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Newsline

July 2001

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


Study Shows Injection Drug Users at Needle Exchange Program Share Few Syringes -- and Those Who Do, Share with Friends

Public health researchers at the Keck School of Medicine of the University of Southern California (USC) and the New York Academy of Medicine report that most injection drug users who take part in community needle exchange programs do not share their needles. The researchers note in the March issue of the American Journal of Public Health that because the results of the two-year study indicated that some drug users continue to share needles, despite the risks of contracting HIV and hepatitis B and C, "programs need to renew efforts to discourage further sharing of syringes obtained from the program." The authors studied nearly 1,200 injection drug users who participated in a Baltimore needle exchange between 1995 and 1997, and they found that about 17 percent of the addicts reported recently sharing a syringe, usually with a friend. Study co-author Thomas W. Valente, an associate professor at the Keck School at USC, said, "People working in HIV prevention need to get the message out that sharing with friends might seem natural and safe, but that isn't necessarily so. It is safer to use your own needle, and even safer to stop injecting altogether." (Boston Globe Online (www.boston.com/globe), 02/28/01)


UCLA Study Shows AIDS-Intervention Programs Curb Risky Sex and Drug Use by HIV-Positive Youth

A recent study from the University of California at Los Angeles found that HIV-infected youths participating in an AIDS-intervention program voluntarily decreased their high-risk sexual behavior by 82 percent and their drug use by one-third. The findings, reported in the March edition of the American Journal of Public Health, offer some encouragement in the effort to curtail the spread of HIV among young people. During the study, researchers worked to assist participants maintain emotional wellness, take responsibility for their health, and reduce their high-risk behaviors. The "Stay Healthy" part of the program involved 12 sessions aimed at helping participants change their behaviors. The teens were introduced to modified behavior routines designed to keep them healthy, and they were educated about how to cope with their HIV status, disclosure issues, and medical-decision making. The second section, called "Act Safe," targeted the prevention of disease transmission to others. (Postnet Online (www.postnet.com), 02/28/01)


Are Native Americans Next Brush Fire in HIV Epidemic?

Dr. Eric Goosby, director of HIV/AIDS Policy for the U.S. Department of Health and Human Services and deputy director for the Office of National AIDS Policy, says that the government and public need to take action in response to the rising rates of HIV infection among Native Americans. "Native Americans have participated historically in behavior patterns that are of high risk for transmitting HIV: alcoholism and injection drug use," Goosby notes. Native Americans also exhibit high rates of sexually transmitted diseases and teenage pregnancy, both indicative of unprotected sexual activity. According to the Centers for Disease Control and Prevention, more than 2,000 cases of AIDS were diagnosed among Native Americans in the United States and its territories in 1999 -- a nearly 25 percent increase over the number of cases in 1997. Late last year, Goosby met and discussed the risks of HIV infection with tribal leaders when he addressed the 57th Annual Session of the National Congress of American Indians, the largest organization of tribal governments in the United States. Goosby explains that targeted prevention messages are needed for Native Americans, particularly young people in this group, so they can learn how to stop their high-risk activities before they contract HIV. (AIDS Alert (www.ahcpub.com) (02/01) Vol. 16, No. 2, P. 27)

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Counseling Weakens HIV, Study Finds

Researchers at the University of Miami (UM) have discovered providing intensive grief therapy to gay men who have lost a partner or friend to AIDS can significantly lower their HIV viral load. The study, directed by psychiatrist Dr. Karl Goodkin, is the first to show that viral load can be affected by behavioral intervention. The research found that men who attended 10 specially designed group-counseling sessions were notably healthier when the level of HIV was measured in their blood. The data revealed that among the HIV-infected men studied, CD4 cell counts were stable for those in intensive therapy, while the CD4 levels of the men who did not receive the UM counseling continued to decline. The research, published in the Journal of Human Virology, received funding from the National Institute of Mental Health, a division of the National Institutes of Health. (Miami Herald (www.herald.com) (03/05/01); Morris, Christine)


Primary Genotypic and Phenotypic HIV-1 Drug Resistance in Recent Seroconverters in Madrid

Spanish researchers investigated the prevalence of resistant HIV strains among 30 recent seroconverters in Madrid. The participants, all of whom reported engaging in high-risk activities recently, were therapeutically naive and were enrolled between 1997 and 1999. The researchers found that the overall prevalence of genotypes linked to lower susceptibility was 26.7 percent, or eight of the 30 subjects. Resistance mutations were seen against nucleoside analogues in seven patients, non-nucleoside reverse transcriptase inhibitors in one, and protease inhibitors in two. Six of the subjects also had the zidovudine-resistant mutations M41L and/or T215Y. Based on their findings, the researchers recommend that resistance testing at the baseline should be considered for the optimal design of first-line antiretroviral therapies. (Journal of Acquired Immune Deficiency Syndromes (www.jaids.com) (02/01/01) Vol. 26, No. 2, P. 145; Briones, Carlos; Perez-Olmeda, Mayte; Rodriguez, Carmen; et al.)


