Subject: CDC AIDS Daily Summary for Date: Wed Oct 17 11:31:01 PDT 2001 (379 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 "New Law Promises Instant HIV Results" INTERNATIONAL NEWS "Study Says AIDS Is Now Chief Cause of Death in South Africa" "Patents Said Not to Cut AIDS Drug Access" MEDICAL NEWS "AIDS Patients Do OK with Transplants" LOCAL AND COMMUNITY NEWS "3,500 Brave Weather for AIDS LifeWalk; Nonprofit Director Says Fund-raiser Didn't Come Close to Meeting Goal" "Grant to Help Jail Care for Inmates with AIDS" EDITORIALS AND COMMENTARY "AIDS During Wartime" NEWS BRIEFS "Elderly, High-Risk People Urged to Get Flu Vaccine; Healthy Urged to Wait" "Bout with TB Doesn't Keep Mariners' Guillen out of Lineup for Long" "Tanzanian President Urges People to Be Wise on AIDS" ************************************************************ NATIONAL NEWS ************************************************************ "New Law Promises Instant HIV Results" Bay Area Reporter (San Francisco) (10.04.01)::Katie Szymanski According to the CDC, of the 2.5 million people who get tested annually for HIV at public sites, 30 percent never return to learn their status. With the rise in HIV transmission, California Assembly member Carole Migden (D-San Francisco) authored and pushed through bill AB1263, which was signed by Governor Gray Davis on Sept. 23. The new law, to take effect in January, will allow implementation of rapid oral HIV testing by counselors at select sites while the test awaits full FDA approval. Rapid oral testing has already been determined to be accurate, according to the bill's backers, and can yield a result in five to 30 minutes. At the very least, the new law should help curb the number of HIV cases that arise from a person not knowing his or her status. Dr. Thomas Coates, director of the University of California-San Francisco's Center for AIDS Research, said the high "fall-off" rate between testing and getting results means that there is a significant population that just "can't face the possibility of a bad result." But it is the waiting rather than the result that may cause the anxiety, said Coates. "Even the knowledge of a wait might be an obstacle," said Coates, who praised Migden's legislation as "removing a legal barrier so that counselors, rather than just lab technicians, are allowed to interpret testing results." "HIV infection is once again on the rise," said a statement from Migden. "Rapid HIV testing will allow for more people to learn their HIV status and make important life decisions." ************************************************************ INTERNATIONAL NEWS ************************************************************ "Study Says AIDS Is Now Chief Cause of Death in South Africa" New York Times (10.17.01)::Rachel L Swarns According to a long-awaited report by the Medical Research Council (MRC) in Johannesburg -the South African equivalent to the US National Institutes of Health -AIDS is the leading cause of death in South Africa. Young adults are especially hard hit, with the overall death rate of women in their 20's now higher than that of women in their 60's, the MRC reported today. By tracking mortality data as far back as 1985, the report provides a portrait of an epidemic that is transforming the ordinary patterns of life and death. The report -the first comprehensive examination of mortality statistics from the AIDS era -found that 40 percent of adult deaths last year were caused by AIDS- related illnesses. Contradicting recent statements by President Thabo Mbeki, who has insisted that violence and other diseases are bigger killers than AIDS, the report said researchers could find no other explanation for the surge in mortality: "We looked at alternative explanations for these patterns and found none of them plausible." Mbeki's officials have repeatedly delayed the report's release and criticized its validity. It is unlikely that the government will take aggressive action based on the findings. Instead, officials at South Africa's statistics agency are questioning the MRC's methodology, citing such problems as incomplete data in rural areas. Despite government resistance to the report, the MRC scientists have refused to back away from their findings. "There is no precedent for this in our history," said Dr. Malegaparu Makgoba, MRC president. "You have a situation where the younger females who are supposed to be healthy and productive are dying in greater numbers than their mothers." "Patents Said Not to Cut AIDS Drug Access" Boston Globe (10.17.01)::John Donnelly A study on Africa in the Journal of the American Medical Association (JAMA Vol. 286, No. 15, October 17, 2001) cites a lack of global aid as the primary impediment to drug access for individuals with AIDS there. A review of company information on patents for 15 antiretroviral drugs in sub-Saharan Africa found that only 21 percent of possible patents existed for these drugs, making patents a minor cause of the lack of drug treatment in Africa. The report, written by Harvard's Amir Attaran and Lee Gillespie-White of the International Intellectual Property Institute, a Washington think tank, has been long awaited by the AIDS activist community. "If you know what's going on in ... Africa, it's really an offensive piece ... that is attacking the interests of the most powerless people on earth now," said James Love, director of the Consumer Project on Technology, a Washington advocacy group. Love countered the report by saying that patents completely block drug access in South Africa, one of a handful of countries in sub-Saharan Africa that could afford to buy substantial quantities of the drugs. He also contended that Glaxo SmithKline has patented many of its popular combination AIDS drugs in much of the continent. Attaran said in an interview that the report should speak for itself. He and Gillespie-White found that in countries that have high numbers of people infected with AIDS and no patented drugs - Angola, Namibia, and Ethiopia, to name three - extraordinarily low numbers of people were being treated. The UN estimates that one in 1,000 Africans infected with AIDS are now receiving treatment. Removing