H.I.V. Is Reported Cured in a Second Patient, a Milestone in the Global AIDS Epidemic

Scientists have long tried to duplicate the procedure that led to the first long-term remission 12 years ago. With the so-called London patient, they seem to have succeeded.

For just the second time since the global epidemic began, a patient appears to have been cured of infection with H.I.V., the virus that causes AIDS.

The news comes nearly 12 years to the day after the first patient known to be cured, a feat that researchers have long tried, and failed, to duplicate. The surprise success now confirms that a cure for H.I.V. infection is possible, if difficult, researchers said.

Timothy Ray Brown was the first person cured of AIDS.

The investigators are to publish their report on Tuesday in the journal Nature and to present some of the details at the Conference on Retroviruses and Opportunistic Infections in Seattle. 

Publicly, the scientists are describing the case as a long-term remission. In interviews, most experts are calling it a cure, with the caveat that it is hard to know how to define the word when there are only two known instances.

Both milestones resulted from bone-marrow transplants given to infected patients. But the transplants were intended to treat cancer in the patients, not H.I.V.

Bone-marrow transplantation is unlikely to be a realistic treatment option in the near future. Powerful drugs are now available to control H.I.V. infection, while the transplants are risky, with harsh side effects that can last for years. 

But rearming the body with immune cells similarly modified to resist H.I.V. might well succeed as a practical treatment, experts said. 

“This will inspire people that cure is not a dream,” said Dr. Annemarie Wensing, a virologist at the University Medical Center Utrecht in the Netherlands. “It’s reachable.”

Dr. Wensing is co-leader of IciStem, a consortium of European scientists studying stem cell transplants to treat H.I.V. infection. The consortium is supported by AMFAR, the American AIDS research organization.

By Apoorva Mandavilli , March 4, 2019 – NYTimes.com

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Revolutionary test could make IVF more successful by looking at the DNA a fertilised egg sheds in the lab

A revolutionary DNA test could make IVF more successful, research suggests. 

Problems with a developing baby’s chromosomes – strands of DNA found in every cell – are thought to be the main cause of miscarriages. 

To maximise a woman’s chance of conceiving via IVF, embryos are therefore screened before they are implanted into her womb to check for any chromosomal issues. 

But this involves taking cells from the embryos, which can damage them and increase the risk of a miscarriage.

The research was carried out by Brigham and Women’s Hospital, Boston, and led by Dr Catherine Racowsky, professor of obstetrics, gynecology and reproductive biology. 

IVF involves taking a woman’s eggs, which then get mixed with her partner’s, or a donor’s, sperm in a lab. After 16-to-20 hours, they are checked to see if the egg has been fertilised.

The fertilised eggs – or embryos – grow in the lab for six days before the best one or two are transferred into the womb. 

But this can do more harm than good and therefore only tends to be carried out when older women – who are more at risk of chromosomal abnormalities – are undergoing IVF. 

To test whether a safer approach is possible, the researchers analysed 52 embryos from IVF clinics that were no longer needed and had already undergone a biopsy.

These embryos were kept in a petri dish for 24 hours.

The scientists then tested 0.01ml of the surrounding fluid in the dish, as well as the embryos themselves to determine how many chromosomes they contained. 

Results – presented at the Fertility 2019 conference in Birmingham – suggested analysing this fluid produced fewer false positives than traditional methods.

A false positive occurs when a test indicates a problem when the embryo is in fact healthy.

‘This shows DNA in spent culture medium can be reliably amplified and sequenced,’ Dr Catherine Racowsky said at the conference.   

And the new method does not harm the embryo.

Virginia Bolton, consultant embryologist at St Guy’s Hospital – who was not involved in the research – told New Scientist: ‘Trying to refine our mechanisms for choosing the embryo that’s most likely to lead to pregnancy is something that’s been eluding us for ever.

‘This [approach] doesn’t damage the embryo in any way.’ 

Dr Bolton believes this technique is better than others being developed that test for the chemicals an embryo secretes.

