Subject: CDC NCHSTP Daily News Update Date: Thu Feb 5 07:31:03 PST 1998 (257 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update February 5, 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 "Confusion of Nelfinavir and Navirapine" "Impending AIDS Vaccine Trial Opens Up Wounds" GENERAL MEDIA "Unusual Fat Accumulations Follow a New Therapy for AIDS" "Surgeon General Nomination Held Up by GOP Conservatives" "Studies Show AIDS 'Cocktails' Help Children Too" "Blood Tests of Workers Restricted by Court" "Viral Load, CD4 Count Best Prognostic Indicators In Pediatric HIV Cases" "State Agrees to Revise Sex Education Curriculum, Again" "133 Children Contract Tuberculosis in Southern Kazakhastan" "1 Million Female Condoms Coming" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Confusion of Nelfinavir and Navirapine" New England Journal of Medicine (02/05/98) Vol. 338, No. 6, P. 396; Max, Blake; Mourikes, Nike Cook County Hospital physicians warn--in a letter to the editor of the New England Journal of Medicine--against accidental confusion of the drugs nelfinavir and nevirapine, which are both used for treatment of HIV. Nevirapine, marketed by Roxane Laboratories as Viramune, is a non-nucleoside HIV-1 reverse transcriptase inhibitor. Nelfinavir, sold by Agouron Pharmaceuticals under the name Viracept, is a protease inhibitor. In addition to having similar generic and brand names, the medications are dispensed at similar tablet strengths. The physicians report two recent cases in which HIV-infected patients visited their hospitals' outpatient clinics because of medication concerns. In one case, the pharmacy had accidentally placed the appropriate nelfinavir label on a bottle of nevirapine, while in the other, three bottles of nevirapine had been labeled as nelfinavir and the patient experienced adverse effects. The authors suggest that physicians and pharmacists pay particular attention when prescribing, transcribing prescriptions for, and dispensing the two drugs. "Impending AIDS Vaccine Trial Opens Up Wounds" Science (01/30/98) Vol. 279, No. 5351, P. 650; Balter, Michael VaxGen, a San Francisco-based biotechnology firm, is hoping to start phase III trials of its AIDS vaccine in the United States and Thailand soon. However, not all researchers are convinced of the gp120 strategy, which uses a genetically engineered version of the gp120 protein found on the outer coat of HIV. AIDS expert David Baltimore, head of a special committee that advises the U.S. government on AIDS vaccines, commented: "It is evident that gp120-based vaccines have not yielded antibodies that neutralize most natural strains of HIV. This raises serious doubts about the utility of these vaccines." Moreover, the National Institute of Allergy and Infectious Diseases decided in 1994 not to devote its own funds for phase III trials of gp120 vaccines. In the current issue of the Journal of Virology, a team led by David Wolinsky of Northwestern University Medical School reports that they found no difference in anti-HIV antibodies in 18 patients who had previously received gp120 vaccines and later became infected with HIV, and those who did not. "The bottom line," said Wolinsky, "is that we had neither beneficial nor adverse effects in any of the individuals we studied." However, research published last year in the Journal of Infectious Diseases and conducted by VaxGen official Phillip Berman, showed that all seven so-called breakthrough subjects were infected with HIV strains containing gp 120 proteins different from the one they had been vaccinated against. Berman believes that a vaccine could be useful if it contained several versions of the gp 120 protein; VaxGen plans to include two versions of the protein in phase III trials. Despite current arguments, it appears that the Food and Drug Administration will soon approve the trials. Mary Lou Clements-Mann, a vaccine expert at Johns Hopkins University School of Medicine, says: "If we don't move forward to phase III, we will never have a vaccine." **************************************************************** GENERAL MEDIA **************************************************************** "Unusual Fat Accumulations Follow a New Therapy for AIDS" New York Times (02/05/98) P. A19; Altman, Lawrence K. Several researchers at the Fifth Conference of Retroviruses and Opportunistic Infections have reported body changes that appear to be related to new combination drug therapies, particularly those that include a protease inhibitor. The studies show a wide range in incidence of unusual fat accumulations--such as "buffalo humps" in the neck and puffy cheeks--in HIV therapy recipients. Australian physician David A. Cooper and colleagues found that 64 percent of their HIV-positive patients receiving treatment reported changes in body shape. However, other studies--coming from Emory University, Cornell University Medical Hospital, San Francisco General Hospital, Ottawa General Hospital, the National Institutes of Health, and the Food and Drug Administration--showed lower percentages of doctor-reported body shape change. The body changes have caused some patients to cease therapy, but frequencies are unknown due to the lack of large studies on the phenomenon. Some patients on protease inhibitor regimens have also developed more serious side-effects--such as diabetes, high blood sugar, and high levels of lipids in their blood--and doctors are concerned about the long-term possibility of increased heart disease in people who use the drugs. Of the unusual fat accumulations, Dr. John W. Mellors of the University of Pittsburgh, noted: "It is not a vain issue, it is a metabolic issue that has a scientific basis and we need to investigate it." "Surgeon General Nomination Held Up by GOP Conservatives" Washington Post (A4); Dewar, Helen On Wednesday, conservative Republicans in the Senate raised objections over Surgeon General nominee David Satcher's record