HIV Patients Less Likely to Get Cancer Treatment: Study

While medications are helping HIV-positive people avoid developing full-blown AIDS indefinitely, a new study finds that cancer patients with HIV are up to four times less likely to be treated for their tumors.

The research comes with caveats. It looked at just three states from 1996, when powerful HIV drugs first began changing the face of the disease, to 2010, when patients routinely took the medications. And the study doesn't explain why HIV-positive people with cancer receive less treatment or how this affected their lifespans.

Still, "the main message is that these patients are not receiving appropriate cancer therapy," said study author Dr. Gita Suneja, an assistant professor of radiation oncology with the University of Utah. "There's a lack of awareness about the issue as a whole because any one physician will see few of these patients. It's something that we need to focus on."

In the 1980s and early 1990s, patients with AIDS -- the disease caused by infection with HIV -- often didn't live long enough to develop cancer, other than a few types linked to the failure of their immune systems. Now, HIV patients often don't develop AIDS and are likely to become ill with cancer as they age.

But these patients aren't the same as others with cancer. HIV-infected people are more likely to develop lung, anal and immune system cancers, possibly because the tumors begin developing before they begin taking HIV medication, said Dr. Michael Horberg, director of HIV/AIDS with Kaiser Permanente.

The new study compared patients in the United States with cancer: more than 3,000 with HIV, and more than 1 million without HIV. The researchers found that the HIV patients were less likely to have received standard treatment for certain types of colon, lymphoma and lung cancers. HIV patients were also more likely to have not received any treatment for certain types of lymphoma, lung, prostate and colorectal cancers.

Among those with a type of lung cancer, for instance, one-third of the HIV patients didn't get the standard surgical treatment, compared to 19 percent of the other patients.

What's going on? Patients may be offered treatment but decline it, said Suneja, who worked on the study while at the University of Pennsylvania. Treatment challenges, which can include drug interactions and a potential increase in immunosuppression after chemotherapy or radiation, may also play a part in the differences, the researchers said.

Horberg said it's also possible that the cancers weren't caught early or that cancer physicians didn't treat the patients as aggressively as they could have.

He also said physicians need to be more careful about making sure that HIV patients don't have cancer, even if the patients are young. "Screening for cancer has to be a key element of HIV care," Horberg said. "There has to be increased vigilance. A physician may not be thinking of lung cancer or anal cancer when a patient is at a younger age, but you actually have to think about it earlier than usual."

In the bigger picture, HIV patients with cancer "should have access to the cutting-edge therapies and be enrolled in studies so we can gather information about how effective these treatments are for them," he said.

The study appeared online June 30 in the Journal of Clinical Oncology.

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Cold Sore Virus Active Without Symptoms, Study Finds

The virus that causes cold sores -- herpes simplex type 1 -- remains active even in the absence of symptoms, according to a new study.

Researchers in Australia found there's an ongoing struggle in the cells of people infected with the virus. This explains why some people with the virus never develop cold sores and why others get them only occasionally. The authors said the findings could lead to the development of new treatments.

"We thought when the disease was dormant, it was a truce. It turns out that the virus is waking up more often than we thought, but our cells are constantly pushing it down," said David Tscharke, associate professor in the Research School of Biology at Australian National University.

"When we thought there was nothing going on we had no targets to look at. Now [that] we know there is an interaction, we can look for ways to help the good guys to win," Tscharke said in a university news release.

In conducting the study, published July 24 in PLOS Pathogens, the researchers used cells and viruses that were genetically modified so infected cells turned bright yellow even when the virus was inactive. This allowed the infected cells to be identified. Then, using a microscope equipped with a laser, the scientists measured levels of viral activity in the cells.

"We expected that we would see no activity in the dormant cells," Tscharke said. "The surprise came when we found the virus was doing something in many cells."

Cells also have different levels of viral activity, the researchers found. "For some it's very low and in others more of the virus genes are turned on. The host cells were responding most strongly when there was lots of virus activity," Tscharke said.

