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April 2000 Treatment Chronicles

From the CDC National AIDS Clearinghouse

April 2000




Despite Gains in Treatment, Number of HIV Infections Continues to Rise. At the end of 1999, global estimates for AIDS rates were not a positive indication for the future. New statistics from UNAIDS and the World Health Organization show that the number of AIDS deaths reached 2.6 million this year, the highest total since the epidemic began. Nearly all the infections and deaths occurred in the developing world, primarily among young adults. About 50 percent of those who contract HIV are infected before age 25, and African girls between the ages of 15 and 19 are at least five times more likely to have HIV than boys the same age. HIV is also leaving behind thousands of orphans whose parents have died from the disease. The former Soviet Union has seen a sharp increase in cases, caused mainly by intravenous drug use with infected needles. In India and China, AIDS is becoming a more serious concern, as an increasing number of women and commercial sex workers become infected. There are an estimated four million prostitutes in China, and surveys show that only half have ever used a condom. Thailand has seen improvement through a HIV prevention program, though, and the Philippines' testing of registered sex workers is also helping to contain the spread of the deadly virus.

Researchers Test Intermittent HIV Therapy. A team of researchers, led by Franco Lori and Julianna Lisziewicz of Georgetown University, has found that intermittently stopping triple-drug therapy boosted the immune systems of two HIV patients studied. The findings, which are published in The Lancet, suggest that taking breaks from drug treatment may actually benefit those with HIV or AIDS. Recent studies have shown that daily doses of antiviral drugs keep the virus at undetectable levels in the blood in most HIV-infected individuals; however, Lori and Lisziewicz suggest that by stopping treatment, the body is able to fight back against the virus. The study followed three HIV patients who were recently infected. One patient was able to control the virus for longer and longer periods after each therapy interruption; the last time he stopped treatment, he was able to go 150 days before starting again. The researchers warn, however, that further trials are needed, and patients and doctors should not attempt to replicate this or other similar research until more is known.

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Government Cites Company for Faulty HIV Tests. Alfa Scientific Designs Inc. has agreed to halt sales of its HIV tests after being charged with falsely representing them as being able to accurately detect the virus that causes AIDS. The company, which is based in San Diego, sells the tests to distributors like Medimax Inc., which was charged in December with falsely stating on the Internet that its HIV tests were accurate and no longer markets the test kits. Jodie Bernstein, director of the Federal Trade Commission's Bureau of Consumer Protection, said that people's lives were at risk because the tests frequently generated false negative results.

HAART Adherence Suboptimal in Inner-City Population. New research shows that up to 39 percent of HIV-infected patients in an inner-city population did not adhere to their antiretroviral regimens. The study, led by Dr. Paul Weidel of the Centers for Disease Control and Prevention, used a confidential interview and a self-administered anonymous survey to determine antiretroviral drug adherence among 173 people in the South Bronx. Common reasons for not adhering to treatment were forgetfulness and lack of access to medications. The researchers, who reported their findings in the December 15 issue of the Journal of Acquired Immune Deficiency Syndromes (1999;22:498-502), called for interventions that help to make dosages easier to remember and that ensure a continued supply of medications.

HIV-Infected Drug Users Less Likely to Receive HAART. Research by the EuroSIDA Study Group suggests that HIV-infected intravenous drug users are 27 percent less likely to receive highly active antiretroviral therapy (HAART) than other HIV exposure groups. The scientists, who evaluated more than 6,600 HIV patients, also found that the drug users responded to the treatment similarly to other groups of patients. The researchers found no differences in the likelihood of receiving HAART in homosexual versus heterosexual subjects. The findings, published in the Journal of Acquired Immune Deficiency Syndromes (1999;22:369-378), suggest that drug users with HIV may have a worse prognosis and more AIDS-related illnesses if they continue to receive HAART less often than other groups.

