Subject: CDC NCHSTP Daily News Update Date: Wed Jan 21 07:31:03 PST 1998 (212 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update January 21, 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 1998, Information Inc., Bethesda, MD. CORRECTION: The title of a New York Times article in the Jan. 20 edition of the CDC NCHSTP Daily News Update contained an error. The correct title should read: "HIV Reporting May Deter Some From Testing." HEADLINES --------- PEER-REVIEWED JOURNALS "A New Classification for HIV-1 (Scientific Correspondence)" "Ethics of HIV Trials" GENERAL MEDIA "New HIV Vaccine to Be Tested" "Rio Revelers Get Reality Check" "Clarithromycin Associated With High Rates of MAC Resistance" "Second Lawsuit Alleges Man Contracted AIDS in Prison" "Drug Diets Tame AIDS" "Condom Trial Begins in Prison" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "A New Classification for HIV-1 (Scientific Correspondence)" Nature (01/15/98) Vol. 391, No. 6664, P. 240; Berger, E.A.; Doms, R.W.; Fenyo, E.-M.; et al. Researchers, led by E.A. Berger of the National Institute of Allergy and Infectious Diseases, have proposed a new HIV-1 isolates classification system based on co-receptor use. They advocate a system in which isolates that use CCR5, but not CXCR4, be termed R5 viruses, and isolates using CXCR4, but not CCR5, should be designated X4 viruses. Additionally, isolates that use both co-receptors with comparable efficiency should be deemed R5X4, and whether the X4 or R5X4 isolates are cell-line adapted should also be specified. Berger and associates note: "Under this system, R5 viruses are the strains most commonly transmitted sexually, consistent with the high resistance of individuals lacking CCR5 to infection." The authors explain that this classification system specifies the isolates' ability to use the major co-receptors. The nomenclature does not indicate whether the virus can replicate in a particular target cell, which the authors believe to be too complicated for simple classification. Furthermore, the researchers add, "The efficiency with which different co-receptors are used by some strains is likely to vary between assay systems." "Ethics of HIV Trials" Lancet (01/17/98) Vol. 351, No. 9097, P. 220; Lurie, Peter; Wolfe, Sydney In a letter to the editor of The Lancet, Peter Lurie and Sydney Wolfe--both of the Public Citizen's Health Research Group--respond to questions regarding the applicability of ACTG 076's findings in the context of the developing world. The study found that the perinatal HIV transmission rate among non-breastfeeding women fell from 23 percent to 8 percent with the use of zidovudine. Lurie and Wolfe note that Kevin De Cock et al. from the Centers for Disease Control and Prevention cited cost and logistical barriers as reasons for not yet implementing the 076 regimen in developing nations. However, statistics from three developing or underdeveloped countries that have adopted regimens similar to 076 indicate perinatal transmission rates very close to those found in ACTG 076 itself. In addition, they add that while R.D. Semba says that placebo-controlled trials are justified because many women in developing countries breastfeed, "breastfeeding is estimated to result in perinatal transmission in 14 percent of women, and the ACTG 076 regimen reduced transmission by 15 percent compared with placebo." In conclusion, Lurie and Wolfe note that "rather than offering weak supposedly scientific rationale for these trials, these authors should accept that the game is up," noting that one study has already eliminated its placebo control and that others may soon follow. **************************************************************** GENERAL MEDIA **************************************************************** "New HIV Vaccine to Be Tested" Bangkok Post Online (01/21/98); Bhatiasevi, Aphaluck On Tuesday, Thailand's Army chief, Chetta Thanajaro, announced the launch of trials for a vaccine targeting the Thai strain of HIV. This marks the world's first trial of a synthetic vaccine, Chiron HIV Thai E gp 120/MF 59, against the E strain of HIV. The E strain, which develops into AIDS faster and has more serious symptoms, is predominantly transmitted through sexual contact and is found mainly in Thailand and the neighboring regions. In the trials, the vaccine will be given to 386 volunteers in three concentrations and will be combined with the B strain in two concentrations. According to General Chetta, the volunteers cannot become infected with HIV through the trials, because the vaccine has been genetically engineered to make recombinant protein rgp 120 look like the surface protein of HIV. The trials are expected to last more than a year