Taking Anti-HIV Meds Prior to Exposure May Help Prevent Infection

TUESDAY, May 29 (HealthDay News) -- Preventive antiretroviral treatment appears to be an effective way to help protect high-risk people against HIV infection, a new study suggests.

HIV, the virus that causes AIDS, can be transmitted through unprotected sex and contaminated needles.

Immediate treatment after HIV exposure can be successful in preventing HIV infection, previous research has found. More recently, several large randomized, controlled trials -- the gold standard of medical research, in which people are randomly assigned to treatment or no treatment -- have shown that giving antiretroviral drugs before people are exposed may also prevent infection.

For the new report, published May 28 in the CMAJ (Canadian Medical Association Journal), researchers reviewed studies published between January 1990 and April 2012 and found that preventive antiretroviral treatment could reduce the risk of HIV infection in high-risk groups such as gay men, intravenous drug users, and women in areas with high rates of HIV.

For example, one recent study that included 900 women from a region with a high rate of HIV found that applying a topical vaginal microbicide 12 hours before and after sex led to a 39 percent reduction in HIV infection rates.

"All pre-exposure prophylaxis [prevention] interventions should be considered one part of a more comprehensive plan for preventing the spread of HIV infection, including standard counseling on safer sexual practices and condom use, testing for and treating other sexually transmitted infections and, in select circumstances, male circumcision and needle exchange programs," Dr. Isaac Bogoch of Harvard Medical School and Massachusetts General Hospital in Boston, and colleagues wrote.

While pre-exposure treatment is promising, there are a number of unanswered questions, such as which groups would benefit most, and the possibility of the development of drug resistance, the researchers noted.

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The U.S. Centers for Disease Control and Prevention has more about HIV transmission.

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Ritual in Some Jewish Circumcisions Raises Risk of Herpes Infection: Report

THURSDAY, June 7 (HealthDay News) -- The practice of "oral-genital suction" performed during some Orthodox Jewish circumcision ceremonies could leave the infant with a potentially fatal herpes virus infection, health officials warn.

New York City and federal health authorities issued a public advisory Thursday cautioning against the sucking practice because it has been linked to 11 infants becoming infected with the herpes simplex virus type 1 since 2000. Ten of the infected newborns were hospitalized, two developed brain damage and two died, the health officials said.

A newborn can become infected when the adult performing the circumcision places his mouth on the circumcision wound to siphon blood away from the cut. The ritual is only embraced by a handful of sects within the Orthodox Jewish community, according to New York City Health Commissioner Dr. Thomas Farley.

"There is no safe way to perform oral suction on any open wound in a newborn," Farley said in a news release. "Parents considering ritual Jewish circumcision need to know that circumcision should only be performed under sterile conditions, like any other procedures that create open cuts, whether by mohelim [the circumciser] or medical professionals."

A report on the infections also appears in the June 8 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Almost 80 percent of adults carry the herpes simplex virus type 1, which is usually spread orally through common activities and is different from the sexually transmitted type 2 version of the virus. The common cold sore is a typical sign of infection with the herpes simplex virus type 1, but most people don't know they are infected because they have no history of symptoms, officials said.

In six of the 11 circumcision cases, health care providers confirmed that the suction ritual had taken place, although there was evidence of a connection in the other five cases. The ritual more than tripled the risk of infection among newborns getting circumcised, the CDC report stated.

New York's deputy health commissioner, Dr. Jay Varma, said: "The [New York City Department of Health and Mental Hygiene] has been concerned about this problem for some time. And so we are taking the approach right now to try and educate parents and the community about the dangers of this very specific procedure.

"The infections we're talking about are not the ones people normally associate with sexual type interaction," he added. "Many actually acquire herpes type 1 when they are children, because it can be gotten through very casual contact. This causes what people commonly call cold sores in the mouth.

"We're not implying in any way that these mohel [circumcisers] have done anything untoward in a sexual context," Varma said. "The point is that regardless if you're a mohel or someone else, having direct contact with the mouth and an open wound is a hazard."

To highlight the risks involved, Varma cited an incident in 2004 when twin boys were diagnosed with herpes following oral-genital suction during circumcision. About two weeks later, both babies developed fevers and lesions around their genitals, buttocks and abdomen. One of boys later died.

The boys' mother and hospital staffers were ruled out as a possible source of infection.

