Deaths from HIV/AIDS in New York City have declined faster than other causes of death in the city, according to Living Healthy 2009–2011, a report by the NYC Department of Health and Mental Hygiene. They’re down 17.9 percent since 2009 and nearly 55 percent since 2002.
In 2011, the city distributed for free more than 36 million male condoms and more than 1 million female condoms. This free condom distribution is the largest such public program nationwide.
To read the report, click here.
By Monte Morin, Los Angeles Times
February 21, 2013
An intensive campaign to combat HIV/AIDS with costly antiretroviral drugs in rural South Africa has increased life expectancy by more than 11 years and significantly reduced the risk of infection for healthy individuals, according to new research.
The two studies, published Thursday in the journal Science, come as wealthy Western nations are debating how best to stretch limited AIDS funding at a time of economic stress.
With an annual price tag of $500 to $900 per patient, antiretroviral therapy programs have stirred frequent debate. Critics argue that adherence to the drug regimen is low and social stigma prevents some from seeking care until they are very ill and have infected others. Cheaper remedies, such as condom distribution, male circumcision and behavior modification, deserve more attention and funding, they say.
The new economic analysis of a $10.8-million campaign in KwaZulu-Natal province concluded that the drug scale-up there had been highly cost-effective.
The program was administered by nurses in rural health clinics in an impoverished region of about 100,000 people. Treatment consisted primarily of daily doses of antiretroviral therapy, or ART, drugs, which patients take every day for their entire lives. Patients picked up their medication at a rural clinic once a month.
In 2003, the year before the drugs were available, 29% of all residents were infected with HIV and half of all deaths there were caused by AIDS. Life expectancy in the region was just over 49 years.
By 2011, life expectancy had grown to 60 1/2 years — “the most rapid life expectancy gains observed in the history of public health,” said study senior author Till Barnighausen, a global health professor at the Harvard School of Public Health.
Based on that increase in longevity, researchers determined just how many years of life were effectively “gained” among residents as a result of ART intervention. They used that figure and the total expense of the program to calculate a cost-effectiveness ratio of $1,593 per life-year saved.
The World Health Organization considers medical intervention to be “highly cost-effective” if the cost per year of life saved is less than a nation’s per capita gross domestic product. The program’s ratio was well below South Africa’s 2011 per capita GDP of about $11,000.
“It’s really a slam dunk of an intervention,” said study leader Jacob Bor, a graduate student at Harvard. “These investments are worthwhile.”
The research team noted that the study period coincided with the arrival of electric power and clean water for area residents. But those alone could not explain the dramatic increase in longevity, they said.
“While mortality due to HIV declined precipitously, mortality due to other causes flat-lined,” Bor said. “These changes were almost certainly due to ART scale-up.”
In a second study from the same region, researchers followed nearly 17,000 healthy people from 2004 to 2011 to determine HIV infection rates in areas with active ART intervention programs.
Healthy individuals in those areas were 38% less likely to contract HIV than people in areas where ART drugs were not widely available, researchers found. People in extremely rural areas also fared better than those in more closely populated areas clustered around national roads.
Overall HIV prevalence increased 6% during the seven years of the study, probably because the antiretroviral drugs allowed people with the virus to live longer, according to the report.
It’s not clear how the results of the new study would translate to areas where stable, cohabiting couples were not the norm, said lead author Frank Tanser, an epidemiologist at the University of KwaZulu-Natal.
AIDS researchers who weren’t involved in the studies said they provide strong support for maintaining programs like the President’s Emergency Plan for AIDS Relief, begun by PresidentGeorge W. Bush in 2003.
“These papers present truly remarkable data,” said Dr. Douglas Richman, director of the Center for AIDS Research at UC San Diego.
Bloomberg 
(02.14.13):: Elizabeth Lopatto
CDC reported that it costs the United States $16 billion annually to treat eight STDs—HIV, syphilis, gonorrhea, hepatitis B, chlamydia, trichomoniasis, herpes, and human papillomavirus (HPV). CDC’s most recent comprehensive data (2008) estimates there are 19.7 million newly diagnosed sexually transmitted infections each year, and that half of these infections occur among young people ages 15 to 24. The most common diagnosis is HPV, which has been linked to throat, cervical, and penile cancers. The report estimates 110 million total sexually transmitted infections among US men and women of all ages.
CDC Epidemiologist Catherine Satterwhite, an author of one of the reports, stated that young people—especially young women—have always been disproportionately affected by STDs because many lack good insurance or easy healthcare access. Satterwhite noted that all STDs are preventable, most are curable, and all have existing treatments. Techniques for preventing STDs include abstinence, condom use, and mutual monogamy for couples. CDC recommends boys and girls have vaccination with Merck’s Gardasil to prevent HPV. In spite of increased incidence of HPV-related cancers, use of HPV vaccine remains low.
HIV is the most expensive STD because it requires life-long treatment. Curable STDs cost $742 million annually. The most common curable STD is chlamydia. To lower prevalence, Satterwhite recommended increased testing, especially for young women, and urged all sexually active people to be tested at least once for HIV.
