Subject: CDC AIDS Daily Summary for Date: Fri Oct 5 11:31:01 PDT 2001 (321 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 "People with HIV Reaching Top of Transplant Lists" INTERNATIONAL NEWS "AIDS 'Leading Killer' in South Africa" "Thousands of Delegates Converge on Melbourne for AIDS in Asia and Pacific Congress" "Life Skills for Young Orphans" "Volunteers Hand Prostitutes Condoms, Advice" "London TB Summit as Seven a Day Are Infected" MEDICAL NEWS "Living with Mom May Help Curb Risky Sex" NEWS BRIEFS "AIDS Walk on Saturday" "Business News in Brief from Around New Jersey" "Mariners Notebook: Guillen Released from Hospital" ************************************************************ NATIONAL NEWS ************************************************************ "People with HIV Reaching Top of Transplant Lists" New York Blade (09.28.01)::Lisa Keen Because the overall health of a patient is among selection factors, fewer than 40 HIV-positive patients have received life- saving liver transplants -even though many gay men with HIV are infected with hepatitis B. But with antiviral drug combinations prolonging the lives and improving the health of those with HIV, more people with HIV are finding themselves on the waiting list for a liver. Hepatitis B, like HIV, often lies dormant for years and then relapses into life-threatening liver disease. Two studies this year suggested that such relapses might be associated with protease inhibitor combinations; a study last year linked relapse to discontinuing the nucleoside 3TC. Also like HIV, hepatitis B can be transmitted through bodily fluids during sex, making co- infection "relatively common," says the National Institute of Allergy and Infectious Diseases. Hepatitis B both weakens the patient and triggers replication of HIV. To be put on the list for a liver, which is maintained by the United Network for Organ Sharing (UNOS), a patient must be evaluated by a hospital that performs liver transplants. Moving to the top of the list is reserved for patients with "sudden liver failure that leaves them with a life expectancy of fewer than seven days," according to UNOS policy, which is up for revision this year. It also suggests that a patient with HIV and without HIV symptoms "should not necessarily be excluded from candidacy for organ transplantation." UNOS requires HIV screening of all potential recipients. Since 1988, only 37 liver transplants have been performed on people with HIV. The 11 of those performed last year represented less than 1 percent of the 4,955 liver transplants carried out in 2000. Activist Larry Kramer, who has AIDS and hepatitis and needs a liver transplant, described the many obstacles facing those needing the procedure. People seeking a transplant often affiliate themselves with hospitals in several cities, each of which typically requires a battery of expensive tests and may demand a deposit of up to $500,000. Kramer, who is on the list to receive a liver at the University of Pittsburgh Medical Center, described navigating the complex system as "like dealing in a foreign language and a foreign country." ************************************************************ INTERNATIONAL NEWS ************************************************************ "AIDS 'Leading Killer' in South Africa" BBC (10.05.01) South Africa's AIDS epidemic has reached "shattering dimensions" and accounted for one in four deaths last year, according to researchers. In a Medical Research Council report, suppressed by the South African government but leaked to the Johannesburg-based Mail and Guardian newspapers, AIDS is designated as the leading cause of death in the country. "Without treatment to prevent AIDS, the number of deaths can be expected to grow within the next 10 years to more than double the number of deaths due to other causes," the report says. Unless AIDS is curbed, the report warns, the disease will kill somewhere between five and seven million South Africans by 2010. The leak of the report comes at a time of growing unhappiness within the ruling party over President Thabo Mbeki's government's stance on AIDS. The health committee has now added its voice to calls for the release of the report in the interest of credibility. Two weeks ago a document was leaked from South Africa's Health Ministry warning that millions of citizens would die of AIDS and recommending more widespread use of antiretroviral drugs, against official policy. The document questioned the morality of President Mbeki's approach. South Africa is believed to have the highest number of HIV patients in the world -officially estimated at 4.7 million. President Mbeki has described poverty as the biggest threat and killer in South Africa and has expressed doubts both about the link between HIV and AIDS and the extent to which the disease has spread in South Africa. "Thousands of Delegates Converge on Melbourne for AIDS in Asia and Pacific Congress" Associated Press (10.05.01)::Emma Tinkler Delegates at an international conference on HIV/AIDS in Asia and the Pacific warned governments that HIV is gathering pace through the region and that they could no longer ignore the epidemic. Representatives from more than 40 countries are due to attend the gala ceremony Friday night opening the 6th International