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In 1983, more than 10,000 transfusion recipients were infected with HIV from tainted blood. In response, the FDA instituted a lifelong ban on blood donations from any man who’d had sexual contact with another man (“MSM” for short). There are no exceptions, even for celibate men who have tested negative for HIV.
Last month, U.K. Department of Health, acting on recommendation in a report from the the U.K. Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO), lifted their similar law banning MSM blood donations — provided the men haven’t had sex in at least one year. Restrictions have been relaxed in Australia, Japan, Sweden, South Africa and New Zealand. Some think the US should follow suit, but others believe the ban should remain to protect transfusion recipients.
Why a one-year deferral?
The SaBTO report looked at data regarding HIV and related diseases and “additional infectious agents” in the donor population as well as the UK overall population. What SaBTO found is that these diseases can be reliably screened for at the time of donation – if the donor is not in an “early window infection” stage. This window is between nine days and 12 months, depending on the disease. During the window, test results could be unreliable -a false negative might appear in donors who’d recently engaged in high-risk behavior, who could then transmit the disease to a recipient.
The SaBTO recommended deferring gay males for either one or five years from their last sexual encounter to ensure the window had been exceeded. The UK chose the one-year deferral.
Should the US follow suit and institute a deferral system rather than an outright ban on donations from gay men?
In favor of maintaining the lifetime ban
In 2009, the Center for Disease Control “estimate[d] MSM represent approximately 2% of the US population, but accounted for more than 50% of all new HIV infections annually from 2006 to 2009.” This data is the most heavily cited in ban-lifting opponents, who say this creates an increased risk to recipients.
Dr. Jay P. Brooks, a professor of pathology and the director of blood banking and transfusion medicine at University Hospital in San Antonio, says the risk is too great to lift the ban:
“If the current policy is changed or eliminated, we just don’t know what the increased risk to the blood supply will be. We could have one additional HIV-positive unit released every 10 years, every 20 years — or one per year. . . But if the policy is changed to relieve the stigma, you have a risk that has been transferred to a completely different group — the recipients — and I think that is an unfair situation.”
The FDA agrees: a petition put forth from the American Red Cross in 2006 called the ban “medically and scientifically unwarranted,” but the FDA maintained that the increased risk of HIV infection in the general population was too great to assume.
In favor of lifting the lifetime ban
The American Red Cross continues to advocate a repeal of the MSM donor ban in favor of a deferral system, as does Dr. James P. AuBuchon, president of the American Association of Blood Banks. “Given the sensitivity of the tests we now have available, there is no detectable increased risk of HIV entering the blood supply by allowing gay and bisexual men to donate. . . [U]nits of blood are typically destroyed quickly if they’re identified as unsuitable, and blood collectors have a robust protocols — including computer systems approved by the FDA — to prevent erroneous releases.”
What the FDA should focus on, says Joel Ginsberg, head of the Gay and Lesbian Medical Association, are “behavioral risks rather than belonging to a particular group” by reworking the donor questionnaire about sexual activity and lifestyle behaviors, regardless of demographic.
There are opponents to this tactic, though–primarily, SaBTO. They felt that “the introduction of extensive donor health check questionnaires regarding sexual history will lead to a loss of existing donors,” when presenting their data to the UK Dept. of Health. So there’s the dilemma: do you lose part of your current donor base to admit the (very few) celibate homosexual men who could then donate under the new, fairer screening process? That gamble is not likely to be accepted in the U.S. The most viable option for lifting the ban appears to be the one-year deferral adopted in 12 other industrialized nations.
OK, Neatoramanauts: If it were on a ballot, would you vote to keep the blood donation ban for gay men intact, or vote to implement a deferral system?
Sources:
Pro/Con: Two views of U.S. prohibiting gay men’s blood donation
American Red Cross Fights Ban On Gays’ Blood
Bloody Personal
Britain Lifts Ban on Gay Men Donating Blood. Could the U.S. Be Far Behind?
SaBTO Donor Criteria Selection Review (April 2011) [PDF]
HIV Incidence Report, CDC 2009
A team of doctors and medical researchers at the University of Pennsylvania tried a bold new experiment on three leukemia patients who seemed to have no hope left. One of them was 65-year-old William Ludwig.
Doctors removed a billion of his T-cells — a type of white blood cell that fights viruses and tumors — and gave them new genes that would program the cells to attack his cancer. Then the altered cells were dripped back into Mr. Ludwig’s veins.
At first, nothing happened. But after 10 days, hell broke loose in his hospital room. He began shaking with chills. His temperature shot up. His blood pressure shot down. He became so ill that doctors moved him into intensive care and warned that he might die. His family gathered at the hospital, fearing the worst.
