Child specific HIV drugs needed to combat virus

A leading HIV expert urged Wednesday drugs giants to focus on developing anti-retroviral medicines for children, after research showed early treatment of babies can reduce death rates by 75 percent. As the International AIDS Society conference wrapped up in Sydney, US researcher Annette Sohn said some 780,000 HIV positive children globally needed anti-retroviral medicines but only 15 percent of them were receiving treatment.

Sohn, an assistant professor at the University of California San Francisco's paediatric infectious diseases division, said there was also a lack of specialised medicine developed for HIV positive children. She said that children's medical treatment often consisted of health professionals simply breaking up adult pills into what they hoped was child-sized doses.

"Better generic paediatric anti-retrovirals that are both potent enough to achieve sustained clinical and virological improvement and have limited long-term metabolic side effects are urgently needed," she said.

Sohn, who is conducting research in Vietnam, said better diagnostic tools for medical practitioners working on paediatric HIV were also needed and some treatment may have to be started before a full diagnosis can be made.

"We are not identifying more HIV positive women during pregnancy and we lack the ability to diagnose their infants, so we don't know they're infected until they're already very sick," she said.

"By that time, it's often too late to prevent opportunistic infections and maximise the treatment benefits of anti-retroviral therapy."

Sohn said the need for action was underlined by studies showing that early anti-retroviral treatment in babies could dramatically improve survival rates.

"Research presented at this and other conferences have increasingly proven that we are waiting too long to treat HIV positive-children in resource-limited settings (poor countries)," she said.

One South African study presented to the conference found that the death rates among babies who were given anti-retrovirals at aged three months was 75 percent lower than those who were not treated.

Avy Violari, from the University of Witwatersrand in Johannesburg, said the study had the potential to revolutionise HIV treatment among babies, which normally only begins after 12 months.

"These findings have implications for guidelines on timing of anti-retroviral therapy in early infancy and support the need for enhanced early diagnosis of infants and early effective transition into care," she said.

The study, titled Children With HIV Early Antiretroviral Therapy, involved 377 babies in Cape Town and Soweto.

Conference co-chair David Cooper, the head of Australia's National Centre in HIV Epidemiology and Clinical Research, said its results could force a rethink about treatment of HIV positive babies.

"Normally babies born to HIV positive mothers aren't treated for 12 months because when they're born they have antibodies from their mothers and it takes that long to know whether the baby itself is infected with the virus," he said.

"This research means we'll have to look very hard at earlier intervention."

The 4th IAS conference ended Wednesday after four days, when more than 1,000 abstracts on HIV research were presented to 5,000 experts.

"It's been an amazing conference, notable for a number of scientific developments, including new treatments that are offering people living with HIV/AIDS and their clinicians greater options in the future," said IAS executive director Craig McClure.

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HIV medics freed after Libya-EU deal

Six foreign medics convicted of infecting hundreds of Libyan children with HIV were freed on Tuesday after a "full partnership" deal between Tripoli and the European Union ended their eight-year ordeal. Their return to Bulgaria ends what Libya's critics called a human rights scandal and could allow the long-isolated north African state to complete a process of normalizing ties with the West.

Bulgarian President Georgi Parvanov pardoned the five nurses and a Palestinian doctor who recently took Bulgarian citizenship after their arrival in Sofia on a French jet. The medics said they were innocent and had been tortured to confess. "I know I am free, I know I am on Bulgarian soil, but I still cannot believe it," 48-year-old nurse Christiana Valcheva said as the medics and their families wept and hugged each other at the airport.

The Bulgarian nurses were flown to Sofia after the EU, which Bulgaria joined in January, agreed a last-minute breakthrough deal with Libya on medical aid and political ties.

"We hope to go on further normalizing our relations with Libya. Our relations with Libya were in a large extent blocked by the non-settlement of this medics issue," EU Commission President Jose Manuel Barroso said.

Libyan Foreign Minister Mohammed Abdel-Rahman Shalgam said the deal had opened the way to "full cooperation and partnership between Libya and the European Union."

Bulgaria and its allies in Brussels and Washington had suggested that not freeing the nurses would hurt Libya's efforts to emerge from decades of diplomatic isolation imposed for what the West called its support of terrorism.

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Circumcision urged in curbing AIDS spread

Australia - A U.S. health expert urged governments worldwide Tuesday to endorse circumcision to slow the spread of HIV, saying men without the procedure have a greater risk of contracting the virus from infected female partners. Experts at an AIDS conference in Sydney also warned that HIV infection rates were rising among men who have sex with men in developing countries because of discrimination and lack of access to health services.

The World Health Organization says male circumcision reduces the risk of female-to-male transmission of the disease by around 60 percent. But only 30 percent of men worldwide have had the procedure, mostly in countries where it is common for religious or health reasons. Robert Bailey, a professor of epidemiology at the University of Illinois, said studies in Africa showed that uncircumcised men were 2 1/2 times more likely to contract HIV from infected female partners, though many health officials were still unclear about its benefits.

"If we had a vaccine that was 60 percent protective, we would be very happy and we would be rolling it out as fast as we can," Bailey told reporters at an International AIDS Society Conference in Sydney, Australia.

"The next step is to get the leaders of countries to actually come up with policy statements endorsing the practice," said Bailey, who has conducted circumcision-related studies in Africa and the United States.

