Kaisernetwork.org (Washington, DC)
13 August 2008
Public Health & Education
FDA Approves Gilead's Antiretroviral Viread for Use as Hepatitis B Treatment
[Aug 13, 2008]
Gilead Sciences on Monday announced that it has received FDA approval to market its antiretroviral drug Viread as a hepatitis B treatment, the AP/International Herald Tribune reports (AP/International Herald Tribune, 8/12). According to Gilead estimates, more than 400 million people worldwide have hepatitis B, an infection that affects the liver and is prevalent in Asia. The disease is the leading cause of liver cancer, and complications associated with hepatitis B result in up to 1.2 million deaths annually.
Viread, which has been available in the U.S. as an HIV/AIDS treatment since 2001, works by blocking an enzyme necessary for hepatitis B replication in liver cells (Reuters India, 8/12). According to Gilead, FDA joins regulators in Australia, Europe, Turkey and New Zealand in allowing the company to market Viread as a treatment for hepatitis B (AP/International Herald Tribune, 8/12).
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Study To Look at Health Care System Trust Among Hispanics With HIV
[Aug 13, 2008]
Wake Forest University Baptist Medical Center in September will begin a two-year study to determine whether a lack of trust of the U.S. medical system is a factor behind a higher mortality rate among Hispanics with HIV/AIDS, the Winston-Salem Journal reports. Previous research has found that a number of factors -- including low incomes, a lack of health insurance and preventive care, and communication barriers -- affect Hispanics' health outcomes.
The new study, funded by the Foundation for AIDS Research, seeks to enroll 200 Hispanics and look at factors affecting the attitudes and opinions of the group about the health care system. Study participants either will be currently living with HIV/AIDS and receiving medical care or living with the virus without any medical care. Hispanics who do not have HIV but are at high risk for the virus based on their behavior also will be included in the study.
Hispanics represented 17%, whites 35% and blacks 45% of new HIV infections in 2006, according to data recently released by CDC. Hispanics' migration "may increase [their] risk behaviors due to factors such as loneliness, isolation, separation from partners, which can result in new partners, drug use and inadequate access to health care," Jennifer Ruth, a CDC spokesperson, said. She added, "Aggressively confronting the epidemic among Latinos is one of CDC's highest HIV prevention priorities. Prevention efforts must be designed to reach a multi-ethnic Latino population."
Scott Rhodes, the study's lead investigator and an associate professor in the Department of Social Sciences and Health Policy at the medical center, said Hispanics "generally" do not get tested for HIV "until they are very, very sick. And, once diagnosed, they don't take their medicine as prescribed, even when they have access to life-extending medicines."
Rhodes said the study will give researchers a "sense of all the variables that are affecting the trust or mistrust of medicine." He added, "From there, we can develop means to build trust and better communicate the value of medical treatment to Hispanics with HIV and preventive methods for those at risk of contracting HIV" (Craver, Winston-Salem Journal, 8/12).
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Seattle Post-Intelligencer Examines Efforts To Improve Medication Management for HIV-Positive People
[Aug 13, 2008]
The Seattle Post-Intelligencer on Monday examined efforts by some organizations and pharmacies in the city and surrounding area to improve medication management for HIV-positive people. The "dozens of pills or more" that some people living with HIV need to take daily "can seem overwhelming," the Post-Intelligencer reports, "Add homelessness, mental illness or drug addiction into the mix, and taking much-needed medication falls from the top of the priority list."
Nurses at the Bailey-Boushay House spend about 56 hours weekly separating two million pills into box sets for each of their clients. The program is operated by Virginia Mason Medical Center and serves about 200 HIV/AIDS patients through its adult day program. More than two-thirds of the clients have chemical dependencies or mental illnesses and almost one-third are homeless. Program staff use "medisets" -- long plastic strips of pills that can be individualized for patients and doses. The program does not require clients to be drug-free or sober to receive treatment, according to the Post-Intelligencer. "We don't know to what extent ongoing drug use interferes or affects the medication they take, but crack or heroin interferes with adherence," Sandy Eastwood, an HIV/AIDS-certified nurse at Bailey-Boushay, said, adding, "They're more than just an HIV-infected person or a person using crack every day, or a homeless person. These are problems no one can manage by themselves -- these folks have struggled their whole lives."
MOMS Pharmacy in Seattle provides HIV-positive people with the option of receiving its version of individualized medications in sealed packs with time-stamping information. The pharmacy also offers prefilled medicine trays, as well as specialized services such as insurance advice, counseling, educational sessions, refill reminder programs and delivery service options. In addition, Rosehedge AIDS Housing and Health Care provides weekly medication boxes for its clients. According to Jayme Sanford, interim director of clinical services at Rosehedge, such facilities see a skewed segment of the HIV-positive population. "On paper, they look good, but HIV dementia and other problems have set in, and even though newer medication has people living longer lives, most of our residents probably won't ever go and live on their own," Sanford said (Black, Seattle Post-Intelligencer, 8/11).
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Global Challenges
Food Shortages Pose Obstacles to HIV Treatment in Mozambique
[Aug 13, 2008]
Although antiretroviral medications are provided at no cost in Mozambique and access to the drugs is "relatively easy," large numbers of HIV-positive Mozambicans are dropping out of treatment programs because of a lack of food, Medecins Sans Frontieres said recently, IRIN/Plus News reports.