HIV Levels Lower in Women

Johns Hopkins University researchers have found that newly diagnosed women with HIV have much less virus in their blood than men at the same stage of infection, although that difference later disappears. The study of 156 male and 46 female injection drug users (IDUs) found that whereas the newly diagnosed men had an average of 50,766 particles per milliliter, the women averaged 15,103. The researchers note, however, that the finding will likely not change treatment, because treatment recommendations changed between the time the article was written and when it was published in today's issue of the New England Journal of Medicine. When the article was written, treatment guidelines recommended initiating treatment when HIV levels reached 20,000 particles per milliliter of blood plasma, but guidelines issues earlier this year advise postponing antiviral therapy until there are 55,000 particles per milliliter. (Washington Post (www.washingtonpost.com) (03/08/01) P. A14)


AIDS Drug Combo Fares Well in Study

A combination of AZT, 3TC, and GlaxoSmithKline's (GSK) Ziagen nucleoside analogs contains the same efficacy in suppressing HIV as the standard cocktail of two nucleosides and a protease inhibitor, according to a recent study funded by GSK. The all-nucleoside cocktail may be an option for patients who have developed resistance to protease inhibitors. The patients who received protease inhibitors did see a greater drop in the amount of HIV in their bloodstream. The results are published in Wednesday's Journal of the American Medical Association. (Bergen Record (www.bergen.com) (03/07/01) P. B8; Tanner, Lindsey)


Trends in HIV Seroprevalence and Needle Sharing Among Puerto Rican Drug Injectors in Puerto Rico and New York: 1992-1999

Researchers investigated trends in HIV seroprevalence and needle-sharing behaviors among Puerto Rican injection drug users (IDUs) in Puerto Rico and New York City between 1992 and 1999. The authors, who used two studies of IDUs in Bayamon, Puerto Rico, and East Harlem, New York, found significant decreasing trends in seroprevalence in the two groups. There were significant decreasing trends in receptive and distributive needle sharing in the New York sample, while the Puerto Rico sample saw a substantial drop in receptive sharing as well. The researchers note that, compared to New York, there were higher levels of needle-sharing behaviors in Puerto Rico; however, the decreasing trends in needle sharing and seroprevalence in both groups are encouraging. According to the authors, "Continued and increased efforts are needed to help maintain and continue declines in risk behaviors and seroprevalence. In addition, prevention efforts to target those behaviors and populations that do not seem to be exhibiting decreasing trends (e.g., IDUs who also use crack in Puerto Rico) are needed." (Journal of Acquired Immune Deficiency Syndromes (www.jaids.com) (02/01/01) Vol. 26, No. 2, P. 164; Deren, Sherry; Robles, Rafaela; Andia, Jonny; et al.)


Risk of Lipodystrophy in HIV-1-Infected Patients Treated with Protease Inhibitors: A Prospective Cohort Study

Researchers completed a study of antiretroviral-naive HIV-1-infected patients in an effort to identify the risk factors for developing lipodystrophy while undergoing highly aggressive antiretroviral therapy (HAART). Evidence of moderate to severe body-fat changes were clinically assessed and categorized as subcutaneous lipoatrophy, central obesity, or both, in adults who were undergoing HAART with two nucleoside reverse transcriptase inhibitors plus at least one protease inhibitor. After 18 months of follow-up, 17 percent of nearly 500 patients exhibited lipodystrophy; that figure increased to 23 percent after 24 months. The findings agreed with earlier studies which found that patients diagnosed with any lipodystrophy exhibited an increase in their CD4-lymphocyte count, a greater decrease in viral load, and a greater increase in triglycerides and cholesterol in comparison to patients who do not develop lipodystrophy. The researchers had hoped that their study would be able to isolate the specific risk factors, but instead the scientists had to conclude that the factors were too multifactorial and overlapping and could not be exclusively attributed to exposure to any one specific antiretroviral agent. (Lancet (www.thelancet.com) (02/24/01) Vol. 357, No. 9256, P. 592; Martinez, Esteban; Morcroft, Amanda; Garcia-Viejo, Miguel A.; et al.)


