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Low HIV Blood Levels Reduce Risk, Enhance Treatment, Say Studies
or
Low Viral Load Means Less HIV Transmission, Better Treatment Success, Say Studies
By Healthy Living News
February 2012
Two new studies verify that blood levels of HIV are important in determining risk of HIV sexual transmission and the success of HIV therapy.
The first study revealed that the risk of HIV transmission is greatly diminished when HIV blood levels, also known as viral load, are at low levels. That study also confirmed a recent break-though advance in HIV prevention.
Published in the Journal of Infectious Diseases, the study included 3,297 HIV-discordant heterosexual African couples (where one person is HIV-infected and the other is not). Viral load levels were frequently measured in the infected partner along with HIV genetic testing to link any transmitted virus by the HIV-infected partner to the uninfected one.
The study reveals that in the infected partner, the lower the viral load, the lower the risk of sexually transmitting the virus to the uninfected partner. Each log level decrease was associated with a three fold decrease in transmission risk.
The study also indirectly confirms the results of the breakthrough “Treatment as Preventions” study released last year. That study, known as HPTN 052, proved that lowering viral load through early initiation of HIV therapy reduces transmission of the virus to uninfected partners by up to 96%.
But can Treatment as Prevention be improved upon further through treatment and technology?
Another study reveals that treatments that suppress HIV to very, very low levels may guarantee the long-term success in treating the virus and preventing its transmission to others.
The study, published in Clinical Infectious Disease, examined how well newer viral load tests predict HIV treatment failure. Tests used by many clinics still measure viral load down to 50 HIV copies per a milliliter sample of blood. But newer tests detect viral load down to even lower levels. So the question was asked, what are the levels of treatment success and failure among those measured with these newer tests?
The study tested 1247 patients using the old ultrasensitive and the newer ultra-ultrasensitive viral load tests. For those who tested below 50 copies, or undetectable on the old test, 211 eventually experienced a rebound in viral load to detectable levels above 50. Before they did, a third of them whose virus rebounded (34%) measured between 40 and 49 HIV copies on the ultra-ultrasensitive tests. For those with even lower viral loads between 39 and about 10 copies, 11% eventually broke through to above 50. For those down to under 10 HIV copies, or undetectable levels on the ultra-ultrasensitive test, only 4% eventually rebounded above 50.
Putting it another way, those with an ultra-ultrasensitive viral load between 39 and 10 HIV copies were twice as likely to rebound to above 50 than those testing undetectable on the new test. Those who tested between 40 and 49 were more than a four-times as likely to rebound.
Other studies show that for those on treatment, viral load levels consistently higher than 50 lead to HIV drug resistance. Forty of those in the study whose viral load broke through eventually had viral load increases above 400. Those in the study with ultra-ultrasensitive levels between 40-49 also tended to be less compliant in taking their medications.
Those who had been on HIV therapy longer, however, tended to suppress HIV to the very lowest levels on the new tests.
It should be noted that being HIV undetectable on any viral load test does not mean being cured of HIV. Studies show there is no guaranteed “safe” level of HIV viral load, only levels that show a reduced risk of transmitting the virus. HIV is still, in theory, transmissible even if your viral load is undetectable. Very low amounts of HIV may still be in the blood and larger amounts are still in the lymph nodes, spleen, or brain and possibly even semen. Viral load levels can also spike from an infection or after a vaccination.
BLACK HISTORY FIRST
1783
First African American to formally practice medicine in the U.S.: James Derham, who did not hold an M.D. degree
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FEBRUARY MEDICAL MONTH
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Black History Medical Facts
February 2012
Cancer
* In 2004, African American men were 1.4 times as likely to have new cases of lung and prostate cancer, compared to non-Hispanic white men.
* African American men were twice as likely to have new cases of stomach cancer as non-Hispanic white men.
* African Americans men had lower 5-year cancer survival rates for lung and pancreatic cancer, compared to non-Hispanic white men.
* In 2005, African American men were 2.4 times as likely to die from prostate cancer, as compared to non-Hispanic white men.
* In 2005, African American women were 10% less likely to have been diagnosed with breast cancer, however, they were 34% more likely to die from breast cancer, compared to non-Hispanic white women.
* African American women are twice as likely to be diagnosed with stomach cancer, and they were 2.4 times as likely to die from stomach cancer, compared to non-Hispanic white women.
