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In This Issue:
AIDS rate jumps among senior citizens
Antiretrovirals suppress HIV in semen
Condoms reduce heterosexual transmission risk
Gephardt pushes US on AIDS drugs
US renews funding for clinical trials network
Judge jails man who broke quarantine
Thai activists protest on licensing issue
The growing wave of seniors living with AIDS could force many in the health industry to re-evaluate how to deal with the disease, affecting researchers, prevention specialists, retirement centers and nursing homes, according to a report in the Houston Chronicle.
Currently, people ages 50 and older comprise 11% (72,000) of all AIDS cases in the U.S., and the CDC cites this group as the fastest-growing segment of the population of people with AIDS.
Between 1991 and 1996, the AIDS rate among older people jumped 22%; the number of older women who were infected through sex more than doubled during that period. And as baby boomers enter their 50s and 60s, the numbers are expected to increase.
This new trend is caused by a series of factors: new drugs that have helped people live longer; infections occurring later in life; and even Viagra, which has allowed older men to re-enter the world of sexual activity.
The statistics, however, have not yet been matched by improvements in understanding, research or education. For many older people with HIV/AIDS, the stigmatization surrounding the disease has led to isolation and foregone treatment. Those seniors who do get help must deal with additional health risks caused by possible side effects from drug therapies, such as rising cholesterol levels. Prescription drugs, when combined with certain HIV medications, may be dangerous, but no medical studies have yet examined the possibility. Also, drug costs can reach as high as $20,000 a year, increasing the overall financial burden on older people, many of whom suffer from additional chronic illnesses.
Thus far, efforts to educate the elderly about prevention at senior centers and nursing homes have been "hit or miss." The National Institute on Aging (NIA) plans to hold a conference next year to discuss intervention strategies for HIV-positive seniors.
Marcia Ory of NIA said, "Society cannot ignore AIDS in [the] pediatric population, in the young adult population or the older population." (Kaiser Daily HIV/AIDS Report, http://www.kff.org]
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High seminal plasma concentrations of zidovudine and lamivudine in HIV-infected men correlate with significant reductions in seminal HIV-1 RNA, according to a study in the December issue of The Journal of Infectious Diseases.
Dr. Myron S. Cohen of the University of North Carolina at Chapel Hill and associates noted that data on the pharmacology of antiretroviral drugs in semen are very limited. They therefore examined seminal and blood plasma HIV-1 RNA concentrations in nine men before and after the initiation of zidovudine and lamivudine therapy.
"The concentration of HIV-1 RNA in seminal plasma was monitored as a potential surrogate marker for infectiousness," they write. Eight of the nine men obtained HIV-1 RNA concentrations below the level of detection (<400 copies/mL) in both blood and seminal plasma. Suppression was maintained in six of the nine men. Overall, "zidovudine and lamivudine [achieved] high concentrations in seminal plasma and significantly [reduced] HIV-1 RNA."
These are the first data on lamivudine concentrations in seminal plasma of HIV-infected men, the investigators point out. "As with zidovudine, the overall median lamivudine semen:blood ratio suggests transport or sequestration into the male reproductive tract."
"Given the ability of antiretroviral drugs to prevent vertical transmission of HIV," they believe the "use of such drugs to prevent sexual transmission is inevitable."
However, they also stress that additional studies to more fully assess the ability of antiretroviral drugs to reduce sexual transmission of HIV are still needed. And these studies should be considered "an urgent public health priority." (Reuters)
Condoms reduce heterosexual transmission risk
When used consistently and correctly, condoms reduce the risk of HIV infection through heterosexual transmission by about 87%, comparable to their efficacy in preventing conception.
In order to obtain an accurate estimate on the overall effectiveness of condoms in the prevention of heterosexual HIV transmission, two researchers from University of Texas Medical Branch at Galveston, conducted a meta-analysis of 25 studies on condom efficacy. All of the studies involved HIV serodiscordant heterosexual couples who had penetrative sexual intercourse.
"Condom usage was classified as always, sometimes or never," Drs. Karen R. Davis and Susan C. Weller explain in the November/December issue of Family Planning Perspectives.
They found that the incidence of HIV transmission among those who always used condoms was 0.9 per 100 person-years, while the incidence among those who never used condoms was 6.7 per 100 person-years.
"Generally, the condom's effectiveness at preventing HIV transmission is estimated to be 87%, but it may be as low as 60% or as high as 96%," the investigators conclude.
"Although our estimate is based upon all published in vivo evidence, it is nevertheless only a crude estimate that does not control for confounding factors," they point out. For example, there may be other differences between the "always-users" and the "never-users" that affect seroconversion rates, such as frequency and duration of exposure.
It is likely that the "estimates obtained for contraception are the upper limits of the condom's efficacy for prevention of HIV transmission." (Reuters/Family Planning Perspectives)
Gephardt pushes US on AIDS drugs
The US should "explore intensely" getting anti-AIDS drugs to infected people in Africa following President Clinton's efforts to resolve the intellectual property disputes between drug companies and South Africa, Democratic House leader Richard Gephardt said during a visit to the country.
Gephardt, minority leader in the House of Representatives, was speaking at a news briefing at the conclusion of a bipartisan congressional visit to three sub-Saharan countries.
