IDSA News - April 2009
Vol. 19 No. 4
(Print All Articles)

Swine Flu Resources

IDSA is working to keep members informed during the swine influenza outbreak.

IDSA is working to keep members informed during the swine influenza outbreak. The latest notices from the Centers for Disease Control and Prevention’s (CDC) Health Alert Network (HAN) and the Food and Drug Administration (FDA) are available on IDSA’s homepage, www.idsociety.org. (IDSA members can sign up to receive these alerts via e-mail online. You must be logged in to have access to this link.) The homepage also includes a link to more resources from CDC, the World Health Organization, and others.

CDC has set up a swine influenza website at www.cdc.gov/swineflu. The site is updated regularly as new information becomes available. A page with interim guidance documents, generated with input from many IDSA members, is available on topics including:

New guidances are being added frequently.

CDC provides clinicians with real-time information to prepare for and respond to emergency events, including the swine influenza outbreak, through the Clinician Outreach Communication Activity (COCA). Participants will receive regular e-mail updates emergency issues and on training opportunities relevant to clinicians. Clinicians can sign up at emergency.cdc.gov/clinregistry/. Audio files from two recent COCA conference calls on swine influenza are available at the bottom of CDC’s swine influenza guidances page.

The World Health Organization (WHO) has also set up a page devoted to swine influenza at www.who.int/csr/disease/swineflu/en/index.html, including regular situation updates. WHO’s site also has a guidances page, which includes:

IDSA and the Pediatric Infectious Diseases Society (PIDS) jointly host the Emerging Infections Network (EIN), a provider-based sentinel network designed to help the public-health community detect trends in emerging infectious diseases. The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. The EIN listserve allows members to discuss new disease trends and difficult cases. Click here for more information or to join EIN.

The Society sent an e-mail notice to members at the beginning of the crisis and will continue to provide information in this manner as necessary. Key experts within and outside CDC and WHO are IDSA members, and Society staff are working closely with all involved to facilitate communication of important information to members, Congress, the media, and the public.


*Please contact communications@idsociety.org, to propose additional resources that would enhance the value of the swine influenza page on the IDSA website.

Lyme Disease CME Course Focuses on Diagnosis, Treatment

IDSA is now offering a free, online course to help physicians, nurses, and other clinicians recognize and diagnose Lyme disease, and treat it promptly and effectively.

IDSA is now offering a free, online course to help physicians, nurses, and other clinicians recognize and diagnose Lyme disease, and treat it promptly and effectively.

The interactive course consists of a series of case studies for participants to evaluate involving patients with a variety of symptoms, including progressive chronic pain, facial palsy, puzzling rashes, persistent headache, and progressive asymmetric bilateral lower extremity numbness.

The course is based on IDSA’s 2006 practice guideline on the treatment and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis. The course was supported by an educational grant from the Centers for Disease Control and Prevention.

Continuing medical education (CME) credits are available for physicians who complete the course; other professionals can obtain a letter of completion.

For more information, see lymecourse.idsociety.org.

IDSA Journal Club

April 2009

This month: catheter-associated bacteruria, when to start HAART, oseltamivir-resistant seasonal influenza, tenofovir and kidney damage, and CMV vaccine.

In this feature, a panel of IDSA members identifies and critiques important new infectious diseases studies in the current literature that have a significant impact on the practice of infectious diseases medicine.


Catheter-Associated Asymptomatic Bacteriuria Should Not be Treated
Reviewed by Sabrina Kendrick, MD

Many catheterized patients with bacteria in the urine but no symptoms are inappropriately treated with antibiotics, according to a study in the May 1 issue of Clinical Infectious Diseases.

