World Hepatitis Day is observed annually on July 28. Hepatitis is broadly defined as an inflammation of the liver and includes the most common types of viral hepatitis labeled A, B, C, D, and E. Hepatitis can also be caused by non-infectious conditions, including autoimmune hepatitis, alcoholic hepatitis, and drug-induced hepatitis (Sievert, 2023).
Hepatitis A infection can be asymptomatic in children under age six, but adults generally present with symptoms which include fever, nausea, vomiting, diarrhea, jaundice, and abdominal pain. Diagnosis is made with a blood test (IgM), with the infection becoming detectable 5-10 days before symptom onset. Treatment for Hepatitis A is supportive care focused on rest, hydration, and control of symptoms. Most patients recover fully within 2-6 months (DynaMed, 2024). The most successful way to prevent Hepatitis A is via vaccination, as well as thorough hand-washing and avoiding contaminated food and water (Sievert, 2023).
Hepatitis B may cause an acute infection or can develop into chronic disease. Acute infections of Hepatitis B are often asymptomatic, but when symptoms present, they are nonspecific and resemble those of Hepatitis A. A serologic panel helps to confirm the diagnosis of Hepatitis B. Additional testing helps to establish the severity of the disease, including Hepatitis B viral load and liver function tests. Patients diagnosed with Hepatitis B should also be screened for Hepatitis C & D, as well as HIV. While an acute HBV infection resolves spontaneously in the vast majority of patients, treatment is indicated for patients with acute liver failure. Patients whose infection fails to resolve within 6-12 months are then diagnosed with Chronic HBV, which can be treated with antiviral medications to suppress virus replication. HBV is transmitted through contact with infected blood, semen, or other bodily fluids, and infected mothers can pass the virus to their babies during childbirth. Vaccination, once again, is a key prevention strategy (Sievert, 2023; DynaMed, 2025).
Hepatitis C is an RNA virus (DynaMed, 2024) which is primarily transmitted through blood contact and sharing of needles, but can also transmit via unsafe healthcare practices (e.g., improper sterilization or accidental needlesticks) (Sievert, 2023). Again, most patients are asymptomatic, but symptoms can include fatigue, myalgia, abdominal pain, nausea, vomiting, low-grade fever, dark urine, and/or jaundice. Risk factors include intravenous and intranasal drug use, anal sex, and exposure to blood and blood products (DynaMed, 2024). No vaccine exists for hepatitis C; however, treatment for HCV has seen significant advances in recent years, with the development of direct-acting antiviral medications with the goal of Sustained Virologic Response (SVR). With SVR, the virus is no longer detectable in the bloodstream six months post-treatment (Sievert, 2023).
Hepatitis D, also called delta hepatitis, does not cause infection on its own. It is a "satellite virus" occurring in patients already infected with HBV. As a result, infected mothers can transmit both HBV and HDV to their babies during childbirth (Sievert, 2023). The HBV vaccine is an important preventive measure to also prevent HDV, but there is no vaccine specific to HDV. However, behavioral risk reduction, including avoiding unsafe sexual and needle-use behaviors, is important. Postexposure prophylaxis is also available for HDV. Diagnosis is made by suspicion of HDV in patients with acute hepatitis or HBV exacerbation. The goal of treatment is to clear the patient of HBV. There is strong evidence for antiviral treatment, but this decision is made for individual patients following close evaluation. One drug, bulevirtide, has been approved by the European Commission for treatment of chronic HDV in adults, but interferon-alpha and pegylated interferon have also been shown to have positive effects (DynaMed, 2025).
Finally, Hepatitis E is another cause of viral hepatitis globally, and is endemic to many parts of the developing world, particularly Africa and Asia. Fecal-oral transmission is the primary cause of HEV. Symptoms of HEV appear 2-8 weeks after infection, and are similar to other viral hepatitis types. Diagnosis is confirmed by either a blood or PCR test. Supportive care is the primary treatment of HEV. Ribavirin may be effective, but there is limited data to support its use. While a vaccine is available in China, the major means of preventing HEV include sanitizing the water supply, basic hygiene, including hand-washing, avoidance of undercooked or raw food consumption, and, where other facilities are not available (e.g., refugee camps), latrine construction (DynaMed, 2024).
