Subject: CDC AIDS Daily Summary for 12/27/02 Date: Fri Dec 27 12:01:04 PST 2002 (358 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Friday, December 27, 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 "Catholics to Take on AIDS" INTERNATIONAL NEWS "Report: China Plans to Mass-Produce Four AIDS Drugs" "First Safe Injection Site to Open by March" MEDICAL NEWS "Therapeutic AIDS Vaccine Said Promising" "Recreational Drugs Can Reduce Safety, Efficacy of Antiretroviral Agents" LOCAL AND COMMUNITY NEWS "Syphilis Outbreak in Los Angeles County Leads to Calls for More Testing" "First Healthcare Center Targeted to Injection Drug Users Opens in New York" NEWS BRIEFS "New California Law to Require Referrals to HIV Specialists" "Scouts to Get Free Condoms at International Jamboree" "A Dark Christmas for AIDS Patients in South Africa" ************************************************************ NATIONAL NEWS ************************************************************ "Catholics to Take on AIDS" Chicago Daily Herald (12.23.02) Teresa Mask Roman Catholic churches are urging parishioners to respond to the AIDS and poverty crises in Africa. Catholics should also do their part in the United States, Bishop Howard J. Hubbard, episcopal moderator for the National Catholic AIDS Network, said in a letter to US bishops last month. The US Council of Catholic Bishops and the National Black Catholic Congress are asking people to help those with the disease and to work on projects aimed at preventing the spread of AIDS. Church officials say the mission must overcome ignorance, racism and stigma about the disease if it is to work. The Catholic Church has sponsored missionary projects and offered financial support to fight AIDS in the past. However, some Catholic churches are expected to elevate AIDS to priority status in 2003. The Archdiocese of Chicago, for example, is working on AIDS prevention projects including a new HIV/AIDS curriculum for children in Catholic schools. Hubbard believes churches are in a good position to help lift the stigma from HIV/AIDS and to fight the discrimination some infected people face. He suggests churches focus on projects directed to blacks and Hispanics, who have higher rates of HIV infection and AIDS deaths. Catholics say AIDS was first raised as a priority by bishops in 2001, but many in the church were slow to respond. "The problem is getting people to be totally aware of the situation. Often it isn't talked about from the pulpit or printed up in the church bulletins," said Dr. Opal Easter, co-chair of the Chicago chapter of the National Black Catholic Congress. "We want to let people in the pews know exactly what's going on." Easter said the organization has made AIDS a key goal for the next five years. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Report: China Plans to Mass-Produce Four AIDS Drugs" Associated Press (12.27.02) China plans to make four types of low-cost AIDS drugs, the official Xinhua News Agency reported Thursday, citing Health Minister Zhang Wenkang. The news agency did not say which drugs would be made or whether all four would be mass-produced, but it did say the price would be about one-tenth that of imported drugs, which currently cost 30,000 yuan (US$3,600) per person each year. The average annual income per person in China is $700. In September, the health ministry denied news reports that it was planning to produce AIDS drugs in violation of foreign patents, but said it wants deeper discounts on the prices of imported drugs. China has begun treating patients with a domestically produced version of AZT, for which patents recently expired. China's health ministry says 10 more Chinese firms have applied for permission to make generic versions of AIDS drugs with expired patents and might be producing them by the end of the year. The disease has been spread mostly by sharing needles for injecting drugs and unsanitary blood-buying rings. In these, operators reinjected sellers with pooled blood after removing the plasma, making it possible for one HIV-infected person to pass the virus to dozens of others. The government responded by announcing a ban on the plasma trade and said it is creating standard blood banks for donors. China spent 2.3 billion yuan (US$272 million) last year to establish and upgrade 459 blood banks, Wenkang said. In addition, China has approved 22 million yuan (US$2.7 million) per year in 2002-2004 in subsidies for treatment in the worst-hit areas. Despite the measures, Zhang said the HIV/AIDS fight could be a "long term, arduous and complicated task." "First Safe Injection Site to Open by March" Vancouver Sun (12.18.02)::Frances Bula Vancouver Mayor Larry Campbell said Canada's first safe injection site for drug addicts will be opened with federal approval in Vancouver by late February or early March. Campbell made the comment after a two-day meeting with Health Canada officials to discuss draft guidelines for what would be the first safe injection sites in North America. The meeting drew about 40 people. Campbell said all indications are that no major barriers will prevent a Vancouver team of health and science agencies from submitting a proposal the first week of January and getting approval within the 60 days required by Health Canada. Vancouver agencies will likely submit an umbrella proposal for several sites to be approved at once, rather than having to file a separate application for each site. That group will likely include the Vancouver Coastal Health Authority, the BC Center for Excellence in HIV/AIDS, and the Center for Disease Control. Although Victoria, Winnipeg, Montreal and Quebec City sent police, health and government representatives, Vancouver is the closest to finalizing a proposal. The guidelines say the sites will