Evidenced-based guidelines distinguish between catheter-associated asymptomatic bacteriuria (CAABU) and catheter-associated urinary tract infection (CAUTI). The authors set out to reveal the extent of inappropriate treatment that results from failure of clinicians to distinguish CAABU from CAUTI. They retrospectively reviewed all urine culture results over a three-month period at a veterans’ affairs hospital. Cultures with >104 colony-forming units/mL of any bacterium or yeast from a hospitalized patient with an indwelling (Foley) or condom catheter in place for at least 24 hours during the preceding seven days prior to admission were included. Excluded patients were those being treated with an antibiotic at the time of hospital admission.

Of the 280 patients who met the inclusion criteria, 164 were considered CAABU. Fifty-three (32 percent) of these asymptomatic patients were treated—inappropriately—with antibiotics. Older age, predominant gram-negative organism, and higher urine white blood cell count were significantly associated with inappropriate treatment of CAABU. Limitations of the study include the retrospective design, possible under-estimation of CAABU and possible over-estimation of and CAUTI.

Recent publications and agencies encourage a national goal of no treatment of asymptomatic bacteriuria. This study documents the poor adherence to guidelines that call for this action and may serve as a platform to develop a strategy to improve adherence to guidelines. Better recognition of the difference between the two conditions may play a key role in the reduction of unneeded antibiotic usage, the authors note.

(Cope et al., CID 2009;48:1182-88.)

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More Debate on When to Begin HAART
Reviewed by Khalil Ghanem, MD

Two recent large observational studies attempted to define the optimal time to start highly active antiretroviral therapy (HAART) in HIV-infected patients. Both studies suggest that earlier initiation of HAART may improve outcomes, but had significant limitations.

The first study, published in The New England Journal of Medicine, included 17,517 U.S. and Canadian asymptomatic HIV-infected patients treated between 1996 and 2005. Patients were stratified into two groups based on CD4 count:  351-500 cells/µl or >500 cells/µl. Both groups were analyzed separately to see if there was a difference in mortality among patients who deferred therapy until their CD4 counts fell below the bottom of the range. Among patients in the first group, there was a 69 percent increased risk of death among patients who deferred therapy until  the CD4 count fell below 350 cells/µl, compared to those who did not defer therapy.  In the analysis of the second group, there was a 94 percent increased risk of death among patients who deferred therapy until  the CD4 count fell below 500 cells/µl, compared to those who did not defer therapy. 

The second study, published in The Lancet, included 24,444 patients enrolled in 18 cohorts and who were followed after the initiation of antiretroviral therapy. The combined primary outcome included death or the development of an AIDS-related condition.  The investigators calculated the risk of adverse outcomes based on data from 21,247 patients who were followed in the pre-HAART era. Deferring the initiation of HAART until the CD4 count was between 251 and 350 cells/µl increased the risk of death or an AIDS-related condition by 28 percent  compared to starting therapy when the CD4 count was between 351 and 450 cells/µl. The effect on mortality alone was not significant.

Both studies suggest that the initiation of HAART before the CD4 count falls below 350 cells/µl may improve outcomes. Whether initiating HAART at a CD4 count of ≥500 cells/µl improves outcome is still unclear. Both studies had significant limitations, including the lack of clarity regarding the causes of death and the reasons for starting therapy.. Moreover, neither study evaluated the side effects of earlier initiation of therapy. 

The question of when to start HAART has been debated for many years. The pendulum appears to be swinging towards earlier initiation of HAART. The ideal time, however, is still unclear.  A randomized controlled trial would be expensive and resource-intensive, but may provide less-biased data to guide clinical practice.

(Kitahata et al, N Engl J Med 2009;360:1815-26, Sterne JA and the When to Start Consortium, Lancet 2009;373:1314-16.)

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Widespread Circulation of Oseltamivir-Resistant Seasonal Influenza Viruses
Reviewed by Melinda Pettigrew, PhD

The 2007-2008 influenza season was the first to demonstrate that highly transmissible oseltamivir resistant strains can develop and spread without extensive oseltamivir usage, according to a study in the March 11, 2009 issue of The Journal of the American Medical Association.

