AIDSTruth.org - New research

Ethics of science communication on the web

AIDSTruth — Thu, 11 Dec 2008 20:22:54 +0000

The internet is a powerful medium for information dissemination. But since it is also unregulated, much disinformation, including AIDS denialism is spread on the web. Maxine Clarke's recent article on the ethics of science publishing on the web is therefore highly topical. It is included in a special theme section on the ethics of science journalism being built by the journal Ethics in Science and Environmental Politics.

Clarke, M. Ethics of science communication on the web.

ABSTRACT: Scientists have evolved a unit of communication to describe their new results and findings: the peer-reviewed scientific paper. The internet is full of erroneous and even dangerous information that is difficult for people without a scientific education or training to interpret in context, particularly given the uncertainties inherent in the scientific process. Those interpreting science for the public, whether journalists, educators or other communicators, should use peer review as a benchmark.

KEY WORDS: Publishing · Science · Peer review · Internet · Research

Download the paper.

New study confirms that AIDS denialism caused more than 330 000 deaths in South Africa

AIDSTruth — Thu, 27 Nov 2008 22:30:12 +0000

Thabo Mbeki: Let hundreds of thousands of his people die while president of South AfricaA new study published in the Journal of AIDS has confirmed earlier estimates by AIDSTruth contributor Nicoli Nattrass that hundreds of thousands AIDS deaths could have been averted by timeous roll-out of antiretroviral therapy in South Africa. The new study by Chigwedere et al. used a model to estimate that more than 330,000 lives or approximately 2.2 million person-years were lost because a feasible and timely ARV treatment program was not implemented in South Africa. Thirty-five thousand babies were born with HIV, resulting in 1.6 million person-years lost by not implementing a mother-to-child transmission prophylaxis program using nevirapine. The total lost benefits of ARVs are at least 3.8 million person-years for the period 2000-2005. This confirms Nattrass's earlier estimates using the ASSA2003 demographic model, which suggested that if the national government had used ARVs for prevention and treatment at the same rate as the Western Cape (which defied national policy on ARVs), then about 171,000 HIV infections and 343,000 deaths could have been prevented between 1999 and 2007. The Guardian and New York times report on the new study.

Nattrass, N. AIDS and the Scientific Governance of Medicine in Post-Apartheid South Africa. African Affairs 2008 107(427):157-176.

Chigwedere, P. et al. Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes. 49(4):410-415, December 1, 2008.

New papers of interest

Eduard Grebe — Mon, 06 Oct 2008 09:30:54 +0000

These papers are of interest:

Risk of death for people with HIV now similar to that seen in the general population

AIDSTruth — Fri, 04 Jul 2008 07:35:55 +0000

Thanks to improving anti-HIV treatment, people with HIV, in the first five years after diagnosis with HIV, now have mortality rates similar to those seen in the general population, according to a large European study published in the July 2nd edition of the Journal of the American Medical Association. Aidsmap has a story on the study.

Changes in the Risk of Death After HIV Seroconversion Compared With Mortality in the General Population

Krishnan Bhaskaran, MSc; Osamah Hamouda, MD; Mette Sannes, MLabTech; Faroudy Boufassa, MD; Anne M. Johnson, MD; Paul C. Lambert, PhD; Kholoud Porter, PhD; for the CASCADE Collaboration

JAMA. 2008;300(1):51-59.

Abstract

Context Mortality among human immunodeficiency virus (HIV)–infected individuals has decreased dramatically in countries with good access to treatment and may now be close to mortality in the general uninfected population.

Objective To evaluate changes in the mortality gap between HIV-infected individuals and the general uninfected population.

Design, Setting, and Population Mortality following HIV seroconversion in a large multinational collaboration of HIV seroconverter cohorts (CASCADE) was compared with expected mortality, calculated by applying general population death rates matched on demographic factors. A Poisson-based model adjusted for duration of infection was constructed to assess changes over calendar time in the excess mortality among HIV-infected individuals. Data pooled in September 2007 were analyzed in March 2008, covering years at risk 1981-2006.

Main Outcome Measure Excess mortality among HIV-infected individuals compared with that of the general uninfected population.

