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July 11, 2002 — New weapons in the AIDS armamentarium are less likely to cause lipid abnormalities than other antiretroviral medications, according to a presentation at the XIV International AIDS conference in Barcelona, Spain, and a report in the July 10 issue of The Journal of the American Medical Association.
"Atazanavir is unique in that it is taken once daily, has a favorable resistance profile and, best of all, has no adverse effect on cholesterol and triglycerides," lead author Robert L. Murphy, MD, from Chicago's Northwestern University, says in a news release. "All other current protease inhibitors adversely affect lipid levels and therefore increase the risk of cardiovascular disease."
In earlier phase III studies, atazanavir was potent, safe and effective. In this study of 346 patients, switching from nelfinavir to atazanavir led to significant improvement in lipid profiles at 12 weeks, with reductions in total cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides, and increased high-density lipoprotein (HDL) cholesterol. The magnitude of the improvement was sufficient to reduce cardiovascular risk or to eliminate the need for dietary or pharmacologic intervention.
In a separate study described in JAMA, HIV patients with lipoatrophy taking a nucleoside reverse transcriptase inhibitor were randomized to either continue their initial treatment or switch to abacavir. At 24 weeks, those who had switched experienced significant but modest improvements in limb fat measured by dual-energy X-ray absorptiometry. Computed tomography also showed a trend toward improvement in subcutaneous thigh, arm and abdominal fat areas.
"Clinical lipoatrophy, as assessed subjectively, did not resolve, however, and at the rate of increase observed may take years to resolve with use of this strategy," write Andrew Carr, MD, and colleagues from the Mitochondrial Toxicity (MITOX) Study Group.
This randomized, open-label study involving 17 centers in Australia and England enrolled 111 adults (109 men) with moderate or severe lipoatrophy who were receiving stavudine or zidovudine, who had stable HIV RNA levels less than 400 copies/mL, and who had not previously received abacavir. Switching to abacavir was safe, with no unexpected adverse events and good control of HIV replication and CD4 cell count. After six months, limb fat mass had only increased by about 11% from baseline. Metabolic measures were unchanged.
"Longer follow-up of this population is needed to determine if lipoatrophy can improve clinically or even resolve," the authors write. "Other strategies under investigation include intermittent antiretroviral therapy and concurrent therapy with thiazolidinediones."
XIV International AIDS Conference: Abstract WeOrB1306. July 10, 2002.
JAMA. 2002;288(2):207-215
Reviewed by Gary D. Vogin, MD
Laurie Barclay, MD, is a staff writer with WebMD.
Medscape Medical News is edited by Deborah Flapan, an associate editor at Medscape. Please send press releases and comments to news@webmd.net.
--------------------------------------------------------------------------------
By Megan Rauscher
NEW YORK (Reuters Health) Jul 09 - In a study of adults with HIV lipoatrophy, switching from stavudine or zidovudine to abacavir led to a "significant, albeit modest" improvement in objective measures of limb fat, without affecting control of HIV replication.
"This is the first study to convincingly show that lipoatrophy can be improved," lead investigator Dr. Andrew Carr of St. Vincent's Hospital in Sydney, Australia, told Reuters Health. "This is important as lipoatrophy is distressing to patients, potentially stigmatizing and has been significantly linked with poorer adherence to antiretroviral therapy," he added.
Nucleoside reverse transcriptase inhibitor (NRTI)-induced mitochondrial toxicity is thought to underlie HIV lipoatrophy, Dr. Carr and colleagues explain in The Journal of the American Medical Association for July 10th, noting that abacavir may be less toxic to mitochondria.
The investigators had 111 subjects with moderate to severe lipoatrophy being treated with stavudine or zidovudine either continue with those drugs or switch to abacavir 300 mg twice daily, while continuing to take their other antiretroviral drugs.
"All patient subgroups seemed to derive benefit from the switch, even those with more severe lipoatrophy," Dr. Carr told Reuters Health. Dual-energy x-ray absorptiometry showed that patients gained "about 10% of the limb fat they had probably lost," he said.
However, subjective improvements in lipoatrophy did not correlate with objective measures, a finding that may reflect the short followup period. "We are continuing to follow these patients, hopefully for another 2 years, to see if the improvement continues and becomes clinically observable," Dr. Carr said.
The metabolic abnormalities associated with lipoatrophy were not significantly altered by the switch to abacavir, although the study was not statistically powered to look at this, Dr. Carr told Reuters Health.
The switch did not adversely effect plasma HIV RNA levels, a secondary study endpoint, but five subjects (10%) developed hypersensitivity to abacavir.
The fact that lipoatrophy affects upwards of 50% of patients on antiretroviral therapy suggests that "we really need to start exploring prevention," Dr. Carr concluded.
By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 10 - In response to the growing problem of antiretroviral resistance, a Global HIV Drug Resistance Surveillance Network has been created, in part, to "facilitate antiretroviral 'gear-up' in the South," Dr. Scott Hammer of Columbia University in New York told participants at the XIV International AIDS Conference here on Wednesday.
Although there is much concern about the spread of HIV drug resistance, "it is not a reason to delay the introduction of antiretroviral therapy" in developing countries, he said. "We need to take the lessons we have learned about drug resistance in the developed world to the developing world." The data that we have on HIV drug resistance is "scattered," he continued. The network will provide a central source of this information.
The new global network on HIV drug resistance is a collaborative effort supported by the International AIDS Society, the World Health Organization, and other partners. The new program will be entirely Internet-based.
The WHO's current goal is to have 3 million HIV-infected patients on antiretroviral therapy by 2005. For the most part, there is currently very little HIV drug resistance in the South, Dr. Hammer said. One of the goals of the new surveillance network is to keep it that way after antiretrovirals are introduced in developing countries.
Another important reason to monitor drug resistance is the possibility that "there may be different susceptibilities of different HIV subtypes," Dr. Hammer continued.
"We're essentially talking about 'molecular epidemiology'," he elaborated. This new surveillance program will provide "data on the circulation, intermingling and recombinant forms of various HIV subtypes."
NEW YORK (Reuters Health) Jul 08 - In areas where antiretroviral drug use is common, more than 25% of newly HIV-infected individuals harbor a virus that is resistant to at least one antiretroviral class, according to a report published in the July 10th issue of the Journal of the American Medical Association (JAMA).
However, in the last 5 years, only transmission of nonnucleoside reverse transcriptase inhibitor (NNRTI)-resistant HIV has increased significantly.
To evaluate time trends in primary HIV-1 drug resistance, Dr. Robert M. Grant, from the Gladstone Institute of Virology and Immunology in San Francisco, and colleagues analyzed viral strains from 225 patients who presented with recent HIV infection between June 1996 and June 2001 at San Francisco General Hospital.
The overall prevalence of resistant strains in 2000/2001 was 27.4%, not significantly different from the 25% prevalence found in 1996/1997, the authors note. However, the prevalence of strains that were resistant to at least two antiretroviral classes increased significantly from 2.5% to 13.2% between the two time periods (p = 0.004 for trend).
Of the entire study group, only one patient, seen in 2000/2001, was infected with a strain that was resistant to three antiretroviral classes, the researchers note.
None of the patients seen in 1996/1997 were infected with NNRTI-resistant strains. In contrast, in 2000/2001, 13.2% of patients harbored strains resistant to NNRTIs (p = 0.01 for trend). No significant increase in the prevalence of strains resistant to other antiretroviral classes was noted.
"Primary resistance indicates triple failure of the healthcare system, including failure of drug treatment to control viral replication in the source partner, failure of behavioral prevention in the source partner receiving treatment, and failure of behavioral prevention in the recently infected person," the authors note.
Findings from another study, also reported in JAMA, highlight the clinical significance of NNRTI-resistant strains. Dr. Scott M. Hammer, from Columbia University in New York, and colleagues assessed the outcomes of 481 patients who were treated with dual or single protease inhibitor (PI) therapy after experiencing virologic failure with a PI-containing regimen.
In addition to receiving amprenavir, abacavir, efavirenz, and adefovir, the patients were randomized to receive saquinavir, indinavir, nelfinavir, or placebo twice daily. Therefore, the study included three dual PI groups and one single PI group.
Patients in the dual PI groups were significantly more likely to achieve viral loads less than 200 copies/mL than those in the single PI group (p = 0.002).
Of note in light of the previous study's findings, patients who were na ve to NNRTIs and those whose strains were highly susceptible to efavirenz, in particular, were significantly more likely to achieve adequate viral suppression than their counterparts.
In a related editorial, Dr. Joel D. Trachtenberg and Dr. Merle A. Sande, from the University of Utah in Salt Lake City, comment that both articles "illustrate the importance of the NNRTI class and its pivotal role in the future management of HIV infection."
The current findings are particularly relevant for developing countries, the editorialist note. "Without the ready availability of PIs, preservation of NNRTI susceptibility is clearly a critical factor to ensure a sustained, widespread treatment success in sub-Saharan Africa and other resource-limited areas," they add.
NEW YORK (Reuters Health) Jul 08 - Hollis-Eden Pharmaceuticals Inc. on Monday said that one dosing group in a phase II trial of its investigational HIV drug, HE2000, exhibited a statistically significant downward slope in viral load, according to a preliminary analysis of the clinical data.
Hollis-Eden presented the data Monday at the International AIDS conference in Barcelona, Spain.
The company is developing HE2000, an immune-regulating hormone, with the goal of using the drug to delay the progression of HIV to AIDS. A drug such as HE2000 would support the new National Institutes of Health (NIH) recommendation to delay initiation of antiretroviral treatment until HIV has significantly progressed towards AIDS, to help reduce the long-term side effects and emergence of viral resistance to HAART, according to Hollis-Eden.
