Yearly Archives: 2012

By Karen Ravn, LATimes.com 

Twitter. A popular online social network? Yes. A vital tool for medical research? Maybe.

“Until now, healthcare providers have primarily used online networks as a promotional tool,” says Lee Aase, director of the Mayo Clinic Center for Social Media. “We think they can be much more.”

Take the case of a surgeon who tweeted about a novel use of laparoscopy for removing a tumor. “It was a quick way to communicate information versus waiting up to a year to publish a paper,” says Dr. Prasanth Prasanna, a radiologist in Salem, Ore., who has studied the use of social media in the medical profession.

Social media can also play an important role in research that does get published. A paper in the September issue of the Journal of Urban Health demonstrated how a social networking smartphone app could be used to recruit study participants.

“It can be challenging to enroll young gay men in HIVprevention studies,” says lead author Dr. Raphael Landovitz of the UCLA Center for Clinical AIDS Research & Education. So research teams used Grindr, an app popular with young gay men for sexual partnering, to find 375 participants for a survey. Landovitz believes the success of this approach augurs well for the use of such apps in recruiting participants for future studies of HIV prevention and treatment.

The Mayo center encourages the use of social media for research and also for teaching people about healthful habits, something Dr. Nina Shapiro has been doing on her blog (www.drninashapiro.com) and in her Twitter posts for about a year and a half. “It’s a way to give true science-based fact mixed with my opinions,” says Shapiro, director of pediatric ear, nose and throat at the Mattel Children’s Hospital at UCLA and associate professor at the David Geffen School of Medicine there. “I can say things as strongly as I feel them, which I can’t really do in my role as an academic.”

Still, to date, patients have been the ones to jump most wholeheartedly into the social media maelstrom, says Paul Keckley, who tracks these developments as executive director of the Deloitte Center for Health Solutions, a research arm of the accounting firm, in Washington, D.C. “For some patients, it’s an avenue for sharing at a vulnerable time.”

Often, patients recommend — or not — particular doctors or facilities. In fact, this may encourage doctors to practice more patient-centered care, says Dr. James Rickert, the founder and president of the Society for Patient Centered Orthopedics. “Everybody online can find out how well you do with patients. You don’t want people to see you being dissed all the time.”

Alternatively, patients may describe their experiences with particular diseases or conditions. Such patient-to-patient connections can help reduce the sense of isolation many people feel when they’re sick.

In a survey of epilepsy patients on one network, PatientsLikeMe, 30% said that before joining, they didn’t know anyone else with their condition. Of those, 63% got in touch with one or more fellow patients on the site.

Patients can also educate one another. A patient just diagnosed with diabetes can learn a lot from someone who’s been diabetic for 30 years, Prasanna says.

In the survey of epilepsy patients, more than half the respondents reported increased understanding of their seizures after joining the network.

Experts foresee both pluses and minuses as patient use of social media booms. Better-informed patients could change the typical doctor-patient relationship, Prasanna suggests: “Make it less hierarchical, more of a level playing field.”

Of course, we’re talking about the Web, so there could be an epidemic of misinformation too. Watch out for anyone claiming tree bark cured his cancer, Keckley cautions.

Indeed, his concern about unreliable information online — “the usual snake oil for financial gain” — drove Dr. Michael Yeh to start the UCLA Endocrine Surgery blog in 2007. “Initially, I wrote some of my own content,” says Yeh, who directs the UCLA endocrine surgical unit. “But it was very time-consuming, and besides, I discovered that patients are more interested in what other patients have to say.” So now the blog is devoted to patient experiences as told by the patients themselves.

Less productive, perhaps, are some patients’ attempts to use social media to have a closer connection with their doctors. In a 2010 survey of online social network use, about one-third of practicing physicians reported receiving friend requests from patients or their family members. About two-thirds of the physicians said accepting such invitations would not be ethical.

Seems you can be “friends” with just about anybody these days — from Queen Elizabeth II to Lady Gaga — but probably not your doctor.

