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3. MUSALLAM KM, Sharara AI, Inati A, Taher AT, et al.
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Eur J Gastroenterol Hepatol. 2010;22:769.
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4. ALONSO RODRIGUEZ L, Barcina Pajares R, Fuentes Vigil J, Gutierrez Gonzalez A, et al.
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7. HONDA M, Sakai A, Yamashita T, Nakamoto Y, et al.
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A new TV and print advertising campaign promoting hepatitis B vaccination debuts in San Francisco this week. The goal of the San Francisco Hep B Free-sponsored effort is to spur the city’s Asian-American population into action against the disease. The ads encourage residents to get a “simple blood test” because “hepatitis B can be treated, even prevented.”

City health officials report as many as one in 10 residents of Asian descent are infected with hepatitis B – one reason behind the city’s liver cancer rate, which is the nation’s highest. By comparison, the hepatitis B rate in the general population is roughly 1 in 1,000.

Central to the problem is the stigma attached to hepatitis B, which is endemic in most regions of Asia, say leaders of San Francisco’s Chinese-American community, the largest Asian ethnicity there.

According to Hep B Free committee member Ted Fang, the infection rate among Asian-Americans is particularly vexing considering a vaccine to prevent hepatitis B has been available for nearly 30 years. “We have the medical tools, so long as doctors will test their patients and monitor them,” he said.

A previous, less blunt campaign by the group did not go far enough, said Vicky M. Wong, president and chief executive of DAE, the San Francisco firm that worked with Hep B Free on the new campaign. “Saying ‘Life is beautiful; get tested,’ doesn’t work,” she said. The new ads show a range of Asian community members and ask the stark question, “Which one deserves to die?”

Though the ads are being published in languages including Chinese, Korean, and Vietnamese, a major target audience is English-speaking doctors outside the Asian community. These physicians may not be aware of the virus’ disproportionate impact on Asian-Americans, organizers say.

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10. ALAVIAN SM, Tabatabaei SV.
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11. BAYARD F, Malmassari S, Deng Q, Lone YC, et al.
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2. GUTELIUS B, Perz JF, Parker MM, Hallack R, et al.
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5. CLEMENT S, Pascarella S, Conzelmann S, Gonelle-Gispert C, et al.
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6. CARDOSO AC, Moucari R, Figueiredo-Mendes C, Ripault MP, et al.
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7. FUKUHARA T, Taketomi A, Okano S, Ikegami T, et al.
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8. SCHAPER M, Rodriguez-Frias F, Jardi R, Tabernero D, et al.
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9. BEAUVILLAIN C, Meloni F, Sirard JC, Blanchard S, et al.
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10. BUKH J, Meuleman P, Tellier R, Engle RE, et al.
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11. MEHTA N, Cunningham CK, Flynn P, Pepe J, et al.
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12. NIEDERAU C, Bemba G, Kautz A, Bertram T, et al.
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2. LEWIS-XIMENEZ LL, Lauer GM, Schulze Zur Wiesch J, de Sousa PS, et al.
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Australia should allow controlled needle and syringe programs (NSPs) in prisons to prevent hepatitis C and HIV transmission among incarcerated needle-sharing injection drug users, a harm-reduction group says. Such an NSP would require prisoners to store a used syringe inside a protective container before swapping it for a clean one in a container, said the Association for Prevention and Harm Reduction Programs Australia (Anex).

Australian researchers have found that almost 40 percent of inmates report injection drug use (IDU) while imprisoned, and about 70 percent of them shared needles. Some prisoners reported a needle being reused by as many as 100 inmates, with needles being re-sharpened by grinding them on cell walls. Two-thirds of corrections officers reported finding contraband needles, which is a potential risk during cell and prisoner searches. About 35 percent of inmates are infected with hepatitis C virus, and 0.5 percent have HIV.

“It is irrefutable that prison authorities owe a duty of care to prisoners, to protect them from foreseeable harm while they are in custody,” said John Ryan, executive director of Anex. Such programs “have been operating for up to 10 years in Switzerland, Germany, Luxembourg, Spain, Moldova, Kyrgyzstan, and Belarus.”

“The introduction of prison-regulated and controlled NSPs in these countries has not resulted in instances of syringes being used as weapons,” Ryan said. “In fact, international experience shows that prison-regulated and controlled NSPs actually can increase institutional safety.”

The evidence that needle and syringe programs (NSPs) are effective in preventing HIV and hepatitis C virus (HCV) is weaker than acknowledged in the current scientific literature, a new analysis of research suggests. The new review of English-language literature to March 2007 included for analysis three high-quality “core” reviews and two supplementary ones.

The metareview found sufficient evidence that NSPs reduce self-reported injecting risk behavior (IRB), and tentative evidence that alternative pharmacy NSPs have an additional impact on IRB. UK researchers found only tentative evidence that NSPs are effective in preventing HIV and insufficient support for their preventing HCV. However, of the five reviews, three did not examine HCV “in any depth,” noted Norah Palmateer, of Health Protection Scotland, and colleagues.

“Insufficient or weak evidence of an effect is not evidence of no effect,” said Palmateer. “It is more a reflection of the studies and evidence available.”

Part of the problem is that the studies have been observational, rather than randomized controlled clinical trials, Palmateer said. Observational studies are open to “selection bias,” she said. For example, if those at greatest risk for HIV tended to use an NSP, a study might find higher HIV prevalence associated with the program. In addition, the NSPs studied had strict limits on the number of syringes and needles they could give clients, she said.

Of 10 HIV-focused NSP studies reviewed in 2004 by the World Health Organization, five had positive findings. However, four of the five had design weaknesses that limit the conclusions that can be drawn. Two of the reviews analyzed by Palmateer’s team included many of the same studies in the WHO report. One research group agreed with WHO, while the other more guardedly found “modest” evidence that NSP’s prevent HIV transmission.

“The main public health implications of the findings are that a higher level of coverage of interventions, including [NSPs], is likely required to reduce blood-borne virus transmission,” said Palmateer.

The full meta-analysis, “Evidence for the Effectiveness of Sterile Injecting Equipment Provision in Preventing Hepatitis C and Human Immunodeficiency Virus Transmission Among Injecting Drug Users: A Review of Reviews,” was published in Addiction (2010;doi:10.1111/j.1360-0443.2009.02888.x).

In San Francisco Friday at the 17th Conference on Retroviruses and Opportunistic Infections, Yale University School of Medicine researchers will present a study, reportedly the first of its kind, of the viability of hepatitis C virus (HCV) in used syringes. When shared among injecting drug users, syringes with detachable needles are more likely to transfer HCV from one person to another, the results show.

In their experiment, Dr. Elijah Paintsil and colleagues loaded HCV-infected blood into syringes, depressed the plunger, and measured the amount of HCV in the residual blood at that time and again nine weeks later. In detachable-needle syringes, HCV persisted at nine weeks in most temperatures. In syringes with attached needles, much less viable HCV was noted.

Paintsil said prevention specialists operating needle-exchange programs should be aware of the study’s results, though he noted that detachable-needle syringes are used much more commonly by drug injectors outside the United States.