Timothy F. Kirn

LOS ANGELES — Exclusive breast-feeding has now been convincingly shown to be associated with less transmission of HIV from infected mother to child than is breast-feeding that is sometimes supplemented with formula, Dr. Hoosen Coovadia said at the 14th Conference on Retroviruses and Opportunistic Infections.

“Most women in the world do not exclusively breast-feed,” said Dr. Coovadia in a lecture in which he discussed the dilemma currently facing Africa, where so many mothers are infected.

Treatment can prevent mother-to-child transmission of HIV during birth with great efficacy, but then the child faces the risk of becoming infected through mother's milk or getting diarrhea from food, water, or formula.

In the developing world, breast-feeding is preferable and the weight of the evidence now suggests that it is the less risky of the alternatives, but probably only if breast-feeding is done exclusively, he said. “Women should change to exclusive breast-feeding because it is associated with a lower rate of transmission,” said Dr. Coovadia, the Victor Daitz professor for HIV/AIDS research at the University of KwaZulu-Natal (South Africa).

To support his case for exclusive breast-feeding, Dr. Coovadia cited a number of studies being presented for the first time at the conference, in which the desirability of breast-feeding in those parts of the developing world with high HIV prevalence was a major topic.

Breast-feeding should be supported in principle because it is so highly nutritious and protective against disease, he said. Estimates suggest, for example, that breast-feeding is so important that it could prevent 13% of the deaths that currently occur in children younger than 5 years of age in low-income parts of the world. No other measure comes close to having that effect. In comparison, the Haemophilus influenzae vaccine could prevent only 4% of deaths (Lancet 2003;362:65–71).

Until now, much of the available information has suggested that the health risks of the two options (breast-feeding vs. using formula) in the developing world were similar, with a slight protective edge to breast-feeding, Dr. Coovadia said.

In one published study, breast-fed children not infected at birth who were born to infected mothers in Botswana were more likely to become infected than were formula-fed infants. But they had a slightly lower mortality at 18 months (JAMA 2006;296:794–805).

The rate at which children of infected mothers become infected themselves through breast-feeding is about 0.74% per mother, and that appears to remain constant throughout the child's first 2 years.

The most recent data, however, suggest that the transmission rate might be lower with exclusive breast-feeding, Dr. Coovadia said. One published study found that only 7% of children who were exclusively breast-fed had become infected by 18 months, compared with 14% of those who were only partially breast-fed (AIDS 2005;19:699–708).

A study in the Ivory Coast found that only about 6% of infants who were exclusively breast-fed became infected per year, compared with 32% of children who were breast-fed and supplemented.

And a late-breaking study presented at this meeting reported a rate of transmission of 4% at 140 days in children who were exclusively breast-fed, compared with 10% in children who were nonexclusively breast-fed, Dr. Coovadia noted.

ELSEVIER GLOBAL MEDICAL NEWS

LOS ANGELES — Exclusive breast-feeding has now been convincingly shown to be associated with less transmission of HIV from infected mother to child than is breast-feeding that is sometimes supplemented with formula, Dr. Hoosen Coovadia said at the 14th Conference on Retroviruses and Opportunistic Infections.

“Most women in the world do not exclusively breast-feed,” said Dr. Coovadia in a lecture in which he discussed the dilemma currently facing Africa, where so many mothers are infected.

Treatment can prevent mother-to-child transmission of HIV during birth with great efficacy, but then the child faces the risk of becoming infected through mother's milk or getting diarrhea from food, water, or formula.

In the developing world, breast-feeding is preferable and the weight of the evidence now suggests that it is the less risky of the alternatives, but probably only if breast-feeding is done exclusively, he said. “Women should change to exclusive breast-feeding because it is associated with a lower rate of transmission,” said Dr. Coovadia, the Victor Daitz professor for HIV/AIDS research at the University of KwaZulu-Natal (South Africa).

To support his case for exclusive breast-feeding, Dr. Coovadia cited a number of studies being presented for the first time at the conference, in which the desirability of breast-feeding in those parts of the developing world with high HIV prevalence was a major topic.

Breast-feeding should be supported in principle because it is so highly nutritious and protective against disease, he said. Estimates suggest, for example, that breast-feeding is so important that it could prevent 13% of the deaths that currently occur in children younger than 5 years of age in low-income parts of the world. No other measure comes close to having that effect. In comparison, the Haemophilus influenzae vaccine could prevent only 4% of deaths (Lancet 2003;362:65–71).

Until now, much of the available information has suggested that the health risks of the two options (breast-feeding vs. using formula) in the developing world were similar, with a slight protective edge to breast-feeding, Dr. Coovadia said.

In one published study, breast-fed children not infected at birth who were born to infected mothers in Botswana were more likely to become infected than were formula-fed infants. But they had a slightly lower mortality at 18 months (JAMA 2006;296:794–805).

The rate at which children of infected mothers become infected themselves through breast-feeding is about 0.74% per mother, and that appears to remain constant throughout the child's first 2 years.

The most recent data, however, suggest that the transmission rate might be lower with exclusive breast-feeding, Dr. Coovadia said. One published study found that only 7% of children who were exclusively breast-fed had become infected by 18 months, compared with 14% of those who were only partially breast-fed (AIDS 2005;19:699–708).

A study in the Ivory Coast found that only about 6% of infants who were exclusively breast-fed became infected per year, compared with 32% of children who were breast-fed and supplemented.

And a late-breaking study presented at this meeting reported a rate of transmission of 4% at 140 days in children who were exclusively breast-fed, compared with 10% in children who were nonexclusively breast-fed, Dr. Coovadia noted.

ELSEVIER GLOBAL MEDICAL NEWS

LOS ANGELES — Exclusive breast-feeding has now been convincingly shown to be associated with less transmission of HIV from infected mother to child than is breast-feeding that is sometimes supplemented with formula, Dr. Hoosen Coovadia said at the 14th Conference on Retroviruses and Opportunistic Infections.

“Most women in the world do not exclusively breast-feed,” said Dr. Coovadia in a lecture in which he discussed the dilemma currently facing Africa, where so many mothers are infected.

Treatment can prevent mother-to-child transmission of HIV during birth with great efficacy, but then the child faces the risk of becoming infected through mother's milk or getting diarrhea from food, water, or formula.

In the developing world, breast-feeding is preferable and the weight of the evidence now suggests that it is the less risky of the alternatives, but probably only if breast-feeding is done exclusively, he said. “Women should change to exclusive breast-feeding because it is associated with a lower rate of transmission,” said Dr. Coovadia, the Victor Daitz professor for HIV/AIDS research at the University of KwaZulu-Natal (South Africa).

To support his case for exclusive breast-feeding, Dr. Coovadia cited a number of studies being presented for the first time at the conference, in which the desirability of breast-feeding in those parts of the developing world with high HIV prevalence was a major topic.

Breast-feeding should be supported in principle because it is so highly nutritious and protective against disease, he said. Estimates suggest, for example, that breast-feeding is so important that it could prevent 13% of the deaths that currently occur in children younger than 5 years of age in low-income parts of the world. No other measure comes close to having that effect. In comparison, the Haemophilus influenzae vaccine could prevent only 4% of deaths (Lancet 2003;362:65–71).

Until now, much of the available information has suggested that the health risks of the two options (breast-feeding vs. using formula) in the developing world were similar, with a slight protective edge to breast-feeding, Dr. Coovadia said.

In one published study, breast-fed children not infected at birth who were born to infected mothers in Botswana were more likely to become infected than were formula-fed infants. But they had a slightly lower mortality at 18 months (JAMA 2006;296:794–805).

The rate at which children of infected mothers become infected themselves through breast-feeding is about 0.74% per mother, and that appears to remain constant throughout the child's first 2 years.

The most recent data, however, suggest that the transmission rate might be lower with exclusive breast-feeding, Dr. Coovadia said. One published study found that only 7% of children who were exclusively breast-fed had become infected by 18 months, compared with 14% of those who were only partially breast-fed (AIDS 2005;19:699–708).

A study in the Ivory Coast found that only about 6% of infants who were exclusively breast-fed became infected per year, compared with 32% of children who were breast-fed and supplemented.

And a late-breaking study presented at this meeting reported a rate of transmission of 4% at 140 days in children who were exclusively breast-fed, compared with 10% in children who were nonexclusively breast-fed, Dr. Coovadia noted.

ELSEVIER GLOBAL MEDICAL NEWS

SAN DIEGO – The Internet is expanding the number of sexual predators who prey on children, because the anonymity of the computer allows these individuals to start indulging their fantasies actively with impunity, several speakers said at a conference on sexual and physical abuse of children.

If there is one thing he has learned from doing a television series about Internet sexual predators, it is that strangers who will attempt to get close to children “are not just the guys who would have prowled the parks in the past,” said Chris Hansen, a television journalist who has been doing a series called “To Catch a Predator” for NBC News Dateline.

In the series, Mr. Hansen and his colleagues pose as young girls interested in sex who converse in Internet chat rooms and try to lure the men to a house where the cameras and the police await them.

So far, they have caught men from all occupations, including teachers, doctors, a New York City firefighter, and even a rabbi, Mr. Hansen noted at the conference, which was sponsored by the Chadwick Center for Children and Families at Children's Hospital and Health Center, San Diego.

Mr. Hansen said he was astounded at the number of men coaxed to the houses the network has developed for the series. In addition, he's been amazed by how varied the backgrounds of the men have been.

The series has set up houses in nine cities so far and has caught hundreds of men. In Long Beach, Calif., for example, 51 men have been arrested for their Internet chats and for showing up at the house; 12 of them already have pleaded no contest.

The rabbi caught by the series, David Kaye, in Fairfax County, Va., may have been the most surprising and illustrates how the Internet is widening the ranks of child predators, Mr. Hansen said.

The rabbi had no previous record of sexual misconduct, and he had been involved in work with Jewish high school students.

Mr. Kaye, recently sentenced to 6 years in federal prison, will have his name on a sexual predators list for at least 10 years.

Law enforcement officials estimate that there may be as many as 50,000 sexual predators of children online, said Lieut. Chad Bianco of the Riverside County (Calif.) Sheriff's Department, which cooperated with the series.

