Subject: CDC NCHSTP Daily News Update Date: Tue Mar 17 09:31:05 PST 1998 (257 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update March 17, 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 Vaccine Trials" GENERAL MEDIA "AIDS Panel Sends Rebuke to Clinton" "Researchers Find a New Way HIV Cripples Immune System" "Love Me Safe" "Hepatitis C Alarm Sounded" "New Green Cross AIDS Case Found" "Gender Differences in Depression Levels Found in HIV-Infected Patients" "31 Hillside Students Test Positive for TB" "CDC Considers Redesigning Minority HIV Programs" "Antiviral Adherence Dilemmas" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "HIV Vaccine Trials" Science (03/06/98) Vol. 279, No. 5356, P. 1433; Jarlais, Don C. Des; Vanichseni, Suphak; Marmor, Michael; et al. In a letter to Science, Don C. Des Jarlais of Beth Israel Medical Center in New York and colleagues discuss ethical considerations in AIDS vaccine trials. They state that the best proven preventative methods in trials must include "social and behavioral interventions to reduce HIV risk behavior." This includes condom dispensation and sterile injection needles to prevent transmission. Meanwhile in a separate letter, Thea Kalebic of the National Cancer Institute responds to the use of placebos in an African AIDS trial involving HIV-infected pregnant women. Kalebic asserts that economic circumstances should not influence ethical norms. Instead, the key issue in ethical standards should be whether the highest standards may be applied in all trials. Kalebic insists that if these standards are not evaluated and implemented in all trials, then developing nations will suffer. The author notes that "acceptance of a double standard, even with the most altruistic of motives, would create the risk of exploitation of those with the least access to health care." In a response to this letter, Edward K. Mbidde of the Uganda Cancer Institute at Makerere Medical School notes that researchers who are members of these countries actively participate in the trials and that these nations have their own ethical review committees. Furthermore, he argues that economic standards do influence ethical considerations and that this is stated in the 1993 CIOMS guidelines. Both Kalebic and Mbidde agree that the availability of funds is a key factor in stemming the HIV epidemic; however, while Kalebic recommends always applying the best possible treatment period, Mbidde suggests that funds be used to provide the best possible treatment under given economic standards. **************************************************************** GENERAL MEDIA **************************************************************** "AIDS Panel Sends Rebuke to Clinton" Washington Post (03/17/98) P. A12; Vobejda, Barbara The Presidential Advisory Council on HIV/AIDS sent a sharp rebuke to President Clinton on Monday, voting unanimously to express "no confidence" in the administration's effort to stop the spread of HIV infection. The 30-member panel made the rebuke to protest the administration's failure to support needle-exchange programs as an HIV prevention method. The chairman of the panel, Dr. R. Scott Hitt, noted that research has been available for at least 14 months supporting the efficacy of needle-exchange programs. "Our frustration is that there's been 14 months of inaction," he said. The panel--which claims support from the American Medical Association, the American Public Health Association, and a National Institutes of Health report--also pointed to Centers for Disease Control and Prevention data that indicates that half of the 40,000 new HIV infections in the United States annually are transmitted by contaminated needles. In its letter to the president, the panel wrote that "it is a lack of political will, not scientific evidence," that has been holding back support for needle-exchange programs. A spokesperson for Health and Human Services Secretary Donna Shalala said that the administration is continuing to review the evidence. Congress will not allow HHS to fund needle-exchange programs until it is proven that they prevent the spread of HIV and do not encourage drug use. "Researchers Find a New Way HIV Cripples Immune System" Baltimore Sun (03/17/98) P. 4A; Birch, Douglas M. A study reported in this month's Proceedings of the National Academy of Sciences indicates that killer T cells may briefly display a surface receptor in the latter stages of AIDS which allows HIV to infect the cells. The study would explain the mysterious declines in the number of killer T cells in the latter stages of HIV disease progression. Researchers at Baltimore's Institute of Human Virology report that the killer T cell receptor is the same as the receptor on helper T cells that HIV attaches to in order to infect the cells. One of the authors of the study and director of the institute, Dr. Robert C. Gallo, said there is no evidence that the killer cells need to sprout the receptor molecule in order to fight pathogens. One treatment strategy, the removal of killer T cells from HIV-infected patients early in disease progression and the readministration of the cells later in the course of infection, may not be working too well, possibly because the cells are infected as they become activated. Gallo explained that by using genetic engineering, it may be possible to alter the killer T cells to keep them from being susceptible to HIV when they are activated. "Love Me Safe" Washington Post--Health (03/17/98) P. 21; Lewis, Nicole The American Social Health Association reports that 12 million new cases of sexually transmitted diseases are reported in the United States each year--two-thirds of them in people under the age of 25. According to health experts, many of the cases could be avoided through the use of "safe sex" practices. The Centers for Disease Control and Prevention has a National AIDS Hot Line at 800-342-2437; 800-344-7432 (Spanish); a National