Paracetamol links to allergy/asthma in young children, study suggests

Links between early paracetamol use and the development of allergies and asthma in five and six year old children have been confirmed by health researchers at the University of Otago, Wellington.

The report by Professor Julian Crane is based on the New Zealand Asthma and Allergy Cohort Study. It investigated the use of paracetamol by 505 infants in Christchurch, and 914 five and six year olds in Wellington and Christchurch to see if they developed any signs of asthma or allergic sensitivity. The study has recently been published in Clinical and Experimental Allergy.

“The major finding is that children who used paracetamol before the age of 15 months (90%) were more than three times as likely to become sensitized to allergens and twice as likely to develop symptoms of asthma at six years old than children not using paracetamol,” says Professor Crane.

“However at present we don’t know why this might be so. We need clinical trials to see whether these associations are causal or not, and to clarify the use of this common medication.”

The research also found that by six years 95% of the study sample were using paracetamol and there was a significant increased risk for current asthma and wheeze. However the findings depended on how much paracetamol was being used, with the risk greater for those with severe asthma symptoms.

“The results at this stage are supportive of a role for paracetamol in asthma and allergic disease,” says Professor Crane.

However there may be many different mechanisms operating in the links between paracetamol and allergy/asthma researchers say. For instance it has been shown that fever in infancy may reduce allergy in childhood, and that paracetamol may affect antigen processing in the immune system early in life, or may be linked to free radical damage and enhancement of allergic inflammation and bronchospasm.

The University of Otago study concludes that although direct causation between paracetamol and allergy/asthma has not been established, neither has paracetamol been shown to have a beneficial effect on disease outcomes when used against fever, and guidelines for its use are unclear.

Provided by University of Otago

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Botox Shots Approved for Migraine

The Food and Drug Administration approved Botox, the anti-wrinkle shot from Allergan, as a treatment to prevent chronic migraines, a little more than a month after the company agreed to pay $600 million to settle allegations that it had illegally marketed the drug for unapproved uses like headaches for years.

Allergan says sales of Botox for chronic migraine and other medical uses will eclipse sales of the drug as a wrinkle smoother. The agency’s decision endorses doctors’ use of Botox to treat patients who suffer from a severe form of migraine involving headaches on at least 15 days a month. Britain’s drug agency approved Botox for the same use this summer.

Botox is already approved by the F.D.A. to treat uncontrolled blinking; crossed eyes; certain neck muscle spasms; excessive underarm sweating; and stiffness associated with muscle spasticity in the elbows and hands. It also is approved for cosmetic purposes — to smooth lines between the eyebrows.

Botox had worldwide sales last year of about $1.3 billion, divided equally between medical and cosmetic uses.

But Allergan said sales of Botox for chronic migraine and other medical uses would soon eclipse sales of the drug as a wrinkle smoother. Allergan is also studying the drug for a variety of new medical uses, including overactive bladder, said Dr. Scott M. Whitcup, the company’s executive vice president for research and development.

“For the business, Botox has been an incredible medication. We call it our pipeline in a vial,” Dr. Whitcup said. “People still think about it as a cosmetic product, but the therapeutic indications in the next five years will far surpass its cosmetic use.”

Industry analysts have forecast worldwide sales of the drug for the severe migraine condition at $250 million to more than $1 billion annually by 2015.

Unlike the occasional headache, the chronic migraine condition is often accompanied by nausea, vomiting, dizziness, intense sensitivity to light and noise, and moderate to severe pain.

The audience for Botox headache shots could be significant because some chronic migraine patients do not improve when they take the pills that are now the standard treatment, neurologists said. Treatments include pills like Topamax, taken daily to prevent migraine, and the triptan family of drugs, taken to ease an existing migraine.

Botox is a purified form of botulinum toxin, a nerve poison produced by the bacteria that causes botulism. Injections of Botox typically act to temporarily blunt nerve signals to certain muscles or glands. Researchers are still exploring how the drug works on migraines. Dr. Whitcup said one theory was that it blocked pain signals from reaching nerve endings.

A Botox migraine treatment generally involves a total of 31 injections in seven areas — including the forehead, temples, the back of the head, the neck and shoulders. To treat the chronic condition, injections are given about every three months.

Industry analysts estimated that the migraine treatment would cost $1,000 to $2,000, depending on the amount of the drug used and the physician’s fee. Some private insurers are likely to cover the migraine treatment now that it has received F.D.A. approval, analysts said, although patients may have to cover a significant co-payment.

“The cost is prohibitive for some,” Randall Stanicky, a vice president for global research at Goldman Sachs, said in an interview earlier this year. “But given the debilitating challenges of having migraines more than 15 days a month, if Botox can cut down on that, it’s clearly going to be a big opportunity.”

Other analysts have expressed skepticism that doctors and patients would embrace the drug, arguing that Botox has a marginal effect on headaches compared with a placebo.

“The true drug effect is minimal,” Corey Davis, an analyst at Jefferies & Company, said in an interview earlier this year.

Patients in one study financed by Allergan, for example, typically experienced about five fewer headache episodes a month than they had before the study — no matter whether they had injections of Botox or a placebo.

After Allergan reviewed the results of that first study, the company changed the primary end point — the scientific goal post — on a second study so that it would focus on the drug’s effect on the number of headache days rather than the number of headache episodes that a person experienced each month. Dr. Whitcup said it was easier for patients to remember how many headache days as opposed to how many headache episodes they had every month.

The second study reported that patients who received Botox injections typically experienced about 2.3 fewer headache days than the placebo group, a statistically significant difference. But the placebo group also experienced considerable improvement — a common feature in pain studies — raising questions among some doctors about the magnitude of the Botox effect.

Dr. Whitcup said Botox had consistently beaten the placebo at different time points in the study and that patients had reported an improvement in their daily functioning and quality of life.

Although the F.D.A. approved the drug for the chronic condition, the agency said in its statement Friday that Botox had not been shown to work for the occasional headache or migraine.

Common side effects were neck pain and headaches. But neurologists point to a more welcome side effect for some — fewer wrinkles.

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Scientists identify gene linked to common birth defect in male genitalia

King's College London, in collaboration with Radboud University Nijmegen Medical Centre in The Netherlands, has discovered a new gene associated with Hypospadias, the congenital malformation of the male genitalia. The research was published today in Nature Genetics.

It was previously known that genetics play a part in developing the condition, with five percent of patients having an affected male relative, but the genes involved were unknown. This study shows for the first time that a gene inherited from the mother is likely to be important in development of the condition.

Hypospadias is a common congenital condition which affects around 1 in 375 boys. In these infants the urethral opening is not located at the tip of the penis, but somewhere halfway, at the base of the penis, or in the scrotum. Children with the condition typically undergo surgery between six and 18 months of age, but the malformation may have medical, psychological and sexual consequences later in life.

Dr Jo Knight, based at the Comprehensive Biomedical Research Centre at King's, assisted in the analysis of a genome-wide association study on 436 boys with hypospadias and 494 without the condition, which was undertaken by Loes van der Zanden and colleagues at Radboud University Nijmegen Medical Centre in The Netherlands.

The study revealed a strong association between changes in the DGKK gene and hypospadias. A boy with a modified DGKK gene has 2.5 times increased risk of being born with the condition compared to other boys. The DGKK gene is located on the X chromosome and is therefore inherited from the mother.

Dr Jo Knight said: 'Until now we knew very little about hypospadias and why some boys are born with the condition. We already knew that there was a greater chance of boys being born with hypospadias if a male relative has the condition, but this study shows that changes in the DGKK gene, found on the X chromosome and inherited from the mother, plays a major role in the development of the condition.

'But we still don't know exactly how this causes the condition, so there is more research to be done to look at other combinations of genes and environmental factors that might trigger the malformation.'

More information: Nature Genetics paper: 'Common variants in DGKK are strongly associated with risk of hypospadias'

Provided by King's College London

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Accuray's CyberKnife VSI System recognized as Best New Radiology Device of 2010

Accuray Incorporated (Nasdaq: ARAY), a global leader in the field of radiosurgery, announced today that the company's CyberKnife® VSI™ System received the 2010 Minnie for Best New Radiology Device from AuntMinnie.com, the largest and most comprehensive community internet site for radiologists and related professionals in the medical imaging industry. Accuray will be presented with the award at the 2010 Radiological Society of North America (RSNA) annual meeting taking place in Chicago, Ill. from November 28 – December 3, 2010.

"The Minnies awards have been an important barometer of excellence in radiology for the past 11 years," said Brian Casey, editor in chief of AuntMinnie.com. "We're pleased to recognize Accuray's CyberKnife VSI System as the Best New Radiology Device of the year."

Through Accuray's R&D commitment to clinically-driven product enhancements that meet the needs of its customers and improve patient care, the company announced the CyberKnife VSI System in November 2009. The CyberKnife VSI System leverages the versatility, simplicity, and intelligence of the CyberKnife System to broaden the range of treatment options physicians can offer their patients - from radiosurgery to conventionally fractionated Robotic IMRT™. By supporting this full spectrum of fractionation schemes, the CyberKnife VSI System allows for more customized treatment plans based on patient-specific situations and conditions, such as patients requiring re-irradiation of previously treated areas, or patients requiring partial breast irradiation. Cutting-edge product enhancements, including a world-class 1,000 MU/minute X-band linear accelerator and auto-segmentation capabilities, make planning and delivery simple, convenient and fast for routine clinical use.

"We are honored to receive this designation from such an influential industry publication," said Euan S. Thomson, Ph.D., president and CEO of Accuray. "The team at Accuray is incredibly proud of the CyberKnife VSI System and the benefits it brings to helping patients win their fight against cancer."

SOURCE Accuray Incorporated

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Walking Slows Cognitive Decline In Alzheimer's Patients And Healthy People

Walking five miles per week may protect the brain and slow cognitive decline in people with mild cognitive impairment (MCI) and Alzheimer's disease, said researchers at a conference of medical imaging professionals in Chicago on Sunday; they also found that walking six miles a week did the same for healthy people.

Dr Cyrus Raji, from the Department of Radiology at the University of Pittsburgh in Pennsylvania, presented the findings of a study where he and his colleagues analyzed changes in brain volume among adults with varying degrees of congnitive impairment, including some with Alzheimer's, and also healthy adults, whose weekly physical activity had been monitored in a cardiovascular study over the previous 10 years.

