Colorado says dentist put thousands at HIV risk from reused syringes

DENVER (Reuters) - A suspended Colorado dentist reused syringes and needles in his now-shuttered practice, potentially exposing thousands of patients to HIV and hepatitis infection, health officials warned on Friday.

The Colorado Department of Public Health and Environment sent letters to 8,000 patients of dentist Stephen Stein, urging them to seek tests for the diseases after learning of 'unsafe injection practices' at two Denver-area clinics he owned between September 1999 and June 2011.

Investigators found that Stein reused needles and syringes in several patients' intravenous lines at his oral surgery and dental implant clinics, in violation of standard medical protocol, the department said in a statement.

'This practice has been shown to transmit infections,' the statement said. It added that there had been no confirmed cases of anyone contracting the viral infections through Stein's clinics.

In the letters sent to Stein's former patients, the health department urged them to be tested for HIV, hepatitis B and hepatitis C, said Jan Stapleman, a department spokeswoman.

Stein's records were incomplete, so it is likely more people were possibly exposed than those already identified, she said.

A hot line established for Stein's patients to call was 'very busy' all day on Friday, Stapleman said.

Stein's lawyer, Victoria Lovato, said her client 'is cooperating with the state's investigation.'

Authorities said any patient who underwent any type of injection at the clinics, including sedation, might be at risk. They cautioned that if any patients of Stein tested positive for any of the viruses, there was no way to determine how they contracted the disease.

Stein's license to practice dentistry in Colorado was suspended for an unrelated matter, said Cory Everett-Lozano, spokeswoman for the state Department of Regulatory Agencies, which oversees medical licenses.

Until that probe is resolved, the reasons for Stein's current suspension are confidential, she said.

Lynn Kimbrough, a spokeswoman for the U.S. Attorney's Office in Denver, said Stein was already the target of a criminal probe for possible prescription fraud before the allegations emerged about reusing syringes. She said no criminal charges had so far been filed.

(Editing by Tim Gaynor and Peter Cooney)



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Hepatitis C Virus Levels Higher in Certain Injection Drug Users

FRIDAY, July 13 (HealthDay News) -- Among injection-drug users in the United States infected with hepatitis C, virus levels are highest among blacks, males and those who are also infected with HIV, the virus that causes AIDS, a new study finds.

A 2010 report from the U.S. Centers for Disease Control and Prevention estimates that up to 3.9 million Americans have chronic hepatitis C infection, which is a leading cause of liver cancer, end-stage liver disease and liver transplantation.

The study was published in the July issue of the journal Hepatology.

Previous research indicates that one-third of injection-drug users aged 18 to 30 -- and up to 90 percent of older users -- are infected with the hepatitis C virus. With such high rates, it's important to learn more about the characteristics of infection in this group of people, Dr. Thomas O'Brien, of the Division of Cancer Epidemiology and Genetics at the U.S. National Cancer Institute, said in a journal news release.

O'Brien also noted that hepatitis C virus levels predict treatment response in people with chronic hepatitis C.

O'Brien and colleagues looked at approximately 1,700 black, Hispanic and white injection-drug users in San Francisco. Nearly 75 percent of the participants were men. Their average age was 46 and the average age at which they first used injection drugs was 18.

'We know that the level of [hepatitis C virus] is an important predictor of treatment response and that these levels seem to be influenced by a number of demographic, clinical, viral and human genetic factors,' O'Brien concluded.

Hepatitis C virus causes long-term infection in up to 85 percent of people with the virus, according to the U.S. National Institute of Allergy and Infectious Diseases.

More information

The U.S. National Institute of Allergy and Infectious Diseases has more about hepatitis C.



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Can HIV Prevention Be Found in a Pill?

An antiretroviral HIV drug has shown effectiveness in reducing infection risk, but the medication could put up some hurdles for physicians and health experts.

Three studies released online this week in the New England Journal of Medicine looked at the efficacy of a combination drug called Truvada (emtricitabine and tenofovir disoproxil fumarate) among heterosexuals.

