Subject: CDC NCHSTP Daily News Update Date: Wed Mar 4 07:31:03 PST 1998 (253 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update March 4, 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 "The Changing Paradigm of Sexually Transmitted Disease Control in the Era of Managed Health Care" "Studies Reveal Early Impact of HIV Infection, Effects of Treatment" GENERAL MEDIA "Infectious-Disease Deaths on Rise, Medical Experts Tell Congress" "New Pediatric Hepatitis C Guidelines" "Parents' Education Dissuades Teen Sex" "Borrowing A Strategy to Fight AIDS" "'No Vacancy' Signs Going Up for the HIV Infected in Jamaica" "Oral Ritonavir Solution Safe and Effective for Use in Pediatric HIV" "Injection Drug Users: Vitamin A Supplements Do Not Lower HIV Load" "Slow-Replicating HIV-1 Variants Signal Long-Term Survival" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "The Changing Paradigm of Sexually Transmitted Disease Control in the Era of Managed Health Care" Journal of the American Medical Association (03/04/98) Vol. 279, No. 9, P. 680; Gunn, Robert A.; Rolfs, Robert T.; Greenspan, Joel; et al. Researchers from the Centers for Disease Control and Prevention have presented a new paradigm for public health approaches to sexually transmitted diseases, describing opportunities for partnerships among local public health STD programs, managed care organizations, and area physicians. These groups would assess regional STD prevention knowledge levels; create clinical primary prevention STD services; determine recommendations and policies for programs; and examine screening, diagnostic, and treatment practices of community-based clinicians. Additionally, STD programs would disseminate new information about diagnosis and therapy to community clinicians; partner notification is another area for collaboration. The group recommends that STD clinics develop partnerships with other governmental agencies and community-based organizations. The researchers note that "the transition to community-wide, population-oriented STD prevention and control paradigm will undoubtedly be difficult." However, they conclude that the changes will result in "improvements in women's and infants' health, reduction in HIV spread, and decreased health care costs." "Studies Reveal Early Impact of HIV Infection, Effects of Treatment" Journal of the American Medical Association (03/04/98) Vol. 279, No. 9, P. 641; Stephenson, Joan Studies reported at the Fifth Conference on Retroviruses and Opportunistic Infections provide information on current HIV/AIDS treatments and disease progression. Dr. Bruce Walker of Massachusetts General Hospital reported that HIV preferentially infects anti-HIV helper T cells early in disease progression. These cells are eliminated before seroconversion, reducing the body's resistance to the virus. Walker's research suggests that early anti-retroviral treatment can aid in protecting the HIV fighting cells. Additionally, scientists discussed methods for eliminating latent HIV reservoirs via the use of cytokines to activate latent cells or through the hastening of memory cell decay. Scientists also reported abnormal distribution of body fat due to certain antiretroviral treatments and the discovery of the oldest confirmed HIV infection, dating back to a Bantu man living in what is now the Democratic Republic of Congo in 1959. **************************************************************** GENERAL MEDIA **************************************************************** "Infectious-Disease Deaths on Rise, Medical Experts Tell Congress" Washington Times (03/04/98) P. A8; Bowman, Les Health experts reported Tuesday that infectious disease deaths rose 22 percent in the United States between 1980 and 1992. Surgeon General David Satcher told Congress that although the United States has increased surveillance methods, technological changes such as rapid air travel and global distribution of foods, and social problems such as drug abuse and homelessness, have contributed to the spread of infectious diseases. Furthermore, Stephen Blount, associate director for global health at the Centers for Disease Control and Prevention, stated: "Controlling disease outbreaks in other countries is a necessity, not only for humanitarian reasons, but also to prevent those diseases from spreading globally." Experts cited the emergence of the Hong Kong avian influenza virus; the appearance of Dengue hemorrhagic fever in Southern states; and increasing tuberculosis, measles, mumps, pertussis, shigella, and hepatitis A rates as examples of the rise in infectious diseases. The government is increasing international efforts to combat the diseases, training a greater number of doctors and scientists in developing nations and instituting global lab partners to monitor the spread of the diseases. "New Pediatric Hepatitis C Guidelines" Fox News Online (03/03/98) Guidelines drafted by the American Academy of Pediatrics (AAP) state that infants born to mothers suspected of carrying the hepatitis C virus should be tested for the infection. The Centers for Disease Control and Prevention reports that approximately 1.8 percent of Americans carry HCV, including 0.3 percent under the age of 19. In the current issue of the journal Pediatrics, the AAP does not recommend routine screening of all pregnant women for the virus but says it should be standard for infants born to high-risk mothers. The AAP notes that breast-feeding by HCV-infected mothers remains safe and that children with the virus should not be excluded from child care centers due to the disease. "Parents' Education Dissuades Teen Sex" USA Today (03/04/98) P. 1D; Elias, Marilyn The Centers for Disease Control