Posted on | June 8, 2012 | No Comments
Dr Francoise Barre-Sinoussi, the noble prize winning scientist, has tantalizingly suggested that a possible cure for Aids may be imminent.
Revealing that she conceives that a cure for HIV is achievable, but is at present unable to give a time span on the much awaited antidote. It is over 30 years since the virus was noted and in the subsequent years more than 30 million people have succumbed to HIV/AIDS. In this time there has evolved many treatments and preventatives to stem the progression of the illness.
Post-SSRI sexual dysfunction is often an unwanted side effect of certain drugs used in the treatment of HIV/aids. Modern Erectile dysfunction treatments such as Pfizer’s Viagra and Cialis manufactured by Eli Lilly can however negate these unwanted side effects.
Posted on | March 7, 2014 | No Comments
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THURSDAY, March 6, 2014 (HealthDay News) — The hope that newborns can be “cured” of HIV — the virus that causes AIDS — with early, aggressive drug treatment was bolstered this week with the announcement that a second baby appears to be free of the virus following therapy that began just four hours after her birth.
The child, born at Miller Children’s Hospital in Long Beach, Calif., is now 9 months old and is considered HIV-negative, researchers reported Wednesday at the Conference on Retroviruses and Opportunistic Infections in Boston.
The first baby apparently cured by early drug therapy — the so-called “Mississippi baby” — is now more than 3 years old and also remains free of HIV infection, said Dr. Deborah Persaud, an associate professor of pediatrics in the division of infectious diseases at Johns Hopkins Children’s Center in Baltimore.
Persaud, who presented the findings Wednesday on the California baby, has also been involved with continued monitoring of the Mississippi baby.
While the two cases have key differences, taken together they seem to indicate that newborns can be cured of infection with HIV if doctors begin treatment within hours of birth.
A federally funded clinical trial will start within a couple of months to arrive at a more scientific assessment of the treatment, said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases.
In the trial, as many as 60 babies who are born with HIV will be put on an antiretroviral drug regimen within 48 hours of birth.
The results of the trial could change the way doctors treat HIV-infected newborns, altering thinking that up until now has favored caution because these drugs can be extremely toxic.
“You have to get the data from the trial. You don’t want to jump ahead of yourself,” Fauci said. “But data that shows when you treat a baby immediately you can actually cure a baby, that changes the equation of risk/benefit. That makes a doctor lean much more toward immediate treatment.”
More than 1,000 babies are born with HIV every day around the globe, according to UNICEF.
The mother of the California baby has advanced AIDS and is mentally ill, researchers said. She had been prescribed HIV medications to protect her baby, but had not taken them, according to published reports.
Normally, doctors put children born to HIV-positive mothers on a two-medication regimen until the virus appears in the babies’ bloodstream, which can take as long as two weeks. At that point, they move to a more aggressive three-drug regimen.
But in the cases of the Mississippi and California babies, doctors chose to quickly put the newborns on the more aggressive regimen, with stunning results.
Fauci noted that doctors can’t yet call the California baby “cured” of HIV infection because she remains on the antiretroviral drug therapy.
“The proof of the pudding is when you take the baby off therapy, and the virus does not bounce back,” he said.
The Mississippi baby provides a more striking case because doctors lost track of the mother and child 18 months after her birth, at which point drug therapy ceased. Doctors next saw the child about 10 months later, and were surprised when they found that the girl remained HIV-free despite receiving no further treatment.
“You can say with a much higher degree of confidence that the Mississippi baby is definitely cured,” Fauci said.
The timing and the heavy medication dose apparently may have prevented HIV from gaining a foothold in the infants’ immune systems, said Dr. Roberto Posada, an associate professor of pediatric infectious diseases at the Icahn School of Medicine at Mount Sinai, in New York City.
HIV typically creates a reservoir in the bodies of those it infects, where it can lay dormant and later return when drug therapy is suspended.
