New Regimens to Prevent Tuberculosis in Adults with HIV Infection

 http://www.nejm.org/doi/pdf/10.1056/NEJMoa1005136

Background
Treatment of latent tuberculosis in patients infected with the human immunodeficiency
virus (HIV) is efficacious, but few patients around the world receive such treatment.
We evaluated three new regimens for latent tuberculosis that may be more
potent and durable than standard isoniazid treatment.
Methods
We randomly assigned South African adults with HIV infection and a positive tuberculin
skin test who were not taking antiretroviral therapy to receive rifapentine
(900 mg) plus isoniazid (900 mg) weekly for 12 weeks, rifampin (600 mg) plus isoniazid
(900 mg) twice weekly for 12 weeks, isoniazid (300 mg) daily for up to 6 years
(continuous isoniazid), or isoniazid (300 mg) daily for 6 months (control group). The
primary end point was tuberculosis-free survival.
Results
The 1148 patients had a median age of 30 years and a median CD4 cell count of
484 per cubic millimeter. Incidence rates of active tuberculosis or death were 3.1 per
100 person-years in the rifapentine–isoniazid group, 2.9 per 100 person-years in the
rifampin–isoniazid group, and 2.7 per 100 person-years in the continuous-isoniazid
group, as compared with 3.6 per 100 person-years in the control group (P>0.05 for
all comparisons). Serious adverse reactions were more common in the continuousisoniazid
group (18.4 per 100 person-years) than in the other treatment groups (8.7
to 15.4 per 100 person-years). Two of 58 isolates of Mycobacterium tuberculosis (3.4%)
were found to have multidrug resistance.
Conclusions
On the basis of the expected rates of tuberculosis in this population of HIV-infected
adults, all secondary prophylactic regimens were effective. Neither a 3-month course
of intermittent rifapentine or rifampin with isoniazid nor continuous isoniazid was
superior to 6 months of isoniazid. (Funded by the National Institute of Allergy and
Infectious Diseases and others; ClinicalTrials.gov number, NCT00057122.)

CHronIC Care for HIV and nonCommunICable dIseases

Estimados colegas  aqui les envio la información para el cuidado integral de las personas viviendo con VIH , y con enfermedades  crónicas no transmisibles.

Este es el link para bajarse el libro en PDF.

http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20110526_JC2145_Chronic_care_of_HIV.pdf

Saludos

Carlos Erazo

INFORMACIÓN DISPONIBLE SOBRE VIH - SIDA EN ECUADOR.

HIV/AIDS SURVEILLANCE DATA BASE

COUNTRY AND RECORD SELECTION CRITERIA
HOME		MAPS	HELP

ESTIMADOS COLEGAS ESTE ES EL LINK PARA IDENTIFCIAR LA FUENTE DE LA INFORMACION DISPONIBLE EN EL ECUADOR Y CONOCIDA EN EL MUNDO ENTERO.




