Jan Dyer

In 2015, young people aged 13 to 24 years—disproportionately young men and boys—accounted for 23% of new HIV infections. Pre-exposure prophylaxis (PrEP) can prevent HIV, and has been found safe and effective for young people, but are health care providers who treat adolescents willing to prescribe it?

Researchers from University of California, San Francisco say internal medicine and infectious disease providers have expressed concerns about adherence, development of resistant HIV strains, higher risk sexual behavior, cost, toxicity, and lack of evidence. Data are lacking, though, among youth providers. To find out how aware those clinicians are about PrEP, and how willing they are to prescribe it, the researchers conducted an online survey of members of the Society of Adolescent Health and Medicine.

Almost all of the 162 respondents had heard of PrEP, and agreed that it prevents HIV. Of the respondents, 57 (35%) had prescribed PrEP. Although 73% said they had treated few to no young patients with HIV, 65% were willing to prescribe PrEP to adolescents (aged 13-17 years) and young adults. Only 30 providers said they would refer adolescents and 25 would refer young adults.

Among the providers who would refer or were not willing to prescribe to adolescents, 35 (67%) would prescribe PrEP if it were FDA-approved for adolescents.

Willingness to prescribe was associated with the provider having enough knowledge to safely provide PrEP to adolescents and a belief that adolescents would adhere to a daily medication regimen. Some also said they would prefer to know that they could ensure confidentiality.

The researchers say their findings highlight potential opportunities to reduce HIV incidence among young people by shaping educational and implementation tools to improve provider self-efficacy and youth adherence. 

In 2015, young people aged 13 to 24 years—disproportionately young men and boys—accounted for 23% of new HIV infections. Pre-exposure prophylaxis (PrEP) can prevent HIV, and has been found safe and effective for young people, but are health care providers who treat adolescents willing to prescribe it?

Researchers from University of California, San Francisco say internal medicine and infectious disease providers have expressed concerns about adherence, development of resistant HIV strains, higher risk sexual behavior, cost, toxicity, and lack of evidence. Data are lacking, though, among youth providers. To find out how aware those clinicians are about PrEP, and how willing they are to prescribe it, the researchers conducted an online survey of members of the Society of Adolescent Health and Medicine.

Almost all of the 162 respondents had heard of PrEP, and agreed that it prevents HIV. Of the respondents, 57 (35%) had prescribed PrEP. Although 73% said they had treated few to no young patients with HIV, 65% were willing to prescribe PrEP to adolescents (aged 13-17 years) and young adults. Only 30 providers said they would refer adolescents and 25 would refer young adults.

Among the providers who would refer or were not willing to prescribe to adolescents, 35 (67%) would prescribe PrEP if it were FDA-approved for adolescents.

Willingness to prescribe was associated with the provider having enough knowledge to safely provide PrEP to adolescents and a belief that adolescents would adhere to a daily medication regimen. Some also said they would prefer to know that they could ensure confidentiality.

The researchers say their findings highlight potential opportunities to reduce HIV incidence among young people by shaping educational and implementation tools to improve provider self-efficacy and youth adherence. 

In 2015, young people aged 13 to 24 years—disproportionately young men and boys—accounted for 23% of new HIV infections. Pre-exposure prophylaxis (PrEP) can prevent HIV, and has been found safe and effective for young people, but are health care providers who treat adolescents willing to prescribe it?

Researchers from University of California, San Francisco say internal medicine and infectious disease providers have expressed concerns about adherence, development of resistant HIV strains, higher risk sexual behavior, cost, toxicity, and lack of evidence. Data are lacking, though, among youth providers. To find out how aware those clinicians are about PrEP, and how willing they are to prescribe it, the researchers conducted an online survey of members of the Society of Adolescent Health and Medicine.

Almost all of the 162 respondents had heard of PrEP, and agreed that it prevents HIV. Of the respondents, 57 (35%) had prescribed PrEP. Although 73% said they had treated few to no young patients with HIV, 65% were willing to prescribe PrEP to adolescents (aged 13-17 years) and young adults. Only 30 providers said they would refer adolescents and 25 would refer young adults.

Among the providers who would refer or were not willing to prescribe to adolescents, 35 (67%) would prescribe PrEP if it were FDA-approved for adolescents.

Willingness to prescribe was associated with the provider having enough knowledge to safely provide PrEP to adolescents and a belief that adolescents would adhere to a daily medication regimen. Some also said they would prefer to know that they could ensure confidentiality.

The researchers say their findings highlight potential opportunities to reduce HIV incidence among young people by shaping educational and implementation tools to improve provider self-efficacy and youth adherence. 

In 2016, a staggering 216 million people developed malaria, and 445,000 died—primarily children in sub-Saharan Africa. But a new first-in-human study sponsored by the National Institute of Allergy and Infectious Disease may help reduce the numbers of future victims.

Enrollment has begun in a phase I trial to test the safety of DM1157, an investigational modified form of chloroquine. Many strains of Plasmodium falciparum are now resistant to chloroquine. In fact, the parasites can expel the drug before it can affect them. Like chloroquine, DM1157 interferes with the parasite’s metabolism, but it also inhibits the parasite’s ability to expel the drug.

