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The emerging HIV/AIDS threat in Asia was the focus last month of a full-day symposium co-hosted by the Mailman School of Public Health and amfAR, the leading U.S. non-profit organization dedicated to the support of AIDS research. The Dec. 3 event was held in observance of World AIDS Day at the Columbia University Morningside Heights campus.

It is estimated that China, by 2010, will have between 10 million and 15 million HIV/AIDS cases, and India could have as many as 25 million—more than any country in the world. "With an estimated 1.1 million new HIV cases in one year alone, the region will soon have more HIV infections than any other part of the world," said Dr. Allan Rosenfield, Mailman dean. Experts fear this rapid spread of HIV/AIDS could undermine economic, social and political structures, creating regional instability and posing a potential threat to our own national security.

"Having witnessed the devastation AIDS has wrought in sub-Saharan Africa, we must act now, applying what lessons we have learned in Africa to prevent the same fate from befalling the vast populations of Asia," said Dr. Mathilde Krim, founding chairman and chairman of the board of amfAR and honored guest at the day's event.

Other speakers included Mailman Professor Jeffrey Sachs, director of Columbia's Earth Institute and special adviser to UN Secretary General Kofi Annan. He offered insights about the economics of controlling AIDS and said that "with our powerful technologies and the smallest of efforts, we could alleviate this pandemic."

Dr. Wafaa El-Sadr, director of Mailman's MTCT-Plus Initiative AIDS treatment program in Africa, said there is a need for comprehensive care in Asia and suggested drug therapy as well as family-centered care are keys to a successful prevention/intervention AIDS initiative.

Leading film actor and social activist Richard Gere served as the keynote speaker. Mr. Gere called for a broad effort by doctors, government, celebrities, and the media to work together in beating this crisis of unprecedented proportions. For additional information and coverage of the event, access http://www.kaisernetwork.org/health_cast/hcast_index.cfm ?display=detail&hc=723.

—Stephanie Berger


Half of all the tuberculosis cases in the United States are attributed to immigrants entering the country with latent infections that later develop into active, contagious disease. Debate exists over whether to screen and treat latent infections because they do not harm the patient or spread to others and the treatment can potentially cause liver damage.

But a new cost-effectiveness analysis shows that a program to detect and treat latent infections in new immigrants to the United States would have substantial health and economic benefits. The analysis also reveals that alternative drugs should be used for immigrants from countries where resistance to the most common treatment is high. The research was published in the Dec. 5 issue of the New England Journal of Medicine.

The debate over latent infection treatment hinges on the possibility that a person whose latent infection might never have become active may suffer serious side effects from the treatment, according to the paper's senior author, Dr. Joshua Graff Zivin, assistant professor of health policy and management in the Mailman School of Public Health. Latent infection treatment can, on rare occasion, cause severe hepatotoxicity, leading to hospitalization and possibly permanent liver damage.

In Dr. Graff Zivin's analysis, a computer model calculated the rate of active infection in a hypothetical group of 700,000 immigrants with and without latent treatment and the cost of treating latent infections.

The model showed that one year of screening and treating new immigrants from developing countries would prevent 9,000 to 10,000 cases of active tuberculosis and save $60 million to $80 million during the lifetime of the immigrants. The drugs, the analysis also showed, would cause severe hepatotoxicity in 0.008 percent of immigrants, or 56 people out of 700,000.

The cost-effectiveness analysis also found that immigrants from Vietnam, Haiti, and the Philippines—where resistance to the most commonly used drug, isoniazid, is high—should be treated with rifampin plus pyrazinamide.

"Even taking into account the side effects," Dr. Graff Zivin says, "treating immigrants for latent infections, as opposed to waiting for active disease to develop, improves the overall health of the immigrant cohort. Moreover, it does so at a cost savings to society."

—Susan Conova


Past research has pointed to a link between chronic anxiety and peptic ulcer disease. But for the past two decades, since the discovery of the Helicobacter pylori bacteria in 1982 and subsequent findings supporting an infectious cause of ulcer disease, the anxiety link has been questioned.

A new study led by Dr. Renee D. Goodwin, assistant professor of epidemiology at the Mailman School of Public Health, though, extends the earlier idea that anxiety and peptic ulcer disease are associated. But it remains unclear whether one causes the other. The results were reported in the November/December issue of Psychosomatic Medicine.

Dr. Goodwin and her colleague Dr. Murray B. Stein, professor of psychiatry at the University of California San Diego, analyzed data from the National Comorbidity Survey, a household survey of 8,098 U.S. adults performed between 1990 and 1992. The survey administered a structured psychiatric interview to a nationally representative sample of individuals.

After controlling for sociodemographic characteristics, such as marital status, age, education, race, and income, and psychiatric and medical comorbidity, the researchers found generalized anxiety disorder is associated with a significantly increased risk of self-reported peptic ulcer disease. They also found that the more generalized anxiety symptoms a person has, the more likely that person is to have peptic ulcer disease. The investigators examined a wide range of psychiatric conditions but found only generalized anxiety disorder, bipolar disorder, and specific phobia are associated with peptic ulcer disease.

People with anxiety or bipolar disorder may be more susceptible to infection and ulcers or ulcers may make people more anxious. Alternatively, a third variable could be associated with increased vulnerability to both generalized anxiety disorder and ulcer. Dr. Goodwin says understanding the causal risk factors for generalized anxiety and ulcer is important because it would help in developing effective prevention strategies.

While Dr. Goodwin's research is based on population-based data, prior studies were based on data from people who had sought treatment for a disorder and were asked to participate in a study. These earlier results were biased towards those people who sought treatment.

Dr. Goodwin plans to do further studies using data from longitudinal, epidemiologic studies that include physiologic data. Physiological data might be more objective than self-reports of ulcer disease.

—Matthew Dougherty


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