Clinton to Propose More Funding for Research. President Clinton asked Congress in late January to allow a $3 billion spending increase to benefit science and technology research. He explained that the $2.8 billion in new spending includes a $1 billion increase in biomedical research for the National Institutes of Health. This money would be used for research into an AIDS vaccine, diabetes, brain disorders and cancer. If Congress approves Clinton's request, the funds would be allocated for fiscal year 2001.

HHS Awards $527 Million for HIV/AIDS Care. Health and Human Services Secretary Donna E. Shalala announced on January 21 that $527 million in Ryan White CARE Act grants will fund primary health care and support services for low-income people in 51 eligible metropolitan areas (EMAs). To qualify for funding for health care, an EMA must have at least 500,000 in population and have reported over 2,000 AIDS cases in the last five years. In announcing the new funding, Shalala noted, "These funds should help local communities better meet the demand of providing health care and support services to people living with HIV/AIDS."

HRSA Announces $21.7 Million to Fund HIV/AIDS Programs in Underserved Areas. The Health Resources and Services Administration (HRSA) has given $21.7 million to fund 51 grants for early HIV intervention care and services for underserved persons. The grants are funded under the Ryan White Comprehensive AIDS Resources Emergency Act. Programs under the act help communities determine HIV-related priorities and fund programs for them, according to HRSA's Dr. Joseph O'Neill.

Fighting AIDS. The editors of the Washington Post made some suggestions for changes in the battle against AIDS at a January meeting of the United Nations Security Council. The use of anti-AIDS drugs is, according to the editors, "impractical" in the developing world, where treatment is too expensive and must be rigorously followed. An effective vaccine would be useful; however, development of one will take years and will not save the millions of people who will contract HIV before a vaccine is ready. An answer to the AIDS epidemic is not just programs about safe sex then, but about programs that change sexual behavior, as have been seen in Thailand and Senegal. Uganda has a model program for education as well, one that has helped to effect an average two-year delay in Ugandan youths having their first sexual experiences. The stigma surrounding AIDS persists and, as people refuse to admit their infection, allows HIV to spread. The editors note that while Vice President Al Gore's focus on AIDS at the Security Council meeting the week of January 24 should help to draw attention to the epidemic, they assert that "he should also spur the developed world to give more aid to developing countries with serious AIDS policies."

Groups Join to Criticize Ruling on HIV Inmates. Several AIDS activists and gay organizations are criticizing a recent Supreme Court ruling that supports Alabama's segregation of HIV-positive inmates. The original Circuit Court of Appeals ruling and the High Court's refusal to hear an appeal allow prisoners in Alabama to be excluded from educational and recreational activities since they pose a risk of HIV transmission to others. The Supreme Court last year asked the Clinton administration's opinion on the matter, and U.S. Solicitor General Seth Waxman said the 11th Circuit ruling should stand. A statement signed by several groups, including AIDS Alabama and the American Civil Liberties Union's National Prison Project, asserts that "their recommendation upholds stigmatization of people with HIV and sets a precedent for an unnecessary and unfair double standard regarding HIV-positive prisoners."

Supreme Court Roundup: AIDS Insurance Cap. The U.S. Supreme Court has refused to hear an appeal against an insurance company's cap on lifetime benefits for AIDS treatment. Policies from Mutual of Omaha give maximum benefits at $25,000 or $100,000, not $1 million or more as provided for non-AIDS-related conditions. The limit on benefits was challenged by two HIV-infected policyholders who had won a 1998 decision in Chicago that was overturned last summer. The appeals court ruled that while the Americans with Disabilities Act ensures access to insurance, it does not regulate the content of insurance policies.

More Than 1 in 8 Americans Do Not Receive HIV Test Results. New research from the Centers for Disease Control and Prevention shows that about 13 percent of U.S. adults who were tested for HIV in 1994 and 1995 never received their test results. According to the report, published in the December 1 issue of the Journal of Acquired Immune Deficiency Syndromes (1999;22:395-400), the reason for testing predicted the likelihood of receiving test results, and those who did not ask for testing were less likely to obtain their results. The study used data from the U.S. National Health Interview Survey, which involved more than 19,000 adults in 1994 and nearly 17,000 adults in 1995. Those surveyed were classified according to their reason for being tested, including compulsory, recommended or self-initiated.

