Publish date: February 8, 2018
Growing old with HIV: What’s likely, and how can physicians help?
Publish date: February 9, 2018
FROM INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
Individuals infected with HIV require early intervention with safe and effective antiretroviral therapy beyond the standard care required for successful aging. The long-term residual inflammation associated with fully suppressive ART must also be addressed, according to a review in the International Journal of Infectious Diseases.
The review was prompted by the increasing number of aging persons with HIV in the population, due to the advent of life-protecting drug treatments.
Gerome V. Escota, MD, and his colleagues at Washington University, St. Louis, assessed the factors faced by the normally aging population and then added an assessment of the path to successful aging given the unique aspects of the HIV infected population (Int J Infect Dis. 2018; 66:56-64).
For example, in San Francisco, 58% of the people with HIV were over 50 years of age by 2014, according to the authors, and those numbers will continue to increase. Such patients will not only be suffering the effects of the normal aging process, but also the potential burden of long-term antiretroviral drug use on their systems.
In addition, even the use of highly-effective antiretroviral therapy does not completely eliminate the inflammatory markers among HIV-infected individuals, and such markers have been associated with increased risk of cardiovascular and other problems. Of particular concern: “It remains unknown whether age-associated inflammation will aggravate residual HIV-associated inflammation in these patients over time,” the authors wrote.
Exacerbated comorbidities that may be a risk among the aging population infected with HIV include cardiovascular disease, osteoporosis, malignancies, chronic liver and kidney disease, and HIV-related neurocognitive disease.
©Willie B. Thomas/iStockphoto
The “low-hanging fruit” for successful aging with HIV includes “improving the cascade of HIV care and addressing health disparity, increasing the proportion of HIV-infected persons who are receiving suppressive [antiretroviral therapy] and maintained in care, using safer antiretroviral medications, and improving the uptake of primary care preventative guidelines among HIV-infected persons.” Such preventative measures include statin therapy, lifestyle modification, smoking cessation, and the treatment of the various risk factors for both natural aging and aging with HIV, the reviewers concluded.
The review was not sponsored and the authors reported that they had no disclosures.
SOURCE: Escota, J V et al. Int J Infect Dis. 2018;66:56-64.
In a rare show of bipartisanship for the mostly polarized 115th Congress, Republican and Democratic Senate leaders announced a 2-year budget deal that would increase federal spending for defense as well as key domestic priorities, including many health programs.
Not in the deal, for which the path to the president’s desk remains unclear, is any bipartisan legislation aimed at shoring up the Affordable Care Act’s individual health insurance marketplaces. Senate Majority Leader Mitch McConnell (R-Ky.) promised Sen. Susan Collins (R-Maine) a vote on health legislation in exchange for her vote for the GOP tax bill in December. So far, that vote has not materialized.
The deal does appear to include almost every other health priority Democrats have been pushing the past several months, including 2 years of renewed funding for community health centers and a series of other health programs Congress failed to provide for before they technically expired last year.
“I believe we have reached a budget deal that neither side loves but both sides can be proud of,” Senate Minority Leader Chuck Schumer (D-N.Y.) said on the Senate floor. “That’s compromise. That’s governing.”
Said McConnell, “This bill represents a significant bipartisan step forward.”
Senate leaders are still negotiating last details of the accord, including the size of a cut to the ACA’s Prevention and Public Health Fund, which would help offset the costs of this legislation.
According to documents circulating on Capitol Hill, the deal includes $6 billion in funding for treatment of mental health issues and opioid addiction, $2 billion in extra funding for the National Institutes of Health, and an additional 4-year extension of the Children’s Health Insurance Program (CHIP), which builds on the 6 years approved by Congress in January.
In the Medicare program, the deal would accelerate the closing of the “doughnut hole” in Medicare drug coverage that requires seniors to pay thousands of dollars out-of-pocket before catastrophic coverage kicks in. It would also repeal the controversial Medicare Independent Payment Advisory Board (IPAB), which is charged with holding down Medicare spending for the federal government if it exceeds a certain level. Members have never been appointed to the board, however, and its use has not so far been triggered by Medicare spending. Both the closure of the doughnut hole and creation of the IPAB were part of the ACA.
The agreement would also fund a host of more limited health programs – some of which are known as “extenders” because they often ride along with other, larger health or spending bills.
Those programs include more than $7 billion in funding for the nation’s federally funded community health centers. The clinics serve 27 million low-income people and saw their funding lapse last fall – a delay advocates said had already complicated budgeting and staffing decisions for many clinics.
And in a victory for the physical therapy industry and patient advocates, the accord would permanently repeal a limit on Medicare’s coverage of physical therapy, speech-language pathology and outpatient treatment. Previously, the program capped coverage after $2,010 worth of occupational therapy and another $2,010 for speech-language therapy and physical therapy combined. But Congress had long taken action to delay those caps or provide exemptions – meaning they had never actually taken effect.
According to an analysis by the nonpartisan Congressional Budget Office, permanently repealing the caps would cost about $6.47 billion over the next decade.
