Matt's Blog

St. Vincent's Hepatitis C Support Group Meeting
Tuesday, July 15, at 6 PM
St. Vincent's Hospital, New York, NY
170 West 12th Street (off 7th Ave, SE Corner)
Coleman Building, Room 1249
This meeting is open to anyone impacted by or interested in Hepatitis C.
It's been established that a strong social support helps people dealing with a
difficult condition. Come join us to add to your support system. We try to offer
education, information and a shoulder with a network.
This months meeting will be an open meeting.
We meet the third Tuesday of each month. Next meeting will be August 19th.
Refreshments will be provided courtesy of Melanie Huml, Peg-Intron Rep for
Schering Plough Pharmaceuticals.
The facilitator of this meeting is Lillian de Mauro, she can be reached at
lilliandem@...
607-746-7199 or 917-385-2480

Hepatitis C virus causes fatty liver disease with enzyme help
Washington, July 11 (IANS) A key enzyme may explain how hepatitis C infection
causes fatty liver - a build-up to threatening diseases like cirrhosis and liver
cancer, according to a study.
The study showed that an enzyme known to play crucial role in lipid production
--fatty acid synthase (FAS) -- was found at higher levels than normal in human
liver cells exposed to the hepatitis C virus.
The research, at a preliminary stage, suggests that testing for higher levels of
FAS could help determine which patients with hepatitis C virus are likely to
develop more serious, long-lasting health consequences prompted by fatty liver.
Nearly 200 million people worldwide are infected by hepatitis C. Seventy percent
of them develop chronic liver disease. The infection is the leading reason for
liver transplantation in the US.
Unlike hepatitis A and B, there is no vaccine to prevent hepatitis C. Since it
is symptom-less, people not aware of being infected until they develop signs of
liver failure, sometimes decades after infection.
The virus replicates and mutates quickly, helping it to evade discovery and
attack by the immune system and allowing it to slowly wreak damage on the liver.
"Our study has provided new insight into how hepatitis C causes fatty liver,"
having "important implications for future studies and efforts to understand how
the virus causes an increase in fatty acid levels," said Tianyi Wang of the
University of Pittsburgh and the study's co-author.
The findings of the study have been published in the online issue of the journal
Hepatology.
IANS
http://mangalorean.com/news.php?newstype=local&newsid=84340

MS plays big role in artist's work
by Alison Stanton - Jul. 9, 2008 10:33 AM
Special for The Republic
When he was 23, Luis Daniel Gutierrez learned that he had multiple sclerosis.
Rather than be taken over by the condition, which can cause painful attacks,
Gutierrez uses his experiences to motivate him as an artist.
His large, colorful paintings often portray a message of survival and the sense
of victory that Gutierrez feels over the disease.
This month, three of Gutierrez's paintings are on display at the Smithsonian
Institution's National Museum of the American Indian in New York City. The
national traveling exhibition is called "Remix: New Modernities in a Post-Indian
World."
One acrylic painting is called Hank Williams Is a Mexican, and the second is
titled She Must Be Speaking to the Spirits, which is about his late mother and
her battles with multiple sclerosis.
The third painting, a self-portrait, is called Voodoo Lives for Your Pins,
depicting Gutierrez as a voodoo doll. He said the piece represents both the
symptoms of multiple sclerosis and the injections of interferon that he takes.
In April, two of Gutierrez's pieces were added to the Heard Museum's permanent
collection in Phoenix.
"I have been an artist since high school," said Gutierrez, now 39. "The only
thing I really liked in school was the art room. Now I've been exhibiting
everything that I can."
When he is not in the studio painting, Gutierrez, a Phoenix resident, teaches
art at Summit Elementary and works as a rickshaw driver.
Although walking and standing can be hard at times, Gutierrez will continue to
use his artwork as a way to inspire both himself and others for as long as he
can.
"I do this so I can give my kind of voice to multiple sclerosis. Of all the
scientific information that is out there on it, nothing is really good," he
said. "So I'm hoping to reach people who like me don't understand the science."
Information: www.luisdan ielgutierrez.com.
'Nothing more normal'
As executive director of the Wellness Community, a Phoenix non-profit
organization that offers support for people with cancer and their loved ones,
Paula Hardison has met dozens of teenagers who are battling the disease.
But as Hardison will tell you, aside from their diagnoses, the teens are like
any others, with typical interests, wants and needs.
As an example, most love to play video games.
With this in mind, on July 19 from 2 to 5 p.m., the Wellness Community, 360 E.
Palm Lane, is hosting the free Wii Tournament for Teens. The tournament, which
is co-sponsored by Starbright Children's Foundation, is open to teens with
cancer and siblings ages 12-23. An RSVP is requested.
"I think what's so important is to create normal and fun activities for teens,
and there is nothing more normal than video gaming for teenagers," Hardison
said.
"So many aspects of their lives are turned upside down, that this is a great way
for them to kick back and have fun."
In addition to video games, Hardison said the afternoon also will include
jewelry-making, henna tattoos, music and food. Prizes including movie tickets. A
Nintendo DT video game will be awarded to the winners.
Hardison said all teens who are dealing with cancer are welcome to attend, even
if they have never been to the Wellness Community.
"We would just welcome them with open arms," she said.
Information: 602-712-1006 or www.twccaz.org .

Suit alleges inadequate care of hepatitis C outbreak in California prisons
An attorney in the federal class-action lawsuit says up to 40% of the 171,000
inmates in state prisons may be infected by hepatitis C.
By Patrick McGreevy, Los Angeles Times Staff Writer
July 9, 2008
SACRAMENTO -- California prison officials are failing to adequately treat an
outbreak of hepatitis C that has infected thousands of inmates, a federal
class-action lawsuit alleged Tuesday.
The lawsuit was filed in Los Angeles on behalf of inmates including Kevin
Jackson, who is at the California State Prison at Solano and alleges that he has
not received proper treatment since being diagnosed with the disease in August
2007.
Up to 40% of the 171,000 inmates in state prisons may be infected with hepatitis
C, said Shawn Khorrami, an attorney for Jackson.
The lawsuit alleges that the California Department of Corrections and
Rehabilitation is wrongly excluding thousands of inmates from liver biopsies and
antiviral treatments and allowing their diseases to progress to more advanced
stages of liver damage. Khorrami said the lack of proper diagnostic testing and
treatment further spreads the disease among inmates.
"The Department of Corrections is playing judge, jury and executioner and doling
out a punishment that no court would allow," Khorrami said. "This is
unacceptable, inhumane and constitutes cruel and unusual punishment."
The lawsuit against Robin Dezember, director of the Division of Correctional
Health Care Services for the prison system, is the latest in a string of legal
challenges alleging that officials have failed to provide adequate medical care
to inmates.
In response to previous litigation alleging substandard treatment of chronic
diseases, the federal court appointed J. Clark Kelso as a receiver authorized to
take control of and overhaul healthcare in the prison system. Kelso has been
pressuring the state to spend billions of additional dollars to upgrade medical
treatment for inmates, including the addition of 10,000 hospital beds in the
prison system.
As a result, the receiver believes that the lawsuit is redundant, spokesman Luis
Patino said.
"This lawsuit is seriously flawed," he said. "I can't imagine how many times the
same class is going to sue the same agency for the same reason."
Kelso is aware of the problem with treating hepatitis C and "it is already being
fixed," Patino said.
However, Khorrami said the receiver has not made enough progress in addressing
the epidemic, which has the potential to affect the general public as infected
prisoners are released into their communities..
patrick.mcgreevy@...
http://www.corrections.com/news/article/18993

