Who can and can't give blood, as NHS calls for donations
Currently only 2% of the population – just under 800,000 people – supports the entire UK blood supply.
Since last year, the health service has been on "amber alert" – meaning supplies have dwindled to the point that it may impact patient treatment. Now, experts are warning that things have turned "critical" and are nearing "red alert" status.
Here, we take a look at the criteria for donating blood – as well as the most common blood types and how to sign up.
According to Give Blood, the general criteria for donating is:
That you are aged 17-65
You're generally fit and healthy
You weigh between 7 stone 12 lbs and 25 stone
You have suitable veins
You meet all donor eligibility
You cannot donate blood if:
You've got some heart conditions, such as heart palpitations, abnormal heartbeat – or if you've had a heart attack, stroke, a heart bypass or you were born with a congenital heart defect
You have tested positive for HIV
You've had an organ transplant
You have had most types of cancer
You have received blood, platelets, plasma or any other blood products after 1 January 1980
You carry hepatitis B or C
You've injected non-prescription drugs – including body-building and injectable tanning agents
You may be asked to wait to donate blood if:
You've given blood too recently – Providing you're otherwise eligible, men can give blood every 12 weeks and women can give blood every 16 weeks.
You are pregnant or you've had a baby in the past six months – You will not be permitted to give blood while pregnant. Nor can you donate blood if you had a blood transfusion during your pregnancy or delivery. If you are trying to conceive it is not recommended, as you'll require all iron stores if/when you do fall pregnant. Once you have passed the six-month post-delivery mark, you may be able to donate blood.
You've recently got a tattoo or a piercing – Although most tattoo and piercing parlours offer safe services, the introduction of a foreign object to the body still carries risk, and so to protect the recipient of the blood, donors must wait for four months after having a tattoo of piercing before they can give blood. This includes microblading or semi-permanent make-up, as well as acupuncture.
You feel ill at the time of donation – It's common for donors to feel faint or anxious before, during and after the procedure, but if you are feeling unwell you must flag ahead of time, as it is important that you do not carry any infection at the time of donating. In order to donate, you must be healed and recovered from an infection for at least 14 days prior.
You're undergoing medical assessment – Similarly, if you are undergoing medical tests and assessments, you may have to wait before you donate blood.
You travel to and from certain countries outside of the UK – You can check whether your travels impact your eligibility to give blood here.
You've had a new sexual partner in the past three months – Regardless of gender, if you've had anal sex with a new partner in the past three months, you might not be able to give blood. Similarly, if you finished taking Pre-Exposure Prophylaxis (PrEP) or Post-Exposure Prophylaxis (PEP) in the last three months, you'll have to wait.
You've had sexual contact with a partner who is – HIV positive, HTLV positive, carries hepatitis B or C, syphilis positive, has injected non-prescribed drugs, has received money or drugs for sex. You will need to wait at least three months.
If you have any health conditions or you're on medication, you can check your eligibility at the NHS Give Blood website here.
O positive is the most common blood type, accounting for roughly 35% of donors. It's followed by blood type A positive, with around 30% of donors falling into this category. The rarest, meanwhile, is AB negative, with just 1% of donors falling into this category.
If you would like to sign up to donate blood or plasma, you can do so at the Give Blood website here. You can also call them on 0300 123 23 23.
The NHS site also outlines which donor centres have availability today – you can check here.
Some sites also welcome walk-ins. You can find your nearest centre here.
