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February 2000 Treatment Chronicles
From the CDC National AIDS Clearinghouse

Compiled by Ernie Evangelista

February 2000


HIV Protein Could Be New Drug Target. Scientists from the University of Massachusetts Medical Center in Worcester have determined two functions of the HIV matrix protein, a molecule that is needed for HIV replication. The findings, published in the journal Nature, could aid in the development of new HIV drugs. The report details how the protein helps HIV invade the cell nucleus and produce its own RNA. According to Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, the discovery suggests that it may be possible to interrupt the order and timing of cellular processes that are needed for HIV to replicate.

South Korean Scientists Claim Breakthrough in Developing AIDS Vaccine. Scientists in South Korea have reported a breakthrough in developing DNA vaccines to protect against HIV in humans. A research team at Pohang University of Science and Technology has created a vaccine that completely protected monkeys against SIV-239. According to the scientists, the vaccine boosted the monkeys' antibodies to the virus and generated immune responses. Professor Sung Young-Chul said that the vaccinated monkeys showed signs of infection in the early phases of the experiment, but the vaccine later was able to keep viral levels under control. Researchers note that it is too soon to know whether the vaccine will help humans fight AIDS, and further trials are needed.

Dual Virus Infections on Rise. More Americans are being diagnosed with both HIV and hepatitis C virus (HCV). Injection drug users are at risk for both diseases. About 40 percent of those with HIV also have HCV, a combination that makes treatment regimens difficult because of multiple side effects. The symptoms of both HIV and hepatitis C can be delayed for years, are unaffected by antibodies, and multiply very quickly. Some nurses and health workers contract both infections from accidental needle sticks. Nurse Karen Daley, president of the Massachusetts Nurses Association, was infected with both viruses last year after an accidental needle stick. On Wednesday, December 1, 1999, she detailed her experience at the Kennedy Library conference, sponsored by Lemuel Shattuck Hospital, the Massachusetts Department of Public Health, and the Massachusetts Medical Society.

Identifying HIV Cases by Name Has Little Impact on Treatment. A November report in the Annals of Internal Medicine has found that keeping records of people infected with HIV by name does not help or hinder treatment, and it does not improve contact notification. Name-based HIV infection surveillance has been implemented in 31 states, but it is a controversial topic. Dr. Dennis Osmond of the University of California at San Francisco and colleagues studied about 400 AIDS patients who were tested in five states with name-based HIV surveillance and found no evidence that name-tracking swayed timely medical care to either side. The researchers concluded that both the negative and positive effects of name-based HIV surveillance may have been overstated by competing advocates.

Validation Studies Begin for New Test to Detect HIV Reservoir. ChromaVision Medical Systems and the University of California at Los Angles (UCLA) School of Medicine will collaborate on studies of a new test designed to detect and quantify the HIV reservoir in people infected with the virus. UCLA's Dr. Kathie Grovit-Ferbas will be the primary researcher of the validation studies involving the Automated Cellular Imaging System (ACIS). Researchers at UCLA also plan to assess the efficacy of ACIS in detecting cytomegalovirus.

Anti-HIV Drugs May Cause Heart Ailments. HIV patients taking protease inhibitor therapy may be at risk for heart attacks, as four men between the ages of 35 and 44 have had heart attacks after two years of therapy. Although no link has been proven, researchers fear that the life-extending anti-HIV drugs may cause cardiovascular disease. HIV patients often experience side effects such as lipodystrophy, diabetes, and high cholesterol, because of antiviral drugs. High cholesterol is also a major risk factor for heart disease, according to the American Heart Association.

HIV Finds Hiding Places Unreachable by Drugs. New research from microbiologist Ashley Haase of the University of Minnesota and colleagues shows that HIV quickly finds hiding places in the body that no drug can attack. According to the study, HIV entered resting T-cells -- which are inactive and not noticed by the immune system -- within three days of getting into the body. The researchers, who report their findings in the journal, Science, infected 14 rhesus monkeys vaginally and observed that by day 12 HIV could be detected throughout the animals' lymphatic systems and organs. A similar pattern of infection was noted in patients with HIV infections, the researchers added.

