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Statement by UNSW’s Kirby Institute on the death of Professor Joep Lange who was on board Malaysian Airlines flight MH17 - 18 July 2014

The Kirby Institute at UNSW today lost a close friend and longtime colleague Professor Joep Lange who, with his partner Jacqueline, were among the almost three hundred people on Malaysian Airlines flight MH17 shot down on the Russian-Ukraine border.

They were on their way to the 20th International AIDS Conference, AIDS2014, in Melbourne, which starts on Sunday 20 July. Joep was one of a number of European researchers believed to be heading to the Melbourne conference.

The University and The Kirby Institute extend their sincere condolences to the families, friends and colleagues of these researchers and all on board flight MH17.

Joep was a close colleague and friend of Kirby Institute Director, Professor David A Cooper.

Professors David Cooper, Praphan Phanuphak and Joep Lange, the co-directors of HIVNAT, a joint research centre in Bangkok

“Joep had an absolute commitment to HIV treatment and care in Asia and Africa,” Professor Cooper said. “The joy in collaborating with Joep was that he would always bring a fresh view, a unique take on things, and he never accepted that something was impossible to achieve. Our joint work in Bangkok, the HIVNAT centre, will stand as his legacy.”

Professors Lange and Cooper were both working in HIV research and treatment from the early years, and since the mid-1990s in resource-poor settings. They shared a specific interest in preventing HIV from taking hold in Asia the way it had in Africa. In 1996, from a conversation they had with their Thai colleague Professor Praphan Phanuphak, the head of the Thai Red Cross AIDS Research Centre, they moved to establish a research centre in Bangkok called HIVNAT.

“The N is for Netherlands where Joep was my opposite number, head of the national HIV research centre, the A for Australia and T for Thailand,” Professor Cooper said. “And it has been so rewarding to have such success in bringing world class research and world class benefits to Thailand and surrounding countries.”

Joep Lange has worked in HIV research and treatment since 1983. He made far-reaching and ground-breaking contributions to the development of affordable HIV treatments, particularly combination therapies, for use in resource-poor countries. Another outstanding area of contribution has been his pioneering role in exploring affordable and simple antiretroviral drug regimens for the prevention of mother-to-child transmission of HIV in resource-poor settings. Both of these have been part of his dedication to increasing access to effective HIV treatment.

At the time of his death, Professor Lange was Professor of Medicine at the Academic Medical Center, University of Amsterdam and Senior Scientific Advisor to the International Antiviral Therapy Evaluation Centre, Amsterdam. He was co-director of the HIV Netherlands Australia Research Collaboration (HIV-NAT) and a former president of International AIDS Society. In 2001, he founded and chaired the PharmAccess Foundation, a not-for-profit organisation based in Amsterdam, designed to improve access to HIV/AIDS therapy in developing countries. He was a founding editor of the academic journal, Antiviral Therapy.

Sunday Surfboats by The Drone Guy - Published on Jul 13, 2014

Just a perfect winter's morning at Palm Beach Sydney.

 What is biodiversity and why is it important? - by CSIRO - Published on 15 Jul 2014

Biodiversity is the term used to encompass the variety of all living organisms on Earth, including their genetic diversity, species diversity and the diversity of marine, terrestrial and aquatic ecosystems, together with their associated evolutionary and ecological processes. But as biodiversity is also a human concept, different people bring their own set of values to bear on it. Dr Steve Morton talks about the different values that humans obtain from biodiversity and the role we will need to play in shaping its future. (07:51)

Access CSIRO's book Biodiversity: Science and Solutions for Australia - www.csiro.au/biodiversitybook (Free to download)

Health papers published this week:

Understanding melanoma development

July 15, 2014 – A new study by University of Kentucky researchers shows how a genetic defect in a specific hormonal pathway may make people more susceptible to developing melanoma, the deadliest type of skin cancer. Fair-skinned people who tend to burn (rather than tan) from sun exposure have a much higher risk for melanoma than darker-skinned people. On the surface, it appears that the amount of melanin, the natural substance in the skin that determines pigment and acts as the skin's "natural sunscreen," would be the only determinant of melanoma risk. However, the truth is more complicated.