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Yahoo
2 hours ago
- Yahoo
All the benefits of having a G&T over a glass of wine
If you're going to indulge in a drink or two, whether on holiday or in a pub garden, a gin and tonic could be the best option for your health. As a registered nutritionist, Sophie Trotman is bound to repeat the words that we are all so used to hearing: 'I would always recommend that you don't drink at all, or at least lower the amount that you drink,' she says. 'Wines can be quite sugary and contain a lot of sulphates,' Trotman says, which can wreak havoc on your digestive system, while beers 'are high in carbohydrates' and can cause your blood sugar to spike. The heroic G&T, meanwhile, is a drink that 'I often recommend to my clients if they don't want to cut out alcohol entirely,' says Trotman. 'The calories and sugar in a single gin with a light tonic are as low as you're going to get.' This will be welcome news to many. The majority of people in Britain now prefer to drink gin and tonic with friends rather than cups of builders' tea, according to spirit brand Bacardi's cocktail trend report, and the UK constitutes the world's biggest market for gin. So what are the benefits of swapping your regular pint or glass of wine for a G&T? The health benefits of a G&T 1. Fewer calories than beer and wine One shot of gin will provide you with around 50 calories, compared with about 130 calories in a medium glass of red or white wine or the 200-300 calories in a pint of beer. A 200ml serving of light tonic to mix your drink will come in at around 30 calories, keeping a health-conscious G&T under 100 calories to a glass. The average British man drinks 17.6 units of alcohol every week, according to NHS data, the equivalent of eight to nine pints of lager (with beer still being the drink consumed most frequently by men in the UK). Drinking the same number of single-measure G&Ts each week – though it is not recommended that any adult consumes more than 14 units of alcohol in this timeframe – would mean cutting around 900 'empty' calories from your diet and losing a stone within a year. Meanwhile, women who switch from the average nine units or four medium glasses of wine per week to single G&Ts would drink 120 fewer calories. This might not sound like much, but tweaks like this can make all the difference in limiting your party-season weight gain. At this time of year when the units we consume will likely outpace our average for the year, 'a gin and tonic is definitely a better option to manage your weight,' Trotman says. 2. Less sugar and carbs than other contenders A single shot of gin contains zero grams of sugar, as well as no carbohydrates. This is one of the reasons that gin is often the drink of those on a ketogenic diet, as it is less likely to knock your body out of its fat-burning state (though all alcohol will make it harder for your liver to process food). Aside from leading to weight gain, drinking any beverage that has a high carbohydrate content – like lager, with 10-15 grams of carbs to a pint, or cider which has as much as 40 grams a glass – can cause uncomfortable bloating and an upset stomach. A no-carb drink such as gin 'will have less of an impact on your blood sugar levels too,' Trotman says, another factor that makes it a better option for keeping your waistline static (and making sure that you've still got some energy the morning after). And while vodkas and rums typically come mixed in fizzy, sugary drinks, the sugar in a slimline tonic typically comes in at around 7.6 grams per 200ml glass, compared with the 21.2g in 200ml of full-fat Coca Cola. Light rather than diet tonic is ideal with your gin as 'diet tonic will be full of artificial sweeteners that can worsen your health in the long term,' Trotman says. 'So if you're having a few, always opt for a light version and a single shot.' 3. A boost from juniper berries and garnishes Gin is made by brewing a neutral-tasting grain with juniper berries and other botanicals such as lemon peel, coriander seeds, cardamom or thyme. Juniper berries contain flavonoids as well as large amounts of vitamin C, which can improve circulation and help ward off colds, and antioxidants which promote skin regeneration. These berries can also speed up your digestive system and soothe inflammation. While the amount of these goodies left over in a single serving of gin is likely 'negligible', Trotman says, gin can also be infused with ingredients that up its health benefits: some kinds on the market have been paired with large volumes of fruit juice for added vitamin C, while some have been specifically blended to provide micronutrients as well as collagen. Others are brewed with extra juniper berries. G&Ts are also easy to make and serve creatively. A quick health tip is just to 'eat the slice of orange that comes with your drink, because every little does help,' Trotman says, or at home 'you could mix in some cranberry juice for antioxidants or add some blueberries for helpful polyphenols'. 4. Easier to drink in moderation The versatility of a gin and tonic is a major reason why Sophie Trotman recommends it to her clients. Along with a light tonic, 'you can add a lot of ice to make it a long drink that you're able to keep sipping over a longer period,' reducing the total amount of alcohol you drink in the course of an evening. The reduced sugar and artificial sweeteners involved meanwhile will make it easier to stop at just a few, turning down the dial on your cravings and helping you to call it a night earlier. Unlike wine, the leftover bottle of which can call from the fridge on a Monday evening, a G&T takes more effort to make and so it becomes 'easier to have days off,' Trotman says. 'It's also very easy to alternate your G&Ts with glasses of water, which you'll thank yourself for the next day,' Trotman says. For those looking to cut down there are other benefits too. 'It shouldn't be a concern, but if you start on G&Ts and switch to a non-alcoholic version later in the night, there will be no label on your glass and so no peer pressure from anyone else to keep going.' 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Business Journals
