Subject: CDC AIDS Daily Summary for Date: Thu Mar 30 07:01:00 PST 2000 (201 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Thursday, March 30, 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 "Viral Load and Heterosexual Transmission of Human Immunodeficiency Virus Type 1" "Investigators' Responsibilities for Human Subjects in Developing Countries" "Blood Products Part of FDA Xenotransplant Plan" GENERAL MEDIA "Just Say no to Sex" "U.S. Challenged by Changing Face of AIDS" "Ryan White AIDS Reauthorization Bill Introduced" "China Reports Rise in AIDS Cases; More Women Infected" "4,000 TB Cases Diagnosed in Swaziland" "Kenyans Using 10 Million Condoms Monthly" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Viral Load and Heterosexual Transmission of Human Immunodeficiency Virus Type 1" New England Journal of Medicine (www.nejm.org) (03/30/00) Vol. 342, No. 13, P. 921; Quinn, Thomas C.; Wawer, Maria J.; Sewankambo, Nelson; et al. To determine the influence of viral load compared to other risk factors for HIV transmission through heterosexual sex, researchers from the National Institute of Allergy and Infectious Diseases, Johns Hopkins University, Makerere University in Uganda, and Columbia University in New York studied 415 couples in Uganda in which one partner was HIV-1-positive and the other was initially HIV-1-negative. The couples were followed for 30 months, with 90 of the 415 initially HIV-negative partners seroconverting during the study. The incidence of seroconversion was greatest among partners aged 15 to 19. While the incidence was 16.7 per 100 per-years among the 137 uncircumcised male partners, no seroconversions took place among the 50 male partners who were circumcised. The average serum HIV-1 RNA level was higher among the HIV-positive subjects whose partners seroconverted than those who partners did not seroconvert. There were no cases of HIV transmission among the 51 individuals with serum HIV-1 RNA levels under 1,500 copies per milliliter. The study found a strong correlation between increased serum HIV-1 RNA levels and a greater risk for transmission of the virus. The researchers concluded that viral load is the primary predictor of the risk of heterosexual transmission of HIV-1, with transmission uncommon in individuals with levels below 1,500 copies of HIV-1 RNA per milliliter. "Investigators' Responsibilities for Human Subjects in Developing Countries" New England Journal of Medicine (03/30/00) Vol. 342, No. 13, P. 967; Angell, Marcia An editorial by Marcia Angell, the editor of The New England Journal of Medicine, raises the question of ethical research behavior in studies carried out in developing countries. The study in question, published in the same issue of the journal by Thomas C. Quinn et al., investigated HIV transmission, focusing on the relation between viral load and heterosexual transmission of HIV-1 in couples discordant for HIV-1 at baseline. The participants went 30 months without receiving treatment for known HIV infection, and the researchers did not inform the partner of an infected individual that his or her spouse had HIV. Quinn et al. said that they told the seropositive participants to tell their partners; however, they did not follow up on this. The ethical standards seen here would not take place in the United States or other developed countries. Dr. Angell explains that she approved the study for publication in the journal, hoping to raise more discussions concerning ethical issues in HIV research. "I believe ... that our ethical standards should not depend on where the research is performed," Angell notes. "I also believe that investigators assume broad responsibility for the welfare of the subjects they enroll in their studies." She added, however, that the ethical questions have many sides and are open to debate. "Blood Products Part of FDA Xenotransplant Plan" Nature Biotechnology (biotech.nature.com) (03/00) Vol. 18, P. 258; Fox, Jeffrey L. The U.S. Food and Drug Administration (FDA) has announced a broad plan for the regulation of xenotransplant products and surgeries. The agency has asked a variety of experts--including members of two advisory panels, representatives from the blood product industry, biotechnology companies, and the public--go over draft guidelines to keep such products from spreading new pathogens to the general population. FDA officials say there is hypothetical risk for pathogens, but past experiences with blood supplies tainted by HIV and hepatitis are real. Safety testing for xenotransplantation is difficult, though, since it is hard to detect a pathogen which may not have been discovered yet; there