Truvada is currently used as a treatment for HIV, but an FDA panel recently recommended approving the drug for preventive treatment as well.

One of the three studies followed 4,747 couples, one of whom was HIV-positive. The other partner was randomly assigned to Truvada, tenofovir (another HIV treatment) or a placebo.

The Truvada group had a 75 percent reduced risk of HIV infection compared to those who took the placebo, and those who took tenofovir had a 67 percent lower risk compared to the placebo group.

In another study, among 1,219 HIV-negative Africans, those taking Truvada were about 62 percent less likely to get the HIV infection.

But the medication, although promising, presents some challenges. A third study done among women in Africa was stopped because too many participants stopped taking the drug.

An editorial that accompanied the studies acknowledged that the studies had "complex and disparate results" and that more studies are needed to understand the potential and pitfalls of the pre-exposure prophylactic HIV treatment.

The authors of the editorial pointed out that although the studies showed no increase in risky sexual behavior or a drop in condom use, care must be taken that use of the drug doesn't indirectly encourage those behaviors.

They added that concern over how the drug is managed shouldn't take away from its promise as a preventive treatment.

What more needs to be done to prevent the spread of the HIV virus? Let us know in the comments.

---

Jeannine Stein, a California native, wrote about health for the Los Angeles Times. In her pursuit of a healthy lifestyle she has taken countless fitness classes, hiked in Nepal, and has gotten in a boxing ring. Email Jeannine | TakePart.com



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GSK's HIV drug beats Gilead market leader in study

LONDON (Reuters) - An experimental once-daily AIDS drug from GlaxoSmithKline and its Japanese partner Shionogi proved better than Gilead's market-leading Atripla in a late-stage clinical trial, increasing hopes for the product.

Dolutegravir, which could reach the market late next year, belongs to a novel class of drugs known as integrase inhibitors that fight HIV/AIDS by blocking the virus causing the disease from entering cells.

It should help British group GSK rejuvenate its HIV/AIDS business - an area it used to dominate but where it has fallen behind rivals, notably U.S.-based Gilead.

The stakes are high with Atripla, the leading HIV/AIDS treatment in the United States, raking in sales of $3.2 billion last year.

Dolutegravir's impressive result may also make a spin-off of GSK's HIV/AIDS business ViiV Healthcare more likely, analysts said. ViiV is currently run as a joint venture with Pfizer, with Britain's biggest drugmaker holding an 85 percent stake.

Dolutegravir's success against Atripla, taken as a single tablet, may impress clinicians as Gilead's own new Quad pill, which also contains an integrase inhibitor, only matched Atripla.

In the latest Phase III study, 88 percent of patients taking a regimen of dolutegravir plus two older drugs for 48 weeks had their virus suppressed against 81 percent for those on Atripla, GSK and Shionogi said on Wednesday.

The superior efficacy was driven by the fact that more patients taking Atripla dropped out of treatment, with 10 percent of those on the Gilead drug stopping due to side effects against 2 percent in the dolutegravir arm.

The result was the second positive final-stage clinical read-out for dolutegravir, following encouraging results against U.S. company Merck & Co's rival Isentress in April.

Two further Phase III trials are expected to report results by the end of the year and dolutegravir could potentially be filed for approval with regulators before the end of 2012, a company spokesman said.

That means the medicine may reach the market before the end of 2013, ramping up competition in the HIV/AIDS market.

GSK shares were up 0.7 percent by 1150 GMT, while Gilead was down 2 percent in pre-market Nasdaq trading.

GSK'S 40 PCT SHARE

Dolutegravir is viewed by analysts as a potential multibillion-dollar-a-year seller, as its once-daily dosing is likely to be attractive to patients. However, the financial gain to GSK will be diluted by its deals with Shionogi and Pfizer.

Income from the medicine will be shared 50:50 between ViiV and Shionogi, so GSK will receive only just over 40 percent after taking account of Pfizer's minority stake in ViiV.