get exemptions from Health Canada only if they are for a "scientific" purpose; that proposals have to have been approved by standard peer reviews and ethical review boards; that all users will be research subjects; and that no one with a criminal record can work at the site. Heather Hay, head of VCHA's Downtown Eastside health project, said the meeting indicated some guideline flexibility. She earlier pointed out that VCHA routinely hires people with criminal records as addiction and alcohol counselors, so banning peer counselors from safe injection sites did not make sense. Budgetary and police oversight issues also remain to be worked out. ************************************************************ MEDICAL NEWS ************************************************************ "Therapeutic AIDS Vaccine Said Promising" Associated Press (12.22.02)::Randolph E. Schmid An experimental vaccine against simian immunodeficiency virus sharply reduced but did not eliminate the amount of SIV in the blood of test animals. Evidence of SIV in the blood of macaques dropped 50-fold, and its evidence in plasma fell 1,000- fold in a 10-month test, said lead researcher Wei Lu of Rene Descartes University-Paris. Unlike preventive vaccines used to keep people and animals from catching a disease, this therapeutic vaccine aims to help them fight the disease by increasing their immune response. The study, "Therapeutic Dendritic-Cell Vaccine for Simian AIDS," was published in the Dec. 23 online issue of Nature Medicine (2002;doi:10.1038/nm806). "This study has opened the possibility of treating HIV infection," using immune cells that have been exposed to a weakened form of the virus, Lu reported. In the experiment, 10 SIV-infected macaques were vaccinated using dendritic cells that had been exposed to chemically inactivated SIV. Dendritic cells are strong producers of antigens that battle diseases invading the body. The macaques were given five injections over two months. While the virus was not eliminated, it was sharply reduced in seven of them as long as 10 months later. "We are now working on an improved protocol aimed at immunologic eradication" of the virus, Lu said. Nina Bhardwaj of New York University and Bruce Walker of Partners AIDS Research Center at Massachusetts General Hospital said in a commentary that the experiments "suggest that immunotherapy may indeed be a realistic goal." But they added that questions about the type of macaque and some other aspects of the work "must temper enthusiasm until the results can be confirmed." In January, Harvard researchers working on an AIDS vaccine for monkeys reported the virus was able to overcome their vaccine by changing a single gene. SIV did not mutate to develop immunity in the seven macaques that maintained their SIV resistance, but Lu said that may have been why the three others in his experiments saw SIV progressively increase in their blood. "Recreational Drugs Can Reduce Safety, Efficacy of Antiretroviral Agents" Drug Week (12.20.02)::Michael Greer Canadian researchers warn that illicit drugs can trigger potentially lethal side effects in HIV patients on antiretroviral therapy. Tony Antoniou and colleagues at Toronto General Hospital conducted a study to "summarize existing data regarding potential interactions between recreational drugs and drugs commonly used in the management of HIV-positive patients." The investigators reviewed data from studies in the MEDLINE database and a number of other sources including textbooks and conference abstracts. They found a number of recreational drugs - including MDMA (Ecstasy), heroin, and LSD - can dangerously alter the pharmacokinetics of protease inhibitors and other antiretroviral agents. Antiretroviral drugs inhibit the cytochrome P450 metabolic pathway, which is used to break down antiretroviral agents and opioids, amphetamines and other classes of recreational drugs, the study reported. PIs and nonnucleoside reverse transcriptase inhibitors (NNRTIs) strongly suppress cytochrome P450-based drug metabolism and have been implicated in MDMA and gamma- hydroxybutyrate overdoses, data showed. Impaired metabolism of LSD, ketamine, methamphetamines, and phencyclidine (PCP) was reported for patients on PI therapy. Reactions seemed particularly severe for those prescribed ritonavir. The NNRTIs nevirapine and efavirenz hastened methadone metabolism and possibly triggered withdrawal symptoms, an effect also found in some PI-treated patients, said the study. The full report, "Interactions Between Recreational Drugs and Antiretroviral Agents," was published in Annals of Pharmacotherapy (2002; 36(10):1598-1613). "Interactions between agents commonly prescribed for patients with HIV and recreational drugs can occur, and may be associated with serious clinical consequences," Antoniou and colleagues concluded. "Clinicians should encourage open dialog with their patients on this topic, to avoid compromising antiretroviral efficacy and increasing the risk of drug toxicity." ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Syphilis Outbreak in Los Angeles County Leads to Calls for More Testing" Associated Press (12.27.02) In Los Angeles, a 62 percent increase in syphilis cases reported by gay men countywide has prompted health advocates to call for more outreach and testing programs. The increase represents about 360 new cases reported this year. It alarms health advocates because many of the syphilis patients were already diagnosed with HIV. "The implications are that gay men are having more unprotected sex," said Karen Mall, director of prevention for the AIDS Healthcare Foundation in Los Angeles. Although curable, "syphilis can lead to neurological problems, blindness and even death," Mall warned. "If you are HIV positive and contract syphilis, complications can come much sooner and be much more powerful." Mall said syphilis rates have been rising since spring 2000. Earlier this year, CDC reported a 68 percent increase in syphilis cases in California in 2001 compared to 2000. "Since AIDS has become treatable and people aren't dying in great numbers we've gotten complacent and safer sex is taking a back-seat," said Michael Weinstein, president of AIDS Healthcare Foundation. He noted the need for more testing centers and outreach programs to stop the spread of syphilis, citing increased testing as one reason for Baltimore's recent reduction in cases. He chided the gay community for not taking a stronger role in fighting STDs: "In places like West Hollywood, where alcohol and sex are primary industries, those communities have a responsibility to promote safer sex and make condoms available." A recent survey of gay bars in West Hollywood found only 57 percent of 14 establishments participating in a city-sponsored free condom program. "First Healthcare Center Targeted to Injection Drug Users Opens in New York" TB & Outbreaks Week (12.24.02) Positive Health Project, a New York syringe exchange program, and Diversified Health Systems Management Inc. recently announced the opening of Positive Health Care, the nation's first comprehensive health care center targeting high-risk clients, including current and former injection drug users. Although New York City encompasses only 3 percent of the US population, the city claims 16 percent of all US AIDS cases. Of the 4,000-6,000 new HIV/AIDS cases reported in New York City in 2000, 39 percent of those infections are attributable to injection drug use. Targeted to injection drug users, PHC is founded on the principles of harm reduction. It provides patients with primary medical care, dentistry, and HIV/AIDS testing and counseling services. The center's patient base includes clients from syringe exchange programs throughout the city. "It is our hope that by offering [patients] access to high quality and nondiscriminatory healthcare, they will begin to realize their self-worth and make lifestyle changes that can reduce their health risks," said Dr. Richard Gold, medical director of the center. Many injection drug users and other high- risk populations are homeless and therefore have limited access to medical services. Moreover, this population often avoids medical services for fear of legal repercussions and discrimination associated with drug addiction. ************************************************************ NEWS BRIEFS ************************************************************ "New California Law to Require Referrals to HIV Specialists" Reuters Health (12.26.02) A California law requiring HMOs to refer HIV-infected patients to AIDS specialists is slated to take effect in mid- January. Gov. Gray Davis signed the legislation in September 2000, but its implementation was delayed as the state and California physicians worked to craft a definition of what constitutes an HIV/AIDS specialist, according to AIDS Healthcare Foundation, the nation's largest AIDS organization. The law gives HMO patients a legal right to obtain care from physicians who have "demonstrated expertise" in treating AIDS. Regulations defining an HIV/AIDS specialist and outlining other requirements have been filed with the Secretary of State's office and will take effect Jan. 16, AHF said. Qualified physicians must meet one of four criteria to be considered an HIV/AIDS specialist. A physician credentialed as an HIV specialist by the American Academy of HIV Medicine is deemed to meet the definition. "This is an important milestone for all Californians living with HIV/AIDS who are covered by managed care plans," said Assemblymember Martin Gallegos (D-Los Angeles), the bill's author. "This bill and these regulations will help save lives." "Scouts to Get Free Condoms at International Jamboree" Associated Press (12.23.02) Scouts attending the 20th World Scout Jamboree in Thailand will be provided with free condoms on request, Dr. Pipat Yingseri of the Public Health Ministry said Tuesday. Yingseri said condoms would be supplied at the event because reports of participants engaging in sex had emerged from past scout gatherings. About 20,000 boy and girl scouts from 80 nations are expected to attend the Dec. 28-Jan. 7 event. Most of the scouts are ages 14 to 18. "We are preparing the condoms to prevent AIDS, not to encourage sexual activity. In case they need them they can ask for them from us," Yingseri said. Yuwarat Jamornvej, the camp chief, said sexual encounters would prove difficult for the campers, given the large number of people in the area and nightly security patrols by up to 300 volunteers. He and public health officials expect illnesses, including sunstroke, to be a bigger problem. "A Dark Christmas for AIDS Patients in South Africa" Times of India (12.25.02) In South Africa, the National Association of People Living with AIDS declared the holiday season "Black Christmas" to highlight the plight of nearly 5 million South Africans living with the disease. "We have a lot of people who are suffering from the disease but yet most of them cannot obtain antiretroviral drugs," said Joe Manciya, a NAPWA spokesperson. To emphasize the concept of "Black Christmas," NAPWA will hold a number of protests against the authorities and companies that produce antiretroviral drugs. "We cannot enjoy our Christmas when our people are dying," Manciya said. AIDS activist Zackie Achmat, who refuses to take antiretrovirals while "most people cannot afford them," said, "If the government continues to fiddle about our requests then you'll find people dying on the steps of parliament. That's how far we are prepared to go in order to get the government to act."