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March 2001 HIV/AIDS Chronicles

March 2001

HIV-Related Oral Lesions Are Less Common With Highly Active Antiretroviral Therapy. Researchers at the Universidad Nacional Autonoma de Mexico discovered that highly active antiretroviral therapy (HAART) that includes a protease inhibitor can reduce the occurrence of HIV-associated oral lesions by 30 percent. The researchers studied the prevalence of oral lesions in 154 AIDS patients in Malaga, Spain, between 1997 and 1998. Just over half of the subjects had HIV-related oral lesions, most commonly oral candidiasis and hairy leucoplakia. The researchers suggest in the December 2000 issue of AIDS Patient Care and STDs (2000;14:627-635) that the drug regimen of reverse transcriptase inhibitors and protease inhibitors may have boosted the patients' immunologic conditions.

Insulin May Help AIDS Patient Gain Weight. A 47-year-old AIDS patient gained 15 pounds after six months of being treated with insulin injections, according to a new report. Researchers from the University of Arizona College of Medicine and the VA Medical Center in Phoenix found that the man, who had lost 20 pounds and was increasingly fatigued despite the fact that he was receiving antiviral drugs and receiving B12 and testosterone injections, weighed 140 pounds after three months of daily insulin shots and 147 pounds after six months. In addition, the patient's CD4 cell count rose while he received the insulin; his CD4 cell count dropped after the shots stopped. The researchers report in AIDS Patient Care and STDs (2000;14:575-579) that the patient reported no adverse effects from the insulin and he asked to resume treatment with the drug because he felt much better.

Health Tips: Dieticians Urge Nutrition Care for People With HIV. A position paper released by the American Dietetic Association (ADA) and Dieticians of Canada states that efforts to improve nutrition should be part of overall health care provided to HIV-infected individuals. Specifically, the groups recommended medical nutrition therapy and nutrition counseling. In addition, ADA spokesman Dr. Keith Ayoob notes that food and water safety issues should be discussed.

Natural Protein May Defend From HIV, Study Finds. Researchers at the University of Colorado Health Sciences Center say that a natural body protein usually associated with cystic fibrosis could be used to fight AIDS because it appears to prevent the AIDS virus from infecting cells. Alpha-1 antitrypsin (AAT) works in several ways against the virus, including blocking the ability of the virus to infect healthy cells and virtually halting the virus' ability to spread out of the cell. Dr. Leland Shapiro says that it could be possible to give extra AAT to HIV-infected patients. AAT is currently used to treat patients with cystic fibrosis and other genetic defects, and it is grown in the milk of genetically engineered animals.

Influenza Vaccination Does Not Accelerate HIV Infection. Records from the Adult and Adolescent Spectrum of HIV Disease Surveillance Project, reviewed by Dr. Patrick S. Sullivan and other investigators with the Centers for Disease Control and Prevention, showed that there is a slight decrease in the progression to AIDS-defining opportunistic disease among patients who were vaccinated against influenza. The study involved information from more than 25,000 patients between 1990 and 1999 at 113 clinics in 10 U.S. cities, with the review published in the journal AIDS. Among the 42 percent of patients immunized against influenza, the hazard was 0.93, with a time to death hazard of 0.97, but investigators could not determine whether the improvements were a result of the vaccination itself or a factor related to increased preventive care or overall interest in physical health. While other studies have demonstrated that CD4 cell counts have lowered or HIV RNA levels have increased with the use of an influenza vaccine, this most recent study, with the benefit of a larger sample size, determines that there is no increased risk in giving influenza vaccines to AIDS patients.

Quest, Stanford Find Antiviral Resistant HIV. Researchers at Quest Diagnostics and the Stanford University School of Medicine have identified an HIV-1 strain that has reduced susceptibility to reverse transcriptase inhibitors. Quest noted that the discovery of this new mutation will provide doctors with information to better select HIV-1 treatments for their patients. The company is using the findings, which are published in the November 2000 issue of the Journal of Virology (2000;74:10707-10713), to report lab results for its HIV-1 genotyping test.

