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"Antiretroviral Therapy in Adults"
Journal of the American Medical Association (01/19/00) Vol. 283,
No. 3, P. 381; Carpenter, Charles C.J.; Cooper, David A.; Fischl,
Margaret A.; et al.
The International AIDS Society-USA Panel has updated its
recommendations on antiretroviral therapy use in HIV-1-infected
adults. The recommendations, based on new drugs available and
phase 3 controlled trials, call for use of CD4 cell counts in
starting antiretroviral therapy. According to the authors,
"Physicians and patients must weigh the risks and benefits of
starting antiretroviral therapy and make individualized and
informed decisions." The guidelines further state that "there
are no definitive data regarding superiority of one acceptably
potent initial regimen over another, and recommendations for
specific combinations of individual drugs cannot be made."
Adherence to antiretroviral therapy should be constantly
assessed, with at least 95 percent adherence needed for best
results in therapy. Testing a patient for drug resistance may
also be necessary, although such testing is currently limited by
several factors, including cost, quality assurance documentation,
and a lack of clinical data regarding the best use of tests and
interpretation of the findings. The reasons for changing an
antiviral regimen include drug failure, adverse effects, or
inconvenience created by the regimen. Monitoring for these signs
and correcting them is crucial to managing the virus, as is
knowledge of current information in the field of HIV and AIDS.
USA Today (01/20/00) P. 15A
Lawmakers in Ohio will hold hearings today to determine the fate
of federal money allocated for sex education. The hearings will
be followed by a vote on whether or not they should release
nearly $975,000 to teach HIV prevention in schools and community
centers.
Miami Herald Online (01/20/00); Rosenberg, Carol
In Miami, Cleo Parker-Smith, manager of South Miami Hospital's
immunology ward, and Andrew Ogden, program coordinator, are
working to educate people about the risks of HIV transmission
through needles, tattoo parlors, and unsafe sex. The team works
with the community, discussing the danger of sharing needles,
safe sex measures, and the advantages of early HIV detection.
Statistics from the Centers for Disease Control show that Miami
has the fourth largest number of AIDS cases in the country, with
22,283, and, as of June, Florida has the nation's second largest
number of people living with HIV or AIDS. Most HIV patients at
South Miami Hospital are impoverished African-American and
Hispanic women, not gay men. Ogden explains this is because poor
women do not have equal access to education and diagnosis, often
only detecting the virus when it has advanced. Most of the gay
men treated at the hospital have been HIV-positive since the
1980s and are able to live at home. The hospital has also
partnered with medical facilities in several Caribbean islands,
where people are less likely to get tested.
Boston Globe Online (01/19/00) P. B4; Kong, Dolores
Rates of chlamydia infection are on the rise in Boston,
especially among teenagers aged 15 to 19, who have a rate of
2,078 cases per 100,000 people. The citywide rate of chlamydia
infection in 1999 was 462 cases per 100,000. The increase is
associated with a newer and simpler diagnostic test as well as
the greater spread of the disease. Overall, rates of sexually
transmitted diseases in Boston have decreased since the 1980s
because of public health messages about safe sex in response to
AIDS. Syphilis rates are down in the Boston area, from 127 cases
per 100,000 in 1990 to 29 cases per 100,000 in 1999, while
gonorrhea case rates have seen a slight increase since 1995, but
peaked at 697 cases per 100,000 in 1989. The largest increase
has been seen in chlamydia cases, with minority teenage girls
recording the most cases. In 1999, the chlamydia rate among
African-American girls in Boston was 5,853 cases per 100,000, and
it reached 5,457 cases per 100,000 for Hispanic girls in the
city.
Reuters Health Information Services (01/19/00)
A study by Dr. Astrid K.N. Iversen of the Arhus University School
of Medicine in Denmark has found that an increasing number of
women infected with HIV-1 through heterosexual contact have non-B
subtypes and chimeric viruses. Most HIV-1 cases in the United
States and Europe are HIV-1 subtype B. The study evaluated 41
infected women from different HIV-1 risk groups, and found a
minority of the patients had subtypes A or C. The researchers,
who published their findings in the Journal of Acquired Immune
Deficiency Syndromes (1999;22:325-332), found that all of the non-B
HIV-1 subtypes were in women who contracted HIV heterosexually, and
21 percent of these women had subtype chimeric viruses while none were
found in the women with subtype B viruses.
Reuters Health Information Services (01/19/00)
At a briefing in Washington, D.C. on Wednesday, representatives
of Advocates for Youth asserted that sex education programs that
stress abstinence only are not effective. The group wants the
federal government to increase funding for contraception sex
education and not decrease support for teenage mothers by
underfunding teen pregnancy prevention programs. James Wagoner,
the president of organization, stated that 80 percent of the drop
in teen births is due to greater use of contraception, and only
20 percent is due to abstinence. A new report from Advocates for
Youth concluded that the U.S. government spends $138 million
annually on programs to reduce teenage pregnancy and high-risk
sexual behaviors, but spends $38 billion for services and support
for the families of teenagers who give birth.
PANA Wire Service (01/19/00)
A survey by the South African Institute of Race Relations shows
that AIDS will cause the country's population growth rate to drop
71 percent by 2010, with over 18 percent of the workforce
infected with HIV by 2005. Minister of Health Dr. Manto
Tshabalala-Msimang stated that there will be 1 million orphans by
2005. The survey also noted that malaria and tuberculosis (TB)
cases were on the rise. There was a 13 percent increase in TB
cases in 1998, and more than 40 percent of South African clinics
do not have adequate drug supplies to fight the disease.
Progress has been made against measles, however, with the number
of cases falling from over 22,000 in 1992 to just 684 in 1998.
Reuters (01/20/00)
In Myanmar, Lieutenant-General Khin Nyunt told participants in
the annual conference of the Myanmar Medical Association that
AIDS is not a catastrophic threat to the country, as only 23,669
HIV infections were detected between 1988 and 1999. Based on a
1997 survey, however, the World Health Organization and UNAIDS
estimate that the actual number of HIV-infected individuals in
Myanmar is closer to 450,000. The agencies noted that Khin
Nyunt's data was based on the number of people who had actually
been tested for HIV. Khin Nyunt said that since the military
came into power, it has spent 3.09 billion kyats in the year to
March 31, 1999, compared to 464 million in the year to March 31,
1998; there are about 350 kyats to the dollar.
Australian Broadcasting Corp. Online (01/20/00)
According to Vietnamese health authorities, the number of
HIV-infected people increased by 51 percent last year, with over
5,800 new cases reported in Vietnam. Western experts, however,
believe at least 100,000 Vietnamese are infected with HIV.
Reuters (01/17/00)
Medeva, a British pharmaceuticals company, has announced that
trials of 103 patients with hepatitis B on the Pacific Rim, where
the disease is more prevalent than in the United States or
Europe, were successful and safe. The trial results showed that
following a second treatment of eight monthly doses, 38.9 percent
of patients did not have replicating hepatitis B in their system.
The drug, Hepagene, also kept the drug from patients' systems
three to nine months after treatment stopped.