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News (Updated January 5, 2003)

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HIV research: the year in review

Thu Jan 2, 7:41 PM ET

Randy Dotinga, Gay.com / PlanetOut.com Network

SUMMARY: While not AIDS cure is in sight, scientists in 2002 did develop greater insight into the disease and its effects.

AIDS remains stuck between a rock and a hopeful place. It's not a guaranteed killer anymore, but it is still much more than a simple nuisance. No cure is on the horizon, but scientists in 2002 did develop greater insight into understanding the disease and its effects on people.

Here's a summary of what researchers learned over the past year:

* As many as 80 percent of HIV patients may suffer from depression and anxiety, according to an October report in the Journal of the International Association of Physicians in AIDS Care. Doctors appear to be missing the severity of the problem. A survey suggested that physicians failed to ask six out of every 10 HIV patients about their mental health.

* On the bright side, 2002 did bring one less reason for HIV patients to be depressed: a common sexual activity might be less risky than previously thought.

To many people, the idea of oral sex -- a blow job -- with a condom, well, sucks. But researchers in Spain looked at 135 heterosexual couples who had unprotected oral sex an estimated 19,000 times during a 10-year period. One partner -- male or female -- in each couple was HIV-positive, but no one became infected, according to the journal AIDS.

"I'm not going to say people can't get HIV from oral sex, but it's a low-risk activity," said a California researcher.

* Ten percent of young gay men in the United States may be infected with HIV, and nearly 80 percent of them have no idea they're sick, according to a study released at the 14th International AIDS Conference in Barcelona, Spain, in July. Blacks and Latinos were at the highest risk of being oblivious, but whites weren't far behind.

* Scientists continue to test HIV vaccines, and they expect results of the most advanced study sometime this year. More tests are expected in countries across the world. But researchers at the U.S. Conference on AIDS in September said they fear that gay men, blacks and IV drug users in the United States will be resistant to vaccine tests because many distrust the government. "There are social and political challenges," a federal official said.

* More HIV patients are developing resistance to AIDS drugs, requiring doctors to tinker with their "cocktails" to keep them alive, according to a July report in the Journal of the American Medical Association. Researchers found that 27 percent of HIV patients were resistant to at least one drug, but the rise of a "superbug" -- immune to all three main types of AIDS medications -- appears to still be on the horizon.

* While some AIDS patients and activists scoff at the idea, doctors have warned for years that HIV patients could "reinfect" themselves if they had unprotected sex (or "barebacked") with another HIV-positive person. Apparently, reinfection can indeed happen: researchers have reported three cases of men who came down with second strains of HIV.

"The bottom line is that even consenting partners who are both infected should practice safe sex," said a Harvard Medical School doctor in a letter to the journal Nature in November.

* Two out of three HIV patients are turning to some form of alternative medicine, according to research released at the annual meeting of the American Psychological Association in August.

Half of those surveyed said they were taking alternative multivitamins, 24 percent used Chinese herbs or botanicals, 17 percent used mineral supplements and 7 percent took garlic. Experts warned patients to be up front with their doctors about what they're taking.

* In September, transgender people made their first appearance ever in front of the microphones at a national HIV conference. Before an attentive audience, activists called for more attention to the HIV risks facing the transgender community.

"There are no funds to target transgenders, there's no data, there's no tracking," one activist said. "We don't know how big or small the numbers are. It's a population that doesn't exist."

HIV 'Blip' Not Harbinger of Drug Failure: Study

NEW YORK (Reuters Health) - Brief spikes in virus levels may occur in more than one quarter of HIV patients taking highly active antiretroviral therapy (HAART), but such "blips" are not necessarily a warning sign that the medications are failing, according to a new study.

Only in 13% of cases did the transient high virus levels persist, the researchers found. In the rest, the virus eventually subsided to undetectable levels.

Lead author Dr. Peter Sklar said that given the toxicities of certain medications, "caution should be warranted before switching and changing in response to an episode of transient viremia because I believe our data shows that they may not have clinical importance."

Sklar is now a research fellow in the Clinical Center of the Critical Care Medicine Department at the National Institutes of Health. The study was completed when he was a fellow in infectious diseases at the George Washington University Medical Center in Washington, DC.

HIV medications seek to reduce the level of virus circulating in the blood to undetectable levels within several weeks of the beginning of treatment.

Sklar said that patients' failure to adhere to their medications might be behind the blips, and added that he hopes this study will "stimulate a discussion" between physicians and their patients about patients' adherence to their therapy.

The study, in a recent issue of the journal AIDS, was part of the HIV Outpatient Study by the Centers for Disease Control and Prevention, and included 448 patients on various types of antiviral therapy.

