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The future of HIV treatment, research is now at MCV

Ryan Murphy

News Editor

Over 1.2 million people are currently living with HIV in America. Over 619,000 have died since HIV was first observed over 30 years ago. In 1994 and 1995, HIV was the leading cause of death for Americans between the ages of 22 and 45 with over 50,000 deaths in America attributed to HIV-related illnesses in 1995 alone.

In Richmond, thousands are living with the disease and about one out of every 2,000 Richmonders is diagnosed with HIV each year. However, HIV is no longer the death sentence it once was.

Through new drugs and cutting-edge research, medical providers like the VCU HIV/AIDs Center have helped to reduce those mortality rates.

The Center treats about 3,000 HIV-infected patients with the latest in HIV treatments. Through the Center, some patients, primarily those with highly drug-resistant strains of the virus, receive access to advanced medicines before they even make it to market.

“Back in the late ’90s and early 2000s, we just didn’t have very many drugs to choose from and there was a really significant pill burden associated with HIV treatment. There were a lot of side effects, the drugs weren’t particularly potent,” said Dr. Jane Cecil, who works at the Center.  She noted that new drugs have improved in almost every way over the medications of a decade ago. Therapies now have fewer side effects and are more effective at suppressing the virus. There are even “combination therapies,” like the drug Atripla, that are effective when prescribed as a single pill taken once a day.

“If they’re newly diagnosed with HIV, the majority of these patients now go on one-pill-once-a-day therapy. That’s pretty remarkable,” said Dr. Daniel Nixon, director of the VCU HIV/AIDS Center.

World Health Organization reports that since 2002, the number of people receiving antiretroviral treatment for HIV exploded by 2,216 percent between 2002 and 2010 — from 300,000 to 6.65 million.

This extensive battery of new medicines to treat HIV enables doctors to work around strains of the virus that become resistant to a certain class of drugs. Different classes attack the virus in different ways and at different stages in the virus’ development.

VCU’s Center negotiates contracts to administer medications in the advanced stages of clinical trials under closely-monitored circumstances. The drugs are usually in Phase III of the approval process, which means the medication is being administered to between 1,000 and 3,000 people to monitor side effects and confirm effectiveness. Once proven safe and effective in Phase III trials, a medicine can be considered by the U.S. Food and Drug Administration.

“(These medicines are) usually on the cusp of FDA approval, so maybe somewhere between six and 12 months in advance of what was already probably a six or eight year development process,” Nixon said.

The Center is working out the final contract now on a drug called Elvitegravir, a new one-pill-a-day version of a class of drugs called the integrase inhibitors. The drugs reduce the amount of HIV in a patient’s blood by blocking integrase, an enzyme key to HIV replication.

“If (a patient’s) virus is resistant to the existing medications, they would benefit from some of the newer things coming out and they need them sooner than later, rather than waiting on FDA approval,” Cecil said. “Treatment-experienced patients … really rely on having access to newer drugs. We can get them on newer agents that may be more effective than some of the existing drugs.”

With the growing list of effective, affordable and safe treatments, this chronic disease is becoming more manageable. Cecil said further advances in medications may reduce the frequency of medication to as little as once a week sometime in the near future. Medications are coming down the pipeline which she said have “very, very long half-lives.” The half-life of a medication is a measure of how quickly the body metabolizes, or breaks down, a medicine. If a drug is metabolized quickly, then it is only active in the body for a short amount of time. With a longer half-life, a newer drug could theoretically continue to be active in a patient’s body for a period of days or a week.

“We now have so many new drug classes available that it’s still quite easy to put together an effective regimen, even if someone’s infected with a resistant strain of virus,” Cecil said. “People can now live almost a normal lifespan with HIV, we think. We’ve now been following people for over 20 years with this infection.”

But for the most part, leading a long and healthy life with HIV involves ensuring patients are receiving the treatment — and making sure the patients are following through. Cecil said there are many obstacles to getting people with HIV into treatment.

“The biggest barrier tends to be, I would say, the stigma and the denial that goes along with finding out someone’s HIV infected. If we could get rid of that, it would take care of a lot of the problem of getting people into care,” Cecil said.

Cecil said depression and denial after an HIV positive diagnosis sometimes stand in the way of effective treatment. Other hurdles include poverty, education, substance abuse histories, mental health and the type and quality of previous healthcare, but these barriers are not insurmountable. Cecil said the level of treatment available now for HIV patients should encourage anyone with HIV to seek treatment.  

