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Do More to Fight HIV in Africa: Study

TUESDAY, July 12, 2016 (HealthDay News) — New HIV infections in African men could be prevented by increasing male circumcision rates and providing more women with HIV antiretroviral therapy (ART), a new study finds.

Researchers said these strategies were linked to a considerable drop in the number of men newly infected with HIV in specific communities in rural Uganda.

“The biology of these two prevention strategies has been proven, but the big question was whether these strategies could have an impact on the number of new HIV infections in communities still struggling to control the spread of the disease,” said study leader Xiangrong Kong. She is an associate scientist in epidemiology and biostatistics at Johns Hopkins’ Bloomberg School of Public Health in Baltimore.

“Before our study, there was no empirical data to show the effects of scaling up these two interventions in real-world settings. It’s important to know whether prevention is working and this is evidence that strongly suggests that African nations should redouble their efforts to scale up these programs,” Kong said a school news release.

The researchers said these promising HIV prevention tactics should be expanded throughout sub-Saharan Africa. In that area, about 25.8 million people are living with the virus that causes AIDS.

The new study included surveys from 45 communities in rural south-central Uganda. The information was collected between 1999 and 2013.

The surveys included data on sexual behaviors, the prevalence of existing HIV infections, rates of new HIV infections, the number of people on ART, and male circumcision rates.

The researchers examined three distinct periods: early years before ART and circumcision became available; years when these preventive measures started to become available; and later when these programs were offered more widely.

During the whole study period, the median coverage of male circumcision increased within the communities from 19 percent to 39 percent. This is still far short of the goal set by the World Health Organization to achieve an 80 percent circumcision rate among men in sub-Saharan Africa, the researchers noted.

In communities where more than 40 percent of men were circumcised, the rate of new HIV infections among men fell by 39 percent, compared to areas where just 10 percent or fewer men were circumcised, the findings showed.

Circumcision helps prevent HIV infection because the foreskin, which is removed during the procedure, has many cells that are HIV targets, the researchers explained.

Still, many men in the areas studied are resistant to the idea of circumcision, the study authors pointed out.

Median ART coverage increased from 0 percent to 21 percent among men and 23 percent among women during the study period, according to the report.

In communities where more than 20 percent of women with HIV were taking ART, rates of new HIV infection among men dropped by 23 percent.

Rates of HIV didn’t fall among women during the study. But the study authors suggested this may change when ART use among men increases.

During the study, ART was only given to those showing signs of reduced immunity in their blood. The researchers noted, however, that it’s now understood that ART is an effective way to prevent the virus from spreading since it makes infected people less contagious.

Anyone diagnosed with HIV should receive ART. That’s true even if they don’t have signs of a weakened immune system, the investigators said.

“We still have a long way to go in curbing the HIV epidemic in Africa,” said Kong. “People need to adopt these strategies, and we need to have sustainable funding to support these efforts.”

The study was published July 12 in the Journal of the American Medical Association.

More information

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

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More Older Americans Cared for at Home

By Steven Reinberg
HealthDay Reporter

TUESDAY, July 12, 2016 (HealthDay News) — More older Americans with chronic health problems are opting to live at home, relying on help from family, paid caregivers or friends, a new study finds.

In 2012, half of seniors with a disability had some type of home health care, an increase from 42 percent in 1998, University of Michigan researchers found.

“The majority of seniors would prefer to stay at home rather than go to a nursing home,” said Dr. R. Sean Morrison, past president of the American Academy of Hospice and Palliative Medicine.

But the unintended consequence of being cared for at home is the strain it puts on caregivers, added Morrison, who is also with the Icahn School of Medicine at Mount Sinai in New York City. He wasn’t involved in the study.

“Research has shown that 40 percent [of caregivers] spend 20 or more hours a week caring for an older relative — that’s half of a full-time job,” Morrison said.

Besides lost work and income, this can lead to depression and other health issues for caregivers, he said.

Also, most insurance plans, including Medicare, provide only very limited coverage for home health aides, Morrison said.

“We can’t say we want more care in the home, less care in institutions, without providing our families the resources that allow them to care for a seriously ill older relative at home,” he said.

If rates from this Michigan study are representative of the nation as a whole, more than 3.1 million more American seniors had home help in 2012 than in 1998, said the study’s lead researcher, Dr. Claire Ankuda, from the university’s department of medicine.

For the study, Ankuda and her colleagues collected data on nearly 5,200 people 55 and older who took part in the Health and Retirement Study by the University of Michigan Institute for Social Research. All had one or more disabling conditions.

People with more than a high school education and above-average net worth accounted for most of the increase in use of paid home health care aides, the researchers found.

