News (Updated April
10, 2011)
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By Randy Dotinga
HealthDay Reporter
WEDNESDAY, April 6 (HealthDay
News) -- In a development that could enhance HIV-prevention research, a new
study of heterosexual couples confirms that the risk of transmitting HIV rises
with the level of the virus in semen and cervical fluid.
The finding -- that more
virus translates to higher likelihood of transmission -- hasn't been proven to
this extent before, said study lead author Dr. Jared M. Baeten of the
"This confirms what
we had thought about the biology of HIV," he said, "and it gives us
new information about genital levels of HIV being particularly important, even
independent of blood levels."
For the study, researchers
obtained samples of genital fluid from 2,521 heterosexual couples living in
seven African countries. Most were married and living together. At the start of
the two-year study, one partner in each couple was infected with HIV, the
AIDS-causing virus, and none was taking anti-HIV drugs.
Over the course of the
study, published April 6 in the journal Science Translational Medicine, 78
partners became infected within the relationship.
The researchers compared
cervical and semen fluid samples from partners who transmitted the virus with
samples from men and women who didn't transmit the virus and found that the risk
of HIV transmission approximately doubled with each specified HIV increase in
genital fluids. (In a few cases, HIV transmission occurred without any sign of
the virus in genital fluids, although it was in the blood.)
The results are
"really useful for figuring out new research studies looking at new
strategies," said Baeten, an assistant professor of global health and
medicine. "You can develop strategies that reduce HIV levels only in the
genital tract, not in the blood, like microbicides."
The study is useful for a
couple of reasons, said Dr. Peter A. Anton, director of the Center for HIV
Prevention Research at
This can help researchers
better understand "the natural protections that the penis, the vagina and
the rectum have that we want to make sure we preserve," he said. The study
"is highlighting what we need to look at going forward," he added.
Still, the study, which
Anton said was "really well done," has some limitations. It only
looked at heterosexual couples and not at people at higher risk of becoming
infected with HIV, such as sex-trade workers and gay men.
And the study doesn't
examine how often HIV-positive people with no detectable virus in their blood
transmit the disease to their partners. Anti-HIV drugs can often reduce the
level of HIV in blood to zero, while the virus hides in other parts of the body.
Worldwide, more than 7,000
new HIV infections are diagnosed daily, according to background information in
Anton's commentary. In the big picture, these new findings can only do so much
to curb the rate of HIV infection, he said.
Noting that many
HIV-positive people are unaware they have the disease, Anton said, "The
biggest issue in transmission is that many people don't know their status."
LONDON (Reuters) - Some of
the world's most powerful medicines are losing the war against drug-resistant
strains of HIV, gonorrhea, tuberculosis and other microbes, global health
experts said on Thursday.
"People assume that
antibiotics will always be there to fight the worst infections, but
antimicrobial resistance is robbing us of that certainty and new drug-resistant
pathogens are emerging," Dr. Thomas Frieden, director of the Centers for
Disease Control and Prevention, said on Thursday.
"It's not enough to
hope that we'll have effective drugs to combat these infections. We must all act
now to safeguard this important resource," Frieden said in a statement
released to coincide with World Health Day.
Here are some facts from
the CDC about antimicrobial resistance and what people can do to prevent it.
* Scope of the problem:
Antimicrobial resistance occurs when germs change in a way that reduces or
eliminates the effectiveness of drugs to treat them. This happens when
antibiotics, antivirals, antifungals and other medications are used too
liberally. About half of antimicrobial drugs -- antibiotics in particular -- are
used unnecessarily or inappropriately prescribed in
* Cost: The
* HIV: Studies suggest 4
to 20 percent of newly diagnosed HIV patients have transmitted a drug-resistant
infection. A 2007 study of HIV patients in the
* Malaria: Worldwide,
there were an estimated 225 million malaria infections and 780,000 deaths in
2009. Most deaths were of children in
* Gonorrhea: More than
700,000 people in the
* Tuberculosis: About 1.3
percent of all U.S. TB cases reported in 2009 were multiple drug-resistant, or
MDR, TB, and there has been one reported case of extensively drug-resistant (XDR)
TB. With MDR or XDR-TB, the standard cocktail of antibiotics does not work and
stronger medicines must be used, often for a longer time. Surgery may also be
required to remove pockets of infection. To prevent the spread of drug-resistant
TB, patients need to take all of their medications exactly as prescribed.
Source:
(Reporting by Julie
Steenhuysen in
Roger Pebody
Published: 08 April 2011
A twelve-year analysis of
deaths in people with HIV in the
Researchers have analysed
deaths recorded in the
Since the introduction of
combination therapy, there has been a dramatic decline in deaths of people with
HIV. The crude mortality rate for people aged 15 to 59 fell from 21.8 per 1000
in 1997 to 8.2 per 1000 in 2008. Nonetheless over 500 people with HIV die each
year, and rates are around five times higher than in the general population.
