Latest from Medscape
Medscape
36 minutes ago
- Health
- Medscape
PEPFAR Spared, but Concerns About Global HIV Response Remain
Experts are expressing relief that the US President's Emergency Plan for AIDS Relief (PEPFAR), a $7.5 billion program credited with saving 26 million lives around the world from HIV, was spared millions of dollars in spending cuts. Last week, the US Senate removed a proposed $400 million reduction in PEPFAR funding from the $9 billion rescission package put forward by President Donald Trump after objections from Democrats and a handful of Republicans. The PEPFAR program, which was set up by President George W. Bush in 2003, provides treatment to two thirds of all patients with HIV across more than 50 countries and has allowed almost 8 million babies to be born healthy to mothers with HIV. 'This isn't a full reset, but it's meaningful,' Jirair Ratevosian, DrPH, a former senior advisor to PEPFAR, told Medscape Medical News. Members of both parties in Congress have found the administration's justifications for the cuts to be deceptive, he added. The blocking of the cuts is 'also a sign that Congress is willing to exert oversight and send a clear message globally: The US is not walking away from the HIV fight.' Ratevosian is an associate research scientist at Yale University in New Haven, Connecticut, with a primary focus on HIV prevention. 'It gives PEPFAR breathing room to continue planning country transitions — something the Trump administration claims to prioritize — and to support innovative programming, including HIV prevention using AI [artificial intelligence],' Ratevosian said. PEPFAR's Future Uncertain But while activists and experts welcomed the news, the future of the program remains uncertain. It is now administered by the US State Department, with little detail about how and where services will be delivered. 'The decision is a testament to the power of global health activism, but it is important to realize that all this does is ensure that $400 million that had already been allocated to be spent on fighting HIV doesn't get spent by Trump,' Asia Russell, executive director of Health GAP, an international organization focused on access to HIV medicines, told Medscape Medical News. Some organizations that are implementing PEPFAR have taken Trump's budget cuts to indicate that they should stop intervening among priority populations like trans patients, gay men, and sex workers. 'Any effective infectious disease response must focus on communities who have an elevated risk of HIV acquisition or poor clinical outcomes.' In a recent report, the Joint United Nations Programme on HIV and AIDS (UNAIDS) said that the weakening aid consensus and significant and abrupt funding shortfalls in the HIV response had triggered widespread disruption across health systems, halting HIV prevention programs and jeopardizing treatment services. UNAIDS predicted an additional 6 million new HIV infections and 4 million additional AIDS-related deaths worldwide between 2025 and 2029 resulting from the collapse of US funding. Ukraine has an estimated 245,000 patients with HIV, which is the second highest prevalence in Europe after Russia. Dmytro Sherembey, head of Ukraine's largest patient-led HIV organization, 100% Life, told Medscape Medical News that his organization had been forced to cut its expenses by 30%. He credits his own survival of HIV to US aid. 'These past few months have been incredibly difficult. Amid the war in Ukraine, we faced the terrifying risk of losing essential funding from PEPFAR. Prevention, awareness, advocacy, and community support programs — key drivers in the HIV response — were hit the hardest,' he said. 'The decision [not to cut funding] brings hope and stability. It means children won't lose parents, parents will have healthy babies, and people in Ukraine will keep accessing life-saving care.' Additional Threats Remain In April, UNAIDS said that Ukraine's national preexposure prophylaxis (PrEP) program was at high risk because of halted procurement. Its current supply is expected to be exhausted by mid-August 2025. 'In Ukraine, we count on the US decision that PEPFAR will continue to fund PrEP,' Andriy Klepikov, PhD, executive director of the Alliance for Public Health, told Medscape Medical News. The Alliance for Public Health is one of the largest HIV-focused nongovernmental organizations in Ukraine and the wider region. Andriy Klepikov, PhD 'We hope that PEPFAR will continue PrEP for key populations (not only for pregnant and breastfeeding women), but there is no confirmation yet,' he added. But while PEPFAR has been spared, additional threats to the global HIV response remain. The United States Agency for International Development (USAID) has been dismantled, the administration has cut nearly $1 billion in HIV funding at the National Institutes of Health, and the CDC's Division of HIV Prevention has been cut significantly. 'There's no sign that the funding of USAID will be restored. Much of the local support for HIV was funded by USAID, such as HIV testing, outreach workers, and support for key populations,' said Andrew Hill, MD, PhD, senior visiting research fellow in the Department of Pharmacology and Therapeutics at the University of Liverpool, Liverpool, England. Andrew Hill, MD, PhD He cited a recent The Lancet paper that suggested that ongoing deep funding cuts could result in more than 14 million additional deaths by 2030. 'If 14 million people do indeed die early as a result of US cuts, this would be the greatest loss of life from any US presidency since World War II.'
