HPV Vaccine Cost Effective for Men who have Sex with Men

Courtesy of Medpage Today

I hope that this information is legitimately considered by Public Health departments and vaccinations of men who have sex with men does happen.  The statistics regarding rates of Anal Carcinoma in men who have sex with men and even more so with men who are HIV + already proved the dire need for vaccinations to occur in this population.  I guess human life isn't as persuasive as cost analysis.  I'm glad someone was able to do that for those who see money over prevention.

Here's the article:

Vaccinating men who have sex with men (MSM) against human papillomavirus (HPV) may be a cost-effective approach to the prevention of anal cancer and genital warts, according to a study using decision-analysis models.


In a best-case scenario, when the vaccine is given to MSM at age 12 years, before any exposure to HPV has occurred, and assuming 50% vaccine coverage and 90% efficacy, the cost effectiveness ratio for each quality-adjusted life year (QALY) gained was $15,290, according to Jane J. Kim, PhD, of the Harvard School of Public Health in Boston.

Even if the vaccine was given later -- for instance at age 26 and exposure to HPV was assumed -- the cost-effectiveness ratio remained below the minimum benchmark of $50,000 per QALY gained, at $37,830, Kim reported online in Lancet Infectious Diseases.

In 2009 the CDC's Advisory Committee on Immunization Practices recommended the use of the quadrivalent HPV vaccine to prevent genital warts for boys and men ages 9 to 26 years, but stopped short of making it a routine vaccination because cost-effectiveness data were lacking.

The vaccine subsequently was shown to be effective in preventing anal lesions in MSM, so the CDC and its advisory committee decided to reconsider the issue.

With the goal of providing guidance on the cost effectiveness of HPV immunization in MSM, Kim performed mathematical modeling in a variety of scenarios, assuming a cost per vaccination of $500, to estimate gains in QALY and expenses avoided for both anal cancer and genital warts.

Variables included age at the time of vaccination and exposure to HPV, incidence of anal cancer in a specific population, and whether the benefit included costs per case of anal cancer or also for genital herpes.

In most scenarios the cost-effectiveness ratios were below $50,000 per QALY

HIV transmitted through Blood Transfusion

Courtesy of NBC

DENVER, Colo. --


He thought he was getting a new lease on life: a new kidney.

Instead a Colorado transplant patient got HIV through a blood transfusion in August 2008.

The Centers for Disease Control and Prevention says the Missouri man who donated the blood lied on the questionnaire about his sex life.

The CDC says it's the first known case of HIV transmission through a blood transfusion in eight years.

"I was horrified," Dr. Joe Chaffin, medical director at Bonfils Blood Center, said.

Bonfils has nothing to do with the incident and Chaffin agreed to speak to help us understand how the system works.

"I would bet that any blood banker that you talk to in the world is horrified. This is our worst nightmare. No one ever wants this to happen and this is what we work our lives for to try and keep this from happening," Chaffin said.

The CDC says that getting the virus from blood transfusions remains exceedingly rare, estimating the risk of it happening to be about 1 in 1.5 million.

Chaffin says every blood center in the country does extensive testing.

"Part of what we do, in addition to asking them the question, the questions about high-risk activity, is we also do a mini-physical exam. And the majority of people in early HIV infection will have cold symptoms basically, and we often will pick up we have the potential anyway to pick up someone HIV-infected," Chaffin said.

But he says you can't safeguard against lying and that's what the CDC says the Missouri donor did on his questionnaire.

Every blood center has donors fill out questionnaires every time they donate.

The FDA mandates 48 universal or standardized questions.

Some blood centers ask more.

According to the CDC, in June 2008, the donor who's only been identified as a man in his 40s, donated blood like he's done a number of times before.

The CDC says in his questionnaire, he didn't report any HIV risk factors and his blood tested negative for the disease.

In November 2008, when donating again, HIV was found.

In a later interview, the married man said he had sex outside his marriage with both men and women, including just before his June 2008 donation.

He admitted he was often drunk and it was often with people he didn't know.

The current testing can't detect HIV early, in the first 10 days of the disease.

"There are things that are being researched right now that there is potential in the future for the elimination of that window period," Chaffin said.

Experts say there is no cause for alarm.

This is very much an isolated incident.

There's never been a better time, a safer time to get a blood transfusion," Chaffin said.

The name of the patient has not been released and most of this case is covered by patient privacy laws.

The questioned donor's blood products were also given to an Arkansas patient who died of heart disease two days after getting a transfusion during a mid-2008 surgery.

The CDC says it's unknown if that patient contracted HIV.

