Friday, October 25, 2013

3-year-old baby born with HIV may have been cured thanks to 'unusually aggressive' treatment

Babies are very flexible developmentally so this may not be replicable in adults

Doctors now have convincing evidence that they put HIV into remission, hopefully for good, in a Mississippi baby born with the AIDS virus — a medical first that is prompting a new look at how hard and fast such cases should be treated.

The case was reported earlier this year but some doctors were skeptical that the baby was really infected rather than testing positive because of exposure to virus in the mom's blood.

The new report, published online Wednesday by the New England Journal of Medicine, makes clear that the girl, now 3, was infected in the womb. She was treated unusually aggressively and shows no active infection despite stopping AIDS medicines 18 months ago.

Doctors won't call it a cure because they don't know what proof or how much time is needed to declare someone free of HIV infection, long feared to be permanent.

'We want to be very cautious here. We're calling it remission because we'd like to observe the child for a longer time and be absolutely sure there's no rebound,' said Dr. Katherine Luzuriaga, a University of Massachusetts AIDS expert involved in the baby's care.

The government's top AIDS scientist, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, agreed.

'At minimum, the baby is in a clear remission. It is possible that the baby has actually been cured. We don't have a definition for cure as we do for certain cancers, where after five years or so you can be relatively certain the person is not going to go and relapse,' he said. A scientist at his institute did sophisticated tests that showed no active virus in the child.

A government-sponsored international study starting in January aims to test early treatment in babies born with HIV to see if the results in this case can be reproduced.

Most HIV-infected moms in the U.S. get AIDS medicines during pregnancy, which greatly cuts the chances they will pass the virus to their babies. But the Mississippi mom got no prenatal care and her HIV was discovered during labor. Doctors considered the baby to be at such high risk that they started the child on three powerful medicines 30 hours after birth, rather than waiting for a test to confirm infection as is usually done.

Within a month, the baby's virus fell to undetectable levels. She remained on treatment until she was 18 months old when doctors lost contact with her. Ten months later when she returned, they could find no sign of infection even though the mom had stopped giving the child AIDS medicines.

Only one other person is thought to have been cured of HIV infection — a San Francisco man who had a bone marrow transplant in 2007 from a donor with natural resistance to HIV, and showed no sign of infection five years later.

In the Mississippi baby, 'there's no immune mechanism we can identify that would keep the virus in check' like that bone marrow donor, said another study author, Dr. Deborah Persaud of the Johns Hopkins Children's Center, who helped investigate the case because she has researched treatment in children.

Dr. Peter Havens, pediatric HIV chief at Children's Hospital of Wisconsin and a government adviser on HIV treatment guidelines, said the child may have an undiscovered genetic trait that helped her manage the virus.

'I'm just not convinced that her dramatic response would be replicable in a large population,' he said. It's too soon to recommend treating other high-risk babies so aggressively without more study, he said.

In the upcoming study, doctors plan to give AIDS medicines for at least two years and watch for signs of remission before suspending treatment and seeing whether a remission results.

The Mississippi case 'did open people's eyes further' about a possible cure, Luzuriaga said. 'We might be able to intervene early and spare children a lifetime of therapy. That is the potential impact of this case.'


Strokes in under 64s soar by 25% in 20 years as doctors issue warning over toll taken by unhealthy lifestyle

DESPITE the way statins are handed out like peanuts

Rocketing global rates of stroke among the young and middle-aged are a ‘wake-up call’, say British experts.  In the past 20 years the number of strokes afflicting people aged 20 to 64 have jumped by a quarter, an international study shows.

Strokes in this age group now make up 31 per cent of the worldwide total, compared with 25 per cent before 1990.

Although the rate of strokes among older people is declining in the UK, Britons are still more likely to die from stroke than someone living in France, Germany and the US.

In the poorest areas of the UK the number of people dying from stroke is around three times higher than in the least economically deprived.

Jon Barrick, chief executive of the Stroke Association, called the study a ‘wake-up call to governments across the globe’.

Poor lifestyles, increasing sedentary habits, obesity and diabetes threatened to eradicate advances made in Britain in recent years, he warned.

Figures from King’s College London earlier this month revealed a 40 per cent fall in stroke rates among  elderly people since the mid-1990s.

Experts said the drop was due to better treatment of high blood  pressure and cholesterol.

But rates remain high for people aged 45 and under, and those of black Caribbean and African origin, and a drop in the total number of strokes is unlikely because more people are  living longer.

The latest findings, published in The Lancet medical journal, form part of the Global Burden of Disease Study 2010, looking at major diseases and causes of ill health in 50 countries.

The results reveal stark differences between rich and poor. [As usual]

Strokes were linked to 46 per cent more disability and illness and 42 per cent more deaths in poorer countries than in richer ones between 1990 and 2010. In rich countries, stroke rates fell 12 per cent over the two decades.

Lifestyle factors such as smoking, high blood pressure and unhealthy diet were thought to play a role in increasing stroke rates in low-to-middle income countries.

Professor Valery Feigin of New  Zealand’s National Institute for Stroke and Applied Neurosciences said: ‘The worldwide stroke burden is growing very fast and there is now an urgent need for culturally acceptable and affordable stroke prevention, management and rehabilitation strategies to be developed and implemented worldwide.’

Each year around 152,000 strokes occur in the UK, costing the NHS an estimated £3.7billion, and there are over a million Britons living with the effects of stroke.

In January, BBC presenter Andrew Marr, 54, suffered a stroke, which he blamed on his relentless schedule.

Mr Barrick said at least half of strokes could be prevented by simple lifestyle changes, such as taking more exercise.

‘The report reveals a shocking disparity between rich and poor, where death rates from stroke are up to ten times higher in lower income countries,’ he said.

‘Closer to home, within the UK, the number of people dying from stroke is around three times higher in the most economically deprived areas, compared to the least deprived.

‘Stroke survivors often face a black hole when discharged from hospital, with one in five in the UK receiving no support from services to help them recover.

‘This is a stark warning. We urgently need to address this global stroke crisis by prioritising stroke prevention and investment into stroke research.’

A second study published in The Lancet Global Health showed that in 2010, three-fifths of the global disability and more than half of deaths due to stroke were from bleeding in the brain.

This type of stroke, known as a haemorrhagic stroke, is deadlier than more common ischaemic strokes that cut blood supply to the brain.


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