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Archive for April 2010

Experts Debate Use of HPV Test

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ABC News (Australia)     (04.28.10)

A new longitudinal study on the impact of human papillomavirus (HPV) DNA testing found a notable effect with respect to the most severe surrogate endpoint markers – cervical cancer, severe cervical intraepithelial neoplasia, or adenocarcinoma.

The trial included more than 58,000 women ages 30-60 in a national cervical cancer screening program in Finland. Participants were randomized either to primary HPV DNA screening (hybrid capture II) with cytology triage if results were positive or to conventional cytological screening. Dr. Ahti Anttila, of the Finnish Cancer Registry in Helsinki, and colleagues then followed the women for up to five years.

In the HPV and conventional arms, there were 76 and 53 cases of CIN III+ respectively, including six and eight that were cervical cancers. “The relative rate of CIN III+ in the HPV arm versus the conventional arm was 1.44 (95 percent confidence interval 1.01-2.05) among all women invited for screening and 1.77 (1.16-2.74) among those who attended.”

Primary HPV screening with cytology triage was more sensitive than the traditional Pap smear in detecting cervical intraepithelial neoplasia III+ lesions, the researchers concluded. “The number of cases of cervical cancer was small, but considering the high probability of progression of CIN III the findings are of importance regarding cancer prevention.”

Some researchers are cautious about the implications for screening policies. HPV tests detect DNA from the viral infection that most people will eventually clear, while cytology can detect changes in cells caused by persisting HPV infection. HPV DNA screening may be more sensitive, but less specific, potentially resulting in over-testing, experts say.

“Just having a positive HPV test by itself isn’t always associated with disease,” said Dr. Deborah Bateson, senior medical coordinator for Family Planning New South Wales. “We know that some people will clear the virus and they won’t have any long-lasting effect on their risk of developing cervical cancer.”

Cytology may be less sensitive, but its specificity makes it a reliable test, said Annabelle Farnsworth, a cytologist with Douglas Hanly Moir Pathology. “If you repeat it over two or three years, you get almost everything,” she said. In Australia, women over age 18 are screened every two years. Women over age 30 in Finland are screened every five years.

The full report, “Rate of Cervical Cancer, Severe Intraepithelial Neoplasia, and Adenocarcinoma in situ in Primary HPV DNA Screening with Cytology Triage: Randomized Study Within Organized Screening Program,” was published in British Medical Journal (2010;340:c1804).

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Written by pkids

April 30, 2010 at 6:54 pm

Zambia Jails Breed AIDS, TB, Report Says

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Edmonton Journal     (04.28.10)

HIV and TB are spreading in Zambian prisons due to poor living conditions and the lack of medical care for inmates, three human rights organizations said Tuesday. Some prisoners have been detained for years in overcrowded cells – where they are more vulnerable to HIV and TB – before being brought to trial, reported Human Rights Watch, Prisons Care and Counseling Association (PCCA), and AIDS and Rights Alliance for Southern Africa.

“The conditions in TB isolation cells are life-threatening, yet inmates who have completed TB treatment choose to continue sleeping in the cells with prisoners with active TB because they are less crowded than general-population cells,” the report says. Zambian prisons have just 14 health care workers for about 15,300 inmates, and only 15 of the 86 prisons have clinics or sick bays.

“People are dying,” said Godfrey Malembeka, a former inmate and prisoner-rights activist who heads PCCA.

HIV testing and treatment for AIDS have improved at some prisons. HIV prevalence last was measured at 27 percent among inmates. However, a ban on condoms in prisons makes it difficult to prevent sexual transmission of HIV, the report says.

To view the report, “Unjust and Unhealthy: HIV, TB and Abuse in Zambian Prisons,” visit http://www.hrw.org/sites/default/files/reports/zambia0410webwcover.pdf.

Written by pkids

April 30, 2010 at 6:51 pm

WHO Warns Gonorrhea Might Soon Become Untreatable

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Deutsche Presse-Agentur     (04.29.10)

Today in Manila, the World Health Organization met with public health experts to devise an action plan for addressing the growing threat of drug-resistant gonorrhea.

Improper use of antibiotics to treat gonorrhea has resulted in resistance to first-line medicines, said WHO. “If this continues, it will only be a matter of time before gonorrhea develops resistance to third-generation antibiotics,” the agency said.

Australia, Hong Kong, and Japan already have reported failures with oral cephalosporin, which is currently used as a last-line gonorrhea treatment, WHO said.

Dr. Shin Young-Soo, the agency’s regional director for the Western Pacific, warned of the serious implications to public health if gonorrhea becomes untreatable. “There is no place for complacency with the possible emergence and spread of multidrug-resistant gonorrhea,” said Shin. “New treatments or alternative treatments for gonorrhea, improving monitoring for antimicrobial resistance, and strengthening gonorrhea prevention and management are urgently needed,” he said.

Countries must improve laboratory capabilities to detect gonorrhea resistance, increase awareness of the problem, and scale up disease control efforts, WHO said.

Left untreated, gonorrhea can lead to infertility, pelvic inflammatory disease, ectopic pregnancy, and infections in newborns. Gonorrhea infection also increases the chances of acquiring and transmitting HIV.

