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TN KY CARES/ HIV/AIDS NEWS
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TN KY CARES / HIV/AIDS

Staggering Ignorance of HIV Revealed in China -- moonotter, 19:59:46 07/24/02 Wed

Staggering Ignorance of HIV Revealed in China


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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.



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UN Foresees 25 Million More AIDS Orphans by 2010 -- moonotter, 20:01:55 07/24/02 Wed

UN Foresees 25 Million More AIDS Orphans by 2010


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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.



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War Spreading AIDS in Africa -- moonotter, 20:03:57 07/24/02 Wed

War Spreading AIDS in Africa


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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."



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Women Lost to AIDS Will Unbalance Africa's Population -- moonotter, 20:05:14 07/24/02 Wed

Women Lost to AIDS Will Unbalance Africa's Population


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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.



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Different Approaches Needed for Each AIDS Epidemic -- moonotter, 20:06:55 07/24/02 Wed

Different Approaches Needed for Each AIDS Epidemic


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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.



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HSV-2 Significantly Increases Risk of HIV Infection -- moonotter, 20:09:17 07/24/02 Wed

HSV-2 Significantly Increases Risk of HIV Infection


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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.



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Diaphragms Might Be Acceptable Means to Protect Against HIV -- moonotter, 20:11:30 07/24/02 Wed

Diaphragms Might Be Acceptable Means to Protect Against HIV


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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.



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Nevirapine May Protect Against HIV Transmission From Sexual Or Blood Exposure -- moonotter, 20:14:17 07/24/02 Wed

Nevirapine May Protect Against HIV Transmission From Sexual Or Blood Exposure


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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.



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New HIV Microbicide Candidates Show Promise in Preclinical Studies -- moonotter, 20:18:47 07/24/02 Wed

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.



Related Links
Conference Coverage
XIV International AIDS Conference


External Links
News From the XIV International AIDS Conference


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Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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Vertical HIV Transmission in US Drops to Lowest Rate in 10 Years -- moonotter, 20:21:09 07/24/02 Wed

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.




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Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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With Maternal ART, Peripartum Nevirapine Does Not Lower HIV Transmission Risk Further -- moonotter, 20:26:40 07/24/02 Wed

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.

JAMA 2002;288:189-198.




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Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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Italian Group Reports Successful IVF Outcome For HIV-Infected Parents -- moonotter, 20:29:46 07/24/02 Wed

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.




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Reuters Health Information 2002. © 2002 Reuters Ltd.
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New AIDS Vaccine Consortium Zeroes in on Neutralizing Antibodies -- No name, 20:36:39 07/24/02 Wed

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."




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AIDS Vaccine Still Seen to Be a Long Way off -- moonotter, 20:39:55 07/24/02 Wed

AIDS Vaccine Still Seen to Be a Long Way off


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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.



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Italian High Court Rules HIV-Infected People Entitled to Disability Benefits -- moonotter, 20:43:02 07/24/02 Wed

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."




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Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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Surgeon General Nominee Faces Tough Questions at Confirmation Hearing -- moonotter, 20:46:12 07/24/02 Wed

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."




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New England Journal of Medicine Pulls Study Due to False Photo -- moonotter, 20:49:26 07/24/02 Wed

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.




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