Over the twelve-year
period, 49% of deaths were due to AIDS. This proportion has fluctuated over the
years, but is not in steady decline.
The researchers then
conducted a case-control analysis. Each case of a person dying of AIDS was
matched with four controls who continued with live with HIV and who were matched
for their date of diagnosis and age at diagnosis.
In multivariate analysis,
after controlling for confounding factors, individuals diagnosed with a CD4 cell
count below 350 cells/mm3 were six times more likely than others to die of AIDS
(odds ratio 6.1, 95% confidence interval 4.9-7.5).
The researchers estimate
that 74% of all AIDS deaths were attributable to late diagnosis. Even among
individuals infected in the
In demographic terms and
still in multivariate analysis, men were more likely than women to die of AIDS
(odds ratio 1.3). However men who have sex with men were less likely to die than
men and women infected through heterosexual contact, whether they were probably
infected in Africa (odds ratio 1.4), the
Injecting drug users had a
much higher risk of death – using men who have sex with men as the comparison
group, the odds ratio was 3.0.
The most common causes of
AIDS deaths were PCP, other AIDS-related pneumonias, non-Hodgkin's lymphoma, TB
and neuro-cerebral causes.
The researchers say their findings point to the importance of earlier diagnosis and treatment in order to prevent deaths of people with HIV.
Experts believe they are
suffering from a psychological phobia of AIDS, but they say they are patients of
"HIV-negative AIDS".
Among them is 30-year-old
Xiang Jun, who prefers not to use his real name, from
Since kissing a woman at a
karaoke house in August 2010, he has noticed some changes in his body.
"My lymph nodes and
muscles swell. At night, I sweat feverishly. I feel dizzy sometimes and can
sleep for a whole day. When feeling ill, I want to kill myself," he says.
He has visited hospitals
for two HIV tests, and both have come back negative for infection.
Still, Xiang has noticed
that, after coming into contact with him, some of his relatives and colleagues
have developed symptoms similar to his.
He suspects that his
disease could be a new, more contagious form of AIDS.
On the Internet, many
people have complained of experiencing symptoms similar to that of Xiang Jun.
Some have also complained of other maladies, including joint aches, canker
sores, and diarrhea, which resemble symptoms of HIV infection.
Some of them have managed
to contact Zeng Guang, chief scientist of epidemiology with the
From 2009 to 2010, the CDC
tested 59 volunteers from the group of "HIV-negative AIDS" patients,
and found no evidence that any had been infected with HIV, says Deng Haihua,
spokesman for the Ministry of Health.
The results did not
suggest that they were infected by any new or unknown viruses, either, Deng
says.
Still, some patients doubt
these conclusions.
Xiang Jun has a friend Lin
Fei, also using a fake name, who suspects that his entire family has exhibited
these symptoms.
"My mother, my wife
and my daughter all have fatigue and night sweats. Is it simply because of a
'psychological phobia?'" asks the 49-year-old man.
"My daughter is only
six and my son is eight. If our symptoms are due to a psychological phobia, they
are too young to know what AIDS really is," according to "Mr.
Fear" from Shenzhen, a city in
EXPERTS ASSEMBLE FOR
EPIDEMIOLOGICAL PROBE
A taskforce has been
formed to conduct an epidemiological probe in February and March of this year
among the target "patients" in
Cai Weiping, a staff
member of the No. Eight People's Hospital in
"The symptoms were
described according to their subjective experiences without clinical
representation. Sometimes they complained of swollen lymph nodes and fevers but
doctors could not verify these symptoms," he said.
Cai says three of the men
who suspect themselves of being infected with HIV have taken their wives to the
hospital, too, but doctors can not locate the symptoms as described by their
spouses.
He remembers the extreme
case of a man from
"He took the medicine
for some time and felt that his symptoms disappeared, but all his clinical
indices remained almost unchanged. After being questioned by the doctor, he
admitted that the HIV positive report was a fake," Cai says.
HIV can be transmitted
through three channels: sex, blood and from mother-to-child during birth.
UNAIDS estimated that
740,000 Chinese of the total population of 1.3 billion were living with HIV by
the end of 2009. Among them, 105,000 were estimated to be AIDS cases.
By the end of August 2010,
the cumulative total of reported HIV-positive cases was 361,599, including
127,203 AIDS cases and 65,104 recorded deaths from the disease.
MEDIA REPORTS SPREAD FEAR,
NOT CURE
There is no official
figure showing the numbers of the phobia groups, but experts fear the population
is growing, especially since unprotected sex has become the main transmission
channel of HIV in
"The media hype to
some extent led some people to panic and to later develop a psychological phobia
to the disease," says Zhang Beichuan, a well-known Chinese AIDS expert.
While the aim of these
media reports is to investigate the spread of HIV/AIDS, the disease is described
as being so horrible that the reports negatively influence the public, he says.
Cai Weiping notes that the
use of Internet increases the amount of those in the "HIV-negative
AIDS" group.
