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1. +
The Future
of HIV/AIDS:
Treatment &
Medication
QUEST
Testimony
May 14, 2013
Mr. Canavero
Mr. Phillips
Akash Mody
ID # 142104
EQ: What is the future of
HIV/AIDS medication and
which therapies will be
effective? What services
are available to HIV/AIDS
patients in the San
Francisco Bay Area?
2. +
Essential Question
What is the future of HIV/AIDS
medication and which therapies will be
effective? What services are available to
HIV/AIDS patients in the San Francisco
Bay Area?
3. +
Sirika Pillay
Stanford Researcher
PhD in Immunology and MSc in Molecular and Cellular
Biology
Pillay, Sirika. Personal Interview. November 20, 2012
“Antiretroviral drugs
are effective
medication against
HIV, and have made
HIV no longer
terminal. People can
still live healthy lives
and live with HIV”
(Pillay).
4. +
HIV Treatment: History
AZT
1st drug approved by FDA.
AZT interferes with virus replication.
AZT can control HIV for a year, after that it will become ineffective.
Drug Combination/Cocktail
A drug cocktail is a dose of medication that includes several different
drugs.
Clinical studies have shown that in most cases HIV infection is more
effectively treated with a combination of drugs. This has led to the
development of different anti-viral cocktails.
The medical drug class for these drugs are called Fixed-Dose
Combination.
DiSpezio, Michael A. "HIV Transmission." The Science, Spread, and Therapy of HIV Disease: Everything You Need to
Know, But Had No Idea Who to Ask. Shrewsbury, MA: ATL, 1998. 52-65. Print.
5. +
HIV Treatments: The Currents
May 2, 2013 – New Drug Therapy
Researchers recently discovered that synthetic
anti-inflammatory substances distantly related to the
active ingredient of marijuana may be able to take
the punch out of HIV while inside one of its major
hideouts: immune cells called macrophages.
April 9, 2013 – Connection to Consultant
In South Africa, people with HIV who start treatment
with antiretroviral therapy have life expectancies
around 80% of that of the general population provided
that they start treatment before their CD4 count drops
below 200.
Public Library of Science. "Treatment leads to near-normal life expectancy for people with HIV in South Africa." ScienceDaily, 9 Apr. 2013. Web. 10
Apr. 2013.
Temple University Health System. "Scientists weaken HIV infection in immune cells using synthetic agents." ScienceDaily, 1 May 2013. Web. 2 May
2013.
6. +
HIV Treatments: The Currents (Cont.)
April 2, 2013 – Self-Testing
A new international study has confirmed that self-
testing for HIV is effective and could be the answer to
controlling the global epidemic.
This systematic review shows HIV self-testing removes much
of the fear and stigma associated with being tested for the
disease.
This study could pave the way for early detection and
treatment around the world, thereby reducing transmission.
March 3, 2013 – First “Fully Functional Cure”
A team of researchers from Johns Hopkins Children's Center,
the University of Mississippi Medical Center and the University
of Massachusetts Medical School describe the first case of a
so-called "functional cure" in an HIV-infected infant.
The finding, the investigators say, may help pave the way to
eliminating HIV infection in children.
McGill University Health Centre. "HIV self-testing: The key to controlling the global epidemic." ScienceDaily, 2 Apr. 2013. Web. 10 Apr. 2013.
University of Massachusetts Medical School. "Researchers describe first 'functional HIV cure' in an infant." ScienceDaily, 3 Mar. 2013. Web. 10 Apr.
2013.
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July 2012 – PrEP and PEP
The FDA approved a combination medication for use
as PrEP among sexually active adults at risk for HIV
infection.
PrEP is short for Pre-Exposure Prophylaxis. It is a
new HIV prevention method in which people who do
not have HIV take a daily pill to reduce their risk of
becoming infected.
"Pre-Exposure Prophylaxis (PrEP)." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Aug. 2012.
Web. 8 Jan. 2013. http://www.cdc.gov/hiv/prep/.