Awareness of viral hepatitis - its symptoms and presentation, prevention strategies, and vaccination - is crucial for all healthcare professionals, especially those treating populations at higher risk due to their practices and regions of origin. Advances in treatment have led to better outcomes for patients, but it is clear there is still more to do.
SEER's website is a one-stop shop for reports on cancer statistics in the United States, including the Annual Report to the Nation on the Status of Cancer (last updated in April 2025). Overall, cancer mortality in the US has been on a decline, and in particular, new cases of and deaths from tobacco-related cancers have decreased; however, rates of cancers associated with excess body weight have been increasing.
For insights on cancer survivorship, however, the NIH Office of Cancer Survivorship is the main source of statistics and graphs and publications related to survivorship.
In May 2025, the National Comprehensive Cancer Network updated their survivorship practice guideline. The guideline is comprised three major areas of focus: General Survivorship Principles, Preventive Health, and Late Effects/Long-Term Psychosocial and Physical Problems. The guideline is comprehensive and frequently updated. Recent updates to the guideline include specific instructions about follow-up visits survivors should have based on their type of treatment, benchmarks for screenings and tests, and changes and additions to websites that are useful for survivors to know about.
The guideline also has a robust definition of survivorship, which recognizes as survivors those living with metastatic disease. The definition concludes with: "As more evidence is established for this population, more specific survivorship guidelines for individuals living with metastatic cancers may be developed." (Sanft et al., 2025) This is an important statement as it highlights both the uncertainty for survivors and changes to how survivorship is measured.
For a cancer survivor like me (cutaneous melanoma diagnosed in 2013, metastases to my lungs in 2014, brain metastases in 2015... but no active disease since 2016), defining survivorship remains difficult. In scanning through the NCCN guidelines, I recognize some of the conditions and potential late effects that my care team monitors for -- I have already dealt with a couple of those. What would be most useful from a patient perspective would be knowing that for malignant melanoma -- a cancer which had few effective treatments until the advent of immunotherapy and targeted therapy in the early 2010s -- survival benchmarks exist based on the newer treatments. But evidence takes time. As a result, the survivorship landscape for melanoma survivors looks very different from that of survivors of cancers that have treatments with much longer track records, such as breast cancers. The newer treatments for melanoma, while no longer experimental, also vary in effectiveness from one patient to another. My own response to treatment has been atypically good, from what my practitioners tell me.
This spring, I marked the milestone of being able to "graduate" to annual scans -- a milestone I achieved not because of nine years of durable cancer-free life, but because I have now surpassed five years since stopping drug treatment. Patients like me do not have the luxury of relying on a well-established set of benchmarks for our survival. Rather, in this era of novel cancer treatments and increasing survival, we must accept the fact that every morning we wake up cancer-free, we add to the available data. While it would be preferable to live with more certainty, I am grateful to be able to contribute to a greater understanding of cancer in this way. The recent update to the NCCN's practice guideline for survivorship helps remind me that I can and should still work towards living an even healthier life as I navigate a new type of survivorship.
References
Sanft, T., Day, A. T., Ansbaugh, S. M., Ariza-Heredia, E. J., Armenian, S., Baker, K. S., Ballinger, T. J., Cathcart-Rake, E. J., Cohen, S. H., Evgeniou, E., Fairman, N. P., Feliciano, J., Flores, T. F., Friedman, D. L., Gabel, N. M., Goldman, M. E., Hill-Kayser, C. E., Hock, K., Kline-Quiroz, C., … Freedman-Cass, D. (2025). NCCN Guidelines® Insights: Survivorship, Version 2.2025. Journal of the National Comprehensive Cancer Network, 23(6), 208-. https://doi.org/10.6004/jnccn.2025.0028
Almost everyone in the world has experienced a headache. People get them for a lot of reasons: illness or a head injury are common causes (1). But for people with headache disorders and migraines, headaches are a chronic illness that interferes with day-to-day life.
