Subject: CDC NCHSTP Daily News Update Date: Tue Jul 7 08:31:05 PDT 1998 (310 lines) From: National AIDS Info Clearinghouse Copyright 1998, Information, Inc., Bethesda, MD CDC NCHSTP Daily News Update Tuesday, July 7, 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. HEADLINES PEER-REVIEWED JOURNALS "Acute Human Immunodeficiency Virus Type 1 Infection" GENERAL MEDIA "Subway Advertisement for Needle-Exchange Program Provokes Debate" "Troubling Side Effects Are Linked to Effective AIDS Drug Therapy" "HIV and Pills: A Complicated Formula" "Law Would Lessen Penalty for Having Illegal Syringes" "U.S. HHS: Mass Treatment for Curable STDs Has [Reduced STD Rates]" "Home Tests Boost Chlamydia Screening" "'Pack Condoms' Teenagers Told" "Metabolic Complications of Antiretroviral Therapies" INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION "An Inexpensive Antibiotic Proves Effective in Reducing Death Among People With HIV in Africa" INFORMATION FROM THE CDC NATIONAL PREVENTION INFORMATION NETWORK "The Multiple Message Error in Yesterday's Daily News Update" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Acute Human Immunodeficiency Virus Type 1 Infection" New England Journal of Medicine (07/02/98) Vol. 339, No. 1, P. 33; Kahn, James O.; Walker, Bruce D. In the New England Journal of Medicine, Dr. James O. Kahn of the University of California at San Francisco, and Dr. Bruce D. Walker of Massachusetts General Hospital review current recommendations for the diagnosis and treatment of acute HIV-1 infection. They note that in female rhesus monkeys, SIV first targets the Langerhans' cells in the lamina propria, which in turn fuse with CD4 lymphocytes and spread to deeper tissue. The virus can be detected in the internal iliac lymph nodes after two days, followed shortly by systemic dissemination. In humans, there is approximately a four- to 11-day period between mucosal infection and initial viremia. Transmission and contraction of HIV-1 is facilitated by breaks in the mucosal barrier, often caused by genital ulcer disease, urethritis, and cervicitis. The virus can also be transmitted across the oral mucosa during genital-oral sex. HIV-1 attaches to host cells via the gp120 protein on the viral envelope. The virus uses either the CCR5 or CXCR4 chemokine receptor as a coreceptor for entry. Langerhans' cells express CCR5 receptors, but may be CXCR4 deficient, providing a possible explanation for the predominance of CCR5 strains. After infection, plasma viremia will rise and then drop to a steady-state level of viral replication. Symptoms of acute HIV-1 infection include fatigue, rash, headache, nausea, and night sweats; however, the nature of these symptoms makes correct diagnosis a challenge and acute infection is often confused for mononucleosis, secondary syphilis, or acute infection with hepatitis A or B, among others. The authors recommend that after diagnosis has been confirmed, maximal suppression treatment should be employed early to fight HIV, using a combination of drugs and ensuring adherence. **************************************************************** GENERAL MEDIA **************************************************************** "Subway Advertisement for Needle-Exchange Program Provokes Debate" New York Times (07/07/98) P. A16; Wren, Christopher S. Positive Health Project, an HIV prevention and needle-exchange center in Manhattan, will run a campaign featuring 1,140 advertisements on some New York City subway cars for a needle-exchange program. The advertisement features Michelangelo's Sistine Chapel fresco in which God's hand reaches toward Adam; in the ad, though, God is carrying needles to give to Adam. The advertisement says that "Sharing needles is the number one cause of HIV in New York City," and implores, "If you shoot drugs--please do not share needles." It also provides information on how to contact the needle-exchange program. New York City has an estimated 250,000 intravenous drug users, with as many as 50 percent infected with HIV. Surgeon General David Satcher estimates that 40 percent of new AIDS infections in the United States are associated with intravenous drug use. In New York City, there are some 5,000 new HIV infections annually. Funding for the advertisements was primarily provided by the Drug Policy Foundation--an advocacy group financed by George Soros, who donated $1 million for needle exchanges last year. Some opponents criticized the advertisements, asserting that they are endorsing the continuation of addiction. "Troubling Side Effects Are Linked to Effective AIDS Drug Therapy" New York Times (07/07/98) P. C7; Altman, Lawrence K. Even though drug cocktails have been effective in helping thousands of patients infected with HIV live longer and improved lives, physicians and researchers are concerned about the increasing incidence of lipodystrophy syndrome, which affects the body's ability to properly metabolize fat, and say they are unsure of the long-term safety of protease inhibitors. While the syndrome also affects body fat distribution and has caused some patients psychological problems, doctors are more concerned about the increased levels of cholesterol and lipids found in the blood of many