[CDC News] CDC HIV/STD/TB Prevention News Update 11/12/03

CDC HIV/STD/TB Prevention News Update
Wednesday, November 12, 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 
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as background on Morbidity and Mortality Weekly Report (MMWR) 
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HEADLINES

NATIONAL NEWS
NEW YORK: "Pfizer Makes Aid Pledge, Breaks Aid Pact"

INTERNATIONAL NEWS
BOTSWANA: "Reluctance to Face Tests Slows Botswana AIDS Fight"

MEDICAL NEWS
DENMARK: "HIV Inhibitor: Boosted Saquinavir Shows Significant 
Safety Benefit over Boosted Crixivan"
UNITED STATES: "Heart Disease Risk: Cocaine Use Increases Heart 
Disease Risk in HIV Patients"

LOCAL AND COMMUNITY NEWS
ILLINOIS: "Mayor to Boost Anti-AIDS Funding, Aide Says" 
OHIO: "Priest's TB Death Leaves Questions"
FLORIDA: "HIV-Positive Receive Free Legal Advice from AIDS 
Project Florida"
PENNSYLVANIA: "National Grant to Fund Penn State HIV Education 
Efforts"

NEWS BRIEFS
SOUTH AFRICA: "South Africa Set to Boost AIDS Spending" 
SIBERIA: "Siberian Region Is First Stop in TB Effort Using Lilly 
Drugs"
UGANDA: "Uganda to Conduct Door to Door HIV Testing"
TENNESSEE: "Magic Johnson to Speak Here About HIV/AIDS"

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                           NATIONAL NEWS
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NEW YORK:
"Pfizer Makes Aid Pledge, Breaks Aid Pact"
Wall Street Journal (11.12.03)::Scott Hensley
     Yesterday, Pfizer retreated from a novel licensing deal for 
its Rescriptor that would have brought an inexpensive version of 
the HIV medicine to poor countries. Under the failed agreement, 
Pfizer would have licensed patents to the Concept Foundation, a 
nonprofit aid organization in Thailand. Partnered with Amsterdam-
based nonprofit International Dispensary Association, the Concept 
Foundation would have arranged for generic makers to produce the 
drug. 
     Pfizer acquired Rescriptor last April through its purchase 
of Pharmacia Corp., which had helped devise the licensing deal. 
The deal promised faster, better production of generic drugs for 
the developing world, and a transfer of technology by which 
generics companies would receive know-how beyond the patent, such 
as manufacturing expertise, from established drug companies.
     But the Rescriptor deal, hailed at the World Economic Forum 
last January, began to fall apart immediately. In a written 
statement at the time, Pfizer said it welcomed Pharmacia's 
"intellectual initiative" but would evaluate it further after the 
merger was complete. 
     Pfizer's Robert Mallett said the company concluded 
Rescriptor was not suitable for the licensing deal because of 
clinical drawbacks: Rescriptor must be taken three times daily, 
instead of once or twice. 
     Joachim Oehler of the Concept Foundation said Rescriptor's 
limitations were known from the start, and that Pfizer's decision 
"is hypocrisy." The Rescriptor project, he explained, was 
intended to help patients and to show the feasibility of a 
voluntary licensing approach "without the limitations of drug-
donation programs and without the hassles of public pricing 
battles between countries and activists on one side, and 
pharmaceutical companies on the other."
     Yesterday at the UN, Pfizer pledged to donate 135 million 
doses of its antibiotic Zithromax over the next five years to 
fight blindness caused by trachoma infections. The International 
Trachoma Initiative, founded in 1998 with Pfizer's support, has 
already provided 8 million doses of the antibiotic worldwide. 
Pfizer's recent commitment is valued at an estimated $500 
million.
     
