Risk of chronic kidney disease and cardiovascular disease in people with HIV should be assessed together

People with HIV should have their risk of cardiovascular disease (CVD) and chronic kidney disease (CKD) assessed together, results from the D:A:D study published in PLOS Medicine show. Investigators found that individuals with a high predicted risk for both CVD and CKD had a much greater risk of developing both CVD and CKD events, compared to people with a high predicted risk for CVD or CKD alone and people assessed as low risk for either morbidity.

“In this analysis we found that HIV-positive people with high predicted CVD or CKD risk were at significant risk for a future CVD or CKD event, and that this risk was multiplicative for those with greater degrees of risk,” comment the authors. “We observed a far higher CKD event rate for those at high risk of both CVD and CKD…the CKD event rate in those with a high CKD risk was highly sensitive to the degree of CVD risk.”

Improvements in treatment and care mean that many people living with HIV have a normal or near-normal life expectancy. However, there is accumulating evidence that HIV-positive individuals are more likely to develop diseases of ageing at an earlier age than their HIV-negative peers.

In the general population, there is a well-established connection between CKD and increased risk for CVD. Moreover, CVD is in turn associated with an elevated risk of CKD. A similar relationship between CKD and CVD risk has been reported in HIV-positive people.

Investigators from the D:A:D collaboration of eleven cohorts in Europe, the US, Argentina and Australia have developed HIV-specific risk models for CVD and CKD. Investigators  hypothesised that people enrolled in D:A:D with a high (5% or greater) five-year risk of both CVD and CKD would have especially high rates of events for both conditions.

They therefore designed a study involving 27,215 people who were in care between 2004 and 2015. The rates of CKD and CVD events were calculated according to five-years risk for these conditions (low = 1% and below; medium = 1-5%; high = above 5%). Analyses were conducted to see if CKD and CVD risk had a multiplicative effect on the incidence of events.

Participants contributed a total of 202,034 person-years of follow-up. Three-quarters were male and the median age at baseline was 42 years. Overall, 13% of people were assessed as having a high CVD risk, with 18% having a high CKD risk and 6% having a high risk for both morbidities.

Overall, the CKD event rate was 7 per 1000 person-years and CVD event rate was 4.5 per 1000 person-years.

People with a high risk of CVD had an almost six-fold (5.63; 95% CI, 4.47-7.09, p < 0.001) increase in their risk of a CKD event compared to low CVD-risk patients. People with a high CKD risk had significant increase in their risk of a CVD event compared to low-risk patients (1.31-fold; 95% CI, 1.09-1.56, p = 0.005).

“We found that both chronic diseases were associated with an elevated risk of the other,” comment the authors. “Overall, our results suggest that among people living with HIV, the association between CVD risk and a future CKD event is stronger than the association between CKD and a future CVD event.”

The conditions had a multiplicative effect for CVD. For people with a low risk of both CKD and CVD, the CVD event rate was just 0.45 per 1000 person-years, but for people with a high risk of both conditions, the CVD rate was 16.5 per 1000 years.

“CVD and CKD risk in HIV-positive persons should be assessed together,” conclude the investigators. “These data also suggest that the primary prevention and effective management of those with comorbidities, prioritising those interventions that have been repeatedly shown to be effective in the general population, will convey the same if not greater benefits for the population of HIV-positive persons.” The researchers also recommend that prevention and management of co-morbidities should be incorporated into HIV treatment and care guidelines.

Author: Michael Carter


World AIDS Day: Addressing comorbidities, resurgence and stigmas

As HIV/AIDS management moves from acute to chronic care, World AIDS Day is a time to celebrate progress and map out a plan for the future. For primary care physicians, it’s also time to reflect on where they fit in when it comes to managing patients and fighting a resurgence.

