MedicalResearch.com Interview with: Prof. Jean-Francois Rossignol, FRSC, FRCPath
Romark Laboratories, LC
MedicalResearch: What are the main findings of the study?Prof. Rossignol: Nitazoxanide, a new orally administered drug in development for treating influenza, reduced the duration of symptoms of uncomplicated influenza compared to a placebo. The drug also reduced viral shedding. Side effects were similar for the drug and placebo treatment arms. The study was designed and conducted in compliance with FDA guidelines for studying new drugs for influenza.
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MedicalResearch.com Interview with Steven Grinspoon, MD
Professor of Medicine, Harvard Medical School
Director, MGH Program in Nutritional Metabolism
Co-Director, Nutrition Obesity Research Center at Harvard
Massachusetts General Hospital
Boston, MA 02114
Medical Research: What are the main findings of the study?Dr. Grinspoon:The primary finding is that tesamorelin, a hypothalamic peptide that increases the endogenous pulsatile secretion of growth hormone, reduced liver fat in HIV-infected patients with increased visceral (abdominal) fat. Increased visceral fat is very closely linked with increased liver fat in HIV patients, but the effects on liver fat were not known. Our data show that tesamorelin reduces liver fat in conjunction with decreasing visceral fat, which may be clinically important for patients with HIV-infection who have both increased abdominal fat and fatty liver disease. In addition the study demonstrated that this treatment strategy was neutral to glucose by the end of the 6 month study.
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MedicalResearch.com: Interview with: Anna Satcher Johnson MPH
Division of HIV/AIDS Prevention
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia
Medical Research: What are the main findings of the study?Answer: The new analysis confirms historical trends suggesting that we’ve made significant progress in reducing HIV in the U.S. over time – overall and among several key populations, including injection drug users and heterosexuals. Overall, new HIV diagnoses from 2002 to 2011 declined 33 percent. However, these findings underscore continued concerns of a surging HIV epidemic among young gay and bisexual men. We found a significant increase in HIV diagnoses among young men who have sex with men between the ages of 13 and 24.
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MedicalResearch.com Interview with:Dr Peter MacPherson MBChB PhD
Wellcome Trust Clinical Research Fellow
Liverpool School of Tropical Medicine
Department of Clinical Sciences
Liverpool School of Tropical Medicine
Pembroke Place, Liverpool L3 5QA
Medical Research: What are the main findings of the study?Dr. MacPherson: In 2012, an estimated 35 million individuals were infected with the human immunodeficiency virus (HIV) worldwide. Antiretroviral therapy (ART) substantially reduces the risk of HIV transmission as well as greatly reducing illness and death, raising hopes that high uptake of annual HIV testing and early initiation of ART could improve HIV prevention as well as care. Achieving high coverage of HIV testing and treatment is a major challenge however, with low rates of HIV testing and poor linkage into HIV care.
Self-testing for HIV infection (defined as individuals performing and interpreting their HIV test in private) is a novel approach that has seen high acceptance in Malawi and the United States, and is a process that could overcome barriers to conventional facility-based and community-based HIV testing, which lack privacy and convenience. However, no studies in high HIV prevalence settings have investigated linkage into HIV care after HIV self-testing.
Among 16,6660 adults in Blantyre, Malawi offered HIV self-testing, optional home initiation of HIV care (including two-weeks of ART for those eligible) compared with standard HIV care resulted in a substantial and significant increase in the proportion of adults initiating antiretroviral therapy.
HIV self-testing was also extremely popular, with 58% of the adult population self-testing with just 6-months.
To our knowledge, this is the first study to investigate a comprehensive home-based HIV testing, eligibility assessment and treatment initiation strategy.
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MedicalResearch.com Interview with: Dr. Colette Smith: PhDResearch Department of Infection and Population Health
University College London, London, UKMedical Research: What are the main findings of the study?Dr. Smith: We followed a group of approximately 45,000 HIV-positive people from Europe, USA and Australia between 1999 to 2011. We found that the death rate approximately halved over the 12-year study period. For every 1,000 people, around 18 died per year in 1999-2001, reducing to 9 deaths per year in 2009-2011.
