H.I.V. Is Spreading in New York City at Three Times the National Rate, a Study Finds

By SEWELL CHAN
31 aug 2008--The virus that causes AIDS is spreading in New York City at three times the national rate — an incidence of 72 new infections for every 100,000 people, compared with 23 per 100,000 nationally — according to a study released on Wednesday by the city’s Department of Health and Mental Hygiene.
The findings, based on a new formula developed by the federal Centers for Disease Control and Prevention, estimated that 4,762 New Yorkers contracted H.I.V. in 2006, the most precise estimate the city had ever offered.
But the city stressed that because the method of estimating infections was new, it could not be said definitively whether the number of new infections in the city had increased or decreased from previous years.
Blacks, and men who have sex with other men, are the groups at greatest risk of contracting H.I.V., the study found. A summary of the new data:
¶Men accounted for 76 percent of new H.I.V. infections and women for 25 percent. (The figures exceed 100 percent because of rounding.)
¶Blacks made up 46 percent of the newly infected; Hispanics, 32 percent; and whites, 21 percent. (Figures for other racial or ethnic groups were not provided.)
¶Those under age 20 made up 4 percent of the newly infected; those 20 to 29 years old, 24 percent; those 30 to 39 years old, 29 percent; those 40 to 49 years old, 29 percent; and those 50 and older, 15 percent.
¶Sex between men was the main cause in 50 percent of new infections; high-risk heterosexual sex in 22 percent; intravenous drug use in 8 percent; and unknown or uncertain causes in 18 percent.
Manhattan accounted for 35 percent of new infections; Brooklyn, 26 percent; the Bronx, 19 percent; and Queens, 17 percent.
As the health department has repeatedly noted, gay minority men were particularly at risk. For example, of new H.I.V. infections among men under age 30 who have sex with men, 77 percent were in black or Hispanic men, as were 59 percent of new H.I.V. infections among men ages 30 to 50 who have sex with men.
Over all, the study found some interesting differences between national and local rates of new H.I.V. infections.
Nearly two-thirds of the city’s new infections occurred in people 30 to 50 years old. Nationally, people under 30 accounted for 41 percent of new infections, compared with 28 percent in New York City.
Also, within New York City, whites were infected at four times the national rate, Hispanics at three times the national rate, and blacks at almost twice the national rate.
The health department said in a news release:
“The analytic technique is new, and the estimates may be imprecise, but even a rough gauge of H.I.V. incidence is a valuable tool for understanding — and combating — the spread of H.I.V. The health department’s new estimate includes 2006 incidence figures for different age groups, racial groups and both genders. By repeating the exercise for subsequent years, researchers may be able to discern increases and decreases over time, and target their prevention efforts accordingly.”
Over the past year, the health department has warned that H.I.V. infections among young gay men have risen and that unsafe sex remains common.