Because adults often don’t find out they have been infected until months or years later, it’s unlikely that the successful treatment of these babies would have any implications for adult HIV therapy, Posada noted.
“It’s difficult to extrapolate these results to adults because babies are so different from adults,” he said. “Their immune systems are at a different stage of development, and you know exactly when they have been infected with HIV — at birth.”
At the same time, these findings do emphasize the importance of treating HIV in adults as early as possible, Fauci said.
Article source: http://www.nlm.nih.gov/medlineplus/news/fullstory_144972.html
Posted on | March 7, 2014 | No Comments
For the first time gene therapy has been used to boost the immune system of people with HIV.
Scientists in the US have modified the genes of HIV patients which might mean that in future they would not need to take daily medication.
It is estimated there are more than 35 million people infected with HIV around the world but the use of anti-retroviral drugs has greatly reduced the number of deaths.
Despite that more than 1.5m people die of complications with AIDS every year.
Fergus Walsh reports.
Posted on | March 6, 2014 | No Comments
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WEDNESDAY, March 5, 2014 (HealthDay News) — In an early step toward drug-free HIV therapy, researchers are reporting the first success in genetically “editing” T-cells in patients’ immune systems to become resistant to the virus.
The findings, published in the March 6 issue of the New England Journal of Medicine, are based on only 12 patients. But experts were cautiously optimistic about what the study accomplished.
Specifically, researchers were able to take T-cells from the HIV patients’ blood, then “knock out” a gene known as CCR5, which controls a protein that allows HIV to enter a cell.
The scientists then infused the genetically altered T-cells back into patients’ blood, where they expanded in number. What’s more, a few patients were taken off their HIV drugs temporarily and saw their virus levels decrease.
“This is impressive,” said Rowena Johnston, director of research for amfAR, the Foundation for AIDS Research.
The altered T-cells “actually seem to be doing exactly what [the researchers] wanted them to,” said Johnston, who was not involved in the study.
Still, she said, there are plenty of questions left and much research ahead. The investigators on the study agreed.
“This was a first-in-human study,” said researcher Bruce Levine, an associate professor of cancer gene therapy at the University of Pennsylvania School of Medicine, in Philadelphia.
That means the trial was designed to see whether it’s even safe to use this approach in people with HIV — and not whether it’s an effective therapy.
The T-cell infusions did appear safe in the short term: Of the 12 patients, only one had a temporary reaction — developing fever, chills and joint pain within 24 hours of the infusion.
“Right now, we’re at the point where we’ve demonstrated safety and feasibility,” Levine said.
Ultimately, scientists want to develop a “functional” cure for HIV — where people’s immune system cells are resistant to the virus, and they can stop taking the lifelong, daily drug regimens currently used to suppress the infection.
Those drugs have turned HIV into a manageable chronic disease for many. But, Levine said, they are costly, cause side effects, and for some people, eventually lose their effectiveness.
No one knows whether the technology used in this study will eventually offer a functional cure. But Levine said there were “hints” that, with further refinement, it could.
One month after the T-cell infusion, half of the study patients stopped their regular HIV drug regimen for up to 12 weeks. Initially, the patients’ “viral load” increased, but for the four who were able to stay off their medication for the full 12 weeks, the viral load declined toward the end.
There were also signs that some of the modified T-cells were resistant to HIV: When patients stopped their medications, the infused T-cells did decline in number — but not to the extent that their unmodified T-cells did.
HIV researchers have been studying the CCR5 protein for years. It’s long been known, Levine said, that the protein allows HIV to gain entry into cells. And people who have a particular mutation in both copies of their CCR5 gene (inherited from both parents) are protected from HIV infection.
CCR5 research has gained momentum in the past several years — particularly after the famous case of the “Berlin patient,” who is considered the first person to be cured of HIV.
