June 25, 2011

Three-year CDC initiative tests 2.8 million Americans for HIV

Press Release

For immediate release: June 23, 2011
Media Contact: National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention - News Media Line, 404.639.8895 , NCHHSTPMediaTeam@cdc.gov

Effort to expand routine HIV testing identifies more than 18,000 people with HIV infection

A three-year, $111 million program to expand access to HIV testing in 25 of the U.S. areas most affected by HIV has provided nearly 2.8 million HIV tests and diagnosed 18,432 individuals who were previously unaware of their HIV infection, the Centers for Disease Control and Prevention announced today.

In addition, of the newly diagnosed individuals for whom follow-up data was available, three-quarters were successfully linked to HIV care as part of CDC’s Expanded Testing Initiative.

The results of the program were published today in the agency’s Morbidity and Mortality Weekly Report.

Between October 2007 and September 2010, CDC provided funding to state and local health departments to support routine HIV testing, primarily in health care settings, such as emergency rooms, sexually transmitted disease clinics and doctors’ offices, as well as in select community venues. The effort focused primarily on reaching African-Americans, who are more severely affected by HIV than any other race or ethnicity in the United States. Based on preliminary indications of the program’s success, in October 2010 CDC expanded the focus and funding of the initiative. CDC now provides funding to 30 areas (up from 25) to reach several populations heavily affected by HIV, including African-Americans, gay and bisexual men, Latinos and injection drug users.

“Ensuring that all Americans know their HIV status is critical to reducing new infections and putting an end to the epidemic,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “These results demonstrate that the nation is making steady progress toward that vision. But more than half of U.S. adults aged 18-64 still have never been tested for HIV, and our work is far from over.”

CDC launched the Expanded Testing Initiative to support its 2006 Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health Care Settings. The recommendations, which call for HIV testing to become a routine part of healthcare for all American adults and adolescents, are designed to remove key barriers to testing in healthcare facilities.

The initiative initially targeted African-Americans, and was particularly successful in this population. During the three-year period, African-Americans accounted for 60 percent of tests performed (1.4 million) and 70 percent of new HIV diagnoses (11,638), and were 1.6 times more likely to test positive for HIV than whites or Hispanics (0.8 percent and 0.5 percent respectively), reflecting long-standing disparities in the U.S. HIV epidemic.

Overall, 90 percent of tests were provided in health care settings, accounting for 81 percent of new HIV diagnoses. Hospital emergency rooms were particularly important venues for HIV testing, accounting for 30 percent of all tests and 32 percent of all previously undiagnosed infections. STD clinics also accounted for a significant number of new diagnoses (20 percent). Community-based organizations, which accounted for most of the HIV tests provided outside of health care facilities, contributed 11 percent of new HIV diagnoses.

CDC data show that while African-Americans represent 14 percent of the U.S. population, they account for nearly half of annual new HIV infections. Research shows that a range of social and environmental factors, including lack of access to health care, poverty, higher rates of STDs, stigma and homophobia, place communities of color, especially African-Americans, at greater risk for HIV.

Like other racial and ethnic groups, as many as one-third of African-Americans with HIV are diagnosed late in the course of their infection, when treatment is less effective and after many opportunities to prevent further spread of the virus have been missed.

In addition to focusing the initiative on African-Americans, CDC also took steps to ensure that resources were directed to reach other populations at highest risk for HIV. Health departments in the 25 participating jurisdictions were asked to utilize local epidemiological data to identify and prioritize specific venues serving hard-hit communities.

“These results are exciting and encouraging,” said Jonathan Mermin, M.D., director of CDC's Division of HIV and AIDS Prevention. “They remind us that high-impact prevention works. With collaboration and focus on those who are hardest hit by this disease, we are making great strides in the fight against HIV.”

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For more information, please visit www.cdc.gov/hiv.

Source
Neth J Med. 2011 May;69(5):216-21.

Gevers TJ, Slavenburg S, van Oijen MG, Drenth JP.

Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.

Abstract

Background: Current guidelines recommend 48 weeks of treatment with pegylated interferon and ribavirin for patients infected with chronic hepatitis C virus (HCV) genotype 1. Several clinical trials have investigated the efficacy of treatment duration longer than 48 weeks, but yielded discordant results. Methods: We performed a structured search of PubMed, Web of Science and the Cochrane library to identify randomised clinical trials in HCV genotype 1 patients who were treated either for 48 or 72 weeks. Sustained viral response (SVR) data were pooled and a sample size weighted pooled proportion was calculated. Results: We identified five studies matching our criteria. Studies randomised at baseline (n=1), at absence of rapid virological response (RVR) at week 4 (n=1), at early virological response at week 12 (EVR) (n=1) or at slow response at week 24 (n=2). In the RCT that randomised at absence of RVR, SVR was significantly higher in the extended treatment arm (57 vs 42%, p=0.02) with an RR of 1.35 (95% CI 1.04 to 1.75). This tendency was also observed in the studies that randomised at slow response (44 vs 35%), although no longer statistically significantly different. Conclusion: Prolonged 72-week treatment should be considered in HCV genotype 1 patients without RVR at week 4, as this increased SVR.

PMID: 21646668 [PubMed - in process] Free full text
 
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Liver Fibrosis Tied to Hep C-Related Vasculitis Prognosis

Last Updated: June 24, 2011

FRIDAY, June 24 (HealthDay News) -- In patients with hepatitis C virus (HCV)-related systemic vasculitis, severity of liver fibrosis and vasculitis at baseline are associated with disease prognosis, according to a study published in the June issue of Arthritis & Rheumatism.

Benjamin Terrier, M.D., from the Assistance Publique Hôpitaux de Paris, and colleagues investigated the clinical, biologic, and therapeutic factors associated with prognosis in 151 HCV RNA-positive patients with vasculitis. Participants were followed up for 54 months between 1993 and 2009, during which time vasculitis was scored using the Five-Factors Score (FFS). Data were collected on clinical, biologic, and therapeutic factors at the initial evaluation, during and at the end of follow-up.

The investigators found that 32 patients died mainly of infection and end-stage liver disease during the follow-up period. Survival rates were 96 percent at one year, 86 percent at three years, 75 percent at five years, and 63 percent at 10 years. Poor prognosis was associated with severe liver fibrosis (hazard ratio [HR], 5.31), and central nervous system, kidney, and heart involvement (HR, 2.74, 1.91, and 4.2, respectively) at baseline. FFS and severe fibrosis correlated significantly with poor prognosis in a multivariate analysis (HR, 2.49 and 10.8, respectively). After adjusting for vasculitis severity, treatment with PEGylated interferon plus ribavirin correlated with a good prognosis (HR 0.34), and treatment with immunosuppressive agents was linked to a poor outcome (HR, 4.05). FFS was a good predictor of outcome, but severity of vasculitis had no prognostic effect on patients without severe fibrosis.

"At the time of the diagnosis of HCV-related systemic vasculitis, severe liver fibrosis and the severity of vasculitis were the main prognostic factors," the authors write.

One of the study authors disclosed financial ties to the pharmaceutical industry.

Abstract
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