The study will enroll up to 104 healthy volunteers aged 18-45 years. One group will fast overnight and then receive either a single dose of the experimental drug at 1 of 7 dosage levels or a placebo. A second group also will fast and receive 1 dose at 1 of 4 dosage levels and repeat the routine for 2 more consecutive days. A third group will be given either a single 300-mg dose or placebo after eating a high-fat meal.

The study is expected to be completed by June 2019.

In 2016, a staggering 216 million people developed malaria, and 445,000 died—primarily children in sub-Saharan Africa. But a new first-in-human study sponsored by the National Institute of Allergy and Infectious Disease may help reduce the numbers of future victims.

Enrollment has begun in a phase I trial to test the safety of DM1157, an investigational modified form of chloroquine. Many strains of Plasmodium falciparum are now resistant to chloroquine. In fact, the parasites can expel the drug before it can affect them. Like chloroquine, DM1157 interferes with the parasite’s metabolism, but it also inhibits the parasite’s ability to expel the drug.

The study will enroll up to 104 healthy volunteers aged 18-45 years. One group will fast overnight and then receive either a single dose of the experimental drug at 1 of 7 dosage levels or a placebo. A second group also will fast and receive 1 dose at 1 of 4 dosage levels and repeat the routine for 2 more consecutive days. A third group will be given either a single 300-mg dose or placebo after eating a high-fat meal.

The study is expected to be completed by June 2019.

In 2016, a staggering 216 million people developed malaria, and 445,000 died—primarily children in sub-Saharan Africa. But a new first-in-human study sponsored by the National Institute of Allergy and Infectious Disease may help reduce the numbers of future victims.

Enrollment has begun in a phase I trial to test the safety of DM1157, an investigational modified form of chloroquine. Many strains of Plasmodium falciparum are now resistant to chloroquine. In fact, the parasites can expel the drug before it can affect them. Like chloroquine, DM1157 interferes with the parasite’s metabolism, but it also inhibits the parasite’s ability to expel the drug.

The study will enroll up to 104 healthy volunteers aged 18-45 years. One group will fast overnight and then receive either a single dose of the experimental drug at 1 of 7 dosage levels or a placebo. A second group also will fast and receive 1 dose at 1 of 4 dosage levels and repeat the routine for 2 more consecutive days. A third group will be given either a single 300-mg dose or placebo after eating a high-fat meal.

The study is expected to be completed by June 2019.

An unexpected finding in a study by National Institute of Health (NIH) researchers suggests that a “good” bacterium commonly found in probiotic digestive supplements works against Staphylococcus aureus (S aureus).

The researchers recruited 200 volunteers in Thailand for the study. They speculated that Thais would not be as affected by food sterilization or antibiotics as people in highly developed urban areas. The researchers analyzed fecal samples from each participant for bacteria correlated with the absence of S aureus. They found 101 samples positive for bacillus, primarily Bacillus subtilis (B subtilis), which is often mixed with other bacteria in probiotic products. The researchers then sampled for S aureus and found 25 positive gut samples and 26 positive nose samples. Strikingly, the researchers say, they found no S aureus in any of the samples that contained bacillus.

Using chromatography and mass spectrometry, the study team identified fengycins—a class of lipopeptides—as the specific bacillus substance that inhibited the S aureus sensing system. Other tests showed that fengycins had the same effect on several different strains of S aureus, including high-risk USA300 methicillin-resistant S aureus  (MRSA).

To further validate their findings, the researchers colonized the gut of mice with S aureus and fed them B subtilis spores. Probiotic bacillus given every 2 days eliminated S aureus. The same test using bacillus where fengycin production had been removed had no effect: S aureus grew as expected.

An unexpected finding in a study by National Institute of Health (NIH) researchers suggests that a “good” bacterium commonly found in probiotic digestive supplements works against Staphylococcus aureus (S aureus).

The researchers recruited 200 volunteers in Thailand for the study. They speculated that Thais would not be as affected by food sterilization or antibiotics as people in highly developed urban areas. The researchers analyzed fecal samples from each participant for bacteria correlated with the absence of S aureus. They found 101 samples positive for bacillus, primarily Bacillus subtilis (B subtilis), which is often mixed with other bacteria in probiotic products. The researchers then sampled for S aureus and found 25 positive gut samples and 26 positive nose samples. Strikingly, the researchers say, they found no S aureus in any of the samples that contained bacillus.

Using chromatography and mass spectrometry, the study team identified fengycins—a class of lipopeptides—as the specific bacillus substance that inhibited the S aureus sensing system. Other tests showed that fengycins had the same effect on several different strains of S aureus, including high-risk USA300 methicillin-resistant S aureus  (MRSA).

To further validate their findings, the researchers colonized the gut of mice with S aureus and fed them B subtilis spores. Probiotic bacillus given every 2 days eliminated S aureus. The same test using bacillus where fengycin production had been removed had no effect: S aureus grew as expected.

An unexpected finding in a study by National Institute of Health (NIH) researchers suggests that a “good” bacterium commonly found in probiotic digestive supplements works against Staphylococcus aureus (S aureus).

The researchers recruited 200 volunteers in Thailand for the study. They speculated that Thais would not be as affected by food sterilization or antibiotics as people in highly developed urban areas. The researchers analyzed fecal samples from each participant for bacteria correlated with the absence of S aureus. They found 101 samples positive for bacillus, primarily Bacillus subtilis (B subtilis), which is often mixed with other bacteria in probiotic products. The researchers then sampled for S aureus and found 25 positive gut samples and 26 positive nose samples. Strikingly, the researchers say, they found no S aureus in any of the samples that contained bacillus.

