HIV/AIDS Newsroom: December 18, 2000
Spontaneous Regression of CIN and Delayed-Type Hypersensitivity to HPV-16 Oncoprotein E7
12/09/00 Vol. 356, No. 9246, P. 1985; Hopfl, Reinhard; Heim, Kurt; Christensen, Neil; et al.
New research from suggests that routine skin tests may reduce the number of interventions needed during treatment for human papillomavirus (HPV) infection. Scientists investigated delayed-type hypersensitivity to human HPV using skin tests with HPV-16 E7 oncoprotein peptides on women currently undergoing treatment for cervical dysplasia or cancer. Of the 48 women tested, 11 were cleared of the disease without treatment while the remaining 37 required surgery. The researchers discovered that antibodies to early antigens (progressors) were found in a higher number of cancer patients than in others, particularly patients with cervical intraepithelial neoplasia. Further tests indicate that E7-specific T-helper cells play a part in the control of HPV.
There is evidence in Scotland of a strain of Neisseria gonorrhoeae resistant to the standard antibiotic, ciprofloxacin. Researchers report that between 1991 and 1999, the proportion of isolates with lowered susceptibility rose from 0.5 percent to 5 percent, while the proportion of isolates with clinical resistance was 2.2 percent in 1999 versus an average of 0.9 percent for the previous four years. The researchers, from Edinburgh University Medical School, feel their data highlights the need for vigilance at a national level in order to obtain complete data regarding the trends of the antibiotic resistance. If left unchecked, the present rate of resistance may cause isolates to become endemic and quinolones will eventually cease to be effective as a primary treatment of gonorrhea.
Plasma Viral Load in HIV-1 and HIV-1 Singly and Dually Infected Individuals in Guinea-Bissau, West Africa
Archives of Internal Medicine Online (archinte.ama-assn.org)
11/27/00 Vol. 160, No. 21,; Andersson, Soren; Norrgren, Hans; Da Silva, Zacarias; et al.
Investigators compared plasma HIV RNA load between patients infected with HIV-1 and HIV-2 in Guinea Bissau, which has a high prevalence and incidence of infection with the two viruses. The study involved 102 individuals, including 19 HIV-1 and 29 HIV-2 seroincident cases tested at a median of less than two years after seroconversion. There were also seroprevalent cases with single (nine HIV-1 cases and 31 HIV-2 cases) or dual (14 cases) infections. The authors determined that the viral set point was 28 times lower in individuals who recently seroconverted to HIV-2 than in recent HIV-1 seroconverters, even in symptomatic stages of the infections. People with dual infection had lower plasma HIV-1 RNA levels than singly infected subjects, the researchers found.
As the pharmaceutical industry and individual drugs companies become more international, groups are discovering that moving their testing programs overseas to less restrictive nations is a better option than performing trials in the United States, where regulators prevent studies of dangerous and questionable medicines and insist that patients are given high-quality care throughout the testing process -- even those patients not taking the drug being reviewed. For instance, Glaxo Wellcome's irritable bowel syndrome medicine, Lotronex, has been withdrawn in the United States for concerns about its side effects in some patients, yet the company had 7,500 patients in tests of the drug throughout the world and will not finish phasing out the studies until the end of December, given their size and scope. Similarly, Triangle Pharmaceuticals was prevented by the Food and Drug Administration from performing large-scale trials in the United States after its prospective AIDS drug mozenavir was linked to heart arrhythmia in dog tests that could lead to blackouts and death, but the company won permission in Mexico for larger trials in humans with the promise from Triangle to the Mexican government that all health and especially heart information would be closely monitored. The lure of foreign testing sites is not just one of less stringent regulations -- other benefits include a broader base of patients willing to undergo experimental treatments and lower cost; one Bristol-Myers Squibb executive noted that a trial that costs $10,000 per person in western Europe costs about $3,000 in Russia, and Eli Lilly reports that its foreign tests are booming, from 590 test patients for the company in all of Africa, the Middle East, and Central and Eastern Europe in 1994 to more than 7,000 this year and as many as 10,000 in Latin America over the coming five years.
