Subject: CDC NCHSTP Daily News Update Date: Tue Feb 24 07:31:04 PST 1998 (271 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update February 24, 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 "Nevaprine-Associated Stevens-Johnson Syndrome (Research Letter)" "Syphilis in Prostitutes From Eastern Europe (Letter)" "Surrogacy in HIV-1 Trials" GENERAL MEDIA "Risk of Sexual Transmission of HIV Unaffected by Vasectomy" "Health Notes: Agent Attacks Hidden HIV" "Glossy View of HIV" "Nova Scotia to Share Hepatitis C Aid Costs" "HHV-8 Implicated in AIDS and Non-AIDS-Related CNS Lymphoma" "HIV Infection May Cause Left Ventricular Dysfunction" "IAVI Announces First Research Awards" INFORMATION FROM OTHER GOVERNMENT AGENCIES "New Satellite Broadcast Series on HIV/AIDS-Related Issues" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Nevaprine-Associated Stevens-Johnson Syndrome (Research Letter)" Lancet (02/21/98) Vol. 351, No. 9102, P. 567; Warren, Kelly J.; Boxwell, Debra E.; Kim, Nancy; et al. Researchers from the Medical College of Wisconsin and the U.S. Food and Drug Administration report incidence of Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) in an HIV-positive patient receiving zidovudine, lamivudine, and nevirapine. The patient had tender oral ulcers and haemorrhagic crusts, which were believed to be a result of using nevirapine. The researchers also note 19 other cases of nevirapine-associated SJS and TEN reported to the FDA since the drug's approval in June 1996. There has been only one published report of zidovudine-mediated TEN since the drug was approved in 1987, and there are no reports of lamivudine-induced SJS or TEN since its 1995 introduction. The researchers note that the likelihood of severe mucocutaneous side effects related to use of nevirapine in persons infected with HIV-1 appears to be among the highest reported for any medication. "Syphilis in Prostitutes From Eastern Europe" Lancet (2/21/98) Vol. 351, No. 9102, P. 572; Smacchia, Camillo; Parolin, Antonio; Di Perri, Giovanni; et al. The 1990s have seen a significant increase in the syphilis notification rate in the Russian Federation and Eastern Europe, write the authors in a letter published in the February 21 issue of the Lancet. Since the industrialized regions of Western Europe have easier access to international travel and significant migration from Eastern Europe, these syphilis rates likely have had an impact on Western Europe. The authors cite data from an outpatient center in Verona, Italy, where 110 foreign-born prostitutes received screening for the most common sexually transmitted diseases over a 19-month period. Nine of the prostitutes, predominantly from Eastern European countries, tested positive for syphilis on their first visit. Furthermore, analysis showed that most of the prostitutes from Eastern Europe had been involved in sex work for less than a year, had more clients per week, and had the highest rate of pregnancy during the study period. This seemed to show inexperience in the practice of prostitution and little knowledge about the risks of STDs and methods of contraception. The letter emphasizes that these findings are representative of only a single center. "Surrogacy in HIV-1 Trials" Lancet (02/21/98) Vol. 351, No. 9102, P. 536; Pozniak, Anton In a commentary in the Lancet, Anton Pozniak of King's College Hospital in London examines the merits and problems with surrogate markers in AIDS drug trials versus clinical endpoints. Surrogate markers, such as HIV RNA levels or CD4 lymphocyte cell counts, are often used in HIV clinical trials, but Pozniak questions whether these markers effectively replicate clinical results. He states that surrogacy data cannot be used to extrapolate clinical efficacy unless they fit two criteria: the surrogate must correlate to the true clinical outcome and must capture the net effect of treatment on clinical outcome. Pozniak asserts: "Surrogate markers must be robust enough for the estimation of a clinical effect that occurs much later than the short-term changes seen with switching or discontinuation of treatment, and they must predict outcome of whatever the past exposure to therapy, or stage of disease." He also notes that even if drugs of the same class have the same biological effects on surrogate markers, efficacy equivalents cannot be made. Pozniak concludes that in light of poor virological responses of patients taking sequential combinations, additional long-term efficacy trials and safety data must be undertaken. **************************************************************** GENERAL MEDIA **************************************************************** "Risk of Sexual Transmission of HIV Unaffected by Vasectomy" Reuters Health Information Services (02/23/98) The possible risk of sexual transmission of HIV must be measured directly in the semen, and vasectomy appears to have little effect on reducing seminal virus levels, report researchers in the March issue of The Journal of Urology. Led by Dr. John N. Krieger of the University of Washington in Seattle, the researchers hypothesized that vasectomy could alter the potential infectiousness of semen, since it decreases seminal cells and eliminates secretions from proximal sites in the male reproductive tract. However, the group's research found no significant differences in pre- and post-vasectomy HIV RNA levels. The group also discovered that HIV RNA levels in semen only weakly correspond to blood levels. The scientists noted that inflammation following the procedure can increase white blood cells and HIV-1 secretion in the genital tract, and