There are quite a few types of headache disorders, but one of the most common is a migraine. But what is a migraine? Migraines are episodic headaches that present with other symptoms like nausea or sensitivity to light or sound. They can also present with or without an aura. Migraines also usually come in phases: the premonitory phase, the headache phase, and the postdrome phase (2).
But what causes migraines? We don’t exactly know the exact cause, but many migraine sufferers, myself included, tend to notice common patterns to their headaches, which are called triggers. For example, cigarette smoke is one of my worst migraine triggers, and if I can’t get away from the smoke fast, I know I’m due for a head full of pain. Migraine triggers are varied and include smells, different types of food, hormonal shifts, and even changes in barometric pressure (2).
Headache disorders like migraines can present huge problems to patients. In fact, migraines are a common cause of disability; the condition affects 15% of women and 6% of men each year (2). These disorders are also undertreated, which increases the burden on those living with these conditions (3).
I have plenty of personal experience with migraines; I’ve suffered from them since I was a kid. When a thunderstorm is coming in, a headache comes with it. Like many of my fellow migraine sufferers, I have learned to live with my attacks: I’m rarely without emergency pain medication, and I’ve worked to identify and avoid triggers as much as possible. Since it’s National Headache and Migraine Awareness month, I thought I’d share some of those tips with everyone.
Identify Triggers: It’s good to look for patterns when it comes to migraines. While there is a risk of inflating correlation with causation, if you notice you get a migraine every time you eat a certain food, it might be worthwhile to cut it out of your diet and see if the frequency of migraines continues.
Keep a log: Some sufferers recommend keeping a “headache journal” where one tracks their headaches, what happened before it, the level of pain of the attack, how long it lasted, and what helped make the pain better. You can do this with an old-fashioned pen and paper journal but there are also plenty of apps you can download that do the same thing.
Be prepared: You can’t control your headaches, but you can better prepare for them. Keep any medication you might need in an attack on you if possible. Have a plan to get home if they are debilitating enough to interfere with driving.
Talk to your doctor: Your doctor might be able to help you identify the cause of your headaches, and if not, prescribe preventive medication that might reduce the frequency of your attacks. They can also talk about potential lifestyle changes that might help.
Raffaelli B, Rubio-Beltrán E, Cho SJ, et al. Health equity, care access and quality in headache - part 2. J Headache Pain. 2023;24(1):167. Published 2023 Dec 13. doi:10.1186/s10194-023-01699-7
Skin Cancer Awareness Ribbon (Photo by Tara Winstead on Pexels)
According to the Skin Cancer Foundation, over 5 million cases of skin cancer are diagnosed in the United States each year, making it the most common cancer in America. Luckily, it is also one of the most preventable. Teaching sun safety is one way to prevent cases of skin cancer before they start.
This Skin Cancer Awareness Month is a special one at GW, which was just this year named a “Skin Smart Campus” by the National Council on Skin Cancer Prevention! GW’s campus now features sunscreen dispensers, with one located near Ross Hall and another on Kogan Plaza. GW has also committed to keeping indoor tanning devices, a significant cause of skin cancers, off its campus.
Learn2Derm is an organization for medical students with an interest in dermatology. The group started at GW, and its membership now encompasses a number of medical schools from across the DC area. This coming Saturday,May 31, from 2-5 p.m., Learn2Derm will host Healthy Skin for the 2025 Summer at the Pennsylvania Ave. Baptist Church, 3000 Pennsylvania Ave. SE, Washington, DC 20020. This annual event shares information about common skin issues, introduces residents to dermatologists in their community, and provides free samples of skin products.