Heinz Family and Welvista offer free HIV medications to people on ADAP Waitlists

From AIDSMed.com

Program Offers Free HIV Drugs for ADAP Waitlisted

A nonprofit group has formed a partnership with three pharmaceutical companies and a mail order pharmacy to offer free antiretroviral (ARVs) drugs to people in states that have instituted waiting lists for their AIDS Drug Assistance Programs (ADAPs).

The great recession has hit people with HIV particularly hard. Lower tax revenues have decimated state budgets and have kept the federal government from offering enough dollars to meet the shortfall. As a result, programs like ADAP—which offer free HIV medications (and sometimes other drugs) through a combination of federal and state dollars—are suffering financial crises.

As of September 2010, nine states have frozen new ADAP enrollments and 3,214 people are on waiting list. Thirteen other states are considering new cost-containment measures. Though Congress approved a recent one-time infusion of additional cash, activists say it falls far short of what is needed.


The pharmaceutical industry does offer an alternative: The companies provide free medication through their patient assistance programs (PAPs) to people with low to moderate incomes who don’t have health insurance. Activists have expressed concern, however, that some people who’ve been wait-listed for ADAP will fall through the cracks.

“The effort to obtain free drugs from programs run by the pharmaceutical manufacturers can be overwhelming, due to complicated paperwork processes, different income-eligibility determinations by each manufacturer, lack of a single entry point and other hurdles,” wrote Jeffrey R. Lewis—the president of the Heinz Family Philanthropies—in an opinion piece in the Boston Herald.

Lewis’s foundation is working jointly with a mail-order pharmacy called Welvista and three ARV-producing pharmaceutical companies—Abbott, Merck and Tibotec—to offer free medications to people who’ve been put on ADAP waiting lists. What’s unique about this partnership is that people don’t even have to fill out any paperwork. It makes enrollment in the program automatic as soon as a person is placed on an ADAP waiting list. Free drugs are then shipped within a day to someone’s home or to his or her provider’s office.

“Unfortunately, Abbott, Merck and Tibotec are the only three pharmaceutical manufacturers that produce HIV/AIDS medications that currently participate in this program,” Lewis said. “The entry of all the other pharmaceutical manufacturers [notably Gilead, ViiV Healthcare, Bristol-Myers Squibb, Roche and Boehringer Ingelheim] would be greatly encouraged and welcomed.” These companies’ participation will be necessary to help streamline access to ARVs not produced by Abbott, Merck and Tibotec.


HIV activist groups, such as the Fair Pricing Coalition, have urged these other companies to consider joining this partnership, and several are actively considering it.

“We are driven by a simple belief that the forces of the marketplace can drive the kind of instrumental change that government cannot or will not accomplish on its own,” Lewis concluded.



1 in 5 Men who have sex with Men is HIV, half of them are unaware of it.

From CDC: 


Study highlights urgent HIV prevention needs for men who have sex with men, especially young men and men of color


Approximately one in five (19 percent) men who have sex with men (MSM) in a study of 21 major U.S. cities is infected with HIV, and nearly half (44 percent) of those men are unaware of their infection, according to a new analysis from the Centers for Disease Control and Prevention. In the study, young MSM and MSM of color were least likely to know their HIV status. The findings were published today in CDC's Morbidity and Mortality Weekly Report.

"This study's message is clear: HIV exacts a devastating toll on men who have sex with men in America's major cities, and yet far too many of those who are infected don't know it," said Kevin Fenton, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "We need to increase access to HIV testing so that more MSM know their status, and we all must bring new energy, new approaches, and new champions to the fight against HIV among men who have sex with men."

The study's results bolster key themes in the President's National HIV/AIDS Strategy for the United States. The recently released strategy states that "the United States cannot reduce the number of HIV infections nationally without better addressing HIV among gay and bisexual men," and MSM are listed among a few priority populations to focus HIV prevention efforts. The President's strategy also sets targets for reducing the number of individuals living with HIV who are unaware of their HIV status.

The CDC study tested 8,153 MSM in 21 cities participating in the 2008 National HIV Behavioral Surveillance System (NHBS), and examined HIV prevalence and awareness of HIV status among this group. NHBS monitors HIV testing, risk behaviors, and access to prevention services among at-risk populations in cities with high numbers of persons living with AIDS.

While MSM of all races and ethnicities were severely affected, black MSM were particularly impacted: 28 percent of black MSM were HIV-infected, compared to 18 percent of Hispanic and 16 percent of white MSM.

The study also found a strong link between socioeconomic status and HIV among MSM: prevalence increased as education and income decreased, and awareness of HIV status was higher among MSM with greater education and income. These findings echo similar disparities found in recent NHBS research among heterosexuals.