The Internet has “allowed all these strangers right into the bedroom,” he said. “The access the Internet allows these people is just incredible.”

Adults tend to use the Internet to access data, while children tend to use it to make social connections. But children often are not properly supervised, because young people tend to be more computer literate than adults are, Lieut. Bianco said.

And that problem has affected even his own family, which is surprising since he has been involved with the television series, and everyone in the family is aware of it, he said.

His underage niece lives with his in-laws, who are relatively computer illiterate. When he was on their computer recently, he discovered that his niece was involved in electronic conversations with a number of adult men, he said.

The Internet and its clandestine opportunities probably are bringing about an explosion of child pornography as well, which directly contributes to the problem of predation, said Ms. Regina B. Schofield, an assistant attorney general in the U.S. Department of Justice.

She said that the initial estimate of the number of pornographic images of children available on the Internet was about 100,000. Now, data indicate that there are probably 3.5 million images, and Internet child pornography is thought to be a $20 billion a year industry.

When investigators have interviewed those arrested for having child pornography, those individuals have said they used the images for masturbation and also as fuel to help act out their fantasies, Ms. Schofield said.

One of the solutions to the problem is that parents and caretakers need to talk with their children and remind them of the dangers of the Internet–as well as the inappropriateness of communications with unknown adults, Lieut. Bianco and the other speakers said.

Turning off the computer at home is not protection enough, because anyone can go down to the local coffee shop and access a wireless connection, the speakers said.

“Dateline's” Chris Hansen confronts a potential online sexual predator during an investigation in Petaluma, Calif. Dateline NBC

SAN DIEGO – The Internet is expanding the number of sexual predators who prey on children, because the anonymity of the computer allows these individuals to start indulging their fantasies actively with impunity, several speakers said at a conference on sexual and physical abuse of children.

If there is one thing he has learned from doing a television series about Internet sexual predators, it is that strangers who will attempt to get close to children “are not just the guys who would have prowled the parks in the past,” said Chris Hansen, a television journalist who has been doing a series called “To Catch a Predator” for NBC News Dateline.

In the series, Mr. Hansen and his colleagues pose as young girls interested in sex who converse in Internet chat rooms and try to lure the men to a house where the cameras and the police await them.

So far, they have caught men from all occupations, including teachers, doctors, a New York City firefighter, and even a rabbi, Mr. Hansen noted at the conference, which was sponsored by the Chadwick Center for Children and Families at Children's Hospital and Health Center, San Diego.

Mr. Hansen said he was astounded at the number of men coaxed to the houses the network has developed for the series. In addition, he's been amazed by how varied the backgrounds of the men have been.

The series has set up houses in nine cities so far and has caught hundreds of men. In Long Beach, Calif., for example, 51 men have been arrested for their Internet chats and for showing up at the house; 12 of them already have pleaded no contest.

The rabbi caught by the series, David Kaye, in Fairfax County, Va., may have been the most surprising and illustrates how the Internet is widening the ranks of child predators, Mr. Hansen said.

The rabbi had no previous record of sexual misconduct, and he had been involved in work with Jewish high school students.

Mr. Kaye, recently sentenced to 6 years in federal prison, will have his name on a sexual predators list for at least 10 years.

Law enforcement officials estimate that there may be as many as 50,000 sexual predators of children online, said Lieut. Chad Bianco of the Riverside County (Calif.) Sheriff's Department, which cooperated with the series.

The Internet has “allowed all these strangers right into the bedroom,” he said. “The access the Internet allows these people is just incredible.”

Adults tend to use the Internet to access data, while children tend to use it to make social connections. But children often are not properly supervised, because young people tend to be more computer literate than adults are, Lieut. Bianco said.

And that problem has affected even his own family, which is surprising since he has been involved with the television series, and everyone in the family is aware of it, he said.

His underage niece lives with his in-laws, who are relatively computer illiterate. When he was on their computer recently, he discovered that his niece was involved in electronic conversations with a number of adult men, he said.

The Internet and its clandestine opportunities probably are bringing about an explosion of child pornography as well, which directly contributes to the problem of predation, said Ms. Regina B. Schofield, an assistant attorney general in the U.S. Department of Justice.

She said that the initial estimate of the number of pornographic images of children available on the Internet was about 100,000. Now, data indicate that there are probably 3.5 million images, and Internet child pornography is thought to be a $20 billion a year industry.

When investigators have interviewed those arrested for having child pornography, those individuals have said they used the images for masturbation and also as fuel to help act out their fantasies, Ms. Schofield said.

One of the solutions to the problem is that parents and caretakers need to talk with their children and remind them of the dangers of the Internet–as well as the inappropriateness of communications with unknown adults, Lieut. Bianco and the other speakers said.

Turning off the computer at home is not protection enough, because anyone can go down to the local coffee shop and access a wireless connection, the speakers said.

“Dateline's” Chris Hansen confronts a potential online sexual predator during an investigation in Petaluma, Calif. Dateline NBC

SAN DIEGO – The Internet is expanding the number of sexual predators who prey on children, because the anonymity of the computer allows these individuals to start indulging their fantasies actively with impunity, several speakers said at a conference on sexual and physical abuse of children.

If there is one thing he has learned from doing a television series about Internet sexual predators, it is that strangers who will attempt to get close to children “are not just the guys who would have prowled the parks in the past,” said Chris Hansen, a television journalist who has been doing a series called “To Catch a Predator” for NBC News Dateline.

In the series, Mr. Hansen and his colleagues pose as young girls interested in sex who converse in Internet chat rooms and try to lure the men to a house where the cameras and the police await them.

So far, they have caught men from all occupations, including teachers, doctors, a New York City firefighter, and even a rabbi, Mr. Hansen noted at the conference, which was sponsored by the Chadwick Center for Children and Families at Children's Hospital and Health Center, San Diego.

Mr. Hansen said he was astounded at the number of men coaxed to the houses the network has developed for the series. In addition, he's been amazed by how varied the backgrounds of the men have been.

The series has set up houses in nine cities so far and has caught hundreds of men. In Long Beach, Calif., for example, 51 men have been arrested for their Internet chats and for showing up at the house; 12 of them already have pleaded no contest.

The rabbi caught by the series, David Kaye, in Fairfax County, Va., may have been the most surprising and illustrates how the Internet is widening the ranks of child predators, Mr. Hansen said.

The rabbi had no previous record of sexual misconduct, and he had been involved in work with Jewish high school students.

Mr. Kaye, recently sentenced to 6 years in federal prison, will have his name on a sexual predators list for at least 10 years.

Law enforcement officials estimate that there may be as many as 50,000 sexual predators of children online, said Lieut. Chad Bianco of the Riverside County (Calif.) Sheriff's Department, which cooperated with the series.

The Internet has “allowed all these strangers right into the bedroom,” he said. “The access the Internet allows these people is just incredible.”

Adults tend to use the Internet to access data, while children tend to use it to make social connections. But children often are not properly supervised, because young people tend to be more computer literate than adults are, Lieut. Bianco said.

And that problem has affected even his own family, which is surprising since he has been involved with the television series, and everyone in the family is aware of it, he said.

His underage niece lives with his in-laws, who are relatively computer illiterate. When he was on their computer recently, he discovered that his niece was involved in electronic conversations with a number of adult men, he said.

The Internet and its clandestine opportunities probably are bringing about an explosion of child pornography as well, which directly contributes to the problem of predation, said Ms. Regina B. Schofield, an assistant attorney general in the U.S. Department of Justice.

She said that the initial estimate of the number of pornographic images of children available on the Internet was about 100,000. Now, data indicate that there are probably 3.5 million images, and Internet child pornography is thought to be a $20 billion a year industry.

When investigators have interviewed those arrested for having child pornography, those individuals have said they used the images for masturbation and also as fuel to help act out their fantasies, Ms. Schofield said.

One of the solutions to the problem is that parents and caretakers need to talk with their children and remind them of the dangers of the Internet–as well as the inappropriateness of communications with unknown adults, Lieut. Bianco and the other speakers said.

Turning off the computer at home is not protection enough, because anyone can go down to the local coffee shop and access a wireless connection, the speakers said.

“Dateline's” Chris Hansen confronts a potential online sexual predator during an investigation in Petaluma, Calif. Dateline NBC

LOS ANGELES — Surveillance data indicate that 10% of people in the United States who become infected with HIV have acquired a virus with some resistance, Dr. Ulana Bodnar said at the 14th Conference on Retroviruses and Opportunistic Infections.

The 11-state survey represents the largest survey done to date regarding HIV resistance. The survey, which looked at specimens from 3,130 newly diagnosed, drug-naive individuals, found that 4% of infections had mutations conferring resistance to nucleoside reverse transcriptase inhibitors, 7% to nonnucleoside reverse transcriptase inhibitors, and 2% to protease inhibitors.

The percentages add up to more than 10% because some viruses were resistant to more than one class of drug.

Multidrug resistance was found in 2% of individuals, with 0.5% having resistance to drugs in all three classes, reported Dr. Bodnar, of the Centers for Disease Control and Prevention, Atlanta.

Overall, 94% were infected with subtype B virus. After subtype B, subtypes C and CRF02-AG were the most common, accounting for 2% and 1% of the infections, respectively, he said in a poster presentation.

The non-B variants were somewhat less likely to have resistance than were the B subtypes (8% vs. 11%); however, the ?difference was not statistically significant.

The findings of the survey “are consistent with what other studies have shown over the past 5 years,” Dr. Bodnar said in an interview. “It is a good baseline with which to consider the data we get down the road.”

The 11 states included in the survey were Colorado, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, North Carolina, South Carolina, Virginia, and Washington. The specimens came from a total of 409 sites.

LOS ANGELES — Surveillance data indicate that 10% of people in the United States who become infected with HIV have acquired a virus with some resistance, Dr. Ulana Bodnar said at the 14th Conference on Retroviruses and Opportunistic Infections.

The 11-state survey represents the largest survey done to date regarding HIV resistance. The survey, which looked at specimens from 3,130 newly diagnosed, drug-naive individuals, found that 4% of infections had mutations conferring resistance to nucleoside reverse transcriptase inhibitors, 7% to nonnucleoside reverse transcriptase inhibitors, and 2% to protease inhibitors.

