News

/News

Reactivation of committees to fight AIDS and major endemics disease defended

Luanda, ANGOLA, April 14 – The Vice President of the Republic, Bornito de Sousa, defended last Friday in Luanda the need to reactivate the national and provincial technical committees to ensure effectiveness in the fight against HIV/AIDS and major endemic diseases. ,Bornito de Sousa was addressing the Third Regular Meeting of the National Commission for the Fight against AIDS and Great Endemics, by reaffirming  the country’s commitment to fighting AIDS and major endemic diseases and considered the municipalisation of health programmes as fundamental, the involvement of communities and local authorities , as well as the promotion of voluntary activism.

 

The Vice President said that the current economic restrictions should not alienate the government from responsibilities and obligations in such important sectors as health.

 

The government is fully aware of the harmful effects of these diseases, both for the economy and for the national strategic objectives.

 

He promised to do everything so that Angola’s response to the AIDS epidemic and great endemics will match the international milestones and goals.

 

He also recalled that in adapting the United Nations global strategy to combat HIV/AIDS in 2014, Angola took up the responsibility to reach at least 90 percent coverage of all people living with HIV, who are not aware of their HIV status and get them treated with antiretroviral.

 

Bornito de Sousa welcomed the reduction in the number of new AIDS infections, as well as deaths, including malaria and tuberculosis.

Source: https://www.einnews.com/pr_news/442069149/reactivation-of-committees-to-fight-aids-and-major-endemics-disease-defended

AIDS group mulls how to preserve a Canadian quilt

The quilt is currently being stored in hockey bags at the Canadian AIDS Society in Ottawa. (Hallie Cotnam/CBC)

A memorial quilt to honour the thousands of people in Canada who have died from complications due to HIV/AIDS has been preserved in a digital form, even as the actual quilt faces an uncertain future.

In the late 1980s, family and friends of people who had died at the height of the AIDS epidemic stitched together cloth panels to form the AIDS Memorial Quilt, sharing the stories of their loved ones at a time when the stigma around the disease threatened to leave people forgotten.

A Canadian version of the quilt sprung from that effort, one that has grown to some 600 panels.

The Canadian AIDS Society wants to preserve the country’s AIDS Memorial Quilt. 0:54

“It was a living legacy, because at the beginning of the epidemic nobody would touch people with AIDS,” said Gary Lacasse, the executive director of the Canadian AIDS Society.

As misinformation about how HIV spread, even funeral homes were hesitant to accept the bodies of those who died from the disease, Lacasse said.

“So this was the friends and the family who did stay with the people who wanted to acknowledge their passing in some stage or form.”

The AIDS Memorial Quilt was stitched together from cloth panels to tell the stories of people who had died from HIV/AIDS at a time when there was still a stigma about the disease. (Halie Cotnam/CBC)

Quilt panels stored in hockey bags

That desire to preserve the memory of those who died is behind the Canadian AIDS Society launch of quilt.ca on Monday, a website to reflect Canada’s historic losses to the disease.

But the actual collection of quilt panels, which the Canadian AIDS Society took over in 2013, is proving more difficult to care for, Lacasse told CBC Radio’s Ottawa Morning on Monday.

The quilt has a home in the Canadian AIDS Society office, but ideally they would find a climate-controlled space, similar to how the US version of the AIDS Quilt is stored, Lacasse said.

Right now the many sections of the quilt are being stored in 33 goalie bags and other assorted plastic bags, while the group looks for a more permanent solution, Lacassse said. If all of the panels were stitched together and unfolded the quilt would be a kilometre long and half-a-kilometre wide.

Uncertain future for the keepers of the Canadian AIDS Quilt.

The AIDS quilt was a symbol of the fight against HIV in the 1980s. But thirty years later it’s being stored in 29 hockey bags and its keepers say its future is uncertain. 5:31

The permanent solution is proving difficult, Lacasse said.

“We looked for different alternatives but alternatives are few and far between,” Lacasse said, since many of the community-based HIV/AIDS organizations that might help out have lost federal funding as the government has directed more money toward HIV/AIDS prevention.

