Subject: CDC AIDS Daily Summary for Date: Mon Oct 22 11:31:01 PDT 2001 (361 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 "A $9.3 Billion Proposal Outlines Global Campaign Against TB" "Cases of HIV Among Inmates in State Prisons Are Leveling off" INTERNATIONAL NEWS "Thai Government to Make Own, Cheaper AIDS Drugs by End of Year" "Marijuana Prescription Law OK'd" MEDICAL NEWS "Prevalence of Adverse Events Associated with Potent Antiretroviral Treatment: Swiss HIV Cohort Study" LOCAL AND COMMUNITY NEWS "Painter Tackles a Giant 'Hero'" "Hull's Zahn Ready for AIDS Hike in Africa" NEWS BRIEFS "A Celebration of Life and Loved Ones for Those Participating in AIDSWalk" "89-Year-old Harvey Chosen as Queen for Fantasy Fest" "Unimpeded Access to Kitsap Clinic to Be Restored" ************************************************************ NATIONAL NEWS ************************************************************ "A $9.3 Billion Proposal Outlines Global Campaign Against TB" Boston Globe (10.22.01)::John Donnelly World Health Organization (WHO) officials, together with businessman George Soros, have developed a plan that says $9.3 billion is needed in the next five years to significantly reduce the incidence of TB. Unlike still-developing global efforts to battle HIV/AIDS and malaria, the TB plan has detailed blueprints on how to attack the deadly bacterium in each of the 20 countries with the highest TB caseload. Health and finance officials will meet in Washington, D.C., today and tomorrow to put the final touches on the plan. They had talked about canceling the meeting in the wake of the Sept. 11 attacks on the United States, but decided to go ahead as scheduled. "The show much go on," said J.W. Lee, WHO's top TB control official. "We're talking about 2 million people dying a year from TB. Before Sept. 11, many people thought that a $9 billion plan was impossible. But Sept. 11 proved money is not the issue. The issue is political will. So if the world wants to fight TB, the world will do it. Sept. 11 changed the whole paradigm of how we look at things." Michael Vachon, spokesperson for Open Society Institute chair Soros, also said the Sept. 11 attacks "make it even more important that we pursue some kind of reform" in the developing world. "The inequities bred by globalization allow people like Osama bin Laden to draw people to their causes. Eliminating poverty isn't going to get rid of terrorism, but it will make it harder for these people to exist," Vachon said. The plan calls for about $900 million a year for five years from wealthy countries. Developing countries are to pay the remaining costs. Soros will propose that the International Monetary Fund oversee the new fund. In 1999, 23 percent of the world's 8.4 million TB patients were receiving the recommended six-month course of medication. With the additional funds, the WHO hopes to extend coverage to 70 percent of those ill with TB. "Cases of HIV Among Inmates in State Prisons Are Leveling off" Associated Press (10.21.01) The occurrence of HIV among inmates in Indiana prisons has leveled off, though it still remains about 10 times higher than the known incidence of HIV in the state's overall population. There are an estimated 215 people in Indiana prisons this year with HIV. Department of Correction officials said that roughly 1 percent, or 21,507 people, in Indiana prisons are HIV-positive. The percentage of HIV-positive inmates in Indiana is well below the national average of 2.1 percent. A Bureau of Justice Statistics report issued in July showed that while the number of HIV cases in US prisons has increased, the number of HIV-positive prisoners has grown at a slower rate than the overall prison population. Prison and health experts attribute the trend to increased awareness of the disease and improved treatment. "Overall the last 10 years we've gone from not knowing, not caring, to people knowing a lot about HIV and people actually caring about the kind of care they provide," said Anne DeGroot, editor of Brown University's HIV and Hepatitis Education Prison Project. "There's been sort of an awakening of physicians in the facilities, and that's what's making the change." Still, health experts and advocates for AIDS patients express concern about maintaining the safety of prisoners living with the disease and preparing them for release to society. They believe more awareness and education are needed. HIV-positive inmates receive medical treatment at Indiana prisons through the Prison Health Services, the