Subject: CDC AIDS Daily Summary for 12/20/02 Date: Fri Dec 20 10:51:01 PST 2002 (410 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Friday, December 20, 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 "AIDS Group Asks Court to Stop AZT Patent Defense" "Young Girls, Older Partners Leads to High STD Risk" INTERNATIONAL NEWS "South African Party Now Says AIDS to Top Its Agenda" "Can a Film Romance Persuade Nigerians to Practice Safe Sex?" MEDICAL NEWS "University of Pittsburgh Findings Illustrate How Kaposi Sarcoma- Associated Herpesvirus Causes Cancer" "Surfactant Protein A Heightens Macrophage Mannose Receptor Activity" LOCAL AND COMMUNITY NEWS "AIDS Housing Coalition Reorganizes" NEWS BRIEFS "AIDS Activists Drop Off Condoms at State Prison" "310 Bangladeshi Children Have HIV: UNICEF" "Hollywood Actor Richard Gere Organizes Celebrity Fundraiser to Fight AIDS in India" "Mandela Song to Highlight AIDS Benefit Concert" ************************************************************ NATIONAL NEWS ************************************************************ "AIDS Group Asks Court to Stop AZT Patent Defense" Reuters (12.19.02)::Doug Macron The AIDS Healthcare Foundation announced Thursday that it has asked a US federal court to stop British drug company GlaxoSmithKline from defending its patent on AZT. AHF has filed a lawsuit against the company alleging patent fraud and price gouging. The largest provider of AIDS care in the United States, the nonprofit AHF began barring GlaxoSmithKline's sales reps from its clinics earlier this year. AHF claims the company was selling AIDS drugs in the developing world for twice as much as other drug companies. Last summer, AHF filed a lawsuit seeking to invalidate GlaxoSmithKline's patent on AZT, the cornerstone of the firm's top-selling antiretroviral drugs Combivir and Trizivir. The suit was later amended to ask that patents on Combivir (lamivudine, zidovudine) and Trizivir (zidovudine, lamivudine, abacavir) also be invalidated. The foundation alleges Burroughs Wellcome falsely claimed its scientists had discovered AZT and its use against HIV in 1986 in order to secure a patent. Glaxo had acquired Burroughs Wellcome before its merger with SmithKline Beecham. AZT was created in 1964 as a possible cancer drug. "They lied to the patent office in the 1980s about discovering AZT's ability to treat AIDS, and in doing so secured exclusive rights to manufacture it," said AHF President Michael Weinstein. "AZT was developed with federal assistance in the 1960s, and the National Institutes of Health tested it for HIV use in the 1980s, but Glaxo secured patents on the substance in the 1980s and locked competitors out. They then priced AZT at thirty-two times the cost of manufacture, a practice repeated with every new AIDS drug since then." "We believe that there should not be a patent on these drugs, and that the market should be open for competition," said AHF General Counsel Tom Myers. GlaxoSmithKline will defend itself against this lawsuit, said a company spokesperson. She called the suit frivolous and noted Burroughs Wellcome's claim to inventorship of AZT had been established in many lawsuits during the 1990s. Preliminary arguments in the case are set for March 10, 2003. "Young Girls, Older Partners Leads to High STD Risk" Reuters Health (12.18.02)::Alison McCook New research demonstrates that teenage girls who have older partners are more likely than girls their same age with younger partners to report high-risk behaviors that can lead to STDs. Elin Begley of Emory University in Atlanta found that teens who said they were dating someone at least two years older were half as likely as girls with partners closer to their own age to report consistent condom use during the past 30 days. Furthermore, girls with older partners were more than twice as likely to say their boyfriends had been with other partners during the past six months. STD screening showed that those with older partners were almost four times as likely to have chlamydia. The trends persisted regardless of the women's level of education and knowledge about preventing HIV and other STDs. All the participants in the current study were pregnant. Had they not been screened for STDs, untreated chlamydia could have posed serious health consequences for the fetuses. Begley screened and surveyed 170 pregnant African American girls between 14 and 20 who came to a prenatal clinic. Begley gave several reasons why teens dating older men might take more sexual health risks than young girls with younger partners. Older partners, she noted, may be less willing to wear condoms and more interested in pregnancy. Also, she pointed out that older men may have had more partners and therefore would be more likely to give young partners chlamydia. Begley reported her findings at the recent 130th Annual Meeting of the American Public Health Association in Philadelphia. She suggested that clinicians educate young women about protecting themselves from STDs and consider asking the age of their partners. Furthermore, she stressed that women with