UN praises China's progress in AIDS fight

China has taken significant steps to fight HIV and AIDS, but long-term challenges include reaching out to more patients in the vast country and overcoming a lack of cooperation from some government officials, a U.N. AIDS official said Tuesday.

There are an estimated 650,000 people living with HIV in China, according to the most recent government statistics from the end of 2005. HIV gained a foothold in China largely due to unsanitary blood plasma-buying schemes and tainted transfusions in hospitals.

''I believe that over the last few years there have been serious progress and good results in the fight against AIDS in China and now the challenge is to sustain these efforts,'' said Peter Piot, executive director of UNAIDS.

Piot said successes in China include commitment and transparency at the top levels of government as well as proper funding, availability of antiretroviral drugs, and outreach programs. ''I've been coming to China for 14, 15 years, and I can say in the first five or six years there was basically no receptivity in terms of the issue,'' he said. ''And now, today, a lot is going on. You look at budgets, systems are being put in place, I think it's really very different.''

Piot recently returned from Shangcai County in Henan province, where unclean blood-buying businesses passed the virus to thousands of people in the 1990s. He toured a clinic and orphanage for AIDS orphans and also visited with patients.

There was a 50% reduction in the number of AIDS deaths in Henan province between 2002 and last year, said Wang Longde, China's vice minister of health, who also spoke at the U.N. news conference.

Cases of transfusions using infected blood have fallen sharply since the 1990s. The government has banned the practice of buying blood and has forbidden donations by prostitutes, intravenous drug users, and others in high HIV risk groups. (AP)
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HIV drug combo can boost immune marker in long-term patients

Patients who successfully respond to drugs that combat the AIDS virus can see a key marker of immune health rebound to a level enjoyed by people without HIV, a study published online Wednesday by The Lancet says.

The paper sheds light on poorly understood conditions as to why some people on antiretroviral drugs can boost and maintain their CD4 immune cells, others see a slower increase in these key defenders while other individuals fail, sometimes tragically so.

Investigators led by Amanda Mocroft of London's Royal Free Centre for HIV Medicine looked at 1,835 people with the human immunodeficiency virus (HIV) before and after they were put on antiretrovirals.

On average, these individuals had a CD4 count of 204 cells per microlitre of blood at the start of the study.

In the first year of taking antiretrovirals, there was a big spurt in the CD4 count, of around 100 cells per microlitre on average.

HIV levels were also suppressed, to below 50 copies of the virus per microlitre, which is considered a key goal in antiretroviral treatment.

Over the next few years, lower -- but still significant -- improvements in the CD4 count continued.

In fact, after three years, patients who had started therapy with a CD4 count of more than 350 cells per microlitre had a CD4 count "approaching the level seen in HIV-negative individuals," Mocroft says.

On average, the boost was around 50 cells per microlitre annually, and this continued even up to the fifth year of treatment, which by the standards of HIV therapy is a long time indeed.

Most rewarding of all was that this enduring improvement was seen among patients who had had low CD4 cells (of less than 200 cells per microlitre) before they began therapy.

Those who began with more than 500 CD4 cells per microlitre saw the least relative improvement.

The upturn in CD4 cells only occurs, though, if patients continue to respond well to the drugs and can keep their HIV count to below 50 copies per microlitre, the authors warn.

CD4 cells are frontline guardians of the immune system and their levels are closely watched barometers of a patient's ability to fight off opportunistic disease and death.

Previous research in this field has been more pessimistic, suggesting that CD4 counts tend to plateau after several years of treatment.

But those studies used less strict criteria for determining whether the drugs were working.

Their benchmark was a viral load -- the number of AIDS viruses in the blood -- of 1,000 and 400 copies per microlitre, whereas the new study sets a far tougher standard of 50 copies or less.

The paper is published by The Lancet ahead of a meeting in Sydney from Sunday to July 25 of the International AIDS Society, which will focus especially on HIV treatment.

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HIV patients build normal immune strength in study

AIDS drug cocktails may be able to restore the ravaged immune systems of some people infected with HIV, researchers reported on Wednesday.

Immune cells known as CD4 T-cells returned to normal levels in an ideal group of patients, picked because they responded optimally to a combination of at least three AIDS drugs, the researchers reported in the Lancet medical journal.

The human immunodeficiency virus, which causes AIDS, plunders the immune system, leaving people vulnerable to a range of infections that may prove fatal.

