Subject: CDC AIDS Daily Summary for Date: Fri Oct 12 11:31:01 PDT 2001 (346 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 "Federal Judge Extends Order Against TennCare" "Close Call with TB a 'Scary' Experience for Guillen" INTERNATIONAL NEWS "UN, Kofi Annan Win Nobel Peace Prize" "Afghanistan Bombing Could Cause AIDS Explosion" MEDICAL NEWS "Tuberculosis Pleurisy More Severe in HIV-Positive Patients" LOCAL AND COMMUNITY NEWS "Coroner Urges Changes After Inmate's Death" "Grandmother in Forefront of AIDS Fight" NEWS BRIEFS "Council Committee Advances Clean-Needle Proposal" "South Africa Government Gives Census Takers Condoms" "Come Take a Walk for AIDS Research" ************************************************************ NATIONAL NEWS ************************************************************ "Federal Judge Extends Order Against TennCare" Associated Press (10.11.01)::Tom Sharp US District Judge William Haynes, after two days of testimony in his Nashville court, on Thursday agreed to extend a restraining order issued last month prohibiting TennCare from closing its enrollment to people who cannot get medical insurance. Haynes will rule on the merits of the case once he has had time to review them. TennCare is the state's health insurance program for poor people. The immediate result of Haynes' decision suspends Tennessee's attempts to begin revamping the program to pass over the hard-to-insure. These are individuals who don't have insurance elsewhere and can't get it because of an existing medical condition. The new policy would markedly affect those who are disabled, those who have chronic or acute medical conditions, those who are chronically mentally ill, and those who have incurable diseases, like HIV/AIDS. Some of these individuals have Medicare, but that federal entitlement does not pay for prescriptions. Total TennCare enrollment is 1.47 million. It has an enrollment cap of 1.5 million. The state can have more than 1.5 million people in the program, but all of those over 1.5 million would be paid for entirely with state dollars. TennCare Director Mark Reynolds said about 2,100 of the 8,000 new TennCare enrollees per month fall into the uninsurable adult category. The federal government pays two-thirds of the cost of the other enrollees. But Tennessee officials say that closing enrollment now could save the state $7.5 million by not allowing new enrollments to push the TennCare budget above $37.5 million. However, according to Gordon Bonnyman of the Tennessee Justice Center, who brought the lawsuit on behalf of future TennCare enrollees, other state agencies have indicated that they will need tens of millions of dollars to handle the people who would no longer be eligible for TennCare. Bonnyman also said that there was no need to stop enrolling eligible people because of the enrollment cap. "If need be the cap can be increased at the request of the state," Bonnyman said. Dr. Stephen Raffanti, a Vanderbilt University professor and medical director of several HIV clinics, called TennCare "crucial for HIV-positive individuals." "Close Call with TB a 'Scary' Experience for Guillen" Seattle Times (10.12.01)::Bob Sherwin When Seattle Mariners shortstop Carlos Guillen was diagnosed with TB, staying alive -not returning to baseball -was his top priority. After struggling since July with a persistent cough, nosebleeds and weakness, Guillen learned on Sept. 7 that he had pulmonary TB. "I called my Mom and asked her, 'What's tuberculosis?'" Guillen said. Then he got scared. "I had surgery that Monday (Sept. 10). That's scary, too. I almost died. The doctors say that out of 10 people, seven die without that surgery." In the procedure, doctors placed an artificial clot in his lung to stop his bleeding and stabilize his condition. Now Guillen is back into a routine with the team. He practiced with his teammates on Thursday and would like to rejoin the active roster if the Mariners advance to the second round of playoffs. Though Manager Lou Piniella last week called that "a remote, remote possibility," Guillen holds out hope. "I'm a little weak. I got a little tired out there today. But I'd still like to play in the playoffs. That is my goal," he said. Guillen, who is from Maracay, Venezuela, said his health began to decline in July. "I had a fever. I couldn't sleep through the night. Tough nights. Sometimes I thought I didn't want to play [until the next day] because I was so tired. But when I got to the ballpark, I changed my mind because I wanted to play every day." The 6-foot-1, 202-pound Guillen lost 10 pounds during his TB treatment but has regained seven pounds. ************************************************************ INTERNATIONAL NEWS ************************************************************ "UN, Kofi Annan Win Nobel Peace Prize" Associated Press (10.12.01) The UN and its Secretary-General Kofi Annan won the Nobel Peace Prize on Friday for "their work for a better organized and more peaceful world." UN spokesperson Fred Eckhard woke Annan and told him the news shortly after 5 a.m. Friday. Speaking on CNN, Eckhard called the award "a vote of confidence in our common future." "Since the end of the Cold War, the UN has been able to move towards its full potential in the peace and security area," Eckhard said. Annan, born in 1938 in Ghana, became UN secretary-general in 1997. He has been praised for his character, moral leadership, his efforts to stop civil wars in Africa and elsewhere and his work to combat AIDS. Following is the text of the 2001 Nobel Peace Citation: "The Norwegian Nobel Committee has decided to award the Nobel Peace Prize for 2001, in two equal portions, to the United Nations (U.N.) and to its Secretary-General, Kofi Annan, for