The Los Angeles Times reported that a second infant born with HIV appears to now be clear of the disease after doctors began aggressive drug therapy just hours after birth. The baby girl, now known as the “Los Angeles baby,” was born last April to a woman who had HIV and was not taking any perinatal HIV medication. Doctors at Miller Children’s Hospital Long Beach revealed that HIV could no longer be detected in the baby after six days.
The infant remains on antiretroviral medication, which prevents doctors from discerning whether the disease is in remission or if the infant is completely cured. "This is uncharted territory," said Dr. Yvonne Bryson, an infectious disease specialist at Mattel Children's Hospital UCLA, who consulted on the Los Angeles baby's care. "The only way we know that we really have remission is to stop therapy."
The baby will remain on HIV medication for at least two years, according to Dr. Audra Deveikis, a pediatric infectious disease specialist at Miller Children's Hospital. The infant’s team of doctors will decide exactly when to stop treatment after they study findings from an upcoming clinical trial involving 60 infants. The Los Angeles baby is not part of the clinical trial.
Last year, doctors declared an infant in Mississippi cured of HIV after beginning treatment within 30 hours after birth and continuing it for 18 months. Two years after discontinuing HIV treatment, that child remains healthy and HIV-free.
The Times of India reported that a National Institute for Research in Tuberculosis (NIRT) study conducted in eight districts in Tamil Nadu, India, found that the content of a key second-line TB drug, cycloserine, was below the World Health Organization standards in all districts. Study researchers collected 10 samples of seven TB drugs from India’s Revised National TB Control Programme (RNTCP) district TB centers, TB units, microscopy centers, and directly observed treatment (DOT) providers throughout a 4–5-month period. Although most of the drugs analyzed met standards, the cycloserine samples did not. The prescribed amount of cycloserine for DOT was 250 milligrams (mg); the content of the key ingredient was only 108 mg in samples tested from some centers.
Cycloserine has been available for 30–40 years, and degradation always has been a concern. Dr. Soumya Swaminathan, director of NIRT, stated that the issue of degradation was increasingly significant since more people with multidrug-resistant TB (MDR TB) were dependent on cycloserine. Dr. Geetha Ramachandran, the study’s lead author, stated that the drug was “extremely sensitive” to high temperatures, and that some RNTCP drug storage centers did not have refrigerators.
State government officials conceded that monitoring the drugs for degradation at the community level was difficult because there were thousands of DOT providers and 800 for MDR TB alone. Many DOT providers lived in thatched huts with no refrigeration available. Remediating the cold storage problem could, in part, involve storing cycloserine tablets in district centers and doling out no more than one week’s supply to DOT providers at a time. TB Expert Dr. Manjula Datta urged manufacturers to change cycloserine’s formulation rather than recommended increased dosages, since logistical issues were a large part of the problem.
Healio reported on a study showing that many individuals at risk for hepatitis B virus (HBV) infection are not tested for exposure in the primary care setting and fewer of those who tested susceptible began the vaccine series.
Researchers from Kaiser Permanente conducted a retrospective study using electronic medical records and found 15,357 adults who tested positive for chlamydia, gonorrhea, or syphilis in 2008 to 2011. The researchers investigated incidence of HBV testing on the same day that individuals received STD tests, the 90-day HBV testing rate after STD testing, and the time to HBV vaccine initiation among those patients who were HBV-susceptible. Patients were considered susceptible if they had negative results on the HBV surface antigen and HBV surface antibody tests.
Only 8.8 percent of patients received both tests for exposure and susceptibility. Of 1,096 who were found to be susceptible to HBV, 10.6 percent began the HBV vaccine series during follow-up and only 2.6 percent who did not have serological testing began the HBV vaccine series. Age at baseline was associated with beginning the vaccine series among susceptible individuals, with older persons more likely to begin the vaccine compared with young adults ages18–24 years.
The researchers concluded that primary care practitioners miss opportunities for HBV testing for active infection and for identifying individuals for vaccination among persons seeking STD treatment.
The full report, “Hepatitis B Testing and Vaccination Among Adults with Sexually Transmitted Infections in a Large Managed Care Organization,” was published online in the journal of Clinical Infectious Disease (2014; doi: 10.1093/cid/ciu103).
The Winnipeg Free Press reported that an 18-month trial in Manitoba, Canada, that provided free human papillomavirus (HPV) vaccination for all women between ages 17–26 would end on March 31. The free HPV immunization was available through doctors’ offices or neighborhood clinics. During the trial, approximately 6,000 young women took advantage of the free vaccine, according to Michael Routledge, the chief provincial public health officer. A five-year-old Manitoba program that sought to immunize every Grade 6 girl would remain in place.
Routledge explained that Manitoba’s vaccine advisory committee reviewed the latest research and the recommendations of a similar national committee and concluded that the benefits of free vaccination for 17–26-year-old women were smaller than the school-based program. Purchasing the vaccine at one-third of retail price for the trial cost the province approximately $1 million.
After March 31, women older than 17 would need a prescription for the three-shot HPV vaccine, which would cost $450. If a young woman started the series before March 31, the province would pay for the entire series. Manitoba doctors could prescribe free HPV vaccination for young women 17–26 if they were “at-risk” for HPV. The criteria included women who have had more than one sexual partner.
HPV is very common and could spread through sexual contact or intimate touching. Approximately 75 percent of people will have an HPV infection; most would not know it. Manitoba reported approximately 45 women with cervical cancer per year and 15 deaths from cervical cancer.
West reported that with the spread of STDs continuing in Belgium, SOS Sida has launched “Get Tested,” the country’s first national awareness campaign, featuring initiatives such as posters with images of youth removing their underwear beneath the cover of a sticker that states “syphilis/gonorrhea/chlamydia not visible. Use a condom.” The campaign will place these posters in 10 cities and college campuses through mid-2015. The campaign also features commercials broadcast by local radio stations featuring the “voice” of dangerous STDs such as gonorrhea, chlamydia, syphilis, human papillomavirus, hepatitis, and HIV/AIDS.
HealthCanal reported that findings published in the March-April edition of the journal Public Health Reports by a team of researchers from the Rollins School of Public at Georgia’s Emory University show that 17.4 percent of prisoners have been exposed to the hepatitis C virus in comparison with 25 percent a decade ago. Lead researcher Anne Spaulding, MD, MPH, assistant professor in Emory’s Department of Epidemiology, and her team estimated hepatitis C cases for all US correctional populations based on data from states that screen inmates routinely for the disease. According to Spaulding, the new statistics are particularly significant in light of the new hepatitis C drugs coming onto the market and the costs associated with them. If the number of individuals needing treatment is lower than previously thought, undertaking treatment is less daunting.
The full report, “Hepatitis C Seroprevalence Among Prison Inmates Since 2001: Still High but Declining,” was published in the journal Public Health Reports (2014; 129(2): 187–195).
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