Abstract
Binge Drinking is Less for Black Adults
The current alcohol use rate for blacks aged 18 and older is significantly lower than the national adult average (44.3% percent versus 55.2%), according to a new study based on a national survey. The study by the Substance Abuse and Mental Health Services Administration (SAMHSA) also reveals that black adults have a lower rate of current binge drinking than the national adult average (21.7% versus 24.5%). Young black adults (aged 18 through 25) are markedly less likely to be currently engaged in binge drinking than are young adults in the general population (25.3% versus 41.6%).
A notable exception to the generally lower levels of alcohol use among black adults is the rate of current binge drinking among pregnant black women aged 18 to 44, which is higher than the national average for pregnant women in the age group (8.1% versus 3.6%).
The study reveals that black adults have a higher rate of current illicit drug use than the national average (9.5% versus 7.9%). The difference in rates of current illicit drug use between black adults and the national average tends to be more pronounced among male adults aged 26 and older. For example, 14.7% of black adults aged 26 to 49 currently use illicit drugs, as opposed to 11.2% of the general adult population in that age group.
Among the other noteworthy findings in the report is that an estimated 1.1 million black adults (4.4%) were classified in the survey as needing treatment for an illicit drug–use problem in the past year. This is higher than the national average of 2.9%. Almost one fourth (24.2%) of black adults in need of treatment received it at a specialty facility. This is significantly higher than the national average of 19.2%.
The study is part of a series of reports examining substance-use patterns among different ethnic, racial, and demographic groups in America. The studies are designed to provide data that will help public health experts, service providers, and communities to understand and address the issues affecting various segments of the population.
Titled “Substance Use among Black Adults,” the report is based on data collected from 2004 through 2008 from a nationally representative sample of 25,798 black adults who participated in SAMHSA's National Survey on Drug Use and Health. The full report is available online at
IOM Report Focuses on Hepatitis Infections in the United States
A recent report by the Institute of Medicine (IOM) confirms that 3.5 to 5.3 million people (1–2% of the U.S. population) have chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. Despite efforts by federal, state, and local government agencies to control and prevent these infections, they remain a serious public health concern. According to the report, the major factor impeding efforts to control HBV and HCV is lack of knowledge and awareness among health care providers, social service professionals, members of the public, and policy makers.
Each year, about 15,000 people in the United States die of liver cancer or liver disease related to HBV or HCV. Past studies indicate that up to 1.4 million people have chronic HBV infections, and up to 3.9 million individuals are infected with chronic HCV. Approximately 65% and 75% of the infected population are unaware that they are infected with HBV and HCV, respectively.
According to the report, three to five times more people are living with chronic viral hepatitis infections than with HIV infection. However, just 2% of the CDC fiscal year 2008 budget was allocated for viral hepatitis, whereas 69% was allocated for HIV/AIDS.
The report recommends that the CDC should develop specific cooperative viral-hepatitis agreements with all state and territorial health departments to support core surveillance for acute and chronic HBV and HCV. For prevention purposes, the benefits of hepatitis B vaccination should be made clear. The report indicates that all states should mandate that the hepatitis B vaccine series be completed or in progress as a requirement for school attendance.
The IOM report also focuses on improvements in viral hepatitis services through a comprehensive five-component approach: outreach and awareness; prevention of new infections; identification of infected people; social and peer support; and medical management of infected persons. In addition to the general population, the report suggests targeting foreign-born individuals from HBV-endemic countries, illicit-drug users, pregnant women, incarcerated populations, community health centers, and facilities that treat “at-risk” individuals (e.g., HIV clinics and shelters) with comprehensive hepatitis services that would have the greatest impact on reducing HBV and HCV infections.
The full IOM report is now available online and published in the February 22, 2010 online ahead of print edition of Hepatology.
ED Drugs Do Not Increase Risk for Irresponsible Sexual Behavior
Does taking erectile drugs lead to an increase in risky sexual behaviors? According to a new study, the answer is no. Drugs for erectile dysfunction, such as Viagra®, do not make men more likely to engage in potentially unhealthy sex. The findings can reassure health care providers that prescribing these medications for erectile dysfunction will result in responsible use.
Researchers from the University of Florida examined data from 2,787 men with an average age of 52 years. All were taking part in a study about aging veterans. About half were HIV positive.
According to the study findings, 28% of the men used erectile-dysfunction drugs over a 1-year period. About 10% of the men in two groups, those who did use the drugs and those who did not, reported behavior defined as sexually risky.
The study was published in the February issue of the Journal of General Internal Medicine, 2010;25(2):115–121.
HPV DNA Testing Should Replace Pap Smear
Italian researchers believe that DNA testing for the human papillomavirus (HPV) should replace the Pap smear as the main way to screen women for cervical cancer. The recommendation is based on a study that found that the HPV test prevented more cases of cervical cancer than did the conventional Pap smear.