The percentages add up to more than 10% because some viruses were resistant to more than one class of drug.

Multidrug resistance was found in 2% of individuals, with 0.5% having resistance to drugs in all three classes, reported Dr. Bodnar, of the Centers for Disease Control and Prevention, Atlanta.

Overall, 94% were infected with subtype B virus. After subtype B, subtypes C and CRF02-AG were the most common, accounting for 2% and 1% of the infections, respectively, he said in a poster presentation.

The non-B variants were somewhat less likely to have resistance than were the B subtypes (8% vs. 11%); however, the ?difference was not statistically significant.

The findings of the survey “are consistent with what other studies have shown over the past 5 years,” Dr. Bodnar said in an interview. “It is a good baseline with which to consider the data we get down the road.”

The 11 states included in the survey were Colorado, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, North Carolina, South Carolina, Virginia, and Washington. The specimens came from a total of 409 sites.

LOS ANGELES — Surveillance data indicate that 10% of people in the United States who become infected with HIV have acquired a virus with some resistance, Dr. Ulana Bodnar said at the 14th Conference on Retroviruses and Opportunistic Infections.

The 11-state survey represents the largest survey done to date regarding HIV resistance. The survey, which looked at specimens from 3,130 newly diagnosed, drug-naive individuals, found that 4% of infections had mutations conferring resistance to nucleoside reverse transcriptase inhibitors, 7% to nonnucleoside reverse transcriptase inhibitors, and 2% to protease inhibitors.

The percentages add up to more than 10% because some viruses were resistant to more than one class of drug.

Multidrug resistance was found in 2% of individuals, with 0.5% having resistance to drugs in all three classes, reported Dr. Bodnar, of the Centers for Disease Control and Prevention, Atlanta.

Overall, 94% were infected with subtype B virus. After subtype B, subtypes C and CRF02-AG were the most common, accounting for 2% and 1% of the infections, respectively, he said in a poster presentation.

The non-B variants were somewhat less likely to have resistance than were the B subtypes (8% vs. 11%); however, the ?difference was not statistically significant.

The findings of the survey “are consistent with what other studies have shown over the past 5 years,” Dr. Bodnar said in an interview. “It is a good baseline with which to consider the data we get down the road.”

The 11 states included in the survey were Colorado, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, North Carolina, South Carolina, Virginia, and Washington. The specimens came from a total of 409 sites.

VAIL, COLO. — Girls and young women who engage in sports will have enhanced performance and less risk of anterior cruciate ligament injury with specific strength and proprioceptive training that lasts only 15 minutes rather than a longer session, Dr. Theodore J. Ganley said at a meeting sponsored by the American Academy of Pediatrics.

Athletes are much more likely to be consistent and stick with a 15-minute-a-day program—which can substitute for a traditional warm-up at sports practice—than with one that requires long workouts. And, coaches can be sold on incorporating such a program by being told that the evidence suggests it improves performance, said Dr. Ganley, the orthopedic director of sports medicine at Children's Hospital of Philadelphia.

Since the 1970s, females have been participating in organized sport much more, and there has been a 1,000-fold increase in the number of anterior cruciate ligament (ACL) injuries in women, Dr. Ganley noted. Depending on the sport, females may injure their ACLs eight times more often than males.

And, in a review of participation and injury Dr. Ganley conducted for Pop Warner Football, he found that cheerleaders actually had a higher injury rate—including knee injuries—than the football players did.

In a large, 2-year study of high-school-age female soccer players, a 15-minute-a-day program similar to that recommended by Dr. Ganley reduced ACL injury risk by 88% in the trained athletes, compared with controls in the first year, and 74% in the second year (Am. J. Sports Med. 2005;33:1003–10).

Several physical and proprioceptive factors have been identified that might be associated with female's increased risk, but attention recently has focused on the fact that many women have greater knee abduction when they land from a jump, Dr. Ganley said.

The goal of much of the training is to train girls and women not to have such “valgus-biased” landings, he said.

Other research has suggested that females might be at increased risk because when they land from a jump, they do so with upright posture and straight knees, which may allow the quadriceps to pull the tibia more forward in relation to the femur.

The training program Dr. Ganley used with the female soccer players began with leg and hip stretches, and then moved to exercises designed to increase strength and proprioception. Those exercises include one known as the Russian hamstring, as well as lunges, runs, and jumps.

The program, known as PEP (Prevent Injury, Enhance Performance), was developed by the Santa Monica (Calif.) Orthopaedic and Sports Medicine Group. It can be found at www.aclprevent.com

Since the 1970s, there has been a 1,000-fold increase in the number of ACL injuries in women. Depending on the sport, females may injure their ACLs eight times more often than males. ©photoaged/FOTOLIA

VAIL, COLO. — Girls and young women who engage in sports will have enhanced performance and less risk of anterior cruciate ligament injury with specific strength and proprioceptive training that lasts only 15 minutes rather than a longer session, Dr. Theodore J. Ganley said at a meeting sponsored by the American Academy of Pediatrics.

Athletes are much more likely to be consistent and stick with a 15-minute-a-day program—which can substitute for a traditional warm-up at sports practice—than with one that requires long workouts. And, coaches can be sold on incorporating such a program by being told that the evidence suggests it improves performance, said Dr. Ganley, the orthopedic director of sports medicine at Children's Hospital of Philadelphia.

Since the 1970s, females have been participating in organized sport much more, and there has been a 1,000-fold increase in the number of anterior cruciate ligament (ACL) injuries in women, Dr. Ganley noted. Depending on the sport, females may injure their ACLs eight times more often than males.

And, in a review of participation and injury Dr. Ganley conducted for Pop Warner Football, he found that cheerleaders actually had a higher injury rate—including knee injuries—than the football players did.

In a large, 2-year study of high-school-age female soccer players, a 15-minute-a-day program similar to that recommended by Dr. Ganley reduced ACL injury risk by 88% in the trained athletes, compared with controls in the first year, and 74% in the second year (Am. J. Sports Med. 2005;33:1003–10).

Several physical and proprioceptive factors have been identified that might be associated with female's increased risk, but attention recently has focused on the fact that many women have greater knee abduction when they land from a jump, Dr. Ganley said.

The goal of much of the training is to train girls and women not to have such “valgus-biased” landings, he said.

Other research has suggested that females might be at increased risk because when they land from a jump, they do so with upright posture and straight knees, which may allow the quadriceps to pull the tibia more forward in relation to the femur.

The training program Dr. Ganley used with the female soccer players began with leg and hip stretches, and then moved to exercises designed to increase strength and proprioception. Those exercises include one known as the Russian hamstring, as well as lunges, runs, and jumps.

The program, known as PEP (Prevent Injury, Enhance Performance), was developed by the Santa Monica (Calif.) Orthopaedic and Sports Medicine Group. It can be found at www.aclprevent.com

Since the 1970s, there has been a 1,000-fold increase in the number of ACL injuries in women. Depending on the sport, females may injure their ACLs eight times more often than males. ©photoaged/FOTOLIA

VAIL, COLO. — Girls and young women who engage in sports will have enhanced performance and less risk of anterior cruciate ligament injury with specific strength and proprioceptive training that lasts only 15 minutes rather than a longer session, Dr. Theodore J. Ganley said at a meeting sponsored by the American Academy of Pediatrics.

Athletes are much more likely to be consistent and stick with a 15-minute-a-day program—which can substitute for a traditional warm-up at sports practice—than with one that requires long workouts. And, coaches can be sold on incorporating such a program by being told that the evidence suggests it improves performance, said Dr. Ganley, the orthopedic director of sports medicine at Children's Hospital of Philadelphia.

Since the 1970s, females have been participating in organized sport much more, and there has been a 1,000-fold increase in the number of anterior cruciate ligament (ACL) injuries in women, Dr. Ganley noted. Depending on the sport, females may injure their ACLs eight times more often than males.

And, in a review of participation and injury Dr. Ganley conducted for Pop Warner Football, he found that cheerleaders actually had a higher injury rate—including knee injuries—than the football players did.

In a large, 2-year study of high-school-age female soccer players, a 15-minute-a-day program similar to that recommended by Dr. Ganley reduced ACL injury risk by 88% in the trained athletes, compared with controls in the first year, and 74% in the second year (Am. J. Sports Med. 2005;33:1003–10).

Several physical and proprioceptive factors have been identified that might be associated with female's increased risk, but attention recently has focused on the fact that many women have greater knee abduction when they land from a jump, Dr. Ganley said.

The goal of much of the training is to train girls and women not to have such “valgus-biased” landings, he said.

Other research has suggested that females might be at increased risk because when they land from a jump, they do so with upright posture and straight knees, which may allow the quadriceps to pull the tibia more forward in relation to the femur.

The training program Dr. Ganley used with the female soccer players began with leg and hip stretches, and then moved to exercises designed to increase strength and proprioception. Those exercises include one known as the Russian hamstring, as well as lunges, runs, and jumps.

The program, known as PEP (Prevent Injury, Enhance Performance), was developed by the Santa Monica (Calif.) Orthopaedic and Sports Medicine Group. It can be found at www.aclprevent.com

Since the 1970s, there has been a 1,000-fold increase in the number of ACL injuries in women. Depending on the sport, females may injure their ACLs eight times more often than males. ©photoaged/FOTOLIA

VAIL, COLO. — Cough-variant asthma is “markedly overdiagnosed” in children, Dr. Carolyn M. Kercsmar said at a meeting sponsored by the American Academy of Pediatrics.

These children sometimes end up being treated with a number of different asthma drugs they do not need because nothing works, said Dr. Kercsmar, director of the children's asthma center at Rainbow Babies and Children's Hospital, Cleveland.

Some of the overdiagnosis results from the fact that children presumed to have cough-variant asthma are not evaluated for evidence of airway obstruction. And, while some children with cough-variant asthma do not have wheezing obstruction, if a physician cannot demonstrate airway obstruction with abnormal spirometry testing results, or if the child does not respond to a bronchodilator, then the physician should not diagnose cough-variant asthma, she said.

Physicians can institute a trial of an inhaled corticosteroid, but it should only be given 2 weeks. “If that cough is not gone in 1–2 weeks, it is not asthma,” she said.

