HIV/AIDS Newsroom: December 1, 2000
Clinical Progression, Survival, and Immune Recovery During Antiretroviral Therapy in Patients With HIV-1 and Hepatitis C Virus Coinfection: The Swiss HIV Cohort Study
(11/25/00) Vol. 356, No. 9244, P. 1800; Greub, G.; Ledergerber, B.; Battegay, M.; et al.
Investigators for the Swiss HIV Cohort Study assessed the clinical progression of HIV-1, as well as the virological and immunological response to highly active antiretroviral therapy (HAART) in HIV-1-infected individuals with or without concurrent hepatitis C virus (HCV) infection. Of more than 3,100 patients starting HAART, 1,157 were co-infected with HCV, the majority of whom had a history of injection drug use. The researchers report that in multivariate Cox's regression, the likelihood of progression to a new AIDS-defining clinical event or to death was independently linked to seropositivity for HCV or active injection drug use. HCV seropositivity, meanwhile, was associated with a smaller CD4-cell count recovery. The authors conclude that "active intravenous drug use and HCV infection seem to be the main contributors to the increase in morbidity and mortality seen in HCV-HIV-1 co-infected."
To commemorate World AIDS Day, the World Bank has put a 32-foot high red ribbon on its headquarters building in Washington, D.C. Debrework Zewdie, lead coordinator for AIDS at the bank, notes that the organization has committed $1 billion to the war against AIDS, including $500 million approved by the board in September for fighting HIV and AIDS in sub-Saharan Africa. Also, the bank -- along with UNAIDS and MTV -- is funding an AIDS awareness video clip in 11 languages that will be broadcast to hundreds of millions of households in 140 nations. The video, narrated by singer Ricky Martin, describes the stories of people with AIDS from around the world. To further mark World AIDS Day, the World Bank's Web site will be blacked out today, showing only statistics about the disease. Caroline Antsey, chief spokeswoman and head of media relations at the bank, explains that "if people wonder why the World Bank is doing this, it is because advocacy is key in the fight against AIDS, particularly because so many people are in denial about it."
Glaxo Enters Fight in Ghana on AIDS Drug
Wall Street Journal (www.wsj.com)
P. A3; Schoofs, Mark
Glaxo Wellcome has caused Cipla, an Indian generic drug maker, to stop selling a knock-off version of its AIDS drug Combivir in Ghana by sending a letter to the government and to Cipla stating that the medicine is illegal as it violates Glaxo's patents. The action comes during international efforts to get more affordable HIV-fighting drugs to poor nations, including promises from drugmakers Bristol-Myers Squibb, Merck, Boehringer Ingelheim, and Roche Holding to reduce the prices of their medicines to more affordable levels in Africa, where 25 million people are infected with HIV. Those companies may be fearful that African nations will become tired of the process and choose to buy illegal generic versions from India, Thailand, and Brazil, where drug firms are not yet under World Trade Organization law concerning patent protection and produce the drugs they choose. However, Glaxo is concerned that without intellectual property protection, the generic rip-off trend will grow to other, larger countries where AIDS is also a problem, eliminating any return on the investment of hundreds of millions of dollars to develop each new drug.
Pfizer has inked an agreement with South Africa to provide its antifungal drug Diflucan (fluconazole) free of charge for two years to patients in the country's public health system. The partnership, which will help AIDS patients with cryptococcal meningitis or esophageal candidiasis, follows intense pressure from activists for the world's top drug firm to provide the drug to the world's poorest people. Pfizer, which reportedly is in talks with other African nations about Diflucan, said the South African agreement is worth about $50 million. Until this point, the South African government has rejected offers of reduced-price or even free AIDS drugs, saying it did not have the infrastructure to administer the treatment.
An unnamed source in the pharmaceutical industry says that a number of large drug companies are negotiating with the Kenyan government to provide low-priced AIDS drugs to the country. However, activists are concerned that the prices will remain too high for the general public, as recent 85-percent cuts from Boehringer Ingelheim, Bristol-Myers Squibb, Hoffmann-La Roche, Glaxo Wellcome, and Merck kept the medicines more expensive than generic versions produced in India. Under the auspices of UNAIDS, a United Nations program, the talks were proposed after the companies apparently made a deal with Senegal and were approached by Kenya, Uganda, Ethiopia, and Botswana, according to the industry source. A full year of AIDS treatment in Kenya costs roughly $5,500, but the average annual income is $300.
Massachusetts health officials said Thursday that the spread of HIV in the state is primarily the result of injection drug use. Jean Flatley McGuire, head of the state Department of Public Health's HIV-AIDS program, noted that women now make up 40 percent of new cases in the state, versus 30 percent nationwide. McGuire explained that most infections in women are the result of sex with male drug users or from sharing contaminated needles while using drugs themselves. In five Massachusetts towns, women account for more than half of the new cases, and nearly two-thirds in New Bedford. At an AIDS conference at the John F. Kennedy Library on Wednesday, physicians and public health experts noted that Massachusetts is the only state in the region that still allows municipalities to veto needle exchanges, and it is one of only a few states nationwide that have not yet decriminalized syringe possession by addicts. An upcoming bill sponsored by State Sen. James P. Jajuga would give towns advisory input, instead of veto power, on needle exchanges. Don C. DesJarlais, a researcher at Beth Israel Medical Center in New York, said that while many people are concerned that providing needles might promote drug use, studies show that needle exchanges can significantly reduce HIV infections without encouraging new users.
The first legal needle exchange program in Connecticut is marking its 10th anniversary. The program, which began as an experiment, aims to help stem the spread of HIV among injection drug users in New Haven. According to a study, the exchange also helps addicts access medical care, food, housing, and drug treatment programs.
Statistics show that 5.4 percent of the sexually active population in Nigeria was infected with HIV as of 1999. In parts of the country, however, up to 21 percent are HIV-positive, and up to 4.9 million people may be infected by 2003, according to some estimates. The Society for Family Health -- founded 15 years ago by Professor Olikoye Ransome-Kuti, whose brother, singer Fela Kuti, died of AIDS -- is helping to stem the spread of HIV in the country, distributing condoms and using witty AIDS information campaigns. The group distributes about 75 million Gold Circle condoms annually, and it tailors its education efforts to Nigeria's various religious and ethnic groups. SFH's David Valentine notes, "We target high-risk groups, chief of which are sex workers, truck drivers, soldiers, and itinerant traders and anyone hanging around junction towns."
In a nationally representative public opinion survey, nearly one in five people (18.7 percent) agreed with the statement "People who got AIDS through sex or drug use have gotten what they deserve." While this Internet survey of more than 5,600 people included only one question on stigma, the finding suggests that stigma related to HIV infection remains a major concern. The stigmatizing response was found more often among men, whites, people aged 44 years and older, individuals without a high school diploma, and individuals who earn less than $40,000 a year. Additionally, respondents who were less knowledgeable about HIV transmission were nearly twice as likely to agree with the stigmatizing statement than those who were correctly informed about HIV transmission. Specifically, 25 percent of those who answered incorrectly that "it is likely for HIV to be transmitted from sharing a glass with someone who is HIV-infected" or "by being coughed or sneezed upon by an HIV-infected individual" agreed with the stigmatizing statement, versus 14 percent of the group who answered the HIV transmission questions correctly. Researchers conclude that increasing knowledge about HIV transmission may decrease stigma surrounding HIV infection and help remove this barrier to HIV testing and other prevention and care services.
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.