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February 1999 Treatment Chronicles

February 1999

Study Cites HIV's Ability to Mutate. Scientists from the Johns Hopkins University in Baltimore and the AIDS Research Institute in Pune, India, have mapped all of the genes of an Indian HIV subtype and have discovered that the virus can easily swap genes with other HIV strains. The researchers, who report their work in the Journal of Virology, note that the strain's ability to switch genes will make it difficult to develop an effective vaccine against the virus. Dr. Bob Bollinger and others sequenced HIV genes from six patients recently infected with HIV, finding that the Indian C subtype was different from C subtypes found in other parts of the world. One of the viral strains sequenced showed pieces of both subtype A and subtype C. Subtype C is the most commonly transmitted form of HIV in India and in Africa.

Merck to Begin Trials of New AIDS Drug That's Easier to Take. Merck said it expects this quarter to initiate early clinical tests of its second protease inhibitor AIDS drug, which it anticipates will have a less complex dosing and scheduling regimen. The drug maker hopes the new generation protease inhibitor can be taken once daily, versus the current Crixivan schedule of two pills every eight hours or thrice daily. In addition, Merck hopes patients will not be required to adhere to a special diet, which is necessary with Crixivan. Merck's improved drug would be a boon to patients struggling with the complexity of AIDS treatments; the elaborate regimens and high cost also inhibit treatment of HIV-infected patients in developing nations.

Glaxo Wins Approval for New AIDS Drug Despite Serious Risks. Glaxo Wellcome's newest AIDS drug, Ziagen, was approved for marketing by the Food and Drug Administration Thursday, December 17, 1998, even though clinical trials showed that about five percent of patients experienced significant, and in some cases, fatal side effects, including fever, nausea, abdominal pain, low blood pressure, and an enlarged liver. Despite the potential drawbacks, the FDA approved Ziagen because it is used to treat a life-threatening disease and may allow some patients to discontinue the use of drug "cocktails" that are the standard in AIDS treatment today. While many patients currently take as many as 20 pills a day, patients who can tolerate Ziagen in combination with another AIDS drug, such as Glaxo's Combivir, would have to only take about four pills a day. Ziagen, a nucleoside analogue reverse transcriptase inhibitor, is the fourth AIDS drug Glaxo has developed.

Indinavir Stones Can Persist for Long Periods in HIV-Positive Patients. Researchers at Walter Reed Medical Center in Washington, D.C., report two cases of prolonged indinavir nephrolithiasis in HIV-positive patients who had interrupted indinavir treatment. In the December issue of Clinical Infectious Diseases, Drs. Mark E. Polhemus and Naomi E. Aronson reported that two HIV-positive men who stopped indinavir treatment due to nephrolithiasis still had the problem after six months without the medication. One patient had the kidney stones for 11 months after indinavir treatment was stopped. The researchers note that while indinavir cessation is the conservative treatment for HIV-infected patients with kidney stones, not all cases resolve with conservative treatment, and physicians should strongly consider withdrawing indinavir with any episode of indinavir nephrolithiasis.

Killing HIV-Infected Cells by Transduction With an HIV Protease-Activated Caspase-3 Protein. Researchers from the Washington University School of Medicine in St. Louis provide proof-of-concept for a "Trojan horse" strategy of inducing cell suicide in HIV-infected cells. Adita M. Vocero-Akbani and colleagues engineered a transducing, modified, apoptosis-promoting caspase-3 protein, called TAT-Casp3. The protein substitutes HIV proteolytic cleavage sites for endogenous sites; it is activated by HIV protease and, thus, remains inactive in uninfected cells. The protein rapidly transduces and targets 100 percent of cells in a receptor-independent manner. The system "allows for the continual adaptability of TAT-Casp3 proteins to HIV strain proteolytic cleavage site variance and/or mutation," the researchers note. They add that the method could be used in the elimination of other pathogens that encode for specific proteases, such as hepatitis C virus and cytomegalovirus.

Increase in Heterosexually Acquired HIV Infection Validated. Researchers from the Centers for Disease Control and Prevention report in the January issue of the American Journal of Epidemiology that most patients with heterosexually acquired AIDS have a valid heterosexual risk of exposure to HIV, supporting reports of an emerging heterosexual AIDS epidemic in the United States. Dr. R. Monina Klevens and others at the CDC investigated heterosexual risk among almost 2,000 patients aged 13 years or older who reported heterosexual risk or no risk for HIV infection; heterosexual risk was validated in 82 percent of the subjects. About one-fifth of the men and over half of the women who initially reported no risk factors for the virus were determined to have most likely contracted HIV heterosexually. The authors suggest that health care workers determined efforts to identify and record accurate information for people infected with HIV and that there be periodic re-examination of patient risk factors to ensure data accuracy.

Gap Between Biology and Reality in AIDS. Last year highlighted a number of problems in HIV treatment. While triple combination therapy helps reduce mortality and opportunistic infections, it does not appear to eradicate opportunistic infections as was previously hoped. Additionally, adherence and toxicity issues have arisen, as the therapy requires strictly held regimens and can result in numerous adverse effects. However, non-nucleoside and new nucleoside analog reverse transcriptase inhibitors may expand treatment options, although the issues of the drugs' long-term safety and efficacy require further research. In the coming year, scientists will explore strategies to eradicate HIV from latently infected reservoirs and will focus on the development of more tolerable drugs with easier regimens.

