Routine HIV Testing Could Be Coming to Your Doctor’s Office

By Sally Chew

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It’s difficult to keep a virus from spreading when you don’t know who has it. One of the main reasons HIV continues to be a problem, even in a developed country like the United States, is that 1 in every 4 HIV–positive Americans goes about life without having any idea he’s infected.
And these 250,000 or so undiagnosed people unknowingly cause another 20,000 new infections a year, according to the American College of Physicians (ACP).

That’s why the ACP issued a report on World AIDS Day, calling on U.S. doctors to test every single one of their patients over the age of 13. “Now there is enough evidence showing that routine HIV screening should be adopted,” says ACP member Amir Qaseem, MD, PhD. He says Americans should get used to checking their HIV status along with their cholesterol. Read More

Medicinal Marijuana Eases Neuropathic Pain in HIV

(HealthDay News) -- Medicinal marijuana helps relieve neuropathic pain in people with HIV, says a University of California, San Diego, School of Medicine study.

It included 28 HIV patients with neuropathic pain that wasn't adequately controlled by opiates or other pain relievers. The researchers found that 46 percent of patients who smoked medicinal marijuana reported clinically meaningful pain relief, compared with 18 percent of those who smoked a placebo.

The study, published online Aug. 6 in Neuropsychopharmacology, was sponsored by the University of California Center for Medical Cannabis Research (CMCR).

"Neuropathy is a chronic and significant problem in HIV patients as there are few existing treatments that offer adequate pain management to sufferers," study leader Dr. Ronald J. Ellis, an associate professor of neurosciences, said in an UCSD news release. "We found that smoked cannabis was generally well-tolerated and effective when added to the patient's existing pain medication, resulting in increased pain relief."

The findings are consistent with and extend other recent CMCR-sponsored research supporting the short-term effectiveness of medicinal marijuana in treating neuropathic pain.

"This study adds to a growing body of evidence that indicates that cannabis is effective, in the short-term at least, in the management of neuropathic pain," Dr. Igor Grant, a professor of psychiatry and director of the CMCR, said in the UCSD news release.

More information
The American Medical Association has more about medical marijuana.

A Bone Marrow Disease With a Brighter Prognosis

(HealthDay News) -- Blood is life. And the rare disease known as aplastic anemia robs the body of life by robbing the body of blood.

The aplastic anemia patient's blood thins as the bone marrow slows its production of blood cells. The results can range from chronic fatigue to heart disease or from endless infections to cuts that won't clot, depending on the type of blood cells that are lacking.

But there's hope: Considered fatal as recently as two decades ago, aplastic anemia is becoming a far more manageable disease. Advances in drug therapies and improvements in the field of transplantation have slashed the death toll, allowing patients to live longer, fuller lives.

"We are getting better at treating aplastic anemia, either in getting rid of it or treating its symptoms," said Dr. Jaroslaw P. Maciejewski, with the Cleveland Clinic's Department of Hematologic Oncology and Blood Disorders.

And those advances are helping doctors gain greater insights into other, more prevalent, health conditions, such as heart disease and leukemia.

An estimated 50,000 people develop aplastic anemia in the United States each year, according to the U.S. National Institutes of Health. (A related blood disorder, myelodysplastic syndrome, or MDS, occurs when the bone marrow begins to produce poorly functioning or immature blood cells. About 20,000 to 30,000 new cases of MDS occur each year.)

It's important to note that many symptoms of aplastic anemia, such as fatigue and infection, can also be caused by other diseases, said Dr. Ronald Paquette, a blood disease researcher with the University of California, Los Angeles' Jonsson Comprehensive Cancer Center.

"If everyone who was fatigued thought they had aplastic anemia, we'd be swamped," Paquette said.

Bone marrow -- the spongy material inside bones -- produces stem cells that normally develop into the three main types of blood cells -- red blood cells, white blood cells, and platelets.

"Essentially, the bone marrow is a factory of blood," Maciejewski said.

In patients with aplastic anemia, the stem cells have been damaged, slowing or stopping the production of all blood cells.

The cause of the damage to stem cells remains unknown in more than half of people with aplastic anemia. Some research has suggested that stem cell damage occurs when the immune system attacks the body's own cells by mistake, according to the National Institutes of Health.

Aplastic anemia has also been linked to exposure to toxins such as pesticides, arsenic and benzene. Some infectious diseases also can cause the disorder, including hepatitis, Epstein-Barr virus, cytomegalovirus, parvovirus B19, and HIV, as well as autoimmune diseases like lupus and rheumatoid arthritis. Finally, some genetic disorders have been linked to it.

Symptoms vary depending on the type of blood cells in shortage:

• Too few red blood cells can mean not enough oxygen is carried to the body, according to the NIH. People who have a low red blood cell count often feel tired. Because the heart has to work harder to pump blood to get enough oxygen to the body's organs and tissues, heart disease can develop over time.
• Too few white blood cells weaken the body's defense against infection. The patient may become ill more often, and the illness can be severe.
• Too few platelets hamper the blood's ability to clot. Patients with a low platelet count may bruise or bleed easily, and their bleeding may be hard to stop.
• Once aplastic anemia is detected, swift treatment is essential, Paquette said. "Because it's a rare disease, it's important to be treated at a specialized center," he said. "The most important thing is to be seen by someone with a lot of experience treating the disease early on."

For patients younger than 30, stem cell transplantation is often the preferred treatment. For those with a matched sibling donor, stem cell transplantation replaces the defective bone marrow with healthy cells, and as many as 80 percent of patients enjoy a complete recovery, according to the Aplastic Anemia & MDS International Foundation Inc.

Advances in stem cell research and anti-rejection drugs have meant that transplantations from unrelated donors also are becoming more successful, Paquette said.

One promising avenue of treatment involves transplantation using stem cells harvested from the umbilical cord of new mothers. "The cells can be cryopreserved [frozen] and saved, then given to unrelated donors," Paquette said. "It's quite encouraging."

For these patients, again, speed is of the essence. "The data show the earlier you do a transplant, the better the outcome," Paquette said.

Patients whose transplants fail, or for whom transplantation is not an option, often receive successful immunosuppressive therapy with agents like anti-thymocyte globulin and cyclosporine. Response rates typically range from 70 percent to 80 percent, according to the Aplastic Anemia & MDS International Foundation Inc.

Blood transfusions from matched donors also are used to keep blood counts high and help relieve symptoms, although they are not an effective long-term treatment.

"Whether we cure the disease or not, patients are getting better across the board," Maciejewski said. "We now can maintain life, keep these patients alive longer."

More information
To learn more, visit the Aplastic Anemia & MDS International Foundation Inc.

One in 4 Teen Girls Has a Sexually Transmitted Disease

(HealthDay News) -- More than 3 million teenaged girls have at least one sexually transmitted disease (STD), a new government study suggests.

The most severely affected are African-American teens. In fact, 48 percent of African-American teenaged girls have an STD, compared with 20 percent of white teenaged girls.

"What we found is alarming," Dr. Sara Forhan, from the U.S. Centers for Disease Control and Prevention, said during a teleconference Tuesday. "One in four female adolescents in the U.S. has at least one of the four most common STDs that affects women."

"These numbers translate into 3.2 million young women nationwide who are infected with an STD," Forhan said. "This means that far too many young women are at risk of the serious health effects of untreated STDs, including infertility and cervical cancer."

These common STDs include human papillomavirus (HPV), chlamydia, herpes simplex virus and trichomoniasis, Forhan said.

Forhan announced the results as part of the CDC's 2008 National STD Prevention Conference, in Chicago.

