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Early changes of AIDS-related lymphoma; new approaches to promote circumcision to reduce HIV risk; updates on HIV lifetime costs of care and quality of life estimates
JAIDS: Journal of Acquired Immune Deficiency Syndromes announced its research article highlights from the October issue now available on the journal website. The journal is published by Wolters Kluwer Health.
Earlier HIV Treatment Increases Costs But Improves Survival
(note: article first appeared online in April 2013 JAIDS as publish ahead of print)
Updates of Lifetime Costs of Care and Quality of Life Estimates for HIV-Infected Persons in the United States: Late Versus Early Diagnosis and Entry into Care, led by Paul G. Farnham, PhD, of the Division of HIV/AIDS Prevention of the Centers for Disease Control and Prevention, the researchers performed simulations to estimate how the lifetime costs of care and health outcomes are affected by the stage of HIV disease at diagnosis and the start of treatment. Average lifetime costs ranged from $250,000 for patients starting treatment at a later stage (CD4 cell count 500 or lower) to between $400,000 and $600,000 for those entering treatment earlier (CD4 cell count less than 200).
But earlier diagnosis and treatment also derived more health benefits from HIV care, including about seven additional years of life. Patients with early diagnosis were also less likely to transmit HIV infection to other people.
"Early diagnosis and treatment of HIV infection increases lifetime costs but improves length and quality of life, and reduces the number of new infections transmitted by nearly 50 percent," Dr Farnham and coauthors write. The results lend new support for the concept of increasing the percentage of patients receiving appropriate medical treatment through each stage of the "HIV Care Continuum" - a central focus of the National HIV/AIDS Strategy.
A research team led by Dr Otoniel Martínez-Maza of UCLA AIDS Institute identified a set of abnormal circulating immune cells (B cells) associated with the development of AIDS-NHL. Even with current antiretroviral medications, some types of AIDS-NHL continue to be common AIDS-defining cancers.
The researchers identified a subset of "activated" B cells present in the blood of HIV-infected patients years before the development of AIDS-HNL. Further experiments suggested that B cells developed the abnormal pattern of activation in response to a specific stimulus, called Toll-like receptor signaling. The findings lend new insights into how AIDS-NHL develops, and may lead to new approaches to early identification of patients at risk.
An editorial by Julia Samuelson and colleagues of the World Health Organization (WHO) discusses some new devices for adult male circumcision, which is associated with a significantly lower risk of female-to-male HIV transmission. To increase circumcision rates in areas where access to surgery is limited - particularly in East and Southern Africa - new types of devices for "voluntary medical male circumcision" have been developed. The WHO has developed a formal process for evaluating these devices.
Samuelson and coauthors note some conflicting results in preliminary studies, including concerns about the potential for adverse events. Other concerns include appropriate training of health care providers, the need for appropriate surgical resources to manage complications, and the acceptability of the devices to men and their partners. The authors conclude, "Current pilot studies, operations and implementation research in local settings along with experience will further inform the optimal use of a device-method in medical male circumcision for HIV prevention services in East and Southern Africa."
Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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