Merck Confidence in AIDS Vaccine Encourages Advocacy Groups. The research head for Merck, the nation's second-leading drug maker, said Tuesday, December 12, that he was encouraged by ongoing early-stage human HIV vaccine studies at the company. Dr. Edward Scolnick told Wall Street analysts that Merck's vaccine candidates use specific HIV genes that are common to the virus' many strains, stimulating antibodies to work against the virus and prompting cellular immune-system cells to attack. The International AIDS Vaccine Initiative's Wayne Koff noted that animal studies reported by Merck in October 2000 -- in which monkeys were given a gene-based vaccine containing SIV and HIV DNA -- were also promising, showing that the vaccine stopped the animals from developing symptoms of HIV infection, although it did not keep them from contracting the disease. Meanwhile, Greg Gonsalves of the Treatment Action Group praised Merck's researchers and history of designing AIDS treatments; however, he said he would like to see more details for the vaccine.

AIDS Group Protests Drug Maker. Bristol-Myers Squibb's employee Christmas party was disrupted on Wednesday afternoon, December 20, by a group of AIDS activists. The protestors shouted accusations that the firm was involved in price-gouging practices for its new AIDS drug Videx. The demonstrators, organized by the New York chapter of ACT UP, were able to enter the drug maker's building but were quickly evicted by security personnel. The activists were apparently concerned with the price of a new formulation of Videx that is easier to take and has fewer side effects to the gastrointestinal tract.

The Limits of $100 Million. In early 1999 year, Bristol-Myers Squibb Chairman Charles A. Heimbold Jr. announced a five-year, $100 million AIDS initiative in Africa. Since that time, the "Secure the Future" project -- described by Heimbold as the "largest such corporate effort in history" -- has pledged about $44 million to 33 programs in southern Africa. However, the drug giant has received criticism from AIDS activists, officials in South Africa, and others regarding both the scope and direction of the program. Some claim that the program is actually helping very few people, while others say the donation's greatest benefit is in public relations, particularly as it may offset some of the pressure to increase access to costly AIDS drugs. A Washington Post review of the program supports some of the criticism, but the story is quite complex. The Secure the Future program has scaled back some of its original estimates, including revising a plan to spend $53 million of the total $100 million grant on "free drug treatment" to "no more than" $33 million. The program emphasizes medical research and is focusing on the education of American and African health workers, with more than three-quarters of the money committed so far going to U.S.-based charitable and medical research groups. The company has also used some of the funds for consultants, retaining former Rep. Ronald V. Dellums, the chairman of President Clinton's advisory council on HIV/AIDS, and giving over $1 million over the past five years to the International Association of Physicians in AIDS Care. While some critics claim the funds are being used to silence criticism, Bristol-Myers officials say the program will help to save lives and reflects the company's commitment to fighting a complex and deadly epidemic.

Vaccine Centers Unite Specialists in the Battle Against Infectious Diseases. In response to President Clinton's 1997 challenge to scientists that an AIDS vaccine be developed within 10 years, the Dale and Betty Bumpers Vaccine Research Center at the National Institutes of Health, located in Bethesda, Maryland, will open in spring 2001. Costing between $35 and $40 million to construct, the center will house all levels of scientific research techniques needed in the search for an AIDS vaccine. Center director Gary Nabel believes that although the primary focus of the center is to develop a vaccine against AIDS, the broader mission is to find vaccines for all diseases. He predicts that within 10 years, there will be a vaccine of sorts for AIDS, but whether it will be optimal or not is hard to say "because the [clinical] trials take so long."