HIV/AIDS Diagnoses Rising from Male-Male Sex


By Michael Smith
ATLANTA, 27 JUNE 2008-- The number of HIV/AIDS diagnoses among men who have sex with men grew 8.6% from 2001 through 2006, the CDC said today. Over the same period, there were significant declines (P<0.05) in new diagnoses in all other risk categories, the agency said in the June 27 issue of Morbidity and Mortality Weekly Report. The finding -- released on National HIV Testing Day -- came from an analysis of trends in the 33 states that have had confidential, name-based HIV case reporting since at least 2001, the agency said.
At the same time, New York announced a three-year plan to test all adults in the Bronx, which has the highest rate of AIDS deaths of the city's five boroughs.
The CDC said that in the 33 states, the estimated average annual percentage increase in new diagnoses among men who have sex with men was 1.5%.
In contrast, new diagnoses among injection drug users fell by an estimated 9.5% annually, while those among people with high-risk heterosexual contact fell by an estimated 4.4% a year.
Among men who have sex with men who were also injection drug users -- treated by the agency as a separate category from MSM -- the annual percentage decrease was 5.2%.
Among men who have sex with men, the increase in diagnoses was more marked in men ages 13 to 24 of all racial/ethnic groups and in black men, the agency said:
The number of HIV/AIDS diagnoses among all black men who have sex with men was 12.4% over the six-year period, for an estimated annual percentage change of 1.9%.
But for black men who have sex with men ages 13 through 24, the increase was 93.1%, with an estimated annual percentage change of 14.9%.
There were 7,658 diagnoses in black men who have sex with men ages 13 through 24, compared with 3,221 in their white counterparts.
The agency pointed out that the 33-state case surveillance data are not representative of all HIV-positive people in the U.S., and added that an estimated 25% of all HIV-positive people have not yet been diagnosed.
National HIV Testing Day "focuses on the importance" of people knowing their HIV infection status, the agency said, adding that getting a diagnosis is the first step to getting treatment.
In New York, city officials said their plan to test all adults in the 1.3-million-population Bronx will require making HIV tests a part of routine medical care.
"Routine would mean if you came into the emergency room for asthma or a broken leg, we test everyone for HIV, if they're willing," city health commissioner Thomas Frieden, M.D., told the New York Times.
The city estimated that 40% of the 830,000 Bronx residents ages 18 to 64 have been tested in the past year and another 250,000 people who have never been tested would be targeted for early testing.
The city plans to offer tests at about 40 clinics, community centers, churches and emergency rooms and will cover the $12 cost of each test, city officials said.
In New York, the rate of AIDS cases is 82 per 100,000 people in Manhattan, compared with 75 in the Bronx, 46 in Brooklyn, 26 in Queens, and 16 on Staten Island.
But 37 people die annually from AIDS for every 100,000 people in the Bronx, compared with 21 for Manhattan, 19 for Brooklyn, eight for Staten Island, and six for Queens.
The higher death rate in the Bronx was attributed to the relative poverty of the population, which may tend to delay testing until later in the process.
One obstacle to wider testing has been New York State's strict consent laws, which doctors have viewed as too onerous for settings such as emergency rooms.
For this push, doctors will be using a script that follows state law but squeezes the consent process into five minutes, according to Donna Futterman, M.D., of Montefiore Medical Center, who developed the script.
An experienced physician can deliver the script in three minutes, Dr. Futterman told the Times, and her own record is one minute.
Additional source: Morbidity and Mortality Weekly ReportSource reference: Centers for Disease Control and Prevention "Trends in HIV/AIDS diagnoses among men who have sex with men -- 33 States, 2001-2006." MMWR 2008; 57: 681-686.

HIV Tests Cost-Effective for Some Seniors

By Randy Dotinga
WEDNESDAY, 19 june 2008-- While older adults may seem the least likely group of Americans to become infected with HIV, a new study suggests it would be cost-effective for doctors to routinely give AIDS tests to some sexually active people in their 60s and 70s.
In fact, an HIV diagnosis and subsequent treatment could potentially add an average of six to nine months to an older person's life, said study co-author Dr. Douglas K. Owens.
"Just because you have someone who's older doesn't mean you shouldn't think about HIV and HIV screening," said Owens, a senior investigator at the VA Palo Alto Health Care System in California and professor of medicine at Stanford University.
Older Americans have been largely overlooked throughout the years of the AIDS epidemic, although they are hardly immune. The federal government only recommends routine HIV testing up until the age of 64.
Still, an estimated 20 percent of HIV patients are older than 50, Owens said. And research with older veterans has suggested that as many as one in 200 is infected with the virus that causes AIDS, he said.
The AIDS threat facing older Americans is often ignored, because "people find it difficult to imagine their parents and grandparents being sexually active," said Rowena Johnston, vice president of research with the Foundation for AIDS Research.
For the new study, published in the June 17 issue of the Annals of Internal Medicine, Owens and his colleagues created a mathematical formula to determine the costs and benefits of routinely testing people aged 55 to 75.
The researchers found that it's cost-effective to test people in that age group if the prevalence of undiagnosed HIV infection is greater than 1 in 1,000 and those being tested have sexual partners at risk of infection.
They reported it may cost $30,000 in tests to lengthen a sexually active 65-year-old person's life by something known as a "quality-adjusted life year," a complicated measurement that takes into account the difficulty of life during illness. On average, diagnosing a 65-year-old with HIV instead of allowing him to remain untreated could lengthen his life by six to nine months, Owens said.
"That's actually a lot. That's a pretty big change," he said. "Many of the interventions we do change life expectancy by a week, a few weeks, maybe a month."
AIDS tests typically cost from $10 to $70, Owens said.
Johnston said doctors with older patients "should to be aware they may be carrying their own biases. It's worth taking into account the person's sexual history and whether they have risk factors."
Still, some observers may question the study's assumption that more than one in 1,000 older adults have HIV and are undiagnosed, said Frank Myers, director of clinical epidemiology and safety systems at Scripps Mercy Hospital in San Diego.
"This study, with its assumptions of HIV prevalence, will not be enough to change HIV screening recommendations by itself," Myers said. But, he added, he hopes the research will motivate health-care providers to ask patients about HIV risk factors and target them with messages about prevention.