patients--conditions that could lead to diabetes. Researchers still do not totally understand the cause of the syndrome, and studies report conflicting rates of incidence; a study in Australia found that 64 percent of patients using protease inhibitors developed the syndrome, while two studies in France and Hong Kong report an incidence of about 25 percent. "HIV and Pills: A Complicated Formula" Washington Post--Health (07/07/98) P. 5; Colburn, Don A Centers for Disease Control and Prevention survey released last week indicates that more than one-quarter of patients receiving anti-HIV medication fail to adhere to their prescribed regimen. On average, HIV-positive patients take 13 pills daily, with some patients taking over 30 pills a day. Ninety-four percent of the 504 HIV-positive outpatients reviewed in the study were receiving medication for their infection. The most common reason cited by patients for lapses in adherence was a failure to remember. The researchers, who reported their findings in the Journal of the American Medical Association, noted that patient adherence may increase if the regimens could be simplified. "Law Would Lessen Penalty for Having Illegal Syringes" Providence Journal-Bulletin (07/03/98); Saltzman, Jonathan Rhode Island is expected to soon approve a law that would change needle possession without a prescription from a felony offense to a misdemeanor. The measure was passed by the House last week, and Governor Almond will reportedly let it become law without his signature; the Senate already approved the bill. In Rhode Island, those caught with an illegal syringe are fined up to $3,000 and face up to five years in prison for a first offense. The new law would impose a maximum $100 fine and a mandatory five- to-10-hour course on drug abuse. The bill is expected to help reduce the HIV rate in the state. In one study of 477 IDUs, needles were shared an average of 14 times in a one-month period. With the new law, public health officials expect the amount of sharing to decrease. According to Dr. Josiah D. Rich, an infectious disease specialist at Miriam Hospita1, intravenous drug use is the most common route of HIV transmission in Rhode Island--one of only four states where over 50 percent of AIDS cases are associated with injection drug use. Critics contend that the reduction in penalties will serve to increase the rate of drug use. The new law would make unprescribed needle possession penalties less than those for shoplifting or some traffic violations. Rich notes, however, that the new law will save the state both money and lives. Syringe arrests accounted for 10 percent of all drug-possession arrests between 1994 and 1996, with 15 percent of those arrested serving an average of 13 months in jail. It costs the state an average of $35,000 to incarcerate a prisoner for a year. "U.S. HHS: Mass Treatment for Curable STDs Has [Reduced STD Rates]" M2 Presswire (07/06/98) A study supported by the National Institute of Allergy and Infectious Diseases and conducted in rural Uganda found that community-wide treatment of sexually transmitted diseases resulted in reduced STD levels and improved pregnancy outcomes, but did not reduce the incidence of new HIV infections. The study, presented at the 12th World AIDS Conference in Geneva, examined the treatment in 56 villages in the Rakai district in Uganda, where 16 percent of the population is HIV-positive. About 10 percent of the population showed evidence of syphilis infection, 50 percent of women had bacterial vaginosis, 25 percent of the women had trichamoniasis, 4 percent had chlamydia, and 2 percent had gonorrhea, at baseline. The study divided the villages into two groups: an intervention group in which over 6,600 HIV-negative adults received antibiotic treatment against STDs and a control group in which about 6,100 HIV-negative adults received nutritional supplements and were treated for parasitic worms. After the second 10-month follow-up, HIV incidence was the same in both groups; however, STD rates fell in the treatment group. One of the researchers, Dr. Ronald Gray of Johns Hopkins University, explained that "in Rakai, STDs are associated with increased risk of HIV transmission in individuals. There is also a substantial background risk of exposure to HIV, irrespective of concurrent STDs. Thus, STDs may have contributed little to overall HIV transmission in this population, indicating that differences in the stage of the HIV epidemic may be important in this regard." "Home Tests Boost Chlamydia Screening" Fox News Online (07/06/98) A study in the current issue of the British Medical Journal indicates that people are more likely to get screened for chlamydia if they can collect samples at home and mail them directly to a laboratory. Researchers led by Dr. Lars Ostergaard of Aarhus University in Denmark report that 93.4 percent of 928 female students who were offered home-sampling options were tested for chlamydia infections, as compared to just 7.6 percent of 833 female students in the control group. Among male students, over 97 percent of the 442-member home-sampling group were tested for infection, while only 1.6 percent of the 246-member control group was tested. In