Sharon G. Hopkins

Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors

The association between needle exchange, change in drug use frequency and enrollment and retention in methadone drug treatment was studied in a cohort of Seattle injection drug users (IDUs). Participants included IDUs classified according to whether they had used a needle exchange by study enrollment and during the 12-month follow-up period. The relative risk (RR) and the adjusted RR (ARR) were estimated as measures of the association. It was found that IDUs who had formerly been exchange users were more likely than never-exchangers to report a substantial (> or= 75%) reduction in injection (ARR = 2.85, 95% confidence limit [CL] 1.47-5.51), to stop injecting altogether (ARR = 3.5, 95% CL 2.1-5.9), and to remain in drug treatment. New users of the exchange were five times more likely to enter drug treatment than never-exchangers. We conclude that reduced drug use and increased drug treatment enrollment associated with needle exchange participation may have many public health benefits, including prevention of blood-borne viral transmission.

Natural Transmission of Bovine Leukemia Virus in Dairy and Beef Cattle

Many potential routes of bovine leukemia virus (BLV) transmission are reviewed in this article. Vertical transmission, in utero, or through colostrum and milk, accounts for a relatively small proportion of infections. Iatrogenic horizontal transmission, through procedures permitting the transfer of blood between cattle, has been shown to be a major route of transmission in most settings. Contact transmission stems from a mixture of natural sources of blood, exudates, and tissues that enter the body through mucosal surfaces or broken skin. Careful analysis of management procedures and environmental conditions present in individual dairy and beef herds affords the greatest opportunity to develop effective BLV prevention programs.

Differences in prescription of antiretroviral therapy in a large cohort of HIV-infected patients.

The objective of this study was to determine factors associated with prescription of highly active antiretroviral therapy (HAART). The authors observed 9530 patients eligible for antiretroviral therapy (ART) in more than 100 hospitals and clinics in 10 US cities. Multiple logistic regression analysis was used to assess factors associated with HAART prescription, stratifying patients by no history versus history of ART to assess the association between prescription and CD4, viral load, and outpatient visits. Overall, female gender (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.60–0.76) and alcoholism (OR, 0.85; 95% CI, 0.74–0.99) were associated with decreased likelihood of HAART prescription. Enrollment at a private facility (OR, 1.33; 95% CI, 1.14–1.56), heterosexual exposure (OR, 1.34; 95% CI, 1.13–1.58), and Hispanic ethnicity (OR, 1.19; 95% CI, 1.04–1.37) were associated with prescription. For patients with no history of prescribed ART, CD4 <500 cells/&mgr;L (OR, 3.94; 95% CI, 2.02–7.66), and high viral load were associated with increased likelihood of prescription; for patients with history of ART prescription, those whose outpatient visits averaged ≥2 per 6-month interval (OR, 1.30; 95% CI, 1.10–1.54) were more likely and those with high viral load were less likely to be prescribed HAART (OR, 0.50; 95% CI, 0.44–0.56). The authors found differences in HAART prescription by gender, race, exposure mode, alcoholism, and provider type for all patients, by CD4 and viral load for patients with no history of ART prescription, and by average number of outpatient visits and viral load for patients with history of ART prescription.

VOLUNTEER BIAS IN NONRANDOMIZED EVALUATIONS OF THE EFFICACY OF NEEDLE-EXCHANGE PROGRAMS

ObjectiveNonrandomized comparisons of the incidence of HIV and hepatitis B and C between injection drug users (IDUs) who do and do not attend voluntary needle-exchange programs may be subject to bias. To explore possible sources of bias, we examined characteristics associated with voluntarily beginning or ceasing to participate in the Seattle needle exchange.MethodsIn a cohort of 2,879 IDUs, a standardized questionnaire measured characteristics present at enrollment. We examined the relation of these characteristics to the proportion of IDUs who began to use the program during the ensuing 12-month follow-up period and to the proportion of current exchangers who dropped out during that period of time.ResultsOf the 494 never-exchangers at baseline, 32% attended the exchange program during follow-up; those who reported sharing syringes or who were homeless at enrollment were more likely to become new exchange users (adjusted risk ratio [ARR] for becoming an exchange user = 1.8 for those who shared syringes, and ARR=2.2, for those who were homeless). Of 1,274 current exchangers, 16% stopped using the exchange during follow-up, with daily injectors (ARR=0.6) and those who reported backloading (ARR=0.6) being relatively less likely to drop out of the exchange.ConclusionsThe analysis suggests that IDUs participating in needle-exchange programs at a given point in time may include a particularly high proportion of those injectors whose pattern of drug use puts them at elevated risk of blood-borne viral infections.

Support among persons infected with HIV for routine health department contact for HIV partner notification.

Public health partner notification (PN) services are provided inconsistently to persons diagnosed with HIV/AIDS in the United States, and some community groups representing persons with HIV/AIDS have opposed widespread application of PN. We surveyed persons with HIV recently reported to our health department and a random sample of HIV-infected persons attending an HIV/AIDS clinic. A total of 95 persons, of whom 76 (80%) were men who have sex with men, completed an anonymous self-administered questionnaire. Eighty-four percent of participants believed the health department should routinely offer everyone diagnosed with HIV help in notifying their partners; 79% indicated they would be somewhat or very likely to provide information to a doctor, case worker, or health department employee for purposes of PN; and 20% indicated they wanted help in notifying a recent sex partner. Seventy-eight percent of participants believed the health department should contact all HIV-infected persons after diagnosis to help them access medical care and social services, and 68% wanted the health department to contact them about the availability of medical or social services. In contrast to common public perceptions, these results suggest that most persons with HIV support health departments routinely contacting people after HIV diagnosis and that many want assistance with PN.

