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Thailand wins praise for AIDS vaccine trial

Thailand wins praise for AIDS vaccine trial

An experimental AIDS vaccine that appears to be the first to protect people was mired for years in controversy, and credit for its success must go to Thailand where the trial was conducted, experts said.

The trial was criticised five years ago by 22 prominent U.S. scientists who doubted it would have any effect. Washington was accused of wasting more than a $100 million by funding it.

But Thai health authorities and their U.S. partners at the National Institutes of Health and the Walter Reed Army Institute of Research pressed on with the trial involving 16,000 volunteers in a country at the forefront of the battle against HIV.

“It was a tough decision. I am glad we made it,” said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, who defied the criticism and continued the trial.

The trial vaccine was made using two failed products — Sanofi-Pasteur’s ALVAC canary pox/HIV vaccine and AIDSVAX, made by a San Francisco company called VaxGen and now owned by the non-profit Global Solutions for Infectious Disease.

Donald Burke, dean of the University of Pittsburgh’s Graduate School of Public Health, said the trial was controversial from the start and had been dismissed by prominent U.S. scientists because of the failure of previous vaccine tests.

“But given the importance of the AIDS epidemic, the decision was made to go forward regardless of these criticisms. It was a difficult choice, but a courageous choice,” said Burke, who was head of AIDS research at Walter Reed before retiring in 1997.

Burke isolated the AIDS virus taken from a young HIV-infected Thai soldier in 1989 after Thai army doctors discovered an HIV outbreak among young recruits in Chiang Mai in northern Thailand. That virus sample went on to become one of the seed viruses in the experimental vaccine, Burke said.

To their credit the Thais did a remarkable job on this,” Dr. Eric Schoomaker, the Surgeon General of the U.S. Army, told reporters. “They did remarkable job of recruiting volunteers and conducting this trial almost flawlessly.”

The $105 million trial was sponsored and paid for by the U.S. government and results showed it cut the risk of infection by 31.2 percent among 16,402 volunteers over three years.

THAI TRIUMPH

Those results mark a triumph for Thailand, a country of 67 million people where a booming sex industry had stoked fears of a major epidemic. Local authorities battled hard against a disease that threatened to spiral out of control some 20 years ago.

Experts had predicted that 4 million people would be infected by 2000 if nothing was done to slow the spread of HIV. But a massive government-led Aids education and prevention campaign in the early 1990s had an enormous effect.

HIV prevalence among injecting drug users in Thailand was as high as 30-50 percent in 1991, and 33.2 percent among female sex workers in 1994, according to UNAIDS. The number of infections has since been reduced to 20,000 annually from 140,000 in 1991.

Billboards and airwaves were bombarded with safe sex messages while health workers promoted condom use in the country’s notorious sex trade. Leading the campaign was “Mr Condom,” family planner-turned Public Health Minister, Meechai Viravaidya.

Health check-ups were made available to sex workers for free. Men were discouraged from visiting prostitutes and condom usage in Bangkok’s brothels rose from 15 percent in the early 1990s to 98 percent by 2000.

Infection rates fell and the exercise remains widely cited as a model in disease prevention among health experts — although numbers have shown signs of creeping up in the last few years among some high risk groups, such as gay and bisexual men.

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H1N1 flu causes unusual damage to lungs: studies

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H1N1 flu causes unusual damage to lungs: studies

The new pandemic H1N1 flu may cause blood clots and other unusual damage in the lungs and doctors need to be on the lookout, U.S. researchers reported on Thursday.

Two studies published in the American Journal of Roentgenology show the need to check X-rays and CT scans for unusual features, and also point out swine flu can be tricky to diagnose in some of the sickest patients.

H1N1 flu is causing a pandemic, and while it is not particularly deadly, it is sickening many younger adults and older children who usually escape the worst effects of seasonal flu.

“It is therefore essential that clinicians be able to recognize possible cases of pandemic H1N1 influenza in high-risk groups so that they order the appropriate diagnostic tests, begin specific antiviral therapy, and prepare to provide intensive supportive measures as needed,” Dr. Daniel Mollura of the National Institutes of Health Clinical Center in Maryland and colleagues wrote.

One middle-aged man who died was not diagnosed until after death, but unusual findings on his X-rays may be able to help doctors save other, similar patients.

Mollura’s team found irregularities called ground-glass opacities in the patient’s lungs using a CT scan. Although the patient was severely ill and had a fever, he tested negative for flu and doctors did not treat him for it.

The man died five days after he went into the hospital and the autopsy confirmed he had swine flu. The lung lesions seen on his CT scan matched lung damage done by the virus, Mollura and colleagues said.

In another study in the same journal, CT scans of patients with severe cases of swine flu showed many had pulmonary emboli, which block the arteries in the lungs, a team at the University of Michigan found.

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Experts hope H1N1 will spur effort on universal jab

Experts hope H1N1 will spur effort on universal jab

The H1N1 swine flu pandemic should spur pharmaceutical researchers to renew efforts to develop a universal flu vaccine and rethink ways of dealing with future pandemics, scientists said on Friday.

Flu experts from the World Health Organization, Swiss drug giant Novartis AG, the U.S. National Institutes of Health and others noted that the arrival of H1N1 had prompted a jump in the potential output of vaccine manufacturing to 900 million doses from 400 million.

But in a letter to the journal Science, they urged drug and health industries to be more proactive in developing and distributing vaccines — and in particular to speed up the search for a universal flu vaccine.

“Although the H1N1 pandemic has the potential to cause a social and economic emergency, it also provides an opportunity to rethink our approach to influenza virus disease and to develop more effective vaccines and economically sustainable solutions for developing and developed countries,” they wrote. “Research toward development of a universal vaccine should be accelerated.”

A universal flu vaccine which would combat all strains of the virus has so far eluded pharmaceutical firms and scientists.

Inovio Biomedical Corp, which is working on such a vaccine, said this week that it expects initial evidence early next year on whether the technology it is using can help to fight diseases.

Johnson & Johnson, the world’s biggest diversified health care company, recently bought a stake in Dutch biotech firm Crucell partly to get hold of flu-mAb, a universal antibody engineered to prevent and treat infections from various influenza A strains.

The swine flu outbreak was declared a pandemic in June and has already infected millions of people around the world. Drugmakers and governments have been scrambling to make and supply vaccines targeting the new H1N1 strain before a feared second wave of infection hits as the northern hemisphere heads into winter.

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