We also studied what people died of. We found that the death rate from AIDS and from liver disease decreased by around two-thirds. Deaths from heart disease approximately halved. However, the rate of cancer deaths (excluding cancers that are classified as AIDS events) remained constant over time.
One in three deaths were caused by AIDS in 1999 to 2011, and this decreased to one in five deaths in the last two years of the study. However, even in recent years it was the joint most common cause of death. The proportion of deaths from cancer increased over time. One in ten deaths were from cancer in 1999 to 2001, and this increased to one in five deaths in 2009 to 2011. By the end of the study it was the joint-most common cause of death.
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MedicalResearch.com Interview with: Jared Baeten, MD PhD
Professor, Departments of Global Health and Medicine
Adjunct Professor, Department of Epidemiology
University of Washington
Seattle, WA 98104
Medical Research: What are the main findings of the study?Dr. Baeten: Among heterosexual African couples in which the male was HIV positive and the female was not, receipt of antiretroviral pre-exposure preventive (PrEP) therapy did not result in significant differences in pregnancy incidence, birth outcomes, and infant growth compared to females who received placebo.
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MedicalResearch.com Interview with: Dr Joshua Thaden MD, PhD
Duke University Division of Infectious Diseases
Durham, North Carolina
Medical Research: What are the main findings of the study?Dr. Thaden:The primary findings of the study are that
The rate of detection of particularly antibiotic resistant bacteria -- the carbapenem-resistant Enterobacteriaceae (CRE) -- has increased 5-fold in a set of community hospitals in the southeastern United States, and that
This increase is due to both changes in how we detect CRE and in increased endemicity (i.e., there are just more CRE around).
MedicalResearch.com Interview with: Pete Dodd (BA, BSc, MMath, PhD)
Research associate in health economic modelling
Health Economics and Decision Science
ScHARR
Regent Court Sheffield
Medical Research: What are the main findings of the study?Dr. Dodd: We found that over 650,000 children under the age of 15 developed tuberculosis in the 22 highest burden countries in 2010, with around 7.6 million becoming infected with the bacillus and more than 50 million harboring latent infection.
Our work points to a much larger gap between notifications and incidence in children compared to adults.
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MedicalResearch.com Interview with:Soo Chan Lee, PhD
Senior Research Associate,
Center for Microbial Pathogenesis,
Department of Molecular Genetics and Microbiology,
Duke University Medical Center,
Durham, N.C. 27710
Medical Research: What are the main findings of the study?Dr. Soo Chan Lee:Mucor circinelloides strain isolated from recalled Chobani yogurt was found to be the most virulent subspecies M. circinelloides forma circinelloides that is commonly associated with human infections. When mice were infected with this fungus through the tail-vein, 80% mortality was observed 5 days post infection. When mice were fed with spores, the fungus survived passage through the GI tract as many as 10 days, indicating the fungus can colonize to cause infections. Whole genome sequence analysis revealed the possibility that this fungus could produce harmful secondary metabolites that are unknown in this fungal species.
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MedicalResearch Interview with: Dr. Don C. Des Jarlais PhD
Director, International Research Core, Center for Drug Use and HIV Research
Research Fellow, NDRI
Director of Research, Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center
Professor of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine
Medical Research: What are the main findings of the study?Dr. Des Jarlais: HIV infection among non-injecting users of heroin and cocaine doubled doubled over the last several decades, from 7% to 14%. Herpes simplex virus type 2 (HSV-2) increases both susceptibility to and transmissibility of HIV. We examined HSV-2 infection among non-injecting heroin and cocaine user over the same time period using stored serum samples. HSV-2 infection was strongly related to HIV infection, and both increased over time. We calculated population attributable risk percentages (PAR%) to estimate the extent to which HSV-2 was driving increased HIV infection. HSV-2 infection was responsible for approximately half of the increase in HIV infection
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MedicalResearch.com: Interview with Connie Celum, MD, MPH
Professor of Global Health and Medicine
Director, International Clinical Research Center
University of Washington
Harborview Medical Center
Seattle WA 98104
MedicalResearch: What are the main findings of the study?Dr. Celum: We conducted a randomized, double blind study of daily oral tenofovir and tenofovir combined with emtricitabine (FTC) as oral pre-exposure prophylaxis (PrEP) for HIV among HIV serodiscordant couples (in which onepartner had HIV and the other partner did not) in Kenya and Uganda. Because of recent studies showing that tenofovir gel could reduce the chances of becoming HSV-2 infected, we studied the subset of HIV-uninfected partners who did not have HSV-2 and compared the rates who became HSV-2 infected during follow-up among those who received oral pre-exposure prophylaxis versus those who received placebo. We found that oral pre-exposure prophylaxis reduced HSV-2 acquisition by 30%.
