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News & Notes

May 2001


Most Pregnant US Women Lack Knowledge about HIV

A report in the January issue of Obstetrics and Gynecology indicates that while many pregnant women in the United States are aware that HIV-infected pregnant women can transmit their infection to their infants, some are not so sure how the virus is actually passed on. Researchers, led by Dr. Emmanuel B. Walter of Duke University Medical Center, found that almost 40 percent of the 1,400 women surveyed were not certain if an HIV-positive woman could transmit the virus to her baby via breast-feeding. In addition, nearly 33 percent thought that babies born to a woman with HIV would definitely become infected, and 49 percent were not aware that there are drugs that can help reduce the risk of newborns contracting HIV. The researchers did note, however, that nearly 90 percent of the women questioned had been offered an HIV test during their pregnancy, with most agreeing to the test, and 60 percent said that routine HIV testing of all pregnant women should be required by law. (Reuters Health Information Services (www.reutershealth.com), 01/01/01)

Immune Reconstitution Better if HAART Initiated During Primary HIV Infection

A recent report in the journal AIDS (2000;14:2643-2651) suggests that individuals who take highly active antiretroviral therapy (HAART) during primary HIV infection see faster and more complete immune reconstitution than patients who start treatment later. Researchers from St. Vincent's Hospital in Sydney, Australia, conducted a prospective study of 58 treatment-naive patients who were given indinavir or nelfinavir plus two nucleoside reverse transcriptase inhibitors. After one year, the median CD4 cell count in the patients with primary HIV-1 infection rose from 470 to 758, while the median increase among the chronically infected patients was much smaller, from 204 to 310. The researchers also found that, compared to those with chronic infection, patients with primary HIV-1 infection saw much larger increases in the number of naive and memory T cells. (Reuters Health Information Services (www.reutershealth.com), 01/03/01)

Association of Initial CD4 Cell Count and Viral Load with Response to Highly Active Antiretroviral Therapy

In a research letter to the Journal of American Medical Association, researchers from Johns Hopkins University School of Medicine report a retrospective comparison of the outcomes of starting highly active antiretroviral therapy (HAART) at different CD4 cell counts and viral loads. The authors focused on reduction of HIV RNA to less than 400 copies in at least one instance within six months of beginning therapy (initial response) and response with no following increase in HIV RNA to over 1,000 copies (durable response). Nearly two-thirds of the patients achieved HIV RNA loads of less than 400 copies, while only 42 percent of the initial responders and 27 percent overall had durable responses. Based on their findings, the researchers recommend that the initial timing of HAART take into account both viral load and CD4 cell count, as the data seems to suggest that the therapy may have a better chance of success in suppressing viremia if given before the disease advances to moderate or severe infection. (Journal of the American Medical Association (www.jama.com) (12/27/00) Vol. 284, No. 24, P. 3128; Chaisson, Richard; Keruly, Jeanne; Moore, Richard; et al.)

Medication Adherence Poor for Many HIV-Infected Children

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Researchers concluded that given the broad range of individual family needs, each situation should be individually addressed regarding the care of HIV-infected children. A study published in the December issue of Pediatric Infectious Disease Journal (2000;19:1148-1153) detailed the percentages of medication adherence and viral loads associated with nonadherence, as well as other issues confronted by the caregivers. Researchers from the Centers for Disease Control and Prevention found that nearly 50 percent of parents or other caregivers of HIV-infected children reported that their child had missed at least one dose of medication in the past week. Many of the caregivers cited telephone access to medical assistance, a medicine that tasted better, lengthier dosing intervals, and no need for refrigeration as keys to better compliance to the HIV treatment program. (Reuters Health Information Services (www.reutershealth.com), 01/04/01)


Serious Adverse Events Attributed to Nevirapine Regimens for Postexposure Prophylaxis after HIV Exposures -- Worldwide, 1997-2000

In September 2000 the Centers for Disease Control and Prevention received two reports of life-threatening hepatotoxicity (liver damage) among health care workers taking nevirapine for post-exposure prophylaxis (PEP) after occupational exposure to HIV. Nevirapine has not been recommended for PEP use and has previously been associated with instances of serious skin conditions, liver damage, and death when used for treating HIV-infected individuals. The recent reports prompted a review of the Food and Drug Administration's registry of serious adverse events, which identified 20 other reports of serious side effects among people who had taken nevirapine for PEP. These 22 cases, in healthy, uninfected individuals who took the drug for a relatively short period of time (two weeks, on average, before onset of symptoms) are cause for serious concern. Anyone considering PEP should consult with their physician to carefully weigh the risks of HIV infection related to their exposure, the potential benefits of post-exposure therapy, and the possible side effects of any PEP regimen. Recommended regimens are outlined in "Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis" (MMWR, Vol. 47, RR-7, May 15,1998; available online at www.cdc.gov/hiv/treatment.htm). In most circumstances, the risks associated with nevirapine as part of an occupational PEP regimen might outweigh the anticipated benefits. (Morbidity and Mortality Weekly Report (www.cdc.gov/mmwr), 01/05/01, Vol. 49, No. 51, P. 1153)

