HIV in metro Atlanta concentrated in four-county geographic cluster

The HIV epidemic in metropolitan Atlanta is concentrated mainly in one cluster of four metro area counties – Fulton, DeKalb, Clayton, and Gwinnett that includes 60 percent of Georgia’s HIV cases, according to a study by researchers in the Emory Center for AIDS Research (CFAR).

The HIV epidemic in metropolitan Atlanta is concentrated mainly in one cluster of four metro area counties – Fulton, DeKalb, Clayton, and Gwinnett that includes 60 percent of Georgia’s HIV cases, according to a study by researchers in the Emory Center for AIDS Research (CFAR).

In a paper published in the Journal of Urban Health, the researchers found that the rate of HIV in the cluster is 1.34 percent. This fits the World Health Organization’s description of a “generalized epidemic” (>1 percent). Outside the cluster, the HIV prevalence in Georgia is 0.32 percent.

The researchers matched HIV prevalence data from the Georgia Division of Public Health, as of October 2007, to census tracts. They also used data from the 2000 census to examine population characteristics such as poverty, race/ethnicity, and drug use.

The large Atlanta HIV cluster is characterized by a high prevalence of poverty along with behaviors that increase the risk of HIV exposure such as injection drug use and men having sex with men.

The investigators also found that 42 percent of HIV service providers in Atlanta are located in the concentrated cluster, which should facilitate prevention and treatment.

Paula Frew, MPH, PhD

“A major aim of our study was to improve public health practice by informing local planning efforts for HIV services,” says corresponding author Paula Frew, MPH, PhD, assistant professor of medicine at Emory University School of Medicine and an investigator in the Emory CFAR.

With more than 50,000 new HIV infections reported yearly in the United States, according to the Centers for Disease Control and Prevention, the HIV/AIDS epidemic continues to be a major public health problem. The number of HIV/AIDS cases is increasing faster in the South compared to other areas of the country. According to Kaiser State Health Facts, Georgia ranks 9th in the nation in the number of HIV/AIDS cases with more than 3,000 new HIV infections diagnosed in 2007.

The study showed differences between Atlanta and other large cities in the distribution of HIV cases. While cases in several other large cities were concentrated in specific neighborhoods, HIV cases in metro Atlanta are more generalized within the four-county metro area. All the cities, however, were similar in the link between HIV, poverty and men having sex with men.

“Prevention efforts targeted to the populations living in this identified area, including efforts to address their specific needs, may be most beneficial in curtailing the epidemic within this cluster,” Frew says.

Other authors of the paper include Emory CFAR members Brooke Hixson, MPH; Saad B. Omer, MBBS, MPH, PhD; and Carlos del Rio, MD.

Another avenue of HIV trickery reveals opportunity

Emory and University of Rochester researchers have discovered an extra way by which HIV adapts to survive in a hiding spot in the human immune system. The results are published in the Journal of Biological Chemistry.

Emory and University of Rochester researchers have discovered an extra way by which HIV adapts to survive in a hiding spot in the human immune system. The results are published in the Journal of Biological Chemistry.

A team led by Baek Kim from the University of Rochester and Raymond Schinazi from Emory found that when HIV faces a shortage of the building blocks it usually uses to replicate, the virus adapts by using different building blocks. The discovery may offer scientists a new way to try to stop the virus.

One of HIV’s favorite hiding spots is an immune cell called a macrophage, whose job is to chew up and destroy foreign invaders and cellular debris. One can think of macrophages as worker bees: they don’t reproduce because they’re focused on getting stuff done.

Raymond Schinazi, PhD, DSc, is director of the Laboratory of Biochemical Pharmacology at Emory's Center for AIDS Research

Normally, HIV uses “dNTPs” (building blocks of DNA), but dNTPs are found at very low levels in macrophages because they’ve stopped dividing and making new DNA. Current drugs generally target dNTPs, and aim at the infection in a different type of cells: T cells.

Macrophages do have high levels of RNA building blocks (“rNTPs”). The team found that HIV uses primarily rNTPs instead of dNTPs to replicate inside macrophages. When the team blocked the ability of the virus to interact with rNTPs, its ability to replicate in macrophages was cut by more than 90 percent.

