New York's AIDS 'superstrain' could be two mediocre strains

Paroma Basu

Madison

Tests will determine whether the much-hyped case was caused by a dual infection.

Months after New York City public health officials announced the discovery of a so-called 'AIDS superbug,' scientists are exploring whether the unusual case is the result of a dual infection, in which a person contracts viral strains from two different people.

Detected in a homosexual man who used methamphetamine, the superbug rapidly progressed to full-blown AIDS and showed resistance to three antiretroviral drugs, features the officials said signaled an "extremely rare" and potentially treacherous strain. Scientists and activists have since criticized the announcement, saying it caused undue alarm before the case was fully understood.

Researchers at New York's Aaron Diamond AIDS Research Center (ADARC) in March reported that the individual had multiple sexual partners in a short period, combined with a dramatic spike in viral load in just two months (Lancet  365, 1031−1038; 2005).

But those factors could be the result of a dual infection, says Geoffrey Gottlieb, an infectious disease expert at the University of Washington in Seattle. In a letter to The Lancet in June, Gottlieb suggested that the case warranted further investigation to rule out the possibility of dual infection (Lancet  365, 1923−1924; 2005). Two other letters in that issue also raised questions about the case.

We cannot rule out the possibility of dual infection.  Marty Markowitz ADARC

Girls abused by dates at higher STD risk

Mon Aug 1, 2005 06:32 PM ET

By Charnicia E. Huggins

NEW YORK (Reuters Health) - Adolescent girls who have been shoved, hit, forced into any sexual activity or otherwise physically or sexually abused by a date are more likely than their non-abused peers to have been tested for a sexually transmitted disease and to report being diagnosed with an STD.

"We are seeing a staggering proportion of teenage girls experiencing physical and sexual violence from dating partners," study author Michele R. Decker, of the Harvard School of Public Health in Massachusetts told Reuters Health.

"Violence against women has been linked with numerous negative health outcomes and I think through this study we are seeing further evidence of the tremendous health consequences of this violence," she added.

Decker and her co-authors analyzed data from 1,621 sexually active girls in grades 9 through 12, who had been involved in the 1999 and 2001 Massachusetts Youth Risk Behavior Surveys.

They found that almost one out of every three girls surveyed said they had ever been sexually and/or physically abused by a date. About a third of girls said they had ever been tested for herpes, genital warts or some other sexually transmitted disease, including HIV. Five percent of girls said they had been diagnosed with a STD.

Altogether, nearly 40 percent of girls who reported having been tested for a STD said they had experienced dating violence, as did more than 50 percent of those diagnosed with a STD or HIV, the researchers report in the medical journal Pediatrics.

Girls who reported experiencing both physical and sexual violence were 2.4 times more likely to say they had been tested for an STD and three times more likely to report having been tested for both an STD and HIV than were their non-victimized peers. These girls were also 2.6 times more likely than their nonabused peers to say they had been diagnosed with a STD, the report indicates.

Overall, "among dating violence victims we see that 1 in 12 girls report a sexually transmitted disease, compared with 1 in 30 for non-victimized girls," Decker said.

When asked why dating violence might be associated with STD testing and diagnosis, Decker responded that it is likely due to a combination of factors.

"Often in a violent relationship the abuse will carry over to sexual experiences," she explained, citing her work with adolescent girls. "That is to say that these girls are often in coercive or forced sexual situations with their dating partners and are unable to request condoms or ensure that condoms are used."

And, Decker added, "men who are abusive to their dating partners often are very risky sexual partners as well, meaning that they are often having multiple sexual partners outside of the relationship and are not necessarily using STD protection," like condoms.

To address dating violence, victims' services in the community are "crucial," according to Decker, and sexual health education should be broadened "to consider the role of sexual coercion and violence."

But "the real work remains to be done with young men to prevent dating violence from ever occurring," Decker told Reuters Health. "To truly prevent dating violence and its damaging health impacts, we must promote healthy and respectful relationships among teens and hold abusers accountable for their actions."

SOURCE: Pediatrics, August 2005.

New TB vaccine design called for in poor nations

LONDON (Reuters) - Tuberculosis vaccines being tested in developed countries will not protect people living in parts of the developing world where they are most needed because they trigger a different body response, researchers said on Monday.

Scientists at University College London (UCL), who looked at variations in immune system responses around the globe, found that in countries near the equator the tuberculosis bacteria turn the body's normal protective response into a harmful one.

So like the BCG, or bacille Calmette-Guerin vaccine, used against TB in some countries, the latest vaccines which use the same approach will not work in developing countries, according to the researchers.

"What we have done is identify the mechanisms that we think lead to the fact that BCG vaccine does not work close to the equator, where the problem really is," Professor Graham Rook, an immunologist at UCL, said in an interview.

"We realized that the vaccine candidates going into clinical trials at the cost of hundreds of millions of dollars haven't in any way answered that particular problem," he added.

