Am Fam Physician. 1999 Apr 15;59(8):2367-2368.
Disclosing Diagnosis to Children with HIV
In a policy statement published in the January 1999 issue of Pediatrics, the American Academy of Pediatrics (AAP) strongly recommends that physicians encourage parents who have school-age children and adolescents with human immunodeficiency virus (HIV) infection to tell those children the truth about their illness. In the statement, the AAP reports that by the end of 1997, there were 8,000 reported cases of acquired immunodeficiency syndrome (AIDS) in children younger than 13 years and over 3,000 adolescents with AIDS.
According to the AAP, studies provide evidence that children who know their HIV status have higher self-esteem than children who are sick but have not been told why. When considering disclosure of the HIV diagnosis, parents and physicians need to take into account the child's cognitive ability, developmental state, clinical status and social circumstances.
Younger children (those who are not yet school-aged) may not need to know the specific diagnosis, but they do need to have their illness discussed with them. The AAP states that younger children are most interested in learning what will happen to them in the immediate future.
The AAP emphasizes that adolescents who are diagnosed with HIV infection need to know and understand the consequences of many aspects of their health, including sexual activity. Adolescents also should help make appropriate decisions about treatment and participation in clinical treatment trials. The AAP stresses that physicians should help parents determine the best way to disclose this information to their child.
Expanded Indication for Lamotrigine
The U.S. Food and Drug Administration (FDA) has approved a new indication for the anticonvulsant medication lamotrigine (Lamictal). Adults with partial epileptic seizures can now convert to monotherapy with lamotrigine if they are currently receiving treatment with a single enzyme-inducing antiepileptic drug. Lamotrigine has been available since 1994 as add-on therapy for the treatment of partial seizures in adults with epilepsy. It also received approval in 1998 as add-on therapy for generalized seizures in persons with Lennox Gastaut syndrome.
In one 28-week clinical study, lamotrigine was evaluated in 156 patients ages 13 to 73 years whose seizures were previously uncontrolled by their medication. More than twice as many patients in the group receiving lamotrigine successfully completed monotherapy, compared with the group receiving valproic acid (56 percent versus 20 percent). The most common adverse events in the monotherapy phase of treatment with lamotrigine were dizziness, nausea, coordination abnormality, vomiting and dyspepsia. Serious rashes have been reported. The manufacturer recommends that patients be instructed to report a rash or other signs or symptoms of hypersensitivity to their physician immediately.
NCI Booklet on Cancer History
The National Cancer Institute (NCI) has made available a revised booklet titled “Closing in on Cancer: Solving a 5000-Year-Old Mystery.” The booklet documents recent research advances in fields including molecular genetics that are providing research opportunities that hopefully will result in diagnostic tools and treatments to control this disease. The 54-page booklet can be ordered by calling NCI's Cancer Information Service at 800-4-CANCER. In addition, a number of booklets can be downloaded from NCI's Web site at http://www.nci.nih.gov.
Report on Screening for Cervical Cancer
The conventional Papanicolaou (Pap) test remains the most effective tool for detecting cervical cancer in adult women at average risk, according to a study sponsored by the Agency for Health Care Policy and Research (AHCPR) under its evidence-based practice program. Results of the study showed that the Pap test was the most reliable when compared with three new available technologies (ThinPrep, AutoPap and Papnet), but that the new technologies may help strengthen diagnostic accuracy in the detection of cervical cancer.
The researchers found that the three new technologies appear to reduce the likelihood that premalignant and malignant cells will be mis-diagnosed as normal, but little was found about the effect of these new technologies on diagnostic specificity. The Pap test, while important in decreasing cervical cancer in women, was not found to be as accurate in its diagnosis of disease as previously believed. Based on the most reliable studies, a single Pap test may miss abnormal cells in nearly one half of women who have abnormal cell growth. When initial and rescreening intervals were lengthened to every three years or more, the new technologies were more cost effective than the traditional Pap test.
The “Evaluation of Cervical Cytology” report is one of a new series of evidence-based reports and technology assessments sponsored by the AHCPR. A summary is available on the AHCPR Web site at http://www.ahcpr.gov. The full report (AHCPR 99-E009) may be obtained free from the AHCPR Publications Clearinghouse by calling 800-358-9295.
Brochure About Exposure to Contaminants Through Consumption of Fish
The Agency for Toxic Substances and Disease Registry (ATSDR) and the U.S. Environmental Protection Agency (EPA) have made available a brochure addressing exposure of persons to chemical contaminants through the consumption of contaminated fish. The brochure, “Should I Eat the Fish I Catch?” was produced as a result of the Administration's Clean Water Action Plan, a blueprint for a cooperative approach to identify and solve pollution problems and to inform citizens and officials about the quality of lakes and waterways, and the safety of the fish and drinking water that come from them.
The brochure is available in English, Spanish and Hmong. For copies, contact EPA's National Center for Environmental Publications, 11029 Kenwood Rd., Cincinnati, OH 45252. For more information, contact the EPA Office of Water, Fish Contamination Program (4305), 401 M St., SW, Washington, D.C. 20460 (e-mail: www.epa.gov/ost/fishadvice); or ATSDR, Division of Health Education and Promotion, MS E-33, 1600 Clifton Rd., NE, Atlanta, GA 30333 (telephone: 404-639-6204).
Incidence Figures on Sexually Transmitted Diseases
The American Social Health Association (ASHA) has released a report about the incidence of sexually transmitted diseases (STDs) in the United States. According to ASHA, an estimated 15.3 million new cases of STDs occurred in 1996, a 25 percent increase over the 12 million cases previously estimated by the Centers for Disease Control and Prevention in 1988. While most of the increase can be attributed to improved detection methods, ASHA notes that STD rates in the United States are higher than any other industrialized country. The populations most at risk are teenagers, women and their infants, and ethnic minorities who are poor and lack access to medical care.
The report was developed by a panel of health experts convened by ASHA on behalf of the Kaiser Family Foundation. The health experts believe that more than two thirds of the 15.3 million cases of STDs were caused by increases in the estimates of human papillomavirus infection and trichomoniasis. Health care professionals are encouraged by ASHA to call the national STD hotline at 800-227-8922 from 8 a.m. to 11 p.m. (EST) and the 24-hour national AIDS hot-line at 800-342-2437 to obtain more information about STDs.
Copyright © 1999 by the American Academy of Family Physicians.
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