IDSA News - December 1, 2007
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Acute Infection Tool Now Available

Missing the signs of acute HIV infection means missing a major prevention opportunity. HIVMA has put together a free poster and fact sheet to help primary care clinicians identify and respond to this earliest and highly infectious stage of the disease.

The poster lists common symptoms of acute infection and stratifies some high-, medium-, and low-risk behaviors. It also recommends some questions to ask patients to identify their potential exposure to HIV. The fact sheet gives clinical recommendations, including what tests to perform and how to interpret results. It also gives advice on counseling the patient in case of positive or negative test results.

If you would like copies to share with students or colleagues that provide primary care, please contact HIVMA’s Rhonda Harrison at cpage@idsociety.org or (703) 299-1215.

Apply for NIH Director’s Pioneer and New Innovator Awards

The National Institutes of Health (NIH) is accepting applications for the 2008 NIH Director’s Pioneer and New Innovator Awards.  The awards provide support to scientists who take an exceptionally creative, innovative approach to major challenges in biomedical or behavioral research.  They are part of the NIH Roadmap for Medical Research and complement other NIH programs that fund innovative research by scientists in the early stages of their research careers. 

Pioneer awards, which are open to scientists at any career stage, provide $2.5 million in direct costs over a period of five years.  New Innovator Awards, which are awarded to new investigators who have not previously received an NIH regular research (R01) or similar grant, provide $1.5 million in direct costs over five years.  For more information on these programs please visit http://nihroadmap.nih.gov/pioneer and http://grants.nih.gov/grants/new_investigators/innovator_award.

HIVMA Accepting Applications for the Minority Clinical Fellowship

The HIV Medicine Association (HIVMA) is now accepting applications for its award-winning fellowship, which is designed to encourage physicians from some of the communities most affected by HIV/AIDS to enter the field of HIV care. The HIVMA Minority Clinical Fellowship offers African American and Latino physicians the opportunity to gain clinical experience and expertise in HIV care.

The need for more minority physicians practicing HIV care is urgent. African Americans make up only 12 percent of the U.S. population but accounted for 50 percent of the AIDS diagnoses in 2005, according to the Centers for Disease Control and Prevention (CDC). Latinos represented 14 percent of the U.S. population and 19 percent of the AIDS cases.  

“The number of African Americans and Latinos with HIV /AIDS continues to grow, but we have not seen a parallel increase of health care providers from those constituencies,” said Arlene Bardeguez, MD, MPH, vice chair of the HIVMA Board of Directors.

“To make matters worse, very few physicians of any race or ethnicity are going into the field of HIV medicine,” added Kimberly Y. Smith, MD, MPH, member of the HIVMA Minority Clinical Fellowship Committee.

Fellowship winners will work with HIVMA mentors at institutions where they will continuously manage HIV-positive inpatients and outpatients. The Fellowships provide each recipient a $60,000 stipend plus benefits for one year as well as $10,000 for the mentor at the sponsoring institution.

Kaiser Permanente granted the HIVMA Minority Clinical Fellowship its National Diversity HIV/AIDS Award this year at its annual diversity conference.

HIVMA acknowledges the generous support of GlaxoSmithKline, Pfizer Inc., Abbott Laboratories, Gilead Sciences, Bristol-Myers Squibb, and Tibotec Therapeutics for this important new initiative.

Applications are due February 15, 2008. Click here for more information or to apply.

HIVMA Offers Fact Sheet on HIV/TB Coinfection

The HIV Medicine Association (HIVMA), IDSA, and the Forum for Collaborative HIV Research have published a fact sheet on HIV and tuberculosis coinfection for policymakers and the media.

The fact sheet includes basic information about the dual epidemic, including diagnosis and treatment challenges, special considerations for pediatric populations, and the threat of drug resistance. The fact sheet makes the case for integrating HIV prevention, treatment, and care activities into TB services, including support for TB care and treatment. It also calls for operational research to assess different approaches to the care of HIV-TB coinfected patients. 

HIVMA and the Forum for Collaborative HIV Research are providing the fact sheet, along with a recent supplement from the Journal of Infectious Diseases on HIV/TB coinfection, to members of Congress who are responsible for the reauthorization of the President’s Emergency Plan for AIDS Relief (PEPFAR). 

