Subject: CDC NCHSTP Daily News Update Date: Wed Jan 14 08:31:03 PST 1998 (281 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update January 14, 1998 The CDC National Center for HIV, STD and TB Prevention provides the following information as a public service only. Providing synopses of key scientific articles and lay media reports on HIV/AIDS, other sexually transmitted diseases and tuberculosis does not constitute CDC endorsement. This daily update also includes information from CDC and other government agencies, such as background on Morbidity and Mortality Weekly Report (MMWR) articles, fact sheets, press releases and announcements. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC NCHSTP Daily News Update should be cited as the source of the information. Copyright 1997, Information Inc., Bethesda, MD. HEADLINES --------- PEER-REVIEWED JOURNALS "The Cost-Effectiveness of Preventing AIDS-Related Opportunistic Infections" "Look Behind Bars For Key To Control of STDs" "Correctional and Community Health Care Collaborations" GENERAL MEDIA "Switch by AIDS Service Group May Lead New York State to Track People With H.I.V." "Poverty, Drug Abuse Fuel Caribbean AIDS Outbreak" "Pennsylvania Adopts HIV Testing for Pro Fighters Seeking Licenses" "State's AIDS Cases Decline for Second Year" "No Excess RDS Seen in Infants Born to HIV-Positive Mothers" "Rio De Janeiro Tightens Controls Over AIDS Tests" "Acyclovir Does Not Improve Survival in AIDS Patients" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "The Cost-Effectiveness of Preventing AIDS-Related Opportunistic Infections" Journal of the American Medical Association (01/14/98) Vol. 279, No. 2, P. 130; Freedberg, Kenneth; Scharfstein, Julie; Seage, George III; et al. Researchers from the Boston Medical Center and elsewhere studied the clinical impact, cost, and cost-effectiveness of treatment for prophylaxis for Pneumocystis carinii pneumonia, toxoplasmosis, Mycobacterium avium complex infection, fungal infections, and cytomegalovirus disease in HIV-infected patients. The study measured projected life expectancy, quality-adjusted life expectancy, total lifetime direct medical costs, and cost-effectiveness in dollars per quality life year (QALY) saved. The researchers found that patients who received no intervention had a quality adjusted-life expectancy of 39.08 months, with medical expenses of $40,288. Patients receiving trimethoprim-sulfamethoxazole for prophylaxis of PCP and toxoplasmosis had a quality adjusted-life expectancy of 42.56 months, at an average medical cost of $16,000 per QALY saved. Prophylaxis for MAC cost $35,000 per QALY saved for azithromycin and $74,000 for rifabutin. Prevention of CMV through use of oral ganciclovir proved to be the least cost-effective, measuring $314,000 per QALY saved. The researchers concluded that while the cost-effectiveness of prophylaxis against HIV-related opportunistic infections varies, the greatest comparative value comes with prophylaxis against PCP or toxoplasmosis. "Look Behind Bars For Key To Control of STDs" Journal of the American Medical Association (01/14/98) Vol. 279, No. 2, P. 97; Skolnick, Andrew Correctional health care experts are calling for increased health care and follow-up services for former inmates to reduce the spread of sexually transmitted diseases in the overall population. The incarcerated population, which numbered 1.6 million in the United States in 1996, is at extremely high risk for tuberculosis and STDs. Between 1989 and 1993, for example, nearly 40 percent of all newly diagnosed HIV infections in Rhode Island were diagnosed in the state prison. In Chicago, nearly one-quarter of all newly diagnosed syphilis cases were found in the Cook County Jail. Yet research from the Centers for Disease Control and Prevention and the National Institute of Justice indicates that there is insufficient collaboration among correctional facilities and public health departments. The Ninth National Survey of HIV/AIDS, Sexually Transmitted Diseases, and Tuberculosis in Correctional Facilities found that only 69 percent of state and federal correctional facilities said they worked with public health departments on testing for STDs. Discharge-planning collaboration occurred even less frequently, with only 65 percent of state and federal institutions reporting that they worked with public health departments. According to the CDC's John Miles, correctional facilities should initiate programs--aimed at educating inmates on prevention and risk-reduction--that continue once the inmate is released into the community. "Correctional and Community Health Care Collaborations" Journal of the American Medical Association (01/14/98) Vol. 279, No. 2, P. 98; Skolnick, Andrew Correctional facility inmates require increased health care as a