Most children with asthma will have a strong family history of either asthma or allergy in a first-degree relative, and that also can be an important piece of information to use for diagnosis.

A methacholine challenge test “can be useful, but not entirely diagnostic” because 10% of normal, nonasthmatic individuals react to a challenge, she said.

A study conducted by investigators at the University of Leicester (England) suggested how uncommon cough-variant asthma may be among children with a chronic cough, Dr. Kercsmar noted.

The study followed 125 preschool children with a reported recurrent cough for between 2 and 4 years. Over the follow-up period, 56% of the children lost their cough and 37% had continued chronic cough. But, only 7% went on to develop asthmalike wheezing, and that percentage was no different from those in a comparison control group (Pediatr. Pulmonol. 1998;26:256–61).

Estimates of asthma suggest that anywhere from 6% to 15% of children will have asthma at some time, but only about 5%–10% of children with asthma will have cough primarily, Dr. Kercsmar said.

VAIL, COLO. — Cough-variant asthma is “markedly overdiagnosed” in children, Dr. Carolyn M. Kercsmar said at a meeting sponsored by the American Academy of Pediatrics.

These children sometimes end up being treated with a number of different asthma drugs they do not need because nothing works, said Dr. Kercsmar, director of the children's asthma center at Rainbow Babies and Children's Hospital, Cleveland.

Some of the overdiagnosis results from the fact that children presumed to have cough-variant asthma are not evaluated for evidence of airway obstruction. And, while some children with cough-variant asthma do not have wheezing obstruction, if a physician cannot demonstrate airway obstruction with abnormal spirometry testing results, or if the child does not respond to a bronchodilator, then the physician should not diagnose cough-variant asthma, she said.

Physicians can institute a trial of an inhaled corticosteroid, but it should only be given 2 weeks. “If that cough is not gone in 1–2 weeks, it is not asthma,” she said.

Most children with asthma will have a strong family history of either asthma or allergy in a first-degree relative, and that also can be an important piece of information to use for diagnosis.

A methacholine challenge test “can be useful, but not entirely diagnostic” because 10% of normal, nonasthmatic individuals react to a challenge, she said.

A study conducted by investigators at the University of Leicester (England) suggested how uncommon cough-variant asthma may be among children with a chronic cough, Dr. Kercsmar noted.

The study followed 125 preschool children with a reported recurrent cough for between 2 and 4 years. Over the follow-up period, 56% of the children lost their cough and 37% had continued chronic cough. But, only 7% went on to develop asthmalike wheezing, and that percentage was no different from those in a comparison control group (Pediatr. Pulmonol. 1998;26:256–61).

Estimates of asthma suggest that anywhere from 6% to 15% of children will have asthma at some time, but only about 5%–10% of children with asthma will have cough primarily, Dr. Kercsmar said.

VAIL, COLO. — Cough-variant asthma is “markedly overdiagnosed” in children, Dr. Carolyn M. Kercsmar said at a meeting sponsored by the American Academy of Pediatrics.

These children sometimes end up being treated with a number of different asthma drugs they do not need because nothing works, said Dr. Kercsmar, director of the children's asthma center at Rainbow Babies and Children's Hospital, Cleveland.

Some of the overdiagnosis results from the fact that children presumed to have cough-variant asthma are not evaluated for evidence of airway obstruction. And, while some children with cough-variant asthma do not have wheezing obstruction, if a physician cannot demonstrate airway obstruction with abnormal spirometry testing results, or if the child does not respond to a bronchodilator, then the physician should not diagnose cough-variant asthma, she said.

Physicians can institute a trial of an inhaled corticosteroid, but it should only be given 2 weeks. “If that cough is not gone in 1–2 weeks, it is not asthma,” she said.

Most children with asthma will have a strong family history of either asthma or allergy in a first-degree relative, and that also can be an important piece of information to use for diagnosis.

A methacholine challenge test “can be useful, but not entirely diagnostic” because 10% of normal, nonasthmatic individuals react to a challenge, she said.

A study conducted by investigators at the University of Leicester (England) suggested how uncommon cough-variant asthma may be among children with a chronic cough, Dr. Kercsmar noted.

The study followed 125 preschool children with a reported recurrent cough for between 2 and 4 years. Over the follow-up period, 56% of the children lost their cough and 37% had continued chronic cough. But, only 7% went on to develop asthmalike wheezing, and that percentage was no different from those in a comparison control group (Pediatr. Pulmonol. 1998;26:256–61).

Estimates of asthma suggest that anywhere from 6% to 15% of children will have asthma at some time, but only about 5%–10% of children with asthma will have cough primarily, Dr. Kercsmar said.

VAIL, COLO. — The new asthma drug Symbicort can be used by patients as both their controller medication and their relief medication, Dr. Carolyn M. Kercsmar said at a meeting sponsored by the American Academy of Pediatrics.

This is because one of the two components of the drug—formoterol—is a long-acting β₂-agonist with a rapid onset, said Dr. Kercsmar, director of the children's asthma center at Rainbow Babies & Children's Hospital, Cleveland.

The new product—a combination of the corticosteroid budesonide and formoterol (in formulations of 80/4.5 mcg and 160/4.5 mcg per inhalation)—was approved for use in the United States in July.

A growing number of trials have shown that when asthma patients have used the combination, exacerbations dropped greatly—and by as much as 79% versus fixed-dose regimens in a recent pediatric study.

That study randomized 341 children (aged 4–11 years) with asthma into three treatment groups: maintenance treatment with Symbicort, plus as-needed use; treatment with a fixed formulation of budesonide/formoterol at the same dose, plus terbutaline as rescue medicine; or treatment with a fourfold higher maintenance dose of budesonide, plus terbutaline as rescue medicine (Chest 2006;130:1733–43).

The reduction in exacerbations is thought to result from the fact that, when patients feel an asthma attack coming on and use Symbicort as a β₂-agonist reliever medication, they also get some additional corticosteroid.

Formoterol has an onset of action of fewer than 15 minutes. The other combination product available in the United States—Advair—contains the long-acting β₂-agonist salmeterol, which does not act so rapidly, she said.

Formoterol “starts working just as fast as albuterol,” said Dr. Kercsmar, who has no financial links to Symbicort or its maker, AstraZeneca Pharmaceuticals LP.

“You're not going to reach for your albuterol; you're going to reach for this and take a puff instead,” she added.

The Symbicort studies have shown that even with this type of use, patients do not get exposed to excessive doses of corticosteroid. Probably, they are achieving greater asthma control over the long term, and not using reliever medication as much.

In the pediatric study, only 6 of 118 (5%) patients using Symbicort for control and rescue ever used it seven or more times a day at one time, compared with 23% on the fixed-dose regimen and 15% on the fixed-dose budesonide; the average rescue use with Symbicort was 0.58 times per day, compared with 0.76 and 0.74 in the other two groups, respectively. The study reported that the yearly growth of the patients on the Symbicort was better than that of patients assigned to only budesonide.

“This decreases exacerbations in a very, very safe fashion,” she said.

Dr. Kercsmar said she intends to advise patients to use Symbicort as a reliever the same way she would advise them to use albuterol. They should use it when they begin to feel an asthma attack, and wait 4 hours before using it again, and should contact a health care provider if they need to use it three times within 12 hours, she said. However, the initial Food and Drug Administration-approved labeling will reflect daily scheduled use as a controlled medication only.

VAIL, COLO. — The new asthma drug Symbicort can be used by patients as both their controller medication and their relief medication, Dr. Carolyn M. Kercsmar said at a meeting sponsored by the American Academy of Pediatrics.

This is because one of the two components of the drug—formoterol—is a long-acting β₂-agonist with a rapid onset, said Dr. Kercsmar, director of the children's asthma center at Rainbow Babies & Children's Hospital, Cleveland.

The new product—a combination of the corticosteroid budesonide and formoterol (in formulations of 80/4.5 mcg and 160/4.5 mcg per inhalation)—was approved for use in the United States in July.

A growing number of trials have shown that when asthma patients have used the combination, exacerbations dropped greatly—and by as much as 79% versus fixed-dose regimens in a recent pediatric study.

That study randomized 341 children (aged 4–11 years) with asthma into three treatment groups: maintenance treatment with Symbicort, plus as-needed use; treatment with a fixed formulation of budesonide/formoterol at the same dose, plus terbutaline as rescue medicine; or treatment with a fourfold higher maintenance dose of budesonide, plus terbutaline as rescue medicine (Chest 2006;130:1733–43).

The reduction in exacerbations is thought to result from the fact that, when patients feel an asthma attack coming on and use Symbicort as a β₂-agonist reliever medication, they also get some additional corticosteroid.

Formoterol has an onset of action of fewer than 15 minutes. The other combination product available in the United States—Advair—contains the long-acting β₂-agonist salmeterol, which does not act so rapidly, she said.

Formoterol “starts working just as fast as albuterol,” said Dr. Kercsmar, who has no financial links to Symbicort or its maker, AstraZeneca Pharmaceuticals LP.

“You're not going to reach for your albuterol; you're going to reach for this and take a puff instead,” she added.

The Symbicort studies have shown that even with this type of use, patients do not get exposed to excessive doses of corticosteroid. Probably, they are achieving greater asthma control over the long term, and not using reliever medication as much.

In the pediatric study, only 6 of 118 (5%) patients using Symbicort for control and rescue ever used it seven or more times a day at one time, compared with 23% on the fixed-dose regimen and 15% on the fixed-dose budesonide; the average rescue use with Symbicort was 0.58 times per day, compared with 0.76 and 0.74 in the other two groups, respectively. The study reported that the yearly growth of the patients on the Symbicort was better than that of patients assigned to only budesonide.

“This decreases exacerbations in a very, very safe fashion,” she said.

Dr. Kercsmar said she intends to advise patients to use Symbicort as a reliever the same way she would advise them to use albuterol. They should use it when they begin to feel an asthma attack, and wait 4 hours before using it again, and should contact a health care provider if they need to use it three times within 12 hours, she said. However, the initial Food and Drug Administration-approved labeling will reflect daily scheduled use as a controlled medication only.

VAIL, COLO. — The new asthma drug Symbicort can be used by patients as both their controller medication and their relief medication, Dr. Carolyn M. Kercsmar said at a meeting sponsored by the American Academy of Pediatrics.

