Subject: CDC AIDS Daily Summary Date: Tue, 10 Feb 1998 09:31:35 PST (230 lines of text) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update February 10, 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 "Transmission of Blood-Borne Viruses After Motor Car Accidents (Letter)" GENERAL MEDIA "HIV List Eyed to Stop Virus" "Tainted Blood Scandal Could Be Worse Than Originally Thought" "J&J To Warn on Antihistamine's Label of Potential Serious Reactions to Drugs" "Maternal Viral Load 'Powerful' Predictor of HIV Vertical Transmission" "Malawi: Traditional Songs to Spread AIDS Messages" "Health Officials Say Recent TB Cases In Schools Are Unrelated" "AZT Trials in Developing Countries: What's Next?" "Post-Sexual Exposure Prophylaxis: A Roundtable Discussion" INFORMATION FROM OTHER GOVERNMENT AGENCIES "New Satellite Broadcast Series on HIV/AIDS-Related Issues" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Transmission of Blood-Borne Viruses After Motor Car Accidents (Letter)" Lancet (02/07/98) Vol. 351, No. 9100, P. 450; Wreghitt, T.G.; Irish, N. In a letter to the editor of The Lancet, British researchers report the exposure, during a 1996 automobile accident, of 10 individuals to the hepatitis C virus. Eight emergency service members and two members of the public were exposed to HCV-antibody-positive blood as the result of a casualty at the accident site. Nine of the individuals were tested upon determination of the deceased person's HCV status; none of these nine patients were positive for the virus after six months of follow-up. Citing a previous report of HIV-1 and hepatitis B infection resulting from a head-butting incident after a car accident, the researchers claim "rapid determination of the blood-borne viral risk is essential to give prompt and appropriate post-exposure prophylaxis for HBV or HIV-1." The researchers urge the creation of emergency service procedures ensuring prompt and appropriate action in order to minimize infection from blood-borne viruses for people exposed in emergency situations. **************************************************************** GENERAL MEDIA **************************************************************** "HIV List Eyed to Stop Virus" Calgary Sun Online (02/10/98) The provincial government of Alberta, Canada, is set to enact measures requiring doctors to report the names of HIV-positive residents. In an effort to control the spread of the virus, physicians would be required to submit the names to local health authorities. The list will not be made public and will not require the names of patients' sexual partners. The measures, to be released officially this spring, come in response to an HIV alert from Edmonton's Capital Health Authority following reports of a 24 percent increase in new HIV infections last year. "Tainted Blood Scandal Could Be Worse Than Originally Thought" CNews Online (02/09/98) Quoting an unnamed senior official with Health Canada, Canadian Broadcast Corporation Radio reported Monday that the number of people infected with the hepatitis C virus through contaminated blood may be higher than expected. The report said that up to 90,000 individuals who have received blood transfusions from the Canadian Red Cross since 1980 may have been infected; original estimates by Justice Horace Krever had placed the number of infected people at 60,000. Mount Sinai Hospital's Dr. Victor Fienman says he agrees with the new estimate, noting that the original statistics counted only the number of HCV cases from 1986 to present. Fienman explained that about 3 percent of all blood transfusion recipients contracted the disease through tainted blood between 1980 and 1986. The provinces and Ottawa are currently engaged in negotiations to determine a compensation plan for the HCV-infected individuals--a plan which could cost more than $2 billion Canadian. "J&J To Warn on Antihistamine's Label of Potential Serious Reactions to Drugs" Wall Street Journal (02/10/98) P. B6; Daerr, Elizabeth; Ingersoll, Bruce Johnson & Johnson's Janssen Pharmaceutica division is changing the labeling for its antihistamine Hismanal to include warnings about interactions with certain antibiotics, antidepressants, and protease inhibitors. Among the drugs that should not be taken concurrently with Hismanal are the hypertension drug Posicor; and the HIV protease inhibitors Crixivan, Invirase, Viracept and Norvir. Two widely prescribed antibiotics--Biaxin and Troleandomycin--were added to the list, as were antidepressants Prozac, Zoloft, Luvox, Serzone, and Paxil. The FDA said the drug interactions have been associated with irregular heart beats, cardiac arrest, and some rare cases of anaphylactic shock. "Maternal Viral Load 'Powerful' Predictor of HIV Vertical Transmission" Reuters Health Information Services (02/09/98) New research published in the February issue of the Journal of Medical Virology indicates that a high maternal level of HIV RNA is a risk factor for transmitting HIV to the infant, and is also linked with an elevated risk of premature birth. The researchers investigated vertical transmission factors in 95 HIV-positive pregnant women, evaluating the women's viral load, clinical status, and CD4 cell count, as well as the HIV status of the 94 children born to the women. Dr. Siobhan O'Shea of the United Medical and