New Device Effective in Reducing HIV
Posted by on October 9, 2013 - 9:44am

It’s often said that the HIV/AIDS epidemic has a woman’s face. The proportion of women infected with HIV has been on the rise for a decade; in sub-Saharan Africa, women constitute 60 percent of people living with the disease. While preventative drugs exist, they have often proven ineffective, especially in light of financial and cultural barriers in developing nations.

A new intravaginal ring filled with an anti-retroviral drug could help. Developed with support from the National Institute of Allergy and Infectious Diseases by Northwestern University visiting associate professor Patrick Kiser, PhD, the ring is easy to use, long lasting and recently demonstrated a 100 percent success rate protecting primates from the simian human immunodeficiency virus (SHIV). The device will soon undergo its first test in humans.

“After 10 years of work, we have created an intravaginal ring that can prevent against multiple HIV exposures over an extended period of time, with consistent prevention levels throughout the menstrual cycle,” said Kiser, an expert in intravaginal drug delivery who joined Northwestern from the University of Utah, where the research was conducted.

The research was published Sept. 16 in the Proceedings of the National Academy of Sciences (PNAS).

Previous studies have demonstrated that antiviral drugs can prevent HIV infection, but existing methods for delivering the drug fall short. Pills must be taken daily and require high doses; vaginal gels that must be applied prior to each sex act are inconvenient, yielding poor usage rates. The new ring is easily inserted and stays in place for 30 days. And because the drug is delivered at the site of transmission, the ring -- known as a TDF-IVR (tenofovir disoproxil fumarate intravaginal ring) -- utilizes a smaller dose than pills.

The upcoming clinical trial, to be conducted in November at Albert Einstein College of Medicine in New York, will evaluate Kiser’s ring in 30 women over 14 days. The trial will assess the ring’s safety and measure how much of the drug is released and the properties of the ring after use.

The paper is titled “Intravaginal Ring Eluting Tenofovir Disoproxil Fumarate Completely Protects Macaques from Multiple Vaginal Simian-HIV Challenges.”

Source:  Megan Fellman on Oct 03, 2013

Northwestern University Feinberg School of Medicine

March 10 National Women and Girls HIV/AIDS Awareness Day
Posted by on March 10, 2013 - 6:32am

Nearly 25% of those infected with HIV/AIDS in the United States are female.   In recognition of National Women and Girls HIV/AIDS Awareness Day on March 10, take a few minutes to learn basic facts about prevention, testing, and issues specific to women. These resources will help:

Prevention -- Learn how HIV is transmitted and how you can protect yourself.
Testing -- Enter your ZIP code to find a testing site near you. If you have concerns about privacy, read about confidential and anonymous testing.
Treatment -- Learn about different treatment options, potential side effects, clinical trials, and related topics.
Issues Specific to Women with HIV -- Men and women need similar types of care for HIV, but there are some differences.
Campaign to Encourage African-American Women to Get Tested -- African-American women account for about 66% of women in the U.S. who have HIV/AIDS. The campaign shares facts and outlines reasons to get tested.

Source:   www.usa.gov

 

Sperm protein may influence AIDS vulnerability in female genital tissue
Posted by on February 27, 2013 - 3:07pm

It's generally known that women's genital tissue is more susceptible to the HIV virus that causes AIDS.  Researcher are studying the various types of epithelial cells in the reproductive tract and the possible protective role of mucus to try to determine what makes women more vulnerable to the spread of this virus.  A new study supported by the National Institute of Child Health and Human Development (NCHID) at the NIH found that an immune system protein normally found in semen may enhance the spread of HIV to tissue from the uterine cervix.  The protein interleukin 7 (IL-7) belongs to a family of proteins that regulates the immune response and is present normally in semen but at even higher levels in the semen in men with HIV.

So far, this experiment is limited to cell cultures in the lab and more work is needed to see if this is true in the living human.   "These experiments show us again how vicious HIV is," said senior author Leonid Margolis, PhD, at NICHD.   "The virus is able to commandeer an immune protein for its own benefit."

