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    <recommendedItem id="20100101_19_401"
                     title="Perinatal HIV Infection Highest Among Blacks"
                     score="0.012"
                     href="http://www.medpagetoday.com/HIVAIDS/HIVAIDS/tb/18305?impressionId=1265801269045"
                     
      &lt;p&gt;The rate of mother-to-child HIV transmission among infants is 23 times higher for blacks than whites, the CDC reported.&lt;/p&gt;
&lt;p&gt;Although rates of perinatal HIV infection have fallen by more than 90% since the 1990s, racial and ethnic disparities not only remain but may be increasing, the agency said in the Feb. 5 issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The finding comes from an analysis of surveillance data from the 34 states that have had confidential name-based reporting since at least December 2003, the agency said.&lt;/p&gt;
&lt;p&gt;In those states, from 2004 through 2007, the overall rate of diagnoses of perinatal HIV infection among children a year old or younger was 2.7 per 100,000, the agency said.&lt;/p&gt;
&lt;p&gt;But the rate among blacks was 12.3 per 100,000, compared with 2.0 for children who were Hispanic, 1.6 for those of other or multiple races, and 0.5 for white infants.&lt;/p&gt;
&lt;p&gt;Compared with the rate among white infants, the rate ratios were 23.1, 3.8, and 3.1 for black, Hispanic, and children of other or multiple races, respectively, the CDC said.&lt;/p&gt;
&lt;p&gt;On the positive side, rates fell significantly during the period for black and Hispanic children  --  from 14.8 to 10.2 per 100,000 for blacks and from 2.9 to 1.7 per 100,000 for Hispanics, the CDC found. The changes were significant at &lt;em&gt;P&lt;/em&gt;=0.003 and &lt;em&gt;P&lt;/em&gt;=0.04, respectively.&lt;/p&gt;
&lt;p&gt;There were no significant changes for white children and those of other or multiple races, the CDC said.&lt;/p&gt;
&lt;p&gt;During the study period, 69% of all children younger than 13 who were diagnosed with HIV were black, 16% were Hispanic, 11% were white, and 4% were of other or multiple races.&lt;/p&gt;
&lt;p&gt;The CDC said that racial and ethnic disparities in HIV/AIDS incidence among children have been known since 1981-1986, when 78% of children with AIDS were either black or Hispanic. Similar disparities have been seen in rates of perinatal HIV infection, the CDC said.&lt;/p&gt;
&lt;p&gt;The annual total of perinatal HIV infections has fallen about 90% since 1991, the agency said, but, despite that, 85% of reported infections during 2004-2007 were in children who were black or Hispanic.&lt;/p&gt;
&lt;p&gt;One limitation of the study, the CDC said, is that the data come from only 34 states and may not give a complete picture, especially since some areas with high AIDS morbidity  --  such as California and the District of Columbia  --  were left out.&lt;/p&gt;
&lt;p&gt;But, the agency argued, the findings in this report are &quot;consistent&quot; with disparities seen among people with AIDS from all 50 states.&lt;/p&gt;
&lt;p&gt;To eliminate perinatal HIV transmission, the CDC said all HIV-infected pregnant women must: &lt;ul&gt; &lt;li&gt;Be diagnosed before they get pregnant or soon after&lt;/li&gt; &lt;li&gt;Get prenatal care&lt;/li&gt; &lt;li&gt;Follow an antiretroviral regimen during pregnancy&lt;/li&gt; &lt;li&gt;Have a cesarean delivery at 38 weeks&apos; gestation if the virus has not been suppressed&lt;/li&gt; &lt;li&gt;Get antiretroviral medication during labor and delivery&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Antiretroviral medication also should be given to the newborns within the first hours after birth and for the first six weeks of life, the CDC said.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_344"
                     title="FDA Revises HIV Drug Label for Liver Complication"
                     score="0.009"
                     href="http://www.medpagetoday.com/ProductAlert/DevicesandVaccines/tb/18229?impressionId=1265801269045"
                     
      &lt;p&gt;WASHINGTON  --  The FDA has updated labels of the HIV drug didanosine (Videx and Videx EC) to include warnings for potentially serious liver damage.&lt;/p&gt;
&lt;p&gt;Although these cases are rare, the drug may cause noncirrhotic hypertension in patients, a potentially fatal complication which the FDA discovered through 42 postmarket, adverse event reports.&lt;/p&gt;
&lt;p&gt;Of those patients, three required liver transplant and four died. Two deaths were caused by esophageal hemorrhage, while two more were caused by progressive liver failure.&lt;/p&gt;
&lt;p&gt;One patient suffered multiorgan failure, cerebral hemorrhage, sepsis, and lactic acidosis.&lt;/p&gt;
&lt;p&gt;The FDA said in a statement that it chose not to recall the drug because it believes its benefits outweigh potential risks, but advised that treatment decisions be made on an individual basis between healthcare professionals and patients.&lt;/p&gt;