Bristol-Myers Warns of AIDS Drugs' Use

While the Food and Drug Administration (FDA) conducts a review of the two products, Bristol-Myers Squibb has issued a warning to AIDS doctors around the world cautioning that two of its AIDS drugs, Zerit and Videx, should be used sparingly in pregnant women after the deaths of three expectant mothers who were taking the medications. An FDA official suggested it is possible that although toxicity problems affect other drugs in the nucleoside analogue class -- which includes the GlaxoSmithKline drugs AZT and 3TC -- the reaction to a particular enzyme is stronger for the two Bristol-Myers products than for other drugs in the class. The deaths could have more far-reaching consequences than just the potential withdrawal of the drugs and the passing of the women: two of the deaths occurred in clinical trials abroad, with one of those deaths taking place in South Africa, where the issue of AIDS drugs is particularly volatile. The women died of lactic acidosis, a rare but recognized complication associated with the nucleoside analogue class, and seven other cases of nonfatal lactic acidosis have been reported among pregnant women taking either a combination of Zerit and Videx or of Zerit with 3TC. (Wall Street Journal (www.wsj.com) (01/08/01) P. B4; Harris, Gardiner)

Confidential Hot Line Helps Troubled Youths

Teenage peers helping each other is what the Teen-FYI hotline is about in Yonkers, New York. The confidential, anonymous program, which can be reached by calling (866) TEEN-FYI, was created by Family Information and Referral Service Teams Inc. of Westchester, and modeled after the New York City Youth Hotline. Teen-FYI is staffed by trained teenagers and supervised by adults. The teens cannot offer counseling or advice; however, they provide information to the caller about when and where to go for help regarding their problem, such as where to go for sexually transmitted disease testing. The $70,000 seed money for the project came from the county and various business and private foundations. The initiative behind the teen operated center is to attract troubled peers who may otherwise not seek assistance. (New York Times (www.nytimes.com) (01/07/01) P. 14-6; Rosenberg, Merri)

Adverse Effects from HIV Postexposure Prophylaxis Are Common

A study published in the December issue of Infection Control and Hospital Epidemiology (2000;21:780-785) reveals that side effects from postexposure prophylaxis (PEP) for HIV are common, although treatment toxicity is rarely serious. Dr. Susan A. Wang of the Centers of Disease Control and Prevention and associates prospectively collected data on the safety of PEP treatments using nearly 500 case workers who were exposed to HIV on the job. Of the 449 patients for whom six-week data were available, more than half of the 197 people who discontinued PEP reported doing so because of adverse effects; nearly 40 percent discontinued treatment because they learned the source patient was not infected with HIV. Approximately three-quarters of the patients reported some symptoms while taking PEP, most commonly nausea, fatigue or malaise, headache, and vomiting. (Reuters Health Information Services (www.reutershealth.com), 01/08/01)

Triple HIV Therapy Increases Antiviral Activity in Children Previously Treated with NRTIs

New research suggests that children who had previously been treated with nucleoside reverse transcriptase inhibitors (NRTIs) and then received a combination of abacavir, lamivudine, and zidovudine saw increased antiretroviral activity. Researchers from Hospital del Nino in Panama City studied 205 children between the ages of three months and 13 years. The patients were randomized to receive either abacavir or a placebo; all participants received lamivudine and zidovudine twice a day. According to their report in the journal Pediatrics (2001;107(1)), 29 percent of the children taking abacavir attained HIV-1 RNA levels of less than 10,000 copies/mL, compared to just 12 percent of those receiving the placebo. In addition, patients in the abacavir group saw their CD4 cell counts increase by a median 99/mL, while the median CD4 level of those in the placebo group dropped 14/mL. (Reuters Health Information Services (www.reutershealth.com), 01/10/01)

Molecule Able to Block HIV's Entrance Into a Cell Found by an MIT Scientist

Dr. Peter Kim, the Massachusetts Institute of Technology (MIT) biologist tapped to become the next head of Merck's drug research unit, has discovered a molecule that can prevent HIV from entering a cell by stopping the process known as membrane fusion by which the HIV cell pulls itself to a host cell. Current AIDS treatments attack the virus once it enters a host cell to prevent it from replicating, but this molecule and several others in a class known as "fusion inhibitors" show promise as alternatives for patients who have either become resistant to current drugs or cannot tolerate the myriad side effects associated with HIV drugs. Hoffmann-La Roche is currently working with Trimeris to develop T-20, a fusion inhibitor that is a top priority for the FDA and could be approved by the middle of next year, but Kim's discovery could be even more effective than T-20. (Wall Street Journal (www.wsj.com) (01/12/01) P. B6; Regalado, Antonio)

Woman Negative, HIV-Positive Man Released

An HIV-positive man recently spent 39 days in a Boca Raton jail until the woman he had sex with months ago was pronounced HIV-negative. If the woman had been found HIV-positive, Jose Pagan could have been facing attempted murder charges, based on a 1996 Florida legislature act that contends that uninformed HIV-infected sexual intercourse is a third degree felony. (Palm Beach Post (finaledition.pbpost.com) (01/13/01) P. 8B; Pacenti, John)

