Kaisernetwork.org (Washington, DC)
3 October 2008
Across The Nation
CDC Releases Updated Estimates About HIV Prevalence in U.S.; Agency Says 1.1 Million People Living With Virus
[Oct 03, 2008]
CDC on Friday in its Morbidity and Mortality Weekly Report released updated estimates of HIV prevalence in the U.S., saying that 1.1 million people were living with the virus at the end of 2006, Bloomberg reports. According to the report, the increase in the number of people living with HIV/AIDS in the U.S. in part is because of more effective antiretroviral drugs that have prolonged the lives of those living with the disease. Based on 2006 data, the study supports previous findings that HIV/AIDS disproportionately affects blacks and men who have sex with men. The estimate takes into account improved methodology and CDC's recent finding that the number of annual new HIV/AIDS infections in the U.S. is 40% higher than previously suspected (Lauerman, Bloomberg, 10/2).
Richard Wolitski, acting chief of CDC's Division of HIV/AIDS Prevention, said, "These data really show the continued impact that the epidemic is having on Americans, and they really reinforce the severe toll that is experienced in multiple communities" (Dunham, Reuters, 10/2). He added that CDC expects HIV prevalence "to keep increasing over time as treatment prolongs the lives of infected people and new infections outpace deaths" (Bloomberg, 10/2).
According to the report, in 2006, 48% of prevalent cases were attributable to male-to-male sexual contact, 28% to heterosexual contact and 19% to injection use. Overall, men accounted for almost 75% of HIV prevalent cases.
In terms of demographics, blacks made up 12% of the overall U.S. population but accounted for 46% of people living with HIV/AIDS in 2006. About 35% of people living with HIV/AIDS were white, and about 18% were Hispanic. In addition, the HIV prevalence rate among black women was almost 18 times higher than the rate among white women, while the prevalence rate was six times higher among black men than among white men (Reuters, 10/2). In addition, the report also found that HIV/AIDS prevalence rate among Hispanic men was more than twice that of white men, while the prevalence rate among Hispanic women was more than four times that of white women (MMWR, 10/3).
Wolitski said, "CDC has recognized and reported data on the disproportionate impact of the disease on blacks in the U.S. since the early years of the epidemic," adding, "This disparity is not one that is new, but it's one that remains and requires a heightened level of response" (Bloomberg, 10/2).
According to CDC, one in five -- or 232,700 of the 1.1 million people living with HIV/AIDS in 2006 -- were not aware of their HIV-positive status (Reuters, 10/2). The agency has called for bolstered HIV testing to enable access to appropriate medical care and ensure those infected understand the risk of spreading HIV. However, a majority of new infections are transmitted by people who do not know they are HIV-positive, CDC said.
The study said, "Expanding the number and reach of effective HIV prevention services for at-risk populations -- including blacks, Hispanics and MSM of all races -- can contribute to reducing the disproportionate numbers of infections in these groups" (Bloomberg, 10/2).
Wolitski said that the increasing number of HIV/AIDS cases and the cost of treating them place a burden on the country's health care system. The study found that 14,000 Americans died of HIV/AIDS-related illnesses in 2006. According to the report, prevalence estimates for 2003 have been revised slightly downward based on improved methodology (Reuters, 10/2).
The study is available online.
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New York Times Examines California HIV Testing Bill
[Oct 03, 2008]
The New York Times on Thursday examined a California bill (AB 1894) that requires health care plans operating in the state to pay for routine HIV testing. The bill was signed into law on Tuesday by Gov. Arnold Schwarzenegger (R) (Cathcart, New York Times, 10/2). According to the California Office of AIDS, about 40,000 Californians are HIV-positive but are not aware of their status. CDC figures show that about 40% of the U.S. population has ever received an HIV test (Kaiser Daily HIV/AIDS Report, 10/1). The law will provide coverage for routine HIV testing for 22.19 million people, according to the California Health Benefits Review Program.
According to the Times, health care providers in California as soon as next year "will no longer have to manipulate the codes on insurance forms to goad private insurers into paying for" HIV tests. In addition, doing away with issues surrounding test costs is a "major step toward making HIV screening more prevalent and, in the process, removing the fear and stigma long attached to the test," the Times reports. The bill's author, Assembly member Paul Krekorian (D), said that HIV tests "should be as routine as a cholesterol or blood pressure test," adding, "It should be a part of basic preventative health care."
According to Krekorian, the law will bring California in line with routine testing recommendations issued by CDC in 2006. He added that it is part of a series of actions to make universal coverage for HIV testing more standard nationwide. "This legislation will set the standard throughout the nation by making HIV screening a routine part of ordinary preventive health care," he said.
Daniel Ciccarone of the University of California-San Francisco said that removing HIV test cost issues means that more physicians will offer the tests to patients. "I certainly feel a little less inhibited," he said, adding, "I do get letters from time to time from insurance providers asking what justified the use of this code." According to the Times, Ciccarone was referring to the codes physicians are required to assign procedures on insurance forms to obtain reimbursement. "I imagine a lot of doctors just shrug and swallow the cost of the testing," Ciccarone said, adding, "I try to rethink the case" and use various codes to indicate that a person is at risk of the virus (New York Times, 10/2).
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Science & Medicine
Studies Examine Ability of Antiretroviral Maraviroc To Control HIV Viral Loads
[Oct 03, 2008]
According to two studies sponsored by drugmaker Pfizer and published in the New England Journal of Medicine on Wednesday, the antiretroviral drug maraviroc, which is sold as Selzentry by Pfizer, might help control viral loads among HIV-positive people who have shown resistance to other treatments, Reuters reports.
