Hepatitis, STDs, TB and other related Subjects

December - January 2008

AUSTRALIA:
"Vitamin D May Help Fight Tuberculosis, Study Finds"
Reuters, (01.28.2008) Maggie Fox
A study of African immigrants found that those with low levels of vitamin D were far more likely to be infected with tuberculosis than those with adequate levels, said Melbourne-based researchers. CDC Summary

SOUTH AFRICA:
"Rights Dilemma as South Africa Faces Drug-Resistant TB Epidemic"
Agence France Presse, (01.27.2008) Mariette le Roux
In South Africa, doctors and public health officials are struggling to balance individual freedoms with the health threat posed by extensively drug-resistant tuberculosis (XDR-TB). Patients with this form of the disease are languishing in isolation wards, battling boredom, depression, and the medicines' side effects.

South African doctors lack the legal tools to forcibly confine XDR-TB patients or compel them to take their medication. "We encourage them not to leave - by law, you can't force them," said Dr. Simon Moeti, senior medical superintendent at Cape Town's Brooklyn Chest Hospital. CDC Summary

UNITED KINGDOM:
"Sex Partner Acquisition While Overseas: Results from a British National Probability Survey"
Sexually Transmitted Infections Vol. 83; No. 7: P. 517-522, (12.01.2007) C.H. Mercer; K.A. Fenton; K. Wellings; A.J. Copas; B. Erens; A.M. Johnson
The number of overseas trips made by UK residents has increased dramatically over the past 20 years. While other studies have examined the frequency of partner acquisition abroad, they have used convenience samples and therefore are not generalizable to the British general population, said researchers in the current study. CDC Summary

AUSTRALIA:
"Pap Smear and Chlamydia Test Double-Up Gets Results"
Australian Associated Press, (01.20.2008) Tamara McLean
Urging women to get screened for chlamydia at the same time they undergo a Pap smear would double Australia's testing rates and help rein in the STD, whose rates have climbed more than fivefold in the past decade, new research shows. CDC Summary

SOUTH KOREA:
"Impact of Extensive Drug Resistance on Treatment Outcomes in Non-HIV-Infected Patients with Multidrug-Resistant Tuberculosis"
Clinical Infectious Diseases Vol. 45: P. 1290-1295, (11.15.2007)
"The aim of this study was to elucidate the impact of extensive drug resistance on treatment outcomes in [non-HIV]-infected patients with multidrug-resistant tuberculosis (MDR-TB)," explained the study researchers. CDC Summary
 

TB "Disease Foes Hope to Speed a Cure"
Times Union (Albany), (01.17.2008) Eric Anderson
Treating TB requires prolonged drug therapy, and in many poor nations adhering to the months-long course of treatment can be very difficult. To improve the odds of successfully treating TB, the Bill & Melinda Gates Foundation has pledged to spend $900 million on TB by 2015. Last year, the foundation awarded a two-year, $1.7 million grant to Drs. George Drusano and Arnold Louie of the Ordway Research Institute in Albany.

"One of the goals of the Gates Foundation is to change the duration of the therapy from six months to two weeks," said Louie. "If you can, you don't have to worry about patient noncompliance and the emergence of resistant strains." CDC Summary
 

UNITED STATES:
"High HPV Rate Seen Even Among Girls Who Had Just One Sex Partner"
Canadian Press, (01.13.2008) Helen Branswell
A new study of 125 university students shows that nearly one-third of women who reported having just one male sexual partner were infected with human papillomavirus (HPV) within a year of starting that relationship. CDC Summary
 

"New Study Blames Columbus for Syphilis Spread"
Reuters, (01.15.2008) Julie Steenhuysen
Christopher Columbus' journey to the New World has been genetically linked to the earliest recorded syphilis outbreak in Europe, a study published Monday suggests. CDC Summary

UNITED KINGDOM:
"New Point of Care Chlamydia Rapid Test – Bridging the Gap Between Diagnosis and Treatment: Performance Evaluation Study"
British Medical Journal doi: 10.1136/bmj.39402.463854.AE, (11.30.2007) Lourdes Mahilum-Tapay; Vivian Laitila; James J. Wawrzyniak; Sarah Alexander; Alison Swain; Penelope Barber; Ines Ushior-Lumb; Beng T. Goh; Catherine Ison
The investigators conducted this study to evaluate the performance of a new chlamydia rapid test with vaginal swab specimens as a potential tool for chlamydia diagnosis and screening. Researchers assessed 1,349 women ages 16-54 attending either a young people's sexual health center (site 1) or one of two genitourinary medicine clinics (sites 2 and 3). CDC Summary

Medscape CME Sexually Transmitted Infections and Cancer: Breaking the Link Through Vaccination
Review data from HPV-vaccine clinical trials and learn how widespread HPV vaccination can reduce the incidence of HPV-related diseases.