China: Rise in AIDS and Syphilis

China disclosed a large percentage rise for 2007 in diseases transmitted sexually or via blood, including AIDS and syphilis, without reporting exact figures. The number of new AIDS cases rose 45 percent in 2007 from the year before and new syphilis cases rose 24 percent, the Health Ministry said on its Web site. It did not elaborate. China has been battling an acknowledged rise in cases of AIDS and H.I.V., the virus that causes AIDS, now mainly sexually transmitted, though it had said before that the overall rate was slowing. In the past, most cases were caused by intravenous drug use. The government said last year that it estimated that about 700,000 people had H.I.V. or AIDS.

Depression Depresses HIV Treatment Response

By Michael Smith
OAKLAND, Calif., Dec. 21 -- More than four in every 10 HIV patients are clinically depressed, a condition that affects how well they respond to anti-HIV drugs, researchers here found.
The good news, however, is that treatment with selective serotonin reuptake inhibitors (SSRIs) appears to restore the benefit of highly active antiretroviral therapy (HAART), according to Michael Horberg, M.D., director of HIV/AIDS for Kaiser Permanente.
In a retrospective analysis of a cohort of 3,359 HIV patients, 42% also had a diagnosis of depression and 36% of those were using SSRIs, Dr. Horberg and colleagues reported online in the Journal of Acquired Immune Deficiency Syndromes.
"The take-home point here is that there is a very high prevalence of depression among HIV patients," Dr. Horberg said.
"All HIV patients should be screened for depression," he said, and if it's found, "treatment for depression -- not just with SSRIs -- should be considered concomitantly, because one helps the other."
The researchers analyzed health records of HIV patients in eight states, enrolled in the Kaiser Permanente and Group Health Cooperative HMOs, who began a new HAART regimen from January 2000 through December 2003.
Of the 3,359 patients who met the criteria, 1,961 had not been diagnosed with depression and served as a control group.
The researchers found:
Depression was associated with significantly decreased odds of achieving 90% or better adherence to HAART. The odds ratio was 0.81, with a 95% confidence interval from 0.70 to 0.98, which was significant at P=0.03.
The condition was also associated with significantly lower odds of a serum HIV RNA level of less than 500 copies per milliliter. The odds ratio was 0.77, with a 95% confidence interval from 0.62 to 0.95, which was significant at P=0.02.
The impact of depression on viral load might just be a function of poorer adherence to HAART, but interestingly, Dr. Horberg and colleagues found, the negative association persisted even when depressed patients were taking their HAART medication properly.
In a multivariable analysis taking HAART adherence into account, depressed patients were 12% less likely to get below the 500-copy level, a difference that remained significant at P=0.05, the researchers reported.
The finding implies that depression itself has an impact on the effect of HAART, over and above any possible impact on adherence, Dr. Horberg said.
Dr. Horberg said he and colleagues were puzzled by one finding, that there appeared to be little benefit of SSRIs among depressed patients who had been on HAART and were switched to a new regimen -- with the addition of an SSRI -- during the study period.
There might simply have been too few patients (428) to see an effect, Dr. Horberg said. But equally, those patients might have been severely depressed or perhaps using an SSRI that was not effective for them.
"We couldn't look at the degree of severity," he said.
The study was limited by its retrospective design, but Dr. Horberg said he and colleagues are planning a prospective study to confirm the findings.
The study was supported by the Garfield Memorial Research Fund of Kaiser Permanente. Dr. Horberg is an employee of the company.
Primary source: Journal of Acquired Immune Deficiency SyndromesSource reference:Horberg MA, et al "Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients" J Acquir Immune Defic Syndr 2007.

