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).
An abstract of the study is available online.
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Opinion
NEJM Publishes Perspective Pieces About HIV/AIDS Vaccine Research, XVII International AIDS Conference
[Aug 28, 2008]
The New England Journal of Medicine on Thursday published two perspective pieces about HIV/AIDS vaccine research and the XVII International AIDS Conference earlier this month in Mexico City. Summaries appear below.
Margaret Johnston and Anthony Fauci: Researchers remain "cautiously optimistic" that increased understanding of HIV will lead to "creative ideas about how to design an effective vaccine," Johnston, director of the Vaccine Research Program in the Division of AIDS at NIH's National Institute of Allergy and Infectious Diseases, and Fauci, director of NIAID, write. According to Johnston and Fauci, vaccines have been "among the most effective public health interventions," but an HIV vaccine has been "elusive and the quest disappointing and frustrating." They add that the "extraordinary mutability and resulting genetic diversity of HIV, which is substantially more complex than that of other human viruses, also present a formidable obstacle to immune control." Researchers "may not be able to develop an HIV vaccine that is highly effective in the classic sense of successful viral vaccines," the authors write, adding, "If we do, it will be in the face of enormous scientific challenges." To address such challenges, researchers "must turn to fundamental research to a degree that has not been required in the development of vaccines for other viral diseases," the authors write (Johnston/Fauci, NEJM, 8/28).
Robert Steinbrook: The XVII International AIDS Conference earlier this month "reflected the fact that the pandemic continues to rage" in both developing and developed countries, such as the United States, "where it is often overlooked," Steinbrook, national correspondent for NEJM, writes in a perspective piece. Steinbrook writes that the message from the conference was that societies and individuals should "implement effective and multifaceted treatment and prevention programs, advance human rights and invest in AIDS health care systems." Steinbrook notes that the incidence of HIV/AIDS infection in the U.S. is "worse than was previously known, particularly among blacks and men who have sex with men" and that at the conference, "black leaders called for the United States to develop a national AIDS strategy and a 'domestic PEPFAR' program." He adds that the "challenge is to sustain and accelerate" the progress shown at the conference before the July 2010 XVIII International AIDS Conference in Vienna (Steinbrook, NEJM, 8/28).
Kaisernetwork.org was the official webcaster of the XVII International AIDS Conference in Mexico City.
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Marginalized Populations Should Be Focus of HIV Prevention Efforts, Opinion Piece Says
[Aug 28, 2008]
Although the U.S. has "relatively abundant resources available to those living with HIV," socioeconomic gaps continue to lead to higher rates of the virus among marginalized groups in the country, Christine Jolly, president of AIDS Care Service, writes in a Winston-Salem Journal opinion piece. Jolly for the past eight years has worked for an HIV/AIDS service organization and writes that she has seen her clients "struggling daily to live simultaneously with HIV and poverty."
Following a trip earlier this month to the XVII International AIDS Conference in Mexico City, Jolly writes that the devastating toll of HIV worldwide has forced "even the most extremely conservative countries" to take "bold steps to" curb the spread of the disease. For example, Jolly writes that Iran has embraced needle-exchange programs and condom distribution to curb the spread of HIV/AIDS. Nevertheless, Jolly writes that HIV-positive people across the globe still are waging battles against discriminatory government policies, including the criminalization of homosexuality.
According to Jolly, a "common thread" throughout the conference was the acknowledgement that HIV prevalence rates are higher among marginalized populations in all countries, whether it be homosexuals, commercial sex workers, ethnic or religious minorities, and women. "To understand why marginalized populations are at higher risk of infection, you have to recognize that these groups often do not have equal access to housing, education, health care, clean drinking water or nutrition," Jolly writes, adding, "Marginalized groups also face discrimination and have less control of funding streams for health and social welfare purposes."
Although many citizens in the U.S. "enjoy rights and a quality of life much higher than do people in other nations," the fact that the country's "legal system acknowledges constitutional and civil rights, but not human rights," means there is a "void when it comes to advocating for the right to quality health care for everyone," Jolly writes, adding, "Without equal access to quality health care, the epidemic will only continue to increase in much of the world."
Although "some societies are busy playing the blame game to avoid taking on their fair share of the systematic responsibility for infections, the medical community, AIDS-service organizations and human-service agencies around the world are in the trenches trying to save lives," according to Jolly. "We will never have enough resources to defeat this epidemic if we don't have the support of our communities. Probably the single largest barrier to gaining that support is the belief that 'AIDS is not my problem,'" Jolly adds (Jolly, Winston-Salem Journal, 8/26).
Kaisernetwork.org was the official webcaster of the XVII International AIDS Conference in Mexico City.
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Recent Releases in HIV/AIDS
JAMA Publishes Article About CDC's HIV Testing Recommendations
[Aug 28, 2008]
"Opt-Out Testing for Human Immunodeficiency Virus in the United States," Journal of the American Medical Association: The study examines CDC's 2006 recommendations for HIV testing in the U.S. that call for routine testing with an "opt-out" strategy. According to the study, the recommendations have affected state laws with some states mandating signed consent and counseling, while other states have changed legislation to reduce barriers to testing. In addition, 35 national professional groups have endorsed the recommendations, and "multiple demonstration projects have shown feasibility." Although metrics to evaluate the health outcomes of CDC's recommendations for HIV testing have been defined, the "data necessary to determine the effect on early entry into care, the actual reduction in disease incidence and the unanticipated consequences are not yet available," the study says (Bartlett et al., JAMA, 8/27).
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