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CDC HIV/STD/TB Prevention News Update
Thursday, October 30, 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
"NIH Faces Criticism on Grants; Coalition Assails 'Smarmy
Projects'"
"Focus Is on Prevention as STDs Continue to Increase"
"Implementation of Rapid HIV Test Off to Slow Start"
"ACT UP Calls for Prison Condoms"
INTERNATIONAL NEWS
"Faulty Machine Means Thousands in British Columbia Got Wrong
Results in STD Test"
MEDICAL NEWS
"Short-Term Effects of Cannabinoids in Patients with HIV-1
Infection"
LOCAL AND COMMUNITY NEWS
"Daley Pressed on AIDS Budget"
NEWS BRIEFS
"Nigeria to Test Polio Vaccines over AIDS"
"Health Study Gives D.C. Good News on Uninsured"
"Jackson Program Receives HIV Grant"
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NATIONAL NEWS
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"NIH Faces Criticism on Grants; Coalition Assails 'Smarmy
Projects'"
Washington Post (10.30.03)::Rick Weiss
The Traditional Values Coalition, a public policy
organization that says it represents more than 43,000 member
churches, yesterday said it will ask the Justice Department to
investigate how scores of health and sexuality studies received
federal funding through the National Institutes of Health.
An official at NIH, which is internationally renowned in
part for its peer-review system of evaluating proposals, said the
studies are an important part of devising better public health
and education strategies. But TVC called them "smarmy projects"
representing at least $100 million in wasted federal funds. TVC's
call is the latest volley in its escalating conflict with NIH and
the agency's congressional and institutional supporters, who see
the attack as part of a larger effort to foist conservative
religious values on the federal scientific enterprise.
"We have nameless, faceless bureaucrats doling out money
like a federal ATM to do things like study the sex habits of
Mexicans before and after they cross over the border. This
doesn't pass the straight-face test," said TVC Executive Director
Andrea Lafferty.
Calling TVC's tactics "scientific McCarthyism," Rep. Henry
Waxman (D-Calif.) has in the past four days sent two angry
letters to Health and Human Services Secretary Tommy Thompson
asking him to stand up to TVC and support NIH.
Lafferty yesterday took sole responsibility for compiling
and sending to Congress a list of about 200 NIH projects related
to sexuality, AIDS and risk-taking. Waxman had expressed
suspicion that HHS officials or others in the Bush administration
helped compile or release the list. Yesterday, in a letter to
Waxman, Thompson denied any HHS involvement but did not address
Waxman's request for information on any meetings or
communications between HHS and TVC.
"We can't have moralizing and ideology trump science when it
comes to protecting the public health," warned Alan Leshner, CEO
of the American Association for the Advancement of Science, the
nation's largest general science organization. "It's vitally
important that we understand the processes by which public health
problems spread if we're ever going to get a handle on issues as
important as HIV/AIDS and drug abuse."
"Focus Is on Prevention as STDs Continue to Increase"
Associated Press (10.28.03)::Michael Koryta
Reported cases of STDs are on the rise in Indiana. According
to state statistics, numbers for chlamydia and gonorrhea have
been rising steadily in recent years, while syphilis is finally
on a decline. Cases of HIV/AIDS are evaluated separately.
In Jackson County, reported STD cases have increased 93
percent since 2000. They have doubled in Monroe County in that
same period, and nearly tripled in Greene and Washington
counties. According to Michael Butler, director of the division
of HIV/STD for the Indiana Department of Health, the rise can be
attributed to two major factors: spread of the diseases and
improved case-finding.
Butler points to successful prevention and treatment
campaigns launched during a syphilis epidemic in 1999 when 443
cases were reported statewide. Last year, that number dropped to
66. "We received a federal grant, and thanks to a very involved
effort on a state, local and federal level, we were able to have
incredible success. The focus of that effort was community input
and action," said Butler. He believes lessons learned then will
help STD prevention as a whole.
Disease Intervention Specialist Penny Caudill, of the Monroe
County Health Department, said STDs are a concern in south-
central Indiana, especially in rural areas where there are few
doctors. "Just getting health care is difficult, and it is more
time-consuming for us," said Caudill, whose department oversees
STD prevention and testing for a 12-county area. "I think people
are becoming more lax regarding prevention," she added.
The presence of Indiana University makes Monroe County even
more difficult for STD management due to the transient lifestyle
of students, Caudill noted.
Anne Reese, director of health and wellness education for
the IU Health Center, said the numbers for herpes and human
papillomavirus - not considered reportable by the state - are
much higher than those for chlamydia and gonorrhea. Reese said
she believes the best way to manage the spread of STDs is by
increasing awareness.
