Subject: CDC NCHSTP Daily News Update Date: Wed Feb 11 07:31:04 PST 1998 (233 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update February 11, 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 "Improved Survival Among HIV-Infected Individuals Following Initiation of Antiretroviral Therapy" "Protease Inhibitors May Reverse AIDS Dementia" "An African HIV-1 Sequence from 1959 and Implications for the Origin of the Epidemic." GENERAL MEDIA "Surgeon General Nominee Is Confirmed, Filling a 3-Year Void" "Stored Lymphocytes Enhance Immunity in HIV-Infected Patients" "Potential NRTI Drug-Drug Interactions in HIV Treatments Reviewed" "Rise in Indian HIV Patients, Says Hospital" "AIDS Patients Can't Afford Price of Life, Says Marina" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Improved Survival Among HIV-Infected Individuals Following Initiation of Antiretroviral Therapy" Journal of the American Medical Association (02/11/98) Vol. 279, No. 6, P. 450; Hogg, Robert S.; Heath, Katherine V.; Yip, Benita; et al. New research indicates that HIV-infected patients who received initial treatment with therapies including stavudine or lamivudine had significantly lower rates of death and longer AIDS-free survival than those whose initial treatment regimens were limited to zidovudine, didanosine, and zalcitabine. The scientists--led by Robert S. Hogg of the British Columbia Center for Excellence in HIV/AIDS at St. Paul's Hospital, Canada--studied 1,178 HIV-infected individuals in British Columbia to characterize the effects of antiretroviral therapy on survival after initiation of treatment. The prospective, population-based cohort study followed patients who initially took zidovudine, didanosine, or zalcitabine-based therapy (ERA-I) or therapy including lamivudine or stavudine (ERA-II) between October 1992 and June 1996. With a total of 390 deaths, the researchers measured a crude mortality rate of 33.1 percent. Members of the ERA-I group were almost two times as likely to die as ERA-II members, with a mortality risk ratio of 1.86. ERA-I patients were 1.93 times more likely to die than ERA-II patients, after adjusting for Mycobacterium avium complex and Pneumocystis carinii prophylaxis use, AIDS diagnosis, CD4 cell count, sex, and age. Moreover, of the patients without AIDS when treatment was started, ERA-I recipients were 2.50 times more likely to proceed to AIDS or death than members of the ERA-II group. "Protease Inhibitors May Reverse AIDS Dementia" Journal of the American Medical Association (02/11/98) Vol. 279, No. 6, P. 419; Skolnick, Andrew, A. Research presented at the 83rd Scientific Assembly and Annual Meeting of the Radiological Society of North America shows that protease inhibitor therapy combined with zidovudine or a similar drug may halt or reverse the progression of HIV encephalopathy. The study, conducted at Yale University School of Medicine, involved 16 patients with advanced AIDS and abnormal magnetic resonance imaging (MRI) brain scans that showed multifocal or severe white matter disease; all patients were taking zidovudine or another nucleoside analog. Nine of the patients were given protease inhibitors--which cannot cross the blood-brain barrier in therapeutic amounts--while the other seven were not, due to clinical reasons. MRI scans taken in two- to 12-month intervals saw stabilization of encephalopathy in eight of the nine patients taking protease inhibitors, with four showing almost total regression. Stabilization was strongly associated with clinical improvement and a reduction in patients' viral load and higher CD4 cell counts. Meanwhile, six of the patients who took no protease inhibitors showed continued progression of abnormalities in their brains along with substantial loss of neurocognitive function; no change was observed in the seventh patient. The researchers note that the results are statistically significant, even though the number of patients in the study was small. "An African HIV-1 Sequence from 1959 and Implications for the Origin of the Epidemic." Nature (02/05/98) Vol. 391, No. 6667, P. 594; Zhu, Tuofu; Korber, Bette T.; Nahinias, Andre J.; et al. Dr. Tuofu Zhu of the Aaron Diamond AIDS Research Center in New York and colleagues report the amplification and characterization of viral sequences of an HIV-1-seropositive plasma sample taken from an adult Bantu male in 1959 living in what is now the Democratic Republic of Congo. The researchers studied 1,213 plasma samples obtained from Africa between 1959 and 1982; the 1959 sample tested positive for HIV-1 through immunoassay, immunoflourescence, Western blotting, and radioimmunoprecipitation methods. The plasma sample is the oldest confirmed case of HIV-1; the case of a Manchester sailor who died of an AIDS-like illness in 1959 was reported to be the oldest, but it has not been confirmed. The sample taken from the Bantu man has a viral sequence that lies near the ancestral node of subtypes B and D in the major group, suggesting that these HIV-1 subtypes may stem from a single introduction into Africa soon before 1959. The team notes, however, that "given the large genetic differences between HIV-1 and HIV-2, the divergence of these viruses could not have occurred in the late 1940s; that branching point must have come considerably earlier." The