The 15 countries that receive U.S. aid under PEPFAR account for 21 percent of the global TB burden and 24 percent of the world’s annual TB deaths. In Botswana, 70 percent of new adult TB cases are HIV-positive; in South Africa, 58 percent; and in Zambia, 55 percent.

Include Your Practice in the HIV Provider Listing

The HIV Provider Listing is an HIVMA-hosted online database of members in HIV clinical care in the United States and Canada who are accepting new patients. The listing is accessible to the public and allows users to search for providers based on location and services provided.

"This is a real opportunity for doctors who provide needed health care for those with HIV to make this information known to the public," said HIVMA Executive Director Christine Lubinski. "Finding a central resource for doctors accepting new patients is consistently identified as a ’must-have’ for getting proper care in a timely manner."

HIVMA is currently updating its database and encouraging members to participate in this worthwhile endeavor. HIVMA and IDSA member physicians in clinical practice and accepting new patients are encouraged to create and maintain a listing by clicking here or by visiting www.hivma.org. Click on “Resources” and then “HIV Provider Listing” to access the listing, and follow the instructions on the form. A member login ID and password are required to sign up. HIVMA will only release the information designated by members who choose to participate.

This valuable public resource is accessed by those in need of HIV care and treatment every day, so please sign up today!

EIN: Antibiotic Locks Common, But No Common Protocol

A large number of clinicians are using antimicrobial locks to prevent or treat catheter-related bloodstream infections, but techniques vary widely, according to a new survey of the Emerging Infections Network (EIN). This result—coupled with significant interest expressed in the subject by EIN members —suggest the need to develop standardized protocols for the use of the locks.

More than 40 percent of respondents to the survey said they used antimicrobial lock therapy (ALT) to salvage infected catheters, most frequently to combat coagulase-negative staphylococcal infections. Vancomycin, often combined with heparin, was the most commonly used antimicrobial, but a wide range of other antimicrobials were reported. Concentrations, durations, and dwell times varied.

More than half of nearly 1,100 EIN members receiving the survey responded—an extremely high response rate. Many others who did not respond expressed interest in the findings.

Several respondents reported their pharmacists had drug compatibility concerns, particularly with the combination of vancomycin and heparin. Some used ethanol solutions, but there was concern that ethanol would damage the catheter.

“We found antimicrobial locks are used fairly often, especially for treating the most common infections,” said EIN Program Coordinator Susan Beekmann, RN, MPH, “but there is no standard method.” Developing standardized protocols would help both clinicians and pharmacists optimize the procedure, she said.

EIN conducted the survey following requests from several members and from the Centers for Disease Control and Prevention. Survey results will be shared with the IDSA and Society for Healthcare Epidemiology of America panel currently working on guidelines for health care-acquired infections, which are expected next year.

Stay Connected - Update your IDSA Member Profile

A complete and accurate profile helps you get the most out of your IDSA Membership!

Help us better serve your needs. Please take a few minutes to review and update your member profile on our website.  Your up-to-date contact and demographic information is essential for us to provide you with timely and useful information. We know how valuable your time is. This information will help us target future communications that coincide with your specific interests.

To update your profile, follow these simple steps:

  • Go to our website, www.idsociety.org, and click on “MyIDSA” at the top of the page
  • Access the member login page and type in your User ID and Password (If you have forgotten your password, e-mail membership@idsociety.org)
  • Click on “Update My Profile”

IDSA Advocacy Update

Physicians Protest Cuts in Physician Payments

More than 12,000 physicians contacted their legislators last month to protest Medicare’s 10.1 percent cut in physician payments scheduled to take effect on January 1, 2008.  The action was spurred by a plea from a coalition of dozens of medical specialty societies, including IDSA, urging physicians to learn more about problems with Medicare’s physician payment formula and contact their members of Congress.  The plan would include additional cuts totaling 40 percent through 2015 unless Congress finds a long-term solution to the physician payment problem. More information is available on our website.

