The price of most affordable generic second-line drug regimen – needed when patients develop resistance to initial treatment – falls to $590 annually, from more than $700 a year ago.

And a one-pill, once-daily first-line regimen based on the drug tenofovir is now available for $210 annually, down 30 percent from 2008.

In total, new price agreements have been struck for 41 adult and paediatric formulations at an average reduction of 16 percent compared to 2008.

There is no cure for the human immunodeficiency virus (HIV) that causes AIDS, but combinations of drugs can keep the virus from replicating and damaging the immune system.

An estimated 33 million people globally are infected with the AIDS virus, most of them living in Africa and other developing countries.

Too much television, low self-esteem, low grades and poor family relationships can add up to early teenage sex, according to a new study. “If you add up all the factors, you get a much more powerful predictor of who has sex and who doesn’t,” said Dr. Janet Hyde, of the University of Wisconsin, who headed the research team.

“One thing probably by itself is not going to do it, but by the time you get two or three risk factors, things start to go downhill,” she added.

Hyde and her team studied 273 teens from 13 to 15. About 15 per cent had early sex. “Kids who engage in early sexual activity are much less likely to use any kind of protection which increases their risk for teen pregnancy and acquiring sexually transmitted diseases,” Hyde said.

One of the best predictors for early teen sex is TV viewing, in part because TV portrays higher levels of sexuality for teens and adults than in reality.

“As we watch a lot of material like that, we come to believe that it is reality. In this case, kids who watch a lot of TV come to believe that all the kids really are having sex, so they’re going to do it too or they are going to be the odd one out,” Hyde, who reported the finding in the Journal of Youth and Adolescence, explained.

TV also often does not portray the negative consequences of sex, such as unexpected pregnancy or sexually transmitted diseases, she said.

But it is not the only risk factor for teens to start having sex before age 15.

Girls who had been sexually active early had lower self-esteem, poor relationships with their parents, lived with either a single mother or step-parent, showed signs of attention-deficit hyperactivity disorder, underachieved at school, and watched more television.

Boys who had early sex were further into puberty, had lower self-esteem, showed signs of ADHD and oppositional defiant disorder, had poor relationships with their parents and also watched more television than other boys. The researchers recommend that all of the risk factors for early teen sex be addressed and that parents participate in the process, as well as teachers and counsellors.

Reuters

From 1985 to 2007, the CD4+ cell counts seen at diagnosis in HIV-infected patients in the US have fallen, suggesting that the virus may be adapting to the host and becoming more virulent, according to a report in Clinical Infectious Diseases.

The study results stem from an analysis of data for 2174 patients who tested positive for HIV antibodies and were enrolled in the TriService AIDS Clinical Consortium HIV Natural History Study. None of the subjects had received antiretroviral treatment and had their CD4+ counts measured within 6 months of their HIV diagnosis. CD4+ cells are immune cells that are used to assess the severity of the infection. As HIV infection progresses, CD4+ cell counts decrease.

The average initial CD4+ cell counts during the periods 1985-1990, 1991-1995, 1996-2001, and 2002-2007 were 632, 553, 493, and 514 cells per microliter, respectively. During the same periods, the percentage of subjects with initial CD4+ cell counts below 350 cells per microliter were 12 percent, 21 percent, 26 percent, and 25 percent.

The reduction in initial CD4+ cell counts was similar in African American and in white patients, the report indicates. Similar trends were also noted for the CD4+ cell count percentage and the total count of lymphocytes, a type of white blood cell involved in the immune response.

In an accompanying editorial, Dr. Maria Dorrucci, from Istituto Superiore di Sanita, Rome, and Dr. Andrew Phillips, from University College Medical School, London, comment that while some studies, such as the current one, have suggested that HIV virulence is increasing, others have found that it is either stable or decreasing.

This, they note, may relate to how virulence is assessed, adding that “it is unclear whether simple immunological or virological proxies for virulence can be expected to adequately capture the whole complexity of HIV virulence” and the susceptibility of the patient to HIV infection.

SOURCE: Clinical Infectious Diseases, May 2009.

“We can make changes, but they don’t mean a thing if our population keeps growing,” he said.

“People have to start thinking on a bigger scale than a few little Band-Aids here or there.”

It is a problem that most of the population growth is going to be in Third World countries where there is a culture of large families, Tammermagi said. “We have to very dramatically overhaul foreign aid to those countries and help them to get family planning,” he said.

Apart from curtailing the number of children, Tammermagi wants to see people commit to changing their lifestyle permanently, not just for 24 hours on Earth Day, an annual event held every April 22.

It is aimed at increasing awareness of environmental issues.

“I think there are glimmers of hope. A lot of people care deeply and are making sacrifices, but … I think only a crisis will force us to change things,” he said.

Crises such as wide-scale civil unrest and mass starvation are probably 20 years away, but are almost inevitable if the world keeps going the same way, he predicted.