Without local support, international agencies would be unlikely to encourage the procedure to avoid being seen as imposing foreign cultures or values, he said.

Circumcision, the removal of the foreskin from the penis, has long been suspected of reducing men's susceptibility to HIV infection because the skin cells in the foreskin are especially vulnerable to the virus.

In March, the WHO urged heterosexual men to undergo the procedure because of compelling evidence that it reduces their risk of getting the disease. However, it cautioned that male circumcision is not a complete protection against HIV, and said men should still use condoms and take other precautions such as abstinence, delaying the start of sexual activity and reducing the number of sexual partners.

"Circumcision could drive the epidemic to a declining state toward extinction," Bailey said. "We must make safe, affordable, voluntary circumcision available now."

Bailey also called on international agencies to ramp up funding for circumcision in countries hardest-hit by the epidemic.

Michel Kazatchkine, the executive director of the Global fund, a leading international health agency, also called for increased funding.

"I believe that the evidence is overwhelming for the efficacy of circumcision," Kazatchkine told The Associated Press on the sidelines of the meeting. "And if countries come to us ... I see no reason at all why we wouldn't fund that."

Kazatchkine said his organization had not yet received any requests for funding for circumcision, and noted that the WHO advice on the topic was only released in March.

Also at the conference, a leading American AIDS research group said HIV infection rates among men who have sex with men were rising in Africa, Asia and Latin America, citing figures from UNAIDS.

Studies also show that less than 5 percent of that group have access to HIV-related health care, the American Foundation for AIDS Research, or amfAR, said.

"This is a massive failure of the HIV/AIDS response globally and I think one that needs to be addressed," said Kevin Frost, amFAR's chief executive officer.

In Kenya, around 40 percent of men who have sex with men are estimated to be HIV positive, compared to a 6 percent rate in the country's overall population, amFAR said. In Senegal, nearly 22 percent are believed to be infected, compared to less than 1 percent of the general population.

In Uruguay and Mexico, 21 percent and 15 percent are estimated to have the disease.

Under an initiative launched at the AIDS Society Conference, amFAR will seek to raise $3 million in the next three years to provide grants for AIDS education and research among men who have homosexual sex in developing countries.

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Circumcision could save millions from HIV infection, conference told

Male circumcision could prevent millions of HIV infections every year and play a major role in controlling the virus' spread in developing nations, a major AIDS conference was told Tuesday. US researcher Richard Bailey called on health authorities to actively promote circumcision, saying the scientific evidence left no doubt that it could reduce HIV infection rates by up to 60 percent.

Bailey, from the University of Illinois, said three studies in Africa had all confirmed a long-standing belief about the effectiveness of circumcision in reducing the risk of HIV infection. "The last two were actually stopped early because they showed such a high level of efficacy that it wouldn't be ethical to continue the trial and withhold circumcision from the control group," Bailey told reporters at the International AIDS Society conference in Sydney.

He said universal circumcision could avert two million new infections and 300,000 deaths in sub-Saharan Africa over 10 years.

Bailey said while health authorities would rush to implement a vaccine that was 60 percent effective, there was an element of squeamishness in some cultures about promoting male circumcision.

"It's been a really long haul because it's the penis after all, so it's not that easy to accept that kind of intervention," he said.

"Circumcision is not just simply a medical procedure, it's tied up in a complex web of cultural and religious practices and beliefs, so it's not easy for politicians and ministries of health to very quickly come out in favour of circumcision in countries where it's not traditionally practiced."

Bailey said leaders in developing nations needed to endorse circumcision because international health authorities would not impose it because they feared being seen as culturally insensitive.

"But the time to act is right now," he said. "Delaying the roll-out of circumcision could be causing more harm, not just because more people are getting infected with HIV than necessary but also people are going to unqualified practitioners."

The conference also heard that the practice, common in Africa, of women rinsing themselves with lemon juice after sex did not reduce the risk of HIV infection.

Nigerian researcher Atiene Sagay said a study of more than 300 Nigerian prostitutes found that women douched to avoid infection but it was totally ineffective.

"People suggested it could be a microbicide (but) we know much better than that now," Sagay said.

He said the practice was not an effective contraceptive measure either, as alkaline semen easily neutralised citric acid.

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Modern technology and ancient surgery battle AIDS

The emergence of new and improved drugs, genetic engineering and the ancient surgical practice of circumcision are the latest weapons in the fight against AIDS, the International AIDS Society conference was told on Tuesday.

A new batch of drugs that slow the progress of HIV in patients and genetically modified cells that prevent further infections are about to become available or trialed, doctors told the world's largest AIDS conference.

"It's an extremely exciting time in terms of drug development. We have better drugs in existing classes, as well as whole new classes of drugs," said Professor David Cooper, co-chairman of the 2007 IAS conference in Sydney.

"Patients and their clinicians now have a much wider choice of drug combinations than ever before," said Cooper, director of Australia's National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales.

But the biggest breakthrough for the world's poorest nations, which will not initially be able to afford these new drugs and which carry the heaviest AIDS burden, lies in a procedure dating back to at least 2,300 B.C. in Egypt -- circumcision.

African studies have shown that male circumcision can reduce HIV transmission from women to men by about 60 percent, said Professor Robert Bailey at the School of Public Health at the University of Illinois at Chicago.

