A recently completed international multi-center clinical trial has found that acyclovir, a drug widely used as a safe and effective treatment to suppress herpes simplex virus-2 (HSV-2), which is the most common cause of genital herpes, does not reduce the risk of HIV transmission when taken by people infected with both HIV and HSV-2.

The majority of people with HIV infection also have HSV-2 infection. Multiple studies have shown that frequent genital herpes recurrences increase the amount of HIV in the blood and genital tract. The HIV virus is also shed from genital herpes ulcers and individuals with such ulcers transmit HIV to others more efficiently. Five preliminary studies showed that it is possible to decrease the amount of HIV in the blood and genital tract through treatment to suppress HSV-2, but these studies did not measure whether this translated into a reduction in HIV transmission. Researchers had hoped that acyclovir's ability to suppress the herpes virus, which causes symptomatic genital sores and breaks in the skin but also frequently is active without symptoms, could reduce the likelihood of sexual transmission of HIV from a person with HIV and HSV-2. The study being reported today is the first to determine whether twice daily use of acyclovir by individuals who are infected with both HSV-2 and HIV reduced the transmission of HIV to their sexual partners.

Led by the University of Washington in Seattle and funded by the Bill & Melinda Gates Foundation, the Partners in Prevention HSV/HIV Transmission Study was conducted among 3,408 African HIV discordant couples, in which one partner had HIV and the other did not. In all the couples, the partner who had HIV also had HSV-2 infection. The study took place at 14 sites in seven countries in eastern and southern Africa (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia). In sub-Saharan Africa, the majority of new HIV infections occur among heterosexual HIV discordant couples, many of whom are in stable partnerships and unaware that one partner has HIV and the other does not. Genital herpes is thought to be a factor in a substantial proportion of new HIV infections in Africa.

In the primary analysis of HIV transmissions determined by laboratory testing to have occurred within the couple and not acquired from an outside partner, there were 41 infections in the acyclovir arm and 43 in the placebo arm - not a significant difference. Acyclovir suppressive treatment reduced the frequency of genital ulcers by 73% and the average amount of HIV in the blood (by 0.25 log10 copies/milliliter, a reduction of 40%), compared to the placebo arm.

"The Partners in Prevention Study is a direct assessment of the impact of herpes suppression on HIV transmission," explained Dr. Connie Celum, the leader of the study and a UW professor of Global Health and Medicine in the Division of Allergy and Infectious Diseases. "A clinical trial of genital herpes suppression in HIV discordant couples is the most direct way to see if we can make a person less infectious and less likely to transmit HIV to their partner. The study did find that acyclovir significantly reduced genital ulcers due to HSV-2 and modestly reduced HIV levels in the blood, consistent with what the preliminary studies of HSV-2 suppressive treatment had shown. However, it appears that these effects were not sufficient to reduce the risk of HIV transmission."

The study also determined whether acyclovir can slow HIV disease progression among individuals with HIV and HSV-2 who also have CD4 T-cell counts that are too high for HIV antiretroviral treatment under current national guidelines. Specifically, the investigators studied the number of participants in the acyclovir and placebo arms whose CD4 T-cell counts declined to below 200, who started HIV medications, or who died. In this analysis, HIV disease progression was slowed by 17% by acyclovir, an effect that was statistically significant. Given that low-cost, safe ways to delay progression of HIV disease are needed for individuals who are not yet taking HIV medications, this result is encouraging, but the modest effect observed in this study may not be sufficient to promote use of this dose of acyclovir for slowing HIV disease.

"Although the primary outcome of reducing HIV transmission was not observed, the study yielded important information that will inform HIV prevention research in a number of ways," Celum said. "Most importantly, we have demonstrated that interventions must achieve a bigger reduction in HIV levels in order to reduce HIV transmission, especially among persons with high HIV levels. This was an ambitious study, which required testing of an estimated 50,000 couples of unknown HIV status in Africa to recruit the 3,408 HIV discordant couples who volunteered to enroll in the study. This was an important and courageous study to undertake, and I applaud our collaborators at the University of Washington, the investigators and study teams in Africa, the study participants, and the communities where the study was done, for their dedication over the past five years. The findings will bear fruit for both the HIV prevention and the vaccine fields for years to come."

HSV-2 is one of the most common sexually transmitted infections worldwide and is especially prevalent in areas with high rates of HIV infection, with up to 90% of individuals who have HIV also being infected with HSV-2. Most people who are infected with HSV-2 do not know they have the virus because symptoms can be mild or absent. HSV-2 infection can cause recurrent sores and breaks in the skin of the genital region, which can be mild and often go unnoticed. HSV-2 infection also attracts immune cells called CD4 T-cells to the genital region, which HIV uses to establish or pass infection.

