Subject: CDC AIDS Daily Summary for Date: Thu Jun 22 08:10:40 PDT 2000 (213 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Thursday, June 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 "Accelerating the Development and Future Availability of HIV-1 Vaccines: Why, When, Where, and How?" "Preventing Cervical Cancer" GENERAL MEDIA "Drugs Show Promise in Tuberculosis Fight" "Immune Response Says HIV Treatment Helps T-cells" "State's Decision Not to Process HIV Test Kits Tries Officials" "Health Department to Begin Campaign" "New Guidebook Offers Help to Pastors in Addressing AIDS" "Africa Debt Relief Needed to Tackle AIDS--WEF" "Condom Use Among Botswana Youth Low" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Accelerating the Development and Future Availability of HIV-1 Vaccines: Why, When, Where, and How?" Lancet (www.thelancet.com) (06/10/00) Vol. 355, No. 9220, P. 2061; Esparza, Jose; Bhamarapravati, Natth In order to stop the HIV pandemic, a safe and affordable preventive vaccine is greatly needed. Authors Jose Esparza, of the WHO-UNAIDS HIV Vaccine Initiative, and Natth Bhamarapravati, of the Mahidol University Center for Vaccine Development in Thailand, note that a vaccine is the best hope to control the pandemic in developing countries; however, it should not replace prevention efforts that are vital to changing behavior. The amount of research needed to produce a vaccine is immense, and funding is crucial to research. A vaccine will require billions of dollars before it is produced, along with many phases of efficacy and clinical trials. Disagreement over the criteria for phase III trials has slowed trials down to 11 years from phase I to phase III. Thus far, only one candidate vaccine has reached phase III trials, and, at most, only two more vaccines will reach this stage within the next five years. Some approaches to help hasten the development of a vaccine include a multibillion dollar vaccine fund and tax-break incentives. A lack of information on immune protection is also hindering research, and studies on primates have seen varying success. The 10 genetic subtypes of HIV-1 also present the issue of which vaccine will be produced first, one that will fight virus subtypes that are prevalent in the West or in African countries. Once an effective HIV-1 vaccine is created, a plan for administering it is needed, so that target populations are reached and the delivery is cost-effective. "Preventing Cervical Cancer" Science (www.sciencemag.org) (06/09/00) Vol. 288, No. 5472, P. 1753; Cain, Joanna M.; Howett, Mary K. The Pap smear has greatly reduced the incidence of invasive cervical cancer in countries where the test is easily available to women. The United States, for example, saw a 74 percent drop in cervical cancer from 1955 to 1992. The deaths from cervical cancer are usually among women who never had a Pap smear. Evidence shows that infection with human papillomavirus (HPV) increases the risk of cervical cancer, so that HPV testing has become a strategy to reduce the risk. However, Joanna M. Cain and Mary K. Howett, both of the Pennsylvania State University College of Medicine, note that HPV testing costs more than a Pap smear and false positives occur often. HPV testing alone is not a confirmation of actual disease and should be used in addition to Pap screening. Most HPV infections are acquired quickly during the first years of sexual activity, with HPV prevalence reaching 25 percent to 39 percent of a sample group. The infection can often be cleared by the body on its own, and just 1 percent of women who have a cervical lesion on a Pap smear that tests positive for HPV develop cervical cancer. The authors note that one key issue involved in screening for cervical cancer is avoiding overtreating young women. They assert that HPV testing should be geared toward individuals "of an age when HPV is most rapidly acquired, but with the knowledge that the majority of infections are readily cleared without the development of precursor lesions." In addition, the public must be educated about HPV subtypes and risks of infection as women grow older. Future HPV prevention efforts will involve the development of an effective vaccine and microbicidal agents to inhibit or inactivate HPV. Cain and Howett assert that is important that HPV screening does not replace the need for Pap smears, which are underused in most countries. **************************************************************** GENERAL MEDIA **************************************************************** "Drugs Show Promise in Tuberculosis Fight" USA Today (www.usatoday.com) (06/22/00) P. 9D; Healy, Michelle Researchers from PathoGenesis in Seattle have developed a potential treatment for drug-resistant tuberculosis (TB). The scientists report in the current issue of Nature that a family of drugs called nitroimidazopyrans has proven effective against TB in animal tests. Given sufficient funding and successful clinical tests, the drug could receive regulatory clearance in five to eight years, the researchers said, which would make it the first new anti-TB therapy in three decades. "Immune