HIV/AIDS Newsroom: October 4, 2000
Transmission of Mycobacterium Tuberculosis From Medical Waste
Journal of the American Medical Association (www.jama.com)
10/04/00; Vol. 284, No. 13, P. 1683; Johnson, Kammy R.; Braden, Christopher R.; Cairns, K. Lisa; et al.
Three workers at a medical waste treatment plant in Washington State developed tuberculosis (TB) infection in 1997. Researchers from the Centers for Disease Control and Prevention investigated the three cases, reviewing their medical records to scan for previous exposures to TB and identifying any mutations in the isolates. The three patient-workers were white, American-born, and between the ages of 28 and 52. All three individuals were HIV-negative and had no known exposure to active TB. The three cases -- whose isolates had different DNA fingerprints, with one matching an isolate from an individual who was only linked to the outbreak via exposure to the medical waste stream -- were the only ones reported in their county in 1997. Citing poor safety at the medical plant and a lack of worker knowledge regarding health risks, the CDC determined that the workers likely contracted TB from medical waste that was not decontaminated before it was sent to the plant. Forty-five percent of the patients' co-workers who had contact with the patients had positive tuberculin skin tests. The authors recommend the use of autoclaving prior to disposal of stocks and cultures, and better safety training for employees.
Researchers from two drug firms, Merck Research Laboratories and ViroLogic, investigated drug potency and exposure in HIV-1 drug resistance. The authors note that while most protease inhibitors for HIV infection have in vivo trough levels higher than their human serum protein binding-corrected IC(95) values for wild-type infection, the troughs are much lower than corrected IC(95) values for HIV strains resistant to protease inhibitors in patients experiencing virologic failure of indinavir and/or nelfinavir. When administered with ritonavir, however, saquinavir, amprenavir, and indinavir blood levels rise significantly, and these indinavir and amprenavir troughs are higher than IC(95) for most protease inhibitor-resistant strains studied. The findings indicate that twice-daily indinavir-ritonavir, and possibly amprenavir-ritonavir, could be effective treatment for patients that have protease inhibitor-resistant HIV infection.
AIDS Response Programs Target Black Community
Atlanta Journal and Constitution (www.accessatlanta.com)
10/04/00; P. 9D; Staples, Gracie Bonds
U.S. Surgeon General David Satcher said Tuesday that young gay men, particularly African Americans, could be the most vulnerable and difficult to reach in the AIDS epidemic. "This is a group that we're very concerned about, who continue to see themselves on the fringes of society," he said. According to Satcher, 7 percent of young gay men have HIV, but 20 percent of African-American gay men are HIV-positive. Satcher, speaking at a news conference during the U.S. Conference on AIDS in Atlanta, noted that most (80 percent) were not aware of their infection until they were tested. The surgeon general also discussed two federal programs, the Crisis Response Team and Leadership Campaign, which aim to help minority communities fight AIDS. Sixteen cities now have crisis response teams.
A new survey by the Henry J. Kaiser Family Foundation shows that parents want more sex education in high school for their teenage children. The report polled 1,501 sets of parents and students in 1999, revealing a bridge between what parents want and what schools provide. About two-thirds of parents want sex education to be at least half a semester long and cover the dangers of HIV and other sexually transmitted diseases. About 84 percent of parents want sex education to discuss the use of birth control and how to discuss the issue with a sex partner. Ninety-seven percent of parents want sex education to teach abstinence and how to deal with rape. Responding to the findings, Heather Cirmo of the Family Research Council, a conservative research group, said, "We believe that the parents who are participating in the study have been duped into believing that comprehensive-based sex education is what's best for their children." The Kaiser study also found disparities between teachers' and students' reports, as only 18 percent of the students in the survey reported being taught abstinence until marriage as the main message, while one-third of teachers said they taught that "young people should only have sex when they are married."
The House of Representatives has passed a measure that would mandate hospitals and healthcare facilities to use safer needle devices. The legislation, which still needs Senate clearance, updates an Occupational Safety and Health Administration standard passed in 1991.
Dr. Amy Lansky and colleagues at the Centers for Disease Control and Prevention have found that sexually active, HIV-positive heterosexuals in the United States are more likely than not to report their sexual risk behaviors. Data from 4,743 HIV-infected heterosexuals showed that close to 50 percent were not sexually active, 13 percent reported having a sex partner who also had HIV, and 60 percent of the remaining individuals reported at least one heterosexual risk behavior for HIV transmission. Compared to nonusers, drug users were more likely to not use condoms and to have multiple sex partners. The researchers, who reported their findings in the September issue of Sexually Transmitted Diseases (2000;27:483-489), noted that the high number of sexually active people with HIV who had unprotected intercourse highlights the need for continuing risk-reduction counseling among these individuals.
The World Health Organization (WHO) has called for a global effort to fight AIDS, tuberculosis, and malaria in developing nations. Speaking at the commencement of a four-day Swiss conference on the issue, WHO Director General Gro Harlem Brundtland said the diseases are affecting the economic growth of developing countries. Brundtland noted that while there are already methods to fight some of the diseases, they must be implemented on a broader scale if poverty is to be reduced. To demonstrate her point, Brundtland cited data showing how HIV and malaria have affected per capita growth in several African nations in recent years.
On Tuesday, a former health care worker in Palo Alto, California, faced felony charges that she assaulted patients with unclean needles. The women, Elaine Giorgi, could be sentenced to 12 years and eight months for medical misconduct, if found guilty. Giorgi was a phlebotomist for a year at SmithKline Beecham's Patient Service Center. The accusations claim that Giorgi cleaned butterfly needles with only tap water and reused them up to three times. Butterfly needles are more expensive but easier to use on people with difficult veins. The plaintiffs also claim that Giorgi tried to hide an under-draw of blood by labeling a tube of one person's blood as another. After the situation was uncovered last year, SmithKline Beecham sent warning letters to 3,700 patients, noting that HIV or hepatitis could have been spread through needle exposure. Health experts will testify this week that the risk of exposure to the viruses via the alleged misconduct is slim.
In an interview with The Hill, White House Office of National AIDS Policy director Sandra Thurman discusses her agency's work in educating the public. Thurman notes that while the AIDS epidemic is rapidly infecting people under age 25, the public is growing complacent due to new drugs and a false sense of security. She believes a general media campaign is needed to educate people and to relay the message that the epidemic is not under control. Special attention is warranted, she says, on how to get the message across to the riskiest segments of the population. As for employers being more compassionate about AIDS, Thurman says that strides have been made but that discrimination and stigma still exist. During Thurman's recent visit to Africa with President Clinton, she saw increased political leadership from Nigeria. However, the percentage of people becoming infected with HIV is growing, and an aggressive campaign is needed to help 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.