Studies Examine Effects of Circumcision, Hepatitis B Treatment on HIV/AIDS

The following summarizes recently released studies on HIV/AIDS.

• Hepatitis B Treatment and Resistance to Antiretrovirals: The hepatitis B drug entecavir might increase HIV-positive people's likelihood of developing resistance to antiretroviral drugs, according to a study presented Wednesday at the 14th Annual Conference on Retroviruses and Opportunistic Infections in Los Angeles, HealthDay News/CBC News reports. For the study, Chloe Thio, an associate professor of medicine at Johns Hopkins University's School of Medicine, and colleagues combined different concentrations of entecavir with 100,000 healthy human immune cells and infected the cells with HIV. The researchers then measured the number of cells that became infected with HIV over time. They found that in entecavir concentrations of less than one-tenth of those used in humans, HIV replication was slowed by half. In addition, researchers found that entecavir did not stop a mutated form of HIV, M 184V, from infecting healthy immune cells. This indicates that the drug contributes to the development of the mutation, and the researchers later confirmed this in clinical trials, according to HealthDay News/CBC News (Gardner, HealthDay News/CBC News, 2/28). The study's findings also have implications for the more than four million people worldwide living with both hepatitis B and HIV who need treatment for hepatitis B but have not started antiretrovirals, Thio in a statement said (AFP/Yahoo! News, 2/28). She added that treatment guidelines for people living with both hepatitis B and HIV recommend entecavir as the first-line treatment for those "who need their hepatitis B treated but not their HIV." Thio said the "guidelines should be changed" (HealthDay News/CBC News, 2/28). The researchers have alerted FDA of the findings so that entecavir labels, which state the drug has no clinical effect on HIV, can be changed and so that physicians treating people with both diseases can be informed. They also have informed Bristol-Myers Squibb, which manufactures and sells entecavir under the name Baraclude. Thio said that coinfected people should "consult with their physicians immediately about entecavir to see if it is the right drug to treat their hepatitis B" (AFP/Yahoo! News, 2/28).
  

• "Male and Female Circumcision Associated With Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho and Tanzania," Annals of Epidemiology: Devon Brewer of the Seattle-based research firm Interdisciplinary Scientific Research and colleagues examined national data samples of young people who had never had sexual intercourse in Kenya, Lesotho and Tanzania, the International Herald Tribune reports The study found that virgin, adolescent males who had been circumcised were two to three times more likely to be HIV-positive than virgin, adolescent males who had not had the procedure (Rosenthal, International Herald Tribune, 2/26). The study also found virgin, adolescent girls from Kenya who had been circumcised were 2.38 times more likely to be HIV-positive than uncircumcised, virgin girls (Brewer et al., Annals of Epidemiology, March 2007). The study highlights "on-the-ground" barriers that routine male circumcision might face in developing countries, including nonmedical personnel performing the procedure in unsanitary conditions and using unsanitary instruments. "The greatest concern is that the push toward mass circumcision could facilitate and promote HIV transmission if it is not done properly," Brewer said (International Herald Tribune, 2/26).