HIV/AIDS Newsroom: October 3, 2000
Recovery of Replication-Competent Virus From CD4 T Cell Reservoirs and Change in Coreceptor Use in HIV Type-1-Infected Children Responding to Highly Active Antiretroviral Therapy
Journal of Infectious Diseases Online (www.journals.uchicago.edu/JID)
09/00 Vol. 182, No. 3, P. 751; Equils, Ozlem; Garratty, Eileen; Wei, Lian S.; et al.
Highly active antiretroviral therapy (HAART) has been shown to suppress plasma viremia in most HIV-infected individuals. A prospective study of 27 HIV-infected children conducted by Cedars-Sinai Medical Center and the UCLA AIDS Institute reveals that in eight of 12 children who responded to HAART, the therapy restricted the number of coreceptors used by the HIV isolate. Six children whose HIV coreceptor tropism changed from X4-tropic to R5-tropic experienced the most significant decreases in coreceptors used. The children who responded to treatment saw a substantial increase in naive CD4 T cells, suggesting that persistent HIV T cell reservoirs are also present in children. The findings also suggest that HAART could affect the number of coreceptors used by the predominant virus isolate.
A new report, "Youth and HIV/AIDS 2000: A New American Agenda," shows that young people are taking fewer sexual risks and are using condoms more, but HIV rates remain steady for teenagers. Presidential AIDS envoy Sandra Thurman, who released the findings during the U.S. Conference on AIDS in Atlanta, noted, "We know what kind of information to give [youths] to help them protect themselves, but we need to define what those messages need to be with greater specificity." That need is particularly great with high-risk groups, including children who are abused or who use drugs. Each year, 50 percent of new HIV infections in the United States occur in young people aged 13 to 24, with African Americans and Hispanics composing 70 percent of new AIDS cases in that age group, according to the report. Thurman cited a recent MTV poll which found that 87 percent of youths did not consider themselves at risk for HIV. Also, noting that many HIV-positive young people are not aware of their infection, Thurman called for greater access to youth-friendly HIV counseling and testing, medical care, and support.
Health Officials Concentrate Efforts to End Syphilis
USA Today (www.usatoday.com)
10/03/00 P. 7D; Haney, Daniel Q.
Health officials in Fulton County, Georgia, recently discovered 25 cases of syphilis in an area known to be a hideaway for crack addicts. Health workers have set out to reach these cases and test others who live in the area. County disease investigator Jerome Powell coaxes crack addicts out from a parking lot to get tested for syphilis, with the ultimate goal of eradicating the disease in the next few years. Although once a common disease in the United States, the disease is fairly rare now, with most cases concentrated in poor, African-American communities in the South. Dr. Helene Gayle, director of the Centers for Disease Control and Prevention's National Center for HIV, STD, and TB Prevention, is optimistic about eliminating syphilis nationwide. "The fact that it is focused in fewer and fewer counties makes it doable," she said. "But we can't get complacent and think it will just go away on its own." The goal is to reach every person infected and promote condom use among those at risk. Seventy percent of syphilis cases are found in the South, and this year the CDC is spending about $19 million on, among other things, syphilis control efforts in Nashville, Raleigh, and Indianapolis. The disease can be cured with two shots of penicillin; however, the challenge is locating patients and their partners. It is difficult to reach the elusive people who trade sex for crack, ignoring condoms and safe sex in their desperate search for more drugs. Churches and soup kitchens are helping reach infected people who may elude CDC workers.
New findings from Hawaii and Missouri reveal that gonorrhea is becoming resistant to more antibiotics, according to federal health officials. The Centers for Disease Control and Prevention has issued new recommendations for doctors who treat the sexually transmitted disease. About 10 percent of gonorrhea cases in Hawaii last year were resistant to ciprofloxacin, while doctors in Kansas City, Missouri, found that 12 men had gonorrhea resistant to azithromycin. The studies reflect the increasing difficulty of treating gonorrhea, as fewer drugs effectively fight the infection. Susan Wang, an epidemiologist at the CDC, notes that "as we lose fluoroquinolones and eventually azithromycin, we will drastically reduce the number of oral antibiotics that we can use to treat gonorrhea," and then doctors will have to start using injectable and more expensive antibiotics. Left untreated, gonorrhea can lead to infertility, ectopic pregnancy, and can facilitate HIV transmission. Cases of gonorrhea in the United States reached an all-time low in 1997, with 326,564 cases reported; however, that number increased to 360,076 cases last year.
The U.S. House of Representatives has passed a measure to allow people who are raped to require their attackers get tested for HIV so early treatment can be administered, if necessary. The approved legislation would withhold federal crime-control funding from states that do not support HIV testing of an accused attacker within 48 hours of the formal indictment. Because there is no companion version in the Senate, the measure -- which was sponsored by Rep. David Weldon (R-Fla.) -- may not be enacted this year.
Research from William O'Brien of the University of Texas Medical Branch at Galveston shows that HIV-infected inmates in Texas often have drug-resistant strains. The scientists found that the resistant virus could be spread within Texas prisons, posing a dual problem, for when prisoners are released, they can infect others in the community. Tests indicate that 48 percent of HIV-positive inmates studied had resistance to the drug 3TC, compared to 35 percent among patients at the medical school's clinic. Resistance to AZT, however, was lower among the prisoners. Approximately 3 percent to 4 percent of Texas inmates have HIV, and infection rates are higher among women in female inmates than male inmates. O'Brien's research also uncovered what he believes to be the first known case of drug-resistant HIV that was transmitted in prison. The individual tested HIV-positive in 1997 after several negative tests, and within a year, physicians identified nine genetic mutations that indicated resistance to some drugs. At that point, the individual had not taken any drugs for his infection.
Enzo Biochem, a biotechnology company, reported Monday that a patient involved in a Phase I trial has generated new immunity cells to fight HIV. The company said that after nearly 10 months, engineered cells grafted to the individual's bone marrow are producing new anti-HIV cells. Enzo is still collecting data on the other five patients in the study, but the company said it hopes to begin Phase II tests of the HGTV-43 treatment soon.
A recent study from Dr. Malanda Nsuami of Louisiana State University Health Sciences Center in New Orleans found that 97 percent of parents support chlamydia testing in high school and almost 90 percent of students were tested during the three-year study. The researchers offered in-school chlamydia testing in three public high schools during the school year. Of the students who were tested more than once, 1.8 percent of males and 7.7 percent of females tested positive for chlamydia at their first test, according to the report in Sexually Transmitted Diseases (2000;27:473-479). The authors note that the high student acceptance rate and overall participation should provide reassurance for other areas considering school-based sexually transmitted disease screening programs.
A analysis of data from Chris Hani Baragwanath Hospital in Johannesburg, South Africa, shows that nearly half of all deaths among children in 1996 were AIDS-related. Dr. Karen Zwi and colleagues at the University of Witwatersrand report in the Archives of Disease in Childhood (2000;83:227-230) that 9 percent of children admitted to the hospital under the age of 15 months were HIV-infected in 1992, compared to 46 percent in 1996. The in-hospital mortality rate increased during that time from 4.3 percent to 5.2 percent among HIV-infected children but fell for HIV-negative children. Zwi and colleagues believe the results reflect how HIV is threatening childhood survival in South Africa.
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.