In other advocacy news, IDSA and HIVMA urged members of Congress to override President Bush’s veto of the fiscal year 2008 bill funding the Department of Health and Human Services and other departments. In a November 14 letter, IDSA and HIVMA said lack of funding would endanger efforts to control the HIV epidemic in the United States, prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA), and prepare for threats such as pandemic influenza. 

Other advocacy items include:

IDSA Members Testify at Pennsylvania Hearing on Lyme Disease

IDSA members testified last month at a Pennsylvania hearing on a state bill that would sanction long-term antibiotic treatment for Lyme disease and mandate insurance coverage for it.

Michael Buckley, MD, FIDSA, of the University of Pennsylvania Health System and John D. Goldman, MD, of PinnacleHealth at Harrisburg Hospital told lawmakers that the medical community is concerned that the bill could be harmful to patient care and to the public health by subjecting patients to unnecessary risks such as serious bloodstream and bowel infections, and by promoting the development of dangerous drug-resistant infections such as methicillin-resistant Staphylococcus aureus (MRSA).

“We believe it is critically important that [the Legislature] be fully apprised of the widespread consensus within the medical and scientific community about the appropriate treatment of Lyme disease, as well as the medical community’s concerns about unproven, potentially harmful treatments for so-called ‘chronic’ Lyme disease that are advocated only by a small group of physicians,” they told members of the Pennsylvania House Committee on Health and Human Services.

Drs. Buckley and Goldman cited IDSA’s 2006 practice guidelines on Lyme disease, which concluded that there is no evidence that Borrelia burgdorferi—the bacterium that causes Lyme disease—persists chronically following 10 to 28 days of antibiotic therapy.

The committee also heard from supporters of long-term antibiotic therapy, including a representative of the International Lyme and Associated Disease Society (ILADS), which maintains that Lyme disease exists in a chronic form and that long-term intravenous ceftriaxone provides clinical benefit.

Dr. Goldman noted that both organizations agree that Lyme disease should be caught in its early stages. However, he explained that five double-blind, randomized, placebo-controlled trials of patients with post-Lyme disease syndrome have shown that antibiotic therapy is not in the best interest of patients.

To read Drs. Buckley and Goldman’s testimony, click here.

For more information, see (non-subscribers can register or pay for access):

Oksi et al. Eur J Clin Microbiol Infect Dis. 2007 Aug;26(8):571-81.

Fallon et al. Neurology. 2007 online Oct. 10;0: 01.WNL.0000284604.61160.2dv1 

Halperin, Neurology. 2007 online Oct. 10;0: 01.WNL.0000291407.40667.69v1.

Klempner et al. N Engl J Med. 2001 Jul 12;345(2):85-92.

Krupp et al., Neurology. 2003 Jun 24;60(12):1923-30.

In Memoriam: Merle A. Sande, MD, FIDSA (1939-2007)

By Thomas Quinn, MD, FIDSA, and W. Michael Scheld, MD, FIDSA

One of the leading figures in our field and a former president of IDSA, Merle A. Sande, MD, passed away peacefully at his home in Seattle on Nov. 14, 2007 surrounded by loved ones. He was 68.

Merle’s contributions to the field of infectious diseases were enormous. He published more than 300 original peer-reviewed articles, review articles, and book chapters on an extraordinarily wide range of bacterial and viral infections and their treatment. This body of work, awesome in breadth, has influenced practically every aspect of infectious diseases.

Shortly after moving to San Francisco in 1980 to become chief of medical services at the San Francisco General Hospital, Merle recognized that a large number of young, otherwise healthy gay men were presenting with unusual opportunistic infections and cancers. Merle’s early recognition of AIDS led to his prodigious efforts in the early clinical care of patients with the disease. He established the first inpatient unit in the world dedicated to the care of patients with AIDS. He and his colleagues were also responsible for establishing and articulating the principles of infection control during the early AIDS epidemic, now known as “universal precautions.” Published in The New England Journal of Medicine (1983;309:740-4), they were a major achievement during an era when fear and paranoia surrounded AIDS.