findings highlight the need for continued surveillance, they assert, noting the diversification of HIV over the past 40 to 50 years. **************************************************************** GENERAL MEDIA **************************************************************** "Surgeon General Nominee Is Confirmed, Filling a 3-Year Void" New York Times (02/11/98) P. A20; Mitchell, Alison Dr. David Satcher, director of the Centers for Disease Control and Prevention, received Senate confirmation on Tuesday as Surgeon General, a position that has been empty for over three years. The confirmation came despite conservatives' opposition to Satcher's views on late-stage abortion and his support of needle-exchange programs to reduce the spread of HIV among intravenous drug users. Satcher's opponents also questioned the ethics of CDC trials in Africa in which HIV-infected pregnant women were given placebos. In a statement after the vote, President Clinton described his nominee as "a mainstream physician who is an eloquent advocate for the health of all Americans." Senator Bill Frist (R-Tenn.), a physician who urged other Republicans to support Satcher's nomination, also noted that he "can think of no one better qualified to be Surgeon General." The vote was 63 to 35, with 19 Republicans joining in support of Satcher's confirmation. "Stored Lymphocytes Enhance Immunity in HIV-Infected Patients" Reuters Health Information Services (02/10/98) In the February issue of the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, Australian scientists report that HIV-positive patients showed improvements in some measures of cellular immunity after infusion of cryopreserved autologous lymphocytes. The researchers, led by Dr. John Dwyer of the Prince of Wales Hospital in New South Wales, collected lymphocytes from 12 HIV-infected asymptomatic males early in the course of their infection and cryopreserved the cells. After seven to 41 months, the scientists infused the lymphocytes back into the patients; seven patients later displayed increased activity of HIV-specific cytotoxic T lymphocytes, decreased viral load, and higher CD4 cell counts, with no adverse effects. The researchers concluded that infusion of cryopreserved autologous lymphocytes may provide some degree of immunity in HIV/AIDS patients, although further research is needed. "Potential NRTI Drug-Drug Interactions in HIV Treatments Reviewed" Reuters Health Information Services (02/10/98) According to a report published in the Journal of Respiratory Diseases, the HIV drugs zidovudine, didanosine, and zalcitabine are the nucleoside reverse transcriptase inhibitors (NRTI) most likely to have clinically significant interactions with other drugs. The researchers noted, however, that compared to other triple-combination drugs such as protease inhibitors and non-nucleoside reverse transcriptase inhibitors, NRTIs usually do not have many drug interactions. The researchers, from the University of Colorado in Denver, suggest that doctors avoid prescribing zidovudine in combination with doxorubicin and ribavirin; and didanosine in combination with indinavir or pentamidine. The doctors also advise caution when prescribing stavudine with other drugs that may cause peripheral neuropathy. "Rise in Indian HIV Patients, Says Hospital" Star Online (02/10/98) Chandran Kanniah, head of health education at Ipoh Hospital in Perak, India, reports that the percentage of HIV-infected Indian patients increased in the region to 30 percent in 1997 from 12 percent in 1996. He noted that the majority of the new infections are in younger people who contracted HIV through either drugs or sexual contact. Kanniah, speaking on Sunday at a one-day seminar on AIDS in Tanjung Rambutan, noted that parents could help in the war against AIDS by teaching their children about the disease. Meanwhile, the secretary of the Education and Research Association for Consumers said the increasing number of HIV infections was a reason for concern, and she attributed the rising number of cases to a lack of educational material, especially in rural areas. "AIDS Patients Can't Afford Price of Life, Says Marina" Star Online (02/10/98); Khoo, Simon Malaysian AIDS Foundation chairman Datin Paduka Marina Mahathir said Monday that many HIV and AIDS patients in developing countries are being denied treatment and an opportunity to live longer because they cannot afford the costly therapies. Marina asserted that while combination therapy has produced a decline in AIDS deaths in the United States and Australia over the last two years, only monotherapy treatment--which is outdated and expensive--is available for HIV patients in Malaysian government hospitals. To that end, the Malaysian AIDS Foundation has set aside 20 percent of its funds to help pay for medical treatment of 25 to 30 patients nationwide. Marina also launched a campaign aimed at increasing public compassion for, and decreasing prejudice against, children with HIV or HIV-positive family members. The campaign, called Orchids for Valentine's '98, is organized jointly by Glaxo Wellcome and the Malaysian AIDS Foundation. ***************************************************************** 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. *****************************************************************