Subject: CDC AIDS Daily Summary for 12/13/02 Date: Fri Dec 13 11:21:04 PST 2002 (369 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Friday, December 13, 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 "US Immigrants Not Bringing HIV with Them: Study" "For 60 Million, the Cure May Kill" INTERNATIONAL NEWS "New AIDS Coalition Aims to Boost Access to Drugs" "China Urges Safer Sex in Rural Areas and Among Migrant Workers" MEDICAL NEWS "HIV Trick Helps Explain Failed Vaccine Attempts" "HIV/AIDS Nephropathy: Mechanisms of Virus-Induced Cell Cycle Disruption Elucidated" EDITORIALS AND COMMENTARY "One Disease Down - Eradication of River Blindness Offers Hope in Fight Against AIDS" NEWS BRIEFS "Mandela Champions South Africa's AIDS Fight" "DNA Analysis Shows Tuberculosis in Britain Predated Roman Armies" "Health Officials Testing for TB at DeKalb School" ************************************************************ NATIONAL NEWS ************************************************************ "US Immigrants Not Bringing HIV with Them: Study" Reuters Health (12.04.02)::Charnicia E. Huggins New research in California found that the prevalence of HIV was similar - less than 2 percent - among US-born and foreign- born patients at Los Angeles-area public health clinics. The research team, led by Dr. Nina T. Harawa of the Los Angeles County Department of Health Services, studied the prevalence of HIV among more than 60,000 foreign- and US-born patients who visited STD clinics in one of seven Los Angeles County public health centers from January 1993 through December 1999. Sixty-two percent of the patients studied were born in the United States; 38 percent were foreign-born. Of the foreign-born, almost 9 in 10 were from Mexico or Central America. The HIV- positive immigrants generally arrived in the United States at around age 21 and were diagnosed with HIV roughly 12 years after they had been in the country. The researchers speculate that most of the immigrants were infected after they entered the United States. Harawa and colleagues noted that the findings indicate the need to ensure that HIV/AIDS prevention and treatment efforts reach US immigrant communities. The study, "HIV Prevalence Among Foreign- and US-born Clients of Public STD Clinics," appeared in the December issue of the American Journal of Public Health (2002;92:1958-1963). Harawa and her team reported that Mexico accounted for almost two-thirds of the foreign-born clinic visitors and nearly one-quarter of the total number of HIV-positive patients. HIV was most common among immigrants from the North Africa/Middle East region. It was least common among those from East Asia/Pacific Islands. "HIV treatment and prevention efforts must be tailored for immigrant populations - particularly those from Latin America, Africa, the Caribbean/West Indies, and the Middle East," Harawa said. She explained that immigrants may be particularly vulnerable to HIV infection because of the economic instability and social isolation that can accompany migration and because often, they immigrate without their partners. "Undocumented immigrants may delay treatment because they fear deportation or are not able to access healthcare," she added. The Department of Justice's Immigration and Naturalization Service currently denies visas or admission to the United States to persons found to be HIV-positive, although some exceptions are granted. "For 60 Million, the Cure May Kill" USA Today (12.13.02)::Steve Sternberg About 60 million people in the United States have conditions that leave them essentially defenseless against vaccinia, the live virus used to make smallpox vaccine. They include people with HIV/AIDS or other immune deficiencies, people who have had organ transplants, cancer patients undergoing chemotherapy, and people with eczema and certain other skin diseases. Health professionals also advise against vaccinating pregnant women, because no one knows how vaccinia might affect fetuses. Although vaccinia is generally easily conquered by a healthy person's immune system, it can have life-threatening side effects - even in healthy people. Research in the 1960s found that 12 people per million developed encephalitis after vaccination. One or two per million die. Widespread vaccination would cause about 4,600 serious side effects and 285 deaths. Those with undiagnosed conditions, including about 300,000 people in the United States with undiagnosed HIV, face the greatest risks: Simple contact with someone just vaccinated could infect some of them. Health authorities cannot accurately balance the risks of vaccination against the likelihood of a smallpox outbreak. Until a case appears, the risk of vaccination will always be greater than the risk of getting smallpox. "Experts are worried," noted Tara O'Toole of the Center for Civilian Biodefense at Johns Hopkins University's Bloomberg School of Public Health, "that a general vaccination program will inevitably cause some lethal side effects ... [that will] demolish the public's faith in vaccination and in following the government's bioterrorism recommendations." The Bush administration's vaccination plan being released today represents a relatively small-scale beginning to mass vaccinations. But even a limited program could unleash vaccinia among people without defenses to it. Doctors can treat severe vaccine reactions with vaccinia immune globulin (VIG), antibodies drawn from the blood of inoculated people. However, only 600 doses of VIG exist. The government has ordered about 30,000 more. Cidofivir, licensed to treat retina infections in people with HIV/AIDS, might be another option, doctors say. Cidofivir alone, or combined with VIG, could make smallpox the latest virus yielding to treatment. ************************************************************ INTERNATIONAL NEWS ************************************************************ "New AIDS Coalition Aims to Boost Access to Drugs" Reuters (12.13.02) UN agencies joined governments and health