Medical News

Hepatitis, STDs, TB and other related Subjects

March - April 2008

INDIA:
"Spousal Sexual Violence and Poverty Are Risk Factors for Sexually Transmitted Infections in Women: A Longitudinal Study of Women in Gao, India"
Sexually Transmitted Infection Vol. 84; No. 2: P. 133-138, (04..2008) H.A. Weiss; V. Patel; B. West; R.W. Peeling; B.R. Kirkwood; D. Mabey
The researchers conducted the current study to describe factors associated with incident sexually transmitted infections (STI) in a population-based sample of women in Gao, India. CDC Summary in World News-Women.

NIAID Details Drug Resistant Tuberculosis Research Agenda
AIDSInfo At-a-Glance Volume 4 Issue 18
Tuberculosis (TB) and HIV strongly affect the disease progression of one another. Forms of multidrug resistant (MDR) and extensively drug resistant (XDR) TB are occurring more and more frequently and are a great concern to the HIV community. To help in the fight against drug resistant TB, NIAID has detailed an MDR- and XDR-TB research plan.

The main goals of the agenda include developing reliable tests to rapidly diagnose TB and identify drug resistance, understanding drug-resistant TB, developing new vaccines and preventive measures, and investigating TB infection in people with HIV and other coinfections.

More information is available:

NIH: Full Press Release
NIAID: MDR- and XDR-TB research agenda
NIAID: TB and HIV
AIDSinfo: Tuberculosis Treatment Guidelines
AIDSinfo: Prevention of Opportunistic Infections Guidelines
AIDSinfo: Treatment of Opportunistic Infections Guidelines

Dramatic Rise Found In Hepatitis C-related Deaths In The United States. ScienceDaily. Retrieved March 27, 2008, from http://www.sciencedaily.com/releases/2008/03/080324173515.htm

Male Circumcision Does Not Offer Protection Against Some STIs, Study Finds
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=51064 See also CDC Summary on Study

World Tuberculosis Day - March 24th, 2008
AIDSInfo At-A-Glance Volume 4 Issue 13
Monday, March 24, is World Tuberculosis (TB) Day, a day set aside to recognize the progress made, and challenges remaining, in the fight against TB. In addition to affecting the general population, TB has a devastating impact on people with HIV/AIDS. Approximately 9.2 million new cases of TB were diagnosed in 2006, 700,000 of which occurred in individuals coinfected with HIV. Of the 1.7 million people who died of TB in 2006, 200,000 were coinfected with HIV.

TB and HIV strongly affect the disease progression of one another. Because of this, it is imperative that people diagnosed with HIV have convenient and reliable access to TB testing (and people diagnosed with TB have similar access to HIV testing) so appropriate treatment and prevention measures can be initiated for the good of the individual patient and to fight the continued spread of both infections. Additionally, the increase in cases of multidrug resistant TB (MDR-TB) in places with high rates of TB/HIV coinfection is of particular concern.

Complete control of TB depends on effective prevention. As such, a TB vaccine, ideally one that is safe and effective for HIV-infected individuals, continues to be a main goal of NIAID-directed TB research efforts.

More information is available:

NIH: Full Press Release
AIDSinfo: Tuberculosis Treatment Guidelines
AIDSinfo: Prevention of Opportunistic Infections Guidelines

"Factors Behind Head and Neck Cancer Revealed"
Reuters , (03.11.2008) Will Dunham
Head and neck cancer, including tumors in the mouth, tongue, nose, sinuses, throat, and lymph nodes, is caused by two distinct culprits with dramatically different risk factors, according to a study by researchers at Johns Hopkins University. CDC Summary

"WHO Warns More TB Cases Slipping Through Detection Net"
Agence France Presse , (03.17.2008)
Globally, new TB case detection rates grew by 6 percent between 2001 and 2005, but that progress slowed to 3 percent in 2006, the World Health Organization warned on Monday. In 2006, about 9.2 million new TB cases were detected worldwide, compared to 9.1 million cases the previous year. But WHO estimates the detection rate was only 61 percent of all cases, and that there were 14.4 million TB cases, including undetected infections, in 2006. CDC Summary