The creation of ViiV in 2009 marked an unusual drug industry collaboration because of the way in which it pooled GSK and Pfizer's HIV/AIDS operations into a new business. There have been doubts, however, as to whether the joint venture would have a viable future, given uncertainty about its new drug pipeline.

The impressive results with dolutegravir will lay some of those worries to rest.

Mark Schoenebaum, an analyst at ISI Group, said the latest data was 'a bit better than expected', although it might not be enough to drive big shifts away from Gilead's drugs.

Citi analysts also noted that concerns remained about the cardiovascular safety of Epzicom, one of the older drugs used with dolutegravir.

Still, the findings are clearly an overall plus for GSK's HIV unit and could help make it a viable standalone business.

'Today's news may prompt further market discussion of a possible spin-off of ViiV as dolutegravir is much the most important pipeline product for this venture,' Deutsche Bank analysts said in a note.

GSK Chief Executive Andrew Witty said last year he had no immediate plans to spin off ViiV but was 'open-minded' about the unit's long-term future.

Merck's Isentress, which had sales of $1.4 billion last year, is currently the only integrase inhibitor approved by regulators, although Gilead's Quad pill containing its integrase inhibitor elvitegravir was recommended by a U.S. expert panel in May.

(Editing by Jon Loades-Carter)



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Teens' Lifestyle Choices Affect Their Blood Pressure

TUESDAY, July 10 (HealthDay News) -- Teen girls who use birth control pills and teen boys who drink alcohol are at increased risk for elevated blood pressure, according to a new study.

The risk is also greater among teens of both sexes who have a high salt intake and those with a higher body mass index (BMI), which is a measure of body fat based on weight and height. High blood pressure (hypertension) increases the chances of heart disease and stroke.

Researchers looked at blood pressure, alcohol consumption, smoking, physical activity levels, prescription medicine use and eating habits among nearly 1,800 teens in Australia.

About 24 percent of the teens had pre-hypertension or hypertension, including 34 percent of those who were overweight and 38 percent of those who were obese.

Average systolic blood pressure (top number in a reading) among boys in the study was 9 mmHg higher than in girls in general. Among boys, systolic blood pressure was significantly associated with salt intake, alcohol consumption and BMI.

Regular physical activity was associated with lower diastolic (bottom number) blood pressure.

The use of birth control pills was significantly associated with higher blood pressure in girls. The average systolic blood pressure of girls who used birth control pills was 3.3 mmHg higher than in those who didn't use this form of contraception, and blood pressure was even higher in girls who used birth control pills and also had higher BMI readings.

Alcohol consumption did not affect blood pressure in girls, according to the study, which was published July 10 in the European Journal of Preventive Cardiology.

The major differences in blood pressure found between teens with healthy and less healthy lifestyles could have a significant impact on their risk for heart disease and stroke in adulthood, the researchers said.

'Adolescents need to be aware that a lifestyle which predisposes to fatness, high salt intake and alcohol consumption may lead to adverse health consequences in adult life. The effects are additive and already associated with hypertension. Moreover, teenage girls taking oral contraceptives should be advised about regular blood pressure monitoring,' study author Dr. Chi Le-Ha, of the Royal Perth Hospital, said in a journal news release.

More information

The U.S. National Heart, Lung, and Blood Institute has more about high blood pressure.



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HPV Vaccine Reducing Infections, Even Among Unvaccinated: Study

MONDAY, July 9 (HealthDay News) -- Even among unvaccinated girls and young women, the human papillomavirus vaccine is reducing infections of certain strains of the virus known to cause genital warts and cervical cancer, new research finds.

The study is among the first to show signs that the human papillomavirus (HPV) vaccine not only prevents infections, but it can also promote herd protection -- a decrease in infections among the unimmunized thanks to lower rates of infections among other people in their community who might otherwise be transmitting the disease.

HPV is the most common sexually transmitted infection in the United States, and is thought to be the leading cause of cervical cancer. Certain strains of the virus can cause other health problems as well, including other genital cancers, anal cancer, head and neck cancers, and genital warts, experts say.

The study involved two groups of women aged 13 to 26 who had already had sexual contact and who were seen at two primary-care clinics in Cincinnati, one of which was a teen health center.

