Subject: CDC NCHSTP Daily News Update Date: Wed Feb 18 07:31:07 PST 1998 (211 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update February 18, 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 "HIV/AIDS Care Calls for Reallocation of Resources" GENERAL MEDIA "Cavities Link to Oral Thrush in HIV Patients" "Needle Exchange Supporters Try Again" "Renal Effects of HIV Protease Inhibitor Indinavir Investigated" "Immune Function in HIV-Infected Subjects Unaffected by Arginine/Fatty Acid Supplements" "Health--India: Compulsory Testing" "Health Ministers Fail to Reach Compensation Deal for Hepatitis C Victims" "Hard to Swallow" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "HIV/AIDS Care Calls for Reallocation of Resources" Journal of the American Medical Association (02/18/98) Vol. 279, No. 7, P. 491; Marwick, Charles New drug regimens that have changed the mortality rate of HIV-infected individuals have also had an effect on management systems for the disease. Dr. John C. Harvey, of Georgetown University, said recently at the International Conference on Health Care Resource Allocation for HIV/AIDS and Other Life-Threatening Illnesses in Washington, D.C., that the reduction of AIDS deaths "has caught the health care systems and social policy planners of every nation off guard." The conference--sponsored by the International Association of Physicians in AIDS Care--focused on the continued spread of HIV despite the decline of AIDS mortality, and how to deal with the problem. Participants offered a range of suggestions, including the testing of candidate AIDS vaccines, public health measures to reduce transmission, the adjustment of drug assistance programs via rationing and lottery, and calls for universal health care. **************************************************************** GENERAL MEDIA **************************************************************** "Cavities Link to Oral Thrush in HIV Patients" Fox News Online (02/17/98) New research published in the February Issue of the Journal of the American Dental Association suggests that cavities in HIV-positive individuals act as fungal reservoirs and should be treated in order to reduce fungal infections. The researchers, from the University of Texas, found a 77 percent rate of infection for candidiasis and its manifestations in HIV-infected patients, compared with 17 percent in HIV-negative patients. Dr. Catherine M. Flaitz noted that in some cases, the fungal infections were very hard to treat, and she recommended placing fillings in teeth or removing teeth that cannot be effectively treated. She also noted that many HIV-positive patients receive medication that causes dry mouth, thereby making them more prone to develop cavities. "Needle Exchange Supporters Try Again" Chicago Tribune Online (02/17/98); Cetera, Mike Needle-exchange program advocates in Chicago are calling for the institution of statewide programs to reduce the transmission of HIV and other bloodborne diseases. State Sen. Donne Trotter (D-Chicago) introduced legislation at the Illinois General Assembly to allow needle-exchange programs--supervised by the Department of Public Health--for injection drug users. Trotter hopes that new information from local needle-exchange research projects and help from supporters will win support in the legislature. According to the new data, the annual HIV infection rate among injection drug users in the region is 1 percent. Trotter's legislation is similar to Connecticut laws enacted in 1990. Needle sharing fell from 52 percent to 31 percent in the first year after Connecticut repealed its laws against needle exchanges, according to the Connecticut Department of Health. "Renal Effects of HIV Protease Inhibitor Indinavir Investigated" Reuters Health Information Services (02/17/98) In the February issue of Antimicrobial Agents and Chemotherapy, Dr. Kuang C. Yeh of Merck Research Laboratories and colleagues report that the protease inhibitor indinavir should be taken with water to lower the risk of nephrolithiasis. The researchers tested 28 healthy male volunteers, monitoring plasma and urine concentrations of indinavir. According to the results, indinavir concentrations increased greater than proportionally to the dose, suggesting nonlinear pharmokinetics. The Merck group also investigated the effects of dietary intake on indinavir pharmokinetics and found that high-fat meals may result in some precipitation of the drug. "Immune Function in HIV-Infected Subjects Unaffected by Arginine/Fatty Acid Supplements" Reuters Health Information Services (02/17/98) According to new research, HIV-positive individuals appear to receive no immunological benefit from supplementing their diets with arginine and omega-3 fatty acids, despite previous studies which showed that the dietary supplements led to improved immune function in patients with some clinical symptoms. However, in the January 1 issue of the journal AIDS, researchers from the Swiss HIV Cohort Study note that the administration of oral nutrient supplements containing vitamins, minerals, and trace elements does result in increased body weight gain in HIV-infected patients. The researchers suggested that although arginine and omega-3 fatty acids had no apparent effects on the immunological factors of the subjects, benefits may be derived from different amounts of the supplements. "Health--India: Compulsory Testing" IPS Wire (02/17/98) The government of Maharashtra, India, in December ordered mandatory HIV testing for all girls in boarding homes in the state, where the first AIDS case in India was reported in 1987. In an effort to protect girls in the homes who are not infected, girls who test positive for the virus are immediately sent to an institution run by a women's welfare group in Sangli. According to reports, scared girls have fled to orphanages to avoid the testing and possible isolation. Critics oppose the measures due to their severity and insensitivity. Dr. S. Salunke, head of health services in Maharashtra, stated: "I will see to it that the order is not implemented by the civil hospitals." Meanwhile, T. Theckekara, secretary of the Department of Women and Child Welfare, maintains that the order to test the girls for HIV was accidentally added to a list of routine medical tests. However, she added, since many of the girls are from the streets, "a fair number of them could be infected with HIV." "Health Ministers Fail to Reach Compensation Deal for Hepatitis C Victims" CNews Online (02/17/98) In Canada, federal, provincial and territorial health ministers failed to reach a compensation agreement for the estimated 60,000 to 90,000 Canadian individuals who were infected with the hepatitis C virus through tainted blood transfusions. Health Minister Allan Rock said that he hopes for a deal sometime in the beginning of March, noting that the process cannot go on much longer. He said: "We have to remember ... it's about providing compassionate, fair and appropriate compensation to people who are injured through no fault of their own." The provinces worry that compensation will be difficult financially, particularly in light of recent cuts in federal transfer payments for health care; however, most agree that offering compensation is a better alternative than facing continuous lawsuits. "Hard to Swallow" POZ (03/98) P. 61; Dahr, Mubarak Post-exposure prophylaxis (PEP) against HIV typically uses two nucleoside drugs and sometimes a protease inhibitor taken within 72 hours of exposure to minimize the risks of infection after possible transmission. PEP, which has been widely debated for both efficacy and ethical considerations, is generally available for health care workers and rape victims who may have been exposed to HIV. The Centers for Disease Control and Prevention said last fall that hospital workers who took AZT after needlestick exposures reduced their risk of contracting HIV by 81 percent. However, some critics dispute the results, claiming that the numbers are inflated. Others argue that even if the CDC results are correct, there is too great a difference between needle-based and sexually-based transmission of HIV to recommend PEP therapy for people at risk due to sexual exposure. According to Dr. David Ostrow of the Awareness Intervention for Men (AIM) project at Howard Brown Center in Chicago: "The time between exposure and treatment tends to be different [for different modes of transmittal]. The dose of HIV delivered is different. And how it is delivered to the body is different--one is into the blood, the other is through the body's cells. We just don't have enough evidence." Opponents have also raised concerns over increasing the risk of developing drug-resistant HIV strains. The use of PEP against HIV is gaining wider acceptance; however, many fear that PEP policy will remain exclusive. Currently, many clinics and hospitals offer PEP therapy only reluctantly or do not offer it at all for people exposed through consensual sex or drug use. Many PEP advocates argue that moral codes lead to exclusionary practice against some high-risk groups, while others say that offering PEP to these groups will encourage or maintain unsafe practices. ***************************************************************** 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. *****************************************************************