Published in Molecular Cell, the study looked at the role of the melanocortin1 receptor (MC1R), the receptor on melanocytes in the skin that gets called into action following ultraviolet exposure to help the skin lay down more UV-blocking melanin to protect itself. Fair-skinned people are more likely to inherit a defect in this receptor, and as a result, cannot make enough melanin to fully protect themselves from UV damage.

Since UV from sunlight or tanning beds is a major cause of melanoma, inherited problems in the MC1R means that the skin lacks natural protection by melanin, which acts as a biologic sunblock. This leads to more UV light chronically getting through to the sensitive layers of the epidermis, where it can contribute to cancer.

However, the UK study showed that MC1R defects contribute to melanoma development in ways other than melanin production. Besides regulating the amount of melanin that gets made in the skin, MC1R also controls how well melanocytes can repair their DNA from UV damage. Having defects in MC1R signaling delays the body's ability to clear out existing DNA damage in the skin - leading to an increased potential for cancerous mutations.

"Knowing whether people have a specific genetic predisposition for melanoma could potentially save many lives," says Dr. John D'Orazio, Associate Professor and the Drury Pediatric Research Endowed Chair at UK's Markey Cancer Center. "If you happen to be born with a problem in this MC1R hormonal pathway, then you need to be extra careful with respect to UV safety."

A good indication of a person's MC1R status is what happens to the skin after sun exposure.

"If you tan well, then your MC1R probably works well," D'Orazio said. "If you tend to burn, then you may have inherited a problem with your MC1R, and you probably should avoid purposeful UV exposure like tanning bed use or unprotected sun exposure."

D'Orazio and his research team found an important molecular link between MC1R signaling and DNA repair in their study. The team hopes to use this information to develop new melanoma-preventive treatments, like additives that can be included in sunblocks to ramp up the skin's ability to deal with UV damage.

Stuart G. Jarrett, Erin M. Wolf Horrell, Perry A. Christian, Jillian C. Vanover, Mary C. Boulanger, Yue Zou, John A. D’Orazio. PKA-Mediated Phosphorylation of ATR Promotes Recruitment of XPA to UV-Induced DNA Damage. Molecular Cell, 2014; 54 (6): 999 DOI: 10.1016/j.molcel.2014.05.030

Does cat poop parasite play a role in curing cancer?

July 15, 2014 - Toxoplasma gondii (T. gondii) is a single-celled parasite that is happiest in a cat's intestines, but it can live in any warm blooded animal. Found worldwide, T. gondii affects about one-third of the world's population, 60 million of which are Americans. Most people have no symptoms, but some experience a flu-like illness. Those with suppressed immune systems, however, can develop a serious infection if they are unable to fend off T. gondii. An Anti-Cancer Agent in Nature?

A healthy immune system responds vigorously to T. gondii in a manner that parallels how the immune system attacks a tumor.

"We know biologically this parasite has figured out how to stimulate the exact immune responses you want to fight cancer," said David J. Bzik, PhD, professor of Microbiology and Immunology, Geisel School of Medicine at Dartmouth.

In response to T. gondii, the body produces natural killer cells and cytotoxic T cells. These cell types wage war against cancer cells. Cancer can shut down the body's defensive mechanisms, but introducing T. gondii into a tumor environment can jump start the immune system.

"The biology of this organism is inherently different from other microbe-based immunotherapeutic strategies that typically just tickle immune cells from the outside," said Barbara Fox, senior research associate of Microbiology and Immunology. "By gaining preferential access to the inside of powerful innate immune cell types, our mutated strain of T. gondii reprograms the natural power of the immune system to clear tumor cells and cancer."

Engineering T. gondii as a Cancer Vaccine

Since it isn't safe to inject a cancer patient with live replicating strains of T. gondii, Bzik and Fox created "cps," an immunotherapeutic vaccine. Based on the parasite's biochemical pathways, they delete a Toxoplasma gene needed to make a building block of its genome and create a mutant parasite that can be grown in the laboratory but is unable to reproduce in animals or people. Cps is both nonreplicating and safe. Even when the host is immune deficient, cps still retains that unique biology that stimulates the ideal vaccine responses.

