October 2016
 << < > >>


Who's Online?

Member: 0
Visitor: 1

rss Syndication

17 Sep 2016 
EXETER, N.H. Tiny New Hampshire has just four votes in the electoral college, but Tim Kaine was back here for his third visit in five weeks. At back-to-back campaign appearances, Hillary Clintons running mate offered a blunt reason for why.

This race is close, the senator from Virginia said at a rally Thursday in this picturesque New England town. I would rather be us right now than them. I think we have a more straightforward path to win and they have a more complicated path. But [there is] nothing to take for granted because, lets be honest, its been a season of surprises.

To many Democrats, the biggest surprise is that Donald Trump has mounted a comeback. Despite being battered all summer by his own missteps as well as a barrage of attack ads from Clinton, the Republican nominee has been surging in the battleground states.

Public polls over the past week show Trump leading Clinton in Ohio, Florida and Iowa; moving into a virtual tie with her in Nevada and North Carolina; and cutting into what had been comfortable Clinton leads in New Hampshire as well as Colorado, Michigan, Pennsylvania and Virginia.

Clintons return to the campaign trail after her highly publicized bout with pneumonia came at what has turned out to be the low point for her of the general election. She is laboring to regain solid footing before the first of three debates, on Sept. 26.

Sen. Tim Kaine (Va.), the Democratic vice-presidential nominee, holds up two books to show what he says is the difference between Hillary Clintons and Donald Trumps visions of America, during a campaign stop in Portsmouth, N.H. (Jim Cole/Associated Press)

Clinton said she believes Trump has helped her in recent days by reopening painful wounds with a discussion of his long-held birther conspiracy. After five years of peddling lies and innuendo about the circumstances of President Obamas birth, Trump on Friday bowed to the facts and acknowledged for the first time that Obama was born in the United States, though he refused to apologize for his efforts to delegitimize the nations first black president.

[The Take: The birther issue will always be part of Trumps history]

It is too early to know whether the episode will be a turning point that reverses gains for him in many of the battleground states. Clinton has fundamental advantages in an electoral map that is tilted generally in favor of Democrats because of changing demographics, giving her more mathematical permutations than Trump to win.

State by state, Clintons advisers have a sober assessment of where the race stands. But, they say, if they can turn out their votes especially among young people, a critical Democratic constituency that has registered soft support for Clinton they have ample ways to block Trump from winning the necessary 270 electoral votes despite clear deterioration in several states.

We expected this to tighten. We expect it to tighten even further, Clinton campaign manager Robby Mook said. Thats why we built a robust campaign in all 50 states, but especially in the battleground states. Its going to come down to small margins. ... Were spending a lot of time making sure of our vote.

For the first time since Trump secured his partys nomination in May, there is genuine confidence among Republicans that he could win. Trump campaign manager Kellyanne Conway said, We own both the momentum and enthusiasm dynamics right now.

Everybody loves a winner, so people now see these polls tightening where were up, tied or within the margin of error in nearly all of the swing states, Conway said. People are starting to see that Trump can actually pull this off.

Strategists for Clinton and her top allied super PAC, Priorities USA, are intently analyzing the polling shift to understand the forces propelling Trump.

Nowhere have Trumps gains been more consistent than in Ohio, a swing state that Obama carried twice and where the Clinton campaign has been vastly outworking Trumps on the ground and outspending it on the airwaves. In the RealClearPolitics average of recent Ohio polls, Trump leads Clinton 42.5percent to 40.8percent in matchups that include both third-party nominees, Gary Johnson of the Libertarian Party and Jill Stein of the Green Party.

Geoff Garin, the Priorities USA pollster, said Trumps surge in Ohio and elsewhere is largely due to his consolidation of Republican and Republican-leaning independent voters. He said that at the moment, at least, these voters the Mitt Romney coalition in 2012 see Trump as an acceptable alternative to Clinton following several weeks of relatively disciplined campaigning by Trump.

The phenomenon we are seeing right now primarily is just Donald Trump being normalized among Republican voters, Garin said. But, he cautioned, it doesnt get him beyond the 2012 map in any form or fashion.