The 24 treatment-na ve subjects in the South Africa-based trial received three cycles of daily subcutaneous injections of either a 50-mg or 100-mg dose of HE2000, or placebo, for five consecutive days every six weeks, and were followed for an additional 12 weeks after the last dosing cycle.
In the 50-mg dose group, investigators observed a statistically significant downward slope in viral load versus placebo during the study period, and the maximum viral load reduction from baseline (0.66 log) at the end of the 30-week study, according to Hollis-Eden.
Patients in the 100-mg arm likewise experienced a downward slope in viral load, but the decline achieved was not statistically significant. A maximum viral load reduction (0.45 log) was observed in the group treated with a 100-mg dose of HE2000.
Hollis-Eden said HE2000-treated patients exhibited statistically significant increases in several cell types associated with innate and adaptive cell-mediated immunity during the study. These cell types include killer cells, dendritic cells and Th1 cells. Investigators noted that these types of cells in the six-patient placebo group generally declined during the course of the study.
"It is very encouraging to...[observe] that the trend line for viral load continued to decline over the course of the eight-month study," said Hollis-Eden Medical Director Dr. Dwight Stickney, in a statement. "This viral load reduction is significant because it demonstrates immunologic control of HIV replication versus a direct antiviral mechanism, particularly given that HE2000 was administered as a single agent on an intermittent basis rather than as part of a drug cocktail given daily."
Investigators observed no serious drug-related adverse events, according to the company. The most commonly reported side effect was mild to moderate reaction at the site of the injection.
Hollis-Eden said it has treated more than 150 patients with HE2000 in phase I/II and phase II clinical trials.
BARCELONA, Spain (Reuters Health) Jul 10 - Patients with advanced HIV infection that has become resistant to all available antiretroviral drug classes might benefit from structured treatment interruption, a leading French researcher said on Wednesday.
Dr. Christine Katlama, of the Hôpital Pitie-Salpetriere in Paris, told Reuters Health at the 14th International AIDS Conference that taking these patients off antiretroviral therapy for a period of 8 weeks resulted in a reduction in viral load when treatment was resumed.
In an open-label study, the French team studied 68 patients who had exhausted all currently available anti-HIV therapies. Eligible patients had a viral load of at least 50,000 copies/mL and CD4 counts below 200/ L.
Half the study group was immediately given "GIGAHAART" (maximal highly active anti-retroviral therapy), including three or four nucleoside reverse transcriptase inhibitors, 500 mg BID hydroxyurea, one non-nucleoside reverse transcriptase inhibitor and three protease inhibitors. The other 34 patients were given an 8-week break before starting the same salvage therapy.
Fifty-three percent of patients in the deferred treatment group experienced a loss of at least one of 29 resistant genotypes examined, Dr. Katlama reported.
Interrupting the treatment seemed to have no adverse effects in these already seriously ill patients, she added.
Viral load in patients randomized to continuous treatment remained constant for 24 weeks after the study began. In contrast, viral load among the structured treatment interruption group dropped by 1 log10 after 24 weeks of resumed drug therapy.
"I was very surprised to see this. I think anyone would have been surprised," Dr. Katlama said. "This study is proof of principle that this approach can benefit those patients who no longer have any treatment options."
BARCELONA, Spain (Reuters Health) Jul 10 - Patients with advanced HIV infection that has become resistant to all available antiretroviral drug classes might benefit from structured treatment interruption, a leading French researcher said on Wednesday.
Dr. Christine Katlama, of the Hôpital Pitie-Salpetriere in Paris, told Reuters Health at the 14th International AIDS Conference that taking these patients off antiretroviral therapy for a period of 8 weeks resulted in a reduction in viral load when treatment was resumed.
In an open-label study, the French team studied 68 patients who had exhausted all currently available anti-HIV therapies. Eligible patients had a viral load of at least 50,000 copies/mL and CD4 counts below 200/ L.
Half the study group was immediately given "GIGAHAART" (maximal highly active anti-retroviral therapy), including three or four nucleoside reverse transcriptase inhibitors, 500 mg BID hydroxyurea, one non-nucleoside reverse transcriptase inhibitor and three protease inhibitors. The other 34 patients were given an 8-week break before starting the same salvage therapy.
Fifty-three percent of patients in the deferred treatment group experienced a loss of at least one of 29 resistant genotypes examined, Dr. Katlama reported.
Interrupting the treatment seemed to have no adverse effects in these already seriously ill patients, she added.
Viral load in patients randomized to continuous treatment remained constant for 24 weeks after the study began. In contrast, viral load among the structured treatment interruption group dropped by 1 log10 after 24 weeks of resumed drug therapy.
"I was very surprised to see this. I think anyone would have been surprised," Dr. Katlama said. "This study is proof of principle that this approach can benefit those patients who no longer have any treatment options."
By Claudio Lavanga
BARCELONA, Spain (Reuters Health) Jul 10 - Researchers in Italy and the US will soon begin human trials with a 'therapeutic' AIDS vaccine designed to help people infected with HIV control the infection in combination with drugs.
The vaccine already been shown to benefit monkeys chronically infected with SHIV in laboratory studies, Dr. Franco Lori told Reuters Health at the International AIDS Conference. Dr. Juliana Lisiewicz, cofounder with Dr. Lori of the Research Institute for Genetic and Human Therapy based in Washington, DC, and Pavia, Italy, is presenting details of the monkey study on Thursday at the Barcelona meeting.
Dr. Lori told Reuters Health that the researchers, when developing the vaccine, studied the case of a man in Berlin whose immune system spontaneously controlled HIV. From these studies, they concluded that they needed to stimulate cytotoxic T cells.
"We do this by using a novel DNA vaccine that contains most of the HIV proteins," he said. "In this way we guarantee a wide spectrum of action, and do not target a specific protein."
He explained that the DNA vaccine is administered topically. "We gently rub the skin so that we expose a network of Langerhans cells. When the vaccine gets in contact with the Langerhans cells, they signal the danger to the closest lymph node, propelling it to recognize the HIV virus, and activate HIV-specific killer cells that can eliminate infected cells."
In the monkey trials, seven chronically infected rhesus macaques were given antiretroviral therapy 3 weeks on and 3 weeks off, while seven others were given the drugs on the same schedule plus the vaccine.
The monkeys that did not receive the vaccine exhibited a rebound in virus levels each time there was a break in drug therapy. The seven that received the vaccine progressively controlled the rebound in viral levels from a median 33,860 copies/mL to <200 copies/mL.
A separate group of monkeys with AIDS showed a viral load drop from a mean of 4,292,260 copies/mL to <200 copies when given the drug-vaccine combination.
"The vaccine is designed to work with the drugs. Drugs can control the virus when people take them as directed, but the bad news is that when patients stop--either because they can't afford them or because they simply forget them--the virus rebounds immediately. In this case, the vaccine would come into action, keeping the virus in check," said Dr. Lori.
"Our preliminary animal data provided promising results where, for the first time, a vaccine therapy suppressed the virus in chronic infection. We are optimistic that we will demonstrate similar results in humans," he told Reuters Health.
The group hopes to begin human trials at the end of this year both in Italy and in the United States. First results are expected at the end of 2003.
NEW YORK (Reuters Health) Jul 10 - A 38-patient study sponsored by the Adult AIDS Clinical Trials Group of the National Institutes of Health shows the patients developed stronger immune responses to HIV after receiving only Remune, an investigational therapeutic vaccine, than they did when they received Remune plus interleukin 2 (IL-2).
Dr. Hernan Valdez of the Case Western Reserve Center for AIDS Research presented the results of the study at the XIV International AIDS Conference in Barcelona, Spain. The Immune Response Corp. (IRC) developed Remune.
All patients in the study had been on regimen of highly active anti-retroviral therapy (HAART) or HAART plus IL-2 for at least 60 days, according to Immune Response. The 38 subjects were immunized with tetanus toxoid; inactivated, gp-120 depleted HIV-1 (Remune); and hepatitis A and B vaccines.
Even though investigators observed increased in CD4+ cell counts, the researchers concluded IL-2 did not enhance immunization responses. Patients receiving Remune alone developed relative stronger immune responses to HIV by a 70% to 24% margin, according to Immune Response.
The patients also experienced a stronger hepatitis A response after receiving the hepatitis A vaccine without IL-2. The group that received only the hepatitis A vaccine developed stronger hepatitis A antibodies (88%) compared to the group that received the vaccine plus IL-2 (36%).
"Non-specific stimulation via IL-2 may hinder the immune response to both Remune and non-HIV vaccines," said Ronald Moss, vice president of medical and scientific affairs for Immune Response, in a statement.
While Remune was once touted as a preventive vaccine, Immune Response is now positioning Remune as a treatment option in several scenarios, according to a company spokeswoman. The therapeutic vaccine may be appropriate as monotherapy to delay the start of HAART treatment, or it may be used in conjunction with HAART.
In May, however, Immune Response reported results of a new product that combines Remune and an adjuvant consisting of sequences of immunostimulatory DNA. The combination vaccine, which Immune Response is developing as a preventive vaccine, proved to be capable of boosting levels of HIV-specific T cells in non-human primates.
July 8, 2002 — Coinfection with hepatitis C virus (HCV) does not adversely affect the outcomes from treatment with highly active antiretroviral therapy (HAART) for HIV, according to a presentation on July 6 at the XIV International AIDS Conference in Barcelona, Spain. Physicians should therefore treat coinfected patients as aggressively as those without HCV infection, the investigators suggest.
