 |
 |
|
|
Liver damage linked to Norvir
HIV alters gene function within days
Vaginal bacteria reduces HIV risk
1 in 8 don’t receive test results
MA prenatal program improves outcomes
Clinton opposes HIV prisoner appeal
Gore to address UN on AIDS
60% of Tanzania hospital patients have AIDS
Forum to discuss hep C, HIV
New treatment education campaign announced
Dr. Mark S. Sulkowski and colleagues in Baltimore, Maryland, also found that coinfection with hepatitis B or C further increased the risk of hepatotoxicity. However, with the exception of those patients on ritonavir, the differences in the rates of antiretroviral-related hepatotoxicity were not significant.
These conclusions are based on the findings of a prospective study that Dr. Sulkowski's group conducted with 298 HIV-infected patients. Between January 1996 and January 1998, the subjects began a new antiretroviral treatment regimen, most of which (71%) contained a protease inhibitor. In addition to HIV infection, 52% of the subjects also had chronic hepatitis C virus infection and 2.7% of the subjects had chronic hepatitis B virus infection.
"Severe hepatotoxicity was observed in 31 (10.4%) of the 298 patients," they report. Compared with the rate in patients taking , or , the "risk of severe hepatotoxicity was 5-fold higher for patients taking ritonavir, which accounted for half of all cases." Dr. Sulkowski's group found that "although chronic viral hepatitis was associated with an increased risk of severe hepatotoxicity among patients prescribed non-ritonavir regimens, most patients with chronic hepatitis C or B virus infection (88%) did not experience significant toxic effects."
Because the incidence of liver damage was so much higher in the ritonavir group, they looked at these patients separately, Dr. Sulkowski explained to Reuters Health. In this group, "it seemed that the drug, rather than hepatitis C, was the major factor in toxicity.
When they looked at the other group of about 248 patients, who were not treated with ritonavir, the "hepatitis C-infected patients were about 3.7 times more likely to develop severe toxicity," he continued. "This suggests that the underlying hepatitis C infection does play a role [in the development of toxicity] at least for some of the medications." "I think the 10% incidence [of toxicity] is probably higher than many people suspected, and certainly the incidence with ritonavir was higher than we anticipated," Dr. Sulkowski pointed out. "But most patients actually did fairly well with these drugs, even the hepatitis C-infected patients."
This suggests that "these patients can be treated safely, but they do need appropriate monitoring of liver enzymes." Although the hepatotoxicity rates with ritonavir were higher than with other protease inhibitors, the primary factors to consider in deciding which HIV drug regimen to give a patient are still drug resistance and patient tolerability, Dr. Sulkowski continued. "Today we need to design drug regimens that patients can adhere to and tolerate over the long-term." However, in situations where there is concern over patient liver damage and where there are choices, "you might chose a drug other than ritonavir.”
Although protease inhibitors have been key in lengthening survival for people with HIV and delaying full-blown AIDS, some doctors have been reluctant to prescribe them because of reported side effects. (Reuters)
Conducted by researchers at the University of Washington, the study examined the level or “expression” of approximately 1,500 genes in cells that were deliberately infected with HIV. The innovative study employed cDNA microarray technology from Amersham Pharmacia Biotech to examine how cells respond to infection by HIV.
“By using gene expression microarrays, we discovered cellular changes in the expression levels of at least 20 different genes by day three of our study,” said Gary K. Geiss, PhD, a senior fellow at the University of Washington's Department of Microbiology who directed the laboratory research.
According to Michael G. Katze, PhD, Professor of Microbiology at the University of Washington and the principal investigator for the study, detecting changes at the cellular level could have a substantial impact on future treatments for the disease. The results published in Virology were part of a preliminary study, and microbiologists at the University intend to conduct a larger study into the impact of HIV on cellular functions.
“When a virus like HIV infects a cell, it takes over and uses the machinery of that cell to help make proteins the virus needs to replicate and live. Genes make up part of that machinery,” said Dr. Katze. “If we can learn which genes are used by the virus but not by the host cell, we may open up new ways for researchers to fight the disease.”
