Breakthrough might lead to changes in HIV treatment guidelines

An announcement in Mississippi of the curing of an HIV born infant has generated excitement about the possibilities of HIV cure in infants.

If proven true after a long term follow up, the development has the possibility of pushing for a change in the guidelines regarding the timing of HIV treatment in infants, in the longer future.

Currently under WHO guidelines, it is only 6 weeks after birth that detection tests are done. In this case, the treatment happened 30 hours after birth. Moreover, treatment was more intense than usual where doctors at the University Mississippi medical centre used three antiretroviral drugs instead of the usual singe dosage, agencies reported.


Though the presence of the virus had not been detected in the mother, the treatment was done before the virus could set into the body completely.

Hannah Gay, a pediatric HIV specialist at the University of Mississippi Medical Center, was quoted by CNN as saying, “ We are hoping that future studies will show that very early institution of effective therapy will result in this same outcome consistently,".


However, doctors and experts in India who DNA contacted, refused to comment till they have more details and till long termfollow up is done. They also hinted at the possibility of this being an 'exceptional case.'.

A National Aids Control Organisation (NACO) official told DNA that “ There are some researchers in South Africa who have also been talking about taking treatment in the direction of early treatment, unlike the current 6 weeks directive.


 But on the basis of one case like this, one cannot expect a change in guidelines which have been formulated after years of research and sample cases. Neither is it advisable to push for it on the basis of just one case.”

The official added that “cure” is too early a word to use. “ A case certainly is being made for early detection leading to a reduction in mortality. I would not use the word cure. Currently, 25% of HIV infected infants die within year and 50 % in 2 years” the official said.


India has the third largest number of people living with HIV according to government's 2011-12 data. However, according to the Department of AIDS Control's Annual Report 2011-12 , only 5% of HIV cases in India are transmitted from mother to child.

Yet, the news remains relevant to India as to other parts of the world because pregnant HIV infected women are a vulnerable group because of lack of infrastructure, testing facilities, knowledge and income levels. Detection facilities too have lagged behind.

This means that most women would not even know they are infected with the virus till it is too late and the baby already born. This is why the Missisippi case, if proven to be applicable universally, makes sense for India since the infant had been born with the virus in an undetected mother.

Anjali Gopalan director of Naaz Foundation which works with individuals affected by HIV says, “It's too early to say whether the cure will be applicable to India, but if it is then it is definitely exciting news. It gives hope to newly born infants infected with the virus”.


The infant from Mississippi was born HIV-positive to a mother who had not been diagnosed as HIV-positive herself until just before delivery. After initial treatment, the mother and child remained absent from the hospital for 5 months. They returned to the hospital when the child was 2 years old, and doctors found remarkably, that she tested negative after repeated tests.

ICMR Secretray Dr V M Katoch refused to comment till further details are forthcoming. Most doctors too reserved their opinion till they got further details. The NACO official also insisted that “long term follow up is necessary before a comment can be made”.    

Cipla to sell MSD’s HIV drug in India

Drug maker Cipla will market multinational company MSD’s HIV drug raltegravir (400mg) tablet in India.

Announcing this India-specific, non-exclusive partnership on Thursday, the two companies said Cipla would market the drug under a different brand name. Access to raltegravir is important for patients who require it as part of third-line salvage regimen where there are few options left, the note added.

A patient-centric approach and access are the cornerstone of the partnership, the companies said in a joint statement, adding that they expected the alliance to broaden the reach of raltegravir in private and public markets in India.

KG Ananthakrishnan, MSD’s Managing Director in India, said that their India-alliance with Cipla would seek to address treatment challenges for high risk patients by providing broader access to innovative medicines and vaccines.

“It is a complementary partnership as MSD brings the research and scientific excellence for raltegravir, and Cipla brings their marketing excellence, significant reach among key clinician categories to drive product access. MSD and Cipla both share the same commitment of providing broader access to HIV treatment,” he said.

MSD also has a tie up with Mumbai’s Sun Pharma on diabetes drugsitagliptin.

3rd line therapy treatment

Cipla’s Chief Medical Officer Dr Jaideep Gogtay said that raltegravir, a third line therapy treatment, would be a value-addition to Cipla’s portfolio of HIV/AIDS treatments, especially for those patients who are resistant to the 1st and 2nd line therapy treatment.


Cipla’s HIV/AIDS medications, including the innovative triple cocktail drug, have been available for patients for over a decade now. “We anticipate this drug being available to patients from middle of this year,” he added.

Subhanu Saxena, Cipla’s MD and global CEO, pointed out: “With Cipla’s strength in India, South Africa and other emerging markets, we have long been the pharmaceutical company serving patients who most need access to affordable medicines. By entering into this marketing partnership with MSD, Cipla is demonstrating its commitment to working with partners globally who share the same pro-access philosophy of Cipla.”

Reduces deaths

Wider access to anti-retroviral therapies (AIDS drugs) led to 29 per cent reduction in estimated annual AIDS-related deaths, the note said, citing Government data from the National Aids Control Programme.

The total number of people living with HIV/AIDS (PLHIV) in India is estimated at around 20.9 lakh in 2011. Children who are less than 15 years of age account for 7 per cent (1.45 lakh) of all infections; while 86 per cent are in the age-group of 15-49 years. Of all HIV infections, 39 per cent (8.16 lakh) are among women, the note said.


Using globally accepted methodologies and updated evidence on survival to HIV with and without treatment, it is estimated that about 1.48 lakh people died of AIDS related causes in 2011 in India. Deaths among HIV infected children account for 7 per cent of all AIDS-related deaths, the note said. 

Mental health issues can up HIV risk

A new study has found that people receiving mental health care are up to four times more likely to be infected with HIV than the general population. Researchers at Penn Medicine and other institutions tested over 1,000 patients in care in Philadelphia and Baltimore. Of that group, several new HIV cases were detected.

The study is one of the largest studies to date to estimate HIV prevalence and risk factors among persons receiving treatment in mental health settings and included researchers from the Centers for Disease Control and Prevention (CDC), as well as the University of Maryland and Columbia University Medical Center. ‘These findings paint a recent picture of HIV infection rates in the community, and reinforce how important it is to identify patients and get them into appropriate infectious disease care in a timely manner while being treated for mental illness,’ lead author Michael B. Blank, PhD, associate professor in Psychiatry at the Perelman School of Medicine, said.


‘With such a high-risk group, it’s imperative to be routinely testing patients to improve care and reduce transmissions to others. Historically, though, HIV testing is often not implemented in mental health care,’ the researcher said. The research team found that 4.8 percent of the mental health patients receiving care (51 individuals) were infected with HIV, which is about four times the base rate in each city and about 16 times the base rate for the United States population.

Thirteen of the 51 infected patients reported that they did not know they were HIV positive, which represents an important failure in our public health system since they were already receiving ongoing mental health care. Results of the study also showed that persons with more severe symptoms of mental illness were at higher risk for being HIV-infected.


The study was published in the American Journal of Public Health.

What is HIV?

The human immunodeficiency virus (HIV) is a retrovirus that destroys or impairs the function of the body’s immune system making the person more susceptible to infections. Unless treated, it develops into full-blown acquired immunodeficiency syndrome (AIDS). The virus infects humans when it comes in contact with tissues lining the vagina, anal area, mouth and eyes, or through a break in the skin. There are two main types – HIV-1 and HIV-2. HIV-2 is typically found in Africa and parts of Asia. HIV-2 is typically found in Africa and parts of Asia. Asia can thus no longer be considered free of HIV-2, and testing for HIV-2 appears mandatory, at least in India. Worldwide, when people refer to HIV they are usually referring to HIV-1.