New Turner U.N. Grants Target AIDS, Energy Needs. Ted Turner's United Nations Foundation announced on Wednesday, December 20, that, as part of its latest round of grants, it will invest $12 million in HIV prevention projects in eight southern African nations. Turner, an Atlanta businessman, has personally pledged $1 billion of his own funds over a 10-year period to the United Nations. Included among the new grants are $2.3 million over 18 months for the U.N. Development Program, U.N. Population Fund, and UNICEF to fight AIDS in South Africa; $2 million over 18 months for an Adolescent Program Initiative in southern Africa run by UNAIDS; and $821,000 over two years to UNAIDS for its global initiative to close the gap between the worldwide need and available resources for fighting AIDS. In addition to the AIDS-related grants, the foundation is also providing funding for energy projects in developing nations and energy efficiency programs in the largest greenhouse gas-emitting countries.

Debate Flares Over Firing of HIV-Infected Hygienist. Several national organizations, including the American Public Health Association and the Infectious Diseases Society of America, are contesting the dismissal of a dental hygienist in Atlanta on the basis of his HIV infection. The man, Spencer Waddell, filed suit after being fired in 1997, when he informed his employer that he had HIV. A briefing filed by attorney Stephen R. Scarborough of the Lambda Legal Defense Fund indicates that dentist Eugene Witkin confirmed that he has had no training regarding HIV transmission and he has not been to any seminars about HIV with regards to dentistry. Also backing Waddell is Northern Arizona University's Dr. Donald Marianos, who participated in the development of the Centers for Disease Control and Prevention's 1991 protocol for HIV-infected healthcare workers.

Ventura County News: Supervisors OK Needle Exchange Program. Declaring a medical emergency, health officials in Ventura County, California, voted Tuesday, December 19, to launch a needle exchange program in an effort to stop the spread of HIV and hepatitis. Dr. Robert Levin, medical director of the county Public Health Department, noted that approximately 50 percent of the injection drug users in the county are infected with hepatitis B or C, while injection drug use is behind the infections of nearly 20 percent of the men with AIDS in the county and 45 percent of the women with AIDS. The nonprofit Rainbow Alliance plans to start the needle exchange program in Ventura and Oxnard in March. Workers will provide clean needles, information about where to get treatment for drug addiction, and HIV testing.

Embattled Law Puts Syringes on Shelves. Since January 1, injection drug users in New York state have been allowed to purchase syringes without a prescription. Previously, new syringes were only available with a prescription, which made them expensive on the black market and resulted in needle sharing among addicts. The new law is a public health effort intended to reduce needle sharing and to stem the spread of blood-borne diseases, including HIV and hepatitis C. New York State Assemblyman Richard Gottfried (D-Manhattan), who has pushed for the law for over a decade, estimated that the HIV epidemic would be only half what it is were it not for the practice of needle sharing. "We are talking about tens of thousands of lives," he said. According to supporters of the new measure, the success of similar programs in other states was critical to the passage of the New York bill. After a needle law was adopted in Connecticut, needle sharing dropped by 50 percent and HIV infections fell by 33 percent in 1992 and 1993. Under the new measure, individuals will be able to buy up to 10 needles at a time from state-registered pharmacies, health care facilities, and professionals. The needles will be packaged with information about the risks of injection drug use, the correct ways to dispose of needles, and the possibilities of treating drug abuse and HIV infection.

Health Tips: AIDS Afflicts the Elderly. While the number of AIDS cases in younger people is reportedly declining, experts at the Administration on Aging (AOA) say that 11 percent of all AIDS cases reported in the United States are in people 50 years of age or older. As better treatments are developed for AIDS, baby boomers with the disease are living longer, increasing the actual reported senior cases of AIDS at a rate of 10 percent per year. The AOA noted that health care professional need to acknowledge that older people may engage in risky behaviors, and they should also learned to evaluate the symptoms of AIDS in this group.

