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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