Subject: CDC AIDS Daily Summary for Date: Thu Oct 11 11:31:01 PDT 2001 (386 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 "TennCare Patients, Doctors, Advocates Try to Prevent Enrollment Closure" INTERNATIONAL NEWS "AIDS Conference Urges End to Discrimination and Drug Profits" "Government Casts Doubt on AIDS Report, but Agrees to Its Release" "Vietnam Barbers Spread Anti-AIDS Message" "Thai Volunteers in Fighting AIDS" MEDICAL NEWS "Tuberculosis Associated with Infliximab, a Tumor Necrosis Factor Neutralizing Agent" LOCAL AND COMMUNITY NEWS "Panel to Review Needle-swap Program" NEWS BRIEFS "US Life Expectancy Reaches New High" "After the Parade Passes by: Patriotic Fervor Can Give Way to Depression as New Reality Takes Hold" "Director of AIDS Organization to Step Down" "AIDS Walk Has Plenty in Store" ************************************************************ NATIONAL NEWS ************************************************************ "TennCare Patients, Doctors, Advocates Try to Prevent Enrollment Closure" Associated Press (10.11.01)::Karin Miller US District Judge William J. Haynes, Jr. could decide as early as today whether to prevent Tennessee Gov. Don Sundquist from closing TennCare, the state's insurance plan for the poor, to people who cannot get insurance elsewhere. The closure is the first step in the state's plan to overhaul TennCare and divide it into three parts. The largest part would be TennCare Medicaid. The second part would be TennCare Standard and would have fewer benefits than the larger version, with stricter eligibility standards. The third part would be TennCare Assist, in which the state would subsidize the insurance premiums of those who have access to employment-based health insurance but cannot afford to purchase it. Because 180,000 of TennCare's 1.4 million current enrollees would be ineligible for any portion of the revamped program, the state would save an estimated $155 million a year. However, it would also forgo an additional $435 million federal funds that purchase premiums and pharmacy rebates. The revamped program would severely affect the state's mentally ill population and many thousands of Tennesseans with incurable diseases who are considered medically uninsurable. According to Gordon Bonnyman of the Tennessee Justice Center, who sought the restraining order, closing the rolls to the uninsurable violates the settlement of a previous lawsuit that he and state officials negotiated last year. Many of the affected enrollees are those most in need of health care coverage. Some have Medicare, but it doesn't pay for prescription drugs. Specifically affected will be individuals with HIV. Dr. Stephen Raffanti, a Vanderbilt University professor and medical director of several HIV clinics, testified that the average HIV patient needs about three drugs at a total cost between $1,000 and $1,500 per month. Those patients are typically poor and would have to cover the costs themselves if not for TennCare. "TennCare is crucial for HIV-positive individuals," he said. Elisabeth Rukeyser, Sundquists' commissioner of mental health and developmental disabilities, is also against the changes. She told state legislators that the new TennCare plan would cost the state $100 million to replace the mental health services lost through the restructuring, as well as $200 million in matching federal funds. ************************************************************ INTERNATIONAL NEWS ************************************************************ "AIDS Conference Urges End to Discrimination and Drug Profits" Agence France Presse (10.10.01) The 6th International Congress on AIDS in Asia and the Pacific wrapped up Wednesday in Melbourne with a call for an end to religious and traditional barriers that prevent people with HIV from getting proper treatment. AIDS workers also asked drug companies to put care before profit to help turn back the HIV pandemic that is sweeping the Asia-Pacific region. "Many governments, religious leaders, educational institutions and even [nongovernmental organizations] refuse to acknowledge the existence of groups particularly vulnerable to HIV infection, such as drug users, sex workers, men who have sex with men, ethnic minorities, transgendered people," said Rob Moodie, chair of the congress. Co-chair Dennis Altmann added, "Many of the countries represented -such as India and China - also face other potentially crippling problems such as endemic poverty, hugely mobile populations and other diseases such as TB and malaria." International AIDS Society President Stefano Vella said drug companies should relinquish patent rights to allow cheaper generic drugs to be sold. "The prices of antiretroviral drugs represent a major factor for the lack