&lt;p&gt;The agency added that causal association is difficult to determine in postmarket reports, but that alternative causes of the hypertension were ruled out in well-documented cases.&lt;/p&gt;
&lt;p&gt;Healthcare professionals who determine didanosine is effective in treating a patient should monitor that patient for the development of portal hypertension and esophageal varices, the agency said.&lt;/p&gt;
&lt;p&gt;Didanosine is used in combination with other HIV medications to help maintain CD4 cells in patients.&lt;/p&gt;
&lt;p&gt;The drug already has a black box warning for lactic acidosis and hepatomegaly with steatosis.&lt;/p&gt;
&lt;p&gt;Like the antiretroviral agents hydroxyurea and ribavirin, didanosine has been associated with the development of liver toxicity.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_217"
                     title="Herpes Therapy Doesn&apos;t Bar HIV Transmission (CME/CE)"
                     score="-0.002"
                     href="http://www.medpagetoday.com/HIVAIDS/HIVAIDS/tb/18071?impressionId=1265801269045"
                     
      &lt;p&gt;Treating herpes has no effect on the transmission of HIV among discordant couples, researchers said.&lt;/p&gt;
&lt;p&gt;The lack of efficacy was found in a large, randomized clinical trial despite significant reductions in HIV viral load among those treated for herpes simplex-2 (HSV-2), according to Connie Celum, MD, of the University of Washington, and colleagues.&lt;/p&gt;
&lt;p&gt;Researchers will have to look for new ways to prevent transmission among discordant couples (in which one partner has HIV and the other does not), Celum and colleagues concluded online in the&lt;em&gt; New England Journal of Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;The study comes after earlier trials also showed that treating HSV-2 with the antiviral acyclovir (Zovirax) did not lower the risk of getting HIV. (See &lt;a href=&quot;http://www.medpagetoday.com/HIVAIDS/HIVAIDS/9884&quot; mce_href=&quot;http://www.medpagetoday.com/HIVAIDS/HIVAIDS/9884&quot; target=&quot;_blank&quot;&gt;Herpes Treatment No Help in Preventing HIV&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;The trials  --  and the current study  --  had their origins in epidemiological and laboratory observations that having an HSV-2 infection increased the risk of contracting HIV.&lt;/p&gt;
&lt;p&gt;Researchers reasoned that a converse effect might also be true  --  treating HSV-2 in HIV-negative people might reduce their risk of infection.&lt;/p&gt;
&lt;p&gt;The reasoning was bolstered by clinical trials showing that treating HSV-2 in HIV-positive people lowered their viral load.&lt;/p&gt;
&lt;p&gt;In the current study, that effect also occurred. HIV-positive volunteers treated with acyclovir saw, on average, a reduction in plasma concentration of HIV by 0.25 log&lt;sub&gt;10&lt;/sub&gt; copies per milliliter compared with members of the placebo group. The difference was significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001.&lt;/p&gt;
&lt;p&gt;But transmission among the couples was not affected, implying that a greater reduction in viral load is needed, the researchers said.&lt;/p&gt;
&lt;p&gt;The study, randomized and placebo-controlled, included 3,408 couples in Africa in which only one of the partners had HIV (but was not taking antiretroviral therapy) and also had an HSV-2 infection.&lt;/p&gt;
&lt;p&gt;The outcome was first reported at the Cape Town meeting of the International AIDS Society last year (See &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/IAS/15242&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/IAS/15242&quot; target=&quot;_blank&quot;&gt;IAS: Acyclovir Flops in Preventing HIV Transmission&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;The primary outcome was transmission between partners, verified by genetic sequencing of the virus.&lt;/p&gt;
&lt;p&gt;Transmission between partners was verified in 84 of the 132 recorded cases of transmission, the researchers said, and they were evenly divided  --  41 among those getting the drug and 43 in the placebo group.&lt;/p&gt;
&lt;p&gt;On the other hand, the use of the drug reduced the occurrence of herpes lesions by 73%, which was significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001.&lt;/p&gt;
&lt;p&gt;The reduction of herpes lesions suggests that the drug was being used, the researchers said, and therefore that the lack of efficacy against HIV was not a result of nonadherence to acyclovir.&lt;/p&gt;