"In the U.S. and Europe, it is estimated that one in three of HIV-infected persons are also infected with hepatitis C and many of them are injection drug users," Glen R. Hanson, Acting Director of the U.S. National Institute on Drug Abuse, says in a news release. "Research needs to continue to determine best approaches to treating those who are coinfected with HIV and hepatitis C."
Between January 1995 and January 2001, 1,955 HIV-infected patients without an AIDS diagnosis enrolled in this study, including 873 patients (44.6%) with HCV seropositivity. The latter group was older, more likely to be African-American and to have a history of intravenous drug abuse than those who were HCV seronegative.
During the study, 1,199 patients were prescribed HAART, including 54% of the HCV-seropositive patients and 67% of the HCV-seronegative patients.
Physicians may be less likely to prescribe HAART to patients infected with both HCV and HIV for fear of liver complications, explains lead author Mark S. Sulkowski, MD, from Johns Hopkins University in Baltimore, Maryland. In this study, fewer patients with HCV seropositivity had received HAART, resulting in relatively high incidences of AIDS and death in this group.
In a subgroup of 429 HCV-seropositive patients with baseline CD4 cell counts between 50 and 200 cells/mm3, risk of death was increased (relative hazard ratio, 1.51, 95% confidence interval, 1.01-2.27). However, after correction for differences in exposure to effective HAART among HCV-seropositive and HCV-seronegative patients, HCV seropositivity was not independently associated with CD4 cell decline, death, progression to AIDS, or immune reconstitution after HAART.
Although the authors acknowledge various study limitations and the need for additional research, they conclude that "these findings emphasize the importance of effective antiretroviral therapy among HCV infected and uninfected persons at immediate risk for the development of AIDS."
XIV International AIDS Conference. July 6, 2002.
Reviewed by Gary D. Vogin, MD
Laurie Barclay, is a staff writer with WebMD.
Medscape Medical News is edited by Deborah Flapan, an associate editor at Medscape. Please send press releases and comments to news@webmd.net.
--------------------------------------------------------------------------------
BARCELONA, Spain (Reuters) Jul 09 - Protesters stormed the stage and shouted down the US health secretary Tuesday as he addressed the world's biggest conference on AIDS, which has highlighted a gulf in access to treatment between rich and poor.
Some 30 AIDS activists rushed forward as U.S. Health and Human Services Secretary Tommy Thompson got up to speak, while dozens more drowned out his words with chants and whistles.
The protesters' action was to press accusations that Washington was failing people with AIDS by not committing more money to a new international global fund against the disease. Thompson, surrounded by a gaggle of bodyguards, continued to deliver his speech unheard.
The week-long meeting, attended by 15,000 delegates, has thrown into sharp relief the difference in prospects for those in Western countries and those in the developing world who are infected with HIV. Those in the poorer group account for 95% of infections.
The UN's Global Fund to fight AIDS, Tuberculosis and Malaria, created in 2001, aims to bridge the gap between treatment and prevention--but has so far won commitments from governments of only $2.8 billion, against the $10 billion it needs each year.
In a prepared text of his speech, Thompson said the United States was leading the world in its support for the fund by committing $500 million, but activists said $300 million was "stolen" from other health programs.
The fund's newly appointed executive director, Richard Feachem, told delegates that existing pledges were a start but billions more dollars were needed.
"These commitments will double the current number of people receiving HAART in the developing world and in Africa HAART recipients will increase six-fold," he said. "This is nothing like enough."
Currently, a mere 0.1% of the 28.5 million people infected with HIV in sub-Saharan Africa get modern drugs, a figure French President Jacques Chirac described as unacceptable in a message to the meeting.
Drug firms unveiled more progress in developing innovative AIDS therapies but anger over the cost of treatments prompted noisy protests and the invasion of company stands at the conference exhibition.
Experts also dampened speculation that the holy grail of an effective vaccine against AIDS could be less than five years away, warning that developing protection against the virus would require more time.
"HIV vaccine development is not a sprint. HIV vaccines need to be developed within the context of a larger prevention effort," Lawrence Corey, principal investigator of the HIV Vaccines Trials Network in the US, told the conference.
By Stephen Pincock
BARCELONA, Spain (Reuters Health) Jul 09 - New guidelines that simplify options for HIV therapy will help millions more people in the developing world gain access to treatment, the World Health Organization and the International AIDS Society said on Tuesday.
Only about 2% of the 6 million people in the developing world who need AIDS drugs now are getting them, despite significant drops in the prices of the medicines.
Improving access has been a key issue at the International AIDS Conference in Barcelona this week, where activists have called for greater efforts from governments, and researchers have tried to find ways to make other aspects of treatment cheaper and simpler.
WHO and IAS say reducing the complexity of highly-active antiretroviral therapy could have a major impact. On Tuesday in Barcelona they officially released new guidelines that give options to poor regions lacking medical staff or sophisticated laboratories.
"For the first time we now have the chance to apply a simplified, easy-to-follow public health approach to AIDS treatment rather than complex individual treatment regimes," said Dr. Gro Harlem Brundtland, WHO director-general.
"This, combined with the falling costs of medicines, means it should be possible to extend the life-span of those living with HIV in resource-limited settings."
The new guidelines aim to provide countries with simple advice on options for treating the disease, as well as monitoring treatment response and other treatment aspects--while taking into account the reality that many places lack even the most basic medical facilities.
"There are almost 'bush' options in there," IAS President Dr. Joep Lange told Reuters Health. "I consider these guidelines to be a major milestone."
BARCELONA, Spain (Reuters Health) Jul 08 - Two drastically cheaper tests to measure CD4+ cell counts and HIV plasma load in individuals with HIV infection are as effective as standard tests, and could play an important role in helping poor countries control the AIDS epidemic, researchers said on Monday at the International AIDS Conference.
Despite significant price reductions in antiretroviral drugs to treat HIV infection in Africa and elsewhere, scientists from the US Centers for Disease Control and Prevention (CDC) said crucial tests that help determine when to start therapy and monitor treatment response are too expensive for many poor countries.
"Drug access alone is not the answer to the treatment challenges in developing countries," CDC researcher Dr. Mandy Wilja told reporters at the conference. "Some countries are in the paradoxical situation where HIV drugs are cheaper than the CD4+ and viral load tests needed to use them effectively."
Dr. Wilja reported that a technique known as panleucogating (PLG) could effectively determine CD4+ cell counts for a quarter of the cost of existing tests.
Dr. Wilja and colleagues from the CDC's laboratories in Uganda compared PLG, which costs less than US$5, with the standard test, FACSCount, which costs US$20. They also compared the blood samples after they were stabilized using Transfix to extend the time between blood drawing and testing.
PLG results correlated closely with the results of the standard FACSCount test when used with fresh blood samples. For blood collected 3 days earlier and stabilized, the correlation between PLG results (R2=0.96) and FACSCount (R2=0.97) was also excellent.
In another study, Dr. Robert Downing, head of the CDC's Uganda labs, reported that a US$30 test to measure the plasma HIV load could be as effective as the standard RNA viral load test, which costs US$150.
The new test measures blood levels of virus-associated reverse transcriptase (RT).
In preliminary tests on a series of samples from three patients, Dr. Downing said the new RT test was as good as the standard assay for measuring trends in viral load over time for patients taking antiretroviral drugs.
However, for two of 13 specimens containing viral loads greater than 10,000 copies/mL, the new test did not detect virus.
"While more research is needed to better understand the variation seen in patients with high viral loads...we believe that the test will provide an affordable alternative for monitoring trends in viral load and guiding treatment decisions," Dr. Downing said.
BARCELONA, Spain (Reuters) Jul 09 - Brazil offered on Monday to share its generic AIDS drugs and technology with 10 of the world's poorest countries in an effort to close the gap in treatment between rich and poor.
Brazil has pioneered the use of generic antiretroviral drugs--to the ire of the pharmaceutical industry--in a highly successful programme for fighting HIV.
Paulo Teixeira, director of the national AIDS programme, said the country now had a duty to share its know-how with other countries in Africa, Asia, Latin America and the Caribbean ravaged by the virus.
"Brazil feels responsible for sharing its experiences with other developing countries, especially when it is related to access to antiretroviral drugs," he told reporters at the International AIDS Conference.
The Brazilian government will provide $1 million of initial funding for the program which will pay for the transfer of technology, training and the donation of drugs manufactured by Brazilian government laboratories.
Teixeira said he was also in discussions with other international organisations, including the Ford Foundation, which has shown interest in participating in one particular project in Africa.
Developing countries are being invited to submit proposals for 10 pilot projects, each of which will treat 100 patients initially, under the scheme launched at the AIDS meeting in Barcelona.
"The quantity is not significant if you consider the number of [HIV-infected] people in developing countries. But we know that to start with treatment we have to prepare professionals and institutions, which means small projects," he said.
Teixeira said he believed there was room for more cooperation between developing countries in fighting AIDS, following last November's decision at a World Trade Organisation ministerial meeting in Doha to allow states to produce cheap generic drugs to combat a "national emergency".
By Ben Hirschler
BARCELONA, Spain, July 12 (Reuters) Jul 11 - The International AIDS Conference closes on Friday with rousing calls from Bill Clinton and other world leaders to mobilise resources for millions of sufferers in the developing world.
Two decades into an epidemic that kills one person every 10 seconds, the gulf between rich and poor is starker than ever. The sophisticated drugs that have turned HIV infection into a chronic condition in the West reach only one in a thousand in Africa, the epicentre of the crisis.
Former U.S. president Clinton, who is the co-chairman of the International AIDS Trust, described AIDS as the biggest single problem for the world, barring nuclear war, and called on Western governments to pay up for a new global AIDS fund.
"First of all, the rich countries should figure out what they owe and pay in a timely fashion," he said. "For the first time in history the world has to take responsibility for a global health crisis."
