Philadelphia, Pa. (April 2, 2013) – Injuries caused by needles and other sharp instruments are a major occupational hazard for surgeons—with high costs related to the risk of contracting serious infectious diseases, according to a special article in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

ASPS Member Surgeon Dr. Kevin C. Chung and colleagues at The University of Michigan Health System, Ann Arbor, review the risks, health impact and costs of “sharps” injuries for surgeons and other operating room personnel. They write, “Increased attention to the health, economic, personal and social implications of these injuries is essential for appropriate management and future prevention.”

High Rate of Sharps Injuries in OR—Surgeons at Highest Risk

Nearly 400,000 sharps injuries occur each year in the United States. About 25 percent of injured workers are surgeons—for whom the risk is highest in the operating room. “Despite healthcare policies designed to protect healthcare workers, injuries remain common,” Dr. Chung and colleagues write. Nearly all surgeons will sustain a sharps injury sometime during their career.  Medical students and residents are also at high risk; fatigue and inexperience are important risk factors.

The main health concern of sharps injuries is the risk of acquiring a communicable disease from a patient. While HIV is the most-feared result, the risk of infection with hepatitis B virus is actually much higher. Sharps injuries can also have a major psychological impact on the injured person and his or her family—particularly during the time needed to confirm that the injured worker is free of infection, which may take several weeks or months.

Once an injury occurs, there are standardized guidelines for post-exposure prevention, depending on whether the patient has any known transmissible infections.  Recommendations include antiviral medications for healthcare workers exposed to HIV and hepatitis B or C virus—ideally starting within hours after the injury.

As a result of the need for testing and treatment, sharps injuries have a major economic impact.  Average costs for testing, follow-up and preventive treatment range from $375 for needlestick exposure from a patient with no known blood-borne illness, up to nearly $2,500 for injuries from a patient with known HIV.

Need for Increased Emphasis on Reporting and Prevention

Post-exposure prevention can only be executed if the injury is reported. One study found that 70 percent of surgeons “never or rarely” report sharps injuries. They may feel they “don’t have time” to report, or may misunderstand the risks involved.

“Fortunately, the majority of sharps injuries are preventable,” Dr. Chung and colleagues write. Engineered safety devices can prevent many injuries—especially if surgeons and other workers are involved in choosing to use them. Other options include the use of “non-sharp” alternatives, creating safe procedures for passing sharp instruments and wearing double gloves to reduce the risk of infection.

Over the years, regulations have been introduced to ensure that proper prevention and reporting strategies are in place. Introduction of the Needlestick Safety and Prevention Act of 2000 led to an overall 38 percent reduction in injuries in all care settings. However, one study reported that the rate of sharps injuries in the operating room actually increased. “Although preventive strategies exist, their success ultimately relies on clinician compliance,” Dr. Chung and coauthors write.

The authors hope their review will help to increase awareness of the risks and potential harms of sharps injuries among surgeons and operating room personnel, and to increase awareness of efforts to reduce the risk. They conclude, “Targeting educational initiatives during medical school and training may improve knowledge among surgeons of the safest ways to practice in the operating room, and ensuring compliance among all surgeons in practice can reduce the economic and psychosocial burden of these highly prevalent injuries.”

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world’s largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

About Lippincott Williams & WilkinsLippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (March 11, 2013) – For HIV-infected patients whose disease is well-controlled by modern treatment, the risk of death is not significantly higher than in the general population, according to a study published in AIDS, official journal of the International AIDS Society. AIDS is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study suggests that patients with undetectable viral loads and near-normal levels of immune cells on state-of-the art antiretroviral therapy (ART) can expect to have about the same risk of death as people without HIV.  The article is available on the AIDS journal homepage and in the March 13 print edition.

What’s the Risk of Death with Well-Controlled HIV?

Dr Alison Rodger of University College London and colleagues assessed mortality rates in a group of patients with “optimally treated” HIV, drawn from two major trials of treatment for HIV infection:  the ESPRIT and SMART trials.  The analysis included nearly 3,300 patients who were not injecting drug users and who received continuous ART.  On treatment, all had achieved undetectable HIV levels and had relatively high levels of CD4+ cells, a key population of immune cells—at least 350 cells/mm³.  (A CD4+ cell count of 500 to 1,000 cells/mm³  is considered normal.)