"These findings are really giving us a lot of pause about how we provide care to adolescent girls who are sexually active," said Dr. Elizabeth Alderman, an adolescent medicine specialist at Children's Hospital at Montefiore in New York City and chairperson of the Executive Committee of the Section of Adolescent Health of the American Academy of Pediatrics. "The numbers are really astonishing."

Forhan noted that most of the burden of STDs falls on young African-American women. "Among African-American teenagers, about one in two were affected compared to one in five white teens," she said.

In terms of the racial disparity, "it's what we've always seen, which is very unfortunate," Alderman said.

In the study, Forhan's team collected data on 838 girls aged 14 to 19 who took part in the 2003-2004 National Health and Nutrition Examination Survey. The study did not include syphilis, gonorrhea or HIV, as earlier studies found very low prevalence of these diseases in this age group.

HPV and chlamydia are the most common STDs found among teenage girls, Forhan said. "Almost one in five overall had a strain of HPV associated with cervical cancer or genital warts," she said.

"We need to be screening adolescent girls who are sexually active and providing them with HPV vaccine," Alderman said. "The recommendations are to screen sexually active girls, but many girls don't disclose to their health-care provider that they are sexually active, even when asked," she said.

As for chlamydia, 4 percent of teenaged girls had this STD, Forhan said. "The majority of chlamydia infections do not have symptoms. If left untreated, it can lead to pelvic inflammatory disease, which leaves these young women at risk for atopic pregnancy, chronic pelvic pain or infertility," she said.

In addition, the study found that 2.9 percent of young women had trichomoniasis, and 2 percent were infected with genital herpes, Forhan said.

According to Forhan, about 50 percent of the teens reported having sex, and the prevalence of STDs in this group was 40 percent. "Even for young women with only one reported lifetime sexual partner, one in five had an STD," she noted.

"If you choose to be sexually active, you need to protect yourself and be screened for these infections," Alderman said. "And all girls between the ages of 11 and 26 should get vaccinated for HPV."

Among women with an STD, 15 percent had more than one infection, Forhan added.
"These data provide a clearest picture to date of the overall burden of STDs in adolescent women in the United States," Forhan said. "The study also underscores the importance of addressing racial disparities in STD rates among young women."

Race itself is not a risk factor for STDs, Forhan said. However, factors such as limited access to health care, poverty, community prevalence of STDs, and misperceptions about individual risk are some of the reasons that STD rates are particularly high among African-Americans, she said.
More information
For more on STDs, visit the U.S. Centers for Disease Control and Prevention.

Scientists Reprogram Human Skin Cells Into Embryonic Stem Cells

(HealthDay News) -- U.S. scientists say they've reprogrammed human skin cells into ones with the same blank-slate properties as embryonic stem cells, a breakthrough that could aid in treating many diseases while sidestepping controversy.

Human embryonic stem cells have the ability to become every cell type found in the human body. Being able to create these cells en masse and without using human eggs or embryos could generate a potentially limitless source of immune-compatible cells for tissue engineering and transplantation medicine, said the scientists, from the University of California, Los Angeles.

The researchers genetically altered human skin cells using four regulator genes, according to findings published online in the Feb. 11 edition of the journal Proceedings of the National Academy of the Sciences.

The result produced cells called induced pluripotent stem cells, or iPS cells, that are almost identical to human embryonic stem cells in function and biological structure. The reprogrammed cells also expressed the same genes and could be coaxed into giving rise to the same cell types as human embryonic stem cells, the researchers said.

"Our reprogrammed human skin cells were virtually indistinguishable from human embryonic stem cells," lead author Kathrin Plath, an assistant professor of biological chemistry and a researcher with the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, said in a prepared statement. "Our findings are an important step towards manipulating differentiated human cells to generate an unlimited supply of patient specific pluripotent stem cells. We are very excited about the potential implications."

The UCLA findings confirm similar work first reported in late November by researcher Shinya Yamanaka at Kyoto University and James Thompson at the University of Wisconsin. Together, the studies demonstrate that human iPS cells can be easily created by different laboratories and are likely to mark a milestone in stem cell-based regenerative medicine, Plath said.

Reprogramming adult stem cells into embryonic stem cells has significant implications for disease treatment. A patient's skin cells, for example, could be reprogrammed into embryonic stem cells that could be prodded into becoming beta islet cells to treat diabetes, hematopoetic cells to create a new blood supply for a leukemia patient, or motor neuron cells to treat Parkinson's disease, the researchers said.

These new techniques to develop stem cells could potentially replace a controversial method to reprogram cells called somatic cell nuclear transfer (SCNT), sometimes referred to as therapeutic cloning. To date, therapeutic cloning has not been successful in humans.

"Reprogramming normal human cells into cells with identical properties to those in embryonic stem cells without SCNT may have important therapeutic ramifications and provide us with another valuable method to develop human stem cell lines," study first author William Lowry, an assistant professor of molecular, cell and developmental biology, said in a prepared statement. "It is important to remember that our research does not eliminate the need for embryo-based human embryonic stem cell research, but rather provides another avenue of worthwhile investigation."

However, top stem cell scientists worldwide stress further research comparing reprogrammed cells with stem cells derived from embryos -- considered the gold standard -- is necessary.

More information
The U.S. National Institutes of Health has more about stem cells.

Antidepressants Help HIV-Infected Patients Stick to Treatment

(HealthDay News) -- People with HIV who suffer from depression are much less likely to stick with their treatment regimens, new research shows.

However, treating their depression with widely used selective serotonin reuptake inhibitor (SSRI) antidepressants can get them back on track, the researchers said.

A team from Kaiser Permanente in Oakland, Calif., analyzed the mental health, disease progression and treatment data of almost 3,400 HIV-infected patients nationwide between 2000 and 2003. All patients were starting a new, highly active antiretroviral therapy (HAART).

Reporting in the current online issue of the Journal of Acquired Immune Deficiency Syndromes, they found that almost half of the study participants (42 percent) had depression during the 12-month study. Those who were depressed were less likely to take their medications and had worse viral response than people who were not depressed. However, when depressed people took prescribed SSRIs -- which include drugs such as Celexa, Paxil, Prozac and Zoloft -- they had the same health outcomes as patients who were not depressed.

"The take-home point of this study is that depression carries a worse prognosis for HAART in HIV patients. However, we also found that SSRIs can reverse this and improve outcomes for HIV-depressed patients," lead author Dr. Michael A. Horberg, director of HIV/AIDS for Kaiser Permanente, said in a prepared statement. "HIV and depression often go hand in hand. If you are HIV-infected, you should be screened regularly for depression, and if you are depressed, and you are going to go on HAART, it's very worthwhile to treat your depression."

More information
To learn more about depression, visit the American Academy of Family Physicians.

Fibers in Semen Help HIV Penetrate Cells

(HealthDay News) -- In a discovery that perplexes HIV experts, an international team reports that tiny fibers commonly found in semen drastically enhance the ability of the virus to do its damage.

According to a study in the Dec. 14 issue of Cell, the fibers capture the virus and then ferry it to target cells, increasing its ability to infect someone by more than 50 times in some cases and more than 100,000 times in others.

The findings could help scientists better understand how AIDS is transmitted. But Rowena Johnston, director of research with the Foundation for AIDS Research (amfAR), noted that the value of the research is limited, because it doesn't "necessarily reflect transmission in the 'real world.' "

"This is intriguing, and it's worth further investigation," said Johnston. "But there's nothing yet that makes me have a 'Eureka' moment."

While scientists have long known about the basics of AIDS transmission, it's not clear why the virus travels more easily through some routes than others.

For example, male-to-female sexual transmission is usually more common than the other way around but not always. And it's also not clear why the virus has become so prevalent even though it has a tiny presence in blood.

