Abstract
HIV-Infected Injection Drug Users Have Poor Kidney Function
Poor kidney function is common among injection drug users (IDUs). However, researchers from the Johns Hopkins Bloomberg School of Public Health have found that this is particularly true for IDUs with HIV. As a result, clinicians should pay greater attention to kidney function in these individuals while prescribing antiretroviral therapies and other medications. IDUs with HIV have an increased risk for kidney disease from a number of factors. These include HIV infection itself, the higher prevalence of viral hepatitis, toxic side effects of antiretroviral therapy, poor access to health care, and socioeconomic and race differences.
The Hopkins researchers analyzed the presence of proteinuria in 902 HIV-positive and HIV-negative IDUs. Most were African-American. In this group, 273 had HIV infection. Nearly a quarter (24.8%) of all the individuals in the study had proteinuria. However, its prevalence was 2.9 times higher among those with HIV infection (45%) compared with uninfected individuals (16%). HIV infection, unemployment, increased age, diabetes, hepatitis C infection, and high blood pressure were all linked to a higher prevalence of proteinuria.
More details on the study can be found in the August 12th online edition of the linical Journal of the American Society Nephrology.
Clinical Trial Will Investigate HPV Microbicide
Thanks to a $4.1 million grant from the National Cancer Institute (NCI), researchers at the Albert Einstein College of Medicine of Yeshiva University will begin studying the microbicide Carraguard® and its activity against HPV. Specifically, the research will include a clinical trial and translational work to evaluate the efficacy of the microbicide in preventing new HPV infections in women. It is a clear gel made from the seaweed derivative carrageenan.
Previous studies of Carraguard®, including a recent phase 3 trial, did not demonstrate effectiveness against HIV. However, it was shown to be safe. Recent laboratory tests now indicate that carrageenan is about 1,000 times more effective against HPV than against HIV. Einstein researchers will enroll 200 women in their clinical trial. They will be assigned to use either Carraguard® or a placebo gel. At the end of 1 year, the women will be examined to determine if the microbicide protected them from acquiring HPV infections. Assays will also be performed to assess its activity and to develop a predictive test for efficacy. Samples will also be taken to look for signs that the gel alters the body's natural defenses against HPV. If so, this would point to potential problems with efficacy and safety in clinical use.
HIV-Positive Women Feel Judged Over Wanting Children
Researchers from Ryerson University in Ontario, Canada have found that HIV-infected women who want children feel they are being judged negatively by their health care providers for wanting to become mothers. They also feel stigmatized by their physicians because of their medical condition. The study is part of a larger report that examines HIV-positive women's desire to have children.
In this study, 159 women with HIV and living in Ontario were surveyed. All were recruited from various AIDS service organizations, HIV clinics, and community health centers. Slightly over half of the women (55%) were born outside Canada, mostly from HIV-endemic countries such as sub-Saharan Africa and the Caribbean; the other group was born in Canada. They were asked to answer demographic-related questions (age, education level, birthplace, ethnicity, income), medical questions relating to their HIV treatments, and psychological questions (level of anxiety, depression). They were also asked if they believed they were being negatively judged by their health care providers, family, and friends about their desire to have children.
The researchers found strong evidence that the women believed they were being judged negatively by their health care providers for wanting children. In addition, there were stark differences between the women born outside and within Canada when it came to the factors contributing to stigmas perceived because of their HIV-positive status. For those not born in Canada, being negatively judged by a physician in Canada for wanting to become pregnant was the strongest predictor of HIV stigma. On the other hand, women born in Canada who reported higher levels of anxiety and lower levels of education were more likely to feel stigmatized by their medical condition. Women born in Canada also reported they felt negatively judged by their health care providers, but not to the same degree as those women born outside of the country. For both groups, family and friends did not play a significant role in the perceived stigmatization of the women's desire for children.
One of the reasons for the perceived stigma may be physicians using outdated guidelines from the late 1980s. These recommended that HIV-positive women should avoid getting pregnant. Today's guidelines and effective antiretroviral regimens allow such women to have children without worrying about HIV transmission. As such, the researchers would like to see more efforts aimed at educating physicians about the near zero risk of maternal-child transmission.
The study was published in the June issue of the Archives of Women's Mental Health 2010;13(3):207–214.