The best way to delay the onset of AIDS in HIV-positive people is to use a mix of antiretroviral drugs, but the cocktail required can be impossibly expensive, particularly for those who live in developing nations. The Brazilian government, however, authorized state laboratories to make generic copies of seven of the 12 cocktail drugs, which cut the cost of annual production by almost two-thirds. In addition, the government distributes the drugs for free to 90,000 people. The program shows that Third-World governments can have a deep impact on fighting AIDS, and that the high cost of the drugs does not make an impassable barrier. Brazil passed a patent law in 1997 that made those seven drugs' patents public property, among other patents, and then decided that it would be less expensive to make the drugs itself. It will begin making the eighth such medicine early next year and is in negotiations with private companies for another four, but Brazilian authorities have told the companies that if they do not lower the cost of those four drugs, the government will invoke a constitutional provision and break the patent licenses. Abbott Labs head of institutional relations Irapuan Oliveira expresses concern about loss of market share and possible quality problems in the substitution of government-made drugs for the company's. Brazil officials say, however, that the first two years of the program have kept 146,000 people out of the hospital and saved Brazil $472 million. It has also helped slow the spread of AIDS. Brazil has tried to enlist the aid of international agencies to share its program, but they have refused. So the nation says it will post the information on its Web site and give away the technology free of charge.
Researchers at the University of Colorado Health Sciences Center say that a natural body protein usually associated with cystic fibrosis could be used to fight AIDS because it appears to prevent the AIDS virus from infecting cells. Alpha-1 antitrypsin (AAT) works in several ways against the virus, including blocking the ability of the virus to infect healthy cells and virtually halting the virus' ability to spread out of the cell. Dr. Leland Shapiro says that it could be possible to give extra AAT to HIV-infected patients. AAT is currently used to treat patients with cystic fibrosis and other genetic defects, and it is grown in the milk of genetically engineered animals.
The Ventura County (Calif.) Public Health Department is recommending a needle exchange program to slow hepatitis and HIV infection rates. Public Health Officer Robert Levin will ask the Board of Supervisors to declare a county emergency, and members of a county coalition of law enforcement agencies say they will not fight the program, even though they do not think it will work. District Attorney Michael Bradbury says that the Law Enforcement Coordinating Committee will shut down the exchange if it seems to be a threat to public safety. Supervisor John K. Flynn says that he thinks the issue is one of public health; public health officer Dr. Robert Levin believes that the exchange could hinder three to eight cases of HIV infection and six to 20 cases of hepatitis C per year.
Analysts say that the presidency of George W. Bush will probably leave Africa marginalized by the United States more than its current status due to an administration that will have little interest in the continent. There are two African-Americans in key roles in the upcoming administration, but neither is expected to push African issues, and Bush is also expected to rely on Vice President-elect Dick Cheney for foreign policy advice -- and Cheney has a history of opposing sanctions against apartheid South Africa. President Bill Clinton reclassified the HIV-AIDS epidemic as a security issue and made other moves to support the continent's economy, but Bush has already said that Africa does not fit into U.S. strategic interests, and some analysts say that American support could be reduced during the new administration. One expert notes that U.S. interest in Africa may move from aid to trade.
Records from the Adult and Adolescent Spectrum of HIV Disease Surveillance Project, reviewed by Dr. Patrick S. Sullivan and other investigators with the Centers for Disease Control and Prevention, showed that there is a slight decrease in the progression to AIDS-defining opportunistic disease among patients who were vaccinated against influenza. The study involved information from more than 25,000 patients between 1990 and 1999 at 113 clinics in 10 U.S. cities, with the review published in the journal AIDS. Among the 42 percent of patients immunized against influenza, the hazard was 0.93, with a time to death hazard of 0.97, but investigators could not determine whether the improvements were a result of the vaccination itself or a factor related to increased preventive care or overall interest in physical health. While other studies have demonstrated that CD4 cell counts have lowered or HIV RNA levels have increased with the use of an influenza vaccine, this most recent study, with the benefit of a larger sample size, determines that there is no increased risk in giving influenza vaccines to AIDS patients.