That patient, whose real name is Timothy Ray Brown, was HIV-positive back in 2007, when he underwent a bone marrow transplant to treat leukemia. His bone marrow donor carried two copies of the CCR5 mutation, and the transplant not only cured his cancer, but also knocked his HIV levels below the threshold of detection. He has been off of HIV drugs since 2008.
For the current study, Levine and his colleagues tried to mimic that CCR5 mutation using what’s called a zinc-finger nuclease — which is basically an artificial enzyme that can snip DNA at a specific site.
That effectively knocked out the CCR5 gene in 11 percent to 28 percent of patients’ T-cells before they were re-infused.
Levine said one of the more immediate goals now is to make the process more efficient. Right now, the technology knocks out both copies of CCR5 in some cells, but only one copy in others.
“Ideally, you’d like both copies knocked out,” Levine said.
Of the four patients in this study whose viral levels declined after stopping their medication, one had undetectable HIV levels when the drug treatment was restarted. Levine’s team later found that the patient naturally carried one copy of the CCR5 mutation.
So that patient, Levine said, essentially got a “head start,” because there was no need for both CCR5 copies to be knocked out.
For her part, Johnston agreed that boosting the efficiency of the CCR5 knockout technique will be key. She said it also has to be tested in larger and more diverse groups of people with HIV, and researchers need to understand how the immune system responds over the long term.
And the “holy grail,” Johnston said, would be to apply gene therapy to the bone marrow stem cells that give rise to the immune system, and not only T-cells.
Worldwide, more than 33 million people are living with HIV/AIDS, and 97 percent of them are in low- to middle-income countries, according to the U.S. Department of Health and Human Services.
If this or any other gene therapy were found to control HIV without the use of drugs, there would still be the questions of how to get it to people, and how to pay for it.
According to the World Health Organization, most people living with the disease globally do not have access to the current treatments.
But Johnston said she believes that if scientists can develop an effective gene therapy, others would find a way to get it to people living with HIV.
“I’m optimistic,” she said. “For many years, people didn’t think it would ever be possible to cure HIV. Now the question is no longer, ‘Is it possible?’ It’s ‘How are we going to do it?’”
The study was partly funded by Richmond, Calif.-based Sangamo BioSciences, which is developing the zinc-finger nuclease technology used in the research. Several co-researchers on the work are employees of the company.
Article source: http://www.nlm.nih.gov/medlineplus/news/fullstory_144949.html
Posted on | March 6, 2014 | No Comments
A radical gene therapy to combat HIV using genetically modified cells that are resistant to the virus has been declared a success by scientists following the first clinical trial.
The treatment, which has never been tested on humans before, raised patients’ defences against HIV by replacing some of their natural immune cells with GM versions.
Tests on people enrolled in the trial found that the disease-resistant cells multiplied in their bodies.
Half of patients were taken off their usual drugs for three months and scientists recorded reduced levels of the virus.
Scientists were cautious not to draw strong conclusions from the small scale trial, which was designed to assess the safety of the therapy, but the early signs have raised their hopes.
“We are absolutely encouraged by these results,” said Bruce Levine, who helped to run the trial with a colleague, Carl June, at the University of Pennsylvania. “This is potentially a new therapy for HIV.”
A few shots of modified immune cells, or perhaps even one large infusion, could become an alternative for HIV patients who currently face spending the rest of their lives on antiretroviral drugs. But Levine said any improvement in the patients’ health would be welcome, even if the therapy had to be used alongside existing treatments.
“People diagnosed in their 20s are on antiretroviral therapy for the rest of their lives. There are side effects. People miss days. And there is drug-resistance. This is a continuing problem,” he said. “Cure is a four letter word. We don’t like to use it, particularly with HIV. We are looking at improving the health and immune function of people with HIV,” he added.
The therapy mimics a rare but natural mutation that makes about 1% of the population resistant to the most common strains of HIV. To infect cells, the virus must latch on to proteins that poke up from the surfaces of the cells. But people with the mutation lack the right protein, called CCR5, so HIV cannot get inside their immune cells. The trial centred on 10 men and two women, aged 31 to 54. All were HIV positive, and had been diagnosed between three and 23 years ago.
