"We are very concerned that it could represent a reversal in the trends that we believe have been relatively stable ... at about 40,000 new cases every year," Valdiserri said. "We have seen a slight increase in reported AIDS cases for the first time since 1993. It is just a 1 percent increase, but it's the first time since 1993."
While welcoming life-prolonging HIV drugs, health officials have worried that people often forget how dangerous HIV is. "We are still talking about a deadly disease for which there is no cure," Valdiserri said. "We are still dealing with this perception that HIV/AIDS is not a problem in America -- it is just a problem overseas. ... We are still very concerned about the estimated 280,000 people in America who are infected with HIV and don't know it."
Valdiserri said CDC had investigated syphilis outbreaks among gay and bisexual men and found that 43-59 percent of those with syphilis knew they were HIV-positive, suggesting they were having unprotected sex despite knowing they could pass on the virus. (Reuters, 02.11.03)
Clinton said his own foundation is working with 15 Caribbean countries and three in Africa to help them train nurses, set up clinics, purchase and distribute medications and institute prevention efforts. He said that while AIDS has fallen out of the public eye in recent years, the global epidemic threatens to undermine fledgling democracies around the world. During an earlier press conference, Clinton said he is concerned also about rising HIV rates among young gay men and minority women in the U.S. "People in some population groups no longer think AIDS is a problem," he said, referring particularly to young gay men. "They just don't think about it much."
Clinton admitted he made a mistake during his presidency in opposing needle exchange programs that allow addicts to trade in used needles for clean ones. "We have to put science over politics," he said. Clinton said he hopes most of the U.S. AIDS money is distributed through the UN Global AIDS Fund, but said he is not opposed to private, faith-based organizations getting involved as well. (Boston Herald, 02.11.03, Michael Lasalandra)
"The pipeline of new drugs has an impressive number of candidates in it. This is something we haven't seen in many years," said Dr. John Mellors, chief of infectious diseases at the University of Pittsburgh. Mellors estimated that a half-dozen drugs in clinical trials could help with drug resistance found both in patients with newly diagnosed AIDS and those finding that their medicines no longer work. Mellors and a panel of researchers found that 10 to 12 medications are in early phases of study -- compared with just one or two drugs in clinical trials a few years ago.
As an indicator for advancement: While the AIDS medicine T-20 continues to await approval by the Food and Drug Administration, researchers are already developing a related drug as a backup if a patient's virus outsmarts the T-20 formulation. Among the prospective drugs garnering attention at the conference is the drug TNX-355. While results are preliminary, early human trials of TNX-355 showed that HIV levels dropped by as much as 97 percent in some patients. The drug also is appealing to both researchers and patients because it is given as a single IV dose, lasting up to two or three weeks.
But Dr. Calvin Cohen, research director of Community Research Initiative of New England, who regularly guides clinical trials of AIDS drugs, talked about the time frame from research to patient and the pitfalls of side effects never anticipated by researchers. "It's wonderful to see the drug industry looking and to see some of these results. But it's also important not to rely on new drugs to get us out of this mess," said Cohen, who is also research director for Harvard Vanguard Medical Associates. (Boston Globe, 02.12.03, Stephen Smith)
New research suggests that longer, more open-ended interruptions of treatment may be more useful than presumably safer, shorter breaks for some patients. However, it is uncertain as to whether there is a net benefit to taking the breaks. "It's much more complicated than we think," said John W. Mellors, an AIDS physician at the University of Pittsburgh and a conference organizer. "The message is, people shouldn't be willy-nilly interrupting treatment."
A Thai study compared three strategies: continuous treatment with three drugs; interruption that was allowed to proceed provided the patient's CD4 cell count (key in measuring immune-system robustness) remained above a specified threshold; and week-on/week-off interruptions. Mortality, complications and quality-of-life measures among the three groups yielded no differences at the end of a year. However, patients on the CD4-guided strategy actually did better in controlling viral load in the bloodstream than people in the week-on/week-off group, and only took drugs for about one-third of the year. A Spanish study compared the yearlong experience of patients randomly assigned to continue antiretroviral treatment or to stop and restart only if either CD4 cell count or viral load cutoffs were reached. Over a year, about 60 percent of the treatment interruption group had to start taking medicines again (after an average eight-week break), while 40 percent stayed off the drugs with no obvious ill effects.
Researchers in a U.S. study compared seven rounds of eight weeks on/four weeks off treatment with continuous antiretroviral therapy, testing a theory that the immune system may be boosted by periodic exposure to HIV swarms (occurring when treatment stops), after which the body might suppress the virus more aggressively or without medicine. No evidence of this happening was found. However, the interrupting therapy group was more likely to develop drug-resistant virus, causing researchers to stop enrolling patients in the trial. Overall, the results of the various studies suggest that frequent interruptions may promote the emergence of drug-resistant virus, especially for patients taking certain drugs that stay in the bloodstream for weeks after the last dosage. Alternatively, it appears that there are people whose immune systems can suppress the virus adequately for long periods of time. It may be possible to identify such people through CD4 or viral load thresholds. A large study through government-sponsored HIV clinics in the United States is testing this idea. (Washington Post, 02.13.03, David Brown)
Hirshfield told her listeners that the study suggests "it may be possible to reach high-risk [men] through Internet interventions." Other hazardous encounters were examined in a study of HIV-positive inmates released from North Carolina prisons. David Wohl and colleagues at the University of North Carolina interviewed about 90 such inmates -- roughly half men and half women -- before they finished their prison terms, and then two months later. About half reported sexual activity soon after release, and 30 percent said it was unprotected sex with a longstanding partner who was either uninfected or whose HIV status was unknown. About one-third of the total group said they thought it was "likely" or "somewhat likely" that they would eventually infect their main partners.
Wohl speculated that prisons' main role in the AIDS epidemic was not as sites where infection was acquired, but as places from where infected people prone to risky behaviors cycled in and out of the population. Intensive prevention efforts could be directed at them, he suggested. (Washington Post, 02.12.03, David Brown)