Co-infection of HIV patients with the silent killer, hepatitis C

Hepatitis C (HCV), a liver condition amenable to appropriate treatment depending on disease status, is caused by different blood-borne HCV genotypes. Approximately 130–150 million people across the globe have chronic HCV infections.  In addition, millions of baby boomers— people born between 1945 and 1965 — may be unaware that they are infected with HCV. Antiviral treatment is successful in 50–90% of diagnosed cases, depending on the treatment used, but access to these resources are limited, according to the World Health Organization.

Co-infection of HIV patients with HCV (~4—5 million people worldwide), causes substantial morbidity and is associated with higher rates of all-cause, liver-related and AIDS-related deaths (1). The onset of treatments tailored to HCV and other known opportunistic infections in HIV patients has been outlined by the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America (2). For patients with an acute HCV co-infection and no spontaneous clearance, treatment should be offered using a genotype-specific regimen as for chronic HCV infection for 24 to 48 weeks. Factors favoring initiation or deferral should be taken into account before initiating HCV-genotype-specific regimens in chronically infected patients according to dosage guidelines based on concomitant anti-retroviral regimens. The national organizations also describe further considerations that should guide HCV therapy in a HIV-infected patient e.g., “HCV treatment is generally not recommended in patients with a CD4+ cell count <200 cells/μL (2).”

A complete summary of guidelines for the prevention and treatment of opportunistic infections in HIV patients can be found here.

References

1.            von Schoen-Angerer T, Cohn J, Swan T, Piot P. UNITAID can address HCV/HIV co-infection. The Lancet. 2013;381(9867):628.

2.            National Guideline Clearinghouse. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://www.guideline.gov/content.aspx?id=45359&search=hiv+and+opportunistic+infections. Accessed 4/23/2014.

Tea and ingenuity (First appeared in The Norwalk Patch

Visionaries with great products and effective marketing skills deserve our praise. Steve Jobs and Bill Gates are two examples that readily jump to mind. The business acumen and drive of these two men have led to the near-ubiquitous use of their products in homes from Norwalk to Nanjing. While each man can point to logistical and personal struggles in making their respective dreams come true, they were fortunate in the sense that the launch of Apple Computers and Microsoft software happened in relatively prosperous times.

What would it take to launch and/or expand a business in the midst of an economic recession? Innovation is undoubtedly an important ingredient of the recipe for success, as demonstrated by revolutionary discoveries made during the years following the Great Depression at Bell Laboratories. Jon Gertner, author of “ The Idea Factory: Bell Labs and the Great Age of American Innovation,” quoted Bill Gates: “My first stop on any time-travel expedition would be Bell Labs in December 1947.” Indeed, the Boston Globepraised Gertner’s book, which describes the New Jersey-based think tank that churned out inventions such as “the transistor, the radio telescope, the laser,” and of course “our entire modern communications infrastructure.” Post-depression America also benefited on a smaller scale from entrepreneurs who had to figure out ways to survive in harsh economic times without the backing of AT&T or “angel investments.”

Time travelers in search of such entrepreneurs can navigate back to October 1929, when the Wall Street stock market crash heralded the start of the Great Depression. One couple, the Bigelows, suddenly had to deal with the financial shock of the husband’s (David, Sr.) job loss and reduced revenues from the wife’s (Ruth Campbell or RC) decorating business. After more than three decades of mastering the decorating business and faced with the knowledge that the market no longer required her services, Ruth Bigelow came to the realization that she had to reinvent herself.

She decided to go into the food business. Her son, David Bigelow, would later recall that his seventy-year-old father and fifty-year-old mother had to dip into their savings to launch the business (in 1945). The production and/or distribution of Chinese seasoning and tapioca kept the fledgling business afloat for its first three years; however, Ruth also had other ideas percolating in the back of her mind.

She had always loved tea and toiled away to perfect a brew blended with orange peel and sweet spice.  One of her friends delivered this favorable feedback: “Ruth, your tea caused nothing but constant comments.” Ruth, who had been searching for a label to describe her delicious brew, thought that “Constant Comment® was an apt description of her tea’s popularity and promptly adopted the phrase.

The Bigelow couple then embarked on an uphill battle to market the tea. Grocers were skeptical about their product and sales were slow in the few stores willing to stock the tea. Ruth and her husband did not give up. They designed a colorful label and Ruth started placing small ads in newspapers directing prospective customers to stores selling her tea. Nevertheless, lack of consumer knowledge and demand had the potential to spell the death knell for their product.

A pivotal moment came when they followed the advice of a food broker, who suggested selling their teas to department stores, gourmet, and gift shops. Another epiphany came when Ruth remembered that a customer had immediately purchased her tea after smelling its unique fragrance. As a next step, the Bigelows filled a jar with tea and a label inviting the customer to “open and take a whiff.”

Sales representatives reported back to the Bigelows that “Constant Comment” ® tea sold at a brisk pace in stores carrying the whiffing jars. The ensuing years brought prosperity and the Bigelows moved their growing business to Norwalk (also highlighted in a 1954 article by The Bridgeport Sunday Post; see exhibit at the Norwalk Museum).

The hurricane of 1955 halted that prosperity. Bridges gave way to the raging waters and the back wall of the Bigelow building also collapsed. David Bigelow recalled in his book, My Mother Loved Tea (a copy is available at the Norwalk Museum), that his aging father was faced with the reality of having to start over once again. Luckily good relationships trumped self-interest. The Bigelow couples’ vendors told them, “pay us when you can.” This open credit policy enabled them to bounce back quickly and Ruth later launched a nationwide ad campaign that played an important role in the early success of “Constant Comment”® tea.  Subsequently, the business was moved to Fairfield in the 1980s.

While the next two generations added over 120 varieties of tea, colorful labels and other innovations to the brand, Ruth continued to experiment by adding tea as an ingredient to many of her recipes as a way of increasing demand for her product. Her“Constant Comment”® holiday punch (orange and pineapple juices, lemonade, ginger ale and freshly brewed “Constant Comment”® tea topped off with orange sherbet and garnished with mint leaves) remains a crowd-pleaser to this very day. Other tea-infused delights that built upon her ideas include Earl Grey Royal cream puffs, green tea ginger teacakes and pomegranate muffins incorporating the flavor of the Bigelow®Pomegranate Pizzazz® tea (Recipes can be found in My Mother Loved Tea and athttp://www.bigelowtea.com/).

Now in its third generation, this family-owned business continues to thrive in Fairfield, CT, Lexington, KY, and Boise, ID, producing over 1.6 billion tea bags annually.

Ruth passed away in 1966 after a protracted battle with cancer and her husband died a few years later at the age of 92. Let us all toast the ingenuity and persistence of an entrepreneurial couple with a cup of Ruth’s favorite brew.

Acknowledgment: Thanks to the Bigelows for reviewing this post. The family also provided images for one-time use. Please direct queries regarding permissions for image reproductions directly to the company.