In This Article
- Pediatric Patients with HIV Vaccinated for MMR Still Lack Immunity
- New Blood Test Predicts Clinical Aging, Alzheimer’s Disease Risk
- Overhydration Should Not Be Ignored in Athletes
- Pharmacists and Physicians Can E-Prescribe, Dispense Controlled Substances
- Chantix Not Linked to Depression, Heart Risks
Pediatric Patients with HIV Vaccinated for MMR Still Lack Immunity
Children with perinatal human immunodeficiency virus (HIV) infection may not be protected against measles, mumps, and rubella (MMR), despite receiving the vaccination for those diseases. These patients may have an impaired initial vaccine response or waning immunity, researchers explained.
Perinatal patients with HIV and perinatally HIV-exposed patients aged 7 to 15 years who are not infected were enrolled in the Pediatric HIV/AIDS Cohort Study between 2007 and 2009. Demographic information, laboratory values, immunization, and clinical data were collected at annual visits, and the most recent serologic specimen was used to determine MMR seroprotection.
The prevalence for measles and rubella seroprotection, and mumps seropositivity was significantly lower in perinatal patients with HIV compared with perinatally HIV-exposed patients. Furthermore, the investigators found a greater number of vaccine doses while receiving sustained combination antiretroviral therapy (≥3 months) and higher nadir CD4 T-cell percentage between the last vaccine dose and serologic testing independently improved the cumulative prediction of measles seroprotection in perinatal patients with HIV.
Retail pharmacists and clinicians should take these findings into consideration when working with pediatric patients, and bring it to the attention of the prescriber.
- Siberry GK, Patel K, Bellini WJ, et al. Immunity to measles, mumps, and rubella in US children with perinatal HIV infection or perinatal HIV exposure without infection. Clin Infect Dis. 2015;61:988-995.
New Blood Test Predicts Clinical Aging, Alzheimer’s Disease Risk
Researchers have recently identified a novel genomic diagnostic tool using multitissue ribonucleic acid (RNA) signature for healthy aging via a peripheral blood sample. “This RNA signature has great potential to assist research aimed at finding treatments for and/or management of [Alzheimer’s disease] and other ageing-related conditions,” Sanjana Sood, MSc, XRGenomics Ltd, London, UK, and colleagues explained.
The investigators conducted a 7-year study at King’s College London, UK, in collaboration with the Karolinska Institutet in Sweden and Duke University in the United States, and used RNA profiling to measure and compare gene expression in human tissue samples. The research first focused on generating a reliable RNA classifier for healthy older muscle tissue. In that effort, 150 probe sets created an accurate classifier of young versus older muscle tissue.
The data were validated in >500 independent samples of muscle, skin, and brain tissue from 15 younger adults (aged 19-28 years) and 15 older adults (aged 59-77 years) without signs of metabolic and cardiovascular disease. The authors found that healthy muscle aging gene scores differed from chronological age using a set of tissue samples from the Uppsala Longitudinal Study of Adult Men birth-cohort where the constant chronological age (approximately 70 years) was compared with healthy muscle age. In addition, they found that the RNA classifier was not sensitive to confounding lifestyle markers, and that a greater gene score at age 70 years was independently associated with better renal function at age 82 years, as well as longevity.
In addition, Sood and colleagues assessed the relationship between the healthy gene score in blood and disease status, using age- and gender-matched case-control analysis. They found that healthy patients (controls) had a significantly greater gene score than patients with cognitive impairments.
Retail pharmacists and clinicians may benefit from following the developments of these data as patients may have questions about their validity and availability. In addition, this test may eventually lead to a novel service offering for patients in the community.
- Sood S, Gallagher IJ, Lunnon K, et al. A novel multi-tissue RNA diagnostic of healthy ageing relates to cognitive health status. Genome Biol. 2015;16:185.
- Knapton S. Drop of blood can show biological age and predict Alzheimer’s disease. The Telegraph. September 7, 2015. www.telegraph.co.uk/news/health/news/11844697/Drop-of-blood-can-show-biological-age-and-predict-Alzheimers-Disease.html. Accessed September 8, 2015.
