Subject: CDC NCHSTP Daily News Update Date: Wed Jan 7 07:31:03 PST 1998 (224 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update January 7, 1998 The CDC National Center for HIV, STD and TB Prevention provides the following information as a public service only. Providing synopses of key scientific articles and lay media reports on HIV/AIDS, other sexually transmitted diseases and tuberculosis does not constitute CDC endorsement. This daily update also includes information from CDC and other government agencies, such as background on Morbidity and Mortality Weekly Report (MMWR) articles, fact sheets, press releases and announcements. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC NCHSTP Daily News Update should be cited as the source of the information. Copyright 1997, Information Inc., Bethesda, MD. HEADLINES --------- PEER-REVIEWED JOURNALS "Prognostic Indicators for AIDS and Infectious Disease Death in HIV-Infected Injection Drug Users" "HIV-1-Resistance Phenotype Conferred by Combination of Two Separate Inherited Mutations of CCR5 Gene" "Rural Communities Struggle With AIDS" GENERAL MEDIA "Cuban HIV Infection Increased in 1997" "New Evidence Suggests Eradication of HIV Is Feasible" "Drop in HIV Level Parallels Reduction in Disease Progression Risk" "Researchers Identify Gateway for HIV Virus Into Human Cells" "Albendazole Sulfoxide Effective Against AIDS-Related E. Intestinalis" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Prognostic Indicators for AIDS and Infectious Disease Death in HIV-Infected Injection Drug Users" Journal of the American Medical Association (01/07/98) Vol. 279, No. 1, P. 35; Vlahov, David; Graham, Neil; Hoover, Donald; et al. Researchers from the Johns Hopkins School of Medicine and the Centers for Disease Control and Prevention conducted a longitudinal cohort study of 522 injection drug users living in Baltimore, MD, to determine whether combining measures of plasma viral load and CD4 cell count increased prognostic accuracy among HIV-infected people, specifically IDUs. Of the subjects, 96 percent were African American and 80 percent were male. During the follow-up of 6.4 years, the researchers noted 146 cases of AIDS and 119 deaths from infectious disease. Based on time-fixed baseline levels, viral load and CD4 cell count were independent predictors of progression to AIDS, although viral load was more predictive in proportional hazards models. The researchers concluded that plasma HIV-1 viral load and CD4 cell counts--used both independently and in combination--are powerful prognostic tools for progression to AIDS and death by infectious disease in populations of predominantly African American IDUs. "HIV-1-Resistance Phenotype Conferred by Combination of Two Separate Inherited Mutations of CCR5 Gene" Lancet (01/03/98) Vol. 351, No. 9095, P. 14; Quillent, Caroline; Oberlin, Estelle; Braun, Josephine; et al. In an effort to identify mutations of the CCR5 gene that could be associated with HIV-1-infection resistance--other than that already associated with a homozygous 32-base-pair deletion in CCR5--researchers from France's Hopital St. Joseph and Pasteur Institute examined the susceptibility of peripheral-blood mononuclear cells (PBMC) to in vitro HIV infection by isolates, using CCR5 as the major co-receptor for viral entry. PBMCs from 18 HIV-negative men who had frequent unprotected sex with HIV-positive partners were analyzed using genotypic analysis of the CCR5 alleles. Meanwhile, CCR5s of the men's fathers and sisters were genetically analyzed, as were those of 209 healthy blood donors who had not been exposed to HIV. The researchers discovered that one of the 18 subjects demonstrated total resistance to infection and carried a single point mutation at position 303 (m303), in addition to the homozygous 32-base pair deletion. This mutation introduced a premature stop codon and prevented the expression of a functional co-receptor. The family studies, meanwhile, revealed that the m303 allele was inherited as a single Mendelian trait, and genotype analysis showed that three of the 209 donors were heterozygous for m303. The researchers concluded that they have found a new CCR5 gene mutation that is present in the general population and offers resistance to HIV infection when associated with the 32-base-pair deletion in CCR5. "Rural Communities Struggle With AIDS" Journal of the American Medical Association (01/07/98) Vol. 279, No. 1, P. 5; Voelker, Rebecca Recent antiretroviral drug treatments and the changing demographics of the AIDS epidemic have raised concerns about the ability of rural health care professionals to keep pace with information on the disease and, thus, to adequately care for and inform patients. In some rural areas of Georgia, Mississippi, and South Carolina, women make up 25 percent of all reported AIDS cases--well above the national average--yet these areas typically do not take measures to offer women education about the virus or testing. As part of efforts to determine the ways that rural communities serve women with HIV, the Health Resources and Services Administration commissioned health care consultant Martha McKinney to study five rural clinics that offer HIV-related care in Georgia, Mississippi, South Carolina, Texas, and Washington. McKinney found that all of the clinics offered general information on HIV, but only two made efforts to specifically target women. McKinney also identified several barriers that keep women living in rural areas from receiving HIV testing, including the fact that many of these women do not believe they are at