This is because one of the two components of the drug—formoterol—is a long-acting β₂-agonist with a rapid onset, said Dr. Kercsmar, director of the children's asthma center at Rainbow Babies & Children's Hospital, Cleveland.

The new product—a combination of the corticosteroid budesonide and formoterol (in formulations of 80/4.5 mcg and 160/4.5 mcg per inhalation)—was approved for use in the United States in July.

A growing number of trials have shown that when asthma patients have used the combination, exacerbations dropped greatly—and by as much as 79% versus fixed-dose regimens in a recent pediatric study.

That study randomized 341 children (aged 4–11 years) with asthma into three treatment groups: maintenance treatment with Symbicort, plus as-needed use; treatment with a fixed formulation of budesonide/formoterol at the same dose, plus terbutaline as rescue medicine; or treatment with a fourfold higher maintenance dose of budesonide, plus terbutaline as rescue medicine (Chest 2006;130:1733–43).

The reduction in exacerbations is thought to result from the fact that, when patients feel an asthma attack coming on and use Symbicort as a β₂-agonist reliever medication, they also get some additional corticosteroid.

Formoterol has an onset of action of fewer than 15 minutes. The other combination product available in the United States—Advair—contains the long-acting β₂-agonist salmeterol, which does not act so rapidly, she said.

Formoterol “starts working just as fast as albuterol,” said Dr. Kercsmar, who has no financial links to Symbicort or its maker, AstraZeneca Pharmaceuticals LP.

“You're not going to reach for your albuterol; you're going to reach for this and take a puff instead,” she added.

The Symbicort studies have shown that even with this type of use, patients do not get exposed to excessive doses of corticosteroid. Probably, they are achieving greater asthma control over the long term, and not using reliever medication as much.

In the pediatric study, only 6 of 118 (5%) patients using Symbicort for control and rescue ever used it seven or more times a day at one time, compared with 23% on the fixed-dose regimen and 15% on the fixed-dose budesonide; the average rescue use with Symbicort was 0.58 times per day, compared with 0.76 and 0.74 in the other two groups, respectively. The study reported that the yearly growth of the patients on the Symbicort was better than that of patients assigned to only budesonide.

“This decreases exacerbations in a very, very safe fashion,” she said.

Dr. Kercsmar said she intends to advise patients to use Symbicort as a reliever the same way she would advise them to use albuterol. They should use it when they begin to feel an asthma attack, and wait 4 hours before using it again, and should contact a health care provider if they need to use it three times within 12 hours, she said. However, the initial Food and Drug Administration-approved labeling will reflect daily scheduled use as a controlled medication only.

LOS ANGELES — Only about half of women in the United States infected with HIV and receiving antiretroviral therapy are started on the proper regimen, according to a study presented at the 14th Conference on Retroviruses and Opportunistic Infections.

A previous, similar study of men reported that only 3% of infected males starting antiretroviral therapy (ART) are started on an inappropriate regimen, said Jennifer Cocohoba, Pharm.D., who, in a poster at the meeting, presented the data she and her colleagues analyzed.

However, “the good news is that the trend appears to be decreasing over time,” she said in an interview.

The cohort analyzed was a subset of 217 women in the Women's Interagency HIV Study (WIHS) who had initiated ART since April 1998, and were not pregnant. The WIHS collects data at six sites across the country from HIV-infected women who are fairly representative of all women being treated with ART, said Dr. Cocohoba, of the National HIV/AIDS Clinicians' Consultation Center at San Francisco General Hospital, in an interview.

In their study, the ART regimen the women received when they began treatment was compared with the Department of Health and Human Services' guidelines at that time. Only 53% were started on the preferred regimen or a recommended alternative, and 30% were started on a regimen that was not recommended but not considered contraindicated.

Of the remaining 17%, 6% were on a contraindicated dual-drug regimen, 6% were on a contraindicated monotherapy regimen, and 5% were on a therapy that was contraindicated because of drug interactions.

When looking at the response to therapy in relation to the regimens, the study found that the women who were started on an appropriate regimen had a mean increase in CD4 T cells of more than 100 cells/mcL, whereas those on an unlisted or inappropriate regimen had a mean CD4 T-cell increase of only 30 cells/mcL.

“This finding is not that surprising,” Dr. Cocohoba said in the interview. Being started on an improper regimen also could compromise the women's response to other regimens later on if they develop resistance and need to switch, she noted.

LOS ANGELES — Only about half of women in the United States infected with HIV and receiving antiretroviral therapy are started on the proper regimen, according to a study presented at the 14th Conference on Retroviruses and Opportunistic Infections.

A previous, similar study of men reported that only 3% of infected males starting antiretroviral therapy (ART) are started on an inappropriate regimen, said Jennifer Cocohoba, Pharm.D., who, in a poster at the meeting, presented the data she and her colleagues analyzed.

However, “the good news is that the trend appears to be decreasing over time,” she said in an interview.

The cohort analyzed was a subset of 217 women in the Women's Interagency HIV Study (WIHS) who had initiated ART since April 1998, and were not pregnant. The WIHS collects data at six sites across the country from HIV-infected women who are fairly representative of all women being treated with ART, said Dr. Cocohoba, of the National HIV/AIDS Clinicians' Consultation Center at San Francisco General Hospital, in an interview.

In their study, the ART regimen the women received when they began treatment was compared with the Department of Health and Human Services' guidelines at that time. Only 53% were started on the preferred regimen or a recommended alternative, and 30% were started on a regimen that was not recommended but not considered contraindicated.

Of the remaining 17%, 6% were on a contraindicated dual-drug regimen, 6% were on a contraindicated monotherapy regimen, and 5% were on a therapy that was contraindicated because of drug interactions.

When looking at the response to therapy in relation to the regimens, the study found that the women who were started on an appropriate regimen had a mean increase in CD4 T cells of more than 100 cells/mcL, whereas those on an unlisted or inappropriate regimen had a mean CD4 T-cell increase of only 30 cells/mcL.

“This finding is not that surprising,” Dr. Cocohoba said in the interview. Being started on an improper regimen also could compromise the women's response to other regimens later on if they develop resistance and need to switch, she noted.

LOS ANGELES — Only about half of women in the United States infected with HIV and receiving antiretroviral therapy are started on the proper regimen, according to a study presented at the 14th Conference on Retroviruses and Opportunistic Infections.

A previous, similar study of men reported that only 3% of infected males starting antiretroviral therapy (ART) are started on an inappropriate regimen, said Jennifer Cocohoba, Pharm.D., who, in a poster at the meeting, presented the data she and her colleagues analyzed.

However, “the good news is that the trend appears to be decreasing over time,” she said in an interview.

The cohort analyzed was a subset of 217 women in the Women's Interagency HIV Study (WIHS) who had initiated ART since April 1998, and were not pregnant. The WIHS collects data at six sites across the country from HIV-infected women who are fairly representative of all women being treated with ART, said Dr. Cocohoba, of the National HIV/AIDS Clinicians' Consultation Center at San Francisco General Hospital, in an interview.

In their study, the ART regimen the women received when they began treatment was compared with the Department of Health and Human Services' guidelines at that time. Only 53% were started on the preferred regimen or a recommended alternative, and 30% were started on a regimen that was not recommended but not considered contraindicated.

Of the remaining 17%, 6% were on a contraindicated dual-drug regimen, 6% were on a contraindicated monotherapy regimen, and 5% were on a therapy that was contraindicated because of drug interactions.

When looking at the response to therapy in relation to the regimens, the study found that the women who were started on an appropriate regimen had a mean increase in CD4 T cells of more than 100 cells/mcL, whereas those on an unlisted or inappropriate regimen had a mean CD4 T-cell increase of only 30 cells/mcL.

“This finding is not that surprising,” Dr. Cocohoba said in the interview. Being started on an improper regimen also could compromise the women's response to other regimens later on if they develop resistance and need to switch, she noted.

VAIL, COLO. — Weight loss can go a long way toward improving the effects of hyperandrogenism in the adolescent with polycystic ovary syndrome, Dr. Patricia S. Simmons said at a meeting sponsored by the American Academy of Pediatrics.

“In the obese patient, this can be all she needs,” said Dr. Simmons, a past president of the North American Society for Pediatric and Adolescent Gynecology. “If their weight normalizes, usually their insulin levels and secondary hyperandrogenism will, too. It is certainly the most effective long-term treatment we have,” she added.

Polycystic ovary syndrome (PCOS) can be associated with a different pathophysiology in different individuals, said Dr. Simmons, a professor of pediatrics at the Mayo Clinic, Rochester, Minn. About 2%–3% of the general female population has PCOS, and it is present in about 53% of adolescents with chronic anovulation and amenorrhea.

One of the condition's hallmarks, hyperinsulinemia, is present in about 20% of adolescents with PCOS. Those individuals are more often obese, but that is not always the case. And in those individuals, the hyperinsulinemia helps drive the hyperandrogenism, which is why weight loss and improving insulin sensitivity can help, Dr. Simmons said.

Though in overweight individuals, weight loss alone may be treatment enough, others may also require drug therapy. The first-line drug for adolescents is an estrogen/progestin oral contraceptive, she said. The progestin inhibits luteinizing hormone, which leads to decreased androgen production by the ovaries, and the inhibition of adrenal androgen production. The estrogen elevates serum hormone-binding globulin, which further inhibits the effects of androgen.

Over the long term, this therapy protects the endometrium from the dysplasia and cancer associated with PCOS.

The oral contraceptive that many experts recommend is Yasmin, with ethinyl estradiol and drospirenone, because that progestin is actually an antiandrogen structurally similar to spironolactone, which itself is used as a treatment for PCOS in conjunction with an oral contraceptive, Dr. Simmons said.

However, there are no data to say that Yasmin is any better than other oral contraceptives in the management of PCOS, she noted.

Patients tend to appreciate oral contraceptive therapy because it improves their acne, makes their menstruation more regular, and stops the progression of their hirsutism.

“The health of adolescents with PCOS who are on oral contraceptives is better than that of their counterparts who are not on them, so it's an easy thing to prescribe with great confidence,” she added.

The diagnosis of PCOS in the adolescent can be difficult, especially since one would like to identify it early and begin addressing some of the long-term health impacts.