This suggests a growing disparity in paid care for disabled seniors. It might also indicate a trend to aging at home, even among those who might be able to afford a nursing home, Ankuda said.

Still, about two-thirds of men and 45 percent of women had no caregiving help, despite some trouble with basic tasks such as making meals, getting dressed, going to the bathroom or managing their medications, she said.

The sharpest increase in home care was observed among seniors with milder disabilities. The researchers also found that paid caregiving accounted for the biggest jump in home health aid, although more seniors also reported relying on spouses and adult children. The percentage using friends for care remained stable.

Support groups can help caregivers cope with the strain, but that’s not enough, Ankuda said. Public policy and the health care system need to pay more attention to caregivers to make sure they’re supported, she said. This is especially true for unpaid family members and friends, she added.

“While caregiving can be meaningful for caregivers, it can lead to burnout and strain, and that can have poor health effects,” Ankuda said. “We have to think about them as part of the health care system.”

Morrison predicted the problem will likely get worse.

“In about 20 to 30 years, there are not going to be enough younger adults to care for us, because we are not having as many children,” Morrison said. “We have to start thinking about that now or in 20 to 30 years it’s going to be a real crisis.”

The report was published July 12 in the Journal of the American Medical Association.

More information

Health in Aging has more on home elder care.

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If 1st Baby’s Early, 2nd Will Be Too: Study

TUESDAY, July 12, 2016 (HealthDay News) — Women who give birth to their first child even a couple of weeks early are up to three times more likely to deliver their next baby prematurely, new research suggests.

“The magnitude of the increased risk surprised us — it really is a potent factor,” said senior study author Laura Jelliffe-Pawlowski. She is associate director of precision health with the University of California, San Francisco’s Preterm Birth Initiative.

For the study, researchers analyzed data from more than 160,000 women who gave birth in California between 2005 and 2011.

The study authors defined “preterm” as birth at less than 37 weeks’ gestation and “early term” birth at 37 to 38 weeks’ gestation.

Preterm birth is the leading cause of infant death and a major cause of life-long neurological issues, such as cerebral palsy, developmental delays, and vision and hearing loss, according to the U.S. Centers for Disease Control and Prevention.

First, the researchers took other risk factors for premature birth into account — such as illegal drug use during pregnancy, high blood pressure, diabetes and urinary tract infections. Still, the researchers found the risk for a subsequent premature delivery was two to three times higher for women who went into early term labor with their first baby. This finding held whether the women went into labor naturally or were induced due to a medical concern, the study found.

Based on these findings, more women could be targeted for closer monitoring and treatments that could help reduce the risk for premature delivery during a second pregnancy, the researchers suggested.

Of all the first-time deliveries included in the study, almost 6 percent of the women were preterm and would automatically be considered high-risk for another premature delivery. But the researchers noted that 22 percent of the women who delivered between 37 and 38 weeks of pregnancy would not have been labeled as high risk in the future under existing standards of care.

“There are so few avenues to lower preterm birth rates, so I’m always thrilled when our work suggests an additional one,” Jelliffe-Pawlowski said in a university news release.

The researchers added that women and their doctors should communicate more clearly so that women have a better understanding of prematurity and their risk of delivering early.

The study findings were published July 11 in the journal Obstetrics & Gynecology.

More information

The March of Dimes has more about premature babies.

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How Safe Is Condomless Sex When Partner With HIV Takes Meds?

By Randy Dotinga
HealthDay Reporter

TUESDAY, July 12, 2016 (HealthDay News) — HIV transmission is highly unlikely among straight couples who have sex without condoms when one partner carries the virus but takes medication, new research suggests.

For gay couples in the same scenario, the risk seems to be only slightly higher.

The Danish study had some major limitations. It only tracked couples for up to two years, and there’s no way to know if the risk of HIV transmission will grow over time as couples age. Also, the HIV-positive participants were almost always careful to take their medication.

And at least one AIDS prevention expert expressed some caution about the study’s conclusions.

Still, “it [the study’s findings] is really great news for patients and their partners,” said HIV specialist Dr. Jared Baeten, vice chair of global health at the University of Washington in Seattle. He was not involved with the study but is familiar with the findings.

“For so long, patients have really cared deeply about the chance they would transmit this virus to people they love. What’s very reassuring about this study, and the bulk of information from other studies, is that people who have HIV and are on treatment appear to have an incredibly low chance of passing on the virus,” Baeten said.

The new study is groundbreaking because it examines the risk of HIV transmission in couples who don’t always use condoms. Most prior studies examined the risk in couples who used condoms, said study co-author Dr. Jens Lundgren, a professor of viral diseases at the University of Copenhagen in Denmark.

