Over the next 5 years, the NIH will award US$15 million to the Center for AIDS Research (CFAR) of the University of California, San Francisco (UCSF; CA, USA) and the Gladstone Institute of Virology and Immunology (GIVI) in order to continue its pioneering translational research. This is a doubling from the previous 5-year award.
“The UCSF–GIVI Center for AIDS Research is absolutely crucial to maintaining and extending the leadership role of San Francisco in responding to the HIV epidemic. It brings together a true community of HIV investigators who represent the many disciplines and campus sites involved in this effort,” said Paul Volberding, codirector of the center.
The NIH CFAR program, which began in 1988, provides strategic, educational and scientific services to HIV/AIDS researchers, and focuses on the importance of interdisciplinary collaboration, particularly between basic and clinical investigators, with an emphasis on the inclusion of minorities and of prevention and behavioral change research. The program supports 19 centers located at leading HIV/AIDS research and academic institutions throughout the US.
“CFAR is particularly vital in encouraging the collaborations across conventional scientific disciplines that can direct the amazing expertise of UCSF scientists to address the newest challenges of HIV disease. As we address scientific and clinical challenges here in San Francisco, as well as in the worldwide epidemic, CFAR will provide the essential infrastructure to facilitate the most important and innovative science we all depend on,” said Warner Greene, who is also a codirector of the UCSF–GIVI center.
The CFAR program already provides infrastructure support to over $80 million of funded HIV/AIDS research at UCSF and affiliated institutions. In the future, the CFAR plans to expand the number of pilot awards available, including for basic science pilots and for mentoring foreign scientists. There will also be increased direct support for international collaborations, specifically in East Africa. Source: University of California, San Francisco: www.ucsf.edu.
Innovative new laser technique targets pathogens selectively
Physicists from Arizona State University (AZ, USA) have developed an innovative new method of destroying microorganisms without damaging human cells. The technique involves manipulation of a near-infrared femtosecond laser via impulsive stimulated Raman scattering.
The researchers found that by appropriately selecting the wavelength and pulse width of the femtosecond laser, they could identify a power density window within which target viruses and bacteria could be inactivated without causing cytotoxic damage to human cells. They used the technique to selectively inactivate M13 bacteriophages, tobacco mosaic virus and Escherichia coli bacteria while, at the same power densities, human Jurkat T cells and Chinese hamster ovary cells remained intact. In a communication in the Journal of Physics: Condensed Matter, the authors suggest that the selective effect may be due to the differences in size and cell wall composition between bacteria, viruses and mammalian cells.
Current antimicrobial strategies, including the use of UV irradiation or pharmaceutical and biochemical methods, do not always discriminate between human and pathogenic cells in this way, can lead to drug resistance and can cause side effects, in addition to having limited efficacy.
The femtosecond laser technique could have wide-ranging applications in biomedical research, for example, in the treatment of diseases such as AIDS and hepatitis, and in the disinfection of blood supplies and of biomaterials in hospitals. Source: Tsen KT, Tsen S-W, Sankey OF, Kiang JG. Selective inactivation of micro-organisms with near-infrared femtosecond laser pulses. J. Phys. Condens. Matter DOI: 10.1088/0953-8984/19/ 47/472201 (2007) (Epub ahead of print).
Simple strategies could prevent half of new extensively drug-resistant TB cases
Up to half of new extensively drug-resistant (XDR) TB cases could be prevented by the introduction of rapidly available infection control measures, according to a new study published in The Lancet. These measures could include increasing the use of face masks, reducing hospital overcrowding and improving ventilation.
Researchers from Yale University School of Medicine (CT, USA) constructed a computer model based on over 2 years’ longitudinal in-patient- and community-based data from Tugela Ferry, a rural community in South Africa. XDR TB has been reported in 37 countries from all regions of the world, including the USA, but it is epidemic among hospitalized patients in South Africa and is particularly widespread in the Tugela Ferry region.
TB is caused by bacteria that infect the lungs and is spread through the air. The vast majority of XDR TB affects HIV-infected individuals, owing to their reduced resistance to infection.
