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October 1999 Treatment Chronicles
From the CDC National AIDS Clearinghouse

Compiled by Ernie Evangelista

October, 1999


AIDS Prevention as Global Mission. Peggy Johnston, associate director for vaccine and prevention research in the division of AIDS and the assistant director for HIV vaccines at the National Institute of Allergy and Infectious Diseases (NIAID), has a long history in HIV research. Distrust and cultural barriers have made fighting HIV difficult in some areas; however, the biochemist has overcome many obstacles with diplomacy. Using a mixture of business savvy and open-hearted negotiation, Johnston has put policies into place that will be invaluable for developing an AIDS vaccine. When working for the International AIDS Vaccine Initiative, which she moved to in 1996, Johnston helped create a global vaccine purchase fund which assures any pharmaceutical company that develops a viable AIDS vaccine a profit. In addition, she helped establish an international research compact that promises countries that participate in vaccine trials affordable prices for any successful vaccine that is developed. Johnston returned to NIAID last year.

Study Sheds New Light on How HIV Infects Cells. Researchers from the Universidad Autonoma de Madrid have discovered why the onset of AIDS is delayed in some people. A mutant receptor for the chemokine CCR2 blocks the entry of HIV into cells through the CCR5 and CXCR4 receptors. Previously, scientists were aware that people with mutant CCR2 receptors took longer to develop AIDS, but it was not known why. The researchers, who report their findings in the August issue of Nature, say that the discovery may unveil new approaches for dealing with HIV progression.

Gates Adds $6 Billion to Vaccine Effort. A new $6 billion donation from Microsoft Chairman Bill Gates is expected to fuel a vaccine initiative to fight diseases including malaria, tuberculosis and HIV. An article in Newsweek also reveals that the William H. Gates Foundation and the Gates Learning Foundation have been consolidated and will now be known as the Bill and Melinda Gates Foundation. Global health experts say that Gates' foundation has reinvigorated efforts to develop and distribute vaccines targeted at childhood illnesses, malaria and HIV. The Bill and Melinda Gates Foundation's major global grants include $50 million to the Malaria Vaccine Initiative, $100 million to the Children's Vaccine Program, $50 million for Motherhood Mortality Reduction, and $25 million for the International AIDS Vaccine Initiative.

"Building a Comfort Zone" with Clients at Risk of HIV. HIV intervention programs are beginning to tailor their message to high-risk groups. Over the years, prevention groups have realized that in order to be effective, counselors must be culturally sensitive and linguistically compatible. In Orange County, California, the Centers for Disease Control and Prevention is providing funding for a pilot program known as prevention case management. The program, which is also being tested in two other states, provides counselors to small numbers of extremely high-risk people.

AIDS Vaccine to be Tested on People. Merck researchers are getting ready to initiate human clinical trials of an AIDS vaccine that yielded promising results in tests with monkeys. Researchers hope the naked DNA vaccine can encourage some immune-system cells that appear important in the body's defense against HIV. Although the animal studies are promising, a vaccine is not imminent, researchers cautioned. Meanwhile, Wyeth-Ayerst also is involved in human clinical trials of its version of the DNA vaccine; several hundred volunteers have already been given a dose of the vaccine.

UNAIDS Calls for Greater Involvement by HIV-Infected People in Fighting Epidemic. Dr. Peter Piot, executive director of UNAIDS, urged the involvement of HIV-infected people in fighting the epidemic. Dr. Piot, speaking at the Ninth International Conference for People Living with HIV/AIDS, stated that the involvement of HIV-infected people in anti-AIDS campaigns could help end prejudice and discrimination against people with HIV and AIDS. In addition, Dr. Piot believes that HIV/AIDS programs require the participation of those who have HIV to be truly successful. Dr. Piot praised Poland, the site of this year's conference, for its HIV prevention strategy which includes mobilizing non-governmental and community organizations in the fight against HIV/AIDS.

Nonoxynol-9 Film Use May Enhance HIV Transmission Risk. A report in the August 20th issue of AIDS warns that nonoxynol-9 film may increase the risk of HIV transmission. Investigators observed 20 female sex workers in South Africa who used nonoxynol-9 film in a phase I, randomized, double-blinded, crossover trial. There were no statistically significant differences between the nonoxynol-9 group and the placebo recipients in terms of genital lesions, reported side effects, and viral load; but when compared to those receiving the placebo,users of the 72 mg nonoxynol-9 film displayed more clinically detected genital lesions and self-reported side-effects. The researchers suggest that phase II trials focus on the margin of safety of nonoxynol-9 film.

CD4 Cell Counts Predict Viral Rebound During HAART. A report in the August issue of the Journal of Infectious Diseases indicates that HIV-infected people with higher CD4 counts are less likely to have viral rebounds when receiving highly active antiretroviral therapy (HAART). A European multi-center team used the Kaplan-Meier method to evaluate 558 HIV-infected people with viral loads equivalent to or less than 500 copies/mL after an average of 30 days of HAART. Investigators anticipated a viral rebound in 42.5 percent of patients at 24 weeks, and 64.3 percent of patients by 84 weeks. Researchers conclude that HIV-infected people beginning HAART with higher baseline CD4 counts, and those with higher CD4 cell increases, are at a decreased risk for viral rebound than those with lower CD4 counts during therapy.

