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|Prevention News Update

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        -NPIN Services- E-mail NPIN                                                                                                         |             | Friday, 
      February 2, 2001 
      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.Peer-Reviewed Journals
      "Evaluation of a Risk Assessment 
          Questionnaire Used to Target Tuberculin Skin Testing in Children"
      General Media
      "Pupils Found Playing With Old 
          Condoms [in D.C.]"
        "Symposium Explores Magnitude, 
          Risks of Global Health Issues"
        "Committee Backs HIV Tests for 
          Mothers-to-Be [in Indiana]"
        "Euro Doctors Warned of HIV Drug 
          Risks in Pregnancy"
        "WTO to Examine US Complaint Against 
          Brazilian Generic AIDS Drugs"
        "Incidence of HIV Infection Declining 
          Among Pregnant North Ugandan Women"
        "Heterosexuals Less Likely to 
          Seek HIV Testing in Italy Than in Other Countries"
        "Ethiopia: Wife Inheritance Said 
          Spreading HIV/AIDS"
      Correction
      "Early Detection of Reverse Transcriptase 
          Activity in Plasma of Neonates Infected With HIV-1: A Comparative Analysis 
          With RNA-Based and DNA-Based Testing Using Polymerase Chain Reaction 
          "
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|"Evaluation of a Risk Assessment Questionnaire Used to Target 
        Tuberculin Skin Testing in Children" Journal of the American Medical Association 
        (01/31/01) Vol. 285, No. 4, P. 451; Ozuah, Philip O.; Ozuah, Theresa P.; 
        Stein, Ruth E. 
        top                                                                                                           |             | Researchers examined the validity of the tuberculosis 
        (TB) risk assessment questionnaire developed by New York City Department 
        of Health (NYCDOH) officials in 1996. Broad programs of tuberculin skin 
        testing have proven to be costly and cumbersome, leading several authorities 
        to suggest that screening should be based on epidemiological risk. The 
        survey developed by NYCDOH was designed to identify those children who 
        would need a skin test. Surveys from 2,920 children aged one to 18 years 
        of age were compiled, and the results indicated that at least 14 percent 
        of the children had at least one risk factor. Of the 413 children in this 
        category, 23--or 5.6 percent--exhibited a positive TB skin test result, 
        whereas just four children--or 0.16 percent--of the 2,507 reporting no 
        risk factors tested positive. Overall, the survey demonstrated a sensitivity 
        rating at 85.2 percent, specificity of 86 percent, a negative predictive 
        value of 99.8 percent, a positive predictive value of 5.4 percent, and 
        an odds ratio of 35.2 percent. Based on these results, the authors concluded 
        that the NYCDOH survey is an accurate assessment for identifying children 
        for TB skin testing.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
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|"Pupils Found Playing With Old Condoms [in D.C.]" 
        Washington Post (02/02/01) 
        P. B4; Goldstein, Avram 
        top                                                                                                                                                                                                                                                       |             | A teacher at a Washington, D.C., elementary 
        school noticed last week that some young children on the playground were 
        playing with discarded condoms, mistakenly thinking they were balloons. 