The scientists began by collecting white blood cells from each of the HIV patients. They then used a procedure called gene editing to modify the cells, so that they carried the rare mutation that makes people resistant to HIV. Finally, they multiplied these cells in the lab and infused a batch of 10 billion back into each patient.
At the start of the trial, all of the patients were on standard antiretroviral therapy. But after infusing them with modified immune cells, six were taken off their usual drugs. As expected, the amount of HIV virus in their bodies began to rise. But as the freshly-injected immune cells multiplied and circulated, they pushed levels of the virus back down again.
Two of the patients were put back on their usual drugs early, because their HIV came back very quickly. But the remaining four showed improvements. In one patient, levels of HIV fell so low they could not be detected. The scientists later found out that he had inherited the rare resistance mutation from one parent, but not the other. “That effectively gave his immune system a head start,” Levine said.
As expected, the infusions led to a rapid rise in the number of immune cells circulating in the patients, but the number of modified cells fell over time, halving roughly once every year. But in patients taken off their drugs, the modified cells fared better than their natural immune cells, presumably because they were more resistant to the virus. Some of the modified cells have lasted for several years. The trial has been running since 2009. All of the participants in the trial are now back on antiretroviral drugs.
Scientists have been excited about the prospect of genetically modifying patients’ immune cells to make them resistant to disease since doctors effectively cured an HIV patient in 2008. Timothy Brown, also known as the Berlin patient, had a bone marrow transplant to treat his leukaemia. Spotting their chance to treat both conditions, his doctors found a donor who carried the rare mutation that made their immune cells resistant to HIV. Immune cells are made in the bone marrow. Since the operation, Brown has had no detectable level of HIV in his body and no longer takes anti-HIV drugs.
Bone marrow transplants are risky operations and cannot be given to everyone with HIV. But modifying patients’ immune cells might be the next best thing. One shortcoming of the latest therapy is that the patients still make normal immune cells, which can and will be infected by the HIV virus.
Levine said one hope for the future was to genetically modify stem cells in the patient’s bone marrow that grow into immune cells. Those patients might then produce a steady flow of resistant immune cells, leaving HIV nowhere to hide.
The World Health Organisation estimated that in 2012, 35.3 million people globally were infected with HIV. Some 2.3 million became infected that year, with more than 1.5 million dying from Aids-related causes. Around 100,000 people live with HIV in the UK, though an estimated fifth are undiagnosed and do not know about their condition.
The latest treatment was not without its problems. Writing in the New England Journal of Medicine, the authors report a total of 130 mild or moderate side effects, 32 of which were linked to the modified cells rather than the infusion procedure. The most common reactions were fever, chills, headaches, muscle and joint pain. One patient was taken to the hospital’s emergency department after falling ill. The scientists note too that the patients’ body odour took on the smell of garlic, a consequence of them breaking down dimethyl sulfoxide, used to preserve the genetically modified cells.
The results of the trial were welcomed by other scientists. Angus Dalgleish, an expert in HIV at St George’s hospital in London, who was not involved in the study, said the cost of antiretroviral drugs over a patient’s lifetime, and the side effects some patients face, meant there was a real need for an alternative therapy.
“Anything that will prevent patients being on drugs the whole time, that allows you to manage the infection without those drugs, is a serious contender,” he said.
The research team now hopes to begin larger trials to see how well the therapy works in more patients, and to test the benefits of different doses.
George Church, a geneticist at Harvard University said that the Pennsylvania team’s therapy was “very important” because it showed that gene editing could be used to help large sections of the population. He and others are working on new forms of gene editing that could allow more precise genetic modification of human cells.
In an editorial accompanying the report, Mark Kay and Bruce Walker at Stanford and Harvard Universities wrote: “The tantalising question raised by the transient treatment interruption is whether it might actually have been partially effective. A definitive answer to this question will require additional studies.”
