STDs / STIs

November – September 2009: AIDS & STDs

At Our Throats: HPV and Tonsil Cancer

Common STD ("STI") Associated with Aggressive Prostate Cancer in Men — Calling this a Sexually Transmitted "Infection" to Make is Sound Less Dangerous May NOT Be Such a Good Idea…

HIV Vaccine: Hope or Hype?

HIV/AIDS disproportionately affects Hispanics in the US

AIDS Prevention Expert Publicly Re-Affirms that 3/09 Comment on Condom Failure Was Correct: "The condom does not prevent AIDS"… "Only responsible sexual behavior can address the pandemic"

Interview with Edward Green on AIDS Prevention in Africa…

HPV AND TONSIL CANCER

The research of an Ohio oncologist, Maura Gillison, is confirming early data showing the annual increases in tonsil cancer among younger patients are due, at least in part, to HPV infection. Changes in sexual behavior during recent decades have probably encouraged the spread of the formerly-rare virus. One HPV strain—transmitted mostly through oral sex and French kissing—suppresses anti-cancer genes, allowing tumor growth in the exposed tissue.


At Our Throats

A new form of tonsil cancer is spreading rapidly. The cause isn't smoking and drinking but a virus.Oncologist Maura Gillison was looking for patients with tonsil cancer for a clinical study several years ago.

The first enlisted was a malpractice lawyer, followed by a doctor, then a scientist. She joked to a colleague that all she needed was a rear admiral. In walked a member of the military brass. All were in their 30s, 40s and 50s.

People in their prime didn't used to get throat tumors. Head-and-neck cancer, as doctors call it, was a disease of older problem drinkers who also chain-smoked (more men than women). Years of exposure to scotch and Lucky Strikes would damage the DNA of cells lining the throat, leading to cancer.

But Gillison, 44, a professor at Ohio State University, was among the first researchers to make a startling realization: The old cigarettes-and-alcohol form of the disease was being eclipsed by a new form, caused by the same human papilloma virus (HPV) that causes cervical cancer.

The tumors grow in the tonsils or in the tissue that remains after tonsillectomy. The only good news is that the prognosis for these patients is better than for the old disease.

Gillison and researchers at the National Cancer Institute estimate that 4,000 people, 75% of them men, develop this new form of throat cancer annually. That's only a tenth of head-and-neck cases, but it's half as many people as get cervical cancer in the U.S.

More worrisome, Gillison's work shows HPV tonsil cancer is increasing at a rate of 5% a year, unusual growth for a cancer diagnosis, even though throat infection with the HPV strain that causes it is exceedingly rare. Any spread of the virus could make the number of cases increase dramatically. "I'm very worried," says Otis Brawley, chief medical officer of the American Cancer Society. Skeptics say the association is not proven, and that too much of the work comes from just Gillison.

Both Gillison and Brawley think a solution may exist: Vaccinate all boys, starting as early as age 9, with Merck ( MRK – news – people )'s HPV vaccine, Gardasil, now heavily promoted for cervical cancer.

Gardasil, however, is already the source of all sorts of controversy. Antivaccine groups oppose it because of its high costs ($360 for three shots) and alleged side effects; the FDA says the vaccine is safe. GlaxoSmithkline ( GSK – news – people ) is developing its own HPV vaccine.

Gillison spent three years trying to draw Merck's attention to HPV tonsil cancer. Finally, she is working with Merck to design a study to see if Gardasil can affect HPV infection in the throat. Merck admits studying the problem is "challenging" but says the potential is big.

Interested in cancer-causing viruses, Gillison started work on the HPV problem in 1996 when she was finishing her Ph.D. and oncology training at Johns Hopkins University. She signed up with a group studying HPV and cervical cancer. But she switched to studying throat cancer patients after finding a few research papers reporting cases in which tumors had the DNA of the HPV virus inside them.

She was shocked to find a substantial number of throat tumors had the HPV type. She also noticed something dramatic when she organized HPV patients by the year they were born. Starting with patients born in 1935, there had been an increase in the number of cases every single year.

Researchers realized that a big change in sexual behavior in the 1950s and 1960s–mainly, that people had more sexual partners–had allowed a virus that had been rare to spread throughout the population. Some researchers say gay men and women seem underrepresented, possibly because they catch the virus elsewhere in the body and develop immunity.

