opioid epidemic. The growth in the use of injectable drugs — specifically the sharing of syringes — has driven up HIV and hepatitis C rates in people using illicit substances.\u003c/p>\n\u003cp>Research shows that needle exchange programs reduce those infections. Separately, a number of cities — San Francisco, Philadelphia, New York, and Seattle, among them— have been exploring opening \u003ca href=\"https://www.statnews.com/2017/12/13/supervised-injection-facilities-doctor/\" target=\"_blank\" rel=\"noopener\">safe injection sites\u003c/a>.\u003c/p>\n\u003cp>But just as some doctors associate PrEP prescription with enabling unsafe behavior, the notion of sanctioned injection sites and syringe programs draws the ire of people who believe they encourage illegal activity.\u003c/p>\n\u003cp>In an opinion piece in the New York Times, Deputy Attorney General Rod Rosenstein warned the Department of Justice would take swift action against cities that open such facilities, calling them illegal.\u003c/p>\n\u003cp>“Americans struggling with addiction need treatment and reduced access to deadly drugs. They do not need a taxpayer-sponsored haven to shoot up,” he wrote.\u003c/p>\n\u003cp>Public health experts counter that criminalizing drug use hasn’t worked. Officials can’t “punish people into getting well,” said Dr. Sarah Wakeman, medical director of the substance use disorder program at Mass. General.\u003c/p>\n\u003cp>“At the highest levels of our government, there’s a lot of opposition and antipathy to the idea of harm reduction,” Wakeman said of Rosenstein’s commentary. “And in fact, in that op-ed, it was very clearly stated that these efforts are ‘enabling’ — which I think is one of the many kind of myths around harm reduction.”\u003c/p>\n\u003cp>“We’ll never get to a place where we can stop the spread of HIV unless we are willing to rethink the way we take care of, and our policy towards people who use drugs in this country,” she said.\u003c/p>\n\u003cp>Needle exchange programs have some high-profile supporters, including top officials who have had up-close experience with the problem. The CDC’s Redfield has a son \u003ca href=\"https://www.apnews.com/8cc276150f7e4860bc05bdd4ac04d5e0\" target=\"_blank\" rel=\"noopener\">who has struggled with opioid addiction\u003c/a>; Surgeon General Jerome Adams \u003ca href=\"https://www.statnews.com/2017/12/07/surgeon-general-and-his-brother/\" target=\"_blank\" rel=\"noopener\">has a younger brother who has fought addiction\u003c/a> for two decades.\u003c/p>\n\u003cp>“We believe there is clear evidence that needle exchange programs can reduce the risk of transmission of HIV infection,” said Redfield. Adams \u003ca href=\"https://www.statnews.com/2018/09/20/surgeon-general-jerome-adams-year-one/\" target=\"_blank\" rel=\"noopener\">told STAT\u003c/a> last week: “When I see a [needle exchange] program close, what that says to me is that we haven’t done a good enough job communicating to the community why this program is important and the value that it provides.”\u003c/p>\n\u003cp>The hardest sell yet may be to convince authorities that successfully containing the spread of HIV in the U.S. requires addressing transmission in prisons. Prisons, in theory, “should be easy, because it’s a confined population,” said Fauci. He acknowledged, however, the gap is wide here between theory and reality.\u003c/p>\n\u003cp>“You’ve just got to get really flexible in what you do and recognize that there is sex going on, there is injection drug use going on. And if you really want to address it, you really have to address it in those settings,” he said. “And that, I know, is going to raise a lot of eyebrows. But it’s got to be done.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/09/26/hiv-aids-end-of-transmission-goal/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1538001420,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":43,"wordCount":2173},"headData":{"title":"Is the End of HIV Transmission in the U.S. Near? | KQED","description":"A mere decade ago, 45,000 Americans a year were contracting HIV. Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS. And yet, today, the struggle against HIV may be undergoing a sea change.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Is the End of HIV Transmission in the U.S. Near?","datePublished":"2018-09-26T22:32:50.000Z","dateModified":"2018-09-26T22:37:00.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"444621 https://ww2.kqed.org/futureofyou/?p=444621","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/09/26/is-the-end-of-hiv-transmission-in-the-u-s-near/","disqusTitle":"Is the End of HIV Transmission in the U.S. Near?","source":"Health","nprByline":"Helen Branswell\u003cbr />STAT","path":"/futureofyou/444621/is-the-end-of-hiv-transmission-in-the-u-s-near","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">\u003cspan class=\"big-cap-wrap\">\u003cspan class=\"big-cap\">A \u003c/span>\u003c/span>mere decade ago, 45,000 Americans a year were contracting HIV. Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">And yet, today, the struggle against HIV may be undergoing a sea change.\u003c/p>\n\u003cp class=\"danger-zone\">U.S. health officials and HIV experts are beginning to talk about a future \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">in which transmission in the United States could be halted\u003c/a>. And that future, they say, could come not within a generation, but in the span of just a few years.\u003c/p>\n\u003cp class=\"\">“We have the science to solve the AIDS epidemic,” Dr. Robert Redfield, the director of the CDC, himself a longtime HIV researcher and clinician, told STAT in a recent interview. “We’ve invested in it. Let’s put it into action.‘’\u003c/p>\n\u003cp class=\"\">Other leaders in the HIV field have been musing about the idea, buoyed by the astonishing impact effective HIV medications have wrought, both on the lives of people infected with or at risk of contracting the virus, and on the trajectory of the epidemic.\u003c/p>\n\u003cp class=\"\">“It’s certainly doable in the United States,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a researcher whose study focused on HIV from the earliest days of the AIDS epidemic.\u003c/p>\n\u003cp>Fauci and other health experts are quick to point out that the goal of stopping transmission entirely is largely theoretical. There will always be some new cases, and the barriers to providing treatment to existing cases remain significant. There are still just under 40,000 people in the U.S. each year contracting HIV. As Fauci put it: “We live in a real world, we don’t live in a theoretical world.”\u003c/p>\n\u003cp>But “if we implement all the tools that we have and if we can theoretically, conceptually, get everybody who’s HIV infected on antiretroviral drug so that they will not transmit the infection to anyone else, theoretically you could end the epidemic tomorrow by doing that,” he added.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In the absence of a highly effective vaccine — and likely, even, in the presence of one — consigning the global HIV/AIDS epidemic to the history books would be impossible. And at the moment, that’s moot: Despite decades of research on HIV vaccines, the holy grail of HIV control remains an unmet goal.\u003c/p>\n\u003cp>Still, even without a vaccine, experts believe transmission could be largely stopped in this country — a goal that until the past few years would have been unthinkable.\u003c/p>\n\u003cp>In March, Redfield told CDC staff that he believed HIV transmission in the United States \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">could be halted over the next three to seven years\u003c/a>.\u003c/p>\n\u003cp>The foundation of the dream is the realization that, if taken correctly, today’s potent antiretroviral drugs will drive down the amount of virus in an HIV-infected person’s system to undetectable levels. People who reach that state, known as viral suppression, are not contagious — even, it seems, if they have unprotected sex.\u003c/p>\n\u003cp>Accumulated data from several studies show that in nearly 80,000 condomless sex acts between pairs of men who had discordant HIV status — one was negative, the other was positive, but virally suppressed — not a single new infection occurred.\u003c/p>\n\u003cp>In the HIV world, that finding has given rise to a slogan: U = U, or undetectable equals untransmissible. To maximize the benefits of viral suppression, though, people must know their HIV status and start treatment if they are infected. Currently the CDC estimates that 15 percent of infected Americans are unaware they are HIV positive.\u003c/p>\n\u003cp>“People with HIV infection need to be diagnosed, getting care, stay in care, get on antiretrovirals, and get their viral load down to undetectable,” Redfield said.\u003c/p>\n\u003cp>Pairing the power of viral suppression with another tool further increases the chances of stopping spread of the virus. That other tool is \u003ca href=\"https://www.statnews.com/2018/07/24/digital-pill-prep-truvada/\">PrEP\u003c/a>, pre-exposure prophylaxis — antiretroviral drugs used to prevent infection in people who are at high risk of contracting the virus.\u003c/p>\n\u003cp>Taken correctly, PrEP reduces the risk of contracting HIV from an infected partner by 95 percent. If the infected partner is virally suppressed, the risk is lower still.\u003c/p>\n\u003cp>But the benefits of PrEP can only be reaped if people use it. Currently too few do. The CDC estimates that about 1.1 million people in the U.S. should be taking PrEP, including men who have sex with men, sex workers, and transgender women, a population with a highly elevated risk of contracting HIV. But only about 200,000 are actually using it, Redfield said.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Paradoxically, doctors bear part of the blame for that gap.\u003c/p>\n\u003cp>“There is a large number of people who are not comfortable prescribing PrEP or have not been taught how to prescribe PrEP, whether it be in their residency, fellowship, or post-graduate training,” said Dr. Robert Goldstein, medical director of the transgender health program at Massachusetts General Hospital and an instructor at Harvard Medical School.\u003c/p>\n\u003cp>“We’re limited by stigma within the medical community and within the LGBT community. We’re limited by lack of provider knowledge. We’re limited by awareness among those at highest risk of HIV infection,” Goldstein said. “And those limitations result in rising rates of new HIV infections in men who have sex with men while we see across the country actually dropping rates of new HIV infections year after year.”\u003c/p>\n\u003cp>In some cases, the problem of too little PrEP prescribing is due to a lack of training, and in other cases, something else may be at play, suggested Dr. Demetre Daskalakis, the New York Department of Health’s deputy commissioner of disease control.\u003c/p>\n\u003cp>“We still have to sell this to [clinicians] who are like, ‘Why would I be offering people PrEP, if it’s going to encourage them to have condomless sex?’” he said. “And our answer tends to be, ‘They’re already having condomless sex and this prevents HIV.’”\u003c/p>\n\u003cp>New York is one of several cities — San Francisco and Washington, D.C., among them — that have moved aggressively to harness the power of the treatment and prevention, working to actively identify people who are HIV-positive but who haven’t yet been tested, or haven’t yet started taking antiretroviral drugs, as well as people who should be using PrEP, but are not.\u003c/p>\n\u003cp>New York has expanded the remit of its sexual health clinics to help identify these patients and get them into treatment, said Daskalakis, who explained it’s about “snagging” the people most at risk “where they come for service.”\u003c/p>\n\u003cp>Anyone who is newly diagnosed with HIV is offered antiretroviral drugs immediately. No waiting for a follow-up appointment, which increases the possibility the patient won’t return. And it’s working “with just staggering success,” said Daskalakis.\u003c/p>\n\u003cp>“What we’re finding is that they get virally suppressed faster,” he said. “It’s sort of the dream, that when you start people on medicines for infections they have on the day of their diagnosis, all of a sudden you see that they’re interested in connecting to care and actually follow through.”\u003c/p>\n\u003cp>Likewise, people who test negative for HIV but who are deemed at risk of becoming infected are offered a starter pack of PrEP. The efforts led to a sharp upswing in the number of people taking PrEP — and a swift decline in the number of new HIV diagnoses. In 2016, new infections dropped 10 percent overall, and 15 percent among men who have sex with men, Daskalakis said.\u003c/p>\n\u003cp>The cost of PrEP is steep — $1,500 a month without insurance or assistance from the manufacturer. But New York state has an assistance program that helps with the cost of the medical care PrEP use requires, and there’s a patient assistance program for those who can’t pay for the drug. At the end of the day, Daskalakis said, with a combination of programs, most patients can access PrEP.\u003c/p>\n\u003cp>“In New York, the answer is yes. But I would be more worried about talking to someone in Mississippi,” he said.\u003c/p>\n\u003cp>That isn’t an insignificant consideration. The epidemic in the United States is currently being driven, in large part, by infections among African-American and Latino men who have sex with men in several Southern states.\u003c/p>\n\u003cp>Fauci is a believer in the active style of HIV interventions New York and other cities are employing. “You can’t do business as usual,” he said. “You’ve got to have an aggressive approach.”\u003c/p>\n\u003cp>But he’s always cognizant that translating the successes of Washington or New York to less urban settings — where access to care is more limited and stigma may be greater — likely won’t be as simple as changing some wording on some brochures.\u003c/p>\n\u003cp>“Is that going to work in Alabama? In Georgia? In Mississippi and Louisiana? That’s where we’ve got to put the focus on,” Fauci said.\u003c/p>\n\u003cp>Another challenge that likely won’t be easily overcome relates to the opioid epidemic. The growth in the use of injectable drugs — specifically the sharing of syringes — has driven up HIV and hepatitis C rates in people using illicit substances.\u003c/p>\n\u003cp>Research shows that needle exchange programs reduce those infections. Separately, a number of cities — San Francisco, Philadelphia, New York, and Seattle, among them— have been exploring opening \u003ca href=\"https://www.statnews.com/2017/12/13/supervised-injection-facilities-doctor/\" target=\"_blank\" rel=\"noopener\">safe injection sites\u003c/a>.\u003c/p>\n\u003cp>But just as some doctors associate PrEP prescription with enabling unsafe behavior, the notion of sanctioned injection sites and syringe programs draws the ire of people who believe they encourage illegal activity.\u003c/p>\n\u003cp>In an opinion piece in the New York Times, Deputy Attorney General Rod Rosenstein warned the Department of Justice would take swift action against cities that open such facilities, calling them illegal.\u003c/p>\n\u003cp>“Americans struggling with addiction need treatment and reduced access to deadly drugs. They do not need a taxpayer-sponsored haven to shoot up,” he wrote.\u003c/p>\n\u003cp>Public health experts counter that criminalizing drug use hasn’t worked. Officials can’t “punish people into getting well,” said Dr. Sarah Wakeman, medical director of the substance use disorder program at Mass. General.\u003c/p>\n\u003cp>“At the highest levels of our government, there’s a lot of opposition and antipathy to the idea of harm reduction,” Wakeman said of Rosenstein’s commentary. “And in fact, in that op-ed, it was very clearly stated that these efforts are ‘enabling’ — which I think is one of the many kind of myths around harm reduction.”\u003c/p>\n\u003cp>“We’ll never get to a place where we can stop the spread of HIV unless we are willing to rethink the way we take care of, and our policy towards people who use drugs in this country,” she said.\u003c/p>\n\u003cp>Needle exchange programs have some high-profile supporters, including top officials who have had up-close experience with the problem. The CDC’s Redfield has a son \u003ca href=\"https://www.apnews.com/8cc276150f7e4860bc05bdd4ac04d5e0\" target=\"_blank\" rel=\"noopener\">who has struggled with opioid addiction\u003c/a>; Surgeon General Jerome Adams \u003ca href=\"https://www.statnews.com/2017/12/07/surgeon-general-and-his-brother/\" target=\"_blank\" rel=\"noopener\">has a younger brother who has fought addiction\u003c/a> for two decades.\u003c/p>\n\u003cp>“We believe there is clear evidence that needle exchange programs can reduce the risk of transmission of HIV infection,” said Redfield. Adams \u003ca href=\"https://www.statnews.com/2018/09/20/surgeon-general-jerome-adams-year-one/\" target=\"_blank\" rel=\"noopener\">told STAT\u003c/a> last week: “When I see a [needle exchange] program close, what that says to me is that we haven’t done a good enough job communicating to the community why this program is important and the value that it provides.”\u003c/p>\n\u003cp>The hardest sell yet may be to convince authorities that successfully containing the spread of HIV in the U.S. requires addressing transmission in prisons. Prisons, in theory, “should be easy, because it’s a confined population,” said Fauci. He acknowledged, however, the gap is wide here between theory and reality.\u003c/p>\n\u003cp>“You’ve just got to get really flexible in what you do and recognize that there is sex going on, there is injection drug use going on. And if you really want to address it, you really have to address it in those settings,” he said. “And that, I know, is going to raise a lot of eyebrows. But it’s got to be done.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/09/26/hiv-aids-end-of-transmission-goal/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444621/is-the-end-of-hiv-transmission-in-the-u-s-near","authors":["byline_futureofyou_444621"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_141","futureofyou_1275","futureofyou_61","futureofyou_651","futureofyou_835"],"collections":["futureofyou_1097"],"featImg":"futureofyou_444626","label":"source_futureofyou_444621"},"futureofyou_443936":{"type":"posts","id":"futureofyou_443936","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443936","score":null,"sort":[1534382357000]},"guestAuthors":[],"slug":"hiv-positive-with-no-money-a-medical-trial-was-a-lifesaver","title":"HIV-Positive With No Money? This Woman's Been There and Wants to Help","publishDate":1534382357,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Did you know that there are more women living with HIV in the world than men? Or that young women and girls make up 60 percent of youth cases? If you didn’t, Loren Jones won’t be surprised. Many people in the U.S. still view HIV as a disease that impacts men – especially gay and bisexual men – far more than women.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You know what? We need more women to be getting treatment and more women in clinical trials.'\u003ccite>Loren Jones\u003c/cite>\u003c/aside>\n\u003cp>“People don’t see women,” says Jones, who’s 65 and has had HIV for more than 30 years. “Even women often don’t see women. All of the attention has focused for so long on gay men.” She shrugs. “That really hasn’t changed that much.”\u003c/p>\n\u003cp>Jones is a friendly, outspoken woman who also fits the broad profile of women and girls most at risk for acquiring HIV in the U.S.: she’s heterosexual, African-American, has been homeless, and had boyfriends who did drugs. She’s also been a mother living in poverty.\u003c/p>\n\u003cp>“If you’d have told me when I was younger that I’d be here, doing what I do, I’d a told you no way,” says Jones. “But you know what? We need more women to be getting treatment and more women in clinical trials.”