South Africa unveils plan to fight HIV
Wed, 14 Mar 2007 13:45:53 GMTBy CELEAN JACOBSON, Associated Press Writer
JOHANNESBURG, South Africa - The government proposed a five-year plan Wednesday to halve the number of new HIV infections in South Africa, saying it had failed to persuade young people to change their sexual habits.
In a report, the government also said the country needed to better address the stigma associated with the disease, which discouraged many people from being tested, and vowed to expand its treatment and care program to cover 80 percent of people with AIDS.
The report's frankness — and the warmth with which it was received by AIDS activists — marked a turnaround in government rhetoric on AIDS, after years of international condemnation for policies that many said went against medical advice and activists' efforts. The health minister in particular has been criticized for questioning antiretroviral treatments and promoting nutritional remedies, such as garlic and lemons, to fight the disease.
"This plan marks a turning point in the struggle to stop the HIV/AIDS epidemic," said Zwelinzima Vavi, the general-secretary of the Congress of South African Trade Unions. "We hail the new spirit, which signals the end to acrimonious debate and the standoff between government and important sectors of our people."
Poor coordination and lack of clear targets and monitoring has helped AIDS to become a major cause of premature death in South Africa, with mortality rates increasing by about 79 percent in 1997-2004, with a higher increase among women, the 120-page report said.
About 5.54 million people were estimated to be living with HIV in South Africa in 2005, with 19 percent of the adult population affected. Women in the 25-29 age group were the worst affected, with prevalence rates of up to 40 percent.
"There are still too many people living with HIV, too many still getting infected," the report said. "The impact on individuals and households is enormous." Children were also vulnerable, with high rates of mother-to-child transmission.
A two-day conference, beginning Wednesday, brought political and business leaders together with AIDS activists to discuss ways to implement the government's five-year plan.
"The National Strategic Plan includes ambitious targets to reverse the course of HIV and AIDS over the next five years," the acting health minister, Jeff Radebe, said. "These bold targets reflect our commitment to combat HIV and AIDS."
The government appointed Radebe last month, after Health Minister Manto Tshabalala-Msimang left her duties due to illness. Since taking the post, Radebe has sought to mend fences with doctors and AIDS activists, including the main Treatment Action Campaign group, after years of Tshabalala-Msimang advising South Africans that natural remedies were better for fighting AIDS than antiretrovirals.
Deputy President Phumzile Mlambo-Ngcuka, appointed last year to efforts in revamping the country's AIDS strategy, said the government had set aside 14 billion rands for the plan, and called on businesses to match its contribution.
She called for targets to be set and met to ensure the plan had the required impact, saying "our actions must be measurable."
The proposed plan — meant to be finalized by the South African National AIDS Council later this month — set a target for reducing the number of new HIV infections by 50 percent by 2011.
To reach the target, it called for more effort in empowering women, who often are targeted in sexual abuse, and to encourage people to be tested for the virus.
More also must be done to promote behavior change in young people, the report said.
Mlambo-Ngcuka urged youths to delay their first sexual experiences and to be at the forefront of the fight against the disease.
"We would like to make sure our young people believe there can be and there will be an Africa free of AIDS," she said.
The Treatment Action Campaign, in the past highly critical of government efforts, welcomed the proposed five-year plan as one of the "best responses" to the epidemic.
"We can already recognize significant departures from the previous plan which didn't have targets or recognize the drivers of the epidemic," said Sipho Mthathi, the campaign's general secretary, according to the South African Press Association.
The report said the government should aim to provide "appropriate packages of treatment, care and support to 80 percent of HIV positive people and their families by 2011."
Currently nearly 250,000 people are receiving antiretroviral therapy — about 20 percent of the estimated number of people living with HIV.
The report also said a tuberculosis epidemic in South Africa was closely linked to AIDS, and voiced concern about the emergence of a nearly untreatable TB strain that preys on those with a suppressed immune system. More coordination in managing the two diseases was needed, it said.
Wed, 14 Mar 2007 06:50:18 GMT
By ZAKKI HAKIM, Associated Press Writer
JAKARTA, Indonesia - Indonesia will not share bird flu samples with the World Health Organization without a legally binding agreement promising the virus won't be used to develop an expensive commercial vaccine, the health minister said Wednesday.
Siti Fadilah Supari, digging her heels in following a weekslong standoff with the global body, said a letter of guarantee from WHO's director general Margaret Chan late last month was not good enough.
"That's just an agreement in principle ... we need one that is legally binding," she told reporters, adding that Asia Pacific health leaders meeting in Jakarta later this month will seek a change in the WHO's 50-year-old virus-sharing system.
The system, which enables influenza samples to be freely passed throughout the global community for public health purposes, needs to be revised so it is "fair for developing countries, poor countries, affected countries," Supari said.
"We will not share our virus sample, without a change in the rules," Supari said.
Several countries are developing vaccines to protect against H5N1, the bird flu virus strain blamed for 168 human deaths worldwide — more than a third of them in Indonesia.
The virus remains mainly an animal disease, but experts fear it may mutate into a form that easily spreads between humans, potentially killing millions.
Indonesia is worried that large drug companies will use its H5N1 strain, sent to WHO affiliated laboratories to confirm human infections, to make vaccines that ultimately will be unaffordable for developing nations.
Chan told Supari in a Feb. 28 letter seen by The Associated Press that WHO would use Indonesia's strain of the virus "for public health risk assessment purposes only."
Until a formal agreement is reached, WHO will obtain authorization from Indonesia before sending any "H5N1 strain as a vaccine seed virus to a vaccine producer for production of influenza H5N1 vaccine," the letter promised.
The government's decision to withhold the vaccine was a major departure from WHO's virus-sharing system, in which influenza samples are freely passed throughout the global community for public health purposes, including vaccine development.