"They chat online and
enhance each other's psychological suggestions," he says. "It is their
anxiety, rather than the disease, that has been contagious."
His view is shared by
Zhang Beichuan, who suggests that treatment for the psychological problem could
be improved.
Lin Peng, head of the
Institute for AIDS Prevention and Treatment under the
Blood samples were sent to
some U.S.-based laboratories in January this year, and as of the end of March,
there had been no reports of an unknown virus found in one-third of the tested
samples.
"With the development
of medical science, it is hard to say whether a new virus would be found or
not," Lin said.
"But one thing is for
sure: currently, no new infectious disease has been discovered."
He called on the public to
be sensible.
"People should also
keep themselves clean, always stay away from commercial sex and drugs," he
said.
By Michael Smith, North American Correspondent, MedPage Today Published: April 09, 2011
Reviewed by Robert
Jasmer, MD; Associate Clinical Professor of Medicine,
But the
association is not seen for HIV-infected people whose immune system remained
relatively intact, according to Daniel Klein, MD, of Kaiser Permanente Northern
California in
The finding -
from a large retrospective case-control study - suggests that anti-retroviral
therapy should be started earlier and that other risk factors should be managed
aggressively, Klein and colleagues reported in a poster presentation at the
American Conference on Treatment for HIV.
Using patient
records from 1996 through 2008, the researchers identified 20,775 people with
HIV, and then matched them for age, sex, year, and medical center with 215,153
people not infected with the virus.
The outcomes
were coronary heart disease or myocardial infarction and patients were followed
until the end of 2008 or until they had an event, left the health plan, or died.
All told,
Klein and colleagues reported, there were 339 cases of coronary heart disease
among the HIV cohort, including 248 heart attacks.
Those numbers
yielded rates per 100,000 person-years of 447 and 275, respectively.
By
comparison, among the non-HIV patients, there were 3,463, events, including
1,825 myocardial infarctions (MIs), they reported, yielding rates per 100,000
person-years of 311 and 162, respectively.
Rate ratios
showed a significantly greater risk for those in the HIV cohort, in a Poisson
regression analysis that adjusted for age, sex, race, smoking, alcohol or drug
abuse, obesity, diabetes, and the use of either lipid-lowering or
antihypertensive therapy.
Specifically,
the rate ratio:
For coronary
heart disease overall was 1.2, with a 95% confidence interval from 1.1 to 1.4,
which was significant at P<0.001.
For MI was
1.4, with a 95% confidence interval from 1.3 to 1.7, which was also significant
at P<0.001.
The
researchers also conducted an analysis within the HIV cohort to look at the
effects of anti-retroviral therapy, recent viral load, and recent and lowest
recorded count of CD4-positive T cells.
They found
that only a nadir CD4 count of 200 cells or fewer was significantly associated
with an increased risk of coronary heart disease.
The analysis
of the HIV cohort also found that the usual suspects -- smoking, increasing age,
diabetes, and hypertension -- were associated with an increased risk, they
reported.
It has been
clear for some time that people with HIV are at higher risk of cardiovascular
disease, according to John Brooks, MD, of the CDC, one of the conference
co-chairs.
But the role
of the virus itself has not been clear, he told MedPage Today, since many
patients have other risk factors -- such as smoking or diabetes -- and
anti-retroviral medications themselves have been implicated.
"The
issue has been what about HIV itself," he said.
The findings
have clear clinical implications, he said. "This gives you something to do
-- don't let that CD4 count go too low."
The study was supported by Pfizer. Klein is an employee of Kaiser Permanente
Klein D, et al. "Contribution of Immunodeficiency to Coronary Heart
Disease: Cohort Study of HIV-infected and HIV-uninfected Kaiser Permanente
Members." ACTHIV 2011; Abstract TCD14
April 5, 2011
By Alex Heigl
Once-daily Nevirapine has won FDA approval, Boehringer Ingelheim
Pharmaceuticals, Inc announced yesterday.
Marketed under the name
Viramune XR, the pill is a one-unit (400 mg), once-daily extended release
formulation of nevirapine for use in combination with other antiretroviral
agents for the treatment of HIV-1 infection in adults.
The pill achieved
non-inferior results when compared to twice-daily Viramune tablets over 48 weeks
in treatment-naive HIV-1 infected adults patients. The safety and
tolerability profile of the drug was the same as well.
"For patients
switching from Viramune, the new formulation of nevirapine provides a dosing
option that may decrease pill burden and dosing frequency," said Peter
Piliero, M.D., executive director, Medical Affairs, Boehringer Ingelheim
Pharmaceuticals, Inc.
Boehringer Ingelheim is
committed to making its HIV medications more available to patients in financial
need and to this end has expanded its Virology Patient Assistance program to
allow more patients to qualify to receive its medicines for free.
Another program the
company offers is the Viramune XR Co-Pay Savings Card, which will pay for the
first initial co-pay of Viramune XR therapy and up to $100 off each monthly
Viramune XR prescription.