\u003c/p>\n\u003cp>Jones is a volunteer member of the \u003ca href=\"http://www.amfar.org/cure-research-institute/\" target=\"_blank\" rel=\"noopener\">amfAR Institute for HIV Cure Research\u003c/a>’s watchdog community advisory board, or CAB. Her role is to inform others about new cure studies, such as the UC San Francisco remission study starting this fall. Clinical trials, she knows from personal experience, are a great way to access HIV care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I was actually positive for 20 years before I took meds,” she says, “I got into treatment by joining a study.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"OxLwEk6hcW75D0coV2Sp2m7d1a2cx02b\"]Jones was the second person in California to join the ongoing WIHS, or \u003ca href=\"https://statepi.jhsph.edu/wihs/wordpress/\" target=\"_blank\" rel=\"noopener\">Women’s Interagency HIV Study\u003c/a>, a pioneering observational study of HIV in US women. Back then, she’d lost weight and her immune T-cell count was way down – signs of HIV’s advance.\u003c/p>\n\u003cp>“I joined to help myself,” she says. “I had no money or insurance, and I got excellent care. Plus, I met others who helped educate me. It’s helped me survive.”\u003c/p>\n\u003cp>The care in a clinical trial is free, and participants were given a small stipend. Since then, Jones has remained on standard HIV therapy and is in good health, with an undetectable viral load.\u003c/p>\n\u003cp>In the trials, she also learned how few women participate in HIV drug studies and how African-Americans and Latinos are \u003ca href=\"https://www.researchgate.net/publication/7374843_Disparities_and_gaps_in_HIV_research_and_care\">historically underrepresented\u003c/a> in HIV trials. In 1994, 9 percent of HIV drug trial participants were women; a decade later, that number had doubled, but by 2011, it was still only 22 percent, according to \u003ca href=\"http://www.catie.ca/en/catienews/2015-10-05/women-found-under-represented-hiv-clinical-trials\">one Canadian study\u003c/a>. It also showed African-Americans and Latinos with HIV received suboptimal care compared with whites – another continuing trend -- and that clinical trials could help close the gap by providing top-level care.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I can take what the scientists say and bring that back to the ghetto because, let me tell you, the scientists don’t know how to talk to people in my community.'\u003ccite>Loren Jones>\u003c/cite>\u003c/aside>\n\u003cp>WIHS studies have shed important light on how women may process HIV drugs differently than men. They’ve also shown how domestic violence, poverty, sexual abuse and racial inequity are major factors that put HIV in a woman’s path.\u003c/p>\n\u003cp>All three are elements of Jones’ HIV story, itself a testament to her grit and ability to survive.\u003c/p>\n\u003cp>Jones, who is gregarious and likes to laugh, was born in Philadelphia. She describes a very lonely childhood growing up in the care of strict Pentecostalist relatives, apart from her parents and five siblings. She loved books and liked school, until she was bussed to a mostly white school. “I took the ghetto bus to a middle-class neighborhood,” she says. “It was absolutely miserable.” Her isolation continued at Penn State, where she studied nursing, struggling to make ends meet.\u003c/p>\n\u003cp>[contextly_sidebar id=\"QxseLeDIn6vIF3w27GoVucGtwJOLzADj\"]That’s when her destiny shifted. While at Penn State, she was invited to dance in a strip bar. “I was a skinny little string bean; she jokes, “there was nothing to see. But the money was good.” After that, she grabbed her freedom. “I was 17, 18,” she recalls, “and California was a big mystery to me. People talked about diversity and freedom. I wanted that.” She hitchhiked to Oakland in seven days -- with seven dollars in her pocket. “I found Berkeley – there were people walking around blowing bubbles in clown suits on stilts.” She never looked back.\u003c/p>\n\u003cp>She didn’t see HIV coming either. Jones was still a church-going good girl, wide-eyed about the world. One day a handsome guy drove by on a motorcycle and she hopped on. “He was a wild child,” Jones recalls, laughing. They had a child but, too soon, her boyfriend took off. Jones relied on temp jobs, but with a toddler, it was too difficult. She fell into homelessness, lived in her car, then joined a tougher crowd. “This was the 80s; they were outlaws, not a violent gang, but tough enough,” she says of her circle. “We were drinking and drugging in the Oakland hills.”\u003c/p>\n\u003cp>One day she visited a health clinic where they offered the HIV test. She wasn’t prepared, but wasn’t totally surprised, to get a positive result. She told no one for two years. “It was very lonely,” she says. “Back then, if you tested positive, you were definitely gonna die; that was the message.”\u003c/p>\n\u003cp>Jones found her new community by accident in the early 1990s at a temp job when she picked up a newsletter from the Oakland-based \u003ca href=\"http://www.womenhiv.org/\" target=\"_blank\" rel=\"noopener\">Women Organized to Respond to Life Threatening Diseases\u003c/a>, or WORLD. It remains a leading platform for HIV-positive women in the Bay Area.\u003c/p>\n\u003cp>“I want women to know about what’s going on with cure research,” says Jones, explaining her newest focus. “We need our communities in here. We can’t just leave it up to the scientists. They need us.”\u003c/p>\n\u003cp>Jones says her role on the Community Advisory Board isn’t to recruit, but to let women know the studies that are available. But she’s very aware of hurdles standing in the way for women to participate – including poverty, health literacy and distrust of the medical profession.\u003c/p>\n\u003cp>“I overcome the obstacles by talking about my experience,” she says of her approach. “I may be college educated, but I ride the bus too.”\u003c/p>\n\u003cp>“I talk to women who are mostly my home girls; they are like me,” she adds. “They are black women with low income, who live in residential hotels, single income, who live with their mama – women who are really down to earth. We can relate.”\u003c/p>\n\u003cp>Jones says she’s learned in her journey that she doesn’t have to be a scientist to help others.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I can take what the scientists say and bring that back to the ghetto, because, let me tell you, the scientists don’t know how to talk to people in my community. I’m comfortable in both worlds -- the scientific and the street. My message is: ‘We gotta find more ways to invite the community to be involved in this cure research.’ They need to get on board.”\u003c/p>\n\n","blocks":[],"excerpt":"Few women with HIV participate in clinical trials, but it can be one of the best ways to get top-notch care, especially for low-income women.","status":"publish","parent":0,"modified":1534447974,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":1336},"headData":{"title":"HIV-Positive With No Money? This Woman's Been There and Wants to Help | KQED","description":"Few women with HIV participate in clinical trials, but it can be one of the best ways to get top-notch care, especially for low-income women.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"HIV-Positive With No Money? This Woman's Been There and Wants to Help","datePublished":"2018-08-16T01:19:17.000Z","dateModified":"2018-08-16T19:32:54.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443936 https://ww2.kqed.org/futureofyou/?p=443936","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/15/hiv-positive-with-no-money-a-medical-trial-was-a-lifesaver/","disqusTitle":"HIV-Positive With No Money? This Woman's Been There and Wants to Help","source":"KQED Future of You","nprByline":"Anne-christine d'Adesky","path":"/futureofyou/443936/hiv-positive-with-no-money-a-medical-trial-was-a-lifesaver","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Did you know that there are more women living with HIV in the world than men? Or that young women and girls make up 60 percent of youth cases? If you didn’t, Loren Jones won’t be surprised. Many people in the U.S. still view HIV as a disease that impacts men – especially gay and bisexual men – far more than women.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You know what? We need more women to be getting treatment and more women in clinical trials.'\u003ccite>Loren Jones\u003c/cite>\u003c/aside>\n\u003cp>“People don’t see women,” says Jones, who’s 65 and has had HIV for more than 30 years. “Even women often don’t see women. All of the attention has focused for so long on gay men.” She shrugs. “That really hasn’t changed that much.”\u003c/p>\n\u003cp>Jones is a friendly, outspoken woman who also fits the broad profile of women and girls most at risk for acquiring HIV in the U.S.: she’s heterosexual, African-American, has been homeless, and had boyfriends who did drugs. She’s also been a mother living in poverty.\u003c/p>\n\u003cp>“If you’d have told me when I was younger that I’d be here, doing what I do, I’d a told you no way,” says Jones. “But you know what? We need more women to be getting treatment and more women in clinical trials.”\u003c/p>\n\u003cp>Jones is a volunteer member of the \u003ca href=\"http://www.amfar.org/cure-research-institute/\" target=\"_blank\" rel=\"noopener\">amfAR Institute for HIV Cure Research\u003c/a>’s watchdog community advisory board, or CAB. Her role is to inform others about new cure studies, such as the UC San Francisco remission study starting this fall. Clinical trials, she knows from personal experience, are a great way to access HIV care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I was actually positive for 20 years before I took meds,” she says, “I got into treatment by joining a study.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Jones was the second person in California to join the ongoing WIHS, or \u003ca href=\"https://statepi.jhsph.edu/wihs/wordpress/\" target=\"_blank\" rel=\"noopener\">Women’s Interagency HIV Study\u003c/a>, a pioneering observational study of HIV in US women. Back then, she’d lost weight and her immune T-cell count was way down – signs of HIV’s advance.\u003c/p>\n\u003cp>“I joined to help myself,” she says. “I had no money or insurance, and I got excellent care. Plus, I met others who helped educate me. It’s helped me survive.”\u003c/p>\n\u003cp>The care in a clinical trial is free, and participants were given a small stipend. Since then, Jones has remained on standard HIV therapy and is in good health, with an undetectable viral load.\u003c/p>\n\u003cp>In the trials, she also learned how few women participate in HIV drug studies and how African-Americans and Latinos are \u003ca href=\"https://www.researchgate.net/publication/7374843_Disparities_and_gaps_in_HIV_research_and_care\">historically underrepresented\u003c/a> in HIV trials. In 1994, 9 percent of HIV drug trial participants were women; a decade later, that number had doubled, but by 2011, it was still only 22 percent, according to \u003ca href=\"http://www.catie.ca/en/catienews/2015-10-05/women-found-under-represented-hiv-clinical-trials\">one Canadian study\u003c/a>. It also showed African-Americans and Latinos with HIV received suboptimal care compared with whites – another continuing trend -- and that clinical trials could help close the gap by providing top-level care.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I can take what the scientists say and bring that back to the ghetto because, let me tell you, the scientists don’t know how to talk to people in my community.'\u003ccite>Loren Jones>\u003c/cite>\u003c/aside>\n\u003cp>WIHS studies have shed important light on how women may process HIV drugs differently than men. They’ve also shown how domestic violence, poverty, sexual abuse and racial inequity are major factors that put HIV in a woman’s path.\u003c/p>\n\u003cp>All three are elements of Jones’ HIV story, itself a testament to her grit and ability to survive.\u003c/p>\n\u003cp>Jones, who is gregarious and likes to laugh, was born in Philadelphia. She describes a very lonely childhood growing up in the care of strict Pentecostalist relatives, apart from her parents and five siblings. She loved books and liked school, until she was bussed to a mostly white school. “I took the ghetto bus to a middle-class neighborhood,” she says. “It was absolutely miserable.” Her isolation continued at Penn State, where she studied nursing, struggling to make ends meet.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>That’s when her destiny shifted. While at Penn State, she was invited to dance in a strip bar. “I was a skinny little string bean; she jokes, “there was nothing to see. But the money was good.” After that, she grabbed her freedom. “I was 17, 18,” she recalls, “and California was a big mystery to me. People talked about diversity and freedom. I wanted that.” She hitchhiked to Oakland in seven days -- with seven dollars in her pocket. “I found Berkeley – there were people walking around blowing bubbles in clown suits on stilts.” She never looked back.\u003c/p>\n\u003cp>She didn’t see HIV coming either. Jones was still a church-going good girl, wide-eyed about the world. One day a handsome guy drove by on a motorcycle and she hopped on. “He was a wild child,” Jones recalls, laughing. They had a child but, too soon, her boyfriend took off. Jones relied on temp jobs, but with a toddler, it was too difficult. She fell into homelessness, lived in her car, then joined a tougher crowd. “This was the 80s; they were outlaws, not a violent gang, but tough enough,” she says of her circle. “We were drinking and drugging in the Oakland hills.”\u003c/p>\n\u003cp>One day she visited a health clinic where they offered the HIV test. She wasn’t prepared, but wasn’t totally surprised, to get a positive result. She told no one for two years. “It was very lonely,” she says. “Back then, if you tested positive, you were definitely gonna die; that was the message.”\u003c/p>\n\u003cp>Jones found her new community by accident in the early 1990s at a temp job when she picked up a newsletter from the Oakland-based \u003ca href=\"http://www.womenhiv.org/\" target=\"_blank\" rel=\"noopener\">Women Organized to Respond to Life Threatening Diseases\u003c/a>, or WORLD. It remains a leading platform for HIV-positive women in the Bay Area.\u003c/p>\n\u003cp>“I want women to know about what’s going on with cure research,” says Jones, explaining her newest focus. “We need our communities in here. We can’t just leave it up to the scientists. They need us.”\u003c/p>\n\u003cp>Jones says her role on the Community Advisory Board isn’t to recruit, but to let women know the studies that are available. But she’s very aware of hurdles standing in the way for women to participate – including poverty, health literacy and distrust of the medical profession.\u003c/p>\n\u003cp>“I overcome the obstacles by talking about my experience,” she says of her approach. “I may be college educated, but I ride the bus too.”\u003c/p>\n\u003cp>“I talk to women who are mostly my home girls; they are like me,” she adds. “They are black women with low income, who live in residential hotels, single income, who live with their mama – women who are really down to earth. We can relate.”\u003c/p>\n\u003cp>Jones says she’s learned in her journey that she doesn’t have to be a scientist to help others.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I can take what the scientists say and bring that back to the ghetto, because, let me tell you, the scientists don’t know how to talk to people in my community. I’m comfortable in both worlds -- the scientific and the street. My message is: ‘We gotta find more ways to invite the community to be involved in this cure research.’ They need to get on board.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443936/hiv-positive-with-no-money-a-medical-trial-was-a-lifesaver","authors":["byline_futureofyou_443936"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_1081","futureofyou_1275","futureofyou_651","futureofyou_80"],"featImg":"futureofyou_443946","label":"source_futureofyou_443936"},"futureofyou_442226":{"type":"posts","id":"futureofyou_442226","meta":{"index":"posts_1591205157","site":"futureofyou","id":"442226","score":null,"sort":[1527886842000]},"guestAuthors":[],"slug":"study-aims-to-show-transplants-between-hiv-positive-patients-are-safe-save-lives","title":"Study Aims To Show Transplants Between HIV-Positive Patients Are Safe, Save Lives","publishDate":1527886842,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>A large-scale clinical trial launched by the National Institutes of Health in May could pave the way for more HIV-positive patients with kidney disease to receive life-saving transplants.[contextly_sidebar id=\"a0scXdDhVUfyg2KqOZ0K4mbuthRZryBP\"]\u003c/p>\n\u003cp>The trial, called the \u003ca href=\"https://www.nih.gov/news-events/news-releases/nih-clinical-trial-track-outcomes-kidney-transplantation-hiv-positive-donors-hiv-positive-recipients\" target=\"_blank\" rel=\"noopener\">HOPE in Action Multicenter Kidney Study,\u003c/a> will assess the risks of transplanting kidneys from HIV-positive donors into patients living with the virus, says Dr. Christine Durand, assistant professor of medicine at Johns Hopkins University and a principal investigator of the study.\u003c/p>\n\u003cp>\"We have an organ shortage crisis in this country and individuals living with HIV are disproportionately affected,\" she says. The research will help determine whether the pool of HIV-infected organs is \"safe and effective.\" If so, she says, it would benefit everyone awaiting kidneys.\u003c/p>\n\u003cp>\"Everytime someone with HIV gets an organ transplant they move everybody else up on the waitlist,\" says Durand.\u003c/p>\n\u003cp>There are \u003ca href=\"https://www.kidney.org/news/newsroom/factsheets/End-Stage-Renal-Disease-in-the-US\" target=\"_blank\" rel=\"noopener\">468,000 Americans\u003c/a> receiving dialysis for end-stage renal disease. According to Durand's research, an estimated 1.5 percent of those live with HIV. About 1 percent of liver transplant candidates have HIV.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"This means that more than 10,000 HIV positive individuals could benefit from a kidney or liver transplant,\" says Durand.\u003c/p>\n\u003cp>The HOPE in Action study will track 160 kidney transplants, half receiving HIV-positive kidneys and half receiving virus-free organs. Recipients will be monitored after surgery for signs of organ rejection, organ failure, and other complications, such as the risk of infecting the patient with more than one strain of HIV.\u003c/p>\n\u003cp>This will allow doctors to more accurately predict risk after these transplants, and offer the procedure to more HIV-positive people on the transplant waiting list. The researchers also hope to make a case for allowing such transplants to become standard care.\u003c/p>\n\u003cp>Currently, HIV-positive transplants are only permitted if they are part of a clinical trial, such as this one. In 2013, President Obama signed a law, \u003ca href=\"https://obamawhitehouse.archives.gov/blog/2013/11/21/hiv-organ-policy-equity-hope-act-now-law\" target=\"_blank\" rel=\"noopener\">the HIV Organ Policy Equity (HOPE) Act\u003c/a>, allowing HIV-positive individuals to donate certain organs (currently only kidneys and livers), but only as part of a research study conducted with oversight by an academic institution.\u003c/p>\n\u003cp>That law partly rolled back a 1988 law which outlawed harvesting HIV-infected organs.[contextly_sidebar id=\"xbpxyu6mzzv9z7TaZRMEIp5klSJ3h0RD\"]\u003c/p>\n\u003cp>\"At the time it was at the height of the AIDS scare,\" Durand says. \"HIV was a death sentence, so there were a lot of laws put into place to protect the blood supply, to protect organ donation.\"\u003c/p>\n\u003cp>HIV-positive transplant candidates are already eligible to receive virus-free organs, but generally \"they face longer wait times than those who don't have the virus,\" says Durand. This is the case, she adds, even though they have similar survival and organ function after transplant.