Universal circumcision could avert two million new infections and 300,000 deaths in sub-Saharan Africa over 10 years, he said.

Africa is the epicenter of the AIDS epidemic. South Africa has an estimated 5.5 million people with HIV and is struggling to stem the spread of the disease in the general population.

Bailey said that while the World Health Organisation (WHO) had now endorsed circumcision as a preventative measure, encouraging the widespread use of circumcision would not be easy.

"Circumcision is not just simply a surgical procedure. It's tied up in a complex web of cultural and religious practices and beliefs," he said.

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Circumcision could save millions from AIDS

Millions of new HIV infections in Africa could be avoided if more men were circumcised, an International AIDS Society conference was told on Tuesday. Studies in Africa have found that male circumcision, the world's oldest surgical procedure dating back to 2300 BC, reduces HIV transmission from females to males by 60 percent.

Universal circumcision could avert 2 million new infections and 300,000 deaths in sub-Saharan Africa over 10 years, said Professor Robert Bailey from the School of Public Health at the University of Illinois in Chicago. "If we had a vaccine that was 60 percent protective we would be very happy and rolling it out as fast as possible," Bailey told the IAS conference in Sydney.

"But no one stands to profit from male circumcision -- no one but the 4,000 in Africa who will be infected tomorrow." Africa is the epicenter of the AIDS epidemic. South Africa has an estimated 5.5 million people with HIV and is struggling to stem the spread of the disease in the general population.

But African nations such as Cameroon and Nigeria, where circumcision is common, have a much lower rate of HIV infection than Zimbabwe and Swaziland where there is little circumcision.

The idea of using circumcision as a weapon against AIDS emerged after studies in Uganda, Kenya, Malawi, Zambia and the United States found the potential to significantly reduce infections, said Bailey, adding the World Health Organisation has now endorsed circumcision as a disease prevention method.

"The challenge ahead for us is how to roll out circumcision safely ... and to persuade leaders in countries that it is going to help their populations," Bailey told a news conference.

"Circumcision is not just simply a surgical procedure. Its tied up in a complex web of cultural and religious practices and beliefs," he added.

"It's not easy for politicians and ministers of health to quickly come out in favor of circumcision in countries where circumcision is not traditionally practiced."

Bailey said aid organizations would not offer the service until local governments endorsed it, for fear of being seen as culturally insensitive.

WOMEN BACK CIRCUMCISION

Women in African nations are expected to be the drivers behind using circumcision to stop HIV infection as they are traditionally associated with ensuring hygiene in communities.

"Women, more than men, equate circumcision with improved hygiene," said Bailey.

"It's often up to women to provide the water, the soap and the materials for men to bathe and cleanse themselves. Many of the women complain the men are not as clean as they could be."

Circumcision should not be seen by men as their only preventative measure against HIV and must still be combined with safe sex practices. Condom use should still be encouraged.

"It's very important not to view this as a standalone surgical procedure," said Bailey.

Many Africans were already seeking circumcision to try and stop the spread of HIV, but many were suffering medical complications because of poor procedures.

There also was some evidence that circumcision may help prevent infection between homosexual men, with one study in Uganda showing a 30 percent reduction in infection

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New HIV infections outpace treatment

Access to life-extending HIV/AIDS drugs in developing countries has improved during the past three years, but new infections still dramatically outpace efforts to bring treatment to patients, health officials said Monday.

Three years ago, fewer than 300,000 people in the developing world were receiving the anti-retroviral drugs that help treat the virus. Last year, 2.2 million people in developing countries received the drugs, according to Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases.

"However, for every one person that you put in therapy, six new people get infected. So we're losing that game, the numbers game," Fauci told Australian Broadcasting Corp. radio.

In many parts of the developing world where the HIV/AIDS epidemic is still growing exponentially, effective prevention strategies — such as condom distribution, needle exchanges and basic education about the disease — reach less than 15 percent of the population.

"The proven prevention modalities are not accessible to any substantial proportion of the people who need them," said Fauci, one of the keynote speakers at the Fourth International AIDS Society Conference on HIV Pathogenesis and Treatment in Sydney, Australia, which runs through Wednesday.

"Although we are making major improvements in the access to drugs, clearly prevention must be addressed in a very forceful way," he added.

According to recent World Health Organization statistics, only 28 percent of the world's HIV/AIDS patients are receiving anti-retroviral drugs.

Dr. Brian Gazzard, chairman of the British HIV Association, said that while great advances have been made in extending access to anti-retrovirals, the disease is still running rampant in parts of Asia and Africa.

"The HIV epidemic is essentially uncontrolled, uncontrolled in Africa, uncontrolled completely in Asia right now," he told reporters at the conference, which has drawn 5,000 delegates from 133 countries. "The epidemic still is in an exponential growth phase ... and I think that is likely to continue."

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Libya to decide fate of foreign medics in HIV case

Five Bulgarian nurses and a Palestinian doctor imprisoned in Libya eight years ago and sentenced to die for infecting hundreds of children with HIV may know this week whether they are to go free.

The medics were sentenced to death in December after being convicted of infecting 426 Libyan children with the deadly virus while working at a children's hospital in the city of Benghazi.

