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This page contains links to external Web sites. HIV Cross-Training Resources ArchiveCDCHIV/AIDS Risk Factor Reporting Alarmingly Low According to new report by CDC, of the approximately 33,000 new HIV/AIDS diagnoses reported to the National HIV/AIDS Reporting System in 2003, over one-third were reported with no identified risk factor. Without accurate risk factor documentation and reporting, state and federal funding for HIV prevention activities and AIDS services may not reach the populations who are most in need. Additionally, surveillance tracking of the HIV/AIDS epidemic requires accurate risk factor information to detect changes in the epidemic. According to CDC, the problem is already severe, but there are signs it is getting worse. This article describes several different risk factors that can be identified and outlines what the CDC is currently doing to encourage reporting of the risk factors as well as what healthcare providers can do to facilitate the reporting. Varicella-Related Deaths – United States, January 2003 – June 2004 Varicella disease is an infectious disease and can result in death. Varicella can be prevented by vaccination. Despite availability of a safe and effective vaccine, varicella deaths continue to occur. During 2003 and the first half of 2004, CDC received reports of eight varicella-related deaths. Six out of the eight deaths occurred among children and adolescents aged under 20 years and none of them were vaccinated. Three deaths occurred in susceptible, unvaccinated, but otherwise healthy children. The deaths presented in this report highlight the importance of timely routine vaccination of children aged 12-18 months, as well as catch-up vaccination to older susceptible children and adolescents according to current recommendations. Varicella Surveillance in Public Elementary Schools – Multinomah County, Oregon, 2002-2004 Varicella vaccination may be reducing the occurrence of chickenpox in Multnomah County public elementary schools: cases reported for the 2003-04 school year were 30% lower than the previous school year and the actual numbers were small (86 and 114, respectively). Surveillance for chickenpox is being conducted in Multnomah County public elementary schools by the Oregon Department of Health Services and the Multnomah Education Services District. For more statistics and methodology, please see the website above. CDC-INFO Replaces CDC National AIDS Hotline in Providing 24 Hour Information and Referral Services on HIV/AIDS HIV Satellite Broadcast & Webcast: Partner Counseling and Referral Services for HIV Prevention This live broadcast and web cast will provide information regarding the goals, purpose and context of HIV Partner Counseling and Referral Services (PCRS) as well as the process, techniques and skills for delivering PCRS. The forum includes interviews at public health organizations. A panel of experts will answer viewers' questions, which can be sent via fax during the broadcast or by e-mail after the broadcast. This broadcast is designed for health departments, community-based organizations, AIDS services organizations, public and private providers who care for persons living with HIV/AIDS (PLWHA), HIV prevention counseling and testing providers, HIV case managers, and healthcare organizations that provide services for PLWHA. 5th Annual Conference of the TB Education and Training Network: Stepping up Education and Training to Eliminate TB When: Aug. 17-19, 2005 Legionnaires’ Disease Associated with Potable Water in a Hotel – Ocean City, Maryland, October 2003-February 2004 The Worcester County Health Department, the Maryland Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention investigated seven confirmed cases of Legionnaires' disease among persons who stayed at a hotel in Ocean City, Maryland over a four-month period. This report summarizes the joint investigation, which implicated the potable hot water system of the hotel as the likely source of infection. This outbreak investigation highlights the importance of enhanced, state-based surveillance for timely detection of travel-associated Legionnaires' disease clusters. Hypothermia-Related Death – United States, 2003-2004 This report describes three hypothermia-related deaths that occurred in the United States, during 2003-2004, summarizes hypothermia-related mortality during 1979-2002, describes risk factors for and symptoms of hypothermia, and reviews measures to prevent hypothermia-related injury and death. The three case studies described in this report mention some of the main risk factors for hypothermia-related deaths: advanced age, mental impairment, and substance abuse. Public-health strategies to reduce hypothermia-related deaths include identifying persons at greatest risk, ensuring resources are available to minimize exposure to cold, and ongoing communication with high-risk persons about how to protect themselves. For statistics and additional recommendations, please see the website above. Tularemia Transmitted by Insect Bites – Wyoming, 2001-2003 In 2001-2003, Wyoming experienced an increase in reported human cases of tularemia. During this period, insect bites (particularly from biting flies such as deer flies) emerged as the most common likely mode of transmission according to the Wyoming Department of Health. This increase in human cases was geographically and temporally associated with a possible increase of tularemia in rabbits. Health care providers and the public should be knowledgeable about the local epidemiology of tularemia, particularly regarding the modes of transmission and resultant clinical types, in order to facilitate a timely diagnosis and take appropriate preventive measures. Progress Toward Elimination of Measles and Prevention of Congenital Rubella Infection – European Region, 1990-2004 European Region of the World Health Organization aims to eliminate indigenous measles and reduce incidence of congenital rubella syndrome to <1/100,000 live births by 2010. In 2004, all 52 countries in EUR had routine 2-dose measles vaccination program; 47 countries also used a rubella-containing vaccine. Routine coverage with the first dose of measles-containing vaccine among children aged 1 year has been >80% since early 1990s (>90% during 1990-2003). During 1994-2004, approximately 27 million persons have been vaccinated against measles through supplemental vaccination implemented in nine countries. Measles incidence declined from 36.2 per 100,000 populations in 1990 to 3.2 in 2004, and some countries (e.g. Finland) succeeded in eliminating measles, mumps, and rubella. Hepatitis A Vaccination Coverage Among Children Aged 24-35 Months – United States, 2003 In 1999, routine hepatitis A vaccination of children was recommended in regions of the country where hepatitis A was more common. Results from the first national hepatitis A vaccination survey show that 50% of 24- to 35-month-old children in the 11 states where routine vaccination is recommended have received at least 1 dose, compared to 25% in the six states where consideration of routine vaccination was recommended. Vaccination rates were highest among populations that have had the highest rates of hepatitis A in the past, such as Hispanic, American Indian, and Alaskan Native children. However, increasing the number of children who are vaccinated against hepatitis A is needed to ensure continued declines in the number of hepatitis A cases in the United States. Tuberculosis Transmission in a Homeless Shelter Population – New York, 2000-2003 This report describes an outbreak of tuberculosis (TB) among homeless persons in a large shelter in New York State, with cases diagnosed and reported in three different local health jurisdictions. The outbreak was recognized through enhanced surveillance, coordinated across several public health jurisdictions, and real time genotyping of TB strains which suggested that multiple chains of transmission were occurring simultaneously. Because standard screening and contact investigation efforts had not been effective in preventing transmission, an intensive onsite active case finding effort involving multiple agencies was undertaken. Four persons with active TB were identified as a result of this intensive case identification, and a program of directly observed treatment for TB-infected individuals was initiated at the shelter. During the subsequent year, five additional active cases have been identified (one culture-negative case and four with the shelter-associated strain), likely linked to transmission in the shelter before the intensive case-finding effort. Only two of these cases were resident at the shelter at the time of diagnosis. QuickStats: Primary Contraceptive Methods Among Women Aged 15-44 Years – United States, 2002 In 2002, the most frequently used contraceptive among women aged 15-44 years was oral contraception. Other leading methods were female sterilization and the male condom. A smaller, but significant, number of women were using the newer, long-acting hormonal methods, including injectables, implants, and the patch. For a graph showing the specific percentages, please see the website above. More information can be found at http://www.cdc.gov/nchs/nsfg.htm. Frequently Asked Questions on HIV and AIDS This site shows the most recently revised answers to frequently asked questions regarding HIV and AIDS. The questions cover a wide range of topics including prevention, definitions, symptoms, treatment, transmission, and clinical studies. Japanese Encephalitis in a U.S. Traveler Returning from Thailand, 2004 Japanese encephalitis (JE) is a leading cause of viral encephalitis in Asia and predominantly affects children. It has a very high mortality (estimated at up to 30%) and, among survivors, a high rate of persistent neurological abnormalities (up to 50%). A student traveling in Thailand returned to the U.S. with encephalopathy and fever. The student stayed approximately 3 days in the rural Chang Mai Valley and one month in Chang Mai City, and reported being bitten by mosquitoes in both places. The Advisory Committee on Immunization Practices (ACIP) recommends JE vaccine for travelers to JE-endemic areas of Asia during the transmission season, especially those spending >1 month in those areas and whose travel itineraries include rural settings. JE vaccine should also be considered for travelers visiting areas with epidemic transmission or those engaging in extensive outdoor activity in rural settings in areas where JE is endemic, regardless of the duration of their visit. In addition, health-care providers and organized international travel programs should ensure that travelers obtain appropriate preventive health guidance before travel. Racial Disparities in Nationally Notifiable Diseases – United States, 2002 To estimate racial disparities in the incidence of nationally notifiable infectious diseases by race/ethnicity, CDC reviewed 2002 data from the Nationally Notifiable Disease Surveillance Systems (NNDSS). This report summarizes the results of that analysis, which indicates that incidence rates were at least two times greater for blacks than whites for eight of 42 nationally notifiable diseases; however, substantial gaps exist in the reporting of racial ethnic data for the 42 diseases, which accounted for approximately 1.3 million of the cases reported by NNDSS. At least 20,000 cases were reported by each of six infectious diseases: Chlamydia (834,555 cases), gonorrhea (351,852), salmonellosis (44,264), Lyme disease (23,763), shigellosis (23,541), and giardiasis (21,206). For three of those six diseases, and eight of the 42 nationally notifiable diseases, the incidence rate for blacks was at least twice as high as the rate for whites in 1992. For gonorrhea, the incidence rate for blacks was 24 times greater, at 570.4 per 100,000 population, compared with 23.6 for whites. For Malaria, the rates were 1.8 for blacks and 0.2 for whites; for Chlamydia, 805.9 for blacks and 90.2 for whites; for syphilis, 9.4 for blacks and 1.1 for whites; for shigellosis, 16.8 for blacks and 4.0 for whites; for typhoid fever, 0.1 for blacks and 0.02 for whites; for hepatitis B, 2.9 for blacks and 1.5 for whites; and for Streptococcus pneumoniae (i.e. invasive, drug resistant), 1.5 for blacks and 0.7 for whites. Please see the website above for data on other ethnicities and diseases. Brief Report: Tuberculosis Outbreak in a Low-Incidence State – Indiana, 2001-2004 This is a summary of the preliminary findings released by the CDC from a retrospective investigation of an ongoing tuberculosis (TB) outbreak in Allen County, Indiana. From January 2001 through June 2004, 59 cases of TB disease were reported in Allen County. Of the 59 cases investigated, 25 were outbreak related, 21 had epidemiologic links and four had genotypic links only. Nearly all patients (96%) were black, 14 were female, and 22 resided in four contiguous postal code areas. Of 16 patients who were tested for human immunodeficiency virus (HIV), all tested negative. Pulmonary TB was present in 18 patients. Six patients were highly infectious, with acid-fast bacilli (AFB) identified on sputum smear and cavitary lung lesions. For the 25 cases believed to be linked, more than 500 contacts have been investigated to date. Eighty-five contacts were recommended for latent TB infection (LTBI) treatment. Only 49 started therapy, however, and 12 did not complete treatment. Two patients who did not complete LTBI treatment and one person who refused treatment developed TB disease. These three people were likely sources of infection for 16 persons who subsequently developed TB disease. Treating Opportunistic Infections Among HIV-Exposed and Infected Children This report provides recommendations from CDC, the National Institute of Health, and the Infectious Diseases Society of America on treating opportunistic infections among HIV-exposed and infected children in the United States. Because HIV-infected women coinfected with opportunistic pathogens might be more likely to transmit these infections to their infants than women without HIV infection, guidelines for treating opportunistic pathogens among children should consider treatment of congenitally acquired infections among both HIV-exposed but uninfected children and those with HIV infection. Compared with opportunistic infections among HIV-infected adults, which are often caused by reactivation of pathogens acquired before HIV infection when host immunity was intact, opportunistic infections among children often reflect primary acquisition of the pathogen and, among children with perinatal HIV infection, infection acquired after HIV infection has been established and begun to compromise an already immature immune system. Treatment recommendations should consider differences between adults and children in terms of drug pharmacokinetics, dosing, formulations, administration, and toxicities. Alcohol Consumption Among Women Who Are Pregnant or Who Might Become Pregnant- United States, 2002 In 2002, with the inclusion of a family planning module in the Behavioral Risk Factor Surveillance System (BRFSS), information became available to assess the alcohol consumption patterns among pregnant women, as well as among those who might become pregnant. CDC analyzed the survey data of the 2002 BRFSS to determine the patterns of alcohol consumption among U.S. women 18–44 years of age. The results of that analysis indicated that the prevalence rates for binge drinking, frequent use, and any use of alcohol remained relatively stable among pregnant women when compared with prevalence rates in the previous report. The results also showed that the prevalence rates for binge drinking, frequent use, and any alcohol consumption for women who might become pregnant were virtually the same as the rates for childbearing-aged women in general. Dysmorphic brain development as result of prenatal alcohol consumption was observed in the fetus as early as 3–6 weeks of gestation. This is a period during which most women might not realize that they are pregnant. To date, no level of alcohol consumption during pregnancy has been found to be safe. Current national guidelines recommend that women who are pregnant or might become pregnant abstain from alcohol use. Basic Statistics from the HIV/AIDS Surveillance Report: HIV Infection and AIDS in the United States, 2003 This is an updated fact sheet providing the basic statistics from CDC's HIV/AIDS Surveillance Report: HIV Infection and AIDS in the United States, 2003. The statistics included in this fact sheet include: HIV estimate, AIDS cases, deaths due to AIDS, AIDS cases by age, AIDS cases by race/ethnicity, AIDS cases by exposure category, Top 10 AIDS case by state/territory, state HIV/AIDS data, and international statistics. Chlamydia Screening Among Sexually Active Young Female Enrollees of Health PlansUnited States, 1999-2001 To evaluate the rates of chlamydia screening among sexually active young females, CDC analyzed 1999-2001 data from the Health Plan Employer Data and Information Set (HEDIS) reported by commercial and Medicaid Health insurance plans. This report summarizes the results from that analysis, which determined that screening rates were low despite slight increases in screening covered both by commercial and Medicaid plans during 1999-2001. Among sexually active female enrollees aged 16-26 years in commercial plans, 20% were screened for chlamydia in 1999, 25% in 2000, and 26% in 2001. Among enrollees aged 16-26 years in Medicaid plans, screening rates were 28% in 1999, 36% in 2000, and 38% in 2001. Lymphogranuloma Venereum Among Men Who Have Sex with Men Lymphogranuloma venereum (LGV) is a systemic, sexually transmitted disease (STD) caused by a variety of the bacterium Chlamydia trachomatis that rarely occurs in the United States and other industrialized countries; the prevalence of LGV is greatest in Africa, Southeast Asia, Central and South America, and Caribbean countries. However, in the Netherlands, which typically has fewer than five cases a year, as of September 2004, a total of 92 cases of LGV had been confirmed during the preceding 17 months among men who have sex with men (MSM). The first 13 cases, diagnosed during April-November 2003, were reported by local health authorities in Rotterdam in December 2003. An alert was sent to the Early Warning and Reporting System of the European Union and to the European Surveillance of Sexually Transmitted Infections Network (ESSTI). In April 2004, a report was made to CDC, and state and local health departments were alerted. Of the 92 cases confirmed in the Netherlands, 30 occurred during 2003 and 62 during 2004. This report describes the ongoing investigation of the LGV outbreak. 2005 National HIV Prevention Conference The 2005 National HIV Prevention Conference will be held from June 12-15, 2005 at the Hyatt Regency Atlanta Hotel in Atlanta, Georgia. The conference offers opportunities to share effective prevention approaches and research findings among governmental, community, and academic partners in HIV prevention. It also strengthens collaborations between program practitioners and researchers in areas including behavioral interventions, vaccine development, monitoring the epidemic, implementing rapid and reliable tests for early HIV diagnosis, and improving access to early treatment and prevention services for persons with HIV. Assessment of Increase in Perinatal Exposure to HIV Among Hispanics20 Counties, Georgia, 1994-2002 CDC received reports from clinicians in a specialized pediatric HIV care clinic (clinic A) suggesting that the number of perinatally HIV-exposed Hispanic infants in the Atlanta metropolitan area had increased disproportionately to the growth of Hispanics in the area's population. To assess this increase and characterize trends in perinatal HIV exposure in this population, CDC collaborated with health-care providers at clinic A, which serves residents in 20 Georgia counties, including the Atlanta metropolitan area. This report summarizes the results of that assessment, which suggest that the increase in the number of perinatally HIV-exposed Hispanic infants was associated with multiple factors, including the growth of the Hispanic population, increasing HIV prevalence and fertility among Hispanics, and lower preconception awareness of HIV serostatus among those with HIV. The findings suggest a need for improved access to voluntary HIV counseling and testing and increased opportunities for reducing the risk for unintended pregnancy among Hispanics in these counties. HIV/AIDS Special Surveillance Report: Enhanced Perinatal Surveillance, United States, 1999-2001 In 1999, Congress appropriated $10 million per year for activities aimed at reducing perinatal HIV infection, including enhanced perinatal HIV surveillance. This report describes the population of HIV-infected women who gave birth during the years 1999-2001. An estimated 6000 to 7000 HIV-infected women gave birth in the United States during the year 2000; an estimated 280-370 infants were infected. 