Extensive HIV Treatment Failure Found Rare


LONDON, Dec. 6 -- Complete failure of HIV treatment on the basis of the three original drug classes is much more the exception than the rule, researchers here said.
Action Points --->
Explain to interested patients that for several years therapy for HIV was limited to drugs from three classes, with the risk that patients could develop resistance to many of them and have few treatment options.
Note that this study suggests that few patients in that period developed so much resistance that they were completely without treatment options.
The finding may be encouraging for clinicians and patients in developing countries, where in most cases only drugs from the three original classes are available, according to Andrew Phillips, Ph.D., of the Royal Free and University College Medical School, and colleagues.
In a cohort of 7,916 HIV patients in the United Kingdom, only 167 ever developed "extensive" failure to respond to the three classes, Dr. Phillips and colleagues reported in the Dec. 8 issue of The Lancet.
And even among those, Dr. Phillips and colleagues said, there was enough residual drug activity so that 60% had an undetectable HIV viral load at least once after they were classified as having extensive virological failure.
"Extensive" failure was defined more strictly than the usual category of "triple-class failure," which is defined simply as failure to respond to at least one nucleoside reverse transcriptase inhibitor (NRTI), one non-nucleoside reverse transcriptase inhibitor (NNRTI), and one protease inhibitor (PI).
"Extensive" failure was defined as:
For nucleoside reverse transcriptase inhibitors, a lack of response to at least one drug each from three subclasses -- zidovudine or stavudine; lamivudine or emtricitabine; and didanosine, tenofovir, or abacavir.
For the non-nucleoside reverse transcriptase inhibitors, lack of response to efavirenz or nevirapine.
For the protease inhibitors, failure of at least one ritonavir-boosted protease inhibitor.
Lack of response -- or "virological failure" -- to a given drug was defined as a viral load higher than 400 copies of HIV RNA per milliliter of blood despite four continuous months of therapy with the medication.
Over 27,441 person-years of follow-up, the researchers found extensive triple-class failure in 167 patients, 90% of them with a lack of response to seven drugs or more, and 58% of them who went on to fail second-line therapies.
The only drug outside the three original classes that was available during the study period was the fusion inhibitor enfuvirtide, but only five of the 167 patients with extensive triple-class failure used it. (Three new drug classes are currently available -- fusion inhibitors, integrase inhibitors, and CCR5 antagonists.)
Despite their relative lack of other options, the five-year risk of death for patients with extensive triple-class failure was 10.6%, with a total of nine deaths over the follow-up period.
Over the whole cohort, the 10-year risk for extensive triple-class failure was 9.2%, but the researchers said that appears to have decreased over time by roughly 14% per year, which was significant at P=0.006.
Two factors of importance in the developing world appear to affect the risk of developing extensive failure, the researchers found in a multivariate analysis of baseline factors:
Being heterosexual was associated with a doubling of the risk. The odds ratio was 2.26, with a 95% confidence interval from 1.50 to 3.40, which was significant at P<00001.
Having a higher CD4 cell count decreased the risk by 32% for every 100 cells per microliter of blood. The odds ratio was 0.68, with a 95% confidence interval from 0.60 to 0.77, which was also significant at P<00001.
Starting treatment with more than 200 cells per microliter gave a cumulative 10-year risk of extensive triple-class failure of 5.5%, compared with 12.1% for those who started therapy with a lower CD4 cell count.
Both factors may affect therapy in the developing world, where the pandemic is largely heterosexual in nature and where a level of 200 CD4 cells is often considered an upper limit for starting therapy.
The good news in the study is that extensive failure was rare, according to Edward Mills, Ph.D., of the Center for Excellence in HIV/AIDS in Vancouver, and Jean Nachega, M.D., of Johns Hopkins Bloomberg School of Public Health, writing in an accompanying commentary.
But, they said, the bad news is that many patients then went on to fail further regimens -- options that are usually not available in the developing world.
The study "underscores the need for access to alternative, less toxic, and more affordable first-line, second-line, and now third-line antiretroviral drugs in developing countries," they argued.
The study was supported by the Medical Research Council of the United Kingdom. Dr. Phillips reported financial links with Boehringer Ingelheim, Roche, Abbott, GlaxoSmithKline, Gilead Sciences, Tibotec, and Janssen-Cilag.
Primary source: The LancetSource reference:Phillips AN, et al "Risk of extensive virological failure to the three original antiretroviral drug classes over long-term follow-up from the start of therapy in patients with HIV infection: an observational cohort study" Lancet 2007; 370: 1923-28. Additional source: The LancetSource reference: Mills E, Nachega J, "A wake-up call for global access to salvage HIV drug regimens" Lancet 2007; 370: 1885-87.