Stuart Stevens, who was Romneys chief strategist and is not backing Trump, agreed: I dont think the structure of the race has changed. The structure favors any Democrat, and it particularly favors Clinton over Trump because Trump doesnt have a campaign.

[Megalomaniac Trump vs. deceitful Clinton: How a group of Virginia voters see the presidential race]

At Clintons New York headquarters, her aides attribute much of the movement to which candidate is under fire and which one is out of the headlines. They have seen erosion in her support among white voters during difficult weeks, though they argue that those voters have shifted to the undecided column rather than moving all the way to supporting Trump.

The Clinton campaign is pessimistic about both Ohio and Iowa, which Obama also won twice. Public polls show Trump ahead in both and comfortably so in Iowa, an overwhelmingly white state and one of the only battleground states in which the Republican establishment has fully embraced Trump. A Monmouth University survey this week showed Trump ahead of Clinton there, 45percent to 37percent, with Johnson running in third, at 8percent.

Florida, another state Obama twice carried, remains extremely competitive, according to public and private polls, and probably will be until the end. Clinton advisers, however, note that they can lose all three of those states and still win the presidency.

Their position is strengthened, they argue, by what they say are strong standings in Virginia and Colorado because of the demographics there, though some public polls show a tightening race in the latter.

Clinton advisers are zeroing in on North Carolina as a potential back-breaker for Trump. In 2012, it was the only major swing state that Romney had won, but it is by no means a sure thing for Trump. The RealClearPolitics average of polls there has Clinton hanging to a razor-tight lead, 42.8 percent to Trumps 42.2 percent, with Johnson at 7.2 percent.

Joel Benenson, Clintons chief strategist and pollster, called North Carolina a roadblock state. If we win North Carolina, along with Virginia, where we are in very good shape, we choke off so many paths to 270 that hes threading a needle that has a smaller eye than any previous Republican candidate.

Trump has demonstrated growing support across much of the Midwest, and Clintons team is closely watching Pennsylvania and Michigan, two states Republicans havent won in six straight elections. Clintons campaign has invested heavily in its ground organization in both states. A campaign official said that if Michigan became truly competitive, that would create complications in their electoral college calculations.

New Hampshires four electoral votes and Nevadas six votes might seem trivial at first glance, but both campaigns recognize that if the election ends up in a photo finish, either or both of those states could play decisive roles.

[Clintons impulse to power through illness set off a cascade of problems]

Hours after Kaines appearances here Thursday, Trump punctuated the attention New Hampshire is getting with an evening rally at the middle school in Laconia.

An overall worry for Clinton is the apparent lack of enthusiasm among millennials; polls show her underperforming compared with Obamas results among younger voters. Clinton advisers say that young people are allergic to Trump, as one put it, but not fully sold on Clinton. The campaigns fear is that young voters either stay home in November or decide to cast ballots for one of the third-party candidates. We need to get them feeling better about her, one official said.

Benenson said of voters ages 18 to 34, We are going to continue to galvanize them, organize them and get them out to the polls in November.

To that end, Kaine visited a hip art cafe Thursday in Portsmouth, N.H., where he spotlighted issues for young professionals. He seized on Trumps new child-care policy requiring six weeks of paid maternity leave for mothers, but no benefits for fathers, as a way of stamping Trump as a candidate from an older era whose idea does not take into account todays generation of families.

Two liberal Clinton supporters popular with millennials Sens. Bernie Sanders (Vt.) and Elizabeth Warren (Mass.) are fanning out to college campuses across Ohio this weekend on Clintons behalf.

Coming out of the two July conventions, Clinton registered solid and in some cases double-digit leads nationally and in the swing states. The conventional wisdom focused not on whether Clinton would beat Trump but on how big her landslide might be.

Clintons aides said one of their biggest concerns then was complacency that her supporters, believing Clintons win to be in the bag, would do little to volunteer in the fall or, worse, stay home on Election Day. For a campaign without much to celebrate in the polls, the new atmosphere at least is a welcome antidote.

Im not a big landslide guy, Kaine told the Exeter crowd. Hillarys attitude is, Im an underdog until Im the winner.