Using chromatography and mass spectrometry, the study team identified fengycins—a class of lipopeptides—as the specific bacillus substance that inhibited the S aureus sensing system. Other tests showed that fengycins had the same effect on several different strains of S aureus, including high-risk USA300 methicillin-resistant S aureus  (MRSA).

To further validate their findings, the researchers colonized the gut of mice with S aureus and fed them B subtilis spores. Probiotic bacillus given every 2 days eliminated S aureus. The same test using bacillus where fengycin production had been removed had no effect: S aureus grew as expected.

Osteoporosis is common among patients with multiple myeloma (MM), in part because both largely affect older adults. And more than half of MM patients will have MM skeletal-related events, which are painful, and can lead to complications (such as spinal cord compression) and death.

But how does pre-existing bone disease contribute to clinical outcomes in MM? Osteoporosis is a “silent condition” and very little is known about its role in MM, say researchers from The Ohio State University in Columbus and University of Massachusetts in Worcester. The standard diagnostic evaluation for MM does not include dual-energy x-ray absorptiometry, therefore assessments of underlying osteoporosis are not routine. Moreover, it is a challenge to distinguish osteoporotic fragility fractures from pathologic MM-induced fractures. Skeletal surveys underestimate bone involvement by about 40%, the researchers note, and are even less specific for distinguishing myeloma-related secondary osteoporosis from primary osteoporosis.

The researchers examined the relationship between the Fracture Risk Assessment Tool (FRAX) and the risk of death in women who developed MM. They analyzed data from 161,808 women in the Women’s Health Initiative (WHI). Of those, 409 developed MM; 362 had no history of cancer.

At baseline, 98 (27%) women had high FRAX scores, and 264 (73%) had low scores. The median follow-up period was 10.5 years from enrollment and 7.2 years from the time of MM diagnosis. Of the patients with MM, 226 died during the follow-up period, including 71 with high FRAX scores and 155 with low scores. MM mortality was higher among women with high FRAX scores: 72%, vs 59% of those with low scores. Poor bone health was associated with greater MM mortality but was not related to delay in time to diagnosis.

During the evaluation, 57 fractures were reported, 65% before MM diagnosis. Fewer than half of the women had a first fracture after diagnosis. The probability of fracture was similar among the women, regardless of FRAX score. Not surprisingly, older women with lower BMI were most at risk.

The WHI does not include information on staging, chemotherapy, or use of bisphosphonates. Therefore, the impact of bisphosphonates could not be determined in this study. The researchers also did not know how many patients might have had pre-existing monoclonal gammopathy of undetermined significance, a disorder in about 3% of the aging population that progresses to MM in 1% per year.

Source:
Rosko AE, Hade EM, Li W, et al. Clin Lymphoma Myeloma Leuk. 2018;18(9):597-602.

Osteoporosis is common among patients with multiple myeloma (MM), in part because both largely affect older adults. And more than half of MM patients will have MM skeletal-related events, which are painful, and can lead to complications (such as spinal cord compression) and death.

But how does pre-existing bone disease contribute to clinical outcomes in MM? Osteoporosis is a “silent condition” and very little is known about its role in MM, say researchers from The Ohio State University in Columbus and University of Massachusetts in Worcester. The standard diagnostic evaluation for MM does not include dual-energy x-ray absorptiometry, therefore assessments of underlying osteoporosis are not routine. Moreover, it is a challenge to distinguish osteoporotic fragility fractures from pathologic MM-induced fractures. Skeletal surveys underestimate bone involvement by about 40%, the researchers note, and are even less specific for distinguishing myeloma-related secondary osteoporosis from primary osteoporosis.

The researchers examined the relationship between the Fracture Risk Assessment Tool (FRAX) and the risk of death in women who developed MM. They analyzed data from 161,808 women in the Women’s Health Initiative (WHI). Of those, 409 developed MM; 362 had no history of cancer.

At baseline, 98 (27%) women had high FRAX scores, and 264 (73%) had low scores. The median follow-up period was 10.5 years from enrollment and 7.2 years from the time of MM diagnosis. Of the patients with MM, 226 died during the follow-up period, including 71 with high FRAX scores and 155 with low scores. MM mortality was higher among women with high FRAX scores: 72%, vs 59% of those with low scores. Poor bone health was associated with greater MM mortality but was not related to delay in time to diagnosis.

During the evaluation, 57 fractures were reported, 65% before MM diagnosis. Fewer than half of the women had a first fracture after diagnosis. The probability of fracture was similar among the women, regardless of FRAX score. Not surprisingly, older women with lower BMI were most at risk.

The WHI does not include information on staging, chemotherapy, or use of bisphosphonates. Therefore, the impact of bisphosphonates could not be determined in this study. The researchers also did not know how many patients might have had pre-existing monoclonal gammopathy of undetermined significance, a disorder in about 3% of the aging population that progresses to MM in 1% per year.

Source:
Rosko AE, Hade EM, Li W, et al. Clin Lymphoma Myeloma Leuk. 2018;18(9):597-602.

