Subject: CDC AIDS Daily Summary for Date: Tue Jun 27 07:01:01 PDT 2000 (194 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Tuesday, June 27, 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 "Hit HIV-1 Hard, but Only When Necessary" GENERAL MEDIA "Peace Corps Expands Anti-AIDS Fight" "Sperm Heating Could Foil HIV" "Cervical Cancer Risk in HIV-Infected Women Explained by HPV Persistence" "TB-HIV Synergy Involves Immune Activation Mediated by INF-gamma, TNF-alpha" "Abstinence 'Til Marriage--the Smart Choice" "Communicable Diseases Prevalence [in Australia] Drops in April" "HIV Women [in Australia] Distrust Treatment Drugs" "Malawi Contemplates AZT For Pregnant Women" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Hit HIV-1 Hard, but Only When Necessary" Lancet (www.thelancet.com) (06/17/00) Vol. 355, No. 9221, P. 2147; Harrington, Mark; Carpenter, Charles C. After four years of widespread highly active antiretroviral therapy (HAART), questions about the cocktail's use continue. Clinicians and activists debate when is the best time to start HAART, how therapy failure should be treated, and how to best fight drug resistance. Studies show that HAART can benefit people with CD4 cell counts under 350. In a World AIDS commentary in The Lancet, Mark Harrington, of the Treatment Action Group in New York, and Charles C.J. Carpenter, of Brown University School of Medicine, Miriam Hospital in Providence, suggest that clinically relevant immune system damage and progression to AIDS and death can be significantly delayed or prevented with careful monitoring of CD4 cell levels and viral loads and when HAART is generally started when the CD4 cell count drops under 350. They note there is currently no available regimen to eliminate HIV-1; all the existing treatments can cause toxic effects; and multidrug resistance can develop unless treatment regimens are followed very closely. "Since the long-term adverse consequences of currently available antiretroviral therapy have become clearer, [it] is important to further define when, in the course of HIV-1 infection, these are outweighed by the proven benefits of antiretroviral therapy," the authors conclude. **************************************************************** GENERAL MEDIA **************************************************************** "Peace Corps Expands Anti-AIDS Fight" Los Angeles Times Online (www.latimes.com) (06/27/00); Briscoe, David Peace Corps Director Mark Schneider is set to announce today a new plan to fight HIV, one that includes training all of its volunteers in Africa about HIV prevention and care and forming a "crisis corps" of 200 former volunteers to help battle the epidemic. "There is no option for any organization working in development other than to play a role in helping these countries confront the HIV-AIDS crisis," Schneider explained. As part of the effort, which will receive additional funding from the Bill and Melinda Gates Foundation and the David and Lucile Packard Foundation, 50 Peace Corps volunteers whose focus is AIDS will be placed in southern and eastern Africa. Peace Corps volunteers will reach hundreds of thousands of people over the next few years, educating those who are at risk for HIV, training communities about prevention, developing leadership among young people for peer counseling, and working on programs to increase nutrition for HIV and AIDS patients. "Sperm Heating Could Foil HIV" BBC News Online (www.news.bbc.co.uk) (06/26/00) French researchers have found that heating sperm to kill HIV does not appear to genetically damage babies, although it will reduce the success of fertility techniques. The researchers heated sperm from mice to 58 degrees Celsius for 30 minutes and then used individual sperm for Intracytoplasmic Sperm Injection (ICSI). ICSI--in which a single sperm is injected into an egg to fertilize it--had to be used because heating makes the sperm immobile and destroys a protein needed to activate the egg during fertilization. The researchers were able to produce two healthy mice, and genetic analysis indicated there was no damage to their DNA. Further research is required, and the scientists plan to continue checking the animals' genes, as well as those of their offspring, to make sure the process is safe. "Cervical Cancer Risk in HIV-Infected Women Explained by HPV Persistence" Reuters Health Information Services (www.reutershealth.com) (06/26/00) Dr. Linda Ahdieh and colleagues at Johns Hopkins