Oral contraceptives do not influence insulin levels, hence the necessity for weight loss in overweight PCOS patients. The use of oral glycemic agents in children and adolescents has not been rigorously studied and is recommended for use only in selective cases, she said.

Dr. Simmons had no conflicts of interest to report.

VAIL, COLO. — Weight loss can go a long way toward improving the effects of hyperandrogenism in the adolescent with polycystic ovary syndrome, Dr. Patricia S. Simmons said at a meeting sponsored by the American Academy of Pediatrics.

“In the obese patient, this can be all she needs,” said Dr. Simmons, a past president of the North American Society for Pediatric and Adolescent Gynecology. “If their weight normalizes, usually their insulin levels and secondary hyperandrogenism will, too. It is certainly the most effective long-term treatment we have,” she added.

Polycystic ovary syndrome (PCOS) can be associated with a different pathophysiology in different individuals, said Dr. Simmons, a professor of pediatrics at the Mayo Clinic, Rochester, Minn. About 2%–3% of the general female population has PCOS, and it is present in about 53% of adolescents with chronic anovulation and amenorrhea.

One of the condition's hallmarks, hyperinsulinemia, is present in about 20% of adolescents with PCOS. Those individuals are more often obese, but that is not always the case. And in those individuals, the hyperinsulinemia helps drive the hyperandrogenism, which is why weight loss and improving insulin sensitivity can help, Dr. Simmons said.

Though in overweight individuals, weight loss alone may be treatment enough, others may also require drug therapy. The first-line drug for adolescents is an estrogen/progestin oral contraceptive, she said. The progestin inhibits luteinizing hormone, which leads to decreased androgen production by the ovaries, and the inhibition of adrenal androgen production. The estrogen elevates serum hormone-binding globulin, which further inhibits the effects of androgen.

Over the long term, this therapy protects the endometrium from the dysplasia and cancer associated with PCOS.

The oral contraceptive that many experts recommend is Yasmin, with ethinyl estradiol and drospirenone, because that progestin is actually an antiandrogen structurally similar to spironolactone, which itself is used as a treatment for PCOS in conjunction with an oral contraceptive, Dr. Simmons said.

However, there are no data to say that Yasmin is any better than other oral contraceptives in the management of PCOS, she noted.

Patients tend to appreciate oral contraceptive therapy because it improves their acne, makes their menstruation more regular, and stops the progression of their hirsutism.

“The health of adolescents with PCOS who are on oral contraceptives is better than that of their counterparts who are not on them, so it's an easy thing to prescribe with great confidence,” she added.

The diagnosis of PCOS in the adolescent can be difficult, especially since one would like to identify it early and begin addressing some of the long-term health impacts.

Oral contraceptives do not influence insulin levels, hence the necessity for weight loss in overweight PCOS patients. The use of oral glycemic agents in children and adolescents has not been rigorously studied and is recommended for use only in selective cases, she said.

Dr. Simmons had no conflicts of interest to report.

VAIL, COLO. — Weight loss can go a long way toward improving the effects of hyperandrogenism in the adolescent with polycystic ovary syndrome, Dr. Patricia S. Simmons said at a meeting sponsored by the American Academy of Pediatrics.

“In the obese patient, this can be all she needs,” said Dr. Simmons, a past president of the North American Society for Pediatric and Adolescent Gynecology. “If their weight normalizes, usually their insulin levels and secondary hyperandrogenism will, too. It is certainly the most effective long-term treatment we have,” she added.

Polycystic ovary syndrome (PCOS) can be associated with a different pathophysiology in different individuals, said Dr. Simmons, a professor of pediatrics at the Mayo Clinic, Rochester, Minn. About 2%–3% of the general female population has PCOS, and it is present in about 53% of adolescents with chronic anovulation and amenorrhea.

One of the condition's hallmarks, hyperinsulinemia, is present in about 20% of adolescents with PCOS. Those individuals are more often obese, but that is not always the case. And in those individuals, the hyperinsulinemia helps drive the hyperandrogenism, which is why weight loss and improving insulin sensitivity can help, Dr. Simmons said.

Though in overweight individuals, weight loss alone may be treatment enough, others may also require drug therapy. The first-line drug for adolescents is an estrogen/progestin oral contraceptive, she said. The progestin inhibits luteinizing hormone, which leads to decreased androgen production by the ovaries, and the inhibition of adrenal androgen production. The estrogen elevates serum hormone-binding globulin, which further inhibits the effects of androgen.

Over the long term, this therapy protects the endometrium from the dysplasia and cancer associated with PCOS.

The oral contraceptive that many experts recommend is Yasmin, with ethinyl estradiol and drospirenone, because that progestin is actually an antiandrogen structurally similar to spironolactone, which itself is used as a treatment for PCOS in conjunction with an oral contraceptive, Dr. Simmons said.

However, there are no data to say that Yasmin is any better than other oral contraceptives in the management of PCOS, she noted.

Patients tend to appreciate oral contraceptive therapy because it improves their acne, makes their menstruation more regular, and stops the progression of their hirsutism.

“The health of adolescents with PCOS who are on oral contraceptives is better than that of their counterparts who are not on them, so it's an easy thing to prescribe with great confidence,” she added.

The diagnosis of PCOS in the adolescent can be difficult, especially since one would like to identify it early and begin addressing some of the long-term health impacts.

Oral contraceptives do not influence insulin levels, hence the necessity for weight loss in overweight PCOS patients. The use of oral glycemic agents in children and adolescents has not been rigorously studied and is recommended for use only in selective cases, she said.

Dr. Simmons had no conflicts of interest to report.

SAN FRANCISCO — The use of complementary and alternative medicines is common but often overlooked among patients infected with HIV, Dr. Jason Tokumoto said at a meeting on HIV management sponsored by the University of California, San Francisco.

Studies have indicated that 70% of HIV-infected patients use some form of complementary or alternative medicine (CAM).

A survey of 1,675 HIV-infected patients found that the most commonly used CAM products included multivitamins (54% of patients), garlic (53%), massage (49%), and acupuncture (45%) (AIDS Care 2001;13:197–208).

Physicians are often unaware of the use of CAM products. “This can be a problem because in some cases these [complementary or alternative medicines] can actually be harmful,” said Dr. Tokumoto of the department of family and community medicine at UCSF.

In one study, 25% of the surveyed HIV-positive patients were using a CAM product that was potentially harmful, and one-third of these patients did not tell their clinicians about their CAM use (J. Aquir. Immune Defic. Syndr. 2003;33:157–65).

For example, St. John's wort, which may have some efficacy for depression, interacts with the cytochrome P-450 enzyme system and can thereby decrease indinavir trough blood levels by 81% and nevirapine levels by 21%.

St. John's wort should not be used with any protease inhibitor or nonnucleoside reverse transcriptase inhibitor, Dr. Tokumoto said.

Garlic, which many HIV patients use to improve lipid levels, should not be used with saquinavir. Garlic can reduce saquinavir blood levels by 51%, probably because it, too, is an inducer of the cytochrome P-450 system, he said.

CAM users tend to be women, be involved in medical decisions, have a negative attitude toward antiretroviral therapy, have been infected for a relatively long time, and have high income and education levels.

Dr. Tokumoto offered these comments about CAM uses and HIV:

▸ Herbals. Nothing known in herbal medicine or Chinese medicine has been shown to be effective in suppressing HIV or stimulating the immune system. A Cochrane review recently looked at nine randomized, placebo-controlled trials of eight herbal products in HIV patients. “What the authors concluded was that none of these herbs really worked,” Dr. Tokumoto said.

There has been debate over whether HIV patients should take echinacea, sometimes used to treat colds, because of concerns that long-term use could lead to immunosuppression.

▸ Micronutrients or vitamins. Studies suggest that most HIV-infected patients are not micronutrient deficient and not clinically vitamin deficient, although it has been reported that HIV-infected persons have low serum levels of vitamins A, E, B6, and B12.

But in one trial, researchers gave micronutrients or placebo to 40 HIV patients for 12 weeks, and found an increase in the mean number of CD4 cells in the micronutrient group and a decrease in the placebo group. There was no difference in viral load (J. Aquir. Immune Defic. Syndr. 2006;42:523–8).

“While these results look promising, this is a small study,” Dr. Tokumoto said.

Dr. Tokumoto said he often has his patients take a multivitamin, despite very limited supporting data and no evidence that supplementation increases CD4 counts or improves mortality.

Some vitamins and antioxidants such as riboflavin, thiamine, and vitamins C, E, and K may theoretically prevent lactacidemia caused by mitochondrial toxicity from nucleoside analogues.

But there have been no trials in HIV patients, and these substances have had only limited value in patients with congenital mitochondrial disease.

“There are scattered anecdotal reports of patients responding to some of these vitamins,” Dr. Tokumoto commented.

▸ L-carnitine. In an uncontrolled study of 21 HIV patients, administration of L-carnitine 1,500 mg twice daily for 6 months appeared to reduce nucleoside analogue-related neuropathy. Overall, 76% of the patients showed improvement (HIV Clin. Trials 2005;6:344–50).

▸ Lipodystrophy. No CAM is currently being investigated for lipodystrophy; however, in one 74-patient survey, 25% used vitamins, 23% used resistance exercise, 21% used specific diets, and some used meditation in an effort to reduce lipodystrophy. Only 37% told their physician they were using these modalities (J. Altern. Complement. Med. 2006;12:475–82).

▸ Hyperlipidemia. The supporting studies of garlic to lower lipid levels are compromised by their short duration and the different preparations used, according to Dr. Tokumoto.

Cholestin, which is produced by red yeast fermented on rice, contains natural statins. This substance has been shown to reduce LDL cholesterol and triglyceride levels by 20%–30%. But there are no studies in HIV patients, and no studies of the interactions with protease inhibitors.

Fish oil has also been shown to cause a decrease in patients' triglyceride levels.

▸ Milk thistle. Milk thistle could be attractive to HIV patients who are on antiretrovirals and/or coinfected with hepatitis B or C because its active ingredient, silymarin, may be hepatorestorative. At the dosages used, it probably does not interfere with the efficacy of protease inhibitors.