In the study, the researchers tracked 888 couples in which only one person was HIV-positive. The participants lived in 14 European countries and were followed for a median of slightly over a year between 2010 and 2014.

About two-thirds of the couples were heterosexual and the rest were gay males. The average age of those in all couples was 42 years.

The study found that 11 partners became infected with HIV — 10 gay men and one heterosexual. But the analysis of the virus in their bodies revealed that none were infected by their partners. Instead, they’d contracted HIV by having sex outside their relationships; 33 percent of HIV-negative gay men reported having condomless sex with other partners compared to 4 percent of heterosexuals.

While no one was infected with HIV by their partners, the researchers acknowledged that chance could have played a role in the findings and that there could be a small actual risk. But the study said it’s unlikely this risk is above 0.3 percent per year for straight couples or 0.7 percent per year for gay male couples.

Lundgren cautioned that the results for heterosexual couples are more certain than those for gay men, and the ongoing study will continue to provide better numbers about their risk.

“The message to heterosexual couples is that the risk of HIV transmission via condomless vaginal sex is extremely low and likely negligible,” Lundgren said, as long as the HIV-positive person has been on full antiretroviral therapy for several months and uses the medication consistently.

For gay male couples, the risk is “very low,” he said, but the research doesn’t yet confirm it’s “extremely low.”

Why do some couples prefer sex without condoms?

Rowena Johnston, vice president and director of research at amfAR, the Foundation for AIDS Research, said, “If we’re honest and talk about what happens in the real world, pretty much everyone thinks condomless sex feels better. That’s what they want to move to if they can.”

For couples like those in the study, the research “suggests that might not be a very risky proposition, but any researcher would find it hard to recommend that you don’t need to use condoms at all,” Johnston said.

Michael Weinstein, president of the AIDS Healthcare Foundation, noted that “condoms remain an inexpensive, highly effective means to prevent HIV transmission. Condoms also protect against transmission of many other sexually transmitted diseases.”

The study was published in the July 12 issue of the Journal of the American Medical Association.

More information

For more about HIV and condoms, visit AIDS.gov.

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Nerve Zap Eased Rheumatoid Arthritis in Small Study

By Amy Norton
HealthDay Reporter

TUESDAY, July 12, 2016 (HealthDay News) — Electronic stimulation of a nerve running from the brain to the gut may help ease stubborn symptoms of rheumatoid arthritis, preliminary research suggests.

The study, of 17 adults with the painful autoimmune disease, tested the effects of vagus nerve stimulation — a technique long used to control seizures in some people with epilepsy.

It found that over six weeks, most of the patients showed some improvements in joint swelling and other symptoms.

One rheumatologist called the treatment approach “intriguing.”

“This isn’t pie in the sky. It’s a potentially viable alternative to what’s available now for RA [rheumatoid arthritis],” said Dr. David Borenstein, a rheumatologist at George Washington University Medical Center, in Washington, D.C.

Vagus nerve stimulation, or VNS, is done using a device that is surgically implanted under the skin of the chest, with a wire that connects it to one of the vagus nerves in the neck. The implant is programmed to periodically send electrical pulses to the nerve.

Recent lab research has suggested the tactic could be useful against RA, said Dr. Kevin Tracey, one of the researchers on the new study.

Rheumatoid arthritis arises when the immune system mistakenly attacks and inflames the lining of joints throughout the body, leading to pain, swelling and stiffness. Over time, that inflammation can cause irreversible damage to the joints.

The vagus nerves pass through the neck and chest into the abdomen, affecting many different processes in the body.

It turns out, Tracey explained, that select fibers that branch off the nerves play a key role in inflammation.

Animal research has shown that stimulating the vagus nerve can lower levels of inflammatory chemicals produced by the immune system, including tumor necrosis factor (TNF) and interleukin-6.

Basically, Tracey explained, the nerve acts as a “natural protective mechanism” against those inflammatory chemicals.

In that way, it works similarly to many of the standard drugs used for RA, said Tracey, who is president of the Feinstein Institute for Medical Research, in Manhasset, N.Y.

Those RA medications, known as “biologics,” include drugs like Enbrel (etanercept), Humira (adalimumab) and Remicade (infliximab).

For some people, Tracey said, the drugs work “miraculously.”

“But for many patients, they are not enough,” he added. “And some people would prefer an alternative to those drugs, which are expensive and have side effects.”

For its study, Tracey’s team implanted a VNS device in 17 patients with rheumatoid arthritis. Seven were in the earlier stages of the disease, and had not responded to a standard anti-inflammatory drug called methotrexate. The rest had more advanced disease and had failed to improve after trying at least two biologic drugs.

