News Flashes

• Two Cases of Fatal and Severe Hepatitis Associated with RIF and PZA
• Invasive Cervical Cancer Before and After HAART
• Tolerability and Antiviral Activity of Fortovase plus Ritonavir
• Correctional Facilities Respond Quickly to TB

Two Cases of Fatal and Severe Hepatitis Associated with RIF and PZA

One of the recommended treatments for latent tuberculosis infection (LTBI) is a 9-month regimen of isoniazid (INH). In some cases, an alternative is a 2-month regimen of rifampin (RIF) and pyrazinamide (PZA). In September 2000, a 53 year-old incarcerated black man in New York died of hepatitis after 5 weeks of RIF-PZA. In December, a 59 year-old white woman in Georgia was admitted to a hospital because of hepatitis after 7 weeks of this regimen. An April MMWR report summarizes the findings of the investigations of these incidents, which underscore the need for clinical monitoring for adverse effects in all patients receiving treatment for LTBI. (MMWR, April 20, 2001/50(15);289-291. Article available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5015a3.htm).

Invasive Cervical Cancer Before and After HAART

An Italian study published in the April issue of JAIDS sought to assess whether the incidence of invasive cervical cancer (ICC) has changed since the introduction of HAART among women with a known duration of HIV infection. Utilizing a prospective cohort study, the Italian Seroconversion Study, the authors researched the incidence of ICC before and after the introduction of HAART in Italy. In the period 1981 to 1995, an increase was observed in the incidence of ICC and other AIDS-defining diseases. The trend continued only for ICC since 1996. According to the authors, it remains to be seen whether the increase in ICC after HAART is attributable to a decreasing competitive mortality from other AIDS-defining diseases, or whether, in fact, ICC "may not be greatly influenced by severe immunosuppression, stressing the importance of clarifying the role of immunosuppression on the development of ICC and thus of determining the direct effect of HAART on ICC." (Dorrucci M., Suligoi B., Rezza G. et al. JAIDS. 4/1/01; 26: 377-380.)

Tolerability and Antiviral Activity of Fortovase plus Ritonavir

Last month, Roche announced preliminary clinical data from four ongoing studies comparing the safety and efficacy of once-daily Fortovase (1600mg) in combination with 100mg of ritonavir, along with two nucleoside reverse transcriptase inhibitors (NRTIs) vs. once-daily efavirenz (600mg) plus two NRTIs in treatment-naive HIV-positive patients. Fortovase plus ritonavir was well tolerated in this trial. Three patients discontinued participation in the trial due to gastrointestinal disorders, pregnancy or loss of contact. (International Workshop on HIV Clinical Pharmacology in Noordwijk, Netherlands, April 2-4, 2001).

Correctional Facilities Respond Quickly to TB

About 250 youths and 200 staff members are being tested for TB at Marion Juvenile Correctional Facility in Ohio. Testing has been ongoing since mid-April, when a doctor told a staff member that she may have the disease. Officials were diverting youths to other detention centers around the state and canceling weekend visitations until test results were released (Associated Press 5/2/01). In South Carolina, three inmates at the Broad River Correctional Institution have early signs of TB, and vulnerable inmates are no longer being assigned to the prison, state health officials said. No cases of TB have been confirmed, but the inmates have been isolated while the tests are analyzed. (Associated Press, 5/5/01)

Back to the HEPP News May 2001 contents page.