Today, Tammermagi will celebrate Earth Day by jogging near his Pender Island home, carrying a plastic bag to pick up litter and eating vegetarian meals.

“It’s more symbolic than anything, but I’m trying to make the big changes as well.

“Our family has only two children and only one car,” he said.

“Nationally, the annual screening rate increased from 25.3 percent in 2000 to 43.6 percent in 2006, and then decreased slightly to 41.6 percent in 2007,” the researchers wrote in the CDC’s weekly report on death and disease.

“Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease (STD) in the United States, with more than 2.8 million new cases estimated to occur each year,” they wrote.

“During 2007, approximately 1.1 million cases of chlamydia were reported to CDC; more than half of these were in females aged 15 to 25 years.”

It often causes few or no symptoms and if not treated with antibiotics can cause pelvic inflammatory disease, infertility, chronic pain and ectopic pregnancy, which is a pregnancy outside the uterus — something that can kill the mother or the baby.

Men and women alike can be infected with chlamydia and can re-infect one another if only one sexual partner is treated. It can make men sterile, too, but only rarely.

Chlamydia can be passed to a newborn and can cause pneumonia and conjunctivitis, or pink eye.

The CDC recommends yearly chlamydia testing of all sexually active women 25 or younger, older women who have a new sex partner or multiple sex partners, and all pregnant women.

An anesthetic spray applied to the penis five minutes before intercourse enables men who suffer from premature ejaculation to last six times longer after penetration, a study shows.

It’s estimated that “as many as 40 percent of men will experience premature ejaculation at some time in their lives,” Dinsmore said.

Topical anesthetic creams have long been used in the treatment of premature ejaculation, but tend to be messy and inconvenient. The PSD502 spray, made by London, UK-based Plethora Solutions Ltd, is a combination of two anesthetics, lidocaine and prilocaine, which act, researchers believe, as desensitizing agents, which can help delay orgasm for men.

“Our study shows that when the PSD502 spray was applied to the man’s penis five minutes before intercourse it improved both sexual performance and sexual satisfaction, which are key factors in treating premature ejaculation” Dinsmore noted.

In the study, Dinsmore, a Plethora Solutions consultant and investigator, and Dr. Michael G. Wyllie, a director and shareholder of the company, randomly assigned 300 young adult men (average age 35) with lifelong premature ejaculation to use the PSD502 spray or an inactive placebo spray for 3 months. Every time a couple had intercourse during the study, they used a stopwatch to measure the time from vaginal penetration to orgasm.

According to a report in the medical journal, the British Journal of Urology (BJU) International, the time from penetration to orgasm increased from an average of 0.6 minutes to 3.8 minutes in the PSD502 spray group and to just 1.1 minutes in the placebo group.

Men in the study were able to last an average of 6.3 times longer after penetration when they used the spray. The placebo group lasted 1.7 times longer.

After 3 months in the study, 90 percent of the men in the treatment group were able to delay orgasm for more than 1 minute following vaginal penetration, compared with 54 percent in the placebo group; 74 percent of men in the treatment group managed to last more than 2 minutes before orgasm, compared with 22 percent in the placebo group.

Sixty-two percent of men in the treatment group said their orgasms were ‘good’ or ‘very good’ after 3 months, compared with 20 percent before the study started. The figures for the placebo group were slightly lower at the end of the study (19 percent) than at the start of the study (21 percent).

There were no serious side effects reported during the study. Treatment-related reactions were reported by five men and six women in the treatment group and one man from the placebo group. The most common problems were loss of erection and a burning sensation in the vagina.

It ordered the agency to allow nonprescription sales to 17-year-olds, and to reconsider its decision regarding over-the-counter access to Plan B.

The FDA on Wednesday said it would allow nonprescription access to 17-year-olds as soon as it received necessary information from the drug’s maker, Barr Pharmaceuticals Inc, now part of Teva Pharmaceutical Industries Ltd.

“The government will not appeal this decision,” the FDA said in a statement on its website.

Teva said it would comply with FDA’s request but it could still take 10 months before the drug is available without a prescription for younger buyers.

“We will continue to work closely with FDA to ensure that all provisions of this decision are met,” it said.

Women’s health advocates cheered the FDA’s decision, with some adding that access should be loosened even more, to allow shelf sales without age restrictions. They along with company officials argue it is critical for women to have quick access to the drug, which aims to prevent pregnancy when used within 24 hours of sexual intercourse.

“It’s a good indication that the agency will move expeditiously to ensure its policy on Plan B is based solely on science,” said Nancy Northup, president of the Center for Reproductive Rights, which initiated the lawsuit in 2005.

National Women’s Health Network policy director Amy Allina said FDA’s move “gets us part way to where we believe the FDA should be.” But she added, “Putting it behind the counter does not make it safer or more effective. In fact, because it creates another barrier it’s likely to make it less effective.”

