Gay Men More Likely to Have Had Cancer

A new study finds that homosexual men are twice as likely as other males to have been diagnosed with and then survive a cancer, shining a light on the unique medical risks that gay people may face. It's not the first time that researchers have noted differences in health risks linked to sexual orientation. Gay men, of course, are at higher risk of becoming infected with HIV, while lesbians may be more likely than heterosexual women to get breast cancer. Both gay men and lesbians have higher rates of tobacco use than the general population, and research has shown that lesbians drink more and are more prone to obesity than other women.

The new study adds to existing knowledge, but "there's a painful dearth of data about lesbian, gay, bisexual and transgender health in general," noted Liz Margolies, executive director of the National LGBT Cancer Network, who's familiar with the new research. In the new study, published online May 9 in Cancer, researchers examined surveys involving more than 122,000 California residents from 2001, 2003 and 2005. Among other things, the surveys asked about sexual orientation and whether the participants had ever been diagnosed with cancer. About 8 percent of the gay men in the group reported having had cancer almost double the rate among the heterosexual and bisexual men surveyed.

Lesbians didn't have a higher rate of cancer than other women, but lesbian cancer survivors were about twice as likely to report that they had fair or poor health compared to heterosexual women. The study can't say whether gays and lesbians are more likely to develop cancer in the first place, since it doesn't include people who have died from the disease or may be too ill to answer questions, stressed study author Ulrike Boehmer, an associate professor of community health sciences at Boston University School of Public Health. Experts already believe that gay men face a higher risk of anal, lung, testicular and immune-system cancers, she said. For their part, lesbians are thought to possibly be at higher risk of breast cancer, perhaps because many of them don't give birth.

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Starting HIV Drugs Earlier May Delay AIDS But Not Death

New research suggests that HIV-infected patients are most likely to stay clear of AIDS longer if they start drug therapy when their immune systems are still relatively strong. However, starting treatment earlier, compared to waiting, didn't affect dying from AIDS. "There wasn't a clear benefit in terms of preventing death" by prescribing the drugs before some guidelines suggest, said Dr. Keith Henry, director of HIV clinical research at Hennepin County Medical Center in Minneapolis and co-author of a commentary accompanying the study, published in the April 19 edition of Annals of Internal Medicine.

The issue of when to begin drug treatment is a hot topic in the field of AIDS/HIV medicine. If physicians wait to begin treatment, patients can delay the expense not to mention the side effects of pricey anti-HIV drugs. But such delays may also give the virus a chance to become more powerful and better able to fend off medications. If they're not treated with drugs, HIV-infected people almost always go on to develop AIDS. So when should doctors turn to the drugs? In the U.S., guidelines suggest that HIV-infected patients take them when the level of CD4 cells an important part of the immune system dips below 0.500 X 109 cells per liter (cells/L).

In Europe, the guideline number is frequently lower meaning a weaker immune system at under 0.350 X 109 cells/L.In the new study, researchers examined how patients did when they began drug therapy with their CD4 cells at a variety of levels. The study authors examined the medical records of almost 21,000 HIV-infected patients who sought treatment in HIV clinics in Europe and through the Veterans Health Administration system in the United States. The researchers found that the death rate was about the same regardless of whether patients began treatment when their CD4 levels dipped under 0.500 X 109 cells/L or if they waited until their immune systems deteriorated more and reached below the level of 0.350 X 109 cells/L.

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Gene Therapy Against HIV Not a Proven Cure

Experts are reacting with cautious optimism to the announcement Monday that researchers reconfigured immune cells so that they became resistant to HIV in six patients infected with the virus. But they say the jury is out on whether the technique might ever spell an end to AIDS. The goal is ultimately a cure or what's called a "functional cure" having the body permanently keep HIV at bay but "we're not there yet," stressed Dr. Michael Kolber, professor of medicine and director of the Comprehensive AIDS Program at the University of Miami Miller School of Medicine.