6 hours ago
- Business Journals
Table of Experts: The future of health care
Hiring continues to trouble area health care providers Though insufficient payment, rising costs and political uncertainty vex Western New York's health care industry, finding and keeping clinicians and staff has remained at the top of their challenges since the pandemic. Industry leaders joined Buffalo Business First Publisher John Tebeau to discuss how they manage to go about their missions to serve the public amid the obstacles. Ultimately, greater collaboration and conversation could be essential to their futures. Joining Tebeau were: Melissa Farrell, COO, Spectrum Health & Human Services, 25 years in the mental health field Raymond Ganoe, president and CEO, Evergreen Health, 30 years in health care James Garvey, executive vice president and COO, Catholic Health, appointed in 2020 after serving in health care markets in the Midwest Dr. Robert Zielinski, oncologist and associate medical director, Buffalo Medical Group, 34th year in practice ATTRACTING WORKERS Health care in general is struggling with staffing and working toward a solution that will get qualified people on the job. The situation became especially critical post-Covid when many baby boomers left the workforce. There was an erosion of talent right across the board but especially in clinical areas, Garvey said, and that left a chasm in the workplace. 'You bring in all these new people, and they don't have those experiences, and you don't have that senior person who could provide that oversight,' Garvey said. In addition to doubling down on recruiting initiatives, the Catholic Health system recognized the need to aggressively move toward further development of leadership. One such program involves identifying early leaders in mid-level careers and assigning them to a sponsor who will work with them toward a leadership goal, Garvey said. The panelists agreed that the mission of an organization is increasingly important in the hiring process. 'You end up having happier employees that stay longer and are more engaged with the direction that the organization is going,' Ganoe said. 'We are bringing a lot of energy into our culture to make sure that we're picking the right people.' To do that, recruitment needs to happen at area colleges and universities where students are informed of the varied organizations in the Buffalo region, he said. The big hospital systems might be an obvious choice for some but given the array of options and their unique missions, students might be turned on to and find a better fit with other types of providers. It is critical to ask the right questions during the interview to make sure the job candidate is aware of what your mission is and those things that are important for your organization. 'They have to pick you, and you have to pick them,' Ganoe said. Evergreen provides primary care, pharmacy services and mental health care that grew out of the world of HIV and AIDS as those conditions became more treatable. The focus expanded to include populations that have been historically disenfranchised in Western New York, Ganoe said. Evergreen is a $135 million organization employing more than 600. One of the reasons why the culture phenomenon is important, Zielinski said, is a generational shift in the approach to work. The Buffalo Medical Group traditionally operated under a production model, where individuals are given the flexibility to work as much or as little as they want and be paid a salary commensurate to what is produced. There are fewer and fewer who embrace high productivity, he said. Greater numbers of physicians and staff are burning out because that is not how they want to practice, Zielinski said. The practitioners in their 40s and established in their careers are less concerned with the salary differences between working for the medical group and positions at hospitals, Zielinski said. They find greater job satisfaction with the schedule of the medical group: no weekends, overnights or holidays. Not so with younger entrants into the field, who will leave one job for another over 50-cents an hour, Zielinski said. What truly frustrates Zielinski, he said, are the job candidates who are hired and given a start date but don't show up and don't respond to further communication. They are never heard from again. 'Presumably they've got a number of lines in the water, and they got a better nibble somewhere else, but they don't have that sense that they might interact with this place someday. We're a small community,' Zielinski said. It is a similar situation at Spectrum Health with job candidates 'ghosting' their offers, staff being lured to other jobs for a few cents more an hour or leaving after achieving a full license from permit status, Farrell said. The organization's leaders try to impress on staff that while pay rates may be higher at other practices, she said, Spectrum offers benefits that amount to 30% more income such as malpractice insurance, health insurance and a 401(k) and it handles all billing. 