A professor of actuarial studies at the University of Cape Town has predicted that about half of all South African adults are at risk for HIV within the next 10 years unless significant changes are made. At a meeting of insurance assessors on Thursday, Rob Dorrington forecast that by 2010, life expectancy in South Africa would drop from 63 years to about 41 years. He also estimated that 13 percent of South Africa's residents will have HIV by the end of this year, with about 2,000 to 2,500 new infections every day. (Reuters (www.reuters.com), (10/12/00); Lovell, Jeremy)
South African President Thabo Mbeki reportedly has decided to back off from the debate over whether HIV causes AIDS, after sparking a firestorm of controversy earlier this year by questioning a link that most scientists accept. His comments have been criticized by AIDS activists and researchers worldwide. Now, according to government spokesman Joel Netshitenzhe, Mbeki "has scaled down on his participation in the debate," so he can deal with other issues. Last month, the Congress of South African Trade Unions and the South African Communist Party publicly declared that HIV causes AIDS, and they called on Mbeki to acknowledge the link. While the president has not yet gone that far, in recent comments to Parliament he said the government's AIDS policies stem from the "thesis" that HIV causes AIDS. Mbeki's retreat, as well as a new AIDS awareness and prevention campaign from the government, seem to indicate that the debate has taken a toll. Morna Cornell of the AIDS Consortium, an umbrella group representing more than 350 AIDS groups in South Africa, noted, "At least [Mbeki is] being strategic enough to recognize the damage that has been caused and to acknowledge it and to extract himself from it." The government has also decided to further investigate nevirapine's use in preventing mother-to-child transmission of HIV. (New York Times (www.nytimes.com), (10/17/00) P. A10; Cauvin, Henri E.)
Dr. Jay Levy of the University of California at San Francisco has an HIV-infected patient who appears very healthy but whose T-cell count is only 21. This patient -- who hikes, bikes, and travels, and who does not take antiviral drugs -- may represent the idea that the human immune system consists of the innate and adaptive systems. The innate immune system contains disease-fighting cells, which may be used to form new AIDS treatments. Innate immunity is the first line of defense, including the skin and saliva. The adaptive system can manufacture B-cells and T-cells to attack a virus, but it can fail when the virus has advanced. Levy's patient has a poor adaptive system, but his innate immunity appears to be functioning well. He has normal levels of interferon-producing cells; interferon inhibits viral replication and modifies the activities of other cells. Dr. Levy is using the study of innate immunity to search for new therapies, by following the CD8 cells and investigating their functions. (San Francisco Chronicle)
A study from Adelaide University in Australia has found that gay men with long-term depression are nearly twice as likely to have unsafe casual sex as other gay men. The study of over 400 gay men found that 40 percent of the men with long-term, low-grade depression (dysthymia) said they engaged in unsafe casual sex in the past six months, versus 22 percent of the men who did not have dysthymia. Dr. Gary Rogers, program director of a care and prevention program at Adelaide University, suggested, "It may be that the low self-esteem that is part of long-term depression leads to men not caring enough about themselves to stay safe." (Australian Associated Press (aap.com.au), 10/11/00)
Giuseppe Pantaleo of the University of Lausanne in Switzerland and a multicenter team report that a combination of abacavir and amprenavir can suppress HIV replication and stabilize CD4 T-cell counts when given soon after infection. A study of 41 HIV-infected patients who were antiretroviral-naive and 49 controls showed that virus replication was suppressed in the HIV-positive patients in comparable numbers to HIV-negative subjects in about 24 to 48 weeks. Dr. Pantaleo also noted that the patients' triglyceride and cholesterol levels remained good after 72 weeks. The study is published in the October issue of AIDS (2000;14:887-897). (Reuters Health Information Services (www.reutershealth.com), (10/09/00); Kahn, Sherry Dr.)
issued by the International Federation of Red Cross and Crescent Societies shows that infectious diseases kill more people than earthquakes or floods. AIDS, malaria, diarrhea, and respiratory diseases killed 100 times as many victims of natural disasters last year. The report notes that diseases like malaria, syphilis, and tuberculosis are reemerging because of failing health systems. Other factors like urbanization, climate change, environmental pollution lead to health risks as well. A 1995 World Bank survey revealed that health spending fell 15 percent on average for 53 countries. The infectious diseases claiming lives can be prevented, often at the cost of only $5 per person. The report cited several low-cost community campaigns in Uganda and Cambodia. (Infectious Diseases in Children (www.slackinc.com/idc.htm), (09/00) Vol. 13, No. 9, P. 85 A)
Kholoud Porter of the Medical Research Council Clinical Trials Unit in London has analyzed how HIV survival changes over time. Porter and colleagues studied data from 19 European seroconverter cohorts in the Concerted Action on SeroConversion to AIDS and Death in Europe study. The researchers note that of the more than 5,400 at risk as of January 1991 or later, 24.2 percent died, and there were significant reductions in mortality from 1997 to 1999. The researchers, who report their findings in the journal AIDS (2000;14:1899-1906), said their findings indicate that knowledge of the duration of HIV infection is necessary to obtaining accurate estimates of survival changes over time. (Reuters Health Information Services (www.reutershealth.com), (10/10/00); Hendry, Joene Dr.)
