WEDNESDAY, May 14 (HealthDay News) -- The largest study of its kind supports the use of a popular three-drug regimen for HIV patients and suggests a cocktail of two classes of drugs is a good alternative.

But an older regimen works almost as well, said study lead author Dr. Sharon Riddler, assistant professor of medicine at the University of Pittsburgh.

"It's not like 10 years ago, where there were huge differences between regimens," Riddler said. "We're looking at relatively small differences, trying to fine-tune what actually works pretty well."

The revolution in AIDS/HIV treatment came more than a decade ago, when combinations of drugs known as "cocktails" entered the market. Patients infected with HIV or who had progressed to AIDS typically had to take numerous pills each day.

Now, pharmaceutical companies have managed to combine multiple drugs into two-pill regimens or even a single pill.

In the new study, published in the May 15 issue of the New England Journal of Medicine, researchers examined the medical records of 753 HIV-positive patients at 55 treatment centers. The patients took one of three regimens, two of which included older drugs known as nucleoside reverse transcriptase inhibitors (NRTIs). Doctors consider them to be effective, but they can cause a variety of side effects.

The researchers found that the combination of a drug known as efavirenz (also known as Sustiva) plus two NRTI drugs did a better job of keeping a lid on levels of the virus in the body. Only 24 percent of those who took the regimen saw their viral load -- a reflection of the amount of HIV in their body -- return to detectable levels.

The virus gained a foothold in one-third of those who took lopinavir-ritonavir plus efavirenz -- two drugs instead of the usual three -- and in 27 percent of those who took lopinavir-ritonavir plus two NRTIs.

The researchers reported that all three regimens boosted the immune systems of the patients who took them.

The findings may bolster the use of efavirenz-based treatments in people whose immune systems are moderately to significantly suppressed, such as those who took part in the study, Riddler said. "For the most part, it's a simpler treatment for patients," she said.

Efavirenz isn't for everyone, Riddler cautioned. "A certain proportion of people won't tolerate efavirenz, and it can't be given to pregnant women," she said. For those patients, regimens that rely on so-called protease inhibitors -- like lopinavir-ritonavir -- may make sense, she said.

The study also suggests that it isn't necessary for all patients to be on NRTIs, Riddler said. "That gives us the opportunity to begin to look at other potential combinations now that we have availability of a couple of new classes of drugs."

And still another expert weighed in on the study.

Rowena Johnston, director of research at the Foundation for AIDS Research, said the study "could actually make a difference in patients' lives," because it gives them more information to help them choose among treatments.

Still, doctors and patients will continue to consider a constellation of factors when they decide which drugs are best, she said. Among other things, she said, they can look at different ways of gauging the effectiveness of the drugs plus side effects and the simplicity of regimens.

"If you put those pieces of information together, you have a better chance of finding the (best) combination for you," she said.

More information

Learn more about HIV treatments from avert.org  .

MONDAY, May 12 (HealthDay News) -- A gene called COMT, already known for its role in schizophrenia, also plays a significant part in the dangerous obstetric complication known as preeclampsia, a new study finds.

Although the current study was done in mice, the researchers envision a time when the findings could be used as a test to identify women at risk of preeclampsia -- and even as a means of preventing the condition.

"This gene regulates the oxygenation of the placenta," explained lead researcher Raghu Kalluri, a professor of medicine at Harvard Medical School. "Preeclampsia is a pregnancy disorder where the placenta is hypoxic (isn't receiving enough oxygen)," he added.

Preeclampsia, which affects about 5 percent of all pregnancies, is a leading cause of sickness for pregnant women and their infants. Symptoms of preeclampsia include high blood pressure, protein in the urine and swelling.

The COMPT (catechol-O-methyltransferase) gene is involved in breaking out estrogen into a metabolite called 2ME (2-methoxyestradiol), which prevents a shortage of oxygen in the placenta. When the gene does not function properly, levels of 2-ME are reduced, setting in motion a series of events that lead to preeclampsia, Kalluri explained.

The report was published online in the May 12 issue of Nature.

In their current experiments, the researchers worked with mice that did not have the COMT gene, and therefore do not produce 2-ME. After 14 weeks of gestation -- equivalent to the third trimester of human pregnancy -- the mice developed high blood pressure and other symptoms of preeclampsia, the researchers found.

The mice also delivered their pups earlier than normal, with a high incidence of stillborn offspring. Once the pups were delivered, the mother's health return to normal, the researchers found.

However, when the mice were given supplemental 2-ME, symptoms of preeclampsia disappeared, Kalluri said.

Kalluri's team found that COMT levels were deficient, and 2-ME levels were also lower, in women diagnosed with preeclampsia.

Because 2-ME is found in the blood and urine, the researchers hope to use their finding to develop a urine test that would identify women at risk from preeclampsia, Kalluri said. "This can be designed as a urine strip test, like pregnancy tests are," he said.

In addition, giving 2-ME to women who have low levels of this protein may prevent them from developing preeclampsia, Kalluri said. "We can give back the missing amount to bring levels back to where they should be," he said.

One expert believes the results are promising, but said more work is needed before 2-ME could become either a screening test or treatment.