Speaking at the 96th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA), being held this week in Chicago, Raji said:

"We found that walking five miles per week protects the brain structure over 10 years in people with Alzheimer's and MCI [mild cognitive impairment], especially in areas of the brain's key memory and learning centers."

"We also found that these people had a slower decline in memory loss over five years," he added.

MCI, short for Mild Cognitive Impairment, is where a person has more problems with memory and thinking skills than is typical for their age, but it is not as severe as that found in Alzheimer's disease. About 50 per cent of people diagnosed with MCI progress to Alzheimer's disease.

The numbers of Americans with MCI and Alzheimer's is set to increase significantly over the next decade, based on current population trends.

There is no cure for Alzheimer's, which is why researchers like Raji and colleagues are keen to find ways to alleviate the symptoms and slow the progression of the disease in people whose thinking and memory are already showing signs of decline.

Raji and colleagues recruited participants from the Cardiovascular Health Study, which is still ongoing, and has been collecting data for 20 years, and analyzed the relationship between their physical activity and brain structure.

Their study involved 426 participants in all, comprising 127 cognitively impaired adults of average age 81 years, and 299 healthy adults of average age 78. Of the cognitively impaired participants, 83 had MCI and 44 had Alzheimer's dementia.

The study data allowed the researchers to measure how far participants walked in a week. Then 10 years later they performed 3D MRI scans of their brains to look for changes in brain volume.

Raji explained that:

"Volume is a vital sign for the brain."

"When it decreases, that means brain cells are dying. But when it remains higher, brain health is being maintained," he said.

READ MORE - Walking Slows Cognitive Decline In Alzheimer's Patients And Healthy People

DIABETES

What is Diabetes?

Diabetes is a common group of chronic metabolic diseases that cause high blood sugar (glucose) levels in the body due to defects in insulin production or function. Diabetes is also known as diabetes mellitus to distinguish it from a relatively rare metabolic disorder called diabetes insipidus that doesn’t affect blood sugar. Symptoms of diabetes occur when a lack of insulin or insulin resistance stops glucose from entering the cells and fueling and energizing the body. The resulting spike in glucose can result in symptoms such as increased hunger and thirst, weight loss, fatigue, and frequent infections. Long-term complications include kidney failure, nerve damage, and blindness.

Types of Diabetes

Diabetes is categorized into two main categories and one subcategory, but all are typified by problems of insulin resulting in high blood sugar levels in the body. The categories are:

Type 1 Diabetes
This type of diabetes is categorized as an autoimmune disease and occurs when the body’s misdirected immune system attacks and destroys insulin-producing beta cells in the pancreas. Although genetic or environmental triggers are suspected, the exact cause of type 1 diabetes—once referred to as insulin-dependent or juvenile-onset diabetes—is not completely understood. Type 1 accounts for only five to 10 percent of diabetes cases in the United States, and while it can occur at any age, most patients are diagnosed as children or young adults. Those with type 1 diabetes must take insulin daily to manage their condition.

Type 2 Diabetes
This type most often develops gradually with age and is characterized by insulin resistance in the body. Because of this resistance, the body’s fat, liver, and muscle cells are unable to take in and store glucose, which is used for energy. The glucose remains in the blood. The abnormal buildup of glucose (blood sugar) can result in hyperglycemia and impaired body functions. Type 2 diabetes occurs most often in people who are overweight because fat interferes with the body’s ability to use insulin, but it also can occur in thin people and the elderly. Family history and genetics play a major role in type 2 diabetes, and inactivity and poor diet can also increase the risk.

Gestational Diabetes
Gestational diabetes is defined as blood-sugar elevation during pregnancy and is known to affect about three to eight percent of women. Left undiagnosed or untreated, it can lead to problems such as high birth weight and breathing problems for the baby. Gestational diabetes usually resolves in the mother after the baby is born, but statistics show that women who have gestational diabetes have a much greater chance of developing type 2 diabetes within five to 10 years.

Prediabetes
This condition is marked by blood sugar levels that are too high to be considered normal but are not yet high enough to be in the range of a typical diabetes diagnosis. Prediabetes increases not only your risk of developing diabetes but also heart disease.

Diabetes Symptoms
Diabetes symptoms occur when glucose (blood sugar) levels in the body become abnormally elevated. The most common symptoms of diabetes include thirst, fatigue, frequent or increased urination, and blurry vision, but symptoms do vary from one person to the next and depend on which type of diabetes you have. Symptoms of type 1 diabetes tend to begin abruptly and dramatically. In type 2 diabetes, the symptoms are similar but develop slowly, or there may be no symptoms at all. It is common for no symptoms to be present in gestational diabetes. In some cases, your symptoms may seem vague or harmless. It is essential that if you experience one or more of these symptoms on a regular basis, you see your doctor immediately for a diabetes screening and blood tests.

Common Diabetes Symptoms

Thirst/Dehydration
Diabetes causes your blood glucose levels to rise. Increased glucose levels cause your body to pull fluid from your cells into the bloodstream and deliver the increased load to your kidneys, causing them to produce more urine than normal. Frequent urination, another common symptom, causes you to feel thirsty and thus drink more liquids, compounding the problem.

Weight loss
Your body’s inability to properly use the glucose generated from the foods you eat, as well as the significant number of calories lost to increased urination, cause your body to break down other energy sources available—such as fat—which can result in weight loss. You may be eating normally and constantly feel hungry yet continue to lose weight.

Fatigue
Glucose is a primary source of fuel for the body. If you have diabetes, your body’s inability to convert glucose into energy will inevitably lead to fatigue, ranging from a general worn-down feeling to exhaustion.

Blurred Vision
Abnormally high glucose levels in the blood can also lead to eye problems such as swelling of the lens, which causes blurred vision. Adequately controlling your blood sugar levels can help correct this symptom over time. Left undetected, though, diabetes can lead to more serious eye problems such as cataracts, glaucoma, and retinopathy. In fact, diabetes is the leading cause of blindness in adults age 20 to 74.

Recurring Infections
High glucose levels in your body’s tissues may hinder the body’s ability to heal and make you more susceptible to various kinds of bacteria and infections, especially of the skin, kidneys, bladder, and feet.

Advanced Diabetes Symptoms
Although some people with diabetes may have no symptoms or mild symptoms that seem relatively harmless, untreated diabetes can result in dangerously high levels of blood sugar, called ketoacidosis. (Ketoacidosis is rare in type 2 diabetes because insulin is still being produced.) This condition can cause:

• Deep, rapid breathing
• Nausea or vomiting
• Stomach pain
• Flushed complexion
• Confusion
• Bad breath
• Coma

Dangerously low levels of blood sugar, called hypoglycemia, are sometimes associated with diabetes treatments. Hypoglycemia can cause:

• Fainting
• Rapid heartbeat
• Sweating
• Dizziness and trembling
• Confusion
• Anxiety
• Drowsiness
• Cramps

Diabetes CausesDiabetes is a chronic disease that is caused by the body’s inability to use glucose (blood sugar) properly due to a lack of or defects in insulin production. The precise cause of this insulin malfunction isn’t entirely understood, but genetic and environmental factors come into play. Additional contributing factors include inactivity and obesity. Specific causes include the following:

Lack of Insulin
This is specific to type 1 diabetes. It occurs when insulin-producing beta-cells are damaged or destroyed and stop producing insulin. Insulin is needed to move blood sugar into cells throughout the body. The resulting insulin deficiency leads to elevated glucose in the blood and prevents the body from being fueled properly.

Insulin Resistance
This is specific to type 2 diabetes. It occurs when insulin is produced normally in the pancreas, but the body is unable to use it properly and move it into the cells for fuel. At first, the beta cells will produce more insulin in an attempt to overcome the body’s resistance to it, but over time, the cells will eventually “wear out.” At that point the body decreases its insulin production, which leads to elevated glucose levels in the blood.

Pregnancy
A small percentage—studies show less than eight percent—of pregnant women may develop gestational diabetes. Hormones developed in the placenta interfere with the body’s normal insulin response and lead to insulin resistance and high levels of glucose in the blood.

Genetics
Inherited risk factors are believed to be a factor in causing all types of diabetes, but because most people with these risk factors do not develop the disease, researchers believe environmental triggers—diet and even climate—may also play a role. Genetics are believed to play an even stronger role in type 2 diabetes, in which family history is one of the leading factors. At the same time, type 2 diabetes also has a stronger environmental basis than type 1 diabetes. In other words, a family history of type 2 diabetes is a hugely important risk factor, but only in western cultures where high-fat diets and sedentary lifestyles are common. People living in non-western cultures rarely develop type 2 diabetes, no matter what their genetic risk.

Diabetes Risk Factors

Diabetes affects more than 20 million Americans, and 57 million Americans have prediabetes (early type 2 diabetes). There are many common risk factors to both type 1 and type 2 diabetes, but some are more specific to one or the other. Here’s a comprehensive overview of risk factors.

Family History
Genetics play a role in determining how likely you are to develop some type of diabetes. Although researchers don’t fully understand the role of genetics in the development of diabetes, statistics show that if you have a parent or sibling with diabetes, your odds of developing it yourself increase.

Age
According to the American Diabetes Association, about one in 13 people in the United States have diabetes. But statistics show that your risk of type 2 diabetes increases as you get older, especially after age 45. In fact, more than 80 percent of cases occur in people over age 45, though recent statistics indicate that the incidence of type 2 diabetes is increasing dramatically among children, adolescents, and younger adults. Likely factors include reduced exercise, decreased muscle mass, and weight gain as you age. Type 1 diabetes is usually diagnosed by the age of 30.

Obesity
Excess body fat—especially around your middle—can lead to insulin resistance and increased blood sugar levels. Research suggests that excess fatty tissue can trigger inflammation in the body that leads to insulin resistance. But many people who are overweight never develop diabetes, so research remains inconclusive on the link between obesity and diabetes.

Poor Diet
Studies have shown that malnutrition—especially low protein and fiber intake—is a contributing factor in developing type 2 diabetes. A diet high in calories, fat, and cholesterol raises your risk, as does obesity, which increases your body’s resistance to insulin.

