HIV/AIDS Newsroom: November 14, 2000
Evaluation of HIV-1 Immunogen, an Immunologic Modifier, Administered to Patients Infected With HIV Having 300 to 549X10/L CD4 Cell Counts
Journal of the American Medical Association (www.jama.com)
11/01/00; Vol. 284, No. 17, P. 2193; Kahn, James O.; Cherng, Deborah Weng; Mayer, Kenneth; et al.
A study of HIV-infected investigated whether the addition of HIV-1 Immunogen would reduce disease progression. A total of 2,527 adults without previous AIDS-related conditions were divided into two groups: approximately half of whom received HIV-1 Immunogen, while the rest received a placebo. A total of 57 percent of the subjects were receiving combination antiretroviral therapy (ART). About 70 percent of the subjects changed his or her type of ART during the trial, and 40 percent added or ended a protease inhibitor during the 48 weeks. During the study, the overall event rate was 1.8 per 100 person years of follow-up. A total of 106 subjects reached an endpoint stage of AIDS-related disease, including 35 who died prior to clinical progression. The most common disease seen was oropharyngeal candidiasis, which occurred in 13 participants. Overall, 42 subjects died: 23 in the HIV-1 Immunogen group and 19 in the control group. The authors note that there were no statistically significant differences between the two groups in terms of changes in HIV RNA, CD4 percentage, or body weight. The researchers concluded that HIV-1 Immunogen with unrestricted ART did not increase HIV progression-free survival rates relative to the use of antiviral therapy alone.
In 1952, Burma -- whose military dictatorship renamed it Myanmar -- had the best health care and literacy rate in Asia. Today, the country ranks second to last for healthcare, and it is struggling with an AIDS epidemic that experts say rivals that in Africa. In addition, the country is faced with heroin and amphetamine smuggling, drug-money laundering, forced labor, and sexual exploitation of young women. Dr. Chris Beyrer, an epidemiologist at Johns Hopkins School of Hygiene and Public Health, asserts that AIDS has become an epidemic because of a lack of response. Statistics show that the HIV rate among prostitutes in Myanmar's two largest cities was about 47 percent in 1999. Heroin addiction and needle-sharing are two key reasons behind HIV's spread, as cheap opium became available in 1988 after the democracy movement was denied. According to a mid-1990s government study, about 4 percent of men and 2 percent of women in Myanmar were addicted to heroin, while more recent data indicate that 57 percent of injection drug users have HIV. Leading doctors in Burma assert that the generals who lead the country, who are known as the junta, are in denial about the disease, with essentially no counseling offered and condoms too expensive for most people to buy. The doctors note that without anti-HIV drugs and a severe shortage of antibiotics, patients often die within a few months of being diagnosed with HIV. Reports also indicate that HIV is spreading in monasteries near Mandalay and in jails, where inmates can donate blood in exchange for food. Because all publications in Myanmar are censored, residents never hear about Myanmar's AIDS epidemic, the flight of foreign investors, or the country's many other problems. State-run newspapers and news programs offer elaborate descriptions of the generals' activities as well as lectures on the proper way to grow produce.
Immunizations Plummet in Poorest Nations Wars, Funding Cuts Blamed for Decline
Boston Globe (www.boston.com/globe)
11/13/00; P. A1; Donnelly, John
A 30-year effort to vaccinate children in the developing world is unraveling, as immunization rates fall under 50 percent in parts of sub-Saharan Africa. The decline in immunization coverage is due to war, HIV/AIDS, and loss of interest among donors. UNICEF has cut immunization funding from $182 million in 1990 to $51.5 million in 1998. Basic immunization funding from the U.S. Agency for International Development has also been slashed, according to the Government Accounting Office, dropping from about $51 million a year in the early 1990s to $47 million in 1998. Ron O'Connor, CEO of Management Sciences for Health (MSH) in Boston, said the reduction in immunization coverage could "be the greatest public health tragedy of our generation. MSH recently received a $29 million grant from the Bill and Melinda Gates Foundation to help rebuild health care services. Rebuilding failing vaccination infrastructure has become a key focus of the Gates' Children's Vaccine Program. Mark A. Kane, the program's director, explained: "We have to look at the needs of developing an AIDS vaccine, a tuberculosis and malaria vaccine, but even if we had those vaccines tomorrow, we would have great difficulty in delivering them." Kane noted that many people in some of the most poorly served regions are not aware of the program, with an estimated 30 million of the 130 million children born each year going unvaccinated. However, Africa is not the only continent being affected by falling immunization rates, with overall coverage in India's Uttar Pradesh state, for example, dropping from 90 percent in 1990 to 30 percent in 1999.
Next month, volunteers throughout Florida will participate in a statewide push to end health disparities among minorities. Melvin Herring Jr., director of equal opportunity and minority health at the Florida Department of Health, said they want to help minority residents by sending minorities to discuss the problem. To boost the effort, the state Department of Health has allocated approximately $10 million to fund more than 50 projects, focusing on infant death, immunizations, HIV/AIDS, diabetes, heart disease, and cancer. In Osceola County, the health department will receive $474,000 for diabetes and HIV prevention programs that will involve door-to-door education, discussions at churches, and visits to gay bars.
Harvard University's School of Public Health has received $25 million from the Bill and Melinda Gates Foundation to study AIDS prevention in Nigeria. The Nigeria initiative will study HIV infection and support prevention efforts, especially among children. Harvard is already running a similar program in Senegal.
The Teen Clinic at Planned Parenthood in Providence, Rhode Island, has a growing number of visitors. The clinic provides sex education, contraceptives, and tests for sexually transmitted diseases, including HIV. Each peer educator specializes in one subject to help talk to other teens knowledgeably. Most of the visitors are female. The number of teens who come per month has reached about 100, up from about 12 a month when the center first opened in 1996, according to director Miriam Inocencio.
Dr. Jared Baeten of the International AIDS Research and Training Program at the University of Washington in Seattle reports that HIV researchers should perform randomized trials to keep nonvaccine factors that affect HIV-1 incidence separate from the effects of the vaccine. Dr. Baeten studied HIV-1 incidence among 953 prostitutes in Kenya, and found a decline in HIV risk over time. The researchers' ideas for vaccine trials were published in the Journal of Acquired Immune Deficiency Syndromes (2000;24:458-464).
The Australian Agency for International Development has donated A$60 million to Papua New Guinea (PNG) to battle AIDS. National AIDS Council chairman Dr. Puka Temu signed the agreement, making it the largest HIV project funded offshore by Australia. While accurate statistics about AIDS in PNG are not available, it is believed that at least 4,000 of the 4.5 million residents are infected. The new funds will be used for counseling, home-based care, diagnosis and treatment, surveillance, and AIDS awareness efforts.
Malawi has instituted a home-care system for tuberculosis (TB) patients, as the growing demand for beds competes with a soaring rate of TB infection. Under the new plan, all non-critical TB patients will be sent home and cared for by relatives or nurses trained to help. Malawi recorded 5,000 cases of TB in 1985; however, that number soared to 24,000 last year. The new system began earlier this month in the northern regions of the country. Deputy director for TB treatment Henry Kanyerere said that no critically ill patients or patients without families will be sent home.
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.