The World Medical Association (WMA), which represents doctors from around the world, is warning that overcrowded prisons help breed tuberculosis (TB). At the group's annual meeting in Scotland, the doctors said that high-risk conditions in prisons must be overcome to stop the spread of diseases -- including TB, hepatitis C and HIV -- in jails. The WMA's Declaration of Edinburgh states, "Overcrowding, lengthy confinement within closed, poor lit, badly heated and consequently poorly ventilated and often humid spaces are all conditions frequently associated with imprisonment and which contribute to the spread of disease and ill-health." The declaration -- which is not legally binding for governments, although most follow WMA statements when establishing policies -- also notes that prisoners should not be put in solitary confinement without sufficient access to healthcare. (Fox News Online (www.foxnews.com), 10/10/00)
People can spread genital herpes without knowing they are infected. An estimated 25 percent of Americans have the disease, according to the Centers for Disease Control and Prevention, but many are not aware of their condition. Dr. Karl Beutner of the University of California at San Francisco estimates that up to 75 percent of infected individuals do not know they have herpes. Patients could thus unknowingly transmit the disease to someone else, who could then spread it to others, including infants at birth. Kathleen Stine, a nurse practitioner involved in a recent genital herpes study at the University of Washington, found that asymptomatic infections are as risky as those with known diagnosis. This could explain why genital herpes has increased during the last 10 years, even as condom use grew. There is no cure for herpes, although drugs like acyclovir can suppress the disease, and abstinence is the only sure means of prevention. (Arizona Daily Star Online (www.azstarnet.com), (10/17/00); Seebacher, Noreen)
Many people with AIDS do not take their medications, with an estimated 20 percent to 50 percent failing to follow their prescribed therapies. Doing this raises the risk of developing drug-resistant strains of HIV, note Ivan Oransky and Sean I. Savitz in a USA Today commentary. The Presidential Advisory Council on HIV/AIDS reported recently that a significant number of HIV and AIDS patients have drug or mental health problems, and it also noted that up to 50 percent of all new HIV infections are among individuals under the age of 25, who report difficulties accessing medical care during regular business hours. The panel called for easier-to-take drugs that are less toxic for the patients. However, the authors note that directly observed therapy (DOT), a system developed for tuberculosis (TB) patients in which healthcare workers watch the patient take his or her medicine, could also be useful. A 1998 study from the Journal of the American Medical Association shows that DOT has reduced the incidence of drug resistance by 82 percent in New York City since 1992. Furthermore, whereas hospitalizing a TB patient can cost more than $8,000, DOT costs about $2,200 per patient. The authors assert that "given the recent development of simpler regimens, every non-compliant HIV patient should be put into a directly observed therapy program," which will save lives, reduce costs, and help stem the spread of HIV. (USA Today (www.usatoday.com), (10/16/00) P. 19A; Oransky, Ivan; Savitz, Sean I.)