The patients’ average age was 43 years; 80 percent were men.  Rates and causes of death in these patients with well-controlled HIV were compared with those in the general population.

During a median follow-up of about three years, 62 of the patients died.  The most common causes of death were cardiovascular disease or sudden death, responsible for 31 percent of deaths; and non-HIV-related cancers, 19 percent.  Only two deaths (three percent) were considered AIDS-related.

Patients with below-normal CD4+ cell counts (350 to 499 cells/mm³) were at elevated risk of death.  Based on the standardized mortality ratio, the risk of death in this group was 77 percent higher than in the general population.

With Normal CD4+ Cell Counts, No Increase in Mortality

However, in HIV-infected patients with a CD4+ cell count of 500 cells/mm³ or higher, the risk of death was not significantly higher than in the general population.  For this group, the risk of death was essentially normal regardless of how low the CD4+ cell count dipped during treatment, as long as it returned to normal.

Over the years, effective ART regimens for HIV infection have become simpler, less toxic, and more effective.  “Due to the success of ART, it is relevant to ask if death rates in optimally treated HIV are higher than the general population,” the researchers write.

Previous studies have suggested that, with successful treatment, mortality risk approaches that of people without HIV.  However, these studies have had important limitations, including a lack of complete information on patient outcomes.  The use of comprehensive follow-up data from the ESPRIT and SMART trials overcomes this limitation.

The new study provides the best evidence yet that, with effective ART that achieving good disease control, the mortality rate for people with HIV is essentially the same as in the general population.  Dr Rodger and colleagues conclude, “Our data support the importance of early diagnosis and treatment to improve clinical outcomes and it is likely that much of the excess mortality associated with HIV would be preventable with timely diagnosis of HIV and initiation of ART.”

Further studies will be needed to clarify the implications for HIV treatment, including the best time to start ART based on CD4+ cell counts.  The researchers also note that other causes of illness or death emerge as the current generation of treated HIV-infected people continues to age.

“Rodger and colleagues add to the considerable body of evidence on which early treatment initiation guidelines are based,” commented Veronica Miller, PhD, Director of the Forum for Collaborative HIV Research.  “Together with studies indicating equal benefit across risk groups, including injecting drug users, as long as individuals are maintained in care, this study further validates universal testing with immediate linkage and retention in care policies.”

About AIDS

AIDS publishes the very latest ground-breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals.  With 18 issues per year, AIDS guarantees the authoritative presentation of even more significant advances. The Editors, themselves noted international experts who know the demands of HIV/AIDS research, are committed to making AIDS the most distinguished and innovative journal in the field.   Visit the journal website at www.aidsonline.com.

About Lippincott Williams & WilkinsLippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

2. Study Says Heavy Drinking Leads to Increased HIV Risk for Men Who Have Sex with Men

Philadelphia, Pa. (March 4, 2013) –The results of two important studies have been published in the March issue of AIDS, the official journal of the International AIDS Society. One study notes that screening for HIV should be performed more frequently—up to every three months for the highest-risk patients, while low-risk groups to be tested every three years. A second study demonstrates a link between heavy drinking and risky behaviors for men who have sex with men (MSM). AIDS is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Northwestern University Study Researches the Most Cost-Effective Approach to HIV Screening

The mathematical modeling study was performed to assess “optimal testing frequencies” for HIV screening in different risk groups.  Current Centers for Disease Control and Prevention (CDC) guidelines recommend annual testing for high-risk groups, such as people with HIV-positive partners, people with multiple partners, injection drug users, and sex workers and once-in-a-lifetime testing for low-risk groups (whose annual risk of acquiring HIV is only one-hundredth of one percent).

The researchers modeled various scenarios in an attempt to “optimize the tradeoff” between the societal costs of testing versus the benefits of earlier HIV diagnosis over a patient’s lifetime. Frequent testing is shown to be an effective method for identifying new HIV infections.  In the past, people with new HIV infections weren’t treated until they had significant declines in immune functioning, as measured by the CD4 cell count.  But there’s a growing consensus that antiretroviral treatment is beneficial for all HIV-infected patients, regardless of CD4 count.  Starting treatment immediately after diagnosis also reduces the risk of transmitting HIV.