HIV Resistance to Lamivudine Develops Rapidly When Given With AZT in Pregnancy. A study published in the November issue of the Journal of Medical Virology suggests that rapid genotypic resistance to lamivudine occurs when the drug is given in combination with zidovudine to HIV-positive pregnant women. The prospective trial involved 14 HIV-infected pregnant women who received zidovudine and five HIV-infected pregnant women who were given zidovudine and lamivudine. Both regimens produced viral load reductions and CD4 cell increases, but the women on the dual therapy saw greater reductions in viral load and larger increases in CD4 cell counts. The researchers note, however, that four of the women receiving both lamivudine and zidovudine had a M184V mutation in the reverse transcriptase gene that is linked to reduced susceptibility to lamivudine at delivery.

Some With HIV Forgo Care, Study Reports. Researchers from the University of California at Los Angeles, the Rand Corp. and eight other institutions have found that one-third of U.S. HIV patients forgo medical care because of the time or money it costs them. Minorities, women, drug abusers, and those in poverty were the most likely to skip treatment and instead work or spend the money for food and shelter. Eight percent reported that they went without food, clothing, or shelter at times to use money for HIV care.

Home HIV Test Halted. Internet company Medimax Inc. has been charged with falsely representing the accuracy of its HIV tests. According to the Federal Trade Commission, the website for company founder David Rothbart claimed Medimax was "the industry leader in the distribution of clinically proven and FDA-approved diagnostic rapid tests." Regulators assert, however, that the test on his site was not approved for sale in the United States. The agency's complaint hopes to stop Rothbart from further misrepresentation regarding the tests and also wants him to repay consumers.

Hospices Are Succumbing to Falling AIDS Mortality. The decline in the number of deaths from AIDS the past few years has affected hospices in the Los Angeles area and throughout the United States, causing some to close their doors as patients live longer and healthier lives. Richard Bettger was once near death because of AIDS, and went to a hospice to die. However, new drug treatments helped him recover within a year and he was able to return to his old life. AIDS mortality in Los Angeles County fell 52 percent in 1997 from 1996, and then by 34 percent in the following year.

Health Chief Urges AIDS Education. On Friday, November 6, 1999, U.S. Surgeon General David Satcher spoke in support of needle exchange programs and AIDS education campaigns. At the U.S. Conference on AIDS, Satcher stated, "The epidemic is far from over." Satcher focused on prevention as the best strategy against HIV, and he noted that research has demonstrated that needle exchanges can get more injection drug users into treatment while not encouraging drug abuse. Dr. Peter Piot, executive director of the joint United Nations Program on HIV/AIDS, also called on the United States to provide increased funding and technical assistance to help control AIDS throughout the world.

AIDS, HIV Rates Down for State, Federal Prisoners. The number of inmate deaths from AIDS declined over 50 percent between 1995 and 1997, according to the U.S. Department of Justice. The report found that 48 of every 100,000 prisoners died from AIDS in 1997, compared to 100 AIDS deaths per 100,000 prisoners in 1995. There were 538 inmate deaths caused by AIDS in 1997, down from 907 in the previous year. The Justice Department also noted that the number of HIV-infected inmates decreased by 333 in 1997, for a total of 23,548 infections.

Activists Give Clinton Administration an F for HIV Prevention. AIDS activists have issued their report card on the U.S. government's response to AIDS, issuing an F for HIV prevention, an A- for research, and a B for care and treatment. The activists said that prevention programs have failed to protect young people being infected with HIV. They also noted the high cost of AIDS drugs, which many developing nations cannot afford. The ratings were high in the research, care and treatment fields due to ongoing investment in AIDS research and continued funding in the Ryan White CARE Act. The failing grade for global AIDS last year was boosted to a C in 1999 after the White House established a global AIDS initiative.

HHS Awards $11 Million in HIV/AIDS. The Health Resources and Services Administration (HRSA) will fund an $11 million grant program next spring to help four demonstration projects and one evaluation center to provide health care to people with HIV/AIDS living on the U.S.-Mexico border. An increasing number of border dwellers are becoming infected with HIV, and many have no access to care. The program is a joint effort between HRSA and its Office of Field Operations, and is funded mostly by the Ryan White CARE Act.

