The Newsline section recalls the pioneering HIV/AIDS publication of the same name produced by the People With AIDS Coalition of New York (PWAC-NY).
Placing thousands of people on antibiotics for anthrax is probably spawning a bigger threat to public health than an anthrax superbug -- more lethal everyday germs, according to doctors and researchers. Cipro and other antibiotics are the same drugs taken for many other germ infections, sometimes as a last resort. "For people who are on Cipro for... 60 days, there's a good chance their normal bacteria will become resistant," said Philip Hanna, an anthrax researcher at the University of Michigan. Such bacteria can cause STDs, pneumonia, blood poisoning and other ailments. The bacteria are especially dangerous to people with weakened immune systems, such as AIDS or cancer patients on immune-suppressing drugs. Penicillin, for instance, the 20th century marvel, eventually lost its force with staph infections from heavy use after World War II. Later, it became weak against gonorrhea after many US soldiers sought treatment after returning from Vietnam. In the early 1990s, dozens of Americans died in TB outbreaks because the germs were resistant to multiple antibiotics. "If you have a lot of people taking a short course of Cipro, we have the classic situation of developing antibiotic resistance," said Dr. Richard Corlin, president of the American Medical Association. Despite worries about drug resistance, medical authorities agree that people with likely exposure to anthrax spores should be treated with antibiotics for both humanitarian reasons and to help maintain public calm. However, experts do recommend limits on Cipro stockpiling and taking the drug without medical advice. They recommend discontinuing the use of antibiotics on farms to protect healthy animals and the over-the-counter provision of the drugs in foreign countries, including Mexico. (Newsday (New York), 11.01.01; Jeff Donn, Associated Press)
Some people with HIV infection may not tell their sexual partners or family members until the disease has progressed. The last in line to know of a person's HIV status seem to be casual sex partners, according to a study presented at the American Public Health Association meeting in Atlanta. Megan E. O'Brien of Tulane's School of Public Health and Tropical Medicine reported the findings. She and her colleagues interviewed HIV clinic attendees between June and September 2000. The majority of participants were African-American. Eighty percent had acquired HIV through sex, largely through heterosexual contact. In all, 269 men and women were interviewed. After an average of nearly three years since diagnosis, 75 percent of interviewees had informed their main sex partner about their HIV status. However, only 25 percent of those with casual sex partners had informed them. People who did not disclose their HIV status to casual partners were less likely to use condoms than those who did reveal their status to at least one casual partner. About 70 percent of interviewees had revealed their status to family members. The low rate of disclosure to casual partners might reflect the success of treatment with antiretroviral drugs. According to O'Brien, many HIV-positive individuals are living longer, healthier lives and some may believe that because they look and feel healthy, they are less likely to transmit the virus. "Individuals with and without HIV need to be educated about the limitations of antiretroviral therapy and the realities of HIV disease," O'Brien said. "A treatment is not a cure," she noted. Individuals who are not infected need to realize that they cannot assume a partner will volunteer their HIV status; therefore, they must protect themselves by consistently using condoms. "HIV is still a disease which carries a social stigma," O'Brien said. "In such a setting, individuals with HIV have little incentive to disclose their HIV status. We need to address the cultural basis for stigma." In addition, however, professionals need to better counsel patients on how to tell different people about their status and how to deal with any "unpleasant reactions." (Reuters Health, 10.31.01)
Rich countries have been so indifferent to the developing world's AIDS crisis that it is easy to overlook an instance in which they have done the right thing. In a speech, Robert Zoellick, the administration's trade representative, announced two concessions to developing countries that cannot afford patented AIDS drugs. Provided they are implemented in good faith, these ought to be enough to silence the controversy on drug pricing that has consumed the AIDS debate. ... "Mr. Zoellick's first concession was that the world's poorest countries should have until 2016 to implement patent laws; previously, the World Trade Organization's rules had made 2006 the deadline. This means that for the next 14 years poor countries can buy cheap generic drugs without infringing patent law, since such laws will not exist. Second, Mr. Zoellick proposed a moratorium of at least five years on WTO challenges to African countries' efforts to fight AIDS and other killer diseases. This means that South Africa, a country that already has patent law, will be able to use the flexibility in its own statutes to access cheap drugs without being hauled before the WTO's dispute settlement panel. "These two concessions do not help countries outside Africa that are too rich to qualify for the 10-year extension but still face a terrible AIDS toll. ...But the US position does offer something to these countries: The draft declaration for the Doha summit reaffirms countries' right to circumvent patent rules in case of health emergencies such as AIDS. ... "The AIDS activists who have fought the US government over its support for international patents should now rethink their stance. They have moved policy away from a morally untenable insistence that poor countries espouse rich countries' patent system, and that is a triumph. ...The danger now is that continued outrage against even a moderated international patent system will drive drug companies to withdraw from research into AIDS and other politically charged diseases. That would be a tragedy." (Washington Post, 11.02.01)