Medscape
an hour ago
- Health
- Medscape
Can New Treatments Overcome Compliance Issues in CVI?
President Donald Trump's recent diagnosis of chronic venous insufficiency (CVI) briefly brought a little-known but common circulatory disorder into the national spotlight. It also underscored a persistent problem that as many as 40% of US adults quietly face: the difficulty of adhering to treatment that is simple in theory but complicated in practice. CVI occurs when veins in the legs struggle to return blood back to the heart, leading to swelling, pain, skin changes, and, in some cases, ulcers. According to the Society for Cardiovascular Angiography & Interventions, first-line treatments include compression therapy, leg elevation, exercise, and weight management. Yet many patients abandon therapy early, either due to discomfort, physical limitations, confusion about the disease, or a frustrating cycle of delayed diagnosis and inaccessible specialty care. Leigh Ann O'Banion, MD 'Chronic venous insufficiency is a widespread but often underrecognized condition that, when left untreated, can lead to significant morbidity,' said Leigh Ann O'Banion, MD, associate clinical professor of vascular surgery at the University of California San Francisco Fresno. As awareness of CVI grows, experts say improving compliance may finally be possible, thanks to smarter technology, more patient-friendly devices, and greater focus on early, proactive care. Why so Difficult? Compression stockings are a cornerstone of CVI management. They work by reducing pressure in leg veins and help prevent blood pooling. But for many, they're also a dealbreaker — notoriously uncomfortable, difficult to put on, and hard to tolerate in hot or humid weather. Naomi Hamburg, MD 'Adherence can be challenging, especially in people with reduced mobility including older adults and people with obesity,' said Naomi Hamburg, MD, interim director of the Whitaker Cardiovascular Institute at the Boston University Chobanian & Avedisian School of Medicine and an attending in the cardiovascular medicine section at Boston Medical Center, both in Boston. 'There are alternatives, including Velcro wraps and compression pumps, that may help, but even those require instruction and support.' Misunderstanding the disease also plays a role in noncompliance, according to Joshua Beckman, MD, past volunteer chair of the American Heart Association's Vascular Health Advisory Committee and current chief of vascular medicine at UT Southwestern Medical Center, both in Dallas. 'I find that patients don't understand how veins work,' Beckman said. 'Once they understand why swelling occurs, it becomes easier to explain why compression garments and leg elevation overnight help combat the higher pressures in the veins.' But even with education, many patients struggle with the fact that compression therapy doesn't cure the condition. 'Compression therapy helps reduce symptoms; it doesn't fix the underlying vein problem,' Hamburg said. When patients give up on compression, clinicians are often hesitant to pursue the next level of care, such as referral for interventional treatment, Hamburg said. 'Lack of use of compression therapy is not a reason for interventional procedures,' Hamburg said, 'because compression is still needed after interventions to have optimal results.' The frustrating cycle of low compliance, worsening symptoms, and reluctance to escalate care keeps many patients trapped in a state of chronic discomfort and progressive disease. Breaking the Bottleneck Breaking the compliance bottleneck will require more than one solution. 'I think most of what is coming are improvements in current types of therapy,' Beckman said — things like smart compression therapy devices that use miniaturized and lightweight actuators and electronics to control the applied pressure. Beckman also cited early-stage research using artificial intelligence to detect venous obstruction or reflux and surgical innovation involving deep vein valve replacements — still in development but showing promise. According to Hamburg, advances in fabric design could make compression garments easier to wear and tolerate, particularly in warm weather. She also highlighted studies exploring surgically implanted valves for deep veins, an option not currently available for most patients with severe CVI. New weight-loss medications may help play a role in some cases of CVI. Obesity is a common risk factor for CVI, Hamburg said, and new drugs for weight management may help people with obesity-related CVI. 