News (Updated September 24,
2006)
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Fri Sep 22, 3:34 PM ET
Washing the penis regularly lowers the risk of HIV infection in uncircumcised men, and even among men who are circumcised, according to two papers in the Journal of AIDS for September.
Male circumcision is associated with a reduced prevalence of HIV, according to Dr. Nigel O'Farrell, from Ealing Hospital in London, and colleagues. They now suggest that interventions to improve genital hygiene may also effective in reducing HIV infection risk.
Specifically, they theorized that the presence of "subpreputial penile wetness" -- a lanolin-like wetness commonly found under the foreskin in most uncircumcised men -- would increase risk, and that washing to keep the area under the foreskin dry would reduce risk.
Their study included 386 uncircumcised men residing in or near Durban, South Africa, who were free of genital lesions or discharge. Clinicians who examined the men observed that half had some degree of wetness around the penis. Approximately 80 percent were judged to be slightly wet, 19 percent as wet, and 2 percent as very wet.
In contrast, only one of 36 circumcised men they examined had wetness.
The prevalence of HIV infection was 66.3 percent among men with penile wetness, versus 45.9 percent in those with no wetness. After adjusting for HIV predictors and confounders, the adjusted odds ratio (OR) for HIV infection was 2.27 when comparing men with wetness versus those who were dry. The degree of wetness did not affect the risk.
The authors note that the HIV prevalence among uncircumcised men without penile wetness was close to that of circumcised men (42.9 percent).
Although many of the factors associated with penile wetness were poverty-related, Dr. O'Farrell's group suggests that "information, education, and communication programs at a number of levels would be needed: for instance, encouraging washing related to sexual activity -- precoital or postcoital or as an everyday life skill."
In the second Journal report, Dr. King K. Holmes, from Harborview Medical Center in Seattle, and associates interviewed 150 men living in Kenya regarding socioeconomic status and hygiene practices; 15 percent were HIV positive, and 97 percent were circumcised.
Components of hygiene associated with risk included the amount of time spent in a bath (more than 10 minutes) and bathing immediately after sex.
Multivariate analysis revealed three independent risk factors for HIV infection: previous treatment for a serious illness, circumcision, and genital hygiene.
SOURCE: Journal of Acquired Immune Deficiency Syndromes September 2006.
Thu Sep 21, 8:12 AM ET
Smoking, already linked to several illnesses, may also increase the risk of infection with HIV, the virus that causes AIDS, researchers said on Thursday.
In a review of studies that looked at the association between smoking and HIV, British doctors said five of the six studies they analysed showed smokers had a higher chance of becoming infected.
Nine of 10 other studies in the review that tracked the progression from HIV to AIDS found no link with smoking.
"The studies identified in this systematic review indicate that while smoking might be independently associated with acquiring HIV infection, it does not appear to be related to progression to AIDS," said Dr Andrew Furber, of the South East Sheffield Primary Care Trust.
Furber and his colleagues, who reported the findings in the journal Sexually Transmitted Infections, said tobacco smoke may increase susceptibility to HIV infection by modifying a variety of immune system responses.
Research has shown that smoking is a leading cause of preventable death. It increases the risk of heart attack and stroke, respiratory problems, lung and other types of cancer.
The researchers suggest in the study that public health measures that encourage smokers to quit could also improve the effectiveness of HIV/AIDS prevention programmes.
About 40 million people worldwide are living with HIV/AIDS. Nearly 5 million were newly infected in 2005 and more than 3 million adults and children died of AIDS in the same year.
Fri Sep 22, 2006 08:39 AM ET
WASHINGTON (Reuters) - More than a quarter of New Yorkers infected with the AIDS
virus are now dying of other causes, researchers said on Monday.
An analysis of 68,669 New York City residents infected with HIV, the virus that causes AIDS, found that of those who died between 1999 and 2004, 26.3 percent died of something other than HIV. That is a 32 percent increase from 1999, when just under 20 percent of HIV patients died of other causes.
Cocktails of drugs that suppress the virus have been credited with allowing HIV patients to lead near-normal lives, and once- or twice-a-day dosing now makes them more manageable.
Nonetheless, AIDS remains incurable and is always fatal in places where the drugs are not available -- notably much of Africa.
