HIV/AIDS Newsroom: October 24, 2000
Antiretroviral Resistance During Successful Therapy of HIV Type 1 Infection
Proceedings of the National Academy of Science Online
09/26/00; Vol. 97, No. 20, P. 10948; Martinez-Picado, J.; DePasquale, M. P.; Kartsonis, N.; et al.
Researchers from Massachusetts General Hospital and elsewhere evaluated antiretroviral resistance in individuals for whom antiretroviral therapy was successfully suppressing HIV-1 RNA to less than 50 copies. The five subjects showed new resistant mutant subpopulations with evidence of residual virus replication during highly active antiretroviral therapy (HAART). The researchers, who based their findings on transient episodes of plasma HIV-1 RNA greater than 50 copies and virus env gene sequence changes, note that each patient received a suboptimal regimen before commencing HAART.
The first country to reach an accord with drug makers after five leading pharmaceutical concerns pledged six months ago that they will provide HIV drugs to poor countries at a lower price, Senegal has negotiated drug price cuts with Bristol-Myers Squibb, Merck, and Glaxo Wellcome. Bristol-Myers said that it will reduce the French price for its Zerit and Videx by 90 percent; Merck said it will provide its protease inhibitor Crixivan and Stocrin, which is available in the United States from DuPont under the brand name Sustiva; and Glaxo will sell its AZT and 3TC at discounted prices. Although none of the firms disclosed the exact cost of discounted products, people close to the negotiations estimate that the combined cost of Zerit and Videx will be roughly $584 a year, and the total annual cost of Crixivan, Stocrin, and a third critical drug that can be added to the combination therapy will be $950 to $1,850. Senegal, which has agreed to implement an anonymous tracking system to monitor whether drugs are being received by patients and whether patients are complying with correct dosing, is apparently in talks with two other firms; however, Roche Holding and Boehringer Ingelheim will not acknowledge whether they are currently seeking an agreement.
Lesbians Not Immune to Sexually Transmitted Infections
Australian researcher Dr. Katherine Fethers has reported that lesbians are just as likely as heterosexual women to contract sexually transmitted diseases like hepatitis and genital herpes. Fethers and colleagues from the Sexual Health Unit in Alice Springs found a higher prevalence of bacterial vaginosis, hepatitis C, and HIV risk factors in lesbians compared with a control group. The researchers, who report their findings in the journal Sexually Transmitted Infections, compared the histories of 1,408 lesbians to 1,423 heterosexual women between 1991 and 1998. Seven percent of women with female sex partners never had sex with a man; however, they were more likely to have had a relationship with a gay or bisexual man and were also more likely to have had more partners than other women.
The number of tuberculosis (TB) cases in England and Wales is at a 15-year high, according to the British Thoracic Society (BTS). In 1999, 6,143 people were diagnosed with TB, versus 5,085 in 1987. London has over 4,000 cases a year, the most in any other large European city. However, only about 14 percent of the United Kingdom's TB "hotspots" have sufficient healthcare workers, the BTS said, and the failure to take TB treatments properly can result in multidrug-resistant disease. Treating multidrug-resistant TB can cost over 60,000 pounds. The chairman of BTS, Professor Peter Ormerod, warned that "TB is not a disease confined to the history books -- and there is no room for complacency."
Scientists from Epimune Inc., the University of California at Los Angeles, Harvard University, and elsewhere have found three proteins the body uses to recognize and fight tuberculosis (TB), which could lead to a new vaccine. The vaccine approach includes a new component in the immune system, CD8 cells, which play a role in fighting AIDS. Alessandro Sette of Epimune and colleagues used the drug company's screening system to identify proteins from the TB bacillus that would induce a CD8 cell response. The researchers found that CD8 cells exposed to the three proteins which generated an immune system response started producing interferon gamma to destroy an infected cell.
Findings presented by Dr. Mark Bower and colleagues, from Chelsea and Westminster Hospital in London, show that the incidence and survival of AIDS-related lymphoma has not significantly changed since the advent of highly active antiretroviral therapy (HAART). A study of 7,840 HIV-positive patients showed a decline in AIDS-related illnesses besides lymphoma. According to their report in the journal Blood (2000;96:2730-2734), however, the researchers believe that HAART could eventually lead to a drop in the incidence of non-Hodgkin's lymphoma. The study found that the incidence of non-Hodgkin's lymphoma ranged from 3 to 7 cases per 1,000 patients both before and after HAART was introduced.
The South African government promoted a simple message on safe sex in newspapers on Monday, asking citizens to abstain from sex, be faithful to their partner, and to use condoms. The simple ads are in contrast to the controversy that has swirled around the country in recent months, as President Thabo Mbeki questioned the link between HIV and AIDS. The government also plans to release this week new guidelines on how it plans to combat HIV and AIDS. The Department of Health reportedly will release nine sets of guidelines relating to the prevention, treatment, and care for HIV and other sexually transmitted infections, including HIV testing and prevention of mother-to-child HIV transmission.
An activist group in South Africa, the Treatment Action Campaign, reportedly has begun smuggling Biosole, an illegal version of the AIDS medicine fluconazole, from Thailand. Fluconazole, sold by Pfizer for 280 baht in Thailand, treats diseases like meningitis and thrush that often attack AIDS patients, is available as Biosole for about 11 baht with the help of the Government Pharmaceutical Organization (GPO). The international charity group Medecins Sans Frontieres said that the South African effort was done to bring awareness to the problem of accessing AIDS drugs in the country, especially affordable ones. According to GPO spokeswoman Krisna Kraisid, many Asian countries are using Biosole because of its availability and price; she also said the drug has been tested and meets safety standards.
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.