If you are interested in dermatology, don’t miss Himmelfarb’s Diversity in Dermatology collection, which brings together e-books and print books that will help you learn to address the needs of populations of every skin tone.
May is National Nurses Month, a time to recognize and celebrate the incredible contributions of nurses to healthcare and our communities! At Himmelfarb Library, we are proud to serve the GW School of Nursing, which continues to excel nationally, earning 3rd, 4th, and 6th place rankings for various online master’s programs in U.S. News & World Report.
As we honor the dedication and impact of nurses, we’re reminded of the timeless wisdom of Florence Nightingale, the founder of modern nursing, who once said, “The very first requirement in a hospital is that it should do the sick no harm." Her words continue to guide the compassionate and ethical care that defines the nursing profession. Poet and author Maya Angelou also captured the profound influence nurses have, stating, “As a nurse, we have the opportunity to heal the heart, mind, soul, and body of our patients, their families, and ourselves. They may forget your name, but they will never forget how you made them feel.”
In addition to their vital role in healthcare, nurses have a rich and fascinating history. Whether you’re a nursing student, a practicing nurse, or simply someone who appreciates the profession, these fun facts highlight just how dynamic and essential nursing truly is:
Nurses' caps, originally worn by Florence Nightingale, were derived from nuns’ habits.
Nurses Week ended on May 12th, Florence Nightingale’s birthday.
Himmelfarb supports GW Nursing with a variety of resources. Our go-to nursing databases include CINAHL, ClinicalKey for Nursing, and PubMed. Himmelfarb has more than 200 nursing journals available! Our five most highly used titles are:
To learn more about Himmelfarb’s nursing resources, visit our Nursing Research Guide. This guide provides information about nursing textbooks, NCLEX resources, and tips on searching the literature. This in-depth guide includes information for BSN, MSN, Nurse Practitioners, DNP, and Ph.D. nursing students! Our Nurse Practitioners Guide includes resources on physical examination, diagnosis, drug information, links to professional organizations, and evidence-based medicine.
April is Stress Awareness month. To learn about the ways stress impacts us and what we can do to reduce stress, check out the comic below:
SOURCES:
Stress. World Health Organization. February 21, 2023. Accessed April 24, 2025. https://www.who.int/news-room/questions-and-answers/item/stress.
LeWine H. Understanding the stress response. Harvard Health. April 3, 2024. Accessed April 24, 2025. https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response.
Lakdawala NK, Stevenson L, Loscalzo J. Cardiomyopathy and Myocarditis. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J. eds. Harrison's Principles of Internal Medicine, 21e. McGraw-Hill Education; 2022. Accessed April 08, 2025. https://accessmedicine.mhmedical.com/content.aspx?bookid=3095§ionid=265451824
Shields GS, Spahr CM, Slavich GM. Psychosocial Interventions and Immune System Function: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Psychiatry. 2020;77(10):1031–1043. doi:10.1001/jamapsychiatry.2020.0431
Alvord M, Halfond R. What’s the difference between stress and anxiety? American Psychological Association. February 14, 2022. Accessed April 24, 2025. https://www.apa.org/topics/stress/anxiety-difference.
Managing stress. Centers for Disease Control and Prevention. August 16, 2024. Accessed April 24, 2025. https://www.cdc.gov/mental-health/living-with/index.html.
January is Thyroid Awareness Month. To observe it, Rotation author and Himmelfarb Librarian Ruth Bueter spoke with Dr. Chelsey Baldwin, MD to learn more about the thyroid. Dr. Baldwin is a board-certified endocrinologist at the GW Medical Faculty Associates (GW Medicine) where she treats patients with thyroid conditions. Dr. Baldwin is also an Assistant Professor of Medicine at SMHS and a thyroid expert.
The Rotation: I’d like to start by saying thank you for meeting with me and helping our readers learn about the thyroid during Thyroid Awareness Month!
Dr. Baldwin: You’re welcome! I’m happy someone wants to talk about it!
