Subject: CDC NCHSTP Daily News Update Date: Thu Jan 15 07:31:04 PST 1998 (256 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update January 15, 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 "Battling HIV on Many Fronts" "Bioethics and Local Circumstances" GENERAL MEDIA "City Will Get Money to Treat Syphilis" "Tracking H.I.V. Infections in New York" "Female, Black AIDS Death Rates Drop [in Chicago]" "Mongolia to Test Soldiers Amid AIDS Scare" "TB Case Isolated: Officials" "Dupont Merck, Signal Slate Joint Hepatitis, HIV Work" "Science & Health Bulletin: Cote d'Ivoire--TB" INFORMATION FROM OTHER GOVERNMENT AGENCIES "Novel Concepts Put to the Test in Three New AIDS Vaccine Trials" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Battling HIV on Many Fronts" New England Journal of Medicine (01/15/98) Vol. 338, No. 3, P. 198; Steinbrook, Robert In a letter to the editor of The New England Journal of Medicine, Dr. Robert Steinbrook replies to concerns about mandatory name reporting (MNR) for HIV-positive patients. He says that concerns about maintaining anonymity are reasons to improve confidentiality and prevent discrimination--not reasons to oppose HIV reporting. According to Steinbrook, even areas that use "unique qualifiers"--coded information that provides information concerning patient statistics without the patient's name--acknowledge "problems inherent in this approach." Steinbrook concludes that "the issue seems no longer to be whether or not HIV infection should be a reportable disease at the federal level, but rather how to proceed." However, he also agrees that alternative HIV testing sites that do not practice MNR "are an important complement to a national reporting system." "Bioethics and Local Circumstances" Science (01/09/98) Vol. 279, No. 5348, P. 155; Mbidde, Edward While the ethical design of clinical trials to prevent perinatal HIV transmission in developing countries has been severely criticized, it is important to remember that health management policies in developing countries differ vastly from those in industrialized nations, writes Edward Mbidde, director of the Uganda Cancer Institute at Makerere University, in a Science magazine editorial. For example, Mbidde notes, the ACTG 076 trial of AZT on perinatal transmission required an extensive treatment period; but in Uganda, there is limited access to prenatal care, and money to support long-term treatment is simply unavailable. The future of conducting clinical trials in developing nations now depends on whether sponsoring agencies stop current trials because of the recent ethical debate, and whether people in developing countries are influenced by the debate. The author asserts continuing the clinical trials is essential for developing nations lacking essential resources. At present, explains Mbidde, ethical guidelines for clinical trials are governed by the Nuremburg Code, the Declaration of Helsinki, and the "International Ethical Guidelines for Biomedical Research Involving Human Subjects." However, in their present form and applied to developing nations, the latter set of guidelines could hinder development of much-needed vaccines and treatments for these regions, Mbidde asserts. He notes, for example, that the 1993 revised edition of the international guidelines restricts phase I drug studies and phase I and II vaccine studies to "developed communities of the country of the sponsor," while phase III vaccine trials and phase II and II drug trials should be conducted simultaneously in both the host and sponsoring countries. Early this year, officials are scheduled to gather in regional meetings across the globe to discuss how to improve the guidelines so that they are more specific and do not restrict conducting ethical clinical studies. **************************************************************** GENERAL MEDIA **************************************************************** "City Will Get Money to Treat Syphilis" Baltimore Sun (01/15/98) P. 1B; Matthews, Robert Guy After the Centers for Disease Control and Prevention reported that Baltimore, MD, ranked No. 1 in the nation for reported syphilis cases--with nearly 80 cases reported per 100,000 people--officials are investing $710,000 into efforts to control the emerging epidemic. The Board of Estimates has agreed to give the City Health Department $150,000, followed by an additional $150,000 in six months. Federal and state health officials are giving Baltimore nearly $410,000, and Maryland Governor Parris Glendening reportedly has told Baltimore Mayor Kurt L. Schmoke that he would give the city more money if needed. Peter Bellenson, director of the Health Department, says he will use the additional funds to hire more syphilis-case trackers, physicians, nurses, and assistants for the city's two clinics. In all, Baltimore spends about $2.1 million each year to control sexually transmitted diseases. "Tracking H.I.V. Infections in New York" New York Times (01/15/98) P. A22 While all 50 states require doctors to report full-blown AIDS cases to public health authorities, only 30 states require reporting of HIV cases, note the editors of the New York Times. In the past, New York has stayed away from mandatory HIV reporting for fear that it would discourage people from being tested. The issue presently is up for reconsideration by the State Health Department and the state's AIDS Advisory Council; this week, Gay Men's Health Crisis, a prominent AIDS service group, reversed its longstanding opposition to such reporting and called upon the state to institute a tracking system. According to the editors, monitoring of HIV is, for the most part, justified by the ever-changing nature of the epidemic and fast-emerging treatments for the disease. No longer can the epidemic simply be tracked by recording only AIDS cases; health officials need to know where the virus is in order to target