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HIV prevention pill Truvada backed by US experts

Dr Robert Grant, Gladstone Institutes: ''I think we are in a era where we can see the end of the Aids epidemic''
A panel of US health experts has for the first time backed a drug to prevent HIV infection in healthy people.
The panel recommended US regulators approve the daily pill, Truvada, for use by people considered at high risk of contracting the Aids virus. The US Food and Drug Administration (FDA) is not required to follow the panel's advice, but it usually does.
Some health workers and groups active in the HIV community have opposed the approval of the drug.
However, correspondents say the move could prove to be a new milestone in the fight against HIV/Aids.
Truvada is already approved by the FDA for people who are HIV-positive, and is taken along with existing anti-retroviral drugs.
Studies from 2010 showed that Truvada, made by California-based Gilead Sciences, reduced the risk of HIV in healthy gay men - and among HIV-negative heterosexual partners of people who are HIV-positive - by between 44% and 73%.
June decision
The Antiviral Drugs Advisory Committee, which advises the FDA, voted 19-3 in favour of prescribing the drug to the highest risk group - non-infected men who have sex with multiple male partners.
They also approved it, by majority votes, for uninfected people with HIV-positive partners and for other groups considered at risk of acquiring HIV through sexual activity.
Truvada has been used as a treatment for people infected with HIV in the US since 2004
The votes followed an 11-hour meeting of the panel in Silver Spring, Maryland, and a lengthy public comments session.
Opposition to the prospect of approving the drug is based on concerns that users could gain a false sense of security, and fears of a drug-resistant strain of HIV.
There is also concern that the high cost of Truvada could divert limited funding from more cost-effective options.
"We need to slow down. I care too much about my community not to speak my concerns," said Joey Terrill, of the Aids Healthcare Foundation, which campaigned against the drug's approval.
Nurse Karen Haughey told the panel: "Truvada needs to be taken every day, 100% of the time, and my experience as a registered nurse tells me that won't happen.
"In my eight years, not one patient that I've cared for has been 100% adherent."
But others welcomed the panel's recommendation.
"This brings us closer to a watershed for global HIV prevention efforts," said Mitchell Warren, executive director of the Aids Vaccine Advocacy Coalition, after the vote.
The FDA is expected to make its decision by 15 June.
In the UK, Sir Nick Partridge, chief executive of Terrence Higgins Trust, said: "There is no single method of prevention that can on its own stop the transmission of HIV.
"Adding Truvada to our existing range of prevention programmes, including safer sex campaigns, using condoms and regular testing for HIV is an exciting prospect.
"But we need to know if people at highest risk of infection are prepared to take a pill every day and whether there would be an increase in risk-taking behaviour which could outweigh the prevention effectiveness of Truvada."
He said a clinical trial to invesitgate these issues would begin in the UK in the autumn.
Source: BBC Health
Testosterone supplements may help male weight loss
Testosterone injections helped obese men with a hormone deficiency to lose weight.
Older obese men could shift excess weight by taking testosterone supplements, suggest findings announced at the European Congress on Obesity.
In a study, hormone-deficient men were given testosterone supplements in a similar way to HRT for older women.
Men lost an average of 16kg over five years when testosterone levels were increased back to normal.
But experts warn that supplements may not be the answer due to possible risks of prostate cancer and heart disease.
“I will remain sceptical until I see a large scale study in a more robust fashion”
End Quote Prof Ashley Grossman University of Oxford
Prof Richard Sharpe from the University of Edinburgh Centre for Reproductive Health said: "The notion that this is a quick fix for obese older men is, as always, simplistic. It is far more sensible and safer for men to reduce their food intake, reduce their obesity, which will then elevate their own testosterone."
Male menopause?
The findings announced at the conference also suggest that raising testosterone levels could reduce waist circumference and blood pressure.
Dr Farid Saad, lead author of the study said: "We came across this by accident. These men were being given testosterone for a hormone deficiency - they had a range of problems - erectile dysfunction, fatigue and lack of energy.
"When we analysed the data we found that every year, for five years, they had lost weight. It may be that the increased testosterone restored their energy levels and led to a behavioural change of being more physically active."
However, experts remain dubious. While some experts have linked low testosterone levels to a male "menopause", with symptoms including changes in sleeping patterns, poor concentration, feeling worthless and anxiety, others have found to have no such link.
Prof Ashley Grossman, an endocrinologist from the University of Oxford said: "This is interesting, but not absolutely convincing. We cannot say for sure that this is the effect of the drug rather than being involved in such a trial.
"I will remain sceptical until I see a large scale study in a more robust fashion." The gold standard test would be to pitch the testosterone injections against a dummy drug in a controlled trial.
The study looked at 115 obese men aged between 38-83 years with low testosterone levels. They were injected with the hormone every 12 weeks to increase levels.
The research, paid for by Bayer Pharma, a manufacturer of testosterone replacement therapy, found no increased risk of prostate cancer, a side-effect found in other studies.
The relationship between obesity and testosterone appears to be a vicious cycle. There are numerous studies showing that obesity, in particular abdominal obesity, is associated with reduced testosterone levels in men and a reduction in muscle.
With ageing, especially beyond 40-50 years, testosterone levels tend to decline slowly, which may predispose to abdominal obesity which will then further lower testosterone levels.
Source: BBC Health