Physician-Patient Communication in HIV Disease:
The Importance of Patient, Physician, and Visit Characteristics

Researchers from the New England Medical Center and Tufts University School of Medicine recently evaluated patient-to-doctor communication regarding HIV. The study involved 264 male and female patients and their physicians in eastern Massachusetts, measuring communication based on a five-item general communications scale and a four-item HIV-specific communication scale that discussed alcohol, drug use, and sexual behaviors. According to the authors, HIV-specific communication was at a higher level between the female patient and homosexual physician, than between the male patient and heterosexual physician. The researchers concluded that better quality HIV-specific communication was provided by female and homosexual physicians than by male and heterosexual physicians. They note that understanding how female and homosexual doctors communicate better may help other doctors be more effective. (Journal of Acquired Immune Deficiency Syndromes (www.jaids.com) (12/15/00) Vol. 25, No. 5, P. 417; Wilson, Ira B; Kaplan, Sherrie)

Lower Pneumonia Risk in Some with AIDS

New research suggests that as long as an HIV-infected individual's level of infection-fighting CD4 lymphocyte cells does not drop below 200 per cubic millimeter of blood, Pneumocystis carinii pneumonia (PCP) will not develop. Although PCP has been a significant problem for patients with HIV, the threat of the deadly pneumonia has been substantially reduced among patients taking new AIDS drug cocktails. The results of two studies published in the New England Journal of Medicine (2001;344:159-167,168-174) indicate that patients with CD4 lymphocyte counts that do not fall under 200 will likely not develop PCP, even if they still have detectable HIV in their blood or if they have already had the pneumonia. (New York Times (www.nytimes.com) (01/17/01) P. A21)


Donor for AIDS Research Center in Queens Asks College to Return Money

New York's Queens College, which received $4.5 million from medical entrepreneur, Dr. Bernard Salick, to help it establish an AIDS research center, was recently asked to return the donation for having failed to follow through with the final agreement. Salick's 1997 initiative gave the college the start-up money to begin the funding process for the construction of a $30 million molecular and cellular biological HIV research center to be operated and directed by Dr. Luc Montagnier, the co-discoverer of HIV. The now former-college president, Allen L. Sessoms, had been responsible for raising the remaining funds needed for the project, which was to be supported by private and public monies, but failed to come through. Salick, who along with Sessoms, had enticed Dr. Montagnier to leave the Pasteur Institute in Paris, to direct the Queens center, has given college officials 10 days to return the funds with interest. (New York Times (www.nytimes.com) (01/19/01) P. C12; Arenson, Karen W.)

Structured Treatment Interruptions Could Increase Risk of HIV-1 Resistance

In a study published in the December issue of the Journal of Acquired Immune Deficiency Syndromes (2000;25:398-402), researchers report that structured treatment interruptions to the drug therapy of HIV patients could significantly increase the risk of drug-resistant HIV-1. The structured interruptions have been suggested as a way of building up an HIV-infected individual's natural immune system and increasing the effectiveness of antiretroviral treatments. However, the researchers suggest that in lieu of these structured interruptions, alternative immune stimulants, such as interleukin-2 or a therapeutic vaccine, be used during continued antiretroviral treatment. (Reuters Health Information Services (www.reutershealth.com), 01/18/01)

Hydroxyurea May Trigger Pancreatitis When Combined with Didanosine

New research published in the British Medical Journal (2001;322:81) suggests that an HIV-infected patient developed pancreatitis after receiving hydroxyurea in an antiretroviral regimen that also included didanosine. Researchers from St. Bartholomew's Hospital in London present the case of a 26-year-old man who was treated with stavudine, didanosine, and nevirapine for 1.5 years, at which point his viral load increased and he was given hydroxyurea two times a day. However, the drug was stopped after 42 days, when the patient reported pain in his upper abdomen, and all drugs were stopped three weeks later, after the patient's condition worsened. The researchers suggest that adding hydroxyurea to the original drug regimen could have precipitated didanosine-induced pancreatitis. (Reuters Health Information Services (www.reutershealth.com), 01/18/01)

Women at Risk of HIV Miss Out on Mental Healthcare

A new report suggests that although some women who are infected with HIV, or at risk for infection, may feel isolated and depressed, many do not receive the necessary mental health care. Researchers surveyed 871 HIV-infected women and 439 HIV-negative women who had similar socioeconomic and behavioral backgrounds. The results of the survey indicate that more than one-third of the respondents, including 38 percent of the women with HIV and 35 percent of the women who were not infected with the virus, felt they could have used some mental health care at some point during the previous six months. According to the report, published with an accompanying commentary in the Journal of the American Medical Women's Association (2001;56:4-8,9-10), only about 66 percent of these women actually obtained such services. (Reuters Health Information Services (www.reutershealth.com), 01/19/01)

Articles abstracted by the National Prevention Information Network (NPIN) of the U.S. Centers for Disease Control and Prevention (CDC).


Back to the May 2001 Issue of Body Positive Magazine.


  
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