[CDC News] CDC HIV/STD/TB Prevention News Update 08/20/03
prevention...@cdcnpin.org
Wednesday, August 20, 2003
The CDC National Center for HIV, STD and TB Prevention provides
the following information as a public service only. Providing
synopses of key scientific articles and lay media reports on
HIV/AIDS, other sexually transmitted diseases and tuberculosis
does not constitute CDC endorsement. This daily update also
includes information from CDC and other government agencies, such
as background on Morbidity and Mortality Weekly Report (MMWR)
articles, fact sheets, press releases and announcements.
Reproduction of this text is encouraged; however, copies may not
be sold, and the CDC HIV/STD/TB Prevention News Update should be
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the articles abstracted below for full texts of the articles.
HEADLINES
NATIONAL NEWS
"AIDS Group Wants Glaxo Drug Off Market"
"Hepatitis A Outbreak Spreads Through Northeast Georgia"
INTERNATIONAL NEWS
"Kenyan Women Reject Sex 'Cleanser'"
"For Ugandan Girls, Delaying Sex Has Economic Cost"
"Street Children at High Risk of AIDS"
MEDICAL NEWS
"Low Treatment Adherence Rates Contribute to Outpatient
Mortality"
"Phase II Trial with PRO 2000 to Prevent HIV Transmission Begins
in Africa"
LOCAL AND COMMUNITY NEWS
"For Children with HIV or AIDS, a Camp Called Hope Is a Summer
Place to Belong"
NEWS BRIEFS
"Medicine, Worker Lack Plaguing Campaign vs. TB"
"Entertainment Has AIDS Message"
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NATIONAL NEWS
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"AIDS Group Wants Glaxo Drug Off Market"
Reuters (08.19.03)
The nation's largest AIDS organization on Tuesday asked
federal regulators to withdraw approval for GlaxoSmithKline's
drug Trizivir in light of a study showing it was inferior to
other treatment combinations. The AIDS Healthcare Foundation said
keeping the drug on the market may be dangerous because some
doctors may be unaware of the new findings and continue to
prescribe Trizivir alone.
Trizivir is a single pill combining three HIV drugs - AZT,
3TC and abacavir - into one twice-daily regimen.
The National Institutes of Health said in March it had
halted part of a trial comparing Trizivir alone to other drug
combinations because Trizivir by itself was less effective at
suppressing HIV.
AHF said it was "apparent that Trizivir may be effective
only if it is taken with other HIV/AIDS drugs." "Trizivir's lack
of effectiveness renders it unsafe," the group wrote in a letter
to the Food and Drug Administration.
GlaxoSmithKline spokesperson Nancy Pekarek said AHF was
"acting irresponsibly" by seeking Trizivir's withdrawal. "What
they are trying to do is deny patients and physicians an
important weapon" against HIV, she said, adding that patients
should not stop treatment prescribed by their doctors. Pekarek
said the NIH study should be considered "in the context of total
available data, which proves the effectiveness of Trizivir." She
also said that a Department of Health and Human Services expert
panel had issued guidelines in July recommending Trizivir as a
first-choice option.
AHF said GlaxoSmithKline continues to aggressively market
Trizivir as a stand-alone treatment despite the NIH trial.
Trizivir is the fifth most-prescribed HIV medication, AHF said.
An FDA spokesperson said the agency will review the request to
pull Trizivir from the market. AHF provides HIV-related medical
care to some 12,000 patients in the United States.
"Hepatitis A Outbreak Spreads Through Northeast Georgia"
Associated Press (08.18.03)
One hundred people in northeast Georgia have been infected
with hepatitis A in the first half of this year, and health
officials are uncertain as to the cause of the outbreak.
"That compares to 20 cases during the same period in 2002,"
said Julie Wolthuis, epidemiologist with the Georgia Department
of Public Health. "Most of the reported cases have been in
adults, but that may be because adults tend to be much more
symptomatic," added Wolthuis.
Outbreaks of hepatitis A are typically connected to daycare
centers, restaurants or prisons, but this year's cases have
occurred randomly throughout the 13-county district, according to
Wolthuis. "There's no pattern to it," she said. "We've done phone
interviews [with patients] and haven't been able to pinpoint one
risk factor over another. Nothing jumped out at us."
Hepatitis A is usually spread through fecal-oral contact,
such as touching the mouth after using the restroom or changing a
diaper, and infects about 23,000 Americans each year. It
generally causes mild illness, with a few days or weeks of fever,
nausea and jaundice. And unlike hepatitis B and hepatitis C,
which can cause chronic liver infection, long-term liver damage
is not associated with hepatitis A.