"Aggressive cancers too often seem like fast moving train wrecks. Cps is the microscopic, but super strong, hero that catches the wayward trains, halts their progression, and shrinks them until they disappear," said Bzik.

Laboratory Success in Melanoma and Ovarian Cancers

Published laboratory studies from the Geisel School of Medicine at Dartmouth labs have tested the cps vaccine in extremely aggressive lethal mouse models of melanoma or ovarian cancer and found unprecedented high rates of cancer survival.

"Cps stimulates amazingly effective immunotherapy against cancers, superior to anything seen before," said Bzik. "The ability of cps to communicate in different and unique ways with the cancer and special cells of the immune system breaks the control that cancer has leveraged over the immune system."

A Promising Future for a Personalized Cancer Vaccine

This new weapon against cancer could even be tailored to the individual patient. "In translating cps therapy to the clinic, we imagine cps will be introduced into cells isolated from the patient. Then Trojan Horse cells harboring cps will be given back to the patient as an immunotherapeutic cancer vaccine to generate the ideal immune responses necessary to eradicate their cancer cells and to also provide life-long immunity against any future recurrence of that cancer," said Bzik.

Fox and Bzik say a lot more study is needed before cps leaves the laboratory. They are trying to understand how and why it works so well by examining its molecular targets and mechanisms.

"Cancer immunotherapy using cps holds incredible promise for creating beneficial new cancer treatments and cancer vaccines," said Bzik.

The above story is based on materials provided by Norris Cotton Cancer Center Dartmouth-Hitchcock Medical Center.

Cholesterol activates signaling pathway that promotes cancer, study shows

July 15, 2014 - Everyone knows that cholesterol, at least the bad kind, can cause heart disease and hardening of the arteries. Now, researchers at the University of Illinois at Chicago describe a new role for cholesterol in the activation of a cellular signaling pathway that has been linked to cancer. The finding is reported in Nature Communications.

Cells employ thousands of signaling pathways to conduct their functions. Canonical Wnt signaling is a pathway that promotes cell growth and division and is most active in embryonic cells during development. Overactivity of this signaling pathway in mature cells is thought to be a major driver in the development of cancer.

"Our research points to a new regulatory role for cholesterol, and also presents an exciting new therapeutic target for suppressing canonical Wnt signaling to treat or prevent cancer," said Wonhwa Cho, professor of chemistry at UIC and principal investigator of the research.

Cho and his colleagues were searching for novel cholesterol-binding proteins when they discovered a binding site for cholesterol on a protein called Dishevelled. Dishevelled is involved in canonical Wnt signaling and in non-canonical Wnt signaling, which plays a role in processes like cell movement and organization. Dishevelled is like a switch on the track - when the signal reaches Dishevelled, the signal is directed along either the canonical or non-canonical Wnt pathway. But until now, any factor governing activation of one pathway over the other was unknown, Cho said.

"Once we realized that cholesterol is able to bind specifically to Dishevelled, we became interested in cholesterol as a potential determinant of which of the Wnt signaling pathways gets activated," he said.

The researchers found that when cholesterol is bound to Dishevelled, the signal continues along the canonical Wnt signaling pathway. Without cholesterol, canonical Wnt signaling cannot occur.

They also noticed that localized increases in cholesterol within cell membrane seemed to selectively promote canonical Wnt signaling over non-canonical Wnt signaling - a finding, Cho said, that might explain why elevated cholesterol increases cancer risk.

"We know that things like high-fat diets, which boost cholesterol levels, have been linked to an elevated incidence of cancer," he said. "Our research provides a mechanism for how cholesterol promotes pathways that lead to cancer."

It also presents a possible therapeutic target. A drug that interferes with the binding of cholesterol to Dishevelled, Cho said, may be effective against those cancers that are driven by canonical Wnt signaling - a list that includes colon cancer, melanoma, breast cancer and lung cancer.

