Subject: CDC NCHSTP Daily News Update Date: Wed Jan 28 07:31:04 PST 1998 (236 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update January 28, 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 "CCR5 Chemokine Receptor Variant in HIV-1 Mother-to-Child Transmission and Disease Progression in Children" "Focal Mycobacterial Lymphadenitis Following Initiation of Protease-Inhibitor Therapy in Patients With Advanced HIV-1 Disease" "Evaluation of Case Management of Patients With HIV Infection in France (Letter)" GENERAL MEDIA "Ex-Prime Minister of Norway Wins Top Job at W.H.O." "Across the USA: Alaska" "HIV-1 Load Correlates With Heterosexual Transmission Risk" "Fomivirsen Effective Against AIDS-Related CMV Retinitis" "Japan Had Record 250 New AIDS Patients in '97" "Number of Tuberculosis Cases Rises in Evenk Region [of Russia]" "AIDS Research Grants Given Out" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "CCR5 Chemokine Receptor Variant in HIV-1 Mother-to-Child Transmission and Disease Progression in Children" Journal of the American Medical Association (01/28/98) Vol. 279, No. 4, P. 277; Misrahi, Micheline; Teglas, Jean-Paul; N'Go, Nicole; et al. Researchers for the French Pediatric HIV Infection Study Group examined the effects of CCR5(delta)32 deletions in children born to HIV-positive mothers. Previous research suggests that people carrying the deletion may be less likely to become infected with HIV and to develop HIV-related disease progression; however, the allele's effect on children is not known. The team studied 512 non-African children--276 of whom were infected--who were born to HIV-1-positive mothers at 52 medical centers. The CCR5(delta)32 deletion was found to have a frequency of 0.05. Only one child--who was not infected with HIV--was homozygous for the deletion, while the 49 heterozygous were equally divided between infected and uninfected. Heterozygous infected children with the deletion showed a slower progression of HIV-related disease stage C symptoms, with 9 percent showing stage C symptoms at 36 months versus 28 percent of the children homozygous for the normal allele. At eight years of age, 49 percent of the heterozygous children showed no stage B or C symptoms, compared to 11 percent of homozygous-normal children. The researchers concluded that heterozygosity for the CCR5(delta)32 deletion does not protect children born to HIV-positive mothers from contracting the virus, although it appears to confer an advantage by substantially delaying the progression of HIV-related disease symptoms. "Focal Mycobacterial Lymphadenitis Following Initiation of Protease-Inhibitor Therapy in Patients With Advanced HIV-1 Disease" Lancet (01/24/98) Vol. 351, No. 9098, P. 252; Race, Elizabeth; Adelson-Mitty, Jennifer; Kriegel, Gila; et al. New research indicates that prophylaxis or screening for subclinical Mycobacterium avium complex infection should be done before initiating protease-inhibitor therapy in patients with advanced HIV-1 infection. Led by Dr. Elizabeth Race of Beth Israel Deaconess Medical Center in Boston, the researchers examined possible side effects of antiviral therapy in five patients with advanced HIV-1 disease. All of the patients had CD4 cell counts of less than 50/mL and had been admitted to the hospital with high-fever, leucocytosis, and evidence of lymph-node enlargement within one-to-three weeks of initiating treatment with indinavir. The team studied the patients' CD4 lymphocyte counts, immunophenotyping, isolator blood cultures, and radiological scans; four patients had blood samples of cervical, paratracheal, or mesenteric lymph nodes taken. The scientists found that focal lymphadentitis after initiation of indinavir treatment resulted in local or disseminated MAC infection in patients with CD4 cell counts measuring less than 50/mL cells. They also note that the inflammatory reactions may be "secondary to significant numbers of functionally competent immune cells becoming available to respond to heavy mycobacterial burden." "Evaluation of Case Management of Patients With HIV Infection in France (Letter)" Journal of the American Medical Association (01/28/98) Vol. 279, No. 4, P. 276; Spira, Rosemary; Leroy, Valeriane; Lacoste, Denis; et al. In a letter to the editor of the Journal of the American Medical Association, a team of French researchers report changes in case management for HIV-positive patients in public hospitals in the Aquitaine region of France between the first half of 1995 and the second half of 1996. Approximately 80 percent of HIV-positive individuals in the area seek treatment at those hospitals, which provide care via outpatient clinics, inpatient hospital wards, and day hospitals. Over the study period, hospital contacts increased by 14.4 percent, but hospitalization in the wards decreased as did the average length of stay. Total outpatient contacts increased 10.3 percent over this period, reaching a plateau. Day hospital contacts remained stable at 51 percent, but the absolute number increased 5.6 percent. Hospital case management expenditures rose 60 percent during the study, in part due to the wide use of viral load measurement in outpatients in 1996 and increases