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                       INTERNATIONAL NEWS
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BOTSWANA:
"Reluctance to Face Tests Slows Botswana AIDS Fight"
Boston Globe (11.08.03)::John Donnelly
     Experts long assumed if the money was available and 
countries in Africa built solid treatment programs offering free 
drugs, people would access them. Not so in Botswana, which offers 
free antiretrovirals, puts up $30 million annually for AIDS 
programs, and has attracted help from the Bill & Melinda Gates 
Foundation, Merck & Co. and the Harvard AIDS Institute. 
     Botswana has trained hundreds of doctors and nurses, and 
will have opened 16 AIDS clinics by 2004. Yet fewer than 9,000 
Botswanans take antiretrovirals, and fewer than 8 percent know 
their HIV serostatus. Health experts believe 350,000 of the 1.6 
million population are infected, a rate of more than 35 percent. 
The effect of the ubiquitous nature of AIDS is twofold: While it 
could shock some into being tested, it could also reinforce a 
false message of hopelessness.
     "When you have that many people who don't know their status, 
anything could happen," said Ernest Darkoh of the Ministry of 
Health. "If each person infected another person, then you could 
have 35 percent prevalence turn into 70 percent prevalence. It's 
insane."
     The crucial push may come from a new initiative championed 
by health officials in Botswana and CDC: giving HIV tests as a 
routine part of checkups in public and private clinics. Two weeks 
ago, President Festus Mogae announced that the government would 
begin routine HIV testing. Recently, he said he does not want 
health workers asking for consent; the burden should be on 
patients to object. The policy remains in flux.
     "I'm very frustrated," said Mogae. "We think because of the 
stigma attached to this sexually transmitted virus, and because 
some of our religious people have said this is a curse or those 
who have it are sinners, that people are afraid to get tested. 
One way of removing the stigma is making testing of HIV a routine 
thing." 
     On Wednesday in Washington, a forum co-chaired by Senate 
Majority Leader Bill Frist will convene to study the lessons of 
Botswana's AIDS program. Mogae will give the keynote address.

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                           MEDICAL NEWS
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DENMARK:
"HIV Inhibitor: Boosted Saquinavir Shows Significant Safety 
Benefit over Boosted Crixivan"
AIDS Weekly (10.20.03)
     Recent study results show that boosted saquinavir 
(saquinavir 1000 mg with ritonavir 100 mg) reduced HIV to 
undetectable levels in significantly more patients than boosted 
Crixivan (indinavir 800 mg with ritonavir 100 mg) at 48 weeks, as 
a result of a higher discontinuation rate in the indinavir arm of 
the study due to adverse events.
     Boosted saquinavir also led to significantly lower increases 
in key lipid measures, including fasting total cholesterol, LDL 
cholesterol and triglyceride levels, than boosted indinavir at 48 
weeks. The results come from the MaxCmin1 trial, the first large, 
randomized study to compare boosted HIV protease inhibitor 
regimens. 
     Co-administering saquinavir and ritonavir to increase levels 
of saquinavir in the blood is an approved European Union 
treatment strategy. A Supplemental New Drug Application (sNDA) 
for the investigational twice-daily saquinavir dosing regimen is 
under review by FDA. Roche is developing a 500 mg tablet 
formulation of saquinavir.
     "The results of the MaxCmin1 study show significantly more 
patients taking boosted saquinavir remained virologically 
suppressed than those on boosted indinavir at 48 weeks, probably 
because of a better toxicity profile for boosted saquinavir," 
said Mike Youle of the Royal Free Hospital in London, a study co-
author. "As safety becomes an ever more significant factor in 
choosing anti-HIV therapy, these results should help guide 
physicians when initiating patients on a protease inhibitor-based 
regimen."
     Fifty-seven percent of patients who received at least one 
dose of the saquinavir therapy had undetectable HIV levels (less 
than 50 copies/mL) at 48 weeks, compared to 46 percent in the 
boosted indinavir arm of the study at 48 weeks. More patients 
withdrew from the study due to side effects of boosted indinavir
(41 percent) than from boosted saquinavir (28 percent). Among 
patients who completed 48 weeks of therapy, HIV blood levels were 
suppressed to less than 50 copies/mL in 79 percent of patients on 
boosted saquinavir and in 77 percent of patients on boosted 
indinavir.
     Boosted indinavir caused a higher risk of elevating blood 
levels of lipids than boosted saquinavir in fasting total 
cholesterol (17 percent vs. 8 percent), LDL cholesterol (18 
percent vs. 3 percent) and triglyceride levels (22 percent vs. 9 
percent), according to the study.
     One hundred patients had at least one severe and/or life 
threatening adverse event: 65 (41 percent) in the boosted 
indinavir arm vs. 35 (24 percent) in the boosted saquinavir arm. 
There was a higher number of renal (13 vs. 1), dermatological (18 
vs. 3) and gastrointestinal (19 vs. 17) adverse events in the 
boosted indinavir arm of the study vs. the boosted saquinavir 
arm, respectively. 
     MaxCmin1 was designed and coordinated by the Copenhagen HIV 
Investigator Program (CHIP). Three hundred seventeen patients 
from 14 countries in North and South America and Europe 
participated. 
     The study, "Randomized Trial to Evaluate Indinavir/Ritonavir 
versus Saquinavir/Ritonavir in Human Immunodeficiency Virus Type 1 
Infected Patients: The MaxCmin1 Trial" appeared in the Journal of 
Infectious Diseases (2003;188:635-642).