"This is an interesting and novel study, which gives insight into the pathophysiology of preeclampsia," said Dr. Arun Jeyabalan, an assistant professor in the division of maternal fetal medicine in the department of Obstetrics, Gynecology and Reproductive Sciences at Magee Women's Hospital, University of Pittsburgh.

Jeyabalan said that it will be sometime before these findings can be extended to patients. Using these findings to develop a screening test is something worth looking into, she added.

"Most of this work is of animals, and I think we have to be cautious before we extend these findings to humans," Jeyabalan said. "But it is something that is definitely worth testing in the future."

More information

For more about preeclampsia, visit the U.S. National Library of Medicine.

MONDAY, May 12 (HealthDay News) -- Patients with Duchenne muscular dystrophy often suffer from heart failure, but Viagra might prevent or delay the onset of this condition, a new Canadian study finds.

In experiments with mice, researchers showed that Viagra (sildenafil) improved heart performance by preventing the breakdown of a compound called cGMP, which relaxes smooth muscle.

"Duchenne muscular dystrophy is a crippling disease that affects both skeletal muscle and cardiac muscle," said lead researcher Christine Des Rosiers, a professor of cardiology in the department of nutrition at the University of Montreal. "Currently, there is a need for the development of more effective treatment strategies for patients affected with this disease."

In their experiments, the researchers used mice bred to mimic Duchenne muscular dystrophy. Then the scientists gave the rodents doses of Viagra comparable to those taken by men for erectile dysfunction.

The researchers found that Viagra improved heart function in the mice by preventing the breakdown of cGMP.

In a further experiment, the researchers inserted a gene into the hearts of the mice that increased the production of cGMP. The result: The mice were able to maintain normal heart function.

The findings are published in this weeks issue of the Proceedings of the National Academy of Sciences.

"Our findings substantiate benefits for the dystrophic heart using a pharmacological approach, namely with sildenafil, which is safe, well-tolerated and currently available for clinical use," Des Rosiers said. "Hence, this could provide the basis for a new avenue for the treatment. Furthermore, the benefits of this therapeutic approach would be expected to extend beyond the heart to affected skeletal muscle and other tissues."

Dr. Valerie A. Cwik, medical director and vice president of research at the Muscular Dystrophy Association, said there's a need for new approaches to the treatment of heart failure in patients with Duchenne and other forms of muscular dystrophy.

"The findings presented by these authors are interesting and certainly have potential clinical implications for the various forms of dystrophinopathy [heart damage]," she said, adding that heart failure is a major cause of illness and death in late-stage Duchenne muscular dystrophy.

"At the present time, there is no consensus or standard of care for optimal management of the cardiac complications of dystrophinopathies, and further research in this area is clearly needed," Cwik said.

While Viagra hasn't been tested in humans to see if it benefits muscular dystrophy patients, it has been available for years and appears to be safe, Cwik noted.

More information

For more on muscular dystrophy, visit the Muscular Dystrophy Association  .

FRIDAY, May 9 (HealthDay News) -- Many teens and young adults in Europe are drinking alcohol and taking drugs for sexual purposes, according to a survey of more than 1,300 people who are regular nightlife-goers.

The results showed that a third of males and a quarter of females aged 16 to 35 drink alcohol to increase their chances of sex, while cocaine, ecstasy and cannabis are used to enhance sexual arousal or prolong sex.

Nearly all of the respondents reported alcohol use, with most having had their first drink when they were 14 or 15 years old. About three-quarters had tried or used cannabis, and about 30 percent had at least tried ecstasy or cocaine.

Even though many respondents believed alcohol and drugs offered sexual "benefits," the survey found that drunkenness and drug use were strongly associated with an increase in risk-taking behavior and feelings of regret about having sex while under the influence of alcohol or drugs.

For example, those who'd been drunk in the previous four weeks were more likely to have had five or more sex partners, sex without a condom, and to have regretted sex after drink or drugs in the past year. Similar consequences were noted in those who'd used cannabis, cocaine or ecstasy.

Respondents who used alcohol, cannabis, cocaine or ecstasy before age 16 were much more likely to have had sex before that age. This was especially true for girls, who were nearly four times as likely to have had sex before the age of 16, if they drank alcohol or used cannabis before that age.

The findings were published in the journal BMC Public Health.

"Trends in recent decades have resulted in recreational drug use and binge drinking becoming routine features of European nightlife," lead author Mark Bellis, of Liverpool John Moores University, said in a prepared statement. "Millions of young Europeans now take drugs and drink in ways that alter their sexual decisions and increase their chances of unsafe sex or sex that is later regretted. Yet despite the negative consequences, we found many are deliberately taking these substances to achieve quite specific sexual effects."

"Sexual activity accompanied by substance use is not just incidental, but often sexually motivated," noted co-author, consultant psychiatrist Amador Calafat. "Interventions addressing sexual health are often developed, managed and implemented independently from those addressing substance use, and vice versa. However, young people often see alcohol, drugs and sex all as part of the same social experience, and addressing these issues requires an equally joined-up approach."

More information

The U.S. National Institute on Alcohol Abuse and Alcoholism has more about alcohol-related risk behaviors among youth.