HIV/AIDS Newsroom: October 17, 2000
UK Faces Rethink on AIDS Treatment
09/28/00; Vol. 407, No. 6803, P. 434; Birmingham, Karen
Britain's policy for treating AIDS could be affected by new research from Dr. Eric Rosenberg at Massachusetts General Hospital (MGH) and Harvard Medical School. Rosenberg and colleagues conducted a study which found that early drug therapy is best to fight HIV infection. Britain's policy has been to delay treatment until a patient's CD4 cells fell below 350 cells per cubic millimeter. Patients in the study who began highly active antiretroviral therapy (HAART) 180 days or less after infection were able to take medication interruptions and keep HIV suppressed. Bruce Walker, a co-author of the study from the Partner AIDS Research Center at MGH, believes early treatment is key, and he wants rapid HIV tests to be licensed. However, the researchers stressed that patients must remain on their medication unless supervised and approved to take a drug holiday. Jonathan Weber of Imperial College School of Medicine in London warns that clinical trials are needed to determine when is best to start treatment given that "just because someone looks great at two years, it doesn't tell you what will happen 14 years later."
South African President Thabo Mbeki reportedly has decided to back off from the debate over whether HIV causes AIDS, after sparking a firestorm of controversy earlier this year by questioning a link that most scientists accept. His comments have been criticized by AIDS activists and researchers worldwide. Now, according to government spokesman Joel Netshitenzhe, Mbeki "has scaled down on his participation in the debate," so he can deal with other issues. Last month, the Congress of South African Trade Unions and the South African Communist Party publicly declared that HIV causes AIDS, and they called on Mbeki to acknowledge the link. While the president has not yet gone that far, in recent comments to Parliament he said the government's AIDS policies stem from the "thesis" that HIV causes AIDS. Mbeki's retreat, as well as a new AIDS awareness and prevention campaign from the government, seem to indicate that the debate has taken a toll. Morna Cornell of the AIDS Consortium, an umbrella group representing more than 350 AIDS groups in South Africa, noted, "At least [Mbeki is] being strategic enough to recognize the damage that has been caused and to acknowledge it and to extract himself from it." The government has also decided to further investigate nevirapine's use in preventing mother-to-child transmission of HIV.
An Innate Defense System
San Francisco Chronicle
10/16/00; P. A8; Russell, Sabin
Dr. Jay Levy of the University of California at San Francisco has an HIV-infected patient who appears very healthy but whose T-cell count is only 21. This patient -- who hikes, bikes, and travels, and who does not take antiviral drugs -- may represent the idea that the human immune system consists of the innate and adaptive systems. The innate immune system contains disease-fighting cells, which may be used to form new AIDS treatments. Innate immunity is the first line of defense, including the skin and saliva. The adaptive system can manufacture B-cells and T-cells to attack a virus, but it can fail when the virus has advanced. Levy's patient has a poor adaptive system, but his innate immunity appears to be functioning well. He has normal levels of interferon-producing cells; interferon inhibits viral replication and modifies the activities of other cells. Dr. Levy is using the study of innate immunity to search for new therapies, by following the CD8 cells and investigating their functions.
There are approximately 700 HIV-infected inmates in the Kaliningrad regional penal system in Russia. Many were unaware that HIV was a risk when they began injecting heroin. Kaliningrad is sometimes considered the AIDS capital of Russia, with some 36,000 cases of HIV or AIDS in the city of more than 1 million people, according to the World Health Organization (WHO). There are 46,000 registered AIDS cases nationwide, Russian Health Ministry statistics show; however, WHO officials say the actual number could be 10 times higher. Doctors now see HIV transmitted frequently through sexual contact, not just through contaminated needles. Murdo Bijl of Medecins Sans Frontieres asserts, "We believe Russia still has a chance to limit the HIV epidemic to the extent that it is controllable." Bijl notes, however, that unless a massive HIV education effort is launched, at least 10 million people out of a projected population of 147 million could be infected by 2005. Without funding, though, mounting such a campaign is difficult. The government set aside about $1 million for AIDS prevention programs last year, compared to $1.6 billion for the Ryan White CARE Act grant program in the United States. The way of life in Russia has changed since the fall of Communism, as drugs and prostitution entered the lifestyle. Heroin addiction has increased dramatically, as many former Soviet republics grow opium. Russia's prisons separate those with HIV from the others. The inmates are given a special diet to help them stay strong against HIV, but Western AZT-type drugs that boost the immune system are too costly, and the prisoners often must make do as best they can.