ICAAC: Integrase Inhibitor Effective for HIV Patients with Multi-drug Resistant Disease

CHICAGO, Sept. 18 -- The investigative integrase inhibitor raltegravir (Isentress) suppresses the viral load to undetectable levels in at least half of HIV patients with virus resistant to three drug classes, researchers said here. All doses of raltegravir were superior to an optimized background of available antiretrovirals, Jose Gatell, M.D., of the University of Barcelona told attendees at the Interscience Conference on Antimicrobial Agents and Chemotherapy.
"The findings at 48 weeks are consistent with the 24-week results and what we know to date about the drug's efficacy and tolerability profile," he said.
The 24-week results were presented at a meeting in Brazil earlier this year, as reported in MedPageToday.com (See: Investigational Integrase Inhibitor Hits HIV Hard).
Dr. Gatell and colleagues randomized 178 patients to three doses of raltegravir and placebo. There were 43 patients assigned to the 200 mg dose of raltegravir twice a day; 465 patients received 400 mg daily; 45 patients received 600 mg daily; and 45 patients received placebo. These were in addition to the best optimized drug regimen available.
Each of the patients had circulating levels of at least 5,000 copies of HIV RNA/mL, had CD4-postive cell counts greater than 50 cells/cubic mm, and documented resistance to three classes of oral antiretroviral therapies - protease inhibitors, nucleoside reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors.
On average, the patients were about 43 years of age and about 85% were men. They had been taking antiretroviral medication for an average of 10 years. After the 24-week study, patients who had been on just the optimized background treatment were allowed to join an open-label extension.
Among patients taking raltegravir, 64% to 71% of patients had suppressed viral loads to undetectable levels using the 400-copy assay. The differences between doses were not considered significant. Approximately, 46% to 64% of patients suppressed virus to undetectable levels using the 50-copy assay.
"In HIV-infected patients failing therapy with triple-class resistant virus, raltegravir in combination with optimized background therapy has potent, superior and durable antiretroviral activity," Dr. Gatell said.
In addition, he said the treatment with raltegravir was well tolerated. "There were very few adverse experiences leading to discontinuations," he said.
"The long-term data shown here reinforces what we know about HIV treatment," said Roy Gulick, M.D., associate professor of medicine at the Weill Medical College of Cornell University in New York, "and that if a new drug is going to be successful it requires that it be used with a background therapy that is also effective."
Dr. Gulick noted that most of the virological failures with raltegravir occurred in patients with a background regimen that had no drugs to which the virus was not resistant. Dr. Gatell reported that two-thirds of the 38 patients who experienced virological failure with raltegravir had background regimens without any drugs that were still effective against the virus.
Merck has filed for approval of raltegravir with the FDA, which has designated the drug for priority review. A decision is expected by mid-October.
Dr. Gatell disclosed possible financial conflicts of interest with Merck, Abbott, Roche, GlaxoSmithKline, Bristol-Myers Squibb, Tibotec, Virgo, Boehringer Ingelheim, and Pfizer.
Dr. Gulick disclosed possible financial conflicts of interest with Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline Kline and Merck. Primary source: Abstracts: 47th Interscience Conference on Animicrobial Agents and Chemotherapy, Sept.17-20, 2007
Source reference: B Grinnsztejn, et al "48 Week Efficacy and Safety of MK-0518, a Novel HIV-1 Integrase Inhibitor, in Patients with Triple-Class Resistant Virus" Abstract H-713: 47th Interscience Conference on Animicrobial Agents and Chemotherapy, Sept.17-20, 2007, p. 295.

