The CDC HIV/Hepatitis/STD/TB Prevention News Update

UNITED STATES: "Epidemic of Cancers Feared with HIV Link"

AUSTRALIA: "The Morning After: Backpackers’ Drinking Habits Linked to High STD Rates"

CANADA: "Homeless and Pregnant, Women Afraid to Seek Care"

CANADA: "Insite Can Save Health Care System $20 Million: Study"

CANADA; UNITED STATES: "Immune Cells Worn Out from HIV Fight Given New Life to Assault Disease: Study"

UNITED STATES: "Fears About HIV Transmission in Families with an HIV-Infected Parent: A Qualitative Analysis"

WASHINGTON: "HIV Clinic Opens in Everett"

WEST VIRGINIA: "West Virginia County Sees Spike in Syphilis Cases"

CALIFORNIA: "San Diego City College Student Diagnosed with TB"

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UNITED STATES:
"Epidemic of Cancers Feared with HIV Link"   back to top
Chicago Tribune , (11.19.2008)   Stephanie Desmon, Baltimore Sun

People with HIV are at a much greater risk of developing certain cancers - including of the lung, liver, head, and neck - than the general population, according to research reported Tuesday at a medical conference in National Harbor, Md.

“We’re seeing people we have treated successfully for HIV at much higher risk” for cancer, said Dr. Kevin Cullen, director of the University of Maryland’s Greenebaum Cancer Center.

The research, presented by Johns Hopkins epidemiologist Meredith Shiels at the seventh annual American Association for Cancer Research International Conference on Frontiers in Cancer Prevention Research, found that people with HIV are twice as likely to develop several cancers not previously linked to the virus. Earlier studies have found the risk of certain cancers is up to ten times higher for people with HIV.

Some of the cancers seen most commonly among HIV patients are those known to have viral causes: anal, head and neck cancers, which have been linked to human papillomavirus; and liver cancer, which can be caused by hepatitis.

Various hypotheses have been offered for the HIV-cancer connection: Thanks to improved drug therapy, more HIV patients are living longer. Patients’ immune systems may be weakened by the virus or damaged by antiretrovirals; indeed, one researcher has questioned whether the drugs themselves may be carcinogenic. Some people with HIV may also engage in more high-risk behaviors.

“We’re really at the first stages of systematically looking at the epidemic and fully looking at cancer,” said Dr. William Blattner, associate director of the University of Maryland’s Institute of Human Virology. “The unusual observation is the cancers are occurring at a much younger age.”

Dr. Malcolm Brock, a Johns Hopkins thoracic surgeon, said HIV patients have three to five times the lung cancer risk of the general population, a phenomenon being studied by researchers from Hopkins and the National Cancer Institute.

AUSTRALIA:
"The Morning After: Backpackers’ Drinking Habits Linked to High STD Rates"   back to top
Sydney Morning Herald , (11.19.2008)   Natasha Wallace

This summer holiday period, the New South Wales Health Department, four Sydney-area councils, and the NSW Backpackers Operators Association are targeting young international travelers with safe-sex messages. The “Safe in the Sack Project” kicks off Dec. 1 and runs through March.

The campaign was prompted by new research from the Sydney Sexual Health Center showing that a culture of binge drinking among young backpackers may be leading to unsafe sexual behaviors and higher STD rates compared with the general population. Dr. Lynne Wray, SSHC’s acting director, said the study of 4,382 travelers and 8,810 non-travelers ages 18-30 who visited the clinic between 1998 and 2006 found 19 percent of travelers drank alcohol at excessive levels, compared with 8 percent for non-travelers.

Of female travelers, 25 percent consumed more than 14 standard drinks per week. Of male travelers, 15 percent consumed more than 28 standard drinks per week. They were more likely to drink that amount - 140g of alcohol for women, 280g for men - in “one or two sessions a week,” the study found.

“Often when they take risks with their sexual health and have unprotected sex, they will often say to us, ‘I’d had too much to drink,’” said Wray.

“The number of heterosexual backpackers coming to the clinic with new [STDs] is of great concern,” said Wray. “A small proportion of these also have HIV infections that they have acquired in other countries on the way to Australia.”

The incidence of chlamydia among backpackers was 8 percent, compared with 5 percent for non-travelers. In addition, 43 percent of travelers reported two or more sex partners in a three-month period, compared with 30 percent of non-travelers.

