NEW
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July 18, 2009)
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Friday, July 17, 2009
AFP Circumcision of men
with HIV does not reduce the risk of infection for women, according to a study
published on Friday by The Lancet.
Male circumcision
unleashed a wave of optimism among AIDS campaigners three years ago when trials
in
Last year, longer-term
analysis of one of the trials found the benefit to be even greater than thought,
with a risk reduction of 65 percent.
One of the big questions,
though, is whether male circumcision could also reduce the risk for women who
have intercourse with an HIV-infected man.
The answer, according to a
randomised trial carried out in
Doctors enrolled 922
uncircumcised Ugandan men aged 15-49 who were badly infected with HIV but who
did not show any symptoms.
Half of the group then had
circumcision, while the other half remained uncircumcised.
The researchers also
enrolled HIV-uninfected women who were partners of the male volunteers. These
numbered 90 women in the circumcised group, and 70 in the uncircumcised groups.
All participants were
intensively schooled in HIV prevention.
The trial was halted at a
partway stage because it would have been futile and questionable to carry on.
Analysis of data after two
years made it clear that there was no protection: 18 percent of women in the
circumcised group who were examined at the follow-up point had become infected,
as opposed to 12 percent in the control group.
Most of the infections in
the circumcised group occurred within six months after circumcision.
This may have been because
some of the men had intercourse without giving time for the circumcision wound
to heal properly, thus exposing the woman to HIV-infected blood in the vagina.
That finding was
surprising and provides a lesson for programmes to promote male circumcision as
a cheap, effective method of preventing HIV among men, say the authors.
Men who undergo
circumcision must be closely counselled about strictly observing sexual
abstinence until the wound heals, and about also using condoms to stop infecting
their partner.
The doctors, led by Maria
Wawer of the Johns Hopkins Bloomberg School of Public Health in
They stress, though, that
circumcision campaigns are still valid.
Even if women do not
directly benefit from male circumcision, they get an indirect advantage, because
the fewer men who are infected with HIV, the lesser the risk to women.
A study published in
October last year in the Journal of the American Medical Association (JAMA)
found that the protective benefit of circumcision to male heterosexuals does not
appear to extend to male homosexuals.
Among 53,567 men who
reported having male sexual partners, researchers found little difference in the
rate of HIV infection between those who were circumcised and those were not.
The theory behind the
effectiveness of circumcision is that the inner foreskin is an easy entry point
for HIV. It is rich in so-called Langerhans cells, tissue that the AIDS virus
finds particularly easy to latch on to and penetrate.
Other questions
surrounding circumcision campaigns are the need to ensure that operations are
done hygienically and with the full knowledge and consent of the male.
Monday, July 13 08:00 pm
Scientists in the
One of the enigmas about
the AIDS pandemic is why women, after infection with HIV-1, seem better able to
combat the virus in its early stages but then advance faster to AIDS compared to
men infected with a similar level of the virus.
The answer lies in the
response of a key component in their immune system, and hormonal differences may
account for it, according to a paper published online by the journal Nature
Medicine.
If right, it throws up new
possibilities for drugs that would hinder the process, its authors added.
The study focuses on
plasmacytoid dendritic cells (pDCs), which are "first responders" in
the immune system. They detect a microbial intruder and then alert other
defenders.
The pDCs recognise the
AIDS virus through a little docking point called Toll-like receptor 7, or TLR7.
Once their TLR7 is switched on, the pDCs call up an important immune-system
molecule called interferon alpha.
Researchers at the Ragon
Institute of the
The team then linked
interferon alpha to the activation of one of the heavy artillery of the immune
system -- CD8 cells.
Previous research has
already spotted an intriguing phenomenon.
The more CD8 cells that
are stimulated, the faster a patient progresses to acquired immune deficiency
syndrome (AIDS), the stage whereby the immune system is so devastated that the
body becomes prey to opportunistic disease. Why this is so is unclear, though.
Ragon Institute
investigator Marcus Altfeld said that the results suggest men and women may
differ in an important way in how their immune systems respond to HIV.
In the early stages of
infection, a stronger activation of their immune system could be beneficial to
women, he said.
But in the long run, the
persistent viral replication and chronic activation of the immune system -- as
indicated by the CD8 cells -- can lead to faster progression to AIDS.
Altfeld said the study
raised new questions about how sex hormones modulate the molecular cascade to
HIV infection. One interesting idea, he added, could be a drug that stops or
slows the TLR7 alarm system.
"Focussing on immune activation separately from viral replication might give us new therapeutic approaches" to tackling the virus, he said in a press release.
Mon Jul 13, 2009 5:20pm
EDT
By Anne Harding
NEW
YORK
"It's the consistent
use of the condom that's important," Dr. Emily T. Martin of Children's
Hospital Research Institute and the
Genital herpes is caused
by infection with herpes simplex virus-2 (HSV-2). The infection can cause
painful sores in the genital area. Treatment for outbreaks and long-term
suppression of the virus is available, but once a person contracts HSV-2 they
will carry it for life.
