Vaginal Gel May Prevent HIV

AIDS researchers have finally found a vaginal gel that halves a woman's risk of getting HIV from an infected sex partner.

The announcement, made at the outset of the 18th International AIDS Conference in Vienna, Austria, marks the beginning of the end of a 20-year search. Those years saw the failure of 11 clinical trials of six different agents intended to help women avoid HIV infection.

Now a vaginal gel containing tenofovir, an anti-HIV drug sold as Viread by Gilead Sciences Inc., is the first shown to protect against infection with the AIDS virus.

The announcement was made by husband/wife researchers Quarraisha Abdool Karim, PhD, and Salim S. Abdool Karim, MD, PHD, of the Center for the AIDS Program of Research in South Africa (CAPRISA) and Columbia University.

"I can now offer tenofovir gel that offers 39% protection. And if she is highly adherent, it can be up to 54% protection. That's far from full protection. But given that about 10% of the population in the area where the gel was tested are infected with HIV, such protection would have a profound effect," said Quarraisha.

"Without the gel, for every 100 women, 10 will be infected in a year. With this gel, only six women will be infected," she added. "For an individual woman, we say, 'If you use it consistently, you cut your chance of infection in half."

The gel is applied 12 hours before sex and again 12 hours later. Salim Abdool Karim said that while this should be done only once every 24 hours, the gel should theoretically offer protection to women who have sex more than once during that time.

If the gel truly works, however, Salim Abdool Karim believes that women will be much more likely to use it than they were in the study, during which they were warned not to rely on it and that it's safety was unproven.

In terms of safety, the gel did not have negative side effects. Virus in women who became infected with HIV despite gel use was not resistant to Viread.
While the Abdool Karims' study must be confirmed, the findings suggest that they used the right approach. By spiking the gel with a drug that enters cells and repels HIV when it tries to enter them, they took a different tack than previous gels, which used general microbicides to kill HIV on vaginal surfaces.

The U.S. National Institute of Allergy and Infectious Diseases (NIAID) already has launched a study to confirm the efficacy of tenofovir gel.

There's an additional benefit to the tenofovir gel. Salim Abdool Karim reported that it also protects against genital herpes infection -- which itself makes a woman more susceptible to HIV infection.
"We also show a 51% reduction in HSV-2 [genital herpes] infection," he said. "Women who have HSV-2 have twice the risk of acquiring HIV. So this would have the benefit of reducing risk of HIV in women who otherwise would have acquired HSV-2 infection."

Abdool Karim said that Gilead has promised him that it will allow South Africa to manufacture tenofovir gel without having to pay any royalties to the company.
The Abdool Karims and colleagues report the findings in the July 20 online journal ScienceExpress.

Less Salt for Everybody

Restricting the amount of sodium chloride in food can lower the risk of cardiovascular morbidities. This is the conclusion that Dieter Klaus and colleagues come to in the current issue of Deutsches Ärzteblatt International.

People whose intake of dietary sodium chloride is in excess of 6 g per day increase their risk of cardiovascular morbidities and hypertension. This is particularly notable in view of the fact that in the Western industrialized nations, one in two deaths is due to a cardiovascular disorder and the average intake of sodium chloride is in the range of 8 to 12 g/d. Salt restriction may help not only to prevent cardiovascular morbidities but may also counteract other lifestyle diseases such as obesity and diabetes.

As a preventive measure, the authors suggest reducing dietary salt intake population-wide. By successively lowering the NaCl content of industrially processed foods by 40% to 50%, people's daily salt intake would be lowered to 5 to 6 g/d per head of population.

Stroke Risk Temporarily Increases for an Hour After Drinking Alcohol, Study Finds

Call it the not-so-happy hour. The risk of stroke appears to double in the hour after consuming just one drink -- be it wine, beer or hard liquor -- according to a small multi-center study reported in Stroke: Journal of the American Heart Association.

"The impact of alcohol on your risk of ischemic stroke appears to depend on how much and how often you drink," said Murray A. Mittleman, M.D., Dr.P.H., senior author of the Stroke Onset Study (SOS) and director of the Cardiovascular Epidemiology Research Unit at Beth Israel Deaconess Medical Center in the Harvard Medical School in Boston, Mass.

Prior to the SOS, researchers didn't know if alcohol consumption had an immediate impact on ischemic stroke (caused by a blood clot in a vessel in or leading to the brain), although modest alcohol use (less than two drinks per day) may potentially lower risk in the long term.