Writing in the Annals of Internal Medicine, Judith Sackoff and colleagues at the New York Department of Health and Mental Hygiene said they found that 31 percent of HIV patients died because of substance abuse, close to 24 percent died of cardiovascular disease and 20 percent died of cancer unrelated to the virus.
"Physicians everywhere must remember that most of their HIV-infected patients will survive to develop the diseases that plague the rest of us," Dr. Judith Aberg of New York University wrote in a commentary.
Another study published in the same journal found that nearly 10 percent of men interviewed in New York who identified themselves as heterosexual reported having sex with at least one man during the previous year.
The survey of 4,193 men conducted by the New York City Department of Health and Mental Hygiene found that 70 percent of the men who had sex with other men were married.
Many admitted they had not used a condom and had not been tested for HIV.
"Doctors need to ask patients about specific sexual practices instead of relying on self-reported sexual orientation to assess risk for unsafe sexual practices and risk for sexually transmitted diseases," said Preeti Pathela, who led the study.
"Public health prevention messages should target risky sexual activities, such as unprotected receptive anal sex, and should not be framed to appeal solely to gay-identified men."
Tue Sep 19, 10:23 AM ET
HIV/AIDS is the biggest single killer of new mothers in South Africa, the Health Department said on Tuesday in a grim new statistic of the pandemic's toll on the country.
The department released a study on maternal deaths from 2002-2004, illustrating a raft of problems with medical care for mothers in the country, which is both the richest in Africa and among the worst hit by the AIDS crisis.
The study looked at 3,406 deaths of pregnant women and new mothers between 2002-2004 and found HIV/AIDS was responsible for 20.1 percent of fatalities -- the largest single category.
Other causes of death included pneumonia and tuberculosis, both frequently associated with HIV/AIDS infection but listed separately, along with hemorrhage, malaria and other illnesses.
Health Minister Manto Tshabalala-Msimang, often criticized by AIDS activists for what they say is the government's slow response to the crisis, said high maternal mortality was "of great concern" but that South Africa was confident it was on the right track.
"We should be confident and defend the position we take as a nation in responding to our health challenges," she said in a statement.
The survey noted that South Africa's national plan to tackle HIV, which includes free anti-retroviral drugs, only began at the end of the research period -- which could help reduce maternal AIDS deaths in future.
But it also detailed other problems with maternal care in South Africa, ranging from lack of transport and inadequate ante-natal education to poor screening for disease and negligence by health workers, which it said were keeping the country's maternal death rate unacceptably high.
Tshabalala-Mismang said that while South Africa was working hard to reduce maternal deaths, there was still much to do.
"We have to particularly address the point raised in the report that a significant number of deaths could have been avoided," she said.
NEW YORK (Reuters Health) - A substantial percentage of men who have homosexual sex still consider themselves "straight," a survey of New York City men suggests.
The findings imply that doctors should not rely on a man's self-described sexual orientation in assessing his risk of HIV and other sexually transmitted diseases, researchers report in the Annals of Internal Medicine.
Instead, they should ask patients specific questions about their sexual behavior, according to the researchers, led by Dr. Preeti Pathela of the New York City health department.
The findings are based on a 2003 health department survey that included 4,193 men age 18 and up. Respondents were asked about their sexual behavior and their sexual orientation.
Almost 4 percent said they were homosexual, while 91 percent described themselves as "straight." The rest said they were bisexual, "unsure," or declined to answer.
But of men who considered themselves heterosexual, nearly 10 percent had had sex with a man, but no woman, in the past year, Pathela's team found. And of the 337 survey respondents who'd had sex with another man, almost 73 percent identified themselves as straight.
Cultural norms may have played a significant role in the discrepancy, according to the researchers. Foreign-born men, who make up a large proportion of New York City men, were more likely than their U.S.-born counterparts to call themselves heterosexual despite having sex with other men.
Men raised in cultures less accepting of homosexuality may be "reluctant" to identify themselves as such, Pathela's team notes, or they may have a narrow definition of what constitutes homosexuality.
In general, self-described heterosexuals, whether they had sex with men or not, had fewer sexual partners than men who said they were homosexual. However, self-described straight men who had sex with other men were less likely than gay men to have had an HIV test recently or to use condoms.