HIV Treatments: The Currents (Cont.)
8. +
Potentials to Lower HIV/AIDS Rates
1. Continued Research:
HIV
Interactions
Structure
Diagnosable Solution- After you are diagnosed with HIV
Drug Combinations
Prevention- Before you are actually diagnosed from HIV
Vaccinations
2. Education- What we already know.
Abstain from activities that involve blood-to-blood contact
Practicing safe sex
Use sterile needles
Know your HIV status
9. +
Continued Research on HIV
April 17, 2013 – Understanding HIV Structure
Researchers have discovered how the protein that blocks
HIV-1 from multiplying in white blood cells is regulated.
HIV-1 is the virus that causes AIDS, and the discovery
could lead to novel approaches for addressing HIV-1 “in
hiding” – namely eliminating reservoirs of HIV-1 that
persist in patients undergoing antiretroviral therapy.
April 4, 2013 – Update on Vaccination Therapy
Observing the evolution of a particular type of antibody in
an infected HIV-1 patient, a new study has provided
insights that will enable vaccination strategies that mimic
the actual antibody development within the body.
Albert Einstein College of Medicine of Yeshiva University. "Discovery may help prevent HIV: Insights into eliminating reservoirs of HIV-1."
ScienceDaily, 17 Apr. 2013. Web. 29 Apr. 2013.
DOE/Los Alamos National Laboratory. "Antibody evolution could guide HIV vaccine development." ScienceDaily, 4 Apr. 2013. Web. 10 Apr.
2013.
10. +
October 2009 – First Vaccine Test
Vaccination tests conducted
in Thailand, among 16,400
participants had a 31% rate
of protection.
While the rate of protection
showed historic results, it
was negligible since 69% still
contracted the virus.
Therefore doctors are unable
to use this vaccine on
patients.
Porter, Lance, ed. "Thai HIV Vaccine Trial Produces Historic Positive Results." HIV Positive Oct.-Nov. 2009: 42-44. Print.
Continued Research on Vaccinations
11. +
SF HIV Prevention Planning
Council (HPPC)
Public Comment
Listened to council and
other county members
Discussed with board
directors.
12. +
Frank Strona- Director of
STD Prevention
Charles Fann and
Robert Blue- PrEP
and PEP
Erin Antunez- LINCS
13. +
Serving the AIDS
Community
ACRC (AIDS Community Research Consortium)
Food Service
Needle Exchange
Stretching Exercise
14. +
Gratification
Packed canned food for
patients diagnosed with HIV or
AIDS, who can not afford
them.
Bags included whole
balanced meals.
I talked with patients living with
AIDS.
15. +
Contribution
Volunteered at a non-profit
organization to help pack meals.
Distributed packed meals for walk-in
AIDS patients, who can not afford to
pay for these meals.
Helped lengthen the lifespan of
patients by providing health options.
17. +
PROTEASE INHIBITORS (PIs)
BRAND NAME GENERIC NAME COMPANY DATE APPROVED
Invirase Saquinavir Roche Dec. 6, 1995
Norvir Ritonavir Abbott Mar. 1, 1996
Crixivan Indinavir Merck Mar. 13, 1996
Viracept Nelfinavir ViiV Healthcare Mar. 14, 1997
Kaletra Lopinavir/Ritonavir Abbott Sep. 15, 2000
Reyataz Atazanavir Bristol-Myers Squibb Jun. 20, 2003
Lexiva (U.S.)
Telzir (Europe)
Fosamprenavir ViiV Healthcare Oct. 20, 2003
Meltrex Formulation Lopinavir/Ritonavir Abbott 2005
Aptivus Tipranavir Boehringer Ingelheim Jun. 22, 2005
Prezista Darunavir Tibotec Jun. 23, 2006
Protease Inhibitors (PIs)
A protease inhibitor is a chemical that hinders the actions of protease.
