Subject: CDC AIDS Daily Summary for Date: Wed Jun 21 07:01:00 PDT 2000 (208 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Wednesday, June 21, 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 "Electric Razors as a Potential Vector for Viral Hepatitis" GENERAL MEDIA "South Africans May Spurn Gift From Pfizer Inc." "US Health Care System Ranked 37th" "Drug Users Flood Hospitals, Metro Detroit Problem Among Worst in Nation" "Congress Starts Annual Fight Over Foreign Funds" "P. Carinii Infections May Be Becoming Resistant to Antimicrobials" "Acyclovir May Protect Against AIDS-Related Lymphoma" "Scientists Hope New Compound Is Better AIDS Drug" "World Bank Approves 212 Million Dollars Loans for Tanzania" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Electric Razors as a Potential Vector for Viral Hepatitis" New England Journal of Medicine (www.nejm.org) (06/15/00) Vol. 342, No. 24, P. 1840; Arbeit, Robert D.; Goodman, Richard P.; Snider, Gordon L. In a letter to the editor, three doctors from the Veterans Affairs Boston Healthcare System respond to a recent report by C.R. Kelly of the Boston Medical Center on the potential risk of viral hepatitis from electric razors. Dr. Arbeit et al. note that the risk of hepatitis from sharing electric razors is "very low." In their system, disposable, single-use safety razors are to be used whenever possible; electric razors--which are used for patients with certain medical conditions, including those who have an increased risk of bleeding--must be thoroughly cleaned after they are returned and before they are distributed to other patients. The authors note that the episode Dr. Kelly described, when one patient picked up an electric just put down by another, was a clear violation of system policy and has prompted a review of current practices. In response, Dr. Kelly writes that since her letter was published in March, sterilization practices at the hospital have been vigilant. She adds, however, that while "the risk of disease transmission associated with the sharing of electric razors is probably very low, ... it should not be dismissed." **************************************************************** GENERAL MEDIA **************************************************************** "South Africans May Spurn Gift From Pfizer Inc." Wall Street Journal (www.wsj.com) (06/21/00) P. B1; Waldholz, Michael Although the notion of philanthropy from drugs companies is very appealing to southern African governments given their small budgets, officials for the South Africa health ministry may well refuse a gift from Pfizer of an AIDS-fighting medication because of the restrictions--including a two-year limit of the donation, the patients for whom the drug may be used, and how the drug's action will be recorded--Pfizer has placed on the offer. While Diflucan is the only effective therapy for the deadly cryptococcal meningitis that affects many HIV patients in sub-Saharan Africa, its daily costs of between $4.50 and $9 are prohibitive for the South African government and most patients. Patients' rights activists, including Doctors Without Borders, have repeatedly asked Pfizer to lower the price of Diflucan, as its cost in Thailand--where Pfizer's patents are not enforceable--is just 60 cents per day, but Pfizer countered with its restricted donation offer. Not surprisingly, Pfizer's charity ends with its patent expiration at the end of 2002, and while that means South African doctors would be able to then buy cheaper generic versions of Diflucan, some officials are suspicious that Pfizer's intention is to acclimate physicians there to the free branded version, as the doctors would be reluctant to switch to a generic formulation when the patent expires. "US Health Care System Ranked 37th" Boston Globe Online (www.boston.com/globe) (06/21/00) P. A2 A survey of the world's health systems, released Tuesday by the World Health Organization (WHO), found that the United States ranked 37th out of the 191 systems reviewed by the organization. The WHO report investigated the quality of care in each country, how much it cost, and how well it was distributed among the people. The United States, which spends the most per person on healthcare each year--$3,700 per person--ranks lower than its industrialized counterparts like Japan, Canada, Scandinavia, the majority of Western European countries, and even several Middle Eastern countries, in part because it fails to provide its poor with adequate healthcare. France came first overall on the list, while the bottom third of the list was made up primarily of countries in sub-Saharan Africa, which have seen their health standards decrease considerably over the last 10 years. According to Dr. Christopher Murray, the WHO's director of global programs on evidence for health policy, "The HIV epidemic has had an enormous hit on African countries, taking 10 years