 

Mother to Child Transmission of HIV: A hopeful update
Posted by on January 3, 2013 - 2:30pm

On Tuesday, December 18th the Women’s Health Research Institute hosted speakers at the monthly lunch series to discuss women’s health, HIV and the vast advances made in HIV care the past 20 years. Although many aspects of HIV transmission, susceptibility, physicality and progress were examined, I was intrigued most by the research presented by Dr. Patricia Garcia on HIV transmission from mother to child.

Dr. Garcia thoughtfully described her vision of a generation without HIV. In that vision, she touched upon the methods through which rapid testing can detect whether a mother is HIV positive, and how that information can be used, along with new prevention methods to create a generation born without HIV.

The data Dr. Garcia presented was very powerful, showing how changes in HIV diagnosis vary greatly by race and gender. She highlighted that of all AIDS diagnoses from 1985-2010, the estimated percentage among adult and adolescent females increased from 7% in 1985 to 25% in 2010.

  Dr. Garcia further showed how the state of Illinois had progressed greatly over the last 15 year, making rapid HIV testing easily available in 2005, at which point the knowledge of HIV status among pregnant women increased significantly. This development influenced the considerable reduction in HIV+ births in the state of Illinois.

 The message is one of continued hope and the success of good health care research. With hard work, women’s health experts and community members saw an issue amongst women and children that could be improved with access, knowledge and prevention, giving new life to an entire generation of children.

HIV in Teens
Posted by on July 7, 2012 - 2:30pm

Despite stable rates of HIV diagnosis in older populations, the rate of HIV diagnoses from 2006 to 2009 increased in teens 15-19 and youth 20-24 years of age, and was highest in the 20-24 year-old age group.  Undiagnosed HIV cases are also thought to be highest among young people. The U.S. Centers for Disease Control and Prevention (CDC) estimates more than half of all undiagnosed HIV infections are youth ages 13 – 24.3.

Of adolescent HIV diagnoses, almost 70 percent are to black teens, even though they constitute a much smaller proportion of the adolescent population in the U.S.    Almost 80 percent of all adolescent infections are to males. Nine out of 10 adolescent male HIV infections result from male-to-male sexual contact. The same proportion of adolescent females is infected from heterosexual contact.

The highest concentrations of HIV diagnoses among adolescents are in the Southeastern United States and, specifically, Florida, South Carolina, and Louisiana.
Although HIV testing is widely available, self-reported rates of HIV testing have remained flat in recent years. Forty-six percent of high school students have had sex at least once, yet only 13 percent report ever having had an HIV test.

New Drug Regimen Reduces HIV Spread from Mom to Infant
Posted by on March 4, 2011 - 4:48pm

Pregnant women who are unaware that they have HIV miss the chance for drug treatment that can benefit not only their own health, but could also prevent them from transmitting the virus to their infants. When HIV is not diagnosed until women go into labor, their infants are usually treated soon after birth with the anti HIV drug zidovudine (ZDV), to prevent the infants from becoming infected with the virus.

Now, a National Institutes of Health study has found that adding one or two drugs to the standard ZDV treatment can reduce the chances by more than 50 percent that an infant will develop an HIV infection.

The study results were presented at the  Conference on Retroviruses and Opportunistic Infections, in Boston. The study was conducted at research hospitals in Brazil, South Africa, Argentina, and the United States, under contract to the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

An estimated one fifth of people in the United States who have HIV are unaware that they harbor the virus.  From 100 to 200 infants are born with HIV in the United States each year, many to women who either were not tested in early pregnancy or who did not receive treatment during pregnancy. Internationally, estimates of HIV testing vary, with only 21 percent of pregnant women in low and middle income countries having been tested for HIV during pregnancy.

"To reduce mother-to-child HIV transmission, it's best to begin antiretroviral treatment during pregnancy," said Heather Watts, M.D., a medical officer in NICHD and an author of the study. "However, when treatment during pregnancy isn’t possible, our results show that adding one or two drugs to the current regimen provides another important means to reduce the chance for mother-to-child HIV transmission."

