Initially founded to combat tuberculosis (TB) more than a century ago, the American Lung Association today urges Congress to act decisively to finally eliminate TB in America. The Comprehensive TB Elimination Act, S. 1551/HR 1532, now pending in the Congress, would propel the U.S. Public Health Service’s efforts and lead international work to eradicate the infection globally. It is imperative that our nation prepare for a potential outbreak because extensively drug-resistant (XDR-TB), which is very difficult to treat, has been identified in the U.S.

We stand on the brink of being able to eliminate TB in this country, but we are starving for new tools to effectively prevent, diagnose and treat TB to deal with a potential resurgence. Many older Americans remember when TB was rampant. Although treatment breakthroughs dramatically curtailed the disease in the U.S., TB continues to pose a threat to our public health; 10 to 15 million Americans are infected with latent TB. Worldwide, there were 9.2 million new cases of TB and 1.7 million deaths (approximately 4700 per day) from TB in 2006. Drug-resistant strains of TB are spreading globally, including extensively drug-resistant TB (XDR-TB), and raising concerns of a future epidemic of virtually untreatable TB.

Astonishingly, in our age of high-tech medicine, we use antiquated diagnostic methods that fail to adequately detect TB in children and those co-infected with HIV/AIDS. The newest class of anti-TB drugs is more than 40 years old. America’s commitment to TB has stalled at a time when we face critical threats.

The Comprehensive TB Elimination Act will: expand CDC-sponsored research on the safety and efficacy of new drugs, diagnostics and vaccines, and studies of populations at risk for TB; authorize and expand CDC demonstration activities on TB elimination, including targeted efforts to prevent, detect and treat the disease among Asian Americans and foreign-born persons in the U.S.; expand research, including study of the relationship between TB and HIV/AIDS, and research training programs at the NIH; and authorize funding for the “Blueprint Plan for TB Vaccine Development”.

As we mark World TB Day, the American Lung Association continues to fight for a high level of commitment and funding to protect Americans from TB. Congress and the President should move quickly to ensure the Comprehensive TB Elimination Act becomes law.

About the American Lung Association

Beginning our second century, the American Lung Association is the leading organization working to prevent lung disease and promote lung health. Lung disease death rates continue to increase while other leading causes of death have declined. The American Lung Association funds vital research on the causes of and treatments for lung disease. With the generous support of the public, the American Lung Association is “Improving life, one breath at a time.”

American Lung Association Continue reading →

The London Times on Monday examined a test that aims to identity the “best potential AIDS vaccine from among other less promising products.” According to the Times, early results from the test indicate that it can detect whether a vaccine candidate will stimulate an immune system response and if the response will actively fight HIV/AIDS. The test, developed by Imperial College London and the International AIDS Vaccine Initiative, is known as a viral inhibition assay. The Times reports that the test is being examined in a Phase I HIV/AIDS vaccine trial.

The test uses blood from HIV-negative people who have been injected with a vaccine candidate. Researchers then mix the blood samples with a live virus in a laboratory setting to determine whether the immune system response prevents HIV from replicating. Researchers hope that the test, which is one of several in development, can be used to examine vaccine candidates and select the most promising for large-scale trials. The project is being funded by a grant worth 40 million British pounds, or about $58 million, from the Department for International Development to IAVI.

Jill Gilmour, director of clinical research at IAVI, said that the method of testing mimics infection and immune response in the body and appears to be promising. “The proof of concept is there,” she said, adding, “We feel it’s pretty reliable. This is measuring something different to the current assays and arguably much more relevant. We believe it can be a key frontline strategy and that it is grounded in sound scientific hypothesis.” IAVI President Seth Berkley said, “If we are able to tease out what looks promising and what doesn’t, then we have a holy grail. At the moment you get to a point where it’s a ‘crapshoot’ as to what you take forward and what you don’t” (Lister, Times, 4/27).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

The authors of a Case Report in this week’s issue of The Lancet warn travellers about exposure to the rare chikungunya virus in Indian Ocean Islands.