The six say they are innocent and were tortured to make them confess. Some Western scientists say negligence and poor hygiene were the real culprits and that the infections started before they arrived at the hospital.

Relatives of the children have said the infections were part of a Western attempt to undermine Muslims and Libya.

Libya's Supreme Court last week upheld the death sentences, placing their fate back in the hands of the government's High Judicial Council, which is controlled by the government and has the power to commute sentences or issue pardons.

With the Council due to meet on Monday, European Union governments are hopeful the six will be set free after hectic negotiations with an association of families.

Both sides have suggested agreement is close, and Libya has hinted it could free the nurses if an accord is reached.

The families have asked for compensation of 10 million euros ($13.3 million) for each infected child's family -- "blood money" under which Islamic law lets victims' relatives withdraw death sentences in return for reparations.

The EU refuses to accept the idea of compensation, which would imply the medics were guilty, but has offered a fund to pay for the children's future care.

Libyan officials say the Council could take several sessions to reach a final decision and will only agree to the release of the nurses if a settlement had been reached in the private talks between the families and the EU.

"The Council will take into consideration several factors like compensation, the age and the time spent by the prisoners in jail," Libyan Foreign Minister Mohammed Abdel-Rahman Shalgam told reporters last week.

Libya emerged from decades of international isolation in 2003 when it scrapped its program of prohibited weapons and returned to international mainstream politics.

Washington said last week it was sending the first U.S. ambassador to Tripoli in nearly 35 years, but failure to free the medics could carry a heavy diplomatic cost for Libyan leader Muammar Gaddafi.

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Double protection doesn't improve HIV prevention

For prevention of HIV infection, there's no advantage to using a diaphragm as well as a condom during sex, according to investigators hoping for an effective female-controlled method of avoiding AIDS.

Dr. Nancy S. Padian and her colleagues tested the theory that covering the cervix with a diaphragm and still using a condom would enhance protection against HIV, in a medical trial involving some 5000 sexually active women living in South Africa and Zimbabwe.

Those randomly assigned to the "intervention" group were given diaphragms and lubricating gel along with condoms, while condoms alone were dispensed to the "control" group.

The women were re-evaluated and counseled about risk reduction and "condom negotiation" during quarterly follow-up visits for up to 24 months.

Despite those efforts, HIV infection rates were high in both groups, the investigators report in an early online issue of The Lancet medical journal. The infection rate was the equivalent of 4.1 cases per 100 women per year in the intervention group and 3.9 cases per 100 woman-years in the control group.

Padian, from the University of California in San Francisco, and her team found, unexpectedly, that fewer women in of the intervention group used condoms than in the control group -- 53.5 versus 85.1 percent.

"Female-controlled methods of HIV prevention are urgently needed," Dr. Ronald H. Gray and Dr. Maria J. Wawer, at Johns Hopkins University in Baltimore, write in an accompanying commentary.

Decades after the start of the HIV epidemic, the only proven prevention methods in adults depend on male cooperation. For that reason, the editorialists emphasize that the "disappointing results" reported from the current study "must not discourage the testing of other novel approaches."

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Africa's men urged to step up AIDS fight

South Africa's top female politician warned Saturday that men must get fully involved in the war against HIV/AIDS if the disease is to be defeated.

"There aren't enough men who are taking enough responsibility to go for tests and live responsibly, and that kind of (behaviour) compromises the fight," Phumzile Mlambo-Ngcuka, South Africa's Deputy President, told the closing session of the International Women's Summit on HIV/AIDS here.

She urged men to live responsibly, to go for tests and participate in projects to help end the pandemic that has infected some affects 39.5 million people worldwide, mostly in sub-Saharan Africa.

"The response to HIV will not be won if men do not come on board since they are equally affected or infected," she said;

South Africa had emphasised men's role in AIDS campaigns by organising men as activists," she said.

Several women living with the virus told the conference of their ordeals of physical and emotional consequences of the virus, of how their husbands infected them before abandoning them or chased them from their homes.

The conference heard that in sub-Saharan Africa, 60 percent of all adults living with the virus are female. Kenya, which hosted the summit, the ratio reaches 67 percent.

The UNAIDS and World Health Organisation, the frontline agencies coordinating the fight against the epidemic, said gender equality and the empowerment of women are key to slowing the spread of the killer virus.

Mlambo-Ngcuka said the empowerment of women was a potent weapon against the disease.

"Addressing the economic status of women" would help them to make choices so that "they can get out abusive relationships, they can acquire the support that they need.

"The most important thing is remove women from the bottom of the prymaid," she said.

As of June 2006, around one million Africans were receiving antiretroviral drugs which help roll back the AIDS virus, a tenfold increase since December 2003.

But this was still less than a quarter of the estimated 4.6 million people in need of the drugs, the conference heard.

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World Bank loans Kenya 80 million dollars to boost war on AIDS

The World Bank has approved a loan of 80 million dollars (60 million euros) to boost Kenya's efforts to fight HIV/AIDS, which poses a major challenge in the country, an official statement said Wednesday.

The funds will be used to strengthen the National AIDS Control Council (NACC), the country's frontline agency in fighting the deadly disease that has killed at least 1.5 million people since 1984.

"We are determined that the support should reach the five million people in Kenya - especially orphans and young women - who are directly and indirectly affected and made very vulnerable by the disease," said Colin Bruce, the bank's representative in Kenya, in the statement.