Results Of 16 534 individuals with median duration of follow-up of 6.3 years (range, 1 day to 23.8 years), 2571 died, compared with 235 deaths expected in an equivalent general population cohort. The excess mortality rate (per 1000 person-years) decreased from 40.8 (95% confidence interval [CI], 38.5-43.0; 1275.9 excess deaths in 31 302 person-years) before the introduction of highly active antiretroviral therapy (pre-1996) to 6.1 (95% CI, 4.8-7.4; 89.6 excess deaths in 14 703 person-years) in 2004-2006 (adjusted excess hazard ratio, 0.05 [95% CI, 0.03-0.09] for 2004-2006 vs pre-1996). By 2004-2006, no excess mortality was observed in the first 5 years following HIV seroconversion among those infected sexually, though a cumulative excess probability of death remained over the longer term (4.8% [95% CI, 2.5%-8.6%] in the first 10 years among those aged 15-24 years).

Conclusions Mortality rates for HIV-infected persons have become much closer to general mortality rates since the introduction of highly active antiretroviral therapy. In industrialized countries, persons infected sexually with HIV now appear to experience mortality rates similar to those of the general population in the first 5 years following infection, though a mortality excess remains as duration of HIV infection lengthens.

Antiretroviral use increases survival sixfold in Thai patients with HIV and TB

Eduard Grebe — Fri, 27 Jun 2008 16:00:21 +0000

In Thailand, people co-infected with HIV and tuberculosis who receive antiretroviral therapy are six times as likely to survive as those who do not, according to a study reported in the June 1st issue of the Journal of Acquired Immune Deficiency Syndromes. See Aidsmap's report on the study.

Antiretroviral therapy for HIV-infected tuberculosis patients saves lives but needs to be used more frequently in Thailand.

Sanguanwongse N, Cain KP, Suriya P, Nateniyom S, Yamada N, Wattanaamornkiat W, Sumnapan S, Sattayawuthipong W, Kaewsa-ard S, Ingkaseth S, Varma JK.

INTRODUCTION: The impact of antiretroviral therapy (ART) on HIV-infected tuberculosis (TB) patients in public health programs in resource-limited settings is not well documented due to problems with statistical bias in observational studies. METHODS: We measured the impact of ART on survival of HIV-infected TB patients in Thailand using a propensity score analysis that adjusted for factors associated with receiving ART. RESULTS: Of 626 HIV-infected TB patients started on ART during TB treatment, 68 (11%) died compared with 295/643 (46%) of patients not prescribed ART (relative risk 0.24, 95% confidence interval: 0.19 to 0.30); in patients with very low CD4 (<10), 12/56 (21%) patients receiving ART died compared with 35/43 (81%) patients not receiving ART (relative risk 0.26, 95% confidence interval: 0.16 to 0.44). Patients treated in the private sector and in rural areas were less commonly prescribed ART. After controlling for propensity to receive ART, the hazard ratio for death among patients treated with ART was 0.17 (95% confidence interval: 0.12 to 0.24). DISCUSSION: Patients who received ART had one sixth the risk of death of those not receiving ART. The survival benefit persisted even for those with a very low CD4 count. Expanding use of ART in HIV-infected TB patients will require increasing ART use in the private sector and rural areas.

PMID: 18520676

New study shows no relationship between substance abuse and immune health

AIDSTruth — Mon, 16 Jun 2008 17:34:39 +0000

Recreational drug use and T lymphocyte subpopulations in HIV-uninfected and HIV-infected men.

Chao C, Jacobson LP, Tashkin D, Martínez-Maza O, Roth MD, Margolick JB, Chmiel JS, Rinaldo C, Zhang ZF, Detels R.

The effects of recreational drugs on CD4 and CD8 T cells in humans are not well understood. We conducted a longitudinal analysis of men who have sex with men (MSM) enrolled in the Multicenter AIDS Cohort Study (MACS) to define associations between self-reported use of marijuana, cocaine, poppers and amphetamines, and CD4 and CD8 T cell parameters in both HIV-uninfected and HIV-infected MSM. For the HIV-infected MSM, we used clinical and laboratory data collected semiannually before 1996 to avoid potential effects of antiretroviral treatment. A regression model that allowed random intercepts and slopes as well as autoregressive covariance structure for within subject errors was used. Potential confounders adjusted for included length of follow-up, demographics, tobacco smoking, alcohol use, risky sexual behaviors, history of sexually transmitted infections, and antiviral therapy. We found no clinically meaningful associations between use of marijuana, cocaine, poppers, or amphetamines and CD4 and CD8 T cell counts, percentages, or rates of change in either HIV-uninfected or -infected men. The regression coefficients were of minimum magnitude despite some reaching statistical significance. No threshold effect was detected for frequent (at least weekly) or continuous substance use in the previous year. These results indicate that use of these substances does not adversely affect the numbers and percentages of circulating CD4 or CD8 T cells in either HIV-uninfected or -infected MSM.