Chikungunya virus is transmitted by mosquitoes and causes fever, joint and muscle pain, headache, and a rash. Symptoms appear 4-7 days after the infecting bite and although the disease is not usually life-threatening, 12% of patients have chronic joint pain three years after the onset of the disease. Between Jan 1, 2006 and March 2, 2006, 77 death certificates were issued in the Indian Ocean Islands, stating chikungunya virus as cause of death.

Researchers at the Medical Outpatient Clinic, University of Lausanne, Switzerland, were called on to advise the public whether to go on planned trips to the Indian Ocean Islands, after treating a woman with chikungunya virus in their institution. The woman, whose symptoms and treatment are detailed in the Case Report, had recently returned from a holiday in Mauritius.

Though the outbreak now seems to be decreasing, the authors advise travellers to take preventive measures against mosquito bites. They also recommend that vulnerable people, such as pregnant women, families with young children and people older than 70 years do not travel to the area at present. “We informed other patients about the magnitude of the risk of contracting the disease and let them decide according to their own judgement,” write Patrick Bodenmann and Blaise Genton (Medical Outpatient Clinic, University of Lausanne, Switzerland).

In an accompanying Comment, Devendra Mourya, of the National Institute of Virology in India, writes “the current outbreak seems to be more severe than previous outbreaks, because so many patients have developed complications and deaths have also been reported. The large population is at risk of the illness, especially travellers from the regions where this disease is not prevalent.”

###

Contact:
Dr Patrick Bodenmann
Medical Outpatient Clinic
Department of Community Medicine and Public Health
University of Lausanne, Switzerland
patrick.bodenmannhospvd.ch

Comment:
Dr Devendra Tarachand Mourya
Microbial Containment Complex
National Institute of Virology, Pune, India
mouryadtvsnl

Contact: Joe Santangelo

Lancet Continue reading →

The governing body of the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Programme Coordinating Board, met in Geneva from 21-23 June to review progress and put in place new measures to ensure greater efficiency and accountability in the AIDS response.

UNAIDS Executive Director, Michel Sidib?©, presented his progress report on the first day of the meeting in which he highlighted the successful outcome of the 2011 United Nations High Level Meeting on AIDS. He also stressed the significance of the adoption of a new Security Council Resolution on AIDS which addresses the link between violence against women and HIV in conflict and post conflict settings.

At the High Level Meeting on AIDS, UN Member States adopted a new Political Declaration on HIV/AIDS which sets bold new targets in responding to HIV. “This declaration has set the agenda for the future of the AIDS response and provided a roadmap for ending the epidemic,” said Mr Sidib?©.

During his speech the Executive Director of UNAIDS also outlined the need to reinforce the concept of shared responsibility in responding to AIDS, particularly at a time when international resources for AIDS are declining. “We need a new type of partnership, a new way to do business which will mean a shift away from donor dependence, towards country owned and country led responses,” he said.

The main item on the agenda of the 28th Meeting of UNAIDS’ Programme Coordinating Board was the Unified Budget, Results and Accountability Framework 2012-2015, which was unanimously endorsed by the Board. The Unified Budget, Results and Accountability Framework has been designed to improve the coherence, coordination and impact of the UN’s response to AIDS, to maximize the impact of the UNAIDS family at country level.

The Accountability Framework will ensure accountability in both programmatic results and in delivering value for money. The Board requested the UNAIDS Secretariat to produce annual reports on the implementation of the framework.

The meeting also included discussions on ensuring that food and nutrition security are integrated into HIV programming. The Board requested UNAIDS to review national AIDS strategies to identify gaps and needs in including food and nutrition and to implement an action plan to address the needs.

More than 300 participants and observers from UN Member States, international organizations, civil society and non-governmental organizations attended the meeting, which was chaired by El Salvador with Poland acting as vice chair and Egypt as rapporteur.

The UNAIDS Executive Director’s report to the Board, the decisions, recommendations and conclusions, and an overview of all documents presented at the 28th PCB can be found at: unaids

Source:

UNAIDS Continue reading →

It’s best known for whitening a load of laundry. But now simple household bleach has a surprising new role: an effective treatment for kids’ chronic eczema.

