Medical Knowledges

U.S. To Launch Health Care Worker Training Program In Mozambique, Health Minister Announces

2011-09-21T08:10:00.048-07:00

The U.S. plans to launch a program to train health care workers in Mozambique in an effort to strengthen the country's health system and fight HIV/AIDS and malaria, Mozambican Health Minister Ivo Garrido announced Wednesday after a meeting with HHS Secretary Mike Leavitt and Mozambican President Armando Guebuza, AIM/AllAfrica reports (AIM/AllAfrica, 8/22). Leavitt and several U.S. officials are on a 10-day tour of four African countries to highlight programs funded by the President's Emergency Plan for AIDS Relief and the President's Malaria Initiative. Their first stop was South Africa, and they also plan to visit Rwanda and Tanzania (Kaiser Daily HIV/AIDS Report, 8/17).

Guebuza and Leavitt at the meeting discussed Mozambique's health infrastructure and ways to strengthen collaboration on health issues between the two countries. Garrido did not disclose further details on the training program but said priority will be given to health professionals working in rural areas in Mozambique. "We believe that we can do a lot more in this area, being the reason our discussions gravitated around issues such as training of human recourses," Garrido said.

Mozambique has a total of about 800 doctors, and there is about one doctor for every 24,000 residents, according to Garrido. This ratio is "frankly bad, when we consider that on average the developed countries have one doctor for less than 1,000 inhabitants," he said. Leavitt expressed his support for the country's efforts to fight HIV/AIDS and malaria, emphasizing that discussions held with Mozambican authorities will help both countries work together more closely. Current estimates show that Mozambique has an HIV/AIDS prevalence of 16.2%, and malaria is responsible for more than 40% of outpatient visits and 30% of deaths among people admitted to hospitals in the country (AIM/AllAfrica, 8/22).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

US Health Savings Accounts Attract Younger, Higher-Income FEHBP Members, Report Finds

2011-09-21T08:10:00.047-07:00

Federal Employees Health Benefits Program members enrolled in high-deductible health plans associated with health savings accounts on average are younger than those enrolled in traditional plans and more likely to have annual incomes of $75,000 or more, according to a Government Accountability Office report released on Thursday, CQ HealthBeat reports. According to the report, which examined data for the first year in which HSAs became available in FEHBP, the average age of members who enrolled in high-deductible plans associated with HSAs was 46, compared with 59 for all members. In addition, the report finds that, when retirees are excluded, the average ages of FEHBP members who enrolled in high-deductible plans associated with HSAs was 44, compared with 47 for all members. However, according to the report, a new health plan unrelated to HSAs that recently became available in FEHBP also attracted a higher rate of younger members. The report states, "Thus it is not clear whether younger individuals were uniquely attracted to high deductible health plans, or if younger enrollees are typical of recently introduced health plans in general." The report finds that 43% of FEHBP members who enrolled in high-deductible plans associated with HSAs had annual incomes of $75,000 or more, compared with 23% of all members. According to the report, the results indicate that high-deductible plans associated with HSAs "uniquely attract higher-income individuals with the means to pay higher deductibles and the desire to accrue tax-free savings." The report also finds:
Cost-sharing for preventive care for FEHBP members enrolled in high-deductible plans associated with HSAs was "the same or less than (for) traditional plan enrollees and always covered certain preventive care services before the deductible was met," although the same services "were not always covered before the deductible by their traditional plan counterparts";

Traditional health plans were much more likely than high-deductible plans associated with HSAs to cover prescription drugs before the deductible was met; and

Monthly premiums for high-deductible health plans associated with HSAs averaged $91 for individuals and $208 for families, compared with $99 and $243, respectively, for traditional plans.
According to the report, more data is required to determine whether FEHBP members who enrolled in high-deductible plans associated with HSAs were healthier than all members. Rep. Pete Stark (D-Calif.) said the report "verifies" that high-deductible plans associated with HSAs "are designed for healthy, wealthy people," adding, "Despite this reality, President Bush is pushing them on low-income workers -- not to provide them with better health insurance, but to meet his long-term goal of dismantling employer-provided health care" (Reichard, CQ HealthBeat, 2/2).

The report is available online. Note: You must have Adobe Acrobat Reader to view the report.

Benefits for Employers
In related news, the Wall Street Journal on Friday examined how HSAs "are generating savings on payroll taxes for companies that adopt them, and they could hasten a shift of health care costs from companies to employees." According to the Journal, HSAs might "be poised to become the 401(k)s of health care: a low-cost substitute for a once standard workplace-provided benefit." Employers receive tax benefits from HSAs, regardless of whether they "contribute a cent" to the accounts, and "the more of their own pay employees set aside each year, the bigger their employers' tax breaks" because of reduced payroll taxes, the Journal reports. According to Rebecca Miller, a tax specialist with McGladrey & Pullen, at a minimum payroll tax savings from HSAs "basically pay the administrative costs" of the accounts. Princeton University economist Uwe Reinhardt added that the payroll tax savings could provide employers with "an incentive to encourage contributions" to HSAs by employees. However, James Klein, president of the American Benefits Council, said, "In the scheme of what health care costs are, I doubt that would be a compelling reason to move to that kind of plan design" (Francis/Schultz, Wall Street Journal, 2/3).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

WHO EURO Region Ministerial Forum On TB Must Reach Out Beyond Borders Of Europe

2011-09-21T08:10:00.046-07:00

The WHO EURO region's Ministerial Forum on tuberculosis on October 22, 2007, in Berlin, must take account of the threat of TB both outside as well as inside Europe if it is to be tackled adequately. These are the conclusions of authors of a Comment published in this week's edition of The Lancet.

The Comment is authored by Dr Bruce Currey, Professor Quazi Quamruzzaman, and Professor Mahmuder Rahman, Dhaka Community Hospital, Dhaka, Bangladesh. They say that in a 21st century that is becoming more and more global, to reduce the incidence of tuberculosis within Europe, European ministers must act together and act now, not simply to control, but also to eradicate poverty and tuberculosis in the source communities of Europe's migrant workers and major trade partners outside Europe. The Ministerial Forum must confront the raging red bull of tuberculosis infections outside Europe.

It goes on to say that the Berlin forum paper emphasises the 66 000 deaths from tuberculosis inside Europe in 2005, but overlooks the 1вЂў6 million deaths outside Europe. It adds that radical reduction of the incidence of tuberculosis both inside and outside Europe requires prevention of the progression to new active cases as well as management of active cases. Eradication is possible, but not with drugs alone.

Further, it adds: "Trade and trade embargoes affect the incidence of tuberculosis. The Centres for Disease Control and Prevention has shown how radical intervention in the Hmong refugee centres of Thailand can reduce the incidence of tuberculosis and multidrug-resistant tuberculosis in the Hmong in Frenso, California."

The Comment authors propose a six-pronged approach to tackling the tuberculosis threat, including incorporating populations outside Europe, and the Forum accepting responsibility for actions such as arms trading and oil prices which increase inequality and tuberculosis incidence worldwide. The last of the six parts of the authors' suggested action calls on the Forum to get behind the UK Prime Minister's address to the UN in July 2007, to "act now" to tackle global poverty and "eradicate" the scourge of diseases such as tuberculosis, and his commitment that there are resources available to eradicate the disease.

The Comment concludes: "If the Berlin Ministerial Forum wishes to act now to eradicate tuberculosis, it must reach out far beyond the borders of Europe."

The Lancet

Uterine Infection In Pregnant Women Linked With Asthma In Preterm Infants, Study Finds

2011-09-21T08:10:00.045-07:00

A study published Tuesday in the Archives of Pediatric and Adolescent Medicine suggests that preterm infants born to women who had a uterine inflammation known as chorioamnionitis face an increased likelihood of developing asthma by age eight, USA Today reports (Rubin, USA Today, 2/2). Chorioamnionitis, a bacterial infection, affects roughly 8% of pregnancies and, by some estimates, is linked with more than 50% of preterm birth -- those before 37 weeks' gestation. Symptoms of the infection include a fever higher than 100.4 degrees, high maternal or fetal heart rate, uterine tenderness, foul-smelling amniotic fluid and elevated white blood-cell counts (Maugh, Los Angeles Times, 2/2). However, the condition can be difficult to diagnose because the symptoms are not definitive and might not occur in some women who have the infection, according to lead author Darios Getahun, a scientist at Kaiser Permanente Southern California's Department of Research and Evaluation (USA Today, 2/2).

Getahun's team reviewed electronic health records for 397,852 births in Southern California from 1991 to 2007 (Allen, Reuters, 2/1). Black children whose mothers gave birth before 37 weeks and had chorioamnionits were 50% more likely to develop asthma by age eight. The likelihood was more pronounced for Hispanic and white babies, who were 70% and 66% more likely to develop asthma, respectively. The increases persisted after researchers accounted for other asthma risk factors. The study found no link between higher asthma rates and chorioamnionitis in full-term births or preterm births among Asians or Pacific Islanders. Getahun's team is now trying to identify a marker in the woman's blood that could verify if symptoms are caused by chorioamnionitis (USA Today, 2/2).

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2010 The Advisory Board Company. All rights reserved.

Upward Trend In Frequency And Cost Of Infections In US Hospitals

2011-09-21T08:10:00.044-07:00

A new review of inpatient data from US hospitals shows that the number of infections caused by a common bacterium increased by over 7 percent each year from 1998 to 2003. The attendant economic burden to hospitals increased by nearly 12 percent annually. The research is published in the November 1 issue of Clinical Infectious Diseases, now available online.

Staphylococcus aureus (also known as staph) is a significant cause of a wide range of infectious diseases in humans, ranging from minor skin infections to life-threatening diseases such as pneumonia and meningitis. In 1998, US hospitals reported a little more than a quarter-million staph infections and slightly over 7 percent of those patients died. By the final year of this study, 2003, hospitals reported nearly 390,000 infections, representing 1 percent of that year's inpatient stays.

The authors suggest one possible reason for the increase in infections is the documented increase of a particularly dangerous type of antibiotic-resistant staph infection known as MRSA (methicillin-resistant Staphylococcus aureus). A more benign possibility is that doctors and hospitals have improved their infection detection and reporting practices.

The good news is that the staph-related in-hospital mortality rate dropped by almost 5 percent each year. The decrease in the in-hospital mortality risk may be due to the introduction of more stringent infection control programs or due to appropriate early treatment of MRSA infections with an effective antibiotic, the authors write.

Hospital expenditures associated with staph infections are substantial, increasing from $8.7 billion in 1998 to $14.5 billion in 2003. This economic burden incorporates such factors as extended length of hospitalization and additional surgery, medications, lab tests, and radiologic studies. Lead author Gary Noskin, MD, of Northwestern Memorial Hospital in Chicago, hypothesized that the reason the economic burden increased at a faster pace than the number of infections is because hospital costs are increasing more quickly.

The authors used data from the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample database, which contains data from approximately 7 million hospital stays annually.

Unfortunately, the authors were not able to determine the contribution of MRSA infections to costs or outcomes because hospitals generally use the same codes for MRSA and regular staph infections. "We do suggest that coding standards should be changed to more accurately reflect the difference between these two bacteria so we can better understand the impact of MRSA," said Dr. Noskin.

###

Founded in 1979, Clinical Infectious Diseases publishes clinical articles twice monthly in a variety of areas of infectious disease, and is one of the most highly regarded journals in this specialty. It is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Arlington, Virginia, IDSA is a professional society representing more than 8,000 physicians and scientists who specialize in infectious diseases. For more information, visit idsociety/.

Source: Steve Baragona

Infectious Diseases Society of America

Understanding how bacteria communicate may help scientists prevent disease

2011-09-21T08:10:00.043-07:00

Rahul Kulkarni, assistant professor of physics at Virginia Tech, has been awarded a Ralph E. Powe Junior Faculty
Enhancement Award from Oak Ridge Associated Universities to continue his research on quorum sensing in bacteria. He is
modeling the sequence of events that initiate activity, such as virulence, by a bacteria colony once it has reached a
critical size.

The Powe award provides seed money of $5,000 to faculty members who are in the first two years of their tenure track as an
investment in promising achievements in an important area. The institution matches the award.

Much like a legislative body, some bacteria need a quorum, the presence of a critical number of individuals, before they can
engage in particular activities. Typically these are activities that are only productive when carried out in unison by a
community of bacteria.

The example often given is bioluminescence. Scientists noticed that once a population or colony of particular bacteria
reached a certain size, the colony began to emit light. "Now many people realize that other important activities also depend
upon a quorum, such as biofilm formation, releasing toxins, or becoming a virulent invader," said Rahul Kulkarni. While
Kulkarni works with Vibrio cholerae as a model bacteria, quorum sensing appears to be a universal process in bacteria. So
what he learns about the communication process known as quorum sensing could one day help scientists prevent a broad range of
diseases caused by bacteria that are human pathogens.

How do bacteria know how many are present? Each bacterium releases a small molecule, called an autoinducer. Each bacterium
also has receptors - proteins on its cell surface -- to sense autoinducers. As the amount of autoinducer reaches a critical
level, the bacteria know they have a quorum because a change is initiated in the receptor protein, which then causes a series
of further changes within each bacterium.

Kulkarni is looking at the network of genes involved in this process. Working with a group at Princeton University and at
Virginia Tech, "we are trying to understand how changes in the environment are integrated and result in changes in behavior,"
he said.

What was not known until recently is a crucial missing link in the network in each bacterium that results in the ability to
change behavior. Just before he came to Virginia Tech in August 2004, Kulkarni and his collaborators at Princeton solved the
mystery. Using bioinformatics and modeling, Kulkarni drafted theoretical predictions for the missing regulatory element,
which were confirmed experimentally by his colleagues at Princeton.

"We showed that the crucial missing element was a group of genes called small RNAs. ("The small RNA chaperone Hfq and
multiple small RNAs control quorum sensing in Vibrio harveyi and Vibrio cholerae," by D.H. Lenz, K.C. Mok, B.N. Lilley, R.V.
Kulkarni, N.S. Wingreen, and B.L. Bassler, published in Cell, July 9, 2004). "As it turns out, quorum sensing is a hot topic
in biology, and small RNAs is another hot topic. The convergence of these topics is exciting, and it has resulted in several
additional questions," Kulkarni said.

He will address these questions in his Powe-funded research. "We are asking, what are the environmental signals, apart from
quorum sensing, that are integrated by the small RNAs to initiate changes in behavior. An example might be the amount of
nutrients in the environment. Another question is why are there multiple RNAs? The sensing and communication circuit
functions even if some of the RNAs are removed - in fact, even if there is only one small RNA. Modeling the circuit will be
crucial in understanding how it functions and integrates signals from multiple inputs," Kulkarni said.

A third question is how the circuit regulates important biological processes, such as biofilm formation and virulence.
"Biofilms make bacteria resistant to antibiotics, so preventing the formation of biofilms or short-circuiting bacteria's
ability to become virulent by disturbing their communication network so they remain harmless, is an alternative strategy to
controlling disease," he said.

Kulkarni will continue his collaboration with the Princeton University group on V. cholerae and will collaborate with
Virginia Tech Biology Professor Ann Stevens, whose group is working on V. fischeri, the bacteria that causes luminescence and
whose genome has recently been sequenced ("Complete genome sequence of Vibrio fischeri: A symbiotic bacterium with pathogenic
congeners," by E. G. Ruby, M. Urbanowski, J. Campbell, A. Dunn, M. Faini, R. Gunsalus, P. Lostroh, C. Lupp, J. McCann, D.
Millikan, A. Schaefer, E. Stabb, A. Stevens, K. Visick, C. Whistler, and E. P. Greenberg, published Feb. 22, 2005 in the
Proceedings of the National Academy of Science.).

Kulkarni received his Master of Science degree in physics from the Indian Institute of Technology in Kanpur and his Ph.D. in
physics from Ohio State University. He was a postdoctoral researcher at the University of California, Davis, and a
postdoctoral research scientist at the NEC Laboratories America Inc. in Princeton, N.J.

Contact: Susan Trulove

STrulovevt.edu

540-231-5646

Virginia Tech

vtnews.vt.edu

The rapid "feminization" of the AIDS pandemic must be confronted

2011-09-21T08:10:00.042-07:00

A Johns Hopkins physician and scientist who has spent a quarter-century leading major efforts to combat HIV and AIDS
worldwide has issued an urgent call for global strategies and resources to confront the rapid "feminization" of the AIDS
pandemic.

In an article appearing in the journal Science online June 10, Thomas C. Quinn, M.D., professor of infectious diseases at
Hopkins and a senior investigator at the National Institute of Allergy and Infectious Disease, reports that women have in the
last 20 years moved from those least affected by HIV to those in whom the disease is spreading fastest. "There has been a
shift in the AIDS pandemic, and the victims are different now," says Quinn, senior author of the Science article.

"Women make up nearly half of the 40 million people worldwide currently infected with HIV, the virus that causes AIDS, and in
some developing countries, women represent the vast majority of those living with HIV/AIDS," Quinn writes, whereas, at the
start of the pandemic in the early 1980s, men accounted for almost 90 percent of cases in developed countries. In the United
States from 1999 to 2003, the yearly increase in AIDS cases rose by 15 percent, but only by 1 percent in men.