Although the data are inconclusive, “I do know some hepatologists who are prescribing milk thistle for their hepatitis C patients,” he said.

▸ Acupuncture. Acupuncture is widely used by HIV patients for pain and neuropathy. One study of 215 patients reported that neither acupuncture nor amitriptyline was more effective than placebo (JAMA 1998;280:1590–5). But most acupuncturists say that the procedure is difficult to study rigorously because treatment is highly individualized, Dr. Tokumoto said.

▸ Marijuana. Anywhere from 14% to 43% of HIV patients may use marijuana medicinally or recreationally. Because of the political climate, marijuana use has not been studied in clinical trials, but smoking marijuana over a short period has been shown not to affect CD4 cell counts, viral load, or antiretroviral levels, he said. Efavirenz use may cause positive results on marijuana drug tests, he added.

SAN FRANCISCO — The use of complementary and alternative medicines is common but often overlooked among patients infected with HIV, Dr. Jason Tokumoto said at a meeting on HIV management sponsored by the University of California, San Francisco.

Studies have indicated that 70% of HIV-infected patients use some form of complementary or alternative medicine (CAM).

A survey of 1,675 HIV-infected patients found that the most commonly used CAM products included multivitamins (54% of patients), garlic (53%), massage (49%), and acupuncture (45%) (AIDS Care 2001;13:197–208).

Physicians are often unaware of the use of CAM products. “This can be a problem because in some cases these [complementary or alternative medicines] can actually be harmful,” said Dr. Tokumoto of the department of family and community medicine at UCSF.

In one study, 25% of the surveyed HIV-positive patients were using a CAM product that was potentially harmful, and one-third of these patients did not tell their clinicians about their CAM use (J. Aquir. Immune Defic. Syndr. 2003;33:157–65).

For example, St. John's wort, which may have some efficacy for depression, interacts with the cytochrome P-450 enzyme system and can thereby decrease indinavir trough blood levels by 81% and nevirapine levels by 21%.

St. John's wort should not be used with any protease inhibitor or nonnucleoside reverse transcriptase inhibitor, Dr. Tokumoto said.

Garlic, which many HIV patients use to improve lipid levels, should not be used with saquinavir. Garlic can reduce saquinavir blood levels by 51%, probably because it, too, is an inducer of the cytochrome P-450 system, he said.

CAM users tend to be women, be involved in medical decisions, have a negative attitude toward antiretroviral therapy, have been infected for a relatively long time, and have high income and education levels.

Dr. Tokumoto offered these comments about CAM uses and HIV:

▸ Herbals. Nothing known in herbal medicine or Chinese medicine has been shown to be effective in suppressing HIV or stimulating the immune system. A Cochrane review recently looked at nine randomized, placebo-controlled trials of eight herbal products in HIV patients. “What the authors concluded was that none of these herbs really worked,” Dr. Tokumoto said.

There has been debate over whether HIV patients should take echinacea, sometimes used to treat colds, because of concerns that long-term use could lead to immunosuppression.

▸ Micronutrients or vitamins. Studies suggest that most HIV-infected patients are not micronutrient deficient and not clinically vitamin deficient, although it has been reported that HIV-infected persons have low serum levels of vitamins A, E, B6, and B12.

But in one trial, researchers gave micronutrients or placebo to 40 HIV patients for 12 weeks, and found an increase in the mean number of CD4 cells in the micronutrient group and a decrease in the placebo group. There was no difference in viral load (J. Aquir. Immune Defic. Syndr. 2006;42:523–8).

“While these results look promising, this is a small study,” Dr. Tokumoto said.

Dr. Tokumoto said he often has his patients take a multivitamin, despite very limited supporting data and no evidence that supplementation increases CD4 counts or improves mortality.

Some vitamins and antioxidants such as riboflavin, thiamine, and vitamins C, E, and K may theoretically prevent lactacidemia caused by mitochondrial toxicity from nucleoside analogues.

But there have been no trials in HIV patients, and these substances have had only limited value in patients with congenital mitochondrial disease.

“There are scattered anecdotal reports of patients responding to some of these vitamins,” Dr. Tokumoto commented.

▸ L-carnitine. In an uncontrolled study of 21 HIV patients, administration of L-carnitine 1,500 mg twice daily for 6 months appeared to reduce nucleoside analogue-related neuropathy. Overall, 76% of the patients showed improvement (HIV Clin. Trials 2005;6:344–50).

▸ Lipodystrophy. No CAM is currently being investigated for lipodystrophy; however, in one 74-patient survey, 25% used vitamins, 23% used resistance exercise, 21% used specific diets, and some used meditation in an effort to reduce lipodystrophy. Only 37% told their physician they were using these modalities (J. Altern. Complement. Med. 2006;12:475–82).

▸ Hyperlipidemia. The supporting studies of garlic to lower lipid levels are compromised by their short duration and the different preparations used, according to Dr. Tokumoto.

Cholestin, which is produced by red yeast fermented on rice, contains natural statins. This substance has been shown to reduce LDL cholesterol and triglyceride levels by 20%–30%. But there are no studies in HIV patients, and no studies of the interactions with protease inhibitors.

Fish oil has also been shown to cause a decrease in patients' triglyceride levels.

▸ Milk thistle. Milk thistle could be attractive to HIV patients who are on antiretrovirals and/or coinfected with hepatitis B or C because its active ingredient, silymarin, may be hepatorestorative. At the dosages used, it probably does not interfere with the efficacy of protease inhibitors.

Although the data are inconclusive, “I do know some hepatologists who are prescribing milk thistle for their hepatitis C patients,” he said.

▸ Acupuncture. Acupuncture is widely used by HIV patients for pain and neuropathy. One study of 215 patients reported that neither acupuncture nor amitriptyline was more effective than placebo (JAMA 1998;280:1590–5). But most acupuncturists say that the procedure is difficult to study rigorously because treatment is highly individualized, Dr. Tokumoto said.

▸ Marijuana. Anywhere from 14% to 43% of HIV patients may use marijuana medicinally or recreationally. Because of the political climate, marijuana use has not been studied in clinical trials, but smoking marijuana over a short period has been shown not to affect CD4 cell counts, viral load, or antiretroviral levels, he said. Efavirenz use may cause positive results on marijuana drug tests, he added.

SAN FRANCISCO — The use of complementary and alternative medicines is common but often overlooked among patients infected with HIV, Dr. Jason Tokumoto said at a meeting on HIV management sponsored by the University of California, San Francisco.

Studies have indicated that 70% of HIV-infected patients use some form of complementary or alternative medicine (CAM).

A survey of 1,675 HIV-infected patients found that the most commonly used CAM products included multivitamins (54% of patients), garlic (53%), massage (49%), and acupuncture (45%) (AIDS Care 2001;13:197–208).

Physicians are often unaware of the use of CAM products. “This can be a problem because in some cases these [complementary or alternative medicines] can actually be harmful,” said Dr. Tokumoto of the department of family and community medicine at UCSF.

In one study, 25% of the surveyed HIV-positive patients were using a CAM product that was potentially harmful, and one-third of these patients did not tell their clinicians about their CAM use (J. Aquir. Immune Defic. Syndr. 2003;33:157–65).

For example, St. John's wort, which may have some efficacy for depression, interacts with the cytochrome P-450 enzyme system and can thereby decrease indinavir trough blood levels by 81% and nevirapine levels by 21%.

St. John's wort should not be used with any protease inhibitor or nonnucleoside reverse transcriptase inhibitor, Dr. Tokumoto said.

Garlic, which many HIV patients use to improve lipid levels, should not be used with saquinavir. Garlic can reduce saquinavir blood levels by 51%, probably because it, too, is an inducer of the cytochrome P-450 system, he said.

CAM users tend to be women, be involved in medical decisions, have a negative attitude toward antiretroviral therapy, have been infected for a relatively long time, and have high income and education levels.

Dr. Tokumoto offered these comments about CAM uses and HIV:

▸ Herbals. Nothing known in herbal medicine or Chinese medicine has been shown to be effective in suppressing HIV or stimulating the immune system. A Cochrane review recently looked at nine randomized, placebo-controlled trials of eight herbal products in HIV patients. “What the authors concluded was that none of these herbs really worked,” Dr. Tokumoto said.

There has been debate over whether HIV patients should take echinacea, sometimes used to treat colds, because of concerns that long-term use could lead to immunosuppression.

▸ Micronutrients or vitamins. Studies suggest that most HIV-infected patients are not micronutrient deficient and not clinically vitamin deficient, although it has been reported that HIV-infected persons have low serum levels of vitamins A, E, B6, and B12.

But in one trial, researchers gave micronutrients or placebo to 40 HIV patients for 12 weeks, and found an increase in the mean number of CD4 cells in the micronutrient group and a decrease in the placebo group. There was no difference in viral load (J. Aquir. Immune Defic. Syndr. 2006;42:523–8).

“While these results look promising, this is a small study,” Dr. Tokumoto said.

Dr. Tokumoto said he often has his patients take a multivitamin, despite very limited supporting data and no evidence that supplementation increases CD4 counts or improves mortality.

Some vitamins and antioxidants such as riboflavin, thiamine, and vitamins C, E, and K may theoretically prevent lactacidemia caused by mitochondrial toxicity from nucleoside analogues.

But there have been no trials in HIV patients, and these substances have had only limited value in patients with congenital mitochondrial disease.

“There are scattered anecdotal reports of patients responding to some of these vitamins,” Dr. Tokumoto commented.

▸ L-carnitine. In an uncontrolled study of 21 HIV patients, administration of L-carnitine 1,500 mg twice daily for 6 months appeared to reduce nucleoside analogue-related neuropathy. Overall, 76% of the patients showed improvement (HIV Clin. Trials 2005;6:344–50).

▸ Lipodystrophy. No CAM is currently being investigated for lipodystrophy; however, in one 74-patient survey, 25% used vitamins, 23% used resistance exercise, 21% used specific diets, and some used meditation in an effort to reduce lipodystrophy. Only 37% told their physician they were using these modalities (J. Altern. Complement. Med. 2006;12:475–82).

▸ Hyperlipidemia. The supporting studies of garlic to lower lipid levels are compromised by their short duration and the different preparations used, according to Dr. Tokumoto.

