Subject: CDC AIDS Daily Summary for Date: Tue Oct 9 10:31:01 PDT 2001 (397 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 "AIDS Vaccine Available Within 10 Years, US Health Expert Says" "Walkers Turn Out for Clinic; Shadow of Sept. 11 Hurts AIDS Event" INTERNATIONAL NEWS "Glaxo Licenses AIDS Drug to Generics Firm" "Tackling Growing Asian AIDS Epidemic to Cost Billions" "Roche Laments Drug Delivery" MEDICAL NEWS "Community-based Approaches to HIV Treatment in Resource-poor Settings" LOCAL AND COMMUNITY NEWS "Cross Purposes? The Black Church Struggles with AIDS" NEWS BRIEFS "Alleviating Poverty Imperative to Stop Spread of HIV/AIDS in Asia" "Russian AIDS Official Issues Gloomy Forecast" "Babies Ingesting Certain Milk May Test Positive for TB" ************************************************************ NATIONAL NEWS ************************************************************ "AIDS Vaccine Available Within 10 Years, US Health Expert Says" Associated Press (10.07.01)::Emma Tinkler Researchers are optimistic an AIDS vaccine will be available within 10 years, but it is unlikely to be fully effective against all strains of the virus, a US health expert said Sunday. Margaret Johnston, associate director of AIDS vaccines at the National Institutes of Health, said there are dozens of vaccine prototypes under development around the world, with some 9,000 people participating in clinical trials. "There's never been more optimism than there is now that an HIV vaccine can be identified," Johnston told delegates to the 6th International Congress on AIDS in Asia and the Pacific in Melbourne, Australia. Johnston said the most advanced vaccine being tested is GP-120, developed by the California-based VaxGen biotech company. The product is made from a protein that forms the outer surface of the virus and stimulates antibodies to neutralize or stop HIV from spreading. The vaccine is now being tested in Thailand, North America and the Netherlands, and the trials' results could be available as early as next month. If the results are promising, another larger trial over three years would be conducted, she said. Johnston said it is anticipated that a future vaccine would protect people from contracting the virus and prevent its spread when given to those who already have the virus. "Walkers Turn Out for Clinic; Shadow of Sept. 11 Hurts AIDS Event" Washington Post (10.07.01)::Petula Dvorak The AIDS Walk crowd on Saturday in Washington, D.C., at one point stretched the length of the Mall, as the leaders of the pack turned at the Capitol and the rear guard whipped around the steps of the Lincoln Memorial. The crowd was smaller than in previous years, but it was a sign of determined life: Those who decided to don their walking shoes when the sky was gray and the Mall was wet at 8 a.m. had their points to make. "With all the focus of giving to the relief effort after September 11, we're being forgotten," said Michael W. Cover, director of communications for the Whitman-Walker Clinic, the primary provider of HIV/AIDS services in Washington, and the recipient of the walk's proceeds. "A lot of other charities are feeling that pinch right now, too." One in 20 adults in the District is HIV-positive, a rate that is one of the highest in the country, according to the Whitman-Walker Clinic. Through its walk last year, the clinic raised about $1 million -but this year it has raised less than $500,000, Cover said. While previous walks have drawn more than 20,000, Saturday's attracted just 3,500. Still, Scott Evertz, director of the White House Office on National AIDS Policy, agreed that such a turnout is a strong indicator of the American spirit. "I've been encouraging people, since September 11, to not forget this issue," Evertz said. "People out here are really showing they care." Clinic Executive Director A. Cornelius Baker echoed this sentiment as he surveyed the scene. "People are already worried about being on the Mall because of the terrorist attacks, the weather is horrible and, look, there are people out there. I think the people down here are showing that life goes on." ************************************************************ INTERNATIONAL NEWS ************************************************************ "Glaxo Licenses AIDS Drug to Generics Firm" Wall Street Journal (10.08.01)::Rachel Zimmerman Pharmaceutical giant GlaxoSmithKline PLC has announced it will allow a South African generic drug maker to produce and market three of its patent-protected AIDS medicines. The move is expected to have a broad impact on pharmaceutical industry economics in developing world markets. Under the deal, United Kingdom-based Glaxo will grant a license to South Africa-based Aspen Pharmacare Ltd. to sell generic versions of AZT, 3TC and Combivir within South Africa to public and government sectors and to certain non-profits and charities. In what appears to be the first such licensing of a patented AIDS drug to a generic drug maker to increase access to the medicines, Glaxo will waive