Kaisernetwork.org (Washington, DC)
28 August 2008
Across The Nation
HIV Spreading in New York City at About Three Times the National Rate, Study Finds
[Aug 28, 2008]
HIV is spreading in New York City at about three times the national rate, with an incidence of 72 new HIV infections per 100,000 people, compared with 23 new infections per 100,000 people nationwide, according to a study released Wednesday by the New York City Department of Health and Mental Hygiene, the New York Times reports (Chan, New York Times, 8/28).
The study's findings are based on a new HIV testing method developed by CDC that can determine when an HIV infection occurred. Previous data did not distinguish recent infections from those that occurred years earlier, according to the health department. About 100,000 New York residents are living with HIV, health officials said (Honan, Reuters, 8/27). According to the study, 4,762 New York residents contracted HIV in 2006 (New York Times, 8/28). Health officials attributed the higher rate of new HIV infections in the city to large populations of blacks, men who have sex with men and other high-risk groups (AP/Google.com, 8/27). According to the health department, it is unclear whether the number of new infections that occurred in the city in 2006 had increased or decreased over previous years because the testing method is new.
According to the study, men accounted for 76% of new HIV infections while women accounted for 25%. Blacks accounted for 46% of new infections, Hispanics for 32% and whites for 21%. Whites living in the city contracted HIV at four times the national rate, Hispanics at three times the national rate, and blacks in the city contracted the virus at almost twice the national rate. The study found that 4% of new infections were among people younger than age 20, while people ages 20 to 29 accounted for 24% of new infections. People ages 30 to 39 and those ages 40 to 49 each accounted for 29% of new infections, while people older than age 50 accounted for 15%. People younger than age 30 accounted for 28% of new infections in New York City, compared with 41% nationwide.
The primary mode of HIV transmission was sex between men, which accounted for 50% of new infections. High-risk heterosexual sex accounted for 22% of new infections, and injection drug use accounted for 8%. The mode of transmission was unknown in 18% of new cases, the study found (New York Times, 8/28).
In addition, the study found that blacks living in the city contracted HIV at three times the rate of whites and that blacks accounted for almost half of new infections (Reuters, 8/27). Of new HIV infections among MSM younger than age 30, 77% occurred in black and Hispanic men. Black and Hispanic MSM ages 30 to 50 also accounted for 59% of new infections among MSM in that age group (New York Times, 8/28).
Assistant Health Commissioner Monica Sweeney said the study's findings reinforce the need to continue promoting HIV testing and prevention throughout the city (AP/Google.com, 8/27). The department in a statement added that "even a rough gauge of HIV incidence is a valuable tool for understanding -- and combating -- the spread of HIV." The department said that by using the same testing method in future years, "researchers may be able to discern increases and decreases [in HIV incidence] over time and target prevention efforts accordingly" (New York Times, 8/28).
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Global Challenges
Uganda Facing Challenges With Its Efforts To Prevent Mother-to-Child HIV Transmission
[Aug 28, 2008]
Mother-to-child HIV transmission rates remain high in Uganda, despite services made available by the government to prevent MTCT, IRIN/PlusNews reports. Government figures estimate 20,000 children contract the virus annually, accounting for 42% of all new cases in the country, according to IRIN/PlusNews. "The large and growing unmet need for pediatric HIV/AIDS (services) demonstrates that failure of our PMTCT programs to avert parent-to-child-transmission of HIV," Keith McKenzie, country representative for UNICEF, said. Of the approximately 100,000 people with antiretroviral drug access in Uganda, 10,000 are children, according to the Ministry of Health. An additional 40,000 children are believed to be in need of treatment access, and slightly more than half of the country's 310 antiretroviral clinics provide pediatric drugs. "If we prevent HIV infection in children, then we do not need to take care of them when they are infected," Phillipa Musoke, chair of the health department's pediatric committee, said.
According to IRIN/PlusNews, most pregnant women in Uganda have access to PMTCT services but 60% to 70% of them deliver at home, making it "impossible" to administer antiretrovirals that can prevent MTCT, according to IRIN/PlusNews. In addition, awareness of available services and infant feeding options still is low, according to IRIN/PlusNews. Deogratius Mugisa of the health ministry in central Uganda's Kayunga district said, "Cultural beliefs, social stigma, ignorance and economic status influenced the mother's attitudes and preference for the different (feeding) alternatives."
Dennis Tindyebwa, technical director of the Elizabeth Glaser Pediatric AIDS Foundation, said that 98% of pregnant women in Uganda agreed to HIV testing and counseling but that only 67% returned for their results. Of those who tested HIV-positive, very few came to health centers to give birth, Tindyebwa said, adding that distances to health centers, a lack of infrastructure, and inadequate services and personnel contribute to the low return rate. He also said that male involvement in PMTCT is low and that men "deny their spouses the opportunity to participate in the program." Head of the Uganda AIDS Commission David Apuuli Kihumuro said that fewer pediatric HIV/AIDS cases would occur if rates of the disease among adults were controlled, adding, "We have a moral obligation to ensure that our children and grandchildren are born and remain free from HIV/AIDS" (IRIN/PlusNews, 8/26).
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Science & Medicine
HAART Might Increase Risk of Asthma in Young Children, Study Says
[Aug 28, 2008]
Highly active antiretroviral therapy might increase the risk of asthma among children because of the therapy's effect on the immune system and CD4+ T cell levels, according to a study recently published in the Journal of Allergy and Clinical Immunology, Reuters reports. According to Reuters, in asthma, an excess of inflammatory and immune cells are produced in the lungs. Therefore, any condition or therapy that bolsters these cells, including HAART, could have an "unwanted effect," Reuters reports.
For the study, William Shearer of Texas Children's Hospital and colleagues examined the incidence and prevalence of asthma in children born to HIV-positive women. The study included 193 children living with HIV, 113 of whom were treated with HAART and 80 of whom never had received HAART. The study also included 2,471 children who were HIV-negative. The researchers found 33.5% asthma medication use among the HAART-treated children of an average age of 13.5, compared with 11.5% among the HIV-positive children who were not treated with HAART. Asthma medication use among HAART-treated children was slightly higher than among HIV-negative children, suggesting that untreated HIV might protect against asthma, according to Reuters. Additional analysis found that it was an increase in T cell levels from HAART that increased the risk of asthma, Reuters reports.
Shearer said that because studies performed before HAART's introduction in the mid-1990s did not detect the problem, "investigators have assumed that asthma is not a complication of pediatric HIV infection." Before HAART was available, T cells levels often decreased among HIV-positive people, preventing an asthmatic reaction. "It was not until the era of HAART, which restored the (T cell) levels, that an increased incidence of asthma was noted," Shearer said. He added that until further research is conducted to verify the findings, physicians should be aware that HAART could increase the risk of asthma among children. In addition, physicians need to alert parents to the issue and provide children with asthma treatment if it occurs, Shearer said (Gale, Reuters, 8/26).
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