        The condoms were taken away from the children, and their parents have 
        been advised to have them periodically tested for infections over the 
        next few months. D.C. health officials say there is little risk that the 
        children contracted HIV or hepatitis via lip contact with the condoms 
        when they were trying to blow them up, but the tests are being recommended 
        as a precaution. Peabody Elementary School principal Jennifer Smith said 
        the incident was regrettable, but there is no way to guarantee that such 
        a situation will not occur again. "There's no telling who's going to be 
        on the playground or what kind of activities will occur there, and that 
        goes for every public school in the District." Theodore Gordon, a senior 
        official at the D.C. Health Department, advised this week that janitors 
        inspect and clean playgrounds every day before school begins.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
|"Symposium Explores Magnitude, Risks of Global Health Issues" 
        Portland Press Herald (02/01/01) 
        P. 1B; Goad, Meredith 
        top                                                                                                                                                                                                                                       |             | The Global Health Symposium, to be held in Portland, 
        Maine, on Friday, will focus on how to get more people thinking globally 
        regarding infectious diseases and grassroots public health services. Co-sponsored 
        by the Maine Chapter of the United Nations Association and the Population 
        Resource Center in Washington, D.C., the program's goal is to find ways 
        to make Americans more aware of how an infectious disease existing on 
        another continent can still critically impact their lives. Symposium participants 
        emphasize that as the world becomes smaller through advanced mobility, 
        the threat of diseases migrating into the United States becomes all the 
        more threatening. Recent statistics indicate that about one-third of the 
        world's population is infected with tuberculosis (TB) and 42 million people 
        have contracted HIV. In addition, diseases like cholera, TB, and malaria 
        have become even more difficult to treat because overuse of some antibiotics 
        has made them resistant to some drugs. The symposium's concern is not 
        just about the spread of the diseases, but also the critical toll the 
        diseases take on the surviving population, both economically and through 
        the number of orphans left by the deaths of parents and family members.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
|"Committee Backs HIV Tests for Mothers-to-Be [in Indiana]" 
        Indianapolis Star (02/01/01) P. 
        B1; Barton, Gina 
        top                                                                                                                                                                                                                                                |             | A controversial measure introduced by Indiana 
        State Sen. Patricia L. Miller (R-Indianapolis) would mandate physicians 
        to test pregnant patients for HIV, unless the patient refuses. Even if 
        a woman rejects the test, however, her baby would be automatically tested 
        for the virus. The bill was approved by an Indiana Senate health committee 
        earlier this week and is now awaiting approval from the full Senate. Two 
        amendments were added to the bill before the committee voted to approve 
        it: one to ensure that both the mother and the baby's test results will 
        be kept confidential, and another that requires Medicaid and insurance 
        companies to cover the testing costs. While Indiana officials last year 
        said testing would cost the state about $250,000 annually, the life time 
        cost of care for a child born infected with HIV is about two times that 
        sum.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
|"Euro Doctors Warned of HIV Drug Risks in Pregnancy" 
        Reuters Health Information Services 
        (02/01/01) 
        top                                                                                                                                                                                                                                                        |             | Physicians in Europe are being warned by the 
        European Medicines Evaluation Agency that pregnant women with HIV who 
        take the anti-AIDS drugs Zerit (stavudine) and Videx (didanosine) may 
        experience lactic acidosis, even to a fatal degree. The disorder occurs 
        when the body is unable to process food into usable energy, causing a 
        build-up of acid in the body that can damage vital organs. The warning 
        comes a month after a similar alert from the Food and Drug Administration 
        to U.S. doctors, with both organizations noting the class of HIV drugs--called 
        nucleoside reverse transcriptase inhibitors--is not recommended for use 
        during pregnancy unless the benefits are much higher than the risks. The 
        warning includes information about seven cases of lactic acidosis, including 
        three fatal cases, in pregnant women taking the two drugs in combination.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
|"WTO to Examine US Complaint Against Brazilian Generic AIDS Drugs" 
        Agence France Presse (02/01/01) 
        top                                                                                                                                                                                                                                                                   |             | The World Trade Organization has established 
        a panel of experts to investigate a U.S. complaint that Brazil's production 
