News in brief - Jan. 12, 2004

Knee replacement consensus - Potassium iodide should be widely available, report says - HIV-positive patients not getting safe-sex message

Knee replacement consensus

Total knee replacement surgery is a safe and cost-effective procedure for people with persistent knee pain and disability, according to a panel charged with reviewing all of the available evidence on the surgery.

More than 20 years of follow-up data indicate that the procedure is successful in the vast majority of patients, according to the consensus panel assembled by the National Institutes of Health. More than 300,000 total knee replacement surgeries are performed in the United States for severe arthritis of the knee joint.

The 11-member panel presented its statement Dec. 10, 2003, at the close of a three-day consensus development conference on the NIH campus.

The panel also reported that there is clear evidence of racial, ethnic and gender disparities in the provision of total knee replacements and thought that physicians' beliefs about their patients, limited familiarity with knee replacement in minority communities and patient mistrust of the health care system all might play a role.

The NIH Consensus Development Program was established in 1977 as a mechanism to judge controversial topics in medicine and public health in an unbiased and impartial way. The panel's statement is an independent report and is not a policy statement of the NIH or the federal government.

Potassium iodide should be widely available, report says

Potassium iodide pills should be available to everyone 40 and younger, especially children and pregnant and lactating women, who live near a nuclear power plant, said a Dec. 4, 2003, report released by the National Research Council.

Potassium iodide prevents thyroid cancer caused by exposure to radioactive iodine, a compound that can be released during a serious accident at a nuclear power plant. But potassium iodide will not protect against other types of radioactive isotopes released during nuclear reactor incidents or from so-called dirty bombs, according to the committee that wrote the report.

To be most effective, potassium iodide must be taken a few hours before exposure to radioactive iodine. Further protection from risk should include evacuation and the destruction of contaminated food.

While plans for pill distribution have focused mainly on a 10-mile emergency planning zone, specific incidents may call for a different zone of distribution.

Potassium iodide pills work by quickly filling the thyroid with nonradioactive iodine, blocking absorption of radioactive iodine.

HIV-positive patients not getting safe-sex message

Even after receiving risk-reduction counseling, some individuals who know they are HIV-positive are engaging in high-risk behavior that could transmit their infection, according to a study in the Jan. 1 issue of Clinical Infectious Diseases.

Interviews with 256 individuals who attended a New York City HIV clinic revealed that 41% had engaged in unprotected sex after learning that they were HIV positive, the study reports.

Trading sex for drugs or money was an important factor associated with high-risk behavior, particularly for women.

"I think what we need to do is make a safe sex counseling message an ongoing part of clinical care, not counseling once a year," said lead author Joseph P. McGowan, MD, of the Bronx-Lebanon Hospital Center in New York. He also warned that monotonous warnings can lead to patient "fatigue" in which risky behavior increases as the message wears off.

Counseling also should not be separated from the cure. "Prevention and treatment have to go hand in hand," Dr. McGowan said.