AIDS is incurable, but doctors try to prop up the immune system with life-extending drug therapy aimed at reducing the amount of virus in the body.

The study involved 1,835 HIV-infected people drawn from a larger study involving more than 14,000 patients from across Europe, Israel and Argentina.

"I think it's very encouraging that if people can respond to treatment well enough and can suppress the virus for long enough, we have sufficient evidence to say their CD4 counts can return to normal," Dr. Amanda Mocroft of Royal Free and University College Medical School in London, one of the researchers, said in a telephone interview.

"Our previous understanding was that there was a plateau in CD4 counts so that CD4 counts would stop increasing after a sufficiently long time taking combination therapy," she added.

Mocroft said not all HIV patients respond as well to these drugs, and many, particularly in the hardest hit regions like sub-Saharan Africa, do not have access to them.

"This is sort of the best-case scenario, if you like, that we can identify a group of patients who we would expect to have a normal CD4 count with sufficient treatment," Mocroft said.

These patients were chosen because they responded well to the treatment, with the drugs suppressing the virus to very low levels. They were tracked for about five years.

Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said doctors who care for HIV-infected patients have noticed this restoration of normal levels of CD4 cells in some of them. Fauci credited Mocroft's team for documenting this phenomenon in a systematic way.

CD4 cells, a type of white blood cell, help protect the body

from infection. But HIV targets CD4 cells, using them to create

more copies of the virus, thus undermining the immune system.

After initial infection, a person can produce more CD4 cells to take the place of those attacked by HIV. But in time, the body cannot make enough, increasingly weakening the immune system.

Although it is impossible to eradicate the virus with existing drugs, it is possible to keep it at extremely low levels in some people with the right combination of drugs.

The AIDS virus infects close to 40 million people globally, most of them in Africa. It has killed more than 25 million.

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World struggling to treat HIV-AIDS

Global AIDS treatment will fall far short of a universal target to have five million people being treated by 2010, due to a continued lack of access to drugs by many of the world's impoverished people, said a new report.

The report analyzing AIDS treatment in 17 countries and titled "Missing the Target" said free HIV treatment was actually not free in many poor countries.

"Free treatment is not truly free in most countries surveyed," said Gregg Gonsalves from the International Treatment Preparedness Coalition, which released the report on Wednesday.

"Charges for diagnostic tests, medical care and other services are putting lifesaving care out of the reach of many thousands of people," Gregg said in a statement.

Although 700,000 more people with HIV received treatment in 2007, the pace needed to accelerate, said the coalition, which represents activists in more than 125 countries.

"Tripling the annual growth rate of treatment access from today's 700,000 to 2 million new people on treatment each year is both possible and necessary to meet the G8 commitment of coming close to universal access by 2010," said the coalition's report.

The United Nations says close to 40 million people are infected with the AIDS virus and that treatment had dramatically expanded from 240,000 people in 2001 to 1.3 million by 2005.

In June, world powers at the Group of Eight (G8) summit in Germany set a target of providing AIDS drugs over the next few years to approximately 5 million people.

STIGMA, MARGINALISED

While increasing numbers of people were being treated for HIV, the latest report said there remained serious challenges with marginalized people, inequitable access to care for rural populations and children, a lack of transportation, the stigma of being diagnosed and the high cost of drugs.

Cambodia, which has some 134,000 people with HIV, was a "success story" in increasing treatment, it said. AIDS drugs only became available in Cambodia in 2004 and there were now 40 centers treating some 21,900 people.

But the report said there was still a "large but silent minority" of marginalized people, such as sex workers, Vietnamese citizens living in Cambodia and people in remote areas and slums, who still did not receive treatment.

"Many of these individuals...are reluctant to seek out health services in general because of fear of stigma and discrimination, if not harassment," it said.

China's free treatment program, started four years ago, had expanded rapidly from August 2006 when 26,000 people were treated to 30,000 by June 2007, said the report. But this was a small percent of the official 650,000 people with HIV in China.

Major obstacles in China to treatment were stigma and a "prohibitively expensive" test to confirm diagnosis, along with a lack of drugs and trained medical staff, it said.

India has one of the world's largest populations living with HIV-AIDS, about 2.5 million people, but as of 2007 only 70,780 people were being treated through 107 centers, said the report.

"Clearly, therefore, only a fraction of those needing treatment are receiving it now or can hope to receive it in the next half a decade," said the report.

South Africa, the epicenter of the AIDS epidemic with 5.5 million people with HIV, was also struggling to treat people.