Posted on | March 6, 2014 | No Comments
6 March 2014
Last updated at 00:44
The human immunodeficiency virus (HIV) attacks the immune system
US researchers have revealed another baby carrying the HIV virus, which leads to Aids, may have been cured through early treatment.
Antiretroviral drugs were reportedly administered to the baby in California just four hours after birth.
The unidentified nine-month-old child is now said to be HIV negative.
It is the second such case after an HIV-positive Mississippi infant brought into remission following early treatment was reported in 2013.
‘Not without risk’
“This is a call to action for us to mobilize and be able to learn from these cases,” Johns Hopkins University paediatrics specialist Dr Deborah Persaud said at a Boston medical conference.
No trace of the virus can now be found in the infant’s blood or tissues, the doctor revealed.
Dr Persaud said the nine-month-old child is still receiving a three-drug anti-Aids cocktail, while the three-year-old Mississippi child stopped receiving antiretroviral treatments two years ago.
“Really the only way we can prove that we have accomplished remission in these kids is by taking them off treatment and that’s not without risk,” Dr Persaud added.
Both children are reported to have been born to mothers infected with HIV, which weakens the body’s immune system.
The human immunodeficiency virus has infected more than 34 million people worldwide, researchers estimate.
Posted on | March 6, 2014 | No Comments
6 March 2014
Last updated at 03:07
HIV budding out of a T-cell, part of the immune system.
Doctors have used gene therapy to upgrade the immune system of 12 patients with HIV to help shield them from the virus’s onslaught.
It raises the prospect of patients no longer needing to take daily medication to control their infection.
The patients’ white blood cells were taken out of the body, given HIV resistance and then injected back in.
The small study, published in the New England Journal of Medicine, suggested the technique was safe.
Some people are born with a very rare mutation that protects them from HIV.
It changes the structure of their T-cells, a part of the immune system, so that the virus cannot get inside and multiply.
Continue reading the main story
What if we can now take the leap to an upfront treatment that can last for years?”
Prof Bruce Levine
University of Pennsylvania
The first person to recover from HIV, Timothy Ray Brown, had his immune system wiped out during leukaemia treatment and then replaced with a bone marrow transplant from someone with the mutation.
Now researchers at the University of Pennsylvania are adapting patients’ own immune systems to give them that same defence.
Millions of T-cells were taken from the blood and grown in the laboratory until the doctors had billions of cells to play with.
The team then edited the DNA inside the T-cells to give them the shielding mutation – known as CCR5-delta-32.
About 10 billion cells were then infused back in, although only around 20% were successfully modified.
When patients were taken off their medication for four weeks, the number of unprotected T-cells still in the body fell dramatically, whereas the modified T-cells seemed to be protected and could still be found in the blood several months later.
The trial was designed to test only the safety and feasibility of the method, not whether it could replace drug treatment in the long term.
Prof Bruce Levine, the director of the Clinical Cell and Vaccine Production Facility at the University of Pennsylvania, told the BBC: “This is a first – gene editing has not to date been used in a human trial [for HIV].
“We’ve been able to use this technology in HIV and show it is safe and feasible, so it is an evolution in the treatment of HIV from daily antiretroviral therapy.”
He says the aim is to develop a therapy that gets people away from expensive daily medication.
Continue reading the main story
The idea of modifying a T-cell to make it resistant and showing it is feasible and they survive – that’s exciting in itself”
Prof Sharon Lewin
“What if we can now take the leap to an upfront treatment that can last for years?”
Such a treatment will be expensive so any benefit will depend on how long people could be freed from drugs and how long that protection would last.
Prof Levine argues this could be several years, which might save money in the long term.
Commenting on the findings, Prof Sharon Lewin from Monash University in Australia, told BBC News: “The idea of modifying a T-cell to make it resistant and showing it is feasible and they survive – that’s exciting in itself.