Merle lobbied heavily at the local, state, national, and international levels for increased funding for care, prevention, and research on AIDS. He established the Gladstone Institute for Virology and Immunology at the San Francisco General Hospital in the early 1990’s and was instrumental in conducting some of the earliest trials of opportunistic infections in AIDS patients in Africa.

In 2001, Merle returned to Uganda and co-founded and co-directed the Academic Alliance for AIDS Care and Prevention in Africa. This unique public-private partnership comprises faculty from Makerere University in Kampala, Uganda, and faculty from several medical institutions in North America. Collectively, they designed and were responsible for construction of the Infectious Diseases Institute (IDI), with funding from Pfizer Inc. This state-of-the-art center for HIV care, prevention, research, and training has become a regional center of excellence in east Africa.

The Academic Alliance partnered with IDSA and HIVMA to form the AIDS Training Program, which provided an opportunity for IDSA members to train African health care workers in HIV/AIDS care in Kampala. To date, 2,000 health care providers from 26 sub-Saharan African countries have been trained in state-of-the-art HIV/AIDS care, as well as the care of other infectious diseases (e.g. tuberculosis and malaria).

Merle accepted his first faculty position at the University of Virginia in 1971, where he rapidly rose to the rank of professor of medicine and served as vice chair and acting chair of the department of medicine. Merle moved to San Francisco in 1980 to become chief of medical services at San Francisco General Hospital and vice chair of the department of medicine at UCSF. In 1996, he assumed the position of chair of the department of medicine at the University of Utah and later, in 2005, he returned to the University of Washington as professor of medicine, his final academic position.

He served on numerous national and international committees, and editorial boards of prestigious journals in the field of infectious diseases. He also was the recipient of multiple awards, including the Alexander Flemming award for lifetime achievement—IDSA’s highest honor—and Uganda’s Presidential Distinguished Service Award for Contributions to Health Care. He edited more than twenty books, and for many years contributed to The Sanford Guide to Antimicrobial Therapy.

Merle will always be remembered as an outstanding, innovative and visionary investigator, educator, mentor, clinician, role model, and leader in our field during a remarkable career that spanned nearly four decades.

He is survived by his wife, Jenny, a sister, four children, and eight grandchildren.

 

 The family has requested that donations be made to:
 The Merle A. Sande Memorial Fund
 c/o Academic Alliance Foundation
 1611 North Kent St, Suite 202
 Arlington, VA 22209

 Please visit the website link below for more information:
 
www.academicalliancefoundation.org/sande-memorial/index.html#MemorialFund 

Members on the Move

David A. Acheson, MD, FIDSA, has been appointed Acting Director of the Food and Drug Administration’s (FDA) Center for Food Safety and Applied Nutrition (CFSAN).  Dr. Acheson is currently Assistant FDA Commissioner for Food Protection, a post he will retain when he assumes his leadership role at CFSAN. 

Andrew T. Pavia, MD, FIDSA, has been appointed to the National Biodefense Science Board, an advisory panel to the Secretary of the U.S. Department of Health and Human Services on scientific, technical, and other issues related to chemical, biological, nuclear and radiological threats.

Welcome, New IDSA Members!

Members

DuTeau, Nancy M., MD
Nasrin, Dilruba, PhD
O'Leary, Thomas R., PharmD
Selvaraju, Suresh B., MD 

Associate Members

Marton, Robert S. 
Pacana, Frank A., PharmD
Sampath, Ranga, PhD
Sherman, Robert F., PharmD 

Members-In-Training

Aldous, Jeannette L., MD
Backer, Martin, MD
Bakhtyar, Arsala, MD
Brownlee, Joshua, MD
Chan, Shih-Han, MD
Chandrasekaran, Obulakshmipriya, MD
Garcia Fernandez, Maria A., MD
Gomez-Urena, Eric, MD
Gounder, Celine R., MD
Jaramillo Hoyos, Carlos M., MD
Layden, Jennifer, MD, PhD
Lowman, Erik, DO
Makinde, Helen, MD
Martin, Andrew R., MD
O'Leary, Sean, MD
Pham, Tri M., MD
Pomakova, Diana, MD
Prakash, Vidhya, MD
Rao, Agam, MD
Rim, Jean, MD
Rivero, Andres, MD
Sangchan, Warankana, MD
Scholle, David, MD
Sikka, Monica, MD
Sturt, Amy S., MD
Syed, Ather, MD, MBBS
Zilioli, Gina, MD