400 Britons wait for an NHS liver - George Best's surgeon gives them to Greeks
for £20,000
By Martin Delgado
One of Britain's leading hospitals is giving NHS livers to private Greek and
Cypriot patients - even though there is a waiting list of 400 Britons in
desperate need of donor organs.
Health service watchdogs have now launched an inquiry into transplants at King's
College Hospital in London, after the scandal was discovered by a Mail on Sunday
investigation.
Surgeons led by Professor Nigel Heaton, who attracted controversy over his
decision to give a transplant to alcoholic football star George Best, are paid
about £20,000 for each operation they carry out.
The hospital has struck a deal with the Greek and Cypriot governments to treat
the patients privately. Senior medical sources have revealed that King's earns
around £85,000 per operation, from which the surgeon's fee is deducted.
Prof Heaton, 53, who makes the final decision on which patients he operates on,
has earned up to £100,000 from five such operations in the past year on top of
his NHS salary of between £150,000 and £200,000.
Between January 2003 and December 2007, 111 liver transplants were carried out
across the country on European Union patients from outside Britain, of which 72
were conducted by the six liver surgeons at King's. Of those 72 patients, 47
were from Greece and Cyprus.
The Healthcare Commission watchdog announced its inquiry into King's after
concerns over the 'unusually high number' of non-British EU patients were
raised.
There is a desperate shortage of donor organs in Britain. At least 400 people in
this country are waiting for a new liver - 20 per cent of whom will die before a
suitable organ can be found.
Many organs are donated by families in harrowing circumstances after their
relatives have been killed in road crashes and other accidents.
The shortage has become so acute that Gordon Brown has called for the
introduction of 'presumed consent', whereby everyone would be considered a
potential donor at death unless an objection had been registered in advance.
Under current legislation, residents of any European Union country are able to
travel to other member states for medical treatment and have the cost reimbursed
by their own health service.
However, some hospitals refuse to consider non-UK patients for transplant
because they believe organs donated in this country should be reserved primarily
for British nationals.
These include the Freeman Hospital in Newcastle upon Tyne and the Queen
Elizabeth Hospital in Birmingham.
A recent meeting of the Liver Advisory Group, which is made up of senior
transplant surgeons, discussed the situation at the Birmingham hospital. Minutes
from the meeting record: 'It was felt that the prime responsibility of the
centre was to transplant UK citizens and by transplanting a non-UK EU patient, a
UK patient would be denied a liver.'
Prof Heaton was criticised six years ago when he gave George Best a transplant,
even though the footballer ignored warnings that his continued drinking was
destroying his health. Best died from multiple organ failure three years after
the operation.
At the time, Prof Heaton defended his decision, saying: 'I don't think it is
fair to ask whether he should have had a transplant because we judge every
patient individually. As doctors, we can take responsibilities only so far.'
The situation at King's is causing deep concern within the medical profession
and among patients.
Ingrid Shillito, a director of the British Liver Trust charity, said: 'The sad
truth is there aren't enough livers donated to give seriously ill people a
second chance of life.
'Liver transplant centres have to make tough choices about which patients get
the few livers that are available, whose need is greatest and who will benefit
most.
'It would be very wrong for financial matters to influence these difficult
decisions, for patients to buy their way to the top of the list.'
King's has admitted that many of its Greek patients come from the Laiko Hospital
in Athens, one of the biggest in the country. The Greek health service,
including its transplant service, is seriously underfunded.
NHS Blood and Transplant (NHSBT), the health authority in charge of transplant
services, decided to refer the King's situation to health watchdogs following a
board meeting on Thursday.
In a statement, it said: 'The board was presented with information about the
unusually high number of non-UK EU residents who received liver transplants at
King's College Hospital NHS Foundation Trust between 2003 and 2007.
'A high proportion of the liver transplants performed [there] on non-UK EU
residents were undertaken on a private basis. NHSBT has an overarching statutory
responsibility to ensure the integrity of organ donation.
'The board is concerned that public confidence in the use of organs donated in
the UK for transplantation may be significantly undermined if disproportionate
numbers of non-UK patients are being treated at a single centre, especially
where this treatment is taking place on a private basis.
'Based on the information presented, the board therefore took the decision to
refer the matter to the Healthcare Commission.'
Prof Heaton, who lives in a £1million detached house in Beckenham, Kent,
declined to comment on the controversy.
A statement from the hospital said: 'Under European law, citizens of the
European Union are entitled to treatment under the NHS, and King's carries out
liver transplants on a small number of patients referred by EU member countries.
The costs for these operations are met through our block contract with the
Department of Health.
'The Greek and Cypriot governments have chosen to pay for treatment provided to
Greek and Cypriot patients outside this block contract arrangement. As a result,
King's receives payment directly from Greece and Cyprus for all Greek and
Cypriot patients treated here.
'Although these patients are effectively treated privately, they have the same
rights as any NHS patient under European law.
'King's surgeons receive no fees for liver transplants carried out either on UK
patients or those from the EU who are entitled to NHS treatment.
'In line with practice across the UK, the surgeons do receive additional fees
for treatment for private patients. This includes those from Greece and Cyprus,
whose governments have chosen for them to be treated in this way.'
The statement added that income from such operations went into the general
hospital budget and was not used specifically to improve transplant services.
The Department of Health said: 'The transplantation of donated livers into
non-UK EU residents who qualify for NHS treatment is lawful. This is guided by
European law which effectively regards such patients as having equal access to
the NHS.
'Decisions over accepting a patient on to the transplant waiting list and
allocating an available liver rest with the individual transplant centre. They
must always give priority to those waiting on the national list of super-urgent
patients.
'We recognise that this is a complex area and will work with NHS Blood and
Transplant and the transplant community to provide further clarification.'
The chairman of the Healthcare Commission, the watchdog investigating King's, is
Sir Ian Kennedy, the distinguished academic who conducted the public inquiry
into the children's heart surgery scandal at Bristol Royal Infirmary in the
Eighties and Nineties.
At the time, Prof Heaton defended his decision, saying: 'I don't think it is
fair to ask whether he should have had a transplant because we judge every
patient individually. As doctors, we can take responsibilities only so far.'
The situation at King's is causing deep concern within the medical profession
and among patients.
Ingrid Shillito, a director of the British Liver Trust charity, said: 'The sad
truth is there aren't enough livers donated to give seriously ill people a
second chance of life.
'Liver transplant centres have to make tough choices about which patients get
the few livers that are available, whose need is greatest and who will benefit
most.
'It would be very wrong for financial matters to influence these difficult
decisions, for patients to buy their way to the top of the list.'
King's has admitted that many of its Greek patients come from the Laiko Hospital
in Athens, one of the biggest in the country. The Greek health service,
including its transplant service, is seriously underfunded.
NHS Blood and Transplant (NHSBT), the health authority in charge of transplant
services, decided to refer the King's situation to health watchdogs following a
board meeting on Thursday.
In a statement, it said: 'The board was presented with information about the
unusually high number of non-UK EU residents who received liver transplants at
King's College Hospital NHS Foundation Trust between 2003 and 2007.
'A high proportion of the liver transplants performed [there] on non-UK EU
residents were undertaken on a private basis. NHSBT has an overarching statutory
responsibility to ensure the integrity of organ donation.
'The board is concerned that public confidence in the use of organs donated in
the UK for transplantation may be significantly undermined if disproportionate
numbers of non-UK patients are being treated at a single centre, especially
where this treatment is taking place on a private basis.
'Based on the information presented, the board therefore took the decision to
refer the matter to the Healthcare Commission.'
Prof Heaton, who lives in a £1million detached house in Beckenham, Kent,
declined to comment on the controversy.
A statement from the hospital said: 'Under European law, citizens of the
European Union are entitled to treatment under the NHS, and King's carries out
liver transplants on a small number of patients referred by EU member countries.
The costs for these operations are met through our block contract with the
Department of Health.
'The Greek and Cypriot governments have chosen to pay for treatment provided to
Greek and Cypriot patients outside this block contract arrangement. As a result,
King's receives payment directly from Greece and Cyprus for all Greek and
Cypriot patients treated here.
'Although these patients are effectively treated privately, they have the same
rights as any NHS patient under European law.
'King's surgeons receive no fees for liver transplants carried out either on UK
patients or those from the EU who are entitled to NHS treatment.
'In line with practice across the UK, the surgeons do receive additional fees
for treatment for private patients. This includes those from Greece and Cyprus,
whose governments have chosen for them to be treated in this way.'
The statement added that income from such operations went into the general
hospital budget and was not used specifically to improve transplant services.
The Department of Health said: 'The transplantation of donated livers into
non-UK EU residents who qualify for NHS treatment is lawful. This is guided by
European law which effectively regards such patients as having equal access to
the NHS.
'Decisions over accepting a patient on to the transplant waiting list and
allocating an available liver rest with the individual transplant centre. They
must always give priority to those waiting on the national list of super-urgent
patients.
'We recognise that this is a complex area and will work with NHS Blood and
Transplant and the transplant community to provide further clarification.'
The chairman of the Healthcare Commission, the watchdog investigating King's, is
Sir Ian Kennedy, the distinguished academic who conducted the public inquiry
into the children's heart surgery scandal at Bristol Royal Infirmary in the
Eighties and Nineties.
http://www.mailonsunday.co.uk/news/article-1032358/400-Britons-wait-NHS-liver--G\
eorge-Bests-surgeon-gives-Greeks-20-000.html

Confusion over law halts Scots organ transplants
By Kate Foster
SCORES of desperately ill Scots have been denied organ transplants because of
mistakes by medical staff and confusion over the law, Scotland on Sunday can
reveal.
An investigation by the authorities has established that on seven occasions in
one year, relatives stepped in to stop organs being taken even though the donor
had signed up to the Organ Donor Register. To do so breaches current donation
laws.
And a separate investigation at a Scottish hospital unit discovered several
occasions where staff missed clear opportunities to provide organs for donation.
In all, it is estimated that as many as 100 potential transplants were lost
because of the problems.
Campaigners said last night the revelations strengthened the case for better
procedures and training within hospitals, and for reform of donation law to a
system of presumed consent. Scotland on Sunday is campaigning for ministers to
make this change.
Papers obtained under Freedom of Information laws show that between November
2006 and December 2007 there were seven occasions on which families intervened
to stop organs being taken from relatives on the register. In some cases
families refused donation altogether and in other cases they refused donation of
certain organs, corneas or tissue.
Two years ago the law was changed, enshrining people's rights to "authorise"
donation of their own organs by signing the Organ Donor Register.
The Human Tissue Act (Scotland) 2006 states that relatives should only be asked
if there are any medical reasons
preventing donation. However, the report reveals that in practice doctors are
unwilling to overrule relatives' wishes even if that means ignoring the wishes
of the deceased.
The loss of seven potential donors is particularly serious because only around
50 Scots a year become organ donors.
The investigation, carried out by government body The Scottish Transplant Group,
was prompted by revelations in Scotland on Sunday last year that doctors were
reluctant on ethical grounds to overrule next of kin.
Last night John Forsythe, chairman of the Scottish Transplant Group, said the
issue was "very sensitive" but insisted doctors would not take organs if it was
going to cause relatives further distress.
He said: "If relatives are saying no because it's a step too far in this tragic
incident then what do you do? There has to be a pragmatic approach. Can you
imagine relatives holding on to a bed, saying we mustn't take loved ones? It
would be awful."
Another investigation, of the neurological intensive care unit at the Southern
General Hospital, Glasgow found "occasional missed opportunities" to refer
accident victims for assessment for their potential as organ donors.
An audit from 2005-2007 found a total of eight cases where a donor might have
been found but was not.
In six cases a donor transplant coordinator was not involved, which is seen by
experts as the best way to reassure families. On one occasion, organ retrieval
could not go ahead because of a lack of theatre space and on the other occasion
a suitable patient was missed.
However, despite this, donation rates were still found to be higher at the
Southern General than at other UK hospitals.
Campaigners point out that every donor is desperately needed. There are
currently 7,551 patients waiting for transplants across the UK and one donor can
save the lives of several people.
Gillian MacCormick, who has been waiting for a liver transplant for two years,
said the wishes of the deceased should be prioritised.
"If someone has requested that their organs be used I definitely don't think
their family has the right to overrule that."
http://scotlandonsunday.scotsman.com/scotland/Confusion-over-law-halts-Scots.426\
0518.jp

Achieving Immunity in Hepatitis B Vaccine Nonresponders
Three double doses of the combined hepatitis A/B vaccine provided protective HBV
immunity in 95% of hepatitis B vaccine nonresponders.
Approximately 5% of hepatitis B vaccine recipients do not generate antibodies to
hepatitis B surface antigen (anti-HBs) at a protective level (10 mIU/mL).
Several strategies to induce protective immunity among these "nonresponders"
have been tested, with varying success. Investigators in Sweden recently
assessed the effectiveness of the combined hepatitis A/B vaccine in 64 adults -
44 nonresponders who had not developed protective anti-HBs levels after 4
intradermal doses of the Engerix-B recombinant hepatitis B vaccine and 20
control partic ipants who were not immune to hepatitis B virus (HBV) or
hepatitis A virus (HAV) and had never received the hepatitis B vaccine. All
participants received 2 mL of combined hepatitis A/B vaccine at 0, 1, and 6
months; serum samples were obtained before each dose and 1 month after the last
two doses.
Among the 44 nonresponders, 26 (59%), 35 (80%), and 42 (95%) showed protective
anti-HBs levels after the first, second, and third hepatitis A/B vaccine doses,
respectively. All 20 controls attained such immunity (10%, 95%, and 100%,
respectively). Thirty-five of the 44 nonresponders (80%) developed anti-HBs
titers
smoking and high body-mass index were associated with lower anti-HBs levels. All
64 participants developed anti-HAV antibodies.
Comment: For hepatitis B vaccine nonresponders who are not immune to HAV, the
combined hepatitis A/B vaccine seems to be an effective and well-tolerated
approach to generating anti-HBs responses. More study is needed to directly
compare this strategy with others (including repeating the hepatitis B vaccine
series or using more-potent adjuvants) and to determine what role the hepatitis
A immune response plays in inducing the hepatitis B response. As an editorialist
notes, we don't know how effective (or how well tolerated) the combined vaccine
would be among persons who are already immune to HAV.
- Daniel J. Diekema, MD, MS
Published in Journal Watch Infectious Diseases July 2, 2008
Citation(s):
Cardell K et al. Excellent response rate to a double dose of the combined
hepatitis A and B vaccine in previous nonresponders to hepatitis B vaccine. J
Infect Dis 2008 Jun 10; [e-pub ahead of print].
(http://dx.doi.org/10.1086/589722)
Diepolder HM. Can specific heterologous immunity boost hepatitis B vaccine
responses? J Infect Dis 2008 Jun 10; [e-pub ahead of print].
(http://dx.doi.org/10.1086/589721)