Overhydration Should Not Be Ignored in Athletes
Water intoxication, also known as hyponatremia, is a condition where water is consumed in such large quantities that the body cannot get rid of the excess through normal mechanisms (eg, sweating or urinating).
Consensus from a panel of 17 experts at the 3rd International Exercise-Associated Hyponatremia Consensus Development Conference suggest that under certain circumstances, overhydration can have severe and even fatal consequences. The panel met with the goal to update their previous consensus statement, and launch an education campaign to address morbidity and mortality associated with preventable and treatable fluid imbalances.
Hyponatremia is no longer isolated to marathon runners or prolonged endurance events, but is now being reported in half-marathons, sprint triathlons, Grand Canyon hikes, Bikram yoga classes, as well as football games from high school to professional levels.
The guidelines recommend that athletes should drink when they feel thirsty and listen to their bodies. The authors emphasize that this should not increase players’ risks for cramping or heat illness. In general, they urge not to force athletes to drink water if they’re not thirsty; don’t make them play if they aren’t feeling well; and if they report feeling too hot, have them sit down.
When discussing health and wellness with their patients, community pharmacists and clinicians should discuss how to properly hydrate during exercise.
- Hew-Butler T, Rosner MH, Fowkes-Godek S, et al. Statement of the 3rd International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Br J Sports Med. 2015 Jul 30. Epub ahead of print.
- Reynolds G. For athletes, the risk of too much water. The New York Times. August 26, 2015. http://well.blogs.nytimes.com/2015/08/26/for-athletes-the-risk-of-too-much-water/?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=1. Accessed September 8, 2015.
Pharmacists and Physicians Can E-Prescribe, Dispense Controlled Substances
According to the Centers for Disease Control and Prevention, deaths associated with prescription painkillers have quadrupled since 1999, leading to >16,000 deaths in the United States in 2013. Almost 2 million Americans aged ≥12 years have abused, or were dependent on, opioids in 2013.
On August 28, Vermont became the final state in the nation to allow the prescription and dispensing of controlled substances electronically, according to a press release from Surescripts.
“Care providers, pharmacies and government officials are working together to combat the prescription drug abuse epidemic that plagues our nation,” Tom Skelton, Chief Executive Officer of Surescripts, said in a statement. “Throwing out the prescription pad and opting for an electronic process makes it easier for patients to get the medications they need while helping to prevent fraud and abuse.”
Earlier in August, the White House announced their funding for the High Intensity Drug Trafficking Areas program, which combines law enforcement and public health resources to help fight painkiller abuse, including developing training for local law enforcement and first responders to help them handle heroin and prescription painkiller-related incidents.
- E-Prescribing of Controlled Substances Now Legal Nationwide [news release]. Arlington, VA: Surescripts; August 28, 2015. http://surescripts.com/news-center/press-releases/!content/e-prescribing-of-controlled-substances-now-legal-nationwide. Accessed September 8, 2015.
Chantix Not Linked to Depression, Heart Risks
Six months of data from 164,766 smokers in England indicate that the smoking cessation drug Chantix (varenicline) were not more likely to have a heart attack than patients using nicotine replacement therapy or another drug to help quit smoking. Similar results were seen for depression risk.
Varenicline has a black box safety warning in the United States because patients reported mental health issues, and it may increase the risk for heart attacks in patients with cardiovascular disease.
“[These] findings suggest an opportunity for physicians to prescribe varenicline more broadly, even for patients with comorbidities, and thereby help more smokers to quit successfully than do at present,” Daniel Kotz, PhD, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Germany, and colleagues concluded.
These data may be of interest to pharmacists and clinicians counseling patients about smoking cessation, and answer questions they have about adverse events associated with this drug.
- Kotz D, Viechtbauer W, Simpson C, et al. Cardiovascular and neuropsychiatric risks of varenicline: a retrospective cohort study. Lancet. 2015 Sep 6. Epub ahead of print.
- Pfizer’s quit-smoking drug not linked to depression or heart risks [news release]. London, UK: Reuters; September 6, 2015. www.reuters.com/article/2015/09/06/us-health-smoking-pfizer-idUSKCN0R610420150906. Accessed September 8, 2015.