A new drug to treat HIV infection was approved by the U.S. Food and Drug Administration on Monday.

Marketed as Tivicay, the medication interferes with an enzyme that is essential to the ability of the HIV virus to multiply and spread within the human body, the agency said in a news release. It is a pill that is to be taken once a day with other HIV drugs, according to the FDA.

"HIV-infected individuals require treatment regimens personalized to fit their condition and their needs," Dr. Edward Cox, director of the Office of Antimicrobial Products in the FDA's Center for Drug Evaluation and Research, said in the release. "The approval of new drugs like Tivicay that add to the existing options remains a priority for the FDA."

Approved for use in both people who have been diagnosed with HIV but have never taken medications to treat the virus and in those who have taken other HIV drugs, Tivicay (dolutegravir) is also approved for certain children under the age of 12.

The approval was based on the results of five clinical trials involving more than 2,500 patients. Insomnia and headaches were common side effects of the medication, along with hypersensitivity and abnormal liver function in HIV patients who have also been diagnosed with hepatitis B and/or C, the agency said in the release.

Almost 50,000 Americans are infected with HIV every year, according to the U.S. Centers for Disease Control and Prevention, and more than 15,000 died of the disease in 2010.

Tivicay is made by GlaxoSmithKline, based in Research Triangle Park, N.C., according to the FDA.

WHO RISK ASSESSMENT Human infections with influenza A(H7N9) virus 13April 2013

WHO RISK ASSESSMENT

Human infections with influenza A(H7N9) virus

13April 2013

Summary of available information
As of 13April 2013, a total of 49 confirmed cases of human infection with avian influenza A(H7N9)
virus have been reported to WHO by the China National Health and Family Planning Commission.
Among these cases, the ages range from 4 to 87; 15 are female. Eleven persons have died, and the
majority of the additional cases are considered severe. Of the 49 cases, 6 have been reported today
and further investigations are taking place. The cases have been reported from three provinces:
Anhui, Jiangsu and Zhejiang, and two municipalities, Beijing and Shanghai. All locations are in Eastern
and Northern China.
Two confirmed cases have been associated with possible family clusters, in which one and two
additional family members,respectively, developed severe pneumonia. Close contacts of confirmed
cases and health care workers caring for cases have been monitored for infection. So far, among the
contacts who have been tested by polymerase chain reaction, none has been shown to have
infection.
This is the first time human infection with this influenza subtype, avian influenza A(H7N9) virus, has
been detected. Previously,sporadic cases of human infection with otherinfluenza A(H7) viruses
have been reported. Those cases were associated with outbreaks of infection in poultry in other
countries. These earlierinfluenza A(H7) human infections generally resulted in mild influenza illness
with some conjunctivitis.
Genetic and laboratory characterization of the first three of these H7N9 virusesisolated from
humans indicatesthat:

• the virus contains a group of avian influenza virus genes from three different avian influenza
viruses;
• to date, genetic analyses of the isolates have shown certain changes, including amino acid
substitutions associated with increased affinity to alpha 2-6 receptors, which suggests that
the H7N9 virus may have greater ability to infect mammalian species, including humans,
than most other avian influenza viruses;
• there are sequence variations among the genes of three isolates that suggestthere has been
more than one introduction of this virus from animal into humans;
• these viruses are expected to be sensitive to the neuraminidase inhibitor drugs oseltamivir
and zanamivir, but resistant to the antiviral drugs amantadine and rimantadine;
• the isolates have a haemagglutinin structure thatis associated with low pathogenicity in
birds.
There are several gaps in critical information at this time, including the animal reservoir(s)in which
this virus is circulating, the main exposures and routes of transmission for how human infections
have been acquired, and the current scope of the spread of this virus among animal and human
populations. Avian influenza A(H7N9) viruses have now been isolated from poultry (including duck)
and pigeon in the live birdmarketsin some areas of China, but whether other potential reservoirs of

this virus may exist, including in other domestic and wild bird species, and mammalian species such
as pigs, has not yet been determined clearly.
So far, this virus has not been associated with reports of severe disease in poultry.
Risk assessment
This initial risk assessment, which has been prepared in accordance withWHO’s published
recommendations for rapid risk assessment of acute public health events1
will be updated as further
information becomes available.
What is the risk of the occurrence of further cases in the affected areas of China and other areas?
The epidemiology of this virus among animals, including the main reservoirs of infection among
animals and the extent of geographic spread, is not yet established. However, it is likely that most
human H7N9 infections so far are associated with infection among as-of-yet undetermined animals
and that further human cases of infection should be expected.
What is the risk of human-to-human transmission?