 http://hivaidssurveillancedb.org/hivdb/RecordSelPage.aspx

SALUDOS

DR. CARLOS ERAZO


Prevalence, in Percent, of Human Immunodeficiency Virus (HIV) for: Ecuador

  Number of records found = 79.Data Quality = All

Geographic Area	Reference Date	Population SubGroup	Sex	Age	Prev. Rate	Sample Size	Virus Type	Specimen Type	Type of Test	Source ID	Comments
Chone	2001	Homosexuals	M	ALL	0	44	HIV1	BW	ELISA, WB	M0835	Port city.
Colta	1988-1989	Indian urban population	B	ALL	0	94	HIV1	B	ELISA, WB	C0103	Located in Chimborazo Province.
Colta	1988-1989	Indian urban population	B	ALL	0	94	HIV2	B	ELISA, WB	C0103	Located in Chimborazo Province.
De Agosto	1988-1989	Indian urban population	B	ALL	0	17	HIV1	B	ELISA, WB	C0103	Located in Pastaza Province.
De Agosto	1988-1989	Indian urban population	B	ALL	0	17	HIV2	B	ELISA, WB	C0103	Located in Pastaza Province.
Eastern Ecuador	1983	Indians	B	ALL	0	70	HIV	B	ELISA	L0031	Waorani Indians.
Esmeraldas	1988	Volunteers	B	ALL	0	422	HIV	B	ELISA, WB	R0020
Esmeraldas	1988	Homosexuals	M	ALL	0	20	HIV	B	ELISA, WB	R0020
Esmeraldas	1988-1989	Black prostitutes	F	ALL	0	37	HIV2	B	ELISA, WB	C0103	Located in Esmeraldas province.
Esmeraldas	1988-1989	Black prostitutes	F	ALL	0	37	HIV1	B	ELISA, WB	C0103	Located in Esmeraldas Province.
Esmeraldas	1988	Prostitutes	F	ALL	1.56	64	HIV	B	ELISA	R0020
Four cities	2001-2002	Homosexuals	M	ALL	2.82	142	HIV1	BW	ELISA*2, WB	M0886	Men having sex w/ men (MSM). Age 18+. Also, see B0549.
Guayaquil	1999-2001	Homosexuals	M	ALL	27.75	227	HIV1	BW	ELISA*2, WB	M0886	Men having sex w/ men (MSM). Age 18+. Also, see B0549.
Guayaquil	1992	STI pts.	B	ALL	1.28	390	HIV1	B	ELISA, WB	R0148	Attending a STI clinic. Age range 15-45 yrs. Apr. 92.
Guayaquil	1992	STI pts.	B	ALL	1.79	390	HIV1	B	ELISA, WB	B0300
Guayaquil	2000-2001	Prostitutes	F	ALL	2.1	1047	HIV1	BW	ELISA*2, WB	M0886	Recruited from brothels, saunas, massage houses, parks, & streets. Age 18+. Also, see B0598.
Guayaquil	1992	Pregnant women	F	ALL	0.26	390	HIV1	B	ELISA, WB	B0300	Age range 15-45 yrs.
Guayaquil	2001	Homosexuals	M	ALL	24.74	97	HIV1	BW	ELISA, WB	M0835	Port city.
Guayaquil	1992	STI pts.	B	ALL	1.93	1190	HIV1	B	ELISA, WB	R0104	Largest city in Ecuador.
Guayaquil	1993	STI pts.	B	ALL	3.58	1395	HIV1	B	ELISA, WB	R0104	Largest city in Ecuador.
Guayaquil	2006	Homosexuals	M	ALL	19	541	HIV	B	RAPID,WB	G0474	Men having sex with men (MSM). Prevalence approximated from a graph. Feb. - June 06. RAPID test: Determine.
National	1988	Blood donors - volunteer	B	ALL	0	25358	HIV	B	ELISA, WB	L0035	Includes donors from Quito & provincial cities. Sept. 86 - Dec. 88.
National	1986	Blood donors - volunteer	B	ALL	0.03	6524	HIV	B	ELISA, WB	L0035	Includes donors from Quito & provincial cities. Sept. 86 - Dec. 88.
National	1994	Blood donors	B	ALL	0.1	88133	HIV	B	ELISA	S0326	90 % of blood donors were screened.
National	1987	Blood donors - volunteer	B	ALL	0	20282	HIV	B	ELISA, WB	L0035	Includes donors from Quito & provincial cities. Sept. 86 - Dec. 88.
Not specified	1989(?)	Hemophiliacs	B	ALL	0	141	HIV	B	ELISA, WB	R0020
Not specified	1988	Military recruits	B	ALL	0	7187	HIV	B	ELISA, WB	L0035	Group also includes other institutional personel.
Not specified	1999-2002	Prostitutes	F	ALL	1.8	N/A	HIV1	BW	ELISA, WB	C0504	Only the prevalence rate was given. Age 18+. Recruited from brothels, massage parlors, hotels, & streets.
Not specified	1988	Promiscuous individuals	B	ALL	0	91	HIV	B	ELISA, WB	L0035
Not specified	1988	Prostitutes	F	ALL	0	100	HIV	B	ELISA, WB	L0035
Not specified	1989	Blood donors	B	ALL	0.02	28672	HIV	B	UNK	R0043
Not specified	1988	Hemophiliacs	B	ALL	1.75	57	HIV	B	ELISA, WB	L0035
Not specified	2008(?)	Homosexuals	M	ALL	15.1	916	HIV	B	UNK	B0741	Men having sex w/ men (MSM).
Not specified	1988	Homosexuals & bisexuals	M	ALL	57.69	26	HIV	B	ELISA, WB	L0035
Portoviejo	2001	Homosexuals	M	ALL	4.08	98	HIV1	BW	ELISA, WB	M0835	Port city.
Quininde	1988	Prostitutes	F	ALL	0	100	HIV	B	ELISA, WB	R0020
Quito	2000-2001	Prostitutes	F	ALL	0.5	200	HIV1	BW	ELISA*2, WB	M0886	Recruited from brothels, saunas, massage houses, parks, & streets. Age 18+. Also, see B0598.
Quito	1988	Blood donors - volunteer	B	ALL	0	17884	HIV	B	ELISA, WB	R0020	Red Cross blood bank.
Quito	1992	Blood donors	B	ALL	0	N/A	HIV1	B	ELISA, WB	R0093	Only the prevalence rate was given.
Quito	1988-1989	Out-pts.	B	ALL	0	50	HIV2	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	1991	STI pts.	B	ALL	1.4	143	HIV1	B	UNK	R0104	Various STI treatment sites.
Quito	1988-1989	Prostitutes	F	ALL	0	94	HIV2	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	2001	Homosexuals	M	ALL	11.11	45	HIV1	BW	ELISA, WB	M0835	Located in Andean region.
Quito	1987	Blood donors - volunteer	B	ALL	0	955	HIV	B	ELISA, WB	R0020	Other blood banks.
Quito	1990	Prostitutes - high SES/income	F	ALL	0	151	HIV1	B	ELISA, WB	R0054	High social economic status. Worked in bars & nightclubs in Mariscal area in the Red Zone of Quito. Oct. - Dec. 90.
Quito	1988-1989	Hospital personnel	B	ALL	0	57	HIV2	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	1986	Partners of AIDS pts.	F	ALL	6.25	16	HIV	B	ELISA, WB	R0020
Quito	1988	Homosexuals	M	ALL	28.57	14	HIV	B	ELISA, WB	R0020
Quito	1988-1989	STI pts.	B	ALL	0	159	HIV1	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	1988-1989	Prostitutes	F	ALL	0	94	HIV1	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	1988-1989	STI pts.	B	ALL	0	159	HIV2	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	1988-1989	Hospitalized pts.	B	ALL	0	99	HIV2	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	1988-1989	Blood donors	B	ALL	0	396	HIV2	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	1988	Blood donors - volunteer	B	ALL	0	1429	HIV	B	ELISA, WB	R0020	Other blood banks.
Quito	1992	STI pts.	B	ALL	0.52	191	HIV1	B	ELISA, WB	R0093	Four STI centers.
Quito	1988-1989	Hospitalized pts.	B	ALL	0	99	HIV1	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	1999-2001	Homosexuals	M	ALL	14.45	263	HIV1	BW	ELISA*2, WB	M0886	Men having sex w/ men (MSM). Age 18+. Also, see B0549.
Quito	1991	STI pts.	B	ALL	1.23	163	HIV1	B	ELISA, WB	R0093	Four STI centers. Nov. - Dec. 91.
Quito	1988-1989	Blood donors	B	ALL	0.51	396	HIV1	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	1988-1989	Out-pts.	B	ALL	0	50	HIV1	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	1988-1989	Hospital personnel	B	ALL	0	57	HIV1	B	ELISA, WB	C0103	Race: White & halfcaste.
Quito	1988	Prisoners	B	ALL	0	662	HIV	B	ELISA, WB	R0020
Quito	1987	Military cadets	B	ALL	0	487	HIV	B	ELISA, WB	R0020
Quito	1987	Blood donors - volunteer	B	ALL	0	16978	HIV	B	ELISA, WB	R0020	Red Cross blood bank.
Quito & Guayaquil	2000-2001	Prostitutes	F	18Y25Y	1.86	590	HIV1	BW	ELISA*2, WB	B0598	Recruited from brothels, saunas, massage houses, parks, & streets.
Quito & Guayaquil	2000-2001	Prostitutes	F	ALL	1.84	1247	HIV1	BW	ELISA*2, WB	B0598	Recruited from brothels, saunas, massage houses, parks, & streets. Age 18+. Breakdown by age is provided & by city in M0886.
Quito & Guayaquil	2000-2001	Prostitutes	F	26Y+	1.69	650	HIV1	BW	ELISA*2, WB	B0598	Recruited from brothels, saunas, massage houses, parks, & streets.
Quito & Guayaquil	1987-1988	Prostitutes	F	ALL	0	369	HIV	B	UNK	R0054
San Cristobal island	1988-1989	General population	B	ALL	0	127	HIV1	B	ELISA, WB	C0103	Located in Galapagos Province.
San Cristobal island	1988-1989	General population	B	ALL	0	127	HIV2	B	ELISA, WB	C0103	Located in Galapagos Province.
Sangolqui	1988-1989	Indian urban population	B	ALL	0	53	HIV1	B	ELISA, WB	C0103
Sangolqui	1988-1989	Indian urban population	B	ALL	0	53	HIV2	B	ELISA, WB	C0103
Six cities	1999-2002	Homosexuals	M	ALL	16.61	632	HIV1	BW	ELISA*2, WB	B0549	Cities: Quito, Guayaquil, & 4 port cities. Breakdown by age is provided.
Six cities	1999-2002	Homosexuals	M	25Y29Y	23.2	125	HIV1	BW	ELISA*2, WB	B0549	Cities: Quito, Guayaquil, & 4 port cities.
Six cities	1999-2002	Homosexuals	M	30Y+	20.4	201	HIV1	BW	ELISA*2, WB	B0549	Cities: Quito, Guayaquil, & 4 port cities.
Six cities	1999-2002	Homosexuals	M	18Y20Y	11.11	126	HIV1	BW	ELISA*2, WB	B0549	Cities: Quito, Guayaquil, & 4 port cities.
Six cities	1999-2002	Homosexuals	M	21Y24Y	11.9	168	HIV1	BW	ELISA*2, WB	B0549	Cities: Quito, Guayaquil, & 4 port cities.
St. Domingo	1987	Prostitutes	F	ALL	0	105	HIV	B	ELISA, WB	R0020
Sucumbios Province	1993	Prostitutes	F	ALL	0	390	HIV1	B	ELISA	B0300	Age range 18-50 yrs.