The U.S. and other Western governments have borne the brunt of protests at the biennial meeting, with activists noisily demanding they commit $10 billion a year to the U.N.'s Global Fund to fight AIDS, Tuberculosis and Malaria. Created in 2001, it has so far secured just $2.8 billion.
Without that money, the World Health Organisation's target of getting antiretroviral drugs to three million people by 2005 will remain a pipedream.
A debate has raged throughout the conference over the balance between prevention and treatment in the developing world, home to 95% of the world's 40 million infections.
Dollar for dollar, prevention is more cost-effective. But to ignore the provision of medicines would be like driving past bus crash victims for an urgent meeting on seatbelt legislation, said Richard Feacham, new head of the global fund.
Despite steep price cuts for poor countries and competition from generic drugs, combination therapy remains out of reach for the vast majority of those in the developing world.
A vaccine is still far from assured. Seth Berkley, president of the International AIDS Vaccine Initiative, said the meeting had been "a reality check" on how the world was doing in the fight against AIDS.
By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 08 - The majority of young gay and bisexual men infected with HIV who live in large US urban areas are unaware of their serostatus, according to the results of a community-based study present here Monday at the XIV International AIDS Conference.
Furthermore, 59% of the HIV-positive men surveyed reported that they considered themselves to be at low risk for infection, lead researcher Dr. Duncan MacKellar, of the Centers for Disease Control and Prevention, told conference participants.
Dr. MacKellar and his colleagues conducted an anonymous survey of 5719 gay or bisexual men, between the ages of 15 and 29 years old, who resided in Los Angeles, Seattle, Dallas, Baltimore, Newark or Miami. The data were collected in neighborhoods, dance clubs and other settings popular among gay men.
Of the 573 men who tested positive for HIV infection, 440 (77%) were unaware of their infection and may have inadvertently transmitted the virus to their partners. The rate was especially high among HIV-infected African American men, 91% of whom reported they did not know their serostatus. Seventy and 60% of Hispanic and white men, respectively, did not know they were infected.
"Over half had either not been tested in the past year or had never been tested for HIV," Dr. MacKellar said. In the previous 6 months, half of the 440 reported having unprotected anal intercourse with one or more men, and nearly half of these men reported that they did not use condoms because they believed that they or their partners were at low risk of infection.
"We definitely need to do more research into barriers to HIV testing," Dr. MacKellar told Reuters Health. Although this study did not explore those factors, others have suggested that the stigma of being tested for HIV remains a barrier to testing, he said. In the current study, the subjects listed two primary reasons for not getting tested--they perceived themselves to be at low risk of infection or they were "scared to learn the results."
"We've got to do a better job of making sure that young men who have sex with men really understand the risks they are engaging in and the risks for acquiring HIV infection," Dr. MacKellar concluded. "We also need to do a better job of getting the word out of the benefits of early diagnosis and care."
In a second report, Dr. Ron Stall, also of the CDC, told conference participants that four psychosocial health problems--multiple drug use, partner violence, history of childhood sexual abuse, and depression--appear to interact to increase high-risk sexual behavior among gay and bisexual men in the US.
"The Urban Men's Health Study is a population-based sample of men who have sex with men," Dr. Stall told conference participants. Rather than sampling men in bars and other venues as is done in many other studies, the researchers "sampled neighborhoods in four American cities than are known to have a relatively high proportion of men who have sex with men. The four cities were San Francisco, Los Angeles, Chicago and New York."
In the course of surveying the 2281 men on a broad range of health problems that included sexual and mental health issues, "we were struck by the extent to which each of the health problems turned out to predict the other," Dr. Stall explained. There appeared to be "an interlocking web" of health problems among the gay men in these cities constituting "simultaneous epidemics that are feeding each other."
The correlation between HIV risk behaviors and multiple drug use, partner violence, history of childhood sexual abuse and depression were particularly "striking." Of those who reported all four problems, 33.3% also reported high-risk sexual behaviors. In contrast, among those who reported none of these problems, only 7.1% reported high-risk sexual behaviors. Similarly, HIV infection was reported by 25% with all four problems, compared with only 13% of those with none of these four other problems.
Overall, the HIV epidemic in this population is "intertwined with and fueled by other psychosexual health problems," Dr. Stall concluded. "One of the reasons why these men may not be able to respond to [HIV] intervention campaigns is that they are dealing with these other problems." He therefore suggests that HIV prevention efforts may be enhanced by focusing on these other issues, "particularly substance abuse and depression."
July 9, 2002 — Routine screening for acute infection with HIV in a low-risk population is feasible using blood specimen pooling and nucleic acid testing, according to a report in the July 10 issue of The Journal of the American Medical Association. The findings were also presented on July 6 at the XIV International AIDS Conference in Barcelona, Spain.
"The acute stage of the infection is almost never diagnosed in clinical practice and is always missed by routine antibody tests," lead author Christopher D. Pilcher, MD, from the University of North Carolina School of Medicine in Chapel Hill, says in a news release. "Without this type of testing, we miss the time when we know that people have by far the most virus in their blood and are at their most infectious. If we can catch infected people during the first weeks when routine antibody tests are still negative, we can help them avoid spreading HIV to their husbands, wives, unborn children, or other intimate partners."
This study tested 8,505 subjects seen at 110 publicly funded testing sites in North Carolina for routine HIV testing and counseling in August and December of 2001. Serum specimens negative by HIV enzyme immunoassay were screened in pools using an ultrasensitive HIV RNA reverse transcriptase-polymerase chain reaction (PCR) assay. Screening all specimens required 147 HIV RNA tests. Confirmatory testing reclassified results for individual HIV RNA-positive specimens as true- or false-positives.
"The reason this wasn't done before was that there are extraordinary difficulties in doing this kind of collaborative research effort in clinical public health settings," Pilcher says. "That we were able to do it is a credit not only to the UNC faculty and staff involved, but also to the people at the state's department of health and laboratory of public health who have shown an ability to think outside the box with regard to HIV."
Of the 8,194 subjects who had not previously tested positive for HIV and who also had sufficient serum for additional evaluation, 39 had long-term HIV infection (prevalence, 47.6 per 10,000 individuals at risk; 95% confidence interval [CI], 33.8-65.0 per 10,000).
Of the 8,155 individuals at risk with negative antibody tests, five were positive for HIV RNA, including four women with true-positive acute infection (prevalence, 4.9 per 10,000; 95% CI, 1.3-12.5 per 10,000). Two of these women developed symptoms consistent with an acute retroviral syndrome in the week after testing. Overall specificity of this screening strategy was 0.999.
"The nucleic acid testing, or PCR, detects patients who may represent a public health threat and who would ordinarily get a falsely reassuring 'negative' test result. We hope that this type of testing can help us cut the risk for the unsuspecting partners of acutely infected patients," Pilcher says.
Increased costs of this testing would be about $2 per test, or $4,109 for each new case diagnosed, which may be a small price to pay to prevent further HIV transmission or begin treatment earlier when it is most effective. "These people can potentially benefit themselves if we know to start them quickly and aggressively on antiretroviral treatment," Pilcher says. "Several very exciting but preliminary studies have shown recently that early treatment in this way may improve their long-term prognosis."
JAMA. 2002;288(2):216-221
Reviewed by Gary D. Vogin, MD
Laurie Barclay, MD, is a staff writer with WebMD.
Medscape Medical News is edited by Deborah Flapan, an associate editor at Medscape. Please send press releases and comments to news@webmd.net.
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BARCELONA, Spain (Reuters Health) Jul 08 - The average life expectancy of people in eleven African countries will drop below 40 by 2010 as HIV continues to shorten the lives of millions, US government researchers said on Sunday.
"By 2010, we project that life expectancies in these countries will be back to levels that have not been seen since the nineteenth century," US Census Bureau's Karen Stanecki told reporters at the International AIDS Conference. "Unfortunately, many African countries are only beginning to see the impact of high levels of HIV prevalence."
Her "middle-case scenario" report, which assumes that the epidemic will begin to level off in Africa over the next 8 years, predicts that the average life expectancy in Botswana and Mozambique will drop to 27 years. Swaziland will see an average of 33 years and Zimbabwe, Zambia and Namibia 34 years. Angola, Lesotho, Malawi and Rwanda and Mali will see life expectancy drop to the mid to late 30s.
The figures, prepared on behalf of the US Agency for International Development, are just the latest in a series that show Africa buckling under the growing AIDS pandemic. Sub-Saharan Africa has some 28 million of the world's 40 million infected people, with infection rates rising over 30% in some countries.
Without AIDS, average life in southern African countries such as Botswana, Namibia and Swaziland would have been around 70 years by 2010, the report shows.
Instead, deaths will outstrip births in five countries by 2010, meaning negative population growth. Without AIDS, Botswana, Mozambique, Lesotho, Swaziland and South Africa would have expected a population growth rate of at least 2%, Stanecki said.
The Census Bureau report confirms that the epidemic will continue to undermine the economic stability of Africa, with the biggest increases in early deaths coming among people in their 30s, 40s and 50s, when they would be at their most productive.
It also shows that the millions of AIDS orphans currently overwhelming many countries will be a growing problem.
"You have a lot of adults missing, and then you have a lot of children who don't have adult supervision or don't have adult leadership. That means increases in orphans, increases in street children," Stanecki said.
By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 11 - In the absence of a significant breakthrough in prevention or therapeutic technologies, the South African Department of Health predicts that the cumulative AIDS mortality may reach 4.5 million by 2010.