As part of ongoing surveillance, the authors tested H1N1 influenza viruses and reviewed cases submitted to the Centers for Disease Control and Prevention (CDC) during the 2007-08 influenza season. Oseltmavir resistance was identified in 12 percent of seasonal H1N1 viruses. (Note: this article does not address H1N1 swine influenza, which is sensitive to oseltamivir.) Overall, 2 percent of circulating influenza viruses were resistant to oseltamivir. Oseltamivir resistant viruses were susceptible to zanamivir and the adamantanes.

Prior to 2007-08, sporadic cases of oseltamivir resistance were limited to treated individuals, person-to-person transmission was rare, and resistant viruses appeared less fit compared to wild type. The current study challenges the notion that resistance arises only under heavy selective pressure and that resistant viruses are less biologically fit. The individuals infected with a resistant strain had not previously taken oseltamivir. There were no differences in demographic and clinical characteristics or disease outcome among those infected with resistant compared to susceptible viruses.

(This year, the trend continued: As of April 11, preliminary CDC data indicated that over 99 percent of seasonal H1N1 influenza viruses were oseltamivir resistant.)

The authors relied on passive surveillance and these data may not be representative of all U.S. infections. Oseltamivir resistance may emerge in other influenza subtypes. These data indicate the critical need for new antiviral drugs, rapid diagnostic tests, and real-time surveillance to inform policy and clinical treatment guidelines.

(Dharan et al. JAMA. 2009;301:1034-41.)

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Tenofovir-associated Kidney Tubular Abnormalities
Reviewed by Sabrina Kendrick, MD

Tenofovir (TDF) exposure is associated with increased risk of kidney tubular abnormalities, often in the absence of renal insufficiency, according to a published report in the March 27 issue of AIDS. Long-term consequences of the tubulopathy are unknown, but the article recommends periodic screening of tubular function parameters for HIV+ patients receiving TDF.

284 HIV+ patients in regular outpatient clinic follow-up were divided into 3 groups: patients receiving highly active antiretroviral therapy (HAART) including TDF for at least 3 months (154 pateints), patients receiving HAART but never exposed to TDF (49); and HIV antiretroviral-naïve individuals (81). Kidney tubular parameters (glucosuria, hyperaminoaciduria, hyperphosphaturia, hyperuricosuria, and β2-microglobinuria) were determined in all patients in this cross-sectional study. Proximal tubular damage was defined as at least two markers repeatedly present with one of them being any of the Fanconi syndrome criteria. Glomerular function was determined using creatinine clearance.

Twenty-two percent of patients receiving HAART containing TDF had tubular damage, compared to 6 percent of those receiving HAART not containing TDF and 12 percent of antiretroviral-naïve patients. Multivariate analysis identified TDF use (OR=21.6) and older age as the only independent predictors of tubular damage. The cross-sectional design of the study limited assessment of time-frames for the TDF-associated tubulopathy development.

The authors recommend periodic measurement of kidney tubular function to assess the toxicities of TDF, particularly in the absence of significant renal insufficiency and accelerated bone loss.

(Labarga et al. AIDS 2009;23:689-696.)

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CMV Vaccine Provides Protection
Reviewed by Jason Weinberg, MD

A recombinant vaccine provided about 50 percent protection against cytomegalovirus (CMV) infection in young women, according to a report in the March 19 issue of The New England Journal of Medicine.

The authors of this study performed a phase 2, placebo-controlled, randomized, double-blind trial to evaluate the efficacy of three doses of a CMV envelope glycoprotein B vaccine. The study was terminated early when an interim analysis determined that women who received the study vaccine were significantly more likely to remain uninfected than women who received placebo.  Rates of CMV infection per 100 person-years were 3.3 in the vaccine group compared to 6.6 in the placebo group, for an overall vaccine efficacy of 50 percent. 

The vaccine was generally well tolerated.  Although more adverse events were associated with vaccine than with placebo, they tended to be mild.