ANALISIS SITUACIONAL DE LOS SISTEMAS DE MONITOREO Y EVALUACIÓN DE LOS PROGRAMAS NACIONALES DE VIH/sida DE LA SUBREGION ANDINA Bolivia, Colombia, Chile, Ecuador, Perú y Venezuela 2008

ANALISIS SITUACIONAL DE LOS SISTEMAS DE
MONITOREO Y EVALUACIÓN DE LOS PROGRAMAS
NACIONALES DE VIH/sida DE LA SUBREGION
ANDINA 2008
Bolivia, Colombia, Chile, Ecuador, Perú y Venezuela

http://bvs.per.paho.org/SCT/SCT2008-008/SCT2008008.pdf

Reunión de Alto Nivel sobre el Sida de 2011

http://www.unaids.org/es/aboutunaids/unitednationsdeclarationsandgoals/2011highlevelmeetingonaids/

"La respuesta mundial al sida continúa dando frutos: un número sin precedente de personas accede al tratamiento y las tasas de nuevas infecciones por el VIH han descendido en casi un 25%

En el momento en que se cumplen 30 años desde que se registrara el primer caso de sida (5 de junio de 1981), el ONUSIDA calcula que 34 millones de personas [30,9 millones- 36,9 millones] viven con el VIH en todo el mundo y que prácticamente 30 millones [25 millones-33 millones] han fallecido por causas relacionadas con el sida.

NUEVA YORK/Ginebra, 3 de junio de 2011—A finales de 2010, en torno a 6,6 millones de personas recibían terapia antirretrovírica en países de ingresos bajos y medios, lo que supone una cifra casi 22 veces superior a la de 2001, según un nuevo informe presentado hoy por el Programa Conjunto de las Naciones Unidas sobre el VIH/Sida (ONUSIDA), titulado Treinta años de sida: las naciones en un punto clave del camino (en inglés).

En 2010, un número récord de 1,4 millones de personas inició por primera vez el tratamiento antirretrovírico, una cifra muy superior a cualquier año previo. Según el informe, al menos 420.000 niños recibían terapia antirretrovírica a finales de 2010, lo que supone un aumento superior al 50% respecto a los 275.000 que lo hicieron en 2008.
 “El acceso al tratamiento transformará la respuesta al sida en la próxima década. Debemos invertir en acelerar el acceso a la terapia del VIH y en encontrar nuevas opciones de tratamiento”, afirmó Michel Sidibé, director ejecutivo del ONUSIDA. “La terapia antirretrovírica es ahora más que nunca un gran motor para el cambio: no solo impide que las personas mueran, sino que también evita nuevas infecciones por el VIH en hombres, mujeres y niños”.

Esta declaración alude a los resultados del ensayo HPTN052 , publicados el 12 de mayo de 2011, que demostraron que si una persona que vive con el VIH se adhiere a una posología antirretrovírica efectiva, el riesgo de transmitir el virus a su pareja sexual seronegativa se puede reducir en un 96%.
 “Los países deben hacer uso de lo mejor que la ciencia puede ofrecer para evitar nuevas infecciones por el VIH y muertes relacionadas con el sida”, afirmó la Vicesecretaria General de las Naciones Unidas, Asha-Rose Migiro. “Estamos en un momento crucial en la respuesta al sida. El objetivo de alcanzar el acceso universal a la prevención, el tratamiento, la atención y el apoyo relacionados con el VIH para 2015 debe convertirse en una realidad”.

Las iniciativas de prevención del VIH están dando frutos
Según el informe, la tasa mundial de nuevas infecciones por el VIH se redujo en prácticamente un 25% entre 2001 y 2009: en la India, este descenso fue superior al 50%; y en Sudáfrica, al  35%. Ambos países albergan al mayor número de personas que viven con el VIH en sus continentes.
El informe concluye que en la tercera década de la epidemia, las personas estaban comenzando a adoptar comportamientos sexuales más seguros, lo que refleja la repercusión de las iniciativas de prevención y sensibilización. Sin embargo, todavía hay escollos importantes. Los varones jóvenes suelen estar más informados sobre la prevención del VIH que sus coetáneas: las últimas encuestas demográficas y de salud arrojaron que en torno al 74% de éstos sabían que los preservativos eran efectivos para prevenir la infección por el VIH, mientras que entre las jóvenes, esta cifra solo era del 49%.
En los últimos años se han producido avances importantes en la prevención de nuevas infecciones entre niños gracias al aumento del número de mujeres embarazadas seropositivas que ha accedido a la profilaxis antirretrovírica durante el embarazo, el parto y la lactancia. El número de nuevas infecciones por el VIH en niños fue en 2009 un 26% menor que en 2001.
Unos 115 países de ingresos bajos y medios están ofreciendo un tratamiento óptimo a las mujeres embarazadas que viven con el VIH siguiendo las recomendaciones de la Organización Mundial de la Salud. Sin embargo, 31 países todavía utilizan terapias subóptimas en muchos de sus programas. El ONUSIDA insta a todas estas naciones a revisar sus directrices de tratamiento y hacer la transición a los tratamientos óptimos recomendados por la OMS."

