News (Updated March 21, 2010)

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Experts warn of acupuncture infection risk

BMJ Group, Friday 19 March 2010

Acupuncture can carry a risk of serious infections and should be regulated more closely, say experts from the University of Hong Kong . Problems seem to be rare, but the fact that they often go unreported means that the side effects we do see may be the tip of the iceberg.

What is acupuncture?

Acupuncture is a traditional Chinese treatment. It's a type of complementary or alternative medicine, and involves having thin needles put into your skin. People try acupuncture for all sorts of conditions, from irritable bowel syndrome to back pain to infertility.

Traditional acupuncturists believe that acupuncture improves the flow of 'Qi' energy around the body. Some modern doctors think that putting needles in the skin could encourage the release of natural chemicals that block pain and help you feel relaxed. However, another theory is that any benefits come from the placebo effect, and from the fact that the circumstances of treatment are often quite relaxing.

Some trials have failed to find a difference between traditional acupuncture and sham acupuncture, which avoids traditional acupuncture points or uses spring-loaded needles that don't pierce the skin.

What could the harms be?

According to specialists in microbiology at the University of Hong Kong , acupuncture without careful use of sterile equipment could carry a risk of infection, either by passing germs between people, or by introducing germs from the skin into the body.

Professor Patrick Woo and his colleagues describe more than 50 reports from around the world of infections after acupuncture, mostly because the patient's skin wasn't properly disinfected. Skin infections seem to be the most common problem, but there have been cases of deeper infections affecting joints or the tissues around the heart, spine, or brain.

There has been an isolated report of an acupuncture patient being infected with an antibiotic-resistant 'superbug' (methicillin-resistant Staphylococcus aureus, or MRSA). The patient needed surgery to remove an infected joint and six months of treatment with strong antibiotics.

Worldwide, there have been five outbreaks of hepatitis B associated with acupuncture, with more than 80 people affected. The most common cause was improperly sterilised reusable needles. It's theoretically possible that HIV could be transmitted by acupuncture, and there have been suspected cases of HIV passed on in this way, but no confirmed cases.

Although serious problems after acupuncture are rare, Professor Woo says that many patients with minor side effects may never seek medical help, meaning we don't know how common milder problems really are. Doctors may miss the connection with acupuncture when they see an infection, especially if there's been a long incubation period after the acupuncture treatment.

How worried should I be?

While it's clear that serious problems can happen after acupuncture, the cases Professor Woo and his colleagues describe are collected from all over the world, and some go back to the 1970s. Serious problems don't seem to be common, and acupuncture in rigorously sterile conditions is unlikely to put you at risk.

The British Acupuncture Council, one of the UK 's professional bodies for acupuncturists, says it isn't aware of any serious acupuncture-related infections being reported in the UK .

Do we need tighter controls?

Professor Woo and his colleagues argue that acupuncturists need to observe infection control measures, such as using disposable needles, skin disinfection procedures, and aseptic techniques. They also call for stricter regulation and accreditation of acupuncturists.

What's the situation in the UK ?

There are several bodies that regulate acupuncturists in the UK , all with their own codes of practice. However, membership of these organisations is voluntary, and there is currently no statutory regulation.

What should I do if I want to have acupuncture?

If you're considering acupuncture, make sure your practitioner is registered with an organisation like the British Acupuncture Council, which has a safe practice code for its 3,000 or so members. This code specifies the use of pre-sterilised disposable needles, sterile skin cleaning equipment, and surgical gloves. There are also other professional bodies for acupuncturists with similar requirements.

You should also check that the person treating you has professional indemnity insurance.

From:

Woo PCY, Lin AWC, Lau SKP, et al. Acupuncture transmitted infections. BMJ. Published online 18 March 2010.

© BMJ Publishing Group Limited ("BMJ Group") 2010

Acne drug may help prevent HIV breakout

ANI, Mar 20, 2010

Acne drug may help prevent HIV breakout (Getty Images)

A cheap acne drug that's been used for decades effectively targets infected immune cells in which HIV, the virus that causes AIDS, lies dormant and prevents them from reactivating and replicating, claim Johns Hopkins researchers.

The drug, minocycline, likely will improve on the current treatment regimens of HIV-infected patients if used in combination with a standard drug cocktail known as HAART (Highly Active Antiretroviral Therapy), according to research published now online and appearing in print April 15 in The Journal of Infectious Diseas es.

“The powerful advantage to using minocycline is that the virus appears less able to develop drug resistance because minocycline targets cellular pathways not viral proteins,” says Janice Clements, Ph.D., Mary Wallace Stanton Professor of Faculty Affairs, vice dean for faculty, and professor of molecular and comparative pathobiology at the Johns Hopkins University School of Medicine.

“The big challenge clinicians deal with now in this country when treating HIV patients is keeping the virus locked in a dormant state,” Clements adds. “While HAART is really effective in keeping down active replication, minocycline is another arm of defense against the virus.”

Unlike the drugs used in HAART which target the virus, minocycline homes in on, and adjusts T cells, major immune system agents and targets of HIV infection. According to Clements, minocycline reduces the ability of T cells to activate and proliferate, both steps crucial to HIV production and progression toward full blown AIDS.