Dr. Norman Neurieter, who advises Secretary of State Colin Powell on science and technology issues, said that the war on terrorism must not deflect attention from the need to combat infectious diseases, some of which could "engulf entire continents" if left unchecked. "The United States and the international community must not and will not let terrorism or microbes destroy the immense promise that this century holds for humankind," Neurieter told a State Department conference on global infectious disease and US foreign policy. His address was to have been delivered by Powell, who was unable to appear due to a scheduling conflict. There should be no delays, "regardless of whether the infection is deliberately spread by domestic or foreign terrorists or whether it is naturally occurring, as with HIV/AIDS, tuberculosis or malaria," Neurieter said. "Already these killers have taken the lives of tens of millions. They can devastate communities. They can cripple economies. They can decimate countries," he said. "HIV/AIDS kills over 8,000 people" every day Neurieter said. "Twenty-two million have died from it since 1980, and 38 million are infected and will die within seven years." Dr. John Lamontagne of the National Institutes of Health said 48 percent of all deaths of people under age 45 and two-thirds of all deaths of children under age 5 are the result of infectious disease. He said 1.5 million to 2.7 million deaths around the world each year are attributable to malaria, which kills one child every 20 to 30 seconds. (Associated Press, 11.02.01, George Gedda)
On a visit to New York, White House Office of National AIDS Policy Director Scott Evertz sought to reassure advocates that HIV/AIDS won't vanish from the Bush administration's radar screen in the wake of the Sept. 11 attacks against the United States. "Nothing has changed around HIV/AIDS. In fact, as you know in New York City, you've discovered there's a population of folks who donated blood whose blood tested positive for HIV, so if anything we've got more people who are in need of treatment and services than before Sept. 11," Evertz told reporters last Tuesday before touring the offices of Gay Men's Health Crisis. Also during his three-day visit, Evertz met with representatives of the American Foundation for AIDS Research, the Brooklyn AIDS Task Force, the Latino Commission on AIDS, the National Black Leadership Commission on AIDS and the Asian & Pacific Islander Coalition on HIV/AIDS. He said that "even in the midst of post-Sept. 11, the administration is responding really positively to the continuing need for HIV/AIDS care, treatment and prevention." Evertz praised AIDS organizations' prevention efforts as "being fairly effective. But clearly we could be doing a better job in certain communities. So as we move forward, we're not going to throw out the baby with the bath water; those prevention efforts that are working will remain in place, because we've said from the very beginning that we were going to let the science drive the policy." Activists have long called for federal support for needle exchange programs. "What I sense is that we may take kind of a Republican approach to that," said Evertz, who is Republican and gay, adding that "at the very least, the administration isn't going to intervene, and may in fact keep our mouths shut on that issue." Evertz noted that AIDS groups, particularly smaller organizations working in hard-to-reach communities, "all need more resources." (New York Blade, 11.02.01, Inga Sorensen)
Ten years ago -- Nov. 7, 1991 -- many thought that one of basketball's most dazzling players had been handed a death sentence. Magic Johnson stood at a packed news conference at the Forum, the scene of his many triumphs with the Los Angeles Lakers, and announced he was retiring at 32 because he had AIDS. Now, he takes AIDS drug cocktails that allow him to focus on business, and not just the business of staying alive. "I feel wonderful," Magic Johnson said last week. "Everything is great, wonderful. I celebrate life and I live every day. Every day is a holiday for me. Nov. 7 won't be any different.... The medicine has done its thing. I think I've done my part," Johnson said. "And God has done his part. It's mind over matter, too. I've never felt I would be sick or get sick. I thought I would be here." At the time of Johnson's announcement, many people did not understand the difference between being HIV-positive and actually having AIDS. Johnson -- who believes he got AIDS by having unprotected sex with women -- exercises daily and still plays basketball. And he is in excellent health, according to Dr. Michael Mellman, Johnson's personal physician for the past 20 years. "There's nothing experimental, nothing high-tech," Mellman said of Johnson's medication. "Anyone who can afford health care can afford what he's doing. He's as healthy as he looks," Mellman said. Since his disclosure and two attempted comebacks following his retirement, Johnson has immersed himself in the business world and his family -- his wife, Cookie, and three children. None has tested positive for the virus. But Hattie Babbitt, executive director of AIDS Action, worried that Johnson's condition may give the mistaken impression that the drugs are a cure. "They do have side effects, and they tend to lose their effectiveness. His healthy appearance may lead young people to incorrectly believe it doesn't matter if they get infected," she said. (Associated Press, 11.07.01, John Nadel)