Chronic, severe eczema can mar a childhood. The skin disorder starts with red, itchy, inflamed skin that often becomes crusty and raw from scratching. The eczema disturbs kids’ sleep, alters their appearance and affects their concentration in school. The itching is so bad kids may break the skin from scratching and get chronic skin infections that are difficult to treat, especially from methicillin-resistant Staphylococcus aureus (MRSA).

Researchers from the Northwestern University Feinberg School of Medicine have discovered powerful relief in the form of diluted beach baths. It’s a cheap, simple and safe treatment that drastically improves the rash as well as reduces flare-ups of eczema, which affects 17 percent of school-age children.

The study found giving pediatric patients with moderate or severe eczema (atopic dermatitis) diluted bleach baths decreased signs of infection and improved the severity and extent of the eczema on their bodies. That translates into less scratching, fewer infections and a higher quality of life for these children.

The typical treatment of oral and topical antibiotics increases the risk of bacterial resistance, something doctors try to avoid, especially in children. Bleach kills the bacteria but doesn’t have the same risk of creating bacterial resistance.

Patients on the bleach baths had a reduction in eczema severity that was five times greater than those treated with placebos over one to three months, said Amy S. Paller, M.D., the Walter J. Hamlin Professor and chair of dermatology, and professor of pediatrics, at the Feinberg School. Paller also is an attending physician at Children’s Memorial Hospital.

The study was published in the journal Pediatrics April 27.

“We’ve long struggled with staphylococcal infections in patients with eczema,” Paller said. She noted more than two-thirds of eczema patients have evidence of staphylococcus on their skin, the bacteria that most commonly causes infection and worsens the eczema. “This study shows that simple household bleach, which we think decreases the staphylococcus on the skin, can help these children.”

In the study, Paller and researchers treated 31 pediatric patients (6 months to 17 years old) who had eczema and a bacterial staph infection for 14 days with oral antibiotics. Half of the patients received bleach in their bath water (half a cup per full standard tub), while the other half received a look-alike placebo. Patients were also instructed to put a topical antibiotic ointment or placebo control into their nose (where the staphylococcus can also grow) for five sequential days of each month. All were instructed to bathe in the bleach twice a week, and soak for five to 10 minutes for three months.

Paller said bathing in the diluted bleach bath water was surprisingly odor-free because of the small amount of bleach added. “In our clinics, no one had the just-out-of-the-swimming pool smell,” she said.

The research team saw such rapid improvement in the kids taking the real bleach baths that they terminated the study early because they wanted the children getting the placebo to get the same relief.

“The eczema kept getting better and better with the bleach baths and these baths prevented it from flaring again, which is an ongoing problem for these kids,” Paller said. “We presume the bleach has antibacterial properties and decreased the number of bacteria on the skin, which is one of the drivers of flares.”

Northwestern researchers launched the study to confirm their hunch about the potential of bleach baths, “since bleach has been used by hospitals in the past few years as a disinfectant to decrease MRSA,” Paller said.

One interesting finding in the study was the eczema on the body, arms and legs improved dramatically with the bleach baths, but the face, which was not submerged in the bath, did not improve, further evidence of the positive effect of the bath.

As a result of the study, Paller suggests that kids who have eczema on their face close their eyes and mouths and dunk under the water to help improve the lesions. In her practice, patients have found that even daily bleach baths are well tolerated. The bleach baths may also be useful for individuals with frequent staphylococcus infection, whether related to eczema or not, and in adults with eczema and recurrent infections.

To help treat a rising number of severe cases of eczema, Northwestern’s Feinberg School has recently opened an Eczema Care & Education Center (eczemacarecenter).

The new center offers patients one-on-one instruction for treating eczema, while a support group helps patients and their families cope with the emotional aspects of the disease.

“This is a disorder that can drive people crazy,” said Peter Lio, M.D., director of the Eczema Care & Education Center and an assistant professor of dermatology and of pediatrics at the Feinberg School. “Eczema beats people down.”