Lack of Exercise
Studies show that exercise makes muscle tissue more responsive to insulin, which is why regular exercise such as aerobic and/or resistance training can help lower your risk of diabetes. Talk to your healthcare provider about an exercise plan that’s right for you.

Ethnicity
Although research is inconclusive, some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans) have a higher incidence of diabetes.

Gestational Diabetes
Women who develop gestational diabetes during pregnancy are at higher risk for developing type 2 diabetes later in life. Women who deliver a baby weighing more than 9 pounds are also at greater risk.

Diabetes Diagnosis

The results of specific glucose tests play a major role in diagnosing diabetes. These tests include:

• Fasting blood glucose test
• Random (non-fasting) glucose test
• Oral glucose tolerance test
• Glycated hemoglobin (A1C) test
• Urine test

In addition, your physician will review your medical history and your family’s medical history, document your diabetes symptoms or lack of symptoms, and conduct a physical exam before making a diagnosis. Because some people with diabetes may not yet have noticeable symptoms, it’s important to have a regular physical or checkup. Random or fasting blood glucose tests are commonly part of an annual physical for diabetes patients.

Diabetes Tests

A series of urine and blood tests are used to diagnose all types of diabetes.

Fasting Blood Glucose (FPG) Test
This is one of the most common and preferred tests; it measures blood glucose in a person who has not eaten anything for at least eight hours. Both diabetes and prediabetes can be diagnosed this way. A blood glucose level of 126 milligrams per deciliter (mg/dL) or higher indicates diabetes.

Random (Non-fasting) Plasma Glucose Test
This measures blood glucose without fasting. This test, along with an assessment of symptoms, is used to diagnose diabetes but not prediabetes. A blood glucose level of 200 mg/dL or higher indicates diabetes.

Oral Glucose Tolerance Test (OGTT)
This blood glucose test, administered after fasting for at least eight hours, is performed two hours after drinking a glucose-containing beverage. It is also common to test blood prior to the glucose drink and then every 30 to 60 minutes afterwards for up to three hours. Both diabetes and prediabetes can be diagnosed this way, and it is routinely used to screen for gestational diabetes. A blood glucose level of 200 mg/dL or higher (two hours after drinking a beverage containing 75 grams of glucose) indicates diabetes. Because glucose levels are normally lower during pregnancy, gestational diabetes is based on slightly different numbers: 155 mg/dL two hours after drinking the glucose beverage.

Glycated Hemoglobin (A1C) Test
The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. The A1C test measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The goal of the A1C test is to measure your average glucose levels for two to three months. A long-term average can be more accurate than a one-time test. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes.

Urine Test
Although this test alone cannot diagnose diabetes, a urine analysis for abnormal levels of glucose and ketones from the breakdown of fat is often used as part of an overall diagnosis.

Diabetes Treatments

There is no cure for diabetes, but it usually can be treated and managed effectively. In fact, some people with mild type 2 diabetes can manage their condition with just diet and exercise and can avoid even having to take medication. Your healthcare provider will consider a comprehensive list of factors—your age; overall health; medical history; type of diabetes; extent of the disease; tolerance for specific medications, procedures, or therapies; expectations for the course of the disease; and your opinion or preferences—when assessing your treatment options. Treatments primarily involve diabetes medication, insulin therapy, and/or a diet and exercise plan.

Diabetes Drugs
Several different classes of oral medications are available to treat type 2 diabetes, and they are effective because these patients still have some ability to produce insulin in the pancreas. There are many types of diabetes pills, each with a specific purpose, and most patients take several different medications. There are no similar medications to treat people with type 1 diabetes. However, these medications may be used in combination with an insulin regime to manage blood glucose levels in type 1 diabetics. Learn more about drugs that lower blood sugar levels.

Insulin Therapy
Insulin therapy is needed for people with type 1 diabetes because their pancreases no longer produce it naturally. In type 2 diabetics, the pancreas produces low levels of insulin and may need lower levels of insulin therapy if other types of treatment do not adequately maintain healthy glucose levels.

Because stomach enzymes interfere with insulin, ingesting insulin orally isn’t effective in lowering blood sugar in diabetics. Insulin must be directly introduced into the bloodstream via injection. Common forms of delivery include a needle and syringe, an insulin pen that contains an insulin cartridge, or an insulin pump that continuously administers proper doses.

Not all insulin is the same. They differentiate from each other by several factors: when the isulin begins working after injection, when it works the hardest, and how long it lingers in the body. For these reasons, your doctor may prescribe different types of insulin to use at different times of the day. These include:

• rapid-acting insulin
• short-acting insulin
• long-acting insulin
• intermediate options

Glucose Monitoring
Regularly checking your blood sugar level is the only way to know if your blood sugar levels remain within your target range. Food, exercise, medications, illnesses, alcohol, time of day, and stress can all affect your glucose levels, causing many unwanted fluctuations.

The more you test your blood sugar and know how your body responds to those factors, the safer you will be. Also, paying attention to any signs of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) can help manage your diabetes. Should you experience symptoms of either, immediately check your glucose level.

You doctor also may recommend regular testing, beyond your regular blood-sugar monitoring, of how effective your diabetes treatment plan is. A common way to do this through called A1C testing. It is not only the international standard for a diabetes diagnosis, but it measures your average blood sugar level over a period of two to three months. The test determines if changes need to be made to diet, insulin regimen, or other factors. While a patient’s target A1C goal varies depending on age and other factors, the American Diabetes Association recommends an A1C reading of below seven percent for most people.

Diet
Diet plays a crucial part in managing diabetes. However, no single diet is perfect for everyone. Diabetics, possibly in conjunction with advice from a dietician, should stick to highly nutritious foods that are low in fat and calories, such as fruits, vegetables, and whole grains. Limiting animal products and sugars also helps in maintaining healthy blood sugar levels. Balancing proportionate amounts of carbohydrates, proteins, sugars, and fats are key to managing diabetes. Regular blood sugar monitoring after meals can help you and your doctor or dietician discover the foods are best for you and those you should avoid.

Exercise
Exercise helps diabetics by lowering their blood sugar. Physical activity not only helps maintain a healthy weight, but it also transports sugar to cells where it is turned into energy. Along with this, aerobic exercise increases a person’s sensitivity to insulin. With exercise, a person’s body needs less insulin to transport sugar. While every person’s diabetes treatment varies, getting about 30 minutes of aerobic exercise each day can help manage your diabetes. As with any part of your diabetes treatment, work with your doctor on an exercise program that fits your age and fitness level.

Pancreas Transplant
Pancreas transplants are usually reserved for people whose diabetes has become so severe that it is unmanageable through traditional treatments. As with any organ transplants, pancreas transplants require immune system-suppressing drugs to prevent the body from rejecting the new organ. Those drugs increase the likelihood of serious side effects, including infection, organ injury, and even cancer. However, if a pancreas transplant is successful, the patient no longer will need insulin treatment because the new pancreas will naturally produce insulin and regulate glucose.

READ MORE - DIABETES

CANCER

Cancer is an umbrella term for a large group of diseases caused when abnormal cells divide and invade other tissue and organs. Cancer is the second leading cause of death in the U.S., and more than 1.5 million Americans are diagnosed with some form of it every year. According to the American Cancer Society, half of all men and a third of all women in the U.S. will develop cancer in their lifetimes.

Cancer Growth and Metastasis

Healthy cells have a specific life cycle, reproducing and dying off in a way that is determined by the type of cell. But sometimes, because of abnormalities, the cells multiply out of control and also do not die off when they should. This process may result in growths called tumors, which in turn can cause a variety of symptoms, depending on where they grow.

However, not all tumors are cancerous. Benign tumors are noncancerous and do not spread to nearby tissues, though they can sometimes grow large and cause problems when they press against neighboring organs and tissue. Malignant tumors are cancerous, and they have the ability to invade other parts of the body.

Cancer cells can also migrate through the bloodstream or lymphatic system from the place they originally grew to distant areas of the body. This process is called metastasis. Cancers that have metastasized are considered more advanced than those that have not, and metastatic cancers tend to be harder to treat and more fatal.

Types of Cancer

Cancers are named for the area in which they begin, even if they spread to other parts of the body. For example, a cancer that begins in the lungs and spreads to the liver is still called lung cancer. There are also several clinical terms used for certain cancers:

• Carcinoma is a cancer that starts in the skin or the tissues that line other organs.Sarcoma is
• a cancer of connective tissues such as bones, muscles, cartilage, and blood vessels.
• Leukemia is a cancer of bone marrow, which creates blood cells.
• Lymphoma and myeloma are cancers of the immune system.

Risk Factors & Treatment

Not all of the causes of cancer are known, but many things have been found to affect a person's risk for developing certain kinds of cancer.

• Diet
• Exposure to chemicals
• Unprotected exposure to the sun
• Genetics
• Certain viruses, such as HPV
• Smoking

Visit the Cancer Prevention section for more information.

Treatment depends on the type of cancer and how advanced it is, but the most common types are:

• Surgery to remove tumors
• Chemotherapy (the use of toxic medications to kill cancer cells)
• Radiation therapy (the use of focused beams of radiation to kill cancer cells)

There is no way to prevent cancer with 100 percent certainty, but there are several ways to significantly reduce your risk of developing it.

Quit Smoking

In addition to lung cancer, smoking tobacco is known to cause cancers of the mouth, throat, larynx, esophagus, stomach, pancreas, kidney, bladder, and cervix. Scientists estimate that 30 percent of all cancer deaths in the U.S. are due to smoking. Secondhand smoke, the smoke that nonsmokers are exposed to by being around smokers, is also known to increase the risk of cancer.

Although smokers who quit do not reduce their cancer risk to the level of someone who has never smoked, quitting still helps. According to the National Cancer Institute, people who stop smoking before age 30 have a 90 percent lower risk of dying due to smoking-related disease (such as lung cancer, emphysema, and chronic bronchitis), and those who quit before age 50 have a 50 percent lower risk.

