Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Jaffe HW[original query] |
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Reflections on 40 Years of AIDS.
De Cock KM , Jaffe HW , Curran JW . Emerg Infect Dis 2021 27 (6) 1553-1560 June 2021 marks the 40th anniversary of the first description of AIDS. On the 30th anniversary, we defined priorities as improving use of existing interventions, clarifying optimal use of HIV testing and antiretroviral therapy for prevention and treatment, continuing research, and ensuring sustainability of the response. Despite scientific and programmatic progress, the end of AIDS is not in sight. Other major epidemics over the past decade have included Ebola, arbovirus infections, and coronavirus disease (COVID-19). A benchmark against which to compare other global interventions is the HIV/AIDS response in terms of funding, coordination, and solidarity. Lessons from Ebola and HIV/AIDS are pertinent to the COVID-19 response. The fifth decade of AIDS will have to position HIV/AIDS in the context of enhanced preparedness and capacity to respond to other potential pandemics and transnational health threats. |
1970s and 'Patient 0' HIV-1 genomes illuminate early HIV/AIDS history in North America.
Worobey M , Watts TD , McKay RA , Suchard MA , Granade T , Teuwen DE , Koblin BA , Heneine W , Lemey P , Jaffe HW . Nature 2016 539 (7627) 98-101 ![]() ![]() The emergence of HIV-1 group M subtype B in North American men who have sex with men was a key turning point in the HIV/AIDS pandemic. Phylogenetic studies have suggested cryptic subtype B circulation in the United States (US) throughout the 1970s and an even older presence in the Caribbean. However, these temporal and geographical inferences, based upon partial HIV-1 genomes that postdate the recognition of AIDS in 1981, remain contentious and the earliest movements of the virus within the US are unknown. We serologically screened >2,000 1970s serum samples and developed a highly sensitive approach for recovering viral RNA from degraded archival samples. Here, we report eight coding-complete genomes from US serum samples from 1978-1979-eight of the nine oldest HIV-1 group M genomes to date. This early, full-genome 'snapshot' reveals that the US HIV-1 epidemic exhibited extensive genetic diversity in the 1970s but also provides strong evidence for its emergence from a pre-existing Caribbean epidemic. Bayesian phylogenetic analyses estimate the jump to the US at around 1970 and place the ancestral US virus in New York City with 0.99 posterior probability support, strongly suggesting this was the crucial hub of early US HIV/AIDS diversification. Logistic growth coalescent models reveal epidemic doubling times of 0.86 and 1.12 years for the US and Caribbean, respectively, suggesting rapid early expansion in each location. Comparisons with more recent data reveal many of these insights to be unattainable without archival, full-genome sequences. We also recovered the HIV-1 genome from the individual known as 'Patient 0' (ref. 5) and found neither biological nor historical evidence that he was the primary case in the US or for subtype B as a whole. We discuss the genesis and persistence of this belief in the light of these evolutionary insights. |
Improving health in the USA: progress and challenges
Jaffe HW , Frieden TR . Lancet 2014 384 (9937) 3-5 The health of Americans continues to improve. Life expectancy at birth, 78·7 years (76·2 years for men and 81·0 years for women), has never been higher.1 Age-adjusted death rates for the four leading causes of death—heart disease, cancer, chronic lower respiratory diseases, and stroke—are all falling.1 Immunisation rates for young children are high, racial and ethnic disparities in childhood vaccinations have largely been eliminated, and most vaccine-preventable diseases of childhood are now at historically low levels.2, 3 Deaths from motor vehicle crashes are at their lowest levels since 1950, and teen pregnancies have fallen to their lowest rate in seven decades.4, 5 What's wrong with this picture? | Although increases in US health-care costs have recently slowed, health spending reached US$2·8 trillion in 2012, or $8915 per person, and accounted for 17·2% of gross domestic product.6 These expenditures exceed those of other high-income countries in Europe, Asia, and North America, but a recent report found US life expectancy and other health outcomes generally poorer than in other high-income countries.7 A fragmented health-care delivery system, physical and social environments, and individual risk behaviours all play a part. |
Potentially preventable deaths from the five leading causes of death - United States, 2008-2010