Older Patients Especially Prone to Depression, Stress. The number of men over age 45 with AIDS has doubled since 1995, and approximately one-quarter of the newly infected women are between the ages of 35 and 44. These statistics, as well as the ability of antiretroviral drugs to extend HIV patients' lives, lend support the suggestion that the HIV-infected population will increasingly shift to people in their middle years. People with HIV in their 50s or older have specific concerns, including depression. Timothy Heckman, associate professor of psychology at Ohio University in Athens, has helped with two studies of depression among older HIV patients. Because older people often live alone, they suffer from feelings of depression, and HIV infection can cause loss of independence and discrimination, leading to thoughts of suicide. Suicide is a top 10 cause of death for adults aged 45 to 65, and HIV infection makes the risk significantly higher. Heckman studied how healthcare workers can help this group of people. Among other things, he found that they should increase group support of older adults, who enjoy meeting people their age with HIV. Coping training is also important, and a support group can create goals to help prevent depression after the loss of a loved one or lost job. Disclosing HIV status is also painful to older adults, who need help with telling their family. A support group provides an arena to practice HIV disclosure. Telephone support groups can link several people at the same time, so they can have a normal conversation, if they are not all together. Internet chat rooms can provide similar support, but many low-income people say that a telephone conference is a more viable option.

Speaking Out to Make AIDS an Issue of Color. In an interview with the New York Times, Phill Wilson, the executive director of the African American AIDS Policy and Training Institute at the University of Southern California, discusses AIDS in the African-American community. Wilson notes, "Let's be clear, when you hear about women and AIDS or babies with AIDS or now even men who sleep with men who have AIDS, whether it's stated or not, those are overwhelmingly black women, black babies, and black men." Statistics from the Centers for Disease Control and Prevention indicate that AIDS is the number one cause of death among African-American men between the ages of 18 and 44 and the number 2 cause of death for African-American women in that age group. In addition, more than 50 percent of the new HIV infections reported in the United States in 1999-2000 were among African Americans. Wilson explains that, in recent years, there have been renewed efforts to fight AIDS in the African-American community, led by the Congressional Black Caucus, the NAACP, Jesse Jackson and the Rainbow Coalition, and others. He also notes, in response to a question about the value of widespread HIV screening, that testing "is a portal to care and treatment" and that "too many African Americans don't know their [HIV] status."

Gathering Focuses on AIDS Awareness, Black Churches' Support Key, Attendees Say. Participants at an AIDS conference in Houston on Saturday, December 9, said that prevention awareness is slowly taking hold among African Americans in the city and more religious leaders have joined in the fight against AIDS. Roy Delesbore, a health program specialist with the Texas Department of Health, noted that while some religious leaders have been hesitant to discuss the disease, that is starting to change, although he said more religious leaders could help. Approximately 300 people attended the conference, which was sponsored by Houston's Health and Human Services Department and City Councilman Jew Don Boney Jr. Boney reported that in the year since Houston Mayor Lee Brown declared an AIDS state of emergency, more than 2,500 new HIV cases have been reported in the city. Sixty-one percent of those cases were among African Americans, he said, and 78 percent of the cases among 13- to 19-year-olds were in African-American females.

[St. Louis] Teenagers Teach Facts, Dispell Myths About HIV and AIDS. As part of their World AIDS Day events, students from Cleveland Naval ROTC Academy in St. Louis talked about HIV and AIDS with eighth graders from Nottingham Middle School. The Cleveland Naval students -- who had been trained with the American Red Cross YouthCorps program -- discussed methods of HIV transmission, including casual unprotected sex, contaminated needles, and blood-to-blood contact with an HIV-infected individual. The program noted that while there are drug regimens that can help control HIV, there is still no cure. The student educators also worked to dispel myths surrounding the disease, such as the belief that one can contract HIV via casual touching or kissing. Statistics from the Missouri Department of Health show there were 1,222 cases of HIV and 2,315 cases of AIDS in St. Louis in 1999, with the fastest-growing rate of infection among individuals between the ages of 15 and 44.

