Gynecology Medical News

United Nations officials on Monday at the XVII International AIDS Conference in Mexico City discussed how rising food prices could affect HIV/AIDS, Reuters reports. The United Nations said that climbing food prices — due to increased use of biofuels, a growing demand for grains to feed large populations in Asia, droughts and market speculation — caused 50 million more people to go hungry in 2007 compared with 2006.

The rising food prices could force low-income women to participate in commercial sex work for basic goods and thus increase new HIV/AIDS cases, officials said.

According to Stuart Gillespie of the International Food Policy Research Institute, recent studies in Botswana, Malawi, Swaziland, Tanzania and Zambia have found links between food shortages and sex work among low-income women. “Food is such a basic need that you can see people really going to great lengths,” Fadzai Mukonoweshuro of the Food and Agriculture Organization in southern Africa said.

Experts at the conference also said malnutrition can affect the health of HIV-positive people. Antiretroviral drugs can upset the stomach if not taken with food, and people living with HIV/AIDS, as well as tuberculosis, require more nutrients and calories, Martin Bloem, chief nutritionist at the World Food Program, said.

Kevin De Cock, director of the World Health Organization’s HIV/AIDS Department, said, “We really need to watch this very carefully. We are in a situation of rising oil prices, rising food prices and at the same time the cost of AIDS is going up along with new infections (Rosenberg, Reuters, 8/4).

Kaisernetwork is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference. A webcast of a conference session on food security and HIV/AIDS is available online.

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Stem cell transplants have become the standard of care for Patients with relapsed lymphoma, but not for Patients who suffer from both this disease
and HIV. A new study showing that this treatment is a viable option for select Patients with HIV-associated lymphoma will be published in the January 15,
2005, issue of Blood, the official journal of the American Society of Hematology.

Because of the immunodeficiency associated with HIV, HIV-positive Patients are more likely to develop lymphoma than HIV-negative individuals, and the
treatment for their cancer is far less likely to be successful.

Sonali Smith, M.D., Assistant Professor of Medicine at the University of Chicago notes, “The treatment of malignant lymphomas in HIV-infected individuals
remains challenging, due to both the high incidence of refractory disease and the high risk of treatment-related complications. The ability of high dose
chemotherapy as demonstrated in this pilot study to effectively treat even refractory disease is highly encouraging and certainly warrants further study.”

Researchers from the City of Hope Cancer Center studied 20 Patients (aged 11 to 68) who had HIV and lymphoma, either Hodgkin’s or non-Hodgkin’s.
The selected Patients had undergone previous standard-dose frontline chemotherapy for their lymphoma, but the majority either failed to achieve a
complete remission or had relapsed after an initial remission. The median length of study follow-up was approximately two and a half years, with a range
of about six months to six years.

All study Patients were to undergo autologous stem cell rescue. In an autologous transplant, stem cells are removed from the patient and frozen for later
use. The patient receives high-dose chemotherapy to kill any lymphoma in the body, and the autologous stem cells are then infused back into the patient
to repopulate the bone marrow wiped out by the chemotherapy.

Before the transplant, Patients were given one of two conditioning regimens, either high dose chemotherapy alone or in combination with radiation therapy,
to destroy the cancerous cells. Most (17 Patients versus three) received the chemotherapy-only option. Radiation therapy was selected for Patients
younger than 55 who had poorer prognostic factors: either the cancer had spread to multiple lymph nodes or the patient had bulky disease (indicated by a
cancerous mass greater than 5 – 10 cm).

Reversible abnormalities in liver function, a side effect of the intensive treatment, were experienced in a majority of the Patients. One patient, the oldest in
the study, developed cardiomyopathy (a weakening of the heart) and kidney failure due to treatment toxicities and died a few weeks after the transplant.
Opportunistic infections, such as herpes zoster and cytomegalovirus infection, also occurred in a few Patients after the transplant, but were managed
with appropriate therapy.

Throughout the study, all Patients were to receive highly active antiretroviral therapy (HAART) to help reduce these opportunistic infections and improve
immunodeficiency, however, only nine Patients were able to tolerate this treatment for the entire study due to side effects such as nausea and
inflammation of the mouth lining. The majority of Patients, though, did resume the HAART therapy soon after discharge from the hospital.

Although two Patients died of relapsed lymphoma a few months after transplant, 17 of the 20 Patients (85 percent) are currently alive and in remission. In
addition, the underlying HIV infection did not worsen as a result of the transplant and associated treatments.