private company under contract with the state to provide health care for all inmates. HIV-positive inmates are also counseled upon entering and leaving any state prison. Upon intake, inmates receive information on ways to avoid the spread of HIV and other infectious diseases such as hepatitis and TB. Caseworkers at the Damien Center, an Indianapolis AIDS service organization, said the Department of Correction doesn't have enough staff to provide the needed pre-release counseling. For many inmates, living with HIV or AIDS after their release isn't a big priority. "They're more concerned about, 'Where am I going to sleep? Where am I going to eat?'" said Damien caseworker Sheryl Phillips. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Thai Government to Make Own, Cheaper AIDS Drugs By End of Year" Associated Press (10.22.01)::Busaba Sivasomboon Thailand's state pharmaceutical enterprise, the Government Pharmaceutical Organization (GPO), announced on Friday that by the end of next year, it plans to manufacture most of the drugs commonly used to treat people with HIV. This will cut the cost of treatment in half, said Thongchai Tavichachart, director of the organization. As a result, the average price of a month's supply of HIV/AIDS drugs will drop to $51 per person from $92.50 at present. In the next three to four months, the GPO will have the capacity to produce enough drugs used in AIDS cocktails, such as AZT and Nevirapine, to serve the needs of 50,000 patients. Within a year, it should be able to supply at least 100,000 patients. The official number of HIV-infected persons in Thailand is 500,000, although other estimates are twice as high. About 200,000 patients are undergoing drug therapy, said Tavichachart. In January, to make medicines more affordable, Thailand changed drug registration regulations in a way that gave high-priced foreign products competition from locally produced generic versions. Tavichachart said the GPO has invested about $445,000 in improving its AIDS drug manufacturing capacity. The enterprise currently manufactures a small amount of the drugs on a trial basis. "Marijuana Prescription Law OK'd" Newsday (New York) (10.19.01)::Anthony Deutsch The Dutch Cabinet on Friday approved a bill to allow Netherlands' pharmacies to fill prescriptions, paid for by the government, for marijuana. "An increasing number of patients suffering illnesses such as cancer, AIDS and multiple sclerosis receive medicinal cannabis," said a statement released by the government. Many patients using the drug without professional assistance have had successful results, it said. "Experiences are positive: less pain, less nausea after chemotherapy, less stiffness with MS," the statement said. The Dutch Parliament is expected, in the next few months, to vote on the proposal to put medicinal marijuana on the national health plan. If the bill is passed by the 150-member legislature, pharmacies would be supplied with "pharmaceutical quality" marijuana after testing by a government agency. Although the sale of marijuana is technically illegal, Dutch authorities tolerate the sale of small amounts in hundreds of so-called coffee shops that operate openly. Under the new law, most users would have their marijuana paid for by the government as long as it is prescribed by a doctor. The prescription marijuana would be grown according to government guidelines. Although several countries tolerate marijuana use by patients, only Canada licenses them to legally grow and possess it, according to a spokesperson for the Washington-based National Organization for the Reform of Marijuana Laws. The Canadian government is also growing marijuana and plans to create a government-run system to distribute it. Nine US states have laws exempting medical users from prosecution under state laws, but patients may still be arrested under federal laws. ************************************************************ MEDICAL NEWS ************************************************************ "Prevalence of Adverse Events Associated with Potent Antiretroviral Treatment: Swiss HIV Cohort Study" Lancet (10.20.01) Vol 358; No 9290: P 1322-1327 ::Jacques Fellay; Karim Boubaker; Bruno Ledergerber; Enos Bernasconi; Hansjakob Furrer; Manuel Battegay; Bernard Hirschel; Pietro Vernazza; Patrick Francioli; Gilbert Greub; Markus Flepp; Amalio Telenti In view of the adverse affects that accompany antiretroviral therapy, precise data on effects have long been indicated. Background data on adverse events to