Written by pkids

April 30, 2010 at 6:49 pm

‘Opt-Out Consent’ for Automatic HIV Test

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Wisconsin State Journal (Madison)     (04.27.10)

Wisconsin has become the 43rd state to pass an opt-out consent law for HIV testing. The measure will take effect in November. Since 2006, CDC has recommended that states adopt an opt-out approach to HIV testing.

The current policy requiring health care providers to secure a patient’s informed written consent before conducting an HIV test presents a significant barrier, said Rep. Mike Huebsch (R-West Salem), who introduced the new legislation with Rep. Jennifer Shilling (D-La Crosse). “With this law, we’ll now treat HIV like other diseases when it comes to testing,” Huebsch said.

“We hope to find more HIV early because we can test more easily,” said Dr. William Agger, an infectious-disease specialist. He noted that HIV screening rates are consistently higher in jurisdictions with opt-out consent laws.

Huebsch said the law maintains strict protections of patient rights and confidentiality. Among its provisions:
*The patient must be given the opportunity to ask questions about the test and to decline testing.
*Health care providers must document they have explained to patients that while testing is voluntary, it will occur unless the patient declines it.
*A person cannot be denied health care based on his or her refusal to be tested.
*The law doubles existing penalties for illegal disclosure of HIV testing results and HIV-related discrimination.
*Disclosure of a patient’s HIV test results can only occur if the patient provides his or her informed written consent.

Written by pkids

April 30, 2010 at 6:48 pm

Posted in HIV/AIDS

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25 Years of HIV Testing in Australia

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Australian Associated Press     (04.13.10)

This month marks a quarter-century since Australia began offering the HIV antibody test. During those 25 years, an estimated 40 percent of adults have undergone the test at least once. A 2008 study found that 80 percent of gay men in Australia had been tested at least once, and one-third said they retested every six months. With some 900,000 HIV tests conducted annually, the screening is one of the nation’s most common medical tests. “The good thing in Australia is we’ve always had free and anonymous testing,” said Levinia Crooks, CEO of the Australian Society for HIV Medicine. “When people are tested, if they find out they have HIV, the response overwhelmingly is concern about who they might have given it to and concern not to give it to anyone else.” Australia continues to diagnose about 1,000 new HIV patients each year and has logged a total of 30,000 cases.

Written by pkids

April 28, 2010 at 11:04 pm

Posted in HIV/AIDS

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Sexual Values and Risky Sexual Behaviors Among Latino Youths

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Perspectives on Sexual & Reproductive Health Vol. 42; No. 1; doi: 10.1363/4202310    (03..10):: Julianna Deardorff; Jeanne M. Tschann; Elena Flores; Emily J. Ozer

The authors introduced the current study by noting that while understanding the sexual values of Latino youths is vital to informing efforts to prevent HIV transmission, few studies have explored associations between culturally based sexual values and behaviors in this population.

In San Francisco from 2003 to 2006, 839 sexually active Latinos ages 16-22 were interviewed. To examine associations between sexual values and behaviors, multiple regression and multinomial logistic regression analyses were conducted, while adjusting for language (as a proxy for acculturation) and other covariates.

The importance attached to female virginity was found to be negatively associated with females’ number of sexual partners in their lifetime (odds ratio, 0.8) and in the past year (0.9); it was positively associated with women’s nonuse of condoms, rather than consistent use, during the first month of their current relationships (1.8).

For males, the importance of satisfying sexual needs increased with the numbers of lifetime and recent sex partners, and with inconsistent condom use during the first month of their relationships (1.4, 1.1 and 1.9, respectively). Being comfortable with sexual communication was positively associated with inconsistent use or nonuse of condoms in the last month of both men’s and women’s current relationships (2.0-2.2). Among female participants, considering satisfaction of sexual needs to be important was associated with more sex partners only for those who attached little value to female virginity.

“It is important to integrate themes of virginity and sexual desire into intervention curricula so youth can better understand how these sexual norms influence their developing sexual identities and behaviors,” the authors concluded.

Written by pkids

April 28, 2010 at 11:02 pm

YouTube Rap Sensation Isn’t Taking TB Lying Down

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Sydney Morning Herald     (04.19.10)

A TB patient quarantined at Sydney Hospital has become an Internet sensation thanks to rap video parodies he created while doctors work to find the right medicines to treat his multidrug-resistant strain. Since December, Christiaan Van Vuuren’s YouTube videos have logged almost 1 million hits.

“It has made my experience in here a lot lighter and taken the intensity away from the medical side of it,” Van Vuuren said of his role as the “Fully Sick Rapper.” “At first there were a couple of really awkward moments with the nurses. One walked in and I had all these heart monitors strapped to my head,” he said. “Another time I was caught dancing with a cape on. Now they give about five or six knocks before they even peer in.”

Currently more than 110 days into his stay, Van Vuuren has caught the attention of the World Health Organization. WHO’s Stop TB program asked him to make a video for World TB Day last month, and he plans to continue promoting awareness of the disease.

“[Stop TB] told me whether I know it or not, what I’m doing is actually really good for tuberculosis, letting people know it’s not just a Third World issue,” said Van Vuuren.

The 27-year-old outdoor advertising sales representative from Sydney contracted multidrug-resistant TB (MDR TB) during travels in South Africa. He was rushed to the hospital late last year after coughing up blood, and doctors discovered a hole in his lung. He remains there with no release date in sight.

Australia records fewer than 1,000 TB cases per year; just 1 percent of these are MDR TB.

Written by pkids

April 28, 2010 at 11:00 pm