'The greatest resource and capital is our people,' Farrell said, 'so that is where we invest to the best of our ability, to help people want to stay with us. When we have turnover, we lose our client population. If you have a therapist you trust, and they leave, you leave, too.' Spectrum Health estimated that when a single clinician leaves, the organization loses tens of thousands of dollars in lost clients and the amount it costs to hire a replacement and the months it takes to train that person, Farrell said. REIMBURSEMENT When health care leaders talk about reimbursement, it is never good news. For example, health care organizations that are heavily invested in physical plants and equipment are challenged by the anticipated cost of maintenance and replacement and the prospect of purchasing the newest technology and new business opportunities, Garvey said. None of it is inexpensive. Another example: To accept various insurances, providers are faced with additional infrastructure costs, because each insurance company has its own set of rules and processes involved. Those costs to the providers are unreimbursed. 'The priority is about patient care and safety,' Garvey said. 'Unfortunately the marketplace here in New York is a very challenging market from the reimbursement perspective.' Buffalo Medical Group had adopted the electronic medical record system known as Epic prior to the pandemic, but Covid forced the evolution of it. Zielinski bemoaned the government's lack of commitment to reimburse its use. He has little confidence in the reimbursement system, calling it 'badly broken.' 'Health care is the only industry out there where the insurance companies control the production. You don't have the people who insure buildings and property dictating construction and automobile building,' he said. 'What our reimbursement system pays for is not remotely what providers or our patients would say is the most important thing to them.' The current system is unsustainable in part because of the 'enormous sums of money' going to pay the pharmaceutical companies. He said he believes that health insurance is getting so expensive that individuals and employers eventually will get priced out, which will lead the country to a government-run single-payer system. 'The reimbursement system is so broken that we need a major overhaul,' Zielinski said. 'I'm not sure if single-payer is the best answer, but I just worry that it's going to be what we fall to because pharma is going to bust the system.' POLITICAL CLIMATE The panelists shared the opinion that things are unlikely to improve amid the uncertainty, instability and lack of clarity being put forward in the current state and national political environment. There was realization in New York State that the healthcare system is broken, so the answer was to spend a lot of money on care, Ganoe said, but the best outcomes were elusive. There are way too many middlemen, and by the time the dollar goes through insurance, there's a nickel left for providers, he said. The move toward a value-based care system would incentivize providers to keep patients healthy. It would give the providers ownership and allow them to be innovative and think creatively about treatment and potentially make more money. 'It feels like now the goal posts have changed, and we're not really going there anymore but we don't know where we're going. So, organizations like ours that have a foot in a fee-for-service world and a foot in a value-based-payment world are now asking, 'What do we do?',' Ganoe said. 'The administrative oversight and energy it is taking to try to figure out where this is going should be put into recruiting, culture and taking care of our employees and our patients, but it is now being diverted toward crisis management. That doesn't help.' EMERGING TRENDS If there are positives that emerged from the pandemic it is the easing of the stigma associated with mental health issues and the awareness of the growing array of treatment services available to address them. That helped bridge the gap for some of those populations that are higher risk, Farrell said. Many of Spectrum Health's services, clients will find, have been embedded in doctors' offices and schools, Farrell said, making access especially convenient. 'You meet people where they're at, and that promotes success, that promotes linkage, and it promotes continuity of care. If you make it easy for people to get care, they're going to follow through,' Farrell said. Spectrum Health provides outpatient behavioral health services. The organization integrates mental health and substance use care for adults and children. In 2017, Spectrum Health piloted the comprehensive community behavioral healthcare center, a federal pilot project which integrated services, so clients didn't have to have more than one treatment provider, Farrell said. 'In the past if you had mental health needs but you were drinking, we would tell you we can't talk about your mental health until you stop drinking,' Farrell said. 'Then we would make them go and try and stop drinking, but when you don't take care of your mental health you drink to cope. The integration has really helped. It also focuses on holistic treatment so looking at social determinants of health, looking at housing, access to healthcare insurance, food security, those types of things.' Spectrum is expanding its services in the Allentown Pediatric & Adolescent Medicine office to include the addition of an entire floor and two more full-time clinicians. The organization, long embedded in the Williamsville high schools, is expanding services into the district's middle schools. Conversations are continuing with other districts as well, she said. 'We found in doing that is that kids have access to services and it eliminates the barriers of transportation,' Farrell said. 