Cholestin, which is produced by red yeast fermented on rice, contains natural statins. This substance has been shown to reduce LDL cholesterol and triglyceride levels by 20%–30%. But there are no studies in HIV patients, and no studies of the interactions with protease inhibitors.

Fish oil has also been shown to cause a decrease in patients' triglyceride levels.

▸ Milk thistle. Milk thistle could be attractive to HIV patients who are on antiretrovirals and/or coinfected with hepatitis B or C because its active ingredient, silymarin, may be hepatorestorative. At the dosages used, it probably does not interfere with the efficacy of protease inhibitors.

Although the data are inconclusive, “I do know some hepatologists who are prescribing milk thistle for their hepatitis C patients,” he said.

▸ Acupuncture. Acupuncture is widely used by HIV patients for pain and neuropathy. One study of 215 patients reported that neither acupuncture nor amitriptyline was more effective than placebo (JAMA 1998;280:1590–5). But most acupuncturists say that the procedure is difficult to study rigorously because treatment is highly individualized, Dr. Tokumoto said.

▸ Marijuana. Anywhere from 14% to 43% of HIV patients may use marijuana medicinally or recreationally. Because of the political climate, marijuana use has not been studied in clinical trials, but smoking marijuana over a short period has been shown not to affect CD4 cell counts, viral load, or antiretroviral levels, he said. Efavirenz use may cause positive results on marijuana drug tests, he added.

LOS ANGELES — Treating genital herpes simplex virus with acyclovir diminishes vaginal HIV shedding and plasma HIV levels in women coinfected with HSV and HIV, which suggests that treating herpes could have a role in reducing HIV transmission, according to two studies presented at the 14th Conference on Retroviruses and Opportunistic Infections.

A study conducted in Thailand by the U.S. Centers for Disease Control and Prevention found that 55% of treated women had a significant reduction in vaginal viral shedding during their treatment, said Dr. Eileen Dunne, of the CDC's Division of Sexually Transmitted Diseases Prevention.

In a study from South Africa, treated women had a reduction in herpes simplex virus type 2; 63% less vaginal shedding, compared with placebo-control women; and a 43% reduction in plasma HIV levels, said Dr. Sinead Delany-Moretlwe, director of research for the reproductive health and HIV research unit at the University of the Witwatersrand, Johannesberg, South Africa.

Neither study was without some equivocal results that tempered the investigators' overall assessment of the findings, but both investigators nevertheless concluded that their trial showed benefit. Both also noted that although their studies were short, they were optimistic that longer trials, currently underway, of HSV suppressive therapy and actual HIV transmission would find that such therapy reduced transmission.

Each trial lasted only 3 months.

The Thailand study analyzed data from 67 women coinfected with HSV and HIV. The women were assigned into one of two groups. One group was treated for 1 month with acyclovir 800 mg twice daily, and the other served as a control. After a 1-month washout with no drugs, the groups were switched.

Overall, 34% of the women had no vaginal HIV shedding at baseline and so had no change through the trial. However, 55% of the subjects did have a significant reduction in HIV shedding while on acyclovir. And there was a 2.8-fold drop in HIV load in vaginal lavage samples, which was statistically significant, though the mean 0.4-log drop in viral load is not far above the 0.3 sensitivity limit of HIV viral load testing.

Dr. Dunne noted, however, that most of the women had never had herpes symptoms, and their HIV was in such an early stage that it was not being treated. And, she said, the treatment might have a more profound effect on people with more advanced disease.

“You might expect the impact would be greater in a group with immunosuppression or a group with symptomatic herpes,” she said.

“We are hopeful that this study foreshadows positive results from the ongoing trials that are evaluating the effect of suppressive therapy [of HSV] on transmission of HIV,” she added.

The South African study had 169 women treated with acyclovir (400 mg twice daily) or placebo for 3 months. Like the patients in the other study, they were HIV positive and not on antiretroviral therapy.

The study found no statistically significant drop in the vaginal HIV viral load. But it did find a 2.4-fold decline in mean plasma viral load relative to placebo, and a larger percentage of the treated patients were found not to be shedding HIV at all visits. Of the treated women, 23% were found to be shedding at fewer than half of their weekly visits, versus 17% of the placebo-control women.

By the third month, HSV shedding had been reduced by 63% in the treated patients, compared with the placebo group.

“We believe this warrants further investigation over a longer follow-up,” Dr. Delany-Moretlwe said.

LOS ANGELES — Treating genital herpes simplex virus with acyclovir diminishes vaginal HIV shedding and plasma HIV levels in women coinfected with HSV and HIV, which suggests that treating herpes could have a role in reducing HIV transmission, according to two studies presented at the 14th Conference on Retroviruses and Opportunistic Infections.

A study conducted in Thailand by the U.S. Centers for Disease Control and Prevention found that 55% of treated women had a significant reduction in vaginal viral shedding during their treatment, said Dr. Eileen Dunne, of the CDC's Division of Sexually Transmitted Diseases Prevention.

In a study from South Africa, treated women had a reduction in herpes simplex virus type 2; 63% less vaginal shedding, compared with placebo-control women; and a 43% reduction in plasma HIV levels, said Dr. Sinead Delany-Moretlwe, director of research for the reproductive health and HIV research unit at the University of the Witwatersrand, Johannesberg, South Africa.

Neither study was without some equivocal results that tempered the investigators' overall assessment of the findings, but both investigators nevertheless concluded that their trial showed benefit. Both also noted that although their studies were short, they were optimistic that longer trials, currently underway, of HSV suppressive therapy and actual HIV transmission would find that such therapy reduced transmission.

Each trial lasted only 3 months.

The Thailand study analyzed data from 67 women coinfected with HSV and HIV. The women were assigned into one of two groups. One group was treated for 1 month with acyclovir 800 mg twice daily, and the other served as a control. After a 1-month washout with no drugs, the groups were switched.

Overall, 34% of the women had no vaginal HIV shedding at baseline and so had no change through the trial. However, 55% of the subjects did have a significant reduction in HIV shedding while on acyclovir. And there was a 2.8-fold drop in HIV load in vaginal lavage samples, which was statistically significant, though the mean 0.4-log drop in viral load is not far above the 0.3 sensitivity limit of HIV viral load testing.

Dr. Dunne noted, however, that most of the women had never had herpes symptoms, and their HIV was in such an early stage that it was not being treated. And, she said, the treatment might have a more profound effect on people with more advanced disease.

“You might expect the impact would be greater in a group with immunosuppression or a group with symptomatic herpes,” she said.

“We are hopeful that this study foreshadows positive results from the ongoing trials that are evaluating the effect of suppressive therapy [of HSV] on transmission of HIV,” she added.

The South African study had 169 women treated with acyclovir (400 mg twice daily) or placebo for 3 months. Like the patients in the other study, they were HIV positive and not on antiretroviral therapy.

The study found no statistically significant drop in the vaginal HIV viral load. But it did find a 2.4-fold decline in mean plasma viral load relative to placebo, and a larger percentage of the treated patients were found not to be shedding HIV at all visits. Of the treated women, 23% were found to be shedding at fewer than half of their weekly visits, versus 17% of the placebo-control women.

By the third month, HSV shedding had been reduced by 63% in the treated patients, compared with the placebo group.

“We believe this warrants further investigation over a longer follow-up,” Dr. Delany-Moretlwe said.

LOS ANGELES — Treating genital herpes simplex virus with acyclovir diminishes vaginal HIV shedding and plasma HIV levels in women coinfected with HSV and HIV, which suggests that treating herpes could have a role in reducing HIV transmission, according to two studies presented at the 14th Conference on Retroviruses and Opportunistic Infections.

A study conducted in Thailand by the U.S. Centers for Disease Control and Prevention found that 55% of treated women had a significant reduction in vaginal viral shedding during their treatment, said Dr. Eileen Dunne, of the CDC's Division of Sexually Transmitted Diseases Prevention.

In a study from South Africa, treated women had a reduction in herpes simplex virus type 2; 63% less vaginal shedding, compared with placebo-control women; and a 43% reduction in plasma HIV levels, said Dr. Sinead Delany-Moretlwe, director of research for the reproductive health and HIV research unit at the University of the Witwatersrand, Johannesberg, South Africa.

Neither study was without some equivocal results that tempered the investigators' overall assessment of the findings, but both investigators nevertheless concluded that their trial showed benefit. Both also noted that although their studies were short, they were optimistic that longer trials, currently underway, of HSV suppressive therapy and actual HIV transmission would find that such therapy reduced transmission.

Each trial lasted only 3 months.

The Thailand study analyzed data from 67 women coinfected with HSV and HIV. The women were assigned into one of two groups. One group was treated for 1 month with acyclovir 800 mg twice daily, and the other served as a control. After a 1-month washout with no drugs, the groups were switched.

Overall, 34% of the women had no vaginal HIV shedding at baseline and so had no change through the trial. However, 55% of the subjects did have a significant reduction in HIV shedding while on acyclovir. And there was a 2.8-fold drop in HIV load in vaginal lavage samples, which was statistically significant, though the mean 0.4-log drop in viral load is not far above the 0.3 sensitivity limit of HIV viral load testing.

Dr. Dunne noted, however, that most of the women had never had herpes symptoms, and their HIV was in such an early stage that it was not being treated. And, she said, the treatment might have a more profound effect on people with more advanced disease.

“You might expect the impact would be greater in a group with immunosuppression or a group with symptomatic herpes,” she said.

“We are hopeful that this study foreshadows positive results from the ongoing trials that are evaluating the effect of suppressive therapy [of HSV] on transmission of HIV,” she added.

The South African study had 169 women treated with acyclovir (400 mg twice daily) or placebo for 3 months. Like the patients in the other study, they were HIV positive and not on antiretroviral therapy.

The study found no statistically significant drop in the vaginal HIV viral load. But it did find a 2.4-fold decline in mean plasma viral load relative to placebo, and a larger percentage of the treated patients were found not to be shedding HIV at all visits. Of the treated women, 23% were found to be shedding at fewer than half of their weekly visits, versus 17% of the placebo-control women.

By the third month, HSV shedding had been reduced by 63% in the treated patients, compared with the placebo group.

“We believe this warrants further investigation over a longer follow-up,” Dr. Delany-Moretlwe said.