High rate of trichomonas treatment failure in women with HIV

A study of recurrent Trichomonas vaginalis infections among women in Louisiana has found similarly high rates of treatment failure for this infection among both HIV-positive and HIV-negative women, indicating that current treatment recommendations may be inadequate. Additionally, the HIV-positive women had higher rates of recurrence due to sexual re-exposure, indicating ongoing unprotected sexual behaviour. The results were published in the April 1 issue of Clinical Infectious Diseases. Read More at NAM >>

Mycoplasma infection linked to HIV shedding from cervix

The sexually transmitted bacteria, Mycoplasma genitalium, has for the first time been linked with an increased risk of HIV DNA shedding in women. But the mechanism of the link appears to be different to that seen with sexually transmitted infections (STIs) such as chlamydia. The study is published in the March 1^st edition of the Journal of Infectious Diseases. Read More at NAM>>

Higher Syphilis Rates Among Blacks, MSM Propel Increase in Overall National Rate, CDC Says
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=50955

Treating Genital Herpes Does Not Reduce Risk of HIV, Study Says http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=50960

WISCONSIN:
"Third Wave Says Two HPV Tests Reach Goals in Clinical Trials"
Associated Press , (03.11.2008)
Madison-based Third Wave Technologies has announced successful trial results for both its high-risk and 16/18 human papillomavirus genotyping products. Together with a Pap test, the high-risk test detects 14 HPV strains, while the 16/18 test checks for the two types that cause 70 percent of cervical cancer cases. The trial involved 3,400 women over age 30, of whom 1,300 had Pap test results that indicated the possibility of cervical disease. This subgroup was given one of the two candidate tests. The results show the tests demonstrated better than 99 percent accuracy in determining which of the women were free of cervical disease. The company plans to apply for Food and Drug Administration approval of the tests in April.

"Perceived Stress Is Associated with Impaired T-Cell Response to HPV16 in Women with Cervical Dysplasia"
Annals of Behavioral Medicine Vol. 35: P. 87-96, (02..2008)
Noting that infection with high-risk subtypes of human papillomavirus (HPV) “is a central factor in the development of cervical neoplasia,” the researchers designed the current study to examine “whether stress is associated with immune response to HPV16 among women with cervical dysplasia.” CDC Summary

A new more effective tuberculosis screening test for HIV+
TB is a strong contributing factor to HIV mortality, therefore it is of crucial importance to be able to diagnosis latent infection early in order to adopt an appropriate treatment and prevent the development of the full disease. Public Release Summary

WHO Releases Report on Global Scale of Drug-Resistant TB
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=50654

NEW YORK:
"Gay Syphilis Surge in 2007"
Gay City News (New York City) , (02.27.2008) Duncan Osborne
The health department is reporting that syphilis cases in New York City shot up by 60 percent from 2006 to 2007, largely due to an increase in cases among men who have sex with men (MSM). CDC Summary

Summaries

UNITED STATES:
"In Hepatitis Trends, Good News and Bad"
New York Times , (04.29.2008) Nicholas Bakalar
In the United States, routine vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) is in large part responsible for declines in new infections to their lowest recorded levels, according to new CDC data. However, the agency recorded slight increases in new hepatitis C virus (HCV) infections, for which there is no vaccine.

HAV is spread by the fecal-oral route, mostly through close personal contact. Outbreaks occurred about every 10 years until the vaccine became available in 1996. During 1995-2006, HAV incidence declined by 90 percent to just 1.2 cases per 100,000 population. Declines were noted especially among children in states where HAV vaccination is routine.

HBV is transmitted through blood or body fluids. Sometimes infection is acquired during birth or during long-term contact with an infected person. Men have higher HBV rates than women, and two groups at highest risk for the disease are injection drug users and men who have sex with men. An HBV vaccine has been available since 1981. During 1990-2006, new HBV infections dropped 81 percent to 1.6 cases per 100,000 population.