and Prevention reports decreased sexual activity among 14- to 17-year-olds who have educated parents. A survey of almost 4,000 adolescents indicates that sexual activity is inversely proportional to the education level of the children's parents. While the survey was conducted in 1992, John Santelli of the CDC said: "There's no reason to think there's any change here." Debra Haffner, head of the Sexuality Information and Education Council of the United States, also noted that new data indicates that adolescents generally start sex later when parents discuss sexuality openly and clearly convey their expectations for delayed intercourse. "Borrowing A Strategy to Fight AIDS" Washington Post (03/04/98) P. B1; Milloy, Courtland In a Washington Post commentary, columnist Courtland Milloy reflects on AIDS in the African American community. He states that "the Black community has continued to stigmatize AIDS, ... in effect, turning against itself." He notes that by year-end 1997, nearly 4,700 people in the District of Columbia had AIDS, 79 percent of whom were African American. Nationwide, one of the highest health priorities is an increase of service access to African American male injection drug users. He also notes that the church, due to its credibility, has been cited as one of the best-suited institutions to head the challenge to AIDS in the African American community, but "a reluctance by many ministers to talk frankly about sex and drugs, except in the most self-righteous tones, has only exacerbated fear and denial in their congregations." Several speakers at a recent AIDS conference in Oakland, CA, recommended that in order for the African American community to fight the disease effectively, community members must come together and fight for policy changes and budgets. "'No Vacancy' Signs Going Up for the HIV Infected in Jamaica" Interpress News Service (03/02/98); Lewis, Marlene A debate concerning mandatory testing for HIV has arisen in Jamaica following a recent survey by the National AIDS Committee which found that four companies in the country required HIV testing as a precondition for employment, with positive test results precluding hiring. One of the companies, the Jamaican Defense Force, refused entry to two female recruits due to positive test results. Ian McKnight, president of Jamaica AIDS Support (JAS), claims that the policy will mean the dismissal of skilled employees who have the potential to work for a number of years before disease progression. Approximately 10,000 Jamaicans have tested positive for HIV since 1982. The National AIDS Committee has called on the government to create a national AIDS policy and legislation that would protect the privacy of HIV-positive individuals and reduce discrimination. "Oral Ritonavir Solution Safe and Effective for Use in Pediatric HIV" Reuters Health Information Services (03/03/98) A report in the March issue of Pediatrics indicates that the protease inhibitor ritonavir is well tolerated by HIV-positive children. Dr. Brigitta U. Mueller of Children's Hospital in Boston, MA, and colleagues conducted phase I/II trials with 48 HIV-positive children, administering various doses of ritonavir in monotherapy and adding zidovudine and/or didanosine after 12 weeks. The team discovered an increase in CD4 cell counts after 4 weeks of monotherapy and a decrease in plasma HIV RNA after 4 to 8 weeks, with cell levels maintained for the remainder of the study. The Food and Drug Administration approved oral ritonavir last year for use against HIV infection in children over 2 years of age. "Injection Drug Users: Vitamin A Supplements Do Not Lower HIV Load" Reuters Health Information Services (03/03/98) According to researchers from Johns Hopkins University, while vitamin A supplements may offer some protection against declining plasma vitamin A levels in HIV-positive injection drug users, the supplements do not appear to reduce HIV loads. The researchers note that low vitamin A levels are associated with HIV progression, and some studies have shown these reduced levels to be a risk factor for mortality and greater risk for vertical transmission of the virus. Dr. David Vlahov and colleagues report in the March issue of the Journal of Infectious Diseases that the supplements had no significant effect on CD4 lymphocyte count or HIV load in injection drug users who received a 60 mg dose of retinol over a 4-week period. Still, the researchers suggest while the vitamin supplements may have no effect on viral loads, potential mechanisms may exist through which vitamin A may have potential benefits against HIV infection. "Slow-Replicating HIV-1 Variants Signal Long-Term Survival" Reuters Health Information Services (03/02/98) Dr. Hanneke Schuitemaker of the Netherlands Red Cross Blood Transfusion Service and colleagues report that variants of HIV-1 with low reproductive capacity may be the cause of long-term survival rates in some infected individuals. The Dutch scientists reported their findings in the March issue of the Journal of Infectious Diseases, recording a correlation between the virus load and the in vitro replicative capacity of non-syncytium-inducing HIV-1 variants (NSI). The researchers noted that individuals with syncitium-inducing HIV-variants measured a higher viral load, more rapid CD4 T cell loss, and more rapid disease progression than HIV-positive patients with NSI HIV-1 variants. The group suggested that different combinations of favorable conditions may result in nonprogression. ***************************************************************** 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. *****************************************************************