"HIV/AIDS first targeted gay men and hemophiliacs in the early 1980s, then subsequently spread most quickly among intravenous
drug users and heterosexuals," he adds. "Now, it is having the most profound impact on women."

Internationally, Quinn and his team have led clinical trials of the first effective treatments that prevent HIV from
replicating, helped establish laboratory and treatment facilities in the Democratic Republic of the Congo, India and Uganda,
and counseled other governments across Africa and Asia about control efforts.

In the new article, he argues that women deserve a separate strategy because of the increasing and disproportionate numbers
becoming infected, and the social consequences of so many young mothers dying and leaving behind children who may also be
infected as well as orphaned. He also points out that medical research suggests hormonal and developmental factors place
young women at greater risk than men for contracting the virus when exposed to it.

In sub-Saharan Africa, 60 percent of people living with HIV are female, Quinn says, and in South Africa, Zambia and Zimbabwe,
young women ages 15 to 24 are three to six times more likely to be infected than men. Women make up half the adult population
living with the virus in the Caribbean and one-third of those in Latin America.

The reasons for the rise in female cases differ among countries, with 97 percent of female HIV infections in the United
States due to heterosexual transmission (81 percent) and intravenous drug use (16 percent). In the developing world,
heterosexual transmission is responsible for nearly all of the infections among women, and mother-to-child transmission
during childbirth further contributes to the spread of the disease. Women are particularly vulnerable to such cultural
factors as their relative lack of power in sexual relationships, widespread poverty, policies that deny women an education
and tolerance of violence against women.

Excessive biological vulnerability to HIV among young women, although not fully understood, is believed to be due to an
immature genital whose mucosal lining is easier for the virus to penetrate; to hormonal factors, such as the use of birth
control pills; and to a high incidence of sexually transmitted diseases, which inflame the female genital area and provide
additional target cells for the virus to infect.

According to Quinn, "societal changes will help over the long run, but immediate and faster action requires coordinated
efforts to focus on women, develop effective microbicides that women can use themselves and a gender-specific vaccine program
that takes into account the different immune responses between women and men."

Also needed, he says, are cultural programs for reshaping gender roles, such as educating more women about safe-sex
practices, use of condoms, lessons on negotiating safe sex, and awareness campaigns about where to seek testing and
treatment.

"Women are different when it comes to HIV infection," says Quinn. "If medical progress is to continue on how best to prevent
and treat the disease, then developing specific strategies that empower women will be key to its success."

For more information or to schedule an interview with Quinn, please contact David March at 410-955-1534, or dmarch1jhmi.edu.

Johns Hopkins Medical Institutions

hopkinsmedicine

Updated HIV Treatment Guidelines Now Include Three GSK HIV Medications For Initial Antiretroviral Treatment Regimens

2011-09-21T08:10:00.041-07:00

Updated treatment guidelines issued
today by the International AIDS Society-USA (IAS-USA) now include three
GlaxoSmithKline HIV medications as part of their recommendations for
initial antiretroviral therapy. These guidelines were presented today at
the International AIDS Conference (IAC) in Toronto, Canada.

In the guidelines, EPZICOM(TM) (abacavir sulfate and lamivudine) and
COMBIVIR(R) (lamivudine and zidovudine) are both recommended nucleoside
reverse transcriptase inhibitors, and LEXIVA(R) (fosamprenavir calcium)
boosted with ritonavir is now listed among the recommended options for
protease inhibitor-based regimens in the initial treatment of adults with
HIV infection.

Additional information in the guidelines recommends the use of EPZICOM
as an initial NRTI backbone. "Abacavir in combination with lamivudine, has
comparable antiretroviral activity with the other dual NRTI components
listed in the guidelines." The guidelines also support the use of COMBIVIR
as a first-line therapy based on the "extensive clinical trial data set and
phase 4 experience supporting use."

The IAS-USA commissions expert panels to issue recommendations and
guidelines to provide standard approaches to patient care. The updated
guidelines published in the current issue of Journal of the American
Medical Association (JAMA) stated that, "[t]he choice of initial drug
centers on acceptability; predicted tolerance; pill burden; comorbid
conditions; short- term, mid-term and long-term adverse event profiles."

The updated guidelines reflect the international perspectives of the
panelists and are designed to serve as a tool for clinicians in countries
where resources are sufficient to provide relatively unrestricted choices
of drugs.

"We are pleased to see that the guidelines committee has recognized
COMBIVIR, EPZICOM, and LEXIVA as important treatment options for patients
with HIV," said Mark Shaefer, Director, Clinical Development, HIV
Infectious Disease Medicine Development Center at GSK.

IMPORTANT INDICATION AND SAFETY INFORMATION
FOR COMBIVIR, EPZICOM, AND LEXIVA

HIV medicines do not cure HIV infection/AIDS or prevent passing HIV to
others.

COMBIVIR

COMBIVIR is a combination tablet containing Epivir(R) (lamivudine, 3TC)
and Retrovir(R) (zidovudine, AZT).

INDICATIO COMBIVIR is indicated in combination with other antiretroviral agents for the treatment of HIV infection.

IMPORTANT SAFETY INFORMATION

All HIV drugs have side effects. The most commonly reported side
effects by patients who take COMBIVIR are: headache (35%), upset stomach
(33%), fatigue (27%), and nasal signs and symptoms (20%). Patients should
see their doctor regularly because serious side effects can occur, such as
muscle damage and a decrease in red and white blood cells. A buildup of
lactic acid in the blood and an enlarged liver, including fatal cases, have
been seen.

Some patients infected with both hepatitis B virus (HBV) and HIV have
worsening of hepatitis after stopping lamivudine (a component of COMBIVIR).
Patients should discuss any change in treatment with your doctor. Patients
who have both HBV and HIV and stop treatment with COMBIVIR should be
closely monitored by a doctor for at least several months.

Worsening of liver disease (sometimes resulting in death) has occurred
in patients infected with both HIV and hepatitis C virus who are taking
anti-HIV medicines and are also being treated for hepatitis C with
interferon with or without ribavirin. If you are taking COMBIVIR as well as
interferon with or without ribavirin and you experience side effects, be
sure to tell your doctor.

When you start taking HIV medicines, your immune system may get
stronger and could begin to fight infections that have been hidden in your
body, such as pneumonia, herpes virus, or tuberculosis. If you have new
symptoms after starting your HIV medicines, be sure to tell your doctor.

Changes in body fat may occur in some patients taking antiretroviral
therapy. These changes may include an increased amount of fat in the upper
back and neck ("buffalo hump"), breast, and around the trunk. Loss of fat
from the legs, arms, and face may also occur. The cause and long-term
health effects of these conditions are not known at this time.
For complete prescribing information about COMBIVIR, visit
us.gsk/products/assets/us_combivir.pdf.

EPZICOM INDICATION

- EPZICOM, in combination with other antiretroviral agents, is indicated
for the treatment of HIV infection in adults.

- EPZICOM is one of 3 medicines containing abacavir. Before starting
EPZICOM, your healthcare professional will review your medical
history in order to avoid the use of abacavir if you have
experienced an allergic reaction to abacavir in the past.

- In one study, more patients had a severe hypersensitivity reaction
in the abacavir once-daily group than in the abacavir twice-daily
group.

- EPZICOM should not be used as part of a triple nucleoside regimen.

IMPORTANT SAFETY INFORMATION

EPZICOM contains abacavir, which is also contained in ZIAGEN(R)
(abacavir sulfate) and TRIZIVIR(R) (abacavir sulfate, lamivudine, and
zidovudine). Patients taking EPZICOM may have a serious allergic reaction
(hypersensitivity reaction) that can cause death.

If you get a symptom from 2 or more of the following groups while
taking EPZICOM, stop taking EPZICOM and call your doctor right away:

1. Fever

2. Rash

3. Nausea, vomiting, diarrhea, or abdominal (stomach area) pain

4. Generally ill feeling, extreme tiredness, or achiness

5. Shortness of breath, cough, or sore throat.

Carefully read the Warning Card that your pharmacist gives you and
carry it with you at all times.

- If you stop EPZICOM because of an allergic reaction, NEVER take EPZICOM
or any other abacavir-containing medicine (ZIAGEN, TRIZIVIR) again. If
you take EPZICOM or any other abacavir-containing medicine again after
you have had an allergic reaction, WITHIN HOURS you may get life-
threatening symptoms that may include very low blood pressure or death.

- If you stop EPZICOM for any other reason, even for a few days, and you
are not allergic to EPZICOM, talk with your healthcare professional
before taking it again. Taking EPZICOM again can cause a serious or
life-threatening reaction, even if you never had an allergic reaction
before. If your healthcare professional tells you that you can take
EPZICOM again, start taking it when you are around medical help or
people who can call a doctor if you need one.

- A buildup of lactic acid in the blood and an enlarged liver, including
fatal cases, have been reported.

- Do not take EPZICOM if your liver does not function normally.

- Some patients infected with both hepatitis B virus (HBV) and HIV have
worsening of hepatitis after stopping lamivudine (a component of
EPZICOM). Discuss any change in treatment with your doctor. If you have
both HBV and HIV and stop treatment with EPZICOM, you should be closely
monitored by your doctor for at least several months.

- Worsening of liver disease (sometimes resulting in death) has occurred
in patients infected with both HIV and hepatitis C virus who are taking
anti-HIV medicines and are also being treated for hepatitis C with
interferon with or without ribavirin. If you are taking EPZICOM as well
as interferon with or without ribavirin and you experience side effects,
be sure to tell your doctor.

- When you start taking HIV medicines, your immune system may get stronger
and could begin to fight infections that have been hidden in your body,
such as pneumonia, herpes virus, or tuberculosis. If you have new
symptoms after starting your HIV medicines, be sure to tell your doctor.

- Changes in body fat may occur in some patients taking antiretroviral
therapy. The cause and long-term health effects of these conditions are
not known at this time.

- The most common side effects seen with the drugs in EPZICOM dosed once-
daily were allergic reaction, trouble sleeping, depression, headache,
tiredness, dizziness, nausea, diarrhea, rash, fever, stomach pain,
abnormal dreams, and anxiety. Most of the side effects do not cause
people to stop taking EPZICOM.

For full prescribing information please visit treathiv

LEXIVA

LEXIVA is a protease inhibitor that was co-discovered by
GlaxoSmithKline and Vertex Pharmaceuticals Incorporated.

INDICATION

- LEXIVA is indicated in combination with other antiretroviral agents for
the treatment of HIV infection in adults.

- The PI-experienced patient study was not large enough to reach a
definitive conclusion that LEXIVA/ritonavir and lopinavir/ritonavir
are clinically equivalent.

- Once-daily administration of LEXIVA/ritonavir is not recommended for
PI-experienced patients. LEXIVA does not cure HIV or prevent passing
HIV to others.

IMPORTANT SAFETY INFORMATION

- You should not take LEXIVA if you have had an allergic reaction to
LEXIVA or AGENERASE(R) (amprenavir).

- High blood sugar, diabetes or worsening of diabetes, and bleeding in
hemophiliacs have occurred in some patients taking protease inhibitors.

- When you start taking HIV medicines, your immune system may get stronger
and could begin to fight infections that have been hidden in your body,
such as pneumonia, herpes virus, or tuberculosis. If you have new
symptoms after starting your HIV medicines, be sure to tell your doctor.

- Changes in body fat may occur in some patients taking antiretroviral
therapy. The cause and long-term health effects of these conditions are
not known at this time.

- Skin rashes can occur in patients taking LEXIVA. Rarely, rashes were
severe or life threatening.

- Opportunistic infections can develop when you have HIV and your immune
system is weak. It is very important that you see your healthcare
provider regularly while you are taking LEXIVA to discuss any side
effects or concerns.

- Most common side effects in clinical studies were diarrhea, headache,
nausea, rash, and vomiting. In most cases, these side effects did not
cause people to stop taking their medicine.

Drug Interactions

- LEXIVA should not be taken with: AGENERASE(R) (amprenavir), Halcion(R)
(triazolam), ergot medications (Cafergot(R), Migranal(R), D.H.E. 45(R),
and others), Propulsid(R) (cisapride), Versed(R) (midazolam), Orap(R)
(pimozide), Zocor(R) (simvastatin), Mevacor(R) (lovastatin), Rifadin(R)
(rifampin), Rescriptor(R) (delavirdine mesylate), or St. John's wort
(Hypericum perforatum). If you are taking Norvir(R) (ritonavir), you
should not take Tambocor(R) (flecainide), or Rythmol(R) (propafenone
hydrochloride).

- Serious and/or life-threatening events could occur between LEXIVA and
other medications, including Cordarone(R) (amiodarone), lidocaine
(intravenous only), Elavil(R) (amitriptyline HCl) and Tofranil(R)
(imipramine pamoate), tricyclic antidepressants, and Quinaglute(R)
(quinidine).

- Women who use birth control pills should choose a different kind of
contraception. LEXIVA can affect the safety and effectiveness of birth
control pills.

- Patients taking Viagra(R) (sildenafil citrate) or LEVITRA(R) (vardenafil
HCl) with LEXIVA may be at an increased risk of side effects.
- This list of drug interactions is not complete. Be sure to tell your
healthcare provider about all medicines you are taking or plan to take,
including over-the-counter drugs, vitamins, and herbals.

Resistance

- Missing or skipping doses of your medicine may make it easier for the
virus to mutate and multiply. Your medicines may not work as well
against a mutated virus and you may become cross-resistant to other HIV
medicines. It's important to take your medicine exactly as prescribed.

For full prescribing information please go to LEXIVA.

About GlaxoSmithKline

GlaxoSmithKline is one of the world's leading research-based
pharmaceutical and healthcare companies and an industry leader in HIV
research and therapies. The company is engaged in basic research programs
designed to investigate new targets to treat HIV.

GSK's Bridges to Access program can help provide qualified individuals
with access to GSK's antiretroviral medications, as well as help identify
insurance or other support for medications. Patients may be eligible for
this program if they are not eligible for prescription drug benefits
through any other private or public insurer, payer or program. In 2004,
GlaxoSmithKline donated more than $372.5 million worth of prescription
drugs to 475,000 patients. For more information, visit bridgestoaccess.gsk or call 1- 866-PATIENT.

About Vertex

Vertex Pharmaceuticals Incorporated is a global biotechnology company
committed to the discovery and development of breakthrough small molecule
drugs for serious diseases. The company's strategy is to commercialize its
products both independently and in collaboration with major pharmaceutical
companies. Vertex's product pipeline is principally focused on viral
diseases, inflammation, autoimmune diseases and cancer. Vertex
co-discovered the HIV protease inhibitor, LEXIVA, with GlaxoSmithKline.

Vertex's press releases are available at vrtx.

GlaxoSmithKline

vrtx

View drug information on Combivir; Lexiva; Trizivir.

When HIV And Liver Disease Co-Exist

2011-09-21T08:10:00.040-07:00

Since successful antiretroviral therapies have made HIV a treatable condition, more HIV patients who are also infected with hepatitis B or C are experiencing the progression of their liver disease. In the face of this novel challenge, experts in the field convened to share information and opinions on the management of such patients. The conference discussions are summarized in June issue of Hepatology, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases (AASLD) The article is also available online at Wiley Interscience (interscience.wiley/journal/hepatology).

Because of shared modes of transmission, HIV and viral hepatitis infections often coexist. Since therapies have made HIV a manageable condition, hepatologists are seeing more infected patients with complex liver issues. To address questions about care for these co-infected patients, an international forum was convened in Jackson Hole, Wyoming in September 2006. The meeting brought together laboratory and clinical researchers, drug developers and government representatives to discuss the state of the field, research needs, and collaborative possibilities. The conference topics are summarized by Kenneth Sherman, MD, PhD, of the University of Cincinnati and colleagues in the current issue of Hepatology.

An estimated 3 to 4 million people are infected with both HIV and hepatitis B (HBV) while 4 to 5 million people have HIV and chronic hepatitis C (HCV). "The natural history of coinfection, particularly for HCV/HIV in the era of highly active antiretroviral therapies is still a matter of debate, and is important as it influences intervention strategies," the authors report. However, recent studies have shown increasing rates of liver disease and related death among those with HIV.

Conference attendees discussed immune responses to hepatic disease in patients with HIV as well as how the viruses interact to result in liver injury. They also considered how treatment options, including antiretroviral agents, might affect the liver.

In treating HIV/HCV co-infected patients, studies have shown that pegylated interferon with ribavirin is better than interferon-only regimens. For patients with HIV/HBV, combination therapy is routine, though viral mutation and drug resistance remain troubling issues. A key topic of conversation was the development of new agents for treating viral hepatitis in patients with HIV. Challenges include the risk of hepatic injury and low patient tolerance which limits compliance. All agreed that new agents should be tried.

Until recently, liver transplantation was not an option for patients with HIV; however, it is now a possibility. "It is imperative not to wait until the patient is moribund," the authors report, adding that successful outcomes depend on the collaboration of surgeons, hepatologists, infectious disease specialists and pharmacologists.

"In summary, a number of areas were identified as needing further research," they conclude. "A close cooperation between clinicians and researchers is required to ensure high quality translational research."

###

Article: "HIV and Liver Disease Forum: Conference Proceedings," Sherman, Kenneth; Peters, Marion; Koziel, Margaret. Hepatology; June 2007; (DOI: 10.1002/hep.21722).

