News (Updated December 3,
2006)
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By MARIA CHENG, AP Medical WriterTue Nov 28, 7:04 PM ET
Within the next 25 years, AIDS is set to join heart disease and stroke as the top three causes of death worldwide, according to a study published online Monday.
When global mortality projections were last calculated a decade ago, researchers had assumed the number of AIDS cases would be declining. Instead, it's on the rise.
Currently ranked fourth behind heart disease, stroke, and respiratory infections, AIDS is set to become No. 3, say researchers in a new report in the Public Library of Science's Medicine journal. It accounts for about 2.8 million deaths every year. But the researchers estimate a total of nearly 120 million people could die in the next 25 years.
Overall, the researchers predict that in three decades, the causes of global mortality will be strikingly similar worldwide — apart from the prevalence of AIDS in poorer countries. Most people will be dying at older ages of noninfectious diseases like cardiovascular disease, stroke and cancer.
The paper by Dr. Colin Mathers and Dejan Loncar of the World Health Organization estimates that at a total of least 117 million people will die from AIDS from 2006 to 2030. In an optimistic future projection, if new HIV infections are curbed and access to life-prolonging antiretrovirals is increased, 89 million people will die from the disease.
"What happens in the future depends very much on what the international community does now," Mathers said.
These marked differences should spark changes in current approaches to controlling AIDS now, say some experts.
"It will be increasingly hard to sustain treatment programs unless we can turn off the tap of new HIV infections," said Dr. Richard Hays, professor of epidemiology at London's School of Hygiene and Tropical Medicine, who was not linked to the study. "These AIDS numbers point to a need to do more in prevention."
Simply focusing on treatment or politically uncontroversial prevention methods will not suffice. "You can't put all your eggs in the abstinence basket," said Hays. "We need a menu of strategies for real people," he said, adding that condom distribution as well as new methods, such as a vaccine, are needed.
Mathers and Loncar analyzed data from more than 100 countries. The authors looked at the links between mortality trends and income per capita, as well as factors including education levels and tobacco use. Their research also used U.N. estimates for projected AIDS infection rates and the World Bank's numbers for future income per capita.
Mathers and Loncar then took all of this information and plugged it into a complex modeling equation to predict the top future causes of death and disease.
"This is an important contribution that will help us determine the priorities in public health," said Dr. Majid Ezzati, an associate professor of international health at Harvard University, who was not connected to the paper.
While it may be possible to avert some of the impending damage from HIV/AIDS, Mathers says that other predictions are unlikely to vary significantly.
As populations age, he explains, they are naturally more susceptible to illnesses like cancer and heart disease than from infectious diseases — even in the developing world. Life expectancy is expected to increase worldwide, with the highest projected life expectancy in 2030 to be in Japanese women, at 88.5 years.
Mathers and Loncar speculate that by 2030, cancer deaths will jump from 7.1 million in 2002 to 11.5 million. The number of deaths from cardiovascular disease is expected to rise from 16.7 million in 2002 to 23.3 million in 2030. Overall, they expect non-communicable diseases to account for 70 percent of all deaths globally, up from 59 percent in 2002.
Though economic development may bring better health care, it also has an unfortunate side effect: more road accidents. Based on rates of increasing car ownership, the World Bank estimates that traffic fatalities will increase globally by 66 percent by 2020. This might be avoided, Mathers says, if developing countries learn from the experience of developed countries, where laws and improved safety practices have sharply cut the numbers of road-related deaths.
Knowing the likely causes of future mortality allows policymakers to attempt to improve the expected outcome. While Mathers and Loncar are unable to account for unforeseen events such as the emergence of new deadly diseases or major outbreaks like a flu pandemic, their projections may help to set the agenda of global health.
"I hope this paper inspires change," said Mathers. "And I hope our pessimistic projections turn out to be wrong."
By MARIA CHENG, AP Medical WriterThu Nov 30, 7:32 PM ET
Circumcision, microbicides and microfinance. These are some of the most promising options being examined as potential ways to prevent AIDS. As World AIDS Day is marked Friday, some public health experts are saying the current focus on universal access to lifesaving antiretroviral drugs has had an unintended effect: sidelining prevention. Without a vaccine, preventing HIV infections is key to controlling the pandemic.
New strategies that attempt to change the very environment of AIDS transmission are now being considered. A study published online Thursday in the British medical journal The Lancet describes how a microfinance project in South Africa cut women's chances of domestic violence by more than half.
