Subject: CDC AIDS Daily Summary for Date: Tue Oct 2 11:31:01 PDT 2001 (373 lines) From: National AIDS Info Clearinghouse Copyright 2001, Information, Inc., Bethesda, MD 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 NATIONAL NEWS "Babbitt to Lead AIDS Action" "New York AIDS Groups Lose Millions in Wake of Terrorist Attacks" INTERNATIONAL NEWS "Asia Is New Battleground Against AIDS: UN" "Mbeki Plays Down AIDS and Orders A Rethink on Spending" MEDICAL NEWS "Impact of Human Immunodeficiency Virus Type 1 (HIV-1) Subtype on Women Receiving Single Dose Nevirapine Prophylaxis to Prevent HIV-1 Vertical Transmission (HIV Network for Prevention Trials 012 Study) -Concise Communication" "Study Points To a Better Hepatitis C Treatment" LOCAL AND COMMUNITY NEWS "Abstinence-Based Sex Ed Is Failing, Teens Say" NEWS BRIEFS "Khadafi Son Urges Release of Bulgarians in AIDS Case" "Health Workers Lack Knowledge About HIV/AIDS" "Shortstop Guillen Improving" ************************************************************ NATIONAL NEWS ************************************************************ "Babbitt to Lead AIDS Action" New York Blade (09.28.01)::Kara Fox On Sept. 17, Harriet C. "Hattie" Babbitt became executive director of AIDS Action, a national AIDS advocacy organization. She replaced Claudia French, who left to become executive director of the Denver-based Gill Foundation. Babbitt, 53, served for three years as deputy administrator for the US Agency for International Development (USAID). Prior to that, she served for four years as US ambassador to the Organization of American States (OAS). She is an attorney and has been affiliated with the Woodrow Wilson International Center for Scholars, the Alan Guttmacher Institute and the National Democratic Institute for International Affairs. "Hattie Babbitt has spent much of her life trying to improve the conditions of America's underserved communities," said a statement released by AIDS Action. "She has also worked extensively on international human rights issues, strengthening the inter-American human rights system while ambassador to the OAS, and has traveled the globe to provide humanitarian relief on every continent, in areas ranging from Kosovo to East Timor. At USAID, Babbitt did HIV/AIDS work in Africa and South Asia and led numerous health-related strategic initiatives." In her new position, Babbitt said she wants to focus on AIDS prevention, care and research. "There are 40,000 cases of new AIDS each year. One person under the age of 25 is infected every hour. I want to work until we have an AIDS-free generation," she said. "We know that prevention works. ... There are prevention treatments that work." She said that access to care will remain a key agenda item for the organization, and she said she will "work with friends on [Capitol] Hill" to get continued funding for people with AIDS. "I am doing this because, like a lot of others, I lost friends to AIDS... . Also, one of our sons, TJ, is gay," Babbitt said. "New York AIDS Groups Lose Millions in Wake of Terrorist Attacks" Advocate (09.27.01) New York City AIDS groups have lost millions of dollars due to interrupted services and the costs of emergency food and shelter for their clients in the wake of the September 11 attack on the World Trade Center, according to New York's AIDS service organization Housing Works. Housing Works reports that top officials from the New York State Department of Health's AIDS Institute are conducting a formal evaluation of the attack's impact on groups serving lower Manhattan. Early data indicate that most organizations experienced "significant disruptions" in services, including office closures, problems with communications and transportation, and restricted client and staff access to services. Additional expenses are anticipated by the health department, including higher expenditures for mental health services. The department expects that money from federal and state relief agencies will be given to groups with significant losses subsequent to the attack. The department's full assessment is expected this week. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Asia Is New Battleground Against AIDS: UN" Times of India (10.02.01)::Agence France Presse The UN's top AIDS official on Tuesday warned that Asia must wake up to the battle against the disease if it wants to avoid the fate of Africa. "At the moment in Asia, the perception is that it is particularly a problem for Africa, but Asia is very vulnerable," said Peter Piot, the director of the Joint UN Program on HIV/AIDS. "The most affected countries are Thailand, Myanmar and Cambodia." According to Piot, the HIV/AIDS epidemic had reached alarming proportions in other countries in the region, including India. "In India, we are close to five million infected people." Piot warned against complacency in the fight against HIV/AIDS. "Actions taken today will determine the global shape of the epidemic in a decade," he said in a lecture at the UN University in Tokyo. Piot was in Japan for talks about progress in setting up a Global Health Fund proposed during a Group of Eight summit. "By the beginning of the next decade, South Africa, which represents 40 percent of Africa's economic output, will be facing an output 17 percent lower than it would be without AIDS," he said. "There is a false sense of security in Asia. But there are also enormous opportunities; if measures are taken and prevention campaigns organized, greater disasters can be prevented," he added. "Mbeki Plays Down AIDS and Orders A Rethink on Spending" British Medical Journal (09.22.01)::Pat Sidley South African President Thabo Mbeki has alarmed doctors and health professionals with a letter he wrote to Health Minister Dr. Manto Tshabala-Msimang in August which ordered a re- examination of health and social policy, spending, and research in light of figures on deaths from AIDS. Mbeki suggested to the health minister that there were fewer deaths from AIDS than conventional wisdom claimed. In citing the number of deaths, Mbeki chose figures from 1995, when deaths from AIDS were considerably lower than they are today and when the figures did not include deaths from diseases related to AIDS. In the letter, Mbeki instructed the health minister to look at 1995 figures, which he extracted from the World Health Organization's Web site. At that time AIDS accounted for only 2.2 percent of deaths in South Africa. Other diseases and disorders were shown to kill many more people. Mbeki made three points for the health minister to consider. He asked whether current health policies dealt adequately with preventing death, given the chief causes of death in the country. He also questioned whether priorities for health and social spending were appropriate. Finally, Mbeki asked whether state funded medical research was appropriate. The letter repeated a proposal from the presidential AIDS panel to question AIDS figures "that are regularly peddled as a true representation of what is happening in our country." The letter stated, "Needless to say, these figures will provoke a howl of displeasure and a concerted propaganda campaign among those who have convinced themselves that HIV/AIDS is the single biggest cause of death in our country." ************************************************************ MEDICAL NEWS ************************************************************ "Impact of Human Immunodeficiency Virus Type 1 (HIV-1) Subtype on Women Receiving Single Dose Nevirapine Prophylaxis to Prevent HIV-1 Vertical Transmission (HIV Network for Prevention Trials 012 Study) -Concise Communication" Journal of Infectious Diseases (08.13.01) Vol 184; P 914- 917::Susan H Eshleman; Graziella Becker-Pergola; Martina Deseyve; Laura A Guay; Martin Mracna; Thomas Fleming; Shawn Cunningham; Philippa Musoke; Francis Mmiro; J Brooks Jackson Little is known about the relationship between HIV-1 subtype (clade) and HIV-1 transmission or pathogenesis. Subtypes A and D account for most HIV-1 infections in Uganda. The HIV Network for Prevention Trials (HIVNET) 012 study in Uganda recently demonstrated that single-dose Nevirapine (Nvp) prophylaxis is effective for preventing mother-to-child transmission (MTCT) of HIV-1. In the HIVNET 012 study, pregnant Ugandan women received a single dose of Nvp at the onset of labor, and infants received a single dose of Nvp within 72 hours of birth. Because clinical outcome of women in HIVNET 012 was monitored for only 6-8 weeks, it was not possible to evaluate the relationship of HIV-1 subtype with clinical outcome. Recent reports compared the rate of disease progression in persons infected with subtype A versus subtype D. One study of women in Senegal with non-A subtypes (C, D, or G) found that the women were more likely to develop AIDS within 5 years of infection than were women with subtype A. Two other studies, including one from Uganda, found no significant difference in disease progression in persons with subtype A or D. This exploratory study examines the relationship between HIV-1 subtype, MTCT, and the development of Nvp resistance in women enrolled in HIVNET 012. In this study, virus loads and CD4 cell counts before Nvp administration were similar among women with subtypes A and D. Women had not received prior antiretroviral therapy