[CDC News] CDC HIV/STD/TB Prevention News Update 10/22/03

CDC HIV/STD/TB Prevention News Update
Wednesday, October 22, 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 cited as the source of the information. Contact the sources 
of the articles abstracted below for full texts of the articles.

HEADLINES

NATIONAL NEWS
"New Mexico Inmates to Get Hepatitis Treatment"

INTERNATIONAL NEWS
"Mandela Joins Celebrities to Launch an Appeal to Fund AIDS Awareness"
"Donors, UN Agree to Boost Support for AIDS Orphans"
"AIDS Threat Worse than Terror, Canberra Warned"
"Cervical Cancer: New US Global AIDS Law Will Undermine Condom Use, Not 
Help Women, Paper Says"

MEDICAL NEWS
"Hepatitis C Virus: Duke, Johns Hopkins to Lead First Comparative Trial 
of Therapies"
"Opportunistic Infection: Increased Antimicrobial Use by HIV Patients 
May Heighten MRSA Risk"

LOCAL AND COMMUNITY NEWS
"Health Officials Report Rise in Hepatitis C"
"Clergy, Community Leaders Address HIV/AIDS Problem"

NEWS BRIEFS
"AIDS Researchers Deplore Lack of Funding in Germany"
"HIV/AIDS Cape to Johannesburg Trek Ends"

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                       NATIONAL NEWS    
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"New Mexico Inmates to Get Hepatitis Treatment"
Associated Press (10.21.03)
     For the first time, New Mexico will begin treating prisoners for 
hepatitis C, which infects roughly one-third of the state's 6,200 
inmates.
     Dr. Frank Pullara, medical director for the state Corrections 
Department, said a new generation of drugs to effectively treat the 
virus was developed only about two years ago, and treatment can range 
from $15,000 to $30,000 per patient. However, Pullara noted, that is 
only a fraction of the $500,000 cost of a liver transplant the state 
would likely have to pay for should an inmate need one.
     Pullara, a University of New Mexico School of Medicine liver 
disease specialist, consulted with other health experts to develop a 
protocol for treating inmates. Although many people with the virus do 
not know they have it, 20-25 percent can develop liver cancer, 
cirrhosis, or lose liver function. At diagnosis, Pullara noted, there 
is no way to tell who might develop complications.
    Inmates with the virus now have their blood tested periodically to 
gauge liver deterioration. Those likely to suffer liver damage are 
referred to a treatment review committee that monitors their liver 
functions more closely. The committee decides for which inmates 
medication is appropriate.
     Prisoners have a right to refuse medication, which Pullara noted 
has "horrendous" side effects including nausea, vomiting and possibly 
severe depression. "This is a fairly brutal treatment," he said, adding 
that for every 100 people with the virus, he could probably only 
convince 10 to take the treatment.

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                       INTERNATIONAL NEWS       
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"Mandela Joins Celebrities to Launch an Appeal to Fund AIDS Awareness"
Associated Press (10.21.03)::Jack Garland
     Nelson Mandela joined stars from the music world in London Tuesday 
to raise HIV/AIDS awareness with a fund-raising campaign named in his 
honor. The international appeal, "46664, Give 1 Minute Of Your Life To 
AIDS," uses Mandela's prison number from his almost two decades of 
incarceration on Robben Island in South Africa.
     At a news conference, Mandela said AIDS is now "a human rights 
issue" and an unfolding tragedy of "unprecedented proportions." 
"Millions of people today infected with AIDS are just that - a number. 
They, too, are serving a prison sentence for life, that is why for the 
first time I am allowing my prison number, 46664, to brand this 
campaign," said Mandela.
     Conceived by former Eurythmics star Dave Stewart and put into 
place in partnership with the Nelson Mandela Foundation and Brian May 
and Roger Taylor of Queen, the 46664 campaign urges people to telephone 
a premium-rate line to hear a celebrity message and unreleased songs 
recorded by top musicians. Callers are logged as having given their 
support to a petition calling on governments to declare a global AIDS 
emergency. The fund-raising element of the appeal will vary from 
country to country, with the Mandela Foundation being the ultimate 
beneficiary. 
     A Nov. 29 concert in Cape Town's Greenpoint Stadium is also 
planned, which will be broadcast around the world via television, radio 
and the Internet. Musicians scheduled to perform include 50 Cent, 
Beyonce, Queen, Moloko and Ms Dynamite. According to a spokesperson, a 
CD and DVD of music are to be released early next year, with profits to 
go to the foundation.
     At the news conference, Sir Richard Branson, chair of Virgin 
Atlantic, a sponsor of the campaign, noted, "It is wonderful to have 
someone of Mr. Mandela's authority and respect to spearhead such a 
campaign, especially at a time when the Catholic Church are trying to 
tell young people not to wear condoms."