Medscape CME/CE Clinical Challenges in the Treatment of External Genital Warts
Until the time when "herd immunity" becomes a reality due to widespread vaccination of both sexes, EGW will continue to pose a management challenge for the clinician.
 

Medescape CME Reducing the Global Burden of HPV-Related Disease: Cervical Cancer and Beyond
A discussion of the epidemiology and pathogenesis of HPV-related diseases and the rationale for and benefits of HPV vaccinations.

NEWS Briefs - Summaries from the CDC HIV/STD/TB Prevention News Update and links to Kaiser HIV/AIDS Reports on the Kaisernetwork and other sources.

HPV vaccine may be of value for women already exposed to some HPV strains
Latest on aidsmap - 7th December 2007
Women who are already infected with some of the four strains of human papilloma virus (HPV) that Gardasil protects against are protected by the vaccine against pre-cancerous or cancerous cervical cell changes caused by the remaining cancer-causing strains, according to research published in the November 15th edition of the Journal of Infectious Diseases. The study also showed that the vaccine was highly effective at preventing anogenital and vaginal lesions caused by the remaining strains.
http://www.aidsmap.com/en/news/CFAA8E9F-1B67-465A-85B4-7F42B4BE50DF.asp

THE NETHERLANDS:
"Human Papillomavirus DNA Testing for the Detection of Cervical Intraepithelial Neoplasia Grade 3 and Cancer: 5-Year Follow-Up of a Randomized Controlled Implementation Trial"
The Lancet Vol. 370; No. 9601: P. 1764-1772, (11.24.2007) N.W.J. Bulkmans, MD; J. Berkof, PhD; L. Rozendaal, MD; et al.
The authors of this study noted that DNA tests for high-risk human papillomavirus (HPV) are more sensitive for cervical intraepithelial neoplasia grade 3 or worse (CIN3+) than cytological screening. However, there is debate about the necessity for such testing in cervical screening. In that context, the researchers examined whether cervical screening is improved through HPV DNA testing.  CDC Summary

Summaries

SOUTH AFRICA:
"Rights Dilemma as South Africa Faces Drug-Resistant TB Epidemic"
Agence France Presse, (01.27.2008) Mariette le Roux
In South Africa, doctors and public health officials are struggling to balance individual freedoms with the health threat posed by extensively drug-resistant tuberculosis (XDR-TB). Patients with this form of the disease are languishing in isolation wards, battling boredom, depression, and the medicines' side effects.

South African doctors lack the legal tools to forcibly confine XDR-TB patients or compel them to take their medication. "We encourage them not to leave - by law, you can't force them," said Dr. Simon Moeti, senior medical superintendent at Cape Town's Brooklyn Chest Hospital.

The facility set a national precedent last year by obtaining a court interdict against four XDR-TB patients who fled repeatedly, placing their families at risk. The court ordered their return, though one has since died and the other three absconded again.

At a recent lung health conference, the South African health department said it is considering mandatory isolation. "What you have at the moment in terms of the South African constitution is that in each case we want to deal with we have to seek legal recourse," said Thami Mseleku, the department's director-general. "It is a process that takes a lot of time and energy. We are looking at whether we can find clauses in our legislation that will allow a general approach to the matter."

The department told the conference it recorded 391 cases of XDR-TB between January and October last year, compared to 74 in 2004.

Dr. Krish Vallabhjee, provincial chief of TB hospitals in Western Cape, cautioned against the implementation of steps that patients could perceive as punitive, saying this could discourage people from seeking treatment in a country where TB stigma is common.

"The [XDR-TB] patients are depressed," said nurse Johanna Blackburn of Brooklyn Chest. "And they feel like they live in a jail."



AUSTRALIA:
"Vitamin D May Help Fight Tuberculosis, Study Finds"
Reuters, (01.28.2008) Maggie Fox
A study of African immigrants found that those with low levels of vitamin D were far more likely to be infected with tuberculosis than those with adequate levels, said Melbourne-based researchers.