Wonhwa Cho et al. Cholesterol selectively activates canonical Wnt signalling over non-canonical Wnt signalling. Nature Communications, July 2014 DOI:10.1038/ncomms5393

Progress in allergic asthma research after ingestion of fruits

July 15, 2014 - Researchers at the UPM suggest that the interaction between two proteins can be the responsible for the allergic asthma episodes after eating an infected fruit. A research group of the Centre for Plant Biotechnology and Genomics (CBGP) of Universidad Politécnica de Madrid (UPM) conducted infection assays of commercial kiwis with Alternaria alternataspores which is a pathogenic fungus involved in chronic asthma in children. Researchers studied the behavior of this fruit and they found that the infected kiwis had the major allergen of the fungus, although symptoms of rot were not seen. This could trigger the involuntary ingestion of the fungus found in this fruit causing an asthmatic crisis in people allergic to Alternaria.

Alternaria alternata is a fungus that proliferates in fruit and vegetables crops and also when are collected and are on sale for the final consumer. A protein known as Alt a 1 and related to the virulence is found in the spores, this protein is described as the major allergen of this fungus. According to this research, this protein can be a major cause of childhood asthma in US.

When a pathogen infects a plant, the defense response is activated producing an increase of certain proteins related to the defense (known as protein 5). Likewise, the fungus increases the production of the proteins involved in attacks or virulence. However, the symptoms of rot by Alternaria alternata are not seen in some fruits, for example, in kiwifruit. All this can cause the involuntary ingestion of the fungus when eating the fruit.

Researchers conducted tests by infecting commercial kiwifruit with spores ofAlternaria alternata and they detected the presence of Alt a 1, a protein of fungal virulence. Also, researchers studied how this protein is involved in the activation of defense protein 5 in kiwifruit. Fourteen days after the infection, the kiwifruits showed a regular aspect without apparent development of the fungus, but through tests conducted in lab (microscopy of specific staining fungus and Kiwi proteins) they detected the presence of Alt a 1 in the pulp.

What is more, they observed that this fungal protein is found in the same areas that the defense protein of the kiwifruit. Using computer modeling techniques, they identified a surface area in Alt a 1 susceptible to interact with the defense protein. In that interaction, Alt a 1 is joined to a region of the protein 5 of the kiwifruit causing a remarkable decrease of its defense activity. These results reveal that Alt a 1 is an inhibitor of the defense proteins of family 5 which is particularly important in processes of fungal infection.

Researchers did not observed development of the fungus in kiwifruit, but they indeed detected the presence of its major allergen through specific staining. From health point of view, the presence of Alt a 1 in apparently healthy kiwis is important since Alternariais described as a major cause of chronic asthma in children. These results suggest that patients allergic to Alternaria can suffer an allergy attack after eating infected kiwifruit.

Cristina Gómez-Casado, Amaya Murua-García, María Garrido-Arandia, Pablo González-Melendi, Rosa Sánchez-Monge, Domingo Barber, Luis F. Pacios, Araceli Díaz-Perales. Alt a 1 from Alternaria interacts with PR5 thaumatin-like proteins.FEBS Letters, 2014; 588 (9): 1501 DOI: 10.1016/j.febslet.2014.02.044

Prostate cancer in young men: More frequent, more aggressive?

July 15, 2014 - The number of younger men diagnosed with prostate cancer has increased nearly 6-fold in the last 20 years, and the disease is more likely to be aggressive in these younger men, according to a new analysis from researchers at the University of Michigan Comprehensive Cancer Center. Typically, prostate cancer occurs more frequently as men age into their 70s or 80s. Many prostate cancers are slow-growing and many older men diagnosed with early stage prostate cancer will end up dying from causes other than prostate cancer.

But, the researchers found, when prostate cancer strikes at a younger age, it's likely because the tumor is growing quickly.

"Early onset prostate cancer tends to be aggressive, striking down men in the prime of their life. These fast-growing tumors in young men might be entirely missed by screening because the timeframe is short before they start to show clinical symptoms," says Kathleen A. Cooney, M.D., professor of internal medicine and urology at the University of Michigan.

Peter Rich was 59 when he was diagnosed with stage 4 prostate cancer. His PSA was only 9, but the disease had already spread to his ribs, spine and lymph nodes.

