CDC NCHSTP Daily News Summary (080516)

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 Summary should be cited as the source of the information. Copyright © 2008, Information Inc., Bethesda, MD.

NATIONAL NEWS

UNITED STATES: Hepatitis Cases Prompt Federal Recommendations

Associated Press (05.15.08) - Friday, May 16, 2008

CDC on Thursday released an accounting of what it found during an investigation prompted by an outbreak of hepatitis C in Nevada. Better surveillance, education and oversight are needed for outpatient clinics, the report found.

Health authorities have said at least 50,000 patients of the now-closed Endoscopy Center of Southern Nevada (ECSN) may have been exposed to hepatitis C, B and HIV due to unsafe injection practices. Staff at the outpatient clinic routinely reused syringes and single-use medicine vials during anesthesia.

To date, more than 80 ECSN patients have tested positive for hepatitis C and reported no risk factors other than their treatments. They are among the approximately 400 former patients of the center who tested positive for the blood-borne virus. According to officials, the other patients may have contracted hepatitis C through common transmission routes, intravenous drug use, blood transfusions, kidney dialysis, organ transplants, receiving blood clotting agents prior to 1987 or sexual contact with an infected person.

While hospitals routinely evaluate infection-control practices, CDC noted this may not be the case for outpatient clinics. "As the use of these settings grows, appropriate methods will be needed to provide similar oversight," the report said.

The report, "Acute Hepatitis C Virus Infections Attributed to Unsafe Injection Practices at an Endoscopy Clinic - Nevada, 2007," was published in CDC's Morbidity and Mortality Weekly Report (2008;57(19):513-517).

CALIFORNIA: Several California Men's Colony Inmates Found to Have Syphilis

San Luis Obispo Tribune (05.09.08) - Friday, May 16, 2008

On May 5, prison officials were notified by medical staff that several California Men's Colony inmates had been diagnosed with syphilis. "The administration is working toward a plan to test who they can and to stop it so it doesn't turn into an epidemic or an outbreak," said Andrew Pitoniak, acting CMC prison spokesperson.

Those diagnosed have been all from one housing unit, and prison medical staff may test every inmate there as well as any other inmates who request screening. The exact number of cases was not known on May 8.

CMC officials were halting prisoner transfers and prohibiting conjugal visits until they ensured the inmates were syphilis-free. Sex between inmates is strictly prohibited, Pitoniak said.

Staff members are educating prisoners about the STD. State clinical staff continue to monitor the situation and assist in identifying initial cases and stopping further transmissions of the disease.

INTERNATIONAL NEWS

CANADA: HIV Drug Linked to Serious Liver Side Effects, Health Canada Warns

Canadian Press (05.15.08) - Friday, May 16, 2008

Canadian health officials and Tibotec, a division of drug maker Janssen-Ortho, are advising patients taking Prezista (darunavir) that serious liver side effects have been linked to the drug. Prezista is used, in combination with ritonavir and other HIV drugs, for patients who have failed other antiretroviral therapy.

Among Prezista patients studied in clinical trials, 0.5 percent developed hepatitis or inflammation of the liver. Since the drug came to market, there have been 13 reported cases of patients taking Prezista developing hepatitis, including two who died. There were in addition 25 reported cases of patients taking Prezista who developed other liver problems, from mid-2006 to the end of 2007, and among whom 14 died.

It is not known whether Prezista contributed to these adverse events and deaths or if they were caused by other medical problems or medications taken by the patients. However, Health Canada said the patients involved all had advanced HIV disease, were taking other medications as well, or had illnesses such as hepatitis B or C infection.

Health Canada urges patients taking Prezista to contact their physician immediately if they experience any of the following symptoms: dark urine, yellowing of the skin, abdominal pain (especially on the right side bellow the ribs), general itchiness, decreased appetite, nausea, vomiting or fatigue. Patients should not stop taking Prezista without first consulting their doctor or pharmacist.

