The Quest for an HIV Cure Looms Large

By: Sarah Hooper, intern, ADAP Advocacy Association, and senior at East Carolina University

Earlier this year, it was revealed by the National Institutes of Health (NIH) that it would pump $14.6 million into a HIV research program headed up by the University of Southern California (USC) and the Fred Hutchinson Cancer Research Center. The aim of the research program is to eliminate the need for HIV patients to take daily medication, and to hopefully achieve an overall cure. 

Photo Source: RT News App

According to End Points News, the therapy would allow a patient’s own stem cells to fight the HIV infection and allow them to make new immune cells when the infection is fought. (End Point News)

“The approach was inspired by three patients who appear to have been cured of the virus — all of whom received blood stem cell transplants from donors who carried a mutation in the CCR5 gene. One of them, dubbed the “Berlin patient,” had been off antiretroviral drugs from 2007,” End Point News said.

In 2006, Timothy Ray Brown (also known as the Berlin patient) was diagnosed with myeloid leukemia. In 2007, Brown received two bone marrow transplants, and halted his HIV medications in the process (ScienceMag). Since the bone marrow transplant, researchers have only found traces of HIV, none of which is able to replicate in Brown’s system- effectively curing him of HIV.

NIH’s new research program is using similar technology in its search to find a cure for HIV. By using stem cells to fight the disease, the need for medication is much lesser, as one’s own body can fight HIV. However, the process Brown went through to fully cure himself of HIV is intense.

“The first is the process of conditioning, in which doctors destroyed Brown’s own immune system with chemotherapy and whole-body irradiation to prepare him for his bone marrow transplant. His oncologist, Gero Hütter, who was then with the Free University of Berlin, also took an extra step that he thought might not only cure the leukemia but also help rid Brown’s body of HIV. He found a bone marrow donor who had a rare mutation in a gene that cripples a key receptor on white blood cells the virus uses to establish an infection. The third possibility is his new immune system attacked remnants of his old one that held HIV-infected cells, a process known as graft versus host disease,” ScienceMag said. 

In September 2020, Brown passed away from his cancer, and the HIV community mourned his loss.

Photo Source: HIV Plus Magazine

The search for a cure to HIV has been ongoing since the virus was discovered. Treatment with antiretrovirals has been a massive step away from a death sentence and towards a normal life for HIV patients. The issue with the HIV virus is it can be hidden in cells while being suppressed by current HIV treatment. The only HIV patients who have been successfully cured of the virus were also undergoing intense treatments for a separate cancer diagnosis, according to ViiV Healthcare. 

These patients underwent a bone marrow transplant in which an HIV free bone marrow was placed in their body, which is a high-risk surgery as is. 

“While their treatments were extremely high risk and not amenable to wide scale implementation, these instances of cure bring hope of what is possible in our efforts to end the HIV epidemic,” ViiV Healthcare said. 

The NIH initiative to eliminate the need for daily medication is an incredible effort made available by years of previous research and effective treatment. If successful, this effort could change the lives of millions of HIV patients in the United States and around the world. 

References:

• A cure for HIV the end goal. (n.d.). Retrieved September 17, 2020, from https://viivhealthcare.com/en-gb/our-stories/innovation-hiv-science/towards-a-cure-exploring-cure-and-remission-in-hiv/
• DeFeudis, N. (2020, September 03). Researchers teamed up to develop a 'three in one' HIV treatment - and the NIH is throwing in $14.6M. Retrieved September 16, 2020, from https://endpts.com/researchers-teamed-up-to-develop-a-three-in-one-hiv-treatment-and-the-nih-is-throwing-in-14-6m/
• Jon Cohen Sep. 25, 2., Meredith Wadman Sep. 16, 2., Adrian Cho Sep. 15, 2., Ian Morse Sep. 14, 2., Eli Cahan Sep. 14, 2., Scott Waldman, E., . . . Rebekah Tuchscherer Aug. 26, 2. (2017, December 10). How did the 'Berlin patient' rid himself of HIV? Retrieved September 16, 2020, from https://www.sciencemag.org/news/2014/09/how-did-berlin-patient-rid-himself-hiv

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

How Drug Imports Can Endanger Patients

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

I was diagnosed with HIV just shy of my 30th birthday. That day, everything changed. I was apprehensive about my prognosis, my treatment plan, and my ability to live a normal life.

