Subject: CDC NCHSTP Daily News Update Date: Wed Feb 4 07:31:03 PST 1998 (317 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update February 4, 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 "Possible Effectiveness of Clarithromycin and Rifabutin for Cryptosporidiosis Chemoprophylaxis in HIV Disease" "Increasing Incidence of AIDS Among Women (Letter)" GENERAL MEDIA "AIDS Virus Identified in Blood Sample Taken From African Man in 1959" "AIDS Drugs Are Effective in Twice-Daily Regimen" "Optimism About AIDS Is Premature" "Citadel of Russia's Wasteful Health System" "Study: HIV Can Live in Vagina" "UK Launches Study Into Tuberculosis Treatment" "Six-Drug Combination Keeps AIDS in Check" INFORMATION FROM OTHER GOVERNMENT AGENCIES "New Findings Help Explain 'Rebound' of HIV Patients Who Discontinue Triple-Drug Therapy" "New Satellite Broadcast Series on HIV/AIDS-Related Issues" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Possible Effectiveness of Clarithromycin and Rifabutin for Cryptosporidiosis Chemoprophylaxis in HIV Disease" Journal of the American Medical Association (02/04/98) Vol. 279, No. 5, P. 384; Holmberg, Scott D.; Moorman, Anne C.; Von Bargen, Jennifer C.; et al. Researchers from the Centers for Disease Control and Prevention report that clarithromycin and rifabutin provide "robust and statistically significant" protection against the development of cryptosporidiosis in immune-suppressed HIV-positive individuals, although further research is necessary. The CDC investigated the relative rates of cryptosporidiosis in HIV-infected patients who were either receiving or not receiving chemoprophylaxis or treatment for Mycobacterium avium complex. Using prospectively collected data from patients' visits to their doctors since 1992, the researchers studied more than 1,000 HIV-infected patients at eight private and two publicly funded HIV clinics throughout the United States. According to their data, 30 of the 707 patients not taking clarithromycin developed cryptosporidiosis, compared to five of the 312 patients who were taking the drug. In addition, two of the 214 patients taking rifabutin developed the disease, versus 33 of the 805 patients not taking the drug. The prophylactic efficacy of either drug, the researchers said, was at least 75 percent. Use of the drug azithromycin appeared to provide no protective effect. "Increasing Incidence of AIDS Among Women (Letter)" Journal of the American Medical Association (02/04/98) Vol. 279, No. 5, P. 356; Wortley, Pascale M.; Fleming, Patricia L. In a letter to the editor of the Journal of the American Medical Association, officials from the Centers for Disease Control and Prevention respond to concerns regarding the definition of heterosexual HIV transmission. Pascale M. Wortley and Patricia L. Fleming state that "the CDC defines heterosexual transmission as sexual contact with a partner who has a primary risk factor (eg, IDU or male-male sex) or is known to have HIV or AIDS." A total of 38,202 of the 82,784 AIDS cases reported through June 1997 without risk have been reclassified, the authors note, with two-thirds of the 9,290 women reclassified as heterosexual risk. Wortley and Fleming agree that differentiating primary from secondary heterosexual transmission is critical, although they say that "doing so requires risk behavior information not only for the case patient and his or her partner, but also for the partner's partners"--data not found on medical records. The authors report a recent evaluation of the classification of heterosexual contact cases and found that 87 percent of women first classified as heterosexual contact were validated and 60 percent of the women initially reported as having no identified risk were reclassified as having a heterosexual risk. Wortley and Fleming assert: "Overall, we feel that our data provide an accurate characterization of the AIDS epidemic among women who were infected as the result of heterosexual contact with an infected partner." They also note that "the CDC has recommended that all states and territories should conduct HIV surveillance as an extension of their AIDS surveillance programs." **************************************************************** GENERAL MEDIA **************************************************************** "AIDS Virus Identified in Blood Sample Taken From African Man in 1959" Washington Post (02/04/98) P. A5; Brown, David On Tuesday, researchers announced the discovery of HIV in a blood sample taken from a man in the Belgian Congo in 1959, making it the oldest confirmed case of human infection by the virus. David D. Ho and Tuofu Zhu of the Aaron Diamond Research