Britain's Department for International Development (DfID) is also expected to provide 33 million dollars (25 million euros) in additional funding towards the country's war against the scourge, the statement added.

The NACC said Tuesday the rate of HIV/AIDS infections in the country of nearly 35 million fell from 6.1 percent in 2004 to 5.9 percent in 2005.

A shift in sexual habits and the more widespread use of condoms had played a large part in curbing infections, whose prevalence Kenya aims to slash to a rate of 5.5 percent by 2010, said the agency.

At least 1.3 million people are currently living with HIV/AIDS in Kenya, 65 percent of whom are women between the ages of 19 and 45, according to NACC statistics.

Last year, Kibaki announced that public hospitals would no longer charge HIV/AIDS patients for life-prolonging anti-retroviral drugs, in a new bid to fight the disease.

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Fighting Ancient Virus May Have Left Humans Vulnerable to HIV

Humans' distant ancestors beat back a now-extinct virus 4 million years ago, but that victory left the species vulnerable to HIV today, scientists believe.

The finding may also explain why chimpanzees, gorillas and other primates resist infection with the virus that causes AIDS, while humans are much more easily infected.

The difference lies in a human gene called TRIM5alpha, which, in lab experiments, effectively blocked infection from a reconstructed portion of the ancient retrovirus, called PtERV1. That virus probably flourished 4 million or 5 million years ago but is extinct today.

Writing in the June 22 issue of Science, the researchers say PtERV1 left behind telltale traces of its DNA inside the genomes of many primates -- with the notable exception of humans, suggesting it never gained a foothold there.

In fact, when geneticists first compared the genomes of humans against those of chimps, "the biggest difference is the presence [in nonhuman primates] of this virus, PtERV1," said study senior author Michael Emerman, a member of the Human Biology and Basic Sciences divisions at the Fred Hutchinson Cancer Research Center, in Seattle.

"There are about 130 copies in the genomes of chimps and gorillas, and maybe other primates, but it's not present at all in the genome of humans," Emerman said.

That could mean one of two things, he said: Either the ancestors of Homo sapiens already carried the TRIM5alpha gene and couldn't be infected by PtERV1, or PtERV1 wiped out all but a few individuals who were lucky enough to carry the gene. Those individuals might then have passed the gene on through their progeny, right up to the humans of today.

However, that early antiviral victory may have a darker legacy.

The experts found that various primate species carry slightly different versions of TRIM5alpha, one of a class of infection-blocking genes called "cellular restriction factors." In the case of Homo sapiens, the gene's ability to block infection against PtERV1 does not seem to extend to another dangerous retrovirus, HIV.

"We know that the human version of TRIM5alpha isn't good at all against HIV," Emerman said.

On the other hand, the TRIM5alpha found in chimps and gorillas appears to be very effective in denying HIV access to cells. It probably wasn't much good against PtERV1, however.

This type of "either/or" situation often happens in genetics, Emerman said. Genes change so that species "get better at something -- but they get worse at something else," he said.

The end result in this case is that "the human type of TRIM5alpha does not restrict HIV, and yet the TRIM5alpha in other primates can restrict HIV infection," explained Rowena Johnston, vice president for research at the Foundation for AIDS Research (amfAR) in New York City. "The critical question is, what do they have that we don't have?" she said.

She and Emerman agreed that the Hutchinson discovery isn't of immediate practical benefit to the fight against AIDS. But Johnston said research focused on cellular restriction factors such as TRIM5alpha remains "one the most promising and interesting areas of research that we have going on in the HIV world right now."

"Is there a way for us to be able to use that information to make our TRIM5alpha more potent against HIV, or at least to work out how it is that TRIM5alpha works in other animals?" she asked. "Or, to see if we can come up with some kind of mimic that would do something similar in humans?"

Advances along those lines are likely to be a "long way off," Johnston cautioned.

"What we are really talking about here are millions of years of human evolutionary history that's made us how we are today," she said. "As the paper says, we've ended up with this trade-off. We have this great protection against PtERV1, and none of the protection against HIV."

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Late valacyclovir for herpes yields greater response

Therapy with valacyclovir (Valtrex, GlaxoSmithKline), started within three months of infection with either herpes simplex virus type 1 (HSV-1) or HSV type 2 (HSV-2), reduces the rate of symptomatic outbreaks compared with placebo, Seattle investigators report in the Journal of Sexually Transmitted Diseases.

However, the response rate to valacyclovir in this study was somewhat lower than rates seen in other studies, in which treatment wasn't started for a year or more after the onset of infection, according to Dr. H. Hunter Handsfield of the Batelle Center for Research and Evaluation and the University of Washington's Center for AIDS and STDs and colleagues.

"All the studies to this point were in patients who had been infected for at least a year before treatment," Handsfield told Reuters Health. "That's what FDA approval of valacyclovir is based on."

Handsfield and colleagues conducted a pilot study of 119 patients with early HSV infection who were randomly assigned to valacyclovir or placebo daily for six months.

The average patient age was 28.7 years, 66 percent were women, 63 percent had HSV-1 infection and 18 percent had HSV-2 infection. The maximum duration of infection was three months for eligibility in the trial.

