Record 83 Million Adults Newly Tested for HIV in 2009

The number of adults tested for HIV reached a record high in 2009, according to an analysis of national survey data released today in a CDC Vital Signs report.

Last year 82.9 million adults between 18 and 64 reported having been tested for HIV. This number represents an increase of 11.4 million people since 2006, when CDC recommended that HIV testing become a routine part of medical care for adults and adolescents, and that people at high risk of infection be tested at least once a year.

Despite this progress, 55 percent of adults—and 28.3 percent of adults with a risk factor for HIV—have not been tested. [Read more…]

HIV May Be Transmitted via Pre-Chewed Food

Researchers have uncovered the first cases in which HIV almost certainly was transmitted from mothers or other caregivers to children through pre-chewed food. The source of HIV in the pre-chewed food was most likely the infected blood in the saliva of the people who pre-chewed the food before giving it to the children. The researchers said their findings suggest that HIV-infected mothers or other caregivers should be warned against giving infants pre-chewed food and directed toward safer feeding options.

The cases indicate that physicians and clinics should routinely include questions about pre-chewing food in their health screening of infant caregivers who have HIV or are suspected of the infection. Also, possible cases of HIV transmission through pre-chewed food should be reported to public health agencies to help increase understanding of the prevalence of such transmission.

Led by Aditya Gaur, M.D., of St. Jude Children’s Research Hospital, with colleagues from St. Jude (Marion Donohoe, CPNP), the University of Miami (Charles Mitchell, M.D., and Delia Rivera, M.D.) and the Centers for Disease Control and Prevention (Kenneth Dominguez, M.D., Marcia Kalish, Ph.D., and John Brooks, M.D.), the researchers published their findings in the August 2009 issue of the journal Pediatrics. Gaur is an assistant member of the St. Jude Infectious Diseases department.

Giving infants pre-chewed food has been reported to transmit infections such as streptococcus and the hepatitis B virus, Gaur said. However, until these cases there was no evidence that the blood-borne HIV could be similarly transmitted. The source of blood in the saliva of the person pre-chewing the food for the child may likely have been visible or microscopic bleeding from the gums or some other part of the mouth, he added.

In their paper, the researchers described three cases in which pre-chewed food was likely the source of HIV transmission to infants.

The case that led to this published report was a 9-month-old infant who was referred to St. Jude because she was HIV positive after earlier tests had been negative.

“Her HIV-positive mother had not breastfed her, and further investigation had ruled out transmission by blood transfusion, injury or sexual abuse,” Gaur said. Also, genetic testing, led by Kalish at the CDC, showed that the daughter had been infected with the same HIV strain as the mother.

“Fortunately, the St. Jude nurse practitioner, Marion Donohoe, was very thorough in her questioning about feeding practices, and she asked about pre-mastication. It turned out this mother had fed her daughter pre-chewed food,” Gaur said.

When Gaur contacted Dominguez at the CDC about the possible case of transmission via pre-chewed food, the center alerted him to two similar cases previously reported by senior author Mitchell and colleague Rivera from the University of Miami. Those cases were not reported to the public at the time because of the lack of sufficient evidence of transmission via pre-chewed food. One case involved pre-chewing by an HIV-infected mother, and the other an HIV-infected aunt who was the caregiver.

Gaur said that information in the three cases suggests that one factor aiding such transmission was mouth bleeding in the caregiver, as well as in the infant due to teething or infection. He also said caregivers’ lack of adherence to their own drug-treatment regimens probably increased their blood HIV levels, increasing the likelihood of transmission.

“These three cases are persuasive enough that they justify cautioning HIV-positive caregivers against giving infants pre-chewed foods,” Gaur said. “Also, we hope increased awareness of this possible mode of transmission will bring more cases to light and more thorough studies, which can either substantiate or refute this transmission route.” Also important, Gaur said, will be the results of surveys now being conducted in collaboration with other research groups in the United States and abroad to determine the extent of infant feeding using pre-chewed food.

