Syringe access for the prevention of blood borne infections among injection drug users

Background  

Approximately one-third of acquired immunodeficiency syndrome cases in the United States are associated with the practice of sharing of injection equipment and are preventable through the once-only use of syringes, needles and other injection equipment.     

Five subtypic specificities of the Bw22 complex in four racial groups.

Five subtypic specificities of Bw22 were defined using 38 informative local and Seventh Histocompatibility Workshop sera: Bw54, 22.2, J2, Bw42, and a new Bw22 associated antigen Te90. The previously defined specificity, 22.1, associated with Cw3, could not be distinguished from Bw54 in this study. Marked restriction in the distribution of four Bw22 specificities (Bw54 excepted) in white, Mexican, black, and Oriental populations was described and provided supporting evidence for the identification of these antigens.     

Successful linkage of medical care and community services for HIV-positive offenders being released from prison

Human immunodeficiency virus (HIV) infection is more prevalent among the incarcerated than the general population. For many offenders, incarceration is the only time that they may access primary care. Project Bridge is a federally funded demonstration project that provides intensive case management for HIV-positive exoffenders being released from the Rhode Island state prison to the community. The program is based on collaboration between colocated medical and social work staff. The primary goal of the program is to increase continuity of medical care through social stabilization; it follows a harm reduction philosophy in addressing substance use. Program participants are provided with assistance in accessing a variety of medical and social services. The treatment plan may include the following: mental illness triage and referral, substance abuse assessment and treatment, appointments for HIV and other medical conditions, and referral for assistance to community programs that address basic survival needs. In the first 3 years of this program, 97 offenders were enrolled. Injection drug use was reported by 80% of those enrolled. There were 90% followed for 18 months, 7% moved out of state or died, and 3% were lost to follow-up. Reincarceration happened to 48% at least once. Of those expressing a need, 75% were linked with specialty medical care in the community, and 100% received HIV-related medical services. Of those expressing a need for substance abuse treatment, 67% were successful in keeping appointments for substance abuse treatment within the community. Project Bridge has demonstrated that it is possible to maintain HIV-positive ex-offenders in medical care through the provision of ongoing case management services following prison release. Ex-offenders will access HIV-related health care after release when given adequate support. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the Health Resources and Services Administration, the Special Projects of National Significance program, or other sponsors.     

Hepatitis C in correctional institutions

The prevalence of chronic infection with hepatitis C virus (HCV) is estimated to be 17 to 27 times higher among incarcerated individuals than in the general US population. To help stem the epidemic of HCV infection in the United States, correctional institutions and public health systems should be integrated. The incarcerated setting represents the first opportunity for many inmates to access health care. Correctional settings offer an important opportunity to diagnose, prevent, and treat HCV infection. In this article, we review HCV screening, testing, and treatment policies in US correctional institutions and discuss prison responses to the HCV epidemic and the feasibility of treatment within prisons and jails. Finally, we emphasize the importance of links to postrelease medical care for HCV-infected inmates and the necessity of comprehensive strategies to effectively manage HCV infection.     

A review of the case for hepatitis B vaccination of high-risk adults

The sequelae of hepatitis B virus infection include fulminant liver failure, chronic liver disease, hepatocellular carcinoma, and death. The hepatitis B vaccine is efficacious, safe, and cost-effective, but has been consistently underutilized in high-risk adults despite long-standing recommendations. Instituting routine hepatitis B vaccination for high-risk adults in settings such as prisons and jails, sexually transmitted disease clinics, drug treatment centers, and needle exchange programs could prevent up to 800 cases of hepatitis, and 10 deaths from hepatitis, per 10,000 vaccinations, with an overall cost savings. Low rates of completion of the three-dose series and lack of funding for adult immunizations have always been challenges to offering hepatitis B vaccines to high-risk adults. However, there is benefit to an incomplete vaccination series, and high-risk populations are accessible for follow-up vaccination outside of traditional medical settings. A clear national objective and federal funding for vaccinating high-risk adults are needed.     

Hepatocellular Carcinoma,Alpha Fetoprotein,and Liver Allocation for Transplantation: Past,Present and Future

Hepatocellular carcinoma (HCC) is one of the leading indications for liver transplantation and has been the treatment of choice due to the oncologic benefit for patients with advanced chronic liver disease (AdvCLD) and small tumors for the last 25 years. For HCC patients undergoing liver transplantation, alpha fetoprotein (AFP) has increasingly been applied as an independent predictor for overall survival, disease free recurrence, and waitlist drop out. In addition to static AFP, newer studies evaluating the AFP dynamic response to downstaging therapy show enhanced prognostication compared to static AFP alone. While AFP has been utilized to select HCC patients for transplant, despite years of allocation policy changes, the US allocation system continues to take a uniform approach to HCC patients, without discriminating between those with favorable or unfavorable tumor biology. We aim to review the history of liver allocation for HCC in the US, the utility of AFP in liver transplantation, the implications of weaving AFP as a biomarker into policy. Based on this review, we encourage the US transplant community to revisit its HCC organ allocation model, to incorporate more precise oncologic principles for patient selection, and to adopt AFP dynamics to better stratify waitlist dropout risk.