There is no evidence of sustained human-to-human transmission. However the two possible family
clusters suggestthat limited human-to-human transmissionmay occur where there is close contact
between cases and other individuals, as occurs in families and, potentially, healthcare settings.
Moreover, the genetic changes seen among these viruses suggesting adaptation to mammals is of
concern, and further adaptation may occur.
What isthe risk of international spread?
At this time, there is no information to indicate international spread of this virus. However, it is
possible that an infected person, who may or may not have symptoms, could travel to another
country. However, if the virus cannot sustain human-to-human transmission, as appears to be the
current situation, then extensive community spread is unlikely.
WHO does not advise special screening at points of entry with regard to this event, nor does it
recommend that any travel or trade restrictions be applied.


References
Most recent disease outbreak news can be found at:
http://www.who.int/csr/don/en/index.html
Background and summary of human infection with influenza A(H7N9) virus (as of 5 April 2013):
http://www.who.int/influenza/human_animal_interface/update_20130405/en/index.html
Frequently Asked Questions on human infection with influenza A(H7N9) virus, China:
http://www.who.int/influenza/human_animal_interface/faq_H7N9/en/index.html

Human infection with a new type of influenza virus A(H7N9)

The World Health Organization (WHO) has been officially notified by the China National Health and Family Planning Commission about human infection (and deaths) with an influenza virus subtype A(H7N9) that has not been previously reported in humans. There is no indication of human-to-human transmission associated with these patients. WHO is working closely with it's Collaborating Centres for influenza to discuss and strengthen diagnostics and case management. At present, the reservoir, source of infection and mode of transmission remain unknown.

Yellow fever vaccination booster not needed

17 MAY 2013 | GENEVA - The yellow fever ‘booster’ vaccination given ten years after the initial vaccination is not necessary, according to WHO. An article published in WHO’s Weekly Epidemiological Record (WER) reveals that the Organization’s Strategic Advisory Group of Experts on immunization (SAGE) has reviewed the latest evidence and concluded that a single dose of vaccination is sufficient to confer life-long immunity against yellow fever disease.

Since yellow fever vaccination began in the 1930s, only 12 known cases of yellow fever post-vaccination have been identified, after 600 million doses have been dispensed. Evidence showed that among this small number of “vaccine failures”, all cases developed the disease within five years of vaccination. This demonstrates that immunity does not decrease with time.

Important news for yellow fever endemic countries and travellers

“The conventional guidance has been that the yellow fever vaccination has had to be boosted after ten years,” says Dr Helen Rees, chair of SAGE. “Looking at really very good evidence, it was quite clear to SAGE that in fact a single dose of yellow fever vaccine is effective. This is extremely important for countries where yellow fever is endemic, because it will allow them to reconsider their vaccine scheduling. It is also important for travelers.”

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes that is endemic to 44 countries in tropical areas of Africa and the Americas. Infection with the yellow fever virus causes varying degrees of disease, from mild symptoms to severe illness with bleeding and jaundice and fatal outcomes.

Estimated 200 000 new cases each year

There are an estimated 200 000 cases of yellow fever worldwide each year. About 15% of people infected with yellow fever progress to a severe form of the illness, and up to half of those will die, as there is no cure for yellow fever. The treatment is aimed simply at reducing patients’ discomfort.

The vast majority of reported cases and deaths occur in sub-Saharan Africa. In endemic regions of Africa, yellow fever natural immunity is acquired with age, putting children at highest risk of infection. Over the past two decades, the number of yellow fever cases worldwide has increased due to declining population immunity to infection, deforestation, urbanization, population movements and climate change.

Vaccination is the most effective measure

Vaccination is considered to be the most important and effective measure against yellow fever. Protective immunity develops within 30 days for 99% of people receiving the vaccination. For routine immunization programmes in Africa, home to 31 of the 44 yellow-fever endemic countries, the vaccine costs about $0.82 per dose.

SAGE is the principal advisory group to WHO for vaccines and immunization. It is charged with advising WHO on overall global policies and strategies, ranging from vaccines and technology, research and development, to delivery of immunization and its linkages with other health interventions. SAGE is concerned with all vaccine-preventable diseases including childhood vaccines and immunization.

For more information please contact:

Fadéla Chaib
Communications Officer/Spokesperson
Telephone: +41 22 791 32 28
Mobile: +41 79 475 55 56
E-mail: chaibf@who.int

Human infection with avian influenza A(H7N9) virus

17 MAY 2013 - Since 8 May 2013, no new laboratory-confirmed cases of human infection with avian influenza A(H7N9) have been reported to WHO by the National Health and Family Planning Commission, China. However, four additional deaths have been reported from previously laboratory-confirmed cases.

