Subject: CDC NCHSTP Daily News Update Date: Tue Mar 10 07:31:03 PST 1998 (274 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update March 10, 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-1 Infection by Artificial Insemination (Research Letter)" "The Evolving Relation Between Humans and Mycobacterium Tuberculosis" "Philippines Finally Passes AIDS Act" GENERAL MEDIA "Getting Personal" "Portugal Probes Illegal AIDS Drug" "Provider Experience Affects Survival of Women With AIDS" "AIDS Drugs Still Too Expensive" "Azithromycin Safe and Effective for MAC Prophylaxis" INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION "HIV/AIDS Among American Indians and Alaskan Natives--United States, 1981-1997" "Tetanus Among Injecting-Drug Users--California, 1997" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "HIV-1 Infection by Artificial Insemination (Research Letter)" Lancet (03/07/98) Vol. 351, No. 9104, P. 728; Matz, B.; Kupfer, B.; Ko, Y.; et al. Researchers at the University of Bonn, Germany, report the incidence of HIV-1 in a 35-year-old female health care worker who apparently contracted the disease through artificial insemination with fresh sperm. Upon learning of the woman's infection, the gynecologist involved retested the sperm donor, who had since seroconverted; nucleotide sequence determination showed 100 percent DNA concordance with reverse transcribed viral RNA from the recipient. The authors warn that "physicians must be discouraged from using fresh sperm," because "the early ... stage of HIV-1 infection may carry a high risk of infection, especially since seminal viral load parallels viremia." Artificial insemination, they note, should be considered as a potential source for HIV infection. "The Evolving Relation Between Humans and Mycobacterium Tuberculosis" New England Journal of Medicine (03/05/98) Vol. 338, No. 10, P. 677; Bloom, Barry R.; Small, Peter M. In an editorial in the New England Journal of Medicine, Drs. Barry R. Bloom of Albert Einstein College of Medicine and Peter M. Small of Stanford Medical Center comment on two studies published in the journal concerning the infectiousness of Mycobacterium tuberculosis. They note that approximately one-third of the world's population is infected with the bacterium, although some 90 percent never become ill. The authors describe the variability of tuberculosis strains as causes of infection, citing research by Valway et al. that reports the outbreak of a particularly virulent tuberculosis strain in an enclosed rural community. According to the authors: "This work emphasizes that M. Tuberculosis continues to evolve as a pathogen, and it should heighten clinicians' awareness that the clinical isolates of M. tuberculosis may be highly transmissible and virulent." They also note that the strain was one of two selected for genomic sequencing and that it may provide clues surrounding the virus' transmissibility and virulence. Bloom and Small also cite another study that provides evidence for genetic variability in humans to tuberculosis; polymorphisms in the natural-resistance-associated macrophage protein 1 (NRAMP1) have been associated with increased susceptibility in Gambian populations. The authors conclude that these studies provide potential tools for assessing the virulence of individual strains and may lead to "new insights into the varied responses of patients to infectious pathogens." "Philippines Finally Passes AIDS Act" Lancet (03/07/98) Vol. 351, No. 9104, P. 734; Wallerstein, Claire The Philippines passed an AIDS bill last week after three years of debate. The Act includes a national education program and promises to protect the human and civil rights of HIV-positive Filipinos. The Act will also penalize HIV-positive persons who deliberately infect others. The delay in passing the act was due in a large part to strong Catholic opposition; the program will emphasize "sexual abstinence and faithfulness within marriage," but will also recognize the importance of condom use. The World Health Organization estimates that 23,000 Filipinos are infected with HIV. **************************************************************** GENERAL MEDIA **************************************************************** "Getting Personal" Washington Post--Health (03/10/98) P. 10; Andriote, John-Manuel In a commentary in the Washington Post, John-Manuel Andriote asserts that American doctors and patients must be more willing to discuss sexual issues. He cites a recent survey by the Kaiser Family Foundation in which 83 percent of 482 women surveyed agreed that they should discuss sexually transmitted diseases with their gynecologists, but only 15 percent actually do so. Endocrinologist Yank D. Coble, a board member of the American Medical Society, says that patients' sexual history and activities are vital for detection and treatment of certain infectious diseases, including HIV. Andriote also cites Sandra R. Leiblum, of the Center for Sexual and Marital Health at the Robert Wood Johnson Medical School, who suggests that doctors may be afraid of bringing up issues that they feel unequipped to handle. However, Leiblum explains that "the physician doesn't have to know how to treat or solve the problem, he just needs to know how to ask enough questions to determine if there is a problem and then who to refer to." To assist physicians in discussing patient sexuality, the American Medical Association has created a workshop curriculum called "Talking to Patients About Sex." "Portugal Probes Illegal AIDS Drug" Las Vegas Sun Online (03/09/98) Portugal's Health Minister, Maria de Belem Roseria, has ordered an investigation into whether a clinic has been conducting tests on AIDS patients with a banned drug and has been recruiting patients through the Internet. According to the daily newspaper Diario de Noticias, a doctor at a Portuguese clinic used the drug, Virodene P058, to treat 63 people. The doctor denied the allegations, claiming that he works within the law. The drug has also been banned in South Africa following the initiation of unauthorized human experiments. The South African Medicines Control Council notes that Virodene contains dimethylformamide--an industrial solvent that can cause hepatic damage and is possibly a carcinogen. "Provider Experience