Gays "Rebelling Against Safe Sex Message." Researchers are now saying that promotions of safe sex targeting the gay community may be causing a backlash in unsafe sexual behavior. One explanation for this reaction may involve simple rebellion to authority, the researchers said Tuesday, December 19. Dr. Michele Crossley, a University of Manchester researcher who presented her findings at the British Psychological Society's conference in London, explained: "Simplistic attempts at health promotion may have exacerbated the problem by failing to bring such psychological dynamics to the public domain, and thus creating a 'taboo' of unsafe sex." Also, research conducted by scientists at the Royal Free Hospital in London indicated that gay men who had taken at least three HIV tests were more likely to engage in dangerous sexual activities and had an increased incidence of HIV infection. The researchers noted that a negative test result seemed to spur some of the men to take more risks.

HIV on the Rise, UN Says Sex, Drugs Blamed. The recent report from the United Nations warns that prostitution and drug use are the primary reasons for the spread of HIV in previously unaffected communities in eastern Europe and Africa. The report estimates that there were 3.8 million new infections in sub-Saharan Africa in 1999, bringing the total for the entire area to over 25 million. UNAIDS head Dr. Peter Piot commented, "The AIDS situation in Africa is catastrophic and sub-Saharan Africa continues to head the list as the world's most affected region." Piot noted that socio-economic instability in many of the countries has resulted in increases in drug use and prostitution, both of which are risk factors for HIV infection.

Countries Pledge to Reduce Youth HIV Infection Rate by 25 Percent. Officials from the Group of Eight (G-8) nations and developing countries reportedly have pledged to cut the youth HIV infection rate by 25 percent by 2005. The officials were meeting at the two-day Okinawa International Conference on Infectious Diseases, a follow-up to the G-8 nations' meeting in Okinawa in July 2000. Japanese officials reported Friday, December 8, that the participants also pledged to have 70 percent of tuberculosis (TB) patients undergo medical treatment, with a cure rate of 85 percent, and they created an action plan that called for each nation to develop a five-year TB prevention plan by November 2001.

Female Condoms to Launch in China. Starting in 2001, Western-made female condoms will be available in China, where at least 500,000 people are infected with HIV. A report in the Shanghai Daily indicated that the Female Health Company of Chicago has registered its Femidom female condom in China, and is working with a local firm to market the condom online. Xu Jinxun of Shanghai's Municipal Commission for Population and Family Planning surveyed 30 couples about Femidom in 1998. According to the newspaper report, 90 percent of the husbands and wives thought the product was acceptable, and 80 percent of women and 73 percent of men said it was preferable to the male condom. Domestically made condoms were introduced in China in 1999, but they have not been much of a hit, with cost and comfort cited as two main issues.

Chinese Measures to Slow HIV Spread Appear Ineffective. A new report suggests that despite China's efforts to end them, prostitution and drug abuse are the primary modes of HIV transmission in the country. According to Dr. Ai-xia Wang of Peking Union Medical College Hospital in Beijing, who presented her findings at the Seventh Western Pacific Conference on Chemotherapy and Infectious Diseases in Hong Kong, condoms are widely used in China; however, they are mostly promoted for family planning, instead of for the prevention of sexually transmitted infections. A separate report estimated that the actual number of HIV infections in China is up to 25 times higher than the official 20,711 cases reported. The report predicted that there might be ten million HIV cases in China by 2010.

Brazil Tackles HIV Head-On by Providing Free Medicine. The best way to delay the onset of AIDS in HIV-positive people is to use a mix of antiretroviral drugs, but the cocktail required can be impossibly expensive, particularly for those who live in developing nations. The Brazilian government, however, authorized state laboratories to make generic copies of seven of the 12 cocktail drugs, which cut the cost of annual production by almost two-thirds. In addition, the government distributes the drugs for free to 90,000 people. The program shows that Third-World governments can have a deep impact on fighting AIDS, and that the high cost of the drugs does not make an impassable barrier. Brazil passed a patent law in 1997 that made those seven drugs' patents public property, among other patents, and then decided that it would be less expensive to make the drugs itself. It will begin making the eighth such medicine in early 2001 and is in negotiations with private companies for another four, but Brazilian authorities have told the companies that if they do not lower the cost of those four drugs, the government will invoke a constitutional provision and break the patent licenses. Abbott Labs head of institutional relations Irapuan Oliveira expresses concern about loss of market share and possible quality problems in the substitution of government-made drugs for the company's. Brazil officials say, however, that the first two years of the program have kept 146,000 people out of the hospital and saved Brazil $472 million. It has also helped slow the spread of AIDS. Brazil has tried to enlist the aid of international agencies to share its program, but they have refused. So the nation says it will post the information on its Web site and give away the technology free of charge.