“The whole point of World AIDS Day is to think back on the patients that were lost, especially when the epidemic was raging and we didn’t really have any real treatment. That was a horrible time,” John S. Cullen, MD, FAAFP, president-elect of the American Academy of Family Physicians (AAFP) and a family practitioner from Alaska, told Medical Economics. “Now, the treatment has gotten so much better that we’re seeing people have medical problems consistent with age.”John S. Cullen, MD, FAAFP

HIV/AIDS is much more of a chronic condition than a fatal disease today, thanks to effective treatment strategies including antiretroviral medications. Although some conditions patients with HIV/AIDS face may be due to the medications they take to manage the disease, Cullen said in a way it’s a miracle that many of these patients are living long enough to have to battle diseases like heart disease, high cholesterol and cognitive issues. In the past, HIV/AIDS patients would not have lived long enough to develop most of these conditions.

World AIDS Day is time for patients and providers to reflect on how far the management of HIV/AIDS has progressed, Cullen said. Observed on December 1 each year, the theme for this year’s World AIDS Day is “Increasing Impact Through Transparency, Accountability and Partnerships.” According to the a statement by Deborah L. Birx, U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health Diplomacy at the Department of State, the theme is meant to be a reflection of the nation’s leadership in fighting the AIDS epidemic both at home and abroad.



Agencies take proactive look at HIV

More Ohio Valley counties trying needle-exchange idea

WHEELING — With a recent spike in newly diagnosed cases of human immunodeficiency virus in southern West Virginia, public health agencies are stepping up efforts to prevent similar HIV outbreaks in the Northern Panhandle.

Statistics for new HIV cases in the six northern counties are not available, but health officials believe the numbers are small.

Regardless of the actual numbers, they said, the threat remains constant and agencies continue to be vigilant in trying to prevent infection.

Howard Gamble, administrator of the Wheeling-Ohio County Health Department, cautioned, “In any jurisdiction in the state of West Virginia or region of Appalachia, the chance of an HIV outbreak is very great.”

Dr. Rahul Gupta, commissioner of the West Virginia Bureau for Public Health, was unavailable for comment on the HIV outbreak in southern counties or to discuss county-by-county cases of HIV.

Toby D. Wagoner, the bureau’s public information officer, said, “We do not release the HIV data by county due to small numbers in an effort to protect the confidentiality of the patient(s). However, we publish cumulative data, and data by district.”

West Virginia’s 2017 HIV/AIDS Surveillance Report listed 1,091 cases of HIV reported in the state from September 1989 through December 2016. The numbers include only people who have been diagnosed with HIV, but not diagnosed with AIDS.

The report indicates that 1,746 people in West Virginia were living with HIV and AIDS in 2016. The number excludes federal prisoners.

According to this report, 101 people were living with HIV and AIDS in 2016 in the state’s District 6, which encompasses Hancock, Brooke, Ohio, Marshall and Wetzel counties.

For the same period, 122 were living with HIV and AIDS in District 5, which includes Tyler and seven other counties.

Gamble said the number of HIV diagnoses is so small that state officials release a year’s worth of data reported in clusters or geographic areas.

In Ohio County, he said, “We aren’t seeing an overall dramatic increase. The state health department is seeing increases across the state and designated areas where they have more potential for problems. In the Northern Panhandle, the number of individuals diagnosed or living with HIV is low compared to the rest of the state.”

Gamble added, “The state of West Virginia addressed this one particular outbreak (in southern counties) and they have it under control. That doesn’t mean the problem is solved. In any other jurisdiction or district, you could have the same thing occur. With any communicable disease, it doesn’t take much to get additional cases.”

In response to the dangers of HIV and other infectious diseases such as hepatitis C and hepatitis B, needle exchange programs and other harm reduction efforts are being launched throughout the Northern Panhandle.

The longest-running needle exchange program in the region is operated by the Wheeling-Ohio County Health Department, in partnership with Northwood Health Systems. Gamble estimated more than 12,000 clean needles have been distributed since the program began in September 2015.

Participation in the weekly session has increased since its inception two years ago. Gamble said the numbers were small initially, but 300-400 needles are given out at each clinic now. The one-for-one free needle exchange program is open at Northwood, 2121 Eoff St., Wheeling, from noon to 3 p.m. every Friday.

Every participant is given a pamphlet listing names and numbers to call for treatment and addiction counseling. He said, “We have had people interested. … We have had people say they’ve talked to Northwood.”