ASIA: Australian Research to Help HIV Care in Asia

Australian Associated Press (05.14.08) - Friday, May 16, 2008

Asia's 140 percent increase in TB cases during the past five years can largely be blamed on the HIV epidemic, researchers were told Wednesday at the annual congress of the Royal Australasian College of Physicians in Adelaide, Australia.

The cells targeted by HIV are the very ones needed to mount a defense against TB, said Professor Suzanne Crowe. As HIV replicates in the body, lymphocytes decrease and macrophages, normally responsible for destroying the TB bacteria, do not work properly. "Thus, reactivation of TB is more common and there is increased risk of new infection in HIV-infected persons," she said.

"What is generally lacking in Asia-Pacific is highly skilled doctors who can manage HIV infection. There is a lack of access to low-cost tests which are needed to monitor HIV infection," said Crowe, an infectious-disease expert at Melbourne's The Alfred hospital. Crowe said she is working on the development of a low-cost, "dipstick-type" test that would function like a home pregnancy test.

MEDICAL NEWS

UNITED STATES: Adverse Effects of HIV Therapy Differ by Race, Sex

Reuters (04.30.08) - Friday, May 16, 2008

A new study observed significant differences in specific adverse events according to sex and race among HIV patients starting antiretroviral therapy (ART). However, Dr. Ellen M. Tedaldi from Temple University School of Medicine and colleagues found no differences in the overall rate of adverse events, death from any cause or treatment withdrawal rates due to drug toxicity.

The researchers compared the frequency and types of side effects by sex and race in 1,301 patients in an ART initiation trial. Study participants included 701 blacks, 225 Latinos and 273 women.

During the average five-year follow-up, there were 409 grade 4 adverse events, grade 4 being the most severe, for a rate of 8.9 per person per 100 years. There were 176 deaths, a rate of 3.0 per person per 100 years; and 523 ART withdrawals because of toxicity, a rate of 13 per person per 100 years.

Black patients reported cardiovascular and kidney adverse events 2.64 and 3.83 times more frequently, respectively, compared with white patients or participants of any other race. The researchers noted that this finding is consistent with greater rates of heart disease, diabetes and kidney disease found in the general black population.

Rates of serious psychiatric events were 2.45 times higher in black men compared to men of other races. "It is likely that grade 4 psychiatric adverse events represent a constellation of factors that include psychosocial and biologic associations," suggested Tedaldi and colleagues. This could reflect undiagnosed mental illness or the central nervous system effects of HIV infection, they noted.

In addition, women had a 2.34-fold higher risk of grade 4 anemia than did men, which was "not unexpected" given the women were predominantly premenopausal and African-American.

The researcher concluded that the results "could inform HIV treating clinicians about particular issues to consider in the selection of antiretroviral regimens for diverse populations."

The study, "Ethnicity, Race and Gender: Differences in Serious Adverse Events Among Participants in an Antiretroviral Initiation Trial: Results of CPCRA 058 (FIRST Study)," was published in the Journal of Acquired Immune Deficiency Syndromes (2008;47(4):441-448).

LOCAL AND COMMUNITY NEWS

TEXAS: Children Contribute Experiences to Fort Worth Book About AIDS

Fort Worth Star Telegram (05.16.08) - Friday, May 16, 2008

"Angels at My Door" is a new children's book that compiles the stories of eight young people affected by HIV/AIDS. The idea for the book grew from a three-day creativity camp at Samaritan House, a community-based group that provides low-cost housing, meals, and counseling to HIV/AIDS patients and their families.

"A child is more easily connected to the spiritual and wondrous views of the world," said co-author Deborah Jung, executive director of Kids Who Care camp. "[A child is] more open and forgiving, a child sees AIDS through the eyes of hope: how to love someone with AIDS, how to pray for them, how to remind them to take care of themselves, and that no matter what, everything will be OK."

On Saturday, child actors will be reading and staging "Angels" and singing original music that accompanies it. In addition, angel-themed artwork by Fort Worth school district students will be on display, and the winner of the angel art competition will be announced. Some of the more than 90 works submitted in the competition were selected to illustrate the book.

