News (Updated August 1,
2005)
[Home]
[Previous
news]
Fri Jul 29, 2005 05:37 PM ET
NEW YORK (Reuters Health) - The results of a new report confirm that
circumcision reduces the risk of urinary tract infection -- but the authors
estimate that more than 100 boys need to be circumcised to prevent one
infection.
The authors recommend circumcision only for boys at high risk of urinary tract infection, but this view is not universally held, commentators suggest.
A reduced rate of urinary tract infection is the most frequently cited benefit of circumcision, Dr. Jonathan Craig and his team at the Children's Hospital at Westmead in Sydney, Australia, note in their report, published in the Archives of Disease in Childhood.
To further investigate, they searched databases to identify studies published between 1987 and 2001 that reported on circumcision and urinary tract outcomes. Their review included 12 articles documenting outcomes for approximately 403,000 children and 1953 episodes of urinary tract infection. Maximum follow-up was 3 years.
Circumcision was associated with a significantly reduced risk of urinary tract infection, a "substantial reduction," the authors note. They calculate that "the number-needed-to-treat to prevent one urinary tract infection is 111" in normal boys. Also, they add, circumcision is associated with a 2 percent to 10 percent complication rate.
Craig and colleagues estimate that the risk of urinary tract infection is 1 percent in normal boys, 10 percent in boys with a history of urinary tract infection, and 30 percent in boys with high-grade reflux of the bladder and ureter.
They recommend that circumcision be considered for boys with a history of urinary tract infection or high-grade bladder and ureter reflux, because the "benefit outweighs the risk of complications in these cases."
Reflecting a "North American view," Dr. Edgar J. Schoen, from Kaiser Permanente Medical Center in Oakland, California, suggests in a related commentary that the researchers' interpretation of their findings is flawed.
For example, he notes, circumcision is ideally performed in newborns, where the complication rate is approximately 0.2 percent to 0.6 percent. He also advocates its use because of other health benefits, such as prevention of penile cancer, some sexually transmitted diseases and HIV.
But in a second commentary giving a "European view," Dr. Padraig S. J. Malone, from Southampton University Hospitals NHS Trust in the UK, remarks that "it is doubtful that a cost-benefit analysis could ever justify routine circumcision" to prevent urinary tract infections. He does, however, recommend further studies to examine the benefit of routine circumcision in preventing kidney scarring.
SOURCE: Archives of Disease in Childhood, August 2005.
Fri Jul 29, 2005 12:33 PM ET
LONDON (Reuters) - Cocktails of anti-AIDS drugs cut the rate of progression from
infection with HIV to full-blown AIDS by 86 percent compared to patients not
receiving any treatment, British researchers said on Friday.
They found that the effectiveness of highly active antiretroviral therapy (HAART), a combination of at least three treatments from two drug classes, increased with time.
Until now the benefits over several years were not known because trials of the drugs, which must be taken for life, were limited to a follow-up of a year or less.
"Our results indicate that HAART reduced the rate of progression to AIDS by 86 percent and that its effectiveness compared with no treatment increased with time since initiation," said Dr Jonathan Sterne, of the University of Bristol, in southwestern England, who headed the research team.
But HAART was less beneficial for patients who were thought to have been infected through intravenous drug use.
The anti-AIDS drug cocktails have transformed the illness in Western countries from a death sentence to a chronic disease, but doctors have been concerned about long-term impact.
The treatments consist of drugs that interrupt the life cycle of the human immunodeficiency virus (HIV) in different ways, allowing the creation of cocktails which fight the rapidly mutating virus on several fronts at once.
HIV destroys the immune system and leaves the body vulnerable to a variety of life-threatening diseases, so-called opportunistic infections, such as tuberculosis.
The scientists studied more than 3,200 patients involved in a Swiss study after January 1996 when HAART first became available in Switzerland.
They compared the impact on patients of HAART, with dual therapy and no drug treatment. The results are reported in the Lancet medical journal.
"The very large benefits of HAART that are achievable in developed countries should remind us of the urgency of providing treatment for millions of people who could benefit in other parts of the world, particularly sub-Saharan Africa," said Sterne.
About 39 million people worldwide are living with HIV/AIDS. Sub-Saharan Africa is the worst affected region.
About 1 million of the 6 million people in poor countries who need the life-saving drugs are receiving them, according to the World Health Organization.
It had hoped to have 3 million people on treatment by the end of 2005 but admitted in June it would not meet the target.
Mon Jul 25, 2005 09:18 PM ET
By Karla Harby
RIO DE JANEIRO (Reuters Health) - Suggestions that a new, highly multidrug resistant and rapidly progressing strain of HIV has evolved in New York City and could become widespread have been refuted by the discovery of the probable patient source of the virus, according to a presentation here on Monday at the 3rd International AIDS Society (IAS) Conference on HIV Pathogenesis and Treatment.