From 2003 to 2006, Dr. Katherine Gibney of the Royal Melbourne Hospital and colleagues tested everyone from sub-Saharan Africa who was treated at the facility - a total of 375 immigrants. Moderate to severe vitamin D deficiency was found in 78 percent of those patients with past or present TB.

While previous studies have found that people with vitamin D deficiencies are more likely to have active TB, the researchers said this study is the first to show this is true of latent TB as well.

"Low vitamin D levels are associated with an increased likelihood of primary infection with Mycobacterium tuberculosis and also, once infected, are associated with increased likelihood of having active TB," said Gibney.

Vitamin D is made when sunlight hits the skin, and food is often supplemented with it. TB affects up to one-third of the world's population, though most cases are latent, meaning patients are infected but do not have symptoms and are unlikely to infect others.

The researchers suggested that doctors consider vitamin D supplements as a treatment for TB.

The study, "Vitamin D Deficiency Is Associated with Tuberculosis and Latent Tuberculosis Infection in Immigrants from Sub-Saharan Africa," was published in Clinical Infectious Diseases (2008;46(3):443-446).
 

UNITED KINGDOM:
"Sex Partner Acquisition While Overseas: Results from a British National Probability Survey"
Sexually Transmitted Infections Vol. 83; No. 7: P. 517-522, (12.01.2007) C.H. Mercer; K.A. Fenton; K. Wellings; A.J. Copas; B. Erens; A.M. Johnson
The number of overseas trips made by UK residents has increased dramatically over the past 20 years. While other studies have examined the frequency of partner acquisition abroad, they have used convenience samples and therefore are not generalizable to the British general population, said researchers in the current study.

From 1999 to 2001, the authors conducted a national probability sample survey of 12,110 UK residents ages 16-44. Sociodemographic, health-related, travel, sexual behavior, and attitudinal data were collected via computer-assisted interviewing. The primary outcomes were the proportion of British residents who reported new sex partners overseas in the previous five years, the country of origin of these new sex partners, and the association between reporting a new partner while abroad with a range of demographic, behavioral, and attitudinal variables.

In all, 13.9 percent of males and 7.1 percent of females reported having new sexual partner(s) while overseas in the past five years. The proportions were significantly higher among respondents who were ages 16-24 and never married (23.0 percent of males and 17.0 percent of females). Half of those with new sex partners overseas reported their partner's origin as the United Kingdom, and over a third as another European country. Along with age and marital status, reporting new partners abroad was associated with a higher number of partners, paying for sex (among men), reporting an STD diagnosis, and HIV testing. Adjustment for sociodemographic factors attenuated the magnitude of these associations but did not remove them.

"A substantial minority of young, unmarried people form new sexual partnerships abroad, but these are typically with residents from the UK or other European countries. Those who have new partners abroad are likely to have higher-risk sexual lifestyles more generally, and to be at higher risk of [STDs]," the researchers concluded. "Greater attention should be paid to sexual health promotion for travelers abroad, especially young travelers, emphasizing the risks of new sexual relationships with compatriots as well as those from other countries in terms of [STD]/HIV acquisition and onwards transmission."
 

AUSTRALIA:
"Pap Smear and Chlamydia Test Double-Up Gets Results"
Australian Associated Press, (01.20.2008) Tamara McLean
Urging women to get screened for chlamydia at the same time they undergo a Pap smear would double Australia's testing rates and help rein in the STD, whose rates have climbed more than fivefold in the past decade, new research shows.

Each year in Australia, more than 40,000 new chlamydia cases are reported. A simple test to detect the disease is available, although many young women continue to miss out. In the study, Canberra researchers determined that combining the chlamydia test with the more commonly sought Pap test would significantly improve screening rates.

More than 31 general practice clinics in the Australian Capital Territory participated in the study. Half offered to administer the chlamydia test when a Pap smear was requested, with the rest remaining with standard opportunistic chlamydia screening. Eligible women ages 16-30 offered the combination were twice as likely to be screened as those attending practices in the opportunistic arm, said lead author Professor Francis Bowden of the Australian National University.

"This is not the final answer to chlamydia screening, as the infection occurs most commonly in the 16- to 25-year-old age group and women less than 20 years are less likely to have a Pap smear, and men are not directly targeted," said Bowden. "But for women in the 20- to 30-year age group, this is an easy way to ensure regular chlamydia screening."

Offering the combination screening would require little additional infrastructure since a cervical cancer screening program is already in place, the researchers noted.

The study, "Screening for Chlamydia trachomatis at the Time of Routine Pap Smear in General Practice: A Cluster Randomized Controlled Trial," was published in the Medical Journal of Australia (2008;188(2):76-80).