"En sida no ha sido erradicado, todavía quedan retos importantes

Según las últimas estimaciones del ONUSIDA, 34 millones de personas [30,9 millones-36,9 millones] vivían con el VIH a finales de 2010, y cerca de 30 millones [25 millones-33 millones] habían muerto por causas relacionadas con el sida desde que se registrara la enfermedad por primera vez hace 30 años.
A pesar de la expansión del acceso a la terapia antirretrovírica, todavía hay un gran déficit de tratamiento. A finales de 2010, nueve millones de personas elegibles para seguir la terapia no podían acceder a ella. El acceso para los niños es aún más limitado que para los adultos: en 2009, solo el 28% de los niños elegibles recibían tratamiento, mientras que para las personas de todas las edades la cobertura era del 36%.
Aunque la tasa de nuevas infecciones por el VIH ha descendido globalmente, el número total de infecciones sigue siendo muy alto, en torno a 7.000 cada día. La reducción global de la tasa de nuevas infecciones oculta las variaciones regionales. Según el informe, África subsahariana y Asia sudoriental fueron las regiones donde el descenso en el número de nuevas infecciones superó la media, mientras que en América Latina y el Caribe fueron más modestos, de apenas un 25%. Por otro lado, esta tasa ha aumentado en Europa oriental, Oriente Medio y África septentrional.
En prácticamente todos los países la prevalencia del VIH en las personas más expuestas al riesgo de infección (hombres que tienen relaciones sexuales con hombres, usuarios de drogas inyectables, profesionales del sexo y sus clientes, y personas transgénero) es mayor que en otra poblaciones. El acceso de estos grupos a la prevención y el tratamiento es generalmente menor debido a la existencia de leyes punitivas y discriminatorias, así como al estigma y la discriminación. Según los datos de abril de 2011, 79 países, territorios y áreas penalizan las relaciones homosexuales consentidas; 116 países, territorios y áreas penalizan algún aspecto del trabajo sexual; y 32 países tienen leyes que permiten la pena de muerte por delitos relacionados con drogas.
Según el informe, las desigualdades de género también siguen siendo un gran obstáculo para responder de manera efectiva al VIH. El virus es la principal causa de muerte de mujeres en edad reproductiva, y más de un cuarto (26%) de todas las nuevas infecciones se dan en mujeres de entre 15 y 24 años.
Se reducen los recursos destinados al sida
Según el informe, las inversiones en la respuesta al VIH en los países de ingresos bajos y medios prácticamente se multiplicaron por 10 entre 2001 y 2009, de USD 1.600 millones a USD 15.900 millones. Sin embargo, los recursos internacionales destinados al VIH se redujeron en 2010. Muchos países de ingresos bajos siguen dependiendo ampliamente de financiación externa. En 56 países, los donantes internacionales cubren, como mínimo, el 70% de los recursos para el VIH.
“Me preocupa que las inversiones internacionales se estén reduciendo en un momento en el que la respuesta al sida está consiguiendo resultados para las personas”, afirmó Sidibé. “Si no invertimos ahora, lo pagaremos con creces en el futuro”.
En 2011, el ONUSIDA y sus asociados propusieron un marco de inversión que concluyó que para 2015 se necesita una inversión de al menos USD 22.000 millones, 6.000 más de los que se dispone actualmente. La repercusión es mayor cuando estas inversiones se destinan a un conjunto de programas prioritarios que se basan en un tipo de epidemia nacional. Se estima que con una inversión de esta magnitud se conseguirán evitar hasta 2020 diez millones de nuevas infecciones por el VIH y 7,4 millones de muertes relacionadas con el sida. El número de nuevas infecciones descendería de unos 2,5 millones en 2009 a en torno a un millón en 2015.
Perspectivas sobre el sida de líderes de todo el mundo
El informe contiene comentarios de 15 líderes de la respuesta mundial al sida, entre otros, el presidente de Sudáfrica, Jacob Zuma; el ex-presidente de los Estados Unidos, Bill Clinton; el ex-presidente de Brasil Luiz Inácio Lula da Silva; el presidente de Malí, Amadou Tounami Touré; y Jean Ping, presidente de la Comisión de la Unión Africana. Estos comentarios versan sobre áreas diversas, como la financiación para el sida, la cooperación Sur-Sur, el liderazgo de los jóvenes, la capacitación de la mujer, las poblaciones más afectadas, el consumo de drogas inyectables, los derechos humanos, el estigma y la discriminación, y la integración de sistemas.
Los jóvenes lideran la revolución de la prevención del VIH
Treinta años de sida: las naciones en un punto clave del camino también incluye un artículo sobre un acto que se celebró recientemente en Robben Island, Sudáfrica, donde el arzobispo Desmond Tutu, copresidente de la Comisión de alto nivel del ONUSIDA sobre la prevención del VIH, pasó el testigo del liderazgo en la respuesta al sida a una nueva generación de jóvenes.
Según el informe, algunos de los mayores avances en la prevención del VIH se han producido entre los jóvenes. Los datos indican que cada vez son más los jóvenes que, en muchos de los países más afectados, están optando por retrasar su iniciación sexual y evitan aquellas conductas sexuales que pueden exponerles a un mayor riesgo de infección."

MAPA DE LA SITUACION DEL VIH-SIDA EN ECUADOR 2010

ESTIMADOS COLEGAS, A LA DERECHA DE SU PANTALLA ENCONTRARAN EL LINK DEL MAPA HACIENDO CLICK SOBRE LA IMAGEN, EN ESTA SE HAN  REFERENCIADO DATOS POR CADA PROVINCIA SOBRE EL MAPA, AL DAR CLICK EN LOS GLOBOS , PODRAN VER LA INFORMACION COLOCADA EN CADA UNA DE LAS PROVINCIAS.

ESTAREMOS HACIENDO USO DE LA TECNOLOGIA DISPONIBLE PARA MANTENERLOS INFORMADOS, COMO FUE NUESTRO COMPROMISO.

SALUDOS.

DR. CARLOS ERAZO

ALGUNOS DATOS INTERESANTES SOBRE EL VIH

LOS CONDONES MASCULINOS SON EFECTIVOS PARA DISMINUIR EL RIESGO DE LA INFECCIÒN DEL VIRUS EN UN 80% A 95% .
LOS CONDONES FEMENINOS SON EFECTIVOS PARA DISMINUIR EOL RIESGO DE LA INFECCIÓN DEL VIRUS EN UN 94% A 97%.

FUENTE: THE SANFORD GUIDE TO HIV/AIDS THERAPY 2010.

SALUDOS

DR. CARLOS ERAZO

HIV Therapy Dramatically Cuts Transmission in Heterosexual Pairs

"By Michael Smith, North American Correspondent, MedPage Today Published: May 12, 2011

Triple-drug therapy dramatically reduced transmission of HIV in heterosexual couples when one partner is infected and the other is not, results of a randomized trial showed.
Treating the infected partner in these discordant couples reduced transmission by 96%, compared with no treatment, according to Myron Cohen, MD, of the University of North Carolina Chapel Hill, and colleagues.
The $73 million trial had been slated to finish in 2015 but was stopped early after those clear-cut results were found by the study's data safety monitoring board during a planned interim review.
A series of mathematical models and observational studies have suggested that treatment of HIV can reduce transmission, and other studies have suggested that anti-HIV drugs might be used as prophylaxis.
But this is the "first, rather dramatic, randomized trial in discordant couples," according to Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, one of the sponsors of the so-called HPTN 052 trial.
It "nails the concept down rather nicely," he said in a telephone media conference.
Outside experts hailed the trial as a giant step forward.