Osteoporosis is common among patients with multiple myeloma (MM), in part because both largely affect older adults. And more than half of MM patients will have MM skeletal-related events, which are painful, and can lead to complications (such as spinal cord compression) and death.

But how does pre-existing bone disease contribute to clinical outcomes in MM? Osteoporosis is a “silent condition” and very little is known about its role in MM, say researchers from The Ohio State University in Columbus and University of Massachusetts in Worcester. The standard diagnostic evaluation for MM does not include dual-energy x-ray absorptiometry, therefore assessments of underlying osteoporosis are not routine. Moreover, it is a challenge to distinguish osteoporotic fragility fractures from pathologic MM-induced fractures. Skeletal surveys underestimate bone involvement by about 40%, the researchers note, and are even less specific for distinguishing myeloma-related secondary osteoporosis from primary osteoporosis.

The researchers examined the relationship between the Fracture Risk Assessment Tool (FRAX) and the risk of death in women who developed MM. They analyzed data from 161,808 women in the Women’s Health Initiative (WHI). Of those, 409 developed MM; 362 had no history of cancer.

At baseline, 98 (27%) women had high FRAX scores, and 264 (73%) had low scores. The median follow-up period was 10.5 years from enrollment and 7.2 years from the time of MM diagnosis. Of the patients with MM, 226 died during the follow-up period, including 71 with high FRAX scores and 155 with low scores. MM mortality was higher among women with high FRAX scores: 72%, vs 59% of those with low scores. Poor bone health was associated with greater MM mortality but was not related to delay in time to diagnosis.

During the evaluation, 57 fractures were reported, 65% before MM diagnosis. Fewer than half of the women had a first fracture after diagnosis. The probability of fracture was similar among the women, regardless of FRAX score. Not surprisingly, older women with lower BMI were most at risk.

The WHI does not include information on staging, chemotherapy, or use of bisphosphonates. Therefore, the impact of bisphosphonates could not be determined in this study. The researchers also did not know how many patients might have had pre-existing monoclonal gammopathy of undetermined significance, a disorder in about 3% of the aging population that progresses to MM in 1% per year.

Source:
Rosko AE, Hade EM, Li W, et al. Clin Lymphoma Myeloma Leuk. 2018;18(9):597-602.

Gastric banding was just as successful as metformin alone in stabilizing prediabetes or new-onset type 2 diabetes in the Beta Cell Restoration through Fat Mitigation study (BetaFat), an NIH-supported study.

The study is part of the Restoring Insulin Secretion (RISE) study, a set of 3 clinical trials designed to find ways to reverse or slow the loss of insulin production and release in people at risk for type 2 diabetes.

In this study, 44 patients were randomly assigned to have a gastric banding procedure, and 44 were taking metformin. After 2 years, people in the gastric banding group had lost an average of 23 lb , vs 4 lb in the metformin group. Insulin sensitivity improved similarly in both groups, as did function of insulin-producing cells. Both groups showed small improvements in blood glucose levels.

Gastric banding was just as successful as metformin alone in stabilizing prediabetes or new-onset type 2 diabetes in the Beta Cell Restoration through Fat Mitigation study (BetaFat), an NIH-supported study.

The study is part of the Restoring Insulin Secretion (RISE) study, a set of 3 clinical trials designed to find ways to reverse or slow the loss of insulin production and release in people at risk for type 2 diabetes.

In this study, 44 patients were randomly assigned to have a gastric banding procedure, and 44 were taking metformin. After 2 years, people in the gastric banding group had lost an average of 23 lb , vs 4 lb in the metformin group. Insulin sensitivity improved similarly in both groups, as did function of insulin-producing cells. Both groups showed small improvements in blood glucose levels.

Gastric banding was just as successful as metformin alone in stabilizing prediabetes or new-onset type 2 diabetes in the Beta Cell Restoration through Fat Mitigation study (BetaFat), an NIH-supported study.

The study is part of the Restoring Insulin Secretion (RISE) study, a set of 3 clinical trials designed to find ways to reverse or slow the loss of insulin production and release in people at risk for type 2 diabetes.

In this study, 44 patients were randomly assigned to have a gastric banding procedure, and 44 were taking metformin. After 2 years, people in the gastric banding group had lost an average of 23 lb , vs 4 lb in the metformin group. Insulin sensitivity improved similarly in both groups, as did function of insulin-producing cells. Both groups showed small improvements in blood glucose levels.

Unless someone has already had a heart attack or other cardiovascular event, daily low-dose aspirin does not prolong healthy independent living, according to the ASPirin in Reducing Events in the Elderly (ASPREE) trial.

The study began in 2010, enrolling 19,114 adults aged ≥ 65 years. The participants were treated with 100 mg/d of aspirin or placebo and followed for an average of 4.7 years. Of participants randomly assigned aspirin, 90.3% were still alive at the end of the treatment without persistent physical disability or dementia, as were 90.5% of those on placebo. Rates of dementia were almost identical in both groups. Major cardiovascular events were similar: 448 in the aspirin group and 474 in the placebo group.

The aspirin group had a slightly higher risk of death (5.9% vs 5.2%). The researchers advise interpreting this cautiously: Most of the deaths were due to cancer. A small increase in new cases of cancer was reported for the aspirin group but may have been due to chance. Heart disease accounted for 19% of deaths and major bleeding for 5%. People taking aspirin were more likely to have significant bleeding (3.8% vs 2.7%).

