Medical News

A therapeutic HIV vaccine could be developed within four to five years, Luc Montagnier, one of three recipients of the 2008 Nobel Prize in medicine, said Saturday at a News conference in Stockholm, Sweden, the AP/Kansas City Star reports (Nordstrom, AP/Kansas City Star, 12/6). According to Reuters, researchers are working to develop a vaccine that would prevent HIV infection or a therapeutic vaccine that would control the virus after infection, making it less transmittable to others. Montagnier, director of the World Foundation for AIDS Research and Prevention, said that he and his colleagues have been working on a therapeutic vaccine for about 10 years, adding, “Our job, of course, is to find complimentary treatment to eradicate the infection.” Montagnier also said, “I hope to see in my lifetime the eradication of, not the AIDS epidemic, but at least the infection. This could be achieved” (Cox, Reuters, 12/6).

According to the AP/Star, attempts to discover an HIV/AIDS vaccine have “proved elusive in the past,” and some recent trials have been halted (AP/Kansas City Star, 12/6).

“Before we get a vaccine, there are many ways to reduce the contaminations by improving ways of life standards in developing and poor countries, in giving them more advice,” Montagnier said (AFP/Yahoo! News, 12/6). Francoise Barre-Sinoussi, a researcher with the Pasteur Institute who shared the Nobel prize with Montagnier, at the News conference said that researchers “have responsibility to try to influence, especially the politicians.” She added, “Still, 25 years after the HIV discovery, (there is) discrimination, stigmatization against HIV-infected individuals, even criminalization,” which is “really not acceptable” (Reuters, 12/6). Barre-Sinoussi also said that it is impossible to predict when a preventive HIV vaccine would be available and that researchers should continue their efforts to develop one (AFP/Yahoo! News, 12/6).

According to the AP/Star, Montagnier and Barre-Sinoussi will share half of the $1.2 million prize, and the other half will go to Harald zur Hausen, a German researcher who linked the human papillomavirus with cervical cancer. The award will be given to the researchers on Wednesday (AP/Kansas City Star, 12/6).
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The Los Angeles Times on Monday examined new practice guidelines issued recently by the American College of Physicians recommending routine HIV testing for all patients beginning at age 13, regardless of whether they engage in high-risk behaviors. CDC in 2006 also released recommendations for HIV screening as part of routine medical care.

Bernard Branson of the HIV/AIDS prevention division at CDC, who helped develop the agency’s current recommendations, said that although physicians in the past might have limited HIV screening suggestions to high-risk patient groups, this approach often failed to identify new HIV cases. By recommending routine HIV screening for all patients, physicians can avoid asking patients sensitive questions about sexual activity and high-risk behavior. In addition, universal HIV testing can benefit teenage patients, who may be reluctant to discuss their sexual activity if they are accompanied by parents, Branson said. He added that patients can benefit from early HIV diagnosis because early treatment is more effective and can delay progression to AIDS. In addition, HIV/AIDS researchers say that increased awareness can slow the spread of HIV, because people who are aware of their HIV-positive status might engage in fewer risky behaviors.

According to the Times, obstacles to universal HIV screening are “falling away” as some states are requiring health insurers to cover HIV testing costs and fewer states are requiring counseling and informed consent before conducting blood tests. However, some physicians still might hesitate to suggest HIV screening because it could “open up a discussion that the physician feels he or she doesn’t want to get into or doesn’t have time for or doesn’t have training for,” Thomas Coates, director of the global health program at the University of California-Los Angeles David Geffen School of Medicine, said. He added that recommending universal HIV screening also raises questions about counseling, referrals and partner notification if the patient tests HIV-positive. However, Coates said it is important to recommend HIV screening even without follow-up discussions because it indicates to patients that HIV tests are an important component of medical care. This can convey important health messages to teenagers, Coates said, adding that when a physician recommends HIV testing, “it’s kind of a signal to the adolescent that this is something that he or she needs to think about.” Christina Elston, managing editor at L.A. Parent magazine, said HIV screening is “a health issue. It isn’t a sex issue,” adding that sometimes “parents confuse that” (Adams, Los Angeles Times, 12/8).

Related Editorial, Opinion Piece

• Washington Post: “The fear and stigma surrounding HIV and AIDS make it difficult to persuade people to get tested,” and therefore “far too many cases of HIV infection go undiagnosed and untreated,” a Post editorial says. According to the editorial, some health care workers might “find it too time-consuming” to offer routine HIV screening, and some health “insurers are balking at paying for the tests.” However, time and money “shouldn’t be more valuable than trying to save lives,” it adds. The editorial calls for increased “focus” and “financial and political oomph at the federal level” to implement universal HIV screening and recommends implementing HIV/AIDS researcher Robert Gallo’s recent call to create a version of the President’s Emergency Plan for AIDS Relief for U.S. cities. The editorial states that PEPFAR “has provided antiretroviral treatment for more than 1.7 million people around the world since 2003,” concluding, “Imagine what PEPFAR could accomplish at home” (Washington Post, 12/7).
  
  
• Elliot Millenson, Washington Times: The “staggering” 600,000 HIV/AIDS-related deaths in the U.S. since the virus was first discovered are “in part a testament to a predictable failure of people to conform to the government’s AIDS prevention ideals of chastity, monogamy and protection,” Millenson, the founder and former CEO of the Johnson & Johnson subsidiary that developed the first home HIV test, writes in a Times opinion piece. Although most people living with HIV in the U.S. “act responsibly, taking steps to prevent infecting others,” Millenson writes that the “reality is that others know they are infected but don’t take steps to inform their partners.” According to Millenson, “If we want to get serious about HIV prevention in America, testing needs to be made a priority.” He adds that it is “time to stop lying to ourselves that our AIDS prevention approach is working” because the numbers of AIDS-related deaths in the country “confirm it’s not.” Millenson concludes, “Promoting sound AIDS prevention approaches, which include encouraging Americans to know their and their partner’s HIV status, as well as understanding the limitations of condoms — and human nature — will lead to a stronger and healthier America” (Millenson, Washington Times, 12/5).