One group was seen at the clinic in 2006 or 2007, before the HPV vaccine, which protects against four strains of HPV, was widely available. The second group was seen in 2009 or 2010, after the vaccines were widely available.

About 60 percent of the latter group had received the vaccine.

Participants filled out a questionnaire with demographic information and information about their sexual activity, and were tested for 37 strains of HPV. The vaccine protects against four common strains of HPV that are known to cause warts or cancer. The strains include types 6 and 11, which cause almost all genital warts, and types 16 and 18, which cause about 70 percent of cervical cancers and 90 percent of anal cancers, said study author Dr. Jessica Kahn, associate professor of pediatrics at Cincinnati Children's Hospital Medical Center.

From 2006 to 2010, the prevalence of these four strains decreased by about 60 percent, from about 32 percent to 13 percent.

Among the vaccinated, rates of HPV infection fell from 32 percent to 10 percent -- a 70 percent drop. Perhaps even more dramatic, rates of infection among the unvaccinated fell from 30 percent to 15 percent -- a 50 percent drop.

'This is a first look at how the vaccine is working in a real-world setting,' Kahn said. 'We were very encouraged to find the rates of HPV fell so dramatically, especially because the girls in the study already had sexual contact, some had more than one sexual partner and some only had one dose to be considered vaccinated.'

'That's what you get in the real world,' she continued. 'You get vaccinated girls who have already had sex, who aren't compliant with the vaccine. It's a messy sample, not the clean sample you get in a clinical trial.'

Although encouraging, Kahn noted, the findings may not be applicable nationally. Most participants in the study were low-income black women, many with Medicaid insurance, and all were drawn from two primary-care centers in the same city.

The study, funded by the U.S. National Institutes of Health, is published online July 9 in the journal Pediatrics.

The U.S. Food and Drug administration has approved two HPV vaccines -- Gardasil and Cervarix. The girls in the study were given Gardasil, which protects against four HPV strains; Cervarix prevents two HPV types.

'If girls are getting vaccinated, they are not spreading HPV to male partners, who then don't spread it to other female partners,' Kahn explained.

Although the prevalence of the four main strains of HPV fell, the overall rate of HPV infection remained 'extremely high,' according to the study. Infection by any strain actually increased from 61 percent to 76 percent during the study's two time periods. Researchers said this highlights the need for vaccines, some of which are under development, that also protect from other strains of HPV.

Dr. Walter Orenstein, a member of the American Academy of Pediatrics' committee on infectious diseases and associate director of the Emory Vaccine Center in Atlanta, said the findings strongly suggest the beginnings of herd immunity against HPV.

'It's too early to be definitive, but there is a very strong suggestion that this vaccine not only protects the [people who received the vaccine] but protects the community as well,' Orenstein said.

The U.S. Advisory Committee on Immunization Practices recommends that girls and boys get vaccines against HPV at age 11 or 12, before they've had sexual contact, or up until age 26 if they missed that window. The vaccine is given in three doses, each two months apart. Orenstein urged parents to follow the recommend schedule.

'This is a vaccine that can protect against cancer. It's important to vaccinate at the recommended ages, before there is sexual debut,' Orenstein said. 'Not only can vaccines protect individuals, but the more individuals who are vaccinated, the more likely the overall community is protected as well.'

More information

The U.S. Centers for Disease Control and Prevention has more on vaccination schedules.



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A Vaccine Protects Those Who Skip It

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New optimism about stemming spread of AIDS virus

WASHINGTON (AP) - An AIDS-free generation: It seems an audacious goal, considering how the HIV epidemic still is raging around the world.

Yet more than 20,000 international HIV researchers and activists will gather in the nation's capital later this month with a sense of optimism not seen in many years - hope that it finally may be possible to dramatically stem the spread of the AIDS virus.

'We want to make sure we don't overpromise,' Dr. Anthony Fauci, the National Institutes of Health's infectious disease chief, told The Associated Press. But, he said, 'I think we are at a turning point.'

