Subject: CDC NCHSTP Daily News Update Date: Tue Jan 27 07:31:03 PST 1998 (275 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update January 27, 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. HEADLINES --------- PEER-REVIEWED JOURNALS "Ethical Issues Facing Medical Research in Developing Countries" GENERAL MEDIA "Tuberculosis on the Rebound" "City Urged to Require Doctors to Report HIV" "MAC Prophylaxis Underused in AIDS Patients" "Trial of p24-VLP Immunogen Successful in HIV-Positive Subjects" "In Cuba, HIV Entails Quarantine No More" "HIV-Positive Employee Wins Bias Complaint" "Greek-Bulgarian Cooperation for AIDS and Hepatitis Prevention" INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION "AIDS Among Persons Aged > or = 50 Years--United States, 1991-1996" INFORMATION FROM OTHER GOVERNMENT AGENCIES "New Satellite Broadcast Series on HIV/AIDS-Related Issues" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Ethical Issues Facing Medical Research in Developing Countries" Lancet (01/24/98) Vol. 351, No. 9098, P. 286; Clarke, Malcolm; Collinson, Andrew; Faal, Hannah; et al. In a commentary in The Lancet, the Gambian Medical Research Council Joint Ethical Committee responds to opinions featured in The Lancet and The New England Journal of Medicine that discussed the ethical implications of placebo-based studies in sub-Saharan Africa. The authors assert that "there is a need for ethically justifiable studies to evaluate implementation of interventions in populations with different socioeconomic, genetic, and environmental features." Many developing countries spend less than $10 a person annually on health care, so research must take cost and availability into account when deciding the "best known practice." Approximately 15 million people have been infected by HIV in sub-Saharan Africa, and even if antiviral therapies were available, their cost is prohibitive for most. The authors note, therefore, that "feasibility studies are needed to compare interventions under local conditions with current standard local therapy, even if that standard is 'nothing.'" Placebo comparisons may be necessary in developing nations, they contend, due to the logistic problems and cost involved in using the best treatment on a nationwide scale. According to the authors, "The need to improve health in developing countries requires informed public-health decisions that will sometimes mean re-examining interventions proved effective under different conditions in resource-rich countries." **************************************************************** GENERAL MEDIA **************************************************************** "Tuberculosis on the Rebound" Washington Post--Health (01/27/98) P. 9; DiBacco, Thomas Tuberculosis has long plagued humankind, dating back to Neolithic times or earlier. In the early 20th century, the United States formed the National Tuberculosis Association to help educate, diagnose, and eradicate the disease. The development of antibiotics, starting with streptomycin in 1944, also helped combat the disease. By the 1970s, the rate of TB in the United States had dropped from 101.5 cases per 100,000 in 1930 to 18.3 cases per 100,000 in 1970. However, the 32-year decline ended in 1985, when cases started to rise in large U.S. cities reporting heavy immigration. By 1991, New York City reported 3,700 new TB cases for the year, and drug-resistant strains of the disease had appeared, resulting from patients' failure to take the full six-month regimen of medication. To that end, public health officials have stepped up their anti-TB efforts, using a strategy called directly observed therapy, in which health authorities personally deliver the medication and watch the patient take it. Public health efforts are also targeting people with compromised immune systems, who are at greater risk of contracting tuberculosis. "City Urged to Require Doctors to Report HIV" San Francisco Examiner Online (01/26/98); Krieger, Lisa A panel of San Francisco AIDS experts is recommending that the city require doctors to report all HIV-infected patients to the Health Department. The controversial recommendations, summarized in a 175-page report, are to be proposed at Tuesday's AIDS summit convened by Mayor Brown and are designed to improve the local AIDS care system, which many consider outdated. Previous policy stated that no reports of HIV tests would be submitted without the explicit consent of the patient. This policy has made it hard to track the spread of the disease. The panel called for blind HIV reporting, replacing the names of the infected individuals with cryptic codes based on unique "identifiers," and also called for voluntary testing and the initiation of free or low-cost HIV testing. Other recommendations outlined in the report include the creation of "Action Point Centers" to help homeless people stick to their treatment schedules and the inclusion of HIV specialists in all city health plans. "MAC Prophylaxis Underused in AIDS Patients" Reuters Health Information Services (01/26/98) Researchers report that less than half of HIV-positive patients eligible for primary prophylaxis against Mycobacterium avium complex receive treatment. At the Fourth Annual Conference of the Macrolides, Azalides, Streptogramins, and Ketolides, Dr. Steven Asch and colleagues at the University of California at Los Angeles Medical Center said that only 41 percent of patients meeting the criteria for primary prophylaxis received drug therapy in the preceding six months and that prophylaxis was less common in low-income, undereducated, uninsured, and minority patients. The Centers for Disease Control and Prevention recommends primary prophylaxis for patients with a CD4 cell count of less than 50 cells/mL and no history of MAC. Asch, who studied nearly 3,000 HIV-infected patients, believes that education of patients, physicians, and insurers may increase the use of indicated prophylaxis for MAC. "Trial of p24-VLP Immunogen Successful in HIV-Positive Subjects" Reuters Health Information Services (01/26/98) Scientists at British Biotech Pharmaceuticals say that Phase II studies of the yeast protein, p24-VLP, show it to be well-tolerated and to induce changes in CD4 cell counts in HIV-positive subjects. In the Journal of Infection, Dr. B.S. Peters of the St. Thomas Hospital in London and colleagues report that they observed an increase in CD4 cell