HIV - HAITI

It is good to hear about research being done in Haiti leading to a change in the protocol for the treatment of HIV. I have seen people die just because their CD4 levels weren't at the 200 level. We would keep seeking medical care for them as they battled one infection after another. One mother of a deaf child had HIV and she kept getting sicker and sicker while her CD4 levels remained over the 200 level. Out of desperation she went out to Cange and they started her on the medicines. Today she is still alive and now a grandmother. Her deaf daughter is now married. More people will survive now with the new WHO protocol change. Pray for those who do research to improve and design new medical treatments. The following article explains the research that was done here in Haiti:


RESEARCH AT GHESKIO LEADS TO UPDATE IN WHO GUIDELINES FOR HIV TREATMENT
(Newswise) - Source: New York-Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College

NEW ENGLAND JOURNAL OF MEDICINE STUDY INDICATES WAITING ON T-CELL DECLINE IS HARMFUL

Prompted by clinical research into the early initiation of antiretroviral therapies for HIV performed at the GHESKIO clinic in Port-au-Prince, Haiti, the World Health Organization (WHO) has revised its treatment protocols for HIV patients.

Final results from the four-year study, led by Weill Cornell Medical College's infectious and tropical disease experts, were published in the July 15 issue of the New England Journal of Medicine.

The research indicates that rather than waiting until a patient's CD4+ T cells fall below the 200 cells per cubic millimeter threshold, as the previous WHO guidelines suggested, immediately initiating antiretroviral therapy (ART) greatly improved the efficacy of those medications. The study also linked early intervention with a decreased rate of incident tuberculosis, a leading cause of death among HIV patients in resource-poor countries.

"Beginning antiretroviral therapy before T-cell counts drop to 200 will save lives. In developed countries, HIV has, in recent years, become a manageable, chronic disease rather than the death sentence it was just a decade ago. These results further strengthen the assertion that the right therapies, initiated as soon as possible, can hold the virus at bay," says Dr. Warren Johnson, study co-author and director the Center for Global Health and the B.H. Kean Professor of Tropical Medicine at Weill Cornell Medical College.

In December 2009, seven months after the researchers concluded their data gathering, the World Health Organization and the United States Department of Health and Human Services both updated their HIV treatment recommendations to reflect the GHESKIO conclusions: that for HIV-1-infected patients, ART is best initiated at a CD4 count of 350 or lower.

Between 2005 and 2008, the investigators recruited 816 HIV-1-infected patients at the GHESKIO clinic. All had CD4 counts between 200 and 350, had no history of AIDS illness, and had never received ART, a drug cocktail that works by inhibiting the enzyme that enables HIV to hijack healthy cells and replicate. The cocktail in this case comprised zidovudine, lamivudine and efavirenz. Study participants were randomly divided into two groups; those in the first group began ART immediately, and those in the second (control) group received ART only when their CD4 counts measured 200 or lower -- standard treatment protocol. Of the 408 subjects in the control group, 160 reached that point and received ART during the study.

"Clinical evidence has long shown that HIV patients become vulnerable to life-threatening illness long before their CD4 count hits 200, but no one had yet definitively established that ART is effective before that crucial number," says Dr. Patrice Severe, study lead author and graduate student in the Weill Cornell Medical College Program in Clinical Epidemiology and Health Services Research. "Because antiretroviral medications are prone -- much like antibiotics -- to eliciting drug resistance in the target disease, establishing that evidence was essential. The GHESKIO study has filled that gap."

Along with Drs. Johnson and Severe, the paper's authors include Drs. Daniel W. Fitzgerald, Roy M. Gulick, Jean W. Pape, Heejung Bang and Ms. Alison Edwards -- all from Weill Cornell; Drs. Marc Antoine Jean Juste, Alex Ambroise, Ludger Eliacin, Claudel Marchand and Ms. Sandra Apollon -- all from GHESKIO; Ms. Janet Nicotera, Vanderbilt University, Nashville; and
Dr. Catherine Godfrey, National Institute of Allergy and Infectious Diseases, Bethesda, Md.

Founded in 1982, GHESKIO (Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, or the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections) is a nongovernmental research and training center internationally recognized for its pioneering work in the treatment of HIV and AIDS-related illnesses. GHESKIO maintains a close relationship with Weill Cornell Medical College. Its founding director, Dr. Jean Pape, is a professor of medicine at Weill Cornell Medical College. Since its inception, GHESKIO has never closed its doors to patients, not even during the recent 7.0 magnitude earthquake that struck Haiti.