“HIV’s much more treatable than most chronic illnesses because the medications are so safe, so potent, so well-tolerated and affordable now with some of the payment sources that are available for patients regardless of their economic background,” Cecil said.

Nixon said that the Center still has problems with people who don’t reliably take medications for one reason or another and a lot of resources are devoted to ensuring that patients are following through with treatment.

“We get support by the Virginia Department of Health to pay for adherence counselors who spend their time with patients trying to help them take their medicines, setting up pill boxes, reminder visits, doing pill counts,” Nixon said. “It doesn’t really matter if patients are on therapy if they’re not taking it.”

Research done at MCV has been vital to shaping national policy. The Center has participated in studies to discern when during the HIV infection is the right time to start anti-retroviral therapies.

“The Department of Health and Human Services guidelines actually have all changed as a result of a lot of that research and we’re treating people earlier and earlier now,” Cecil said.

The Center is currently involved in a National Institutes of Health study called the “Strategic Timing of Anti-Retroviral Treatment” study, or START. The initiative is a broad, multicenter trial.

Nixon said the study will go beyond the basics of a clinical trial and examine the effects of HIV and the virus’ treatment on bones, lungs and the cardiovascular and neurologic systems in detail.

“All of these are affected by HIV and potentially affected by the treatment. To answer the question of when to start (HIV treatment), you have to take a look at the whole patient and not just a few parameters,” Nixon said. “I would call it a total-body approach that looks at all the total systems and not just one or two outcomes.”

Researchers have long looked beyond regular treatment to perhaps one day curing HIV.

In very rare cases, HIV has already been cured in individuals. Timothy Brown, the famed “Berlin Patient,” received a bone marrow transplant to treat leukemia in 2006. The donor had a rare genetic mutation that prevents HIV from entering the cells. Brown, once HIV positive, has been off of antiretroviral medications for five years and doesn’t exhibit any signs of the disease. According to research presented earlier this year at the 2012 International AIDS Conference, two more patients in Boston have been treated and cured in the same way.

However, bone marrow transplants are a very high-risk treatment and only occur in situations where patients need them for reasons beyond HIV. Researchers continue to seek a better, lower-risk option for a cure. At the Center, researchers are in the very early stages of developing strategies that will attempt to seek out the virus where it hides in the body and eradicate it.

While curing the disease would be a huge victory for researchers, perhaps more important would be the ability to prevent new infections.

“There is some promise in the area of the vaccine but I think that’s still a long way off and I think more important than treatment, honestly, is prevention,” Cecil said.

This is the second in a three-part series on HIV at VCU. Read part one here and part three here

9 Comments on The future of HIV treatment, research is now at MCV

  1. am from usa.am here to give my testimony about how i got my hiv disease and how i flew it quickly after having trust on my spell doctor who cured me immediately .since the year i married to the man i didnt love because my parents false me to marry him.i have been enjoying relationship and sex life with him .he do spend time on work and dont have time for me . sometime he do sleep at his work and also do carry women because he has the money to spend but doesnt spend it on me . so i was so jealous to the extent that i cant control my anger and i decided to start cheating on him with exboyfriend . because my husband donot always be at home except on weeend .i have sex with him without protection .after somemonths been in love with my exboyfriend i was so sick and decided to go have a test and i found i was hiv positive . i feel so sad and i was ashamed because i didnt now how to open up to my husband i hate before my exboyfriend denied me and when my husband found out about what wads going on he devoirced me and i was ill for good 3years i went to many places for solution but there was no solution . so one day i was asing GOOGLE some question on how i can get a cure and how i can get some medication which i will be taking to my own suprise they brought one email out named drogodomigodospiritualhome@gmail.com that this powerful man can cure hiv i didnt believe about the cure before but i toke the email and search it on GOOGLE and found many good testimonies about him people have been giving more testimonies about him so i contacted him about my situation . he told me all the procedures which i will take and i did before i knew what was happening he called me and told me to go for an hiv test which i did and when the result was out i was hiv negative .thanks to drogodomigodo now as i am giving this testimony am fully settled down with my husband now and we love ourselves .i give this testimony for people around that was in my shoes so that they can also be cured like me .so if you also need a solution also you can email him at DROGODOMIGODOSPIRITUALHOME@GMAIL.COM

