The emergence of the SARS-CoV-2 variants B.1.1.7 (VOC-202012/01), 501Y.V2 (B.1.351), and P.1 (B.1.1.28.1) has aroused many concerns, including worsening Covid-19 and escape from vaccine-induced ...immunity.
The editors of the
Journal
note that although the rapid development of Covid-19 vaccines would appear to be a landmark success in global health mobilization, the truth is very different: the ...availability of the vaccines differs vastly across the globe.
The South African Response to the Pandemic Abdool Karim, Salim S
New England journal of medicine/The New England journal of medicine,
06/2020, Letnik:
382, Številka:
24
Journal Article
Recenzirano
Odprti dostop
South Africa’s early interventions have delayed the peak of Covid-19 cases. The author describes the eight stages of the national response and ongoing challenges.
...the end of the pandemic is only possible when vaccines that are effective against circulating variants are distributed equitably across the world. ...for surveillance of the circulation of ...SARS-CoV-2 variants, sharing of variant-specific PCR primers could help to monitor their spread, particularly in resource-limited countries. ...a central repository of samples of sera and cells from individuals with past infection or past immunisation with available COVID-19 vaccines should be established for seroneutralisation and cellular immunity functional testing against newly discovered variants.
Debate ensued when mathematical models
1
predicted that universal testing and treatment could achieve epidemic control within a few years in a high-burden setting. However, the idea rapidly gained ...new credence when antiretroviral therapy (ART)–induced viral suppression was shown to be highly effective in preventing transmission of human immunodeficiency virus type 1 (HIV-1) in a clinical trial.
2
Four large, cluster-randomized, controlled trials, each with a different approach to maximizing viral suppression, set out to assess the effect of universal testing and treatment on community HIV incidence. In 2018, the Treatment as Prevention (TasP) trial
3
involving 28,419 persons in 22 communities showed . . .
Summary One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has ...been declared a national emergency. In 2007, South Africa, with 0·7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government's response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.
Abstract
Passive immunization with broadly neutralizing antibodies (bnAbs) is a promising approach to reduce the 1.7 million annual human immunodeficiency virus (HIV) infections globally. Early ...studies on bnAbs showed safety in humans, but short elimination half-lives and low potency and breadth. Since 2010, several new highly potent bnAbs have been assessed in clinical trials alone or in combination for HIV prevention. Published data indicate that these bnAbs are safe and have a half-life ranging from 15 to 71 days. Only intravenous VRC01 has advanced to an efficacy trial, with results expected in late 2020. If bnAbs are shown to be effective in preventing HIV infection, they could fast-track vaccine development as correlates of protection, and contribute as passive immunization to achieving the goal of epidemic control. The purpose of the current review is to describe the current status and provide a synopsis of the available data on bnAbs in clinical trials for HIV prevention.
The use of broadly neutralizing antibodies (bnAbs) is a promising approach that could help reduce the human immunodeficiency virus (HIV) epidemic burden. This review describes the status and available data on bnAbs in clinical trials for HIV prevention.
Vaccines alone, unless they achieve high population coverage, offer long-lasting protection, and are effective in preventing both SARS-CoV-2 transmission and COVID-19, will not end the pandemic or ...allow the world to return to “business as usual”. ...high levels of global vaccine-mediated protection are achieved across the world, it could be catastrophic if measures such as mask wearing, physical distancing, and hand hygiene are relaxed prematurely.4 Countries, communities, and individuals must be prepared to cope in the longer-term with both the demands and the consequences of living with such essential containment and prevention measures. The COVAX initiative is just an initial step towards addressing vaccine equity and global coordination for vaccine access, especially for lower income countries.12 At the other extreme is a pessimistic scenario, in which SARS-CoV-2 variants emerge repeatedly with the ability to escape vaccine immunity, so that only high-income countries can respond by rapidly manufacturing adapted vaccines for multiple rounds of population reimmunisation in pursuit of national control while the rest of the world struggles with repeated waves and vaccines that are not sufficiently effective against newly circulating viral variants. CW is a member of the working group on pandemics and crisis of the Group of Chief Science Advisors to the European Commission and the European Group on Ethics in Science and New Technologies and has received grants from the German Federal Ministry of Research and Education, the German Federal Ministry for Family and Seniors, the Bertelsmann Foundation, the German Federal Ministry for Health, the German Federal Ministry of Justice and for Consumer Protection, personal fees from Agaplesion gAG as a member of supervisory board, and personal fees from several companies and organisations all unrelated to this Comment.
Antiretroviral-based strategies for HIV prevention have shown inconsistent results in women. We investigated whether vaginal microbiota modulated tenofovir gel microbicide efficacy in the CAPRISA ...(Centre for the AIDS Program of Research in South Africa) 004 trial. Two major vaginal bacterial community types—one dominated by Lactobacillus (59.2%) and the other where Gardnerella vaginalis predominated with other anaerobic bacteria (40.8%)—were identified in 688 women profiled. Tenofovir reduced HIV incidence by 61%(P = 0.013) in Lactobacillus-dominant women but only 18% (P = 0.644) in women with non-Lactobacillus bacteria, a threefold difference in efficacy. Detectible mucosal tenofovir was lower in non-Lactobacillus women, negatively correlating with G. vaginalis and other anaerobic bacteria, which depleted tenofovir by metabolism more rapidly than target cells convert to pharmacologically active drug. This study provides evidence linking vaginal bacteria to microbicide efficacy through tenofovir depletion via bacterial metabolism.
PDF