Yoon PW , Bastian B , Anderson RN , Collins JL , Jaffe HW . MMWR Morb Mortal Wkly Rep 2014 63 (17) 369-74 In 2010, the top five causes of death in the United States were 1) diseases of the heart, 2) cancer, 3) chronic lower respiratory diseases, 4) cerebrovascular diseases (stroke), and 5) unintentional injuries. The rates of death from each cause vary greatly across the 50 states and the District of Columbia (2). An understanding of state differences in death rates for the leading causes might help state health officials establish disease prevention goals, priorities, and strategies. States with lower death rates can be used as benchmarks for setting achievable goals and calculating the number of deaths that might be prevented in states with higher rates. To determine the number of premature annual deaths for the five leading causes of death that potentially could be prevented ("potentially preventable deaths"), CDC analyzed National Vital Statistics System mortality data from 2008-2010. The number of annual potentially preventable deaths per state before age 80 years was determined by comparing the number of expected deaths (based on average death rates for the three states with the lowest rates for each cause) with the number of observed deaths. The results of this analysis indicate that, when considered separately, 91,757 deaths from diseases of the heart, 84,443 from cancer, 28,831 from chronic lower respiratory diseases, 16,973 from cerebrovascular diseases (stroke), and 36,836 from unintentional injuries potentially could be prevented each year. In addition, states in the Southeast had the highest number of potentially preventable deaths for each of the five leading causes. The findings provide disease-specific targets that states can use to measure their progress in preventing the leading causes of deaths in their populations. |
Blood system changes since recognition of transfusion-associated AIDS
Epstein JS , Jaffe HW , Alter HJ , Klein HG . Transfusion 2013 53 Suppl 3 2365-74 The year 2013 brought us to the close of the third decade since the discovery of human immunodeficiency virus (HIV), originally called lymphadenopathy‐associated virus or human T‐lymphotropic virus Type 3 (HTLV‐III), as the cause of AIDS.1, 2, 3, 4, 5, 6 This landmark occasions a time for reflection on the transformations of the blood system that were set in motion by recognition of transfusion‐associated AIDS (TAA). While the decade of the 1980s was characterized by rapid introduction of novel strategies to address an unprecedented challenge, changes made in the 1990s, though independently significant, were also reactive, as the system tried to define and incorporate the lessons of TAA. In the latter decade, criticisms of prior decision making, coupled with new technology options, led to a broad‐based initiative to enhance blood safety. In the new millennium, ongoing efforts to address blood safety have focused repeatedly on threats from known and emerging infectious diseases. However, concerns have arisen about a trend of increasing safety costs with progressively decreasing added benefits. This commentary summarizes key changes to the blood system during this 30‐year period and discusses the evolving framework for blood safety decision making that is taking form. |
The evolving epidemiology of HIV/AIDS
De Cock KM , Jaffe HW , Curran JW . AIDS 2012 26 (10) 1205-13 Following its recognition in 1981, the HIV/AIDS epidemic has evolved to become the greatest challenge in global health, with some 34 million persons living with HIV worldwide. Early epidemiologic studies identified the major transmission routes of the virus before it was discovered, and enabled the implementation of prevention strategies. Although the first identified cases were in MSM in the United States and western Europe, the greatest impact of the epidemic has been in sub-Saharan Africa, where most of the transmission occurs between heterosexuals. Nine countries in southern Africa account for less than 2% of the world's population but now they represent about one third of global HIV infections. Where broadly implemented, HIV screening of donated blood and antiretroviral treatment (ART) of pregnant women have been highly effective in preventing transfusion-associated and perinatally acquired HIV, respectively. Access to sterile equipment has also been a successful intervention for injection drug users. Prevention of sexual transmission has been more difficult. Perhaps the greatest challenge in terms of prevention has been in the global community of MSM in which HIV remains endemic at high prevalence. The most promising interventions are male circumcision for prevention of female-to-male transmission and use of ART to reduce infectiousness, but the extent to which these interventions can be brought to scale will determine their population-level impact. |
