Drug
Guide corrections
Zerit XR approved
T-20 side effects
Avoid smallpox vaccine
Lesbian transmission
Ashe remembered
Oral sex risk
“I’m really beginning to loathe the CDC”
Around the globe
Drug
Guide corrections
The activist section of the
HIV Drug Guide
(January/February) incorrectly stated that Videx is associated
with “the common discoloration of the finger nail beds of
African Americans.” That side effect is seen with Retrovir
(AZT). Under Kaletra, the activist statement that “the company
reports…[no] resistance” refers only to people on therapy
for the first time. Also, the drug guide failed to note the
only approved once-daily dose of a protease inhibitor: Agenerase
when taken with Norvir. The recommended dose of Viracept is
1250 mg (five 250 mg tablets) twice daily. We apologize for
the oversights.
Zerit
XR approved
The U.S. Food and Drug Administration
(FDA) in late December approved a once-a-day, extended release
formulation of Zerit (stavudine, d4T). The dose is 100 mg
for people weighing 132 pounds or more, and 75 mg for those
weighing less. In a large trial, the new formulation was equally
effective to standard Zerit. Side effects were also similar.
The primary side effect of Zerit is peripheral neuropathy,
numbing and tingling in the hands and feet, which can become
permanently debilitating if left untreated. Several studies
also suggest that Zerit, as well as other antiretrovirals,
is associated with facial atrophy (wasting).
T-20
side effects
The promising experimental
HIV drug T-20 (brand name Fuzeon) has been associated with
a low incidence of eosinophilia and a hypersensitivity (allergic)
reaction. Eosinophils are a type of white blood cell. An increase
is associated with allergic reactions. The manufacturer reports
that eosinophilia was found in 10% of patients on T-20 in
two large clinical trials (TORO 1 and 2). It was found in
2% of the control group (the participants not on T-20). The
reaction may be associated with an inflamatory reaction, and
people with asthma and dermatitis may get it more regularly.
Two cases occurred on re-challenge (when patients are put
back on a drug after having gone off it). One person experienced
kidney and respiratory failure. Both re-challenged individuals
had rash, fever and vomiting.
Avoid
smallpox vaccine
The smallpox vaccine so much
in the news over the past year should be avoided by people
with HIV and those in close proximity to them. People who
get a shot might be contagious for up to about three days,
so they should avoid contact with those who are immunosuppressed
and people with skin conditions. There is medication that,
if taken soon after exposure to smallpox, may prevent infection
(see The Buzz).
Lesbian
transmission
A report in the February
1 edition of Clinical Infectious Diseases discusses
a case of female-to-female sexual transmission of HIV. Such
cases are very rare. Researchers believe transmission occurred
through the sharing of sex toys. Other risk factors were ruled
out. Although the objects were not used during menstruation,
bleeding sometimes occurred through vigorous use. Testing
for the presence of drug resistance in the virus of both women
helped confirm the transmission from one woman to the other.
Ashe
remembered
February marked the tenth
anniversary of the death of famed tennis player, Arthur Ashe.
He died of complications of AIDS after having contradicting
HIV in a blood transfusion during heart surgery. The publicity
that Ashe brought to HIV/AIDS helped transform the way that
“mainstream” America viewed the disease. A role model to so
many young African Americans, Ashe was the first black man
to win Wimbledon in 1975. He was the first black male to win
U.S. national titles, both the U.S. Open and U.S. amateur
championships. He would have been 59 years old.
Oral
sex risk
A study reported late last
year, in the November 22 issue of AIDS, clarified issues
related to HIV transmission in oral sex between men. The researchers
noted that after one study which found an 8% transmission
through oral sex [out of a group of about 110 men], people
began to think that in general, 8% of transmission between
men could be through oral sex. In preliminary results with
239 men from this longitudinal study, they found a zero percent
transmission due to oral sex. However, using a different analysis,
the risk could be greater.
In their conclusion, the
researchers stated, “These data confirm that the risk of HIV
infection attributable to fellatio among MSM [men who have
sex with men] and in the MSM population is especially low.
It is important that health professionals, including HIV counselors
have valid information to impart to their sexually active
clients. If individuals believe that the risk of HIV from
fellatio is high or on a par with well-documented high-risk
exposures such as anogenital sex, they may not feel that sexual
behavior choices make a difference… one’s choice of sexual
practices do matter.”
