News (Updated July 8, 2007)
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Sat Jul 7, 2007 1:48 AM BST
NEW YORK (Reuters Health) - Independent of cigarette smoking, infection with
HIV, the virus that causes AIDS, is associated with an elevated risk for
developing lung cancer, a study shows.
Dr. Gregory D. Kirk from the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland and colleagues evaluated lung cancer deaths among participants in injection drug users followed since 1998 as part of an AIDS study.
There were 27 lung cancer deaths among the 2,086 participants; 14 of the deaths occurred in HIV-infected subjects.
After adjusting for potentially confounding factors like age, sex and smoking status, HIV infection was associated with a 3.6-fold increased risk for lung cancer death compared to HIV-negative status.
"As HIV-infected persons survive longer, we are continuing to see that non-AIDS outcomes are becoming the primary causes of morbidity and mortality," Kirk told Reuters Health. "Our study suggests that the risks for these non-AIDS outcomes may be modulated by HIV infection."
"We hope to combine our data with other HIV and at-risk cohort studies to confirm the association between HIV and lung cancer," Kirk said.
"Also, we are evaluating a series of smoking/tobacco related biomarkers in HIV infected and uninfected persons with similar smoking patterns to compare if the biological effect of smoking differs by HIV status, and if so, is this related to degree of immune suppression or to antiretroviral treatment," he added.
SOURCE: Clinical Infectious Diseases, July 1, 2007.
Fri Jul 6, 2:44 AM ET
AIDS sufferers and transplant patients are at a much higher risk than the general population of developing a range of cancers, Australian research released Friday has found.
A new study, published in The Lancet medical journal, suggests a link between a depleted immune system and 20 different types of cancer and could be a breakthrough in the understanding of the causes of the malignancies.
Lead researcher at Sydney's University of New South Wales, Professor Andrew Grulich said the research looked at two groups -- those infected with HIV/AIDS and kidney transplant patients.
"Immune suppression is really the only thing they share," he told AFP.
"What we found is that the extent of cancer occurrences in these two populations was very similar. Both had increased rates in a wide variety of cancers."
The research analysed the results of 12 previous studies completed in Australia, the US, Europe and Canada and involving more than 444,000 people with HIV/AIDS and some 32,000 organ recipients.
It found that of the 28 cancers studied, both groups were at a significant risk of developing 20 of them including cancer of the liver, stomach, cervix, eye, lip, mouth and penis.
HIV/AIDS patients were found to be 11 times more likely to develop Hodgkin's lymphoma while those who had undergone a transplant were almost four times more likely to develop the disease.
Grulich said most of the 20 cancers were mostly linked to infection.
He said for those cancers not linked to viruses or bacteria, such as breast and prostate cancer, both groups had similar rates to the general population.
"Until now, the accepted wisdom was that there were only three cancers associated with HIV -- this paper finds that it is more like 20," he said.
Grulich, who works at the university's National Centre in HIV Epidemiology and Clinical Research, said the findings could overturn the previously held view that some of these cancers were linked to lifestyle risks such as smoking and sexual practices rather than infection.
"We believe that the finding points to an immune deficiency and not those other risk factors," he said.
The results could change way HIV/AIDS patients are treated, he added.
"This evidence suggests that immune deficiency is associated with risk of cancer and this suggests we need to maintain people's immune systems at a higher level -- and that might mean putting HIV patients on anti-retroviral drugs earlier than is currently the case," he said.
The research comes ahead of a major international conference on HIV/AIDS which will take place in Sydney on July 22-24.
Thu Jul 5, 7:06 PM ET
An experimental drug that researchers hope will cast a lifeline to HIV patients who have exhausted first-line treatment has shown early promise in long-awaited trials, The Lancet reports on Saturday.
Etravirine, also called TMC125, is designed as an alternative for patients who are resistant to a class of drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs).
An international consortium of doctors has been testing etravirine on NNRTI-resistant patients in two 48-week trials, the third and final phase of a long and complex process to assess new drugs for safety and effectiveness.
The volunteers in the DUET 1 and 2 trials are divided into two groups. Half receive etravrine and half a dummy, lookalike pill, a placebo.
In addition, all receive two standard anti-HIV drugs from a different treatment class, known as protease inhibitors, and also take selected NNRTIs.
The benchmark of success for helping patients with resistance problems is a "viral load" -- a count of the human immunodeficiency virus (HIV) which causes AIDS) -- to below 50 viruses per millilitre of blood.
At the 24-week point in the two trials, 56 and 62 percent of patients in the etravirine group had achieved this goal, The Lancet paper says. Among the "placebo" group, the rate was 39 and 44 percent.
Side effects were "mild or moderate" in severity, with generally little difference between the etravirine-takers and the placebo group.
Etravirine, made by a Belgian firm, Tibotec, has been closely followed by AIDS campaigners.
Antiretroviral drugs, as drugs to combat HIV are known, can save people with the AIDS virus, although they are not a cure.