Congress on AIDS in Asia and the Pacific (ICAAP) which runs until Oct. 10 in Melbourne, Australia. Werasit Sittitrai, associate director of UNAIDS' Asia, Pacific and Middle Eastern Division, said the congress comes at a critical time when some countries have become complacent about the epidemic. In Asia, about 6.4 million people carry HIV, an infection rate second only to sub-Saharan Africa. "A lot of countries feel that AIDS is not here, and will not be here," Sittitrai said at a news conference. A UN-sponsored report released Thursday by the nongovernmental organization Monitoring the AIDS Pandemic (MAP) Network, showed that the once relatively low levels of infection of HIV/AIDS in Asia have increased markedly. While only Thailand, Myanmar and Cambodia showed substantial HIV epidemics in 1999, the virus has now spread rapidly in Indonesia, Iran, Japan, Nepal and Vietnam, according to the report. In China - home to a fifth of the world's people -the infection is moving into new groups of the population. Shabana Azmi, an Indian film star and member of India's upper house of parliament said, "We have officially 3.5 million HIV-positive cases in India, but in spite of that ... there is absolutely no political commitment whatsoever." "Life Skills for Young Orphans" Christian Science Monitor (10.02.01)::Danna Harman Ervline Awino, 15, is her family's sole provider. Her father died of AIDS five years ago; her mother is infected now; and her five sisters are under age 10. Ervline is one of a growing number of Kenyan children forced by the AIDS epidemic to play the part of adult at home. And while orphanages can offer a bed and meals, aid groups are increasingly trying to salvage something lost in institutions: the warmth and support that can come only from family ties. "These children should not be sent away to orphanages or boarding schools, because being lonely only adds to trauma," said Tobias Odero, a counselor with the Baltimore-based Christian Children's Fund. "When the siblings are together, they feel warmth. ... If they are separated, they are weak. They lose their roots." Odero spends his days visiting the homes of the orphans in the region, assisting with finances and morale. According to the World Health Organization, some 12 million children have been orphaned by HIV/AIDS. In Kenya, 600 people die every day from AIDS, and surviving children are left to protect themselves and their family land. Increasingly, relatives who traditionally would take children in are simply too overwhelmed. Like a growing number of nongovernmental organizations across the continent, Kibera Community Self Help Project (KCSHP) provides services for AIDS orphans and helps them stay together in family units. The agency has set up a free school for these orphans, and offers counseling, healthcare, and classes in sewing and woodwork. Volunteers follow the youngest orphans home to make sure they bathe and eat, and support groups are offered for the older orphans. "We train them in self-reliance so they know they have to look after themselves; they know there is no one else who will do it," said Caroline Omondi, head of KCSHP orphans program, who was orphaned by AIDS herself. "Volunteers Hand Prostitutes Condoms, Advice" Moscow Times (10.02.01)::Elizabeth Wolfe As night falls in Moscow, a 28-year-old man and a teenage girl approach a group of prostitutes with an unusual proposition: free condoms, pamphlets about safe sex, brochures about the risks of HIV/AIDS, and advice on where to go for a free doctor's consultation. The volunteers work with Harm Reduction, whose Moscow branch was set up by Doctors Without Borders Holland in 1997. The Russian nongovernmental organization Return to Life took over its operations in April 2001. When the organization was launched, it aimed to help drug users kick their habit and reorder their lives. Its volunteers began working with sex workers only last year. Now their goal is to curb the rising rates of HIV in both groups. "The ideal result of our work would be to stop HIV," said Dima Blagagovo, who heads the Moscow office. "The realistic variant is if one or two people learn to act carefully. Say one person quits using drugs, or one person uses a condom when he should." According to statistics from Doctors Without Borders provided by the Health Ministry, there were 56,630 new cases of HIV in Russia in 2000. Yet in the first seven months of this year, the ministry has registered 54,608 new cases -an increase of 96.4 percent. Unofficial statistics suggest that the numbers are actually seven to 10 times higher. The overwhelming majority of HIV cases are among drug users, but the disease is spreading to young men and women in the sex industry. Harm Reduction's efforts for drug users involve handing out alcohol swabs and brochures. Needle exchange programs are illegal in Moscow, but Blagagovo said he is trying to convince local health authorities, with whom he often meets, to change the law. The group has also begun work with a home for children abandoned by their drug-using or HIV-infected mothers. "London TB Summit as Seven a Day Are Infected" Evening Standard (London) (10.03.01)::Zoe Morris TB experts met this week to discuss ways of tackling the resurgence of the disease in London. Almost half of