An Unequal Calculus of Life and Death. The advent of antiretroviral drugs in the United States and other wealthy nations has helped to extend many HIV patients' lives, but very few people benefit from the treatments in Africa. While an estimated 25 million Africans are infected with HIV, only about one-tenth of 1 percent receive antiretroviral therapy. Last year had seen calls to action and pledges of assistance from governments and the pharmaceutical industry. A review by the Washington Post, however, indicates that, fundamentally, not much has changed, as only one of the five drug companies that promised deep price reductions has disclosed the actual cuts. In addition, Pfizer agreed to provide its antifungal Diflucan free of charge to AIDS patients in South Africa, but the drug has not yet been delivered. Moreover, no one has taken up the White House's offer of $1 billion, which is available in the form of Export-Import loans with commercial interest rates. Some drug makers are apparently concerned that deep price discounts in Africa could have far-reaching implications, such as the re-export of cheaper drugs from poor to wealthy nations, or a possible backlash if the price cuts then focused attention on high profit margins in developed nations. Harvard economist Jeffrey Sachs notes, "Like most things in the world, it comes down to money, and nobody has been willing to commit money to this."

Most Untreated African HIV Children Will Die by Age 3. An 18-month study recently conducted in Malawi concluded that nearly 90 percent of African children infected with HIV do not survive beyond their third birthday. Researchers from the Johns Hopkins University in Baltimore found that 89 percent of the 190 HIV-infected children who were alive at six months of age died by age three, while a European study concluded that less than 20 percent of HIV-infected children died by three years of age and an American study reported that three-quarters lived to age five. According to the authors, the number of deaths among HIV-infected children in Africa could be reduced by improving medical attention to persistent diarrhea and chronic middle-ear infections. The research is published in the December 2000 issue of Pediatrics (2000;106).

Child Prostitution and the Spread of AIDS. There are at least 13 million children in Morocco, most of whom must make a living any way they can to help support their families, including prostitution. The threat of HIV is ever present for the street children of Morocco. But the actual number of reported HIV/AIDS cases (809) is low in comparison to the Health Ministry's total estimate of 400,000 sexually transmitted disease cases running through the country. The Moroccan AIDS Service Organization began a study to gather information regarding the habits of male prostitutes in hopes of recommending a preventative methods program. The study revealed that male prostitutes had little or no awareness of the dangers of HIV and had no skills sets with which to bargain with their clients for safe sex. Although a program educating people about the disease and the prevention of it was established as a result of the study, efforts are hampered because local police consider the possession of condoms as proof of illegal prostitution and, thus, many prostitutes are reluctant to carry the prophylactics with them.

AIDS Activists Win Mandela Award. The Nelson Mandela Award for Health and Human Rights, an annual award established in 1993 by the Henry J. Kaiser Family Foundation, has been given to two South African AIDS activists. According to the foundation, the recipients of the 2000 award are Dr. Hoosen Coovadia, the head of the department of pediatrics at Natal University, and Judge Edwin Cameron, who revealed in 1998 that he was infected with HIV. Coovadia, the chair of the AIDS 2000 Conference held in Durban earlier in 2000, was recognized for his commitment to studying pediatric AIDS in the country. Cameron, meanwhile, attracted worldwide attention at the AIDS conference when he publicly condemned international pharmaceutical firms and South Africa's president, Thabo Mbeki.

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