Center in New York and Andre J. Nahmias of Emory University reported the results at the Fifth Conference on Retroviruses and Opportunistic Infections as well as in this week's issue of the journal Nature. Molecular analysis of the sample, taken in a study on malaria resistance by Arno Motulsky at the University of Washington, shows that the infected man probably contracted the disease approximately a decade after the virus moved from non-human primates to human hosts. Ho and Zhu note that comparisons between the newly discovered sample and current human immunodeficiency viruses show a "common ancestor" virus from the late 1940s or early 1950s, placing the origin of the virus at an earlier date than many scientists had believed. Nahmias began testing for HIV in 1,213 of Motulsky's samples shortly after antibody tests became available in 1985. After he narrowed down the samples to one--which tested positive for HIV through every available test at the time--Ho and Zhu assessed a portion of the sample using polymerase chain reaction to amplify DNA from the serum sample and test conclusively for the presence of HIV. Zhu and Ho, along with collaborators at Los Alamos National Laboratory, used mutation rates to date the "common ancestor" virus. Although Ho said "this [finding] is clearly not going to impact on how we take care of our patients today," he noted the data may give researchers a better idea of HIV and other "emerging infections" function over time. "AIDS Drugs Are Effective in Twice-Daily Regimen" Wall Street Journal (02/04/98) P. B13 At the Fifth Conference on Retroviruses and Opportunistic Infections, Agouron Pharmaceuticals and Merck & Co. announced that their protease inhibitors--Viracept and Crixivan, respectively--are as effective when taken twice daily as the thrice daily regimen used to reduce the level of HIV in patients' blood. The new data implies that patients taking the drug cocktails may be able to reduce the number of times per day they have to take the medicine. The complex regimen of taking several pills at varying times during the day has been one key reason why many patients on the multi-drug therapy fail. Agouron officials noted that the cost of the twice daily Viracept regimen would cost about $500 more per year, although the strength of the medicine in terms of milligrams remains the same. "Optimism About AIDS Is Premature" Wall Street Journal (02/04/98) P. A22; Philipson, Tomas J.; Posner, Richard A. In a commentary in the Wall Street Journal, Thomas J. Philipson, a professor at the University of Chicago, and Richard A. Posner, a chief judge of the Seventh U.S. Circuit Court of Appeals, comment on the new statistics that show a 44 percent reduction in AIDS deaths in the United States. They note that the drop in AIDS deaths largely results from the development of new protease inhibitor treatment, which extends the lives of HIV-infected individuals. However, the authors believe that the advent of these treatments will actually cause the increase in the total number of HIV infections. They assert: "The more treatable a disease is, the smaller is the benefit to the individual of behavioral changes that reduce the risk of becoming infected." Philipson and Posner argued in their 1993 book: "Private Choices and Public Health: The AIDS Epidemic in an Economic Perspective," that the disease is self-limiting and that the government's appropriate role in fighting the disease was quite limited. They pointed out that HIV is highly avoidable via behavioral change and that clean needles and condoms will allow rational people to prevent the spread of HIV. According to the authors, policy makers should focus on changing risky behavior and the incentives involved in disease-related behavior in order to halt the cycles of "excessive pessimism and optimism" which can result in distorted policy. They conclude: "In the case of AIDS, this pattern has featured too much investment in the search for a cure--the benefits of which may be largely offset by the risky behavior that the cure encourages." "Citadel of Russia's Wasteful Health System" New York Times (02/04/98) P. A1; Specter, Michael The Pediatric Tuberculosis Center in Tomsk, Russia, has 500 beds, a dozen buildings, and a staff of 134, but it only has 13 patients. Last year, it never treated more than 20 children at a time, making the center indicative of the wastefulness of national finances prevalent in the Russian health system. Tomsk has a population of half a million, yet it has 88 hospitals, many of them duplicating services. However, Russian health officials allocate funds to centers based solely on the number of beds in each