CDC NCHSTP Daily News Summary (070924)

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 NCHSTP Daily News Summary should be cited as the source of the information. Copyright © 2007, Information Inc., Bethesda, MD.

NATIONAL NEWS

UNITED STATES: Failure of Vaccine Is Setback in AIDS Fight

New York Times (09.22.07) - Monday, September 24, 2007

On Friday, Merck & Co. announced that an independent interim analysis of its HIV vaccine candidate MRKAd5 found it neither prevented nor curbed HIV infection in participants in a Phase II trial. Thus the trial, which began in 2004 and involved 3,000 uninfected volunteers mostly from the United States and Latin America, was halted on the advice of the trial's monitoring board. Merck said clinical study data will be shared with scientists, and the board recommended Merck continue to monitor trial participants.

Dr. Anthony S. Fauci, director of the National Institutes of Allergy and Infectious Diseases, which conducted the trial with Merck, called the results "obviously disappointing" but said it is too soon to draw sweeping conclusions about the class of Merck's vaccine candidate. In Merck's vaccine approach, an attenuated cold virus delivered three synthetically engineered genes from HIV - gag, pol, and nef - meant to stimulate a strong T-cell response against possible HIV infection.

Those who do well against HIV infection tend to have stronger T-cell responses. And initial animal and human experiments testing the idea behind the vaccine candidate, cell-mediated immunity, were encouraging.

However, in an analysis of 1,500 vaccine trial volunteers, the monitoring board found clear evidence the vaccine was not effective. Among 741 participants who received at least one dose of the vaccine, 24 had acquired HIV infection within 13 months of follow-up. Among 762 people who received a placebo vaccine, 21 were found to have acquired HIV. MRKAd5 did not reduce HIV levels in infected participants' blood, either, which would have been a major achievement in itself.

NEW YORK: Law Not Affecting HIV Testing

Times Union (Albany) (09.18.07) - Monday, September 24, 2007

New York's law requiring the names of HIV-positive individuals to be submitted to the state is not discouraging people from getting tested, according to a study by the Department of Health's AIDS Institute. "Most people didn't even know we had names-based reporting," said James Tesoriero, the institute's director of program evaluation and research and the study's lead author.

The HIV Reporting and Partner Notification Act, which went into effect June 1, 2000, mandates that unless people test anonymously, the names of persons with HIV and AIDS must be reported to state health officials. Previously, the names of AIDS cases only were reported the state. The law also requires that medical staff ask individuals who have tested HIV-positive to reveal the names of their sexual partners in a bid to notify them of their potential exposure to HIV. Providing names of sexual partners is voluntary.

Tesoriero and colleagues studied data collected between 1998 and 2004 from several HIV testing sites and surveys of 761 high-risk people recruited from STD clinics, gay bars, and needle exchanges. Just 26 percent of respondents knew that positive test results are reported by name. Women and older individuals were more likely to know about name-based reporting, while minorities and people ages 18-24 were less likely to know. Just 5 percent of participants cited concerns about their name being reported to the state as a reason to delay or avoid HIV testing. Fifty percent knew that naming sexual partners is voluntary.

The study, "The Effect of Name-Based Reporting and Partner Notification on HIV Testing in New York State," was published in the American Journal of Public Health (2007;97(9): doi:10.2105/AJPH.2006.092742).

ILLINOIS: Governor Grants $2.5 Million to HIV/AIDS Group

Windy City Times (Chicago) (09.19.07) - Monday, September 24, 2007

Illinois Gov. Rod Blagojevich has announced $2.55 million in grants to 17 community-based HIV/AIDS housing organizations statewide. The funds will be used to provide lodging and meals to residents; for rehabilitation and facility repairs; and for supportive services such as case management, mental health counseling, and substance abuse treatment.

Blagojevich spokesperson Justin DeJong said the amount granted this year is $125,000 more than last year. The Illinois Department of Public Health has awarded the federal HUD Housing Opportunities for Persons with AIDS grants since 1996.

"People fighting HIV/AIDS shouldn't have to make a choice between being able to afford the medications they need, or being able to pay for basic living expenses like rent and food," Blagojevich said. "These grants are one more way in which we're helping make sure that those living with HIV/AIDS have a stable living environment in which to better fight this disease."

Chicago House is one of the grant recipients; its CEO, the Rev. Stan Sloane said, "According to a recent study, people who are not properly housed are 16 times more likely to have HIV/AIDS. The need for HIV/AIDS housing continues to skyrocket, and this grant from the Illinois Department of Public Health will help Chicago House reduce that need in the City of Chicago."

Other grant recipients include AIDS Care (Chicago), Jo Ray House (Chicago), Phoenix Center (Springfield), Bethany Place (Belleville), The Children's Place Association (Chicago), and Vision House (Chicago).