According to the researchers, the HPV test should become the screening tool of choice for women aged 35 and older. One advantage is that it could be done less frequently than the Pap test. Only women who have tested positive for HPV would then undergo Pap smears.
DNA testing for HPV has some disadvantages. For example, it is less likely to pick up more false positives than is a Pap smear. This results in many more callbacks for women to undergo further testing.
The Italian researchers compared HPV testing alone with HPV testing plus a Pap smear in 94,370 women aged 25 to 60 years. During the first phase of the study, women from 35 to 60 years who tested positive for HPV were given a colposcopy. Younger women had a colposcopy if their Pap smears were abnormal or if HPV results were positive several times.
According to the study, screening for HPV DNA appeared to be more effective in older women. However, the testing in younger women led to overdiagnosis of a particular type of cervical lesion.
More details about the study can be found in the January 19 online edition of The Lancet Oncology.
Clinical Trial Investigates Two Experimental HCV Drugs
Vertex Pharmaceuticals is enrolling patients for the first clinical trial evaluating the hepatitis C virus (HCV) protease inhibitor telaprevir. In this trial, telaprevir will be dosed in combination with the HCV polymerase inhibitor VX-222. The phase 2 clinical trial will evaluate sustained viral response rates (SVR; defined as undetectable HCV RNA 24 weeks after the end of treatment) by using multiple 12-week response-guided regimens of telaprevir/VX-222–based combination therapy, including two-drug regimens that contain only telaprevir and VX-222.
The trial is expected to enroll approximately 100 treatment-naïve genotype 1 HCV patients at 20 clinical trial sites. Most of these sites will be located in the United States. Enrollment is expected to be completed in the second quarter of 2010.
The randomized, parallel-group, dose-ranging trial is designed to evaluate the safety and antiviral activity, including SVR, of multiple 12-week response-guided telaprevir/VX-222–based combination regimens. The primary end point of this trial is to assess safety and tolerability of telaprevir/VX-222–based combination therapy. A secondary end point is to assess the proportion of patients in each study arm who achieve SVR. The four arms to the trial each will enroll 25 participants who will undergo 12 weeks of treatment. The first arm will consist of telaprevir (1,125 mg, BID) + VX-222 (100 mg, BID), whereas the second arm will consist of telaprevir (1,125 mg, BID) + VX-222 (400 mg, BID). Two other arms will add pegylated interferon and ribavirin to the first two arms.
The trial will use response-guided criteria aimed at evaluating shorter-duration treatment regimens. All patients, regardless of treatment group, whose HCV RNA levels are undetectable (<10 IU/mL) at weeks 2 and 8 of treatment, will stop their assigned treatment at week 12. Patients who do not meet these criteria will complete their assigned treatment, and at week 12, those in the dual-drug regimen will receive follow-on therapy of 24 weeks of pegylated-interferon (peg-IFN) and ribavirin (RBV), for a total of 36 weeks of treatment. Patients in the quad-therapy regimens who do not meet these criteria at week 12 will receive an additional 12 weeks of follow-on therapy with peg-IFN and RBV for a total of 24 weeks of peg-IFN and RBV therapy.
Based on an evaluation of on-treatment safety, pharmacokinetic, and antiviral data from patients in each arm of the trial, Vertex may elect to enroll up to two additional treatment arms that will evaluate telaprevir/VX-222–based combination therapy. The components of the treatment regimens of these arms will be selected based on clinical data that emerge from the four initially studied regimens. Up to 25 patients are expected to enroll in each additional treatment arm.
Herpes Infects One in Six in United States
According to the Centers for Disease Control and Prevention (CDC), as many as one in six Americans is infected with herpes simplex virus type 2 (HSV-2). The findings are part of the agency's data from the 2005 to 2008 National Health and Nutrition Examination Survey, which involves households from across the country.
The prevalence of HSV-2 has remained stable since the last survey, which was done from 1999 to 2004. Currently, prevalence rests at about 17% of the U.S. population. According to the report, women and blacks are the most likely to be infected. The prevalence among women was 20.9%, nearly twice that of men at 11.5%. Among blacks, 39.2% are infected. This is a rate more than 3 times that of whites, at 12.3%. Black women had the highest prevalence of HSV-2, at 48%. The report noted that women also are more susceptible to other sexually transmitted diseases and that the racial disparities found with HSV-2 may be due to more infections among blacks, which make them more likely to be exposed to herpes.
These infection rates should be considered serious. People with herpes are 2 to 3 times more likely to become infected with HIV. Having herpes also makes it more likely that an HIV-infected person will give HIV to others. The survey also found that the prevalence of herpes increases with age, from 1.4% among those aged 14 to 19 years to 26.1% among people aged 40 to 49 years.
The prevalence of herpes is also higher among those who reported having many sex partners. About 4% of those with one lifetime sex partner were found to have herpes, compared with about 27% of those who reported having 10 or more partners. In addition, more than 80% of people infected with herpes do not know they are infected.