that sperm can persist in semen for up to three months after a vasectomy. "Health Notes: Agent Attacks Hidden HIV" United Press International (02/24/98); Wasowicz, Lidia Researchers at Duke University believe that an inexpensive anti-cancer medication could also eliminate HIV reservoirs in lymphoid tissue that is unaffected by combination drug therapies. Scientists believe these reservoirs to be the re-infection source when drug regimens are discontinued. The drug, cyclophosphamide, destroys lymphoid tissue cells and has been safely used to treat lymphomas. "Glossy View of HIV" New York Times (02/21/98) P. A26; Elovich, Richard Richard Elovich, director of HIV prevention at Gay Men's Health Crisis, notes in a letter to the editor of the New York Times that HIV and AIDS patients are often targeted by drug companies' advertisements. Elovich writes that he is concerned that marketing of HIV drugs could overshadow HIV prevention campaigns. "In minority communities, where HIV prevention ads rarely appear, drug ads sell the idea that treating HIV is as simple as swallowing a Claritin, trivializing the challenges and pain of this illness," he notes. Elovich points out that the ads do not mention that HIV drug regimens are expensive, difficult to follow, and often have adverse effects. "Nova Scotia to Share Hepatitis C Aid Costs" Toronto Globe and Mail (02/20/98) P. A4; McIlroy, Anne Nova Scotia Health Minister Jim Smith announced that the province expects to contribute $10 million Canadian dollars to a compensatory health package for people infected with hepatitis C through blood transfusions. Nova Scotia is the first province to announce how much their government is willing to contribute to the program. Thousands of Canadians were infected with the disease; some of them have launched a C$3 billion lawsuit against the Canadian Red Cross Society and the federal and provincial governments. If the other provinces allocate similar amounts of money to the fund, the package would total approximately C$300 million. Durhane Wong-Rieger, president of the Canadian Hemophilia Society, said that the package would be acceptable if the federal government contributes an additional C$1.2 billion and if the provinces agree to pay for the treatment of the disease. Patients who receive government compensation will be required to sign a waiver promising not to sue or to drop their liability suits. "HHV-8 Implicated in AIDS and Non-AIDS-Related CNS Lymphoma" Reuters Health Information Services (02/23/98) According to a report in the February issue of Neurology, human herpes virus 8 (HHV-8) may contribute to the pathogenesis of central nervous system (CNS) lymphomas. The virus, already associated with Kaposi's sarcoma, has been found in primary effusion lymphomas; these lymphomas have several common features with AIDS-related primary CNS lymphoma. Dr. John R. Corboy of the University of Colorado Health Sciences Center in Denver and colleagues examined brain lymphoma specimens from 24 AIDS patients and 12 HIV-negative patients, and found that 56 percent of the primary CNS specimens from both groups contained HHV-8 DNA. No virus DNA was found in the control group without lymphoma. Dr. Leon G. Epstein, of the University of Rochester in New York, observes that the increasing lifespan of HIV patients--due to new drug regimens--will likely lead to an increase in incidence of lymphoma and other CNS complications. "HIV Infection May Cause Left Ventricular Dysfunction" Reuters Health Information Services (02/23/98) In the January 5 issue of the International Journal of Cardiology, researchers from the Operto Medical School in Portugal report that HIV-positive individuals have poorer left ventricular function than HIV-negative individuals. The researchers studied 98 HIV-infected patients and 40 HIV-negative controls, and found increased diastolic dysfunction, isovolumic relaxation time, and left ventricular diastolic diameters in the HIV-positive patients. The scientists also reported depressed ejection fraction in 32 percent of the infected individuals. Asymptomatic HIV-infected individuals also showed left ventricular dysfunction, although the problem was less severe at earlier stages of the infection. "IAVI Announces First Research Awards" IAVI Report (01/98-03/98) Vol. 3, No. 1, P. 11 The International AIDS Vaccine Initiative (IAVI) has announced its first three awards for research in the development of potential HIV vaccines. IAVI awarded nearly $33,000 to Ronald Desrosier of the New England Regional Primate Research Center and Harvard Medical School over six months to develop a large-scale, long-term study of the safety of a live-attenuated SIV vaccine in monkeys. John Mills at the Macfarlane Burnet Center in Australia will receive up to $415,500 over two years to study a DNA-based, live-attenuated vaccine in animal models, creating weakened SIV DNA that causes infection but not disease. The third award--almost $495,000--went to Norman Letvin of Beth Israel Deaconess Medical Center and Joseph Sodroski of the Dana Faber Cancer Research Institute for a two-year project designed to develop hybrid viruses for use against HIV subtypes E and C. Founded in 1996, IAVI is a global consortium funded by the Rockefeller, Sloan, and Starr Foundations; the Joint United Nations Program on HIV/AIDS; Until There's A Cure Foundation, and the World Bank. **************************************************************** 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. 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. *****************************************************************