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MedicalResearch.com: Interview with Kay Wang
Academic Clinical Lecturer
Nuffield Department of Primary Care Health Sciences
University of Oxford, Oxford, UK
MedicalResearch: What are the main findings of the study?Dr. Wang: We have found evidence of recent whooping cough infection in 1 in 5 school age children who see their doctor with a persistent cough and in 1 in 6 children who have been fully vaccinated against whooping cough. We have also shown that whooping cough can still cause clinically significant cough in fully vaccinated children.
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MedicalResearch.com Interview withDr. Stuart Gordon MD
Gastroenterologist
Henry Ford Hospital
Detroit, MI 48202.
MedicalResearch: What are the main findings of the study?Dr. Gordon: In a large American cohort of Hepatitis B patients, those who took antiviral therapy had a significantly lower risk of developing liver cancer than those who did not take such therapy.
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MedicalResearch.com Interview with: Dr. Christian S Hinrichs MD
Assistant Clinical Investigator
Center for Cancer Research
National Cancer Institute
Bethesda, MD 20814
MedicalResearch: What are the main findings of the study?Dr. Hinrichs:Objective tumor regression occurred in 3/9 patients with metastatic cervical cancer. Two responses were complete and are ongoing 22 and 15 months after treatment with a single infusion of T cells targeting the HPV oncoproteins.
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MedicalResearch.com Interview with:Dr. Brad Spellberg MD
Associate Program Director
Internal Medicine Training Program
Professor of Medicine, David Geffen School of Medicine at UCLA, Division of General Internal Medicine
MedicalResearch: What are the main findings of the study?Dr. Spellberg: The rates of community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) varied dramatically among academic medical centers in California, New York, Illinois and North Carolina, suggesting there is not a uniform change in the "national epidemic" of the "superbug" that has generated extensive public health concern over the past decade, according to a new study.The study surveyed hospital records of 4,171 cases of MRSA and MRSA-related infections between 2008 and 2011 in five medical centers located in Los
Angeles, San Francisco, Chicago, New York City and Raleigh-Durham, NC.The rates of MRSA acquired in the community declined 57% from 2008-2011 in
the Los Angeles medical center. In contrast, CO-MRSA rates tripled at the
New York medical center, while the rates remained stable in San Francisco,
Chicago and Raleigh-Durham.
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MedicalResearch.com Interview with: Dr. Eric M. Mortensen, M.D., M.Sc.
VA North Texas Health Care System and
University of Texas Southwestern Medical Center, Dallas
MedicalResearch: What are the main findings of the study?Dr. Mortensen: The main findings of our study was that for older patients hospitalized with pneumonia that with the use of azithromycin although there is a small increase in the number of non-fatal heart attacks there was a much lower decrease in mortality. In addition there were no other significant increases in cardiac events. So the overall risk:benefit ratio was that for each non-fatal heart attack there were 7 deaths that were prevented.
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MedicalResearch.com Interview with:Dr. Duncan M. Chanda MD
Institute for Medical Research & Training and UNZA-UCLMS
Research and Training Project
University Teaching Hospital
Lusaka, Zambia
MedicalResearch: What are the main findings of the study?Dr. Chanda:The main findings are that in this cohort of relatively healthy patients, with a median CD4 of 367, ART can be delayed till the end of TB short course chemotherapy without deleterious effects. This differs from studies that looked at cohorts with very low median CD4 ( around 25-150 in most cases) in which early cART was found to reduce mortality and other AIDS defining events.