In the study, gene expression profiles were closely observed using the Microarray System from Amersham Pharmacia Biotech. The genes were examined prior to and after HIV exposure to determine how quickly cellular genes would be significantly influenced by viral infection. The results of the study show that HIV infection alters the function of a broad array of cellular genes, including some genes associated with immune system functions. (Company press release)
Lab tests show that lactobacilli produce substances capable of fighting infection. Strains of lactobacilli appear to “play a pivotal role in controlling the microenvironment of the vagina,” explain American and Kenyan researchers led by Dr. Joan Kreiss of the University of Washington in Seattle. They report their findings in the December issue of The Journal of Infectious Diseases.
In their study, Kreiss and colleagues evaluated the relationship between lactobacilli colonization and infection with HIV and other sexually transmitted diseases in over 650 HIV-negative sex workers in Mombasa, Kenya. All the women were studied over a period of about 6 months. The team also assessed the women for bacterial vaginosis, a disorder where there is a decrease in lactobacilli in the vagina, but an increase in other bacteria. This disorder had been linked to pelvic inflammatory disease and increased risk of preterm delivery.
At the beginning of the study, 26% of women tested positive for vaginal lactobacilli.
Kreiss' team found that women without vaginal lactobacilli were at “increased risk of acquiring HIV-1 infection and gonorrhea,” compared with women who carried the organism. HIV infection risks seemed particularly low among women carrying a particular strain of hydrogen peroxide-producing Lactobacillus, the authors add.
On the other hand, bacterial vaginosis appears to increase susceptibility to HIV infection, the team report.
Overall, they say, this group of African prostitutes had “extremely low” levels of lactobacilli compared with women in the general population, but “extraordinarily high” levels of more harmful organisms, including infection with bacterial vaginosis.
Based on these findings, Kreiss and colleagues conclude that “the absence of vaginal lactobacilli may increase the efficiency of male-to-female HIV-1 infection.”
Topical drugs containing active lactobacilli are currently under development. Public health programs providing women at high risk for AIDS access to these drugs could represent “exciting opportunities for new methods of HIV-1 control,” the authors conclude. (Reuters)
"The reason for HIV testing was the only factor that independently predicted the likelihood of receiving test results," Dr. Guoyu Tao, of the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues report. Specifically, they found that individuals who did not initiate testing "were significantly less likely to receive their test results."
Dr. Tao's team evaluated data obtained in the US National Health Interview Survey, which included responses from 19,127 adults in 1994 and 16,848 adults in 1995. This is a household survey of the non-institutionalized US population aged 18 years or older.
In addition to questions on demographics, HIV risk behaviors and HIV knowledge, participants who were tested for HIV were classified according to reason for testing. The categories included compulsory, recommended and self-initiated HIV testing.
"Overall, 12.5% of persons tested in 1994 and 13.3% in 1995 had not received their test results," the researchers report in the December 1st 1999 issue of the Journal of Acquired Immune Deficiency Syndromes.
For individuals who initiated HIV testing in 1995, only 4.3% did not receive the results. In 1994, only 6.1% of such individuals did not receive their results.
The highest percentage of persons who did not receive the results of HIV testing was seen among hospitalized or surgical patients. In 1995, 22.9% of these individuals did not receive their HIV test results and in 1994, 24.2% did not receive their results.
Altogether, Dr. Tao's group estimates that "2.3 million of the 17.5 million people tested annually for HIV infection did not receive their test results."
They believe that these data suggest the need for alternative strategies to increase the rate of returns for their test results.
About 70% of all HIV testing was performed in healthcare settings, which presents an opportunity during pretest counseling to stress the importance of receiving the results, they point out. Other strategies may include telephone notification, or the use of rapid HIV screening assays that can provide results at the time of testing. (Reuters)
Dr. Barbara J. Turner, of the University of Pennsylvania Medical Center in Philadelphia, and colleagues evaluated the Medicaid records of 1,723 HIV-infected women who delivered an infant between 1993 and 1995.