'If you ask a 16-year-old to carve out two hours of their week every week, it's pretty impossible to do. So they can come to us on their free period or during their lunch and get services right there. We also found that that helps to mitigate some the cultural barriers to seeking treatment.' Spectrum has addressed access to mental health services for clients living in rural areas through promoting telehealth sessions and in Wyoming County, a clinician is available for home visits for the aging population. The organization also has established peer counseling for adults, youth and parents offered by those who have lived experience with mental health care. 'When somebody approaches it and normalizes it and says 'I've been there. My child has gone through this too, and let me tell you what helped us', there's power in that, and so people are more willing to engage,' Farrell said. STRENGTH IN NUMBERS Given their shared challenges, the panelists said continued collaboration and conversation will serve to strengthen Western New York's health care market. All the region's organizations interact on a daily basis one way or another, and there are great examples of joint efforts among them, Garvey said. 'We struggle sometimes with that just because we get caught up in our own respective spaces,' he said. 'Everybody knows everybody so you can have that conversation. Just think about what you're doing the right way and start the dialogue. These conversations aren't threatening to an organization, they can challenge an organization.' THE EXPERTS: JAMES GARVEY, Executive Vice President and COO, Catholic Health DR. ROBERT ZIELINSKI, Associate Medical Director and Oncologist, Buffalo Medical Group Mobility clinic offers real hope to those suffering with paralysis expand Buffalo now offers the possibility of mobility to the paralyzed. A person who suffers catastrophic paralysis is usually discharged from the hospital after treatment for the initial injury with the unfortunate conclusion, 'There's only so much we can do.' For these patients there has been no local rehabilitative pathway to offer hope of experiencing movement like there are in Atlanta, Denver and elsewhere. If a patient doesn't have the financial resources to pay for further rehabilitation out of town, then the person endures other issues associated with lack of mobility, such as pressure sores, breathing problems, muscle atrophy and digestion issues. Those Western New Yorkers who have traveled to get the specialized rehabilitation, return and quickly lose the gains they've made because there is no supportive technology here. To serve this population in Western New York, Daemen University's Dr. Michael Brogan and Dr. Laura Edsberg developed the Institute for Mobility Innovation and Technology, known at the IMIT, located at the Villa Maria College Athletic Center in Buffalo through a partnership with the college. Among the specialized equipment at the IMIT are state-of-the-art robotically assisted machines that are used in gait training and movement. One of most expensive pieces of equipment, few exist across the country, this unit consists of a large track on the ceiling where a robot is attached with harnesses that hang down to support body weight while an individual is on a treadmill. 'The benefit of this is you can walk,' Edsberg said. 'The way our brain relearns is if you keep that pattern the same the neuroplasticity will help that gait come back. This is typically the piece of equipment people use immediately post injury to try and get walking again, even when you don't have sensation, in hopes that your brain starts to send the signals again.' As the patient improves, the role of robotics can be reduced so the patient can control more of the motion. Even if walking isn't fully restored, the patient can continue to train on the equipment to get the exercise needed to get muscles in motion and blood flowing to offset atrophy, encourage wound healing and decrease any painful muscle spasms. Another important piece of equipment is called an alter gravity treadmill where the patient is zipped into a special unit that fills with air and reduces gravitational load so the individual can build trunk stability and improve gait. Movement is primary; everything else follows. 'Physiological effects end up being the cause of someone's poor quality of life and death, so maintenance is a big part of this,' Brogan said. 'If you wanted to feel better you can go to a gym or you could walk around the park. Where do people who can't move go?' The IMIT was funded with $2 million foundation grants and $1.2 million from then state Senator Tim Kennedy for equipment. The foundation money also supports maintenance of the equipment. This type of rehabilitation can return the individual to a more functional, independent state and lead to a better quality of life potentially including a return to work, Brogan said. 'They may not be a mail carrier, but they could work at the post office doing any job inside the building,' Brogan said. It also cuts costs by reducing the number of clinicians needed to work one-on-one with the patient at a time. Brogan, executive vice president and provost at Daemen University and a career-long physical therapist, and Edsberg, professor of natural sciences and the director of the Center for Wound Healing Research, initially collaborated on research on refractory wounds, or those that won't heal. These wounds are typically suffered by those who are immobilized by paralysis through an accident or stroke or conditions such as multiple sclerosis and Parkinson's. The IMIT was the evolutionary result of their work. Edsberg envisions advocacy as another important aspect of the IMIT. Insurance so far hasn't covered such rehabilitation. She expects to approach insurance companies with data from the IMIT hopeful that insurers will recognize not only the many patient benefits but the cost savings from decreased hospitalizations from complications from immobility. Research also will involve the most effective number of weekly visits to the IMIT for optimum results. The IMIT additionally provides Daemen students with the unique opportunity to work with the state-of-the art equipment. Daemen will also create opportunities for other schools to do neural placements at the IMIT program. 