“The results of this study are significant because, despite the use of effective antiviral drugs such as HAART, lymphoma is still a major cause of suffering
and death in HIV-infected individuals. It’s important to know that stem cell transplant is an available and highly successful treatment option for these
Patients,” said Amrita Krishnan, M.D., a staff physician at the City of Hope Cancer Center and lead author of the study.

This work was supported in part by United States Public Health Service Grants CA30206, CA33572, AI38592, and MO1 RR-43 from the General Clinical
Research Center branch of the National Center for Research Resources, National Institutes of Health. Amrita Krishnan, M.D., was the recipient of a
Lymphoma Research Foundation of America Fellowship Award. Co-author Arturo Molina, M.D., was the recipient of an American Cancer Society Clinical
Oncology Career Development Award.

To receive a copy of the study or to arrange an interview with Amrita Krishnan, M.D., lead author of the study, please contact Laura Stark at 202-776-0544
or lstarkhematology.

The American Society of Hematology (hematology) is the world’s largest
professional society concerned with the causes and treatment of blood disorders. Its mission is to further the understanding, diagnosis, treatment, and
prevention of disorders affecting blood, bone marrow, and the immunologic, hemostatic, and vascular systems, by promoting research, clinical care,
education, training, and advocacy in hematology.

Blood, the official journal of the American Society of Hematology, is the most cited peer-reviewed publication in the field. Blood is issued to Society
members and other subscribers twice per month, available in print and online at
bloodjournal.

Contact: Laura Stark
lstarkhematology
American Society of Hematology

Hospitals in states where Medicaid does not pay for routine male circumcision are only about half as likely to perform the procedure, and this disparity could lead to an increased risk of HIV infection among lower-income children later in life, according to a UCLA AIDS Institute study.

Researchers found that at hospitals in the 16 states where the procedure is not covered, circumcision rates were 24 percentage points lower than at hospitals in other states, with lower rates particularly prevalent among Hispanics. The mean male circumcision rate for all states was 55.9 percent.

The study, published in the January issue of the American Journal of Public Health, is available online at ajph/cgi/content/full/99/1/138.

The findings are important because they document the effect of state Medicaid reimbursement policies on the medical services that are actually delivered, said the study’s lead author, Arleen A. Leibowitz, a professor of public policy and a researcher with both the UCLA Center for HIV Identification, Prevention and Treatment Services and the UCLA AIDS Institute. These services include male circumcision, which has been shown to lead to substantial health benefits in later life.

“Since children whose childbirth expenses are paid for by Medicaid are, by definition, lower income, the Medicaid policy in 16 states of not reimbursing for male circumcision is generating future disparities in health between children born to rich and poor families,” Leibowitz said.

In 1999, the American Academy of Pediatrics (AAP) stated that the medical benefits of male circumcision were not enough for the group to recommend that the procedure be made routine at all hospitals. As a result, some states began withdrawing Medicaid coverage for circumcision.

But recent clinical trials in South Africa, Kenya and Uganda have revealed that male circumcision can reduce a man’s risk of becoming infected with HIV from a female partner by 55 to 76 percent. In June 2007, the AAP began reviewing its stance on the procedure.

The UCLA researchers relied on data from the 2004 Nationwide Inpatient Sample (NIS), collected as part of the Healthcare Cost and Utilization Project of the federal Agency for Healthcare Research and Quality. They studied information on about 417,000 routine discharges of newborn males from 683 U.S. hospitals.

In addition to the overall lower circumcision rates, the researchers found that the more Hispanics a hospital served, the fewer circumcisions the hospital performed. For Hispanic parents, the circumcision decision was about more than simply cost, since male Hispanic infants were unlikely to receive the procedure even in states in which it was fully covered by Medicaid.

The 16 states without Medicaid coverage for male circumcision are California, Oregon, North Dakota, Mississippi, Nevada, Washington, Missouri, Arizona, North Carolina, Montana, Utah, Florida, Maine, Louisiana, Idaho and Minnesota.

The study authors estimate that if all states’ Medicaid plans paid for male circumcision, the national rates for the procedure would increase to 62.6 percent. If all states dropped the coverage, the rate would fall to about 38.5 percent.