Admin · 4 views · Leave a comment
23 Jun 2016 
Story highlightsClinton has a formidable cavalry hitting Trump fast, hard and oftenTrump, meanwhile, is largely the star of his campaignHillary Clinton and her allies aren't making those mistakes.The presumptive Democratic nominee and her formidable cavalry including President Barack Obama, Elizabeth Warren and Joe Biden are hitting Trump fast, hard and often. And they aren't making jokes about his hands. Instead, they are questioning his temperament, his business acumen and his fundamental values as an American in a nonstop bid to make him unpalatable to voters.The effort was on full display Tuesday when Clinton delivered stinging rebukes of Trump's business competence, which is at the heart of his public persona."A few days ago, he said, 'I'm going to do for the country what I did for my business,'" Clinton said during her speech in the crucial battleground state of Ohio. "So let's take a look at what he has done. He's written a lot of books about business -- they all seem to end at Chapter 11."Clinton casts Trump as dangerous on the economyTrump sought to rebut Clinton and get back on offense Wednesday during a major speech in New York. It's an approach many Republicans have long sought and focused on issues including human rights, trade, and immigration.Clinton is "a world-class liar," Trump said. "Just look at her pathetic email and server statements ... or her phony landing in Bosnia, where she said she was under attack but the attack turned out to be young girls handing her flowers."New definitionStill, the first skirmishes of the general election reveal the organizational, messaging and fundraising flair of the Clinton campaign, and are allowing a candidate who has sometimes struggled to frame a coherent message for her campaign to find new definition with her attacks on Trump.Trump: 'We don't know anything about Hillary in terms of religion'Trump has often exacerbated the challenge as he's stumbled from crisis to crisis in recent weeks, ensuring much of the media coverage has focused on self-inflicted drama rather than his campaign or Clinton's weaknesses."It is like the Trump campaign went on vacation for the past 48 days," said Ford O'Connell, a Republican political strategist who is not affiliated with Trump's campaign. In one sign of the organizational gap between the two campaigns, the Clinton campaign says it has put in place 50 state directors who will stay through the election -- while Trump struggles to stand up a much more limited campaign infrastructure.One reason Trump may be finding the general election season tougher is that -- unlike Clinton -- he doesn't have a roster of supporters with the political stature to seize the media oxygen. In the Trump campaign, the candidate is the star.Nightcap: The latest news and political buzz from CNN Politics | Sign upBut on the Democratic side, Clinton has powerful allies. Obama grabbed at a chance to excoriate Trump over his response to the Orlando terror attack, portraying him as un-American and upbraiding him for "loose talk and sloppiness."Clinton's own subsequent critique of Trump's hawkish reaction to the gun rampage at an LGBT nightclub was clearly coordinated with the White House. Biden followed up in a speech saying Trump would lead America in the world with the "insecurity of a bully."Trump's chief tormentorAnother top surrogate and potential vice presidential pick, Warren, has emerged as Trump's chief Democratic tormentor on Twitter, and sent out her first fundraising email on behalf of Clinton Tuesday.Trump doesn't have that kind of political heavy artillery. His delicate relationship with top Republicans and his own missteps mean few top GOP leaders will go on television to defend him.Clinton closing in on running mate searchThe early weeks of the general election have come as a relief for many Democratic insiders, who chafed at Clinton's failure to build enthusiasm during her primary race and her often ponderous campaign skills.The most significant morale boost came in the form of Clinton's rollicking takedown earlier this month of Trump as a potential commander-in-chief.Clinton speaks every day and it's rare for all her staffers in Brooklyn to watch her remarks. That wasn't the case when she spoke in San Diego. Aides and staffers in Brooklyn all watched the speech live, in a sign of how significant it was to her campaign.The 2016 Electoral