prevention and treatment programs. Now, the main issue surrounding the use of tracking systems is whether they should be name- or code-based. AIDS advocates typically favor codes in order to maintain confidentiality, but some officials say the epidemic is easier to track if names are used. New York, meanwhile, needs to examine carefully whether codes would be effective for its system--if one is instituted. If a code-based system does not appear to be effective, a name-based system should be considered, the editors assert. They point out that New York has used a name-based AIDS tracking system for nearly 20 years with no breaches of confidentiality. "Female, Black AIDS Death Rates Drop [in Chicago]" Chicago Tribune Online (01/14/98); Christian, Sue Ellen AIDS-related death rates dropped among Chicago-area women and African Americans, according to public health statistics released Wednesday. This marks the first decline in the rate among Chicago women since the beginning of the epidemic. AIDS mortality rates began to drop in 1996 due to new drug regimens, but the drop resulted primarily from decreases among white males. Health providers say that the new statistics indicate that women and African Americans are benefiting from increased access to medical care, more awareness of medications, and outreach programs targeting poor areas of Chicago. However, the rate among men continues to fall at a much greater pace than the rate among women. According to Dr. Marge Cohen, director of the HIV program for women and children at Cook County Hospital: "The women are still lagging behind. You have to see there is a problem here; it's a failure of our system to provide appropriate living conditions and holistic medical care for women that their death rate has not gone down like men." "Mongolia to Test Soldiers Amid AIDS Scare" Reuters (01/14/98); Halasz, Irja The Mongolian army plans to test all soldiers for HIV and other sexually transmitted diseases, following widespread panic concerning the introduction of HIV into the sparsely populated country. Fear spread after the nation's health minister reported that one of four prostitutes who had slept with an HIV-infected Cameroon man has tested positive for the virus. The army will commence testing of all members within two to three months, following the creation of a specialized medical team trained at the national AIDS center. Testing will start with military hospital patients and will proceed to distant military posts. "TB Case Isolated: Officials" Toronto Sun Online (01/14/98); Lem, Sharon Canadian health officials report that the case of a high school student in Toronto who was diagnosed with tuberculosis appears to be isolated. As a preventative measure, the Toronto health department will screen close contacts of the student, including 1,650 students and 100 teachers at Agincourt Collegiate High School. The student was diagnosed with TB in December and has returned to school following antibiotic treatment. "Dupont Merck, Signal Slate Joint Hepatitis, HIV Work" Investor's Business Daily (01/14/98) P. A2 DuPont Merck says it has formed a partnership with Signal Pharmaceuticals to develop drugs for the hepatitis C virus and HIV. Over a three-year period, the companies will target antiviral drugs that regulate critical steps in the life cycles of HCV and HIV. As part of the partnership, DuPont Merck will invest $25 million in Signal's initial public offering. "Science & Health Bulletin: Cote d'Ivoire--TB" PANA Wire Service (01/14/98); Kwinjeh, Grace Ivory Coast's health minister, Maurice Kacou Guikahue, has expressed concern at the country's rising number of tuberculosis cases, which rose from 12,000 in 1996 to more than 13,000 last year. In an effort to ensure detection of all cases, Guikahue recommended significant reductions in TB test charges at all hospitals, stating that high charges "discourage patients from seeking tests and cause delays in the diagnosis treatment of the disease." According to the World Health Organization, the rising number of impoverished and malnourished people in overcrowded urban areas and laxity in national anti-TB programs has led to a resurgence of the disease. WHO also blames the disease's association with AIDS for its increase; tuberculosis is the major cause of mortality among HIV-positive Ivorians. **************************************************************** INFORMATION FROM OTHER GOVERNMENT AGENCIES **************************************************************** "Novel Concepts Put to the Test in Three New AIDS Vaccine Trials" NIAID News (01/14/98); Carroll, Diana Researchers supported by the National Institute of Allergy and Infectious Diseases are launching three new clinical trials of novel HIV vaccine approaches and are already recruiting human volunteers from NIAID's AIDS Vaccine Evaluation Group (AVEG). The new trials--AVEG 027, AVEG 028, and AVEG 033--bring the total number of human vaccine protocols conducted through AVEG to 45, using more than 2,400 volunteers since 1988. Says Jack Killen, director of NIAID's Division of AIDS: "These three trials are part of NIAID's comprehensive approach to HIV vaccine development. Each of these studies will test a new idea or approach toward an effective, safe vaccine." In AVEG 027, researchers will investigate live recombinant canarypox ALVAC-HIV vCP205 delivered initially by injection and then through the mucosa; in AVEG 028, a new vaccine strategy based on the Salmonella bacteria will be tested; and in AVEG 033, GM-CSF--a new adjuvant or vaccine booster--will be combined with a canarypox virus-based vector with HIV proteins to determine whether GM-CSF can improve immune response. ***************************************************************** The AIDSNews Mailing List is maintained by the CDC National Center for HIV, STD and TB Prevention. 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