HIV/AIDS Newsroom: September 18, 2000
Mother-to-Child Transmission of Hepatitis C Virus: Evidence for Preventable Peripartum Transmission
09/09/00 Vol. 356, No. 9233, P. 904; Gibb, D.M.; Goodall, R.L.; Dunn, D.T.; et al.
British researchers evaluated hepatitis C virus (HCV)-infected women and their infants to determine the rate of transmission for the virus between mother and child. A total of 441 mother-child pairs were studied at three hospitals in the United Kingdom and Ireland. According to the data, 50 percent of the uninfected children became HCV-antibody negative by eight months and 95 percent by 13 months of age. The overall risk of vertical HCV transmission was 6.7 percent, and it was nearly four times higher in women coinfected with HIV than in women without HIV. According to the authors, the estimated specificity of polymerase chain reaction (PCR) for HCV RNA was 97 percent, while sensitivity was 22 percent in the first month, although that soared to 97 percent after that. Of the 31 children delivered via caesarean section, none showed evidence of hepatitis C, and breastfeeding appeared to have no effect on transmission, although just 59 women breastfed their infants. The researchers note, "The low sensitivity of HCV RNA soon after birth and the finding of a lower transmission rate after delivery by elective cesarean section suggest that HCV transmission occurs predominantly around the time of delivery." They write that antenatal HCV testing should be re-evaluated if further research confirms the findings on elective cesarean section.
Abbott Laboratories obtained a surprising early approval from the Food and Drug Administration for its new protease inhibitor AIDS medicine, Kaletra, which reduced HIV in the bloodstream to undetectable levels for the majority of patients taking the drug during clinical trials. Following its application to the agency on June 1, Abbott did not expect approval until later this fall. Kaletra is, in fact, a blend of two AIDS medicines, lopinavir, or ABT-378, and ritonavir, which is currently available under the brand name of Norvir. The combination drug lowered signs of HIV to below detectable levels in 83 of 100 patients after nearly two years in the study.
Vaccine Helps Thwart Herpes in Women
Dallas Morning News (www.dallasnews.com)
09/18/00; Beil, Laura
A new vaccine appears to prevent herpes virus in women. The vaccine has proven 73 percent to 74 percent effective in preventing genital herpes in women who were considered at high risk for the infection because their sexual partners were already infected. The University of Utah's Dr. Spotswood Spruance, who reported his findings at the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy in Toronto on Sunday, noted, "We've got a grip on the herpes virus for the first time." In one study, 10 percent of women not vaccinated developed herpes, while 3 percent of vaccinated women developed the disease. For men, the differences in infection rates were not statistically significant among the two groups. The vaccine's effects were also limited for women who had already been exposed to one type of herpes virus. The vaccine is meant to prevent HSV-2, which causes genital herpes. According to Dr. Spruance, a herpes vaccine like the one he studied would be best geared toward adolescent girls, who still have low HSV-1 infection rates.
The Brazilian government's policy of producing generic AIDS drugs and distributing them free to patients has helped turn around the lives of many people with AIDS and has become a model for success. An estimated 580,000 of the country's 167 million residents are HIV-positive, compared to a forecast of 1.2 million back in 1980. In Rio de Janeiro and Sao Paulo, the regions most affected by AIDS, the number of AIDS-related deaths have dropped 40 percent and 54 percent, respectively. The country's drug distribution program, which began in 1992, now spends $400 million a year to give medicines to 81,000 patients. The price of AIDS drugs that compete with Brazil's brands have also fallen 72 percent, another benefit to the program. Brazil manufactures the drugs under World Trade Organization rules that allow generic drugs during a national emergency. The program has 133 testing and counseling centers and has been successful in reaching the country's poor and working class. There are now about 600 nongovernmental organizations (NGOs) in Brazil with AIDS program, and $325 million in World Bank loans have helped the groups operate needle exchanges, distribute condoms, and provide counseling. Even South Africa may follow Brazil's lead, as it studies the country's manufacturing of generic medications. Commenting on the success of Brazil's anti-AIDS program, Jorge Werthein, the Brazil representative for UNAIDS, said, "It's a well-organized, well-formulated program that works because the government has managed to integrate the whole society -- especially NGOs."