&lt;p&gt;Overall, the rate of HIV transmission in the study was 2.7 cases per 100 person-years, markedly lower than earlier observations. The researchers attributed that to such interventions as monthly counseling on risk reduction and free condoms.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study had support from the Bill and Melinda Gates Foundation, as well as the University of Washington, the National Institute of Allergy and Infectious Diseases, Gen-Probe, and the National Institute of Mental Health.&lt;/p&gt;&lt;p&gt;Celum reported financial links with GlaxoSmithKline and several other authors reported links with various pharamceutical companies.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_205"
                     title="Slim Evidence for Effect of Home Care on HIV Treatment (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/HIVAIDS/HIVAIDS/tb/18037?impressionId=1265801269045"
                     
      &lt;p&gt;Home-based care can improve some aspects of HIV treatment, according to a systematic review of reported studies.&lt;/p&gt;
&lt;p&gt;But the evidence is slim, and no studies looked at how home-based care affects AIDS progression or death, according to Taryn Young, MBChB, of the Medical Research Council of South Africa, and Karishma Busgeeth of the Council for Scientific and Industrial Research in Pretoria, South Africa.&lt;/p&gt;
&lt;p&gt;In addition, few of the studies evaluated home-based care in developing countries, where it is being considered to alleviate pressure on hospitals, the researchers noted in a &lt;em&gt;Cochrane Systematic Review&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Home-based care is aimed at improving quality of life and reducing the need for hospital care, &quot;especially where public health services are overburdened,&quot; the researchers wrote in the review.&lt;/p&gt;
&lt;p&gt;But there has been no systematic evaluation of home-based care in the setting of HIV/AIDS, they said.&lt;/p&gt;
&lt;p&gt;To help fill the gap, they found 13 published reports, referring to 11 randomized clinical trials, as well as two such trials currently under way.&lt;/p&gt;
&lt;p&gt;Of the 11 studies with published reports, 10 randomized individuals and one (in Uganda, the only one conducted in Africa) randomized households.&lt;/p&gt;
&lt;p&gt;The studies looked at a range of interventions: &lt;ul&gt; &lt;li&gt;Three studies evaluated home-based intensive nursing versus standard care for effects on patient knowledge of HIV and related medication, adherence, viral load, and CD4 counts.&lt;/li&gt; &lt;li&gt;Two studies compared a transprofessional team versus an independent primary care nurse. One looked at quality of life and survival and the other at the time patients spent in the program, as well as cost.&lt;/li&gt; &lt;li&gt;Two studies compared the effect of computer-based education versus brochures, nothing, or standard medical care on such outcomes as perceived social isolation, decision-making confidence, health status, quality of life, risk behaviors, and health service utilization.&lt;/li&gt; &lt;li&gt;Two studies looked at exercise.&lt;/li&gt; &lt;li&gt;One study looked at two months of home total parenteral nutrition versus dietary counseling.&lt;/li&gt; &lt;li&gt;One study of diarrhea compared home-based water chlorination, safe storage, and education with education alone.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The researchers reported that intensive home-based nursing significantly improved self-reported knowledge of HIV and medications, self-reported adherence, and differences in pharmacy drug refills.&lt;/p&gt;
&lt;p&gt;Another study, which looked at the proportion of participants with greater than 90% adherence, found statistically significant differences over time with home-based nursing. But that study found no significant change in CD4 counts and viral loads.&lt;/p&gt;
&lt;p&gt;The third such study found significant differences in HIV stigma, worry, and physical functioning but no differences in depressive symptoms, mood, general health, and overall functioning.&lt;/p&gt;
&lt;p&gt;The studies comparing comprehensive case management by transprofessional teams compared to usual care by primary care nurses showed no effect.&lt;/p&gt;
&lt;p&gt;The study comparing home total parenteral nutrition and dietary counseling found no significant impact on overall survival and rate of readmission to hospital.&lt;/p&gt;
&lt;p&gt;The two computer-based studies found no effect on health status and decision-making confidence and skill, but did find a reduction in social isolation after controlling for depression.&lt;/p&gt;
&lt;p&gt;The two trials evaluating home exercise programs found conflicting results.&lt;/p&gt;
&lt;p&gt;And the home-based safe water systems reduced diarrhea frequency and severity among persons with HIV in Africa, the researchers reported.&lt;/p&gt;
&lt;p&gt;In general, the researchers concluded that there were few studies; study populations tended to be small; and the studies did not address the effect of home-based care on important medical endpoints, such as mortality.&lt;/p&gt;