Lacasse hopes the website will help educate future generations to what people went through when the disease first appeared in Canada. And he hopes the quilt can find a way to live on, too.

“This is a living expression of the AIDS movement and how it came about,” he said.

Source: http://www.cbc.ca/news/canada/ottawa/aids-quilt-canada-1.4622347

Canadian researchers developing device to prevent HIV transmission

Scientists at the University of Waterloo are working on a new tool they hope could protect women from HIV infection, and drew their inspiration from a group of Kenyan women who are naturally immune to the virus.

Dr. Emmanuel Ho, a professor in the School of Pharmacy at Waterloo, has designed the device that is meant to mimic what protects a unique group of sex workers in Kenya who have a natural immunity to HIV.

What Ho learned about these women is that they have low levels of activity in their T cells, which are the cells the immune system sends into action whenever a virus enters the body.

Normally, T cells become fighter cells and kill off infecting viruses, but Dr. Ho explains that HIV outwits T cells by corrupting and destroying them.

“HIV says, ‘Hey, you know what? These T cells play an important role. Let me infect them and deactivate them.’ And once there are low level of T cells in the body, that’s what leads from HIV infection to AIDS,” he told CTV Toronto.

When T cell levels drop, the body is vulnerable to even the mildest of infections. But if the T cells are “resting” and do not attempt to fight HIV, HIV won’t attempt to destroy them. This state of T cell resting is called being “immune quiescent.”

Ho decided to look at whether there was a way to induce T cell quiescence in women with a medication delivered right at the point of infection in the vagina. Ho decided to try hydroxychloroquine, a drug commonly used to prevent malaria, and to treat rheumatoid arthritis and other autoimmune conditions

“We thought: can a drug similar to hydroxychloroquine that has some kind of immunomodulatory effect, can it maintain or induce this resting T cell state?” Ho said.

His team decided to test the idea by creating a vaginal implant composed of a hollow tube with two flexible arms to hold it in place. The tube is filled with hydroxychloroquine which is released slowly and absorbed by the walls of the vaginal tract.

The implants were tested in animals and Ho’s team noticed a significant reduction in T cell activation, meaning the vaginal tract demonstrated an immune quiescent state. Their results appear in the Journal of Controlled Release.

Ho says further research will help his team learn whether the implant could be a stand-alone option for preventing HIV or if it could be used in conjunction with other transmission prevention strategies.

But he thinks the implant would be a more reliable system than pills since people tend to forget to take pills. His team hopes to begin clinical trials on humans within the next five years.

Source: https://www.ctvnews.ca/health/canadian-researchers-developing-device-to-prevent-hiv-transmission-1.3888351

Infectious disease physicians earn less than most other specialties: 5 survey findings

 

Physicians specializing in infectious diseases earn less than most other physicians, which causes a number of medical students to opt out of pursuing the specialty, according to a survey conducted by the Infectious Diseases Society of America.

The online survey received 2,504 responses from 6,793 active IDSA members as of March 2017.

Median compensation for ID experts overall is $215,000 a year, according to the 2017 survey of 2,504 respondents who are members of IDSA. Infectious disease physician compensation ranks towards the bottom compared to other physicians and is approximately less than half of what some specialists earn, according to other surveys.

For example, a recent Medscape survey found infectious disease physicians earned $231,000 in compensation annually on average, compared to plastic surgeons, who were the survey’s highest paid physicians, earning $501,000 on average.

Here are five survey findings on compensation for infectious disease physicians in hospitals and clinics.

1. The typical hospital/clinic physician reported an income of $237,500.

2. The survey found male hospital/clinic physicians reported a higher median income than their female peers ($250,000 compared to $220,000).

3. Half of hospital/clinic physicians in the survey practice general infectious disease. These physicians tended to report higher incomes than physicians focused on HIV only or on Hepatitis C and HIV only.

4. Over one-third (37 percent) of physicians reported at least part of their compensation is tied to performance as measured by quality metrics, including those related to HIV, Hepatitis C, Clostridium difficile infection rate and surgical site infection rate.