CANADA:
"Homeless and Pregnant, Women Afraid to Seek Care"   back to top
Edmonton Journal , (11.12.2008)   Jodie Sinnema

Edmonton’s needle exchange program, Streetworks, on some days looks more like a prenatal clinic. Since 2005, Alberta has logged 14 congenital syphilis cases from an outbreak that also affects many potential Streetworks clients.

“We’re the needle exchange program, but we work with the crowd that this was affecting, those that are involved in drug use, those who are involved in the sex trade, so we decided to do a project,” said Marliss Taylor, program manager for Streetworks.

Using a $95,000 (US $76,700) grant from the Public Health Agency of Canada, Streetworks is able to target syphilis and other STD services to homeless pregnant women. The grant funds a part-time nurse position and two outreach workers who scour downtown, hop buses along 118th Avenue, and check places such as Kindred House and Hope Mission. So far, outreach workers Karen Turner and Laurie McDermott have found 50 pregnant women, including five who either had syphilis or were antibody-positive from a previous infection.

At Streetworks, nurse Amber Krasowki and Dr. Rubeena Ahmad also give women Pap smears and draw blood for testing. The small back room is fitted with an examination table donated by the Royal Alexandra Hospital (RAH). Krasowki counsels the women about breastfeeding, drug use, and their babies. Many of the women are reluctant to visit regular medical facilities, lacking an established address and fearful their babies will be seized by Children’s Services.

In March 2009 the federal grant runs out, but Taylor hopes to find more funding. Streetworks has started a program to train health professionals about working with street people. Krasowki has been invited to speak with nurse practitioners at RAH, and she hopes to accompany new physicians on their rounds there. The program is developing a booklet on healthier pregnancy and living on the streets, and Taylor wants to create DVDs to educate the women.

CANADA:
"Insite Can Save Health Care System $20 Million: Study"   back to top
Ottawa Citizen , (11.18.2008)   Linda Nguyen

A new computer simulation model study shows Vancouver’s supervised injection facility Insite can save the city $20 million (US $16 million) in health care costs and boost its population’s lifespan over a 10-year period.

In the study, Dr. Ahmed Bayoumi of St. Michael’s Hospital in Toronto and the University of Toronto and colleagues measured the projected impact on Vancouver over the next decade with and without Insite. When the only impact of the controversial facility is assumed to be a decrease in the prevalence of needle sharing by injecting drug users, the projected net savings is nearly $14 million (US $11.3 million) over 10 years. Compared with a model that had no such facility, Insite adds 920 life-years.

When the researchers included factors like incidence of HIV and hepatitis C, survival rates and the frequency of referrals to social services like methadone treatment, the financial saving increases to as much as $20 million (US $16 million) and the number of life-years saved peaks at 1,070.

Insite, the only facility of its kind in North America, could avert a total of 1,191 cases of HIV and 54 cases of hepatitis C over a decade, the researchers found.

“Vancouver’s supervised injection site is associated with improved health and cost savings, even with conservative estimates of efficacy,” the authors concluded.

The study, “The Cost-Effectiveness of Vancouver’s Supervised Injection Facility,” was published in the Canadian Medical Association Journal (2008;179(11):doi:10.1503/cmaj.080808).

CANADA; UNITED STATES:
"Immune Cells Worn Out from HIV Fight Given New Life to Assault Disease: Study"   back to top
Canadian Press , (11.11.2008)   

Researchers report they have found a way to revivify “killer” CD8 immune cells, which could some day be used to assist the body’s natural infection-fighting power against HIV. CD8 cells normally seek and destroy infected cells, but they become “exhausted” by HIV infection, said study co-author Dr. Mario Ostrowski.

With HIV infection, CD8 cells “don’t produce all the chemicals required to kill infected cells,” Ostrowski said. “They can’t perform any function. They’re just totally wimpy and exhausted.”

Worn-out CD8 cells also exhibit high levels of a molecule called Tim-3 normally used to slow the immune system down after an infection has been successfully dispatched. In test tubes, researchers blocked Tim-3 in CD8 cells taken from HIV patients and found the cells were revitalized. “We observed that blocking the Tim-3 pathway rescued those cells and restored their ability to fight off infection,” said Ostrowski.