At the 19 participating research sites, the NICHD/ HIV Prevention Trials Network 040 study evaluated 1,684 infants born to women whose HIV infections were not diagnosed until they were in labor. The infants were randomly assigned to three groups: those receiving the standard 6 weeks of therapy with ZDV, those receiving 6 weeks of ZDV plus 3 doses of nevirapine (NVP) during the first week of life, and those receiving 6 weeks of ZDV plus two weeks of lamivudine (3TC) and nelfinavir (NFV). The study results showed that treatment with the two and three drug regimens reduced HIV transmission by more than 50 percent.

"Our results showed conclusively that the two and three drug regimens are superior to the standard treatment with zidovudine," said study chair Karin Nielsen-Saines, M.D., clinical professor of pediatrics  at the David Geffen School of Medicine at the University of California at Los Angeles.

To read the entire NIH press release, click HERE.

 

 

Women and HIV/AIDS
Posted by on November 30, 2010 - 11:04am

December 1 is World AIDS Day and the Institute for Woman's Health Research in Chicago is focusing this blog on HIV/AIDS in Women.  There is also a link to a comprehensive update at the end of this page.

Both women and men need similar types of HIV care, but there are some important differences:

  • Women often have gynecological conditions as a result of HIV infection. These can include persistent and difficult-to-treat vaginal yeast infections, pelvic inflammatory disease, cervical dysplasia (abnormal cell changes in the cervix), and an increased likelihood of developing cervical cancer.
  • Women may have concerns about pregnancy and childbirth—whether for a current pregnancy or for the future. It is best to talk with your provider about these concerns.
  • Women who are diagnosed with HIV should have a Pap smear and a pelvic exam ASAP. They should have a follow-up Pap smear 6 months later.
  • Women are less likely to develop Kaposi’s Sarcoma, a type of cancer that is a common opportunistic infection and an AIDS-defining condition.
  • Women are often diagnosed later in the stages of HIV infection, so they can be more susceptible to opportunistic infections.
  • Women often must be stronger advocates for themselves and their treatment when engaged in HIV care. Many times women face multiple barriers to care.

Frequently Asked Questions
If I am diagnosed with HIV, can I still get pregnant?
Yes. Being diagnosed with HIV shouldn’t prevent you from getting pregnant. You can take medications that will help to prevent your baby from getting HIV from you. For more information, see Having Children.

I thought HIV was something that only affected gay men. I’m a straight woman. Am I at risk for HIV?
If you are sexually active or inject drugs (or have sex with someone who does), you are at risk for HIV. Many women are unaware of their partner’s current or past sexual or drug-taking behaviors. It is possible for a man to become infected with HIV by injecting drugs or by having sex with an HIV-positive woman and then transmitting the virus to a different female partner. In addition, many men who have sex with men (MSM) don’t consider themselves “gay” or bisexual, and they may also have sexual relationships with women. It’s important to ask your partner if he has had sexual contact with other men or ever used injection drugs—and for BOTH of you to be tested for HIV before you have sex without a condom. If you have any doubts about your partner’s HIV status, or his sexual or drug-taking behaviors, insist on consistent condom use every time you have sex.

For more information on women and HIV/AIDS from the US Dept. of Health and Human Services, Office On Women's Health, click HERE.

Maternal Deaths: Decreasing…Slowly
Posted by on August 3, 2010 - 4:01pm

The health of pregnant women can say a lot about a region. It can indicate the accessibility and affordability of health care, as well as how much recognition maternal health receives in the region. A healthy pregnancy results in healthier children and decreased risk for maternal death. Conversely, measuring maternal mortality rates can also indicate the level of health resources within a country

In 2000, the United Nations adopted the Millennium Declaration, which established a series of goals including Millennium Development Goal 5. The goal aimed for a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015. The MMR is a common statistic used to indicate the number of women, that die while pregnant or within 42 days of giving birth, for every 100,000 live births.

The Bill and Melinda Gates Foundation funded a study looking at maternal mortality rates over the past 28 years. In a report published in the Lancet this May, the authors examined the MMR across the globe using a variety of national and regional reports.

