Positive
mums to get more choice in labour
The British HIV Association is set to drop its recommendation that HIV positive
expectant mums should have babies by Caesarean section. The long-awaited revision
of its HIV and pregnancy guidelines, due this autumn, will mean hospitals
should start offering positive pregnant mums with an undetectable viral load
a choice of vaginal or C-section delivery. British treatment activists welcomed
the decision. "This is something weıve been campaigning about for six years,"
said Simon Collins, of HIV i-Base. "Data came out at the Geneva Aids Conference
in 1998 showing that as long as women had a fully-suppressed viral load, the
risk of transmission could be pushed down to near-zero, and having your baby
by Caesarean did not reduce the risk further."
He added that Caesarean deliveries had risks of their own "and could complicate
subsequent births, especially if women go back to Africa where Caesareans
are less available". Previous data showing Caesareans reduced the risk of
transmission dated from the days when single drugs, which donıt cause complete
viral suppression, were being offered to pregnant women, he added. The report
will continue to support the choice of an elective Caesarean by HIV positive
women who want it as additional insurance against transmission.
New studies reignite nevirapine row
The non-nucleoside drug nevirapine was the centre of a storm of protest at
the Bangkok Aids Conference. South African health minister Manto Tshabalala-Msimang
ignited the debate when she announced plans to deregulate its use as a single
drug to prevent mother-to-baby transmission. But after a stormy meeting with
South African activists, she then agreed it should remain available pending
better alternatives. Nevirapine is cheap, and a single dose, unaccompanied
by other drugs, cuts the infection rate in babies by at least 50 per cent.
But concerns have been expressed for some time because that single dose also
causes 50 per cent resistance to the drug in those taking it.
This drops from 50 per cent after birth to 14 per cent at six months, but
no one knows if it will fade away altogether in time. And a study from Thailand
earlier this year showed mothers and babies who acquired nevirapine resistance
did do less well when subsequently treated. However, two studies at Bangkok
showed that combining nevirapine with three weeks of AZT before birth or just
four days of AZT/3TC after birth reduced the amount of nevirapine resist ance
from 50 to 10 per cent.
Two other studies highlighted nevirapine. One showed that when fluconazole,
used to treat candida infections and cryptococcal meningitis, the second most
common Aids-defining infection in the developing world, is given with nevirapine
it approximately doubles nevirapine levels. This may explain some of the high
levels of nevirapine toxicity observed. Another study by Australian doctor
Simon Mallal found a strong association between a particular genetic variation
and hypersensitivity to nevirapine.
This causes a dangerous allergic reaction involving liver inflammation, fever
and rash during the first six weeks or so on the drug, and fatalities have
occurred. Mallal said a relatively simple test might now be used to predict
who was more likely to develop an allergic reaction. Last year, Mallal's team
discovered a similar genetic predisposition to hypersensitivity to abacavir.
Work and love can cure the gay blues
A study of suicidal feelings among gay men in the UK has revealed that HIV
status, treatment and physical health have little affect on whether they feel
suicidal. Only two factors made a difference: having a job, and having a boyfriend.
Unemployed men were 2.3 times more likely to feel suicidal than those who
worked. And single men were 2.1 times more likely to consider taking their
own lives than those in a relationship. Clinical psychologist Professor Lorraine
Sherr, of the Chelsea and Westminster Hospital, looked at the rate of 'suicidal
thoughts' among gay men in two different groups: 523 HIV positive men attending
clinics in 2002-3 and 2,999 gay men, both positive and negative, surveyed
annually in the years 2001-4.
Twenty-two per cent of clinic attendees recorded having had suicidal feelings
at some point in the previous year. Sherr commented that this was "worryingly
high" given that the rate in the general population was around two per cent.
In the general community survey, about one in eight (13 per cent) consistently
reported suicidal feelings
But the difference was not due to having HIV, Sherr said. It was because HIV
positive gay men are more likely to be jobless. When all the variables were
taken into account, the gay men were no more likely to be suicidal if they
had HIV, even if their treatment was failing or they were ill.
Partners get HIV, but not from boyfriends
A study of HIV negative gay partners of HIV positive men found that men acquired
HIV from long-term partners quite rarely, and showed evidence of a successful
immune response to it if they did. Almost all the infections in the negative
men studied were from casual partners. Dr Tuofu Zhu found 14 out of 98 negative
partners (15 per cent) became HIV positive over a four year period. Two caught
HIV from their partners early in their relationship, but appeared to have
mounted a successful immune response to it. They had HIV antibodies and the
virus could only be detected by hypersensitive viral load testing, which picked
up HIV in their blood at a count of 0.05 copies.
Twelve had recognisable HIV infections with positive antibody tests. Some maintained low viral loads in the 500-2000 range, and showed evidence of an immune response to HIV. Others had standardı viral loads in the tens of thousands. But all 12 had clearly not caught HIV from their regular partners. Genetic analysis of the virus they carried showed that not only was it completely different in each case from the virus their partner carried, but that on average it was more different than any randomly selected North American strain would have been.
This study adds further evidence to the idea that prolonged sexual exposure
to HIV may generate a degree of immunity, but only to that specific virus.
Holiday sex plays havoc with sexual health
Holiday sex abroad has become a significant factor in the UK upsurge in sexually
transmitted infections, a UK doctor says. Dr Karen Rogstad, writing in the
British Medical Journal, said all groups were at risk of STIs and HIV. In
two London STI clinics, one in every eight cases of STIs was due to sex abroad.
Rogstad found UK women on holiday were slightly more likely to have a new
partner than men. But women were a lot more likely to have sex with a foreigner,
increasing the risk of contact with infections unusual in the UK, such as
syphilis or two 'tropical' STIs previously uncommon in the UK, chancroid and
lymphogranuloma venereum. More than 40 per cent of UK women who had sex on
holiday had it with someone from another country compared with 20 per cent
of men. The Caribbean, which has the worldıs second highest HIV prevalence
as an area after sub-Saharan Africa, was a particularly popular sex destination
for women .
Sixty-two per cent of women who had had sex abroad had it in the Caribbean.
Gay men had the most sex in the US and EU countries, while straight men favoured
the Caribbean and the Far East. No fewer than seven in 10 cases of HIV in
UK-born heterosexual men were acquired abroad last year. A quarter of these
infections were probably acquired in Thailand.
