Thursday, November 20, 2008

• Early Treatment for HIV-Positive Infants Reduces Death Risk by 76%, Study Says

Early Treatment for HIV-Positive Infants Reduces Death Risk by 76%, Study Says
[Nov 20, 2008]

      HIV-positive infants who begin receiving antiretroviral therapy immediately after being diagnosed with the virus are 76% less likely to die than HIV-positive infants who do not receive treatment until the disease has progressed, according to a study published Thursday in the New England Journal of Medicine, Reuters reports.

For the study, Avy Violari of the University of Witwatersrand in South Africa and colleagues assigned 377 HIV-positive infants to two groups. One group began antiretroviral treatment at about seven weeks of age, while the second group did not begin treatment until their CD4+ T cell counts dropped or they began showing symptoms of AIDS. Among the infants in the early treatment group, 4% died after 40 weeks of treatment, compared with 16% in the group that did not receive treatment until later (Emery, Reuters, 11/19). The study also found that early treatment reduced progression of the disease by 75%, from 26% in the late treatment group to 6% in the early treatment group (BBC News, 11/19).

The researchers halted the study early because the results were so conclusive and provided all infants in the study with antiretrovirals. In addition, the study led officials from Europe, the U.S. and the World Health Organization to recommend immediate antiretroviral treatment for HIV-positive infants.

According to Reuters, 370,000 children were newly diagnosed with HIV in 2007, and two million children worldwide are living with the virus (Reuters, 11/19).

Comments, Reaction
Violari said the findings "reinforce the view that there are no reliable predictors" on disease progression for infants younger than age one and that CD4 counts do not determine with "enough accuracy" if infants "are becoming sick." The researchers were "alarm[ed]" at how fast the disease progressed in young infants, Violari said, noting that "some infants could seem fine in the morning and get sick and die by nightfall." She added that after analyzing the study data, it "became clear that treating all infants at the earliest opportunity after diagnosis was the best course of action" (BBC News, 11/19).

Violari said that it will take a "few years" to implement early HIV testing and treatment programs for infants because testing for infants is expensive and it will be difficult to identify HIV-positive infants in developing countries (Reuters, 11/19). Mark Cotton of the Comprehensive International Program of Research on AIDS said that implementing such programs will require "both manpower and resources."

Diana Gibb of the Medical Research Council in the United Kingdom said the No. 1 priority should be preventing mother-to-child HIV transmission. "The drug regimens are no picnic for these babies and even with improved outcomes in early life, there is still no cure for AIDS," Gibb said (BBC News, 11/19).

The study is available online.

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Health Care Workers Face Increased Risk of Mortality From HIV, Other Bloodborne Diseases, Study Finds
[Nov 20, 2008]

      A new CDC study published in the American Journal of Industrial Medicine has found that health care workers face an increased risk of dying from bloodborne diseases, such as HIV, and related illnesses compared with workers in other fields, Reuters reports. The study also found that male health care workers face a more than twofold risk of dying from HIV/AIDS-related causes. According to researchers Sara Luckhaupt and Geoffrey Calvert of CDC's National Institute for Occupational Safety and Health, accidental needle sticks and other workplace accidents can put health care workers at an increased risk of exposure to bloodborne diseases. Luckhaupt notes that evidence over the past 20 to 25 years shows that health care workers have been more likely to die from bloodborne diseases than workers in other fields, Reuters reports.

The study examined data from the National Occupational Mortality Surveillance system from 1984 to 2004, which included 248,550 deaths from HIV/AIDS, hepatitis B and C, liver cancer and cirrhosis. According to Reuters, the researchers in a previous study found that male health care workers were at an increased risk of HIV and hepatitis but conducted the new study to determine if deaths from these infections also were higher in the health care field.

Results pointed to a more than doubled risk of dying from HIV/AIDS-related causes for male health care workers -- as well as a nearly doubled likelihood of dying from hepatitis B -- compared with workers in other fields. Hepatitis C and cirrhosis deaths were also more likely among male health care workers. For female health care workers, hepatitis C was more frequent than in other occupations. An analysis of mortality risk based on occupation showed that male nurses faced the highest risk of HIV/AIDS and hepatitis B mortality, while female nurses were 31% less likely to die from HIV/AIDS-related causes than women outside of the health care industry, Reuters reports.

Luckhaupt said that the researchers are unable to say how much the increased risk is because of occupational or non-occupational exposure but added that it is "important to look at both." The researchers wrote, "The greatest limitation to our study was that information was not available on possible confounding factors, such as sexual risk behaviors, history of blood transfusions, intravenous drug use and alcohol use." They added that previous studies indicate that most infections among health care workers are not contracted on the job and that occupational factors could be a stand-in for other risk factors. They suggest that "interventions to decrease the risk of bloodborne pathogens among health-care workers may need to be gender-specific" in order to better understand why male health care workers show an increased risk for bloodborne disease mortality (Harding, Reuters, 11/19).

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Young Travelers in Australia At Risk of HIV, Other STIs Because of Drinking Habits, Specialists Report
[Nov 20, 2008]

      Young travelers in Australia who engage in binge drinking and unsafe sexual activity are contributing to increasing rates of sexually transmitted infections, including HIV, according to specialists, the Herald Sun reports (McLean, Herald Sun, 11/19). According to the Sydney Morning Herald, the rise in STIs has prompted the New South Wales' Department of Health, four Sydney councils and the NSW Backpackers Operators Association to target the group with no-cost condoms and safer-sex messages over the summer holiday period (Wallace, Sydney Morning Herald, 11/19).