UNITED STATES:
"Heart Disease Risk: Cocaine Use Increases Heart Disease Risk in 
HIV Patients"
AIDS Weekly (09.15.03)
     A recent study showed that cocaine use increases the risk of 
heart disease in HIV patients.
     "Cardiac dysfunction in AIDS is an important problem," while 
"cocaine is an epidemic associated with sudden death, cardiac 
dysfunction, and congestive heart failure," US scientists 
explained. "Cocaine use and HIV frequently coexist in the same 
patient, yet the combined impact of both is poorly understood."
     R.L. Sutliff and colleagues at Emory University used 
"cocaine treatment of an established murine AIDS transgenic model 
(NL4-3Delta gag/pol; TG) to define the combined effects of AIDS 
and cocaine on cardiac pathophysiology."
     "To determine the effects of cocaine and HIV-1 proteins on 
mortality, wild-type and NL4-3 Delta gag/pol mice received saline 
or cocaine via continuous infusion by Alzet osmotic pumps for 28 
days (chronic)," they wrote. "Acute cocaine administration (10 
days; 40 mg/kg/day) was used to study the nonlethal effects of 
cocaine in TGs. Echocardiograms and single time point 
electrocardiograms were performed at the termination of each 
experiment," and "hearts were removed and examined 
histopathologically."
     "Chronic cocaine treatment (80 mg/kg/day; 28 days) markedly 
decreased median survival in both wild-type and TG; however, TG 
survival was significantly more decreased," the report showed. 
"In acute studies, TG echocardiographic changes included 
increased left ventricular mass and increased left ventricular 
fractional shortening compared with all cohorts."
     "Electrocardiographic changes were absent among the groups," 
the scientists wrote. "Histopathologically, perivascular fibrosis 
and interstitial fibrosis were evident in cocaine-treated TG."
     "Data suggest that additive cardiac insults (from AIDS and 
cocaine) result in combined deleterious effects," the researchers 
concluded.
     The study, "Cocaine Increases Mortality and Cardiac Mass in 
a Murine Transgenic Model of Acquire Immune Deficiency Syndrome," 
appeared in Laboratory Investigation (2003;83(7):983-989).
 
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                    LOCAL AND COMMUNITY NEWS
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ILLINOIS:
"Mayor to Boost Anti-AIDS Funding, Aide Says" 
Chicago Sun-Times (11.11.03)::Fran Spielman
     Just two weeks after Mayor Richard Daley insisted he could 
not go beyond the $100,000 AIDS funding increase he had already 
proposed, Budget Director Bill Abolt promised to do just that in 
the second round of amendments to the 2004 budget. Abolt did not 
say where the money would come from or how much the increase 
would be. He did say a lobbying effort by aldermen campaigning 
for $1 million more persuaded the mayor to change his mind.
     "This is a significant issue. There's clear, broad-based 
support within the council and we want to accommodate their 
concerns.... We want to make sure that the budget addresses the 
issues that they see in the community," Abolt said. 
     "When you have a thousand new cases a year and 80 percent of 
them in minority communities, a stigma has been removed.... People 
recognize that HIV is affecting their communities with the same 
kind of vigor that had attacked the gay white male community in 
the early '80s," said Alderman Tom Tunney (44th), who applauded 
the mayor for responding to what has emerged as the number-one 
budget complaint. 
     Twenty-eight aldermen have co-signed a resolution calling 
for an increase in AIDS prevention funding, and ten of them have 
agreed to co-sponsor a budget amendment to bolster corporate 
funding by $1 million, 10 times more than in the mayor's version 
of the budget.

