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Breaking the Cycle of AIDS

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As the world marks International AIDS Day on December 1, 2011, the Rambam Newsletter takes the opportunity to focus on RHCC’s many achievements in this area. From ground-breaking research to novel treatments through special clinics and educational approaches, Rambam plays an important role in AIDS-related activities on a global scale.

By Roberta Neiger, ProText

In the war against AIDS, Rambam is battling – and winning – on every front. Starting from infancy, the hospital has succeeded in breaking the cycle of AIDS. No less than 100% of all babies born at Rambam to HIV-positive mothers have been disease-free. In 1997, the first baby born to a mother with AIDS at Rambam was delivered – disease-free. Subsequently, hundreds of healthy babies have been born here to mothers who carry the HIV virus. Additionally, in recent years, there has been a significant rise in the number of mothers-to-be who have received treatment at the hospital’s AIDS Institute.

The Institute of Immunology, Allergy and AIDS staff
Pioter Fliter-RHCC

This great success is due to innovative drug therapies, the close connection between medical personnel and patients, and heightened awareness among both the women and delivery room staff, according to Prof Shimon Pollack, director of the Institute of Immunology, Allergy and AIDS at Rambam. The institute accompanies the women from the beginning of their pregnancies to post-partum. And for years following birth, an interdisciplinary team monitors both babies and mothers.

The treatment is simple and precise: in the second half of pregnancy, the mother receives treatment that lowers her viral load and reduces chances that her fetus will be infected. The birth itself is supervised by Dr Eynat Kedem, an expert in pediatrics and HIV medicine and Carcom Maor, the head nurse in the institute. During childbirth, the mother receives medicine intravenously to prevent contagion. After, the infant is given treatment orally for four to six weeks. Says Prof Pollack, “this treatment allows these children to enjoy healthy lives”

In related news, several months ago at Rambam, a woman with HIV became the mother of not just one baby, but of healthy twins. The woman was a patient at an unusual RHCC center that offers IVF treatment for AIDS carriers and patients with chronic viral illnesses.

AIDS research at Rambam is not only enriching medical knowledge, it is making treatment widely accessible, even to foreign workers who have no health insurance. In the ‘ENCORE’ project, supported by the US National Institutes of Health (NIH) through the international ‘INSIGHT’ program, researchers in 27 countries are comparing today’s effective treatment protocol with a new regime, which may be superior.

HIV treatment is based on a cocktail, a combination of drugs, explains Prof Pollack, and the ENCORE project is seeking the most effective combination for combating AIDS. Whatever combination proves superior, 1,500 research subjects worldwide stand to benefit from new therapy that is either as good as, if not better than current treatment.

“This is a win-win situation,” says Prof Pollack. “This research probes an important subject, and in Rambam, it also brings care to uninsured people from all over Israel, many of whom are foreign workers. I hope that by the time the study comes to an end, government policy will change and we will be able to continue treating uninsured patients in the regular Israeli AIDS center environment.”

In other INSIGHT AIDS-related research, the ‘START’ program is bringing Rambam together with 100 AIDS centers worldwide to investigate when to commence treatment. Now, according to accepted criteria set by the International AIDS Society, one third or more of HIV-positive patients do not receive early treatment because their immune system is deemed ‘OK’ by treatment guidelines.

“Project START will investigate whether patients can benefit from earlier treatment, as evidence indicates. If this proves preferable, the guidelines will be changed,” says Prof Pollack, who is Principal Investigator (PI) for all INSIGHT projects in Israel. Every AIDS-related research project of INSIGHT in Israel comes under his supervision.

Looking ahead, Prof Pollack hopes to tackle the problem of people with AIDS who are living longer. The disease becomes more prominent in this population, and may develop into renal, bone, cardiovascular or other chronic diseases, often the combined result of aging and long-term medication.

“There is still no cure for HIV,” says Prof Pollack. “We know how to suppress the virus drastically, but if you stop treatment, it will re-emerge. It’s like dousing a fire with water. It reduces the flame, but if you stop, the fire will blaze.”

Prof Pollack sees AIDS Day as an opportunity for public education, a chance to offer free HIV screening and distribute information in the community. After all, he says, “Education is the most efficient preventive measure. If you know how to behave properly in terms of sexual contact, you are doing what is best for yourself and for the public at-large.”