The big new focus is on trying to get more people with HIV treated early, when they're first infected, instead of waiting until they're weakened or sick, as the world largely has done until now. Staying healthier also makes them less likely to infect others.

That's a tall order. But studies over the past two years have shown what Fauci calls 'striking, sometimes breathtaking results,' in preventing people at high risk of HIV from getting it in some of the hardest-hit countries, using this treatment-as-prevention and some other protections.

Now, as the International AIDS Conference returns to the U.S. for the first time in 22 years, the question is whether the world will come up with the money and the know-how to put the best combinations of protections into practice, for AIDS-ravaged poor countries and hot spots in developed nations as well.

'We have the tools to make it happen,' said Dr. Elly Katabira, president of the International AIDS Society, which organizes the world's largest HIV conference, set for July 22-27. He points to strides already in Botswana and Rwanda in increasing access to AIDS drugs.

But Fauci cautioned that moving those tools into everyday life is 'a daunting challenge,' given the costs of medications and the difficulty in getting people to take them for years despite poverty and other competing health and social problems.

In the U.S., part of that challenge is complacency. Despite 50,000 new HIV infections here every year, an AP-GfK poll finds that very few people in the United States worry about getting the virus.

Also, HIV increasingly is an epidemic of the poor, minorities and urban areas such as the District of Columbia, where the rate of infection rivals some developing countries. The conference will spotlight this city's aggressive steps to fight back: A massive effort to find the undiagnosed, with routine testing in some hospitals, testing vans that roam the streets, even free tests at a Department of Motor Vehicles office, and then rapidly getting those patients into care.

'These are the true champions,' Dr. Mohammed Akhter, director of the city's health department, said of patients who faithfully take their medication. 'They're also protecting their community.'

___

A few miles east of the Capitol and the tourist-clogged monuments, the Community Education Group's HIV testing van pulls into a parking lot in a low-income neighborhood with a particularly high infection rate. An incentive for the crowd at a nearby corner is the offer of a $10 supermarket gift card for getting tested.

Christopher Freeman, 23, is first in line. He was tested earlier this year and says showing off that official paper proclaiming him HIV-negative attracts 'the ladies.'

'Forget money, it's the best thing you can show them,' he said.

But that test was months ago, and Freeman admits he seldom uses condoms. He climbs into the van and rubs a swab over his gums. Twenty minutes later, he's back for the result: Good news - no HIV. But counselor Amanda Matthews has Freeman go through a list of the risk factors; it's education to try to keep him and his future partners safe.

'Just try to get yourself in the habit of using condoms,' she said. 'You say it's hard to use condoms but what if you do contract the virus? Then you've got to take medications every day.'

Freeman waves his new test result with a grin, and walks off with a handful of free condoms.

At a nearby bus stop, counselor Laila Patrick encounters a little resistance while handing out condoms, when a woman says that encourages sex outside of marriage.

'Stopping AIDS is everyone's business. You're looking out for the next person,' Patrick said. 'You might just want to help someone be safe.'

___

About 34 million people worldwide have HIV, including almost 1.2 million Americans. It's a very different epidemic from the last time the International AIDS Conference came to the United States, in 1990. Life-saving drugs emerged a few years later, turning HIV from a death sentence into a manageable chronic disease for people and countries that can afford the medications.

Yet for all the improvements in HIV treatment, the rate of new infections in the U.S. has held steady for about a decade. About 1 in 5 Americans with HIV don't know they have it, more than 200,000 people who unwittingly can spread the virus.

Government figures show most new U.S. infections are among gay and bisexual men, followed by heterosexual black women. Of particular concern, African-Americans account for about 14 percent of the population but 44 percent of new HIV infections.

Your ZIP code plays a role in your risk, too. Twelve cities account for more than 40 percent of the nation's AIDS cases: New York, Los Angeles, Washington, Chicago, Atlanta, Miami, Philadelphia, Houston, San Francisco, Baltimore, Dallas and San Juan, Puerto Rico. Many are concentrated in specific parts of those cities.