"We noticed an increase in cases [of hepatitis A] when
school started last year," said Mamie Coker, health services
coordinator for the Hall County school system. "Usually, we get
only a couple of cases, but during the past school year we had
seven or eight. At least one of the students was hospitalized,"
reported Coker.
Melody Stancil, director of the public health office in
Gainesville, said the outbreak peaked in February and March, and
the number of cases has been dropping since then. In Georgia,
children are immunized against hepatitis B only, although
vaccines are available for hepatitis A.
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INTERNATIONAL NEWS
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"Kenyan Women Reject Sex 'Cleanser'"
Washington Post (08.18.03)::Emily Wax
In some rural African villages, tradition holds that widows
must sleep with the ritual "cleanser" - men who sleep with women
after their husbands die - in order to be allowed to attend their
husbands' funerals or be inherited by their husbands' brother or
relative (another customary practice). Unmarried women who lose a
parent or child must also sleep with cleansers. Village elders in
Gangre, Kenya, say the custom must be carried out or the
community will be cursed with bad crops. Areas that still
practice the tradition have the highest rates of HIV/AIDS,
causing Africans to question and change traditions as the disease
ravages the continent.
The cleansing job, held by hundreds of thousands of men
across rural Africa, is seen as low class but essential to
"purifying" women. Cleansers are paid in cows and crops, as well
as cash. They can be found in some rural parts of Uganda,
Tanzania and Congo. They are also a staple in Angola and across
West Africa, specifically in Ghana, Senegal, Ivory Coast and
Nigeria, according to African aid workers who have been trying to
discuss the HIV risk that cleansers present.
The tradition dates back centuries and is rooted in a belief
that spirits haunt a woman after her husband dies. She is also
thought to be unholy and "disturbed" if she is unmarried and
abstains from sex. The custom has always been unpopular among
women.
"It's a custom that must be stopped," said Janet Walsh,
deputy director of Human Rights Watch, which published a report
on it. "Condoms are never used; they say it has to be skin-to-
skin to work." Women in Africa are six times as likely to
contract HIV as men, largely because of rape and customs like
cleansing, in which one man can infect hundreds of women. Nancy
Oundda, a nurse with the African Medical Research Foundation,
predicted that people's attitudes toward the practice will change
"with education, and if they realize what this tradition is
doing."
"For Ugandan Girls, Delaying Sex Has Economic Cost"
New York Times (08.18.03)::Marc Lacey
Lillian, a 16-year-old Ugandan slum dweller orphaned by
AIDS, studies hard, picks here friends carefully, is wary of bad
influences, and is so committed to avoiding AIDS that she has
become a leader in her school's Straight Talk Club, which
promotes abstinence. Yet the biggest threat to Lillian's
virginity may not be her hormones or those of her peers, but her
empty pockets and her ambition.
Sex starts early here for a variety of reasons. There is the
sexual curiosity that stirs in young people everywhere. Marriage
for young girls is common as well, with girls dropping out of
school, often to become an older man's second or third wife. Sex
also presents an opportunity to make money where young women find
few jobs available. Poverty can weaken even those with the most
resolve.
Benjamin Wamusiru, an English teacher who leads the
abstinence club at a local school, said remaining abstinent "is
difficult with all the pressures in society.... It's toughest on
the girls."
Dreaming of college, Lillian struggles to pay the fees
required of all secondary students here. Tuition is about $30 a
month. Recently, some of the cousins with whom she has lived
since the death of her uncle - who cared for her after her
parents died until he, too succumbed to AIDS - have begun
pressuring her to raise money by selling herself.
Lillian's latest school bill came to about $90. She did not
know where she would find the money. "It's difficult for me to
say what I'll do," she said glumly.
If she did have sex, she said, her resolve weakening, it
would not be about love, because marriage would end her
education. And she would try to remember everything the club had
taught her. She would use a condom and hope that the man would be
kind. "If it was a single man who wasn't married, if he had a
good character, maybe I'd consider it," she said. "It would be
for my future."
"Street Children at High Risk of AIDS"
Inter Press Service News Agency (08.18.03)::Diego Cevallos
According to experts' estimates, as many as 7 percent of the
approximately 20,000 youngsters ages 13-17 who live on the
streets of Mexico City are HIV-infected. Ignorance, unprotected
sex, promiscuity and drug use are spreading the virus quickly
among this high-risk group.
