What's New in Treatment Information?
Excerpts from Hotline Memos of October 2001
from the Information Department of Project Inform
What Should People Living with HIV Be Concerned with As Far As the Threat of Terrorists Using Smallpox As a Biological Weapon?
Recently, rumors have suggested that terrorists may use smallpox as a biological weapon, much like the cases of anthrax in the US. The reason it's getting a lot of attention in the US is simply a matter of the federal Department of Health and Human Services (DHHS) wanting to look prepared. It's probably very unlikely that smallpox would ever be used as a weapon. This is because once smallpox starts spreading in any population, the risk of it spreading around the world is high. It would inevitably go right back to the terrorists who used it in the first place. Right now, smallpox is almost totally eradicated except in a few countries. Spreading smallpox around the world again would earn the wrath of almost everyone.
The DHHS is currently testing diluted versions of the current smallpox vaccine to see if that will stretch out the supply. The DHHS is reluctant to start manufacturing more of that supply as it's a relatively dirty vaccine, made from smallpox sores from calves and pigs. If they have to make more, they would rather engineer a new and better vaccine. The current vaccine will kill some of those who use it and make others sick.
Statements have been made discouraging the use of smallpox vaccines in people with immune deficiencies. Technically, that would include people with AIDS, but it's less sure if it would also include HIV-positive people with intact immune systems. It's probably safe to say that doctors would want to make decisions with their patients about this on an individual basis, based on the patient's history and current condition.
However, at this time, it's a moot point to speculate about getting a smallpox vaccination. Nobody is yet getting the vaccine in any form. When treating smallpox, it's possible to use one of the anti-CMV drugs, cidofovir from Gilead. The federal government has discussed the situation with Gilead, as has Project Inform. There are apparently large stocks of the drug in storage under Gilead's control because the drug never sold well for CMV. This was due to its serious kidney toxicity, its intravenous administration and cases of CMV dropping dramatically.
The drug has a long shelf life and Gilead apparently made much more of it than they could ever sell. The government hasn't officially decided whether it will use cidofovir if there's an outbreak of smallpox, but it would probably be reserved for serious, life-threatening cases only. There's little reason to believe they would try to use it in a preventive way, given its toxicity.
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