That was me in 2001 (pre-Dx)

Fortunately, medical advances have turned HIV from a certain death sentence into a manageable condition. Still, like all Americans who depend on complex medications to stay healthy, I worry about high drug prices, and this concern has only intensified amid the COVID-19 pandemic. Especially since some of the proposed "solutions" to high drug prices would put patients' health at risk.

Just recently, the Trump administration announced that it would allow states to import prescription medications from Canada with the aim of saving money for consumers. Doing so, though, could expose millions of Americans to counterfeit drugs, while achieving little in the way of savings.

I've seen firsthand how importation schemes can put patients at risk.

Shortly after learning I was HIV-positive, I ordered my anti-retroviral drugs from an online Canadian pharmacy. For two months, I received medications via mail without ever wondering where they were sourced or whether they contained the active ingredients I needed to keep me alive.

Then my doctor intervened. She told me that drugs purchased through online storefronts are often adulterated or counterfeit—in fact, the global trade in fake medicines is a $30 billion-a-year business. Unknowingly, I had been rolling the dice with my health.

There are two types of counterfeit drugs. The first contains potentially deadly substances—everything from arsenic to antifreeze. The second contains few, if any, active ingredients. Though pills in the latter category don’t contain actual poisons, they can be just as deadly.  Anti-retroviral drugs have to be taken exactly as prescribed; missing even a few doses can allow the virus to reemerge.

There is no mechanism in place to regulate the quality of drugs imported by American patients. A senior official at Health Canada explicitly told the US surgeon general that her agency "does not assure that products being sold to U.S. citizens are safe, effective, and of high quality." The FDA, meanwhile, plainly states that it "cannot ensure the safety and effectiveness of drugs that it has not approved."

Photo Source: PolicyMed.com

Moreover, drugs purportedly from Canada could come from anywhere. A 2017 study by the National Association of Boards of Pharmacy found that three-quarters of online pharmacies claiming to sell Canadian drugs actually sourced their products from places like India, Singapore, and Hong Kong, all major suppliers of counterfeits. Back in 2005, the FDA reported that only 15% of imported drugs marketed as Canadian actually originated in Canada. The other 85% came from "27 countries around the globe," meaning that many likely didn't go through rigorous quality control.

It's relatively easy to get hoodwinked by online pharmacies that promise quality drugs at bargain prices. CanadaDrugs.com, for instance, started out in 2001 as a seemingly reputable online pharmacy. But soon it turned to distributors outside of Canada to secure medicines. In 2018, a U.S. court prosecuted and fined the company for selling fake cancer drugs to American doctors.

Counterfeiters have shown they are willing to prey on people living with all kinds of diseases, including HIV. In 2011, a British regulatory agency discovered that two fake HIV medications had infiltrated the market and were circulating among patients.

Opening the door to drug imports would allow that kind of thing to happen here, putting us all at risk. And it's not even certain that legalizing importation would cut costs. The FDA acknowledges that it is "unable to estimate the cost savings" from President Trump's new plan. Former FDA Commissioner Scott Gottlieb wrote that "when importation of foreign drugs is done under a regulated scheme, it really wouldn't save money."

Right now, Americans are anxious enough about our health. Let's not add drug imports to our list of things to worry about.

