Subject: CDC AIDS Daily Summary for Date: Mon Mar 20 07:01:00 PST 2000 (204 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Monday, March 20, 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 "Strategies for Long-Term Success in the Treatment of HIV Infection" GENERAL MEDIA "Health Tips: Standard Antibiotics No Longer Good Enough Against TB" "U.N. Plans to Give Condoms to Troops" "Florida Inmates Help Test HIV Drugs" "South Africa in a Furor Over Advice About AIDS" "AIDS Workers Take Battle to New York's Streets" "AIDS Expert Urges Focus on Drug Abuse" "Claims Falling HIV/AIDS Rate Doesn't Include Indigenous Communities" "Country-Boy Crackheads" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Strategies for Long-Term Success in the Treatment of HIV Infection" Journal of the American Medical Association (www.jama.com) (03/08/00) Vol. 283, No. 10, P. 1329; Gallant, Joel E. The advent of highly active antiretroviral therapy (HAART) has made HIV a chronic, manageable disease if treatment is carefully prescribed and followed. The hypothetical treatment of a 39-year old woman who switched drugs frequently and did not fully adhere to her regimen shows the dangers of developing resistance to the drugs through nonadherence. The woman exhausted her choices of AIDS drugs fairly early in her disease because of this and also because of her physician's lack of knowledge. Author Joel E. Gallant, from the Johns Hopkins University School of Medicine in Baltimore, notes that expert care should be given to designing a treatment regimen that will be fully followed and tolerable. Without this required expertise, regimens become less effective because of cross-resistance between the three drug classes. Genotypic and phenotypic resistance assays can help determine an effective salvage regimen if cross-resistance occurs. The assays do not work for everyone, however. Viral load testing is now useful in determining a patient's status in relation to a CD4 cell count. The goal of suppression of viral replication remains for drug regimens, and it is up to the patient and a qualified physician to make informed choices for reaching this goal. **************************************************************** GENERAL MEDIA **************************************************************** "Health Tips: Standard Antibiotics No Longer Good Enough Against TB" United Press International (03/20/00); Wasowicz, Lidia A report in the Archives of Internal Medicine (2000;160:630-636) shows that treatment with standard antibiotics is not effective for many tuberculosis (TB) cases in developing countries. The researchers, led by Dr. Peter Small of Stanford University Medical Center, said that between one-third to one-half of patients in developing nations have a drug-resistant form of the bacterium. "Although affordable, increasingly available, and effective for most patients, the standard approach is inadequate for treating patients with drug-resistant tuberculosis," Small said, calling for new methods of fighting drug-resistant strains of the disease. "U.N. Plans to Give Condoms to Troops" Washington Post (www.washingtonpost.com) (03/18/00) P. A13; Lynch, Colum The United Nations has decided to hand out one condom a day to each of 16,000 male troops to be sent to Congo and Sierra Leone this year. U.N. bases from the Balkans to Mozambique attract brothels with dozens of women, and the soldiers are not punished for visiting the prostitutes. The situation is difficult, as some diplomats fear that some countries may not want to supply or accept troops who may spread HIV. Funding for the condoms may be approved within the next week, costing $10 per peacekeeper a month or nearly $2 million a year for forces in Congo and Sierra Leone; U.N. officials said the program may also be adopted for future missions. "Florida Inmates Help Test HIV Drugs" Florida Times-Union Online (www.jacksonville.com/tu-online) (03/19/00); Foley, Bill Some HIV-infected inmates at the South Unit of the Central Florida Reception Center, near Orlando International Airport, are serving as test subjects for combinations of HIV and AIDS drugs. While there is concern that some prisoners may not completely understand the risks involved or that they may have been pressured to participate, a report in the St. Petersburg Times notes that many prisoners say that as research subjects, their health has improved. Still, the report also noted that some patients do not seem well informed about the potential danger, with one former inmate reporting that he never asked or was told about the "potentially life-threatening" hypersensitivity listed on the consent form that might result from use of abacavir; however, he says he is not concerned because he can stop the treatment