To date, WHO has been informed of a total of 131 laboratory-confirmed cases, including 36 deaths.

Authorities in affected locations continue to maintain enhanced surveillance, epidemiological investigations, close contact tracing, clinical management, laboratory testing and sharing of samples as well as prevention and control measures. In the past week, the Shanghai and Zhejiang provincial governments have started to normalize their emergency operations into their routine surveillance and response activities. WHO offices in country, regional and headquarters continue to work closely to ensure timely information updates.

Until the source of infection has been identified and controlled, it is expected that there will be further cases of human infection with the virus.

So far, there is no evidence of sustained human-to-human transmission.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions.

WHO continues to work with Member States and international partners. WHO will provide updates as the situation evolves.

Researching HIV in WikiLeaks Cables

All 251,287 WikiLeaks "Cablegate" cables have now been released (apparently by opponents of Assange). They are searchable, and 'HIV' is mentioned in 1534 of them. While 107 cables are tagged 'HIV', many other relevant cables are not.

Several specialized search engines will search this huge archive for whatever you want. We used www.CableDrum.net for this article. (Apparently the full text of the cables is indexed in Google, though not in Bing.)

To try CableDrum yourself, visit the site and type HIV into the "Search text" box, then click the Search button. A search might take half a minute or so, but then you should see the Subject of the first 25 of the 1534 cables containing 'HIV'. To read the full text of the cable, click the "Reference ID" on the left of the Subject line.

For this article we decided to look at two issues:

• What was the U.S. reaction as it became clear that Australia was doing much better than the U.S. in AIDS prevention -- apparently due mainly to very different policies on needle exchange?
• How did the U.S. embassies see PEPFAR (President's Emergency Fund for AIDS Relief), the outstandingly successful U.S. program to make AIDS treatment available on a large scale to poor countries that otherwise had very little access?

Our research is incomplete, and presented mainly to show you how to use the cable database.

AUSTRALIA AND NEEDLE EXCHANGE

"[Needle exchange programs] have played a vital role in helping prevent the spread of blood-borne illnesses in Australia, according to Paul Dessaur of WASUA. 'In Australia, for instance, the rate of HIV amongst injecting drug users is less than 1 percent, and that is unheard of, and it's purely because we introduced these programs way back in 1986,' he said." [2012,www.cdcnpin.org/scripts/display/NewsDisplay.asp?NewsNbr=59528]

We don't have a comparable U.S. figure for the infection rate among IDUs, but it is probably well over 10 times higher.

Our search for HIV and Australia as tags found nothing. A search for:
HIV Australia
in the full text found 79 cables. Most of them were unrelated, so we tried:
Australia hiv "syringe exchange"
with no result. But:
Australia hiv "needle exchange"
found one result, www.cabledrum.net/cables/09MOSCOW3072, which is relevant (one of only two we've found so far). It described Russia's chief medical officer as "positive about needle exchange
programs, saying that they were proving effective."

Searching for
Australia "needle exchange"
(no need to mention HIV) found 7 results, including the above, plus another relevant cable (www.cabledrum.net/cables/09UNVIEVIENNA64), also dated 2009, referred to the "new USG [United States Government] position: support for needle exchange programs as a method to prevent the spread of HIV/AIDS, and for medication-assisted therapy as part of a comprehensive treatment protocol against narcotic addiction, and continued USG opposition to the term 'harm reduction'." 

What we have not yet done is to read through all the cables mentioning just "needle exchange", "syringe exchange", or with a tag HIV (about 150 cables in all), to find anything that may be relevant.

But already it seems fairly clear already that there is no acknowledgement or discussion of Australia's success with needle exchange anywhere in the text of the 251,287 cables obtained by WikiLeaks. Any such cable would almost certainly include the word 'Australia', and either 'needle exchange' or 'syringe exchange', and we checked all of those cables.

PEPFAR SUCCESS

Our work on this search is less complete. Much more remains to be done.