While the benefits of
condom use for preventing the spread of HIV infection , Chlamydia, gonorrhea and
other STDs is well established, evidence on whether condoms are an effective
barrier against HSV-2 virus has been mixed, Martin and her team note.
The researchers combined
data from six different studies of HSV-2 incidence and condom use, including
5,384 people in total, to provide a more definitive answer. All study
participants were free of HSV-2 infection when the studies began. During
follow-up, which averaged just over a year, 415 contracted genital herpes.
People who reported always
using condoms were 30 percent less likely to contract the infection than people
who didn't use condoms, Martin and her team found, while the risk of becoming
infected rose steadily with the number of unprotected sex acts.
Condoms are only partly
protective, the researcher noted, because HSV-2 can spread by skin-to-skin
contact, which could occur in areas not covered by the condom. Also, she pointed
out, even when people with genital herpes don't have a visible outbreak of
infection, they may be able to infect others with the virus.
Nevertheless, Martin
added, "30 percent is partial protection, but it's protection."
SOURCE: Archives of
Internal Medicine, July 13, 2009.
On Thursday July 16, 2009,
6:35 pm EDT
FOSTER CITY, Calif. (AP)
-- Drugmaker Gilead Sciences Inc. said Thursday it entered a partnership with
Tibotec Pharmaceuticals to develop a single daily antiretroviral HIV pill.
The proposed drug would
combine
Tibotec, a unit of Johnson
& Johnson, would be responsible for developing rilpivirine as a standalone
drug.
In aftermarket trading,
On Friday July 17, 2009,
10:04 am EDT
The stock gained $1.31, or
2.8 percent, to $48.18 in morning trading. Shares have traded between $35.60 and
$57.63 over the last 52 weeks.
The company, known for its
blockbuster HIV treatments, will work with Tibotec Pharmaceuticals to develop a
single-pill combination of TMC278, or rilpivirine, and Truvada. Financial terms
of the deal were not disclosed.
"Based on the deal
terms, it appears that Gilead had the dominant hand at the negotiating table, as
it reads to us more like a licensing agreement than a partnership," said
Leerink Swann analyst Dr. Joshua Schimmer, in a note to investors.
He said it is difficult to
assess the value of the program without late-stage study data, but
Schimmer reaffirmed a
"Outperform" rating on the stock.
17 Jul 2009 17:06:00 GMT
Source: Medecins Sans
Frontieres (MSF) - International
Disruptions in the supply
of anti-retroviral (ARV) drugs and other essential medical items in at least six
African countries are putting HIV patients' lives at risk. Funding gaps and
supply management problems have led to the delay, suspension, or risk of
suspension of the supply of life-saving HIV drugs.
MSF and podcasts:
The inaction of national
governments, donors, and their partners must end and they must take urgent and
concrete measures, says MSF, speaking one day ahead of the 5th International
Aids Society Conference in
The consequences of
disruptions in funding and supplies are potentially catastrophic: if the start
of new patients on treatment has to be suspended or delayed, then the lives of
many in urgent need of drugs are at risk. For those already on treatment, the
interruptions or lowering of the dosage will lead to treatment failure and a
higher risk of developing drug-resistance. In recent months, disruptions have
directly affected MSF's HIV programmes.
In
"All around us,
clinics stop enrolling patients because there are just not enough ARV
supplies," says Eric Goemaere, MSF Head of Mission in
In
MSF teams in
Disruptions are a result
of a shortage of in-country funding and delays by donor governments in
fulfilling their commitments. Major international funding institutions such as
the Global Fund for AIDS, tuberculosis and malaria and PEPFAR face budget caps
or uncertainty in the replenishment of funding. Supply management and
procurement issues at country level compound the problem, as any delay in
funding puts the supply chain in danger.
"MSF is extremely
concerned about the lack of effective action from governments, their partners,
and international donors in assuring the continued funding and supply of ARVs
and other medical items for treatment," adds Meinie Nicolai, MSF Director
of operations. "They are playing with fire. No ARVs means no HIV/AIDS
treatment. Governments and donors must respond to funding and supply problems
urgently and effectively."
Tuesday, July 14 12:23 pm
It has also agreed a new
free voluntary licensing agreement for AIDS drug abacavir, or Ziagen, with South
African generic drugmaker Aspen Pharmacare , in which it has a 16 percent stake.
The latest steps,
announced by Glaxo Chief Executive Andrew Witty on a visit to
Glaxo took a lead in
February by promising to place many of its patents on drugs for tropical
diseases into a free "pool," but it stopped short of offering patents
on medicines for HIV/AIDS, which it does not consider to be a neglected disease.
"Up until now I've
not really seen the articulation of how a patent pool in this particular area
(HIV/AIDS) would change things dramatically," Witty told reporters in
conference call.
"The patent pool on
neglected diseases was because there was really no research going on in that
area -- HIV is not a neglected disease."
So far Glaxo is the only
big drug company to have committed to pool some of drug patents, although it was
joined in the initiative last week by
A further 10 million
pounds in seed funding will go to support public-private partnership work in
developing AIDS medicines specifically for children.
(Reporting by Ben
Hirschler; Editing by Greg Mahlich)