In the new study, led by a German team, scientists tried to figure out if components of human semen might affect transmission of the AIDS virus.

"We were not expecting to find an enhancer and were even more surprised about the strength," study author Dr. Frank Kirchhoff, of the University Clinic of Ulm, said in a statement. "Most enhancers have maybe a two- or threefold effect, but here, the effect was amazing, more than 50-fold, and, under certain conditions, more than 100,000-fold. At first, I didn't believe it, but we ran the experiment over and over, always with the same result."

Dr. Jeffrey Laurence, a professor of medicine and director of the Laboratory for AIDS Virus Research at Weill Medical College of Cornell University, said there could be something similar at play in cervical fluid that affects transmission. "In a lot of situations in the real world, women transmit HIV quite easily...," Laurence said.

He added that many other factors affect transmission of HIV, from bodily abrasions to menstrual cycles and use of oral contraceptives.

Could this latest finding bring scientists closer to an AIDS vaccine? Laurence, who thinks a vaccine is decades off, is doubtful. Prevention, however, might be another matter.

Laurence said it might be possible to develop an "antidote" for the virus-boosting powers of semen and put it in a microbicide that people could use before sex.

More information
Learn more about the basics of AIDS from aids.org.

Doctors See Return of Kaposi's Sarcoma in Handful of AIDS Patients

(HealthDay News) -- San Francisco doctors say they've seen a small number of longtime HIV patients with mild cases of Kaposi's sarcoma, a potentially dangerous condition that once plagued people with AIDS.

It's not clear why Kaposi's sarcoma is making a comeback, or whether it may pose a significant health threat to AIDS patients. Still, it's unusual that the condition is appearing in people who have largely controlled the AIDS virus in their bodies, said report lead author Dr. Toby Maurer, associate professor of dermatology at the University of California, San Francisco.

Kaposi's sarcoma, a type of skin cancer that causes disfiguring lesions, was largely limited to Mediterranean men before the AIDS epidemic. When the epidemic began in the United States, many gay men with AIDS developed the condition, apparently because their bodies already harbored the virus that causes it, Maurer said.

Kaposi's sarcoma stigmatized AIDS patients by causing lesions on their faces, and some people died. But a new generation of AIDS drugs released in the late 1990s helped patients strengthen their immune systems and kept Kaposi's sarcoma at bay, at least in the Western world.

The condition remains common in Africa, where it affects both men and women, Maurer said.

The condition hasn't disappeared entirely in the United States, however, and is still seen in AIDS patients who don't take antiretroviral drugs.

In a new report, published in a letter to the editor in the Sept. 27 issue of the New England Journal of Medicine, Maurer and his colleagues said they've seen an "unusual" cluster of nine cases of Kaposi's sarcoma in patients who have their HIV infection under control.

The patients, who were diagnosed with Kaposi's sarcoma between 2004 and 2006, had been HIV-positive for an average of 18 years and had taken antiretroviral AIDS drugs for an average of seven years. The average age of the patients was 51.

"They've been doing well for a long period of time, and they have Kaposi's sarcoma," Maurer said. "We're curious as to what this means. Is something going on with their immune systems after years of HIV and drug therapy? It's a reminder of how HIV presented 25 years ago, and it brings up a lot of questions and worries."

Fortunately, the new cases of Kaposi's sarcoma are not severe, although they do begin with lesions, Maurer said. Doctors can use a variety of treatments, including injections and a topical gel, to treat the condition.

Dr. David Aboulafia, attending hematologist and oncologist at Virginia Mason Clinic in Seattle, said AIDS patients should know that Kaposi's sarcoma remains very rare, especially when compared to the early days of the AIDS epidemic, when it struck about one-third of patients.

And the treatments available today are effective and fairly easy for people to tolerate, he said.

More information
Learn more about Kaposi's sarcoma from the U.S. National Institutes of Health.

Scientists Probe How HIV Infection Turns Into AIDS

(HealthDay News) -- The common scientific wisdom on how HIV infection proceeds to full-blown AIDS might be wrong, two U.S. researchers say.

They hope that their new insights, if proven, will lead to exciting new treatment targets down the line.

Working from a complex mathematical model of viral replication and immune cell death, the researchers now suspect that AIDS begins when one especially fast-killing strain of HIV gains the upper hand over a less-lethal, but more prolific, strain.

"This throws into question a lot of the notions that have been accepted about the evolution of the virus" within a typical infected human, explained study co-author Dominik Wodarz, associate professor of biology at the University of California, Irvine.

He and another researcher, David Levy, of New York University, published their findings in the July 31 issue of the Proceedings of the Royal Society B.

Since its first recorded appearance nearly three decades ago, HIV infection has followed the same deadly path: a short, weeks-long period of acute flu-like symptoms followed by years of asymptomatic dormancy, and then symptoms of immune system breakdown that herald the emergence of AIDS.

But what is it that tips asymptomatic, low-level infection into AIDS?

The common dogma among scientists has long been that various strains of HIV battle a silent war within the body over time until the fittest -- defined as the strain that reproduces itself the most -- wins. That strain then goes on to overwhelm the body's immune cells and destroy the host's defenses against disease.

To test that theory, Wodarz and Levy constructed a complex mathematical model that took into account two factors about HIV: how fast the various strains replicate and how fast they kill cells (not always the same thing, the researchers noted). They also factored in human immune system responses to HIV.

What the two scientists found surprised them. According to the new model, AIDS actually begins when a less fit variety of HIV wins the day. This strain kills immune system cells extremely widely and quickly, but, in doing so, also limits the number of copies of itself it can produce. "It basically kills its own habitat, its house," Wodarz explained.

However, because this form of HIV is very good at quickly killing large numbers of immune cells, "once these less-fit strains emerge, they can plunge the patient into AIDS," Wodarz said.

In many cases, two or more strains of the virus can co-infect the same immune system cell, he added. If a fast-killing variety is one of those strains, it kills the cell before slower -- but better-replicating -- versions can go to work making millions of new viral particles.

"But without this ganging up on the same cell, the killer virus [that leads to AIDS] would go extinct, because evolution would select against it -- because it is less fit and replicates less," Wodarz explained.

That means that -- according to the model -- one way of keeping AIDS at bay might be to make sure that only one type of HIV invades a cell at any given time.

Specific cellular mechanisms do allow a second or third viral particle to enter a cell, and a medicine that thwarted these "party crashers" might keep the deadliest form of HIV from ever emerging, Wodarz speculated.

He pointed to wild monkeys that are infected throughout their lives with HIV-like simian immunodeficiency virus (SIV) but never get sick.

"Some of them have a lot of the virus, and it evolves a lot, but it does not cause AIDS, ever," Wodarz said. He suspects the monkey's immune cells may have evolved to block secondary viral entry and thereby keep the most dangerous strain of SIV at bay.

Not everyone is convinced by the new model, however.

Dr. Benigno Rodriguez is assistant professor of medicine at Case Western Reserve University in Cleveland, and a specialist in the evolution of HIV disease. He called Wodarz and Levy's paper "an interesting concept," but said it contained a few significant flaws.

First of all, he said, most of the available data suggests that HIV does get better at forming copies of itself as AIDS progresses. And Rodriguez believes the two scientists have left another important factor out of their model -- the fact that most AIDS patients' immune cells are not killed off by the virus directly but are destroyed by so-called "bystander" mechanisms that accompany AIDS.

"In an individual with advanced disease, if you look at the number of cells that are actually infected [with HIV], we are talking less than 1 percent," he said. "But, in reality, that individual may have lost 20, 30, 50 percent of his immune cells."

Rodriguez also questioned the importance of multiple strains of HIV infecting the same immune cell. "The data that we already have in hand shows that multiple infection is relatively infrequent," he said.

