H.I.V. Spreads in China, Affecting New Populations

Infection with the AIDS virus in China is spreading beyond the country’s original high-risk groups — heroin addicts in the south and blood sellers in rural central counties.

A new study finds that the virus has spread to all provinces, and cases are rising quickly among gay men and female prostitutes. Heterosexual transmission is increasing. In Yunnan, the country’s hardest-hit province, two men were infected for each woman as of 2006; 10 years earlier, the ratio was 13 to 1.

Although the number of estimated cases — 700,000 — is low for a population of 1.3 billion, it has risen 8 percent since 2005, according to the study, published last week in Nature.

“The epidemic is expanding, and more effective preventive measures are urgently needed,” said the authors, who include seven scientists from Chinese universities and government agencies and Dr. David D. Ho from the Aaron Diamond AIDS Research Center at Rockefeller University.

Scientists believe AIDS entered in the 1980s with drug traffickers in Yunnan, which borders Southeast Asia’s opium “Golden Triangle.” It grew in Henan, where illegal blood banks pooled blood from indigent farmers, spun it to remove clotting factors and returned mixed red cells to all sellers.

Tracking H.I.V. subtypes suggests the virus has moved along drug-trafficking routes, creating an outbreak in western Xinjiang.

To prevent spread to the general population, the authors endorse condom promotion among sex workers, exchange of clean drug-injection needles for used ones, methadone maintenance and free antiretroviral therapy. source : nytimes.com

Speaking Out for a Group Once Unheard-Of: Aging With AIDS

In the early 1990s, a diagnosis of AIDS was both a likely death sentence and a stigma. There were few treatment options, and many Americans were terrified of people infected with H.I.V.

Today, because of antiretroviral therapy and an array of drugs to treat both symptoms and side effects, AIDS has become a chronic condition to be managed, at least in the developed world. No longer is the face of AIDS emaciated and covered with lesions; Americans with the disease are stronger and healthier, their concerns fading from public view.

Myron Gold, 67, is one of them. In 1993, Mr. Gold was walking in Manhattan around Christmastime when he collapsed and was rushed to the emergency room. A social worker later walked in and loudly announced that he had H.I.V.

Mr. Gold remembers the panic on the faces of the other patients. “When you said that in ’93, you emptied the whole emergency room,” he said. “Everyone ran for their lives.”

Still, he was unfazed by his diagnosis. A former fashion designer who became an AIDS and gay-rights activist, he was already familiar with the disease and how it ravaged the body. He was given a prescription for AZT, the most common treatment at the time, and was told he had six months to live.

Fifteen years later, he is alive and relatively well — and that, paradoxically, is the problem.

“This is not an illness about people in their 20s and teens,” he said. “This is an illness about every age spectrum, from young to old.”

In fact, 29 percent of those infected with H.I.V. are over 50. And because the immune system deteriorates with age, the virus is all the more aggressive in older people.

“I’ve been through 28 medications,” Mr. Gold said. His T cells — a component of the immune system, used as a marker of its health — “are low and they’re not working.”

Moreover, conditions that are often part of the aging process, like arthritis and dementia, can also be caused by H.I.V. So sorting through symptoms and effectively treating them — not to mention avoiding dangerous drug interactions — can be daunting.

There is also an alarming rate of infection among older Americans. In 2005, 15 percent of new H.I.V. and AIDS diagnoses were among people over the age of 50, according to the Centers for Disease Control and Prevention. Yet government recommendations call for routine AIDS screening only up to age 64, omitting the elderly population.

“What about people 65 and older?” Mr. Gold asked. “They’re having unprotected sex, they’re using drugs.”

He says that is why he continues his advocacy for people with AIDS and for stronger prevention efforts. He sits on both the New York and national boards of the nonprofit group Association of H.I.V. Over 50, attends City Council meetings and has spoken before Congress and the New York Legislature.

Not long ago, he visited a senior center in the Canarsie section of Brooklyn to discuss safe sex practices. The women who attended, “all over 80 years old,” he said later, rushed toward the table afterward for the free condoms he was distributing. (“They said to me, ‘It’s not for me, it’s for my grandson,’ ” he said.)

Politicians don’t like to talk about the spread of AIDS among the elderly, Mr. Gold says; nobody wants to hear about Grandma’s sex life. But he adds that change cannot happen without open discussion.