The findings do not warrant a blanket recommendation against pre-chewed food for infants, the researchers emphasized. The practice, which has been reported from many parts of the world including the United States may be integral to providing adequate infant nutrition and grounded in culture and tradition. On a global level, educating HIV-positive caregivers will require cognizance of culturally sensitive issues and potential nutritional consequences linked to pre-chewing, the investigators said. The findings also do not imply that HIV can be transmitted through saliva during oral contact such as kissing. In the cases the researchers studied, HIV transmission was likely enabled by bleeding gums or open mouth sores.

“Importantly, this report does not challenge the accepted belief that saliva does not carry HIV and that transmission does not occur in kissing,” Gaur said. “The exception is that transmission can occur when the people involved have damaged mucosa in their mouths, and blood is mixed with the saliva.”

Source: St. Jude Children’s Research Hospital; Pediatrics, August, 2009

Research Shows Promise for Cystic Fibrosis and HIV Therapies

Innovative therapies against cystic fibrosis have shown promise for increasing the effectiveness of antibiotics in the treatment of chronic and acute bacterial respiratory infections in cystic fibrosis patients, and may also provide a model for potential HIV therapies in the future.

A number of compounds that block a key protein (exoenzymeS or ExoS) have been identified by Professor Igor Stagljar of the University of Toronto, with one—exosin—inhibiting infections in mammalian cells.

Past studies have shown it is possible to prevent or delay the onset of certain chronic or deadly infections in cystic fibrosis patients with early antibiotic treatment. But the current availability of antibiotics against Pseudomonas aeruginosa, a pathogen that can cause urinary tract infections, respiratory system infections, dermatitis, soft tissue infections, bacteremia, bone and joint infections, gastrointestinal infections and a variety of systemic infections, is limited and the pathogen shows signs of drug resistance.

In an article published in the journal PLoS Genetics, a team of investigators identified several drugs that block a Pseudomonas aeruginosa toxin called ExoS.

"These studies created a road map to the rational design of more potent, highly selective inhibitors against other similar toxins using a totally novel yeast-based approach," says lead author Stagljar. "This innovative approach is an important advance, not only for the value it may have in cystic fibrosis treatment, but also because this technique could be used to design novel therapies for any bacterial pathogen as well as the HIV virus."

Staglar’s next step is to test the action of their inhibitors in an animal model of cystic fibrosis, which if successful may provide a way for the treatment ofthis debilitating disease.
In the next phase of their research, Stagljar and his colleagues plan to test the action of their inhibitors in an animal model of cystic fibrosis. If successful, the therapeutics may provide an avenue for the treatment of this debilitating disease.

Source: University of Toronto

New Drug Isentress (Raltegravir) Approved by FDA for HIV Treatment

The U.S. Food and Drug Administration (FDA) has approved raltegravir tablets for treatment of Human Immunodeficiency Virus (HIV)-1 infection in combination with other antiretroviral agents in treatment-experienced adult patients who have evidence of viral replication and HIV-1 strains resistant to multiple antiretroviral agents.

Raltegravir is the first agent of the pharmacological class known as HIV integrase strand transfer inhibitors, designed to interfere with the enzyme that HIV-1 needs to multiply. Raltegravir, sold under the trade name Isentress, received a priority review by the FDA.

"This is an important new product for many HIV-infected patients whose infections are not being controlled by currently available medications," said Janet Woodcock, M.D., FDA’s deputy commissioner for scientific and medical programs, chief medical officer and acting director, Center for Drug Evaluation and Research.

When used with other anti-HIV medicines, raltegravir may reduce the amount of HIV in the blood and may increase white blood cells, called CD4+ (T) cells, that help fight off other infections.

FDA’s approval of raltegravir is based on data from two double-blind, placebo-controlled studies in 699 HIV-1 infected adult patients with histories of extensive antiretroviral use. A greater proportion of the patients who received raltegravir in combination with other anti-HIV drugs experienced reductions in the amount of HIV in the blood, compared with patients who received placebo in combination with other anti-HIV drugs.

The most common adverse events reported with raltegravir were diarrhea, nausea, and headache. Blood tests also showed abnormal elevated levels of a muscle enzyme in some patients receiving raltegravir. Caution is advised when using raltegravir in patients at increased risk for certain types of muscle problems, including those who use other medications that can cause muscle problems.

Patients taking raltegravir may still develop infections, including opportunistic infections or other conditions that may develop in patients living with HIV-1 infection. The long-term effects of raltegravir are not known, and its safety and effectiveness in children less than 16 years of age has not been studied.