The bottom line, according to the Cleveland expert: As with any mathematical model, this one needs to be tested out in the laboratory.

Wodarz agreed that experimental verification is necessary, but he said mathematical disease models more often than not prove to be right.

In fact, he said, it was just such a model that led scientists to discover that HIV never stops evolving in the body -- even during infection's years-long asymptomatic phase.

"In HIV, mathematical models have led to great progress before," Wodarz said.

More information
To find out more about HIV/AIDS, head to the U.S. National Institute of Allergy and Infectious Disease.

Pool Safety Tips Keep Everyone's Head Above Water

(HealthDay News) -- Drowning is the second leading cause of death among American children ages 14 and younger, but a few simple measures can greatly reduce the risk of such tragedies, experts say.

Every year, about 760 children in that age group die from accidental drowning, and about 3,000 are treated at emergency departments after near-drowning incidents, according to Children's Healthcare of Atlanta and Safe Kids Georgia.

It doesn't have to be that way, they say. "The most important precaution is active supervision. Simply being near your child is not necessarily supervising," spokeswoman Beverly Losman said in a prepared statement.

She noted that while 94 percent of parents say their supervise their children while they're swimming, many of those parents admit that they do other distracting activities at the same time, such as talking, eating, reading or looking after another child.

"A supervised child is in sight at all times with your undivided attention focused on the child. When there are children in or near the water, adults should take turns serving as the designated 'water watcher' paying undivided attention," Losman said.

She offered these other precautions:
Pools and spas should be surrounded on all four sides by a fence at least five feet high with gates that close and latch automatically. This type of isolation fencing could prevent 50 percent to 90 percent of child drownings in residential pools, studies estimate.

Consider a pool alarm and alarms on doors, windows and gates leading to the pool.
Pools and spas with a single drain should have an anti-entrapment drain cover and a safety vacuum release system to prevent children from being caught underwater in the powerful suction of the drain.

Don't leave toys in or near a pool where they may attract unsupervised children.
When children are about age 4, enroll them in swimming lessons. But don't assume that swimming lessons make a child "drownproof" -- they still need active supervision when swimming.

Remember that inflatable swimming aids, such as water wings, are not flotation devices and don't prevent drowning.

Keep rescue equipment, a phone and emergency numbers by the pool.

More information
The Nemours Foundation has more about children and water safety.

Rattlesnake Capsules Linked to Salmonella Poisoning

(HealthDay News) -- Capsules of dried rattlesnake meat -- a Hispanic folk remedy purported to cure a host of health problems including acne, impotence, AIDS and cancer -- can be contaminated with a potentially lethal strain of salmonella bacteria, a U.S. infection control expert warns.

John James, a microbial epidemiologist at Children's Hospital in Denver, said the life-threatening strain of bacteria -- Salmonella arizonae -- in capsules of dried rattlesnake meat caused a child to become seriously ill. The child survived.

James talked about that case and the overall issue on Saturday at the annual scientific sessions of the Society for Healthcare Epidemiology of America in Baltimore.

"Anecdotal evidence linking capsules of dried rattlesnake meat to salmonella poisoning has been reported for years. For the first time, however, we've used DNA molecular testing to prove definitively that the salmonella bacteria found in the dried meat was the cause of a life-threatening case of salmonella blood poisoning in a patient treated at our hospital," James said in a prepared statement.

Salmonella arizonae is commonly found in snakes and lizards.

"Unfortunately, the rattlesnake capsules -- believed by some to treat many types of diseases -- are often given to people whose immune systems already are compromised," James said. The child in this case had systemic lupus.

"These capsules should be removed from the market, or the manufacturers should be required by the U.S. Food and Drug Administration to irradiate the product before it is sold," James said.

Chlamydia Screening Programs Don't Work: Expert

(HealthDay News) -- Population-wide screening programs for chlamydia, the most commonly reported sexually transmitted disease, may not actually work, a Swiss expert contends.
That's especially true for so-called "opportunistic" programs, which routinely test patients for chlamydia whenever they seek medical care.

"We do not have sufficient evidence that this approach to a screening program does more good than harm at reasonable cost," said Dr. Nicola Low, an epidemiologist at the University of Bern.
But despite that, and despite increasing rates of infection in nations that have screening programs, more countries continue to adopt this approach, Low wrote in an article appearing in this week's British Medical Journal.

U.S. social health experts took a neutral tone when discussing the report.

"We support current guidelines from the Centers for Disease Control and Prevention, which recommend annual chlamydia screening for sexually active females ages 25 and younger as well as older women at risk for this disease," said Fred Wyand, a spokesman for the American Social Health Association in Research Triangle Park, N.C.

"We believe it's especially important for women to be tested for chlamydia, since the infection is often asymptomatic, but if undetected and untreated can lead to serious health complications, such as pelvic inflammatory disease and infertility," Wyand added. "We are also in favor of discussion and research to determine which approaches to screening are most effective, in terms of both cost and in reducing the incidence of chlamydia infection."

Infection with the Chlamydia trachomatis pathogen is the most common preventable cause of pelvic inflammatory disease (PID) in young women. PID, in turn, can lead to ectopic pregnancy and infertility.

Chlamydia infection, which usually causes no symptoms, is easily treated, often with a single dose of antibiotics. Detection is also easy, with a urine-sample test; results are generally available within a day.

But recent evidence is emerging to suggest that chlamydia may result in fewer severe complications that previously thought. Chlamydia is currently the only sexually transmitted infection for which population screening has been implemented, stated a BMJ editorial.
Two types of screening programs exist. Proactive screening involves using population registries to invite people to be screened for a particular infection at regular intervals. Opportunistic screening targets people using health services for other reasons.

Chlamydia screening is currently recommended in Sweden, the United States and Canada, according to the BMJ report. An opportunistic screening program for all sexually active women and men under 25 years of age, the National Chlamydia Screening Programme, is scheduled to start in England in 2008.

But the evidence for such programs is weak, Low said.

In Sweden, a drop in chlamydia rates in the mid-1990s was attributed to widespread testing, but, in fact, the fall in rates coincided with a national campaign to prevent a more dangerous pathogen, HIV. Since 1995, chlamydia infection rates have been rising again in Sweden.
Similarly, in the United States, decreases in rates of chlamydia infection have been attributed to opportunistic screening programs.

Yet no randomized, controlled trial has shown that screening reduces long-term complications from chlamydia. And studies that do show a value have not been well-designed, while tending to overestimate the cost-effectiveness of the screening programs, Low noted.

Low argued that a consistent definition of "screening program" is needed and that screening programs for all diseases should be standardized.

"There is a difference between 'screening' and a 'screening program,' " Low said. "Any benefits of screening in a population will only be achieved if screening is implemented as a program. This means regular repeated screening of all those in the target population. Opportunistic screening as usually practiced does not ensure that people who have been screened once are invited for subsequent screening tests."

The bottom line, according to the Swiss expert: "Low overall coverage and infrequent screening will not control the spread of an asymptomatic, infectious disease."

There also needs to be more research to determine if screening programs really are effective, especially the more targeted, proactive kind, Low said. "There are trials of proactive chlamydia screening showing a benefit after one round of screening," she said. "The sustainability and duration of benefit of this approach to screening are therefore unknown."

Any screening program shouldn't replace prevention, another expert stressed.

"Prevention is really the best way to go, and sexually transmitted diseases are no exception to that rule," said Dr. Patricia Sulak, professor of obstetrics and gynecology at Texas A&M Health Science Center College of Medicine and an ob/gyn at Scott & White Hospital in Temple, Texas.
"Really, the best way for us to reduce problems is to look at the source of the problems, and that's multiple sexual partners," she said. "The earlier you start having sex, the greater the chance of becoming infected. We want to make sure we get prevention across."