Syringe Type Affects HIV Transmission
In injection drug users (IDUs), the type of syringe used to inject drugs may have a different effect on HIV transmission in these individuals. Using a mathematical model, researchers at RTI International were able to illustrate the potential impact of syringe type on injection-related HIV epidemics in low- and high-risk intravenous drug user populations.
According to the researchers, when a plunger on a syringe is fully depressed, all syringes retain fluid in what has been termed "dead space." In high dead-space syringes, which usually have detachable needles, more than 1,000 times more blood is retained in the syringe after washing than in low dead-space syringes. Even a small percentage of exposures involving high dead-space syringes can increase the spread of HIV dramatically, especially in high-risk populations. The study also demonstrated that injection-related HIV epidemics are likely to be controlled in areas or populations where 95% percent of syringe-sharing episodes use low dead-space syringes. Most IDUs in the United States use low dead-space syringes. However, some users continue to use high dead-space syringes.
The findings may explain why there are large geographic differences in the prevalence of HIV in IDUs. The researchers would like to see syringe exchange programs provide low dead-space syringes to IDUs when considering harm reduction measures for HIV. However, the type of syringes given out should match the needs of the local users.
More details of the study can be found in the August issue of Addiction 2010;105(8):1439–1447.
Barriers Prevent Patients from Seeking Treatment
A national survey finds that emotional barriers (i.e., stigma, fear, denial, and shame) and structural barriers (i.e., lack of knowledge, transportation, and insurance coverage) can prevent people living with HIV/AIDS from seeking medical care and treatment. The findings help in the further understanding of the obstacles to care for many patients and may help address the gaps in medical care and treatment for this population.
According to the national survey results, emotional barriers are the key barriers across all three patient groups surveyed from both the patient and the health care provider (HCP)/allied health care provider (AHP) perspective. Patients surveyed included those who were diagnosed with HIV and under care, diagnosed and not under care, or undiagnosed and at risk for HIV. Not feeling sick is a major barrier across all three patient groups. Fear of medication side effects and the realization that taking medication means “facing reality” and the possibility of financial struggle are top tier barriers among the two diagnosed groups. Stigma and denial are significant barriers among the undiagnosed.
Health care providers were found to underestimate the impact of emotional rather than structural barriers on a patient's willingness to undergo HIV testing, access care, and even initiate HIV treatment when medically appropriate. Patients who were under care were more likely to rate their doctor as influential in treatment decisions compared to patients in the other two groups surveyed. Understanding these barriers and how they differ across patient groups and health care providers throughout the country may provide key insights in helping to increase the number of people who receive the care they need.
Two parallel surveys were conducted among 234 patients (104 under care, 54 not under care, and 76 at-risk) and 299 health care and allied health professionals (90 MDs, 40 NPs, 33 PAs, 136 AHPs) during November 2008 through January 2009. Interviews were conducted over the phone, online, or in person and lasted approximately 30–45 min.
According to the national survey data presented, health care professionals were more likely to view substance abuse issues (49% for patients under care and 66% for patients not under care) or struggling to handle financial and basic needs (58% for patients under care and 64% for patients not under care) as reasons why people living with HIV were not receiving treatment. On the other hand, patients receiving care indicated that fear of side effects (82%), denial of needing treatment because they did not feel sick (69%), and HIV stigma (55%) were key barriers. Findings were similar for patients who were diagnosed but not under care.
The national survey, commissioned by Bristol-Myers Squibb, was presented at the 18th International AIDS Conference, Vienna, Austria, July 18–23, 2010.
HCV Patients Have Lower Work Productivity and Higher Medical Costs
A U.S. study has found that patients with chronic HCV infection have lower work productivity compared to individuals without HCV. What's more, they also incur higher medical benefit costs.
Researchers from Bristol-Myers Squibb and others compared health care benefit costs and productivity issues for patients with and without chronic HCV infection. A total of 339,456 U.S. subjects were evaluated. These included 1,664 employees with HCV and 337,792 in the healthy control. Employees with HCV infection were found to experience significant health-related work absences. They also experienced greater health benefit costs and further co-morbidity compared to those workers who did not have HCV.
HCV-infected workers had 4.15 more total annual absence days and processed 7.5% fewer units of work per hour than those in the control group. Health care benefit costs were also significantly higher in the HCV group with a total incremental difference of $8,352 per year, including $490 in indirect (absence) costs.
The study was published in the August issue of Hepatology 2010;52(2):436–442.