Myron S. Cohen

Bio: Myron S. Cohen is an academic researcher from University of North Carolina at Chapel Hill. The author has contributed to research in topics: Population & Acquired immunodeficiency syndrome (AIDS). The author has an hindex of 103, co-authored 549 publications receiving 46021 citations. Previous affiliations of Myron S. Cohen include University of Massachusetts Medical School & Scripps Health.

Trichomoniasis in men and HIV infection: Data from 2 outpatient clinics at Lilongwe Central Hospital, Malawi

Abstract: Background. Little is known about the epidemiologic profile of trichomoniasis in men and its relationship to human immunodeficiency virus (HIV) infection. Among men presenting for care for symptomatic sexually transmitted infections (STIs) in Malawi, trichomoniasis is not considered for first-line treatment. Methods. We conducted a cross-sectional survey of 1187 men attending either a dermatology or STI outpatient clinic in the capital of Malawi. Men were interviewed, and the etiologies of the STIs were determined. Results. At the STI clinic ( men), we identified 150 men (20%) with Trichomonas vaginalis infection, n p 756 358 men (47%) with HIV infection, and 335 men (44%) with Neisseria gonorrhoeae infection. At the dermatology clinic ( men), we identified 54 (13%), 118 (27%), and 2 (0.5%) men, respectively. At both clinics, a lower n p 431 education level and reporting never having used a condom were predictive of T. vaginalis infection. Only at the dermatology clinic was older age associated with infection, and only at the STI clinic were marital, genital ulcer disease, and HIV-infection status associated with T. vaginalis infection. At the STI clinic, urethral symptoms attributable to trichomoniasis were more severe among HIV-positive men than among HIV-negative men. Conclusions. Given its high prevalence and the increased risk for HIV transmission, T. vaginalis infection should be reconsidered for inclusion in the Malawi STI-treatment regimen for men.

A new deal in HIV prevention: lessons from the global approach.