Sklar told Reuters Health that patients with persistent high levels of the virus were more likely to have been exposed to a variety of anti-viral treatments, and may thus have developed resistance to the drugs.

Dr. Diane Havlir, chief of the AIDS division at San Francisco General Hospital, called the study "important" and said that it shows from a "practical clinical standpoint that very low viral rebound does not lead to immediate immune collapse."

Havlir said in an interview that the study "supports current therapeutic approaches of 'careful monitoring' when transient increases in viral load are seen as opposed to a hasty decision to switch therapy." This, she added, can lead to "premature" switching that can exhaust future treatment options.

Blood Factors for Hemophilia Don't Spread Virus-CDC

NEW YORK (Reuters Health) - Virally inactivated blood products used to treat patients with bleeding problems are unlikely to spread hepatitis, according to a new report from the Centers for Disease Control and Prevention CDC).

Since 1998, the CDC and roughly 140 federally funded hemophilia treatment centers have monitored the safety of blood products through the Universal Data Collection surveillance project, the CDC's Dr. Anna Kirtava and colleagues note in January 3rd issue of the Morbidity and Mortality Weekly Report.

The blood of people with hemophilia does not clot properly, putting them at risk of uncontrolled bleeding. Hemophilia patients are treated with concentrates containing factors that help blood clot, which can contain blood donated by many different people. While there were outbreaks of hepatitis and HIV among people with hemophilia who received such products in the 1970s to early 1990s, manufacturers now use procedures to inactivate any viral material present in blood factor products.

In investigations conducted between May 1998 and June 2002, 1,149 patients with bleeding disorders seroconverted to hepatitis-positive status. This means that their blood went from being free of antibodies to the hepatitis virus to containing these antibodies, but does not necessarily signify infection with the virus. For example, vaccination for hepatitis causes seroconversion.

Importantly, the researchers say, "none of these cases was attributable to blood products received during this time period."

Most seroconversions of hepatitis A virus (HAV) and hepatitis B virus (HBV) could be attributed to vaccination, 99% and 90%, respectively, they report. The remaining seroconversions most likely represented infections from other sources, or "fluctuations in antibody levels" that can occur in people with HIV.

Baby Boys in Malawi at Greater Risk Than Girls

NEW YORK (Reuters Health) - Young boys in the African nation of Malawi have twice the risk of dying in their first few years as do girls--an observation researchers describe as both surprising and unexplainable.

"Basically, it is well known that a bit more boys than girls are born in all populations," said Dr. P. Ashorn of the University of Tampere Medical School in Finland. "Normally, boys have slightly higher mortality in childhood, so that the sex ratio is close...at puberty and early adulthood."

But in rural Malawi, said Ashorn, "we found that between 9 and 36 months of age, males had twice as high mortality than females--a surprise."

For a three-year period, Ashorn and colleagues looked at the death rate among boys and girls in a rural district in Malawi in sub-Saharan Africa. Most Malawians survive on subsistence farming, amidst widespread poverty and low levels of literacy.

The researchers followed 767 infants from birth up to age three. All immunizations against major diseases, such as polio, tetanus, and measles, were recorded. About 66% to 98% of children were vaccinated, depending on the shot, and vaccination rates were similar among boys and girls.

In the current issue of the Archives of Disease in Childhood, the authors report that 100 babies and 47 boys and girls between the ages of one and two died during the study period.

The researchers found that death rates were higher among boys than girls immediately after birth, but were more or less similar during the next 8 months. However, they found that between the ages of 9 months and 3 years, the boys were twice as likely to die as the girls.

Although 18% of the mothers had been infected with HIV prior to giving birth, there was no association between HIV status and the higher death rate among boys.

The researchers did find that wasting, stunted growth and abnormally low weights were more common among the boys than the girls. Causes of death included malnutrition, malaria, anemia, respiratory infections, diarrhea, and in one case, an accident.

The authors suggest that the increased risk for mortality among boys may be related to a local social bias. In Malawi, daughters tend to remain at home to care for parents after sons marry and move away. This might drive parents to more quickly seek health care for their daughters than their sons, the authors speculate, though immunization rates were nearly identical among boys and girls.

"At the moment, we have no good explanation to the finding," Ashorn told Reuters Health. "Part of the difference is likely to be related to the fact that boys are more often malnourished than girls. Also, it is known that some infectious diseases affect boys and girls in different ways, and this may be one explanation for our finding.

"There is no evidence that parents...would be caring for girls and boys in a different way," Ashorn added, noting that the research will continue to try to find an explanation for the higher death rate among boys.