Plan B is a set of two pills that contain higher doses of progestin than are used in prescription birth control pills.

Conservative groups have opposed any nonprescription access to the drug, saying among other things that it could lead to promiscuity.

“The FDA violated its standards when it made the high dose Plan B available nonprescription to adults. But now the FDA is making the drug available to minors without parental consent,” Concerned Women for America President Wendy Wright said in a statement. “The FDA should have challenged the decision.”

Barr had earlier sought over-the-counter access for those 16 and older.

The FDA under President George W. Bush delayed making any decision for three years. Then In 2006 it allowed behind-the-counter sales to those age 18 and older who showed proof of age while still requiring a prescription for girls 17 and younger.

Even with the new FDA decision, the company would have to submit additional data on the drug for 16-year-olds, said Diana Zuckerman, head of the National Research Center for Women & Families.

Despite the limitations, sales of Plan B “have more than doubled” since it became available for adults from pharmacists in 2006, Teva said.

With a recession on, she was worried about job security.

“People say, ‘You’re a nurse, you’ll always have a job.’ I think it’s not as true as people think it is.”

The recession may be a factor influencing more Americans to opt out of parenthood with abortions and vasectomies, although there is no data available yet to suggest a trend.

Even so, there is some anecdotal evidence that would-be parents are factoring the rough economic times into the most personal of reproductive choices, some experts said.

In 2005, the last year for which data is available, the U.S. abortion rate fell to the lowest level since 1974, according to the Guttmacher Institute in New York, a nonprofit group focusing on reproductive issues.

But at the National Abortion Federation, a hotline for women seeking abortion information has been “ringing off the hook,” according to the group’s president, Vicki Saporta.

“We are currently getting more calls from women who report that they or their partner have recently lost their job, and we are also hearing from more women facing eviction,” she said.

One recent inquiry came from a 24-year-old married woman in Colorado who was evicted after her landlord went into foreclosure. Another came from a 32-year-old pregnant mother in Virginia who had lost her job and health insurance.

“As more and more women and families are struggling due to the crisis, it’s affecting more than just low-income families. Now more middle-class and working class families are facing the types problems that we’ve heard from low-income women,” Saporta said.

As with many other nonprofits, abortion assistance groups are being inundated with requests for aid just as funding is drying up.

In the first quarter of 2009, the New York Abortion Access Fund increased funding for abortions 60 percent from year-ago levels, and the number of women receiving assistance more than doubled.

The reach of the recession may stretch beyond women’s reproductive decisions to those of men.

Lawrence Ross, a urologist and former president of the American Urological Association, said he and his colleagues have noticed a roughly 50 percent increase in vasectomies in the past four to six months, which he attributes in part to the ailing economy.

About half a million men opt for vasectomies in the United States each year, a number which has remained flat over the years, Ross said.

“Many of them are afraid that they are going to lose their jobs and their health insurance. So while they are covered, a lot more patients, it pushed them over the edge to get it done more quickly,” he said.

“A lot of them are saying that we’ve decided to limit our family, the costs of education and raising kids is so high.”

At the same time, urologists have seen a drop in the number of men seeking vasectomy reversals.

While a vasectomy is a relatively simple procedure and typically costs between $1,000 to $1,500, a reversal costs roughly ten times as much.

In particular, they looked at radiation treatment given to women after lumpectomy. The treatment is considered a standard of quality cancer care and has been shown to reduce breast cancer recurrence and mortality. However, many women still don’t receive it.

Earlier studies have suggested that demographic characteristics influence whether a woman receives postsurgical radiation. A patient’s race, age and how far she lives from a radiation therapy facility all are factors that affect her chance of receiving the treatment.

But the latest report looked at the doctors behind the decisions. The researchers analyzed data on nearly 30,000 women aged 65 and older who were diagnosed with breast cancer between 1991 and 2002 and who received lumpectomy. They also analyzed data on the 4,453 surgeons who operated on the women.

About one in four women were not treated with radiation after surgery. Older women, black women, unmarried women and those living outside urban areas were less likely to receive radiation. But after controlling for those factors as well as characteristics of each woman’s cancer, the Columbia researchers spotted other trends.

Women who received radiation were more likely to have a female surgeon. Women who were treated by more experienced surgeons were also more likely to receive radiation treatment, as were women treated by doctors trained in the United States.

Dr. Dawn L. Hershman, co-director of the breast program at the Herbert Irving Comprehensive Cancer Center at Columbia University, said it’s not clear why women treated by female surgeons were more likely to receive radiation. It may have to do with the nature of a woman’s relationship with her doctor or the doctor’s communication style.

“It’s important to figure out all the factors that can contribute to improving quality of care,” said Dr. Hershman. “There are many fantastic male surgeons….It shouldn’t be taken that every woman should be seen by a woman, but there are some contributing factors to this difference that we need to investigate further.”