Subject: CDC NCHSTP Daily News Update Date: Thu May 18 09:21:04 PST 2000 (182 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Thursday, May 18, 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 "Prophylaxis Against Opportunistic Infections in Patients With Human Immunodeficiency Virus Infection" GENERAL MEDIA "Patent Holders Fight Proposal on Generic AIDS Drugs for Poor" "AIDS Drugs Can Lead to Diabetes, Report Finds" "Prisoners With AIDS, HIV Return at High Rate" "Fewer Births in HIV-Positive Women Linked to Disease Duration" "Fighting AIDS in Africa" "HIV Co-Discoverers Win Spanish Research Prize" "Mozambique's 'Play Safe' AIDS Project Rated as Successful" "UNICEF Funds Angolan AIDS Awareness Project" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Prophylaxis Against Opportunistic Infections in Patients With Human Immunodeficiency Virus Infection" New England Journal of Medicine (www.nejm.org) (05/11/00) Vol. 342, No. 19, P. 1416; Kovacs, Joseph A.; Masur, Henry Individuals with HIV often deal with opportunistic infections (OIs) that cause substantial morbidity and mortality. A review of the guidelines for preventing these infections, set by the Public Health Service and the Infectious Diseases Society of America, reflects the changes in treatment that are now available to patients with HIV/AIDS. OIs are becoming less common, due to the use of highly active antiretroviral therapy. Mycobacterium avium and cytomegalovirus infections have decreased significantly. The rate of infection for Pneumocystis carinii pneumonia (PCP), however, remains fairly high because of non-adherence to prevention. HIV-infected individuals are more likely to develop OIs when CD4 cell counts fall below 200 per cubic millimeter. Recommended prevention of OIs include recognizing HIV, avoiding exposure, receiving immunization, and using primary prophylaxis. Physicians recommend that primary prophylaxis be given until CD4 cell counts have risen above 200 for diseases like PCP and Mycobacterium avium complex. For diseases like cerebral toxoplasmosis, cytomegalovirus retinitis, and cryptococcal meningitis, treatment is almost always permanent. Prevention and treatment of these infections in combination with HIV infection continues to require close supervision and understanding of drug interactions. **************************************************************** GENERAL MEDIA **************************************************************** "Patent Holders Fight Proposal on Generic AIDS Drugs for Poor" New York Times (www.nytimes.com) (05/18/00) P. A5; McNeil Jr., Donald G. Brazil has surprised world health officials by requesting the creation of a database of all AIDS drugs prices, which would allow poor countries to obtain the best deal on drugs. Large pharmaceutical companies oppose the proposal, claiming it allows countries that ignore drug patents to sell their AIDS drugs for pennies a dose, illegally, in places like India and Thailand. Reactions to the idea continue the debate over drug prices, as patent holders claim only they should manufacture and sell their drugs. Public health advocates and AIDS activists claim poor nations can use clauses in treaties that say during health emergencies the production of generic drugs is allowed. A committee will draft amendments using Brazil's idea and will include members from large developed countries and AIDS-ravaged countries. The database would prove hard to maintain by the World Health Organization, since drug prices change often and there is a risk that some may consider the database an endorsement by the United Nations agency that all the treatments it listed were safe. "AIDS Drugs Can Lead to Diabetes, Report Finds" Reuters (www.reuters.com) (05/17/00) Researchers from Washington University in St. Louis have found that protease inhibitors that help HIV patients can cause diabetes by hampering the storage of glucose. Mike Mueckler and colleagues discovered that human fat cells absorb less glucose after they are exposed to protease inhibitors, which helps explain the unusual fat deposits and metabolic changes that some AIDS patients have experienced. The findings are published in the Journal of Biological Chemistry. "Prisoners With AIDS, HIV Return at High Rate" Arkansas Democrat-Gazette Online (www.ardemgaz.com) (05/18/00); George, Emmett Arkansas' prison system has a high number of HIV-infected inmates returning, according to Max Mobley, deputy director for health programs. Out of 35 HIV-infected inmates released in 1999, 26 have returned after committing parole violations or new offenses. Mobley suggested many came back because "they couldn't afford the medicines" needed to treat their conditions. Inmates with AIDS are cared for under the state's medical services contract, at a cost of about $10,300 each per year; however, inmates are not segregated from the general group unless they are sexually active, aggressive, or very ill. Correction officials have been forming plans to build a special facility for the elderly, chronically ill, mentally ill, and those with HIV or AIDS in Malvern. "Fewer Births in HIV-Positive Women Linked to Disease Duration" Reuters Health Information Services (www.reutershealth.com) (05/17/00) An analysis of data comparing pregnancy rates of 1,642 women with AIDS and 8,443 uninfected women shows that HIV-seropositive women are less likely to become pregnant. Dr. Lisa Lee from the Centers for Disease Control and Prevention and colleagues found that the length of HIV infection relates to declining birth rates, but the lowered birth rates are unrelated to such factors as contraceptive use, induced abortion, or drug use. The researchers suggest that fertility declines as HIV infection continues, as stated in the Journal of Epidemiology (2000;151:1020-1028). "Fighting AIDS in Africa" New York Times (www.nytimes.com) (05/18/00) P. A30; Atkin, Lucy Lucy Atkin, the director of the Margaret Sanger Center of Planned Parenthood in New York City, writes in a letter to the editor that President Clinton should be praised for trying to improve access to AIDS drugs for Africa. With only 1 percent of all AIDS drugs sold in sub-Saharan Africa, "the 23 million people in the area living with HIV or AIDS have little reason to disclose their status or even be tested, and little incentive to take part in safe practices and community outreach initiatives," Atkin notes. Also needed are better family planning and sexuality education programs. "HIV Co-Discoverers Win Spanish Research Prize" Agence France Presse (www.afp.com) (05/17/00) Renowned AIDS experts Luc Montagnier and Robert Gallo have been awarded Spain's Prince of Asturias research prize for the discovery of HIV. The prize is given every year in eight categories and is worth around $27,000. Montagnier is a professor at the Pasteur Institute in Paris and at Queens College in New York City, while Gallo is head of the Institute of Human Virology at the University of Maryland in Baltimore. "Mozambique's 'Play Safe' AIDS Project Rated as Successful" PANA Wire Service (www.africanews.org/PANA) (05/17/00) Mozambican health officials believe the "Play Safe" project, which started seven months ago, has been successful in fighting AIDS. The project involves training athletes about HIV and other sexually transmitted diseases and passing out leaflets containing advice and information about how to prevent the infections. Already, nearly 640 people have been trained, and about 400,000 condoms and 50,000 pamphlets have been distributed. According to Mozambique's health ministry, the classes "are aimed at providing soccer players, referees, sports leaders, and sympathizers with knowledge that will allow them to engage in safe and responsible sexual practices." Officials also noted that there are about 700 new HIV infections every day in Mozambique. "UNICEF Funds Angolan AIDS Awareness Project" PANA Wire Service (www.africanews.org/PANA) (05/17/00) UNICEF has agreed to donate $16,000 to help fund an AIDS awareness program in southern Angola. Tom Wolsen, the UNICEF representative in the region, said the funds will be used to help stress the importance of prevention in the fight against AIDS. The donation will go to the nongovernmental organization Aprazador, which will focus on young people using lectures and plays and will distribute condoms and HIV prevention information.