Subject: CDC AIDS Daily Summary Date: Fri Feb 5 07:31:02 PST 1999 (231 lines) From: National AIDS Info Clearinghouse Copyright 1999, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Friday, February 5, 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 "Live Attenuated, Multiply Deleted Simian Immunodeficiency Virus Causes AIDS in Infant and Adult Macaques" "Tuberculosis in Patients With Human Immunodeficiency Virus Infection" "Renal Atrophy Associated With Long-Term Treatment With Indinavir" GENERAL MEDIA "Drug-Resistant HIV Becomes More Widespread" "After Living With HIV, Living Without Medication" "US to Give HIV Drug Fast-Track Review" "China Urges AIDS Education for Migrant Population" "Japanese Study Confirms Efficacy of the Female Condom" INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION "Tuberculosis Outbreaks in Prison Housing Units for HIV-Infected Inmates--California, 1995-1996" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Live Attenuated, Multiply Deleted Simian Immunodeficiency Virus Causes AIDS in Infant and Adult Macaques" Nature Medicine (02/99) Vol. 5, No. 2, P. 194; Baba, Timothy W.; Liska, Vladimir; Khimani, Anis H.; et al. Researchers from the Dana-Farber Cancer Institute in Boston and others conducted experiments showing that mutant SIV strains with large deletions in the nef and vpr regions and in the negative regulatory element induced AIDS in inoculated macaques. As a result, the authors note, "Given the inherent instability of the virus genome that accumulates additional deletions in vivo, and significant pressure(s) that allows the host to select for replicating viral species within the individual, we conclude that a live attenuated virus vaccine based on attenuation of replicative capacity rather than attenuation of virulence may cause AIDS and should not be considered as a candidate for a human AIDS vaccine." The researchers, led by Timothy W. Baba, observed that six of eight inoculated infant macaques developed AIDS, while early signs of immune dysfunction were seen in the other two monkeys. Additionally, four of 16 inoculated adult macaques showed resurgence of chronic viremia after prolonged follow-up. "Tuberculosis in Patients With Human Immunodeficiency Virus Infection" New England Journal of Medicine (02/04/99) Vol. 340, No. 5, P. 367; Havlir, Diane V.; Barnes, Peter F. HIV-positive individuals are at an increased risk for primary or reactivation of tuberculosis and for second episodes of TB from exogenous reinfection. Research indicates that HIV-infected patients produce less interferon-gamma when exposed to Mycobacterium tuberculosis compared to HIV-negative patients with TB, suggesting that reduced T1 lymphocyte response, which produce the interferon, contributes to the susceptibility to tuberculosis. Tuberculosis also appears to increase HIV progression, with the risk of death in HIV-infected patients with TB reported to be twice that of HIV-positive patients without TB, independent of CD4 cell count. The high death rate among TB patients is apparently because of progressive HIV disease, versus TB itself. All patients with tuberculosis are suggested to undergo testing for HIV coinfection because of the possible benefits of early detection. Selective testing of HIV in these patients is not recommended due to the common failure to identify risk factors related to heterosexual transmission by health care providers. Acid-fast staining, mycobacterial cultures, and drug susceptibility testing are suggested. Restriction length fragment polymorphism allows for the identification of specific M. tuberculosis strains, enabling the documentation of disease transmission. The Centers for Disease Control and Prevention suggests a minimum of six months treatment for TB, with longer treatment for slow clinical or bacteriologic response. Rifampin and rifabutin treatment can have effects on and be affected by anti-HIV treatment. Chemoprophylaxis for tuberculosis is recommended for at-risk HIV-infected individuals. "Renal Atrophy Associated With Long-Term Treatment With Indinavir" New England Journal of Medicine (02/04/99) Vol. 340, No. 5, P. 392; Hanabusa, Hideji; Tagami, Hisamichi; Hataya, Hiroshi In a letter to the New England Journal of Medicine, Dr. Hideji Hanabusa of Ogikubo Hospital in Tokyo and colleagues report two cases of HIV-positive patients on prolonged indinavir treatment who developed renal atrophy. The two patients, who had hemophilia, also showed persistent pyuria and elevated serum creatine levels. The pyuria resolved and serum creatine levels normalized eight weeks after indinavir was replaced by nelfinavir in the regimen, although the size and shape of the kidneys did not change. According to the authors, AIDS patients are at increased risk for renal disorders due HIV nephropathy and the nephrotoxic effects of drug treatment. They note that patients receiving indinavir for long periods should be watched closely for adverse renal effects. **************************************************************** GENERAL MEDIA **************************************************************** "Drug-Resistant HIV Becomes More Widespread" Wall Street Journal (02/05/99) P. B5; Waldholz, Michael Researchers involved in a number of different studies presented data Thursday that suggests drug-resistant forms of HIV are now more prevalent in the United States, a trend that will complicate and even threaten the successful use of new anti-AIDS medicines. The studies, conducted with two new