5. Hospital/clinic physicians said they plan to expand their careers and improve their compensation in various ways, including providing administrative services to hospitals (32 percent), adopting telemedicine to expand clinical reach (21 percent), pursuing a position in hospital leadership (20 percent) and incorporating clinical research into their practice (16 percent).

Written by Megan Knowles

Source: https://www.beckershospitalreview.com/compensation-issues/infectious-disease-physicians-earn-less-than-most-other-specialties-5-survey-findings.html

Biennial awards gala AccolAIDS 2018 to honour leading figures and organizations in B.C.’s HIV/AIDS movement

  • SPUKKATO/GETTY IMAGES

This year’s celebration of all those who are helping to lead the way in B.C.’s HIV/AIDS movement is almost here.

The biennial awards gala known as AccolAIDS will be held from 6 to 10 p.m. on Sunday (April 22) at the Vancouver Convention Centre (1055 Canada Place).

Tickets are $150 and the evening includes a three-course meal, wine, a cash bar, entertainment, and silent and live auctions. Proceeds will go to the Positive Living Society of B.C., which offers programs and services to people living with HIV in B.C.

Meanwhile, online voting for the People’s Choice Award closes soon. Votes are also being accepted until 9 a.m. on Thursday (April 19).

There are 20 nominees to choose from, ranging from volunteers, artists, and medical professionals to organizations, companies, and labs. To vote, visit this AccolAIDS webpage.

For full details about the event, visit the AccolAIDS website.

Source: https://www.straight.com/life/1058891/biennial-awards-gala-accolaids-2018-honour-leading-figures-and-organizations-bcs

HIV-infected people are living for years, but age-related diseases set in early

A woman receives an HIV/AIDS blood test on World AIDS Day last December. (Efrem Lukatsky/AP)
 April 14

David Hardy has been treating HIV-infected patients since the early 1980s, when the epidemic began. In those days, people newly diagnosed with AIDS lived for only about six months. Hardy, an infectious-disease specialist and internist, was ecstatic when powerful new drug combinations came into widespread use in 1996, enabling HIV-infected people to measure their lives in decades rather than months. But in recent years, his euphoria has turned bittersweet.

“Most people assume that the medicines have worked and that everything has gone back to normal, and that’s not really true,” says Hardy, who directs research for Whitman-Walker Health in Washington and who still sees patients weekly. “While we have suppressed HIV very well, we’ve now discovered that the medicines only treat part of the problem.”

Many HIV-infected people, now in their 50s and 60s, who have lived for years with HIV under control, are developing aging-related conditions — heart, liver and kidney disease, certain cancers and frailty, for example — at a rate significantly higher than uninfected people of the same age. “These are things that people develop all the time as they get old, but they are occurring at an earlier age in HIV-positive people,” Hardy says.

“The first goal was to save someone from dying of HIV infection,” agrees Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) and a leading researcher involved in developing the AIDS drug combinations. “After we started successful therapy that suppressed the virus and extended lives, we began to notice that people were getting diseases associated with aging sooner than their chronological age would indicate they should be getting them.”

An aging HIV population

In 2014, an estimated 45 percent of Americans living with HIV were older than 50, amounting to 428,724 people, according to the Centers for Disease Control and Prevention, while 27 percent were older than 55 and 6 percent were 65 and older. These include people diagnosed a decade or more before life-prolonging drugs became available, as well as older Americans diagnosed with late-stage AIDS who did not begin HIV drug therapy until then.

Experts believe this timing — the point at which someone starts therapy after infection — is key to understanding what is happening now. It involves how the body’s immune system behaves following infection with HIV.

“If you are in your 50s today and you were infected when you were 20, you had about 10 years of living without therapy before the drugs came along and helped you survive,” says Carl Dieffenbach, director of NIAID’s AIDS division. In this group, and in older people diagnosed with late-stage AIDS, the period without treatment “led to a tremendous amount of damage to their immune system.”

HIV not only damages the immune system, it also turns on that system indefinitely, meaning the immune response triggered by HIV never really shuts down, even once drugs have begun to quell the virus. “With most infectious invaders, the immune system responds and then is supposed to rest, like a fire engine waiting to come out when there is a fire to be fought,” Dieffenbach says. “With HIV, those firetrucks keep driving around looking for fires, even when there are none.”

