Monthly Archives: February 2017

The Main Killer of Drink Is Not Alcohol

Older people who drink heavily don’t necessarily have to fear dying of liver disease, a researcher said.

In a population-based Dutch study, only a handful of heavy drinkers in an older cohort died of liver-related causes, according to Jeoffrey Schouten, MD, of Erasmus Medical Center in Rotterdam, the Netherlands.

The major causes of death were cardiovascular disease and cancer, but not hepatocellular carcinoma, Schouten reported at the annual meeting of the American Association for the Study of Liver Diseases.

On the other hand, the study confirmed previous studies that suggest light and moderate drinking is protective, Schouten said.

He and colleagues followed 3,884 residents of Rotterdam — all 55 or older at the start of the study in 1990 — for a median of 15.2 years, until they died or until Dec. 31, 2008.

The participants were stratified by their drinking level, with the aim of understanding the causes of death for those who drank heavily, as well as the links between all-cause mortality and alcohol consumption.

Every four or five years, participants went through cycle of examinations, including clinical studies and questionnaires on various aspects of their lives, such as alcohol consumption. The clinical exams included blood work, anthropomorphic measurements, and imaging studies.

The study included the following:

  • 1,398 non-drinkers
  • 1,144 light drinkers (less than one gram of alcohol a day)
  • 963 moderate drinkers (between 10 and 30 grams daily)
  • 379 heavy drinkers (more than 30 grams a day)

Over the study period, Schouten reported, there were 1,825 deaths: 556 from cardiovascular disease, 496 from cancers, and 773 from a host of other causes, including three from alcohol-related liver disease.

Among the 188 heavy drinkers who died, 28% died of cardiovascular causes and 34% of cancer, he said. But only three cases of alcohol-related cancers and no cases of liver cancer were reported.

Only two of the heavy drinkers, or 1%, died of alcohol-related liver disease, he said.

A multivariate analysis showed that light and moderate drinkers fared better than both non-drinkers and heavy drinkers in terms of all-cause mortality.

Schouten said previous studies have showed similar patterns, but they were limited because older people were under-represented.

He added that doctors can use the findings to discuss the major risks among older patients who drink heavily, such as cardiovascular disease and cancer, rather than liver disease.

The findings, while not surprising, have some implications for how doctors counsel older patients about their drinking, according to Mack Mitchell, MD, of UT Southwestern Medical Center in Dallas, who was not part of the study, but who was one of the moderators of the session at which it was presented.

“Many people believe they should not drink alcoholic beverages above a certain age for health reasons,” he told MedPage Today, but the study showed that, “the mortality rate for those drinking in moderation was actually lower.”

So the message should not be to stop drinking but to stop drinking to excess, he said.

But for patients who remain heavy drinkers, he said, doctors can tell them that liver damage is the least of their worries — heart disease and cancer are the risks they should be concerned about.

Marijuana Users Highly at Risk for Psychosis

Psychotic illness occurs significantly earlier among marijuana users, results of a meta-analysis suggest.

Data on more than 22,000 patients with psychosis showed an onset of symptoms almost three years earlier among users of cannabis compared with patients who had no history of substance use.

The age of onset also was earlier in cannabis users compared with patients in the more broadly characterized category of substance use, investigators reported online in Archives of General Psychiatry.

“The results of this study provide strong evidence that reducing cannabis use could delay or even prevent some cases of psychosis,” Dr. Matthew Large, of the University of New South Wales in Sydney, Australia, and co-authors wrote in conclusion.

“Reducing the use of cannabis could be one of the few ways of altering the outcome of the illness because earlier onset of schizophrenia is associated with a worse prognosis and because other factors associated with age at onset, such as family history and sex, cannot be changed.”

Psychosis has a strong association with substance use. Patients of mental health facilities have a high prevalence of substance use, which also is more common in patients with schizophrenia compared with the general population, the authors wrote.

Several birth cohort and population studies have suggested a potentially causal association between cannabis use and psychosis, and cannabis use has been linked to earlier onset of schizophrenia. However, researchers in the field remain divided over the issue of a causal association, the authors continued.