However, few local needle users have requested testing for HIV or hepatitis C.

“We’ve screened very, very few people for anything. Maybe it will take a while for people to say, ‘I want to be screened or tested.’ Our numbers are extremely low when it comes to that,” Gamble said.

Michael Bolen, administrator of the Brooke County Health Department, said the federal Centers for Disease Control and Prevention previously identified Brooke and Hancock counties within the top 100 counties across the country at greatest risk for HIV or hepatitis.

“We’re definitely concerned about it,” he said.

To combat the threat of infection, Brooke, Hancock and Jefferson counties have formed the Ohio Valley Harm Reduction Coalition. The group has started a one-for-one needle exchange program, Bolen said.

Used needles can be exchanged for new, clean syringes at three locations: Northwood Health Systems, 353 American Way, Weirton, from 1-3 p.m. every Friday; Family Recovery Center, 1010 N. Sixth St., Steubenville, 1-3 p.m. on the first and third Friday of every month; and at the Hancock County Health Department, 100 N. Court St., New Cumberland, 1-3 p.m. every Thursday.

In addition to the obvious health risk that an outbreak poses in a community, infectious diseases carry significant economic impact.

Bolen said the needle exchange operates at a very small cost. He added, “When you look at the cost of an outbreak or even several cases of HIV or hepatitis C, it’s hundreds of thousands of dollars per case. We all pay for that. Whether private insurance or government-assisted insurance, everyone has to pay for that issue.”

For example, Bolen said the lifetime cost of treating a single case of hepatitis C is estimated at $80,000 to $120,000, while the lifetime cost for one case of HIV is approximately $500,000. Thus, a 100-person outbreak would result in considerable cost for “a state that is already struggling economically,” he said.

Jackie Huff, administrator of the Hancock County Health Department, could not be reached for comment on the preventive efforts.

Dara Pond, administrator of the Marshall County Health Department, said, “We’ve had no recent confirmed cases (of HIV). … We are, of course, closely monitoring the situation and working closely with the state.”

Pond said Marshall County has joined a harm reduction coalition and is early in the development of a needle exchange program.

“We do have prevention education available. We offer free condoms, free (sexually-transmitted disease) testing and are able to provide referrals for counseling and treatment,” she said. “We also are working with a women’s regional committee to discuss partnering with our family planning programs and harm reduction to hopefully prevent HIV-infected pregnancies, as well.”

Regarding the potential for an HIV outbreak, Karen Cain, administrator of the Wetzel-Tyler County Health Department, said, “It’s always a threat since we have intravenous drug users. So we are starting a clean needle exchange program after the first of the year.”



Access to HIV treatment demanded for transgender persons

PESHAWAR: Various civil society organisations on Friday voiced concern about the increasing incidence of HIV among transgender persons in the province and asked the government to ensure that the community has access to free screening, counselling and treatment for the infection.

The demand was raised during a consultative dialogue of stakeholders, including non-governmental organisations, at the Peshawar Press Club.

Noted among speakers in the event organised by the NGO Blue Veins were president of the TransAction Alliance Farzana Jan, programme coordinator of Blue Veins Qamar Naseem, religious leader Mufti Jamil, Youth Gleam Organisation’s Gul Haider, coordinator of Pakhtunkhwa Civil Society Network Taimur Kamal, project director on provincial HIV/AIDS programme Dr Saleem and Radesh Singh Tony.

They said the transgender persons in the province experienced high levels of stigma, discrimination, gender-based violence and abuse, marginalisation and social exclusion and thus, limiting their access to services, damaging their health and welfare and putting them at a higher risk of HIV.

The speakers appreciated the provincial government’s announcement to establish centres for HIV patients in Malakand, Mardan, Abbottabad, Kohat, Bannu, DI Khan and Peshawar and set up a second family care centre for HIV/Aids patients at the Lady Reading Hospital, Peshawar, saying the facilities will make HIV screening , treatment and counseling easier for transgender persons.