Adults 50 and Older Account for Increased Proportion of HIV/AIDS Cases

Adults aged 50 and older account for increasing proportions of prevalent and new HIV/AIDS cases, researchers report in the Journal of the American Geriatrics Society.
Using the CDC's HIV/AIDS Reporting System, researchers examined trends in HIV/AIDS cases in New Jersey from 1992 through 2003/2004.
In 1992, people aged 50 and older accounted for 6% of all prevalent HIV/AIDS cases in the state; by 2004, this had increased to 26%. In addition, although the incidence declined in older adults, they accounted for a significantly greater proportion of new cases in 2003 than in 1992 (18% vs. 6%).
The authors conclude: "The older age group needs targeted HIV prevention education." Noting the important role of healthcare providers, they say that "thorough sex and drug risk assessments should be part of routine care for these patients," and "those at risk should be offered HIV counseling and testing."

IAS: New Drugs Effective Against HIV Resistance

SYDNEY, July 25 -- A combination of two new HIV drugs can reduce the virus to undetectable levels even in patients with a highly resistant strain, according to two studies presented here.
In the DUET-1 and DUET-2 trials, researchers tested the new protease inhibitor darunavir (Prezista) against the combination of darunavir and emtravirine, a new non-nucleoside reverse transcriptase inhibitor (NNRTI). In both arms of the trials, low-dose ritonavir was also given.
The proportion of patients reaching an undetectable level of HIV -- defined as fewer than 50 copies of HIV RNA per milliliter of blood -- was 17% higher for patients on the combination in DUET-1 and 18% higher in DUET-2, investigators reported at the International AIDS Society meeting.
A typical patient in the two parallel studies had been treated with up to a dozen drugs, had suffered one or more AIDS-defining illnesses, and had a CD4 cell count of about 100 per microliter of blood.
"They were also harboring highly-resistant virus," said Christine Katlama, M.D., of the Hôpital Pitié-Salpêtrière in Paris, who presented the studies.
She noted that two-thirds of the patients had two or more mutations that caused resistance to NNRTIs and half had four or more mutations that generate resistance to protease inhibitors.
In both studies, patients were placed on the best possible background regimen of drugs. The all were treated with darunavir and half were randomly assigned to also get emtravirine.
By week 24 of treatment:
In DUET-1, 56% of patients getting emtravirine and 39% of those in the other group had reached a confirmed viral load of less than 50 copies per milliliter. The difference was significant at P=0.005.
In DUET-2, the corresponding proportions were 62% and 44%, significant at P=0.0003.
Interestingly, even when patients had no other active drugs in their background, more than 40% of patients getting both darunavir and emtravirine reached the less than 50-copy level.
Adverse effects were similar between the arms, she said, except for rash and diarrhea -- usually mild and self-limited -- which was higher in the emtravirine arm, Dr. Katlama said.
The drug will be useful to clinicians, because it represents a chance to use a member of the NNRTI class in patients who have developed resistance, said Jose Gatell, M.D., head of the infectious diseases and AIDS units of the University of Barcelona Hospital. Dr. Gatell was co-chair of the 2002 World AIDS Conference in Barcelona.
Usually, when patients need salvage therapy, "we don't even think of the NNRTIs, because they will have usually developed resistance," he said. "Now we will have something (in that class) available to us that works."
Detailed reports on the 24-week data from the two studies were published earlier this month in a special HIV issue of The Lancet, somewhat to the chagrin of IAS officials, who had expected the journal to hold off publishing until the eve of this conference.
The International AIDS Society did not require presenters to report potential conflicts or the sponsorship of research. The DUET studies were supported by Tibotec, which is developing both drugs.Primary source: The LancetSource reference: Lazzarin A et al. "Efficacy and safety of TMC125 (etravirine) in treatment-experienced HIV-1-infected patients in DUET-2: 24-week results from a randomised, double-blind, placebo-controlled trial." Lancet 2007; 370: 39-48. Additional source: The LancetSource reference: Madruga JV et al. "Efficacy and safety of TMC125 (etravirine) in treatment-experienced HIV-1-infected patients in DUET-1: 24-week results from a randomised, double-blind, placebo-controlled trial." Lancet 2007; 370: 29-38.