Fauci agrees. “It isn’t only the [initial] immune response against HIV,” he says. “It’s a global turning-on of the immune system — and the longer you wait to take drugs, the more robust the immune activation.”

Many AIDS researchers believe that this “immune activation” is the primary mechanism underlying the accelerated rate of age-related diseases. HIV-infected patients must take multiple medications daily, some with side effects, but experts believe the AIDS drugs aren’t a major contributor to these conditions. “It’s much less the drugs; it’s the immune activation,” Fauci says.

Medications don’t cure

HIV medications control HIV, but they don’t cure it. The virus persists in numerous reservoirs in the body, including the lymph nodes, which prompt immune activation as well as chronic inflammation. “Inflammation and immune activation accelerate heart disease and stroke, and chronic HIV infection results in both,” says Robert T. Schooley, a longtime AIDS researcher and professor of medicine in the infectious-diseases division at the University of California at San Diego. “One can calculate a given patient’s risk for stroke or heart attack based on how elevated laboratory markers of inflammation are.”

Several studies have shown the heightened risk of cardiovascular disease among those with HIV. They have a 50 percent higher risk of heart attack compared with noninfected controls, and a more than fourfold higher rate of sudden cardiac death compared with the general population. They also are in greater danger from complications associated with heart failure.

Certain cancers are increasing among them as well. Early in the epidemic, some cancers — Kaposi’s sarcoma, non-Hodgkin’s lymphoma and invasive cervical cancer, for example — often developed in HIV-infected individuals, signaling the onset of full-scale AIDS. These “AIDS-defining” cancers initially decreased with the introduction of anti-HIV drugs and have remained relatively steady during the past two decades. However, the burden of non-AIDS-defining cancers — anal cancer, lung cancer, Hodgkin’s lymphoma, liver cancer and head and neck cancers, among others — has grown during that period. Many of these are caused by viruses other than HIV.

(These include hepatitis B and C viruses and liver cancer; human papillomavirus and head, neck and anal cancers; and Epstein Barr virus and Hodgkin’s lymphoma.)

Experts believe these arise in HIV-infected people predominantly because their impaired immune systems can’t effectively fight the viruses responsible. Lung cancer is an exception because it is not caused by a virus. But many HIV-infected people smoke, and also suffer lung infections and other assaults.

These cancers account for a growing number of cancer-related deaths among the HIV population. “As people are dying less often of AIDS and opportunistic infections, cancer is becoming one of the most common causes of death in people with HIV,” says Robert Yarchoan, chief of the National Cancer Institute’s HIV and AIDS malignancy branch. “Also, the incidence of most cancers increases as people age, and HIV-infected people are becoming more susceptible, just like the rest of us.”

One ongoing study has shown that patients who start AIDS antiretroviral drug therapy early generally fare better than those who wait, including significantly reducing their chances of developing full-scale AIDS. But even a brief period between infection and the onset of therapy can harm the immune system and cause problems, experts say.

Leaky gut

“Very shortly after someone is infected, the lymphatic system in the gastrointestinal tract undergoes a major transformation” known as microbial translocation, often called “leaky gut,” a condition where microbes from the GI tract escape and enter the bloodstream, according to Amy Justice, a professor of medicine at Yale University who studies HIV among veterans. “It happens quickly after infection, and we’re not very good at preventing it. Even when we treat them [with anti-HIV drugs] early, they still have more microbial translocation than people who don’t have HIV — and it feeds the chronic inflammation.”

Moreover, drinking alcohol exacerbates leaky gut, “so drinking when you have HIV is not a good thing,” she says.

In fact, drinking, smoking, recreational drug use and obesity — a common side effect of antiretroviral therapy — also probably contribute to the medical problems of HIV patients, experts say. “The challenge is to try to get them to change ingrained health behaviors at midlife,” Justice says. “This is hard for anyone, with or without HIV, but probably more important if you’ve got HIV.”

