Subject: CDC AIDS Daily Summary Date: Tue Jan 19 07:31:01 PST 1999 (227 lines) From: National AIDS Info Clearinghouse Copyright 1999, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Tuesday, January 19, 1999 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 HIV/STD/TB Prevention News Update should be cited as the source of the information. HEADLINES PEER-REVIEWED JOURNALS "Acute Hepatitis B Infection Associated With Blood Transfusion in England and Wales, 1991-7: Review of Database" GENERAL MEDIA "Scientists Enlist H.I.V. to Fight Other Ills" "Lesbian Study Lauded by Health Activists" "Across the USA: Georgia" "Giuliani Restores Methadone for Addicts" "Resistant TB Takes Hold in Sweden" "Tuberculosis Fears Rise at Orange High" "Policy Could Bar HIV-Infected Students From Sports" "Sustaining the Investment in AIDS Research" "China Confronts AIDS: International Help Needed to Stop the Spread" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Acute Hepatitis B Infection Associated With Blood Transfusion in England and Wales, 1991-7: Review of Database" British Medical Journal Online (01/09/99) Vol. 318, No. 7176, P. 95; Soldan, K.; Ramsay, M.; Collins, M. While all blood donations in England and Wales have been screened for hepatitis B surface antigen since the 1970s, there is still a low rate of hepatitis B virus (HBV) transmission due to tainted blood transfusions. Researchers from the Public Health Laboratory Service Communicable Disease Surveillance Center in London reviewed transfusion-associated hepatitis B cases between 1991 and 1997. They found that 24 of 4,185 (0.6 percent) cases were associated with transfusion in England and Wales. Investigative reports by the National Blood Services were not feasible or inconclusive for 10 of the cases. For the remaining 14 cases, three were from surface antigen-negative donors during acute HBV infection and 11 were from negative donors during late carriage of the virus. The authors note that the reports underestimate the number of cases due to transmission, but that transmission is still rare due to transfusion. They state that testing for antibodies to the hepatitis B core antigen would have detected most of the infectious donations identified, although the practice would also detect non-infectious donors, which could result in a loss of donations. The researchers recommend cost analysis of the situation to determine if the benefits of such a testing system are warranted. **************************************************************** GENERAL MEDIA **************************************************************** "Scientists Enlist H.I.V. to Fight Other Ills" New York Times (01/19/99) P. D1; Pollack, Andrew Some scientists and biotechnology companies are attempting to use HIV as a vector for gene treatment. The scientists are trying to eliminate HIV's ability to cause disease after infection, modifying the virus to carry genes that may help treat diseases such as hemophilia, cancer, and possibly even AIDS. Researchers involved in the projects state that there is virtually no chance of someone acquiring HIV from the gene treatment because the HIV strains used carry no disease-causing genes and cannot replicate and spread in the body. However, some scientists note that the strains could possibly recombine with genetic material from other viruses, allowing the virus to become infectious. Dr. Eric Poeschla, of the University of California at San Diego, reminds that "it's a human pathogen that's caused a terrible pandemic, so one needs to be thoughtful about using it, even in a crippled form." While the infectious ability of HIV and other viruses make them ideal candidates for gene vectors, gene therapy has not yet been particularly successful. Often the vectors are destroyed by the immune system or they do not deliver enough of the genes. HIV, though, can evade the body's immune system successfully and can carry large genes, incorporating them into the chromosomes of both dividing and non-dividing cells. "Lesbian Study Lauded by Health Activists" Washington Post--Health (01/19/99) P. 9; Hosaka, Tomoko A report released last week by the Institute of Medicine indicates that lesbians face unique challenges in the medical community and that many health care professionals are ignorant of lesbian health needs. Andrea Solarz, head of the committee that authored the report, "Lesbian Health, Current Assessment and Directions for the Future," said that most of the issues concern interaction and access as opposed to specific health risks. Some activists note that gay and lesbian health organizations have focused on HIV issues for the past two decades instead of on other health issues in the community. According to some health activists, lesbians are sometimes overlooked for sexually transmitted diseases or Pap smears because they do not have sex with men. However, researchers are still unsure if lesbians and heterosexual women have different risks, and few reliable studies on lesbian health exist. While lesbians are usually at low risk for chlamydia, syphilis, gonorrhea, human papillomavirus, and HIV, they can still acquire these diseases, particularly as surveys indicate that most lesbians have had heterosexual intercourse at some point in their lives. Lesbians can also become infected through bisexual partners who acquired infections from men. "Across the USA: Georgia" USA Today (01/18/99) P. 4A According to an AIDS advocacy group in Georgia, of 4,144 people tested for HIV last year, 2.7 percent tested positive. In 1997, 1.8 percent of 4,290 people tested HIV-positive. The