In countries in the northern hemisphere, the immune system protects the body against TB with TH1 cells. BCG and new candidate TB vaccines are designed to boost the TH1 cells.

But in people living near the equator, the TH1 cells are already on alert, so the protective mechanism is switched on but does not work because another inappropriate response is also turned on which undermines it.

"What is needed, in our opinion, is not a vaccine that turns on the protective mechanism because that is already there but rather a vaccine that turns off the subversive mechanism that shouldn't be there," said Rook, who reported the findings in the journal Nature Reviews Immunology.

TB is a contagious airborne disease that affects about 9 million people each year and kills 2 million. The World Health Organization has warned that TB has reached alarming proportions in Africa where co-infection with HIV makes a lethal combination.

"We are not saying that funding for TB vaccination in developing countries should be stopped -- quite the contrary, given that TB kills between 2 and 3 million people every year. But we are concerned that the BCG vaccine is failing these countries and that TB vaccines currently on trial are likely to go the same way," Rook added.

The researchers believe a new vaccine approach -- turning off the damaging immune response -- could be used to develop vaccines to combat other infections including HIV.

Circumcision Not a Cure-all for AIDS

(2005-08-07)

Circumcision may result in false belief that safe-sex practices are no longer necessary. The result could be a worsening of the incidence of HIV infection, especially for women.

A paper, read at a conference in Brazil, claims that male circumcision has the potential to reduce female-to-male transmission of human immunodeficiency virus (HIV). The "Wall Street Journal" reported that the "Lancet," the pre-eminent medical journal in the world, refused to publish the paper for unknown reasons.

The researchers said circumcision might help in reducing HIV transmission women-to-men. What they don't say is that male circumcision doesn't protect women from HIV. An infected circumcised man having sex with a woman is just as likely to spread the disease as an intact man. The same goes for any male partner with whom he has sex. The problem is that men and women may erroneously believe that circumcision is like a condom, which then leads to unprotected sex and transmission of the virus.

Robert Bailey, the scientist who sponsored the study, has been promoting circumcision to prevent HIV transmission since 1989. The world medical community thus far has not accepted his published studies. The present study, which was conducted in South Africa, is his latest effort. In such cases, one must be aware of possible researcher bias.

UNAIDS has cautioned against circumcision.

If circumcision were promoted as a way of preventing HIV infection, people might abandon other safe sex practices, such as condom use. This risk is far from negligible - already, rumors abound in some communities that circumcision acts as a "natural condom. A sex worker interviewed in the city of Kisumu in Kenya summed up this misconception, saying, "I can sleep with circumcised men without a condom because they don't carry a lot of dirt on their penis." While circumcision may reduce the likelihood of HIV infection, it does not eliminate it. In one study in South Africa, for example, two out of five circumcised men were infected with HIV, compared with three out of five uncircumcised men. Relying on circumcision for protection is, in these circumstances, like playing Russian roulette with two bullets in a (five-shot) revolver rather than three.

The World Health Organization (WHO) said they were concerned that demand for circumcision, as a result of misinterpreting this study, may encourage healers and witch-doctors, which could boost the risk of HIV infection rather than prevent it due to using contaminated instruments. They also fear a false security from having been circumcised, and reduced sensitivity in the penis may cause an increase in risky, sexual behavior and a decline in condom use leading to increased transmission of the virus.

Circumcision itself is believed to be a vector for transmission of HIV in Africa due to the unsanitary condition of African hospitals, clinics, and traditional circumcisors.

Many South African tribes, such as the Xhosa, practice male circumcision as a cultural ritual, yet South Africa has an extremely high incidence of HIV-positive males. Male circumcision apparently has not worked in South Africa. Recently, authorities in Eastern Cape Province arrested a ritual circumciser who was circumcising numerous youths with the same non-sterile knife.

Circumcision is a radical operation that amputates significant erogenous tissue from the penis. Many people call forced or coerced circumcisions an assault and male genital mutilation.

Men must be warned of loss of sensation - resulting in decreased erectile power, difficulty in ejaculating, and decreased sexual satisfaction, before consent for the surgical amputation is obtained.

Two similar studies have not yet been published. Bailey's present study has not yet been peer-reviewed. The three studies must be carefully reviewed before a determination of the value of circumcision in preventing female-to-male HIV transmission, and even then, legal and ethical issues about self-determination must be addressed before advocating the procedure.

Even if the studies prove true and accurate, Africa cannot afford to circumcise all its males. A safe circumcision costs $15, compared to the already-proven methods for stopping the spread of HIV/AIDS, education and condom use, which cost $1.

Circumcision has many risks, including infection, penile loss, hemorrhage, hypovolemic shock, and death. The claimed benefit must be balanced against these very real risks.

George Hill
Doctors Opposing Circumcision
iconbuster@earthlink.net
225-383-8067
http://www.doctorsopposingcircumcision.org

Circumcision Protects Men Against HIV Infection

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