The Partners in Prevention HSV/HIV Transmission Study is the first clinical trial to directly test whether suppressing HSV-2 infection could reduce rates of HIV transmission and HIV disease progression. The study, which began recruitment at the 14 African sites in November 2004, ended follow-up of participants in October 2008. The study was randomized, placebo-controlled and double-blinded, meaning that both participants and care providers did not know which treatment the participants were receiving. Both the placebo and treatment groups received standard HIV prevention services, which included being supplied with condoms, treated for other sexually transmitted infections, and provided care for HIV infection. All participants received extensive counseling, both individually and as a couple, throughout the study period, on how to reduce the risk of HIV infection.

Scientists in the USA have discovered why smokers may be more prone to chronic gum disease (periodontitis). One of the bacteria responsible for this infection responds to cigarette smoke - changing its properties and the way it infects a smokers mouth.

The study published recently in the Society for Applied Microbiology journal Environmental Microbiology, showed that the bacterium Porphyromonas gingivalis adapts and changes its DNA and membrane proteins in response to cigarette smoke.

Several genes of P. gingivalis associated with its virulence (infectivity), detoxification, oxidative stress mechanisms and DNA repair are altered by exposure to cigarette smoke. As a result, the expression of a number of the proteins in the cell membrane is changed. This affects important characteristics of the bacterial cells themselves and how the immune system recognizes this pathogen.

This could explain why smokers are more likely to be resistant to treatment for periodontitis and are more susceptible to oral disease caused by infection with P. gingivalis.

Finding an effective treatment for smokers infected with P. gingivalis will be easier now that these changes in the bacterium's 'properties' have been identified.

University of Louisville researcher, Dr David Scott said: "It has long been known that smokers are more susceptible to periodontitis than are non-smokers. However, the reasons why are not so clear. Our study shows, for the first time, that components in cigarette smoke alter key characteristics of a major bacterial pathogen which, subsequently, changes how our immune system reacts to it. It may turn out that we need to develop alternate treatment plans for smokers and non-smokers".

The US Centers for Disease Control and Prevention (CDC) said that doctors should not delay giving antivirals to pregnant women with flu symptoms because the risks of premature labor, pneumonia and dehydration are too great and outweigh the risk of the drug affecting the baby.

Dr. Anne Schuchat, Interim Deputy Director for Science and Public Health at the CDC said in a press briefing about the H1N1 situation on Tuesday:

"We are ... seeing some severe complications among pregnant women in this year's novel H1N1 virus problem."

The CDC is currently investigating about 20 cases of pregnant women infected with the virus, some of them with severe complications.

One of the three H1N1 deaths in the US was a pregnant woman in Texas who did not take anti-flu drugs.

Flu usually affects pregnant women more severely than other people because their immune system is weaker. Shuchat said pregnant woment are more vulnearable to severe complications include pneumonia and dehydration as well as complications for the newborn, like premature labor".

She said the CDC urge doctors caring for pregnant women who they think may have flu to treat them promptly with antivirals.

"Sometimes, physicians are reluctant to treat pregnant women with medicines, and sometimes pregnant women are reluctant to take medicines because, of course, they are sometimes risky during pregnancy," said Shuchat.

But she said that experts who have looked at the situation in detail are adamant that the benefits to pregnant women with flu of taking antivirals are much greater than the "theoretical concerns about the drugs".

Without actually naming them, Shuchat said that either of the two medicines that the novel H1N1 is susceptible to should be used, but she was probably referring to Tamiflu and Relenza.

Relenza (zanamivir) and Tamiflu (oseltamivir) belong to the same class of drug known as neuraminidase inhibitors used to treat Influenzavirus A and Influenzavirus B.

In a separate briefing reported by the New York Times, CDC medical officer Dr Denise Jamieson, also advised doctors not to delay. If there is flu in the community, and you would otherwise not hesitate to give antivirals to a non-pregnant patient with flu symptoms, then:

"Don't delay because she's pregnant ... the benefit of giving Tamiflu outweighs the risk," said Jamieson.

She added that "Tamiflu and Relenza are fairly safe in pregnancy".

Shuchat said that while they didn't know a lot about this new H1N1 and pregnancy, it was important to look back on what is known about seasonal influenza and pregnancy, and the recommendation is that pregnant women are strongly urged to take the seasonal flu vaccine to protect themselves from complications during pregnancy.

She said the authorities are keen to stress the importance of prompt antiviral treatment in pregnancy and the CDC will be shortly be issuing a Morbidity and Mortality Weekly Report (MMWR) with some clinical data about the H1N1 pregnancy cases they have been investigating.

Schuhat also said that the way the US was using antivirals in response to the new H1N1 outbreaks was different to European countries. She said the circumstances in the US were very different to that of many countries in Europe.