antiretroviral treatment have been recorded in clinical trials, post-marketing analyses, and in anecdotal reports. But no systematic study has been done to assess adverse events. Using a standard clinical and laboratory method, the investigators evaluated the prevalence of adverse events in 1,160 patients who were receiving antiretroviral treatment. They measured the toxic effects associated with various regimens: protease inhibitor (PI), non-nucleoside and nucleoside analogue reverse transcriptase inhibitor and specific compounds. Data were obtained from outpatients in the Swiss HIV Cohort Study using a structured interview and laboratory analyses to identify and describe all potential adverse events attributed to treatment according to standard definitions. Identification of independent associations using logistic regression analysis was also utilized. The Swiss HIV Cohort Study is a prospective cohort study of individuals with HIV-1 who were followed up in one of seven Swiss clinics. Patients were identified by the type of antiretroviral regimen they were on. Patients who had changed their regimen in the last 30 days were excluded from the study. During the visit, physicians completed a questionnaire based on classification used by the AIDS Clinical Trials group on adverse events. According to the authors, "Physicians explicitly asked patients if symptoms listed in the questionnaire had arisen within the 30 days preceding the visit. Lipodystrophy was described according to Carr and colleagues. Potential adverse events were scored according to severity (1=mild, 2=moderate, 3=severe, 4=serious) and the likelihood of resulting from antiretroviral treatment (unlikely, possible, probable, and certain), after the definition of the World Health Organization." Standard comprehensive laboratory assays were done on each patient on or immediately before (<10) their clinic visit. The results of the study indicated that 47 percent of patients had clinical adverse affects from antiretroviral combination therapy. Nine percent of effects were graded as serious or severe. Twenty-seven percent of laboratory results showed adverse effects, and 16 percent of these were rated serious or severe. The more drugs taken in combination, the lower the HIV levels but the higher the likelihood of side effects. According to the investigators, "It should be underscored that more than two-thirds of patients might have complaints if precisely questioned and that adverse events have an effect on adherence and on development of viral resistance, which might lead to treatment discontinuation or failure. Yearly surveys using the proposed cross-sectional analysis could help to assess changes in prevalence of specific toxic effects and in overall well-being of patients receiving antiretroviral treatment." The authors, in addition, recommended that post-marketing surveillance of toxic effects be conducted by pharmaceutical companies. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Painter Tackles a Giant 'Hero'" Washington Times (10.20.01)::Geoff Edgers Eric Waugh's latest painting, "Hero," will be twice as tall as the Statue of Liberty. Three trucks will be needed to move it. "Hero" will be shown just once, at the North Carolina Museum of Art in December. The Montreal-based artist hopes to raise $4 million for children with AIDS and other illnesses by selling posters of the original painting and framed, sliced-up pieces of the original. The money will benefit Minnesota's Camp Heartland, which serves children affected by HIV/AIDS, and the Starlight Children's Foundation. The inspiration for "Hero" -whose image is a bright abstract of an adult with an arm around a child -came from a 1995 CBS News documentary, "Before Your Eyes: Angelie's Secret." The show chronicled a young girl's battle with HIV, and soon after Waugh saw it, he visited Camp Heartland, which was featured in the film, and created "Hero." The poster-size version has already appeared in background shots on the TV shows "Seinfeld," "Baywatch" and "Caroline in the City." Waugh chose the North Carolina Museum of Art after his sponsor, art.com, suggested that the museum, with its 165 acres of parkland, would be a good setting. This summer, he pitched the idea to museum Director Larry Wheeler. "I had to be persuaded that it was, first of all, a good cause," Wheeler said. "We don't generally do fund-raisers for charities or other organizations. I also wanted to make sure the art wasn't schlock." The unveiling is set for Dec. 1, World