There is no tag for 'PEPFAR' (which seems odd), but the word appears in 587 of the cables. The next step might be to read all places where 'PEPFAR' appears in these cables, to see what is interesting. This would exclude the cable about checking whether the 20 telephones in a new PEPFAR office were working correctly -- and those with only general statement of good intentions, such as:
"USG-Nigeria PEPFAR team submitted the 2010 annual Country Operation Plan (COP) to the Global AIDS Coordinator January 29. The plan builds a partnership for sustainability with the Nigerian Government to continue strengthening ongoing service delivery to patients; renew focus on health systems strengthening; and align activities with the Nigerian National Strategic Framework for HIV-AIDS, 2010-2015. The Plan will also intensify and focus prevention efforts; deepen integration of HIV-AIDS response into the broader health care system; strengthen the health care system at all levels; and expand access to quality services. USAID's proposed FY2010 PEPFAR budget is 249.9 million dollars."

THE SURPRISE

What most surprised us is the lack of perspective in the diplomatic world -- how little attention and actual thinking concern HIV, an epidemic that has killed tens of millions of people including half a million in the U.S. Vastly more attention goes into the drug war -- a shooting war which, in its current form, started a century ago in the U.S., and has been a continuous failure ever since. It still has no victory in sight, only more of the same. The basic flaw may be the same as in other U.S. shooting wars -- the lack of any sane or real mission, since the actual purpose of the war is to create financial opportunities for corporations, contractors, careerists, and other well-placed special interests.

A fundamental problem is that perspective and thinking are dangerous in diplomatic (and other government or corporate) careers; those who think may not last. In theory the thinking will be done at higher levels, but the system is too corrupt for that. So major institutions proceed like zombies, decade after decade and century after century, with results that we see every day.

AIDS2012 Conference, July 22-27 -- Washington DC or Anywhere

AIDS2012, the XIX International AIDS Conference, happens this month, July 22-27, 2012, at the Washington Convention Center in Washington, DC. More than 20,000 people are expected to attend. AIDS2012, organized by the International AIDS Society (iasociety.org) and many others, is the largest AIDS gathering in the world. It takes place in different countries, every two years.

Below are some online information sources that can help you follow the conference news, whether you are at the meeting or not.

[Note: in case you happen to be in the Washington area but not attending the conference officially, one part of the conference, the Global Village, is free and open to the public this year. About 250 AIDS-related organizations from around the world will be presenting there, so you can probably find people you want to meet. While there are likely to be scheduled presentations within the global village, it is mainly a place for informal discussions. (See below for how to participate in these and other discussions even if you are far from Washington.)]

All the sites in this article are publicly accessible (although parts of the official site can only be visited by persons attending the conference, who log in with their conference credentials).

Of the hundreds of sites that will report news from the conference and would be worth listing here, we picked just a handful that are most important for our readers to know about.

OFFICIAL CONFERENCE SITE: WWW.AIDS2012.ORG

When looking at all the dozens of items and links available on the home page, don't overlook the navigation bar at the top, with links to the official conference blog, and to the Global Village (plus the youth program, and the media center).

The U.S. government's AIDS blog, blog.aids.gov/, has an entry listing the official partners of the IAS for this conference. For the full list, see http://blog.aids.gov/2012/06/how-to-stay-updated-during-aids-2012.html. Some of the partner organizations:
 * The Kaiser Family Foundation will provide official coverage of the conference, including video of some of the major sessions, and daily news reports. For more information see www.kff.org/hivaids/hiv062712nr.cfm.
 * For basic science news reporting, Science magazine (sciencemag.org) is a good place to start, especially Jon Cohen's articles on AIDS.
[But like too many science and medicine journals, some of the articles are for sale for prohibitive individual prices (at profit margins we estimate at 100,000% or greater, compared to the cost of online delivery -- note that the journals seldom pay for any of the research being reported). To see the full text, you need to be rich or be part of an institution such as a university. Usually anyone can see at least an abstract or summary of research article, and sometimes the full text is made free as well. And some some material is free, but only to registered users (registration is free).]
 * The same is true for the Lancet, a medical journal that is also one of the official partners. The Lancet published a number of AIDS articles shortly in advance of the conference, at www.thelancet.com/journals/lancet/issue/vol379no9835/PIIS0140-6736%2812%29X6026-4. Publishing in advance is helpful, since interested persons can read the new information ahead of time and use it to inform many discussions at the meeting.
 * POZ/Aidsmeds (http://poz.com/), and Aidsmap (www.aidsmap.com/), are two other conference partners with excellent news coverage on AIDS, written for persons with AIDS and the interested public. Check their conference coverage before, during, and after AIDS2012.
 * For religious information, check the Interfaith pre-conference meeting,blog.aids2012.org/post/Interfaith-pre-conference-%E2%80%9CTaking-Action-for-Health-Dignity-and-Justice%E2%80%9D.aspx  (This page was hard to find from the main aids2012.org page, which may explain why there were no comments as of early July.)

