Subject: CDC AIDS Daily Summary for Date: Fri May 12 07:01:01 PDT 2000 (227 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Friday, May 12, 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 "Russian TB Epidemic Prompts Legal Reform" "Counting the Cost" "Working in the Hot Zone: Galveston's Microbe Hunters" "New US Tuberculosis Guidelines Suggest Targeted Screening" GENERAL MEDIA "AIDS Drug Plan Spurs Call to Cut Prices Elsewhere" "AIDS Drug Makers Seen Blunting Criticism With UN Pact" "Interview: Libya Lawyer Says Bulgarians in HIV Case Claim Duress" "High-Risk Sexual Behavior Persists Among Many Gay Men" "AIDS Spreading Fast Among S. Africa's Youth" "Politics of AIDS Relief Add to Africa's Suffering" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Russian TB Epidemic Prompts Legal Reform" Lancet (www.thelancet.com) (04/29/00) Vol. 355, No. 9214, P. 1525 Medecins San Frontieres (MSF) wants legal reform in the former Soviet Union to help control the tuberculosis outbreaks in prison. A MSF panel calls for less crowded cells, better screening and better tracking. "Counting the Cost" New Scientist (www.newscientist.com) (04/29/00) Vol. 2236, P. 14; Le Page, David; Day, Michael AIDS activists have admonished the South African government for not making sufficient enough inroads in combating HIV. South African President Thabo Mbeki has been criticized for refusing to fund AZT prescription for pregnant women for the prevention of HIV transferent to children because he believes that the drug is too toxic, dismissing the country's Medicines Control Council after they rejected Mbeki's proposal of a home-grown AIDS treatment based on a toxic industrial solvent, and establishing a special panel to determine whether AIDS and HIV exist and if HIV indeed leads to AIDS. KwaZulu-Natal health minister and ruling party ANC's National Executive Committee member Zweli Mkhize counters that the real problem lies with the exorbitant prices charged by the pharmaceuticals industry. However, nevirapine, a cheaper drug that prevents mother-to-child transmission, has been accused of causing the liver-related deaths of five South Africans involved in clinical trials, despite the fact that it has never been associated to liver damage during its extensive use worldwide. Hooosen Coovadian, an AIDS researcher at the University of Natal, notes that preventing babies being born with AIDS is not perceived as cost-effective since they do not spread the disease and are not economically productive. At least 40 percent of the country's funds designated for AIDS last year went unspent. "Working in the Hot Zone: Galveston's Microbe Hunters" Science (www.sciencemag.org) (04/28/00) Vol. 288, No. 5466, P. 598; Enserink, Martin Galveston, Texas, is home to the University of Texas Medical Branch (UTMB), where virologists and microbiologists study tropical and infectious diseases. Malaria researcher Joseph Vinetz moved to the area from Johns Hopkins, as the number of faculty has tripled to 70 and funding rose to nearly $10 million this year. The researchers study malaria, dengue, hantavirus, yellow fever, and hemorrhagic fevers. Much of the field work is easily done in Central America. Galveston's past is filled with outbreaks of yellow fever, cholera, typhoid, and dengue. UTMB was not well-known for much of the 20th century, but has become a strong university supported with a new lab with biosafety level-three rooms. Bob Shope, leader of Yale's Arbovirus Research Unit, left New England to help build UTMB and its lab. Last year, Vinetz found the code for the mosquito gut protein that the malaria parasite uses to travel into its glands. A new BSL-4 lab is in the works in Galveston, which is sure to attract more experts in virology, such as C.J. Peters of the Centers for Disease Control and Prevention's Special Pathogens Branch. The scientists say it is easy to work together in Galveston, because no one considers themselves to be the boss. The virologists are working to study the structure of proteins to create defenses against possible bioterrorism, studying flaviviruses, alphaviruses, and arenaviruses, and are supported by a $3.7 million grant from the Defense Advanced Research Projects Agency. The location near Mexico also provides easy study of recent dengue and hepatitis outbreaks along the border. "New US Tuberculosis Guidelines Suggest Targeted Screening" Lancet (www.thelancet.com) (04/29/00) Vol. 355, No. 9214, P. 1525; Pirisi, Angela The American Thoracic Society and the Centers for Disease Control and Prevention have released new guidelines for treating latent tuberculosis in America. The guidelines emphasize the need for targeted testing of those at risk, such as immigrants. The study used 30 years of data to show the success rate of treatment and adherence. Directly observed therapy will help with compliance. **************************************************************** GENERAL MEDIA **************************************************************** "AIDS Drug Plan Spurs Call to Cut Prices Elsewhere" Wall Street Journal (www.wsj.com) (05/12/00) P. B1; Harris, Gardiner; Waldholz, Michael Thursday's announcement that five major drug makers--Bristol-Myers Squibb, Glaxo Wellcome, Merck, Roche Holding, and Boehringer Ingelheim--will slash prices for their AIDS drugs has initiated calls for additional programs to help the poor worldwide and fueled controversy over whether drugs prices in the United