Avoid Carcinogens

A carcinogen is a chemical known to cause cancer. Cigarette smoke, discussed above, contains more than 50 carcinogens. Other carcinogens include:

• Asbestos
• Benzene
• Cadmium
• Nickel
• Radon
• Uranium
• Vinyl chloride

Minimize Exposure to UV and Other Radiation

Ultraviolet (UV) radiation from the sun (and tanning beds) can damage the DNA of skin cells and cause skin cancer. When going out in the sun, always take precautions to protect yourself by wearing a hat, sunglasses, and clothing that covers most of your skin, or by applying sunscreen frequently. Learn more about UV rays, SPF, and the most affective sunscreens.

Other forms of radiation—such as high levels of radon (a radioactive gas) in your home and medical tests that use radiation (x-rays, CT scans)—can also cause cancer. To avoid unnecessary exposure to radiation, test your home for radon (find simple, inexpensive test kits at hardware stores), and avoid excessive x-rays and similar tests when possible.

Eat Healthy and Exercise

Studies have shown that a diet high in fat and red and processed meats increases the risk of colon, prostate, and other cancers. Excessive alcohol consumption—more than one drink per day for women and two per day for men—is also linked to cancers of the mouth, esophagus, and liver. On the other hand, a diet rich in fruits, vegetables, and whole grains has been found to decrease the risk of digestive system, lung, and other cancers.

Exercising regularly can also lower your cancer risk. Adults who get at least 2.5 hours of moderate intensity physical activity per week lower their risk of colon cancer by a third compared to those who do not exercise.

Obesity and Cancer
A combination of good food choices and exercise helps to achieve and maintain a healthy weight. These lifestyle habits help reduce the risk of cancer (and other diseases such as heart disease and diabetes). Studies have shown that being overweight or obese can increase your risk of breast, colon, esophageal, kidney, gallbladder, and uterine cancers.

Get Tested

Routine cancer tests do not prevent cancer from developing, but they do allow cancers to be detected early, which greatly improves a patient’s prognosis. The American Cancer Society recommends regular screenings for the following:

Breast Cancer
There has been a recent controversy regarding when women should begin regular screenings for breast cancer. The American Cancer Society (ACS) recommends annual mammograms starting at age 40. The U.S. Preventive Services Task Force (USPSTF) recommends that women between the ages of 50 and 74 years should have a screening mammogram every other year to check for breast cancer. Talk to your doctor about the right screening plan for you.

Cervical Cancer
The ACS recommends that women begin cervical cancer screening three years after their first vaginal intercourse but no later than 21 years of age, after which they should be screened every year if they are sexually active. Women between ages 30 and 65 whose previous pap smears have been normal should have the test done every three years.

Prostate Cancer
The ACS is less definitive about prostate cancer screening, stating that men should “make informed decisions with their doctor about whether to be tested.” This is due to the lack of research to prove that the potential benefits of screening outweigh the harms of testing and treatment. Men who are 50 years of age should discuss the pros and cons of screening. Those at a higher risk of prostate cancer—such as African-American men or men with a family history of prostate cancer—should start talk to their doctors at age 45.

Colorectal Cancer
There are several tests to screen for colorectal cancer and/or polyps. According to the ACS, women and men over the age of 50 should have an annual fecal occult blood test, which screens for cancer. Other recommended tests that screen for cancer and polyps include a flexible sigmoidoscopy (recommended every five years), a colonoscopy (every 10 years), a double-contrast barium enema (ever 5 years), or a CT colonography (every 5 years). Talk to your doctor about which tests and screening schedule is right for you.

Get Vaccinated

HPV
Some types of human papillomavirus (HPV) can infect the genital area; in fact, genital HPV is the most common sexually transmitted infection. Certain types of HPV can cause genital warts, while other types can cause cervical cancer. A vaccine against HPV called Gardasil has been approved by the FDA and is recommended for all girls and women between ages 9 and 26.

Hepatitis B
Hepatitis B virus causes inflammation of the liver, potentially resulting in serious liver disease including chronic infection, scarring, and cancer. According to the Centers for Disease Control and Prevention (CDC), children should get their first dose of the vaccine—usually given in a series of three or four shots—at birth and should have complete the vaccine by 6 to 18 months of age. It is recommended for anybody under age 18 who did not get the vaccine at birth and for unvaccinated adults at higher risk for the disease.

The vaccine is not recommended for anyone severely allergic to baker’s yeast or other components of the vaccine. Those are ill or who have had a previous severe allergic reaction to the vaccine should not be vaccinated.

There are a variety of symptoms that may indicate the presence of cancer. Unfortunately, other diseases can cause similar problems, so it’s important that you see a doctor if you are having problems with one or more of the symptoms below. Conversely, cancer may be present even in the absence of symptoms, so regular screenings are important for certain cancers.

• Pain
• A lump under the skin
• A new mole or a mole that changes size, or a lesion that doesn’t heal
• Hoarseness
• A cough that doesn't go away, coughing up blood, or shortness of breath
• Trouble swallowing or pain/heartburn after eating
• Changes in bowel or bladder habits, or blood in the stool or urine
• Unexplained weight gain or loss
• Enlarged lymph nodes
• Neurologic symptoms such as tingling sensations, changes in vision, or seizures
• Extreme weakness or fatigue
• Depression

Cancer Treatments

Depending on the type of cancer, where it is located, how advanced it is, and whether it has spread to multiple areas of the body, doctors will choose one or a combination of the treatments below. These treatments can be used as primary therapy (used to kill existing cancer cells) or as adjuvant therapy (used to prevent cancer from coming back).

Surgery

The goal of surgery is to remove all or most of the cancerous tumor(s). Surgery is a very common cancer treatment, but it cannot be used in all cases. For example, cancers of the blood, such as leukemia, do not form tumors. Some tumors may be inoperable because they have grown into or are very close to vital organs. Cancer that has metastasized throughout the body cannot be treated with surgery.

The side effects of cancer surgery are the same as any other kind of surgery and include pain and possible infection. In addition, surgery may damage nearby organs or other important tissue, causing a range of problems.

Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells. It is usually given in cycles where the patient is treated for several days and then has a recovery period before another cycle of treatment. There are dozens of chemotherapy drugs, each with its own set of side effects, but the most common side effects are hair loss, nausea, vomiting, diarrhea, weakness, fatigue, and a weakened immune system.

Radiation therapy

Radiation therapy is the use of concentrated radiation to kill cancer cells. While chemotherapy affects the entire body, radiation is usually targeted to specific areas, either by implanting radioactive materials in the body or by using computerized machines that control beams of radiation to deliver a very specific dose. Common side effects of radiation therapy are nausea, vomiting, skin sensitivity or burns, and fatigue.

Other Cancer Treatments

Surgery, chemotherapy, and radiation therapy are the most common treatment types, but other options may be available:

• Hormone therapy uses drugs and surgery to reduce levels of hormones that make certain kinds of cancers grow, especially breast and prostate cancers.
• Biological therapy (or immunotherapy) attempts to train the body's own immune system to recognize and fight cancer cells.
• Gene therapy attempts to alter the DNA of cancer cells, either to return them to normal or to make them more susceptible to other types of treatment.
• Palliative care focuses on improving overall quality of life for patients and families facing serious illness. Recent research has found that cancer patients receiving palliative care had a better quality life and lived longer than those who only received standard treatment.

READ MORE - CANCER

Allergy

Also called: Hypersensitivity

An allergy is a reaction of your immune system to something that does not bother most other people. People who have allergies often are sensitive to more than one thing. Substances that often cause reactions are

• Pollen
• Dust mites
• Mold spores
• Pet dander
  
• Insect stings
• Food
• Medicines

How do you get allergies? Scientists think both genes and the environment have something to do with it. Normally, your immune system fights germs. It is your body's defense system. In most allergic reactions, however, it is responding to a false alarm.
Allergies can cause a runny nose, sneezing, itching, rashes, swelling or asthma. Symptoms vary. Although allergies can make you feel bad, they usually won't kill you. However, a severe reaction called anaphylaxis is life-threatening.

NIH: National Institute of Allergy and Infectious Diseases

READ MORE - Allergy

Asthma in Children

Asthma is a chronic disease that causes the airways - the tubes that carry air in and out of your lungs - to become sore and swollen. In the United States, about 20 million people have asthma. Nearly 9 million of them are children. Children have smaller airways than adults, which makes asthma especially serious for them. Children with asthma may experience wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night.

Many things can cause asthma, including :

• Allergens - mold, pollen, animals
• Irritants - cigarette smoke, air pollution
• Weather - cold air, changes in weather
• Exercise
• Infections - flu, common cold

When asthma symptoms become worse than usual, it is called an asthma attack. Asthma is treated with two kinds of medicines: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms.

READ MORE - Asthma in Children

Asthma

Asthma is a chronic disease that affects your airways. Your airways are tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that you are allergic to or find irritating. When your airways react, they get narrower and your lungs get less air. This can cause wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night.

When your asthma symptoms become worse than usual, it's called an asthma attack. In a severe asthma attack, the airways can close so much that your vital organs do not get enough oxygen. People can die from severe asthma attacks.
Asthma is treated with two kinds of medicines: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms.

NIH: National Heart, Lung, and Blood Institute

READ MORE - Asthma

Anthrax, NIAID Fact Sheet

About the Microbe

Anthrax is an acute infectious disease caused by the spore-forming, rod-shaped bacterium Bacillus anthracis. Predominantly a cause of livestock disease, B. anthracis forms durable spores that can lie dormant in the soil for years. Once eaten by a grazing animal, the spores are activated and the bacteria reproduce. After the bacteria spread, they typically kill the infected animal and return to the soil or water once again as spores.

The bacterium's destructive properties are due largely to toxins, which consist of three proteins: protective antigen, edema factor, and lethal factor.

• Protective antigen (PA) binds to select cells of an infected person or animal and forms a channel that permits edema factor and lethal factor to enter those cells.
• Edema factor (EF), once inside the cell, causes fluid to accumulate at the site of infection. EF can contribute to a fatal buildup of fluid in the cavity surrounding the lungs. It also can inhibit some of the body's immune functions.
• Lethal factor (LF), once inside the cell, disrupts a key molecular switch that regulates the cell's functions. LF can kill infected cells or prevent them from working properly.