This pattern is "troubling," according to the researchers, and it highlights the need to target STD prevention messages beyond men who call themselves homosexual.
"It is of utmost importance for providers to take a sexual history that ascertains the sex of (the) partner or partners," Pathela's team writes. "Given our data, asking about a patient's sexual identity will not adequately assess his risk."
SOURCE: Annals of Internal Medicine, September 19, 2006.
Tue Sep 19, 2006 09:02 PM ET
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Only 23 percent of women infected with human papillomavirus, or HPV, became pregnant during in-vitro fertility or IVF treatments, compared to 57 percent of uninfected women, the researchers found.
"Sexually transmitted diseases are a major cause of infertility. However, possible links between HPV infection and infertility have not been systematically investigated," the researchers wrote in their report, published in the journal Fertility and Sterility.
"Unfortunately, the virus is very common among people of reproductive age. Testing for HPV might become a useful addition to the screening tests done for IVF patients and could help physicians to advise them," Dr. Joseph Sanfilippo, president of the American Society for Reproductive Medicine, which publishes the journal, said in a statement.
The researchers did not look at the link between fertility in general and HPV.
Dr. Steven Spandorfer and colleagues at the New York Hospital-Cornell Medical Center studied 106 patients scheduled to have IVF. They were all tested for HPV, HIV, chlamydia, and gonorrhea.
The women were all uninfected, except for 17 women who tested positive for HPV. These women were less than half as likely to conceive as women who either had never been infected, or whose bodies had successfully cleared the virus.
Genital HPV infection is very common, according to the U.S. Centers for Disease Control and Prevention.
About 20 million people in the United States alone are currently infected with HPV, the CDC says. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives -- more than 6.2 million Americans every year.
HPV can cause cervical cancer, which kills about 300,000 women worldwide each year, including about 4,000 in the United States.
Merck and Co. this year won a license for a vaccine called Gardasil, which prevents infection with the most dangerous strains of HPV. Vaccine experts recommend that most young girls receive it before they become sexually active.
Friday September 22, 4:49 pm ET
FOSTER CITY, Calif. (AP) -- Biopharmaceutical company Gilead Sciences Inc. said Friday it signed eight non-exclusive licensing agreements with India-based generic drug companies for versions of its HIV treatment, Viread.
The licenses grant the companies rights to produce and distribute version of the drug, tenofovir disoproxil fumarate, to 95 developing nations, including India. The companies include: Alkem Laboratories Ltd., Aurobindo Pharma Ltd., FDC Ltd., J.B. Chemicals & Pharmaceuticals Ltd., Matrix Laboratories Ltd., Medchem International, Ranbaxy Laboratories and Shasun Chemicals & Drugs Ltd.
Terms of the deals were not disclosed.
Gilead made similar deals with India-based Emcure Pharmaceuticals Ltd., Hetero Drugs Ltd. and Strides Arcolab Ltd. in August.
Sat Sep 23, 9:15 AM ET
Sexually transmitted diseases including HIV infections are on the rise among Singaporean teenagers as a result of promiscuity and disregard for safe-sex practices.
Official figures showed that patients seeking medical help for sexually-transmitted infections in the 10-19 year age bracket more than doubled to 678 in 2005 from 256 in 2001, the Straits Times reported Saturday.
The age group's share of all such infections rose from 3.8 per cent in 2001 to 6.1 per cent last year, with more of them becoming infected with the HIV virus that often leads to full-blown AIDS.
Between 1985 and 2004, 18 teens were diagnosed as HIV-positive - about one new case every year.
Last year alone, four boys aged between 17 and 19 tested positive for HIV after having sex with men.
The report said counsellors who work with teens report they are now sexually active at a younger age and more are having unprotected sex with multiple partners, but there was also greater awareness of the need for testing.
Theresa Soon, assistant manager of a clinic run by the Department of Sexually-Transmitted Infections Control, told the daily that teens who showed up at the clinic have had an average of four sex partners.
Singapore has about 4.3 million people, a fifth of them foreigners.
Officials have expressed alarm over the growth of HIV infections but the government has rejected widespread promotion of condom use and instead partly blamed the problem on the gay community.