Lio said he just worked with an 11-year-old girl who had missed a half-year of school because of her severe eczema. “As we were working with her and demonstrating how to treat her skin, she started weeping,” he said. “Between the tears, she said ‘I’m crying because I know I’m going to get better.’ ”

Scientists believe eczema may be triggered by urban pollutants and toxins and/or allergies, and certainly shows a genetic tendency. “We don’t have all the answers and are still learning about this disease,” Lio said.

Source:
Marla Paul

Northwestern University Continue reading →

Novavax, Inc. (Nasdaq: NVAX) announced final selection of a Respiratory Syncytial Virus (RSV) vaccine candidate that will be advanced into additional preclinical studies to support an Investigational New Drug (IND) application. As previously announced, Novavax has been evaluating a number of RSV vaccine candidates, all of which have successfully induced antibody responses in mice. Novavax scientists have now engineered a new vaccine candidate which has been shown to protect mice against RSV disease and can be produced at sufficient yields to allow commercial manufacture. This new candidate is directed against a protein on the surface of the virus, the “F” or “fusion” protein, which is the protein that the virus uses to infect and fuse with cells in the respiratory tract and cause disease.

The new RSV-F vaccine candidate consists of novel three-dimensional particles containing the F protein. The structure of the F protein in these particles is identical to the configuration in which it exists on the surface of the native virus. The particle nature of the vaccine holds the promise for inducing a broad set of immune responses including antibody and cell mediated immune responses to prevent infection of the respiratory tract and attack respiratory cells that may already be infected with RSV.

The first preclinical study of this new vaccine candidate in mice showed that it induced production of antibodies that neutralized live RSV. In addition, the vaccine protected mice against replication of RSV in the lungs. The study included groups of mice that received two injections of RSV-F vaccine at doses of 1, 10, or 30 micrograms with and without adjuvant. The study showed that the RSV-F vaccine induced neutralizing antibody responses at all doses evaluated. The highest titers were observed with vaccine formulations that contained an aluminum-based adjuvant. Following vaccination, mice were exposed to live RSV through the nose. Even without adjuvant, the lowest dose (1.0 mcg) of RSV-F vaccine prevented RSV infection in the lungs of these mice. However, protection from RSV infection was not observed in unvaccinated mice. Based on these favorable pre-clinical data obtained with this RSV-F vaccine candidate and the ability to produce it at commercial yields, the Company has selected it for advanced preclinical development.

Today, the only therapy against RSV disease is a monoclonal F antibody. The antibody reduces RSV-related hospitalizations in infants and young children at high risk of severe disease. However, several injections are required and the lifespan of the antibody in the body has a limited duration. Therefore, a vaccine that induces long lasting protection against RSV-F would be highly desired by healthcare providers. There is currently no approved vaccine for the prevention of RSV and the market potential for such a vaccine could exceed $1 billion annually.

Dr. Penny Heaton, Chief Medical Officer and Vice President of Development at Novavax, stated: “A vaccine against the RSV-F protein is an ideal candidate to progress into advanced preclinical testing. Studies of the monoclonal RSV-F antibody show it protects against hospitalizations for severe RSV disease, suggesting that a vaccine which induces neutralizing antibody against RSV-F has the potential to be a powerful weapon against this disease.”

ABOUT RESPIRATORY SYNCYTIAL VIRUS

RSV is the most commonly identified cause of lower respiratory tract illnesses in infants and young children. Repeated infections occur throughout life causing moderate to severe cold-like symptoms. More severe lower respiratory tract disease is also seen in elderly adults over age 65 years similar to the severe illness witnessed in children. It is estimated that RSV infects more than 8.5 million adults annually, including the elderly over age 65 years. This virus is responsible for approximately 900,000 hospitalizations annually in the United States and major European countries. In the United States alone, RSV leads to 177,500 hospitalizations in high risk adults resulting in annual medicals costs exceeding $1 billion.

ABOUT NOVAVAX

Novavax, Inc. (Nasdaq: NVAX) is a clinical-stage biotechnology company creating novel vaccines, including H1N1, to address a broad range of infectious diseases worldwide using advanced proprietary virus-like-particle (VLP) technology. The company produces these VLP-based, potent, recombinant vaccines utilizing new and efficient manufacturing approaches.