As of 2007 some 257,100 patients were receiving drugs at specialist centers, with 30,000 on waiting lists, and up to 110,000 people being treated privately, said the report.

The report said South Africa had a long way to go meet its goal of treating 80 percent of new AIDS cases by 2011.

"Treatment delivery is working and there can be no more excuses for losing this momentum or letting millions die of AIDS," said Zackie Achmat of South Africa's Treatment Action Campaign.

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Male circumcision can cut HIV infection, studies show

Scientific studies have confirmed a long-standing belief that male circumcision can reduce HIV infection rates in men by 60 percent, an international AIDS conference will be told next week.

David Cooper, the co-chairman of an International AIDS Society (IAS) conference to be held in Sydney from July 22-25, said research on male circumcision represented a major development in HIV prevention.

"We always knew that if you went into any particular African country that HIV rates among Muslim men were lots lower," Cooper told AFP.

"But we were never sure that the Muslim men had lower numbers of partners than non-Muslim men, so people always doubted it."

Cooper said the only way to ensure the link between lower HIV rates and circumcision was not due to cultural factors was to carry out random trials, the results of which will be presented at the Sydney conference.

He said three trials were conducted in South Africa, Kenya and Uganda, each involving more than 2,000 heterosexual men, half of whom were circumcised.

"The reduction in HIV infection was about 60 percent, so clearly it works," said Cooper, who is also the director of Australia's National Centre for HIV Epidemiology and Clinical Research.

Cooper said the studies showed circumcision could be a powerful tool in helping curb HIV infection in sub-Saharan Africa, where infection rates in some countries are up to 40 percent of the adult population.

He said, however, that any introduction of widespread male circumcision in developing countries needed to be carried out with an education campaign that reinforced a safe sex message.

"In some areas of sub-Saharan Africa men are requesting circumcision, which is a bit of a worry, as they may think they're protected and they're not," Cooper said.

"It merely reduces the risk, you still have to use condoms, men can't think 'that's all I need to do, I can now have unsafe sex'."

The clinical reason for circumcision's preventive effect is still being investigated.

One theory is that the foreskin has a very thin lining and suffers minor abrasions during intercourse, making it easier for the human immunodeficiency virus (HIV) to enter the man's bloodstream. Another is that the foreskin is rich in Langerhans cells, whose surface is configured in such a way that the AIDS virus readily latches on to them.

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World struggling to treat HIV/AIDS

Global AIDS treatment will fall far short of a universal target to have five million people being treated by 2010, due to a continued lack of access to drugs by many of the world's impoverished people, according to a new report.

The report, which analyzed AIDS treatment in 17 countries and titled "Missing the Target," stated that free HIV treatment was actually not free in many poor countries.

"Free treatment is not truly free in most countries surveyed," said Gregg Gonsalves from the International Treatment Preparedness Coalition, which released the report on Wednesday.

"Charges for diagnostic tests, medical care and other services are putting lifesaving care out of the reach of many thousands of people," Gregg said in a statement.

Although 700,000 more people with HIV received treatment in 2007, the pace needed to accelerate, said the coalition, which represents activists in more than 125 countries.

"Tripling the annual growth rate of treatment access from today's 700,000 to 2 million new people on treatment each year is both possible and necessary to meet the G8 commitment of coming close to universal access by 2010," said the coalition's report.

The United Nations says close to 40 million people are infected with the AIDS virus and that treatment had dramatically expanded from 240,000 people in 2001 to 1.3 million by 2005.

In June, world powers at the Group of Eight (G8) summit in Germany set a target of providing AIDS drugs over the next few years to approximately 5 million people.

STIGMA, MARGINALISED

While increasing numbers of people were being treated for HIV, the latest report said there remained serious challenges with marginalized people, inequitable access to care for rural populations and children, a lack of transportation, the stigma of being diagnosed and the high cost of drugs.

Cambodia, which has some 134,000 people with HIV, was a "success story" in increasing treatment, it said. AIDS drugs only became available in Cambodia in 2004 and there were now 40 centers treating some 21,900 people.

But the report said there was still a "large but silent minority" of marginalized people, such as sex workers, Vietnamese citizens living in Cambodia and people in remote areas and slums, who still did not receive treatment.

"Many of these individuals...are reluctant to seek out health services in general because of fear of stigma and discrimination, if not harassment," it said.