At follow-up, the investigators found that the valacyclovir-treated patients had an average of 1.7 outbreaks of HSV infection per year compared with 3.4 episodes per years with placebo.

The average time to first recurrence of symptoms was 80 days with valacyclovir and 54 days with placebo. Eighteen patients (47 percent) on valacyclovir were recurrence-free at the end of the study period compared with 10 patients (27 percent) on placebo.

Handsfield said that although the response rate is somewhat lower with early compared with delayed antiviral treatment, "there is every reason to suppose, based on the pattern of response seen in other studies, that the response rate will continue to improve over time...and reach that seen in previous studies."

"One important public health message here is that HSV infection...doubles the risk of
HIV infection...Patients should be offered early therapy and also counseled about the risk of transmission to uninfected sexual partners," and the importance of abstaining from intercourse during outbreaks and always using condoms.

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Experts say many in Britain malnourished

It may be obvious that most Britons are overweight. What isn't so obvious is that at least 2 million of them are likely malnourished — and that includes some of the people who are too fat.

Experts say the poor state of the average British diet — often high in fat, salt and calories, but low on nutrition — means malnutrition is a problem even though food is plentiful.

"You can't always tell if a person is malnourished with your eyes," said Dr. Marinos Elia, a professor of clinical nutrition and metabolism at Southampton University. "People may be eating too much food, but they may not be eating enough fruits and vegetables."

Dr. Alastair McKinlay, a gastroenterologist and chairman of a British malnutrition action group, put it bluntly: "There's a widely held misconception that if you're fat, you can't be malnourished."

Some experts even contend that the food rationing system during World War II offered Britons more nutrition than what they're eating today. From 1939-45, Britons got books of coupons, which they traded in for limited amounts of items like flour, milk, eggs, meat and canned fruit.

"Rationing was a huge success because it ensured that if you got your allotted amounts, you got a nutritionally reasonable diet," said Dr. Colin Waine, chairman of the National Obesity Forum. "I'm not advocating a return to rationing, but it was a more balanced diet back then."

Despite the unlimited food supply today, Waine said people don't always make the right choices.

Many nutrition experts believe the number of malnourished Britons is closer to 4 million, about 6 percent of the population, than the government's estimate of 2 million.

Most malnourished people have a chronic illness like AIDS, cancer or tuberculosis. In the last five years, according to the Department of Health, the number of hospital-identified malnourished patients has risen by more than 40 percent, though experts say that is largely due to heightened surveillance rather than a dramatic jump in cases.

There are no statistics on how many obese people may be malnourished, but doctors say they are seeing patients who are both overweight and malnourished. According to government statistics, 75 percent of Britons are overweight; more than one-fifth are obese.

While malnourished fat people are hardly in danger of starvation, other health problems are possible along with obesity-related complications like diabetes and heart disease. Once they start losing weight, malnourished people may actually burn their own tissue, including muscle, rather than fat.

Usually, people with vitamin deficiencies have skin problems, a swollen thyroid or bleeding gums. In severe cases, malnourished people might also experience hair loss, muscle wasting, a swollen abdomen, anemia or rickets.

In a country like Britain, experts say, malnutrition is rarely noticed. "You've got to have pretty severe deficiencies before this is picked up," said Waine. "But I think a lot of people are on the borderline."

Part of the blame goes to the rise of processed and fast foods, most of which contain only small amounts of healthy nutrients. The national diet is in such trouble that earlier this month, the United Kingdom's Food Standards Agency recommended that folic acid be added to the nation's flour; a lack of it in the diet of pregnant women has been linked to birth defects.

Recent surveys estimate that fewer than 20 percent of adults eat the recommended five daily portions of fruits and vegetables.

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G-8 offers $60B to combat AIDS in Africa

Germany's development minister said Friday the Group of Eight member states had agreed on a program worth more than $60 billion to combat the spread of HIV/AIDs in Africa.

"That has been agreed upon," Heidemarie Wieczorek-Zeul told state ZDF television, ahead of talks between the leaders at the G-8 summit in the northern German resort of Heiligendamm.

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Doctors urge mass circumcision for AIDS-hit South Africa

AIDS experts have called for a mass circumcision programme in South Africa, condemning a "deafening silence" from policy makers since studies revealed it sharply cut infection rates.

As scientists this week questioned a lack of movement on using male circumcision as a preventative method, delegates at South Africa's national AIDS conference called for the rollout of a mass circumcision programme.

Earlier this year the World Health Organisation (WHO) recommended the procedure after three studies in Africa showed it reduced chances of contracting
HIV by up to 60 percent.

But although countries such as Kenya, Malawi, Swaziland, Zimbabwe, Mozambique and Tanzania have drawn up plans for widespread circumcision, the South African government has done nothing to date.

"I think by now I would support people starting to think about a mass circumcision campaign," said Neil Martinson of the Perinatal HIV/AIDS research Unit.

Martinson said concerns over whether South Africans thought it was a culturally acceptable practice that would lead to risky sexual behaviour were not proven to be valid.

"In South Africa, high proportions of men and women find it acceptable to be circumcised, people (in the studies) weren't going around and sleeping around more because they didn't have a foreskin."

With an AIDS vaccine years away, the focus has turned to HIV prevention and the conference aims to build consensus about ways to do this.