Effect of trimethoprim-sulfamethoxazole as Pneumocystis carinii pneumonia prophylaxis on bacterial illness, Pneumocystis carinii pneumonia, and death in persons with AIDS

To measure the effect of trimethoprim-sulfamethoxazole (TMP-SMX) in preventing bacterial illness, Pneumocystis carinii pneumonia (PCP), and death in people with AIDS, we conducted a retrospective medical record review of 1078 persons who were observed for 3 years on average who attended nine outpatient facilities in Seattle, Washington between January 1990 and April 1996. We calculated relative risk estimates to measure the protective effect of TMP-SMX on the development of major bacterial illnesses, PCP, and death. Use of TMP-SMX decreased the risk of PCP (relative risk [RR] = 0.23; 95% confidence interval [CI], 0.14-0.36) and deaths not attributable to PCP (RR = 0.59; 95% CI, 0.47-0.73). Prevention of major bacterial illnesses of known etiology was of borderline significance (RR = 0.77; 95% CI, 0.57-1.05) and became statistically significant with the addition of patients with infections of unknown etiology (RR = 0.77; 95% CI 0.61-0.97). Use of TMP-SMX PCP prophylaxis significantly reduced the risks of death and of PCP and was associated with a trend toward reduced risk of major bacterial infections.

Food Animal and Poultry Retroviruses and Human Health

In summary, studies reported to date have largely failed to demonstrate human infection with animal and poultry retroviruses or an association between human diseases and these viruses. A number of studies, most of them serologic, have attempted to demonstrate human infection with these viruses. The lack of antibodies in apparently exposed groups of persons suggests an absence of infection. However, another possible explanation is that humans may be immunologically unresponsive to infection with these viruses. Although attempts to infect normal human cells in vitro with many of these viruses have not been reported, BLV and BIV appear to grow poorly or not at all. On the other hand, ALSV subgroup D infect and transform human cells in vitro. However, the production of infectious virus in vitro has been low or nonexistent. This may explain the absence of antibodies in human populations. Furthermore, many of the methods used to detect infection, either directly or indirectly, have either low sensitivity or problems with specificity. Several epidemiologic studies have tried to show a relationship between human and animal leukemia or lymphoma. In many of these studies the actual exposure to retroviruses is unknown and exposure to animals may merely represent exposure to other risk factors that are more important but were either not considered or are undefined; alternatively, a common exposure may be responsible for malignancy in humans and animals with no interspecies relationship. Based on the reported studies, these viruses appear unlikely to be responsible for any significant occurrence of human disease, particularly lymphoid malignancies. Although a definitive statement of no risk to human health is probably unwarranted, the evidence to date indicates that the risk is low and perhaps nonexistent. Thus, no specific public health recommendations regarding retrovirus-infected animals or poultry are warranted at this time.

Lack of an epidemiologic link between Kaposi's sarcoma and CNS lymphoma in patients with AIDS

To the Editor: After reading the report detecting the presence of human herpesvirus eight (HHV-8) in primary CNS lymphoma tissue,1 we were interested to see whether our local data would show an association between Kaposis sarcoma (KS), a known HHV-8-associated tumor, and primary CNS lymphoma. Both KS and primary CNS lymphoma are AIDS-defining malignancies.2 As part of the Centers for …

Acceptance, Benefits, and Challenges of Public Health-Oriented Pet Business Regulations in King County, Washington.

CONTEXT New regulations were implemented in King County, Washington, in 2010 requiring pet businesses to obtain a permit from Public Health-Seattle & King County (Public Health) and undergo annual inspections to provide education and ensure compliance with regulatory standards. The regulations were developed as a tool for zoonotic disease control and prevention education for businesses and their customers, as well as for environmental protection. OBJECTIVE To assess the acceptance, benefits, and challenges of the new regulations and identify ways for Public Health to improve educational efforts and assist businesses with compliance. DESIGN Cross-sectional survey. SETTING King County, Washington. PARTICIPANTS Pet businesses with Public Health permits in 2013. MAIN OUTCOME MEASURE Self-administered survey responses. RESULTS The response rate was 40.5%. The majority of respondents provided grooming, pet day care, and kennel/boarding services from small, independent businesses. Sixty-one percent reported Public Health inspections as beneficial, especially concerning disinfection procedures and using an infection control plan. Almost three-fourths of respondents used the Public Health template to develop the infection control plan. Forty-four percent reported using the educational materials provided by Public Health, and 62% used educational materials from other sources. Most respondents reported that they gained benefits from the pet business permit, although fewer agreed that they obtained a good value from the permit and fee. The most common benefits reported were protection of animal and human health and establishing the credibility of the pet business. CONCLUSIONS Major challenges with the implementation of the pet business regulations were not generally reported by respondents. Most respondents reported a collaborative relationship between Public Health and the pet businesses. Improvements in infection control practices and positive responses to the inspections were reported by pet businesses. Survey results were used to improve infection control plan templates, increase the use of educational materials, and improve the Web site and business portal performance.

AIDS surveillance: knowledge, attitudes, and practices of health care professionals in Washington State.

Health professionals in Washington State were surveyed in 1993 to assess acquired immunodeficiency syndrome (AIDS) reporting knowledge, attitudes, and practices. Seventy-five percent responded. Two thirds of previous reporters were informed about the 1993 AIDS case definition and reporting requirements, but 32 percent had neglected to report. Forty-eight percent were concerned about confidentiality of reported cases. Half favored human immunodeficiency virus reporting and 21 percent opposed it. In order to promote complete and timely AIDS reporting, current and future reporters need ongoing education on reporting requirements and methods. The importance of AIDS surveillance data for community planning as well as assurance of protection of confidentiality should be emphasized.