Subject: CDC AIDS Daily Summary for Date: Mon May 22 07:01:01 PDT 2000 (196 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Monday, May 22, 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 "Antiretroviral Drug Resistance Testing in Adult HIV-1 Infection" GENERAL MEDIA "Human Trials of Oral HIV Vaccine to Begin" "Mbeki's Visit to U.S. Puts AIDS Activists in a Quandary" "On AIDS Drugs, a Mixed Blessing" "Experts Key on Causes of AIDS Among Blacks" "Report: Cutbacks and Overconfidence Harming Thai Battle Against AIDS" "WHO Targets AIDS, Smoking, Malaria" "Getting Teens' Attention" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Antiretroviral Drug Resistance Testing in Adult HIV-1 Infection" Journal of the American Medical Association (www.jama.com) (05/10/00) Vol. 283, No. 18, P. 2417; Hirsch, Martin S.; Brun-Vezinet, Francoise; D'Aquila, Richard T.; et al. Testing for drug resistance in HIV-1 infection is critical when choosing a new treatment regimen after previous failures and when selecting therapy for pregnant women. The International AIDS Society-USA Panel recommends the use of drug resistance testing in these cases. Both phenotype and genotype assays are available to test for drug resistance. There are some unresolved technical issues in testing regarding set standards, but the benefits of testing still outweigh the room for error. When using HIV drug resistance testing, clinicians should take into account factors other than test results when changing therapies. These factors include drug treatment history, viral load, medication tolerance, adherence likelihood, and related medical conditions. In addition to its recommendations for patients who have failed other regimens and pregnant women, the panel suggests that resistance testing be considered for treatment-naive individuals with established infection; however, it is not firmly recommended for these patients. In pregnant women, zidovudine is suggested as part of the regimen to prevent HIV transmission from mother to child. The researchers note that while resistance testing is costly, when properly used, it can help reduce the overall costs of therapy by identifying appropriate treatments. **************************************************************** GENERAL MEDIA **************************************************************** "Human Trials of Oral HIV Vaccine to Begin" Boston Globe Online (www.boston.com/globe) (05/22/00) P. A4 Researchers are planning to launch human tests of an oral HIV vaccine within the next 18 months. The vaccine is to be tested by Maryland's Institute of Human Virology in Baltimore and Uganda; however, the trial must still be approved by the U.S. Food and Drug Administration. Researchers say the oral vaccine would be less expensive and easier to administer than the injected vaccines now being investigated. Dr. Robert Gallo, head of the Institute of Human Virology, noted that while the vaccine is probably not the ultimate solution for protecting against HIV, it could be very important. "Mbeki's Visit to U.S. Puts AIDS Activists in a Quandary" New York Times (www.nytimes.com) (05/21/00) P. 1-4; Wakin, Daniel J. AIDS activists have been shocked by South African President Thabo Mbeki's open stance on AIDS, after he appointed an AIDS panel consisting of some HIV-theory dissidents. Mbeki is now in the United States on his first visit since becoming president. Activists have decided to greet him with neutrality, without pushing him and possibly making things worse. Jane Silver of the American Foundation for AIDS Research said the effort is to keep the focus on AIDS in Africa. She noted, "Finally, the world is focusing on AIDS in Africa. Part of the challenge is making sure it is not sidetracked." Activists are concerned that reopening the debate about whether HIV causes AIDS could persuade some people to ignore safe sex warnings and possibly fuel the arguments by some that AIDS is a Western conspiracy directed at the Third World. "On AIDS Drugs, a Mixed Blessing" New York Times (www.nytimes.com) (05/22/00) P. A22; Kollodge, Richard; Kerfoot, Matthew W.; Simmons, David; et al. Four letters to the editor discuss the recent announcement by drug companies to provide cheaper AIDS drugs for Africa. Some of the authors applaud the reduced drug costs but also call for better world healthcare, work on an AIDS vaccine, and improvements in poverty, basic sanitation and food supply. David Simmons, a medical anthropologist at Michigan State University, calls the effort "too little too late," and notes that the agreement "does little to stimulate poor