The studies were conducted among 1,049 people in Australia, Europe and North America, and all the participants were resistant to three of the six classes of HIV/AIDS drugs that are available. At the study's 48-week mark, at least 42% of the people who took maraviroc once or twice daily with a standard HIV/AIDS drug combination therapy reported viral loads below levels that cause visible damage to the immune system, compared with 18% of the participants who received a placebo along with a standard combination therapy.
Maraviroc belongs to a new class of HIV drugs called HIV entry inhibitors, or CCR5 receptor antagonists, which are being developed to address drug resistance to available therapies. All of the study participants tested positive for the strain of the virus that uses CCR5, according to Reuters. During the study, participants also were given antiretrovirals that target the virus' ability to replicate, Reuters reports. Researchers said that maraviroc did not produce any unusual side effects in the participants. Although the drug's label currently warns against possible liver problems, Roy Gulick of the Weill Cornell Medical Center in New York who led the study said that "our study simply didn't see liver toxicity, so that's reassuring." According to Gulick, results from the study's 96-week mark are being examined and might be presented at a meeting in November (Emery, Reuters, 10/1).
The first study is available online. The second study and a related editorial also are available online.
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Global Challenges
HIV Cases Increasing Among Women, MSM in Rural China, Study Says
[Oct 03, 2008]
The number of HIV/AIDS cases among men who have sex with men has increased eightfold during the past few years in areas of China, according to a study published recently in the journal Nature, Reuters reports. The study also found that the proportion of women in their reproductive years who are HIV-positive has doubled during the past 10 years. According to researchers, this indicates that HIV/AIDS is moving from high-risk groups to the general population.
The study said that there were about 700,000 HIV/AIDS cases in China as of October 2007 -- an 8% increase compared with 2006. Researchers focused the study on China's Yunnan province, which borders Laos, Myanmar and Vietnam and has a history of opium and heroin trade. HIV/AIDS cases also have been concentrated among injection drug users in Yunnan, according to Reuters. The researchers examined 3.2 million blood samples taken between 1989 and 2006 in Yunnan.
According to the study, about 37.5% of cases in 2006 were transmitted through heterosexual contact. HIV/AIDS cases among MSM increased from 0.4% in 2005 to 3.3% in 2007, according to the study. The study showed that women now comprise 35% of HIV/AIDS cases in Yunnan, compared with 7.1% in 1996. According to the researchers, the fact that 90% of women living with HIV are of child-bearing age makes it "likely to translate into more vertical transmission from mother to child."
Cases involving IDUs decreased to 40% in 2006 from 100% in 1989. "HIV/AIDS is spreading beyond the high-risk populations, largely due to increased transmission through sexual contact," researcher Zhang Linqi, director of the AIDS Research Center in Beijing, said, adding, "It implies that HIV/AIDS is not only a disease that affects high-risk populations but the general population alike."
Zhang said that the changing demography of people living with HIV "makes treatment and vaccine development even more challenging" because there are different strains of the virus circulating in the region. He added that prevention strategies that have been proven successful should be increased (Tan, Reuters, 10/1).
Link to this story.
HIV-Positive Women in Nepal Call for Greater Assistance From Government
[Oct 03, 2008]
Nepal's HIV/AIDS policies and programs have failed to address the problems of women living with HIV/AIDS in the country, HIV-positive women with Shakti Milan Samaj -- a social organization working on behalf of women living with HIV/AIDS -- said during a press conference on Wednesday, the Rising Nepal reports. The women also called on the government to guarantee access to no-cost treatment, care, resettlement, social security and jobs, as well as a special program to help them maintain a living. They added the government "should make arrangements for free education to our children and announce legal action against all violence against us regarding it as a crime against the state."
At the press conference, the women said that although the country has received significant funding for efforts to fight HIV/AIDS, the government still does not address the issues they face. According to the Rising Nepal, women in the country are vulnerable to HIV in part because of cultural and economic factors, as well as domestic violence. Shakti Milan Samaj Chair Goma Rai said that about 55 HIV-positive women receive skill development training through the organization, and 65 children have been provided with education support (Rising Nepal, 10/1).
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Drug Access
Health Workers Cannot Refuse To Provide Treatment to HIV-Positive People, India's Supreme Court Rules
[Oct 03, 2008]
A panel of India's Supreme Court on Wednesday approved instructions from the country's Centre Party that health care workers in all government and private hospitals cannot refuse medical treatment to people living with HIV/AIDS, The Hindu reports. The Supreme Court panel -- consisting of Chief Justice K.G. Balakrishnan, as well as Justices Ashok Bhan and P. Sathasivam -- ruled that all of India's states should implement the Centre's instructions, which state that all medical professionals in both public and private sectors must treat people living with HIV/AIDS "in a professional manner, treating them always with dignity and care" and with "no discrimination of stigma whatsoever." Health workers cannot refuse medical treatment based on a person's HIV/AIDS status, and those working in the private sector "in particular are directed to immediately familiarize themselves with the National AIDS Control Organisation's comprehensive protocols and policies with regard to care and treatment," the Centre's instructions said. In addition, reports of denial of services to HIV-positive people should be considered serious and investigated, the instructions said, adding that all states should ensure that certain districts have at least one antiretroviral treatment center (The Hindu, 10/2).
According to the Economic Times, the Centre's instructions also called for "strict action" on "all irrational prescriptions" of antiretrovirals, as well as a ban on advertisements offering potential cures for HIV/AIDS because "there is no proven cure available for HIV/AIDS so far." Solicitor-General Gopal Subramanium also told the Supreme Court panel that India's primary health centers in rural states like Andhra Pradesh, Karnataka, Tamil Nadu and Kerala were "working very well." The panel disagreed and said that in some rural parts of the country, "there is no doctor available. Even in a 50-bedded hospital not a single doctor is present" (Economic Times, 10/2).
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