Contact: Amy Molnar

John Wiley & Sons, Inc.

System To Pinpoint Airline Passengers Who Contaminate Cabins

2011-09-21T08:10:00.039-07:00

Researchers developing a system that uses mathematical models and sensors to locate passengers releasing hazardous materials or pathogens inside airline cabins have shown that the technique can track a substance to an area the size of a single seat.

The technique might enable officials to identify passengers responsible for the unintentional release of germs, such as contagious viruses, or the intentional release of pathogens or chemical agents in a terrorist attack, said Qingyan (pronounced Chin-Yan) Chen, a professor of mechanical engineering at Purdue University.

"The goal is to be able to track the source if a person released a biological agent, such as anthrax, or inadvertently released a pathogen such as pandemic flu by sneezing, for example," he said.

The research is supported by the Air Transportation Center of Excellence for Airline Cabin Environment Research, established by the Federal Aviation Administration. The work aims to improve air quality and safety inside airline cabins.

The inadvertent release of infectious pathogens inside an aircraft is especially dangerous during lengthy international flights, said Chen, who is a principal director of the center. The effort involves an interdisciplinary team of Purdue researchers from chemical and mechanical engineering, physics and chemistry.

The center's Purdue-related research focuses on developing mathematical models for software that will be needed to operate such a tracking system and learning how to precisely place several sensors to accurately trace hazardous airborne materials back to the source.

Research findings are detailed in a paper being published in June in Indoor Air - International Journal of Indoor Environment and Health. The paper was Chen and mechanical engineering doctoral student Tengfei Zhang.

The technique, called "inverse simulation," analyzes how a material disperses throughout the cabin and then runs the dispersion in reverse to find its origin. Sensors track the airflow pattern and collect data related to factors such as temperature, velocity and concentration of gases and particles in the air.

"This is difficult to do, in part because an airline cabin is a pretty large area," Chen said. "The procedure now requires several days of computing time to complete the track, meaning the method could be used only after a contamination occurs."

Chen has recreated a commercial airliner's passenger compartment, complete with rows of seating, at Purdue's Ray W. Herrick Laboratories. Data from experiments in the lab are used to validate results from the computational models. The lab is equipped with three sensors and recreates the exhalation and body heat of passengers and an airliner's "linear diffuser" environmental control system, which supplies fresh and recirculated air for passengers. Boxy devices located on several seats reproduce body heat, and each has a tube that expels a gas to simulate passengers exhaling. Recreating body heat is important because it affects airflow inside airliners, Chen said.

Future work will concentrate on speeding the computation time, with a goal of one day creating a system that alerts pilots in real time and pinpoints a contaminant's source.

"We need to find a way to enhance the computing speed, and we have a strategy to do that," Chen said.

The method is most accurate when three sensors are used to track a material. Using three sensors, the Purdue researchers showed that the method could track a substance to within about two feet of its origin in an airline cabin.

"We would be able to tell you the general area of the origin, and from that you could figure out which passenger seats were in this area," said Chen, whose research is based at Herrick Laboratories.

The same principle could be applied to systems designed for other environments, such as office buildings, he said.

The Air Transportation Center of Excellence for Airline Cabin Environment Research includes Auburn University, Harvard University, Boise State University, Kansas State University, the University of California at Berkeley, and the University of Medicine and Dentistry of New Jersey. Auburn is the center's lead administrative university, while Purdue and Harvard are co-technical leaders.

Research through the center aims to:

* Understand and mitigate environmental health issues on airplanes, including contamination of cabin air with engine oil or hydraulic fluid.

* Study how cabin pressure affects passengers, especially those with cardiopulmonary conditions, as well as flight attendants and pilots who work in the environment daily.

* See how elevated ozone levels at higher altitudes affect the cabin environment.

* Look at the basic science of how contaminants travel through the cabin.

* Learn which sensors best detect certain materials in cabin air.

* Discover the best strategies to decontaminate an airplane.

Purdue's team is concentrating on tracking and decontaminating airborne agents.

The research is funded primarily by the Federal Aviation Administration. The center is sponsored by the FAA's Office of Aerospace Medicine.

www.purdue.edu

UNAIDS Encouraged By Decision By Libya's High Judicial Council To Revoke Death Penalty For Health Care Professionals

2011-09-21T08:10:00.038-07:00

The Joint United Nations Programme on HIV/AIDS (UNAIDS)
welcomes the ruling by the High Judicial Council of Libya to revoke the death sentence
previously imposed on six healthcare workers by the Supreme Court. The Council
announced recently that it would commute the death sentence for the medical
professionals to life imprisonment.

The six health care workers (five Bulgarian nurses and one Palestinian doctor), imprisoned
since 1999, had been accused of deliberately infecting 426 children with HIV whilst working
at a hospital in Benghazi, Libya.

Although welcoming the revocation of the death sentence, UNAIDS is concerned that certain
scientific evidence appears to not have been taken into consideration during the
proceedings which, could have led to their acquittal. In this regard, UNAIDS expresses the
hope that this decision will open the way for a speedy and just resolution of this matter.

Since the proceedings began, the Palestinian Doctor has been granted Bulgarian citizenship
and the Bulgarian government is expected to enter into further discussions with Libya on the
transfer of the six to Bulgaria.

Since 1999, 56 of the children found to be infected with the virus have died. UNAIDS
expresses its deep concern and empathy for the children affected and for their families, and
welcomes the news that an agreement has reportedly been reached to ensure that they
have future treatment, care and support.

UNAIDS will continue to support the Government of Libya for a comprehensive response to
HIV; to prevent HIV transmission; provide for treatment, care and support for those living
with HIV; and protect the rights of those affected by HIV.

UNAIDS is an innovative joint venture of the United Nations, bringing together the efforts and
resources of the UNAIDS Secretariat and ten UN system organizations in the AIDS response. The
Secretariat headquarters is in Geneva, Switzerland-with staff on the ground in more than 80
countries. Coherent action on AIDS by the UN system is coordinated in countries through UN theme
groups, and joint programmes on AIDS. UNAIDS' Cosponsors include UNHCR, UNICEF, WFP,
UNDP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank.

unaids

Washington Post Examines HIV/AIDS Outreach Efforts Aimed At African Immigrants

2011-09-21T08:10:00.037-07:00

The Washington Post on Tuesday examined HIV/AIDS outreach efforts aimed at African immigrants in the U.S. According to the Post, some health researchers say that the "message" that HIV/AIDS also affects Africans in the U.S. is "growing in importance as they become increasingly concerned that the AIDS epidemic ravaging sub-Saharan Africa is following migrants from that continent to America."

Local studies conducted across the U.S. have found "greatly disproportionate" HIV/AIDS rates among Africans, and health care providers in the Washington, D.C., area are recording similar trends, the Post reports. However, many providers are encountering a similar problem in that because many health departments do not ask patients where they were born, most HIV-positive African immigrants are categorized in surveys as "black" or "African-American."

"Quite frankly, many providers don't distinguish between Africans and African-Americans," Garth Graham, deputy assistant secretary for minority health at HHS, said. He added, "It doesn't take into account the different cultural backgrounds and perceptions of wellness and disease that these individuals have ... that's one of the glaring challenges that we're facing."

Other health care providers say that the issue is compounded by stigma, language barriers and fears over deportation. Some immigrants are not familiar with the concept of preventive medicine and do not realize that an early HIV diagnosis can improve survival changes, according to providers. "You have to be sick to go to the doctor in Africa," Ashenafi Waktola, a district-area physician who was born in Ethiopia, said, adding, "That is disastrous with AIDS."

According to the Post, there are no "precise" national data about HIV/AIDS among African immigrants. However, studies conducted in places such as Minnesota and the Seattle area, which have relatively large African immigrant populations, have found much higher HIV/AIDS rates among Africans. Studies in Canada and Europe have found similar results, the Post reports. In the district area, information on country of origin "varies so much by jurisdiction and is so spotty that it provides only a blurry snapshot," according to the Post. However, a recent district Health Department survey conducted among groups that provide HIV/AIDS services to impoverished populations in the region found that 10% of those clients were born in Africa.

In addition, of the 31,256 AIDS cases reported in Maryland through September 2007, African immigrants accounted for 716, or 2.3%, of the cases -- slightly higher than their percentage of the population, which is about 2%. In Montgomery County, Md., 392, or 15%, of all reported AIDS cases were among Africans, who account for about 4% of the population. According to officials with Maryland's AIDS Administration, they are unsure how to explain the disparity between the Montgomery County and statewide data because reporting about country of origin by health providers is "often inconsistent or incomplete," William Honablew, an administration spokesperson, said. Other officials said that it is possible that health providers in Montgomery more routinely offer HIV tests to immigrants and record country of origin data more reliably. According to Honablew, the large majority of AIDS cases among African immigrants in Maryland have been recorded in Montgomery and Prince George's counties, and the AIDS Administration is planning an HIV program targeting African communities in those counties.

In Virginia, country of origin was recorded in 26% of the 1,062 new HIV cases reported in 2006, according to the state Department of Health. African immigrants, who account for less than 1% of the population in the area, accounted for 5% of all 1,062 newly recorded cases. According to the Post, African immigrants "almost certainly would account for a higher share if national origin were consistently recorded." According to a study conducted by a Seattle-King County epidemiologist, African immigrants in 2003 and 2004 accounted for at least 13% of the 639 new HIV infections in nine Northern Virginia counties.

Many health care providers and researchers said they believe that most HIV-positive immigrants contracted the virus in their homelands in part because the virus is diagnosed in the later stages in many cases. Because few educational materials aimed at African immigrants are available, outreach workers sometimes use materials written for U.S.-born blacks that have little cultural relevance for Africans, the Post reports. In addition, stigma often presents a large obstacle. Because African immigrant communities are "segmented and tight-knit," providers say that African immigrants "fear they would know a doctor or interpreter from the same community and that word of their condition would spread," according to the Post (Brulliard, Washington Post, 9/2).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

U.N. Launches Programs In Three Indian Prisons To Prevent Spread Of HIV Among Inmates

2011-09-21T08:10:00.036-07:00

The United Nation's Office on Drugs and Crime has launched programs in three Indian prisons that aim to prevent the spread of HIV among inmates, the Press Trust of India reports. According to Jaidev Sarangi, a prison expert with UNODC, the United Nations in collaboration with state governments and civil societies has launched programs in Tihar jail in New Delhi, Arthur Road jail in Mumbai and Amritsar Central jail in Punjab.

There are 14,126 inmates in Tihar, 2,000 in Arthur Road and 2,000 in Amritsar, the Press Trust of India reports. According to a study conducted by India's Ministry of Social Justice and Empowerment and UNODC, about 10% of the inmate population in Tihar was found to be using drugs. Sunil Kumar Gupta, a law officer at the prison, said that there are 38 inmates at the prison who are HIV-positive.

"The basic purpose is to address the twin problems of drugs and HIV in prisons," Sarangi said. He added, "So, our strategy is to prepare the inmates to face the challenges of drug abuse and HIV in jails and also after their release." According to Sarangi, the programs will provide prison staff and inmates with HIV/AIDS education by engaging them in workshops. "We try to increase their knowledge and awareness about drugs and HIV in priso[n] settings," he said, adding that the "next step is the enhancement of life skills to enable prisoners to cope with day-to-day challenges in an out of prisons."

According to Sarangi, similar programs have been launched in prisons in Sri Lanka and Nepal. R. Gunashekar, project officer for UNODC, said that the "next step is to [establish similar programs] in one jail in each state and Union Territories in the country" (Press Trust of India, 7/10).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Wall Street Journal Examines Reason Abbott Increased Price Of Antiretroviral Norvir

2011-09-21T08:10:00.035-07:00

Previously undisclosed documents and e-mails reviewed by the Wall Street Journal indicate that executives at Abbott Laboratories attempted to "diminish the attraction" of the company's antiretroviral drug Norvir by increasing the price of the drug, the Journal reports. Norvir is used in combination therapies that include drugs manufactured by pharmaceutical companies other than Abbott, according to the Journal. According to the documents and e-mails, Abbott in the fall of 2003 "grew worried about new competition to" its antiretroviral Kaletra, and the company's executives began discussing ways to decrease the popularity of Norvir with the "goal of forcing" HIV-positive people "to drop the rival drugs and turn to Kaletra," the Journal reports (Carreyou, Wall Street Journal, 1/3). In December 2003, Abbott quadrupled the per-patient wholesale price of Norvir, which is known generically as ritonavir. Norvir is used primarily as a booster for other protease inhibitors, such as Bristol-Myers Squibb's Reyataz and Merck's Crixivan (Kaiser Daily HIV/AIDS Report, 8/5/04). Abbott exempted Medicaid, Medicare and state AIDS Drug Assistance Programs from the price increase, and the company announced that it would expand its patient assistance program. Institutions, such as state prisons, were not exempt from the price increase. The cost of Norvir increased from $51.30 for 30 100mg capsules to $257.10 for 30 100mg capsules, or by $5,000 more annually, which made Kaletra -- costing $7,000 annually -- the less expensive option for HIV-positive people residing in the U.S., according to the Journal. The increase "created a huge price discrepancy" between Kaletra and rival drugs, according to David Wohl, an associate professor at the University of North Carolina who also works with HIV-positive prison inmates. Abbott has said that it did not increase the price of Norvir to promote Kaletra and that the increase did not affect other drug companies. According to Abbott, the price increase was intended to better show Norvir's medical value, the Journal reports.

Reaction, Legal Actions
According to the Journal, the price increase "triggered an uproar" among some HIV/AIDS advocates and physicians. After a May 2004 hearing to consider authorization of a cheaper generic version of Norvir before its patent expired, NIH stated that it did not have the authority to determine if a drug's price was too high and ruled against a generic. The public "outcry faded" over time and "[p]rivate health insurers took a bigger blow but had little leverage, because they could hardly deny patients a lifesaving drug," according to the Journal. However, Abbott settled a lawsuit over Norvir's pricing filed by the AIDS Healthcare Foundation and agreed to support programs at the foundation, the Journal reports. Illinois Attorney General Lisa Madigan (D) has been investigating Norvir's price increase for three years and has said that it might violate the state's consumer fraud law. In addition, a lawsuit filed in U.S. district court in Oakland, Calif., by two HIV-positive people and the Service Employees International Union's Health and Welfare Fund is scheduled to go to trial in early 2008, the Journal reports (Wall Street Journal, 1/3).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

View drug information on Crixivan; Kaletra Capsules and Oral Solution; Norvir.

Why Are The Elderly So Vulnerable To Pneumonia?

2011-09-21T08:10:00.034-07:00

A study featured on the cover of the March 15 Journal of Immunology is providing insight into why the elderly are so vulnerable to pneumonia and other bacterial infections.

The study has been published online in advance of print.

Compared with younger adults, the elderly are at higher risk of becoming seriously ill or dying from pneumonia. Moreover, vaccines against the disease are less effective in the elderly.

To help understand why, Loyola researchers examined two types of immune system cells, macrophages and B cells, located in specialized areas in the spleens of mice. (Macrophages gobble up bacteria, while B cells produce antibodies that fight bacteria.)

Macrophages and B cells appeared to be just as effective in old mice as they were in younger mice. But there were fewer of them.

"If we knew how to replenish these cells, we might be able to lower the risk of bacterial infections in the elderly," said senior author Pamela Witte, a professor in the Department of Microbiology and Immunology at Loyola University Chicago Stritch School of Medicine. "This is an unexplored area in aging."

The finding also could provide clues to developing vaccines against pneumococcal pneumonia that would be more effective in the elderly, said first author Shirin Birjandi, who is completing her PhD at Loyola.

For example, Birjandi said, current vaccines instruct B cells to make antibodies against bacteria that cause pneumonia. But if humans are like mice, the elderly will have fewer B cells. So it might make more sense to develop vaccines that instead target other immune system cells, Birjandi said.

In their study, Loyola researchers examined B cells and macrophages that form microscopic rings in the spleen called marginal zones. These marginal zones form protective rings, preventing bacteria from passing through.

Photographs taken by the researchers show that in the spleens of young mice, macrophages form distinct rings in the marginal zones. (One of these photos appears on the cover of the Journal of Immunology.) In old mice, however, the photographs show that marginal zone rings are dramatically disrupted. (In humans, the equivalent ages of the old mice would be between 70 and 80.)

Researchers wrote that understanding changes such as these "is important for developing more efficient therapies for preventing diseases, such as bacterial pneumonia, that have shown to be highly detrimental in the elderly."

Other co-authors of the study are Jill Ippolito and Anand Ramadorai.

The research was supported by grants from the National Institutes of Health.

Source:
Loyola University Health System

United Therapeutics Announces Pulmonary Hypertension Opinion Leaders' Guidance On Intravenous Therapies

2011-09-21T08:10:00.033-07:00

United
Therapeutics Corporation (Nasdaq: UTHR) today announced new guidance from
pulmonary arterial hypertension opinion leaders relating to intravenous
therapies. The new guidance was issued by the Scientific Leadership
Committee (SLC) of the Pulmonary Hypertension Association in response to
the release of a slide presentation prepared by CDC researchers entitled
"Bloodstream infections among patients treated with intravenous
epoprostenol and intravenous treprostinil for pulmonary arterial
hypertension, United States 2004 - 2006". The slides accompanied a
presentation to the SLC on February 23, 2007, and may be published as a
report in the CDC's Morbidity and Mortality Weekly Report. The new guidance
from pulmonary hypertension opinion leaders is for physicians to be mindful
of the range of possible gram negative and gram positive infectious
organisms in patients with long-term central catheters and initiate
appropriately broad spectrum antibiotics in patients with suspected
bloodstream infections until culture results and antibiotic sensitivity are
known.