patents as the culprit of the lack of access to AIDS drugs in Africa serves the pharmaceutical industry's momentum to strengthen patents laws on medicine for developing countries, according to Love and others. They contend that the article will be used by the industry at the World Trade Conference meeting next month in Doha, Qatar. Richard Laing, a professor of international health at Boston University, said yesterday that as long as Glaxo SmithKline blocks access to drugs in sub-Saharan Africa, "there's not going to be an effective product." He also pointed out that the list of drugs that are not patented presented in the article offers an opportunity for national licensing boards to approve generic copies for import. While Laing agreed with the report's conclusion on the importance of financial aid to developing countries to fight AIDS, he thought that Attaran and Gillespie- White "made a mistake of overstating their case" that patents were not an obstacle to treatment. But Jeffrey P. Kemprecos, a Merck spokesperson, thought the report was clear. "It's all a financing issue," he said. "Even if the drugs for HIV/AIDS cost 50 cents a day, how could most people in Africa afford more than 20 to 40 days worth of drugs?" ************************************************************ MEDICAL NEWS ************************************************************ "AIDS Patients Do OK with Transplants" United Press International (10.15.01)::Ed Susman According to researchers at the World Congress of Nephrology in San Francisco, patients infected with HIV appear to do well following the receipt of donor kidneys and livers. Despite the fact that patients routinely must receive cyclosporine, an immuno-suppressant administered so that organ rejection does not occur, HIV/AIDS patients do gain from the operation. "Frankly, a lot of us thought that giving cyclosporine to these patients would be almost immediately fatal," said Dr. Lynda Frassetto, associate clinical professor of medicine at the University of California-San Francisco. Frassetto said that eight of her first nine transplant patients have survived the procedure, one for as long as 18 months. The patient who died, Frassetto told UPI, was infected through blood products used to treat childhood leukemia. He received two liver transplants but died 15 months later of advanced hepatitis. Three patients received livers. Six patients received kidneys. With the exception of one teenager, adults who received organs ranged in age from 38 to 53 at the time of the operation. In a presentation at the conference, co-sponsored by the American Society of Nephrology and the Amsterdam-based International Society of Nephrology, Frassetto discussed the details of the study. Nine patients who had HIV and stable viral loads thanks to antiretroviral drugs were selected. They were all treated for any other existing disease or condition before undergoing transplant. They received a transplant because they were either next in line on a transplant list, had a family member donor, or agreed to accept organs that were rejected from other institutions, usually because the donor was elderly. In the patients receiving cyclosporine, the level of CD4- positive cells increased, sometimes markedly. The larger the number of CD4-positive cells, the greater the immune competence. "Fifteen years ago, having HIV infection was an absolute exclusion for receiving a transplant," said Dr. Solomon Smith, a nephrologist and AIDS specialist affiliated with the Veterans Affairs Hospital in Columbia, S.C. "But now, with treatments, we have extended the life expectancy of AIDS patients so that these patients with liver and kidney failure can benefit from these transplants." Frassetto said that the procedures are still new and are not to be routinely advocated. "Any transplant into an HIV-infected patient should be done as part of an experimental protocol," she said. "This is still a very complicated procedure and requires the help of a lot of specialists in surgery, transplantation, AIDS treatment as well as nephrology." ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "3,500 Brave Weather for AIDS LifeWalk; Nonprofit Director Says Fund-raiser Didn't Come Close to Meeting Goal" Dallas Morning News (10.14.01)::Sherry Jacobson Organizers of the 11th annual LifeWalk for AIDS to benefit AIDS Arms Inc. drew an enthusiastic crowd of about 3,500 people to downtown Dallas on Saturday. However, the financial contributions generated by the event fell far short of expectations. "We were hoping to raise $500,000 in cash this year," said Rodney Holcomb, executive director of the 15-year- old Oak Cliff agency, which provides case management services for people with HIV/AIDS. "But we didn't even get to the halfway mark." In all, the event raised about $220,000. Another $15,000 to $20,000 could arrive later from walkers who stayed home because of the weather. Last year the agency raised $385,000 from the walk. Since 1990, the event has collected more than $4 million, which AIDS Arms has shared with several other AIDS agencies. About 11,000 people in North Texas are living with HIV/AIDS. About 90 percent of those people live in Dallas County. Holcomb said he had worried for weeks that local AIDS fund- raising efforts would be hurt by the Sept. 11 attacks. Since then, relief efforts to help the victims and their families have prompted a national outpouring of contributions. "What happened to our walk is a strong indication of how adversely impacted local fund-raising will be from now on," he said. "Unfortunately, it's going to have a direct impact on our ability to provide services to people." Although most of its $3.4 million budget comes from federal money, the agency uses local contributions to expand its services to handle a growing caseload. "If we don't get the money from somewhere else, we're going to have to figure out how to cut back an already lean operation," Holcomb said. "Grant to Help Jail Care for Inmates with AIDS" Press Journal (Vero Beach, Fla.) (10.15.01)::Jayne Hustead Indian River, Fla., county jail inmates with AIDS would be better off in a Florida state prison, say public health, legal