The trial, reported Feb. 28 at a meeting of HIV specialists in Boston, "was a proof-of-principle that they could go in and do this. They demonstrated that the cells stayed in the patients, but the patients were not cured," said Kolber, who was not involved in the new research. Another expert agreed that the treatment's true potential remains uncertain. "If successful, this probably could have wide application, but going from six patients to an entire epidemic is a ways to go," said Dr. Michael Horberg, director of HIV/AIDS at Kaiser Permanente Health Plan and vice chair of the HIV Medicine Association.

"With other successes we've already had, that makes it more promising and people are starting to have a greater vision as to what's possible." However, as Kolber pointed out, this trial was what's known as a phase I trial, which means it was primarily looking at safety, not effectiveness, although investigators do often report on initial effectiveness results at this stage. The idea came from an isolated case that first made headlines in 2009, involving the so-called "Berlin patient." This man, an American AIDS patient living in Germany, was apparently cured after receiving blood cells from a donor who happened to have a rare, natural immunity to HIV.

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New Drug Strategy Shows Promise Against HIV

Scientists are reporting early but promising results from a new drug that blocks HIV as it attempts to invade human cells. The approach differs from most current antiretroviral therapy, which tries to limit the virus only after it has gained entry to cells. The medication, called VIR-576 for now, is still in the early phases of development. But researchers say that if it is successful, it might also circumvent the drug resistance that can undermine standard therapy, according to a report published Dec. 22 in Science Translational Medicine.

The new approach is an attractive one for a number of reasons, said Dr. Michael Horberg, director of HIV/AIDS for Kaiser Permanente in Santa Clara, Calif. "Theoretically it should have fewer side effects and there's probably less of a chance of mutation in developing resistance to medication," said Horberg, who was not involved in the study. Viruses replicate inside cells and scientists have long known that this is when they tend to mutate potentially developing new ways to resist drugs. "It's generally accepted that it's harder for a virus to mutate outside cell walls," Horberg explained.

The new drug focuses on HIV at this pre-invasion stage. "VIR-576 targets a part of the virus that is different from that targeted by all other HIV-1 inhibitors," explained study co-author Frank Kirchhoff, a professor at the Institute of Molecular Virology, University Hospital of Ulm in Ulm, Germany, who, along with several other researchers, holds a patent on the new medication. The target is the gp41 fusion peptide of HIV, the "sticky" end of the virus's outer membrane, which "shoots like a 'harpoon'" into the body's cells, the authors said. The launch of this peptide is a first step in the virus's bid to inhabit host cells.

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Docs Claim Transplant Cured Man of HIV, But Experts Urge Caution

In a rare case, a man living in Germany who had both leukemia and AIDS no longer has any detectable HIV cells in his blood following a stem cell transplant for his leukemia three years ago. But experts were quick to caution that the case does not have practical implications for the treatment of AIDS worldwide. As it turns out, the donor for that transplant carried a rare mutation in a gene that increases immunity against the most common form of HIV.

First reported in 2009, this follow-up study, published online in the journal Blood, confirms that the recipient patient is still free of both leukemia and HIV three years after the transplant. But one expert issued strong words of caution in interpreting the finding. "Our phones have been ringing off the hook," said Dr. Margaret Fischl, director of the AIDS clinical research unit at the University of Miami Miller School of Medicine. "We are having patients calling us and asking if they can stop their antiretroviral therapy and the answer is uncategorically no."

The theory is that if you could wipe out every infected cell you could cure HIV, Fischl said, but this is a unique case. The patient had intense chemotherapy and radiation, then relapsed and was given a second transplant from the same donor. The donor was unique in that he had a gene that could fight the most common form of HIV. This mutation is seen in about one in every million people, Fischl explained.

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Daily Pill Lowers Odds for Infection With HIV

A pill a day cut the risk of HIV infection by almost 44 percent in those at highest risk for contracting the virus, namely sexually active gay and bisexual men, a new study finds. The reduction in risk climbed to nearly 73 percent among study participants who took the pill, called Truvada, 90 percent of the time, the researchers added. Truvada is already available by prescription in the United States as a treatment for HIV-infected people.

