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Meeting Addresses MTCT Of HIV In Africa
Health officials recently held a regional consultation in Kenya to examine mother-to-child HIV transmission services and pediatric HIV/AIDS care in nine Eastern and Southern African countries, IRIN/PlusNews reports. The consultation -- hosted by UNICEF, UNAIDS and the World Health Organization -- included representatives from Ethiopia, Kenya, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda and Zambia. The meeting addressed issues in MTCT prevention services -- including the continued use of single-dose nevirapine instead of more effective combination therapies, as well as delays in diagnosing and initiating treatment -- that are weakening prevention programs in focus countries. According to IRIN/PlusNews, 70% of pregnant women in Eastern and Southern African countries are seen by a health care provider at least once during pregnancy. However, 43% of HIV-positive pregnant women have a health care worker present during labor who can administer PMTCT treatment. In Uganda, a national policy calls for all sub-county level health facilities to provide PMTCT services, but only 53% offer such services because of health worker shortages. Janet Kayita, regional PMTCT adviser for UNICEF, said, "We are doing a bad job of testing women for HIV and then following them up, and an even worse job of ensuring that infants receive appropriate prevention and treatment services." She added that national PMTCT guidelines have not reached local levels. "These policies must become a reality for the people they were designed to help," Kayita said, adding that primary health care systems at all levels must be strengthened (IRIN/PlusNews, 5/25).Some officials at the meeting called on African governments to reach 80% of pregnant women, mothers and children with services; reduce by 50% the number of women and infants who do not receive follow-up care; and double the number of HIV-positive children who receive antiretroviral treatment. Xinhuanet reports that prevention services currently reach about 50% of pregnant women in all Eastern and Southern African countries. At the close of the consultation, officials issued a set of recommendations for meeting PMTCT goals, including increased community involvement in prevention programs; reduced workloads for health workers; and increased coverage of and compliance with PMTCT regimens. In addition, the experts urged governments to prioritize regions with high HIV burdens and strengthen data management to better understand trends (Ooko, Xinhuanet, 5/25). James Kamau, coordinator of the Kenya Treatment Access Movement, recommended that more women in the country deliver in hospitals in order to ensure that they receive PMTCT services (Mwaniki, Daily Nation, 5/25). David Alnwick, a UNICEF regional adviser, said, "It is critical at this juncture, when many countries are faced with shrinking budgets and competing demands, that we do not lose the momentum of what needs to be done to create an AIDS-free generation" (Xinhuanet, 5/25).
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News of the day
Centrist Dems Say Abortion Issues Must Not Delay Health Reform; Conservatives Step Up Criticism
Five centrist House Democrats, led by antiabortion-rights Rep. Tim Ryan (Ohio), on Tuesday issued a proposal that would neither require nor ban private insurers from covering abortion services as long as federal dollars are not used, the Washington Post"s "Capitol Briefing" reports. In a letter sent to House Speaker Nancy Pelosi (D-Calif.), Ryan and Reps. Dale Kildee (Mich.), James Langevin (R.I.), Artur Davis (Ala.) and Kendrick Meek (Fla.) said that their proposal "maintains the current status quo in the private market" and would not "preempt constitutionally permissible" state restrictions related to abortion, such as parental notification laws. The representatives called their proposal a "common ground solution." Current federal law prohibits the use of federal Medicaid funds for abortion services in nearly all circumstances. The lawmakers said that they are "increasingly concerned about potential roadblocks around the issue of abortion" in the health reform debate in Congress. According to "Capitol Briefing," antiabortion-rights Democrats are concerned that health reform legislation could lead to indirect federal funding of abortion services through private insurers participating in a proposed health insurance exchange (Eggen, "Capitol Briefing," Washington Post, 7/21). In the letter, the representatives said that they would like to include language in the final health reform bill "that makes clear that no insurance company will be required to pay for an abortion except in extraordinary circumstances." In addition, insurance providers would not be prohibited from paying for abortion services "so long as health insurance plans offered in the exchange that choose to provide abortion coverage pay for those services with funds that are separate and distinct from any federal subsidies," the letter said. Ryan said he hopes the proposal will be introduced in committee on Wednesday as an amendment (Smith, Politico, 7/21).House Members Step Up Efforts To Exclude Abortion CoverageMeanwhile, antiabortion-rights House members are intensifying their efforts to exclude abortion coverage from the chamber"s health reform bill (HR 3200), which they said includes a "hidden mandate" that would allow federal money to cover the procedure, the AP/Houston Chronicle reports. Rep. Bart Stupak (D-Mich.) said that he plans to join other antiabortion-rights House members at a news conference on Wednesday to criticize the legislation. Stupak helped draft a June 25 letter to Pelosi saying that he and 19 other Democrats would not support any health reform bill "unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan." The bill does not mention abortion, which supporters say means that the legislation is neutral on the issue (Alonso-Zaldivar, AP/Houston Chronicle, 7/22).Antiabortion-Rights Coalition Launches CampaignA coalition of antiabortion-rights groups this week is launching a three-week campaign aimed at excluding abortion coverage from health reform legislation, Politico reports. The coalition includes James Dobson, founder of Focus on the Family; Tony Perkins, president of the Family Research Council; Richard Land of the Southern Baptist Convention; David Bereit of 40 Days for Life; and Charmaine Yoest, president of Americans United for Life. Yoest said AUL intends to send a letter to President Obama on Thursday citing its "belief that the bills are intended to include abortion."Laurie Rubiner, vice president for public policy and advocacy at the Planned Parenthood Federation of America, said that abortion is "not mandated any more than any other service or procedure in health reform." She added that excluding abortion coverage could result in women losing the coverage they currently have under private plans. The abortion-rights opponents" demand to exclude abortion coverage "violates the first principle of health care reform, which is: Don"t make people worse off under health care reform than they are today," Rubiner said (Smith, Politico, 7/22).
Medical Devices

