Hadassah lab enables HIV-infected men to have healthy kids

Health Scan: Vitamin D helps combat hepatitis C while smokers diagnosed with early-stage lung cancer double their chances of survival.

By JUDY SIEGEL-ITZKOVICH
A special lab – the first in the country – has been set up in the AIDS center at Hadassah University Medical Center in Jerusalem’s Ein Kerem that from February will give male HIV carriers the opportunity to father healthy babies.
The idea of using chemicals to “rinse” semen to eliminate the AIDS virus began some 20 years ago in the US. But one failed attempt led to the woman getting infected without the man receiving antiretroviral therapy to reduce his “viral load.” As a result of that tragic case, the US Centers for Disease Control refused to approve the practice.
Prof. Shlomo Ma’ayan, director of the AIDS center, says he already has about 50 “discordant couples” (the man an HIV carrier and the woman healthy) who plan to undergo in-vitro fertilization (IVF) after the men’s sperm is rinsed. The technology is available in a few dozen medical centers, but at none in this region; thus Ma’ayan expects medical tourists from Turkey, Greece, Cyprus and other countries.
Women HIV carriers can undergo fertility treatment without their partners being endangered; all she needs is to undergo antiretroviral therapy during her pregnancy. The risk of fetal HIV infection this way is less than 1%, notes Ma’ayan.
The chemical rinse used today has been utilized for other types of procedures and found to keep the HIV virus from multiplying. However, it does make it slightly more difficult to produce a pregnancy. The success rate for the first attempt is about 30%, he says.
Today, says Ma’ayan, the procedure requires only the usual informed consent. The rinsed semen is examined for HIV just to be sure and then frozen at -180ºC before being used.
Five years ago, such a procedure was supposed to begin in another Israeli hospital, but due to “licensing problems,” it never took off, said the AIDS expert. The ministry recently decided to designate Hadassah-Ein Kerem as the national center for rinsing sperm and Rambam Medical Center in Haifa for treating female HIV carriers who want children and suffer from mechanical problems that can be solved by IVF.
The rinsing procedure will be provided as part of the basket of health services, just as IVF to produce two healthy babies per woman (up to a maximum age) is free.
Among those participating in the project, besides Ma’ayan is Dr. Keren Olstein of the AIDS Center, Prof. Neri Laufer and Prof. Alex Simon of obstetrics and gynecology and Prof. Dana Wolf of the clinical virology unit. The lab was established with donations from Prof Ray Schinazi of Emory University and Prof. Philippe Halfon of Marseille and their families.
VITAMIN D AGAINST HEPATITIS C
Hepatitis C is one of the most severe infectious liver diseases, and is spread by sexual or blood contact, or from mother to fetus. Up to 85% of those infected develop chronic disease. Now researchers at Assaf Harofeh Medical Center in Tzrifin have discovered that the disease almost disappears when patients are given vitamin D. Dr. Sayef Abu Moch, director of the liver clinic at the hospital and head of the research team, presented his findings at a recent meeting of the American Society for Liver Research.
When taken together with ribavirin and interferon alpha – anti-viral drugs traditionally given to control hepatitis C and other infections – vitamin D has a significant effect, he said. In 44% of patients given vitamin D for a month, the virus disappeared from their blood, compared to only 18% in the control group. After three months, the virus went away in 96% of the vitamin D group and 48% of the control group. After half a year, the virus was gone from the blood, lymph glands and liver of 90% of those who took vitamin D.
In recent years, the amount and frequency of antiviral treatment has been changed to make it more effective, said Abu Moch. But success rates were higher among white-skinned than dark-skinned people, he noticed. The liver specialist realized there is much less vitamin D in the latter because dark skin does not absorb the sun’s ultraviolet rays as well as the former, and thus does not produce the vitamin easily. Thus he decided to try vitamin D to bolster the drugs.
Asked to comment, Dr. Menachem Oberbaum – director of the Center for Integrative Complementary Medicine at Jerusalem’s Shaare Zedek Medical Center – said that of those infected, 30% to 75% will develop hepatitis and eventually liver cirrhosis, and within 30 years many will develop liver cancer. Therapeutic possibilities are limited, and unlike other hepatitis viruses (A and B), no effective vaccine is available.
“The treatment suggested by Dr. Abu Moch is very interesting because vitamin D is actually free from side effects (unlike interferon treatment), very cheap and shows an impressively positive effect; I would even venture that it is too impressive,” said Oberbaum. If the new findings are published in a peer-reviewed medical journal, they would be very important for the medical profession, since this disease affects nearly 170 million people worldwide. In Israel, about 2% of the population are seropositive for hepatitis C and have had to undergo the unpleasant treatment protocol mentioned. The addition of vitamin D to this protocol, should it be proven effective, would make a significant contribution to the existing treatment regimen,” he said.  
NEVER TOO LATE TO QUIT
Smokers diagnosed with early-stage lung cancer can double their chances of survival over five years if they stop smoking compared with those who continue, finds a study just published in the British Medical Journal (BMJ). This is the first review of studies to measure the effects of continued smoking after diagnosis of lung cancer. The University of Birmingham researchers suggest it may be worthwhile to offer smoking cessation treatment to patients with early-stage lung cancer.
Smoking increases the risk of developing a primary lung cancer; lifelong smokers have a 20-fold increased risk compared with nonsmokers. But it was not known whether quitting after a diagnosis of lung cancer has any benefit. So researchers at the University of Birmingham in the UK conducted a meta-analysis of 10 studies that measured the effect of quitting after a diagnosis of lung cancer. They found that people who continue to smoke after a diagnosis of early-stage lung cancer had a substantially higher risk of death and a greater risk of the tumor returning compared with those who stopped smoking immediately. Data suggested that most of the increased risk was due to cancer progression.
Further analysis found a five-year survival rate of 63% to 70% amongquitters, compared with 29% to 33% among those who continued to smoke.In other words, about twice as many quitters would survive for fiveyears.
These findings support the theory that continued smoking affects thebehavior of a lung tumor, say the authors. They also provide a strongcase for offering smoking cessation treatment to patients withearly-stage lung cancer. Further trials are needed to examine thesequestions, they conclude.