Hope for HIV microbicide breakthrough: scientists
Researchers are closing in on a breakthrough microbicide gel to help prevent HIV infection in women, scientists said on Monday, but a lack of funding by major pharmaceutical companies is hampering research.
"I think for many years the microbicides research field was a little bit tentative about making too much noise about the potential of this technology," Helen Rees, executive director of South Africa's Reproductive Health and HIV Research Unit, said on the sidelines of an international conference in Cape Town.
"At this point the microbicides research field is feeling that there might well be the possibility of having an effective microbicide in the next few years," she told Reuters.
Microbicides cover a range of vaginal and rectal creams, gels or suppositories that kill microbes and aim to cut the transmission of HIV and possibly other sexually transmitted diseases when applied before sex.
If proven successful, they could provide a powerful prevention tool for AIDS and one that, unlike condoms, can be directly controlled by women.
Five potential microbicide products are in advanced clinical trials and scientists say the first results should be made public within two years.
Rees, a co-chair of the Cape Town conference, said the trials and other new products, many of them being tested in South Africa -- the country hardest hit by AIDS -- offered exciting prospects for a scientific breakthrough.
"There are a lot of new products coming through the pipeline, new molecules and exciting new potential products that look, in the laboratory and in animal models, as if they will probably be even more effective against HIV," she said.
"What we will see as the months and years go by are some of these products being formulated and moving rapidly into the clinical trial phases."
DISEASE OF THE POOR
Some delegates complained about a lack of interest shown by major pharmaceutical companies in funding research, possibly due to smaller markets for the products in rich countries.
"There is global consensus that there has been a slow uptake in terms of funding microbicides research," said World Health Organization Assistant Director-General Joy Phumaphi.
"We continue to be concerned about this ... we would like to see the pharmaceutical industry more involved," she said.
Developing countries, and particularly sub-Saharan Africa have been hardest hit by AIDS, and most of the new HIV infections worldwide continue to be amongst the poor.
But researchers say many of the products being tested could be highly effective in treating diseases such as herpes and chlamydia, both major problems in the developed world.
Manto Tshabalala-Msimang, South Africa's health minister, told delegates medical officials should guard against unethical practices in trials conducted mostly in poor communities.
Many participants in trials were not fully aware of the risks and, desperately poor, were lured by money to take part, she said.
Fewer teens realize dangers of "huffing"
About 20 percent of U.S. teenagers admit they have gotten high by inhaling common household products, and fewer understand the dangers of this practice compared with teenagers five years ago, according to a report released Monday.
The findings reflect a drop-off in educational efforts begun in the 1990s to combat the growth of inhalant abuse, says the Partnership for a Drug-Free America, which is publishing the report.
Sniffing or "huffing" vapors from ordinary products like glue, spray paint, nail polish remover and gasoline was once a "fringe" activity, said Steve Pasierb, president and CEO of the Partnership.
But by the mid-1990s, the practice had "exploded nationwide," he told Reuters Health, and even elementary school children were experimenting with the inhalants readily available under their kitchen sinks.
In 1995, the Partnership launched a large advertising campaign that was credited with boosting awareness of the dangers of inhalant abuse -- which include damage to the brain, liver, kidneys, vision, hearing and even sudden death from suffocation or heart arrhythmias.
More importantly, surveys found an accompanying decline in the percentage of kids who'd ever tried huffing, from 23 percent in 1995 to 18 percent in 2001.
But the new findings, based on a national survey of more than 7,200 teenagers and 1,200 parents, suggest awareness has waned and abuse is on the rise.
Overall, the survey found, 64 percent of teens "strongly" agreed that huffing can be fatal, down 19 percent from 2001. And 77 percent strongly agreed that inhalants can cause brain damage, down 9 percent.
"It's a lack of education," Pasierb said, noting that parents and kids alike need more information.
Only 5 percent of the parents in the survey thought their child had ever abused an inhalant, although 20 percent of teens said they had.
Some parents may simply be unaware of the practice, but many may believe that their child wouldn't do it, Pasierb noted.
He said the Partnership is restarting its ad campaign warning against inhalant abuse, because today's middle-schoolers weren't exposed to the educational efforts of the 1990s.
"This is something we need to keep up," Pasierb said.
The campaign includes advice on how parents can recognize signs of inhalant abuse, such as chemical odors on children's hands or clothes, spray cans or soaked rags in their rooms, and physical and behavioral signs such as a dazed appearance, red and runny eyes or nose, irritability and problems at school.
A parents' guide is published on the Partnership's Web site, www.drugfree.org.
Pa. Hospital Has 'No Transfusion' Surgery
When Irv Shapiro found out he needed surgery to fix a ruptured heart valve, one of the first questions he asked his doctor was whether he should donate his own blood.