“The first cells that HIV infects in the genital tract are non-dividing target cell types such as macrophages,” Kim says. “Current drugs were developed to be effective only when the infection has already moved beyond these cells. Perhaps we can use this information to help create a microbicide to stop the virus or limit its activity much earlier.”

Compounds that interfere with the use of rNTPs already exist and have been tested as anti-cancer drugs.

“We are now developing new anti-HIV drugs jointly based on this novel approach that are essentially non-toxic and can be used to treat and prevent HIV infections,” Schinazi says.

Baek Kim, PhD

The first authors of the paper are graduate students Edward Kennedy from Rochester and Christina Gavegnano from Emory. Other authors include graduate students Laura Nguyen, Rebecca Slate and Amanda Lucas from Rochester, and postdoc Emilie Fromentin from Emory.

The research was funded by the National Institute of Allergy and Infectious Disease and the Department of Veterans Affairs.

University of Rochester press release

What’s left when it comes to research?

Emory Rollins School of Public Health professor Dr. Howard Kushner contends that the connection between left-handedness and a raft of mental and physical disorders has gained currency since the 1980s and ‘90s.

Cesare Lombroso

In an editorial appearing in a recent issue of The Lancet, Emory Rollins School of Public Health professor Dr. Howard Kushner contends that the connection between left-handedness and a raft of mental and physical disorders has gained currency since the 1980s and ‘90s.

Although Kushner acknowledges a long history of suspicion surrounding left-handedness, he spotlights one Cesare Lombroso, a Turin physician who spent a great deal of time in and around the 19th century pointing a negative finger at left-handedness. Lombroso’s contemporaries mistakenly considered his studies, albeit mere observations, to be cutting-edge science.

Although scientific standards have changed since Lombroso’s time and today’s studies do not portray left-handedness with such profound negativity, Kushner says, “general claims about the pathology of left-handedness persist.” This despite studies showing left-handers displaying exceptional intellectual and creative talents.

So, what are we to conclude about the connection between left-handedness and health? Kushner doesn’t say. Instead, he asks us to consider that despite all the advanced scientific tools we have at our disposal, researchers should keep in mind that these very tools may not enable us to conclusively explain the mystery behind left-handedness and its meaning. Yet, we should not stop trying. After all, he says, today’s researchers are making solid contributions to such research–while raising provocative questions along the way.

New 3D MRI Technology Puts Young Athletes Back in Action

New technology has made it possible for surgeons to reconstruct ACL tears in young athletes without disturbing the growth plate.

Emory MedicalHorizon
New technology has made it possible for surgeons to reconstruct ACL tears in young athletes without disturbing the growth plate.

John Xerogeanes, MD, chief of the Emory Sports Medicine Center and colleagues in the laboratory of Allen R. Tannenbaum, PhD, professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, have developed 3-D MRI technology that allows surgeons to pre-operatively plan and perform anatomic Anterior Cruciate Ligament (ACL) surgery.

Link to YouTube video

The ACL is one of the four major ligaments in the knee, somewhat like a rubber band, attached at two points to keep the knee stable. In order to replace a damaged ligament, surgeons create a tunnel in the upper and lower knee bones (femur and tibia), slide the new ACL between those two tunnels and attach it both ends.

Traditional treatment for ACL injuries in children has been a combination of rehabilitation, wearing a brace and staying out of athletics until the child stops growing – usually in the mid-teens – and ACL reconstruction surgery can safely be performed.  Surgery has not been an option with children for fear of damage to the growth plate that would cause serious problems later on.

Xerogeanes explains that prior to using the 3-D MRI technology, ACL operations were conducted with extensive use of X-Rays in the operating room, and left too much to chance when working around growth plates.

Preparation with the new 3-D MRI technology allows surgery to be completed in less time than the traditional surgery using X-Rays, and with complete confidence that the growth plates in young patients will not be damaged.

Video Answers to Questions on ACL Tears

National Academy of Sciences recognizes Yerkes Primate Center neuroscientist

Elizabeth A. Buffalo, PhD, a researcher at the Yerkes National Primate Research Center, is one of two recipients of the Troland Research Awards, bestowed by the National Academy of Sciences,

Elizabeth A. Buffalo, PhD

The National Academy of Sciences (NAS) has recognized 13 individuals with awards acknowledging extraordinary scientific achievements in the areas of biology, chemistry, physics, economics and psychology.