"We welcome the new guidance from pulmonary hypertension opinion
leaders," said Martine Rothblatt, Ph.D., United Therapeutics' Chairman and
Chief Executive Officer. "We believe that if a patient is predisposed to
sepsis, then subcutaneous Remodulin, which has never been associated with
septicemia, is the safest catheter-based treatment option; other patients
have a very small chance of developing sepsis. For a disease in which mean
survival is counted in single digit years, everyone wants to go the extra
mile to provide patients needing prostacyclin therapy with the most options
-- this is why we developed the micro-pump, ice-free and rapid-switch
characteristics of intravenous Remodulin."

Scientific Leadership Committee Guidance

The Pulmonary Hypertension Association Scientific Leadership Committee
(SLC) is composed of more than 20 leaders in the field of pulmonary
hypertension. The members of the SLC are clinicians, research scientists,
and nurses who come from medical centers recognized for performing
outstanding research and providing excellent care for patients with
pulmonary hypertension. The mission of the SLC is to provide medical and
scientific leadership and guidance for the mission of the Pulmonary
Hypertension Association by proactively facilitating the development of new
knowledge about pulmonary hypertension, actively disseminating knowledge
about pulmonary hypertension to medical and public audiences, and
advocating and raising awareness about pulmonary hypertension.

Following the CDC researcher's presentation, the SLC posted the
following guidance statement on the Pulmonary Hypertension Association
website, phassociation:

"The SLC notes the observation that patients on long-term intravenous
therapy are susceptible to bloodstream infections caused by a broad range
of organisms. The Centers for Disease Control and Prevention (CDC) report
suggests a hypothesis that different patient profiles may be subject to
higher risk of various types of infections. The SLC considers the CDC
document to be a hypothesis generating report which does not permit
definitive or specific conclusions at this time. Therefore, the SLC
supports the following:

1. Further appropriately designed studies are required to determine the validity of the hypothesis raised by the current document.

2. Pending rigorous studies, physicians should be mindful of the range of possible gram negative and gram positive infectious organisms in patients with long-term central catheters and initiate appropriately broad spectrum antibiotics in patients with suspected bloodstream infections until culture results and antibiotic sensitivity are known.

3. Choice of specific parenteral prostacyclin agents, as well as all pulmonary vascular targeted therapy should continue to be based on a global assessment of efficacy, risk, expense and feasibility of each agent in each individual patient's clinical context."

United Therapeutics' Response

"We will work closely with the Pulmonary Hypertension Association and
prescribers to improve patient care. We are confident that central line
filters and heightened emphasis on sterility best practices will go a long
way to address the issues raised in the CDC presentation," said Roger
Jeffs, Ph.D., United Therapeutics' President and Chief Operating Officer.
"As with any therapy for a life-threatening condition, prescribers will
balance the risk/benefit profile of IV Remodulin against their patients'
needs in light of the experiences they have had with the drug."

United Therapeutics plans to take the following actions in response to
the Scientific Leadership Committee guidance:

-- United Therapeutics will commence a multi-center, multi-national,
multi-year and multi-agent prospective study to scientifically test the
hypothesis of whether there are differences in the risk of sepsis and
sepsis sub-types among parenterally-delivered prostacyclin mimetics and
analogs. The company anticipates this study to enroll several hundred
patients and is expected to commence later this year. "We are excited
about taking the lead in testing some of the hypotheses suggested by
the CDC's observations," said David Zaccardelli, PharmD, United
Therapeutics' Senior Vice President for Pharmaceutical Development. "No
doubt there is much new information to be learned from prospective
study of a large number of patients receiving chronic intravenous
therapy for pulmonary hypertension."

-- United Therapeutics also plans to coordinate a working group with the
Pulmonary Hypertension Association and physicians and nurses, along
with its network of specialty distributors and home health care
providers, to develop unified best practice recommendations related to
the chronic administration of IV prostanoids via central venous
catheters.

-- United Therapeutics will revise Remodulin package labeling to more
fully describe the known infection risk and appropriate technique that
should be practiced when preparing and administering intravenous
treprostinil.

About Remodulin

Remodulin(R) is indicated as a continuous subcutaneous infusion or IV
infusion (for those not able to tolerate a subcutaneous infusion) for the
treatment of PAH in patients with NYHA Class II-IV symptoms to diminish
symptoms associated with exercise.

Remodulin is indicated to diminish the rate of clinical deterioration
in patients requiring transition from Flolan(R); the risks and benefits of
each drug should be carefully considered prior to transition.

Important Safety Information:

Remodulin is contraindicated in patients with hypersensitivity to
Remodulin, its ingredients, or similar drugs. Remodulin is a potent
vasodilator. It lowers blood pressure, which may be further lowered by
other drugs that also reduce blood pressure. Remodulin inhibits platelet
aggregation and therefore, may increase the risk of bleeding, particularly
in patients on anticoagulants. Abrupt withdrawal or sudden large reductions
in dosage of Remodulin may result in worsening of PAH symptoms and should
be avoided. Caution should be used in patients with hepatic or renal
problems. The most common side effects of Remodulin included those related
to the method of infusion. For subcutaneous infusion, infusion site pain
and infusion site reaction (redness and swelling) occurred in the majority
of patients. These symptoms were often severe and could lead to treatment
with narcotics or discontinuation of Remodulin. For IV infusion, line
infections, sepsis, arm swelling, tingling sensations, bruising, and pain
were most common. General side effects (>5% more than placebo) were
diarrhea, jaw pain, vasodilation, and edema.

About United Therapeutics

United Therapeutics is a biotechnology company focused on the
development and commercialization of unique products for patients with
chronic and life- threatening cardiovascular, cancer and infectious
diseases.

Forward-Looking Statements

In addition to historical information, this press release contains
forward-looking statements about the publication of a report in the CDC's
Morbidity and Mortality Weekly Report, United Therapeutics' plans to
commence a study of sepsis in parenterally-delivered prostanoids, and the
design of such study and its enrollment commencement date, United
Therapeutics' plans to coordinate a working group to develop unified best
practice recommendations for IV prostanoids, its plans to revise Remodulin
package labeling, and expectations with respect to the impact of central
line filters and best practices on the issues raised in the presentation
that are based on United Therapeutics' current beliefs and expectations as
to future outcomes. These expectations are subject to risks and
uncertainties such as those described in United Therapeutics' periodic
reports filed with the Securities and Exchange Commission which may cause
actual results to differ materially from anticipated results. Consequently,
such forward-looking statements are qualified by the cautionary statements,
cautionary language and risk factors set forth in United Therapeutics'
periodic reports and documents filed with the Securities and Exchange
Commission, including the company's most recent Form 10-K and Form 10-Q.
United Therapeutics is providing this information as of February 26, 2007
and undertakes no obligation to publicly update or revise the information
contained in this press release whether as a result of new information,
future events or any other reason.

United Therapeutics Corporation

unither

View drug information on Remodulin.

The Use of Topical Ointments for the Treatment of Osteoarthritis Questioned

2011-09-21T08:10:00.032-07:00

Topical ointments used to treat the symptoms of osteoarthritis the major cause of disability in older people do not work for more than a few weeks say researchers according to a recent study. According to researchers, the current guidelines in Europe and the United States recommend the use of topical treatments containing non-steroidal anti-inflammatory drugs to relieve osteoarthritis pain.

Researchers explain many people with osteoarthritis use topical treatments because they cannot tolerate oral NSAIDs. These drugs often cause stomach upset, and many people who start taking them stop.The current study analyzed results from 13 previous studies comparing topical NSAID treatments to sham treatments or treatment with NSAIDs taken by mouth. Results showed the topical treatments were better at relieving pain than the sham treatments, but only for about two weeks.

The most effective treatment, even in the first week, was taking an NSAID by mouth. As expected, the studies showed oral NSAIDs were more likely to cause gastrointestinal problems and more people quit taking them. However, the topical treatments had problems as well, causing more itching, burning and rashes.

Thus researchers conclude saying that more studies have to be done in this regard to support the long term use of topical NSAIDs in osteoarthritis.

Study Finds Respiratory Symptoms More Reliable Indicator Of H1N1, Not Fever Alone

2011-09-21T08:10:00.031-07:00

New research shows that individuals with mild H1N1 infection may go undetected using standard diagnostic criteria, according to a study in the August issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology, (APIC). The study concludes that coughing or other respiratory symptoms are more accurate in determining influenza infection than presence of a fever.

Currently, public health officials rely on body temperature (detecting fever) to screen individuals for potential infection with H1N1. For example, during a pandemic, standard screening at airports relies on body temperature scanners to detect the presence of fever. However, the study's authors found that coughing, not fever, is a more reliable indicator of infection because nearly half of the individuals with mild infection may not have fever.

A team led by Sang Won Park, MD, professor at the Seoul National University, investigated confirmed cases of H1N1 who were hospitalized and quarantined during the early stages of the pandemic in 2009. The study's results showed only 45.5 percent of the case subjects had fever. Individuals with mild infection and no fever have the potential to evade detection at airports or medical triage units, thus continuing the chain of infection.

"Our study found that fever is not reliable for case definition, even though it has been regarded as a key factor in determining influenza infection," said Dr. Park. "We are aware of other studies that show fever present in as few as 31 percent of confirmed cases of influenza. We found that the most sensitive indicator was cough."

Dr. Park adds that that "screening should take any kind of respiratory manifestation into account."

About AJIC: American Journal Of Infection Control

AJIC: American Journal of Infection Control covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

Notes

"Mild form of 2009 H1N1 influenza infection detected by active surveillance: Implications for infection Control" appears in the American Journal of Infection Control, Volume 38, Issue 6 (August 2010) published by Elsevier.

Authors:

Ina Jeong, MD, Division of Pulmonary and Critical Care Medicine, Department
of Internal Medicine and Lung Institute, Seoul National University

Chang-hoon Lee, MD, Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.

Deog Kyeom Kim, MD, Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.

Hee Soon Chung, MD, Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.

Sang Won Park, MD, Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.

Source:

APIC

U.K. To Provide About $12B To Improve Health Services In Developing Countries, Fight HIV/AIDS, Official Says

2011-09-21T08:10:00.030-07:00

United Kingdom International Development Secretary Douglas Alexander on Monday announced that the government will provide six billion British pounds, or $11.8 billion, over seven years to improve health services and systems in developing countries to fight HIV/AIDS, AFP/Google reports (AFP/Google, 6/2).

According to Alexander, the seven-year strategy aims to ensure universal access to HIV prevention, treatment, care and support. The Achieving Universal Access strategy will commit the United Kingdom to increasing coverage of services for injection drug users, meeting the needs of AIDS orphans and children affected by the disease, and working with other groups to reduce the cost of antiretroviral treatment, the Press Association reports. The strategy also will commit the country to preventing mother-to-child HIV transmission and increasing the availability of family planning services, including male and female condoms. The United Kingdom will spend more than 200 million pounds, or about $394 million, over the next three years to support social protection programs and will increase funding for research and development of HIV/AIDS vaccines and microbicides by 50%.

Under the plan, the U.K. Department for International Development also will provide about $100 million pounds, or $197 million, over the next six years to improve Nigeria's national response to HIV. About $30 million pounds, or $60 million, of that funding will be specifically allocated to provide no-cost condoms to Nigeria (Press Association, 6/2).

Comments
Alexander in a written statement said the financial commitment "demonstrates [the United Kingdom's] determination to remain at the forefront of global efforts to achieve universal access." He added, "If we are to achieve universal access and to halt and reverse the spread of AIDS, the evidence demonstrates that we require a long-term approach, across a range of health systems and services" (AFP/Google, 6/2).

Shadow International Development Secretary Andrew Mitchell welcomed the announcement but called for more scrutiny. The "strategy paper is sensible and constructive," Mitchell said, adding, "But the government needs to be more self-critical about whether we are actually getting the results we expect, both on behalf of the people we are trying to help, and of British taxpayers." Mitchell noted that an annual assessment of the program's impact is needed rather than the planned independent review in three years. "We also need specific interim country-level targets so that leaders can be held to account on their promise to deliver universal access to HIV/AIDS prevention and treatment by 2010," he said.

Phil Bloomer, director of campaigns and policy at Oxfam, said, "The announcement of this much needed, long-term financial commitment to help strengthen health systems in the developing world is a very welcome one." He added, "But tackling the AIDS epidemic will require more than investment in health systems. It is also about factors such as education, awareness raising, counseling and the provision of security of food and income for all those who need it, whether" living with or affected by HIV/AIDS (Press Association, 6/2).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

US Congress Must Include Additional Money for Global Fund in Final Budget Bill, Editorial Says

2011-09-21T08:10:00.029-07:00

Congress must approve final budget legislation that includes a Senate amendment that would authorize an additional $500 million for the... Global Fund To Fight AIDS, Tuberculosis and Malaria in order to "solidif[y] America's commitment to the battle against three deadly diseases plaguing the developing world," an Indianapolis Star editorial says (Indianapolis Star, 3/19). The Senate on Thursday approved 51-49 a fiscal year 2006 $2.6 trillion budget resolution (S Con Res 18), including an amendment that would provide a $500 million increase in funding for the Global Fund and bring the total FY 2006 amount for the fund to $800 million. President Bush in his FY 2006 budget request proposed $300 million go to the Global Fund. The House also must approve the funding increase for it to take effect (Kaiser Daily HIV/AIDS Report, 3/18). By approving the funding increase, the Senate "took an important step toward reducing the diseases' staggering death toll," the editorial says. The increase also could help to "leverage donations from other countries," according to the editorial. The Global Fund has "an impressive track record in fighting AIDS," and to deny the group additional funding "would be a setback in the battle against AIDS and other infectious diseases," the Star concludes (Indianapolis Star, 3/19).

"Reprinted with permission from kaisernetwork kaisernetwork. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork/dailyreports/hiv.. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Use Of Certain Antibiotics In Topical Cream Could Prevent HIV Transmission, Study Says

2011-09-21T08:10:00.028-07:00

A class of antibiotics known as aminoglycosides could be used to make a topical cream that would trigger production of a protein in humans to prevent HIV transmission, according to a study published Tuesday in PLoS Biology, the Orlando Sentinel reports.

For the study, researchers led by Alexander Cole of the University of Central Florida used the antibiotics to trigger a dormant human gene to produce a protein called retrocyclins that resists HIV transmission. The researchers applied the antibiotics to vaginal tissues and cervical cells and found that it stimulated the tissues and cells to produce retrocyclins. Cole said there is a "good chance the aminoglycosides antibiotics will be used in a topical cream as a way to prevent the transmission of HIV from men to women." He noted that more research, including human trials, is necessary to determine the safety and efficacy of a potential cream.

Cole said the discovery that aminoglycosides can trigger cells to produce retrocyclins is a "promising find," adding that the researchers "will be moving forward with this -- full steam ahead." Phalguni Gupta, a scientist at the University of Pittsburgh who specializes in infectious diseases, said the research is "very hopeful," adding that the use of aminoglycosides in a cream or gel would be an "important part of the arsenal in the fight against" HIV/AIDS (Quintero, Orlando Sentinnel, 4/28).

The study is available online.

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

The Severity Of Side Effects After Salmon Vaccination Depends On The Antigen Composition

2011-09-21T08:10:00.027-07:00

During the course of his doctoral studies, Stephen Mutoloki examined tissue reactions of salmon to oil-based vaccines and elucidated the components that play a significant role in the development of these reactions.

Vaccines are used in aquaculture to avoid outbreaks of infection from bacteria and viruses. If given at the start of the sea-water phase, oil-based vaccines provide protection against bacterial infection for the entire life in the animal. However, oil-based vaccines produce local side-effects in the form of pigmentation and adhesions between internal organs, which in some cases are severe enough to reduce the carcase quality at slaughter. The underlying mechanisms of side-effect development are little known.

Stephen Mutoloki discovered that the reaction to the vaccine, and especially to the bacterial component of the vaccine, comes in several "waves". These waves consist of cells that migrate to the injection site, and in the van of these is the "rapid-response troop", the neutrophilic granulocytes. These are followed by the "clean-up team", the macrophages, and later still by the cells that provide the actual protection against disease later in life, the lymphocytes. This is the same sequence one finds in a natural infection and is the result of a collaboration between the processes of inflammation and of immunity. How aggressive the reaction within the tissue is, depends on how many granulocytes that are involved and how many clean-up cells arrive.

The main findings in Dr. Mutoloki's work show that the species has a lot to say for how effectively the "clean-up" progresses. The rainbow trout has in general more effective cleaning-up cells, while the Atlantic salmon does a poorer job with a correspondingly greater and longer-lasting tissue reaction. The clean-up phase is also affected by the vaccine's composition, that is, the more unrefined a vaccine, the more inflammatory cells that will accumulate and the greater the tissue reaction. The type of antigen in the vaccine is also significant. Moritella viscosa is, for example, more difficult to clean up after than Aeromonas salmonicida. And if the vaccinated fish uses more resources to clean up than to create immunity against future infections, the tissue relation may become too dominating and produce unwanted side-effects.