if he feels there is a problem. Under the voluntary program, HIV-infected inmates receive combinations of more than 12 medications, in an effort to determine which drugs work best at which doses for various types of patients. "South Africa in a Furor Over Advice About AIDS" New York Times (www.nytimes.com) (03/19/00) P. A21; Swarns, Rachel L. South African President Thabo Mbeki recently consulted with two American scientists who do not believe that HIV causes AIDS, sparking concerns that already high HIV infection rates in the country will continue to climb. Mbeki spoke with biochemist David Rasnick and Charles Geshekter, a professor of African history at California State University at Chico. Parks Mankahlana, the president's spokesman, explained that Mbeki wanted to speak to everyone and get all opinions. But Dr. Awa Coll-Seck of the United Nations' Department of AIDS Policy in Geneva fears that Mbeki's move could have dangerous results. "People will reassure themselves, perhaps, that they can continue risky behavior because HIV is not the real cause of AIDS," Coll-Seck said of the issue of whether there is a causal link between HIV and AIDS. Most researchers and organizations, including UNAIDS and the World Health Organization, believe the relationship between the virus and AIDS has already been well established. Rasnick and others claim that AIDS is caused by malnutrition and recreational drug use. "AIDS Workers Take Battle to New York's Streets" Nando Times Online (www.nando.net) (03/19/00); Carroll, Melanie The Positive Health Project, founded in 1993, is the largest AIDS prevention center on Manhattan's West Side, offering counseling, testing, support groups, and a needle exchange. Jason Farrell, executive director of the organization, often organizes demonstrations in nightclubs, offering free condoms and needles to those interested. Running on an annual budget of $800,000, the project hands out 13,000 syringes and 36,000 condoms a month, advocating harm reduction. Farrell notes that while the group advocates drug abstinence, "the goal is not exclusively to get people off drugs, but to stop infectious diseases." "AIDS Expert Urges Focus on Drug Abuse" Reuters (03/19/00); Brunnstrom, David Nick Crofts, deputy director of the Macfarlane Burnet Center in Melbourne, Australia, is warning that, in order to prevent massive epidemics among addicts, Asian governments need to focus on drug abuse. Crofts, also the director of the Center for Harm Reduction, helped compile the "Manual for Reducing Drug-Related Harm in Asia," a 350-page guide for policy makers that includes 10 years of research and advice to fight AIDS in Asia, including needle exchanges and methadone treatment. According to Crofts, a rise in Asian amphetamine abuse is contributing to the increasing HIV rate, and putting addicts in jails does not stop their use of drugs, merely increasing their rate of sharing. Furthermore, he noted that shooting galleries in Vietnam and Myanmar often use one large syringe to inject hundreds of people with drugs, increasing the risk of disease transmission. "Claims Falling HIV/AIDS Rate Doesn't Include Indigenous Communities" Australian Broadcasting Corp. Online (www.abc.net.au) (03/20/00) A new report from Australia's National Center for HIV Epidemiology asserts that the nationwide reduction in HIV/AIDS is not being seen in the country's indigenous population. According to the report, the number of infected indigenous people is low but stable, primarily among women and young people in heterosexual relationships. Kerry Arabena of the Australian National Council on AIDS said these individuals need more education about HIV, especially those in rural areas. "Country-Boy Crackheads" Economist (www.economist.com) (02/26/00) Vol. 354, No. 8159, P. 43 A report by the National Center on Addiction and Substance Abuse at Columbia University shows that teenagers in rural areas of the United States are more likely to use drugs than urban teens. The study indicates that eighth-graders living in the country were two times more likely to have used amphetamines in the past month. Country teens are also 34 percent more likely to have smoked marijuana, 50 percent likelier to use cocaine, and 83 percent more likely to abuse crack cocaine. Rural eighth-graders are more likely to drink alcohol and use tobacco as well. Methamphetamine is easily made in rural areas, since the ingredients to cook it can be found at a supermarket. With the increased use of needles for drugs comes increasing cases of AIDS. Statistics show that the number of AIDS cases soared 82 percent in rural areas between 1994 and 1999, versus 59 percent in large metropolitan areas. ****************************************************************