Mr. Gold is proud that he has long outlived his initial diagnosis, but AIDS has weakened his body and he now relies on an electric scooter to get to advocacy meetings and speaking events. Still, he keeps going.

“My work is what feeds me now,” he said. “Call me in 10 years, I’ll still be here.”

Rare Treatment Is Reported to Cure AIDS Patient

Doctors in Berlin are reporting that they cured a man of AIDS by giving him transplanted blood stem cells from a person naturally resistant to the virus.

But while the case has novel medical implications, experts say it will be of little immediate use in treating AIDS. Top American researchers called the treatment unthinkable for the millions infected in Africa and impractical even for insured patients in top research hospitals.

“It’s very nice, and it’s not even surprising,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. “But it’s just off the table of practicality.”

The patient, a 42-year-old American resident in Germany, also has leukemia, which justified the high risk of a stem-cell transplant. Such transplants require wiping out a patient’s immune system, including bone marrow, with radiation and drugs; 10 to 30 percent of those getting them die.

“Frankly, I’d rather take the medicine,” said Dr. Robert C. Gallo, director of the Institute of Human Virology at the University of Maryland School of Medicine, referring to antiretroviral drugs.

Moreover, the chances of finding a donor who is a good tissue match for the patient and also has the rare genetic mutation that confers resistance to H.I.V., the virus that causes AIDS, are extremely small. Nonetheless, the man has been free of the virus for 20 months even though he is not using antiretroviral drugs, and the success in his case is evidence that a long-dreamed-of therapy for AIDS — injecting stem cells that have been genetically re-engineered with the mutation — might work.

The cure was announced Wednesday by Dr. Gero Hütter and Dr. Eckhard Thiel, blood-cancer specialists at Charité Hospital in Berlin. The case was described last week in The Wall Street Journal.

Attempts to use bone-marrow transplants in AIDS treatment have been made since the 1980s. In one case, a patient with both AIDS and lymphoma died of the cancer two months later, but was found to harbor no H.I.V.; it was not known if something in the transplant had protected him.

And in a famous 1995 case, Jeff Getty, a prominent San Francisco advocate for AIDS patients, received bone marrow from a baboon, which is resistant to the human virus. He survived 11 years, but died of AIDS and cancer; the transplant had not protected him but antiretroviral triple therapy had been invented in time to help.

Dr. Hütter said one of the 80 potential donors who matched his patient closely enough for leukemia treatment also happened to have the mutation.

That mutation, discovered in a few gay men in the 1990s and known as Delta 32, must be inherited from both parents. With it, the white blood cells produced in the marrow lack the surface receptors that allow H.I.V. to invade the immune system.

Even if it is prevented from replicating by drugs, the H.I.V. can lie dormant in lymph and nerve cells for years. But without the necessary receptors, any virus coming out of dormancy has no way to infect them.

Doctors say the case gives hope for therapies that artificially induce the Delta 32 mutation.

For example, Dr. Irvin S. Y. Chen, director of the AIDS Institute at U.C.L.A. , is working on using RNA “hairpin scissors” to cut out the bits of genetic material in blood stem cells that code for the receptors. The concept is working in monkeys, he said. Eventually, he hopes, it will be possible to inject them into humans after wiping out only part of the immune system with drugs. “I think that would carry no risk of death,” he said.

Children and Medical Mistakes

Parents take their children to the doctor to help keep them well. So it’s always chilling to read stories about children who are harmed as a result of medical care.

Today’s story called “Small Patients, Big Consequences in Medical Errors,” by Laurie Tarkan, is a must-read for any parent and explains why children are at higher risk for medical mistakes that result in more serious consequences. You may recall how the actor Dennis Quaid’s newborn twins nearly died last year after receiving 1,000 times the prescribed dose of a blood thinner. A study in the journal Pediatrics in April found that problems due to medications occurred in 11 percent of children who were in the hospital, and that 22 percent of them were preventable.

Medical mistakes are a greater threat to kids than adults because they are physically smaller and their organs are still developing, which means even a small mistake in a medication dose can have profound effects. Children also are less able to communicate what they are feeling, making it more difficult to identify a problem when it occurs. Doses of pediatric medications also often must be calculated based on height and weight, increasing the risk for error.

Source : nytimes.com