Subject: CDC AIDS Daily Summary for 12/18/02 Date: Wed Dec 18 11:31:15 PST 2002 (372 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Wednesday, December 18, 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 Stance on Abortion and Condom Use Rejected at Population Conference" INTERNATIONAL NEWS "Association of TB, HIV Linked to Increase in TB Cases in Zimbabwe" "More Women Living with HIV/AIDS" MEDICAL NEWS "Drug Resistance Doesn't Affect Outcome for Vietnamese Tuberculous Meningitis Patients" "Isoniazid Safe for Liver Transplant Candidates" LOCAL AND COMMUNITY NEWS "Columbus High Staff, Students Tested for TB" "Community Involvement Could Cut Local AIDS Risk, Study Finds" NEWS BRIEFS "HIV Test Offer for All Pregnant Women" "Companies Agree to Continue HIV Drug Safety Studies" "Biotech Company to Slash AIDS Drug Price in Africa" "World Bank Gives US$12.6 Million to Sri Lanka to Stop Spread of AIDS" ************************************************************ NATIONAL NEWS ************************************************************ "US Stance on Abortion and Condom Use Rejected at Population Conference" Associated Press (12.17.02)::Vijay Joshi The United States lost a vote at the end of the UN-sponsored Asian and Pacific Population Conference in Bangkok Tuesday, as Asian Pacific countries rejected the Bush administration's stand against abortion and condom use among adolescents. The conference adopted a plan of action on population policies in a bid to reduce poverty in the region. The 22-page plan included a series of recommended steps to implement an international family planning agreement reached in Cairo in 1994. It suggested fighting poverty by concentrating on 12 areas including family planning, gender equality and combating HIV/AIDS. Population policies "must encompass the principle of voluntary and informed decision making and choices, the preservation and protection of human rights, including the matters related to reproductive rights and reproductive health services," the plan says. It also includes "consistent condom use" - a phrase the United States wanted struck out - as a way to reduce vulnerability to HIV infection. US delegates said that "reproductive health services" and "reproductive rights" could be read as advocating abortion and underage sex. Conference delegates said the ministerial meetings were often heated, with the United States seeking to pressure other countries. "We wanted a development oriented conference, but the issue we had a heated debate on was abortion and underage sex," said Kim Hak-Su, executive secretary of the UN Economic and Social Commission for Asia and the Pacific. Faced with a deadlock, the conference took a vote - highly unusual at UN conferences - on two key chapters of the plan. The United States lost the first vote 31-1 with two abstentions, and the second 32-1 with two abstentions, allowing the population plan to be adopted. The United States ended up agreeing on the plan without change, said Thoraya Obaid, executive director of the UN Population Fund. Its concerns were attached in a separate document that will not affect the plan. US support for population programs is important for the region. Earlier this month, the Bush administration blocked $34 million in funds appropriated by Congress for the UN Population Fund. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Association of TB, HIV Linked to Increase in TB Cases in Zimbabwe" Xinhua News Agency (12.16.02) Panganai Dhliwayo, the World Health Organization medical officer in Harare, said Monday the increase in the number of people with TB in Zimbabwe is the result of the association between TB and HIV infection. "The number of new TB cases has risen since 1990, and the overwhelming reason for this is the onset of the HIV/AIDS pandemic," Dhliwayo said. "The decline in the economy had added to the increase, as TB had always been a disease of poverty," he said. New TB cases had declined steadily beginning in the early 1960s, and by the early 1980s had fallen to less than 50 new cases per 100,000 people. However, "The rate increased from about 68 cases per 100,000 people in 1987 to more than 350 cases per 100,000 in 2001," Dhliwayo said. Now there are 485 new cases per 100,000 people, he said. Rural to urban migration, Dhliwayo said, had resulted in a high incidence of TB, thanks to overcrowding and the emergence of backyard shacks. He said the greatest challenge now is combating the TB/HIV epidemic in a synchronized manner that addresses both infections: Tackling one but not the other would not be effective. The effort entails the countrywide diagnostic services for direct sputum microscopy and community involvement in direct observation of treatment. There is a great need to remove the stigma surrounding the infections if efforts to control them in Zimbabwe are to be successful. In countries like Uganda, where there has been more openness about HIV, stigma is less common, Dhliwayo said. "More Women Living with HIV/AIDS" Inter Press Service (12.13.02)::Abdou Faye Women in Senegal are finding themselves at the heart of the HIV/AIDS risk pool. In 14 years, the number of women living with HIV/AIDS has almost quadrupled, while the proportion of men having the disease has not even doubled. Recent UNAIDS and World Health Organization reports show that Senegal, which had succeeded in lowering the incidence of AIDS from 1.7 to 1.4 percent in 2002, is facing a rapid infection rate among women. Estimated at only 9,108 in 1988, the number of Senegalese women living with HIV/AIDS has reached 35,945 in 2002. During the same period, the number of men living with the virus has risen only from 24,048 to 41,326. Today 77,000 people are living with HIV/AIDS, and, in 2001, some 4,700 AIDS-related deaths were recorded in Senegal. Aminata Toure, head of the Gender and Human Development Program for the West African regional office of the UN Fund for