They said the National AIDS Control Programme statistics alarmingly showed that HIV was prevalent among 27.2 percent of the people injecting drugs and 5.2 percent among transgender sex workers.

Mr Naseem said the transgender community was particularly vulnerable to sexually transmitted diseases and HIV/AIDs and therefore, the government should take proper measures for their protection.

He demanded access to free HIV screening, counseling and medication services.

The programme coordinator of Blue Veins welcomed a resolution moved in the provincial assembly calling HIV as major health concern among transgender community in Khyber Pakhtunkhwa.

He said the risk was related primarily to sexual behaviours, especially unprotected anal sex with an HIV positive partner but also, other structural factors made the community vulnerable to the disease but no major steps had been taken to address the situation.

Mr Naseem urged the government to ensure provision of health services to transgender community and said the community members should be properly consulted on the provincial transgender protection policy as a key stakeholder.

Ms Farzana Jan regretted that lack of awareness had kept the transgender community away from HIV testing and treatment, while Mr Mufti Jamil said the transgender persons faced discrimination in education, health and other sectors of economy.

Mr Taimur said the HIV-related stigma and trans-phobia created barriers for transgender persons to have access to screening and treatment.

He called for better targeted prevention approaches in combination with increased welfare and employment opportunities to address the needs of transgender persons.


Are drug dealers who mix fentanyl into heroin serial killers?

Labelling drug dealers who mix fentanyl into cocaine and heroin “serial killers” might change their perspective on their behaviour, says BC Greens MLA Adam Olsen.

Olsen made the comment in a wide-ranging interview with Daily Hive, alongside fellow BC Green MLA Sonia Furstenau and BC Greens leader Andrew Weaver.

‘We have serial killers in our midst’

“I had somebody stand up in a townhall meeting…and he says, ‘We don’t have a fentanyl crisis. We have serial killers in our midst and we’re not dealing with them,” Olsen recalled.

“I wonder if the people who are sloppily mixing fentanyl into the cocaine and into the heroin started to hear themselves being referred to as serial killers, if perhaps they might have a change in perspective on what their behaviour is.”

According to the BC Coroners Service, between January and September this year alone, 914 people in BC died when drugs they were taking turned out to contain fentanyl.

Of those who died, some 29% were aged between 30 and 39 years old. Some 19% were aged 19 to 29 years old. Men accounted for 83% of those who died.

“Let’s start calling it. There’s a much, much bigger issue here,” said Olsen.

“And maybe put a fine point on the kind of behaviour that’s going on in our society, where you have people who make decisions to basically put thousands of people in danger.”


C_KAW/ Shutterstock

‘This comparison really misses the mark’

Aiyanas Ormond with advocacy group the Vancouver Area Network of Drug Users says Olsen’s comparison “really misses the mark.”

“There is a huge criminalized market in these drugs with large well organized businesses organizing production and distribution,” said Ormond.

“The idea that some nefarious character is cutting this stuff independently and with bad intentions is silly.”

These people are workers, says Ormond, simply following orders from people higher up in a well organized operation.

“The fact that fentanyl is so ubiquitous shows that there is an industry wide shift to fentanyl,” said Ormond.

“Talking about this as individual criminality or deviant behaviour entirely misses the point that these crises are a predictable product of the drug war.”

‘We need to destigmatize substance use’

Meanwhile, Furstenau said she is in contact with BC Minister of Mental Health and Addictions, Judy Darcy, on the issue, but all she hears is that a plan is coming.

“In the meantime, people are dying,” said Furstenau, who adds that people aren’t so much dying from drug overdoses, as being poisoned.

“We need to shift the language around this. And we need to destigmatize the use of substances.”

Furstenau believes decriminalizing the possession of personal amounts of all drugs, as in Portugal, could help immensely.

“As long as we keep this a criminal, stigmatized part of our society, we’re not going to change things, so it’s going to need this fundamental shift.”

But you also need to look at the pain and trauma that is creating drug addiction, she says.

“What are the steps that are getting to that place and how do we start unravelling it? … All human beings need to be treated with dignity and respect.”

Is prescription heroin the answer?

