HIV policy: the path forward--a joint position paper of the HIV Medicine Association of the Infectious Diseases Society of America and the American College of Physicians.

Executive Summary The American College of Physicians (ACP) and the Infectious Diseases Society of America (IDSA) have jointly published 3 policy statements on AIDS, the first in 1986 [1], the second in 1988 [2], and the third in 1994 [3]. In 2001, the IDSA created the HIV Medicine Association (HIVMA), and this updated policy paper is a collaboration between the ACP and the HIVMA of the IDSA. Since the last statement, many new developments call for the need to reexamine and update our policies relating to HIV infection. First, there have been major advances in treatment for HIV infection that have transformed HIV/AIDS from a terminal illness to a chronic disease for many of those who have access to potent therapies and expert medical care [4]. Second, there has been a profound expansion and intensification of the global HIV pandemic, particularly in sub-Saharan Africa, coupled with significant US leadership and resources aimed at providing prevention and care services to affected populations in developing countries. Third, the concerns that were prevalent in the mid-1990s regarding the possibility of HIV transmission in health care settings have ultimately proven to be unfounded as the result of the adoption of universal precautions in those settings. In this article, we emphasize the public health and clinical imperatives for earlier identification of persons with HIV infection; the urgent need to expand access to state-of-the-art HIV care and treatment for infected individuals; the need for access to comprehensive prevention and education for those living with and those at risk for HIV infection; and the need for stronger national leadership to respond to the HIV epidemic in the United States and in the developing world. In December 2008, the ACP and HIVMA released a guidance statement on screening for HIV infection in health care settings that recommended that clinicians adopt routine screening for HIV infection and encourage patients to be tested. Also included in the guidance statement is a recommendation that clinicians determine the need for additional screening on an individual basis

The molecular epidemiology of tuberculosis in Montreal and British Columbia /

Though the incidence of tuberculosis (TB) in Canada is low, TB remains a problem in specific population subgroups-most notably the foreign-born, who account for a steadily increasing proportion of all cases. The foreign-born represented 80% of all patients diagnosed with active TB on the island of Montreal in 1997 and 75% of all cases in British Columbia.The extent to which foreign-born persons transmit TB to the Canadian-born is not known. Using DNA Restriction Fragment Length Polymorphism (RFLP), this study sought to estimate the proportion of active cases of TB among the Canadian-born potentially attributable to foreign-born sources.M. tuberculosis isolates from patients diagnosed with active TB in British Columbia and Montreal from July 1, 1995 through June 30, 1997 were characterized by RFLP analysis, using the standard IS6110 technique. Patients whose isolates had identical DNA fingerprints were considered to be clustered (confirmed by spoligotyping for isolates with ≤5 IS6110 copies), indicating recent infection and potential person-to-person transmission.Of the 706 isolates analyzed, 54 clusters were identified composed of 147 patients. Foreign birth was found to be negatively associated with clustering. HIV positive status, intravenous drug use, and alcohol use were found to be associated with an increased incidence of clustering.Of the 54 clusters found, 9 (17%) had both foreign- and Canadian-born members and in only 4 (7%) was there potential transmission from a foreign-born source case to a total of 5 Canadian-born persons. The estimated proportion of active TB among the Canadian-born potentially attributable to recent transmission from foreign-born cases was 0.8% in British Columbia, and 12% in Montreal