MMWR News Synopsis for November 26, 2014
Antiretroviral Therapy Enrollment and Outcomes Among HIV-Infected Adolescents and Young Adults Compared with Older Adults — Seven African Countries, 2004–2013
Adolescent and young adult antiretroviral therapy (ART) enrollees, aged 15-24 years, in seven African countries were mostly female, unemployed, unmarried, commonly pregnant, and had significantly higher rates of loss to follow-up from ART than older adults. Evidence-based interventions to reduce loss to follow-up for adolescent and young adult ART enrollees in Africa are urgently needed as this could help reduce mortality and HIV incidence in this age group. Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to declines in global annual HIV-related deaths, estimated annual HIV-related deaths among adolescents have increased by about 50% with most deaths occurring in Africa. In addition, in 2012 an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15–24 years. Difficulty enrolling HIV-infected adolescents and young adults (aged 15-24 years) in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this age group. To evaluate age-related ART retention challenges, data from retrospective cohort studies conducted in seven African countries among 16,421 adult and adolescent ART patients were analyzed by CDC investigators. Compared with older adults, adolescents and young adults had higher LTFU rates in all seven countries, reaching statistical significance in three countries. Evidence-based interventions to reduce LTFU for adolescent and young adult ART enrollees are urgently needed and could help reduce mortality and HIV incidence in this age group.
Provision of Antiretroviral Therapy for HIV-Positive TB Patients — 19 Countries, Sub-Saharan Africa, 2009–2013
All HIV-positive tuberculosis (TB) patients should receive antiretroviral therapy, which reduces the incidence of HIV-associated TB and reduces mortality among HIV-positive TB patients. Antiretroviral therapy (ART) reduces the incidence of HIV-associated TB disease, and early initiation of ART after the start of TB treatment reduces progression of HIV infection and death among HIV-positive TB patients. In spite of recommendations for all HIV-positive TB patients to receive ART, a high proportion of persons with TB disease and HIV infection who should be on life-saving are not yet receiving treatment. Provision of ART for all HIV-positive TB patients is needed to reduce the morbidity and mortality of HIV-associated TB and decrease the global burden of TB and HIV.
Current Cigarette Smoking Among Adults — United States, 2005–2013
The report underscores the need to fully implement effective actions to successfully reduce smoking. A combination of tobacco price increases, smoke-free laws, high-impact media campaigns, and easy access to quitting assistance, are critical to reducing cigarette smoking and smoking-related disease and death, particularly among subpopulations with the greatest burden. Cigarette smoking among U.S. adults declined from 20.9 percent in 2005 to 17.8 percent in 2013. However, in 2013, 42.1 million U.S. adults were current cigarette smokers, and cigarette smoking remains particularly high among certain groups, including adults who are male; younger, multiracial or American Indian/Alaska Native; have less education; live below the federal poverty level; live in the South or Midwest; have a disability/limitation; or who are lesbian, gay, or bisexual. These disparities call attention to the importance of enhanced implementation and reach of proven strategies to prevent and reduce tobacco use among these groups, as well as expanded questions on surveillance tools to better capture data on subpopulations with the greatest burden of tobacco use.
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