"This study is another milestone in the history of HIV," said John Bartlett, MD, of Johns Hopkins. "The concept of treatment for prevention is proven."

"Patients can take the drugs for their own health and for public health," Bartlett added in an email to ABC News/MedPage Today.

The findings have the potential to transform approaches to the treatment and prevention of HIV," according to Mark Kline, MD, of Baylor College of Medicine in Houston.

Kline noted in an email to ABC News/MedPage Today that a trial in the mid-1990s showed that administering a single anti-HIV drug to pregnant women could prevent mother-to-child transmission of the virus.

That finding had "an immediate and direct impact on public health policies" and led many experts to think that treatment might prevent infection in other settings, he said.

"Now, we have conclusive evidence from a prospective, randomized treatment trial in support of that contention," Kline said.

Indeed, the findings "must serve as a clarion call" for expanded access to treatment, according to Mitchell Warren, executive director of the New York-based AIDS Vaccine Advocacy Coalition.
"We now have evidence from a randomized trial confirming what has been seen in observational settings: (antiretroviral) treatment is prevention," Warren told MedPage Today in an email.
The study, conducted by the HIV Prevention Trials Network, began in April 2005 and enrolled 1,763 couples, 97% of them heterosexual, in nine countries.
All the HIV-infected participants -- 890 men and 873 women -- had relatively intact immune systems, with CD4-positive T-cell counts between 350 and 550 per cubic millimeter and were not eligible at the time for HIV treatment based on their local guidelines.
They were randomly assigned to get immediate treatment or to wait until their CD4 counts fell to 250 or they had an AIDS-defining event.
All told, the review found 39 cases of HIV infection among the previously uninfected partners, and genetic analysis showed that 28 of those came from the infected partner. (Seven did not, and four are still being analyzed.)
But 27 of the linked infections occurred in the deferred treatment group and just one in the immediate therapy arm, a difference that was significant at P<0.0001.
All participants in the deferred treatment arm are now being offered triple-drug therapy regardless of their CD4 count, Cohen told reporters during the telephone media conference.
He said that the original plan for the study was to have homosexual couples included, but very few agreed to take part. For that reason, he said, it would be a "mistake" to assume this finding would apply to men who have sex with men.
Cohen added that the trial shows that even with a relatively intact immune system, transmission can occur. "You can't look at a high CD count and make the assumption that transmission is not going to occur," he said.
HIV transmission risk is linked to the amount of the virus in the blood, the so-called viral load, but many physicians will assume that if the CD4 count is relatively high, they can "let it go," Fauci said. The study investigators are currently analyzing viral load data from the trial, he said.
The treatment regimens used in the trial varied depending on the location of patients, Fauci said, with 11 different antiretroviral drugs employed in various combinations.
The researchers also found that 17 cases of extrapulmonary tuberculosis occurred in the HIV-infected partners in the deferred treatment arm and just three in the immediate treatment arm. The difference was significant at P=0.0013.
There were 23 deaths -- 10 in the immediate treatment group and 13 in the deferred treatment arm -- but the difference was not significant."


LINK:  http://www.medpagetoday.com/HIVAIDS/HIVAIDS/26442?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=188864

Early HIV Treatment Associated with Greatly Reduced Transmission to Partners

Estimados colegas , aqui les dejo el link para poder revisarlo:

http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HPTN052.aspx

Saludos

Dr. Carlos Erazo

A 10-year study on early HIV treatment has been stopped prematurely after a monitoring board found convincing evidence that it "can have a major impact on reducing HIV transmission," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in an NIH announcement Thursday.
Called HPTN 052, the international study was conducted primarily among some 1800 heterosexual couples. One partner in each couple was uninfected at entry. Infected partners were randomized either to immediate treatment with a three-drug antiretroviral regimen or to deferred treatment (until CD4 counts fell below 250 per cubic millimeter or an AIDS-related event occurred).
There were 28 new infections linked to partners, 27 of which occurred among the deferred-treatment group, giving a relative reduction in transmission of 96%.
Dr. Carlos del Rio of Journal Watch HIV/AIDS Clinical Care commented that the findings "prove once and for all that antiretroviral therapy not only is good for the individual but it is also good for society, as it reduces HIV transmission."

Findings Result from NIH-funded International Study

Men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners by taking oral antiretroviral medicines when their immune systems were relatively healthy, according to findings from a large-scale clinical study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
The clinical trial, known as HPTN 052, was slated to end in 2015 but the findings are being released early as the result of a scheduled interim review of the study data by an independent data and safety monitoring board (DSMB). The DSMB concluded that it was clear that use of antiretrovirals by HIV-infected individuals with relatively healthier immune systems substantially reduced transmission to their partners. The results are the first from a major randomized clinical trial to indicate that treating an HIV-infected individual can reduce the risk of sexual transmission of HIV to an uninfected partner.
“Previous data about the potential value of antiretrovirals in making HIV-infected individuals less infectious to their sexual partners came largely from observational and epidemiological studies,” said NIAID Director Anthony S. Fauci, M.D. “This new finding convincingly demonstrates that treating the infected individual—and doing so sooner rather than later—can have a major impact on reducing HIV transmission.”
Led by study chair Myron Cohen, M.D., director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, HPTN 052 began in April 2005 and enrolled 1,763 couples, all at least 18 years of age. The vast majority of the couples (97 percent) were heterosexual, which precludes any definitive conclusions about effectiveness in men who have sex with men. The study was conducted at 13 sites in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States and Zimbabwe. The U.S. site collected only limited data because of difficulties enrolling participants into the study. However, data from one serodiscordant couple at the site was included in the DSMB’s analysis. At the time of enrollment, the HIV-infected partners (890 men, 873 women) had CD4+ T-cell levels—a key measure of immune system health—between 350 and 550 cells per cubic millimeter (mm³) within 60 days of entering the study. The HIV-uninfected partners had tested negative for the virus within 14 days of entering the study.
The investigators randomly assigned the couples to either one of two study groups. In the first group, the HIV-infected partner immediately began taking a combination of three antiretroviral drugs. In the second group (the deferred group), the HIV-infected partners began antiretroviral therapy when their CD4 counts fell below 250 cells/mm³ or an AIDS-related event, such as Pneumocystis pneumonia, occurred. Throughout the study, both groups received HIV-related care that included counseling on safe sex practices, free condoms, treatment for sexually transmitted infections, regular HIV testing, and frequent evaluation and treatment for any complications related to HIV infection. Each group received the same amount of care and counseling.
In its review, the DSMB found a total of 39 cases of HIV infection among the previously uninfected partners. Of those, 28 were linked through genetic analysis to the HIV-infected partner as the source of infection. Seven infections were not linked to the HIV-infected partner, and four infections are still undergoing analysis. Of the 28 linked infections, 27 infections occurred among the 877 couples in which the HIV-infected partner did not begin antiretroviral therapy immediately. Only one case of HIV infection occurred among those couples where the HIV-infected partner began immediate antiretroviral therapy. This finding was statistically significant and means that earlier initiation of antiretrovirals led to a 96 percent reduction in HIV transmission to the HIV-uninfected partner. The infections were confirmed by genetic analysis of viruses from both partners.
Additionally, 17 cases of extrapulmonary tuberculosis occurred in the HIV-infected partners in the deferred treatment arm compared with three cases in the immediate treatment arm, a statistically significant difference. There were also 23 deaths during the study. Ten occurred in the immediate treatment group and 13 in the deferred treatment group, a difference that did not reach statistical significance.
The study was designed to evaluate whether antiretroviral use by the HIV-infected individual reduced HIV transmission to the uninfected partner and potentially benefited the HIV-infected individual as well. Additionally, the study was designed to evaluate the optimal time for a person infected with HIV to initiate antiretrovirals in order to reduce HIV-related sickness and death. Based on their analysis, the DSMB recommended that the deferred study arm be discontinued and that the study participants be informed of the trial’s outcome.
“We want to thank the study participants for making such an important contribution in the fight against HIV/AIDS. We think that these results will be important to help improve both HIV treatment and prevention,” said Dr. Cohen.
Study participants are being informed of the results. Individuals who became HIV-infected during the course of the study were referred to local services for appropriate medical care and treatment. HIV-infected participants in the deferred treatment group will be offered antiretroviral therapy.  The study investigators will continue following the study participants for at least one year.
The study was conducted by the HIV Prevention Trials Network, which is largely funded by NIAID with additional funding from the National Institute on Drug Abuse and the National Institute of Mental Health, both part of the NIH. Additional support was provided by the NIAID-funded AIDS Clinical Trials Group. The antiretroviral drugs used in the study were made available by Abbott Laboratories, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline/Viiv Healthcare and Merck & Co., Inc.
The 11 HIV drugs that were used in various combinations included the following:

• atazanavir (300 mg once daily)
• didanosine (400 mg once daily)
• efavirenz (600 mg once daily)
• emtricitabine/tenofovir disoproxil fumarate (200 mg emtricitabine/300 mg tenofovir disoproxil fumarate once daily)
• lamivudine (300 mg once daily)
• lopinavir/ritonavir 800/200 mg once daily (QD) or lopinavir/ritonavir 400/100 mg twice daily (BID)
• nevirapine (200 mg taken once daily for 14 days followed by 200 mg taken twice daily)
• ritonavir (100 mg once daily, used only to boost atazanavir)
• stavudine (weight-dependent dosage)
• tenofovir disoproxil fumarate (300 mg once daily)
• zidovudine/lamivudine (150 mg lamivudine/300 mg zidovudine taken orally twice daily)

In an ongoing international clinical study called Strategic Timing of Antiretroviral Therapy, NIAID is examining the optimal time for asymptomatic HIV-infected individuals to begin antiretrovirals. For additional information about the HPTN 052 study, see the Questions and Answers. Visit the NIAID HIV/AIDS Web portal for more information about NIAID’s HIV/AIDS research.

Curso Básico de EPI INFO

Estimados colegas, aqui encontraremos un curso básico de Epi Info en español con videos muy claro y útil.

Aqui estan los links.

Parte  I.    http://www.cure4kids.org/private/lectures/ppt2059/zip_C4K-2046-0MX-Dise_Creacion_Datos_I.zip/player.html

Parte II. http://www.cure4kids.org/private/lectures/ppt2060/zip_C4K-2047-0MX-Dise_Creacion_Datos_II.zip/player.html

Parte III. http://www.cure4kids.org/private/lectures/ppt2057/zip_C4K-2044-0MX-Codigo_check.zip/player.html

Parte IV. http://www.cure4kids.org/private/lectures/ppt2061/zip_C4K-2048-0MX_Grabar_Datos%202.zip/player.html

Parte V. http://www.cure4kids.org/private/lectures/ppt2062/zip_C4K-2049-0MX-Analyze_Data.zip/player.html

Parte VI. http://www.cure4kids.org/private/lectures/ppt2063/zip_C4K-2050-0MX-Importar_Exportar.zip/player.html

Parte VII. http://www.cure4kids.org/private/lectures/ppt2064/zip_C4K-2051-0MX_Generando_Informe.zip/player.html


Pueden obtener el curso y bajarse los documentos en esta dirección.

http://www.phconnect.org/group/epiinfo/forum/topics/epi-info-online-tutorials-in


Este link le llevará a una presentación del curso básico de EPI INFO.

Saludos

Dr. Carlos Erazo

GRFICOS EN EPI INFO(PORTUGUES)

ANALISIS DE DATOS CON EPI INFO (PORTUGUES) PARTE 1

ANALISIS DE DATOS CON EPI INFO (PORTUGUES)

USO DEL STATCALC EN EPI INFO (PORTUGUES)

ANALISIS CON EPI INFO CONSTRUYENDO TABLAS

ANALISIS INICIAL DE FRECUENCIA EN EPI INFO

CLASE DE EPI INFO INGRESANDO DATOS

PRIMERA CLASE DE EPI INFO

Instalación del EPIINFO desde el INTERNET

HIV and injecting drug use: a global call for action

 http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611604753.pdf

HIV and injecting drug use: a global call for action When world leaders meet in New York at the UN High-Level Meeting on AIDS (June 8–10, 2011), they will review the past decade’s progress and chart the future course of the global HIV response. There are some advances to celebrate, with global HIV incidence falling and access to treatment improving. But there are also unmitigated failures to be addressed moving forward. As a Lancet Series emphasised last year, people who inject drugs have been left behind in global eff orts to scale up access to HIV prevention, treatment, care, and support. Their needs have been neglected, and their rights have been ignored, and, in many cases, horribly
violated as governments have chosen to pursue punitive, disproportionate drug laws instead of evidence-based health strategies to address drug-related harm. The June meeting represents a unique opportunity to correct these injustices. A new document—the Beirut Declaration on HIV and Injecting Drug Use: A Global Call for Action—released at the 22nd International Harm Reduction Conference, Beirut, Lebanon (April 3–7, 2011), sets out how the international community has failed people who inject drugs and the actions now required by governments. Crucially, evidence-based programmes (needle and syringe exchange programmes, opioid substitution, and antiretroviral treatment) targeting the 16 million people who inject drugs worldwide need to be fi nanced, implemented, and scaled up across all settings to prevent and treat HIV infection. Ineff ective drug policies also need to end, funding for harm reduction  needs to be vastly increased, and vulnerable groups who inject drugs (including women, young people, and people in prison) need access to integrated health and harm-reduction services. These actions should be explicitly included in the new global declaration on
HIV/AIDS that will be drafted at the June meeting with measurable targets to hold governments accountable. Misplaced moral judgments have underpinned the neglect of people who inject drugs in the global HIV response. Yet it is wholly immoral to let people become infected with HIV or die when evidence-based interventions exist to prevent these outcomes. A bold and humane response is needed from governments at the June meeting and beyond. Millions of lives are at stake.