\u003c/p>\n\u003cp>As HIV testing and treatment improved, donation has become feasible, she says. And \u003ca href=\"http://jasn.asnjournals.org/content/26/9/2222.abstract\" target=\"_blank\" rel=\"noopener\">early research started to show\u003c/a> transplant survival rates could be similar to those of transplant recipients without HIV.\u003c/p>\n\u003cp>But \"many transplant centers say they don't have the expertise or experience to perform these transplants,\" says Durand. The HOPE study may provide data to change this and set clinicians' fears to rest.\u003c/p>\n\u003cp>One center participating in the trial is Indiana University Health in Indianapolis. They've yet to perform a transplant but in April, the Indiana Donor Network, Indiana's organ procurement organization recovered organs from an HIV-positive donor for the first time, and successfully matched a kidney and a liver to two people who needed them out of state. Dr. Tim Taber, chief medical officer for the Indiana Donor Network and a transplant nephrologist at Indiana University Health says he thinks the HOPE in Action study can change clinicians' attitudes about HIV-positive transplantation.\u003c/p>\n\u003cp>\"I think people will be more comfortable with it after a while and after they see that it's been successful so I think it will become more and more common to see HIV-positive donors procured and put in, obviously, HIV-positive recipients,\" he says.\u003c/p>\n\u003cp>It took a few years after Obama signed the HOPE Act for transplants to actually happen between HIV-positive people. In 2015, the National Institutes of Health and Health and Human Services \u003ca href=\"https://www.niaid.nih.gov/sites/default/files/hopeactcriteria.pdf\" target=\"_blank\" rel=\"noopener\">published safeguards and research criteria\u003c/a> for medical centers willing to perform these transplants as clinical research. And a team at Johns Hopkins performed \u003ca href=\"https://www.npr.org/sections/health-shots/2016/03/31/472389956/new-source-of-transplant-organs-for-patients-with-hiv-others-with-hiv\" target=\"_blank\" rel=\"noopener\">the first HIV-positive organ transplant\u003c/a> in 2016.[contextly_sidebar id=\"hUwHooQjUeRk2Iaphb8SlbZQA0om8DpO\"]\u003c/p>\n\u003cp>Any organ procurement organization that follows the NIH research criteria can send HIV-infected donor organs to transplant centers.\u003c/p>\n\u003cp>So far only 16 out of 58 organ procurement organizations around the country have worked on HIV-positive cases since the HOPE Act made it legal, according to Brianna Doby, donation community consultant for a team at Johns Hopkins University that supports organ recovery organizations dealing with their first HIV-positive donor.\u003c/p>\n\u003cp>So far, there have been approximately 50 HIV-positive kidney and liver transplants performed in the U.S. This is far fewer than researchers at Johns Hopkins predicted in a 2011 study, published in the American Journal of Transplantation. They estimated between 500 and 600 new HIV-positive organs would become available after the HOPE Act.\u003c/p>\n\u003cp>Doby says for the past several decades the transplant system has focused on doing everything possible to exclude disease from the donor pool, including HIV and Hepatitis C. And some organ procurement organizations still fear their staff will be at risk when working with an HIV-positive donor. But that needs to change, she says.\u003c/p>\n\u003cp>\"We need to be able to work with organs that increase the risk of those disease, or if you have one of those diseases, find a donor that has those,\" she says. \"Because it's the best shot you have at life, right?\"\u003c/p>\n\u003cp>For the HOPE Act to fulfill its potential Doby says more donors are needed. \"The HOPE Act is not widely known about and many people might just assume they can't be donors if they are also HIV-positive, so they don't register,\" she says.\u003c/p>\n\u003cp>Donation centers are gradually starting to recover more HIV-infected organs, according to Dorry Segev, a transplant surgeon at Johns Hopkins and another principal investigator on the new NIH study. Some local organ procurement centers are \"interested in being pioneers in this area and have been really responsive and good at recovering organs from donors with HIV,\" Segev wrote in an e-mail, while others are \"waiting in the wings to see what happens.\"\u003c/p>\n\u003cp>Any fear they have about the safety of harvesting HIV-positive organs are unfounded he says. He hopes more centers will realize that \"recovering HIV+ organs is not just something interesting, but is actually a responsibility to our patients.\"[contextly_sidebar id=\"XejfKo4ekdt9y93X9my8fqXKEZLcgJLe\"]\u003c/p>\n\u003cp>At hospital transplant centers, clinicians biggest fear is that patients could contract a second strain of HIV from the donor, Segev explains. \"In fact,\" he wrote, \"we have such good [antiretroviral therapy] regimens that basically any strain of HIV can be suppressed with \u003cem>some\u003c/em> ART regimen, so no matter what strain of HIV comes from the donor, we can basically treat it in the recipient.\"\u003c/p>\n\u003cp>If a hospital performing transplants wants to receive HIV-positive organs they have to receive institutional review board approval and prove that they can meet transplantation criteria outlined by the Department of Health and Human Services. The process might deter some transplant centers from participating.\u003c/p>\n\u003cp>Indiana Donor Network's Taber says it's not hard to meet the requirements to procure HIV-positive organs because the safety precautions are the same whether or not there's an infection. His protocol is to \"treat everybody like they have some infection from the moon that you don't want to get.\"\u003c/p>\n\u003cp>And if it can help more patients get transplants, he says, it's a good thing.\u003c/p>\n\u003cp>\"It provides just another opportunity for patients to get transplanted,\" he says.\"It's not a home run but it's one more way to get these people off the list.\"\u003c/p>\n\u003cp>Durand says there's a lot of untapped potential to work with HIV-positive organs. So far 24 centers meet the criteria to perform transplants between people with HIV. Among these centers, Durand said there are more than 300 patients with HIV who have agreed to accept an HIV-positive organ. \"We expect this number to grow significantly,\" she says.\u003c/p>\n\u003cp>And if the trial goes well, it might open the door to other organs. She hopes future research trials will include hundreds of HIV-positive people waiting for hearts and lungs.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced in collaboration with WFYI and \u003c/em>\u003ca href=\"http://sideeffectspublicmedia.org\" target=\"_blank\" rel=\"noopener\">\u003cem>Side Effects Public Media\u003c/em>\u003c/a>\u003cem>, a news collaborative covering public health.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Study+Aims+To+Show+Transplants+Between+HIV-Positive+Patients+Are+Safe%2C+Save+Lives&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Hundreds of otherwise viable organs that are HIV-positive are wasted each year, while HIV-positive patients in need of transplants languish on waiting lists. Researchers want to change that.","status":"publish","parent":0,"modified":1527875629,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1452},"headData":{"title":"Study Aims To Show Transplants Between HIV-Positive Patients Are Safe, Save Lives | KQED","description":"Hundreds of otherwise viable organs that are HIV-positive are wasted each year, while HIV-positive patients in need of transplants languish on waiting lists. Researchers want to change that.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Study Aims To Show Transplants Between HIV-Positive Patients Are Safe, Save Lives","datePublished":"2018-06-01T21:00:42.000Z","dateModified":"2018-06-01T17:53:49.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"442226 https://ww2.kqed.org/futureofyou/?p=442226","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/06/01/study-aims-to-show-transplants-between-hiv-positive-patients-are-safe-save-lives/","disqusTitle":"Study Aims To Show Transplants Between HIV-Positive Patients Are Safe, Save Lives","source":"Health","nprByline":"Emily Forman, NPR","nprImageAgency":"Courtesy of Johns Hopkins Medical","nprStoryId":"615860200","nprApiLink":"http://api.npr.org/query?id=615860200&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/06/01/615860200/researchers-want-to-show-hiv-positive-organ-donation-is-safe-and-can-save-lives?ft=nprml&f=615860200","nprRetrievedStory":"1","nprPubDate":"Fri, 01 Jun 2018 07:42:00 -0400","nprStoryDate":"Fri, 01 Jun 2018 05:00:00 -0400","nprLastModifiedDate":"Fri, 01 Jun 2018 07:42:06 -0400","path":"/futureofyou/442226/study-aims-to-show-transplants-between-hiv-positive-patients-are-safe-save-lives","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A large-scale clinical trial launched by the National Institutes of Health in May could pave the way for more HIV-positive patients with kidney disease to receive life-saving transplants.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The trial, called the \u003ca href=\"https://www.nih.gov/news-events/news-releases/nih-clinical-trial-track-outcomes-kidney-transplantation-hiv-positive-donors-hiv-positive-recipients\" target=\"_blank\" rel=\"noopener\">HOPE in Action Multicenter Kidney Study,\u003c/a> will assess the risks of transplanting kidneys from HIV-positive donors into patients living with the virus, says Dr. Christine Durand, assistant professor of medicine at Johns Hopkins University and a principal investigator of the study.\u003c/p>\n\u003cp>\"We have an organ shortage crisis in this country and individuals living with HIV are disproportionately affected,\" she says. The research will help determine whether the pool of HIV-infected organs is \"safe and effective.\" If so, she says, it would benefit everyone awaiting kidneys.\u003c/p>\n\u003cp>\"Everytime someone with HIV gets an organ transplant they move everybody else up on the waitlist,\" says Durand.\u003c/p>\n\u003cp>There are \u003ca href=\"https://www.kidney.org/news/newsroom/factsheets/End-Stage-Renal-Disease-in-the-US\" target=\"_blank\" rel=\"noopener\">468,000 Americans\u003c/a> receiving dialysis for end-stage renal disease. According to Durand's research, an estimated 1.5 percent of those live with HIV. About 1 percent of liver transplant candidates have HIV.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"This means that more than 10,000 HIV positive individuals could benefit from a kidney or liver transplant,\" says Durand.\u003c/p>\n\u003cp>The HOPE in Action study will track 160 kidney transplants, half receiving HIV-positive kidneys and half receiving virus-free organs. Recipients will be monitored after surgery for signs of organ rejection, organ failure, and other complications, such as the risk of infecting the patient with more than one strain of HIV.\u003c/p>\n\u003cp>This will allow doctors to more accurately predict risk after these transplants, and offer the procedure to more HIV-positive people on the transplant waiting list. The researchers also hope to make a case for allowing such transplants to become standard care.\u003c/p>\n\u003cp>Currently, HIV-positive transplants are only permitted if they are part of a clinical trial, such as this one. In 2013, President Obama signed a law, \u003ca href=\"https://obamawhitehouse.archives.gov/blog/2013/11/21/hiv-organ-policy-equity-hope-act-now-law\" target=\"_blank\" rel=\"noopener\">the HIV Organ Policy Equity (HOPE) Act\u003c/a>, allowing HIV-positive individuals to donate certain organs (currently only kidneys and livers), but only as part of a research study conducted with oversight by an academic institution.\u003c/p>\n\u003cp>That law partly rolled back a 1988 law which outlawed harvesting HIV-infected organs.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"At the time it was at the height of the AIDS scare,\" Durand says. \"HIV was a death sentence, so there were a lot of laws put into place to protect the blood supply, to protect organ donation.\"\u003c/p>\n\u003cp>HIV-positive transplant candidates are already eligible to receive virus-free organs, but generally \"they face longer wait times than those who don't have the virus,\" says Durand. This is the case, she adds, even though they have similar survival and organ function after transplant.\u003c/p>\n\u003cp>As HIV testing and treatment improved, donation has become feasible, she says. And \u003ca href=\"http://jasn.asnjournals.org/content/26/9/2222.abstract\" target=\"_blank\" rel=\"noopener\">early research started to show\u003c/a> transplant survival rates could be similar to those of transplant recipients without HIV.\u003c/p>\n\u003cp>But \"many transplant centers say they don't have the expertise or experience to perform these transplants,\" says Durand. The HOPE study may provide data to change this and set clinicians' fears to rest.\u003c/p>\n\u003cp>One center participating in the trial is Indiana University Health in Indianapolis. They've yet to perform a transplant but in April, the Indiana Donor Network, Indiana's organ procurement organization recovered organs from an HIV-positive donor for the first time, and successfully matched a kidney and a liver to two people who needed them out of state. Dr. Tim Taber, chief medical officer for the Indiana Donor Network and a transplant nephrologist at Indiana University Health says he thinks the HOPE in Action study can change clinicians' attitudes about HIV-positive transplantation.\u003c/p>\n\u003cp>\"I think people will be more comfortable with it after a while and after they see that it's been successful so I think it will become more and more common to see HIV-positive donors procured and put in, obviously, HIV-positive recipients,\" he says.\u003c/p>\n\u003cp>It took a few years after Obama signed the HOPE Act for transplants to actually happen between HIV-positive people. In 2015, the National Institutes of Health and Health and Human Services \u003ca href=\"https://www.niaid.nih.gov/sites/default/files/hopeactcriteria.pdf\" target=\"_blank\" rel=\"noopener\">published safeguards and research criteria\u003c/a> for medical centers willing to perform these transplants as clinical research. And a team at Johns Hopkins performed \u003ca href=\"https://www.npr.org/sections/health-shots/2016/03/31/472389956/new-source-of-transplant-organs-for-patients-with-hiv-others-with-hiv\" target=\"_blank\" rel=\"noopener\">the first HIV-positive organ transplant\u003c/a> in 2016.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Any organ procurement organization that follows the NIH research criteria can send HIV-infected donor organs to transplant centers.\u003c/p>\n\u003cp>So far only 16 out of 58 organ procurement organizations around the country have worked on HIV-positive cases since the HOPE Act made it legal, according to Brianna Doby, donation community consultant for a team at Johns Hopkins University that supports organ recovery organizations dealing with their first HIV-positive donor.\u003c/p>\n\u003cp>So far, there have been approximately 50 HIV-positive kidney and liver transplants performed in the U.S. This is far fewer than researchers at Johns Hopkins predicted in a 2011 study, published in the American Journal of Transplantation. They estimated between 500 and 600 new HIV-positive organs would become available after the HOPE Act.\u003c/p>\n\u003cp>Doby says for the past several decades the transplant system has focused on doing everything possible to exclude disease from the donor pool, including HIV and Hepatitis C. And some organ procurement organizations still fear their staff will be at risk when working with an HIV-positive donor. But that needs to change, she says.\u003c/p>\n\u003cp>\"We need to be able to work with organs that increase the risk of those disease, or if you have one of those diseases, find a donor that has those,\" she says. \"Because it's the best shot you have at life, right?\"\u003c/p>\n\u003cp>For the HOPE Act to fulfill its potential Doby says more donors are needed. \"The HOPE Act is not widely known about and many people might just assume they can't be donors if they are also HIV-positive, so they don't register,\" she says.\u003c/p>\n\u003cp>Donation centers are gradually starting to recover more HIV-infected organs, according to Dorry Segev, a transplant surgeon at Johns Hopkins and another principal investigator on the new NIH study. Some local organ procurement centers are \"interested in being pioneers in this area and have been really responsive and good at recovering organs from donors with HIV,\" Segev wrote in an e-mail, while others are \"waiting in the wings to see what happens.\"\u003c/p>\n\u003cp>Any fear they have about the safety of harvesting HIV-positive organs are unfounded he says. He hopes more centers will realize that \"recovering HIV+ organs is not just something interesting, but is actually a responsibility to our patients.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At hospital transplant centers, clinicians biggest fear is that patients could contract a second strain of HIV from the donor, Segev explains. \"In fact,\" he wrote, \"we have such good [antiretroviral therapy] regimens that basically any strain of HIV can be suppressed with \u003cem>some\u003c/em> ART regimen, so no matter what strain of HIV comes from the donor, we can basically treat it in the recipient.\"\u003c/p>\n\u003cp>If a hospital performing transplants wants to receive HIV-positive organs they have to receive institutional review board approval and prove that they can meet transplantation criteria outlined by the Department of Health and Human Services. The process might deter some transplant centers from participating.\u003c/p>\n\u003cp>Indiana Donor Network's Taber says it's not hard to meet the requirements to procure HIV-positive organs because the safety precautions are the same whether or not there's an infection. His protocol is to \"treat everybody like they have some infection from the moon that you don't want to get.\"\u003c/p>\n\u003cp>And if it can help more patients get transplants, he says, it's a good thing.\u003c/p>\n\u003cp>\"It provides just another opportunity for patients to get transplanted,\" he says.\"It's not a home run but it's one more way to get these people off the list.\"\u003c/p>\n\u003cp>Durand says there's a lot of untapped potential to work with HIV-positive organs. So far 24 centers meet the criteria to perform transplants between people with HIV. Among these centers, Durand said there are more than 300 patients with HIV who have agreed to accept an HIV-positive organ. \"We expect this number to grow significantly,\" she says.\u003c/p>\n\u003cp>And if the trial goes well, it might open the door to other organs. She hopes future research trials will include hundreds of HIV-positive people waiting for hearts and lungs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced in collaboration with WFYI and \u003c/em>\u003ca href=\"http://sideeffectspublicmedia.org\" target=\"_blank\" rel=\"noopener\">\u003cem>Side Effects Public Media\u003c/em>\u003c/a>\u003cem>, a news collaborative covering public health.