Study reveals effective preventive dose, pain drug for tuberculosis treatment, bad news and new steps in Uganda . . . and more

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New approaches to disease treatment and prevention, as well as failures in old approaches are part of what we’re reading this week . . .
NIH-Funded analysis estimates effective PrEP dosing for men who have sex with men: An analysis of data from the iPrEx study looked at the amount of the antiretroviral medicine Truvada associated with reducing risk of acquiring HIV. The analysis found that participants needed to take Truvada at least four times a week to lower their risk of getting HIV by 90 percent, and that one pill daily would lower risk of getting the virus by 99 percent. The study’s authors warn, however, that their findings apply only to men who have sex with men, as the study could not examine how the results might vary with the route of HIV exposure.

Pain drug fights resistant tuberculosis: It sounds like the makings of a tabloid newspaper headline: “Scientists discover an inexpensive answer to a deadly disease in your medicine cabinet!” (or maybe your grandmother’s medicine cabinet — or your veterinarian’s, the drug in question is an old arthritis treatment more commonly used for animals now), but according to this study something like that appeared to happen when researchers looked at the effects of different drugs on tuberculosis. “Most were antiinfectives already known to kill Mtb,” the researchers wrote. “One active drug stood out because it fit none of those categories.” The anti-inflammatory drug oxyphenbutazone was used in the early 1950s, the authors note, but was eventually phased out with the introduction of similar drugs that were less toxic and less irritating to the gastrointestinal system. Oxyphenbutazone, however, continued to be available in regions “where cost governs access,” including, apparently to treat pain and fever from tuberculosis. The authors found reports of 84 patients who had been given  the drug, cleared evidence of tb bacteria in their sputum, gained weight faster and tolerated treatment better than similarly placed patients. The suggested advance against drug resistant tuberculosis remains hypothetical though, with obstacles preventing approval of the medicine being tested for tuberculosis treatment on humans, according to the Medical News Today article.

Questions in Uganda over governments ability to cut new HIV infections: Uganda’s official AIDS response strategy is long on words ( “. . . creating a sustainable enabling environment that mitigates the underlying structural drivers of the epidemic, re-engaging leadership and energizing coordination of HIV prevention . . .”) but short on results as HIV prevalence in the country climbs — from 6.4 percent to 7.3 percent of the population in the last 5 years — this Irin article says. While the government has blamed complacency and “risky behaviours,” the director of a local organization blames absence of effort to reach the populations hit hardest, including men who have sex with men, and people involved in sex work. In addition, sadly for a country once hailed for its response to the epidemic, lack of interest and investment on the government’s part is also mentioned.

Uganda goes for Option B+ for HIV positive pregnant women: While the story above looked at discouraging trends in Uganda, this story brings hope, with the government announcing it is launching efforts to provide “Option B+” which would make available antiretroviral treatment for life to pregnant HIV-positive women. The benefits of the option include continuity of treatment for the woman, prevention of viral transmission in future pregnancies, and the protection  from transmission full treatment provides for HIV-negative partners. Uganda had used an option geared only toward preventing transmitting the virus to the child, with antiretroviral drugs provided from the 14th week of pregnancy through a week after delivery. The adoption of the this strategy, introduced by first lady Janet Museveni, appears to herald new commitment to fighting the epidemic in this country, but the article cautions that financial challenges will slow availability of the option, and says that only 36 percent of the nation’s health facilities currently offer comprehensive services to prevent mother-to-child HIV transmission.

Obstacles to vaccine trial participation: The AIDS Vaccine 2012 conference earlier this week brought journalists from around the world to Boston where they gathered answers to the questions hanging over epidemics at home. This SciDev Net story by Ugandan journalist Esther Nakkazi looks at how women bearing the brunt of the epidemic also face challenge to participating in vaccine trials.

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