Nevirapine a better HIV drug? Press Release for PLoS MedicineOctober 13, 2004Nevirapine is Better than Efavirenz at Raising "Good" Cholesterol Two of the most commonly prescribed drugs for treating HIV (antiretroviral drugs)-nevirapine and efavirenz-can both raise levels of the "good type" of cholesterol (HDL cholesterol), but nevirapine raises it higher than efavirenz, according to a new study by van Leth and colleagues published in the launch issue of PLoS Medicine. "These data suggest that nevirapine may be preferable to efavirenz in HIV-infected adults who have increased cardiovascular risk," says Andrew Carr, an HIV specialist at St. Vincent's Hospital in Sydney, Australia, who was not involved in the study. Cardiovascular risk factors include high blood pressure, diabetes, and smoking, which put patients at higher risk of heart disease and stroke. However, perceived cardiovascular risk is only one factor that would affect the choice between these two drugs, notes Carr. Efavirenz is thought to be marginally better than nevirapine at keeping HIV infection under control; efavirenz is also advantageous because patients only need to take it once a day, whereas nevirapine must be taken twice daily. The new study "moves clinicians and patients away from 'one-size-fits-all antiretroviral therapy,'" says Carr, allowing them to weigh up the different advantages and disadvantages of each drug. In the study, the researchers compared the cholesterol levels in 417 patients with HIV who were taking nevirapine against 289 patients who were taking efavirenz. None of the patients had been on any antiretroviral drugs before. Patients taking nevirapine had a significantly larger increase in HDL cholesterol compared with patients taking efavirenz. Although the increase was higher with nevirapine, this does not prove that nevirapine is better at reducing the risk of heart disease and strokes, says Carr. The researchers did not look at the risk of these diseases in their study. Praphan Phanuphak, of the Thai Red Cross AIDS Research Center in Bangkok, Thailand, who was one of the authors of the study, says that the findings are particularly important for treating HIV in the developing world. "Nevirapine is much cheaper, particularly in developing countries where generic drugs are available," says Phanupak. "In many developing countries, nevirapine is incorporated in fixed dose combination with other drugs such as stavudine and lamivudine which costs only US$1 per day." Citation: van Leth F, Phanuphak P, Stroes E, Gazzard B, Cahn P, et al. (2004) Nevirapine and efavirenz elicit different changes in lipids profile in antiretroviral-therapy-naive patients with HIV-1. PLoS Med 1 (1): e19. The published article will be accessible to your readers at: http://www.plosmedicine.org/perlserv/?request=getdocument&doi=10.1371/journal.pmed.0010019 Press-only preview of the article: http://www.plos.org/downloads/plme-01-01-vanleth.pdf Related image for press use: http://www.plos.org/downloads/plme-01-01-vanleth.jpg CONTACT: Frank van Leth Academic Medical Center Meibergdreef 9 Amsterdam, Noord-Holland 1105 AZ Netherlands +31-20-566-7860 +31-20-691-8821 (fax) f.c.vanleth@amc.uva.nl ******************************************** Oats Not Safe for All Patients with Celiac Disease Most patients with celiac disease can eliminate their symptoms-at a price: lifelong adherence to a gluten-free diet. This means no wheat, rye, barley, and, until recently, no oats. Then some recent studies suggested that oats did not cause the intestinal inflammation characteristic of the disease, and thus oats are now often included in the celiac disease diet. This is good news for patients coping with severe restrictions on what they can and must not eat, but a study by Ludvig Sollid and colleagues in the launch issue of PLoS Medicine suggests that oats are not safe for all patients. Like other chronic inflammatory diseases, celiac disease is caused by a complex interplay between genetic and environmental factors, but it is better understood than most. Long believed to be a relatively rare disorder, it is now thought to affect about one in 250 people worldwide. Clinical symptoms are present in less than half of patients and vary considerably, but patients with symptomatic disease have a higher risk of developing colon cancer and lymphomas. Genetically, almost all patients have one of two predisposing HLA molecules, which determine the context in which their immune system encounters foreign antigens, including gluten proteins found in wheat and other cereals. In individuals with celiac disease, the immune system mounts an abnormal response to gluten, which is characterized by gluten-reactive intestinal T cells and by inflammation and compromised function of the small intestine. Ludvig Sollid and colleagues applied the current understanding of celiac disease and a range of molecular pathology tools to studying the response to oats