'But we need more studies to understand this better,' she added. Front-Line Detectors Earlier detection is another key to breaking the compliance bottleneck, and primary care providers are often the first, and only, clinicians positioned to catch CVI early. 'Many doctors don't think about chronic venous insufficiency or don't know about the importance of it for patients,' Hamburg said. 'When I trained in internal medicine, I don't remember learning about it or how to treat it.' When swelling or skin changes suggest CVI, she encouraged clinicians to initiate compression therapy immediately before a referral or ultrasound. 'The first step is to take off socks and shoes and examine the legs,' she said. 'We get so much information from the legs about both arterial and venous circulation.' Beckman agreed. 'Early application of compression garments and leg elevation can reduce symptoms and slow progression,' he said. 'That first step, from a trusted provider, makes a huge difference.' Studies also suggest CVI may be linked to broader cardiovascular problems, such as peripheral artery disease and heart failure. 'I now routinely assess cardiovascular risk factors in patients with CVI,' she said. 'We need to think about venous health not in isolation but as part of whole-body cardiovascular health.' The path to specialty care, however, is not straightforward for all patients. Geographic isolation, sometimes referred to as 'vascular deserts,' and limited access to specialists, insurance hurdles, and transportation issues often stand in the way of early intervention. These access barriers can be particularly acute in underserved populations, said O'Banion, who also serves as the medical director for the Foundation to Advance Vascular Cures. 'Insurance coverage and out-of-pocket costs can also be prohibitive, especially for newer therapies. Systemic mistrust, lack of awareness, and logistical issues such as transportation or the inability to take time off work further complicate access,' she said. To bridge these gaps, O'Banion and her colleagues launched CHAMPIONS — the Comprehensive Heart and Multidisciplinary Limb Preservation Outreach Network. The program brings vascular screenings and education directly to community sites such as food banks, health fairs, and local events. 'CHAMPIONS often serves as the first and only point of contact with a vascular specialist for many individuals,' she said. When timely intervention is possible, patient outcomes improve significantly. According to O'Banion, patients who undergo endovenous ablation — especially newer, nonthermal, non-tumescent techniques — report faster recovery and higher satisfaction than those relying solely on compression. 'These newer technologies expand the number of patients eligible for outpatient care and reduce the discomfort, downtime, and risk associated with more invasive options,' she said. In both well-resourced and rural environments, O'Banion said, patients frequently present late in the disease course, often after extended periods of conservative management or missed opportunities for earlier diagnosis. 'Late-stage referrals are common,' she said. 'But when patients understand what's happening in their bodies and feel supported in managing it, they're much more likely to stick with treatment.' Experts said Trump's diagnosis may have temporarily brought CVI into the public eye, but the disease is likely affecting millions more silently. 'It also serves as a reminder that even individuals presumed to have the best medical care may fall through the cracks of delayed diagnosis,' O'Banion said. And as innovation continues, the burden of early detection and patient education still falls largely on frontline providers. 'CVI is not just a quality-of-life condition,' O'Banion said. 'It's a disease with real consequences. But with better tools and earlier action, we can improve outcomes for millions.' Beckman reported consulting for Medtronic. O'Banion reported receiving research grants and serving as a consultant for Abbott, Medtronic, Shockwave, Gore, Penumbra, and Reflow Medical. Hamburg reported having no relevant disclosures.
Medscape
2 hours ago
- Health
- Medscape
Long COVID Gene Variants: A Step Toward a Diagnostic Test?