The potential protection afforded to women who received the vaccine in this study is encouraging, but the ultimate goal of maternal vaccination is to prevent congenital CMV infection, a substantial cause of central nervous system impairment in infants.  Specific immunologic correlates of protection against CMV infection are still not completely understood, and it is difficult to predict whether antibody responses induced by maternal vaccination will provide adequate protection against congenital infection. The study was not powered to determine if maternal vaccination provided significant protection against congenital CMV infection.

Other important issues remain undefined.  For instance, when should CMV vaccine be given?  How long will protection last?  Will vaccination provide protection to infants whose mothers have already been infected with CMV?  Although not yet definitive, the results of this study should encourage ongoing efforts to develop a vaccine that will prevent CMV infection in young women and congenital CMV in their infants.

(Pass et al.  N Engl J Med 2009; 360:1191-9.)

IDSA Responds to H1N1 Influenza

IDSA has an important role to play in helping to address the current outbreak of H1N1 influenza, commonly known as swine flu.

IDSA has an important role to play in helping to address the current outbreak of H1N1 influenza, commonly known as swine flu. We are focusing on three areas:

  1. Providing useful updates to the membership, being careful not to duplicate other sources. The first update went out this weekend. We are also updating IDSA’s website, www.idsociety.org, with information from the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, and other sources as we receive it. This issue of IDSA News includes an article compiling some useful resources [LINK] from CDC, the World Health Organization (WHO), and others. We are also using our Emerging Infections Network (EIN) to get input from members about their information needs.  
  2. Responding to media inquiries to help educate the public. Our staff compiles talking points daily to help our spokespeople respond to media. (If you are responding to media calls locally, our public relations firm, PCI, can make our talking points available to you. Contact Ashley Mattys at amattys@pcipr.com.) Our overall message is, “Stay calm. Be prepared.” We are doing what we can to help quell undue alarm. We have a group of media-trained leaders who have agreed to handle media calls, and we are responding to as many as we can. Our role is to support CDC, WHO, and other health authorities in their efforts to provide accurate, timely information, and to empower the public to take appropriate steps.
  3. Supporting CDC and the National Institute of Allergy and Infectious Diseases (NIAID) in responding to the current outbreak and where appropriate suggesting ways to improve response and preparation for a possible next wave this fall. Many IDSA members are involved in efforts to keep CDC’s various guidance documents current as this situation unfolds.

IDSA has established a core response group appointed to coordinate our efforts, including members of the Pandemic Influenza Task Force, the Rapid Communications Work Group, the National and Global Public Health Committee, and others. The core response group is in regular contact with officials at CDC, WHO, and other authorities, and will be coming to other groups for input as needed.

At this time of crisis it is important that we speak with one voice to provide consistent, accurate, and reassuring information. The authorities, particularly CDC, are doing an admirable job at a challenging time. IDSA members can provide valuable leadership in their local communities as well. Others will turn to you for your expertise, and we will work to provide you with the best information available.

EIN: Test Your Diagnostic Skills with the Gorgas Course Case of the Week

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The Emerging Infections Network (EIN) is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. Any diagnostic or therapeutic recommendations and all opinions presented are those of the individual contributor. They do not necessarily represent the views of EIN, IDSA (EIN's sponsor), or the Centers for Disease Control and Prevention, which funds the EIN. The reader assumes all risks in using this information.

 

The Gorgas Courses in Clinical Tropical Medicine, given at the Tropical Medicine Institute at Cayetano Heredia University in Lima, Peru, shares with EIN interesting cases seen by the participants that week during the February/March course offerings. For the ninth consecutive year, course directors David O. Freedman, MD, FIDSA, and Eduardo Gotuzzo, MD, are pleased to bring the course to EIN.


New cases are mailed to EIN members via the listserve every week for nine weeks. Each case includes a brief history and digital images pertinent to the case. A link to the actual diagnosis and a brief discussion follow.

