Infectious HIV strains spreading in India
INDIAN SCIENTISTS have found new strains of the HIV1-C subtype – which is responsible for half of the world’s HIV infections – are evolving rapidly in this country. The proportion of some of these new strains of the HIV1-C went up from two per cent in 2000–2003 to 30 per cent a decade later, said their study published in the Journal of Biological Chemistry. The HIV1-C accounts for more than 95 per cent of infections in India. This is for the first time that scientists have shown that HIV1-C, considered stable since its detection in early 1980s, is evolving. The scientists, led by Udaykumar Ranga, professor of molecular biology and genetics at the Jawaharlal Nehru Centre for Advanced Scientific Research (JNCASR), Bangalore, have identified five different strains of HIV1-C. Of these, one strain was found to be more infectious than others. For their study, the scientists used blood samples collected from diverse hospitals and research institutes in Bangalore, Chennai and New Delhi. What helps the HIV virus infect human beings is a protein called NF-kappaB. While other HIV strains have one or two copies of NF-kappaB, the conventional HIV1-C subtype has three copies, which explains its higher prevalence all over the world. Significantly, the JNCASR scientists found the more infectious of the new strains to have as many as four copies of NF-kappaB – though they were not more virulent than the original strain. “Our data do not suggest that the new viruses promote faster disease progression to AIDS,” Ranga said. According to Ranga, no change in disease management strategy is indicated. “The old and new viruses share the same reverse transcriptase gene; hence, the new viral strains must be as sensitive to anti-retroviral therapy as the old viral strains are.” Retroviruses reproduce by transcribing their ribonucleic acid (RNA) into deoxyribonucleic acid (DNA), using the reverse transcriptase enzyme. The resultant DNA inserts itself into host cell DNA and is reproduced along with the cell and its daughters. Shahid Jameel, group leader for virology, International Centre for Genetic Engineering and Biotechnology, New Delhi, said that the molecular features of their genome do make HIV viruses replicate better, leading to greater transmission. “But then, now there is more awareness and better anti-HIV drug availability that will counter increased transmission potential,” Jameel said. (SciDev)
SMS can help HIV patients cut viral load
MOBILE PHONE communication between clinicians and HIV patients can improve adherence to drug treatment and help to cut viral load, a study has shown. In the study conducted in Kenya, researchers found that text messages supported improved adherence to antiretroviral therapy (ART) and suppression of the most common strain of HIV. The WelTel trial involved sending weekly messages to patients asking whether they were well or whether they were experiencing problems with their treatment. Sarah Karanja, an HIV/sexually transmitted infection prevention officer for the Kenya AIDS Control Project run by the University of Manitoba, Canada, and one of the researchers involved in the study, says: “Patient clinician cell phone communication provided constant interaction between the drug providers and the patients. If a patient had a problem, they were able to contact the clinician, who would, in turn, provide immediate assistance.” If a patient failed to call, she says, the clinician would ring to find out why and give assistance. Most of the problems reported during the trial, she says, were related to social stigma or drug side effects. Adherence trials began in 2005 when antiretroviral drugs were first rolled out in Kenya’s hospitals and patients were given fairly widespread access. At this time, Karanja says, most people already had access to mobile phones, prompting the WelTel Kenya antiretroviral trial based around text messaging to begin in May 2007. According to Judy Gichoya of the Regional East African Center for Health Informatics, several randomised controlled trials have provided enough scientific evidence about text messaging’s role in improving adherence to treatment. She says that the text reminders used in the study, which was published in PLOS One in September, were further proof that they can boost adherence to long-term medication regimes for chronic illness. “There is a role for cell phone technology in HIV prevention, through promoting adherence to preventive measures,” she says. “Patients may use the cell phones for their own personalised initiatives, such as the use of alarms for medication reminders.” But Gichoya warns that the possibility of disclosure of status, loss of privacy and technical difficulties must also be addressed before text messaging can be used on a large scale for health purposes. “There are no studies describing the use of cell phones to improve adherence to HIV/AIDS treatment guidelines and studies addressing [their use in bringing about] behaviour change [in other health areas] cite difficulty in outcome measurement and high costs as hampering their scalability,” she says. (SciDev)