Preliminary results of a study into persistence of Ebola virus in body fluids show that some men still produce semen samples that test positive for Ebola virus nine months after onset of symptoms. The report was published on October 14 in the New England Journal of Medicine. The long-term study is being jointly conducted by the Sierra Leone Ministry of Health and Sanitation, Sierra Leone Ministry of Defence, the World Health Organization and the U.S. Centers for Disease Control and

Prevention.

“Sierra Leone is committed to getting to zero cases and to taking care of our survivors, and part of that effort includes understanding how survivors may be affected after their initial recovery,” says Amara Jambai, M.D., M.Sc., Deputy Chief Medical Officer for the Sierra Leone Ministry of Health and Sanitation. “Survivors are to be commended for contributing to the studies that help us understand how long the virus may persist in semen.”

Ninety three men over the age of 18 from Freetown, Sierra Leone, provided semen samples that were tested to detect the presence of Ebola virus genetic material. The men enrolled in the study between two and 10 months after their illness began. For men who were tested in the first three months after their illness began, all were positive (9/9; 100 per cent). More than half of men (26/40; 65 per cent) who were tested between four to six months after their illness began were positive, while one quarter (11/43; 26 per cent) of those tested between seven to nine months after their illness began also tested positive. The men were given their test results along with counseling and condoms. What remains unclear is why some study participants had cleared the fragments of Ebola virus from semen earlier than others. The U.S. Centers for Disease Control and Prevention in Atlanta is conducting further tests of the samples to determine if the virus is live and potentially infectious.

“These results come at a critically important time, reminding us that while Ebola case numbers continue to plummet, Ebola survivors and their families continue to struggle with the effects of the disease,” says Bruce Aylward, WHO Director-General’s Special Representative on the Ebola Response. “This study provides further evidence that survivors need continued, substantial support for the next six to 12 months to meet these challenges and to ensure their partners are not exposed to potential virus.”

“Ebola survivors face an increasing number of recognized health complications,” said CDC Director Tom Frieden, M.D., M.P.H. “This study provides important new information about the persistence of Ebola virus in semen and helps us make recommendations to survivors and their loved ones to help them stay healthy.”

There are more than 800 male survivors across the three countries who need appropriate education and regular testing to help them take appropriate measures to prevent potential exposure of their partners to the virus.

In an effort to prevent childhood obesity, researchers are conducting a study at the Edmonton Oliver Primary Care Network (PCN) using RIPPLE (the Resource Information Program for Parents on Lifestyle & Education). RIPPLE is a screening, brief intervention and referral to treatment program. It is designed to screen children’s weight status, deliver a brief intervention to parents related to children’s lifestyle behaviours, and provide referrals to treatment and other supportive resources for parents.

Researchers believe this program will help parents better identify their children’s diet and physical activity habits. Parents of 5 to 17 year olds can participate while they wait for their appointment with their pediatrician at the Allin Clinic. Using a tablet, they answer a series of questions related to their children’s eating and activity habits.

“Through this technology, parents are giving us better, more accurate information about their children’s lifestyles,” says Jillian Avis, a PhD candidate with the Department of Pediatrics (Faculty of Medicine & Dentistry) at the University of Alberta.

“We’re hoping to enhance parents’ awareness and increase their motivation to support children’s healthy lifestyle behaviors,” says Dr. Geoff Ball, associate professor with the Department of Pediatrics at the University of Alberta. “We follow up after one month to determine what, if any, changes are taking place and to connect them to more resources, if necessary.”

This project is funded by a research grant from the Canadian Institutes of Health Research, Alberta Innovates – Health Solutions, and Public Health Agency of Canada.

A large study with follow-up over 14 years offers a unique way of looking at the risk of cancer among HIV-positive individuals by accounting for the competing risk of death in the era of highly effective antiretroviral therapy (ART), as reported on October 6 in the Annals of Internal Medicine. The study was funded primarily by grants from the National Institutes of Health.

The study population consisted of 86,620 HIV-infected and 196,987 uninfected adults followed between 1996 and 2009 in 16 cohorts from the U.S. and Canada participating in the NA-ACCORD.

Researchers used the competing risk of death approach to estimate cumulative cancer incidence by HIV status and calendar era. Among HIV-infected subjects, the median CD4 count increased. Despite increasing age, the mortality rate decreased, but even in 2005-2009 the mortality rate was over three-fold higher than in uninfected subjects.