Six weeks after the VNS devices were implanted, most of the patients were doing better, the study found.

About 70 percent had at least a 20 percent improvement in their symptoms — including a reduction in the number of tender, swollen joints. In the group with early stage rheumatoid arthritis, 57 percent had at least a 50 percent improvement; that was true for about 30 percent of patients with more advanced RA.

On top of that, their blood levels of TNF and some other inflammatory chemicals declined.

There was no “control group” to compare the patients against, Borenstein pointed out. But, he said, the symptom improvements were comparable to what’s typically seen with biologic drugs.

According to Tracey, there were no major side effects: Some patients developed hoarseness, which is a known issue with VNS devices.

There are still plenty of questions left, though.

It’s not clear how long the benefits last, or what side effects there could be in the long run. Tracey said that because the therapy lowers TNF in the blood, in theory it could have the same side effects that biologic drugs do — such as an increased risk of infections.

“We won’t know all of the side effects until we do larger trials,” he said.

But, Tracey added, VNS has been used for years for epilepsy and has proven “very safe” for those patients.

Borenstein agreed that more studies are needed to see how vagus nerve stimulation might fit into RA treatment.

He also questioned whether other methods of stimulating the vagus nerve — including simple breathing techniques — could be helpful.

“Is there an approach that could be used as a complementary therapy, along with medication?” Borenstein said.

SetPoint Medical, a company that is developing “neuromodulation” therapies for rheumatoid arthritis and other diseases, funded the study. Tracey is a consultant to the company, and several of his co-researchers are SetPoint employees.

More information

The American College of Rheumatology has more on rheumatoid arthritis.

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Drink Water, Stay Slimmer?

By Kathleen Doheny
HealthDay Reporter

TUESDAY, July 12, 2016 (HealthDay News) — Water might be a secret weapon for dieters, research involving nearly 10,000 adults suggests.

“Those who were inadequately hydrated had higher body mass indexes (BMIs) than those who were adequately hydrated,” said study leader Dr. Tammy Chang, an assistant professor of family medicine at the University of Michigan Medical School.

Also, people who took in too little water daily had 50 percent higher odds for obesity compared to those who consumed enough, the study found.

That link held even after the researchers compensated for factors such as age, gender and income.

The study “indicates hydration might impact weight, but it does not prove that,” said Connie Diekman, director of university nutrition at Washington University in St. Louis.

“What it does show, though, is that a diet that includes more water, whether as a beverage or the water found in fruits and vegetables, is likely associated with a healthier weight,” said Diekman, who wasn’t involved in the study.

For the study, water intake was assessed as adequate or inadequate based on urine samples provided for the U.S. National Health and Nutrition Examination Survey 2009-2012. The more than 9.500 participants ranged in age from 18 to 64, and nearly one-third were inadequately hydrated, the study found.

BMI is a calculation of body fat based on height and weight. Overall, the sufficiently hydrated adults had an average BMI of 28, versus 29 for those deemed inadequately hydrated. (A BMI of 25 is considered overweight; 30 is obese.)

“Our study is a cross-sectional study, a snapshot in time,” said Chang. The researchers can’t actually prove cause and effect, or even which direction the link or association seems to work.

“It might be that people who are obese have behaviors that keep them from being hydrated,” Chang said. They may eat, for instance, when they are actually thirsty.

Conversely, drinking enough water may also make people feel fuller, Diekman said, so they eat less and don’t gain excess weight. Or someone who is adequately hydrated may eat an overall healthy diet, she noted.

Explaining why water intake may be linked with a healthier weight was beyond the scope of the study, Chang said.

Chang suggests a simple measure to gauge hydration: “I just say look at your urine,” she said. “If your urine is very light, like water, you know you are getting enough water. If it’s dark yellow, that means you probably need more water.”

Advice on fluid needs should be included in weight loss advice, the researchers said.

Recommendations vary, but the Institute of Medicine suggests 125 ounces of water daily for men and 91 ounces for women, from all food and beverages combined.

Water also can be found in water-laden foods such as apples, celery, cucumbers, plums and watermelon, to name a few.

Heavier people need to consume more fluids than slimmer ones, the study authors said.

While coffee and other caffeine-containing drinks can act as diuretics, they don’t seem to boost dehydration risk, experts say. You can count them in fluid intake, Chang said, ”but I wouldn’t recommend drinking coffee to hydrate.”

The study was published in the July-August issue of the Annals of Family Medicine.

