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EPIDEMICS
Mobile phones help bolster Uganda's fight against HIV
by Staff Writers
Kampala (AFP) July 25, 2012


Cancer drug flushes out lurking AIDS virus: study
Paris (AFP) July 25, 2012 - Scientists in the United States said Wednesday they had used a cancer drug to flush out the AIDS virus lurking dormant in trial patients' white blood cells -- a tentative step towards a cure.

The ability of the HIV genome, or reproductive code, to hide out in cells and be revived after decades poses a major obstacle in the quest for a cure.

Being able to expose the virus in its hiding place would allow scientists to target the host white blood cells in a killing blitz.

"It is the beginning of work toward a cure for AIDS," David Margolis, co-author of the study published in the journal Nature, told AFP as the International AIDS Conference was under way in Washington.

HIV is a retrovirus, inserting its DNA into the genome of host white blood cells, CD4+T cells in this case, and turning them into virus factories. Sometimes it goes into hiding in some cells even as others keep on producing.

Some 34 million people around the world are living with HIV, which destroys the immune system and has caused about 30 million AIDS-related deaths since the disease first emerged in the early 1980s.

In the latest study, researchers in the United States used the chemotherapy drug vorinostat to revive and so unmask latent HIV in the CD4+T cells of eight trial patients.

The patients were also on antiretroviral drugs, which stops HIV from multiplying but have to be taken for life because they do not kill the virus hidden away in reservoirs.

"After a single dose of the drug, at least for a moment in time, (vorinostat) is flushing the virus out of hiding," Margolis said of the trial results -- the first drug ever shown to do so.

"This is proof of the concept, of the idea that the virus can be specifically targeted in a patient by a drug, and essentially opens up the way for this class of drugs to be studied for use in this way."

The drug targets an enzyme that allows the virus to lie latent.

The researchers cautioned that vorinostat may have some toxic effects and stressed this was merely an early indication of feasibility that had to be explored further.

Exactly what would happen after the virus was unveiled in reservoir cells was also not certain, said Margolis.

"We know that many cells that produce HIV die in the process. We know many cells that produce HIV can be identified and killed by the immune system. As far as we can tell, all the viruses floating around while patients are taking therapy don't get into cells because they are blocked by the therapy," he said.

Without a host cell, the virus would die within a few minutes.

"There is a possibility that this could work. But ... if it is only 99 percent true and one percent of the virus escapes, it won't succeed. That is why we have to be careful about our work and what we claim about it."

In a comment published with the study, HIV researcher Steven Deeks said the research provided "the first evidence that ... a cure might one day be feasible".

But, as is common with early clinical trials, the study raised more questions than answers -- including ethical concerns about giving potentially toxic drugs to HIV-infected people who are otherwise healthy, he said.

"These data from the lab of David Margolis are genuinely exciting for those exploring pathways to achieving a cure for AIDS," Oxford University HIV researcher John Frater told AFP, calling for investment in further research.

HIV immunologist Quentin Sattentau called the findings promising, but said other types of reservoir cells, including in the brain, may not respond to this treatment.

"Thus there is a long way to go before we will know if this can work to completely eradicate HIV from an infected person."

Stella Nayiga clutches her mobile phone as she describes the messages that she received punctually every morning and evening for over a year, reminding her to take her antiretroviral (ARV) drugs regularly.

"The text messages would come twice a day and were saying things like 'Dear friend, please take care of yourself' and when you got them you knew it was time to take your medicine," Nayiga, 28, told AFP.

"As a human being you can always forget to take the drugs -- maybe not for the whole day but sometimes for some hours -- but this service really helps you to remember."

An HIV-positive health worker in the Kampala suburb of Kawempe, Nayiga was part of an innovative scheme that used mobile phones to help remind around 400 patients diagnosed with the virus to take their ARVs regularly.

A collaborative project between a local clinic and a Dutch-run non-governmental organisation, the programme is part of an attempt in Uganda to harness the power of mobile technology to help fight HIV.

Those involved say that it soon became clear that receiving the daily messages was a big help for the people taking the drugs.

"We saw that because of the mobile messaging there was a really tremendous improvement in adherence," said Samuel Guma, director of Kawempe Home Care, which runs the clinic involved.

ARVs -- taken twice daily -- require a minimum adherence rate of around 95 percent to be truly effective and the SMS scheme saw the number of people taking the drugs correctly rise from 75 percent to over 90 percent.

Sitting in an office in an upscale suburb of Kampala, Bas Hoefman, founder of the Dutch-run NGO Text to Change, the organisation behind the text messaging programme, lists the different ways mobile phones can be used to fight HIV.

Starting off in Uganda five years ago, Text to Change used SMS quizzes to try and educate people about HIV issues and encourage them to go for testing -- sometimes offering incentives such as phone credit.

Since then the organisation has run over 30 HIV-related projects using mobile phones across Africa, such as promoting medical male circumcision in neighbouring Tanzania -- and has reached an estimated 1 million people in Uganda alone.

"There was a fatigue for people receiving the old messages via traditional media -- mobile phones are now so commonly used, especially among the youth, that we realised it was time to repackage the information," Hoefman said.

With mobile phones used for everything from sending money to a rural relative to paying electricity bills, the number of subscribers in Uganda has boomed and now reaches over 40 percent of the population.

But while using mobiles may be an effective way to deal with HIV issues, the projects are dependent on foreign donors, and with aid budgets dwindling that means alternative ways of financing the projects need to be found.

"We are looking for business models of how we can combine sending out health messages with other messages that people are maybe willing to pay for," Hoefman said, citing market research and advertising as two possibilities.

Uganda has been widely praised for its groundbreaking AIDS policy, which saw condom use promoted and disease rates slashed from over 15 percent in the early nineties to around six percent.

In recent years, however, the HIV rate has started creeping up again as the government, influenced by US evangelists, has placed greater emphasis on policies such as abstinence.

While mobile technology in Uganda can be a useful tool to fight the spread of disease and target vulnerable groups, it cannot mask deeper government failures, health experts say.

"Uganda has a crisis -- it is not speeding up treatment coverage fast enough ... and it is not investing sufficiently in all of the prevention interventions communities need to protect themselves," said Asia Russell, international policy director at Health Gap, an AIDS advocacy group working in Uganda.

"More important is a clear commitment, along with a costed, implemented national plan to end AIDS in Uganda through dramatically scaled up prevention and treatment services."

As for those involved in the ARV text programme, they are searching for new financing to allow them to continue the programme after US government funding for parts of it -- including the ARV alerts -- stopped late last year.

"It can seem like an expensive venture in the short run, but in the long run it turns out to be very cheap," clinic director Guma said.

"But if more people take their medication regularly they become much less infectious, and then in turn we could start to see a drop in the rate of new infections."

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