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MedicalResearch Interview: Dr Nicoline van der Maas MD
Epidemiologist
National Institute for Public Health and the Environment
Centre for Infectious Disease Control
Epidemiology and Surveillance
The Netherlands
MedicalResearch: What are the main findings of the study?Dr. van der Maas: The main finding, presented at the ESPID, is that we found no difference in growth, development and infection related contact rates with the general practitioner after the first year of life between infants of unvaccinated mothers and infants of mothers, vaccinated with an adjuvanted Influenza A (H1N1) vaccine during the second and third trimester of pregnancy.
The offer of a H1N1 vaccination to pregnant women in their second and third trimester did not have a negative impact on infants’ health during the first year of life.
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MedicalResearch.com Interview with: Meagan F. Vaughn, PhD
Postdoctoral Trainee
Department of Epidemiology
Gillings School of Global Public Health
University of North Carolina at Chapel Hill
MedicalResearch: What are the main findings of the study?Dr. Vaughn: Outdoor workers are at high-risk for tick-borne diseases. Adherence to recommended tick-bite prevention methods is poor. While permethrin treatment of clothing is highly protective against many arthropod vectors, the need for frequent reapplication lessens adherence. A double-blind randomized intervention was conducted to determine the effectiveness of long-lasting permethrin-impregnated uniforms for tick bite prevention among outdoor workers from North Carolina. Treatment group uniforms were factory-impregnated with long-lasting permethrin by Insect Shield, while control group uniforms received sham treatment. Participants completed weekly tick bite logs during two tick seasons. 130 participants reported 1,045 work-related tick bites over 5,251 person-weeks of follow-up. The effectiveness of long-lasting permethrin impregnated uniforms for prevention of work-related tick bites was 82% (p<0.001) for the first year and 34% (p=0.38) for the second year. These results indicate that long-lasting permethrin impregnated uniforms are highly effective for at least one year against tick bites among North Carolina outdoor workers.
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MedicalResearch.com Interview with:Professor Stuart Allan
Faculty of Life Sciences, AV Hill Building
The University of Manchester
Manchester, M13 9PT
MedicalResearch.com: What are the main findings of the study?Dr. Allan: Using an experimental model of stroke it was found that animals with preceding Streptococcus pneumoniae infection had a worse outcome than uninfected animals. This confirms and extends previous data, both clinical and preclinical, that systemic inflammation is a key contributor to stroke outcome. Importantly, effects of infection were also demonstrated in animals with co-morbidities associated with stroke (atherosclerosis and age), with outcomes worse than observed in healthy young subjects. Exacerbating effects of infection on stroke are mediated via the pro-inflammatory cytokine, interleukin-1 (IL-1), shown by reversal of the increased ischaemic brain damage and functional impairments by treatment with the IL-1 receptor antagonist (IL-1Ra). Infection also leads to increased platelet activation and microvascular coagulation after stroke, which contributes to the increased injury. Collectively, these data are the first to show, how systemic inflammatory mechanisms induced by one of the most common non-invasive, human S.pneumoniae isolates, lead to critical illness after stroke in different rodent species and strains, and how common stroke comorbidities interact with infection to worsen outcome after stroke. (more…)
MedicalResearch.com Interview with: Sergio D. Rosenzweig, MD, PhD
Director, Primary Immunodeficiency Clinic (PID-C)
Head of the Infectious Diseases Susceptibility Unit at the Laboratory of Host Defenses, National Institutes of Allergy and Infectious Diseases National Institutes of Health
Bethesda, MD, 20892
MedicalResearch.com: What are the main findings of the study?Dr. Rosenzweig: We diagnosed a disease called CDG-IIb in two siblings with severe development issues and very low levels of immunoglobulins, which include infection-fighting antibodies. These children were referred to the NIAID Primary Immunodeficiency Clinic through the NIH Undiagnosed Diseases Program. CDG-IIb is an extremely rare congenital disorder of glycosylation (CDG), with only one other case reported. The genetic defect of the disease disrupts glycosylation, the process for attaching and trimming sugars from proteins. Almost 50% of our proteins have sugars attached, and these are called glycoproteins. They include immunoglobulins and also some viral glycoproteins that are made when cells are infected by a virus. The spread of some viruses, including HIV and influenza, depend on viral glycoproteins in order to infect additional cells and form viral protective shields. We found that this type of virus was less able to replicate, infect other cells, or create adequate protective shields in CDG-IIb patient cells because of the glycosylation defect. In comparison, adenovirus, poliovirus, and vaccinia virus, which either do not rely on glycosylation or do not form protective glycoprotein shields, replicated normally when added to both CDG-IIb and healthy cells.