Deadly Liver Damage Threatens HIV Survivors. A new study from researchers at the Johns Hopkins University School of Medicine shows that 10 percent of HIV patients taking the protease inhibitor Norvir are experiencing severe liver problems. The team studied 298 HIV patients in Baltimore, more than half of whom were co-infected with hepatitis C. After about six months of follow-up, 26 of 211 patients receiving protease inhibitors had developed severe liver toxicity, which can lead to liver failure. Patients on Norvir were more likely to have liver toxicity compared to other protease inhibitors, at a rate of 30 percent to 7 percent. Results of the study were published in a January issue of the Journal of the American Medical Association.

HIV/AIDS Among Racial/Ethnic Minority Men Who Have Sex With Men. Men of color now account for a greater proportion of AIDS cases among men who have sex with men than do white men. Based on an examination of U.S. AIDS cases over the past decade, the Centers for Disease Control and Prevention study found that men of color represent an increasing proportion of AIDS cases among gay and bisexual men, rising from 31 percent in 1989 to 52 percent in 1998. African-American men comprised one-third of AIDS cases among men who have sex with men, while Latino men represented 18 percent of cases. While declining from 69 percent in 1989, white men continued to represent 48 percent of AIDS cases among men who have sex with men in 1998. Data from the report also suggest that the stigma of homosexuality may be playing a key role in the disease's spread, and point to the early age at which gay and bisexual men are becoming infected.

African-Americans Need Better Access to HIV Care and Testing. Public health officials met in Washington recently to discuss HIV and its effects on the African-American community, hoping to offer some new plans for stopping the epidemic. At the meeting, Victor Barnes of the CDC stated that the lack of access to health care and lax adherence to treatments are two reasons for the epidemic's rise among African Americans. Economic and cultural barriers, along with a failure to test for HIV until symptoms appear, are also factors. Barnes said the CDC hopes to receive increased funding for community programs and also plans to increase its surveillance of HIV.

AIDS Program Targets Latinos. Hispanic homosexuals often do not declare their sexuality because of stigmas that continue to surround homosexuality. Juan Torres, age 22, is a peer advisor at the Latino Health Institute in Massachusetts, which will air safe sex and AIDS awareness shows on public access channels on cable television in January. The institute has a weekly program on Boston Neighborhood Network, a public access station, but this is the first instance in which the hosts will directly address the issue of AIDS and homosexual Hispanic men. A gay Hispanic himself, Torres will help broadcast the messages in Spanish to reach individuals who have been ignoring the AIDS problem or who are unaware. The institute's Dr. Anibal Sosa notes that new immigrants who are less familiar with the language often find it hard to learn about resources for HIV and AIDS, and so the program also aims to help them.

Continued Risky Behavior in HIV-Infected Youth. New research indicates that both adolescents and adults continue to engage in risky activities even after they were diagnosed with HIV. Researchers from the University of Washington School of Public Health and the Seattle-King County Department of Public Health reviewed data for more than 3,000 HIV-infected youths and adults in an effort to describe and compare the risk behaviors of the two groups. The data was obtained from the Seattle-King County Adult/Adolescent Spectrum of HIV-Related Diseases Study, conducted between January 1990 and February 1998. The results show that both female and male youths were over two times as likely as adults to engage in risky behavior, including engaging in unsafe sex and sharing injection drug paraphernalia. The authors note, however, that both the youths and the adults participated in risky activities after HIV diagnosis, showing the need for public health campaigns targeting individuals infected with HIV as well as those at risk for HIV/AIDS.

HIV-Positive Man Gets 18 Months for Biting. A HIV-positive Baltimore man who bit a security guard last year was sentenced on January 5, to 18 months in jail for assault and reckless endangerment. Eric Glaspie was not given credit for time served after the scuffle at a store where officers believed he was using a fake check. During the incident, Glaspie cut his mouth and bit one of the security guards on the arm. The incident took place on June 18, 1999, and the security guard has tested negative for HIV.