The researchers emphasize that, study findings notwithstanding, older adults should follow their physician’s advice about daily aspirin use. The new findings do not apply to people with an indication for aspirin, including stroke, heart attack, or other cardiovascular disease.

Unless someone has already had a heart attack or other cardiovascular event, daily low-dose aspirin does not prolong healthy independent living, according to the ASPirin in Reducing Events in the Elderly (ASPREE) trial.

The study began in 2010, enrolling 19,114 adults aged ≥ 65 years. The participants were treated with 100 mg/d of aspirin or placebo and followed for an average of 4.7 years. Of participants randomly assigned aspirin, 90.3% were still alive at the end of the treatment without persistent physical disability or dementia, as were 90.5% of those on placebo. Rates of dementia were almost identical in both groups. Major cardiovascular events were similar: 448 in the aspirin group and 474 in the placebo group.

The aspirin group had a slightly higher risk of death (5.9% vs 5.2%). The researchers advise interpreting this cautiously: Most of the deaths were due to cancer. A small increase in new cases of cancer was reported for the aspirin group but may have been due to chance. Heart disease accounted for 19% of deaths and major bleeding for 5%. People taking aspirin were more likely to have significant bleeding (3.8% vs 2.7%).

The researchers emphasize that, study findings notwithstanding, older adults should follow their physician’s advice about daily aspirin use. The new findings do not apply to people with an indication for aspirin, including stroke, heart attack, or other cardiovascular disease.

Unless someone has already had a heart attack or other cardiovascular event, daily low-dose aspirin does not prolong healthy independent living, according to the ASPirin in Reducing Events in the Elderly (ASPREE) trial.

The study began in 2010, enrolling 19,114 adults aged ≥ 65 years. The participants were treated with 100 mg/d of aspirin or placebo and followed for an average of 4.7 years. Of participants randomly assigned aspirin, 90.3% were still alive at the end of the treatment without persistent physical disability or dementia, as were 90.5% of those on placebo. Rates of dementia were almost identical in both groups. Major cardiovascular events were similar: 448 in the aspirin group and 474 in the placebo group.

The aspirin group had a slightly higher risk of death (5.9% vs 5.2%). The researchers advise interpreting this cautiously: Most of the deaths were due to cancer. A small increase in new cases of cancer was reported for the aspirin group but may have been due to chance. Heart disease accounted for 19% of deaths and major bleeding for 5%. People taking aspirin were more likely to have significant bleeding (3.8% vs 2.7%).

The researchers emphasize that, study findings notwithstanding, older adults should follow their physician’s advice about daily aspirin use. The new findings do not apply to people with an indication for aspirin, including stroke, heart attack, or other cardiovascular disease.

People living with HIV who inject drugs often encounter multiple obstacles, both personal and system related, to beginning and adhering to treatment. But NIH researchers found that an “integrated and flexible intervention” not only helped patients overcome those barriers, but also cut deaths by 50%.

The study, HPTN 074, took place in Indonesia, Ukraine, and Vietnam—3 countries with HIV epidemics driven by injection drug use. Researchers enrolled 502 adults with HIV who inject drugs, and 806 adults without HIV, who inject drugs with them (their injection partners). At ≥ 1 injection partner of every person in the study enrolled. The HIV participants were assigned either the national standard of care for HIV infection and drug use, or the standard of care plus the intervention designed to facilitate treatment. The participants were followed for 1 to 2 years.

In the intervention group, participants were referred to local health care providers for anti-HIV therapy. They were also each assigned a systems navigator, who helped the patient identify and overcome structural barriers to starting and staying in care, such as unfamiliarity with how to enroll in medical care, or difficulty keeping appointments. Psychosocial counselors helped each participant overcome their unique psychological obstacles, such as lack of interest in therapy or fear of stigma.

At the end of the study, 15% of participants with HIV who received standard care had died, compared with 7% of the intervention patients. About 26% of deaths among HIV participants were “clearly” HIV related; 3% were due to drug overdose. Among the 42% of patients who died of unknown cause, 24% had weak immune systems.

The intervention had a “remarkably positive impact” on the participants, said Protocol Chair William Miller, MD, PhD. After 1 year, 41% of the intervention group had undetectable levels of HIV, compared with 24% of the standard-care group. Moreover, 72% of the intervention group were still in treatment, compared with 43% of the standard-care group. Similarly, 41% of intervention patients were in treatment for substance use, compared with 25% of standard-care patients.

The study is designed to be scalable to other settings. Investigators have offered the intervention to all the study participants living with HIV. They will be followed for a second year to find out whether the positive impact is sustained.

Source:

National Institutes of Health.  Novel intervention halves rate of death among people living with HIV who inject drugs. https://www.nih.gov/news-events/news-releases/novel-intervention-halves-rate-death-among-people-living-hiv-who-inject-drugs. Published August 31,2018. Accessed October 25, 2018.

People living with HIV who inject drugs often encounter multiple obstacles, both personal and system related, to beginning and adhering to treatment. But NIH researchers found that an “integrated and flexible intervention” not only helped patients overcome those barriers, but also cut deaths by 50%.