NORWEGIAN SCHOOL OF VETERINARY SCIENCE

UllevГҐlsveien 72

veths.no

Taiwan Harm Reduction Program For IDUs Praised At International Conference

2011-09-21T08:10:00.026-07:00

Taiwan's harm reduction program for injection drug users -- which has reduced the number of new HIV cases among the group by about 50% over a three-year period -- recently received praise at the International Harm Reduction Association's 20th International Conference in Bangkok, Thailand, Inter Press Service reports. According to Inter Press Service, Taiwan's HIV incidence declined to 1,752 new cases in 2008, compared with more than 3,300 in 2005 -- nearly double the number recorded in 2004. Sheng Mou Hu, the country's health minister at the time, said the success in reducing the number of new HIV cases can be attributed to the approach that "harm reduction should be based on human rights." The program was launched in 2006 and includes elements like enhanced screening and monitoring of HIV-positive IDUs, a needle-exchange program and methadone replacement initiatives. As a result, IDUs in Taiwan are presented to the public as "patients" who required medical attention rather than criminals, Inter Press Service reports.

Ton Smits, executive director of the Asian Harm Reduction Network, said, "No other country in Asia can match Taiwan's achievement in launching and sustaining this harm reduction program." He said that in most Asian countries, policies relating to drug control "are in direct conflict with HIV-related policy, undermining harm reduction programs in the region." He also noted that 3% of IDUs in Southeast Asia have access to harm reduction services and that such programs are "facing a financial crisis," with a 90% resource gap in 2009. According to Gerry Stimson, executive director of IHRA, 2% to 3% of all available resources for HIV/AIDS is spent on harm reduction strategies. Stimson said, "If we are serious about reducing HIV infection amongst IDUs, then we are going to need between $2 billion and $3 billion this year and the next."

According to Inter Press Service, some encouraging signs have been seen in other Asian countries -- such as China, Malaysia, Thailand and Vietnam -- that are beginning programs similar to Taiwan's that treat IDUs through public health approaches rather than law enforcement measures. IDUs still are listed as one of the most vulnerable groups in the region, Inter Press Service reports. According to IHRA, there are close to 16 million IDUs in 158 countries worldwide. Information released at the conference said that some estimates place the number of HIV-positive IDUs at three million, while others place it at more than 6.6 million (Macan-Markar, Inter Press Service, 4/25).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Treatment Not 'Economical' Way To Fight Global HIV/AIDS; Prevention Would Save More Lives, Money, Opinion Piece Says

2011-09-21T08:10:00.025-07:00

"It is humane to pay for AIDS drugs in Africa, but it isn't economical," and spending money on prevention would save more lives, economist Emily Oster writes in an opinion piece in the July 25 issue of... Forbes. By comparing the number of years of life saved by antiretroviral drugs with the number of years saved by other interventions, such as education, Oster shows that treatment is the most expensive way to fight the disease but is not the most effective. For example, if a regimen of generic antiretroviral drugs cost $1 per person per day, and one year of drug therapy saves one year of life, then each life-year costs $365, excluding the cost of delivering the drug to the patient, Oster says. However, using antibiotics to treat sexually transmitted diseases that produce open sores -- such as gonorrhea, syphilis and genital warts -- and therefore increase a person's risk of contracting HIV would cost just $3.65 per year of life saved, according to Oster. In addition, estimates from an aggressive education campaign in Uganda indicate that education would save lives at just $16 annually per year of life. "It may be that we have an objective other than maximizing the efficiency of dollars spent," Oster says, noting that providing hope to millions of Africans who are parents might "have value in and of itself." Oster continues, "But if we choose treatment, we must know what we are giving up. The tradeoffs are there whether we want to face them or not," concluding, "What economics can do is tell us -- in numbers, in black and white -- what we give up and what we gain" (Oster, Forbes, 7/25).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

The Quest For An Effective HIV Vaccine Presents New Possibilities, Challenges

2011-09-21T08:10:00.024-07:00

A vaccine that prevents HIV infection remains an important goal in the fight against AIDS, but the current top HIV vaccine candidates may not work in this way, say scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). Rather, the first successful preventive HIV vaccines, if administered prior to HIV infection, may reduce HIV levels in the body, thereby delaying the progression to AIDS and the need to start antiretroviral drugs. These vaccines may also reduce the chance that a person infected with HIV would pass the virus on to other people, according to NIAID Director Anthony S. Fauci, M.D., and Margaret I. Johnston, Ph.D., director of NIAID's Vaccine Research Program in the Division of AIDS.

In a review article in the New England Journal of Medicine, Drs. Johnston and Fauci examine the daunting challenges posed by HIV, the evolution of HIV vaccine research, the role T cells may play in HIV vaccine effectiveness, and how the first successful HIV vaccine may fit into a comprehensive HIV/AIDS prevention effort.

Vaccines typically work by mimicking the effects of natural exposure to a specific microbe. Because of initial exposure, the immune system develops the ability to recognize the specific microbe and can protect the human body against it if it reappears. HIV, however, has thwarted scientists' efforts thus far to develop a classic preventive vaccine for the virus because of its ability to integrate into target cells and evade clearance by the immune system. The interaction between HIV and the immune system is complex, and how different HIV-specific immune responses help to control infection is only partially understood.

"The development of an HIV vaccine is a complex research challenge because the virus is unusually well-equipped to elude immune defenses," says Dr. Fauci. "Much progress has been made; however, we must continue research efforts to improve our understanding of HIV and how it evades the immune system, to design new vaccine candidates and to assess the most promising ones in clinical trials."

Dr. Johnston adds, "An important research challenge is to determine if these so-called T-cell vaccines that primarily induce a cellular immune response can have a beneficial effect by reducing viral levels and preserving critical cells needed to control infection. There will be a tremendous public health challenge as well, in an HIV vaccine that does not completely prevent the virus from establishing itself in the body."

Once HIV enters the body, it infects crucial CD4+ T cells, replicates, spreads throughout the body and establishes HIV reservoirs in lymphatic tissues. Within weeks of exposure, virus levels peak and then decline to levels that may remain low for months or years. It is believed that CD8+ T cells--so-called killer T-cells--are responsible for this reduction in HIV levels; however, their ability to continue to suppress the virus declines over time as the virus mutates and the immune system is progressively destroyed.

The infection of CD4+ T cells occurs very early in HIV disease, and virus persists indefinitely. Other viruses also replicate robustly but, unlike HIV, most do not establish a permanent reservoir of infected cells in the body. The window of opportunity to prevent long-term HIV infection may close permanently once a pool of latently infected cells is in place, Drs. Johnston and Fauci note. Neutralizing antibodies, which can attach to and eliminate free virus, only appear after HIV levels have declined substantially. Further, the effectiveness of these antibodies is stymied because of the rapid genetic changes that occur in HIV's outer envelope protein, which allow the virus to escape detection.

While early efforts to develop an HIV vaccine focused on the viral envelope, an improved understanding of how HIV causes disease has brought increased attention to the role that T cells could play in an HIV vaccine by spurring cellular immunity. Numerous animal and human studies have confirmed how important cellular immunity is in the early and later stages of HIV infection, even though the virus is never completely eliminated. Vaccines that induce strong cellular immune responses may have some benefits, say the authors. In non-human primate models of HIV infection, T-cell vaccines have reportedly decreased the total amount of virus produced during early infection, caused a reduction in virus levels following the acute stage of infection, or produced some combination of these effects. In many of these animals, disease progression was also delayed.

Based on the scientific evidence, several questions remain, say Drs. Johnston and Fauci: Can a vaccine that does not prevent HIV infection but reduces virus levels and preserves a segment of uninfected CD4+ T cells from destruction benefit the immunized individual" Might people immunized with T-cell vaccines before HIV exposure remain disease-free for a prolonged period once they are infected"

Additionally, T-cell vaccines may reduce secondary HIV transmission if they can help the immune system keep viral replication at a very low level for a long time. Studies have suggested that people with high levels of virus--namely those in the early and late stages of infection--are most likely to infect their sexual partners. A preventive vaccine given before exposure to HIV might stifle the initial burst of virus, better control virus levels and potentially reduce that person's ability to infect other people, Drs. Johnston and Fauci assert.

Vaccines of this type present several complications, however. T-cell-mediated control of HIV infection may not stave off disease forever. Additional human studies would be needed to determine if the vaccine also reduces the spread of HIV. Finally, an HIV vaccine that delays but does not completely prevent disease could not stand alone as a preventive measure; the public health community would need to include it as part of a broader HIV prevention program, so that recipients would minimize, or ideally, not engage in high-risk behaviors, according to the authors.

Currently, several vaccines that induce primarily T-cell responses are in or will soon enter expanded human clinical trials to determine if they impact HIV infection. Researchers also continue to give high priority to creating an HIV vaccine that induces broadly neutralizing antibodies, which might prevent the establishment of HIV infection. Although rare, such antibodies do exist, giving hope to scientists that a vaccine to induce such antibodies can be designed.

Drs. Johnston and Fauci conclude that a vaccine that prevents HIV infection by clearing the virus before cells become latently infected remains the goal. In addition, they believe that even a vaccine that does not prevent infection could prove beneficial if it prolongs the disease-free period and possibly even reduces virus transmission. If such a vaccine is shown to be successful and is eventually licensed, it would need to be delivered as part of a comprehensive, multifaceted HIV prevention program.

###

NIAID is a component of the National Institutes of Health. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on basic immunology, transplantation and immune-related disorders, including autoimmune diseases, asthma and allergies.

The National Institutes of Health (NIH)--The Nation's Medical Research Agency--includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit niaid.nih/.

Reference: MI Johnston and AS Fauci. An HIV vaccine--evolving concepts. The New England Journal of Medicine DOI: 10.1056/NEJMra066267 (2007).

Contact: Kathy Stover

NIH/National Institute of Allergy and Infectious Diseases

U.N. Envoy Calls For E.U. Health Plan To Help Tackle TB, HIV In Africa

2011-09-21T08:10:00.023-07:00

Jorge Sampaio, United Nations special envoy for the fight against tuberculosis, on Tuesday called for a European Union initiative that would aim to curb the spread of TB and HIV in Africa, TheParliament reports. Speaking before the E.U. Parliament's development committee, Sampaio said that the two diseases are spreading rapidly across the continent and that African countries are unable to combat them without assistance. "We are providing antiretrovirals to as many people as we can in Africa, but they are now dying because of tuberculosis, which is curable," Sampaio said. According to Sampaio, the European Union should strengthen cooperation and coordination between HIV and TB programs. In addition, Africa does not have enough health workers to diagnose the two diseases and monitor treatment, Sampaio said, adding that an E.U. plan to train health workers on managing the diseases "would not be too expensive." An E.U. health plan for Africa also would help minimize the economic effects of the diseases, which in some African countries cause of loss of 7% of national GDP annually, Sampaio said. In addition, building more hospitals and laboratories could help tackle the diseases, he said. Socialist members of the European Parliament, such as Emanuel Jardim Fernandes, said the plan should be included in the agenda of the next E.U.-Africa summit, which the Portuguese presidency will chair in December (Rufino, TheParliament, 4/11).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Walk For Life This June To Support People Living With HIV, UK

2011-09-21T08:10:00.022-07:00

HIV and sexual health charity Terrence Higgins Trust is looking for willing walkers to don their ruby slippers for people living with HIV on Sunday 5th June for this year's Walk for Life 10k event.

When: 12pm, Sunday 5th June, 2011

Where: Starts and ends in Potter's Fields Park, London, SE1 2AA

Walk for Life is the biggest HIV /AIDS awareness walking event in Europe, previously run by HIV charity Crusaid and now Terrence Higgins Trust, following the two charities' merger last summer, and this year the event has a wonderful Wizard of Oz fancy dress theme.

Participants walk a picturesque 10k route, which starts in Potters Fields Park next to Tower Bridge, continues up to Covent Garden via St Pauls and Waterloo Bridge, along the South Bank back to Potters Fields, and all funds raised go to the Hardship Fund supporting people living with HIV in poverty.

All ages can sign up (the park and route are wheelchair and buggy accessible) and, whether you come in fancy dress or just as you are, it's a great summer's day out for friends, partners and families, with plenty of celebrity spotting opportunities along the way. Previous famous names taking part have included Danni Minogue, The Feeling, Liz McClarnon, 4 Poofs & A Piano and Glen Wallace. The event starts at mid-day, taking an average of two to three hours, and walkers will be welcomed back to the park with entertainment, food and drink stalls.

Simon Whiteman, Terrence Higgins Trust's Head of Community Fundraising had this to say about the event: "For over 20 years, thousands of people have shown wonderful support for Walk for Life, walking to celebrate love, life and determination and raise vital funds for people living with, and affected by HIV. It's a chance to get fit and have a fun day outdoors with friends and family before reaching the 'Emerald City' finish. In the current economic climate, life is getting harder day by day for many people diagnosed with HIV so the Harship Fund needs your support more than ever before. Even a small donation will make a difference, so please sign up to this year's event."

If you would like to take part in this year's Walk for Life as a walker, or to enter a team, register online here to sign up for this year's event. It costs just ВЈ10 to register, which helps THT cover the costs of the event and ensure that walker sponsorship goes to people living with HIV.

Source:

Terrence Higgins Trust

Virginia HIV/AIDS Advocates Seek To Increase Treatment Access For Minorities

2011-09-21T08:10:00.021-07:00

HIV/AIDS advocates in Virginia plan to "reach out" to non-English speakers by focusing on language barriers and other cultural differences that impede their access to care, according to a three-year service plan released on Wednesday, the AP/Hampton Roads Daily Press reports. The Statewide Comprehensive Plan for HIV Services -- which details plans to count the number of non-English speaking HIV-positive people, hire more multilingual HIV care providers and establish a state directory that lists multilingual providers -- aims to foster relationships with ethnic and faith-based groups to ensure that non-English speaking communities receive equal treatment and that providers are sensitive to cultural differences, including those surrounding the discussion of sexual behaviors, the AP/Daily Press reports. Officials plan to survey state-funded providers' "cultural competence" and create training programs to address prejudices, according to the AP/Daily Press. Diana Jordan, director of Health Care Service, said, "The (minority) concern has been apparent to people addressing HIV issues for a long time. In this plan, our intent is to take a more tangible approach." Jordan said that it is increasingly important to address the needs of non-English speaking communities, including undocumented immigrant communities, which do not face mandatory HIV testing upon entering the U.S. (Walker, AP/Hampton Roads Daily Press, 2/1).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Statement Of The European Society Of Human Reproduction And Embryology On The European Commission Proposal Of Viral Screening In Assisted Reproduction

2011-09-21T08:10:00.020-07:00

With 900,000 assisted reproduction treatments annually such as IVF and intrauterine inseminations in Europe the Commission's proposal to screen both partners before each treatment could lead to costs of over EUR 140 million annually. These figures do not include the additional overhead costs such as administration, personnel and documentation that the hospitals would have to carry on top of that. The new interpretation of the EU Directive would have substantial implications on the costs of fertility treatments in Europe.

On 19-20 October in a meeting with the National Competent Authorities, the Commission stated that in terms of the directive, all patients must be tested for HIV, hepatitis, Human T-lymphotropic virus, and syphilis prior to each treatment and that this is not open for national interpretation.

Assisted Reproductive Technology (ART) is currently covered under the European Union Tissues and Cells Directive (EUTCD; EC/2004/23), a legal document originating from the European Union's public health programme. The Directive covers donation of all tissues and cells within the EU (except blood and blood-products).

Sperm samples from couples who are married or have been together for several years are treated as 'partner donation'. However, couples seeking assisted reproduction generally undergo a series of treatments in one year instead of one single donation as is the case for organ or tissue donations. So testing would have to be done for the same couple and for each treatment.

Currently 500,000 IVF treatments are performed in Europe, on top of these come 400,000 intrauterine inseminations (IUI). Since both partners need to be screened this would lead to 1.4 million tests a year. With an average cost of EUR 100 per test kit, this would result in a cost burden of EUR 140 million for the European ART sector.

"In the history of ART and the area covered by the Directive there has been no single documented report of viral transmission", explained Dr. SГёren Ziebe from the University Hospital of Copenhagen. "How can we document something that never happened?" he added. This interpretation will have a profound impact on all units conducting assisted reproduction.

Most national authorities are in line with ESHRE and see this interpretation of the Directive as not relevant to the ART sector. "The ART field should have a separate specific Directive given that ART is so different in its specifications compared to tissue or organ donations", said Prof. Jean Francois GuГ©rin, from the University of Lyon.

ESHRE acknowledges that non-partner donation is an area with separate requirements. In Denmark viral screening for diseases such as HIV or Hepatitis B is valid for 24 months. In France it is valid for up to 12 months. At the moment the period of validity is interpreted by the national authorities and there seems to be different interpretations and practices at the national level. "It has been suggested to establish a formal working group with professionals in the field of ART and other relevant professionals such as microbiologists as well as national regulators", explained Dr. SГёren Ziebe. "This group, if established by the Commission, could be very useful in order to reach a consensus in this area", he said.