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After Ireland ordered a recall of locally produced pork products which may be tainted with cancer-causing toxins. UK authorities say they are monitoring the situation with Irish authorities. The United Kingdom imports approximately half of all Ireland’s pork product exports. According to a spokesperson for the Food Standards Agency (FSA) in the UK, people need not be overly worried.
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California’s Department of Health Care Services has failed to enact a six-year-old state law (AB 2197) that calls for the implementation of a program to provide medical care to low-income California residents living with HIV, according to a ruling announced Thursday by the Los Angeles County Superior Court, the Los Angeles Times reports (Rau, Los Angeles Times, 12/5). The ruling comes in response to a lawsuit filed last year by the AIDS Healthcare Foundation claiming that DHCS failed to expand coverage under Medi-Cal, the state’s Medicaid program, to HIV-positive Californians who had not developed AIDS (AP/San Francisco Chronicle, 12/5).

The law, signed by former Gov. Gray Davis (D) in September 2002, calls for the state to provide full Medi-Cal benefits to HIV-positive people who already are enrolled in the state’s AIDS Drug Assistance Program, “who are not disabled and who would otherwise qualify for benefits under the Medi-Cal program.” Before the law was passed, only people with an AIDS diagnosis who were considered disabled were eligible for benefits under Medi-Cal. To fund the program’s expansion, the law suggested moving Medi-Cal beneficiaries with AIDS from the current fee-for-service system to a less expensive managed care program. The money saved would go toward financing the expansion of Medi-Cal benefits to people with HIV (Kaiser Daily HIV/AIDS Report, 4/4/07).

Judge James Chalfant, who issued the ruling, wrote that California “has not fulfilled its statutory obligation” by failing to enact some measures required by the legislature and insufficiently completing others. According to the ruling, DHCS outreach efforts to encourage AIDS patients to switch to managed care were limited to meetings with advocates and medical providers, as well as flier distribution in three counties on one occasion. Chalfant wrote that it is “clear” that the department “simply has not done the necessary outreach and awareness activity to encourage AIDS patients on Medi-Cal to adopt managed care.” In addition, the department decided against contacting patients directly because it assumed, without evidence, that federal medical privacy laws would prohibit such action, Chalfant wrote. In addition, Chalfant ruled that DHCS did not comply with the law’s requirement to determine how much it would pay Medi-Cal providers to treat HIV-positive people or calculate how much would be saved when people living with AIDS moved into managed care. The department also did not attempt to find other methods to pay for care for HIV patients, did not seek additional revenue sources and rejected potential revenue sources brought to its attention, Chalfant ruled (Los Angeles Times, 12/5). Chalfant ordered AHF to develop a plan for helping DHCS comply with the law, and the foundation is scheduled to submit the plan on Dec. 17.

Ged Kenslea, spokesperson for AHF, said the court’s ruling “is a scathing indictment of the state for not doing anything to comply” with AB 2197, adding that “DHCS can’t pick and choose which laws they follow” (AP/San Francisco Chronicle, 12/5). Michael Weinstein, president of AHF, said the department “never had any intention of enforcing this law because they thought they had a right to determine which laws they enforce or don’t,” adding that hundreds or thousands of HIV-positive people might have lost out on health services because the state resisted enacting the law. DHCS officials said they had not fully reviewed the ruling or determined their next steps but added that they had acted appropriately. Norman Williams, a spokesperson for DHCS, said the department believes the law will not work because California’s managed care programs for AIDS patients — which currently enroll 1,800 people — cost the state more than fee-for-service programs. According to the Times, the law explicitly says that the state can not incur additional costs by extending Medi-Cal to people living with HIV (Los Angeles Times, 12/5). Williams said the state had performed a cost analysis demonstrating that the law would not work without additional funding (AP/San Francisco Chronicle, 12/5).
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Bill Gates, co-founder of the Bill & Melinda Gates Foundation, on Wednesday urged President-elect Barack Obama to fulfill his pledge to double U.S. foreign assistance to $50 billion by the end of his first term for global health and other issues, the Washington Post reports. Speaking at George Washington University, Gates said that the U.S. must sustain funding for fighting disease abroad or recent advancements in global health could be reversed, adding, “In a crisis, there is always a risk that you take your eyes off the future and you sacrifice long-term investments for short-term gains. You have to seek both.” In addition, Gates said that the current financial crisis could be an opportunity for innovation. “Difficult times can launch great ideas,” he said (Rucker, Washington Post, 12/4).

According to CNN.com, Obama on his Web site has committed to increase foreign aid investment to $50 billion by the end of his first term to fund debt cancellation for developing nations, address HIV/AIDS and fight global poverty. Gates said he believes that Obama will follow through on this pledge, adding that Congress will need to vote for final funding decisions (Mooney, CNN.com, 12/3). Although the current economic situation might have “changed some people’s view of what we can afford,” if the U.S. “can support the president as he stands by his pledge to the poorest nations — even in the face of our own financial crisis — it will make a phenomenal statement about the kind of partner America plans to be in the world,” Gates said. He added that the U.S. could “make the most of this downturn and the budget scrutiny that comes with it” by selectively cutting some aid programs while expanding others (Guth, Wall Street Journal, 12/4).

When asked about his legacy in 15 years, Gates said he hopes his foundation can spur “dramatic improvement in global health” and contribute to “dramatic reduction in disease in many of the top areas: malaria, tuberculosis, AIDS, childhood diseases” (Washington Post, 12/4).
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