MAPA DE LA SITUACION DEL VIH-SIDA EN ECUADOR 2010

ESTIMADOS COLEGAS, A LA DERECHA DE SU PANTALLA ENCONTRARAN EL LINK DEL MAPA HACIENDO CLICK SOBRE LA IMAGEN, EN ESTA SE HAN  REFERENCIADO DATOS POR CADA PROVINCIA SOBRE EL MAPA, AL DAR CLICK EN LOS GLOBOS , PODRAN VER LA INFORMACION COLOCADA EN CADA UNA DE LAS PROVINCIAS.

ESTAREMOS HACIENDO USO DE LA TECNOLOGIA DISPONIBLE PARA MANTENERLOS INFORMADOS, COMO FUE NUESTRO COMPROMISO.

SALUDOS.

DR. CARLOS ERAZO

ALGUNOS DATOS INTERESANTES SOBRE EL VIH

LOS CONDONES MASCULINOS SON EFECTIVOS PARA DISMINUIR EL RIESGO DE LA INFECCIÒN DEL VIRUS EN UN 80% A 95% .
LOS CONDONES FEMENINOS SON EFECTIVOS PARA DISMINUIR EOL RIESGO DE LA INFECCIÓN DEL VIRUS EN UN 94% A 97%.

FUENTE: THE SANFORD GUIDE TO HIV/AIDS THERAPY 2010.

SALUDOS

DR. CARLOS ERAZO

HIV Therapy Dramatically Cuts Transmission in Heterosexual Pairs

"By Michael Smith, North American Correspondent, MedPage Today Published: May 12, 2011

Triple-drug therapy dramatically reduced transmission of HIV in heterosexual couples when one partner is infected and the other is not, results of a randomized trial showed.
Treating the infected partner in these discordant couples reduced transmission by 96%, compared with no treatment, according to Myron Cohen, MD, of the University of North Carolina Chapel Hill, and colleagues.
The $73 million trial had been slated to finish in 2015 but was stopped early after those clear-cut results were found by the study's data safety monitoring board during a planned interim review.
A series of mathematical models and observational studies have suggested that treatment of HIV can reduce transmission, and other studies have suggested that anti-HIV drugs might be used as prophylaxis.
But this is the "first, rather dramatic, randomized trial in discordant couples," according to Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, one of the sponsors of the so-called HPTN 052 trial.
It "nails the concept down rather nicely," he said in a telephone media conference.
Outside experts hailed the trial as a giant step forward.

"This study is another milestone in the history of HIV," said John Bartlett, MD, of Johns Hopkins. "The concept of treatment for prevention is proven."

"Patients can take the drugs for their own health and for public health," Bartlett added in an email to ABC News/MedPage Today.

The findings have the potential to transform approaches to the treatment and prevention of HIV," according to Mark Kline, MD, of Baylor College of Medicine in Houston.

Kline noted in an email to ABC News/MedPage Today that a trial in the mid-1990s showed that administering a single anti-HIV drug to pregnant women could prevent mother-to-child transmission of the virus.

That finding had "an immediate and direct impact on public health policies" and led many experts to think that treatment might prevent infection in other settings, he said.

"Now, we have conclusive evidence from a prospective, randomized treatment trial in support of that contention," Kline said.