SOUTH KOREA:
"Impact of Extensive Drug Resistance on Treatment Outcomes in Non-HIV-Infected Patients with Multidrug-Resistant Tuberculosis"
Clinical Infectious Diseases Vol. 45: P. 1290-1295, (11.15.2007) Hye-Ryoun Kim; Seung Sik Hwang; Hyun Ji Kim; Sang Min Lee; Chul-Gyu Yoo; Young Whan Kim; Sung Koo Han; Young-Soo Shim; Jae-Joon Yim
"Recently, serious concerns about extensively drug-resistant tuberculosis (XDR-TB), which shows resistance to second-line anti-TB drugs in addition to isoniazid and rifampicin, have been raised. The aim of this study was to elucidate the impact of extensive drug resistance on treatment outcomes in [non-HIV]-infected patients with multidrug-resistant tuberculosis (MDR-TB)," explained the study researchers.

Patients diagnosed and treated for MDR-TB at Seoul National University Hospital between January 1996 and December 2005 were included. XDR-TB was defined as TB caused by bacilli showing resistance to both isoniazid and rifampicin and also showing resistance to any fluoroquinolone and to at least one of the following three injectable anti-TB drugs: capreomycin, kanamycin, and amikacin. Univariate comparison and multiple logistic regression were performed to identify the impact of extensive drug resistance on treatment outcomes.

The final analysis included 211 non-HIV-infected patients with MDR-TB. Of these, 43 (20.4 percent) had XDR-TB. Treatment failure was observed in 19 patients (44.2 percent) with XDR-TB, compared to treatment failure in 46 patients (27.4 percent) with non-XDR-TB (P=.057). Independent risk factors for treatment failure included the presence of extensive drug resistance (adjusted odds ratio [OR], 4.46; 95 percent confidence interval [CI], 1.35-14.74) and underlying co-morbidity (adjusted OR, 2.62; 95 percent CI, 1.00-6.87). A higher level of albumin was inversely associated with treatment failure (adjusted OR, 0.87; 95 percent CI, 0.77-0.97).

"The presence of extensive drug resistance, the presence of co-morbidity, and hypoalbuminemia were independent poor prognostic factors in non-HIV-infected patients with MDR-TB," the researchers concluded.
 

NEW YORK:
"Disease Foes Hope to Speed a Cure"
Times Union (Albany), (01.17.2008) Eric Anderson
Treating TB requires prolonged drug therapy, and in many poor nations adhering to the months-long course of treatment can be very difficult. To improve the odds of successfully treating TB, the Bill & Melinda Gates Foundation has pledged to spend $900 million on TB by 2015. Last year, the foundation awarded a two-year, $1.7 million grant to Drs. George Drusano and Arnold Louie of the Ordway Research Institute in Albany.

"One of the goals of the Gates Foundation is to change the duration of the therapy from six months to two weeks," said Louie. "If you can, you don't have to worry about patient noncompliance and the emergence of resistant strains."

Drusano, the institute's co-director, and Louie are especially interested in testing drugs against strains that awake from latency after weeks or months. Isolating these strains, the team will try different combinations of drugs to find the most effective, quick treatment.

The researchers are studying different mixes of drugs using an in-vitro device that replicates the way drug concentrations drop over time in the body. With data from earlier trials, Drusano is creating a mathematical model that will predict how the efficacy of TB drugs differs given changes in any of 35 variables. The drugs' interactions are also being assessed. Data from the mathematical model will go back to Louie, who will attempt to validate the model's predictions.

The team is collaborating with AstraZeneca PLC, where drug treatments will be tested on mice, winnowing possible quick-treatment candidates ahead of any human trials. Ordway is focusing on optimizing existing therapies and shortening treatment times, while other researchers are studying potential new treatments.
 

UNITED STATES:
"High HPV Rate Seen Even Among Girls Who Had Just One Sex Partner"
Canadian Press, (01.13.2008) Helen Branswell
A new study of 125 university students shows that nearly one-third of women who reported having just one male sexual partner were infected with human papillomavirus (HPV) within a year of starting that relationship.

Furthermore, three years later, nearly 50 percent of these women had been infected at least once, even though they still had only one sexual partner.

Lead author Dr. Rachel Winer, of the University of Washington-Seattle, said, "This paper shows that even just with one partner there's a high risk of infection."