The rapid progression to AIDS observed in a patient discovered earlier this year led the New York City Department of Health to issue a press release on February 11, 2005, warning of a possible new, highly virulent and multidrug resistant HIV strain. This was followed by reports in The Lancet and elsewhere.
The apparent source patient, "Patient Zero," is a resident of Connecticut and his clinical course is typical of AIDS patients with his disease, behavior and medical compliance, said Dr. Gary Blick, medical and research director of Circle Medical LLC, Norwalk, Connecticut.
The patient's viral replication capacity is 41 percent, and since he has become fully adherent to highly active antiretroviral treatment (HAART), his CD4 levels and viral copy number, measures of disease progression, have remained stable
"He is not a rapidly progressive patient," Blick said. His life partner's disease course is similarly unremarkable.
By contrast, the New York City patient, whose disease so alarmed clinicians, has shown a viral replication capacity as high as 136 percent, Blick said. The patient was infected with the virus about four months before he progressed to AIDS. That patient has a history of extensive unprotected sex and multiple partners, often while using crystal methamphetamine.
The Patient Zero identified in Connecticut carries a virus that is a 99.5 percent genetic match to that of the New York patient, Blick said. His life partner, who is also HIV positive, has a genetic match of 98.5 percent.
In addition to the genetic evidence of virus transmission, the patients involved were able to identify each other visually and confirmed anal-receptive or anal-insertive intercourse, Blick said.
Blick hypothesized that the rapid course and treatment resistance experienced by the New York patient can be attributed to unusual host factors, including an unusually active sexual lifestyle and heavy use of crystal methamphetamine.
It is also possible that this HIV strain is not as responsive to treatment or that these two factors are interacting to product this outcome, he said.
Blick added that the widespread practice of "poz-to-poz" unprotected sex, in which sexual partners who are both HIV positive fail to take precautions, may be riskier than previously assumed.
Mon Jul 25, 2005 11:22 AM ET
TOKYO/LONDON (Reuters) - GlaxoSmithKline Plc said on Monday it had begun final
Phase III trials in June of a new kind of pill that can block the AIDS virus
before it enters human cells.
The experimental medicine, known as a CCR5 inhibitor and called aplaviroc or GSK 873140, was licensed from Japan's Ono Pharmaceuticals, which received a milestone fee from Europe's biggest drugmaker following the start of the studies.
GSK's decision to launch Phase III tests, even though Phase II trials have not yet been completed, reflects the race among rival drugmakers to be first to market with the new kind of AIDS treatment.
If successful, CCR5 inhibitors should have fewer toxic side effects and offer hope to patients whose virus has developed resistance to existing antiretroviral medicines.
Industry analysts estimate that a successful CCR5 drug should generate sales of $500-700 million a year, with the first products likely to reach the market in 2007 or 2008.
Other companies working in the field include Pfizer Inc, which started Phase III testing several months ago, and Schering-Plough Corp.
News of the latest drug trials was disclosed by GSK on the sidelines of the International AIDS Society conference being held in Rio de Janeiro.
Joseph Eron, Professor of Medicine at the University of North Carolina, said the new drugs could provide an important treatment option for people with HIV/AIDS, by offering a different mode of action and an improved toxicity profile.
Most existing HIV drugs work inside the body's immune cells, after the virus has infected -- and they can cause anemia, nerve pain, diarrhea, fat wasting and even organ damage.
That has led researchers to study other approaches.
Switzerland's Roche Holding AG and U.S. biotech group Trimeris Inc launched the first drug, Fuzeon, to stop HIV from entering healthy immune cells in 2003.
But Fuzeon is expensive, must be injected twice daily and sales -- $135 million in 2004 -- have been disappointing.
The new drugs can be given as a tablet and work by locking a cellular doorway, or co-receptor, called CCR5.
The idea for the drug class came from the observation that people with mutated CCR5 can resist HIV infection, even after exposure to numerous high-risk sexual partners. Just under 2 percent of Caucasians carry the mutation.
Ono said it would book the milestone payment for the start of Phase III trials in the April-June quarter. The size of the payment was not discloSed.
By S.SRINIVASAN, Associated Press WriterFri Jul 29, 8:36 PM ET
India will introduce female condoms later this year to help fight the spread of AIDS among its billion-plus population, with cheap supplies available to commercial sex workers, the state-owned contraceptive maker said Friday.
"Female condoms will empower the woman to protect herself from infection," M. Ayyappan, managing director of Hindustan Latex Ltd. told The Associated Press.
A government study in 2004 showed that despite annual sales of 1.6 billion male condoms, cases of HIV in India had reached 5.1 million, second only to South Africa, and that a third of them were women.
According to the study, 15 percent of cases were sex workers and another 22 percent housewives with a single partner.
Ayyappan said some male clients resisted using condoms when they visited sex workers which was one reason why the government's strategy to promote male condoms as the primary protection against infection had achieved only limited success.
"Female condoms will transfer the power of decision-making to women," Ayyappan said.