More information
For more on chlamydia, visit the U.S. Centers for Disease Control and Prevention.

Breast-Feeding Helps Shield Babies From HIV

(HealthDay News) -- By breast-feeding only, HIV-positive mothers reduce the risk of postnatal HIV infection in their babies, South African researchers report.

The study, published in the March 31 issue of The Lancet, also found that early introduction of animal milk and solid foods while breast-feeding increases the risk that infants will be infected with HIV, the virus that causes AIDS.

The findings suggest that current World Health Organization, UNICEF and UNAIDS infant-feeding guidelines need to be revised, said researchers from the University of KwaZulu-Natal.
They found that infants of HIV-positive mothers who received formula milk in addition to breast milk were nearly twice as likely to be infected by HIV as infants who received breast milk only. The addition of solid foods increased the risk of HIV infection in the infants 11-fold.
The death rate at three months for babies who were fed animal milk or solid foods was more than double that of babies who received breast milk only, the researchers found.

"The key finding of our study is the definite demonstration that early introduction of solid foods and animal milks increases HIV transmission risks compared with exclusive breast-feeding from birth. These data, together with evidence that exclusive breast-feeding can be supported in HIV-infected women (and uninfected women), warrant revision of the present UNICEF, WHO, and UNICEF infant feeding guidelines that were revised in 2000," the study authors wrote.

More information

The U.S. National Institute of Allergy and Infectious Diseases has more about HIV infection in infants and children.

Diabetes Epidemic Spreading Worldwide: Experts

(HealthDay News) -- More than two-thirds of the world's estimated 246 million diabetics come from less-affluent developing nations, and more must be done to curb a disease that now rivals HIV/AIDS in terms of suffering and death around the globe.

That sobering assessment was offered by experts gathered at this week's Global Changing Diabetes Leadership Forum in New York City, which included keynote speaker former President Bill Clinton. The conference is one of the largest such gatherings ever of scientists, health-care advocates and government leaders focused on the issue.

"This truly is an epidemic," warned Dr. Martin Silink, president of the International Diabetes Federation (IDF), which represents more than 200 diabetes associations across 158 countries. "Seventy percent of the global burden of diabetes is now in developing countries, even though that seems paradoxical. People think that it should be in the developed world where there is access to fast food and lots of obesity."

But rapid lifestyle changes are affecting the health of people in China, India, South America, and elsewhere, he said. "As their economies develop, diabetes is now subverting the gains of economic development," Silink said.

The issue has gained such urgency that the United Nations' General Assembly in December passed a global resolution to encourage the prevention, treatment and care of diabetes. The U.N. has only passed one such disease-targeted resolution before, when it vowed to fight HIV/AIDS.

Some statistics from the IDF:
By 2025, the number of people with diabetes is expected to rise to 380 million worldwide, with 80 percent living in the developing world.

Each year, another 7 million people develop diabetes, while 3.8 million die of diabetes-linked causes.

In many countries in Asia, the Middle East and the Caribbean, diabetes already affects 15 percent to 20 percent of the adult population.

India now has the largest number of diabetics (almost 41 million) in the world, followed by China (nearly 40 million), the United States (19.2 million) and Russia (9.6 million).

Diabetes increasingly affects the young or middle-aged, with more than half of diabetics in developing countries between the ages of 40 and 59.

According to the experts, a "perfect storm" of genetics and social change is driving the spread of obesity-linked type 2 diabetes in poorer countries. Visitors to today's China quickly notice McDonald's, KFC and other fast-food outlets springing up in major cities. At the same time, the foot and bicycle are making way for the car on urban streets.

Scientists have also long understood that Asians, Hispanics and blacks are more vulnerable, genetically, to develop type 2 disease compared with those of European descent.

"They simply don't have to get as obese as a European to get diabetes," Silink explained. Among non-Europeans, even a relatively modest increase in abdominal fat -- the so-called "spare tire" -- can trigger changes that lead to insulin insensitivity and diabetes.

"The risk of diabetes in a European starts rising after a body mass index (BMI, a ratio of weight to height) of about 25 or 26," the normal threshold for overweight, Silink said. "But for a person coming from Bangladesh or India, that risk curve starts after a BMI of just 22," he said.

A person who is 5-feet, 8-inches tall and weighs 145 pounds has a BMI of 22.

Too often, expensive, pay-as-you-go health-care systems in developing countries mean diabetes isn't even detected until it reaches crisis levels, Silink added. The results -- prolonged disability, amputation, even death -- can destroy a family's income.

Urban stress is another factor driving the epidemic, as the world's poor seek employment in cities, Silink said. For reasons that remain unclear, "we know that simply moving from a rural environment to a city doubles your risk of diabetes without any change in body mass," he said. "And if you have to go to a 'mega-city' -- a population of over 10 million -- the risk probably rises fourfold."

Another expert said it's not too late to put the brakes on this developing crisis, however.
Dr. Alan Moses was the former chief medical officer of Harvard's Joslin Diabetes Center and is now associate vice president of medical affairs at pharmaceutical giant Novo Nordisk, which sponsored the conference.

"We tend to think of the costs associated with diabetes and worry that putting appropriate resources into diabetes is going to cost more," he said. "But diabetes is one of the few conditions where when you improve health, you actually reduce the cost burden on society. It should be viewed as an investment with a real return."

Certain steps taken by governments in the developed world are already helping. For example, Sen. Guy Barnett of Australia, himself a type 1 diabetic, said his government is moving to change what he labeled an "obesinogenic" environment Down Under.

Along with the United States, "we are one of the fattest countries on Earth," Barnett told reporters at a press conference held Wednesday. "But for governments everywhere, (diabetes) is a monster that is getting bigger and bigger."

With one in 10 Australian children now obese, the Australian government has mandated healthy school lunches, boosted funding for after-school physical activity programs and negotiated with fast-food giant McDonald's to make menus healthier. Former U.S. President Clinton helped broker similar deals with food companies last year to keep unhealthy sodas and snacks out of American schools.

Those and other initiatives can and should be tested in countries worldwide, Silink said. In one sense, he said, developing countries have a real edge on the West, since "they are still in the process of developing their new towns, their urban centers.

"So, in terms of town planning, societal engineering, they have a chance to engineer it for health and not for conditions that are detrimental to human health," Silink said. "It's up to the diabetes world to work with the various organizations to make this happen."

More information
Find out more about diabetes at the American Diabetes Association.

Sleeping Pill Wakes Woman After 2 Years in Coma

(HealthDay News) -- A dose of the prescription sleep aid Ambien had the opposite effect on one French woman, awakening her from a two-year coma.

The 48-year-old woman suffered from akinetic mutism -- a sort of persistent coma in which the patient is alert but can neither speak nor move. She had lain in this state after sustaining damage to the frontal lobe of her brain due to a lack of oxygen caused by an attempted suicide by hanging.

But one day she was given zolpidem (Ambien) to treat ongoing insomnia.

"Twenty minutes later, her family noticed surprising signs of enhanced arousal," the study authors wrote. "She became able to communicate to her family, to eat without (swallowing) troubles, and to move alone in her bed. These effects started 20 minutes after drug administration and lasted for two to three hours."

After treatment, the patient could walk for short periods, and to speak if prompted, though not spontaneously. "This phenomenon was so reproducible that caregivers used to give her up to three tablets each day without sleepiness as 'side effect,' " the researchers wrote.