Forward Looking Statement

Statements herein relating to future development results and performance, conditions or strategies and other matters, including expectations regarding product and clinical developments, are forward-looking statements within the meaning of the Private Securities Litigation Reform Act. Novavax cautions that these forward-looking statements are subject to numerous assumptions, risks and uncertainties, which change over time. Factors that may cause actual results to differ materially from the results discussed in the forward-looking statements or historical experience include risks relating to the early stage of Novavax’s product candidates under development; current results may not be predictive of future results; further testing is required before an IND may be filed with the FDA and human clinical trials can begin; uncertainties relating to clinical trials; results in human clinical trials may not be consistent with animal study results; dependence on the efforts of third parties; competition for clinical resources and patient enrollment from drug candidates in development by other companies with greater resources and visibility; and risks that we may lack the financial resources and access to capital to fund our operations including further preclinical work and clinical trials.

Source: Novavax, Inc Continue reading →

“Governor Signs Historic Bill to Address HIV/AIDS Within California’s Black Community,” City of Los Angeles AIDS Coordinator Office: California Gov. Arnold Schwarzenegger (R) late last month signed a bill (AB 1142) into law that aims to address the disproportionate impact of HIV/AIDS on the health of blacks in Los Angeles, the Inland Empire, the Sacramento area, San Diego and the San Francisco Bay Area. The law — which contains no funding and prohibits the use of state general funds for its implementation — requires a not-for-profit organization be set up by Jan. 1, 2008, to expand and coordinate a statewide prevention and services infrastructure to help support provider networks, as well as to coordinate research, data and funding services for HIV/AIDS-related issues concerning blacks (Los Angeles AIDS Coordinator Office release/Business Wire, 10/3).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

Researchers speaking in the first plenary session of the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) have offered insights into current and future HIV prevention research and discussed how biomedical developments over the past two years are beginning to shape debate on the future of HIV prevention policy.

The presentations reflect the breadth of expertise among the more than 5,000 researchers, clinicians and community leaders attending the conference, which runs from 17-20 July in Rome.

“We appear to be at a watershed in terms of HIV/AIDS science,” said IAS 2011 International Chair and International AIDS Society President, Elly Katabira. “It is a sign of how far the HIV/AIDS community has come in three decades that we are now beginning to discuss how to best combine traditional ways of preventing HIV such as condoms, needle exchange and testing with biomedical approaches such as a vaginal gel, early antiretroviral treatment and PrEP.”

“The developments in biomedical science over the past few years are very encouraging but at the same time only reinforce the need to maintain a robust HIV/AIDS research agenda,” said Stefano Vella, IAS 2011 Local Co-Chair and Research Director at the Istituto Superiore di Sanit?  (ISS).

The Changing Face of HIV Vaccine Research

In his plenary remarks, Gary Nabel, (United States) Director of the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases (NIAID) said that despite the fact that an AIDS vaccine posed an exceptional research challenge, and progress had been slow, two recent developments have renewed optimism for the prospects of a vaccine.

Firstly, though efficacy was modest, the RV144 efficacy trial conducted in Thailand provided a proof of concept that a vaccine can prevent HIV infection in humans. The fact that a vaccine can prevent infection rather than simply controlling viremia has significant implications for its potential public health impact.

Secondly, it has become clear that broadly neutralizing antibodies are made in a substantial number of HIV-1 infected subjects (10-25%). Exceptionally, broadly neutralizing antibodies have been derived from these subjects by several groups in the past year. Using structure-based rational vaccine design, Nabel and his team at the Vaccine Research Center identified a human antibody, termed VRC01, which neutralizes more than 90% of naturally circulating viruses. This antibody recognized the highly conserved CD4bs of the viral envelop required for entry.

The molecular details of how this antibody recognizes the virus have been discovered, and researchers have identified a class of antibodies with related properties. With this knowledge, it has been possible to trace how these antibodies are generated in humans. These advances provide critical insight into the design of an AIDS vaccine and open the door to new immune prevention strategies.