The BC Greens have proposed expanding a project in Vancouver’s Downtown Eastside, which makes prescription heroin available for chronically addicted users.

The Providence Crosstown Clinic offers medical-grade heroin and a legal painkiller hydromorphone, in a supervised medical setting.

The service currently has around 135 patients, although two or three more are added every week. On average, patients have used illegal opioids for 15 years.

The clinic is staffed by doctors, nurses, social workers and addictions counsellors, and offers life-skills counselling, housing referrals and direction to legal assistance.

Dr. Scott MacDonald, Physician Lead at Crosstown Clinic, told Daily Hive the injections are part of a continuum of medical and psychosocial care for patients.

“When they have access to our clinic, over and over again I’ve seen their lives transformed as they get healthier,” said MacDonald.

“The illegal activities they’re involved in, in order to purchase the illicit opioids disappears, and they get psychosocial help.”

Image: Ambulance / Shutterstock

‘These are exactly the folks at risk’

MacDonald said the patients they treat have been in jail for an average of 35 months in their lifetimes. They are mostly men, in their 40s and 50s.

“These are exactly the folks that are most at risk in the overdose crisis,” said MacDonald.

“The people that are dying, the vast majority, are long-term opioid users for whom the current treatments have failed.”

MacDonald said the clinic’s treatment is not only more effective than methadone and oral treatments for this group of people – it’s also more cost effective.

“When a new treatment like this both provides better care at reduced cost, that is a new treatment that a society should provide,” said MacDonald.

“It should be available to people who need it.”

Ormond agrees, saying, “VANDU definitely supports prescription heroin programs to give people who use opiates a safe, predictable source of the drug.”

“Prescription heroin programs have many benefits in addition to keeping people from overdosing on the unstable and unpredictable criminalized drug market.”

‘This affects people from all walks of life’

A statement provided to Daily Hive from the Ministry of Mental Health and Addictions said the government supports “limited” expansion of prescription heroin at Crosstown Clinic.

“The continued loss of life underlines the seriousness of this crisis and how it affects people from all walks of life and in every corner of this province,” reads the statement.

“This cannot be allowed to become the new normal, and we need to seek other solutions that are bold and innovative.”

The ministry expects Crosstown will have space for 50 more patients next year, but prefers to expand access to suboxone, methadone, and hydromorphone, as treatments.

“Our focus has been on improving access to injectable hydromorphone, as studies show it to be as effective as prescription heroin, and it is more readily available,” reads the statement.

According to the Ministry, health authorities plans for implementing injectable hydromorphone treatment are currently being evaluated.

“We will have a more definitive assessment of the time it will take to scale up access to hydromorphone treatment in the near future,” read the statement.

‘BC has buried its head in the sand’

Olsen acknowledges the idea of prescription heroin is controversial, but says that is because BC has buried its head in the sand, imagining “our perfect society is all good.”

“The controversy happens when you start to pull it back and uncover the conversations that were not going to happen,” said Olsen.

“The situation still exists, whether we want to pretend it doesn’t or not… It’s time to pull it apart and say let’s have a real conversation about this.”

Author: Jenni Sheppard


Hepatitis increases mortality rates in HIV patients

Honesty ‘is best HIV policy’ for gay couples

The survey leader said:

The survey leader said: “Having a conversation means we are both in agreement and we know whether we are protected or not.” 
Image: iStock

If men in same-sex relationships could talk more honestly about additional sexual partners, they would be less at risk of contracting HIV, a new Southern Africa study reveals.

This is one conclusion from the Human Sciences Research Council’s study.

South African researchers, with the support of two US universities, the Gay and Lesbian Network and Namibian NGO Positive Vibes, conducted the first study on male gay couples in the region.

Study project leader Zaynab Essack said in the survey of 220 people, 78% of men reported being in monogamous unions.

She said it was known overseas that gay men often had “explicit” agreements about having outside partners and deciding how to use protection with additional partners.

This lowers their risk of HIV.

Essack said: “Having a conversation means we are both in agreement and we know whether we are protected or not.”

