Enrollment of racial/ethnic minorities in NIAID-funded networks of HIV vaccine trials in the United States, 1988 to 2002.

OBJECTIVE: The purpose of this study was to analyze enrollment of racial/ethnic minorities in Phase I and Phase II HIV vaccine trials in the U.S. conducted by National Institute of Allergy and Infectious Diseases (NIAID)-funded networks from 1988 to 2002. METHODS: A centralized database was searched for all NIAID-funded networks of HIV vaccine trial enrollment data in the U.S. from 1988 through 2002. The authors reviewed data from Phase I or Phase II preventive HIV vaccine trials that included HIV-1 uninfected participants at low to moderate or high risk for HIV infection based on self-reported risk behaviors. Of 66 identified trials, 55 (52 Phase I, 3 Phase II) met selection criteria and were used for analyses. Investigators extracted data on participant demographics using statistical software. RESULTS: A total of 3,731 volunteers enrolled in U.S. NIAID-funded network HIV vaccine trials from 1988 to 2002. Racial/ethnic minority participants represented 17% of the overall enrollment. By pooling data across all NIAID-funded networks from 1988 to 2002, the proportion of racial/ethnic minority participants was significantly greater (Fisher's exact test p-value < 0.001) in Phase II trials (278/1,061 or 26%) than in Phase I trials (347/2,670 or 13%). By generalized estimating equations, the proportion of minorities in Phase I trials increased over time (p = 0.017), indicating a significant increase in racial/ethnic minority participants from 1988 to 2002. CONCLUSIONS: There has been a gradual increase in racial/ethnic minority participation in NIAID-funded network HIV vaccine trials in the U.S. since 1988. In the light of recent efficacy trial results, it is essential to continue to increase the enrollment of diverse populations in HIV vaccine research.

Sexually transmitted disease screening by United States obstetricians and gynecologists.

OBJECTIVE: To assess compliance with practice guidelines and to determine the extent of missed opportunities for sexually transmitted disease (STD) prevention by describing screening practices of a national sample of obstetricians and gynecologists and comparing them to the practices of other specialists. METHODS: Physicians (n = 7300) in five specialties that diagnose 85% of STDs in the United States were surveyed. Obstetrics and gynecology (n = 647) was one of the five specialties. Besides providing demographic and practice characteristics, respondents answered questions about who they screen (nonpregnant females, pregnant females) and for which bacterial STDs (syphilis, gonorrhea, chlamydia). RESULTS: Responding obstetricians and gynecologists were most likely to be non-Hispanic white (75%), male (66%), and in their 40s (mode 43 years old). They saw an average of 90 patients per week during 47 hours of direct patient care. Approximately 95% practiced in private settings. Almost all (96%) screened some patients for at least one STD. Obstetricians and gynecologists screened women more frequently than other specialties, but no specialty screened all women or all pregnant women. CONCLUSION: Obstetricians and gynecologists screen women for STDs at a higher rate than other specialties represented in this study. Consistent with published guidelines, most obstetricians and gynecologists in our survey screened pregnant women for chlamydia, gonorrhea, and syphilis. Nonetheless, only about half of obstetricians and gynecologists screened nonpregnant women for gonorrhea or chlamydia, and fewer screen nonpregnant women for syphilis.

Life expectancy in patients surviving more than 5 years after hematopoietic cell transplantation.

PURPOSE Hematopoietic cell transplantation can cure hematologic malignancies and other diseases, but this treatment can also cause late complications. Previous studies have evaluated the cumulative effects of late complications on survival, but longer-term effects on life expectancy after hematopoietic cell transplantation have not been assessed. PATIENTS AND METHODS We used standard methods to evaluate mortality, projected life expectancy, and causes of death in a cohort of 2,574 patients who survived without recurrence of the original disease for at least 5 years after allogeneic or autologous hematopoietic cell transplantation from 1970 through 2002. Sex- and age-specific comparisons were made with US population data. Results Estimated survival of the cohort at 20 years after transplantation was 80.4% (95% CI, 78.1% to 82.6%). During 22,923 person-years of follow-up, 357 deaths occurred. Mortality rates remained four- to nine-fold higher than the expected population rate for at least 30 years after transplantation, yielding an estimated 30% lower life expectancy compared with that in the general population, regardless of current age. In rank order, the leading causes of excess deaths were second malignancies and recurrent disease, followed by infections, chronic graft-versus-host disease, respiratory diseases, and cardiovascular diseases. CONCLUSION Patients who have survived for at least 5 years after hematopoietic cell transplantation without recurrence of the original disease have a high probability of surviving for an additional 15 years, but life expectancy is not fully restored. Further effort is needed to reduce the burden of disease and treatment-related complications in this population.

HIV infections and associated costs attributable to syphilis coinfection among African Americans.

OBJECTIVES: We estimated the number and cost of syphilis-attributable HIV cases among African Americans. METHODS: A mathematical model of HIV transmission was used to estimate the number of partnerships consisting of HIV-discordant African Americans in which infectious syphilis was present and the number of new HIV cases attributable to syphilis in these partnerships. RESULTS: In 2000, an estimated 545 new cases of HIV infection among African Americans could be attributed to the facilitative effects of infectious syphilis, at a cost of about 113 million dollars. CONCLUSIONS: Syphilis prevention could reduce HIV incidence rates and the disproportionate burden of HIV/AIDS on the African American community, resulting in substantial reductions in future HIV/AIDS medical costs.