Tenofovir (Viread, produced by Gilead), a new antiretroviral medication, lowered the viral load of patients who had developed drug resistant virus (see News Flashes, Aug/Sept HEPP News). The FDA has now approved the medication for use in all HIV-positive patients (10/26/01). Tenofovir has been shown to reduce the viral load by as much as 75% when used in combination with other medications. Experts caution against prescribing tenofovir for drug-naive patients until study results on the use of the drug in newly diagnosed patients are released. Tenofovir is a once-a-day pill that will cost about $4,135 for a year's supply. (Associated Press, 10/28/01)
The FDA recently approved gene-based test, Visible Genetic Inc.'s Trugene, that analyzes an HIV patient's viral mutations in terms of drug resistance. This test will aid physicians in prescribing the best medications for each patient depending on his/her viral genotype. Trugene uses a blood sample to identify all known genetic mutations in the virus. It then compares the individual's genetic mutations to over 70 mutations known to be linked to resistance to specific drugs. The turnaround time is three days and will cost $300-$500 per patient (see Paar D., Altice F., HEPP News September 2000). This is the first genotyping test to receive FDA approval. Other genotyping tests are available from many commercial suppliers including the Phenosense test from Virologic. (Associated Press, 9/27/01)
A survey of physicians in California, Florida, Massachusetts, and New York found that those with less experience caring for HIV/AIDS patients need expert advice in the process of treating patients. The study presented physicians with two hypothetical HIV/AIDS patients and asked the physicians how they would treat those patients. Infectious disease specialists were more likely to recommend treatments consistent with those of the HHS and the International AIDS society than were general internal medicine physicians. The general internists, however, were often aware of gaps in their knowledge and said they would refer the patient to a specialist. (2001 July. The AIDS Reader 11(7): 348-353.)
Indiana DOC officials estimate that approximately 1% of state inmates are HIV positive but do not know the exact number because Indiana does not have a mandatory testing law for inmates. Although a bill was passed by the state legislature last year that would require mandatory HIV and HCV testing for all inmates, it was vetoed by the governor for budgetary reasons. This testing is estimated to cost $173,285 per year. HIV testing is available to inmates upon request. Experts recommend educating and counseling prisoners to be voluntarily tested for HIV and HCV. (Indianapolis Star, 10/24/01)
A study reports that in 1997, hepatitis C cost the U.S. approximately $5.46 billion in medical costs, lost wages, and lost home production. Hepatitis C is the most common blood-borne infection in the U.S. These costs are on par with the cost of asthma in US for the same year ($5.8 billion). There are estimates that HCV-related mortality could triple within the next twenty years, indicating that increased prevention, treatment, screening, and research are necessary. (Arch Int Med 2001; 161 (18): 2231-2237.)
The Massachusetts state legislature plans to cut a program that teaches physicians and others at risk for hepatitis C about the disease due to a budget impasse. Although the Massachusetts state senate set aside $3.9 million for the program for fiscal year 2002 (which began on July 1, 2001) the House did not allocate any funding. According to a policy issued by the governor's office, agencies are to operate on a lower budget. The program provided counseling and education for those at risk for contracting hepatitis C and raised awareness of people who were unaware they were infected with HCV. The cuts will affect education programs but will have no effect on treatment funding. Approximately 110,000 people in Massachusetts are estimated to be infected with HCV. (Boston Herald, 10/5/01)
Syphilis is on the rise among gay and bisexual men. This spike in syphilis cases has been recorded in San Francisco, San Diego, Florida, Boston, and Chicago according to the San Francisco Department of Public Health. The number of syphilis cases in San Francisco nearly doubled from 42 in 1999 to 77 in 2000 with a similar increase expected this year. Officials there say 16 syphilis cases in San Francisco this year have been linked to an Internet chat room for gay and bisexual men. Although the Internet service provider has been reluctant to post syphilis warnings, it has given the Health Department access to the chat room to post prevention messages, an offer that has been rejected as "ineffective." Health officials view the rise in syphilis cases as a decline in safe sex practices and a "complacency" about HIV. Syphilis sores (like other STDs) leave a person more vulnerable to HIV infection. (San Francisco Chronicle, 10/26/01)
This article was provided by Brown Medical School. It is a part of the publication HEPP News.