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MedicalResearch.com Interview with:Roger Paul Baxter, MD
Co-Director Kaiser Permanente Vaccine Study Center
Oakland, CA 94612.
MedicalResearch.com What are the main findings of the study?Dr. Baxter: Menveo, the currently licensed CRM-conjugate meningococcal vaccine, showed an excellent booster response in adolescents, regardless of which conjugate vaccine they had received previously. Also, although titers from the priming dose waned, at 3 years there were still protective antibodies in the majority of immunized individuals. The other US-licensed meningococcal conjugate vaccine, Menactra, uses a different protein conjugate.
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MedicalResearch.com Interview with: Amy Nunn, ScD, MS
Assistant professor (research) of Behavioral and Social Sciences
Brown University School of Public Health
MedicalResearch.com: What are the main findings of the study?Answer: The main findings are that people living in poor, mostly-minority urban neighborhoods, where health resources such as HIV testing and linkages to care are often lacking, are at a greater risk of contracting HIV and dying of AIDS. This is not because of differences in behavior. It's because they live in medically underserved areas where HIV incidence is very high and fewer people know their status. Fewer people knowing their status means fewer people on treatment. Fewer people on treatment means it's easier for people to come into contact with the virus, even if they don't engage in any higher risk behavior.
In the paper, my colleagues and I call for increasing the focus of public health efforts on these neighborhoods where the epidemic is concentrated and contributing heavily to racial and economic disparities in AIDS mortality.
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MedicalResearch.com Interview with: Michael B. Blank, PhD
Associate Professor of Psychology in Psychiatry
Perelman School of Medicine
University of Pennsylvania
Philadelphia, PA 19104-3309
MedicalResearch.com: What are the main findings of the study?Dr. Blank: We found that people in treatment for mental illnesses in inpatient and outpatient settings in Philadelphia and Baltimore were about times as likely to be infected with HIV as the general population in those cities and about 16 times as likely to be HIV infected as the general population of the US. We also found that severity of psychiatric symptoms increased the likelihood of infection.
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MedicalResearch.com Interview with: Mary A.M. Rogers, PhD, MS
Research Associate Professor
Research Director, Patient Safety Enhancement Program
Department of Internal Medicine
University of Michigan Ann Arbor, MI 48109-2800
MedicalResearch.com: What are the main findings of the study?Dr. Rogers: The risk of serious infection is considerably elevated after receiving allogeneic (donor) red blood cell transfusions. For every 38 patients under consideration for transfusion, 1 patient could be spared an infection if more restrictive hemoglobin thresholds were used. When patients were given transfusions only after their hemoglobin fell below 7.0 g/dL, 1 patient avoided an infection of every 20 patients treated. The results were most consistent in elderly patients receiving hip and knee replacement surgeries. Their risk of infection decreased by 30% when lower hemoglobin thresholds were used.
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MedicalResearch.com Interview with:Eleftherios Mylonakis, M.D., Ph.D., FIDSA
Dean's Professor of Medical Science
Chief, Infectious Diseases Division
Alpert Medical School and Brown University
and Dr. Irene Kourbeti MD
Research Associate
Infectious Disease Division
Rhode Island Hospital, Providence, RI
MedicalResearch.com: What are the main findings of the study?Answer: There was high quality of evidence that biologic agents are associated with increased risk of all opportunistic infections, but there was no difference in mortality attributed to the opportunistic infections. Patients receiving biologics were twice more likely to develop opportunistic infections (OIs) compared to controls (OR 1.79; 95% CI, 1.17-2.74) with a number needed to harm (NNH) of 582 patients. That means that 1 opportunistic infection would occur in every 582 patients receiving biologics. The opportunistic infections usually occurred at the commencement of the use of the biological agent and they were not statistically more in patients with a previous exposure to anti-TNF agents as compared to the patients that had never received an anti-TNF agent..
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MedicalResearch.com Interview with: Shelley S. Magill, M.D., Ph.D.
