Antiretroviral treatment of HIV infected adultsBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7556.1489 (Published 22 June 2006) Cite this as: BMJ 2006;332:1489
All rapid responses
New NIH study supports "old" immune-based treatment model for HIV/AIDS
The study described below strongly supports the immune therapy approach to HIV infection, first suggested in the late 1980's, officially submitted as a "treatment model" to the NC DHHS in April, 1992 and later published in the Journal of Naturopathic Medicine, Volume 4, Number 1 (see http://www.healthchina.org/document/doc20041027.html on website www.healthchina.org )
Your comments and suggestions for rapidly developing this immune-based HIV treatment method will be deeply appreciated by the 40+ million people worldwide infected with HIV/AIDS. They deserve the best possible treatment at the lowest possible cost, truthful answers to their questions, and ethical, compassionate help from all of us.
Sadly, even the newest and most expensive drugs have failed to cure AIDS, or add years of life to those with HIV infection. After 20 years of costly failure by the pharmaceutical industry, it is time to try the logical, common-sense approach which has proven effective in fighting other viruses such as rabies and hepatitis: vaccines and antibodies.
It is too late to save the millions who have already died of AIDS, but there is still hope for a longer life for those now infected with HIV.
Gary J. Minter
Science 9 June 2006:
Vol. 312. no. 5779, pp. 1530 - 1533
Preserved CD4+ Central Memory T Cells and Survival in Vaccinated SIV-Challenged Monkeys
Norman L. Letvin,1,2* John R. Mascola,1 Yue Sun,2 Darci A. Gorgone,2 Adam P. Buzby,2 Ling Xu,1 Zhi-yong Yang,1 Bimal Chakrabarti,1 Srinivas S. Rao,1 Jörn E. Schmitz,2 David C. Montefiori,3 Brianne R. Barker,2 Fred L. Bookstein,4,5 Gary J. Nabel1
Vaccine-induced cellular immunity controls virus replication in simian immunodeficiency virus (SIV)–infected monkeys only transiently, leading to the question of whether such vaccines for AIDS will be effective. We immunized monkeys with plasmid DNA and replication-defective adenoviral vectors encoding SIV proteins and then challenged them with pathogenic SIV. Although these monkeys demonstrated a reduction in viremia restricted to the early phase of SIV infection, they showed a prolonged survival. This survival was associated with preserved central memory CD4+ T lymphocytes and could be predicted by the magnitude of the vaccine-induced cellular immune response. These immune correlates of vaccine efficacy should guide the evaluation of AIDS vaccines in humans.
1 Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
2 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
3 Duke University Medical Center, Durham, NC 27710, USA.
4 Department of Statistics and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
5 Department of Anthropology, University of Vienna, Austria.
* To whom correspondence should be addressed. E-mail: email@example.com
Competing interests: No competing interests
Kober and Van Damme (2004) while writing about the scaling up access
to antiretroviral treatment (ART) in Southern, they asked the question
“Who will do the job”. Prof. Deeks singled out drug availability, limited
resources in terms of equipment as some of the constraints facing Africa
with regard to ART. At global level it could be said that financial
resources are not regarded as the main immediate constraint anymore,
because the World Bank has committed large amounts of funds through its
Multicountry HIV/AIDS Programme for Africa (MAP) and private foundations,
such as the Bill and MelindaGates Foundation, and the Clinton Foundation
are contributing to increased funding for HIV/AIDS. Since 2003, the US
President’s Emergency Plan for AIDS Relief (PEPFAR) has provided more
funds for procuring ARVs ; other donors have committed substantial
amounts of funds globally and, above all, the countries with the highest
HIV/AIDS burden have also allocated funds from their own resources. But
that the lack of human resources for health is regarded as the single most
serious obstacle to the rollout of ART. Although some countries such as
South Africa and Tanzania have developed comprehensive human resource
strategies, the situation of human resources for health in most countries
is precarious. The six dimensions of human resources for health include
their number, their geographical repartition, their level of expertise,