Map: Plot Clinton's path to the nomination"I think Hillary's speech in San Diego set the tone for the general election. It was experience versus ineptitude and the fact that he has still been unable to respond to that speech speaks volumes," said Bakari Sellers, a former South Carolina state lawmaker, Clinton supporter and CNN commentator.Clinton campaign hands are relieved the primary campaign against Vermont Sen. Bernie Sanders is over, as it pitted them against friends and a candidate with whom they often agreed.Then there is the mood of the Democratic candidate herself.In her gleeful filleting of Trump's character, the former secretary of state seems to have found her voice as never before during this campaign. "Just as he shouldn't have his finger on the button, he shouldn't have his hands on our economy," Clinton said Tuesday, in an economic speech modeled on the San Diego appearance.Her attack boasted the clarity that her own sometimes murky campaign narrative has often lacked.Though the Clinton campaign is encouraged by how well the general election is going so far, no one is ready to celebrate."You don't know if Donald Trump is really this inept or if he is crazy like a fox. He is very dangerous. You don't know what you are dealing with and I think the Clinton campaign is betting on dangerous," said Sellers.O'Connell, the Republican consultant, said Trump could still revive his campaign and cause serious problems for Clinton, provided he focused on just two goals: showing how "he is going to make the lives of average Americans better and why Hillary Clinton is unfit to be President."Democrats would be wise not to be too sanguine. A CNN/ORC national poll Tuesday showed their candidate only five points up nationally on Trump despite his travails. And Quinnipiac University polls had them tied in swing states Pennsylvania and Ohio, though the presumptive Democratic nominee had an eight-point lead in Florida.And if the firing Monday of Trump's controversial campaign manager Corey Lewandowski signals a more professional Trump operation, Clinton's fun could quickly fade. The former reality star's tirades against a judge sitting in a case targeting Trump University and his expansion of his plan for a temporary ban on Muslim immigration did more than anger Republican Party chieftains. The controversies overshadowed news coverage of Clinton's own liabilities and hampered Trump's efforts to make a case against her especially after a highly critical State Department Inspector General's report found she had broken regulations by setting up a private email server as secretary of state.'Horrible few weeks'And he is shrugging off his rough patch, blaming it on "a horrible few weeks I've had with the press," on NBC's "Today" show Tuesday.But it will be harder to dismiss the the gulf between Clinton and Trump effort in a crucial area of the electoral battleground organization and fundraising. Stunning filings with the Federal Election Commission Monday found that Clinton had $42 million on hand while Trump had barely more than $1 million at the end of May. Clinton burying Trump: $42 million to $1.3 millionClinton employs 684 paid staffers, according to her FEC report. Trump has just 30 paid staffers, according to some reports. Clinton's campaign and the DNC have more paid staffers in Ohio and Pennsylvania -- two states Trump has to have in November -- than he has in his entire organization.The fundraising data in particular sent shockwaves through the political world and raised serious doubts about the credibility of Trump campaign. Arizona Republican Sen. Jeff Flake, a Trump critic, said the numbers were "another signal it's not a serious campaign."Trump allies, however, insist their candidate will quickly stand up an effective operation and question whether his money deficit will matter."It is lunacy to think this campaign is going to turn on money," said Barry Bennett, a senior Trump adviser on CNN on Tuesday. "We have got two of the most well-known people in the world running against each other from diabolically different policy platforms." CNN's Dana Bash and Deirdre Walsh contributed to this story
Admin · 10 views · Leave a comment
05 Apr 2016 
A Republican Alabama lawmaker said Tuesday that he is filing an impeachment resolution against GOP Gov. Robert Bentley in the wake of a scandal involving one of the governor's top aides, who has since resigned. (AP)