In the US the virus is pretty much in every state, and she suspects it is also in the states that haven't reported confirmed cases yet.

"We don't have a situation where we can contain the virus's geographic distribution, and our focus is on reducing illness and death and mitigating the impact that this virus has as well as focusing our efforts on areas where they can have the most impact," said Schuhat.

So the priority is to use antivirals where the treatment will make a difference, she explained.

"And that's for people with severe illness presentation or for people who have underlying medical conditions or pregnancy, where the complications of an influenza infection might be worse than in other people," said Schuhat.

While other countries are still using the drug for preventive reasons, in the US the focus is on treatment. Prevention is not " likely to have a benefit here in the United States based on the transmission patterns we're seeing and the stage of the outbreak that was present by the time we recognized this virus", said Schuhat.

Exercise is known to have a positive effect on maintaining a healthy lifestyle, and a study in the May issue of the Journal of Thoracic Oncology has shown that exercise also plays an important role in both primary and secondary prevention of cancer. The Journal of Thoracic Oncology is the official journal of the International Association for the Study of Lung Cancer. Dr. Jennifer Temel at Massachusetts General Hospital found that exercise impacts the health and quality of life of patients with an advanced or incurable lung cancer diagnosis. Between October 2004 and August 2007, Dr. Temel and her team enrolled 25 lung cancer patients in a study to evaluate the feasibility, efficacy and safety of a structured, hospital-based exercise program in these patients.

The evaluation consisted of twice-weekly sessions of aerobic exercise and weight training over an eight week period. The baseline evaluation included assessments of exercise response, functional exercise capacity (measured by the six-minute walk test) and muscle strength. The structured sessions took place in a group format and lasted between 90-120 minutes and also evaluated the health related quality of life.

Although less than half of the participants were able to complete the exercise program, researchers found it promising that those individuals who did complete the study experienced a significant reduction in lung cancer symptoms and no deterioration in their six-minute walk test or muscle strength. The results of this study also suggest that community-based or shorter exercise programs may be more feasible for lung cancer patients to complete. Researchers concluded that additional studies should explore the connection between exercise habits and lung cancer survival rates in order to further characterize the future development of exercise programs.

More than 300 million people around the world have asthma, and the disease imposes a heavy burden on individuals, families, and societies.

The Global Burden of Asthma Report, indicates that asthma control often falls short and there are many barriers to asthma control around the world. Proper long-term management of asthma will permit most patients to achieve good control of their disease. Yet in many regions around the world, this goal is often not met.

Poor asthma control is also seen in the lifestyle limitations experienced by some people with asthma. For example, in some regions, up to one in four children with asthma is unable to attend school regularly because of poor asthma control. Asthma deaths are the ultimate, tragic evidence of uncontrolled asthma.

According to the Global Burden of Asthma Report, the majority of asthma deaths in some regions of the world are preventable. The theme of World Asthma Day 2009, an awareness-raising event organized by the Global Initiative for Asthma (GINA), is "You Can Control Your Asthma."

This theme emphasizes that effective asthma treatments exist and, with proper diagnosis, education, and treatment, the great majority of asthma patients can achieve and maintain good control of their disease. When asthma is under control, patients can live full and active lives.

According to the GINA Global Strategy for Asthma Management and Prevention (2007), asthma control means that a person with asthma has:

* No (or minimal) asthma symptoms
* No waking at night due to asthma
* No (or minimal) need to use "reliever" medication
* The ability to do normal physical activity and exercise
* Normal (or near-normal) lung function test results
* No (or very infrequent) asthma attacks

Some people with asthma symptoms may never receive a diagnosis of asthma, and thus do not have the opportunity for good asthma treatment and control. Various factors such as poor access to medical care, under-recognition by health professionals, lack of awareness among patients, and overlap of asthma symptoms with those of other diseases contribute to under-diagnosis of asthma.

One of the major barriers to asthma control is the high cost of medicines. For example, the cost of medicines is often higher than average monthly salary of a nurse in developing countries.

Also the Asthma medications are not available in some areas with alarming levels of asthma, such as parts of the Middle East, Southern Asia, Central America, and North, West, and East Africa.

Treatment that is not consistent with evidence-based guidelines may hamper asthma control. There are wide variations in clinical management of asthma in different parts of the world, and even when cost is not a barrier under-treatment may still occur.

The under-use of inhaled gluco-corticosteroids for long-term management of asthma is a common problem. These medications diminish chronic inflammation in the lungs of asthma patients, and are a key to controlling the disease.

In many regions of the world, people with asthma may be exposed to conditions such as outdoor or indoor air pollution, cigarette smoke, or chemicals on the job that make their asthma worse. Avoiding risk factors that cause asthma symptoms is an important strategy for improving control.