HCV is also spread through blood and body fluids. There were 3.2 million chronically HCV-infected Americans in 2006. While the number of new infections continues to be small, reports have plateaued since 2003, with a slight increase in 2006. Injection drug use is the most common risk factor for HCV.

“The trends in A and B reflect the power of vaccinations to prevent disease to the point where we can talk about eliminating them,” said Dr. John W. Ward, director for viral hepatitis at CDC. However, “[HCV] is common in the U.S., and more effective interventions are needed.”

The full report, “Surveillance for Acute Viral Hepatitis — United States, 2006,” was a Surveillance Summary published in Morbidity and Mortality Weekly Report (2008;57:SS-2).

UNITED STATES:
"Study Links HPV to Lung Cancer"
ABC News , (04.28.2008) Russell Goldman
Human papillomavirus has long been linked to cancers of the sex organs, particularly the cervix. More recently, scientists have found connections between HPV and cancers of the mouth and throat. Now comes word from a new study that the STD may be associated with lung cancer as well.

Dr. Arash Rezazadeh of the University of Louisville presented his team’s findings last week at the First European Lung Cancer Conference in Geneva. In an examination of 23 lung cancer samples, “The researchers found six samples that tested positive for the presence of [HPV], the virus that also causes many cases of cervical cancer. One was later shown to be a cervical cancer that had spread to the lungs,” said a statement issued by the conference.

Smoking remains the chief risk factor for the development of lung cancer, and all the samples studied came from smokers. However, “the fact that five out of 22 non-small-cell lung cancer samples were HPV-positive supports the assumption that HPV contributes to the development of non-small-cell lung cancer,” said the statement.

While this is the first research to track the combined impact of smoking and HPV on the lungs, doctors have known for some time that female smokers who acquire HPV are more likely than nonsmokers to develop cervical cancer, according to Dr. Lauren F. Streicher, an OB/GYN and a professor at Northwestern Medical School. “Seventy to 80 percent of women are exposed to HPV, but less than 1 percent of women get cervical cancer. We know lesions on the cervix are more likely to become cancerous in smokers,” she said.

The study did not address whether Gardasil, the HPV vaccine approved by the Food and Drug Administration, might be effective against lung cancer. However, the HPV type - 16 - found in the lung cancer samples is among those targeted by the vaccine. “Type 16 is the one that causes cancer,” Streicher said. “As more of these studies are completed, we’re learning that the vaccine would clearly be preventive in many different kinds of cancers, not just cervical.”

"University of North Carolina-Chapel Hill, Harvard Team Up on Inhaled TB Vaccine"
News and Observer (Raleigh, NC , (03.15.2008) Jean P. Fisher
Scientists have developed an experimental tuberculosis vaccine that is administered as an inhaled fine powder. The standard vaccine must be refrigerated and reconstituted in medical-grade water before being injected. These requirements can limit immunization efforts in developing countries where people often live far from medical facilities and have neither clean water nor electricity.

The scientists reformulated the existing TB vaccine and tested it on guinea pigs, and they found it protected the animals better than the conventional injected vaccine. Just 1 percent of lung and spleen tissue taken from animals vaccinated with the inhaled vaccine then exposed to tuberculosis showed TB contamination, compared to about 5 percent of lung and 10 percent spleen tissue for those animals given the standard injected vaccine.

If the vaccine were to be approved, it would likely be administered to adults using a simple tube inhaler that looks like a plastic drinking straw. After piercing the tube, patients would breathe in while holding it in their mouth. According to Tony Hickey, one of the scientists at UNC, infants could receive the vaccine via a modified pacifier.

“You can have the baby essentially suck on it and blow the powder into the back of the throat,” he said.

The next step for the research team is to test its safety in humans and then conduct clinical trials. Hickey said plans are underway to test it as soon as next year in South Africa, where TB is highly prevalent.

