News in brief - Feb. 17, 2003

Fighting AIDS abroad - Task force speaks on cervical cancer screening - Director of Stop TB program named head of WHO - Experts recommend against widespread CRP testing

Fighting AIDS abroad

In his State of the Union address, President Bush asked Congress to commit $15 billion over the next five years -- including nearly $10 billion in new money -- to fight AIDS in Africa and the Caribbean.

The president also proposed a new Emergency Plan for AIDS Relief to help the people of Africa.

He noted that nearly 30 million people in Africa have been infected with the AIDS virus, including 3 million children younger than 15. In some African nations, more than one-third of the adult population is infected, he said. And yet only 50,000 of those suffering from AIDS are able to receive the medicine they need, he added.

Effective anti-retroviral drugs have been dropping in price from about $12,000 per year to under $300 a year, Bush said, making it possible to use the funds to help many people with AIDS live long and productive lives. He predicted that the new infusion of funds for purchasing anti-retroviral drugs would prevent 7 million new AIDS infections, treat at least 2 million people and provide humane care for millions of those who are infected or for children orphaned because of the disease.

The day after Bush's address, House Energy and Commerce Committee Chair Billy Tauzin (R, La.) said he would hold hearings and a markup on the president's recommendations in the coming months.

Task force speaks on cervical cancer screening

The U.S. Preventive Services Task Force issued new cervical cancer recommendations Jan. 22. The task force determined that routine cervical cancer screening is unnecessary for women 65 and older who have had regular normal Pap smears and are not otherwise at increased risk for cervical cancer.

The task force also recommended that younger women who have had at least two normal annual screenings need to be screened only every three years. The harm of continued routine screening for older women, such as false-positive tests and resulting invasive procedures, may outweigh the benefits, the task force said.

The task force also recommended starting to screen women three years after they begin sexual activity or at age 21, whichever comes first. Annual screening is appropriate until a woman has had at least two to three consecutive normal Pap test results.

The task force also:

Recommended against screening women who have had a total hysterectomy for a noncancerous condition.
Concluded that there is insufficient evidence to recommend either for or against using new technologies such as liquid-based cytology instead of conventional Pap smears.
Concluded that the evidence is insufficient to recommend either for or against the use of human papillomavirus testing as a primary screening tool for cervical cancer.

Director of Stop TB program named head of WHO

Dr. Jong Wook Lee, MPH, has been nominated by the World Health Organization's executive board to replace Dr. Gro Brundtland as head of the organization. Dr. Lee will start his term in July if his nomination is approved by the World Health Assembly in May. Dr. Lee has worked for the agency for the past 19 years as head of the WHO Global Program for Vaccines and Immunizations and the Stop TB program.

In his manifesto, submitted while campaigning for the position, he promised to decentralize the organization, pursue public-private partnerships and look to rebuild the health care infrastructure in poor countries. "Resources -- human and financial -- remain grossly inadequate in many countries, and health care systems face collapse," he wrote. "Communities -- particularly the poor -- lack access to the most basic of services and drugs. We must turn political commitment into global action."

Experts recommend against widespread CRP testing

An expert panel convened by a major government public health agency and a large nonprofit health charity have come out against populationwide use of the test for C-reactive protein but are recommending limited use of the test among certain groups.

Higher levels of the protein have been linked to an increased risk of heart disease.

The Centers for Disease Control and Prevention and the American Heart Assn., in a paper published in Circulation last month, wrote that the test could be an independent marker of risk and may be useful in evaluating patients at moderate risk for a heart attack within the next 10 years, based on current health status and family history.

"For clinicians and public health practitioners, it is important to emphasize that although abnormal hs-CRP values identify high-risk persons, we have no evidence that treatment strategies based on hs-CRP levels improve survival or reduce cardiovascular complications."

The panel also recommended that levels of CRP could, in people with stable coronary disease, indicate the risk of death or recurrent heart attack. Patients with persistently high CRP also should be evaluated for causes unrelated to heart disease.