1 in 8 HIV-infected women did not receive prenatal care and 1 in 9 was not tested for HIV before giving birth. The report also lists goals and recommendations in reducing prenatal HIV infection. HIV Transmission Among Black College Student and Non-Student Men Who Have Sex With Men --- North Carolina, 2003 In the United States, young black men who have sex with men (MSM) and reside in urban settings have high rates of infection with human immunodeficiency virus (HIV), with incidence and prevalence as high as 14% and 32%, respectively. Few epidemiologic and behavioral studies have been conducted in this population, and even fewer data are available for black MSM from non-urban areas of the southern United States. In November 2002, the North Carolina Department of Health (NCDOH) identified two cases of acute HIV infection among non-Hispanic black male college students. A retrospective review of all men aged 18--30 years with HIV diagnosed during January 2000--May 2003 indicated an increase in HIV case reports in male college students, from two cases in 2000 to 56 during January 2001--May 2003 (5). Of these 56, a total of 49 (88%) were black, and nearly all were MSM, including some men who had sex with both men and women. In August 2003, NCDOH invited CDC to assist with an epidemiologic investigation of young HIV-positive black MSM in North Carolina. This report summarizes the results of that investigation, which indicated that black MSM college students and non-students in North Carolina had high rates of HIV risk behaviors, underscoring the need for enhanced HIV-prevention programs in these populations. Tuberculosis Transmission in Multiple Correctional Facilities --- Kansas, 2002--2003 Tuberculosis (TB) is a substantial health concern in correctional facilities; inmates and employees are at high risk, and TB outbreaks can lead to transmission in surrounding communities. In September 2002, after diagnosis of smear-positive pulmonary TB in a prison inmate, the Kansas TB Control Program, initiated a 6-month contact investigation. This report summarizes the results of that investigation, which determined that, while symptomatic for TB, the inmate had resided in three different jails and a state prison, placing hundreds of employees and other inmates at risk for TB infection. Transmission of Hepatitis B Virus in Correctional Facilities Incarcerated persons have a disproportionate burden of infectious diseases, including hepatitis B virus (HBV) infection. Among U.S. adult prison inmates, the overall prevalence of current or previous HBV infection ranges from 13% to 47%. The prevalence of chronic HBV infection among inmates is approximately 1.0%--3.7%, two to six times the prevalence among adults in the general U.S. population. Incarcerated persons can acquire HBV infection in the community or in correctional settings. This report summarizes the results of 1) an analysis of hepatitis B cases among Georgia inmates reported to the Georgia Department of Human Resources, Division of Public Health (DPH) during January 1999--June 2002, including a retrospective investigation of cases reported during January 2001--June 2002; and 2) a prevalence survey conducted in prison intake centers during February--March 2003. These efforts identified cases of acute hepatitis B in multiple Georgia prisons and documented evidence of ongoing transmission of HBV in the state correctional system. The findings underscore the need for hepatitis B vaccination programs in correctional facilities. Hepatitis B Vaccination of Inmates in Correctional Facilities In May 2000, the Texas Department of Criminal Justice (TDCJ), which oversees custody of state jail and prison inmates, implemented a hepatitis B vaccination program. To determine hepatitis B vaccination rates of inmates during 2000--2002, TDCJ reviewed charts of inmates released during a 3-day period for documentation of vaccination. This report summarizes the results of that study, which indicated that rates of vaccine acceptance and vaccine series completion among inmates were high. Establishing hepatitis B vaccination programs in prisons and jails can prevent a substantial proportion of HBV infections among adults in the outside community. Alcohol Among Adolescents and Adults - New Hampshire, 1991-2003 The New Hampshire Department of Health used CDC-developed measures to facilitate a statewide trend analysis of alcohol use among adolescents and adults. In 2003, a total of 30.6% of state adolescents reported binge drinking. In 2001, 15.8% of adults reported binge drinking and 6.3% reported heavy drinking. Heterosexual Transmission of HIV - 29 States, 1999-2002 Thirty five percent (35%) of all new HIV infections in the United States are acquired through heterosexual transmission. Eight-four percent (84%) of heterosexually acquired HIV infections involved non-Hispanic blacks or Hispanics and most cases were females. This ready-to-use presentation is available through the CDC. The training includes nine STD presentations, a user's guide with suggested agendas, discussion questions and a script for interactive group exercise. To receive the training materials, enter the website and register for a password, which will be email to you. Uni-Gold RecombigenTM HIV: FDA News Release On December 23, 2003, the FDA approved the Uni-Gold RecombigenTM HIV rapid HIV test, a single use rapid test that detects HIV antibodies in plasma, serum and whole blood. It is the only test that is approved for all three sample types. Uni-Gold Recombigen is restricted to clinical laboratories having an adequate quality assurance program. Test results are produced in 10 minutes.
Implementation of Named HIV Reporting - New York City, 2001 (pp. 1-3) In June 2000, the New York City Department of Health and Mental Hygiene began tracking diagnosis of HIV (non-AIDS) and AIDS diagnoses. The data revealed that persons who were diagnosed with HIV during 2001 (compared with people living with AIDS) were more likely to be female, non-Hispanic black, younger than 45 years of age and residents of the Bronx or Brooklyn. Prenatal HIV Testing and Antiretroviral Prophylaxis at an Urban Hospital - Atlanta, GA, 1997-2000 (pp. 4-7) In 1995, the U.S. Public Health Service (USPHS) recommended universal prenatal HIV counseling and voluntary testing. The CDC analyzed the prenatal program at Grady Memorial Hospital in Atlanta to identify missed prevention opportunities. HIV testing of pregnant women allowed for nearly all HIV-exposed infants to receive the drug ZDV. Back to Top
CSAT
Older Adults in Substance Abuse Treatment: Update This report examines admissions of adults aged 55 or older from 1995 to 2002. In 2002, this age group comprised approximately 62 million people in the United States. Estimates indicate that the number of adults aged 55 or older will reach 75 million by 2010, and that the number of adults aged 50 or older with substance abuse problems will increased from 2.5 million in 1999 to 5.0 million in 2020. In 2002, there were 66,500 admissions aged 55 or older to substance abuse treatment. The admission rate for adults aged 55 or older was 107 per 100,000, which was considerably lower than the rate of 801 admissions per 100,000 for the population younger than 55. Other findings include:
Age at First Use of Marijuana and Past Year Serious Mental Illness
This report focuses on the association between age at first use of marijuana and past year serious mental illness (SMI). All of the findings presented are annual averages based on the combined data from 2002 and 2003 NSDUH. Some of the main findings include:
Updated Directory of Drug, Alcohol Abuse Treatment Programs Available SAMHSA's updated guide to finding local substance abuse treatment programs is now available. The guide, National Directory of Drug and Alcohol Abuse Treatment Programs 2005, provides information on thousands of alcohol and drug treatment programs located in all 50 states, the District of Columbia, Puerto Rico, and four U.S. territories. The directory is designed to quickly provide the reader with important information on levels of care and types of facilities, including those with programs for adolescents, persons with co-occurring substance abuse and mental disorders, individuals living with HIV/AIDS, and pregnant women. This latest directory provides a listing of more than 11,000 community substance abuse treatment programs and complements the internet-based Substance Abuse Treatment Facility Locator (http://findtreatment.samhsa.gov). To obtain a free copy of the guide, contact SAMHSA's Clearinghouse (http://store.health.org/whatsnew/) or call (800) 729-6686.
Polydrug Admissions: 2002 Polydrug abuse is common among alcohol and drug users. The Treatment Episode Data Set provides information on the primary, secondary, and tertiary substances of abuse reported by persons admitted to treatment in publicly funded facilities. Among the 1.9 million TEDS admissions in 2002, polydrug abuse was more common than abuse of a single substance. Other findings reported include:
Infectious Diseases in Corrections Report (IDCR) (Formerly the HEPP Report) - Immune Reconstitution Syndrome Potent combination antiretroviral (ARV) therapies have significantly impacted clinical care and improved the prognosis of HIV-infected individuals. Their use, however, may trigger an inflammatory reaction in some individuals soon after they begin anti-HIV therapy. Known as immune reconstitution syndrome (IRS), immune restoration disease (IRD), or immune reconstitution inflammatory syndrome (IRIS), this process can involve opportunistic infections (OI), malignancies, or inflammatory disorders. Collectively, these are believed to result from restored immune function in the setting of previously unrecognized antigenic stimuli. Since correctional physicians often have to start or re-start highly active antiretroviral theray (HAART) for inmates/patients who did not receive or have access to such treatments before incarcerations, IRS may occur in correctional settings with increasing frequency. This article (accessible on the website above) discusses IRS with an aim to alert correctional practitioners to its implications Smoked Cocaine vs. Non-Smoked Cocaine Admissions : 2002 This report presents data from the 2002 Treatment Episode Data Set (TEDS) on admissions where cocaine was the primary substance of abuse reported. It compares smoked cocaine (primarily crack or rock cocaine) admissions with non-smoked cocaine (primarily powdered cocaine) admissions. Non-smoked cocaine is usually inhaled, injected, or taken orally.
State Estimates of Substance Use from 2002-2003 National Survey on Drug Use & Health SAMHSA unveiled the state substance abuse data from the 2002 and 2003 NSDUH. This report estimates state rates of use of illegal drugs, binge drinking, serious mental illness, and tobacco use. Estimates of past month use of any illicit drug ranged from a low of 6.3% in Utah to a high of 12.0% in Alaska for all persons ages 12 and older. Other states with high past month use of any illicit drug include Colorado, Montana, Oregon, Nevada, New Mexico, New Hampshire, Rhode Island, Vermont and the District of Columbia. Other substance abuse information, including rates for specific illegal drug use in each state, is also available. The full report can be found at the website above. Substance Use and Need for Treatment among Youths Who Have Been in Foster Care Youths from substance-abusing families frequently have serious emotional and behavioral problems, including a tendency to choose risky behavior, such as alcohol or other drug use. Substance abuse is a factor in at least three quarters of all foster care placements, and recent studies indicate high rates of lifetime substance use and substance use disorders for youths in the foster care system. This report looks at the need for and receipt of substance abuse treatment among youths who have been in foster care; all estimates are annual averages based on combined 2002 and 2003 NSDUH data.