“What most people are aiming for in HIV is a way you take treatment for a short period of time and that keeps the virus under control.”
She said drug treatment would not be replaced by this, especially in the early stages of the infection.
But it might lead to people eventually replacing drugs with an immune upgrade, but “it’s still a long way off”.
Posted on | March 5, 2014 | No Comments
A baby born with HIV may have been cleared of the virus after doctors gave her treatment for the infection within hours of her birth.
Doctors gave the baby’s mother anti-HIV drugs during labour to cut the risk of passing her HIV on, and began treating the baby four hours after she was born in suburban Los Angeles last April.
Sensitive blood tests suggested that the baby has been completely cleared of the virus, but the infection can hide in tissues and return. “We don’t know if the baby is in remission … but it looks like that,” said Yvonne Bryson, an infectious disease specialist at Mattel children’s hospital at UCLA who consulted on the girl’s care.
Doctors revealed the case at an Aids conference in Boston on Wednesday.
The baby girl could be the second to be freed of HIV after early treatment with anti-HIV drugs. The first case was reported last year, when doctors gave drugs to a baby born in Mississippi. She was treated until she was 18 months old, but doctors then lost contact with her.
When the girl came back to the clinic 10 months later, doctors could find no sign of the infection. Now aged three-and-a-half, she is still clear of HIV.
Posted on | March 2, 2014 | No Comments
1 March 2014
Last updated at 19:20 ET
HIV still carries a stigma in parts of sub-Saharan Africa
Fifteen-year-old Tadisa was never expected to live. Her mother Grace was HIV-positive and passed the virus on to Tadisa at birth.
In the 1990s, thousands of babies born with HIV in Zimbabwe died in infancy, as today’s cheap life-saving drugs were not available in sub-Saharan Africa.
But to the great surprise of doctors, there are thousands of teenagers like Tadisa who have lived with HIV for more than a decade.
When Dr Rashida Ferrand wanted to research these young survivors, she was told none were still alive.
“Five years ago people would shake their heads in disbelief and say: ‘Well, no, nobody survives,’” said the HIV expert from the London School of Hygiene and Tropical Medicine.
“Survival beyond five years is considered absolutely exceptional.”
No-one knows exactly why people like Tadisa survived childhood with untreated HIV.
But while they have lived longer than expected, their lives have not been straightforward.
Many suffer chronic health complications, including disfigurement, and as a result are socially ostracised.
Dr Ferrand now treats these teenagers in Zimbabwe and is a passionate advocate for them.
“These children are more likely to be poor and to have lost their parents to Aids,” she said. “They’ve been shifted around amongst guardians and missed education, so the odds are stacked against them.”
‘Untreated HIV infection’
Sub-Saharan Africa accounts for 69% of the world’s HIV cases. Today, nearly one in 20 adults live with the condition.
Life-saving antiretroviral therapy (ART) has been available for free since 2004 in the region and has transformed the outlook of those with the virus.
But children like Tadisa who survived unexpectedly have often gone untreated, and the complications of untreated HIV – such as damage to the lungs and heart – are debilitating.
“There’s also some brain damage leading to them not being able to perform in school,” said Dr Ferrand. “There are some obvious visible signs of longstanding untreated HIV infection, such as stunting and skin disfigurement.
Part of the problem is a lack of awareness: four out of five children with HIV do not know that they have the virus.
Their medical problems are often put down to normal childhood illnesses and they do not get tested for HIV until they are in their teens.
‘Culture of silence’
Dr Ferrand described a “culture of silence” and said the “most shocking” aspect of her research was that nearly all the older children and adolescents who have tested positive could have been diagnosed earlier.
Two-thirds had been to a primary health care clinic in the previous six months, a quarter had been in hospital at some point in their lives, and more than half had a parent or sibling with HIV.
Despite this, no-one had thought to test them for HIV.