PMID: 18180115 [PubMed - in process]

Ugandan study shows 95% reduction in mortality with ART and co-trimoxazole prophilaxis

AIDSTruth — Wed, 21 May 2008 12:15:51 +0000

Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study.
doi:10.1016/S0140-6736(08)60345-1

Mermin J, Were W, Ekwaru JP, Moore D, Downing R, Behumbiize P, Lule JR, Coutinho A, Tappero J, Bunnell R.

BACKGROUND: Antiretroviral therapy (ART) is increasingly available in Africa, but physicians and clinical services are few. We therefore assessed the effect of a home-based ART programme in Uganda on mortality, hospital admissions, and orphanhood in people with HIV-1 and their household members.

METHODS: In 2001, we enrolled and followed up 466 HIV-infected adults and 1481 HIV-uninfected household members in a prospective cohort study. After 5 months, we provided daily co-trimoxazole (160 mg trimethoprim and 800 mg sulfamethoxazole) prophylaxis to HIV-infected participants. Between May, 2003, and December, 2005, we followed up 138 infected adults who were eligible and 907 new HIV-infected participants and their HIV-negative household members in a study of ART (mainly stavudine, lamivudine, and nevirapine). Households were visited every week by lay providers, and no clinic visits were scheduled after enrolment. We compared rates of death, hospitalisation, and orphanhood during different study periods and calculated the number needed to treat to prevent an outcome. FINDINGS: 233 (17%) of 1373 participants with HIV and 40 (1%) of 4601 HIV-uninfected household members died. During the first 16 weeks of ART and co-trimoxazole, mortality in HIV-infected participants was 55% lower than that during co-trimoxazole alone (14 vs 16 deaths per 100 person-years; adjusted hazard ratio 0.45, 95% CI 0.27-0.74, p=0.0018), and after 16 weeks, was reduced by 92% (3 vs 16 deaths per 100 person-years; 0.08, 0.06-0.13, p<0.0001). Compared with no intervention, ART and co-trimoxazole were associated with a 95% reduction in mortality in HIV-infected participants (5 vs 27 deaths per 100 person-years; 0.05, 0.03-0.08, p<0.0001), 81% reduction in mortality in their uninfected children younger than 10 years (0.2 vs 1.2 deaths per 100 person-years; 0.19, 0.06-0.59, p=0.004), and a 93% estimated reduction in orphanhood (0.9 vs 12.8 per 100 person-years of adults treated; 0.07, 0.04-0.13, p<0.0001). INTERPRETATION: Expansion of access to ART and co-trimoxazole prophylaxis could substantially reduce mortality and orphanhood among adults with HIV and their families living in resource-poor settings.

PMID: 18313504 Full-text

New research on early HAART published in New England Journal of Medicine

AIDSTruth — Sat, 17 May 2008 21:40:47 +0000

Riddler SA, Haubrich R, DiRienzo AG, Peeples L, Powderly WG, Klingman KL, Garren KW, George T, Rooney JF, Brizz B, Lalloo UG, Murphy RL, Swindells S, Havlir D, Mellors JW; AIDS Clinical Trials Group Study A5142 Team. 2008. Class-sparing regimens for initial treatment of HIV-1 infection. N Engl J Med 358, 2095-2106. PMID: 18480202

Hirschel B, Calmy A. 2008. Initial treatment for HIV infection -- An embarrassment of riches. N Engl J Med 358, 2170-2172. PMID: 18480210

Study confirms reduced mortality in Malawi after introduction of antiretroviral therapy

AIDSTruth — Fri, 09 May 2008 23:06:22 +0000

A study published today in The Lancet shows evidence of reversal in population-level effect of HIV on adult mortality.

Jahn et al. 2008. Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi. The Lancet 371, 1603-1611. DOI:10.1016/S0140-6736(08)60693-5

From the abstract:

Our findings of a reduction in mortality in adults aged between 15 and 59 years, with no change in those older than 60 years, suggests that deaths from AIDS were averted by the rapid scale-up of free antiretroviral therapy in rural Malawi, which led to a decline in adult mortality that was detectable at the population level.

Appropriate interventions reduce mother-to-child transmission of HIV in the UK and Ireland

AIDSTruth — Wed, 07 May 2008 16:11:14 +0000

A new study published in the journal AIDS shows that transmission rates have been reduced through appropriate interventions in the UK and Ireland.

Townsend at al. AIDS. 22(8):973-981, May 11, 2008. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006.

A good report on the study at aidsmap.