their work for a better organized and more peaceful world. "For one hundred years, the Norwegian Nobel Committee has sought to strengthen organized cooperation between states. The end of the Cold War has at least made it possible for the U.N. to perform more fully the part it was originally intended to play. Today the organization is at the forefront of efforts to achieve peace and security in the world, and of the international mobilization aimed at meeting the world's economic, social and environment challenges. "Kofi Annan has devoted almost his entire working life to the U.N. As Secretary-General, he has been preeminent in bringing new life to the organization. While clearly underlining the U.N.'s traditional responsibility for peace and security, he has also emphasized its obligations with regard to human rights. He has risen to such new challenges as HIV/AIDS and international terrorism, and brought about more efficient utilization of the U.N.'s modest resources. In an organization that can hardly become more than its members permit, he had made clear that sovereignty cannot be a shield behind which member states conceal their violations. "The U.N. has in its history achieved many successes, and suffered many setbacks. Through this first Peace Prize to the U.N. as such, the Norwegian Nobel Committee wishes in its centenary year to proclaim that the only negotiable route to global peace and cooperation goes by way of the United Nations." "Afghanistan Bombing Could Cause AIDS Explosion" Reuters (10.12.01):: Wendy Pugh The US-led attacks on Afghanistan will eventually disrupt the flow of opium from one of the world's top suppliers and could cause heroin-injecting to surge in neighboring Pakistan, leading to a potential AIDS catastrophe, researchers said on Friday. Intravenous drug use is one of the major causes of the spread of HIV/AIDS. Heroin prices on the Pakistan-Afghanistan border plunged after the Sept. 11 attacks on the United States as Afghanistan's opium stocks were unloaded. But the flood of heroin slowed after the United States and Great Britain began airstrikes on Sunday. Researchers attending an international conference in Melbourne said climbing heroin prices could force Pakistani addicts who sniffed the drug when it was inexpensive and plentiful to turn instead to intravenous drug use. "This could be a public health crisis of unimaginable proportions," said Alex Wodak of Sydney's St. Vincent's Hospital. According to Wodak, an explosion in AIDS in Pakistan would have implications for the whole of Asia. Nadeem-ur-Rehman, an HIV/AIDS worker and researcher in Pakistan with nongovernmental organization Nai Zindagi (New Life), said there were already signs of a shift to intravenous injecting in the border city of Quetta. According to Rehman, Pakistan was estimated to have 500,000 chronic heroin abusers, about 44,000 of whom inhale the drug in a practice called "chasing the dragon." Rehman said that although the prevalence of AIDS in Pakistan was less than 1 percent of the population, needle sharing, the sale of blood to health services, prostitution and unprotected sex left the country vulnerable. "Everything is there. You can't say we are immune because we are a Muslim country," Rehman said. Seven million people in the Asia-Pacific region are living with HIV/AIDS, representing about 20 percent of the worldwide totals, according to UN figures. ************************************************************ MEDICAL NEWS ************************************************************ "Tuberculosis Pleurisy More Severe in HIV-Positive Patients" TB & Outbreaks Week (10.02.01)::Michael Greer Researchers in Uganda have found that HIV-positive patients face greater risk from TB-related lung inflammations than do HIV- negative patients. H. Luzze of Uganda's National Tuberculosis Treatment Center and the Uganda-Case Western Reserve University Research Collaboration at Kampala's Mulago Hospital and colleagues conducted a study to "compare clinical and radiographic presentation, and diagnostic methods, in adults with tuberculosis pleurisy who are negative and positive for [HIV]." They found that patients coinfected with TB and HIV made up the vast majority of TB pleurisy cases, and they suffered more virulent forms of the condition than other patients. Luzze and colleagues studied 142 patients with confirmed pleural TB, 80 percent of whom also had HIV. Coinfected patients had more severe and more persistent pleurisy, they said, with significantly lower levels of pleural fluid lymphocytes. These patients were also more likely to have positive mycobacterial pleural fluid cultures. The researchers also observed a slightly higher rate of pleurisy with parenchymal infiltration in HIV patients, study data showed, although the discrepancy did not reach the level of significance. Serum effusions from the visceral pleura were comparable for patients regardless of their HIV status. "HIV-positive patients with tuberculosis pleurisy had a more severe illness than HIV-negative patients," the researchers concluded. "Liquid culture media were superior to solid media with regard to diagnostic yield and time until diagnosis." The full report, "Evaluation of Suspected Tuberculosis Pleurisy: Clinical and Diagnostic Findings in HIV-1 Positive and HIV Negative Adults in Uganda," appeared in the International Journal of Tuberculosis and Lung Diseases (2001; 5 (8): 746-753). Also on the team were researchers from Makerere University in Kampala; the Medical Research Council Program on AIDS at the Uganda Virus Research Institute in Entebbe; and the London School of Hygiene and Tropical Medicine in the United Kingdom. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Coroner Urges Changes After Inmate's Death" Post-Gazette (Pittsburgh) (10.12.01)::Ann Belser Allegheny County, Pa., Coroner Dr. Cyril H. Wecht on Thursday recommended changes in the way the county jail provides medical care to inmates after a Hill district man died in custody. Wecht said his office was not recommending any criminal charges be filed, and he would not comment on whether the quality of care for Timothy Meyers rose to the level of negligence. Meyers, 32, had hepatitis C, HIV and a seizure disorder that resulted from a 1995 brain abscess. According to an inquest conducted into Meyers' death, he did not tell nurses his medical history until he had been in the jail for several days. Once he gave his history, Meyers was given prescription drugs for HIV and an anti-seizure medication. But the following morning, May 27, he suffered a seizure in his cell. Guards responded at first and then called for a nurse, but it took her about 10 minutes to reach Meyers and, when she got there, she was hindered in helping Meyers because she had not been allowed to take a crash cart loaded with medical equipment into the jail pod. Attempts to revive Meyers in the infirmary were unsuccessful. Wecht recommended some changes in procedures, and Dr. Bruce Dixon, director of the Allegheny County Health Department, which oversees medical treatment at the jail, said some improvements already are in the works. Wecht said the nurse should have been allowed to take the crash cart into the jail pod, but that security concerns have kept medical personnel from doing so. Wecht also recommended that the jail find a better way to access past medical records on prisoners. Dixon said the jail now has a medical records clerk in the facility around the clock. He said the jail will also be reviewing the scheduling of doctors at the facility, following Wecht's recommendation that doctors be assigned there on nights and weekends. "Grandmother in Forefront of AIDS Fight" Post and Courier (Charleston, S.C.) (10.08.01)::Lynne Langley Mary Etta Brown N'Jie of Johns Island, S.C., has been "living with AIDS" for 12 years. Although she does not have the disease, she has taken care of a daughter and granddaughter who both died of HIV/AIDS. Granddaughter Megan Ashley Jewel Brown was born weighing 18 ounces. Her grandmother immediately gave two units of blood in the hope that the transfusion could wash AIDS from Megan's system. Megan was on a respirator in intensive care. N'Jie took Megan home on her first birthday and got her daughter Nicole, who also had AIDS, an apartment downstairs. "Thank God Megan stayed with us for 32 months. ... She died at home. I wanted that." N'Jie has since adopted two children who have the disease. Nearly 10 years ago she met Carrie, whom she has adopted, in the New York hospital nursery where she worked. "She was a sick, sick baby. ... The mother was a drug addict and said she'd rather I have her." Then an agency asked N'Jie to take Marcia for one day, and she ended up adopting that child, now nearly 11. "No one wanted them, and I got attached to them," she said. N'Jie gives each girl eight medicines three times daily. Carrie also needs a tube feeding and therapy for her breathing at night. "A lot of people ask me why I bog myself down with this. I don't trust anyone else with my children." N'Jie said. Today's AIDS medicines are wonderful, said N'Jie, recalling that baby Megan was one of the first to test AZT. Patients need to understand the importance of taking their medicines in precisely the way prescribed because otherwise they won't work, she said. "This is not a game. This is a war on the body, and we are just beginning to know what is going on." Society hasn't changed as much as medications have, N'Jie said. "A lot of people think AIDS is a disgrace ... But why should I be ashamed? [AIDS] is an everyday thing in society, and you can't pull the shades down," N'Jie said. ************************************************************ NEWS BRIEFS ************************************************************ "Council Committee Advances Clean-Needle Proposal" Union-Tribune (San Diego) (10.11.01)::Ray Huard By a 3-2 vote on Wednesday, the San Diego Public Safety & Neighborhood Services Committee backed a one-year pilot program to give clean needles to intravenous drug users. If approved by City Council, the privately financed program will use a motor home to distribute syringes in neighborhoods chosen because of high rates of STDs and drug-related arrests. The program was recommended by a task force -comprised of doctors, health care workers, city officials and police -appointed by council a year ago. "It's very rare in our lifetimes that we're going to be given this opportunity to save someone's life, and I certainly am not going to shirk that responsibility," said Councilmember Donna Frye. Councilmember George Stevens opposed the measure: "Those persons who are on drugs, who are using needles, they should just say no to drugs and change their life." "South Africa Government Gives Census Takers Condoms" Associated Press (10.07.01) The 100,000 census takers who fanned out across South Africa this week were issued packs of condoms as part of an AIDS awareness campaign. No workers are forced to take them, however. "But it would be good if they had it with them in the event that something happened while they're visiting a house," said Owen Thothela, Free State census manager. "Come Take a Walk for AIDS Research" Atlanta Journal & Constitution (10.12.01) AID Atlanta and 14 other AIDS services organizations will benefit from this Sunday's AIDS Walk Atlanta. Registration begins at 12:30 p.m. in Piedmont Park. For information, telephone 404- 876-9255 or visit www.aidswalk.net/aidswalkat.