Attempts to confirm an earlier onset of psychosis among cannabis users have been complicated by individual studies’ variation in methods used to examine the association. The authors sought to resolve some of the uncertainty by means of meta-analysis.

A systematic search of multiple electronic databases yielded 443 potentially relevant publications. The authors whittled the list down to 83 that met their inclusion criteria: All the studies reported age at onset of psychosis among substance users and nonusers.

The studies comprised 8,167 substance-using patients and 14,352 patients who had no history of substance use. Although the studies had a wide range of definitions of substance use, the use was considered “clinically significant” in all 83 studies. None of the studies included tobacco in the definition of substance use.

The studies included a total of 131 patient samples.

Substance use included alcohol in 22 samples, cannabis in 41, and was simply defined as “substance use” in 68 samples.

Alcohol use was not significantly associated with earlier age at onset of psychosis.

On average, substance users were about 2 years younger than nonusers were. The effect of substance use on age at onset was greater in women than in men, but not significantly so. Heavy use was associated with earlier age at onset compared with light use and former use, but also not significantly different, the authors reported.

Substance users were two years younger at the onset of psychosis compared with nonusers. Age at onset was 2.7 years earlier among cannabis users compared with nonusers.

Acknowledging limitations of the study, the authors cited the lack of information on tobacco use and its association with earlier age at onset of psychosis, and the lack of data on individual patients inherent in all meta-analyses.

Despite the limitations, the authors said the findings have potentially major clinical and policy implications.

“This finding is an important breakthrough in our understanding of the relationship between cannabis use and psychosis,” they wrote in conclusion. “It raises the question of whether those substance users would still have gone on to develop psychosis a few years later.”

“The results of this study confirm the need for a renewed public health warning about the potential for cannabis use to bring on psychotic illness,” they added.

Many Dangerous Bacteria Spread Outside the Hospital

 The dangerous bacteria Clostridium difficile spreads not only in hospitals but also in other health-care settings, causing infections and death rates to hit “historic highs,” U.S. health officials reported Tuesday.

C. difficile is a deadly diarrheal infection that poses a significant threat to U.S. health care patients,” Ileana Arias, principal deputy director at the U.S. Centers for Disease Control and Prevention, said during a morning news conference. “C. difficile is causing many Americans to suffer and die.”

The germ is linked to about 14,000 deaths in the United States every year. People most at risk from C. difficile are those who take antibiotics and also receive care in any medical facility.

“This failure is more difficult to accept because these are treatable, often preventable deaths,” Arias said. “We know what can be done to do a better job of protecting our patients.”

Much of the growth of this bacterial epidemic has been due to the overuse of antibiotics, the CDC noted in its March 6 report. Unlike healthy people, people in poor health are at high risk for C. difficile infection.

Almost 50 percent of infections are among people under 65, but more than 90 percent of deaths are among those aged 65 and older, according to the report.

Previous estimates found that about 337,000 people are hospitalized each year because of C. difficile infections. Those are historically high levels and add at least $1 billion in extra costs to the health care system, the CDC said.

However, these estimates might not completely reflect C. difficile’s overall impact.

According to the new report, 94 percent of C. difficile infections are related to medical care, with 25 percent among hospital patients and 75 percent among nursing home patients or people recently seen in doctors’ offices and clinics.

Although the proportion of infection is lowest in hospitals, they are at the core of prevention because many infected patients are transferred to hospitals for care, raising the risk of spreading the infection there, the CDC said.

Half of those with C. difficile infections were already infected when they were admitted to the hospital, often after getting care at another facility, the agency noted.

The other 50 percent of infections were related to care at the hospital where the infection was diagnosed.

The CDC said that these infections could be reduced if health care workers follow simple infection control precautions, such as prescribing fewer antibiotics, washing their hands more often and isolating infected patients.

These and other measures have reduced C. difficile infections by 20 percent in hospitals in Illinois, Massachusetts and New York, the CDC said.

In England, infections have been cut 50 percent in three years, the agency said.

Patients get C. difficile infections mostly after taking antibiotics, which can diminish the body’s “good” bacteria for several months.