$6.3 Million Available to Fund Family and Juvenile Drug Courts SAMHSA announced the availability of FY 2005 funds for family and juvenile treatment drug courts. These grants will provide funding to be used by treatment providers and the courts to provide alcohol and drug treatment, and services to support treatment, including assessment, case management and program coordination for those in need of treatment drug court services. It is expected that approximately $6.3 million will be available to fund up to 16 awards. Approximately $3.15 million will provide eight awards for family treatment drug courts and $3.15 million will be available for about eight awards for juvenile treatment drug courts. The maximum allowable award is $400,000 per year for up to three years. The actual award amount may vary, depending on unanticipated program requirements and the number and quality of the applications received. Who can apply: Eligible applications are individual treatment drug courts or state or county court integrated systems as long as all grand funds are dedicated to the individual drug court. How to apply: Application for No. TI 05-005 is available by calling SAMHSA's clearinghouse at (800) 729-6686, or by downloading from www.grants.gov. Due date: April, 15, 2005 Substance Abuse Treatment Admissions Among American Indians and Alaska Natives: 2002
Nonmedical Oxycodone Users: A Comparison with Heroin Users Illicit Drug Use Among Lifetime Nondrinkers and Lifetime Alcohol Users Data from SAMHSA's 2002 and 2003 National Survey on Drug Use and Health were pooled to examine the patterns of illicit drug use among adults aged 21 or older who have used alcohol in their lifetime compared with the patterns of illicit drug use among adults who have never used alcohol in their lifetime. Some statistics included in this report are:
Private-for-Profit and Private-Non-Profit Substance Abuse Treatment Facilities, 2003 Of the 13,623 facilities responding to SAMHSA's 2003 National Survey of Substance Abuse Treatment Services (N-SSATS), 87% were operated by private organizations. Among the private facilities, 26% were operated by for-profit organizations and 74% were operated by non-profit organizations. Private non-profit facilities had a higher average percentage of clients who were being treated for both drug and alcohol abuse (58%) than private for-profits (48%) and were more likely to offer residential treatment (36% vs. 15%). Other findings include:
Characteristics of Primary Heroin Injection and Inhalation Admissions: 2002 In 2002, heroin was reported as the primary substance of abuse for 15% of the 1.9 million admissions in SAMHSA's Treatment Episode Data Set (TEDS). Admissions trend data suggest that many users begin using heroin in the inhaled form and switch to injecting heroin later in their lifetime. Among primary heroin admissions, the routes of administration for heroin were injection (62%), inhalation (33%), smoking (2%), oral (2%), and other (1%). Heroin admissions did not differ in their preferred route of administration by gender but did differ significantly by racial group. Primary heroin inhalation admissions were more likely to be Black (45%); while primary heroin injection admissions were more likely to be White (58%). Also, primary heroin injection admissions were more likely than heroin inhalation admissions to be from the West (32% vs. 3%). Youth Substance Use and Family Income Research has found that youth smoking is negatively associated with family income. The 2003 National Survey on Drug Use and Health (NSDUH) asked respondents aged 12 or older to report on their lifetime use of cigarettes, alcohol, and illicit drugs. NSDUH also asked about total family income. This report provides information on lifetime use of a variety of substances by youths aged 12 to 17 according to annual family income level. Some of the main findings include:
When a mutation occurs in one of the HIV proteins that is a target of an antiretroviral drug, the result may be decreased susceptibility or resistance to that drug, and lack of inhibition of viral replication by that drug. Because HIV replicated at such a rapid rate, virtually all possible mutations in the HIV genome are generated within a patient on a daily basis. In this way, all HIV patients, including those naïve to therapy, harbor a diverse population of viruses with differing susceptibilities to the currently available antiretroviral drugs. This report summarizes methods to identify resistant viruses and how to interpret the results to aid in shaping the appropriate antiretroviral therapy. Gender Differences in Substance Dependence and Abuse Based on the 2003 National Survey on Drug Use and Health, 74.5 million (61%) females aged 12 or older and 30.0 million (70%) males aged 12 or older used alcohol during the past year. Also, 15.2 million (12%) females and 19.8 million (17%) males used an illicit drug during the past year. Some the findings presented in this report include:
Alcohol Dependence or Abuse and Age at First Use In 2003, almost 74% of adults age 21 or older reported that they had started drinking alcohol before the current legal drinking age of 21: 4% started drinking before age 12; 14% started between ages 12-13; 33% started between ages 15-17; and 22% started drinking between ages 18-20. Among the 14 million adults aged 21 or older who were classified as having past year alcohol dependence or abuse, more than 13% (95%) had started drinking alcohol before age 21. The 2003 National Survey on Drug Use & Health reported that persons reporting first use of alcohol before age 15 were more than 5 times as likely to report past year alcohol dependence or abuse than persons who first used alcohol at age 21 or older (16% vs. 3%). The data also show that males aged 21 or older were more likely than females to report having first used alcohol before the age of 15. The survey found that whites had the lowest rate of never having used alcohol (nine percent) compared to blacks, Asians or Hispanics, and also the highest rate of initiating alcohol use before age 21 (79 percent) and the highest rate of alcohol use before age 15 (20 percent). Adolescent Treatment Admissions: 1992-2002 All substance abuse treatment admissions increased 23% between 1992 and 2002. The number of adolescent treatment admissions, however, increased 65% (from 95,000 admissions in 1992 to 156,000 in 2002) and accounted for 8% of all admissions reported to SAMHSA's Treatment Episode Data Set (TEDS) in 2002. Between 1992 and 2002, adolescent substance abuse treatment admissions reporting marijuana as the primary substance increased from 23% to 64% while substance abuse treatment admissions reporting alcohol as the primary substance decreased from 56% to 20% of all adolescent substance abuse treatment admissions. In 2002, more than half (54%) of adolescent substance abuse admissions were referred to substance abuse treatment through the criminal justice system compared with 40% in 1992. State Estimates of Substance Use from the 2002 National Survey on Drug Use and Health This report is the first presenting State estimates from the 2002 National Survey on Drug Use and Health (NSDUH). In 2002, NSDUH collected interview data from approximately 68,000 respondents. Highlights include:
The DASIS Report: Substance Abuse Treatment Admissions Referred by the Criminal Justice System The criminal justice system is a major source of referrals to substance abuse treatment. Specific criminal justice venues and programs referring clients to substance abuse treatment include State and Federal courts, other courts, probation programs, other recognized legal entities, diversionary programs, prisons, and "driving under the influence/driving while intoxicated" (DUI/DWI) programs. This report details the character and nature of criminal justice system-referred admissions. Highlights include:
Club Drugs, 2002 Update This issue of The DAWN Report focuses on emergency department (ED) visits related to the abuse of a group of drugs often referred to as "club drugs." Four such drugs are included in this analysis-GHB, Ketamine, LSD, and MDMA. According to estimates from the Drug Abuse Warning Network (DAWN) for 2002:
July 2004 SAMHSA: OAS Although much attention has been placed on methamphetamine abuse on the west coast of the United States, recent data suggest that the problem may be spreading eastward. The Drug Abuse Warning Network (DAWN) collects data on drug abuse-related emergency department (ED) visits throughout the U.S. and may provide some insights into the eastward diffusion of methamphetamine abuse. Highlights include:
The NSDUH Report: Participation in Youth Activities and Substance Use among Youths The 2002 National Survey on Drug Use and Health (NSDUH) asks youths aged 12 to 17 how many different kinds of school-based, community-based, church- or faith-based, and "other" activities (e.g., karate lessons) that they participated in during the past 12 months.1 Respondents also are asked about their past month use of cigarettes, alcohol, or illicit drugs. "Any illicit drug" refers to marijuana or hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically. Prior research has linked participation in youth activities to a lower risk of substance use among youths. Highlights include:
Mortality Data from the Drug Abuse Warning Network, 2002 This report provides information on deaths involving drug abuse, reported by the 31 metropolitan cities in the DAWN network. In the average metropolitan area, 16% of the drug abuse deaths were ruled as suicides, 57% were ruled accidental and 27% were to undetermined or other causes. The most common drugs involved in single-drugs deaths were cocaine, heroin/morphine and the other narcotic analgesics. Highlights from DAWN: Philadelphia, 2002 One percent of the 27,753 emergency department (ED) visits were related to drug use. The highest drug in drug related ED visits was cocaine. Philadelphia had the highest rate of marijuana related visits among the 21 DAWN areas. Highlights from DAWN: Los Angeles, 2002 One percent of the 2.7 million emergency department (ED) visits in Los Angeles were related to drug abuse. The highest drug in drug-related ED visits was alcohol-in-combination with other drugs. Los Angeles was in the lower half of all drug related visits for the 21 DAWN areas. Pregnancy and Substance Abuse In 2002, approximately 3% of pregnant women aged 15-44 used illicit drugs in the past month, compared with 9% of non-pregnant women in the same age group. Marijuana was the most widely used drug among both groups of women. Pregnant women aged 15 to 25 were more likely to use illicit drugs than pregnant women aged 26 to 44. Treatment Admissions Involving Narcotic Painkillers Between 1992 and 2000, treatment admission rates for narcotics painkiller abuse more than doubled. Between 1997 and 2000, over half of the admissions for narcotics painkiller abuse were male and over 80% were White. The number of treatment admissions increased for all ages, especially among people aged 20 to 30. Back to Top