Here is the case from Week 1 (Feb 2, 2009):

The following patient was seen in the outpatient department of the 36-bed Tropical Disease Unit at Cayetano Heredia National Hospital. We thank Dr. Alejandro Llanos and his staff for advice and collaboration in this presentation.

History: Approximately 8 months after moving to the Peruvian jungle, this 25-year-old male biologist developed a firm painless papular leg lesion that subsequently ulcerated. No trauma. No fever, weight loss or systemic symptoms. No cough, hoarseness, respiratory symptoms or otorhinolaryngogical symptoms.

Epidemiology: Born in Lima and lived in Piura in Northern Peru until moving in October 2007 to Madre de Dios to a field station bordering Manu National Park.

Physical Examination: Afebrile. Large ulcerated lesion with raised borders and a clean base on the left leg with small satellite lesions [Image A on website; see URL below]. On examination with a nasal speculum a small ulcer with erythema and raised borders was noted on the middle third of the nasal septum [Image B on website]. Indirect laryngoscopy was negative. Chest was clear. No lymphadenopathy or hepatosplenomegally.

Laboratory Examination: Normal chest X-ray. Normal hematology and liver function.

To view an images as described above, along with results of diagnostic procedures performed on the lesions, please go to this web page: http://gorgas.dom.uab.edu/2009cases/090202.html

The diagnosis and discussion follow the images.


E-mail the Emerging Infections Network.

The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public-health community detect trends in emerging infectious diseases.

A joint project of IDSA and the Pediatric Infectious Diseases Society (PIDS) and supported by funding from the Centers for Disease Control and Prevention, EIN tracks emerging infectious diseases and keeps the public-health community up to date with issues that are currently affecting or may soon affect members’ clinical practices.The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. Both IDSA and PIDS members are eligible to join. The EIN listserve allows members to discuss new disease trends and difficult cases. Click here for more information or to join EIN.




Drug Approvals, Recalls, Adverse Events Update

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IDSA offers two e-mail services to help members stay informed of updates from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). Recent alerts have included:

IDSA members can sign up for these services online. (You must be logged in to have access to this link.)


Is Your Facility Experiencing Antibiotic Shortages?
Report these to FDA and IDSA.

Meeting Offers Practice Advice, Resources for Clinicians

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Helpful resources from IDSA’s third Clinical Practice Meeting are now available through the IDSA website. The meeting took place this March in San Diego.

Notable presentations included ”The Nuts and Bolts of E/M Coding: A Detailed Look at the Codes Used by ID Specialists,” with Barb Pierce, CCS-P, ACS-EM. During this session, participants went through real-life consultations and learned how an auditor looks at your claims.

H. Gunner Deery II, MD, FIDSA, provided insight on how to make sure you receive your 4 percent bonus by participating in the Physician Quality Reporting Initiative (PQRI) and the Medicare Electronic Prescribing program. His advice: read the directions, train your staff, and keep it simple by reporting on three measures and consider adding one measure as a safety net.

The meeting also included sessions on how to negotiate infection control contracts, address the challenges of human resources management, and improve billing and coding processes. Other topics included wound care clinic management and best practices, electronic medical records and other health care technology, and Medicare’s Recovery Audit Contractors program.

The audio-synced slides from this meeting are available for purchase from Sound Images.

The IDSA website also has resources on billing and coding, quality improvement initiatives, negotiating compensation, dealing with audits, and the Recovery Audit Contractors program. (You must be logged in to access these links.)

Resources on Medicare Audits Available

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IDSA has developed resources to help members understand and navigate Medicare’s Recovery Audit Contractors (RAC) claims review process, a new program intended to identify improper payments.

As reported in last month’s IDSA News, RAC was designed by Congress to fight Medicare waste, fraud, and abuse; but IDSA and other medical societies are concerned that physicians will be wrongly penalized for common billing mistakes or subjective coding decisions on evaluation and management services. The program has begun in some regions and is expected to be active nationwide by Jan. 1, 2010.

