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ObjectivesTo examine the impact of serum-derived bovine immunoglobulin, an oral medical food known to neutralize bacterial antigen and reduce intestinal inflammation, on restoration of mucosal immunity and gastrointestinal function in individuals with HIV enteropathy.DesignOpen-label trial with intensive 8-week phase of bovine serum immunoglobulin (SBI) 2.5 g twice daily with a 4-week washout period and an optional 9-month extension study.MethodsHIV enteropathy was defined as chronic gastrointestinal symptoms including frequent loose or watery stools despite no identifiable, reversible cause. Upper endoscopy for tissue immunofluorescent antibody assay and disaccharide gut permeability/absorption studies were performed before and after 8 weeks of SBI to test mucosal immunity and gastrointestinal function. Blood was collected for markers of microbial translocation, inflammation, and collagen kinetics. A validated gastrointestinal questionnaire assessed changes in symptoms.ResultsAll eight participants experienced profound improvement in symptoms with reduced bowel movements/day (P = 0.008) and improvements in stool consistency (P = 0.008). Gut permeability was normal before and after the intervention, but D-xylose absorption increased in seven of eight participants. Mucosal CD4 lymphocyte densities increased by a median of 139.5 cells/mm2 from 213 to 322 cells/mm2 (P = 0.016). Intestinal-fatty acid binding protein (I-FABP), a marker of enterocyte damage, initially rose in seven of eight participants after 8 weeks (P = 0.039), and then fell below baseline in four of five who continued receiving SBI (P = 0.12). Baseline serum I-FABP levels were negatively correlated with subsequent rise in mucosal CD4 lymphocyte densities (r = -0.74, P = 0.046).ConclusionSBI significantly increases intestinal mucosal CD4 lymphocyte counts, improves duodenal function, and showed evidence of promoting intestinal repair in the setting of HIV enteropathy.

Objectives. We studied the effect of local approval of syringe exchange programs in California (through Assembly AB136) on program availability and performance. Methods. We determined the number of active syringe exchange programs in California by conducting Internet searches and obtaining information from the state and from local programs. To track changes in program availability and performance between 2000 and 2002, we interviewed 24 program directors annually for 3 years about program characteristics, syringe exchange policies, law enforcement contact, and other issues. We conducted multivariate analyses to determine whether AB136 approval status was associated with changes in performance. Results. Fifteen local governments (13 counties and 2 cities) enacted the new law by 2002, and operating syringe exchange programs increased from 24 to 35. The proportion of these programs that were not locally approved declined from 54% to 40%. No new approved programs were started in high-need counties. Total syringes exchanged increased by more than 1 million per year, average annual budgets increased by more than 50%, and police harassment of the program volunteers, clients, and operators declined. Improvements at approved syringe exchange programs accounted for these changes. Conclusions. Statewide approval and funding appears necessary to further syringe exchange availability in California. (Am J Public Health. 2008;98:278-283. doi: 10.2105/AJPH.2005.080770)

We described the availability and outcomes of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) testing services at syringe exchange programs throughout California, using interviews with 24 syringe exchange program directors and 560 syringe exchange clients. Both HIV and HCV testing services were available in 62% of programs, 21% had HIV testing only, and 17% had neither. Programs administered by health care/social service providers were more likely than independent syringe exchange programs to have HIV and HCV testing services available. Among clients of programs with testing available, clients of illegal programs were significantly less likely than clients of legal programs to have used syringe exchange HIV and HCV testing services. The availability of HIV and HCV testing services at syringe exchange programs varies, and the use of existing testing services by clients is not universal. Efforts to increase both the availability of HIV and HCV testing services at syringe exchange programs and the use of existing testing services are needed. Keywords: HIV testing; Hepatitis C virus; Syringe exchange programs; Injection drug use

An attempt is made to examine whether different syringe dispensation policies were associated with client-level injection-related HIV risk. It is suggested that clients of syringe exchange programs (SEPs) with syringe distribution dispensation policies exhibit lower odds of reusing syringes than clients of SEPs with one-for-one or one-for-one-plus syringe dispensation policies.