Diabetes
* African American adults were 1.9 times more likely than non-Hispanic white adults to have been diagnosed with diabetes by a physician.
* In 2002, African American men were 2.1 times as likely to start treatment for end-stage renal disease related to diabetes, compared to non-Hispanic white men.
* In 2003, diabetic African Americans were 1.7 times as likely as diabetic Whites to be hospitalized.
* In 2005, African Americans were 2.2 times as likely as non-Hispanic Whites to die from diabetes.
Heart Disease
* In 2005, African American men were 30% more likely to die from heart disease, as compared to non-Hispanic white men.
* African Americans were 1.4 times as likely as non-Hispanic whites to have high blood pressure.
* African American women are 1.7 times as likely as non-Hispanic white women to be obese.
HIV/AIDS
* Although African Americans make up only 13% of the total U.S. population, they accounted for 47% of HIV/AIDS cases in 2006.
* African American males had more than 7 times the AIDS rate of non-Hispanic white males.
* African American females had more than 21 times the AIDS rate of non-Hispanic white females.
* African American men were more than 9 times as likely to die from HIV/AIDS as non-Hispanic white men.
* African American women were more than 20 times as likely to die from HIV/AIDS as non-Hispanic white women.
Immunization
* In 2005, African Americans aged 65 and older were 40% less likely to have received the influenza (flu) shot in the past 12 months, compared to non-Hispanic whites of the same age group.
* In 2005, African American adults aged 65 and older were 30% less likely to have ever received the pneumonia shot, compared to non-Hispanic white adults of the same age group.
* Although African American children aged 19 to 35 months had comparable rates of immunization for hepatitis, influenza, MMR, and polio, they were slightly less likely to be fully immunized, when compared to non-Hispanic white children.
Infant Mortality
* In 2005, African Americans had 2.3 times the infant mortality rate of non-Hispanic whites.
* African American infants were almost four times as likely to die from causes related to low birthweight, compared to non-Hispanic white infants.
* African Americans had 1.8 times the sudden infant death syndrome mortality rate as non-Hispanic whites.
* African American mothers were 2.6 times as likely as non-Hispanic white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all.
* The infant mortality rate for African American mothers with over 13 years of education was almost three times that of Non-Hispanic White mothers in 2004.
Stroke
* African American adults are twice as likely than their White adult counterparts to have a stroke.
* African American males were 60% more likely to die from a stroke than their White adult counterparts.
* Analysis from a CDC health interview survey reveals that African American stroke survivors were more likely to become disabled and have difficulty with activities of daily living than their non-Hispanic white counterparts.
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U.S. Blacks More Likely to Die of Colon Cancer Than Whites: Study
This gap in survival is widest among those diagnosed with advanced disease, research shows
By Alan Mozes
February 2012
HealthDay News
Although colorectal cancer death rates in the United States have fallen across the board over the last 20 years, the dip has been smaller among blacks than whites, a new study indicates.
Specifically, the racial spread in death rate trends appears to be most notable among patients diagnosed with the most advanced stage of the disease, according to the results of an investigation by the American Cancer Society (ACS).
"The widening racial disparity for [advanced]-stage has a disproportionate impact on overall colorectal cancer mortality disparities because [advanced]-stage accounts for approximately 60 percent of the overall black-white mortality disparity," the study authors explained in an ACS news release.
The study team, led by Dr. Anthony Robbins, pointed out that up until 1980, black Americans were actually less likely to die from colorectal cancer overall than whites. Since then, however, the availability of ever-better screening and treatment options has turned that dynamic on its head. The result: by 2007, the rate of death among blacks was 44 percent greater than that among whites.
The reason, the authors suggested, may be that black patients do not seem to be getting screened or treated as often and as aggressively as white patients.
The aim of the current ACS study was to find out how exactly racial differences in plummeting death rates have been playing out with respect to disease progression: namely, early-stage (in which cancer is localized); mid-stage (in which cancer has spread to regional lymph nodes); and late-stage (in which the cancer is made its way throughout the patient's body).
To explore that question, the team analyzed two decades of information that had already been gathered by the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program database.
The review, released online Dec. 19 in advance of print publication in the Journal of Clinical Oncology, revealed that while racial differences in death rate declines were apparent at every stage of disease, the divide was most stark among late-stage patients.
