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The U.S. Department of Housing and Urban Development (HUD) on Wednesday announced that it will provide several housing assistance grants to help low-income families living with HIV/AIDS, the Boston Globe reports (7/23). “A record $310 million will assist 58,000 U.S. households annually, officials said,” KITV.com reports. The grants were distributed based on the number of AIDS cases reported nationwide. The Gregory House Programs of Honolulu, a nonprofit that provides housing assistance, substance use and other services, will receive $1.3 million (KITV.com, 7/22). The Frannie Peabody Center in Portland, Maine, will receive $1.3 million; the city of Portland will receive $1.4; New Hampshire will receive over $716,000; and the Burlington Housing Authority in Vermont will receive over $392,000, the Globe reports (7/23).

This information was reprinted from dailyreports.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily U.S. HIV/AIDS Report, search the archives and sign up for email delivery at dailyreports.kff.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

Quantities of a prescription medication used throughout the world for treating malaria have been identified as lacking any active ingredient and presumably counterfeit. These are being removed from the market in Ghana, where they were discovered recently and confirmed as fake last Friday. The discovery was made by a vigilant citizen who contacted the Medicines Quality Monitoring program set up by the U.S. Agency for International Development (USAID)-supported Drug Quality and Information (DQI) Program, implemented by the U.S. Pharmacopeial (USP) Convention. USP is a nonprofit scientific organization that develops globally recognized standards for the quality of medicines. Through the DQI Program, USP works in developing countries to help verify, assure and improve the quality of medicines intended to treat life-threatening neglected diseases such as malaria, HIV/AIDS and tuberculosis, as well as advance the appropriate use of these medicines.

The fake drug found in Ghana did not contain the active pharmaceutical ingredients of the Novartis Coartem® product it was being sold as, posing a significant health threat to patients relying on the medication. This drug is an artemisinin-based combination therapy recommended by the World Health Organization (WHO) for treating “uncomplicated” malaria, which is endemic in 108 countries, 45 in Africa. A major barrier in combating malaria throughout much of the developing world is the widespread presence of counterfeit and adulterated drugs, which undermines the public health. Not only do these drugs fail to deliver the appropriate treatment to individual patients - putting their lives at risk - but they contribute to the growth of drug-resistant strains of malaria, one of the greatest challenges to malaria control today.

In this case, a local citizen brought a suspicious sample of “Coartem®” to one of five sentinel sites set up in the country to monitor and test medicine quality. After failing initial testing at the site, further testing by Ghana Foods and Drug Board (FDB) confirmed the medicine was indeed counterfeit. The USP DQI Program established the sentinel sites in coordination with the FDB and other partners with funding from USAID/Ghana under the President’s Malaria Initiative.

“This episode illustrates that the system the DQI Program established to improve drug quality by removing counterfeits is working,” said Rev. Jonahan Martey, head of the FDB’s Quality Control Laboratory. “Our joint efforts have only just begun to improve the public health situation here in Ghana, which has been continually challenged by the overwhelming presence of poor quality medicines. I look forward to continuing our work together to address malaria and other neglected diseases in the country - among the biggest threats to the citizens of Ghana.”

The FDB is currently seizing the drugs from wholesale and retail pharmacies as well as from licensed chemical sellers and is warning patients about the presence of the counterfeit Coartem® tablets.

“We are pleased to see this compelling example of how the Medicines Quality Monitoring program established by the USP DQI Program is directly and positively impacting the health of patients in Ghana,” said Patrick Lukulay, Ph.D., director of the program. “In this case, a local citizen brought the questionable medicine to one of the sentinel sites, which demonstrates one of the key ways we hoped the sites would work - by becoming an integrated part of the local community that citizens would feel comfortable and confident going to with concerns.”

The USP DQI Program is a cooperative agreement first awarded to USP by USAID in 2000 and renewed in 2005. Through the program, USP works in countries throughout Asia, Eastern Europe, Latin America and sub-Saharan Africa. Explaining the program, Lukulay notes that, “Every citizen deserves access to good quality medicines, and helping to make this a reality is our mandate.”

Source:
Francine Pierson

US Pharmacopeia

View drug information on Coartem.

New data collected at Columbia University Medical Center and by the Mount Sinai School of Medicine are helping researchers understand the extent to which a certain protein - NGAL - can play a significant role in marking chronic kidney disease resulting from HIV while at the same time distinguishing nephropathy from more common causes such as diabetes and hypertension.

It’s well-known that Human Immunodeficiency Virus-associated nephropathy (HIVAN) is an important cause of kidney disease in HIV-infected patients. Antiretroviral therapy plays an important role in the treatment of HIVAN, yet despite advances in understanding HIVAN, current recommendations for treatment have largely been based on observational data and can only definitively made after a kidney biopsy.

The current study, spearheaded by Columbia University’s Jonathan Barasch, M.D., Ph.D., along with Ali Gharavi M.D., Ph.D., Neal Paragas M.S., Thomas Nickolas M.D., M.S., and Vivette D’Agati M.D., together with Paul Klotman, M.D., Christina Wyatt M.D., and Susan Morgello M.D., of the Mount Sinai School of Medicine and Landino Allegri in Parma, Italy, and Prasad Devarajan in Cincinnati Childrens Hospital, represents the examination of data from human cohorts in New York and Parma, and from mouse models created by Dr. Klotman.

The team noted that NGAL, or Neutrophil Gelatinase Associated Lipocalin, a protein they previously discovered in damaged kidneys, was prominently expressed in kidney tissue and in the urine of humans and in mouse models of HIVAN. The high levels of the urine protein were out of proportion to the degree of chronic renal failure, for example that typifies patients with other types of chronic glomerular diseases of both mice and humans. Most strikingly, Paragas, Barasch, and Gharavi noticed that the rise in urinary NGAL levels was in conjunction with the development of a specific type of lesion, namely tubular cysts that typify HIVAN. The association with these cysts consequently may justify their biopsy or an aggressive treatment with antiretroviral drugs when high levels of urine NGAL are discovered.

“From what we can tell, NGAL is unexpectedly expressed in great abundance by kidney cysts allowing the clinician to potentially identify HIVAN among other types of chronic kidney diseases and hopefully to intervene to prevent a kidney from ultimately dying from what physicians refer to as ESRD, or ‘end-stage renal disease,’” Dr. Barasch says.

Dr. Barasch cautions that studying a much larger human cohort would be needed in order to determine the precise relationship of NGAL to HIVAN and whether the protein is a good enough predictor of tubular cysts, but he finds the results of the study unexpected and intriguing.

The research appears in an upcoming Journal of the American Society of Nephrology and was funded in part by the Emerald Foundation, the March of Dimes, the National Institutes of Health and the Glomerular Center of Columbia University.

Not adequately diagnosing kidney problems can be life-threatening and NGAL expression which is induced in kidney disease and damage can help identify patients at risk of kidney failure even in those without HIV. Last year, Dr. Barasch and Nickolas found that approximately 65 percent of patients with NGAL protein in the urine upon presentation to the Emergency Department will require care by a nephrologist, another 32 percent will need dialysis, and 29 percent will require care in the intensive care unit, over the course of a week following the subsequent hospitalization. That study was published in the June 3, 2008, issue of the Annals of Internal Medicine.

Source:
Alex Lyda

Columbia University Medical Center