Faculty Bibliography

The findings also extend to an earlier study that found a reduced frequency of malaria among H.I.V.-infected adults in Uganda who took the antibiotic and slept under bed nets. Dr. Jonathan Mermin of the Centers for Disease Control and Prevention in Atlanta led the adult study, which was published in The Lancet last year. But Dr. [Anne Gasasira] said that because the adult and pediatric studies used different methodologies, the findings could not be directly compared. In the past, doctors assumed that a child who came to a clinic for fever in Uganda had malaria until it was proved otherwise. But because malaria was far less common among the participants who received the combination therapy, Dr. Gasasira said, doctors now assume that any fever in a young child must be investigated for a cause other than malaria. Dr. [Elaine Abrams], the Columbia expert, said in an interview that the Uganda findings had additional implications for treating H.I.V.-infected children in malarious areas. Because pediatricians are concerned that prolonged use of cotrimoxazole could lead to resistant malaria, they often stop the drug among AIDS patients when tests show significant improvement in the health of their immune system after antiretroviral therapy

Merck's drug works by inhibiting the action of integrase, an enzyme produced by the virus that incorporates the virus' genetic material into the DNA of a patient's immune cell. Once incorporated, the viral DNA commandeers the cell to make more copies of the virus

[John W. Mellors], who was not involved in the studies but has been a consultant to the manufacturers of the drugs, said he 'wouldn't be going out on a limb' to say the new results were as exciting as those from the mid-1990s, when researchers first discovered that cocktails of drugs could significantly prolong lives. While there are now 20 approved drugs to treat HIV and AIDS, there are only four different mechanisms by which the drugs work. In many patients, the rapidly replicating virus evolves resistance to one or more drugs, usually because patients don't take their drugs on time as prescribed

A case in point is the effort to encourage formula-feeding instead of breast-feeding to prevent transmission of the virus that causes AIDS from mother to infant. At the 14th Conference on Retroviruses and Opportunistic Infections here on Monday, scientists reported findings from a number of studies citing the dangers of formula-feeding in poor countries that challenged the current recommendations. The findings led participants to urge researchers to find safer ways for breast- feeding and using formula in the battle to stop the AIDS pandemic. Based on earlier studies, the World Health Organization has said that exclusive breast-feeding has a lower risk of transmitting HIV than breast-feeding combined with other fluids or foods

Pfizer's drug works by blocking a protein on human immune system cells that H.I.V. uses as a portal to enter and infect the cell. It would be the first drug that targets the human body rather than the virus. In two Phase 3 studies sponsored by Pfizer involving 1,049 patients, more than 40 percent of patients who received maraviroc had undetectable levels of virus after 24 weeks of a 48-week study. That was about twice the rate of those who received placebo. As in the Merck trials, patients were resistant to three classes of drugs and were receiving an optimized combination of older drugs. About 85 percent of newly infected patients have a virus that uses CCR5 while only about half of highly drug-resistant viruses use that portal. There has been some concern that blocking CCR5 would encourage the development of viruses that use the alternative portal -- and those viruses seem to be associated with worse outcomes

Dr. [Moses Sinkala] said health officials ''should strongly encourage breast-feeding into the second year of life for infants found to be HIV-infected.'' The reason was that infected infants had a lower death rate the longer they were breast-fed, said Dr. Donald M. Thea of Boston University, a co-author of the Zambian study. In a main address to the conference, Dr. Hoosen Coovadia, an AIDS expert from Durban, South Africa, pointed out the many well-documented advantages of breast-feeding. Dr. Coovadia pleaded with pediatricians and health officials not to lose sight of the fact that breast-feeding provided one of nature's greatest health benefits. United Nations AIDS estimates that 300,000 infants die each year from becoming infected through breast-feeding. Unicef estimates that 1.5 million infants die each year from mothers who avoided breast-feeding

The trials in Africa and India involved a chemical, cellulose sulfate or Ushercell, and were the second failure of a potential microbicide in a full-scale trial in recent years. In one of the latest trials, a standard check by an independent scientific committee found an increased risk of HIV infection among women who used cellulose sulfate compared with those who used a placebo gel. An ideal microbicide would work in three ways. First, it would kill HIV in the vagina and cervix. Second, the microbicide would prevent any virus that escaped from attaching to a woman's cells, which is the way HIV starts to infect. Third, for any virus that did enter cells, the microbicide would block an enzyme that HIV needs to replicate

The trials, in Africa and India, involved a chemical, cellulose sulfate or Ushercell, and were the second failure of a potential microbicide in a full-scale trial in recent years. In one of the latest trials, a standard check by an independent scientific committee found an increased risk of H.I.V. infection among women who used cellulose sulfate compared with those who used a placebo gel. An ideal microbicide would work in three ways. First, it would kill H.I.V. in the vagina and cervix. Second, the microbicide would prevent any virus that escaped from attaching to a woman's cells, the way the virus starts to infect. Third, for any virus that did enter cells, the microbicide would block an enzyme, reverse transcriptase, that the virus needs to replicate. The new findings were surprising, researchers said, because 11 smaller trials of more than 500 women conducted since 1999 showed that cellulose sulfate was safe. The chemical, which was developed as Ushercell by Polydex Pharmaceuticals in Toronto, was active against H.I.V. in laboratory tests

'Children affected by AIDS are now more visible and are taken more seriously in global, regional and national forums where they had received little consideration before,' the United Nations children's agency said in a report Tuesday. Better testing to find children with HIV, the AIDS virus, and simpler formulations of the anti-retroviral drugs that combat the infection have increased the number of children under treatment, Unicef said. Additional factors were lower prices for the drugs and improved skills among health workers. The progress since then, though small, has exceeded Unicef's expectations, Peter McDermott, Unicef's chief for HIV/AIDS, told reporters by telephone. 'Children do very well on treatment.' Still, about 10 percent of pregnant women in capital cities in sub-Saharan Africa are HIV-infected. But the vast majority of pregnant African women do not have access to drugs that would prevent transmitting the virus to their infants. So about one-third of their children will become infected at or shortly after birth, Unicef said

''Children affected by AIDS are now more visible and are taken more seriously in global, regional and national forums where they had received little consideration before,'' the United Nations agency said in a report. Better testing to find children with H.I.V., the virus that causes AIDS, and simpler formulations of the antiretroviral drugs that combat the infection have increased the number of children under treatment, Unicef said. Additional factors were lower prices for the drugs and improved skills among health workers. Still, about 10 percent of pregnant women in capital cities in sub-Saharan Africa are infected with H.I.V. But the vast majority of pregnant African women do not have access to drugs that would prevent transmitting the virus to their infants. So about one-third of their children will become infected at or shortly after birth, Unicef said. The data available for 2005 shows that only seven countries cited in the report provided drugs to at least 40 percent of infected pregnant women to prevent H.I.V. among newborns: Argentina (87 percent), Brazil (48 percent), Botswana (54 percent), Jamaica (86 percent), Russia (84 percent), Thailand (46 percent) and Ukraine (90 percent)