“PIs [Protease Inhibitors] block the protease enzyme and prevent the cell from
producing new viruses” (“Protease Inhibitors” par. 1).
By meddling with this enzyme, proteins essential to the virus replication are not
reproduced. In this way, the HIV virus fails to take over the host cell.
Using a single protease inhibitor is not effective, as the HIV DNA will form a
resistant strain; using multiple protease inhibitors as drug combinations are
effective because when one drug fail, the other drugs kick in terminating the
resistant strains.
"Protease Inhibitors (PIs)." AIDS Meds. N.p., 14 Nov. 2012. Web. 22 Apr. 2013. <http://www.aidsmeds.com/archive/PIs_1068.shtml>.
19. +
Nucleoside/Nucleotide Reverse
Transcriptase Inhibitors (NRTIs)
Nucleoside/Nucleotide Reverse Transcriptase (NRTIs) slows the replication process of HIV
DNA.
“NRTIs, sometimes called „nucleoside analogues‟ or „nukes,‟ contain faulty versions of the
building blocks (nucleotides) used by reverse transcriptase to convert RNA to DNA. When
reverse transcriptase uses these faulty building blocks, the new DNA cannot be built
correctly. In turn, HIV's genetic material cannot be incorporated into the healthy genetic
material of the cell and prevents the cell from producing new virus” (“Nucleoside” par. 2).
In this way, the HIV will infect a cell but will not be able to make a new virus from that cell.
AZT, mentioned previously, falls under the drug class NRTI.
"Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)." AIDS Meds. N.p., 31 Jan. 2012. Web. 22 Apr. 2013. <http://www.aidsmeds.com/
archive/NRTIs_1082.shtml>.
NUCLEOSIDE/NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs)
BRAND NAME GENERIC NAME COMPANY DATE APPROVED
Retrovir Zidovudine (AZT) ViiV Healthcare Mar. 19, 1987
Zerit Stavudine (d4T) Bristol-Myers Squibb Jun. 24, 1994
Epivir Lamivudine (3TC) ViiV Healthcare Nov. 17, 1995
Ziagen Abacavir ViiV Healthcare Dec. 17, 1998
Videx Didanosine (ddI) Bristol-Myers Squibb 1999
Videx EC Didanosine (ddI) Bristol-Myers Squibb Oct. 31, 2000
Viread Tenofovir Gilead Oct. 26, 2002
Emtriva Emtricitabine (FTC) Gilead Jul. 2, 2003
20. +
NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs)
BRAND NAME GENERIC NAME COMPANY DATE APPROVED
Viramune Nevirapine Boehringer Ingelheim Jun. 21, 1996
Rescriptor Delavirdine ViiV Healthcare Apr. 4, 1997
Sustiva (U.S.)
Stocrin (elsewhere)
Efavirenz Bristol-Myers Squibb Sep. 17, 1998
Intelence Etravirine Tibotec Jan. 18, 2008
Edurant Rilpivirine Tibotec May 20, 2011
Non-Nucleoside/Nucleotide Reverse
Transcriptase Inhibitors (NNRTIs)
NNRTIs work similar to NRTIs, but activate a different protein to
prevent the DNA from replicating into a new virus.
Nucleoside and Non-nucleoside analogs are drugs that target
the copying of genetic information by HIV.
“NNRTIs, also known as „non-nucleosides‟ or „non-nukes‟ for
short, attach themselves to reverse transcriptase and prevent
the enzyme from converting RNA to DNA. In turn, HIV's genetic
material cannot be incorporated into the healthy genetic
material of the cell, and prevents the cell from producing new
virus” (“Non-Nucleoside” par. 1).
"Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)." AIDS Meds. N.p., 22 June 2011. Web. 22 Apr. 2013. <http://www.aidsmeds.com/
archive/NNRTIs_1612.shtml>.
22. +
Other Drug Classes
Fusion Inhibitors, CCR5 Antagonists, and Integrase Inhibitor area all
Entry Inhibitor Drugs.