Zackie Achmat, founder of the Treatment Action Campaign in South Africa, spoke to members of the XIV International AIDS Conference at a plenary session on Wednesday. His message was heard via videotape because he was too ill to attend the conference. Achmat, who is HIV-positive, has refused to take antiretroviral drugs until these drugs become available to his fellow countrymen.
In addition to the predicted high death toll, the Department of Health reports that in 2000, AIDS-related illness accounted for 628,000 hospital admission, amounting to 24% of all public hospital admissions. The associated costs add up to at least 3.6 billion Rand annually, or 12.5% of the nation's budget.
Achmat pointed to evidence for the feasibility of providing antiretroviral therapy to South Africans. Since the last International AIDS conference 2 years ago in Durban, M dicins Sans Fronti res began to offer antiretroviral therapy to HIV-infected patients in Khayelitsha, outside of Cape Town.
Most of these patients presented with CD4+ counts <48 cells/ L and HIV RNA loads >170,000 copies/mL, Achmat said. Yet after 6 months of treatment, 90% of the patients achieved undetectable viral loads and improved immune responses.
These findings, Achmat pointed out, follow the success achieved in Haiti by Dr. Paul Farmer of Partners in Health. Dr. Farmer, who is also affiliated with Brigham and Women's Hospital in Boston and a professor at Harvard Medical School, and his colleagues have implemented in Haiti a program of directly observed therapy with highly active antiretroviral therapy (DOT-HAART). The strategy is similar to the approach that has been used with tuberculosis with great success.
"Treatment does work; treatment is cheaper than letting people fall ill and die; and treatment is attainable," AIDS activist Judge Edwin Cameron of South Africa told conference participants. Cameron, who also has AIDS, echoed the call to action that energized the Durban conference.
"Treatment for the world's people with HIV living in resource-poor settings is an obtainable goal," Cameron continued. What is now needed, he said, is the $10 billion per year for the Global Fund.
"We also need to appeal to the drug companies to issue voluntary licenses with small royalties" to poor countries, he added.
"It is expected in 2002 that 300,000 people in South Africa will die of AIDS," he said. "Thousands, and eventually millions, of South Africans like myself will die because they do not have access to these treatments."
Number of HIV Cases in Former USSR Now Outstrip Those in US
BARCELONA, Spain (Reuters Health) Jul 11 - The HIV epidemic in the former Soviet Union is growing faster than anywhere in the world and threatens to spread from injecting drug users into the wider population unless action is taken, researchers said on Thursday.
"From a small number of cases in 1995, HIV infections have grown so quickly that an estimated one million people in the former Soviet Union are infected with HIV--more than in the US," Dr. Anna Shakarishvili from the US Centers for Disease Control and Prevention told reporters at the International AIDS Conference.
At present, 90% of HIV-infected people in former Soviet states are injecting drug users, but Dr. Shakarishvili and colleagues from the Russian Association for Sexually Transmitted Infection Prevention now report worrying signs of an epidemic among sex workers and the homeless that threatens to spread further through heterosexual sex.
The researchers studied 400 non-drug using men and women at centers for the homeless in Moscow and found that 1% were HIV-positive, compared to just 0.18% in the general population. Thirty percent were infected with sexually transmitted diseases like chlamydia and gonorrhea, which increase the risk of becoming infected with HIV.
Over 64% of men and 40% of women in the study said they did not use a condom the last 10 times they had sex, Dr. Shakarishvili added.
In another study, the researchers looked at HIV rates and risk-taking among 190 women who exchanged sex for money or other commodities, only 21% of whom considered themselves as sex workers. Of these women, 2.8% were HIV-positive and around 70% had one or more sexually transmitted disease.
The women had an average of 168 partners in the past year, 1% took opiate drugs, and 5% used cannabis. Ninety percent said they used condoms, 63.2% practiced oral sex and 15.8% had anal sex.
"This research shows marginalized women are at significant risk through heterosexual sex," Dr. Shakarishvili said. "Without intervention, the epidemic could spread more widely to the general heterosexual population through commercial sex work."
By Stephen Pincock
BARCELONA, Spain (Reuters Health) Jul 09 - An alarming degree of ignorance about HIV/AIDS among Chinese people has been revealed by a major survey published on Tuesday, with one in six saying they had never heard of the disease that has claimed 25 million lives.
Of those who had heard of AIDS, nearly three-quarters did not know its cause and almost 90% did not know how HIV infection could be detected. The results of the survey of 7,000 people, conducted by China's State Family Planning Commission in collaboration with the US Centers for Disease Control and Prevention (CDC), were released at the International AIDS conference in Barcelona.
Dr. Deborah Holzman from the CDC and colleagues say theirs is the first major survey of knowledge about AIDS among Chinese people. The researchers said the findings suggested the general public in China lacked a "sense of risk of infection and an awareness of self-protection. Widespread information and education efforts are urgently needed."
Although 91% knew HIV could be transmitted, 52% did not know it could be transmitted through a blood transfusion, 81% were unaware that it could be transmitted by drug users sharing needles, and 85% were not aware it could be passed from an infected woman to her newborn child.
Some 17% of those questioned in 7 different regions had never heard of AIDS. Although 74% of respondents said AIDS was preventable, 77% did not know it could be prevented by using condoms correctly. The survey comes amid an increased international focus on China, where AIDS cases are likely to soar there in coming years.
The United Nations said last month China was on the brink of an HIV/AIDS catastrophe of unimaginable proportions. Up to 1.5 million Chinese were infected with HIV by the end of last year and the figure could grow to 10 million by 2010 without effective countermeasures, UNAIDS warned.
"Clearly with such a huge population--most of it lacking even basic knowledge of AIDS--China must become a major priority in the global effort to fight HIV," Dr. Eugene McCray, director of the CDC's global AIDS programmes, told a news conference in Barcelona.
"When the vast majority of the population does not know how AIDS can be prevented or that women can pass HIV on to their children, aggressive HIV prevention is clearly required." He said the question for China was how quickly and aggressively it would respond to prevent the epidemic having the tragic impact it had had in sub-Saharan Africa.
On Monday in Barcelona, UN officials and AIDS activists denounced widespread silence in Asia over the AIDS epidemic despite fears Asia could eventually overtake Africa as the continent hardest hit by the disease.
By Stephen Pincock
BARCELONA, Spain (Reuters Health) Jul 10 - The number of children who lose one or both parents to AIDS could increase to 25 million by the end of the decade, United Nations agencies said on Wednesday.
Already the scale of the problem is horrific, according to a report released Wednesday at the International AIDS Conference. Last year, 34 million children were orphaned in sub-Saharan Africa, one third of them due to AIDS, the document shows.
"This is without doubt one of the most shocking reports that has been released at this conference," said Peter Piot, the executive director of the Joint United Nations Program on HIV/AIDS. The report, entitled Children on the Brink 2002, predicts that by 2010 almost 6% of all children in Africa will be orphaned because of the disease.
Piot compared the impact of AIDS on children to what occurs during wars. But fathers are killed in wars, he said, and AIDS robs children of both parents. "This unprecedented crisis will require radically scaled-up national, regional and community responses in the decades to come," he added.
The report was published jointly by UNAIDS, the UN's children's agency UNICEF, and USAID, which provides funding to fight the epidemic. It used estimates developed by the US Bureau of Statistics and data from 88 countries in Asia, Africa, Latin America and the Caribbean.
UNICEF Executive Director Carol Bellamy said the AIDS crisis was "tearing apart" the traditional extended family that normally supports orphans.
"Grandparents can only cope with so many grandchildren and they're getting older as it is," she said. "And its not just looking after the children, but confronting the bias against these children as well. Children become outcasts in the community; they get thrown out of school--if they were even going to school."
Bellamy emphasized the importance of providing support to protect and care for children, to mobilize and strengthen community-based responses and to help orphans to stay in school. Governments also have a part to play by developing essential services to meet the needs of the most vulnerable children.
"There's no question that children who are orphaned are at increased risk of being outcasts in the community, of being denied even the minimal resources that might be available in these communities," she said. "That then leads to more chance that they become street children, and they will more likely be in that population that is vulnerable to AIDS."
While Africa has the highest proportion of orphans, Asia has the largest number, but fewer lost their parents to AIDS. Approximately two million were orphaned by AIDS in 2001. But just as the AIDS epidemic is spreading in Asia, so too could the number of orphans.
By Stephen Pincock
BARCELONA, Spain (Reuters Health) Jul 09 - Wars and internal conflict are increasing the spread of HIV in Africa, where some 28 million of the world's 40 million infected people live, aid agency Save the Children said on Tuesday.
The number of African states involved in wars and internal conflicts has doubled from 11 to 22 since 1989, the charity's Doug Webb said at the International AIDS Conference in Barcelona. Countries like Sierra Leone, Angola, Rwanda and Burundi, where HIV rates are already high, will suffer an increasing burden as a result.
"If we don't address this, we are going to see HIV clustering in these countries in conflict over the medium to long term," he said.
Webb told reporters that the dislocation, poverty and starvation that accompany conflicts make people more vulnerable to infection. Add to this the destruction of education and health systems in war-torn countries, plus an increase in rape and sexual exploitation, and you have a recipe for "a double emergency."
"In conflict situations, children are even more vulnerable because food is scarce, they might have been forced from their homes and there is an increased likelihood of sexual exploitation," he said.
Save the Children released a new report on the issue of HIV and Conflict at the conference, showing that 680,000 children in the Democratic Republic of the Congo, the African country with the largest ongoing war, have lost parents to AIDS.
In Uganda, members of rebel armies, who had an HIV rate of 27%, sexually abused thousands of women.