Tri-Staters headed to Transplant Games
Jul 04, 2008 @ 10:55 PM
By DAVID E. MALLOY
HUNTINGTON -- More than 19 years ago, Dell Rachell of Russell, Ky., was given 18
months to live.
"A virus attacked my digestive system," Rachell said Thursday. "I probably
picked up something when I was on a USO show overseas. They said I wasn't a good
candidate for a transplant. I had lost a lot of weight and had trouble
breathing."
At the time she was living in Los Angeles and finally found a doctor to help her
and she got on the donor list in 1991. But then her insurance company refused to
cover her needed liver transplant. Her company president then got on the phone
and threatened to pull his company's health insurance if they didn't cover the
transplant. A few days later, the insurance company agreed to cover the cost of
the operation at the UCLA Medical Center.
Rachell marks every March 16 as her "Life Day," bringing breakfast to employees
at Pathways in Ashland to honor the day she was given a new lease on life.
The family of a 17-year-old teenage boy killed in a school shooting in Tuscon,
Ariz., donated his liver to Rachell.
"I've been handed a miracle," she said. His dad said I was the only thing left
of his son. They chose to donate life. It's the best thing you can do," Rachell
said. "If you want to make your life count, pay it forward."
Next week, Rachell and six other Tri-State area residents will attend the
Transplant Games in Pittsburgh where transplant recipients will compete in a
number of sporting competitions to honor those who gave their organs to allow
people like Rachell a second chance at life.
Rachell, 67, will participate in the 50-meter dash, two swimming events and a
5-K walk. "I'm leaving on Thursday," she said. "I want to be there for the
opening ceremonies. I have events scheduled every day."
She is among four members of the Second Chance at Life group in Ashland who will
be participating in the games.
Joy Bryant Harris, 59, of Huntington also will be heading to Pittsburgh next
week to participate in the games.
"I want to do this just because I can," Harris said. "I want people to know
there is life after a transplant. It gives us a good quality of life."
Bryant was suffering from an auto-immune disease several years ago when she
ended up getting put on the liver transplant list in 2005. She was only on the
list for 23 days when she got a new liver.
"A lot of people die while they're on the list," said Bryant, a member of
Tri-State Transplant Support Group. "There are almost 100,000 people on the
transplant list. About 18 of them die every day." The group meets at 7 p.m. the
first Thursday of the month at the 4th Avenue Methodist Church in Huntington.
She plans to run in the 100-meter, 200-meter and 4-by-100-meter races in
Pittsburgh. "They have the games every two years," she said. "It will be neat to
meet so many other survivors. We're going there to honor our donors. Everyone
should be a donor. Don't take your organs to heaven, heaven knows we need them
here."
Max Stull, a retired civil engineer, and David Lockwood, a Huntington lawyer,
also will be heading to Pittsburgh. They'll be playing tennis.
While Lockwood received a heart transplant at the University of Kentucky, Stull
had a liver transplant at the University of Pittsburgh Medical Center. Stull's
sister agreed to give him half of her liver for a transplant, but it didn't go
well and he ended up getting another liver from an organ donor.
"I was out of it for eight days," said Stull. "Organ donation is a good thing.
Without it, I wouldn't be here right now. Half the people on the transplant list
don't make it. There is a critical need for donors."
Patricia Rice of Ashland already has her bags packed for the trip to Pittsburgh.
Along with her suitcase, Rice will be taking her bowling ball to Pittsburgh. "I
love to bowl," she said. She and her husband, James, participated in the mixed
bowling league at Blue Ribbon Lanes before she got sick.
Rice got a liver transplant at the University of Kentucky in December of 2004.
The former Wal-Mart employee didn't have any health insurance, but was covered
by her husband's insurance policy.
"I was on the transplant list for six months," she said. "This is not about me,
it's about my donor. I have learned how important organ donation is. My whole
family has signed up to be donors."
Since her operation, Rice has gotten to hold her two grandchildren. "I wouldn't
have had that chance without the transplant," she said.
People can volunteer to be an organ donor by signing up when they renew their
driver's license, Harris said. "You also need to inform your family of your
wishes," she said.
http://www.herald-dispatch.com/news/x2102942159/Tri-Staters-headed-to-Transplant\
-Games

Future of Hepatitis C patients in UAE hangs in 'ministerial' balance
By Dina El Shammaa and Nina Muslim, Staff Reporters
Published: July 05, 2008, 23:23
Abu Dhabi/Dubai: Hepatitis C patients in the UAE are anxious, wondering
whether their days in the country are numbered as the Ministry of Health mulls a
decision whether to deny them residency.
The ministry on Tuesday decided to hold off on implementing a mandatory
check for Hepatitis C during residency medical exams and thereby denying
expatriates who test positive their resident permit.
Gulf News reported on April 21 the Health Ministry planned to add the
blood-borne disease to the list of deportable diseases on July 1.
Residents with the disease told Gulf News they have been living with a
sense of dread while waiting for the ministry's final decision. All asked to
remain anonymous due to the stigma.

Working Women: Deshawn McMillan
Deshawn McMillan still breaks down when she talks about her mother Sheila
Reddick who passed away in 2005. She was near the top of the list waiting for a
liver transplant.
"I watched my mother die, I was standing there when she took her last breath,"
McMillan told ABC 7's Allison Starling.
"Her last words to me were just, 'I don't want to die and leave you all'. She
was talking about me and my siblings."
Shortly after, McMillan made it her life's mission to raise awareness about
organ donation. She created a non-profit in honor of her mother, called
"Sheila's Saving a Life Campaign". McMillan says it only takes minutes to sign
up online or at the DMV but many people are unaware that just one donor can help
up to 50 people. Since the start of the Sheila Campaign, nearly 150 people have
signed on in the D.C. Area to be organ donors.
"If it were your mother or your child just put yourself in those shoes, and that
will kinda shed some light and encourage people to say you know, I think I'll go
and I'll sign up and I'll be an organ donor."
In addition to her full-time job with the government printing office, McMillan
is also attending college at night studying criminal justice an she is the
mother of two.
http://www.wjla.com/news/stories/0708/533368.html

Hepatitis B Patients Face Broad Discrimination in China
Ostracized and unable to secure jobs, victims turn to a support web site, now
banned by the communist regime
By Wu Xue'er
Epoch Times Staff
HONG KONG-Having passed a civil service exam, a Zhejiang University graduate was
subsequently rejected when he was found to have hepatitis B. In a fury, he
killed the recruiting official.
It was 2003, and he had graduated from one of China's finest schools. The court
found him guilty of murder and handed down the death penalty. He tore the court
document stating his sentence into pieces.
A Ph.D. from Xiamen University was unable to secure a job when he was found to
be a carrier of hepatitis B. He ended his life by hanging himself in a bathroom.
Many such tragedies occur in China every year, according to Lu Jun, coordinator
of the Yirenping Center in Beijing and host of the "Liver and Gallbladder Care"
Web site.
Hepatitis B patients face serious discrimination in China. Lu says that such
discrimination leads directly to hatred, social exclusion, and tragedies such as
these. People with hepatitis B have difficulty finding employment or attending
school.
Eighty percent of foreign companies with branches in China also refuse to hire
people with hepatitis B.
It is estimated that approximately 100 million people in China carry the
hepatitis B virus. Since 2003, many have connected through the "Liver and
Gallbladder Care Forum" (bbs.hbvhbv.com).
The forum has become a home for hepatitis B patients who seek information and
basic human rights. It enables them to fight discrimination, including
organizing anti-discrimination lawsuits against government agencies.
Instead of supporting the forum, however, Lu says that the Chinese communist
regime has responded by suppressing and banning it. This has led to much anger
and disappointment among those affected.
Lu identifies three factors that have contributed to the widespread
discrimination against hepatitis B patients.
First, a lack of government regulation of advertising practices used by
pharmaceutical companies resulted in exaggerated claims of the infectious nature
of hepatitis B. Though their intention was to increase sales, their tactics led
the public to fear and misunderstand the disease.
Second, the government process for hiring civil service employees included
screening for hepatitis B beginning in 1997. Many private enterprises followed
suit, rejecting hepatitis B patients from employment.
Third, laws have been passed banning hepatitis patients in China from holding
certain jobs, including janitor, elevator operator, cashier, schoolteacher, and
all jobs in the food industry. These laws, over 20 in number, have deprived
hepatitis B patients of their basic rights.
http://en.epochtimes.com/news/8-7-4/72904.html

Man loses appeal to have gov't pay for transplant
Updated Fri. Jul. 4 2008 2:40 PM ET
The Canadian Press
TORONTO -- An Ontario man has lost another appeal to have the government pay for
a life-saving liver transplant in England that doctors refused to perform at
home.
Adolfo Flora contracted hepatitis C from a tainted blood transfusion in the
1970s and was diagnosed with liver cancer in 1999.
He was told by several Ontario doctors that he had about six to eight months to
live and was not a suitable candidate for a liver transplant.
Flora researched options in other countries and paid about $450,000 to undergo
treatment in London, England.
He underwent chemoembolization to treat his tumours and had a section of his
brother's liver transplanted into his body.
The Ontario Court of Appeal has denied his appeal for compensation, as did the
Divisional Court and the province's Health Services Appeal and Review Board
before that.
Ontario Court of Appeal Justice Eleanore Cronk wrote in a decision released
Friday that she was "sympathetic to the difficult circumstances and choices that
confronted Mr. Flora when his liver cancer was detected."
Cronk said that although his situation was compelling, the case rested on the
reasonableness of the decision to not fund his surgery and concluded there was
"no basis on which to interfere with the board's decision."
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080704/liver_transplant_08\
0704/20080704?hub=Health