“I’m
really beginning to loathe the CDC”
So says Positively Aware
columnist and sexual health activist Laura Jones about the
U.S. Centers for Disease Control and Prevention (CDC). In
an e-mail to the staff on December 23, she writes, “The following
item is under ‘Medical News’ in today’s [HIV/STD/TB Prevention
News Update]. The ‘Medical Institute for Sexual Health’ is
one of those abstinence-only places, based in Austin, that
is putting out public-ed materials based on selective interpretation
of research data (and I don’t even know what Virus Weekly
is). There’s no mention of the fact that we already know that
the effectiveness rates of condoms are less for viruses transmitted
by skin-to-skin contact (HPV, herpes) than for infections
transmitted through contact with body fluids, and no mention
of why this is so (condoms only cover a limited area of skin,
la la la). They aren’t talking at all about breakage or improper
use when they’re discussing these findings, either.
The item was taken from a
source called Virus Weekly. It begins, “A new scientific
report, ‘Sex, Condoms, and STDs: What We Now Know,’ released
by the Medical Institute for Sexual Health, reveals that condoms,
even when used 100 percent of the time, fail to reduce the
risks of some of the most common STDs to an acceptable level.
One of the key findings listed in the item: “There is no evidence
of any risk reduction for sexual transmission of HPV [human
papillomavirus] even with 100 percent condom use.”
Says Jones: “There’s evidence
that use of even diaphragms and cervical caps reduce the risk
of cervical HPV infection because they cover the cervix, so
there’s obvious benefits to use of condoms in protecting the
cervix and rectum. Plus, no one can ever know for sure when
they picked up HPV, so it’s hard to do conclusive research
now that this infection is so widespread. It’s also virtually
harmless in quite a few cases, depending on the strain you
pick up and the functionality of your immune system. They
aren’t talking straight about HPV at all.”
In the past year, members
of Congress and health advocates have attacked the Bush administration
for promoting scientific misinformation through the CDC. “Simply
put, information that used to be based on science is being
systematically removed from the public when it conflicts with
the administration’s political agenda [such as abstinence-only
education],” 14 Democrats wrote in a letter to the U.S. Department
of Health and Human Services.
Around
the globe
Women make up half…
…of all HIV infections.
The annual UNAIDS and WHO report (United Nations Joint Programme
on AIDS and World Health Organization), released in December,
showed that women living with the virus almost equaled the
number of men with HIV for the first time. In many African
countries, women have outnumbered men for years. The provisionary
figures show that around the world, there are an estimated
38.6 million adults and 3.2 million children under age 15
with HIV. Women with HIV number 19.2 million.
Bill Gates in India
Microsoft CEO Bill Gates
announced he would donate $100 million from the Bill &
Melinda Gates Foundation to help fight the spread of AIDS
in India. Although the money will go through the health department,
the health minister cautioned that the projection from Gates
and other people from the U.S. of how many people will have
HIV/AIDS in India was “spreading panic.”
Thailand
Public health authorities
in Thailand earlier this year reported that HIV infection
among teen-agers rose from 11 to 17 percent. That’s nearly
one out of five teenagers.
Access coalition
The World Health Organization
(WHO) in late December helped launch the International HIV
Treatment Access Coalition (ITAC). In a press release, WHO
Director-General Gro Harlem Brundtland said, “Does anyone
deserve to be sentenced to certain death because she or he
cannot access care that costs less than $2 a day? Is anyone’s
life worth so little? Should any family become destitute as
a result? Should children be orphaned? The answers must be
no, no, no and no.” ITAC will work with a variety of institutions
on medical training, drug procurement and other tasks. Visit
www.itacoalition.org.
“Mass
murder”
“Mass murder by complacency.”
That’s what the United Nations special envoy on HIV/AIDS called
the effect of rich countries not giving enough to a global
fund on tuberculosis, malaria and HIV/AIDS. Canadian Stephen
Lewis also said that a war with Iraq would disable humanitarian
efforts needed around the world. “This pandemic cannot be
allowed to continue, and those who watch it unfold with a
kind of pathological equanimity must be held to account. There
may yet come a day when we have peacetime tribunals to deal
with this particular version of crimes against humanity.”
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