and law enforcement representatives. The Florida prison system has state-of-the-art AIDS treatment available. Prison inmates receive medication while incarcerated, and upon release get a 30- day supply of medication and a referral to the public health department in the city where they are going to live, said Nancy L. Heinrich, human services program manager coordinator at the Indian River County Health Department. At the county jail, however, medical care for HIV-infected inmates "historically hasn't been good," Heinrich said. Heinrich received word last Thursday that she has received a $36,413 grant from the Florida Department of Health to implement jail screening, education and links with outside medical providers. The program seeks to increase by 50 percent the number of inmates who request testing to ascertain their HIV status and to provide post-release treatment planning for 100 percent of infected inmates. One of the biggest problems at the jail -where there are typically six to 10 HIV-infected inmates on any given day -is interruption of an AIDS patient's medications, Heinrich said. Education is also a key part of Heinrich's plan, which calls for inmates to be given the opportunity to attend a series of classes that would focus on health education, risk reduction and skill-building. "We've never done anything like this," said Heinrich. "This [plan] will help keep people from falling between the cracks." ************************************************************ EDITORIALS AND COMMENTARY ************************************************************ "AIDS During Wartime" Bay Area Reporter (San Francisco) (10.04.01)::Matt Sharp "... The deluge of dollars from public and private sources has been astonishing in the aftermath of the [Sept. 11] attacks. In two weeks, charities raised half a billion dollars for victims and their families. The US government is said to have committed $40 billion to the disaster. The entertainment industry presented a telethon shown on four major television networks (and several cable channels) that raised over $150 million in just two hours. ... "The phenomenal reaction to the attacks will most certainly have unfavorable consequences to all national programs including efforts to combat AIDS that were underway or being planned before Sept. 11. ... There is great concern about the future of AIDS and how the government and public will respond in wartime. ... Government HIV research efforts will most certainly be affected if the National Institutes of Health begins prioritizing funds for research into the threat of biological warfare. "Why didn't the world react to the global AIDS epidemic as effectively as it has to the terrorist attacks? One wonders, given the huge loss of life caused by AIDS, and the fact that the global crisis remains an overwhelming menace, why hasn't more been done? While it is not fair to pit disasters against each other, just as it is not fair to claim any disease is more exceptional than another, it is shocking to compare the worldwide and national response to AIDS to the response to the terrorist attacks. Some will say that the attacks were more immediate and emotional, but anyone who has survived AIDS would say that AIDS is just as poignant and still spreading out of control. ... "[According to long-time San Francisco AIDS activist Laura Thomas], 'We need to develop strategies to keep a focus on AIDS that doesn't detract from the need to take care of the survivors of the recent attacks. Pouring more money into defense and into limited civil rights in this country will only hinder our ability to care for people here, including people living with HIV/AIDS.'..." ************************************************************ NEWS BRIEFS ************************************************************ "Elderly, High-Risk People Urged to Get Flu Vaccine; Healthy Urged to Wait" Associated Press (10.17.01)::Randolph E Schmid Supplies of flu vaccine this year will be adequate to meet demand, but because deliveries are running late, healthy people are being asked to postpone their shots so the elderly and other high-risk groups can be vaccinated first. Nancy Cox of the CDC said Tuesday that 79 million doses of vaccine -4 million more than last year -will be available. Those who should get vaccinated first are: people age 65 and older; residents of nursing homes and facilities for the chronically ill; children and adults with chronic heart or lung disorders, such as asthma; children and adults who need regular medical care due to chronic diseases such as diabetes, kidney disease and immune suppression; people age six months to 18 years who are receiving long-term aspirin therapy; pregnant women who will be in their second or third trimester during flu season; and health care workers. "Bout with TB Doesn't Keep Mariners' Guillen out of Lineup for Long" USA Today (10.17.01)::Mike Dodd Two-and-a-half weeks after being diagnosed with pulmonary TB, Seattle Mariners' shortstop Carlos Guillen has been cleared to return to the field and was expected to be activated for the American League Championship Series. Manager Lou Piniella said it was "almost assured" that Guillen would be added to the roster and would start several games against the New York Yankees. Guillen was hospitalized and quarantined for several days after his illness was diagnosed Sept. 28. He continues to take antibiotics every four hours. "I feel better right now than when I was playing before," said the 26-year-old Venezuelan, who had continued playing despite being sick for much of the season's second half. "Tanzanian President Urges People to Be Wise on AIDS" Xinhua News Agency (10.15.01) Tanzanian President Benjamin Mkapa on Sunday urged his people to respect professional advice on how to combat HIV/AIDS, warning them that antiretroviral drugs are not a solution to the killer disease. Although many people know about AIDS, he said, that knowledge was not leading them to change their behavior. A national AIDS policy will be launched soon, Mkapa said. It is estimated that one in every 10 adults in Tanzania is HIV- positive, and 72,000 babies are born with HIV each year in the nation.