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Potential new drug could be taken twice a year to treat HIV

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Scientists are reporting an early step toward an HIV drug that could potentially be taken only a couple of times per year.

A single injection of the experimental drug, called lenacapavir, was able to lower blood levels of HIV in a small group of patients. And it was capable of maintaining active levels in the blood for more than six months.

It all raises the possibility of one day having an HIV treatment that only needs to be taken twice a year.

The current treatment regimens for HIV — combinations of oral drugs often called “cocktails” — generally work quite well, said study co-author Dr. Martin Rhee.

“But patients often say that over time, taking daily pills can be a burden,” said Rhee, director of clinical research for Gilead Sciences, Inc. — which is developing lenacapavir.

So the hope is that longer-acting HIV medications could “free people from daily pills,” Rhee said.

Beyond that, he noted, longer-acting drugs could potentially offer a simpler way to prevent HIV in high-risk people: Right now, that’s done with a daily pill regimen known as PrEP (pre-exposure prophylaxis).

However, much more work remains ahead. The new study, published July 1 in the journal Nature, offers a “proof of principle” that a dosing interval of every six months is possible, Rhee said.

The researchers found that in 40 healthy people, lenacapavir appeared safe and could remain active in the body for more than six months. And in 32 people with previously untreated HIV, a single injection reduced viral levels in the blood within nine days.

It’s encouraging that the drug is “amenable to dosing every six months,” said Dr. Rajesh Gandhi, an infectious disease physician at Massachusetts General Hospital, in Boston.

Gandhi, who is also chair-elect of the HIV Medicine Association, agreed there is a need for longer-acting HIV drugs.

The catch is that HIV is not treated with one drug alone — to keep the virus suppressed and limit the chances of it becoming resistant to medication.

So, for any twice-a-year regimen to become a reality, Gandhi explained, two long-acting drugs would have to be paired.

“So the question is, what do you partner this drug with?” he said.

Rhee said Gilead is working on such a partner. More immediately, the researchers will study the effects of lenacapavir, taken every six months, in HIV patients who’ve tried many standard drugs and are resistant to them.

Other longer-acting drugs for HIV are further along — though the doses are more frequent than twice a year.

Researchers are studying a combination of two injection drugs — cabotegravir and rilpivirine — that is given monthly. The hope is to keep HIV suppressed in patients who’ve gotten the virus down to very low levels with standard oral drugs.

Meanwhile, cabotegravir is also being tested for preventing HIV in high-risk people, according to the U.S. National Institutes of Health. In those trials, injections are given every two months.

But while infrequent doses would be convenient and — hopefully — make adherence easier, there are safety questions. If people have side effects from the drug, for example, does that mean they are stuck with them for six months?

To help avoid that, Gandhi said, studies have been using a “lead-in” phase: Patients first take oral versions of the long-acting drugs, to make sure they can tolerate them.

But another concern, Gandhi said, is what could happen if patients miss or delay an injection: As levels of the drug wane in the body, the virus could come roaring back, and possibly develop resistance to the medication.

Rhee agreed that is an issue that will face all long-acting HIV medications under development.

Still, the progress toward new options is encouraging, according to Gandhi. People with HIV should know that scientists are still working on new treatments, he said — including ways to potentially cure it.

“We’re still committed to finding a cure,” Gandhi said.

More information

The U.S. Department of Health and Human Services has more on HIV treatment.

Copyright 2020 HealthDay. All rights reserved.



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Common meds linked to faster mental decline in seniors

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A group of widely used medications might speed up older adults’ mental decline — especially if they are at increased risk of dementia, a new study hints.

The medications in question are called anticholinergics, and they are used to treat a diverse range of conditions — from allergies, motion sickness and overactive bladder to high blood pressure, depression and Parkinson’s disease.

The drugs are known to have short-term side effects such as confusion and fuzzy memory.

But studies in recent years have turned up a more troubling connection: a heightened risk of dementia among long-term users.

The new findings, published Sept. 2 in Neurology, add another layer: Healthy older adults on these medications had an increased risk of developing mild cognitive impairment. That refers to subtler problems with memory and thinking that may progress to dementia.

And the link, researchers found, was strongest among two groups of people already at heightened risk of Alzheimer’s disease: those who carry a gene variant that raises the odds of the disease, and people with certain biological “markers” of the disease in their spinal fluid.

The results do not prove anticholinergic drugs are to blame, cautioned Heather Snyder, vice president of medical and scientific relations at the Alzheimer’s Association.

“This study shows an association in a very specific population, but it does not prove causation,” said Snyder, who was not involved in the research.

However, it is biologically plausible that the drugs could increase dementia risk, said Dr. Allison Reiss, an associate professor at NYU Long Island School of Medicine.

The medications, she said, block a chemical called acetylcholine, which transmits messages among nerve cells. Acetylcholine is involved in memory and learning, and is typically low in people with Alzheimer’s.

“The preponderance of evidence suggests it’s better to avoid these medications in older adults,” said Reiss, who is also an advisory board member at the Alzheimer’s Foundation of America.

That’s especially true, she added, when alternatives exist.

Many medications sold for allergies, colds and coughs have anticholinergic properties — and are available over-the-counter. So it’s important, Reiss said, that older adults be aware that non-prescription drugs are not automatically “safe.”