countries' rights to produce inexpensive quality drugs." Meanwhile, Carmen Price, director of Agency Services for United Way New York City, asserts that the AIDS epidemic must be attacked from inside, fighting poverty as well as HIV and the stigma and lack of information surrounding the virus. "Experts Key on Causes of AIDS Among Blacks" Bergen Record Online (www.bergen.com) (05/21/00); Johnson, Linda A. A three-day meeting called "An Honest Perspective on HIV/AIDS 2000" ended this weekend in New Jersey, convening government and medical officials, politicians, clergy, and activists. Experts noted that eliminating the stigma surrounding AIDS and increasing funding for prevention programs could help stem the spread of HIV among African Americans. To address the problem, the experts suggested seeking help from churches and universities, demanding more funding for community AIDS organizations, and launching an aggressive effort to get African Americans tested for HIV. The conference, which focused on AIDS in African-American communities in the Northeast, included officials from the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the Congressional Black Caucus. According to Glaxo Wellcome, which sponsored the forum, African Americans made up 61 percent of the HIV infections reported last year and 54 percent of those recorded in 1998. "Report: Cutbacks and Overconfidence Harming Thai Battle Against AIDS" Las Vegas Sun Online (www.lasvegassun.com) (05/21/00) A report in the Thai newspaper The Nation claims that budget Cuts and overconfidence could harm Thailand's efforts against AIDS. On Sunday, the paper reported an increase in HIV prevalence among pregnant women and quoted one expert who warned that a "second wave of AIDS problems is now emerging." According to the report, the proportion of HIV-infected pregnant women last year increased to 1.78 percent from 1.53 percent in 1998, after several years of declines. Dr. Chaiyos Kunanusont, the former head of the health ministry's AIDS division who provided the data, said Thailand's success against AIDS may have resulted in complacency, and he noted that HIV infection rates are still high among some groups, including injection drug users and prostitutes. The Nation also reported concerns by AIDS activists about the end of a government program to distribute free condoms as the result of budget constraints. "WHO Targets AIDS, Smoking, Malaria" Los Angeles Times Online (www.latimes.com) (05/21/00) The World Health Organization (WHO) announced on Saturday that there is a need for more concerted international action against AIDS, malaria, and smoking-related diseases. At the end of its annual conference in Geneva, the WHO listed various measures that need to be taken against the world's greatest health issues. The assembly noted, for example, that AIDS drugs must be more accessible, and delegates also discussed such issues as human cloning and tobacco taxation. "Getting Teens' Attention" Internet Health Care (www.internethealthcaremag.com) (05/00) P. 32; Sherer, Richard A. As part of the second year of its campaign against teen pregnancies and sexually transmitted diseases like HIV, the Illinois Department of Public Health last July launched a Web site intended to attract and educate a teenage audience. The site, called "Respect Your Mind: Protect Your Body," features bright, youth-friendly graphics and colors and includes "listening booths" in which teens discuss sexual issues, RealAudio clips of younger individuals discussing sexual and health issues in realistic settings, a question-and-answer page, a series of situational questions that enable visitors to view the consequences of a particular course of action, and a link to "scoop this," a game in which visitors test their knowledge. Public relations agency Golin/Harris International developed the site for the Illinois health department, interviewing more than 500 teenagers in the state and visiting other teen-oriented sites to understand the attitudes and preferences of teenagers in order to be able to design the site to best appeal to their audience. "It's not a standard health department site," says director Maya Draisin of the International Academy of Digital Arts and Sciences. "They took a topic and an audience that needs to hear that information and did an exceptional job of speaking to that audience." Although it is too early yet to assess its effectiveness, the site has received five awards to date, and the state health department is encouraged by a slight decline recently in the number of new HIV infections reported in Illinois.