Interesting news out of the AIDS Conference.

Scientists in the United States said Wednesday they had used a cancer drug to flush out the AIDS virus lurking dormant in trial patients’ white blood cells — a tentative step towards a cure. The ability of the HIV genome, or reproductive code, to hide out in cells and be revived after decades poses a major obstacle in the quest for a cure. Being able to expose the virus in its hiding place would allow scientists to target the host white blood cells in a killing blitz. “It is the beginning of work toward a cure for AIDS,” David Margolis, co-author of the study published in the journalNature, told AFP as the International AIDS Conference was under way in Washington.

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The OraQuick In-Home HIV Test is designed to allow individuals to collect an oral fluid sample by swabbing the upper and lower gums inside of their mouths, then place that sample into a developer vial, and obtain test results within 20 to 40 minutes. A positive result with this test does not mean that an individual is definitely infected with HIV, but rather that additional testing should be done in a medical setting to confirm the test result. Similarly, a negative test result does not mean that an individual is definitely not infected with HIV, particularly when exposure may have been within the previous three months. The test has the potential to identify large numbers of previously undiagnosed HIV infections, especially if used by those unlikely to use standard screening methods.

The first trial in humans of an injectable, once-a-month formulation of an HIV drug has found that drug levels were maintained at a level that should in theory be high enough to protect recipients against infection, and that the drug has so far produced very few side effects. The research was presented at the 19th Conference on Opportunistic Infections (CROI), in Seattle.
The small trial at the St Stephen’s AIDS Trust (SSAT) at London’s Chelsea and Westminster Hospital gave 27 women and six men a single injection of the long-acting formulation of the drug rilpivirine, which was licensed as an oral HIV treatment last year as Edurant and is also in the tenofovir/FTC/rilpivirine pill Complera. Rilpivirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) drug and is especially suitable to be turned into a long-lasting injectable form because the daily dose of it required to suppress HIV is very small.
No other HIV drugs are currently in a usable long-lasting injectable form, which will limit the use of long-acting rilpivirine (RPV-LA) in combination therapy, but it could conceivably make an ideal candidate as a prevention drug, as people would not need to remember to take it every day. Other preventative drugs already formulated as monthly injections include the injectable contraceptiveDepo Provera and some anti-psychotic drugs.
SSAT recruited 27 HIV-negative women aged 18 to 50, more than 50% of them black African or Caribbean, for the trial and gave them one of three doses of RPV-LA as an intramuscular injection: 300, 600 or 1200mg (the oral dose of RPV is 25 mg/day). Drug levels were then measured over the course of the next twelve weeks in blood, vaginal fluid and in vaginal tissue samples. A substudy gave six men the 600mg dose and measured RPV-LA levels in blood, rectal fluid and rectal tissue samples.
Thirty days after injection, blood and vaginal fluid levels of rilpivirine were about 60 nanograms per millilitre (ng/ml) in both blood and vaginal fluid in women given the 600mg dose, and about 80 and 120ng/ml respectively in women given the 1200mg dose. Blood levels in men given the 600mg dose were about 70ng/ml at 30 days. For comparison, the trough levels of rilpivirine in people taking daily oral doses is about 140ng/ml; but the EC₅₀ (the amount needed to reduce viral replication by 50%) in newly-infected T-cells is 27ng/ml. It is thought these levels should be adequate to prevent HIV infection.  
Over the time period, levels of drug seen were about 80% higher in vaginal fluid than in blood in women taking the 300mg dose and about 20% higher in the other two doses: conversely, drug levels in vaginal tissue were about 25% lower than in blood, and 50% lower up to day 14 in the 300mg dose group.
Drug levels in rectal fluid were low but it is thought this was due to sample contamination: concentrations in rectal tissue were about the same as concentrations in blood.
The trial participants complained of very few side-effects apart from tenderness and some swelling at the injection site. There were no allergic reactions, psychological symptoms or effects on heart rate. Safety is of course a major consideration in a drug that remains in the body for up to twelve weeks.
Researcher Akil Jackson said, “There is an obvious need in HIV prevention and treatment for formulations that reduce the need for the user to depend on daily administration,” but added that these were very preliminary results and did not establish what dose would actually be protective. Further safety and drug-level studies in HIV-negative volunteers are to be conducted at the University of Pittsburgh, home of the Microbicide Trials Network, before the drug is given to volunteers with HIV.

The British government is telling doctors that the usual course of treatment for gonorrhea is now largely useless.

• The Health Protection Agency says we may be heading to a point when the disease is incurable unless new treatments can be found. For now, doctors must stop using the usual treatment cefixime and instead use two more powerful antibiotics. One is a pill and the other a jab. The HPA say the change is necessary because of increasing resistance. [snip] As recently as 2005, no gonorrhoea bacteria with reduced susceptibility to cefixime could be found in the UK. The bacterium that causes the infection - Neisseria gonorrhoeae - has an unusual ability to adapt itself and has gained resistance, or reduced susceptibility, to a growing list of antibiotics - first penicillin itself, then tetracyclines, ciprofloxacin and now cefixime.