CMHSMental Care Coming to Streets Albuquerque Mayor Martin Chavez unveiled at $4 million program to take mental health treatment directly to people who need it acutely – some members of the homeless community. The city has contracted with University of New Mexico Hospital to deliver a treatment program called ACT – Assertive Community Treatment – which seeks to deliver services to people who are mentally ill but whose needs haven't been met by more traditional services. Part of what makes this program different from more traditional services is that an entire team of service providers will go to the client, rather than vice versa. The typical treatment history of someone served by ACT is characterized by frequent emergency room and psychiatric hospitalization, and substance abuse or repeated appearances in the criminal justice system. Spending on Mental and Substance Use Disorders Concentrated in the Public Sector A new study, National Expenditures for Mental Health Services and Substance Abuse Treatment 1991-2001, shows that public spending for mental health services and substance abuse treatment amounted to $67.4 billion in 2001, while private spending amounted to only $36.3 billion. The data appears in the online edition of Health Affairs at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.133. The report provides data on all national expenditures for mental health and substance abuse treatment, and does not include indirect costs such as the impact of mental illness on productivity or societal costs linked to drug-related crime. Public spending includes spending by all levels of government, federal, state and local, and includes Medicaid and Medicare. Private spending includes insurance payments, patients paying out of their own pockets and charity care. The full report is available at http://www.samhsa.gov/spendingestimates/toc.aspx. Kids Suffer from Parents' Meth Addiction This article examines the effect methamphetamine abuse has on the children of users. There are variety of ways methamphetamine use affects the children: exposure to the drug in the womb, contamination from toxic chemicals used in home-based meth manufacture, explosions and fires, long-term neglect from parents obsessed with their drug habits, physical abuse and sexual abuse, among others. Iowa officials are blunt about the difficulties of properly caring for meth-exposed children and combating the underlying drug epidemic. An effective response requires coordinated action by law enforcement officers, hazardous-material cleanup crews, health and social services agencies, substance-abuse programs, the courts and legislature. SAMHSA Issues Group Therapy Guide for Substance Use Disorders Treatment SAMHSA unveiled a comprehensive guide on the use of group therapy in the treatment of substance use disorders. The consensus panel that created "Substance Abuse Treatment: Group Therapy" emphasized that group therapy is effective treatment and is a cost effective way to deliver treatment. The guide, Treatment Improvement Protocol #41 http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.78366 in SAMHSA's TIP series, is designed to aid substance abuse counselors who employ group therapy in the treatment of substance use disorders. The consensus panel found that group therapy offers a number of advantages to patients, including positive peer support, a reduction in their sense of isolation, real-life examples of people in recovery, and help from peers in coping with substance abuse and other life problems. TIP 41, DHHS Publication No. (SMA) 05-3991, can be ordered through SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI), P.O. Box 2345, Rockville, M.D. 20847-2345 or by calling (800) 729-6686. State Hospitals' Screening of Patients Finds Many with Drug Treatment Needs This article describes the five-year, $16 million project, paid for by a federal grant, called Washington State Screening, Brief Intervention, Referral and Treatment, or WASBIRT, administered by the Department of Social and Health Services Division of Alcohol and Substance Abuse. The screenings found that although it was expected initially that about 20% of those who are screened would be positive, 46-58% are actually screening positive instead. The program's goals are to identify more emergency room patients with alcohol or other drug disorders, deliver screening and brief interventions in the emergency rooms, deliver brief treatment on an outpatient basis at certified treatment centers and increase referrals of dependent people from emergency rooms. The program also hopes to reduce subsequent emergency room use, medical costs, criminal behavior, disability and death of patients with alcohol and other drug problems. $22 Million Available for Comprehensive Community Mental Health Services for Children and Their Families Program SAMHSA announced the availability of FY 2005 funds for cooperative agreements to develop integrated home and community-based services and supports for children and youth with serious emotional disturbances and their families. Who can apply: Eligibility is limited to public entities including state governments or political subdivisions of state government, Indian or tribal governments, District of Columbia government, and government territories of Guam, Commonwealth of Puerto Rico, Northern Mariana Islands, Virgin Islands, American Samoa, and Trust Territory of the Pacific Islands (Palau, Micronesia, and the Marshall Islands). How to apply: Application for No. SM-05-010 is available by calling SAMHSA's clearninghouse at (800) 789-2647 or by downloading the application from www.grants.gov. Due date: May, 17, 2005 This report describes a recent outbreak of drug-susceptible TB that occurred among staff at two closely situated correctional facilities during the period April-September 2004 in Florida. The staff members infected with TB included HIV-positive patients. The outbreaks illustrate the complexities of TB control in congregate settings and highlight the need for further improvements in TB control measures in prisons and jails. Collaborative Care Helps Combat Teen Depression Hazelden Report: Methamphetamine-Related Treatment Admissions Increase in Metro Area Acting Governor Seeks $200M to House Mentally Ill People New Jersey's acting Governor Richard Codey used his State of the State address to continue his focus on treating mental illness and disability, calling for a $200 million plan to build housing for patients. His housing plan would create 10,000 new affordable housing units for mentally ill and disabled people over the next 10 years. This will facilitate the recovery in the community of many mental health consumers. It will also provide housing for many homeless individuals who may have serious mental illnesses. Governor Codey's other mental health-related proposals include: forgiving up to $20,000 in student loan debt for new social workers and a campaign to help mothers who suffer depression after giving birth. Infectious Diseases in Corrections Report (IDCR) (Formerly the HEPP Report) Mental Ills Seen in Families of Alcoholics A new research released by the Archives of General Psychiatry reported that the first degree relatives of alcoholics are more likely to also become addicted to alcohol as well as to other drugs. It also reported that a close family history of alcoholism appears to put people at increased risk of mental health problems, such as depression and panic disorder. The rate of alcoholism among people with a family history ranged from 29 to 37 percent, depending on the definition used. The investigators diagnosed the problem in between 14 and 21 percent of the study participants who did not have an alcoholic relative. Overall, relatives of alcoholics were twice as likely to become addicted to alcohol as people without a family history of the disease. Relatives of alcoholics were also significantly more likely to become addicted to other drugs. For example, people with a close family history of alcoholism were more than three times more likely to become addicted to cocaine. The researcher stated that these finds suggested that there may be "shared genetic vulnerability factors" that put people at risk of multiple disorders if they have a family history of alcoholism. Many Abused Kids Don't Get Mental Health Services A study released in the Archives of General Psychiatry reported that many abused and neglected children involved in the child welfare system do not receive needed mental health services despite having a high rate of emotional and behavioral problems. Young children and those who remained in their home while authorities investigated potential maltreatment were found to be less likely to receive mental health services than older children and those placed in group or foster care. From an analysis of the national Survey of Child and Adolescent Well-being and the national Caring for Children in Child Welfare studies, it was found that about 42 percent of the children had behavioral and emotional problems that required some type of mental health treatment, but only 28 percent received such help within a one-year period. children from counties in which the local child protective services agency and mental health agencies shared office space, participated in join training or otherwise worked together were more likely to receive mental health services than those from areas with low levels of interagency coordination. U.S. Born Mexican Americans and Non-Hispanic Whites at Increased Risk for Psychiatric Disorders According to the results of a National Institutes of Health study reported in the Archives of General Psychiatry, Mexican-Americans and non-Hispanic Whites born in the United States have higher risk for developing psychiatric disorders than their foreign-born counterparts who have immigrated to the United States. The psychiatric disorders included alcohol and drug use disorders, major depression, dysthymia, mania, hypomania, panic disorder, social and specific phobia, and general anxiety disorder. The researchers found that non-Hispanic Whites' lifetime rate of experiencing a psychiatric disorder (51.2 percent) was greater overall than that for all Mexican Americans (36.7 percent). Psychiatric disorders were more prevalent among U.S.-born survey participants (47.6 percent among Mexican Americans and 52.5 percent among non-Hispanic Whites) than among their foreign-born counterparts (28.5 percent and 32.3 percent, respectively). Lifetime rates of alcohol use disorder and specific mood and anxiety disorder among U.S.-born Mexican Americans and non-Hispanic Whites were nearly twice those of their foreign-born counterparts. Drug use disorder rates among U.S.-born non-Hispanic Whites were more than twice those of their foreign-born counterparts, whereas the corresponding rates among U.S.-born Mexican Americans (12 percent) were eight times those of Mexican Americans born outside the United States (1.7 percent). Largest Ever Comorbidity Study Reports Prevalence and Co-Occurrence of Alcohol, Drug, Mood and Anxiety Disorders An estimated 17.6 million American adults (8.5 percent) meet standard diagnostic criteria for an alcohol use disorder and approximately 4.2 million (2 percent) meet criteria for a drug use disorder. Overall, about one-tenth (9.4 percent) of American adults, or 19.4 million persons, meet clinical criteria for a substance use disorder - either an alcohol or drug use disorder or both - according to results from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Blueprint for Change: Ending Chronic Homelessness for Persons with Serious Mental Illnesses and Co-Occurring Substance Use DisordersJanuary 2004 The Blueprint for Change report provides an outline of four action steps that states and communities can follow to prevent or end homelessness among people with serious mental illness. Often, these people also have co-occurring substance abuse disorders. The report can be used by organizations to plan, organize and sustain services for people with serious mental illnesses or co-occurring disorders who are homeless. How States Can Use SAMHSA Block Grants to Support Services for People Who are Homeless This report focuses on the actions that have already been undertaken by states on behalf of the homeless. The homeless population is often beset with co-occurring disorders; approximately 20% of people who are homeless have a serious mental illness and about 50-70% have a substance abuse disorder. Recent efforts at the Federal level to address homelessness have prompted State and local health, mental health, substance abuse, homeless, and housing agencies to work collaboratively to integrate services, improve planning and coordination between treatment and housing providers, and increase access to needed housing, treatment and supports for people who are homeless and have multiple needs. The report profiles the actions several states have taken using SAMHSA sponsored grants. CMHS Program Spotlight: Children, Adolescent and Family Programs The CMHS Web site provides a brief description of its Children, Adolescent and Family program and updates on recent activities and publications. The program provides grants for the improvement and expansion of systems of care to meet the needs to the estimated nationwide 4.5-6.3 million children with serious emotional disturbances and their families. Back to Top
Other Resources
Rare STD Reported in U.S. Cities CDC is currently working to establish a surveillance system to monitor the disease nationwide and to develop better screening for it in health clinics. So far, the cases of disease in the U.S. appear to be limited to gay and bisexual men; experts fear it could be a signal that gay men are returning to riskier behaviors. For more information, see the article, "A foreign STD sets off worry in hub," in the May 30, 2005 edition of the Boston Globe.
