HIV Prevention

HIV Prevention in Adolescents Faces Legal Barriers

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Laws vary from state to state regarding parental consent when it comes to medical treatment for adolescents. This in itself is not a bad thing as parents have defined rights when it comes to their children’s health. However, when it comes to HIV prevention and research, these laws could pose a public health issue. For some regions, lines are blurred between what constitutes treatment or therapy, and prevention (particularly for HIV and other STDs), and what types of rights adolescents have when it comes to these matters.

Studies are conclusive when it comes to the number of young adults contracting HIV. The facts are:

  • The second largest at-risk population are individuals aged 13 to 24.
  • Of the new infections reported in the United States, researchers found 23% are in this age group.
  • Out of that number, over 70% are young gay and bisexual men.
  • This high-risk group would greatly benefit from certain preventative measures, such as safer sex practices, and using antiretroviral therapies for those who are not HIV-positive.

This latter method has been shown to greatly reduce the risk of contracting the virus. Not only would these measures aid young persons who are at the highest risk of transmitting and contracting the virus, but it could also help stem the growing tide of HIV outbreaks.

What Can Aid Prevention in Adolescents?

The ethical side is clear, and poses no threat. The legalities are what stand in the way. Each state has different laws governing parental consent. Most of these hinge on treatment, not necessarily prevention. It would essentially clear the roadblock if lawmakers and health officials collaborated, amending certain laws to allow for prevention of HIV and other sexually transmitted infections in minors without parental consent.

Another approach is to create clear legal boundaries between treatment and prevention. This could help in areas where laws are not clear-cut, yet tie the hands of healthcare workers as far as aiding the younger population in preventative care. Lastly, having a consistent law code in this regard would also help assure that this particular type of care could be given and received anywhere within the US.

Finding Safer HIV Treatments for Children

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HIV treatments for children is different from treating adults – particularly, for those under three years of age. Doctors have little in the way of guidelines for such treatment. Studies focus on determining which treatments are the most beneficial, with the least long term damage.

Often HIV positive women who are pregnant are given the pharmaceutical drug nevirapine to protect the fetus from transmission. Unfortunately, the drug prevents HIV transmission by only 50%. However, in the event the child does contract HIV, research indicates that, once born, these children can transition from the common treatment for infants to the drug used to treat adults. The drug used for adults is efavirenz, and is not usually administered to persons under the age of three. For infants, a completely different class of drug is used as HIV therapy. Lopinavir/ritonavir is the recommended choice, thus far, for HIV-positive children under three. However, when little ones– those who had exposure to nevirapine in the womb– were given efavirenz, research yielded favorable results.

Researchers were pleasantly surprised by the effectiveness that the changeover brought about. Viral rebound was similar as with the use of the lopinavir/ritonavir. More promising than those results were the CD 4 T-cell counts. These are immune cells that are targeted by the virus. This deadly attack greatly reduces the number of these important immune cells. In children treated with efavirenz, the CD 4 T-cell count was higher than in children provided with the recommended drugs for their age group. In under a year’s time, liver function also proved better than those on the traditionally used medications.

In conclusion, so far, as long as an infant has their infection under control, HIV treatments for children using nevirapine can safely be transitioned to efavirenz. From the studies completed and research gathered, researchers still need further studies to show more results. At this time, the results appear promising though. Experts also plan to investigate long-term effects. In the meantime, finding gentler and more effective ways to treat little ones is high on the priority list.

Increased HCV in HIV-Positive MSM

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Disturbing increases in the number of Hepatitis C infections among certain groups have researchers scrambling to find an effective means of combating it. The virus that causes Hepatitis C (HCV) is blood borne, making injectable drug use a common way to contract the infection. The latest trend, though, is not among people who inject drugs. It is among men who have sex with men (MSM) and are HIV positive. Just why this is happening and how to curb the upward swing in HCV numbers is what researchers are looking into controlling HIV.

Of course, people who inject drugs are certainly at risk for infection, so for the studies that had been performed on this topic, only those who did not abuse injectable drugs were followed so as not to skew the results. Unfortunately, throughout the last decade or so, the number of HIV-infected MSM who have contracted HCV had steadily increased. The problem is that, in recent years, those numbers have increased at a more rapid pace than had been previously predicted.