Samlee Plianbangchang, the WHO's Southeast Asia director, said he was confident this month's meeting in Jakarta would go a long way to finding a solution that would satisfy both sides.
"It's a matter of time," he said. "I'm sure that there is a common path, WHO and the country can move together."
Study Quick walks may help smokers quit
Wed, 14 Mar 2007 03:28:39 GMTBy MARIA CHENG, AP Medical Writer
LONDON - As little as five minutes of exercise could help smokers quit, says a new study. Research published in the international medical journal Addiction showed that moderate exercise, such as walking, significantly reduced the intensity of smokers' nicotine withdrawal symptoms.
"If we found the same effects in a drug, it would immediately be sold as an aid to help people quit smoking," said Dr. Adrian Taylor, the study's lead author and professor of exercise and health psychology at the University of Exeter.
Taylor and colleagues reviewed 12 papers looking at the connection between exercise and nicotine deprivation. They focused on exercises that could be done outside a gym, such as walking and isometrics, or the flexing and tensing of muscles. According to their research, just five-minutes of exercise was often enough to help smokers overcome their immediate need for a nicotine fix.
After various types of moderate physical exertion, researchers asked people to rate their need for a cigarette. People who had exercised reported reduced a desire.
"What's surprising is the strength of the effect," said Dr. Robert West, professor of health psychology at University College London. West was not involved in the review. "They found that the acute effects of exercise were as effective as a nicotine patch," he said.
West cautioned that it was unknown how long the effects of exercise would last. "You could in theory use exercise to deal with short bouts of nicotine cravings, but we don't know if it would help in the longer term," he said. It is likely that exercise would have to be combined with a larger strategy of other anti-smoking techniques to be successful in helping people quit.
Nearly anything that distracts people from smoking is thought to help, but scientists have long suspected that exercise might have a more potent effect. Taylor theorized that exercise could produce the mood-enhancing hormone dopamine, which could, in turn, reduce smokers' nicotine dependence.
Still, experts were not convinced about the study's practical applications. "Doctors can tell patients to do things until they're blue in the face, but the limiting factor may be getting people to actually take up exercise," said Dr. Peter Hajek, professor of clinical psychology at Queen Mary University Hospital in London. Hajek was not involved in the study.
Hajek said that if people were taught simple exercises, including isometric exercises they could do at their desk, they could potentially stave off their need for a cigarette break. "When you are dying for a cigarette, you can try to exercise instead," he said.
FDA approves advanced breast cancer drug
Tue, 13 Mar 2007 22:14:02 GMTBy ANDREW BRIDGES, Associated Press Writer
WASHINGTON - Women with an aggressive form of advanced breast cancer that other treatments have failed to stop gained a new option Tuesday with the approval of a novel drug — but how much benefit it offers is unclear.
The GlaxoSmithKline PLC drug, Tykerb, is to be taken once daily in pill form and is meant for women who have received prior treatment with the intravenous drug Herceptin and older chemotherapy drugs called taxanes and anthracyclines, the company said. The Food and Drug Administration said it approved Tykerb for use in conjunction with the chemotherapy drug Xeloda.
Glaxo said Tykerb would be available in two weeks. It will cost about $2,900 a month, the company said.
The initial results of a study reported last year showed that Tykerb in combination with Xeloda delayed tumor growth for an average of 8 1/2 months, or about twice as long as Xeloda alone. Tykerb worked so well that the international study was stopped early and all participants were offered the drug. However, Glaxo said a later analysis of the results of that study showed the delay actually was closer to nearly seven months for women on both drugs, versus almost five months for those on Xeloda alone.
The FDA said it was too early to know if women taking Tykerb and Xeloda would live longer than those taking the latter drug alone.
The lack of that information has left one advocacy group disappointed. Survival — and not progression of disease — gives a truer picture of a cancer drug's efficacy, Barbara A. Brenner, the executive director of Breast Cancer Action, told the FDA in a March 5 letter.
"The FDA should not approve drugs that have not shown either a survival benefit or improved quality of life for breast cancer patients with metastatic disease," Brenner's letter read in part.
FDA drugs chief Dr. Steven Galson said Tykerb expanded the options available to women with a type of advanced breast called HER2 positive when it has metastasized, or spread.
"Today's approval is a step forward in making new treatments available for patients who have progression of their breast cancer after treatment with some of the most effective breast cancer therapies available," Galson said.
Tykerb, like Herceptin, is part of a new generation of cancer medicines that more precisely target tumors without killing lots of healthy cells.
Herceptin has been an important option for many women with advanced, HER2 positive breast cancer, but eventually it stops working and women succumb to the disease.
Both drugs target a protein called HER-2/neu, which tumors make in abnormally large quantities in roughly one-fourth of all breast cancers. While Herceptin targets the outside of the HER2 protein, Tykerb works from the inside of the cell.
Because of that difference, Tykerb works in some HER2 positive breast cancers that have been treated with Herceptin but no longer benefit from the older drug, the FDA said.
Generally, women with HER2 positive breast cancer face a greater risk of disease progression and death. Approximately 8,000 to 10,000 women die from metastatic HER2 positive breast cancer each year, the FDA said.
Xeloda, or capecitabine, is made by Switzerland's Roche Holding AG. South San Francisco-based Genentech Inc. makes Herceptin, also known as trastuzumab.
Eventually, Tykerb could be studied for use with Herceptin, said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. And Glaxo said it's studying Tykerb as a treatment for other cancers.
"Some of those reports have been promising and others less so. But it is too early to know which other cancers — if any — are going to respond to this new drug," Lichtenfeld said.
Expanded use of Tykerb eventually could make it a blockbuster drug for Glaxo, with annual sales approaching or exceeding $1 billion, analysts have said.