Raltegravir also has not been studied in pregnant women. Women who are taking HIV medications when they get pregnant are advised to talk with their physician or other health care professional about use of this drug during pregnancy, and about registering with the Antiviral Pregnancy Registry if they use raltegravir.

Raltegravir is distributed by New Jersey-based Merck & Co., Inc.

Source: U.S. Food and Drug Administration (FDA)

HAART Drug Cocktail May Halt HIV-Related Brain Damage

A combination of antiretroviral drugs, known as Highly Active Anti-Retroviral Therapy (HAART), shows promise in halting brain damange caused by HIV, according to a Swedish research study published in the journal Neurology.

Participants were given the drug combination for a period of 12 months, and Researchers tested the subjects’ cerebrospinal fluid for the neurofilament light protein before, during and after treatment. The protein is a biomark for brain injury.

The researchers found that, of the 53 people in the study, approximately 40 percent had high levels of the protein at the commencement of treatment. After one year of treatment, only four of the participants still showed high levels of neurofilament light, suggesting that the drug combination not only treats the infections caused by HIV, but also appears to halt brain damage caused by the virus.

According to Åsa Mellgren, MD, PhD, an author of the study, HAART treatment "appears to halt the neurodegenerative process caused by HIV. This study confirms that neurofilament light protein serves as a useful marker in monitoring brain injury in people with HIV and in evaluating the effectiveness of HAART." He added that further study of the protein is needed that includes more extensive neurological measures, including cognitive testing.

Dr. Mellgren is from the Clinic of Infectious Diseases SÄS in Borås, Sweden, and the Sahlgrenska Academy at Göteborg University in Göteborg, Sweden. The study was supported by grants from the National Institutes of Health, Göteborg University, and Research Foundation of Swedish Physicians against AIDS.

Source: Neurology (October 9, 2007)

Party Drugs Likely Help Spread HIV Infections

A recent survey in the US has revealed that the increasing use of party drugs such as the stimulant “ice” (a methamphetamine) may be the cause behind escalating HIV-infections among gay men.

Although the study does not confirm that these party drugs are the direct causes of HIV infections, constantly increasing trends cannot be ignored.
Methamphetamine that is used in these drugs stimulates the male libido and enables them to stay awake for hours and have marathon sex sessions. And, a higher rate of risky sexual behavior is likely to lead to higher HIV infection rates.

In addition to drug use, many infected men have also confirmed that they either met their sex partners in a club or used the services provided on the Internet to arrange for anonymous sex partners. This also increases the risk of HIV infection.

Source: AAP (7/24/07)

HIV Infection Risk Much Lower for Circumcised Men

Uncircumcised men are more than twice as likely to to contract HIV from an infected female partner, according to the World Health Organization (WHO), because the skin cells in the foreskin are particularly susceptible to the HIV virus.

Circumcision reduced the risk of contracting HIV by about 60 percent, a far greater result than the 30% reduction targeted by an AIDS vaccine.

At an AIDS conference in Sidney, Australia, Robert Bailey, an epidemiology professor at the University of Illinois, urged international health agencies to promote male circumcision as an effective means to lower the rate of HIV infections.

In March, 2007, the World Health Organization issued a statement urging males to get circumcised for health reasons.

However, the organization stressed that circumcision does not protect from HIV, and says that “men should still use condoms and take other precautions such as abstinence, delaying the start of sexual activity and reducing the number of sexual partners.”

References: AP (7/24/07)

Setback in “Female-Controlled” AIDS Prevention

Researchers have been studying ways in which women can better protect themselves against HIV/AIDS. In a 3-year multi-million dollar study of African women who used a latex diaphragm, it was found that women who used the diaphragm had the same infection rates as women who did not.

The study concludes that a latex diaphragm is not an effective method for women to protect themselves against HIV.

Another trial run in 2000 that had tested whether contraceptive jelly Nonoxynol-9 might be used by women for HIV prevention also failed, concluding that the women who used the Nonoxynol-9 were in fact more likely to be infected by the HIV virus than women who were given a placebo gel.

Source: San Francisco Chronicle (7/12/07)