An update on HIV research and care, nearly two years into the COVID-19 pandemic
On the occasion of World AIDS Day, we spoke with Dr. Jean-Pierre Routy, Clinical Director of the Chronic Viral Illness Service at the MUHC, Senior Scientist in the Infectious Diseases and Immunity in Global Health Program at the Research Institute of the MUHC and Director of the FRQS AIDS and Infectious Diseases Network. Dr. Routy is also the co-chair of the International AIDS Conference 2022, which will be held from July 29 to August 2, 2022, in Montreal.
To mark World AIDS Day, you have organized an event to pay tribute to the pioneers of Quebec’s HIV-AIDS response.
Yes. We want to pay tribute to the doctors and field workers who initiated the fight against AIDS in Quebec 40 years ago, to talk about the progress that was made and commemorate HIV victims. Hosted by Yanick Villedieu, science journalist at Radio-Canada, the evening will include testimonies from some of the pioneers, as well as literary reading selected by author Catherine Mavrikakis, and read by Jean Marchand.
You talk about progress… What is the status of HIV/AIDS research today?
After 40 years of research, there is still no effective HIV vaccine. The challenge is to develop an HIV vaccine that does not create inflammation, and so far, this has not been successful.
In fact, the “superpower” of HIV is that it infects cells when they enter an inflammatory phase to fight an enemy. The cells “cry wolf” and the wolf—in this case HIV—infects them more easily because it knows where they are. This mode of action is unique to HIV, which infects CD4 lymphocytes that are central to the coordination of the immune response. Moreover, we know that the colon has more CD4 cells and therefore more HIV, because the cells are more inflamed.
For this reason, recent scientific developments about the gut microbiome is of particular interest to HIV research. Every day, immune cells in the digestive system must stop microbes while allowing nutrient absorption. Alteration of these immune cells contributes to an inflammatory syndrome related to a greater passage of microbial particles into the blood. This regulatory process could be modified by drugs that act in the digestive tract, as suggested in a recent study that we published in PNAS.
On the other hand, where we have failed with vaccines, we have prevailed with antiretroviral drugs, which are now incredibly powerful. These treatments make it possible to achieve and maintain an undetectable viral load and thus to stop sexual transmission—hence the equation undetectable = untransmissible (u=u). People living with HIV, and who follow treatment, no longer transmit the virus. For people who engage in risky behaviours, taking daily medication protects them from acquiring the virus, but not from other sexually transmitted infections.
In both types of treatment, people must take daily medication, which is sometimes difficult. As a result, what is being developed now is a long-acting injectable drug that could protect an individual for six months. A two-month version is already on the market in Canada; its development was delayed by the COVID-19 pandemic. The 6-month version should have a greater impact.
How has the COVID-19 pandemic affected research and care?
Like other diseases, AIDS has been overshadowed by COVID-19. A lot of research money was invested in COVID-19. In many cases, the same doctors who were working on HIV started working on SARS-Cov-2. So obviously, research has slowed down a bit.
On the care and prevention side, the pandemic has affected the follow-up of some patients. Approximately 10 per cent of patients stopped their treatment or interrupted their medical follow-up, which led, for some, to hospitalizations. Some patients lost their jobs and stopped taking their medication due to a drop in income. There has also been a decrease in the number of tests performed, following temporary closure of testing centres. We do not have precise figures yet, but this has certainly had an impact on health and the transmission of HIV.
What are your hopes for the future?
COVID-19 has had dramatic effects around the world but remains benign in the majority of cases. HIV, on the other hand, affects people for life and remains a major source of stigma.
It is important to re-engage and follow the science—the theme of the upcoming International AIDS Conference 2022, to be held in Montreal next summer. We need to re-engage patients, prevention, vaccine research, and the pharmaceutical industry. All of this must be based on science, and that involves fighting anti-immigrant, anti-LGBTQ2+ rhetoric. When it comes to communicable diseases, we must never let our guard down.
Omicron subvariant appears more contagious, but not more severe, Denmark says
The BA.2 subvariant of the Omicron coronavirus variant, which is dominant in Denmark, appears more contagious than the more common BA.1 sub-lineage, Danish Health Minister Magnus Heunicke said on Wednesday in a national address.