counts of 15 HIV-positive patients who received the protein but not in the control group, although these increases were not statistically significant. The compound, which is engineered from portions of HIV p24 protein and is being investigated as an immunotherapeutic agent in HIV-positive patients, did not produce adverse side-effects. The research team concluded that higher doses and larger numbers are needed to determine if there are significant humoral or cellular responses. "In Cuba, HIV Entails Quarantine No More" St. Petersburg Times Online (01/27/98); Payton, Jack During the 1980s and 1990s, the Cuban government quarantined HIV-positive individuals, crediting the measures with keeping the country's AIDS rate lower than that of any other country in the region. As of 1997, Cuba had registered less than 1,700 HIV cases, despite having a population of more than 11 million. The country has extensive HIV testing measures, routinely screening pregnant women, blood donors, hospital patients, government officials, and "risk groups" for the virus. Meanwhile, due to the expense of isolating HIV-infected individuals and the possible influx of other infected persons from tourism, the nation began reexamining its HIV policy several years ago. Today, Cuba no longer quarantines HIV patients, offering treatment and counseling instead. Part of the new strategy includes a Health Ministry effort to distribute condoms free of charge and increased cooperation with international groups like Doctors Without Borders. "HIV-Positive Employee Wins Bias Complaint" Federal Times (01/26/98) Vol. 33, No. 51, P. 9; Daniel, Lisa Equal Employment Opportunity Commission Administrative Judge Marlin Schreffler has ruled that the Veterans Affairs Department must reinstate an HIV-positive employee who was fired after revealing his illness. The VA medical center in Baltimore asserted that clerk-typist Carl L. Mack was fired due to tardiness, absences, and his failure to call in to say he would not be present for work. Schreffler did not find evidence that Mack's absences created a hardship in the office nor were they proved to be any more excessive than those of other clerk-typists in the office. Mack claims that as a result of his termination, he subsequently lost his house, could no longer support his daughter, lost all of his possessions, and was forced to sleep in the streets. Judge Schreffler awarded Mack back pay with interest and $185,000 in compensatory damages, stating that it was clear that Mack's employers were aware that his absences were the result of illness. The VA may choose to reject the ruling, in which case Mack would need to appeal to the EEOC or file a federal lawsuit. "Greek-Bulgarian Cooperation for AIDS and Hepatitis Prevention" Macedonian Press Agency Online (01/26/98) In Greece and Bulgaria, the medical schools of Sofia, Philipoupolis Varna, Pleven, and Star Zagora are set to open centers for the prevention of sexually transmitted diseases. The three-year program will focus on the prevention of such STDs as HIV, hepatitis B and C, and syphilis. **************************************************************** INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION **************************************************************** "AIDS Among Persons Aged > or = 50 Years--United States, 1991-1996" Morbidity and Mortality Weekly Report (01/23/98) Vol. 47, No. 02 Early in the human immunodeficiency virus (HIV) epidemic, infection occurred disproportionately among older persons as a result of transmission through receipt of contaminated blood or blood products. Through 1989, receipt of contaminated blood or blood products accounted for only 1% of cases among persons aged 13-49 years; in comparison, this risk factor accounted for 6%, 28%, and 64% of cases among persons aged 50-59 years, 60-69 years, and > or = 70 years, respectively. Because of implementation of voluntary donor deferral and routine screening of blood donations in 1985, the number and proportion of acquired immunodeficiency syndrome (AIDS) cases associated with this risk factor decreased among persons aged > or = 50 years. However, among persons aged > or = 50 years, the number and proportion of persons with AIDS associated with other modes of exposure increased. This report describes the characteristics of persons aged > or = 50 years with AIDS reported during 1996 and presents trends in the incidence of AIDS-opportunistic illnesses (AIDS-OIs) diagnosed during 1991-1996 by mode of HIV exposure for persons aged > or = 50 years. The findings indicate that, even though the incidence of AIDS-OIs during 1996 was higher among persons aged 13-49 years (89%), the proportion of AIDS-OIs accounted for by those aged > or = 50 years (11%) was substantial. **************************************************************** INFORMATION FROM OTHER GOVERNMENT AGENCIES **************************************************************** "New Satellite Broadcast Series on HIV/AIDS-Related Issues" Department of Health and Human Services (DHHS) (01/27/98) DHHS announces a satellite broadcast series designed to deliver the latest HIV/AIDS prevention and care information to the largest possible audience. Each two-hour program will examine an issue of interest to people affected by HIV/AIDS--health care providers, social workers, researchers, educators, caregivers, and people with HIV. Viewers will be able to call a toll-free telephone number during the broadcast to ask the panelists questions or to make comments. The first broadcast will occur on February 27, 1998, from 1-3 PM EST and will cover the DHHS publication "Guidelines for the Use of Antiretroviral Agents in HIV-infected Adults and Adolescents." Panelists will include Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases; John G. Bartlett, M.D., Professor, Johns Hopkins University School of Medicine; and Eric P. Goosby, M.D., Director, HHS Office of AIDS/HIV Policy. Additional viewing site information may be obtained on the World Wide Web at http://www.tech-res-intl.com/hivaids/. Copies of the guidelines may be obtained from the AIDS Treatment Information Service (ATIS) Web Site at http://www.hivatis.org/upguidaa.html. ***************************************************************** The AIDSNews Mailing List is maintained by the CDC National Center for HIV, STD and TB Prevention. 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