But the longer a patient receives these drugs, the likelier it is that he or she will develop resistance problems as the virus mutates. In the case of NNRTIs, HIV can sidestep existing drugs with just a tiny mutation in a single amino acid.
The treatment options narrow further if a patient is found to suffer bad side effects from these powerful molecules.
The hope for etravirine is that it will open up a new front against resistant virus and raise the genetic barrier to developing resistance.
SHANGHAI: Chinese have sex for the first time at an average age of 22.1 years, according to the 2007 Face of Global Sex report published on Tuesday by the Durex Network.
The global average age is 17.
Professor Gao Ersheng from the Shanghai Family Planning Institute said the mean age was about the same as that at which people in China get married, although incidents of premarital sex were on the rise.
"In urban China, the age at which people have their first sex is probably lower than 22," he said.
The Durex report surveyed more than 26,000 people from 26 countries and found the global average age for first-time sex had risen from under 16 to over 17 since last year.
The report found that while most respondents from Asian countries such as China, Singapore and Malaysia said they had their first sexual experience later than their peers in the West, they also said they were better prepared psychologically.
The report also showed that 81.5 percent of those polled had used a form of birth control. China ranked in the top 3 in this regard.
Women were found to be more likely to take precautions, as too were people with a higher educational background.
People who feel able to communicate with their parents or other family members on sex and health issues were also more likely to use condoms, the survey said.
However, Gao said he believed no more than half of China's youth used condoms or other precautions during first-time sex.
"According to earlier national surveys, only a quarter of those having premarital sex for the first time used a condom," he told China Daily.
In recent years, there has been more attention paid to raising people's awareness of sexually transmitted diseases such as AIDS, Gao said. This has led to the more widespread use of condoms in urban China, but there has been no obvious rise in rural areas.
"Many youngsters believe their sex partners won't have an STD," Gao said, "and abortion seems easy - you hear commercials for 'painless abortions' quite often."
But among China's high-risk groups, such as sex workers, the use of condoms has increased greatly, Gao said.
In another survey on sexual well-being by the Durex Network this year, just 42 percent of Chinese people said they were completely satisfied with their sex life. The satisfaction rate is lower among women.
According to the report, Chinese have sex an average of 122 times a year - higher than the global average - but only 24 percent said they reached orgasm every time. The global average is 48 percent.
Bumpy road ahead for China's TCM modernization |
By Karen Tye and Karl Zhong
Shanghai. July 4. INTERFAX-CHINA - As drug discovery options run dry with fewer and fewer synthetic lead compounds and structure-based medicines being discovered, multinationals are increasingly turning to traditional Chinese medicines as a new source.
TCM modernization, the identification of an active ingredient in a herbal remedy that results in the mass production and marketing of a drug with a detailed pharmacokinetic profile, is the latest buzzword in the pharmaceutical industry, both home and abroad.
However, medical researchers have told Interfax that China's TCM modernization is still in its early stages, and that a lack of standards and technology are inhibiting the modernization of TCMs.
Bottlenecks in TCM development
"There is no standard to assess the quality and efficacy of TCMs," said Tang Senping, a senior researcher from the Shanghai Institute of Materia Medica. "So many researchers have to explore ways for the TCM sector to modernize."
A lack of a set of standards for the industry is just one of the obstacles standing in the way to developing China's TCM industry.
According to a TCM researcher, surnamed Bi, from the Institute of Materia Medica of the Chinese Academy of Medical Sciences, the more chemical analyses that are made on traditional Chinese medicine materials, the fewer the number of active ingredients are being discovered. "This in turn poses a technological challenge for TCM development," Bi said.
It is also common that different TCMs will be used to treat patients with the same disease, and that when a TCM is used in a clinical trial, it often produces different clinical effects depending on the patient, Bi said.
Capital is also a key issue in TCM development. Some Chinese drug makers have developed TCM drugs with as little as RMB 8 million ($1.05 million), compromising safety and efficacy.
Artemisinin - China's TCM success story
"China's TCM modernization is still in its early stages," Bi said. To date, only one Chinese-developed drug, artemisinin, has received international acclaim for its effectiveness in treating malaria symptoms.
Artemisinin, a substance extracted from the plant Artemisia annua L (sweet wormwood), has received approval from the World Health Organization for use in combination therapy to combat multi-drug-resistant Plasmodium falciparum, a widespread form of malaria that contributes to more than 500 million severe infections and more than 1 million deaths a year around the world.
Artemisinin has been used by Chinese people for centuries to treat fever but was further developed in 1972 by Chinese scientists as a remedy for malaria.
In response to increasing resistance to anti-malarials, the WHO recommends ACTs (artemisinin-based combination therapy) as the preferred alternative in areas experiencing resistance to conventional monotherapies.
There are now four ACTs available commercially. However only one, Coartem, a combination anti-malarial developed by Novartis AG, has received WHO pre-qualification, which means it meets standards that make it acceptable for procurement by United Nation agencies. The treatment, which was first registered in 1998, contains artemether, a derivative of artemisinin, as well as lumefantrine.
