HIV/AIDS Newsroom: December 29, 2000
Hepatitis B Vaccination and Hepatocellular Carcinoma Rates in Boys and Girls
Journal of the American Medical Association (www.jama.com)
12/20/00 Vol. 284, No. 23, P. 3040; Chang, Mei-Hwei; Shau, Wen-Yi; Chen, Chien-Jen; et al.
Researchers from the Taiwan Childhood Hepatoma Study Group recently released the results of a vaccination program, started in 1984, in which the hepatitis B virus (HBV) vaccine was given to the unborn infants of mothers infected with the hepatitis B e antigen. The tests were based on the premise that hepatocellular carcinoma (HCC), a disease that normally strikes adults between the ages of 40 and 60, can in fact, strike children who reside in areas where HBV is common. The collected data showed that the boy-girl incidence ratio declined from 4.5 between 1981 and 1984 to 1.9 in 1990 to 1996. The incidence of HCC in boys born after the program began was much lower than that for boys born before 1978. There was, however, no significant decline in HCC incidence in girls born during the same periods. The authors concluded, therefore, that boys may derive more HCC-prevention benefits from HBV vaccination than girls. The researchers also theorized that "the remarkable predominance of HCC in boys suggests that factor(s) in addition to chronic HBV infection may contribute to hepatocarcinogenesis in males, particularly the early occurrence in prepubertal males."
Early last year, Bristol-Myers Squibb Chairman Charles A. Heimbold Jr. announced a five-year, $100 million AIDS initiative in Africa. Since that time, the "Secure the Future" project -- described by Heimbold as the "largest such corporate effort in history" -- has pledged about $44 million to 33 programs in southern Africa. However, the drug giant has received criticism from AIDS activists, officials in South Africa, and others regarding both the scope and direction of the program. Some claim that the program is actually helping very few people, while others say the donation's greatest benefit is in public relations, particularly as it may offset some of the pressure to increase access to costly AIDS drugs. A Washington Post review of the program supports some of the criticism, but the story is quite complex. The Secure the Future program has scaled back some of its original estimates, including revising a plan to spend $53 million of the total $100 million grant on "free drug treatment" to "no more than" $33 million The program emphasizes medical research and is focusing on education American and African health workers, with more than three-quarters of the money committed so far going to U.S.-based charitable and medical research groups. The company has also used some of the funds for consultants, retaining former Rep. Ronald V. Dellums, the chairman of President Clinton's advisory council on HIV/AIDS, and giving over $1 million over the past five years to the International Association of Physicians in AIDS Care. While some critics claim the funds are being used to silence criticism, Bristol-Myers officials say the program will help to save lives and reflects the company's commitment to fighting a complex and deadly epidemic.
Immigrant Who Carried Dangerous TB to Canada Sues Federal Government
Ottawa Citizen (www.ottawacitizen.com)
12/29/00 P. A5
A class-action lawsuit has been filed against the Canadian government by Dominican Republic immigrant Gaspare Benjamin for mistakenly allowing him to enter Canada with a deadly strain of drug-resistant tuberculosis (TB). Also joining the C$500 million suit are Benjamin's wife, Hilary Lomas, and two other individuals who contracted the disease during the year before Benjamin's illness was detected. In all, more than 1,500 Ontario residents may have been exposed to TB as a result of Benjamin's infection and 92 people were possibly infected. A notice of action filed last week alleges that immigration officials and a Hamilton-area doctor were negligent for "failing to properly assess and test" Benjamin. In 1999, Benjamin was examined by a Canadian doctor in the Dominican Republic and permitted to immigrate to Ontario. An internal investigation earlier this month revealed that the doctor misread a chest X-ray which showed that Benjamin was infected with contagious TB.
Canadian officials announced that, starting next fall, immigrants to the country will undergo more stringent medical exams, including tests for hepatitis B and HIV. Immigrants who test positive will not be allowed entry. Officials are also introducing tougher medical exam policies for individuals visiting Canada for more than six months. The new rules follow an incident in which an immigrant from the Caribbean exposed about 900 people in the Hamilton area to a deadly strain of tuberculosis.
Drug addicts in Vancouver may soon have a walk-in "safe injection site," a controversial method used in several European cities to reduce heroin and cocaine overdoses. Vancouver has the highest number of drug overdose deaths in all of Canada, with an average of 147 annually since 1993. Dean Wilson, the chairman of the Harm Reduction Action Society, feels the high rates of drug overdose fatalities and increased rates of needle-borne HIV and hepatitis warrant the program. Wilson notes that the injection sites "can keep addicts alive long enough to let them make the right decisions" about halting their drug use. While Vancouver's mayor, Phillip Owen, says he is not opposed in principle to safe injection sites, he notes there first needs to be informed public support and the sites must be part of a comprehensive plan based on prevention, treatment, enforcement, and harm reduction. Owen, who says safe injection sites should be developed as part of a national drug policy, suggested that as many as 15 Canadian cities should open drug injection sites simultaneously, so addicts do not just start migrating to Vancouver.
A 23-year-old Ohio woman is suing her husband, claiming he knowingly gave her a sexually transmitted disease. The woman -- who is currently divorcing her husband -- alleges that her husband contracted human papilloma virus (HPV) from another woman and then "intentionally, willfully, and/or with wanton disregard for (her) safety, transmitted (the) sexually transmitted disease to" his wife. The woman's attorney says the reasons for the suit are based primarily on protecting his client's future health care costs for a disease that is only treatable, not curable. He also notes that effects of the disease-including large lesions on the genital region -- have affected his client's "ability to attract a mate." Just days before this suit was filed, another Ohio woman filed suit against her former fiance for reasons that include allegedly giving her genital herpes.
In Rhode Island, the state Health Department will train 15 people to teach members of the Hispanic community about HIV and AIDS. The Progreso Latino "health angels" will visit schools, homes, community centers and the streets to discuss how HIV is spread and how it can be prevented. The program's activity had fallen slightly since the last coordinator left, but with the support of the State Health Department officials and other health educators, training for more health angels -- who receive a stipend for their work -- is ongoing. The program is financed by a three-year grant from the Health Department and includes enough to hire a new coordinator.
Researchers at the Universidad Nacional Autonoma de Mexico discovered that highly active antiretroviral therapy (HAART) that includes a protease inhibitor can reduce the occurrence of HIV-associated oral lesions by 30 percent. The researchers studied the prevalence of oral lesions in 154 AIDS patients in Malaga, Spain, between 1997 and 1998. Just over half of the subjects had HIV-related oral lesions, most commonly oral candidiasis and hairy leucoplakia. The researchers suggest in the December issue of AIDS Patient Care and STDs (2000;14:627-635) that the drug regimen of reverse transcriptase inhibitors and protease inhibitors may have boosted the patients' immunologic conditions.
A new report in the December issue of the Journal of Acquired Immune Deficiency Syndromes (2000;25:353-359) indicates that the majority of HIV-positive women in northern Thailand likely contracted the virus from their spouses. The researchers, led by Dr. Fujie Xu of the U.S. Centers for Disease Control and Prevention, investigated HIV infection patterns in more than 800 northern Thai women between 1998 and 1999. According to the researchers, slightly more than 3 percent of the study group was infected with HIV, and heterosexual sex was the only risk factor these women reported. Approximately three-quarters of the women with HIV said their only sexual contact was with their husband, and nearly 50 percent of the women considered themselves to be at low -- or no -- risk for infection.
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.