"To think of mortality was devastating. It was like any major loss - shock and numbness," says Rich, who had to retire from his job as a school social worker because of his cancer treatment.

Rich was diagnosed six years ago. Average survival for stage 4 disease is generally less than three years.

"What we both said when we got the diagnosis was, well, that's not acceptable," Rich says of himself and his wife, Carol. "I'm a fighter."

Cooney and Scott Tomlins, M.D., Ph.D., assistant professor of pathology at U-M, are leading a new study supported by the U.S. Department of Defense to look at DNA of both normal and cancerous prostate tissue of men diagnosed with advanced prostate cancer before age 61. They will be looking at whether these younger men are more likely to have inherited genetic mutations. For more information on this study, contact the U-M Cancer AnswerLine at 800-865-1125.

Men with a family history of prostate cancer have a two- to three-times greater chance of being diagnosed with prostate cancer. That risk increases for young men with multiple affected relatives.

Prostate cancer runs in Rich's family. Like Rich, his brother was diagnosed in his 50s, and a cousin and uncle had prostate cancer as well.

The new analysis, which appears in Nature Reviews: Urology, found that men with early onset prostate cancer had more genetic variants than men diagnosed with prostate cancer at a later age. The researchers suggest that genetic counseling or increased surveillance in younger men with a family history of prostate cancer may be warranted.

American men have a 16 percent risk of developing prostate cancer in their lifetime, but only a 3 percent lifetime risk of dying from it. The challenge, Cooney says, is understanding which subset of prostate cancers are most likely to be aggressive and deadly.

"The unexpectedly poor prognosis of advanced stage early onset prostate cancer supports the idea that a new clinical subtype might exist in the subset of men with early onset prostate cancer. This subtype is more aggressive and requires more specialty expertise, including genetic sequencing," Cooney says.

Claudia A. Salinas, Alex Tsodikov, Miriam Ishak-Howard, Kathleen A. Cooney.Prostate cancer in young men: an important clinical entity. Nature Reviews Urology, 2014; 11 (6): 317 DOI: 10.1038/nrurol.2014.91

Study of noninvasive retinal imaging device presented at Alzheimer's conference

July 13, 2014 – A noninvasive optical imaging device developed at Cedars-Sinai can provide early detection of changes that later occur in the brain and are a classic sign of Alzheimer's disease, according to preliminary results from investigators conducting a clinical trial in Australia. The researchers will present their findings July 15 in an oral presentation at the Alzheimer's Association International Conference 2014 in Copenhagen, Denmark. They also were invited by conference organizers to participate in a "breaking news" news conference beginning at 7:30 a.m. Sunday, July 13 in Copenhagen, 1:30 a.m. EDT.

"In preliminary results in 40 patients, the test could differentiate between Alzheimer's disease and non-Alzheimer's disease with 100 percent sensitivity and 80.6 percent specificity, meaning that all people with the disease tested positive and most of the people without the disease tested negative. The optical imaging exam appears to detect changes that occur 15-20 years before clinical diagnosis. It's a practical exam that could allow testing of new therapies at an earlier stage, increasing our chances of altering the course of Alzheimer's disease," said Shaun Frost, a biomedical scientist and the study manager at the Commonwealth Scientific and Industrial Research Organisation. CSIRO is Australia's national science agency.

Frost, first author of the AAIC 2014 abstract, will make the oral presentation. He said 120 participants of a full study of 200 had completed testing.

Keith Black, MD, professor and chair of Cedars-Sinai's Department of Neurosurgery, director of the Maxine Dunitz Neurosurgical Institute and the Ruth and Lawrence Harvey Chair in Neuroscience, said the accumulation of beta-amyloid plaque in the brain is a hallmark sign of Alzheimer's, but current tests detect changes only after the disease has advanced to late stages. Researchers believe that as treatment options improve, early detection will be critical, but existing diagnostic methods are inconvenient, costly and impractical for routine screening.

"PET scans require the use of radioactive tracers, and cerebrospinal fluid analysis requires that patients undergo invasive and often painful lumbar punctures, but neither approach is quite feasible, especially for patients in the earlier stages of disease," he said. Positron emission tomography, or PET, is the current diagnostic standard.