groups Thursday in launching a new drive, the International HIV Treatment Access Coalition, to get life-prolonging drugs to millions of AIDS patients in poor countries. Currently, only one person in 20 has treatment in these countries. ITAC, which brings together a host of organizations ranging from the World Health Organization to Brazil's Health Ministry, aims to boost that ratio sharply. Only some 300,000 people with AIDS, or five percent of the total in low- to middle-income countries, have access to HIV- related medicines, compared with almost 100 percent in rich countries. The UN has set a target of boosting the number receiving treatment in poorer states to 3 million by 2005. Of the 42 million people infected with HIV, 95 percent live in developing countries. "This should have happened yesterday but at least it is starting now. We have already lost too many lives," Fezeka Ntsukela Zuzwayo, a South African community worker living with HIV, told a news conference in Geneva. Organizers said the coalition would share information on best practices in purchasing and using the medicines, evaluate health programs, and keep up the international pressure for cheaper drugs. "If we continue as we are today, we will never reach the UN target," said Professor Joep Lange, president of the International AIDS Society and coordinator of the new coalition. "We need to map out what needs to be done but nobody can do that alone," he said. "China Urges Safer Sex in Rural Areas and Among Migrant Workers" Agence France Presse (12.11.02) Family planning associations throughout China will be asked to do a better job of teaching the rural and migrant population about safe sex to prevent HIV/AIDS, the state's China Daily said Wednesday. Most rural branches of the China Family Planning Association lack good education programs on reproductive health and disease prevention, CFPA Chair Jiang Chunyun said. CFPA, boasting over 1 million branches and more than 80 million members, is a vast network throughout urban and rural China. Its primary task in the past has been to promote the country's family planning policy, which generally restricts urban couples to one child and rural couples to two if the first one is a girl. But with a rise in HIV/AIDS cases, family planning workers are now being asked to promote safe sex. "People in rural areas, especially in the country's western regions, are lacking basic knowledge on contraception, AIDS prevention and family planning," Jiang said at a CFPA meeting Tuesday. "Meanwhile, tens of thousands of rural people are flowing into cities, most of whom concentrate in small and medium-sized non-state enterprises, where few family planning associations are set up," he said. Yang Kuifu, vice chair of the association, pledged that in the future, CFPA would strive to reach every household in every village and every work unit. Experts estimate more than 8 million Chinese have STDs - far larger than the official figure of 830,000 STD patients - and that the figure is growing by almost 40 percent a year, the China Daily reported recently. ************************************************************ MEDICAL NEWS ************************************************************ "HIV Trick Helps Explain Failed Vaccine Attempts" Reuters Health (12.11.02)::Amy Norton Scientists have discovered a new way HIV evades the body's immune response, helping to explain why it has been so hard to develop a broadly effective AIDS vaccine. The finding adds the "final piece to the puzzle" of how HIV eludes the immune system's infection-fighting antibodies, which are produced in large numbers when the virus invades, said Dr. Peter Kwong, a vaccine researcher at the US National Institute of Allergy and Infectious Diseases and the study's lead author. The full report, "HIV-1 Evades Antibody-Mediated Neutralization Through Conformational Masking of Receptor-Binding Sites," is published in this week's issue of Nature (2002;420:623-624,678-681). "All these antibodies are generated, but virtually none neutralizes the virus," said Kwong. And while scientists have learned a great deal in recent years about HIV's ability to evade the body's defenses, a big question has been precisely how a key protein on HIV's surface, gp120, escapes being neutralized by antibodies. Gp120 plays a vital role in getting HIV into the cells it targets for infection. But the protein also offers large exposed binding sites for neutralizing antibodies to latch onto, Kwong explained. So the question has been why these antibodies - whether unleashed from the natural immune response or elicited by a vaccine - largely fail to neutralize HIV. Kwong and colleagues looked at the interaction between the gp120 molecule and a number of antibodies. They found that, in the face of nearly all of the antibodies, an "energetic barrier" was set up around the gp120 receptor sites. "The barrier's set up in a very specific way to prevent neutralization," Kwong said. Kwong explained the antibodies only bind one at a time to the gp120 receptor sites on HIV. In contrast, the immune system cells that HIV infects have multiple sites that simultaneously bind to the gp120 receptors. So it appears that HIV is set up to have a barrier against interaction with antibodies, but not with its target cells. Because of gp120's role in HIV infection, many experimental HIV vaccines have been based on the premise of generating neutralizing antibodies against the protein. The current study should spark efforts already under way to refine gp120-based HIV vaccines, according to Theodore Jardetsky of Northwestern University, whose commentary accompanies the findings. Kwong noted that researchers are also developing HIV vaccines that focus on immune system components other than the antibody arm. "HIV/AIDS Nephropathy: Mechanisms of Virus-Induced Cell Cycle Disruption Elucidated" AIDS Weekly (10.28.02)::Michael Greer US researchers have shed new light on the processes that lead to the development of kidney dysfunction