HIV/AIDS Newsroom: January 29, 2001
The Pills Identification Test: A Tool to Assess Adherence to Antiretroviral Therapy
Journal of the American Medical Association (www.jama.com)
01/31/01 Vol. 285, No. 4, P. 412; Parienti, Jean-Jacques; Verndon, Renaud; Bazin, Claude
French researchers examined the level of antiretroviral (ARV) therapy compliance among a group of HIV-infected individuals, using a pills identification test (PIT). During the tests, held in outpatient clinics in Caen and Paris-Bichat University Hospitals in France, 224 patients were asked to identify the ARV drugs they had been taking on a board that featured 23 ARV pills. There were two similar, or "twin pills," for every ARV pill exhibited. PIT scores were calculated based on the total of improperly identified pills weighted against the degree of similarity between the pills. Final calculations were made by associating PIT results with the four-item adherence scale used for other chronic diseases. The researchers determined that two-thirds of the patients had good adherence to ARV therapy based on the adherence scale, while more than three-quarters had satisfactory PIT scores. The PIT was easily performed, accepted by patients, and could be used in addition to the four-item adherence test to determine a patient's compliance to ARV therapy. The researchers concluded that physicians might also be able to use it to evaluate a patient's knowledge of their own therapy program and as a way to determine their compliance to drug treatments for conditions other than HIV.
Researchers from the Centers for Disease Control and Prevention recently investigated 1,080 patients diagnosed with pulmonary sputum-positive tuberculosis (TB) and 6,225 of the patients' personal contacts. According to the findings, just over a third of the 4,793 personal contacts who underwent tuberculin skin tests had positive results. Of the individuals who tested positive, 1,381 were recommended for drug therapy; however, only 707 of the 1,277 subjects who began treatment actually completed therapy. The researchers, who reported their findings in the December issue of the American Journal of Respiratory and Critical Care Medicine, concluded that marked improvements are needed in the identification process of TB patient contacts. These include visiting patients' homes, tracking dates of the contacts' exposure to the patients for better follow up, and greater use of directly observed therapy.
Gates Makes Large AIDS Pledge
Washington Post (www.washingtonpost.com)
01/28/01 P. A23
As the first HIV vaccine specifically designed for Africa awaits human clinical trials, Microsoft billionaire Bill Gates has personally pledged $100 million towards ongoing research. His private initiative to jumpstart the program, is a reaction to the market failure of the past 20 years in the development of an effective vaccine for the world's estimated 5 million HIV-infected people. Rising to Gates' challenge to the rich and powerful at the World Economic Forum, the first corporate sponsor of the International AIDS Vaccine Initiative, online company Yahoo, Inc., has pledged $5 million over the next three years.
The new HIV drug therapies are being untruthfully proffered as a miracle cure for HIV, garnering responses of continued unsafe sexual behavior. Some say, in fact, that the advertisements exhibiting happy people supposedly living with HIV encourage high-risk individuals to act with even more carelessness. Health experts feel that there is a great misconception of the current HIV drug therapies in that they elicit feelings of over-confidence among patients, thinking it is a miracle cure. Experts believe that television networks can assist in contradicting the oversell by the pharmaceutical companies of their HIV drugs by lifting their ban on condom advertising. University of California at San Francisco professor, Joseph Cantania, pointed out in an article published in Science journal last fall that the focus of the health campaigns has always targeted the new HIV cases, and not the new AIDS cases. He feels public health officials should be required to report new HIV cases, as with other infectious diseases. Conscientious surveillance, public education, and renewed personal responsibility are the keys to controlling the spread of HIV.
The government of Kenya has given the final approval to begin human clinical trials of a new HIV vaccine in Africa. Still in the early stages, the vaccine is a joint venture of researchers from Britain and Kenya. British human trials are underway, but it will be five years before the vaccine is ready for use. Bill Gates, chairman of Microsoft, has donated nearly $200 million to bolster the clinical trial program.
South Africa's President Mbeki has backed down on his previous controversial statement of refusing to believe that AIDS is caused by HIV, and has approved a program to treat patients for free with the expensive HIV drugs. The program would provide drug therapy to HIV-positive pregnant women and victims of rape in an attempt to stop the increasing number of mother-to-infant infections. It is estimated that more than 70,000 HIV-positive infants are born each year in South Africa. Mbeki's program will include the use of the drug nevirapine and involved eighteen state hospitals to provide free HIV testing for pregnant women, medication, and infant milk. His earlier refusal of providing free antiretroviral drugs stemmed from the cost and the side effects, threatening legal action against anyone who provided the drugs. Mbeki's government position on the cause of AIDS still has not changed, but his latest move provided some hope for those embroiled in the battle against the spread of the disease, which has effected nearly 10 per cent of the South African population.
As scientists learn more about proteasomes and the boundless selection scheme, they learn an even greater appreciation of how protein death is linked to life. Researchers investigated the molecular role of proteasomes during cellular processes discovering that it works by literally disassembling the protein into pieces. The scientists found that the breakdown of protein plays a major role in the overall regulation of the metabolism by producing the amino acids necessary for sugar creation and energy output during times of malnourishment or illness. Cases of massive protein breakdown are evident in the wasted and weak muscles exhibited by people with advanced HIV, cancer, and untreated diabetes. Viruses such as HIV and human papillomavirus have been able to mutate sufficiently to imitate and manipulate the protein breakdown technique for their own purposes. Scientists also speculate that other diseases, such as neurodegenerative disorders like Parkinson's and Alzheimer's, may be a result of abnormal proteins' resistance to breakdown by proteasomes.
The Centers for Disease Control and Prevention announced in September that the National AIDS Hotline and the National STD Hotline would be merging their services to become the CDC National STD and AIDS Hotline. The AIDS hotline has taken about 13 million calls since it was launched in 1983.
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.