"I am surprised there is no action on male circumcision. Where are the male activists? Studies show a 60 percent reduction (in risk) but there is silence," Glenda Gray, who will oversee the first HIV vaccine trials run in the country, told a panel discussing prevention research.

The primary investigator into the first circumcision trial held in South Africa, Bertran Auvert of the French Institute of Health and Medical Research, told AFP it was time for implementation.

"It's not even my opinion. It's now a WHO recommendation," he said.

The circumcision debate revealed one of the biggest challenges was getting the message across that being circumcised was not foolproof.

In some cultures in South Africa circumcision is seen as a rite of passage into adulthood, and boys go to initiation schools where they are circumcised with a spear-like instrument.

Critics of the mass use of male circumcision to combat HIV, like Tim Quinlan from the University of KwaZulu Natal's Health Economics and HIV/AIDS Research Division (HEARD), said there were dangers of jumping into the use of male circumcision without it forming part of a larger package of measures.

He questioned the fact that circumcision only protected men, and not women who were at greatest risk of contracting the virus.

However Professor Alan Whiteside, also based at HEARD, called for the "routine offer of circumcision for every male child born in a public hospital."

"It is so blindingly obvious that there are real reasons for circumcision. It is going to happen. What we need is informed advocacy and communication." Circumcision involves the removal of the foreskin which contains cells to which the HI Virus clings more readily.

South Africa has the second highest number of HIV sufferers in the world, after India, with some 5.5 million people living with the disease.

"There has been a deafening silence from policy people in this country, what else should we do, what else is there?" asked Martinson.

"The protective effect is long lasting, it's almost like a vaccine."

He said that research may be needed on how to increase the demand for circumcision.

"Must we target sexual partners, so women say 'I won't sleep with you if you are not cut?"

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S. Africa must raise wages to fight AIDS

South Africa will not be able to halt the spread of HIV/AIDS unless it increases wages for government health care workers and other public servants, the head of a leading HIV/AIDS advocacy group said on Wednesday.

In a presentation at the third South African AIDS conference, Siphokazi Mthathi, general secretary of the Treatment Action Campaign, warned that discontent in the public sector threatened to undermine the government's plan to expand the availability of life-saving AIDS drugs and other treatments to hundreds of thousands of HIV-positive people.

An estimated 12 percent of South Africa's 47 million people are infected with HIV, and some 1,000 die each day from AIDS and related diseases.

"We cannot talk about implementing an ambitious national plan when we do not pay public workers properly," Mthathi told 4,000 researchers, activists and healthcare workers at the conference in Durban.

Mthathi's remarks came on the sixth day of a massive strike by public servants in South Africa. Unions representing nearly 1 million doctors, nurses, teachers and other workers walked off the job on Friday after the government refused to meet their demands for an across-the-board 12 percent wage increase.

The government is offering a 6.5 percent increase.

A small group of public servants protested outside the AIDS conference on Tuesday, shortly before Deputy President Phumzile Mlambo-Ngcuka and other government officials arrived to officially open the four-day event.

South African officials say government health care workers will play a key role in the new national AIDS plan, which was unveiled in March to the delight of activists, scientists and others who had criticized the government for failing to take strong action against the epidemic.

The new strategy, among other things, envisions a five-fold increase in the number of HIV-positive people on anti-retroviral drugs by 2011. An estimated 700,000 needy South Africans cannot currently get these medications, sometimes because there is no doctor in their community to prescribe the drugs.

Activists have cited a shortage of doctors, especially in rural areas, as one of the main obstacles to halting HIV/AIDS in southern Africa, the epicenter of the epidemic.

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South Africa's traditional healers help fight HIV

Tryphina Ngwenya slides a pink condom over the magic wooden stick normally used to conjure up ancestral spirits, unleashing a ripple of laughter among her audience of traditional South African healers.

"You see it's easy -- there's nothing poisonous or dangerous about condoms," she told the group of some 80 sangomas -- as traditional healers are locally known -- draped in brightly colored wraps, animal hides and beads.

Ngwenya has recruited the sangomas -- sometimes called witchdoctors -- as foot soldiers in the fight against HIV, which has infected about one in three adults in this deeply traditional corner of rural South Africa.

She is teaching them basic AIDS awareness and prevention.

Many of the healers once believed HIV was a curse from the spirit world and patients had been bewitched. Some claimed they could cure AIDS -- and many who have not been trained continue to claim this.

But while they still prescribe roots and herbs for ailments and mutter incantations to dispel evil spirits, these sangomas now also issue condoms, refer patients to clinics for HIV tests and urge them to take life-prolonging anti-retroviral drugs.

"Before, I didn't even know what this HIV animal was, but the training has brought sophistication to my work," said Miriam Tembe, who has been consulting the spirits for tips on treating patients for 25 years.

The training helped her with the practice of scarring a patient then rubbing herbs or powder into the wound: "I used to use one razor for five people -- I used to kill people," she added. "Now I teach them how to protect themselves."

BEWITCHED

The project linking traditional practioners with modern health systems is being run by African Medical and Research Foundation (AMREF), which says more than two-thirds of people in rural Africa consult sangomas before attending a clinic.

Sangomas are revered and trusted in rural communities and play multiple roles as spiritual guide, healer and counselor. Mostly but not always woman, they might offer tips to a young couple on their sex life, advise on proper burial rites, or concoct a treatment for toothache -- all in a day.