The full report, “Sexually Transmitted Infections Among US Women and Men: Prevalence and Incidence Estimates, 2008,” was published in the journal Sexually Transmitted Diseases (2013; doi: 10.1097/OLQ.0b013e318286bb53).
The full report, “The Estimated Direct Medical Cost of Selected Sexually Transmitted Infections in the United States, 2008,” was published in the journal Sexually Transmitted Diseases (2013; doi: 10.1097/OLQ.0b013e318285c6d2).
(Last updated:2/12/2013; last reviewed:2/12/2013)
The following key changes were made to update the March 28, 2012, version of the guidelines.
Co-Receptor Tropism Assay
A genotypic tropism assay is now commercially available. The assay predicts HIV-1 co-receptor usage based on sequencing of the V3-coding region of HIV-1 env, the principal determinant of co-receptor usage. The Panel recommends that a genotypic tropism assay be used as an alternative to a phenotypic tropism assay before initiation of a CCR5 antagonist-containing regimen (BII).
Initiating ART in Treatment-Naive Patients
The Panel has updated its recommendations on initiation of ART in treatment-naive patients. The Panel’s recommendations are listed below.
What to Start: Initial Combination Regimen for Antiretroviral-Naive Patients
The following changes and updates were made to this section:
Acute and Recent (Early) HIV Infection
Additional Updates
Minor revisions have also been made to the following sections:
President Barack Obama included AIDS in his first State of the Union speech after his reelection: “In many places, people live on little more than a dollar a day. So the United States will join with our allies to eradicate such extreme poverty in the next two decades by connecting more people to the global economy; by empowering women; by giving our young and brightest minds new opportunities to serve; and helping communities to feed, and power, and educate themselves; by saving the world’s children from preventable deaths; and by realizing the promise of an AIDS-free generation, which is within our reach.”
WASHINGTON. January 30, 2013 – Thanks to $155K in grant investments from AIDS United, six community-based organizations in Puerto Rico will have expanded capacity for vital HIV prevention services in one of the most disproportionately-affected areas in the United States and its territories. The support from AIDS United comes from a funding partnership with Johnson & Johnson, H. van Ameringen Foundation, MAC AIDS Fund, Merck Corporation, and Elton John AIDS Foundation.
The projects receiving AIDS United support include peer‐based, in-person education and counseling outreach; syringe services programs; and social media outreach, designed to reach the populations most highly impacted by the epidemic on the island, including injection drug users, women, homeless individuals and youth, particularly young men who have sex with men, (MSM). According to the Centers for Disease Control and Prevention (CDC), in 2010, Puerto Rico ranked in the top 10 AIDS case rates among all states and territories in 2010; had an HIV death rate higher than any U.S. state or territory; and had a rate of HIV infection of 33.8, compared with the United States’ total rate of HIV infection of 19.7.
“These new investments help further AIDS United’s longstanding commitment to addressing the disproportionate severity of the HIV epidemic in Puerto Rico,” said Michael J. Kaplan, AIDS United President and CEO. “Through this unique funding pool, more than $675K has been invested since 2008. We are continuously communicating with community‐based organizations and advocates about how we might best meet the HIV prevention programming needs there. Ensuring that Puerto Rico has the resources and the capacity-building assistance it needs to aggressively respond to HIV brings AIDS United even closer to fulfilling our mission to end the HIV epidemic in the United States.”
The Puerto Rico grantees are:
WASHINGTON — Only one in five federally funded safety-net health centers reported testing all patients ages 13 to 64 for HIV, despite a 7-year-old CDC recommendation to do so, a government report found.
Another 55% reported targeting high-risk patients for testing, the Department of Health and Human Services Office of Inspector General (OIG) stated in a report issued Monday. The high-risk testing is an approach aligning with recommendations from the U.S. Preventive Services Task Force.
Another 1% of sites reported testing all adults, but not teens. The remaining 24% of sites offered HIV tests only when patients requested it or had HIV symptoms, the report found.
The health centers, all of which received money from the federal Health Resources and Services Administration (HRSA), reported a lack of financial resources from patients and sites as one factor that limited their HIV testing.
“Respondents from one health center site reported that patients who were not eligible for free HIV tests were unlikely to pay for tests, and respondents from another health center site reported that patients had difficulty paying even the small office visit fee, let alone an additional testing fee,” the report said.
For its report, the OIG selected a random 500 health centers from among more than 8,100 sites that were receiving HRSA funding in November 2010. Of those, 149 were excluded because they did not provide primary care, they were no longer in operation, or their contractors did not respond to the OIG’s inquiries.
Of the remaining 351 eligible sites, the OIG received responses from 324. Those sites were surveyed from May 2011 to November 2011 on their compliance with four CDC recommendations from 2006 on HIV testing.
The recommendations significantly changed how primary care providers should provide HIV tests. The recommendations for providers — aimed to reduce the stigma of such testing and increase the number of people who know their status — included:
A study published in November in Annals of Internal Medicine found that routine HIV screening has the potential to reduce sexual transmission of the virus.