"A lack of international funding is the single largest obstacle to reducing the spread of HIV in conflict situations," the report says. "Governments, donors and humanitarian agencies must take urgent action to protect the lives of an estimated 15 million young people directly threatened by HIV/AIDS in conflicts and related emergencies around the world."
In a separate report, health information group Healthlink Worldwide and Panos London said targeting HIV prevention efforts to soldiers could help fight the AIDS epidemic.
"Twenty-two million people serve in the armed forces across the world, many of whom are men in their 20s and 30s, and sex is a preoccupation," Mark Foreman, the report's author, told journalists.
In African armed forces, for example, HIV rates averages between 20% and 40%, said Foreman. In Cambodia, up to 17% of the armed forces were estimated to be HIV positive in 1999, compared to 3.7% in the general population.
But inadequate funding, fear of breaching confidentiality and restricted access make tackling the problem difficult.
"Programs for HIV treatment and care in armies need to be expanded and integrated into programs for the civilian population," Foreman said. "This is, of course, not only to benefit soldiers themselves but to protect the short-term and long-term partners."
BARCELONA, Spain (Reuters) Jul 09 - High rates of AIDS among young African women will lead to a population imbalance that will take generations to overcome and make the AIDS epidemic even worse, a top UN official said on Tuesday.
Experts called for more prevention efforts to be targeted at young women of child-bearing age to counter the spread of HIV among them.
United Nations figures show that women make up 58% of people in sub-Saharan Africa living with HIV/AIDS. Young women in the region are now up to six times more likely than young men to be infected with HIV, a report by the UN Population Fund indicates.
The result would be a hole in the "age pyramid" that had only been seen before in times of war, Dr. Peter Piot, executive director of UNAIDS, said. In wartime, mainly men were affected, but, among the young infected by HIV in Africa, it was mostly women, he told a news conference at the International AIDS Conference.
This would cut birth rates because women will die young and many children that are born will become orphans, Dr. Piot said.
"There will be societies where in a certain age group there will be far more men than women and that in itself is going to make the spread of HIV even worse because...there will be more men who will have sex with the same female partner," he said.
Dr. Piot said that African teenage girls were generally not infected by boys of their own age, but by older men. "That is one of the major driving forces of HIV in young people in sub-Saharan Africa," he added.
Suman Mehta, HIV/AIDS coordinator for the UN Population Fund, said many older men used teenage prostitutes while in some countries, "sugar daddies" were common. "Some HIV-positive men feel that if they have sex with virgins they can be cured of the virus," she added.
Dr. Piot said there was also a lot of "transactional sex" such as between teachers and students.
Benjamin Raletsatsi, of the Botswana Family Welfare Association, said sexually active young people in his country often did not even know how HIV was contracted.
"The message is very clear," Mehta said. "We must act immediately to prevent new infections, to halt the epidemic, to save lives. It is imperative that we reach all persons at risk of infection with information, knowledge, skills and the means to protect themselves from infection."
The UN experts called for global access to both male and female condoms and Dr. Piot said there was a need for greater investment in the development of vaginal microbicides aimed at killing HIV.
By Patricia Reaney
BARCELONA, Spain (Reuters) Jul 08 - Different strategies are needed to curb the spread of HIV/AIDS, which is not one but many epidemics throughout the world, a leading AIDS expert said on Saturday.
"There is no country which has controlled HIV/AIDS, and different parts of the world face their own special challenges," Dr. Kevin De Cock, of the Centers for Disease Control and Prevention (CDC) program in Kenya, told a news conference.
Whether it is through intravenous drug use in southern and eastern Europe, commercial sex workers in Asia, heterosexual sex in Africa or risky behavior in the United States, the spread of the virus is insidious and must be tackled on various fronts.
In the United States, which is the most heavily affected country in the industrialized world with almost one million people living with HIV, Dr. De Cock said public health priorities must focus on reinvigorating prevention efforts because there has been no drop in the incidence of the disease.
"Despite some advances, HIV incidence in the United States has not declined significantly over the past decade, with approximately 40,000 new infections occurring annually," he added on the eve of the 14th International AIDS Conference.
In Eastern Europe, where the epidemic is spreading at the most rapid pace and mostly among men, Dr. De Cock called for needle exchange programs, testing for HIV, and interventions to reduce drug use and secondary sexual transmission.
What happens next in Asia will depend largely on the spread of HIV through India and China, the two most populous countries in the region. Dr. De Cock said curtailing intravenous drug use, improving the safety of blood supplies (particularly in China), and targeting the prevention message to commercial sex workers and their clients, are tactics required to limit the spread of the virus in Asia.
The situation in Africa, which bears the highest burden of AIDS, is compounded by eroding health infrastructure and threats from other diseases such as malaria and tuberculosis. "Health in general has gone backwards in sub-Saharan Africa over the past 20 years," according to Dr. De Cock, whose comments on the epidemic are also published in the latest issue of The Journal of the American Medical Association.
Sub-Saharan Africa represents 77% of AIDS deaths, 70% of HIV-infected people, 68% of new infections and 90% of children infected with the virus. Dr. De Cock questioned the extent to which public health strategies could reverse the epidemic without long-term economic development or an HIV vaccine.
"Despite the obstacles, the increased attention to, and resources for, global health--the moral challenge of this era--offer hope and opportunities not seen before in the history of the HIV/AIDS pandemic," he added.
By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 08 - There is a strong link between herpes simplex virus 2 (HSV-2) infection and increased risk of HIV infection, according to the results of two studies reported on Monday at the XIV International AIDS Conference.
"HSV-2 infection is the silent enemy in the HIV epidemic," Dr. Steven J. Reynolds of Johns Hopkins University in Baltimore told conference participants on Monday. Although a number of studies have identified genital ulcer disease as a major risk factor for HIV infection, few have looked at the impact of acute HSV-2 infection on HIV acquisition, he explained.
In his study, Dr. Reynolds, of Johns Hopkins University in Baltimore, and colleagues at the National AIDS Research Institute in Pune, India, looked at the effect of incident HSV-2 infection as a risk factor for HIV transmission.
The retrospective cohort included 2732 HIV-seronegative patients attending one of three sexually transmitted disease clinics in Pune between 1993 and 2000. At baseline, 1175 (43%) were HSV-2-infected.
Dr. Reynolds group found that the subsequent incidence of HIV infection was 5.8 per 100 person-years. After adjusting for known HIV risk factors, the relative risk of HIV infection associated with chronic HSV-2 infection was 1.69. The RR of HIV infection associated with remote primary HSV-2 infection was 1.81.
"Recent HSV-2 infection was independently associated with a 3.64-fold increased risk of primary HIV infection" (p<0.001), the investigators report.
In a second study, researchers led by Dr. A. Kamali of the Medical Research Council, Entebbe, Uganda, also observed a strong association between HSV-2 infection and HIV risk.
Dr. Kamali's group evaluated approximately 20,000 adults enrolled in a community-randomized trial in Uganda that aimed to improve rates of STDs and behavioral factors to reduce HIV transmission rates.
Overall, the researchers found that HSV-2 prevalence was significantly higher among HIV-positive patients (80%) than among HIV-negative patients (23%). The incidence of HSV-2 per 100 person-years was also significantly higher among HIV-positive (15.7) than among HIV-negative (3.0) patients (p<0.001 for both measures).
Based on these findings, "I think there is a need for HSV-2 treatment to reduce the incidence of HIV" in this population, Dr. Kamali concluded.
The HSV-2 prevalence is high in developing countries, "but among certain groups in the US it's very high as well," Dr. Reynolds told Reuters Health. Although the overall HSV-2 prevalence in the US is about 20%, the prevalence in the gay/bisexual community is comparable to that in developing countries. "And most people with HSV-2 don't know their serostatus," he added.
"There is an interaction between the two viruses," Dr. Reynolds continued. "And it's a complex interaction, with many factors involved."
Some studies have shown that "in recurrent herpes, there's an influx of CD4 cells...that may facilitate HIV infection," he said. "And in cells that are infected with both viruses, the replication of HIV is much more rapid. So that may also affect the ability of HIV acquisition."
"If we could get an [HSV-2] vaccine that was effective and target it at a high-risk population, we may have an impact on HIV rates," said Dr. Reynolds. But so far, "there hasn't been a vaccine yet that's been shown to be effective." To reduce HIV transmission, an HSV vaccine would have to be at least 80% effective, he added.
However, there is an ongoing trial in which subjects are receiving herpes simplex treatment with acyclovir in an effort to reduce the rates of HIV transmission.
BARCELONA, Spain (Reuters Health) Jul 09 - Contraceptive diaphragms should be studied as a potential means for women to protect themselves against AIDS, researchers said on Tuesday.
Diaphragms might offer protection against HIV, but attempts to study whether this would work "have been stymied by the issue of acceptability," said co-author Dr. Sungai Chipato from the University of Zimbabwe at the International AIDS Conference in Barcelona.
The urgency of the search has been heightened by United Nations figures showing that women make up 58% of people in sub-Saharan Africa who have AIDS or HIV. Young women in the region are now up to six times more likely than young men to be infected with HIV, a report by the UN Population Fund said.
But Western researchers have not considered diaphragms as one of the options, believing that women would not use them, Dr. Chipato said.
She told delegates at the conference that a study of 156 Zimbabwe women whose husbands or partners did not consistently use condoms showed that 98% were in fact willing to use a diaphragm, at least part of the time.
"Now that we know that they are acceptable, diaphragms need to be tested for efficacy in preventing HIV," she said in a statement.
By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 09 - A single dose of nevirapine taken once or twice a week, or every other day, may act as a prophylaxis for HIV infection among individuals exposed to the virus through sexual or blood contact, a US team reported here at the XIV International AIDS Conference.