AMREF wants sangomas to keep providing spiritual succor and basic healthcare, and also to use their influence and authority to promote HIV-testing and modern medicine in areas where many people are distrustful of hospitals, clinics and ARV drugs.

"Traditional healers are so important in these communities. People trust them more than they trust us nurses," said Ivy Mdletshe, a nurse who works in AMREF's HIV testing centre.

Zandile Bukhosini has benefited from the system. When her feet swelled up and she developed a hacking cough she assumed she had been bewitched and went straight to see Tembe -- her local sangoma.

Fortunately, Tembe knew how to spot the symptoms of tuberculosis, which often accompanies HIV infection. She consulted the spirit world as usual, then sent Bukhosini for an HIV test. The results were positive.

"When Miriam sent me for a test I was skeptical, but her medicine had helped me before so I decided to trust her," said the 25-year-old, hunched inside a mud and straw hut, the bitter aroma of burning incense wafting from the corner.

Now, with Tembe's support, Bukhosini is taking anti-retroviral drugs and looks happy and healthy.

"Miriam encouraged me to take the medicine the doctors gave me," she said. "But she also gives me her own treatment and tells me if I need to slaughter a chicken to appease the ancestors."

TOXIC DRUGS

The AMREF project has particular resonance in South Africa, where Health Minister Manto Tshabalala-Msimang has angered AIDS activists by appearing to question accepted science and emphasizing treatments such as lemon, garlic and the African potato.

Ngwenya insists the two approaches are not mutually exclusive, and argues sangomas can help treat some of the side effects of HIV -- such as skin problems or coughs and colds -- and break down the stigma attached to it.

"Obviously there is not a traditional healer who can cure AIDS but they can help treat the symptoms and help support patients by giving them what they want to believe," she said.

But she also says much more must be done. An estimated 200,000 traditional healers are practicing in South Africa -- there are almost 900 in this small district of some 200,000 people -- and organizations like AMREF have trained just a handful.

Many healers still tell patients anti-retroviral drugs are toxic, condoms are infested with disease-carrying worms and killing a goat will appease ancestral spirits and cure the sick.

And while a few weeks of basic training can halt dangerous practices like razor-sharing, healers may continue to promote traditional methods over modern medicine.

But most sangomas see little conflict between the two approaches, and say learning about orthodox healthcare has helped improve their traditional practice.

"How can the ancestors be angry with me?" said sangoma Philile Gumbi when asked what the spirits thought when she encouraged patients to turn to modern medicine: "Both me and the hospitals are doing the same thing -- we are saving lives."

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Libya warns against foreign pressure in HIV case

Libya warned foreign governments on Sunday against trying to force the release of five nurses sentenced to death for infecting hundreds of Libyan children with
HIV, saying talks to find a mutual solution were under way.

U.S. President George Bush reiterated his unwavering support for the release of the Bulgarian medics, held in a Libyan jail since 1999, and said in an interview aired on Friday that he hoped they would be released soon.

"We were hoping that President Bush would state his sympathy for the disaster of those children and the suffering of their families, which has gone on for many years," the Libyan foreign ministry said in a statement carried by state news agency JANA.

"There are contacts and negotiations to find a solution satisfactory to all parties," it said. "No one has the right to intervene in the affairs of the Libyan judicial system and we affirm the respect of the independence of our judicial system."

The European Union and United States have stepped up pressure to resolve the dispute and signs are growing that a deal could come soon. On Friday a spokesman for the children's families said a settlement could be reached by June 21.

The nurses and a Palestinian doctor were convicted in December of deliberately infecting 426 children with HIV in a highly politicised trial that has hampered attempts by OPEC-member Libya to restore full relations with the West.

The nurses say they are innocent and were tortured to make them confess. Libyan leader Muammar Gaddafi has suggested they infected the children under the orders of unnamed foreign governments.

Some Western scientists say negligence and poor hospital hygiene are the real culprits and the six are scapegoats.

Libya has repeatedly warned foreign governments not to try to influence its judiciary, while suggesting it might free the nurses if an agreement is reached to pay compensation to the children's families.

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Doctors in Italy perform first lung transplant on HIV-positive patient

An Italian hospital has carried out the first ever transplant of two lungs into a patient with HIV, who is doing well after the operation, a spokeswoman said.

The patient, an adult man whose life was in danger from respiratory illness, "was operated on at the start of the week and his post-operation diagnosis is good," said Serena Pizzo, spokeswoman for the Mediterranean Institute for Transplantation and Advanced Specialised Therapies (ISMETT) in Palermo.

Liver, kidney and pancreas transplants for HIV-positive patients have previously been performed successfully, but the operation in Italy was the first involving lungs, she said.
"The possibility of carrying out transplants on HIV-positive patients has been made possible by a new range of treatments that are very effective against HIV," said Paolo Grossi, a specialist in infectious diseases in charge of monitoring the patient's post-operative condition.

Pizzo said one of the main difficulties in performing transplants on HIV-positive patients is that they must be submitted to treatments that lower their immune systems while they are already immune-deficient.

ISMETT, a public institution, partners with the University of Pittsburgh Medical Centre in the United States.

Alessandro Nanni Costa, director of the national transplantation centre, called the operation "an important event for progress in the transplantation world."

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