Elizabeth A. Buffalo, PhD, a researcher at the Yerkes National Primate Research Center, is one of two recipients of the Troland Research Awards. Buffalo is being honored for innovative, multidisciplinary study of the hippocampus and the neural basis of memory. Troland Research Awards of $50,000 are given annually to recognize unusual achievement by young investigators and to further empirical research in experimental psychology.

The recipients will be honored in a ceremony on Sunday, May 1, during the NAS 148th annual meeting.

National AIDS Strategy: Comments on a coordinated effort

In this month’s issue of the journal Future Microbiology, Emory infectious disease physician/scientists Rana Chakraborty and Wendy Armstrong from Emory School of Medicine summarize and comment on the goals and challenges of the National HIV/AIDS Strategy released July 10, 2010.

In this month’s issue of the journal Future Microbiology, Emory infectious disease physician/scientists Rana Chakraborty and Wendy Armstrong from Emory School of Medicine summarize and comment on the goals and challenges of the National HIV/AIDS Strategy released July 10, 2010.

The National AIDS Strategy was the result of a directive by the Obama Administration to the Office of National AIDS Policy. The strategy’s overall goals were to reduce the number of people who become infected with HIV, to increase access to care and improve health outcomes for people living with HIV, and to reduce HIV-related health disparities.

“The National HIV/AIDS Strategy calls for a long overdue national coordinated effort to curb the rise in new HIV infections and enhance therapy in those already infected,” write the authors.

While the goals are worthy, the strategy will present many challenges, and the authors address each goal individually, and highlight challenges:

  • The initiatives are expensive, and already resources in the United States are not adequate to treat all patients currently diagnosed with HIV infection.
  • Convincing the general population that HIV is still a major problem and an incurable and often-fatal disease will remain a challenge.
  • Nontraditional testing sites outside clinics or hospitals, such as churches, while central to enhancing testing, may present problems of confidentiality.
  • Increasing the number and diversity of available providers of care is difficult given the current financial realities of the American healthcare system where medical practices with a high percentage of HIV patients often can’t break even financially.

The creation of a strategy is a positive step, say the authors, but it needs a clear financial commitment. The strategy’s strengths include a focus on specific high-risk populations, the concept of re-introducing conventional prevention methods including condom distribution and needle-exchange programs, and creating better outreach between leading HIV/AIDS centers in cities and HIV providers in rural settings.

Renowned Scientist Recipient of Emory’s First Annual Neuroscience and Ethics Award

Emory University Center for Ethics, Yerkes National Primate Research Center and The Neuroscience Initiative will present the First Annual Neuroscience and Ethics Award Lecture, “Determinism, Consciousness and Free Will” on January 18 at 4 pm at Emory’s Harland Cinema at the Dobbs University Center. The guest speaker, and first to be recognized with this award, is Michael Gazzaniga, PhD, a scientist and author considered one of the pioneers in the emerging field of cognitive neuroscience.

Michael Gazzaniga, PhD
Michael Gazzaniga, PhD, will deliver the lecture “Determinism, Consciousness and Free Will.”

Emory University Center for Ethics, Yerkes National Primate Research Center and The Neuroscience Initiative will present the First Annual Neuroscience and Ethics Award Lecture, “Determinism, Consciousness and Free Will” on January 18 at 4 pm at Emory’s Harland Cinema at the Dobbs University Center.

The guest speaker, and first to be recognized with this award, is Michael Gazzaniga, PhD, a scientist and author considered one of the pioneers in the emerging field of cognitive neuroscience.

“Dr. Gazzaniga is a world renowned scientists who, in addition to his other accomplishments, pioneered the study of split-brained patients and so revealed how the different hemispheres of our brains function,” says Paul Root Wolpe, PhD, director of the Emory University Center for Ethics.

“He has won our First Annual Emory Neuroscience and Ethics Award because, throughout his career, he has tried to apply his scientific understandings to improve the human condition, including serving on President Bush’s Bioethics Commission and publications such as his book The Ethical Brain.  I can think of no finer choice to be the first recipient of this Award.”

Gazzaniga founded and presides over the Cognitive Neuroscience Institute and is editor-in-chief emeritus of the Journal of Cognitive Neuroscience, which he also founded.  In addition, he is the one of the co-founders of the Cognitive Neuroscience Society, which was named in the late 1970’s.