The research was supported by a Grand Challenge Grant from the Bill and Melinda Gates Foundation.

The full report, “Immunization by Bacterial Aerosol,” was published in the Proceedings of the National Academy of Sciences (2008;105(12):4656-4660).

NEW ZEALAND:
"Circumcision and Risk of Sexually Transmitted Infections in a Birth Cohort" back to top
Journal of Pediatrics Vol. 152; No. 3: P. 383-387, (03..2008) Nigel P. Dickson, FRACP; Thea van Roode, MSc; Peter Herbison, MSc; Charlotte Paul, PhD
The researchers undertook the current study to determine the impact of circumcision in early childhood on the acquisition of sexually transmitted infections (STIs) by age 32.

The circumcision status of a cohort of boys born from 1972 to 1973 in Dunedin, New Zealand, was sought at age three. Information about STI acquisition was obtained at ages 21, 26 and 32. STI incidence rates were calculated, taking into account timing of sexual initiation, and comparisons were made between circumcised and uncircumcised men. Where appropriate, adjustments were made for potentially confounding socioeconomic and sexual behavior factors.

The study population comprised 499 men, of whom 201 (40.3 percent) had been circumcised by age three. Little variations in socioeconomic and sexual behavior characteristics were noted between the two groups. Up to age 32, the incidence rates for all STIs were not statistically significant: 23.4 and 24.4 per 1,000 person-years for the uncircumcised and circumcised men, respectively. Adjusting for any of the socioeconomic or sexual behavior characteristics did not affect the results.

“These findings are consistent with recent population-based cross-sectional studies in developed countries, which found that early childhood circumcision does not markedly reduce the risk of the common STIs in the general population in such countries,” the authors concluded.

UNITED STATES:
"Factors Behind Head and Neck Cancer Revealed"
Reuters , (03.11.2008) Will Dunham
Head and neck cancer, including tumors in the mouth, tongue, nose, sinuses, throat, and lymph nodes, is caused by two distinct culprits with dramatically different risk factors, according to a study by researchers at Johns Hopkins University.

Heavy tobacco and alcohol use has long been recognized as a cause of head and neck cancer, which affects more than 35,000 people in the United States annually. Since 2000, scientists have also known that human papillomavirus (HPV) infection, a common STD, was linked to certain of these cancers, particularly those in the upper throat and back of the tongue.

The study focused on 240 people diagnosed with head and neck cancer between 2000 and 2006. Almost 40 percent of the patients had an HPV infection but lacked the well-known risk factors for head and neck cancer - tobacco smoking, alcohol use, and poor oral hygiene. The participants with HPV-linked cancer cases had a totally different set of risk factors, including certain sexual behaviors and marijuana use. Among these cases, the sexual factors linked to cancer were the presence of an STD and increasing numbers of lifetime sex partners, including oral sex.

“These are completely different cancers and we need to view them as such,” Dr. Maura Gillison, professor of oncology and epidemiology at Johns Hopkins, said of the cancers found in HPV-infected versus non-infected patients. “They just happen to occur in the same place. The risk factors didn’t appear to overlap at all, and there didn’t appear to be any interaction between them.”

Not only were the patient populations different in HPV-positive and HPV-negative head and neck cancer, the tumors appeared different under a microscope, said Gillison. Patients with HPV-linked cancer also tended to respond better to treatment than those who were not infected with the virus, she added.

The study, “Improved Survival of Patients with Human Papillomavirus-Positive Head and Neck Squamous Cell Carcinoma in a Prospective Clinical Trial,” was published in the Journal of the National Cancer Institute (2008;100(4):261-269).

"Chlamydia Trachomatis Reinfection Rates Among Female Adolescents Seeking Rescreening in School-Based Health Centers"
Sexually Transmitted Diseases Vol. 35; No. 3: P. 233-237, (03..2008) Charlotte A. Gaydos, DrPH; Catherine Wright, MPH; Billie Jo Wood, MS; Gerry Waterfield, MS, CPNP; Sharon Hobson, MS, CPNP; Thomas C. Quinn, MD
Noting that chlamydia trachomatis (CT) infections are common among adolescents attending middle and high schools, the authors of the current study sought to assess the reinfection rates of CT for females attending school-based health centers.

