Subject: CDC NCHSTP Daily News Update Date: Fri Jan 30 07:31:03 PST 1998 (238 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update January 30, 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 "Treatment of HIV-1-Associated Microsporidiosis and Cryptosporidiosis With Combination Antiretroviral Therapy (Early Report)" "Hormonal Contraception and Genital-Tract Shedding of HIV-1-Infected Cells (Letter)" GENERAL MEDIA "Hepatitis Lawsuit Blamed on Provinces" "EC (Election Committee) Gives the Nod, AIDS Policy Is on the Way" "New HIV-Related Cerebellar Degenerative Disorder Described" "Stavudine Now Most Widely Prescribed NRTI in HIV Therapy" "Group Calls for Increased Funding for Women's Health Research" "Aides Urge Anonymous AIDS Trace" "Find AIDS Work Cash, Says Permsec" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Treatment of HIV-1-Associated Microsporidiosis and Cryptosporidiosis With Combination Antiretroviral Therapy (Early Report)" Lancet (01/24/98) Vol. 351, No. 9098, P. 256; Carr, Andrew; Marriott, Deborah; Field, Andrew; et al. Australian researchers have determined that combination antiretroviral therapy that includes a protease inhibitor can aid in the treatment of HIV-1 related Enterocytozoon bieneusi and Cryptosporidium parvum. The bacteria can induce microsporidiosis and cryptosporidiosis infections in the gastrointestinal tracts of HIV-1-infected individuals, causing persistent diarrhea, weight loss, and abdominal pain. The scientists administered medical regimens of combination therapy that included at least one HIV-1 protease inhibitor to five patients with microsporidiosis, three with cryptosporidiosis, and one with both infections; all nine men were infected with HIV. The researchers saw complete clinical responses in all nine subjects, who gained an average of 15 kg in weight and ceased taking all antidiarrheal and antimicrobial treatments. Moreover, follow-up stool microscopy found that eight of eight men tested showed neither pathogen, while all five patients tested by endoscopy were also negative for the pathogens. Five of the nine patients remained symptom free for an average of 13 months, while four of the patients had recurring diarrhea between seven and 13 months. The researchers noted that while neither infection was eliminated, combination that includes an HIV-1 protease inhibitor can effect "complete and sustained clinical, microbiological, and histological resolution of HIV-1-associated opportunistic infections." "Hormonal Contraception and Genital-Tract Shedding of HIV-1-Infected Cells (Letter)" Lancet (01/24/98) Vol. 351, No. 9098, P. 294; Mostad, Sara; Overbaugh, Julie; Kreiss, Joan In a letter to the editor of The Lancet, Sara Mostad and colleagues from the University of Washington respond to assertions that they used odds ratios, instead of risk ratios, to measure the association between hormonal contraception and shedding of HIV-1-infected cells from the cervix and vagina, thereby overestimating the relative risks. According to the researchers, they "chose to use odds ratios as the measure of association throughout the report to allow direct comparison of adjusted and crude values." Mostad et al. also respond to questions concerning the importance of evaluating the presence of HIV-1 infected cells as a relative measure of infectiousness. The researchers agree that this is a valid concern in studies that use viral DNA or RNA as infectious virus markers, since "it is unclear whether HIV-1-infected cells or free virions are the most important in transmission of HIV-1." However, they assert, because "how well either of these markers of viral presence indicates infectiousness is not well understood ... our understanding of both the mechanism and correlates of HIV-1 transmission is likely to depend on understanding both cell-associated and cell-free virus in genital-tract fluids." Finally, Mostad and colleagues defend their genital swab sampling technique, asserting that the method was intended to assess individually cervical and vaginal shedding of HIV-1-infected cells, thus enabling the identification of correlates that are site-specific. **************************************************************** GENERAL MEDIA **************************************************************** "Hepatitis Lawsuit Blamed on Provinces" CNews Online (01/29/98) On Wednesday, 55 residents of Alberta, Canada, filed a lawsuit for damages related to hepatitis C-tainted blood transfusions that they received during the late 1980s. The suit--filed against the Canadian Red Cross, the federal and Alberta governments and 17 provincial hospitals--would be unnecessary if the governments could agree on compensation, according to patient advocates. A compensation package was expected to be announced Thursday in Vancouver, but officials canceled the meeting because of disagreements over monetary amounts and eligibility. Plaintiffs in British Columbia, Ontario, and Quebec have filed similar actions. Hepatitis C was recognized as a possible problem in the blood supply in 1986, but Canada did not begin screening until four years later. Thus far, all provinces have arranged compensation for individuals infected with HIV through blood transfusions, but only Quebec