Sunday July 22, 2018

HIV Drug Is Not Linked to Depression: Study

A new study of a popular HIV drug could ease concerns about its link to depression

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A doctor draws blood from a man to check for HIV/AIDS at a mobile testing unit in Ndeeba, a suburb in Uganda's capital, Kampala.
A doctor draws blood from a man to check for HIV/AIDS at a mobile testing unit in Ndeeba, a suburb in Uganda's capital, Kampala. VOA
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A new study of a popular HIV drug could ease concerns about its link to depression. Researchers in Uganda found that efavirenz, once feared to lead to depression and suicide, did not cause the expected negative side effects in their patients.

Efavirenz is an affordable, once-a-day pill used around the globe to treat and prevent HIV/AIDS. It’s “the treatment of choice” in most of the world, according to Africa Health Research Institute’s Mark Siedner, “especially [in] countries that depend on global aid to treat HIV.”

But some fear that efavirenz may come with a cost.

Some studies in the United States and Europe found the drug increased patients’ risk of depression or suicide, although other studies did not.

The mixed results prompted many doctors in the United States to prescribe more expensive but potentially safer drugs.

Siedner wanted to take another look at the risk of depression, this time in an African population. From 2005 until 2015, he and a team of Ugandan and U.S. doctors tracked 694 patients who took either efavirenz or another antiretroviral medication. They regularly asked the patients whether they experienced depression or suicidal thoughts.

No difference

Their analysis, published in the Annals of Internal Medicine, showed there was no difference between the two treatments. Siedner told VOA, “In other words, efavirenz was not associated with a risk of depression. If anything, there seems to be a signal that potentially it was associated with a decreased risk. But it wasn’t a strong enough [signal] for us to say that.”

The authors also reported that of the 17 participants who died in the course of the study, not a single death was a suicide.

Siedner has two possible explanations for why their findings differed from those in Western countries. “One potential cause is that every single ethnic group in the world, of course, is different, and different in many different ways — different socially, different environmentally, and in this case they may be different genetically.” His team is looking at whether the genes that control metabolism of the drug have a role to play in this story.

HIV Aids is a deadly disease.
HIV virus is Not Linked To Depression. Flickr

A second explanation could be the effectiveness of the drug. Because efavirenz is so potent, it could be keeping people healthier than they expected, so patients are less likely to report negative emotions.

The study is important, said Anthony Fauci, who heads the National Institute of Allergy and Infectious Diseases, because it pushes back against “the initial observation of suicidal ideation and suicide and depression” as caused by efavirenz. He told VOA, “I think now what you’re seeing is that with these conflicting reports, it’s likely someone will come in [with] the proposal to do a randomized study and take a look. So the story isn’t ended with this paper.”

As more research on the safety of efavirenz is conducted, new and cheaper drugs that might replace it are on the horizon. One of them, dolutegravir, might also pose a risk, however. A study in Botswana found dolutegravir was linked to neural tube defects in embryos, meaning it might not be safe for pregnant women. As always, further research is needed to confirm whether this is a common problem or specific to the population studied in Botswana.

Also read: UNAIDS : World Is At A “Defining Moment” In A Battle Against HIV/AIDS

“I think the whole field right now is in a bit of a holding pattern,” Siedner said when asked about dolutegravir and the future of HIV medication. (VOA)

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Will Polio Workers Step Out of Their Comfort Zones to End Virus?

What's more, the border between Afghanistan and Pakistan stretches for more than 2,000 kilometers. Thousands of people who cross this very porous border can easily transmit the virus in both countries.

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Polio
Widespread unrest in Afghanistan has kept thousands of children from receiving polio vaccines this year. Conflict in northern Nigeria does the same. VOA

The move to end Polio started in 1985 with Rotary International. At that time, polio paralyzed hundreds of thousands of children every year. There is still no cure, but two scientists developed vaccines against the virus in the 1950’s.