INTERNATIONAL NEWS

AFRICA: West Africa: Rural Areas Need AIDS Services, Researchers Say

Inter Press Service (09.16.07) - Monday, September 24, 2007

According to Bonfo Bassirou, an Ivory Coast researcher for the Swiss Center for Scientific Research, rural areas of Ivory Coast have only sporadic HIV/AIDS campaigns with little follow up. By contrast, urban areas have resources for circulating prevention messages, providing testing and managing HIV/AIDS. "Today, the rural regions remain a place of HIV illiterates, as prevention campaigns are virtually nonexistent there," Bassirou said.

According to a 2005 study by the Ministry of Health, overall HIV prevalence is higher in urban areas (5.7 percent) than rural areas (4.7 percent). The study estimates national prevalence at 4.7 percent.

Bassirou noted there are no centers for voluntary HIV testing in rural areas, and in rare instances where testing centers have been opened in towns in the country's interior, the facilities are often too far away from neighboring villages. In addition, rural regions are more vulnerable due to high illiteracy rates, close to 60 percent in the countryside, compared to 40 percent nationally.

Maria Fatou Drame, a Senegalese researcher, said, "Even in Senegal, everything is focused on urban areas, while rural areas such as the northeast of Senegal, for example, have extensive need" for HIV/AIDS programs. Drame said that in August 2006 a regional HIV/AIDS committee in Tambacounda, a southern Senegal village, decried "the marginalization of the region" in which 16 HIV/AIDS programs were funded with about $255,000. According to UNAIDS, adult HIV prevalence in Senegal is less than 1 percent, one of the lowest rates in Africa.

Burkinabe researcher Dramane Sawadogo said differences in information should be addressed by training rural educators to raise HIV/AIDS awareness among farmers and putting mobile clinics into operation for testing. UNAIDS estimates adult HIV prevalence in Burkina Faso at about 2 percent.

CANADA: British Columbia STD Cases Double in a Decade

Edmonton Journal (09.22.07) - Monday, September 24, 2007

According to the British Columbia Center for Disease Control, the province saw some 9,100 new cases of chlamydia last year, compared to 4,100 reported cases in 1997. Reported gonorrhea cases rose to more than 1,000 last year, compared to 455 cases ten years ago. Officials say the number of British Columbia residents testing positive for STDs has more than doubled in the past decade.

Health officials warn of a "hidden epidemic" because people do not talk about STDs and may not show symptoms. Dr. Mark Gilbert of the disease control center said the numbers could partly be attributed to increased testing, advances in testing, and increasing efforts to notify partners.

Patricia Mirwaldt of University of British Columbia Student Health Services said unprotected sex is a likely factor in the sharp increase in rates. UBC has handed out 25,000 condoms and 10,000 educational brochures to help combat the trend.

The two main STDs at UBC are chlamydia and human papillomavirus. Although chlamydia cases are up, Gilbert said there has been a decrease in the health problems it causes if left untreated.

In the late 1990s, according to Mirwaldt, fear of HIV/AIDS led to condom use. As new therapies were introduced, people became less fearful and less willing to use condoms.

Overall in British Columbia, the number of people testing positive for HIV has decreased. There were 363 new HIV cases in 2006, down from 521 in 1997. However, specific population groups such as First Nations communities are seeing an increase.

Gilbert noted that a McCreary Center Society's 2003 survey of high school students found that many youths, especially girls, are waiting longer to have sex, and more sexually active youths are using condoms.

CANADA: Parents, Experts Fear HPV Program Has Been Fast-Tracked

Hamilton Spectator (09.17.07) - Monday, September 24, 2007

The decision by the governments of Ontario, Nova Scotia, Newfoundland, and Labrador, and Prince Edward Island to offer HPV vaccinations to girls has met with controversy. Some commentators have asked why HPV made it to the publicly funded list so quickly, while others wonder about side effects.

In a commentary published last month in the Canadian Medical Association Journal, researchers wrote, "There is no epidemic of cervical cancer in Canada to warrant the sense of urgency for a vaccination program." The Canadian Cancer Society estimates that 1,350 women will be diagnosed with cervical caner in 2007 in Canada, and 390 will die from it.

The team, led by McGill University epidemiologist Abby Lippman, noted that questions such as how long the vaccine protection will last and how well it will work in young girls remain to be answered. They also caution that the vaccine may create a false sense of security in girls, leading them to ignore the need for safe sex and regular Pap smears.

Dr. John Schiller, a senior investigator with the US National Cancer Institute and one of the inventors of the vaccine, said, "There's no reason to think that there's going to be rare, serious adverse events from the vaccine that haven't come up so far in the clinical trials, but you never know until the data's in."

Dr. David Williams, Ontario's associate chief medical officer of health, said the public health community has been watching the vaccine's progress for years through the various stages of clinical trials.