Update: On Tuesday, Alabama lawmakers took the first steps to try to impeach Bentley."We're looking at this governor who has essentially betrayed the trust of the people of Alabama," state Rep. Ed Henry told NBC News. "This is about the actions and lies that have caused us some doubts about his leadership."

Henry added: "If he truly loves the people of this state, he will step down."

It'd require a remarkable amount of unity among the Republican legislature to be successful, and Bentley, who maintains he's done nothing illegal, has vowed to fight the charges.

There are no grounds for impeachment, & I will vigorously defend myself & administration from this political attack.

Gov. Robert Bentley (@GovernorBentley) April 5, 2016

Todays press conference is nothing more than political grandstanding intended to grab headlines and take the focus away from impt. issues.

Gov. Robert Bentley (@GovernorBentley) April 5, 2016

For five years, I have faithfully served the people of Alabama. There is a lot of work to do before I end my term in office in 2019.

Gov. Robert Bentley (@GovernorBentley) April 5, 2016

I have laid out a strategic plan for success, and I will continue to focus my efforts on making Alabama a great state.

Gov. Robert Bentley (@GovernorBentley) April 5, 2016

But as we reported earlier Tuesday, Bentley hasn't admitted to much of anything -- even as he has kind-of-apologized.

On Monday, Alabama Gov. Robert Bentley (R) made what appearedlike a typical apology for a politician admitting to a sex scandal. At an unrelated public appearance, he asked for forgiveness from God, from those he hurt and from Alabama residents for his transgressions.


"I've asked God to forgive me because that's the most important thing. I want back in His fellowship. And so I asked God to forgive me. But I asked other people to again forgive me and I've already done that and I have truly asked the people of this state they're the folks who love me and are the best people in the world I have asked them to forgive me."

But wait a minute. Forgive him for what? Bentley hasn't ever admitted to the affair he has been accused of. He has denied having inappropriate physical contact with his now-former chief political adviser, even as state officials formally file an ethics complaint to see whether he used public money and personnel to carry out the alleged affair.

Most reasonable Alabama residents following this scandal (and many in the state are) would probably sum up their governor's weird apology this way: He'sasking them for forgiveness for something everyone is pretty darn sure happened but he won't say happened. It's almost like he's speaking in code to his own state.

That kind of verbal gymnastics is a big problem for Bentley. If he's truly adamant about finishing his term as governor,dancing around the issue of whether he had an affair is not helpinghim earn back the trust of the people he has supposedly apologized to.

We get that when their backs are against the wall, politicians are particularly flexible with the facts and their word choices. (Remember: "I did not have sexual relations with that woman?") But since this whole thing broke open two weeks ago, Bentley has defied credulity even more than usual with his explanations for what exactlyhappened.

[An inside look at how Gov. Robert Bentley's sex scandal broke wide open]

The only thing Bentley has admitted to in this whole, soap opera-like saga has been having a very graphic phone conversation with someone with the same first name as his chief adviser, Rebekah Caldwell Mason. And it's fair to wonder whether Bentley would have ever admitted that had the actual tape not been out in the world for all to hear and cringe at.

Bentley hasn't exactly addressed head-on his professions of love and lust for the person on the other end of that phone call, either. Here's what he said at a press conference the day after his former friend and fired top law enforcement official went to the media with audio "proof" Bentley had carried out an affair with Mason:

When a reporter asked if the governor was in love with the adviser hes rumored to have had an affair with, Bentley said this:

I love many members of my staff, in fact, all the members of my staff. Do I love some more than others, absolutely.

Another cringe.

It reminds us of one of Washington's more lurid sex scandals. In 2007,Sen. David Vitter (R-La.) whose phone number showed up in a prostitution ring, only apologized for "a very serious sin" in his past. He said he'd keep the matter between God and his family and never clarified what that sinactually was.

In his public appearances since, Bentley hasn't clarified much more either. He said that whatever happened had happened "years ago" -- the implication beinghe's over it, so why aren't Alabamans?

(On Monday, Bentley gave a nodtothattimeline, saying: "I personally have addressed this issue. I addressed this tape that came out that was recorded three years ago. I addressed that. I have addressed the issues related to that. Those issues have been taken care of long ago. But it has just been made public just recently and I have to address them again.")

[How Gov. Bentley 'lost his mind']

Even the way the governor asked for forgiveness was perplexing; Bentley framed the whole thing in the past tense, like he had the necessaryconversations with God and with the Alabama people awhile ago, and they "had" forgiven him.

But for the people of Alabama to be able to forgive him and move on like Bentley apparently thinks they have, they firstwill probably want to know what they're forgiving him for.

Admin · 98 views · Leave a comment
24 Jan 2016 
Facilities Maintenance Companies will help you. Working with HVAC may be hard to start with, but in the end it's easy if you have the right kind of information. This article was put together to help people that want to learn about this kind of a thing. Keep reading if this is interesting to you.

When purchasing a new HVAC system for your home, be sure it is energy efficient. These days, most new HVAC systems are energy efficient there is a energy star label on the equipment. However, to be sure your utility costs do not go through the roof, choose equipment that is energy efficient.