and did not receive antiretroviral therapy after the single dose of Nvp, which is consistent with the standard of care in Uganda. Of the 102 women analyzed in this study, 50 (49 percent) had subtype A, 35 (34 percent) had subtype D, 4 (4 percent) had subtype C, and 12 (12 percent) had recombinant HIV-1, which is similar to the distribution of subtypes found in Uganda in recent epidemiological studies. Because only the subtypes of the HIV-1 pol region were analyzed, it is possible that the subtypes of other HIV-1 genes may differ, reflecting the high rate of HIV-1 intersubtype recombination in Uganda. Researchers found no difference in the rate of MTCT in women with HIV-1 subtype A or D, which is consistent with a recent study from Kenya, which found no significant difference in the frequency or mode of MTCT in women with HIV-1 subtypes A or D. More extensive studies are needed to define further the role of HIV-1 subtype on MTCT in different clinical settings. However, researchers observed a higher rate of Nvp resistance in women with subtype D than those with subtype A after single-dose Nvp prophylaxis. Confirmation in larger studies is needed to evaluate further the influence of subtype A after single-dose Nvp prophylaxis. A higher rate of Nvp resistance in women with subtype D HIV-1 could reflect a high replication rate of subtype D HIV-1. HIV-1 subtypes also differ in the frequency of amino acid polymorphisms at positions associated with antiretroviral drug resistance. Such differences may influence the fitness of HIV-1 with antiretroviral drug resistance mutations, such as K103N. The authors concluded that the potential selection of Nvp resistance in women receiving the HIVNET 012 regimen "must be balanced against the simplicity, efficacy, and cost-effectiveness of the regimen. Implementation of this regimen could prevent HIV- 1 infection in millions of HIV-1 exposed infants over the next decade." "Study Points To a Better Hepatitis C Treatment" Washington Post (10.02.01)::Susan Okie According the early release of a study to be published on November 14, 2001 in the New England Journal of Medicine, almost all cases of chronic liver disease caused by the hepatitis C virus could be prevented if people were given the antiviral drug interferon soon after becoming infected. The study, led by Michael P. Manns of the University of Hannover, represents an important advance over current, less effective treatments for chronic hepatitis C. "These findings are persuasive," said Raymond T. Chung, medical director of the liver transplant service at Boston's Massachusetts General Hospital. "I think one of the more important implications ... is that we have to be more vigilant for the discovery" of new cases of hepatitis C infection. About 4 million Americans and about 170 million people worldwide are estimated to be infected with hepatitis C. The German study found that 42 of 453 newly infected patients who received six months' treatment with interferon alfa-2b became virus-free and remained so after therapy ended. About 6,500 people in the United States become infected with virus each year, according to the CDC. About one-quarter of those who chronically remain infected develop cirrhosis. The virus kills between 8,000 and 10,000 Americans annually. Identifying people with hepatitis C is difficult and expensive, requiring multiple laboratory tests to distinguish liver function impaired by hepatitis C from other forms of liver inflammation. Most people infected with the virus acquired it from transfusions before a blood test for the virus was licensed in 1990. It can be spread through intravenous drug use and by contaminated medical and dental instruments. Tattooing has been implicated in some cases. It can also be transmitted sexually or from a pregnant woman to her infant. In the reported study, funded in part by the drug's manufacturer, researchers treated 44 hepatitis C patients with interferon alfa-2b daily for four weeks, then three times a week for another 20 weeks. Forty-three received the full treatment; one stopped after 12 weeks because of side effects. Tests conducted 24 weeks after treatment found that hepatitis C was undetectable in 42 of 43 patients. Interferon can cause side effects such as muscle and joint aches, headache and fever. Some patients experience depression or a reduction in white blood cells or platelets. Six months of treatment with interferon alfa-2b costs about $6,000, according to investigator Manns. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Abstinence-Based Sex Ed Is Failing, Teens Say" Los Angeles Times (09.30.01)::Jessica Garrison Some Santa Ana teenagers who say they are tired of seeing friends get pregnant and drop out of school are asking the school board to change the way it teaches about sex. The youths say the city's rate of teenage motherhood -one of the highest in California -shows that the school district's abstinence-based sex education curriculum is not working. "We feel the school board should be concerned," said Century High School senior Maricela Sandoval. "We want them to teach contraception, and how to deal with relationships." Sandoval is one of 15 young Santa Ana women and men recruited by the Campfire USA Orange County Council Speak Out program to research teenage pregnancy in the city. The group, funded by a grant from the California Wellness Foundation (CWF), paid for the volunteer teens' transportation and snacks during the 18 months they spent surveying fellow students about their sex habits and polling parents about what should be taught in schools. Twelve groups around the state have received the CWF grants. The youths have already begun speaking individually with school board members. They plan to go before the board this month to demand that health teachers give students more information about the prevention of STDs and how to get birth control pills and condoms in addition to abstinence counseling. Currently, Santa Ana schools give students basic biological information but emphasize abstinence. Teachers tell students where to look in the phone book to find numbers of family planning clinics. A 1996 University of California-Berkeley study identified Santa Ana as one of seven "trouble spots" in Southern California for teenage births, with more than 8 percent of girls ages 15 to 17 having babies each year. The students' survey found that three out of five area teenagers said they were sexually active, and the majority of teenagers, parents and health teachers surveyed all supported improving the sex education curriculum. ************************************************************ NEWS BRIEFS ************************************************************ "Khadafi Son Urges Release of Bulgarians in AIDS Case" Agence France Presse (10.02.01) Libyan leader Moamer Kadhafi's son said Monday he is pressing for the release of six Bulgarians facing death for allegedly deliberately infecting Libyan children with the HIV virus. "I want and I hope the criminal side of the accusation to be abandoned, so that the problem is not seen as a deliberate act but as a mistake due to chance. That is the aim of our work," Seif Al-Islam told the daily 24 Hours. The defendants -a Bulgarian doctor and five nurses and a Palestinian doctor -are accused of deliberately injecting 393 children with HIV-infected blood products in a hospital in the northern Libyan city of Benghazi. Bulgarian authorities, including President Petar Stoyanov, have said they hoped the most serious charges would be dropped. "Health Workers Lack Knowledge About HIV/AIDS" Vietnam News Briefs (10.02.01) Lack of knowledge about HIV/AIDS among doctors and physicians is one of the most dangerous factors in disease transmission, according to a survey conducted last year by Vietnam's National Committee for AIDS Prevention and the Ministry of Health. In the three provinces of Quang Ninh, Nam Dinh and Nghe An, 1,178 health workers were surveyed. These provinces have witnessed the widest spread of the disease. The survey of health workers -the first of its kind -says 2.6 percent do not know the cause of AIDS, 1.2 percent do not know all of the ways AIDS can be transmitted and up to 94.2 percent answered incorrectly about the main symptoms of the disease. In addition, up to one third of the health workers surveyed have not attended training courses about HIV/AIDS prevention. With regard to preventing AIDS, 1.7 percent never and 6 percent rarely wear gloves when handling the blood and swabs of AIDS patients. "Shortstop Guillen Improving" Associated Press (10.02.01) Janie McCauley Seattle Mariner's manager Lou Piniella is unable to visit his starting shortstop, who remains quarantined with pulmonary TB, but he reports Carlos Guillen is doing better. A Northwest Hospital nursing supervisor said Monday that Guillen was comfortable, resting and able to move around his room. She was unsure when he would be discharged. "They don't want any visitors," said Piniella. The Mariners hope to have Guillen back when they open the playoffs at home Oct. 9, probably against American League Central champion Cleveland, but Piniella isn't counting on it. Guillen, who was diagnosed with TB on Friday, is receiving antibiotics. Other team members are scheduled to be tested for the disease on Thursday.