HIV/AIDS Newsroom: October 23, 2000
A Proposed National Policy on Health Care Workers Living With HIV/AIDS and Other Blood-Borne Pathogens
Journal of the American Medical Association (www.jama.com)
10/18/00 Vol. 284, No. 15, P. 1965; Gostin, Lawrence O.
In 1991, the Centers for Disease Control and Prevention recommended that all healthcare workers (HCWs) with HIV inform all patients of their HIV status before performing exposed procedures. Since 1991, new evidence shows that the risk of transmitting blood-borne pathogens in healthcare areas is very low, suggesting a change in national policy is necessary. Lawrence O. Gostin of the Georgetown University Law Center writes that a change in CDC guidelines would cause statewide reforms and help set a national standard of care. Studies have shown that the likelihood of transmitting hepatitis B is much greater than the risk of transmitting HIV during invasive procedures and other patient-related situations. HIV test results from over 22,000 patients and 63 HCWs with HIV found no cases of transmission as of July 1999, according to the CDC. The question of whether HIV-infected health workers put their patients at risk is crucial to these recommendations. The courts have determined that a theoretical risk of transmission is enough to be discriminatory. Hospitals should provide infection control and training for any workers with HIV. As for privacy rights, most Americans believe patients have a right to know about their doctors. However, Gostin does not believe the law should make healthcare workers disclose their HIV status to any patients, given the low risk of transmission and lack of behavioral risk factors. Gostin asserts, "A new national policy, focused on management of the workplace environment and injury prevention, would achieve high levels of patient safety without discrimination and invasion of HCW privacy." He proposes that a program to prevent bloodborne pathogen transmission include policies addressing universal precautions like gloves and gowns, sterilized equipment for each patient, infection control training, prevention methods, and exposure prevention during surgical procedures.
Oxford University's medical research council has backed away from a possible intellectual property dispute with the University of Nairobi regarding joint research on an AIDS vaccine. Nairobi media reportedly protested when Oxford filed for a patent application for the vaccine without telling its Kenyan partners. Andrew McMichael of Oxford University said his team had erred in filing for the patent alone, but he claimed their sole intent was to protect the research from possibly devious commercial groups. There is a one-year grace period in which the patent application can be altered and both parties are said to have settled their differences; however, it is not yet clear how Kenya's contributions to the vaccine project will be recognized. The vaccine -- which is based on the discovery that some prostitutes in Nairobi may have cells that protect them from HIV infection -- is currently in human tests in the United Kingdom and will be tested in Kenya later this year.
For the Record: [Ryan White CARE Act]
Washington Post (www.washingtonpost.com)
10/21/00 P. A4
President Clinton has signed a bill that reauthorizes the Ryan White CARE Act, providing over $1 billion a year for AIDS prevention and treatment. The original law was named in honor of Ryan White, a young man with hemophilia who died in 1990 after contracting HIV from a blood transfusion.
A tuberculosis (TB) outbreak that resulted in two deaths in Sacramento County, California, has prompted health officials to increase their campaign to screen the homeless. A cluster of 12 TB cases was seen in June. Since that time, the county has spent hundreds of thousands of dollars to track down and treat nearly 1,000 contacts of the individuals who tested positive for TB. At the same time, county officials say they anticipate a rise in newly homeless families and want to open an overflow shelter next month. Sacramento County Health Officer Glennah Trochet said that homeless service providers will be instructed on how to recognize signs of TB, and they will take individuals with suspected infection to a county facility for tests. According to Trochet, DNA fingerprinting revealed that the 12 cases were related, all among homeless individuals or people who worked closely with the homeless. So far, the county has tested 400 contacts, with 50 percent showing positive results and 68 of those individuals opting for preventative treatment.
A Maryland biotechnology firm that focuses on tuberculosis has won a $300,000 Challenge Grant from the National Institute of Allergy and Infectious Diseases to continue working on a compliance-monitoring device that helps patients take their medication as directed. Sequella's monitor is worn on the wrist and detects information about how much of a drug is ingested and when it was taken. The information gathered is based on a fluorescent tracer compound in the medication that can be measured through the skin.
The National Institutes of Health recently said that it would provide $6 million in first-year funding for a joint research effort into the hepatitis C virus (HCV). Included in the national study are researchers from Children's Hospital in Columbus, Ohio. The scientists hope to determine why certain people can overcome HCV infection but others cannot. According to Chris Walker, lead scientist at Children's Research Institute, "Eight out of 10 [HCV patients] will be infected for life and have deterioration in liver function. Very few will clear the virus spontaneously within a few weeks." There are an estimated 200,000 HCV cases in Ohio, but only about one-quarter of those individuals know they are infected. The Centers for Disease Control and Prevention estimates that approximately 60 percent of all new HCV cases are the result of needle sharing.
An analysis of five studies from the Pediatric AIDS Clinical Trials Group by Dr. Jane Lindsey of the Harvard School of Public Health in Boston shows that age can affect clinical outcomes of children treated with antiretroviral drugs. The researchers found that lower virologic markers at baseline were independent predictors of survival in children over age one. Dr. Lindsey explained that surrogate markers in adult studies cannot always be applied to infants and children. The scientists, who report their findings in the November issue of the Journal of Infectious Diseases (2000;182:1385-1393), suggest that doctors consider baseline and treatment-caused changes in HIV RNA before making decisions on medication.
In an effort to obtain more resources and lower drug prices in the war against AIDS, the international charity VSO has launched a two-year campaign detailing the high number of HIV/AIDS patients in developing nations. Liz Orton, VSO's campaign manager, said, "The situation in Africa is intolerable. ... In order for this situation to get better, developing countries must have more resources for healthcare and drug prices must come down." The campaign's report, called "Drug Deals," says that millions of people who are dying without medicines needed to treat various AIDS-related infections, including meningitis.
HIV-infected drug users in prison need to receive prevention education and treatment that continues when they are released. John Miles, special assistant for corrections and substance abuse for the Centers for Disease Control and Prevention, explained that many people do not realize that when an inmate goes from a controlled environment into the free community, it can be difficult for that individual to find healthcare services. The parole system alone cannot do follow-up healthcare for inmates who leave, because most inmates leave without receiving parole. Some models for follow-up HIV care are seen in the correction systems of Rhode Island, New York, and Massachusetts. Rhode Island's prison system works with Miriam Hospital and Brown University to provide HIV care to prisoners. The state's small size makes it easy to provide a continuum of care for inmates, often with the same physician caring for the individual during and after his time in jail. The New York correction system workswith community-based organizations to provide counseling to incarcerated HIV patients. Lester Wright, deputy commissioner and chief medical officer for New York State Department of Correctional Services, says these organizations also help prisoners who are discharged from jail and need medication upon their release. He notes that while most of the state's inmates are from New York City, special arrangements must be made for individuals in upstate New York. Meanwhile, the Hampden County Correction Center's HIV program for inmates in Ludlow, Mass., is a role model because it helps plan for housing, child care, and other services that former inmates with HIV need. Both the Centers for Disease Control and Prevention and the Soros Foundation have provided the Hampden County with research funding for the effort.
The Centers for Disease Control and Prevention has released a draft 5-year plan for HIV/AIDS prevention for public comment. The draft strategic plan was developed collaboratively by external consultants active in HIV/AIDS prevention and CDC staff. The draft five-year strategic plan details priority goals, objectives and strategies for domestic and international HIV prevention. The draft plan can be accessed at CDC's website (www.cdc.gov) or by calling the National Prevention Information Network (NPIN) by calling NPIN at 1 (800) 458-5231. The public comment period runs until today, October 23, 2000.
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.