About the Disease

People rarely contract anthrax from healthy animals. Contact with infected livestock or their products such as leather and wool does, however, cause a limited number of anthrax cases throughout the world. In the United States, only 236 anthrax cases were reported between 1955 and 1999, an average of about five per year. Most of those cases were occupational exposures in people who work with animal carcasses or products. The treatable cutaneous (skin) form of the disease is most common. Worldwide incidence is unknown, but anthrax occurs more frequently in developing countries, especially those without strong veterinary public health programs. Anthrax is not transmitted from person to person.

Human anthrax occurs primarily in three forms: cutaneous, gastrointestinal, and inhalation.

• Cutaneous anthrax occurs when the bacteria, usually from infected animal products, enter a break in the skin. The skin reddens and swells, much like an insect bite, then develops a painless blackened lesion or ulcer that may form a brown scab. If left untreated, the infection can spread through the body. Cutaneous anthrax is the most common form of the diseases and responds well to antibiotics. It is rarely fatal if treated before it becomes invasive.
• Gastrointestinal anthrax may arise when a person eats contaminated food. The infection often causes fever accompanied by gastrointestinal problems such as vomiting, abdominal pain, diarrhea, or loss of appetite. In some cases, lesions may form in the nose and throat instead of the lower digestive tract. In both cases, gastrointestinal anthrax can spread through the body and is often fatal if not treated immediately. This form of anthrax, however, is not known to have occurred in the United States.
• Inhalation anthrax, sometimes called respiratory or pulmonary anthrax, occurs when the bacterial spores are inhaled. The early symptoms resemble those of a common cold or sore throat. The spores travel from the lungs to immune cells called macrophages in the nearby lymph nodes. There they begin to reproduce and secrete their toxins, causing severe breathing problems and shock. Treatment is difficult once the bacteria have reached that stage, and death often ensues. Naturally occurring inhalation anthrax is rare. Prior to the bioterrorist attack of 2001, the last known case of inhalation anthrax in the United States occurred in 1976 in a California craftsman who apparently contracted the infection from contaminated, imported yarn.

Treatment and Prevention

Antibiotics

Several different antibiotics kill B. anthracis as it reproduces within people and animals. If diagnosed early, anthrax can be treated. Unfortunately, infected people often confuse early symptoms with more common infections and do not seek medical help until severe symptoms appear. At that point the destructive anthrax toxins, which are not affected by antibiotics, have risen to high levels, making treatment difficult. Although cutaneous anthrax has telltale signs and symptoms making diagnosis easy, early stage gastrointestinal and inhalation anthrax are more likely to be mistaken for common maladies.

Vaccine

An anthrax vaccine is licensed for limited use. The vaccine is currently used to protect members of the military and individuals most at risk for occupational exposure to the bacteria, such as abattoir workers, veterinarians, laboratory workers, and livestock handlers. The vaccine consists of filtered proteins and other components of a weakened B. anthracis strain adsorbed to aluminum hydroxide. PA is the major component of the vaccine that provides protection against infection. The vaccine contains no whole bacteria.

Health experts currently do not recommend the vaccine for general use by the public due to the rarity of anthrax and the potential for adverse side effects. Researchers have not determined the safety and efficacy of the vaccine in children, the elderly, and people with weakened immune systems. In addition, the recommended vaccination schedule is 6 doses given over an 18-month period, so the vaccine would likely offer little protection in response to a bioterrorist attack. For these reasons, a new anthrax vaccine is needed.

NIAID Basic Research

Several biologic factors contribute to B. anthracis's ability to cause disease. By uncovering the molecular pathways that enable the bacterium to form spores, survive in people, and cause illness, NIAID hopes to identify new ways to diagnose, prevent, and treat anthrax.

Toxin Biology

Scientists are studying the anthrax toxins to learn how to block their production or action. Recently, NIAID grantees determined the three-dimensional structure of the LF protein as it attaches to its target inside cells. The research showed for the first time that LF uses a long groove on its side to latch onto that target. At the same time, another group of researchers identified a protein receptor on the surface of host cells to which PA attaches. Using a specific fragment of that receptor protein, the researchers were able to block the attachment of PA, thereby preventing formation of the PA channel and inhibiting the toxic effects of LF and EF in test-tube experiments. Other investigators have engineered mutant, inactive PAs that prevent bacteria-produced PAs from forming the channel. The studies of PA and LF should enable researchers to develop small molecules that can be used as therapeutics to treat anthrax by inhibiting its toxins.

The Anthrax Bacterium Genome

The instructions that dictate how a microbe works are encoded within its genes. Bacteria often contain genes at two locations. The bacterial chromosome is a long stretch of DNA that houses most of those genes, but smaller loops of DNA called plasmids also carry genes that can be exchanged between different bacteria. Because plasmids often contain genes for toxins and antibiotic resistance, knowing their DNA sequence is important.

In B. anthracis, the genes for PA, LF, and EF are found on plasmids that have already been sequenced. In addition, researchers recently reported the complete chromosomal DNA sequence of two B. anthracis isolates, including the bacterium that infected a Florida victim of the recent anthrax attack. Genome sequencing of more than a dozen other B. anthracis strains and related bacteria has already begun.

By comparing the DNA blueprints of different B. anthracis strains, researchers hope to learn why some strains are more virulent than others. Small variations among the genomes of different strains may also help investigators pinpoint the origin of an anthrax outbreak. Knowing the genetic fingerprint of B. anthracis might lead to gene-based detection mechanisms that can alert scientists to the bacteria in the environment or allow rapid diagnosis of anthrax in infected people. Variations between strains might also point to differences in antibiotic susceptibility, permitting doctors to immediately determine the appropriate treatment.

DNA sequencing also opens the door to functional genomics, in which the B. anthracis genome will be analyzed to determine the function of each of its genes and how they interact with each other or with host-cell components to cause disease. Genes are the instructions for making proteins, which in turn build components of the cell or carry out its biochemical processes. Knowing the sequence of B. anthracis genes therefore helps scientists discover key bacterial proteins that can then be targeted by new drugs or vaccines.

Spore Biology

B. anthracis spores are essentially dormant and therefore must wake up, or germinate, to become reproductive, disease-causing bacteria. Researchers are therefore studying the germination process to learn more about the signals that cause spores to become active once inside an animal. Efforts are underway to develop models of spore germination in laboratory animals; scientists hope those models will enable discoveries leading to drugs that block the germination process.

Host Immunity

People who contract anthrax produce antibodies to PA, and similar antibodies appear to protect animals from infection. Recent studies also suggest that some animals can produce antibodies to components of B. anthracis spores. Those antibodies, when studied in a test tube, prevent spores from germinating and increase their uptake by the immune system's microbe-eating cells. It therefore might be possible to develop a vaccine that can be given after exposure to fight both the reproductive form of B. anthracis and any spores that may linger in the lungs following antibiotic treatment.

As part of NIAID's strategic plan, researchers will study how both the innate and adaptive immune responses are triggered by a B. anthracis infection. The adaptive immune response consists of B cells and T cells which specifically recognize components of the anthrax bacterium. The innate immune system, however, responds more generally to a wide range of microbial invaders and likely plays a key role in the body's front-line defenses. Scientists will conduct studies of how those two arms of the immune system act to counter infection, including how B. anthracis spore germination affects individual immune responses.

NIAID Therapeutics Research

Following the recent discoveries of how PA and LF interact with their cellular targets, researchers are screening thousands of small molecules in hopes of finding a compound that is practical for use as an anti-anthrax drug. In addition, NIAID is working with the Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Department of Defense (DoD) to accelerate testing of collections of compounds for their effectiveness against inhalation anthrax. Many of those compounds have already been approved by FDA for other indications and therefore could quickly be approved for use in treating anthrax should they prove effective.

NIAID is seeking new drugs that attack B. anthracis at many levels. These include agents that prevent the bacterium from attaching to cells, compounds that inhibit spore germination, and inhibitors that block the activity of key enzymes such as anthrax lethal factor. The Institute will also develop the capacity to synthesize promising anti-anthrax compounds in sufficient purity and quantity for preclinical testing.

NIAID Vaccine Research

Researchers are working on new, improved anthrax vaccines that may be more easily given to a diverse population. NIAID is collaborating with DoD to develop a next-generation vaccine based on a laboratory-produced, or recombinant, PA variant. Antibodies to PA also appear to recognize some components of the bacterial spore, making PA-based vaccines promising candidates for broad protection against anthrax. The Institute will supervise phase I and phase II trials of the recombinant PA vaccine in different formulations.

To help move potential vaccines into clinical testing, NIAID will develop the infrastructure to produce pilot lots of promising candidates and expand the Institute's testing capacity. To assist in its vaccine research efforts, NIAID will establish a centralized immunology laboratory to assess the efficacy of different vaccine candidates.

NIAID Diagnostics Research

Research is underway to develop improved techniques for spotting B. anthracis in the environment and diagnosing it in infected individuals. A key part of that research is the functional genomic analysis of the bacterium, which should lead to new genetic markers for sensitive and rapid identification. Genomic analysis will also reveal differences in individual B. anthracis strains that may affect how those bacteria cause disease or respond to treatment.

Anthrax and Bioterrorism

CDC has classified B. anthracis as a Category A agent. Those agents are considered the highest threat to national security due to their ease of transmission, high rate of death or serious illness, and potential for causing public panic.

In October 2001, anthrax spores were sent through the U.S. mail and caused 18 confirmed cases of anthrax (11 inhalation, 7 cutaneous). Five individuals with inhalation anthrax died; none of the cutaneous cases was fatal.

More Information

National Institute of Allergy and Infectious Diseases
National Institutes of Health
31 Center Drive, MSC 2520
Bethesda, MD 20892-2520
http://www.niaid.nih.gov/newsroom/releases/anthraxspec.htm

National Library of Medicine
MEDLINEplus
8600 Rockville Pike
Bethesda, MD 20894
1-800-338-7657
http://www.nlm.nih.gov/medlineplus/anthrax.html

U.S. Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-888-232-3228
http://www.bt.cdc.gov/Agent/Anthrax/Anthrax.asp

World Health Organization
Avenue Appia 20
1211 Geneva 27
Switzerland
(00 41 22) 791 21 11
http://www.who.int/emc/diseases/anthrax/

U.S. Department of Agriculture
Washington, D.C. 20250
http://www.usda.gov/homelandsecurity/anthraxfs.htm

U.S. Food and Drug Administration
Food and Drug Administration
5600 Fishers Lane
Rockville, Maryland 20857
1-888-INFO-FDA (1-888-463-6332)
http://www.fda.gov/oc/opacom/hottopics/bioterrorism.html

Johns Hopkins University Center for Civilian Biodefense Studies
http://www.hopkins-biodefense.org/pages/agents/agentanthrax.html

NIAID is a component of the National Institutes of Health (NIH). NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.

Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

U.S. Department of Health and Human Services

READ MORE - Anthrax, NIAID Fact Sheet

HIV Infection in Minority Populations

Overview

Minority populations in the United States, primarily African Americans and Hispanics, constitute 57 percent of the more than 700,000 cases of AIDS reported to the U.S. Centers for Disease Control and Prevention (CDC) since the epidemic began in 1981. African Americans make up almost 38 percent of all AIDS cases reported in the United States, yet according to the U.S. Census Bureau, they comprise only 12 percent of the U.S. population. Hispanics represent 19 percent of all AIDS cases. Including residents of Puerto Rico, they represent 13 percent of the population in this country. According to CDC

• As of June 2001, African Americans and Hispanics represented 51 percent of AIDS cases reported among males and 77 percent of those in females.
• As of June 2001, 58 percent of all women reported with AIDS are African American and 20 percent are Hispanic
• African American children represent 58 percent of all pediatric AIDS cases.
• Of the 194 pediatric AIDS cases reported between July 2000 and June 2001, 163 (84 percent) were in African Americans and Hispanics.
• In 1999, AIDS accounted for an estimated 50 percent of deaths among African Americans and 18 percent among Hispanics. It is the leading cause of death among African-American men ages 25-44.
• Injection drug use is a major factor in the spread of HIV in minority communities. Through June 2001, injection drug users accounted for 20 percent of all AIDS cases among both African Americans and Hispanics.

NIAID Research on HIV Infection and AIDS

The National Institute of Allergy and Infectious Diseases (NIAID), the lead component for AIDS research at the National Institutes of Health (NIH), is at the forefront of the war against this continuing health crisis, which disproportionately affects minority populations.

NIAID supports scientific research at universities, medical schools, hospitals and research institutions, both in the United States and abroad, aimed at preventing, diagnosing, and treating HIV infection and AIDS and other infectious diseases as well as allergic and other immune system disorders.

NIAID's AIDS research agenda includes conducting clinical trials that address the specific needs and concerns of minority populations, ensuring that minority patients have access to all clinical trials and sharing the latest information on AIDS treatment and prevention. In addition, NIAID's Office of Special Populations Research and Training encourages research aimed at improving the health of minority populations. The office also works to increase the effectiveness of outreach and education programs.

Through its Office of Communications and Public Liaison and the Dale and Betty Bumpers Vaccine Research Center, NIAID works with community-based organizations to disseminate information about HIV infection and AIDS and NIAID research activities to minority communities.

Clinical Research

NIAID programs and/or networks evaluate promising therapies to fight HIV infection and its associated complications, as well as approaches to reconstitute HIV-damaged immune systems. These include the Adult AIDS Clinical Trials Group (AACTG),the Pediatric AIDS Clinical Trials Group(PACTG), the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA), the HIV Prevention Trials Network (HPTN), the Acute Infection and Early Disease Research Program (AIEDRP), and the Division of Intramural Research Clinical Program.

Together, these programs represent the largest AIDS treatment and prevention initiative in the United States. Recruiting minorities into clinical trials is a priority for NIAID to ensure that research results will apply to all populations affected by HIV. With the epidemic moving swiftly into minority communities, inclusion of these patients is particularly urgent.

The AACTG investigates therapeutic interventions for HIV infection, AIDS, and complications of HIV-associated immune deficiency in adults. AACTG sites receive additional funding from the National Institute on Drug Abuse (NIDA) to increase participation of injection drug users, who are also hard hit by the AIDS epidemic.

The PACTG evaluates clinical interventions for treating HIV infection and HIV-associated illnesses in neonates, infants, children, adolescents. Both the PACTG and the HPTN are researching approaches to interrupt mother-to-infant transmission in pregnant women. In 2001, 6,186 and 6,426 participants were enrolled in AACTG and PACTG studies respectively. In the AACTG, 26 percent were African American, 19 percent were Hispanic, and 3 percent were Asian/Pacific Islander or Native American. In the PACTG, 47 percent were African American, 25 percent were Hispanic, and 1 percent Asian/Pacific Islander or Native American.

The HPTN is a global multicenter network dedicated to non-vaccine prevention research with a focus on HIV endpoints. They have directed their educational outreach efforts to minority communities working to increase trial volunteerism.

CPCRA is a network of community-based health centers and clinics which support clinical research in community settings by conducting large comparative studies that examine how to use available therapies more effectively as well as the long-term consequences of different treatments. Currently, CPCRA trials are under way in 17 cities at 18 units. In 2001, 4,244 people participated in CPCRA studies. Of those, 49 percent were African American, 13 percent were Hispanic, and 1 percent were Native American or Asian/Pacific Islander.

NIAID also supports clinical research on vaccine and non-vaccine strategies to prevent HIV infection. Vaccine studies are carried out through the HIV Vaccine Trials Network (HVTN) and non-vaccine prevention studies are conducted by the HPTN. The HVTN is a global network of clinical sites which evaluate preventive HIV vaccine in all phases of clinical trials. They allow for studies that examine differences in HIV diversity and genetic background , all of which may prove crucial to developing an effective vaccine for use around the world. Through close collaborations and education outreach programs with communities where vaccines will be tested, the HVTN hopes to enroll a diversified population in its clinical trials, ensuring access and representation of populations most affected by and vulnerable to HIV spread.

The HVTN and HPTN opened in 2000 and have enrolled thousands of study participants. In 2001, 383 and 9,517 people participated in the HVTN and HPTN, respectively. Of those in the HVTN, 21 percent were African American, 3 percent were Hispanic, and 1 percent Native American or Asian/Pacific Islander. In the HPTN, 57 percent of participants were African American, 7 percent Hispanic, and about 3 percent Native American or Asian/Pacific Islander.

In addition, NIAID supports two major programs to enhance basic and clinical HIV research performed at minority institutions: Research Centers in Minority Institutions and AIDS Clinical Trials Infrastructures in Minority Institutions.

Epidemiologic Research

NIAID conducts and supports research on HIV infection in a variety of population groups, including minority populations. These studies are conducted through the Women and Infants Transmission Study (WITS/WITS II), the Women's Interagency HIV Study (WIHS), and the Multicenter AIDS Cohort Study (MACS). Inner-city women, children, and injection drug users are the focus of WITS/WITS II. Eighty-four percent of the women in this study are from minority populations.

Similar populations of women are the focus of the WIHS, which NIAID established and awarded funds to six U.S. sites in 1993 to investigate primarily the impact of HIV infection on women. Several other NIH institutes also collaborate on WIHS and provide funds for various components. They include NIDA, the National Cancer Institute, National Institute of Child Health and Human Development, and National Institute of Dental and Craniofacial Research.

Active community involvement through the WIHS sites and the WIHS National Community Advisory Board helps encourage minority women to participate in the studies. More than 80 percent of the women currently enrolled in WIHS are from minority populations.

In the United States, the Multicenter AIDS Cohort Study (MACS) and WIHS are the two largest observational studies of HIV/AIDS in homosexual or bisexual men and in women, respectively. These studies have made major contributions to understanding how HIV is spread, how the disease progresses, and how it can best be treated. Over the past year, these studies expanded their enrollment to increase the size of the study groups by 60 percent and increase the number of minority participants. The enlarged groups will focus on contemporary questions regarding HIV infection and treatment.

More Information

For information about Food and Drug Administration-approved HIV-related clinical trials being conducted throughout the United States, contact the AIDS Clinical Trials Information Service.
1-800-TRIALS-A (1-800-874-2572)
301-519-0459 (International)
1-888-480-3739 (TTY/Deaf Access)
http://actis.org

For federally approved treatment guidelines on HIV/AIDS, contact the HIV/AIDS Treatment Information Service:

1-800-HIV-0440 (1-800-448-0440)
1-888-480-3739 (TTY/Deaf Access)
301-519-0459 (International)
http://hivatis.org

Both services operate from 12 p.m. to 5 p.m. Eastern Time, Monday through Friday. Spanish-speaking specialists are available.

To receive materials or to talk with a Health Communication Specialist, contact the CDC National HIV and STD Hotline. This service is available 24 hours a day.

1-800-227-8922
1-800-342-2437
1-800-243-7889 (TTY/Deaf Access)

To get information specifically about clinical trials conducted by the NIAID Intramural AIDS Research Program, call 1-800-243-7644 (http://clinicaltrials.gov).

NIAID is a component of the National Institutes of Health (NIH). NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.

Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

U.S. Department of Health and Human Services
June 2002

READ MORE - HIV Infection in Minority Populations

HIV Infection in Infants and Children

Overview

The National Institute of Allergy and Infectious Diseases (NIAID) has a lead role in research devoted to children infected with the human immunodeficiency virus (HIV), the virus that causes the acquired immunodeficiency syndrome (AIDS).

NIAID-supported researchers are developing and refining treatments to prolong the survival and improve the quality of life of HIV-infected infants and children. Many promising therapies are being tested in the Pediatric AIDS Clinical Trials Group (ACTG), a nationwide clinical trials network jointly sponsored by NIAID and the National Institute of Child Health and Human Development (NICHD). Scientists also are improving tests for diagnosing HIV infection in infants soon after birth so that therapy can begin as soon as possible.

Epidemiologic studies are examining risk factors for transmission as well as the course of HIV disease in pregnant women and their babies in an era of antiretroviral therapy. Researchers have helped illuminate the mechanisms of HIV transmission as well as the distinct features of pediatric HIV infection and how the course of disease and the usefulness of therapies can differ in children and adults.

Researchers also are studying ways to prevent transmission of HIV from mother to infant. Notably, Pediatric ACTG investigators have demonstrated that a specific regimen of zidovudine (AZT) treatment, given to an HIV-infected woman during pregnancy and to her baby after birth, can reduce maternal transmission of HIV by two-thirds.¹ Many consider this finding to be one of the most significant research advances to date in the fight against HIV and AIDS.