"Donors, UN Agree to Boost Support for AIDS Orphans"
Agence France Presse (10.21.03)
     A two-day meeting of donors, UN aid agencies and advocacy groups 
ended Tuesday in Geneva with agreement to boost efforts to help the 
growing number of children - mostly in sub-Saharan Africa - orphaned by 
AIDS. UNICEF and UNAIDS said in a statement that they had decided to 
improve support for families and education for at least 14 million AIDS 
orphans. Some 80 organizations discussed an estimate by UNAIDS that $1 
billion is needed for the improvements. 
     By 2001, 14 million youngsters had lost one or both parents to 
HIV/AIDS, with about 80 percent of cases occurring in sub-Saharan 
Africa. "The number of people orphaned by AIDS is projected to rise to 
at least 25 million by 2010," Peter Piot, the chief of UNAIDS, said at 
the meeting.
     "The crisis of orphans and other children made vulnerable by 
HIV/AIDS is massive, growing and long-term," said UNICEF Executive 
Director Carol Bellamy. "But two-thirds of countries hard hit by the 
disease do not have strategies to ensure children affected grow up with 
even the bare minimum of protection and care," she added.    

"AIDS Threat Worse than Terror, Canberra Warned"
Australian (10.22.03)::Amanda Hodge
     The chief of the Asia and Pacific AIDS Society said yesterday that 
HIV looms as a greater long-term security threat to the Asia-Pacific 
region than global terrorism, with infections throughout Asia set to 
outstrip those in Africa within a decade.
     "We have already seen in Africa that once HIV starts affecting a 
lot of people, you get the beginnings of a societal collapse because 
the people who get sick are disproportionately in those age groups 
societies depend on to keep them going," said Dennis Altman, society 
president and a La Trobe University politics professor. Regional 
statistics are sketchy, he said, but HIV has already infected millions 
in Papua New Guinea, Indonesia, China and India, and it is expected to 
kill 10,000 Cambodians each year for the next 10 years. 
     "Teachers, nurses, civil servants and police are dying faster than 
they can be replaced, so over time you get the potential for a whole-
of-society collapse. That's a pattern we've seen in African countries 
and one beginning to happen in other parts of the world," Altman said.
     The African experience has demonstrated the link between HIV and 
famine as large numbers of workers succumb to the disease, Altman said 
in a paper to be delivered today at the Australasian Society for HIV 
Medicine conference in Cairns. 
     Altman said the Australian government is right to focus on global 
terrorism but cannot afford to ignore the lessons from Africa's 
epidemic, which prove that if HIV is left unchecked it has the 
potential to destroy nations.