From the Centers for Disease Control and Prevention
Emory University School of Medicine
Atlanta, Georgia
MedicalResearch.com: What are the main findings of the study?Dr. Magill: The results of this survey show that healthcare-associated infections continue to be a threat to patient safety in U.S. acute care hospitals. Among the more than 11,000 patients included in the survey, approximately 4% (or 1 in 25) had at least one healthcare-associated infection at the time of the survey. We used these results to develop national estimates of healthcare-associated infections. We estimated that in 2011, there were approximately 721,800 healthcare-associated infections in U.S. acute care hospitals. The most common types of infections were surgical site infections (SSIs), pneumonias, and gastrointestinal infections.
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MedicalResearch.com Interview with: Dr. Judith A. Smith Pharm.D.
Associate Professor
Department of Gynecologic Oncology & Reproductive Medicine
Division of Surgery
The University of Texas MD Anderson Cancer Center in Houston
MedicalResearch.com: What are the main findings of the study?Dr. Smith: This study first demonstrated in vitro suppression of HPV expression. After a single dose at 24 hours and with repeated dosing every 24 hours for 7 days followed by 7 days of no treatment, HPV eradication was achieved. These findings were confirmed with in vivo animal studies. HPV expression was eradicated with once daily AHCC dosing for 90 days and sustained after 30 day observation off treatment. Immune modulation (increase) of IFNα (p < 0.03), IFNβ (p <0.03), and IFN (p< 0.03) and IgG1 (P < 0.05) was observed in AHCC treated mice compared to untreated controls.
AHCC mechanism of immune modulation of the IFN pathways to eradicate HPV was particularly relevant because E6/E7 oncogenic activity in HPV infection is believed to be related to suppression of IFN expression/signaling. These data suggest AHCC may help clear HPV infections and have a potential role in the prevention of HPV-related cancers.
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MedicalResearch.com Interview with:Shamez Ladhani, MRCPCH PhD
Health Protection Services, Immunisation, Hepatitis, and Blood Safety Department, Public Health England, London
MedicalResearch.com: What are the main findings of the study?Dr. Ladhani: Pregnancy was associated with an increased of serious infection by a bacterium called Haemophilus influenzae which is usually associated with respiratory tract infections. Nearly all the H. influenzae were unencapsulated; that is, they did not have an outer sugar capsule which is often required to make the bacterium more virulent. The encapsulated H. influenzae type b (Hib), for example, was the most common cause of bacterial meningitis in your children prior to routine immunisation. We also found that infection with unencapsulated H. influenzae was associated with poor pregnancy outcomes, including miscarriages, stillbirth and premature birth.
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MedicalResearch.com Interview with:Dr Rachel J Sacks
Jefferiss Wing, St Mary's Hospital
Imperial College Healthcare NHS Trust,
London UK
MedicalResearch.com: What is the background of this study?Dr. Sacks: 2247 anonymous questionnaires were completed by young women, aged 13-19 years old, attending sexual health services across England, looking at their HPV vaccination outcomes and prevalence of risk factors associated with HPV acquisition and cervical cancer development, and comparing the survey results with national data where available. Known HPV acquisition and cervical cancer development risk factors include cigarette smoking, early age at first intercourse, increasing number of lifetime partners, co-infection with other sexually transmitted infections.
MedicalResearch.com: What are the main findings of the studyDr. Sacks:
Young women, aged 13 to 19 years old attending sexual health services across England had higher prevalence of known risk factors associated with HPV acquisition and cervical cancer development, compared with national data.
Survey respondents had lower HPV vaccination offer and lower HPV vaccination completion rates than nationally.
Subgroups within the survey respondents were identified as having a significantly lower offer and significantly lower completion rate of the HPV vaccination. These subgroups included respondents from London, those of non-white ethnicities, 17 to 19 year olds, smokers and those not in education, employment or training (NEETs).
The highest risk individuals, in terms of HPV related risk factors, were the least likely to be offered and additional the least likely to complete the HPV vaccination course.
Currently sexual health services in England are not involved in the delivery of the HPV vaccination programme and this is felt to be a huge missed opportunity for the primary prevention of HPV acquisition and its potential sequelae. Sexual health services should be included as a supplementary HPV vaccination delivery site in order to target these particularly vulnerable young women and to increase the success of the HPV vaccination programme in England.
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