Subject: CDC AIDS Daily Summary Date: Mon Feb 1 07:31:01 PST 1999 (271 lines) From: National AIDS Info Clearinghouse Copyright 1999, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Monday, February 1, 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 "Grappling With Global Concerns in the Search for an HIV Vaccine" GENERAL MEDIA "Researchers Trace AIDS Virus to a Subspecies of Chimpanzee" "Some AIDS Patients Restored by Drugs Suddenly Decline" "Abbott Laboratories to Present Findings of Viral-Reducing AIDS Drug Today" "No Entry" "Potential Threat to Blood Supply Emerges, Demanding Caution" "Hemophiliacs File Suit Over U.S. Tainted Blood" "HIV-1 Can Survive in Syringes for More than 4 Weeks" "Unequal Health" "Recovery or Resistance?" INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION "Adherence to HIV Therapies: HIV Treatment and Prevention Issues" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Grappling With Global Concerns in the Search for an HIV Vaccine" Journal of the Association of Nurses in AIDS Care (01/99-02/99) Vol. 10, No. 1, P. 17; Grady, Christine The Joint United Nations Program on HIV/AIDS (UNAIDS) has conducted a series of global consultations dealing with the issue of conducting ethical vaccine research in developing countries. Many view an HIV vaccine as the best method of stopping the spread of HIV globally. Research would be easiest and trials most beneficial in populations with a high HIV prevalence where anti-HIV treatment is not available. Most of the high prevalence populations are in developing nations; conversely, most of the companies and agencies conducting vaccine research are in developed nations. This leads to a number of ethical dilemmas, including whether it is acceptable for a group to conduct a trial in another country if could not conduct one in its own. Additionally, there is the issue of whether trial sponsors should supply anti-HIV medication to participants who become infected, even if the participants would never have been able to get treatment had they contracted the virus in a non-trial setting. To help answer these and other questions, UNAIDS sponsored discussions of proposed guidelines for HIV vaccine research. Participants in the discussions came to agreement on some issues, but there were disagreements on others. Much of the procedural guidelines for HIV vaccine research will most likely come from already existing codes of research ethics. **************************************************************** GENERAL MEDIA **************************************************************** "Researchers Trace AIDS Virus to a Subspecies of Chimpanzee" New York Times (www.nyt.com) (02/01/99) P. A1; Altman, Lawrence K. An international team of scientists, led by Dr. Beatrice H. Hahn, of the University of Alabama at Birmingham, reports that they have traced the roots of HIV-1 to a subspecies of chimpanzee, Pan troglodytes troglodytes, in Africa. The researchers, who announced their finding at the opening of the sixth annual Conference on Retroviruses and Opportunistic Infections in Chicago, said that the discovery could help lead to HIV control therapy. The chimpanzee subspecies has been able to survive with the virus SIV cpz--which is 98 percent similar to HIV-1--without becoming ill. Researchers may focus on why HIV-1 causes death in humans, even though SIV cpz does not appear to cause illness in chimpanzees. The finding may also aid in the future detection of viruses that could possibly jump from animal to human hosts. Hahn and colleagues added that chimpanzees are being extensively hunted; the monkeys are sold in the "bushmeat" trade, which may be placing people at risk for cross-species transmission. Dr. Thomas M. Folks, of the Centers for Disease Control and Prevention, also noted that the number of infected chimpanzees in captivity is too small to conduct extensive research, and the animals in the wild are endangered and slowly nearing extinction. Hahn et al. will publish their findings in this week's issue of the journal Nature. "Some AIDS Patients Restored by Drugs Suddenly Decline" Wall Street Journal (www.wsj.com) (02/01/99) P. B1; Tanouye, Elyse Despite the initial success of AIDS drugs to reduce viral levels to below detectable levels in many patients, researchers say an increasing number of patients who have benefited from the drugs for several years are developing resistance to the drugs and experiencing an increase in viral levels. Indeed, findings set to be presented at an AIDS conference in Chicago show that only about two-thirds of patients using a drug regimen including Merck's Crixivan had very low levels of virus copies in their blood after three years, compared with about 90 percent of patients earlier in the study. Researchers have said they did not expect the drugs to be effective forever, but they cannot explain why some patients are suddenly not responding. One theory suggests that the low viral levels in the body trick the immune system into thinking the threat is gone and that the body stops fighting the virus. "Abbott Laboratories to Present Findings of Viral-Reducing AIDS Drug Today" Wall Street Journal (www.wsj.com) (02/01/99) P. B8; Burton, Thomas M. Abbott Laboratories plans Monday to release clinical findings that show its experimental AIDS drug, ABT-378, reduced viral loads to below-detectable levels in 90 percent of patients when the drug was combined with an existing AIDS drug, Abbott's Norvir. Because the study, which is to be reported in Chicago at the Sixth Conference on Retroviruses and Opportunistic Infections, only involved patients who had never received treatment with other protease-inhibitors, researchers said they were unsure how the treatment would affect patients who previously used other protease drugs. The researchers also noted the drug caused minimal short-term side effects, such as headache and diarrhea, and that no patients stopped participating in the trial because of side effects, which they emphasized is very unusual. Abbott said the drug was about half way through clinical trials and that it expected to submit a marketing application to the Food and Drug Administration in mid-2000. "No Entry" Investor's Business Daily (www.investors.com) (02/01/99) P. A4; Lau, Gloria Durham, N.C., based Trimeris Inc. has shown that its T-20 drug can prevent HIV from attacking and infecting healthy cells. The drug, a fusion inhibitor, constitutes a new class of anti-HIV medication. In clinical trials, T-20 reduced virus levels in the blood