While the risk of developing age-related conditions “is substantially increased” for people with HIV, the situation isn’t necessarily all grim, Justice says. “Not everyone is miserable and sick,” Justice says. “Many are doing incredibly well. A lot is in their control, if they can change their health behaviors.”

The NIAID’s Dieffenbach agrees. “Everybody has his or her own set of risk factors, and what HIV infection tends to do is magnify your lifestyle choices, or your genetics,” he says. “What we are grappling with now is defining this. Aging occurs, and with it the risk of getting one or more of these diseases. What is it about HIV that hastens the process? Can we do anything about it? Those are the things we are trying very hard to address.”

https://www.washingtonpost.com/national/health-science/hiv-infected-people-are-living-for-years-but-age-related-diseases-set-in-early/2018/04/13/ee26f74e-3120-11e8-8abc-22a366b72f2d_story.html?noredirect=on&utm_term=.6694cf4842ed

Chinese universities add HIV test kits to vending machines to tackle virus’ rise in taboo sex culture

Along with chips, instant noodles and soft drinks, students in a growing number of Chinese universities now have the option of also grabbing an HIV test kit to go from their campus vending machine.

Key points:

  • HIV self-test kits are selling for $6.20 each and the test can be done anonymously
  • New HIV cases in people aged between 15 to 24-year-old doubled from 2008 to 2015
  • About 758,000 people were reported to be living with HIV in China by the end of last year

Three Shanghai universities have installed machines to offer the self-test kits this month as a part of a pilot project to promote early detection and treatment of HIV/AIDS in a culture where the virus is stigmatised.

The annual number of newly diagnosed HIV cases among teenagers aged 15 to 19 increased more than 150 per cent in China over the past decade.

As a part of the project, universities are selling the kits for a significantly discounted 30 yuan ($6.20), compared with 298 yuan ($61.20) on e-commerce site Taobao.

A major drawcard of the system — in a country where HIV and homosexuality are still taboo subjects — is that students can do the test anonymously by dropping off their urine sample in the vending machine’s return box for testing.

Students can check their results online after three to five working days by entering the serial number on the kit. During the trial period, the $6.20 is then reimbursed after receiving their result.

However, the Chinese Association of STD and HIV/AIDS Prevention and Control warned in a statement on their website that the test was only a “preliminary screening” and could provide a “false-positive result”.

“If the test result is positive, it should be reviewed promptly,” it said.

Universities started offering the self-test kits in 2016 to curb the rising HIV infection rate among students, and the program has since been rolled out to Chinese provinces including Heilongjiang, Sichuan, Yunnan and Guangxi as well as in the capital Beijing last year.

HIV and homosexuality remain taboo subjects in China

Zhongdan Chen, a technical officer from the World Health Organisation’s China office, said the annual rates of new HIV diagnoses among people aged between 15 and 19 years old in China had almost tripled between 2008 and 2017.

“Two critical reasons include weak implementation of national policies to provide sexual education in schools and communities, and limited focus on adolescents and youth-specific interventions as part of the national HIV efforts,” Dr Chen said.

“Many of these students don’t want to visit traditional testing sites such as hospitals and clinics due to fear of discrimination,” he added.

At of the end of 2017, about 758,000 people were reported to be living with HIV in China, Dr Chen says, but added that an estimated 30 per cent of people living with HIV did not know their HIV status.

“Due to stigma and discrimination, among other reasons, uptake of the available HIV testing, prevention and treatment tools and services among key populations has remained far from adequate,” he said.

“Innovations in tools and service delivery approaches are urgently needed to make these services available, accessible, acceptable and of adequate quality, especially for high risk populations.”

He said some other countries, including US, UK, France and Kenya were also scaling up HIV self-testing by enabling access to and regulating HIV test kits through websites, pharmacies, workplaces, and community-based organisations.

A vending machine for HIV tests was installed at a gay sauna in Britain’s southern city of Brighton last year in an attempt to fight the epidemic.

The machine distributes free finger prick self-test kits that also allow the users to collect and check the results anonymously.