Alejandro Escovedo has another breakthrough album
The Associated Press
Friday, July 4th 2008, 4:00 AM
NEW YORK - Ask his fellow musicians about Alejandro Escovedo, and you'll
hear nothing but praise.
Yet the Texan singer-songwriter, who plays Wednesday at Highline Ballroom,
has never been a household name.
And even among rock fans, his work, though influential, is not widely
known: He's been more of an aficionado's musician.
But over the last few years, the veteran singer, songwriter and guitarist
has gotten a higher profile, though he's still far from mainstream.
His album "Boxing Mirror" in 2006 was deemed by some critics to be the
greatest work of his decades-long career; with his new album "Real Animal,"
released last month, he cracked the Billboard Top 200 album chart for the first
time.
Escovedo doesn't know why, after suffering through a devastating bout with
hepatitis C and near financial ruin, that these last few years have been so
fruitful, artistically and commercially.
He says it's never been a priority for him. But at 57, he is clearly
enjoying his moment now.
Q: After "Boxing Mirror" many critics said that was your definitive or
career album - they're saying the same thing about the new CD.
Escovedo: It's nice to have a lot of career albums, I guess. I think that
(with) "Boxing Mirror" ... after this illness that I was faced with and the
uncertainty of whether I would play again. There was a lot emotional rallying
around the album and myself. For me the fact that I made an album at all was
quite a feat and that was a victory in itself. And now with this album, it's a
completely different world for me and I view everything differently now as a
result of what I went through in the past. ... It was deeply personal in a more
kind of emotional, spiritual sense I guess.
Q: Your fans saw you and experienced your shows differently once you
recovered from hepatitis. Did you come back and look at your audience
differently?
Escovedo: Absolutely. Most profoundly. I think it was a matter of
understanding how music bonds all of us. There was this larger family of people
suddenly. I viewed them differently. I viewed everything differently you know,
and so the relationship with all the people who had supported me through all of
this was pretty profound.
Q: Did you ever lose faith in music?
Escovedo: It's interesting because I think that a certain point when I
became ill, it was almost like I blamed the music for the disease. ... I didn't
play my guitar for a year - and I didn't write any songs, really, and there was
a lot of things that happened. Not only did I go through this illness, but my
father passed away, so that was extremely major in my life, but I think as a
result of that I really wanted to come back and play music again. ... In a way,
I had lost some of that, but I regained it in a big way, much larger way
actually.
Q: Do you sometimes feel a little nostalgic for the old days, when things
were smaller? There's such buzz now - you're on the verge of no longer being
rock 'n' roll's best kept secret.
Escovedo: I've played in small clubs now for 33 years so it's like my
home. But I enjoy - I always wanted to play for people and I've always felt that
we really had something to offer to a larger audience. There's times when I miss
the camaraderie that I had with a band like the True Believers, my brother and
John Dee and everybody else who played with us and hung out with us and
traveling from town to town in a van is a real romantic life and it's a very
arduous life, too. I mean it's difficult, but I'm ready for this. I've waited
all my life for this so I'm open to whatever happens.
Q: Why do you think it didn't happen before?
Escovedo: I can't answer that. If I could, I think I'd be a manager or
something.
Q: You must have thought about it.
Escovedo: Sometimes it's interesting. You watch your friends succeed or
whatever you want to call it. They get places, you know and maybe a glimmer of
thought comes in, "Well, why can't we have that?" We see our friends traveling
in buses and we're still in the van or whatever you know. But it's never with
envy and also I've watched so many people be the next big thing and they're not
doing what I'm doing now and they don't have the body of work that I have at
this point, so I think it's fine.
Q: Is Jonathan Demme doing a movie about you?
Escovedo: Well, that's in the ether I think. It's still in the works. It
hasn't been filmed yet. We filmed a little bit two years ago at South by
Southwest where in one night I took every configuration of the different types
of things I do from playing as a duet to a string quartet or quintet at that
time, then I played with the whole orchestra, strings and the rock band and then
I also reunited my band Buick MacKane to play. We were just like this trashy
garage band you know. So we did film that. But that's about all that's been
filmed so far. You'd have to ask Jonathan.
Q: Having almost died, do you think that really changed you as person?
Escovedo: You know, I don't know that it was a radical transformation,
because in a way I saw a lot of myself that I didn't like and there were times
that I felt like I was a monster of some sort but I learned how to deal - not
that it's complete in any way - but I shed a lot of those things. Maybe anger
and frustration, a lot of the grief that I might have held inside me. I tried to
let go of that and maybe the disease itself helped me rid myself of those
things. But I think what happens is that everything becomes sharply in focus
suddenly and for me as a result of hepatitis C, I quit drinking and I live a
cleaner life as far as substances and things I put in my system and that has
lent itself to a lot of clarity that I didn't have prior to that.
http://www.nydailynews.com/latino/2008/07/04/2008-07-04_alejandro_escovedo_has_a\
nother_breakthro.html

Hepatitis C treatment programme launched
Saturday, July 05, 2008
By our correspondent
KHAIRPUR: Hepatitis C treatment support programme was launched in Khairpur on
Friday. The Sindh Devolved Social Service Programme (SDSSP) invited donor
agencies to assist the programme.
Representative of the SDSSP Muhammad Nawaz motivated the donors to support the
idea of establishing a Hepatitis C treatment centre in Khairpur. Accordingly,
the donor agencies provided funds of Rs 1.2 million, which have been utilised to
build the Hepatitis C Treatment Centre at the Civil Hospital, Khairpur, Nawaz
said.
He said the centre had started functioning from July 4. Required medicines have
also been purchased. He said a similar project will be taken up by the Pakistan
Red Crescent Society, Khairpur.
Nawaz said the Sindh government had also released an amount of Rs 1.6 million
for treatment of Hepatitis-C patients. He said this amount will help treat 438
patients.
http://www.thenews.com.pk/daily_detail.asp?id=122267

Hepatitis C Vaccine Delivered By Inovio Biomedical's Electroporation System
Shows Increased T-Cell Responses And Reduced Viral Loads, Study
Inovio Biomedical Corporation (AMEX:INO), a leader in enabling the development
of DNA vaccines using electroporation-based DNA delivery, announced today that
its partner, Tripep AB, reported additional interim results from its ongoing
phase I/II clinical study of its ChronVac-C® therapeutic DNA vaccine, which is
delivered using Inovio's electroporation-based DNA delivery system. These
preliminary results are from the first two patients in the intermediate dose
group to complete treatment against hepatitis C virus infection. Samples taken
before, during and after treatment showed that the viral levels in blood
decreased up to 87% and 98%, respectively, during treatment. Simultaneous
activation of the patients' T-cell responses to the hepatitis C virus was
recorded in conjunction with the viral load reductions. Inovio's electroporation
delivery technology is intended to enhance the potency of DNA vaccines against
cancers and infectious diseases.
ChronVac-C® is a therapeutic vaccine given to individuals already infected with
the hepatitis C virus with the aim of clearing the infection from the liver by
boosting the body's immune response against the virus. This clinical study is
being conducted at the Infectious Disease Clinic and Center for Gastroenterology
at the Karolinska University Hospital in Huddinge and Solna, respectively, in
Sweden. The intended enrollment of 12 patients is being divided into three dose
groups with increasing doses of ChronVac-C. Each patient receives four
vaccinations one month apart. After the last vaccination, patients are followed
for another six months. The study's main purpose is to assess safety. It is also
testing whether the treatment boosts the immune response (immunogenicity) to HCV
and its effect on virus replication in the liver. If the patient is completely
virus-free six months after completing treatment, he/she will be considered
cured.
In the group treated with the low dose of ChronVac-C, transient activation of
T-cell responses was recorded but no reduction of viral load. In the group
treated with the intermediate dose, T-cell responses were recorded
simultaneously with clear reductions in the serum levels of hepatitis C virus,
suggesting that the therapy is dose-dependent. No severe adverse events have
been recorded. All three patients in the high dose group have started therapy
and we expect results from this group during the fall.
Avtar Dhillon, MD, Inovio's president and CEO, stated: "Recognizing that this is
still a very limited patient population and data set, we are encouraged by the
results of this hepatitis C virus phase I/II clinical study. Existing treatments
are hard on patients, often described as being similar to chemotherapy, and are
only effective in roughly half of patients treated. We are pleased that to date
this therapy has not produced these chemotherapy-like side effects nor serious
adverse events and, without yet reaching the highest dose levels, is producing
positive results. The fact that there may be a dose-dependent correlation
between T-cell responses generated and reduction in hepatitis C viral load may
position ChronVac-C, in which we have partial ownership, to potentially play a
role as a first-line therapy or as an adjunct to existing therapies. We look
forward to the continuing clinical assessment of this promising DNA vaccine
candidate."
The total market for therapies against hepatitis C infections was estimated by
Rodman & Renshaw to be around $3.5 billion in 2005 and to grow to more than $8.0
billion in sales by 2012.
About Inovio Biomedical Corporation
Inovio Biomedical (AMEX:INO) is focused on developing multiple DNA-based
immunotherapies and DNA vaccines. Inovio is a leader in developing human
applications of electroporation using brief, controlled electrical pulses to
increase cellular uptake of a useful biopharmaceutical. Human data has shown
that Inovio's electroporation-based DNA delivery technology can significantly
increase gene expression and immune responses from DNA vaccines. Immunotherapy
partners include Merck, Wyeth, Vical, University of Southampton, Moffitt Cancer
Center, the U.S. Army, National Cancer Institute, and International Aids Vaccine
Initiative. Inovio's technology is protected by an extensive patent portfolio
covering in vivo electroporation. More information is available at
http://www.inovio.com.
This press release contains certain forward-looking statements relating to our
plans to develop our electroporation drug and gene delivery technology. Actual
events or results may differ from our expectations as a result of a number of
factors, including the uncertainties inherent in clinical trials and product
development programs (including, but not limited to, the fact that clinical
results referenced in this release may not be indicative of results achievable
in other trials or for other indications and that results from one study may
necessarily not be reflected or supported by the results of other similar
studies), the availability of funding to support continuing research and studies
in an effort to prove safety and efficacy of Inovio's technology as a delivery
mechanism, the availability or potential availability of alternative therapies
or treatments for the conditions targeted by Inovio or its collaborators,
including alternatives that may be more efficacious or cost-effective than any
therapy or treatment that Inovio and its collaborators hope to develop,
evaluation of potential opportunities, issues involving patents and whether they
or licenses to them will provide Inovio with meaningful protection from others
using the covered technologies, whether such proprietary rights are enforceable
or defensible or infringe or allegedly infringe on rights of others or can
withstand claims of invalidity and whether Inovio can finance or devote other
significant resources that may be necessary to prosecute, protect or defend
them, the level of corporate expenditures, assessments of our technology by
potential corporate or other partners or collaborators, capital market
conditions, the actual size and stability of the market(s) developed for our
therapies, if any, and other factors set forth in our Annual Report on Form 10-K
for the year ended December 31, 2007, our 10-Q for the three months ended March
31, 2008 and other regulatory filings from time to time. There can be no
assurance that any product in our product pipeline will be successfully
developed or manufactured, that final results of clinical studies will be
supportive of regulatory approvals required to market licensed products, or that
any of the forward-looking information provided herein will be proved accurate.
Inovio Biomedical Corporation
http://www.medicalnewstoday.com/articles/113964.php