“State Medicaid plans that attempt to reduce costs in the short run by not covering the cost of infant male circumcision may be generating higher health care costs for HIV/AIDS and other sexually transmitted infections in the future,” Leibowitz said.

###

Study co-authors were Katherine Desmond, M.S., and Thomas Belin, Ph.D, both with UCLA.

A National Institute of Mental Health grant to UCLA’s Center for HIV Identification, Prevention and Treatment Services funded the study.

The UCLA AIDS Institute, established in 1992, is a multidisciplinary think tank drawing on the skills of top-flight researchers in the worldwide fight against HIV and AIDS, the first cases of which were reported in 1981 by UCLA physicians. Institute members include researchers in virology and immunology, genetics, cancer, neurology, ophthalmology, epidemiology, social sciences, public health, nursing and disease prevention. Their findings have led to advances in treating HIV, as well as other diseases, such as hepatitis B and C, influenza and cancer.

Source: Enrique Rivero

University of California – Los Angeles

Mission Pharmacal today announced the successful completion of a randomized, placebo-controlled, double blind
multi-center trial evaluating two dosing regimens of Tindamax(R)
(tinidazole) for the treatment of bacterial vaginosis (BV), the most common
vaginal infection in the United States.

Based on results from the trial, Mission Pharmacal plans to file a
supplemental New Drug Application (sNDA) for the use of Tindamax(R) as a
treatment for BV with the U.S. Food and Drug Administration (FDA) in the
second quarter of 2006. Tindamax(R) is currently approved in the United
States for the treatment of trichomoniasis, the intestinal infections
giardiasis and intestinal amebiasis, and amebic liver abscess.

In the study, patients with BV were randomized to one of three
treatment arms: 2g of Tindamax(R) once daily for two days, 1g of
Tindamax(R) once daily for five days, or placebo.

“Tindamax(R) may offer a significant advance in the control of
bacterial vaginosis, as a shorter course oral treatment option than the
current standard of care,” said Dr. Jack Sobel, Professor of Medicine and
Infectious Diseases, Wayne State University in Detroit, and one of the lead
investigators of the Phase III study.

Other centers and investigators for the clinical trials included: Dr.
David Soper, Medical University of South Carolina, Charleston; Dr. Harold
Wiesenfeld, Magee-Womens Hospital, Pittsburgh; Dr. Charles Livengood, Duke
University, Durham, North Carolina; Dr. Daron Ferris, Medical College of
Georgia, Augusta; Dr. Paul Nyirjesy, Drexel University, Philadelphia; Dr.
Stephanie Taylor, Louisiana State University, New Orleans; Dr. Jeanne
Marrazzo, University of Washington, Seattle; Dr. Ashwin Chatwani, Temple
University, Philadelphia; and Dr. Paul Fine, Planned Parenthood, Houston.
Microbiologic evaluations were performed in the laboratory of Dr. Sharon
Hillier, at Magee-Womens Hospital in Pittsburgh.

“Mission Pharmacal is committed to providing treatments that address
common health concerns, especially among women,” said Neill Walsdorf, Jr.,
President of Mission Pharmacal. “The completion of this study is an
important milestone for the company and gives Mission Pharmacal a larger
role in the vaginitis treatment market.”

About Bacterial Vaginosis

As the most widespread form of vaginal infection, BV is one of the main
causes of the 10 million doctor visits for vaginitis in the United States
annually. Approximately 4.5 million prescriptions are written for BV
treatment each year in the United States.

BV symptoms include a foul or fishy odor in varying degrees and a
milk-like vaginal discharge. Signs of BV also include a vaginal pH level
exceeding 4.5 and the presence of clue cells seen in a microscopic
evaluation of vaginal discharge. Clue cells are vaginal epithelial cells
coated with bacteria. BV is caused by an overgrowth of anaerobic bacteria
in the vagina, with a concomitant decrease in protective lactobacilli.

BV is associated with an increased risk for contracting a sexually
transmitted disease, including HIV. Additionally, women who suffer from BV
are at increased risk for pelvic inflammatory disease, endometritis,
post-operative infections following gynecologic surgery, and other
obstetrical and gynecological complications.

