Technology and medicine join forces through an in-home HIV test

Despite approximately 2.5 million new cases of HIV each year worldwide, six out of 10 go undiagnosed. Dr. Nitika Pant Pai and her team at the Royal Victoria Hospital of the McGill University Health Centre (MUHC) hope to address this global health issue with the development and release of an in-home HIV self-testing program.

Pant Pai and her team received the 2013 Accelerating Science Award (ASAP) in Washington D.C. on Oct. 21, for their work in creating a self-diagnosis program. The program involves an oral, over-the-counter self-test that detects the presence of HIV antibodies using oral fluid samples from the gum lining of the mouth. The presence of antibodies indicates that the body has recognized the human immunodeficiency virus and produced proteins in response to counteract it. This test is coupled with an interactive website and mobile phone app called HIVSmart to assist patients in the testing process.

“The key barriers to not showing up to testing in health facilities are stigma, discrimination, social visibility associated with an HIV diagnosis, [and] long waiting times,” explained Pant Pai in the finalist video HIV Self-Test Empowers Patients for the ASAP award. The purpose of this self-test is to empower patients by providing them with the resources to perform the diagnosis confidentially and at their own convenience.

The mobile app and website form a package that guides people through the testing process. The app provides a 24-hour help line, links to counseling, and instructional videos.

“The development of this innovative application represents a major advancement in our ability to deal with the evolving HIV epidemic that affects people worldwide,” said Dr. Vassilios Papadopoulos, executive director and chief scientific officer of the Research Institute of the McGill University Health Care (RI-MUHC), to McGill’s Medical online newsletter Med e-News.

The app is currently designed for Android devices, and could be released to the public within the next few months. Researchers hope to develop the app for other mobile devices and in more languages in order to make the self-test more accessible to people worldwide.

While we sleep, our brains take out the trash

Scientists have long been perplexed by the function of sleep. For animals at risk of predation, sleep seems evolutionarily disadvantageous. And, even though we consider sleep to be a period of rest, the sleeping brain uses up almost as much energy as the awake brain. All of these complexities were addressed in a recent study led by author and University of Rochester neurosurgeon Maiken Nedergaard that proposes a new biological explanation for the purpose of sleep.

The study, published this past Thursday in Science, revealed findings that the brain’s clean-up system—known as the glymphatic system, which is responsible for flushing out toxic waste products released by cells during the day—rapidly increases in mice that are asleep.

“Brain cells shrink when we sleep, allowing fluid to enter and flush out the brain,” Nedergaard told the Washington Post. “It’s like opening and closing a faucet.”

This action makes it easier to clean the spaces around the cells. Essentially, the system works by circulating cerebrospinal fluid throughout the brain tissue to flush any residual waste into the bloodstream. The by-products are then carried to the liver for detoxification.

One protein of particular interest that is flushed out during this process is beta-amyloid—the protein responsible for forming plaques in the brains of Alzheimer’s patients.

Using a technique known as two-photon microscopy, scientists observed the movement of cerebrospinal fluid in a live mouse brain in real time. They discovered that while the mouse was asleep, the fluid rushed through the brain quickly. In contrast, when the mouse was woken up, the flow was highly constrained. The study noted that beta-amyloid protein cleared out of the brain twice as fast in a sleeping rodent as in an alert mouse.

This study provides new insights into potential treatment for neurodegenerative diseases like Parkinson’s and Alzheimer’s disease which are associated with an accumulation of cell waste in the brain. Nedergaard and her colleagues are currently developing an MRI diagnostic test for glymphatic clearance. In the future, Nedergaard believes a drug could be developed to force a cleanup of the brain if necessary.