China's free treatment program, started four years ago, had expanded rapidly from August 2006 when 26,000 people were treated to 30,000 by June 2007, said the report. But this was a small percent of the official 650,000 people with HIV in China.

Major obstacles in China to treatment were stigma and a "prohibitively expensive" test to confirm diagnosis, along with a lack of drugs and trained medical staff, it said.

India has one of the world's largest populations living with HIV-AIDS, about 2.5 million people, but as of 2007 only 70,780 people were being treated through 107 centers, said the report.

"Clearly, therefore, only a fraction of those needing treatment are receiving it now or can hope to receive it in the next half a decade," said the report.

South Africa, the current center of the AIDS epidemic with 5.5 million people with HIV, was also struggling to treat people.

As of 2007 some 257,100 patients were receiving drugs at specialist centers, with 30,000 on waiting lists, and up to 110,000 people being treated privately, said the report.

The report said South Africa had a long way to go meet its goal of treating 80 percent of new AIDS cases by 2011.

"Treatment delivery is working and there can be no more excuses for losing this momentum or letting millions die of AIDS," said Zackie Achmat of South Africa's Treatment Action Campaign.

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AIDS case deal may forgive Libyan debt

Several eastern European countries would forgive Libyan debt dating back to the Cold War under a proposal to compensate families whose children were allegedly infected with the AIDS virus by five Bulgarian nurses and a Palestinian doctor, a victims' advocate said Saturday.

The six foreign medics have been sentenced to death in the case, and Libyan officials have said a settlement could pave the way for their release.

Jailed since 1999, the six deny having infected more than 400 children and say their confessions were extracted under torture. Experts and outside scientific reports have said the children were contaminated as a result of unhygienic conditions at a hospital in the northeastern coastal city of Benghazi. Fifty of the infected children died.

Libya's Supreme Court upheld the death sentences for the medics in an appeal ruling on Wednesday. But that decision could still be overturned by country's highest judicial authority, the Supreme Judiciary Council, which is set to review the case on Monday. The council could approve or reject the convictions or set lighter sentences.

Idriss Lagha, head of the Association for the Families of HIV-Infected Children, told The Associated Press that a settlement was being finalized involving the transfer of money to a fund through the remission of debt to Bulgaria and several other eastern European countries.

Seif al Islam, the son of longtime Libyan leader Moammar Gadhafi, told a French newspaper published on Saturday that $400 million in compensation would be paid to the families.

"The indemnities are financed by international contributions in the form of debt remission," the newspaper Le Figaro quoted him as saying. "The concerned countries are Bulgaria, Slovakia, Croatia and the Czech Republic."

An agreement on the case has "not yet been reached" with the European Union, said Seif al Islam, who heads a powerful Libyan association that has worked to resolve the deadlock.

Government officials from Bulgaria and other nations reportedly involved in the deal have all denied they were sending cash to the families.

Le Figaro, without citing sources, reported that each family would get $1 million.

Companies in the four countries are all owed money from Libya largely dating back to the communist era. Bulgaria says Libya owes it $290 million, and the Czech news agency CTK put the Libyan debt to Prague at about $300 million in 2002.

The spokeswoman for Slovakia's ruling party said Saturday that Prime Minister Robert Fico had discussed with Libyan officials in February the possibility of using some of the country's debt to compensate the families.

Katarina Klizanova Rysova said negotiations between the two countries were still under way, but any deal would require Libya to eventually repay the debt.

"Slovakia can provide the finances for the Libyan families only on condition that the debt is paid off," she said.

Rysova said Libyan debt to her country was about $130 million, but the final sum was still being negotiated.

Bulgarian Foreign Minister Ivailo Kalfin reiterated Friday that Bulgaria would not pay compensations because that would imply the medics were guilty. But he also said he was optimistic a settlement was close that could result in the medics being pardoned.

A Foreign Ministry spokesman was not immediately available for comment Saturday.

Czech Foreign Ministry spokeswoman Zuzana Opletalova said the medics' case "is not over yet and it is premature to speak about any compensation."

The Czech Finance Ministry would not comment.

The Libyan government is under intense international pressure to free the medics. The case has become a sticking point in the regime's attempts to rebuild ties with the United States and European countries.

Libyan officials have said the families' acceptance of a compensation settlement is key to resolving the deadlock and would allow the death sentence to be withdrawn.

Often referred to as "blood money," compensation for death or suffering is a legal provision in the traditional Islamic code in the Middle East and North Africa.

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