Late-stage HIV infection can lead to deficits in memory, attention, and the execution of tasks. As a result, people with HIV-related cognitive deficits are less likely to be accurate when taking their antiviral medicines. Dr. Steven M. Albert, associate professor of clinical sociomedical sciences at the Mailman School of Public Health, and colleagues reported in the September issue of AIDS and Behavior that people with HIV-related cognitive deficits are more likely to adopt fixed regimens for medication management actions that tend to lower viral loads than those without cognitive deficits.
Among people with HIV-related cognitive deficits, viral loads were lower if people adopted fixed medication regimens. The researchers say those with HIV-associated cognitive deficits are likely to adopt this type of behavior when taking their medicines, either because they themselves find it an effective way to ensure adherence or because others have suggested they do so.
Dr. Albert's team also found a widely shared lay understanding of medication strength in this sample of HIV-positive people that more milligrams mean the medicine is stronger even across different classes of medicine. Respondents assumed that medicines with higher milligram dosages were more likely to be addictive, needed to be taken with food, and produced side effects. This folk model of medication efficacy is widely believed; Dr. Albert reported that the belief was also common in a non-HIV comparison sample. This finding is important for understanding how people actually take medications, when they decide to reduce dosages without consulting physicians or when they attribute symptoms to their medications.
Prostate cancers in Hispanic men may produce more prostate-specific antigen (PSA) than those in Caucasian men, which suggests cutoff points used to diagnose prostate cancer may have to be adjusted for Hispanic men, according to a new study by P&S and Mailman School of Public Health researchers.
"More research needs to be done before we can say what is a reasonable cutoff, because this is just an initial study," says Dr. Erik T. Goluboff, associate professor of clinical urology at P&S, director of urology at the Allen Pavilion at NewYork-Presbyterian Hospital, and senior author of the study.
The investigators also found PSA levels to be better for discriminating between benign and malignant disease in Hispanic men than in Caucasian men. This could be due to biologic differences in prostate cancer or to prior differences in access to health care. For example, Caucasian patients are more likely to have undergone prostate cancer screening in the past, which probably would detect the more blatant cases of malignant disease.
The researchers decided to look at PSA and supplementary prostate volume and density measurements in Hispanics because many studies have compared PSA's effectiveness as a marker in African American and Caucasian men, but few have examined it in Hispanic men. Prostate cancer was diagnosed in almost 7,000 Hispanic men in America and accounted for an estimated 1,200 deaths among Hispanic men in 2001, making it the most commonly diagnosed cancer and the second leading cause of cancer deaths for Hispanic men.
The study, which appeared in the August issue of the Journal of Urology, compared the medical records of 404 Hispanic and 341 Caucasian men who had either elevated PSA or an abnormal digital rectal examination or both. None of the patients had previously been diagnosed with or treated for prostate cancer. Biopsies were done and ultrasound was used to measure the volume and density of the prostate.
Dr. Goluboff and colleagues are continuing to study the relationship of prostate size to prostate cancer in Hispanic and Caucasian men. They also are engaged in a study of the long-term effect of prostatectomy on PSA and cancer control.
Despite having a lower incidence of breast cancer, African American women with the disease have a poorer prognosis than Caucasian women, even when compared with women with the same stage of cancer. Socioeconomic factors and differences in tumor biology may contribute to this disparity. Now, researchers have found evidence that a racial difference in white blood cell count may also contribute.
Dr. Dawn Hershman, assistant professor of medicine and an oncologist at the Irving Comprehensive Cancer Center, recognized the importance of the difference when she noticed that her African American patients took longer to complete chemotherapy than her other patients. In all women, each round of chemotherapy reduces the number of white blood cells, but if the number doesn't rebound to a certain threshold in time for the next round, treatment may be delayed or reduced. African American women have, on average, 25 percent to 40 percent lower white blood cell counts than other women, so their white blood cell count does not recover from chemotherapy treatment as quickly.
In the present study, Dr. Hershman and her colleagues looked in the tumor registry at Columbia-Presbyterian Medical Center to check for racial differences in cell count before and after treatment and in length of treatment intervals.
The study compared 43 African American women with 93 Caucasian counterparts of the same age and tumor stage. Compared with Caucasians, the African American women had lower white blood cell counts before and after treatment and their treatment lasted an average four weeks longer (19 weeks vs. 15 weeks). The results are published in the Oct. 15 Journal of the National Cancer Institute.
Though the data cannot rule out other explanations such as access to care the difference in treatment may contribute to the poorer survival of African American women with breast cancer. Previous studies show lower doses and treatment delays decrease survival from breast cancer in all women. Dr. Hershman is conducting a larger study to investigate the reasons for the longer treatment as well as a study to determine if the current white blood cell threshold is appropriate for women with naturally low baseline counts.