HIV/AIDS: Still a world threat three ... JPost

Young people could be forgiven for thinking that acquired immune deficiency & syndrome (AIDS) has existed as long as polio or tetanus – and even that it is & only a chronic disease easily managed with drugs. But in fact, the virus – which & in the 1950s jumped in West Africa from chimpanzees to man – was diagnosed for & the first time only three decades ago.

Although carriers of the human & immunodeficiency virus (HIV), if properly cared for, have a near-normal life & expectancy, AIDS remains a fatal disease for tens of millions of victims in much & of the developing world, especially sub-Saharan Africa. In Botswana, which is & perched on top of South Africa, estimates are that by 2020, there will be more & residents infected with HIV than those who are not.

Yet the Western world & is far from immune: In the US alone, it is estimated that more than one million & people are living with HIV, and more than half a million have died of full-blown & AIDS.

Although AIDS used to be front-page news in the Israeli media – at & least on World AIDS Day every December 1 – in recent years, the Health Ministry & has treated it in a low-key manner. Instead of speaking to the public with press & conferences and publicity campaigns, it has only issued press releases and used & voluntary organizations that target the homosexual, drug-user and migrant & populations, and has worked quietly among immigrants from countries where AIDS & is endemic.

Although many countries require all pregnant woman and & newborns to be tested for HIV, the ministry does not regard this as mandatory, & arguing that it is an "unnecessary expense."

In its statement for World & AIDS Day some four months ago, the ministry focused on homosexual men. It noted & that among the 420 newly diagnosed Israeli HIV cases in 2010, 148 of them were & homosexual men and that a fifth of the 2,000 gay men who participated in a study & admitted to not using condoms during the previous six months, making the rate of & condom use in this group four times higher than the figures of HIV-infected men & in 2000.

The fact that HIV/AIDS is increasingly regarded as a chronic & rather than a fatal disease has produced laxity in protection among high-risk & groups, the ministry said. Only a minority of Israeli carriers die of AIDS, due & to the more effective AIDS "cocktail" of drugs provided at government expense. & Heterosexuals are also among the infected, as are drug users and people who & originated in countries where AIDS is endemic. Since 1981, a total of 6,579 & cases of HIV and full-blown AIDS have been diagnosed; of those, 1,330 died or & left the country. Thus, more than 5,300 HIV carriers and AIDS patients live in & Israel today – although it is widely acknowledged that there are about as many & undiagnosed carriers still unaware of their condition.

There have been & needle-exchange programs for drug addicts for the last half-dozen years, while & more advanced testing kits shorten the window of time between infection and when & the virus shows up in the blood to less than two months. People who identify & themselves can receive free HIV testing not only in the major hospitals' AIDS & centers, but also from the four public health funds; people who refuse to & identify themselves are able to get tested in the ministry's sex clinics, as & well as those run by the Israel AIDS Task Force in Tel Aviv and the Open House & in Jerusalem.

The AIDS Center at the Hadassah University Medical Center & in Jerusalem's Ein Kerem neighborhood held a clinical conference for the & hospital staff last month to update them on HIV/AIDS and report on what the & center staff has been doing. The hospital's new auditorium was filled with over & 150 doctors, nurses and medical students who took time off from a busy day to & listen.

Internal medicine and infectious disease specialist Prof. Shlomo & Maayan, who established Hadassah's AIDS clinic in 1990 and has directed its AIDS & Center since 1997, hosted the event.

There are 33 million known HIV & carriers, mostly in Africa, said Maayan, and three million new cases each year. & "About two million die of AIDS in an average year, with the result that 15 & million children have been orphaned.

"We heard in 1981 about a strange & infectious disease. It was published that between October 1980 and May 1981, & five young men, all active homosexuals, were treated for Pneumocystic carinii & pneumonia at three different hospitals in Los Angeles. Two died. But until 1985, & we didn't even know what it was," recalled the Hadassah physician.

"Then, & in 1985, a retrovirus was discovered that caused a fatal disease that was spread & largely by sexual contact," he continued.

"Sixty million people around & the world have been infected, and half of them have died."

Scientists & despaired, thinking AIDS would be the new Black Death, but in the mid-'90s, with & the development of a "cocktail" of anti-retroviral drugs (protease inhibitors), & the spread of HIV slowed.

"The spread of the pandemic reached a plateau & in 2007," he said, "but the disease will continue for many years until it is & defeated – if at all."

Five years ago, generic anti-retrovirals reached & Africa and brought some hope of survival to infected residents, half of whom are & women.

Although a great deal of money and effort have been invested in & developing an HIV vaccine to prevent infection, they have not been successful so & far because of the many mutations in the "envelope surrounding the virus," & Maayan explained.

