SciDev.Net

This special issue is a large collection of opinion pieces, research and review articles, and news features that highlight the advances in knowledge and challenges to the treatment and prevention of HIV/AIDS, including articles on randomised trials of promising HIV drugs.

It also includes a look at the preventive potential of microbicides and prophylactic HIV drugs. Another key issue covered is the patients' right to access to HIV treatment, and the barriers to treatment that people face if they are migrants or from socially excluded groups such as injecting drug users.

One weapon that those fighting HIV long for is an effective vaccine, and researchers outline the scientific and policy challenges of developing an HIV vaccine. The issue of paediatric HIV/AIDS cases is also discussed.

In June 2006, the UN emphasised the crucial role of food and nutrition in mitigating the effects of HIV/AIDS. This briefing paper explains how these issues are intertwined, and analyses why there has been little action in this area so far.

When food is scarce, women tend to get the smallest portion, leading them seek food elsewhere. This might include selling sex for food, putting them at a higher risk of HIV infection. Malnutrition can also weaken the immune system, making it easier to pick up infections but harder to get rid of them.

According to the report, health and food authorities each see it as the other's responsibility to integrate nutrition into HIV programmes. Donors and national policymakers have also been reluctant to support initiatives for integration. The first challenge, says the report, is raising awareness of the UN endorsement to secure action. Donors and governments should work to strengthen links between policies — the responsibility to reduce HIV/AIDS must not rest with the health sector alone. Finally, nutrition indicators should be included in clinical surveillance and reporting.

This briefing paper highlights the challenges in harmonising efforts to provide universal HIV/AIDS care. The 'Three Ones' principles, set in place to make the global fight against HIV/AIDS more efficient, advocate one action framework to coordinate all partners, one national AIDS authority and one country-level monitoring and evaluation system.

But, as the report points out, limited capacity in developing countries and a lack of incentives for donors to revise their practices are barriers to implementing these principles. There are also tensions between national ownership and accountability to donors.

By looking at countries that have been most successful in fighting the disease, such as Botswana and Malawi, the report outlines the keys to improving access to HIV/AIDS care.

Empowering national leadership is vital: what is needed are national HIV/AIDS strategies that have explicit priorities, are evidence-based, and link to other development plans. The multilateral donor community also needs to improve its delivery of technical support.

This annual update gives an overview of the latest developments in the global HIV/AIDS epidemic and provides regional statistics on the diseases's spread. It shows that numbers of people living with HIV and the number of deaths from AIDS are growing.

The report presents trends in HIV prevalence, including estimates of the number of young people and women infected in different countries. It discusses how high-risk behaviour such as unprotected sex and intravenous drug use contributes to the epidemic and how external factors such as malaria, tuberculosis, migration or political conflict affect HIV prevalence.

For this report, malaria and HIV/AIDS specialists were consulted on interactions between the two diseases and how having both affects people's health. They said there is still much to learn about the biological and clinical effects that malaria and HIV/AIDS have on each other. But some conclusions are already clear: integrating healthcare services is essential to reducing the burden of both diseases where they are prevalent. Health services providing HIV/AIDS prevention, treatment and care can serve as access points for malaria prevention and control. Likewise, new laboratory capacity to support HIV treatment and monitoring can also be used for malaria diagnosis. More research and debate is needed, however, before formulating new public health policies. 

For this report, malaria and HIV/AIDS specialists were consulted on interactions between the two diseases and how having both affects people's health. They said there is still much to learn about the biological and clinical effects that malaria and HIV/AIDS have on each other. But some conclusions are already clear: integrating healthcare services is essential to reducing the burden of both diseases where they are prevalent. Health services providing HIV/AIDS prevention, treatment and care can serve as access points for malaria prevention and control. Likewise, new laboratory capacity to support HIV treatment and monitoring can also be used for malaria diagnosis. More research and debate is needed, however, before formulating new public health policies. 

This review, although aimed primarily at a scientific audience, is a clearly written account of how HIV is believed to have evolved over the past 40 or so years since its spread to humans from apes. The authors argue for the importance of widespread monitoring of how HIV continues to change genetically, as it moves from person to person and within infected individuals, so as to help control drug resistance and design effective vaccines against HIV.

Based on data from 28 interviews among scientists, this commentary describes in clear terms how the health biotechnology industry is thriving in South Africa, nurtured by a confidence among scientists that arose originally with the development of mining and arms industry during the apartheid regime. With the emphasis on serving local needs, particularly the development of new drugs and vaccines for HIV/AIDS, South Africa is providing a shining example of how other developing countries can follow suit.

This Commentary describes the increasing ethical dilemmas now being faced by researchers in areas with high incidence of HIV/AIDS, as they investigate immune responses to non-HIV/AIDS diseases such as malaria. Studies of immune responses require an HIV test to check whether the research volunteer is likely to have impaired immunity, which means that clear ethical guidelines are now needed to govern whether or not such research programmes need to include provisions for voluntary counselling and testing, and other services for HIV/AIDS treatment and care.