SATELLITE SESSIONS

For officially recognized satellite sessions (both non-commercial, and commercial) see:
aids2012.org/WebContent/File/AIDS2012_Satellites_List.pdf
Sometimes the public can go to these; sometimes a conference badge is required.

NON-OFFICIAL SITES (NOT OFFICIALLY CONNECTED WITH THE CONFERENCE)

Of hundreds of news and other sites, we note three:
 AIDS2012 Reunion, www.aids2012reunion.org/  A new organization, focused entirely on this conference for now.
 Project Inform, www.projectinform.org/. One of the first AIDS treatment information organizations, still doing excellent AIDS treatment news coverage.
 NATAP (National AIDS Treatment Advocacy Project), www.natap.org/, especially for important technical/scientific information.

For more conference coverage, you can do a Google search such as:
"aids conference" 2012
This search finds about 2,000,000 pages on this and other conferences -- fortunately listed by Web popularity. The official aids2012.org pages are organized at the top of the search results, quickly followed many non-official websites and page -- so you don't need to scroll through hundreds of official pages first.

USING TWITTER TO FIND CONFERENCE COVERAGE

You don't need a Twitter account. Just go to search.twitter.com and search for whatever interests you. Twitter shows what's going on now, not going far back into the past. Note: Twitter's search will probably show you the "Top" tweets, but let you choose "All" -- which you probably do want to choose. Also note that Google no longer works for finding tweets; Twitter unfortunately revoked Google's access a year ago, to improve its own search instead.

You can search for #aids2012 (best to include the hash mark). This "hash tag" was suggested by the conference, to use in the text of tweets (Twitter messages) in order to bring them to the attention of people searching for information about the conference. But anyone with a Twitter account can use this hash tag in their tweets -- so be aware that spam or misinformation could also be sent this way.

The Global Village is tweeting officially from @gvaids2012 (no one else can send FROM that Twitter address). We haven't seen anyone using the similar hash tag #gvaids2012 as of early July (note the hash mark punctuation instead of the at-sign), but we recommend it and think people will be using it during the conference and a little before. Anyone with a Twitter account can send a tweet from their phone or computer with this hash tag in it, immediately and without waiting for anyone's approval -- a good way to share news instantly within or about the Global Village (as well as with the rest of the world). And if the people running the official @gvaids2012 account like some of these messages, they can re-tweet them to all followers of @gvaids2012 (whether or not those followers ever search for the hash tag). So using a name in this way (with the'@' from the owner of the Twitter account exclusively, and the '#' for the hash tag that anyone can use) gives both an official and an unofficial channel on the subject (the Global Village of AIDS2012, in this case).

Note that anyone in the world can discuss the AIDS2012 conference on Twitter -- no need to be in Washington. (Well, not anyone; some countries ban Twitter.) You do not need a Twitter account nor any prior knowledge to search recent tweets at search.twitter.com, e.g. for #aids2012, or for the Global Village. You do need a Twitter account to send your own tweets, and also to follow others' Twitter accounts (meaning  to receive all the tweets they send).

Each tweet can only have 140 characters -- basically a short sentence. But about a dozen of the 140 can optionally be used for a Web link, so the tweet can tell you about something quickly, and let you click for more information if you want. As of July 11, 2012,m a new tweet is being sent about every two minutes during the workday Washington time, usually pointing you to more information on the Web, and also at the conference.

A major advantage of Twitter is that you can look things up by searching (either for a hash tag, or just for a word in the tweet), and then connect with people who share a mutual interest, whom you might never otherwise have met.

CONFERENCES OF THE FUTURE

The bottom line is that you can virtually attend AIDS2012, and have input, even if you are thousands of miles from Washington. We believe that conferences will and should continue to evolve in this direction. Eventually the lectures presenting scientific, medical, and other information will be largely online, with important results released any time they are ready, not held up for arbitrary conference or publication dates. Online (or DVD) presentations are better educationally than lectures in auditoriums, since everyone can see the slides and hear the speakers, can rewind if necessary, and can consult outside materials easily. Why should scientific and medical research reports be tied to the great expense of air travel, hotels, and conference admission?

Future physical meetings will be for persons who need to meet face-to-face with particular working groups and individuals. Based on past experience of online communication actually increasing physical meetings, these better-focused conferences could be even larger than the ones today. For those who can travel abroad it will be better to make one international trip to take care of most of one's global meeting needs, than to make separate trips. And for those who cannot travel, online and DVD information will be much better than it is today -- and more important than the physical meetings that are hundreds of times more expensive.