Great Britain's new TB cases occur in London. On an average day, seven Londoners show the first signs of the disease -a persistent cough, chest pains and sweats. Almost 140 toddlers, parents, staff and caregivers were screened after an outbreak at Wee Ones nursery in Wandsworth in May, which stemmed from a teacher thought to have been infected abroad. Figures released Wednesday reveal that six children from the nursery and five family and friends of the teacher have full- blown TB. An additional 39 children and 12 friends and family from the nursery have a TB infection but not active TB. Merton, Sutton and Wandsworth health authority is carrying out an internal investigation and considering whether the outbreak could have been prevented after the teacher's diagnosis in March. Dr. Emma Robinson, a consultant in communicable disease control at the authority, said, "The results support current evidence on TB -only those in close contact with the index case are at risk. We made a concerted effort to screen as widely as possible in order to protect the community." TB rates are high among London's homeless and in poor neighborhoods. There were more than 3,000 TB cases in London last year -more than double the rate of New York. General practitioners and specialists have warned there are not enough resources to cope with London's rising TB rate. ************************************************************ MEDICAL NEWS ************************************************************ "Living with Mom May Help Curb Risky Sex" Reuters Health (09.24.01)::Charnicia E Huggins Teenage African-American girls who live with their mothers and who feel that they have supportive families may be less likely to engage in sexually risky behavior, according to a new study. "Kids need to feel that they have the support of their family," lead author Dr. Richard Crosby of Emory University Rollins School of Public Health said. "And at least among African-American female teens, there is something protective about residence with their mom." The protective effects are relatively modest, he said, but they can translate into significant public health outcomes when magnified over a population. To investigate, Crosby and his team studied 522 sexually active African-American females ages 14 to 18. Nearly half (46 percent) of the study participants reported living with their mothers and having high family support. These teens were about half as likely as their peers to report having had any unprotected sex -with a steady partner or with any partner -in the past 30 days. They were also about half as likely as their peers to say they had unprotected sex with a non-steady partner in the past 6 months. Furthermore, teens who lived with their mothers were more likely to report that they frequently communicated with their sex partner about sexual risk, such as discussing how to prevent STDs, the report indicates. These adolescents also tended to have more positive attitudes about using condoms -agreeing, for example, that "condoms create a sense of safety." In light of the findings, "HIV/STD-prevention programs for female adolescents that include the mothers may promote positive and lasting effects," the authors concluded. Further research is needed, however, to determine if the findings are applicable to African-American male teens or to white youth, Crosby said. The study was published in Preventive Medicine (2001;33:175-178). ************************************************************ NEWS BRIEFS ************************************************************ "AIDS Walk on Saturday" Washington Post (10.05.01) AIDS Walk Washington 2001 will take place Saturday, starting at 9 a.m. at the Washington Monument grounds. The walk, which raises money for those living with HIV and served by the Whitman Walker Clinic, starts and ends at the monument. The post-walk program starts at 10:30 a.m. and includes a concert by the Coats. Registration is $15. For information, telephone 202-332-9255. "Business News in Brief from Around New Jersey" Associated Press (10.05.01) Dr. Luc Montagnier, a virologist and co-discoverer of HIV, has joined the Regent Group Inc. as a member of its subsidiary Millenium Biotechnologies Inc. research team. Montagnier will oversee clinical trials in the United States and Africa, as well as publishing data, for Resurgex, the company's recently released nutritional supplement. Millenium Biotechnologies is a newly formed research and development company focusing on nutritional supplements and their impact on the treatment of chronic debilitating diseases. "Mariners Notebook: Guillen Released from Hospital" Seattle Post-Intelligencer (10.05.01)::John Hickey Carlos Guillen was released from the hospital yesterday, his case of TB no longer contagious. But there is no telling when the Mariners shortstop might be able to play again. "He's in an improved condition," Mariners team physician Mitch Storey said. "He'll be re-examined Wednesday, and we'll make a judgment on his status at that time." Guillen was hospitalized for five days after the diagnosis, and has been ruled out for the first round of the American League Division Series that starts Tuesday. Meanwhile, Mariners players and staff members spent the day being tested for TB as a precaution.