and will be conducted in two phases. A third phase involving thousands of volunteers will be implemented if the trials are successful. "Rio Revelers Get Reality Check" Fox News Online (01/20/98) Brazil's Health Ministry will distribute 10 million condoms and give free HIV prevention advice during next month's annual carnival celebration. A spokeswoman for the AIDS coordination department explained, "The euphoria provoked by carnival and the excessive consumption of alcohol make it a moment when people are more likely to forget about prevention." The Health Ministry plans to target Rio's Sambadrome, distributing 200,000 condoms there, and Salvador, the capital of the northeastern state of Bahia. Brazil's move marks the largest condom distribution the AIDS coordination department has engaged in. The health ministry purchased 50 million condoms in 1997, but plans to quadruple that in 1998. Brazil has recorded approximately 95,000 HIV infections, but health officials say that the actual number could be as high as 450,000. "Clarithromycin Associated With High Rates of MAC Resistance" Reuters Health Information Services (01/20/98) Dr. Luiz E. Bermudez and colleagues at the Kuzell Institute in San Francisco report that macrolide resistance in treating or preventing Mycobacterium avium complex developed more often in animal experiments with clarithromycin than with azithromycin. The study, published in the January issue of Antimicrobial Agents and Chemotherapy, found that resistant strains developed in 100 percent of mice treated with clarithromycin at both eight and 12 weeks. None of the mice treated with azithromycin showed resistant strains at eight weeks and only 14 percent developed resistant strains at 12 weeks. Dr. Bermudez observed that clarithromycin had a greater initial effect than azithromycin against MAC. However, clarithromycin's shorter tissue half-life may allow the growth of resistant bacteria. The study will continue by evaluating the resistance rate in clinical trails with AIDS patients. "Second Lawsuit Alleges Man Contracted AIDS in Prison" St. Louis Post-Dispatch Online (01/20/98); Malone, Roy Michael E. Blucker has alleged that he contracted HIV when he was raped by gang members while he was an inmate at the Menard Correctional Center in Chester, Illinois. Blucker's lawyer, Joseph Condon, claims that two Menard staff members were "deliberately indifferent" to his client's complaints. Condon asserts that Blucker was too terrified of the gang members to ask for protective custody, but that prison psychiatrist Dr. Nageswararao Vallabheneni was aware of the sexual abuse and the possibility that Blucker had contracted HIV. The lawyer for the defense, Deborah Barnes, states that "Mr. Blucker never indicated to Lt. Caraway [head of the prison's internal investigations] or Dr. Vallabhaneni the things he's claiming he told them. ... There is no good reason why he didn't avail himself of protective custody if these things were happening." Blucker said he filed the suit in an attempt to try and change the prison system, which he claims allows inmates to rape and spread HIV. "Drug Diets Tame AIDS" Toronto Sun Online (01/20/98); Lem, Sharon At a satellite conference in Montreal, Dr. Mark Wainberg--president of the International AIDS Society and director of McGill University's AIDS Center--and Dr. Calvin Cohen--a professor at Harvard Medical School--said that protease inhibitors must be taken in combination with other drugs in a strictly controlled regimen to be effective. Mutations and drug resistance can develop if the regimen is not followed. Wainberg noted, "There's a lot of evidence that shows if a patient misses some pills, and takes only two of the three anti-viral drugs, the virus can replicate in the presence of two drugs and cause resistance, which it can't do with three drugs." Cohen also stressed the importance of selecting a drug regimen that the patient can follow and the importance of tracking the drug's progress. "Condom Trial Begins in Prison" Australian Associated Press (01/19/98) Western Australia's Wooroloo Prison Farm began a three-month trial on Monday in which inmates can purchase condomsthrough an internal mailing system. A Justice Ministry spokesman said, "We're not condoning sex in prisons, but we're not naive, we know it happens, and we're trying to make sure there's some sort of way to stop the spread of sexually transmitted diseases like hepatitis and AIDS." Additional trials in other prison systems are planned depending upon the success of the Wooroloo test. ***************************************************************** 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. 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