Can you tell us a little about what inspired you to become an endocrinologist and how you became interested in the thyroid?
I thought I was going to be a primary care doctor. I enjoy the outpatient setting and I enjoy long-term relationships. I found that I really enjoyed having expertise and that I wanted to be an authority on some topic. I think that primary care is incredibly challenging because you’re in charge of so much, and this gave me a way to keep some of those things that I really wanted - those long-term relationships, and an outpatient setting - and I got to develop an expertise.
The physiology of endocrine is my favorite, so that’s what led me to choose endocrine. And then thyroid, interestingly enough, when I was a fellow I thought I was going to do pituitary. I enjoyed it, and it’s the control center of the endocrine system. But I had a mentor who was a thyroidologist and essentially took me under his wing as far as interest in research, and that’s how it developed, meeting the right person at the right time in my career.
What brought you to GW?
My husband works for the federal government and we were told that we were moving from New York City to DC. I knew I needed to find an academic institution to continue what I had begun at NYU, which is an academic career. I really enjoy seeing patients, but it really balanced things out for me to also have teaching, and to be around people who are thought leaders and are trying to push the envelope, find something new, and are thinking about how to make medicine better than it was 10 years ago. That’s what you find in academic medicine. I actually stayed behind in New York for a year and a half waiting for the right job to open for me, and that was GW.
We at GW are very glad to have you!
Thank you, Ruth!
Many people outside of medicine might not be familiar with the thyroid. I wasn’t familiar with it until I was diagnosed with hypothyroidism a few years ago. Can you tell us a little bit about it, its role in the body, and how healthy thyroid function contributes to overall health?
Sure. So the thyroid is a relatively small gland, it’s about 15 grams, and it sits in the midline at the base of the neck. So this little gland produces thyroid hormone, and thyroid hormone travels via the blood to all cell types of the body. Of course, I’m a little biased, but what I like to say is that by being a thyroidologist, I have my hand in the physiology of almost every tissue type: the heart beating at the right rate, blood pressure maintenance, how fast the gut moves, or when there’s disease - too slow, too fast - weight management, mental health. The list goes on and on. It makes my job challenging, but also, it’s quite intriguing physiology.
So again, for people who may not be as familiar with the thyroid, what are some of the things that can go wrong with the thyroid? What are the most common thyroid problems you see with your patients?
When I’m giving an overview of things that can go wrong with the thyroid, we can think of hormonal problems and we can think about structural problems. For hormonal problems, the thyroid can either not function well enough - the hypothyroidism that you suggested - and again you just think of the metabolism of all of the cell types slowing down, not getting the correct signals. And then the opposite can happen where there’s too much thyroid hormone, and think about being in an overdrive state when it comes to metabolism. And so both [hypothyroidism and hyperthyroidism] are one, incredibly common, and as you shared, can happen to young patients. So I see a large diversity of patients, and interestingly enough, a lot of young patients.
When we think about structural problems - nodule development. These nodules can be benign, the majority of nodules will be benign. But sometimes, they can one, overproduce hormone and we’re back into that overactive state. Or two, they’re just large enough that they’re causing symptoms due to the fact that the neck is a small space, and they either need to be removed or shrunk in order to alleviate symptoms.
And then finally, thyroid cancer. Thyroid cancer is a passion of mine. I truly am excited about all of the progress we are making in fine-tuning the treatment of thyroid cancer to individualize patient needs. And so that’s kind of a brief overview of what can go wrong with the thyroid.
You talked a little bit about thyroid cancer being a passion of yours. So what are some things that you can do to help patients with thyroid cancer? Are there new treatments, or something that you’re excited about in that area?
Well, interestingly enough, it’s not necessarily new treatments, at least for a majority of patients, it’s learning when treatment isn’t necessary. We’re learning more and more that some of these small cancers and early cancers do not have an aggressive course. And maybe we went a little overboard in the past giving patients treatments that didn’t necessarily change the outcome and took on risk. We’re getting much better at fine-tuning that, making sure that, as one of the famous thyroidologists once said “make sure that the punishment fits the crime.”