'Then when they go out to their jobs in their community, they will realize they should be advocating for this for their patients,' Edsberg said. 'I think this will put them ahead of other graduates.' THE EXPERTS: DR. MICHAEL BROGAN , Executive Vice President for Academic Affairs and Provost DR. LAURA EDSBERG, Co-founder and Co-Director of the Institute for Mobility Innovation & Technology (IMIT) D'Youville to bring more primary care doctors to WNY expand D'Youville University is months away from establishing the area's second academic training ground for primary care doctors. The institution is expected to welcome the first students into its College of Osteopathic Medicine a year from now. The program will further enhance D'Youville's array of health care programs that together align with a broader vision of transforming health care and health care education in Western New York, university President Dr. Lorrie Clemo said. Clemo said it is the most ambitious project ever undertaken by the university. The $120 million price tag covers the purchasing of the building, renovations and hiring the faculty. The 285 Delaware Ave. location, a mile away from the university's main campus on Porter Avenue, is significant in that it will bring hundreds of medical students to the heart of downtown Buffalo. The first class of students will begin in the fall 2026 semester. Full enrollment of 720 is expected in six years. The health care sector is eagerly awaiting them. About 27,000 primary care doctors in New York State are expected to retire within the next five years. 'What our program is going to do is to train primary care physicians, but our intent is to try to keep them here,' Clemo said. 'We know specifically that 80% of the students that received the doctor of osteopathy degree stay in primary care.' Clemo said she came to D'Youville in 2017, attracted to coming to Buffalo and moving into the president's role because the university was well positioned as a healthcare education institution. 'In the last eight years we've been able to distinguish ourselves with the great programs that prepare our students for the new work that is evolving in higher education and in health care right now,' Clemo said. 'More importantly what I saw here was a community that cared about improving health care, and I saw that we would be able to be a part of that vision, that movement that started with the BNMC (Buffalo Niagara Medical Campus). We've become very connected to that.' Doctors of osteopathy differ from medical doctors in that they practice holistic medicine, disease prevention and alternative therapies. The university has forged more than 1,200 articulation agreements with primary care physicians and has 400 partners who have signed on to be part of the medical students' training in their third and fourth years. The partners are geographically diverse, from health centers and urban trauma centers in Buffalo to rural practices in Chautauqua, Cattaraugus and Allegany counties. Clemo also is hopeful of forging collaborations with area institutions so their students who want medical education can come to D'Youville without having to repeat courses. The program is primarily recruiting local students, but expectations are it will be attractive to those students outside of Western New York and New York state, Clemo said. 'Our intent is to keep students here after they graduate because they'll be connected with the great caregivers in the region,' Clemo said. Another objective of the local focus is to help achieve the comfortability that patients will have graduates of D'Youville's program. 'We need physicians who understand the communities that they're going to be working in,' Clemo said. 'So that's part of the reason we've designed the program so that students from the community will be able to train in the community and also be able to practice in the community once they finish their training.' The program is anticipated to mirror the timeline of D'Youville's pharmacy program where a student enters as a freshman and achieves a doctorate in five years, Clemo said. The medical students then attend residency programs after graduation. D'Youville has more than 35 healthcare programs whose students interact and work in teams across the disciplines in the interprofessional approach that is embedded in the university's curriculum. This approach enables the communication and collaboration that benefits the patient. The addition of the medical students will enhance that experience for the students across all the majors. 'Our graduates will have had that experience not only in simulation but working with each other with real patients prior to going into the work world,' Clemo said. D'Youville is planning to build 188 single rooms in a new residence, specifically for graduate-level students, including the medical students, at 433 West Ave. Construction is expected to begin in January and be completed by August 2027. The aim is to ease the burden on students from having to find accommodations in Buffalo's housing shortage.