of nine patients with celiac disease. The researchers found that intolerance to oats exists at least in some patients with celiac disease, and that those patients have the same molecular reaction to oats that other patients have to wheat, barley, or rye. This strongly suggests that oats are not safe for all patients with celiac disease, but given the small number of patients and the fact that they were not randomly selected, future studies are needed to determine the frequency of oats intolerance. Citation: Arentz-Hansen H, Fleckenstein B, Molberg O, Scott H, Koning F, et al. (2004) The Molecular Basis for Oat Intolerance in Celiac Disease Patients. PLoS Med 1 (1): e1. The published article will be accessible to your readers at: http://www.plosmedicine.org/perlserv/?request=getdocument&doi=10.1371/journal.pmed.0010001 Press-only preview of the article: http://www.plos.org/downloads/plme-01-01-sollid.pdf Related image for press use: http://www.plos.org/downloads/plme-01-01-sollid.jpg CONTACT: Ludvig Sollid University of Oslo Rikshospitalet Oslo, Norway +47-2307-3811 +47-2307-3510 (fax) lmsollid@labmed.uio.no ******************************************** Getting the Fluid Balance Right in Malaria Every year around a million people, mainly small children, die of malaria. Dehydration is thought to contribute to fatal cases of the disease and, hence, doctors often give fluids to treat very ill children. However, research published on October 19, 2004, in the new open access journal PLoS Medicine suggests that children with severe malaria may not be as badly dehydrated as was previously thought. "This challenges the view that dehydration is a major contributor to the pathology of this frequently lethal disease," says Nick White (Mahidol University, Thailand), who was not involved in the study. Until now, research efforts have been hampered because scientists did not have an easy way to assess the amount of fluid depletion in the body; ideally, scientists should be able to measure how much water is contained within the body's cells and how much water lies outside them. Sanjeev Krishna and colleagues from St George's Hospital Medical School, London, UK, have developed new techniques that allow these two volumes to be measured, along with the total body water. They used these techniques to measure fluid volumes in 35 children with moderate-to-severe malaria who lived in Gabon and found that none of the children were severely dehydrated. So, based on these data-obtained from a carefully studied, albeit small, group of children-what should people who treat children with malaria do? The researchers recommend that clinicians should think again about how vigorously they replace fluid in children with malaria, and suggest that if a doctor has access to ways of assessing fluid volume more precisely, they should do so (not a trivial undertaking in many hospitals where these children are treated). "The optimum resuscitation approach in severe childhood malaria remains to be defined," says White. "The relative advantages of blood, colloids, and crystalloids need to be characterized." Citation: Planche T, Onanga M, Schwenk A, Dzeing A, Borrmann S, et al. (2004) Assessment of Volume Depletion in Children with Malaria. PLoS Med 1 (1): e18. The published article will be accessible to your readers at: http://www.plosmedicine.org/perlserv/?request=getdocument&doi=10.1371/journal.pmed.0010018 Press-only preview of the article: http://www.plos.org/downloads/plme-01-01-krishna.pdf Related image for press use: http://www.plos.org/downloads/plme-01-01-krishna.jpg CONTACT: Sanjeev Krishna St. George's Hospital Medical School London, UK +44-(020)-8725-5836 +44-(020)-8725-3487 (fax) s.krishna@sghms.ac.uk ******************************************** THE FOLLOWING RESEARCH ARTICLES WILL ALSO BE PUBLISHED ONLINE: An Immune Basis for Lung Parenchymal Destruction in Chronic Obstructive Pulmonary Disease and Emphysema The underlying changes that cause smoking-related damage are unclear. This paper suggests that there is a skew towards increased T helper 1 lymphocytes, which may drive progression of this damage. Citation: Grumelli S, Corry D, Song L, Song L, Green L, et al. (2004) An Immune Basis for Lung Parenchymal Destruction in Chronic Obstructive Pulmonary Disease and Emphysema. PloS Med 1 (1): e8. The published article will be accessible to your readers at: http://www.plosmedicine.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0010008 Press-only preview of the article: http://www.plos.org/downloads/plme-01-01-kheradmand.pdf CONTACT: Farrah Kheradmand Baylor College of Medicine Houston, TX USA +1-713-798-8622 +1-713-798-3619 (fax) farrahk@bcm.tmc.edu ******************************************** Distribution of Major Health Risks: Findings from the Global Burden of Disease Study Analysis of 26 major global health risk factors by age, sex, exposure level, and epidemiological subregion reveals that many of them are widely spread in a population rather than restricted to a minority. Citation: Rodgers A, Ezzati M, Van der Hoorn S, Lopez A, Murray C et al. (2004) Distribution of Major Health Risks: Findings from the Global Burden of Disease Study. PLoS Med 1 (1): e27. The published article will be accessible to your readers at: http://www.plosmedicine.