A large-scale global study has identified genetic variants that are risk factors for long COVID, a discovery that helps researchers better understand the biological systems involving the disease and one small, early step toward the elusive goal of developing a long COVID diagnostic test. International researchers with the Long COVID Host Genetics Initiative used data from 33 independent studies and 19 countries across North America, Europe, the Middle East, and Asia to analyze the genomes of nearly 16,000 patients with long COVID, representing populations from six genetic ancestries. Nearly 1.9 million controls were included in the genome-wide association study, a research method that scans complete sets of DNA to identify genetic variations associated with a specific trait or disease. Genetic variants found in the FOXP4 gene had a statistically significant risk linked to long COVID, the study, published in Nature Genetics , found. The FOXP4 gene is known to impact lung function, and its expression levels were higher in those with long COVID than in controls. In addition, the risk variants had a consistent effect across different ancestries. The researchers also found a causal relationship between a SARS-CoV-2 infection and long COVID and an additional causal risk between infections severe enough to require hospitalization and long COVID. Researchers also analyzed possible connections between variants associated with long COVID and those linked to other diseases and conditions. Scientists said the overall findings provided evidence that was consistent with long COVID research that suggests both individual genetic variants and environmental risk factors contribute to disease risk. The findings also provide genetic proof linking abnormal lung physiology and the development of long COVID, the authors concluded; however, they noted that long COVID symptoms are not only limited to lung function and may include fatigue and cognitive dysfunction as well. The study's co-author, Hanna Ollila, PhD, with the Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland, underscored that the newly discovered genetic variants were not predictive for clinical tests or personal disease risk. 'The findings from our study, and from genome-wide association studies in general, tell about biological mechanisms behind a disease. This can then help to understand the disease better. For example, is it a disease neuronal, immune, metabolic, and so on?' said Ollila, who is also a researcher with the Department of Anesthesia and Center for Genomic Medicine at Massachusetts General Hospital, Boston. There are still many steps between these types of discoveries and the development of a diagnostic test, she explained, since these types of genetic variants do not function like high-impact variants such as the BRCA mutations in breast cancer. 'In other words, they do not strongly predict whether someone will develop long COVID at the individual level,' Ollila said. 'Instead, they highlight the biological systems involved in the disease. In this case, our findings point to immune pathways related to lung function.' Ollila explained that genetics can guide diagnostic development by pointing to underlying mechanisms, which may then help identify biomarkers in blood or other tissues. These biomarkers could eventually contribute to diagnostic tools, but it is a process that takes time and collaboration and often depends on progress across several fields of research including imaging and clinical phenotyping. Researchers hope that when larger sample sizes become available for bigger studies, the analyses and understanding of the correlations will become more precise, bringing more understanding and clarity on genetic risk factors, biological mechanisms, and biomarkers that could someday help with disease diagnosis. 'We are likely still several years away, and possibly even a decade or more, from having a clinically useful diagnostic test based on genetic or biological markers for long COVID,' said Ollila. 'That said, progress is accelerating thanks to the growing number of well-characterized cohorts and international collaborations. While these genetic findings are not yet ready for clinical application, they are an important step toward understanding long COVID, its relationship with other diseases, and the disease mechanisms that modulate risk for long COVID.'
Medscape
3 hours ago
- Health
- Medscape
Are Preschoolers in the US Meeting Healthy Behavior Goals?
TOPLINE: Only about 20% of preschoolers in the US followed five to six healthy habits, with clear differences by socioeconomic factors and geographic location. Children who lived in homes with enough food, had safe neighborhoods, had parents with excellent or very good mental health, and often ate meals with their families were more likely to have healthy behaviors. METHODOLOGY: Researchers analyzed data from the 2021 and 2022 National Survey of Children's Health to assess factors related to healthy behavior among children aged 3-5 years in the US. A total of 23,123 children were included in the analysis, with data collected through parent or caregiver reports. Six healthy behaviors were examined: daily consumption of fruits, daily consumption of vegetables, no sugary drinks, frequent outdoor play, limited screen time, and adequate sleep. Logistic regression modeling was used to assess relationships between healthy