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Study+Aims+To+Show+Transplants+Between+HIV-Positive+Patients+Are+Safe%2C+Save+Lives&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/442226/study-aims-to-show-transplants-between-hiv-positive-patients-are-safe-save-lives","authors":["byline_futureofyou_442226"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_141","futureofyou_61","futureofyou_651","futureofyou_1510","futureofyou_198"],"featImg":"futureofyou_442227","label":"source_futureofyou_442226"},"futureofyou_441435":{"type":"posts","id":"futureofyou_441435","meta":{"index":"posts_1591205157","site":"futureofyou","id":"441435","score":null,"sort":[1525907695000]},"guestAuthors":[],"slug":"hiv-patients-say-gilead-suppressed-safer-drug-to-preserve-profits","title":"HIV Patients Say Gilead Suppressed Safer Drug to Preserve Profits","publishDate":1525907695,"format":"aside","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>A group of HIV patients based in California filed two separate lawsuits on Wednesday against Bay Area drugmaker Gilead Sciences for promoting a drug they say caused permanent kidney and bone damage. The \u003ca href=\"https://www.aidshealth.org/wp-content/uploads/2018/05/gilead-personal-injury-final.pdf\" target=\"_blank\" rel=\"noopener\">personal injury\u003c/a> and\u003ca href=\"https://www.aidshealth.org/wp-content/uploads/2018/05/class-action-complaint-final.pdf\" target=\"_blank\" rel=\"noopener\"> class action\u003c/a> suits, filed in a Los Angeles district court, accuse the company of shelving a safer version of the drug in order to maximize profits and extend the sales of its existing drug tenofovir disoproxil fumarate.\u003c/p>\n\u003cfigure id=\"attachment_441443\" class=\"wp-caption aligncenter\" style=\"max-width: 796px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/viread.png\">\u003cimg class=\" wp-image-441443\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/viread.png\" alt=\"\" width=\"796\" height=\"329\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread.png 754w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-160x66.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-240x99.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-375x155.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-520x215.png 520w\" sizes=\"(max-width: 796px) 100vw, 796px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Tenofovir disoproxil fumarate was sold under the brand name Viread. \u003ccite>(U.S. Dept. of Health and Human Services)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Both complaints say the company knew as far back as 2001 that TDF was highly toxic but failed to warn patients of the dangerous side effects. The drug was originally sold under the brand name Viread.\u003c/p>\n\u003cp>\"A company I trusted with my life took advantage of that trust by misrepresenting the side effects of TDF, calling it the ‘Miracle Drug’ and using other deceptive marketing strategies,\" said Michael Lujano, from Los Angeles, one of two plaintiffs in the personal injury suit. \"Gilead shelved a far safer drug called tenofovir alafenamide fumarate simply to increase its long-term profits.\"\u003c/p>\n\u003cp>Another plaintiff in the class action suit, Ricardo Wohler, says he has lost 17 teeth in just three years due to the drug. The 52 year-old real estate agent from Marin took TDF for 12 years and was never made aware of its potential side effects, he said.\u003c/p>\n\u003cp>\"I learned how to smile without opening my mouth, how to speak without showing my teeth. This had an entire impact on my life, my self security, my self esteem, but also on my finances.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Gilead said it is \"thoroughly reviewing the complaints and will not provide comment until that process is complete.\"\u003c/p>\n\u003cp>The suits accuse Gilead of deceptive marketing practices and putting profits before the health of its customers. The complaint says the company made $18 billion in profits in 2015.\u003c/p>\n\u003cp>\"Under these circumstances, the laws must be read to protect public health from corporate greed,” says Liza Brereton, attorney for plaintiffs and in-house counsel for the AIDS Healthcare Foundation.\u003c/p>\n\u003cp>AHF, which filed both lawsuits with co-counsel Rutherford Law, says it is funding the litigation and will not accept any financial recovery in excess of its actual costs.\u003c/p>\n\u003cp>Two other Californians filed a separate class action lawsuit on behalf of all patients living in California who were prescribed the drug from Oct. 26, 2001 through the present and were exposed to Gilead’s alleged misrepresentations, either directly or through their doctor.\u003c/p>\n\u003cp>The Food and Drug Administration reportedly issued two warning letters to Gilead for false misrepresentations about the drug's risks, according to the personal injury complaint.\u003c/p>\n\u003cp>A warning letter issued in 2002 accused a company sales representatives of falsely stating that TDF had “no toxicities” and was “benign” and “extremely safe.\" The company was slapped with another warning letter one year later, requiring Gilead to retrain its sales representatives.\u003c/p>\n\u003cp>The drugmaker began funding research of an alternative drug called TAF in 2001 but suppressed findings that showed it was far less toxic, according to the class action complaint.\u003c/p>\n\u003cp>Faced with a sharp decrease in profits, the complaint says, the drugmaker eventually released those findings in 2014, when Gilead’s patent on TDF was approaching expiration.\u003c/p>\n\u003cp>From the \u003ca href=\"http://www.latimes.com/business/la-fi-gilead-hiv-drug-lawsuit-20180509-story.html\" target=\"_blank\" rel=\"noopener\">Los Angeles Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>In April 2001, the scientists published research on a different chemical version of the medicine called tenofovir alafenamide fumarate, or TAF.\u003c/p>\n\u003cp>That animal study showed TAF had a thousand-fold greater activity against HIV than the original medicine invented in Europe, raising the possibility that it would have far less toxicity.\u003c/p>\n\u003cp>Gilead then paid doctors across the country to give TAF to patients in small clinical trials. The positive results of those studies were not published for years — secrecy that the lawsuits filed Tuesday say was \"an act of extreme malice.\"\u003c/p>\n\u003cp>Instead, in October 2004, Gilead abruptly announced that it was ending research on TAF after an \"internal business review.\" And it continued to pour money into selling the older drug, which was bringing in billions of dollars each year.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>A previous federal lawsuit filed in 2016 is currently pending following the publication of a previous \u003ca href=\"http://www.latimes.com/business/la-fi-gilead-20160529-snap-story.html\" target=\"_blank\" rel=\"noopener\">Los Angeles Times article\u003c/a> that accused the company of stifling development of the safer drug.\u003c/p>\n\n","blocks":[],"excerpt":"Gilead promoted a drug that caused kidney and bone damage while shelving a far safer drug, says the lawsuit.","status":"publish","parent":0,"modified":1525971366,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":730},"headData":{"title":"HIV Patients Say Gilead Suppressed Safer Drug to Preserve Profits | KQED","description":"Gilead promoted a drug that caused kidney and bone damage while shelving a far safer drug, says the lawsuit.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"HIV Patients Say Gilead Suppressed Safer Drug to Preserve Profits","datePublished":"2018-05-09T23:14:55.000Z","dateModified":"2018-05-10T16:56:06.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"441435 https://ww2.kqed.org/futureofyou/?p=441435","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/05/09/hiv-patients-say-gilead-suppressed-safer-drug-to-preserve-profits/","disqusTitle":"HIV Patients Say Gilead Suppressed Safer Drug to Preserve Profits","path":"/futureofyou/441435/hiv-patients-say-gilead-suppressed-safer-drug-to-preserve-profits","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A group of HIV patients based in California filed two separate lawsuits on Wednesday against Bay Area drugmaker Gilead Sciences for promoting a drug they say caused permanent kidney and bone damage. The \u003ca href=\"https://www.aidshealth.org/wp-content/uploads/2018/05/gilead-personal-injury-final.pdf\" target=\"_blank\" rel=\"noopener\">personal injury\u003c/a> and\u003ca href=\"https://www.aidshealth.org/wp-content/uploads/2018/05/class-action-complaint-final.pdf\" target=\"_blank\" rel=\"noopener\"> class action\u003c/a> suits, filed in a Los Angeles district court, accuse the company of shelving a safer version of the drug in order to maximize profits and extend the sales of its existing drug tenofovir disoproxil fumarate.\u003c/p>\n\u003cfigure id=\"attachment_441443\" class=\"wp-caption aligncenter\" style=\"max-width: 796px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/viread.png\">\u003cimg class=\" wp-image-441443\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/viread.png\" alt=\"\" width=\"796\" height=\"329\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread.png 754w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-160x66.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-240x99.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-375x155.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-520x215.png 520w\" sizes=\"(max-width: 796px) 100vw, 796px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Tenofovir disoproxil fumarate was sold under the brand name Viread. \u003ccite>(U.S. Dept. of Health and Human Services)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Both complaints say the company knew as far back as 2001 that TDF was highly toxic but failed to warn patients of the dangerous side effects. The drug was originally sold under the brand name Viread.\u003c/p>\n\u003cp>\"A company I trusted with my life took advantage of that trust by misrepresenting the side effects of TDF, calling it the ‘Miracle Drug’ and using other deceptive marketing strategies,\" said Michael Lujano, from Los Angeles, one of two plaintiffs in the personal injury suit. \"Gilead shelved a far safer drug called tenofovir alafenamide fumarate simply to increase its long-term profits.\"\u003c/p>\n\u003cp>Another plaintiff in the class action suit, Ricardo Wohler, says he has lost 17 teeth in just three years due to the drug. The 52 year-old real estate agent from Marin took TDF for 12 years and was never made aware of its potential side effects, he said.\u003c/p>\n\u003cp>\"I learned how to smile without opening my mouth, how to speak without showing my teeth. This had an entire impact on my life, my self security, my self esteem, but also on my finances.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Gilead said it is \"thoroughly reviewing the complaints and will not provide comment until that process is complete.\"\u003c/p>\n\u003cp>The suits accuse Gilead of deceptive marketing practices and putting profits before the health of its customers. The complaint says the company made $18 billion in profits in 2015.\u003c/p>\n\u003cp>\"Under these circumstances, the laws must be read to protect public health from corporate greed,” says Liza Brereton, attorney for plaintiffs and in-house counsel for the AIDS Healthcare Foundation.\u003c/p>\n\u003cp>AHF, which filed both lawsuits with co-counsel Rutherford Law, says it is funding the litigation and will not accept any financial recovery in excess of its actual costs.\u003c/p>\n\u003cp>Two other Californians filed a separate class action lawsuit on behalf of all patients living in California who were prescribed the drug from Oct. 26, 2001 through the present and were exposed to Gilead’s alleged misrepresentations, either directly or through their doctor.\u003c/p>\n\u003cp>The Food and Drug Administration reportedly issued two warning letters to Gilead for false misrepresentations about the drug's risks, according to the personal injury complaint.\u003c/p>\n\u003cp>A warning letter issued in 2002 accused a company sales representatives of falsely stating that TDF had “no toxicities” and was “benign” and “extremely safe.\" The company was slapped with another warning letter one year later, requiring Gilead to retrain its sales representatives.\u003c/p>\n\u003cp>The drugmaker began funding research of an alternative drug called TAF in 2001 but suppressed findings that showed it was far less toxic, according to the class action complaint.\u003c/p>\n\u003cp>Faced with a sharp decrease in profits, the complaint says, the drugmaker eventually released those findings in 2014, when Gilead’s patent on TDF was approaching expiration.\u003c/p>\n\u003cp>From the \u003ca href=\"http://www.latimes.com/business/la-fi-gilead-hiv-drug-lawsuit-20180509-story.html\" target=\"_blank\" rel=\"noopener\">Los Angeles Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>In April 2001, the scientists published research on a different chemical version of the medicine called tenofovir alafenamide fumarate, or TAF.\u003c/p>\n\u003cp>That animal study showed TAF had a thousand-fold greater activity against HIV than the original medicine invented in Europe, raising the possibility that it would have far less toxicity.\u003c/p>\n\u003cp>Gilead then paid doctors across the country to give TAF to patients in small clinical trials. The positive results of those studies were not published for years — secrecy that the lawsuits filed Tuesday say was \"an act of extreme malice.\"\u003c/p>\n\u003cp>Instead, in October 2004, Gilead abruptly announced that it was ending research on TAF after an \"internal business review.\" And it continued to pour money into selling the older drug, which was bringing in billions of dollars each year.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>A previous federal lawsuit filed in 2016 is currently pending following the publication of a previous \u003ca href=\"http://www.latimes.com/business/la-fi-gilead-20160529-snap-story.html\" target=\"_blank\" rel=\"noopener\">Los Angeles Times article\u003c/a> that accused the company of stifling development of the safer drug.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/441435/hiv-patients-say-gilead-suppressed-safer-drug-to-preserve-profits","authors":["11428"],"categories":["futureofyou_1060","futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_952","futureofyou_651","futureofyou_80","futureofyou_1056","futureofyou_931"],"featImg":"futureofyou_441443","label":"futureofyou"},"futureofyou_440869":{"type":"posts","id":"futureofyou_440869","meta":{"index":"posts_1591205157","site":"futureofyou","id":"440869","score":null,"sort":[1524250800000]},"guestAuthors":[],"slug":"chasing-a-new-way-to-prevent-hiv-passive-immunization","title":"Chasing A New Way To Prevent HIV: Passive Immunization","publishDate":1524250800,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>After decades of intense effort, an effective vaccine against HIV is not on the horizon — and, some say, may never be possible. So some AIDS researchers are going passive.\u003c/p>\n\u003cp>As in passive immunization.[contextly_sidebar id=\"Xmf3XI2gbMPO20A46mYbeYfSv5R7TcOk\"]\u003c/p>\n\u003cp>Active immunization is what an effective vaccine does. It stimulates the recipient to make antibodies that protect against a disease. Passive immunization involves the direct injection of antibodies extracted from survivors of a particular infection.\u003c/p>\n\u003cp>It's an \u003ca href=\"https://academic.oup.com/cid/article/51/2/239/303856\" target=\"_blank\" rel=\"noopener\">old method\u003c/a> of preventing infection when a vaccine isn't available — once used, for instance, to protect at-risk people from hepatitis before vaccines were developed. Instead of the lifelong protection from a really good vaccine, passive immunization is a temporary bulwark against infection.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.nature.com/articles/s41591-018-0001-2\" target=\"_blank\" rel=\"noopener\">new report\u003c/a> in \u003cem>Nature Medicine \u003c/em>gives reason to believe it can work against HIV — at least, so far, in monkeys.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"7iTJpxzoihSEFdeAGr40HVv2JFxPnQpZ\"]A single injection of two anti-HIV antibodies protected five of six macaque monkeys from infection for six to nine months as they got weekly inoculations of a potent human-simian hybrid of the virus called SHIV.\u003c/p>\n\u003cp>\"We think this approach might be an important way to prevent transmission in humans, particularly in regions of the world where HIV is endemic,\" says \u003ca href=\"https://irp.nih.gov/pi/malcolm-martin\" target=\"_blank\" rel=\"noopener\">Malcolm Martin\u003c/a>, chief of the viral pathogenesis and viral section of the National Institute of Allergies and Infectious Diseases and a senior author of the paper. \"This is not a vaccine but a way to prevention.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.gatesfoundation.org/Who-We-Are/General-Information/Leadership/Global-Health/Emilio-Emini\" target=\"_blank\" rel=\"noopener\">Emilio Emini\u003c/a>, director of the Gates Foundation's HIV program, a funder of the new research, agrees the approach is worth pushing. \"The potential is there for the development of a neutralizing antibody cocktail that could be injected to provide many months of protection against HIV infection,\" Emini says. (The Gates Foundation is also a funder of NPR and this blog.)\u003c/p>\n\u003cp>Over the last few years, scientists have identified something like 100 of these anti-HIV antibodies, giving them plenty of opportunities to mix and match for maximum effectiveness.\u003c/p>\n\u003cp>The hope is that an injection of these antibodies every six to 12 months could protect large numbers of people from HIV in parts of the world where most infections are occurring. Currently 1.8 million people are newly infected with HIV every year. And other means of prevention, such as a daily pill containing anti-HIV drugs, have proved too cumbersome. \"Taking a pill every day can be just about impossible to do in a population of young people, even under the best of circumstances,\" Emini says.\u003c/p>\n\u003cp>And protecting that young population is key. \"In southern Africa, in particular, over the past 10 or 15 years there's been an explosion of young people,\" Emini says. \"In many of these countries the average age is in the 20s. Having the means to protect these young people is something that will be absolutely critical to controlling the epidemic.\"[contextly_sidebar id=\"jyiWKAHmWck20bKRGd11NV0NQ6LVdv2F\"]\u003c/p>\n\u003cp>The \u003cem>Nature Medicine \u003c/em>paper is just the latest report from a burgeoning new branch of HIV research that's gathering momentum.\u003c/p>\n\u003cp>\"This is not just about doing cool science — and this is cool science,\" says Mitchell Warren, executive director of \u003ca href=\"https://www.avac.org/\">AVAC\u003c/a>, a global HIV prevention advocacy group. \"People are excited about this antibody research as a whole new prevention approach. The long-term goal is still a vaccine. But in HIV prevention we will take what we can get.\"\u003c/p>\n\u003cp>But if you've been following AIDS, you might be wondering how antibodies from HIV-infected people could possibly protect against infection. After all, the hallmark of HIV infection is that immune defenses don't work.\u003c/p>\n\u003cp>The answer is that researchers are using antibodies derived from a tiny fraction of HIV-infected people — about 1 percent — called \"elite controllers\" or (the term Martin prefers) \"elite neutralizers.\" As his term indicates, these \"elite\" patients make antibodies that can neutralize, or kill, HIV. The patients typically have low levels of the virus and can live longer without virus-suppressing drugs before they get symptoms of immune system collapse, or AIDS.\u003c/p>\n\u003cp>Ultimately, most elite neutralizers do progress to AIDS if they don't take antiviral drugs. The reason, Martin says, is that during the initial stages of their HIV infection, their immune system \"takes a major hit from which it never recovers.\" That allows HIV to establish hideaways, or reservoirs, in the body. By the time their immune systems start generating antibodies to neutralize HIV, Martin says, \"it's too late\" to keep the infection under control forever. The horse is out of the barn.