Source: Hanna Hanssen

European Society for Human Reproduction and Embryology

U.S. Provides Assistance To Burkina Faso For Meningitis Epidemic

2011-09-21T08:10:00.019-07:00

The United States
Government, through the U.S. Agency for International Development (USAID),
will provide $450,000 through the U.S. Embassy in Ouagadougou to the UN
Children's Fund (UNICEF) for vaccines urgently needed to maintain control
of an outbreak of meningitis. On April 10, U.S. Ambassador Jeanine Jackson
issued a disaster declaration.

Since January 2007, health authorities with the Government of Burkina
Faso (GOBF) have reported more than 19,500 cases of meningitis, exceeding
the total number of reported cases during the last major meningitis
outbreak in the country in 1996. As of April 4, 1,337 people had died from
the infectious disease.

According to the UN Office for the Coordination of Humanitarian
Affairs, 41 of 55 health districts require immediate assistance to treat
meningitis and prevent further loss of life. The rapid increase in the
number of reported cases has strained the capacity of the GOBF to respond.

USAID will continue to monitor the situation and provide additional
support as needed.

For more information about our humanitarian assistance programs, please
visit: usaid/our_work/humanitarian_assistance.

U.S. Agency for International Development

usaid

Talley Environmental Care™ Launch New Website For TECcare™ Antimicrobial Technology

2011-09-21T08:10:00.018-07:00

Talley Environmental Care has launched a new website to support their TECcare antimicrobial technology.

The website www.teccare has details of the new safe antimicrobial technology developed by Talley
Environmental Care Ltd, this technology has been developed to meet the ever changing demands of industry
and society as a whole, whilst ensuring the safety of the people and the environment.

Talley Environmental Care is a UK based company situated in Romsey, Hampshire with Environment
Protection Agency (EPA) approved manufacturing facilities.
Established in 2007 the company's purpose is the promotion of TECcare antimicrobial technologies
nationally and internationally through direct distribution or through strategic partnerships and licensing
agreements.

TECcare antimicrobial technologies have been rigorously tested using EN, EU and AOAC testing protocols
in accordance with Good Laboratory Practice and can be used in Federally Inspected meat, poultry and
seafood processing locations.

Their expertise is based in Research & Development around novel core technologies unique to Talley
Environmental Care. All products within the TECcare range are developed to meet the specific needs of
clients.

TECcare antimicrobial technology does not contain damaging chemicals and skin irritants such as alcohols,
phenols, chlorine and aldehydes, so avoids the serious hazard issues of comparable products like Hydrogen
Peroxide and Chlorine releasing agents such as bleach, so the technology is well suited for repeated use on
surfaces. It is safe and effective as well as being fully biodegradable and environmentally friendly.

All of the products have been extensively tested by GLP accredited laboratories and have shown to kill /
deactivate an extensive range of pathogens including MRSA, Cdifficile, Norovirus, Human Influenza A, as
well as an extensive range of other bacteria, bacterial spores, viruses, moulds and fungi. Clinical test data
and reports are available for download from the website
The TECcare antimicrobial technology can be used in a variety of areas and industries including Healthcare,
Pharmaceuticals, Advanced Wound care, Dentistry, Food and Beverage, Hospitality and Leisure, Water
Treatment, Schools and Nurseries as well as for General Domestic Hygiene.

Source
Talley Environmental Care

UCLA Researchers Develop T-cells From Human Embryonic Stem Cells

2011-09-21T08:10:00.017-07:00

Researchers from the UCLA AIDS Institute and the Institute for Stem Cell Biology and Medicine have demonstrated for the first time that human embryonic stem cells can be genetically manipulated and coaxed to develop into mature T-cells, raising hopes for a gene therapy to combat AIDS.

The study, to be published the week of July 3 in the online edition of the Proceedings of the National Academy of Sciences, found that it is possible to convert human embryonic stem cells into blood-forming stem cells that in turn can differentiate into the helper T-cells that HIV specifically targets. T-cells are one of the body's main defenses against disease.

The results mark the first time that scientists have been able to derive T-cells out of human embryonic stem cells, said Zoran Galic, assistant research biologist, and lead researcher on the study.

"This tells you that you may be able to use human embryonic stem cells to treat T cell and other blood diseases. This could be a very important weapon in the fight against AIDS," Galic said.

The study is available at pnas/papbyrecent.shtml

In their study, the researchers cultured human embryonic stem cells, which were incubated on mouse bone marrow support cells, which in turn converted them into blood forming cells. Those cells were then injected into a human thymus gland that had been implanted in a mouse, and the thymus then changed those blood-forming cells into T-cells. Located just above the heart in humans, the thymus is the organ where T-cells develop. It gradually shrinks in adults, weakening the immune system over time.

These results indicate that it is possible to decipher the signals that control the development of embryonic stem cells into mature T-cells, said study co-author Jerome Zack, associate director of the UCLA AIDS Institute, and professor of medicine and of microbiology,
immunology and molecular genetics at the David Geffen School of Medicine at UCLA.

"That way we can eventually repopulate the immune system in patients needing T-cells," Zack said.

This in turn could give rise to gene therapy approaches to treat other diseases involving T-cells. In addition to HIV, for instance, the technique could be used to treat severe combined immunodeficiency, or the "bubble boy disease," which leaves its victims without a working immune system, forcing them to a life in an antiseptic, germ-free environment.

###

Other researchers who participated in this study are Scott G. Kitchen, Amelia Kacena, Aparna Subramanian, Bryan Burke and Ruth Cortado, all with the David Geffen School of Medicine at UCLA.

The National Institutes of Health funded the study.

Established in 1992, the UCLA AIDS Institute is a multidisciplinary think tank drawing on the skills of top-flight researchers in the worldwide fight against HIV and AIDS, the first cases of which were reported in 1981 by UCLA physicians. Institute members include researchers in virology and immunology, genetics, cancer, neurology, ophthalmology, epidemiology, social science, public health, nursing, and disease prevention. Their findings have led to advances in treating HIV as well as other diseases such as hepatitis B and C, influenza, and cancer.

The Institute for Stem Cell Biology and Medicine was launched on March 6, 2005, with a UCLA commitment of $20 million over five years. The institute brings together geneticists, engineers, ethicists, chemists, policy experts, pathologists, immunologists, oncologists, hematologists and scientists from other disciplines to uncover the mysteries of the growth and development of adult and embryonic stem cells. The institute is a collaboration of the David Geffen School of Medicine at UCLA, UCLA's Jonsson Cancer Center, the UCLA Henry Samueli School of Engineering and Applied Science, and the UCLA College of Letters and Science.

Contact: Enrique Rivero

University of California - Los Angeles

Vitamin C May Aid In COPD/Pneumonia Prognosis

2011-09-21T08:10:00.016-07:00

During exacerbation, vitamin C is markedly decreased in inflammatory diseases, such as acute pneumonia and COPD, according to a new study. Serbian researchers compared the values of serum ascorbate concentration and laboratory inflammation indicators in 60 nonsmoking patients. The patients were split into three groups: 20 patients with acute pneumonia (group I), 20 patients with stable COPD (group II), and 20 patients with exacerbated COPD (group III). Researchers concluded that patients in groups I and III had significantly decreased levels of vitamin C and increased inflammation before therapy, compared with patients after therapy. It is suggested that the elevation of vitamin C in serum is a good prognostic parameter for disease evaluation.

###

CHEST 2006 abstract briefs

Contact: Jennifer Stawarz

American College of Chest Physicians

Study Shows Automatic Faucets Carry High Levels Of Bacteria, Unsafe For Use In High-Risk Patient Hospital Settings

2011-09-21T08:10:00.015-07:00

Researchers at The Johns Hopkins University School of Medicine have determined that electronic faucets are more likely to become contaminated with unacceptably high levels of bacteria, including Legionella spp., compared with traditional manually operated faucets. The study will be presented on Saturday at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).

Electronic-eye, non-touch faucets have been increasingly utilized in healthcare settings to lower water consumption and in an attempt to reduce recontamination of the hands of healthcare personnel. Emily Sydnor, MD, infectious disease fellow at The Johns Hopkins University School of Medicine, and colleagues, working in conjunction with the facilities and engineering departments at Johns Hopkins Hospital examined bacterial growth from faucets of two clinical wards within the hospital from December 2008 through January 2009. Their study included 20 manual faucets and 20 electronic faucets, each receiving water from the same source.

Cultures obtained from the faucets showed that 50 percent of water cultures from electronic faucets grew Legionella spp. compared to 15 percent of water cultures from manual faucets. Sydnor also found that 26 percent of water cultures from electronic faucets had significant growth on heterotrophic plate count (HPC) cultures, an estimate of the number of bacteria in the water, compared to 13 percent of water cultures from manual faucets. While the HPC rates were not statistically different, Sydnor believes the differences are worth noting.

Additionally, following a flush of the water system using chlorine dioxide the disparity between electronic and manual faucets persisted. After the cleaning, 29 percent of electronic faucet cultures were still contaminated with bacteria compared with seven percent of manual faucet cultures.

Sydnor speculated that the increased bacterial growth in electronic faucets may be due to contamination of the numerous parts and valves that make up the faucet. During the course of collecting water samples, researchers discovered that all of the electronic faucet parts grew Legionella spp.

She explained that the study's findings should not create cause for concern over the use of electronic faucets by the general public. "The levels of bacterial growth in the electronic faucets, particularly the Legionella spp., were of concern because they were beyond the tolerable thresholds determined by the hospital. Exposure to Legionella spp. is dangerous for chronically ill or immune compromised patients because it may cause pneumonia in these vulnerable patients. The levels we found of both Legionella spp. and bacterial burden on HPC were still within the level that is well tolerated by healthy individuals," said Sydnor. Following the study, Johns Hopkins Hospital is replacing electronic faucets in clinical areas with manual faucets, and has decided not to install electronic faucets in clinical areas of its new hospital building now under construction.

Regardless of faucets type, Gordon noted that the importance of proper hand-hygiene practices by healthcare personnel to help reduce transmission of pathogens in healthcare settings should not be marginalized. "Proper hand hygiene practices are a basic and evidence-based element of helping to prevent HAIs."

"As infectious disease experts, our job is to remain vigilant about protecting patients from potential exposure to infection causing agents. This means that no matter how innovative the technology, the benefits must always be weighed against patient protection," said Steven Gordon, MD, president of SHEA.

Source:

Tamara Moore

Society for Healthcare Epidemiology of America

Urban Demolition Projects in Zimbabwe Disrupting AIDS Treatment, Could Lead to Drug Resistance, More Infections, Report Says

2011-09-21T08:10:00.014-07:00

Zimbabwe's urban evictions campaign, which the government has said is necessary to eradicate black market activity in urban shantytowns, might be compounding the HIV/AIDS epidemic in the country, according to a... report released on Sunday by Human Rights Watch, the AAP/Sydney Morning Herald reports (AAP/Sydney Morning Herald, 9/11). The government began the evictions in May and used bulldozers to demolish shops and homes. About 700,000 people were left homeless (Quinn, Reuters, 9/11). Many HIV-positive people have had to move to rural areas where there is little access to antiretroviral treatment, and "hundreds of people are now going to die," the report says (AAP/Sydney Morning Herald, 9/11). In addition, the National Blood Transfusion Service Zimbabwe said the demolitions also have led to a blood shortage in the country, as regular donors have moved away or are unreachable (BBC News, 9/11). Many people are reluctant to donate blood for fear they might learn they are HIV-positive. Zimbabwe's blood donation system is voluntary and is one of the few in Africa that screens donated blood for HIV, according to Xinhua News Agency (Mucharowana/Gao, Xinhua News Agency, 9/11). The country has just 650 units of blood available instead of the required 3,000 units (BBC News, 9/11). Meanwhile, a government official on Friday said that Zimbabwe's HIV/AIDS prevalence has fallen from 24% last year to 21% because of behavior change among the adult population (Xinhuanet/People's Daily Online, 9/11).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Yet Another New Study Links RN Nurse Staffing To An Increase In Patient Infections And Hospital Costs

2011-09-21T08:10:00.013-07:00

A new study published
in the July issue of the open access journal Critical Care finds that
understaffing of registered nurses in hospital intensive care units
increases the risk of serious infections for patients; specifically
pneumonia, a preventable and potential deadly complication that can add
thousands of dollars to the cost of care for hospital patients.

The study is the second in three months to link poor ICU staffing to
hospital infections, and the fourth this year to link poor RN-to-patient
ratios to poor patient outcomes for hospitalized patients. The new research
bolsters the case for increasing RN staffing in hospitals and limiting the
number of patients assigned to a nurse as has been proposed in pending
legislation, the Patient Safety Act (H.2059), currently before the
Massachusetts legislature.

Stephane Hugonnet and colleagues from the University of Geneva
Hospitals, Switzerland, investigated the number of patients admitted to the
ICU who developed ventilator-associated pneumonia (VAP), over a four-year
period. They then compared this to the number of nurses on duty for each
patient in the preceding days. VAP affected over a fifth of the 936
patients who received mechanical ventilation during the study. The team
found that when there were lower numbers of nurses, patients were more
likely to catch pneumonia six days or more after being placed on a
ventilator. This could be due to short-staffed nurses having less time to
follow hand hygiene recommendations and proper isolation procedures or
being unable to provide adequate care to the ventilated patient. The
nurses' training level had no effect on infection rates.

"This study shows that a low nurse-to-patient ratio increases the risk
of late-onset VAP," said Hugonnet. "It also adds to the growing body of
evidence demonstrating that adequate staffing is a key determinant and a
prerequisite for adequate care and patient safety." VAP is caused by
bacteria entering the lungs as a consequence of the ventilator tubing and
is one of the most common preventable problems affecting critically ill
hospital patients. It can cause a stay of about an average of 10 extra days
in the hospital at a cost of $10,000 to $40,000.

"This is yet another in a long line of recently published studies that
clearly demonstrate that improving RN staffing ratios has enormous societal
benefits in terms of lives saved and reduced complications, while also
being highly cost effective," said Karen Higgins, RN, an ICU nurses at
Boston Medical Center and co-chair of the Coalition to Protect
Massachusetts Patients, an alliance of 107 leading health care, civic and
consumer groups promoting passage of The Patient Safety Act. "There is no
longer any rationale for allowing hospitals to deprive patients of the
lifesaving care nurses are capable of providing if and when nurses have a
safe number of patients to care for at one time."

New Study Links ICU RN Staffing to Increased Infections/2

A 2003 report by the prestigious Institute of Medicine on the impact of
nurses' working conditions on patient safety found that poor RN staffing
and excessive overtime increased the likelihood of preventable patient
injuries and deaths. One of the recommendations of the IOM report was for a
strict limit of no more than two patients for nurses in ICUs as well as to
provide limits on overtime for nurses.

Nurses in Massachusetts hospitals, including those working in ICUs are
regularly forced to accept unsafe patient assignments as identified in the
new study. A study of actual RN staffing levels in the state's hospitals
conducted by the Massachusetts Nurses Association and Andover Economic
Evaluation in 2006 found that in a shocking 36 percent of observations
hospitals failed to meet the accepted minimum standard of no more than two
patients per nurse in the intensive care unit.

The Patient Safety Act (H. 2059) would dramatically improve care by
setting a safe limit on the number of patients assigned to a nurse. The
measure, which is co-sponsored by State Rep. Christine Canavan (D-Brockton)
and Senator Marc Pacheco (D-Taunton), calls upon the Department of Public
Health to set a safe limit on the number of patients a nurse is assigned at
one time. In addition, the bill calls for staffing ratios to be adjusted
based on patient needs. It also bans mandatory overtime, and includes
initiatives to increase nursing faculty and nurse recruitment. During the
last legislative session, the Massachusetts House of Representatives passed
a similar bill by a vote of 133-20. A hearing on the bill has been
scheduled before the Joint Committee on Public Health on Oct. 24, 2007.

The Coalition to Protect Massachusetts Patients

protectmasspatients

The Effect Of Dietary Supplements, Acids And Animal Protein On Gastrointestinal Disorders

2011-09-21T08:10:00.012-07:00

High protein intake may be associated with increased risk of inflammatory bowel disease, while fatty acids found in olive, peanut and grapeseed oils may protect against the development of ulcerative colitis, according to new data being presented at Digestive Disease Week® (DDW®) 2010. DDW is the largest international gathering of physicians and researchers in the field of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

"We know more now than we ever have about the effect of specific nutrients on GI health, and these studies bring us closer to treating, and perhaps even preventing some of these disorders," according to Kelly A. Tappenden, PhD, RD, University of Illinois. "Although there is more research to be done on these important issues, armed with these new data on the links between diet and GI disorders, we can continue to work toward better therapies and improved health outcomes."

Retinol Supplements Antiviral Action of Pegylated Interferon and Ribavirin Combination Therapy in Patients with Chronic Hepatitis C: Prospective Pilot Study (Abstract #T2004)

Vitamin A supplements increase the anti-viral effect of gold-standard treatment drugs for hepatitis C (HCV), according to a new study from Shimane University School of Medicine in Izumo, Japan. This is the first study in which vitamin A (retinol) was given during all 48 weeks with PegINFО±2b and rivabirin in order to evaluate the early viral response and outcome (rate of sustained virological response, etc.) of patients with chronic HCV.