"AIDS: The Drugs Won't Be Enough"

In a commentary in the Washington Post, the dean of the Harvard School of Public Health, Barry R. Bloom, notes that, while the drugs are beneficial, "just sprinkling AIDS drugs around the world . . . could create drug-resistant strains that would spread worldwide and cause painful side effects in those already suffering." Because just giving people the drugs does not mean they know how to use them, Bloom suggests looking to tuberculosis (TB) for answers. Although once thought prohibitively expensive, TB drugs came down in price once they were put into large-scale TB control programs, and directly observed therapy -- in which healthcare workers watch patients take their medications to ensure compliance and prevent the development of drug-resistant strains -- has been very effective where implemented. Bloom notes that if such a strategy were shown to work for AIDS, a system could be set up quickly because many AIDS patients have tuberculosis, and he also asserts that "priority for treatment must go to those with the greatest risk of infection . . . [though] treatment efforts must not take priority over programs to prevent transmission through education about safe sex and use of condoms." (Washington Post (www.washingtonpost.com) (03/09/01) P. A27; Bloom, Barry R.)


Insulin Resistance in HIV Lipodystrophy Syndrome

Researchers recently completed a study identifying the incidence of insulin resistance in HIV-patients who exhibit signs of lipodystrophy. The authors noted two significant metabolic changes occurring in those patients, including significant insulin resistance and hyperlipidemia linked to fat redistribution. The characteristic bunching of metabolic abnormalities, as exhibited by fasting hyperinsulinemia in relationship to normal fasting glucose levels, results in a high insulin resistance condition and may also place HIV-infected lipodystrophy patients at a higher risk for cardiovascular disease (CVD). Another significant factor for CVD risk is the weight gain associated with HIV-related lipodystrophy and insulin resistance. There are insulin-sensitizing drug compounds currently being used to combat the metabolic changes brought on by the condition, but further clinical trials are recommended to determine the long-term effects of the treatment. The researchers feel that until more is understood about the condition, clinicians should recommend a treatment program based on modified diet, exercise, and weight management for patients with HIV-associated lipodystrophy. (AIDS Clinical Care (02/01) Vol. 13, No. 2, P. 1; Hadigan, Colleen; Grinspoon, Steven)


Prophylaxis with a Nevirapine-Containing Triple Regimen After Exposure to HIV-1

British researchers present a study of a triple-drug combination, including nevirapine, that was used as prophylaxis after occupational or sexual exposure to HIV-1. Of the 57 individuals evaluated during the program, only 41 underwent documented follow-up, with five exhibiting a level-three or -four drug-induced hepatitis and two developing a rash. The researchers note that the high rate of adverse effects calls into question the safety of such a drug regimen for this group. "More data are needed on the tolerability and outcome of different post-exposure prophylaxis regimens," they conclude. (Lancet (www.thelancet.com) (03/03/01) Vol. 357, No. 9257, P. 687; Benn, Paul D.; Mercey, Danielle E.; Brink, Nicola)


Clinic Casts Lifeline to Isolated Migrant Workers

In New Paltz, New York, a health clinic designed primarily as part of a 12-year-old migrant health program stays busy year-round in the farming regions of the Hudson Valley. The program, one of only three in the state designed to provide primary care for the estimated 30,000 to 90,000 migrant workers, is supported by state and federal funds. The clinics charge patients only $10 for a first visit and $5 thereafter. Hudson River Healthcare, a Peekskill-based community health center, operates the New Paltz clinic. Another year-round clinic operates in Goshen, Orange County, and during the growing season, extends services to patients in outlaying counties as well, by using a mobile health van and trailer clinic. The clinics can offer migrant workers a full array of medical and social services, including HIV tests, Pap tests and contraception, immunizations, and tuberculosis screenings. Social assistance includes enrollment in Medicaid, Child Care Plus, and a food subsidy program for children and pregnant women. (New York Times (www.nytimes.com) (03/13/01) P. D5; Fuentes, Annette)


Back to the July 2001 Issue of Body Positive Magazine.


  
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