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AIDS Epidemic May Be Subsiding: Report

 A new United Nations report suggests that the AIDS epidemic might be waning: The number of new HIV infections worldwide is at a record low, AIDS-related deaths are down 35 percent, and more people with HIV are getting the lifesaving medications they need.

International health officials even set a tentative date for the planned demise of HIV, the virus that causes AIDS.

"If we accelerate all HIV scale-up [increased efforts to fight the virus] by 2020, we will be on track to end the epidemic by 2030," Michel Sidibe, executive director of UNAIDS, said in an agency news release. "If not, we risk significantly increasing the time it would take -- adding a decade, if not more."

At the end of 2013, an estimated 35 million people worldwide were living with HIV, according to the UNAIDS report, which was released Wednesday.

However, the trend in recent years is promising. In the last three years, new HIV infections have dropped 13 percent, and the 2.1 million new HIV infections reported last year are the fewest since the turn of the century.

New HIV infections among children fell by 58 percent since 2001, and are below 200,000 for the first time in the 21 most affected countries in Africa.

The largest decline in new infections was in the Caribbean -- 40 percent since 2005, the researchers noted. But new infections did increase 8 percent in western Europe and North America, 7 percent in the Middle East and North Africa, and 5 percent in eastern Europe and central Asia since 2005.

The news on AIDS-related deaths worldwide was also heartening, with statistics showing a 35 percent decline after the number of deaths peaked in 2005. AIDS-related deaths did increase by 66 percent in the Middle East and North Africa. The only other regions where AIDS-related deaths are rising are eastern Europe and central Asia, where the death toll increased 5 percent between 2005 and 2013. Tuberculosis remains the leading cause of death among people with HIV.

Also, a growing number of people with HIV are receiving lifesaving antiretroviral drugs. In 2013, 2.3 million more patients gained access to the medications, boosting the total number to nearly 13 million by the end of 2013. As of now, that number could be as high as nearly 14 million, according to UNAIDS.

In sub-Saharan Africa, nearly 90 percent of people who know they have HIV are receiving treatment, the findings showed.

Ending the HIV epidemic by 2030 would prevent 18 million new infections and 11.2 million AIDS-related deaths between 2013 and 2030, U.N. officials noted.

However, some experts questioned the wisdom of setting such a high goal.

"We've made progress, but the number of people getting infected is still extraordinarily high," Shabbar Jaffar, a professor of epidemiology at the London School of Hygiene and Tropical Medicine, told theAssociated Press. Jaffar added that boosting efforts to fight the disease in Africa, where almost 70 percent of people with HIV live, would be hard because "they [health officials] are already working beyond capacity at the moment."

While there was good news in the report, it also noted that 19 million of the 35 million people worldwide who are infected with HIV do not know they have the virus.

"Whether you live or die should not depend on access to an HIV test," Sidibe said. "Smarter scale-up is needed to close the gap between people who know their HIV status and people who don't, people who can get services and people who can't, and people who are protected and people who are punished."

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HIV Meds May Also Help Control Hepatitis C, Study Finds

 For patients infected with both HIV and hepatitis C, HIV antiretroviral therapy may help control both viruses, a small study suggests.

Researchers said doctors could use their findings to improve treatment strategies for people with the two diseases.

"The findings suggest that HIV suppression with antiretroviral medications plays an important role in the management of individuals with [hepatitis C] and HIV infection," said study leader Dr. Kenneth Sherman, a professor of medicine at the University of Cincinnati College of Medicine. "It supports the concept that in those with HCV/HIV infection, early and uninterrupted HIV therapy is a critical part of preventing liver disease."

The researchers conducted the study to address concerns that treating patients who have HIV -- the AIDS-causing virus -- and hepatitis C with HIV antiretroviral therapy would damage the liver and cause more harm than good.