Adolescents who attended school-based health centers and reported they were sexually active were screened for CT using nucleic acid amplification tests on cervical or urine samples. From 1996 to 2003, 10,609 females were tested. In a calendar year, the overall prevalence ranged from 15.1 percent to 19.5 percent. Reinfection was defined as a positive test result occurring between 30 and 365 days after initial positive result.

A total of 897 female students who tested positive for CT returned for at least one subsequent test 30—365 days later. Of these, 236 had one or more subsequent positive tests for a one-year cumulative incidence of reinfection of 26.3 percent (95 percent confidence interval=23.4-29.2 percent. Young age at first CT infection was significantly associated with increased risk of subsequent infection (P<0.01). Across sites, cumulative incidence of reinfection in study participants ranged from 14.3 percent to 38.9 percent.

The chlamydia cumulative incidence of reinfection in this population was high and supports CDC’s recommendation that adolescents be screened frequently for CT, especially those with a history of a previous infection, the authors concluded.

GLOBAL:
"WHO Warns More TB Cases Slipping Through Detection Net"
Agence France Presse , (03.17.2008)
Globally, new TB case detection rates grew by 6 percent between 2001 and 2005, but that progress slowed to 3 percent in 2006, the World Health Organization warned on Monday. In 2006, about 9.2 million new TB cases were detected worldwide, compared to 9.1 million cases the previous year. But WHO estimates the detection rate was only 61 percent of all cases, and that there were 14.4 million TB cases, including undetected infections, in 2006.

“This is not a good sign, because our target is to detect all cases that exist,” said Mario Raviglione, director of WHO’s Stop TB department. “There is 39 percent that we are unable to find, but which we think is there.”

WHO attributed the flagging detection rate to some national programs that were unable to continue at their previous pace. In many African countries, there has been no increase at all in detection rates. Other TB cases could be slipping through national reporting systems as patients receive care from private doctors, non-governmental or community groups.

“We’ve entered a new era,” said Margaret Chan, WHO’s director-general. “To make progress, firstly public programs must be further strengthened. Secondly, we need to fully tap the potential of other service providers.”

There were about 700,000 new TB cases and 200,000 TB deaths among people living with HIV in 2006, WHO said. An estimated 1.5 million HIV-negative people died from TB worldwide that year.

“The report tells us that we are far from providing universal access to high-quality prevention, diagnostic, treatment and care services for HIV and TB,” said Dr. Peter Piot, executive director of UNAIDS. “The report clearly demonstrates how closely linked TB and HIV are,” he said, noting that TB is “the single most important cause of death for people living with HIV.”

"Doctor Training Urged to Fight Syphilis Spread"
Reuters , (03.17.2008) Julie Steenhuysen
Many doctors are ill-prepared to respond to the current resurgence of syphilis in developed nations, US researchers said in a new report.

Syphilis has been on the rise in high-income nations since the beginning of the 21st century, the authors said. “In many of these countries we are seeing very high rates in men who have sex with men [MSM],” said Dr. Kevin Fenton, the study’s lead author and the director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. Yet, “In many countries, physicians may have lost some of the skill sets associated with diagnosing syphilis.”

CDC last week reported that US syphilis rates were up in 2007, the seventh consecutive year in which an increase was documented. The proportion of cases diagnosed among MSM rose from 5 percent in 1999 to 64 percent in 2007. The increase is particularly concentrated among a subgroup: MSM who have high-risk sex with multiple partners.

The authors said the evidence makes the case for quick intervention steps, including increased screening, media campaigns, condom distribution, and outreaches to change the behavior of those most at risk.

