Subject: CDC AIDS Daily Summary for Date: Wed Mar 1 15:31:01 PST 2000 (249 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Wednesday, March 1, 2000 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. Contact the sources of the articles abstracted below for full texts of the articles. HEADLINES PEER-REVIEWED JOURNALS "Effect of Breastfeeding and Formula Feeding on Transmission of HIV-1" "Prevention of Mother-to-Child HIV Transmission in Resource-Poor Countries" "Effect of Recent Thymic Emigrants on Progression of HIV-1 Disease" GENERAL MEDIA "More Warnings Go Out to Georgetown Patients" "Zimbabwe's Sad Lack: Land to Bury AIDS Victims" "Afghan Heroin Feeds Addiction in Region, U.N. Report Declares" "Japan, U.S. to Battle AIDS in Cambodia" "AIDS in the Classroom" INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION "Perinatal Guidelines" "Send Me Guidelines!" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Effect of Breastfeeding and Formula Feeding on Transmission of HIV-1" Journal of the American Medical Association (www.jama.com) (03/01/00) Vol. 283, No. 9, P. 1167; Nduati, Ruth; John, Grace; Mbori-Ngacha, Dorothy; et al. A study on the effect of breastfeeding or formula feeding on the transmission of HIV to infants shows that formula feeding could prevent more than 40 percent of infant infections from breastfeeding. The trial took place in Nairobi, Kenya, and included 401 mother-infant pairs, with all mothers being HIV-positive and antiretroviral-naive. The mothers were put into either a breastfeeding or formula feeding group. The results of the study show that 92 infants were infected with HIV, including 61 in the breastfed group and 31 in the formula group. The probability of HIV infection was greatest during the first six months of life, at 75 percent. The estimated rate of breast milk HIV transmission was 16.2 percent through the age of two. The infants from both groups in the study were at similar risk for mortality until age two, showing the hazards of breastfeeding and noncompliance with formula feeding. Of women who breastfed, only 58 percent had an infant who was HIV-free at age two. The authors conclude that formula feeding can reduce the risk of HIV transmission, but the necessary health structure is also needed to provide information on formula feeding to mothers. "Prevention of Mother-to-Child HIV Transmission in Resource-Poor Countries" Journal of the American Medical Association (www.jama.com) (03/01/00) Vol. 283, No. 9, P. 1175; De Cock, Kevin M.; Fowler, Mary Glenn; Mercier, Eric; et al. Infants who acquire HIV-1 infection from their mothers number around 590,000 a year, the majority of whom are in developing countries. The problem of pediatric HIV infections is growing, as more women are becoming infected, especially in Africa and Asia. One way to combat HIV in infants is to give antiretroviral treatment to the pregnant woman and possibly to the newborn. Researchers from the Centers for Disease Control and Prevention note that several factors are important, including primary prevention of HIV in women, determining the shortest effective drug therapy, identifying the optimal drug or drug combination, and preventing breastfeeding-related HIV transmission. The researchers add that novel methods are also necessary to increase uptake of voluntary HIV counseling and testing. According to the authors, "Prevention of HIV infection in children requires HIV and AIDS to be addressed as a disease of the family and community and leads to consideration of other interventions, such as reproductive healthcare for women and support for children orphaned by the epidemic." "Effect of Recent Thymic Emigrants on Progression of HIV-1 Disease" Lancet (www.thelancet.com) (02/19/00) Vol. 355, No. 9204, P. 599; Hatzakis, Angelos; Touloumi, Giota; Karanicolas, Rose; et al. By studying the predictive ability of measurements of T-cell receptor-rearrangement excision DNA circles (TREC) in 127 HIV-infected patients with hemophilia, researchers found that the TREC concentration in the peripheral T-cell pool complements HIV RNA load and CD4 T-cell count in estimating the rate of disease progression. Scientists from Greece and from the Aaron Diamond AIDS Research Center in New York determined that although TREC have no function alone, they do show the population of recent thymic emigrants that have not changed much cellularly. The TREC concentration is important in predicting the onset of AIDS and death. The researchers note that "the direct correlation between the gradients of the declines in TREC and CD4 T cells supports the hypothesis that the decrease in recent thymic emigrant cells is causally related to the loss of CD4 T cells." **************************************************************** GENERAL MEDIA **************************************************************** "More Warnings Go Out to Georgetown Patients" Washington Post (www.washingtonpost.com) (03/01/00) P. B4; Goldstein, Avram More patients from Georgetown University Medical Center have been advised to receive blood tests to check for HIV, hepatitis, and other viruses after an X-ray technician, Jeffrey Royal, admitted to siphoning fentanyl from patients and replacing it with saltwater. Letters to 294 patients were mailed last week, and the total should reach almost 600 following a manual review of patient records for the radiology procedure. Royal was fired February 2, and health officials are concerned he may have used dirty needles to inject the saltwater in patients' drug lines. Spokesman Paul Donovan said the risk of infection is low, but all precautions are being taken. The hospital is now considering screening job applicants for prescription and illicit drugs before hiring them. Another case of drug abuse among a healthcare worker took place in Texas in 1991, when a technician received three years in jail for infecting patients with hepatitis C after replacing fentanyl with saltwater. "Zimbabwe's Sad Lack: Land to Bury AIDS Victims" New York Times (www.nytimes.com) (03/01/00) P. A4; Cauvin, Henri E. In Zimbabwe, AIDS deaths are filling up cemeteries in record time. The United Nations estimates that 25 percent of Zimbabwe's 6 million adults are infected with HIV. The Granville cemetery in Harare was built to last around 40 years, but the current rate of deaths may fill it in less than half that time. Economic problems have forced Zimbabweans into poverty, and the shortage of burial space is only one problem faced because of AIDS. Every day the gravediggers at Granville dig at least a dozen burial plots, sometimes digging more than twice that number. A burial costs around $14 for an adult and $8 for an infant, but many cannot afford the costs for a site in a maintained area and are buried near grass that is five feet high. "Afghan Heroin Feeds Addiction in Region, U.N. Report Declares" New York Times (www.nytimes.com) (03/01/00) P. A6; Crossette, Barbara The United Nations Drug Control Program stated in a report Tuesday that Afghanistan is now the largest producer of opium and is also a major manufacturer of heroin, which has resulted in an increase in addiction in the region. According to the study, Pakistan and Iran have among the world's highest rates of heroin addition. The report, prepared by the United Nations' Pino Arlacchi, noted that "the number of heroin addicts in the region exceeds that of Western Europe and is still on the increase." Not only are the communities of addicts in the region considered easy targets for organized crime, the report said, but they are also vectors for HIV transmission. "Japan, U.S. to Battle AIDS in Cambodia" Nando Times Online (02/29/00) Japan and the United States have announced plans to send researchers to Cambodia in order to fight AIDS and other diseases in the country. The plan was one of several discussed at a meeting to promote cooperation between Japan and the United States in terms of solving problems in the world. Meeting co-chair Yoshiji Nogami, the Japanese deputy foreign minister, noted that "in terms of urgency and seriousness, the infectious diseases program for Cambodia is extremely important not just for that country but also as a base of activities for the wider region." Japan and the United States review the progress made in the Common Agenda for Cooperation in Global Perspective, which they adopted in 1993, every year. "AIDS in the Classroom" U.S. News & World Report (www.usnews.com) (02/14/00) Vol. 128, No. 6, P. 32; Whitelaw, Kevin The AIDS epidemic is killing Africa's teachers, and with them, Africa's hope for the future. Some estimates show that one- third of teachers are infected with HIV, and in Zambia, two teachers are dying for every one that graduates from training school. Teachers are not the only ones dying, but the impact of their loss is greatly felt in the upcoming generation. Many children are orphaned by AIDS, as life expectancy in 10 African countries has fallen to levels below that of 1975. Many female students are quitting school to care for infected parents. Teachers, who are more likely to be in rural areas, have sex more often outside of marriage, including with students. They can also afford prostitutes, who help spread HIV. The peak of AIDS deaths is yet to come, however, and the educational system is already feeling the effects of the losses. In order to offset the high rate of death, companies often hire two people for one job. New infections occur half of the time in people younger than 25, and schools are not doing enough to teach young students about safe sex. In fact, the classroom rarely discusses sex, which remains taboo in most places. Uganda has set an example by cutting HIV rates in urban areas in half, while countries like Zambia are only now realizing the varied effects of AIDS and the need for change. *************************************************************** INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION *************************************************************** "Perinatal Guidelines" HIV/AIDS Treatment Information Service (ATIS) (hivatis.org) The HIV/AIDS Treatment Information Service announces the release of the newly updated "U.S. Public Health Service Task Force Recommendations for the Use of Antiretroviral Drugs in Pregnant Women Infected with HIV-1 for Maternal Health and for Reducing Perinatal HIV-1 Transmission in the United States". http://hivatis.org/guidelines/perinatal/PerinatalFeb2500.pdf This is the first time these guidelines have been updated as a "Living Document" since their publication in the MMWR in 1998. New sections of the document include combination antiretroviral therapy and pregnancy outcomes, protease inhibitor therapy and hyperglycemia, and mitochondrial toxicity and nucleoside analogue drugs. Additional changes discuss international antiretroviral prophylaxis clinical trials as well as provide a new clinical scenario (#3) regarding recommendations for handling HIV-infected women in labor who have had no prior therapy. These and other changes are highlighted in the PDF document to make it easier to identify changes from the previous version. The document will also be available in HTML next week. The Perinatal Guidelines is available in PDF format http://hivatis.org/guidelines/perinatal/PerinatalFeb2500.pdf. PDF format requires the Adobe Acrobat Reader, which is available from Adobe Acrobat: http://www.adobe.com/prodindex/acrobat/readstep.html. "Send Me Guidelines!" HIV/AIDS Treatment Information Service (ATIS) (hivatis.org) ATIS offers a new "Send Me Treatment Guidelines" service. You may request a single copy of the Perinatal Guidelines be mailed or e- mailed to you. To request the Guidelines, please e-mail atis@hivatis.org or call 1-800-448-0440, TTY 1-888-480-3739, or our International number 1- 301-519-0459 and specify that you would like a copy of the Perinatal Guidelines. If you request a copy be mailed to you, please include your complete mailing information. ****************************************************************