Antidepressant Directly Stimulates Brain Growth Factor Receptors

The widely used antidepressant and pain medication amitriptyline--but not other closely related drugs -- can impersonate the brain"s own growth factors, researchers at Emory University School of Medicine have shown. The results are published online and will appear in the June 26 issue of the journal Chemistry & Biology. Amitriptyline, a tricyclic antidepressant first introduced in the 1960s, and other tricyclics are thought to exert their effects by increasing the levels of the messenger chemicals serotonin and norepinephrine in the brain. But the delay required for antidepressants to work has led scientists to the idea that a secondary effect, pushing neurons to survive and grow, must occur indirectly. The finding that amitriptyline can directly stimulate molecules that help neurons grow and resist toxins suggests a separate mechanism by which some antidepressant and pain relief compounds may function. Keqiang Ye, PhD, associate professor of pathology and laboratory medicine at Emory University School of Medicine, and his colleagues were looking for chemicals that could imitate a protein in the brain known as NGF (nerve growth factor). NGF has been used experimentally to treat Alzheimer"s disease and the degeneration of nerves in the extremities caused by diabetes. However, NGF cannot cross the blood-brain barrier and has puzzled investigators with its side effects, such as increased sensitivity to pain. Working in Ye"s laboratory, postdoctoral fellow Sung-Wuk Jang sorted through a library of chemicals to find those that could stimulate one of NGF"s "receiver dish" molecules on nerve cells, called TrkA. The way NGF works is to pull together two TrkA molecules on the cell surface. "We were surprised to find that amitriptyline has these same properties," Ye says. "This is an antidepressant that has been used for decades." Doctors also prescribe amitriptyline for chronic pain such as migraine headaches or the nerve damage caused by diabetes, he notes. In laboratory tests, amitriptyline could protect neurons from oxygen and glucose deprivation or the toxin kainic acid. Only amitriptyline, and not other antidepressants, could duplicate NGF"s ability to stimulate neurons to send out "neurites," small projections thought to be the beginnings of connections to other neurons. Amitriptyline directly binds TrkA and a related molecule called TrkB, the authors found. Amitriptyline could also bring together a mismatched pair of TrkA and TrkB - a phenomenon not seen before, Ye says. Also surprising was the finding that other tricyclic antidepressants, even those with a similar molecular structure such as imipramine, could not match amitriptyline"s ability to stimulate cells through TrkA. In a model of antidepressant function called a "forced swim test," amitriptyline"s effects do not depend on TrkA, because it still works on mice with modified TrkA genes, the authors found. Recent studies have indicated that the presence of TrkB is necessary for antidepressants to function in mouse models. The relationship between amitriptyline"s ability to directly stimulate TrkA and TrkB and its antidepressant and pain-relief properties needs to be explored further, Ye says. The research was supported by the National Institutes of Health. Reference: S-W Jang, X. Liu, C-B Chan, D. Weinshenker, R.A. Hall, G. Xiao and K. Ye. Amitriptyline is a TrkA and TrkB receptor agonist that promotes TrkA/TrkB heterdodimerization and has potent neurotrophic activity. Chemistry and Biology, 16, x-y (2009). Holly Korschun Emory University


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