Evidence for selection at HIV host susceptibility genes in a West Central African

human population

Kai Zhao, Yasuko Ishida, Taras K Oleksyk, Cheryl A Winkler and Alfred L Roca

Background

HIV-1 derives from multiple independent transfers of simian immunodeficiency virus (SIV) strains from chimpanzees to human populations. We hypothesized that human populations in west central Africa may have been exposed to SIV prior to the pandemic, and that previous outbreaks may have selected for genetic resistance to immunodeficiency viruses. To test this hypothesis, we examined the genomes of Biaka Western Pygmies, who historically resided in communities within the geographic range of the central African chimpanzee subspecies (Pan troglodytes troglodytes) that carries strains of SIV ancestral to HIV-1.

Results

SNP genotypes of the Biaka were compared to those of African human populations who historically resided outside the range of P. t. troglodytes, including the Mbuti Eastern Pygmies. Genomic regions showing signatures of selection were compared to the genomic locations of genes reported to be associated with HIV infection or pathogenesis. In the Biaka, a strong signal of selection was detected at CUL5, which codes for a component of the vif-mediated APOBEC3 degradation pathway. A CUL5 allele protective against AIDS progression was fixed in the Biaka. A signal of selection was detected at TRIM5, which codes for an HIV post-entry restriction factor. A protective mis-sense mutation in TRIM5 had the highest frequency in Biaka compared to other African populations, as did a protective allele for APOBEC3G, which codes for an anti-HIV-1 restriction factor. Alleles protective against HIV-1 for APOBEC3H, CXCR6 and HLA-C were at higher frequencies in the Biaka than in the Mbuti. Biaka genomes showed a strong signal of selection at TSG101, an inhibitor of HIV-1 viral budding.

Conclusions

We found protective alleles or evidence for selection in the Biaka at a number of genes associated with HIV-1 infection or progression. Pygmies have also been reported to carry genotypes protective against HIV-1 for the genes CCR5 and CCL3L1. Our hypothesis that HIV-1 may have shaped the genomes of some human populations in West Central Africa appears to merit further investigation.

 

 

 

 

The American Journal of Preventive Medicine released a special supplemental issue this week titled, “Implementing Pre-Exposure Prophylaxis (PrEP) in the US: Moving from Evidence to Practice”. CDC’s Dr. Dawn Smith served as a senior editor on this commissioned issue of AJPM.

Articles in the issue address PrEP implementation, lessons learned from dissemination and implementation of other health interventions, policy issues surrounding PrEP implementation, and gaining practice-based evidence about PrEP use in the United States. PrEP has been tested in clinical trials settings and found to be efficacious when used consistently for men who have sex with men and heterosexual men and women at high risk for HIV. Obtaining early practice-based evidence is critical to inform the next stages of PrEP dissemination, implementation, and evaluation and define its role in an integrated set of biomedical, behavioral, and structural HIV prevention programs.

 For more information on this special edition, click HERE

HIV surveillance data among Men who have Sex with Men (MSM) and Injection Drug Users (IDU)

Surveillance is the foundation of the nation’s HIV prevention efforts. It is critical to have accurate population estimates in order to better understand the HIV burden among risk groups as well as to make a substantial impact and save lives through better HIV prevention program planning. Without census estimates available for the number of injection drug users (IDU) or men who have sex with men (MSM) in the U.S., it has been difficult to quantify disease rates and disparities in disease rates among IDU and MSM compared to their population sizes in the same way we do for other factors such as sex, race/ethnicity, and age.

While there have been a variety of methods and estimates of the population sizes of these groups, CDC was interested in developing single estimates to use in interpreting HIV surveillance data. Because meta-analysis quantitatively combines estimates from multiple studies, it provides a strong basis for a national estimate of the proportions of MSM and IDU in the U.S. CDC recently published estimates of the populations’ sizes of MSM and IDU in the U.S. using meta-analysis of multiple national, population-based surveys.

Since the beginning of the HIV epidemic in the United States, men have accounted for the largest proportion of cases, and the large majority of those men have been gay, bisexual, and other MSM. In 2010, MSM accounted for 63% of all new HIV infections, and MSM with a history of injection drug use (MSM-IDU) accounted for an additional 4% of new infections and IDU (male and female) accounted for approximately 9% of all new infections. At the end of 2009, an estimated 56% of persons living with an HIV diagnosis in the U.S. were MSM or MSM-IDU and 16% were IDU.