To put this theory to the test, they closely examined 17 patients infected with both viruses for two years. The patients received approved HIV antiretroviral drugs. They were also examined frequently, and their blood was routinely tested to track any changes in the viruses and their immune response.

The findings were published July 23 in the journal Science Translational Medicine.

Some patients experienced an initial increase in a blood test that shows changes in liver injury, hepatitis C or both in the first 16 weeks of the study.

Over 18 months, however, the study revealed that "viral loads" for hepatitis C dropped back down to levels expected for a patient infected with only hepatitis C and not HIV.

"The drop in [hepatitis C] viral levels was a big surprise, and not what we necessarily expected," said Sherman in a university news release. "There is a complex interaction of biological effects when patients are infected with both HIV and the hepatitis C virus." He explained that initially HIV treatment results in a transient increase in hepatitis C viral replication and evidence of liver injury. However, over time, HIV suppression leads to reduced hepatitis C viral replication.

In the United States, up to 300,000 people are infected with both hepatitis C and HIV. Globally, that number increases to between 4 million and 8 million, the researchers said.

Drug makers Bristol-Myers Squibb and Gilead Sciences supplied the antiretroviral medications used in the study at no charge. One of the scientists involved in the research, Dr. Judith Feinberg, a professor of infectious diseases at the University of Cincinnati, is a Bristol-Myers Squibb investigator and speaker.

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Nearly 5 Percent of Young U.S. Women Have Chlamydia: CDC

An estimated 1.8 million Americans aged 14 to 39 are infected with the sexually transmitted disease chlamydia, and many don't know it, federal health officials reported Thursday.

Rates of infection are highest among young women. An estimated 4.7 percent of women aged 14 to 24 were infected with the easily treated disease in 2012, which often has no symptoms. But, if left untreated, chlamydia can lead to infertility, problems during pregnancy and other health threats.

"Chlamydia is common, and it's especially common in young women. Most young women who are infected don't know they have it," said study author Elizabeth Torrone, an epidemiologist with the U.S. Centers for Disease Control and Prevention's division of STD prevention.

"This report really underscores the need for young women to be screened for chlamydia annually," she said.

The report was based on statistics from the 2007-2012 National Health and Nutrition Examination Survey.

Infection rates were highest among black women aged 14 to 24 -- at 13.5 percent. Among Mexican-American women, the rate of infection was 4.5 percent. And among white women, it was 1.8 percent, according to the study.

The overall prevalence of chlamydia among those aged 14 to 39 has remained virtually unchanged for nearly a decade, according to the report. From 2007 to 2008, the infection rate was 1.6 percent; from 2009 to 2010, it was 1.7 percent; and from 2011 to 2012, it was 1.9 percent.

Chlamydia is easily diagnosed with a urine test, and it is easy to treat with antibiotics, Torrone said. She added that it's important that the partners of infected women be treated, too.

Dr. Metee Comkornruecha, an adolescent medicine specialist at Miami Children's Hospital, said the findings "line up with what we are seeing."

If the infection is caught early, it is usually cured with a single dose of an antibiotic, Comkornruecha said. If the infection has spread, however, the treatment may require two weeks of antibiotics or, in some cases, stronger intravenous antibiotics, he said.

The U.S. Preventive Services Task Force recommends that all sexually active women under the age of 25 be screened yearly for chlamydia, Torrone said.

A woman's risk for infection decreases as she ages, according to the report. It was published in the Sept. 27 issue of the CDC's Morbidity and Mortality Weekly Report.

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Studies Link Cold Sore Virus to Alzheimer's Risk

The virus that causes common cold sores -- herpes simplex -- might increase the risk of Alzheimer's disease, two studies by Swedish researchers suggest.

In fact, being a carrier of certain antibodies to the virus can double the risk of Alzheimer's disease, the researchers found.

"The identification of a treatable cause [herpes simplex] of the most common dementia disorder is a breakthrough," said lead researcher Dr. Hugo Lovheim, an associate professor in the department of community medicine and rehabilitation at Umea University in Sweden.

