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Modern technology and ancient surgery battle AIDS

Tue 24 Jul 2007

By Michael Perry

SYDNEY, July 24 (Reuters) - The emergence of new and improved drugs, genetic engineering and the ancient surgical practice of circumcision are the latest weapons in the fight against AIDS, the International AIDS Society conference was told on Tuesday.

A new batch of drugs that slow the progress of HIV in patients and genetically modified cells that prevent further infections are about to become available or trialled, doctors told the world's largest AIDS conference.

"It's an extremely exciting time in terms of drug development. We have better drugs in existing classes, as well as whole new classes of drugs," said Professor David Cooper, co-chairman of the 2007 IAS conference in Sydney.

"Patients and their clinicians now have a much wider choice of drug combinations than ever before," said Cooper, director of Australia's National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales.

But the biggest breakthrough for the world's poorest nations, which will not initially be able to afford these new drugs and which carry the heaviest AIDS burden, lies in a procedure dating back to at least 2,300 B.C. in Egypt -- circumcision.

African studies have shown that male circumcision can reduce HIV transmission from women to men by about 60 percent, said Professor Robert Bailey at the School of Public Health at the University of Illinois at Chicago.

Universal circumcision could avert two million new infections and 300,000 deaths in sub-Saharan Africa over 10 years, he said.

Africa is the epicentre of the AIDS epidemic. South Africa has an estimated 5.5 million people with HIV and is struggling to stem the spread of the disease in the general population.

Bailey said that while the World Health Organisation (WHO) had now endorsed circumcision as a preventative measure, encouraging the widespread use of circumcision would not be easy.

"Circumcision is not just simply a surgical procedure. It's tied up in a complex web of cultural and religious practices and beliefs," he said.

NEW DRUGS

New drugs and improved second-generation drugs will not only be more effective in fighting HIV, the IAS conference was told, but could offer treatment to patients whose disease had become immune to earlier drugs.

Recent research has shown that new classes of anti-retroviral drugs, which include various inhibitors, provide superior benefit to patients with highly resistant HIV, said Joseph Eron, professor of medicine at the University of North Carolina.

"I think that while it will take some time, some of these new agents will also be very useful in the developing world were we are seeing the emergence of resistant virus," said Eron in detailing the new drugs.

At the cutting edge of the AIDS battle is genetic engineering, with human trials about to start on genetically modifying a HIV patient's blood stem cells and T cells and reintroducing them into the body to better fight the disease.

"This is a permanent modification of the cells. As long as the cells persist in the patient they will be resistant to further infection," said Professor John Rossi, head of biological sciences at the U.S. Beckman Research Institute.

"We realise that this is not a treatment that will be applied universally," said Rossi, adding the treatment should allow patients to reduce drug dosage.

Rossi and Eron called on drug companies to make new drugs available to the world's poorer nations.

Medecins Sans Frontieres (MSF) told the IAS conference on Monday said that while there had been dramatic price reductions in some HIV drugs, the newer, less toxic drugs recommended by the WHO had become more expensive. An MSF report said some new drugs had risen in price by nearly 500 percent from $99 to up to $487.

The United Nations says close to 40 million people are infected with HIV 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.


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