This opinion piece was also published in the November 1st edition of the International Business Times.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Biden & Science Win; Trump & Stigma Lose

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

On Saturday, November 7th at 11:25 AM Eastern Standard Time, people living with HIV/AIDS breathed a collective sigh of relief as the Associated Press called the 2020 Election, and recognized Joseph R. Biden, Jr. as the 46th President-Elect of the United States. In that very moment, science bested stigma. The electoral landslide turned the page on a dark chapter in this nation's history. As a 501(c)(3) nonprofit organization the ADAP Advocacy Association stayed neutral during the election for obvious reasons, but we welcomed the news with open arms!

Soon to be gone are Donald J. Trump's constant attacks on vulnerable populations disproportionately impacted by HIV/AIDS - such as the LGBTQ community, Muslims, racial & ethnic minorities, and immigrants. They will be replaced by compassion, empathy, and a keen understanding that sound public health policies are rooted in science.

Since 2016, HIV-related stigma was fueled by government sanctioned healthcare discrimination, eliminating most non-discrimination protections, and the discharge of military service members living with HIV/AIDS, only naming a few. Not to mention there were numerous misguided public health changes harmful to the HIV community driven by politics rather than sound policy, such as drug importation, pro-insurance co-pay accumulator regulations, raiding Ryan White funding for immigrant deportation, and proposed budget cuts. And don't forget how Trump’s anti-FDA Tweets undermine public health!

And that doesn't even consider the nearly 250,000 deaths due to COVID-19 resulting from Trump's lack of presidential leadership. But our nation's poor response to the coronavirus didn't come as any surprise considering that Trump tapped anti-LGBTQ, anti-science Vice-President Mike Pence. After all, Pence was the same guy who, as Indiana's Governor, oversaw one of the Hoosier State’s worse HIV outbreaks in the state's history.

But all of that darkness is about to change...

Starting on January 20, 2021, a brighter future awaits the LGBTQ community under the Biden-Harris Administration's commitment to advance equality. This change alone is significant, considering how new HIV-infections continue to disproportionately impact much of the LGBTQ community. Since the 1990s, President-Elect Biden has been a strong supporter of the Ryan White HIV/AIDS Program and its AIDS Drug Assistance Program, as well as a staunch ally of President George W. Bush's President’s Emergency Plan for AIDS Relief (PEPFAR). 

Jirair Ratevosian, M.P.H., who served as the Legislative Director for HIV/AIDS Caucus Co-Chair Rep. Barbara Lee, summarized Biden's support for HIV-related causes (The Body, 2020):

"The vice president’s prioritization of HIV/AIDS programs continued after his Senate career. The Obama-Biden administration delivered major advances in prevention and treatment efforts for people living with HIV. The Affordable Care Act (ACA) assisted Americans living with HIV by eliminating preexisting conditions and provided them with much-needed health insurance. In addition, the Obama-Biden administration eliminated the entry ban for tourists and immigrants living with HIV; ensured HIV testing would be covered under the ACA; implemented a comprehensive National HIV/AIDS Strategy; and directed federal agencies to examine the intersection of HIV with violence against women and gender-related health disparities. The programs under ACA had an important impact on addressing HIV prevention and treatment in communities of color."

Biden has made his intentions clear: "You deserve a partner in the White House to fight with conviction and win the battles ahead. Together we’ll pass the Equality Act, protect LGBTQ+ youth, expand access to health care, support LGBTQ+ workers, win full rights for transgender Americans, recommit to ending the HIV/AIDS epidemic by 2025, advance LGBTQ+ rights around the globe, not just at home" (Artavia, 2020). 

Women - especially women of color - will also have a brighter future under the Biden-Harris Administration. Vice-President-Elect Kamala Harris will be well-positioned to ensure more is done for African American women and Latina women, who as we all know are disproportionally impacted by HIV/AIDS in the United States.

Biden's record on public health isn't perfect, but it is far better than what we've witnessed the last four years. The ADAP Advocacy Association stands ready to aid the Biden-Harris Administration's efforts to return our nation's HIV epidemic response to science-based policies.

