Congressional Conference Committee Ends Ban on Needle Exchange Funding
Minimal Increases in Federal Funding Approved by Congress
U.S. Department of Health & Human Services and WHO Guidelines Call for Earlier HIV Treatment
UCLA Researchers Find that Stem Cells Can Be Engineered to Kill HIV
Congressional Conference Committee Ends Ban on Needle Exchange Funding
In a press release issued on December 9, The AIDS Institute’s Deputy Executive Director, Carl Schmidt said, “The AIDS Institute applauds a House and Senate Appropriation conference committee for agreeing to remove the longstanding ban on federal funding for syringe exchange programs as part of a FY10 spending measure. We are pleased the Congress is prioritizing evidence over ideology by supporting this proven HIV and hepatitis prevention intervention that does not increase drug use.”
The measure was approved by the Conference Committee Tuesday night. They rejected an attempt to reinstate the ban, as well as an amendment which would have greatly restricted where syringe exchange programs can operate. “Our government now will have an additional tool that it can use to prevent HIV/AIDS in our country,” added Schmidt.
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Minimal Increases in Federal Funding Approved by Congress
The House and Senate Appropriations Conference Committee has agreed with the President’s request to end funding for abstinence-only until marriage programs and instead to fund a Teen Pregnancy Prevention Initiative that will support both evidence-based and other approaches to reduce teen pregnancies, a move applauded by parents, teachers, medical providers and other advocates all over the country.
While that measure is worth celebrating, several increases in federal funding for HIV/AIDS programs left AIDS activists underwhelmed. The proposed bill would increase funding for HIV prevention at the Centers for Disease Control and Prevention (CDC) by $36 million (5.2%), which is much less than the $53 million proposed by the President and approved by the House. Last year, the CDC announced that over 56,000 people are infected with HIV every year in the United States, 40% higher than previous estimates. The CDC estimates it needs an increase of $877 million every year for five years in order to reduce HIV transmission by half by 2020.
The Ryan White HIV/AIDS Program, which provides treatment and support services to low-income people living with HIV/AIDS, would receive an increase of $52.5 million (2.3%), which is close to the $54 million requested by the President and passed by the House. This includes a $20 million increase to the AIDS Drug Assistance Program, which is in crisis in nine states, with people on waiting lists numbering over 340. Twelve other states are cutting back eligibility and reducing drug formularies.
The Conference Committee rejected the President’s proposal to flat fund the Housing Opportunities for Persons with AIDS (HOPWA) program at $310 million and approved a $25 million increase.
“The proposed spending measure contains some excellent policy changes and we thank the Congress for demonstrating great leadership in these areas,” commented Michael Ruppal, Executive Director of The AIDS Institute. “However, now is not the time to turn our back on the people with the greatest needs. It is our hope that we can see larger increases beginning with the release of the President’s budget early next year.”
The House and Senate are expected to consider the spending measure within the next week and send it to the President for his signature.
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U.S. Department of Health & Human Services and WHO Guidelines Call for Earlier HIV Treatment
Liz Highleyman reported in the Bay Area Reporter on December 3 that new treatment guidelines issued by both the U.S. and the international World Health Organization are now recommending initiating antiretroviral (ARV) treatment earlier for HIV-positive people.
“A growing body of clinical evidence suggests that earlier therapy reduces HIV-related illnesses and deaths, and it ‘may also decrease inflammation and immune activation thought to contribute to higher rates of cardiovascular and other co-morbidities reported in HIV-infected cohorts,’ according to the U.S. Department of Health and Human Services' (HHS) revised "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents."
According to the new recommendations of the expert panel, adult and adolescent patients should begin ARV therapy if their CD4 count is below 350 cells/cubic millimeter, and the therapy is "recommended" for those with higher counts of 350-500 cells/cubic millimeter. For patients with CD4 counts above 500 cells/cubic millimeter, half the panel recommended starting ARVs, and half viewed treatment as "optional." Pregnant women, people with HIV-associated kidney disease and those co-infected with hepatitis B should begin treatment regardless of CD4 count, the panel said.
In addition, raltegravir (Isentress) has been moved to the "preferred" list of first-line HIV drugs. Efavirenz (Sustiva), ritonavir-boosted atazanavir (Reyataz), and boosted darunavir (Prezista) are the other three options preferred in combination with tenofovir plus emtricitabine (Truvada). The lopinavir/ritonavir combination pill (Kaletra) is now designated an "alternative."
For more information, visit aidsinfo.nih.gov.
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UCLA Researchers Find that Stem Cells Can Be Engineered to Kill HIV
Researchers from the UCLA AIDS Institute and colleagues have, for the first time, demonstrated that human blood stem cells can be engineered into cells that can target and kill HIV-infected cells — a process that potentially could be used against a range of chronic viral diseases.
The study, published Dec. 7 in the-peer reviewed online journal PLoS ONE, provides proof-of-principle — that is, a demonstration of feasibility — that human stem cells can be engineered into the equivalent of a genetic vaccine.
"We have demonstrated in this proof-of-principle study that this type of approach can be used to engineer the human immune system, particularly the T-cell response, to specifically target HIV-infected cells," said lead investigator Scott G. Kitchen, assistant professor of medicine in the division of hematology and oncology at the David Geffen School of Medicine at UCLA and a member of the UCLA AIDS Institute. "These studies lay the foundation for further therapeutic development that involves restoring damaged or defective immune responses toward a variety of viruses that cause chronic disease, or even different types of tumors."
Taking CD8 cytotoxic T lymphocytes — the "killer" T cells that help fight infection — from an HIV-infected individual, the researchers identified the molecule known as the T-cell receptor, which guides the T cell in recognizing and killing HIV-infected cells. These cells, while able to destroy HIV-infected cells, do not exist in enough quantities to clear the virus from the body. So the researchers cloned the receptor and genetically engineered human blood stem cells, then placed the stem cells into human thymus tissue that had been implanted in mice, allowing them to study the reaction in a living organism.
The engineered stem cells developed into a large population of mature, multifunctional HIV-specific CD8 cells that could specifically target cells containing HIV proteins. The researchers also found that HIV-specific T-cell receptors have to be matched to an individual in much the same way that an organ is matched to a transplant patient.
The next step is to test this strategy in a more advanced model to determine if it would work in the human body, said co-author Jerome A. Zack, UCLA professor of medicine in the division of hematology and oncology and associate director of the UCLA AIDS Institute. The researchers also hope to expand the range of viruses against which this approach could be used.
"This approach could be used to combat a variety of chronic viral diseases," said Zack, who is also a professor of microbiology, immunology and molecular genetics. "It's like a genetic vaccine."
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