What appears to happen is that one strain of the HPV virus, which is transmitted largely through oral sex, but also by French kissing or even just sharing a water glass, suppresses two anticancer genes.

HPV tonsil cancer is not as lethal as traditional throat cancers, but the treatment is still brutal. Martin Duffy, a 69-year-old Boston economist and consultant who doesn't smoke and has run 40 Boston marathons, dropped 30 pounds to 120 pounds while being treated with Erbitux and radiation. He was diagnosed with tonsil cancer in February and is slowly recovering.

The death rate in head-and-neck cancer has been dropping, but doctors are still discouraged: It turns out the less threatening virus was responsible for many of those cancers. James Rocco, a head-and-neck surgeon at the Massachusetts Eye & Ear Infirmary, says, "We're probably doing no better than we were 30 years ago."

[http://www.forbes.com/forbes/2009/1102/health-cancer-tonsils-virus-hpv-at-our-throats.html;  Matthew Herper, 10.15.09, Forbes Magazine dated November 02, 2009; abstinence.net, 24November2009]

 

 

 

 

 

COMMON STD ASSOCIATED WITH AGGRESSIVE PROSTATE CANCER
POSTED: SEP 29, 2009

A new study suggests that although men infected with trichomoniasis have only a slightly higher risk of prostate cancer than uninfected men, they are three times more likely to die of the disease, which often occurs in a more aggressive form.

For the abstract of this study, go to

http://jnci.oxfordjournals.org/cgi/content/abstract/djp306v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Lor

elei+A.+Mucci&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT [www.abstinence.net, 29Sept09]

 
HIV Vaccine- Hope or Hype?
On September 24, 2009, reports surfaced of an HIV vaccine found to be effective in a large trial.1,2 News reports about promising HIV vaccines have circulated before, but none of the vaccines have proven beneficial in large trials or have entered the marketplace. Is this HIV vaccine different from the others?
 
This vaccine trial, also known as RV 144, was sponsored by the U.S Army and the Thailand Ministry of Public Health, with additional funding provided by the National Institutes of Health.

The RV 144 vaccine trial used a combination of two HIV vaccines that had been manufactured using engineered HIV genes and an HIV protein.3 No whole HIV viruses, dead or alive, were included in the vaccine so that HIV infection could not result from the vaccine itself.

Beginning in 2003, over 16,000 volunteers aged 18-30 years were recruited in Thailand to participate in the study.4 Half of the volunteers were assigned to receive the experimental vaccine, consisting of 6 immunizations over 6 months, while the other half of the volunteers were assigned to receive a series of placebo injections.3 All of the participants were followed for 3 years after they finished their injections, receiving an HIV test and HIV risk prevention counseling every six months.4
 
After the vaccine trial concluded in June 2009, researchers found that 74 of the 8,198 people who received the placebo injections and 51 of the 8,197 people who received the experimental vaccine combination had been infected with HIV during the course of the study, concluding that the vaccine was about 30% effective at preventing HIV.2,3

Furthermore, the vaccine combination appeared safe. An international Data and Safety Monitoring Board did not identify any safety concerns throughout the trial.4

Further details of this vaccine trial will be available in October 2009, when researchers will present their results at the AIDS Vaccine Conference in Paris.1
 
In short, the RV 144 vaccine trial demonstrated that, though the HIV vaccine recipients had a lower HIV infection rate and had few adverse effects, the results were very modest.

However, the small benefit resulting from this vaccine series is considered a large triumph by some HIV researchers. This could be because no other vaccine candidate that has undergone large scale testing has been shown to significantly decrease HIV infections among the vaccine recipients when compared to people who did not receive the vaccine.2

It is important to note, though, that these results do not in any way suggest that a vaccine is ready for the public. In fact, the researchers themselves admit that this vaccine is not for marketing.

Instead, they consider it a step toward guiding further HIV vaccine development and research.3 Furthermore, even though researchers saw a difference in the HIV infection rate among those who received the vaccine, they are unable to explain the reason for the difference.

Once infected with the HIV virus, there were no differences in the HIV virus levels of participants whether they received the vaccine or not.

So it is difficult to say exactly how the vaccine may prevent HIV infection, if it really does.

In this aspect the study failed to answer one of its primary research questions. Therefore, further research will be necessary to clarify how this vaccine works and if this observed decrease in HIV infection rate can be reproduced.
 
In summary, there are several important points to glean from these new HIV vaccine trial results.

