Healthsifter by mary desmond pinkowish, since 2003

AIDS Cured? Maybe not so much...

Science magazine covers the caveats in the AIDS story from earlier this week about the man who has reportedly been cured of the infection in Germany. Not so fast, according to Science. Here's an excerpt:

As with every previous cure story, however, this one has a long list of caveats. A true cure, for example, would mean that an infected person has become virus-free. But, as the man's doctor, Gero Hütter, acknowledged at a recent meeting on viral persistence and eradication held by the American Foundation for AIDS Research (amfAR), low levels of HIV can escape detection by all but the most sensitive tests, and these tests have not yet been done on the patient's blood. Every time "cured" people's blood has been examined with these techniques in the past, researchers have found the virus. Indeed, participants at the amfAR meeting agreed to dub the man only "functionally" cured: It's possible, if not likely, that he harbors the virus in tiny quantities in cells that were not ablated before his transplant.

Other caveats further underscore the limitations of this advance. Ablating a person's bone marrow and then transfusing them with another's cells is a high-risk procedure, leading to death in up to one-third of patients.

A Possible Cure for AIDS?

This is from an article posted today by amfAR, the Foundation for AIDS Research. It was written by their senior scientific consultant, Jeffrey Laurence, MD, about a possible step towards curing AIDS, not just treating it:

"...a brief report in February 2008 by a group of physicians from Germany appeared to change everything when presented as a poster at the annual Conference on Retroviruses and Opportunistic Infections in Boston. It described a 40-year-old man—an American working in Berlin—whose HIV had been under good control for several years using a typical cocktail of drugs known as HAART. Then he developed acute leukemia.

In an attempt to cure the leukemia, he underwent a course of radiation therapy and chemotherapy in preparation for a stem cell transplant. But in his case, rather than simply using the best match among available stem cell donors, his physicians did something very clever. They also screened potential donors for a natural mutation known as delta32 CCR5. CCR5 is the primary means by which most types of HIV infect cells. Individuals lacking this CCR5 receptor—the 1.5 percent of the Caucasian population in America and Europe with the delta32 mutation—are completely resistant to infection by the most common forms of HIV.

The patient’s stem cell transplant was a success, although relapse of his leukemia required a second transplant using the same donor. Now off all anti-HIV drugs for almost two years, the patient continues to show no detectable signs of HIV in his blood, bone marrow, lymph nodes, intestines, or brain. To the limits of our ability to detect HIV, it appears that the virus has been eradicated from his body. At the very least this patient represents a functional cure: he is off all anti-HIV meds, has a normal T-cell count, and exhibits no evidence of virus."

Wow.

Read more about the CCR5 recepter here, at the CDC web site.

HIV Transmission and Circumcision

Time magazine covers the recent article in the Journal of the American Medical Association (JAMA) about the effect of circumcision on AIDS transmission. This is an excellent explanation about what's known about the topic. You'll find the entire discussion interesting. Here's a portion:

"Circumcision is believed to lower H.I.V. transmission in several ways. The inner surface of the foreskin is rich with cells that are more vulnerable to H.I.V. than cells on other parts of the penis; because they are also closer to the epithelial surface and at higher risk for tears during intercourse, they increase susceptibility to infection. Removal of the foreskin further lowers men's odds of developing genital ulcers (from diseases such as syphilis), which in turn lowers their vulnerability to H.I.V. during intercourse. In theory, circumcision should be protective for all men who participate in insertive sex, including heterosexual men and men who have sex with men."

You can find a summary of the original JAMA article here.

Circumcision and AIDS: New Data

Data presented at the International AIDS Conference in Mexico City seems to support the idea that circumcision protects against infection with HIV. This is a contentious area. Quoting here from Yahoo! News on the newly-presented study:

"US researcher Robert Bailey of the University of Illinois at Chicago put forward long-term data from a trial in Kisumu, Kenya, that in its initial phase enrolled 2,784 uncircumcised uninfected men.

Half of the group were circumcised, and the others were circumcised at a later date and they were later tested for HIV.