Previously, the number of patients with HCV who achieved a sustained virologic response after the standard therapy of peg-interferon and ribavirin was low, so investigators at Shimane University School of Medicine sought a way to enhance the anti-viral effect of interferon and ribavirin on HCV.

They found that retinol improved the antiviral effect of PegIFNО±-2b/ribavirin in patients with chronic HCV. "Our findings show that it is possible to improve the poor results of the gold-standard treatment for hepatitis C with virtually no risk of side effects," said Shuichi Sato, MD, second department of internal medicine at Shimane University. "We believe that more patients will benefit from our findings."

Investigators studied 42 patients with chronic HCV as part of a multi-center prospective trial. Patients were automatically randomized between the control and retinol groups by the secretariat. The control group received pegylated interferon alpha-2b once a week intramuscularly, plus 600 or 800 mg per day of ribavirin orally for 48 weeks. In the retinol group, in addition to the above treatment, patients also received oral retinol at 30,000 units per day during the combination therapy.

The HCV negativity rate at eight weeks after starting pegylated interferon alpha-2b and ribavirin combination therapy was 61.7 percent for the retinol group and 23.8 percent for the control group. Also, the rates of sustained virological response were 66.7 percent and 42.9 percent, respectively. There were no differences for the rates of non-response and discontinued treatment between the groups, and no adverse event caused by retinol was observed in patients who received pegylated interferon plus ribavirin combination therapy.

Dr. Sato added that very often high doses of different vitamins are being used solo or alongside different drugs for various conditions, but that this should always be done under direct medical supervision.

Dr. Sato will present these data on Tuesday, May 4 at 8:00 a.m. CT in Hall F, Ernest N. Morial Convention Center.

Dietary Oleic Acid May Protect Against the Development of Ulcerative Colitis - A UK Prospective Cohort Study (Abstract #100)

Oleic acid in one's diet may help reduce or prevent the development of ulcerative colitis (UC). Oleic acid, a monounsaturated fatty acid, is present in olive, peanut, and grapeseed oils and may prevent ulcerative colitis from developing by suppressing inflammation by blocking chemicals in the bowel that aggravate inflammation. UC affects men and women of all ages and is characterized by inflammation of the lining of the colon or large bowel, which can cause distressing symptoms such as abdominal pain, diarrhea and weight loss.

Researchers led by Andrew R. Hart, MD, senior lecturer in gastroenterology, University of East Anglia, Norwich, U.K., sought to determine whether people eating more oleic acid are protected against developing UC. They studied more than 25,000 men and women aged 40 to 65 years in Norfolk, England, who were recruited between 1993 and 1997 into a study called EPIC (European Prospective Investigation into Diet and Cancer). These participants, initially without UC, completed a diary of all the foods they ate for one week including foods eaten, the quantity and brands in detail.

The diaries were then coded by specially trained nutritionists using a specific computer program called DINER. The nutritionists, using DINER, calculated the dietary intake of different foods consumed by participants, including oleic acid. Patients were followed up to 2004 to identify those who were subsequently diagnosed with UC. Researchers compared any differences in diet, including oleic acid, between those who were diagnosed with UC and those who remained healthy.

The study found that individuals with the highest intake of oleic acid had a 90 percent lower risk of developing UC. Dr. Hart estimates that approximately half the cases of UC could be prevented if larger amounts of oleic acid were consumed - as much as two to three tablespoons of olive oil per day could have a protective effect.

Dr. Hart said similar work in other countries is now required to determine if the results are reproducible and consistent in other groups. These are required to confirm whether oleic acid is truly protective. If so, researchers believe that dietary modifications may prevent this distressing illness and that the use of oleic acid supplements should be clinically assessed as treatment for patients with UC. Additionally, while most conditions are treated with drugs rather than dietary treatments, Hart noted that a proven complementary approach using both may be a research topic for the future to benefit more patients.

"If we could show that dietary treatments complement drug treatments then that could have a better outcome than either approach by itself," he said. "This is critical since many patients with UC have to take medications life-long, may need surgery and have an increased risk of complications including cancer and perforation of the large bowel."

Punya de Silva, MD presented these data on Sunday, May 2 at 11:45 a.m. CT in 295-296, Ernest N. Morial Convention Center.

Higher Resolution Rate of Clostridia Difficile Enteritis in Hospitalized Patients with Normal Vitamin D Levels (Abstract #T1793)

A new study shows that patients with low vitamin D levels who develop Clostridia difficile (C. diff) have a higher recurrence rate and possibly higher hospital mortality. C. diff is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis, and often occurs after taking antibiotics.

Previous studies have shown that normal levels of vitamin D are associated with improved outcomes in hospitalized patients, and conversely, low levels of vitamin D have been associated with higher mortality rate in hospitalized patients. Investigators at New York Hospital Queens-Weill Cornell Medical College, led by Moshe Rubin, MD, director of gastroenterology, sought to determine whether vitamin D levels are associated with a persons' ability to resolve their infection.

Researchers tracked 83 patients who had been admitted to the hospital who were then diagnosed with C. diff. They measured vitamin D levels in all of the patients, then followed their hospital course. Researchers noted how many patients were still alive after 30 days, and compared the outcome of patients with normal vitamin D levels to those with low levels. They found that up to 40 percent of people, especially in an older age group with multiple illnesses, died from some cause if they developed C. diff during that hospitalization.

Furthermore, while they may not die from C. diff, Dr. Rubin said it definitely adds a major complication that contributes to high mortality.

Researchers found that those with normal levels of vitamin D had a higher resolution rate, and a lower recurrence rate than those with low vitamin D levels. These findings are consistent with what is currently understood about vitamin D - it plays a role in immune function, may be an important factor in fighting infection, low levels seem to be a marker for not resolving diseases in general and it is associated with higher mortality rates.

Sixty-two patients were tracked for 30 days; 45 percent had normal vitamin D levels while 55 percent had low vitamin D levels. In the normal vitamin D group, they found 53 percent remained disease-free for 30 days, but in the group with low vitamin D levels, only 26 percent resolved their C. diff infections. Dr. Rubin noted that since this study was observational, it does not prove a cause and effect relationship between vitamin D levels and recurrence of C. diff, but it does identify an association.

Dr. Rubin said that since the study sample was relatively small, it should be repeated with a larger patient population to corroborate the data.

"We're starting to understand the importance of vitamin D in relation to overall health and to particular infections, like C. diff," said Dr. Rubin. "It's important to pay attention to nutritional issues and possibly even supplement vitamin D in patients with low levels to help fight serious infections."

Dr. Rubin will present these data on Tuesday, May 4 at 8 a.m. CT in Hall F, Ernest N. Morial Convention Center.

Animal Protein Intake and Risk of Inflammatory Bowel Disease: The E3N Prospective Study (Abstract #98)

For the first time, in a large prospective study, researchers have identified an association between high protein intake and a significantly increased risk of inflammatory bowel disease (IBD). While doctors have long suspected that diet contributes to IBD, little has been assessed, and the studies conducted have been retrospective, which are less informative because they rely on the study participants' ability to recall what they have consumed in the past. This study examined the effects of different sources and amounts of protein.

Using participants in France's E3N cohort study, researchers led by Prevost Jantchou, MD, of the Center for Research in Epidemiology and Population and colleagues identified 77 women ages 40 to 65 with validated cases of IBD. In each case, the onset of IBD occurred after the first dietary questionnaire was administered, thereby assuring that they could be studied prospectively.

Dr. Jantchou examined participants' macronutrient (protein, fat and carbohydrate) intake, and determined that more than two-thirds of them had elevated levels of protein intake. Participants were divided into three groups based on their mean protein intake: the lowest intake group had a mean daily protein intake of 1.08 grams/kg of body weight; the middle group had 1.52 grams/kg; and the highest group had 2.07 grams/kg. The FDA recommends a daily intake of 0.8 grams of protein per kilogram of body weight.

When examining the effects of specific types of protein, Jantchou found that animal protein represented a threefold risk of developing IBD in the highest group compared to the lowest group. Specifically, animal protein from meat and fish, not dairy, created an increased risk, while vegetable protein created no increased risk of developing IBD.

Researchers found that the increased risk from animal protein intake were the same for Crohn's disease and ulcerative colitis. They also found that smoking and hormonal therapy, two factors known to be related to the risk of IBD, did not change their results.

"Our findings represent a tremendous step forward in our understanding of inflammatory bowel disease," said Dr. Jantchou. "For years we've known there was a connection between diet and IBD, and we now know specifically which aspect of diet is related to disease occurrence. The next step is to look at the effect of animal protein in patients already diagnosed with IBD to be able to give them better dietary advice."

Dr. Jantchou presented these data on Sunday, May 2 at 11:15 a.m. CT in 295-296, Ernest N. Morial Convention Center.

Alcohol Consumption as a Modifiable Risk Factor in Elective Surgery (Abstract #791)

Alcohol consumption is a significant contributor to adverse outcomes in elective surgery, according to a new study from the University of Massachusetts Medical School.

Researchers studied more than 300,000 discharge records from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database for elective adult admissions. The database includes data from approximately 125 hospitals across the country. Because of its size, this study was able to account for internal biases and determine the independent effect of alcohol consumption on morbidity and mortality following surgery.

Patient records examined in the study were divided into two groups: those with active alcohol exposure, which was defined as at least two drinks per day everyday for two weeks prior to surgery, and those who did not have active alcohol exposure. Those with active alcohol exposure represented 2.5 percent of the records examined. Researchers measured outcomes including length of stay, wound infection, sepsis and death, and found that alcohol use was an independent predictor of pneumonia, sepsis, superficial surgical site infection, wound disruption and longer median hospital stays, and that acute alcohol consumption had a significant effect on mortality.

"This is important information for both patients and surgeons," said Shimul A. Shah, PhD, assistant professor of surgery at the University of Massachusetts Medical School and senior author of the study. "Based on the significant adverse effects on outcomes following surgery, patients who regularly consume this amount of alcohol may want to consider postponing elective surgery until they have abstained from drinking for at least two weeks prior to surgery. Or surgeons may want to consider delaying surgery until patients have shown abstinence from alcohol for at least two weeks to avoid some of the potential complications."

Dr. Shah added that his study's findings serve as a basis for further research that can be done on the local level to examine alcohol consumption trends in more depth to determine the potential that undiagnosed cirrhosis is contributing to these poor surgical outcomes.

Dr. Shah will present these data on May 4 at 2:45 p.m. CT in 243, Ernest N. Morial Convention Center.

Source:

Amy Levey

Digestive Disease Week

University Of Washington Institute For Health Metrics To Host Conference On Improving Calculation Of Global Health Data

2011-09-21T08:10:00.011-07:00

About 300 public health officials and researchers from around the world gathered on Wednesday for a two-day conference aimed at improving methods for collecting, analyzing and disseminating global health data, including information on HIV/AIDS, the Seattle Post-Intelligencer reports. The University of Washington Institute for Health Metrics and Evaluation, which was created in large part by a grant from the Bill & Melinda Gates Foundation, is hosting the conference, which is co-sponsored by the Lancet.

The conference will focus on the next phase of the World Health Organization's Global Burden of Disease Project, created by Alan Lopez, an expert on international health at the University of Queensland-Australia, and IHME Director Christopher Murray. The project seeks to establish more effective methods for analyzing disease trends, establishing health priorities, identifying the effectiveness of disease-fighting projects and assessing health delivery and quality, the Post-Intelligencer reports. One of the project's creations is the disability-adjusted life year, or DALY, which combines morbidity and mortality rates to provide a more complete depiction of the effect of a disease (Paulson, Seattle Post-Intelligencer, 4/9).

Richard Horton, editor of the Lancet, said that there has been an "enormous rumor mill about potential rivalries between individuals and organizations" about the way statistics are reported, adding, "I think the conference is very much about saying, 'Let's kill these rumors and try to build a proper cooperative relationship'" (Doughton, Seattle Times, 4/9). Murray said, "There's a lot of good work being done out there, but it's being done by many groups who don't talk to each other ... and who often use different yardsticks to assess their efforts" (Seattle Post-Intelligencer, 4/9).

UNAIDS Executive Director Peter Piot, who will lead a session at the conference, plans to work with Murray and his team to tease out more detail from UNAIDS statistics, the Times reports. Piot said that he also is eager to use new methods developed at IHME to determine the effectiveness of programs created to slow the spread of the epidemic. The Gates Foundation also has asked IHME to assess its $258 million Avahan program, an HIV-prevention program targeted at Indian sex workers and their clients (Seattle Times, 4/9).

Lopez said, "We're still quite ignorant about the health conditions of the developing world, but I'd say we're a little less ignorant than we were 15 years ago." He added that a "good example" of a disease that needs improved data reporting methods is malaria, adding, "We still don't really know how many people die every year from malaria ... or if it's increasing or decreasing" (Seattle Post-Intelligencer, 4/9).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Two common antiretrovirals are equally effective, but one has fewer side effects

2011-09-21T08:10:00.010-07:00

In the July 14 issue of The Journal of the American Medical Association (JAMA), researchers from Johns Hopkins and other institutions will present results from what is believed to be the first three-year, randomized, double-blind, clinical trial comparing antiretroviral therapies for HIV infection.

News tip from the 2004, XV International Conference on AIDS, July 11-16, Bangkok, Thailand

Their findings, to be made public July 11 at a JAMA media briefing, show that combination regimens including tenofovir DF (Viread) or stavudine (d4T, Zerit) are equally effective, but tenofovir DF has less toxic outcomes with respect to cholesterol levels, lipodystrophy (changes in distribution of body fat) and peripheral neuropathy (pain or numbness in legs.)

The study involved more than 600 patients in 81 centers in the United States, South America and Europe, and was conducted from July 2000 to January 2004.

"These results support the use of tenofovir DF as a component of initial therapy for HIV infection," says study lead author Joel Gallant, M.D., M.P.H., assistant professor and associate director of the AIDS Service at The Johns Hopkins University School of Medicine.

Comparing the Efficacy and Safety of Tenofovir DF vs. Stavudine in Combination Therapy in Antiretroviral-Naпve Patients. Joel E. Gallant, Schlomo Staszewski, Anton L. Pozniak, Edwin DeJesus, Jamal M.A.H. Suleiman, Michael D. Miller, Dion F. Coakley, Biao Lu, John J. Toole, Andrew K. Cheng,. (JAMA. 2004; 292:191-201. Available post-embargo at JAMA)

Contact: David March

dmarch1jhmi.edu

410-955-1534

Johns Hopkins Medical Institutions

View drug information on Viread; Zerit.

Zimbabwe's HIV/AIDS Programs Overlook Farm Communities, Advocates Say

2011-09-21T08:10:00.009-07:00

Zimbabwean farm workers are not receiving adequate education, treatment or care from the country's HIV/AIDS programs, advocates in the country have said, PlusNews reports. According to PlusNews, many factors have increased farmers' vulnerability to the effects of the disease -- including a lack of affordable antiretroviral treatment, the historic exploitation of farmers, a series of droughts and a land redistribution program conducted in 2001. In addition, HIV prevention campaigns often do not reach farm workers, which has "allow[ed] myths about the disease to go unchallenged," PlusNews reports. In an effort to curb the spread of HIV among farmers, the General Agriculture and Plantations Workers Union of Zimbabwe has distributed no-cost condoms and has held workshops that encourage HIV testing. However, Gift Muti, deputy secretary-general of the GAPWUZ, said that the amount of unintended pregnancies and the rate of sexually transmitted infections "clearly show[s] that [farmers] are not using the condoms." The Zimbabwe Business Council on AIDS in collaboration with GAPWUZ is planning on conducting a survey to determine the impact of HIV/AIDS on commercial and communal farms (PlusNews, 10/3).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Task Force Calls For Lifting Of HIV/AIDS-Related Travel Restrictions

2011-09-21T08:10:00.008-07:00

An international task force on HIV/AIDS-related travel restrictions chaired by UNAIDS and the Norwegian government is calling on nations worldwide to remove such bans, AFP/Yahoo! News reports. According to UNAIDS, about 74 countries have imposed HIV/AIDS-related travel restrictions, and 13 of them have banned people living with the virus from entering the countries entirely.

The task force -- which includes governments, United Nations agencies, civil society groups and HIV-positive people -- met for the first time from Feb. 25-26 in Geneva. The task force is expected to discuss issues surrounding the travel restrictions at several meetings in the next few months, including an HIV/AIDS meeting at the U.N. General Assembly in June and the Global Forum on Migration and Development in October.

According to a UNAIDS statement, HIV-positive people while in their destination country can face deportation "often without confidentiality and into situations of great discrimination and economic devastation." UNAIDS Executive Director Peter Piot said that HIV/AIDS-related travel restrictions illustrate the "exceptionality of AIDS." He added, "No other condition prevents people from entering countries for business, tourism or to attend meetings. No other condition has people afraid of having their baggage searched for medication at the border, with the result that they are denied entry or worse -- detained and then deported back to their country." UNAIDS said that it hopes that "combined efforts" from members of the task force will "influence governments to remove such restrictions" (AFP/Yahoo! News, 3/7).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

The American Society For Microbiology Honors Manuela Raffatellu

2011-09-21T08:10:00.007-07:00

Manuela Raffatellu, M.D., Assistant Professor, Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine, has been chosen by the American Society for Microbiology (ASM) to receive a 2010 ICAAC Young Investigator Award. Sponsored by the ASM, this award recognizes an early career scientist for research excellence in microbiology and infectious diseases.

