Subject: CDC NCHSTP Daily News Update Date: Fri Mar 13 07:31:05 PST 1998 (255 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update March 13, 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 "Evidence for the HIV-1 Phenotype Switch as a Causal Factor in Acquired Immunodeficiency" GENERAL MEDIA "Drug Use Fuels HIV Epidemic in Russia" "House Panel Kills Needle Exchange Bill" "AIDS Activists Vow Needle-Exchange Civil Disobedience" "Bistriazoloacridones Identified as New Class of Potential HIV Inhibitors" "D0870 Promising for AIDS-Related Fluconazole-Resistant Candidiasis" "Tanzania: Female Condoms Receive Wide Support" "Advances in the Virology of HIV Infection and Implications for Clinical Management" "CDC Launching New Era in Testing by Giving OK to Rapid Screening Tests" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Evidence for the HIV-1 Phenotype Switch as a Causal Factor in Acquired Immunodeficiency" Nature Medicine (03/98) Vol. 4, No. 3, P. 346; Glushakova, Svetlana; Grivel, Jean-Charles; Fitzgerald, Wendy A phenotypic switch from macrophage (M)-tropic/non-syncytia-inducing (NSI) viruses to T cell (T)- tropic/syncytia-inducing (SI) viruses may be a key component in the development of AIDS in HIV-infected individuals, report scientists at the National Institute of Child Health and Human Development. Initial HIV-1 infection results from the transmittal of M-tropic/NSI viruses, which hyperactivate the immune system. The researchers tested the mechanism through which AIDS develops by creating an ex vivo model of humoral immunity to recall antigens using human lymphoid tissue that supports both the M-tropic and T-tropic HIV-1 isolates. The scientists measured an enhanced immunologic response when the tissue was infected with M-tropic/NSI HIV-1 isolates, but immune response was blocked by the T-tropic/SIV isolates through a specific irreversible effect on B-cells. In conclusion, the researchers noted that "the results stress once more the importance of tissue integrity for maintaining an immune response and for development of immunodeficiency upon HIV infection." **************************************************************** GENERAL MEDIA **************************************************************** "Drug Use Fuels HIV Epidemic in Russia" IPS Wire (03/12/98) A tenfold increase in injection drug use in Russia in the past 3 years has led to a corresponding increase in HIV and AIDS incidence. Between 1995 and November 1997, the number of IDUs testing positive for HIV rose from three to around 2,800. Health experts are unsure whether the rise is due to sharing of infected needles or sexual transmission; many IDUs share needles and engage in heavy sexual activities. National authorities have been slow to crack down on drug use, and international and non-governmental efforts to combat drug use have only just begun. According to UNAIDS, sexually transmitted diseases have risen dramatically in Russia as well. "House Panel Kills Needle Exchange Bill" Rocky Mountain News (03/10/98) P. 5A; Luzzader, Dan A proposal to legalize needle-exchange programs in Colorado was defeated by a party-line vote of 7-4 by the state's Health, Environment, Welfare and Institutions Committee. The bill would not have set up needle-exchange programs, but would have eliminated a state law disallowing the possession of needles as a violation of drug paraphernalia laws. More than 50 witnesses testified on the subject; they were evenly divided on the issue. Advocates of the bill claim that the public health issues outweigh drug enforcement problems. Steve Lowenstein of the Colorado Department of Health and Environment noted that 7 percent of needles exchanged in a California program tested positive for HIV. However, opponents asserted that the legalization of needle-exchange programs would undermine drug enforcement and send the wrong message about drug abuse. Mark Paschall, one of the seven Republicans who voted to kill the bill, said that the programs would essentially create "police free zones" and undermine drug prevention efforts. Representative Bob Hagedorn, one of the Democrats who voted for the bill, stated: "This is a public health issue; it is not a moral issue." "AIDS Activists Vow Needle-Exchange Civil Disobedience" Denver Post (03/11/98) P. 3B; Kirksey, Jim Following the Colorado Legislature's refusal to eliminate needle paraphernalia laws for needle-exchange programs, regional AIDS activists are vowing to expand existing underground needle exchanges as an act of civil disobedience. Paul Simons, a leading AIDS activist in Denver, called for dialogue between activists and local health and law officials. "If those talks do not come to fruition, if they don't produce a needle-exchange program, then we, meaning ... myself and other HIV/AIDS activists, have no other choice than to go out and commit civil disobedience." District Attorney Bill Ritter, who testified in favor of the legalization of the programs, said that he would uphold the law. His sentiments were mirrored by members of the city administration. Teresa Donahue, manager of environmental health for Denver, noted: "We are as frustrated as Paul [Simons] is, and others are,, about the Legislature. We believe the answer is to go back and fight again next year." "Bistriazoloacridones Identified as New Class of Potential HIV Inhibitors" Reuters Health Information Services (03/12/98) According to a study in the March issue of Antimicrobial Agents and Chemotherapy, temacrazine shows selective antimicrobial activity against HIV-1 cells in vitro, indicating that a new class of drugs called bistriazoloacridones may hold promise as potential antiretrovirals. Dr. William G. Rice at the National Cancer Institute-Frederick Cancer Research and Development Center and colleagues report that temacrazine