“This analysis provides easily interpretable information for HIV patients and their providers about their long-term cancer risk, and helps us identify where public health and clinical efforts should be focused to achieve the biggest impacts,” said co-author Richard D. Moore, MD, MHS, of the Johns Hopkins School of Medicine, and overall principal investigator of the North American Cohort Collaboration on Research and Design (NA-ACCORD).

“In the era before antiretroviral therapy, people who were infected with HIV were dying of AIDS. Now that use of this therapy is greatly increasing the lifespan of HIV-infected patients, their risk of developing other diseases, such as cancer, has increased,” said lead author Michael J. Silverberg, PhD, MPH, Research Scientist at the Kaiser Permanente Northern California Division of Research. “These patients have a higher burden of cancer compared with the general population due to impaired immune function and chronic inflammation, as well as a higher prevalence of risk factors including smoking and viral co-infections.”

“Our approach allowed us to disentangle the effects of longevity from other factors on the risk of cancer,” explained Silverberg. “For example, we found that longevity was the main contribution to the increased risk over time for anal, colorectal and liver cancers. The risk for other cancers, such as lung cancer, melanoma and Hodgkin’s lymphoma, did not appear to increase over time. This was because the increased risk with longevity was compensated for by other factors, such as decreases in smoking or adverse sun exposure behaviors.”

The researchers identified several clinical implications regarding cancer screening in HIV patients:

— The high smoking prevalence in HIV patients, along with high lung cancer incidence, suggests that HIV-infected smokers may benefit from new guidelines for annual lung cancer screening with low-dose computed tomography. In addition, development of targeted smoking cessation interventions for HIV patients should remain a priority.

— The rise in colorectal cancer risk among HIV patients, despite a decline in the general population, indicates the possible need for increased screening among HIV patients aged 50-75 years, as recommended for the general population.

— The increasing risk of liver cancer over time indicates a need to ensure universal hepatitis B virus (HBV) vaccination for HIV patients who are HBV seronegative, and to provide treatment of HBV infection using antiretroviral therapy (ART) regimens with anti-HBV activity and of hepatitis C virus (HCV) infection with recently approved interferon-free therapies.

— The highly effective human papillomavirus (HPV) vaccine, which was licensed in 2011 for the prevention of anal cancer, has been found to produce immunity in HIV patients, suggesting that vaccination has the potential to substantially decrease the burden of anal and possibly HPV-related oral cavity/pharyngeal cancers, although further research is needed.

— Research is also needed to follow-up on observational studies that suggest statin use by HIV patients may reduce cancer risk, presumably due to their anti-inflammatory effects.

— Efforts need to be intensified to promote early, sustained ART, the only known approach to prevention of Kaposi sarcoma and non-Hodgkin’s lymphoma and possibly other cancers linked to immunosuppression or inflammation.

On October 5, Jarden Life Sciences published a white paper discussing available strategies to help to reduce risk and variability in temperature-sensitive pharmaceutical sampling. The paper outlines the advantages of active systems for temperature assurance, which offer decreased risk, increased potential for return-on-investment and improved efficiencies for temperature-sensitive pharmaceutical sampling when compared to passive systems.

In its white paper, Jarden Life Sciences says the growing number of biologic pharmaceuticals is a contributing factor to the need for reliable methods of distributing temperature-sensitive products in the last mile of the supply chain.

“As the demand for and prevalence of biologic drugs increases, so does the need for effective, efficient and compliant solutions for distributing temperature-sensitive drug samples,” said Scott Dyvig, program manager, Packaging Engineering and Technical Services at Jarden Life Sciences. “Active temperature-control systems, like Jarden Life Sciences’ Envirocooler™ ActiVault™, offer a reliable and consistent temperature environment for the last mile of product distribution, increasing efficiencies and reducing costs over time.”

The Jarden Life Sciences’ white paper on temperature-sensitive pharmaceutical sampling provides insight into such areas as the impact of biologic drug development on product sampling; active vs. passive temperature-control systems: risks and rewards; and active systems as a business solution and key elements in the last mile of the cold chain distribution process

According to Jarden Life Sciences, passive cooling systems are the alternative to active systems, but they “require additional steps to set up and maintain and are more vulnerable to human operator error when creating the cooling environment needed to sustain the temperature range for certain pharmaceuticals, such as biologics.” The company believes active systems, on the other hand, “rely on a power source that can provide a more reliable and consistent temperature for the transport of biologic samples, substantially decreasing the number of steps taken by the user and reducing variability caused by external environmental changes.”