Affects Survival of Women With AIDS" Reuters Health Information Services (03/09/98) A study, reported in the March 5 issue of the journal AIDS, indicates that HIV-positive women have a 50 percent increased survival rate if they receive care at an experienced clinic instead of one with less HIV experience. Dr. Christine Laine of Jefferson Medical College in Philadelphia, PA, and colleagues examined the survival time of 887 HIV-positive women who visited 117 clinics in New York. The researchers found that 71 percent of patients enrolled in high-experience clinics were still alive 21 months after diagnosis, compared to 53 percent of those treated at less-experienced clinics. The researchers also found that survival correlated positively with methadone treatment and pregnancy. "AIDS Drugs Still Too Expensive" Africa News Service (03/09/98); Kagambirwe, Karyeija; Barenzi, Lilliane Uganda AIDS Control Program Manager Dr. Elizabeth Madraa said that the announcement by Glaxo Wellcome of a 75 percent reduction in the price of the AIDS drug AZT still will not allow the average Ugandan to afford treatment. The price of the drug has been reduced for pregnant women in developing nations in an attempt to reduce vertical mother-to-child HIV transmission. However, Madraa said: "We thought they would go beyond that. Who is supposed to subsidize the rest of the cost?" She explained that more essential treatment drugs are needed, such as medication for tuberculosis, meningitis, and pneumonia. An estimated 1.5 million Ugandans have AIDS. "Azithromycin Safe and Effective for MAC Prophylaxis" Reuters Health Information Services (03/09/98) According to a study by Dr. Edward C. Oldfield III of Eastern Virginia Medical School and colleagues, weekly azithromycin treatment for disseminated Mycobacterium avium complex infection in AIDS patients is safe and effective, and reduces MAC-related mortality and respiratory tract infections. The randomized, placebo-based study--reported in the March issue of Clinical Infectious Diseases--examined 174 AIDS patients and found a 15.1 percent risk reduction among patients receiving azithromycin as compared to the placebo group. Patients with CD4 cell counts of less than 25 cells/microliter at baseline showed the greatest benefit, with a 5-fold reduction of disseminated MAC events. The group also noted a significant reduction in presumed non-MAC bacterial infection, specifically pneumonia and sinusitis, due to the regimen. **************************************************************** INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION **************************************************************** "HIV/AIDS Among American Indians and Alaskan Natives--United States, 1981-1997" Morbidity and Mortality Weekly Report (03/06/98) Vol. 47, No. 13, P. 154 The Centers for Disease Control and Prevention reports that 1,783 American Indians and Alaskan Natives (AI/ANs) had AIDS as of December 31, 1997, or 0.3 percent of the national total. AI/ANs represent less than 1 percent of the U.S. population. HIV surveillance was conducted in 25 states during 1994-1997, with 267 HIV-positive AI/ANs reported in that period. The CDC survey noted similar risk/exposure group characteristics among AI/ANs to those of all AIDS patients in the United States, with men who have sex with men reported as the mode of HIV exposure in 49 percent of the AI/AN cases and in 48 percent of all AIDS patients nationwide. Still, men who engaged in homosexual sex and used injection drugs comprised a larger portion of the AI/AN AIDS population (14 percent) as compared to the general AIDS population (6 percent). AIDS among AI/ANs is clustered generally in selected geographical areas in the West and in smaller cities and rural areas. Additionally, the CDC reports that the Native American population is affected disproportionately by social and behavioral factors associated with increased HIV risk. Native Americans are more likely than the general population to be young, socioeconomically disadvantaged, and unemployed. They also have high rates of sexually transmitted disease infection. The CDC recommends that prevention efforts focus on community efforts, targeting specific risk behaviors that consider the cultural diversity and traditional beliefs of Native Americans in rural and urban communities. "Tetanus Among Injecting-Drug Users--California, 1997" Morbidity and Mortality Weekly Report (03/06/98) Vol. 47, No. 8, P. 149; O'Malley, C.D.; White, E.; Schechter, R.; et al. A high concordance between tetanus infection and injection drug use in California prompted a review of regional tetanus cases. Of 11 tetanus cases reported in California in 1997, 55 percent occurred among injection drug users (IDUs); 40 percent of the 67 tetanus cases reported in the state during the previous decade had been among IDUs. The vast majority (89 percent) of infected patients were Hispanic. The researchers discuss two specific cases: a 59-year-old female Hispanic IDU and a 45-year-old male Hispanic IDU. The woman died despite reported hygienic injection technique, while the man survived following 13 weeks of hospitalization. Tetanus--which can be facilitated through open fractures, abscesses, abrasions, and punctures--has a case-fatality of 25 percent. A recent serologic survey shows that 59 percent of Mexican Americans--the predominant Hispanic population in California--show antibody to tetanus toxoid, compared to 73 percent of non-Hispanic whites. This has been suggested as a possible reason for the disproportionately high tetanus levels among Hispanic IDUs. The Centers for Disease Control and Prevention recommends tetanus vaccine for prevention of the disease. Recommendations on preventing HIV among IDUs may also reduce tetanus transmission; however, they may not be effective against spores inoculated from the skin or contained within the drugs. An editorial note accompanying the report asserts that efforts to prevent tetanus infection should highlight vaccination against the disease, which is almost completely preventable through vaccination and proper wound treatment. ***************************************************************** 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. *****************************************************************