People can spread genital herpes without knowing they are infected. An estimated 25 percent of Americans have the disease, according to the Centers for Disease Control and Prevention, but many are not aware of their condition. Dr. Karl Beutner of the University of California at San Francisco estimates that up to 75 percent of infected individuals do not know they have herpes. Patients could thus unknowingly transmit the disease to someone else, who could then spread it to others, including infants at birth. Kathleen Stine, a nurse practitioner involved in a recent genital herpes study at the University of Washington, found that asymptomatic infections are as risky as those with known diagnosis. This could explain why genital herpes has increased during the last 10 years, even as condom use grew. There is no cure for herpes, although drugs like acyclovir can suppress the disease, and abstinence is the only sure means of prevention.
A report in the American Heart Journal (2000;140:575-584) shows that transmission of HIV to a fetus does not affect cardiac function in utero. Dr. Lisa Hornberger of Toronto's Hospital for Sick Children and colleagues studied 173 fetuses in 169 HIV-infected women, using fetal echocardiograms and measuring biparietal diameter, femur length, and cardiovascular dimensions. Compared to fetuses determined to be HIV-negative, the fetuses determined after birth to be HIV-infected had slightly smaller left ventricular dimensions but similar echocardiographic results. Dr. Hornberger suggests that fetuses from women with HIV could have increased placental vascular resistance.
A new study from Johns Hopkins University shows that people age 40 or over who are infected with hepatitis C virus (HCV) have over three times the risk of type 2 diabetes. Shruti Mehta and colleagues evaluated over 9,800 adults, 2 percent of whom had HCV infection. According to their report in the Annals of Internal Medicine (2000;133:592-599), the rate of type 2 diabetes was higher in the HCV group compared to those HCV-negative, for subjects over 40. The findings support the idea that HCV infection can cause type 2 diabetes through progressive liver damage.
The AIDS Resource Center of Wisconsin received $1.2 million to help provide outpatient care to low-income people with HIV or AIDS. The federal grant will provide primary care for AIDS patients who have no access to medical care.
The 13th International AIDS Conference in Durban, South Africa, brought together in July many leaders and AIDS experts from around the world. The meeting chronicled the growing number of infections among young people in Africa, as controversial words from South African President Thabo Mbeki rang in the ears of the media. Responding to Mbeki's questioning of the link between HIV and AIDS, over 5,000 physicians and others signed a document known as "The Durban Declaration," reporting evidence that HIV does cause AIDS. Debates over affordable anti-HIV drugs continue, as Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases reminded the audience, it is a huge step to finally consider using antiviral therapy in developing nations. AIDS journalist Laurie Garrett warned that overuse of antivirals without strict adherence could lead to drug-resistant HIV, because the virus mutates quickly. Although five pharmaceutical companies have promised to reduce their drug prices, generic drugs would be the best solution in countries without patent laws. Boehringer Ingelheim's offer for free nevirapine for HIV-infected pregnant women was denied by South Africa, which may be thinking of the long-term care of AIDS orphans. Many companies are focusing on the need to improve the medical infrastructure of poorer nations, in order to deliver the necessary drugs at an affordable cost. Speaking at the closing session of the conference, former South African president Nelson Mandela asserted, "In the face of the grave threat posed by HIV/AIDS, we have to rise above our differences and combine our efforts to save our people. History will judge us harshly if we fail to do so now, and right now." Mandela noted Africa's history of collective leadership, and he called for programs to fight discrimination, prevent future HIV infections, and support individuals already infected with the virus.
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.