Vending machines could be explored in Australia: AFAO

The Australian Federation of AIDS Organisations chief executive Darryl O’Donnell said it was incredibly important that the testing be convenient, particularly for those who needed to test regularly.

“We need to make it as easy and accessible as possible for people to test for HIV — we want people to know their HIV status,” he said.

“Vending machines are certainly an interesting and novel approach, and it’s something that we could definitely explore in Australia, but the task is to make sure that we’ve got the right test that could be dispensed in that way.”

People in Australia could order a HIV self-test online, he added, but it wasn’t something that was widely known and adopted — and sometimes those tests could be expensive.

Mr O’Donnell also noted there were no approved urine tests for HIV in Australia, and testing was still done by blood samples.

“One of the most important things we can do to better respond to HIV is to increase the rate of HIV testing,” Mr O’Donnell said.

“There’s been a lot of effort over recent years to make HIV testing more convenient; we’ve seen the introduction of rapid HIV tests that allow people to obtain a result in about 20 minutes, and there are a lot of services that are now opening up that are community-based or peer-led HIV testing services, particularly for those who need to test regularly.”

By Christina Zhou and Bang Xiao

Source: http://www.abc.net.au/news/2018-04-14/chinese-universities-stock-hiv-test-kits-in-vending-machines/9636386

Genetically altered broadly neutralizing antibodies protect monkeys from HIV-like virus

NIH scientists report single dose elicited long-term protection.

What

Two genetically modified broadly neutralizing antibodies(link is external) (bNAbs) protected rhesus macaques from an HIV-like virus, report scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. After introducing genetic mutations into two potent HIV bNAbs, researchers prepared intravenous infusions of two bNAbs known as 3BNC117-LS and 10-1074-LS. Single infusions of each modified bNAb protected two groups of six monkeys each against weekly exposures to simian-human immunodeficiency virus (SHIV) for up to 37 weeks, compared with a median of three weeks in 12 monkeys receiving no antibody. SHIV is a manmade virus commonly used in HIV nonhuman primate studies.

The study, led by Malcolm A. Martin, M.D., chief of the NIAID Laboratory of Molecular Microbiology, also assessed the efficacy of injecting a combination of both modified bNAbs into six monkeys subcutaneously — a route of administration considered more feasible in resource-limited clinical settings. This bNAb mixture, administered at a three-fold lower concentration than the individual antibodies infused intravenously, protected this group of monkeys for a median of 20 weeks.

Dr. Martin’s team demonstrated that the genetic mutations introduced into the original bNAbs increased their durability following injection and led to the extended period of protection. The mutations did not affect the way the bNAbs bound to the virus but extended their activity following injection. This extended activity in the body could theoretically allow for longer periods between clinical visits to receive the prevention modality, if proven safe and effective in humans. This approach joins other candidate drugs and biomedical technologies that aim to provide long-term protection against HIV in the absence of an HIV vaccine.  Among ongoing studies are two large Phase 3 trials in Africa and the Americas known as the AMP Studies, for antibody-mediated prevention.

Given the success of the modified bNAbs in nonhuman primates, researchers will next test their safety and efficacy  in people. A Phase 1 clinical trial to evaluate 3BNC117-LS already has begun. To learn more about this study, visit ClinicalTrials.gov using identifier NCT03254277.

Article

R Gautam et al. A single injection of crystallizable fragment domain-modified antibodies elicits durable protection from SHIV infection. Nature Medicine DOI: 10.1038/s41591-018-0001-2 (2018).

who

Anthony S. Fauci, M.D., NIAID Director, and Malcolm A. Martin, M.D., lead author on the study and chief of the Laboratory of Molecular Microbiology in NIAID’s Division of Intramural Research, are available for comment.

Contact

To schedule interviews, please contact Judith Lavelle, (301) 402-1663, niaidnews@niaid.nih.gov(link sends e-mail).

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Source: https://www.nih.gov/news-events/news-releases/genetically-altered-broadly-neutralizing-antibodies-protect-monkeys-hiv-virus

Researchers puzzle over whether HIV accelerates cancer progression

Although people living with HIV may be diagnosed with cancer at an earlier stage because they get more consistent care than the general population, it is also possible that a higher likelihood of late cancer diagnosis among people with HIV is an indication that HIV may accelerate cancer progression, according to research presented at the 25th Conference on Retroviruses and Opportunistic Infections (CROI 2018) last month in Boston.