The study, HPTN 074, took place in Indonesia, Ukraine, and Vietnam—3 countries with HIV epidemics driven by injection drug use. Researchers enrolled 502 adults with HIV who inject drugs, and 806 adults without HIV, who inject drugs with them (their injection partners). At ≥ 1 injection partner of every person in the study enrolled. The HIV participants were assigned either the national standard of care for HIV infection and drug use, or the standard of care plus the intervention designed to facilitate treatment. The participants were followed for 1 to 2 years.

In the intervention group, participants were referred to local health care providers for anti-HIV therapy. They were also each assigned a systems navigator, who helped the patient identify and overcome structural barriers to starting and staying in care, such as unfamiliarity with how to enroll in medical care, or difficulty keeping appointments. Psychosocial counselors helped each participant overcome their unique psychological obstacles, such as lack of interest in therapy or fear of stigma.

At the end of the study, 15% of participants with HIV who received standard care had died, compared with 7% of the intervention patients. About 26% of deaths among HIV participants were “clearly” HIV related; 3% were due to drug overdose. Among the 42% of patients who died of unknown cause, 24% had weak immune systems.

The intervention had a “remarkably positive impact” on the participants, said Protocol Chair William Miller, MD, PhD. After 1 year, 41% of the intervention group had undetectable levels of HIV, compared with 24% of the standard-care group. Moreover, 72% of the intervention group were still in treatment, compared with 43% of the standard-care group. Similarly, 41% of intervention patients were in treatment for substance use, compared with 25% of standard-care patients.

The study is designed to be scalable to other settings. Investigators have offered the intervention to all the study participants living with HIV. They will be followed for a second year to find out whether the positive impact is sustained.

Source:

National Institutes of Health.  Novel intervention halves rate of death among people living with HIV who inject drugs. https://www.nih.gov/news-events/news-releases/novel-intervention-halves-rate-death-among-people-living-hiv-who-inject-drugs. Published August 31,2018. Accessed October 25, 2018.

People living with HIV who inject drugs often encounter multiple obstacles, both personal and system related, to beginning and adhering to treatment. But NIH researchers found that an “integrated and flexible intervention” not only helped patients overcome those barriers, but also cut deaths by 50%.

The study, HPTN 074, took place in Indonesia, Ukraine, and Vietnam—3 countries with HIV epidemics driven by injection drug use. Researchers enrolled 502 adults with HIV who inject drugs, and 806 adults without HIV, who inject drugs with them (their injection partners). At ≥ 1 injection partner of every person in the study enrolled. The HIV participants were assigned either the national standard of care for HIV infection and drug use, or the standard of care plus the intervention designed to facilitate treatment. The participants were followed for 1 to 2 years.

In the intervention group, participants were referred to local health care providers for anti-HIV therapy. They were also each assigned a systems navigator, who helped the patient identify and overcome structural barriers to starting and staying in care, such as unfamiliarity with how to enroll in medical care, or difficulty keeping appointments. Psychosocial counselors helped each participant overcome their unique psychological obstacles, such as lack of interest in therapy or fear of stigma.

At the end of the study, 15% of participants with HIV who received standard care had died, compared with 7% of the intervention patients. About 26% of deaths among HIV participants were “clearly” HIV related; 3% were due to drug overdose. Among the 42% of patients who died of unknown cause, 24% had weak immune systems.

The intervention had a “remarkably positive impact” on the participants, said Protocol Chair William Miller, MD, PhD. After 1 year, 41% of the intervention group had undetectable levels of HIV, compared with 24% of the standard-care group. Moreover, 72% of the intervention group were still in treatment, compared with 43% of the standard-care group. Similarly, 41% of intervention patients were in treatment for substance use, compared with 25% of standard-care patients.

The study is designed to be scalable to other settings. Investigators have offered the intervention to all the study participants living with HIV. They will be followed for a second year to find out whether the positive impact is sustained.

Source:

National Institutes of Health.  Novel intervention halves rate of death among people living with HIV who inject drugs. https://www.nih.gov/news-events/news-releases/novel-intervention-halves-rate-death-among-people-living-hiv-who-inject-drugs. Published August 31,2018. Accessed October 25, 2018.

Coffee drinking has been linked to the reduced risk of fibrosis progression, liver cirrhosis, and hepatocellular carcinoma in some patients, including those with hepatitis C virus (HCV) infection, but the results of studies in patients with hepatitis B virus (HBV) infection have been inconsistent. Given the “global impact of HBV infection and the wide consumption of coffee,” researchers from Tzu Chi University in Taiwan, wanted to find out more.

They analyzed data from 328 patients with chronic HBV infection who were enrolled in a population-based gastroesophageal reflux disease study. Of those, 155 patients also entered into a 5-year follow-up study. 

Among the patients with chronic HBV, 137 did not drink coffee. Of the 191 who did, 61 drank it on < 4 days a week, and 130 drank it ≥ 4 days.

Initially, the researchers observed an inverse association between coffee drinking and serum aspartate aminotransferase (AST) levels, as well as predicting indices of liver fibrosis in patients with HBV infection. Patients who drank ≥ 4 cups of coffee per day had a 70% decrease of serum AST, a 70% decrease of the AST to platelet ratio index, and a 70% decrease of fibrosis-4 index values. 