        of generic AIDS drugs discriminates against patent holders in the United 
        States. According to the complaint, "Brazil's 1996 industrial property 
        law discriminates against U.S. owners of Brazilian patents whose products 
        are imported into, but not locally produced in, Brazil." The generic drug 
        program was launched to help provide treatment to thousands of people 
        with HIV. Medecins Sans Frontieres (MSF) is urging the United States to 
        drop its request, asserting that it "threatens Brazil's policy in the 
        fight against AIDS," according to MSF's Bernard Pecoul.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
|"Incidence of HIV Infection Declining Among Pregnant North Ugandan 
        Women" Reuters Health Information Services 
        (02/01/01) 
        top                                                                                                                                                                                                                                   |             | Researchers reported a drop in the number of 
        HIV-1 infections among pregnant women utilizing health clinics in the 
        Gulu District of North Uganda during 1993 and 1997, reflecting the decreased 
        number of HIV-1 infections among all women of the same age within the 
        same region. Dr. Massimo Fabiani of the Instituto Superiore di Sanita 
        in Rome, Italy and other researchers monitored the prevalence of infection 
        among women aged 15 to 39 who were interviewed and examined at an antenatal 
        clinic between 1993 and 1997. In the study, published in the January 5th 
        issue of AIDS (2001;15:97-103), the researchers noted that the 
        incidence of infection decreased from 26 percent in 1993 to 16.1 percent 
        just four years later. The researchers found no geographical relationship 
        in the decline, noting that the women were from urban and rural areas, 
        but collectively represented a decline in the overall infection rate of 
        women in the region.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
|"Heterosexuals Less Likely to Seek HIV Testing in Italy Than in 
        Other Countries" Reuters Health Information Services 
        (02/01/01)  
        top                                                                                                                                                                                                                           |             | A new report in the January issue of Preventive 
        Medicine (2001;32:40-48) suggests that although the overall rate of 
        HIV testing among heterosexuals in Italy is fairly high, the proportion 
        of heterosexual individuals who seek voluntary testing in the country 
        is lower than in other nations. Researchers from the Instituto Dermopatico 
        dell'Immacolate in Rome conducted in 1998 a telephone survey of more than 
        2,600 individuals between the ages of 18 and 49. While the prevalence 
        of having ever been tested for HIV was 27 percent for men and 32.8 percent 
        for women, the rates for only voluntary testing dropped down to 8.4 percent 
        of men and 6.1 percent of women. The researchers also note that although 
        individuals who reported risky sexual activities were more likely to seek 
        voluntary testing, not all risk-takers went for voluntary testing and 
        many of the subjects had never been tested.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
|"Ethiopia: Wife Inheritance Said Spreading HIV/AIDS" 
        Africa News Service (02/01/01) 
        top                                                                                                                                                                                                                                                                                  |             | A representative of the Women's Affair Bureau 
        in Gambella, Ethiopia, recently said that the traditional practice of 
        men inheriting their deceased relatives' wives has helped to spread HIV 
        in the region. Bureau members recently held a regional seminar during 
        which they discussed a government-mandated cessation to the traditions 
        of polygamy and wife inheritance, citing them both as key factors in the 
        spread of the virus that causes AIDS.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
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|"Early Detection of Reverse Transcriptase Activity in Plasma of 
        Neonates Infected With HIV-1: A Comparative Analysis With RNA-Based and 
        DNA-Based Testing Using Polymerase Chain Reaction" Journal of Acquired Immune Deficiency Syndromes 
        (01/01/01) Vol. 26, No. 1, P. 93; Reisler, Ronald B; Thea, Donald M.; 
        Pliner, Vadim; et al. 
        top |             | This study details the research into the applications 
        of Amp-RT in the early HIV-1 infection diagnosis process and prognosis 
        of infants, and compares results with earlier RNA and DNA-based PCR testing. 
        HIV-1 transmission from mother to infant is the primary cause of the infection 
        in children, so doctors are continually in search of a way to diagnose 
        the infection quickly enough to be able to introduce aggressive antiretroviral 
        treatment in anticipation of the toxicities and difficulties of administering 
        the overall therapy to the infant. The new assay was more sensitive in 
        detecting HIV-1 infection but demonstrated no significant advantage over 
        RNA viral load testing in predicting disease progression, early on. Researchers 
        stress that the study data is evidence of the usefulness of early testing 
        for infants as young as 14 days old who have been exposed to HIV-1 and 
        that early testing can result in more predictions of accurate disease 
        progression.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
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