Australian research reveals AIDS, cancer link

AIDS sufferers and transplant patients are at a much higher risk than the general population of developing a range of cancers, Australian research released Friday has found.
A new study, published in The Lancet medical journal, suggests a link between a depleted immune system and 20 different types of cancer and could be a breakthrough in the understanding of the causes of the malignancies.
Lead researcher at Sydney's University of New South Wales, Professor Andrew Grulich said the research looked at two groups -- those infected with HIV/AIDS and kidney transplant patients.
"Immune suppression is really the only thing they share," he told AFP.
"What we found is that the extent of cancer occurrences in these two populations was very similar. Both had increased rates in a wide variety of cancers."
The research analysed the results of 12 previous studies completed in Australia, the US, Europe and Canada and involving more than 444,000 people with HIV/AIDS and some 32,000 organ recipients.
It found that of the 28 cancers studied, both groups were at a significant risk of developing 20 of them including cancer of the liver, stomach, cervix, eye, lip, mouth and penis.
HIV/AIDS patients were found to be 11 times more likely to develop Hodgkin's lymphoma while those who had undergone a transplant were almost four times more likely to develop the disease.
Grulich said most of the 20 cancers were mostly linked to infection.
He said for those cancers not linked to viruses or bacteria, such as breast and prostate cancer, both groups had similar rates to the general population.
"Until now, the accepted wisdom was that there were only three cancers associated with HIV -- this paper finds that it is more like 20," he said.
Grulich, who works at the university's National Centre in HIV Epidemiology and Clinical Research, said the findings could overturn the previously held view that some of these cancers were linked to lifestyle risks such as smoking and sexual practices rather than infection.
"We believe that the finding points to an immune deficiency and not those other risk factors," he said.
The results could change way HIV/AIDS patients are treated, he added.
"This evidence suggests that immune deficiency is associated with risk of cancer and this suggests we need to maintain people's immune systems at a higher level -- and that might mean putting HIV patients on anti-retroviral drugs earlier than is currently the case," he said.
The research comes ahead of a major international conference on HIV/AIDS which will take place in Sydney on July 22-24.