Abstract: We have now entered the second decade of the human immunodeficiency virus (HIV) pandemic. Medical science has responded to this new disease with remarkable dissection of the HIV virus and equally detailed descriptions of the clinical evolution of opportunistic infections and neoplasms in patients with the acquired immunodeficiency syndrome (AIDS). An entire industry has developed to address and improve strategies for the management of patients with HIV disease. Much of the funding for HIV research in the United States has focused on the development of vaccines [1] and antiviral therapy [2]. In essence, it was (and might still be) hoped that our technology can generate a magic bullet to end the AIDS epidemic. Although critically important, this approach has had no immediate effect on the spread of AIDS. An aggressive HIV prevention campaign was politically difficult, if not impossible, to initiate in the United States throughout the 1980s. Prevention of HIV requires detailed knowledge of who is at the greatest risk for disease; however, infected patients were threatened with loss of livelihood, health insurance, personal safety, and social support [3]. This social and political climate slowed our understanding of the spread of HIV and the scope of the epidemic. Although an HIV prevention campaign requires an effort to change sexual behavior, such a campaign would probably have offended and alienated some American voters. Efforts to promote condom education and use were frustrated at every level. Regardless of the clear-cut role of intravenous drug use in the HIV epidemic, drug rehabilitation programs were not expanded, and needle exchange programs were not federally funded. As a result of these and other problems, the public health community found itself constrained in its efforts to prevent HIV disease. These latter problems were summarized by Dr. Donald Francis in his farewell address to the Centers for Disease Control and Prevention [4] and dramatized by the book and movie And the Band Played On. Finally, the prevention of sexually transmitted diseases (STDs), which are now recognized to facilitate transmission of HIV, was not given high priority. Indeed, during the 1980s, the incidence and prevalence of all the treatable bacterial STDs (gonorrhea, chlamydial infection, syphilis, chancroid) and herpes simplex virus type 2 infection increased. By default, HIV control in the United States evolved to focus on the screening of blood donors and HIV testing and counseling. Most other countries (both industrialized and developing) have implemented more comprehensive HIV control programs. These are best exemplified in developing countries by the World Health Organization's Global Program on AIDS and the U.S. Agency for International Development's AIDS Control and Prevention Program, which is coordinated by Family Health International in more than 30 countries. The Clinton administration is likely to support a comprehensive HIV prevention plan for the United States as well as programs similar to those advocated by the Global Program on AIDS and the U.S. Agency for International Development. Our purpose is to describe these programs and to suggest some fundamental changes in addressing the STD problem in the United States. The Global Program on AIDS and the U.S. Agency for International Development strategies are designed to prevent sexual transmission of HIV with minimal dependence on technology and resources. The programs focus on three linked components: condom promotion and distribution, change in sexual behavior (delaying onset of intercourse by adolescents, avoidance of high-risk sexual practices, and partner number reduction), and control of those STDs that appear to facilitate the transmission of HIV [5]. Mathematical models of the AIDS pandemic strongly suggest that only concomitant implementation of these three strategies will maximally reduce the spread of HIV [6]. Accordingly, each of these goals deserves further discussion. Condoms can help to reduce the spread of STDs, including HIV infection [7]. However, condom distribution has evoked concern about the message sent by their availability [8]. It has been argued that the very act of making condoms available endorses promiscuous sex, especially for less mature (and potentially more easily confused) adolescents. This notion contrasts with data suggesting that sex education can reduce risky behavior in some adolescent populations [9]. Sexual behavior is complex and poorly understood. Experiments designed to better understand ways to change sexual behavior are in progress, and the results are critically important to the war on AIDS. The sexual behavior of a population can probably be changed only very slowly. Further, all Americans do not share the same risk for STD and HIV infection [10]. The continued spread of many STDs is dependent on high-risk groups whose sexual behaviors appear to allow at least some of these diseases to flourish [11]. Different groups can be expected to respond differently to new information and to efforts to change behavior. Campaigns against HIV and STDs are now becoming more focused on high-risk groups, although such targeting has stimulated serious controversy [12]. Available data strongly suggest that STDs that cause skin ulcers (genital herpes, syphilis, and chancroid) or mucosal inflammation (gonorrhea, chlamydial infection, and trichomoniasis) greatly facilitate HIV transmission [5, 13]. This finding is now popularly referred to as epidemiologic synergy [5]. Prevention of these classic STDs has become a high priority. Unfortunately, in developing countries, drugs to treat STDs are often not available. In the United States, STD care is tremendously hindered by inadequate staffing and overcrowding of public health clinics, where STD care has traditionally been delivered, and the lack of STD education for health care workers in the private sector. How did we get where we are? More than 30 years ago Surgeon General Thomas Parran helped to develop a U.S. public health infrastructure that shifted STD care and control to the public sector. These public health measures, combined with the use of effective antibiotics, led to a dramatic decrease in STDs. In 1954 the American Journal of Syphilis, Gonorrhoeae, and Venereal Diseases ceased publication after four successful decades, as a direct result of reduced interest. of physicians and medical students [14]. Changes in the 1950s led to at least two generations of physicians with little experience in STD treatment, risk assessment, or the public health aspects of STD case management. A 1982 survey of 127 medical schools in the United States and Canada showed that 87 offered no clinical teaching about STDs to students, and 96 offered no such training for residents [15]. We now anticipate the inception of a stronger and more comprehensive U.S. AIDS prevention program. This program offers a unique opportunity for practicing physicians. Given the movement toward managed care and preventive health care services, it appears likely that physicians in the private sector will play a greater role in the management of patients with STDs. Treatment of STDs must be comprehensive, and physicians will require more experience in treating STDs as well as strategies to work effectively with the public sector. The physician who recognizes one STD must look for others; he or she must treat partners and counsel the patient. Who will provide the education for the proper management of STDs? Medical schools are under tremendous pressure to teach their students how to manage primary care problems in outpatient settings [16]. Sexually transmitted disease clinics have a high volume of outpatients with interesting and important problems. We have had excellent experience with students and residents who choose to work in our STD clinics and who evaluate this experience very positively. Even before the AIDS epidemic began, several expert panels recommended that medical schools establish affiliations with STD treatment facilities so that medical students and physicians in training would have the opportunity for supervised clinical experience treating STDs [15]. This education is even more imperative now; it will be essential to enable private sector physicians to play a leading role in the new and improved war on STDs and HIV.

Time required for elimination of Neisseria gonorrhoeae from the urogenital tract in men with symptomatic urethritis: comparison of oral and intramuscular single-dose therapy.

Abstract: Background and Objectives: The spread of sexually transmitted diseases (STDs), including gonorrhea, is affected by the duration of infection. Oral antibiotic therapy for gonococcal infection has been shown to be as effective as conventional intramuscular injection with ceftriaxone. Rapid cure would be expected to limit further spread of gonorrhea. However, the speed with which Neisseria gonorrhoeae is eliminated from the urogenital tract has not been evaluated. Goal of this Study: To determine the time required for elimination of Neisseria gonorrhoeae from the urine, mucosa, and semen in male subjects after treatment with ceftriaxone (250 mg intramuscularly), ciprofloxacin (500 mg by mouth, single dose) or cefixime (400 mg by mouth, single dose). Results: In 14 subjects, gonococci were eliminated from the urine within 4 hours of therapy and the mucosa within 24 hours after therapy. In 9 additional subjects, gonococci were eliminated from the semen by 24 hours after therapy. Conclusion: These results support the efficacy of single-dose oral therapy for gonorrhea and suggest that earlier follow-up for proof of cure in clinical trials of new antibiotics for gonorrhea may be acceptable. Rapid elimination of gonorrhea reduces the risk for continued transmission of the organism

Neutralization titer biomarker for antibody-mediated prevention of HIV-1 acquisition

Abstract: Abstract The Antibody Mediated Prevention trials showed that the broadly neutralizing antibody (bnAb) VRC01 prevented acquisition of human immunodeficiency virus-1 (HIV-1) sensitive to VRC01. Using AMP trial data, here we show that the predicted serum neutralization 80% inhibitory dilution titer (PT 80 ) biomarker—which quantifies the neutralization potency of antibodies in an individual’s serum against an HIV-1 isolate—can be used to predict HIV-1 prevention efficacy. Similar to the results of nonhuman primate studies, an average PT 80 of 200 (meaning a bnAb concentration 200-fold higher than that required to reduce infection by 80% in vitro) against a population of probable exposing viruses was estimated to be required for 90% prevention efficacy against acquisition of these viruses. Based on this result, we suggest that the goal of sustained PT 80 >200 against 90% of circulating viruses can be achieved by promising bnAb regimens engineered for long half-lives. We propose the PT 80 biomarker as a surrogate endpoint for evaluation of bnAb regimens, and as a tool for benchmarking candidate bnAb-inducing vaccines.