HHS Announces $95 Million to Improve the Health of Minorities
HHS Secretary Mike Leavitt announced $95 million in grants to develop a new program that will reduce the number of cancer deaths in minority and poor populations. This new initiative, called the Community Networks Program (CNP), was developed by HHS and National Cancer Institute. Its aim is to reduce cancer disparities through community participation in education, research and training. Up to 25 grantees will develop programs to increase the use of cancer interventions in underserved communities. Interventions will include proven approaches including smoking cessation, increasing healthy eating and physical activity, and early detection and treatment of breast, cervical and colorectal cancers. Programs will be designed to reach communities and populations experiencing a disproportionate share of the cancer burden, and will address African Americans, American Indians/Alaska Natives, Hawaiian Natives and other Pacific Islanders, Asians, Hispanics/Latinos, and rural underserved populations. A list for awards issued to date can be viewed at the website above. Drinking in Middle School Tied to Risky SexMay 6, 2005 MedlinePlus A new study showed that students who said they started drinking by the 7th grade were more likely to say they had unprotected sex, multiple partners, sex while drunk or high, or been pregnant. Another related study showed that middle-schoolers who binge drink were more likely to binge drink in high school. However, kids who said their parents were involved in their lives were less likely to say they tried binge drinking. This suggests that parents can influence kids' choices. Both of the studies appear in the May 2005 issue of American Journal of Public Health.
Genital Herpes Vaccine Making Progress The largest study to date of a genital herpes vaccine under development by GlaxoSmithKline shows it is safe, well tolerated and produces an immune response. The antibody response seen with the vaccine, based on a surface protein of herpes simplex virus (HSV) 2, is at least as strong as that seen with natural infection. The study involved 7,460 men and women and was intended to explore the effects of gender and prior HSV infection on immune responses. The findings of this study appear in the May 1, 2005 issue of Clinical Infectious Diseases.
Cheaper Group Tests Flag Infectious HIV Carriers
Health officials in North Carolina have found a cost-effective way to identify people whose infection with the AIDS virus is so recent that the standard screening test would not normally work. A new system pinpoints carriers earlier in the course of the disease, when they're at least 10 times more infectious than those detected by the standard test. The system involves combining blood samples from 90 patients so that a highly sensitive, but expensive, test known as nucleic aid amplification can look for traces of HIV. If HIV is found in a batch, smaller batches are tested until technicians pinpoint which person is the carrier. For more detailed description and findings of this study, see the May 5, 2005 issue of New England Journal of Medicine.
Drug Might Lessen HIV Brain Impact Researchers reported that an antibiotic in use for 30 years might help relieve brain and nervous system effects of the AIDS virus. Researchers at the Johns Hopkins University found monkeys treated with the antibiotic minocycline had less brain damage and inflammation and less viral infection of the central nervous system. Treatment with anti-retroviral medications can help control HIV infection elsewhere in the body, but the method can cause neurological problems, in part because Minocycline was formulated to cross the blood-brain barrier.
HIV, Hepatitis Patients Risky for Surgeons
Researchers from Johns Hopkins University reported that nearly 40% of surgeries may involve patients who have HIV or hepatitis, placing surgeons at risk of contracting the diseases. They suggested surgeons who want to avoid these risks should use alternatives to knives and meedles in high-risk procedures whenever possible. The researchers noted previous studies have shown 87% of surgeons will, at some point in their career, suffer an injury that breaks the skin and possibly exposes them to these disease. Out of 709 surgical procedures involving adults over a one-year period, 38% of the patients were infected with HIV, hepatitis B or hepatitis C. Nearly half the men tested positive for one of these diseases. The findings are reported in the May issue of the Annals of Surgery.
Contraceptives Do Not Hamper HIV Drugs
Data from the Women's Interagency HIV Study showed that birth control hormones do not impact the effectiveness of highly active anti-retroviral therapy for HIV infections. The scientists compared contraceptive users and non-users matched for age and ethnicity. No link between the use of hormonal contraceptive use and changes in viral suppression were found. The results did not change with the length of time the woman had been using hormonal contraception. The findings appear in the May 1, 2005 issue of the American Journal of Epidemiology. Insomnia Common in Depressed HIV Patients A recent medical literature review showed that HIV-infected patients who also have depressions are more likely to have sleeping problems, which may add to the burden of their disease. The researchers noted that ongoing insomnia can affect the ability to keep up with day-to-day responsibilities, and for people with a chronic illness such as HIV, those responsibilities include sticking to a medication regiment. They also noted that although insomnia is a well-recognized symptom of depression, because HIV-positive people have so many other health issues (commonly prescribed powerful medications and may have opportunistic infections), doctors may not realize that the reason patients can't sleep is because they are depressed. More information can be found in the March/April 2005 issue of Psychosomatic Medicine. Half of U.S. Kids Face Parental Substance Abuse A report from Columbia University's National Center on Addiction and Substance Abuse showed that half of all U.S. children live in a house where a parent or other adult uses tobacco, drinks heavily or uses illegal drugs. The center also stated that "Children of alcohol and drug abusers are at increased risk of accidents, injuries and academic failure. Such children are more likely to suffer conduct disorders, depression or anxiety, conditions that increase the risk children will smoke, drink and use drugs." The report is an analysis of the center's own research as well as dozens of reports including US government survey on families and health behavior and the Children's Defense Fund. It found that 35.6 million U.S. children, about half of all children in the country, live in a home where a parent or other adults uses tobacco, drinks heavily or uses illicit drugs. More than 37% of U.S. children live with an adult who uses tobacco, nearly 24% live with a binge or heavy drinker and 12.7% live in a household where a parent or other adult uses illicit drugs. Hepatitis C Antibodies May Be Slow to Appear The findings of a long-term study of injection drug users newly infected with hepatitis C virus (HCV) show that antibodies to the virus may not appear in the blood until two months after they have been infected. The researchers said these results "underscore the importance" of nucleic acid screening of blood donations to prevent HCV transmissions. The findings also reaffirm the need to follow HCV-positive injection drug users long-term to check for viral persistence. Among 179 HCV antibody-negative injection drug users followed in the study, an "alarming" 34% became infected despite risk reduction counseling. As expected, individuals with early-phase HCV infection were largely without symptoms. Virus in the bloodstream was the earliest sign of HCV infection, preceding the detection of HCV antibodies by 5 to 6 weeks, and in one case, by more than 12 months. In cases of viral persistence, stable blood levels of HCV RNA were noted in some individuals within 3 months after the virus was first detected in the blood, while in others, it was not apparent until more than 1 year later. More details for this study can be found in the April 1, 2005 issue of Clinical Infectious Diseases. AIDS Virus Destroys Immune Cells Fast – Studies Within days of infection, the AIDS virus destroys more than half of the immune cells that might recognize and help fight it – a finding that may force a re-evaluation of how to tackle the deadly infection. Two separate studies in monkeys showed that SIV, the monkey version of HIV, attacks CD4 memory T-cells right away and wipes out more than half of them. The findings will be difficult to replicate in people, because most people do not know exactly when they have been infected with AIDS virus, which gradually destroys the immune system, leaving patients vulnerable to numerous infections. The researchers noted that 30-60% of CD4 memory T-cells through the body were infected by SIV at the peak of infection, and most of these infected cells disappear within four days. Furthermore, the data demonstrated that the depletion of memory CD4 T-cells occurs to a similar extent in all tissues. As a consequence, over one half of all memory CD4 T-cells in SIV-infected macaques are destroyed directly by viral infection during the acute phase. This means any attempt to vaccinate against HIV or to provide efficient treatment must stop this process right away. HHS Announces New Communication Tools to Help Parents Talk to Their Teens about Abstinence HHS Secretary Mike Leavitt announced a new set of communication tools to help equip parents to talk with their teens about sex and relationships while encouraging them to remain abstinent from unhealthy behaviors. The new communication tools include the 4parents.gov website as well as Parent, Speak Up and Teen Chat guidebooks. The 4parents.gov website focuses on risk and promotes abstinence from multiple risk behaviors, including early sexual activity. In addition, the website provides medically accurate information about a variety of health topics. The parent guide titled Parents, Speak Up is designed to complement the 4parents.gov and equip parents of preteens and adolescents with the understanding, knowledge, skills and tools they need to talk with their teens about the risk associated with early sexual activity and the benefits of abstinence until marriage. The Teen Chat guidebook is designed for preteens and teens through age 19. Teen Chat provides information about sex and relationships, including sexually transmitted diseases, peer pressure, and abstinence. It provides suggested activities such as icebreakers for talking with parents, and short quiz to increase awareness of STDs. Teen Chat can also be used as a resource for parents and organizations or institutions that work with teens. Africa Lags in Fight Against TB, WHO Report Says Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection – March 24, 2005 An updated pediatric guidelines in using antiretroviral agents is available at the website above. The following can be accessed:
HIV, Abuse Increase Suicide Risk A Johns Hopkins Bloomberg School of Public Health study suggests women who are HIV-positive or have been abused are more likely to consider suicide. The researchers analyzed data from Project WAVE (Women, AIDS, and the Violence Epidemic). They examined the rates of suicidal thoughts and attempts and compared how the rates relate to women's HIV and abuse experiences. Thirty-one percent of the 611 women interviewed reported suicidal thoughts and 16 percent reported having attempted suicide. Abused women were four times more likely than non-abused women to have though about suicide. The researchers also found that, among HIV-positive women, those recently diagnosed thought about suicide more frequently. Twenty-four percent of non-abused, HIV-negative women had problems with depression, whereas 72 percent of abused, HIV-positive women reported the same. The study is published in the March/April 2005 issue of Women's Health Issues. Medicare Offers Counseling to Help Smokers Quit Officials for Medicare announced that older Americans who want to quit smoking can receive counseling through Medicare to help them kick their tobacco habit, but only if they suffer from certain diseases or health problems. To receive the counseling, Medicare patients must suffer from heart or lung disease, weak bones, cataracts or other diseases caused or worsened by tobacco use. It would also cover patients taking insulin or other medicines that can be less effective with smoking, including drugs to treat high blood pressure, depression, and blood clots. Not all enrollees will benefits, and the new coverage will not pay for drugs, patches or other products touted to curb smoking. Such medication, if they are a prescription, could be covered under a Medicare drug benefit that starts in 2006. Although it is unclear how many of the 41 million elderly enrolled in Medicare would quality for the benefit, the American Medical Association said most seniors would probably be able to claim the benefit because there are so many health problems among smokers. Oklahoma Task Force Examines Jail Costs of Substance Abuse, Mental Health The Oklahoma Governor's and Attorney General's Task Force on Mental Health, Substance Abuse and Domestic Violence examined issues involving the criminal justice system and learned about Oklahomans who are incarcerated for nonviolent offenses in an overcrowded jail and prison system when treatment for an existing mental illness or substance abuse was a viable alternative. The report found that Oklahoma's criminal justice system spends 63 percent of its annual budget (over $1 billion) to address the needs of people with mental illness or substance abuse/addiction. The study found that almost 18 percent of prison inmates are being treated for a diagnosable mental illness and that 50 percent of all criminal justice system expenses are attributable to substance abuse issues. The task force suggests that the state expand and appropriately staff therapeutic-model courts and pre-trial conditional jail diversion programs. All counties should have regional access to therapeutic-model programs, including drug courts, mental health courts, and crisis centers, with oversight by the Department of Mental Health and Substance Abuse Services. Treatment and Management of HIV Infection in the United States This conference is designed for all frontline clinicians providing HIV care for adults, adolescent, children and pregnant women. Continuing education credits may be earned by participating health care providers, through University of California, San Francisco, and will follow FDA, ACCME, AMA and other professional group standards and guidelines. Health professionals who care for individuals with HIV disease are encouraged to register to attend this inaugural event. Selected collaborating federal agencies: CDC, HRSA, NIH, DOJ, VA For more information, please contact the conference organizers at 202-973-8658 or USHIVconference@courtesyaccoc.com. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States This newly released guidelines include revisions to the December 17, 2004 Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant Women Infected with HIV-1 for Maternal Health and for Reducing Perinatal HIV-1 Transmission in the United States made by the Perinatal HIV Guidelines Working Group. The full guideline is available in PDF format on the website above. Heart Attack Risk with HIV Drugs a Concern A large multi-center study showed the risk of having a heart attack for HIV-positive people increases the longer they're on anti-HIV drug therapy. However, the researchers noted the overall absolute risk of a heart attack is still "modest." The latest analysis includes data collected between 1999 and 2004 for more than 23,400 participants who had been on combination antiretroviral drugs for an average of 4.5 years. During the study period, 277 patients had a first heart attack. Although not a large percentage, the researchers noted that the patients in the study are young, with an average age of just 39 years. After accounting for other potential risk factors, the researchers observed a 17 percent increase in heart attack for each year of combination antiretroviral therapy. Condom Use, Not Abstinence, Cuts Uganda's HIV Rate The declining prevalence of HIV infection in Uganda has often been attributed to increased rates of abstinence and monogamy, but new data suggest that the decline is primarily the result of increased condom use, as well the effect of people dying from AIDS. The researchers have followed 44 communities continuously over the past decade in the Rakai district in southwestern Uganda. Over 85% of all adults participated and each year the surveys included data for about 10,000 adults. Overall, HIV rates declined significantly among all adults, from 18% to 11% and in young adults, from 17% to 8%, but no significant changes were noted in adolescents. It was noted that while significant and very encouraging increases in condom use among adults and adolescents were seen, rate of multiple partners also increased, with the rate of abstinence declining among young people during the same period. Clue Found to How HIV Invades Cell Researchers at the Children's Hospital Boston and Harvard Medical School have shown that the HIV virus alters its shape and triggers changes that allow it to enter cells. They obtained a three-dimensional image of a protein called gp120, part of HIV's outer membrane or envelope, before it transforms and binds to so-called CD4 receptors on target cells. The researchers stated that the "Knowing how gp120 changes shape is a new route to inhibiting HIV – by using compounds that inhibit the shape change." The findings are reported in the science journal Nature. Scientists Map Rare HIV Antibody U.S. researchers have mapped the structure of a rare human antibody that could neutralize HIV. For various reasons, most antibodies produced by humans are unable to neutralize the virus. However, the immune systems of some HIV patients have been able to produce antibodies that are more effective than others. Researchers have found the structure of one such antibody, called 4E10, which targets a protein called GP41 that exists on the surface of HIV. The virus uses GP41 to glue its membrane to the cell it is infecting. Because 4E10 attacks the virus before it enters cells, it can prevent HIV infection if it is present in the bloodstream prior to exposure to the virus. An HIV vaccine would seek to use 4E10 just as exiting vaccines against diseases use neutralizing antibodies. Tenth Annual International Meeting of the Institute of Human Virology When: Aug. 29-Sept. 2, 2005 This conference will include presentations on the latest in HIV/AIDS basic, clinical, and epidemiological research and will be attended by elite scientists from around the world. Abstract submissions are due May 23rd. The event is organized by the Institute of Human Virology. For more information, please contact Gwen Fariss Newman at 410-706-4616(p), 410-706-1952(f), or newmang@umbi.umd.edu. Mouse "Model" of AIDS Mimics Human Disease AIDS research has been hampered because mice, which usually provide an excellent model for studying human disease, cannot be infected by HIV. Now, researchers have created a modified HIV strain that can infect mice. The "chimeric" virus, dubbed EcoHIV, infects about 75% of mice tested – an efficiency that is comparable to that of HIV in humans. Researchers noted that this will assist in the development of an AIDS vaccine, since "if there's one place we ought to be able to discover how to get a good response it's in a mouse where you have live virus infection that you might be able to control" The findings are reported in the Proceedings of the National Academy of Sciences, online February 22, 2005. US Approves Treatment for Smallpox Shot Reaction U.S. Food and Drug Administration announced the approval of a product taken from the blood of people who have been vaccinated for smallpox to treat reactions from the shot. The product called Vaccinia Immune Globulin Intravenous is made out of human plasma. Current smallpox vaccine is decades old and in the past have killed about 1 in a million people who got the shot. The product above has been shown to help treat some of the adverse reactions to the vaccine, by boosting the body's immune response to the vaccinia virus. HIV Patients Warned About Popular Drug A new study reported that a class of prescription drugs known as HIV protease inhibitors, widely used to keep the HIV-virus from progressing to AIDS, may cause potentially lethal heart rhythm disturbances in some patients. Though the researchers said they consider the drugs' therapeutic benefits still greater than the risk of heart problems linked to their use, they urge physicians to apply this new finding by following there patients more closely over the long term. The findings of this study appear in the British journal, The Lancet. Uncoordinated Research Threatens HIV Progress, Says WHO WHO has called for international cooperation on testing potential vaccines for HIV/AIDS because it is concerned that the current boom in research could exhaust available clinical trial capacity. WHO vaccine research director has called for trials to be shared among a number of sites, each of which are responsible for testing vaccines on a particular strain of the disease. Other issues needing consideration include the appropriate use of trial sites for other HIV research, coordinating work on vaccine test trials and improving access to anti-retroviral treatment. It was also noted that despite more than 65% of worldwide infections being in sub-Saharan Africa, only four out of 70 clinical trials for phase I/II HIV vaccines have taken place in the region. STD Rates Cut by Rapid Treatment of Sex Partners A study reported in the New England Journal of Medicine reported that immediately treating the partners of people infected with gonorrhea or chlamydia can reduce rates of recurrence of these sexual transmitted diseases. The study observed 1860 patients with gonorrhea or chlamydia whose partners were randomly to receive expedited treatment or were referred for standard treatment. With the expedited treatment strategy, the patients who were diagnosed with an STD had the option of either giving antibiotic agents directly to their partners or indirectly through a member of the study staff. During 3 to 19 weeks after treatment, persistent or recurrent infections were noted in 10% of patients in the expedited treatment group, lower than the 13% rate seen in the standard referral group. When surveyed, patients in the expedited treatment group were less likely to report having sex with an untreated partner than those in the standard referral group. Details for the study can be found in the Feb. 17th issue of the New England Journal of Medicine. Sudden Rises in HIV Levels No Concern, Report Says A study from the Baltimore Institution found that sudden jumps of HIV levels in patients taking drugs for the AIDS-causing infection are harmless blips and do not mean the treatment against the virus is losing its punch. They reported that the blips are mathematical variations stemming from the test used to gauge the amount of virus in the body. A statistical analysis of blood samples from HIV-positive patients found that blips occurred in nine of the 10 patients and typically lasted less than three days. The tests found no mutations taking place. For more information, please see the February 16th issue of the Journal of the American Medical Association. AIDS Vaccine 2005 This meeting will gather scientists from all fields with a special interest in the development of vaccines against HIV/AIDS.