University have found that HIV-related immunosuppression in women is associated with persistent human papillomavirus (HPV) infection. The longitudinal study of 268 women, including 184 with HIV, tested the likelihood of subsequent HPV positivity in the 187 who had at least one positive test for HPV. HIV-positive women with less than 200 CD4 cells had a 92.9 percent chance for future infection, while the probability of future infection among HIV-negative women and HIV-positive women with CD4 counts at or above 200 was 47.5 percent and 78.7 percent, respectively. The researchers, who published their findings in the American Journal of Epidemiology (2000;151:1148-1157), said the results highlight the need for access to antiretroviral therapy for HIV-infected women. "TB-HIV Synergy Involves Immune Activation Mediated by INF-gamma, TNF-alpha" Reuters Health Information Services (www.reutershealth.com) (06/26/00) Two research teams from the Centers for Disease Control and Prevention have reported new findings about how active tuberculosis (TB) amplifies HIV replication. Led by Dr. Stephen Lawn, one team found increased viral replication in lymphocytes and macrophages of subjects with both active TB and HIV-1 infection, with higher levels of HLA-DR on viral envelopes. The second team, led by Dr. Julie Turner, examined the in vitro effect of HIV-1, Mycobacterium tuberculosis, or both pathogens on mononuclear cells from individuals who are PPD-negative and HIV-negative. The researchers presented their findings at Tuberculosis 2000 in New York City. "Abstinence 'Til Marriage--the Smart Choice" MSNBC Online (www.msnbc.com) (06/26/00); Goldman, Emily A new survey from Montana reveals that more teenagers in the state are waiting to have sex. The 1999 Montana Youth Risk behavior survey found that 57 percent of high schools students have not had sex, up from 54 percent in 1997. A statewide campaign launched last October uses ads on billboards, radio, and television to promote abstinence. "Communicable Diseases Prevalence [in Australia] Drops in April" Australian Associated Press (aap.com.au) (06/26/00) Australia saw a decrease in prevalence of hepatitis C, sexually transmitted diseases (STDs), and vaccine-preventable diseases in April. According to the most recent Communicable Diseases Intelligence bulletin, the prevalence of hepatitis C fell from 1,233 notifications from 2,015 in March and 1,782 one year ago. Reported cases of STDs dropped, with 984 cases of chlamydia compared to 1,412 in March, and 98 syphilis notifications compared to 169 in the previous month. The bulletin noted there were no reports of cholera, plague, rabies, or yellow fever in April. In addition, there were no notifications of diphtheria, tetanus, or polio, while reported cases of measles, mumps, and rubella were lower compared to April 1999. There were, however, 20 cases of measles reported this past April, versus 11 in March--primarily in South Australia, Victoria, and New South Wales. The report also said that the number of new HIV diagnoses in December 1999 rose to 60, compared to 41 one year earlier. "HIV Women [in Australia] Distrust Treatment Drugs" Australian Associated Press (aap.com.au) (06/26/00); Leung, Chee Chee A new report from the Australian Research Center in Sex, Health, and Society suggests that HIV-infected women in Australia are more distrustful of antiretroviral drugs than men. Less than 66 percent of the women surveyed used antiretroviral drugs, versus 75 percent of the men. Author Karalyn McDonald said many women were not convinced the drugs worked, since all of the trials were conducted on men, and more than 50 percent of the women reported side effects from the drugs. Women composed 11.4 percent of diagnosed HIV cases in Australia in 1999. "Malawi Contemplates AZT For Pregnant Women" Africa News Service (www.africanews.org) (06/26/00); Gama, Hobbs Malawi's government is debating whether to give AZT to pregnant women in the country. The health ministry recently imported supplies of the drug; however, thus far it has been selling it to patients at state hospitals. The ministry was forced to significantly reduce the price of a month's supply of AZT following protests that even middle-class residents could not pay for the drug. Health Secretary Wesley Sangala said the government will make its decision about providing AZT to pregnant women after studies in other countries about AZT's effect on perinatal HIV transmission are complete.