That has been a huge change in thyroid cancer culture, and making sure that the expertise disseminates that practitioners are more comfortable not being aggressive. Because that can actually be really hard on the clinician too, you feel like you’re not doing every little thing you can to prevent recurrence and/or progression. But the bottom line is that knowing when to hold back is truly important.
And then, advancements in thyroid cancers that are new: There are some really rare, aggressive thyroid cancers. Being at a tertiary care center like we are, I, unfortunately, get to see those more often than many clinicians will. And it is so exciting to see that based on molecular or genetic therapies, we are able to make huge impacts on patient survival. There’s a cancer called anaplastic thyroid cancer, that had a dismal overall survival of about 6 months. We are drastically changing that outcome by being able to target these molecular targets within the tumor. It’s really exciting! We published a paper on a case just like that last year. So again, I’m just excited to be a part of that shift and see real progress.
Are there things that we can do to help maintain healthy thyroid function as patients?
This question is usually the one that is the most difficult. There isn’t a whole lot to do for preventative measures when it comes to the most common hormonal problems which are autoimmune. Unfortunately, those are genetic predisposition risks, and as I tell my patients, there’s nothing you’re gonna do about that. You were born with that code.
And then that second factor, we’re not totally sure what it is that triggers autoimmune disease. Was it a virus? Was it something environmental? But we don’t know what that is to tell people to avoid it. And maybe can’t even avoid it if it’s something common, like a virus or a cold.
Dietarily, the United States and many developed countries iodinate their salt, so iodine is no longer a concern, which at one point was a nutritional problem with the thyroid. But that is really limited to countries that don’t have a national iodination program and are mountainous. Otherwise, natural iodine from the sea protects populations closer to the ocean.
As far as thyroid cancer risks, those tend to be radiation exposures, are things that we know. Those tend to be things like disasters that are non-intentional. So I’m not sure a patient can do much to avoid that. The tough answer there is that there are not a whole lot of preventative measures. But of course, regular exercise and a good diet are the things that I harp on because those are important for everyone’s health.
What has been the most rewarding aspect of treating patients with thyroid disease? And/or what is your favorite aspect of your work?
I think one that struck me yesterday was when I was seeing a young patient with a recent diagnosis of thyroid cancer, and rightfully so, they were nervous, they were anxious about how is this going to look for them, and what is this going to be. It’s really nice to be that guide for that patient. Essentially setting up expectations, what are we going to do to get the very best outcome? I find that part of my job incredibly rewarding.
And two, while I’m giving this talk to the patient, I’ve got a resident and a fellow with me who are learning how to do the same thing for their patients. So it’s kind of full circle - you serve the patient in front of you, and then you additionally serve patients that benefit from your students.
So you touched a little on some thyroid research you’ve done related to thyroid cancer, but can you tell us about some of the thyroid research you have done?
We did talk about that thyroid cancer paper where we published the first case of using targeted therapies, Dabrafenib and Trametinib, to target a patient with differentiated thyroid cancer that was unresectable harboring a BRAF mutation, using those targeted therapies. The uniqueness of this was that it wasn’t an anaplastic cancer, it was a differentiated thyroid cancer, but we used the prior research to apply there.
Some other projects that I work on, I do a lot with minimally invasive techniques for thyroid structural disease, so that means those big nodules that are bothersome, those nodules that overproduce hormones, and very small thyroid cancers. Within the last 5-10 years, there has been a new modality on the block, minimally invasive techniques like laser therapy, and radio frequency, which is my expertise. Coming down the road even newer things like nanopulsed therapy. I do a lot of work there.