Indeed, the findings "must serve as a clarion call" for expanded access to treatment, according to Mitchell Warren, executive director of the New York-based AIDS Vaccine Advocacy Coalition.
"We now have evidence from a randomized trial confirming what has been seen in observational settings: (antiretroviral) treatment is prevention," Warren told MedPage Today in an email.
The study, conducted by the HIV Prevention Trials Network, began in April 2005 and enrolled 1,763 couples, 97% of them heterosexual, in nine countries.
All the HIV-infected participants -- 890 men and 873 women -- had relatively intact immune systems, with CD4-positive T-cell counts between 350 and 550 per cubic millimeter and were not eligible at the time for HIV treatment based on their local guidelines.
They were randomly assigned to get immediate treatment or to wait until their CD4 counts fell to 250 or they had an AIDS-defining event.
All told, the review found 39 cases of HIV infection among the previously uninfected partners, and genetic analysis showed that 28 of those came from the infected partner. (Seven did not, and four are still being analyzed.)
But 27 of the linked infections occurred in the deferred treatment group and just one in the immediate therapy arm, a difference that was significant at P<0.0001.
All participants in the deferred treatment arm are now being offered triple-drug therapy regardless of their CD4 count, Cohen told reporters during the telephone media conference.
He said that the original plan for the study was to have homosexual couples included, but very few agreed to take part. For that reason, he said, it would be a "mistake" to assume this finding would apply to men who have sex with men.
Cohen added that the trial shows that even with a relatively intact immune system, transmission can occur. "You can't look at a high CD count and make the assumption that transmission is not going to occur," he said.
HIV transmission risk is linked to the amount of the virus in the blood, the so-called viral load, but many physicians will assume that if the CD4 count is relatively high, they can "let it go," Fauci said. The study investigators are currently analyzing viral load data from the trial, he said.
The treatment regimens used in the trial varied depending on the location of patients, Fauci said, with 11 different antiretroviral drugs employed in various combinations.
The researchers also found that 17 cases of extrapulmonary tuberculosis occurred in the HIV-infected partners in the deferred treatment arm and just three in the immediate treatment arm. The difference was significant at P=0.0013.
There were 23 deaths -- 10 in the immediate treatment group and 13 in the deferred treatment arm -- but the difference was not significant."


LINK:  http://www.medpagetoday.com/HIVAIDS/HIVAIDS/26442?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=188864

Early HIV Treatment Associated with Greatly Reduced Transmission to Partners

Estimados colegas , aqui les dejo el link para poder revisarlo:

http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HPTN052.aspx

Saludos

Dr. Carlos Erazo

A 10-year study on early HIV treatment has been stopped prematurely after a monitoring board found convincing evidence that it "can have a major impact on reducing HIV transmission," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in an NIH announcement Thursday.
Called HPTN 052, the international study was conducted primarily among some 1800 heterosexual couples. One partner in each couple was uninfected at entry. Infected partners were randomized either to immediate treatment with a three-drug antiretroviral regimen or to deferred treatment (until CD4 counts fell below 250 per cubic millimeter or an AIDS-related event occurred).
There were 28 new infections linked to partners, 27 of which occurred among the deferred-treatment group, giving a relative reduction in transmission of 96%.
Dr. Carlos del Rio of Journal Watch HIV/AIDS Clinical Care commented that the findings "prove once and for all that antiretroviral therapy not only is good for the individual but it is also good for society, as it reduces HIV transmission."