Using positron emission tomography (PET) scans, the researchers found that the drug treatment caused the woman's frontal lobes to become "way more active," noted Dr. James Grisolia, a neurologist at Scripps Mercy Hospital in San Diego. He was not involved in the research, which was led by Dr. Christine Brefel-Courbon, of the University Hospital in Toulouse, France.

Speaking of the case, Grisolia said that, "It is a function of drugs like this that, besides putting you to sleep, they can also increase blood flow. And that activity apparently trumped the sleepiness caused by the medication in this one patient," he explained.

The results are published in the March issue of Annals of Neurology.

"This is a clinical mini-miracle that may give more insight into how the brain works," Grisolia added. "In the long run, it might help us to help other people that are in unresponsive or semi-coma states."

According to Grisolia, other case reports have shown coma patients "awakening" through stimulant medications, but never from a medication like zolpidem. How the drug worked its magic in this case remains unknown. "It needs case reports and further study in the lab to get a handle on this," he said.

Dr. Tetsuo Ashizawa, professor and chairman of the department of neurology at the University of Texas Medical Branch, Galveston, called the report "interesting." But he cautioned against using such a single-patient study as a basis for treating other, seemingly similar cases.

"I understand the desire of the family member to give Ambien to patients" as a result of this study, he said, "but I would not tell them that they should expect improvement. As a physician, I would say this worked in this lady but it may not work in your father or mother, so they should not have unreal expectations. If it works, OK, but if it doesn't, don't be disappointed."
Still, Grisolia said he expects more reports on the effect of zolpidem in akinetic mutism will be published as a result of this study.

"I'm sure that anyone that has a relative who is in a long-term coma is going to be interested in having the doctor try Ambien and see if it makes a difference. So we may get more case reports very quickly," he said.

A spokeswoman for Sanofi-Aventis, the pharmaceutical company that manufactures Ambien, declined to comment on the study.

More information
For more information on zolpidem, visit the U.S. National Library of Medicine.

Researching Alternatives: A Talk With Donald Abrams

By Bob Huff
June 2003
You have a reputation as being a rigorous clinical researcher and tough advocate for making evidence-based treatment decisions.

Yet you've also been very open to studying a number of alternative and complementary therapies that have been used in the HIV patient community. How did all these concerns come together and what are you involved with these days?

I was training in oncology at UC San Francisco just as the first AIDS cases were reported. I helped found the AIDS program there and I've been participating in academic clinical research for over 20 years. More recently I've become an associate fellow of the Program in Integrative Medicine at the University of Arizona that was founded by Andrew Weil.

This is a two-year program, mostly online, that is increasing my training and background in integrative medicine, including things like botanical medicine, manual medicine, and spirituality. It's been a stimulating experience so far and I'm really enjoying it.

I've been interested in complementary medicine since the very beginning of my career, so one of the reasons I'm doing the fellowship is to learn more that I can integrate into my own healthcare discussions with my patients. Of course another impetus is to see what other things we might want to do clinical research on.

My intention is to continue to investigate the complementary and alternative approaches that our patients are using. We want to determine whether or not they may be beneficial, but also determine whether or not they may be harmful, particularly in how they interact with the conventional medications that patients are taking.

In the earliest days of AIDS we didn't have any treatment for this new disease; people were dying and everybody was frightened. Being here in San Francisco, we were near the Linus Pauling Research Institute in Palo Alto, so there were a number of people in the city who were proponents of high doses of Vitamin C.

One of the first responses we saw in the early '80s were storefront clinics opening up where people went to receive intravenous injections of very high doses of Vitamin C.

At that point in time we didn't even know that it was a virus causing the disease. So I used to go around on the lecture circuit with someone who would talk to audiences of concerned people who listened to him while hooked up to intravenous infusions of Vitamin C.

Then I would speak as the academician who cautioned people that we really don't know if this is beneficial and there may be some dangers to being hooked up to intravenous vitamin C, and so on. Ultimately, this led to me to write a grant proposal in collaboration with the Linus Pauling Institute.

It was right about the time we learned that HIV was the cause of AIDS so we wrote a proposal to the NIH to study the in vitro effects of Vitamin C on HIV. That grant didn't get funded.

In San Francisco at that time there were also a number of DNCB proponents. DNCB, dinitroclorobenzene, is actually a photographic chemical used for developing pictures, but it is also a skin sensitizer that had been used to test for delayed hypersensitivity reactions.

There were people who believed that somehow it might be useful in restoring some of the T-cell immunity that patients with this new disease were lacking. So there were people who would paint themselves weekly or so with DNCB until they developed these skin reactions, thinking that the skin reaction was some sort of improved T-cell immune response that would help combat the virus.

And again, seeing that people were using this and seeing that we really didn't have much else happening, I worked with some of the DNCB proponents, as well as some experts from the University of California -- I remember Jay Levy was involved, as was Marcus Conant and others -- and we wrote a protocol that we submitted to the FDA for funding. That also was rejected.

Around the time that AZT first became available in 1986, I went to a conference in Japan where I was introduced to some investigators from the Ueno Fine Chemicals company who told me that they had the cure for this disease. They said it was something that was very commonly used in Japan but they couldn't tell me about it until I signed a confidentiality agreement.

That turned out to be dextran sulfate. Not long after I was going through the process of filing the paperwork to get approval from the FDA to do a phase I study of dextran sulfate in the United States when evidently some people heard about it.

They realized that it was a product that was widely available in Japan -- I believe it was used for lowering cholesterol -- so they started an importation scheme similar to what had happened in earlier days with isoprinosine and ribavirin, which were brought across the Mexican border.

But people had now become more sophisticated in their methods and began to import dextran sulfate from Japan to sell in the underground AIDS therapy market.

I remember that activists stormed the offices of a Japanese drug distributor in New York for refusing to make dextran sulfate more widely available. Ultimately it became such a political issue that, even though my clinical trial here in San Francisco didn't show much benefit, Congress got involved and the AIDS Clinical Trial Group (ACTG) was asked to do a study of dextran sulfate through the NIH-funded mechanism. It turned out the drug was not even absorbed into the blood.

Another Japanese product I worked with was lentinin, which was an intravenously administered extract of shiitake mushroom. In Japan it was felt to be an immune booster for patients with cancer. Although it was being used by mainstream doctors in Japan, it was an alternative therapy here because it was not something that we had ever learned about or used in hospitals in the U.S. That's David Eisenberg's description of what an alternative therapy is -- that it's not taught about in medical schools or widely available in U.S. hospitals -- and certainly shiitake mushroom extracts qualified. Again, that's another study we did that had negative findings;

there was no benefit to the intravenous infusions of lentinin. Since I've learned more about botanicals, it would seem to me that if there were immune enhancing benefits to shiitake mushrooms then they are more likely to be obtained by eating them rather than by injecting an extract intravenously.

During that time I was also involved with studies of conventional therapies. Even in the days of early AZT monotherapy, which I was not a big supporter of, I was involved in trying to put some evidence behind the claims of the proponents for these various agents. And since that time, I've had a constant history of investigating conventional therapies through the federally-funded CPCRA (Community Programs for Clinical Research on AIDS), and more recently through the ESPRIT study of interleukin 2, as well as in other, sometimes pharmaceutical industry-sponsored trials. But always ongoing with those studies, I've been involved with clinical trials of complementary and alternative interventions.

When we first became aware of immune thrombocytopenic purpora (ITP) in AIDS, I worked with a nurse who was very interested in therapeutic touch and we studied men with low platelet counts to see if therapeutic touch could decrease their stress and increase their platelet counts. That was another study that turned out to be fairly negative.