In the IDSA Journals

Suppressing Herpes Virus May Reduce Infectiousness of HIV

A recent study of men co-infected with herpes simplex virus type 2 (HSV-2) and HIV demonstrated that drugs used to suppress HSV-2 may also indirectly decrease the levels of HIV-1 in the blood and rectal secretions, making patients less likely to transmit the virus. (Zuckerman et al. J Infect Dis. 2007;196:1500-1508.)

Seminal Plasma Inhibits Vaginal Microbicides

This study found that two microbicides in Phase II/III clinical trials were much less effective against herpes simplex virus type 2 (HSV-2) when the virus was introduced in seminal plasma compared to saline solution. Most previous studies have introduced the virus in saline solution or tissue culture media. The results suggest the microbicides will need to be modified to retain effectiveness under certain in vivo conditions. (Patel et al., J Infect Dis. 2007;196:1394-1402.)

U.S. Measles Immunity High, but Not Uniform

Overall measles antibody seropositivity between 1999 and 2004 was high enough to promote herd immunity in nearly all U.S. population subgroups between ages 6 to 49 years. The exception is the 1967 to 1976 birth cohort, probably related to lower vaccination rates among children before the widespread implementation of school immunization requirements, and a decrease in vaccine availability when federal funding for vaccine purchase was suspended, from 1969 to 1971.  The 1967 to 1976 cohort may be at increased risk if measles is re-introduced into the United States. (McQuillan et al. J Infect Dis. 2007;196:1459-1464.) 

Hospital Staph Infections Increasing in Frequency and Cost

Trends in the Staphylococcus aureus infection rate, associated economic burden, and associated mortality in U.S. hospitals from 1998 through 2003 were assessed from the Nationwide Inpatient Sample database. During this period, the prevalence of S. aureus infection at U.S. hospitals increased between1998 and 2003 at an annual rate of 7 to11 percent, with the rate depending on how the hospital stay was classified. The economic burden of S. aureus infection to hospitals also increased over this period, with annual increases ranging from 9 to 18 percent. The risk of in-hospital mortality associated with S. aureus infection remained stable or decreased over this period. (Noskin et al. Clin Infect Dis. 2007;45:1132-1140.)    

Patients’ Knowledge and Attitudes about Antiviral Drugs Fall Short   

Patients’ attitudes, beliefs, and knowledge regarding antiviral medication and vaccination for influenza were ascertained through a survey performed at an internal medicine clinic. Overall antiviral knowledge was poor. Compared with other patients, patients with conditions associated with a high risk for complications from influenza were no more likely to have had influenza vaccination, were not more knowledgeable about antiviral medication, and were no more likely to contact their physician within 48 hours after symptom onset. Only 37 percent of patients were willing to pay more than $20 for antiviral medication. (Gaglia et al., Clin Infect Dis. 2007;45:1182-1188.)

CD4+ Cell Count at First HIV Care Visit Declines

To determine whether patients with H-IV infection were presenting themselves for care at an earlier disease stage than in past years, the authors examined the immune status and time between HIV infection diagnosis and presentation for care among patients from the Johns Hopkins HIV Clinic for the period 1990–2006. Disappointingly, heterosexual men, women, and injection drug users had an increase in the severity of immunocompromise at presentation over the course of the study, and women and individuals with heterosexual transmission showed no improvement with respect to the time between HIV infection diagnosis and presentation for care. (Keruly and Moore, Clin Infect Dis. 2007;45:1369-1374.) 

Keep Up with Drug Approvals, Recalls, Adverse Events

As a new service for its members, IDSA now offers via email the latest information from the Food and Drug Administration on label changes, adverse events and other safety information, newly approved drugs, and other nformation on FDA-approved drugs and biologics applicable to the field of infectious diseases.  Recent alerts have included:

To sign up for this service, IDSA members can visit http://www.idsociety.org/Content.aspx?id=4250.