M0002 Progresses To Phase IIb Trial Following Positive Results In Cirrhotic
Ascites
Movetis NV, a European specialist pharmaceutical company, announced that M0002
is progressing to phase IIb following positive results of a phase IIa
multiple-dosing trial for the treatment of ascites, the accumulation of fluid in
the abdomen in patients with liver cirrhosis resulting from liver conditions
such as hepatitis C, hepatitis B or alcoholism.
M0002 is an orally-active selective vasopressin 2 receptor antagonist and a
member of a new class of compounds, known as aquaretics, which inhibit water
reabsorption from the renal collecting duct. The compound induces free water
clearance without loss of sodium.
The randomized, double blind, placebo controlled, dose-titration study explored
the safety, tolerability, pharmacokinetic profile and efficacy of M0002 in
cirrhotic subjects with ascites and hypo- or normonatraemia. It was conducted in
Belgium at multiple centers and enrolled 15 patients who were treated once daily
with drug or placebo for 15 days.
"The data are encouraging," states Prof Dr. F. Nevens, Chief of Hepatology at
the University Hospital in Leuven and principal investigator of the trial.
"M0002 was very well tolerated and proved to have a good safety profile. No
unexpected side-effects were seen in these very ill patients. The
pharmacokinetic profile was in line with expectations."
Although a small number of patients were included in the study, a trend towards
more stabilized and normalized plasma sodium levels was seen in those treated
with M0002.
Remi Van den Broeck, Chief Development Officer of Movetis, said, "We are
delighted with the promising results from the dose-titration trial. We will
begin patient recruitment shortly for a Phase IIb dose-finding study. At Movetis
we are committed to improving the lives of patients with ascites and we believe
that M0002 may eventually offer hope to many who suffer from the condition."
About cirrhotic ascites
Cirrhosis is a consequence of chronic liver disease, most commonly caused by
alcoholism and hepatitis B or C. It is characterized by replacement of liver
tissue by fibrous scar tissue as well as regenerative nodules, leading to
progressive loss of liver function. Ascites, the accumulation of fluid in the
peritoneal cavity, is a major complication of cirrhosis. The development of
ascites is a significant marker in the progression of cirrhosis as it is
associated with high mortality over two years, and signifies the need to
consider liver transplantation as a therapeutic option.
Dr. F. Wong, Associate Professor of Medicine at Toronto General Hospital, when
asked for comment on the disease and on the therapeutic options, said:
"The development of ascites, or fluid in the abdominal cavity, is a common
complication of liver cirrhosis. Its onset signifies the progression of liver
cirrhosis into the decompensated stage with worsening of prognosis to 50%
survival in 2 years. The treatment of ascites includes the use of dietary sodium
restriction, diuretics (loop diuretics and or spironolactone) and large volume
paracentesis. The continued use of diuretics is limited by the development of
complications such as electrolyte abnormalities, and many patients eventually
become diuretic resistant, that is, the use of diuretics is no longer resulting
in a reduction of ascites. Such patients are totally dependent on large volume
paracentesis as a means of controlling the ascites. The use of paracentesis is
inconvenient to the patient and requires significant medical manpower."
Both Prof. Wong and Prof. Nevens agree that there is an urgent need for newer
and effective drugs to better manage cirrhotic patients with ascites.
About M0002
M0002 is a selective vasopressin 2 receptor antagonist and is a member of a new
class of compounds - aquaretics - that produce significant diuresis without the
loss of electrolytes. Conventional diuretic drugs, which are currently used to
treat ascites, have the drawback that they promote the excretion of both salt
and water, leading to possibly symptomatic hyponatremia (abnormally low
concentration of sodium in the blood). In contrast, M0002 primarily increases
free water clearance. This important differentiation could potentially offer
clinical advantages in the treatment of cirrhosis and other disorders caused by
water-retention.
About Movetis
Through a clear focus on gastroenterology (GI), Movetis seeks to improve the
lives of millions of patients - both adults and children - by discovering,
developing and ultimately commercialising innovative treatments targeting GI
conditions with a high unmet medical need. Movetis NV - founded in Belgium in
December 2006 - aims to become a leading European specialty pharmaceutical
organisation focused on GI diseases. Movetis has a broad GI portfolio with one
product in preregistration, two products in clinical development, one product
ready to move into clinical development and four in preclinical development, all
addressing important areas including chronic constipation, ascites, paediatric
reflux in infants, diabetic gastroparesis, specific subgroups of patients with
severe forms of irritable bowel syndrom or dyspepsia. In addition, Movetis has
rights to a large library of qualified lead compounds with potential for
development in different GI indications and access to know how for compounds in
secretory diarrhoea. The current portfolio has been licensed from Janssen
Pharmaceutica NV, Belgium and Ortho-McNeil Pharmaceutical Inc., two Johnson &
Johnson (J&J) companies.
http://www.movetis.com
http://www.medicalnewstoday.com/articles/113870.php

Council OKs HIV Cuts
By: DUNCAN OSBORNE
07/03/200
The City Council passed a 2009 budget on June 29 that succeeded only in reducing
the cuts to HIV services made by the Bloomberg administration and did not
maintain any funding for hepatitis C and crystal meth programs.
"We are happy that we were able to at least make a partial restoration in the
HIV outreach area," said City Council Speaker Christine Quinn just before she
joined New York City's annual gay pride march on Fifth Avenue. "We wish we could
have done more... All of us in government, in the HIV/AIDS community, in the
healthcare community, are going to have to come together and try to find ways to
do more with less."
While AIDS advocates and the city agree that health department HIV dollars are
reduced in the $59.1 billion budget, there is no agreement on how large a
reduction the budget contains.
In its proposed budget, the Bloomberg administration claimed a cut of $1.3
million in city health department spending for "HIV/AIDS service contracts and
our rapid test kit distribution to local hospitals," according to a May 7 health
department statement.
But a city budget document showed a $4.5 million drop in the city's contribution
to health department spending on AIDS from $13.3 million to $8.8 million, or a
34 percent cut. Prior to publication of an earlier story in Gay City News, the
health department did not respond to requests seeking an explanation of the
discrepancy.
The overall health department budget for HIV prevention and treatment, which
includes city, state, and federal dollars, went from $214 million in the 2008
fiscal year to $172 million in 2009 though, in a response reported in an earlier
story, the department said some of the state and federal funds would be
restored.
City Council officials put the reduction in health department AIDS spending at
$10.1 million and said the Council restored $5.8 million for a total reduction
of $4.3 million.
On July 1, Housing Works, an AIDS group, released an analysis of the budget that
put the health department HIV cuts at $4.8 million and reported that hepatitis C
and crystal meth programs at that agency had been eliminated entirely.
The reduced funds, whatever the amount, come as the health department is
reporting increases in new HIV diagnoses among young gay men of color and a 60
percent increase in syphilis cases in 2007 over 2006 among all gay and bisexual
men in the city.
City dollars for sexually transmitted disease services increased in the proposed
2009 budget from $5.5 million to $5.9 million, but with state and federal cuts
the overall budget for the services declined from $15.9 million to $14.4
million. One position was eliminated in sexually transmitted disease services.
Earlier this year, AIDS and gay groups asked the City Council to add $5.5
million to the budget to address HIV among African-American, Latino,
Asian-American, and Native-American men who have sex with men.
What may also hurt AIDS groups is a reduction in the discretionary funds that
members of the Council distribute to organizations in their districts.
"We cut back on the Council's internal budget by eight percent and discretionary
funding by eight percent," said Quinn, an out lesbian who represents Chelsea.
Some AIDS groups seemed resigned to the cuts.
"I think it is unfortunate given the epidemic that we have," said Soraya Elcock,
deputy director of policy and government affairs at Harlem United, an AIDS
group. "It's clearly about needing additional resources to address all the
issues in the city."
Dr. Marjorie J. Hill, chief executive officer of Gay Men's Health Crisis (GMHC),
had a similar view.
"In 2008, at a time when HIV rates are increasing in our city and our country,
in particular among [men who have sex with men] of color and women of color, I
am disappointed that the city leadership could not do more for HIV," she said as
she waited to join the pride march.
The City Council approved the budget in a rare weekend session to make the July
1 start of the 2009 fiscal year. The vote, 49-to-1, had only Brooklyn Councilman
Charles Barron voting no.
Housing Works, which has long been known for its aggressive advocacy, was
distributing a flyer during the pride march, the day of the vote, that read,
"Speaker Christine Quinn Stands Still on AIDS."
Charles R. Long, a spokesman for the group, said, "We're highly upset about it.
We think it's ridiculous when the rates in the city are going up... It's
egregious."
http://www.gaycitynews.com/site/news.cfm?newsid=19828350&BRD=2729&PAG=461&dept_i\
d=568864&rfi=6

Hospital faces probe on transplants
3 hours ago
A hospital has been referred to health watchdogs amid concerns it is giving too
many liver transplants to foreigners.
NHS transplant bosses alerted the Healthcare Commission after figures showed 72
non-British European Union nationals were given new livers in four years at
King's College Hospital in London. Of those, 37 were given to Greek and Cypriot
nationals in what were classed as "private" operations.
But the hospital, Europe's leading liver transplant centre, on Sunday reassured
patients it was "absolutely not true" that patients from outside the UK could
"buy" a transplant.
It insisted the figures were an anomaly caused by the fact the Greek and Cypriot
governments operate a different funding arrangement with the Department of
Health than other states.
Most countries pay the Government a block fee to cover their citizens' treatment
in the UK. However, Greece and Cyprus pay hospitals directly on a
patient-by-patient basis and so the procedures are classed as "private".
The proportion of Greeks and Cypriots was so high because unlike most European
countries, they do not operate their own transplant system, a hospital spokesman
said.
European law dictates that EU citizens are equally entitled to NHS services,
including transplants, as Britons. However, some hospitals choose to prioritise
UK patients.
Board members of NHS Blood and Transplant decided to refer the King's situation
to watchdogs at a meeting on Thursday. In a statement, it said: "The Board was
presented with information about the unusually high number of non-UK EU
residents who received liver transplants at King's College Hospital NHS
Foundation Trust between 2003-2007.
"A high proportion of the liver transplants performed (there) on non-UK EU
residents were undertaken on a private basis. While there is no evidence that
the organ allocation system is being breached, NHSBT has an overarching
statutory responsibility to ensure the integrity of organ donation.
"The Board is concerned that public confidence in the use of organs donated in
the UK for transplantation may be significantly undermined if disproportionate
numbers of non-UK patients are being treated at a single centre, especially
where this treatment is taking place on a private basis."
http://ukpress.google.com/article/ALeqM5i15ozHDyKHuBgA8FWSxOzfOB2_rQ