She worries these chemicals may become diluted, skewing the results, whereas ‘the DNA is either there or it isn’t’, she said.  

February 13, 2019, thedailymail.co.uk, by Alexandra Thompson

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From a Deceased Woman’s Transplanted Uterus, a Live Birth

A novel uterus transplantation procedure may help more infertile women become pregnant.

A woman who received a uterus transplanted from a deceased donor has given birth to a healthy child, researchers in Brazil said on Tuesday. It is the first such birth to be reported.uterus

Uterine transplants from living donors have succeeded; at least 11 babies have been born this way since 2013. But a viable procedure to transplant uteri from deceased women could drastically increase the availability of the organs.

“We talk about lifesaving transplants. This is a life-giving transplant, a new category,” said Dr. Allan D. Kirk, the chief surgeon at Duke University Health System, who was not involved in the research.

“Biologically, organs of the living and the dead aren’t all that different,” he added. “But the availability of deceased donors certainly could open this up to a much broader number of patients.”

The operation, detailed in a case study published in The Lancet, followed 10 other attempted uterus transplants from deceased donors in the United States, Turkey and Czech Republic. It was the first successful uterine transplant in Latin America.

Infertility affects more than one in 10 women of reproductive age worldwide. The subject in this study, born without a uterus, received the organ from a 45-year-old woman who had delivered three children naturally. The donor had died of a stroke.

Seven months after the 10-hour transplant surgery — after menstruation began, and once it became evident that the patient’s body had not rejected the organ — doctors implanted the uterus with one of the patient’s own eggs.

A six-pound baby girl was delivered through cesarean section, according to Dr. Dani Ejzenberg, a gynecologist at the Hospital das Clínicas at the Universidade de São Paulo in Brazil, who led the research.

In the future, patients may be able to turn to organ banks instead of searching for volunteers, and living donors could avoid risky complications such as infections or serious bleeding.

By Emily Baumgaertner  New York Times, December 5, 2018

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Chinese Scientist Claims to Use Crispr to Make First Genetically Edited Babies

The researcher, He Jiankui, offered no evidence or data to back up his assertions. If true, some fear Crispr could open the door to “designer babies.”

Ever since scientists created the powerful gene editing technique Crispr, they have braced apprehensively for the day when it would be used to create a genetically altered human being. Many nations banned such work, fearing it could be misused to alter everything from eye color to I.Q.Crispr

Now, the moment they feared may have come. On Monday, a scientist in China announced that he had created the world’s first genetically edited babies, twin girls who were born this month.

The researcher, He Jiankui, said that he had altered a gene in the embryos, before having them implanted in the mother’s womb, with the goal of making the babies resistant to infection with H.I.V. He has not published the research in any journal and did not share any evidence or data that definitively proved he had done it.

But his previous work is known to many experts in the field, who said — many with alarm — that it was entirely possible he had.

“It’s scary,” said Dr. Alexander Marson, a gene editing expert at the University of California in San Francisco.

While the United States and many other countries have made it illegal to deliberately alter the genes of human embryos, it is not against the law to do so in China, but the practice is opposed by many researchers there. A group of 122 Chinese scientists issued a statement calling Dr. He’s actions “crazy” and his claims “a huge blow to the global reputation and development of Chinese science.”

If human embryos can be routinely edited, many scientists, ethicists and policymakers fear a slippery slope to a future in which babies are genetically engineered for traits — like athletic or intellectual prowess — that have nothing to do with preventing devastating medical conditions.

While those possibilities might seem far in the future, a different concern is urgent and immediate: safety. The methods used for gene editing can inadvertently alter other genes in unpredictable ways. Dr. He said that did not happen in this case, but it is a worry that looms over the field.

Dr. He made his announcement on the eve of the Second International Summit on Human Genome Editing in Hong Kong, saying that he had recruited several couples in which the man had H.I.V. and then used in vitro fertilization to create human embryos that were resistant to the virus that causes AIDS. He said he did it by directing Crispr-Cas9 to deliberately disable a gene, known as CCR₅, that is used to make a protein H.I.V. needs to enter cells.

