HIV/AIDS Newsroom: October 16, 2000
Human Immunodeficiency Virus Type 1 Infection of Alveolar Macrophages Impairs Their Innate Fungicidal Activity
American Journal of Respiratory and Critical Care Medicine (www.ajrccm.atsjournals.org)
09/00 Vol. 162, No. 3, P. 966; Ieong, Michael H.; Reardon, Christine Campbell; Levitz, Stuart M.; et al.
Researchers from the Pulmonary Center at Boston University School of Medicine evaluated the effects of HIV-1 infection on innate immunity through the study of cryptococcus neoformans (CN), a fungal pathogen. Alveolar macrophages are the first defense against CN. The scientists tested to see whether HIV impaired the macrophages' ability to prevent cryptococcal infection. They discovered that reduced antifungal behavior was not due to the cytotoxic effect of HIV. Instead, the researchers note that the innate fungicidal activity of primary alveolar macrophages was affected after in vitro HIV-1 infection via "a mechanism involving a defect of intracellular antimicrobial processing."
The rise of heroin addiction in Kyrgyzstan has resulted in a need for needle exchange programs, especially in the capital city, Bishkek. An estimated 80 percent of heroin in Europe arrives from Afghanistan and Pakistan, sent through the former Soviet republics. Heroin is cheap enough for the poor people of Bishkek to afford and has now replaced opium as the drug of choice. Heroin is also much more addictive than opium. The number of intravenous drug users in Kyrgyzstan has quadrupled in the past 10 years, but experts say that number is still low enough to avert an epidemic, using aggressive enforcement and such harm-reduction tactics as needle exchanges. Earlier this year, two needle exchanges funded by the United Nations and the Open Society Institute, part of the Soros Foundation, were launched in Bishkek and Osh -- the first such programs in all of Central Asia. The Soros group has since opened other needle exchange programs in Kazakhstan, and demand for the needles has surpassed all expectations. And the need for clean needles is significant. According to a survey of 100 drug users in Osh, 96 reported sharing needles, with 35 saying they used the same needle more than 20 times. One half of the respondents did not know they could become infected through a needle. Data from the United Nations and the Soros Foundation reveal that 11 percent to 18 percent of the injection drug users in Bishkek are HIV-positive, while the number in Osh, where there are not as many education programs, ranges from 32 percent to 49 percent.
Truth and Consequences
Washington Post (www.washingtonpost.com)
10/16/00 P. C4; Stepp, Laura Sessions
A new educational campaign from the National Campaign to Prevent Teen Pregnancy grabs the attention of teenagers with huge lettering of words like CHEAP and DIRTY. In the ads, the labels are printed across teens dressed in normal clothing, designed to get teenagers to think about the consequences of having sex. One ad says, "Condoms are CHEAP. If we'd used one, I wouldn't have to tell my parents I'm pregnant." The ads are bold and demand that teens think about how to react to a friend's pregnancy or unprotected sex. Health and Human Services Secretary Donna Shalala admits the ads are "shocking," but she notes "they cut through the clutter of all the messages bombarding teens and get them to think for themselves about the risks and responsibilities of pregnancy." Many Web sites and magazines have agreed to run the ads for free. However, Michael McGee, vice president for education at Planned Parenthood Federation of America, believes the ads are too negative and will not send them to clinics. These new ads are not meant to display slogans like "Respect yourself," but to gain attention and spark conversations. "Since the teen birth rate is falling, health workers want to use the slide to hopefully create a new social norm," said Isabel Sawhill of Brookings Institution and the National Campaign's president.
Indianapolis' syphilis rate appears to be falling, after its peak as the nation's highest last year. The city recorded 407 cases of syphilis in 1999. However, the first nine months of this year show 250 recorded cases, down from 292 at this point last year. Dr. Virginia Caine, director of the Marion County Health Department, says efforts to stop the disease seem to be working, although teenagers represent a higher percentage of the infections this year compared to 1999.