Dr. Philip Tierno, director of clinical microbiology and pathology at New York University Medical Center, said the sucking practice is a "bad idea."

"There are about 500 different microorganisms in the human mouth," he said. "So, I think it's insanity. It's not only unhygienic, but it can potentially kill the child. So, for the protection of children this is a practice that should be discontinued."

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For more on herpes, visit the U.S. National Library of Medicine.

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FDA Advisers Back Pill to Help Prevent HIV Infection

THURSDAY, May 10 (HealthDay News) -- U.S. Food and Drug Administration advisers on Thursday endorsed the use of the drug Truvada as a means to help prevent HIV infection in healthy people at high risk of contracting the AIDS-causing virus.

In a series of votes that could lead to a major new weapon in the fight against AIDS, the FDA advisers recommended approval of the daily pill for healthy, at-risk individuals, including gay and bisexual men and heterosexual couples with one HIV-infected person, the Associated Press reported.

The FDA is not bound to follow the recommendations of its advisory panels, but it typically does so. A final decision is expected by mid-June.

A report released earlier this week by the FDA suggested that scientists believe the drug is safe and effective. It has been available since 2004 to treat people already infected with HIV.

But there are potential drawbacks to using the medication as a way to try to prevent HIV infection. Truvada -- which combines two HIV-fighting drugs, tenofovir (Viread) and emtricitabine (Emtriva) -- is very expensive and may cause side effects. And although doctors can already prescribe it to people trying to avoid HIV infection, critics contend it's too early to officially allow it to be promoted for that use.

On the other hand, those who support marketing the drug as a preventive agent say it can help high-risk people avoid the disease, especially if they don't use condoms or if they want an added layer of protection.

"I don't see it as a panacea, but it's an option, and that's important," said Dr. Kenneth Mayer, an AIDS specialist and medical research director of The Fenway Institute at Fenway Health in Boston. "Some people won't use a condom, but will say, 'if you give me another option, I'll use that.'"

Truvada works to combat HIV from replicating in the body's cells. Mayer explained that in someone who is not yet infected but is exposed to HIV, the drug may prevent the virus from reproducing even if it has already invaded cells. As a result, he said, "the virus cannot start turning the newly exposed person's body into a 'factory' to produce more HIV particles."

A study published in 2010 in the New England Journal of Medicine found that Truvada cut the risk of HIV infection by almost 44 percent in those at highest risk for contracting the virus, namely sexually active gay and bisexual men. The risk reduction climbed to nearly 73 percent among study participants who took the pill 90 percent of the time, the researchers added.

Research suggests that people who use Truvada daily along with condoms would gain an added layer of protection, because condoms aren't 100 percent effective. But one organization, the AIDS Healthcare Foundation, worries that wider use of the drug could lead to more infections by discouraging people from bothering to use condoms.

"Why would you take this medication if you intended to use condoms?" asked the group's president, Michael Weinstein, in an interview with Bloomberg News. He used a sartorial metaphor to elaborate how unlikely that might be: "You've got to be really paranoid about your pants falling down to wear a belt and suspenders."

A. David Paltiel, a professor at Yale University School of Medicine, said his research has shown that the use of preventive drug treatments should reduce the risk of infection overall. Still, he said, it's unknown if "people (would) take more chances because they feel protected by a 'chemical condom.'"

Potential markets for Truvada as a preventive drug, Mayer said, include gay men who have sex with more than one man and any committed couple in which one person is HIV-positive, including some heterosexual couples who want to have children.

Mayer, who has conducted research into the drug, said that allowing the marketing will probably lead to an increase in its usage for prevention. But, "this is not a one-time, end-of-the-problem approach like a shot of penicillin to treat an infection like syphilis," he said. "Also, it involves someone perceiving that he or she is at risk, or a provider being comfortable enough to ask about a person's risk. We know that a lot of health providers don't like to talk to their patients about sex."

Truvada, which is manufactured by Gilead Sciences, can also cause a long list of side effects, including gastrointestinal problems. And it's costly, with prices in the United States tagged at about $26 a day or $10,000 a year. Still, a study released this year found the drug would be cost-effective if used extensively by gay and bisexual men at high risk of becoming infected.

For his part, Paltiel said his research came to the same conclusion: That widespread use of the drug in high-risk people would be "as cost-effective as other widely accepted public health and medical interventions."

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Find out more about HIV/AIDS at the U.S. National Library of Medicine.

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