"Cervical Cancer: New US Global AIDS Law Will Undermine Condom Use, Not 
Help Women, Paper Says"
Women's Health Weekly (10.16.03)
     A recent paper contends that high cervical cancer death rates 
among women in developing countries reflect a lack of access to Pap 
smears and other screening programs, not a high prevalence of human 
papillomavirus (HPV) infection.
     Genital HPV - certain strains of which can lead to cervical cancer 
- is common globally, but in countries where women receive timely 
screening and treatment, cervical cancer rates are low. A new US global 
AIDS law requires an analysis of HPV prevalence and a study of the 
impact of condom use on the spread of HPV in sub-Saharan Africa, 
ostensibly to combat high rates of cervical cancer.
     According to the paper, "HPV in the United States and Developing 
Nations: A Problem of Public Health or Politics?" by Cynthia Dailard 
(Guttmacher Report on Public Policy; August 2003;6(3)), evidence from 
developed nations suggests the law's focus on HPV prevalence is 
misplaced and will undermine confidence in condoms without helping poor 
women get screening services.
     Despite high rates of HPV infection among Americans, cervical 
cancer accounts for only 1 percent of cancer deaths in women. Pap tests 
allow early detection and treatment of precancerous changes in cervical 
cells. Globally, cervical cancer kills 225,000 women a year, almost 85 
percent of them in developing countries where cervical screening is 
often unavailable.
     Proponents of the US law say that because HPV is spread by skin-
to-skin contact, it cannot be entirely prevented by condom use, so only 
abstinence before marriage and monogamy within it can protect women 
from HPV and cervical cancer. According to Dailard, using HPV to 
undermine global confidence in condoms places people at risk of 
contracting a number of diseases and does not address the issue of 
providing cervical cancer screening for developing nations.

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                       MEDICAL NEWS     
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"Hepatitis C Virus: Duke, Johns Hopkins to Lead First Comparative Trial 
of Therapies"
Hepatitis Weekly (10.13.03)
     In hopes of refining treatment practices for hepatitis C, 
researchers at Duke University Medical Center and the Johns Hopkins 
University School of Medicine will lead the first ever direct 
comparison of two leading treatments for the infection.
Hepatitis C infects nearly 3.9 million Americans, according to CDC. 
Approximately 70 percent of patients have chronic hepatitis C, which 
can cause cirrhosis and liver cancer and is the leading indication for 
liver transplantation in the United States.
     A combination of interferon and ribavirin is the most common 
hepatitis C treatment. A recent advance has been pegylated interferon, 
which improves pharmacokinetic characteristics compared to standard 
interferon, allowing more convenient weekly dosing instead of three 
times a week.
    The study - led by John McHutchinson, MD, director of 
gastroenterology and hepatology research at the Duke Clinical Research 
Institute, and Mark Sulkowski, MD, assistant professor of medicine at 
Johns Hopkins - will compare three treatment regimens in 2,880 
hepatitis C patients. The trial, IDEAL (Individualized Dosing Efficacy 
vs. flat dosing to Assess optimaL pegylated interferon therapy) is 
sponsored by the Schering-Plough Research Institute. Patients will be 
given one of two available pegylated interferon treatments - pegylated 
interferon alfa-2b (PEG-INTRON, by Schering-Plough Corp.) and pegylated 
interferon alfa-2a (PEGASYS, by Hoffman-LaRoche Inc.) - combined with 
ribavirin.
     "The beginning of this trial is truly a milestone in research for 
treatments of hepatitis C virus," said McHutchinson. "This is the first 
time we have directly compared these two treatments in a head-to-head 
manner. We hope to learn important information that will directly 
impact the treatment of our hepatitis C patients."
     The trial will enroll patients from 100 different sites 
nationwide. Dosing is one of the primary differences between the two 
treatments, scientists said. Alfa-2a is given in the same dosage to all 
patients, while Alfa-2b is given based on the individual patient's 
weight. The trial's goal is to determine which treatment results in a 
sustained viral response (an undetectable level of virus in the 
patient's blood 24 weeks after the end of therapy) in the largest 
proportion of patients.
     "By eradicating the virus during and after therapy, we are able to 
forestall, and in many cases, prevent further damage to the liver. This 
has a huge impact on patient health and quality of life and translates 
into prolonged survival, a lower incidence of liver cancer and may 
prevent the need for liver transplantation," said McHutchinson, who has 
served as a paid consultant to Schering and has received research 
support and lectured on behalf of both Schering-Plough and Hoffman-
LaRoche.

