Health
Who Will Care for Infants With H.I.V. Overseas?
The Trump administration has dismissed the few remaining health officials who oversaw care for some of the world’s most vulnerable people: more than 500,000 children and more than 600,000 pregnant women with H.I.V. in low-income countries.
Expert teams that managed programs meant to prevent newborns from acquiring H.I.V. from their mothers and to provide treatment for infected children were eliminated last week in the chaotic reorganization of the Health and Human Services Department.
Some of the consequences of the dismissals are only now coming to light.
While it was known that some staff members devoted to H.I.V. prevention in other countries had been lost, The New York Times has learned that all such experts have now been terminated or are awaiting reassignment at the Centers for Disease Control and Prevention, the State Department and the U.S. Agency for International Development.
These maternal health programs are still funded by the President’s Emergency Plan For AIDS Relief, or PEPFAR. But without personnel to manage the initiatives or to disburse the money, it’s not clear how the work will continue.
The Health and Human Services Department did not respond to a request for comment.
“We hope this is not a sign that treating mothers and children is no longer important in PEPFAR, and that this is a mistake that can be corrected,” said a federal health official who spoke on condition of anonymity for fear of retaliation.
The stakes are high. Already in sub-Saharan Africa, a child under 15 dies of AIDS every seven minutes.
On Tuesday, a study in The Lancet estimated that suspending PEPFAR could lead to about one million new H.I.V. infections by 2030 and could lead to nearly 500,000 AIDS deaths among children and the orphaning of 2.8 million more.
After the nascent Trump administration froze all foreign aid, Secretary of State Marco Rubio issued a waiver permitting delivery of “core lifesaving medicine, medical services” and other activities funded by the United States.
A waiver specific to PEPFAR later explicitly continued support for programs meant to prevent mother-to-child transmission of H.I.V., and to provide treatment of infected women and children.
The paperwork allowing the aid to resume took weeks after the waiver was issued, and several organizations are only just beginning to receive federal funds required to run the programs.
“You can dismantle something very quickly, but now you’re trying to build it back up with a fraction of the staff and potentially 5 percent of the institutional knowledge,” said a federal official who wasn’t authorized to speak to the news media and requested anonymity.
All experts in pediatric H.I.V. were all let go in the gutting of U.S.A.I.D., leaving a single unit at the C.D.C. with the expertise to advise overseas programs. That team was lost in last week’s reorganization, along with another that handles disbursement of funds for 300 grants in more than 40 countries.
Given the State Department waiver, those layoffs came as surprise to the federal health workers and to the organizations that rely on them.
“We clearly understood that H.I.V. services for mothers and children would fall under” the waiver, said Dr. Anja Giphart, executive vice president of medical and scientific affairs at the Elizabeth Glaser Pediatric AIDS Foundation.
The foundation depends on the C.D.C. for about 60 percent of its budget. “We were totally blindsided that the whole unit at C.D.C. is being terminated,” she said.
The organization has been promised funds until September. But only a few people were authorized to use the payment system at the C.D.C.
“Everyone is scrambling now to figure out how to pay country teams and partners,” said a C.D.C. official who requested anonymity for fear of retaliation.
Other experts said that they were not surprised by the hollowing out of the C.D.C.’s H.I.V. teams despite the waiver.
“What we’ve seen is that there’s no rhyme and reason to any of the actions that the administration is taking,” said Jirair Ratevosian, who served as the chief of staff for PEPFAR in the Biden administration.
Care for children and pregnant women with H.I.V. is complex.
Infants need an H.I.V. test different from the one used for adults, and infected babies must take a separate set of medications. They succumb quickly to complications when treatment is interrupted.
“Especially when you think about children, time is of the essence,” Dr. Giphart said. “That seems to not really be taken into consideration with all these changes that are being made.”
In low-income countries, pregnant women with H.I.V. usually get treatment at prenatal clinics. Without treatment, one in three pregnant women may pass H.I.V. on to her baby.
Treatment decreases the risk of transmission to less than 1 percent. PEPFAR has prevented nearly eight million such infections in newborns since its inception, in 2003.
The foreign aid freeze imposed in January has resulted in shortages of pediatric H.I.V. drugs in many countries and the delayed delivery of a new H.I.V. drug treatment.
The C.D.C. experts who were let go had been helping low-income countries prepare for this transition, tracking stocks and helping to direct the medications to the places with the most urgent needs, said an official who spoke on condition of anonymity for fear of retaliation.
“This coordination is especially critical right now because we’re in a period of immense change,” the official said.
Health
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POST-DOSE PATTERN — New research reveals why the COVID vaccine can trigger heart issues, especially in one group
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SCREENING DEBATE — A new study questions whether annual mammograms are necessary for most women
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Health
Aging-related joint disorder increasingly affects people under 40, study finds
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Cases of gout are rising in younger individuals, according to a global study.
The condition, which is a type of inflammatory arthritis, steadily increased in people aged 15 to 39 between 1990 and 2021, researchers in China announced.
Although rates vary widely between countries, the total number of young people with the condition is expected to continue rising through 2035.
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The study, published in the journal Joint Bone Spine, investigated 2021 data from the Global Burden of Disease (GBD), spanning 204 countries within the 30-year timeframe.
The data measured gout prevalence, incidence and years lived with disability, tracking global trends over time. The results showed a global increase across all three outcomes.
Gout is expected to continue rising in young people through 2035. (iStock)
Prevalence and disability years increased by 66%, and incidence rose by 62%. In 2021, 15- to 39-year-olds accounted for nearly 14% of new gout cases globally, the study found.