"Implementation of Rapid HIV Test Off to Slow Start"
Los Angeles Times (10.29.03)::Daniel Costello
Despite Food and Drug Administration approval of a 20-minute
finger-prick HIV test nearly a year ago, fewer than a dozen
California sites offer it. Health officials say strict state
testing guidelines and confusion about how to implement the test
have limited its introduction in California.
In several instances, officials are not advertising what
sites are conducting the new test for fear of being overrun with
patients. But the heart of the problem, state health officials
say, is the fact that California has some of the most stringent
regulatory testing guidelines in the country.
Federal regulations require that any site offering blood
tests outside of traditional laboratory settings apply for a
waiver. In addition, California requires test givers to have at
least a high school diploma and go through more extensive
training than the federal government requires.
Many of those expected to give the test are HIV counselors
who often have little or no experience administering blood tests.
Most of them have worked with tests that use an oral swab, and
have not had to deal with many of these state and federal rules
before.
"It's been a little confusing figuring out how this test
fits in with our current system and all the rules that surround
it," said Deanna Sykes, who has overseen implementation for
California's Office of AIDS.
An 11-site pilot testing program scheduled for late May
began in only four locations because many lacked measures
guaranteeing the test's safety and accuracy, officials said. A
recent Los Angeles proposal for 26 testing sites was held up for
several weeks because state health officials were unsure a group
application was technically valid. After checking with federal
officials, the state decided it was all right; however, it could
still be months before counselors are trained.
By processing waivers more quickly and offering training,
state health officials hope there could be as many as 700 rapid
testing sites statewide by next summer. The Legislature is also
expected to consider a bill early next year that would condense
some of the training into one session.
"ACT UP Calls for Prison Condoms"
Gay City News (New York City) (10.23.03)::Aaron Parsley
On Oct. 21, members of ACT UP-NY assembled at the Lincoln
State Correctional Facility in Harlem and demanded that the New
York State Department of Health take over health care inside
state prisons because, they claimed, the Department of
Corrections is not fighting a crisis of HIV and hepatitis C
infections among inmates. The activists said the crisis is the
result of inadequate health care, a lack of testing, and a ban on
condoms in state prisons.
The protest precedes a Nov. 14 hearing of the state Assembly
Committee of Health in which three related bills are to be
discussed. Assemblymember Richard N. Gottfried (D-Manhattan) is
sponsoring two bills that together would define the health care
systems of state and local correctional facilities as hospitals,
bringing them under the oversight of NYSDOH, and require that
they implement HIV/STD education and prevention programs,
including condom distribution.
"These are not earth-shattering proposals," said Ronald
Johnson, associate executive director of Gay Men's Health Crisis.
"It would just bring prison hospitals into line with the rest of
the state."
Emmaia Gelman from ACT UP-NY said that while state and
federal health officials promote condom use to protect against
HIV and hepatitis C, condoms are contraband in state prisons.
"The CDC insists that people use condoms, but 60,000 inmates do
not have access," Gelman said, adding that sex between inmates,
while illegal, does take place. Group member Melvyn Stevens said
he believes a lack of education, confidentiality and access to
medication are all part of the problem.
Chino Hardin, who has spent time at Rikers Island
correctional facility, said she tested HIV-positive while
incarcerated, but all her tests since she was released have come
back negative. Hardin believes she was told she was HIV-positive
because she is lesbian. "The same thing happened to a friend,"
Hardin said. "I think it's happening on purpose. It's a form of
punishment."
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INTERNATIONAL NEWS
************************************************************
"Faulty Machine Means Thousands in British Columbia Got Wrong
Results in STD Test"
Canadian Press (10.29.03)::Terri Theodore
A technical problem with a diagnostic machine in Cranbrook,
British Columbia, switched thousands of test results for
chlamydia and gonorrhea to their opposites, said Alison Paine,
spokesperson for the Interior Health Authority. "In other words,
if you were a positive, you would have received a negative
reading. If you were a negative, you would have received a
positive reading," said Paine. About 3,000 people are believed to
have taken the tests between Nov. 1, 2000 and May 24, 2002.
Paine said the company that manufactures the machine
notified the authority in July of the defect. "We immediately
stopped using the machine," said Paine. Becton, Dickenson and
Co., based in New Jersey, manufactures the BD ProbeTec. A
spokesperson was unavailable for comment. Only two machines out
of 1,000 tested worldwide have shown the defect - incorrectly
installed optical bundles - according to the company's Web site
product notice. The company said it is working with Health Canada
to ensure the machine is recalled.
