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a Message from the editorWe at Physicians Weekly are proud to present this monograph on infectious disease. Created with the assistance of key opinion leaders and experts in the field, these features offer clinical and evidence-based information and news surrounding the manage ment of infectious disease, which continue to be a challenging problem for hospitals, doctors, and providers across other healthcare settings. Physicians Weekly will continue to feature news about infectious disease in the coming months. Your feedback and opinions are welcome, email keithd@physweekly.com. Thanks for reading!

sincerely,

Keith dOria Editorial Director, Physicians Weekly

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Research suggests that the epidemiology of HIV/aIds in rural areas of the united states differs from that of urban and peri-urban areas. small studies have found that sub-populations in rural areas may be less likely to receive quality care and achieve optimal HIV outcomes when compared with indi-viduals living in urban areas. However, generalizing HIV/aIds care in rural areas may be misguided because each has its own unique characteristics. Concern is growing in the research community that

Lucy e. Wilson, MD, scMAdjunct Assistant Professor, Department

of Medicine

Johns Hopkins University School of Medicine

Chief, Center for Surveillance, Infection Prevention, and Outbreak Response

Office of Infectious Disease Epidemiology and Outbreak Response

Infectious Disease and Environmental Health Administration

Maryland Department of Health and Mental Hygiene

While patients with HIV/AIDS who live in non-urban areas share many of the same characteristics of those

who live in urban areas, there are important differences that can impact healthcare access and outcomes. Better

representation of these patients in research is warranted.

comparingomparing

Rural & Rural & urbanin HIV care

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who live in urban areas, there are important differences that can impact healthcare access and outcomes. Better

representation of these patients in research is warranted.

44

comparing Rural & urban HIV care Lucy E. Wilson, MD, ScM

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community-acquired pneumonia (Cap) remains a frequent cause of morbidity and mortality and ranks as the top cause of

death from an infectious disease in the world as well as the third leading cause of death overall. In addition to dying within the hospital, patients hospitalized with pneumonia are at an increased risk of death for months to years after being discharged. Over the past decade, significant efforts have been made to improve the care and outcomes associated with Cap. These efforts, however, are often complicated by the fact that about half of all Cap-associated mortality is not directly due to the infection.

Mark L. Metersky, MD, fccPMedical Director, Center for Bronchiectasis Care

Division of Pulmonary and Critical Care Medicine

University of Connecticut Health Center

Predicting Death from Pneumonia A recent analysis has found that comorbidities appear to be important predictors of mortality in patients with pneumonia both before discharge and during the immediate post-discharge period.

Cardiovascular complications and death from other comorbidities cause a substantial proportion of Cap-associated mortality.

Recently, 30-day mortality for patients with pneu-monia became a publicly reported performance measure by CMs. Hospitals are now being measured based on how their Cap patients fare after they are discharged. In addition to patient-related factors, 30-day mortality can be affected by the quality of care provided in hospitals and after discharge, says

Mark L. Metersky, Md, FCCp. although risk factors for mortality in patients with Cap have been investigated extensively, relatively few studies have compared patient-specific factors for mortality before and after discharge from the hospital.

Predicting MortalityIn a retrospective analysis in an issue of Chest, dr. Metersky and colleagues reviewed 21,223

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community-acquired pneumonia (Cremains a frequent cause of morbidity and mortality and ranks as the top cause of University of Connecticut Health Center

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Predicting Death from Pneumonia Mark L. Metersky, MD, FCCP

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n early 5 million ameri cans are infected with hepatitis C, and more than 80% of these individuals are baby boomers. alarmingly,

75% of people with hepatitis C arent aware they are infected.

The CdC recently took a significant step and issued new guidelines recommending that all baby boomers (those born between 1945 and 1965) have a one-time test for hepatitis C. This is an important recommendation that could detect another 800,000 of those infected and could potentially save 120,000 lives. to help implement the recommendations, physicians should talk to their patients about being tested.

Michael J. Ryan, MD, facPDirector of DLDS Research

Gastrointestinal & Liver Specialists of Norfolk

Clinical Professor of Medicine

Eastern Virginia Medical School

Co-Chair, I.D. Hep C Campaign

American Gastroenterological Association

characterizing Hepatitis cHepatitis C is the leading cause of liver failure, liver cancer, and liver transplants in the united states. Its often considered a silent disease because the infection is asymptomatic in over 80% of those chronically infected. Over a period of 20 to 50 years, hepatitis C will lead to cirrhosis in 25% to 50% of cases and will result in death in at least 5% to 10% of cases. In fact, as of 2007, the number of deaths from hepatitis C surpassed that attributable to aIds.

Hepatitis C remains the only viral infection that can be cured, and this move toward broader testing comes at an important time as therapy continues to improve. Cure rates with protease inhibitors recently approved by the Fda range between 68% and 79%. For many patients, these therapies will cut treatment time in

half. With more than 50 drugs in development, the cure rate is likely to improve to greater than 90% over the next 5 to 10 years, and therapy will be easier to tolerate and take less time to become effective.

testing Matterstesting for hepatitis C, which averages $50 to $150 per test, has been shown in studies to be cost-effective, especially as the epidemic costs the u.s. an estimated

$30 billion per year. That number is projected to rise to $80 billion per year by 2025. Curing the majority of those affected will dramatically reduce those costs.

physicians should recognize that routine physical exams may not detect hepatitis C. up to 40% of infected people will have normal liver blood tests, so a specific antibody test must be conducted. In addition to talking to baby boomers about hepatitis C testing, physicians should also discuss testing with other high-risk patients, including those who received blood products prior to 1992, people with a history of intravenous drug use (even once), healthcare workers, sexual partners of those infected, and those with tattoos and body piercings. Recently, concern has also been raised for potential transmission in nail salons and barber shops, although this issue continues to be evaluated.

The american Gastroenterological association has also joined the fight against hepatitis C. It recently launched I.D. Hep C, a national campaign to increase awareness about hepatitis C among patients and healthcare professionals as well as encourage baby boomers to get tested. The campaign website www.IdHepC.orgprovides resources for patients and physicians, including a flyer on testing that can be distributed to patients or made available in waiting rooms.

click here to see more information on this article, including the contributors financial disclosure information and references.

Hepatitis c testing: Calling All Baby Boomers

Readings & Resources

smith BD, Morgan RL, Beckett Ga, falck-Ytter Y, Holtzman D, Ward JW. Hepatitis C virus testing of persons born during 1945 to 1965: recommendations from the Centers for Disease Control and Prevention. Ann Intern Med. 2012 Aug 16 [Epub ahead of print]. Available at: http://annals.org/article.aspx?articleid=1310557.

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