The vaccine that is currently used against hepatitis B infections is effective, but its use is limited because of its high cost. This study investigated the feasibility of substituting an intradermal (injected under the skin rather than into muscle) vaccine containing lower dosages of the surface antigen, hepatitis B surface antigen, (HBsAg). (Antigen stimulates the production of specific antibodies; in this case an immunized individual would have antibodies against hepatitis B.) Medical students are one of the groups at increased risk for contracting the hepatitis B virus (HBV) and were used as the subjects of this study. Ninety-two healthy young students volunteered for the study and were screened for previous exposure to the virus. The subjects were given a low-dose intradermal injection of Heptavax-B, containing the active ingredient HBsAg, which was followed up with additional injections at one month and at six months. Measurement of HBsAg antibody levels were also taken at these intervals and again after one year had elapsed. Some minor abnormalities were observed in the tissue area surrounding the injection site. At the six-month interval, 18 percent of the students had a hardening of the tissue at the injection site, but this disappeared by the end of one year. Another side effect which persisted in 63 percent of the subjects for over a year was a discoloration of the skin. Tests made at six months indicated levels of antibodies at greater than or equal to 10mlU per ml for HBsAG. At the end of one year 95 percent of the subjects showed antibody levels greater than or equal to 10mlU per ml and 75 percent actually had levels exceeding 100mlU per ml. It was concluded that Heptavax-B is a safe and economic means of providing immunization to large groups of people. The authors believe that the value of this technique is significant because universal vaccination is being considered for children in this country and Heptavax-B may provide the best method.

This article describes the secondary syringe exchange (SSE) practices of injection drug users (IDUs) attending 23 syringe exchange programs (SEPs) in the state of California during 2002 (n = 539). The sample was primarily heroin injecting, about two thirds male, half White and half other racial/ethnic groups. Participants were interviewed with a structured questionnaire that included items on sociodemographic factors, drug use practices, sexual practices, use of SEP and other social services, and satisfaction with SEP services. Interviews lasted about 30 minutes. SSE was highly prevalent: 75% of IDUs reported participating in SSE in the 6 months before interview. Program characteristics, such as legal status, SSE policy, and exchange policy, did not affect the prevalence of SSE among SEP clients. Infectious disease risk behaviors were significantly more common among SSE participants than nonparticipants. SSE participants were more likely to share syringes ( p [ABSTRACT FROM AUTHOR]

Background: A vaccine is needed to prevent human immunodeficiency virus type 1 (HIV-1) infection., Methods: A double-blind, randomized trial of a recombinant HIV-1 envelope glycoprotein subunit (rgp120) vaccine was conducted among men who have sex with men and among women at high risk for heterosexual transmission of HIV-1. Volunteers received 7 injections of either vaccine or placebo (ratio, 2 : 1) over 30 months. The primary end point was HIV-1 seroconversion over 36 months., Results: A total of 5403 volunteers (5095 men and 308 women) were evaluated. The vaccine did not prevent HIV-1 acquisition: infection rates were 6.7% in 3598 vaccinees and 7.0% in 1805 placebo recipients; vaccine efficacy (VE) was estimated as 6% (95% confidence interval, -17% to 24%). There were no significant differences in viral loads, rates of antiretroviral-therapy initiation, or the genetic characteristics of the infecting HIV-1 strains between treatment arms. Exploratory subgroup analyses showed nonsignificant trends toward efficacy in preventing infection in the highest risk (VE, 43%; n=247) and nonwhite (VE, 47%; n=914) volunteers (P=.10, adjusted for multiple subgroup comparisons)., Conclusions: There was no overall protective effect. The efficacy trends in subgroups may provide clues for the development of effective immunization approaches.