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0010027 Press-only preview of the article: http://www.plos.org/downloads/plme-01-01-rodgers.pdf CONTACT: Anthony Rodgers The University of Auckland Auckland, New Zealand +64-9-373-7967 +64-9-373-1710 (fax) a.rodgers@auckland.ac.nz ******************************************** HIGHLIGHTS FROM THE PLOS MEDICINE MAGAZINE SECTION: How Should the Health Community Respond to Violent Political Conflict? Violent political conflict is on the front pages again, in Iraq, Afghanistan, and Sudan. "Such violent political conflicts stir us-the global health community-to discover our own humanity amidst the bloodshed," says Anthony Zwi, a public health professor at the University of New South Wales, Sydney, Australia. Zwi discusses lessons that health professionals can learn from past conflicts in dealing with future ones. Citation: Zwi A (2004) How should the health community respond to violent political conflict? PLoS Med 1 (1): e14. The published article will be accessible to your readers at: http://www.plosmedicine.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0010014 Press-only preview of the article: http://www.plos.org/downloads/plme-01-01-zwi.pdf CONTACT: Anthony Zwi The University of New South Wales Sydney, Australia +61-(2)-9385-3811 +61-(2)-9313-6185 (fax) a.zwi@unsw.edu.au ******************************************** CDC Director Shares Vision for Tackling the HIV Pandemic Julie Gerberding makes a powerful plea to the global health community to expand its prevention and treatment efforts to bring the pandemic under control. "The real challenges," she says, "are delivering drugs in a safe and effective way, monitoring therapy, and sustaining the pipeline of drugs so that ongoing treatment can be guaranteed." Citation: Gerberding J (2004) Steps on the critical path: arresting HIV/AIDS in developing countries. PLoS Med 1 (1): e10. The published article will be accessible to your readers at: http://www.plosmedicine.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0010010 Press-only preview of the article: http://www.plos.org/downloads/plme-01-01-gerberding.pdf CONTACT: Julie Gerberding Centers for Disease Control and Prevention Atlanta, GA USA +1-404-639-7231 hhc7@cdc.gov ******************************************** From Pipeline to Patients: Developing New Drugs for Neglected Diseases In the poorest countries, over 350 million people are at risk from neglected diseases, like sleeping sickness and Chagas disease. Available treatments are inadequate or nonexistent. New solutions are urgently needed. Bernard Pécoul describes how the Drugs for Neglected Diseases Initiative (DNDi) is working to ensure that the advances of science that have brought comfort to the wealthy will also benefit the poor. "DNDi is a virtual organisation with a growing network of academic and research and development expertise at its disposal," says Pécoul. Citation: Pécoul B (2004) New drugs for neglected diseases: from pipeline to patients. PLoS Med 1 (1): e6. The published article will be accessible to your readers at: http://www.plosmedicine.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0010006 Press-only preview of the article: http://www.plos.org/downloads/plme-01-01-pecoul.pdf CONTACT: Bernard Pécoul Drugs for Neglected Diseases Initiative Geneva, Switzerland +41-(0)-22-906-9230 dndi@dndi.org ******************************************** Debate: Should Health Professionals Screen All Women for Domestic Violence? Domestic violence has serious health consequences, but experts are divided on the best way to tackle it. One suggestion is that every time a woman is seen by any health professional, the professional should ask her whether she is being abused. Is there enough research to prove that such screening would be helpful? Ann Taket, professor of primary care at London South Bank University, UK, says there is. Nadine Wathen and Harriet McMillan at McMaster University, Hamilton, Canada argue that screening may cause more harm than good. Citation: Taket A (2004) Should health professionals screen all women for domestic violence? PLoS Med 1 (1): e4. The published article will be accessible to your readers at: http://www.plosmedicine.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0010004 Press-only preview of the article: http://www.plos.org/downloads/plme-01-01-taket.pdf CONTACT: Ann Taket London South Bank University London, UK +44-(0)-20-7815-8097 +44-(0)-20-7815-8099 (fax) a.r.taket@lsbu.ac.uk Public Library Of Science |
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