“You don’t want to add any medications that aren’t necessary,” said Reiss, who had no role in the study.

Meanwhile, certain prescription drugs for depression, high blood pressure, Parkinson’s disease and schizophrenia have anticholinergic properties, as do medications for overactive bladder and urinary incontinence.

Reiss said that people with questions about their prescriptions should talk to their doctor.

For the new study, researchers led by Lisa Delano-Wood, from the University of California, San Diego, followed 688 older adults who initially had no problems with memory or thinking skills. One-third said they’d been regularly taking anticholinergic drugs for more than six months — usually far more than one.

In fact, they were taking an average of almost five medications per person.

Over the next 10 years, people on anticholinergics were more likely to develop mild cognitive impairment, which was gauged through yearly tests. Over half — 51% — developed the condition, versus 42% of older adults not taking anticholinergics.

The researchers did consider other factors that affect dementia risk — such as people’s education levels and history of heart disease or stroke. And after adjusting for those factors, older adults on anticholinergics were still 47% more likely to develop mild impairment.

The link was even stronger among people who carried a gene variant that raises Alzheimer’s risk: Anticholinergic use more than doubled their risk of impairment. A similar pattern was seen among study participants with Alzheimer’s-linked proteins in their spinal fluid.

That, Reiss said, suggests the medications might have “accelerated a process that was already in place.”

Snyder said the results “illustrate that we need better treatments — not only for Alzheimer’s and other dementias, but for other common conditions associated with aging.”

More information

The University of British Columbia has more on anticholinergic drugs.

Copyright 2020 HealthDay. All rights reserved.



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Even ‘social smokers’ up their odds of death from lung disease

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Even light smokers are much more likely to die of lung disease or lung cancer than nonsmokers, a new study warns.

“Everyone knows that smoking is bad for you, but it’s easy to assume that if you only smoke a little, the risks won’t be too high,” said study co-leader Pallavi Balte, of Columbia University Irving Medical Center, in New York City.

The new study shows how wrong that thinking can be. It included nearly 19,000 people in the United States, average age 61, who were followed for an average of 17 years. During that time, nearly 650 died of lung disease (such as emphysema) and 560 died of lung cancer.

Among nonsmokers, less than 2% died from lung disease and less than 1% died from lung cancer. But among social smokers (fewer than 10 cigarettes a day), those numbers were over 3% and close to 5%, respectively.

Not surprisingly, heavy smokers (more than 20 cigarettes a day) fared worst, with more than 10% dying from lung disease and about 13% from lung cancer, the study found.

After accounting for other potential factors — such as age, sex, race, level of education and body weight — the researchers concluded that social smokers were 2.5 times more likely to die of lung disease and 8.6 times more likely to die of lung cancer than nonsmokers.

Social smokers had around half the rate of death from lung disease as heavy smokers, but their rate of lung cancer death was two-thirds that of heavy smokers, according to the study.

The results were scheduled for presentation at a virtual meeting of the European Respiratory Society. Data and conclusions presented at meetings should be considered preliminary until peer-reviewed.

The findings show that cutting down on smoking is no substitute for quitting, the researchers concluded.

“Previous research suggests that people are cutting down on smoking. For example, in the U.S.A., the proportion of smokers smoking less than 10 cigarettes per day has increased from 16% to 27%,” Balte said in a society news release.

“You might think that if you only smoke a few cigarettes a day you are avoiding most of the risk. But our findings suggest that social smoking is disproportionately harmful,” Balte said.

If you don’t want to die of lung cancer or respiratory disease, the best action is to quit completely, she added.

More information

The U.S. Centers for Disease Control and Prevention offers a guide for quitting smoking.

Copyright 2020 HealthDay. All rights reserved.



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Antidepressant use rising in U.S., mostly in women, CDC says

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Sept. 4 (UPI) — Nearly 18% of all adult women in the United States used antidepressant medication between 2015 and 2018, compared to just over 8% of men, according to data released Friday by the Centers for Disease Control and Prevention.

Overall, during the decade between 2009-2010 and 2017-2018, antidepressant use increased to 14% from 11%, the agency found. Use increased more for women — to 19% from 14% — than for men — to 9% from 7%.

In 2018, slightly more than 7% of adults in the United States said they suffered from a “major depressive episode,” the agency said.

The findings are based on an analysis of data from the National Health and Nutrition Examination Survey for the 10-year period between 2009 and 2018.

Depression is a mental health disorder in which sufferers experience a persistent depressed mood or loss of interest in activities, causing significant impairment in daily life, according to the National Institute of Mental Health.

Antidepressant medications are used to reduce the symptoms of depression, and include selective serotonin reuptake inhibitors, or SSRIs, and serotonin and norepinephrine reuptake inhibitors, or SNRIs.

From 2015 through 2018, antidepressant use increased with age and was highest among women aged 60 and over, at slightly more than 24%, the CDC found.

In addition, use of the drugs was higher among non-Hispanic White adults, at 17%, compared with non-Hispanic Black adults, at 8%, and non-Hispanic Asian adults, at 3%.

Adults with at least some college education were more likely to use antidepressants than those with a high school education or less, the agency said.



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