 

Estimates for MSM and IDU populations

Using meta-analysis with behavioral data from population-based surveys, CDC found that men who engaged in same-sex behavior in the past five years comprised 3.9% (3.5 – 4.4) of the U.S. adult male population. Men who recall ever engaging in same-sex behavior comprised 6.9% (5.1-8.6) of the U.S. adult male population. In a recent publication, CDC used the 5-year estimate as a conservative, mid-range estimate of the size of the MSM population. Compared to other men and women, HIV rates among MSM were 38 to 75 times as high, and syphilis rates were 63 to 109 times as high.

 

 Similar to the MSM population size estimate, CDC conducted a meta-analysis of behavioral data from national surveys to estimate the number of persons in the U.S. who have injected drugs to use as a denominator to calculate HIV diagnosis and prevalence rates for IDU.

 

The meta-analysis estimated that lifetime IDU comprise 2.6% (95% confidence interval (CI): 1.8% – 3.3%) of the U.S. population age 13 years or older; the past-year IDU estimate was 0.30% (95% CI: 0.19 % – 0.41%). Comparing black IDU to white IDU, the rate of HIV diagnosis was nearly 15 times as high; comparing Hispanic/Latino to white IDU, the rate was more than 9 times as high.

 

CDC continues to work on developing national estimates of population sizes for other transmission categories (MSM/IDU and heterosexual contact). Given the need for comparability across groups, it is expected that disease rates by transmission category will be calculated based on the ‘ever’ behavioral recall period for all groups, including MSM.

 

National estimates of population sizes can be used to provide a broader understanding of the HIV epidemic among those at risk for transmission and acquisition of HIV. These estimates and disease rate calculations also provide important tools for monitoring and characterizing the HIV epidemic in the United States as well as planning and optimizing the allocation of resources to programs serving disproportionately affected populations and addressing health inequities. As such, they can be helpful in implementing and monitoring the National HIV/AIDS Strategy.

 

The MSM article is available HERE: http://www.benthamscience.com/open/toaidj/articles/V006/SI0065TOAIDJ/98TOAIDJ.pdf

 

The IDU poster presentation may be viewed HERE: http://www.hivforum.org/storage/hivforum/documents/_2012NationalSummit_Posting/c_115_lansky.pdf

By DONALD G. McNEIL Jr. at NYTimes.com

Ambassador Eric Goosby, the Obama administration’s global AIDS czar, was named to lead a new Office of Global Health Diplomacy on Friday, the State Department said. Dr. Goosby will continue to head Pepfar, the President’s Emergency Plan for AIDS Relief, which pays for prevention and treatment. His new role was welcomed by some advocacy groups and U.N.AIDS, the United Nations agency. Chris Collins, policy chief for AmFAR, which promotes AIDS research, said high-level diplomacy was crucial to getting countries to spend more on their epidemics, and to asking them to stop ignoring politically unpopular victims like gay men, drug users and prostitutes. Also on Friday, Kathleen Sebelius, secretary of health and human services, created a post in her department, assistant secretary for global affairs, and appointed Dr. Nils Daulaire to it.

L.I.F.E. Project

HIV Prevention Group for Young Gay Men of Color ages 18-24.

This group is for youth that are seeking a safe space where they can be themselves. This intervention addresses issues and social norms in the Los Angeles community and serves as a place where this youth can meet some of their peers.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLICK HERE  to read original article at plusnews.org

Plague. Killer disease. All are terms still routinely used by Kenya’s media to describe the HIV epidemic more than thirty years after it was first identified. Experts say the media needs to step up to promote a better understanding of the illness.

“The use of words like ‘scourge’ or ‘sufferer’ in the media to refer to HIV/AIDS or to people living with it… shows the disease is such a bad thing, yet there are people living with it, and examples are countless, who are doing normal things and leading normal lives,” Allan Maleche, a human rights lawyer and head of the Kenya Legal and Ethical Issues Network on HIV and AIDS, told IRIN/PlusNews. “Stigma has been one of the issues that helped HIV to spread, and there is need to train the media on how to report HIV in less stigmatizing ways.”

Media outlets often concentrate on the more salacious or scandalous details of stories involving HIV rather than the more informative, educational aspects.

One woman interviewed by a Kenyan TV station earlier this year told IRIN/PlusNews of her disappointment when the story was broadcast. “The journalists dwelt mainly on how I got infected instead of how I protected my unborn child from infection, which was my main aim of calling the journalist,” she said.