She added, "It's unlike other STDs where… the virus or bacteria is in core [population] groups. HPV is different in that it's just very common among everyone who's having sex. So even just being exposed to one partner makes you susceptible to infection."

The authors suggested that some women in the study may have become newly infected after two or three years because of decreased condom use. Also, the infections may have resulted from male partners having sex with others; unreported sexual activity with other partners; or sexual activity other than intercourse.

Furthermore, the rate of infection was higher among women who thought their male friends had had more than two previous sexual partners, as opposed to those who thought their partner's experience was more limited.

According to Dr. Monika Naus, director of an immunization program in British Columbia, these findings underscore the wisdom of offering the HPV vaccine to girls before they have sex. In Canada, by age 16, 28.3 percent of males and 33.4 percent of females have had sexual intercourse. The US National Institute of Allergy and Infectious Diseases supported the study.

The full report, "Risk of Female Human Papillomavirus Acquisition Associated with First Male Sex Partner," is published in the Journal of Infectious Diseases (2008;197:279-282).

 

UNITED STATES:
"New Study Blames Columbus for Syphilis Spread"
Reuters, (01.15.2008) Julie Steenhuysen
Christopher Columbus' journey to the New World has been genetically linked to the earliest recorded syphilis outbreak in Europe, a study published Monday suggests.

US researchers studied the evolution of Treponema, the family of bacteria that includes syphilis (Treponema pallidum), and they found syphilis is closest in relation to a subspecies of the bacteria in Guyana that causes yaws - typically a childhood disease spread by skin-to-skin contact. The team concluded that yaws was an ancient infection, but venereal syphilis "or a progenitor came from the New World to the Old World and this happened pretty recently in human history," said Kristen Harper, the study's lead author and an evolutionary biologist at Emory University.

Harper believes a nonvenereal form of yaws evolved into sexually transmitted syphilis, though it is unclear how this occurred. "All we can say is the ancestor of syphilis came from the New World, but what exactly it was like, we don't know," she said. "When you put together our genetic data with the epidemic in Naples in 1495, that is pretty strong support for the Columbian hypothesis."

But the study's conclusions rely too much on genetic changes from just two Guyana bacteria strains, Connie Mulligan of the University of Florida and colleagues suggest in a forthcoming editorial. Better evidence would come from DNA extracted from ancient tissue or bones, she said.

"This is a grainy photograph," acknowledged Harper, who added that more research needs to be done.

The full report, "On the Origin of the Treponematoses: A Phylogenetic Approach," was published in Public Library of Science Neglected Tropical Diseases (2008;2(1):e148. doi:10.1371/journal.pntd.0000148)); the related editorial, "Molecular Studies in Treponema Pallidum Evolution: Toward Clarity?," is due to be published in next week's issue.
 

THE NETHERLANDS:
"Human Papillomavirus DNA Testing for the Detection of Cervical Intraepithelial Neoplasia Grade 3 and Cancer: 5-Year Follow-Up of a Randomized Controlled Implementation Trial"
The Lancet Vol. 370; No. 9601: P. 1764-1772, (11.24.2007) N.W.J. Bulkmans, MD; J. Berkof, PhD; L. Rozendaal, MD; et al.
The authors of this study noted that DNA tests for high-risk human papillomavirus (HPV) are more sensitive for cervical intraepithelial neoplasia grade 3 or worse (CIN3+) than cytological screening. However, there is debate about the necessity for such testing in cervical screening. In that context, the researchers examined whether cervical screening is improved through HPV DNA testing.

Participants were women ages 29-56 in the regular cervical screening program in the Netherlands. The women were randomly assigned to cytological and DNA testing (n=8,575) or conventional cytological testing only (n=8,580). After five years, both groups underwent combined cytological and DNA testing. Follow-up was 6.5 years or more. Analyses were done by intention to treat.

At baseline, more CIN3+ lesions were detected in the combined testing group than in the control group (68/8,575 vs. 40/8,580, 70 percent increase, 95 percent confidence interval 15-151; p=0.007). The number of CIN3+ lesions detected in the second round was lower in the intervention group than in the control group (24/8,413 vs. 54/8,456, 55 percent decrease, 95 percent confidence interval 28-72; p=0.001). The number of CIN3+ lesions did not differ between groups.

"The implementation of HPV DNA testing in cervical screening leads to earlier detection of CIN3+ lesions," concluded authors. "Earlier detection of such lesions could permit an extension of the screening interval."  CDC HIV/STD/TB Prevention News Update
 

See Fall Archives