More information

The U.S. National Heart, Lung, and Blood Institute has advice on attaining a healthy weight.

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Mouse Study Hints at Hope Against Blindness

By Dennis Thompson
HealthDay Reporter

MONDAY, July 11, 2016 (HealthDay News) — Researchers report they have regenerated parts of damaged optic nerves in a handful of blind mice, a breakthrough that might lead to a human cure for glaucoma and other nerve-related blindness.

A combination of gene therapy and visual stimulation prompted partial regrowth of the optic nerves, restoring some communication between the brain and the eye in these mice, said study senior researcher Andrew Huberman.

“We didn’t regenerate every cell from the eye to the brain,” said Huberman, an associate professor of neurobiology at Stanford University School of Medicine, in Palo Alto, Calif. “It was a small fraction of the total number of cells.

“Nonetheless,” he added, “the mice could use that limited number of regenerated cells to see certain things. They went from being blind mice to being mice that could see a number of things.”

Nerve cells attached to the central nervous system normally do not regenerate, Huberman said. People blinded by glaucoma — in which increasing eye pressure damages the optic nerve — never regain the sight they lost.

Eye doctors typically put all their effort into preventing further loss of vision in people with glaucoma, said Dr. Andrew Iwach, chair of the Glaucoma Research Foundation.

“This data shows that there is a bridge to get to the other side of this, to go from being on defense to being on offense, where we can help people see,” said Iwach, an associate clinical professor of ophthalmology at the University of California, San Francisco. “That would be a game-changer for many patients.”

But Dr. Harry Quigley, director of the Glaucoma Center at the Johns Hopkins’ Wilmer Eye Institute in Baltimore, warned that people blinded due to nerve damage should not get their hopes up for an impending cure based on these results.

“It isn’t anything that could be turned into therapy in a human anytime soon, and I don’t think they’re suggesting that,” Quigley said.

For this study, Huberman and his colleagues used forceps to crush the optic nerve leading to one eye in a group of laboratory mice. They then set about trying to repair the nerve they’d damaged, using different therapies.

Simply regrowing the connection between the eye and the brain wasn’t enough — the researchers also had to make sure that the connection would rewire itself correctly. “If neurons don’t wire up correctly, you get failures of the brain to function properly,” Huberman explained.

Partial regeneration of the optic nerve occurred when researchers used gene therapy to stimulate the mTOR pathway, a process in the body that promotes growth of nerve tissue.

The research team also had some success in promoting optic nerve regeneration through visual stimulation. Placed in a “mouse IMAX theater,” the mice used only their damaged eye to watch a series of high-contrast moving bars. That therapy promoted some nerve regrowth, the researchers said.

But neither approach alone could re-establish the link between brain and eye. “We found that the neurons would regrow, but not very far,” Huberman said. “They would grow towards the brain, but they couldn’t reconnect with the brain.”

However, combining both gene therapy and visual stimulation caused a small part of the optic nerve to fully regenerate a connection between the eye and the brain, the researchers found.

“When we did that, we saw an incredible synergistic effect,” Huberman said. “The axons not only regrew, but they grew very fast and they regrew all the way back into the brain.”

Vision tests performed after the therapy showed that the connection had wired up properly.

One test projected an expanding dark circle onto the damaged eye, meant to give the impression of a bird of prey’s approach. The mice responded to the stimulation, scrambling for shelter to avoid the threat.

Huberman hopes to begin human experiments soon. “We are going directly from this into human studies,” he said. “We’re very quickly trying to move this towards technology that would allow stimulation of neurons, to test whether that would enhance regeneration.”

However, curing glaucoma-created blindness in a human will be much more complex than partially restoring sight in lab mice, Quigley said. Research with animals often doesn’t pan out in humans.

And Quigley noted that the optic nerve sustains chronic long-term damage from glaucoma, which presents a much messier problem than that faced by the lab mice.

The experiment “is not a model of glaucoma. This is a model of optic nerve injury by crushing,” Quigley explained. “Glaucoma is not as clean and easy as crushing the nerve, which is quick and dirty and all the nerve cells die at once.”

In addition, the researchers destroyed 50,000 optic nerve cells in the mice, but only were able to regenerate about 200, he noted.

“Would that really give rise to a functional improvement over blindness?” Quigley asked. “There’s no question you can do something to improve the regrowth of some few nerve cells in the eye. The difficulty is that for the many, many people who have eye diseases who are already visually impaired or blind, they’re going to think, ‘Oh, great! This is a treatment that’s going to help me.’ “

The study findings were published online July 11 in the journal Nature Neuroscience.

More information

For more on glaucoma, visit the U.S. National Eye Institute.

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