Once tested, there was no standard way for young people to be told of their status, according to research at Harare’s Parirenyatwa Ol Clinic by Dr Ferrand and her colleagues.
They asked 31 patients aged between 16 and 20 how they discovered they were HIV-positive.
Although the advice was for their parents or guardians to tell them, the adolescents preferred to hear the news for themselves.
“I wanted to be told at the clinic just so I know that it’s really true, that I’ve been tested, and it’s true”, said one 17 year-old girl.
Some children had guessed, such as one 17-year-old boy who told the researchers: “My mother was lying to me saying I have a heart problem, I have a hole in my heart. So I decided to say, ‘Okay.’
“But I knew. I knew that when I was coming here I was HIV-positive.”
And sometimes the news was given in an abrupt manner.
“My grandmother told me at home,” said one 18-year-old boy. “I was watching TV. My grandmother came up to me and said: ‘Hey, A, do you know that you’re HIV-positive?’ I said, ‘Okay.’ She said it twice: ‘You’re HIV-positive.’ I just said, ‘Okay.’”
The adolescents learn most about their condition from each other rather than their parents and guardians, the researchers found.
Once diagnosed, they can keep the virus at bay with the free ARTs.
But one reason their guardians did not bring them for diagnosis and treatment was to protect them and their families.
“They fear that if the child is disclosed to, he will go about in the streets or at school telling others and other relatives that don’t know that the parents are positive,” said a counsellor at Parirenyatwa Ol Clinic. “So they will be stigmatized or discriminated against as a family.”
In 2013 a UNICEF report stated that only about a third of children with HIV were receiving ARTs, compared with around two-thirds of adults.
New WHO guidelines say testing should be offered to all adolescents living in areas of the world where HIV is common, particularly sub-Saharan Africa.
Dr Ferrand believes it is an issue of child rights that the young people learn about their HIV status and receive treatment.
Hear Dr Ferrand speaking to Health Check on the BBC World Service.
Posted on | February 28, 2014 | No Comments
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THURSDAY, Feb. 27, 2014 (HealthDay News) — Half of teens who were infected with HIV at birth may face a higher risk of heart attack and stroke when they’re older, new research suggests.
“These results indicate that individuals who have had HIV since birth should be monitored carefully by their health care providers for signs of cardiovascular disease,” said study co-author Dr. George Siberry of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Other research has linked HIV infection and certain HIV medications to higher risk of heart disease. This study — published online in the journal Circulation — examines the potential long-term risk for teens, although it only estimates risk and doesn’t track the teenagers over time.
Siberry and colleagues came to their conclusions after examining results from from the Pediatric HIV/AIDS Cohort Study, a long-term research project that has monitored children and young people infected with HIV — the virus that causes AIDS — since birth.
The new report is based on tests of 165 teens aged 15 or older who were born to mothers with HIV and have taken anti-HIV medication all their lives. The researchers examined their cholesterol levels, blood sugar levels, smoking habits, blood pressure and weight — factors that predict harmful build-up and thickening in the major arteries to the heart.
About half were considered to be at higher risk of heart disease.
“It’s too soon to recommend changing treatment regimens on the basis of our findings,” study first author Kunjal Patel, of Harvard School of Public Health, said in a journal news release.
“Until we can learn more, we can best serve adolescents who have HIV by monitoring their risk factors for heart disease carefully and urging them to adopt other measures that have been found to reduce the risk of heart disease in the general population: exercising, maintaining a healthy diet and not smoking.”
Article source: http://www.nlm.nih.gov/medlineplus/news/fullstory_144850.html
Posted on | February 25, 2014 | No Comments
For Immediate Release: Monday, February 24, 2014
Researchers advise reducing risk through diet, exercise, not smoking
Nearly half of adolescents who have had HIV since birth may be at increased risk for cardiovascular disease — including heart attack and stroke — later in life, according to a National Institutes of Health network study.
