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2010: The year in medical breakthroughs

What were the major medical studies of 2010? And how will they affect the treatment of disease in the U.S.? Need to Know asked leaders in the fields of HIV, cancer, heart disease, diabetes and Alzheimer’s. Here’s what they had to say.

Doctors believe a man is cured from HIV after a bone marrow transplant.

Timothy Ray Brown, also known as “the Berlin patient,” received the transplant in 2007 as part of a lengthy treatment course for leukemia. Fortunately, the patient, who was infected with HIV, was able to receive a bone marrow transplant from a donor who not only matched the patient’s “tissue type” but also lacked an essential receptor or “door” that HIV uses to enter cells. The patient received two transplants from this special donor and has remained free of HIV in the blood, even though he has not been given any medications since the transplant. This research will continue to be studied as doctors collect data from the patient’s blood, liver, gut, spinal fluid and brain tissue.

In science, it is not possible to prove a negative. Until every cell in the patient’s body is examined, you cannot say HIV has been totally eradicated. But three and a half years is a long time off therapy to have an undetectable virus. The Berlin patient’s declining anti-HIV antibodies support this. He has lost antibodies to all but the envelope or exterior of the virus. He no longer has any antibodies against the internal viral proteins.

Widespread use of this treatment approach is unlikely. Full bone marrow transplants are dangerous and only performed in extreme circumstances, usually to fight recurrent cancers. But this argues for modified approaches such as those being done by researchers.

“We believe that research into ways to cure HIV are warranted and need better funding,” said AIDS Research Alliance’s vice-president and medical director Dr. Stephen Brown. “It is unconscionable that a disease that infects 33 million people around the world should receive so little funding aimed at a cure.” Dr. Brown cited a recent report put out by the AIDS Policy Project which calculated that, even by the broadest definition, “no more than 3 percent of NIH funding goes towards HIV curative research.” AIDS Research Alliance researchers have also calculated that, even if only 5 percent of developed country patients infected with HIV were able to be cured, “there would be cumulative savings of over $13 billion dollars over their lifetime.”

Source: AIDS Research Alliance

A vaginal gel might prevent HIV infection.

A gel applied before and after sexual intercourse to prevent HIV transmission was one of the most important research developments in the HIV field this year.
The results of this trial are important because access to such a gel would place the power to control HIV prevention directly in the hands of women.

It will probably take several years for the gel to be available for doctors to prescribe to patients or for women to buy over the counter in pharmacies.

Source: International Aids Society

CT scans decreased lung cancer by 20 percent.

The most important study affecting the largest number of people in the U.S. this year was the November report on a National Lung Screening Trial, in which researchers announced that screening heavy smokers for lung cancer with spiral CT scans decreased deaths from lung cancer by about 20 percent, and deaths from all causes in the screened group by about 7 percent compared with annual chest X-rays.

Although more information from the study is pending, if the results hold up on further review and discussion, it is possible that people who meet the criteria of the study — those with 30 pack-years (or 20 cigarettes a day for a year) of smoking, either a current smoker or someone who stopped within 15 years of scanning, and between the ages of 55 and 74 — will have access to these scans for screening purposes in the near future.

Organizations like the American Cancer Society plan to take a careful look at the complete results of the study before making any recommendations as to who might benefit most from lung cancer screening. In addition, they will be looking closely at the potential harms of screening, including the impact of surgery that finds non-cancerous problems and unexpected poor outcomes of surgery.

While never smoking in the first place and quitting smoking if you are already a smoker are the best recommendations to prevent deaths from lung cancer, it is possible that this clinical trial will result in saving thousands of lives every year.

Source: American Cancer Society

Biomarkers might point to the disease.

The most potentially beneficial research this year in Alzheimer’s was on biomarkers — or biological indicators of the disease. Just as biomarkers can indicated heart disease, doctors have determined early biological signs of Alzheimer’s. The test to determine Alzheimer’s biomarkers is done by a brain imaging scan and spinal fluid sampling. Although this research is promising, it will take years before doctors can use the tests on patients.

Alzheimer’s is thought to begin affecting the brain years, perhaps even decades, before outward symptoms are noticeable. But there is currently no single, generally accepted way to identify the disease in its earliest stages before symptoms are evident. At the same time, drugs are being developed that may be able to slow or stop the progression of Alzheimer’s.

Source: Alzheimer’s Association

Aggressive treatment for people with diabetes to reduce their risk of cardiovascular disease is not necessary.

More than 17 million Americans are diagnosed with diabetes, and heart disease death rates are two to four times higher for them compared with people without diabetes. New research finds that aggressive blood pressure control does not reduce cardiovascular disease risk in people with type 2 diabetes who are at a high risk. In a second study, researchers found a combination therapy with a statin plus a fibrate was no better at reducing risk than a statin alone in patients with type 2 diabetes at high risk for cardiovascular disease.

However, combination lipid therapy may be successful in reducing cardiovascular disease risk in those type 2 diabetes patients with low HDL cholesterol and low triglycerides. These results will be helpful for targeting specific treatments that best reduce cardiovascular risk in people with diabetes.

Source: American Heart Association and American Diabetes Association