is no sure method for identifying unknown pathogens. However, blood suppliers are upset over recommendations in the draft guidelines that could thwart blood donations at already low levels. Members of the advisory panel have recommended measures that would simplify blood donor questionnaires and suggested the draft guidelines disqualify only xenotransplant recipients and their partners from giving blood. **************************************************************** GENERAL MEDIA **************************************************************** "Just Say no to Sex" USA Today (www.usatoday.com) (03/30/00) P. 9D; Villalva, Maribel Joe McIlhaney Jr. of the Medical Institute for Sexual Health, a nonprofit organization that encourages abstinence until marriage, claims that programs that promote abstinence as the only choice are the most effective in preventing teenage sex. However, Debra Haffner of the Sexuality Information and Education Council of the United States notes there is no published, peer-reviewed proof that abstinence-only programs have long-term results. She said, though, there is some evidence that comprehensive sex education programs that also include contraception have been shown to delay sexual activity. "U.S. Challenged by Changing Face of AIDS" Reuters (03/30/00); Dunham, Will The AIDS epidemic, once seen as a disease of middle-class gay White men, has become a killer of minorities and the poor, including African-American and Hispanic homosexual men, intravenous drug users, and inner-city women. Government statistics show that minorities account for seven in 10 new AIDS cases. AIDS is the leading cause of death for African-American men between the ages 25 to 44, and the disease is the No. 3 cause of death for African-American women in the same age group. AIDS is also significantly affecting Hispanics, and U.S. Surgeon General Dr. David Satcher notes the strong stigma attached with being homosexual in both the African-American and Hispanic communities is keeping some men from seeking HIV prevention or treatment services. "Ryan White AIDS Reauthorization Bill Introduced" Reuters Health Information Services (03/29/00) Sens. James Jeffords (R-Vt.) and Edward Kennedy (D-Mass.) introduced legislation to the Senate on Wednesday that would reauthorize and revise the 1990 Ryan White AIDS CARE Act to provide rural areas with more funds for AIDS. The original measure was mainly geared toward urban areas most affected by AIDS; however, the new bill would double the minimum base funding for states and add a supplemental state grant for rural and underserved areas. The legislation also calls for an expansion of the AIDS Drug Assistance Program. A House version of the legislation, being written by Rep. Tom Coburn (R-Okla.), will likely be introduced next week. "China Reports Rise in AIDS Cases; More Women Infected" Nando Times Online (www.nando.net) (03/29/00) The Chinese health ministry has reported an increasing number of HIV infections for 1999, with more women at risk. There were 4,677 new cases of HIV in China last year, up 41.5 percent from 1998, according to Health News, the Chinese health ministry's newspaper. The report noted that 15.4 percent of all HIV infections in China are now among women. China has recorded more than 17,300 cases of HIV infection since 1985, including 647 cases of AIDS. "4,000 TB Cases Diagnosed in Swaziland" PANA Wire Service (03/29/00) Swaziland recorded more than 4,000 new cases of tuberculosis (TB) last year, with 800 deaths from the disease. Health and Social Welfare Minister Dr. Phetsile Dlamini noted that 58 percent of TB patients are also infected with HIV, according to a 1998 study. Many of the TB cases are among young people, Dlamini said. She highlighted the need for effective treatment to stop the transmission of the TB bacterium to others. "Kenyans Using 10 Million Condoms Monthly" PANA Wire Service (03/29/00); Okoko, Tervil Increased awareness about HIV and AIDS has spurred greater use of condoms in Kenya, according to health officials. At a recent workshop, Meshack Ndolo, the head of the National AIDS and Sexually Transmitted Diseases Control Program reported that Kenyans are using 10 million condoms a month. Ndolo also said the incidence of syphilis has dropped significantly in the past decade, although many people are still contracting sexually transmitted diseases, with about 120,000 cases being treated every month. The official noted that the AIDS epidemic is taking its toll on society, affecting the work force, raising medical costs, and causing psychological trauma. ****************************************************************