MEDICAL NEWS

CANADA: Estimating the Number Needed to Vaccinate to Prevent Diseases and Death Related to Human Papillomavirus Infection

Marc Brisson, PhD; Nicolas Van de Velde, MSc; Philippe De Wals, MD, PhD; Marie-Claude Boily, PhD

Canadian Medical Journal Vol. 177; No. 5: P. 464-468 (08.28.07) - Monday, September 24, 2007

"A vaccine against human papillomavirus (HPV) types 6, 11, 16, and 18 is now licensed for use in Canada and many other countries," explained the authors of the current study, which sought to "estimate the number needed to vaccinate to prevent HPV-related diseases and death."

The researchers developed a cohort model of the natural history of HPV infection. "Model simulations were based on 209 different parameter sets that reproduced Canadian HPV type-specific data for infection, cervical intraepithelial neoplasia, cervical cancer, and genital warts. The number needed to vaccinate was calculated as the number of women who would need to be vaccinated to prevent an HPV-related event during their lifetime," the authors wrote.

For a cohort of 12-year-old girls, the number needed to vaccinate to prevent one episode of genital warts would be 8 (80 percent credibility interval [CrI] 5-15) and 324 for one case of cervical cancer (80 percent CrI 195-757), the study results showed. These estimates were based on the assumption that the vaccine offers lifelong protection and is 95 percent efficacious. If vaccine protection is assumed to reduce by 3 percent per year, the predicted number needed to vaccinate would rise to 14 (80 percent CrI 6-18) and 9,080 (80 percent CrI 1040-does not prevent), respectively. The latter number would be significantly reduced with a vaccine booster dose, to 480 (80 percent CrI 254-1,572).

HPV vaccination may considerably reduce the incidence of genital warts, cervical intraepithelial neoplasia and cervical cancer, the authors concluded. However, the benefits, especially in terms of cervical cancer reduction, are highly dependent on the duration of vaccine protection, on which evidence is currently limited, they wrote.

NEWS BRIEFS

UGANDA: Uganda to Begin Producing ARVs

Xinhua News Agency (09.21.07) - Monday, September 24, 2007

On Friday, Uganda's Daily Monitor quoted a senior health official as saying the country would start producing generic antiretroviral drugs (ARVs) next month. ARV shipments from abroad can take six months to arrive, potentially causing shortages of the drugs for patients who must take them daily, said Sam Zaramba, director-general of health services. Two firms, Uganda's Quality Chemicals Ltd. and Cipla Ltd. of India, will produce the reportedly less-costly ARVs at their $30 million plant in Kampala. The price cut would allow more of the 300,000 people needing ARVs to receive them. Currently, about 100,000 people are receiving ARVs in the country, said Elizabeth Madraa, head of the AIDS Control Program. In addition to generic ARVs, the plant will produce malaria drugs.

SOUTH KOREA: South Korea's Seoul to Propose Inclusion of AIDS Patients in Disability Act

Xinhua News Agency (09.20.07) - Monday, September 24, 2007

In November, city officials in Seoul plan to propose expanding the state's disabilities act to cover people with AIDS. "Organizing and financing health care services for the AIDS patients have become important health policy concerns" a city official said. "As the burden of fighting the disease solely falls on the patients themselves, a person with a diagnosis of AIDS should be deemed disabled."

CALIFORNIA: Maxygen Drug Program for Hepatitis C with Roche Placed on Hold Because of Preliminary Results

Associated Press (09.21.07) - Monday, September 24, 2007

Redwood, Calif.-based Maxygen Inc. on Friday said the development of its hepatitis C drug candidate MAXY-alpha (R7025) has been put on hold by its partner, Roche. In evaluating preliminary results from an early-stage clinical trial, researchers noted an unanticipated decline in the drug's effects among most subjects who received two doses. The two companies formed a partnership to develop new drugs in 2003. Maxygen CEO Russell Howard said the future of the drug is uncertain in the light of "these unexpected findings."

GEORGIA: Tests Show Four Students Don't Have TB

Macon Telegraph (09.24.07) - Monday, September 24, 2007

At Sprayberry High School in Marietta, where a teacher is suspected of having TB, four students who tested positive for exposure have been determined not to have the disease. The negative diagnosis was made based on chest X-rays after the four had a positive reaction to skin tests, said Jay Dillon, district spokesperson. The four were among 142 students screened. The teacher is on paid leave.

GEORGIA: Forum Highlights Local Clinical Trials of HIV/AIDS Treatments

Southern Voice (Atlanta) (09.21.07) - Monday, September 24, 2007

On Thursday, Sept. 27, the Atlanta-based AIDS Survival Project will present a forum at which an expert panel will discuss the latest local clinical trials for HIV/AIDS treatment or prevention. Panelists will include representatives from Emory University's HIV/AIDS Clinical Trials Unit, the Hope Clinic of the Emory Vaccine Center, the AIDS Research Consortium of Atlanta and GlaxoSmithKline. The free forum, which begins 5:30 p.m. and includes dinner, will be held at ASP's offices, 139 Ralph McGill Blvd. For the required pre- registration, telephone 404-874-7926.

CDC HIV/Hepatitis/STD/TB Prevention News Update

For Monday, September 24, 2007