Subject: CDC AIDS Daily Summary Date: Thu Feb 11 06:31:03 PST 1999 (227 lines) From: National AIDS Info Clearinghouse Copyright 1999, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Thursday, February 11, 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 "Transfusion Medicine" "Screening Adolescent Females for Chlamydia Infection" "Transmission of Mycobacterium Tuberculosis From Patients Smear-Negative for Acid-Fast Bacilli" "Risk of New AIDS Diseases in People on Triple Therapy (Research Letter)" GENERAL MEDIA "Drop in Teen Birthrates Attributed to Abstinence" "Watchdog Urges Recall of Clot-Destroying Drug" "Across the USA: Alaska" "Health in Ghana" "Bill Would Require HIV Disclosure" "Cambodia Gripped by Worsening HIV Epidemic" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Transfusion Medicine" New England Journal of Medicine (02/11/99) Vol. 340, No. 6, P. 438; Goodnough, Lawrence T.; Brecher, Mark E.; Kanter, Michael H.; et al. In the first of a two part series, Dr. Lawrence T. Goodnough of the Washington University School of Medicine and others provide an overview of the current state of blood transfusion. In the United States, there has been a decline in the use of red-cell transfusions, allowing the United States to become less dependent on blood imported from the European Union. Blood collection has decreased as well, though, partially due to unfounded fears that collection processes can be risk factors for HIV transmission and due to the loss of donors through increased screening and testing procedures. While 46 percent of the population over the age of 18 had donated blood at some point, according to a 1993 survey, only 5.4 percent had actually donated that year. Women and minorities were less likely to be regular donors. Due to the marked decrease in transfusion-transmitted HIV incidence, mathematical models have been designed to assess risk from transfusion for the virus. It is estimated that there is one case of HIV due to transfusion for every 200,000 to 2 million units used. Following the implementation of HIV-antibody testing in March 1985, only about five cases of transfusion-associated HIV were reported to the Centers for Disease Control and Prevention per year over the next five years, compared to 714 cases in 1984. Screening processes implemented in the 1970s caused a reduction in the incidence of hepatitis B virus. The estimated risk of transfusion-transmitted hepatitis C virus is now one in 103,000 transfusions. Other viruses, including human T-cell lymphotropic virus types I and II, can be transmitted through transfusion. The authors conclude that the risk of death from transfusion is now so low that no alternative to transfusion is as safe. They add that blood conservation will be driven more by cost and inventory-related issues. "Screening Adolescent Females for Chlamydia Infection" Journal of the American Medical Association (02/10/99) Vol. 281, No. 6, P. 514; Klausner, Jeffrey D.; Burstein, Gale R.; Zenilman, Jonathan M.; et al. In a letter to the editor of the Journal of the American Medical Association, Dr. Jeffrey D. Klausner of the San Francisco Department of Public Health comments on a recent recommendation by Dr. Gale R. Burstein and others for semi-annual screening of female adolescents for Chlamydia trachomatis. Klausner asserts that Burstein et al. used a homogeneous population a high-incidence area in their study to justify the recommendation. He argues that each jurisdiction should base screening policy on local prevalence data, as many places have significantly lower rates. A successful screening program should be modeled after current immunization programs, including mandatory chlamydia screening for school entry. In response, Burstein, of Johns Hopkins University, and others note that most areas have a chlamydia prevalence rate of greater than 10 percent among the female adolescent population. They agree in theory that screening practices should be based on local conditions, but remind that the chlamydia burden is often poorly described in many areas and that some health care infrastructures do not have the resources to generate these data. Additionally, chlamydia rates may be underestimated due to less sensitive assays than the ones they used. The authors recommend the screening of all sexually active adolescent females for chlamydia infection, regardless of history or symptoms. "Transmission of Mycobacterium Tuberculosis From Patients Smear-Negative for Acid-Fast Bacilli" Lancet (02/06/99) Vol. 353, No. 9151, P. 444; Behr, M.A.; Warren, S.A.; Salamon, H.; et al. Data from an ongoing study of the molecular epidemiology of tuberculosis in San Francisco indicates that TB transmission in the city is due to patients with smear-negative, culture-positive TB about 17 percent of the time. The researchers, led by M. A. Behr of McGill University Health Center in Montreal, Canada, analyzed data from DNA fingerprinting and microscopic examination of acid-fast bacilli among 1,359 patients. The data showed that the relative transmission rate of smear-negative patients was 0.22 compared with smear-positive patients. The authors note that "while the use of sputum smear does identify the most