Kaisernetwork.org (Washington, DC)
19 November 2008
Science & Medicine
Higher Risk of Certain Cancers Being Recorded in HIV-Positive People
[Nov 19, 2008]
Physicians in the U.S. are reporting a higher risk for certain types of cancers -- such as liver, head, neck and lung -- in people living with HIV/AIDS, raising concerns that a cancer epidemic is imminent in the population, the Baltimore Sun reports. According to the Sun, Meredith Shiels, a doctoral candidate at the Johns Hopkins Bloomberg School of Public Health, presented a paper on Tuesday at the seventh annual American Association for Cancer Research International Conference on Frontiers in Cancer Prevention Research that said people living with HIV are twice as likely as the general population to develop cancers not previously linked with the virus. Other studies have found that people living with HIV have as much as a 10 times greater chance of developing certain cancers compared with the general population. William Blattner, an associate director of the University of Maryland Institute of Human Virology, said researchers are "really at the first stages of systematically looking at the epidemic and fully looking at cancer." He added that "[b]efore, you died from AIDS, so you didn't have time to develop cancer. ... The unusual observation is the cancers are occurring at a much younger age."
Although researchers do not know the exact reasons for the increased risk of developing some cancers, there are several theories as to why HIV-positive people are more susceptible, such as the increased life expectancy due to antiretroviral drugs; weakened immune systems related to the virus or the effects of antiretrovirals; and the likelihood of increased high-risk behaviors in people living with HIV. The Sun reports that a well-known researcher "wonders" if antiretrovirals could be a carcinogen. In addition, many cancers found in people living with HIV are known to be caused by viruses, such as anal, head, neck and cervical cancers -- which have been linked to the human papillomavirus -- and liver cancer, which has been linked to hepatitis. Mark Wainberg, director of the McGill University AIDS Center in Montreal, said, "There's a real concern about all these cancers and what they portend. Obviously, we don't want an epidemic of cancers in long-term HIV-infected people."
According to the Sun, physicians have discovered that treatments for cancer do not work as well in patients who have compromised immune systems, and some researchers have suggested that cancer develops regularly in all people but the immune system is able "to keep most of them in check." A person living with HIV may not have an immune system that is able to do this as effectively, the Sun reports. However, people with HIV who develop cancer do not "always have the weakest immune systems, further confounding researchers," according to the Sun. Eric Engels, a researcher at the National Cancer Institute studying HIV/AIDS and lung cancer, said research into how the immune system and cancer interact could provide a wider application than just helping people living with HIV. "This research has implications for people who have a healthy immune system, too," he said.
The Sun also reports that cases of lung cancer among people living with HIV are increasing, and a 2003 study conducted by Johns Hopkins thoracic surgeon Malcolm Brock found 80 cases of HIV-positive lung cancer patients out of a total 12,000 lung cancer patients who received treatment at Johns Hopkins Hospital dating back to 1950. Brock said people living with HIV have a three to five times higher risk of developing lung cancer than the general population, with a high risk even when controlled for smoking. He also said the median age of lung cancer patients who are living with HIV is 46, compared with 64 among the general population. "The deaths here were overwhelmingly cancer-related. They were not due to AIDS," Brock said, adding that "these patients die and they die quickly," with an average period of six years between HIV diagnosis and lung cancer diagnosis. Engels said that although the cancer is not caused by a virus, it could be the result of an unknown infection, scarring of the lungs or some type of inflammation, which could explain why it is increasingly being found in people living with HIV.
Shiels said that the trend in cancer development in HIV-positive people might have been detected earlier if antiretrovirals were developed sooner. "Perhaps if they had lived longer, we would have seen this 10 years ago," she said. Kevin Cullen, director of the University of Maryland Greenebaum Cancer Center, said that 10 or 20 years ago "virtually no one [living with HIV] who developed cancer could survive rigorous cancer treatment," but antiretrovirals have allowed people to successfully undergo cancer treatment.
Wainberg said that recent gains in HIV/AIDS treatment have given some people who are at high risk for contracting the virus a false sense of security. "There is no doubt that there are people among vulnerable groups who now have a bit of an attitude of ... 'If I get HIV, the drugs are going to help me anyway,'" he said, adding that high-risk groups need to know about the risks of cancers associated with HIV. Engels said that recent findings involving an increased risk of cancer among people living with HIV should not reduce the developments in HIV/AIDS treatment in the U.S. He said, "If you had to pick a time and a place to live with HIV infection, America today would be the best time and place we've ever had. But we're finding these problems coming to the surface that we didn't see before" (Desmon, Baltimore Sun, 11/19).