By Gina Kolata, Sui-Lee Wee and Pam Belluck, NYTimes.com – November 26, 2018

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Stigma Against Gay People Can Be Deadly

L.G.B.T. people experience a range of social, economic and medical disparities that jeopardize their long-term health.

I’ve never been sure what to expect when meeting someone who’s just tried to take his own life. But I’ve learned to stop expecting anything.

Sometimes, the person in front of me barely speaks, staring right through me, lost in a deep catatonic depression. Sometimes he or she can’t stop talking, breathlessly describing what happened as if we’re gossiping at brunch after an hour of SoulCycle.LGBTQ

Yesterday, my patient, a 20-something graduate student, swallowed a jumble of unmarked pills, hoping to die, after his father told him never to come home again. Today, he greeted me with a soft smile, his delirium starting to clear, his heart beating normally again.

“Whoops,” he said.

He’d been a happy kid who aimed to please. He once felt so bad for lying about having done his homework before playing video games, he told me, that he’d grounded himself. Sociable but square, he didn’t drink until he was 21, even though he’d gone to a college with a reputation for partying. Deeply religious, he was gay but desperately wanted not to be.

Now his father’s disavowal pushed him over the edge, capping a string of stigmatizing experiences at home, at school and at church. He’d had enough.

For decades, we’ve known that lesbian, gay, bisexual and transgender individuals experience a range of social, economic and health disparities — often the result of a culture and of laws and policies that treat them as lesser human beings. They’re more likely to struggle with poverty and social isolation. They have a higher risk of mental health problems, substance use and smoking. Sexual minorities live, on average, shorter lives than heterosexuals, and L.G.B.T. youth are three times as likely to contemplate suicide, and nearly five times as likely to attempt suicide.

Some of these disparities have interpersonal roots: social exclusion, harassment, internalized homophobia. But often they stem from an explicit denial of rights: same-sex marriage bans, employment discrimination, denial of federal benefits. Discrimination in any form can have serious health consequences: Sexual minorities living in communities with high levels of prejudice die more than a decade earlier than those in less prejudiced communities.

But civil rights advances and growing public acceptance of L.G.B.T. individuals in recent years are among the more transformative social changes in modern American history. And evidence increasingly suggests this shift has measurably improved health care access and health outcomes for L.G.B.T. populations.

The halting, patchwork nature of L.G.B.T. rights expansions across the country has allowed researchers to study the effects on health and well-being by comparing states that expanded rights to those that failed to introduce protections, or actively curtailed them. Since Vermont became the first state to formally recognize same-sex partnerships in 2000, many other states either legalized same-sex marriage, or conversely, passed constitutional amendments banning it — until the landmark 2015 Supreme Court decision in Obergefell v. Hodges required all 50 states to recognize same-sex marriage.

By Dhruv Khullar, M.D., NYTimes.com, October 9, 2018

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Major Climate Change Report Describes a Strong Risk of Crisis as Early as 2040

A landmark report from the United Nations’ scientific panel on climate change paints a far more dire picture of the immediate consequences of climate change than previously thought and says that avoiding the damage requires transforming the world economy at a speed and scale that has “no documented historic precedent.”

The report, issued on Monday by the Intergovernmental Panel on Climate Change, a group of scientists convened by the United Nations to guide world leaders, describes a world of worsening food shortages and wildfires, and a mass die-off of coral reefs as soon as 2040 — a period well within the lifetime of much of the global population.climate change

The report “is quite a shock, and quite concerning,” said Bill Hare, an author of previous I.P.C.C. reports and a physicist with Climate Analytics, a nonprofit organization. “We were not aware of this just a few years ago.” The report was the first to be commissioned by world leaders under the Paris agreement, the 2015 pact by nations to fight global warming.

The authors found that if greenhouse gas emissions continue at the current rate, the atmosphere will warm up by as much as 2.7 degrees Fahrenheit (1.5 degrees Celsius) above preindustrial levels by 2040, inundating coastlines and intensifying droughts and poverty. Previous work had focused on estimating the damage if average temperatures were to rise by a larger number, 3.6 degrees Fahrenheit (2 degrees Celsius), because that was the threshold scientists previously considered for the most severe effects of climate change.

