ZEN SCIENCE SCAN

Book review

“a gripping story of hero-

ic struggles in tackling

complex issues done by

weaving personal lives

into major societal is-

sues whilst finding one's

own life in a new con-

text”

- Professor Teboho Moja, NYU

In This Issue

Aim/The Heroine

Next Door

Real-world study of

HIV/TB/NCDs

Advances in research

& diagnostics

Opportunities & chal-

lenges in TB disease

management

Why HIV/AIDS still

matters

Photo Caption

Aim The purpose of a newsletter is to provide a snapshot of research information to a

general audience. The global realities of co-existing diseases are of particular con-

cern because of poorer clinical outcomes and reduced quality of life. Here, I sum-

marize advances in HIV, TB, and diabetes management (sub-themes in my book),

with a focus on Sub-Saharan Africa.

Disclaimer: Research is an evolving endeavor and information may become

redundant or change as a result of new discoveries. Please seek medical advice

from your personal physician.

The Heroine Next Door The emotionally-wounded survivors of the 9/11 attacks include a fifty-year old,

South African Muslim scientist, Leila, who lost her fiancée, Khalid, on that fateful

day. She is the narrator of a story threading together the lives of four South African

Muslims navigating a technologically advanced and increasingly-complicated

world beset with infectious diseases such as HIV/AIDS and TB.

Atypical abbreviations: bNAb, broadly neutralizing antibody; HAART, highly active

antiretroviral therapy

Communicable and Non-communicable Diseases (NCDs) Newsletter February /March 2015

Real-world study of HIV/TB/NCDs According to the International Diabetes Federation, people with diabetes are more

likely to develop TB compared with non-diabetics. Africa is one of the regions with

the highest anticipated increase in diabetes by 2030. South Africa, a country with

one of the highest global TB burdens, will be one of countries on the continent

facing the deadly duo of diabetes and TB. Moreover, the co-existence of this dis-

ease with other communicable and non-communicable diseases such as hyper-

tension and HIV have been demonstrated in a South African clinic. One of the

important observations made in this study was the higher prevalence of multiple

morbidities, hypertension and diabetes in younger patients (18-35 yr. and 36-45

year age groups respectively) receiving antiretroviral therapy (ART) compared

with patients who did not receive ART.1 In addition, successful management of

HIV patients with ART prolongs life, thereby increasing the burden of HIV+-

individuals with comorbid, non-communicable diseases. Because there are imme-

diate and long-term health consequences in terms of clinical outcomes and risks

for patients with multimorbid diseases, it is necessary to rethink the integration

and coordination of HIV and TB management in Sub-Saharan Africa.

Source: 1. Oni, T. et al. BMC Infect Dis 15, 20, 2015

Diabetes Overall, the Africa region has the highest proportion of undiagnosed diabetes, at

78%. Furthermore, an estimated 344,000 deaths can be attributed to this disease,

representing 6.1% of deaths from all causes.

HIV/NCD management One example of integrated care is illustrated in my book, The Heroine Next Door, and others can be found on Google.

Advances in research & di-agnostics In the absence of the ideal HIV

vaccine, the optimization of target-

ed ART delivery and scale-able

manufacture of clinically effective

microbicide components remain

urgent priorities.

Nanocarriers delivering HAART

and tobacco-plant-based manufac-

ture of a bNAb have been evaluat-

ed in separate preclinical studies

summarized on my website. In

addition, I have mentioned two

diagnostic kits :

http://www.heroinenextdoor.com/

index.html

Improving HIV vaccine efficacy (SlideShare)

HIV/AIDS and diabetes estimates in South Africa (SlideShare)

Clinical Trials

Patients with active, drug-

sensitive TB receive a

standard six-month

course of therapy. Novel

agents that shorten the

treatment duration and

are active against multi-

drug-resistant TB are an

urgent priority in combat-

ting the second leading

cause of infectious

deaths after HIV. Patients

are currently being re-

cruited for clinical trials to

assess two anti-

mycobacterial nitroimid-

azoles, TBA-354 and PA-

824 (Clinicaltrials.gov

IDs: TBA-354

[NCT02288481] and

[NCT02193776]). Preclin-

ical data confirmed and

extended prior findings

demonstrating the effica-

cy of novel nitroimidazole

-containing-drug combi-

nations in treating TB,

irrespective of resistance

to existing drugs. The

outcomes from clinical

trials will determine

whether laboratory data

can be matched in pa-

tients.

Source: Tasneen, R. et

al. Antimicrob Agents

Chemother 59, 129-35,

2015

.

Tuberculosis symptoms and challenges in seeking a durable cure (Norwalk Patch)

Opportunities & challenges of TB disease management Antibiotic stewardship – composed of six core elements (active and supplemental strat-

egies such as prospective audit of antimicrobial use and development of evidence-

based practice guidelines that incorporate local microbiology and resistance patterns;

information technology; microbiology laboratory; monitoring of process and outcome

measurement; comprehensive multidisciplinary team approach ) – is geared towards

minimizing antibiotic resistance and optimizing the use of frontline and last-line medica-

tions against bacterial pathogens.

Appropriate disinfection and decontamination of hospitals, clinics, and other medical

centers to reduce the prevalence of this airborne pathogen will be an important aspect

of any integrated patient-centered care and prevention strategy. The merits and perils

of automated systems such as hydrogen peroxide vapor and ultraviolet light disinfec-

tion systems to reduce the impact of hospital-acquired infections are discussed in Auto-

mated Technologies for Patient Room Disinfection and Decontamination of Biosafety

Level 4 Infectious Agents, Including Ebola Virus.

Strategies for optimizing the development of new antibiotics have been reviewed here

and the possibility exists of improving treatment by alternating antibiotics (Kim, et al).

Source: Kim, S., Lieberman, T. D. & Kishony, R. Proc Natl Acad Sci U S A 111,

14494-9, 2014

Author Bio

Zeena Nackerdien is a sci-entist and writer of numer-ous peer-reviewed and online publications on

science and society.

Contact Information:

bloedsiekte@gmail.com

Visit me on the web at

http://

www.heroinenextdoor.co

m/index.html

Why HIV/AIDS still matters Some Americans may also point to the low adult HIV prevalence (0.2% versus

4.7% in Sub-Saharan Africa) in this country and declining fatalities as signs of

treatment success and an opportunity to reduce financial aid to other countries

showing similar successes. A closer examination of the numbers suggest that the

answer is no. Only 25% of HIV-infected individuals in the USA have suppressed

viral loads and only one in four people are able to reap full treatment benefits by

successfully navigating the HIV care continuum. Moreover, the disease may be

under-reported in this country, as the number of people with undiagnosed HIV is

estimated to be one in six.

An effective vaccine for HIV/AIDS? Long-term expression of a broad and potent entry inhibitor could bypass the need

for a conventional vaccine. Gardner et al. suggests that stable expression of

bNAbs protected macaques from several challenges with simian HIV, suggesting

that it can function as an effective HIV-1 vaccine.

Source: Gardner, M. R. et al. Nature advance online publication, 2015

Zeena Nackerdien (PhD)

bloedsiekte@gmail.com

HIV, TB, and NCDs in a nutshell