The findings are the latest results from the Pediatric HIV/AIDS Cohort Study (PHACS), a multi-site, long-term follow-up study of children and youth who have had HIV since birth, sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and supported by eight other institutes at NIH.
The results are based on clinical assessments of 165 teens age 15 or older with HIV, who were born to mothers with HIV and who have been treated with anti-HIV medications since birth.
The researchers estimated each study participant’s overall cardiovascular risk using a score based on measures of cholesterol levels, blood sugar level, smoking, blood pressure, and weight. The combined score has been shown to predict the presence of buildup and thickening in the major arteries to the heart and abdomen, known to increase the risk for conditions such as heart attack and stroke.
The study results were published online in Circulation.
According to the study authors, previous studies have found that the severity of HIV infection and a history of taking specific HIV drugs are linked to cardiovascular disease in adults. The current study is the first to evaluate overall risk for cardiovascular disease in teens with HIV infection since birth.
The study’s first author was Kunjal Patel, D.Sc., M.P.H., of the Harvard School of Public Health, in Boston. Other authors were from the 14 institutions affiliated with the PHACS Network.
“Our results show that a large proportion of teens who have had HIV their whole lives appear to be at significant risk for cardiovascular disease later in life,” said co-author George Siberry, M.D., of NICHD, one of the NIH institutes supporting the study. “These results indicate that individuals who have had HIV since birth should be monitored carefully by their health care providers for signs of cardiovascular disease.”
To calculate a participant’s cardiovascular disease risk, the researchers used a scoring system called the Pathobiological Determinants of Atherosclerosis in Youth, or PDAY. The PDAY score is calculated on the basis of a person’s cholesterol levels, blood sugar levels, weight, and other factors known to influence risk of cardiovascular disease. The score estimates the likelihood that a person has a build-up of artery clogging plaque in the coronary arteries or in the abdominal aorta (the main artery in the abdomen). Researchers consider a PDAY score of 1 to indicate an 18 percent or 24 percent greater chance of plaque build-up in the coronary arteries or abdominal aorta respectively, compared to a score of zero, thought to indicate the chances for cardiovascular disease among those of the same age and sex with no known risk factors.
Of participants in this study of adolescents with HIV infection since birth, 48 percent had a score of 1 or higher for the coronary artery measure. For the abdominal aorta measure, 24 percent scored 1 or above. The researchers also evaluated changes in PDAY scores over a four-year time period and did not observe any major trends.
The study authors noted that PDAY scores of 1 or higher were primarily attributable to high cholesterol levels. Other risk factors, such as smoking and high blood pressure, that are more common in older adults, were uncommon in these young participants. Participants who were treated with the HIV drug class known as protease inhibitors were more likely to have higher PDAY scores. Teens with a history of AIDS were also more likely to have higher PDAY scores. This study only looked at HIV-specific factors influencing cardiovascular risk in this group. It did not look at other factors such as diet, physical activity, or genetics. The study authors called for more research to understand all the potential factors that could influence cardiovascular risk in this group.
“It’s too soon to recommend changing treatment regimens on the basis of our findings,” Dr. Patel said. “Until we can learn more, we can best serve adolescents who have HIV by monitoring their risk factors for heart disease carefully and urging them to adopt other measures that have been found to reduce the risk of heart disease in the general population: exercising, maintaining a healthy diet, and not smoking.
Information on nutrition and healthy eating is available from the NIH’s National Heart Lung and Blood Institute, at http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/tools-resources/nutrition.htm.
In addition to funding from the NICHD, support for PHACS is also provided by the National Heart, Lung, and Blood Institute; the National Institute of Alcohol Abuse and Alcoholism; the National Institute of Allergy and Infectious Diseases; the National Institute on Deafness and Other Communication Disorders; the National Institute of Dental and Craniofacial Research; the National Institute on Drug Abuse; the National Institute of Mental Health; the National Institute of Neurological Disorders and Stroke; and the NIH Office of AIDS Research.
About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s website at http://www.nichd.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
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