\u003c/p>\n\u003cp>[contextly_sidebar id=\"w4gEpTxAayvKFMwRczIPppV0noiBfi2u\"]In the new work and \u003ca href=\"https://www.npr.org/sections/health-shots/2013/10/31/242093426/aids-scientists-encouraged-by-antibodies-that-hit-monkey-virus)\">previous experiments\u003c/a>, Martin and colleagues have identified the particular antibodies from these rare patients that can prevent HIV infection in the test tube. They then harvest these antibodies from patients and test them in monkeys to see if they prevent HIV infection from getting established in the first place. They've also learned to tweak the antibodies, introducing mutations that extend their lifetime in the bloodstream. And they've found that passive immunization works best when they combine two types of antibodies in one injection.\u003c/p>\n\u003cp>Two other findings improve the prospects that passive immunization may work in the real world:\u003c/p>\n\u003cul>\n\u003cli>It can be given by subcutaneous injections — a simple jab just under the skin — a much simpler and cheaper maneuver than the intravenous infusions used in earlier studies.\u003c/li>\n\u003cli>Small doses — three times lower than earlier IV doses — were enough to give many months of protection. That will bring the cost down too.\u003c/li>\n\u003c/ul>\n\u003cp>These elements \"make this report very important,\" Emini says. \"Everything is moving in the right direction.\"\u003c/p>\n\u003cp>Martin says another promising factor is the likelihood that the injected antibodies will stick around longer in humans' bloodstream than they do in monkeys' – thus offering more durable protection.\u003c/p>\n\u003cp>That's because a monkey's immune system recognizes the human-derived antibodies as foreign and so generate antibodies against the antibodies, clearing them from the blood. In studies when humans have been injected with these antibodies, Martin says, \"so far, there has been no report of humans ever developing anti-antibodies. So it's very likely, though we don't have proof of this, that these antibodies will last longer when we give them to humans.\"\u003c/p>\n\u003cp>The antibody cocktail researchers envision would contain neutralizing antibodies directed at multiple parts of the HIV outer coat. That would work against various strains of HIV circulating around the world and reduce the risk the virus would develop resistance.\u003c/p>\n\u003cp>Still, genetically engineered antibodies \"are actually quite expensive to produce,\" Emini acknowledges. \"So we need to develop ways to produce them at cost levels that are realistic for countries where most of the infection still occurs.\" The Gates Foundation's target price is no more than $150 per person per year — an amount comparable to the cost of HIV drug treatments now \u003ca href=\"https://www.npr.org/sections/health-shots/2013/10/31/242093426/aids-scientists-encouraged-by-antibodies-that-hit-monkey-virus)\">reaching 21 million people a year\u003c/a>.\u003c/p>\n\u003cp>Momentum behind the passive immunization against HIV is [contextly_sidebar id=\"qBSUXVbfErfptQT2yYDrSIGwPatdWI2n\"]growing. \u003ca href=\"https://www.avac.org/trial-search?field_prevention_option_tid%5B%5D=1&keys=&title=&field_status_value=Ongoing&field_phase_value=All\">Eight human studies are underway\u003c/a> using the approach.\u003c/p>\n\u003cp>Two of them are enrolling a total of 5,000 people at risk of HIV infection — men who have sex with men in the United States, Latin America and South Africa, and women in seven African countries.\u003c/p>\n\u003cp>Those trials are using one of the first of the 100 anti-HIV antibodies to be discovered, called VRC01. But it has to be delivered every two months in 45-minute intravenous infusions. So even if that's shown to be effective in preventing HIV infections, it's not going to be practical as a real-world prevention strategy.\u003c/p>\n\u003cp>The two-antibody combination in the new report might be. It's being injected into humans in a small study that began last August. It's designed to see if any adverse effects arise, but it can also yield useful data on how long the antibody persists in humans and whether humans mount an immune defense against them.\u003c/p>\n\u003cp>Even though the monkey studies and human trials are preliminary, there's a sense of urgency behind the passive-immunization approach. Despite surprising success in getting anti-HIV treatment to infected people in most-affected nations, nobody thinks the world can treat its way out of the HIV pandemic.\u003c/p>\n\u003cp>\"The concern is that if we don't control the pandemic, 15 or 20 years from now we'll have more people with HIV in southern Africa than we had 15 years ago,\" Emini says. \"So the urgency remains very strong, and getting stronger.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Richard Knox is a New Hampshire-based health and science reporter, former NPR science correspondent and currently senior correspondent for WBUR in Boston. He's been reporting on HIV/AIDS since the beginning of the epidemic. Contact him @DickKnox\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Chasing+A+New+Way+To+Prevent+HIV%3A+Passive+Immunization&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The idea is to inject anti-HIV antibodies that would kill the virus when people get exposed. A new study is promising — although it was conducted on monkeys.","status":"publish","parent":0,"modified":1524244262,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1474},"headData":{"title":"Chasing A New Way To Prevent HIV: Passive Immunization | KQED","description":"The idea is to inject anti-HIV antibodies that would kill the virus when people get exposed. A new study is promising — although it was conducted on monkeys.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Chasing A New Way To Prevent HIV: Passive Immunization","datePublished":"2018-04-20T19:00:00.000Z","dateModified":"2018-04-20T17:11:02.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"440869 https://ww2.kqed.org/futureofyou/?p=440869","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/04/20/chasing-a-new-way-to-prevent-hiv-passive-immunization/","disqusTitle":"Chasing A New Way To Prevent HIV: Passive Immunization","source":"Hope/Hype","nprImageCredit":"Foto24","nprByline":"Richard Knox, NPR","nprImageAgency":"Gallo Images/Getty Images","nprStoryId":"603525972","nprApiLink":"http://api.npr.org/query?id=603525972&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/goatsandsoda/2018/04/18/603525972/chasing-a-new-way-to-prevent-hiv-passive-immunization?ft=nprml&f=603525972","nprRetrievedStory":"1","nprPubDate":"Thu, 19 Apr 2018 11:21:00 -0400","nprStoryDate":"Wed, 18 Apr 2018 13:41:00 -0400","nprLastModifiedDate":"Thu, 19 Apr 2018 11:21:15 -0400","path":"/futureofyou/440869/chasing-a-new-way-to-prevent-hiv-passive-immunization","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>After decades of intense effort, an effective vaccine against HIV is not on the horizon — and, some say, may never be possible. So some AIDS researchers are going passive.\u003c/p>\n\u003cp>As in passive immunization.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Active immunization is what an effective vaccine does. It stimulates the recipient to make antibodies that protect against a disease. Passive immunization involves the direct injection of antibodies extracted from survivors of a particular infection.\u003c/p>\n\u003cp>It's an \u003ca href=\"https://academic.oup.com/cid/article/51/2/239/303856\" target=\"_blank\" rel=\"noopener\">old method\u003c/a> of preventing infection when a vaccine isn't available — once used, for instance, to protect at-risk people from hepatitis before vaccines were developed. Instead of the lifelong protection from a really good vaccine, passive immunization is a temporary bulwark against infection.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.nature.com/articles/s41591-018-0001-2\" target=\"_blank\" rel=\"noopener\">new report\u003c/a> in \u003cem>Nature Medicine \u003c/em>gives reason to believe it can work against HIV — at least, so far, in monkeys.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>A single injection of two anti-HIV antibodies protected five of six macaque monkeys from infection for six to nine months as they got weekly inoculations of a potent human-simian hybrid of the virus called SHIV.\u003c/p>\n\u003cp>\"We think this approach might be an important way to prevent transmission in humans, particularly in regions of the world where HIV is endemic,\" says \u003ca href=\"https://irp.nih.gov/pi/malcolm-martin\" target=\"_blank\" rel=\"noopener\">Malcolm Martin\u003c/a>, chief of the viral pathogenesis and viral section of the National Institute of Allergies and Infectious Diseases and a senior author of the paper. \"This is not a vaccine but a way to prevention.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.gatesfoundation.org/Who-We-Are/General-Information/Leadership/Global-Health/Emilio-Emini\" target=\"_blank\" rel=\"noopener\">Emilio Emini\u003c/a>, director of the Gates Foundation's HIV program, a funder of the new research, agrees the approach is worth pushing. \"The potential is there for the development of a neutralizing antibody cocktail that could be injected to provide many months of protection against HIV infection,\" Emini says. (The Gates Foundation is also a funder of NPR and this blog.)\u003c/p>\n\u003cp>Over the last few years, scientists have identified something like 100 of these anti-HIV antibodies, giving them plenty of opportunities to mix and match for maximum effectiveness.\u003c/p>\n\u003cp>The hope is that an injection of these antibodies every six to 12 months could protect large numbers of people from HIV in parts of the world where most infections are occurring. Currently 1.8 million people are newly infected with HIV every year. And other means of prevention, such as a daily pill containing anti-HIV drugs, have proved too cumbersome. \"Taking a pill every day can be just about impossible to do in a population of young people, even under the best of circumstances,\" Emini says.\u003c/p>\n\u003cp>And protecting that young population is key. \"In southern Africa, in particular, over the past 10 or 15 years there's been an explosion of young people,\" Emini says. \"In many of these countries the average age is in the 20s. Having the means to protect these young people is something that will be absolutely critical to controlling the epidemic.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The \u003cem>Nature Medicine \u003c/em>paper is just the latest report from a burgeoning new branch of HIV research that's gathering momentum.\u003c/p>\n\u003cp>\"This is not just about doing cool science — and this is cool science,\" says Mitchell Warren, executive director of \u003ca href=\"https://www.avac.org/\">AVAC\u003c/a>, a global HIV prevention advocacy group. \"People are excited about this antibody research as a whole new prevention approach. The long-term goal is still a vaccine. But in HIV prevention we will take what we can get.\"\u003c/p>\n\u003cp>But if you've been following AIDS, you might be wondering how antibodies from HIV-infected people could possibly protect against infection. After all, the hallmark of HIV infection is that immune defenses don't work.\u003c/p>\n\u003cp>The answer is that researchers are using antibodies derived from a tiny fraction of HIV-infected people — about 1 percent — called \"elite controllers\" or (the term Martin prefers) \"elite neutralizers.\" As his term indicates, these \"elite\" patients make antibodies that can neutralize, or kill, HIV. The patients typically have low levels of the virus and can live longer without virus-suppressing drugs before they get symptoms of immune system collapse, or AIDS.\u003c/p>\n\u003cp>Ultimately, most elite neutralizers do progress to AIDS if they don't take antiviral drugs. The reason, Martin says, is that during the initial stages of their HIV infection, their immune system \"takes a major hit from which it never recovers.\" That allows HIV to establish hideaways, or reservoirs, in the body. By the time their immune systems start generating antibodies to neutralize HIV, Martin says, \"it's too late\" to keep the infection under control forever. The horse is out of the barn.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In the new work and \u003ca href=\"https://www.npr.org/sections/health-shots/2013/10/31/242093426/aids-scientists-encouraged-by-antibodies-that-hit-monkey-virus)\">previous experiments\u003c/a>, Martin and colleagues have identified the particular antibodies from these rare patients that can prevent HIV infection in the test tube. They then harvest these antibodies from patients and test them in monkeys to see if they prevent HIV infection from getting established in the first place. They've also learned to tweak the antibodies, introducing mutations that extend their lifetime in the bloodstream. And they've found that passive immunization works best when they combine two types of antibodies in one injection.\u003c/p>\n\u003cp>Two other findings improve the prospects that passive immunization may work in the real world:\u003c/p>\n\u003cul>\n\u003cli>It can be given by subcutaneous injections — a simple jab just under the skin — a much simpler and cheaper maneuver than the intravenous infusions used in earlier studies.\u003c/li>\n\u003cli>Small doses — three times lower than earlier IV doses — were enough to give many months of protection. That will bring the cost down too.\u003c/li>\n\u003c/ul>\n\u003cp>These elements \"make this report very important,\" Emini says. \"Everything is moving in the right direction.\"\u003c/p>\n\u003cp>Martin says another promising factor is the likelihood that the injected antibodies will stick around longer in humans' bloodstream than they do in monkeys' – thus offering more durable protection.\u003c/p>\n\u003cp>That's because a monkey's immune system recognizes the human-derived antibodies as foreign and so generate antibodies against the antibodies, clearing them from the blood. In studies when humans have been injected with these antibodies, Martin says, \"so far, there has been no report of humans ever developing anti-antibodies. So it's very likely, though we don't have proof of this, that these antibodies will last longer when we give them to humans.\"\u003c/p>\n\u003cp>The antibody cocktail researchers envision would contain neutralizing antibodies directed at multiple parts of the HIV outer coat. That would work against various strains of HIV circulating around the world and reduce the risk the virus would develop resistance.\u003c/p>\n\u003cp>Still, genetically engineered antibodies \"are actually quite expensive to produce,\" Emini acknowledges. \"So we need to develop ways to produce them at cost levels that are realistic for countries where most of the infection still occurs.\" The Gates Foundation's target price is no more than $150 per person per year — an amount comparable to the cost of HIV drug treatments now \u003ca href=\"https://www.npr.org/sections/health-shots/2013/10/31/242093426/aids-scientists-encouraged-by-antibodies-that-hit-monkey-virus)\">reaching 21 million people a year\u003c/a>.\u003c/p>\n\u003cp>Momentum behind the passive immunization against HIV is \u003c/p>\u003cp>\u003c/p>\u003cp>growing. \u003ca href=\"https://www.avac.org/trial-search?field_prevention_option_tid%5B%5D=1&keys=&title=&field_status_value=Ongoing&field_phase_value=All\">Eight human studies are underway\u003c/a> using the approach.\u003c/p>\n\u003cp>Two of them are enrolling a total of 5,000 people at risk of HIV infection — men who have sex with men in the United States, Latin America and South Africa, and women in seven African countries.\u003c/p>\n\u003cp>Those trials are using one of the first of the 100 anti-HIV antibodies to be discovered, called VRC01. But it has to be delivered every two months in 45-minute intravenous infusions. So even if that's shown to be effective in preventing HIV infections, it's not going to be practical as a real-world prevention strategy.\u003c/p>\n\u003cp>The two-antibody combination in the new report might be. It's being injected into humans in a small study that began last August. It's designed to see if any adverse effects arise, but it can also yield useful data on how long the antibody persists in humans and whether humans mount an immune defense against them.\u003c/p>\n\u003cp>Even though the monkey studies and human trials are preliminary, there's a sense of urgency behind the passive-immunization approach. Despite surprising success in getting anti-HIV treatment to infected people in most-affected nations, nobody thinks the world can treat its way out of the HIV pandemic.\u003c/p>\n\u003cp>\"The concern is that if we don't control the pandemic, 15 or 20 years from now we'll have more people with HIV in southern Africa than we had 15 years ago,\" Emini says. \"So the urgency remains very strong, and getting stronger.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Richard Knox is a New Hampshire-based health and science reporter, former NPR science correspondent and currently senior correspondent for WBUR in Boston. He's been reporting on HIV/AIDS since the beginning of the epidemic. Contact him @DickKnox\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Chasing+A+New+Way+To+Prevent+HIV%3A+Passive+Immunization&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/440869/chasing-a-new-way-to-prevent-hiv-passive-immunization","authors":["byline_futureofyou_440869"],"categories":["futureofyou_1062","futureofyou_1"],"tags":["futureofyou_650","futureofyou_141","futureofyou_61","futureofyou_651","futureofyou_1056"],"collections":["futureofyou_1097"],"featImg":"futureofyou_440870","label":"source_futureofyou_440869"},"futureofyou_437567":{"type":"posts","id":"futureofyou_437567","meta":{"index":"posts_1591205157","site":"futureofyou","id":"437567","score":null,"sort":[1513112415000]},"guestAuthors":[],"slug":"frontiers-of-hiv-research-the-man-who-was-nearly-cured","title":"The Man Who Was Nearly Cured of HIV","publishDate":1513112415,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>The cases of Clark Hawley, 54, and Luis Canales, 31, presented at the \u003ca href=\"http://www.curecountdown.org/research-index/2017/9/12/2017-hiv-cure-summit\" target=\"_blank\" rel=\"noopener\">amfAR HIV Cure Summit \u003c/a>in San Francisco last November, provided at least a temporary answer to a big question: Can very early treatment after exposure to HIV lead to complete eradication of the virus — an actual cure?\u003c/p>\n\u003cp>No.\u003c/p>\n\u003cp>But almost.\u003c/p>\n\u003caside class=\"pullquote alignright\">Early antitretroviral treatment brings about a striking period of long-term remission, also called a 'functional cure,' in an HIV patient. \u003c/aside>\n\u003cp>In Hawley’s case, nearly immediate treatment did usher in a striking period of long-term remission, also called a \"functional cure,\" in which zero trace of HIV was detected in his blood or tissue samples, without the benefit of drugs.\u003c/p>\n\u003cp>The men were recruited as part of an ongoing observational UCSF study. Both were given an initial dose of the antiretroviral combination Truvada, also known as pre-exposure prophylaxis, or PrEP, within two weeks after their suspected exposure to the virus. The treatment came so soon after infection that their immune systems had yet to generate an antibody response. In Hawley’s case, only a more sensitive genetic test called PCR, which measures an individual’s \u003ca href=\"https://www.aidsmap.com/Viral-load/page/1327496/\" target=\"_blank\" rel=\"noopener\">viral load\u003c/a>, showed signs of HIV. After the initial treatment, both men were switched to a daily four-drug antiviral regimen, which drove the virus below detectable levels.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>What happened next is a mystery.\u003c/p>\n\u003cp>[contextly_sidebar id=\"6nfWarjopr6zyonYcblrTOe4VSljxsdZ\"]As reported Nov. 7 in \u003cem> \u003ca href=\"https://protect-us.mimecast.com/s/8JwmB0iVvmacp?domain=journals.plos.org\" target=\"_blank\" rel=\"noopener\">PloS Medicine\u003c/a>\u003c/em>, a UCSF team led by Drs. Timothy Henrich and Steven Deeks said it failed to detect any trace of HIV in Hawley’s blood or tissue for the two years he remained on medication. Typically individuals on successful HIV therapy are classified as “undetectable” when drugs drive viral activity below observable levels in the blood. But it’s known that a small amount of residual virus called the HIV reservoir may be found in tissue using sensitive PCR tests. These came up negative.