  2. am from uk am here to give my testimony about how i got my hiv disease and how i flew it quickly after having trust on my spell doctor who cured me immediately .since the year i married to the man i didnt love because my parents false me to marry him.i have been enjoying relationship and sex life with him .he do spend time on work and dont have time for me . sometime he do sleep at his work and also do carry women because he has the money to spend but doesnt spend it on me . so i was so jealous to the extent that i cant control my anger and i decided to start cheating on him with exboyfriend . because my husband donot always be at home except on weeend .i have sex with him without protection .after somemonths been in love with my exboyfriend i was so sick and decided to go have a test and i found i was hiv positive . i feel so sad and i was ashamed because i didnt now how to open up to my husband i hate before my exboyfriend denied me and when my husband found out about what wads going on he devoirced me and i was ill for good 3years i went to many places for solution but there was no solution . so one day i was asing GOOGLE some question on how i can get a cure and how i can get some medication which i will be taking to my own suprise they brought one email out named drozallaspellhome@outlook.com that this powerful man can cure hiv i didnt believe about the cure before but i toke the email and search it on GOOGLE and found many good testimonies about him people have been giving more testimonies about him so i contacted him about my situation . he told me all the procedures which i will take and i did before i knew what was happening he called me and told me to go for an hiv test which i did and when the result was out i was hiv negative .thanks to drogodomigodo now as i am giving this testimony am fully settled down with my husband now and we love ourselves .i give this testimony for people around that was in my shoes so that they can also be cured like me .so if you also need a solution also you can email him at drozallaspellhome@outlook.com

  3. This is how a great spell caster helped me in getting rid of my HIV disease.
    I am Richards Stone from USA i was diagnosed of this disease for over three years without knowing until January this year. I thought all hope is lost, I was down I couldn’t join my colleagues in doing some certain things, truly I was in a great pain, I tried all my best to be happy again but I can’t, until a good friend of mine introduced a great spell caster to me who is DR ODI, saying that she saw many testimonies on how he helped people getting rid of their HIV Virus he gave me his email which is oyeyetemple@gmail.com, I spoke to him and being a kind man he quickly answered me. I told him my problems, he asked me to buy some items, and though I couldn’t find the items I sent him the money to buy the items for me. Which he did successfully, he cast the spell and asked me to go for medical checkup which I did, I didn’t believe when the doctor told me that am HIV negative, truly am still short of words, I thank DR ODI for the great deeds, if you are having a similar problem please contact him oyeyetemple@gmail.com or call +2348115531558

  4. i want to use this medium to let everyone know that HIV/AIDS has cure and that Dr.Ofemo is the solution.am Sarah Wilson from United State i was tested HIV/AIDS positive once year 2013, then early this month August 21 i saw so many testimony on blog on how Dr.Ofemo known as herbalist spiritual' cured people with his herbal medicine, i did not believe but i just decided to give him a try, I contacted him and he prepare the herbs cure for me which i took, after taking it in 2 week, he told me to go for check up, could you believe that i was confirm HIV/AIDS Negative after the test, and i went to a different hospital and it was also Negative, i am so happy. If you have any problem or you are also infected with any disease like Herpes, HIV, Cancer, Syphilis, Hepatitis B, all types of Cancer, Gonorrhea, and solves life's problems that you might have etc. kindly contact him now;drofemospelltemple@gmail.com thank you once again his email via drofemospelltemple@yahoo.com or his cell number +2348163387496

  5. i want to use this medium to let everyone know that HIV/AIDS has cure and that Dr.Ofemo is the solution.am Sarah Wilson from United State i was tested HIV/AIDS positive once year 2013, then early this month August 21 i saw so many testimony on blog on how Dr.Ofemo known as herbalist spiritual' cured people with his herbal medicine, i did not believe but i just decided to give him a try, I contacted him and he prepare the herbs cure for me which i took, after taking it in 2 week, he told me to go for check up, could you believe that i was confirm HIV/AIDS Negative after the test, and i went to a different hospital and it was also Negative, i am so happy. If you have any problem or you are also infected with any disease like Herpes, HIV, Cancer, Syphilis, Hepatitis B, all types of Cancer, Gonorrhea, and solves life's problems that you might have etc. kindly contact him now;drofemospelltemple@gmail.com thank you once again his email via drofemospelltemple@yahoo.com or his cell number +2348163387496 .