Americans Support Public Health Spending. A recent Harris poll shows that Americans favor health care that spends more on prevention and health promotion and relatively less for treatment. According to the survey, 91 percent of the survey respondents said that the prevention of infectious diseases like tuberculosis, measles, influenza and HIV was "very important." In addition, 88 percent said that conducting medical research into the causes and prevention of diseases was "very important," while 87 percent considered immunization a key issue.

Gore Vows AIDS Initiative. Vice President Al Gore pledged on January 10, to seek $150 million from Congress to combat HIV and other infectious diseases in Africa and Asia, noting that AIDS is as significant a threat to global security as war. If approved, the new funds would raise the total for fighting AIDS overseas to $325 million. The funding would mostly go toward sub-Saharan Africa, where AIDS is the leading cause of death. At the meeting of the United Nations Security Council, Namibian health minister Libertine Amathila and others warned that AIDS is ruining national health budgets in Africa. Amathila noted, "Africa has the least access to drugs but the greatest access to arms." Vice President Gore also reported that the White House plans to request $50 million from Congress to finance research and to buy and distribute drugs that attack other major killers, including tuberculosis, hepatitis B and yellow fever.

Ethics Scholars Back Needle Exchanges. Scholars attending a meeting of the Society of Christian Ethics have expressed support for needle exchange programs that aim to prevent HIV infections. Under the group's resolution, the number of needles in use must not be increased and drug treatment must be linked to exchange programs. About 900 ethics professors at universities and seminaries comprise the society, which is based at DePaul University in Chicago.

Relief Organization Calls for International US Action on HIV Drugs. Medecins San Frontieres (MSF) has urged the Clinton administration to take steps for expanding international access to AIDS drugs. MSF wants the United States to actively support the production of antiretroviral drugs in countries like Thailand that have the ability to produce the drugs locally. The group noted that Thailand is legally able under international law to manufacture a generic version of ddI, but the government reportedly has been pressured not to by the drug's manufacturer and by the U.S. trade representative.

USAID Announces 12 African Nations to Receive Funding. Twelve African countries, including Ethiopia, Kenya, South Africa and Uganda, will receive additional fiscal year 2000 funding under President Clinton's LIFE (Leadership and Investment Fighting an Epidemic) initiative, according to the U.S. Agency for International Development (USAID). The money is given based on the governments' commitment to stopping the spread of HIV and will be used for prevention efforts. The funds will also support those sick with AIDS, help children orphaned by the disease, treat pregnant women with HIV/AIDS, and help build health infrastructure in the countries. Since 1986, USAID has given over $1.2 billion to help fight AIDS in the developing world.

AIDS Slows Rise in Population. Africa's population continues to increase despite the deadly toll that AIDS has taken, experts report. Africa's population tripled between 1950 and 2000 and should double again this century, according to Joseph Chamie of the United Nations' population division. Fertility rates remain high enough to allow growth in Africa, as countries like Uganda have managed to decrease HIV infection rates. Signs of hope that other countries are fighting AIDS come as Kenyan President Daniel arap Moi has endorsed using condoms. Chamie forecasts that the world's population will hit 9 billion by 2050, up from 6.1 billion at present.

Poverty and Superstition Fuel the Spread of AIDS in Africa. In Kenya, many people lack education regarding AIDS, and superstition has also hindered prevention efforts. Health care workers in the Nairobi slum of Kibera note, for example, that some Kenyans believe that condoms are ineffective because they have tiny holes in them. The United States announced, the week of January 10, that $150 million in additional funding will be used to help fight HIV in Africa. Education is the key, as condoms are often not accepted as safe nor used consistently. In Kibera, youths turn to sex as their only pleasure because books are too expensive and there are no playgrounds for sports. Kenyan President Daniel arap Moi declared AIDS a national disaster in October, but mismanagement of the Kenyan treasury has left little money for AIDS prevention or treatment.



  
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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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