The aim of the model was to assess the effects of administrative, environmental and personal infection control measures on the spread of XDR TB. The model was 95% accurate in predicting the trend of normal and XDR TB spread in Tugela Ferry, and provides the first estimates of the XDR TB burden in South Africa.
According to the model, more than 1300 new cases could arise in the region by the end of 2012 if no new interventions are introduced. “It is critically important to take steps now to prevent the further spread of XDR TB,” said Sanjay Basu, PhD student and lead author of the study. “If we wait to act, this form of TB will spread further in the community and beyond borders. When a drug-resistant strain hit New York (NY, USA) in the 1990s, it cost over US$1 billion to bring under control.”
The authors argue that the best approach to prevent the spread of XDR TB is to change the healthcare environment. They found that while increasing face mask use would avert fewer than 10% of new cases, combining this with reducing hospitalization time and moving towards out-patient therapy could prevent almost one-third of cases. Furthermore, improving ventilation, addressing hospital overcrowding, and enhancing access to HIV testing and faster diagnostic tests could prevent approximately 50% of new cases.
The authors conclude that a combination of available nosocomial infection control strategies could prevent nearly half of XDR TB cases, even in a setting where resources are limited. “We can do a lot to change what is going on,” said senior author Gerald Friedland, Professor of Medicine at Yale. “This is a train crash between the two epidemics of HIV and TB, and we have to address both problems together to fix this situation.”
Source: Basu S, Andrews JR, Poolman EM et al. Prevention of nosocomial transmission of extensively drug resistant tuberculosis in rural South African district hospitals: an epidemiological modelling study. Lancet 370, 1500–1507 (2007).
Lymphatic filariasis may be eradicated by affordable mass drug administration
Elimination of a neglected tropical disease by once-yearly mass drug administration (MDA) could be cheaper than bargained for, according to an international survey conducted by Ann Goldman and colleagues of the George Washington University (DC, USA). At a cost of US$0.06–2.23 per person treated, control of lymphatic filariasis (LF) will be more attainable as part of eradication programs in poor countries.
LF is a debilitating and disfiguring disease, causing bloating of limbs as well as internal damage to the kidneys and lymphatic systems. The culprits, endemic in many South East Asian and African regions, are thread-like filarial worms, which are transmitted via mosquito vectors. Although not fatal, the disease is responsible for significant morbidity.
To date, there is no known cure, but with the available tools LF is still considered eradicable by the WHO. Spread of the disease can be prevented by interrupting transmission through MDA of the two drugs albendazole and diethylcarbamazine to the entire endemic population once annually for 5–6 years. Goldman’s team, whose study was published in Public Library of Science Neglected Tropical Diseases in November, assessed the cost of such a mass therapy approach in seven countries (Ghana, The Philippines, Tanzania, Egypt, Burkina Faso, Dominican Republic and Haiti).
The per-person price estimate of MDA came as a positive surprise. “The study demonstrates that the costs of MDA programs for LF elimination are comparable to those estimated for other similar disease control and elimination programs,” explained the authors. The between-country variation observed (up to US$2.00) was largely attributed to the age (newness) of the MDA program, the use of volunteers and the size of the population treated. “Such findings can be used on a national scale for program planning, development and fundraising, and on a global scale for calculating current global costs, predicting scale-up costs and calculating savings from integration with other programs”, the researchers added.
According to WHO data, 1.307 billion people worldwide are currently at risk of catching LF. However, previous MDA interventions have been successful in reducing these figures. A 2006 endeavour by Weil and colleagues to control the disease in Egypt saw prevalence rates fall from 11.5 to 1.2% in the most endemic study area, Giza. As emphasized by David Molyneux of Liverpool School of Tropical Medicine (UK), MDAs certainly provide a ‘quick-win’ control for “one of the most widespread, disabling and stigmatizing of diseases.” Low cost of implementation is thus welcome news.