References:

• Artavia, David (2020, September 25). Joe Biden Recommits to Ending HIV, Passing Equality Act, LGBT+ Rights. Out. Retrieved online at https://www.out.com/politics/2020/9/25/joe-biden-recommits-ending-hiv-passing-equality-act-lgbt-rights. 
• Ratevosian, Jirair (2020, July 27). Joe Biden Is Our Strongest Option to End the HIV Epidemic. The Body. Retrieved online at https://www.thebody.com/article/joe-biden-strongest-option-to-end-hiv-epidemic.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

HIV & COVID-19 in Southern Black Communities

By: Venton C. Hill-Jones, Chief Executive Officer, Southern Black Policy & Advocacy Network

It is no secret that Black Americans in the U.S. South lead our nation in diagnoses and deaths caused by HIV, cancer, diabetes, hypertension, obesity, high cholesterol and lack of mental health resources. Knowing this, it came as no surprise that the Black community would also lead the nation per capita in diagnosed and undiagnosed cases of COVID-19, as well as the virus’ mortality rate. According to amfAR, The Foundation for AIDS Research, Black communities are facing a disproportionate impact of COVID-19 in the U.S. South. 

In a May 2020 study conducted by amfAR, it was reported that in the United States: “COVID-19 diagnoses and deaths increased in counties with a greater proportion of Black residents. While disproportionately Black counties constitute only 22% percent of U.S. counties, they account for 52% and 58% of COVID-19 cases and deaths, respectively. Ninety-one percent of disproportionately Black counties are located in the Southern U.S.” 

During the COVID-19 pandemic, SBPAN has worked to utilize social media and digital engagement (web meetings, virtual conferences, etc.) to continue the dialogue with Black public health and community leaders representing, and serving, these Southern Black communities. Through our engagement, we have found that many leaders feel that, prior to COVID-19 pandemic, conversations and actions surrounding the overarching state of public health in the South were limited. As a result, Black communities living in the U.S. South face a disproportionally high number of health disparities directly linked to the social and economic barriers rooted in the unique history of racism, religion, segregation, and slavery in the U.S. South. Because of this environment, the U.S. South remains the epicenter of health disparities that continue to reduce the morbidity and mortality of Black communities living in this part of the United States.

As we navigate the COVID-19 pandemic, social unrest and the ongoing call for racial equity in the South, we must focus our conversations and mobilization efforts on addressing intersecting epidemics and social challenges. Now is not the time to regress in having open dialogues, showing human solidarity and human perseverance, nor showing collective support for our society. Look at how promptly we bonded together to administer personal prevention essentials (PPE), enacted federal/state legislations and local ordinances to assist families and individuals with food, housing, and supplemental income that have been financially impacted, or ensured everyone that wants to get tested has the unencumbered availability to do so. Now imagine if we utilized those same strategies, focus, and fortitude and applied them to the same public health emergencies that will remain once COVID-19 is gone?  

People living with HIV/AIDS in the Black community mirror the same external barriers that require the exact same meaningful impact that we have responded to COVID-19 with. There are basic human right essentials including employment and housing that we need all local municipalities to pass anti-discrimination ordinances against. Only through solidarity and perseverance can we collectively make further progress in addressing health disparities for southern Blacks."

About the Southern Black Policy & Advocacy Network. SBPAN is a non-profit 501(c)(3) organization that was created in 2018 to improve health, social, and economic conditions facing Black communities living in the U.S. South. SBPAN's mission is to improve health outcomes and reduce social, and economic disparities impacting Black communities living in the U.S. South through training, education, advocacy and mobilization. SBPAN is committed to building and strengthening programs and partnerships focused on improving the health and quality of life for diverse populations of Black southern communities in the U.S., specifically those living at the intersection of marginalized Black communities including, but not limited to those who are same gender loving (SGL), lesbian, gay, bisexual, transgender (LGBT), youth, women, and persons over the age of 55. Donate to Southern Black Policy and Advocacy Network.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.