There is a strong link between HIV transmission and abusive relationships, with abusive men more likely to have multiple partners or to become violent if asked to use condoms.
"If you address the broader risk environment, women and communities can be quite creative in finding solutions," said Dr. Julia Kim, one of the Lancet study's authors.
In the study, 430 women in rural South Africa were loaned money to start small businesses. Most women sold fruit, vegetables, clothes or offered tailoring services. With economic and social independence, women were no longer obligated to remain in violent relationships.
Rates of HIV infection continue to grow, with 4 million new cases worldwide every year. The battle continues to be waged even in countries that were previously models of control. Due to erratic condom use and the virus' spread into new populations, like married women, HIV has made a worrying return to countries such as Thailand and Uganda.
"We need to run faster to get ahead of the virus," said Jennifer Kates, vice president and director of HIV policy at the Kaiser Family Foundation, an independent U.S.-based organization that works on AIDS issues worldwide. Because the AIDS outbreak is accelerating, so too must the public health response.
Dr. Purnima Mane, a senior UNAIDS official, estimates that public health officials need to plan for at least the next two decades before seeing a substantial decline.
There is no one-size-fits-all solution. Only in sub-Saharan Africa is AIDS really hitting the general population. In the rest of the world, intravenous drug users, prostitutes and gay men are at highest risk.
"You have to focus on where transmission is actually occurring," said Dr. Kevin De Cock, director of the HIV/AIDS department at the World Health Organization. Surprisingly little information is available on how most HIV infections are acquired. Without that, it is difficult to know which interventions would be most effective.
Even when countries do know where AIDS is spreading the fastest, there is no guarantee they will focus on the epicenter. In Latin America, the disease primarily infects gay men. And in much of Russia and eastern Europe, it is drug users. Yet in both regions, most resources go toward educating general populations.
"We would make quite a bit of headway if countries acted on the information they had," Mane said.
Governments must be held accountable for their choices, said Dr. Jim Yong Kim, an AIDS expert at Brigham and Women's Hospital and Harvard University. Kim advocates "prevention scores," which would rate governments on how appropriately their AIDS dollars were being spent.
Potential solutions include microbicides, pre-exposure use of antiretrovirals and circumcision.
Microbicides under study or development include a vaginal gel that could help women protect themselves against HIV in countries where men are notoriously reluctant to use condoms, and substances that enhance natural vaginal defense mechanisms by maintaining an acidic pH, killing pathogens by stripping them of their outer covering or preventing replication of the virus after it has entered the cell.
Preliminary trials in South Africa last year showed circumcised men were 60 percent less likely than uncircumcised men to become infected from female partners. New data from trials in Uganda and Kenya are due in mid-December from the National Institutes of Health in the United States, the trials' sponsor.
Still, experts say there is no silver bullet. Success ultimately hinges on implementation.
"It will be so disappointing if we have a new tool but we can't deliver it," said Kim, adding that bottlenecks in health care need to be addressed now if the outbreak is to be curbed.
While WHO's ambitious "3 by 5" strategy, an attempt to put 3 million people on antiretrovirals by 2005, failed to reach its target, the urgency inspired by the campaign did galvanize the global community. Much of that drive has dissipated since the campaign ended. A recent report from the International Treatment Preparedness Coalition says efforts are stagnating, meaning the world will miss the UNAIDS 2010 target of treating 9.8 million people by more than half.
Kim said public health experts have an unfortunate tendency to spend too much time in meetings before taking action.
"While officials work on a process of getting consensus and no one is held accountable," he said, "poor people die."
Thu Nov 30, 2006 11:21 AM ET
By Gene Emery
BOSTON (Reuters) - Doctors seeking to reduce the dangerous side effects of long-term HIV therapy have discovered that taking a breather is not better.
People infected with the HIV virus and who have treatment timeouts are more than twice as likely to die or suffer other serious consequences than those kept on a steady diet of drugs, a study published in this week's New England Journal of Medicine shows.
The study was supposed to follow patients for six years, but it was called off after about 16 months because the dangers of intermittent treatment are so high.
And while doctors expected the risk of heart, liver and kidney disease to decline with intermittent drug use, primarily because those were regarded as side effects of the newest HIV medicines, the likelihood of those problems actually increased.
"Treatment may increase the risk, but the absence of treatment appears to increase the risk even more," James Neaton of the University of Minnesota told Reuters.
Under the rules of the study, 2,720 volunteers from 33 countries were given holidays of various lengths from their drug therapy once their CD4+ counts, a measure of the health of the immune system, hit 350. Drug treatment resumed if their counts dropped below 250.