The IDSA website now includes a page with details about the program, information about claims and appeals, and links to other resources. (You must be logged in to access this page.)

Physician Practices Must Protect Against Identity Theft by May 1

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Physician practices must have policies in place to protect against identity theft under a Federal Trade Commission (FTC) rule going into effect on May 1. The American Medical Association (AMA) has developed tools to help physicians comply.

FTC’s “Red Flags Rule” requires creditors to protect clients’ personal identifying information—for example, insurance information—from being used fraudulently. FTC considers physician practices to be creditors because they bill after services are rendered and often defer collection of copayments until after receiving reimbursement from insurance providers. Physician practices that do not have policies in place by May 1 are subject to a $2,500 fine per “knowing violation” of the rule that suggests a pattern of behavior.

AMA disagrees with this interpretation and is opposing implementation of the rule. However, with the deadline looming, AMA has developed resources to help physicians comply. Resources, including an explanation of the rule and a sample compliance policy, are available online.

Dr. Eric Goosby Appointed Global AIDS Coordinator

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A member of the Center for Global Health Policy’s scientific advisory committee, Eric Goosby, MD, has been named to head the Office of the U.S. Global AIDS Coordinator at a critical juncture in the global fight against HIV/AIDS. Dr. Goosby has been at the forefront of HIV prevention and treatment—both domestically and internationally—since the epidemic first emerged in 1981 and will bring new energy and vision to the role.

But Dr. Goosby will need adequate resources to make good on President Obama’s campaign promise to dramatically expand AIDS treatment and prevention by spending an additional $1 billion per year. “Dr. Goosby is an exceptional candidate who should not be hamstrung by ill-considered and unnecessary budgetary decisions that short-change global AIDS,” writes Senior Communications Specialist Deirdre Shesgreen in Science Speaks, the Global Center’s blog.

Read more on Dr. Goosby and catch up on other recent HIV and TB news at http://www.sciencespeaks.wordpress.com/. Other recent postings include:

--An interview with Blessi Kumar, of Rahein, a health and development consultancy and technical support group, on the impact of TB on women. The Global Center’s David Bryden spoke with Kumar about that issue at the Stop TB Forum in Rio.

--New concerns about HIV and TB drug-shortages and treatment interruptions have emerged as the global economic downturn takes a deep toll in the developing world.

WHO Recommends HPV Vaccine

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The World Health Organization (WHO) is now recommending that national immunization programs include routine vaccination against human papillomavirus (HPV) for young adolescent girls.

WHO recommends HPV vaccine in countries where preventing cervical cancer is a public health priority, programs and financing are sustainable, and cost-effectiveness has been considered.  

WHO does not give a preference for one vaccine over the other, but the organization recommends that policymakers evaluate factors such as the prevailing HPV-related disease, vaccine efficacy for that disease, the target population for whom the vaccine is approved, price, supply, and cold-chain requirements.

A coordinated strategy should be implemented including education about reducing risks, screening for cervical cancer, and diagnosis and treatment of disease. However, WHO does not recommend postponing vaccination if these strategies cannot be implemented right away.

An estimated 260,000 women die of cervical cancer and about 500,000 new cases are diagnosed each year. Rates of cervical cancer are highest in many parts of the developing world. The disease generally occurs among women over 40.

The recommendations are published in the April 9, 2009 Weekly Epidemiological Record.

IDSA Advises Congress on H1N1 Influenza

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IDSA is providing input to staff of key members of congressional committees responding to H1N1 influenza. The Society supports President Obama’s request for $1.5 billion in supplemental funding and is advising members of Congress on how the disease highlights the importance of addressing issues of antiviral and antibiotic resistance.