One risk factor has to do with those who abuses non-injectable drugs. Such drugs as methamphetamine also increased the risk for HCV infection nearly 29 fold. During the studies, a number of participants had repeat HCV infections. These individuals are 20 times more likely to be re-infected. They would contract the virus, seek out treatment, but then contract the disease once again. Not surprising then, high-risk sex behavior and drug abuse saw the highest increases when it came to Hepatitis C.

Projected numbers are not promising for the future either. Currently, out of 1,000 HIV-positive MSM about 20 will present with a Hepatitis C infection over the course of one year. The number of new HCV infection cases is only going to increase. Many believe that this is in part due to lack of education and prevention programs. Just what needs to be taught and which types of programs would prove effective remains to be seen. Education about safe sex practices and drug abuse are being developed to target this growing population. Further study on the matter is underway for controlling HIV.

Saving Lives With “Test and Treat” Strategy for HIV-Infected Individuals

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Antiretroviral Therapies have proven to help those who are HIV positive to enjoy a happy and full life. Those receiving treatment can have relatively normal lifespans. Decades of research and testing has made this outcome possible. Yet, there are many worldwide who are infected but who do not receive regular care or treatment. This causes a rise in mortality and poorer quality of life. So, in an effort to reach out and ensure that everyone is tested and treated without some falling through the cracks, a program was instituted in one region that had promising results as a HIV treatment as prevention approach.

A ‘test and treat’ method was applied to one area where HIV care was lacking. Program goals were to make testing and treatment simpler and faster while at the same time reducing the time between testing and therapy. Participants were tested for HIV along with a CD4 count and received results during the same visit. Included in that initial visit were both counseling prior to treatment and eligibility for antiretroviral therapy.

Faster Treatment Saves Lives

The time between HIV infection confirmation and the beginning of a patient’s therapy was greatly reduced – down to around five days – where previously it hovered at almost two months. Due to the efficient manner in which these cases were handled, the numbers showed that more patients received their treatments and followed through. Even better was how drastically the mortality numbers fell. One estimate puts the mortality rate at 13%, where before it was nearly 40%. When the program started little information had been gathered on the HIV positive population. This made it a bit more challenging to determine just how successful the test and treat method was. Undeniably, however, it met with great results that instill confidence in this type of streamlined care.

The success of this program highlights the need to implement HIV treatment as prevention in other areas. Some revision may need to take place so that it fits the needs of the region. Another matter meriting consideration is the cost. Researchers figured that for each patient who survived, the cost was US$235. This basically covered the first year of treatments and intervention. So from a financial standpoint, the cost is minimal compared with the outcome, making the program one that is feasible just about anywhere.

 

DC Proves Needle Exchanges Have Value for Prevention

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Sometimes, less is more. For HIV prevention programs, this is truly the case in needle exchange programs. One simple idea, in concept and execution, has saved one city millions of dollars and has prevented over 100 new cases of HIV in just two short years.

The needle exchange program is one of the easiest ways to help prevent HIV (and other viral infection) outbreaks and new cases in general. Along with that, it is by far one of the most cost effective tools on the war front against AIDS today. The program’s success is also helping in the ongoing debate over program funding. One study has put that success into numbers.

Simple idea, big results – that sums up the program. Basically, patients who need prescription medications that are administered via needles must return their used needles before they are given their next doses. For a while, the government aided in the funding for these and similar programs. Congress placed a ban on programs such as this in 1998. The ban prohibited the use of federal funds for needle exchange programs. States and their cities were, of course, allowed to use their own funds to support the programs, but many were unable to do so.

In late 2007, this ban was lifted in DC. Almost immediately, the Department of Health reinstituted the needle exchange program and programs for HIV testing, plus programs for aid addiction treatment. Once the ban lifted and the programs went into effect, researchers began to track the programs’ progress.

When comparing the numbers, from those during the ban to those after, impressive results were seen. The team first determined how many new injection drug use (IDU) cases presenting with HIV has occurred. Using the information they had gathered, an estimated 296 cases of HIV would have presented during two more years of the program funding ban. This is compared to the 176 injection drug users who did become infected with HIV with the programs in effect. Lifting the ban saved over 100 people from possibly contracting HIV in just two short years! There are financial benefits as well. Treatment for 120 people would have cost millions. It is estimated that taxpayers saved $44.3 million.

DC is not the only area benefiting from these types of programs. Regions across the US are reporting similar results.

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