For example, while early-stage white patients experienced a roughly 30 percent drop in death rates over the last 20 years, their black peers experienced about a 13 percent decline. Among mid-stage patients, the drop was almost 49 percent among whites versus 34 percent among blacks.
But for those with the most advanced stage of disease, the gap was even greater: death rates had dropped by nearly 33 percent among whites compared with just under 5 percent among blacks, the investigators found.
The authors noted that black Americans tend to be screened less often, are less likely to have timely follow-ups when they are screened, and are generally less well informed when it comes to the latest and best treatment options. The researchers suggested that to rectify the problem, an effort should be made to bump up early-stage detection of colorectal cancer among black patients.
SOURCE: American Cancer Society, news release, Dec. 22, 2011
Black Women at Greater Risk For Certain Breast Cancers, Says Study.
Genetic Basis for Aggressive Cancer Identified
February 2012
Researchers have identified a genetic risk factor for two types of breast cancer that largely affects women of African descent. The cancers can carry a worse prognosis than other forms of the disease. However, the discovery could also lead to better screening and treatments for the cancers.
The researchers were searching for genetic risk factors associated with what is known as estrogen-receptive negative breast cancer. Women of African descent are more likely to have this type of breast cancer than women from other racial and ethnic backgrounds, according to the researchers. They are also are more at risk for an even more aggressive cancer known as triple-negative breast cancer. Triple-negative means the breast cancer is not estrogen receptor (ER), progesterone receptor, or Her2/neu caused breast cancer.
The researchers compared data of breast cancer in African American women and women with European ancestry who had triple-negative breast cancer.
That revealed that the genetic variant, or chromosome mutation known as 5p15, increases the chances of developing triple-negative tumors, especially for women under age 50.
The good news is that knowing the gene variant may someday lead to tests that can determine who is at greater risk of developing cancer. Fergus Couch, professor of laboratory medicine and pathology at the Mayo Clinic, and co-principal investigator explained that the region of the genome they studied has been the focus of investigations of other cancers as well, including serous ovarian cancer, glioma, and lung cancer.
“So, this might be a global marker for other cancers,” said Couch, whose research focuses on genetically inherited forms of cancer.
The researchers will continue the search for genetic risk factors for these aggressive cancers like triple-negative breast cancer which could lead to better cancer screening, earlier cancer detection, and new treatments.
“We plan to enlarge this study with other genome-wide research that is also focused on estrogen receptor-negative disease" said Christopher Haiman, professor of preventive medicine at the Keck School and co-principal investigator for the study. “Identification of additional susceptibility regions for aggressive forms of breast cancer will continue to inform us about these tumors and, hopefully, provide new information that can be used for screening, prevention and targeted treatment.”
The study appeared in Nature Genetics.
PHYSICIANS MEDICAL FORUM HOSTS DAY-LONG CONFERENCE TO RECRUIT AFRICAN AMERICAN STUDENTS TO ATTEND MEDICAL SCHOOL AND PRACTICE IN THE OAKLAND/SAN FRANCISCO BAY AREA AND NORTHERN CA
Pre-med, University/College & Post-baccalaureate Students and High School Seniors Invited to Take Part Saturday, Feb. 18th
The number of African American students applying to medical school is increasing. First-time applicants to medical school reached an all-time high in 2011, increasing nationally by 2.6 percent over last year, according to new data released in October, 2011 by the Association of American Medical Colleges (AAMC). Total applicants rose by 2.8 percent with gains across most major racial and ethnic groups for a second year in a row... African American applicants increased by 4.8 percent.
BlackNews.com
February 2012
The Physicians Medical Forum (PMF) aims to increase the number of African American physicians, residents and medical students in the Oakland/San Francisco Bay and Northern California, while helping to improve the delivery of culturally competent medical care to better meet the health care needs of African Americans and community at-large. To that end, on February 18th, the non-profit organization will host its annual "Doctors on Board Program - a day-long, tuition-free, information-filled series of seminars, workshops and case studies to encourage the increase of black students attending medical school.
"The October 2011 AAMC report is encouraging," said J. Renee Navarro, PharmD, M.D., Vice-Chancellor for Diversity & Outreach at the University of California, San Francisco. "This is truly a sign that the pipeline programs are successful and beginning to reach black and other minority students. Programs like "Doctors On Board" are essential in providing mentorship, linkages and networks for students interested in becoming physicians."