in HIV patients. "The aberrant cell-cycle progression of HIV-1 infected kidney cells plays a major role in the pathogenesis of HIV-associated nephropathy," explained Peter J. Nelson and colleagues at Mount Sinai School of Medicine in New York City. "However, the mechanisms whereby HIV-1 induces infected glomerular podocytes or infected tubular epithelium to exit quiescence are largely unknown." Nelson and coauthors found that HIV genes trigger the expression of cyclin D1 and other cell cycle-associated protein by podocytes. The researchers examined podocyte cell cultures and transgenic mice infected with HIV. Podocytes that expressed HIV genes in vitro or in vivo showed a significant upregulation of cyclin D1 mRNA and protein, the report stated. Study data also showed that infected podocytes expressed phospho-pRb (Ser780) at elevated levels. The protein has been linked to cyclin D1-induced G1-to-S phase cell cycle progression. The cyclin-dependent kinase inhibitor flavopiridol prevented both HIV gene transcription and cyclin D1 expression, the authors stated. Their full report, "HIV-1 Expression Induces Cyclin D1 Expression and pRb Phosphorylation in Infected Podocytes: Cell- Cycle Mechanisms Contributing to the Proliferative Phenotype in HIV-Associated Nephropathy," is published in the September issue of BioMed Central Microbiology (2002;2:26). "HIV expression induces cyclin D1 and phospho-pRb (Ser780) expression in infected podocytes," Nelson and colleagues concluded, "suggesting that HIV-1 activates cyclin D1-dependent cell-cycle mechanisms to promote proliferation of infected renal epithelium." ************************************************************ EDITORIALS AND COMMENTARY ************************************************************ "One Disease Down - Eradication of River Blindness Offers Hope in Fight Against AIDS" Sarasota Herald-Tribune (12.09.02)::Staff editorial "Just when you thought that good news no longer happens in Africa, along comes this bulletin: West Africa has now been declared officially free of 'river blindness,' according to the UN's World Health Organization. "The disease, spread via fly-borne parasites, once ravaged the eyesight of more than 2 million people in West Africa. Because the flies breed in rivers, millions of acres of waterside agricultural land were abandoned, inhibiting food production and economic growth. "It took about 10 years of pressure and planning, but in 1974 a concerted eradication effort got rolling, and now it has finally paid off. WHO reported last week that '18 million people have grown up free of the threat of river blindness.' Abandoned farmland is being reclaimed. "Credit this success to the initiative of West African countries, the long-term financial commitment of donor nations, the toil of health workers and the free medicines contributed by Merck & Co. "Remarkable as this health milestone is, however, it is overshadowed by the growing storm cloud of the AIDS virus, which now infects some 30 million people in sub-Saharan Africa alone. "The region, beset by a culture of denial that allows AIDS to flourish, lacks the money and health care infrastructure to conquer this plague. What's needed are the kind of home-grown will power and worldwide commitment that combined so formidably against river blindness. "Eradication of that disease seemed impossible just three decades ago. Yet human will made it achievable, after all. That's a lesson to remember in the long AIDS war ahead." ************************************************************ NEWS BRIEFS ************************************************************ "Mandela Champions South Africa's AIDS Fight" Associated Press (12.12.02)::Mike Cohen "This is a serious matter, it's war," former South African President Nelson Mandela said of AIDS Thursday during a visit to a clinic in Khayelitsha on the outskirts of Cape Town. Wearing a T-shirt reading "HIV-positive," Mandela spoke freely about condoms and the necessity for people to be faithful to their partners and for AIDS patients to be accepted by their communities. He also urged young people to wait as long as possible to have sex. Aides to Mandela say he now spends 60 percent of his time fighting the epidemic. Mandela has lost two relatives to AIDS; there is no indication Mandela himself is HIV- positive. "DNA Analysis Shows Tuberculosis in Britain Predated Roman Armies" Agence France Presse (12.12.02) Roman armies have been suspected of introducing TB to Britain, but the disease was present in the nation hundreds of years before those armies arrived, the English Heritage association reported Thursday. DNA analysis of part of a skeleton found in the southern English county of Dorset has revealed that a man who died there between 400 and 230 BC had the disease. "This is the earliest case of TB yet found in Britain, and it indicates that even in a remote rural settlement, the disease was here centuries before the Roman conquest," said association archeologist Simon Mays. Previously, the earliest British case of TB was thought to have been in 55 BC - around the time of Julius Caesar's first military campaign in the country. The world's earliest recorded case of TB has been observed in a skeleton more than 6,000 years old, which was found in Italy. "Health Officials Testing for TB at DeKalb School" Associated Press (12.12.02) On Friday, DeKalb County, Ga., health officials expect to wrap up TB testing for some 2,000 staff and students at Redan High School. Testing began Dec. 6 when officials learned that a person at the school - who was removed and is currently being treated - tested positive for an active form of the disease. Test results should be available by the middle of next week. Officials from CDC and the Georgia Division of Public Health have provided test kits and experts to analyze the data. In October, county officials began an unrelated TB investigation at Tucker High School after one person was found with an active case of TB and removed for treatment.