Weill Cornell Medical College Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research from bench to bedside, aimed at unlocking mysteries of the human body in health and sickness and toward developing new treatments and prevention strategies. In its commitment to global health and education, Weill Cornell has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, the Medical College is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances -- including the development of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient.

Weill Cornell Medical College is affiliated with NewYork-Presbyterian Hospital, where its faculty provides comprehensive patient care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. The Medical College is also affiliated with the Methodist Hospital in Houston, making Weill Cornell one of only two medical colleges in the country affiliated with two U.S.News & World Report Honor Roll hospitals. For more information, visit http://www.med.cornell.edu/.

photos - mich - part 1

We drove out to the village of Bonnette last week to see Rachel's mother. She is the woman who is paralyzed on one side of her body and who couldn't look after her baby. Rachel was placed into an orphanage. Rachel is now in the United States. She was one of the children who benefited from the humanitarian parole after the earthquake. Jantje handed out some sandals to the children near Rachel's mother's house.

The teenage girls got hair bands for their hair.

The main purpose of the trip to Bonnette was to bring Mich to see his mother. We parked Kimosabee by the spring and walked the rest of the way to the village. It is a nice walk. I didn't want Kimosabee to get any dirt on him from the muddy roads.

We passed some men sitting in the shade of these trees.

This is a wildflower we spotted on our walk to the village. Natures beauty!

photos - mich - part 2

This is the "downtown" area of Bonnette. 2 of the churches in Bonnette suffered earthquake damage. This is the largest church in the village. The mission "Project Papillon" is constructing the school which is next to the church building.

Mich is a celebrity in the village. All the children came runing to see how he was doing. He is not a shy boy.

He showed the children pictures that he had brought along to show his mother.

Mich's mother is the woman with her head wrapped in a multi-colored scarf. She had to wait until the other children finished looking at the pictures before she got her chance.

The children in the village are joyful in spite of their poverty.

photos - mich - part 3

The children enjoy goofing around in front of the camera!

We followed the same direction as this herd of cows to walk to the area of the village where Paulna and Mich's family lives.

We had an escort on our walk! You can't sneak into the village without people seeing you especially foreigners!

These 2 boys were walking by this gnarly tree.

This boy is one of Paulna's younger cousins.

photos - mich - part 4

The boy with the white undershirt is Mich's brother Luckenson.

His legs are deformed too because of rickets, which is caused by a nutritional deficiency in the diet. He will be needing surgery to correct the bowing in his femur (Paulna's leg used to be malformed too and is now straight after receiving surgery). Pray an orthopedic surgeon can be found to help him. Mich is now 14 years's old. His malnutrition stunted his growth.

I call this the "steeplechase" walk. Everyone followed us wherever we went. Even over obstacles! It was fun.

The children enjoyed meeting Jantje.

Some of the children accompanied Mich back to the truck.

photos - delmas 31 bridge - part 5

The Delmas 31 bridge is now open! We went for a walk last week to check it out. Manu was scared of walking too close to this billy goat.

The workers did a good job on the bridge. Water flows where it should and vehicles can cross on top! The earthquake destroyed the bridge but the Haitian people have persevered and rebuilt it!

Manu gives the bridge a thumbs up!

The children wanted to explore some of the ravine. Here Jantje is getting a helping hand crossing the pile of garbage. An american orphanage dumps their garbage into the ravine. We will need to try and convince them to be more environmental!

On both sides of the ravine were bountiful gardens full of banana plants and this papaya tree/stalk.

photos - delmas 31 bridge - part 6

The person who designed the fruit and vegetable garden is Paul. When he first started he cleared out a bunch of the garbage to get at the soil underneath. Then the planting started. He doesn't own or rent this land. It is government land on one side and on the other side is part of the land of the Brothers of St. Louis church. At first they didn't want him working the land.

Then they realized the greenery growing and welcomed his beautification efforts. Since then his garden has blossomed. Here is Paul planting a new banana plant.

The tuberous root of this plant is eaten, like a potato/yam.

There are bananas growing everywhere. This bunch is growing well. Paul is proud of his work. He is a christian and told us that when he was younger he prayed for a place to grow. He found the ravine area and considers his garden as a gift from God. Pray for Paul's Garden.

Before we left he wanted to give us this gift of bananas.