But those patients were 2-1/2 times more likely to die or be hit by an AIDS-related infection than the 2,752 volunteers who were told to keep taking their medicine, regardless of their CD4+ count.
Also, the people who received intermittent drug treatment were 70 percent more likely to develop heart, kidney or liver problems.
"This was a big surprise," Neaton said.
Fifty-five of those who had intermittent treatment died from various causes, while 30 who had continual treatment died, the study said.
AGGRESSIVE THERAPIES
Doctors had thought that kidney, liver and heart disease were caused by the aggressive therapies that have allowed HIV patients to live longer.
Among patients who received the drugs only when they seemed to be needed, "we expected the rate of cardiovascular disease to be 15 percent lower," the researchers said.
The new findings suggest that those health problems may instead be the result of long-term infection with the HIV virus, Neaton said.
Doctors involved in the Strategies for Management of Anti-Retroviral Therapies (SMART) study had hoped that patients could take a break from the treatments because the therapy is difficult and expensive.
"The prospect of lifelong treatment is difficult for people with HIV," said David Cooper of the University of New South Wales in Australia. "We are gratified that the SMART study has so clearly delineated the risk and benefits of these two strategies."
At a conference on AIDS, Dr. Anthony Fauci, head of the U.S. National Institute for Allergy and Infectious Diseases, said he did not believe any doctor should now offer patients treatment breaks, at least not breaks monitored by watching their CD4 immune cells.
"I think for practical purposes, it is the end," Fauci told reporters. He said doctors might still try the treatment holiday approach if they monitor viral load -- how much virus is circulating in the patient's blood.
Thu Nov 30, 2006 9:59 AM ET
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Routine, universal testing for the AIDS virus as recommended by a federal agency will likely cost the United States $900 million, but will pay off in terms of lives and money, experts said on Wednesday.
They said the federal government will need to allocate more money to programs that pay for treating uninsured HIV patients, and said cities, states and groups that run clinics will have to hire more staff.
Treatment must be available to everyone who is tested, or else much of the incentive to get the test is gone, the researchers told a conference on AIDS testing in Washington.
"We are talking about a little more than $900 million a year," said Dr. David Holtgrave of Johns Hopkins University in Baltimore.
But two experts said their experiences show the effort is worthwhile.
"The data scream that we need to be doing this," said Dr. Michael Saag of the University of Alabama at Birmingham Center for AIDS Research.
In September the U.S. Centers for Disease Control and Prevention recommended near-universal testing for the AIDS virus, saying too many people are missed by the current practice of focusing on people who seem to be at high risk.
HIV infects more than 1 million people in the United States and the CDC estimates that 40,000 people become newly infected every year. But many do not know it because at first HIV causes mild symptoms, quietly destroying the immune system over time.
"When we have good therapy that works best when people start early, that is inappropriate," Dr. John Bartlett of Johns Hopkins University in Baltimore told a news conference.
The CDC estimates that between 16 million and 22 million HIV tests are conducted in the United States every year. President George W. Bush's 2007 budget request to Congress allocates $70 million for HIV testing.
ALREADY PAYING OFF
Dr. Marsha Martin of the Washington, D.C. HIV/AIDS Administration said the city began a universal testing policy last June that has already paid off.
"We have the highest AIDS rate in the country -- 179 per 100,000 (population)" she said.
"Since June we have screened more than 16,000 individuals," Martin added. Of these, 580 have been positive, giving an infection rate of 3.5 percent -- far above the estimated U.S. national rate of between 0.8 percent and 1.2 percent.
Tests are being given at student clinics at universities, in hospital emergency wards and hospital walk-in clinics, as well as at free clinics across the city, she said.
Saag said at his clinic, people who come in after their immune systems are already damaged -- as measured by a count of immune cells called CD4 T-cells -- die sooner. Just 35 percent to 50 percent live eight years, as opposed to 75 percent of people who seek testing and treatment while their CD4 counts are above 350, a level considered fairly healthy.
Saag said to care for a person whose CD4 count is more than 350, it costs $12,000 a year but it costs $40,000 a year to treat someone whose CD4 count has fallen below 50.
Cocktails of HIV drugs can keep patients from developing AIDS, although there is no cure for the infection.
"They stay healthy. They stay active in society. It's a win-win-win proposition, well worth the investment," said Saag.
Churches, communities and organizations now have to encourage people to get tested, said Phill Wilson, chief executive officer of the Black AIDS Institute.