AIDS Day. Waugh has completed about 22,000 square feet and has 19,000 square feet left to paint. "Eric will get it done," reassured Tom Lotrecchiano, art.com's national sales director. "He's a painting machine." "Hull's Zahn Ready for AIDS Hike in Africa" Boston Globe (10.11.01)::Emily Shartin Jean Zahn was affected by a TV news segment that detailed the plight of South African children orphaned because of AIDS. Now she is preparing for a 75-mile hike through South Africa's rugged mountains next April. The Hull, Mass., resident will be joining at least 145 hikers -including 17 from Massachusetts - on the African AIDSTrek, a week-long journey to raise money and awareness for AIDS research. She will sleep in a tent, walk alongside wildlife and climb 4,500-foot mountains along the way. She decided against simply sending a donation in the belief that visibility is important so South Africans can see someone is paying attention. "They have to know we know" Zahn said. "The story has to come out." The African AIDSTrek is one of 27 fundraising events that will be run next year by Pallotta Team Works, a for-profit organization that says it has contributed $190 million to AIDS and breast cancer research since 1994. Billed as Pallotta's boldest event ever, the trek was developed in response to South Africa's public health crisis. According to Zahn, the experience will force her to face vast cultural differences. "I've never gone into a country where I am the minority," she said. "Am I fearful? No. Am I thoughtful? Yes." Zahn, who teaches spiritual healing techniques, has raised $1,200 of the $10,000 she needs. Since the Sept. 11 attacks on New York and Washington, she said she's been criticized by people who believe her energy would be better spent on domestic causes. However, she believes the attacks reaffirmed her need to reach out. "I look at it as the world," said Zahn. "I think we are here to help each other." ************************************************************ NEWS BRIEFS ************************************************************ "A Celebration of Life and Loved Ones for Those Participating in AIDSWalk" Philadelphia Inquirer (10.22.01)::Marcia Gelbart An estimated 30,000 people participated in the 15th annual Philadelphia AIDSWalk on Sunday. About 800 teams registered for the event -33 percent more than last year. Susan L. Higginbotham, executive director of the AIDS Fund, said the event raised $615,000 to add to the nearly $12 million that has been raised since the walk began. Additional donations will eventually raise the amount to $900,000, she said. People participated in the 12-kilometer walk, 12-kilometer run or one-mile stroller walk to support 38 Philadelphia-area organizations that assist people living with HIV/AIDS. "I just want people to remember that there are local needs," Higginbotham said, noting that an estimated 30,000 people in the Philadelphia area live with the virus. "89-Year-old Harvey Chosen as Queen for Fantasy Fest" Associated Press (10.20.01) Wilhelmina Harvey, the 89-year-old former Florida Keys mayor, was crowned queen of this year's Key West Fantasy Fest on Friday night. She will preside over the 10-day festival of costuming and masking with Tom Wheaton, owner of a local health club. The royal campaign is more than a popularity contest. Winners are crowned by raising more money than competitors to benefit Key West's AIDS Help Inc. The organization provides support services for people with AIDS and community education to reduce the spread of HIV. This year, candidates raised $148,650, pushing the grand total amassed since 1989 to more than $1.2 million. Fantasy Fest concludes on Oct. 28. "Unimpeded Access to Kitsap Clinic to Be Restored" Seattle Times (10.20.01)::Florangela Davila A military checkpoint erected to provide security for naval housing in Bremerton, Wash., will be moved next week after public health officials complained it was scaring off clients who needed to reach a nearby county health clinic. Health and county officials raised concerns about the checkpoint, which was installed after the Sept. 11 terrorist attacks. They said it was intimidating clients, especially those who wanted confidentiality as they sought testing for HIV/AIDS/STDs, or those who might be in the country illegally. A dozen patients in the past two weeks had reported not being able to get through the checkpoint or feeling intimidated by it, or had requested services away from the clinic, according to the facility's HIV/AIDS manager.