AIDS: the early years and CDC's response
Curran JW , Jaffe HW . MMWR Suppl 2011 60 (4) 64-9 The MMWR description of five cases of Pneumocystis carinii pneumonia (PCP) among homosexual men in Los Angeles was the first published report about an illness that would become known as acquired immunodeficiency syndrome (AIDS) (1). Appearing 4 months before the first peer-reviewed article (2), the timeliness of the report can be credited to the astute clinical skills and public health sensitivity of Dr. Michael Gottlieb and his colleagues at the University of California, Los Angeles, School of Medicine and Cedars-Sinai Hospital, who worked closely with Dr. Wayne Shandera, the CDC Epidemic Intelligence Service (EIS) officer assigned to the Los Angeles County Department of Health Services. | | The Parasitic Diseases Division of CDC's Center for Infectious Diseases already had become concerned about other reports of unusual cases of PCP. The Division housed the Parasitic Disease Drug Service, which administered the distribution of pentamidine isethionate for PCP treatment. Because PCP was rare and pentamidine was not yet licensed in the United States, it was available only from CDC. A review of requests for pentamidine had documented that PCP in the United States was almost exclusively limited to patients with cancer or other conditions or treatments known to be associated with severe immunosuppression (3). Recent requests for this drug from physicians in New York and California to treat PCP in patients with no known cause of immunodeficiency had sparked the attention of Division staff. |
Immune reconstitution and risk of Kaposi sarcoma and non-Hodgkin lymphoma in HIV-infected adults
Jaffe HW , De Stavola BL , Carpenter LM , Porter K , Cox DR . AIDS 2011 25 (11) 1395-1403 OBJECTIVE: Given the well documented occurrence of immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients who recently started combination antiretroviral therapy (cART), we examined whether cART initiation increased the risk of Kaposi sarcoma and non-Hodgkin lymphoma (NHL) using data from the Concerted Action on SeroConversion to AIDS and Death in Europe (CASCADE) collaboration. DESIGN: A nested matched case-control study design was used to assess the effects of individual CD4 cell trajectories and exposure to cART close to the time of cancer diagnosis. METHODS: Cases were patients diagnosed with either cancer during follow-up with a minimum of two consecutive CD4 cell readings within the year preceding diagnosis. For each case, up to 10 controls, matched by sex and cohort, were selected by random sampling. Changes in CD4 cell count, calculated by simple and piecewise linear regression, and recent exposure to cART were compared within matched case-control sets using conditional logistic regression. RESULTS: Using data on 689 cases and 4588 controls, we found that an initially low and decreasing CD4 cell count during the year prior to cancer diagnosis is predictive of both Kaposi sarcoma and NHL. Most of this cancer risk is explained by the immunodeficiency characteristic of the period before cART initiation; however, an increased cancer risk was seen in patients who initiated cART in the previous 3 months (odds ratio 2.31; 95% confidence interval 1.33, 4.00). CONCLUSION: Although IRIS may transiently increase the risk of Kaposi sarcoma or NHL in HIV-infected patients, the timely initiation of cART remains the best strategy to avoid the development of these malignancies. |
Reflections on 30 years of AIDS
De Cock KM , Jaffe HW , Curran JW . Emerg Infect Dis 2011 17 (6) 1044-1048 June 2011 marks the 30th anniversary of the first description of what became known as HIV/AIDS, now one of history's worst pandemics. The basic public health tools of surveillance and epidemiologic investigation helped define the epidemic and led to initial prevention recommendations. Features of the epidemic, including the zoonotic origin of HIV and its spread through global travel, are central to the concept of emerging infectious diseases. As the epidemic expanded into developing countries, new models of global health and new global partnerships developed. Advocacy groups played a major role in mobilizing the response to the epidemic, having human rights as a central theme. Through the commitments of governments and private donors, modern HIV treatment has become available throughout the developing world. Although the end of the epidemic is not yet in sight and many challenges remain, the response has been remarkable and global health has changed for the better. |
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