  6. I have been HIV positive for 3 years and long for the day to be free of this disease. I would love to be part of any trial that helped find the cure, i have an undetectable viral load and CD4 count of around 1100.
    I have tried almost everything but I couldn't find any solution on my disease, despite all these happening to me, i always spend a lot to buy a HIV drugs from hospital and taking some several medications but no relieve, until one day i was just browsing on the internet when i came across a great post of !Michelle! who truly said that she was been diagnose with HIV and was healed that very week through the help of this great powerful healing spell doctor ,I wonder why he is called the great Dr, Odia, i never knew it was all because of the great and perfect work that he has been doing that is causing all this. so I quickly contacted him, and he ask me some few questions and so i did all the things he asked me to do,He ask me to buy some herbs and which I did for my cure,only to see that at the very day which he said i will be healed, all the strength that has left me before rush back and i becomes very strong and healthy, this disease almost kills my life all because of me, so i went to hospital to give the final test to the disease and the doctor said i am HIV negative, i am very amazed and happy about the healing doctor Odia gave to me from the ancient part of Africa, you can email him now for your own healing too on his email: ( drodiaherbalistcenter@gmail.com ) or call him on +2348077306724. He is always able to help you get your heart desire granted…………….. I thank Dr, Odia

  7. Hello everyone here in this forum i am so glad that i have this great opportunity to come out here and share my testimony on how Dr Molemen was able to cure me totally from Hiv disease, i have been suffering from this Disease for approximately 4 Years now, i have tried various ways to get rid of this Virus out of my body, i have also purchase for Medical treatment from my doctor but they all failed, sometime back now while i was browsing the Internet i found some good quote concerning Dr Molemen Herbal Medicine, and how he has been using it to save souls from Different Disease including Cancer, someone also said she was been cured of Hiv from his medicine, and they gave out his contact details in case anyone needs his help, i decided to contact Dr Molemen and i told him about my Hiv illness he told me not to worry that he was going to send me his herbal medicine all i was to do is to send him my personal details and also my home address so he can post the Medicine to me, actually i did all that was required by this Man, i took the medicine just as prescribe by him, he told me to go for check up in the hospital which i did and to my great surprise my Doctor told me the Hiv Virus was no longer there, i even went to other hospital for better confirmation its was still the same thing, Today i am so happy that i am Negative again, Dr Molemen has given me reasons to share tears of Joy, you can reach to Dr Molemen on his email address at ( drmolemenspiritualtemple@gmail.com / dr.molemenspiritualtemple@yahoo.com) or call him on +2347036013351

  8. Hello,
    I was diagnosed of this HIV deadly disease a friend of mine introduce
    Dr oba to me and I actually did contact him after he has prepare what
    he said he will do and he sent it to me and I used it according to his
    prescription after one week I went to the hospital to check my status
    again because I was feeling differently from the way I used when I was
    tested POSITIVE to my greatest surprise the status was NEGATIVE the
    medical doctors there was surprise and I have to tell the whole world
    about this if you are still having this similar problem I recommend
    you to Dr oba for you here is his email dr.obaherbalhome@hotmail.com or dr.obaherbalhome1@gmail.com
    call him on +2348151943640 or contact him on (Facebook Dr Oba Herbs) or email me on benatialopez@gmail.com

  9. Happiness is all i see now I never thought that I will live on earth before the year runs out. I have been suffering from a deadly disease (HIV) for the past 3 years now; I had spent a lot of money going from one places to another, from churches to churches, hospitals have been my home every day residence. Constant checks up have been my hobby not until this blessed day, I was searching through the internet, I saw a testimony on how DR Camala helped someone in curing his HIV disease, quickly I copied his email which is dr.camalahivaidscure@yahoo.com just to give him a test I spoke to him, he asked me to do some certain things which I did, he told me that he is going to provide the herbal cure to me, which he did, then he asked me to go for medical checkup after some days after using the herbal cure, I was free from the deadly disease, he only asked me to post the testimony through the whole world, faithfully am doing it now, please brothers and sisters, he is great, I owe him in return. if you are having a similar problem just email him on ( dr.camalahivaidscure@yahoo.com )

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