OHIO: 
"Priest's TB Death Leaves Questions"
Plain Dealer (11.09.03)::Regina McEnery
     Three months ago, the Rev. Norbert Oloya Atinmedi, a 36-
year-old priest from Uganda, arrived in Cleveland for a three-
year stay. Atinmedi, a member of the Apostles of Jesus, was 
assigned to St. Michael Hospital as chaplain. But by Oct. 24, he 
had died of respiratory failure due to multiple organ failure, 
AIDS and tuberculosis. The TB diagnosis prompted University 
Hospitals Health System to order skin tests for 300 hospital 
workers and 15 patients at St. Michael who may have been in 
contact with Atinmedi. No one has tested positive yet.
     It is not known whether Atinmedi confided to members of his 
order about his health problems, but his Cleveland assignment 
would have been derailed if local religious authorities had known 
his underlying health problems. The Cleveland Diocese requires 
priests to pass a physical and to provide information about any 
health concerns. In Atinmedi's case, health status was seen as 
especially relevant because his role as chaplain put him in daily 
contact with sick patients. 
     "It was our understanding, from the Apostles of Jesus, that 
he had passed a physical," said Robert Tayek, a diocese 
spokesperson. Tayek said the diocese was unaware that Atinmedi 
had TB or AIDS until he died. A TB diagnosis would have 
disqualified him from serving in the diocese. An AIDS diagnosis 
would have been handled on a case-by-case basis, he said.
     Atinmedi obtained a three-year religious worker's visa from 
the US State Department in Kenya. While US laws prohibit people 
from immigrating to the United States if they have TB, the laws 
do not apply to the thousands of non-immigrating visitors.
     Since 1993, Ohio's TB cases among the foreign-born have 
risen from 13 percent to 40 percent. Most infections originated 
abroad where TB is endemic. "Many of the cases that occur among 
the foreign-born occur within a few years of arrival in the US," 
said Elizabeth Koch, medical epidemiologist with the Ohio 
Department of Health. Ohio receives about $1 million annually 
from CDC for TB control and adds $230,000 of its own money.    

FLORIDA:
"HIV-Positive Receive Free Legal Advice from AIDS Project 
Florida"
South Florica Sun-Sentinel (11.07.03)::Gregg Lasky
     A new AIDS Project Florida (APFL) program offers free legal 
advice to people with HIV. The brainchild of attorney Norman 
Kent, a civil rights attorney, activist, and publisher of the 
Express Gay News, the program provides an answer for lawyer 
friends and colleagues who ask how they can help.
     "People living with HIV often suffer legal consequences, so 
I'm trying to use my connections in the legal community and 
create a bank of supportive lawyers who can help," said Kent, who 
is finishing his first year as director of APFL. The pro bono 
service is offered every Friday, but demand is so high that 
project officials hope to increase office hours as more attorneys 
sign on, according to Toni Latino, director of APFL's community 
legal assistance center.
    APFL offers medical treatment, educational and prevention 
services to uninsured HIV-positive South Floridians. It is the 
region's largest AIDS service organization, with 50 full-time 
staffers, 15 mental health interns and more than 200 volunteers. 
Kent said the demographics of the HIV epidemic are changing. More 
than 50 percent of new cases are coming from the African-American 
community, and people older than 50 and younger than 16 each 
represent 12 percent of new cases. With its proximity to the 
Caribbean, South Florida is experiencing a swell of new cases 
involving Haitian immigrants.
     The new legal program helps clients deal with issues such as 
living wills, power of attorney and other partnership issues 
while they are still relatively healthy, which gives them peace 
of mind, Latino said. This weekend, APFL will stage its first 5K 
run and walk fund-raiser along Ft. Lauderdale beach. For 
information about the race or the legal assistance center, 
telephone 954-537-4111.

PENNSYLVANIA:
"National Grant to Fund Penn State HIV Education Efforts"
Centre Daily Times (11.10.03)::Gwenn Miller
     A $7,200 grant from the National Association for Student 
Affairs Administrators was awarded to Penn State to help students 
educate their peers on HIV risk reduction. Health officials say 
college students overlook or fail to understand their risk for 
contracting HIV/AIDS. Penn State was one of six universities to 
receive the grants.
     A student action team at Penn State was formed to help enact 
the grant through a social marketing campaign to make HIV/AIDS 
more visible on campus. "What it's doing is really empowering 
these students," said Susan Kennedy, associate director for 
educational services at University Health Services. The team will 
create posters informing students of risk, prevention and health 
services available on campus.
     The team is charged with a daunting task. A survey of 2,400 
undergraduate students (782 participated) conducted in January 
revealed that 52 percent of those questioned thought they knew 
"very little or a little" about HIV/AIDS. "I had no idea that 
there was so little awareness about HIV and AIDS and sexual 
health on campus among students," said junior Julie Linek, a 
member of the student action team.
      Thirty-five of the students surveyed reported they or their 
partner always used a male or female condom or dental dam as a 
form of protection during sexual activity in the past year. Of 
the undergraduate students who had vaginal or anal intercourse, 
50 percent said they used a condom at last intercourse.
     Another member of the team, junior Steph Sharp, said 
students seem to understand they are at risk for HIV infection, 
but they do not seek more information about transmission 
prevention. "It's disturbing in the sense that they realized they 
don't know a lot, yet so few have taken action against it," Sharp 
said. 
 
