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Rohit Ramchandani and colleagues propose a framework to ensure essential public health tools are fairly distributed in future pandemics

The immunoregulatory and anti-infective properties of normal circulating polyclonal Abs have been exploited for the therapeutic purposes in the form of IVIG as well as several hyperimmune globulins. Current knowledge on the therapeutic use of normal Igs is based on the discoveries made by several pioneers of the field. In this paper, we review the evolution of IVIG over the years. More importantly, the process started as an s.c. replacement in γ globulin–deficient patients, underwent metamorphosis into i.m. Ig, was followed by IVIG, and is now back to s.c. forms. Following successful use of IVIG in immune thrombocytopenic purpura, there has been an explosion in the therapeutic applications of IVIG in diverse autoimmune and inflammatory conditions. In addition to clinically approved pathological conditions, IVIG has been used as an off-label drug in more than 100 different indications. The current worldwide consumption of IVIG is over 100 tons per year.

This article examines the AIDS epidemic and what the international community has gotten right what we have done wrong and why we need to urgently dispel several emerging myths about the epidemic and the global response to it. It suggests that we have to identify how to finance a sustained response to AIDS for another several decades develop long-lasting links with broader efforts to strengthen health systems continue to invest in research and development and put a more serious effort into tackling stigma and discrimination.

On Tuesday 14 October 2014, 850 family members, friends, colleagues, prominent scientists and dignitaries from all over the world gathered in Amsterdam to pay tribute to the lives and legacies of Joep Lange and Jacqueline van Tongeren. The remembrance was held at the Amsterdam Medical Centre (AMC) where Joep and Jacqueline met and worked together for many years. The day was organized by the AMC, the Amsterdam Institute for Global Health and Development (AIGHD) and PharmAccess Foundation. The latter two were both founded by Joep. A morning symposium titled ‘Research in action: from AIDS to global health to impact’ highlighted Joep's scientific legacy (Figure 1). During the remembrance in the afternoon, a range of speakers shared memories of Joep and Jacqueline. As was the case during their lives, the personal and the professional were closely intertwined throughout the day. As Prof Peter Piot said, Joep and Jacqueline shared a common perspective on life: ‘La folie suprême est de voir la vie comme elle est et non comme elle devrait être.’ If there was one thing that defined them both, it was indeed that they saw life – and lived it – not as it was, but as it should be. ‘Joep's place in history is really as the visionary architect of combination therapy,’ Prof Piot stated, adding that ‘it cannot be stressed enough that he was ahead of his time, a true innovator.’ Joep's contribution didn't stop at science. Dr Khama Rogo of the World Bank explained that ‘it's not enough to be a doctor or a researcher if you're not also an activist.’ Joep fully understood the importance of translating research into action and generating impact for people. Prof Marcel Levi, chairman of the AMC, summarized the enormity of the impact Joep had on the world with the words ‘it's rare to know someone who has saved millions of lives.’ The scientific symposium traced Joep's career, starting in the early eighties with the treatment of the first AIDS patients and the design of antiretroviral therapy, moving towards the emerging field of global health and ending with his most recent focus: using knowledge derived from scientific research to improve access to quality health care in real-world settings. From Prof Françoise Barré-Sinoussi, who won the Nobel Prize for the discovery of HIV, to Prof Michael Merson, who founded Duke University's Global Health Institute, the list of presenters reads like a who's who of people involved at key moments in the history of HIV and global health (Figure 2). ‘And Joep,’ as Barré-Sinoussi said, ‘contributed to all eras of HIV.’ More memories of Joep and Jacqueline shared throughout the day are available at http://www.joepandjacqueline.org/remembrance/ .

Prohibition can prevent access to harm reduction treatment, including methadone, for people who inject drugs, writes Michel Kazatchkine

Eastern Europe and Central Asia have the largest drug epidemic globally and the fastest and still expanding HIV epidemic. The Russian Federation and Ukraine together account for over 90% of the reported AIDS cases in the region. If small in absolute numbers, the epidemics are however significant in prevalence rate in most countries of Central Asia. Most heroin and many of the new synthetic or home-made drugs are injected, which has led to high prevalence levels (up to 90%) of HCV infection in people who inject drugs (PWID). The two epidemics of HIV and HCV are in turn interlinked with TB and MDR-TB that are highly prevalent among marginalized populations in the region. Despite progress in the last two years, access to antiretroviral treatment remains far below global levels and increases more slowly than new reported cases of HIV. Access to prevention is limited with low coverage of needle exchange programs and very low or inexistent access to opioid substitutive therapy. There are few exceptions to this situation, including Ukraine where harm reduction programs are being scaled up together with significant peer outreach programs for PWIDs. This is likely to be the reason why the epidemic curves in the Russian Federation and Ukraine are now diverging. The region faces many structural, cultural, societal and political obstacles in responding to these quadruple epidemics. Without a significantly expanded and strengthened response, these epidemics will remain major causes of illness and premature deaths in the region. (Published: 2 November 2014) Citation : Abstracts of the HIV Drug Therapy Glasgow Congress 2014 Kazatchkine M. Journal of the International AIDS Society 2014, 17(Suppl 3) :19501 http://www.jiasociety.org/index.php/jias/article/view/19501 | http://dx.doi.org/10.7448/IAS.17.4.19501