With over 350 vaccine candidates against 88 different pathogens, including HIV, now in development in academia and industry, this commentary, written for a broad audience, provides a broad overview of the current trends that will determine which candidates are most likely to reach the poor in developing countries. These include obstacles such as poor vaccine coverage with existing vaccines and a skewing of the vaccine industry away from producing vaccines against diseases that predominantly affect poor developing nations, and new organisations, funding initiatives and incentives, such as public private partnerships, that are now helping to overcome these obstacles.

This commentary outlines in clear terms the justification for making antiretroviral drugs accessible on a large scale in developing countries, noting particularly that antiretroviral drugs are now affordable, available, and cost-effective when provided in conjunction with prevention measures, and that viral resistance can be controlled.

This review puts the HIV/AIDS epidemic into perspective against other new and re-emerging diseases that have raged among human populations since the beginning of agriculture around 10,000 years ago, including SARS, bovine spongiform encephalopathy (BSE)/variant Creutzfeldt-Jakob disease (vCJD) and Nipah fever, and old diseases such as tuberculosis and cholera. The authors argue that with a better understanding of how the emergence of such diseases is governed by changes in human ecology – such as movement, environment, living conditions and social interactions – we may be in a better position to anticipate when and where there is a risk of another new disease appearing.

This short online review aimed at non-specialists summarises the current status of microbicides research, describing in clear and concise terms the different types of microbicides currently in clinical trials, how they act, and their potential shortcomings. It refers to the increasing political and financial support that the microbicides field has gained recently, not least because of the lack of an effective HIV vaccine, but also points to the need for further developments to ensure the long-term success of microbicides as HIV prevention tools, including better ways of ensuring adherence to use.

Launched to coincide with the 2004 International AIDS Conference in Bangkok, in this strategy document, the IAVI outlines plans to strengthen and expand the research and development pipeline of candidate HIV vaccines, and engage as partners those countries most affected by HIV/AIDS. Future scientific strategy includes focusing on vaccines that trigger neutralising antibodies, and understanding how live weakened vaccines work in animal models for clues to what is needed in a vaccine for protecting people.

In response to controversy over a trial in Cambodia that was halted earlier this year, this document, written for a broad audience, addresses a range of issues regarding tests of the antiretroviral drug tenofovir in healthy uninfected individuals. The clinical trials, taking place in Africa, Asia and the Americas, aim to see whether Tenofovir can protect against HIV infection in those who are at high risk of exposure to the virus — so-called Pre-Exposure Prophylaxis, or PREP. But its use raises a whole set of concerns regarding its potential impact on trial volunteers and their communities, including the prospects for encouraging drug-resistant strains of HIV to emerge and higher risk sexual behaviour.

This collection of 43 essays is by people involved in HIV/AIDS research, community education, clinical trials and advocacy, and aims to both inform and encourage global action. Written in an easy-to-read style, it introduces many of the major scientific, policy, social, ethical and economic challenges of developing an AIDS vaccine, with chapters covering issues such as HIV vaccine science, vaccine safety, ethics of clinical trials, informed consent, community action to encourage HIV vaccine development, and sources of information and help. Notable contributions from developing country authors include the personal experiences of a vaccine scientist involved in establishing the first HIV vaccine trials in Uganda, the vulnerability of women to HIV/AIDS in India , and the challenges of recruiting women to participate in clinical trials in Kenya. Illustrations include photographic accounts of the HIV virus and its life cycle, and clinical and laboratory tests on clinical trial volunteers.

This news feature aimed at a broad scientific audience likens the perplexing task of trying to develop an HIV vaccine to “flying without a compass”. HIV poses unique challenges, including its infinite variability and protective coating that masks it from antibodies, yet researchers have evidence from both human and animal studies suggesting that it may one day be possible to trigger an immune response that protects against infection.

A policy working paper concerning the demand for an HIV vaccine usefully compares studies conducted globally and nationally, concerning both public and private sectors, in order to help inform future healthcare strategies and financial planning, and investment from industry in HIV vaccine research and development.

This policy brief highlights key issues in assessing the demand for an HIV vaccine, including what factors influence demand, such as efficacy and cost of vaccine candidates and acceptability among target populations, and differences between public and private sectors in their willingness to pay for a vaccine and political commitment.

This is a useful policy paper that assesses the total level of spending needed for AIDS vaccine research and development in the near future and the gap between current and projected spending. It considers the main stumbling blocks in vaccine research and development that could be significantly overcome with sufficient increase in spending: identification of high-quality candidate vaccines, increasing the number of such candidates entering clinical trials, and speeding up the establishment of clinical trials with faster recruitment of volunteers and regulatory approval.