No Time to Lose Getting More from HIV Prevention (2001) / Chapter Skim
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From page 80... ...
In this chapter, the Committee discusses the promise that these technologies offer for preventing new HIV infections, and we describe how development of these technologies can be accelerated by increased collaboration among public and private-sector agencies. PROMISING NEW TOOLS Rapid Testing Methods for Detecting HIV Antibodies The Centers for Disease Control and Prevention (CDC)
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In contrast, rapid HIV tests deliver results in approximately 10 minutes, enabling health care workers to provide results2 and post-test counseling in the same visit (CDC, 1998~. Although several rapid tests have been developed, the Single Use Diagnostic System (SUDS)
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Evidence suggests that rapid testing is feasible, accepted by clients, and may significantly increase the proportion of individuals who learn their HIV status (Kessler et al., 1997; Irwin et al., 1996~. Because the entire testing and counseling experience is conducted in the same day, rapid tests can enable health care workers to take full advantage of the "teachable moments" that may occur when, by requesting HIV testing, individuals are psychologically more open to prevention education and can benefit from information about treatment services.
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From page 83... ...
Additionally, there are concerns about the cost of rapid tests; the SUDS test costs about $10, whereas standard EIA tests cost approximately $2.50 (Kane, 1999~. However, a study of the use of rapid testing for pregnant women in labor who did not have prenatal care indicated that the cost savings generated by the reduction in perinatal HIV transmission (achieved by giving therapeutic zidovudine to women found to be infected)
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From page 84... ...
Microbicides represent a true user-controlled method that can be employed without the consent of a sexual partner. Microbicides use several methods to prevent HIV infection, including blocking the virus from entering mucosal cells (e.g., Neurath et al., 1996; Pearce-Pratt and Phillips, 1996; Miller et al., 1995)
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From page 85... ...
For example, the use of a placebo may be problematic because it may adversely affect vaginal flora. In addition, standard ethical protocols in microbicide clinical trials require the use of condoms by all trial subjects, which makes it difficult to distinguish whether significant protective effects are due to the condom or the microbicide (Lawson et al., 1999; Wulf et al., 1999; de Zoysa et al., 1998~.
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From page 86... ...
These issues will be discussed in greater detail later in this chapter. Antiretroviral Therapies Since the introduction in 1985 of the first antiretroviral drug, zidovudine, dramatic advancements have been made in developing stronger and more effective antiretroviral agents to treat HIV infection.
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From page 87... ...
The effectiveness of combination antiretroviral therapies is thought to have contributed to a resurgence in risk behavior among men who have sex with men, due to their perception that HIV infection is no longer a significant health threat (Kelly et al., 1998a; Kelly et al., 1998b; Dilley et al., 1997~. Other studies of gay men and HIV-infected men and women suggest that reductions in viral load associated with antiretroviral therapies may prompt individuals to believe that seropositive sexual partners who are taking these medications are less infectious (Kalichman et al., 1998; Kravcik et al., 1998)
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The International AIDS Vaccine Initiative (IAVI) and other organizations are currently spearheading efforts to encourage more private sector investment in vaccine research and development (IAVI, 2000~.
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Other reasons included the potential poor return on investment, the cost and duration of the development process, the prospect of litigation, difficulties in obtaining patents, and the probability of having to work cooperatively with the public sector (Blakeslee, 2000~. A subsequent survey of 30 pharmaceutical companies found that, while many of these concerns had waned due to increased evidence for market
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From page 90... ...
The International AIDS Vaccine Initiative, created in 1995, and the Alliance for Microbicide Development and the Consortium for Industrial Collaboration in Contraceptive Research, both created in 1999, are examples of such partnerships. Philanthropic and private organizations such as the William and Flora Hewlett Foundation, the Moriah Fund, the Bill and Melinda Gates Foundation, and the American Foundation for AIDS Research recently have begun to contribute to microbicide research.
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From page 91... ...
In particular, the National Institutes of Health should place high priority on the development of anti-HIV microbicides and vaccines, and this prioritization should be accompanied by increases in funding. Similarly, the Food and Drug Administration should accelerate its efforts to approve prevention technologies that show promise in clinical trials (e.g., new antiretroviral therapies, new microbicidal and vaccine candidates)
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Baruch A, Jones M, Facey K, Whitacre C, McAuliffe VJ, Friedman HM, Merigan TC, Reichman RC, Hooper C, Corey L.1996. Treatment of human immunodeficiency virus infection with saquinavir, zidovudine, and zalcitabine.
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1998. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial.
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1993. Human immunodeficiency virus infection among patients in a gynecology emergency department.
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2000. Viral load and heterosexual transmission of human immunodeficiency virus type 1.
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1999. Microbicides and barrier methods in HIV prevention.
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