Difficult to cover

Journalists IRIN/PlusNews spoke to said stories about HIV were more difficult to cover than other news stories, involving in-depth research, a strong understanding of scientific subjects and tough interviews dealing with very personal issues.

“Covering HIV and AIDS is… a sensitive area and… you have to look at issues from the [position] of the interviewee… People living with HIV are often misjudged, blamed for ‘getting it’, which in turn leads to their being stigmatized and shunned,” Waweru Mugo, a freelance Kenyan journalist who has written extensively on HIV, told IRIN/PlusNews. “This therefore requires a journalist to be careful with the language [so] that [it] does not discriminate and stigmatize further.”

“I suggest that journalists are trained and retrained in the use of language, for it requires ethical and professional handling,” he added.

Jane Thuo, chief executive officer of the Association of Media Women in Kenya, noted that there is a need to ensure HIV continues to receive press coverage amid newer, equally serious health issues such as cancer and other non-communicable diseases.

Training

In 2002, the Coalition of Media Health Professionals produced a guide to reporting on HIV for Kenyan journalists in an effort to boost journalists’ sensitivity on the subject. But experts say there is a need for specific training for journalists who write about HIV.

One such  training, sponsored by the International Planned Parenthood Federation (IPPF), was recently held in the Kenyan capital Nairobi. Tom Japanni, a senior BBC producer and trainer for the two-day workshop, noted that journalists were well placed to simplify the medical terminologies and disseminate them to the society.

“We are advantaged to be able to interpret health-related research findings, parliamentary bills and other related instruments, even in our local languages,” he said. “That is all the more reason journalists should be well equipped to deliver the correct information to the society. You must be informed for you to inform others.”

“There are people in Kenya who still do not understand HIV beyond transmission, prevention and treatment,” Helen Barsosio, a Kenyan-based reproductive health researcher and the technical advisor on HIV programs for the NGO HOPE worldwide, told IRIN/PlusNews. “This kind of training is ideal for journalists to enable them to understand the correct language to use while reporting and to identify the stories within the HIV main story.”

Having an effect

“We train the journalist on the art of interview, among other areas,” said Anne Mikia, a radio specialist and trainer at Internews, which supports local media around the world. “Interviewing a person living with HIV needs a lot of skill, lest you offend the interviewee.”

Although Mikia says it is difficult to measure the impact of their trainings, she noted that stigmatizing language and pictures were on the decline in most major media houses.

“The trainings… go for only one week, and that is not sufficient for a journalist to acquire absolute effective skills on HIV reporting,” she added, noting that journalists need to use their own initiative to develop the skills to report on HIV.

A local network of HIV-positive journalists is also playing a role in improving reporting on HIV in the media. “We realized that journalists rarely speak about themselves but report only what others have said or done. As journalists living with HIV, we can easily address HIV issues because we relate with them,” said Elvis Bassudde, chairman of the East Africa chapter of Journalists Living with HIV/AIDS.

“A journalist living with HIV and who sits in an editorial committee can [more] easily campaign for a space for an HIV story than one who is not.
“

By Julie Steenhuysen at Reuters.com

CHICAGO (Reuters) – An influential U.S. panel has called for routine HIV screening for all Americans aged 15 to 65, a change that could help reduce some of the stigma about getting tested for the sexually transmitted infection that causes AIDS.

The draft recommendations, released on Monday by the U.S. Preventive Services Task Force, a government-backed group of doctors and scientists, also called for routine HIV testing for all pregnant women.

“The prior recommendations were for screening high-risk adults and adolescents,” said task force member Dr Douglas Owens who is a medical professor at Stanford University.

“The current recommendation is for screening everyone, regardless of their risk,” said Owens, who is also affiliated with the Veterans Affairs Palo Alto Health Care System in California.

Nearly 1.2 million people in the United States are infected with HIV, yet 20 to 25 percent of them do not know it.

“This marks a monumental shift in how HIV in the United States can be prevented, diagnosed and treated,” said Carl Schmid, deputy executive director of The AIDS Institute, an AIDS advocacy group.

The new guidelines by the task force are expected to affect the reimbursement of HIV testing, removing one of the barriers to the tests, Schmid’s group said in a statement.