off life expectancy." "Drug Users Flood Hospitals, Metro Detroit Problem Among Worst in Nation" Detroit News (www.detnews.com) (06/20/00) P. 1; Hansen, Ronald J. The metropolitan Detroit area has one of the nation's worst hard-drug problems, as residents are sent to hospitals or die as a result of cocaine or heroin use more often than in Los Angeles, Miami, or New Orleans. Washington, D.C., which has a similar-sized metro area, has only a fraction of drug-related hospital visits compared to Detroit, based on data from the U.S. Department of Health and Human Services' Drug Abuse Warning Network. Experts attribute the problem to several factors, including Detroit's large international airport, the region's proximity to an international border, a large college-age population, and areas of poverty. Between 1996 and 1998, Metro Detroit saw over 600 percent more heroin cases requiring medical attention than the Atlanta area and 68 percent more hospital visits for cocaine overdoses than in the Los Angeles-Long Beach region. Officials are seeing hard drug use cause a rise in crime and health problems. Nearly one-third of the state's 9,950 reported AIDS cases are injection drug users, and over half of the cases are in Detroit and Wayne County. The increasing purity and lower price of heroin are also of concern; in Metro Detroit, heroin was about 48 percent pure last year, compared to 27 percent in 1996. The higher purity of the drug also means that more new users may snort it instead of injecting it. "Congress Starts Annual Fight Over Foreign Funds" Reuters (www.reuters.com) (06/21/00); Wilson, Christopher The House Appropriations subcommittee on foreign operations has approved a measure cutting U.S. funds for Third World debt relief. The bill also cut funding for the World Bank to about $780 million, which will mean major cuts in America's contribution to the World Bank's soft loan program, the primary source of money used to combat HIV and AIDS. "P. Carinii Infections May Be Becoming Resistant to Antimicrobials" Reuters Health Information Services (www.reutershealth.com) (06/20/00) Researchers, led by Dr. Charles Beard of the Centers for Disease Control and Prevention, have discovered that resistance appears to be developing to the sulfone and sulfonamide antimicrobial drugs used to treat Pneumocystis carinii pneumonia. The three-year study of AIDS-related P. carinii isolates in 191 patients found that humans play a key role in the transmission cycle of P. carinii. According to the researchers, two single mutations of dihydropteroate synthase--a target of sulfone and sulfonamide drugs--were identified in less than 6 percent of isolates, while the double mutant was present in half. The report was published in the May-June issue of Emerging Infectious Diseases (2000;6:265-272). "Acyclovir May Protect Against AIDS-Related Lymphoma" Reuters Health Information Services (www.reutershealth.com) (06/20/00) High doses of acyclovir given for a year could help lower the rate of AIDS-related non-Hodgkin's lymphoma, according to Dr. Ignatius Fong of the University of Toronto. Dr. Fong and colleagues studied 29 AIDS patients with non-Hodgkin's lymphoma and 58 control subjects matched for age, sex, and duration of AIDS. The results revealed that 46.6 percent of control subjects had used acyclovir at doses of 800/mg or more a day for a year, compared to 6.9 percent of the lymphoma patients, while 72.4 percent of patients with the lymphoma and 32.8 percent of the control subjects had never taken acyclovir prior to developing lymphoma. The researchers, who published their findings in the May issue of Clinical Infectious Diseases (2000;30:757-761), concluded that high-dose acyclovir or ganciclovir/foscarnet given for at least 12 months is linked to protection against AIDS-related non-Hodgkin's lymphoma. "Scientists Hope New Compound Is Better AIDS Drug" Reuters (www.reuters.com) (06/20/00) Researchers, led by Vasu Nair of the University of Iowa, have created a new compound that may be able to fight HIV. The team reported in the Journal of the American Chemical Society (2000;122:5671-5677) that they used molecular engineering to create a compound that may live in cells longer than current drugs that treat the virus. The compound, an integrase inhibitor, has not been tested on humans or animals, but it has shown promise in test tube experiments. "World Bank Approves 212 Million Dollars Loans for Tanzania" PANA Wire Service (www.africanews.org/PANA) (06/20/00) The World Bank has approved $212 million worth of credits for Tanzania to use in programs that promote growth and governance. One credit of $190 million will be used to improve economic stability and public service delivery. The second credit of $22 million will go towards the health sector, supporting a health project to fight the spread of HIV and improve women and children's health services.