Other advocacy items include:

  • IDSA and other physician groups urged Congress to support the Obama Administration’s proposal to include $329.6 billion in the FY 2010 budget to improve physician payments over the next 10 years.  The proposal would provide more realistic payments for physicians than Medicare’s current “sustainable growth rate” (SGR) formula. Congress has passed temporary legislation six times since 2003 to override cuts that would have taken place under the SGR.
  • IDSA cautioned members of the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee in a letter urging prudence in bundling providers’ payments when enacting widespread reform of the health care delivery system. The letter urged Congress to first allow the Centers for Medicare and Medicaid Services (CMS) to fully test this payment method to determine any possible pitfalls.

Report: Federal HIV Policies Need to Keep Pace with Scientific Advancements

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Despite significant medical and scientific advances in HIV/AIDS during the past decade, federal public policy continues to lag behind, according to a joint position paper by the HIV Medicine Association (HIVMA) and the American College of Physicians (ACP). The new paper, published in the May 15 issue of Clinical Infectious Diseases, outlines several strategies for bringing public policy up to speed with the science, to help ensure that HIV/AIDS is effectively controlled in the United States and abroad.

Specifically, the two groups are calling for enhanced federal support of prevention, screening, and treatment programs, and funding to maintain a competent HIV workforce.

“Today, people with HIV can live to near-normal life-spans,” said Michael Saag, MD, FIDSA, chair-elect of HIMVA. “This progress was unimaginable when most of us entered the field in the early 1980s. But most federal public policies on HIV/AIDS were established in the 1990s and haven’t been revisited since that time.”

Too many people in the United States have no access to care or unreliable access to care, Dr. Saag said, and the problem is only getting worse due to the growing shortage of HIV medical providers. As the first generation of HIV clinicians retires, the health care system faces a shortage of qualified successors. In a 2008 survey of Ryan White-funded clinics , 69 percent reported difficulty recruiting HIV clinicians, and reimbursement and lack of providers were the leading factors.

About 20 percent of people living with HIV are undiagnosed, and about 36 percent of people with HIV are diagnosed so late that they already have progressed to full-blown AIDS. For that reason, HIVMA and ACP are calling for coverage of routine HIV testing by Medicare, Medicaid, other government agencies, and private payers.

Although the Centers for Medicare and Medicaid Services (CMS) is considering covering HIV testing, the proposed policy would only apply to high-risk patients. ACP and HIMVA want all populations to have access to screening, regardless of risk factors or type of insurance.

“Routine HIV testing is critical to identifying people with HIV and connecting them with care,” said Jeffrey Harris, MD, FACP, president of ACP. Screening also helps with prevention because patients who are in treatment with suppressed viral loads are less likely to transmit the virus.

“Our public policy has particularly lagged behind the science in the area of prevention,” said Kathleen Squires, MD, HIVMA vice chair. “We are still providing federal funding for abstinence-only education despite study after study showing that abstinence-only education is not effective. The federal government doesn’t support needle exchange programs, despite evidence that such programs work and don’t promote drug use.” Prevention efforts in the United States and abroad must take a more well-rounded approach that is grounded in science, the two groups say.

Treatment for HIV disease is one of the most effective medical interventions available today, and yet 50 percent of people with HIV in the United States do not have a reliable source of HIV care. HIVMA and ACP are calling for access to care through enactment of a federal entitlement program for low-income people with HIV, as recommended by the Institute of Medicine.

“With health care reform on the agenda for policymakers, the release of this paper comes at a pivotal time,” said Fred Ralston, MD, FACP, chair of ACP’s Health and Public Policy Committee. “We urge policymakers to incorporate our recommendations into health care reform and in making federal funding decisions for the coming fiscal year.”

Immunization Advocates Urge Supreme Court to Review Vaccine Injury Decision

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IDSA and other groups are urging the U.S. Supreme Court to overturn a recent Georgia decision that could threaten the federal no-fault vaccine injury compensation system.

IDSA and the Pediatric Infectious Disease Society (PIDS) have joined several other groups in signing on to an American Academy of Pediatrics (AAP) “friends of the court” brief  in response to a recent decision by the Georgia Supreme Court that would allow cases alleging injury from childhood vaccines to be decided by state juries, circumventing the federal system.