Secretary of State Colin Powell attended the 12th annual Africare dinner at the Washington Hilton and delivered a message that the crowd of nearly 2,000 was eager to hear. "Africa matters deeply to America," he said. Powell vowed that America will not let the war on terrorism distract it from battling the AIDS epidemic in Africa. According to Powell, about 6,000 people die every day as a result of AIDS. "AIDS could kill a continent," he said. "It is a catastrophe. It is a disaster. It is a pandemic of the worst kind." Africare has experienced difficulty raising funds in the aftermath of the Sept. 11 attacks. "Individual donations are down," said Africare President C. Payne Lucas. "It's very difficult to make the case [for Africa] in this environment when people really just want to reach out to help the people who suffered at the Pentagon and New York." Africare funds AIDS clinics, water purification projects and other programs across the continent. Over its 12-year history, Washington-based Africare has spent more than $350 million funding projects in 35 African countries. "Every single day," Powell said, "Africare is helping to put tools in people's hands and hope in their hearts." Powell won a standing ovation from the crowd and praise from Lucas. "This guy Colin Powell cares! He cares!" Lucas said. The affair, which raised about $1.3 million, was Africare's annual Bishop John T. Walker dinner, named after the first African-American Episcopal bishop to the Washington Diocese, who served as chair of Africare from 1975 until his death in 1989. The group's annual Bishop Walker Award was presented to Louis W. Sullivan, president of Morehouse School of Medicine and secretary of Health and Human Services in the first Bush administration. (Washington Post, 11.07.01, Peter Carlson)
CDC researchers have identified a new class of HIV that could give rise to infections that are resistant to AZT and potentially thwart the effectiveness of antiretroviral therapy in some patients. HIV's ability to mutate and become resistant to a patient's treatment is a growing concern worldwide. But the new HIV subtype was found in newly diagnosed patients who had not yet started therapy. The scientists analyzed viral samples from 603 patients before the patients began drug therapy. Slightly more than 3 percent of the patients had mutations in a particular region of an HIV gene that gives the virus a high potential to become drug-resistant, according to J. Gerardo Garcia-Lerma and colleagues. These patients had mutations that differed from mutations in the same gene that are already known to make HIV resistant to AZT. But experiments showed that HIV with these new mutations carried a significant potential for developing resistance to AZT (zidovudine) and possibly to stavudine. According to the researchers, "a close monitoring of treatment responses in patients infected with these viruses is prudent," as the mutations have a "higher potential... to compromise the efficacy of antiretroviral therapy." Studies have shown that in patients treated with AZT, AZT resistance does not necessarily blunt the effectiveness of HIV drug combinations that include a protease inhibitor, noted an editorial by Dr. Daniel R. Kuritzkes of the University of Colorado Health Sciences Center in Denver. However, these drug regimens may not be as effective in patients who have AZT resistance before ever starting therapy. The article, "Increased Ability for Selection of Zidovudine Resistance in a Distinct Class of Wild-Type HIV-1 From Drug-Naive Persons," appears in the Proceedings of the National Academy of Sciences early online edition at www.pnas.org. (Reuters Health, 11.05.01)
Is the Time From HIV Seroconversion a Determinant of the Risk of AIDS After Adjustment for Updated CD4 Cell Counts?
The major effect of the progressive immune suppression caused by HIV-1 is an increased risk of a number of opportunistic infections and rare tumor types which define the clinical spectrum of AIDS. It has been reported that time from infection (seroconversion) is a strong prognostic marker for the onset of AIDS. Other studies have suggested that individuals with similar CD4 cell counts have similar rates of progression independent of different times from seroconversion. The objective of this study was to investigate, using a very large set of pooled cohorts, whether there is a residual effect of time from infection on the risk of AIDS and to quantify this effect in terms of an increase in risk. The study also investigated this objective for each specific AIDS-defining illness. Concerted Action on SeroConversion to AIDS and Death in Europe (CASCADE) is a collaboration of investigators involved with 19 cohorts in Europe and Australia that began in 1997. All cohorts contain individuals for whom it was possible to estimate the time of HIV seroconversion. All analysis ended with data at December 31, 1995 in order to avoid confounding the findings with the effect of highly active antiretroviral therapy (HAART), which became widely prescribed after that date. Using pooled data from 19 seroconverter cohorts, the authors considered time to the first AIDS-defining event following the CD4 cell count below 500 cells/mm3, 350 cells/mm3, and 200 cells/mm3. All data were adjusted for age, gender, exposure category, and HIV test interval in Cox Models stratified by cohorts. Of 3,825, 3,006 and 1,804 individuals reaching CD4 thresholds of 500, 350, and 200 respectively, 1,274, 1,192 and 985, respectively, developed AIDS. The authors found a significant effect of time from seroconversion on the risk of AIDS even after adjusting for updated CD4 counts. The risks after one year were 7 percent, 6 percent and 4 percent, respective to the three cohort groupings. The effect of time appeared to be nonlinear, with no increase in the risk of AIDS after 4 years from seroconversion. The residual effect of time differed significantly according to type of AIDS-defining event initially diagnosed. Time from seroconversion to CD4 threshold was not associated with progression to Pneumocystis carinii pneumonia (PCP), herpes simplex virus infection (HSV) and deaths in persons without AIDS. Conversely, time from seroconversion was found to have a stronger association with progression to Kaposi Sarcoma (KS) and mycobacterial disease, not including tuberculosis. Given the results of the study, the authors advised against the use of time in assessing an infected individual's risk of AIDS over and above a given CD4 cell count. "Such knowledge, however, is of more benefit when assessing a patient's risk of KS or mycobacterial disease, other than tuberculosis, rather than PCP or HSV infection," the authors said. (Journal of Acquired Immune Deficiency Syndromes, 10.01.01, Vol 28; No 2: P 158-165; Concerted Action on SeroConversion to AIDS and Death in Europe (CASCADE Collaboration))
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