Several of the Bay Area's most prominent physicians and medical school representatives will provide students with an innovative and exciting opportunity to explore varied facets of medicine and provide information about medical school preparation, medical specialties, and life as a physician. Segments of the "Doctors on Board Program" will include: a workshop on admissions & financial aid; a seminar with currently-enrolled medical students and residents; a "mock" Ethicon Knot Tying Basic Skills Training Session; "mock" medical clinics with real patients; and a workshop for parents of future doctors. Upon completion of the program, students will be awarded certificates with a reception immediately following.
There is no cost for students to attend the conference sponsored by Physicians Medical Forum. Students who wish to take part in this groundbreaking, one-day program must submit the Student Application by Monday, February 6, 2012.
WHO: Physicians Medical Forum (PMF)
WHAT: "Doctors on Board Program" (Pre-Medical School Recruitment Conference)
WHEN: Saturday, February 18, 2012 | 6:30 A.M. to 6:00 P.M.
Registration & breakfast (6:30 A.M. - 8:00 A.M.)
Workshops, lunch, mock training & medical clinics (8:00 A.M. - 4:00 P.M.)
Award ceremony and networking reception (4:00 P.M. - 6:00 P.M.)
WHERE: Oakland Marriott City Center | 10th and Broadway, downtown Oakland
Dr. Albert L. Brooks, PMF President and Chief of Medical Services at Washington Hospital in Fremont, California said, "I am proud to be a part of the Physician's Medical Forum, and look forward to meeting and mentoring young African American students who aspire to become doctors. It is rewarding to know that so many physicians from throughout Northern California are donating their time to encourage young minds to consider attending medical school."
Members of the PMF Board of Directors, Sinkler Miller Medical Association (SMMA), and Student National Medical Association (SNMA) Region 1; students from UCSF, UC Davis, and Stanford University Schools of Medicine; and numerous other prominent physicians, faculty, residents, administrators, and business professionals will instruct, mentor, and network with student participants.
PMF Executive Director Stalfana Bello said, "PMF understands that an active, viable, diverse and thriving medical community is key to retaining physicians. The "Doctors On Board Program" is vital in its effort to encourage students to pursue careers in medicine, which is so imperative to maintaining healthy inner-city communities."
The "Doctors on Board Program" is supported by Alta Bates Summit Medical Center. Physicians Medical Forum has also received grants from Wells Fargo, California Healthcare Foundation, California Endowment, Safeway, Inc., SGC Financial & Insurance Services, and Kaplan Test Prep.
Books Available
 
 
 
Racial Disparities Seem to Persist in Depression Diagnosis
Older black Americans less likely to receive diagnosis than white peers, study finds
By Robert Preidt
February 2012
Racial and cultural factors still affect the diagnosis and treatment of depression in elderly Americans, despite improvements to diagnostic tools and therapies in recent decades, according to a new study.
Researchers found that elderly blacks are less likely to be diagnosed -- and therefore treated -- than whites or Hispanics.
About 6.6 percent of elderly people in the United States have an episode of major depression each year, making it a significant public health issue for older Americans, the Rutgers University researchers pointed out in a university news release.
If it's left untreated or undertreated, depression can have a major negative impact on quality of life and can also complicate medical conditions that are common in elderly people, including congestive heart failure, arthritis and diabetes, Ayse Akincigil, an assistant professor in Rutgers' School of Social Work, and colleagues explained.
The investigators analyzed data collected from nearly 34,000 Medicare beneficiaries between 2001 and 2005, and found that rates of depression diagnosis were 6.4 percent for whites, 4.2 percent for blacks, 7.2 percent for Hispanics, and 3.8 percent for other groups.
"Efforts are needed to reduce the burden of undetected and untreated depression and to identify the barriers that generate disparities in detection and treatment," the researchers concluded.
"Promising approaches include providing universal depression screening and ensuring access to care in low-income and minority neighborhoods," they added. "An increase in the reimbursement of case management services for the treatment of depression also may be effective."
The study was released online in advance of publication in an upcoming print issue of the American Journal of Public Health.
SOURCE: Rutgers University, news release, Dec. 20, 2011
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