by more than 90 percent in 78 HIV-infected patients, with no reports of nausea, fever, or rash. The company, which will announce the results of its results on Thursday at a conference in Chicago, plans to market the medication in combination with other available anti-HIV medications. CEO Ross Johnson explained, "We know that one drug is not enough, so it's not a matter of one drug being better than another, but a matter of adding an additional weapon to the fight." Trimeris will have to test at least 400 more people before it can file for approval from the Food and Drug Administration, but the company hopes to receive clearance by mid-2000. "Potential Threat to Blood Supply Emerges, Demanding Caution" USA Today (www.usatoday.com) (02/01/99) P. 14A; Wilkinson, Susan An editorial in the USA Today argues that over-cautious screening for Creutzfeldt-Jakob disease (CJD) and selection against blood donors who have visited Britain since 1980 may be prudent. A Food and Drug Administration panel voted in December to exclude possibly infected individuals from donation. While there is a chance that the disease could cause infection through transfusion, an action to prevent the spread of the disease through the blood supply would reduce donor volume by about 11 percent. However, the magnitude of risk is not known and the editors insist that caution should be exercised. They cite the spread of HIV through blood transfusion in the United States in the 1980s as an example of the possible problem that could be caused by CJD. In a counterpoint reply, Susan Wilkinson, president of the American Association of Blood Banks, states that there have been no reported cases of CJD in the United States to date and that no cases have been associated with transfusion anywhere in the world. She adds that the transmission of CJD through the blood supply is still theoretical and that selection against possible carriers could result in the loss of 2.1 million blood units annually. Wilkinson states that blood shortages are an everyday concern and that the deferring of donors will result in a substantial decrease in blood availability in the United States. "Hemophiliacs File Suit Over U.S. Tainted Blood" Washington Times (www.washtimes.com) (1/30/99) P. A8; Crary, David A group of hemophiliacs have filed a class-action suit against the Canadian government and two companies for their involvement in the use of tainted blood plasma taken from U.S. prisoners in Canadian blood products. The plaintiffs claim that approximately 1,000 Canadian hemophiliacs contracted hepatitis C between 1980 and 1985 from the blood products. They are suing the government, Continental Pharma Cryosan, and Connaught Laboratories, for $655 million. "HIV-1 Can Survive in Syringes for More than 4 Weeks" Reuters Health Information Services (www.reutershealth.com) (01/29/99) Researchers report in the Jan. 1 issue of the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology that viable HIV-1 can be recovered from syringes four or more weeks after initial use. Dr. Nadia Abdala and colleagues from Yale University state that their findings highlight the need for needle-exchange programs. They assert that potentially dangerous dirty needles need to be removed from circulation. "Unequal Health" Scientific American (www.scientificamerican.com) (01/99) Vol. 280, No. 1, P. 40; Nemecek, Sasha The "Health, United States, 1998" study from the U.S. Department of Health and Human Services reveals that while Americans are healthier than they have ever been, there are health disparities between certain groups. Poor and certain ethnic minorities appear to be significantly less healthy than whites; the government has allocated over $220 million in an effort to help eliminate health inequalities by 2010. The program will target infant mortality, diabetes, cancer screening and management, heart disease, immunization, and HIV/AIDS. A total of $156 million has been set aside for HIV/AIDS prevention and treatment among minority groups, particularly for costly anti-HIV medications. Still, some researchers wonder how effective the program will be. John W. Lynch of the University of Michigan School of Public Health and colleagues found that relative income also played a role in overall health. The National Medical Association, which represents 22,000 African-American physicians and their patients, said that several factors, such as unhealthy lifestyles among poor and minority groups and a lack of health insurance, may not receive adequate attention under the current program. "Recovery or Resistance?" Discover (www.discover.com) (01/99) Vol. 20, No. 1, P. 42; Glausiuz, Josie Immunologist Brigitte Autran, of the Pitie-Salpetriere Hospital in Paris, reported in June that early triple-drug therapy results in drastic decreases in viral loads and increases in CD4 cell counts. However in October, researchers found that the reduction of the regimen to just one or two medications allowed a viral rebound. Furthermore, triple-drug therapy does not work for everyone, and sub-optimal treatment may lead to the development of resistance. Scientists are concerned that multidrug-resistant strains of HIV may become common in newly infected individuals. **************************************************************** INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION **************************************************************** "Adherence to HIV Therapies: HIV Treatment and Prevention Issues" The Department of Health and Human Services is pleased to announce the Third Satellite Broadcast in a Series of HIV/Related Issues is scheduled for February 24, 1999, 1:00-3:00 PM EST. The broadcast, "Adherence to HIV Therapies: HIV Treatment and Prevention Issues" will take a close look at critical issues in disease management. Panelists for this broadcast include: Frederick L. Altice, M.D., Yale University AIDS Program Cornelius Baker, National Association of People With AIDS John G. Bartlett, M.D., Johns Hopkins University School of Medicine Margaret Chesney, Ph.D., UCSF AIDS Research Institute and Center for AIDS Prevention Studies Thomas Coates, Ph.D., UCSF AIDS Research Institute and Center for AIDS Prevention Studies The broadcast will focus on initiation, maintenance, and improvement of adherence to the new treatment regimens and the role of HIV prevention in the new era of improved HIV disease management. Additional information about downlink sites for viewing this broadcast can be found at: http://www.tech-res-intl.com/hivaids