Using this data, the authors determined that there were about 340,000 maternal deaths in 2008 compared with 530,000 deaths in 1980. Between 1980 and 2008, the authors found some interesting trends. India had the largest number of maternal deaths of any country overall but the MMR substantially decreased over time. Eastern Asia reported the greatest reduction in maternal deaths while maternal mortality actually increased in sub-Saharan Africa during the 1990s. As of 2008, sub-Saharan Africa made up 52% of the global maternal deaths.

Additionally, in 2008, all the countries in western Europe, Canada, and Australia had maternal mortality rates below 10 (Italy was lowest with 4). The USA, on the other hand, had an MMR of 17, an increase from 1980, which the authors say may be due to increased reporting.

In contrast, over 21 countries had no data for the entire period between 1980 and 2008. Many of these countries are in northern Africa and the Middle East, which may indicate a low awareness of maternal mortality issues.

While the global MMR decreased over the past 28 years, the spread of HIV over the 1980s and 1990s initially caused maternal deaths to increase. Better treatment of HIV-positive women now prevents many of these maternal deaths (and decreases the spread of the virus during childbirth). Over this time period, the MMR was estimated to decrease 1.5% a year. While an improvement, it does not meet the 5.5% annual MMR decrease needed to meet Millennium Development Goal 5.

While the authors could only speculate on the direct causes of decreased maternal death rates, they do suggest some possibilities. During this same time period as the study, the total fertility rate decreased, which usually correlates with decreases in maternal mortality. In addition, income per person rose, particularly in Asia and Latin America. This can affect maternal and child mortality by increasing nutritional status and access to health care. Maternal education levels and birth assistance by a skilled professional also increase maternal health.

While it appears that the maternal mortality ratio will not meet the 2015 goals of the Millennium Declaration, continued efforts are being put forth to promote this important issue. President Obama has also proposed the Global Health Initiative, which will invest federal dollars to help other countries strengthen their health systems, with an emphasis on maternal and child health. In addition, public health advocacy groups also work around the globe to support this mission, including the White Ribbon Alliance. By working together, these organizations may continue to increase the awareness of health care for pregnant women and reduce maternal deaths.

______________

To read Kate’s posts about issues surrounding cancer and fertility, go to the Oncofertility Consortium Blog.

December is HIV Awareness Month!
Posted by on December 3, 2009 - 10:51am

Human Immunodeficiency Virus (HIV) damages the white blood cells of the immune system, reducing the body’s ability to fight off bacterial infection, viruses, and other diseases such as pneumonia and some cancers.  Late stage HIV is often referred to as Acquired Immunodeficiency Syndrome (AIDS).

The most common causes of HIV infection are through sexual contact, infected blood transfusion, or sharing needles or syringes.  HIV symptoms vary with the phase of infection.  Early symptoms may resemble a flu virus, but infected individuals may show no symptoms for eight or nine years.  Later symptoms include swollen lymph nodes, weight loss, fever, and diarrhea.  Advanced HIV and AIDS symptoms are more severe and include night sweats, chills, fever, lesions or white spots in the mouth, headache and chronic diarrhea.  Treatment for HIV involves an array of anti-retroviral medications, coordinated to each individual’s response.  New treatments are continually being developed and tested in clinical trials.

Resources at Northwestern for HIV:

The HIV Center at Northwestern Memorial Hospital offers comprehensive assessment and treatment for HIV.  The Center offers services such as patient/family education, medication instruction, clinical trials, medical and legal referrals and an infusion center.  Within the HIV Center there are specialty clinics for patients needing care in medical areas of hepatology, neurology, ophthalmology and hematology, and also in obstetrics and gynecology.  Inpatient hospital care is also provided with an interdisciplinary approach to disease treatment.

For more information contact: (312) 926-8358

Northwestern Physicians/ Researchers specializing in HIV treatment:

The Division of Infectious Disease at Northwestern’s Feinberg School of Medicine offers inpatient and outpatient services for the diagnosis and treatment of HIV and other infectious diseases.  The Division’s 9 full-time faculty members all receive external grants for basic science and clinical research projects.  Dr. Sarah Sutton’s research interests include perinatal transmission of HIV, and HIV and women, while Dr. Steven Wolinsky, the Division Chief, studies the evolutionary mechanisms at work in the emergence, spread and containment of diseases such as HIV.