older partners could benefit from repeated STD screening during their pregnancies, as they were less likely to use condoms and thereby risked reinfection. ************************************************************ INTERNATIONAL NEWS ************************************************************ "South African Party Now Says AIDS to Top Its Agenda" Reuters (12.19.02)::Manoah Esipisu The African National Congress, South Africa's ruling party, put AIDS at the top of its development agenda in a statement delivered at a party conference in the university town of Stellenbosch. The move represents a policy shift after what detractors claim has been years of neglect of the deadly pandemic. President Thabo Mbeki has come in for international criticism by publicly questioning the scientific link between HIV and AIDS. The ANC said it was readying a comprehensive battle plan to fight the disease, which infects almost 5 million South Africans, or one person in nine. However, Mbeki, elected this week to lead the ANC for another five years, made only slight reference to AIDS in his keynote address to the conference, and suggested that TB was a more serious problem. Joel Netshitenzhe, chief government spokesperson, assured reporters that the ANC realized the AIDS problem had ballooned since the last party conference in 1997. He said the ANC would have an "appropriate resolution" on the AIDS problem by the time the conference closed Friday. Kgolema Motlanthe, ANC secretary-general, said the ANC envisioned a multiple strategy including AIDS drugs and measures to alleviate poverty. In the past, the government has dragged its heels on providing antiretroviral drugs through public hospitals, arguing that they were expensive, unproven, and toxic. Recent pilot programs showing that such drugs can dramatically improve AIDS patients' health may have helped influence the party's new commitment to anti-AIDS activism. South Africa has the world's highest single-country AIDS caseload, and AIDS has become increasingly visible as a social, political and economic problem. Despite the ANC's promise of a new stance, an article in the British Guardian caused some to doubt the government's intentions. The piece quoted Health Minister Manto Tshabalala- Msimang as saying South Africa could not afford AIDS drugs because it needs the money to defend itself against potential aggressors, including the United States. She vehemently denied the report on Thursday, calling it "bizarre" and "distorted," and saying she never suggested that the United States could invade South Africa. "Can a Film Romance Persuade Nigerians to Practice Safe Sex?" Wall Street Journal (12.20.02)::Michael M. Phillips The US government, Western aid agencies and two local filmmakers are trying to deliver an anti-AIDS message by combining Nigerians' taste for soap-operatic movies with their flair for copyright piracy. The result: a religiously palatable feature film that they hope will persuade Nigerians to avoid risky sex. In just four months, and at a cost of only $29,000, the US government-financed feature film "Awakening" has reached an audience estimated to number in the tens of millions, through theaters, national television broadcasts and black-market videos. "Awakening 2" is now in production. And the plot of "Awakening 3" is incubating at 2 Effects Empire, the Kano production company of 29-year-old Yakubu Mohammed and his 29-year-old partner Sani Musa Danja. Family Health International, a private aid group, manages the project for the US Agency for International Development. In "Awakening," Danja plays Babangida, the promiscuous young man who evidently contracts HIV from Mariya, the poor vendor, who reluctantly sleeps with rich men to eke out a living. Babangida regrets his libertine ways when he meets the virginal Jamila. The first film ends in suspense as Babangida awaits his HIV test results. The movie never mentions condoms, and a local cleric cleared its message of faithfulness and premarital abstinence. The filmmakers are now stuck on the cliffhanger: Should rakish Babangida, who has HIV, marry the love of his life, Jamila, who doesn't? Or should he leave her at the altar and marry Mariya, the beautiful, HIV-positive street vendor? "If we really want to stop the spread of AIDS, we have to take our religion into account," said Mohammed. So Babangida should pick Mariya, he argued, because Islamic teaching requires the sick to isolate themselves from the healthy - even though Western AIDS activists frown on anything that smacks of stigma. While the Nigerian Health Ministry estimates that nearly 6 percent of adults ages 15 to 49 nationwide are HIV-infected, a recent Central Intelligence Agency study predicts that as many as 26 percent of adult Nigerians will carry the virus by the year 2010 unless drastic steps are taken. ************************************************************ MEDICAL NEWS ************************************************************ "University of Pittsburgh Findings Illustrate How Kaposi Sarcoma- Associated Herpesvirus Causes Cancer" Cancer Weekly (12.10.02) Findings by researchers at the University of Pittsburgh Cancer Institute illustrate how Kaposi sarcoma-associated herpesvirus inhibits the body's immune response and causes cancer cells to grow through a technique called immune evasion. KSHV causes Kaposi Sarcoma, a cancer of the blood vessel cells that often occurs in tissues under the skin or mucous membranes, and is the most common malignancy occurring among AIDS patients. Patrick S. Moore and Yuan Chang - the team that previously discovered KSHV - examined the expression of a virus-derived cytokine (a hormone-like substance that regulates cells during an immune response) in KSHV. Moore and Chang found that this cytokine, virus-derived interleukin-6 (vIL-6), not only inhibits immune function but also causes cancerous cells to grow. vIL-6 protects virus-infected cells from undergoing growth arrest and apoptosis, or cell death, which is the normal way that the immune system attempts to limit viral infections. The full report, "Viral IL-6-Induced Cell Proliferation and Immune Evasion of Interferon Activity," was published recently in Science (2002;298(5597):1432-1435). vIL-6 inhibits the signaling of antiviral factor interferon (IFN), a normal immune response that blocks virus-infected cells from growing. However, KSHV has a built-in sensor mechanism that perceives an increased signaling of IFN and responds by increasing the production of vIL-6, in effect inhibiting the activation of the tumor-suppressor pathway during the immune response and acting like a switch by turning off the production of IFN. In addition, in some cells, vIL-6 not only stops the suppression of tumors, but also causes normal cells that are not infected with KSHV to proliferate abnormally. "These results illustrate that tumor viruses can cause cancers because they have evolved to subvert cell defenses and make use of the same signaling pathways that are used to suppress tumors to instead cause tumors to grow," said Chang. "In other words, the virus is able to sense its environment and modify that environment to make it more habitable for the virus. By inhibiting a normal immune mechanism to evade the immune system, the virus can accidentally trigger tumor cell growth." Moore and Chang cautioned that this mechanism does not entirely explain how KSHV causes cancer, but it is an important principle in understanding tumor virology. Chang said vIL-6 may be a promising target for novel therapies against KSHV-associated tumors often found in lymphoma and Castleman disease, a rare disorder characterized by noncancerous tumors that may develop in the lymph node tissue throughout the body. "Surfactant Protein A Heightens Macrophage Mannose Receptor Activity" TB & Outbreaks Week (12.17.02)::Michael Greer US researchers have shed new light on the early immune response to M. tuberculosis and other bacterial pathogens. "Inhaled particulates and microbes are continually cleared by a complex array of lung innate immune determinants, including alveolar macrophages (AMs)," explained Alison A. Beharka and colleagues at the University of Iowa and the Veterans Affairs Medical Center in Iowa City, the University of Colorado Health Sciences Center in Denver, and the University of Cincinnati. "AMs are unique cells with an enhanced capacity for phagocytosis that is due, in part, to increased activity of the macrophage mannose receptor (MR)." Surfactant protein A increases macrophage MR activity, which can enhance or, in some cases, degrade immune responses to infection, Beharka and coauthors found. SP-A, a key component of lung surfactant, is known to augment macrophages' ability to kill infected cells through phagocytosis, the investigators said. Their study shows that SP-A selectively upregulates MR on human monocyte-derived macrophages. Study data showed that SP-A upregulation occurred quickly, even in the absence of new protein synthesis, suggesting the extra MR was drawn from intracellular sources. However, the siphoning of intracellular MR triggered by SP-A could impair immune defenses against intracellular microbes, the authors warned. Their full report, "Pulmonary Surfactant Protein A Up-Regulates Activity of the Mannose Receptor, a Pattern Recognition Receptor Expressed on Human Macrophages" was published in the Journal of Immunology (2002;169(7):3565-3573). "SP-A upregulation of MR activity provides a mechanism for enhanced phagocytosis of microbes by AMs, thereby enhancing lung and host defense against extracellular pathogens or, paradoxically, enhancing the potential for intracellular pathogens to enter their intracellular niches," Beharka and colleagues concluded. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "AIDS Housing Coalition Reorganizes" Houston Voice (12.13.02)::Penny Weaver The nonprofit AIDS Housing Coalition Houston Inc. has reorganized in its attempts to assist people with HIV/AIDS. Executive Director Matt Locklin said organization volunteers recently elected officers for 2003-2004, and these incoming leaders have decided to direct AHCH resources to a new emergency- based housing initiative dubbed the West Heights Shelter. The West Heights Shelter will serve both male and female occupants, as its rooms are private. On-site house hosts supervise the facility, where participants are mentored on social services in self-styled "AIDS 101" survival course. A fee of up to $10 per day per person may be charged, Locklin said, but those who cannot afford to pay will not be turned away. Nutritious food, clothing, furnishings and other amenities are to be made available as public donations allow, Locklin said. The average stay in such a facility is seven days to six weeks, with a maximum stay of 90 days. "The West Heights area was chosen over the old Montrose neighborhoods for availability of low income housing nearby," Locklin said. "Efforts will be targeted to moderately ill AIDS patients who may have fallen through the cracks in the system. Real, live, sick human beings - that nobody else can help today because of funding cuts and red tape." The startup of the new shelter was made possible by a grant from the Houston Endowment Inc., Locklin said. Volunteers are sought to assist with the facility. AHCH had used its after-hours Club Nsomnia, a "bring your own beer" club, to raise funds for the organization and its Montrose Cottages, which provided assistance for HIV-positive clients. But in July, Texas Alcoholic Beverage Commission agents raided the club and alleged illegal activities were taking place. Club operators alleged that law enforcement officials conducted an illegal search and seizure. Without the funds from Nsomnia, Locklin said AHCH could not continue its operations and was forced to refocus its efforts. Established in 1994, AHCH has helped more than 400 residents with the transitional and emergency housing programs it sponsors, Locklin said. ************************************************************ NEWS BRIEFS ************************************************************ "AIDS Activists Drop Off Condoms at State Prison" Times Union (Albany, N.Y.) (12.18.02)::Brendan Lyons In Coxsackie, N.Y., Tuesday, several AIDS activists marched to the gates of Coxsackie Correctional Facility and dropped 2,000 condoms at the feet of corrections officers. New York state prohibits inmates from having condoms, and officials say sex between inmates is illegal. But members of ACT UP-NY claim state officials are ignoring the reality of inmates having sex, and some prisoners are becoming infected with HIV behind bars. "The New York state prison system is a factory for thousands of new HIV infections each year," said Ken Bing, an ACT UP-NY member. "When prisoners are released, those new HIV infections become a public health crisis for their home communities. Prisons are pouring a huge HIV burden out into New York state, which has a horrific human cost as well as a financial cost to the state," Bing said. "310 Bangladeshi Children Have HIV: UNICEF" Agence France Presse (12.18.02) "State of the Children Report 2003," a study released by UNICEF in Dhaka this week, reported that at least 310 Bangladeshi children have HIV, and another 2,100 children have been orphaned by the disease. Earlier this month, Bangladesh released official figures saying that 248 people in the nation have HIV, and 20 have died of AIDS. But UNICEF puts the number of HIV patients at about 13,000. "Hollywood Actor Richard Gere Organizes Celebrity Fundraiser to Fight AIDS in India" Associated Press (12.20.02) Hollywood actor Richard Gere was in Bombay Friday to host a carnival with actors from India's film industry to raise awareness and funds to help prevent mother-to-child HIV transmission. Gere, who often calls India his second home, has been campaigning against the spread of AIDS in South Asia. Gere's charity also supports health clinics in India and aims to build roads and a sewage system in Dharmsala, a mountain town in northern India that is home to Tibetan spiritual leader the Dalai Lama. An estimated 4 million people have HIV in India, or less than 1 percent of the country's population. A recent US report - rejected by the Indian government - predicted the nation could have 20 million to 25 million HIV-infected people by 2010. "Mandela Song to Highlight AIDS Benefit Concert" New York Times (12.19.02)::Reuters Nelson Mandela will be just another prison number again when he hosts an HIV/AIDS benefit concert on Robben Island, South Africa, where he spent 18 of his 27 years in apartheid jails. The Feb. 2 concert - featuring U2's Bono, Shaggy, Queen, and Macy Gray - will be held within the walls of the island prison, which is now a World Heritage site. Organizers say the 84-year-old Mandela will walk onto the stage to the tune of a new song "48864," the number he wore as a prisoner during his time on the island. The Robben Island event will be beamed to a simultaneous concert venue at Greenpoint Stadium in Cape Town, which has a capacity of 35,000 people. The concert will be televised globally with all funds raised going to the Nelson Mandela Foundation, UNAIDS, the High Commissioner for Human Rights, and the Robben Island Museum.