\u003c/p>\n\u003cp>Hawley then went off the drugs, a step that was part of the study design. About seven months later, the virus rebounded, quickly multiplying into an active infection. He immediately resumed antiretroviral treatment, which again rendered the virus undetectable.\u003c/p>\n\u003cfigure id=\"attachment_437571\" class=\"wp-caption alignright\" style=\"max-width: 1000px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\">\u003cimg class=\"wp-image-437571 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\" alt=\"\" width=\"1000\" height=\"754\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding.jpg 1000w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-160x121.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-800x603.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-768x579.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-960x724.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-240x181.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-375x283.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-520x392.jpg 520w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Steven Deeks, right, who talked about the results of early intervention after exposure to the HIV virus, at amfAR's 2017 HIV Cure Summit. On the left is long-time HIV researcher Dr. Paul Volberding. \u003ccite>(amfAR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But what puzzled scientists was that his body still showed no sign of an antibody response. That suggested his immune system had never had sufficient time to generate a defense because the drugs had worked so quickly that they halted the initial infection. Yet, they knew he still had HIV from the results of a viral load test. More genetic tests confirmed the resuscitated virus was the same strain he was initially exposed to.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We got close; we may have been off by a day or two.'\u003ccite>Dr. Steven Deeks, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Deeks said Hawley probably has a small latent reservoir of HIV somewhere in his body, which hasn’t grown due to Truvada’s suppression of the virus’s initial spread. His status is now in a kind of limbo, somewhere between having HIV and not.\u003c/p>\n\u003cp>“The whole excitement around Clark is that we were able to initiate therapy so early that we were hoping to prevent the establishing of latency,” says Deeks. “But it did not happen. We got close; we may have been off by a day or two. We did not achieve a real cure.”\u003c/p>\n\u003cp>Even if Hawley had been permanently freed of HIV, the problem with any protocol based on such early treatment is that doctors rarely detect a patient’s infection in the first days after exposure. Rather, the case is significant due to the milestone of pushing a patient into long-term remission free of medication, and because it might offer new clues on how to induce a permanent state of HIV dormancy.\u003c/p>\n\u003cp>\u003cstrong>Dramatically Reducing HIV Reservoirs\u003c/strong>\u003c/p>\n\u003cp>Canales’ case is also tantalizing. He was given a PrEP dose of Truvada 12 days after exposure, and for two years showed no sign of HIV in blood or tissue samples on both viral load and PCR tests. Because of Hawley’s relapse experience after stopping therapy, doctors kept him on the treatment. The only way they could detect signs of the virus in Canales was by transferring some of his cells into mice bred with a copycat human immune system. They were able to intermittently spy a virus particle here or there upon removing the cells from the mice. As with Hawley, early treatment had dramatically limited the amount of virus that would later coalesce into a dormant pool in his body.\u003c/p>\n\u003cp>“I think we have proven to ourselves that early treatment will never be curative,” Deeks said, referring to complete eradication of the virus within someone’s body. When pressed whether he really meant “never,” he amended his answer: “No, not yet.”\u003c/p>\n\u003cp>“But we can definitely shift the balance in favor of the patient,” he went on, “because the reservoir is reduced a hundred- to a million-fold.”\u003c/p>\n\u003cp>Deeks and his team are now investigating a series of HIV vaccines aimed at providing an immune booster to control the pieces of virus that remain in a patient’s body, the final step in sending HIV patients into remission — no medication required. Beyond that, if such tools could wipe out the last pockets of HIV, medical science would have finally achieved its ultimate goal in the fight against AIDS — an actual cure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Anne-christine d’Adesky is a longtime chronicler of HIV research. Her 90s-era AIDS memoir, “The Pox Lover,” was published in June.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Clark Hawley is a patient whose HIV went into long-term remission, also known as a 'functional cure,' after receiving very early antiretroviral treatment.","status":"publish","parent":0,"modified":1518461043,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":983},"headData":{"title":"The Man Who Was Nearly Cured of HIV | KQED","description":"Clark Hawley is a patient whose HIV went into long-term remission, also known as a 'functional cure,' after receiving very early antiretroviral treatment.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"The Man Who Was Nearly Cured of HIV","datePublished":"2017-12-12T21:00:15.000Z","dateModified":"2018-02-12T18:44:03.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"437567 https://ww2.kqed.org/futureofyou/?p=437567","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/12/12/frontiers-of-hiv-research-the-man-who-was-nearly-cured/","disqusTitle":"The Man Who Was Nearly Cured of HIV","source":"KQED Future of You","nprByline":"Anne-christine d'Adesky\u003cbr />KQED Future of You","path":"/futureofyou/437567/frontiers-of-hiv-research-the-man-who-was-nearly-cured","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The cases of Clark Hawley, 54, and Luis Canales, 31, presented at the \u003ca href=\"http://www.curecountdown.org/research-index/2017/9/12/2017-hiv-cure-summit\" target=\"_blank\" rel=\"noopener\">amfAR HIV Cure Summit \u003c/a>in San Francisco last November, provided at least a temporary answer to a big question: Can very early treatment after exposure to HIV lead to complete eradication of the virus — an actual cure?\u003c/p>\n\u003cp>No.\u003c/p>\n\u003cp>But almost.\u003c/p>\n\u003caside class=\"pullquote alignright\">Early antitretroviral treatment brings about a striking period of long-term remission, also called a 'functional cure,' in an HIV patient. \u003c/aside>\n\u003cp>In Hawley’s case, nearly immediate treatment did usher in a striking period of long-term remission, also called a \"functional cure,\" in which zero trace of HIV was detected in his blood or tissue samples, without the benefit of drugs.\u003c/p>\n\u003cp>The men were recruited as part of an ongoing observational UCSF study. Both were given an initial dose of the antiretroviral combination Truvada, also known as pre-exposure prophylaxis, or PrEP, within two weeks after their suspected exposure to the virus. The treatment came so soon after infection that their immune systems had yet to generate an antibody response. In Hawley’s case, only a more sensitive genetic test called PCR, which measures an individual’s \u003ca href=\"https://www.aidsmap.com/Viral-load/page/1327496/\" target=\"_blank\" rel=\"noopener\">viral load\u003c/a>, showed signs of HIV. After the initial treatment, both men were switched to a daily four-drug antiviral regimen, which drove the virus below detectable levels.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>What happened next is a mystery.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>As reported Nov. 7 in \u003cem> \u003ca href=\"https://protect-us.mimecast.com/s/8JwmB0iVvmacp?domain=journals.plos.org\" target=\"_blank\" rel=\"noopener\">PloS Medicine\u003c/a>\u003c/em>, a UCSF team led by Drs. Timothy Henrich and Steven Deeks said it failed to detect any trace of HIV in Hawley’s blood or tissue for the two years he remained on medication. Typically individuals on successful HIV therapy are classified as “undetectable” when drugs drive viral activity below observable levels in the blood. But it’s known that a small amount of residual virus called the HIV reservoir may be found in tissue using sensitive PCR tests. These came up negative.\u003c/p>\n\u003cp>Hawley then went off the drugs, a step that was part of the study design. About seven months later, the virus rebounded, quickly multiplying into an active infection. He immediately resumed antiretroviral treatment, which again rendered the virus undetectable.\u003c/p>\n\u003cfigure id=\"attachment_437571\" class=\"wp-caption alignright\" style=\"max-width: 1000px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\">\u003cimg class=\"wp-image-437571 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\" alt=\"\" width=\"1000\" height=\"754\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding.jpg 1000w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-160x121.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-800x603.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-768x579.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-960x724.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-240x181.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-375x283.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-520x392.jpg 520w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Steven Deeks, right, who talked about the results of early intervention after exposure to the HIV virus, at amfAR's 2017 HIV Cure Summit. On the left is long-time HIV researcher Dr. Paul Volberding. \u003ccite>(amfAR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But what puzzled scientists was that his body still showed no sign of an antibody response. That suggested his immune system had never had sufficient time to generate a defense because the drugs had worked so quickly that they halted the initial infection. Yet, they knew he still had HIV from the results of a viral load test. More genetic tests confirmed the resuscitated virus was the same strain he was initially exposed to.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We got close; we may have been off by a day or two.'\u003ccite>Dr. Steven Deeks, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Deeks said Hawley probably has a small latent reservoir of HIV somewhere in his body, which hasn’t grown due to Truvada’s suppression of the virus’s initial spread. His status is now in a kind of limbo, somewhere between having HIV and not.\u003c/p>\n\u003cp>“The whole excitement around Clark is that we were able to initiate therapy so early that we were hoping to prevent the establishing of latency,” says Deeks. “But it did not happen. We got close; we may have been off by a day or two. We did not achieve a real cure.”\u003c/p>\n\u003cp>Even if Hawley had been permanently freed of HIV, the problem with any protocol based on such early treatment is that doctors rarely detect a patient’s infection in the first days after exposure. Rather, the case is significant due to the milestone of pushing a patient into long-term remission free of medication, and because it might offer new clues on how to induce a permanent state of HIV dormancy.\u003c/p>\n\u003cp>\u003cstrong>Dramatically Reducing HIV Reservoirs\u003c/strong>\u003c/p>\n\u003cp>Canales’ case is also tantalizing. He was given a PrEP dose of Truvada 12 days after exposure, and for two years showed no sign of HIV in blood or tissue samples on both viral load and PCR tests. Because of Hawley’s relapse experience after stopping therapy, doctors kept him on the treatment. The only way they could detect signs of the virus in Canales was by transferring some of his cells into mice bred with a copycat human immune system. They were able to intermittently spy a virus particle here or there upon removing the cells from the mice. As with Hawley, early treatment had dramatically limited the amount of virus that would later coalesce into a dormant pool in his body.\u003c/p>\n\u003cp>“I think we have proven to ourselves that early treatment will never be curative,” Deeks said, referring to complete eradication of the virus within someone’s body. When pressed whether he really meant “never,” he amended his answer: “No, not yet.”\u003c/p>\n\u003cp>“But we can definitely shift the balance in favor of the patient,” he went on, “because the reservoir is reduced a hundred- to a million-fold.”\u003c/p>\n\u003cp>Deeks and his team are now investigating a series of HIV vaccines aimed at providing an immune booster to control the pieces of virus that remain in a patient’s body, the final step in sending HIV patients into remission — no medication required. Beyond that, if such tools could wipe out the last pockets of HIV, medical science would have finally achieved its ultimate goal in the fight against AIDS — an actual cure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Anne-christine d’Adesky is a longtime chronicler of HIV research. Her 90s-era AIDS memoir, “The Pox Lover,” was published in June.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/437567/frontiers-of-hiv-research-the-man-who-was-nearly-cured","authors":["byline_futureofyou_437567"],"categories":["futureofyou_452","futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_650","futureofyou_1275","futureofyou_651"],"featImg":"futureofyou_437568","label":"source_futureofyou_437567"},"futureofyou_435658":{"type":"posts","id":"futureofyou_435658","meta":{"index":"posts_1591205157","site":"futureofyou","id":"435658","score":null,"sort":[1506621769000]},"guestAuthors":[],"slug":"research-dampens-hopes-of-hiv-cure-shows-progress-on-remission-without-drugs","title":"Research Dampens Hopes of HIV Cure, Shows Progress on Remission Without Drugs","publishDate":1506621769,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>In 2016, hopes ran high that an HIV cure may be just around the corner. An experimental approach known as “shock and kill” seemed \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/12/17/new-hiv-studies-offer-fresh-hope-for-a-cure/\" target=\"_blank\" rel=\"noopener\">promising\u003c/a>. That treatment takes aim at dormant, undetected traces of the virus lingering within immune cells.\u003c/p>\n\u003cp>In recent months, however, those hopes have dampened.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We are starting to see that control in an [antiretroviral-drug-free] system is attainable. I think that’s a more realistic goal to pursue, one that can benefit millions of people now living with this disease. For now, a cure is still proving elusive.'\u003ccite>Anthony Fauci, National Institute of Allergy and Infectious Diseases\u003c/cite>\u003c/aside>\n\u003cp>While shock and kill can effectively flush HIV from its hiding places in tissue reservoirs, some virus particles may still remain, new research shows. Now researchers are investigating why, in the hopes that the answer will point, if not to a cure, than at least to therapies that will ensure the long-term health of patients.\u003c/p>\n\u003cp>In March, scientists from the lab of veteran HIV-hunter Dr. Robert Siliciano published \u003ca href=\"http://jem.rupress.org/content/214/4/959\" target=\"_blank\" rel=\"noopener\">research \u003c/a>showing that dormant T cells harboring HIV particles will spread through cell division. The discovery was a surprise, because researchers long assumed such cells were inactive. By using a new DNA mapping technique, the Siliciano team found identical HIV fragments, called proviruses, in daughter T-cells.\u003c/p>\n\u003cp>“We knew before that the [HIV]reservoir is very long-lived,” said Siliciano\u003cstrong> \u003c/strong>in a \u003ca href=\"https://hub.jhu.edu/2017/05/31/hiv-aids-cure-latent-reservoirs/\">press release\u003c/a>. “Now it is clear that these cells aren't just sitting there but are dividing and replenishing themselves.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The standard tests that measure HIV replication, called viral load tests, aren’t sensitive enough to detect such stealth viral spread. Siliciano cautioned that even though the HIV pool may be tiny — a dormant virus particle here or there — it could, at least theoretically, retrigger an active HIV infection.\u003c/p>\n\u003cp>This sobering news has caused leading scientists to reconsider the challenge of eradicating every last trace of HIV in the body, the definition of a full cure. That task now seems much more daunting.\u003c/p>\n\u003cp>In a recent review of research on an AIDS cure, Dr. Anthony Fauci, head of the National Institutes of Allergy and Infectious Diseases, was characteristically blunt in assessing the challenges ahead. At this year's International AIDS Conference, held this July in Paris, he told an audience that a cure, though still a worthy goal, was “difficult to impossible.”\u003c/p>\n\u003cp>While antiretroviral, or ART, medication has significantly\u003ca href=\"http://www.bbc.com/news/health-39872530\" target=\"_blank\" rel=\"noopener\"> prolonged the lives\u003c/a> of those infected with HIV, the treatment is still out of reach to many globally. In addition, the drugs have side effects, and long-term health impacts for those in treatment are still unclear. A cure would also eliminate any fear of passing on the virus or seeing HIV bounce back.\u003c/p>\n\u003cp>The new developments do not mean that shock and kill is dead. However, the strategy may need to be combined with different approaches and weapons to eradicate the silent HIV pool. Already, new therapies, called \"lock and block,\" are being tried to prevent any viral escape from the reservoir to reduce risk of reinfection.\u003c/p>\n\u003cp>\u003cstrong>New Target in Sight: Long-Term Remission Without Drugs\u003c/strong>\u003c/p>\n\u003cp>In the meantime, Fauci was more excited by promising studies pointing to long-term remission without drugs as a viable treatment plan. A growing body of data shows that some people who initially take ART drugs and later go off them can remain healthy for months and even years. When these patients are tested for HIV infection, their viral load -- a measure of active infection -- is below detectable levels. This has led to the rise of new buzzwords in AIDS circles: “ART-free remission.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'We knew before that the [HIV] reservoir is very long-lived. Now it is clear that these cells aren't just sitting there but are dividing and replenishing themselves.'\u003ccite>Robert Siliciano, Johns Hopkins University\u003c/cite>\u003c/aside>\n\u003cp>\"We are starting to see that control in an ART-free system is attainable,” said Fauci. “I think that’s a more realistic goal to pursue, one that can benefit millions of people now living with this disease. For now, a cure is still proving elusive.”\u003c/p>\n\u003cp>At this year’s International AIDS Conference, most media coverage focused on cases in which antiretroviral treatment has been interrupted with good results. One attention-grabbing study featured a South African child who appeared \u003ca href=\"http://programme.ias2017.org/Abstract/Abstract/5836\" target=\"_blank\" rel=\"noopener\">HIV-free\u003c/a> eight-and-a-half years after stopping medication.\u003c/p>\n\u003cp>Such long-term remission is not unheard of. Earlier studies have reported on a French teenager whose HIV viral load levels remain undetectable after 11 years. Other work has followed a subset of patients whose infection levels are similarly undetectable after more than four years. These cases were observed in studies; it's unknown how much they reflect what's happening in terms of larger populations. Shock and kill studies have found a wide range of viral rebound times in patients who go off ART.