First, there may be hope. After many years of disappointing results, this trial provides some evidence that an effective HIV vaccine may be a possibility.

Second, this vaccine appears to be safe but offers only limited effectiveness. Further vaccine research will need to take place, and any widely available vaccine that will result from this research is still many years away.

And, lastly, no vaccine is 100% effective for all populations. Therefore, the most important message for HIV prevention, and the prevention of other potential consequences of risky sexual behavior, is that risk avoidance is a person's most effective option for remaining healthy and disease-free.

Avoiding all sexual activity outside of a lifelong committed relationship with an uninfected partner is the only 100% effective way to prevent the sexual transmission of infections.
 
References:
1. US Military HIV Research Program. HIV vaccine study first to show some effectiveness in preventing HIV [press release: September 24, 2009]. Rockville, MD: US Military HIV research Program, US Army Medical Research and Materiel Command. Available at: http://www.hivresearch.org/phase3/RV144-Press-Release-Sponsor.pdf. Accessed: 2009 Sept 24.
2. National Institutes of Health. HIV vaccine regimen demonstrates modest preventive effect in Thailand clinical study. NIH News September 24, 2009. Available at: http://www.nih.gov/news/health/sep2009/niaid-24a.htm. Accessed: 2009 Sept 24.
3. US Military HIV Research Program. RV 144 FAQs. Rockville, MD: US Military HIV research Program, US Army Medical Research and Materiel Command. September 24, 2009. Available at: http://www.hivresearch.org/phase3/RV144-FAQs-20090924.pdf. Accessed: 2009 Sept 24.
4. US Military HIV Research Program. RV 144 Phase III Trial Fact Sheet. Rockville, MD: US Military HIV research Program, US Army Medical Research and Materiel Command. September 2009. Available at: http://www.hivresearch.org/phase3/MHRP-Phase-III-Fact-Sheet.pdf. Accessed: 2009 Sept 24.
 [29September 2009, HIV Vaccine Update, The Medical Institute, www.medinstitute.org]

 

_________________________________________ 
MI Commentary:
Results recently announced of an experimental vaccine against HIV tested in Thailand have received great attention and applause. "A watershed event in the deadly epidemic" said CBS News. "Today marks an historic milestone," said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition.
 
This study does indeed give renewed hope that some day it may be possible to find a viable HIV vaccine.
The Medical Institute is, of course, greatly in favor of scientific advances which would result in the prevention of AIDS.

So, what are t

he facts?
 
– Of the 8,000+ who were involved in the Thai study and were given the vaccine, 51 developed new infections. That's 51 persons now afflicted with a deadly virus. Those participants not getting the vaccine suffered 74 new infections. That's 74 more persons afflicted with the deadly virus.

Yet both groups had the benefit of condoms, counseling and treatment.
 
– This vaccine is being touted as producing a 31% reduction.

Yet, public health approval is generally not given to a vaccine unless proven effective in at least 50-80% of cases. This vaccine, therefore, will not be available anytime soon.
 
– Only certain strains of HIV were involved in the study. Whether there would be any effect against other strains in Africa or elsewhere is unknown.
 
The cost of this study, to date, is some $105,000,000.
 
Other reservations concerning the study have also been voiced but one issue is particularly troubling.

Even if an approved HIV vaccine is developed, and the cost to the user (or taxpayer) is not excessive, who would be required to take the vaccine? Mandatory? Not so far fetched as you might think.

Getting the HPV [Human Papilloma Virus] vaccine, which admittedly is only effective against some of the HPV types, and, which costs $360-$400 per person, is now being required for any female aged 11-26 attempting to obtain a "green card" in this country or some seeking to achieve citizenship.

So do we now envision a time when people will have to obtain multiple such injections? For other strains of HIV? Other types of HPV? Other STDs? How many? At what cost?
 
So before we jump to any conclusions about this new vaccine, let's take a look at its potential use.

Perhaps at least some of the many millions of dollars being spent on attempting to discover an HIV vaccine might be better spent on preventing people from participating in the activities which account for almost all HIV transmission.

HIV/AIDS and other STDs aren't primarily caused by actions such as coughing or sneezing, but, rather, by elective behavior.

Wouldn't it be wise to spend a few dollars on trying to alter this elective behavior? Food for thought.
 
[29September 2009, HIV Vaccine Update, The Medical Institute, www.medinstitute.org]
 
 
 

 

October 15th is National Latino AIDS Awareness Day
HIV/AIDS disproportionately affects Hispanics in the US.