An HVAC system is a really expensive investment. This is why you should do some browsing before purchasing your system. Try to find a good sale so you can get your system at a discount. Before making a decision, check out a couple of sites. A great site to begin is

One of the most important things to consider when purchasing a new heating and cooling system is the manufacturer's warranty. Units come with a variety of warranties. Choose one with a long warranty for maximum long term savings. Generally, it is advised that homeowners should purchase the extended warranty if one is offered.

Before having someone install a new HVAC system or maintain or repair yours, make sure they are insured. If anything happens while they are working at your home, they are financially covered and you will not be responsible, having someone who is insured work on your system will assure that.

The energy efficiency of a unit should be taken into consideration when purchasing a new cooling and heating system. Although you should be concerned about the price of a unit, the efficiency of the unit will save you thousands over the lifetime of the heating and cooling system and should weigh heavily on your buying decision.

In the winter, wearing layers can save you a ton of money on your utility bill. If you can install a digital thermostat that makes the house cooler when you're asleep and warmer just before you get up, you can see significant savings on your next bill when it arrives.

Make sure that the HVAC contractor you plan to hire does not use subcontractors to do their work. Many people use this as an excuse to shirk their responsibility in the event that something goes wrong when your system is being worked on. Only allow this if there is a note in the contract about what will happen if there is an issue.

To run an efficient HVAC, you must ensure your house is fully insulated. First, if you have the right kind of insulation and enough of it, check into your attic to find out. Investing in getting that up to grade is better than installing a strong HVAC system if not!

Preferably twice, per year, though you should have your HVAC system inspected at least once. This visit will include a motor inspection and checking the freon. This will keep you energy comfortable and efficient.

Change your air conditioner filter quarterly. Alternatively, four times a year. This not only keeps the air coming into your home easier and cleaner to breathe, it takes a lot of stress off of your AC unit itself. You get to enjoy health, money savings and reduced energy use altogether at once.

While price should be one of the considerations you make when you are hiring an HVAC contractor, do not allow it to cloud your judgement. In order to make a sound decision, there are other factors that need to be considered. Experience level, work ethic and positive reviews are a few things that should be considered as well.

Installing a whole-house fan can either cool your home without the use of air conditioning or make your air conditioner more efficient. It blows out all of the hot air which collects in your attic, and this air flow draws in cool air from your basement and up into your home.

There are sizing calculators available to determine the proper sized system for your home. It won't be cost effective to run if you purchase something that is too big. Look at the manual to figure out the manufacturing rates the unit for accurate cooling information.

If you feel like you are spending too much money on your heating and cooling, there is a simple way to reduce this cost. Raise or lower the temperature depending on the season. A single degree in temperature change can equate to almost a nine percent savings in cooling and heating costs.

Also how well the system is still running, though when you have a short list of contractors to consider, ask the people on their reference list about not only the service they received. Did they need more work down the road? Has the company come back to make things right?

Consider which direction the air flows out of your air conditioner when you decide where to place it. Make sure you have plenty of air flow control options if you are forced to install the unit in a corner.

While it is common practice to negotiate a rate quoted by a contractor, you should not offer an amount that the contractor will find offensive. They have to pay for things like insurance and overhead costs. Keep this in mind when you are trying to haggle with them for a better rate.

It is important that any contractor you hire is familiar with your make and model of HVAC unit. Ask them what brands they work with most frequently and compare it to what you have. Instead consider who has the best reputation if you can't find a contractor that knows your brand well.

Once a year the biggest step to preventing problems in your air conditioner is getting a professional tune-up. Before the summer, this is especially important. This is when your air conditioning system will be working its hardest. Getting regular tune-ups reduces the risk of malfunctions and will keep you cool all summer long.

Using the preceding tips will help you ensure smooth operation of your HVAC system. Getting to your home and noticing that there isn't air going out of your vents doesn't feel good. Then thinking about repair costs makes it even worse. You can prevent all of this because you now have great information that this article gave to you. Keep these tips in mind as you perform regular maintenance on your HVAC system.

facility maintenance

Admin · 169008 views · Leave a comment
01 Dec 2015 
(Reuters Health) - The odds of getting HIV can be dramatically reduced by taking two pills prior to sex and two more after, according to a new study of 400 high-risk gay men and transgendered women published online by the New England Journal of Medicine in conjunction with World AIDS Day.