\u003c/p>\n\u003cp>In his AIDS conference roundup of cure research, Fauci noted that in studies where patients discontinue treatment, the average time for HIV to rebound has already more than doubled. Up until 2000, the virus reappeared within 7 to 14 days of a patient going off medication. Since that time through 2015, the average was 28 days. That’s due in part to better drugs, Fauci said. The increases may also be driven by patients receiving treatment soon after exposure to HIV, which may help maintain stronger immune systems.\u003c/p>\n\u003cp>“Every lab has a few patients who have a great deal of variability to time they rebound,” Fauci said. \"It may be two weeks in some people, or three months, or many months. What we are seeing is, tucked away in there, that people treated with good drugs could stop therapy and go for an extended time” without HIV coming back.\u003c/p>\n\u003cp>To Fauci, this pattern of increasing remission times, as we move through the third decade of AIDS, is an important finding. It may not be as sexy or definitive as attaining a cure, but remission without drugs would represent a welcome sea change for the 36.7 million people living with HIV, including the \u003ca href=\"http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2016/november/20161121_PR_get-on-the-fast-track\" target=\"_blank\" rel=\"noopener\">18 million\u003c/a> on daily ART pills.\u003c/p>\n\u003cp>Fauci's also excited about a monkey antibody, alpha4beta7, which has a close human equivalent: the FDA-approved drug vedolizumab that is used to treat Crohn's disease and ulcerative colitis. Fauci's team saw \"sustained remission\" in macaques which had been given the monkey antibody and which had been infected with a simian sister virus to HIV.\u003c/p>\n\u003cp>Fauci's lab is now completing a short study of vedolizumab plus ART in 17 patients and expects results by the end of October.\u003c/p>\n\u003cp>\u003cstrong>'The Devil You Know'\u003c/strong>\u003c/p>\n\u003cp>Many HIV/AIDS advocacy groups remain focused on cure research, and are grappling with the newly discovered impediments to shock and kill. All the same, remission without drugs is still a hot topic.\u003c/p>\n\u003cp>“I think a lot of people would like a remission,” said Jessica Salzwedel, who works in community literacy at the AIDS Vaccine Advocacy Coalition in New York.\u003c/p>\n\u003cp>She’s also seen a lot of excitement about long-acting injectable therapies, in which ART drugs are administered in a shot that can last four or eight weeks, instead of the regimen of daily pills patients now take.\u003c/p>\n\u003cp>Salzwedel feels people on ART may prefer the certainty of knowing HIV is being controlled rather than the question mark of going off ART during a research trial and waiting to see if the virus bounces back. For now, “It’s the devil you know versus the devil you don’t. Some people would rather live with a pill and know they are virally controlled.”\u003c/p>\n\u003cp>“We have to explore all avenues,\" summed up Fauci. \"But I think remission is a very viable way to go.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Anne-christine d'Adesky is a longtime chronicler of HIV research. Her 90s-era AIDS memoir, \"The Pox Lover,\" was published in June.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Last year hopes ran high an HIV cure may be near, but recent research has presented new stumbling blocks. Meanwhile, a positive trend: Relapse times have lengthened for those who stop taking medication.","status":"publish","parent":0,"modified":1506714251,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":29,"wordCount":1352},"headData":{"title":"Research Dampens Hopes of HIV Cure, Shows Progress on Remission Without Drugs | KQED","description":"Last year hopes ran high an HIV cure may be near, but recent research has presented new stumbling blocks. Meanwhile, a positive trend: Relapse times have lengthened for those who stop taking medication.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Research Dampens Hopes of HIV Cure, Shows Progress on Remission Without Drugs","datePublished":"2017-09-28T18:02:49.000Z","dateModified":"2017-09-29T19:44:11.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"435658 https://ww2.kqed.org/futureofyou/?p=435658","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/09/28/research-dampens-hopes-of-hiv-cure-shows-progress-on-remission-without-drugs/","disqusTitle":"Research Dampens Hopes of HIV Cure, Shows Progress on Remission Without Drugs","nprByline":"Anne-christine d'Adesky\u003cbr />Future of You","path":"/futureofyou/435658/research-dampens-hopes-of-hiv-cure-shows-progress-on-remission-without-drugs","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In 2016, hopes ran high that an HIV cure may be just around the corner. An experimental approach known as “shock and kill” seemed \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/12/17/new-hiv-studies-offer-fresh-hope-for-a-cure/\" target=\"_blank\" rel=\"noopener\">promising\u003c/a>. That treatment takes aim at dormant, undetected traces of the virus lingering within immune cells.\u003c/p>\n\u003cp>In recent months, however, those hopes have dampened.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We are starting to see that control in an [antiretroviral-drug-free] system is attainable. I think that’s a more realistic goal to pursue, one that can benefit millions of people now living with this disease. For now, a cure is still proving elusive.'\u003ccite>Anthony Fauci, National Institute of Allergy and Infectious Diseases\u003c/cite>\u003c/aside>\n\u003cp>While shock and kill can effectively flush HIV from its hiding places in tissue reservoirs, some virus particles may still remain, new research shows. Now researchers are investigating why, in the hopes that the answer will point, if not to a cure, than at least to therapies that will ensure the long-term health of patients.\u003c/p>\n\u003cp>In March, scientists from the lab of veteran HIV-hunter Dr. Robert Siliciano published \u003ca href=\"http://jem.rupress.org/content/214/4/959\" target=\"_blank\" rel=\"noopener\">research \u003c/a>showing that dormant T cells harboring HIV particles will spread through cell division. The discovery was a surprise, because researchers long assumed such cells were inactive. By using a new DNA mapping technique, the Siliciano team found identical HIV fragments, called proviruses, in daughter T-cells.\u003c/p>\n\u003cp>“We knew before that the [HIV]reservoir is very long-lived,” said Siliciano\u003cstrong> \u003c/strong>in a \u003ca href=\"https://hub.jhu.edu/2017/05/31/hiv-aids-cure-latent-reservoirs/\">press release\u003c/a>. “Now it is clear that these cells aren't just sitting there but are dividing and replenishing themselves.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The standard tests that measure HIV replication, called viral load tests, aren’t sensitive enough to detect such stealth viral spread. Siliciano cautioned that even though the HIV pool may be tiny — a dormant virus particle here or there — it could, at least theoretically, retrigger an active HIV infection.\u003c/p>\n\u003cp>This sobering news has caused leading scientists to reconsider the challenge of eradicating every last trace of HIV in the body, the definition of a full cure. That task now seems much more daunting.\u003c/p>\n\u003cp>In a recent review of research on an AIDS cure, Dr. Anthony Fauci, head of the National Institutes of Allergy and Infectious Diseases, was characteristically blunt in assessing the challenges ahead. At this year's International AIDS Conference, held this July in Paris, he told an audience that a cure, though still a worthy goal, was “difficult to impossible.”\u003c/p>\n\u003cp>While antiretroviral, or ART, medication has significantly\u003ca href=\"http://www.bbc.com/news/health-39872530\" target=\"_blank\" rel=\"noopener\"> prolonged the lives\u003c/a> of those infected with HIV, the treatment is still out of reach to many globally. In addition, the drugs have side effects, and long-term health impacts for those in treatment are still unclear. A cure would also eliminate any fear of passing on the virus or seeing HIV bounce back.\u003c/p>\n\u003cp>The new developments do not mean that shock and kill is dead. However, the strategy may need to be combined with different approaches and weapons to eradicate the silent HIV pool. Already, new therapies, called \"lock and block,\" are being tried to prevent any viral escape from the reservoir to reduce risk of reinfection.\u003c/p>\n\u003cp>\u003cstrong>New Target in Sight: Long-Term Remission Without Drugs\u003c/strong>\u003c/p>\n\u003cp>In the meantime, Fauci was more excited by promising studies pointing to long-term remission without drugs as a viable treatment plan. A growing body of data shows that some people who initially take ART drugs and later go off them can remain healthy for months and even years. When these patients are tested for HIV infection, their viral load -- a measure of active infection -- is below detectable levels. This has led to the rise of new buzzwords in AIDS circles: “ART-free remission.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'We knew before that the [HIV] reservoir is very long-lived. Now it is clear that these cells aren't just sitting there but are dividing and replenishing themselves.'\u003ccite>Robert Siliciano, Johns Hopkins University\u003c/cite>\u003c/aside>\n\u003cp>\"We are starting to see that control in an ART-free system is attainable,” said Fauci. “I think that’s a more realistic goal to pursue, one that can benefit millions of people now living with this disease. For now, a cure is still proving elusive.”\u003c/p>\n\u003cp>At this year’s International AIDS Conference, most media coverage focused on cases in which antiretroviral treatment has been interrupted with good results. One attention-grabbing study featured a South African child who appeared \u003ca href=\"http://programme.ias2017.org/Abstract/Abstract/5836\" target=\"_blank\" rel=\"noopener\">HIV-free\u003c/a> eight-and-a-half years after stopping medication.\u003c/p>\n\u003cp>Such long-term remission is not unheard of. Earlier studies have reported on a French teenager whose HIV viral load levels remain undetectable after 11 years. Other work has followed a subset of patients whose infection levels are similarly undetectable after more than four years. These cases were observed in studies; it's unknown how much they reflect what's happening in terms of larger populations. Shock and kill studies have found a wide range of viral rebound times in patients who go off ART.\u003c/p>\n\u003cp>In his AIDS conference roundup of cure research, Fauci noted that in studies where patients discontinue treatment, the average time for HIV to rebound has already more than doubled. Up until 2000, the virus reappeared within 7 to 14 days of a patient going off medication. Since that time through 2015, the average was 28 days. That’s due in part to better drugs, Fauci said. The increases may also be driven by patients receiving treatment soon after exposure to HIV, which may help maintain stronger immune systems.\u003c/p>\n\u003cp>“Every lab has a few patients who have a great deal of variability to time they rebound,” Fauci said. \"It may be two weeks in some people, or three months, or many months. What we are seeing is, tucked away in there, that people treated with good drugs could stop therapy and go for an extended time” without HIV coming back.\u003c/p>\n\u003cp>To Fauci, this pattern of increasing remission times, as we move through the third decade of AIDS, is an important finding. It may not be as sexy or definitive as attaining a cure, but remission without drugs would represent a welcome sea change for the 36.7 million people living with HIV, including the \u003ca href=\"http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2016/november/20161121_PR_get-on-the-fast-track\" target=\"_blank\" rel=\"noopener\">18 million\u003c/a> on daily ART pills.\u003c/p>\n\u003cp>Fauci's also excited about a monkey antibody, alpha4beta7, which has a close human equivalent: the FDA-approved drug vedolizumab that is used to treat Crohn's disease and ulcerative colitis. Fauci's team saw \"sustained remission\" in macaques which had been given the monkey antibody and which had been infected with a simian sister virus to HIV.\u003c/p>\n\u003cp>Fauci's lab is now completing a short study of vedolizumab plus ART in 17 patients and expects results by the end of October.\u003c/p>\n\u003cp>\u003cstrong>'The Devil You Know'\u003c/strong>\u003c/p>\n\u003cp>Many HIV/AIDS advocacy groups remain focused on cure research, and are grappling with the newly discovered impediments to shock and kill. All the same, remission without drugs is still a hot topic.\u003c/p>\n\u003cp>“I think a lot of people would like a remission,” said Jessica Salzwedel, who works in community literacy at the AIDS Vaccine Advocacy Coalition in New York.\u003c/p>\n\u003cp>She’s also seen a lot of excitement about long-acting injectable therapies, in which ART drugs are administered in a shot that can last four or eight weeks, instead of the regimen of daily pills patients now take.\u003c/p>\n\u003cp>Salzwedel feels people on ART may prefer the certainty of knowing HIV is being controlled rather than the question mark of going off ART during a research trial and waiting to see if the virus bounces back. For now, “It’s the devil you know versus the devil you don’t. Some people would rather live with a pill and know they are virally controlled.”\u003c/p>\n\u003cp>“We have to explore all avenues,\" summed up Fauci. \"But I think remission is a very viable way to go.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Anne-christine d'Adesky is a longtime chronicler of HIV research. Her 90s-era AIDS memoir, \"The Pox Lover,\" was published in June.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/435658/research-dampens-hopes-of-hiv-cure-shows-progress-on-remission-without-drugs","authors":["byline_futureofyou_435658"],"categories":["futureofyou_1062","futureofyou_1"],"tags":["futureofyou_650","futureofyou_1364","futureofyou_1275","futureofyou_651","futureofyou_1365","futureofyou_1145"],"featImg":"futureofyou_435681","label":"futureofyou"},"futureofyou_430874":{"type":"posts","id":"futureofyou_430874","meta":{"index":"posts_1591205157","site":"futureofyou","id":"430874","score":null,"sort":[1500913920000]},"guestAuthors":[],"slug":"childs-hiv-infection-suppressed-without-aids-drugs","title":"Child's HIV Infection Suppressed Without AIDS Drugs","publishDate":1500913920,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>A South African girl born with the AIDS virus has kept her infection suppressed for more than eight years after stopping anti-HIV medicines — more evidence that early treatment can occasionally cause a long remission that, if it lasts, would be a form of cure.\u003c/p>\n\u003cp>Her case was revealed Monday at an \u003ca href=\"http://www.aidsinfo.nih.gov/\">AIDS\u003c/a> conference in Paris, where researchers also gave encouraging results from tests of shots every month or two instead of daily pills to treat HIV.\u003c/p>\n\u003cp>“That’s very promising” to help people stay on treatment, the U.S.’s top AIDS scientist, Dr. Anthony Fauci, said of the prospects for long-acting drugs.\u003c/p>\n\u003cp>Current treatments keep \u003ca href=\"http://medlineplus.gov/hivaids.html\">HIV\u003c/a> under control but must be taken lifelong. Only one person is thought to be cured — the so-called Berlin patient, a man who had a bone marrow transplant in 2007 from a donor with natural resistance to HIV.\u003c/p>\n\u003cp>But transplants are risky and impractical to try to cure the millions already infected. So some researchers have been aiming for the next best thing — long-term remission, when the immune system can control HIV without drugs even if signs of the virus remain.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Aggressive treatment soon after infection might enable that in some cases, and the South African girl is the third child who achieved a long remission after that approach.\u003c/p>\n\u003cp>She was in a \u003ca href=\"http://clinicaltrials.gov/ct2/show/NCT02788175\">study\u003c/a> sponsored by the agency Fauci heads, the National Institute of Allergy and Infectious Diseases, that previously found that early versus delayed treatment helped babies survive.\u003c/p>\n\u003cp>The girl, who researchers did not identify, started on HIV drugs when she was 2 months old and stopped 40 weeks later. Tests when she was 9 1/2 years old found signs of virus in a small number of immune system cells, but none capable of reproducing. The girl does not have a gene mutation that gives natural resistance to HIV infection, Fauci said, so her remission seems likely due to the early treatment.\u003c/p>\n\u003cp>The previous cases:\u003c/p>\n\u003cp>—A French teen who was born with HIV and is now around 20 has had her infection under control despite no HIV medicines since she was roughly 6 years old.\u003c/p>\n\u003cp>—A Mississippi baby born with HIV in 2010 suppressed her infection for 27 months after stopping treatment before it reappeared in her blood. She was able to get the virus under control again after treatment resumed.\u003c/p>\n\u003cp>At least a dozen adults also have had remissions lasting for years after stopping HIV medicines.\u003c/p>\n\u003cp>A study underway now is testing whether treating HIV-infected newborns within two days of birth can control the virus later after treatment stops. It started in 2014 in South America, Haiti, Africa and the United States, and some of the earliest participants might be able to try stopping treatment later this year.\u003c/p>\n\u003cp>Treatment might get easier if two large studies underway now confirm results reported Monday from a study testing a long-acting combo of two HIV drugs — Janssen’s rilpivirine and ViiV Healthcare’s cabotegravir.\u003c/p>\n\u003cp>Cabotegravir is experimental; rilpivirine is sold now as Edurant and used in combination with other drugs for treating certain types of HIV patients.\u003c/p>\n\u003cp>After initial treatment to get their virus under control, about 300 study participants were given either daily combination therapy pills or a shot every four or eight weeks of the long-acting drug duo to maintain control.\u003c/p>\n\u003cp>After nearly two years, 94 percent on eight-week shots, 87 percent on four-week shots and 84 percent on daily pills had their infections suppressed, with similar rates of side effects.\u003c/p>\n\u003cp>“The results were good regardless of whether people came monthly or every two months for their treatment. This has important policy implications,” said Dr. Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre at the University of Cape Town in South Africa, and a co-leader of the conference.\u003c/p>\n\u003cp>The study was sponsored by the drugmakers. Results were published in the British medical journal \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31917-7/fulltext?elsca1=tlpr\">Lancet.\u003c/a>\u003c/p>\n\u003cp>Two large studies aimed at winning approval to sell the treatment are testing the monthly shots. Janssen said in a statement that good results from eight-week shots warrant reconsidering the longer approach.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If it works, “this will have a huge impact on how we manage that very important group of people who are not able to access and take drugs on a day-to-day basis,” such as those with mental health or drug abuse problems, said Dr. Steven Deeks, an AIDS specialist at the University of California, San Francisco.\u003c/p>\n\n","blocks":[],"excerpt":"A South African girl born with the AIDS virus has kept her infection suppressed for more than eight years after stopping anti-HIV medicines. Current treatments keep HIV under control but must be taken lifelong. ","status":"publish","parent":0,"modified":1501110319,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":771},"headData":{"title":"Child's HIV Infection Suppressed Without AIDS Drugs | KQED","description":"A South African girl born with the AIDS virus has kept her infection suppressed for more than eight years after stopping anti-HIV medicines. Current treatments keep HIV under control but must be taken lifelong. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Child's HIV Infection Suppressed Without AIDS Drugs","datePublished":"2017-07-24T16:32:00.000Z","dateModified":"2017-07-26T23:05:19.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"430874 https://ww2.kqed.org/futureofyou/?p=430874","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/07/24/childs-hiv-infection-suppressed-without-aids-drugs/","disqusTitle":"Child's HIV Infection Suppressed Without AIDS Drugs","nprByline":"Marilynn Marchione\u003cbr />Associated Press","path":"/futureofyou/430874/childs-hiv-infection-suppressed-without-aids-drugs","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A South African girl born with the AIDS virus has kept her infection suppressed for more than eight years after stopping anti-HIV medicines — more evidence that early treatment can occasionally cause a long remission that, if it lasts, would be a form of cure.\u003c/p>\n\u003cp>Her case was revealed Monday at an \u003ca href=\"http://www.aidsinfo.nih.gov/\">AIDS\u003c/a> conference in Paris, where researchers also gave encouraging results from tests of shots every month or two instead of daily pills to treat HIV.\u003c/p>\n\u003cp>“That’s very promising” to help people stay on treatment, the U.S.’s top AIDS scientist, Dr. Anthony Fauci, said of the prospects for long-acting drugs.\u003c/p>\n\u003cp>Current treatments keep \u003ca href=\"http://medlineplus.gov/hivaids.html\">HIV\u003c/a> under control but must be taken lifelong. Only one person is thought to be cured — the so-called Berlin patient, a man who had a bone marrow transplant in 2007 from a donor with natural resistance to HIV.\u003c/p>\n\u003cp>But transplants are risky and impractical to try to cure the millions already infected. So some researchers have been aiming for the next best thing — long-term remission, when the immune system can control HIV without drugs even if signs of the virus remain.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Aggressive treatment soon after infection might enable that in some cases, and the South African girl is the third child who achieved a long remission after that approach.\u003c/p>\n\u003cp>She was in a \u003ca href=\"http://clinicaltrials.gov/ct2/show/NCT02788175\">study\u003c/a> sponsored by the agency Fauci heads, the National Institute of Allergy and Infectious Diseases, that previously found that early versus delayed treatment helped babies survive.\u003c/p>\n\u003cp>The girl, who researchers did not identify, started on HIV drugs when she was 2 months old and stopped 40 weeks later. Tests when she was 9 1/2 years old found signs of virus in a small number of immune system cells, but none capable of reproducing. The girl does not have a gene mutation that gives natural resistance to HIV infection, Fauci said, so her remission seems likely due to the early treatment.\u003c/p>\n\u003cp>The previous cases:\u003c/p>\n\u003cp>—A French teen who was born with HIV and is now around 20 has had her infection under control despite no HIV medicines since she was roughly 6 years old.\u003c/p>\n\u003cp>—A Mississippi baby born with HIV in 2010 suppressed her infection for 27 months after stopping treatment before it reappeared in her blood. She was able to get the virus under control again after treatment resumed.\u003c/p>\n\u003cp>At least a dozen adults also have had remissions lasting for years after stopping HIV medicines.\u003c/p>\n\u003cp>A study underway now is testing whether treating HIV-infected newborns within two days of birth can control the virus later after treatment stops. It started in 2014 in South America, Haiti, Africa and the United States, and some of the earliest participants might be able to try stopping treatment later this year.\u003c/p>\n\u003cp>Treatment might get easier if two large studies underway now confirm results reported Monday from a study testing a long-acting combo of two HIV drugs — Janssen’s rilpivirine and ViiV Healthcare’s cabotegravir.\u003c/p>\n\u003cp>Cabotegravir is experimental; rilpivirine is sold now as Edurant and used in combination with other drugs for treating certain types of HIV patients.\u003c/p>\n\u003cp>After initial treatment to get their virus under control, about 300 study participants were given either daily combination therapy pills or a shot every four or eight weeks of the long-acting drug duo to maintain control.\u003c/p>\n\u003cp>After nearly two years, 94 percent on eight-week shots, 87 percent on four-week shots and 84 percent on daily pills had their infections suppressed, with similar rates of side effects.\u003c/p>\n\u003cp>“The results were good regardless of whether people came monthly or every two months for their treatment. This has important policy implications,” said Dr. Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre at the University of Cape Town in South Africa, and a co-leader of the conference.\u003c/p>\n\u003cp>The study was sponsored by the drugmakers. Results were published in the British medical journal \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31917-7/fulltext?elsca1=tlpr\">Lancet.\u003c/a>\u003c/p>\n\u003cp>Two large studies aimed at winning approval to sell the treatment are testing the monthly shots. Janssen said in a statement that good results from eight-week shots warrant reconsidering the longer approach.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If it works, “this will have a huge impact on how we manage that very important group of people who are not able to access and take drugs on a day-to-day basis,” such as those with mental health or drug abuse problems, said Dr. Steven Deeks, an AIDS specialist at the University of California, San Francisco.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/430874/childs-hiv-infection-suppressed-without-aids-drugs","authors":["byline_futureofyou_430874"],"categories":["futureofyou_1062","futureofyou_1"],"tags":["futureofyou_1275","futureofyou_651","futureofyou_80"],"featImg":"futureofyou_157427","label":"futureofyou"},"futureofyou_389212":{"type":"posts","id":"futureofyou_389212","meta":{"index":"posts_1591205157","site":"futureofyou","id":"389212","score":null,"sort":[1494865169000]},"guestAuthors":[],"slug":"life-expectancy-for-some-people-with-hiv-now-almost-normal-study","title":"Life Expectancy for Some People With HIV Now Almost Normal: Study","publishDate":1494865169,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>People in North America and Europe who are infected with HIV and who begin treatment with a triple-drug cocktail can expect to live nearly as long as people who aren’t infected by the virus, a new study suggested.\u003c/p>\n\u003cp class=\"danger-zone\">A combination of factors — including less toxic drugs and better medical management — have resulted in longevity gains for people who are HIV-positive, concluded \u003ca href=\"http://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30066-8/fulltext?elsca1=tlpr\" target=\"_blank\" rel=\"noopener noreferrer\">the study\u003c/a>, published in the journal Lancet HIV.\u003c/p>\n\u003cp class=\"danger-zone\">“Between 1996-99 and 2008-10, life expectancy in people living with HIV starting [antiretroviral therapy] increased by around 10 years for both sexes, in Europe and North America,” wrote the authors, who work at a variety of academic institutions through North American and Europe.\u003c/p>\n\u003cp class=\"danger-zone\">The findings reflect a trend that has been apparent for some time among people with HIV and their health care providers. A disease that was once a death sentence has become a chronic condition for people who have access to and the ability to stick with an HIV drug regimen.\u003c/p>\n\u003cp>“We’re just getting better at what we do,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Fauci, who was not involved in this study, is a leader in HIV research; he continues to see HIV-positive patients who get treatment at the National Institutes of Health.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We have better drugs. … People are adhering better because they know these drugs really work,” he told STAT. “I think the combination of all of those [factors] easily explains in a logical way the results of that study.”\u003c/p>\n\u003cp>The authors also suggested patients may be more motivated to take care of their health — quitting smoking, say — and their doctors more motivated to aggressively treat other health conditions because both understand that HIV treatment is effective.\u003c/p>\n\u003cp>The researchers pooled data from 18 studies that followed or are following HIV-positive people in 10 countries in Europe and North America, giving them information on roughly 88,500 people. They compared survival and longevity data for people who began taking triple-drug therapies during three periods of time — 1996 to 1999, 2000 to 2003, and 2008 to 2010.\u003c/p>\n\u003cp>The researchers looked at both death figures in the first year of treatment — when patients were typically at their sickest — and then life expectancy of people who survived the first year of treatment.\u003c/p>\n\u003cp>They concluded that an HIV-positive 20-year-old who started antiretroviral therapy between 2008 and 2010 and whose infection was well controlled by the drugs could expect to live to the age of 78.\u003c/p>\n\u003cp>Still, a commentary published with the study noted that these gains, while impressive, aren’t being made by all infected with HIV, particularly by individuals who are not white, have a history of injection drug use, or began treatment with low white blood cell counts.\u003c/p>\n\u003cp>Ingrid Katz of Harvard Medical School and Brendan Maughan-Brown of the University of Cape Town in South Africa wrote that in order to make additional gains in life expectancy, early detection of HIV and commencement of treatment will be needed.\u003c/p>\n\u003cp>Fauci said he thinks that further life expectancy gains can be made for people with HIV. But he believes the damage the virus does can’t be completely erased by early treatment. “I think we’re going to get really close to a normal life expectancy,” he said. “I would be surprised if it would be exactly the same. But I think it will be close enough to be dramatic.”\u003c/p>\n\u003cp>The study was funded by Britain’s Medical Research Council and the UK Department of International Development as well as the European Union.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/05/10/hiv-life-expectancy-study/\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"A combination of factors — including less toxic drugs and better medical management — have resulted in longevity gains for people who are HIV-positive, according to a new a study.","status":"publish","parent":0,"modified":1495036567,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":660},"headData":{"title":"Life Expectancy for Some People With HIV Now Almost Normal: Study | KQED","description":"A combination of factors — including less toxic drugs and better medical management — have resulted in longevity gains for people who are HIV-positive, according to a new a study.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Life Expectancy for Some People With HIV Now Almost Normal: Study","datePublished":"2017-05-15T16:19:29.000Z","dateModified":"2017-05-17T15:56:07.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"389212 https://ww2.kqed.org/futureofyou/?p=389212","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/05/15/life-expectancy-for-some-people-with-hiv-now-almost-normal-study/","disqusTitle":"Life Expectancy for Some People With HIV Now Almost Normal: Study","source":"KQED Future of You","nprByline":"Helen Branswell\u003cbr />\u003ca href=\"https://www.statnews.com/\">STAT\u003c/a>","path":"/futureofyou/389212/life-expectancy-for-some-people-with-hiv-now-almost-normal-study","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>People in North America and Europe who are infected with HIV and who begin treatment with a triple-drug cocktail can expect to live nearly as long as people who aren’t infected by the virus, a new study suggested.\u003c/p>\n\u003cp class=\"danger-zone\">A combination of factors — including less toxic drugs and better medical management — have resulted in longevity gains for people who are HIV-positive, concluded \u003ca href=\"http://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30066-8/fulltext?elsca1=tlpr\" target=\"_blank\" rel=\"noopener noreferrer\">the study\u003c/a>, published in the journal Lancet HIV.\u003c/p>\n\u003cp class=\"danger-zone\">“Between 1996-99 and 2008-10, life expectancy in people living with HIV starting [antiretroviral therapy] increased by around 10 years for both sexes, in Europe and North America,” wrote the authors, who work at a variety of academic institutions through North American and Europe.\u003c/p>\n\u003cp class=\"danger-zone\">The findings reflect a trend that has been apparent for some time among people with HIV and their health care providers. A disease that was once a death sentence has become a chronic condition for people who have access to and the ability to stick with an HIV drug regimen.\u003c/p>\n\u003cp>“We’re just getting better at what we do,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Fauci, who was not involved in this study, is a leader in HIV research; he continues to see HIV-positive patients who get treatment at the National Institutes of Health.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We have better drugs. … People are adhering better because they know these drugs really work,” he told STAT. “I think the combination of all of those [factors] easily explains in a logical way the results of that study.”\u003c/p>\n\u003cp>The authors also suggested patients may be more motivated to take care of their health — quitting smoking, say — and their doctors more motivated to aggressively treat other health conditions because both understand that HIV treatment is effective.\u003c/p>\n\u003cp>The researchers pooled data from 18 studies that followed or are following HIV-positive people in 10 countries in Europe and North America, giving them information on roughly 88,500 people. They compared survival and longevity data for people who began taking triple-drug therapies during three periods of time — 1996 to 1999, 2000 to 2003, and 2008 to 2010.\u003c/p>\n\u003cp>The researchers looked at both death figures in the first year of treatment — when patients were typically at their sickest — and then life expectancy of people who survived the first year of treatment.\u003c/p>\n\u003cp>They concluded that an HIV-positive 20-year-old who started antiretroviral therapy between 2008 and 2010 and whose infection was well controlled by the drugs could expect to live to the age of 78.\u003c/p>\n\u003cp>Still, a commentary published with the study noted that these gains, while impressive, aren’t being made by all infected with HIV, particularly by individuals who are not white, have a history of injection drug use, or began treatment with low white blood cell counts.\u003c/p>\n\u003cp>Ingrid Katz of Harvard Medical School and Brendan Maughan-Brown of the University of Cape Town in South Africa wrote that in order to make additional gains in life expectancy, early detection of HIV and commencement of treatment will be needed.\u003c/p>\n\u003cp>Fauci said he thinks that further life expectancy gains can be made for people with HIV. But he believes the damage the virus does can’t be completely erased by early treatment. “I think we’re going to get really close to a normal life expectancy,” he said. “I would be surprised if it would be exactly the same. But I think it will be close enough to be dramatic.”\u003c/p>\n\u003cp>The study was funded by Britain’s Medical Research Council and the UK Department of International Development as well as the European Union.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/05/10/hiv-life-expectancy-study/\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/389212/life-expectancy-for-some-people-with-hiv-now-almost-normal-study","authors":["byline_futureofyou_389212"],"categories":["futureofyou_452","futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_651","futureofyou_1143"],"featImg":"futureofyou_134902","label":"source_futureofyou_389212"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. 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For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us","airtime":"SUN 2pm-3pm, MON 12am-1am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png","officialWebsiteLink":"https://www.wnycstudios.org/shows/otm","meta":{"site":"news","source":"wnyc"},"link":"/radio/program/on-the-media","subscribe":{"apple":"https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2","tuneIn":"https://tunein.com/radio/On-the-Media-p69/","rss":"http://feeds.wnyc.org/onthemedia"}},"our-body-politic":{"id":"our-body-politic","title":"Our Body Politic","info":"Presented by KQED, KCRW and KPCC, and created and hosted by award-winning journalist Farai Chideya, Our Body Politic is unapologetically centered on reporting on not just how women of color experience the major political events of today, but how they’re impacting those very issues.","airtime":"SAT 6pm-7pm, SUN 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Our-Body-Politic-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://our-body-politic.simplecast.com/","meta":{"site":"news","source":"kcrw"},"link":"/radio/program/our-body-politic","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/our-body-politic/id1533069868","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9feGFQaHMxcw","spotify":"https://open.spotify.com/show/4ApAiLT1kV153TttWAmqmc","rss":"https://feeds.simplecast.com/_xaPhs1s","tuneIn":"https://tunein.com/podcasts/News--Politics-Podcasts/Our-Body-Politic-p1369211/"}},"pbs-newshour":{"id":"pbs-newshour","title":"PBS NewsHour","info":"Analysis, background reports and updates from the PBS NewsHour putting today's news in context.","airtime":"MON-FRI 3pm-4pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.pbs.org/newshour/","meta":{"site":"news","source":"pbs"},"link":"/radio/program/pbs-newshour","subscribe":{"apple":"https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2","tuneIn":"https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/","rss":"https://www.pbs.org/newshour/feeds/rss/podcasts/show"}},"perspectives":{"id":"perspectives","title":"Perspectives","tagline":"KQED's series of of daily listener commentaries since 1991","info":"KQED's series of of daily listener commentaries since 1991.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Perspectives-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/perspectives/","meta":{"site":"radio","source":"kqed","order":"15"},"link":"/perspectives","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/id73801135","npr":"https://www.npr.org/podcasts/432309616/perspectives","rss":"https://ww2.kqed.org/perspectives/category/perspectives/feed/","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"}},"planet-money":{"id":"planet-money","title":"Planet Money","info":"The economy explained. 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The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.","airtime":"SAT 4pm-5pm","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/reveal300px.png","officialWebsiteLink":"https://www.revealnews.org/episodes/","meta":{"site":"news","source":"npr"},"link":"/radio/program/reveal","subscribe":{"apple":"https://itunes.apple.com/us/podcast/reveal/id886009669","tuneIn":"https://tunein.com/radio/Reveal-p679597/","rss":"http://feeds.revealradio.org/revealpodcast"}},"says-you":{"id":"says-you","title":"Says You!","info":"Public radio's game show of bluff and bluster, words and whimsy. 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