E-drug: Journals on AIDS epidemic
---------------------------------------------
Dear e-druggers,
You will all be aware that the XV International
AIDS conference will be in Bangkok this next week.
A previous email has told you how you can keep in
touch with all the proceedings and MSF (next
message) has provided some background information
and some details about their contributions during
the conference.
Some major journals have devoted a lot of space
to the issues. Valeria Frighi has provided us
with information about the New England Journal of
Medicine.
Important NEJM articles can be downloaded free from from
http://content.nejm.org/current.shtml
for example
Volume 351:115-117 July 8, 2004
The AIDS Epidemic in 2004
Robert Steinbrook, M.D.
As the AIDS pandemic enters its 24th year, the number of people
living with human immunodeficiency virus (HIV) infection continues
to increase steadily (see Figure).1 Two thirds of infected persons
are in Africa, where the epidemic exploded during the 1990s, and
one fifth are in Asia, where the epidemic has been growing rapidly
in recent years. As of the end of 2003, an estimated 34.6 million to
42.3 million people throughout the world were living with HIV
infection, and more than 20 million had died of AIDS.2 In that year
alone, about 4.8 million people became infected with HIV, and
about 2.9 million died of AIDS.
The previous week, an article about use of
multivitamins with ARV therapy was published in
NEJM.
available at
http://content.nejm.org/content/vol351/issue1/index.shtml
A Randomized Trial of Multivitamin Supplements and HIV Disease
Progression and Mortality
Wafaie W. Fawzi, M.B., B.S., Dr.P.H., Gernard I. Msamanga, M.D.,
Sc.D., Donna Spiegelman, Sc.D., Ruilan Wei, Ph.D., Saidi Kapiga,
M.D., Sc.D., Eduardo Villamor, M.D., Dr.P.H., Davis Mwakagile,
M.D., M.Med., Ferdinand Mugusi, M.D., M.Med., Ellen Hertzmark,
M.A., Max Essex, D.V.M., Ph.D., and David J. Hunter, M.B., B.S.,
Sc.D.
Background Results from observational studies suggest that
micronutrient status is a determinant of the progression of human
immunodeficiency virus (HIV) disease.
Methods We enrolled 1078 pregnant women infected with HIV in a
double-blind, placebo-controlled trial in Dar es Salaam, Tanzania,
to examine the effects of daily supplements of vitamin A
(preformed vitamin A and beta carotene), multivitamins (vitamins
B, C, and E), or both on progression of HIV disease, using survival
models. The median follow-up with respect to survival was 71
months (interquartile range, 46 to 80).
Results Of 271 women who received multivitamins, 67 had
progression to World Health Organization (WHO) stage 4 disease
or died � the primary outcome � as compared with 83 of 267
women who received placebo (24.7 percent vs. 31.1 percent;
relative risk, 0.71; 95 percent confidence interval, 0.51 to 0.98;
P=0.04). This regimen was also associated with reductions in the
relative risk of death related to the acquired immunodeficiency
syndrome (0.73; 95 percent confidence interval, 0.51 to 1.04;
P=0.09), progression to WHO stage 4 (0.50; 95 percent confidence
interval, 0.28 to 0.90; P=0.02), or progression to stage 3 or higher
(0.72; 95 percent confidence interval, 0.58 to 0.90; P=0.003).
Multivitamins also resulted in significantly higher CD4+ and CD8+
cell counts and significantly lower viral loads. The effects of
receiving vitamin A alone were smaller and for the most part not
significantly different from those produced by placebo. Adding
vitamin A to the multivitamin regimen reduced the benefit with
regard to some of the end points examined.
Conclusions Multivitamin supplements delay the progression of
HIV disease and provide an effective, low-cost means of delaying
the initiation of antiretroviral therapy in HIV-infected women.
Thank you Valeria.
The Lancet vol364/iss9428 has a series of
articles that address many of the issues we have
discussed on e-drug. You will see all the
article on the following contents page
http://www.thelancet.com/journal/vol364/iss9428/contents
Generic antiretroviral drugs--will they be the
answer to HIV in the developing world?
N Kumarasamy
Concurrent sexual partnerships help to explain
Africa's high HIV prevalence: implications for
prevention
Daniel T Halperin, Helen Epstein
Seizing the opportunity to capitalise on the
growing access to HIV treatment to expand HIV
prevention
Helene Gayle, Joep M A Lange
Unexpected drug interactions and adverse events with antiretroviral drugs
Graeme Moyle, Marta Boffito
HIV escape from cytotoxic T lymphocytes: a potential hurdle for vaccines?
Dan H Barouch, Norman L Letvin
The Global Fund to Fight AIDS, Tuberculosis and
Malaria: funding for unpopular public-health
programmes
Thomas Kerr, Karyn Kaplan, Paisan Suwannawong, Ralf Jurgens, Evan Wood
Social marketing of condoms is great, but we need more free condoms.
Deborah A Cohen, Thomas A Farley
If you cannot download articles you would like,
please contact the moderator at
e-drug@healthnet.org
--
To send a message to E-Drug, write to: e-drug@healthnet.org
To subscribe or unsubscribe, write to: majordomo@healthnet.org
in the body of the message type: subscribe e-drug OR unsubscribe e-drug
To contact a person, send a message to: e-drug-help@healthnet.org
Information and archives: http://www.essentialdrugs.org/edrug