Within its limitations, the study suggests that current recommendations for HIV testing are “too conservative, especially for low risk groups who would benefit from more frequent testing,” according to Lucas and Armbruster.  They conclude, “These results should encourage policymakers and medical professionals to reconsider how often adolescents and adults should be tested for HIV.”

The full article is available on the AIDS journal homepage and in the March 13 print and online edition.

University of North Carolina Study Reveals Heavy Drinking Affects HIV Risk for MSM

Researchers analyzed long-term follow-up data on MSM from a large study of HIV risk factors.  All men were HIV-negative at the beginning of the study.  Using special statistical weighting techniques, Dr Cole and colleagues analyzed the joint effects of alcohol consumption and sexual behavior on the risk of acquiring HIV (seroconversion) during follow-up. Findings show that for men who have sex with men (MSM), heavy drinking may lead to an increased risk of acquiring HIV.

Overall, 529 cases of HIV seroconversion were identified during follow-up.  Thirty percent of the men reported having unprotected sex with multiple partners in the two years before the study.

Risk is especially high for men who are heavy drinkers and have multiple partners, suggests the study by Stephen R. Cole, PhD, of University of North Carolina, Chapel Hill, and colleagues.  They write, “These findings suggest that alcohol interventions to reduce heavy drinking among MSM should be integrated into existing HIV prevention activities.” 

The full article can be read by visiting the AIDS journal homepage and can also be found in the March 13 print edition.

About AIDS

AIDS publishes the very latest ground-breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals.  With 18 issues per year, AIDS guarantees the authoritative presentation of even more significant advances. The Editors, themselves noted international experts who know the demands of HIV/AIDS research, are committed to making AIDS the most distinguished and innovative journal in the field.   Visit the journal website at www.aidsonline.com.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Study in AIDS Journal Uses Advanced Mapping Techniques to Assess Role of ‘Spatial Accessibility’

Philadelphia, Pa. (December 4,  2012) – Road networks and geographic factors affecting “spatial accessibility” have a major impact on the spread of HIV across sub-Saharan Africa, according to a study published online by the journal AIDS, official journal of the International AIDS Society. AIDS is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Using sophisticated mapping techniques and detailed databases, Dr Andrew J. Tatem of the University of Florida and colleagues have found “coherent spatial patterns in HIV-1 subtype distributions” across Africa.  The researchers write, “A comprehensive understanding and evidence-base on accessibility, travel and mobility in resource poor settings would…provide a valuable resource for the strategic planning of disease control.”  The article is available on the AIDS journal homepage and in the November 28 print edition. 

Molecular HIV Data Overlaid on Spatial Accessibility Maps…

Dr Tatem and his team performed a spatial analysis of the distribution of HIV for the years 1998 to 2008 to explore the impact of transportation networks and geography on the spread of HIV.  Molecular data on specific HIV subtypes were obtained and analyzed in relation to “detailed and complete” spatial datasets on Africa-wide road networks.

In addition to roads, the data included a wide range of factors affecting “spatial accessibility,” such as land cover, settlement locations, bodies of water, and topography.  Sophisticated models were used to calculate not just the distance between locations, but also the ease of traveling from one place to another.

Even simply laying a chart of HIV subtypes over a map of travel times between settled areas makes the link between spatial accessibility and HIV subtype “clearly evident.”  Dr Tatem and coauthors write, “[C]lusters of similar subtype distributions are well connected and easily accessible from one another, whereas regions of low accessibility separate groupings of similar subtype distributions.” 

…Show Role of Travel in Spread of HIV Subtypes

Transport networks and ease of travel—rather than the straight-line distances between locations—provided a much better explanation for the distribution of HIV subtypes.  The data showed clustering of certain subtype distributions in well-connected regions—such as the western, eastern, and southern Africa and Ethiopia—that are separated by areas of “limited connectivity.”

In contrast, the difficulty of travel in certain areas of central Africa likely restricted the spread of HIV, the researchers suggest.  “The relatively poor connectivity in central Africa likely contributed to the slow initial growth of the epidemic in the first half of the 20th century,” according to Dr Tatem and colleagues.  The same factor may explain why HIV rates remained relatively low in central Africa, while soaring elsewhere.

