Subject: CDC AIDS Daily Summary for 12/06/02 Date: Fri Dec 6 11:21:07 PST 2002 (395 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Friday, December 06, 2002 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 "Analysis Shows Cost-Effectiveness of Screening Immigrants for Latent TB Infection" INTERNATIONAL NEWS "AIDS Higher Among South African Children" "All-Out Effort Fails to Halt AIDS Spread" MEDICAL NEWS "High Relapse Rate Seen After 'Successful' Drug-Resistant TB Treatment" "Vaginal Contraceptive/HIV Fighter Seems Promising" LOCAL AND COMMUNITY NEWS "Heroin Addicts' Infection Rate High" "Long Before AIDS Crisis Was Declared, She Was on the Case" NEWS BRIEFS "New Headquarters for Quilt" "Manhattan: Fewer AIDS Cases" "Nebraska Wesleyan Administrators Veto Condoms in Vending Machines" "Massive Charity Gift Drive Targets Kids with HIV/AIDS this Year" ************************************************************ NATIONAL NEWS ************************************************************ "Analysis Shows Cost-Effectiveness of Screening Immigrants for Latent TB Infection" Associated Press (12.05.02)::Stephanie Nano Screening and treating immigrants from developing countries for dormant TB infections would prevent thousands of cases and save tens of millions of dollars, according to a new study. The number of US TB cases has been dropping, but immigrants account for a growing proportion of them. Of the nearly 16,000 US cases last year, about half were in foreign-born persons - up 27 percent from a decade earlier. Potential immigrants now get a chest X-ray to detect active TB; those who are sick are required to get treatment. The Institute of Medicine has recommended that a skin test for inactive, or latent, infections also be given to those from countries where TB is common. The new study looked at whether such a practice would be cost-effective. The study, "Global Drug-Resistance Patterns and the Management of Latent Tuberculosis Infection in Immigrants to the United States," was published in the New England Journal of Medicine (2002;347(23)1850-1859). Using immigration figures from 2000, researchers in New York calculated all the costs of screening and treating immigrants when they enter the country. They compared that to the cost of treating the active TB cases that would eventually arise if nothing were done. They estimated that screening and treating dormant infections for a single year would prevent 9,000-10,000 active TB cases and save $60 million to $90 million. "This is a wake-up call that, yes, tuberculosis is a preventable disease," said Dr. Lee B. Reichman, executive director of the New Jersey Medical School National Tuberculosis Center. The challenge, he said, is to get doctors to recognize this and test and treat their patients for latent TB. If screening of immigrants is adopted, "then we can really make a dent in the tuberculosis problem," Reichman said. The study also compared different antibiotics, taking into account drug resistance in each country or region. Researcher Dr. Kamran Khan, now at St. Michael's Hospital at the University of Toronto, said this information can be used to tailor treatment for immigrants. ************************************************************ INTERNATIONAL NEWS ************************************************************ "AIDS Higher Among South African Children" Associated Press (12.05.02)::Sahm Venter South Africa's first nationally representative study on HIV/AIDS, commissioned by former President Nelson Mandela, shows a higher than expected level of HIV infection - 5.6 percent - among children ages two to 14. "This is a serious and urgent problem," said Mandela at the launch of the "Nelson Mandela/HCRSC Study of HIV/AIDS." "Without children there can be no nation, there can be no future leaders of our country," he said. Part government-funded, the Human Sciences Research Council was the body commissioned by Mandela to conduct the survey. The study also found that 13 percent of children ages two to 14 had lost a mother, father or both parents to AIDS. The study found 11.4 percent (4.5 million people) of South Africans are infected with HIV, more than any other country in the world. HIV prevalence among those ages 15 to 49 is 15.6 percent. The 84-year-old Mandela was speaking from a podium bearing a poster showing his face and the words "Good Leaders Lead," a reference to his dedication in the fight against AIDS since leaving office in 1999. "It tells us that HIV and AIDS affects all South Africans - men, women and children, youth, adults and even older people, Africans, whites, colored [mixed race] and Indians," Mandela said. "This study also shows us that we need to focus our attention not only on Africans, but also on whites and coloreds." While at 12.9 percent, HIV infection among black South Africans