result of their high risk for tuberculosis, HIV, syphilis, and other sexually transmitted diseases, yet very few programs exist which follow up inmate health care after release from detention. Two facilities, however, serve as models for follow up care due to their collaboration with local public health departments: The Hampden County Correctional Center in Ludlow, MA, and the Rhode Island Adult Correctional Institute in Cranston. A study of Rhode Island's prison release health care program for HIV-seropositive women, published in 1996 in the American Journal of Public Health, found that the program appeared to lower the recidivism rate and had positive effects on former inmates' high-risk behaviors. Recidivism rates were significantly lower than those of HIV-infected women--released during the previous year--who did not have the help of the release project. The Hampden County Correctional Center opened in 1992, and provides health care to HIV-positive inmates--from various jails and prisons in metropolitan Springfield, MA--before, during, and after incarceration. Dr. Thomas Conklin, the center's director of health services, notes that the program costs $6 per inmate per day, which is lower than the cost of most other prison health care programs. Furthermore, a two-year study of 162 HIV-infected former inmates found a recidivism rate of 46 percent, versus a rate of 72 percent for the correctional facility's overall population. According to Hampden physician Thomas Lincoln, this community-based model of correctional health care could be useful for other facilities located in similarly sized metropolitan centers. **************************************************************** GENERAL MEDIA **************************************************************** "Switch by AIDS Service Group May Lead New York State to Track People With H.I.V." New York Times (01/14/98) P. A15; Richardson, Lynda According to an official statement set to be released today, Gay Men's Health Crisis now supports HIV reporting to the New York State Health Department. With this support, state legislators are now more likely to institute such a tracking system. Explains State Senator Kemp Hannon (R-Garden City): "If people felt all the advocacy groups were against it, they may feel it would be futile to pursue it." The decision by the service group presents a dramatic change in attitude. Previously, the group opposed such reporting for fear it would discourage people from being tested and receiving early treatment. Some AIDS activists, meanwhile, are angry about the decision, especially because the Gay Men's Health Crisis does not explicitly oppose name-based HIV reporting; however, the group's statement does note that it supports a code-based tracking system. In order to establish an HIV reporting system, New York needs a regulatory change or legislation. Assemblywoman Nettie Mayersohn (D-Queens) has already introduced a bill for a name-based reporting system, while the state's AIDS Advisory Council is expected to make recommendations on the issue in early March. "Poverty, Drug Abuse Fuel Caribbean AIDS Outbreak" Washington Post (01/14/98) P. A12; Kovaleski, Serge F. Across the Caribbean, the number of new AIDS cases has increased dramatically over the past five years, according to the Caribbean Epidemiology Center (CAREC) in Trinidad. Health officials say the AIDS epidemic in the region has grown worse because of migration, poverty, low levels of education, the growing popularity of crack cocaine, and the frequency of men's and women's having multiple sex partners. In fact, the region has the world's second-highest incidence rate behind sub-Saharan Africa, with nearly 310,000 people having HIV or AIDS and an adult prevalence rate of almost 2 percent. Faced with an annual AIDS incidence rate of 146.6 people per 100,000, the Bahamas has taken some positive steps in the fight against the epidemic, including treatment programs for pregnant women with HIV. Still, health officials remain concerned that many people are simply ignoring the risks, while the epidemic is straining the region's economy and already limited resources. The Caribbean Epidemiology Center has been working with its member countries to improve HIV testing, establish accreditation systems for laboratories and workers, monitor sexual behavior patterns, and develop educational programs. "Pennsylvania Adopts HIV Testing for Pro Fighters Seeking Licenses" Philadelphia Inquirer (01/14/98) P. E1; Searcy, Jay On Tuesday, the Independent Regulatory Review Commission granted the Pennsylvania State Athletic Commission permission to enforce a new regulation requiring professional boxers and kickboxers to be tested for HIV before fighting. Pennsylvania joins Nevada, Arizona, Maryland, Massachusetts, New Jersey, New