The medication is Gilead's Truvada, a combination of tenofovir and emtricitabine, approved by the U.S. Food and Drug Administration in 2012 to prevent HIV infections and intended to be given daily.

The study suggests that may not be necessary, and the pills can be taken as needed.

"This is a great study that shows a high level of protection, higher than we've seen before," Dr. Nicholas Van Sickels, an infectious disease specialist at Tulane University in New Orleans, told Reuters Health in a telephone interview. "It's the first big published study to offer an alternative" to daily therapy, said Dr. Van Sickels, who was not connected with the research.

As-needed treatment "was nearly close to full protection," chief author Jean-Michel Molina of Hopital Saint-Louis in Paris told Reuters Health by phone. "We could say it offers similar protection to a condom, although a condom protects against other sexually-transmitted diseases as well."

However, the study, which used placebo pills for comparison, did not directly compare protection rates to people who took Truvada daily. Gilead helped finance the test.

Past research had suggested that once-a-day therapy worked no more than 42% of the time because people weren't taking their pills, said Molina. "Our assumption was that using on-demand treatment would be a way to improve adherence. They would take the drugs when they needed it, before and after sexual exposure."

"If you were to take the drug on demand it would potentially reduce the cost," which in the U.S. is about $1,000 to $1,200 a month, said Van Sickels. "It would also potentially reduce the toxicity. It can have effects on the kidneys and the bones. If youre taking less, that may be less of a problem."

Dr. Aaron Tobian of Johns Hopkins University School of Medicine, who was also not involved in the study, cautioned that the results might be different in real-world settings, telling Reuters Health in an email that it will be important to see if such therapy "is effective for preventing HIV infection among individuals not participating in a clinical trial."

In the new study, the volunteers from France and Canada were instructed to take two pills with food two to 24 hours before sex, followed by a third pill 24 hours later and a fourth 24 hours after that. If the sexual encounters continued, they were told to take their pills once a day until two days after the sex ended.

All were given condoms and counseling to further reduce their infection risk.

Since the study began in 2012, the researchers reported, Truvada reduced the infection rate by 86%. But that reflects the prevention of just 12 cases. The number is small, in part, because the rules were altered in mid-study to allow all volunteers to take the drug. The reason: preliminary results, along with the findings from other research, made it clear that it would be unethical to deny the medicine to people at risk for infection.

While 14 of the 201 people taking placebo pills became infected with HIV, there were only two infections among the 199 in the Truvada group. And those two men in the Truvada group never took the drug, so the success rate could be considered even higher, Dr. Molina said.

The volunteers were typically followed for just over 9 months. The study will continue to June, he said.

Volunteers taking the drug reported nearly three times as many gastrointestinal problems such as nausea, diarrhea, vomiting and abdominal pain as placebo recipients. They were also more likely to develop signs of kidney problems.

The study, known as IPERGAY, did not find that the drug affected volunteers risk of acquiring other types of sexually transmitted infections: 81 of the 400 picked up chlamydia, 88 developed gonorrhea, 39 acquired syphilis and five got hepatitis C.

The short duration of the study may have elevated the estimated protection rate "due in part to high initial adherence," the researchers cautioned.

Because the study was unable to assess the long-term toxicity of the drug, "ultimately safety concerns will have to be balanced against potential benefits from HIV-1 prevention," they said.

"We now have a choice of daily or on-demand, and to offer more choice is great" for gay men, Molina said.

"People are telling us they are more relaxed when they have sex," said Molina. "They are less concerned that they will get HIV."

But he cautioned that the results may not apply to heterosexual men or women.

About 1.2 million people in the U.S. are infected with HIV, 20% more than a decade ago. More than two thirds of the new cases involve men who have sex with men. Over 2 million people acquire the infection worldwide each year.

SOURCE: The New England Journal of Medicine, online December 1, 2015.

Admin · 42 views · Leave a comment

1, 2  Next page