AIDS cure is here
posted by god 953 days 11 hours 37 minutes ago
As the world just celebrated "AIDS day" a trado-medical doctor, Hats Ugochukwu, has called on leaders to stop the celebration until they acknowledge that they have found a cure to the dreaded disease
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There are many parallels between hepatitis C and HIV. Hepatitis C is predominantly acquired by parenteral transmission. Injection drug use accounts for 50% or higher for all patients who are HCV infected. The groups that had both HCV and HIV are going to be predominantly injection drug users who are co-infected with the two viruses because sexual transmission of hepatitis C is relatively inefficient, so in gay men who are HIV positive, hepatitis C is present in only about 10% of all cases.
Nevertheless, hepatitis C is sexually transmitted and again, when you are counseling your patient who is hep C positive, if they are co-infected you will counsel them for safe sex regardless. But if they are hep C positive alone, the current CDC guidelines are that you should tell that individual that the risk of sexual transmission in a stable, mutually monogamous sexual relationship is small and that patients don’t need to change their current sexual practices. However, if they engage in any high risk sexual activity, they should use condoms.
The perinatal transmission of hepatitis C is also well documented and again, very little is understood about the natural history of perinatally acquired hepatitis C. This is an area of active investigation currently. But again, it is relatively inefficiently transmitted perinatally, in contrast to hepatitis B which is very efficiently transmitted perinatally. The risk of transmission, particularly perinatal transmission, appears at least in part to be related to the level of viremia, the hepatitis C viremia in the mother. That also may be true for other modes of transmission such as needle stick exposure and even sexual exposure, sexual transmission. But the frequency of transmission events is sufficiently low that currently we have not been able to study this question adequately.
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Treatment: there are also, this last week, the hepatologists were officially in the world of combination therapy for treatment of naive individuals. Interferon plus ribavirin was FDA approved for chronic hepatitis C infection. I’ll talk a little bit about this and it’s applicability to our patients who are HIV positive. The efficacy of interferon alone has, with increasing study, become decreasing and it is amazing to us to even think how interferon could have been FDA approved - probably eight years ago now. It certainly would not have been FDA approved if the data that we have today on sustained response rates to interferon had been fully available back then. In some trials now, sustained response rates run in the 3-5% range with a year of interferon treatment. You should think about that when you are treating your HIV/HCV co-infected patient because interferon as a single drug, particularly in people who have high levels of virus - and that is true for the co-infected patient - is a very inadequate drug.
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There’s a lot of interest now in the hepatitis C protease as a target for antiviral development. Also the hepatitis C polymerase, the HRNA and RNA dependent polymerase. But you would predict, and in fact we have already shown this with interferon, that resistance will rapidly develop, or will certainly develop over a period of time if you give a single agent. We are now beginning to use molecular techniques to track evolution of viral species of hepatitis C as has been done for HIV, in patients undergoing various other therapies that I’ll tell you about today.
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