I then became interested in traditional Chinese medicine (TCM) and, in fact, one of the colleges of TCM here in San Francisco sent me to China in 1989 just to learn about Qigong (Chi Kung) -- that exercise that's felt to improve the immune system -- to see if it was something that I wanted to study here. Although I never studied Qigong I collaborated with Misha Cohen from the Quan Yin Healing Arts Center here in San Francisco. We did three studies of traditional Chinese herbal interventions for, first, symptomatic HIV, then for patients with diarrhea without a pathogenic source, and then another study for patients with anemia.

The last two were hindered by the fact of being initiated about the time that HAART became available, so patients with diarrhea as well as anemia became scarce. There were also a lot of pills that needed to be taken in these Chinese herbal investigations and patients at that time were taking huge amounts of pills with their antiretroviral regimens, so the studies weren't very attractive. None of these studies had spectacular results and the anemia study was terminated for poor enrollment.

Have "soft endpoints" such as life satisfaction created a problem for designing and conducting credible studies?

The TCM herbal study that we published in 1996 investigated herbs versus placebo in symptomatic HIV infection. At the time of the study in 1993, we had patients with about 14 symptoms on average and we found that there was a significant decrease of symptoms in the herb-treated group -- they decreased from 14 to 12 -- whereas the other group still had 14 symptoms. We also found that they had improved "life satisfaction" which improved by a factor of +0.86 or thereabouts.

Yet, if you look at the rest of the results, the Chinese herbal patients actually lost weight over 12 weeks compared to the placebo group, and their CD4 counts also dropped -- not statistically significant, but it was a trend. So that was an example of where their symptoms improved and their life satisfaction increased, but the parameters that we would normally look at to see if a patient is doing well (i.e., weight and CD4 count) went in the wrong direction. So, although I was also first author on a study that showed that epoetin alfa improves quality of life in HIV patients who are anemic, I'd have to say that a study whose main endpoint is quality of life is something I would find difficult to interpret.

The CPCRA actually did a large study of acupuncture for patients with HIV-related peripheral neuropathy that was published in JAMA. That was a landmark, having the NIH support an acupuncture study, although, again, it turned out to have negative results; acupuncture didn't appear to be effective in treating peripheral neuropathy.

About this time I began trying to study another botanical, which has consumed my efforts for the past decade, and that would be cannabis, or marijuana. Starting in 1992 I began proposing and developing clinical trials to investigate first the effectiveness -- but then I realized that that wasn't going to happen -- so subsequently, the safety of smoked marijuana in patients with HIV.

We finally completed a study in the year 2000, that we hope will soon be published, that looked at the safety of marijuana in patients taking protease inhibitor regimens. And since that time we have obtained funding from the State of California that allows us now to conduct clinical trials to look at the potential effectiveness of smoked marijuana in patients with various syndromes. We have also just completed a pilot study in patients with HIV peripheral neuropathy, which allowed us to ascertain that there was some effectiveness of marijuana. But an open-label pilot study is not going to prove that, so we're now in the process of continuing on with a randomized, placebo controlled, double-blind trial in patients with HIV-related peripheral neuropathy. We're also doing marijuana studies in patients with cancer who have pain who are on opioid analgesics, and another study to look at the effect of smoked marijuana in patients who have delayed nausea and vomiting from breast cancer chemotherapy.

It was working with marijuana and all the problems that are inherent in studying a plant as a therapy that has led me to a broader interest in botanicals and the use of substances that come from nature as medicinal agents. Certainly, for thousands of years, people have depended primarily on these things. Whether or not they worked is unclear, but as an oncologist I know that many of my most potent chemotherapeutic agents were derived from plants. So right now we are waiting to hear if a protocol we submitted to the National Center for Complementary and Alternative Medicine (NCCAM) to investigate the lipid lowering effects of oyster mushrooms in patients on Kaletra is being funded. There's good evidence that mushrooms, including oyster mushrooms in particular, have some activity for lowering blood lipids and cholesterol.

We're also just finishing a three-year NCCAM grant studying the effects of DHEA, dehydroepiandrosterone, which is an over-the-counter adrenal steroid that people are taking for many reasons. We received a grant to investigate it as an antiviral and to see what impact it has on the immune system. Hopefully that data will be available by the end of the year and we will know if DHEA had any impact, positively or negatively, in our patients.

The goal, ultimately, would be to submit a center grant to the NCCAM, to allow us to establish a center here for the study of botanicals in HIV because there are still a number of herbal preparations and mushroom extracts that warrant further investigation for their potential benefit -- and to make sure that they're not harmful in our patients.

Safety keeps coming up again and again as one of the inarguable justifications for doing this research.

There's not a huge amount that we know about some of these botanical products and how they're metabolized, but there's probably more than people think. There are a number of textbooks available that talk about herb-drug interactions. That was the question in our marijuana study: is there an interaction between cannabinoids and protease inhibitors, which are both metabolized by cytochrome P450 enzymes in the liver, that may alter the activity of the protease inhibitors such that patients lose their viral suppression when they mix cannabis with their treatments?

And in fact, in our article that was already published in AIDS, we saw no such effect. We've all heard about garlic and St. John's Wort and their interactions, and I think there are many other agents that we would like to study to make sure that they are not having significant interactions with protease inhibitors. We don't want people to either lose control of their viremia (through underdosing) or experience toxicity (through overdosing) because of antiretroviral concentrations that have been affected by herb-drug interactions.

You had to be enormously persistent to accomplish your marijuana study. In the current political climate, is it going to be more difficult to do marijuana studies?

I think we're blessed to live in the State of California, which is somewhat of a freestanding republic in and of itself. In 1996, the people of California voted to allow physicians to talk to their patients about the medicinal use of cannabis. Then, through the work of Senator John Vasconcellos, one of our state senators, appropriations were made to the University of California that established the Center for Medicinal Cannabis Research (http://www.cmcr.ucsd.edu/). And that Center has had funds for the past three years that allows it to support clinical trials to investigate the use of marijuana for medicinal purposes.

Whereas the NIH and NIDA, via their congressional mandate, could only give marijuana to clinical trials that show that it was harmful (they are the National Institute on Drug Abuse, not for Drug Abuse, as NIDA's director Alan Leshner always reminded me), they were not really able to provide us with marijuana to study the benefits. But now, they have modified their system so they can provide marijuana for peer reviewed clinical trials that will look at its effectiveness as a therapeutic agent -- as long as they are not funding it. So they have now created this ability for us to obtain government marijuana.

Is there a need to increase provider knowledge about these issues?

I think a part of the problem is a lack of communication from both sides. Patients don't really perceive that these substances are something that they need to tell their doctor about -- in fact many studies show they don't want to tell their doctor because they're afraid they're going to be reprimanded or told that they're wasting their money. And many physicians never even think about asking about these things as potential confounders or as things that are causing clinical symptoms.

There also may be a variable of where in the country you are. I know many surveys show that we in the West have the highest percentage of people in the population who are using complementary and alternative interventions. So many of my colleagues here might be more familiar with how to ask the question and what to be looking for.

I remember once seeing a patient at our drop-in clinic who clearly had a drug rash. I looked through his chart -- this was when we had paper charts -- and he had a high CD4 count and a low viral load but he wasn't taking any medications.

So I said to the guy, "You're not taking any medications, huh?" And he said, "No."
"Are you taking any vitamins?" And he said, "Yeah."

So I asked him what he took and he listed about four or five vitamin preparations. Then I asked, "Do you take any herbs?" And he said, "Sure."

And so I listed the three or four herbal substances th
at he took.
"Do you take any minerals?" And he said, "Yeah."
By the time I finished I had a list of 12 different things he was taking.
So I asked, "Well, how come everybody else wrote down that you don't take anything?" And he said, "Well, nobody ever asked me before."


more info at:
http://www.dreddyclinic.com/integrated_med/integrated_med.htm

What Happened to That Imaginary Bird Flu Epidemic?