Low awareness of HIV infection a major concern, particularly for younger men

The study provided additional insight into the populations of MSM most in need of HIV testing and prevention:

Among racial/ethnic groups, black MSM with HIV were least likely to be aware of their infection (59 percent unaware, vs. 46 percent for Hispanic MSM and 26 percent for white MSM).

While young MSM (under age 30) had lower HIV prevalence than older men, they were far more likely to be unaware of their HIV infection. Among MSM aged 18-29 who had HIV, nearly two-thirds (63 percent) were unaware, versus 37 percent for men age 30 and older.

Among young MSM, young MSM of color were less likely than whites to know they were HIV-infected. Among HIV-infected black MSM under age 30, 71 percent were unaware of their infection; among HIV-infected Hispanic MSM under age 30, 63 percent were unaware. This compares to 40 percent of HIV-infected white MSM under age 30.

CDC officials note that low awareness of HIV status among young MSM likely reflects several factors: they may have been infected more recently, may underestimate their personal risk, may have had fewer opportunities to get tested, or may believe that advances in HIV treatment minimize the threat of HIV. For young MSM of color, discrimination and socioeconomic factors – such as poverty, homophobia, stigma, and limited health-care access – may be especially acute and pose particular challenges.

"For young men who have sex with men – including young men of color who are least likely to know they may be infected – the future is truly on the line," said Jonathan Mermin, M.D., director of CDC's Division of HIV/AIDS Prevention. "It is critical that we reach these young men early in their lives with HIV prevention and testing services and continue to make these vital services available as they become older."

CDC estimates that the majority of new sexually transmitted infections are transmitted by individuals who are unaware of their infection, and studies show that once people learn they are HIV-infected, most take steps to protect their partners. Therefore, because undiagnosed infection likely plays a major role in HIV transmission, reaching younger MSM with regular HIV testing is critical.

CDC recommends that MSM of all ages get tested for HIV at least annually, or more often (every three to six months) if they are at increased risk (e.g., those with multiple or anonymous sex partners, or who use drugs during sex). Notably, only 45 percent of HIV-infected MSM who were unaware of their infection had been tested in the past year, underscoring the importance of more frequent testing among those at highest risk.

While HIV prevention for MSM remains a top CDC priority, agency officials note that a renewed national commitment to HIV prevention is needed to reduce the toll of HIV on MSM and increase access to prevention.

For more information, please visit www.cdc.gov/hiv or www.actagainstaids.org

Young Adults in their 20's who have lived with HIV their whole life.

From The Philadelphia Inquirer

Young adults who have lived their whole lives with HIV

Sanders, of West Philadelphia, belongs to a rare group; he was born HIV-positive when he was perinatally infected via his mother either during pregnancy and delivery or breastfeeding.


At the time, HIV was a death sentence. Sanders and several thousand other infected babies weren't expected to live very long.

But thanks to more than two dozen drugs, the oldest babies are now reaching 30, and living into uncharted territory.

Their challenges are daunting. Along with homework, puberty, and just surviving the rough streets of Philadelphia, they've dealt with losing sick parents and friends, disclosing their status, engaging in sex with uninfected partners, and enduring medical side effects with unknown consequences.

Sanders, now 24, has experienced it all. "My main goal is to get people to talk about HIV," said Sanders, a brand rep for a clothing line and peer educator for iChoose2live, a Philadelphia-based youth program that encourages HIV awareness and career building. "I want to destigmatize it."

More than a million people are living with HIV in the United States, mostly contracted from sex or drugs, according to the Centers for Disease Control and Prevention. Just 1 percent got HIV perinatally or through the bleeding disease hemophilia and blood transfusions.

In 2007, an estimated 7,757 people were living in the 37 states reporting to the CDC who had been diagnosed with perinatally transmitted HIV before age 13.

In Philadelphia, where the overall HIV infection rate is five times the national average, at least 272 current residents were perinatally infected, though officials say the figure could be far higher.

Great news on research for Vaginal Microbicides

From Health News Digest.com



Pitt Gets $11.8 Million to Develop Microbicide Films for HIV Prevention


 
(HealthNewsDigest.com) - PITTSBURGH, Sept. 15 – With the support of an $11.8 million, five-year federal grant, researchers at the University of Pittsburgh and their collaborators are developing a quick-dissolving vaginal film containing a powerful drug that reduces the risk of HIV infection, and they plan to begin testing it locally within a year.