The pill, which was tested in over 2,500 men at 11 sites in six countries worldwide, combines two HIV antiretroviral medications, emtricitabine (Emtriva) and tenofovir (Viread). Experts are hailing the results as a big step in the worldwide effort to combat the spread of the HIV virus, which infected some 2.7 million people worldwide in 2008. And it adds to other efforts to prevent spread, such as a topical gel containing tenofovir that was found last summer to be effective in preventing HIV infection in women in southern Africa.

"These results represent a major advance in HIV prevention research," Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention at the U.S. Centers for Disease Control and Prevention, said in a statement. "For the first time, we have evidence that a daily pill used to treat HIV is partially effective for preventing HIV among gay and bisexual men at high risk for infection, when combined with other prevention strategies. Given the heavy burden of HIV among gay and bisexual men, a new tool with potential additive benefit is exciting and welcome news."

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More Older Americans Living With HIV

Better treatments are extending the lives of people with HIV, but aging with the AIDS-causing virus takes a toll that will challenge the health care system, a new report says. A survey of about 1,000 HIV-positive men and women ages 50 and older living in New York City found more than half had symptoms of depression, a much higher rate than others their age without HIV. And 91 percent also had other chronic medical conditions, such as arthritis (31 percent), hepatitis (31 percent), neuropathy (30 percent) and high blood pressure (27 percent). About 77 percent had two or more other conditions. About half had progressed to AIDS before they got the HIV diagnosis, the report found.

"The good news is antiretroviral therapies are working and people are living. If all goes well, they will have life expectancies similar to those without HIV," said Daniel Tietz, executive director of the AIDS Community Research Initiative of America. "But a 55-year-old with HIV tends to look like a 70-year-old without HIV in terms of the other conditions they need treatment for," he said Wednesday at a meeting of the Office of National AIDS Policy at the White House in Washington, D.C. The research included interviews with 640 men, 264 women and 10 transgender people. Dozens of experts on HIV and aging attended the meeting, which was intended to identify the needs of older adults with HIV and to explore ways to improve services to them.

Currently, about 27 percent of those with HIV are over 50. By 2015, more than half will be, said the report. Because of their special needs, this poses challenges for public health systems and organizations that serve seniors and people with HIV, Tietz said. HIV can be isolating, Tietz said. Seventy percent of older Americans with HIV live alone, more than twice the rate of others their age, while about 15 percent live with a partner, according to the report. The survey found that loneliness was higher among HIV-positive adults than for other older Americans. One reason is that many men and women conceal the condition from friends and family for fear of stigma or rejection, both real and imagined, Tietz said.

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No Gender-Based Difference Seen in Anti-HIV Drug Response

Men and women have the same responses to the anti-HIV drugs darunavir and ritonavir, researchers have found. The new study included 429 HIV-positive patients at 65 sites in the United States, Puerto Rico and Canada. HIV is the virus that causes AIDS. The participants were given 600 milligrams of darunavir and 100 mg of ritonavir twice daily. The treatment response rates were 73 percent in women and 73.5 percent in men, the investigators found. Rates of adverse events were also comparable between the sexes. The most common side effects were nausea, diarrhea and rash. The findings are published in the Sept. 21 issue of the journal Annals of Internal Medicine. The Gender, Race and Clinical Experience (GRACE) study was funded by Tibotec Therapeutics, which markets darunavir.

The study authors noted that 32.8 percent of the female participants dropped out before the end of the study, compared with 23.2 percent of the males. This suggests that more needs to be done to retain women in clinical trials. "It is critical that women are involved in clinical trials to evaluate the efficacy and toxicity of new treatments not just for HIV but for all diseases," lead author Dr. Judith Currier, a professor of medicine and chief of the division of infectious diseases at the David Geffen School of Medicine at the University of California, Los Angeles, said in a UCLA news release.

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