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Study Finds HIV-Positive People Taking Some Antiretrovirals Are at Increased Risk of Diabetes, Heart Disease
[Nov 19, 2008]
HIV-positive people receiving treatment for the virus might be at an increased risk of developing heart disease and type 2 diabetes because some antiretroviral drugs can cause fat on the arms, legs, face and buttocks to move to the stomach, researchers at Australia's Garvan Institute said Monday, the Sydney Morning Herald reports. According to the Herald, excess weight around the waist can increase a person's chances of developing cardiovascular and metabolic disorders, but physicians say newer classes of drugs, which do not cause fat redistribution, are too expensive for most people.
Katherine Samaras -- lead author of the study, which was published in the journal Obesity -- said the findings indicate that older antiretrovirals, still commonly used in Australia, can give many HIV-positive patients the same level of heart disease risk seen in obese people with sedentary lifestyles. The Herald also reports the study found that antiretrovirals can cause fat cells to create inflammatory molecules promoting certain diseases. Samaras said, "When fat cells are healthy, they help maintain our metabolism, but if they become too large or are affected by drugs, such as HIV medications, they can produce" numerous chemicals linked to heart disease. She added, "We also have the problem that the older drugs are off-patent now and very cheap, so they are the frontline treatment" in developing countries. According to Samaras, "There are drugs on the market which do not have these side effects, but they are not yet on" Australia's pharmaceutical benefits programs and are "too expensive for most people. The primary concern is to optimize viral suppression, that is reduce the virus load in the body, to minimize its effects." She added that physicians should ensure that their HIV-positive patients are regularly screened for diabetes (Benson, Sydney Morning Herald, 11/18).
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Gannett/Desert Sun Examines Antiretroviral Isentress
[Nov 19, 2008]
Gannett/Desert Sun on Monday examined Merck's antiretroviral drug Isentress, which was approved by FDA last year. According to Gannett/Desert Sun, since FDA approved the drug, some HIV-positive people and "medical experts say it appears to work, improving the condition of some HIV patients and sparking hope that drugmakers may develop similar medications."
Isentress, which is known generically as raltegravir, has been shown to be effective for people who have developed resistance to other available drugs. The medication is part of a new class of drugs called integrase inhibitors. Homayoon Khanlou, chief of medicine for the AIDS Healthcare Foundation, said, "We do need the new class of drugs. There are not many newer agents in the pipeline." Roy Steigbigel -- a professor of medicine at Stony Brook University in New York who recently co-authored a study on Isentress in the New England Journal of Medicine -- said the drug shows "great promise in people whose virus is resistant to many of the other available drugs." He also said studies are "ongoing" to determine if similar results would be seen in patients who have never taken antiretrovirals.
According to Gannett/Sun, Isentress was approved in six months under an FDA fast-track process, which some advocates and lawmakers say they would like the agency to use more frequently to increase approval of HIV/AIDS drugs. Mark Milano, an HIV treatment educator at the AIDS Community Research Initiative of America, said, "People are dying now. If we wait five more years to get the drugs out, people will avoid the risks but they will also be dead." Gannett/Sun reports that the Desert AIDS Project for six months last year participated in a clinical trial of Isentress, during which participants were offered the new drug along with other medications (Barfield Berry, Gannett/Desert Sun, 11/17).
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Global Challenges
Misconceptions Continue To Contribute to Discrimination Against HIV-Positive People in China, UNAIDS Official Says
[Nov 19, 2008]
People living with HIV/AIDS in China continue to experience discrimination based on public misconceptions of the disease, Bernhard Schwartlander, UNAIDS China country coordinator, said on Tuesday, Xinhuanet reports. Commenting on the results of a survey about HIV/AIDS-related knowledge and behavior among the Chinese -- which indicated that misconceptions and discrimination remain high despite years of public education efforts -- Schwartlander said that many people are unwilling to live with an HIV-positive person, or have meals or work with an individual living with the virus.