CCR5 and Integrase are the proteins located on the cell wall of host
cells, to which the HIV virus attaches to.
“Entry inhibitors target the CD4 protein or the CCR5 or CXCR4
receptors on a CD4 cell's surface. If entry inhibitors are successful in
blocking these proteins, HIV is unable to bind to the surface of CD4
cells and gain entry into the cells” (“Entry Inhibitors” par. 2).
In this way, the HIV virus is unable to gain entry into the host cell at all
and unable to create a new HIV virus.
“HIV-positive people who have become resistant to PIs, NRTIs, and
NNRTIs will likely benefit from the entry inhibitors because they are a
different class of drugs” (“Entry Inhibitors” par. 4).
OTHER CLASSES
BRAND NAME GENERIC NAME COMPANY DATE APPROVED
Fuzeon Enfuvirtide (T-20; Fusion Inhibitor) Roche/Trimeris Mar. 13, 2003
Selzentry (U.S.)
Celsentri (elsewhere)
Maraviroc (CCR5 Antagonist) ViiV Healthcare Sep. 18, 2007
Isentress Raltegravir (Integrase Inhibitor) Merck Oct. 12, 2007
"Entry Inhibitors (including Fusion Inhibitors)." AIDS Meds. N.p., 16 Sept. 2011. Web. 22 Apr. 2013. <http://www.aidsmeds.com/archive/
EIs_1627.shtml>.
24. +
FIXED-DOSE COMBINATIONS
BRAND NAME GENERIC NAME COMPANY DATE APPROVED
Combivir Zidovudine/Lamivudine
(NRTI)
ViiV Healthcare Sep. 27, 1997
Trizivir Zidovudine/Lamivudine/Abacavir
(NRTI)
ViiV Healthcare Nov. 14, 2000
Epzicom (U.S.)
Kivexa (Europe)
Lamivudine/Abacavir
(NRTI)
ViiV Healthcare Aug. 2, 2004
Truvada Tenofovir/Emtricitabine
(NRTI)
Gilead Aug. 2, 2004
Atripla Tenofovir/Emtricitabine/Efavirenz
(NRTI/NNRTI)
Gilead/
Bristol-Myers Squibb
Jul. 6, 2006
Complera Tenofovir/Emtricitabine/Rilpivirine
(NRTI/NNRTI)
Gilead/Tibotec 2011
Stribild Tenofovir/Emtricitabine/Elvitegravir/Cobicistat
(NRTI/Integrase Inhibitor)
Gilead 2012
Drug Combinations/Fixed-Dose Combination
Fixed-Dose Combinations are the drug class for drug combinations/cocktails.
Fixed-Dose Combinations are “capsules or tablets that contains two or more drugs. This
type of drug formulation allows a patient to take multiple drugs at on time to decrease pill
burden and increase adherence” (“Fixed-Dose Combination”).
The last four drugs in the fixed-dose combination, Truvada, Atripla, Complera, and
Striblid, are considered PrEP and PEP.
These drugs include Tenofovir and Emtricitabine.
"Fixed-Dose Combination." Health HIV. N.p., 2013. Web. 21 Apr. 2013. <http://www.healthhiv.org/modules/info/glossary_of_hiv_terms.html>.
26. +
So, what is the future of HIV/AIDS
medication and which therapies will
be effective, and which service are
available in the SF Bay Area?
Education is the best prevention from a non-medical aspect.
Practicing safe sex and using sterile needles will lower the HIV/AIDS
spread.
From my research, I have found that drug cocktail is the best method of
medication.
PrEP and PEP seem to be the most effective.
Administer antiretroviral drug therapy before the CD4 count drops 200.
Patients who are diagnosed with AIDS should try to maintain healthier
lifestyles that includes eating whole balanced meals, exercising daily, and
sleeping the required 8 hours of sleep.
27. +
The Future
Continued research of the interactions between blood cells and the
HIV is required, although new research on the “proteins that blocks
HIV-1 from multiplying in white blood cells is regulated” and “observing
the evolution of a particular type of antibody in infected HIV-1 patients”
seem promising.