But the study found that, in South Africa and Namibia, when there was an explicit agreement between partners about having an extra person on the side, the extra partners were only allowed to be a woman.

Partners interviewed separately sometimes gave different answers on whether the couple was monogamous or not.

Essack said couples needed to be able to talk openly about possible additional sexual partners. “Developing the skill for open communication can enhance relationships, trust and honesty.”

There is no national figure of HIV rates in gay and bisexual men, but small studies show a prevalence of between 10% to 50% of all gay men. The prevalence of HIV among South Africans aged 15 to 49 is 17%.

Only a third of those surveyed knew the preventative drug Truvada reduced the risk of contracting HIV by at least 90% if taken daily. Only 2% used it.



Special Needs Students Help Feed HIV and AIDS Patients

Every other Friday a group of special needs students participate in the Food Pantry Care Program at St. Mary Medical Center in Long Beach. They are in a transition program through the LA County Office of Education, learning job skills by bagging up groceries for HIV and AIDS patients.

“We learn how to survive in the real world,” said Damian, a student in the program.

The training program has been led by special education teacher Tim Smith for 17 years. He says it gives his students a rare opportunity to train for their future while also giving back to the community.

“I don’t think my students typically see themselves as contributing members of society and this is a situation where they can come and realize they can contribute and give back, so it does a lot for self-esteem and self-worth,” Smith said.

Tammy Basile is a registered dietician who supervises the food pantry. She says it couldn’t operate without these dedicated volunteers.

“These volunteers have been the most dependable, hardest working individuals I’ve ever worked with,” Basile said.

The food is free to patients like Dan Rafferty who has lived with HIV for 25 years.

“Most of us that have gone through full blown AIDS are on social security, disability and we can’t afford food in this day and age. And if it wasn’t for Tammy and the food pantry I wouldn’t be able to survive,” Rafferty said.

Despite their disabilities, the students fully understand that the work they do helps others.

“I feel this warm feeling and it makes me appreciate that I’m healthy and I have food in my house,” said Gonzalez.

Unfortunately, this is the last year of the transition program for the special education students. It’s being eliminated due to budget cuts. The non-profit food pantry is going to need volunteers and donations of food and a refrigerated truck. For more information on volunteering visit

Author: Angie Crouch


Rare strain of gonorrhea identified in Canada, compounding fears of drug resistance

strain of gonorrhea that is resistant to one of the key drugs used to treat the sexually transmitted infection has been found in Quebec. It is the first time a strain of the bacteria that is resistant to the drug ceftriaxone has been found in North America.

The finding underscores that the days of easy treatment of gonorrhea are numbered.

“Antibiotic-resistant gonorrhea is coming,” said Elizabeth Torrone, surveillance team leader in the division of sexually transmitted disease prevention at the Centers for Disease Control and Prevention.

Ceftriaxone, an injectable antibiotic, is part of the standard treatment for gonorrhea. It is given in combination with a second antibiotic in pill form, azithromycin.

This drug combination is the last of the easy-to-administer, should-work-for-everyone antibiotic therapies available to treat gonorrhea, which has plowed its way through all the drugs in the medical armamentarium. Pharmaceutical companies are working to develop new drugs, but none is expected to hit the market soon.

“A few years ago you would just give a pill. Now you need a shot. And with time, you’ll need some maybe more toxic shots. It’s getting harder to treat,” said Dr. Jean Longtin, head of Quebec’s public health laboratory and senior author of an article on the new case. It was published in Emerging Infectious Diseases, a journal published by the CDC.

Though this case is the first in North America, it is not the first time ceftriaxone-resistant gonorrhea has been diagnosed. It was previously spotted in Japan in 2015 and there have been a few other cases seen in Asia and Europe since.

The genetic signature of the bacteria that infected the Quebec woman had some close similarities to the Japanese case, which suggests that strain might be spreading. The woman did not travel to Asia but her most recent boyfriend had previously traveled to Thailand and China and had unprotected sex in both countries.

Public health authorities tested the man, but by the time they did, he tested negative for gonorrhea.

