Subject: CDC AIDS Daily Summary for Date: Tue May 23 07:01:00 PDT 2000 (211 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Tuesday, May 23, 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 "Standard Short-Course Chemotherapy for Drug-Resistant Tuberculosis" "The Global Problem of Multidrug-Resistant Tuberculosis" GENERAL MEDIA "Clinton and Mbeki Meet for AIDS Talks" "U.S. Health Official Concerned About Mbeki AIDS Policy" "What $8 a Year Could Do for Africa" "World Bank Aims Funds at Russian TB Epidemic" "Angiogenesis Inhibitor Clinically Active Against AIDS-Related Kaposi's Sarcoma" "Uganda: Openness Will Fight AIDS--VP" "China Steps Up War on Drugs" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Standard Short-Course Chemotherapy for Drug-Resistant Tuberculosis" Journal of the American Medical Association (www.jama.com) (05/17/00) Vol. 283, No. 19, P. 2537; Espinal, Marcos A.; Kim, Sang Jae; Suarez, Pedro G.; et al. A large-scale study of the impact of multidrug-resistant tuberculosis (TB) on directly observed treatment short-course (DOTS) evaluated 6,402 TB cases from six countries. Eighty-six percent were new cases and 14 percent had been treated previously. Of these cases, 1,148 new cases and 390 retreatments were drug-resistant. The six countries involved were Korea, Peru, Hong Kong (China), Ivanovo Oblast (part of Russian federation), the Dominican Republic, and Italy. Treatment failure was higher among new multidrug-resistant TB cases than among new cases that were susceptible. Treatment failure was also higher in patients with rifampicin resistance other than multidrug resistance, any isoniazid resistance other than multidrug resistance, and in patients with disease resistant to rifampicin only. Treatment was successful in 83 percent of new cases, while 2 percent died. Out of the retreatment patients, 57 percent had successful responses, 6 percent died, and 14 percent experienced failure with short-course chemotherapy. Therefore, multidrug-resistant cases had higher failure rates overall. The data suggest that the World Health Organization's recommendation for short-course chemotherapy is not effective for some patients with drug-resistant TB. A modified strategy should aim to locate drug-resistant cases quicker and take into account available resources. Countries should adopt DOTS and treat all cases properly, supervising rifampicin therapy carefully. "The Global Problem of Multidrug-Resistant Tuberculosis" Journal of the American Medical Association (www.jama.com) (05/17/00) Vol. 283, No. 19, P. 2575; Horsburgh, C. Robert, Jr. In a commentary, Dr. C. Robert Horsburgh of the Schools of Public Health and Medicine at Boston University notes that the World Health Organization has heightened its efforts to fight multidrug-resistant tuberculosis (TB) through the use of directly observed therapy short-course (DOTS). In Tarrant County, Texas, a strategy that works to prevent TB using elements of DOTS has helped to reduce primary drug resistance from 14 percent to 2.1 percent while multidrug resistant TB among relapsed patients dropped 80 percent. Today, 119 countries practice DOTS, but the program has not worked effectively enough in reducing multidrug-resistant cases where they are already present. As Dr. Horsburgh writes, it is unlikely that DOTS will cut these rates to low levels by itself. The study in the same issue of the Journal of the American Medical Association (2000;283:2537-2545) points this out on a large scale. Marcos A. Espinal and colleagues suggest that new strategies be formed to treat multidrug-resistant patients, including the use of individually-tailored regimens. Fighting drug-resistant TB has become a worldwide emergency, affecting the United States just as it affects Chile and Russia. Fighting the disease will require commitments to DOTS and DOTS Plus programs as well as to efforts to find new therapies, Horsburgh concludes. **************************************************************** GENERAL MEDIA **************************************************************** "Clinton and Mbeki Meet for AIDS Talks" Washington Post (www.washingtonpost.com) (05/23/00) P. A26; Babington, Charles South African President Thabo Mbeki discussed Africa's poverty and disease problems with President Clinton on Monday. Mbeki continued to be skeptical regarding HIV causing AIDS, briefly speaking to reporters before the meeting. He also clarified his stance regarding the AIDS drug AZT, noting that his concern is that South Africa may not have "a strong enough medical infrastructure" to cope with "the potential toxicities and counter-indications" of the drug. Earlier this month, Clinton ordered that sub-Saharan African countries be given importing or manufacturing discounts for patented anti-AIDS drugs; however, the drugs may still be too costly for the nations' millions of HIV and AIDS patients. "U.S. Health Official