"Opportunistic Infection: Increased Antimicrobial Use by HIV Patients 
May Heighten MRSA Risk"
AIDS Weekly (10.13.03)
     M. Miller and colleagues at Columbia University studied 500 
subjects from a community-based cohort of drug users between February 
1999 and March 2000. They found that increased antimicrobial use by HIV 
patients might heighten their risk of methicillin-resistant 
Staphylococcus aureus infection.
     "HIV-infected individuals, especially those with a history of 
injecting drug use, are at high risk of Staphylococcus aureus 
infection," the researchers noted. "Moreover, the use of antimicrobial 
agents for opportunistic infections may increase nasal colonization by 
antimicrobial-resistant Staphylococcus aureus in this population and, 
subsequently, levels of infection with multidrug-resistant 
Staphylococcus aureus in the community."
     Test results revealed that 24 percent of the subjects had 
Staphylococcus aureus infections, and "only HIV infection and 
homelessness were associated with Staphylococcus aureus colonization," 
according to the study. Ten isolates (8 percent) were methicillin-
resistant Staphylococcus aureus.
     Methicillin-resistant Staphylococcus aureus isolates were found 
among 14 percent of HIV-infected subjects, vs. 3 percent of HIV-
uninfected subjects. Among those colonized and HIV-infected, the mean 
number of resistant isolates was higher for those currently reporting 
antibiotic use and for those with CD4 counts equal to or less than 
200/microliter.
     "The increased use of antimicrobial agents in HIV-infected 
individuals colonized with Staphylococcus aureus may be an underlying 
mechanism that contributes to the presence of multidrug-resistant 
Staphylococcus aureus in the community," the researchers reported.
     Miller and coauthors published their study, "Staphylococcus Aureus 
Colonization in a Community Sample of HIV-Infected and HIV-Uninfected 
Drug Users," in the European Journal of Clinical Microbiology & 
Infectious Diseases (2003;22(8):463-469).

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                       LOCAL AND COMMUNITY NEWS 
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"Health Officials Report Rise in Hepatitis C"
Journal-Standard (Freeport, Ill.) (10.22.03)::Travis Morse
     Illinois' Stephenson County Health Department is watching 
hepatitis C rates after noting a rise in cases in 2002. 
     A county health department annual report showed 17 hepatitis C 
cases in 2002, a 40 percent increase over the 12 cases reported in 
2001. But the Illinois Department of Public Health reported 22 cases of 
hepatitis C in Stephenson County for 2002. County Health Administrator 
Jeff Todd said the discrepancy reflects the inclusion of later test 
results and that the IPDH figure is probably accurate, which means an 
80 percent increase in the number of hepatitis C cases. 
     The case count represents disease carriers - individuals who are 
infected but not symptomatic. From April 2001 - when the federal 
government made hepatitis C a reportable disease - to the present, the 
state reported 818 infected persons.
     Pam Kirkpatrick, communicable disease coordinator for the Health 
Department, said doctors are doing a better job of screening for 
hepatitis C and advising patients about risk factors, including having 
received a blood transfusion or solid organ transplant before July 
1992, having received clotting factors made before 1987, and having 
ever been on long-term kidney dialysis. CDC estimates that injection 
drug use accounts for 60 percent of all new cases of the ailment, 
although body piercing or tattooing with unsterilized needles, sharing 
personal care items, sharing drug paraphernalia and sexual activity 
resulting in blood-to-blood contact can also lead to infection. 
Antiviral therapy is effective about half the time.
     Former "Baywatch" star Pamela Anderson has hepatitis C. According 
to news reports today, she told US magazine in an upcoming issue, "I 
think I've got a good 10 years left in me, which is sad, too. Maybe 15, 
if I'm lucky." Anderson, who was diagnosed with the disease in 2001, is 
currently using homeopathic treatments, according to reports. 
     Todd said there are currently about 2 million to 4 million 
undiagnosed cases of hepatitis C nationwide. 