“Efforts must be made to incorporate and evaluate new diagnostic tools, social network approaches, innovative evidence-based prevention interventions, robust disease surveillance, and systematic monitoring and evaluation of prevention, treatment, and care activities,” the authors wrote.

Fenton stressed the importance of addressing the growing problem: “We have seen with other epidemics of [STDs] that even if the initial rise occurs in [MSM], it is unlikely to stay in that group for any long periods of time. The data suggest we are now seeing increases among heterosexuals in the US and in Europe as well.”

The full report, “Infectious Syphilis in High-Income Settings in the 21st Century,” was published in The Lancet (2008;8(4):244-253).

"Study Says Romance Makes for Safer Sex"
Washington Post , (03.04.2008) Laura Sessions Stepp
An analysis of data from the National Longitudinal Study of Adolescent Health found that sexually active teens who identify their relationships with a partner as romantic and who socialize together are more likely to use contraception than similar teens in more casual relationships.

Jennifer Manlove, a senior researcher at Child Trends and one of the study’s authors, said teens may feel more comfortable talking about contraception with a partner they know and trust. And particularly among girls, good communication and a quality relationship appear to play an important role in decision-making.

The analysis of information on more than 4,500 unmarried, sexually experienced young people showed that girls were more likely to use contraception with a partner their age than with older males. On average, the teens were 16 at sexual debut.

The study also showed that consistent birth control use in one relationship does not necessarily continue in another. Four out of 10 sexually active students reported no or infrequent contraceptive use. Students who reported having multiple partners were especially likely not to use protection.

Manlove said the analysis demonstrates that it is not enough for parents to focus simply on whether their teens are having sex. She encouraged parents to engage their children in conversations about the characteristics of health relationships, relationship dynamics, and the importance of contraception.

The study, “Contraceptive Use Patterns Across Teens’ Sexual Relationships: The Role of Relationships, Partners, and Sexual Histories,” was published in the journal Demography (2007:44(3):603-621).

"Sex Diseases in Many Gay Men Go Unfound, Experts Say"
New York Times , (03.13.2008) Lawrence K. Altman
STD screening is a critical part of health care for sexually active gay men, but few present annually for testing as CDC recommends. In addition, when gay men do present, many doctors fail to screen them for STDs, researchers reported Wednesday at the 2008 National STD Prevention Conference in Chicago.

A study by CDC’s Dr. Kristen Mahle found that among asymptomatic gay men, many were not tested at all anatomical sites of exposure, so that more than one-third of rectal gonorrhea infections and more than a quarter of throat infections were missed. Gonorrhea tests should include specimens from all possible sites, including the throat, rectum, and genitals.

Just 39 percent of gay men reported being screened for syphilis, and 36 percent reported being tested for gonorrhea, during a 2003-2005 study of HIV-negative gay men in 15 US cities by CDC’s Dr. Eric Tai.

In eight cities in 2005, doctors tested 82 percent of HIV-positive gay patients for syphilis, but just 22 percent or fewer for gonorrhea and chlamydia, reported Dr. Karen Hoover of CDC.

Staffing and budgetary constraints at the federal, state, and local levels partly explain the lack of comprehensive testing, said Dr. John M. Douglas Jr., director of CDC’s Division of STD Prevention.

Another problem is that newer tests are not being used as much as they should be, said Douglas and others at the conference. The nucleic acid amplification test (NAAT) is more accurate, easier to use, and can detect twice as many gonorrhea and chlamydia infections in the throat and rectum, according to Dr. Julius Schachter of the University of California-San Francisco and colleagues including the San Francisco Department of Public Health. NAATs are also faster than culture-based tests. However, the three Food and Drug Administration-approved NAATs are for screening the genitalia, not the throat and rectum.

CDC is working with the Food and Drug Administration and test makers to gather evidence that would allow NAATs to also be approved for rectal and throat screening.