Avoiding the most serious damage requires transforming the world economy within just a few years, said the authors, who estimate that the damage would come at a cost of $54 trillion. But while they conclude that it is technically possible to achieve the rapid changes required to avoid 2.7 degrees of warming, they concede that it may be politically unlikely.

For instance, the report says that heavy taxes or prices on carbon dioxide emissions — perhaps as high as $27,000 per ton by 2100 — would be required. But such a move would be almost politically impossible in the United States, the world’s largest economy and second-largest greenhouse gas emitter behind China. Lawmakers around the world, including in China, the European Union and California, have enacted carbon pricing programs.

New York Times – October 8, 2018 by Coral Davenport

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Do IVF And Other Infertility Tech Lead To Health Risks For The Baby?

When patients come to Dr. Molly Quinn for infertility treatments like IVF, they usually aren’t too interested in hearing about the possible downsides, she says. They just want to get pregnant.

Still, she always discusses the risks of procedures such as IVF. For example, there’s an increased likelihood of twins or triplets — which increases the chances of medical complications for both moms and babies. And stimulating the ovaries to ripen extra eggs can, in a small number of cases, cause the ovaries to rupture.IVF

Quinn, an infertility specialist and assistant professor of obstetrics and gynecology at the University of California, Los Angeles, now has a new hazard to consider. According to research published this month in the Journal of the American College of Cardiology, children conceived through certain infertility treatments may be at a higher risk for cardiovascular disease.

Parents shouldn’t panic, the study’s authors say: The findings are preliminary, and the study cohort was fairly small. Still, they say, it means that families who used infertility treatments like IVF should be particularly vigilant about screening for high blood pressure in their children and help them avoid other cardiovascular risk factors, such as smoking, obesity and a sedentary lifestyle.

“Fertility clinics should really … counsel about potential risks for their kids,” says Dr. Urs Scherrer, a visiting professor at the University of Bern in Switzerland and a senior author of the study.

Scherrer and his colleagues followed the health of children conceived through assisted reproductive technology for more than a decade. ART is an umbrella term that covers a number of different types of procedures, including in vitro fertilization, in which sperm and eggs are mixed in a lab dish, and intracytoplasmic sperm injection, in which sperm are inserted directly into eggs. Today, roughly 2 percent of all births in the U.S are conceived via ART.

In 2012, the same team of scientists published a major paper showing that 65 healthy kids born with the help of ART were more likely than their peers to have early signs of problematic blood vessels. The current study, comparing 54 of those original children with 43 age- and sex-matched peers, shows those early irregularities — signs of “premature vascular aging”, the scientists say — persist into adolescence and young adulthood.

Kids in the study who were conceived via ART are now 16 years old, on average, but have blood vessels resembling those of middle-aged adults, the scientists found.

NPR.org, by Mara Gordon, September 19, 2018

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Lots of Successful Women Are Creating Frozen Eggs. But It May Not Be About Their Careers.

“Freeze Your Eggs, Free Your Career,” announced the headline of a Bloomberg Businessweek cover story in 2014. It was the year that Facebook and then Apple began offering egg freezing as a benefit toemployees. Hundreds of think pieces followed, debating the costs and benefits of using frozen eggs in an effort to “postponing procreation” in the name of professional advancement.

In the years since, many more women across the world have  usedfrozen eggs. Many are highly educated. But the decision may have very little to do with work, at least according to a new study. In interviews with 150 American and Israeli women who had undergone one cycle, careerplanning came up as the primary factor exactly two times.

Instead, most women focused on another reason: they still hadn’t found a man to build a family with.frozen eggs

“The stereotype that these ambitious career women are freezing their eggs for the purposes of their career — that’s really inaccurate at the present time,” said Marcia Inhorn, a medical anthropologist from Yale University, and one of the authors of the study, which was presented Monday at the European Society of Human Reproduction and Embryology’s conference in Spain.