About Tindamax(R)

Tindamax(R) is a second-generation 5-nitroimidazole, chemically related
to metronidazole, a first-generation nitroimidazole compound. Tindamax(R)
has been found in studies of trichomoniasis patients to provide an improved
side-effect profile with a low incidence of nausea and vomiting, and a long
duration of action, with therapeutic concentrations remaining for 48 hours
following a single 2g dose. In addition, tinidazole spares protective
vaginal lactobacilli. Tinidazole is indicated for BV treatment in many
European countries

About Mission Pharmacal

Mission Pharmacal, the maker of Citracal(R), is a family-owned
pharmaceutical company based in San Antonio. For more than 50 years, the
company has been dedicated to identifying unmet health needs in the
marketplace and developing innovative prescription and over-the-counter
products to meet them. Currently, Mission Pharmacal provides physicians and
consumers with pharmaceutical, nutritional and diagnostic products. For
more information, visit missionpharmacal.

Mission Pharmacal
missionpharmacal Continue reading →

Busy practice nurses believe that, if rotavirus vaccination was recommended for inclusion
in the childhood immunisation programme, they could save time by administering the pentavalent oral rotavirus vaccine
RotaTeq®* at the same time as an injectable vaccine that is already given routinely.

According to a survey presented at the Health Protection 2010 conference in Warwick1, practice nurses anticipate that
administration of the oral rotavirus vaccine would take the same length of time as the injectable DTaP/IPV/Hib vaccine (10
minutes).

However, if the two vaccines were administered at the same visit, the estimated consultation and administration time for the
rotavirus vaccine is 4 minutes 26 seconds. In other words co-administration would take less than 15 minutes rather than two
visits of ten minutes each.

Attitudes to the oral rotavirus vaccine and its administration were the same whether or not the practice nurse had experience of
administering oral vaccines.

The survey, carried out by ICM Research, was conducted via computer-assisted telephone interviews with practice nurses from
across the UK who routinely administer infant vaccinations (children aged one to 12 months). To keep the sample balanced,
20% of those interviewed had no experience of administering an oral vaccination.

Interviews were split between 200 nurses who saw an online video demonstration of the oral rotavirus vaccine being
administered and 300 who did not.

“The economic impact of introducing the oral rotavirus vaccine into the childhood vaccination programme is important. The
potential impact on Practice Nurses’ time is small and the benefit of preventing rotavirus disease is great. The oral rotavirus
vaccine can be easily added to the appointment time during which we administer the injectable vaccines to our infants,” says
George Kassianos, GP Bracknell and RCGP Immunisation Lead.

The onset of rotavirus gastroenteritis can be rapid and unpredictable. As rotavirus disease is seasonal, with most cases
occurring between January and April, reducing rotavirus cases would also free up valuable NHS resources at a time when they
are often stretched.2

The survey was conducted by independent market research company ICM Research and funded by Sanofi Pasteur MSD
manufacturer of the pentavalent oral rotavirus vaccine RotaTeq®.

* Rotavirus vaccine, live, oral

Notes

More about rotavirus gastroenteritis

By the age of five, almost every child will experience an episode of rotavirus gastroenteritis. While it is estimated that annually 3.6 million
children experience an episode of rotavirus, 87,000 are hospitalised and over 700,000 require a doctor’s visit; with a cumulative risk of
hospitalisation and doctor’s visits of one in 54 and one in seven respectively.3 Among European children aged 5 or younger, about 200 to
250 die every year from rotavirus disease.4

As rotavirus is highly contagious and relatively resistant to its environment,5,6 vaccination is recognised as the only effective control measure
to have a significant impact on the burden of severe paediatric rotavirus gastroenteritis.7,8

The typical symptoms of rotavirus infection are watery diarrhoea, vomiting, fever and abdominal pain. The severity ranges from
asymptomatic forms (most of the cases) to severe forms with a dramatic loss of body fluid (dehydration) that can be fatal.7, 9

Re-hydration is the key treatment and should be applied as soon as possible. There are no risk factors for developing a severe case of
rotavirus gastroenteritis. Overnight, seemingly mild form of the disease can become life-threatening9 and require hospitalisation for
intravenous re-hydration. Different rotavirus types can circulate concomitantly and in proportions that may vary from country to country and
from one season to another. Thus, it is hard to predict which rotavirus type will infect a child.10 Unlike for many other childhood infectious
diseases, several infections with rotavirus are needed to build protection against rotavirus disease. Successive infections usually occur with
different rotavirus types. A protection of 92% required three successive rotavirus infections according to a study.11 Nearly 90% of rotavirus
gastroenteritis cases occur between three months and three years of age.2