"1 in 4 US Teen Girls Has Sexually Transmitted Disease"
Associated Press , (03.11.2008) Lindsey Tanner
Slightly more than one in four US females ages 14-19 has an STD, according to a survey CDC researchers presented Tuesday at the 2008 National STD Prevention Conference in Chicago. The findings are based on 838 females who participated in the nationally representative 2003-04 National Health and Nutrition Examination Survey. The first-of-its-kind study screened the teens for chlamydia, human papillomavirus (HPV), trichomoniasis, and herpes.

The STD rate for all those surveyed was 26 percent, which by extrapolation would be more than 3 million girls nationwide, CDC said. Nearly half the African Americans surveyed had at least one STD, compared to 20 percent each for whites and Mexican Americans.

Just half those surveyed reported having sex; among them, the STD rate was 40 percent, reported lead investigator Dr. Sara Forhan.

Among the teens, 18 percent were infected with HPV, which can cause cervical cancer; 4 percent had chlamydia infection, which can lead to infertility; 2.5 percent had trichomoniasis; and 2 percent had genital herpes.

The data likely reflect current prevalence, said Dr. John M. Douglas Jr., director of CDC’s Division of STD Prevention. STD screening is under-utilized, and many young girls do not think they are at risk, Douglas said. In addition, he said, some doctors erroneously believe: “Sexually transmitted diseases don’t happen to the kinds of patients I see.”

Given the potential consequences of STDs, “screening, vaccination, and other prevention strategies for sexually active women are among our highest public health priorities,” said Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

CDC recommends annual chlamydia screening for all sexually active women under age 25, HPV vaccination for girls ages 11-12, and catch-up HPV shots for females ages 13-26.

"Glaxo Says Data Show Cervarix Vaccine Works Against Cancer-Causing HPV Strains in Women"
Associated Press , (03.10.2008)
Clinical data show that GlaxoSmithKline PLC’s vaccine candidate Cervarix is effective for more than six years at preventing certain strains of human papillomavirus. The data, which were collected as part of follow-up to an earlier study, were presented in Tampa, Fla., at a meeting of the Society of Gynecologic Oncologists.

In a trial involving 776 vaccinated women tracked for almost six-and-a-half years, Glaxo said nearly all still had high levels of antibodies to HPV types 16 and 18. Cervarix was nearly 100 percent effective at blocking cancerous lesions caused by these HPV types, the company said. Furthermore, it offered 78 percent protection against type 45 and 60 percent protection against type 31. Together, these four HPV types are linked to about 80 percent of cervical cancer cases worldwide, Glaxo said.

Trial participants, ranging in age from 15 to 25, were each given three Cervarix injections or three placebo shots. Glaxo reported no significant health risks associated with the vaccine.

Glaxo first sought Food and Drug Administration approval of Cervarix in 2007 and believes it will be able to bring the vaccine to market this year. Cervarix is already approved for use in 55 nations, including countries of the European Union.

"Perceived Stress Is Associated with Impaired T-Cell Response to HPV16 in Women with Cervical Dysplasia"
Annals of Behavioral Medicine Vol. 35: P. 87-96, (02..2008) Carolyn Y. Fang, PhD; Suzanne M. Miller, PhD; Dana H. Bovbjerg, PhD; Cynthia Bergman, MD; Mitchell I. Edelson, MD; Norman G. Rosenblum, MD, PhD; Betsy A. Bove, PhD; Andrew K. Godwin, PhD; Donald E. Campbell, PhD; Steven D. Douglas, MD
Noting that infection with high-risk subtypes of human papillomavirus (HPV) “is a central factor in the development of cervical neoplasia,” the researchers designed the current study to examine “whether stress is associated with immune response to HPV16 among women with cervical dysplasia.”

The authors noted that cell-mediated immunity against HPV16 “plays an important role in the resolution of HPV infection and in controlling cervical disease progression.” And while research suggests that stress is associated with cervical disease progression, “few studies have examined the biological mechanisms that may be driving this association.”

The subjects of the study were 74 women who presented for colposcopy and who completed measures of health behaviors, stressful life events, and perceived stress. During gynecological examination, a cervical sample was obtained for HPV typing. A blood sample was drawn to evaluate proliferative T-cell response to HPV16.