Those findings indicated that coffee might have a “generally beneficial” effect on liver inflammation and fibrosis progression in patients with chronic liver disease, the researchers say. However, at the end of the 5-year follow-up, the incidences of liver cirrhosis complications and changes of serum predicting indices of liver fibrosis were comparable between HBV coffee drinkers and nondrinkers. That indicated, the researchers believe, that the beneficial effect “seems to be outweighed” in patients with chronic HBV infection.

The researchers suggest that the protective effects of coffee consumption on liver inflammation and insulin resistance may not be able to surpass the direct carcinogenic effect of HBV, and even the HBV virus replication.

Coffee drinking has been linked to the reduced risk of fibrosis progression, liver cirrhosis, and hepatocellular carcinoma in some patients, including those with hepatitis C virus (HCV) infection, but the results of studies in patients with hepatitis B virus (HBV) infection have been inconsistent. Given the “global impact of HBV infection and the wide consumption of coffee,” researchers from Tzu Chi University in Taiwan, wanted to find out more.

They analyzed data from 328 patients with chronic HBV infection who were enrolled in a population-based gastroesophageal reflux disease study. Of those, 155 patients also entered into a 5-year follow-up study. 

Among the patients with chronic HBV, 137 did not drink coffee. Of the 191 who did, 61 drank it on < 4 days a week, and 130 drank it ≥ 4 days.

Initially, the researchers observed an inverse association between coffee drinking and serum aspartate aminotransferase (AST) levels, as well as predicting indices of liver fibrosis in patients with HBV infection. Patients who drank ≥ 4 cups of coffee per day had a 70% decrease of serum AST, a 70% decrease of the AST to platelet ratio index, and a 70% decrease of fibrosis-4 index values. 

Those findings indicated that coffee might have a “generally beneficial” effect on liver inflammation and fibrosis progression in patients with chronic liver disease, the researchers say. However, at the end of the 5-year follow-up, the incidences of liver cirrhosis complications and changes of serum predicting indices of liver fibrosis were comparable between HBV coffee drinkers and nondrinkers. That indicated, the researchers believe, that the beneficial effect “seems to be outweighed” in patients with chronic HBV infection.

The researchers suggest that the protective effects of coffee consumption on liver inflammation and insulin resistance may not be able to surpass the direct carcinogenic effect of HBV, and even the HBV virus replication.

Coffee drinking has been linked to the reduced risk of fibrosis progression, liver cirrhosis, and hepatocellular carcinoma in some patients, including those with hepatitis C virus (HCV) infection, but the results of studies in patients with hepatitis B virus (HBV) infection have been inconsistent. Given the “global impact of HBV infection and the wide consumption of coffee,” researchers from Tzu Chi University in Taiwan, wanted to find out more.

They analyzed data from 328 patients with chronic HBV infection who were enrolled in a population-based gastroesophageal reflux disease study. Of those, 155 patients also entered into a 5-year follow-up study. 

Among the patients with chronic HBV, 137 did not drink coffee. Of the 191 who did, 61 drank it on < 4 days a week, and 130 drank it ≥ 4 days.

Initially, the researchers observed an inverse association between coffee drinking and serum aspartate aminotransferase (AST) levels, as well as predicting indices of liver fibrosis in patients with HBV infection. Patients who drank ≥ 4 cups of coffee per day had a 70% decrease of serum AST, a 70% decrease of the AST to platelet ratio index, and a 70% decrease of fibrosis-4 index values. 

Those findings indicated that coffee might have a “generally beneficial” effect on liver inflammation and fibrosis progression in patients with chronic liver disease, the researchers say. However, at the end of the 5-year follow-up, the incidences of liver cirrhosis complications and changes of serum predicting indices of liver fibrosis were comparable between HBV coffee drinkers and nondrinkers. That indicated, the researchers believe, that the beneficial effect “seems to be outweighed” in patients with chronic HBV infection.

The researchers suggest that the protective effects of coffee consumption on liver inflammation and insulin resistance may not be able to surpass the direct carcinogenic effect of HBV, and even the HBV virus replication.

A group of teenage 4-H members take part in a state agricultural fair, after which one of the boys comes sick. But luckily they have also attended the CDC’s Disease Detective Camp in Atlanta and use their newly acquired detective skills to find out why their friend got sick.

That is the story in “The Junior Disease Detectives: Operation Outbreak,” the new graphic novel the CDC has developed with the Department of Agriculture and 4-H.

Spoiler alert: it was the flu. The novel is designed to help young people understand the potential health risks of human influenza viruses that normally circulate in swine, known as variant flu infections.

Four new variant virus infections have been associated with attendance at agricultural fairs in 2 US states, the CDC reports. Most are connected to infected pigs or their environments in fair settings. While variant flu infections in people are rare, the CDC says, they can lead to hospitalization and death. In 2017, 67 variant virus infections were reported in the US; 6 resulted in hospitalization, including 2 ICU admissions.

The novel is intended for use in middle and high school science, technology, engineering, and mathematics (STEM) classrooms. It is the first of a planned series of educational activities being rolled out throughout the 2018-2019 school year.

The novel is available as a free mobile app, and can be downloaded at https://www.cdc.gov/flu/resource-center/freeresources/graphic-novel/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fgraphicnovel%2Findex.html.