Nabel concluded by saying that the urgency for an effective AIDS vaccine has never been greater, and that it will become increasingly difficult to conduct efficacy trials in the future. By taking advantage of the recent scientific advances and coupling them with efficient clinical trial designs, the search for an effective AIDS vaccine can and must be accelerated.

Managing HIV Treatment in 2011

Giovanni Di Perri (Italy), from the School of Medicine, University of Turin, discussed how a number of high-standard clinical trials have put in a place a hierarchy of therapeutic solutions available today. Consequently, this has given the actual impression that no dramatic changes will take place in the near future.

Although the currently available therapeutic guidelines indicate that the management of HIV infection would appear straightforward, Di Perri pointed out that in the real world a series of variables (often at an individual level) frequently require the adoption of non-conventional drug combinations.

Variables such as tolerability and /or toxicity together with the increasing pressure on cost reduction are driving discussion around the clinical use of alternative therapeutic regimens.

These regimes have not been fully validated by adequately sized (statistically powered) and designed clinical trials. Nevertheless, the applied knowledge of some specific pharmacologic properties of antiretrovirals – as well as a closer consideration of single patient profiles (including pharmacogenomics) — might help to better tailor antiretroviral therapy at the individual level, an intention fully justified by the need of lifelong therapy.

The Combined Approach to Preventing HIV Infection

Robin Shattock, (United Kingdom), Professor of Mucosal Infection and Immunity at Imperial College in London, argued that the time is now right to consider a combination of biomedical and non-biomedical strategies to prevent HIV infection.

Combinations of non-biomedical strategies aimed at individual behavioral change and community intervention to reduce HIV risk and vulnerability have been applied for nearly three decades, with differing success. These include sexually transmitted infection (STIs) diagnosis and treatment, HIV education and knowledge of HIV serostatus, condom social marketing, rights-based behavioural change, prevention of mother-to-child transmission, needle exchange, blood safety, infection control in healthcare, and legal protection for people living with HIV.

However, a number of new biomedical tools (or prevention technologies) have demonstrated variable success in randomized controlled trials (RCT) including:
medical male circumcision (MMC) (57%);
daily oral tenofovir (TDF) plus emtricitabine (FTC) used as pre-exposure prophylaxis (oral-PrEP) by HIV-negative men who have sex with men (MSM) (iPrEX study) (44%);
1% tenofovir gel (microbicide) applied vaginally before and after sex by HIV-negative women as topical pre-exposure prophylaxis (CAPRISA 004 study) (39%);
a prime-boost HIV vaccine regimen(RV144 study) (31% effectiveness);
early use of antiretroviral treatment (ART) (treatment for prevention (T4P)) by an HIV-infected individual has been shown to reduced heterosexual transmission to an uninfected partner by 96% (HPTN052)

Approaches that could be studied now include focused assessment of medical male circumcision combined with microbicide gels for men’s female partners. A second combination to evaluate would be T4P for the infected partner combined with antiretroviral (ARV) PrEP for the HIV-negative partner. At least 18% of sexual transmissions in the HPTN052 trial may have been acquired from partners outside the primary relationship. Thus the offer of ARV PrEP for the HIV-negative partner together with T4P for the infected partner may provide a more cost-effective option per infection averted.

Source:
Lindsey Rodger

IAS 2011 Continue reading →

All works published in PLoS Medicine are open access. Everything is immediately available without cost to anyone, anywhere to read, download, redistribute, include in databases, and otherwise use subject only to the condition that the original authorship is properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License.

Association of Tuberculosis with smoking and indoor air pollution

Smokers have an increased risk of tuberculosis (TB) infection, TB disease, and of dying from TB compared to people who do not smoke.

A new study from Hsien-Ho Lin and colleagues at Harvard School of Public Health reviewed the published evidence for an association between tobacco smoking, passive smoking, and indoor air pollution from fuels such as wood and charcoal and the risk of infection, disease, and death from TB. Among hundreds of reports from electronic databases, the authors reviewed 33 eligible papers on tobacco smoking and TB, five papers on passive smoking and TB, and five on indoor air pollution and TB.