of access to therapy in developing countries," he said. "This cost should be met by the wealthy countries." However, Australian Foreign Minister Alexander Downer said international trade agreements on patents for HIV/AIDS drugs should be followed. "Obviously we would like to feel these drugs can be made available at the lowest possible price, but that has to be done in a way that is consistent with international law, and it has to be an appropriate regime to make it possible." Also during the conference, Nick Crofts of the Macfarlane Burnett Center, Australia's largest virology and communicable disease research institute, called for better treatment of drug addicts in Asia, home to half the world's intravenous drug users. "They are perceived as the least deserving, anti-social," he said. "Government Casts Doubt on AIDS Report, but Agrees to Its Release" Associated Press (10.10.01) The South African government on Wednesday cast doubt on the findings of a report, which it commissioned, that claims AIDS accounted for a quarter of all deaths in the nation last year. The Medical Research Council's (MRC) report said AIDS was responsible for 40 percent of adult deaths last year, and it estimated that AIDS will kill between 5 million and 7 million South Africans by 2010. The government, which has been widely criticized for its handling of the AIDS crisis, had hoped to delay release of the report until December. But a copy was leaked to the media after President Thabo Mbeki ordered a review of health spending on the basis of 1995 statistics showing that AIDS accounted for only 2.2 percent of deaths in the nation. Joel Netshitenzhe, government spokesperson, said concerns remain about the research's methodology and its findings. South Africa only monitors HIV infection rates at free ante-natal clinics, which the government said was not a representative sample. "The only recourse we have at present regarding estimating the extent of the epidemic is through demographic modeling," said a government statement. The main problem with the MRC's statistical model, the government said, was in its assumptions about the probability of HIV transmission. "For example, in Uganda, a much lower probability of transmission is used for their AIDS death calculations," the statement said. Further studies are planned; activists are accusing the government of collecting endless data while the epidemic runs increasingly out of control. "Vietnam Barbers Spread Anti-AIDS Message" Union-Tribune (San Diego) (10.03.01)::Angela Takats, Reuters In a country where access to mass media is limited, 50 barbers in Haiphong, a busy port city in Vietnam, have been trained as AIDS educators by the nonprofit organization Family Health International (FHI). "Barber Tien" snips away at the mop of dark hair in front of him, chatting with his young male customer. "You really must use condoms if you are sleeping with more than one woman because you don't know who could have AIDS," he says as he trims. Barbers like Tien work in teams of 10 and set up their stands by the roadside. On their mirrors are stickers that read "Condoms are wonderful to stop AIDS" and "Sharing needles is bad." Underneath shelves stacked with scissors lie comics and information sheets on HIV. "Often people need to ask questions and interact," says Thomas Kane, Vietnam director for FHI. It's not just the barbers of Haiphong who spread the word in AIDS -a team of 20 shoeshine boys also pass on the message as part of efforts to halt its spread. The projects have been running for six months and tens of thousands of customers have been given information about AIDS. In Vietnam, intravenous drug users and sex workers are most likely to contract the disease. Official figures show around 40,000 people were HIV-positive as of June 2001, but health workers say the total is more than three times that number. The widespread drug problem in Haiphong, as in many other parts of Vietnam, means the infection spreads rapidly. Some 70 percent of intravenous drug users in Haiphong are HIV-positive and the government, together with FHI, has now set up drop-in centers where users can pick up clean needles and learn about the health risks they face. One such shelter opened in October. In addition to getting free condoms and health information, those who drop by can also play table tennis and visit consulting rooms. "Thai Volunteers in Fighting AIDS" Xinhua News Service (10.05.01)::Huang Heng; Yang Qingchuan; Huang Yong When Namani Nangpon became a teacher 13 years ago in Nongboudang School, located in the suburb of Chiang Rai, Thailand, she never heard of AIDS. Certainly she never imagined that her students would die from the terrible disease. Since then the northern area of Thailand, including