The report also found that 29% of sites adopted the CDC’s recommended practice of not offering prevention counseling. When it came to gaining patient consent for HIV testing as with other tests, 27% adopted the practice, and 15% provided an HIV test as a standard, opt-out test, the report found.
HRSA funds grantees that administer clinics for community health, migrant health, homeless health, and public housing primary care. In 2011, such sites provided care to more than 17 million patients, and, with the CDC estimating one in five people in the U.S. living with HIV doesn’t know his status, HRSA centers can play a critical role in reducing the transmission of the virus, the OIG said.
To spur compliance with the CDC’s recommendations, the OIG recommended that HRSA require its health centers to determine the prevalence of undiagnosed HIV in the patient populations, adding that the agency also should require centers to report on their progress in determining prevalence.
Although the CDC recommends against routine testing if the prevalence is less than 0.1%, few health centers in the report tested enough patients to establish such a benchmark.
While they work to establish their patient populations’ HIV prevalence, health centers should also be required by HRSA to report the number of patients who have tested positive among all those tested at the site, the OIG recommended.
HRSA already requires its centers to report the number of tests provided. “However, HRSA does not collect information about how many of those HIV tests resulted in HIV-positive diagnoses,” Monday’s report noted.
HRSA does require clinics that receive funding through the Ryan White HIV/AIDS program — a HRSA program for HIV-positive patients who can’t afford care — track certain performance measures regarding HIV testing and care. “However, this requirement does not cover health center grantees that do not receive such funding,” the report said.
A new collaborative study led by Yale, the VA Healthcare System, and the North American Cohort Collaboration supports the accuracy of an index used for predicting mortality as patients with HIV age. The study appears in the Journal of Acquired Immune Deficiency Syndromes (JAIDS).
The course of chronic HIV infection has changed with the advent of antiretroviral therapy (ART). Viral suppression is common, the authors write, and there have been reductions in AIDS-related deaths in regions where ART is easily accessible. Yet, the authors say, people with HIV infection continue to experience a higher rate of mortality due not just to HIV-related factors, but because chronic HIV infection appears to exacerbate vulnerability to aging-related organ system injury.
The Veterans Aging Cohort Study (VACS) Index, funded by the National Institutes of Health (NIH), builds upon older indices that measured biomarkers for HIV (the virus that causes AIDS) — such as CD4 cell count, HIV-1 RNA levels, and patient age — in order to determine mortality risk. The newer VACS Index takes other critical factors into account, such as the increasing role of multi-organ system injury and hepatitis C infection, and the decreasing role of other factors such as CD4 count.
The researchers analyzed data from over 5,000 veterans and over 10,000 non-veterans representing 14 separate cohorts of HIV-infected patients around the country who had had at least a year of exposure to ART. They followed up with those patients for just over three years. Researchers found the new VACS index to be much more accurate and effective than an index restricted to CD4 count, HIV-1 RNA, and age.
According to senior author Dr. Amy Justice, professor of internal medicine at Yale School of Medicine, “The VACS Index accurately estimates risk of mortality among those aging with HIV infection whether they live in Canada or the United States. Further, it is accurate among men and women, those who are older and younger, and white individuals and people of color.” The team has developed an app that allows patients and their providers to use this information in care. It can be accessed online.
Justice is professor of medicine and public health at Yale School of Medicine; she also serves as section chief of general internal medicine in the VA Connecticut Healthcare System and is affiliated with Yale’s Center for Interdisciplinary Research on AIDS.
This study was supported by grants from the National Institutes of Health. Other funding was provided by the Training Program in Environmental Epidemiology, and other grants from the NIH. This work was also supported by the Centers for Disease Control, the Canadian Institutes for Health Research, and the Canadian Trials Network.
Other authors are Janet Tate of Yale and the VA Healthcare System, West Haven; Sharada P. Modur, Keri N. Althoff, Lisa P. Jacobson, Kelly A. Gebo, Richard Moore, Gregory D. Kirk and Stephen Game of Johns Hopkins University; Mari M. Kitahata of the University of Washington; Michael A. Horberg of the Mid-Atlantic Permanente Research Institute; John Brooks and Kate Buchacz of the Centers for Disease Control; James Goedert of the National Institutes of Health; Sean Rourke and Anita Rachlis of the University of Toronto; Sonia Napravnik and Joseph Eron of the University of North Carolina Chapel Hill; Ronald Bosch of Harvard Medical School; James H. Willig of the University of Alabama; Benigno Rodriguez of, Case Western Reserve University; Robert Hogg of Simon Fraser University in Vancouver; Marina Klein of McGill University in Montreal; John Gill of the University of Calgary; Steven Deeks of the University of California San Francisco; Timothy Sterling of Vanderbilt University; Kathryn Anastos of Einstein Medical School; and the NA-ACCORD and VACS Project Teams.
(Image via Shutterstock)