Researchers interviewed 390 ischemic stroke patients (209 men, 181 women) about three days after their stroke regarding many aspects of their lives. Patients were excluded if the stroke seriously impaired their ability to speak or if they weren't well enough to participate. Fourteen patients had consumed alcohol within one hour of stroke onset.
Compared with times when alcohol wasn't being used, the relative risk of stroke after alcohol consumption was:

• 2.3 times higher in the first hour;
• 1.6 times higher in the second hour; and
• 30 percent lower than baseline after 24 hours.

The patterns remained the same whether participants had consumed wine, beer or distilled spirits. When the researchers eliminated patients who had been exposed to other potential triggers (such as exercising vigorously or drinking a caffeinated beverage) just prior to their strokes, the alcohol connection didn't change. Only one participant had consumed more than two drinks in the hour preceding the stroke, and removing that data didn't alter the pattern.

"The evidence on heavy drinking is consistent: Both in the long and short term it raises stroke risk," Mittleman said. "But we're finding it's more complicated with light to moderate drinking. It is possible that the transiently increased stroke risk from moderate alcohol consumption may be outweighed by the longer term health benefits."

Just after drinking, blood pressure rises and blood platelets become stickier, which may increase the possibility of a clot forming. However, consistent use of small amounts of alcohol is associated with beneficial changes in blood lipids and more flexible blood vessels, which may reduce risk overall.

"At this point we don't have enough evidence to say that people who don't drink should start, or that people who drink small amounts -- on the order of one drink a day -- should stop," Mittleman said.
A more definitive answer would require a controlled study in which some people are randomly selected to consume alcohol while others don't, he said.

The findings may not apply to patients with severe stroke.

Stroke is the No. 3 killer and a leading cause of long-term major disability in the United States, according to American Heart Association statistics.

The American Heart Association recommends that if you drink alcohol, do so in moderation. This means no more than two drinks per day for men and one drink per day for women. (A drink is one 12-ounce beer, 4 ounces of wine, 1.5 ounces of 80-proof spirits, or 1 ounce of 100-proof spirits.) High intakes can be associated with serious adverse effects and may increase alcoholism, high blood pressure, obesity, stroke, breast cancer, suicide and accidents. Consult your doctor on the benefits and risks of consuming alcohol in moderation.

The study is supported by an American Heart Association grant.

Medicine in Domestic Spoons Increases Overdose Risk, Doctors Warn

Parents are being urged not to use domestic spoons to give children medicine after a study found significant differences in capacity. A parent using one of the biggest domestic teaspoons would be giving their child 192 per cent more medicine than a parent using the smallest teaspoon and the difference was 100 per cent for the tablespoons. This increases the chance of a child receiving an overdose or indeed too little medication.

The study in the August issue of IJCP, the International Journal of Clinical Practice, looked at 71 teaspoons and 49 tablespoons collected from 25 households in Attica, Greece.
It found that the capacity of the teaspoons ranged from 2.5ml to 7.3ml, with an average and median volume of 4.4ml. The capacity of the tablespoons ranged from 6.7ml to 13.4ml, with an average of 10.4ml and a median of 10.3ml.

"The variations between the domestic spoon sizes was considerable and in some case bore no relation to the proper calibrated spoons included in many commercially available children's medicines" says Professor Matthew E Falagas, Director of the Alfa Institute of Biomedical Sciences in Athens, Greece.

The 25 women who took part in the study were aged between 24 and 84 with an average age of 48. Most had between one and three different teaspoons and tablespoons in their house but two women had as many as six different teaspoons and one of those also had five different tablespoons.

"We not only found wide variations between households, we also found considerable differences within households" says Professor Falagas.
The researchers were also keen to see whether there were any differences when five of the women were asked to dispense liquid from a calibrated 5ml medicine spoon. They found that only one dispensed the correct dose of liquid, with three dispensing 4.8ml and one 4.9ml.

This method is also more effective if children are very young or reluctant to take medicine, as a spoon can be pushed away and spilt, leaving the parent unsure about how much the child has actually taken.

"Dosing and administering medication to children is different from adults" says Professor Falagas. "Paediatric dosages need to be adjusted to age and body weight and, as a result, children are considered to be more vulnerable to dosage errors than adults.

"Low-cost medicine syringes are widely available from pharmacists, very easy to use and will give parents greater confidence that they have dispensed the correct dose."

[ BY RITU PANDEY ]