A Global Problem

According to UNAIDS (The Joint United Nations Programme on HIV/AIDS) and the World Health Organization (WHO),^2,3 at the end of 1998, an estimated 1.2 million children worldwide under age 15 were living with HIV/AIDS. Approximately 3.2 million children under 15 had died from the virus or associated causes. The number of children who had lived with HIV from the start of the epidemic through 1997 was estimated to be 3.8 million. As HIV infection rates rise in the general population, new infections are increasingly concentrating in younger age groups.

Statistics for the year 1998 alone show that

• 590,000 children under age 15 were newly infected with HIV.
• One-tenth of all new HIV infections were in children under age 15.
• Approximately 7,000 young people aged 10 to 24 became infected with HIV every day-that is, five each minute.
• Nine out of 10 new infections in children under 15 were in sub-Saharan Africa.
• An estimated 510,000 children under 15 died of AIDS-related causes, up from 460,000 in 1997.

More than 95 percent of all HIV-infected people now live in developing countries, which have also suffered 95 percent of all deaths from AIDS. In countries with the longest-lived AIDS epidemics, some doctors report that children ill from HIV occupy three-quarters of pediatric hospital beds, and childrens' life expectancy has been shortened dramatically. In Botswana, for example, because of AIDS, the life expectancy of children born early in the next decade is just over age 40; without AIDS, it would have been 70. In Namibia, the infant mortality rate is expected to reach 72 deaths per 1000, up from a non-AIDS rate of 45 per 1000.

The United States has a relatively small percentage of the world's children living with HIV/AIDS. From the beginning of the epidemic through the end of 1998, 5,237 American children under age 13 had been reported to the Centers for Disease Control and Prevention (CDC) as living with HIV/AIDS.⁴ Three hundred eighty-two cases of pediatric AIDS were reported in 1998.⁵ There are many more children who are infected with HIV but have not yet developed AIDS. Half of all new HIV infections reported to the CDC have been in people younger than 25.⁶ One encouraging fact is that the number of pediatric AIDS cases estimated by the CDC fell by two-thirds from 1992 to 1997 (947 to 310 cases).⁷

The U.S. cities that had the five highest rates of pediatric AIDS during 1998 were New York City; Miami, Florida; Newark, New Jersey; Washington, D.C.; and San Juan, Puerto Rico.⁸ The disease disproportionately affects children in minority groups, especially African Americans.⁹ Out of 8,461 cases in children under 13 reported to the CDC through December 1998, 58 percent were in blacks/not-Hispanic, 23 percent were in Hispanics, 17.5 percent were in whites/not-Hispanic, and 5.33 percent were in other minority groups.¹⁰

According to 1996 data, the latest available, HIV infection was the seventh leading cause of death for U.S. children through 14 years of age.¹¹ However, the CDC reported a drop of 56 percent from 1994 to 1997 in the estimated number of children who died from AIDS.¹² New anti-HIV drug therapies and promotion of voluntary testing are having a major impact.

Transmission

Almost all HIV-infected children acquire the virus from their mothers before or during birth or through breast-feeding. In the United States, approximately 25 percent of pregnant HIV-infected women not receiving AZT therapy have passed on the virus to their babies. The rate is higher in developing countries.

Most mother-to-child transmission, estimated to cause over 90 percent of infections worldwide in infants and children,^13,14 probably occurs late in pregnancy or during birth. Although the precise mechanisms are unknown, scientists think HIV may be transmitted when maternal blood enters the fetal circulation, or by mucosal exposure to virus during labor and delivery. The role of the placenta in maternal-fetal transmission is unclear and the focus of ongoing research.

The risk of maternal-infant transmision (MIT) is significantly increased if the mother has advanced HIV disease, increased levels of HIV in her bloodstream, or fewer numbers of the immune system cells -- CD4+ T cells -- that are the main targets of HIV.

Other factors that may increase the risk are maternal drug use, severe inflammation of fetal membranes, or a prolonged period between membrane rupture and delivery. A study sponsored by NIAID and others found that HIV-infected women who gave birth more than four hours after the rupture of the fetal membranes were nearly twice as likely to transmit HIV to their infants, as compared to women who delivered within four hours of membrane rupture.¹⁵

HIV also may be transmitted from a nursing mother to her infant. Studies have suggested that breast-feeding introduces an additional risk of HIV transmission of approximately 10 to 14 percent among women with chronic HIV infection.¹⁶ In developing countries, an estimated one-third to one-half of all HIV infections are transmitted through breast-feeding.¹⁷ The WHO recommends that all HIV-infected women be advised as to both the risks and benefits of breast-feeding of their infants so that they can make informed decisions. In countries where safe alternatives to breast-feeding are readily available and economically feasible, this alternative should be encouraged. In general, in developing countries where safe alternatives to breast-feeding are not readily available, the benefits of breast-feeding in terms of decreased illness and death due to other infectious diseases greatly outweigh the potential risk of HIV transmission.

Prior to 1985 when screening of the nation's blood supply for HIV began, some children were infected through transfusions with blood or blood products contaminated with HIV. A small number of children also have been infected through sexual or physical abuse by HIV-infected adults.

Preventing Maternal-Infant Transmission (MIT)

In 1994, a landmark study conducted by the Pediatric ACTG demonstrated that AZT, given to HIV-infected women who had very little or no prior antiretroviral therapy and CD4+ T cell counts above 200/mm3, reduced the risk of MIT by two-thirds, from 25 percent to 8 percent.¹⁸ In the study, known as ACTG 076, AZT therapy was initiated in the second or third trimester and continued during labor, and infants were treated for six weeks following birth. AZT produced no serious side effects in mothers or infants. Long-term follow-up of the infants and mothers is ongoing. Pediatric ACTG protocol 185 tested an AZT regimen and was reported in 1999 to have lowered MIT to about 5 percent.¹⁹ Combination therapies have been shown to be beneficial in the treatment of HIV-infected adults, and current guidelines have been designed accordingly.²⁰ In HIV-infected pregnant women, the safety and pharmacology of these potent drug combinations need to be better understood, and NIAID is conducting studies in this area.

Researchers have shown that this AZT regimen has reduced MIT in other populations in which it has been used. Observational studies in the past few years in the United States and Europe indicate that similar reductions can be achieved by using this regimen in regular clinical care settings. In the U.S., the number of MIT-acquired AIDS cases reported to the CDC fell 43 percent from 1992 to 1996, probably because of providing AZT to HIV-infected mothers, better guidelines for prenatal HIV counseling and testing, and changes in obstetrical management.^21,22

Recent studies have shown that short regimens, too, of AZT can be beneficial in cutting back on MIT. In March 1999, researchers reported on a randomized study in Thailand on the short-term use of AZT during late pregnancy and labor in a group of non-breast-feeding women (the drug was not given to infants). They concluded that the treatment was safe and effective and can reduce the rate of MIT by 50 percent.²³ Another recent study using a short-term AZT regimen (including post-partum) in groups of women in Ivory Coast and Burkina Faso, Africa, while limited, supported this finding.²⁴

Following up on the success of ACTG 076, the Pediatric ACTG has begun new HIV prevention trials that build on the AZT regimen. These trials include other antiviral agents and multidrug combinations in an attempt to reduce MIT even more than that achieved by AZT alone. Also, in early 1999, a study sponsored by UNAIDS of a combination regimen of AZT plus lamivudine (3TC) in three African countries showed promising results.²⁵

The AZT regimen used in ACTG 076 is not available in much of the world because of its high cost (approximately $1000 per pregnancy, not counting counseling or testing) and logistical demands. The cost of a short-course AZT regimen is substantially lower, but is still prohibitive in many countries. International agencies are studying whether there may be innovative ways to provide AZT at lower cost, e.g., through reductions in drug prices to developing countries, partnerships with industry, etc. NIAID is pursuing a global strategy that assesses whether simpler and less costly regimens to prevent mother-to-infant HIV transmission can be effective in various settings.

In September 1999, an NIAID-funded study (HIVNET 012) demonstrated that short-course therapy with nevirapine lowered the risk of HIV-1 transmission during the first 14-16 weeks of life by nearly 50 percent compared to AZT in a breastfeeding population.²⁶ This simple, inexpensive regimen offers a potential cost-effective alternative for decreasing mother-to-child transmission in developing countries.^27.

The International Perinatal HIV Group reported in April 1999 that elective caesarean section delivery can help reduce vertical transmission of HIV, though it is not without risk to certain women.²⁸ When AZT treatment is combined with elective caesarean delivery, a transmission rate of 2 percent has been reported.²⁹

Because a significant amount of MIT occurs around the time of birth, and the risk of maternal-fetal transmission depends, in part, on the amount of HIV in the mother's blood, it may be possible to reduce transmission using drug therapy only around the time of birth. NIAID has planned other studies that will assess the effectiveness of this approach as well as the role of new antiretrovirals, microbicides and other innovative strategies in reducing the risk of MIT of HIV.

Diagnosis

HIV infection is often difficult to diagnose in very young children. Infected babies, especially in the first few months of life, often appear normal and may exhibit no telltale signs that would allow a definitive diagnosis of HIV infection. Moreover, all children born to infected mothers have antibodies to HIV, made by the mother's immune system, that cross the placenta to the baby's bloodstream before birth and persist for up to 18 months. Because these maternal antibodies reflect the mother's but not the infant's infection status, the test is not useful in newborns or young infants.

In recent years, investigators have demonstrated the utility of highly accurate blood tests in diagnosing HIV infection in children 6 months of age and younger. One laboratory technique called polymerase chain reaction (PCR) can detect minute quantities of the virus in an infant's blood. Another procedure allows physicians to culture a sample of an infant's blood and test it for the presence of HIV.

Currently, PCR assays or HIV culture techniques can identify at birth about one-third of infants who are truly HIV-infected. With these techniques, approximately 90 percent of HIV-infected infants are identifiable by 2 months of age, and 95 percent by 3 months of age. One innovative new approach to both RNA and DNA PCR testing uses dried blood spot specimens, which should make it much simpler to gather and store specimens in field settings.