on AIDS studies and abortion. A vote on Satcher was delayed until Sen. David Ashcroft (R-Mo.) receives further information on Satcher's role, as Director of the Centers for Disease Control and Prevention, in an African AIDS study that uses placebos. Ashcroft and others are also concerned about CDC research on HIV-positive infants and Satcher's support of needle-exchange programs. However, Sen. Bill Frist (R-Tenn.), the only physician in the Senate, said that Satcher is highly qualified for the post in terms of knowledge, experience, and values. Although he said he does not agree with Satcher on certain issues, he rejected most of the criticism against Satcher as "straight politics." President Clinton nominated Satcher last year for the position, which has been empty for three years since the resignation of Joycelyn Elders. "Studies Show AIDS 'Cocktails' Help Children Too" Reuters (02/04/98); Fox, Maggie Sandy Burchett of Harvard University and others reported at the Fifth Conference on Retroviruses and Opportunistic Infections that triple-drug AIDS cocktails work as well as in children as in adults. Doctors have been reluctant to give children the therapy due to concerns over toxicity, efficacy, and recommended dosage; however, Burchett's study found good results in 432 seriously ill HIV-positive children receiving AZT, ddI, and nevirapine. Only 5 percent of the children died and more than 40 percent responded to the triple-drug therapy, compared to 14 percent of those receiving only ddI and AZT, and 8 percent taking only ddI and nevirapine. Burchett, who noted that the drugs were fairly well tolerated, said that her group now plans to study four-drug cocktails. "Blood Tests of Workers Restricted by Court" New York Times (02/05/98) P. A19 The U.S. Court of Appeals for the Ninth Circuit ruled Tuesday that the Lawrence Berkeley Laboratory's secret blood testing of its clerical workers for syphilis, sickle-cell anemia, and pregnancy violated their state and federal privacy rights. The court held that testing for conditions unrelated to job performance is unlawful. "Viral Load, CD4 Count Best Prognostic Indicators In Pediatric HIV Cases" Reuters Health Information Services (02/04/98) According to a report in the January issue of The Pediatric Infectious Disease Journal, a combination of plasma HIV RNA concentration and CD4 lymphocyte percentage is the best method for predicting which HIV-positive children are at high risk. Dr. Ross E. McKinney Jr. of Duke University, and colleagues, studied 86 HIV-infected children for two years and found that of the 22 who died or experienced disease progression during that period, viral load and CD4 cell count were significant predictors of such events. Of the subjects who started with a low CD4 percentage and a high viral load, 92 percent died or had a new diagnosis after an average of 179 days. Meanwhile, only 4 percent of the 86 children with high CD4 counts and low viral load died or experienced disease progression during follow-up. The researchers noted that children with viral loads of less than 100,000 HIV RNA copies/mL seemed to fare well, and they suggested that this viral level be used as a threshold for treatment change. "State Agrees to Revise Sex Education Curriculum, Again" Boston Globe Online (02/05/98) The Connecticut Board of Education has agreed to review its sex education curriculum guidelines for state schools due to complaints over recent revisions. The review was spurred by opposition to measures requiring fourth-graders to be able to "describe puberty and the reproductive process" and guidelines that fifth-through-eighth-graders be able to "show respect for all individuals regardless of sexual orientation." The revised guidelines also remove all mention of HIV or AIDS and advises students be taught to "avoid all forms of sexual contact." According to Diane M. Celeste, a health education consultant at the University of Connecticut, telling students to "avoid all forms of sexual contact" gives out the wrong impression. "Sexual contact can mean kissing, hugging, holding hands, none of which cause pregnancy or can transmit HIV/AIDS, but which are healthy alternatives to be used in strategies to avoid sexual intercourse," she explained. "133 Children Contract Tuberculosis in Southern Kazakhastan" Itar Wire Service (02/05/98) Kazakhastan health officials report that 133 children in the city of Zhanatas contracted tuberculosis during a routine fall vaccination last year. Although the children contracted TB as early as last September, local authorities reportedly concealed the incident from national officials as they tried to cure the children on their own. According to Albert Askarov, deputy chief of Kazakhastan's sanitary and epidemiological surveillance service, their inability to do so forced them to report the incident several days ago. Askarov said the children were infected because untrained medics accidentally used the wrong, more concentrated, formulation of the vaccine for injections. National and regional health officials are now investigating the situation. "1 Million Female Condoms Coming" Africa News Service (02/04/98); Namutebi, Joyce In an effort to protect women from sexually transmitted diseases and unwanted pregnancies, the Ugandan government is set to import 1 million female condoms, according to the Health Ministry's Dr. Elizabeth Madraa. Madraa, who made the announcement at a meeting of the National Taskforce for Women and AIDS on Tuesday, explained: "We wanted a barrier method which could easily be used by women without causing conflict within the family setup." The official did not say when the condoms will be available, but she did note that the government will subsidize them to reduce their cost. ***************************************************************** 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. *****************************************************************