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November/December 1999 Treatment Chronicles

From the CDC National AIDS Clearinghouse

November/December, 1999

It Costs $17,600 a Year to Treat HIV in U.S. Study. The cost to treat a person with three to four drugs for HIV is $17,600 a year. The multi-drug treatment urged is called highly active antiretroviral therapy (HAART), which keeps the virus level extremely low. A study by Caro Research, an independent consulting firm in Massachusetts, showed that HAART reduced the cost of treating an HIV patient by 30 percent a year. Researchers also stated that the cost of HAART is less than the cost of treating full-blown AIDS patients.

AIDS Eclipses War, Orphaning Millions of Children, U.N. Says. Officials from the United Nations Children's Fund (UNICEF) said September 15 that as a result of the AIDS epidemic, some 13 million African children will be orphaned within the next 18 months. At the 11th International Conference on AIDS and Sexually Transmitted Diseases in Lusaka, Zambia, UNICEF head Carol Bellamy stated, "By any measure, the HIV-AIDS pandemic is the most terrible undeclared war in the world, with the whole of sub-Saharan Africa a killing field." UNICEF noted that the overwhelming majority of AIDS orphans are in Africa, and most have higher rates of malnutrition, stunting and illiteracy. Furthermore, Bellamy pointed out that whereas the United States spends $880 million to prevent about 40,000 new cases each year, Africa as a whole spends only about $150 million for four million new cases, with only 10 percent of that sum coming from governments. Community education should be a top priority, Bellamy said, adding that access to voluntary and confidential HIV testing for pregnant women and treatment to help prevent mother-to-child HIV transmission should also be goals.

Africa's AIDS Epidemic. Nine African nations have declared AIDS a national disaster in their countries. At the 11th International Conference on AIDS and Sexually Transmitted Diseases (ICASA) in Lusaka, Zambia, officials from Burkina Faso, Lesotho, Malawi, Mozambique, Congo Republic, Swaziland, Tanzania, Zambia and Zimbabwe said the disease was a threat to development "requiring an emergency response."

World Bank to Increase Funding in Africa. The World Bank has announced a significant increase in its funding for AIDS programs in Africa. According to World Bank official Callisto Madavo, a large portion of the International Development Association's (IDA's) $3 billion annual budget will be devoted to the war on AIDS in Africa, although no specific sum was mentioned. Madavo, speaking at the introduction of the World Bank's new anti-AIDS plan in Lusaka, Zambia, explained that to obtain this funding, governments must request it and have specific plans for its use.

UNAIDS Makes Full Use of ICASA. The United Nations Joint Program on HIV/AIDS (UNAIDS) is training staff members of the International Conference on AIDS/HIV and Sexually Transmitted Diseases (ICASA) about issues related to the epidemic. According to UNAIDS training officer Philippe Gasquet, the staff is being instructed about HIV/AIDS issues at both the regional and national levels, and advocacy techniques are also being addressed. The training workshop, organized for UNAIDS country program advisors (CPAs) who coordinate HIV activities at the field level in African nations, also includes junior professional officers from several European countries who will work with the CPAs.

Bellamy Named to Second Term as UNICEF Chief. United Nations Secretary-General Kofi Annan has reappointed Carol Bellamy as head of the U.N. Children's Fund. In a statement, Bellamy noted there have been many successes in her first term and pledged to make AIDS and poverty among her priorities for the coming session.

Call for Governments to Back Development of AIDS Vaccine. At a two-day meeting of the World Federation of Scientists in Erice, Sicily, participants drew up a statement highlighting the need to develop an AIDS vaccine and asking governments to become more involved. The statement notes that the urgency "is such that even a partially effective vaccine would still be valuable in significantly reducing the rate at which HIV is spreading." In addition, because the greatest demand for an AIDS vaccine will be in the developing world and it would thus probably not generate large profits for manufacturers, the Erice statement recommends new incentives to bring companies into public and private partnerships. Two signatories of the document include Dr. Robert Gallo, head of the Institute of Human Virology in Baltimore, and Dr. Luc Montagnier, director of the World Foundation for AIDS Research and Prevention in Paris.

Topic of Cancer. A 13-year longitudinal study of 3,616 people with AIDS revealed that almost 25 percent developed some form of cancer. Kaposi's sarcoma and non-Hodgkin's disease were common and expected. However, the prevalence of Hodgkins disease and unusual varieties of lip and skin cancers was worrisome. Andrew Grulich, author of the study, believes that antiretroviral drugs improve the body's immune system but do not return it to normal, making people with AIDS more prone to cancer as they age. It is recommended that doctors look for symptoms of such cancers on a regular basis. Also, people with HIV should go for regular skin screenings with doctors knowledgeable about the virus.

M.L. Labs Permitted to Do AIDS Drug Test in U.S. The U.S. Food and Drug Administration has given England's M.L. Laboratories permission to conduct intermediate Phase II tests of its Viraldon AIDS drug. The study will involve late-stage AIDS patients who will receive the treatment every other day for eight weeks. Phase II/III trials of the drug are currently being conducted in the United Kingdom.

Bristol-Myers Wins FDA Approval for Combined Use of Two HIV Drugs. The U.S. Food and Drug Administration has approved two AIDS drugs from Bristol-Myers Squibb for use both with each other and with other AIDS treatments. The two reverse transcriptase inhibitors, Zerit and Videx, have been used on their own since the early part of the decade; but they can now also be used with protease inhibitors and the non-nucleoside analogue efavirenz.