Currently, we’re working on a project looking at thyroid ultrasonography, and predictive factors for whether or not a patient will end up hypothyroid after removing half of the thyroid. Additionally, I’m working with Dr. Khati in radiology and Dr. Joshi, one of our surgeons. We’re looking at the reliability of a system called TI-RADS - it’s a radiology system for grading thyroid nodules, and how do we make that reproducible not only between providers but interdisciplinary providers, because that has been a critique of the system in the past. We’re trying to say that at GW, we figured out how to make this a reliable system. Those are some of the projects that I’ve worked on and that are still ongoing.
In addition to your clinical duties, you teach first and second-year medical students here at GW. You said you also work with fellows and residents. Can you tell us why you enjoy sharing your passion for medicine and endocrinology with medical students?
Sure. When teaching, you get to go back over that physiology for endocrine, which is really fun, and it’s fun to see the students kind of find that same passion again. Beyond that, I enjoy working with students, residents, and fellows because they remind me of how important it is to be a lifelong learner, constantly being curious, and constantly being willing to explore and go outside of your comfort zone, especially the students. They’re so altruistic still, and I hope that they continue that, and it actually reignites altruism in me. There are multiple benefits to teaching.
When you aren’t treating patients or teaching medical students, what do you enjoy doing in your free time?
I have a dog that takes up as much time as I can give her. And I’m learning French, so that is something that I’ve been trying to do for self-growth. My husband, whenever he’s not traveling for work, we try to make sure we’re out and about exploring the town. And so I keep myself quite busy outside of work as well.
What advice do you have for students just starting in medicine?
Be curious! Ask any question. There aren’t dumb questions. I remember looking back and being so scared to ask something. Like maybe that wasn’t a good enough question. You wonder what stones you left unturned. And this is that time in your life when you get to ask anything and be curious, and you never know what you might find that sparks your interest, and your passion, and leads you down the path that could be the most rewarding career in medicine.
Is there anything else you’d like to share?
I think I’ve said it all!
Thank you so much for taking the time to speak with us today! Happy Thyroid Awareness Month!
January is Glaucoma Awareness Month, a good time to take a look at recently published research from the field. A forthcoming study in the Journal of Alzheimer’s Disease uses data from a prospective cohort study called Adult Changes in Thought (ACT), which follows cognitively normal older adults until Alzheimer’s disease and related dementia development. Those included in the group were study participants with a diagnosis of glaucoma who filled prescriptions for glaucoma medications (including alpha-adrenergic agonists, beta-adrenergic antagonists, miotics, carbonic anhydrase inhibitors, and prostaglandins) for at least ten years.
Davidson et al. cite sensory impairment as one modifiable potential source of dementia risk. Glaucoma is a common cause of visual impairment in older adults, and several past studies have suggested glaucoma may be associated with a higher risk of dementia, although this is not yet proven. Additionally, glaucoma and dementia may potentially share molecular pathways and clinical features which are associated with neurodegeneration.
Treatment of glaucoma focuses on reduction of intraocular pressure through daily use of topical eye drops. Because both glaucoma and dementia are highly prevalent in older adults, therefore Davidson et al. feel it is important to study the potential connections between the two.
Patients included in this study are older adults at risk of dementia from Kaiser Permanente Washington (state). Participants are followed by ACT until they develop Alzheimer’s disease and related dementia. The study looked at age and dementia risk, first glaucoma medication fill, in addition to other factors. 521 participants in the ACT study were ultimately included in this analysis. 62% were female, and beta-adrenergic antagonists were the most frequently prescribed type of medication. The mean exposure time for each study participant to beta-adrenergic antagonists was 1.4 years.
The study concluded that with each year of alpha-adrenergic agonists (AAA), there was a 33% higher risk of dementia (but not Alzheimer ’s-type dementia). The findings of Davidson et al showed that beyond AAA, there was no other glaucoma medication class associated with dementia or Alzheimer’s-type dementia. This constitutes a new finding, because exposure to glaucoma medication use has not been studied extensively, nor has use of AAA previously been linked to an increased risk of dementia. It is important to note that some studies have also pointed to adrenergic dysregulation as playing a role in cognitive decline. Topical use of AAA drops induces central adrenergic activity in some patients, which the authors hypothesize could be a mechanism leading to adrenergic dysregulation.