“We still do not know how the virus triggers Tim-3 or if this is restricted to HIV infection,” said Dr. Lishomwa Ndhlovu, a study co-principal at the University of California-San Francisco. “But our findings may provide a new direction to vaccines and therapies that will potentially reverse these dysfunctional cells and allow them to control HIV-1 replication.”

The full report, “Tim-3 Expression Defines a Novel Population of Dysfunctional T Cells with Highly Elevated Frequencies in Progressive HIV-1 Infection,” was published in the Journal of Experimental Medicine (2008;doi:10.1084/jem.20081398).

UNITED STATES:
"Fears About HIV Transmission in Families with an HIV-Infected Parent: A Qualitative Analysis"   back to top
Pediatrics Vol. 122; No. 5: P. e950-e958 (doi:10.1542/peds.2008-0390), (10.31.2008)   Burton O. Cowgill, PhD, MPH; Laura M. Bogart, LM, PhD; Rosalie Corona, PhD; Gery Ryan, PhD; Mark A. Schuster, MD, PhD

Advances in antiretroviral treatment to prevent mother-to-child HIV transmission have made it possible for more HIV-positive parents to have children. But few studies have examined transmission fears that might remain for these families and how they address such fears, noted the authors. The current study describes transmission-related fears in families with an HIV-infected parent.

From March 2004 to March 2005, researchers conducted in-person interviews with 33 HIV-positive parents, 27 children ages nine to 17, 19 adult children and 15 family members or friends who cared for the children and/or parents. Interview transcripts were analyzed for transmission-related themes.

Many of the families identified at least one HIV transmission-related fear, including specific fears related to blood contact, bathroom items, kissing/hugging, and food. Families addressed these fears by educating children about the ways HIV can be transmitted and establishing rules to minimize transmission risk in the household. HIV-positive parents also expressed concern about acquiring opportunistic infections from a sick child.

“Many of the fears experienced by HIV-infected parents and their children were based on misconceptions about modes of HIV transmission,” the researchers concluded. “Pediatricians and others who treat these children may be able to offer counseling to allay fears that family members have about household transmission of HIV.”

WASHINGTON:
"HIV Clinic Opens in Everett"   back to top
Daily Herald (Everett) , (11.18.2008)   Sharon Salyer

Snohomish County HIV patients can now access health care closer to home, thanks to the opening of a satellite branch of Harborview Medical Center in south Everett. Previously, patients had to travel to Harborview’s main clinic in downtown Seattle for treatment.

The new clinic is located in the Community Health Center of Snohomish County’s medical building at 1019 112th St. SW., and is open on Wednesdays from 8:30 a.m. to 3 p.m. While the clinic is open to any of the approximately 600 county residents living with HIV/AIDS, it specifically targets those currently without regular health care.

HIV patients must be closely monitored to ensure they do not develop resistance to their treatment regimens, said Dr. Robert Harrington, medical director of Harborview’s HIV/AIDS clinic. “It’s a lifelong infection, so you have to consider the long-term effects of the medication you’re using,” he explained.

In September 2007, Harborview opened a similar clinic in Bremerton to serve Kitsap County HIV/AIDS patients. Over the past year, it has scheduled around 450 appointments, said Harrington.

For more information about the Everett clinic, telephone 866-463-1669.

WEST VIRGINIA:
"West Virginia County Sees Spike in Syphilis Cases"   back to top
Associated Press , (11.18.2008)   

Ohio County health officials and specialists from the state Bureau for Public Health are troubled by a spike in syphilis diagnoses in the Wheeling area this year. At least seven area cases have been reported in 2008, compared to zero in all of 2007. Statewide, syphilis has been on the rise since 2003, but experts are wondering what is behind the rise in cases around Wheeling. County health departments are being urged to offer syphilis testing to anyone at risk for STDs, as well as to stock up on drugs to treat syphilis.

CALIFORNIA:
"San Diego City College Student Diagnosed with TB"   back to top
Associated Press , (11.19.2008)   

San Diego County health officials are notifying around 190 students and staff at San Diego City College they may have been exposed to TB following the diagnosis of active disease in a student at the school. The student attended classes from late August to early November, said Leslie Ridgeway, spokesperson for the county Health and Human Services Agency. The student is the county’s 201st case of TB this year, she said.

Prevention News Update will not be published from Thursday, November 20, 2008, through Friday, November 28, 2008. Publication will resume on Monday, December 1, 2008.