in spending for antiretroviral treatment. According to the researchers, the findings suggest that decreases in French hospital stays for HIV-positive patients in 1996 mirror similar reports from U.S. hospitals. **************************************************************** GENERAL MEDIA **************************************************************** "Ex-Prime Minister of Norway Wins Top Job at W.H.O." New York Times (01/28/98) P. A8; Olson, Elizabeth The World Health Organization has elected former Norwegian Prime Minister Gro Harlem Brundtland to a 5-year term as head of the agency, making her the first woman to head WHO. Brundtland, who will succeed Dr. Hiroshi Nakajima, vowed to restore credibility to the United Nations agency, starting with internal reform. Nakajima has held the position of director general for 10 years and will step down in late July. Among its many duties, WHO organizes global responses to epidemics and coordinates immunization efforts. "Across the USA: Alaska" USA Today (01/28/98) P. 11A Alaskan health officials plan to require health care workers to report all HIV-infected individuals by name to the state Division of Public Health. At present, only the names of AIDS patients are reported. "HIV-1 Load Correlates With Heterosexual Transmission Risk" Reuters Health Information Services (01/27/98) A team of researchers, led by Dr. Margaret Ragni of the Hemophiliac Center of Western Pennsylvania in Pittsburgh, concluded that the risk of HIV-1 transmission to the heterosexual partners of HIV-positive hemophiliacs becomes greater as the patient's viral load rises. In the January 1 issue of the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, Ragni and colleagues report that they examined 39 HIV-positive hemophiliac men and their heterosexual partners, measuring HIV-1 RNA in frozen plasma samples taken from the men 20 to 62 months after seroconversion. The researchers concluded that the men who transmitted HIV to their partners had significantly higher levels of HIV-1 RNA than those who did not transmit the disease. No correlation between age, time of seroconversion, CD4 cell count, or diagnosis of AIDS between the transmitters and non-transmitters was observed. "Fomivirsen Effective Against AIDS-Related CMV Retinitis" Reuters Health Information Services (01/27/98) Isis Pharmaceuticals reports that a Phase III trial of its antisense oligonucleotide fomivirsen (ISIS 2922) produced statistically significant effects against AIDS-related cytomegalovirus retinitis. The drug was administered via intravitreal injection in three weekly doses to 18 AIDS patients who had not been treated for unilateral CMV retinitis, while 10 AIDS patients with CMV were put into a deferred treatment group. The study found a median time to observed disease progression of 71 days for the immediate treatment group and a median time of 14 days for the deferred treatment group. The researchers noted that while some patients experienced temporary increases in intraocular pressure and mild-to-moderate intraocular inflammation, Fomivirsen is safe and effective for the treatment of previously untreated peripheral CMV retinitis in AIDS patients. "Japan Had Record 250 New AIDS Patients in '97" Kyodo News Service (1/27/98) Japan's Health and Welfare Ministry's AIDS Surveillance Committee announced Tuesday that a record 250 new AIDS cases were recorded in 1997. The agency also reported 397 new HIV infections, 162 of which were related to sexual contact. By year-end 1997, Japan had recorded a total of 1,684 AIDS cases and 3,357 HIV-positive individuals. One of the committee members stressed the need "to promote preventive education that focuses on the sexual behavior of men." "Number of Tuberculosis Cases Rises in Evenk Region [of Russia]" Itar Wire Service (01/28/98) Health officials in the Evenk region of eastern Russia have reported a two-fold increase in tuberculosis cases over recent years. According to deputy head of the Evenk regional administration Galina Khutokogir, approximately one in three families of indigenous residents had a case of TB and 10 percent of the children are registered in a tuberculosis center. Khutokogir said the situation could be ameliorated by improving the living conditions of the indigenous northerners and warned that TB will remain an epidemic in the northern regions until the difficult financial situation changes. "AIDS Research Grants Given Out" CNews Online (01/28/98) The Canadian Foundation for AIDS Research awarded nearly $1 million Canadian dollars in grants last year. The privately funded charitable group awarded grants of either C$20,000 or C$60,000 to 14 recipients, including the University of Toronto, McGill University AIDS Center, Children's Hospital of Western Ontario, and the University of Calgary. The group collects donations from private individuals and corporations and has provided over C$4 million to more than 150 research projects as of December 1997. An estimated 50,000 Canadians are infected with HIV, the group noted. ***************************************************************** 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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