Introduction : Scientific research has demonstrated the clinical benefits of earlier initiation of antiretroviral treatment (ART), and that ART can markedly reduce HIV transmission to sexual partners. Ensuring universal access to ART for those who need it has long been a core principle of the HIV response, and extending the benefits of ART to key populations is critical to increasing the impact of ART and the overall effectiveness of the HIV response. However, this can only be achieved through coordinated efforts to address political, social, legal and economic barriers that key populations face in accessing HIV services. Discussion : Recent analyses show that HIV prevalence levels among key populations are far higher than among the general population, and they experience a range of biological and behavioural factors, and social, legal and economic barriers that increase their vulnerability to HIV and have resulted in alarmingly low ART coverage. World Health Organization 2014 consolidated guidance on HIV among key populations offers the potential for increased access to ART by key populations, following the same principles as for the general adult population. However, it should not be assumed that key populations will achieve greater access to ART unless stigma, discrimination and punitive laws, policies and practices that limit access to ART and other HIV interventions in many countries are addressed. Conclusions : Rights-based approaches and investments in critical enablers, such as supportive legal and policy environments, are essential to enable wider access to ART and other HIV interventions for key populations. The primary objective of ART should always be to treat the person living with HIV; prevention is an important, additional benefit. ART should be provided only with informed consent. The preventive benefits of treatment must not be used as a pretext for failure to provide other necessary HIV programming for key populations, including comprehensive harm reduction and other prevention interventions tailored to meet the needs of key populations. An end to AIDS is only possible if we overcome the barriers of criminalization, stigma and discrimination that remain key drivers of the HIV epidemics among key populations. Keywords: treatment; HIV/AIDS; human rights. (Published: 18 July 2014) Citation: Grubb IR et al. Journal of the International AIDS Society 2014, 17:19320 http://www.jiasociety.org/index.php/jias/article/view/19320 | http://dx.doi.org/10.7448/IAS.17.1.19320

Andy Guise, Michel Kazatchkine, Tim Rhodes, and Steffanie A. Strathdee Public Health and Policy, London School of Hygiene and Tropical Medicine, and International HIV/AIDS Alliance, Brighton, United Kingdom; United Nations Secretary-General Special Envoy on HIV/AIDS in Eastern Europe and Central Asia, Geneva, Switzerland; and Division of Global Public Health, Department of Medicine, University of California San Diego

Injecting drug use drives the huge HIV/AIDS epidemic in the region, but Russian law does not permit the substitution treatment that is shown to help. The end of its provision on 1 May will have huge repercussions, says Michel Kazatchkine

The published work on HIV in people who use drugs shows that the global burden of HIV infection in this group can be reduced. Concerted action by governments, multilateral organisations, health systems, and individuals could lead to enormous benefits for families, communities, and societies. We review the evidence and identify synergies between biomedical science, public health, and human rights. Cost-effective interventions, including needle and syringe exchange programmes, opioid substitution therapy, and expanded access to HIV treatment and care, are supported on public health and human rights grounds; however, only around 10% of people who use drugs worldwide are being reached, and far too many are imprisoned for minor offences or detained without trial. To change this situation will take commitment, advocacy, and political courage to advance the action agenda. Failure to do so will exacerbate the spread of HIV infection, undermine treatment programmes, and continue to expand prison populations with patients in need of care.

Since the Global Fund was established in 2002, it has expanded from 15 to 300 staff and plans to triple its current size by 2010, reaching a spending target of US$ 6 billion per year to meet projected demand. Single disease campaigns have recently come under fire for destroying health systems, but Kazatchkine argues that vertical funds can, in fact, strengthen health systems. He tells the Bulletin about his organization’s plans to finance health systems in developing countries while continuing to fund country programmes for AIDS, tuberculosis and malaria.

This article describes several urgent actions that are needed to promote rapid scale-up of effective and integrated services for tuberculosis and HIV and to tackle the factors that increase vulnerability and put people at risk of HIV-related tuberculosis. These include: bold national leadership health system restructuring to foster greater integration of tuberculosis and HIV services that provide routine tuberculosis screening treatment and prevention to people living with HIV; and to offer HIV counseling and testing to all patients with signs and symptoms of tuberculosis decentralized care to ensure improved access investment in new tools and better use of existing tools and global leadership from donors countries of the global south and key health agencies.

We have measured the quantities of naturally occurring autoantibodies in the serum of normal, unmanipulated individuals. These changes over time following broad-band complex dynamical patterns that are similar in mouse and man. The patterns more likely reflect the network architecture of the natural antibody repertoire, regulating the activation and decay of individual clones. The temporal changes of both disease-specific and nonspecific autoantibodies are consistently modified in autoimmune individuals.