Under the Affordable Care Act, insurers are required to cover preventive services that are recommended by the task force. The change brings the group more in line with the U.S. Centers for Disease Control and Prevention, which in 2006 recommended HIV testing for everyone between 13 and 64.

The recommendations, which had been expected, are based on the latest evidence showing the benefits of early HIV testing and treatment. Recent studies have shown that HIV treatment can reduce transmission of the virus to an uninfected partner by as much as 96 percent.

“Treatment has two benefits. One is to the person who has HIV, and also treatment helps prevent transmission and protects a person’s partner,” Owens said.

Dr. Jeffrey Lennox, a professor of medicine at Emory University School of Medicine and chief of infectious disease at Grady Memorial Hospital, an inner-city hospital in Atlanta, said under the current recommendations, many doctors simply fail to offer the tests.

“In our practice, we see patients every week who are newly diagnosed with HIV – people who have seen many physicians in the past 10 years and none of them had ever offered testing,” Lennox said.

Many of these patients have far advanced disease, that could have been caught earlier and successfully treated.

Owens said he hopes the change will make it easier for doctors to offer testing.

“You are offering this to adolescents and adults and everyone. The conversation you have with people is likely to be easier,” he said.

The draft recommendations are based on a study of the most recent evidence on the risks and benefits of HIV testing published in the Annals of Internal Medicine.

The guidelines will be available for a 30-day public comment period before final recommendations are released, likely sometime next year.

Carole Leach-Lemens from aidsmap.com

HIV testing and counselling of couples quickly led to consistent condom use among serodiscordant couples in stable relationships in South Africa, researchers report in the advance online edition of the Journal of Acquired Immune Deficiency Syndromes. 

In this secondary analysis of self-reported behavioural data of 508 HIV-infected participants recruited into the Partners in Prevention study (aciclovir as secondary prophylaxis in HIV/HSV-2 co-infected people to prevent HIV transmission to their HIV-negative partner), 71% of those just learning their HIV status reported unprotected sex, compared to a quarter who knew their status for the full month.

One month later, when all had had couples’ HIV testing and counselling (HTC), and so were aware of their discordant relationship, the proportion of those having unprotected sex fell dramatically, from 71 to 8%.

Monthly counselling for the HIV-infected partner, quarterly individual or couples’ HTC for the uninfected partner, and condom provision for both resulted in these low levels of unprotected sex being maintained at the end of one year.

“The finding that mutual awareness is more protective than individual awareness is complemented by findings from the full trial: HIV-uninfected participants reported less frequent unprotected sex with study partners, whose HIV status was known, than with outside partners, whose HIV status was often unknown,” the authors comment.

Most HTC efforts are targeted to individuals so leading to missed HIV prevention opportunities.

In stable HIV-discordant relationships the uninfected partner is at continued risk of getting HIV. Biomedical interventions (such as antiretroviral treatment [ART] taken by the infected partner or pre-exposure prophylaxis [PrEP] by the uninfected partner) can significantly reduce the risks of transmission. However, in many settings the infected partner may not be eligible for ART and/or PREP is not yet available.

Estimates of the proportion of the estimated annual incidence of 1.8 million new infections in sub-Saharan Africa attributable to unprotected sex within stable HIV-discordant partnerships range from 14 to 94%.

For those without access to biomedical interventions, effective behavioural interventions (individual and couples’ HTC) are critical for those in discordant relationships at risk for HIV.

While couples’ HTC is linked to increased condom uptake compared to individual HTC, the timing of uptake and whether those engaging in unprotected sex engage in fewer acts are poorly understood.

With this in mind, the authors chose to look at whether HTC with ongoing counselling and condom distribution would lead to reduced unprotected sex in serodiscordant couples in stable relationships.

Behavioural data from participants enrolled in three South African sites was analysed: Gugulethu, Orange Farm and Soweto.

The primary factor of interest was the timing of HTC for the HIV-positive participant. At baseline, the HIV-positive participant reported the date of their first HIV-positive test. This date was subtracted from the baseline date to determine the number of days since HTC: 0 to 7, 8 to 14, 15 to 30 or more than 30 days.