Bradley Accuses Gore of Scare Tactics on Health. Presidential hopeful Bill Bradley has denied Gore's claim that Bradley's plan to use vouchers and tax credits to help everyone pay for private insurance would be detrimental to the poor because it eliminates Medicaid. Gore claims the vouchers would not be enough to help the uninsured, and would affect many minority groups who depend on Medicaid. Health care and gay rights advocates also claim that Bradley's plan would be hard for people with HIV, who rely on Medicaid, including about 90 percent of children with AIDS who currently need Medicaid to help pay for treatment.

Rubber Replacement. The sap of the guayule plant, a desert shrub found in Mexico and southwestern Texas, may be an effective alternative to latex, according to new research. An estimated 20 million Americans experience allergic reactions to latex, which is used in condoms and surgical gloves. Researchers report in the British weekly, New Scientist, that the guayule sap is hygienic, non-allergenic and stronger than the sap of the Brazilian rubber plant, from which latex is made.

Encouraging Use of Coupons to Stimulate Condom Purchase. A study conducted in Vancouver, British Columbia, sought to determine whether issuing high-value coupons for condoms influenced condom purchases by young adults. Using coupons for 10 percent and 75 percent off, the researchers found that the discount coupons were successful in encouraging people to buy condoms. While both males and females responded to the coupons, purchases by males increased significantly. The male consumers became more focused on a few brands, while the females tended to investigate other options and spent more time considering a purchase. Also, while both coupon values significantly increased the number of men who browsed the condom displays, only the 75 percent off coupon boosted females' browsing relative to the base level.

Use of Reality "Female Condoms" for Anal Sex by U.S. Men Who Have Sex With Men. Researchers surveyed more than 2,200 HIV-seronegative men who have sex with men about their use of the Reality female condom. Of the men, 48 percent had heard of using the female condom for anal sex, and 13 percent of them reported using it in the last six months. Almost half of the receptive users complained that the female condom was painful, prevented pleasure and was hard to keep in place. More than a third of the insertive users also reported problems. Based on their findings, the researchers concluded that more tests involving the safety and efficacy of the female condom in anal sex are required, especially with the looming risk of HIV infection.

AIDS Sickening African Economies; Farms Are Idle, Jobs Unfilled. The AIDS epidemic in Africa is sickening and weakening the agrarian economies of the continent, as an increasing part of the work force is unable to perform any labor. AIDS is taking the lives of young men and women with young families, causing many families to live on hand-outs and loans. It is estimated that for the next two decades the continent's rate of economic growth will slow 1.4 percentage points each year as a result of the diminishing labor pool. Over 5,000 people a day die from AIDS in Africa, a number that some experts say could reach nearly 13,000 by 2005. Included among the many examples of companies affected by AIDS, Zambia's largest cement company has seen a 15-fold increase in absenteeism since 1992, Uganda's railroad company has lost 15 percent of its work force each year, and 11 percent of the workers at the South African electric utility Eskom are reported to have HIV.

India Has an Alarming Number of HIV-Positive Newborns. A new report from UNICEF shows that 30,000 newborns in India are born with HIV every year. The large number highlights the need for an aggressive campaign against HIV, and the need for women to be able protect themselves against diseases. According to UNICEF's Alan Court, 25 percent of 400 women attending clinics in the city of Pune tested positive for a sexually transmitted disease and 13.6 percent tested HIV-positive, yet more than 90 percent reported only having had sex with their husbands. India recently announced that as many as 3.5 million people in the country may be infected with HIV.

