June 2008

[Major shift in HIV prevention priorities needed]
[Cancer rates increasing in people with HIV]
[Antidepressants may be active against HIV/AIDS and cancer]
[Adverse events linked to facial filler reported]
[Free antiretroviral treatment effective in Malawi]

Major shift in HIV prevention priorities needed

Focusing on male circumcision and reducing multiple sexual partners should become the cornerstones of prevention efforts in the HIV-prevalent parts of Africa, according to researchers from the Harvard School of Public Health and the University of California, Berkeley.

The researchers found that the most common HIV prevention strategies are having a limited effect on the predominantly-heterosexual epidemics found in Africa. They noted difficulties in reaching consistent condom use in regular heterosexual relationships, and that testing programs have produced no evidence of HIV reduction in populations. According to the researchers, the treatment of other STDs has had discouraging results, from vaccine development trials and microbicide testing have been disappointing, and abstinence is not likely to have a major effect.

They also found that some of the assumptions underlying such strategies as poverty or war being major causes of AIDS in Africa are unsupported by scientific evidence.

In contrast, many studies in the past two decades have shown that male circumcision significantly reduces the risk of heterosexual HIV infection. In west Africa, where male circumcision is widespread, the prevalence of HIV remains relatively low. When initial findings from three recent randomized controlled trials of male circumcision in Africa showed at least a 60% reduction in HIV risk, the trials were stopped early because it was not ethical to withhold the benefits of this simple surgical procedure.

Similarly, partner reduction appears to have played a primary role in reducing HIV rates in Cote d’Ivoire, Kenya, Uganda and Zimbabwe, as well as in urban Ethiopia and Malawi. The researchers also noted the success of Uganda’s “Zero Grazing” campaign to reduce casual sex.

Only 1% of total prevention funding requested by the United Nations AIDS Program is earmarked for male circumcision, and that reducing multiple sexual partnerships would probably garner only a small fraction of HIV prevention investments, according to the researchers.

The results were published in Science (2008;320:749-750).

Cancer rates increasing in people with HIV

Cancer rates are increasing among patients with HIV, according to results from a new study conducted by CDC researchers.

The study involved 54,780 men and women who have with HIV.

Kaposi’s sarcoma and non-Hodgkin’s lymphoma have long been associated with HIV/AIDS, but after analyzing trends from 1992 to 2003, the researchers found that these two types of cancer are relatively less common among Americans with HIV. However, other cancers are increasing as a result of patients with HIV living longer because of advances in HIV medications.

By 2003, anal cancer had become 59 times more common among patients with HIV than in the general population, according to data from the study. Hodgkin’s disease was 18 times more common. Liver cancer, lung cancer, melanoma, throat cancer and colorectal cancer all are more common among patients with HIV than in the general population.

The results also showed that patients with HIV may have a slightly reduced risk for prostate cancer. Men with HIV are more likely to have lower testosterone levels, which could be protective against prostate cancer, according to the researchers.

The study results were published in Annals of Internal Medicine (2008;148:728-736).

Antidepressants may be active against HIV/AIDS and cancer

Antidepressant drugs enhanced the activity of natural killer cells, according to researchers from the University of Pennsylvania in Philadelphia.

The research emerged from findings which showed that stress and depression impair natural killer cell function and can accelerate the progress of HIV and AIDS.

The researchers recruited depressed and non-depressed women who were HIV-positive and treated them with three drugs to treat stress and depression. Citalopram, a selective serotonin reuptake inhibitor, and CP-96345, a substance P antagonist, increased natural killer cell activity. The third drug, RU-486, a glucocorticoid antagonist, had no effect.

“The findings show that natural killer cell function in HIV infection may be enhanced by selective serotonin reuptake inhibition and substance P antagonism,” Dwight Evans, MD, of the University of Pennsylvania, said in a press release.

The results were published in Biological Psychiatry (2008;63:899-905).

Adverse events linked to facial filler reported

Patients who have injections of polyalkylimide may have immune-related adverse events many months after receiving the injections, according to researchers from two universities in Spain.

Polyalkylimide, which is often sold as Bio-Alcamid (Polymecon) in other countries, is a permanent filler used for the treatment of HIV-associated facial lipoatrophy. Polyalkylimide is not approved for use in the United States.

The research was conducted at the Vall d’Hebron University Hospital in Barcelona and the Autonomous University of Barcelona. The researchers assessed 25 people who appeared to have adverse events from polyalkylimide injections 12 months or more after treatment. The HIV status of study participants was not mentioned in the article.

Twenty-four participants reported tender nodules at the injection site, and 20 participants had laboratory abnormalities suggestive of immune inflammation. Six participants reported headaches and fever. Adverse events diminished and ultimately resolved in 11 participants during 21 months of follow-up.

Based on these case reports, it is not possible to determine how many patients who receive polyalkylimide treatment will have these immune responses. However, these adverse events appear to be a relatively rare phenomenon.

The results were published in Archives of Dermatology (2008;144:637-642).

Free antiretroviral treatment effective in Malawi

Mortality rates of adult patients with HIV and AIDS in Malawi have been significantly reduced after the introduction of free antiretroviral therapy, according to researchers from the University of Cape Town, South Africa.

The effect has been large enough to detect at the overall population level.

Between 2004 and 2006, the country offered free ART to more than 80,000 patients. The researchers collected and analyzed population data on HIV-related mortality both before and after the free ART program was introduced.

The study population included 32,000 Northern Malawians. Mortality rates were measured from August 2002, before the free ART clinic opened, to February 2006, eight months after the free ART clinic opened.

According to the researchers, the mortality rate among patients aged 15 to 59 years was 9.8 per 1,000 person-years of observation prior to June 2005. The probability of death for both men and women in the same age group was approximately 43%, with approximately 65% of deaths related to AIDS. The data collected after the opening of the free ART clinic indicated that 107 of the approximate 334 people who needed treatment accessed it. A 10% reduction in mortality occurred in adults, and a 35% reduction in adults who lived near the main road where pre-ART mortality was highest.

When subgrouping by age, the researchers found that mortality rates among adults aged 60 years or older did not change. The results were published in The Lancet (2008;371:1558-1559).

– Compiled by Rob Volansky