"Clergy, Community Leaders Address HIV/AIDS Problem"
Associated Press (10.17.03)::Cheryl Wittenauer
     The black community in St. Louis should follow the lead of the 
white gay community in mobilizing against HIV/AIDS, the chief of the 
city Health Department's Family and Community Health Bureau said 
Friday. "We aren't owning it," Bill Dotson, who is black, told the 
mostly black audience of ministers, lawmakers and health advocates 
gathered for a conference on the public health crisis of HIV/AIDS among 
blacks in St. Louis city and county. 
     Blacks, who make up half of the city's population, account for 
more than 75 percent of all new HIV cases reported. While heart 
disease, cancer and stroke account for 60 percent of deaths among the 
city's black population, Dotson said the leading cause of death for St. 
Louis' black community is the "inability to embrace lifesaving 
information." Turning to the ministers, he added: "That's why we need 
your help, to help develop a message people will listen to."
     St. Louis had set a goal of reducing AIDS morbidity 20 percent by 
2005, said Dotson. "We have not done that," he noted. "For the last two 
years, the numbers have gone up."
     Black church and civic leaders met at America's Center to discuss 
what to do about the crisis. Leaders at the meeting spoke of black men 
who are gay or bisexual but do not disclose it because homosexuality is 
seen as a sign of weakness or "whiteness." Unsuspecting black women are 
contracting the AIDS virus through sexual contact with those men, city 
Health Commissioner Melba Moore said.
     The 150 ministers and legislators in attendance were asked to 
commit to discussing the disease from the pulpit, distributing 
educational materials, and providing opportunities for testing. 
     Legislators were asked to include HIV/AIDS in political platforms 
and town meetings, as well as to sponsor and endorse legislation 
supporting prevention and increasing funding.

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                       NEWS BRIEFS              
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"AIDS Researchers Deplore Lack of Funding in Germany"
Agence France Presse (10.21.03)
     On Tuesday, German researchers criticized the lack of funding 
Germany dedicates to efforts to find an AIDS vaccine and called on the 
government to rethink its priorities. "According to our calculations, 
the budget for research into an AIDS vaccine is about seven million 
euros [US$8.25 million]," said Bernhard Fleckenstein, head of research 
at Erlangen-Nuremberg University. "That is around 300 times less than 
in the United States," he said. The director of the Robert Koch 
Institute, a research facility specializing in contagious diseases, 
complained the German government had not set clear goals in fighting 
"the biggest medical catastrophe of modern times." The researchers are 
among 25 scientists holding a two-day conference at the institute in 
Berlin on developments in Germany's fight against HIV/AIDS.

"HIV/AIDS Cape to Johannesburg Trek Ends"
Star (South Africa) (10.22.03)::Ndivhuwo Khangale
     Three German athletes hoping to raise HIV/AIDS awareness by 
running and cycling from Cape Town to Johannesburg finished their 
journey yesterday at Chris Hani Baragwanath Hospital in Soweto. Joachim 
Franz, Dr. Michael Ströhmann, and Daniel Dost were accompanied by an 
18-member team comprising doctors and technical supporters. The absence 
of top government officials who had been expected to officially welcome 
the trio did not seem to bother them. They were joined by at least 45 
South African athletes from the Masibambanane Community Project, an 
HIV/AIDS project based in Cape Town, to form the South Africa Run & 
Bike for Help. The Germans, who were led by Franz, visited schools, 
community centers and public venues on their trek, which began Oct. 7. 
"The money that I will raise through this project, which is expected to 
be up to R1.5 million (US$215,000), will all be donated to HIV/AIDS in 
South Africa in April next year," Franz said.

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