Illinois Medicine

VISIONARY DRUG? T PHOTO: LLOYD DEGRANE HIV BEHIND BARS $7 million grant will test, treat inmates—an estimated one-seventh of infected population T HE COLLEGE OF MEDICINE IS AMONG RECIPIENTS OF A $7 MILLION GRANT from the National Institutes of Health to study effective ways to find, test and treat inmates with HIV. Researchers from the college, the University of Illinois at Chicago School of Public Health and the Cook County Jail will focus on inmates in Cook County and at Illinois state prisons. They will work to increase the number of inmates tested, provide more effective anti-retroviral therapy to HIV- positive prisoners and provide case management after prisoners' release to continue effective treatment. The need is rampant, says Lawrence Ouellet, MD, research professor of epidemiology and one of the principal investigators. "Each year, an estimated one in seven individuals infected with HIV passes through a correctional facility," he says, "which sug- gests that these facilities are key sites for public health interventions targeting HIV/AIDS." The researchers will help make HIV testing a routine feature of health exams to maximize the number of inmates tested, says Michael Puisis, MD, a co-principal investigator and chief operating officer at Cermak Health Services of Cook County Jail. Cur- rently, inmates must "opt-in" for HIV testing. Whereas under the new procedure, the inmates will have the option to opt out. The project also will evaluate how well telemedicine could provide HIV care to state prison inmates. A physi- cian at UIC will take a complete history and perform a physical exam via confidential, interactive video tele- conferencing, eliminating the need for prisoners to be transported from remote locations for care. "In the past, inmates housed in the Illinois Department of Corrections prison facilities had very limited access to subspecialty care," says Jeremy Young, MD, assistant professor of infectious diseases at UIC and a co-principal investigator. The project also will offer case-management ser- vices to newly released HIV-positive inmates to encour- age ongoing care and will provide partner notification, counseling and testing for people in detainees' social networks who may be at risk for infection. In addition to Cook County Jail and the University of Illinois at Chicago, the research partnership includes the Illinois Department of Corrections, AIDS Foundation of Chicago, South Side Help Center and Public Health Institute of Metropolitan Chicago. New drug provides treatment option for top cause of adult blindness HE LEADING CAUSE OF ADULT BLINDNESS may benefit more from a drug therapy than laser treatment, according to a new study that included the College of Medicine. Researchers in Chicago partici- pated in a national multicenter trial that compared treatments for diabetic macular edema, a swelling of the retina associated with diabetes that's the most common cause of blindness among adult Americans. The study looked at the results of treating this condition by injecting the drug ranizumab—mar- keted by Genentech as Lucentis—and compared them with results of laser treatment, which has been the standard of care for the last 25 years. The study, which will be published online in the journal Ophthalmology, followed 691 people treated at 52 sites, including the University of Illinois at Chicago. The study "shows the power of targeted treatment for diabetic macular edema," says Jen- nifer Lim, MD, professor, Charles I. Young Chair of Ocular Research in Ophthalmology and Visual Sciences at UIC and a site principal investigator on the study. "We were able to achieve much higher visual acuity improvements than ever be- fore," she says, adding that the treatment came without significant side effects. Patients were randomly assigned to one of four treatment groups: sham injections plus prompt laser treatment within one week, rani- zumab injections plus prompt laser treatment, ranizumab plus deferred laser treatment after six months or more, or injections of a corticosteroid drug plus prompt laser treatment. After one year, nearly half the eyes treated PHOTO: LLOYD DEGRANE with ranizumab had improved to the point where patients could read at least two additional lines on an eye chart than before treatment. Results were similar whether ranizumab was accompa- nied by prompt or delayed laser treatment. Fewer than 5 percent of patients in the treatment groups experienced a visual loss of two or more lines. In contrast, only about 30 percent of patients receiving laser treatment alone or corticosteroid plus laser treatment improved their ability to read two or more lines on an eye chart, while 13 to 14 percent had a visual loss of two or more lines. "Ranizumab is an important new treatment option for people with diabetes," says Lim, direc- tor of the retina service at UIC, who hopes that the high complication rate for patients treated with the corticosteroid will help to end the use of this outmoded treatment option. 8 | WINT ER 2 011

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