is the highest, the infection among whites is 6.2 percent - "considerably higher," said the report, than in the United States, Australia and France "where prevalence among whites is less than 1 percent." The study also revealed widespread support among South Africans for the provision of antiretroviral drugs, Mandela said. Two hundred field workers visited the homes of 9,963 people throughout South Africa during the research. Nearly 9,000 people agreed to be tested for HIV infection. People in institutions such as prisons, boarding schools and military barracks were not included in the sample. "All-Out Effort Fails to Halt AIDS Spread" Washington Post (12.02.02)::Michael Grunwald Two years into the five-year African Comprehensive HIV/AIDS Partnership, Botswana is learning what big money, free drugs and strong leadership can and cannot do to halt the epidemic. "We're making astounding progress, and it's astoundingly inadequate," said Ernest Darkoh, a physician and former management consultant for McKinsey & Co. who runs Botswana's antiretroviral program. The reality is that the nation spends its weekends at funerals. More than one-third of Botswana's adults are HIV- positive. Life expectancy has plunged from over 65 to under 40. More than 65,000 children have lost their parents to AIDS, and that number is projected to double or triple by 2010. If the United States had Botswana's rate of AIDS deaths, it would lose 15,000 citizens per day. The Bill & Melinda Gates Foundation and the drug conglomerate Merck & Co. have both pledged $50 million in assistance over five years. Merck is also offering an unlimited supply of antiretroviral medicines, which are available only to about one-tenth of 1 percent of infected people elsewhere in Africa. The Harvard AIDS Institute has developed a training program for the nation's health care workers and has launched a new research laboratory in the capital, Gaborone. Botswana's president, Festus Mogae, has provided aggressive leadership, warning his people in fiery speeches that they are "threatened with annihilation," chairing his country's AIDS council, and badgering health officials with questions about condom distribution in prisons and construction timetables for clinics. Since January, more than 3,000 patients have enrolled in Botswana's antiretroviral program - known as Masa, or New Dawn. So far, only 3 percent have dropped out, even though the drugs can cause side effects such as nausea, headaches and dizziness. About 5 percent have died, which might sound high, except that Darkoh said these patients were so sick at the outset that their expected death rate without antiretroviral treatment would have been 30-40 percent. ************************************************************ MEDICAL NEWS ************************************************************ "High Relapse Rate Seen After 'Successful' Drug-Resistant TB Treatment" TB & Outbreaks Week (12.03.02)::Michael Greer Researchers warn that the long-term success of treatment for drug-resistant tuberculosis may be lower than previously believed. G.B. Migliori and colleagues at the World Health Organization in Geneva; the WHO Collaborating Center for Tuberculosis and Lung Diseases in Tradate, Italy; the Ivanovo TB Dispensary in Ivanovo, Russia; and the Central Tuberculosis Research Institute in Moscow investigated the "frequency of TB recurrence among MDR [multidrug-resistant] patients who achieved treatment 'success' on standard short-course chemotherapy." Migliori and colleagues found that treatment success, especially for patients given Category I drug regimens, was often short-lived. Data from 18 TB patients with infections resistant to isoniazid and rifampicin, at least, showed roughly 28 percent suffering relapses, with 2.46 cases of recurrent disease per 100 person-months. Category I patients considered cured after directly observed treatment of isoniazid, ethambutol, rifampicin and pyrazinamide had a relapse rate of 40 percent. Patients treated with a Category II regimen, which adds streptomycin to the Category I regimen, had a relapse rate of 12.5 percent. The median time to relapse was 8 months. The full report, "Frequency of Recurrence Among MDR-TB Cases 'Successfully' Treated with Standardized Short-Course Chemotherapy," was published in the International Journal of Tuberculosis and Lung Disease (2002;6(120):858-864). "The frequency of TB recurrence among MDR-TB patients declared 'cured' after short-course chemotherapy is high," Migliori and colleagues concluded. "Culture-based bacteriological confirmation at the end of treatment is recommended." "Vaginal Contraceptive/HIV Fighter Seems Promising" Reuters Health (12.05.02) An experimental vaginal gel appears to be a safe, effective contraceptive, according to animal studies. The compound, SAMMA, blocked