The strain of bird flu that can be deadly to humans appears not to have moved through the world with migrating flocks of wild birds, despite scientists' fears.

Thousands of wild birds were tested in a wide variety of countries. There was no sign of the virus at all in Africa, and only sparse detections in Europe. It is unknown to scientists why bird flu is not spreading in the wild more widely and quickly. (But not unknown to us when we understand the New Biology)

More than 13,000 wild birds were tested since February in the Netherlands, a major bird migration route. None have carried the virus. The EU has started to ease restrictions in recent weeks, but continues to strictly regulate poultry in farms near wildlife water reserves and river deltas.

Despite all those 'Chicken Little' warnings from so-called 'health experts,' that rumored bird flu epidemic -- predicted to kill some 2 million Americans -- turned out to be a whole lot of hot air.

When you know the true cause of dis-ease which is the over-acidification of the blood and tissues due to an inverted way of living, eating and thinking then you understand this imaginary bird flu virus has more to do about selling more drugs and making more money for big business then protecting our health.

For more information on the truth about viruses read our book, Sick and Tired and the Second Thought About Viruses, Vaccines and the HIV/AIDS Hypothesis. Sick and Tired can be found at your local book store or on our website at: http://www.dreddyclinic.com/ and

www.dreddyclinic.com/online_recources/articles/disease/what_bird_flu.htm


References:
New York Times May 11, 2006
Boston Globe May 11, 2006
USA Today May 11, 2006
Mercola #799

HIV-Infected Intestinal Immune Cells Never Rebound

(HealthDay News) -- Within a few weeks of being infected by HIV, most of a person's memory T-cells vanish and are not likely to return even after years of antiretroviral treatment, a new study finds.

Previous research has shown that HIV infection depletes memory T-cells -- which are mostly found in the intestinal tract -- within days. In contrast, T-cells circulating in the blood typically decline over several years, according to background information in the article.

It's known that T-cells in the blood can return to normal levels when HIV patients take antiviral drugs. But it wasn't clear whether intestinal memory T -cell levels returned to normal.

In this study, researchers at the Aaron Diamond AIDS Research Center in New York City and elsewhere performed intestinal biopsies on HIV patients who had started treatment shortly after they were infected.

Reporting in the journal PLoS Medicine, the researchers found that intestinal T-cell levels remained low in 70 percent of patients even after several years of HIV treatment.
The findings indicate the doctors treating HIV patients need to watch for infections or other gastrointestinal problems that could result from prolonged impairment of intestinal immune function, the researchers said.

The study results also suggest the need to conduct studies on treatments to preserve immune function in people newly infected with HIV.

More information
The U.S. National Center for HIV, STD and TB Prevention offers advice about living with HIV/AIDS.

Earlier HIV Therapy Helps Beat Back Hepatitis C

(HealthDay News) -- Starting HIV antiretroviral therapy earlier than generally recommended may lead to better control of the hepatitis C virus in people also infected with HIV, a new study finds.

Infection with both hepatitis C and HIV is a growing problem, say researchers at the Partners AIDS Research Center at Massachusetts General Hospital, Boston.

While the immune systems of many people infected with the hepatitis C virus (HCV) are able to naturally control levels of that virus, this natural control may be lost in people who are also infected with HIV, the virus that causes AIDS.

"The global burden on health of chronic viral infections is immense, and HCV and HIV are chief among culprit viruses," study co-author Dr. Arthur Kim said in a prepared statement.
"Due to shared routes of transmission, infection with both viruses is common. Unfortunately, HCV behaves as an opportunistic infection in the presence of HIV and is becoming a leading cause of illness and death in persons with HIV," Kim said.

This study included 60 people infected with both HIV and HCV, and 17 infected only with HCV. The findings suggest that, in people infected with both viruses, it may be beneficial to start antiretroviral therapy before levels of immune system CD4 helper T-cell levels drop too low to maintain control of HCV.

The findings appear in the December issue of PLoS Medicine.
"Currently, a nationwide trial is recruiting people for a study examining whether earlier treatment of HIV will improve hepatitis C treatment outcomes," Kim said. "Part of this study will investigate how earlier treatment may affect immune responses."

More information
The U.S. Centers for Disease Control and Prevention has more about HIV/HCV co-infection.

Circumcision Reduces HIV Rates, U.S. Studies Confirm

(HealthDay News) -- U.S. researchers in Africa said Wednesday that they found that circumcision is such a good defense against HIV infection that they shut down two studies early, and instead offered all participants a chance to be circumcised.

One study in the east African country of Kenya showed that circumcision cut adult males' HIV infection risk from heterosexual intercourse by 53 percent, while another study in Uganda lowered the risk by 48 percent, according to results released Wednesday.

The findings, financed by the U.S. National Institutes of Health (NIH), pointed out that the latest conclusions confirmed previous investigations into the value of circumcision as a protection against HIV, the virus that causes AIDS. This is especially important in Africa, where AIDS is an epidemic in many countries, infecting an estimated 25 million people on the continent.

Despite the good news, there is still plenty of reason for caution, AIDS experts said.
"Male circumcision is a difficult intervention to implement, and the preventive effect is relative, not absolute," said Thomas Coates, an AIDS specialist and a professor of medicine at the University of California at Los Angeles. "The magnitude of effect is 50 to 60 percent, which still leaves ample room for people to get infected with HIV."

There are other caveats as well: The study did not look at male-to-female transmission, and it was also not clear whether circumcision makes it less likely that gay men could transmit HIV to each other.
In the United States, homosexual transmission of HIV is more common than heterosexual transmission, the experts said. And most men in the United States are circumcised, making the procedure less effective as a possible prevention tool.

Still, the findings could have plenty of meaning in Africa, where HIV is commonly spread between men and women.

Studies have suggested the value of circumcision in the past, but researchers wanted to confirm the previous findings.

According to the NIH, most adult Africans are circumcised, but the rate drops below 20 percent in some areas of southern Africa where HIV and AIDS are common.

In one of the two studies, researchers enrolled 2,784 HIV-negative, uncircumcised men in Kenya beginning in 2002. The other study, in Uganda, started in 2003 and enrolled 4,996 HIV-negative, uncircumcised men.

Some of the men were assigned to immediately undergo circumcision, while others had to wait two years.
Then researchers studied whether the circumcision had any effect on their rates of getting HIV.
The results were so encouraging that an oversight board halted the studies this week, and ordered that all participants be given circumcisions instead of having to wait.
In Kenya, researchers found that only 22 of the 1,393 circumcised men in the study were infected with HIV, compared to 47 of the 1,391 men who had yet to be circumcised.

The numbers for Uganda weren't immediately available.
"Circumcision is now a proven, effective prevention strategy to reduce HIV infections in men," Robert Bailey, a study investigator and professor of epidemiology at the University of Illinois at Chicago, said in a statement.

It's not entirely clear how circumcision reduces HIV infection. But researchers have suggested that the foreskin may provide a moist, safe environment for the AIDS virus and provide more immune cells for HIV to infect.

Coates called the study results the "second greatest finding in HIV prevention," right behind research that confirmed drugs could stop mother-to-baby transmission of the AIDS virus.
Still, he added, "combination prevention" remains crucial -- combining circumcision with using condoms, reducing sexual partners, and delaying the first time people have intercourse.

The Associated Press reported that the link between male circumcision and HIV prevention was first noted in the late 1980s. The first major clinical trial, of 3,000 men in South Africa, found last year that circumcision cut the HIV risk by 60 percent.

More information
The Nemours Foundation's Web site discusses the pros and cons of circumcision.