“There is no evidence that the BA.2 variant causes more disease, but it must be more contagious,” Heunicke told a news conference.
The BA.1 lineage currently accounts for 98% of all cases globally but in Denmark has been pushed aside by BA.2, which became the dominant strain in the second week of January.
The UK Health Security Agency has designated BA.2 a variant under investigation, saying it could have a growth advantage.
Preliminary calculations suggest BA.2 could be 1.5 times more infectious than BA.1, Denmark’s top infectious disease authority, Statens Serum Institut (SSI), said in a note on Wednesday.
However, an initial analysis by the institute showed no difference in the risk of hospitalisation for BA.2 compared to BA.1.
“There is some indication that it is more contagious, especially for the unvaccinated, but that it can also infect people who have been vaccinated to a greater extent,” SSI’s technical director Tyra Grove Krause said at the briefing.
This could mean the peak of Denmark’s epidemic will extend a bit further into February than previously forecast, Krause said.
BA.2 cases have also been registered in Britain, Sweden and Norway, but to a much lesser extent than in Denmark.
Denmark on Wednesday announced plans to scrap the last of its COVID-19 restrictions by Feb 1, the latest country in Europe to do so despite record high daily infection numbers.
(Reporting by Nikolaj Skydsgaard and Stine Jacobsen;Editing by Alison Williams, Kirsten Donovan)
Pfizer, Moderna shots safe during in vitro fertilization; healthy gut bacteria may help prevent long COVID
The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that has yet to be certified by peer review.
mRNA vaccines safe during in vitro fertilization
COVID-19 vaccines using mRNA technology do not affect fertility outcomes during in-vitro fertilization (IVF), researchers have found.
They compared rates of fertilization, pregnancy, and early miscarriage in IVF patients who had received two doses of the vaccines from Pfizer with BioNTech or ModernaO> with those in unvaccinated patients. The 222 vaccinated and 983 unvaccinated patients who underwent ovarian stimulation – medical treatment to stimulate development of eggs – had similar rates of eggs retrieved, fertilization, and embryos with normal numbers of chromosomes. The 214 vaccinated and 733 unvaccinated patients who underwent frozen-thawed embryo transfer – where their eggs were collected from the ovaries and fertilized by sperm in a laboratory, creating embryos that were frozen and later thawed and transferred to the womb – had similar rates of pregnancy and early pregnancy loss, according to a report published on Tuesday in Obstetrics & Gynecology.
“Our findings contribute to the growing body of evidence regarding the safety of COVID-19 vaccination in women who are trying to conceive,” the researchers concluded.
Healthy gut bacteria may protect during COVID
The bacteria living in your small intestine may contribute to the risk for long COVID after infection with SARS-CoV-2, new findings suggest.
Researchers analyzed the “gut microbiome” in 116 COVID-19 patients in Hong Kong in 2020, when regulations required that every infected person be hospitalized. More than 80% were mildly or moderately ill, but more than 75% had at least one persistent symptom. After six months, the most common symptoms were fatigue (reported by 31%), poor memory (28%), hair loss (22%), anxiety (21%) and sleep disturbances (21%), according to a report published on Tuesday in Gut. Analyses of stool samples obtained at hospital admission and over the succeeding months showed long COVID patients “had a less diverse and less abundant microbiome,” said Siew C. Ng of The Chinese University of Hong Kong. “Patients who didn’t develop long COVID had a gut microbiome similar to that of people without COVID-19.”
Lack of “friendly” immunity-boosting Bifidobacteria species was strongly associated with persistent respiratory symptoms, Ng noted. While the study cannot prove that healthy gut organisms prevent long COVID, the findings suggest “maintaining a healthy and balanced gut microbiota via diet, avoidance of antibiotics if possible, exercise and supplementing with depleted bacteria species including Bifidobacteria” might be helpful, she said.
New PCR test can identify variants
A new type of PCR test can quickly tell which variant of the coronavirus is causing infection, helping doctors choose the most effective antibody treatments, researchers said.
