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Study Shows Decreased Risk Of Death From Opportunistic Infections With Earlier Antiretroviral Treatment
HIV-positive people with opportunistic infections who receive earlier antiretroviral treatment lower their risk of death compared with people who delay treatment, according to a new study conducted by the Stanford University School of Medicine and published in PLoS One, the San Jose Mercury News reports. The findings could lead to changes in recommendations for antiretroviral treatment protocol, specifically for patients diagnosed with HIV at an advanced stage, the Mercury News reports. The study included 262 HIV-positive participants at 39 health care sites across the U.S., and 20 participants in South Africa. During the yearlong study, the researchers found that among the participants who were treated promptly after developing an opportunistic infection, 14% died or developed another infection. The researchers also found that 24% of participants who deferred treatment for an average of 45 days died or had a decrease in health outcomes. According to the Mercury News, the question of when to start HIV-positive people on antiretroviral treatment remains unclear because of issues such as the high cost of medicines, side effects, and drug interactions or resistance. Andrew Zolopa, head of Stanford University School of Medicine"s division of infectious diseases and lead investigator of the study, said that physicians often treat HIV-positive people for an "acute crisis, then follow up later with treatment for HIV." He continues, "But that answer is wrong. The study shows very clearly that there is no safety downside to doing this -- and the benefit is quite substantial, reducing death by 50%." "Even in San Francisco, one of the first epicenters of HIV in the United States, we still find that many people present late in the course of their illness with an opportunistic infection," Mitch Katz, director of San Francisco"s Department of Health who was not involved in the study, said. He added, "This study shows that it is lifesaving to treat those persons with antiretroviral drugs while they are still in the hospital." Katz said that the results could lead to changes in HIV/AIDS practices worldwide. The International AIDS Society, CDC and the British AIDS Society have developed guidelines recommending that early antiretroviral treatment be considered in patients with opportunistic infections, Zolopa said. In addition, NIH is considering an international study to examine earlier initiation of antiretroviral treatment involving more than 9,000 people from both developed and developing countries (Krieger, San Jose Mercury News, 5/15).
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Neighborhood Violence Affects Disadvantaged Youth And The Influence Of Family And Religion On Youth Delinquency
Research published in the June issue of the American Sociological Review examines issues surrounding families, communities, youth and delinquency. The following briefs highlight selected sociological findings.
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Fear Of Family Reaction Is Barrier To Treatment For Depressed Teens
Although teen depression poses a widespread problem for which proven treatments exist, few depressed teens receive any care.
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Cancer Researchers Link DICER1 Gene Mutation To Rare Childhood Cancer

Research published recently in Science Express from the journal Science demonstrates the first definitive link between mutations in the gene DICER1 and cancer. By studying the patterns of DNA from 11 families with an unusual predisposition to the rare childhood lung cancer pleuropulmonary blastoma (PPB) investigators found that children with the cancer carried a mutation in one of their two DICER1 gene copies. DICER1 makes an important protein that works to suppress other genes through intermediary molecules known as microRNAs. Scientists have learned that microRNAs can fine-tune the expression of many other genes, which is particularly important in normal human development. Recent research has also focused on DICER1 as having a potential role in cancer because the micro-RNA molecules it produces appear vastly different from normal when found in cancer cells; some suggest that the pattern of microRNAs in cancers resembles an embryonic stage. "When we realized that DICER1 was in the segment of chromosome that was shared among children with PPB we were very excited," said D. Ashley Hill, MD, lead author and chief of Pathology at Children"s National Medical Center. "PPB is a tumor that appears to arise out of a localized area of abnormal lung development. The implications of a defect in a master controller gene for normal organ development would be significant." Hill says not everyone who inherits a mutation develops PPB and children with PPB are typically normal in every other way. The team theorizes that something else must happen to the normal copy of DICER1 in lung cells for a tumor to develop. When the research team looked at PPB tumors to see if there is any DICER1 protein being made from the remaining normal copy of the gene, they were surprised by the results: "We expected to see that the tumor cells had no DICER1 protein giving us a nice explanation for why the tumor cells had gone haywire." But that wasn"t the case. They found that the benign cells that grew on the surface of the tumor had lost the DICER1 protein. "During lung development the cells that line the airways and the cells that make up the support structures have to communicate." Hill explained. "Loss of DICER1 in the airway lining cells could disrupt this communication, possibly setting the stage for abnormal growth." Studying tumor cells for genetic mutations has led to many advances in the understanding of cancer. This discovery may represent a first step in understanding a new mechanism for how cancer begins. Conceivably, the mutated cells do not turn into tumors themselves. Instead, these cells influence surrounding cells to grow quickly, setting the stage for additional genetic mutations in cells that then become cancerous. Hill"s team will now focus on demonstrating the sequence of events that result from loss of DICER1. Only 50 or 60 cases of PPB are diagnosed worldwide each year. The cancer presents as cysts in early stages and progresses to solid lung tumors over time. If detected in the earliest stages, 90 percent of patients appear to be cured when treated with a surgical intervention and sometimes chemotherapy. The research was conducted at Children"s National Medical Center, the International Pleuropulmonary Blastoma Registry at Children"s Hospitals and Clinics of Minnesota, and Washington University School of Medicine and other collaborating institutions. Jennifer Leischer Children"s National Medical Center


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