Study Confirms Power of Anti-HIV Drugs
The powerful cocktail of drugs known as highly active antiretroviral therapy (HAART) prevents HIV infection from progressing to AIDS in a majority of patients over the long term, researchers report.
Based on these findings, experts in Britain contend that HAART is appropriate for treating HIV infection where it has hit hardest -- in developing countries.
The report appears in the July 30 issue of The Lancet.
"Compared with no treatment, HAART, which has been available since 1996, reduces the progression for HIV to AIDS and death by 86 percent," said Jonathan A.C. Sterne, a reader in medical statistics at the Department of Social Medicine at the University of Bristol.
"In addition, the benefit of HAART increases with time since starting treatment," he noted. In other words, the longer one waits to start treatment, the more the immune system becomes compromised, reducing the benefit of HAART, Sterne explained.
HAART involves a combination of three and sometimes more drugs that work in combination to suppress the activity of HIV. First discovered in the mid-1990s, the therapy has greatly extended the lives of thousands of infected individuals in the developed world. The drugs are expensive, however, and have so far remained out of reach of most HIV-positive individuals living in poorer countries.
In their study, Sterne's team collected data on 3,245 HIV patients who participated in the Swiss HIV Cohort Study starting in 1996, when HAART first became available to Swiss patients. They compared the outcomes of patients receiving HAART to those of patients receiving no treatment, and with patients receiving only two HIV drugs.
The researchers report that HAART was effective in preventing long-term progression to AIDS. But they also found that people who became infected with HIV via injection drug use were less likely to benefit from HAART than other patients. "This might be because these people adhere to treatment less well," Sterne said.
HAART does have side effects, including an increased risk of heart disease, Sterne noted. "These results provide reassurance that there are very big benefits of the treatment that outweigh the adverse effects," he said.
The British researcher believes the study clearly shows the value of HAART over time. "These results show the huge potential benefit of making HAART available in developing countries, in particular in sub-Saharan Africa," Sterne said. "The benefits are so enormous that there are huge potential gains by trying to making HAART accessible in developing countries."
One expert said the findings come as little surprise. "This study is a statistical analysis to prove what we already know clinically," said Michael Allerton, the HIV operations policy leader at the Permanente Medical Group in Oakland, Calif.
"To my mind, the only time anyone had any doubt about HAART working was in South Africa, with the president of South Africa [Thabo Mbeki], who doesn't believe that HIV causes AIDS," Allerton said. "The concern is not if it works, but how you find an effective way to distribute it that it continues to maintain its efficacy."
Fructose Sweetener Spurs Obesity
Another study finds that high consumption of soft drinks and other sweetened beverages contributes to obesity. But this study, conducted in mice, suggests that one form of natural sweetener -- fructose -- may be especially likely to encourage weight gain.
In the study, researchers at the University of Cincinnati allowed mice to freely consume either plain water or fructose-sweetened water and soft drinks.
The mice that drank the fructose-sweetened water and soft drinks gained weight, even though they took in fewer calories from solid food.
By the end of the study, the mice that consumed fructose-sweetened beverages had 90 percent more body fat than the mice that consumed water only.
The findings suggest that the total amount of calories consumed when someone includes fructose in their diets may not be the only cause of weight gain. Consuming fructose may actually affect metabolism in a way that leads to more fat storage, at least in mice, the researchers said.
"Our study shows how fat mass increases as a direct consequence of soft drink consumption," study author Dr. Matthias Tschop, associate professor in the University of Cincinnati's psychiatry department and a member of the Obesity Research Center at the university's Genome Research Institute, said in a prepared statement.
"We were surprised to see that mice actually ate less when exposed to fructose-sweetened beverages, and therefore didn't consume more overall calories. Nevertheless, they gained significantly more body fat within a few weeks," Tschop said.
The study appears in the July issue of the journal Obesity Research.
Acupuncture Can Ease Headaches
Acupuncture treatments cut the frequency of tension headaches in half in individuals prone to the ailment, a new study found.
But the researchers also point out that minimal acupuncture -- defined as "superficial needling at non-acupuncture points" and considered a sham treatment -- was just as effective, according to a German study appearing in this week's issue of the British Medical Journal.