&lt;p&gt;&quot;Further large studies should therefore focus on evaluating these significant endpoints, on feasible interventions for developing countries, and on how home-based care fits into the current treatment context,&quot; they concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;There was no external support for the study. The researchers reported no conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_113"
                     title="HIV Switch Trial Succeeds and Fails (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/HIVAIDS/HIVAIDS/tb/17922?impressionId=1265801269045"
                     
      Changing HIV drug regimens reduced metabolic side effects in two clinical trials, researchers said  --  but, unfortunately, the switch resulted in some loss of control over the virus.&lt;br&gt;
&lt;br&gt;The unexpected loss of efficacy when patients changed from lopinavir and ritonavir (Kaletra) to raltegravir (Isentress) led to the trials being halted after 24 weeks, Peter Sklar, MD, of Merck Research Laboratories in North Wales, Pa., and colleagues reported online in &lt;em&gt;The Lancet&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Even so, the finding may not rule out the switch in some patients, the investigators said in the journal. An unplanned analysis showed that patients without a previous virological failure did equally well in both arms of the trial, they reported.&lt;br&gt;
&lt;br&gt;This means the results &quot;will probably generate some debate and controversy,&quot; J. Michael Kilby, MD, of the Medical University of South Carolina in Charleston, wrote in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;Although the unplanned analysis can&apos;t prove anything, he noted, it seems likely that cross-resistance to raltegravir, a so-called integrase inhibitor, had built up in some patients during previous treatment failures, even though they had not taken the drug itself.&lt;/p&gt;
&lt;p&gt;The result &quot;is a reminder that whenever possible, to assure sustained dependable activity, even our most promising antiretroviral agents should be used in combination with two or more fully active drugs,&quot; Kilby said.&lt;/p&gt;
&lt;p&gt;Protease inhibitors  --  such as lopinavir and ritonavir  --  have been associated with metabolic abnormalities such as elevated triglycerides, although other HIV drugs can also cause those and other side effects.&lt;/p&gt;
&lt;p&gt;But adverse events associated with raltegravir appeared to be minimal, so the drug&apos;s manufacturer, Merck, began parallel randomized, double-blind, double-dummy trials to test whether switching from stable lopinavir-ritonavir therapy to raltegravir would improve matters.&lt;/p&gt;
&lt;p&gt;All patients in the study would also continue background therapy with two or more nucleoside or nucleotide reverse transcriptase inhibitors.&lt;/p&gt;
&lt;p&gt;Combined, the two studies had 702 patients, with 350 switched to raltegravir and 352 remaining on lopinavir-ritonavir.&lt;/p&gt;
&lt;p&gt;Over the first 12 weeks after the switch, percentage changes in lipid concentrations were significantly greater at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001 in the raltegravir groups than in the lopinavir-ritonavir groups.&lt;/p&gt;
&lt;p&gt;Specifically: &lt;ul&gt; &lt;li&gt;Total cholesterol declined 12.6% among the raltegravir patients, compared with a gain of 1% among those who did not switch.&lt;/li&gt; &lt;li&gt;Non-HDL cholesterol fell 15% versus a gain of 2.6%. &lt;/li&gt; &lt;li&gt;Triglycerides declined 42.2% versus a gain of 6.2%.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;However, at week 24, only 84.4% of the patients in the raltegravir group had a viral load of less than 50 copies of viral RNA per milliliter of blood. In contrast, 90.6% of the lopinavir-ritonavir group had a viral load below that level.&lt;/p&gt;
&lt;p&gt;The treatment difference of minus 6.2 percentage points meant that raltegravir didn&apos;t meet a preset test for noninferiority.&lt;/p&gt;
&lt;p&gt;On the other hand, when the analysis was restricted to patients who had not previously experienced a treatment failure, the researchers found, success rates were not significantly different between the groups  --  89% for raltegravir and 90% for lopinavir-ritonavir.&lt;/p&gt;
&lt;p&gt;The finding &quot;underscores the complex considerations involved in providing the best possible treatment regimens for individual patients,&quot; Sklar and colleagues said in the journal.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The studies were sponsored by Merck. Sklar is an employee of the company and several other authors reported financial links with Merck or other pharmaceutical companies.&lt;/p&gt;&lt;p&gt;Kilby reported he had previously received research support from Merck.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>