The researchers separately assessed different aspects of TB risk: TB infection as measured by a positive tuberculin skin test, TB disease, and mortality from TB. They found an approximately 2-fold increase in risk of TB infection among smokers as compared with nonsmokers. The great majority of studies evaluating the link between active smoking and TB disease or TB mortality also showed an association, but these data could not be combined together because of wide potential differences between the studies. In addition, there was some association of TB with passive smoking, and also with indoor air pollution, though the evidence for these associations was more limited, and will need to be confirmed by further work.

The authors conclude that “TB control programs might benefit from a focus on interventions aimed at reducing tobacco and indoor air pollution exposures, especially among those at high risk for exposure to TB”.

Citation: Lin H, Ezzati M, Murray M (2007) Tobacco smoke, indoor air pollution and tuberculosis: A systematic review and meta-analysis. PLoS Med 4(1): e20.

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An innovative treatment for HIV patients developed by McGill University Health Centre researchers has passed its first clinical trial with flying colours. The new approach is an immunotherapy customized for each individual patient, and was developed by Dr. J-P. Routy from the Research Institute of the MUHC in collaboration with Dr. R. S?©kaly from the Universit?© de Montr?©al. “This is a vaccine made for the individual patient – an “haute couture” therapy, instead of an off-the-rack treatment” said Dr Routy.

By “priming” the immune system, as with a vaccine, to fight the specific strain of HIV/AIDS infecting a given patient, the scientists believe they have developed a therapy that shows immense promise and could be an even more effective weapon against the virus than the anti-retroviral cocktails currently in use. The results of the first-stage clinical trials, which tested the therapy in conjunction with anti-retroviral drugs, were published recently in Clinical Immunology. Phase 2 of the clinical trial, which is nearly complete, is testing the therapy’s efficacy on its own at 8 different sites in Canada.

The new therapy uses dendritic cells which are removed from each HIV-infected patient and subsequently multiplied in-vitro. Dendritic cells present material from invading viruses on their surface, allowing the rest of the immune system to identify and attack the invaders. “They are the “grand conductors” of the immune response,” explains Dr Routy. “With them, you push the immune system, in all its functions, at the same time.” In the current trial, dendritic cells were exposed to a sample of HIV RNA (ribonucleic acid) specific to the patient involved. This exposure encouraged the cells to develop defences specific to that viral strain. The modified cells – called AGS-004 – were then injected back into the patients.

Not only were there few reported side-effects from the AGS-004, but the researchers also measured increased levels of CD8-lymphocytes in the patients – the “attack” cells of the human immune system that the treatment is intended to mobilize, thus confirming that the intervention was targeted and controlled.

By boosting the immune system in this way, Routy hopes to develop an HIV/AIDS treatment that will require fewer injections and less long-term toxicity for patients than antriretrovirals.

Dr. Jean-Pierre Routy is a practitioner in the Division of Hematology at the MUHC as well as a researcher in the Infection and Immunity Axis at the Research Institute of the MUHC. He is also an Associate Professor of Hematology at McGill University in addition to a senior clinical researcher with the Fonds de la Recherche en Sant?© du Qu?©bec (FRSQ).

Funding: This study was funded by a grant from the Canadian Network for Vaccines and Immunotherapeutics (CANVAC), the Canadian HIV Trials Network (CTN), the National Institutes of Health (NIH) and Argos Therapeutics.

Partners: This article was co-authored by Rafick-Pierre S?©kaly, Universit?© de Montr?©al, Mohamed-Rachid Boulassel of the McGill University Health Centre (MUHC), Bader Yassine-Diab and Oleg Yegorov of the Universit?© de Montr?©al and Centre Hospitalier de l’Universit?© de Montr?©al (CHUM), Lothar Finke, Don Healey, Renu Jain, Tamara Monesmith ,Charles Nicolette and Irina Tcherepanova of Argos Therapeutics, In, Durham, USA.

Source: Julie Robert

McGill University Health Centre Continue reading →