U.N. Issues Grim Report on the 11 Million Children Orphaned by AIDS. A United Nations report issued for World AIDS Day shows that over 11 million children have been orphaned by AIDS since 1981, and that number is expected to reach 13 million by the end of next year. AIDS is believed to be the leading disease causing children to lose a parent. Approximately 95 percent of the orphaned children live in sub-Saharan Africa, UNAIDS and UNICEF said. The report noted that whereas in the past families would take care of orphans, "the traditional African extended family is breaking down under the unprecedented burden of the pandemic." Dr. Peter Piot, head of UNAIDS, added that many of the orphans become child laborers or end up on the streets, becoming targets for gangs, militia and child armies. In addition, the report said that, compared to children orphaned for other reasons, AIDS orphans are at greater risk for malnutrition and related conditions, illness, abuse and sexual exploitation.

Central Europe Has Lowest HIV-Related Mortality in Region. A Fall 1999 study by members of the EuroSIDA Study Group found that there are increased survival rates for HIV-infected people living in central Europe. The study, which ran from 1994 to 1997, included 7,331 HIV-positive individuals in 18 European countries. Overall, the group found that patients in central Europe fared better than those living in northern or southern Europe. According to the researchers, the risk of death in central Europe was at least one-third lower than that in southern Europe and in northern Europe; however, they suggest the numbers will soon be comparable as treatment strategies become more widespread.

Canada Enters Into New Collaboration With UNAIDS. Health Canada is now a Collaborating Center according to UNAIDS standards. Canadian Health Minister Allan Rock has stated that the partnership between UNAIDS and Health Canada will help other countries deal with the AIDS epidemic, including many in Africa. Developing African countries have been most affected by AIDS and have few resources to combat the spread of HIV. Health Canada aims to help provide technology, research and surveillance for these countries.

UNAIDS Again Calls on Private Sector to Address AIDS in the Developing World. Officials with the Joint United Nations Program on HIV/AIDS see a great need for the private sector to help control the AIDS epidemic in developing nations. Three areas in which the private sector can help are implementing vertical transmission prevention programs, developing vaccines and improving access to treatment. The HIV vaccine is one plan that needs continued investment for a long-term solution, UNAIDS said.

Asia Risks Surpassing Africa in AIDS Epidemic. Without the necessary precautions, Asia could overtake Africa in the AIDS epidemic by 2005, according to a senior Chinese health official. Cases of HIV and AIDS in Asia are increasing rapidly, with an annual growth rate of about 20 percent in 1998, United Nations statistics show. The fact that India and China are the world's most populated countries could make AIDS explode in Asia as HIV cases there increase. Xu Hua, associate secretary-general of the China Sexually Transmitted Diseases and AIDS Foundation, stated that a census would be helpful to determine the extent of the problem, but a lack of resources was hampering efforts.

Researchers Stung by Claims of AIDS Origin. The Wistar Institute, which developed an attenuated live polio vaccine in the 1950s, said November 8, 1999, that it would allow two independent laboratories to test lab specimens to prove that its research in Africa was not responsible for initiating the transfer of SIV from chimpanzees to humans, where it mutated into HIV. The decision came after the release of a new book by British journalist Edward Hooper, titled The River: A Journey to the Source of HIV and AIDS, which argues the vaccine was produced with tissue from chimpanzees infected with SIV and then tested on children. Researchers directly involved with the development and testing of the polio vaccine in the 1950s adamantly denied the accusations and said the chimpanzees were used to test the vaccines, not produce them. Four years ago, Swedish scientists tested one of the samples to dispel similar arguments, but the new testing will involve both lots in order to reach a final conclusion.

Gay and Lesbian Charities Look to Life Beyond AIDS. Tim Gill is the openly gay founder of Quark Inc., and he is a passionate philanthropist who gives up to 40 percent of his company's $4 million in annual donations to AIDS-related causes. David Bohnett of GeoCities also has his own foundation, based in Los Angeles, which helps support gay and lesbian centers and advocacy. AIDS, however, does not loom as heavily as it once did. Gay and lesbian charities have shown that they want to move beyond AIDS and become part of the varied philanthropic community. The budgets of gay and lesbian charities and social services now total about $100 million, a huge step since fundraising for AIDS began years ago. AIDS charities still receive immense donations, but many groups are seeing a drop in numbers. Some believe the use of antiviral drugs may be falsely signaling donors that AIDS research no longer needs funding, while others cite donor fatigue as a reason for the reduced donations.




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