Online Syphilis Testing Shows Promise According to a new report in the medical journal Sexually Transmitted Disease, online syphilis testing is a convenient alternative to standard testing in a clinic, and the Internet approach could potentially increase screening rates. To combat the growing epidemic of syphilis among men who have sex with men, the San Francisco Department of Public Health developed STDTest.org, a website that allows people to print out a laboratory requisition slip for syphilis testing, have their blood drawn at one of several locations, and then receive their result anonymously online. During the site's first year of operation in 2003, a total of 218 tests were performed. Thirteen subjects had positive screening tests and six new syphilis infections were diagnosed and treated. While initial start-up costs were around $20,000 for this online service, the authors note that maintenance costs were "much lower than other syphilis screening programs of men who have sex with men." For more information, please see the February issue of Sexually Transmitted Diseases. New York City Health Officials Announce Detection of Rare Drug-Resistant HIV Strain, Issue Alert New York health officials announced a virulent strain of HIV that is resistant to most antiviral drugs and progresses from infection to full-blown AIDS within two or three months has been identified for the first time in a New York City resident. The city health department also issued an alert to physicians, hospitals, and medical providers asking them to test all HIV-positive patients for evidence of the strain. Although drug-resistant HIV strains are common in patients who have been treated with antiretroviral drugs, multiple-drug-resistant HIV is "extremely rare" in patients who are newly diagnosed and previously untreated, according to a health department release. In addition, HIV infection usually takes about 10 years to progress to an AIDS diagnosis, but this patient apparently progressed to AIDS in a matter of months. This combination of highly drug resistant HIV and rapid disease progression has not been identified before. The New York patient is a man in his mid-40s who reported multiple male sex partners and unprotected anal intercourse, often while using crystal methamphetamine. However, the doctors said the patient's crystal methamphetamine use did not account for his rapid decline from the virus. Crystal meth has become a major problem recently with men who have sex with men. It gives users increased energy and increased sexual desire. It impairs judgment, so users may forget to take their HIV medication, leading to higher amounts of the virus in blood and greater infectivity – and they may not use condoms. International Trial of Two Microbicides Begins A large, multisite trial designed to examine the safety and preliminary effectiveness of two candidate topical microbicides to prevent HIV infection has opened to volunteer enrollment. Although no licensed microbicides are available to the public currently, scientists hope these agents – designed to be applied to the surface of the vagina to prevent sexually transmitted infections – will one day be a key tool in the fight against HIV/AIDS. The first volunteers were enrolled this week at sites in Durban, South Africa, and at the University of Pennsylvania in Philadelphia. Enrollment will begin shortly at sites in four additional African countries – Malawi, Tanzania, Zimbabwe and Zambia. Approximately 3,220 women will be enrolled in the trial, which is expected to last approximately 30 months. Chlamydia Screening Hits the High Street Under new plans announced by the British Public Health Minister, free screening tests for chlamydia are to be offered by high street pharmacies; London and Cornwall will be the first areas to trial the new scheme, and the Department of Health is now inviting bids from interested pharmacies. Those successful in their bid will provide free screening for 16- to 24-year-olds – including partners of those who test positive. They may also be able to offer patients the choice of receiving treatment at the pharmacy. The scheme will be monitored for two years and, if deemed successful, could be rolled out nationally. According to the Public Health Minister, locating screening services on the high street would make it easier for young men and women to get tested for Chlamydia, speeding up the detection and treatment of chlamydia cases. Chlamydia is the UK’s most common sexually-transmitted disease, with almost 90,000 cases diagnosed in the UK, Wales and Northern Ireland. Doctor Suggests Simple Drug for Malaria In this week's British's Medical Journal, James Tumwine at Kampala's Makerere Medical School said the simple artemether given as a suppository to children with severe malaria before they reach hospital can save many lives. His research in Uganda compared the effectiveness and safety of conventional treatment (intravenous quinine) with artemether, given as a suppository in 103 children aged between 6 months and 5 years with severe malaria. The study found two treatments broadly comparable. He said rectal artemether could be used to treat severe malaria where qualified staff and equipment for intravenous therapy is not available. Genetic Testing Needed to Follow TB Outbreaks Simply tracing one exposed person to the next is not an accurate way to follow the spread of tuberculosis, Norwegian researchers report. Instead, formal genetic testing, or "genotyping," is needed. Reporting in the medical journal Thorax, researchers at the Norwegian Institute of Public Health in Oslo presented the findings following a tuberculosis outbreak that occurred in 2003 involving 15 recent immigrants in the same community. All 15 had social contact with each other and 13 belonged to the same church. Standard survey and culture techniques gave an incomplete picture of how the outbreak involved. Genotyping testing was needed to fill in the blanks. The authors emphasize that "traditional contact tracing needs confirmation by genotyping before transmission patterns of M. tuberculosis can be conducted...especially between patients with several risk factors for infection." NIDA-Funded Studies Show Expanding HIV Screening is Cost Effective Two multicenter research teams supported in part by the National Institute on Drug Abuse have independently determined through the development of computer models that routine screening for HIV in health care settings is as cost effective as screening for such other conditions as breast cancer and high blood pressure, and can provide important health and survival benefits. The studies also suggest that screening that leads to a diagnosis of HIV infection may further lower health care costs by preventing high-risk practices and decreasing virus transmission. One study, led by David Paltiel of Yale University, found that testing of people with a 1-in-100 chance of carrying HIV, as currently recommended, is more cost-effective, every three to five years, than the routine screening widely used for breast cancer, colon cancer, diabetes and high blood pressure. Paltiel also said that a one-time testing of the entire population would also be a good economic tradeoff. The other study, led by Gillian Sanders of Duke University, said testing should be offered at urgent care centers, emergency rooms and some primary care clinics - in any location where HIV prevalence is thought to be at least 0.5 percent. Both of the studies are reported in the Feb. 10 issue of the New England Journal of Medicine. Drug Interaction Warning: for Saquinavir/Ritonavir Co-administered with Rifampin The website above contains a drug interaction warning to health care providers. Drug-induced hepatitis with marked transaminase elevations has been observed in healthy volunteers receiving Rifampin 600mg once daily in combination with Ritonavir 100mg/Saquinavir 1000mg twice daily. For all study participants, dosing of all study medications was immediately terminated and the study was discontinued. Following drug discontinuation, liver function tests in all affected subjects are returning to normal, clinical symptoms have abated and no deaths from this clinical study have been reported. Health care professionals are encouraged to report any unexpected events associated with the use of saquinavir/ritonavir directly to Roche Laboratories at 1-800-526-6367 or to the FDA MedWatch program by phone at 1-800-FDA-1088, by fax at 1-800-FDA-0178 or by mail (MED WATCH, 5600 Fishers Lane, Rockville, MD 20852-9787). Parents with HIV Avoid Some Contact A new study published in the February issue of Archives of Pediatrics & Adolescent Medicine suggested more than a quarter of HIV-infected parents avoid physical contact with their children. Researchers said parents avoid hugging or kissing from fear of transmitting the disease or of catching an infection from the children. The RAND study involved interviews with 344 parents receiving health care for HIV in the United States. The researchers found 36.1 percent of HIV-infected patients interviewed felt at least "a little" fear and 19 percent felt moderate fear of transmitting HIV to their children. Fourteen |