Dr. Jonas Salk produced one with an inactivated virus that could protect against polio without spreading the disease. Later, Dr. Albert Sabin developed an oral vaccine with weakened strains of the virus.

In 1988, public and private groups joined the effort in the Global Polio Eradication Program. Members included governments, the World Health Organization, the United Nations Children’s Fund (UNICEF), Rotary International, the U.S. Centers for Disease Control and Prevention (CDC) and the Bill and Melinda Gates Foundation.

Since then, the number of polio cases has dropped by 99.9 percent. Last year, 22 children were crippled by this disease. The wild polio virus exists in only three countries: Pakistan, Afghanistan and Nigeria, but it’s still a global threat.

Dr. John Vertefeuille, from the CDC said, “This last mile is a complicated mile.” It’s not just because of conflict or terrorism. “It’s extreme remoteness. It’s very fragile health systems.” And in these remote conflict prone areas gaining access to children can be a major problem.

If polio exists anywhere, it can once again spread everywhere.

Polio
In many places the vaccinators are women because women can go into the homes, talk to other women and gain access to the children. Wikimedia

Vertefeuille and other experts discussed strategies to realize a polio-free world July 10 at the Center for Strategic and International Studies in Washington.

Widespread unrest in Afghanistan has kept thousands of children from receiving polio vaccines this year. Conflict in northern Nigeria does the same.

What’s more, the border between Afghanistan and Pakistan stretches for more than 2,000 kilometers. Thousands of people who cross this very porous border can easily transmit the virus in both countries.

While the funding and technical support has to come from large, private-public partnerships, immunization teams succeed best if they are local. Approaches have to take culture and customs into consideration.

In many places the vaccinators are women because women can go into the homes, talk to other women and gain access to the children.

Elsewhere, soldiers vaccinate children when they take over an area run by anti-government forces. Vaccination teams have to be prepared to move quickly when there is a lull in the fighting and to deliver multiple doses of vaccine in a short period of time.

Polio
Community volunteers are a great resource. Some get cell phones so they can alert health officials if a child becomes paralyzed. VOA

Surveillance is just as critical. To end polio, you have to know where the outbreaks are. Community volunteers are a great resource. Some get cell phones so they can alert health officials if a child becomes paralyzed.

Another challenge is getting children in migrant groups vaccinated. Vertefeuille says this is where technology helps. The CDC uses satellites to see where people have moved and what areas are abandoned. Clues are where structures have been repaired, where the grass grows on roads, indicating abandoned areas, and where it doesn’t, indicating where people are living.

Dr. Andrew Etsana from the International Federation of Red Cross and Red Crescent Societies said these groups present a particular challenge because “you have people moving with a virus and it is difficult to track them and vaccinate the vulnerable children in this mobile population.”

Another issue is the nature of viruses themselves. Viruses mutate. So far, the polio vaccines have been effective, but if not enough children get vaccinated, the virus can change, and perhaps make the vaccine less effective. That’s why every child needs to be vaccinated.

Outbreaks that can be avoided by vaccinating the whole population so that there are no gaps for the mutated virus to slip through.

International experts are working with local leaders to close this gap.

Another issue is complacency. Etsana said, “People are getting tired. The program has been going on. They thought it would have ended.”

Rotary has pledged to continue its support, other groups as well. International support and funding is critical to ending polio, but after three decades, many people have never seen polio. Etsana says he sees complacency creeping into all areas of the program. “The funders of the program are also getting tired. The fund is drying up and if the fund dries up and the job is not done, we’re going to have a major problem. We may have reinfection.”

Also Read-After Three Years Struggle, WHO Declares Somalia Polio Free

But, if people recognize the program’s value – it has united communities, established vaccine centers, created partnerships never before imagined – the world can not only end polio, but tackle other diseases as well. The polio program is widely credited with stopping the spread of Ebola in Nigeria while the disease ravaged other west African countries. (VOA)