About 83 of those tested during the time were given a clean
bill of health when they had one of the diseases. The rest were
told they were infected and were given treatment when they did
not have the diseases, said Paine. The number affected multiplies
when considering that each of those tested had at least one sex
partner to whom the results also mattered. Most of the 83 have
been contacted, Paine said, but not all. She urged them to
telephone 1-888-887-8811 for treatment.
************************************************************
MEDICAL NEWS
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"Short-Term Effects of Cannabinoids in Patients with HIV-1
Infection"
Annals of Internal Medicine (08.19.03) Vol. 139; No. 4: P. 258-
266::Donald I. Abrams, MD; Joan F. Hilton, DSc; Roslyn J. Leiser,
RN; Starley B. Shade, MPH; Tarek A. Elbeik, PhD; Francesca T.
Aweeka, PharmD; Neal L. Benowitz, MD; Barry M. Bredt, MA; Bradley
Kosel, PharmD; Judith A. Aberg, MD; Steven G. Deeks, MD; Thomas
F. Mitchell, MPH; Kathleen Mulligan, PhD; Peter Bacchetti, PhD;
Joseph M. McCune, MD, Phd; Morris Schambelan, MD
In 1986, the Food and Drug Administration approved a
synthetic, oral form of marijuana's main psychoactive component,
delta-9-tetrahydrocannabinol (dronabinol) for treating
chemotherapy-induced nausea and vomiting. A randomized,
controlled trial demonstrated that dronabinol increased self-
reported appetite but not weight in patients with AIDS-related
wasting syndrome, leading to an expansion of the labeling
indication for this use in 1992. Patients with AIDS-related
wasting syndrome, a preterminal manifestation of AIDS before the
advent of highly active antiretroviral therapy, often reported
they preferred smoked marijuana to dronabinol because it was
easier to titrate the dose to achieve the desired effect.
With the increased availability of protease inhibitor-
containing antiretroviral regimens in the mid-1990s, the
incidence of AIDS-related wasting syndrome decreased markedly.
Protease inhibitors, which can inhibit or stimulate the hepatic
cytochrome P-450 enzyme system, are subject to many drug-drug
interactions, and the potential for drug-drug interaction between
protease inhibitors and marijuana is worrisome since many HIV-
infected patients continue to smoke marijuana as an appetite
stimulant or to decrease nausea.
Considering the potential for both a protease inhibitor-
cannabinoid interaction and an effect of smoked marijuana on the
immune system, the authors designed this study to determine the
safety or toxicity profile of cannabinoids (smoked or oral) in
persons with HIV infections. They chose HIV RNA levels as the
primary outcome because an intervention that interacted
unfavorably with either the antiretroviral agent pharmacokinetics
or the immune system directly could cause a perturbation of viral
suppression.
Study participants were required to be at least 18 years
old, have documented HIV infection, and be receiving a stable
antiretroviral treatment regimen of either indinavir or
nelfinavir for at least eight weeks before enrollment.
Participants were also required to have a stable viral load,
defined as less than a threefold (0.5 log10) change in HIV RNA
level for the 16 weeks before enrollment. All participants were
required to have previous experience smoking marijuana.
Of the 69 study participants admitted to the inpatient study
unit, 67 were randomly assigned between May 1998 and May 2000.
Thirty-seven patients were receiving nelfinavir-containing
regimens and 30 patients were receiving indinavir-containing
regiments. Of these, three and two patients, respectively, left
the study prior to the pharmacokinetic analysis on day 14. The
remaining 62 participants completed the 21-day inpatient
intervention and were eligible for all end points (marijuana
group, 20 patients; dronabinol group, 22 patients; and placebo
group, 20 patients). Participants were randomly assigned to a
3.95 percent-tetrahydrocannabinol marijuana cigarette, a 2.5 mg
dronabinol capsule, or a placebo capsule three times daily before
meals.
Most patients were men (89 percent) older than age 40 (68
percent), and half were of nonwhite ethnicity. More patients in
the marijuana and dronabinol groups than in the placebo group had
previous AIDS diagnoses and detectable HIV RNA than in the
placebo group. Overall, 58 percent had undetectable HIV RNA
levels (<50 copies/mL); only five patients had HIV RNA levels
greater than 10,000 copies/mL, four of whom were receiving
nelfinavir-containing regimens. Baseline CD4+ and CD8+ cell counts
were similar in all groups.
Over the 21-day follow-up period, increases in CD8+ cell
counts were on average 20 percent (CI, 7 percent to 38 percent)
greater for patients receiving marijuana than for patients
receiving placebo, and marginally greater (10 percent [CI, -5
percent to 29 percent]) for patients receiving dronabinol than
for those receiving placebo. In the adjusted repeated-measures
model, the cannabinoid effects were similar (lower confidence
bounds: marijuana group, 4 percent; dronabinol group, -3
percent). An analysis of expanded immune system phenotypes and
functions revealed few statistically significant effects.
