Updates
By Carol A. Kemper, MD, FACP
Osteopenia in HIV
Sources: Mondy K, Tehas P. Clin Infect Dis. 2003;36(S2):S101-105; Mondy K, et al. Clin Infect Dis. 2003;36(4):482-490.
HIV-infected individuals may be at significantly increased risk for osteopenia and osteoporosis. Problems such as avascular necrosis of the hips, spontaneous hip fractures, and vertebral compression fractures are being seen with increased frequency. While the pathogenetic mechanisms for this have not been determined, an association with antiretroviral therapy has been suspected.
As part of their ongoing studies of metabolic complications of HIV, Mondy and Tehas examined the incidence of bone demineralization, bone metabolism, and histomorphometric studies in 128 patients, 93 of which were followed for up to 72 weeks. Low body weight, a history of weight loss, steroid use, and smoking were strongly associated with the development of osteopenia. There was no clear-cut effect of antiretroviral therapy on bone mineral density (BMD), after controlling for other risk factors. In a subset of 73 patients who were receiving 2 nucleosides and a PI, 95% of whom had undetectable viral loads, 43% were defined as osteopenic/osteoporotic. However, there was no association between bone mineral loss and specific PIs.
Interestingly, markers for bone resorption and formation, including elevated alkaline phosphatase, osteocalcin, and urine pyridinoline, were generally increased for the whole cohort, but were not associated with the development of low BMD. HIV clinicians should consider this potential problem in their HIV-infected patients, especially those who are thin and smoke. Exercise, smoking cessation, and nutritional supplements (eg, calcium) may reverse the process in some, although hormonal therapy, bisphosphonates, and raloxifene may be necessary.
SARS Creates a Marketing Dream
Sources: New York Times. Section A, Page 1, May 10, 2003; www.hwdistllc.com/mwsubscribe.
The SARS outbreak is creating a frenzy for homeopathic remedies and disinfectants, especially in China, where a growing middle class with cash to spend has cleaned out store shelves of disinfectants, masks, and gloves. Following an article in a Chinese youth daily, which wrote that a specific bleach solution, called Long An 84, would kill the SARS virus, there was a run on the product, and customers are now being limited to 1 bottle. Coupled with the Chinese’s long-held belief in herbal remedies and health tonics, any variety of herbs, potions, lotions, and creams that purport to do anything from stimulate the immune system to kill the SARS virus are selling like hotcakes. The cost of ordinary products, like honeysuckle, have increased 10 times in the past few weeks, as demand has forced prices higher.
Web sites for natural remedies against SARS are also popping up. An interesting one is touting the "Urbani SARS formula," named for Dr. Carlo Urbani who sadly died from SARS in March while administering to the sick in Thailand. The Urbani SARS formula combines methanolic extracts of 2 berry bushes—Amlanchier alnifolia and Rosa nutkana—both types of Rosacea. Various researchers have explored the potential antiviral properties of the Rosacea family, which reportedly have activity against coronavirus. Extracts of these plants were used by Native Americans for stomach ailments and parturient women. The mixture has been combined with other root and plant extracts to boost natural immunity. Meanwhile, 2 hours south of Beijing, visitors to China’s largest wholesale herbal market have reportedly jumped from 20,000 to 460,000 per day. Can you imagine a half a million people thronging into one market place everyday? What a perfect opportunity for spread of a respiratory pathogen.
Baboons & STDs
Source: ProMED-mail post. May 1, 2003; www.promedmail.org.
Preliminary reports from this and another web site describe an outbreak of a possible new strain of venereal disease affecting baboons in the Manyara National Park in Tanzania. Tanzanian authorities have reported that at least 200 male baboons have contracted a mystery ailment that results in excruciatingly painful genital ulcers. Some of the baboons have apparently died because the pain has been so intense. The park officials have been referring to the ailment as "syphilis," although this has not been substantiated, and no mention was made of whether female baboons were being affected. A number of different researchers and laboratories are trying to identify the problem— and more information is anticipated.
Dr. Kemper is Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center Section Editor, Updates Section Editor, HIV
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