Kaisernetwork.org (Washington, DC)
28 October 2008
Across The Nation
Philadelphia Inquirer Examines HIV/AIDS in Philadelphia
[Oct 28, 2008]
The Philadelphia Inquirer on Tuesday examined how estimates indicate that new HIV infections in Philadelphia are occurring at a rate more than five times the national average. According to the Inquirer, the estimates, which are based on CDC data released in August, are part of a broader government strategy to slow the spread of the virus.
According to the Inquirer, approximately 1,400 Philadelphians contract HIV each year, and those who are not aware of their HIV-positive status are believed to be responsible for transmitting the majority of new infections. There currently are more than 16,000 people living with HIV/AIDS in the city. More than half of new cases in Philadelphia are transmitted through heterosexual contact, a third among men who have sex with men and 13% from injection drug use. John Cella, director of the city's AIDS Activities Coordinating Office, said that the high number of new cases is "a wake-up call that we've got to do better."
According to experts, "the local picture is of a disease that is transmitted largely by people who do not think of themselves as being at high risk and have not until recently been primary targets for prevention efforts," according to the Inquirer. For example, rates of HIV nationwide are highest in black communities, and Philadelphia has the second-highest percentage of black residents of the 10 most populous U.S. cities at 43.2%, according to the 2000 census. Consequently, the Inquirer reports that public health workers are "trying to get past cultural barriers that contribute" to high HIV/AIDS rates among minority communities with initiatives such as needle-exchange programs and efforts by the city's Department of Public Health to offer HIV testing in emergency departments, city prison intakes, homeless shelters and mobile units that travel to neighborhoods and social gatherings. According to Cella, the number of HIV tests performed in Philadelphia is expected to double by the end of 2008 from the 30,000 tests typical of previous years.
Nevertheless, research suggests that more than one-fifth of HIV-positive people are not aware of their status, and CDC believes this demographic is responsible for the majority of new cases. Cella added that although advocates in MSM communities, who primarily are white, have been educating themselves about HIV/AIDS for decades, there is "a lot of hidden homosexuality in black and Latino communities." Karam Mounzer, medical director of the Jonathan Lax Center, said, "There is no question in my mind that we are seeing a younger population of African-American kids with the virus," adding, "We are also seeing more young African-American females."
David Metzger, director of the HIV prevention research division at the University of Pennsylvania School of Medicine, said that the structure of Philadelphia and its neighborhoods also help explain the city's high rates of the virus, adding that old Northeast cities tend to have fixed boundaries while other cities periodically "annex" surrounding suburbs. Although this does not affect who contracts HIV, it could lower a city's rate, according to Metzger. In addition, neighborhood structures might cause HIV to spread faster, Metzger said, adding that in some poor black and Hispanic communities, there is a greater chance of coming in contact with HIV "even if you are not doing practices that are considered particularly risky" (Sapatkin, Philadelphia Inquirer, 10/28).
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Science & Medicine
Merck's Antiretroviral Isentress More Efficient in Suppressing HIV Among Untreated Patients
[Oct 28, 2008]
Merck's antiretroviral drug Isentress suppresses levels of HIV in previously untreated patients better than the company's antiretroviral efavirenz, according to research presented Sunday at a meeting of the American Society of Microbiology and the Infectious Diseases Society of America, Reuters reports. According to Phase III clinical trial results, Isentress -- known generically as raltegravir -- reduced HIV viral loads to undetectable levels in 86% of patients compared with 82% of patients treated with efavirenz (Fox, Reuters, 10/26).
FDA in October 2007 approved raltegravir for use by HIV-positive people who have not responded to other treatments. Raltegravir works by blocking an HIV enzyme called integrase. Integrase is one of the three enzymes necessary for HIV to replicate in the body, and integrase inhibitors stop HIV from inserting its genes into uninfected DNA (Kaiser Daily HIV/AIDS Report, 10/15/07). The agency also granted Isentress accelerated approval for use among patients who showed initial signs of resistance to existing antiretrovirals. According to Merck, up to 40% of the approximately 500,000 HIV-positive people in the U.S. receiving antiretrovirals have developed resistance to the drugs. In addition, researchers at the conference said that drug-related adverse effects were significantly fewer in patients treated with Isentress (44%) than with efavirenz (77%) (AFP/Yahoo! News, 10/26).
Robin Isaacs, executive director for infectious disease clinical research at Merck, said, "There was a desperate unmet medical need for those patients who had failed other therapies" until recent years. He added that Isentress and Pfizer's Selzentry -- also approved last year -- helped address that need, along with three other new drugs: Boehringer Ingelheim's Aptivus, and Johnson & Johnson's Prezista and Intelence. According to Isaacs, patients "have all these different options now, which they didn't before, to build new successful regimens."
According to AP/Yahoo! Finance, Pfizer at the conference also presented research from a 48-week study comparing its antiretroviral Selzentry with Bristol-Myer Squibb's antiretroviral Sustiva in a total of 417 patients also receiving GlaxoSmithKline's antiretroviral combination drug Combivir. In both groups, 68% of patients had the HIV virus reduced to undetectable levels; however, 4.2% of those who got Selzentry and 14.2% taking Sustiva stopped because of side effects (Johnson, AP/Yahoo! Finance, 10/26).
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Global Challenges
Lebanon Holds HIV/AIDS Workshop for Religious Leaders
[Oct 28, 2008]
Lebanon on Monday opened a three-day conference for religious leaders in the country to raise awareness about HIV/AIDS issues, the Daily Star reports. More than 60 participants attended the workshop, which was organized by the United Nations Development Program and the Public Health Ministry. In a statement read by UNDP Country Director Seifeldin Abbaro, UNDP Resident Representative Martha Ruedas said, "Until now, the Arab world had not addressed the issue of HIV/AIDS with enough energy because people were too scared or not sufficiently informed to discuss the disease." She added that the situation is beginning to change, according to the Daily Star.
One of the workshop's goals is to acquaint participants with the Cairo Declaration of Religious Leaders in the Arab Region in Response to HIV/AIDS, which was signed in 2004 by 80 religious leaders from 19 Arab countries. It also has been endorsed by more than 300 other leaders. The workshop also discussed the Tripoli Declaration, which was endorsed by 80 female religious leaders who said they would focus on the rights of women and children in relation to HIV/AIDS.
Mostafa Mahmoud al-Nakib -- national AIDS program manager at the health ministry who was representing Health Minister Mohammed Jawad Khalifeh -- said that attitudes in Lebanon need to shift away from the belief that HIV/AIDS affects only sex workers or others who engage in high-risk sex. "Statistics proved that this disease affects everyone," he said, adding, "It does not discriminate against age, gender, religion or nationality." Workshop participants also discussed how to prevent HIV/AIDS-related discrimination, and Ruedas and other speakers stressed that religious leaders should become involved with HIV/AIDS efforts at the grassroots level. "You can access all communities once a week, every week, across Lebanon," Ruedas said, adding, "You work on a daily basis with community-based organizations, and I respectfully tell you that it is you who are well-placed to lead." Participants also were provided with references from the Koran and the Bible to use in their HIV/AIDS work (Tabar, Daily Star, 10/28).
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