UAB Docs Working on New HIV Battler. Scientists from the University of Alabama at Birmingham (UAB) have initiated clinical trials of a new fusion inhibitor HIV drug that they anticipate will be able to fight the virus before it enters healthy cells. The compound, called T-1249, consists of a protein that inhibits the process through which the virus attaches to a cell. Early studies suggest the product is as promising as protease inhibitors were when they were at this stage of development and that it is even effective against viral strains that are now resistant to current HIV drugs. T-1249 is being billed as an improvement over a similar product, T-20, which is now in phase II trials. While T-20 has to be administered by catheter, T-1249 can be injected by patients in a manner similar to insulin injections. Trimeris, which is working with UAB and Duke University on the trials, has signed a research and development agreement with Roche for both products.

HAART May Reverse Mild HIV Dementia. Findings published in Neurology, the journal of the American Academy of Neurology, suggest that the early phases of HIV-related dementia may be treatable. According to the research, highly active antiretroviral therapy (HAART) can undo chemical changes and brain damage that stem from HIV infection. Study author Dr. Linda Chang of the University of California at Los Angeles noted that these changes may even be reversible with early detection and treatment because early HIV-associated dementia is linked to chemical, not structural, brain changes. The researchers studied 16 patients with HIV-cognitive motor complex before and after HAART was administered. According to the study, 14 of the patients also had clinical improvements in HIV dementia, with myoinositol levels returning almost to normal in most.

Preaching Prevention. Dr. Robert G. Brooks, Florida's new health secretary, stated September 20 that public health officials need to emphasize disease prevention, a focus that would include teaching abstinence. At a statewide abstinence educators conference in Jacksonville, Brooks pointed out that while teenage pregnancy rates are falling, surveys indicate that the pressure to have sex is very high for teenagers. In addition, the U.S. is dealing with epidemics of sexually transmitted diseases like chlamydia and human papillomavirus, with more than three million STDs reported among young people annually.

Complacency About HIV Growing Among Those Seen Most at Risk. The first ever National HIV Prevention Conference, sponsored by the Center for Disease Control and Prevention and seventeen other organizations, opened the weekend of August 28 in Atlanta. The four-day conference will cover the latest patterns in HIV and AIDS deaths, as well as infection rates for the general population. At the meeting, health officials noted there is increasing complacency about HIV, particularly among some individuals at high risk for the disease. Dr. Helene Gayle, director of the CDC's National Center for HIV, STD, and TB Prevention, said, "Despite a growing complacency about the need for HIV prevention, HIV remains a serious disease that is still very much with us and there is a greater need for HIV prevention today more than ever." While the rate of new HIV infections has dropped from about 100,000 a year to 40,000 a year, health officials noted that the epidemic is increasingly affecting women and minorities. According to U.S. Surgeon General David Satcher, African Americans accounted for about 25 percent of new AIDS cases reported in mid-1980s, Hispanics about 14 percent, and women about 8 percent. As of 1997-1998, however, African Americans made up 45 percent of the cases, Hispanics made up 22 percent, and women made up 23 percent. Gayle said that poverty and racism are key factors in regards to who contracts HIV and who receives effective treatment for the disease. In addition, she noted that while fewer people were being diagnosed with HIV, the declines now are not as significant as they were two years ago, with some high incidence rates in populations thought to have the virus more under control.

HHS Awards $3.9 Million to Improve HIV/AIDS Care. The U.S. Department of Health and Human Services (HHS) has awarded $3.9 million in planning grants in an effort to increase HIV/AIDS care to African-Americans and people in rural and underserved regions. In announcing the awards, HHS Secretary Donna E. Shalala said, "These grants will help address two key challenges of this epidemic: -- the disproportionate impact of HIV/AIDS on the African-American community and an increasing need for access to care for individuals in rural and underserved communities." A total of 79 public and private organizations will receive funding under the Title III Grant Program of the Ryan White CARE Act, including 60 grants worth $3 million that are part of an HHS partnership with the Congressional Black Caucus.

TV Teaches College Students Casual Sex Is OK, Study Finds. A new report from the University of Michigan suggests that college students who believe that sex is expected in a relationship may developed that notion from television. According to the study, which was published in the August issue of the Journal of Sex Research, young women who see as few as 22 hours of television each month were more likely support a "recreational" concept of sex than those who watch less television. Researcher L. Monique Ward said, "TV's countless verbal and visual references to dating and sexual relationships" affect young adults' attitudes and expectations about sex. However, Ward noted that television often shows an unrealistic view of sex -- one that is risk-free and glamorous and can lead to confusion or disappointment.

Insisting on Condoms Strengthens Relationship. New research in The Journal of Adolescence shows that requesting a new sex partner to use a condom brings more respect into the relationship, contrary to previous beliefs. Whereas previous studies had found that many people may be embarrassed to suggest using the prophylactics for fear that their partners might think they have a sexually transmitted disease, the new findings indicate that the partner is more likely to have more respect and to like the other individual more. In addition, the use of a condom appeared to have no effect on beliefs about the partner's perception that the other individual had an STD. The study was based on role-playing by 268 college students about first-time sex.

Psychological and Demographic Factors Linked With HIV Therapy Adherence. New research from Spanish investigators suggests that individuals who are depressed and who have a perceived lack of social support have difficulty adhering to antiretroviral drug therapies for HIV infection. The team studied 366 HIV-infected patients over the course of six months; all patients completed a questionnaire that featured parts of the Beck Depression Inventory and the Hamilton Anxiety score test. Only 57.6 percent of patients demonstrated a satisfactory level of compliance -- defined as taking at least 90 percent of prescribed drugs -- but the researchers note the level is similar to that found in previous research. The findings are published in the September 10 issue of the journal AIDS.

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This article was provided by AIDS Survival Project. It is a part of the publication Survival News.