Kaisernetwork.org (Washington, DC)
20 November 2008
Science & Medicine
Early Treatment for HIV-Positive Infants Reduces Death Risk by 76%, Study Says
[Nov 20, 2008]
HIV-positive infants who begin receiving antiretroviral therapy immediately after being diagnosed with the virus are 76% less likely to die than HIV-positive infants who do not receive treatment until the disease has progressed, according to a study published Thursday in the New England Journal of Medicine, Reuters reports.
For the study, Avy Violari of the University of Witwatersrand in South Africa and colleagues assigned 377 HIV-positive infants to two groups. One group began antiretroviral treatment at about seven weeks of age, while the second group did not begin treatment until their CD4+ T cell counts dropped or they began showing symptoms of AIDS. Among the infants in the early treatment group, 4% died after 40 weeks of treatment, compared with 16% in the group that did not receive treatment until later (Emery, Reuters, 11/19). The study also found that early treatment reduced progression of the disease by 75%, from 26% in the late treatment group to 6% in the early treatment group (BBC News, 11/19).
The researchers halted the study early because the results were so conclusive and provided all infants in the study with antiretrovirals. In addition, the study led officials from Europe, the U.S. and the World Health Organization to recommend immediate antiretroviral treatment for HIV-positive infants.
According to Reuters, 370,000 children were newly diagnosed with HIV in 2007, and two million children worldwide are living with the virus (Reuters, 11/19).
Comments, Reaction
Violari said the findings "reinforce the view that there are no reliable predictors" on disease progression for infants younger than age one and that CD4 counts do not determine with "enough accuracy" if infants "are becoming sick." The researchers were "alarm[ed]" at how fast the disease progressed in young infants, Violari said, noting that "some infants could seem fine in the morning and get sick and die by nightfall." She added that after analyzing the study data, it "became clear that treating all infants at the earliest opportunity after diagnosis was the best course of action" (BBC News, 11/19).
Violari said that it will take a "few years" to implement early HIV testing and treatment programs for infants because testing for infants is expensive and it will be difficult to identify HIV-positive infants in developing countries (Reuters, 11/19). Mark Cotton of the Comprehensive International Program of Research on AIDS said that implementing such programs will require "both manpower and resources."
Diana Gibb of the Medical Research Council in the United Kingdom said the No. 1 priority should be preventing mother-to-child HIV transmission. "The drug regimens are no picnic for these babies and even with improved outcomes in early life, there is still no cure for AIDS," Gibb said (BBC News, 11/19).
The study is available online.
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Public Health & Education
Health Care Workers Face Increased Risk of Mortality From HIV, Other Bloodborne Diseases, Study Finds
[Nov 20, 2008]
A new CDC study published in the American Journal of Industrial Medicine has found that health care workers face an increased risk of dying from bloodborne diseases, such as HIV, and related illnesses compared with workers in other fields, Reuters reports. The study also found that male health care workers face a more than twofold risk of dying from HIV/AIDS-related causes. According to researchers Sara Luckhaupt and Geoffrey Calvert of CDC's National Institute for Occupational Safety and Health, accidental needle sticks and other workplace accidents can put health care workers at an increased risk of exposure to bloodborne diseases. Luckhaupt notes that evidence over the past 20 to 25 years shows that health care workers have been more likely to die from bloodborne diseases than workers in other fields, Reuters reports.
The study examined data from the National Occupational Mortality Surveillance system from 1984 to 2004, which included 248,550 deaths from HIV/AIDS, hepatitis B and C, liver cancer and cirrhosis. According to Reuters, the researchers in a previous study found that male health care workers were at an increased risk of HIV and hepatitis but conducted the new study to determine if deaths from these infections also were higher in the health care field.
Results pointed to a more than doubled risk of dying from HIV/AIDS-related causes for male health care workers -- as well as a nearly doubled likelihood of dying from hepatitis B -- compared with workers in other fields. Hepatitis C and cirrhosis deaths were also more likely among male health care workers. For female health care workers, hepatitis C was more frequent than in other occupations. An analysis of mortality risk based on occupation showed that male nurses faced the highest risk of HIV/AIDS and hepatitis B mortality, while female nurses were 31% less likely to die from HIV/AIDS-related causes than women outside of the health care industry, Reuters reports.
Luckhaupt said that the researchers are unable to say how much the increased risk is because of occupational or non-occupational exposure but added that it is "important to look at both." The researchers wrote, "The greatest limitation to our study was that information was not available on possible confounding factors, such as sexual risk behaviors, history of blood transfusions, intravenous drug use and alcohol use." They added that previous studies indicate that most infections among health care workers are not contracted on the job and that occupational factors could be a stand-in for other risk factors. They suggest that "interventions to decrease the risk of bloodborne pathogens among health-care workers may need to be gender-specific" in order to better understand why male health care workers show an increased risk for bloodborne disease mortality (Harding, Reuters, 11/19).
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Global Challenges
Young Travelers in Australia At Risk of HIV, Other STIs Because of Drinking Habits, Specialists Report
[Nov 20, 2008]
Young travelers in Australia who engage in binge drinking and unsafe sexual activity are contributing to increasing rates of sexually transmitted infections, including HIV, according to specialists, the Herald Sun reports (McLean, Herald Sun, 11/19). According to the Sydney Morning Herald, the rise in STIs has prompted the New South Wales' Department of Health, four Sydney councils and the NSW Backpackers Operators Association to target the group with no-cost condoms and safer-sex messages over the summer holiday period (Wallace, Sydney Morning Herald, 11/19).
Lynne Wray, acting director of the Sydney Sexual Health Centre, said the trend is consistent with recent research showing that backpackers are more likely to report drinking alcohol to excess and not using condoms, thus increasing their risk of contracting an STI. Wray said that the "number of heterosexual backpackers coming to the clinic with new" STIs "is of great concern" and that a "small proportion of these also have HIV infections that they acquired in other countries on the way to Australia." She added that the trend revealed that basic safer-sex messages have not been effective and that it "is important for people to pack condoms while traveling and remember that many countries popular with backpackers have higher rates of HIV and STIs than Australia" (Herald Sun, 11/19).
Link to this story.
Toronto Health Officials Tackle Rise in Number of HIV, STI Cases
[Nov 20, 2008]
Health officials in Toronto are attempting to address an increase in the number of reported sexually transmitted infections, including HIV, in the city, the National Post reports. STI figures through September from Toronto Public Health show that 405 HIV cases, 5,480 chlamydia cases, 1,293 gonorrhea cases and more than 200 new cases of infectious syphilis have been diagnosed.
Jane Greer -- counselor and administrator at Hassle Free Clinic, which specializes in diagnosing and treating STIs -- said, "We're just swamped, both with people seeking testing and people testing positive for things like gonorrhea, chlamydia, herpes, first [human papillomavirus] diagnosis." She added that the issues surrounding syphilis cases are "ongoing" and that she is especially alarmed by the number of syphilis cases diagnosed at the clinic, usually among HIV-positive people.
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