HIV "is a serious problem among street kids, because many of
them are too involved in drugs to even care," said Silvia Garcia,
who works with Casa Alianza, the Latin American branch of the New
York-based Covenant House, which aids street children. The most
widely consumed drug among these children is a solvent used to
clean plumbing pipes. Sniffing the product from a tissue causes
hallucinations and offers temporary relief from hunger, sadness
and loneliness. The second-most popular drug is crack cocaine.
Even though a local nongovernmental organization "hands out
free condoms for us to have safe sex, the kids don't use them,
either out of embarrassment, because they don't know how to use
them, or because they prefer to swap them for drugs," said Raul,
a street boy with HIV. None of the street kids interviewed by the
Mexican NGO Caracol said they had used a condom during that year.
Many of the males said their girlfriends believed the
intrauterine device protected them from STDs.
"We must recognize that due to the lack of schooling and
high levels of drug use among street children, as well as the
frequent practice of exchanging sex for food, drugs or
protection, they are a group at high risk of contracting the
disease," said Martin Perez, head of Caracol. Since 1997, the NGO
has been offering safe sex workshops to Mexico City street
children. The Mexican chapter of Casa Alianza also provides
education and takes in HIV-positive street children, offering
them medical and psychological assistance. In addition, the
government carries out awareness campaigns. People who test
positive for HIV are supplied with antiretroviral drugs free of
charge through NGOs and public hospitals.
Perez said that some NGOs offer kids free HIV tests, but
many youths never pick up the results. "We have even found that
some of the kids believe they already have the disease, just
because they had an AIDS test."
AIDS is the third leading cause of death among men ages 25-
44 in Mexico, and 86 percent of the estimated 150,000 people
living with HIV in Mexico, a country of 100 million people, are
men, according to UNICEF.
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MEDICAL NEWS
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"Low Treatment Adherence Rates Contribute to Outpatient
Mortality"
Health & Medicine Week (07.07.03)
Low treatment adherence by outpatients strongly contributes
to the high tuberculosis mortality rate in HIV patients,
according to researchers in Portugal. "Adherence to
antituberculosis treatment, a major determinant of outcome, is of
special concern in [HIV]-positive patients," explained M. Rocha
and colleagues at the University of Porto's Center for
Respiratory Disease Diagnosis in Constituicao. "However,
tuberculosis death in HIV-positive patients remains higher than
in HIV-negative patients, regardless of adherence."
Looking to assess determinants for an unfavorable
tuberculosis outcome, defined as no cure or death, as well as
nonadherence to antituberculosis treatment, the researchers
examined 70 HIV-positive patients with TB who were referred to an
outpatient center.
"Patient outcome was compared to HIV risk factors, other
opportunistic diseases, antiretroviral drug use, current IV drug
use, a methadone program participation, tuberculosis features,
treatment characteristics and adherence," they noted. The
researchers also compared adherent and nonadherent patient
characteristics.
"An unfavorable outcome occurred in 22.9 percent of patients
and 32.9 percent were nonadherent with therapy," the data showed.
"Nonadherence was the only independent determinant for an
unfavorable outcome," said the researchers.
According to the report, "adherence was independently
associated with current IV drug use, treatment complications and
use of methadone."
Thus, the study "confirms that [HIV]-infected patients,
treated as outpatients, have high rates of nonadherence and that
adherence is the strongest determinant for tuberculosis outcome,"
concluded the study authors. "Independently of the current use of
drugs, a methadone program improves adherence to treatment," they
noted.
The study, "The Role of Adherence in Tuberculosis HIV-
Positive Patients Treated in Ambulatory Regimen," was published
in European Respiratory Journal (2003;21(5):785-788).
"Phase II Trial with PRO 2000 to Prevent HIV Transmission Begins
in Africa"
Women's Health Weekly (07.17.03)
Indevus Pharmaceuticals Inc. announced the initiation of a
phase II clinical trial in Kampala, Uganda, to assess the safety
of PRO 2000, a topically administered vaginal microbicide
designed to prevent HIV infection. The randomized, double-blind,
placebo-controlled trial will enroll approximately 100 sexually
active female volunteers to be treated for four weeks.
Researchers will evaluate the safety of PRO 2000 during and at
the end of the study, based on the presence of local genital
effects and systemic abnormalities.