An estimated 50 percent of all new HIV infections across the United States are in blacks.
"AIDS today is a black disease, plain and simple," Wilson said. "For me, the answer is simple -- marshal black folks."
At least a third of the world's population is estimated to be infected with the TB bacteria, which are protected by a thick waxy coat and can lie dormant for years. People who are infected normally only get sick when their immune systems are weak.
In an article published in the open access journal, PLoS Medicine, the researchers tested the compound, OPC-67683, on infected mice.
It attacked the walls of the bacteria and "stopped it from dividing further", said Makoto Matsumoto of Otsuka Pharmaceutical Co. Ltd.'s Microbiological Research Institute.
The compound was also effective in fighting multi-drug resistant (MDR-TB) strains of TB, he said.
"Now, we want to check (the efficacy of the compound) in human patients. We are getting approval for human clinical tests," Matsumoto told Reuters on Tuesday.
TB is an infectious disease caused by the bacterium, Mycobacterium tuberculosis. It affects the lungs, central nervous, lymphatic and circulatory systems, bones and joints.
One in 10 latent infections progresses to active TB disease, which, if left untreated, can kill more than half its victims. It killed 1.7 million people worldwide in 2004.
Although it is mainly a scourge in developing countries, a rising number of people in the developed world are sickened by it because their immune systems are compromised by immunosuppressive drugs, substance abuse or HIV/AIDS.
Dealing with the disease remains a huge challenge because many strains of TB have become resistant to antibiotics.
Apart from MDR-TB, or strains that are resistant to two of the most effective first-line TB drugs, there is now extensively drug-resistant TB (XDR-TB), which is resistant to three or more of the six classes of second-line drugs.
Matsumoto said the compound, which his company synthesised, should be used in combination with other drugs to prevent or slow the development of drug resistance.
By Ben Wilson
SYDNEY, Nov 27 (Reuters) - Australian biotech firm Virax Holdings Ltd. said on Monday eight big mining companies had agreed to pay for trials of its HIV vaccine in South Africa, which is battling one of the world's worst AIDS crises. Virax applied to South Africa's drugs regulator in September for approval to conduct a clinical trial of its VIR201 HIV vaccine, with global mining giant BHP Billiton Ltd./Plc. BHP.L as the main sponsor.
On Monday it said another seven mining and metals firms from Australia, Britain, Japan and South Africa had offered funding.
Details of the total funding were not disclosed, but Virax spokesman Tim Duncan said the typical cost for trials of this size was usually between $5 million and $6 million.
Duncan said biotech firms often find it difficult to get early-stage funding for clinical trials, but Virax had positioned itself as potentially able to solve some problems facing large mining and metals companies operating in South Africa.
"Part of it is general social responsibility, but a lot of it is actually driven by the fact they need solutions for their work forces," he said.
An estimated one in nine of South Africa's population, or more than 5.5 million people, are infected with HIV.
Mining has been the sector hit hardest, according to a business survey last year by the Bureau for Economic Research.
Over half of mining firms said the pandemic had already hit profits and nearly 80 percent said it was expected to have an impact on their bottom line in five years.
A United Nations' report published last week said South Africa's AIDS epidemic continues unabated, suggesting the disease's prevalence has yet to peak.
The proposed trial of VIR201, which aims to stimulate the body's immune system and suppress virus levels in HIV-infected patients, will involve 140 HIV positive subjects in five HIV clinics across four South African provinces.
Duncan said Virax's application to run the trials was expected to be considered shortly, and that it was looking for more local support to help it achieve full funding in early 2007.
The seven new participants announced on Monday were Gold Fields Ltd. GFIJ.J, Harmony Gold Mining HARJ.J, Lonmin Plc. LMI.L, Mitsubishi Materials Corp. 5711.T, Nippon Mining & Metals Co. Ltd., part of Nippon Mining Holdings 5016.T group, Rio Tinto Ltd./Plc. RIO.L and Sumitomo Metal Mining Co. Ltd. 5713.T.
Friday December 1, 7:58 am
The program will allow patients with HIV and AIDS who have become resistant to other treatments access to maraviroc, a drug currently in late stage clinical trials.
Maraviroc belongs to a class of drugs known as CCR5 antagonists, which work differently than other HIV drugs in that they seeks to block the virus from entering white blood cells in the first place rather than trying to fight the virus within the cell.
Pfizer will begin enrolling patients from over 30 countries in the program in the next few months. Patients will receive the treatment along with background therapy and be monitored by researchers.