inhibited acute, chronic, and latently infected HIV-1 infected cells, selectively inhibiting HIV-1 transcription during the postintigrative phase of virus replication. The drug also blocked HIV-1 RNA formation without interfering with cellular gene transcription or events associated with the HIV-1 Tat and Rev regulatory proteins. The group concluded that the temacrazine is highly selective toward molecules involved in HIV-1 transcription, suggesting that the agent could have an antiviral activity against many replication-component cell types and viral expression states. "D0870 Promising for AIDS-Related Fluconazole-Resistant Candidiasis" Reuters Health Information Services (03/12/98) Dr. Brian G. Gazzard at Chelsea and Westminster Hospital in London and colleagues report that D0870, a new orally active triazole antifungal agent, may be a safe and effective treatment against fluconazole-resistant oral candidiasis in AIDS patients. Findings reported in the March 5 issue of the journal AIDS indicate that D0870 assists in the clearing of dysphasia and is well tolerated. The group found that 16 of 26 patients showed improvement, while nine showed no improvement and one had full clearance of thrush. Still, the researchers noted that the results were disappointing in terms of efficacy, although low plasma D0870 concentrations may be, in part, to blame for the suboptimal responses. "Tanzania: Female Condoms Receive Wide Support" Africa Information Afrique (03/12/98) Tanzanian women have given wide support to the recently introduced female condom. The condoms will be sold by Population Service International (PSI), a non-profit organization. The National AIDS Control Program, noting that heterosexual sex is responsible for over 90 percent of HIV infections in the country, believes that the female condoms will play a key role in reducing HIV transmission. The group also noted that at least 800,000 of Tanzania's 30 million residents are infected with HIV. Research indicates that some men oppose the new condoms, claiming that some female sex workers will use a female condom with several customers in order to save money; however, a PSI survey indicates that most sex workers do not accept unsafe sex. "Advances in the Virology of HIV Infection and Implications for Clinical Management" AIDS Clinical Care (03/98) Vol. 10, No. 3, P. 1; Vella, Stefano Advances in clinical research have resulted in the development of powerful combination antiretroviral therapies that have significantly influenced HIV treatment outcomes. In AIDS Clinical Care, Stefano Vella, ACC associate editor and chair of the Italian HIV Clinical Research Program, reviews recent advancements in retroviral therapy and future therapeutic strategies. Greater understanding of the replication characteristics of HIV has justified early and aggressive treatment practices. However, recent research has indicated that antiretroviral therapies are not likely to eliminate HIV since evidence of infectious HIV has been obtained in patients undergoing long-term therapy. Focus should be redirected toward decreasing the half-life of latently infected cells and identifying other cellular reservoirs. Vella strongly recommends the utilization of plasma HIV and RNA levels in monitoring antiretroviral treatment. Plasma HIV RNA levels may indicate the durability of virologic success, and recent studies have shown that in order to slow rebounds in viral load and development significantly, levels below 50 copies/ml must be reached. However, a viral load decreased beyond the limits of detection by genotypic or phenotypic assays does not mean viral replication has been sufficiently suppressed. Future therapeutic strategies may involve maximally suppressive therapies that require strict adherence in order to successfully limit the possibility for resistant variants. Other possible strategies under study include a de-intensifying regimen that follows aggressive therapy treatment. "CDC Launching New Era in Testing by Giving OK to Rapid Screening Tests" AIDS Alert (03/98) Vol. 13, No. 3, P. 25 The Centers for Disease Control and Prevention has changed its policy on rapid HIV screening tests; the CDC now recommends that in some instances, health care providers release early results of HIV tests rather than having patients wait 2 weeks while a test to confirm the results is performed. Such early disclosure may be made available to patients at tuberculosis and sexually transmitted disease clinics; women in labor with no history of prenatal care and uncertain HIV status; and healthcare workers who have either been stuck by a needle or who are involved in high risk situations. Among the concerns about such early disclosure are the methods of conveying positive results; the agency was considering a policy that would call for patients who have positive results, but who also reside in a low-prevalence area and are not involved in activities that put them at risk, to be told that they "probably" or "very likely" do not have HIV. Patients at high risk would be told that they "probably are" infected. The CDC's recommendation is expected to be adopted by the Food and Drug Administration, a move that CDC experts say will open a new market in the United States for prompt HIV screening tests. Although rapid tests are being used on a wide scale outside the United States, FDA policy prohibiting disclosure of provisional rapid-test results has prevented companies from pursuing the U.S. market. At least one product is already being marketed, while an additional two are being tested and a fourth is expected to reach the market within a year or two. ***************************************************************** 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. *****************************************************************