sensitive diagnostic tests, indicated that roughly 20 percent to 30 percent of people newly infected with HIV have a form of the virus that is now resistant to one of the 13 medicines used in drug cocktails. Investigators from one study presented evidence that about 10 percent of newly infected people are contracting a form of the virus that can withstand at least two drugs. In separate news, DuPont Co. said its Sustiva, which works through a different mechanism than rival protease inhibitors, is as effective as new protease inhibitors when it is used in drug cocktails. The findings were presented at the Sixth Conference on Retroviruses and Opportunistic Infections in Chicago. "After Living With HIV, Living Without Medication" Washington Post (02/05/99) P. A1; Brown, David Researchers at the National Institutes of Health are trying to determine if HIV-infected patients on protease inhibitor therapy who have responded to treatment can successfully fight off the virus after discontinuing their drug regimen. Richard Davey, the head of the study, said they have targeted 50 patients, expecting that only about 20 percent will fail to relapse, although there is no concrete data. Many people who use the drugs complain of the rigorous schedule involved in taking the medications and of their adverse effects. A few reports suggest that some people on therapy become non-progressors. As Davey explains, "We think that in some cases, the body's immune system may be able to control virus at low levels without [the drugs], and if so, we'd like to characterize those patients." All of the participants must have undetectable viral levels and have been on combination therapy for a year to be eligible. In the event of HIV resurgence, participants will be urged to resume therapy. A similar study at Massachusetts General Hospital removed 20 people who had been on therapy from treatment. While their infections have been suppressed since then, one of the researchers involved reports that the first patient to stop the drug treatment recently showed reemergence of HIV infection and resumed treatment. "US to Give HIV Drug Fast-Track Review" Boston Globe Online (02/05/99) P. A13 Trimeris Inc. has received fast-track status from the Food and Drug Administration for its new fusion inhibitor, T-20. The drug is designed to inhibit the entry of HIV into the cell, while protease inhibitors and reverse transcriptase inhibitors target HIV after it has entered the cells. Trimeris, which will present a preliminary report of Phase II trials of 78 patients at the Sixth Conference of Retroviruses and Opportunistic Infections in Chicago, noted that earlier research has shown the drug to be effective against HIV. "China Urges AIDS Education for Migrant Population" Reuters (02/05/99) According to the People's Daily in China, Chinese migrant workers are at risk for HIV and are in need of education programs in order to stem the virus' spread. A total of 96 percent of the 80 million to 120 million migrant workers in the country are sexually active, while almost 90 percent of the workers reportedly have no knowledge of HIV prevention. At a recent conference, experts called on the Chinese government to launch AIDS awareness programs for the workers. There are an estimated 300,000 HIV-positive people in China, and experts warn that there could be as many as 10 million infections by 2010, if no action is taken to prevent the spread of the disease. "Japanese Study Confirms Efficacy of the Female Condom" Infectious Disease News (01/99) Vol. 12, No. 1, P. 28; Palmer, Heather A. A Japanese study of the Female Health Company's Female Condom indicates that it is highly effective when used properly. The study, conducted by James Trussell of the Woodrow Wilson School of Public and International Affairs at Princeton University, found the failure rate over six months time to be 0.8 percent. Family Health International found the failure rate to be 2.6 percent over six months in a United States study. The typical use failure rate in the Japanese study was 3.2 percent, compared to a typical use failure rate of 12.4 percent in the U.S. study. **************************************************************** INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION **************************************************************** "Tuberculosis Outbreaks in Prison Housing Units for HIV-Infected Inmates--California, 1995-1996" Morbidity and Mortality Weekly Report (02/05/99) Vol. 48, No. 4, The California departments of corrections and health services together with local health departments statewide investigated two tuberculosis outbreaks that occurred in the HIV units of state prisons and spread to the community. Because HIV infection so severely weakens the immune system, people infected with both HIV and TB have a 100 times greater risk of developing active TB disease, which can then spread to others. During these outbreaks, 32 cases of tuberculosis were confirmed among HIV-infected inmates and parolees, and a visitor. These findings point to the rapid cycle of TB transmission in the prison environment. Early diagnosis, isolation of infectious TB cases and effective treatment among HIV-infected inmates is needed to cure TB disease and to minimize outbreaks. Following these investigations, new procedures were developed by the California departments of corrections and health services to ensure that suspected TB cases are tracked, and contacts are identified rapidly to prevent future outbreaks.