Findings Result from NIH-funded International Study

Men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners by taking oral antiretroviral medicines when their immune systems were relatively healthy, according to findings from a large-scale clinical study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
The clinical trial, known as HPTN 052, was slated to end in 2015 but the findings are being released early as the result of a scheduled interim review of the study data by an independent data and safety monitoring board (DSMB). The DSMB concluded that it was clear that use of antiretrovirals by HIV-infected individuals with relatively healthier immune systems substantially reduced transmission to their partners. The results are the first from a major randomized clinical trial to indicate that treating an HIV-infected individual can reduce the risk of sexual transmission of HIV to an uninfected partner.
“Previous data about the potential value of antiretrovirals in making HIV-infected individuals less infectious to their sexual partners came largely from observational and epidemiological studies,” said NIAID Director Anthony S. Fauci, M.D. “This new finding convincingly demonstrates that treating the infected individual—and doing so sooner rather than later—can have a major impact on reducing HIV transmission.”
Led by study chair Myron Cohen, M.D., director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, HPTN 052 began in April 2005 and enrolled 1,763 couples, all at least 18 years of age. The vast majority of the couples (97 percent) were heterosexual, which precludes any definitive conclusions about effectiveness in men who have sex with men. The study was conducted at 13 sites in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States and Zimbabwe. The U.S. site collected only limited data because of difficulties enrolling participants into the study. However, data from one serodiscordant couple at the site was included in the DSMB’s analysis. At the time of enrollment, the HIV-infected partners (890 men, 873 women) had CD4+ T-cell levels—a key measure of immune system health—between 350 and 550 cells per cubic millimeter (mm³) within 60 days of entering the study. The HIV-uninfected partners had tested negative for the virus within 14 days of entering the study.
The investigators randomly assigned the couples to either one of two study groups. In the first group, the HIV-infected partner immediately began taking a combination of three antiretroviral drugs. In the second group (the deferred group), the HIV-infected partners began antiretroviral therapy when their CD4 counts fell below 250 cells/mm³ or an AIDS-related event, such as Pneumocystis pneumonia, occurred. Throughout the study, both groups received HIV-related care that included counseling on safe sex practices, free condoms, treatment for sexually transmitted infections, regular HIV testing, and frequent evaluation and treatment for any complications related to HIV infection. Each group received the same amount of care and counseling.
In its review, the DSMB found a total of 39 cases of HIV infection among the previously uninfected partners. Of those, 28 were linked through genetic analysis to the HIV-infected partner as the source of infection. Seven infections were not linked to the HIV-infected partner, and four infections are still undergoing analysis. Of the 28 linked infections, 27 infections occurred among the 877 couples in which the HIV-infected partner did not begin antiretroviral therapy immediately. Only one case of HIV infection occurred among those couples where the HIV-infected partner began immediate antiretroviral therapy. This finding was statistically significant and means that earlier initiation of antiretrovirals led to a 96 percent reduction in HIV transmission to the HIV-uninfected partner. The infections were confirmed by genetic analysis of viruses from both partners.
Additionally, 17 cases of extrapulmonary tuberculosis occurred in the HIV-infected partners in the deferred treatment arm compared with three cases in the immediate treatment arm, a statistically significant difference. There were also 23 deaths during the study. Ten occurred in the immediate treatment group and 13 in the deferred treatment group, a difference that did not reach statistical significance.
The study was designed to evaluate whether antiretroviral use by the HIV-infected individual reduced HIV transmission to the uninfected partner and potentially benefited the HIV-infected individual as well. Additionally, the study was designed to evaluate the optimal time for a person infected with HIV to initiate antiretrovirals in order to reduce HIV-related sickness and death. Based on their analysis, the DSMB recommended that the deferred study arm be discontinued and that the study participants be informed of the trial’s outcome.
“We want to thank the study participants for making such an important contribution in the fight against HIV/AIDS. We think that these results will be important to help improve both HIV treatment and prevention,” said Dr. Cohen.
Study participants are being informed of the results. Individuals who became HIV-infected during the course of the study were referred to local services for appropriate medical care and treatment. HIV-infected participants in the deferred treatment group will be offered antiretroviral therapy.  The study investigators will continue following the study participants for at least one year.
The study was conducted by the HIV Prevention Trials Network, which is largely funded by NIAID with additional funding from the National Institute on Drug Abuse and the National Institute of Mental Health, both part of the NIH. Additional support was provided by the NIAID-funded AIDS Clinical Trials Group. The antiretroviral drugs used in the study were made available by Abbott Laboratories, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline/Viiv Healthcare and Merck & Co., Inc.
The 11 HIV drugs that were used in various combinations included the following:

• atazanavir (300 mg once daily)
• didanosine (400 mg once daily)
• efavirenz (600 mg once daily)
• emtricitabine/tenofovir disoproxil fumarate (200 mg emtricitabine/300 mg tenofovir disoproxil fumarate once daily)
• lamivudine (300 mg once daily)
• lopinavir/ritonavir 800/200 mg once daily (QD) or lopinavir/ritonavir 400/100 mg twice daily (BID)
• nevirapine (200 mg taken once daily for 14 days followed by 200 mg taken twice daily)
• ritonavir (100 mg once daily, used only to boost atazanavir)
• stavudine (weight-dependent dosage)
• tenofovir disoproxil fumarate (300 mg once daily)
• zidovudine/lamivudine (150 mg lamivudine/300 mg zidovudine taken orally twice daily)

In an ongoing international clinical study called Strategic Timing of Antiretroviral Therapy, NIAID is examining the optimal time for asymptomatic HIV-infected individuals to begin antiretrovirals. For additional information about the HPTN 052 study, see the Questions and Answers. Visit the NIAID HIV/AIDS Web portal for more information about NIAID’s HIV/AIDS research.