"Whether treatment of herpes infection with antiviral drugs may slow the Alzheimer's progression is not known, but is certainly worth investigating in clinical studies," he said.

But others aren't so sure that there's a clear cause and effect relationship between herpes simplex and Alzheimer's disease.

Dr. Sam Gandy, director of the Center for Cognitive Health at Mount Sinai Hospital in New York City, doubts that herpes and Alzheimer's disease are connected.

"From time to time data such as these appear in the literature, but they do not address causality or mechanism. The new data are likewise not definitive, and they do not say anything new about the association," he said.

"I do not disbelieve the data. I simply do not know whether the association has anything to do with the cause of Alzheimer's disease," Gandy added.

Herpes simplex is a common infection, affecting up to 90 percent of the population, according to background information in the article. It's the virus that causes cold sores, according to the American Academy of Dermatology (AAD). Once you have herpes simplex, you have it for life, though the virus isn't always active, according to AAD.

The theory linking the herpes virus and Alzheimer's disease is that the virus weakens the immune system, allowing the virus to spread to the brain, which may start the process toward dementia, the researchers said.

In one study of nearly 3,500 people followed for an average of 11 years, Lovheim's team found that having certain antibodies to a herpes infection doubled the risk of developing Alzheimer's disease.

In the second study, blood samples were taken from 360 Alzheimer's patients an average of 9.6 years before being diagnosed with the disease. The researchers compared these with samples taken from people without Alzheimer's disease. When comparing all of the samples, the researchers found no association between Alzheimer's and herpes infection. However, when they looked only at people who'd had their blood taken at least 6.6 years prior, there was a significant association between the herpes virus and the risk of developing Alzheimer's disease.

"I think herpes virus causes a significant proportion of all cases of AD -- about 40 to 50 percent -- according to our data," Lovheim said.

Lovheim said that these studies indicate that the role the herpes virus plays in the development of Alzheimer's disease is more than a chance association, but instead indicate a causal relationship.

"I think a causal relationship is likely, but like all epidemiological studies, there might always be confounders one has not thought about or not measured," he said. "In a few years we hope we will be able to start clinical studies to investigate whether antiviral drugs might slow the progression of Alzheimer's disease," he said.

However, Greg Cole, the associate director of the Geriatric Research and Clinical Center at the UCLA Alzheimer Disease Research Center in Los Angeles, isn't convinced.

"More than 90 percent of the population has antibodies to herpes, and they are not all destined to develop Alzheimer's disease," he said.

However, an immune response or infection connection between herpes and Alzheimer's disease is possible, Cole noted.

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Multiple Drug Use Raises Infection Risk for 'Swinging' Couples

Multiple drug use put couples who "swing" at increased risk for sexually transmitted diseases (STDs), a new study shows.

Swingers are defined as heterosexual couples who have group sex, swap partners and/or visit sex clubs for couples. Researchers looked at 289 people, average age 49, in the Netherlands who said they were swingers and visited an STD clinic between 2009 and 2012.

Half of the participants said they'd had six or more sex partners in the last six months, and had not used a condom during vaginal sex. More than half said they'd had group sex during the same time, and half of them did not use condoms.

One quarter of the men reported having sex with other male swingers in the last six months, according to the study published Oct. 23 in the journal Sexually Transmitted Infections.

Overall, rates of chlamydia and/or gonorrhea were 13 percent, but no other STDs were present among the participants.

The researchers found that 79 percent of the swingers said they used erectile dysfunction drugs and recreational drugs such as cocaine, LSD, methamphetamines, marijuana, laughing gas and alcohol, and that 46 percent reported multiple drug use.

Recreational drug use (other than alcohol and erectile dysfunction drugs) was associated with high-risk sexual behaviors in men and women, while drug use was only independently associated with STDs in female swingers, especially those who took part in group sex.

"Drug-using populations are a target for interventions that address the practice of safer sex along with secondary prevention of drug use," the researchers wrote.

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