hospital, so the Pediatric Center will receive $1 million in regional funds this year. Still, Tomsk has seen a remarkable surge in infectious and parasitic diseases; more people in Russia died of curable tuberculosis last year than got the disease in the United States. Yet, Russia boasts 130 hospital beds per 10,000 people, more than any other country in the world; by comparison, the United States has 40 beds per 10,000 people. According to the British relief agency, Merlin, three-quarters of the $4 million spent on TB treatment and testing in Russia is wasted. Igor Linok, chief administrator of the Tomsk regional health insurance fund, asserts: "You could not invent a more ridiculous health care system than the one we have now." "Study: HIV Can Live in Vagina" USA Today (02/04/98) P. 5D; Davis, Robert; Marklein, Mary Beth; Sternberg, Steve A new study indicates that HIV-infected women have actively replicating virus in their vaginal secretions and may have somewhat different HIV variants in their blood and vaginal secretions. The research suggests that HIV-positive mothers may expose newborns to the virus through both blood and vaginal secretions during birth. It also adds further understanding to female-to-male HIV transmission. Dr. Jeffrey Lenox of Emory University, who announced the findings at the Fifth Conference on Retroviruses and Opportunistic Infections, noted that multidrug antiviral treatments virtually eliminate HIV in vaginal secretions and in the blood. "UK Launches Study Into Tuberculosis Treatment" Reuters (02/03/98) Researchers at the Imperial College School of Medicine in London have begun a two-year study funded by the British Lung Foundation to investigate drugs that might regulate the production of the hormone interleukin-8 and develop a treatment for tuberculosis that is effective in just a few weeks. Current treatments cure the disease in about six months, but many patients who quit taking the drugs as soon as they feel better become ill again and must start their treatment over; patients can also develop resistance to TB drugs by not completely eliminating the infection the first time. The researchers plan to study the role IL-8 plays in regulating white blood cells, and they hope the findings will also lead to treatments for other lung diseases. "Six-Drug Combination Keeps AIDS in Check" United Press International (02/04/98); Susman, Ed Australian doctors reported at the Fifth Conference on Retroviruses and Opportunistic Infections that a six-drug regimen including protease inhibitors keeps viral loads of HIV below detectable levels in patients, even if they had previously failed other multidrug treatments. The patients receiving the therapy--which consists of d4T, ddI, 3TC, nevirapine, nelfinavir, and saquinavir--had been undergoing AIDS treatment for 10 years; 16 of the 20 patients responded to the new regimen, according to Sydney physician Dr. Cassy Workman. Workman expressed surprise that the new, extensive regimen succeeded, because it contains only two new drugs, nevirapine and nelfinavir. He said this offers hope that other AIDS drugs may be "recycled." **************************************************************** INFORMATION FROM OTHER GOVERNMENT AGENCIES **************************************************************** "New Findings Help Explain 'Rebound' of HIV Patients Who Discontinue Triple-Drug Therapy" NIAID News (02/02/98); Carroll, Diana Researchers from the National Institute of Allergy and Infectious Diseases have determined that signaling molecules called cytokines may induce the rebound of latent HIV in resting CD4 T-cells after antiretroviral multidrug therapy has been stopped. The NIAID researchers--led by Dr. Anthony Fauci--and two other research teams recently found latent HIV reservoirs in CD4 cells even after taking "highly active retroviral therapy" (HAART) for several months. The new data indicate that it may be able to purge the HIV reservoirs by activating resting, latently infected CD4 T-cells with cytokines, resulting in the death of these cells while preventing the further spread of HIV through HAART. According to Dr. Fauci: "The findings underscore the risks involved in discontinuing antiretroviral therapy, even if the patient feels better and has a viral load that is 'undetectable' using standard assays." The findings will be presented today at the Fifth Conference on Retroviruses and Opportunistic Infections. "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 HIV/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. 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. *****************************************************************