Subject: CDC NCHSTP Daily News Update Date: Mon Mar 9 07:31:04 PST 1998 (228 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update March 9, 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 --------- GENERAL MEDIA "U.S. Awakes to Epidemic of Sexual Diseases" "Scientists Probe Emerging, Resistant Diseases" "Officials Investigate Whether Man With Rare Strain of TB Infected Others" "Three Million TB Deaths A Year" "Tuberculosis Kills 125 People in Liberia's Capital" "Imiquimod Reduces Genital Warts in HIV-Positive Patients" "Clinical Implications of Virological 'Failure': Interview With Steven Deeks, M.D., San Francisco General Hospital" "Chemokine Advances May Provide New HIV Therapies" "AMA: HIV Discrimination Unethical" **************************************************************** GENERAL MEDIA **************************************************************** "U.S. Awakes to Epidemic of Sexual Diseases" New York Times (03/09/98) P. A1; Stolberg, Sheryl Gay Due to high rates of sexually transmitted diseases such as human papilloma virus, chlamydia, and herpes, the Centers for Disease Control and Prevention has launched a massive campaign against STDs. Debate about STD policy has been spurred in large part by a 1996 report from the Institute of Medicine, titled "The Hidden Epidemic," which concluded that "an effective national system for STD prevention currently does not exist." The institute estimated that the government spent some $230 million in 1995 on STD programs, excluding HIV; however, the direct cost of treating these diseases totaled $7.5 billion. Up to 12 million new STD cases are reported to disease control centers annually, about 80 times the number of new cases of tuberculosis, HIV, and AIDS combined. Individuals with gonorrhea, syphilis, chlamydia, or herpes are also two to five times more likely to contract HIV, according to Dr. Judith N. Wasserheit, head of the CDC's Division of STD Prevention. The new CDC campaign was recently launched in Baltimore, where the syphilis rate is 18 times greater than the national average. Stemming the spread of syphilis is one focus of the campaign; nearly 53,000 new cases of the STD were reported in 1996, and President Clinton has called on Congress to appropriate $10 million in the fiscal year 1999 budget to boost this effort. Later this month, 30 leaders in the fields of education, health, religion, and entertainment will meet in Washington, D.C., to advise the federal agency on how to spread its prevention and education message. The CDC already plans to alter its distribution of prevention grants next year to require state health departments to enlist community partners. "Scientists Probe Emerging, Resistant Diseases" Reuters (03/08/98); Cooper, Mike On Sunday, an international conference involving scientists and researchers from more 70 nations convened to discuss emerging infectious diseases and increasing drug-resistance in microbes. The four-day conference, co-sponsored by the Centers for Disease Control and Prevention and the American Society of Microbiology, will feature more than 2,000 researchers discussing topics such as the effect of global warming on infectious diseases, governmental funding, and the impact of infectious diseases on world mortality. Additionally, U.S. Health and Human Services Secretary Donna Shalala will break ground for the CDC's new $90 million flu and tuberculosis research laboratory. "Officials Investigate Whether Man With Rare Strain of TB Infected Others" Postnet Online (03/08/98) According to St. Louis health officials, a 50-year-old man with a rare, drug-resistant strain of tuberculosis may be responsible for the infection of two dozen patients and staff at the residential care facility where he lived. A team of doctors, nurses, and public health administrators has been appointed to track any others who may have been exposed. The team, led by epidemiologist Dr. Don Weiss, will perform skin tests and chest X-rays in an identification process which could take up to three months. With 47 new cases, St. Louis County had a 46 percent increase in active TB cases in 1997, while the city reported a 36 percent increase to 60 new cases. More than 1,300 additional people in the city also tested positive for TB in skin tests, but have not developed the disease. "Three Million TB Deaths A Year" Sri Lanka Daily News Online (03/09/98); Bulathsinghala, Frances At a media conference, Dr. V. R. Weerartne, director of the Respiratory Disease Control Program in Sri Lanka, reported that 3 million people in that country die from tuberculosis annually. At the seminar, organized to create awareness in preparation for World Tuberculosis Day on March 24, Weerartne said that treatment noncompliance is one of the main reasons for the spread of the disease; treatment for TB is provided free at all Sri Lankan government hospitals. More than 6,500 patients in Sri Lanka contracted the disease during 1997; this number does not include patients who received treatment in private hospitals. According to Dr. V. Senaratne, a physician at the Chest Hospital, poverty, malnutrition, smoking, and AIDS have all contributed to the epidemic. "Tuberculosis Kills 125 People in Liberia's Capital" CNN Interactive Online (03/08/98) Tuberculosis is reported to have caused the death of at least 125 people in Monrovia, Liberia, since December, with another 119 