HIV and two strains of herpes simplex virus in laboratory testing. Investigators believe the encouraging results justify further testing. "The tests performed so far suggest a high degree of safety," reported the team led by Dr. Lourens J.D. Zaneveld of Rush-Presbyterian-St. Luke's Medical Center in Chicago. The full report, "Use of Mandelic Acid Condensation Polymer (SAMMA), a New Antimicrobial Contraceptive Agent, for Vaginal Prophylaxis," was published in the November issue of Fertility and Sterility (2002;78:1107-1115). Zaneveld and colleagues noted that "a US patent on the microbial and contraceptive properties of SAMMA has been granted." The research results to date "support completion of the preclinical studies and evaluation of SAMMA in clinical trials." Public health officials have long wanted an anti-STD option, such as a vaginal cream or gel, that would allow women more control than condoms. In regions of the world where AIDS is widespread and condom use is infrequent, the need is acute. Researchers once speculated that vaginal creams containing the spermicide nonoxynol-9 would block the spread of HIV. Later, they found that nonoxynol-9 actually increased a woman's risk of contracting HIV because it could destroy healthy vaginal cells and "good" bacteria. Investigators working with the Program for the Topical Prevention of Conception and Disease, a not-for-profit Chicago- based group, discovered that SAMMA has the potential to prevent pregnancy and fight a number of STDs without harming normal cells or disrupting the healthy environment of the vagina. In recent tests, SAMMA did not kill sperm in human semen, but it did block sperm function. In animal tests, the gel reduced pregnancy rates by more than 90 percent. It blocked HIV, HSV-1 and HSV-2 and inhibited the growth of gonorrhea, but had a weaker effect on chlamydia. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Heroin Addicts' Infection Rate High" Baltimore Sun (12.05.02)::Jonathan Bor Nearly half of heroin addicts in Baltimore's drug treatment programs are unaware that they suffer from chronic blood infections such as HIV and hepatitis, according to a study by the Johns Hopkins School of Public Health. Despite the disturbing picture of health problems associated with addiction, the researchers said the city has an excellent chance to reduce the toll through its methadone maintenance centers. Officials with the Open Society Institute, the foundation that paid for the study, said the methadone centers should screen clients for blood-borne infections and refer those who need care to clinics. "You want to break down the barriers between drug treatment and the health care system," said Dr. Robert Schwartz, an addictions specialist with OSI. Researchers found that nearly two out of three addicts were infected with hepatitis C, a chronic infection that can eventually trigger liver failure and cancer. Only one-third of those infected knew it. Meanwhile, one in five addicts were infected with HIV. Eighty percent were aware they were infected, presumably because HIV testing is widely available and encouraged by public health campaigns. Only 3 percent were infected with syphilis. Researchers credited the city Health Department's campaign in the mid-1990s with curbing what was then a serious syphilis epidemic. In the two-year study, OSI paid for case managers at the clinics who referred infected addicts for medical care. About 2,000 addicts were vaccinated against hepatitis B. The researchers and OSI recommended that the treatment centers offer free testing for HIV, syphilis, and hepatitis B and C, using state laboratory services. They also urged treatment centers to seek federal funding for hepatitis B vaccines. The clinics should refer patients to federally funded community health centers and the city clinics that treat STDs, the study said. An unanswered question, however, is how to pay for the services - particularly hepatitis C treatment, which can cost as much as $35,000. Federal funding is fragmented and scarce. "Long Before AIDS Crisis Was Declared, She Was on the Case" Baltimore Sun (12.05.02)::Erika Niedowski One of Benita Paschall's first reactions when Baltimore Mayor Martin O'Malley declared a "state of emergency" in the city's fight against AIDS this week was: "Well, it's about time." "It's been an emergency. It's been an emergency for over 10 to 15 years," she said Wednesday. "The wreckage has already reached mammoth proportions." The head of the Baltimore Prevention Coalition, a private nonprofit group with its headquarters in Mount Vernon, Paschall has been working as an HIV/AIDS prevention activist since the 1980s. She has done outreach on the streets, held education sessions at the city jail, and sponsored safe sex parties for women. As executive director of the coalition, which