Previously-published research from this trial found that, after two years, circumcised men were 59-percent less likely to contract the human immunodeficiency virus (HIV) than uncircumcised counterparts.

The benefit was so astonishing that at this 24-month mark, the uncircumcised men were offered circumision, as it would have been unethical not to have done so.

...According to French researcher Bertran Auvert, who led the original South African study, circumcision could avert up to 3.8 million infections and half a million deaths in sub-Saharan Africa between 2006 and 2016, and up to 5.8 million deaths by 2026"

The Nature AIDS Blog from Mexico City

Reports for the scientific journal Nature are blogging from the International AIDS Conference in Mexico City. Check it out.

Drug Combinations Lengthen Life in People with HIV and AIDS

A study conducted in tens of thousands of HIV-infected people in Europe and North America between 1996 and 2005 confirms that their lives are lengthened by a cocktail of anti-HIV drugs. The results of the study, which had pharmaceutical industry support, are published in The Lancet. This is how Physician's First Watch reported the results:

"...researchers estimated the remaining years of life in some 43,000 patients starting combination therapy at various points since 1996 on the basis of reported deaths within the cohorts. They found that the years of life remaining for a 20-year-old starting therapy increased from 36 in the 1996–99 period to almost 50 years in the 2003–05 period."

So that means that an infected 20-year-old person starting therapy now could expect to live to nearly 70, assuming no additional medical advances occurred in the interim to prolong his/her life even longer.

Certain groups of patients don't seem to get as much benefit from the drug combo. These include people who acquired HIV through IV drug use and people whose white blood cell counts (CD4 counts) were extremely low when they started treatment.

This AIDS cocktail is sometimes called HAART, the acronym for Highly Active Antiretroviral Therapies. The Howard Hughes Medical Institute just published a user-friendly article on how and why it seems to work.

HIV Infection Rates Increase in Young Men

New diagnoses of HIV infection have increased by 12% a year since 2001 among gay and bisexual men, according to the results of a 33-state study by the CDC. The increase is highest among young black men aged 13 to 24, according to an article at the US News and World Report web site. The original report from the CDC is here. The report points out that that some other sexually transmitted diseases increase the risk of HIV transmission:

"Ulcerative and nonulcerative sexually transmitted diseases (STDs) such as syphilis and gonorrhea facilitate HIV transmission from infected MSM [men who have sex with men] and acquisition of HIV by noninfected MSM; therefore, screening for STDs in private and public clinical settings is an important component of HIV prevention in MSM"

Kenya's Free Circumcision Project

Scientists have used data from western Kenya showing that circumcision reduces a man's risk of contracting the AIDS virus by 60% to start free circumcision clinics in Kenya.These will be similar to projects already running in Swaziland, Rwanda, and Zambia. One of the scientists working on this project, Robert Bailey, is an epidemiologist who first noted the trend toward lower HIV infection rates in circumcised men several years ago.

Circumcision to Prevent HIV: How Big a Deal? Part 3

And Iggy writes:

That sounds about right. All the news outlets sensationalize it as "50~60% reduction in risk". It's not so sensational when you see the absolute values of the risk were 2.5% and 1.2% All you have to do is look at USA and all its tens of thousands of circumcised men dead from AIDS to realize that using circumcision to prevent HIV is foolish.

This refers to a post last week, where I mentioned that circumcision "slashes" the risk of HIV transmission. Thanks for the point of view. News outlets? Sensationalizing something? I'm shocked!

Circumcision to Prevent HIV: How Big a Deal?

A week or so ago, I mentioned in a post about circumcision that the risk of HIV transmission in Africa was "slashed" by the procedure. A reader, Hugh, replied:

"Slashes" might be the first word that springs to mind, but in absolute terms the HIV rate in the African trials was 2.5% in the intact subjects and 1.2% in the circumcised subjects, a difference of 1.3%. This makes the Number Needed to Treat 39. It would be much higher where the rate is lower, such as the US - hundreds or even thousands of wasted circumcisions. And that assumes that circumcision was responsible for the difference, which may not be the case.