Progression of HIV Disease in Children

Researchers have observed two general patterns of illness in HIV-infected children. About 20 percent of children develop serious disease in the first year of life; most of these children die by age 4 years.

The remaining 80 percent of infected children have a slower rate of disease progression, many not developing the most serious symptoms of AIDS until school entry or even adolescence. A recent report from a large European registry of HIV-infected children indicated that half of the children with perinatally acquired HIV disease were alive at age 9. Another study, of 42 perinatally HIV-infected children who survived beyond 9 years of age, found about one-quarter of the children to be asymptomatic with relatively intact immune systems.

The factors responsible for the wide variation observed in the rate of disease progression in HIV-infected children are a major focus of the NIAID pediatric AIDS research effort. The Women and Infants Transmission Study, a multisite perinatal HIV study funded by NIH, has found that maternal factors including Vitamin A level and CD4 counts during pregnancy, as well as infant viral load and CD4 counts in the first several months of life, can help identify those infants at risk for rapid disease progression who may benefit from early aggressive therapy.

Signs and Symptoms of Pediatric HIV Disease

Many children with HIV infection do not gain weight or grow normally. HIV-infected children frequently are slow to reach important milestones in motor skills and mental development such as crawling, walking and speaking. As the disease progresses, many children develop neurologic problems such as difficulty walking, poor school performance, seizures, and other symptoms of HIV encephalopathy.

Like adults with HIV infection, children with HIV develop life-threatening opportunistic infections (OIs), although the incidence of various OIs differs in adults and children. For example, toxoplasmosis is seen less frequently in HIV-infected children than in HIV-infected adults, while serious bacterial infections occur more commonly in children than in adults. Also, as children with HIV become sicker, they may suffer from chronic diarrhea due to opportunistic pathogens.

Pneumocystis carinii pneumonia (PCP) is the leading cause of death in HIV-infected children with AIDS. PCP, as well as cytomegalovirus (CMV) disease, usually are primary infections in children, whereas in adults these diseases result from the reactivation of latent infections.

A lung disease called lymphocytic interstitial pneumonitis (LIP), rarely seen in adults, also occurs frequently in HIV-infected children. This condition, like PCP, can make breathing progressively more difficult and often results in hospitalization.

Children with HIV suffer the usual childhood bacterial infections -- only more frequently and more severely than uninfected children. These bacterial infections can cause seizures, fever, pneumonia, recurrent colds, diarrhea, dehydration and other problems that often result in extended hospital stays and nutritional problems.

HIV-infected children frequently have severe candidiasis, a yeast infection that can cause unrelenting diaper rash and infections in the mouth and throat that make eating difficult.

Treatment of HIV-Infected Children

NIAID investigators are defining the best treatments for pediatric patients. Currently there are 16 drug products approved by the FDA for the treatment of adult HIV infection. Through major contributions by the Pediatric ACTG, 10 antiretroviral agents have pediatric label information, including 3 protease inhibitors.²⁸ While the basic principles that guide treatment of pediatric HIV infection are the same as for any HIV-infected person, there are a number of unique scientific and medical concerns that are important to consider in the treatment of children with HIV infection. These range from differences from adults in age-related issues such as CD4 lymphocyte counts and drug metabolism to requirements for special formulations and treatment regimens that are appropriate for infants through adolescents. As in adults, treatment of HIV-infected children today is a complex task of using potent combinations of antiretroviral agents to maximally suppress viral replication.

Researchers supported by NIAID are focusing not only on the development of new antiretroviral products but also on the critical question of how to best use the treatments that are currently available. Treatment strategy questions designed to identify what the best initial therapy is, when failing regimens should be switched and strategies for how to address the antiretroviral needs of children with advanced disease are examples. Long-term assessment of these children is also a high priority to assess sustained antiretroviral benefits as well as to monitor for potential adverse consequences of treatment.

Problems of Families

A mother and child with HIV usually are not the only family members with the disease. Often, the mother's sexual partner is infected, and other children in the family may be infected as well. Frequently, a parent with AIDS does not survive to care for his or her HIV-infected child.

In the countries hardest hit by the AIDS epidemic, some 8.2 million children under 15 around the world have been orphaned by AIDS - 90 percent of them in sub-Saharan Africa alone.³¹ The rate is expected to increase. One in three of these orphans is under age five.³² Communities and extended families are struggling with and often overwhelmed by the vast number of AIDS orphans. Many orphans and other children from families devastated by AIDS face multiple risks, such as forced relocation, violence, living on the streets, drug use, and even commercial sex. Other children suffer because sex education and services are not available to them or do not communicate effectively to them. Living in a country undergoing political turmoil or where fathers migrate for work can also raise the risk of a child becoming HIV-infected.

Resources

Note: The UNAIDS and CDC publications referenced in this article may be viewed on the World Wide Web at http://www.unaids.org and http://www.cdc.gov.

AIDS Clinical Trials Information Service. For information about pediatric and adult AIDS clinical trials open to enrollment, call (800) TRIALS-A, 9 a.m. to 7 p.m. Eastern Time, Monday through Friday. Web: http://www.actis.org E-mail: actis@actis.org.

National AIDS Hotline. Staffed 24 hours a day, seven days a week. English Service: 1-800-342-AIDS. Spanish service: 1-800-344-7432. Deaf service (TDD): 1-800-243-7889.

The National Pediatric HIV Resource Center. A non-profit organization that serves professionals who care for children, adolescents and families with HIV infection and AIDS. Phone: 973-972-0410 or toll free: 1-800-362-0071. Web: http://pedhivaids.org/. E-mail: ortegaes@umdnj.edu.

The Pediatric AIDS Foundation. A national non-profit organization dedicated exclusively to supporting reseach for AIDS in children. Phone: 310-314-1459. Web: http://www.pedaids.org E-mail: info@pedaids.org.

The Pediatric Branch of the National Cancer Institute (NCI) conducts clinical trials for HIV-infected children on the NIH campus in Bethesda, Md. Phone: (301) 402-0696. NCI webpage: http://www.nci.nih.gov

References

1. Connor, E. et al. 1994. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 311:1173-80.
2. UNAIDS. AIDS Epidemic Update (Dec., 1998):1, 2, 3, 7, 8., 9, 17.
3. UNAIDS. Report on the Global HIV/AIDS Epidemic (June, 1998):6, 8.
4. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report (Dec. 1998) 10(2):7.
5. Ibid., p. 26
6. Rosenberg, P., et al. 1994. Declining age at HIV infection in the United States. N Engl J Med 330:789-90.
7. Centers for Disease Control and Prevention, op cit., p. 36.
8. Ibid., pp. 10-11.
9. UNAIDS, Update, p. 6.
10. Centers for Disease Control and Prevention, op. cit., p. 24.
11. Centers for Disease Control and Prevention. National Center for Health Statistics. 1998. National Vital Statistics Report 47 (9):26.
12. Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, p. 39.
13. NAIDS, Report.
14. Quinn, T. 1996. Global burden of the HIV pandemic. Lancet:348:99-106.
15. Landesman, S., et al. 1996. Obstetrical factors and the transmission of human immunodeficiency virus type 1 from mother to child. N Engl J Med 334: 1617-23.
16. Monitoring the AIDS Pandemic (MAP) Network. 1998. The status and trends of the HIV/AIDS epidemics in the world:17.
17. UNAIDS, Report, p. 48.
18. Connor, E., et al., op. cit.
19. Stiehm, E., et al. 1999. Efficacy of zidovudine and human immunodeficiency virus (HIV) hyperimmune immunoglobulin for reducing perinatal HIV transmission from HIV-infected women with advanced disease: results of Pedatric ACTG protocol 185. J Infect Dis 179(3):567-75.
20. Centers for Disease Control and Prevention. 1998. Public Health Service Task Force recommendations for the use of antiretroviral drugs in pregnant women infected with HIV-1 for maternal health and for reducing perinatal HIV-1 transmission in the United States. MMWR Recommendations and Reports 47 (RR-2). May be viewed on the Web at http://www.hivatis.org.
21. Wilfert, C., et al. 1999. Consensus statement: Science, ethics, and the future of research into maternal infant transmission of HIV-1. Lancet 353 (9155):832-35.
22. Centers for Disease Control and Prevention. 1997. Update: Perinatally acquired HIV/AIDS-United States, 1997. MMWR 46: 1086-92.
23. Shaffer, N., et al. 1999. Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: A randomised controlled trial. Lancet 353 (9155):773-79.
24. Dabis, F. et al. 1999. 6-month efficacy, tolerance, and acceptability of a short regimen of oral zidovudine to reduce vertical transmission of HIV in breastfed children in Cote d'Ivoire and Burkina Faso. Lancet 353 (9155):786-92.
25. Saba, J., The PETRA Trial Study Team. 1999. Interim analysis of early efficacy of three short course ZDV/3TC combination regimens to prevent mother-to-child transmission of HIV-1. Presented at the Sixth Conference on Retroviruses and Opportunistic Infections. Chicago: February 1, 1999.Guay, L, et al. 1999. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 354:795-802.
26. Marseille, E., et al. 1999. Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa. Lancet 654:803-09.
27. Riley, L.E. and Green, M.F. Elective caesarean delivery to reduce the transmission of HIV. 1999. N Engl J Med 340:13, 1032.
28. Mofenson, L.M., Fowler, M.G. In press. Interruption of materno-fetal transmission. Reported in Shaffer, N., op. cit.
29. HIV/AIDS Treatment Information Service. 1999. Guidelines for the use of antiretroviral agents in pediatric HIV infection. May be viewed on the Web at http://www.hivatis.org/.
30. UNAIDS, Report, p. 9.
31. Centers for Disease Control and Prevention. National Center for HIV, STD, and TB Prevention. Divisions of HIV/AIDS. International Projections/Statistics. Web: http://www.cdc.gov/hiv/stats.htm#international
32. UNAIDS, Update, p. 9.
    

NIAID is a component of the National Institutes of Health (NIH). NIAID conducts and supports research to prevent, diagnose and treat illnesses such as HIV disease and other sexually transmitted diseases, tuberculosis, malaria, and other infectious diseases as well as asthma and allergies.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892
Public Health Service
U.S. Department of Health and Human Services
February 2000

Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

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