Currently Chinese pharmaceutical companies such as Kunming Pharmaceutical Group Ltd. supply Novartis with the raw materials for Coartem while Shanghai Fosun Pharmaceutical has teamed up with scientists from the Chinese Academy of Sciences to develop a new anticancer drug based on artemisinin.
TCMs to treat epidemics
AIDS, bird flu, SARS. You name the epidemic and more than likely, there is a TCM to treat it.
TCM experts convening at a seminar held by China's Ministry of Health, the WHO and China Association of Chinese Medicine, agreed to formulate China's own approach to the prevention and treatment of human avian influenza, by combining TCMs with modern medicine, according to Chinese media in January.
A similar treatment approach was developed in 2004 during the SARS epidemic. However, officially, the WHO does not recommend any herbal treatments for use in any disease.
In such cases, TCMs are being used as complementary medicines alongside western medicines to improve the immunity of patients.
"The big issues for herbal therapies in the eyes of Western patients and physicians are safety. Certification for purity and consistency of dosing is key. Another issue is drug-drug interaction [the effects of mixing one drug with another], a fact often overlooked when people buy medicines," chief medical officer of World Link in China, Dr. Larry Perin, said.
China has long advocated the use of TCMs to treat AIDS and the MoH has subsidized or offered free treatment to poverty-stricken AIDS patients as a substitute for more expensive western drugs. However, while TCMs may be cheaper and enable broader treatment access to AIDS patients across China, scientific evidence and efficacy still remains a large, unanswered issue. Furthermore, drug interactions further increase the uncertainty of treatment with TCMs.
TCM development by multinationals
Some multinational companies are cooperating with Chinese research institutions on the development of plant medicines.
"The Institute of Materia Medica of the Chinese Academy of Medical Sciences has already cooperated with several foreign companies on the development of TCMs over the past two or three years," Bi said.
Those co-operations include relationships with Taisho Pharmaceutical Co. Ltd., Bayer and Servia, which has lasted for more than 20 years. The institute received $8 million from Taisho to develop China's first anti-hepatitis drug, bicyclol.
In November, 2004, the Shanghai Institute of Materia Medica and Novartis Pharma AG extended their cooperation on the research of plant medicines.
On the same day, phase one studies at Hutchinson Whampoa Ltd.'s TCM modernization research and production base was completed with an investment of RMB 30 million ($3.94 million).
The Shanghai University of Traditional Chinese Medicines established its Ferid Murad TCM Modernization Center in 2003, to explore the relationships between nitric oxide and cardiovascular diseases, nervous system diseases, endocrine system diseases and inflammatory processes, and develop new strategies for the prevention and control of those diseases.
What will modernization do to China's TCM industry?
TCM treatment is applied when the body's forces, the yin and yang, are out of balance. There are other theories such as the five elements, Qi, Shen and the meridian system of the body, but the key concepts focus on the body attaining homeostasis and harmony through a holistic approach to maintaining good health.
Based on Taoist philosophy and more than 2000 years of experience, the main aspects of TCM treatment include acupuncture, moxibustion (application of heat on the body) and the use of Chinese herbal medicine.
Western medicine, on the other hand, is largely based on the symptom and cure method.
However, China's TCM market already encompasses a whole spectrum of commercialized over-the-counter symptom-based cures readily available from the country's 260,000 drugstores.
Many of these products are purchased without the advice of a TCM practitioner and more often, a pharmacist is not involved in the sale either. According to Zhang Shufang, the secretary-in-chief of the China Licensed Pharmacists Association, there are only 120,000 licensed pharmacists in China.
Already, this mass-marketing approach signals that perhaps, there could be loopholes in TCM theory.
Furthermore, China's turn to "modernization" will be sure to rile some fundamentalist TCM scholars. The essential aim of modernization is to detect, formulate and apply the active ingredient of a TCM herb using western scientific approaches, otherwise known as evidence-based medicine.
Such a process will probably be no more different to that used in discoveries such as digoxin, an extremely potent medication for heart arrhythmia, and the tumor-killing cancer drug, paclitaxel, which are both derived from plants.
It seems that TCMs are already being backed into a corner. The Medicines and Healthcare Products Regulatory Agency of the United Kingdom announced in January it would seek public consultation over the review of a provision in the Medicine Act 1968, which will require a professional standard for TCMs, accountability of herbal practitioners, and plant medicines to meet European Union good manufacturing production (GMP) standards.
At present, very few Chinese TCM manufacturers hold EU GMP certificates while EU countries are the top destination of China's TCM exports.
The TCM industry achieved sales of RMB 114.01 billion
($14.73 billion) last year, recording profits of RMB 10.42 billion ($1.35
billion). Profit growth for the year only reached 2.89 percent though, much
lower than that of 2005, which was 8.85 percent.
However, if China's maintains its push for TCMs as a complementary medicine, or
continues its TCM modernization endeavors, the further building of standards
such as GMP is necessary if Chinese manufacturers are to crack the international
market and expand overseas.
One thing seems clear, all roads are leading in the one direction - towards the need for tighter standards.