"Recently, monoclonal antibodies were synthesized by & reverse-engineering that manage to penetrate the natural protective layer and & neutralize the virus at a number of sites on the envelope," he said. "Maybe & someday this discovery will lead to an effective vaccine, but we don't really & know if it would work."

Hadassah University Medical Center treats some & 350 HIV carriers and AIDS patients, he continued, 41 percent of them women. & "Half are immigrants from countries where AIDS is endemic; 30% are homosexuals; & 10% are foreign migrant workers and another 10% addicts who inject & drugs."

His Ein Kerem center employs four physicians, two social workers, & a nurse, a pharmacist and a technician, as well as four advisers in the testing & center, and two coordinators for Ethiopian immigrants who come from the & community itself. In the last six years, the characteristics of immigrants and & non-immigrants have become very similar, he said.

The center's activities & put a special focus on gynecology/obstetrics for both the Jerusalem region and & the Palestinian Authority. In addition to carrying out HIV testing, it also & follows up at-risk pregnancies, has a national clinic to produce safe & pregnancies for male carriers and healthy women; and conducts research and & counseling internationally, especially with Ethiopia.

The center's Dr. & Karen Olshtein-Pops noted in her lecture that the drug zidothymidine (AZT) was & initially thought to have much potential in treating AIDS. But as it was used & alone (a monotherapy), doctors quickly became disappointed. Then a two-drug & therapy of anti-retrovirals was developed in 1994; it worked much better. In & 1997, a third drug appeared, to which carriers reacted even better.

The & drug cocktail with combinations of five main drugs followed. There still are & side effects, but patients no longer have to swallow dozens of pills a day, as & several medications have been combined into one pill.

There had been a & dispute among AIDS experts regarding when HIV carriers should start taking the & drug cocktail; today, it is decided according to the levels of CD4 immune cells & in the blood.

"Some said to wait until it reached 200," said & Olshtein-Pops, "but today it is done already when the level falls between 500 & and 350."

She noted that a 46-year-old man named Timothy Brown, an HIV & carrier who underwent a bone marrow transplant two decades ago because he also & developed leukemia, is today free of the virus and essentially cured.

The & transplant transferred a genetic variation that made his system resistant to & HIV.

"Bone marrow transplants could be good," said the Hadassah doctor, & "but it's almost impossible to find a suitable donor.

Researchers are & thinking of utilizing genetic engineering to create lymphocytes without a & certain receptor using HIV patients' own cells. There is some optimism, but the & research is at an early stage."

Following Israeli research and & recommendations, the World Health Organization has endorsed circumcision in & sub-Saharan Africa as a prophylactic to reduce the infection risk & significantly.

As life expectancy for HIV carriers has lengthened, & Olshstein-Pops runs a fertility program at Hadassah to allow healthy women to & have babies fathered by infected men. At the AIDS Center, 48% of couples treated & there include one healthy member and one carrier. If the woman is free of HIV, & the man's semen can be "rinsed" to remove the HIV virus; the virus is not able & to penetrate the sperm itself, but is found mostly in the leukocytes. The & would-be father must undergo drug treatment for at least six months and then & give a semen donation that is rinsed.

So far, said Olshtein-Pops, 58 & couples – most of them married and in their 30s – have registered. The & participants include 32 native-born Israelis, seven Israeli Arabs, 10 born in & Eastern Europe and nine in Ethiopia.

Of 22 women who have undergone & artificial insemination with rinsed sperm, 16 got pregnant by artificial & insemination. Three women miscarried, but two couples are now on their second & pregnancy. Two births involved twins.

There wasn't a single case of a & healthy woman who was infected with HIV from her partner, she concluded with & pride.

Nurse Michelle Bashan spoke about how to prevent women with HIV & from infecting their infants. There are 10 cases annually in Israel of pregnant & HIV carriers. They receive AZT during pregnancy to reduce the presence of the & virus, and the baby is delivered by cesarean if it is high and vaginal delivery & if it is not. The women are not allowed to breastfeed, as the breast milk of & carriers can transmit the virus to the baby. These methods have prevented the & transfer of the virus to the infant in nearly all cases, she said.

Bashan & urged the Health Ministry to issue a directive to test all pregnant women for & HIV.

"It is done in the US and elsewhere, but not here. It is advisable & so we have no surprises," she said.

Maayan – who has traveled to Africa & many times – summed up by noting that "Hadassah has spearheaded much & international cooperation on AIDS. We have conducted joint research, such as on & drug resistance in Addis Ababa, and dozens of doctors and nurses have come here & for advanced training. There is also a medical student exchange & program.

"As AIDS involves not only medical but also social and economic & influences, it has to be dealt with holistically, and this is what we have done & in the Third World. We have a lot to give."