That’s when patients can get sick from C. difficile, which can be picked up from contaminated surfaces or spread by health care providers.

The predominant sign of C. difficile infection is diarrhea, which can cause dehydration. If serious, the infection can become deadly. Other symptoms include fever, nausea and loss of appetite.

The CDC advises that if diarrhea occurs after a patient starts antibiotics, C. difficileshould be suspected and treatment continued with another antibiotic.

Commenting on the report, infectious disease expert Dr. Marc Siegel, an associate professor of medicine at New York University, said, “All these recommendations are fine; the problem is they are not going to work, you can’t stop these practices. This bug exists in a climate of overuse of antibiotics.”

It is hard to eradicate C. difficile because it buries itself in the colon, then recurs and testing isn’t always accurate, Siegel said. “It’s a pervasive problem in hospitals, and even in communities,” he said.

Children Born Almost Virus-Free Virus for 9 Years, Without Meds

A child in South Africa who was born with HIV has been virtually free of the virus for nearly nine years now and didn’t take anti-HIV drugs for most of that time, according to a new report of the case.

The child was treated with HIV medications early in life, but has not received anti-HIV drugs for eight and a half years, according to the researchers, who reported the case today (July 24) at an international AIDS conference in Paris.

The researchers hope that by studying this child, they may gain a better understanding of how a person’s body can, in some cases, control HIV without the use of daily drugs. Such further research may potentially lead to new, long-acting treatments for the disease.

“Further study is needed to learn how to induce long-term HIV remission in infected babies,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said in a statement. “However, this new case strengthens our hope that by treating HIV-infected children for a brief period beginning in infancy, we may be able to spare them the burden of life-long therapy” and the health consequences of long-term HIV infection, Fauci said.

The South African child was diagnosed with HIV in 2007 at 32 days old. The child was enrolled in a study, funded by NIAID, that aimed to test the effects of early HIV treatment. Children in the study were randomly assigned to receive antiretroviral therapy (ART) drugs either immediately after their HIV diagnosis, or only once they showed symptoms of the disease.

The child in the new report received ART drugs immediately after diagnosis and continued receiving them for 40 weeks. After the treatment stopped, the researchers could no longer detect HIV in the child’s blood; and follow-up tests showed that the child remained healthy and HIV-free in the years following the treatment.

When the child was nine and a half years old, the researchers conducted rigorous testing to determine if HIV was present anywhere in the child’s body. They used very sensitive test, and found that a tiny proportion of the child’s immune cells contained the virus, but the virus was dormant. The researchers otherwise found no evidence of HIV — standard tests could not detect the virus and the child had no symptoms.

This isn’t the first time that early HIV treatment has led to apparent remission in a child. In 2013, researchers reported the case of a baby born with HIV in Mississippi who was treated with anti-HIV drugs just 30 hours after birth. In that case, the baby remained apparently HIV-free for more than two years without drug treatment, until the virus reappeared in her blood. In 2015, researchers in France reported the case of an HIV-positive child who began treatment at 3 months of age, but later stopped treatment and remained HIV-free more than 11 years later.

It’s not exactly clear why some children may be able to live so long without needing ongoing HIV treatment. It’s thought that early treatment with anti-HIV drugs may prevent the virus from establishing reservoirs, or “hiding places,” in the body, which allow the virus to reemerge when treatment stops.

It’s also likely that the South African child has other, innate factors that contributed to that person’s HIV remission, the researchers said. Among the 143 infants who received the same treatment — 40 weeks of ART immediately after diagnosis — the average length of remission was about 30 weeks, according to the Washington Post. Some children in the study were in remission for more than two years, but no others went as long as the 8.5 years that was seen in the current case.

“By further studying the child, we may expand our understanding of how the immune system controls HIV replication,” said study co-author Caroline Tiemessen, head of cell biology at South Africa’s National Institute for Communicable Diseases (NICD) in Johannesburg.

The U.S. National Institutes of Health is currently conducting a trial to test whether giving ART to HIV-infected babies within 48 hours of birth leads to long-term control of the virus after treatment is stopped.