So far, azithromycin has been the weaker of the two links in this combination treatment; resistance to it has been rising. Longtin noted that just four years ago in Quebec, all gonorrhea strains tested were susceptible to azithromycin, but now about 20 percent are resistant to the drug.

The woman was treated with the drug combination, and in her case, the azithromycin cured her infection. But with resistance to that drug rising, that cannot be considered a given.

Untreated gonorrhea can lead to infertility and increase the risk that an infected person will contract HIV. Infants born to a woman who is infected can develop blindness as a consequence of contracting the bacteria during birth.

The number of gonorrhea infections in the U.S. has risen sharply over the past few years. There were 335,000 cases diagnosed in 2012, but by last year that number had risen to nearly 469,000, according to data from the CDC. Infection rates are rising among all ages of sexually active people.

That makes the problem of increasing resistance even more acute, said Torrone, who was not involved in the new study.

“We know there’s a lot more gonorrhea out there, which means a high probability of maybe coming into contact with a strain that has reduced susceptibility,” she told STAT.

Dr. Alan Katz, who is with Hawaii’s state board of health, has also seen evidence that the power of the current therapy for gonorrhea is eroding.

Katz and his colleagues reported last year on a cluster of cases in Hawaii where the infecting bacteria had high-level resistance to azithromycin and weakening susceptibility to ceftriaxone.

The Quebec case gives him pause.

“This worries me. It worries me because we haven’t seen the ceftriaxone decreased susceptibility at this level,” Katz said.

Everyone involved in the fight against gonorrhea knows that it’s only a matter of time before the bacteria evolve to withstand the current therapy. “Gonorrhea is a really smart bug, and it has developed resistance to most of the recommended treatments in the past,” Torrone said.

So what happens then? Treatment becomes a lot harder, experts predict. Drug doses will likely be increased — in Britain, the standard treatment already involves double the dose of ceftriaxone used in the United States, Torrone said.

The current treatment paradigm — a person who tests positive is given the drugs and rarely asked to come back for retesting to ensure they are cured — may no longer work. Testing may require trying to grow the bacteria from a sample to see if any antibiotics work against it. That’s currently only done in a small number of cases.

Scientists are also looking at older antibiotics that can be harder to take, drugs that have largely stayed on the shelf because they have unpleasant side effects. “Are we going to have to go to these really killer drugs to deal with gonorrhea?” Katz wondered.



Indigenous AIDS group fears for patients as funding set to be cut

The Canadian Aboriginal AIDS Network is facing a 46 per cent cut in some of its government funding.

Indigenous People in Canada are infected with HIV at a rate much higher than the rest of the population.



Indigenous People in Canada are infected with HIV at a rate much higher than the rest of the population.

The Canadian Aboriginal AIDS Network (CAAN) has had funding from the Public Health Agency of Canada — approximately $900,000 in 2017 — reduced by 46 per cent in next year’s budget.

Ken Clement, the network’s CEO, said they use that funding to look at the big picture and ensure HIV prevention and treatment programs are culturally relevant.

“It’s a high-level kind of work that supports community organizations,” said. “We enshrine in the work culture as prevention, culture as advocacy. Culture is the base of the work we all do.”

Indigenous people have an HIV rate 2.7 times higher than the general population, and 11 per cent of new infections are within the Indigenous community.

The Public Health Agency said they’re still aggressively funding projects involving HIV and the Indigenous Community, including CAAN, which will receive almost $2 million between now and 2020, plus funding from other government agencies.

In a statement they said they support projects most likely to reduce the spread of HIV.

“These projects focus on slowing the spread of HIV and hepatitis C, decreasing the number of people who are unaware of their infections, increasing the number of people who are accessing treatment, and reducing the impact of stigma,” said Gary Holub, a spokesperson for the department, in an email. “The program does not fund an organization’s operations.”

Clement said he would like the government to reconsider. He said having less money means they will be able to do less to ensure Indigenous people receive treatment that is relevant to them.

“Indigenous rights to equitable health, without discrimination and stigma, is key to ensure we approve and support healthy indigenous people in Canada.”