'Maps tell the story,' said Brown University assistant professor Amy Nunn, who is beginning a campaign that will bring a testing van door-to-door in the hardest-hit Philadelphia ZIP code.

'It's not just what you do, it's also where you live. There's just a higher chance that you will come into contact with the virus,' she explained.

___

Prospects for a vaccine are so far elusive and health disparities are widening, so why the optimism as expressed by the Obama administration's goal of getting to an AIDS-free generation?

Consider the potential strategies, to add to tried-and-true steps such as condom use and treating HIV-infected pregnant women to protect their unborn babies:

-Studies found treatment-as-prevention could lower an HIV patient's chance of spreading the virus to an uninfected sexual partner by a stunning 96 percent. In the U.S., new guidelines recommend starting treatment early rather than waiting until the immune system has weakened. Abroad, the United Nations hopes to more than double the number of patients being treated in poor countries to 15 million by 2015.

-Other studies show a longtime AIDS medication named Truvada can prevent infection, too, if taken daily by healthy people who are at risk from their infected sexual partners. The U.S. Food and Drug Administration is expected to decide by fall whether to formally approve sale of Truvada as an HIV preventive.

-A study from South Africa found a vaginal gel containing anti-AIDS medication helped protect women when their infected partners wouldn't use a condom, generating more interest in developing women-controlled protection.

-Globally, experts also stress male circumcision, to lower men's risk of heterosexually acquired HIV.

___

Testing is a key step in improving prevention. The AP-GfK poll found 57 percent of adults say they've been tested at some point, a bit higher than federal estimates, but not enough. The government recommends at least one test for adults, and that populations at higher risk get tested at least once a year.

Following those recommendations depends in part on people's concern about AIDS. The poll found just over half of Americans consider HIV as much or more of a problem now than two decades ago. But less than 20 percent are worried about getting it themselves, and even populations at higher risk don't consider HIV a big threat. Some 16 percent of black respondents said they're very worried about HIV, compared with 4 percent of whites.

'We've become complacent about HIV in America, and it's a real tragedy because hundreds of thousands of people in our own country aren't getting the care they need,' said Chris Collins of amFAR, The Foundation for AIDS Research.

The drugs can cost up to $15,000 a year in the U.S., and overall treatment costs are rising as people with HIV live longer. In developing countries, those drugs can cost less than $400 a year.

The AP-GfK Poll was conducted June 14-18 by GfK Roper Public Affairs and Corporate Communications. It involved landline and cellphone interviews with 1,007 adults nationwide. Results for the full sample have a margin of sampling error of plus or minus 4.0 percentage points.

_____

In the U.S., the government is targeting the hardest-hit communities as part of a plan to reduce HIV infections by 25 percent by 2015, said Assistant Secretary of Health Howard Koh. Work is under way to learn the best steps to get people treated early, including in cities such as Washington, where 2.7 percent of residents have HIV, roughly four times the national rate.

Washington resident Zee Turner knows it's hard to stick with care. She's had HIV for two decades, learning the news when her baby was born sick. Health workers helped mom and daughter receive then-newly emerging treatments, and they're doing well today.

'I felt that I should get out here and try to help somebody else, because somebody had to help us get into care,' said Turner, now 53 and a community health worker.

The city's latest HIV count suggests progress, with a slight decrease in new diagnoses and a majority of patients being connected with medical care. Community workers such as Turner are called to try to help people stay on treatment when other problems intervene.

'If they're on drugs, I take them to the drug program. If they need help going on Medicaid, I go with them to Medicaid,' Turner said. 'Any problem they have, I'm going to try to fix it and get them back into care.'

___

Associated Press Deputy Director of Polling Jennifer Agiesta and News Survey Specialist Dennis Junius contributed to this report.

___

Online:

International AIDS conference: http://www.aids2012.org

Poll results: http://www.ap-gfkpoll.com

HTML interactive features world map of incidents of HIV by country, explanation of increase of HIV in recent years and a chronology of the epidemic: http://hosted.ap.org/interactives/2012/hiv-aids



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