Vaccination is a near possibility from a “prevention” method aspect, as
opposed to drug “treatment” method.
Services in SF Bay Area
San Francisco provides a free partner service to potentially new HIV patients
as part of the LINCS Service.
This service allows patients to know their HIV status, which can allow
new HIV patients to stop the spread of HIV before they infect other
partners.
ACRC, in San Mateo, provides free whole balanced meals to AIDS patients
those who cannot afford them. They also offer free stretching class to improve
overall fitness and needle exchanges to prevent further spread.
I started my project to learn about the what is the future of HIV/AIDS effective therapies.Hence I formulated my question, “What is the future of HIV/AIDS medication and which therapies will be effective?”
I connected with Sirika Pillay, a Stanford Researcher. She holds a PhD in Immunology and MSc in Molecular and Cellular Biology.She inspired me during our interview, when she mentioned, ““Antiretroviral drugs are effective medication against HIV, and have made HIV no longer terminal. People can still live healthy lives and live with HIV.”
In order to learn about the future treatments and medication of HIV, we first need to learn about the history of HIV treatment.AZT was the first drug approved by the FDA, that interferes with virus replication. After the first year, HIV becomes ineffective.Another option is Drug Combination or Drug Cocktail. A drug cocktail is a dose of medication that includes several different drugs, and these have proven to be more effective lately.
Coming to the current event, it has been proved in South Africa, that patients who start the antiretroviral drugs will improve their life expectance to around 80% of the general population. This affirms Sirika’s statement, at the beginning, about HIV patients living healthier lives.
March 3, 2013 was a major breakthrough in the battle against HIV. Medical advancements have helped to eliminate HIV infection in a child. The first functional cure is a beacon of hope to future medical researchers.July 2012 was also a major month for HIV treatments. PrEP and PEP, which are the currently used drugs, are approved by the FDA.
My main experience event was attending the SF HIV Prevention Planning Council meeting, where I gave my own public comment. I listened to several council member and discussed with board members about the future advancements in HIV.
Among the board directors that I discussed with, Frank Strona helped my project a lot. He helped set up meetings with other important HIV experts in San Francisco. I met with Charles Fann and Robert Blue who are PrEP and PEP experts. I also met with Erin Atunez from LINCS, a partner service in San Francisco.
Since I was unable to volunteer at LINCS, I found a non-profit organization- ACRC. AIDS Community Research Consortium provides services such their food service, needle exchanges, and their stretching exercise. I was however only able to volunteer at their food services and help set for the stretching exercise class.
At ACRC, I packed canned food that would be later distributed for HIV/AIDS patients who can not afford them.
When I was packaging a bag, an AIDS patient walked in and I handed him a bag of healthy meals. I knew that in the long run, I would help that patient maintain a healthier lifespan by providing a whole balanced diet.
After I had met with Robert Blue, I decided to make a list of all HIV drugs approved by the FDA. When I met with Robert Blue the second time, he had informed me the at last three drugs on the list are PrEP/PEP drugs, along with Truvada. In order to be classified as PrEP/PEP a drug must contain Tenofovir and Emtricitabine.When I showed the list of PrEP/PEP drugs to my service coordinator, Milton quickly pointed out that Atripla has many side effects, mainly by the third drug in the combination. Efavirenz has many side effects, as shown by the table on the left. This has helped me to answer my essential question, that while PrEP/PEP are effective drug combinations, a patients should be careful in their selection.
So my answer so far is not complete yet. My prior knowledge still the best suggestions: practicing safe sex and using sterile needles. My research confirmed that drug cocktails are the best preventive medications, among which PrEP and PEP are the most effective. Patients who enter the AIDS stage should maintain healthy lifestyles by eating whole balanced meals, and exercising daily.
I hope that one day, these images of HIV virus will no longer be associated with fear among researchers and patients. Thank you for listening to my presentation.