its rights to any royalty payments. Instead, Aspen, South Africa's largest generics maker, has agreed to pay a 30 percent fee on net sales to one or more nongovernmental organizations for AIDS education and prevention. Shire Pharmaceuticals Group PLC, also of the United Kingdom, which licenses 3TC to Glaxo, also agreed to the arrangement. AZT is also know as Retrovir; 3TC as Epivir; and Combivir combines the two medicines. Steven Saad, group CEO of Aspen, said his company could make a generic version of Combivir for between $1 and $1.50 a day. Under pressure -and facing the threat of generic drug makers like India's Cipla Ltd. -several major pharmaceutical companies have slowly cut the price of AIDS drugs, some even to cost, during the past 18 months. Glaxo's AIDS drugs are the most heavily used in South Africa, and previously the company had cut the price of Combivir in the nation to $2 a day for the public sector, nongovernmental organizations and certain private employers. Although this compares to $17.23 a day for the drug in the United States, the government was not buying. Howard Pien, Glaxo's president of international pharmaceuticals, would not qualify the amount the company would lose under the new arrangement but said, "it's not going to be material." Glaxo will continue to sell the three drugs in South Africa's private sector market. "Tackling Growing Asian AIDS Epidemic to Cost Billions" Associated Press (10.06.01)::Emma Tinkler On Saturday at the 6th International Congress on AIDS in Asia and the Pacific, International AIDS Society President Stefano Vella said that tackling the Asian epidemic would require billions of US dollars annually. It would also mean adaptations in research efforts and in complex drug therapy regimens, which are often used incorrectly by people in Asia, he said. "It has been calculated that between 7 billion and 9 billion US dollars per year for at least 10 years is needed to bring prevention, care and support to the south of the world," Vella said, adding that this cost should be met by wealthy nations. However, he said it would be a mistake "to think that just having money for drugs would solve the problem." Addressing the inequalities between rich and poor countries in access to health care is . the most moral, scientific, technical and political challenge of this century," Vella said. Vella said providing treatment to HIV patients required health facilities that could also be used for other diseases common in Asia, such as TB and malaria. With vaccines "not on the immediate horizon," making HIV drugs more available in Asia is also necessary. "We know very well that antiretroviral therapy [for the treatment of HIV] . has had a dramatic impact on mortality and mobility," Vella said. The five-day congress was the first large gathering of world HIV/AIDS experts, community leaders and lawmakers since the UN General Assembly held a special session devoted to the disease in July. The 189-member General Assembly adopted by consensus the Declaration of Commitment on HIV/AIDS, a global agenda aimed at reversing the pandemic by 2015. "Roche Laments AIDS Drug Delivery" Associated Press (10.05.01) With AIDS drug prices slashed for the poorest countries, the problem now is how to get the vital medicine delivered to people with the disease, the head of Swiss pharmaceutical giant Roche said Friday. "We're committed to playing a part in fighting AIDS and for that purpose we're supplying our drugs at no profit or free of charge, but I think people understand the issue is no longer price," said Roche Chief Executive Franz Humer. "We need infrastructure, training . political will and commitment." Pharmaceutical companies, under fire for charging amounts beyond the reach of poor countries, have begun cutting prices. AIDS activists have accused the companies of blocking efforts by some countries to produce cheaper generic versions of the drugs. But the drug makers have warned that their research and development efforts on HIV/AIDS drugs could slow or stop if their patent rights are not protected. Humer met Thursday with UN Secretary-General Kofi Annan and officials from six other drug companies for talks on improving access to AIDS drugs. Measures discussed included reducing drug prices, improving health services and encouraging private sector involvement, Humer said. In addition, "Major employers in afflicted countries should also allocate resources to promote prevention," said Humer, adding that the discussions also included encouraging partnership between local government groups, UN agencies and the pharmaceutical industry. ************************************************************ MEDICAL NEWS ************************************************************ "Community-based Approaches to HIV Treatment in Resource-poor Settings" Lancet (08.04.01) Vol 358;P 404-409::Paul Farmer; Fernet Léandre; Joia S Mukherjee; Marie Sidonise Claude; Patrice Nevil; Mary C Smith-Fawzi; Serena P Koenig; Arachu Castro; Mercedes C Becerra; Jeffrey