Click to see physician profiles and clinic information:

https://www.nmff.org/findPhysician/physearch.asp

https://www.nmff.org/ClinicalMedical/department.asp?id=21

IWHR Highlighted Researcher

Dr. Kimberly Scarsi, PharmD, MSc is a Research Assistant Professor in the Division of Infectious Disease at Northwestern University.  Her research focuses on the pharmacokinetics of HIV treatment in women, particularly during pregnancy.  Dr. Scarsi's research recognizes the need for studies in women since previous research has been conducted primarily in men.  Dr. Scarsi is studying the fluctuation in antiviral concentrations during pregnancy, toward the goal of treating these women more efficiently.  She is also comparing results of her studies in the US with sister studies in Africa, where nearly 60% of those infected with HIV are women.  Recently Dr. Scarsi was chosen as a recipient of an Institute for Women's Health Research Pioneer Grant for the establishment of a long-term database of women in which she will be doing single-timed blood samples over the course of their pregnancy.  She hopes to pinpoint the changes that occur in the second and third trimesters so that physicians may adjust dosages accordingly.  Eventually the project may become a multicenter study in the US and internationally.

Useful Links and Resources:

http://www.cdc.gov/hiv/

http://www.webmd.com/hiv-aids/default.htm

http://www.nmac.org/index

http://www.hiv.com/

IWHR Monthly Forum: Dr. Celeste Watkins-Hayes
Posted by on November 18, 2009 - 4:01pm

The Institute for Women's Health Research held its monthly forum on Tuesday with speaker Dr. Celeste Watkins-Hayes giving her talk entitled, "'Dying from' to 'living with' HIV/AIDS: Framing Institutions and the coping process of infected black women."

Dr. Watkins-Hayes began her talk by highlighting the huge discrepancies in HIV/AIDS occurrence by race: through 2007, 60% of women with HIV/AIDS were black or African-American identified. The statistics are even more striking in the local Chicago area: blacks in Chicago account for 55% of HIV/AIDS incidence, while only being 36% of the entire population. Similarly shocking, black women in Chicago account for 76% of all HIV/AIDS occurrences in the city.

The remainder of the talk discussed the results of the Sister to Sister study that Dr. Watkins-Hayes performed in Chicago. The study worked with 25 women with HIV/AIDS through two in-depth interviews and one other observation session where the woman's health status was known and salient. The participants had an average age of 36, all had children, and the majority had low income (<15K/year).

The crux of Dr. Watkins-Hayes' argument is that many individuals can serve as "framing institutions" for a woman diagnosed with HIV or AIDS, these are the people or communities that give the initial information about health status, give a framework for how to understand the social meaning of the illness, give women a language to discuss their diagnoses, and offer resources for dealing with the implications of their disease.  Often, these institutions are the doctors and nurses that give the initial HIV or AIDS status, but they can also be as diverse as drug and alcohol abuse rehabilitation centers that are targeting very different problems than an HIV/AIDS, or pastors and private therapists. These people, rather than friends or family, seem to be responsible for shaping how women really look at the disease and begin to accept it. If these framing institutions are not supportive or shaming about the health diagnoses, women are less likely to begin to transition to "living with" their disease. While middle and upper class women are more likely to have access to private framing institutions, lower income women are at significant risk, due to lack of time, money, or acess, of not finding strong, positive framing institutions.

I urge you all to check out Dr. Watkins-Hayes biography page; on it you will find a link to the website she helps organize, links to some of her excellent publications, and descriptions of her current projects. One of her major upcoming projects is a large scale study of the social implications of HIV/AIDS for African-American women. If you'd like to hear more about the study, or discuss being a participant, please contact one of the students working with Dr. Hayes Watkins on the project, Amanda Armour at ara@u.northwestern.edu or 312-320-1223.