York, and California in requiring testing for HIV. State Boxing Commissioner George Bochetto said the regulation was not as comprehensive as he had hoped for, but that it is a step in the right direction. Greg Sirb, of the State Athletic Commission, explained that athletes will have to pay for the testing themselves, but the Commission is working with public health officials to have testing offered for free. However, the free testing issue has drawn fire from Health Secretary Daniel Hoffman, who notes that the actual risk of contracting HIV during a bout is minimal and that the money used for free testing could be better used to educate athletes about the disease. "State's AIDS Cases Decline for Second Year" Washington Post (1/14/98) P. B3 The Virginia Department of Health has reported a 2.9 percent drop in new AIDS cases in 1997, marking the second consecutive year of decline. In the previous year, state health officials reported a 22 percent decrease in new AIDS cases. The state noted that in 1997, AIDS cases increased slightly among teenagers, African Americans, and people aged 40 to 49. Moreover, the number of reported HIV cases in Virginia remained steady, with 11 more infections reported in 1997 than in 1996. "No Excess RDS Seen in Infants Born to HIV-Positive Mothers" Reuters Health Information Services (01/13/98) To determine whether the incidence of neonatal respiratory distress in infants born to HIV-positive mothers is higher than that in infants born to uninfected mothers, Dr. Richard Martin and colleagues from Ohio's Rainbow Babies & Children's Hospital examined 600 infants born to HIV-positive mothers over a four-year period. Based on previous studies indicating that infants born to HIV-positive mothers have higher rates of prematurity and low birth weight, the researchers initially postulated that such infants would also have a higher risk of respiratory distress syndrome (RDS). However, according to findings published in the December issue of The Journal of Pediatrics, the researchers found only 16 cases of RDS and five cases of bronchopulmonary dysplasia. The researchers concluded that the incidence of respiratory distress in infants born to HIV-positive mothers is not higher than that anticipated for infants born to uninfected mothers. "Rio De Janeiro Tightens Controls Over AIDS Tests" Reuters (01/13/98) Rio de Janeiro announced that, starting next week, it will require verification of all positive HIV tests with a second test. State Health Secretary Rosangela Bello--who made the announcement Tuesday in response to a highly publicized false diagnosis of one Brazilian woman--said that if HIV is diagnosed, laboratories and public and private hospitals will have to conduct a second screening with new blood samples to confirm the results. On Sunday, a television news program reported that Silvana Marins received a positive HIV test result, which she later discovered to be incorrect after seeking subsequent tests at a different hospital. Bello said the original diagnosis may have resulted from a mislabeling of Marins' blood sample and noted that this was the first misdiagnosis since 1992 at Sao Francisco de Assis University Hospital, where Marins was tested last fall. "Acyclovir Does Not Improve Survival in AIDS Patients" Reuters Health Information Services (01/13/98) In the January issue of Clinical Infectious Diseases, researchers report that--contrary to previous research--there appears to be no correlation between acyclovir therapy and prolonged survival in AIDS patients. Dr. Ramon A. Torres and colleagues evaluated data from the Community Program for Clinical Research on AIDS observational cohort, analyzing the effects of acyclovir treatment on more than 2,300 AIDS patients over a 4-year period. The researchers found that intermittent and continuous acyclovir use actually seemed to increase the risk of death, but they warn that the results should be interpreted cautiously. The authors note that unlike randomized trials, it is not apparent why some patients received the drug therapy and others did not, and they suggest that selection bias could have affected the findings. ***************************************************************** The AIDSNews Mailing List is maintained by the CDC National Center for HIV, STD and TB Prevention. Regular postings include the CDC NCHSTP Daily News Update, conference announcements, clinical trials information, current funding opportunities, and selected MMWR articles. To SUBSCRIBE, send the command "subscribe aidsnews firstname lastname" to the address listproc@aspensys.com. To UNSUBSCRIBE, send the command "unsubscribe aidsnews" to the address listproc@aspensys.com. If you need assistance, please contact aidsinfo@cdcnac.org. *****************************************************************