"The retina, unlike other structures of the eye, is part of the central nervous system, sharing many characteristics of the brain. A few years ago, we discovered at Cedars-Sinai that the plaques associated with Alzheimer's disease occur not only in the brain but also in the retina. By 'staining' the plaque with curcumin, a component of the common spice turmeric, we could detect it in the retina even before it began to accumulate in the brain. The device we developed enables us to look through the eye - just as an ophthalmologist looks through the eye to diagnose retinal disease - and see these changes."

This clinical trial was designed to enable researchers to correlate retinal plaque detected by optical imaging with brain plaque detected by PET scans. Studies involved patients diagnosed with Alzheimer's, a group with mild cognitive impairment and a group of people with no evidence of brain abnormality.

The retinal beta-amyloid plaque findings and optical imaging technology began at Cedars-Sinai with studies in live rodents and the post-mortem investigation of human retinas of people who had died with Alzheimer's. Maya Koronyo-Hamaoui, PhD, assistant professor of neurosurgery in the Department of Neurosurgery and the Department of Biomedical Sciences, and Yosef Koronyo, a research scientist, were first authors of the original results that were published in a journal and presented at the AAIC in 2010. The Australian study is one of several in progress to determine if similar results can be confirmed in humans living with the disease.

"This large double-blind clinical trial appears to validate our novel human retinal amyloid imaging approach using curcumin labeling. It further demonstrates significant correlation with brain amyloid burden, thereby predicting accumulation of plaques in the brain through the retina," said Koronyo-Hamaoui, a faculty principal investigator and head of the Neuroimmunology and Retinal Imaging Laboratory at Cedars-Sinai.

The above story is based on materials provided by Cedars-Sinai Medical Center.

Adding alcohol to energy drinks leads to an increased urge to drink

July 17, 2014 - Public health advocates in recent years have become concerned not with the consumption of energy drinks by youth but also their joint consumption with alcohol by young adults. New research provides evidence of a mechanism through which energy drinks may increase binge drinking: combining energy drinks with alcohol increases people's desire to keep drinking more than if they drank alcohol alone.

Results will be published in the August 2014 online-only issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"A number of cross-sectional studies show that young adults who mix alcohol with energy drinks (A+ED) have higher levels of alcohol consumption than their peers who don't mix energy drinks with alcohol, and some studies suggest that this practice increases the risk of 'binge drinking,'" explained Rebecca McKetin, a fellow at the Australian National University's Centre for Research on Ageing, Health and Well-being. "However, it may simply be the case that people who drink more often are more likely to drink A+EDs among other things. Yet if it is the case that energy drinks increase binge drinking, the popularity of A+EDs could exacerbate alcohol-related harms among young people, particularly harms related to intoxication, such as car accidents and injuries from fights or falls." McKetin is also the corresponding author for the study.

"When we consider that research has shown much higher consumption rates in people attending licensed venues, this study suggests the need for our policy makers to get serious about addressing this issue," added Peter G. Miller, associate professor of psychology at Deakin University, Geelong Waterfront Campus in Australia. "Along with other research released recently from Western Australia showing increased harms on nights when people consumed energy drinks, it is becoming more apparent about how associations between energy drink consumption and greater levels of intoxication and harm can be explained, and that the concerns of researchers regarding social order and public health appear to be warranted, despite industry lobbying to the contrary." Miller noted the recent ban by Lithuania on the sale of energy drinks to anyone under 18 years of age.

Study authors assigned 75 participants (46 women, 29 men) aged 18 to 30 years to an alcohol-only or A+ED condition in a double-blind randomized pre- versus post-test experiment. Participants received a cocktail containing either 60 ml of vodka and a Red Bull® Silver Edition energy drink (n=36) or 60 ml of vodka with soda water (n=39); both cocktails also contained 200 ml of a fruit drink. The primary outcome measure was the Alcohol Urge Questionnaire that was taken at pre-test and 20 minutes later at post-test. Other measures taken at post-test were the Biphasic Alcohol Effects Questionnaire, the Drug Effects Questionnaire, and breath alcohol concentration (BAC).