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                       NEWS BRIEFS
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SOUTH AFRICA:
"South Africa Set to Boost AIDS Spending" 
Reuters (11.12.03)::Gordon Bell
     Today in Cape Town, South African Finance Minister Trevor 
Manuel said the government will nearly quadruple its HIV/AIDS 
spending to more than $1.7 billion over the next three years, 
with $270 million earmarked for the roll-out of a national 
antiretroviral treatment program. Treasury officials said the 
allocation for the drugs was new money. Under growing pressure at 
home and abroad to respond more aggressively to the epidemic to 
avert a long-term economic decline, President Thabo Mbeki's 
government approved the universal antiretroviral roll-out in 
August and ordered officials to finalize an operational plan. The 
cabinet said today the Treasury had allocated the required 
resources for the treatment program. A cabinet meeting scheduled 
for next week is expected to give the final go-ahead for the 
plan.

SIBERIA:
"Siberian Region Is First Stop in TB Effort Using Lilly Drugs"
Indianapolis Star (11.12.03)::Jeff Swiatek
     Eli Lilly and Co. said Tuesday that it will donate drugs and 
that its corporate foundation will pay $1 million to support a 
program in Tomsk, Siberia, to stamp out multidrug-resistant 
tuberculosis. Using 30 trained Russians and experts from Harvard 
University, the effort's results will be tracked closely and 
studied to serve as a model for other programs, said Gail 
Cassell, Lilly's vice president of scientific affairs. Tomsk has  
one of the largest populations with multidrug-resistant 
tuberculosis; these account for about 13 percent of its TB 
infections. Boston's Brigham and Women's Hospital will help train 
Russian medical fellows to treat the disease and will analyze the 
program's research data.

UGANDA:
"Uganda to Conduct Door to Door HIV Testing"
Xinhua News Agency (11.10.03)
     To gain a more accurate picture of how many Ugandans are 
living with HIV, the government plans to conduct door-to-door HIV 
testing. Joseph Musinguzi, a senior medical officer in the 
country's AIDS Control Program, was quoted Monday by the 
government newspaper New Vision as saying that within a few 
months, health teams will move door to door, interviewing 
randomly selected people and testing them for HIV. The National 
HIV/AIDS Sero-Survey is expected to answer critics' charges that 
Ugandan HIV/AIDS figures are not accurate because they are 
obtained only from pregnant women. Citizens selected by random 
sampling to be tested under the new initiative will sign consent 
forms, and their names will not be recorded. Their blood samples 
will also be checked for syphilis, herpes simplex virus-2 and 
hepatitis B. 

TENNESSEE:
"Magic Johnson to Speak Here About HIV/AIDS"
Commercial Appeal (11.11.03)::James Dowd
     Former NBA superstar Magic Johnson will be the featured 
speaker at a Nov. 18 HIV/AIDS screening and health fair in 
Memphis. Organizers hope the event at the Mississippi Boulevard 
Christian Church, located at 70 N. Bellevue in Midtown, will 
attract people who may be HIV-infected but have put off being 
tested. The fair will be held from 3-5 p.m. in the church 
fellowship hall and will include more than 30 medical and 
educational exhibits. "So many people, particularly in the 
African-American community, are not getting the proper treatment 
because they refuse to be tested. But the appeal of Magic Johnson 
ought to attract a lot of people," sad Carolyn Bryant, director 
of Mississippi Boulevard's counseling center. New Directions 
Inc., a nonprofit helping people living with HIV/AIDS since 1989, 
will conduct the free and confidential testing using the oral 
swab method. The event is free but registration is required; 
telephone 888-212-4684.

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