A two-dose course of nevirapine administered perinatally has proven effective in preventing vertical transmission of HIV to infants. This prompted Dr. J. Brooks Jackson and colleagues from Johns Hopkins University in Baltimore to undertake a phase I/II trial to investigate the efficacy of nevirapine prophylaxis among high-risk HIV-negative subjects.
In the HIVHOP 101 trial, a total of 33 high-risk HIV-negative subjects received one of three regimens for 12 weeks. Twelve patients received a 200-mg nevirapine tablet once weekly; 12 received 200-mg nevirapine tablets twice weekly; and nine took 200-mg nevirapine tablets every other day, Dr. Jackson told conference attendees. Eleven, eight, and five patients, respectively, completed the trial.
Sixteen of the 33 patients reported continued high-risk activity throughout the study, Dr. Jackson said. None of the 24 patients were HIV-positive at followup.
The subjects were also tested for toxicity and were followed by phone after 20 weeks. Although elevations in liver function enzymes were observed in each treatment group, and were highest in the every-other day group, no serious side effects were observed.
Dr. Jackson concluded that nevirapine prophylaxis is safe, as administered in these regimens over a 12-week period. However, he pointed out that caution is needed when administering nevirapine to patients with hepatitis B virus or other liver disease.
One possible application of nevirapine prophylaxis would be among commercial sex workers, Dr. Jackson suggested. For example, in some developing countries, women travel from rural to urban areas to work in the sex trade for limited periods of time and then return home. Therefore, nevirapine may provide a good short-term HIV prophylaxis for these women who have high HIV exposure for limited amounts of time.
"If the data hold up, and the safety looks good, perhaps nevirapine can be used for an extended period," Dr. Jackson added.
New HIV Microbicide Candidates Show Promise in Preclinical Studies
By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 10 - Two new compounds are showing promise for use as topical vaginal and anal HIV microbicides, according to presentations delivered here on Wednesday at the XIV International AIDS Conference.
"Any HIV topical microbicide has to be safe--there is very, very little room for toxicity," Dr. Mary Klotman of Mount Sinai School of Medicine in New York told conference attendees.
One such potential compound is "SAMMA," a polymer derived from sulfuric acid treatment of mandelic acid. The agent is not a surfactant and it is not sulfated, making it less likely to damage the vaginal epithelium and flora. SAMMA is also colorless, odorless and inexpensive to produce, important features for a candidate microbicide, she said.
In in vitro experiments, Dr. Klotman and her colleagues evaluated the activity and toxicity of SAMMA combined with clinical isolates of HIV and primary cell culture systems including human cervical cells, macrophages and T cells. They also tested SAMMA with cells engineered to express single HIV coreceptors.
In dose ranges of 10 to 100 micrograms per milliliter, SAMMA blocked laboratory-adapted and primary isolates of HIV in primary cells. SAMMA also blocked infection with R5 and X4 HIV isolates.
In addition, SAMMA effectively blocked HIV binding to cells and glycoprotein gp120. Similar effects were observed with herpes simplex virus. No measurable toxicity was seen.
"SAMMA inhibits both laboratory-adapted and primary isolates of HIV," Dr. Klotman concluded. This compound shows little or no cytotoxicity, has an "excellent selectivity index" and merits further evaluation, she added.
In a second study, a topical microbicide containing the nonnucleoside reverse transcriptase inhibitor dapivirine (TMC120) was able to completely inhibit vaginal transmission of HIV in a mouse model.
This the first in vivo evidence that an NNRTI is feasible as a HIV microbicide, according to Dr. Simonetta Di Fabio of the Istituto Superiore di Sanita in Rome. Dr. Di Fabio presented her teams' data from a hu-SCID mouse model developed to simulate in vivo vaginal transmission of HIV.
After a single vaginal application with 25 mL of a gel containing dapivirine, 21 female mice were challenged with human peripheral blood lymphocytes infected with a laboratory strain of HIV.
Rates of protection were 70% to 80%, Dr. Di Fabio told conference participants. When the gel was adjusted to reduce its viscosity, the rates of protection reached 100%. Because of the marked improvement seen after the gel viscosity was reduced, "the findings suggest that distribution is an important factor," she added.
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Vertical HIV Transmission in US Drops to Lowest Rate in 10 Years
By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 09 - The number of US infants born with HIV infection has dropped 80% in the past 10 years, US health officials said on Tuesday.
Increased HIV testing of pregnant women and the use of antiretroviral drugs to prevent vertical transmission cut the number of infected infants from a peak of 1760 in 1991 to about 300 in 2000, researchers from the Centers for Disease Control and Prevention (CDC) said.
"This is one of our country's greatest success stories in the HIV epidemic," Dr. Robert Janssen, of CDC, told reporters at the XIV International AIDS Conference.
HIV kills 1600 children a day worldwide, according to UNAIDS figures. Inexpensive antiretroviral drugs, such as AZT and nevirapine, can prevent a high proportion of mothers from passing the virus to their infants if the drugs are given before and after delivery.
The US, Europe and the United Nations have all recently said that preventing mother-to-child transmission should be a priority for prevention programs, and Dr. Janssen said the latest figures served to confirm this.
"We must continue our efforts to extend these successes in the US and continue to emphasize the urgent need for perinatal prevention in the developing world," he said.
The study was conducted by CDC researcher Dr. Patricia Fleming and others, who based their estimates on cases of HIV infections and AIDS reported in 25 states with longstanding reporting of the disease, together with AIDS prevalence data from across the US.
In 2000, between 129,500 and 135,300 women between the ages of 13 and 44 years were HIV-infected, compared with about 80,000 in 1991, Dr. Fleming said.
Because vertical prophylaxis regimens are not completely effective, further reductions in the number of infected infants will be difficult until the number of infected women declines.
"The simple fact is that the best way to prevent new infections in babies is to prevent infections in women," she said in a statement.
With Maternal ART, Peripartum Nevirapine Does Not Lower HIV Transmission Risk Further
By Megan Rauscher
NEW YORK (Reuters Health) Jul 09 - In HIV-infected pregnant women receiving prenatal care and standard antiretroviral therapy (ART) with elective cesarean section available, the risk of HIV transmission is low and there is no demonstrable benefit of adding intrapartum/newborn nevirapine therapy.
This finding, from the International Pediatric ACTG 316 Team, is reported in The Journal of the American Medical Association for July 10th. "Based on studies conducted in women who breastfeed their infants and are on no other antiretroviral therapy, it was anticipated that the two-dose intrapartum/newborn nevirapine regimen would provide an additional benefit in interrupting perinatal HIV transmission," Dr. Coleen K. Cunningham told Reuters Health. But that was not the case.
In the study, the researchers treated 1270 nonbreastfeeding women receiving ART with 200-mg oral nevirapine or placebo after the onset of labor. Their newborns received 2-mg/kg oral nevirapine 48 to 72 hours after birth.
The trial was halted early because of the low overall transmission rate (1.5%). "The very fact that overall transmission rates are so low would not have been predicted from previously available data," Dr. Cunningham, from the State University of New York Upstate Medical Center, noted.
"Most striking," she said, "is the fact that the two-dose nevirapine regimen did not lower transmission rates even in the women at highest risk of HIV transmission, based on high HIV RNA and low maternal CD4." The team believes that the frequent use of antenatal highly active ART and the fact that 34% of women elected to deliver by c-section are reasons for the low transmission rates observed.
The majority (53%) of the perinatal transmissions noted in the study occurred in utero and therefore would be unaffected by this intrapartum regimen, the authors say.
The researchers think this two-dose intrapartum/newborn nevirapine regimen could prevent HIV infection in "many" children in developing countries where antepartum ART is not available. But in the presence of ART and elective c-section it is not worthwhile.
Italian Group Reports Successful IVF Outcome For HIV-Infected Parents
By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 11 - Five hundred healthy infants have been born to HIV-positive parents in Europe over the past 14 years through in vitro fertilization (IVF), an Italian researcher said at the XIV International AIDS Conference here this week.
Dr. Enrico Semprini, from the University of Milan, told Reuters Health that 5000 cycles of IVF had been performed for couples in which at least one partner was HIV-positive. The oldest child born by this technique is already 14 years old, the Italian researcher said during a symposium organized by the Catalonian regional government.
For couples in which the man was seropositive, no cases of infected infants have occurred Dr. Semprini said.
For couple in which the women is seropositive, there is a 0% to 2% risk that the infant will be infected if the woman receives appropriate care. This includes optimal antiretroviral therapy and delivery by Cesarean section, Dr. Semprini said.
Dr. Anne Duerr, who studies HIV at the US Centers for Disease Control and Prevention (CDC), told Reuters Health there has not been enough data to recommend offering IVF to seropositive people.
"We do not have complete follow-up. When we have it, then we can use the data from Dr. Semprini's team," she told Reuters Health.
New AIDS Vaccine Consortium Zeroes in on Neutralizing Antibodies
By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 09 - The International AIDS Vaccine Initiative (IAVI), together with the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases at the US National Institutes of Health, has launched a 5-year initiative to investigate HIV neutralizing antibodies, which they hope will accelerate the development of an AIDS vaccine.
Although progress has been made in the development of vaccine candidates that elicit cell-mediated immunity, the induction of a broadly neutralizing antibody response has presented a larger obstacle, IAVI officials said Tuesday at the XIV International AIDS Conference.
"We need new [AIDS vaccine] candidates with broadly neutralizing antibodies. And IAVI is bringing together the world's experts on neutralizing antibodies to work in consortium to solve this thing," IAVI spokesman Victor Zonana told Reuters Health.
"It's a multi-year, multi-million dollar commitment. Basically, IAVI is contributing the financial resources and the project management skills," he explained. To this end, "we have at our disposal $126.5 million from the Bill & Melinda Gates Foundation."