Most current PCR tests can check broadly for the presence of the virus but cannot identify specific variants. The new test uses special “probes” – fluorescently labeled molecules – called “sloppy molecular beacons” that glow in different colors when they attach themselves to DNA or RNA in the virus. When the sample from the patient is heated, the probes fall off their DNA or RNA targets and their color disappears. They fall off at different temperatures depending on the DNA or RNA sequence they were bound to. Because the variants each have some unique sequences, they can be identified based on the pattern of color changes at each temperature, explained Dr. David Alland of \?
“We have already performed a clinical study which showed that the assay was 100% sensitive and 100% specific for identifying variants of concern including Delta and Omicron,” Alland said. “We are asking the N.J. Dept of Health to clear our test” so that New Jersey labs can use it, he added. A typical hospital molecular laboratory would be able to perform it, his team reported on Friday on medRxiv ahead of peer review.
U.S. study finds slight myocarditis risk with mRNA vaccines
There is a small but increased risk for heart muscle inflammation, or myocarditis, following receipt of the mRNA COVID-19 vaccines from Pfizer/BioNTech and Moderna, researchers from the U.S. Centers for Disease Control and Prevention have found.
The 1,626 cases documented in the Vaccine Adverse Event Reporting System from December 2020 through August 2021 “exceeded the expected rates,” the researchers reported on Tuesday in JAMA. Overall, 73% of reported cases were in people under age 30, and 82% were males. The highest rates were found among adolescent and young adult males. For every million doses of Pfizer’s vaccine, there were roughly 71 cases of myocarditis in males ages 12 to 15 and 106 cases in males ages 16 or 17. In young men ages 18 to 24, the rate per million doses was roughly 52 with the Pfizer shots and 56 after Moderna shots. About 96% of patients with myocarditis were hospitalized. In 87%, symptoms were gone by the time they were discharged. Non-steroidal anti-inflammatory drugs were the most common treatment.
“This risk should be considered within the context of the significant benefits of COVID-19 vaccination in preventing COVID-19 infection and potential serious complications,” said a spokesperson for the authors, who noted that COVID-19 itself confers a 16-times higher risk for myocarditis. “The benefits of COVID-19 vaccination continue to outweigh any potential risks.”
Click for a Reuters graphic on vaccines in development.
(Reporting by Nancy Lapid; Editing by Bill Berkrot)
A third of airline pilots still not flying as pandemic drags on -survey
More than one-third of airline pilots are still not flying as the pandemic continues to take its toll on aviation globally, according to a new survey, though the situation has improved from a year earlier when the majority were grounded.
A poll of more than 1700 pilots by UK-based GOOSE Recruitment and industry publication FlightGlobal, released on Wednesday, found 62% globally were employed and currently flying, up from 43% a year earlier.
The proportion of unemployed pilots fell from 30% to 20%, while 6% were on furlough, compared with 17% previously as air traffic began to bounce back from 2020 lows.
But in the Asia-Pacific region, the worst-hit globally by a drop in international travel due to tough border restrictions, the proportion of those unemployed rose from 23% to 25%. The region also had the lowest number that were employed flying at 53%.
“We have … seen some expatriates return home from the region due to concerns over quarantine or being stuck for long periods away from friends and family,” the report on the survey said.
Hong Kong’s Cathay Pacific Airways, a large expatriate employer in Asia, has lost hundreds of pilots through the closure of its Cathay Dragon regional arm as well as almost all of its overseas bases during the pandemic.
Pilot attrition at Cathay has also been rising amid strict layover rules that leave crew members locked https://www.reuters.com/world/asia-pacific/locked-hotels-hong-kongs-covid-19-rules-take-mental-toll-cathay-pilots-2021-11-26 in hotels when they are not flying.
Of the pilots still flying globally, 61% told the survey they were concerned about their job security.
“It appears only Northern America is back to post-COVID passenger numbers,” said an unnamed captain flying in the Middle East and Africa. “The rest of the world, especially developing nations, are still struggling to get vaccines, and are still not travelling.”
(Reporting by Jamie Freed in Sydney; Editing by David Gregorio)
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