"Based on the results of our trial, as well as of yet-unpublished observational data from a larger number of patients in routine care, it seems that many (German) patients benefit definitively, so I see no reason to discourage patients from trying it," said Dr. Klaus Linde, senior author of the study and an epidemiologist with the Institute of Medical Statistics and Epidemiology at the Technical University of Munich.
But he added, "As there was no relevant effect over an inadequate acupuncture intervention, I would be a bit cautious to actively recommend it widely."
According to the study authors, in a given year, 38 percent of Americans have episodic tension-type headaches and 2 percent have chronic, tension-type headaches. In 1997, a consensus statement issued by an expert panel at the U.S. National Institutes of Health, included headache as one of a number of conditions that might be helped by acupuncture.
While acupuncture is widely used for different types of headaches, experts remain conflicted over how effective it really is.
In traditional Chinese medicine, acupuncture is practiced to restore the flow of energy in the body. The technique most widely studied by scientists involves penetrating the skin with thin, solid, metallic needles that are manipulated by hand or electrical stimulation.
For the randomized, controlled trial at 28 outpatient centers in Germany, 270 mostly female patients experiencing tension headaches were divided into three groups.
One group was treated with traditional acupuncture and another with minimal acupuncture, while the control group received no acupuncture at all. Those in the two acupuncture groups received 12 sessions each spread over eight weeks.
Headache rates among those in the traditional acupuncture group fell by almost half: The number of days with headache decreased by 7.2, compared with 6.6 in the minimal acupuncture group. Those in the control group experienced only 1.5 fewer days with headaches. Improvements in the traditional acupuncture group were similar to improvement seen with accepted treatments.
About a fifth of those in the traditional acupuncture group reported side effects, such as dizziness, other headaches and bruising.
Interestingly, the improvements continued for months after the intervention, rising slightly as time progressed.
After the main study segment had ended, individuals in the control group were given acupuncture for eight weeks and also experienced improvements, albeit less than the original study participants.
The fact that traditional and minimal acupuncture had such similar results may indicate that the location of needles don't have a huge impact on how effective the treatment is, the study authors wrote.
Even though apparent sham acupuncture and real acupuncture have similar effects, Dr. Charles Kim, a pain medicine specialist at Mount Sinai Medical Center in New York City who also practices acupuncture, thinks something must be happening.
"The research to date has somehow shown that acupuncture does stimulate the release of endorphins, but, more specifically, I do treatments with electrostimulation and a lot of the research has shown that certain frequencies of stimulation with acupuncture induces beta-endorphins at certain frequencies," he said.
It's also possible that both acupuncture and the sham treatment are associated with strong placebo effects. A similar phenomenon was seen in a trial on acupuncture and migraines, which Linde was also involved with and which was published in May.
"As the large response to minimal acupuncture was so impressive, it would be extremely interesting to see whether similar results are obtained in other countries, and if so, what the reasons are," Linde said. "There is some evidence that any repetitive needling might influence pain perception and memory, and also that the whole ritual and setting of acupuncture is powerful. Research in this direction could be extremely interesting."
Hospital Reminders Lower Urinary Catheter Risk
Urinary catheters are often necessary for hospitalized patients, but risk of infection rises with extended use. A new study finds that a simple reminder system can help doctors remember to remove these catheters after two days, reducing patient risk and discomfort.
"Doctors are responsible for ordering the removal of catheters, but research has shown that many of them forget which patients have catheters and how long they have them," lead researcher Dr. Sanjay Saint, a hospitalist at the VA Ann Arbor Healthcare System and an associate professor of internal medicine at the University of Michigan Medical School, said in a prepared statement. "Our reminder system helps doctors do the right thing," Saint said.
In their 16-month study, his team of researchers found that having nurses flag patients' records with a written reminder to doctors resulted in many patients having catheters for a much shorter time.
The written reminder system is inexpensive and the cost is more than made up by the savings a hospital achieves by reducing catheter-related infections, the researchers add.
Their findings appear in the August issue of the Joint Commission Journal on Quality and Public Safety.
It is estimated that, at any given time, about 25 percent of hospital patients have urinary catheters. Many patients have the catheters in for much longer than they need them, which increases their risk of suffering a urinary tract or blood infection, the researchers said.
Pig-Borne Disease Found in Mainland China
A slaughterhouse worker contracted a pig-borne disease in southern China, a hospital official said Saturday. He was the first mainland case outside the Sichuan province, where 32 farmers have died since June from the illness.