This is the first major scientific collaboration to concentrate on the discovery of HIV neutralizing antibodies. "What we suspect is that cell-mediated immunity alone cannot work fast or effectively enough to provide the high degree of protection across a large population that we tend to associate with the concept of vaccines," said Dr. Dennis Burton, Consortium Director. "We are likely to need to elicit neutralizing antibodies as well."
Along with Dr. Burton and Dr. Ian Wilson, both from The Scripps Research Institute in La Jolla, California, other founding members include Drs. Robert Doms of the University of Pennsylvania in Philadelphia; John Moore of the Weill Medical College of Cornell University in New York; and Joseph Sodroski of the Dana-Farber Cancer Institute in Boston.
Members from the NIAID include Drs. Gary Nabel, Richard Wyatt, and Peter Kwong.
"Sterile protection would be the best result of all, but even if neutralizing antibodies only blunt infection, this could be a major contribution to an effective vaccine," Dr. Doms commented.
"This is a mini-Manhattan project," Zonana added. The AIDS vaccine is "a solvable problem--neutralizing antibodies do exist in some rare individuals--5 have been isolated--and we're going after it."
By Stephen Pincock
BARCELONA, Spain (Reuters Health) Jul 08 - A vaccine that offers at least partial protection against HIV could be available within a decade, but poor countries will be left without access for years longer unless manufacturing and distribution capacity is built now, a leading researcher said on Saturday.
Dr. Seth Berkley, founder and president of the International AIDS Vaccine Initiative (IAVI), told a meeting ahead of the 14th International AIDS Conference that an effective vaccine is the only way to end the pandemic, which threatens to kill more than 68 million people between 2000 and 2020.
"From our perspective, we now have a set of reasonable candidates," he told Reuters Health on the sidelines of the meeting. "I would say it's possible we could have a vaccine in as short as 6 months and as long as 5, 7, 10 years."
But the developing world could be left behind again, as it has been with expensive antiretroviral drugs, Dr. Berkley said. Ensuring quick global rollout of a vaccine requires the means of producing large amounts and having the facilities to distribute it.
"The critical issue is, if a vaccine turns out to look good but we don't have the manufacturing facilities, the delivery systems or the financing systems, what will happen is that we'll have [a case of] 'Eureka! This [is a] great advance,' but we won't be able to use it for a very long time.
"If you wait until the day we have a vaccine that works, it'll be five or more years before it gets to the places that need it."
With 15,000 people a day contracting HIV, mostly in the developing world, each month equates to a quarter of a million people missing out on the protection a vaccine might offer, Dr. Berkley said.
"That's not a scientific problem, but a political problem--building the commitment to have what is a new paradigm: simultaneous North-South availability of an AIDS vaccine.
"The challenge for politicians is that vaccines tend to have a longer timeline," he said. "The timeline of the average politician means they're not going to be around when these vaccines appear."
The results of studies with vaccines in early stages of clinical development are expected to be presented during the week-long conference. The most advanced candidate, AIDSVAX developed by the US biotech company VaxGen, has been undergoing final Phase III tests in Thailand and results are expected by the beginning of 2003.
Another phase III trial, of AIDSVAX combined with Aventis Pasteur's ALVAC vaccine, looks likely to go ahead within a year, also in Thailand. Supachai Rerks Ngarm from the Thai Department of Public Health told the meeting that results are expected by around 2006.
Other vaccines are in more preliminary phases, which means proof or otherwise of their effectiveness is more distant.
Italian High Court Rules HIV-Infected People Entitled to Disability Benefits
By Rossella Lorenzi
FLORENCE, Italy (Reuters Health) Jul 10 - HIV-infected people are entitled to ask for disability benefits, even if they tolerate antiviral therapies and do not show evidence of immunodeficiency, Italy's highest appeals court established in a landmark ruling.
The Corte di Cassazione, whose ruling was made public on Wednesday, made the decision in the case of a 35-year-old woman, who in 1996 had asked a court in Florence for social security benefits. The woman, who had advanced HIV infection, made the request as she needed daily pharmacologic treatments and was unable to work profitably.
The Florence court denied the monthly disability check on the grounds that there wasn't a reduction of working ability, as the woman appeared to tolerate drug treatment well. The court also rejected the argument of a "psychic collapse" related to the knowledge of suffering from a fatal disease.
The Cassazione court reversed the ruling, pointing out that "tolerating antiviral therapies doesn't exclude effects of severe disease on working capability."
The ruling also called "summary" the denial of mental disability, and established that whenever requests from HIV/AIDS patients are examined, the psychological impact of the disease has to be carefully considered.
"Many HIV/AIDS sufferers will ask for disability benefits following this ruling," Angelo Magrini, the president of the Associazione Italiana Politrasfusi, told Reuters Health. "It has been our battle to have these benefits recognized. Yet for many it isn't enough. I am referring to those infected as a result of tainted blood products. They are still waiting for justice to be done."
Surgeon General Nominee Faces Tough Questions at Confirmation Hearing
By Julie Rovner
WASHINGTON, DC (Reuters Health) Jul 09 - Months after his nomination was announced to become the next Surgeon General of the United States, Arizona trauma surgeon and deputy sheriff Dr. Richard Carmona finally got his hearing before the US Senate Health, Education, Labor and Pensions Committee Tuesday, where he faced pointed questions about allegations made Monday in an article in the Los Angeles Times.
Dr. Carmona said he was "quite disappointed" in the lengthy article, which accused him of management difficulties, of having trouble passing his surgical board examinations, and of having a hard time getting along with colleagues. "Sometimes decisions have to be made that people disagree with," he said of those who leveled the charges.
But Senators were not as quick to brush off the allegations. "You have a reputation as a swashbuckler," said Sen. Jack Reed, D-R.I., suggesting that one incident cited in the article, in which Dr. Carmona reported a nurse to state authorities for unprofessional conduct after he reportedly agreed not to do so, "smacks of a double standard."
Dr. Carmona denied he ever agreed not to report the nurse, because the report "was required by state law." The nurse in question, he added, "had problems...she was undependable, could not provide the services she was supposed to."
When he was not responding to allegations, Dr. Carmona demonstrated for the committee a fluent understanding of a wide array of health issues, ranging from asthma to bioterrorism to childhood obesity, to HIV/AIDS. He told one senator he might support the idea of having the government take over the manufacturing and distribution of vaccines. "The government has a role in ensuring immunizations are available," he said. "I think it's something we should continue to look at."
Dr. Carmona also said that his overarching theme is prevention. Whether talking about AIDS, bioterrorism, or asthma, he said, "all of those things you mention, including weapons of mass destruction, are amenable to prevention strategies."
By the end of the hearing, at least one key senator, committee chairman Edward Kennedy, D-Mass., appeared to have been won over. "Anyone who's listened to your responses on this wide range of issues has to be very, very impressed," Kennedy said.
But Dr. Carmona's approval could be delayed by one of his strongest backers. Sen. John McCain, R-Ariz., who introduced Dr. Carmona to the committee, is blocking all Senate nominations as part of an unrelated dispute with the Bush administration over appointees to the Federal Election Commission.
McCain told reporters it "would be inappropriate" to make an exception even for Dr. Carmona, whom he called "extraordinarily, perhaps uniquely qualified to address the needs of our nation as Surgeon General."
New England Journal of Medicine Pulls Study Due to False Photo
BOSTON (Reuters) Jul 11 - In a highly unusual move, the New England Journal of Medicine has retracted a 1998 AIDS study after concluding it included a photograph lifted from research published eight years earlier.
The journal's editor, writing in the July 11th edition, said the photograph was doctored to make it look different.
Although the photograph, taken through a microscope, had been inverted top to bottom and side to side, and then given some extra elements, other aspects of the picture turned out to be identical to a picture in a 1990 study, published in the American Journal of Cardiology. Both photos involved HIV and the heart.
"When there's a piece of data that's been called into question, we have to assume that the whole data set is questionable," Dr. Gregory Curfman, the Journal's executive editor, told Reuters on Wednesday.
Dr. Curfman said because the patterns in such photographs are as individual as a fingerprint, it now seems obvious that the image was "lifted, twisted and doctored" by someone involved with the 1998 study, conducted by the Italian Group for the Cardiological Study of Patients Afflicted with AIDS.
Dr. Curfman said the chief author of the paper, Dr. Giuseppe Barbaro, from the University LaSapienza in Rome, refused to retract the paper, insisting that the Journal could not prove the two photographs were the same.
"We didn't buy that," Dr. Curfman said. "The likelihood of having the same pattern in two separate micrographs is vanishingly small."
Instead, the Journal itself retracted the paper. Dr. Curfman said it was only the second time in his 16-year tenure at the Journal that the publication has had to retract a paper because the authors refused to do so.
Efforts to contact Dr. Barbaro in Italy were unsuccessful.
Dr. Curfman said the chief investigator of the 1990 study, Dr. Wayne Grody of UCLA School of Medicine, recognized the similarities between the images and alerted the Journal early this year.
The 1998 study was considered important because it came at a time when scientists were debating the effect of HIV on cardiac muscle. Physicians had long known that AIDS patients risked heart damage, but it was not clear whether the damage was due to the virus itself, the antiretroviral agents used, or from a side-infection that occurs in immunocompromised patients.
The photograph in the Dr. Barbaro study claimed to show the AIDS virus in heart muscle cells, and "it raised the possibility that HIV itself was toxic to the heart muscle," said Dr. Curfman.
The now-retracted paper has been cited at least 25 times in the medical research, five of those times in studies published by Dr. Barbaro and others.