Prior research has shown that people with HIV are more likely to develop several types of cancer, though for other types there appears to be no difference between HIV-positive and HIV-negative people. The increase in risk among people with HIV is especially notable for virus-linked cancers such as cervical and anal cancer (caused by human papillomavirus), liver cancer (caused by hepatitis B and C) and certain types of lymphoma (associated with Epstein-Barr virus).

Keri Calkins and colleagues from Johns Hopkins University in Baltimore compared outcomes among HIV-positive people with cancer enrolled in the Johns Hopkins HIV Clinical Cohort and the mostly HIV-negative general population represented in the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database.

To date, there has been limited research on disease progression and outcomes among HIV-positive people with cancer. Some studies suggest that people with HIV are diagnosed with cancer later, are less likely to be treated and have poorer survival, but data have been inconsistent, they noted as background. Greater immune suppression may result in more aggressive cancer and may make cancer treatment less tolerable. HIV-positive people are also more likely to have risk factors such as smoking and viral co-infections that affect cancer risk and outcomes.

The researchers compared 254 people newly diagnosed with their first cancer (excluding Kaposi sarcoma) between 1997 and 2014 and nearly 1.9 million people diagnosed with first cancers of the same types in the SEER database between 2000 and 2014.

In the Johns Hopkins cohort, 69% were men, 78% were black and the median age at diagnosis was 50 years. The most common cancers were non-Hodgkin lymphoma (21%), lung cancer (17%), liver cancer (9%), Hodgkin lymphoma (7%), prostate cancer (7%), breast cancer (6%) and anal cancer (6%).

People in the Johns Hopkins cohort were substantially more likely than those in the SEER database to be diagnosed with localised cancer (30% vs 6%, for a probability difference of 24%), after adjusting for age, sex, race/ethnicity, year of diagnosis and cancer type. Localised cancer generally indicates that it is at an early stage, though some cancers progress slowly and can still be localised years after they develop.

Likewise, the chances of having cancer spread to distant parts of the body were also higher in the HIV-positive group (45% vs 9%, for a probability difference of 36%). Distant metastasis is typically an indication of late-stage cancer, though some cancers progress rapidly and can spread throughout the body soon after they arise.

Overall, people in the Johns Hopkins cohort and those in the SEER database had a similar likelihood of receiving any kind of cancer treatment (83% vs 87%, respectively). This remained the case when looking at people with CD4 counts above or below 200 cells/mm3, the latter indicating substantial immune suppression.

HIV-positive people with cancer had overall shorter survival – by 5.4 months – than those in the general population within the first 5 years after a cancer diagnosis when adjusting for demographic factors, year of diagnosis and cancer type. However, the difference was no longer statistically significant after accounting for cancer stage and treatment.

The difference in survival was more pronounced – a reduction of 11.7 months – among HIV-positive people with a low CD4 count. This difference was smaller (a reduction of 6.8 months) but remained significant after adjusting for cancer stage and treatment.

Notably, there was no difference in survival among HIV-positive people with CD4 counts above 200 cells/mm3, which should now be the status of almost everyone taking modern antiretroviral therapy.

“People with HIV are more likely to be diagnosed with cancer at earlier and later stages than the general US population, suggesting that HIV may contribute to faster progression and that engagement in HIV care may improve earlier detection,” the researchers concluded.

Author:Liz Highleyman

Source: http://www.aidsmap.com/People-with-HIV-are-diagnosed-with-cancer-both-earlier-and-later-than-HIV-negative-population/page/3255546/

Trudeau Liberals to overhaul ‘discriminatory’ immigration law targeting people with disabilities

‘These newcomers are not a burden to Canada’: Liberals announce changes to immigration policy for persons with disabilities

Prime Minister Justin Trudeau’s Liberal government has announced major changes to Canada’s immigration policy that will make it far easier for persons with disabilities and their family members to immigrate to Canada.