Referring to Clinton's announcement at the recent meeting of the World Trade Organisation that he was calling on drug companies to drop their legal challenges to SA's drug laws, Gephardt said his visit had shown the great need for anti-AIDS drugs in Africa.
He said more efforts had to be made following Clinton's efforts to "kick- start" the process because the drugs were still too expensive for many in Africa "and ways have to be found to get them into the countries that need them".
"I go back with a renewed feeling that we have to do more with the rest of the world to address what is a pandemic."
The group said in a statement: "We are committed to increasing our government's help in the fight against HIV/AIDS. To this end we are pleased to announce that US assistance to confront this deadly disease in SA will increase more than fourfold...in 2000."
Gephardt and his eight colleagues from both the Democratic and the Republican parties visited SA, Zimbabwe and Nigeria. (Johannesburg Business Day)
US renews funding for clinical trials network
Funding for the Adult AIDS Clinical Trials Group (AACTG), the largest clinical trial network in the world, has been renewed, according to a statement by officials at the National Institute of Allergy and Infectious Diseases (NIAID). NIAID announced that the AACTG will receive $80 million in the first year of a 5-year grant.
The AACTG network supports studies examining antiviral interventions, methods of immune system reconstitution, and treatment and prevention of HIV-related infections and complications.
"The AACTG consists of a Coordinating and Operations Center, Statistical and Data Analysis Center and 32 AIDS Clinical Trials Units across the country, including sites in Texas, Tennessee, Pennsylvania, Rhode Island and New York," the NIAID statement continued.
"AACTG studies have been and will continue to be an invaluable source of scientific data, significantly advancing our ability to treat HIV," according to NIAID director, Dr. Anthony S. Fauci.
Future priorities of the AACTG include defining optimal antiretroviral treatment strategies for each stage of HIV infection, developing treatments and prophylaxis for opportunistic infections, and treating hepatitis C infection in HIV-infected patients. Additional focus will also be given to finding ways to reduce anti-HIV drug interactions and side effects, and to eliminate viral reservoirs. (Reuters)
Judge jails man who broke quarantine
A case involving violation of public health laws and breaking quarantine orders has resulted in a Milwaukee man with tuberculosis (TB) receiving six months in jail.
Ross Schmidt was sentenced Monday after pleading guilty to several health violations, including a count of bail jumping after he consumed alcohol while undergoing treatment for TB. Judge Jean W. DiMotto has ordered that Schmidt maintain sobriety, be assessed for possible drug and alcohol counseling, seek employment, and continue taking his TB medications. Any violation of the conditions will cause his probation to be revoked and could add more jail time. (Milwaukee Sentinel-Journal)
Thai activists protest on licensing issue
Representatives of the estimated 1 million Thais infected with HIV set up camp outside Thailand's Health Ministry on Dec. 22nd to demand that the government break a US drug firm's monopoly on an AIDS drug.
About 100 protesters, wearing yellow T-shirts, called on the government to issue a compulsory licence to allow cheap local production of the antiretroviral drug didanosine (ddI), which is produced and marketed by Bristol-Myers Squibb. Campaigners say the vast majority of those infected cannot afford the treatment because of the high price of ddI.
The activists erected tents and vowed to continue their protest around the clock until Friday. "We are demanding the government impose a compulsory licence to give the Public Health Ministry the right to produce the essential drug didanosine," said Paisal Tanhood, chairman of the HIV Infection Network, which has more than 20,000 members.
Thailand's Government Pharmaceutical Organization (GPO) began producing zidovudine in 1995 at about a quarter of the price of the imported version. Compulsory licensing would allow the local production didanosine on payment of a royalty, but no developing country has yet taken the radical step, fearing trade retaliation by the US.
In Thailand, ddI costs about 49 baht ($1.25) per tablet, putting the monthly cost of a ddI-zidovudine regimen at about 8,000 baht ($205) in a country where the minimum monthly wage is 5,400 ($138). Activists say Bristol-Myers has offered to cut ddI's price, but not to the extent local production would eventually allow.
A ministry spokesman said talks were continuing between the GPO and Bristol-Myers but he declined to elaborate. Bristol-Myers officials were not available for comment on the licensing issue.
Paisal, 34, who was diagnosed with HIV infection 8 years ago, told Reuters he was unable to afford ddI, but his wife was using it free under a trial program at a government hospital. "Only 5% of about 1 million people with HIV have access to ddI because it's so expensive, so cutting the price a bit is not a good solution for under-privileged people," he said.
Activists said making ddI in Thailand was the best solution, but they doubted the government would be bold enough to stand up to the threat of US pressure. "DdI is the hope for those with HIV, but I don't think Thailand will dare take the radical action in colliding head-on with the United States because of the fear of trade retaliation," Saree Aongsomwang of the Foundation for Consumers said. (Reuters)
A new national dating service specifically designed for people living with HIV disease has been established at http://www.livingpositive.com .
The web page's organizer, Donald Johnson, said that the project is "an attempt to help bring all HIV positive people together into a safer, anonymous and cost free environment. Meeting and dating people is one of the most frightening aspects of living with HIV. With all my heart, I hope that I have made this much easier for all of us."
The web page, called "Living Positive," recently was expanded to include state sections and a chat site.
"I believe that no one should feel isolated because of HIV. And, hopefully, Living Positive will breakdown the walls of isolation and help bring happiness to the lives of everyone harboring this pesky little virus," Johnson said.