He said the company's aim was to provide every sex worker with the right to use a condom every time with every client.
HLL will initially import condoms from the London factory of Chicago-based Female Health Co. and start selling them in September, Ayyappan said, without detailing how many would be imported. He said the company would start manufacturing their own condoms at a later date.
A female condom is a lubricated shield that is slipped, closed-end first, into the vagina. The open end remains outside, partially covering the labia.
While a yearlong study funded by the two companies showed that 94 percent of sex workers polled liked and wanted to use the female condom, Ayyappan said one of the difficulties in promoting it would be price.
It will cost the company about $1 to import one condom, while marketing and distribution will add another $1.3, he said.
India's Ministry of Health and Family Welfare has agreed to support the new product as part of the National AIDS Control Program and is considering a subsidy to bring down the price to 12 cents for commercial sex workers.
A typical sex worker gets anywhere between $1 and $23 per client although most women's earnings are nearer the lower end of the range.
Female condoms will also be available over the counter for $2.3 each.
Chandrasekhar Gowda, who heads a non governmental project teaching sex workers how to protect themselves from sexually transmitted infections, including HIV, said that sex workers needed more than just a condom.
"The female condom will give woman a choice. She will no longer be dependent on the man's decision," Gowda said.
"But it can be fully successful only if sex workers are able to negotiate the use of condom with their clients. We must work to increase the negotiating power of sex workers so that men come to accept female condoms. "
By MICHAEL ASTOR, Associated Press WriterMon Jul 25, 6:35 PM ET
Heroin flowing out of Afghanistan is creating a new AIDS epidemic among drug addicts in Eurasia, where the disease once had been rare, scientists said Monday.
Dr. Christopher Beyrer said a rising number of HIV infections had been detected in Belarus, Iran, Moldavia, Tajikistan, the Ukraine and other countries along the route traffickers use to smuggle Afghan heroin into Eastern Europe.
HIV, the virus which causes AIDS, is often spread among intravenous drug users who share needles.
Beyrer said the situation was especially dangerous because only about 10 percent of drug users have access to needle exchange and drug substitution programs in those countries, where cheap heroin has become readily available since the Taliban regime in Afghanistan was toppled.
Beyrer, an associate professor of epidemiology and international health at the Johns Hopkins Bloomberg School of Public Health, spoke Monday at the Third International AIDS Society Conference on Pathogenesis and Treatment.
The four-day conference, which ends Wednesday, has assembled some 5,000 scientists, health care providers and public policy specialists to discuss the latest advances in the fight against AIDS.
"Today's presentations give us a window into an evolving epidemic that is growing steadily more severe," said Dr. Celso Ramos, a former president of the Brazilian Infectology Society. "The global response must be as dynamic as the epidemic itself."
The fight against AIDS was given a new impetus earlier this month after world leaders at the G8 meeting in Scotland endorsed the goal of universal access to antiretroviral treatment by 2010.
Antiretroviral drugs are the only available treatment for the disease. The drugs are effective but expensive, and many patients have side effects and develop resistance to them over time.
The Sapphire, the latest in the Cell-Dyn line, primarily aims to complete blood counts, and can also conduct additional tests using monoclonal antibodies. Blood counts are tests ordered by doctors to screen for such disorders as anemia or infection.
The machine uses a blue diode laser to provide analysis of red blood cells, white blood cells and platelets. Also, the company said the machine can run tests -- such as T-cell identification for HIV patients -- that are usually sent out to a specialized lab.
Mon Jul 18,10:27 PM ET
Emory University has sold its royalty rights to an HIV drug for $525 million, which school officials said Monday they believe is the largest amount ever for such a sale.
Gilead Sciences Inc. and Royalty Pharma will purchase the royalty interest owed Emory for emtricitabine, also known as Emtriva.
Under the terms of the agreement, Gilead and Royalty Pharma will make a one-time cash payment of $525 million to Emory in exchange for elimination of the emtricitabine royalties due to Emory on worldwide net sales of the drug.
Gilead will pay 65 percent of the amount, with New York-based Royalty Pharma covering the rest, and will then receive royalty payments from Gilead. Emory also retains the right to buy a share of Royalty Pharma's stake in the payments.
Emtricitabine, which is used to inhibit the replication of the virus that causes AIDS, was discovered by three Emory researchers and licensed to Triangle Pharmaceuticals by Emory University in 1996. Gilead acquired Triangle in 2003.
Emtricitabine, marketed by Foster City, Calif.-based Gilead as Emtriva, was approved by the U.S. Food and Drug Administration in July 2003 for the treatment of HIV infection in combination with other antiretroviral agents.
Emtricitabine is also a component of the triple fixed-dose combination product under development by the Bristol-Myers Squibb Co. and Gilead Sciences joint venture. In connection with amending and restating the license agreement, Gilead will make a one-time payment of $15 million to Emory on closing of the transaction.
The deal is expected to close by July 29.