The authors note that their findings were unexpected, and they cannot fully rule out that the association between AAA glaucoma medication and dementia is related to patients who have more severe glaucoma. (Data on the severity of the glaucoma was unavailable to researchers.) AAA was not a first-line medication, but rather one prescribed to patients after beta blockers or prostaglandins are unsuccessful. In the cohort being studied, AAA was the third most prescribed medication for glaucoma.
While Davidson et al. acknowledge study limitations, this finding indicates an important area for future research, to look at medication exposure time and other factors such as other drugs patients have been taking concurrently with glaucoma medications.
References
Davidson, O., Lee, M. L., Kam, J. P., Brush, M., Rajesh, A., Blazes, M., Arterburn, D. E., Duerr, E., Gibbons, L. E., Crane, P. K., Lee, C. S., & Eye ACT study group (2025). Associations between dementia and exposure to topical glaucoma medications. Journal of Alzheimer's disease: JAD, 13872877241305745. Advance online publication. https://doi.org/10.1177/13872877241305745
In 1981, the CDC first reported on a rare lung infection that would eventually be called Acquired Immune Deficiency Syndrome. The subsequent discovery of HIV in 1984 paved the way for effective treatment of HIV through antiretroviral therapy (ART). Additionally, prevention strategies such as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) are helping prevent people from getting HIV.
The knowledge that a higher viral load indicated higher transmissibility of HIV was apparent to researchers prior to 1996 (Murphy, 2023). While the Swiss Federal AIDS Commission announced in 2008 that a person who is seropositive, but has had an undetectable viral load for at least six months, does not risk transmitting HIV to a seronegative partner.
Today, the majority of research on U=U is conducted in the public health sector, to examine how – and how accurately – knowledge of U=U is disseminated across the world. In a November 2024 Personal View published in The Lancet. HIV, an international team of authors surveyed evidence relating to viral load suppression and the U=U message – which has been translated to different wordings across cultures and languages – with a view towards ending HIV as a public health crisis by 2030 (Okamoto et al., 2024). Among the chief aims of U=U is enabling people with HIV to thrive, and addressing barriers to thriving – namely, stigma, discrimination, and criminalization. There are 80 countries that have HIV-specific criminal laws, and sexual transmission of HIV is prosecuted – even where no actual transmission has taken place (Okamoto et al. 2024).
From: Okamoto, E. E., Anam, F. R., Batiste, S., Dukashe, M., Castellanos, E., Poonkasetwattana, M., & Richman, B. (2024). Ending AIDS as a public health threat: the imperative for clear messaging on U=U, viral suppression, and zero risk. The Lancet. HIV, 11(11), e783–e790. https://doi.org/10.1016/S2352-3018(24)00241-8
Making evidence-based education a priority is a key to the success of U=U. Yet awareness of U=U remains critically low among individuals, healthcare providers, and communities. Another challenge to U=U arises in barriers to viral load-testing access. Without access to such testing, individuals are unable to confirm their virus status. When regular adherence to ART is a challenge, this can lead back to stigmatization in individuals who are HIV positive.
Despite U=U having been understood for decades, there remain challenges – systemic, legislative, and cultural – to it being widely accepted and adopted by the public. But it is a key to ending HIV as a public health crisis, so we will likely continue to see evidence being generated on public awareness and implementation of U=U.
Okamoto, E. E., Anam, F. R., Batiste, S., Dukashe, M., Castellanos, E., Poonkasetwattana, M., & Richman, B. (2024). Ending AIDS as a public health threat: the imperative for clear messaging on U=U, viral suppression, and zero risk. The Lancet. HIV, 11(11), e783–e790. https://doi.org/10.1016/S2352-3018(24)00241-8
