HIV/AIDS Newsroom: September 25, 2000
Privacy vs. Access: A Medical Debate
Atlanta Journal and Constitution (www.accessatlanta.com)
09/24/00 P. 17A; Eversley, Melanie
The use of medical databases concerns privacy advocates, but provides health providers with valuable information. Researchers at the Centers for Disease Control and Prevention want to track AIDS, tuberculosis, and other diseases to help eradicate them. However, many people feel that medical privacy is a right, and is violated by records of personal data. Corporations, state governments, and federal authorities keep track of medical conditions to help clinicians. Health and Human Services Secretary Donna Shalala has proposed new guidelines to allow law enforcement and public health researchers to access medical databases. Helene Gayle, director of the CDC's National Center for HIV, STD, and TB Prevention, explained that anonymous testing sites never include a name.
African National Congress executive committee member Manne Dipico has stated that HIV causes AIDS. Dipico is the first ANC member to publicly break from President Mbeki's stance on HIV. Manne Dipico announced his position while opening a new center for AIDS at Kimberley, South Africa. Mbeki continues to state that HIV may be a factor leading to AIDS, but is not the only one. South Africa does not offer antiretroviral drugs to rape victims or pregnant women to prevent HIV transmission.
HIV Education, Prevention Programs Needed for US Seniors
Reuters Health Information Services (www.reutershealth.com)
09/22/00; Zwillich, Todd
A study from the National Institute on Aging shows that HIV/AIDS education programs are overlooking people over age 50, even though this age group reports high-risk sexual behavior. Dr. Isaac Montoya, HIV researcher with Affiliated Systems Research of Houston, stated that most prevention programs are aimed at young people, who are considered the most vulnerable, yet few programs have been extended to older Americans. According to Dr. Diane Zablotsky of the University of North Carolina in Charlotte, about 9.5 percent of the women diagnosed with HIV through 1999 were over age 50. One program aimed at older people offers seniors in Miami AIDS education, relying on public funds that contribute $100,000 a year.
Progress towards an AIDS vaccine is growing, as human trials for over 20 vaccine candidates have started. President Clinton supports vaccine development, offering tax credits and other incentives for pharmaceutical firms. This has led to a doubling in the AIDS vaccine research budget. However, Clinton does not support the International AIDS Vaccine Initiative, a small group that provides capital for biotech start-ups to speed the development process. IAVI does not ask for a share of the profits, but requires that the vaccine be distributed in developing countries at an affordable cost. The group's second candidate has begun human trials, a vaccine targeted at HIV found in Africa. Britain, the Netherlands, and Canada have contributed to the group's efforts. Clinton finally signed a law for $20 million over two years to go towards IAVI, but Congress must approve.
Researchers from the University of Wisconsin have discovered that HIV avoids the body's immune responses during the first few weeks of infection. David Watkins, professor of pathology at UW-Madison, said the discovery offers a potential new approach to fight AIDS. Watkins, students Todd Allen and David O'Connor, studied rhesus monkeys infected with SIV. According to Watkins, his study shows that people infected with HIV create immune responses that HIV cannot sustain, though the virus avoids them, so it could be promising to use this ability in a vaccine.
The Federal Trade Commission is cracking down on unapproved AIDS tests, which are sold to Americans over the Internet and sometimes exported to other countries. The FTC is taking legal action against a California distributor, hoping to keep unapproved tests away from other countries and Americans.
Japan experienced an almost 10 percent rise in the number of new tuberculosis (TB) cases last year, the third consecutive year of increase. A total of 48,264 new TB cases were diagnosed in 1999, more than 4,200 more than were diagnosed in the previous year. Japan has the highest incidence of the disease among developed countries including Australia, Britain, France, and the United States. People in their 70s comprised the largest number -- approximately 40 percent -- of new cases.
Anti-HIV drugs used in highly active antiretroviral therapy (HAART) have helped transform HIV into a chronic disease, if the patient adheres to the therapy. Paul Volberding, a professor of medicine at the University of California at San Francisco, and director of the UCSF Positive Health Program, explains that physicians treating HIV patients must also use general internal medicine skills, like lipid management. Around 50 percent of patients are able to keep HIV at an undetectable level in their blood, and the majority must deal with adverse events. HIV patients at San Francisco General Hospital are generally able to live full lives, even with detectable levels of the virus. The patients have to realize that HAART has good and bad effects, but drug adherence is essential to making the treatment effective. Psychosocial problems also contribute to adherence problems. Ronald Valdiserri of the Center for Disease Control and Prevention's National Center for HIV, STD, and TB Prevention explains that peer groups often can provide the support for troubled patients that physicians cannot. Drug regimens involve taking the pills at certain times, with or without food, and often switching when the virus rebounds. The decision to change therapies must be made carefully, with clinicians debating whether to postpone a switch or do it while viral load is low. The side effects of antivirals recently being seen are lipodystrophy and high cholesterol. The rise in drug resistance presents another hurdle to scientists, but physicians remain hopeful that the newest class of anti-HIV drugs will prove beneficial to patients. Scientists continue to search for ways to reduce the number of pills and side effects involved.
Although the practice of allowing patients to remain sick while a treatment is available for the purposes of research has been called deplorable for decades, it still exists in the form of placebo testing for new medicines. While not the same system as used in the Tuskegee Syphilis Study, in which 400 poor African Americans were left untreated for years, even after the advent of penicillin, placebo-controlled trials appear to violate the 1964 Declaration of Helsinki, which states that "every patient -- including those in a control group, if any -- should be assured of the best proven diagnostic and therapeutic method." While many scientists say that some trials use placebos with no harm to patients, and in such cases their use is justified, the World Medical Association may state in a new draft of the declaration next month that placebo testing is allowed in the testing of medicines for illnesses that are not life-threatening. The ruling would eliminate much of the discrepancy between rules and practice and would acknowledge that there are gray areas in scientific research; however, a new debate would form surrounding the question of appropriate illnesses to treat and to leave untreated during clinical trials. Meanwhile, patient advocates like the group Public Citizen claim that there are too many placebo trials already, noting that many studies outside of the United States and Europe involve dangerous practices like withholding AIDS or blood pressure medications, despite there being adequate treatments, all for the purpose of research. But if taken literally, the declaration in its current form would eliminate virtually all placebo trials, including those for hair loss or a headache analgesic, according to Yale University School of Medicine professor Robert Levine. He proposes changing the document to eliminate the ban for all but debilitating or life-threatening diseases, with an emphasis on comparing new medicines to older ones -- the method that in fact gives the most information to scientists.
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.