A few weeks later, the fevers were gone. And so was the leukemia.
Another patient had a complete remission, and the third had a partial remission. What is surprising about the experimental treatment is that it uses diabled HIV-1, the virus that causes AIDS, to carry the new cancer-fighting genes to the patient’s T-cells.
The University of Pennsylvania team seems to have hit all the targets at once. Inside the patients, the T-cells modified by the researchers multiplied to 1,000 to 10,000 times the number infused, wiped out the cancer and then gradually diminished, leaving a population of “memory” cells that can quickly proliferate again if needed.
The researchers remain cautious, because so few patients have been given the treatment, and because the therapy itself can be dangerous. But Mr. Ludwig has gained 40 pounds and a playing golf again. Read how they did it at the New York Times. Link -via Metafilter
Scientists are looking into a new technique for the fight against AIDS…and yes, it involves glow-in-the-dark cats! Two genes are inserted into feline eggs before fertilization, one being the jellyfish gene that causes cats to glow (“tracking purposes.”) The other is a rhesus macaque gene that blocks cell infection by feline immunodeficiency virus, which provides insight into how gene therapy can treat the virus affecting humans.
The macaque restriction factor, TRIMCyp, blocks FIV by attacking and disabling the virus’s outer shield as it tries to invade a cell. The researchers know that works well in a culture dish and want to determine how it will work in vivo. This specific transgenesis (genome modification) approach will not be used directly for treating people with HIV or cats with FIV, but it will help medical and veterinary researchers understand how restriction factors can be used to advance gene therapy for AIDS caused by either virus.
The method for inserting genes into the feline genome is highly efficient, so that virtually all offspring have the genes. And the defense proteins are made throughout the cat’s body. The cats with the protective genes are thriving and have produced kittens whose cells make the proteins, thus proving that the inserted genes remain active in successive generations.
So far there haven’t been negative effects seen in the cats. If time proves that the experiment was safe and without consequences, I have three words: I want one.
Link -via TreeHugger
Samuel K. Sia, a biomedical engineer at Columbia University, has developed a cheap test for HIV infection that can return accurate results almost instantly:
“We have engineered a disposable credit card-sized device that can produce blood-based diagnostic results in minutes,” said Sia. “The idea is to make a large class of diagnostic tests accessible to patients in any setting in the world, rather than forcing them to go to a clinic to draw blood and then wait days for their results.”[...]
Sia hopes to use the mChip to help pregnant women in Rwanda who, while they may be suffering from AIDS and sexually transmitted diseases, cannot be diagnosed with any certainty because they live too far away from a clinic or hospital with a lab. “Diagnosis of infectious diseases is very important in the developing world,” said Sia. “When you’re in these villages, you may have the drugs for many STDs, but you don’t know who to give treatments to, so the challenge really comes down to diagnostics.” A version of the mChip that tests for prostate cancer has also been developed by Claros Diagnostics and was approved in 2010 for use in Europe.
Link -via DVICE | Photo: mChip
Keep in mind that early news reports on scientific stories are sometimes wildly inaccurate. But, that said, it appears that doctors claim to have cured an HIV-infected man:
The ‘Berlin Patient,’ a U.S. citizen named Timothy Ray Brown, underwent a procedure in which HIV-resistant stem cells from an individual with an unusual genetic profile were introduced into his body. The donor patient’s CD4 cells lacked the CCR5 co-receptor — the most common variety of HIV uses CCR5 co-receptors as a “docking station,” attaching to it in order to enter and infect CD4 cells. People with this particular genetic mutation are almost completely protected against infection.[...]
Berlin doctors published his detailed case history in the New England Journal of Medicine in February 2009. Now they’ve published a follow-up report in the journal Blood, saying: “It is reasonable to conclude that cure of HIV infection has been achieved in this patient.”
Link via Glenn Reynolds | Image: NIH
Behold the power of the moolah. The World Bank has just released new studies that show they can significantly lower the infection rates of HIV and other sexually transmitted diseases by paying people to do (or not do) something:
In the first study, a two-year program rewarded young girls in Malawi, rife with poverty and high HIV infection rates, with cash payments for regular school attendance. In Tanzania, the Bank paid young adults in cash to avoid unsafe sex.
The studies "show the potential for using cash payments to prevent people, especially women and girls, from engaging in unsafe sex while also ensuring that they stay in school and get the full benefit of an education," said David Wilson, who heads the Bank’s global HIV/AIDS program.
In the education study in Malawi’s Zomba district, which has both high HIV rates and school dropout rates among young girls, the World Bank found cash payments for at least 75 percent school attendance each month reduced infection rates by 60 percent, compared to an unpaid control group.
