The CDC National Center for HIV, STD, and TB Prevention provides the following information as a public service only. Providing synopses of key scientific articles and lay media reports on HIV/AIDS, other sexually transmitted diseases and tuberculosis does not constitute CDC endorsement. This daily update also includes information from CDC and other government agencies, such as background on Morbidity and Mortality Weekly Report (MMWR) articles, fact sheets, press releases, and announcements. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC HIV/STD/TB Prevention News Update should be cited as the source of the information. Contact the sources of the articles abstracted below for full texts of the articles.
New England Journal of Medicine (www.nejm.org) (03/30/00) Vol.
342, No. 13, P. 921; Quinn, Thomas C.; Wawer, Maria J.;
Sewankambo, Nelson; et al.
To determine the influence of viral load compared to other risk
factors for HIV transmission through heterosexual sex,
researchers from the National Institute of Allergy and Infectious
Diseases, Johns Hopkins University, Makerere University in
Uganda, and Columbia University in New York studied 415 couples
in Uganda in which one partner was HIV-1-positive and the other
was initially HIV-1-negative. The couples were followed for 30
months, with 90 of the 415 initially HIV-negative partners
seroconverting during the study. The incidence of seroconversion
was greatest among partners aged 15 to 19. While the incidence
was 16.7 per 100 per-years among the 137 uncircumcised male
partners, no seroconversions took place among the 50 male
partners who were circumcised. The average serum HIV-1 RNA level
was higher among the HIV-positive subjects whose partners
seroconverted than those who partners did not seroconvert. There
were no cases of HIV transmission among the 51 individuals with
serum HIV-1 RNA levels under 1,500 copies per milliliter. The
study found a strong correlation between increased serum HIV-1
RNA levels and a greater risk for transmission of the virus. The
researchers concluded that viral load is the primary predictor of
the risk of heterosexual transmission of HIV-1, with transmission
uncommon in individuals with levels below 1,500 copies of HIV-1
RNA per milliliter.
"Investigators' Responsibilities for Human Subjects in Developing
Countries"
New England Journal of Medicine (03/30/00) Vol. 342, No. 13, P.
967; Angell, Marcia
An editorial by Marcia Angell, the editor of The New England
Journal of Medicine, raises the question of ethical research
behavior in studies carried out in developing countries. The
study in question, published in the same issue of the journal by
Thomas C. Quinn et al., investigated HIV transmission, focusing
on the relation between viral load and heterosexual transmission
of HIV-1 in couples discordant for HIV-1 at baseline. The
participants went 30 months without receiving treatment for known
HIV infection, and the researchers did not inform the partner of
an infected individual that his or her spouse had HIV. Quinn et
al. said that they told the seropositive participants to tell
their partners; however, they did not follow up on this. The
ethical standards seen here would not take place in the United
States or other developed countries. Dr. Angell explains that
she approved the study for publication in the journal, hoping to
raise more discussions concerning ethical issues in HIV research.
"I believe ... that our ethical standards should not depend on
where the research is performed," Angell notes. "I also believe
that investigators assume broad responsibility for the welfare of
the subjects they enroll in their studies." She added, however,
that the ethical questions have many sides and are open to
debate.
Nature Biotechnology (biotech.nature.com) (03/00) Vol. 18, P.
258; Fox, Jeffrey L.
The U.S. Food and Drug Administration (FDA) has announced a broad
plan for the regulation of xenotransplant products and surgeries.
The agency has asked a variety of experts--including members of
two advisory panels, representatives from the blood product
industry, biotechnology companies, and the public--go over draft
guidelines to keep such products from spreading new pathogens to
the general population. FDA officials say there is hypothetical
risk for pathogens, but past experiences with blood supplies
tainted by HIV and hepatitis are real. Safety testing for
xenotransplantation is difficult, though, since it is hard to
detect a pathogen which may not have been discovered yet; there
is no sure method for identifying unknown pathogens. However,
blood suppliers are upset over recommendations in the draft
guidelines that could thwart blood donations at already low
levels. Members of the advisory panel have recommended measures
that would simplify blood donor questionnaires and suggested the
draft guidelines disqualify only xenotransplant recipients and
their partners from giving blood.
USA Today (www.usatoday.com) (03/30/00) P. 9D; Villalva, Maribel
Joe McIlhaney Jr. of the Medical Institute for Sexual Health, a
nonprofit organization that encourages abstinence until marriage,
claims that programs that promote abstinence as the only choice
are the most effective in preventing teenage sex. However, Debra
Haffner of the Sexuality Information and Education Council of the
United States notes there is no published, peer-reviewed proof
that abstinence-only programs have long-term results. She said,
though, there is some evidence that comprehensive sex education
programs that also include contraception have been shown to delay
sexual activity.
Reuters (03/30/00); Dunham, Will
The AIDS epidemic, once seen as a disease of middle-class gay
White men, has become a killer of minorities and the poor,
including African-American and Hispanic homosexual men,
intravenous drug users, and inner-city women. Government
statistics show that minorities account for seven in 10 new AIDS
cases. AIDS is the leading cause of death for African-American
men between the ages 25 to 44, and the disease is the No. 3 cause
of death for African-American women in the same age group. AIDS
is also significantly affecting Hispanics, and U.S. Surgeon
General Dr. David Satcher notes the strong stigma attached with
being homosexual in both the African-American and Hispanic
communities is keeping some men from seeking HIV prevention or
treatment services.
Reuters Health Information Services (03/29/00)
Sens. James Jeffords (R-Vt.) and Edward Kennedy (D-Mass.)
introduced legislation to the Senate on Wednesday that would
reauthorize and revise the 1990 Ryan White AIDS CARE Act to
provide rural areas with more funds for AIDS. The original
measure was mainly geared toward urban areas most affected by
AIDS; however, the new bill would double the minimum base funding
for states and add a supplemental state grant for rural and
underserved areas. The legislation also calls for an expansion
of the AIDS Drug Assistance Program. A House version of the
legislation, being written by Rep. Tom Coburn (R-Okla.), will
likely be introduced next week.
Nando Times Online (www.nando.net) (03/29/00)
The Chinese health ministry has reported an increasing number of
HIV infections for 1999, with more women at risk. There were
4,677 new cases of HIV in China last year, up 41.5 percent from
1998, according to Health News, the Chinese health ministry's
newspaper. The report noted that 15.4 percent of all HIV
infections in China are now among women. China has recorded more
than 17,300 cases of HIV infection since 1985, including 647
cases of AIDS.
PANA Wire Service (03/29/00)
Swaziland recorded more than 4,000 new cases of tuberculosis (TB)
last year, with 800 deaths from the disease. Health and Social
Welfare Minister Dr. Phetsile Dlamini noted that 58 percent of TB
patients are also infected with HIV, according to a 1998 study.
Many of the TB cases are among young people, Dlamini said. She
highlighted the need for effective treatment to stop the
transmission of the TB bacterium to others.
PANA Wire Service (03/29/00); Okoko, Tervil
Increased awareness about HIV and AIDS has spurred greater use of
condoms in Kenya, according to health officials. At a recent
workshop, Meshack Ndolo, the head of the National AIDS and
Sexually Transmitted Diseases Control Program reported that
Kenyans are using 10 million condoms a month. Ndolo also said
the incidence of syphilis has dropped significantly in the past
decade, although many people are still contracting sexually
transmitted diseases, with about 120,000 cases being treated
every month. The official noted that the AIDS epidemic is taking
its toll on society, affecting the work force, raising medical
costs, and causing psychological trauma.