Kaiser Daily HIV/AIDS Report Highlights Recently Released Journal Articles on HIV/AIDS
The following highlights recently released journal articles on HIV/AIDS.
- "The Role of Health Care in the Spread of HIV/AIDS in Africa: Evidence From Kenya," International Journal of STD and AIDS: Stuart Brody of the University of Paisley in Scotland and Eva Deuchert of the University of Freiburg in Germany analyzed data from the 2003 Kenya Demographic and Health Survey of 1,620 pregnant women who did not report being HIV-positive prior to receiving neonatal tetanus-toxoid shots, the Washington Times reports. The researchers found that the pregnant women who received a tetanus shots were almost twice as likely to subsequently test HIV-positive, compared with those who did not receive a tetanus shot. According to Brody, the findings of the study and previous studies provide "mounting evidence" that health organizations are "misguided" in focusing HIV-prevention efforts on a strategy that promotes safer sex. George Schmid, a senior researcher for the World Health Organization's HIV/AIDS Department, questioned the study's design and findings. According to Schmid, less than 5% of infections worldwide are transmitted by unsafe injections (Bawa, Washington Times, 11/1). The study authors recommend that health care resources be reallocated to address health care-related HIV transmission (Brody/Deuchert, International Journal of STD and AIDS, November 2006).
- "Pregnant Women With HIV Infection Can Expect Healthy Survival: Three-Year Follow-Up," Journal of Acquired Immune Deficiency Syndromes: Fabiola Martin of St. Mary's NHS Trust in London and colleagues followed up with 311 HIV-positive pregnant women who had given birth to assess their long-term health, Reuters Health reports (Reuters Health, 10/30). The researchers divided the women into three groups depending on their immune status. One group was treated with zidovudine monotherapy, the second group received highly active antiretroviral therapy during and after pregnancy, and a third group received short-term HAART during pregnancy only (Martin et al., JAIDS, 10/1). The average follow-up time was 33 months, according to Reuters Health. The study found that 98% of all the women survived through the last follow-up visit without progressing to AIDS. The study also found that three of the 85 women who received zidovudine monotherapy had disease progression; two of the 154 women who were treated with HAART during and after pregnancy had disease progression; and one of the 71 women who were treated with short-term HAART during pregnancy had disease progression. Researchers concluded that with access to HAART, teh progression to AIDS for women giving birth is uncommon, and it is possible to achieve a frequency of mother-to-child HIV transmission that is less than 1% (Reuters Health, 10/30).
- "Initial Highly Active Antiretroviral Therapy With a Protease Inhibitor Versus a Non-Nucleoside Reverse Transcriptase Inhibitor: Discrepancies Between Direct and Indirect Meta-Analyses," Lancet: Roger Chou of Oregon Health and Science University and colleagues reviewed 12 trials over 24 weeks comparing non-nucleoside reverse transcriptase inhibitor-based highly active antiretroviral treatment, which can sometimes be administered once daily, with protease inhibitor-based HAART, which must be taken more frequently, in HIV-positive people who had little or no previous antiretroviral exposure (Chou et al., Lancet, 10/28). The study found that NNRTI-based treatment regimens were more effective at decreasing viral load than PI-based regimens and that they were as effective as PI-based regimens in fighting disease progression. In addition, the study found that similar numbers of HIV-positive people in both treatment groups stopped taking HAART because of adverse effects associated with the medication. According to researchers, the findings favor NNRTIs as a more convenient HIV/AIDS treatment method that could boost patient adherence to the drug regimen (CQ HealthBeat, 10/27).
- "Short-Term Risk of AIDS or Death in People Infected With HIV-1 Before Antiretroviral Therapy in South Africa: A Longitudinal Study," Lancet: Motasim Badri of the Desmond Tutu HIV Centre at the University of Cape Town in Cape Town, South Africa, and colleagues examined 1,399 HIV-positive people residing in Cape Town who had no access to antiretroviral drugs or who were receiving zidovudine only and cohorts of HIV-positive Europeans and Australians at similar clinical stages of the disease to determine when antiretroviral therapy should begin in resource-limited settings (Badri et al., Lancet, 10/7). The study noted that current World Health Organization guidelines, which recommend that HIV-positive people in lower-income countries begin antiretroviral treatment when their CD4+ T cell counts fall below 200, are based on studies carried out in high-income countries (SAPA/Business Day, 10/30). The study found that the Cape Town residents with CD4+ T cell counts of less than 200 or greater than 350 had a similar six-month risk of progression to AIDS to those in the European and Australian cohorts. However, for participants in Cape Town with CD4+ T cell counts between 200 and 350, the risk of progressing to AIDS was 1.9 times greater, compared with the European and Australian cohorts. "The high death rate before development of AIDS and a high risk of AIDS in those with CD4 cell counts of 200 to 350 cells ... indicate that delay in initiation of [antiretroviral therapy] is associated with increased morbidity and mortality," the researchers write, concluding, "These findings might help to amend criteria for start of ART in resource-limited settings" (Badri et al., Lancet, 10/7).
- "HIV Stigma, and Rates of Infection: A Rumour Without Evidence," PLoS Medicine: "On any ranked list of stigmatized conditions, HIV would have to lie towards the top," but the "actual evidence base" to prove a direct link between HIV-related stigma and the pandemic "is almost nonexistent," Daniel Reidpath of Brunel University's Centre for Public Health Research and Kit Yee Chan of Deakin University's School of Health and Social Development write in a PLoS Medicine essay. Blaming stigma for fueling the HIV/AIDS pandemic "gives too much weight to individual behavioral change as the answer to HIV prevention," Reidpath and Yee Chan write, adding that it also "neglects the more difficult issues" associated with how "HIV spreads in populations, the social vulnerabilities it exploits and the ways in which individuals within subpopulations interact with each other and with members of other subpopulations." The authors add that there are some "core scientific issues" that need to be resolved if the question of the link between HIV stigma and the HIV/AIDS pandemic is to be determined. "Whether HIV stigma is one of the greatest barriers to the global control of the epidemic remains a hypothesis," the authors write, concluding, "The scientific investigation of it demands significant effort, and should be a matter of priority" (Reidpath/Yee Chan, PLoS Medicine, October 2006).