"Of the women included in the study, 75.3% participated in the prenatal care program," the investigators report in the January issue of the American Journal of Public Health. Overall, Dr. Turner's group found that the proportions of preterm birth and low birthweight were lower among the program participants.
Women who participated in the program had "at least a 40% reduction in the adjusted odds of preterm delivery." The relationship between low birthweight and program participation appeared to be more complex. For women with no usual source of prenatal care, program participation reduced the adjusted odds of low birthweight by 60%.
However, for women with a usual source of prenatal care, they observed no apparent benefit of program participation on birthweight.
"If the benefits seen in this HIV-infected cohort are generalizable to other women enrolled in New York State Medicaid," the researchers suggest that "the Prenatal Care Assistance Program is likely to yield both clinical and financial benefits."
Although a cost-benefit analysis has not yet been performed, it is known that the "costs of adverse birth outcomes are enormous," and represent "about 10% of all costs of care for children." (Reuters)
If the court takes the administration's advice, it will leave intact a sweeping ruling that bars these inmates from more than 70 programs available to other prisoners, including work-release programs that can shorten their incarceration.
The justices will decide this month whether to hear the appeal in the closely watched, nearly 15-year-old case, which presents the question of how to assess whether a disability is a ''significant risk'' to others that cannot be eliminated by the ''reasonable accommodation'' ordinarily required under federal laws that prohibit discrimination on the basis of disability.
A federal appeals court ruled last year that the categorical exclusion of the H.I.V.-infected inmates from prison programs did not violate the Rehabilitation Act of 1973, given the fatal nature of AIDS and the prospect that prisoners could transmit the virus to one another.
The administration told the court that, although the appeals court might have ruled too broadly, its approach was generally correct and its decision should not be reviewed.
The United States Court of Appeals for the 11th Circuit, in its 8-to-3 ruling last April, said, ''When the adverse event is the contraction of a fatal disease, the risk of transmission can be significant even if the probability of transmission is low,'' adding, ''death itself makes the risk significant.''
The Americans with Disabilities Act of 1990, enacted after the Alabama lawsuit was filed, incorporated the same ''significant risk'' defense against a discrimination charge.
A coalition made up of public health organizations and AIDS specialists is supporting the appeal by the Alabama prisoners, arguing that the circuit court relied on ''subjective fear and stigma'' rather than the objective, scientific risk assessment that the Supreme Court insisted on in a 1998 ruling that was its first look at AIDS in the context of federal disability law.
In that case, a suit by an H.I.V.-positive woman against a dentist who refused to treat her in his office, the court said the assessment of ''significant risk'' should be made in light of the views of public health authorities, based on ''objective, scientific information.''
The brief for the coalition, filed by the Lambda Legal Defense and Education Fund, a gay advocacy group in New York, said the appeals courts had ignored the 1998 ruling by relying on a theoretical risk of transmission without regard to the particular circumstances. That approach, the brief said, ''threatens to justify virtually any discrimination against persons with H.I.V. in employment, health care, education, and every other aspect of community life.''
Alabama, Mississippi and South Carolina automatically segregate H.I.V.-positive inmates. The federal prison system, like those of most states, evaluates inmates individually and decides, on the basis of their history and psychological profile, whether to exclude them from particular activities.
The administration filed its brief in response to a request from the court for the federal government's views. The appeals court's ruling ''may well be overbroad,'' Seth P. Waxman, the solicitor general, told the justices, adding that ''the court should have carefully examined the circumstances and effect'' of participation of inmates in the programs.
The brief said such an examination might have shown that there was no danger in permitting H.I.V.-positive inmates to participate in such activities as religious services, data processing classes, and testing for high school equivalency diplomas. Nonetheless, the brief said, there was no need for the court to take the case because the appeals court's opinion, even if questionable in the particulars, was generally correct in deferring to Alabama prison officials the assessment of the risk presented by ''the violence that is an inescapable part of prison life.''