risk even if they engage in high-risk behaviors. Dr. Petra Liljestrand of San Francisco General Hospital's Community Provider AIDS Training Project, meanwhile, conducted a telephone survey of HIV-care-related experience among 102 rural California physicians. She found that although more than 50 percent of respondents have been in practice for at least 17 years, nearly 18 percent had never seen an HIV-positive patient. Liljestrand warns, however, that her findings offer only a limited view of rural physicians' experience and practices. **************************************************************** GENERAL MEDIA **************************************************************** "Cuban HIV Infection Increased in 1997" Reuters (01/06/98) By year-end 1997, the number of people infected with HIV in Cuba had risen about 60 percent compared to 1996 levels, to 1,800. Cuban health officials note that an accumulated total of 666 people have been diagnosed with AIDS; of that group, 478 have died. The experts noted that the Communist-ruled nation's rate of infection was lower than the rate in other countries in Latin America and the Caribbean, but said the low rate was itself problematic because many young people do not consider HIV a real threat. Also of concern was the growing number of tourists in Cuba who appear to be visiting the island, in part, for sex. "New Evidence Suggests Eradication of HIV Is Feasible" Reuters Health Information Services (01/06/98) New research published in the January issue of the Journal of Virology suggests that the HIV-1 reservoir in AIDS patients may be limited. Dr. Hanneke Schuitemaker of the Netherlands Red Cross and colleagues assessed HIV-1 variants in periphery, lymphoid, and nonlymphoid tissues and isolated syncytium-inducing and non-syncytium-inducing genotypes from various sites, including the brain, lung, and testes. The researchers said that, excluding brain tissue, they detected no signs of the existence of true tissue reservoirs for HIV-1. The presence of a distinct virus reservoir in the brain, they said, highlights the need to use drugs with good bioavailability in brain tissue as part of combination therapies. "Drop in HIV Level Parallels Reduction in Disease Progression Risk" Reuters Health Information Services (01/06/98) To determine the value of using changes in both viral load and CD4 cell counts to assess the prognosis of people with HIV, a multicenter team from the University of Alabama in Birmingham--led by Dr. Michael Saag--evaluated data for 1,330 HIV-positive people participating in seven antiretroviral therapy trials. The researchers--who reported their findings in the January issue of the Journal of Infectious Diseases--discovered that the risk of clinical disease progression falls in proportion to drops in HIV-1 RNA levels during the first six months of treatment, but it rises with a lack of HIV RNA or CD4 response. Based upon a comparison against subjects with a non-syncytium-inducing phenotype, the researchers found that patients with the syncytium-inducing phenotype had a 100 percent higher risk of disease progression--a finding the researchers say may suggest that viral phenotype is independent of patient prognosis. The team concluded that both HIV-1 RNA and CD4 lymphocyte treatment responses and pretherapy levels should be used to measure patient prognosis after the initiation of antiretroviral therapy. "Researchers Identify Gateway for HIV Virus Into Human Cells" Fresno Bee Online (01/05/98) According to a report in the Journal of Virology, researchers from New York's Aaron Diamond AIDS Research Center have identified a discrete region of the CCR5 co-receptor that may be the gateway used by HIV to penetrate human cells. Additionally, the researchers note, a mutation of that region prevents the fusion of the virus and could offer hope for a cure. Tatjana Dragic, lead author of the report, said: "We had previously shown that CCR5 was a co-receptor for HIV, and other studies have shown that mutations in CCR5 can confer resistance to HIV. The data reported here bring us one step closer to understanding the precise role of CCR5 in the HIV infection process." "Albendazole Sulfoxide Effective Against AIDS-Related E. Intestinalis" Reuters Health Information Services (01/06/98) In the December issue of Antimicrobial Agents and Chemotherapy, Drs. S.K. Katiyar and T.D. Edlind of Allegheny University report that the sulfoxide metabolite of albendazole--a benzimidazole derivative--is effective against Encephalitozoon intestinalis, a common opportunistic infection found in HIV-positive people. Based upon the in vitro activity of 14 benzimidazole derivatives on green monkey kidney cells infected with E. intestinalis, the researchers found that 10 of the 14 derivatives were inhibitory at concentrations of 1 to 10 ng/mL, and albendazole sulfoxide was 1.7 times more inhibitory than albendazole and considerably less toxic. ***************************************************************** The AIDSNews Mailing List is maintained by the CDC National Center for HIV, STD and TB Prevention. Regular postings include the CDC NCHSTP Daily News Update, conference announcements, clinical trials information, current funding opportunities, and selected MMWR articles. To SUBSCRIBE, send the command "subscribe aidsnews firstname lastname" to the address listproc@aspensys.com. To UNSUBSCRIBE, send the command "unsubscribe aidsnews" to the address listproc@aspensys.com. If you need assistance, please contact aidsinfo@cdcnac.org. *****************************************************************