WIRED
7 hours ago
- WIRED
The First Widespread Cure for HIV Could Be in Children
Aug 1, 2025 9:19 AM Evidence is growing that some HIV-infected infants, if given antiretroviral drugs early in life, are able to suppress their viral loads to undetectable levels and then come off the medicine. An ARV tablet being held in Kisumu, Kenya, on April 24, 2025. Photograph:For years, Philip Goulder has been obsessed with a particularly captivating idea: In the hunt for an HIV cure, could children hold the answers? Starting in the mid-2010s, the University of Oxford pediatrician and immunologist began working with scientists in the South African province of KwaZulu-Natal, with the aim of tracking several hundred children who had acquired HIV from their mothers, either during pregnancy, childbirth, or breastfeeding. After putting the children on antiretroviral drugs early in their lives to control the virus, Goulder and his colleagues were keen to monitor their progress and adherence to standard antiretroviral treatment, which stops HIV from replicating. But over the following decade, something unusual happened. Five of the children stopped coming to the clinic to collect their drugs, and when the team eventually tracked them down many months later, they appeared to be in perfect health. 'Instead of their viral loads being through the roof, they were undetectable,' says Goulder. 'And normally HIV rebounds within two or three weeks.' In a study published last year, Goulder described how all five remained in remission, despite having not received regular antiretroviral medication for some time, and in one case, up to 17 months. In the decades-long search for an HIV cure, this offered a tantalizing insight: that the first widespread success in curing HIV might not come in adults, but in children. At the recent International AIDS Society conference held in Kigali, Rwanda, in mid-July, Alfredo Tagarro, a pediatrician at the Infanta Sofia University Hospital in Madrid, presented a new study showing that around 5 percent of HIV-infected children who receive antiretrovirals within the first six months of life ultimately suppress the HIV viral reservoir—the number of cells harboring the virus's genetic material—to negligible levels. 'Children have special immunological features which makes it more likely that we will develop an HIV cure for them before other populations,' says Tagarro. His thoughts were echoed by another doctor, Mark Cotton, who directs the children's infectious diseases clinical research unit at the University of Stellenbosch, Cape Town. 'Kids have a much more dynamic immune system,' says Cotton. 'They also don't have any additional issues like high blood pressure or kidney problems. It makes them a better target, initially, for a cure.' According to Tagarro, children with HIV have long been 'left behind' in the race to find a treatment that can put HIV-positive individuals permanently into remission. Since 2007, 10 adults are thought to have been cured, having received stem cell transplants to treat life-threatening blood cancer, a procedure which ended up eliminating the virus. Yet with such procedures being both complex and highly risky—other patients have died in the aftermath of similar attempts—it is not considered a viable strategy for specifically targeting HIV. Instead, like Goulder, pediatricians have increasingly noticed that after starting antiretroviral treatment early in life, a small subpopulation of children then seem able to suppress HIV for months, years, and perhaps even permanently with their immune system alone. This realization initially began with certain isolated case studies: the 'Mississippi baby' who controlled the virus for more than two years without medication, and a South African child who was considered potentially cured having kept the virus in remission for more than a decade. Cotton says he suspects that between 10 and 20 percent of all HIV-infected children would be capable of controlling the virus for a significant period of time, beyond the typical two to three weeks, after stopping antiretrovirals. Goulder is now launching a new study to try and examine this phenomenon in more detail, taking 19 children in South Africa who have suppressed HIV to negligible levels on antiretrovirals, stopping the drugs, and seeing how many can prevent the virus from rebounding, with the aim of understanding why. To date, he says that six of them have been able to control the virus without any drugs for more than 18 months. Based on what he's seen so far, he has a number of ideas about what could be happening. In particular, it appears that boys are more likely to better control the virus due to a quirk of gender biology to do with the innate immune system, the body's first-line defense against pathogens. 'The female innate immune system both in utero and in childhood is much more aggressive than the male equivalent when it encounters and senses viruses like HIV,' says Goulder. 