Sources: Goldman AS, Guisinger VH, Aikins M et al. National mass drug administration costs for lymphatic filariasis elimination. PLoS Negl. Trop. Dis. 1(1), e67 DOI:10.1371/journal.pntd.0000067 (2007);
Ramzy RMR, El Setouhy M, Helmy H et al. Effect of yearly mass drug administration with diethylcarbamazine and albendazole on bancroftian filariasis in Egypt: a comprehensive assessment. Lancet 367(9515), 992–999 (2006);
Molyneux DH. Elimination of transmission of lymphatic filariasis in Egypt. Lancet 367(9515), 966–968 (2006).
Roche announce final REPEAT results
Roche have announced the final results from the Retreatment With PEGASYS In Patients Not Responding To Peg-Intron Therapy (REPEAT) study, showing that once-weekly treatment with PEGASYS® (peginterferon α-2a) and daily treatment with COPEGUS® (ribavirin) for 72 weeks is promising for patients with chronic HCV whose infection was unresponsive to previous treatment with Peg-Intron® (peginterferon α-2b) and ribavirin.
The results also demonstrated that response at 12 weeks was a good indicator of the final outcome. Most patients who had undetectable virus at 12 weeks achieved a sustained virological response after the full 72 weeks of treatment, whereas most patients with detectable virus at 12 weeks did not achieve a sustained virological response.
PEGASYS is approved for the treatment of HCV. In combination with COPEGUS (ribavirin) it is indicated for the treatment of adults with chronic HCV who have compensated liver disease and have not previously been treated with interferon-α. The combination is also the first and only FDA-approved regimen for the treatment of chronic HCV in patients coinfected with HCV and HIV.
The REPEAT study enrolled 950 patients from Europe, North America and Latin America.
“One of the greatest areas of need in hepatitis C today is to find solutions for patients who have not seen treatment success with an initial course of therapy. REPEAT is an important study which adds significantly to our knowledge about how to manage these patients, demonstrating that extending treatment with PEGASYS and COPEGUS is a promising option,” said Donald Jensen, MD, Professor of Medicine and Director of the Center for Liver Diseases at the University of Chicago Hospital (IL, USA), and lead investigator of REPEAT. “A significant finding from REPEAT is confirmation of the reliability of using a patient’s response at 12 weeks as a predictor of treatment success, even in patients with cirrhosis. This means that patients who achieve undetectable virus at 12 weeks can continue treatment with a good likelihood of success. It also means that clinicians can confidently discontinue treatment in patients who do not achieve an early response.”
“REPEAT exclusively enrolled patients who had not previously responded to pegylated interferon combination therapy, in this case Peg-Intron and ribavirin,” Jensen continued. “These patients are a more difficult-to-treat group than relapsers and those who did not respond at all to treatment with non-pegylated interferons, either alone or with ribavirin. For this reason, results from REPEAT cannot be meaningfully compared to results from trials with a large proportion of patients who were relapsers or who did not respond to treatment with older interferons.”
The results were presented at the 58th Annual Meeting of the American Association for the Study of Liver Diseases in Boston on 2 November.
Source: Roche Pharmaceuticals: www.rocheusa.com.
H5 avian influenza outbreak in the UK
A 3-km protection zone and a 10-km surveillance zone have been set up after turkeys from a premises near Diss on the Norfolk/Suffolk border (UK) were tested positive with the H5 strain of avian influenza virus on 12 November. Subsequently, a wider restricted zone that covers most of Norfolk and all of Suffolk has also been set up as a precautionary measure while further tests are being carried out to confirm whether or not the virus strain is H5N1. The premises also contain ducks and geese, all of which will be culled. Movements of poultry out of the restricted zone are not permitted and all poultry keepers throughout the UK are being informed.
The UK Department for Environment, Food and Rural Affairs (Defra) recently published a ‘Lessons to be Learned Report’ in August regarding the outbreak of H5N1 avian influenza in Suffolk earlier in February 2007 when this new case of H5 virus emerged from the same region. Confirmatory test results are awaited while the investigation is ongoing.
Source: Department for Environment, Food and Rural Affairs, UK: www.defra.gov.uk