Lawmakers would also forestall cuts mandated by the ACA to reduce the payments made to so-called Disproportionate Share Hospitals, which serve high rates of low-income patients. Those cuts have been delayed continuously since the law’s 2010 passage.
Limited programs are also affected. The deal would fund for 5 years the Maternal, Infant and Early Childhood Home Visiting Program, a program that helps guide low-income, at-risk mothers in parenting. It served about 160,000 families in fiscal year 2016.
“We are relieved that there is a deal for a 5-year reauthorization of MIECHV,” Lori Freeman, CEO of the Association of Maternal & Child Health Programs – an advocacy group – said in an emailed statement. “States, home visitors, and families have been in limbo for the past several months, and this news will bring the stability they need to continue this successful program.”
And the budget deal funds programs that encourage doctors to practice in medically underserved areas, providing just under $500 million over the next 2 years for the National Health Service Corps and another $363 million over 2 years to the Teaching Health Center Graduate Medical Education program, which places medical residents in Community Health Centers.
Kaiser Health News correspondent Emmarie Huetteman contributed to this article. KHN’s coverage of these topics is supported by Heising-Simons Foundation and The David and Lucile Packard Foundation. Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
Fetal alcohol spectrum disorders incidence exceeds previous estimates
Publish date: February 8, 2018
Clinical Psychiatry News
USPSTF: Screen all pregnant women for syphilis
Publish date: February 6, 2018
The U.S. Preventive Services Task Force issued a draft recommendation that all pregnant women be screened for syphilis infection.
The recommendation, released Feb. 6, follows an evidence review of studies conducted since the task force’s most recent recommendation in 2009, which also called for universal screening of pregnant women.
“Despite consistent recommendations and legal mandates, screening for syphilis in pregnancy continues to be suboptimal in certain populations,” the evidence review noted. The rate of congenital syphilis in the United States nearly doubled from 2012 to 2016.
“Because the early stages of syphilis often don’t cause any symptoms, screening helps identify the infection in pregnant women who may not realize they have the disease,” task force member Chien-Wen Tseng, MD, of the University of Hawaii, said in a statement.
Treatment is most effective early in pregnancy, and can reduce the chances of congenital syphilis. The draft recommendation calls for pregnant women to be tested at the first prenatal visit or at delivery, if the woman has not received prenatal care.
FROM THE JOURNALS
Schizophrenia and gender: Do neurosteroids account for differences?
Publish date: February 7, 2018
Clinical Psychiatry News
Neurosteroids may be tied to the gender differences found in the susceptibility to schizophrenia, a cross-sectional, case control study showed.
“These findings suggest that neurosteroids are involved in the pathophysiology of schizophrenia in male patients but not so much in female patients,” reported Yu-Chi Huang, MD, of the department of psychiatry at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, and associates.
To conduct the study, the researchers recruited 65 patients with schizophrenia from an outpatient department and psychiatry ward of the hospital. Eligible patients were aged 18-65 years, diagnosed with schizophrenia as defined by the DSM-IV-TR, and taking a stable dose of antipsychotics for at least 1 month before the start of the study. In addition, the participants could have no history of major physical illnesses and had to be of ethnic Han Chinese origin. Thirty-six of the patients were men.
The control group was made up of 103 healthy hospital staff and community members who were within the same age range as the patients. The controls could have no history of illicit drug use, physical illnesses, or psychiatric disorders and had to be ethnic Han Chinese. Forty-seven members of the control group were males (Psychoneuroendocrinology. 2017 Oct;84:87-93).
Brain Development Disruptions May Explain Sex Differences in Depression, CVD
Participants fasted and blood samples were obtained. Dehydroepiandrosterone (DHEA) levels were measured using the DHEA ELISA [enyme-linked immunosorbent assay] – ADKI-900-093, dehydroepiandrosterone sulfate (DHEAS) levels were measured with the Architect DHEA-S reagent kit, and pregnenolone levels were measured using the pregnenolone ELISA kit. Psychiatric diagnoses were assessed for both groups using a psychiatric interview based on the Mini-International Neuropsychiatric Interview, the Positive and Negative Syndrome Scale (PANSS), and the 17-item Hamilton Depression Rating Scale. Several factors tied to schizophrenia were evaluated, including the age of onset, illness duration, and use of antipsychotics. The numbers were placed into a database and analyzed.
After controlling for age and body mass index, the researchers found that in male patients with schizophrenia, DHEA and DHEAS serum levels were positively associated with the age of onset of schizophrenia (P less than .05) and negatively associated with the duration of illness (P less than .05). In addition, they found that pregnenolone levels were associated positively with general symptoms of the PANSS in the male schizophrenia patients (P less than .05 ). Furthermore, the levels of DHEA, DHEAS, and pregnenolone were lower among the male schizophrenia patients, compared with the serum levels of the healthy male controls. No differences were found in serum levels among the female patients with schizophrenia and the healthy controls.
The findings suggest that DHEA, DHEAS, and pregnenolone could be markers of the duration of illness and the severity of general symptoms among male patients with schizophrenia. To read the entire study, click here.