Lynne Wray, acting director of the Sydney Sexual Health Centre, said the trend is consistent with recent research showing that backpackers are more likely to report drinking alcohol to excess and not using condoms, thus increasing their risk of contracting an STI. Wray said that the "number of heterosexual backpackers coming to the clinic with new" STIs "is of great concern" and that a "small proportion of these also have HIV infections that they acquired in other countries on the way to Australia." She added that the trend revealed that basic safer-sex messages have not been effective and that it "is important for people to pack condoms while traveling and remember that many countries popular with backpackers have higher rates of HIV and STIs than Australia" (Herald Sun, 11/19).

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Toronto Health Officials Tackle Rise in Number of HIV, STI Cases
[Nov 20, 2008]

      Health officials in Toronto are attempting to address an increase in the number of reported sexually transmitted infections, including HIV, in the city, the National Post reports. STI figures through September from Toronto Public Health show that 405 HIV cases, 5,480 chlamydia cases, 1,293 gonorrhea cases and more than 200 new cases of infectious syphilis have been diagnosed.

Jane Greer -- counselor and administrator at Hassle Free Clinic, which specializes in diagnosing and treating STIs -- said, "We're just swamped, both with people seeking testing and people testing positive for things like gonorrhea, chlamydia, herpes, first [human papillomavirus] diagnosis." She added that the issues surrounding syphilis cases are "ongoing" and that she is especially alarmed by the number of syphilis cases diagnosed at the clinic, usually among HIV-positive people.

Rita Shahin, an associate medical officer of health for the city, said that the rise in chlamydia might be attributable to a campaign aimed at increasing testing. She said, "We're trying to find more. So that's, in a way, a good thing that the rates of chlamydia are going up." Chlamydia can increase a person's risk of contracting other STIs, including HIV (Alcoba, National Post, 11/19).

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Sex Work Increasing on Colombia's Caribbean Coast, Contributing to Increased HIV Prevalence, IRIN/PlusNews Reports
[Nov 20, 2008]

      The sex tourism industry is expanding in the Colombian city of Cartagena, which could be contributing to an increase in HIV prevalence in the region, IRIN/PlusNews reports. According to IRIN/PlusNews, a combination of wealthy tourists and local residents has driven the rise in commercial sex work in Cartagena, which is located on Colombia's Caribbean coast. Mayerlin Verqara Perez, a program coordinator at Fundacion Renacer -- a nongovernmental organization that aims to prevent the sexual exploitation of children and adolescents -- said the situation has become "a lot worse in the last 10 years."

Fundacion Renacer estimates that about 650 children in the city are working in the sex trade industry. Perez added that more children are participating in sex work and at younger ages than in previous years. The organization recruits about 400 children annually to participate in a psycho-social assistance program, which provides testing and treatment for sexually transmitted infections, counseling, skills training, and education about sexual and reproductive health. Many young people who use the organization's services are diagnosed with STIs, but only three have tested positive for HIV, IRIN/PlusNews reports. However, many young people might be afraid to undergo testing, Fabian Cardenas, regional director of Fundacion Renacer, said. According to Cardenas, many young sex workers "don't take any protective measures" because of limited knowledge about HIV and difficulties in obtaining condoms. In addition, under age sex workers often comply with their clients' preference for condom use, Cardenas said, adding that some clients consider condoms unnecessary because they believe younger sex workers do not have STIs.

According to IRIN/PlusNews, Colombia's HIV prevalence is less than 1%, and the disease primarily affects men who have sex with men. However, heterosexual transmission has increased in recent years in the Caribbean region, where one in three HIV-positive people is a woman, compared with the national rate of one in four. Ricardo Garcia, UNAIDS country director, said the region's macho culture -- under which it is socially acceptable for men to have multiple sex partners -- could account for the increased HIV prevalence on the Caribbean coast. He added that sex work also could be a contributing factor (IRIN/PlusNews, 11/18).

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Scottish Study Shows One-Third of Men with HIV Unaware of Status; NHS Launches HIV Awareness Campaign
[Nov 20, 2008]

      More than one-third of HIV-positive men in Scotland's capital of Edinburgh are unaware of their status, according to a recent study conducted by the Dutch group Wolters Kluwer Health, the Edinburgh Evening News reports. According to the News, HIV tests were conducted among 599 men at universities and gay bars throughout Edinburgh, and 33 men tested positive for HIV. Of these men, 12 were unaware that they were living with the virus. The study said, "A high proportion of the HIV-positive men were undiagnosed and not receiving benefits of clinical care." The study also said clinics should "proactively" offer testing to decrease the number of undiagnosed cases.

The release of the study coincides with a new HIV awareness campaign conducted by NHS Lothian in partnership with the Edinburgh-based Gay Men's Health to warn people with multiple sexual partners and men who have sex with men against complacency regarding the virus. The campaign, called the HIV Comeback Tour, will promote condom use and regular HIV testing, as well as attempt to discredit myths surrounding the virus. Steve O'Donnell, spokesperson for NHS Lothian, said, "In many cases, HIV transmission occurs within relationships, so we are reminding [MSM] that it is dangerous simply to assume that neither they nor their partner has HIV or that unprotected sex will be safe."

According to the News, the campaign's messages will be displayed on 20 city buses and 200 posters throughout the city, and posters and postcards will be distributed to bars, physicians' offices and libraries. The campaign's timing overlaps with World AIDS Day on Dec. 1. "The HIV Comeback Tour is now a well established and effective Lothian campaign highlighting the re-emergence of HIV as a continuing sexual health risk for [MSM]," Jim Sherval, a public health specialist for NHS Lothian, said. "World AIDS Day is a day to combat prejudice and remind people to protect themselves. It seemed absolutely right that we should bring both campaigns together."

According to the News, an estimated 5,000 people in Scotland are living with HIV (Morris, Edinburgh Evening News, 11/18).

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