Concerned About Mbeki AIDS Policy" Reuters (www.reuters.com) (05/22/00) U.S. Surgeon General David Satcher expressed his concern over South African President Thabo Mbeki's positions on AIDS and AZT use for pregnant women, before a White House dinner on Monday. AZT, or zidovudine, can help reduce the risk of mother-to-child HIV transmission, according to the Centers for Disease Control and Prevention. Satcher said that he and other officials had discussed with Mbeki his decision not to provide AZT to pregnant women due to concerns about its cost and safety. Mbeki rejected on Monday reports that he doubted AZT's efficacy and said he was talking with the World Health Organization about ways to dispense AIDS treatments. "What $8 a Year Could Do for Africa" Washington Post (www.washingtonpost.com) (05/23/00) P. A29; Sachs, Jeffrey D. In a commentary, Jeffrey D. Sachs, the director of the Center for International Development at Harvard University, notes that spending $8 a year from every American could help fight HIV/AIDS, tuberculosis, and malaria in Africa. These diseases take the lives of millions of Africans every year, and a global effort led by America could stop the death toll. The United Nations recently estimated that $4 billion is needed each year to fight AIDS worldwide, and with several countries donating, the cost would be easily affordable. The creation of better vaccines could reduce these costs even further and prevent pain for both the people and the economy. Sachs also discusses the issue of debt cancellation, calling it a critical issue for Africa. In response to his question of whether Americans would be willing to provide $8 a year to help control and prevent several deadly diseases, Sachs writes, "In the America I know, the answer is surely yes--whether you are a liberal Democrat or a conservative Republican, a well--paid professional or a working-class family." "World Bank Aims Funds at Russian TB Epidemic" Reuters (www.reuters.com) (05/22/00); Henderson, Peter The number of tuberculosis (TB) cases in Russia is soaring, with experts estimating there were up to 200,000 TB cases in the country in 1998. A senior World Bank official said Monday that $2.5 million of an existing bank loan will be used as a stop-gap measure to help Russia fight the disease over the next six months. The World Bank board is expected to discuss in October a $170 million loan for Russia, including up to $120 million for TB with the remainder going for AIDS care. According to the World Bank's Dr. Jean-Jacques de St. Antoine, many of the TB patients are prisoners or live in poverty; however, HIV-infected individuals are also at high risk of contracting the disease, and the number of HIV infections in Russia has increased significantly over the past three years. "Angiogenesis Inhibitor Clinically Active Against AIDS-Related Kaposi's Sarcoma" Reuters Health Information Services (www.reutershealth.com) (05/22/00) Dr. Mary Cianfrocca of Fox Chase Cancer Center in Philadelphia has found that once a day treatment with angiogenesis inhibitor col-3 generated a response in 33 percent of patients with AIDS-related Kaposi's sarcoma (KS). The study of 18 patients with KS found a grade 3 or 4 toxicity, and one third of the patients had positive responses. Seven patients left the trial because of adverse effects, which included photosensitivity and headache. The researchers, who reported the results of the phase I dose-escalating trial at the Fourth International AIDS Malignancy Conference at the National Institutes of Health last week, noted that overall incidence of serious side effects was low. "Uganda: Openness Will Fight AIDS--VP" Africa News Service (www.africanews.org) (05/22/00); Nsubuga, Henry Mukasa Uganda's vice president, Dr. Speciosa Kazibwe, said straight talk and openness will help in the fight against AIDS. Kazibwe made her comments at the 17th International AIDS Candlelight Memorial, the theme of which was "Break the Silence: Honor Every Death, Value Every Life." She called for action, not just words, and remembered those who died of AIDS with a bonfire. AIDS is devastating the work force in Africa and causing security concerns worldwide. "China Steps Up War on Drugs" United Press International (www.upi.com) (05/22/00); Macleod, Calum Police in China's southern Yunnan province are heightening their fight against drug smuggling from the Golden Triangle. In four months, police have arrested 3,500 suspected drug dealers and confiscated 1,000 kilograms of heroin and opium. Yunnan borders Burma, Laos, and Vietnam, and is the portal for heroin to enter China. Along with the increase in drug use among ethnic minorities in regions bordering Burma and Laos have been increased cases of HIV. According to a report in the China Daily, Ministry of Health sources say that over 70 percent of China's HIV carriers contracted the virus through injection drug use.