Some 163 confirmed and suspected cases blamed on the bacteria streptococcus suis have been found in Sichuan in China's southwest, where farmers who handled or butchered infected pigs have been sickened in dozens of villages and towns.
The latest case is a 43-year-old man in Chaozhou, a city in Guangdong province, which borders Hong Kong and is hundreds of miles southeast of Sichuan. He "recovered and was discharged," said an official from the Chaozhou Central Hospital, who would not give her name or any other details.
It wasn't clear whether Chinese health officials believed the case was linked to the Sichuan outbreak.
Phone calls to other government offices in Guangdong rang unanswered.
Guangdong officials provided information on the case to authorities in Hong Kong but didn't say whether they thought it was linked to Sichuan, said Eva Wong, a spokeswoman for the territory's Health Department.
An official of the Hong Kong Centre for Health Protection, Ching Cheuk-tuen, said initial evidence shows the Guangdong man fell ill after direct contact with pigs.
"The information given to us by Guangdong health officials shows they do not consider it to be special or unusual," Ching told reporters.
One case was reported in Hong Kong this week, but Wong said it wasn't believed to be connected to the Sichuan outbreak because the man hadn't traveled in the month before his illness.
It was Hong Kong's 10th such case since May 2004, according to the Health Department.
In Sichuan, 24 people are hospitalized in critical condition and 11 have been discharged, the Chinese Health Ministry said Saturday on its Web site. No person-to-person transmissions have been reported.
Cases have been found in five new sites in Sichuan, including the provincial capital of Chengdu, the China Daily newspaper said.
The official Xinhua News Agency said no family members of the man in Guangdong have shown symptoms, which include nausea, fever, vomiting, and bleeding under the skin.
Reports of the latest outbreak triggered fears that another epidemic was sweeping China, which has battled severe acute respiratory syndrome, or SARS, and avian influenza in the past two years.
The World Health Organization said it is the largest recent outbreak of the pig-borne disease in the region.
Xinhua on Thursday cited China's Health Minister, Gao Qiang, as saying the epidemic appeared to be under control in Sichuan but warning that the region still needs to take precautions.
Health Tip: Old Enough for a Seat Belt?
How do you know when your child can move out of a booster seat and into a seat belt?
According to the Hospital For Sick Children in Toronto, your child is ready when:
* He or she reaches the weight or height limit of your booster seat, or when the middle of your child's ears are above the back of the vehicle seat, head restraint or booster seat.
* Your child can sit with his back against the vehicle seat with legs bent over the front edge of the seat.
* The lap belt fits across your child's upper thighs and the shoulder belt fits between the child's neck and arm.
Health Tip: Protect Your Child's Teeth
Chipped, broken and knocked-out teeth are common childhood dental emergencies.
Prevent accidents to your kids' teeth with these tips from the Children's Hospital of Philadelphia:
* Keep drawers and doors closed and stairs secured from babies and toddlers.
* When children first learn to stand alone, they often use furniture to pull themselves up and balance. Make sure you secure furniture that's at your child's level.
* Caution your child about drinking from water fountains. Kids can ram their teeth into the metal water jet.
* If your child plays contact sports, see that he wears a mouth guard.
Here's a secret for getting the most iron from spinach. Have a glass of orange juice! Our bodies are far better able to access the iron in iron-rich plant foods -- fortified grains, legumes and dark greens -- if eaten with something acidic, such as citrus juice or tomato sauce. And even though Popeye was always carrying the spinach around, it's more likely that his sweetie Olive Oyl needed the iron more -- 75% of American women under the age of 50 are iron-deficient. If you're concerned about iron deficiency, see your doctor for a blood test, the only way to properly diagnose the condition. Adult men rarely need iron supplements.
Fitness Tip of the day:
Eat your veggies.
Listen to your mom; veggies will enhance your workout. Most veggies contain pantothenic acid, an essential nutrient that helps you stay fit and alert. This essential part of your diet contributes to the production of amino acids, helps metabolize fat and assists in the manufacture of neurotransmitters, the chemicals that carry messages in the brain.
FAQ of the day:
What's the difference between an herb and a spice?
Spices are generally derived from the dried seeds, roots or bark of a plant, often a tropical one. Herbs generally come from leaves, flowers and stems.