their commitment, their working conditions, and their production. At the
moment not only there is insufficient number of health professionals for
national health systems in general, there is even a greater shortage of
personnel involved in ART. For instance, the South African government
estimated that 13,805 new health professionals (doctors, nurses,
pharmacists, dieticians and counsellors) would be needed by 2008 to meet
the targets of its Operational Plan for Comprehensive HIV and AIDS Care,
Management and Treatment, but it has a vacancy rate of 31.1%. And the few
human resources available are maldistributed, with most of them residing
in urban areas. Two decades into the HIV/AIDS epidemic, there are skill
few HIV/AIDS specialists formally trained and the various courses offered
are often uncredentialled and uncoordinated particularly those vertically
run by international organizations. This is particularly worrying if one
considers the fact that the lower level of health care professionals such
as pharmacy assistants are seldom targeted for such trainings yet they are
the ones doing the job. Moreover, with regard to commitment of health care
workers, in many countries, particularly lower cadres are paid salaries
that are below subsistence level. This coupled to unsatisfactory working
conditions characterised by overwork, lack of support, burnout, lack of
equipment; the personnel is simply overwhelmed. Yet the production of
health professionals by institutions of higher learning is not on the
increase as it could be expected but the capping of number of new entrants
through governmental budgetary imperative, the shrinking number of
academics through retirement of old “guards’, with no replacement by young
ones, contribute to the decreased throughput.
Clearly the one way major donors could assist in addressing global
perspectives relating to ART and health of populations in developing
countries, is to commit to human resources development. This assistance
could be unveiled by helping countries to develop a coherent human
resources strategy, an implementation plan, and providing more funding to
enable access to higher education by the majority of the youth that is
currently not at varsity due to financial constraints.
Chen L. Hanvoravongchai HIV/AIDS and human resources [Editorial].
Bulletin of World Health Organization 2005;83(4):243–44.
Chen L, Evans T, Anand S, et al. Human resources for health:
overcoming the crisis. Lancet
Dovlo D. Using mid-level cadres as substitutes for internationally
mobile health professionals in
Africa. A desk review. Human Resources for Health 2004;2:7.
Hanson K, Ranson KM, Oliveira-Cruz V, et al. Expanding access to
priority health interventions:
a framework for understanding constraints to scaling up. Journal of
International Development 2003;15:1–14.
Hongoro C, McPake B. Human resources in health: putting the right
agenda back to front [Editorial]. Tropical Medicine and International
Kober K, van Damme W. Scaling up access to antiretroviral treatment
in southern Africa:
who will do the job? Lancet 2004;364(9428):103–07.
Liese B, Blanchet N, Dussault G. The Human Resource Crisis in Health
Services in Sub-Saharan Africa. Background paper. Washington DC: World
Loewenson R, McCoy D. Access to antiretroviral treatment in Africa
[Editorial]. BMJ 2004;
McCoy D, Chopra M, Loewenson R, et al. Expanding access to
antiretroviral therapy in sub-
Saharan Africa: avoiding the pitfalls and dangers; capitalizing on
Journal of Public Health 2005;95(1):18–22.
South African Department of Health. Operational Plan for
Comprehensive HIV and AIDS Care, Management and Treatment for South
Africa. Pretoria: Department of Health, November 2003.
Padarath A, Chamberlain C, McCoy D, et al. Health personnel in
southern Africa: confronting
maldistribution and brain drain. Equinet Discussion Paper No.3. Zimbabwe:
Systems Trust, MEDACT.
Skhosana N et al. HIV disclosure and other factors that impact on
adherence to antiretroviral therapy: the case of Soweto, South Africa
African Journal of AIDS Research 2006, 5(1): 17–26
USAID. The Health Sector Human Resource Crisis in Africa: An Issues
Paper. Washington DC7 USAID, AED, SARA, 2003.
Competing interests: No competing interests
They say a Freudian slip is when you say one thing and mean your
mother. I presume Professor Deeks did not really mean that highly active
retroviral therapy reduces the long term risk of morality (sic) related to
Competing interests: No competing interests