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The SPARTAC study (Short Pulse Anti-Retroviral Therapy at HIV Conversion) was a randomised clinical trial of short (12 weeks) or long (48 weeks) pulsed antiretroviral therapy (ART) at primary or recent HIV infection, compared to deferred therapy (standard of care). The trial has shown a significant effect of 48 weeks ART, compared to deferred therapy; 12 weeks ART had no effect. This definitive result from the SPARTAC trial has informed HIV treatment guidelines nationally and internationally; patients identified with primary or recent HIV infection are now recommended to commence ART, based in whole or part on the evidence arising out of SPARTAC. As a consequence of the SPARTAC trial, it is no longer ethical to undertake research amongst individuals with recent HIV infection without offering immediate ART.
In 2011, 34 million people worldwide were living with, and 1.7 million died from, HIV/AIDS. Since 2002, HIV-positive people have benefited from research by the Antiretroviral Therapy Cohort Collaboration (ART-CC) based at University of Bristol (UoB). Research on the timing of ART led to updated international HIV treatment guidelines that recommended starting treatment earlier. Research on life expectancy highlighted the benefits to patients of earlier ART, and was used by policy makers, clinicians and patient groups to promote earlier treatment. Patients are now starting treatment earlier resulting in increased life expectancy. Insurance companies changed their criteria for providing life insurance, influenced by ART-CC.
Highly Active Anti-Retroviral Therapy (HAART) is a combination of drugs used to effectively control HIV infection. Since 1987 Nucleoside Reverse Transcriptase Inhibitors (NRTIs) had been used in HAART combinations to specifically target HIV-1 reverse transcriptase, however, resistance and side effects soon prompted the need for an alternative. In 1998, University of Oxford Professors David Stuart and David Stammers provided the first detailed structural framework to facilitate the design of a highly effective alternative class of drug, the Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). NNRTIs have since been developed for clinical use, impacting the pharmaceutical industry and profoundly improving the quality of life of patients.
HIV-infected infants are at high risk of disease progression and death. Until 2008 guidelines recommended waiting until the infant displayed symptoms, or had a weakened immune system before starting treatment. The CHER trial found that starting infected infants on antiretroviral therapy as early as possible substantially reduced mortality compared with waiting until they developed symptoms or their immune system weakened. These results led quickly to changes in guidelines for treating HIV-infected infants issued by the US, World Health Organisation (WHO), Paediatric European Network for Treatment of AIDS (PENTA) and South Africa. These revised guidelines, if fully implemented along with early infant diagnosis, would reduce the number of infant deaths because of HIV by 76%, saving the lives of approximately 46,800 infants globally each year.
UCL investigators have been at the forefront of characterising and assessing HIV drug resistance since 1990, soon after the very first HIV drug was licenced. There are currently more than 25 drugs available, and our work over the last 23 years has directly determined how best these therapies are used, and monitored in infected patients. We have extended our work to a global perspective, in conjunction with the current rollout of antiretroviral therapy to areas of the world devastated by the epidemic - work which now informs guidelines of the World Health Organisation (WHO), and has resulted in a marked reduction in mortality.
In sub-Saharan Africa, 22 million people live with HIV/AIDS. Annual mortality is 1.5 million and sexual transmission accounts for ~90% of new infections. Young women are disproportionately affected due to socio-cultural issues. Seeking to empower them with an urgently needed female-initiated protective method, Malcolm & Woolfson developed the first antiretroviral (AR) microbicide vaginal ring (VR), which provides slow, continuous release of dapivirine for long-lasting protection against vaginal HIV transmission. Consequently, global microbicide development strategies were transformed, with the focus shifted from immediate-use gels to long-acting VRs. In August 2012, the dapivirine VR commenced final stage (Phase III) clinical trials in Africa.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organisation (WHO) regularly report estimates for the prevalence of HIV and associated metrics for almost every country in the world. These statistics are essential for tracking the scale and the impact of HIV epidemic and are used routinely in the policy decisions and funding allocation decisions of national governments and international donors and therefore have a major impact on international public health. The methods underlying those estimates were originally developed, and continue to be refined and updated, by an international group of researchers at Imperial College London.
The research into the main socio-cultural causes, consequences and management of the HIV/AIDS epidemic in South Africa (undertaken by Dr Liz Walker, in collaboration with colleagues in South Africa) has had significant impact in South Africa on the development of the education and training of health and social care professionals working in the context of, and specializing in, HIV/AIDS. The programme of research has resulted in the production of an educational and training resource that is used in HEIs and other professional training settings. The educational resource is unique as it foregrounds HIV/AIDS as the context within which all health and social care practice is undertaken in Southern Africa.
Derek Matravers' research in aesthetics has contributed to the public discourse on art by offering a plausible postmodern definition of `art'. Matravers' definition offers a way of understanding art that places the emphasis on reasons, and thus moves beyond the obscurantism associated with contemporary art. His podcast on the subject, as part of the PhilosophyBites series, has taken the topic into public discourse. His work has also influenced the art world. Matravers participated in a conceptual art piece, where his ideas on the definition of art were incorporated into the art piece, effectively blurring the borders between the philosophy and the object of study.
This case study focuses on three areas in relation to the social impact of art, across the categories of `cultural life' and `public discourse'.
1) Artistic collaborations with non-artistic specialists in order to generate new interdisciplinary pathways
2) Artistic collaborations with non-artists within a given community or non-artistic institutional setting in order to create new forms of artist-audience participation
3) The sharing of knowledge/skills between either non-artistic specialists or a non-specialist audience and artists in the production of a shared task or project.
4) Performance-based practice inside and outside of the gallery
The outward facing nature of this research, then, addresses the way such work tests the prevailing competences, boundaries and identities of artist and audience alike. This means researchers are involved with both artistic and non-artistic funding-bodies and agencies as the basis for work on a range of critical issues affecting the borders between the art institution and non-artistic settings and contexts.