the control group, 7.9 percent of females and 25 percent of males who were tested had chlamydia infections. In the home sampling group, 5 percent of females and 2.6 percent of males who were tested were infected with chlamydia. The researchers concluded that "asking patients to provide home samples may reduce the number of complications from C trachomatis and its prevalence." "'Pack Condoms' Teenagers Told" BBC News Online (07/07/98) The Brook Advisory Center in the United Kingdom is advising teenagers to take condoms with them when they go on vacation this summer following the discovery that many young people have unprotected sex while away. A recent survey showed that one-quarter of people aged 16 to 29 years had sex with one or more new partner on vacation, and nearly 75 percent of men and 49 percent of women said they did not practice safe sex. Some studies suggest that up to 10 percent of teens are infected with a sexually transmitted disease. "Metabolic Complications of Antiretroviral Therapies" AIDS Clinical Care (06/98) Vol. 10, No. 6, P. 41; Dube, Michael P.; Sattler, Fred R. Protease inhibitors have been reported to have some adverse effects, including new-onset diabetes millitus, abnormal body fat distribution, and hyperlipidemia. While these disorders have been associated with protease inhibitor treatment, none of them have been definitively linked to the medications. Protease inhibitor-associated diabetes was first reported by the Food and Drug Administration in June 1997. As of November 1997, 141 cases of hyperglycemia had been reported for indinavir, 31 for saquinavir, 23 for ritonavir, 24 for the combination of ritonavir and saquinavir, and 15 for nelfinavir. Most of the cases have been reported in men, and these reports may reflect background incidence of the disease in the general population. Patients who develop the disease may have a predisposition for diabetes--including insufficient B-cell reserves or preexisting insulin resistance. Generally, the complication has been treated without eliminating protease inhibitor therapy. Hypertriglyceridemia has also been reported in association with protease inhibitor treatment. The disorder was previously recognized as a complication of HIV infection, but it also occurs in patients who respond positively to protease inhibitor treatment. The disorder could result in increasing cardiovascular complications for HIV-infected patients, especially since AIDS mortality rates are falling. Cardiovascular risk reduction--including cessation of smoking and hypertension control--is recommended. Additionally, changes in body fat distribution has been observed in conjunction with protease inhibitor treatment, although some have seen abnormal adipose tissue distribution before initiation of the therapy. One recent study found that 64 percent of patients on a protease inhibitor regimen self-reported abnormal fat distribution. The proportions were higher for patients receiving ritonavir plus saquinavir, as compared to those taking indinavir. Because it is not clear whether stopping or changing medications will consistently resolve lipodystrophy, neither alternative is routinely recommended. **************************************************************** INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION **************************************************************** "An Inexpensive Antibiotic Proves Effective in Reducing Death Among People With HIV in Africa" Centers for Disease Control and Prevention (07/03/98) The Centers for Disease Control and Prevention and the Ivory Coast Ministry of Public Health reported at the 12th World AIDS Conference that HIV-infected African patients who were co-infected with tuberculosis had a 48 percent decline in mortality and a 44 percent drop in hospitalizations after receiving trimethoprim/sulfamethoxazole (TMP/SMX). The drug is most commonly used in the United States to treat Pneumocystis carinii pneumonia; however, PCP is rare in Africa and is thus not commonly prescribed there. Patients in Africa who are co-infected with TB and HIV have a high mortality rate, often dying due to other diseases such as toxoplasmosis, pneumococcal pneumonia, and salmonellosis. In the trial, TMP/SMX treatment was initiated one month after TB treatment. According to the researchers, the drug was safe and effective in preventing these diseases. The researchers feel that the drugs will have a significant effect on the mortality rate and quality of life of HIV-infected TB patients in developing nations. **************************************************************** INFORMATION FROM THE CDC NATIONAL PREVENTION INFORMATION NETWORK **************************************************************** "The Multiple Message Error in Yesterday's Daily News Update" You may have received multiple copies of yesterday's CDC NCHSTP Daily News Update. This problem is under investigation. Both internal and external systems are being reviewed for immediate correction. We apologize for any inconvenience. **************************************************************** The AIDSNews Mailing List is maintained by the CDC National Center for HIV, STD, and TB Prevention. Regular postings