More than 55 percent of participants tested positive for one or more HPV subtypes. The women who did not show proliferative responses to HPV (non-responders) were more likely to be HPV-positive compared to women who had a response (responders).

In a finding consistent with study hypotheses, logistic regression revealed that higher levels of perceived stress were associated with non-response to HPV16 after controlling for relevant covariates. Stressful life events were not found to be associated with T-cell response to HPV.

“Higher levels of perceived stress are associated with impaired HPV-specific immune response in women with cervical dysplasia, suggesting a potential mechanism by which stress may influence cervical disease progression,” the authors concluded.

A new more effective tuberculosis screening test for HIV+
A person infected by HIV who is also contaminated with Koch’s bacillus bears a greater risk of developing active TB than a non HIV-infected individual. Latent TB infection diagnosis has for several decades been founded on a positive response to the tuberculin skin test (TST). However, TST’s reliability is limited in highly TB-endemic geographical settings because the presence in the environment of mycobacteria similar to that which causes TB plus the BCG vaccination people receive in early infancy can skew the results. Moreover, in HIV+ patients, the sensitivity of the test is drastically reduced owing to their inability to develop an allergic reaction, the very basis of the skin test. TB is a strong contributing factor to HIV mortality, therefore it is of crucial importance to be able to diagnosis latent infection early in order to adopt an appropriate treatment and prevent the development of the full disease.

The development of new IGRA3 tests is based on in vitro measurement of T-cells secretion of interferon- when challenged with antigens specific to Mycobacterium tuberculosis, the bacterium causing tuberculosis. Such assays now provide a means of getting round the drawbacks of the tuberculin skin test (TST). Yet, although these new screening methods are more effective than TST in a situation of low TB endemicity, their validity in populations subject to high risk of latent TB infection still has to be clearly established.

The data gathered from recent studies must now be analysed in greater detail in order to determine if the new tests based on measurement of the immune response to M. tuberculosis-specific antigens can serve as a reliable diagnostic method for TB infection in geographical areas where the disease is endemic and BCG coverage is strong. Such investigations should also found out if in the future these tests could be used as markers of the development of the disease within a given population.
http://www.eurekalert.org/pub_releases/2008-03/idrp-anm030508.php

NEW YORK:
"Gay Syphilis Surge in 2007"
Gay City News (New York City) , (02.27.2008) Duncan Osborne
The health department is reporting that syphilis cases in New York City shot up by 60 percent from 2006 to 2007, largely due to an increase in cases among men who have sex with men (MSM).

There are limitations to the department’s data, because only about two-thirds of patients consent to be interviewed by staff. Ninety-seven percent of syphilis patients in 2007 were men, and 87 percent were MSM. “Of those that we’ve interviewed, 57 percent reported being HIV co-infected,” said Dr. Susan Blank, assistant commissioner in the department’s Bureau of STD Control. Co-infection with an STD can facilitate transmission and acquisition of HIV.

According to the department’s figures:
*The syphilis case count was 621 in 2004, 616 in 2005, and 578 in 2006. The 2007 figure was 927.
*The distribution by racial/ethnic group was: black men, 31 percent; white men, 24 percent; Latino men, 24 percent; men of other/unknown race or ethnicity, 21 percent.
*Most cases were diagnosed in Manhattan (43 percent), Brooklyn (27 percent) and Queens (15 percent).
*The biggest increases were found in Chelsea, Greenwich Village, Union Square and Washington Heights — suggesting the trend is being driven by men in largely white gay neighborhoods.

Blank said the city will “probably, unfortunately” pass the 1,000-case mark in 2008. After peaking at more than 5,000 new syphilis cases in 1988, the numbers fell in the 1990s before beginning to rise again in 1999 as cases increased among MSM.

Some gay and AIDS groups expressed disappointment at the figures but said the data reflect the increases they had been seeing among their clients.

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