In 1997, Gazzaniga was elected to the American Academy of Arts & Sciences.  He is the past-president of the Association for Psychological Science, served on the President’s Council on Bioethics and, in 2005, was elected to the National Academies Institute of Medicine. In 2009, he presented the Gifford Lectures at the University of Edinburgh.

Gazzaniga’s book The Ethical Brain describes in laymen’s language how the brain develops a value system, and the ethical dilemmas facing society as our comprehension of the brain expands.

For more information, contact Jamila Garrett-Bell.

Tobacco free cities project aims to curb smoking in China

Jeffrey Koplan, MD, MPH, director of the Emory Global Health Institute and vice president for Global Health at Emory University, is leading the second phase of the Tobacco Free Cities project in China, funded by the Bill and Melinda Gates Foundation. The project, which launched in 10 Chinese cities this week, is a partnership with the ThinkTank Research Center for Health Development in Beijing.

Jeffrey Koplan, MD, MPH

Jeffrey Koplan, MD, MPH, director of the Emory Global Health Institute and vice president for Global Health at Emory University, is leading the second phase of the Tobacco Free Cities project in China, funded by the Bill and Melinda Gates Foundation. The project, which launched in 10 Chinese cities this week, is a partnership with the ThinkTank Research Center for Health Development in Beijing.

Vice mayors of each of the 10 cities signed an official pledge to strive to create tobacco-free cities for residents. China has more than 300 million smokers, the most of any country, and more than 500 million people in China are exposed to secondhand smoke.

“The two-year project aims to enhance the overall capacity in smoking-tobacco control of the cities and help ease the burden caused by tobacco to public health, the environment and the economy,” Koplan says in an article in China Daily.

The project launch was covered by other major Chinese news outlets, including Xinhua News Agency.

The first phase of the Tobacco Free Cities project launched in June 2009 in seven Chinese cities. The project is part of the Emory Global Health Institute-China Tobacco Partnership. In January 2009 Emory University received a $14 million, five-year grant from the Gates Foundation to establish the partnership.

Winter Storm 2011

Emory Healthcare puts patients first and provides 24 hour service to Atlanta Metro residents with doctors, nurses and staff staying in facilities to provide healthcare during one of the worst snow and ice storms to hit North Georgia in decades. Here is a television report that aired this evening at 5:24 pm on Atlanta’s WSB-TV Channel 2, (ABC affiliate).

Emory Healthcare puts patients first and provides 24 hour service to Atlanta Metro residents with doctors, nurses and staff staying in facilities to provide healthcare during one of the worst snow and ice storms to hit North Georgia in decades.

Here’s a television report that aired this evening at 5:24 pm on Atlanta’s WSB-TV Channel 2, (ABC affiliate).

WSB-TV report on Emory Healthcare during the January 2011 ice storm
Click for full report from WSB-TV, plus related article

Support from Family and Close Friends Helps Recovery

As we watch the daily progress of Representative Gabrielle Giffords, observers have commented that her recovery has been moving along more quickly than expected, and took a big leap after the visit from President Obama. Related? Perhaps.

Representative Gabrielle Giffords
Representative Gabrielle Giffords. Photo courtesy Giffords’ House office.

As we watch the daily progress of Representative Gabrielle Giffords, many close observers have commented that her recovery has been moving along more quickly than expected, and took a big leap after the visit from President Obama.  Related?  Perhaps.

Emory Psychologist, Dr. Nadine Kaslow, says there is no question that love and support from family, friends, and others individuals a patient is close to, can make an enormous difference in the recovery process.

She explains that after people come out of a coma, they often seem to have a special connection to those who were there for them during the coma, even if they don’t actually remember anything in a conscious way. Efforts to communicate with the patient, she says, whether those be verbal or physical, can reinforce linking and communication. She adds patients who have physical contact from a loved one seem to visibly relax and engage more.

At Emory, as we move more and more to patient and family centered health care, we actively encourage loved ones to talk with the patient, read to the patient, touch and stroke the patient. Additionally, beds and shower facilities are provided so that family members can be with their loved ones around the clock.

Owen Samuels, MD, director of Emory University Hospital’s neuroscience critical care unit, reiterates that patient families are now recognized as central to the healing process and their presence can even reduce a patient’s length of stay. He says that in a neurology ICU, where the average length of stay is 13 days, but is often many, many more, this can be especially beneficial.