Xinhuanet reports that the survey of more than 6,000 students, white- and blue-collar workers and migrant workers found that 48% still believe HIV can be transmitted through a mosquito bite. It also found that although 80% of respondents know HIV can be transmitted through injection drug use or unsafe sex, 18% thought they could contract the virus through a sneeze or cough. In addition, when asked about their attitude toward an HIV-positive family member, nearly 16% said they would no longer contact or speak to the person, although more than 50% said they would encourage the relative to seek treatment and support. Schwartlander said, "These data are really a cause for concern," adding, "We see that there are still many misconceptions around AIDS among the population, which contribute to stigma and discrimination."
According to Xinhuanet, the survey also found that 57.2% of young respondents between ages 15 and 24 said they did not know how to correctly use condoms. Schwartlander said that this is a "worrying contradiction between knowledge and behavior." He added, "Though people know that HIV can be transmitted through unprotected sex, many still do not protect themselves with a condom when engaging in risky behavior." Xinhuanet reports that sexual activity is the most common mode of HIV transmission in China, with 19% of respondents reporting that they would use a condom if they had sex with a new partner.
The survey also found that half of respondents believed that HIV/AIDS was a serious problem in China but 88% regarded their chance of contracting the virus as zero. Furthermore, the survey suggested that more information about HIV testing is needed in the country.
The survey was conducted in Beijing, Shanghai, Shenzhen, Wuhan, Zhengzhou and Kunming by the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria; the China HIV/AIDS Media Partnership; Renmin University; and UNAIDS (Xinhuanet, 11/18).
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Lesotho's HIV Testing Program Has Not Met Goals, Groups Say
[Nov 19, 2008]
An HIV testing campaign launched in Lesotho in 2005 has failed to meet its goals because of a lack of funding and administrative issues, according to a report released on Tuesday by Human Rights Watch and the AIDS and Rights Alliance for Southern Africa, AFP/Yahoo! News reports. The campaign aimed to test 1.3 million people over age 12, but as of August 2007, about 25,000 people had been tested for HIV. Training counselors and expanding support services for people living with HIV/AIDS also were part of the campaign's goals, but inadequate funding and administrative failures deterred progress in both areas, the report said (AFP/Yahoo! News, 11/18).
Although the groups noted that Lesotho was one of the first nations to implement a mass testing campaign, the report also found that the campaign did not take adequate steps to ensure confidentiality and other rights (Georgy, Reuters South Africa, 11/18). According to the report, Lesotho's testing program did not ensure that people undergoing HIV tests gave informed consent. In the report, the groups also called for access to follow-up counseling and care after testing. "Lesotho's program was noble in ambition but weak in action," the groups said in a statement (AFP/Yahoo! News, 11/18). Michaela Clayton of ARASA said, "The administrative failures also meant that the program was unable to adequately safeguard people's rights" (Reuters South Africa, 11/18).
AFP/Yahoo! News reports that Lesotho is among the countries most affected by HIV/AIDS in Southern Africa, with 23.2% of people ages 15 to 49 living with the disease (AFP/Yahoo! News, 11/18). "Community-based HIV testing programs have real potential for reaching people who are otherwise unlikely to test," Joseph Amon, director of the HIV/AIDS and human rights program at HRW, said, adding, "It sounds like a simple approach, but for these programs to be truly successful, they must provide counseling, ensure confidentiality and link people to HIV prevention and treatment services" (Reuters South Africa, 11/18).
The report is available online.
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Opinion
PEPFAR 'Most Impressive' of Bush's Efforts in Africa, Opinion Piece Says
[Nov 19, 2008]
President Bush "did better than most people are willing to admit in his dealings with Africa, a continent long victimized by the geopolitical tug of war between America and its adversaries," columnist DeWayne Wickham writes in a USA Today opinion piece. "Most impressive of these efforts" has been the President's Emergency Plan for AIDS Relief, Wickham writes, adding that Bush earlier this year signed a bill to reauthorize PEPFAR at $48 billion over five years. In addition, Wickham writes that the Bush administration since 2003 has provided funding to increase the number of HIV-positive people in Africa with antiretroviral drug access from 50,000 to about 1.4 million, according to Jendayi Frazer, assistant secretary of the Bureau of African Affairs. He concludes that what should not "go unnoticed by historians is what Bush did to combat the scourge of AIDS in Africa" (Wickham, USA Today, 11/18).
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