Congress enacted the National Childhood Vaccine Injury Compensation Act in 1986 to safeguard the nation’s vaccine supply and to provide fair and timely compensation to the small number of children who are injured by vaccines. The law came about because vaccine-related lawsuits against manufacturers had spiked in the 1980s, causing several manufacturers to abandon the field or avoid pursuing promising new vaccines. To put an end to the numerous state lawsuits, Congress set up a no-fault compensation system administered by the U.S. Court of Claims.

The Georgia case, American Home Products Corp. v. Ferrari, which was decided last October, would essentially reverse the federal law. In that case, the Georgia Supreme Court ruled that Marcelo and Carolyn Ferrari’s civil lawsuit against vaccine manufacturers Wyeth and GlaxoSmithKline on behalf of their autistic son is not barred by the federal law.

“If this decision is allowed to stand, it could lead to the very same crisis that Congress sought to prevent in passing the original legislation. There is a genuine threat to our nation’s public health if manufacturers abandon or consider abandoning the production of vaccines. This decision would set our country back decades, and have deadly consequences for our children,” said Stephan E. Lawton, JD, who co-authored the amicus brief.

In filing the brief, the medical societies and other organizations lent their support to the current no-fault system, and urged that the Georgia decision be overturned.

The manufacturers filed petitions for review with the U.S. Supreme Court in early March and expect to hear whether the court will hear their appeal in mid May.

Other organizations that joined AAP, IDSA, and PIDS in the brief include:

  • American Academy of Family Physicians
  • AAP Section on Infectious Diseases
  • American College of Osteopathic Pediatricians
  • American Medical Association
  • American Public Health Association
  • Every Child By Two
  • Immunization Action Coalition
  • Vaccine Education Center at The Children's Hospital of Philadelphia

Welcome, New IDSA Members!

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Associates

Barnhill, Caroline, MPH
Braden, Marion, BSN, RN
Holloway, Katie, PharmD
Kemp, Brian, MD
Lawrence, Kenneth, PharmD
Marshall-Olson, Angela, DO
Patel, Hina, PharmD
Smith, Kathleen, MPA, PA-C
Solomon, Corinne, PharmD
West, Donald, DMD

Members

Buesing, Mary, MD
Cachay, Edward, MD
Correa Ochoa, Margarita Maria, PhD
Du, Ping, MD, PhD
Duque Molina, Marcela Maria, MD
Gualtero Trujillo, Sandra Milena, MD
Ibagon Nieto, Harold Humberto, MD
Illescas, Luis Ricardo, MD
Jimenez-Alzote, Maria del Pilar, MD, MS
Kim, Peter, MD, MS
King, Lonnie, DVM, MPA, MS
Martinez-Arciniegas, Gabriel, MD
Martinez-Buitrago, Ernesto, MD
Munera Jaramillo, Maria Isabel, MD
Ponce Santodomingo, Cesar Guillermo, MD
Tolle, Michael, MPH
Valderrama Beltran, Sandra Liliana, MD
Williams, Azaria, MD, PhD

Members-in-Training

Alonson, Carolyn, MD
Aslam, Fazila, MBBS
Brown, Aisling, MD
Custodio, Haidee, MD
Hachaambwa, Lottie, MD
Peyrani, Paula, MD
Reddy, Srinivasulu, MBBS, MSc
Rowhani-Rahbar, Ali, MD, PhD
Stillwell, Terri, MD, MPH

IDSA Seeks Reviewers for Translated Guidelines

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The IDSA Standards and Practice Guidelines Committee is looking for volunteers to help review translated guidelines. IDSA is translating some of its guidelines into other languages and needs assistance reviewing the translations for accuracy.  Languages of particular interest include Spanish, Japanese, and Portuguese. 

Interested individuals should e-mail a CV including language of interest to Jennifer Padberg, MPH, director of Clinical Affairs, at mailto:jpadberg@idsociety.org.