The European Commission is funding the study, which is a
collaboration among investigators at the Imperial College in
London and the Medical Research Council Clinical Trials Unit in
London; the MRC Program on AIDS in Uganda, Uganda Virus Research
Institute, Entebbe; St. Francis' Hospital, Nsambya, Kampala,
Uganda; and Indevus. Indevus has filed an investigational new
drug application for PRO 2000 with US Food and Drug
Administration.
"This trial will provide safety data for PRO 2000 in a
sexually active, developing-country population, and PRO 2000 may
be investigated in such African populations in expanded phase III
testing in the future," said Dr. Bobby Sandage, executive vice
president, research and development at Indevus. "Findings will
build upon the growing clinical database for the drug. The
current database includes a previous phase I trial sponsored by
the MRC in healthy, sexually abstinent women, as well as a phase
I/II trial sponsored by the National Institutes of Health in
healthy, sexually active women and HIV-infected, sexually
abstinent women.
"The majority of HIV infections are now acquired through
heterosexual intercourse," Sandage continued. "Because vaginal
microbicides increase the opportunities for sexually active women
to play a more active role in the prevention of heterosexual
transmission of HIV, we see this as a potentially important new
HIV prevention strategy."
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LOCAL AND COMMUNITY NEWS
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"For Children with HIV or AIDS, a Camp Called Hope Is a Summer
Place to Belong"
South Florida Sun-Sentinel (08.17.03)::Liz Doup
At camp Hope in Houston, Texas, no one thinks kids are weird
for taking yucky medicine. And no one stares when someone spikes
a high fever or cannot keep breakfast down. Most important, no
one pulls away or calls them names because they are HIV-infected.
Dr. Ana Puga brought 49 children - one-third of the campers -
from Broward County to the 200-acre camp. They are all treated at
the Children's Diagnostic and Treatment Center, a nonprofit
clinic in Fort Lauderdale where Puga is medical director of the
Comprehensive Family AIDS Program.
At Hope, the children mix with kids from Texas, Romania and
Mexico, a reminder that HIV affects children all over the globe.
Every morning, they do the routine: First breakfast, then morning
meds. Next, they do a rousing version of a funny camp dance
called the Cha Cha Slide. Most of the camp's counselors leading
the dance are camp veterans; the counselors are black, white and
brown, men and women, gay and straight.
Getting kids to Camp Hope is neither easy nor economical,
feat, with tuition at about $1,000 per child. A $50,000 grant
from Broward County's Children's Services Council and money from
the nonprofit Fort Lauderdale-based HIV/AIDS group Tuesday's
Angels covers transportation and some tuition. AIDS Foundation
Houston picks up the remaining camp costs.
Camp Hope, owned by the nonprofit organization Camp for All,
is one of only a handful of camps across the country giving
infected kids a chance to just be kids. Earlier this summer, 67
HIV-positive children from Palm Beach, Broward and Miami-Dade
counties went to Boggy Creek Camp near Orlando or Camp Heartland,
which runs camps near Minneapolis and Malibu, Calif.
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NEWS BRIEFS
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"Medicine, Worker Lack Plaguing Campaign vs. TB"
Philippine Daily Inquirer (08.20.03)
Medicine shortages and the lack of medical technologists are
threatening the Philippines' TB program with failure,
particularly in far-flung areas of the country, according to
medical officers and workers at a recent meeting in Davao City.
These problems explain the nation's failure to reduce TB in
recent years, they said. Health workers nationwide have been
implementing the Directly Observed Treatment Short-Course (DOTS)
strategy, said Dr. Rogelio Chua, regional health chief. "Seventy
percent of those affected by TB are breadwinners. For every
Filipino who develops TB, one family goes hungry," Chua said.
"DOTS will help prevent economic displacement brought about by
absenteeism and the loss of jobs from current illness." At least
75 Filipinos die every day from TB.
"Entertainment Has AIDS Message"
Lexington Herald Leader (08.20.03)
The Kentucky Department for Public Health HIV/AIDS Branch
and the state Department of Education are sponsoring a conference
aimed at educating young people about HIV and other STDs. The
conference will be held Saturday, August 23, from 9:30 a.m. to 4
p.m. at the Dunbar Center, 565 North Upper Street in Lexington.
Those ages 13-24 are invited to participate in activities that
will teach principles of abstinence, negotiating/refusal skills
and safer sex. The event will feature food, entertainment and
talent competitions. Parental consent is required for
participants younger than 18. Drum corps and step dance
performers will also entertain and deliver HIV prevention
messages. For more information, telephone Ramonda Yocum at 502-
564-6539 or e-mail Ramond...@mail.state.ky.us.
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