and Saskatchewan have formally committed to compensation packages for those infected with hepatitis C. Compensation could measure in the billions of dollars for the provinces; Health Minister Halvar Jonson said that compensation will probably not occur until a national package is settled. "EC (Election Committee) Gives the Nod, AIDS Policy Is on the Way" Economic Times of India Online (01/29/98); Singh, Radhika In New Delhi, India's Election Committee has approved the health ministry's draft National AIDS Prevention and Control Policy, allowing circulation of the preliminary document among central ministries and state governments. The document is designed to help stop the spread of HIV and reduce its impact upon health and socioeconomic conditions by educating people--especially members of high-risk groups--about the implications of the disease and providing them with protection such as condoms. The draft document also focuses on the improvement of community health care services to help HIV-infected patients, the creation of blood safety policy, sexually transmitted disease control, and the development of indigenous medicine systems. "New HIV-Related Cerebellar Degenerative Disorder Described" Reuters Health Information Services (01/29/98) Dr. M. Tagliati of the Mount Sinai Medical Center in New York and colleagues have reported findings of previously unobserved primary cerebellar degenerative disorder without the dementia that accompanies HIV infection. In the January issue of Neurology, the researchers describe cerebellar syndrome characterized by "unexplained degeneration" in 10 HIV-positive individuals over an eight-year period. The patients had varied CD4 lymphocyte counts, but all showed gait ataxia, impaired coordination, dysarthria, and abnormal eye movements. Although the cause of the disorder is unclear, the researchers suggested a possible association with HIV or related inflammatory products, such as cytokines or chemokines. "Stavudine Now Most Widely Prescribed NRTI in HIV Therapy" Reuters Health Information Services (01/29/98) Bristol-Myers Squibb officials report that stavudine has surpassed zidovudine as the most often-prescribed thymidine nucleoside reverse transcriptase inhibitor (NRTI) for HIV treatment. According to Dr. Robert Murphy of Northwestern University, stavudine has an impressive resistance profile and is well tolerated by patients. Company officials note that U.S. government guidelines currently specify that a thymidine analog be included as part of a combination antiviral therapy for HIV patients; stavudine and zidovudine are the only two available thymidine NRTI drugs. "Group Calls for Increased Funding for Women's Health Research" U.S. Newswire (01/29/98) The Society for the Advancement of Women's Health Research is calling for increased U.S. spending for women's health issues. Phyllis Greenberger, executive director of the society, noted that "HIV/AIDS and other sexually transmitted diseases is one example of an area that would benefit from expanded research. ... Women are more biologically receptive to developing STDs and suffer from more infections which have no symptoms." The society advocates additional spending of $46.5 million by Congress in the next fiscal year, $30 million of which would go to the National Institutes of Health. "Aides Urge Anonymous AIDS Trace" Virtually Northwest Online (01/28/98); Burke, James Advisers to Governor Gary Locke of Washington are calling for the reporting of HIV-infected individuals in the state by using a system of unique identifier codes instead of names. The Governor's Advisory Council in HIV/AIDS said that the use of codes would help to ensure confidentiality and privacy, while allowing accurate data collection. The issue is controversial, with some saying that fewer people will seek HIV testing if they are not assured anonymity, while others claim that mandatory name-based HIV reporting allows health officials to treat cases more aggressively. Of the states that currently have HIV reporting systems, only Maryland and Texas use unique identifiers. The Centers for Disease Control and Prevention recently said that experiments with unique identifiers in the two states revealed several problems, including incomplete codes and the lack of behavioral risk information. "Find AIDS Work Cash, Says Permsec" Africa News Service (01/29/98) North-Western Providence Permanent Secretary Ronald Makuma has urged the provincial Zambia National Awareness Network to increase funding for HIV/AIDS awareness efforts. Makuma stated that while workshops and seminars have been held, no follow-up activities or logistical help has been provided to aid in program implementation. He also claimed that governmental and non-governmental agencies have done little in the province to control and prevent the spread of HIV. Health board clinical officer for the Solwezi District, Derrick Nyirenda, also noted that the incidence of sexually transmitted diseases is increasing substantially in Solwezi, which is ranked third in HIV/AIDS cases in Zambia. ***************************************************************** 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. *****************************************************************