'Usually that's a good thing, but because HIV infects activated immune cells, it actually seems to make girls more vulnerable to being infected.' In addition, Goulder notes that because female fetuses share the same innate immune system as their mothers, the virus transmitted to them is an HIV strain that has become resistant to the female innate immune response. There could also be other explanations for the long-lasting suppression seen in some children. In some cases, Goulder has observed that the transmitted strain of HIV has been weakened through needing to undergo changes to circumvent the mother's adaptive immune response, the part of the immune system which learns to target specific viruses and other pathogens. He has also noted that male infants experience particularly large surges of testosterone in the first six months of life—a period known as 'mini-puberty'—which can enhance their immune system in various ways that help them fight the virus. Such revelations are particularly tantalizing as HIV researchers are starting to get access to a far more potent toolbox of therapeutics. Leading the way are so-called bNAbs, or broadly neutralizing antibodies, which have the ability to recognize and fight many different strains of HIV, as well as stimulating the immune system to destroy cells where HIV is hiding. There are also a growing number of therapeutic vaccines in development that can train the immune system's T cells to target and destroy HIV reservoirs. Children tend to respond to various vaccines better than adults, and Goulder says that if some children are already proving relatively adept at controlling the virus on the back of standard antiretrovirals, these additional therapeutics could give them the additional assistance they need to eradicate HIV altogether. In the coming years, this is set to be tested in several clinical trials. Cotton is leading the most ambitious attempt, which will see HIV-infected children receive a combination of antiretroviral therapy, three bNAbs, and a vaccine developed by the University of Oxford, while in a separate trial, Goulder is examining the potential of a different bNAb together with antiretrovirals to see whether it can help more children achieve long-term remission. 'We think that adding the effects of these broadly neutralizing antibodies to antiretrovirals will help us chip away at what is needed to achieve a cure,' says Goulder. 'It's a little bit like with leukemia, where treatments have steadily improved, and now the outlook for most children affected is incredibly good. Realistically in most cases, curing HIV probably requires a few hits from different angles, impacting the way that the virus can grow, and tackling it with different immune responses at the same time to essentially force it into a cul-de-sac that it can't escape from.' Children are also being viewed as the ideal target population for an even more ambitious experimental treatment, a one-time gene therapy that delivers instructions directing the body's own muscle cells to produce a continuous stream of bNAbs, without the need for repeated infusions. Maurico Martins, an associate professor at the University of Florida, who is pioneering this new approach, feels that it could represent a particularly practical strategy for low-income countries where HIV transmission to children is particularly rife, and mothers often struggle to keep their children on repeated medication. 'In regions like Uganda or parts of South Africa where this is very prevalent, you could also give this therapy to a baby right after birth as a preventative measure, protecting the newborn child against acquisition of HIV through breastfeeding and maybe even through sexual intercourse later in life,' says Martins. While Martins also hopes that gene therapy could benefit HIV-infected adults in future, he feels it has more of a chance of initially succeeding in children because their nascent immune systems are less likely to launch what he calls an anti-drug response that can destroy the therapeutic bNAbs. 'It's very difficult for most antibodies to recognize the HIV envelope protein because it's buried deep within a sugar coat,' says Martins. 'To overcome that, these bNAbs carry a lot of mutations and extensions to their arms which allow them to penetrate that sugar coat. But the problem then is that they're often viewed by your own immune system as foreign, and it starts making these anti-bNAb antibodies.' But when Martins tested the therapy in newborn rhesus macaques, it was far more effective. 'We found that the first few days or two weeks after birth comprised a sort of sweet spot for this gene therapy,' he says. 'And that's why this could really work very well in treating and preventing pediatric HIV infections.' Like many HIV scientists, Martins has run into recent funding challenges, with a previous commitment from the National Institutes of Health to support a clinical trial of the novel therapy in HIV-infected children being withdrawn. However, he is hoping that the trial will still go ahead. 'We're now talking with the Gates Foundation to see whether they can sponsor it,' he says. While children still comprise the minority of overall HIV infections, being able to cure them may yield further insights that help with the wider goal of an overall curative therapy. 'We can learn a lot from them because they are different,' says Goulder. 'I think we can learn how to achieve a cure in kids if we continue along this pathway, and from there, that will have applications in adults as well.'