The primary outcome was unprotected sex self-reported by the HIV-positive participant. Predicted probabilities of unprotected sex in the last month were calculated at baseline, at month one and month twelve.

HIV-positive participants were predominantly female (77%) with a mean age of 33 years. Most (82%) had at least one child and few (4%) reported having had more than one partner in the last month. Over 60% were married or cohabiting and 79% had been together for more than one year.

Only 4% of HIV-positive participants reported recent relationship violence.

At baseline, 13, 26, 11 and 50% of HIV-positive participants were tested at less than seven, 8 to 14,15 to 30 and more than 30 days, respectively, before baseline. Newly tested is defined as 30 days and under; previously tested as over 30 days.

At baseline, the proportions of HIV-positive participants reporting more than one sex act in the last month with their study partner among new and previously tested were 94.1 and 96.1%, (p=0.3) respectively; at one month and at twelve months after baseline 87.9 and 89.1% (p=0.7) and 73.6 and 78.2% (p=0.3), respectively, reported sexual activity.

Over time the predicted probabilities of unprotected sex declined.

Among the new and previously tested, at baseline, the proportion reporting unprotected sex in the last month was 53% compared to 25%, at one month the proportions decreased to 9 and 13% respectively; and at one year the proportions were 6 and 14%.

The mean numbers of unprotected sex acts among the new and previously tested were 8 and 6, 8 and 7, and 6 and 6 at baseline, one month and one year, respectively.

These findings are consistent with previous studies (in Africa) of the protective nature of couples’ HTC for HIV-discordant couples and increased condom use.

However, this analysis, the authors note, is one of the first showing that condom use happens within the first week following couples’ HTC.

Understanding the effectiveness of HTC in a time of rapid scale-up is critical. HTC cannot be evaluated in a randomised trial because not providing HTC is unethical, the authors note. So this trial “provided an opportunity to address the impact of couples HTC on HIV prevention in an ethical, rigorous way”.

While the authors knew the exact time when HIV status was learned, they only knew of sexual behaviour within a one-month interval. So the timing of HTC and sexual behaviour among the newly tested is unclear.

They note that two aspects of their study design suggest unprotected sex was happening before HTC:

1. Once the newly tested had been aware of their HIV status for one month, they reported lower levels of unprotected sex.
2. The more time someone was unaware of their status, the more likely they were to report unprotected sex at baseline.

The authors advise caution in generalising these findings to other than stable relationships.

Most of the couples were in long-term relationships with minimal levels of intimate partner violence. The authors suggest that looking at couples’ HTC within less stable as well as more violent relationships warrants study.

Their findings lend support to strategies recently recommended in the World Health Organization’sGuidance on Couples HIV Testing and Counselling including home-based testing, supportive HIV-disclosure counselling and partner notification.

The authors conclude that their findings “add to a growing body of evidence demonstrating that couples HTC is effective at rapidly increasing condom uptake, facilitating on-going condom use and lowering rates of HIV transmission…With expanding HTC capacity in Africa, decision-makers need to consider how to reach couples. Such expansion will help a high risk group make informed sexual health decisions and likely prevent a substantial number of HIV infections.”

Deportation. Detention. Barred entry. These are just some of the scenarios that people with HIV have to deal with when it comes to international travel.

By Emily Jane Fox from money.cnn.com

Now, CEOs from 40 well-known companies are calling for countries to get rid of their HIV-related travel restrictions. Corporate leaders say the travel restrictions are discriminatory and detrimental to the globalized economy, in which companies have to be free to send employees around the world.

Currently, 45 countries have laws or policies in place that deport, detain or deny entry to people who are HIV positive, according to UNAIDS, the United Nation’s program on HIV/AIDS. HIV is the virus that causes AIDS.

Five countries in the Middle East bar people living with HIV from entering. Another five, including Singapore, Egypt and the Turks and Caicos, require that people who want to stay in their countries for longer than five days have to show they do not have HIV.

Until recently, the U.S. too had regulations that barred HIV-infected foreign nationals from receiving a visa to enter the country. President Obama lifted them in January 2010.

The American restrictions were introduced in 1987, when Congress directed the U.S. Department of Health and Human Services to add HIV to its list of diseases of public health significance. Foreign nationals were tested for the immunodeficiency virus during medical screening by U.S. immigration.