The event, part of the ongoing AIDS-themed More Life Festival, starts at 10:30 at the Central Library, downtown Fort Worth. For more information, visit www.morelifetexas.com/calendar.htm.

CALIFORNIA: San Francisco: Help Us Make It Hepatitis B Free Now

San Francisco Chronicle (05.13.08) - Friday, May 16, 2008

May is Hepatitis Awareness Month. Hepatitis B affects 2 million Americans, and as many as one in 10 Asian/Pacific Islanders in America, especially those from China, Korea and Vietnam, is chronically infected. A recent study found that two-thirds of Asian- American San Francisco residents with chronic hepatitis B were unaware they were infected.

The goal of the "San Francisco Hep B Free" campaign is to screen and vaccinate all people at risk of infection. Several screening efforts in the city specifically target this at-risk population, including:

*Free hepatitis B screenings from 4 p.m. to 8 p.m. on Wednesdays and Fridays, and from 11 a.m. to 3 p.m. on the first Saturday of each month, at the Asian Pacific Wellness Center, 730 Polk St., 4th floor; telephone 415-292-3400 for an appointment.

*Free hepatitis B screenings from 9 a.m. to noon on the first Saturday of each month at UCSF Medical Center at Mount Zion, 2330 Post St., 1st floor; telephone 415-885-3580.

NEWS BRIEFS

CANADA: Council Seeks $100,000 for Needle Exchange Cleanup

Ottawa Citizen (05.15.08) - Friday, May 16, 2008

The Ottawa Council on Wednesday asked the provincial government for a matching $100,000 (US $100,391) contribution to help the city collect discarded needles. The Ontario government rejected Ottawa's initial request for $200,000 (US $200,782). The council halved that figure, saying it was accessing extra money that would have gone to pay the salary of Dr. David Salisbury, former medical officer for health. The province pays 75 percent of that position's salary. How to deal with discarded needles has been an ongoing question since Ottawa's needle distribution program was launched in 1991. The number of improperly disposed-of needles jumped from 813 in 2000 to 2,029 last year. Ottawa says the money it has budgeted for clean-up, $50,000 (US $50,195) is not sufficient.

TEXAS: Tests Reveal Dozens of TB Carriers, but No Danger

Houston Chronicle (05.15.08) - Friday, May 16, 2008

Recent testing of students and staff at Galena Park High School found about 30 people who tested positive for TB but no one who was symptomatic or contagious, according to health officials. The skin tests were performed on May 5 as a precaution because a student showed TB symptoms and tested positive in April; that student has been away from school since April 4. Rita Obey, a spokesperson for Harris County Public Health and Environmental Services, said a chest X-ray is standard for people who test positive. Those whose results were positive represented about 12 percent of the individuals who tested, and "we don't get concerned until the number approaches 30 percent," she said. In January, 19 of 150 people screened at another school in the Galena Park district, North Shore Senior High, tested positive for TB exposure.

NEW YORK: STDs Are Focus of Health Day

Journal News (White Plains) (05.15.08) - Friday, May 16, 2008

The Lower Hudson Valley Perinatal Network on Thursday hosted its second annual community health day. With the theme "It takes a village to address the risk. Give babies a healthy start," the program was particularly aimed at raising awareness of STDs among residents of childbearing age. "You want to make sure you have the best chance of having a healthy birth," said Cheryl Hunter-Grant, the network's executive director. "If you have a sexually transmitted disease and you get pregnant, you are more likely to have a baby born too small or too soon." Some 200 medical and community groups from four counties took part.

NEW YORK: AIDS Walk New York

New York Times (05.16.08) - Friday, May 16, 2008

The 6.2-mile AIDS Walk New York takes place this Sunday, with sign-up at 8:30 a.m. and the walk at 10 a.m. Sign- up is at the Central Park entrance near Fifth Avenue and 59th Street. Gay Men's Health Crisis sponsors the fundraiser. For more information, telephone 212-807-9255 or visit www.Aidswalk.net.

CDC HIV/Hepatitis/STD/TB Prevention News Update

For Friday, May 16, 2008