STD Hot Line at 800-227-8922; and a National Herpes Hot Line at 919-361-8488. The phone services provide free, confidential information about the diseases and condom use. "Hepatitis C Alarm Sounded" United Press International (03/16/98) The California Center for Health Improvement urged state policy makers to create a long-term strategy for fighting the hepatitis C virus. As many as 500,000 Californians may carry the virus, which has no known cure or vaccine and causes long-term liver damage. A report by the non-profit, public health group estimates that as many as 40 percent of incarcerated males and 50 percent of incarcerated females are infected with hepatitis C, as compared to a 1.8 percent incidence among the general U.S. population. The researchers warn that the death rate from the disease could triple over the next 20 years if nothing is done to halt the virus' spread. The report urged California to support vaccine development research and preventative education campaigns. "New Green Cross AIDS Case Found" Daily Yomiuri Online (03/17/98) The Yomiuri Shimbun reports that a 30-year-old man who was diagnosed with AIDS in January contracted HIV at a Kansai, Japan, hospital 15 years ago through the administration of an unheated blood product produced by the Green Cross Corp. The man will reportedly file a 115 million yen suit against the pharmaceutical company and the national government. Approximately 2,600 individuals received the unheated blood product; 11 were found to have contracted the virus through the administration of the product. While most were tested for HIV in 1996 during a Health and Welfare Ministry investigation, the infected man apparently was not tested due to an administrative error. The hospital recently confirmed that the man was given Christmassin in 1983 to treat a blood clot. "Gender Differences in Depression Levels Found in HIV-Infected Patients" Reuters Health Information Services (03/16/98) A study by G. van Servellen and coinvestigators at the University of California School of Nursing in Los Angeles, indicates that HIV-infected women appear to have higher levels of depression and more physical symptoms than HIV-positive males. The study, reported recently at a meeting of the American Psychosomatic Society in Florida, examined anxiety and depression levels among 82 men and 44 women at a community-based HIV/AIDS clinic. Another study reported at the meeting found that, among 98 HIV-positive and 73 HIV-negative homosexual men who were recently bereaved, 28 percent of the men showed zinc deficiency. The HIV-infected men had a slightly higher prevalence--33 percent--of the deficiency. "31 Hillside Students Test Positive for TB" Deseret News Online (03/16/98) Thirty-one children at Hillside Intermediate School in Utah have tested positive for exposure to tuberculosis, although only one case of infection has been confirmed. Salt Lake City-County Health officials offered free testing after a student was diagnosed with the disease; those students found to have been exposed will undergo chest X-rays to determine if they have active disease. The last case of a known tuberculosis infection in a student occurred in February 1996. "CDC Considers Redesigning Minority HIV Programs" AIDS Alert (03/98) Vol. 13, No. 3, P. 33 Criticism about the way the Centers for Disease Control and Prevention disburses grants to community based organizations (CBOs) for HIV prevention programs in minority communities has prompted a review of the way the agency distributes its entire HIV prevention grant. The criticism and resulting review was largely brought on by the competition the agency created last year to determine which CBOs would receive grants. In 1997, the number of agencies applying increased, and in the fierce competition, two-thirds of the experienced applicants who had previously received funding were turned away. The CDC attributes the increased competition to the slowing of funds from non-governmental sources. Several agencies complained to their constitutional representatives, who sought answers from the CDC. As a result the CDC is looking at the way it distributes funding to racial and ethnic minority communities, and plans to consult with community leaders to share experiences and ideas. "Antiviral Adherence Dilemmas" Focus (02/98) Vol. 13, No. 3, P. 1; Roland, Michelle E. Given the uncertainty of potentially harmful long-term side effects of antiviral HIV therapy, the significant short-term side effects of the drug regimens, and the lack of conclusive data on the efficacy of treatment initiated at the very early stages of the disease, many factors have to be taken account when determining a patient's course of treatment. The decision to start any form of therapy should be based on knowledge of the risks, such as the possibility of life-threatening side-effects and lifestyle changes that may be necessary to adhere to the strict dosing regimens, especially since missed doses have been linked to viral resistance. Healthcare practitioners can enhance adherence by finding cues that may help remind patients to take their medication, and by reviewing medications with patients in the clinic prior to the start of therapy. Although studies have not yet identified the number of doses a patient has to miss before resistance develops, they have suggested an association between an increase in viral load and notes in individual medical records that suggest non-adherence; a direct relationship between the risk of developing a detectable viral load and delays in refilling prescriptions; and an increase in viral load in those who missed three days of therapy. Pharmacy-run medication centers can also prove valuable in identifying non-adherence. ***************************************************************** The AIDSNews Mailing List is maintained by the CDC National Center for HIV, STD and TB Prevention. 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