Health of lesbian, gay, bisexual, and transgender populations

The Lancet Institute of Medicine

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611604820.pdf


Health of lesbian, gay, bisexual, and transgender populations The past 20 years have seen dramatically increased visibil ity of people who are lesbian, gay, bisexual, and transgendered (LGBT) in US society. This diverse and vibrant group are now active and welcome members of many communities
across the country and are well recognised and praised for being a major force in the positive global response to the HIV/AIDS epidemic. Substantial achievements to advance their health status, such as the established partnership between LGBT organisations and foundations or corporations to access funding to address the HIV/AIDS epidemic, have been achieved. Yet, there is still a great deal to learn. Basic demographic data are lacking for LGBT populations in the USA. Many health practitioners are not well informed about how to care for LGBT populations, or about what constitutes healthy development of LGBT adolescents, and they do not understand enough about the development of sexual orientation, diverse gender identities, LGBT families, or the eff ect of stigma and discrimination on health. To develop a more complete picture of the health status of people who are LGBT and to identify research gaps, the Institute of Medicine (IOM) released The Health of Lesbian,
Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Using a life-course perspective, the report examines the health status of these populations in three stages: childhood and adolescence, early and middle adulthood, and later adulthood. The IOM fi nds that, although these populations share the full range of health risks with the rest of society, they are also exposed to a unique yet poorly understood set of additional threats.
For instance, compared with their heterosexual peers, members of the LGBT community are at increased risk of suicide, depression, harassment, and victimisation, and they may have higher rates of smoking and alcohol use. It is worth noting that for teenage lesbian and bisexual girls, pregnancy rates may be higher than those of heterosexual girls. Girls may deliberately attempt to get pregnant in an eff ort to defi ne and strengthen an identity for themselves. In early and middle adulthood, lesbians and bisexual women may also be at higher risk for breast cancer and for obesity, while men who have sex with men, especially those who are HIV-positive, are at increased risk for anal cancer. Meanwhile, in some studies, lesbians were signifi cantly more likely than heterosexual women to receive a diagnosis of heart disease. In later adulthood, LGBT are less likely to have a partner or children to provide them with health and social care, resulting in their greater dependence on friends, caregivers, and LGBT organisations. There has been clinical concern about rates of diabetes, ovarian disease, and stroke among transgender older people potentially as a result of longterm hormone treatments. Furthermore, HIV/AIDS re mains  a crucial health issue for gay or bisexual men, transgender women, and LGBT who inject drugs. Additionally, people who are LGBT face barriers to equitable health services in
the USA, such as diffi culty in obtaining health insurance, fear of discrimination from providers, and a shortage of providers who are well trained in their health needs. When addressing health issues for people who are LGBT, researchers are confronted with many challenges, one of which is a lack of systematically or accurately collected data. The LGBT community make up a  sometimes hidden minority of the population and it is hard to recruit suffi cient numbers to studies to yield meaningful results. Moreover, the LGBT acronym does  not represent a homogeneous group, and it can be
diffi cult to defi ne and measure sexual orientation and gender identity. Additionally, some LGBT individuals are reluctant to disclose details about themselve s and take part in research, because research topics may be  sensitive and can be perceived as intruding on privacy. The availability of high-quality evidence is central to improvement of knowledge. The report calls for a research agenda to collect data, examine appropriate method ology, train researchers, and develop policy on
research participation, provided that privacy concerns can be satisfactorily addressed. It also emphasises several priority research areas—demography, social infl uences, health-care inequalities, and intervention research. The IOM report is groundbreaking. Not only does it re view the LGBT community’s health needs comprehen sive ly, but it also brings a sea change in establishing edu cation al and research guidance for LGBT health. Actions in response to the report are already underway,
such as integration of LGBT health education into medical school curricula. The full participation of the LGBT community in their health and wellbeing is crucial. Above all, scientifi c and clinical engagement is essential to improve awareness and understanding of LGBT health issues, and to incorporate them into mainstream health care. 􀂄 The Lancet Institute of Medicine

HHS Action Plan to Reduce Racial and Ethnic Health Disparities

Estimados colegas , este es el enalce para poder bajar el pdf de los planes para disminuir la desigualdad en salud basados en etnicidad y raza.


http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf

Saludos

Dr. Carlos Erazo

Approaching 30 Years of HIV/AIDS in the United States

PolicyApril 08, 2011

By Ronald Valdiserri, M.D., M.P.H., Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services

Dr. Ronald Valdiserri

In less than two months, we will mark the 30th anniversary of the first reported cases of what we now know as AIDS. In June 1981, the Centers for Disease Control and Prevention (CDC) reported a rare form of pneumonia diagnosed in five, previously healthy, gay men from Los Angeles. The report raised concerns that these five men had been exposed to something that caused their profound immune suppression. Now we know that their disease resulted from infection with HIV.
As we mark this significant milestone, we solemnly mourn the more than 600,000 Americans who have lost their lives to HIV disease. But we also honor, with pride, the men, women, and young people who have made important contributions to 30 years of fighting the HIV/AIDS epidemic in the United States and around the world. And certainly we celebrate the substantial advances in prevention, diagnosis and treatment that have been made in the past three decades. Although our journey hasn’t finished, we’ve come a very long way since those early days when so much was unknown about this deadly new disease.
Perhaps, most importantly, this observance will prompt each of us to consider how we can extend and enhance our individual and collective responses to the epidemic so that it does not persist for another 30 years. For the first time we have a National HIV/AIDS Strategy (NHAS) that all of us can use as a game-plan to better focus and coordinate our individual and organizational efforts. The Strategy was informed by our 30 years of experience with HIV/AIDS. Achieving its goals — reducing new HIV infections, increasing access to HIV care, improving health outcomes for people living with HIV, and reducing HIV-related health disparities — requires the active participation of all sectors of society. This includes not only local, state, tribal and federal governments, but also businesses, faith communities, philanthropy, the scientific and medical communities, educational institutions, people living with HIV, and many others.

If you have not yet had the opportunity to do so, I encourage you to read the Strategy and other information about its implementation available on AIDS.gov. Being familiar with the details of the Strategy will provide you with an even stronger foundation for engaging in efforts to enhance the HIV prevention, care and treatment, and stigma reduction activities that may be underway in your community. And if these efforts are not taking place in your community, the Strategy can suggest principles and priorities against which to assess current activities as well as opportunities to bring together new partners to help make that happen. A number of activities are being planned in recognition of this 30-year milestone. Shortly, AIDS.gov will post a page so you can follow the commemorative activities planned by various Federal government agencies.
After 30 years of HIV/AIDS, we need to recognize how far we have come but, at the same time, continue to commit ourselves to accomplishing what remains to be done. Then, we will truly achieve the vision of the NHAS:

“The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”

High-Grade AIN Among HIV-Infected Men Who Have Sex with Men

In a 3-year prospective study, the cumulative incidence of high-grade anal intraepithelial neoplasia was 37% among HIV-infected MSM receiving ART.