A small film, like those used to deliver breath fresheners, could have several advantages over vaginal microbicide gels that are already being tested overseas, said Sharon Hillier, Ph.D., professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine, senior investigator at Magee-Womens Research Institute (MWRI), and co-principal investigator of the new project, which is funded by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

“Multiple films could be packaged in discrete cartridges without the need for refrigeration, making them portable and easier to store and distribute, and therefore probably cheaper than a gel,” she noted. “And, because they aren’t likely to be as messy as a gel, women might be willing to use them routinely, perhaps on a daily basis.”

The film would provide an alternative dosage form that preclinical testing suggests can release the drug faster and more efficiently than the gel version.


“An effective microbicide strategy should include different forms of the product,” Dr. Rohan said. “Women will have preferences, and having options to meet those needs will lead to greater use and therefore better protection from infection.”

In addition to tenofovir, the researchers will develop and test a second film containing another anti-HIV agent that has yet to be determined.

and from KTIV

University of Nebraska-Lincoln getting $3.8 Million for Vaginal Microbicide.

LINCOLN, Neb. (AP) - With help from $3.8 million in new funding, Nebraska researchers are working on production of a cream that would help women resist transmission of HIV, the AIDS virus.


The money for the work at the University of Nebraska-Lincoln's Biological Process Development Facility comes from the Mintaka Foundation of Medical Research, which is supported by the Wellcome Trust.


The UNL researchers are developing a process to manufacture a stable and affordable microbicide called 5P12-RANTES.


UNL says in a news release that the Biological Process Development Facility is using a molecule discovered by Mintaka researchers. The work will lead to a protein suitable for human testing as a vaginal cream.

Prison Systems in South Carolina and Alabama segregate HIV/AIDS patients

From The Post and Courier

COLUMBIA — Jon Ozmint, director of the state prison system, told Gov. Mark Sanford today that he is expecting a lawsuit from the Obama administration about the policy to test and segregate inmates who have HIV and AIDS.


Ozmint said the U.S. Justice Department sent the state Department of Corrections a letter within the past month that raises issues with the agency's policies.

South Carolina and Alabama are the only states that order inmates with HIV and AIDs to be placed in separate housing.

South Carolina inmates are tested for the virus and disease when they arrive at prison. Those who are infected — many of whom Ozmint said don't know they are infected — are sent to live at the Corrections Department main campus off Broad River Road in Columbia.

Ozmint said the president is doing the "bidding" of the American Civil Liberties Union and operating on "left wing politics" that will harm inmates and further the spread of HIV and AIDS in South Carolina.

The alternative is to go the way of some other states and not test the inmates, Ozmint said. That would increase the risk of spreading the virus and disease among other prisoners and inmates in the event of assaults and sex, he said. It also would put the prison staff at a greater risk, he said.

The policy means that HIV- and AIDS-positive inmates are getting treatment and education on how to manage their health, Ozmint said. The prison system couldn't afford to hire specialists to provide HIV and AIDS care throughout the entire state to cover all the facilities, he said.

Treatment of an inmate with full-blown AIDS could cost as much as $2,000 a month, so reversing the policy could mean an immediate savings for the state. But Ozmint said the savings isn't worth the price.

"This is about whether you want more AIDS or less AIDS," Ozmint said.

Ozmint said the Corrections Department is prepared for a court challenge.

Sanford said the threat of a lawsuit over the policy is "crazy."

Victoria Middleton, executive director of the ACLU of South Carolina, said she applauds the Justice Department's apparent position.

“We are glad to hear that the Department of Justice appears to recognize the importance of dismantling this illegal, discriminatory and unnecessary policy. HIV prevention can and should be managed with information and risk-reduction programs – not with illegal stigma and isolation," Middleton said in a statement.

The U.S. Justice Department has not yet provided a response.

Josh Gelinas, communications director for the Corrections Department, said the agency is not releasing the letter from the Justice Department until the agency has completed its response and sent it to the federal government. The Post and Courier has requested a copy from the Justice Department as well.


Gelinas said the prison system created dormitories specifically for HIV-positive inmates in 1998, a decision that has been upheld by the courts. In the past, inmates have brought cases against the prisons over the policy.

"To be clear, inmates in these dormitories are allowed to attend activities with other inmates, including work, school and faith-based programs," Gelinas said in an e-mail.

Gelinas said that since the prisons began housing HIV-positive inmates together, only one instance of the disease being transmitted from one inmate to another was recorded. That happened last year, he said.

The number of HIV-positive inmates has dropped from 582 in 2000 to 420 as of Jan. 1, according to Gelinas. During that same time, the total prison population increased from 22,053 to 24,734.