More about RotaTeq®

RotaTeq® (Rotavirus vaccine, live, oral) is an orally administered, fully liquid and ready-to-use vaccine given in 3 doses. In its clinical
development RotaTeq has demonstrated a consistent level of efficacy not only across different trials; 98% to 100% against severe paediatric
rotavirus gastroenteritis, but also across regions; Latin America, US and Europe, and populations; term, premature and breastfed infants.12,
13, 14, 15 Protection provided by RotaTeq covers the main risk period of RVGE that extends from 3 months to 3 years of age, with a high level
of efficacy starting 14 days after the first dose and up to 3 years after the third dose.2, 10, 16, 17

As of March 2010, RotaTeq® has been licensed in 95 countries and launched in 56 around the world18 including the member states of the
European Union, and more than 18 million doses have been distributed worldwide. In Western Europe, rotavirus vaccination is now part of
the national immunisation program in Austria, Belgium, Finland and Luxembourg.

References

1. Stuart C et al. Evaluation of Consultation Time for Paediatric Vaccines, poster presented at Health Protection 2010, September 2010 healthprotectionconference

2. Van Damme et al.Multicenter prospective study of the burden of rotavirus acute gastro-enteritis in Europe, 2004-2005: the REVEAL study. JID 2007: 195 (suppl 1) S4-S16.

3. Soriano-Gabarro M. et al. Burden of rotavirus disease in European countries. Pediatr Infect Dis J 2006:25 (1):S7-S11.

4. Parashar UD, Glass RI. Rotavirus vaccination in Europe: the time has finally arrived. J Pediatr Gastroenterol Nutr 2008;46:21-23.

5. Fischer TK, Bresee JS, Glass RI. Rotavirus vaccines and the prevention of hospital acquired diarrhea in children. Vaccine 2004;22:49-54.

6. Dennehy PH. Transmission of rotavirus and other enteric pathogens in the home. Pediatr infect Dis J 2000; 19[Suppl10]: S103-5.

7. Clark HF and Offit PA. Vaccines for rotavirus gastroenteritis universally needed for infants. Ped Ann 2004; 33(8). 537-543.

8. Parashar UD. et al. Global illness and deaths caused by rotavirus disease in children. Emerg Inf Dis 2003;9:565-572.

9. Matson D.O. In: Long SS Ed. Principles and Practice of Paediatric Infectious Diseases. New York: Churchill Livingstone 2003. 1105-1108.

10. Van Damme et al.Distribution of rotavirus genotypes in Europe, 2004-2005: the REVEAL study. JID 2007:195(suppl 1) S17-S25.

11. VelГЎzquez FR et al.Rotavirus infections in infants as protection against subsequent infections. N Engl J Med 1996; 335:1022-1028.

12. Block SL et al.. Efficacy, immunogenicity, and safety of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine at the end of shelf life. Pediatrics 2007;119:11-18.

13. Vesikari T et al.Safety and Efficacy of a Pentavalent HumanпїЅпїЅ”Bovine (WC3) Reassortant Rotavirus Vaccine. N Engl J Med 2006; 354(1):23-33.

14. Goveia M.G et al. Safety and efficacy of the pentavalent human-bovine (wc3) reassortant rotavirus vaccine in healthy premature infants. Pediatr Infect Dis J 2007; 26:1099-1104.

15. Goveia and al. Efficacy of pentavalent Human-Bovine (WC3) reassortant rotavirus vaccine based on breastfeeding frequency. Pediatr Infect Dis J 2008, 27(7):656-658.

16. Vesikari T. et al.. Sustained efficacy of the pentavalent rotavirus vaccine, RV5, up to 3.1 years following the last dose of vaccine Pediatr Infect Dis J. 2010;29(10): 1-7.

17. Dennehy P et al. Efficacy of the Pentavalent Rotavirus Vaccine, RotaTeq®, between Doses: Potential Benefits of Early Protection. PAS and ASPR Joint Meeting. Honolulu HawaГЇ USA, May 2008
(abstract and oral presentation).

18. Merck internal data, March 2010.

Source:

Sanofi Pasteur MSD

View drug information on Rotateq.

