Days of cheap HIV drugs numbered

Cheap generic drugs are often the only affordable AIDS therapy — half of the 700,000 people receiving anti-HIV drugs worldwide rely on generic drugs manufactured in India, according to Ellen 't Hoen of Médecins Sans Frontières. But the price of generic drugs is set to soar. The India Patents Act (1970) recognized patents on pharmaceutical processes but not on products, allowing Indian manufacturers to produce cheap copies of drugs using alternative processes. Although India emerged as a world leader in generic drug production, the trade cost pharmaceutical companies an estimated US$500 million annually. New legislation approved by the Indian parliament recognizes patents on processes and drugs. The changes in legislation were a condition of India's membership of the World Trade Organization, which has an agreement on intellectual property rights that member countries must adhere to. Critics insist that increasing the price of drugs will lead to premature loss of lives. SciDev.Net

Social factors of health

A commission on social determinants of health, prompted by a report highlighting the need to consider the social factors behind health problems, is being launched by the WHO with the aim of recommending policies to improve health. In Sweden, the probability of a man dying between age 15 to 60 is 8.3%, compared with 82.1% in Zimbabwe. Even in the same country there are inequalities — there is a 20-year gap in the life expectancy of an Australian Aboriginal compared with a Torres Straits islander. Lee Jong-wook (Director-General, WHO) commented that “some links between poverty and health seem obvious but in practice they can be complex and paradoxical. When the ... causes of such anomalies are known, there is a strong basis for corrective action.” Lancet

New pneumonia vaccine for children

Pneumonia causes an estimated 19% of the 10 million childhood deaths worldwide annually, and Streptococcus pneumoniae causes up to 50% of severe pneumonia cases in developing countries. A licensed 7-valent vaccine is already available, but in this trial a 9-valent vaccine was tested in more than 8,000 Gambian children aged 6 to 51 weeks. The vaccine reduced the incidence of pneumococcal disease by 77% and child mortality by 16% compared with a control Haemophilus influenzae vaccine. In 65% of cases of invasive disease, the cause was a serotype present in the 9-valent vaccine, compared with the 48% of disease that was caused by serotypes present in the 7-valent vaccine. The authors commented that increasing the number of serotypes in the vaccine might further enhance protection. Lancet

Avian influenza

An inactivated vaccine version of an H5N1 avian influenza virus, first isolated in 2004 and manufactured by Sanofi Pasteur, will shortly go on trial in 450 healthy human volunteers in New York, Baltimore and Los Angeles to assess its safety. Anthony Fauci, Director of the NIAID, which is coordinating the study, noted that “the initiation of this vaccine trial marks a key advance in our efforts to prepare to respond to an avian flu pandemic”. If the trial is successful, further trials in children and the elderly — those most likely to die if an influenza pandemic occurred — will be carried out. Reuters

Defensins to combat anthrax

Treatment of anthrax with antibiotics often fails because circulating anthrax toxin in the blood is lethal in the absence of the bacterium. Human α-defensins, which are bactericidal peptides, have now been shown to neutralize anthrax toxin and can prevent toxin lethality in animal studies. Although antibacterial drugs based on defensins have not yet come to the market, the research team, led by Stefan Kauffmann, hope that a defensin-based therapy for anthrax in humans will be ready in a couple of years time. PNAS

HIV 'super strain' identified

The 'super strain' of HIV (named 3-DCR) that was identified in a New York man is a mutated strain of the B subtype of HIV-1, the most widespread of the two main branches of the AIDS virus. It is resistant to multiple anti-retrovirals and led to the rapid onset of full-blown AIDS. The infected individual had unprotected sex with multiple partners and used an illegal stimulant, metamfetamine. Martin Markowitz (Aaron Diamond AIDS Research Centre, New York) cautioned that “efforts to prevent HIV-1 transmission need to be intensified, with particular emphasis on the epidemic that is being propelled by the use of metamfetamine”. Lancet

Outbreak news

CDC/Fred Murphy and Sylvia Whitfield.

Meningitis. Twenty-seven suspected cases of meningococcal disease were reported in North Darfur, Sudan, with 55% of cases confirmed as Neisseria meningitidis. A mass vaccination campaign with more than 160,000 doses of the trivalent vaccine will target at-risk populations.

Dengue fever. The death toll from dengue fever in Yemen has risen to 12 out of 185 people infected. Ongoing control measures include spraying to kill the mosquito vector and filling swamps where these insects breed.

Haemorrhagic fever. The rare Marburg virus has been identified as the cause of an acute haemorrhagic fever epidemic in the Uige province of Angola that has affected 102 people and claimed 96 lives since October 2004. Case numbers have increased monthly, with 75% of patients under 5 years. Efforts to improve infection control, the only means of controlling this disease, have been intensified.