Dr. Raffatellu earned her M.D. at the University of Sassari, Italy, and completed her postdoctoral work at Texas A&M University and the University of California, Davis.

Early in her post-doctoral studies, Dr. Raffatellu was intrigued by the clinical observation that the human pathogen Salmonella typhi does not trigger an inflammatory response in the gut. Her subsequent work contributed to the identification of the Vi capsular antigen as a novel virulence factor promoting immune evasion by S. typhi. More recently, Dr. Raffatellu's research has been focused on the gut pathogen Salmonella typhimurium, with the goal of elucidating its interaction with both immunocompetent and immunocompromised hosts. Dr. Raffatellu became interested in understanding which components of the gut inflammatory response prevent S. typhimurium from systemic spreading by containing the infection to the mucosa. Her work has identified a novel role for early T cell responses and the cytokine IL-17 in preventing S. typhimurium dissemination from the gut, thus benefiting the host. Dr. Raffatellu subsequently began studying the mechanisms by which S. typhimurium thrives in the inflamed gut, and currently continues to work on the mucosal response to Salmonella.

The ICAAC Young Investigator Award will be presented during ASM's 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), September 12-15, 2010 in Boston, MA.

Source:

Garth Hogan

American Society for Microbiology

Texas Department Of State Health Services Urges Primary Amebic Meningoencephalitis Precautions

2011-09-21T08:10:00.006-07:00

The Texas Department of State Health Services is reminding swimmers and skiers to take precautions to avoid infection from Naegleria fowleri, an ameba assumed to be present in all rivers, lakes, ponds, tanks and streams.

The ameba can cause primary amebic meningoencephalitis, or PAM, an infection of the brain. Though PAM is rare, it is almost always fatal.

The ameba thrives in warm, stagnant water but may be present in any body of fresh water. A combination of lower water levels, high temperatures and stagnant or slow-moving water may produce higher concentrations of the ameba.

Infection typically occurs when water containing the ameba is forced up the nose when diving or jumping into the water or when skiing. Initial symptoms of the infection include severe headache, high fever, stiff neck, nausea and vomiting.

The ameba does not live in salt water or in swimming pools and hot tubs that are properly cleaned, maintained and treated with chlorine.

DSHS offers these precautions to reduce the already low risk of infection:

- Never swim in stagnant water.

- Hold your nose or use nose clips when skiing, jet skiing or jumping into any water.

Other dangers associated with lakes and rivers include diving into waters that are too shallow or that may hide rocks and debris. Never leave children unattended around water.

Nine cases of PAM have been reported in Texas since 2000, including one in 2008.

Source
Texas Department of State Health Services

Third Malaysian State to Require Mandatory HIV Testing for Muslim Couples Wishing to Marry

2011-09-21T08:10:00.005-07:00

The northern Malaysian state of Kelantan in January will become the third of 13 states in the country to require HIV testing for Muslim couples who plan to marry, a state Islamic official said on Wednesday, Malaysia's... New Straits Times reports. Kelantan State Islamic Development and Propagation Committee Chair Hassan Mohamood said the state government ruled that any Muslim living in Kelantan who wishes to marry must provide evidence of an HIV test before registering for mandatory marriage counseling. If a person tests HIV-positive, the couple would be counseled on the risks and consequences related to HIV/AIDS, Mohamood said, adding, "It is then up to them if they still want to proceed with their marriage." Free HIV testing is available at government-run hospitals, but Mohamood said a small fee might be introduced in the future, according to the New Straits Times (Abdullah, New Straits Times, 5/25). "We will only recognize test results issued by government hospitals and will not entertain tests conducted at private clinics or hospitals," he said, adding, "The government is not in the business of stopping anyone from getting married, but we have to stem the spread of such a disease and ensure that those infected know what they are doing" (Star, 5/26). About 900 new HIV cases were reported in Kelantan in 2004, and 58,012 HIV cases have been reported in Malaysia since the end of 2003, AFP/Khaleej Times reports. The Malaysian states of Johor and Perlis already require HIV testing for Muslim couples wishing to marry (AFP/Khaleej Times, 5/26). Johor in October 2001 became the first state to issue the fatwa, or religious decree, for the mandatory tests (Kaiser Daily HIV/AIDS Report, 10/31/01).

"Reprinted with permission from kaisernetwork kaisernetwork. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork/dailyreports/hiv.. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

West Nile Virus Arrives in New York

2011-09-21T08:10:00.004-07:00

Three Mosquito Pools in the Bronx Test Positive for WNV; Two Manhattan Residents Have West Nile Fever; New Yorkers Aged 50 and Older Urged to Take Precautions -

The first signs of West Nile virus (WNV) in New York City during the 2005 mosquito season have been detected, health officials announced today. Three pools of mosquitoes collected in the Bronx have tested positive for WNV; the infected mosquitoes were identified in the neighborhoods of Eastchester, Woodlawn, and Baychester. The Department of Health and Mental Hygiene (DOHMH) has increased mosquito surveillance and larviciding in these areas; no spraying is planned at this time.

Additionally, two Manhattan residents - both males, ages 50 and 54 - have been preliminarily diagnosed with West Nile fever. Both patients have recent travel history outside the City and investigations are underway to better determine where they were infected. While they have exhibited symptoms of WNV infection (e.g., headache, fever, chills), neither of them were hospitalized and both are recovering. With the official arrival of the West Nile virus season, DOHMH Commissioner Thomas R. Frieden, MD, MPH reminded New Yorkers - particularly those over the age of 50 - to eliminate standing water, where mosquitoes can breed around the home, reduce exposure to mosquitoes, and use insect repellants.

"Many older New Yorkers still may not know they are most likely to get seriously ill if infected with West Nile virus," Commissioner Frieden said. "As the summer goes on, people over the age of 50 - and especially those over the age of 65 - should guard against mosquito bites and all New Yorkers should get rid of standing water and make sure window screens are installed tightly and are free of tears or holes."

Protect Against West Nile Virus

Protect Yourself

If outside at dusk or dawn, when mosquitoes are the most active:

-- Cover up. Wear long pants, long-sleeved shirts, and socks.

-- There are currently two types of proven, effective mosquito repellents approved for use in New York State: those that contain the chemical DEET, and those that contain Oil of Lemon Eucalyptus. Always follow label instructions.

Protect your home

-- Get rid of standing water, where mosquitoes can breed.

-- Empty garbage containers and lids, buckets, cans, flower pots, pool covers, and other items where water collects.

-- Remove discarded tires.

-- Clean and chlorinate swimming pools. Empty and cover them if they're not in use.

-- Turn over wading pools when not in use.

-- Clean pet water bowls and bird baths frequently.

-- Make sure gutters are clear of debris so they can drain properly.

-- Cover wells or other outdoor water storage.

-- Use screens. Put screens on windows and doors to keep mosquitoes out. Fix or replace broken screens.

Protect your community

-- Report dead birds and standing water. Dead birds may indicate WNV infection, and mosquitoes breed in standing water. Report both online at nyc/health/wnv or by calling 311.

-- Help your neighbors. Remind or help neighbors to eliminate standing water from their property.

In 2004, there were five human cases of West Nile virus in New York City, two of which were the more serious form (encephalitis) and required hospitalization. A full summary of WNV activity for 2004 can be found online at nyc/html/doh/html/wnv/wnvr1-2004.shtml.

To report dead birds online, CLICK HERE; to report standing water online, visit: nyc/html/doh/html/wnv/wnvwater.shtml. New Yorkers can also call 311 or CLICK HERE for more information about West Nile virus and how to prevent mosquito bites.

The Lancet Assesses The Five Candidates Running For The Next Executive Director Of The Global Fund

2011-09-21T08:10:00.003-07:00

Three of the five candidates running for the job of the next Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria lead the field, with the edge going to one, according to an Editorial in this week's issue of The Lancet.

On Nov 1, the next Executive Director of the Global Fund will be announced. The five candidates are: Hilde Johnson, senior adviser to the President of the African Development Bank; Michel Kazatchkine, France's ambassador against HIV/AIDS and communicable diseases; Jim Kolbe, a Republican Congressman for Arizona; Bill Roedy, Vice Chairman of MTV Networks and President of MTV Networks International and an ambassador for UNAIDS; and Michel Sidibe, Director of the Country and Regional Support Department at UNAIDS.

In the Editorial, The Lancet assesses each candidate and comments: "The key criteria for this post are to optimise the Global Fund's grant performance, to accelerate results, and to mobilise resources, including getting donors to honour their pledges. Most importantly, the appointee needs to understand the importance of evaluation, and to break down the dependencies that can arise from being a donor or a recipient, ensuring that the relationship is one of true partnership. From the five candidates, Johnson, Kazatchkine, and Sidibe lead the field, with the edge going to Sidibe because of his strong first-hand experience of Africa."

###

Contact: Lancet press office

Lancet

UNAIDS Executive Director Piot Says He Is 'Hopeful But Not Yet Optimistic' About Curbing HIV/AIDS Pandemic

2011-09-21T08:10:00.002-07:00

The HIV/AIDS pandemic can be reversed because world leaders have a greater awareness of the disease and more funding is being funneled into the fight against it,... UNAIDS Executive Director Peter Piot said this week ahead of the U.N. 2005 World Summit in New York, BMJ reports. "I'm hopeful but not yet optimistic," Piot said, adding, "We have the political will to reverse the epidemic." He cited the President's Emergency Plan for AIDS Relief -- a five-year, $15 billion program proposed by President Bush that directs funding for HIV/AIDS, tuberculosis and malaria primarily to 15 focus countries and provides funding to the Global Fund To Fight AIDS, Tuberculosis and Malaria -- as a step in the right direction. "When global leaders meet, AIDS is on the agenda," he said, adding, "Heads of government or their deputies are leaders (against AIDS) in about 40 countries. ... They can be a link between the civil society and the state -- a link that is often missing" (Hopkins Tanne, BMJ, 9/17).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Tailoring AIDS Research To Ethnic Communities and Gender

2011-09-21T08:10:00.001-07:00

The underrepresentation of women, various ethnic groups and those with low-incomes limits the effectiveness of HIV/AIDS clinical trials and can have a serious impact on the eventual success of vaccines, says Professor Peter Newman of the Faculty of Social Work and the Centre for Applied Social Research at U of T.

Newman helped co-ordinate six focus groups involving women, Latinos and African-Americans in Los Angeles and found barriers to participation in HIV vaccine trials based on several concerns: a fear of HIV infection from the vaccine; fear of false-induced positives (testing positive in response to the vaccine); physical side effects; uncertainty about vaccine efficacy and other vaccine characteristics; general mistrust of medical research; low perceived HIV risk in their personal lives; the demands of taking part in a research study; and HIV/AIDS stigma.

Newman's research also found that these test groups would be motivated to take part in vaccine trials on the basis of gaining protection against HIV infection; free insurance and/or medical care, altruism and monetary incentives. "The rates of HIV infection are higher in certain populations, such as aboriginal communities and African and Caribbean women in Canada," Newman says. "While HIV/AIDS doesn't discriminate, some populations are more vulnerable due to discrimination and poverty; we often know how an HIV/AIDS drug is going to work in a white male between the ages of 25 to 44 but we know less about how well it will work in a woman or in a person of colour."

Newman believes this research will inevitably help those underrepresented in HIV vaccine and other AIDS clinical trials that aren't usually involved or studied. "I want to know how we can facilitate access to clinical trials among vulnerable communities and also to support a process for designing and disseminating culturally appropriate information to enable individuals to decide whether or not they should take part."

"My bottom line is that I'm not convincing people to join an HIV vaccine or other clinical trial; I'm working to facilitate appropriate and culturally relevant knowledge transfer and exchange so that persons from various communities will be empowered to decide if this is something they want to do and to mitigate any risks of involvement."

Newman's research is partially funded by the Canadian Institutes of Health Research, Social Sciences and Humanities Research Council of Canada and the National Institutes of Health in the U.S.

UNIVERSITY OF TORONTO, CANADA

Syphilis Cases Increasing In New York City, Could Fuel Increase In HIV Cases

2011-09-21T08:10:00.000-07:00

The New York City Department of Health and Mental Hygiene in the first three months of 2007 recorded 260 syphilis cases, including 10 among women, an increase in the number of cases recorded during the same period in 2006, the New York Times reports. According to the Times, syphilis is most common among men who have sex with men, although the sexually transmitted infection is increasing among women in the city (Kershaw, New York Times, 8/12).

According to CDC officials, the number of syphilis cases in the U.S. reached an all-time low in 2000. However, the number of cases has risen annually from 2000 to 2005, the most recent year for which the agency has figures. CDC analysts estimate that in 2000, MSM accounted for 7% of syphilis cases in the country but accounted for more than 60% in 2005. According to CDC, syphilis incidence in the overall population was 2.1 cases per 100,000 people in 2000, compared with three cases per 100,000 people in 2005, or 8,724 cases (Kaiser Daily HIV/AIDS Report, 7/2). According to the Times, syphilis incidence in New York City in 2005 was 7.7 cases per 100,000 people.

Most new syphilis cases in the city occur among blacks or Hispanics, although syphilis among whites is increasing at a faster rate than among other groups, according to a recent survey. Syphilis incidence among white men in the first quarter of 2007 was three times the incidence during the same period in 2006, the Times reports.

According to officials with the health department, the increase could be fueled by MSM who also have sex with women. Stuart Berman, a CDC epidemiologist, said that men with syphilis living in New York City reported bisexual behavior more than men with syphilis in other cities. According to federal health officials, people with syphilis are two to five times more likely to contract HIV because of open sores caused by the infection.

Health experts have warned that an increase in syphilis cases could contribute to an increase in HIV cases, the Times reports. Perry Halkitis, a professor of applied psychology at New York University, said there "[m]ost certainly" would be an "increase in HIV transmission." Drug use that can contribute to increased sexual activity and unsafe practices, risky sex among HIV-positive people, complacency about the risks of HIV and decreased condom usage all could be contributing to the increase in syphilis cases, according to federal and local health officials. Susan Blank, the city commissioner for sexually transmitted disease prevention and control, said that the health department is alerting residents and health care providers about the importance of syphilis screening. The health department is offering no-cost and confidential testing at all of its public clinics, Blank said. Some health officials say that the increase in cases among women underscores the need for people to learn their partners' sexual history because some women might not know that their partners have sex with men (New York Times, 8/12).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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Warren Buffet To Give About $3B To Susan Thompson Buffet Foundation, More Than $30B To Gates Foundation

2011-09-21T01:13:00.001-07:00

Berkshire Hathaway Chair Warren Buffett on Sunday in a letter disclosed that he plans to donate stock currently valued at about $3 billion to the Susan Thompson Buffett Foundation, which is named after his late wife and supports reproductive health and rights, family planning and college scholarship programs, the Wall Street Journal reports (Richardson, Wall Street Journal, 6/26). Warren Buffett's donation will be added to the $2.5 billion bestowed to the foundation in the will of Susan Thompson Buffett, who in 2004 died of a stroke (Loomis [1], Fortune, 6/25). The Buffett Foundation has been a "quiet force" in population control and has made "substantial donations" to organizations that support abortion rights, according to the Journal (Wall Street Journal, 6/26). In the past, the Buffets' philanthropic efforts reportedly have contributed to the Center for Reproductive Rights in support of its court battle to overturn Nebraska's ban on so-called "partial-birth" abortion; the ban was overturned in 2001. Their foundation also has given money to Ipas, the Population Council, the Planned Parenthood Federation of America, NARAL Pro-Choice America, Family Health International, the Religious Coalition for Reproductive Choice, Catholics for a Free Choice and the National Campaign to Prevent Teen Pregnancy. In addition, they funded millions of dollars to help mifepristone, which causes a medical abortion when taken in conjunction with the drug misoprostol, win FDA approval (Kaiser Daily Women's Health Policy Report, 7/25/03).
Donation Given To Gates Foundation
Many observers had expected Buffett to give most of his money to the Buffett Foundation, but on Sunday he disclosed that his biggest donation will be stock valued at $30.7 billion to the Bill & Melinda Gates Foundation, which works on global health and poverty issues, the Chicago Tribune reports (Miller, Chicago Tribune, 6/26). Buffet said, "If I had died before Susie and she had begun to distribute our wealth, this is the foundation that would have scaled up to a much bigger size," adding, "I came to realize that there was a terrific foundation that was already scaled up ... and that could productively use my money now." Buffett Foundation President Allen Greenberg has "done an excellent and thoughtful job of running it," Buffet said, adding, "His results-to-cost ratio is as good as I've ever seen. And he'll keep on that same path now, not just with Susie's money, but with mine too" (Loomis [2], Fortune, 6/25). Buffett also announced that he plans to give $1.07 billion each to foundations run by his three children -- the Howard G. Buffet Foundation, the Susan A. Buffet Foundation and the NoVo Foundation, according to the Tribune. The foundations support the arts, child protection, education and the environment (Chicago Tribune, 6/26).