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    <recommendedItem id="20100101_19_401"
                     title="Perinatal HIV Infection Highest Among Blacks"
                     score="0.01"
                     href="http://www.medpagetoday.com/HIVAIDS/HIVAIDS/tb/18305?impressionId=1265783357402"
                     
      &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="20090101_19_1162"
                     title="Chronic Kidney Disease Slower to Kill Blacks"
                     score="-0.006"
                     href="http://www.medpagetoday.com/Nephrology/ESRD/tb/13748?impressionId=1265783357402"
                     
      TORONTO, April 16 -- In the later stages of chronic kidney disease -- but before dialysis is needed -- black patients are less likely to die than whites, U.S. researchers found.
              &lt;p&gt; 
              &lt;p&gt;On the other hand, blacks had a higher incidence of end-stage renal disease (ESRD), probably because of the increased earlier survival, according to Csaba Kovesdy, M.D., of the Salem VA Medical Center in Salem, Va., and colleagues.
              &lt;p&gt; 
              &lt;p&gt;Over time, however, the decline in kidney function was similar between whites and blacks, the researchers said online in the &lt;em&gt;Clinical Journal of the American Society of Nephrology&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;The finding parallels observations among dialysis patients, where blacks are over-represented but have better survival rates than whites, the researchers said.
              &lt;p&gt; 
              &lt;p&gt;To see what happens before dialysis is needed, the researchers studied outpatients referred to the Salem VA facility for nondialysis dependent chronic kidney disease between Jan. 1, 1990 and June 30, 2007, and followed them until April 1, 2008.
              &lt;p&gt; 
              &lt;p&gt;The 1,243 patients were 68 years old on average, 24% of them were black, and they had an average estimated glomerular filtration rate (GFR) of 37 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;.
              &lt;p&gt; 
              &lt;p&gt;All told, 451 patients died before starting dialysis and 267 reached ESRD during a median follow-up of 2.8 years.
              &lt;p&gt; 
              &lt;p&gt;In a crude analysis, blacks were markedly less likely to die, with a hazard ratio compared to whites of 0.75 (95% CI 0.59 to 0.95), which was significant at &lt;em&gt;P&lt;/em&gt;=0.02.
              &lt;p&gt; 
              &lt;p&gt;They were also substantially more likely to reach ESRD, with a hazard ratio of 1.64 (95% CI 1.28 to 2.12), which was significant at &lt;em&gt;P&lt;/em&gt;&lt;0.001.
              &lt;p&gt; 
              &lt;p&gt;However, when the researchers adjusted for case mix, baseline laboratory values, and medications, the differences become nonsignificant.
              &lt;p&gt; 
              &lt;p&gt;On the other hand, the decline in estimated GFR did not differ significantly before or after adjustment.
              &lt;p&gt; 
              &lt;p&gt;The difference in mortality, Dr. Kovesdy and colleagues said, was explained by the case mix of the study population, and especially differences in the baseline prevalence of cardiovascular disease between blacks and whites.
              &lt;p&gt; 
              &lt;p&gt;Blacks had significantly lower rates (at &lt;em&gt;P&lt;/em&gt;&lt;0.001) of atherosclerotic cardiovascular disease -- 44% versus 61% -- when they entered the study, the researchers noted.
              &lt;p&gt; 
              &lt;p&gt;And that lower all-cause mortality appeared to be mostly responsible for the higher incidence of ESRD in black patients, they said.
              &lt;p&gt; 
              &lt;p&gt;Since the estimated GFR was similar between groups, the increased incidence of ESRD among blacks was unlikely to be a result of faster progression, the researchers said.
              &lt;p&gt; 
              &lt;p&gt;The study&apos;s limitations include its retrospective nature and the fact that participants were male patients from a single medical center, which may mean results are not representative of the overall population with nondialysis dependent chronic kidney disease. In addition, the referral population had a relatively high rate of ESRD incidence, which may not be representative of the general population, the researchers said.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases.
              &lt;p&gt; 
              &lt;p&gt;The researchers did not report any conflicts.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
          
    </recommendedItem>
    <recommendedItem id="20090101_3_383"
                     title="High Uric Acid Levels Signal Hypertension in Blacks"
                     score="-0.008"
                     href="