"Girls who received payments not only had less sex, but when they did, they tended to choose younger, safer partners," the World Bank said in a statement on the studies, which were released on the first day of the 18th International AIDS Conference in Vienna.
Cash transfers, the institution said, enabled a significant drop in what is called "transactional sex" among girls and young women who trade intercourse for assistance, gifts or money.
Link – via Andrew Sullivan’s The Daily Dish
Previously on Neatorama: Paying Forgetful Patients To Take Their Meds
A trial of a powerful new microbicidal vaginal gel reduced the HIV infection rate of test subjects by 54%. The gel is a 1% solution of the antiretroviral drug tenofovir, which stops HIV replication. At Scientific American, Katherine Harmon writes:
A reliable HIV-prevention method for women has thus far proved hard to come by, leaving many millions of at-risk women subject to their partner’s decision about condoms.
But a gel that can be applied discretely could severely cut back on HIV, a disease that currently infects an estimated 33 million people worldwide. Researchers involved in the new study calculated that if about a third of women in South Africa could use this gel, in the next 20 years, 1.3 million HIV infections—and 820,000 HIV-related deaths—could be prevented in that country alone.
Link | Image: NIH
AIDS researchers discovered an antibody in one patient that is able to defeat 91% of all known strains of HIV:
The HIV antibodies were discovered in the cells of a 60-year-old African-American gay man, known in the scientific literature as Donor 45, whose body made the antibodies naturally. The trick for scientists now is to develop a vaccine or other methods to make anyone’s body produce them as well.[...]
HIV is a highly mutable virus, but one place where the virus doesn’t mutate much is where it attaches to a particular molecule on the surface of cells it infects. Building on previous research, researchers created a probe, shaped exactly like that critical site, and used it to attract only those antibodies that efficiently attack it. That is how they fished out of Donor 45 the special antibodies: They screened 25 million of his cells to find 12 that produced the antibodies.
Donor 45′s antibodies didn’t protect him from contracting HIV. That is likely because the virus had already taken hold before his body produced the antibodies. He is still alive, and when his blood was drawn, he had been living with HIV for 20 years.
The researchers hope to use this discovery to develop a vaccine for HIV.
Link via Popular Science | Image: CDC | Previously: Progress on HIV Vaccine
Donald G. McNeil, Jr. writes in The New York Times that a new vaccine tested on 16,000 Thai volunteers demonstrated improved resistance to the virus that causes AIDS. According to the National Institute of Allergy and Infectious Diseases, it’s a significant discovery. McNeil writes:
Col. Jerome H. Kim, a physician who is manager of the army’s H.I.V. vaccine program, said half the 16,402 volunteers were given six doses of two vaccines in 2006 and half were given placebos. They then got regular tests for the AIDS virus for three years. Of those who got placebos, 74 became infected, while only 51 of those who got the vaccines did.
Although the difference was small, Dr. Kim said it was statistically significant and meant the vaccine was 31.2 percent effective.
Dr. Fauci said that scientists would seldom consider licensing a vaccine less than 70 or 80 percent effective, but he added, “If you have a product that’s even a little bit protective, you want to look at the blood samples and figure out what particular response was effective and direct research from there.”
Before you get your hopes up, keep in mind this warning from Zach Weiner about science journalism. We still have a long way to go.
Link via Popular Science
Image: U.S. Department of Health and Human Services
SARS Corona Virus by Luke Jerram
Artist Luke Jarram has created glass sculptures of some of the deadliest diseases known to man including HIV, E. Coli and Small Pox. The incredibly intrincate sculptures challenge both the state of the art in glass sculpting and the ability of scientists to visualize these diseases. For instance scientists are unable to describe to Jarram how RNA is situated in the Capsid.
Jarram’s website includes a video showing how he uses glass blowing techniques to create the sculptures. The video shows him working on the HIV sculpture.
From the Upcoming 
ueue, submitted by OddNumber.
While people in the United States endlessly debate what should be done with the country’s drug problem, Portugal went ahead and decriminalize the use and possession of illicit drugs 5 years ago.
Here’s what the country learned:
In the face of a growing number of deaths and cases of HIV linked to drug abuse, the Portuguese government in 2001 tried a new tack to get a handle on the problem—it decriminalized the use and possession of heroin, cocaine, marijuana, LSD and other illicit street drugs. The theory: focusing on treatment and prevention instead of jailing users would decrease the number of deaths and infections.
Five years later, the number of deaths from street drug overdoses dropped from around 400 to 290 annually, and the number of new HIV cases caused by using dirty needles to inject heroin, cocaine and other illegal substances plummeted from nearly 1,400 in 2000 to about 400 in 2006, according to a report released recently by the Cato Institute, a Washington, D.C, libertarian think tank.
Brian Vastag of Scientific American has more on the story: Link