The solicitor general said the case presented the question of ''whether behavior that is concededly high-risk is likely to occur if H.I.V.-positive and non-H.I.V.-positive prisoners are integrated in a number of prison programs.'' The brief continued: ''The answer to that question turns not on medical judgments about the risk inherent in certain behaviors, but on prison management judgments about the ability of prison authorities to control prisoners in various settings and programs.''
In defending its policy, Alabama points to a much lower rate of H.I.V. transmission in its prison population than in states that do not segregate infected inmates. The state told the court that over eight years, out of 30,000 inmates who did not have H.I.V. when they entered prison, only two became infected while in prison.
Their decision on whether to take this case may depend on whether the justices see implications beyond the prison context and on the extent of their concern about whether their ruling in the 1998 dental patient case, Bragdon v. Abbott, had provided sufficient guidance to the lower courts.
The current case is called Davis v. Hopper, No. 98-9663. For many years, it was known as the Onishea case, but the lead plaintiff in the class-action lawsuit, Lydia Onishea, is no longer in custody, and another inmate, Arion Davis, was substituted.
The inmates, represented by the National Prison Project of the American Civil Liberties Union, have argued that decisions about exclusion or inclusion should be based on individualized assessments of the inmate and the program.
U.S. Ambassador Richard Holbrooke, often touted as a possible secretary of state in a Gore administration, invited the vice president to be the kickoff speaker during America's monthlong presidency which he is using to focus on African problems.
Holbrooke said in a statement that Gore will preside at the council meeting, the first time in history that a U.S. vice president has done so.
The meeting will also be the first ever on a health issue, Holbrooke said.
His spokeswoman, Mary Ellen Glynn, said “it met with some resistance,” mainly because AIDS is already being discussed in the U.N. Economic and Social Council and some diplomats felt there was no need to discuss it in the Security Council as well.
The appearance also follows months of controversy related to claims that Gore has sought to block access to AIDS medications for South Africa and less-developed nations.
“The Security Council meeting is unprecedented in the history of the United Nations,” Holbrooke said in the statement. “AIDS is far more than a health issue in Africa. It is also a security issue. Vice President Gore will address the changing nature of security threats around the globe including, specifically, the security threat presented by AIDS in Africa.”
At a news conference last month, Holbrooke said the AIDS epidemic is jeopardizing economies and security especially in southern Africa.
He noted that between 25 and 30 percent of the population of some key countries in Africa is carrying HIV or has AIDS.
“It is being transmitted at a very high rate, perhaps as high as 50 percent, from pregnant women to children,” he said.
“It is so heavily stigmatized in most of the area, except Senegal and Uganda, that people don't admit they have the disease because they're afraid they'll lose their jobs,” Holbrooke said.
Asked what the United States hopes will come out of Monday's meeting, Holbrooke's spokeswoman Glynn said: “The most important thing is destigmatization _ recognition of AIDS as a security threat because it affects so many people.”
U.N. Secretary-General Kofi Annan, a Ghanaian who has led efforts to focus U.N. attention on Africa, will also address the meeting along with Dr. Peter Piot, executive director of UNAIDS, and Mark Malloch Brown, administrator of the U.N. Development Program.
Holbrooke also said he plans to hold open meetings on Burundi where he said the situation “could explode,” on
Congo and Sierra Leone which have shaky cease-fires, on Angola, and on the plight of refugees
A study by NACP has shown that more than 520,000 Tanzanians have AIDS. More alarmingly, about 1.5 million Tanzanians have HIV, the virus that causes AIDS and eventually death.
Reports from some companies including Tanzania Harbors Authority reveal that over 50 percent of their expenses meant for administration go on HIV/AIDS cases.
The Parastatal Pension Funds, has recently said that about 84 percent of its compensation payments to it's members, which are the employees of the government parastatals, go to the families whose relatives died from HIV/AIDS and its related infections.
Since the disease was first reported in Tanzania in 1983, over 103,000 people have died of it, according to the NACP.
Over 80 per cent of AIDS patients are between 20 and 44 years old. "In some parts of Tanzania, AIDS has become the leading cause of death among adult men and women," NACP says.
