HIV/AIDS Newsroom: January 18, 2001
Prevalence and Incidence of HIV Among Out-of-Treatment Injecting Drug Users, Chicago 1994-1996
Journal of Acquired Immune Deficiency Syndromes (www.jaids.com)
12/15/00; Vol. 25, No. 5, P. 443; Ouelet, Lawrence J.; Thorpe, Lorna E.; Huo, DeZheng; et al.
Researchers studying injection drug users (IDUs) in Chicago report a decline in HIV incidence among the addicts, although newer users are still at a higher risk of infection. The researchers assessed 794 IDUs ranging in age from 18 to 50 and who were not enrolled in drug rehabilitation at the time of study enrollment. The volunteers were initially baseline tested for HIV with follow up tests performed six and 12 months later. The subjects also answered questionnaires relative to demographic information, medical or drug use and treatment history, and sexual behavior. At the time of testing, the baseline seroprevalence of HIV was at 18 percent. Logistic regression of the results determined that the dominant characteristics of HIV prevalence occurred among persons fitting the following criteria: Puerto Rican ethnicity, admitted homosexual or bisexual preferences, four or more years of intravenous drug use, or a history of crack cocaine smoking within the last six months. According to the data, there were seven HIV seroconversions in 632 person years of risk, resulting in an incidence rate of 1.1 per 100 person years of risk. One factor positively associated with HIV seroconversion was injection drug use for three years or less.
New research suggests that as long as an HIV-infected individual's level of infection-fighting CD4 lymphocyte cells does not drop below 200 per cubic millimeter of blood, Pneumocystis carinii pneumonia (PCP) will not develop. Although PCP has been a significant problem for patients with HIV, the threat of the deadly pneumonia has been substantially reduced among patients taking new AIDS drug cocktails. The results of two studies published in the New England Journal of Medicine (2001;344:159-167,168-174) indicate that patients with CD4 lymphocyte counts that do not fall under 200 will likely not develop PCP, even if they still have detectable HIV in their blood or if they have already had the pneumonia.
Trying to Replace the Pap Smear
Washington Post (www.washingtonpost.com)
01/18/01; P. E1; Chea, Terence
Digene Corp., a biotechnology firm in Gaithersburg, Maryland, has developed a gynecological test that it hopes may eventually replace the Pap smear. Although the Pap smear has been in place for over 50 years, during which time the death rate from cervical cancer has dropped by more than 70 percent, the makers of the new Hybrid Capture 2 HPV Test believe their test is more efficient and effective. Whereas the Pap test identifies cell abnormalities that are evidence of cervical cancer or potential cervical cancer, the Hybrid Capture 2 HPV Test detects the presence of DNA belonging to the human papillomavirus (HPV), which is known to be present in 99 percent of cervical cancer cases. The test is approved in the United States for use as a secondary tests when the Pap smear provides inconclusive results, which happens in about 7 percent of the cases. Because the Pap smear is firmly entrenched in American medicine, Digene's efforts to replace the traditional test will be uphill, and will include winning approval from federal regulators and the support of gynecologists, insurers, and women's health advocates. Already, however, several large insurance firms have agreed to cover Digene's test, and some leading diagnostic labs now automatically perform the test when Pap smear results are not conclusive.
HIV-infected pregnant women who took an AIDS drug cocktail reduced the risk of transmitting the virus to their infants from 40 percent to 5 percent, Hong Kong health officials announced this week. The study, conducted by the Hong Kong government, was undertaken because of fears that the growing proportion of HIV-infected women in the region could result in a surge in infected babies. Hong Kong has recorded more than 1,500 cases of HIV, including 183 new cases last year, with two among babies. Sexual contact is the primary mode of transmission, the government said.
In the World Health Organization's monthly journal Bulletin, four experts note that tuberculosis (TB) patients can take up to four combination pills a day, instead of the current regimen of up to 16 separate tablets. The experts said that the new treatment, which is being used in only 40 countries so far, has become less expensive. The authors pointed out that patients who do not complete the full TB drug regimen risk developing and spreading drug-resistant strains of the disease. "Multiple interruptions of treatment have been shown to be the predominant cause of drug resistance," the experts said.
Parents of Head Start school children in Lowell, Mass., crowded into classrooms on Tuesday, outraged at what some believed to be negligence on the part of the administration's response of a recent tuberculosis (TB) case. More than 260 children were recently exposed to TB from a "floating" classroom teacher who thought she had pneumonia instead. The parents expressed concern that Head Start officials were being vague about the situation and underplaying the risks of infection, that the teacher had been sick for months, and that health officials were taking an aggressive approach for preventative treatment. One mother said she did not want to have to put her son through the second round of testing that would occur if even one of the children tests positive for TB. Some parents said many of their questions at the informational meeting were not answered; a second session was held Wednesday for parents who could not attend the first.
The Los Angeles County Jail system has serious problems in terms of medical inefficiencies and physician accessibility, a new report claims. The report, from the County Board of Supervisors, included comments from attorney Merrick Bobb, who monitors the Sheriff's Department for the board. His investigation into over 7,181 complaints regarding the medical care in the jail system found evidence of substandard medical care, including a lack of immediate medical care access for patients who had life-threatening conditions, such as HIV or heart conditions. Many HIV-infected inmates complained about delays in receiving their medications in a timely and uninterrupted manner. Bobb attributes the substandard medical care to chronic medical understaffing as well as communication, coordination, and logistics problems.
A woman in Boulder, Colorado, has been diagnosed with multi-drug resistant tuberculosis (MDR-TB). An investigation of the woman's friends, acquaintances, and family turned up 18 people who have tested positive for the TB bacterium, all of whom were put on a strict regimen of antibiotics. Health officials note that if the patient and her contacts do not complete their treatments, they run the risk of developing an even more resistant strains of TB. The woman, an immigrant in her 20s, represents the 10th case of MDR-TB in the state since 1993, and the first in several years.
Researchers evaluated the level of antiretroviral adherence in HIV patients, most of whom had a personal history of drug abuse, by introducing a system of cue-dose training and monetary rewards. While the control group was given nondirective inquiries about treatment adherence, the cue-dose training group had personalized cues to remember their dose times and feedback from the Medication Event Monitoring System, and a third group received cue-dose training plus a cash reward for correctly timed bottle opening. The study, published in the December issue of Journal of General Internal Medicine (2000;15:841-847), found that patients showed only a short-term improvement in their levels of adherence when given cash incentives to maintain their regimen of medication. The researchers concluded that although the concept of incentive-based medical treatment is not a widely discussed one, they feel that the results of their experiment warrant further investigation.
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.