Human Rights Watch on Monday in a letter to Polish Prime Minister Jaroslaw Kaczynski said that a law proposed in the country that would ban discussions on homosexuality in schools violates freedom of speech and could deny children access to HIV/AIDS information, London’s Guardian reports (Connolly, Guardian, 3/20). The legislation, proposed last week by Deputy Education Minister Miroslaw Orzechowski, would allow teachers to be fired for promoting what it called “homosexual culture.” According to the AP/International Herald Tribune, the bill does not define clearly what is meant by homosexual culture but seems to include basic information about HIV/AIDS and lessons promoting tolerance toward men who have sex with men (AP/International Herald Tribune, 3/19). Education Minister Roman Giertych said the aim of the proposed law is to “prohibit the promotion of homosexuality and other deviance.” He added, “One must limit homosexual propaganda so that children won’t have an improper view of family.” President Lech Kaczynski has given his support to the law (Guardian, 3/20). HRW in the letter called on Jaroslaw Kaczynski to stop the legislation, protect the rights of MSM and women who have sex with women in schools, and “disassociate his administration from rhetoric that promotes discrimination and spreads hatred.” Scott Long, director of HRW’s gay rights program, said, “Polish authorities claim to be protecting families, but in fact they are trying to deny children free speech and lifesaving information on HIV/AIDS.” He added, “Schools should be training grounds for tolerance, not bastions of repression and discrimination.” The proposed law faces a vote in Parliament, the AP/Herald Tribune reports (AP/International Herald Tribune, 3/19). The legislation has been fast-tracked and a vote is expected by the end of the month. Giertych has said he hopes a similar ban will be adopted across the European Union (Guardian, 3/20).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Studies of the spinal fluid of patients given anti-HIV drugs have resulted in new findings suggesting that the brain can act as a hiding place for the HIV virus. Around 10% of patients showed traces of the virus in their spinal fluid but not in their blood a larger proportion than previously realised, reveals a thesis from the University of Gothenburg, Sweden.

We now have effective anti-HIV drugs that can stop the immune system from being compromised and prevent AIDS. Although these drugs effectively prevent the virus from multiplying, the HIV virus also infects the brain and can cause damage if the infection is not treated.

“Antiviral treatment in the brain is complicated by a number of factors, partly because it is surrounded by a protective barrier that affects how well medicines get in,” says Arvid EdГ©n, doctor and researcher at the Institute of Biomedicine at the Sahlgrenska Academy. “This means that the brain can act as a reservoir where treatment of the virus may be less effective.”

The thesis includes a study of 15 patients who had been effectively medicated for several years. 60% of them showed signs of inflammation in their spinal fluid, albeit at lower levels than without treatment.

“In another study of around 70 patients who had also received anti-HIV drugs, we found HIV in the spinal fluid of around 10% of the patients, even though the virus was not measurable in the blood, which is a significantly higher proportion than previously realised,” explains EdГ©n.

The results of both studies would suggest that current HIV treatment cannot entirely suppress the effects of the virus in the brain, although it is not clear whether the residual inflammation or small quantities of virus in the spinal fluid in some of the patients entail a risk of future complications.

“In my opinion, we need to take into account the effects in the brain when developing new drugs and treatment strategies for HIV infection,” says EdГ©n.

HIV

HIV, human immunodeficiency virus, belongs to the retrovirus family and takes two forms, HIV-1 and HIV-2, which can be transmitted through blood, semen and other secretions and bodily fluids. In the acute phase, patients suffer from fever, swollen lymph glands and rashes. These symptoms do recede, but AIDS develops after a long period of infection. Attempts to produce an HIV vaccine have been ongoing since the 1980s, but have yet to be successful.

Source: University of Gothenburg

The Boston Globe on Sunday examined various approaches to health policy that suggest easing the reliance on employer-sponsored health insurance as a means to reduce the number of uninsured U.S. residents. Supporters of such policies argue that the link between employment and health insurance in the U.S. contributes to the problem of the uninsured. According to the Globe, liberal and conservative lawmakers and health policy experts who support such beliefs propose “very different solutions to the problem” of the uninsured but “agree that employer-based health insurance is an idea whose time had come and gone.” Robert Moffit, director of the Center for Health Policy Studies at the Heritage Foundation, favors an “individual mandate” policy, which would require all individuals to purchase health insurance. Under that plan, the federal government would provide subsidies to help low-income residents purchase coverage. The individual mandate approach is supported by Massachusetts Gov. Mitt Romney (R), who has consulted with Moffit and hopes to enact legislation establishing such a system in his state, the Globe reports. Susan Sered, a researcher at the Center for Women’s Health and Human Rights at Suffolk University, agrees with Moffit that the U.S. health care system depends too heavily on employer-sponsored coverage but thinks that broadening government-sponsored health insurance is the best solution. She argues that under the current health care system, many U.S. residents who lose employer-sponsored coverage often become uninsured because they exceed Medicaid income requirements. According to the Globe, other proposals include establishing “something akin to the British system,” which includes both public and private coverage; addressing underlying issues of economic inequality; and maintaining employer-sponsored coverage for workers in big companies and offering more insurance alternatives to other people (Kendall, Boston Globe, 10/16).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