Sachs; Amir Attaran; Jim Yong Kim AIDS mortality has dropped precipitously in affluent countries, in large part because of access to highly active antiretroviral therapy (HAART). The main objections to the use of these agents in less developed countries have been their high cost and the lack of health infrastructure necessary to use them. However, the authors have demonstrated that it is possible to carry out an HIV treatment program in a poor community in rural Haiti, the poorest country in the Western Hemisphere. Relying on an already existing tuberculosis-control infrastructure, the researchers have been able to provide directly observed therapy with HAART (DOT-HAART) to about 60 patients with advanced HIV disease. In this report, the researchers discuss objections to the widespread use of HAART, and suggest that directly observed therapy of chronic infectious disease with multi-drug regimens can be highly effective in settings of great privation as long as there is sustained commitment to uninterrupted care that is free to the patient. Haiti is by all conventional criteria the poorest country in the Western hemisphere and one of the poorest in the world. Not coincidentally, Haiti is also the hemisphere's most HIV-burdened country. In 1999, UNAIDS reported national HIV seroprevalence as 5 percent among women attending antenatal clinics -rates were twice as high in urban slums. Shortly after the publication of the ACTG-076 trial, the researchers began offering zidovudine to pregnant women to block mother-to-child transmission. More than 90 percent of women offered HIV testing accepted it after zidovudine was made available free of charge, and dramatic declines in vertical HIV transmission ensued. In 1997, the researchers began offering post-exposure prophylaxis with a three-drug regimen (usually zidovudine, 3TC, and a protease inhibitor) to victims of rape or professional injury. Beginning in late 1998, a small number of patients with long-standing HIV disease who no longer responded to syndromic treatment of opportunistic infections were offered directly observed HAART. In the clinic, DOT-HAART is modeled on successful tuberculosis-control efforts. That is, each HIV patient has a community-health worker who observes ingestion of pills; responds to patient and family concerns; and offers moral support. Response to HAART in an initial cohort of 60 patients has been dramatic. As elsewhere, patients receiving HAART are far less likely to require admission to the hospital than are patients with untreated HIV disease. "We believe that if DOT-HAART can be implemented in the devastated Central Plateau of Haiti it can be implemented anywhere," the researchers wrote. The two primary objections to use of HAART in poor communities have been the high costs of the medications and the lack of infrastructure necessary to deliver them effectively. However, several firms, including one based in India, have developed very low-cost formulations of zidovudine, 3TC, D4T, ddI, and nevirapine. The effective treatment of multidrug- resistant tuberculosis (MDR-TB) in impoverished regions may offer important lessons. Working in rural Haiti and in a slum in Lima, Peru, the research group pioneered a community-based strategy to treat MDR-TB. Using strict DOT and the same standards of care as in tertiary medical centers in the United States or Europe, the researchers achieved results better than those reported in industrialized countries. Patients tolerated drug regimens more complex and far more toxic than HAART, with low rates of abandonment. The authors called this approach "DOTS-Plus," because it incorporates the managerial strengths of the DOTS strategy but relies on drug-susceptibility testing to determine treatment regimens appropriate for each patient. This strategy is now being replicated in the former Soviet Union, where MDR-TB constitutes a growing problem. The researchers believe that much of the policy debate regarding the role of HAART in responding to AIDS has been misguided. In sub-Saharan Africa and Haiti, where HIV is the reason for plummeting life expectancies and for increasing numbers of orphans, the authors discern fairly overt obstructionism to the use of HAART. HAART has already been declared cost-effective in Europe, North America, and even Brazil, where HIV has become, for many, a chronic infection. "We know from experience that repeated claims of unfeasibility are simply not true. Multiple research projects carried out in sub-Saharan Africa have shown that more-developed world diagnostic tests can be used to follow viral load and to reveal the genotype of drug-resistant strains of HIV. It is time that more-developed world therapeutics follow," the authors concluded. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Cross Purposes? The Black Church Struggles with AIDS" Essence (10.01.01)::Afi-Odelia E Scruggs For a long time, the AIDS battle was fought primarily in the public health arena. But activists and educators, wanting to reach the black community, have pointed to a crucial role for black churches. It is a role that churches are now assuming, but with a complicated mix of messages and moral values. The Rev. Marvin McMickle reflects the new mode of black church ministry. His Antioch Baptist Church in Cleveland, Ohio, has a program that provides services to HIV-infected women and their families. What began as services for church members grew to include "the infected and the affected," even if they aren't church members. Earl Pike, executive director of the AIDS Taskforce of Greater Cleveland, said it is difficult for churches to put moral issues aside, especially when it comes to sex. While the public health arena accepts that people will have sex and that you can reduce the risk by getting people to use condoms, "the church approach -total abstinence until marriage -assumes that two people have never had intercourse before marriage and will never have intercourse with anyone outside of that marriage," he said. "What percentage of the population fits that profile of virgins getting together for lifelong monogamy?" Pike asked. "It's an ideal." McMickle is convinced that the church can step up and reconcile its differences with people needing help. "I don't think we saw [our program] as condoning behavior," he said. But, "the epidemic isn't going to be resolved by ignoring it." This is a stance that others agree with wholeheartedly, even in the face of behavior that many are uncomfortable with, like homosexuality and drug use. Pernessa Seele, founding director and CEO of the Balm in Gilead, an organization that mobilizes African-American churches to become centers for education and compassion, goes one step further. Seele believes churches have an obligation to "become a community for AIDS education," she said. "HIV is killing us. At the end of the day, it's about the Christian's responsibility toward the suffering," she said. Earl Pike remains optimistic about the black church and its ministry to women and children. "If African-American churches were to take an honest look at the community they serve, they would find that it would be women and children. The church plays a large role in women's lives," he noted. Besides, "if you can keep people alive, then you have the opportunity to struggle with different religious interpretations of sexuality," he said. ************************************************************ NEWS BRIEFS ************************************************************ "Alleviating Poverty Imperative to Stop Spread of HIV/AIDS IN Asia" Associated Press (10.08.01)::Emma Tinkler Alleviating poverty is imperative if Asia and the Pacific are to slow the spread of AIDS, according to Indrana Gupta, associate professor at the Institute of Economic Growth in New Delhi. She cited a recent World Bank report showing that in 1998, 522 million people, or 40 percent of the population of South Asia, were surviving on less than $1 per day. "We have huge numbers [of people] who are desperately poor and are living in conditions that are conducive to a high spread of the [HIV] epidemic," Gupta told delegates to the 6th International Congress on AIDS in Asia and the Pacific. Gupta also said that governments, economists and health organizations need to integrate poverty alleviation alongside other programs for prevention and control of HIV/AIDS. "Russian AIDS Official Issues Gloomy Forecast" BBC (10.08.01) Vadim Pokrovskiy, director of the Federal Research Center for AIDS Prevention, told the Russian news agency Interfax that 150,000 of those currently infected with HIV in Russia will have AIDS by 2006. Between 1996 and 2000, HIV was spread in Russia mainly through the use of intravenous drugs, according to the center. In 2000, only 57,000 cases of HIV infection were registered, but in the first nine months of 2001 there were 63,000 cases, he said. Pokrovskiy stressed that the real number of those infected with HIV is higher than the official statistics. "The number of those who are officially registered as infected [with HIV] is approximately one-fifth of the total number. That means a minimum of 750,000 Russians are now infected with HIV, and the most probable number is 1 million," he said. "Babies Ingesting Certain Milk May Test Positive for TB" Kyodo (10.08.01) Japan's Snow Brand Milk Products Co. said on Friday that babies who drink one of its powdered milk products could test positive for tuberculosis even though they are not infected with TB. Two such cases have been reported so far, and one case has been temporarily isolated, the company said. Both babies tested negative for TB in DNA testing. The company said the results could occur when a dead harmless virus in the product reacts to the conventional TB testing method. The virus might have been contained in the "NeoMilk Sukoyaka" product in the manufacturing process at Hokkaido plant, which makes a protein substance used for the product, the company said. Snow Brand said it will alter the manufacturing line to prevent future contamination.