Researchers from the Netherlands, led by Dr. Tom van der Poll, have found that concurrent bacterial infection can encourage HIV replication through upregulation of chemokine receptors on T cells. Van der Poll and colleagues at the University of Amsterdam injected eight HIV-negative volunteers with lipopolysaccharide, testing the surface levels of CXCR4 and CCR5.They were surprised to find that bacterial infection increased the surface levels of the two chemokines per CD4 T cell. The researchers, who report their findings in the journal Blood (2000; 96:2649-2654), believe intercurrent disease should be closely watched and treated in patients with HIV. (Reuters Health Information Services (www.reutershealth.com), (10/17/00); Agrawal, Alka)
Jane Fowler, thought HIV was a problem only for gay men, not for divorced heterosexual women. The 64-year-old woman became infected through a heterosexual encounter in which she did not insist on condom use because she was unaware of the risk. Fowler, the founder of the National Association on HIV Over 50, now devotes her time to warning other seniors about the risks of HIV. Although people over 50 make up just 10% of all AIDS cases, older Americans face unique challenges in terms of treatment and prevention. Treating AIDS in the elderly is difficult due to other health conditions and possible drug interactions, and there is little research to guide treatment decisions. Researchers also know little about the sexual behavior of seniors, which is why Marsha Ory of the National Institute on Aging organized a conference last month to discuss AIDS in older people. Studies indicate that older women know far less about HIV than younger women, and a University of North Carolina study suggests that 4.5 million American women over 40 engage in risk behaviors that might put them at risk for HIV. According to Ory, many older people take the same risks as younger people, and "age isn't a vaccine" that will protect them from infection. According to CDC, as of 1999, some 78,000 people 50 years of age and older had developed AIDS, approximately 10,000 of whom were over the age of 65. (USA Today (www.usatoday.com), (10/16/00) P. 7D; Sternberg, Steve)
A study conducted for the Gay and Lesbian Medical Association (GLMA) shows that gay and bisexual men are not getting vaccinated against hepatitis A and B. The survey of 2,566 men revealed that only 35.5 percent had received the two shots to prevent hepatitis A, although that number is up from 22.3 percent in the previous year, and 38.9 percent were vaccinated for hepatitis B, versus 33.4 percent one year ago. GLMA spokesman Ron Tierney said many factors -- including affordability issues, discomfort with medical professionals, and a lack of awareness -- contribute to the low coverage rates. He also noted that gay men may be uncomfortable discussing with their doctors matters that could be associated with sexual identity. (Reuters Health Information Services (www.reutershealth.com), (10/18/00); Cunningham, Chris)
A new study from Johns Hopkins University shows that people age 40 or over who are infected with hepatitis C virus (HCV) have over three times the risk of type 2 diabetes. Shruti Mehta and colleagues evaluated over 9,800 adults, 2 percent of whom had HCV infection. According to their report in the Annals of Internal Medicine (2000;133:592-599), the rate of type 2 diabetes was higher in the HCV group compared to those HCV-negative, for subjects over 40. The findings support the idea that HCV infection can cause type 2 diabetes through progressive liver damage. (Reuters Health Information Services (www.reutershealth.com), 10/16/00)
Health policy expert Lawrence Gostin of Georgetown University Law Center has stated that the government should not require HIV-positive doctors to tell their patients they are infected. Gostin, whose proposal is published in today's Journal of the American Medical Association (2000;284:1965-1970), noted that as the rules stand now, they "pose significant human rights burdens" and are not supported by data regarding the risk of doctor-patient transmission. The Centers for Disease Control and Prevention is currently undertaking a routine review of the guidelines, which state that HIV-positive healthcare workers should reveal their status to patients undergoing invasive procedures. (Washington Post (www.washingtonpost.com), (10/18/00) P. A34)
Investigators from the United States, Germany, and the Netherlands evaluated the role of HIV-1 on follicular dendritic cells in the process of decay of plasma virus as the result of antiretroviral therapy. Using a mathematical model for HIV-1 dynamics in lymphoid tissue, the researchers analyzed data for the decay of HIV during treatment. The model showed that viral clearance and death of short-lived productively infected cells could be faster than previously thought. The study also indicated that the second stage of decay may not be caused by long-lived or latently infected cells. (Proceedings of the National Academy of Science Online (www.pnas.org), (09/26/00) Vol. 97, No. 20, P. 10966; Hlavacek, William S.; Stilianakis, Nikolaos I.; Notermans, Daan W.; et al.)
A new bill in New Jersey would require teachers to stress abstinence in sex education and HIV prevention classes. The bill, sponsored by Assembly woman Marion Crecco (R-Essex), would promote abstinence as "the only completely reliable means" of avoiding pregnancy and sexually transmitted infections. Opponents of the bill believe abstinence is already part of sex education. The bill, which was approved Monday by the Education Committee, has now been sent to the full Assembly. (Newark Star-Ledger Online (www.nj.com/news), 10/17/00)
French researchers performed a study of pregnant women with hepatitis C virus (HCV) infection, comparing liver biopsy samples taken before and after delivery of the babies. Twelve pregnant women with HCV infection and 12 non-pregnant women with HCV took part in the study. The results revealed that pregnancy may worsen histopathological injury related to hepatitis C, although the researchers note that the long-term effects of this are unknown. The liver deterioration may also be related to post-partum immune rebound. (The Lancet (www.thelancet.com), (10/14/00) Vol. 356, No. 9238, p. 1328; Fontaine, Helene; Nalpas, Bertrand; Carnot, Francoise; et al.)
Articles abstracted by the National Prevention Information Network (NPIN) of the U.S. Centers for Disease Control and Prevention (CDC).
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