States should be regulated. Varying reactions include Kaiser Family Foundation President Drew Altman's comment that the announcement will convince organizations like HMOs, hospitals, and federal and state governments to demand lower prices and Anti-AIDS Foundation of Spain President Jose Torres's observation that it will be difficult to ensure that the low-cost medicines reach their intended destinations rather than end up on the black markets because African governments have not really responded to the AIDS threat and are rife with political corruption. South Africa is pleased with the pact, but is being cautious, as seen in Health Ministry spokeswoman Patricia Lambert's statement that the agreement will not be acceptable if it contains conditions preventing the country from pursuing cheaper alternatives, such as generic versions, parallel importing, and compulsory licensing. The deal is expected to pressure other drug companies into cutting prices for their AIDS drugs as well, such as Abbott Laboratories, the manufacturer of HIV protease inhibitor Norvir, which stated that it is considering joining the initiative; however, Pfizer has vowed that it will not take part because it already has plans to donate Diflucan, a drug used to treat cryptococcal meningitis-related fungal infections, to South Africa. "AIDS Drug Makers Seen Blunting Criticism With UN Pact" Reuters (www.reuters.com) (05/11/00); Brinkerhoff, David Restricted access to AIDS drugs due to price has become a major issue for AIDS activists and has generated growing criticism that major pharmaceutical firms are placing earnings growth above the needs of the developing world. A deal brokered by the United Nations involving the reduced prices of AIDS drugs offered by five drug makers could go a long way in combating negative perceptions about the drug giants. While Cambridge Pharma Consultancy head of business strategy Martin Postle believes that the move will significantly affect the companies' anti-viral units, Washington Analysis senior vice president Ira Loss contends that financial losses will be minimal because the deal will involve sales that did not previously exist. Mehta Partners drug analyst Viren Mehta points out that the deal will enable the pharmaceutical companies to obtain valuable scientific knowledge since they will have access to areas that are the most affected by the AIDS epidemic, providing them with a better idea of the different virus strains and mutations and how the virus develops resistance to specific drugs. "Interview: Libya Lawyer Says Bulgarians in HIV Case Claim Duress" Reuters (www.reuters.com) (05/12/00); Sabeva, Galina A lawyer defending six Bulgarian medics accused by Libya of infecting hundreds of children with HIV said two of the medics confessed under duress. Lawyer Osman Byzanti must speak to his clients through an interpreter, and has met the defendants twice. The accused face the death penalty if convicted of intentionally infecting 393 children in a Benghazi hospital with HIV. Over 40 of the children have died from AIDS, which Libya claims was part of a conspiracy. "High-Risk Sexual Behavior Persists Among Many Gay Men" Reuters Health Information Services (www.reutershealth.com) (05/11/00) A study by Dr. Udi Davidovich from the Amsterdam Municipal Health Service, published in the April 14 issue of AIDS, studied 285 young gay men in monogamous relationships. A questionnaire given to the men determined that 12 percent discussed negotiated safety sex and what risks they would take, but 10 percent did not follow it. A second study from Dr. D.J. Wiley of UCLA studied 937 men with HIV and evaluated if ejaculate exposure during anal sex causes rapid CD4 cell loss. The researchers determined that 42 percent of the men had CD4 cell loss stemming from factors associated with ejaculate exposure and the risk of sexually transmitted diseases. "AIDS Spreading Fast Among S. Africa's Youth" Arizona Daily Star Online (www.azstarnet.com) (05/12/00) Young people in South Africa are rapidly contracting AIDS, according to a study by Abt Associates of South Africa Inc. The epidemic is growing fastest among people aged 15 to 25, and officials fear President Thabo Mbeki's mistrust of Western ideas about HIV causing AIDS will hamper any progress. Fifty percent of young people with HIV in South Africa are expected to die by age 35, with teenage girls and young women most afflicted. The study by Abt is the first to analyze the epidemic's impact on certain age groups. "Politics of AIDS Relief Add to Africa's Suffering" Seattle Times Online (www.seattletimes.com) (05/12/00) President Clinton's executive directive to keep alive part of the Africa trade bill that allows poor African countries to obtain cheaper AIDS drugs has prompted pharmaceutical companies to offer discounts on the drugs. The drug companies have acted to prevent African nations from turning to generic drugs produced in other countries. Although the promise of lower drug prices offers hope, Africa's ineffective medical infrastructure makes it difficult to deliver the treatments. Many fear that the cheaper prices will lead to political corruption in distributing the drugs. AIDS drugs must be taken under a rigorous schedule, and medical supervision is hard to come by. Africa continues to deal with an epidemic as the option of cheaper drugs provides little relief. ****************************************************************