“Dark as the future appears, the fight to stem AIDS must go on” because prevention programs avert HIV cases and treating HIV-positive people with antiretroviral drugs saves lives, according to a UNAIDS and World Health Organization report released on Monday, a San Francisco Chronicle editorial says (San Francisco Chronicle, 11/22). The report, titled “AIDS Epidemic Update: December 2005,” estimates that the total number of HIV-positive people worldwide has reached its highest level ever, increasing from 39.4 million in 2004 to 40.3 million currently. Nearly five million new HIV cases occurred in 2005, and about 3.1 million people died of AIDS-related illnesses this year, bringing the total number of deaths from the disease to more than 25 million since 1981. Although the report notes that the number of HIV cases increased in every region of the world except the Caribbean last year, some countries that have invested heavily in prevention programs — including Kenya, Zimbabwe and some Caribbean countries — have lowered their HIV prevalence rates. In addition, access to HIV treatment has improved over the last two years, with more than one million people in middle- and low-income countries receiving antiretroviral treatment, leading to an estimated 250,000 to 300,000 avoided deaths in 2005, according to the report (Kaiser Daily HIV/AIDS Report, 11/21). “Second wave” countries such as China, India and Russia must “tamp down AIDS” before “it’s too late,” the Chronicle says, adding that rich countries must contribute funding above the estimated $9 billion already pledged for next year. Waiting for “a surefire curative or a vaccination” is not “a strategy in this war,” the editorial says, adding that prevention messages can reduce the number of new infections now. “Dispelling myths and ignorance with facts pays off,” the editorial says. “While the world braces for a possible avian flu pandemic, it shouldn’t forget one that’s already here — AIDS,” the Chronicle says (San Francisco Chronicle, 11/22).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

HIV/AIDS advocates and people living with the disease in Miami on Thursday protested a state plan that changes the provider of HIV/AIDS care for Medicaid beneficiaries, the Miami Herald reports. The protest was organized by the not-for-profit AIDS Healthcare Foundation, which filed a contract bid protest with the state’s Agency for Health Care Administration after losing its longtime Medicaid contract last month to the for-profit firm Specialty Disease Management Services, the Herald reports.

AHF currently provides 70 disease-management nurses across the state. The foundation in its revised bid for the Medicaid contract proposed using 35 field nurses and at least 15 nurses at a call center. Steve Gutos — a spokesperson for Jacksonville, Fla.-based Specialty Disease Management — would not comment on how many nurses his agency plans to employ. However, the Herald obtained a copy of the firm’s proposal to the state, which indicates that the agency plans to use up to 24 registered nurses and licensed practical nurses. Seven of those would be based at a Jacksonville call center, according to the document.

Donna Stidham, a registered nurse and chief of managed care with AHF, said the state’s plan under the new firm is not workable because HIV/AIDS patients require more personal monitoring. ‘If you have diabetes and don’t take care of yourself, you will end up in the emergency room and then go see your doctor,’ Stidham said, adding, “With HIV, you don’t get sick quickly. The medicines are not easy to take. You need someone to monitor you and make sure the right regimen is in place.’ Gutos said the comparison between the two plans is inaccurate, adding, ‘It’s not the same program in terms of what the state requested. [The state] selected us after a very thorough selection process.”

Officials with AHCA and Specialty Disease Management said the contract was awarded fairly, the Herald reports. Agency spokesperson Doc Kokol said the state decreased the contract from $9 million to $4.5 million because many of the 8,000 Medicaid beneficiaries statewide receive care through other contractors in Broward and Duval counties. Kokol said, ‘We are confident that recipients will receive the care and quality of care that they expect and they deserve,” adding, “The services are the same, but I can’t get into how those are provided” (Robinson/Caputo, Miami Herald, 6/7).

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