Women's Development, said, "Women affected by HIV/AIDS are often not responsible for their illness. They do not have the right to refuse risky sexual relations and are often the victims of irresponsible acts committed by others." "Some men continue to have sex with their wives even when they know they're infected," she said. Toure is calling for a revision of certain provisions of Senegalese family law that make men heads of households. The economic dependence of women on men increases the burden of the epidemic, according to Marieme Soumare, the coordinator of the Association for Women at Risk of AIDS, a nongovernmental organization. Soumare, whose mission is to assist women at risk, such as sex workers and women whose marriages have ended, also blames "the social and religious conditions in Senegal," which compel "women to accept risky sexual relations." "Poverty is the root of the problem, and women constitute the poorest segment of the Senegalese population," Soumare said. ************************************************************ MEDICAL NEWS ************************************************************ "Drug Resistance Doesn't Affect Outcome for Vietnamese Tuberculous Meningitis Patients" AIDS Weekly (12.16.02)::Michael Greer Researchers in Asia and the United Kingdom have found surprising information about the course of tuberculous meningitis in Vietnamese patients. Mycobacterial drug resistance had little effect on the outcome of treatment for infected adults studied by G.W. Thwaites and colleagues at the University of Oxford-Wellcome Trust Clinical Research Unit in Ho Chi Minh City and other institutions in Vietnam, Thailand, and the United Kingdom. The researchers examined 56 Vietnamese tuberculous meningitis patients, confirmed by cerebrospinal fluid culture. Patients coinfected with HIV were significantly more likely to carry mycobacterial populations resistant to streptomycin and isoniazid, according to the study. However, data showed that neither isoniazid nor streptomycin resistance was associated with increased mortality risks. Microbial genotype and HIV coinfection also failed to impact patient mortality rates. The only clinical variable linked to heightened mortality risk was coma score. This variable independently predicted death during hospitalization. "Treatment of tuberculous meningitis before the onset of coma saves lives," Thwaites and others wrote. "Resistance to isoniazid and/or streptomycin does not appear to affect outcome." Their full report, "Isoniazid Resistance, Mycobacterial Genotype and Outcome in Vietnamese Adults with Tuberculous Meningitis," was published in the International Journal of Tuberculosis and Lung Disease (2002;6(10):865-871). "Isoniazid Safe for Liver Transplant Candidates" Drug Week (12.20.02)::Michael Greer US researchers have reported that the potent antituberculosis agent isoniazid could safely be administered to patients who may undergo liver transplants. "Optimal timing of initiation of isoniazid chemoprophylaxis in liver transplant recipients who test positive on the tuberculin skin test has not been defined," according to Nina Singh and colleagues at the University of Pittsburgh and the Veterans Affairs Medical Center in Pittsburgh. Singh and coauthors found isoniazid therapy could be initiated during the transplant candidacy period without increasing toxicity. However, the efficacy of isoniazid prophylaxis was unclear. The researchers assessed treatment outcomes in 19 transplant candidates who took a one-year isoniazid regimen after positive tuberculin skin tests. The report stated that the patients were evaluated over a nine-year period, with a median follow-up of 55 months. Study data showed markers of hepatic function were similar among isoniazid-treated patients and controls during the 12 months of treatment. Isoniazid prophylaxis did not affect - positively or negatively - overall outcome and post-transplant survival. All 19 patients completed the one-year isoniazid regimen. The full report, "Safety and Efficacy of Isoniazid Chemoprophylaxis Administered During Liver Transplant Candidacy for the Prevention of Posttransplant Tuberculosis," was published in the journal Transplantation (2002;74(6):892-895). "In liver transplant candidates at risk for M. tuberculosis infection after transplantation, isoniazid chemoprophylaxis used during candidacy was well tolerated and did not adversely effect hepatic function or outcome as compared with the control patients," Singh and colleagues concluded. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Columbus High Staff, Students Tested for TB" Columbus Ledger-Enquirer (12.18.02)::Mark Rice Health workers screened 120 students and staff for tuberculosis at Columbus High School in Columbus, Ga., on Tuesday. The testing took place after the Columbus Health Department notified the school that one of its 1,236 students - a male whose name has not been released - has the communicable disease. Only those students and staff in the boy's classes and on the bus he rides to school were screened. Testing only about 10 percent of the school's population is adequate because those persons tested were the ones who had closest contact with the boy. "TB isn't like measles, where anybody that passes you in the hallway could get infected," said Dr. Zsolt Koppanyi, director of the West Central Georgia Health District. "It's most likely to be transmitted in a confined space." He said officials are still trying to track down all the people who had close contact with the boy. Koppanyi said he called school Principal Susan Bryant immediately after a local hospital official contacted his department Monday to report the TB case. The boy has been discharged and is taking medicine at home. "We can't tell what stage of the disease he is in yet," Koppanyi said, adding that improperly treated TB can be deadly. This is the 32nd TB case this year in the district's 16- county