Response Says HIV Treatment Helps T-cells" Reuters (www.reuters.com) (06/21/00) Preliminary data from the Immune Response Corp. indicates that the drug Remune can activate killer T-cells against HIV. The double-blind, placebo-controlled study involved 243 HIV-infected patients who had not previously taken antiviral drugs. The company presented the data from the phase II clinical research on Tuesday, at the European Conference on Experimental AIDS Research in Madrid. "State's Decision Not to Process HIV Test Kits Tries Officials" St. Louis Post-Dispatch (www.stlnet.com) (06/21/00) P. A1; Kee, Lorraine The St. Louis Department of Health and Hospitals and other groups are struggling following a recent announcement by the state that it will no longer process oral screening tests for HIV at its lab. Approximately 25 percent of the HIV tests in the city use the oral screenings, and now city health officials must pay for their processing. Missouri health officials allot 650 OraSure test kits to the St. Louis region each year; however, the city health department used up its supply in just two months. The hundreds of additional tests that the city has purchased in previous years and has had processed at no charge by the state--about 2,400 last year--will not longer be covered. Mary Menges, head of the state Health Department's STD/HIV/AIDS prevention and care services division, said the state cannot afford to pay for the extra oral tests, but she noted that HIV blood tests from public health departments will still be processed for free. Some outreach groups complained about the poor timing of the change, since National HIV Testing Day is next Tuesday, June 27, and several other upcoming events had planned to use the oral tests as well. "Health Department to Begin Campaign" Amarillo Globe-News Online (www.amarillonet.com) (06/21/00); Doyle, Thomas In Texas, the Amarillo Department of Public Health has announced plans for an aggressive campaign against sexually transmitted diseases in Potter and Randall counties. According to Claudia Blackburn, the director of public health for the Amarillo Health Department, Potter County had the highest annual chlamydia rate in the entire state between 1995 and 1997. "Our response was to write a grant proposal to the Texas Department of Health. We said we were going to cut the number of chlamydia and gonorrhea infections by 10 percent in one year." One aspect of the campaign--which is to start next month--will be increased case surveillance, since a staff shortage has prevented the investigation of about 75 percent of the cases. The STD program plans to hire four more workers to help increase the percentage of cases investigated to at least 80 percent, Blackburn said. The effort, to be funded by an Innovation Grant from the Texas Department of Health, will also focus on case intervention. "New Guidebook Offers Help to Pastors in Addressing AIDS" Los Angeles Times (www.latimes.com) (06/21/00) P. B3; Stewart, Jocelyn Y. Bishop Kenneth Ulmer, pastor of Faithful Central Baptist Church in Inglewood, California, uses a passage from the bible to highlight the Christian message of healing without questioning an illness and how it is contracted. He uses the message to reach people with AIDS and to encourage AIDS education. A new book for pastors called "Healing Begins Here: A Pastor's Guidebook for HIV/AIDS Ministry Through the Church" contains these messages, and is intended to help African-American ministers who want to help stop AIDS in the community. Some pastors are not comfortable addressing AIDS, sex, homosexuality, and drug abuse in sermons. However, the Rev. Alfreda Lanoix of Unity Fellowship Church in Los Angeles noted, "Sex education is all about values. What better place to teach values than in the church." The guidebook, a collaborative effort between the Statewide HIV/AIDS Church Outreach Advisory Board and the California Department of health Services' AIDS office, provides information on how to start an AIDS ministry and how to approach the subject in the congregation. Copies of the book are free. "Africa Debt Relief Needed to Tackle AIDS--WEF" Reuters (www.reuters.com) (06/21/00); Isa, Mariam The World Economic Forum (WEF) has released a report calling for debt relief in Africa to allow its governments money for health and AIDS programs. The 290-page report cited war, floods, and disease outbreaks as threats to the African economy. AIDS is expected to hurt foreign investment and strain government budgets as overall profits decline. The report noted that debt relief has been given to only a fraction of countries considered for it. "Condom Use Among Botswana Youth Low" PANA Wire Service (www.africanews.org/PANA) (06/21/00) Margaret Mosojane, a community leader in Botswana, said Tuesday that many youths in the country are not using condoms, despite their efficacy in helping to prevent the spread of HIV. Mosojane cited the high rate of teen pregnancy in Botswana as evidence of unprotected sex among youths. One of the countries hardest hit by the AIDS epidemic, Botswana is estimated to have an HIV infection rate of about 25 percent.