UN offers new HIV testing guidance

Health professionals should routinely offer to test people for HIV instead of waiting for patients to request it, according to new advice from the United Nations Wednesday.
In making the recommendations, the World Health Organization and UNAIDS are underlining the need to identify the millions worldwide who need treatment. WHO estimates that approximately 80 percent of HIV-positive people in developing countries are currently unaware of their status.
"If we are serious about ensuring universal access to drugs, there has to be a fundamental change in the approach to HIV testing," said Dr. Kevin De Cock, director of WHO's AIDS department.
The UN now advises health workers to test patients for HIV as part of standard medical care, but only with the patient's informed consent.
Yet there are questions about how the cash-strapped countries in Africa might adopt these guidelines. Of the estimated 40 million people living worldwide with HIV/AIDS, nearly 65 percent are in Africa.
Because current estimates of the number of HIV/AIDS patients include people who don't know their status, experts do not expect the numbers to rise dramatically if more people are tested.
Though universal testing will certainly identify more HIV-positive people needing lifesaving anti-retrovirals, there is already a long waiting list: Nearly 5 million people in sub-Saharan Africa are still without treatment.
Identifying more AIDS patients whom countries cannot afford to treat threatens to create an even bigger backlog of people who know they are sick, but have no access to care.
Most AIDS experts believe that increased HIV testing will help, even if the conditions are not perfect.
"No one wants a situation where people find out they're HIV-positive and can't get anti-retroviral treatment," said Jennifer Kates, vice president and director of HIV policy for the Kaiser Family Foundation. "But if we waited until everything was perfectly aligned, we would never respond."
Another benefit of testing: Past studies also have shown that once people are aware that they are HIV-positive, they tend to practice safer sex — which could give prevention efforts a boost.
Africa's weak health infrastructure, though, is a huge stumbling block. The continent urgently needs at least another 4 million health workers to fill the gap, according to WHO. Without doctors and nurses to administer the HIV tests or to provide the necessary treatment when patients are identified, such guidance will create even more stress for Africa's already fragile health systems.
Still, the new testing procedures should mean that HIV patients are found earlier.
"The biggest problem we have now is that our health care systems are overburdened with very sick people who come in too late," said Zackie Achmat, chairman of South Africa's Treatment Action Campaign.
"These new guidelines are long overdue," said Achmat. "We cannot deal with the burden on the health care service if we don't prevent people from becoming so sick that they become a supreme burden on it," he said.
Increased HIV testing and the treatment and infrastructure it ultimately entails will require more money, yet no new funds have been announced to help countries implement these policies.
The UN estimates that the fight against AIDS in 2007-2008 requires $22 billion, and there is still a considerable shortfall. Last year, the deficit for global AIDS programs was about $6 billion.
While health authorities would like to see the new UN recommendations adopted as soon as possible, much will depend on whether countries decide to follow their advice.
"I hope that countries start implementing this immediately," said WHO's De Cock. "But we know you can't just flip the switch and change everything in one day."

1/3 of sexually active older adults with HIV/AIDs has unprotected sex

Findings suggest more prevention efforts may be needed
ATHENS, Ohio (April 24, 2007) -- One out of three sexually active older adults infected with HIV has unprotected sex, according to a study by Ohio University researchers. A survey of 260 HIV-positive older adults found that of those having sex, most were male, took Viagra and were in a relationship.
AIDs cases among the over-50 crowd reached 90,000 in 2003. According to the Centers for Disease Control and Prevention, they will account for half of all HIV/AIDS cases in the United States by 2015 because medical intervention has extended the lifespan of those infected with HIV. Additionally, drugs such as Viagra have made it possible for older adults to remain sexually active longer.
Past studies have shown that up to 65 percent of older adults ages 60 to 71 have sexual intercourse. Among older adults who are HIV-positive, according to the Ohio University findings, 38 percent are sexually active.
“Those who are more likely to engage in riskier behavior – for example, those who are using drugs – are more likely to have unprotected sex,” said graduate student Travis Lovejoy, who led the study along with Ohio University health psychologist Timothy Heckman. “What we don’t know yet is whether these individuals are in a monogamous relationship with someone else who is HIV positive and believe there is no risk of infection.”
The study also found that sexual activity was more prevalent among HIV-positive older adults who were not cognitively impaired, were younger and who considered their overall health to be good.
Because many older adults with HIV are not sexually active, those who do have unprotected sex account for just 13 percent of the overall number of infected people who are aged 50 or older. However, one-third of those who are sexually active have unprotected sex, which suggests that prevention efforts may need to be more highly targeted toward these individuals.
The behavioral information was pulled from a survey of 260 HIV-positive older adults who were participating in a study examining support groups. The study was funded by a three-year, $1.8 million grant from the National Institute of Mental Health and the National Institute of Nursing Research.
Lovejoy presented the findings at the annual conference of the Society of Behavioral Medicine in March.