A group of teenage 4-H members take part in a state agricultural fair, after which one of the boys comes sick. But luckily they have also attended the CDC’s Disease Detective Camp in Atlanta and use their newly acquired detective skills to find out why their friend got sick.

That is the story in “The Junior Disease Detectives: Operation Outbreak,” the new graphic novel the CDC has developed with the Department of Agriculture and 4-H.

Spoiler alert: it was the flu. The novel is designed to help young people understand the potential health risks of human influenza viruses that normally circulate in swine, known as variant flu infections.

Four new variant virus infections have been associated with attendance at agricultural fairs in 2 US states, the CDC reports. Most are connected to infected pigs or their environments in fair settings. While variant flu infections in people are rare, the CDC says, they can lead to hospitalization and death. In 2017, 67 variant virus infections were reported in the US; 6 resulted in hospitalization, including 2 ICU admissions.

The novel is intended for use in middle and high school science, technology, engineering, and mathematics (STEM) classrooms. It is the first of a planned series of educational activities being rolled out throughout the 2018-2019 school year.

The novel is available as a free mobile app, and can be downloaded at https://www.cdc.gov/flu/resource-center/freeresources/graphic-novel/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fgraphicnovel%2Findex.html.

A group of teenage 4-H members take part in a state agricultural fair, after which one of the boys comes sick. But luckily they have also attended the CDC’s Disease Detective Camp in Atlanta and use their newly acquired detective skills to find out why their friend got sick.

That is the story in “The Junior Disease Detectives: Operation Outbreak,” the new graphic novel the CDC has developed with the Department of Agriculture and 4-H.

Spoiler alert: it was the flu. The novel is designed to help young people understand the potential health risks of human influenza viruses that normally circulate in swine, known as variant flu infections.

Four new variant virus infections have been associated with attendance at agricultural fairs in 2 US states, the CDC reports. Most are connected to infected pigs or their environments in fair settings. While variant flu infections in people are rare, the CDC says, they can lead to hospitalization and death. In 2017, 67 variant virus infections were reported in the US; 6 resulted in hospitalization, including 2 ICU admissions.

The novel is intended for use in middle and high school science, technology, engineering, and mathematics (STEM) classrooms. It is the first of a planned series of educational activities being rolled out throughout the 2018-2019 school year.

The novel is available as a free mobile app, and can be downloaded at https://www.cdc.gov/flu/resource-center/freeresources/graphic-novel/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fgraphicnovel%2Findex.html.

In 2015, researchers showed that polioviruses could travel in groups—or “packets”—that is, membrane-bound vesicles containing multiple virus particles. The researchers used the Trojan horse analogy to describe it. But they could not say whether the system applied to animals and humans, or how effective the “horses” were in infecting host cells.

To find out, the researchers focused on rotaviruses and noroviruses, which are mainly spread through stool-contaminated food or liquids. And they found that the viruses were indeed shed as packet-enclosed clusters in the stool. Moreover, the virus clusters were significantly more infectious than the free, unbound viruses in the fecal samples tested.

The researchers say the high level of infectiousness is likely due to the vesicles delivering many viruses at once to the target tissue. The vesicles also protect their “viral cargo” from being destroyed by prolonged exposure to enzymes and may even make it invisible to the antibodies in the stool or gut.

The virus packets are not only extremely potent, but aggressive. More studies are needed, and more antivirals, the researchers say, but in the meantime, soap and water can help keep them down.

In 2015, researchers showed that polioviruses could travel in groups—or “packets”—that is, membrane-bound vesicles containing multiple virus particles. The researchers used the Trojan horse analogy to describe it. But they could not say whether the system applied to animals and humans, or how effective the “horses” were in infecting host cells.

To find out, the researchers focused on rotaviruses and noroviruses, which are mainly spread through stool-contaminated food or liquids. And they found that the viruses were indeed shed as packet-enclosed clusters in the stool. Moreover, the virus clusters were significantly more infectious than the free, unbound viruses in the fecal samples tested.

The researchers say the high level of infectiousness is likely due to the vesicles delivering many viruses at once to the target tissue. The vesicles also protect their “viral cargo” from being destroyed by prolonged exposure to enzymes and may even make it invisible to the antibodies in the stool or gut.

The virus packets are not only extremely potent, but aggressive. More studies are needed, and more antivirals, the researchers say, but in the meantime, soap and water can help keep them down.

In 2015, researchers showed that polioviruses could travel in groups—or “packets”—that is, membrane-bound vesicles containing multiple virus particles. The researchers used the Trojan horse analogy to describe it. But they could not say whether the system applied to animals and humans, or how effective the “horses” were in infecting host cells.

To find out, the researchers focused on rotaviruses and noroviruses, which are mainly spread through stool-contaminated food or liquids. And they found that the viruses were indeed shed as packet-enclosed clusters in the stool. Moreover, the virus clusters were significantly more infectious than the free, unbound viruses in the fecal samples tested.

The researchers say the high level of infectiousness is likely due to the vesicles delivering many viruses at once to the target tissue. The vesicles also protect their “viral cargo” from being destroyed by prolonged exposure to enzymes and may even make it invisible to the antibodies in the stool or gut.

The virus packets are not only extremely potent, but aggressive. More studies are needed, and more antivirals, the researchers say, but in the meantime, soap and water can help keep them down.