MAY/JUNE 2005
In The News
Errata: Vol. Vol. 8, Issue 4
In the IDCR, "Managing STIs in Jails," two errors occurred. On page two, column one, in section three, the unpublished data from a study on male inmates in the NYC jail system should read, "Unpublished data from a recent study on male inmates in the NYC jail system revealed a relatively high rate of asymptomatic chlamydial infection, especially in males 35 years and younger." The subsequent sentence should read, "This finding led to the current universal screening for chlamydia and gonorrhea in all males younger than 35 years in the NYC jail system."
25% of Women in WIHS Stop HAART
A recent analysis of the Women's Interagency HIV Study (WIHS) has demonstrated that 25% of women stop highly active antiretroviral therapy (HAART) for at least six months during study follow-up of five years. The risk of discontinuation was over one and a half times greater after 1998 as compared to the two and a half years preceding 1998. Discontinuers were more likely to be African-American or Latina and less likely to be white. Additionally, discontinuers were more likely to have had AIDS, lower median increase in CD4 cell count, higher viral loads, and were more likely to be depressed. Adieh-Grant, et al. suggest that access to treatment for depression may be helpful and that poor adherence is associated with depressive symptoms.
Ahdieh-Grant, et al. JAIDS. 2005; 38(4):500-03.
CD4 Count Predicts Cervical SILs
Current cervical cancer screening guidelines state that the interval between screenings can be safely extended to three years in healthy HIV-uninfected women 30 years and older who have normal cytology results and negative test results for HPV DNA. Harris, et al. analyzed data from the Women's Interagency HIV Study (WIHS), an observational cohort study, to determine the incidence of squamous intraepithelial lesions (SILs) in HIV-infected women with normal cytology results, by baseline oncogenic human papillomavirus (HPV) DNA results. The incidence of SILs were estimated according to baseline HPV DNA, stratified by HIV serostatus and CD4 cell count. Development of SILs in women with negative HPV results at two years was as follows: in HIV-infected women with CD4 cell counts less than 200/ul, 9%; with CD4 cell counts between 200ul and 500ul, 9%; and with CD4 cell counts greater than 500/ul, 4%. At two years, Multivariate Cox models showed that there was not a significant difference in the incidence of any SILs between HIV-infected and HIV-uninfected women who had CD4 cell counts greater than 500/ul. Harris et al. concluded that the similar low cumulative incidence of any SIL among HIV-infected and HIV-uninfected women with CD4 counts greater than 500/ul and who had normal cervical cytology and negative results for oncogenic or all HPV DNA tests at baseline suggests that similar cervical screening may be applicable to both groups, although the authors note that this strategy warrants further study in an appropriately designed trial.
Harris, et al. JAMA. 2005; 293(12):1471.
Breast/Uterine Cancer Reduced in Women with AIDS
James Goedert, MD told participants at the 96th annual meeting of the American Association for Cancer Research that women with AIDS have a lower risk of developing cancer of the breast and uterine corpus, perhaps because of alterations in body fat and hormone imbalance. Of 77,739 women with AIDS who were followed from five years, prior to, and 10 years after, AIDS diagnosis, 274, 31, and 29, developed breast cancer, ovarian cancer, and cancer of the uterine corpus, respectively. The incidence of breast cancer was 32% less in women with AIDS compared to women without AIDS.
96th annual meeting of the American Association for Cancer Research. April 2005: Anaheim, CA. www.natap.org
NCCHC Update: "Love Me Tender" Program
Approximately 3% of the total female population incarcerated in the Texas Department of Criminal Justice (TDCJ) are pregnant upon entry and 61% are of child-bearing age. Many of these women are pregnant for the first time and have little or no prenatal care prior to incarceration. To address these factors, TDCJ developed the "Love Me Tender" program. Pregnant women are housed together and are transported to the labor and delivery unit at the University of Texas Medical Branch (UTMB) to have their babies. They are subsequently housed in a unit in the TDCJ hospital and UTMB nursery staff cares for the babies until discharge. Newborns are brought to see their mothers Monday through Friday for two hours to encourage bonding. Previously, incarcerated women who delivered their babies at UTMB were only allowed a one-time visit with their newborn during hospitalization. Outcomes of this program have demonstrated improved self-esteem, improved behavioral relationships, and a commitment to avoid re-incarceration.
National Commission on Correctional Healthcare: "Love Me Tender" Program session.
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