The study provides evidence that short-term use of
cannabinoids, either oral or smoked, does not substantially
elevate viral load in individuals with HIV infection who are
receiving stable antiretroviral regimens containing nelfinavir or
indinavir. Neither CD4+ nor CD8+ cell counts seemed to be adversely
affected by the cannabinoids during the study; lower confidence
bounds on estimated cannabinoid effects typically exceeded 0,
indicating benefit rather than harm. The short-duration clinical
trial suggests acceptable safety in a vulnerable immune-
compromised patient population. "Further studies investigating
the therapeutic potential of marijuana and other cannabinoids in
patients with HIV infection and other populations are ongoing and
should provide additional safety information over longer exposure
periods," determined the authors.
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LOCAL AND COMMUNITY NEWS
************************************************************
"Daley Pressed on AIDS Budget"
Chicago Tribune (10.30.03)::Gary Washburn
Concerned about increasing HIV infections among gay and
bisexual men and in minority communities, Chicago officials said
Wednesday they will seek a more than 25 percent increase in Mayor
Richard Daley's proposed AIDS budget. Daley's city budget of $3.7
million for AIDS prevention and care next year represents a
$100,000 increase from 2003. But that funding is down from a high
of $3.9 million spent in 1997, said Alderperson Thomas Tunney,
who is seeking an amendment pushing for a $1 million increase.
Ten City Council members so far have agreed to seek a higher
figure, but Daley gave no indication he would budge.
"Half the people who I grew up with in the early 1980s who
were gay or bisexual are dead," said Tunney. Now "there is a
'fatigue' about safe sex, condom use. We cannot rest with this
disease running rampant through our community, through our city."
This year Chicago is receiving $43 million in federal funds
to fight HIV/AIDS. The city is waiting to see if a requested
$600,000 increase for next year will be granted, said Chicago
Health Commissioner Dr. John Wilhelm. The city's finances are so
constrained that it appears the $100,000 in increased AIDS
funding will represent the only item in the Health Department's
spending plan that will grow next year, said Wilhelm.
Overall, new AIDS cases in Chicago have remained relatively
stable, at about 1,000 a year. But syphilis cases have been on
the rise, signaling unprotected sex and the potential for an
increase in HIV infections.
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NEWS BRIEFS
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"Nigeria to Test Polio Vaccines over AIDS"
Associated Press (10.30.03)::Dulue Mbachu
Nigerian authorities said yesterday that polio vaccines
recently administered in a nationwide campaign will undergo
laboratory testing to calm fears about AIDS. Vice President
Abubakar Atiku ordered testing on the vaccines for agents that
could spread HIV or sterility, Nigeria's state television
reported. On Friday, health workers launched a drive to immunize
15 million African children at immediate risk of contracting
polio - an effort hampered in Nigeria by the assertion of Islamic
radicals that the drive is part of a US plan to decimate the
Muslim population by spreading AIDS and infertility.
International health officials and the Nigerian government have
called the allegations ridiculous, and UN officials involved in
the campaign say proof of the vaccine's safety has been
repeatedly supplied. Ninety-nine percent of all new polio cases
worldwide are in Nigeria, Pakistan and India. Health authorities
in India say they are close to defeating the disease: A
successful immunization campaign there has lowered new polio
cases to 145 as of Oct. 14, compared with 1,556 in 2002.
"Health Study Gives D.C. Good News on Uninsured"
Washington Post (10.30.03)::Avram Goldstein
A new Henry J. Kaiser Family Foundation telephone survey of
1,581 District of Columbia residents shows the city's uninsured
population has fallen to 50,000 - one of the nation's lowest
rates. The survey, an effort to help the city plan health care
programs, found that 24 percent of residents identified the
control of HIV/AIDS and STDs as the city's most pressing health
issue. Thirty percent of blacks cited HIV/AIDS and STDs as the
city's most urgent health concern, compared with 13 percent of
Latinos and 16 percent of whites.
"Jackson Program Receives HIV Grant"
Biloxi Sun Herald (10.30.03)
The Nominal Group Inc. of Jackson is Mississippi's only
institution to receive funding from the $156.5 million announced
by the Department of Health and Human Services last week to
support substance abuse prevention and treatment for people at
risk for HIV. The group's program, "Reducing the Risk to West
Jackson," will receive a one-year planning grant of $102,272 to
begin strategic planning efforts for HIV prevention in areas
suffering from addiction problems.
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