Most of these mid-to-late 30s women were already established in their careers by the time they got to the clinic, the study found.

“They weren’t freezing to advance; they were facing the overarching problem of partnership,” she said. This was the case, even among those who worked for companies that offered to pay for the procedure.

by Heather Murphy, New York Times – July 3, 2018

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Yet Another New Study Shows No Difference In Outcome of Children Raised By Gay Parents Or Straight Parents

A new study by Italian scientists says that the psychological adjustment in children of same-sex parents is the same for kids of heterosexual parents.

Professor Roberto Baiocco, PhD, and several of his colleagues from Sapienza University of Rome have conducted a survey to see the difference in how children grow up depending on whether their parents are gay men, lesbian women, or a straight couple.another study

The Study, titled With Same-Sex or Different-Sex Parents, Child Outcomes Linked to Family Functioning, was published by Wolters Kluwer and appears in the Journal of Development & Behavioral Pediatrics.

The study included 70 gay fathers who had children through surrogacy, 125 lesbian mothers who had children through donor insemination, and 195 heterosexual couples who had children through spontaneous conception. In addition, the children were between the ages of 3 to 11 years old.

After obtaining the participants, the scientists split them up into three groups which were categorized by “child characteristics.”

From there, parents were asked a series of questions based on their ability to act successfully as a parent (self-agency), extent of agreement/adjustment between parents, family functioning, and the child’s psychological adjustment which the scientists defined as their “strengths and difficulties.”

by Devin Randall, InstinctMagazine.com, June 28, 2018

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Blood Test Might Predict Pregnancy Due Date and Preterm Birth

The blood test is far from ready for use, but research is promising. If it works in bigger studies, it could help prevent deaths of babies born prematurely.

Scientists have developed an inexpensive blood test to predict a pregnant woman’s due date and possibly identify women who are at risk of giving birth prematurely.

The research, which is still preliminary and involved small numbers of women, was led by a prominent pioneer in the field of genetic blood testing, Stephen Quake at Stanford University, who said the test could eventually provide a low-cost method of gauging the gestational age of a developing fetus.pregnancy blood test

The test, which detects changes in RNA circulating in a pregnant woman’s blood, estimated due dates within two weeks in nearly half the cases, making it as accurate as the current, more expensive method, ultrasound, and more accurate than guesses based on a woman’s last menstrual period.

Using a similar analysis of RNA in blood from eight women who delivered prematurely, the researchers were able to correctly classify six of their pregnancies as preterm. If much larger studies achieve comparable results, the test could become a tool to help prevent unnecessary induction of labor or Cesarean deliveries, and could possibly help save babies would have died because they were born too early.

Premature birth is the leading cause of newborn death in the United States. And 15 million babies a year are born prematurely around the world.

“I think it’s really a very exciting study that suggests an approach that may have a lot of potential for predicting preterm delivery,” said Dr. Louis Muglia, director of the Center for Prevention of Preterm Birth at Cincinnati Children’s Hospital Medical Center at the University of Cincinnati. “It can certainly help you understand where the baby is in maturity,” he said, which could aid doctors in gauging when to deliver babies of women who go into unexpected early labor.

In the study, published Thursday in the journal Science, the team, which was co-led by Dr. Mads Melbye, who runs the Statens Serum Institute in Denmark, analyzed the blood of 31 Danish women taken every week throughout their pregnancies, which were all full-term. The researchers studied genes linked to the placenta, the maternal immune system and the fetal liver, and found nine of those genes produce RNA signals that change distinctly as pregnancy progresses.

“RNA is what’s happening in the cells at any given moment,” said Dr. Quake, who is also co-president of the Chan Zuckerberg Biohub, which funded the study, along with the Bill and Melinda Gates Foundation and others. “We had this idea that we could make a molecular clock to see how these things change over time and it should allow you to measure gestational age and see where things are in pregnancy.”

by Pam Belluck, New York Times, June 7, 2018

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