New HIV infections in decline

There were about 17% fewer new infections worldwide in 2008, compared with 2001, but fewer than half of those infected began treatment, a World Health Organization and UNAIDS report says.

UNAIDS Executive Director Michel Sidibe formally released the report in Shanghai because of concerns that China will become a new epicenter of the AIDS pandemic. HIV infections were once a problem only with homosexuals and intravenous drug abusers in that country, but the pandemic is rapidly spreading into the general population. (Eugene Hoshiko / Associated Press / November 24, 2009)

The estimated number of new HIV infections each year has declined about 17% since 2001, but for every five people infected, only two begin treatment, according to a report from the World Health Organization and UNAIDS released Tuesday.
About 2.7 million people were newly infected with the virus that causes AIDS last year, compared with about 3.3 million in 2001 -- although direct comparisons are difficult because the numbers are counted differently now. The biggest gains were in sub-Saharan Africa, where there were 400,000 fewer infections, even though the region still accounts for 67% of all new infections.
An estimated 33.4 million people were HIV-positive worldwide in 2008, a slight increase from 33 million in 2007. That increase occurred in large part because more people are living longer after infection because of the increased availability of antiretroviral drugs that keep the virus in check.
About 4 million people were receiving AIDS drugs at the end of 2008, compared with 3 million the previous year. Nonetheless, an additional "5 million people need treatment and are not receiving it," Dr. Teguest Guerma, acting director of the WHO's HIV/AIDS department, said at a Tuesday news conference.
She said that about 2.9 million lives had been saved so far by increased access to the drugs as a result of the U.S. President's Emergency Plan for AIDS Relief and other international assistance programs.
The drugs have also cut down on mother-to-child transmission and reduced the number of orphaned children. About 200,000 infant infections have been averted since 2001, Guerma said.
Even so, about 430,000 children were born with HIV in 2008, bringing the number of children under the age of 15 living with the virus to 2.1 million.
The report was formally released in Shanghai by UNAIDS Executive Director Michel Sidibe because of concerns that China will become a new epicenter of the AIDS pandemic. HIV infections were once a problem only with homosexuals and intravenous drug abusers in that country, but the pandemic is rapidly spreading into the general population.
The rate of new infections through heterosexual contact in China tripled between 2005 and 2007, according to the new report. About 40% of new infections were acquired through heterosexual contact last year, with homosexual sex accounting for 32% and most of the rest related to drug abuse.
According to the Chinese government, the number of people confirmed to be living with HIV was 319,877 at the end of last month, up from 135,630 in 2005. Most experts view those numbers as suspiciously low, however, for the world's most populous country. In large part, that is because the groups most at risk are highly stigmatized in China and at risk of imprisonment or harsher penalties, so it is difficult to get accurate numbers.
A similar situation occurs in the Middle East and North Africa, according to Dr. Paul De Lay, a deputy executive director of UNAIDS. "Even in sub-Saharan Africa, we still have a dearth of information about high-risk groups," he said.
As in China, the AIDS epidemic is changing in Eastern Europe and Central Asia. Where it once was characterized chiefly by drug abuse and prostitution, it is now spreading into the general population. AIDS prevention programs in those regions are not shifting as rapidly, and are still focused on high-risk groups.
thomas.maugh@latimes.com

Copyright © 2009, The Los Angeles Times

CDC warns holiday could bump up flu cases

Just as the H1N1 pandemic seems to be waning around the country, some health officials are worried that crowded malls, holiday gatherings and higher numbers of travelers could lead to more infections. Thanksgiving is typically followed by at least a modest bump in early seasonal flu cases, according to reports from the past few years. But swine flu accounts for nearly all flu cases right now.

So the government has launched a new travel-health campaign. The Centers for Disease Control and Prevention urges people to travel only if they are well, get vaccinated against H1N1 and seasonal flu, wash their hands often, and cover coughs and sneezes with a tissue or sleeve.

BATCH OF H1N1 VACCINE MONITORED FOR REACTIONS

Canadian doctors have been advised not to use a batch of 170,000 doses of H1N1 vaccine while authorities investigate reports of allergic reactions among recipients, drug maker GlaxoSmithKline PLC said Tuesday. Authorities routinely monitor vaccines for any signals of problems, such as the allergic reactions that do occur, rarely, every year. A company spokeswoman said GlaxoSmithKline is looking into reports that the batch might have caused more allergic reactions than normal. AP

PEAK OVER IN MINNESOTA: State officials say the worst of the H1N1 outbreak is past, at least for this wave. B3

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Doctors, patients react to changes in breast cancer guidelines

Many worry lives will be lost because of less screening

Area breast cancer survivors reacted with horror to a federal panel's finding that says women do not need routine mammograms to screen for breast cancer until they turn 50.

They were baffled by the panels' recommendation that doctors no longer teach women to do breast self-exams. These recommendations were issued early last week by the U.S. Preventive Task Force, part of the U.S. Department of Health and Human Services.