Although the study has some important limitations, it adds important evidence for understanding how transport infrastructure and geography have affected—and will continue to affect—the spread of HIV.  The authors hope that the modeling techniques used can be extended to map cultural and other factors affecting HIV subtype distribution and transmissibility.  More accurate data on “actual volumes and flows of human travel” could also lend new insights.

“The increased travel and mobility of people may lead to the accelerated spread of new variants and the further diversification of the global HIV epidemic,” Dr Tatem and coauthors write.  They believe that ongoing efforts to monitor the spread of HIV subtypes could have important implications for developing effective prevention and treatment strategies.

About AIDS

AIDS publishes the very latest ground-breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals.  With 18 issues per year, AIDS guarantees the authoritative presentation of even more significant advances. The Editors, themselves noted international experts who know the demands of HIV/AIDS research, are committed to making AIDS the most distinguished and innovative journal in the field.   Visit the journal website at www.aidsonline.com.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (December 4, 2012) – Can treatment with modern anti-HIV drugs help fight hunger for HIV-infected patients in Africa?  Starting antiretroviral therapy for HIV reduces “food insecurity” among patients in Uganda, suggests a study published online by the journal AIDS, official journal of the International AIDS Society. AIDS is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Treatment including antiretroviral therapy (ART) may lead to a “positive feedback loop” whereby improved functioning and productivity lead to increased ability to work—and thus to decreased food insecurity, according to the study by Kartika Palar, PhD and colleagues of University of California Los Angeles and RAND Corporation. The article is available on the AIDS journal homepage and in the November 28 print edition.

Food Insecurity Decreases in Year after Starting ART

The researchers studied 602 patients receiving first-time care for HIV disease at two clinics in Uganda.  At one clinic, patients were started on ART, the most effective drug treatment for HIV.  Patients at the other clinic were close to becoming eligible but not yet started on ART.

During the first year of treatment, the two groups were compared for changes in their level of food insecurity, defined as “the limited or uncertain availability of adequate food.”  Based on a simple questionnaire, about half of patients had severe food insecurity at the start of treatment (53 percent in the ART group and 46 percent of those not receiving ART).

In both groups, starting HIV treatment led to improved food security.  However, the trend was more pronounced in the group receiving ART.  By twelve months, the rate of severe food insecurity had decreased to 13 percent of the ART group versus 18 percent in the non-ART group.

Examination of other variables gave insight into the “pathway” by which ART may lead to improved food security.  Patients starting antiretroviral drugs had greater improvements in work status and in mental health—particularly decreased scores for depression.  Although physical health also improved during treatment—with or without ART—this did not seem to contribute to the reduction in food insecurity.

Changing the ‘Vicious Cycle’ to an ‘Upward Spiral’

Researchers are just beginning to explore the socioeconomic and psychological benefits of ART for HIV-infected patients.  In developing countries such as Uganda, food insecurity is a common problem with important effects on health.  Previous studies have shown that patients with food insecurity are less likely to follow up with recommended treatment for HIV and have poorer treatment outcomes.

The new study provides evidence that starting treatment for HIV—especially treatment including ART—leads to improved food security.  The reductions in food insecurity were achieved even though neither of the study clinics offered food assistance.

“Our results suggest that greater ability to work and reduced symptoms of depression may be the primary pathways through which ART improves food insecurity,” Dr Palar and coauthors write.  They suggest a “bidirectional relationship” between ART and food insecurity.

While ART alone can’t solve the problem of food insecurity, the researchers believe that policymakers should consider interventions to halt the “vicious cycle” by which HIV leads to worsening social and economic outcomes.  Dr Palar and colleagues conclude, “Well-integrated and implemented interventions in the context of comprehensive care have the potential to produce an ‘upward spiral’ where food security and ART can mutually reinforce each other for the benefit of all those in treatment.”

About AIDS

AIDS publishes the very latest ground-breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals.  With 18 issues per year, AIDS guarantees the authoritative presentation of even more significant advances. The Editors, themselves noted international experts who know the demands of HIV/AIDS research, are committed to making AIDS the most distinguished and innovative journal in the field. Visit the journal website at www.aidsonline.com.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com