"We found that when people drink A+EDs that they have a stronger desire to keep drinking than if they drank alcohol on its own," said McKetin. "This would mean that someone who drinks A+EDs would want to keep drinking more than their friends who don't. What we can't say is whether this translates into people drinking more. Obviously other factors would play a role there - people can over-ride their desires and many things play into a decision about whether someone would keep drinking or not. However, if it did translate into greater alcohol consumption, we would expect to see people who drink A+EDs drinking more than their peers who don't."

Miller agreed. "A greater urge to drink has substantial implications when we think about the nature of drinking episodes," he said. "As people become intoxicated, even at low levels, they show less inhibitions and are likely to drink more in a cycle of greater intoxication. Of course, the drunker you get, the more likely you are to get injured, be a victim or perpetrator of an assault, or even drive home while drunk, let alone making bad choices about the people you associate with and possible sexual behaviour."

"The most important implication of the findings is in terms of policies around the sale of energy drinks in bars and night clubs where people are consuming alcohol, and the sale of pre-mixed A+EDs more generally," said McKetin. "Our findings suggest that energy drinks may increase people drinking to intoxication, and consequently increase the risk of alcohol-related problems like drunk-driving and alcohol-fuelled violence. Our study alone does not provide enough evidence to advocate for restrictions on the availability of energy drinks in bars, but it is an important step."

"These results tell us that findings in Australia are similar to those in the USA," added Miller. "It's also worth noting that the very low levels of alcohol and energy drinks used in these types of experiments are due to the restraints of ethics committees, yet people are using far more than this on average out on the street.This difference between what is acceptable in a strictly controlled and monitored experiment versus unregulated pubs and clubs tells us about the worrying degree to which unsafe behaviour is occurring and the need for regulators to act."

Rebecca McKetin, Alice Coen. The Effect of Energy Drinks on the Urge to Drink Alcohol in Young Adults. Alcoholism: Clinical and Experimental Research, 2014; DOI: 10.1111/acer.12498

Causes of death shifting in people with HIV

July 17, 2014 - HIV-positive adults in high income countries face a substantially reduced risk of death from AIDS-related causes, cardiovascular disease, and liver disease compared with a decade ago, according to a large international study published in The Lancet. The study which involved nearly 50,000 HIV-positive adults receiving care and antiretroviral therapy (ART) at more than 200 clinics across Europe, USA, and Australia found that overall death rates have almost halved since 1999, while deaths due to AIDS-related causes and cardiovascular disease have declined by around 65% and liver-related deaths by more than 50%.

Although deaths from most causes declined over the study period, there was no reduction in death rates from non-AIDS cancers which remained stable over time (1.6 deaths per 1000 years 1999-2000 to 2.1 in 2009-2011). Non-AIDS cancers are now the leading cause of non-AIDS deaths in people with HIV, accounting for 23% of all deaths.

Using data from the Data collection on Adverse events of anti-HIV Drugs (D:A:D) study, the researchers looked at trends in underlying causes of death in people with HIV between 1999 and 2011, who were followed-up for a median of 6 years.

Of the 3909 deaths that occurred over the study period, around 29% of individuals died from an AIDS-related cause, which remains the most common cause of death. Cancers (15%; mainly lung cancer) were the most frequent causes of non-AIDS deaths, followed by liver disease (13%; mainly due to hepatitis), and cardiovascular disease (11%).

Mortality decreased from about 17.5 deaths per 1000 person-years in 1999-2000 to 9.1 deaths per 1000 years in 2009-2011 - a drop of around 50%. Similar decreases in deaths related to AIDS (5.9 deaths per 1000 person-years to 2.0), liver disease (2.7 to 0.9), and cardiovascular disease (1.8 to 0.9) were also seen. The proportion of all deaths due to AIDS (34% to 23%) and liver disease (16% to 10%) declined over the decade, while the proportion of deaths due to cardiovascular disease remained constant at 10%.

The researchers note that substantially reduced death rates from liver and cardiovascular disease cannot be fully explained by changes in patient demographics or improvements in viral suppression or CD4 count, and might result from the better management of traditional risk factors such as smoking, alcohol use, and hepatitis, or the use of less toxic ART regimens.