Dental Schools of Guy's and St. Thomas's Hospitals in London and colleagues found that the mother's viral load was a better indicator of vertical transmission than CD4 cell counts; the estimated rates of transmission were 2 percent for women with 1,000 HIV RNA copies/mL, 11 percent for 10,000 copies, and 40 percent at 100,000 copies. The researchers also found that the mean gestation at delivery dropped by an average of 1.3 weeks for every 10-fold increase in HIV RNA load in the mother. "Malawi: Traditional Songs to Spread AIDS Messages" Africa Information Afrique (02/10/98); Mwanza, Patrick The AIDS Society of Malawi plans to use traditional songs in AIDS information and education campaigns. Malawi has a 65 percent illiteracy rate, making verbal communication a more effective measure in the fight against AIDS. Traditional songs have already been used in family planning messages and other projects aimed at modifying behavior. "Health Officials Say Recent TB Cases In Schools Are Unrelated" Newsday Online (02/06/98) Ken Shilkret, tuberculosis program manager at the New Jersey Health Department and Senior Services, says that three cases of tuberculosis in area schools are not related or significant. Despite the death of a college student last week from TB, Shilkret said the cases were isolated. "This is not an outbreak," he said. TB testing began last Friday for 141 students and faculty at Bloomfield College, which reported the TB-related death of a female, foreign-born student. New Jersey reports at least 35 deaths annually due to TB, while 700 residents contract the disease every year. A 14-year-old student at Clifton High School and a fourth-grader at Old Bridge have also tested positive for TB, although the Old Bridge student has a non-contagious type of the disease. Twenty four of 163 people tested at Clifton High School were positive for tuberculosis, but none were ill. "AZT Trials in Developing Countries: What's Next?" AIDS Alert--International (02/98) Vol. 13, No. 2, P. 1 AIDS researchers are awaiting the results of a January 22 interim analysis of two placebo-controlled trials of short-course zidovudine for the prevention of perinatal HIV transmission. The studies, conducted in Thailand and the Ivory Coast, have sparked controversy over the ethics of drug trials. Opponents say the two trials do not provide the best possible treatment for pregnant women receiving placebo regimens. However, Dr. Kevin DeCock, director of the Centers for Disease Control and Prevention's division of HIV/AIDS surveillance, asserts that the trials are ethical because developing countries do not have the expertise and infrastructure to implement the administration of the regimen proven effective in ACTG 076, which includes lengthy oral doses of AZT. Furthermore, he notes, no one knows whether a shorter-course of AZT will prevent perinatal HIV transmission. DeCock argues that no alternatives to a placebo-controlled trial could be conducted to yield the desired results. He observes: "The ideal equivalency trial would be short-course against 076. However, if you find a short regimen is less effective [against ACTG 076 regimens], you still don't know if it's better than nothing." The results from the new studies may be used to determine the course of future perinatal transmission studies. UNAIDS is now funding a pilot program in Vietnam, Ivory Coast, Thailand, and Chile that includes costs for the procurement and distribution of reduced price antiretroviral drugs, including the use of AZT to reduce perinatal HIV transmission. "Post-Sexual Exposure Prophylaxis: A Roundtable Discussion" AIDS Clinical Care (02/98) Vol. 10, No. 2, P. 1; Cotton, Deborah In a roundtable discussion in AIDS Clinical Care, doctors debate the necessity of post-sexual exposure prophylaxis (PEP) with combination antiretroviral therapy, which has become the standard treatment for needlestick and other exposures in the healthcare setting. Michael Katz and Julie Gerberding, who are involved in a San Francisco-based PEP program, recommend offering PEP to people who have had unprotected anal or vaginal intercourse with a person known to have, or at risk for, HIV. They also recommend the program for those who have had unprotected receptive oral intercourse with ejaculation. Steve Boswell, head of the Fenway Community Health Clinic in Boston, said that the broad categories are useful in order to acquire the maximum data about the types of exposure for which PEP is sought. Boswell noted that the data will be used in a research project backed by Glaxo Wellcome and the Massachusetts Department of Health. Meanwhile, Katz and Gerberding pointed out that the key factors in an effective PEP program include assessment of HIV risk, HIV testing and evaluation, expertise on antiviral therapies, enhanced counseling and/or referral to prevention services, and convenient access to services. They also said the average cost of PEP for a four-week treatment--including AZT, 3TC, a protease inhibitor, medical care and tests--is about $1,700; Boswell cited similar costs, ranging from $1,300 to $1,800. **************************************************************** 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, such as 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. 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