According to IRIN/Plus News, antiretrovirals should be taken with regular meals to allow the body to combat opportunistic infections associated with HIV/AIDS; however, some HIV-positive people lose their jobs when their health declines, which makes it difficult to afford food and continue treatment. "It's hard to know the specific reasons why people abandon treatment, but there are lots of patients with low weight and nutrition problems," Clarice Nheleti, psychologist and supervisor at MSF's psychosocial unit, said.
MSF has responded to these nutrition problems by establishing a food support program in Mozambique's capital of Maputo for HIV-positive patients who have unstable economic circumstances. Because the organization is unable to assist all people in need, MSF focuses on people who are "visibly weak, those who come from families with no possessions and those who are too feeble to work," Nheleti said. MSF provides support for six months, which is generally long enough for patients to regain their strength and return to work, IRIN/Plus News reports.
In Mozambique, 16% of the population of 21 million people is HIV-positive, and more than 300,000 people experience severe food insecurity. According to Mozambique's Department of Health, of the 88,000 adults and 6,000 children taking antiretroviral drugs by the end of 2007, only 9.7% were receiving food aid. "Talking about nutrition in Mozambique is extremely complex, because the question of lack of food does not only affect HIV-positive patients," Amos Sibambo -- an advocate from the National Network of Associations of People Living with HIV/AIDS, or Rensida -- said. Sibambo emphasized the need for the government and civil society to understand the importance of nutrition for people living with HIV and to take action to address these issues. Rensida plans to raise awareness of these topics on World Food Day, scheduled for Oct. 16, by organizing lectures by nutritionists and presentations on specific diets for people living with HIV (IRIN/Plus News, 8/11).
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Yemen Times Examines HIV/AIDS Surveillance, Discrimination Related to Disease in Country
[Aug 13, 2008]
Although Yemen -- which has recorded 2,431 HIV/AIDS cases -- is considered one of the countries with the lowest number of people living with the disease worldwide, some organizations, including the country's National AIDS Control Program, say that the numbers likely do not accurately reflect the true number of people living with HIV/AIDS in the country, the Yemen Times reports. According to the Times, unreported cases and lack of surveillance could explain the low number of cases in the country.
The World Health Organization in 2003 estimated that unreported cases could bring the number of HIV-positive people in Yemen up to 24,000. In the first half of 2008, the National AIDS Control Program discovered 108 new HIV/AIDS cases, 94 of which were reported among citizens -- a fact that challenges the country's perception that the disease mainly affects foreigners and refugees -- the Times reports.
A 2007 report by Yemen's Public Health and Population Ministry in collaboration with Marie Stopes International that asked Yemenis if they knew of anyone living with HIV/AIDS found that 15% of both rural and urban residents said they knew of at least one HIV-positive person. However, the report also revealed a negative attitude toward the disease, with more than 50% of the 1,400 respondents saying that those living with HIV/AIDS should be "separated" from the rest of society.
Misconceptions and a lack of information about HIV/AIDS -- particularly among those living in rural areas, about three-fourths of Yemen's population -- are a significant reason for the discrimination against HIV-positive people, according to a Ministry of Public Health and Population report. Misconceptions included the belief that HIV can be transmitted through shaking hands, hugging and mosquito bites, as well as sharing drinking glasses and plates. Discrimination also has been reported in hospitals, with some hospitals refusing to treat HIV/AIDS patients altogether.
The Times also profiled Khalid Mahyoob -- a former nurse at Aden's Al-Jumhury Hospital who contracted HIV from an HIV-positive patient -- and his recently established association, called Life Impulse, which works to correct misconceptions about HIV/AIDS and fight discrimination (Ishaq, Yemen Times, 8/11).
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Opinion
CDC Report on HIV/AIDS in U.S. Should Serve as 'Wake-Up Call' for Policymakers, Health Workers, Opinion Piece Says
[Aug 13, 2008]
A recent CDC report on HIV/AIDS in the U.S. -- which found that about 56,000 new HIV infections occur in the U.S. each year -- "should serve as a wake-up call from the AIDS amnesia surrounding the domestic epidemic in recent years," Susan Blumenthal, senior policy and medical adviser at the Foundation for AIDS Research, and Melissa Shive, a former research assistant at amfAR and medical student at the University of California-San Francisco, write in a Washington Times opinion piece.
According to the authors, domestic "research and prevention funding" for HIV/AIDS has been "inadequate in recent years" and often "hindered by ideology and politics." They write that the U.S. "desperately needs the same kind of leadership and commitment at home that our country has shown" with the President's Emergency Plan for AIDS Relief and other global programs, adding, "Progressive policies are urgently needed that recognize HIV/AIDS as an emergency in America as well as overseas."
The next president should "establish a domestic science-based PEPFAR that would create a national strategy to eradicate HIV/AIDS at home," the authors write. They added that such a plan should "provid[e] necessary funding to increase research; implement evidence-based prevention programs that target vulnerable groups; address issues of stigma, discrimination and poverty; and improve access to lifesaving treatments and health care to eradicate" HIV/AIDS. The authors conclude that a national plan that "mobilizes all sectors of our society" to fight HIV/AIDS "combined with continuing global investment and leadership," means that one day people might "have to turn to the history books to learn there ever was a disease called AIDS" (Blumenthal/Shive, Washington Times, 8/12).
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