group expressed concern over the rising incidence of the disease, particularly among young homosexual men. "Giuliani Restores Methadone for Addicts" Washington Times (01/17/99) P. A5 Heroin addicts will again be able to receive methadone through New York City hospitals. Six months ago, New York City Mayor Rudolph Giuliani said that he wanted to abolish methadone maintenance programs, but an experimental plan showed little success at five public hospitals. Giuliani will no longer require addicts to enter abstinence programs. "Resistant TB Takes Hold in Sweden" M2 Presswire (01/18/99) The Swedish infection protection agency has discovered several cases of drug-resistant tuberculosis in the country during the 1990s. The appearance of the pathogen in children indicates an active spread of the disease in Sweden, although the number of cases is still very low, the researchers said. "Tuberculosis Fears Rise at Orange High" MSNBC Online (01/19/99) Over 2,100 parents of students at Orange High School in Orange, Calif., were informed that their children may have been exposed to tuberculosis after a boy at the school was diagnosed with the disease. Health Care Agency Tuberculosis Controller Penny Weismuller will send letters recommending TB testing for 250 to 350 of the students and staff who had close contact with the infected student. "Policy Could Bar HIV-Infected Students From Sports" Dallas Morning News Online (01/16/99) The Poudre School District in Colorado is deciding whether to let HIV-infected students participate in school sports. A policy was unanimously approved by the district board recently that disallows students with "serious communicable diseases"--including HIV--from playing school sports; however, a committee of parents, health workers, and school officials still needs to make a final decision on the policy. The American Civil Liberties Union said that the policy is hard to enforce because it is only triggered when students disclose their health status. Christine Cimini, an attorney for the ACLU, said the organization would consider challenging the policy if a student is barred from playing sports because of his or her disease status. Health experts note that there is a very small chance that HIV-infected athletes could transmit the virus through play, even in contact sports. "Sustaining the Investment in AIDS Research" Scientist (01/04/99) Vol. 13, No. 1, P. 9; Nathanson, Neal In an opinion piece in the Scientist, Neal Nathanson, the director of the Office of AIDS Research at the National Institutes of Health, outlines the reasons for disproportionate funding for HIV/AIDS research, explaining why the continuation of investment in research is vital for the future. Nathanson first states that, while the AIDS death rate has declined in the United States, HIV incidence remains stable and is increasing in some sub-populations. Worldwide, new HIV epidemics are emerging. According to Nathanson, HIV/AIDS research needs sustained funding because it is transmissible. A breakdown in the fight against HIV could lead to an outbreak of infections. Diseases like cancer and heart disease, which may not receive as much funding per individual affected, are not infectious. The research done for HIV/AIDS has also led to treatments for other diseases and other discoveries. Still, HIV drugs have not eliminated viral replication in the hosts, and more research needs to be done on the long-term effects, the development of drug resistance, adherence issues, and differential access to the drugs. Prevention efforts must be maintained and fostered. Heterosexual transmission has become the chief route of HIV infection in most of the world, and drug users and their partners are the quickest growing segment of AIDS cases in many countries, including the United States. The development of an HIV vaccine is of the utmost priority, Nathanson concludes, and the process will be exceedingly difficult. "China Confronts AIDS: International Help Needed to Stop the Spread" Scientist (01/04/99) Vol. 13, No. 1, P. 1; Watanabe, Myrna E. China faces a growing AIDS problem. While there have only been 11,700 reported cases of AIDS in the country, the government estimates that there are 300,000 people infected with HIV--a figure the World Health Organization says is closer to 600,000. Xiwan Zheng, the deputy director of China's National Center for AIDS Prevention and Control, said that there could be as many as 1 million HIV-infected people in China by 2000. Intravenous drug users make up the majority of seropositive people in the southwestern provinces, while the virus in central China is associated with tainted blood donations and immigration. Sexual transmission is the main source of infection in the coastal region. The country has multiple subtypes of HIV-1, including A, B, B', C, D, E, and F, as well as a unique recombinant C/B' strain. A general deficiency of funding and human resources, coupled with a prevailing lack of AIDS education, could make it hard to fight the spread of the disease. Furthermore, medication is severely limited because antiretrovirals are not yet approved in the country; however, even if they were available they would be too expensive for most people. The government has taken an active interest, though, and is committing resources towards AIDS prevention and research. Still, officials realize that they will need international help to succeed and are trying to work with various international agencies, including UNAIDS, the WHO, the International AIDS Vaccine Initiative and the U.S. Centers for Disease Control and Prevention.