In 2006, 17% of new HIV infections occurred in the Hispanic population.

The rate of new HIV infections in the Hispanic population was almost 3 times that of the rate in the white population.1
 
In order to reach out to Hispanic youth, MI has developed many of its educational resources in both Spanish and English. Several new Spanish resources will be available in October, including:
 
Por Qué Abstinencia (Why Abstinence), an update to our popular La Abstinencia Porque brochure, shows teens that abstinence isn't about never having sex. It's about waiting to have the safest and best sex in a life-long committed relationship! This brochure also covers why condoms still leave you at risk, and shows teens that avoiding sexual activity is the only way to avoid pregnancy, STIs and to remain safe.
 
Está Bien Decir No (It's OK to Say No) shows teens creative ways to say "No" to sex when the pressure hits. This brochure helps teens figure out what to say and do if someone pressures them to have sex.
 
El Condón (The Condom) answers the question "Do condoms make sex safe?" by revealing the results of published research about the effectiveness of condoms. With the most up-to-date data, explore the facts about condoms, and their limitations for preventing STIs.
 
Qué Estabas Pensando? (What Were You Thinking?) presents recent research about how adolescent brain development significantly affects risk taking behavior and decision-making capability. This fascinating brochure sheds light on what is really going in the minds of today's teens. It also includes tips for parents on how to stay engaged and involved on in their teen's life, even when it gets tough.
 
Also available for preorder is the new BILINGUAL book Sex: The Talk/ Sexo: El Diálogo. Written in both Spanish and English, this book answers many questions kids ask about sex, assisting parents and educators to communicate important sexual health information to adolescents in bilingual communities.
 
Reference:
1. Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008.300(5):520-9.

 

 

 

AIDS Prevention Expert Publicly Re-Affirms that 3/09 Comment on Condom Failure Was Correct. Once again, the director of Harvard's AIDS Prevention Research Project, Dr. Edward Green, has publicly affirmed at the 30th Annual Rimini Meeting for Friendship Among the Peoples, sponsored by the Communion and Liberation lay movement that "The condom does not prevent AIDS"…

"As a scientist [I] was amazed to see the closeness between what the Pope said last March in Cameroon and the results of the most recent scientific discoveries," said Dr. Green.  "The condom does not prevent AIDS. Only responsible sexual behavior can address the pandemic."

"When Benedict XVI said that different sexual behavior should be adopted in Africa, because to put trust in condoms does not serve to fight against AIDS," he continued, "the international press was scandalized."

On his first pastoral visit to Africa, he said that condoms only heighten the problem of AIDS, that  AIDS "is a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which even aggravates the problems," he told reporters.

Notable critics were notoriously pro-abortion former British Prime Minister Tony Blair and his wife Cherie.  Interestingly, Blair, who joined the Catholic Church in 2007, but has not repudiated his anti-life views, is a featured speaker at this year's Rimini event.

The Pope was supported at the time, however, by doctors, and by Dr. Green himself.

While affirming these comments, the AIDS expert also manifested a limited support for condoms in individual situations, a view that remains contrary to Catholic teaching. "The condom can work for particular individuals, but it will not serve to address the situation of a continent."

"To propose the regular use of the condom as prevention in Africa could have the opposite effect," he said.

Green pointed to the very notable success of the Ugandan 'ABC' strategy, which says, "Abstain, Be faithful, and, as a last resource, use a Condom."

"The Ugandan president was able to tell the truth to his people, to young people, that on occasions some sacrifice, abstinence and fidelity are necessary," he said.  "The result has been formidable."
[RIMINI, Italy, August 27, 2009, P. B. Craine, www.LifeSi

teNews.com]

 

 

CONDOMS : INTERVIEW WITH EDWARD GREEN ON AIDS PREVENTION IN AFRICA

Q: Some statistics show that African countries where condoms are more easily available are the same countries where Aids incidence is higher. Does this mean that condom distribution worsened the situation…?

A: …We do have studies that show how inconsistent condom use – which is also typical condom use – is worse than no condom use. And there is a prospective study in Uganda showing that intense condom promotion leads to riskier sexual behavior, along with suggestive evidence that this occurs elsewhere.

(Source: http://www.tempi.it/007320-liberal-academic-edward-green-pope-right-about-aids-and-condom?page=1; Abstinence Clearinghouse, 25Aug09)