The first World Bank report on AIDS in Thailand shows that reductions in the country's HIV/AIDS budget has significantly affected prevention and care efforts. Eight percent of the budget was set aside for prevention programs, with 63 percent allocated for treatment and care and 16 percent for orphan care and programs to prevent vertical HIV transmission. The report noted that just 6 percent of the budget was used for grants for nongovernmental organizations for community-level anti-HIV efforts, while the 7 percent was used for management and research. "The low level and recent declines in public spending on AIDS prevention are alarming," the World Bank noted. The report also said, "There are still many cost-effective opportunities to reduce high-risk behavior among groups not yet reached by the AIDS program." The report found that HIV prevalence among pregnant women rose from 1.74 percent in 1997 to2.02 percent last year, and it also highlighted a drop in condom use, especially among young men who visit prostitutes. Bangkok Senator Mechai Viravaidya stated that the reduced budget for condom distribution resulted in an increase in new HIV cases among sex workers. Mechai also said that long-term prevention campaigns are necessary to stop the spread of HIV, as 200 people in Thailand contract the virus every day. According to Anuphong Chitvarakorn, AIDS division director, the condom budget for the coming year will be tripled to 45 million baht as part of health officials' 100- percent condom use campaign.
Senior Vatican official Monsignor Jacques Suaudeau of the Pontifical Council for the Family quietly suggested earlier this year that the church alter its ban on condom use, noting that condoms are a "lesser evil" compared to spreading HIV. While Suaudeau follows the church's opposition to artificial birth control, he stated in an article that the condom "is one of the ways to 'contain' the sexual transmission of HIV/AIDS; that is, to limit its transmission." The author noted that condoms have been useful in preventing sexually transmitted diseases in Thailand and Uganda. The article, which appeared in the April 19 issue of in L'Osservatore Romano, "the official voice of the Holy See," is a change from standard Vatican thinking. In Brazil, Roman Catholic bishops have also suggested the use of condoms to stem the spread of HIV. The article by Suaudeau has encouraged HIV prevention workers, who see it as a breakthrough; but some others believe the Church may take back the statement. Suaudeau's article apparently drew little attention until two Jesuit priests, the Rev. Jon D. Fuller of Boston University and the Rev. James F. Keenan of Weston Jesuit School of Theology in Cambridge, wrote an article about it in the September 23 issue of the Jesuit magazine America.
A bill signed by California Gov. Gray Davis on Friday requires health insurers to make sure that policyholders with HIV or AIDS are referred to AIDS specialists. The bill, which was sponsored by the AIDS Health Care Foundation, is a temporary measure and aims to help HIV and AIDS patients receive the best treatment. For now there is no official specialty in AIDS. The California Health Care Association already considers HIV a specialty; however, the AIDS Health Care Foundation noted that the American Medical Association has not yet designated an official specialty in HIV or AIDS.
A bipartisan bill called the Needlestick Safety and Prevention Act would help protect healthcare workers from needle injuries, requiring hospitals and other employers of healthcare professionals to use "safer medical devices." The Centers for Disease Control and Prevention reports that each year, nearly 400,000 healthcare workers in the United States are accidentally stuck with needles, putting them at risk for infection with HIV and hepatitis B and C. Registered nurse Karen Daley, president of the Massachusetts Nurses Association, testified before Congress about how she contracted HIV and hepatitis C from a work-related needle injury last year. The bill is supported by the American Hospital Association, which represents some 5,000 U.S. hospitals.
The World Health Organization (WHO) reports that more people in the Western Pacific region are becoming infected with HIV each year. The total number of HIV cases could reach 1 million by the end of 2000. Cambodia and Papua New Guinea have experienced "increasing HIV epidemics," the WHO said, mostly among heterosexuals. The WHO report noted that HIV infections among injection drug users in China, Malaysia, and Vietnam are significant, while there are "low levels of HIV transmission" in Japan, the Pacific Island nations, the Philippines, and South Korea, and declining rates of infection in Australia and New Zealand. The report predicted HIV rates to stay under 1 percent for all adults in the region, except in Cambodia.
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.