individuals hospitalized due to the disease. Dr. Harrison attributes the increase in mortality to fighting in the capital in April and May 1996, when infected patients returned to the community. "Imiquimod Reduces Genital Warts in HIV-Positive Patients" Reuters Health Information Services (03/06/98) Researchers at the University of California, San Francisco, have concluded that the immune response modifier imiquimod significantly reduced the size of genital warts in HIV-positive patients. The results of the 16-week, double-blind, vehicle-controlled study--involving 100 HIV-positive subjects co-infected with external genital warts--were reported at the 56th Annual Meeting of the American Academy of Dermatology. The subjects received 5 percent imiquimod cream; 11 percent of the medicated group showed a complete clearing of warts, while 38 percent measured a wart surface area reduction of 50 percent or greater. Although the cream caused erythema in 60 percent of the subjects, the researchers concluded that imiquimod is a safe and effective treatment for genital warts in patients with HIV or AIDS. "Clinical Implications of Virological 'Failure': Interview With Steven Deeks, M.D., San Francisco General Hospital" AIDS Treatment News (02/20/98) No. 289, P. 1; James, John S. In an interview with AIDS Treatment News, San Francisco General Hospital's Dr. Steven G. Deeks recently reported that some patients taking protease-inhibitor-containing drug therapies that failed to control HIV had a higher CD4 cell count and clinical status than would be expected. Deeks and colleagues reviewed the medical records of 143 HIV-infected patients who had "failed" protease inhibitor treatment at San Francisco General Hospital. The researchers found that "failure of a PI [protease inhibitor] containing regimen, defined virologically, may not be predictive of subsequent CD4 T-cell decline (over the following 12 months)." Deeks noted that if patients gain even small T-cell responses, these may translate into a prolonged clinical benefit, while patients who do not respond positively may need more aggressive prophylaxis measures. He also said that maintenance of PI therapy despite failure could result in high level drug resistance and continued side effects. Deeks recommends that immunologists investigate whether virologic failure and resistance to protease inhibitors confers loss of virologic virulence. Furthermore, he cautions that non-nucleoside reverse transcriptase inhibitors only be used when other options have been exhausted. "Chemokine Advances May Provide New HIV Therapies" Scientist (03/02/98) Vol. 12, No. 5, P. 9; Smaglik, Paul The discovery of several chemokine receptors and identification of proteins that attach onto cell entrances has encouraged HIV researchers to consider therapies that stop the virus from invading healthy cells. Scientists have identified coreceptors CCR5, CXCR4, and CD4 as actively developing treatment through chemokine receptors, since they offer an earlier point for treatment than protease inhibitors. Other studies, reported last year in the Journal of Experimental Medicine, have also indicated that despite great diversity among viral strains, coreceptors CCR5 and CXCR4 dominate HIV entry. In the same journal, testing at the University of Pennsylvania Medical Center showed that the polypeptide ALX40-4C successfully blocked infection by HIV T-tropic strains. Researchers are re-examining samples in hope of finding an M-tropic HIV concentration. Another blocking approach involves the use of therapeutic and preventative vaccines produced from altered versions of chemokine proteins called ligands. Testing conducted by the University of Maryland's Institute of Human Virology and reported in the journal Science, found that purified macrophage-derived chemokine (MDC) suppresses the infection of T-cells by M-tropic and T-tropic viruses by latching onto the receptors of activated T-cells. Robert Gallo, director of the institute, theorizes that an MDC and AOP-RANTES cocktail--a modified version of the RANTES chemokine--could potentially prevent HIV infection and decrease a threat of mutation. Delivering gene therapy to HIV-infected cells has shown potential, but many scientists continue to believe such studies are inherently problematic due to the sheer number of infected T-cells and the replication speed of HIV. "AMA: HIV Discrimination Unethical" American Medical News (03/02/98) Vol. 41, No. 9, P. 2 The American Medical Association has filed a brief with the U.S. Supreme Court in February condemning the actions of physicians and dentists who refuse to treat HIV-positive patients as illegal and unethical. The brief was filed in support of a Bangor, ME, patient whose dentist, Randon Bragdon, refused to fill a cavity after her HIV status was disclosed. Two lower courts had found Bragdon guilty of violating the Americans With Disabilities Act, but he appealed to the Supreme Court. When Bragdon refused to provide treatment, he violated an ethical obligation to assist those with communicable disease, the AMA said, citing data from the Centers for Disease Control and Prevention that indicate no known cases of patient-to-dentist HIV transmission. ***************************************************************** 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. *****************************************************************