He hoped to avoid being transfused with someone else's blood, but wasn't thrilled with the idea of spending weeks before surgery having pints of his own blood drawn and put in storage. So when he found out that Pennsylvania Hospital offered a third option -— once only available to Jehovah's Witnesses -— it was a relief.
"Not needing a blood transfusion, not having to get blood taken out of me, and a fast recovery time -— I was OK with all of that," said Shapiro, 60, a founding partner of an architectural firm and heavy traveler.
Pennsylvania Hospital is now able to offer so-called "bloodless surgery" to 90 percent of its patients who want it, joining a small but growing number of bloodless medicine programs around the country that also serve the general public. Advocates put the number at about 120.
Many states have bloodless surgery centers or hospitals that perform no-transfusion surgery for Jehovah's Witnesses, who believe the Bible forbids transfusions, but not for the general public.
Some hospitals are now providing no-transfusion surgery to more patients because of advances in equipment and changes in protocols.
Bloodless surgery techniques vary depending on the type of operation, but can include efficient heart-lung bypass machines that circulate a patient's blood during surgery; using high-tech scalpels that clot the blood as they cut tissue; or freezing tissue before it's excised.
There is also pre-surgery planning. Doctors start seeing patients weeks before surgery to prepare.
Among the benefits are reductions in recovery time, hospital stay, cost and complications -— as well as an estimated $20,000 in savings per patient, said Dr. Charles Bridges, the Pennsylvania Hospital cardiologist who performed Shapiro's surgery.
The general consensus in the medical community is that it is best to avoid donor blood transfusions whenever possible, but that transfusions remain an important lifesaving strategy. The American Medical Association endorses "autologous" blood transfusion -— giving a patient his own blood -— but takes no specific stance on no-transfusion surgery.
Pennsylvania Hospital has for at least a decade performed all kinds of no-transfusion surgery on Jehovah's Witnesses, Bridges said. In the year that no-transfusion heart surgery has been offered to patients, Bridges estimated that he has performed between 50 and 75 -— up from about 10 just a few years earlier.
Heart surgery, because it is associated with extensive blood loss, is more difficult to do "bloodless" than other operations. In traditional open-heart surgery, a patient may need up to six units of red blood cells, four units of plasma and 10 units of platelets, according to the American Red Cross.
"People used to think of open-heart surgery as this draconian thing," Bridges said. "Now we have what really is a kinder, gentler open-heart surgery."
The best no-transfusion candidates typically are those needing only one procedure -— repair of a single heart valve or a single bypass, for example. It also can be done in more complex operations, however.
About six weeks after Shapiro's surgery to fix his damaged mitral valve, he was back at work part time.
"I feel very lucky that I was told about the transfusion-free option and that I was a perfect candidate for it," he said.
From pre- to post-surgery, the goal is conserving the patient's own blood, Bridges said.
"There's no downside to it that we can see, and there's certainly no downside that's been documented," Bridges said.
About a month before no-transfusion surgery, blood tests are conducted. Anemic patients receive weekly injections of medications, as well as intravenous iron supplements, to increase their red-blood-cell count.
During surgery, blood that gets suctioned or sponged out of the body cavity is salvaged, and highly efficient pumps keep blood circulating while the heart and lungs are stopped. After surgery, less blood is taken for post-operation tests.
"You have to be meticulous, you have to be organized, and you have to really work as a team before, during and after surgery," Bridges said.
Patients who choose the no-transfusion option eliminate the risk of blood-borne infection and complications from clerical errors. They also get out of the hospital an average of one day earlier and avoid potential transfusion-related complications including immune system suppression, inflammatory response, and renal or respiratory failure, Bridges said.
Bloodless surgery is also preferable to having patients transfused with their own blood, Bridges said. Blood that has been stored degrades and deforms outside the body and doesn't flow through blood vessels or carry oxygen as well when it goes back in.
The trend toward avoiding transfusions is gaining momentum among doctors and patients, said Dr. Patricia Ford, director of Pennsylvania Hospital's Center for Bloodless Medicine & Surgery. Transfusions are lifesavers during emergencies, but they can be avoided in most elective operations, she said.
"There is a movement that, for a lot of us, started as part of caring for Jehovah's Witnesses and learning about blood conservation and management," said Ford, who also is president-elect of the Society for the Advancement of Blood Management, a Wisconsin-based advocacy group.
The group said that the number of bloodless medicine programs nationwide has risen from 100 to about 120 in the past six years. The American College of Surgeons, a division of the American Medical Association, said it does not keep statistics on bloodless surgery.
"Transfusions are like getting a transplant; they can be risky and should be a last resort," Ford said. "Frankly, all of the things we use are available to every hospital. ... The hope is that every hospital will do this eventually."