A new trade bill sponsored by Chairman William Roth Jr. (R-Del.) would ban imports of dog and cat fur products and gray market cigarettes. The measure includes a provision to temporarily suspend tariffs on the imports of two HIV treatments, DPC 961 and DPC 083.
Sexually active college students in Ottawa, Canada, are being asked to take part in the area's first study of chlamydia for young adults aged 19 to 24. Students at Algonquin College, Carleton University, La Cité collegiale, and the University of Ottawa will be asked to participate in the Chlamydia 2000 study. The sexually transmitted disease is the most common among Canadians aged 15 to 24. The number of reported chlamydia cases in Canada fell between 1991 and 1996; however, Health Canada expects the chlamydia rate this year to be nearly 24 times higher than the gonorrhea rate.
Many AIDS patients do not take their medications, with an estimated 20 percent to 50 percent failing to follow their prescribed therapies. Doing this raises the risk of developing drug-resistant strains of HIV, note Ivan Oransky and Sean I. Savitz in a USA Today commentary. The Presidential Advisory Council on HIV/AIDS reported recently that a significant number of HIV and AIDS patients have drug or mental health problems, and it also noted that up to 50 percent of all new HIV infections are among individuals under the age of 25, who report difficulties accessing medical care during regular business hours. The panel called for easier-to-take drugs that are less toxic for the patients. However, the authors note that directly observed therapy (DOT), a system developed for tuberculosis (TB) patients in which healthcare workers watch the patient take his or her medicine, could also be useful. A 1998 study from the Journal of the American Medical Association shows that DOT has reduced the incidence of drug resistance by 82 percent in New York City since 1992. Furthermore, whereas hospitalizing a TB patient can cost more than $8,000, DOT costs about $2,200 per patient. The authors assert that "given the recent development of simpler regimens, every non-compliant HIV patient should be put into a directly observed therapy program," which will save lives, reduce costs, and help stem the spread of HIV.
Jane Fowler, thought HIV was a problem only for gay men, not for "heterosexual divorcees." The 64-year old woman became infected through a heterosexual encounter in which she did not insist on condom use because she was unaware of the risk. Fowler, the founder of the National Association on HIV Over 50, now devotes her time to warning other seniors about the risks of HIV. Although people over 50 make up just 10% of all AIDS cases, older Americans face unique challenges in terms of treatment and prevention. Treating AIDS in the elderly is difficult due to other health conditions and possible drug interactions, and there is little research to guide treatment decisions. Researchers also know little about the sexual behavior of seniors, which is why Marsha Ory of the National Institute on Aging organized a conference last month to discuss AIDS in older people. Studies indicate that older women know far less about HIV than younger women, and a University of North Carolina study suggests that 4.5 million American women over 40 engage in risk behaviors that might put them at risk for HIV. According to Ory, many older people take the same risks as younger people, and "age isn't a vaccine" that will protect them from infection. According to CDC, as of 1999, some 78,000 people 50 years of age and older had developed AIDS, approximately 10,000 of whom were over the age of 65.
Afghanistan, ravaged by war, has become a source of diseases such as malaria, typhoid, polio, and tuberculosis (TB), according to Abdul Hakim Hakimi, head of the General Department for Curative Medicine. He said that drug-resistant TB is a problem in the Badghis and Ghor provinces. The official also noted, "Pakistan and other neighboring countries complain that Afghanistan has become like a stockpile of polio," as healthcare workers in the country continue to use old and sometimes ineffective techniques. The sanctions imposed due to the Taliban regimen's refusal to deliver suspected terrorist Osama bin Laden have hurt health programs and halted the delivery of vaccines, Hakimi said.
The Centers for Disease Control and Prevention has released a draft 5-year plan for HIV/AIDS prevention for public comment. The draft strategic plan was developed collaboratively by external consultants active in HIV/AIDS prevention and CDC staff. The draft five-year strategic plan details priority goals, objectives and strategies for domestic and international HIV prevention. The draft plan can be accessed at CDC's website (www.cdc.gov) or by calling the National Prevention Information Network (NPIN) by calling NPIN at 1 (800) 458-5231. The public comment period runs until October 23, 2000.
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.