has 12 employees and a budget of more than $500,000, Paschall herself does not do much prevention preaching on the streets anymore. But her group, founded in 1992, reaches out to people in all corners of the city, urging them to practice safe sex and get tested for HIV and other STDs. As of June last year, about half of the 23,664 people in Maryland with HIV/AIDS lived in Baltimore, according to the state AIDS administration. When it comes to HIV/AIDS, Paschall knows that while everyone tends to talk about labels - gay, straight, bisexual - she doesn't like to. She thinks they cloud the real issue, which is changing unsafe sexual behaviors. "Your orientation doesn't matter," she said. "It's the behavior that matters." Under her leadership, the coalition launched another initiative known as "TransAm," which supports the city's African- American transsexual community - offering referrals for HIV testing and substance abuse treatment. The group publishes a newsletter and sponsors "Ladies Social Teas" every Wednesday. For more than a year, Paschall has also hosted a weekly radio program on WOLB called "State of Emergency," which deals with topics ranging from AIDS to domestic violence and how they affect blacks in Baltimore. ************************************************************ NEWS BRIEFS ************************************************************ "New Headquarters for Quilt" Atlanta Journal-Constitution (12.03.02)::Richard L. Eldredge On Monday in Atlanta, about 75 NAMES Project Foundation supporters, including founder Cleve Jones, attended the dedication ceremony of the new national headquarters for the AIDS Memorial Quilt. The quilt's new home in the city's Inman Park neighborhood includes a massive warehouse in which to store the more than 48,000 panels dedicated to 88,000 people who have died of AIDS. Rep. John Lewis (D-Ga.) told the crowd how pleased he is to have the tribute housed in his district, an area already rich with civil and human rights history. He also spoke about the recent spike in infection statistics involving African-American women. "Manhattan: Fewer AIDS Cases" New York Times (12.03.02)::Stacy Albin According to the New York Department of Health and Mental Hygiene, the number of newly diagnosed cases of AIDS dropped by more than 17 percent last year, to 4,677. As recently as 1997, new cases totaled 7,316. The department said AIDS data are continually restated because of new reporting requirements and changes in classification. AIDS-related deaths totaled 1,774 last year, down nearly 10 percent from the year before. The number of New Yorkers living with AIDS was 50,715, up nearly 6 percent from the previous year, in part because of advances in medication, the department said. Of the new cases in 2001, blacks and Hispanics made up 82 percent. "Nebraska Wesleyan Administrators Veto Condoms in Vending Machines" Associated Press (12.05.02) The administrative council of Nebraska Wesleyan University in Lincoln on Monday voted to reject a plan to make condoms available in residence hall vending machines, according to Sara Boatman, vice president for student affairs. That leaves in place a policy that provides condoms through the student health center and women's resource center. Last month, members of the Student Affairs Senate voted 29-10 to recommend expanded access to condoms in the dorms. "I feel like the student senate did what they needed to do for the students and the administration did what they needed to do for the university," said Whitney Livingston, a junior from Lincoln and the senate president. Three years ago, the student senate passed a bill to put five condom machines on campus, but administrators vetoed the plan after studying campus opinion for several months. "Massive Charity Gift Drive Targets Kids with HIV/AIDS this Year" Associated Press (12.04.02)::Tim Whitmire Whether to reach out to people affected with HIV/AIDS has been a tough issue for many Christian groups. But Franklin Graham said Wednesday it was an obvious decision for his Operation Christmas Child gift drive, an outreach effort of his Samaritan's Purse Christian Relief agency. In its 10th year, OCC says it will deliver 6 million shoe boxes filled with toys, school supplies and candy to children in 100 countries. This year's special recipients are African children affected by HIV/AIDS. Graham spoke Wednesday at a Charlotte, N.C., distribution center - one of six around the country - where 1.3 million boxes will be processed for shipping overseas. Graham, the son and successor of evangelist Billy Graham, said Christians should worry less about how people contract HIV/AIDS and more about how they can help. "I hope that in this country we can get churches involved in helping people with HIV/AIDS. I want it in every church's missionary budget," he said.