I've Got Rhythm, Who Could Ask for Anything More (to Avoid Relapse)?
Social rhythm plays a part in onset of affective episodes in bipolar patients.
Light, as a natural zeitgeber, is well known to affect mood. Social cues (e.g.,
meals, meetings, or exercise) also may entrain circadian rhythm. Does lack of
social rhythms or their disruption result in mood instability that precipitates
the onset of affective episodes? These researchers examined social rhythm
regularity and its effect on vulnerability to bipolar episodes.
Approximately 20,500 college students were screened in two phases (self-reported
inventory and diagnostic interview) to obtain 57 students with cyclothymic or
bipolar disorder not otherwise specified and 149 students with bipolar II
disorder (individuals with bipolar I were not studied). Fewer than one third
received treatment during follow-up. The control group consisted of 208 healthy,
demographically matched students. All participants completed a social rhythm
regularity questionnaire, designed to quantify daily social rhythm patterns.
They underwent structured interviews every 4 months that assessed symptoms and
occurrence of affective-disorder episodes (mean follow-up duration, 33 months).
Compared with controls, students with bipolar disorders performed significantly
fewer regular activities, although the frequency of endorsed activities was the
same between groups. In survival analyses, both regularity and diagnostic group
predicted the time to affective, hypomanic, or manic episode. Less regularity
predicted shorter time to onset of affective episode.
Comment: Cause and effect are difficult to tease apart: Does a more severe
affective disorder result in fewer activities, or does the lack of a regular
schedule result in relapse? Another confounder is the undertreatment of most of
these study participants. It is worthwhile for clinicians to explore the
regularity of our patients' meals and exercise, in addition to sleep, and
educate them about social zeitgebers.
- Jonathan Silver, MD
Published in Journal Watch Psychiatry June 30, 2008
Citation(s):
Shen GHC et al. Social rhythm regularity and the onset of affective episodes in
bipolar spectrum individuals. Bipolar Disord 2008 Jun; 10:520.
Medline abstract (Free)

Liver donor's family, recipient unite online
By JENNIFER C. YATES - 9 hours ago
PITTSBURGH (AP) - They were precocious toddlers, both blond-haired and
blue-eyed, separated by a thousand miles between Miami and a small Kentucky
town.
The two girls would never meet, but would be brought together through
unthinkable tragedy: Trine Engebretsen was born with a genetic disorder that
would require what at the time was an extremely rare liver transplant, and
Amanda DeLapp would die at just 18 months after being stricken with a brain
tumor.
In an operation in Pittsburgh in 1984, Amanda's family donated their daughter's
liver to Trine, making her one of the nation's youngest patients ever to receive
a liver transplant.
For years, each family would try to contact the other. Trine's family sent a
picture of their daughter dressed for Christmas to the DeLapp family, a picture
that still sits on the bedroom dresser of Alisha DeLapp, Amanda's mother. That
correspondence was followed by years of miscommunication, with each family
mistakenly thinking the other didn't want any contact.
But Amanda's younger sister, born after her death, never gave up hope of one day
meeting the girl who received her sister's liver. Keisha DeLapp had found Trine
on the Internet years ago, and read about her participation as a swimmer in the
U.S. Transplant Games. She read about Trine's wonderful health, including her
complete independence from drugs that prevent organ rejection.
Like other twentysomethings, Keisha also kept a MySpace page, with a simple
quote at the top: "Faith is not simply believing that God can ... It is knowing
that He will."
Earlier this year, Keisha looked for Trine online again, found her on MySpace
and sent her a greeting:
"Hi. I'm Keisha DeLapp, Amanda DeLapp's sister. Me and my family would love to
have contact with you if you would like to. Let me know."
This month, the U.S. Transplant Games will be held for the first time in
Pittsburgh, one of the pioneering centers for transplants in the country, and 25
years after the operation that forever connected the Engebretsen and DeLapp
families.
At the games, these two families will look each other in the eyes for the first
time, exchanging hellos, hugs and memories of the event that changed both their
lives.
___
Amanda was Alisha DeLapp's first child, born in 1981. The little girl known as
Mandy to her family was healthy and happy, even walking by the time she was 8
months old, her mother recalls.
A year later, everything changed. Amanda was hospitalized because she was
vomiting and had pneumonia-like symptoms. Her parents rushed her to the hospital
closest to their Mayfield, Ky., home, but doctors were unable to figure out what
was wrong. As her condition deteriorated, doctors sent Amanda to a hospital in
Nashville, about two hours away.
Doctors there found the problem, telling Amanda's anxious parents their daughter
had a brain tumor and was going to die. Amanda DeLapp was 18 months old.
A nurse at the hospital asked the couple if they would consider donating
Amanda's organs.
"To me, at that time, it had to be God helping us to decide," Alisha DeLapp
remembers. "I can look back at that now and know it was the hardest decision I
ever had to make."
Alisha and her husband returned home. On TV, they saw on the news that a little
girl named Trine had received a liver transplant. Alisha remembered the little
girl; she had seen Trine and her mom, Mary Ann Lunde, on the Phil Donahue show
appealing for help. They had also made other national TV appearances.
The DeLapps knew immediately that their daughter's liver had saved Trine's life.
(They later learned that Amanda's kidneys were donated to a man in his 20s.)
Transplants were rare at the time, and in a matter of hours the local news
channels were calling the DeLapps for comment. They agreed to an interview with
a local TV station, which was broadcast on the "Today" show.
The DeLapps' were interviewed along with Trine's family. They didn't speak
directly to each other, but it was the closest the families would come to it for
years.
Trine Engebretsen, now 26, doesn't remember much about her lifesaving liver
transplant when she was 2 1/2 years old.
She had been born with a genetic disorder called alpha-1 antitrypsin deficiency,
which resulted in her body not producing enough of a key enzyme in the liver.
In addition to the family's appeals for help on TV, her father, a Norwegian
citizen, appealed to the Norwegian government, which agreed to pay for Trine's
surgery. He was Norway's youngest passenger ship captain, and was lost at sea in
a hurricane when Trine was 13.
When Trine arrived at Children's Hospital of Pittsburgh for the transplant,
doctors estimated she had less than 24 hours to live.
She was one of several children who had transplants at the Pittsburgh hospital
in 1983 and 1984, remembers pioneering transplant surgeon Dr. Thomas Starzl, who
performed her operation. The patients were known as "Reagan children," because
then-President Reagan had been using his Saturday radio addresses to drum up
public interest in transplantation.
"At the beginning of the 1980s, the only place in the U.S. that was doing these
was here in Pittsburgh," Starzl said.
Starzl remembers Trine and over the years says he has met several donor
families.
"I was profoundly and still am profoundly grateful to them, particularly in
those days because it wasn't common (to donate organs). It required a lot of
social conscience," Starzl said.
___
Over the years, Trine's family tried to contact the DeLapp family. She knew the
family lived in Kentucky, but says letters her mother sent to an address for
Amanda's grandparents were returned, unopened.
Several years ago, Trine wrote a thank you note to the DeLapps for her
transplant and gave it to the organ-procurement organization for Kentucky hoping
they could pass it along to the family. The note never made it to them.
Meanwhile, she immersed herself in transplant-related endeavors.
"I very much feel that it's important and also I like to give back. I don't feel
like I'm under an obligation. I want to give back," Trine said.
She first attended the U.S. Transplant Games in 1992, and has attended most of
the games since then. She has participated in swimming, running and even signed
up for the shot put this year.
She met her fiance, Ryan Labbe, in an online forum about organ transplants. He
moved from New England to Miami to be with her, and received his own liver
transplant earlier this year.
Trine has been off immunosuppressant medications for 11 years, something that's
becoming more common among transplant recipients. She is applying for medical
school, in hopes of studying something transplant-related, and works for the
Life Alliance Organ Recovery Agency in Florida.
On a Friday night at her office, around 6 p.m., her Blackberry went off. It was
a friend request from her MySpace page.
It was from 23-year-old Keisha DeLapp.
"I almost fell off my chair," Trine says.
Alisha DeLapp, now 48, had gone on to have Keisha and a son before she and her
husband divorced. She followed Trine's progress through online stories from the
various U.S. Transplant Games she competed in over the years. She kept the
picture of Trine as a child in her Christmas dress - eerily, it was the same
dress Amanda had worn in a Christmas snapshot - and hoped one day to be able to
update it with a more recent photo.
"I know it's not my daughter, but it's just as special knowing that my daughter
saved her life," Alisha DeLapp said. "I'm proud of her, with the things that
she's chosen to do with her life. It's so impressive to me."
The two families have been communicating via e-mail since Keisha and Trine made
contact earlier this year. They've talked about the many years they tried to
connect, and how thankful they are for each other - each in their own ways.
"I've waited 24 years to be able to say thank you," Trine says from her home in
Florida.
When the transplant games commence on July 11, the three will meet for the first
time in downtown Pittsburgh, just miles from where Trine's surgery took place.
Starzl will also be there to greet them. The women will give thanks for each
other through hellos and hugs, and probably some tears.
"I never got to know my sister. I never got to meet her or anything. By no means
is Trine my sister, but that's kind of like a part of her," Keisha says. "This
whole experience, I'm just glad that it happened."
http://ap.google.com/article/ALeqM5iafSpJL014AXI_fK0qLWtCmBBnUQD91OGI382

Kuwaiti leads in organ transplant
RIYADH: Since cooperation began between Kuwait's Hamid Al-Essa Organ Transplant
Center and the Saudi Center for Organ Transplantation (SCOT) in early 1996, 95
organs have been successfully transplanted to waiting patients from 171 donors
who were confirmed as brain dead.
SCOT's Chairman Dr Faisal Shaheen yesterday lauded the Kuwaiti organ transplant
center, saying that it has conducted many successful organs transplant
procedures, after carrying out the first simultaneous pancreas and kidney
transplant.
Shaheen said that Kuwait had become one of the Middle East's leading states in
kidney transplants, as well as being one of the foremost nations across Asia and
rating above many African facilities. Kuwait ranks sixth internationally in its
abilities to expand in the field of organ transplants, including heart and liver
procedures, he said.
He further pointed out that since 1996, 95 organ donations to SCOT came from
Kuwait, with the harvest of organs from the country including kidneys and
corneas, while the Saudi Arabian side benefited from the lungs, hearts and
livers.
Shaheen stressed the importance of such cooperation between the two Gulf states
in saving hundreds of lives, and benefiting from enhancing medical staff and
exchanging expertise. He said that he considered such joint cooperation a model
to be followed by other GCC states, especially after the suspension of organ
transplants in some nations.
He expressed his gratitude to Kuwait's health minister and undersecretaries, as
well as to Dr. Mustafa Al-Mousawi, the Chairman of Kuwait's Hamid Al-Essa Organ
Transplant, along with the center's medical staff.
Shaheen explained that SCOT has developed and increased its kidney transplant
procedures to 400 operations annually, while the number of liver transplants
performed has risen to 622 operations from different donors.
Around 38 kidney, seven liver, 55 heart, 39 heart valve and four lung
transplants were successfully performed by SCOT through mutual cooperation in
exchanging donor organs with Kuwait, Qatar, Bahrain, and Spain, he added. ---
KUNA
http://www.kuwaittimes.net/read_news.php?newsid=MTExNjY2MDQ2Mg==

