The director of the Tacoma-Pierce County Health Department in Washington, Dr. Frederico Cruz-Uribe, has proposed that all jail inmates arrested on drug- or sex-related charges be tested for HIV. Dr. Cruz-Uribe has proposed that these inmates, along with pregnant women and inmates who present with symptoms of STDs during a doctor's visit, be required to undergo HIV testing. Those who test positive would then be offered counseling and treatment advice; their sexual and needle-sharing partners would be notified. Although some experts support the proposal, likening the situation to the eradication of smallpox, other experts believe these policies undermine civil rights and that such a policy would not hold up in court. (Associated Press, 11/19/01)
Researchers from the CDC have detected a distinct group of HIV-1 viruses in 3.3% of treatment naive, newly diagnosed HIV-1 positive patients. These viruses have mutations in the reverse transcriptase region of the genome that make these viruses more likely to develop drug-resistant mutations. These mutations are different from those known to cause zidovudine resistance, but indicate a significant potential for zidovudine (AZT) and possibly stavudine (d4T) resistance. This is especially troubling because zidovudine is commonly used in drug cocktails, experts report. Multi-drug resistant viruses will have a negative impact on the incidence of HIV and AIDS cases. (PNAS. 2001; 98:24 [13907-13912])
The Connecticut Department of Public Health will begin gathering data, including names, of HIV-positive adults in order to track these individuals. Individuals do have the option to request anonymity. Health care providers and clinics will have the responsibility of informing patients of that option. Although the state commissioner of public health believes that this new plan serves the needs of the HIV-positive community, other experts claim that the new system will discourage some individuals from seeking testing. (Hartford Courant, 11/7/01)
A study from the Women's Interagency HIV Study cohort reports that women who have low levels of HIV in their blood may still have high levels of virus in their genital tracts. One-third of women whose blood viral load was lower than 500 copies/mL still had high levels of HIV in their genital tracts and experienced genital tract viral shedding, increasing the rate of transmission through sexual encounters and pregnancies. Some experts believe that genital tract HIV levels may better estimate the chances of HIV transmission. (Lancet 2001; 358: 9293 [1593-1601])
A group of 11 inmates in Oregon have filed suit against the state Department of Corrections over the state's treatment of inmates with hepatitis C. The group of inmates from the Salem, Oregon State Penitentiary are claiming that the policies of the DOC exclude inmates from HCV treatment and testing. The inmates are seeking $17.5 million for the treatment of HCV-positive inmates and mandatory testing of all new inmates. Corrections officials do not believe the inmates will win the suit, explaining that no system in the country has a similar policy. (Portland Oregonian, 11/2/01)
A study of gold mine workers in South Africa has revealed that HIV-positive individuals were more likely to experience recurrent tuberculosis (TB) infection, even after successful completion of TB therapy. Approximately 27% of the HIV-positive mine workers experience recurrence of TB compared to 13.7% of the HIV-negative participants. Recurrence due to relapse was more common in the HIV-negative participants, while recurrence due to reinfection was more common among the HIV-positive participants. However, there was a large number of cases for which the cause of recurrence was unknown among the HIV-positive participants. HIV infection was shown to be the most significant risk factor for reinfection with TB, according to the study. (Lancet, 2001; 358: 9294)
This article was provided by Brown Medical School. It is a part of the publication HEPP News.