behaviors and various characteristics of the child, family, and community. TAKEAWAY: The prevalence of healthy behaviors among preschoolers varied, with 32.4% not consuming sugary drinks and 65.3% consuming fruit daily. Only 20.3% of preschoolers engaged in five to six healthy behaviors. Black non-Hispanic, Hispanic, and Asian non-Hispanic children were less likely to engage in five to six healthy behaviors than White non-Hispanic children (adjusted prevalence rate ratio [aPRR], 0.38, 0.57, and 0.64, respectively; P < .05 for all). Children aged 3 years were more likely to engage in five to six healthy behaviors than those aged 5 years. Engagement in five to six healthy behaviors was more likely among children with parents with excellent or very good mental health (aPRR, 1.30), those living in safe neighborhoods (aPRR, 1.17), those living in homes with enough food (aPRR, 1.35), and those who ate meals with their families 4 or more days a week (aPRR, 1.70; P < .05 for all). State-level variations were substantial, with Vermont having the highest adjusted prevalence of preschoolers engaging in five to six healthy behaviors (36.2%) and Mississippi, the lowest (8.3%). IN PRACTICE: 'Study findings underscore the importance of the family context and the challenges families experience in supporting children's engagement in HBs [healthy behaviors], with fewer than half of preschoolers having no sugary beverages, limited screen time, or eating vegetables daily,' wrote the authors of the study. 'There are opportunities to promote healthy living among children across multiple domains of influence, including direct counseling, screening, and referral to community resources to meet basic needs, and supporting family-focused policies and programs,' they added. SOURCE: The study was led by Julie F. Donney, PhD, of the Office of Epidemiology and Research at the Maternal and Child Health Bureau, Health Resources and Services Administration in Rockville, Maryland. It was published online on July 14, 2025, in the American Journal of Preventive Medicine. LIMITATIONS: The design of the study made it difficult to determine if healthy behaviors were caused by certain factors. The link between family or community factors and healthy behaviors may be affected by unmeasured variables such as parenting styles or seasonal changes. Different definitions of healthy behaviors were not examined. DISCLOSURES: This study did not receive any specific funding. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
4 hours ago
- Health
- Medscape
Point-of-Care Testing Cuts Antibiotic Use in Pharyngitis
TOPLINE: Point-of-care testing for group A beta-hemolytic Streptococcus (Strep A) significantly reduced antibiotic prescriptions in children and adults with signs of pharyngitis, even when used as the sole intervention. METHODOLOGY: Researchers performed a meta-analysis of eight randomized controlled trials conducted between 2007 and 2021, evaluating point-of-care testing for Strep A vs standard care. The analysis included 4249 children and adults with pharyngitis, cough, or sore throat who underwent point-of-care testing for Strep A either alone or alongside other interventions. Primary outcomes were the impacts on antibiotic prescriptions, clinical decisions, and patient health outcomes. Secondary endpoints assessed diagnostic accuracy of Strep A testing, including sensitivity and specificity measurements. TAKEAWAY: Point-of-care testing reduced antibiotic prescriptions by 38% compared with standard care (risk ratio [RR], 0.62; P < .0001) and by 41% when it was the sole intervention (RR, 0.59; P < .001). The implementation of point-of-care testing also led to a reduction in inappropriate antibiotic prescriptions (RR, 0.45; 95% CI, 0.31-0.97; P = .038). However, there were no significant differences in the patient health outcomes, such as days until pain resolution and days of school/work missed, the use of ancillary testing, or other medications such as analgesics with point-of-care testing. The reported diagnostic accuracy of Strep A point-of-care testing showed sensitivity ranging from 65% to 94% and specificity from 85% to 94%. IN PRACTICE: 'Physicians can therefore use Strep A POCTs [point-of-care tests] to inform their decisions on antibiotic prescribing without compromising patient health outcomes. In clinical practice, physicians must be aware of the limitations of Strep A POCTs, in particular, the limited sensitivity for detecting GAS [group A beta-hemolytic Streptococcus],' the authors of the study wrote. SOURCE: This study was led by Ann-Sophie Mägdefrau and Carolin Kathner-Schaffert, Jena University Hospital and InfectoGnostics Research Campus Jena, both in Jena, Germany. It was published online on July 9, 2025, in Open Forum Infectious Diseases. LIMITATIONS: High statistical heterogeneity in the meta-analyses limited the precision of the pooled effect estimates. Only three trials reported patient health outcomes, restricting evaluation of the effect of Strep A point-of-care tests on measures like recovery time. Additionally, none of the trials were blinded, introducing potential bias — particularly in evaluating subjective outcomes like pain and symptom resolution. DISCLOSURES: This study received funding from the German Federal Ministry of Education and Research. The authors reported having no relevant conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