Universal HIV Screening at a Major Metropolitan TB Clinic: HIV Prevalence and High-Risk Behaviors Among TB Patients. Researchers from Texas evaluated the outcome of universal HIV screening among patients at a public tuberculosis clinic in Fort Worth. HIV testing found 98 cases of HIV among 768 TB patients screened between Dec. 1, 1987, and Aug. 31, 1996. Among the 98 patients with HIV, 93 percent had one or more risk factor for HIV. Comparatively, 42 percent of the 670 HIV-negative patients had one or more risk factor. No combination of HIV risk factors identified all of the HIV-infected patients. The authors conclude that the metropolitan TB clinic is useful for HIV screening and that all TB patients should have access to HIV-antibody testing and counseling.

U.S. Man Sentenced to Life for Giving Son AIDS. Brian Stewart, a blood technician at several St. Louis-area hospitals, has been found guilty of injecting his 11-month-old son with HIV-infected blood and sentenced to life in prison by the St. Charles County Circuit Court. The sentence, which has an option for parole, was recommended by the jury and was the maximum allowed in the first-degree assault case.

Wyoming Ranks Low in Reported AIDS and HIV Cases. The number of HIV-infected people in Wyoming is falling, according to statistics released recently by the state. Eight HIV cases were reported last year, one-third less than the previous year. Three AIDS cases were also reported last year, which is half as many as reported in 1997. However, the state also reports that the mortality rate among HIV-infected individuals remains high.

100 Million Pound Boost to AIDS Fight. British Prime Minister Tony Blair is expected to announce a 100 million pound initiative to fight AIDS worldwide, with the majority of the funds going to African countries. According to officials, the money will go the Joint UN Program on HIV/AIDS, as well as other programs. Seventy percent of the 33.4 million HIV-infected people in the world live in Africa.

Japan Still Complacent About HIV/AIDS. According to analysts, Japan has the lowest public awareness of HIV/AIDS among industrialized nations, despite a steadily rising number of HIV and AIDS cases in the country. Over 550 new HIV cases were reported in the first 10 months of 1998, with 38 percent of the overall number HIV infections and full-blown AIDS cases occurring among people in their twenties. However, some awareness campaigns have been implemented, including a popular recent television drama that focused attention on HIV and teenage prostitution and led to an increase in testing. Also, UNICEF Japan is backing an education campaign, along with the Health and Welfare Ministry and other non-governmental organizations, that centers on changing attitudes toward the disease and promoting prevention and education. Some analysts note that attitudes and taboos concerning the open discussion of sex need to change before AIDS education comes to the fore.

AIDS in the Third World. Last year, 2.5 million people died of AIDS, making it the fourth largest killer in the world. Over 47 million people have been infected with HIV since the disease was first identified, including 14 million who have died. HIV is believed to have crossed to humans from chimpanzees in the middle part of the century in Congo, spreading around the world as the African population became increasingly infected, particularly in east and southern Africa. Botswana, Namibia, Swaziland, Zimbabwe and South Africa have been particularly affected by the disease, which could wreak economic havoc on the countries. HIV could also have drastic results in Asia, where seven million people are already infected. Insurance companies and employers are expected to take big hits due to HIV. In South Africa, 15 percent of civil servants are estimated to be infected with the virus. At the household level, the disease may be even more destructive. HIV often gets passed between partners and from mother-to-child. While a cheap vaccine would be the best treatment for the disease, prevention is currently the best course of action for many poor countries. A number of countries, including Thailand, Uganda and Senegal, have shown that preventive efforts can make a difference in helping to stem the spread of the disease.

AIDS Lays Waste to a Nation. United Nations statistics indicate that as many as 25% of adults in Zimbabwe are infected with HIV. Despite having the highest HIV rate in the world, behavioral changes to stop the spread of the disease have been slow in coming. While condom sales have doubled, some researchers report that there is little evidence that people are using the condoms or abstaining from high-risk sexual behavior. Furthermore, Zimbabwe spent just $300,000 in 1998 on AIDS campaigns. Many of the people who are dying from the disease are in their earning-prime and child-rearing years, which has led to a breakdown of extended families and an increasing number of orphans. Prostitution at truck stops and sex with multiple partners have been blamed for helping to spread the disease in the country. According to UN statistics, women in Zimbabwe who are between the ages of 15 and 19 are five times more likely to be infected with HIV than men.

Challenging the Conventional Stance on AIDS. Conspiracy theories about HIV still abound despite a wealth of available scientific evidence. Recently, the Rev. Al Sharpton and his National Action Network sponsored the Harlem AIDS Forum, which featured many outspoken opponents to traditional views on HIV and AIDS. Of approximately twelve speakers, only one believed that HIV is the cause of AIDS, but he also argued that the virus was being spread to people of color throughout the world through the World Health Organization via its vaccine programs. Event organizer Curtis Cost explained that the objective of the meeting "was to allow people to hear disparate perspectives, and to do their own research." According to a survey conducted by the Institute of Minority Health Research at Emory University's Rollins School of Health, 74% of African-Americans questioned believed they were very likely or somewhat likely to be used as test subjects for studies without their consent. Eighteen percent reported that they believe that HIV was an engineered virus and almost ten percent said that AIDS is part of a genocidal plot to kill black people. The AIDS epidemic has been particularly prevalent in the African-American community; although African-Americans comprise only 13% of the United States's total population, they accounted for 57% of new infections in 1997, according to the CDC. Some AIDS activists among the community disapprove of the conspiracy theories, asserting that they serve to subvert prevention efforts such as testing and safe sex.

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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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