The cost-effectiveness of treating male trichomoniasis to avert HIV transmission in men seeking sexually transmitted disease care in Malawi.

Abstract: Allocation of funds to program areas where they may have an impact is critical to the success of any HIV control program. We examined the cost-effectiveness of providing first-line treatment for male trichomoniasis in Malawi a condition not commonly considered in syndromic management throughout sub-Saharan Africa. We used decision tree analysis to assess program costs and outcomes among a 1-year population of male sexually transmitted disease (STD) clinic attendees estimated at 10000 in Lilongwe. Our main outcomes were program costs from the government perspective and HIV infections averted. We conducted univariate and multivariate sensitivity analyses on selected parameters. In our study population of male STD clinic attendees with an HIV prevalence of 44% and a Trichomonas vaginalis prevalence of 20% including universal metronidazole as a first-line treatment for trichomoniasis at $0.05 per dose would increase program costs by $277 (year 2000 US dollars) and avert 23 cases of HIV. The incremental cost-effectiveness ratio (ICER) over the current STD management guidelines was $15.42 per case of HIV averted. The number of HIV infections averted under sensitivity analysis ranged from 2 to 52 with attendant ICERs varying from cost savings to $162.92. Consideration of wider social benefits such as the costs of HIV infections to the individual or the government would further enhance the cost-effectiveness of this program. As part of a larger program to control STDs incorporating metronidazole to treat male trichomoniasis could represent a cost-effective means to reduce HIV transmission in this high-risk group. (authors)

Prevention of HIV-1 Infection with Early Antiretroviral Therapy

Abstract: Background Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. Methods In nine countries, we...

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults

Abstract: Lionel A. Mandell, Richard G. Wunderink, Antonio Anzueto, John G. Bartlett, G. Douglas Campbell, Nathan C. Dean, Scott F. Dowell, Thomas M. File, Jr. Daniel M. Musher, Michael S. Niederman, Antonio Torres, and Cynthia G. Whitney McMaster University Medical School, Hamilton, Ontario, Canada; Northwestern University Feinberg School of Medicine, Chicago, Illinois; University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, and Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas; Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi School of Medicine, Jackson; Division of Pulmonary and Critical Care Medicine, LDS Hospital, and University of Utah, Salt Lake City, Utah; Centers for Disease Control and Prevention, Atlanta, Georgia; Northeastern Ohio Universities College of Medicine, Rootstown, and Summa Health System, Akron, Ohio; State University of New York at Stony Brook, Stony Brook, and Department of Medicine, Winthrop University Hospital, Mineola, New York; and Cap de Servei de Pneumologia i Allergia Respiratoria, Institut Clinic del Torax, Hospital Clinic de Barcelona, Facultat de Medicina, Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer, CIBER CB06/06/0028, Barcelona, Spain.

Role of free radicals and catalytic metal ions in human disease: an overview.

Abstract: Publisher Summary This chapter discusses the role of free radicals and catalytic metal ions in human disease. The importance of transition metal ions in mediating oxidant damage naturally leads to the question as to what forms of such ions might be available to catalyze radical reactions in vivo . The chapter discusses the metabolism of transition metals, such as iron and copper. It also discusses the chelation therapy that is an approach to site-specific antioxidant protection. The detection and measurement of lipid peroxidation is the evidence most frequently cited to support the involvement of free radical reactions in toxicology and in human disease. A wide range of techniques is available to measure the rate of this process, but none is applicable to all circumstances. The two most popular are the measurement of diene conjugation and the thiobarbituric acid (TBA) test, but they are both subject to pitfalls, especially when applied to human samples. The chapter also discusses the essential principles of the peroxidation process. When discussing lipid peroxidation, it is essential to use clear terminology for the sequence of events involved; an imprecise use of terms such as initiation has caused considerable confusion in the literature. In a completely peroxide-free lipid system, first chain initiation of a peroxidation sequence in a membrane or polyunsaturated fatty acid refers to the attack of any species that has sufficient reactivity to abstract a hydrogen atom from a methylene group.

Regression Diagnostics: Identifying Influential Data and Sources of Collinearity

Abstract: 1. Introduction and Overview. 2. Detecting Influential Observations and Outliers. 3. Detecting and Assessing Collinearity. 4. Applications and Remedies. 5. Research Issues and Directions for Extensions. Bibliography. Author Index. Subject Index.

Sexually transmitted diseases treatment guidelines.

Abstract: The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.