Impacts of the pandemic are a lower life expectancy; a higher dependency ratio a slower GDP growth; absenteeism at work place; a decline in productivity; increasing health costs; soaring poverty; rising infant and child mortality, a growing number of orphans' social stress; long periods of illness; increased funeral costs, and bereavement.
NACP says priorities have to be placed on reducing the number of sexually transmitted diseases (STDs); toning down unsafe sexual behavior among highly mobile groups of people; reducing STD transmission among commercial sex workers; maintaining safe blood transfusion and helping poor women who invariably depend on sex to have other ways of earning a livelihood.
The program discourages un-protected sex among men with multiple partners. Its priorities are also about educating girls; reducing vulnerability of women in an adverse cultural environment and improving the well-being of people living with HIV/AIDS.
As STDs are among the top 10 causes of the disease spread in Mainland Tanzania, STD programs have been launched to diagnose and treat the disease early - and promote health care seeking behavior.
NACP says unprotected sex with multiple partners is a major factor fueling HIV/AIDS. Studies have shown that half of HIV prevalence is among long distance truckers and bar maids in Dar Es Salaam.
Military recruits are at a higher risk of HIV infection and other STDs than others. This is partly because they are sexually active and mobile; yet, military regulations bar them from marriage for t least six years while they are in service.
To serve their lives, therefore, NACP stresses the provision and promotion of condom use.
NACP also emphasizes the provision of STD case management services; the screening and counseling sexual behavior.
About 65 per cent of Tanzanians are below 25 years of age; and they are extremely vulnerable to HIV and other STD infections through indulging in early sexual intercourse.
Globally, people newly infected with HIV in 1998 numbered 5.8 million. The number of people living with HIV/AIDS was 33.4 million, according to the AIDS Epidemic Update of December 1998 issued by UNAIDS and the World Health Organization (WHO).
The Update quotes WHO as saying AIDS killed 2.5 million people in 1998. "Sub- Sahara Africa in home to 70 per cent of the people who become infected with HIV this year," it warns. "Africa, the global epidemic center, continues to dwarf the rest of the world on the AIDS balance sheet".
Dr. Beneath Fimbo of NACP told a workshop for journalists recently in Tanzania that the highest HIV prevalence was found in people aged between 35 and 39 years.
Dr, Fimbo suggested that the development of health services in the country was being stymied by AIDS.
The speaker, Kenneth Rothstein, MD, Associate Director at the Center for Liver Disease of Albert Einstein Medical Center, will discuss issues concerning HIV and Hepatitis C co-infection. Admission is free. Starting at 6:30pm there will be a small reception and the presentation is from 7:00pm-9:00pm. This training counts 2 hours toward the Case Management Coordination Project continuing education requirements for Ryan White Year 09. For more information, call (215) 985-4448.
FIGHT’s Frontline Information Series will take place on Wednesday, January 26, 2000. It will be held at St. Luke's & the Epiphany Church, located at 330 S. 13th St., 13th Street between Spruce and Pine Streets. The topic is Pain Management and Substance Abuse. The speaker is to be announced. The discussion will deal with pain management as an essential part of treating chronic illness, how a counselor can help as well as the difference between pain management and substance abuse. The seminar is from 3:oopm-5:00pm. Admission is free and refreshments will be served. This training also counts 2 hours toward the Case Management Coordination Project continuing education requirements for Ryan White Year 09.
The most important aspect of this program is the Peer Group Leadership Network (PGLN), according to participants.
Under the coordination of We The People’s Warren L. Hunt and FIGHT’s Hassan J. Gibbs. MEE has trained people living with HIV / AIDS and other advocates to deliver key campaign messages, share information and resources, generate awareness about treatment options, and minimize barriers people often face when seeking prevention and treatment services.
Presentations from the campaign are available to organizations and facilities in the Delaware Valley at no cost. Most presentations are 1 – 1.5 hours long. To schedule a presentation or for more information, please call or email the following numbers: Hassan J. Gibbs 215-732-0214 or email to Hjgibbs@critpath.org, or Warren L. Hunt at 215-406-2889.