The incidence of anal cancer has been increasing since the introduction of potent combination antiretroviral therapy (ART), but the reasons are unclear. In the present study, researchers evaluated the incidence of high-grade anal intraepithelial neoplasia (AIN) among 247 HIV-infected men who have sex with men (MSM) who were either initiating or already receiving potent ART. Participants underwent anal cytological analysis and high-resolution anoscopy (HRA) at baseline and then every 6 months to 1 year for 3 years.

During follow-up, 17% of participants had high-grade squamous intraepithelial lesions at least once, and 54% of participants had high-grade AIN (AIN2/3) at least once. In two men (1% overall), the condition progressed to invasive anal cancer. At 3 years, the cumulative incidence of high-grade AIN was 37%, and the progression rate from a lesser abnormality at baseline was 12.8 new cases per 1000 person-months. In a multivariate analysis, several factors were significantly associated with high-grade AIN: age 40, CD4 count <50 cells/mm³ before ART initiation, and infection with human papillomavirus (HPV) type 16 or 18. Treatment with the same ART regimen for at least 4 years was associated with a reduced risk for high-grade AIN.

Comment: Although this study was small, it furthers our understanding of the risk for progression of AIN among HIV-infected MSM in the current treatment era. The incidence of new high-grade AIN may have been overestimated if lesions were missed on initial screening. Nevertheless, the data support the need for aggressive screening for AIN in the routine care of individuals who have engaged in receptive anal sex — and the aggressive monitoring of AIN when it is discovered. Although ART may provide some benefit in terms of reducing the risk for progression of AIN, the effect is not overwhelming. What we do not yet know is whether early detection and treatment of AIN in the ART era confers a reduction in the incidence of invasive cancer or improves survival.

— Sonia Nagy Chimienti, MD

Published in Journal Watch HIV/AIDS Clinical Care March 28, 2011

En breve colocaremos más información para su apoyo

Estimados colegas, esta semana se subirán artículos nuevos relacionados con el tema.

Gracias por su paciencia

Dr. Carlos Erazo

Human Papillomavirus Infections in Men: Incidence and Clearance

Among HIV-negative men in three countries, the incidence of new genital HPV infection was 38.4 cases per 1000 person-months.

Human papillomavirus (HPV)-related cancers occur in men and women, yet little is known about the natural history of HPV infections in men. Now, investigators have conducted a prospective study to assess the incidence and clearance of HPV among HIV-negative men aged 18 to 70. (One of the investigators receives support from Merck, which produces an HPV vaccine.)

Participants were recruited from the general population, universities, and organized healthcare systems in the U.S., Brazil, and Mexico. Before enrollment and every 6 months thereafter, they underwent swabbing of the penis and scrotum for HPV testing (detection of DNA by polymerase chain reaction; genotyping) and completed a computer-based questionnaire.

Although the full cohort involved 4074 men, most analyses were conducted among the first 1159 who enrolled and completed 2 weeks of follow-up (mean age, 32.1; median follow-up, 27.5 months). The incidence of new genital HPV infection was 38.4/1000 person-months and did not vary with age. Median time to clearance was 7.2 months for oncogenic HPV types and 7.6 months for nononcogenic types. This interval was significantly longer in 18- to 30-year-olds than in older men. In multivariate analysis, oncogenic HPV infection was significantly associated with having a high number of lifetime female sexual partners or recent male anal-sex partners.

Comment: This study shows that HPV infection is common among men. An editorialist notes different natural histories in men and women: The rate of penile intraepithelial neoplasia is 10 to 20 times lower than the rate of cervical intraepithelial neoplasia, even though HPV infection rates are higher in men than in women. Because condoms provide only limited protection against HPV acquisition, the role of vaccination merits study. The present findings provide useful information about HPV acquisition and clearance in men. However, as the authors caution, the study cohort is a select population, so incidence estimates may not be generalizable to men in the three countries evaluated.

— Mary E. Wilson, MD

Published in Journal Watch Infectious Diseases March 9, 2011

Opt-Out HIV Testing: What Are We Waiting For?

Although the CDC recommends that HIV testing be performed in all clinical settings unless the patient refuses, several states still require written consent. This study shows why it's time for those laws to change.

An estimated 232,700 people in the U.S. are infected with HIV but do not know it. Many of them will engage with the healthcare system for reasons unrelated to their HIV status, and those visits represent opportunities for testing and awareness. To that end, the CDC has recommended since 2006 that HIV testing be performed in all healthcare settings on every patient aged 13 to 64, unless the patient explicitly declines (i.e., "opt-out" testing). However, for at least several years after that recommendation was issued, the laws in nine states (Alabama, Hawaii, Massachusetts, Michigan, Nebraska, New York, Pennsylvania, Rhode Island, and Wisconsin) continued to require written informed consent. In this modeling analysis, investigators estimated the survival gains that could occur with a change in those laws.

Based on published data from San Francisco (JW AIDS Clin Care Mar 26 2007), the researchers assumed that removing the requirement for written consent would increase the rate of HIV diagnosis by 48.5%. Under that assumption, having the nine states change their laws would result in a higher average CD4-cell count at diagnosis and a mean survival gain of 1.5 years per HIV-infected individual. This in turn would translate into a total of 537,399 life-years gained. (Even with only a 24.8% increase in the rate of diagnosis, 304,765 life-years would be gained.) These survival gains would vanish if the proportion of HIV-infected people who avoided testing exceeded 18.2%.

Comment: The results of this paper are based on modeling, and the estimates may be overly optimistic. Nonetheless, the states that have not yet changed their laws (4 at the time of this writing: Massachusetts, Michigan, Nebraska, and Pennsylvania) should pass legislation immediately to remove the requirement for written consent. Doing so would lead to earlier detection of HIV infection, longer survival times, and fewer new infections, all of which would advance the goals of the recently released National HIV/AIDS Strategy. Given the unacceptably high rate of HIV incidence in this country, we simply cannot wait any longer.

— Carlos del Rio, MD

The Editor-in-Chief of Journal Watch AIDS Clinical Care was involved in the research described here. Consequently, he was not involved in the selection of this article for coverage, nor was he involved in the writing or review of this summary.

Published in Journal Watch HIV/AIDS Clinical Care March 14, 2011

CITATION(S):

April MD et al. Projected survival gains from revising state laws requiring written opt-in consent for HIV testing. J Gen Intern Med2011 Feb 1; [e-pub ahead of print]. (http://dx.doi.org/10.1007/s11606-011-1637-5)