Delivered early Monday morning in the foyer of the House of Commons, the announcement by Immigration Minister, Ahmed Hussen, comes after months of reporting by Global News that exposed major flaws with the way Immigration, Refugees and Citizenship Canada handles permanent residency applications for persons with disabilities. This included allegations immigration officials were either breaking the law or not properly implementing their own policies when denying certain applicants.

Known as “medical inadmissibility” due to excessive demand, the law, as currently written, allows the government to deny people residency in Canada because they or an immediate family member have a disability or medical condition that could place “excessive demand” on publicly funded health and social service programs. This often means denying residency to parents whose children have disabilities.

The changes announced Monday, however, mean the government will no longer consider certain social service spending when deciding if someone can immigrate to Canada, particularly social service spending related to special education needs.

This decision is especially meaningful to potential — and otherwise viable — immigrants whose children have intellectual disabilities – such as autism or Down syndrome – because it means their applications will no longer be denied due to special education needs and other social service spending that could be required once they arrive in Canada.

Hussen said the changes will take effect immediately. Families whose applications have been denied in the past due to special education costs related to a child’s disability will need to reapply if they wish to be considered under the new rules.

As Global News first reported, these types of cases make up roughly one-third of all applicants denied permanent residency because of excessive demand. Hussen added that with the new changes, roughly 75 per cent of all cases denied in the past will now be accepted – that equals roughly 750 applications a year.

Gov’t plan triples cost threshold used to deny based on medical condition

In addition to eliminating special education costs as a barrier to immigration, Hussen announced the government plans to triple the cost threshold used to deny applicants whose medical conditions could result in health-care costs once they arrive in Canada.

Currently set at $6,655 a year, which the government says was the average per-capita health and social service spending in Canada in 2016, the new limit for denying residency because of medical costs will be closer to $20,000 a year once the changes are implemented. Hussen said the government plans to move toward the complete elimination of this threshold in the future, pending the outcome of ongoing negotiations with the provinces.

Hussen did not provide details on who will pay for the additional medical costs – the provinces or the federal government. He did, however, say he is working closely with the provinces and territories to find a solution and that his office will monitor the impact of these changes on public health care systems. He added that much of the funding for health care spending in Canada already comes from the federal government in the form of health and social service transfers to the provinces.

Global News exposes major problems, keeps families together

Monday’s announcement by Hussen reverses a 40-year-old policy that many legal experts have said discriminates against persons with disabilities and their family members. It comes after the Global News’ series Inadmissible, which revealed serious problems with the way Immigration Canada administers the excessive demand policy.

Over an eight-month period, the series exposed the devastating impact of the policy on hard-working people from across the country, many of whom have been in Canada for years, separated from their families, paying taxes and contributing to Canadian society.

The decision to change the policy also follows a Parliamentary committee report that last December recommended the government repeal Section 38-1-C of the Immigration and Refugee Protection Act, the section of the law that deals with medical inadmissibility due to excessive demand.

Liberal MP Rob Oliphant chairs the committee. In his report, Oliphant said the cost of granting residency to all those denied due to excessive demand was minuscule, representing just 0.1 per cent of what Canada spends on health care each year. He also acknowledged the many contributions made by Global News toward exposing systemic problems with the law.

“Witnesses [who appeared before the committee] referred to the significant investigative journalism that Global News had undertaken, which brought to light a range of significant concerns regarding Section 38-1-C and its application,” he wrote.

Several families profiled by Global News who were denied permanent residency because of a child’s disability had the decisions in their case reversed. Hussen specifically mentioned these families in his announcement Monday, saying cases like theirs were a driving factor behind the government’s decision.

These families included Mercedes Benitez, a Filipino caregiver living in Toronto whose 18-year-old son, Harold, has Down syndrome and has been separated from his mother for a decade. It also includes Jon and Karissa Warkentin, who were denied permanent residency because their six-year-old daughter, Karalynn, has a mild intellectual disability.

Source: https://globalnews.ca/news/4142592/trudeau-liberals-overhaul-discriminatory-immigration-law-disabilities/