infectious patients, those with negative smears should not be considered non-infectious." "Risk of New AIDS Diseases in People on Triple Therapy (Research Letter)" Lancet (02/06/99) Vol. 353, No. 9151, P. 463; Miller, Veronica; Staszewski, Schlomo; Nisius, Gabriella; et al. German researchers report on the degree to which triple therapy-associated increases in CD4 cell counts are related to the reduction of new AIDS disease risks. In a study of HIV-positive people who started triple-drug therapy, patients who had CD4 cell counts of less than 20 per microliter had a greater mortality rate and increased number of AIDS events compared to patients who had cell counts of above 100 per microliter at a mean follow-up of 1.4 years. According to the authors, the findings indicate that CD4 cell count increases in the peripheral blood in response to treatment are indicative of substantially reduced risks for new AIDS diseases. **************************************************************** GENERAL MEDIA **************************************************************** "Drop in Teen Birthrates Attributed to Abstinence" Washington Times (02/11/99) P. A6; Wetzstein, Cheryl The Consortium of State Physicians Resource Councils (PRC), an organization that represents 2,000 health care professionals, is asserting that teen birth rates have fallen due to increased abstinence, not greater condom use. Furthermore, they note that more teens, particularly boys, are abstaining from sex. They attribute the increase in abstinence to HIV/AIDS education, abstinence education, and growing cultural acceptance of saving sex for marriage. Rep. Tom Coburn (R-Okla.) said that the findings support the federal government's $50 million abstinence education program. He added that the education is important in light of the fact that condoms give little or no protection against some sexually transmitted diseases, including human papillomavirus. The study contradicts findings by the Centers for Disease Control and Prevention that indicate the decline in teen births is primarily due to greater contraceptive use. "Watchdog Urges Recall of Clot-Destroying Drug" New York Times (02/11/99) P. A21 The consumer advocacy group Public Citizen Wednesday asked the U.S. government to issue a recall of Abbott Laboratories' Abbokinase because of concerns the clot-destroying drug could be contaminated with hepatitis through the raw materials used to manufacture it. In November, the FDA banned sales of Abbokinase to look into possible manufacturing violations, but the investigation did not confirm that any vials were contaminated, and sales of the drug resumed last month. Justifying its call for a recall of the drug, Public Citizen accused the FDA of ignoring advice from its own inspectors to confiscate $100 million worth of the drug and the raw materials used in its production, which consist of kidney cells taken from dead infants in Colombia. "Across the USA: Alaska" USA Today (02/11/99) P. 10A Alaska will begin name-based HIV reporting, now requiring physicians and laboratories to report the names of individuals who test positive for the virus to the state. According to officials, there have been 442 cases of AIDS reported in the state since 1982. "Health in Ghana" Washington Times (02/11/99) P. A17 Ghana has been given a $20 million grant from the U.S. Agency for International Development to help improve family health. The funds will be used to address issues such as HIV prevention, overpopulation, and child immunization. "Bill Would Require HIV Disclosure" Cleveland Live NewsFlash/Plain Dealer Online (02/10/99); Tatge, Mark A new bill in the Ohio legislature would require HIV-infected people to notify potential sexual partners of their infection. The bill, which passed the Ohio House last fall by a vote of 93-1 before failing in the Senate, would make it a felony offense for an HIV-positive person have sexual relations with someone without first disclosing their HIV status. Offenders would face two to eight years in prison and a maximum fine of $15,000. Current law requires HIV-status disclosure, but does not carry any penalty. Some lawmakers defended the action, citing cases in which people knowingly transmitted the virus to others without informing their partners. AIDS advocates who oppose the measure note that there are other blood-borne diseases, such as hepatitis C, which are just as dangerous that are not regulated in this manner. "Cambodia Gripped by Worsening HIV Epidemic" Kyodo News Service (02/10/99) Cambodian Health Ministry officials said Wednesday that the country may soon become one of the nations most affected by HIV in the world. Tea Phalla, deputy director of the National Center for HIV and AIDS, said that about 100 people contract HIV daily in Cambodia and that high risk behavior, poverty, migration, high levels of sexually transmitted diseases, and access to inexpensive prostitutes are helping to spread the disease. According to estimates, 18,000 people in Cambodia have progressed to AIDS and about 150,000 are infected with HIV. Conservative estimates hold that the epidemic will cost Cambodia about $2 billion by 2006, if effective intervention is not implemented.