Boy's virus fears after shock taxi incident
A SCHOOLBOY may need Hepatitis B injections for the rest of his life after
cutting his finger on a syringe filled with blood in a Harrogate taxi.
Young Adam Rooney pricked his finger on the needle while rummaging for loose
change in the pouch behind the driver's seat.
The 12-year-old had been celebrating his mum's birthday when the accident
happened. The taxi, from Harrogate's Central Radio
Cars was off duty and being driven by the boy's uncle, who has worked at the
firm for 14 years.
Adam and his mum Sharon now face a nervous three month wait for final tests to
reveal whether the youngster has contracted Hepatitis B from the three-inch
syringe.
While the needle is believed to have originated in Harrogate, Central owner
Kevin O'Boyle said it was the first time in 42 years he had dealt with a problem
like this.
The incident took place on June 24 in Liverpool, where Adam lives with his mum.
The youngster was immediately rushed to Alder Hey children's hospital for blood
tests, where doctors confirmed he did not have AIDS or HIV.
Mrs Rooney said she still feels "sick to the stomach" every time she thinks
about the syringe and she described waiting for the results of the AIDS test as
one of the most terrifying moments of her life.
Mrs Rooney said: "I was just so shocked. That syringe could have had animal
blood, rat poison, anything inside it. It is just sickening - to pull a prank
like this is so horrible.
"We have had a terrifying week and every time I think about it I feel sick. It
is very frightening for us all."
Following the latest visit to the hospital yesterday, Mrs Rooney was told Adam
needs a fresh blood test in six weeks, and another in three months.
Only then can Hepatitis B be ruled out. In the meantime, Adam will need regular
injections in case he has contracted the virus.
The incident is now being investigated by officers from North Yorkshire Police.
A police spokesman said: "Enquiries are ongoing to determine the full
circumstances surrounding the incident. At this early stage it is still unclear
whether or not a criminal offence has been committed."
Central taxis owner Kevin O'Boyle said: "If a customer is going to go to the
lengths of hiding a syringe in a pocket, I can not see it being practical for
the driver to check everywhere to see if something has been left.
"To look in every nook and cranny, in practice, is not going to happen."
ashley.marshall@...
http://www.knaresboroughpost.co.uk/harrogate-news/Boys-virus-fears-after-shock.4\
257581.jp

Iraq, Afghanistan Vets Swell Homeless Ranks
Produced by Chip Mitchell on Monday, July 07, 2008
When military veterans return home from battle, reentry into society
is not always easy. Just visit a homeless shelter for evidence: The Department
of Veterans Affairs estimates one in five homeless are former military
personnel. Federal agencies are helping provide housing, job training,
counseling and medical care. But despite these efforts, the number of homeless
vets in Chicago is holding steady. And former Iraq and Afghanistan warriors are
just beginning to show up among the homeless. Some service providers worry these
vets will eventually flood the system.
VOLUNTEER: Six, seven, eight, nine...
A long line of homeless military veterans snakes its way toward
tents in this West Side parking lot. In the line stands a 33-year-old former
Marine from Wisconsin. It's 10 in the morning, but he already has alcohol on his
breath. Tape holds together the floppies on his feet. Safety pins fasten his
jeans.
JASON: I need pants, but they don't have any for me.
His first name is Jason. He asks us not to use his last name.
He and some 500 other veterans are here for free meals, health
screenings and clothes. It's part of an event called a Stand Down. The name
comes from the military command to take a break. Government agencies, community
groups and businesses hold Stand Downs like these once or twice a year in dozens
of U.S. cities. Most of the vets served during the Vietnam era.
But Jason says his service ended with tours in Iraq. And it doesn't
take long before he bumps into another Marine back from that war.
ambi: Marines introduce themselves
VOLUNTEER: The only shirt I have, I have a large shirt here. You
want it?
Jason never expected to find himself living out of a backpack in his
own country.
JASON: If it's not going to rain at night I go to the dog park,
right across the street from Greektown, across from St. Patrick's Catholic
Church. And then when it does rains, there's an abandoned bank in Greektown, and
the drive-through has a roof over it. And I go in there and I sleep under there.
Jason says he's been living like this for four years. After his
discharge, he says he wasn't mentally prepared to work. With both his parents
gone and his marriage ruined, he says, he had no safety net.
JASON: I'm on food stamps, man. I have to live out of soup kitchens.
I have to panhandle. I have to ask people for leftovers to eat.
MILLER: Go into the command tent and, once that's done, they'll...
A Vietnam vet named Samuel Miller helps guide Jason and the others
from one tent to another. Miller helps run an agency that connects former
service members to employment and housing.
MILLER: This is also about fellowship. Most of us veterans
understand the plight of other veterans, and it makes sense for us to help them.
After the clothing tent, Jason makes his way to a medic inside a
gymnasium.
JASON: Sit down here?
MEDIC: Yeah, you can just have a seat right there.
JASON: They're taking my blood, testing me for HIV and Hep. C.
Jason says Department of Veterans Affairs physicians have diagnosed
him with a variety of mental illnesses, including PTSD, short for post-traumatic
stress disorder. But the medications made him feel like a zombie, he says, so he
quit them.
The VA estimates that on any given night 154,000 U.S. veterans are
homeless.
A major factor is untreated mental illness. Some experts say Iraq
and Afghanistan veterans are more likely than Vietnam vets to suffer mental
illness because more of them have seen combat. A Rand Corporation study finds
that only half of those returning from today's wars have sought treatment, and
only half of them have received treatment that researchers consider adequate.
A shortage of affordable housing compounds the problem.
JONES: If you're making minimum wage [or] $7.50 an hour, it's kind
of hard to support yourself and pay $650-$700 a month in rent.
Horace Jones works with vets for a local agency called Inner Voice.
In the Chicago area, the VA helps provide about 300 housing units for former
service members.
JONES: And they all have waiting lists. And so you can imagine if
I'm out there on the street, even though I pull myself together enough to go and
try to get into a program, they tell me that, 'Well, we'll put you on the
waiting list.' So what am I to do but return to what I've been doing, which is
most likely drugs and alcohol and just living on the street.
But the VA's Pete Doherty says, if vets seek help, they'll get what
they need. Doherty directs the VA's national homeless program.
DOHERTY: If you have a substance abuse problem, we try to help you
with that. If you have a mental health problem, we try to help you with that. We
support 500 and some community groups and organizations that provide
transitional housing and other services. We offer residential treatment programs
on our own. And we are now going to extensively expand the ability to have a
permanent place to stay. We're on exactly the right track.
VOLUNTEER: Got your wrist bands on, guys?
At the Stand Down, Jason devours a plate of fried chicken. He says
more vets back from Iraq and Afghanistan need this help.
JASON: A lot of them aren't coming out. They're probably ashamed to
come here. They psychologically shut down and preserve their appearance as if
there's nothing wrong. But that isn't right. That isn't true. They got head
issues.
HERSKOVIC: It takes time to burn your bridges, use up your
resources.
Chicago-area VA homeless director Eugene Herskovic says that means
it'll take time for the latest generation of warriors to show up in the homeless
population.
HERSKOVIC: It's a looming issue.
Homeless advocates predict there won't be enough resources to meet
this need.
http://www.wbez.org/Content.aspx?audioID=26372

We have lost another dragon slayer/advocate
On Thursday, June 26, 2008, CalHEP lost one of our founding steering committee
members, Sherri Ziegler. Sherri passed away following a short illness.
Sherri worked tirelessly to advocate for those in need of support and services,
especially in rural northern California. She always had a positive attitude even
when she faced obstacles that would overwhelm most people. Sherri will be missed
by many and her death will leave a huge gap in the HCV advocacy world. "I will
miss her advocacy efforts, but most of all I will miss her kindness, compassion,
warm heart and her beautiful smile," said Alan Franciscus, a long-time friend
and colleague - a sentiment echoed by all who were touched by Sherri.
Sherri worked diligently to provide education, support, and services for people
with HCV in her community. She was an invaluable resource to the Peach Tree
Clinic and the Sutter, Yuba and Butte County Health Departments. Although we
thought of her as a one woman dynamo, Sherri mentored countless advocates all
over the rural north and through them, her legacy will endure.
In addition to helping CalHEP get started, Sherri founded the Nor Cal Hepatitis
C Network to help increase hepatitis C awareness and support. Sherri was also a
founding member the National Hepatitis C Advocacy Council (NHCAC), a member of
the National Viral Hepatitis Roundtable (NVHR) and the California Hepatitis C
Task Force. Sherri loved to travel with her message of hope for people who, like
her, were affected by hepatitis C. She was a determined advocate in Sacramento
and in Washington DC. - www.calhep.org
Some pics at: http://www.calhep.org/Sherri-page.html
http://www.hcvadvocate.org/

Mortality Rate in HIV Patients Resembles That of General Population
By Todd Neale, Staff Writer, MedPage Today
Published: July 02, 2008
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine,
Harvard Medical School, Boston.
LONDON, July 2 -- Five years after HIV seroconversion, patients in developed
countries appear to have mortality rates similar to those of the general
population, researchers here found
Yet HIV patients with well-estimated seroconversion dates, at least
patients 15 to 24 years old, still have a 4.8% excess mortality rate 10 years
after infection, Kholoud Porter, Ph.D., of the Medical Research Council Clinical
Trials Unit here, and colleagues reported in the July 2 issue of the Journal of
the American Medical Association.
Overall, the excess mortality rate for HIV patients compared with the
general population dropped 94% from the years before 1996 -- before highly
active antiretroviral therapy (HAART) was widely introduced -- through 2006.
"Ongoing monitoring of excess mortality will be important as new treatment
advances are implemented in an attempt to further reduce mortality rates among
HIV-infected individuals," the researchers said.
As the life expectancy for HIV patients continues to climb higher, other
causes of death will take on a more prominent role in determining overall
mortality. (See: HIV Life Expectancy Approaching Normal)
To explore changes in mortality rates in these patients, Dr. Porter and
colleagues from the Concerted Action on Seroconversion to AIDS and Death in
Europe (CASCADE) collaboration examined data from 16,534 patients who were
diagnosed with HIV from 1981 through 2006.
They calculated that estimates of HIV seroconversion dates were accurate
to within 18, 12, and six months for 100%, 87%, and 63% of patients,
respectively, and were based on documented evidence of seroconversion. In 95% of
cases, this comprised a documented negative HIV antibody test result, which was
dated less than three years before the first positive result.
The estimated seroconversion date was the midpoint between the last
negative and first positive test results.
A comparison group from the general population was taken from the Human
Mortality Database and matched by age, sex, calendar year at risk, and country.
The HIV patients (median age at seroconversion 29, 78% male) came from 23
cohorts in 10 European countries, Australia, and Canada. All were exposed either
sexually or through injection drug use.
More than half (57%) were exposed through male-male sex, 18% through
injection drug use, and 24% through male-female sex.
The median follow-up was 6.3 years (range one day to 23.8 years).
Through the end of follow-up, 2,571 patients had died compared with 235
deaths that would be expected in the general population cohort.
The excess mortality rate decreased steadily from 40.8 per 1,000
person-years before the introduction of HAART in 1996 to 6.1 in 2004 through
2006 (excess HR 0.06, 95% CI 0.05 to 0.08).
Although mortality rates were similar between HIV patients and the general
population in the first five years after infection, HIV patients had excess
mortality starting at 10 years post-infection.
HIV patients ages 15 to 24, for example, had a 4.8% excess probability of
death after being infected for 10 years in 2004-2006.
Overall, HIV patients ages 45 and older had a 2.54-fold higher risk of
excess mortality compared with those ages 15 to 24 (excess HR 2.54, 95% CI 2.10
to 3.07, P<0.001).
Also, exposure through injection drug use carried a higher risk than
exposure through male-male sex (excess HR 1.52, 95% CI 1.36 to 1.69, P<0.001),
which may be the result of the direct risks of substance abuse and a higher
likelihood of mental illness and co-infections, according to the researchers.
Females were at a decreased risk of excess mortality (excess HR 0.80, 95%
CI 0.70 to 0.91, P=0.001).
The amount of time spent receiving HAART increased from 17% in 1996-1997
to 73% in 2004-2006.
Additionally, the proportion of nonnucleoside reverse transcriptase
inhibitor-based regimens increased from 18% in 1998-1999 to 40% in 2004-2006. At
the same time, the proportion of protease-inhibitor-based HAART decreased from
71% to 42%.
Ritonavir boosting of protease-inhibitor regimens rose from 7% in
1996-1997 to 79% in 2004-2006.
The researchers said that, because the mortality estimates for 2004
through 2006 came from patients infected in the mid-1990s, "such estimates may
be pessimistic in terms of the long-term outlook for more recently infected
individuals."
They acknowledged some limitations to the study, including the likelihood
that the cohort of HIV patients differed from the general population in ways
that were not controlled for -- for example, in smoking habits.
Also, they said, the patients in this study were diagnosed and monitored
from an early stage of disease and may not be representative of the HIV-infected
population in general.
The study was funded by grants from the European Union. The authors
made no disclosures.
Primary source: Journal of the American Medical Association
Source reference:
Bhaskaran K, et al "Changes in the risk of death after HIV seroconversion
compared with mortality in the general population" JAMA 2008; 300: 51-59.
http://www.medpagetoday.com/HIVAIDS/HIVAIDS/tb/9991