If taken daily for life, HAART usually can protect people from becoming ill, but it’s not a cure. The HIV virus is kept at a low level but isn’t ever entirely purged; it stays quietly hidden in some immune cells. If a person stops HAART or misses a dose, the virus can reactivate out of those immune cells and begin to spread.

The idea for using minocycline as an adjunct to HAART resulted when the Hopkins team learned of research by others on rheumatoid arthritis patients showing the anti-inflammatory effects of minocycline on T cells. The Hopkins group connected the dots between that study with previous research of their own showing that minocycline treatment had multiple beneficial effects in monkeys infected with SIV, the primate version of HIV. In monkeys treated with minocycline, the virus load in the cerebrospinal fluid, the viral RNA in the brain and the severity of central nervous system disease were significantly decreased. The drug was also shown to affect T cell activation and proliferation.

“Since minocycline reduced T cell activation, you might think it would have impaired the immune systems in the macaques, which are very similar to humans, but we didn’t see any deleterious effect,” says Gregory Szeto, a graduate student in the Department of Cellular and Molecular Medicine working in the Retrovirus Laboratory at Hopkins . “This drug strikes a good balance and is ideal for HIV because it targets very specific aspects of immune activation.”

Banana beats anti-HIV drugs

Ekaterina Starshaya

On March 19, a new study to be published in the Journal of Biological Chemistry, scientific journal, concluded that banana lectins, a naturally occurring chemical, has the ability to stop the transmission and prevention of HIV.

This novel research from the University of Michigan Medical School found BanLec, "a jacalin-related lectin isolated from the fruit of bananas, a potential component for an anti-viral microbicide that could be used to prevent the sexual transmission of HIV-1. BanLec is an effective anti-HIV lectin and is similar in potency to T-20 and maraviroc, two anti-HIV drugs currently in clinical use."

Michael D. Swanson, a doctoral student in the graduate program in immunology at the University of Michigan Medical School and lead author of the study, said "the problem with some HIV drugs is that the virus can mutate and become resistant, but that's much harder to do in the presence of lectins. Lectins can bind to the sugars found on different spots of the HIV-1 envelope, and presumably it will take multiple mutations for the virus to get around them."

According to University of Michigan Health System , the "authors say even modest success could save millions of lives. Other investigators have estimated that 20 percent coverage with a microbicide that is only 60 percent effective against HIV may prevent up to 2.5 million HIV infections in three years."

David Marvovitz, M.D., professor of internal medicine at the U-M Medical School , led the study and explained, "HIV is still rampant in the U.S. and the explosion in poorer countries continues to be a bad problem because of tremendous human suffering and the cost of treating it. That's particularly true in developing countries where women have little control over sexual encounters so development of a long-lasting, self-applied microbicide is very attractive."

HIV/AIDS Vaccine: Why It Won’t Be Coming Soon

March 15, 2010

Onome Akpogheneta

In a recent article describing progress towards an  HIV/AIDS vaccine, Herbert Virgin and Bruce Walker commented that the HIV/AIDS biomedical research community “still lack(s) fundamental knowledge regarding the nature, quality and quantity of immune responses that should be induced” for successful vaccination. Defining appropriate viral proteins for vaccination is also problematic, as is determining “whether preventative vaccine strategies should focus on protection from infection or protection from disease progression”. With so many “knowable unknowns”, HIV/AIDS remains an ongoing global challenge.

Since the identification of the viral infection in the early 1980s, an estimated 60 million people have been infected with HIV and 20 million are thought to have died as a result of AIDS.

Low HIV sexual transmission rates (less than 1% of HIV exposures lead to infection) are thought to increase significantly during acute phases of the infection when viral loads are elevated, and one third of infants born to HIV infected mothers acquire the infection.

Virgin and Walker focused upon immunological knowledge and tools for vaccine design, suggesting that in their absence, the route to a successful HIV/AIDS vaccine may be elusive and distant. It remains possible that a viable vaccine could emerge as a surprising success from vaccine trials. Even with success, a viable HIV/AIDS vaccine will likely not be 100% effective; recent promising trials in Thailand suggested a reduction of 31% in HIV acquisition as a result of vaccine use. As such, the likelihood of a successful HIV/AIDS vaccine is remote and a vaccine will be only one of several preventative tools to be used against HIV/AIDS.

Current estimates suggest that over 7,000 new HIV infections occur daily around the world. The heaviest HIV/AIDS disease burden (71%) is in Sub-Saharan Africa, but prevalence continues to rise in many areas of the world including Eastern Europe and Central Asia . In order to effectively challenge HIV/AIDS, interventions must be targeted to particular countries and individuals at greatest risk.

“It’s not enough to simply funnel more funding into current AIDS research efforts” commented the authors. Resonant also was the call to those working in the field of HIV research to learn from others with relevant expertise. The authors suggest that “there is no lack of enthusiasm among scientists outside the HIV field to get involved in HIV/AIDS related research; rather there is merely a lack of a way in”.

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