"To think that women shouldn't do a breast self-exam — why not?" asked Janet Sobel, who runs a private physical therapy practice for breast cancer survivors in Chevy Chase. "It just makes no sense. We've come so far in our breast cancer treatment because women are conscious and doing self-exams, getting mammograms."</SW_PHOTO=8709>

Many of her clients were in their 40s when they were diagnosed, Sobel said.

The task force also said that "current evidence is insufficient" to determine the benefit or harm of screening mammography for women 75 years and older. For women 50 to 74 years old the panel recommended mammograms every two years, instead of the accepted standard of annual screenings.

"You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health, and personal values," said Dr. Diane Petitti, vice chairwoman of the task force, in a statement.

But local doctors argued that the panel's recommendation will reverse decades of medical understanding about detecting and treating breast cancer as early as possible.

"Why are they even addressing an issue that was answered 25 years ago with multiple studies?" said Dr. Katherine Alley, the medical director of Suburban Hospital's breast program who said she does about 400 breast cancer surgeries a year.

In 2003, Montgomery County had just over 157 women per 100,000 diagnosed with breast cancer, the second-highest of any county in Maryland, according to the latest available statistics from the state's Department of Health and Mental Hygiene. Maryland as a state had the sixth-highest reported breast cancer mortality rate among women in the nation from 1999-2003.

The evidence is conclusive, Alley said, that there was a survival advantage to yearly mammograms for women age 40 and older. About 10 to 15 percent of breast cancers do not show up on mammograms, Alley said.

She has not changed her recommendation that women 40 and older get annual mammograms, and said it crossed her mind that cost considerations may have affected the panel's recommendations.

"That's not science-based medicine," Alley said.

Women always get the shaft when it comes to medical care, said breast cancer survivor Stacy Rabinovitz, 50, of Rockville.

"If this was prostate cancer they were talking about, this wouldn't be happening," she said.

Dr. Pam Wright, a breast surgeon at Suburban, said that of the biopsies done to analyze abnormalities appearing in mammograms, 20 percent show cancer. The procedure has also become simpler over the last decade, taking less time and requiring less tissue.

"We've had patients calling all day," Wright said on Thursday. "I have patients who have mammograms scheduled and they want to know if they should cancel."

Breast cancer survivor Meg Baker of Kensington, meanwhile, wondered how the affordability of mammograms for certain women could be affected down the road by the panel's recommendations.

"I'm just wondering if insurance coverage is going to become unavailable because of this," Baker said.

Damascus resident and breast cancer survivor Becky Keyser, 49, mentors breast cancer patients, the majority of whom are in their 40s, she said.

Keyser had no history of breast cancer in her family, was physically fit, did not smoke, did everything right, she said. Almost three years ago her annual mammogram found the cancer and saved her life. She had two types of breast cancer, one was invasive and aggressive.

"I think they're playing Russian Roulette with women's lives," Keyser said.

In a Nov. 16 statement on its Web site, the National Cancer Institute (part of the National Institutes of Health in Bethesda) responded to the panel's recommendations by saying: "NCI has had screening mammography recommendations for many years, and we need to evaluate them in light of the Task Force's recommendations — for all women, not only for those of average risk. It's too early for us to make any decisions right now."

In basic information provided on its Web site, the National Cancer Institute still recommends that women in their 40s without high-risk factors should get mammograms every one to two years.

Adventist HealthCare will hold a free community health forum, "Understanding the New Breast Screening Guidelines and What They Mean for Women," at 7 p.m., Dec. 3, in the Birch/Sycamore Rooms at Shady Grove Adventist Hospital, 9901 Medical Center Drive, Rockville. A panel of experts, including oncologists, radiologists, surgeons and breast cancer survivors, will share perspectives on the new guidelines and answer questions.

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Web site targets dangerous toys Consumers can check hazards, report items

BY FRANCINE KNOWLES fknowles@suntimes.com

Parents looking to avoid hazardous toys as they begin their holiday shopping can find quick help in the latest Trouble in Toyland report from the Illinois Public Interest Research Group.

The group unveiled a new interactive smart phone Web site to guide people while they shop for toys. The site lets them check on possible hazards while at the store or on their home or work computer before venturing out to shop. And if consumers discover they bought a dangerous toy or run across one while shopping, they can report it on the site.

There is cause for shoppers to be on the alert. The latest data from the Consumer Product Safety Commission revealed toy-related injuries sent more than 82,000 children under the age of 5 to emergency rooms in 2008. Nineteen died from toy-related injuries last year, the group notes.

The report focuses on three categories: choking hazards; ear hazards, and toxins, lead and other hazards.

Despite a ban on small parts in toys for children under 3, there are still toys available that can cause a child to choke, the report notes.

It also found:

• Many toys tested exceeded 85 decibels, which is higher than the highest volume level recommended by the American Society for Testing and Materials.

• Children's products that contain concentrations of certain toxic compounds of up to 7.2 percent, although earlier this year, toys and other children's products containing more than 0.1 percent of the compounds were banned.

The report is at www.illinois pirg.org, and the interactive Web site is www.toysafety.mobi.

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