Chiang Rai, has been hit hardest by AIDS. Here prostitution, drugs and a mobile population have produced a crisis. Health officials estimate that around 10 percent of Chiang Rai's 1.2 million people are infected -more than five times the national figure. "I felt the children whose parents were infected seemed to be shied away [from] by other children and I started visiting two nearby villages to inform people there about the knowledge of AIDS. Afterwards, other teachers also followed my steps," she said. Thanks to the efforts of the teachers, all the students in the school now study and play together. "They know some of them have been infected, but they will not detest them," Namani said. When Namani started teaching children and their parents about HIV/AIDS, she said that she never regarded herself as a volunteer, but rather that she was fulfilling her responsibility as a teacher. "Before you tell them how to live with AIDS patients and their children, you must teach them what AIDS is and how the epidemic infects people. Changing behaviors of villagers is an important method to prevent the AIDS, but it is not easy; only knowledge can give them strength," she said. "Children with AIDS-infected parents must be able to go to school [like] other children. We cannot cure their parents, but we can prevent them from [becoming infected]," said Namani. ************************************************************ MEDICAL NEWS ************************************************************ "Tuberculosis Associated with Infliximab, a Tumor Necrosis Factor Neutralizing Agent" New England Journal of Medicine (10.11.01) Vol 345; No 15: P 1098-1104 Joseph Keane, MD; Sharon Gershon, PharmD; Robert Wise, MD, MPH; Elizabeth Mirabile-Levens, MD; John Kasznica, MD; William D Schwieterman, MD; Jeffrey N Siegel, MD; M Miles Braun, MD, MPH Infliximab is a humanized antibody used in the treatment of Crohn's disease and rheumatoid arthritis. It is active against tumor necrosis fact (TNF-a). Infusions of infliximab can be administered in a single dose, a monthly regimen, or on day 0, day 14, day 42, and then every 8 weeks. The half-life of infliximab is 10 days, and its biologic effect persists for up to 2 months. Infliximab has been given to about 147,000 patients throughout the world since 1998. Through the MedWatch reporting system at the US Food and Drug Administration (FDA), cases of TB after infliximab therapy began to be reported soon after it was introduced in 1998. Between 1998 and 2000 there were 12 reported deaths. For this report, the investigators analyzed all reports of TB related to infliximab that the FDA received as of May 29, 2001. Infliximab nearly quadruples the incidence of TB. Over a median period of 12 weeks there were 70 reported cases of TB associated with infliximab treatment. In 48 patients, TB developed after three or less treatments. Forty patients had extrapulmonary disease. Of the 17 patients that had disseminated disease, 11 had lymph-node involvement, 4 had peritoneal disease, two had pleural disease and one person each had meningeal, enteric, paravertebral, bone, genital and bladder disease. Diagnosis with TB was confirmed by biopsy in 33 patients. Within the 70 reported cases, 64 cases were from countries with low rates of TB. The rate of reported cases of TB among patients treated with infliximab was higher than the background rates for their respective countries. The reported frequency of TB with infliximab treatment was much higher than the incidence of other opportunistic infections related to the use of the drug. The authors did not have complete information about the status of patients with respect to TB infection before they were treated with infliximab. The authors believe that most patients had reactivation disease in view of their age (median, 57 years), the small number with reported exposure to TB, and the low incidence of TB in countries from which reports were received. The findings of the study have important implications. Infliximab is an effective treatment for two debilitating diseases for which other treatments are often inadequate. According to the study, infliximab may make TB more active due to the drug's immuno-suppressant effect. "Active tuberculosis may develop soon after the initiation of treatment with infliximab. Before prescribing the drug, physicians should screen patients for latent tuberculosis infection or disease," the researchers said. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Panel to Review Needle-swap Program" Union-Tribune (San Diego) (10.10.01)::Ray Huard A privately financed pilot program to let drug users exchange dirty needles for clean ones was scheduled to be reviewed yesterday by a San Diego City Council committee. The program is aimed at curbing the spread of hepatitis, AIDS and other blood-borne diseases among intravenous drug users. "We have some really responsible, reputable people who think this program is worth trying," said City Council member Toni Atkins, chair of the Public Safety and Neighborhood Services Committee. The program was recommended by the Clean Syringe Exchange Program Task Force, which includes doctors, health care workers and city officials, including a police captain. In October 2000, City Council declared a public-health emergency, a step required by state law before a needle exchange program can be started. At the same time, the council created the task force to devise a pilot program. In December, with a new mayor and four other new members, the council deadlocked 4-4 on whether to continue the declaration of a health emergency, but the task force continued its work. With the election this year of City Council members Ralph Inzunza, Jr. and Donna Frye, a majority of the panel appears to support a pilot needle exchange program. Under the task force proposal, clean needles would be distributed from a motor home that would visit communities with high rates of drug-related arrests or STDs. Drug users seeking clean needles would be issued laminated city identification cards to prove to police that they are participating in the program. Otherwise, they would be subject to arrest for possessing drug paraphernalia. Users also would be offered counseling and referred to detoxification and drug treatment centers. The Alliance Foundation, a nonprofit philanthropic health-care organization, will cover the estimated $340,000 cost of the pilot program, which will be evaluated. ************************************************************ NEWS BRIEFS ************************************************************ "US Life Expectancy Reaches New High" Reuters (10.10.01)::Maggie Fox The CDC reported Wednesday that Americans are surviving longer, and more are dying of diseases associated with old age. American life expectancy reached a new high of 76.9 years, up from 76.7 years in 1999, mostly because fewer people are dying early from heart disease and cancer. Death rates from murder, suicide, accidents, stroke, diabetes, chronic lower respiratory diseases, chronic liver disease and AIDS were also down last year, the report said. More and more Americans are lucky enough to die of old age, said Ari Minino, a demographer at the CDC's National Center for Health Statistics, who helped write the report. Heart disease (which claimed more than 700,000 American lives last year) and cancer (which claimed more than 550,000) are still the biggest killers of Americans. "After the Parade Passes by: Patriotic Fervor Can Give Way to Depression as New Reality Takes Hold" Boston Herald (10.10.01)::Azell Murphy Cavaan Experts say the unity and patriotism that flowered after the Sept. 11 attacks on the United States are typical responses to enormous tragedy. But as the holidays approach and the terrorist threat continues, more people are at risk for depression and related problems. "High levels of stress and anxiety tend to lead people to drink more and engage in behavior that is riskier than usual," said Richardo Rodriguez of Boston's Multicultural AIDS Coalition (BMAC). And, he said, AIDS workers nationwide are gearing up for an especially tough year as some volunteers who donated blood to the emergency response effort learn they are HIV-positive. Moreover, organizations like BMAC are experiencing unprecedented drops in donations as Americans divert their contributions to disaster funds. "AIDS doesn't slow down because of a national crisis. The pain is just exacerbated," he said. "Director of AIDS Organization to Step Down" Associated Press (10.10.01) Larry Kessler, co-founder of the AIDS Action Committee of Massachusetts, announced Wednesday that he will step down as the organization's executive director. He will remain on the job until a search firm finds a replacement, which could take four months to a year. Kessler, whose new title will be founding director, said, "It's been the best job I've ever had, but also the most challenging and sometimes the saddest. It's time to move over a little bit and focus on some of the other things we need to do." "AIDS Walk Has Plenty in Store" Dallas Morning News (10.11.01)::Robert Miller Organizers of the annual AIDS Arms LifeWalk in Dallas this Saturday are hoping to raise at least $500,000. Corporate sponsorships have already brought in an estimated $381,000. Last year's walk raised $385,000. The walk begins at 9 a.m. at City Hall and will wind through the downtown Neiman Marcus store. For information, telephone 214-443-WALK or visit www.AIDSLifeWalk.org.