They conclude by calling for further research to gain a clearer understanding of why the risk of dying from a non-AIDS cancer remains high and to assess the effect of specific antiretroviral drugs on non-AIDS cancer rates.

According to study leader Dr Colette Smith from University College London in the UK, "These recent reductions in rates of AIDS-related deaths are linked with continued improvement in CD4 count and provide further evidence of the substantial net benefits of ART. But despite these positive results, AIDS-related disease remains the leading cause of death in this population. Continued efforts to ensure good ART adherence and to diagnose more individuals at an earlier stage before the development of severe immunodeficiency are important to ensure that the low death rate from AIDS is sustained and potentially decreased even further."

Writing in a linked Comment, Steven Deeks and Peter Hunt from the University of California in San Francisco, USA, say, "The benefits of ART are unquestioned, and their beneficial effect on the HIV epidemic continues to grow. Still, clear limitations exist because many patients are not accessing treatment, and some problems persist even in those on ART, including a higher than expected risk of non-AIDS cancers and other morbidities. Finally, it needs to be emphasised that we are still early in the ART era. In the absence of a cure, most patients will need to continue on ART for decades. Continued monitoring for unexpected consequences of treatment will be needed indefinitely."

The study appears in a special issue of The Lancet published ahead of AIDS 2014, the 20th international AIDS conference of the IAS, taking place in Melbourne, Australia, from 20-25 July, 2014.

Colette J Smith, Lene Ryom, Rainer Weber, Philippe Morlat, Christian Pradier, Peter Reiss, Justyna D Kowalska, Stephane de Wit, Matthew Law, Wafaa el Sadr, Ole Kirk, Nina Friis-Moller, Antonella d'Arminio Monforte, Andrew N Phillips, Caroline A Sabin, Jens D Lundgren. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. The Lancet, 2014; 384 (9939): 241 DOI: 10.1016/S0140-6736(14)60604-8

Widespread support for rapid HIV testing in dental surgeries

July 15, 2014 - More than 80 per cent of oral health patients are willing to receive rapid HIV-testing in dental settings, which could help reduce the spread of the HIV according to a groundbreaking study revealed today at a Sydney University HIV Testing Symposium. The first of its kind study of 521 Sydney-based dental patients assessed patients' willingness to undergo rapid HIV testing in dental settings, their preference for HIV testing-type type and their willingness to pay for the test.

Rapid HIV testing is a screening test that swiftly detects the presence of HIV antibodies in a person's body by testing blood or oral fluids.

It can be done as a simple finger prick or a saliva swab, and results can be made available within 20 minutes.

Rapid HIV testing is currently unavailable in dental settings anywhere in the world although the technology has been widely available for a decade.

Australians will soon be able to access rapid HIV-testing themselves after the federal government last week announced that it had lifted restrictions preventing the manufacture and sale of oral home-testing kits.

"Dentists are well placed to offer rapid HIV testing because they're located throughout the community, have ongoing relationships with their patients, and have the necessary training and expertise to recognize systemic diseases that have oral manifestations, such as HIV/AIDS," says the study's lead author, Dr Anthony Santella of the University of Sydney.

The new research finding has important policy implications, according to Dr Santella: "If rapid HIV testing was widely available in dental settings it could help to reduce the spread of the virus by informing people who aren't aware that they are HIV-positive.

"It's important that policymakers and other stakeholders consider expanding rapid HIV testing beyond medical and sexual health clinics because the average time from HIV infection to diagnosis in Australia is currently more than three years."

"As well, we have fresh evidence that around 45 per cent of dentists feel prepared and willing to perform rapid HIV-testing. This means it would be feasible to offer rapid HIV testing through dental settings, especially in targeted at risk communities."

Among those saying they'd be willing to undergo rapid HIV testing in a dental setting, 76 per cent preferred an oral saliva swab, 15 per cent preferred a pin prick test, and eight per cent preferred a traditional blood test that draws blood through a needle.

The above story is based on materials provided by University of Sydney.

Disclaimer: These articles are not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of Pittwater Online News or its staff.