Men from 35 to 39 years old and people in high-income regions had the highest burden, but high-income North America topped the list for highest rates.
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Men were also found to have lived more years with gout due to high BMI, while women tended to have the condition as a link to kidney dysfunction, the study noted.
The total number of cases is expected to increase globally due to population growth, but the study projected that rates per population would decrease.
The researchers noted that data quality, especially in low-income settings, could have posed a limitation to the broad GBD data.
What is gout?
Gout is a common form of arthritis involving sudden and severe attacks of pain, swelling, redness and tenderness in the joints, according to Mayo Clinic. It most often occurs in the big toe.
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The condition occurs when urate crystals accumulate in the joint. These form when there are high levels of uric acid in the blood, which the body produces when it breaks down a natural substance called purines.
A gout flare-up can happen at any time, often at night, causing the affected joint to feel hot, swollen, tender and sensitive to the touch.
Urate crystals, described as sharp and needle-like, build up in the joint, causing intense pain and swelling. (iStock)
Purines can also be found in certain foods, like red meat or organ meats like liver and some seafood, including anchovies, sardines, mussels, scallops, trout and tuna, according to the Mayo Clinic. Alcoholic drinks, especially beer, and drinks sweetened with fruit sugar can also lead to higher uric acid levels.
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Uric acid will typically dissolve in the blood and pass through the kidneys into urine, but when the body produces too much or too little uric acid, it can cause a build-up of urate crystals. These are described by the Mayo Clinic as sharp and needle-like, causing pain, inflammation and swelling in the joint or surrounding tissue.
Risk factors for gout include a diet rich in high-purine foods and being overweight, which causes the body to produce more uric acid and the kidneys to have trouble eliminating it.
Experts urge patients to seek medical attention for gout flare-ups. (iStock)
Certain conditions like untreated high blood pressure, diabetes, obesity, metabolic syndrome and heart and kidney diseases can increase the risk of gout, as well as certain medications.
A family history of gout can also increase risk. Men are more likely to develop the condition, as women tend to have lower uric acid levels, although symptoms generally develop after menopause.
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Untreated gout can cause worsening pain and joint damage, experts caution. It may also lead to more severe conditions, such as recurrent gout, advanced gout and kidney stones.
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The Mayo Clinic advises patients to seek immediate medical care if a fever occurs or if a joint becomes hot and inflamed, which is a sign of infection. Certain anti-inflammatory medications can help treat gout flares and complications.
Fox News Digital reached out to the researchers for comment.
Health
New study questions whether annual mammograms are necessary for most women
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A new study suggests that annual mammograms may not be the only effective approach for preventing breast cancer.
The research, published in the Journal of the American Medical Association (JAMA), tested a risk-based breast cancer screening approach against standard annual mammography.
The WISDOM randomized clinical trial, led by study authors from universities and healthcare systems across the U.S., considered more than 28,000 women aged 40 to 74 years old, splitting them into a risk-based screening group and an annual mammography group.
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Researchers calculated each woman’s individual risk based on genetics (sequencing of nine breast cancer genes) and other health factors.
A new study suggests that annual mammograms may not be the only effective approach for preventing breast cancer. (iStock)
Those who were at the highest risk were advised to alternate between a mammogram and an MRI scan every six months. Patients with elevated risk were told to get an annual mammography and counseling.
Average-risk women were guided to get mammograms every two years, while low-risk individuals were advised to have no screening until they became higher risk or reached age 50.
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The researchers found that risk-based screening did not lead to more advanced cancer diagnoses (stage 2B or higher) compared with annual screening, indicating that it is just as safe as traditional methods. The risk-based approach, however, did not reduce the number of biopsies overall, as researchers had hoped.
Among the risk-based group of women, those with higher risk had more screening, biopsies and detected cancers. Women at lower risk had fewer procedures.
The research, published in the Journal of the American Medical Association (JAMA), tested a risk-based breast cancer screening approach against standard annual mammography. (iStock)
“[The] findings suggest that risk-based breast cancer screening is a safe alternative to annual screening for women aged 40 to 74 years,” the researchers noted in the research summary. “Screening intensity matched individual risk, potentially reducing unnecessary imaging.”
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Fox News medical contributor Dr. Nicole Saphier, associate professor of radiology at Memorial Sloan Kettering Cancer Center in New Jersey, commented that while these findings are important, the study “completely sidelines” what screenings are designed to do — detect cancer early.
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“If you don’t measure stage 0, stage 1 or stage 2A cancers, you can’t tell whether personalized screening delays diagnosis in a way that matters for survival and treatment intensity,” Saphier, who was not involved in the study, told Fox News Digital in an interview.
Those who were at the highest risk were advised to alternate between a mammogram and an MRI scan every six months. (iStock)
More than 60% of breast cancers in the U.S. are diagnosed at stage 1 or 2A, where cure rates exceed 90%, the doctor noted.
The trial doesn’t “fully evaluate” whether risk-based screening changes detection at the earliest and most treatable stages, where screening “delivers its greatest benefit,” according to Saphier.
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“Mammography is not without risk — radiation exposure, false positives, anxiety and potential over-diagnosis are real and should be acknowledged,” she said. “But it remains the most effective, evidence-based tool for detecting breast cancer early, when treatment is most successful.”
The expert added that labeling women under 50 as “low risk” is “outdated,” as breast cancer diagnoses are on the rise in younger females.
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“Until long-term mortality data support alternative approaches, annual screening beginning at 40 for average risk women should continue,” Saphier added. “Women should be assessed for breast cancer risk by 25 years old to determine if screening should begin earlier.”
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