Man Arrested for AIDS Cure Claims. Alfred Flores, a convicted murderer and the president of Las Vegas-based New Technologies & Concepts Inc., was arrested on Thursday, August 12, on charges of fraud stemming from claims that the company had developed a cure for AIDS. The entirely false information was distributed via a number of press releases aimed at stockholders and claimed that the cure, called Plasma Plus, was able to completely rid the body of HIV, an unsubstantiated claim that was supported by false information from clinical tests. The false claims pushed the company's stock prices up 8-fold. Flores was charged with securities fraud and faces 10 years in prison and a $1 million fine; no further information could be gathered about him or his company.

HIV Load Reflects Current Immune Suppression in Late-Stage Disease. Dr. Eric A. Engels and colleagues explored the relationship between HIV viral load during late stages of the disease in hemophiliacs. Investigators conducted a retrospective study of HIV-positive hemophiliacs who had CD4 counts of less than 200/uL at baseline. The report, published in the August 17th issue of the Annals of Internal Medicine, indicates that HIV viral load is a good predictor of the risk of disease progression, and mirrors current levels of immunosupression. Therefore, HIV load levels complement CD4 cell counts, and may be a useful factor in patient management.

Home Collection HIV Testing May Reach Some High-Risk Individuals. A study of San Francisco residents tested for HIV indicates that those who use home collection HIV testing methods have an overall lower risk profile than those who are tested at anonymous publicly funded sites. The study, published in the August 15th issue of the Journal of Acquired Immune Deficiency Syndromes, also found that home collection methods were used less frequently than tests performed at publicly funded anonymous sites. According to the report, however, home collection HIV tests appear to be used by some high-risk individuals who may not otherwise be tested at a publicly funded site. The researchers found that the HIV prevalence among the home collection testers was 0.9 percent, compared to 1.8 percent among the publicly funded testers.

Trends in Perinatal Transmission of HIV/AIDS in the United States. Researchers from the CDC investigated trends in the incidence of perinatal AIDS and associated factors. The group also studied the effect of recommendations made by the U.S. Public Health Service (PHS) regarding prenatal HIV testing and zidovudine therapy to reduce perinatal HIV transmission. Based on an analysis of AIDS surveillance data and data from states that report HIV, the researchers report that cases of perinatal AIDS peaked in 1992 and then dropped 67 percent through 1997. That figure included an 80 percent decline in AIDS cases occurred among infants and a 66 percent decline among children between the ages of one and five. In addition, rates of AIDS among infants declined 69 percent from 1992 to 1996, compared to a 17 percent drop in births to HIV-positive women between 1992 and 1995. The researchers also observed an increase, from 70 percent to 94 percent, in perinatally exposed children between 1993 and 1997 whose mothers were tested before giving birth; the percentage who received zidovudine increased from seven percent to 91 percent. The CDC concluded that the declines in AIDS incidence and an increase in zidovudine use to reduce perinatal HIV transmission indicate that there has been success in implementing PHS guidelines. The decline cannot be explained through reductions in the number of births or the effects of therapy in delaying AIDS, however.

Statewide HIV/AIDS Disease Management Program to Open in Florida. The AIDS Healthcare Foundation and Florida's Agency for Health Care Administration are teaming up to launch the nation's largest HIV/AIDS disease management program. The program, dubbed Positive Healthcare/Florida, will enroll 7,500 HIV-positive Medicaid recipients in Florida. Positive Healthcare/Florida will provide services regarding disease management, including specific education, treatment recommendations and support for patients. The program will also provide AIDS treatment guidelines for primary care physicians and education for physicians and healthcare providers.

African-Americans with HIV in Georgia. African Americans represent 28 percent of Georgia's population, but last year they made up nearly three-quarters of the state's newly reported AIDS cases, according to new data. In 1990, African Americans made up 49 percent of new AIDS cases in Georgia. Of the state's 1,325 new AIDS cases in 1998, 976 were in African Americans.

Moderate HIV/STD Prevalence Reported Among Prevention Program Participants. A report published in the August issue of Sexually Transmitted Diseases suggests that needle-exchange program sites may be ideal venues for sexually transmitted disease (STD) and HIV prevention programs. Canadian researchers found that, generally, the prevalence of HIV and STDs among program participants was moderate, with a 0.4 percent prevalence of Neisseria gonorrheae, a 3.4 percent prevalence of Chlamydia trachomatis, a 5.5 percent prevalence of HIV among former injection drug users, and a 10.1 percent prevalence of HIV among current injection drug users. Risk factors that were independently associated with HIV infection among the injection drug users included female sex, needle-sharing with an HIV-infected person, and a history of hepatitis. The report was based on a study of 738 drug users participating in an STD/HIV prevention and needle exchange program, including both injection and noninjection drug users.

Gore Hopes New AIDS Pact Will Help Shake Protesters. Vice President Al Gore has suggested a deal with South Africa under which the African nation would agree to a written statement that its new drug law will not violate intellectual property rights. The agreement is a part of Gore's efforts to satisfy protesters who have been dogging the candidate along the campaign trail with accusations about his heartlessness towards AIDS patients in South Africa. The protests are in response to the United States' demands that South Africa repeal a law that would reduce the costs of imported drugs to treat AIDS; U.S. drug manufacturers have been protesting the imports under the premise that the new law violates their patents. Observers, however, say the agreement may not satisfy the protesters or the drug manufacturers; according to Shannon Herzfeld, senior vice president at the Pharmaceutical Research and Manufacturers of America, the African nation would still need to alter the law.




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