region, said department TB Coordinator Rosia Thomas. It is rare for more than 100 students to be screened at once. Brenda Dozier, assistant superintendent for student services, said she could not recall a similar case in her 32 years in the district. Bryant sent a letter home with selected students to ask their parents for permission to be tested. She was not aware of any family that refused. Four Health Department nurses joined two school nurses to administer the TB tests at the school. "Community Involvement Could Cut Local AIDS Risk, Study Finds" Commercial Appeal (Memphis, Tenn.) (12.14.02)::Mary Powers Future AIDS prevention efforts need more community, police and church involvement, more accountability and more creative strategies for reaching those at greatest risk of becoming infected, according to recommendations outlined Friday by Dr. Jebose Okwumabua of the University of Memphis. "We need to get out of our ivory towers," Okwumabua told about 40 people, including AIDS activists, public health workers and federal officials. Okwumabua, a University of Memphis College of Education associate professor, was the study's principal investigator. The suggestions stem from a federally funded assessment of local AIDS trends conducted this summer in the South Memphis and Midtown ZIP Codes. The areas were selected because of their high prevalence of AIDS. Together, they are home to 962 of the roughly 5,664 Shelby County residents with HIV and 654 of the 3,550 residents with AIDS. Along with talking to neighborhood residents, bar and club owners, drug users and prostitutes, the research relied on eight field investigators who visited places like crack houses and Overton Park at night to get a better idea of how to prevent new AIDS infections. The field investigators received two days of training before being sent into neighborhoods to conduct interviews and identify where and when high-risk behavior occurred. They included public Health Department employees, neighborhood residents and recovering drug and alcohol addicts. The study was funded with a $27,000 grant from the federal Office of AIDS Policy. Recommendations will be distributed to state, county and local officials as well as AIDS service organizations. Such rapid assessments have been done in 16 communities nationwide. ************************************************************ NEWS BRIEFS ************************************************************ "HIV Test Offer for All Pregnant Women" Scotsman (Scotland) (12.18.02)::John Innes Under a directive issued by the Scottish Executive, all expectant mothers are to be offered routine screening for HIV. The program is to be in operation by April. At present, only a few health boards offer the screening, which women have the option to refuse. "It used to be the case that we could do little for the baby if the mother was infected. But the whole point of the test is that now, if pregnant women are infected, we can reduce the risk for their baby by nearly 20-fold," said Dr. Syed Ahmed, AIDS coordinator for the Greater Glasgow National Health Service Board. "Companies Agree to Continue HIV Drug Safety Studies" Reuters Health (12.16.02)::Richard Woodman Pharmaceutical companies have agreed to continue studies for at least another year to assess whether HIV medicines increase the risk of heart disease and other complications, an AIDS specialist said Monday. Last month during an HIV congress in Glasgow, HIV/AIDS groups voiced concerns that manufacturers would stop funding studies into the side effects of highly active antiretroviral treatment before the extent of any increased risk could be determined. The European AIDS Treatment Group also expressed its worries to the Steering Committee on the Metabolic Complications of HAART, which includes company representatives as well as researchers and regulators. "I think we can confidently say now that we have funding agreed for a further year from all the companies involved and for a second year from most," said British committee member Professor Ian Weller, of University College-London. The studies of metabolic complications were launched in 1999 at the request of the European Medicines Evaluation Agency. AIDS activists say patients may have to be followed for decades to obtain definitive answers about the long- term risks of therapy. "Biotech Company to Slash AIDS Drug Price in Africa" Associated Press (12.18.02) Gilead Sciences announced it will cut the price of its AIDS drug Viread for all of Africa and 15 UN-designated "least- developed" countries elsewhere. The company will sell the drug at "no profit," charging only for production and distribution. Gilead will supply Viread directly to qualified treatment programs. The company will create a Web site to accept applications and hopes to begin drug shipments by the middle of next year. Applying programs will be evaluated based on their ability to sustain an effective treatment program and adequately prescribe and store the drug. Gilead spokesperson Amy Flood said Tuesday the company has not determined what Viread will cost in the developing nations. The drug costs $4,320 annually per patient in the United States. "World Bank Gives US$12.6 Million to Sri Lanka to Stop Spread of AIDS" Associated Press (12.17.02) The World Bank will provide $12.6 million to Sri Lanka to fight the spread of HIV and reduce the stigma associated with the disease, a bank statement said Wednesday. The island nation of 18.6 million people has a "narrow window of opportunity to prevent a nationwide AIDS epidemic," the statement said. The World Bank grant will finance a national HIV/AIDS prevention project. It will also support Sri Lanka's efforts to reduce the risk of an emerging epidemic of TB, to which people with HIV are particularly susceptible, the statement said. Nearly 4,800 people in Sri Lanka are infected with HIV, according to UNAIDS and the World Health Organization.