Deportable diseases: List of despair
By Kamakshi Gupta, Saff Reporter
Tuberculosis and hepatitis B are now included in the list of deportable
diseases, a health official has confirmed.
Dr Mahmoud Fikree, CEO of Health Policies at the Ministry of Health, said
expatriates found positive for any of these diseases at the time they're
applying for or renewing their visa will be deported in accordance with a new
decree issued by Humaid Mohammad Obaid Al Qutami, the Minister of Health.
New law
"According to the law, any person with tuberculosis will be deported. Anyone
with hepatitis B will also be deported. The previous law covered hepatitis B, TB
and leprosy, but it was under a different category," he said.
Ministry sources said officials are still studying whether or not to include
hepatitis C in the deportable diseases list, which also includes HIV and AIDS.
"There still need to be technical studies on the diseases before we can include
it in the list," said Fikree.
"This is the first phase of the law. We will review it after three to four
months," Fikree said.
Mandatory screening
Screening for hepatitis B is mandatory only for certain categories of workers
such as babysitters, maids or servants, cooks and butchers. Under the new law
anyone entering the country irrespective of the type of profession will have to
undergo mandatory hepatitis B screening. Vaccination for hepatitis B has also
been made compulsory.
At the time of visa renewal, only the aforesaid categories of workers will have
to undergo hepatitis B screening.
"Hepatitis B patients are directly deported. TB patients are kept in isolation
rooms, stabilised and then deported," a health ministry source said.
Syphilis, meanwhile, has also been included in the compulsory medical fitness
tests, but officials clarified that it is not in the list of deportable diseases
as long as medical treatment is undertaken.
Housemaids
Housemaids will have to undergo compulsory pregnancy tests at the time of visa
renewal, a health official said.
"Presently housemaids only undergo pregnancy tests at the request of their
sponsor. However, according to the new decree, visas for housemaids will be
renewed only after they undergo pregnancy tests," said Maisa Al Bustani, Head of
Medical Fitness Department, at the Department of Health and Medical Services
(Dohms). In addition to the Dh50 pregnancy test, maids and food-handlers will
also have to undergo compulsory stool tests.
http://www.xpress4me.com/news/uae/dubai/20008423.html

Fatty liver in patients with HIV associated with metabolic abnormalities
Michael Carter, Thursday, July 03, 2008
Patients treated with antiretroviral therapy have a high prevalence of fatty
liver disease, according to an Italian study published in the July 15th edition
of the Journal of Infectious Diseases. The overall prevalence of the condition
amongst individuals in the study was 37%. None of these individuals had
hepatitis B or C infection, drank excessively or were drug users.
A risk factor for nonalcoholic fatty liver disease was cumulative length of
treatment with nucleoside reverse transcriptase inhibitors (NRTIs), and the
investigators suggest that "nonalcoholic fatty liver disease fatty liver disease
is the hepatic equivalent of metabolic syndrome".
Nonalcoholic fatty liver disease is, as the name suggests, associated with a
fatty liver, often called hepatitis steatosis. It happens in patients without
other risk factors for a fatty liver, which includes infection with hepatitis B
or hepatitis C, or excessive alcohol consumption. Nonalcoholic fatty liver
disease can not only lead to liver problems, including fibrosis (scarring of the
liver), but also to changes in the body's metabolism, such as atherosclerosis
(hardening or the arteries). The presence of nonalcoholic fatty liver disease is
not only a marker of the presence of cardiovascular disease, but it may also be
an early cause of this.
The benchmark test for nonalcoholic fatty liver disease is a liver biopsy. But
other screening tools include ultrasound, and CT and MRI scans. The presence of
a fatty liver using a CT scan is detected when the attenuation of liver tissue
is greater than that seen in the spleen. A liver-spleen attenuation ratio of <
1.1 can predict over 30% of cases of fatty liver disease. In addition, the
condition is often accompanied by inflammation of the liver shown by increases
in ALT and AST levels.
It is estimated that between 14% - 31% of the general population have
nonalcoholic fatty liver disease. The condition is associated with obesity and
diabetes.
A few previous studies have looked at the prevalence of nonalcoholic fatty liver
disease in patients with HIV. These suggested that it was present in 30% - 40%
of individuals, with one study finding that it occurred more often in
antiretroviral-treated patients with lipodystrophy than in the general
population.
It has been suggested that nonalcoholic fatty liver disease might be a long-term
side-effect of anti-HIV treatment. Investigators in Modena therefore designed a
cross-sectional (or "snap-shot") study to find out the prevalence and
risk-factors for nonalcoholic fatty liver disease in a group of 225 patients who
had been taking anti-HIV treatment for at least two years.
None of the patients were coinfected with hepatitis B or hepatitis C, used
recreational drugs, or had significant alcohol consumption. CT scans were used
to check for the presence of the condition, and those with liver-spleen
attenuation values of below 1.1 were diagnosed as having nonalcoholic fatty
liver disease.
Most of the patients (72%) were men and the mean age was 48. Obesity, defined as
a body mass index (BMI) above 30 was present in 5% and patients, and 14% had
diabetes. Liver inflammation, shown by elevations in ALT and ASTs, was present
in 28%.
On the basis of CT scans, 37% of patients were diagnosed with nonalcoholic fatty
liver disease. The condition was present in significantly (p < 0.001) more men
(44%) than women (28%).
Other factors significantly associated with the condition included higher total
cholesterol (p = 0.04); lower "good" HDL cholesterol (p = 0.047); impaired
insulin metabolism (p < 0.001); liver inflammation, as indicated by higher ALT
(p < 0.001) and AST (p < 0.001) values; a higher BMI (p < 0.001); larger waist
circumference (p < 0.001); higher waist-to-hip ratio (p < 0.001); and visceral
adiposity (p = 0.017).
Subsequent multivariate analysis showed the following factors were significantly
associated with nonalcoholic fatty liver disease:
a.. Elevated ALTs and ASTs (OR, 4.59; 95% CI, 2.09 - 10.08).
a.. Male sex (OR, 2.49; 95% CI, 1.07 - 5.81).
a.. Elevated waist circumference (OR, 1.07; 95% CI, 1.03 - 1.11).
a.. NRTI treatment (OR, 1.12; 95% CI, 1.03 - 1.22).
The investigators stress that their findings show that each year of treatment
with an NRTI increased the risk of nonalcoholic fatty liver disease by 11%.
There was a non-significant association between nonalcoholic fatty liver disease
and hardening of the arteries (p = 0.08).
They comment, "in our cohort, nonalcoholic fatty liver disease was an entity
most commonly seen among HIV-infected, nonobese, lipoatrophic men." They note
that they found an association between the condition and abnormalities in
cholesterol, as well as high blood sugars, increased waist circumference and
visceral adiposity. They write, "these associations led us to believe that there
are etiologic links between nonalcoholic fatty liver disease and HIV-associated
body fat redistribution syndrome (i.e. lipodystrophy) and other HIV-associated
metabolic abnormalities, particularly serum lipid abnormalities and decreased
insulin sensitivity".
Reference
Guaraldi G. et al. Nonalcoholic fatty liver disease in HIV-infected patients
referred to a metabolic clinic: prevalence, characteristics, and predictors. J
Infect Dis 47: 250 - 257, 2008.
http://www.aidsmap.com/en/news/4B789DA4-50C9-4677-B0D1-1893872D174B.asp

The potentially fatal virus that can remain hidden for years
Last updated 14:22, Thursday, 03 July 2008
Hepatitis is a potentially fatal virus which is transmitted through blood then
attacks the liver.
It has been dubbed 'the silent epidemic' because symptoms are vague and many do
not realise they have the disease until it reaches an advanced stage.
In Hepatitis C liver damage occurs slowly over 20-30 years and can result in
cirrhosis, cancer and eventual failure of the organ.
The main causes of infection are: pre 1991 transfusions; drug addicts sharing
needles and snorting straws; sharing razors; having tattoos in unhygienic
parlours and medical and dental procedures abroad.
Mothers can also pass the virus on to their babies.
There are up to 466,000 people with Hepatitis C in England, related deaths have
trebled over the last ten years.
There is no vaccine but treatment is available.
The groups of people at high risk of Hepatitis B are the same as Hepatitis C,
with the addition of those having unprotected sex.
It can cause either short term acute illness, which will often resolve itself,
or long term chronic illnesses which may lead to cirrhosis and cancer.
More than one million people across Europe are infected with Hepatitis B each
year. There is a vaccination and some experts want to make it a childhood
immunisation.
If the infection lasts more than six months (chronic hepatitis infection), a
hospital liver specialist may recommend an antiviral drug treatment called alpha
interferon. This treatment aims to reduce the risk of permanent liver damage
(cirrhosis) and liver cancer.
http://www.newsandstar.co.uk/1.134201

Number of teenagers being treated for hepatitis has quadrupled
By Steph Johnson
Last updated 14:24, Thursday, 03 July 2008
The number of teenagers being sent out of county to be treated for Hepatitis B
and C has more than quadrupled over the last year.
The region's Health Protection Unit was notified about nine North Cumbrian
youngsters who tested positive for the liver diseases, a rise of seven on 2006.
They need to be monitored at specialist clinics in London, Birmingham and Leeds
because of their age.
But the actual number of teenagers who have to get help away from home is likely
to be highe