|AIDS - HIV - 2|
February 2, 199 - AP - Washington
Black Americans are becoming infected with AIDS at record rates, receiving poorer care than whites and dying faster.
Now, almost two decades into the AIDS epidemic, about 1,000 health care providers and activists gathered for the first medical conference on AIDS among black Americans _ a frantic hunt for ways to fight the exploding racial divide.
AIDS in the United States is evolving from a disease that once mostly affected white homosexuals into one largely of poor blacks, often infected from dirty drug needles or heterosexual encounters.
Blacks make up 12 percent of the U.S. population but a devastating 45 percent of new AIDS cases. AIDS has been the leading killer of blacks between 25 to 44 for most of the decade. One in 50 black men and one in 160 black women are estimated to be infected.
``This is an historic event,'' Phill Wilson of the National Black Lesbian and Gay Leadership Forum told the conference Thursday. ``What we do ... will determine whether or not we make a difference.''
``This is no less a daunting challenge than we faced in the civil rights movement,'' added Dr. Stephen Thomas of Emory University.
The doctors, social workers and activists sought practical, day-to-day advice on fighting HIV, the AIDS virus, in communities often wracked by poverty and drugs, where a legacy of racism has left distrust of the medical system.
How do you get a drug user or a homeless person tested for HIV? How do you treat the hotel maid who can't afford the time off to go to a clinic only open weekdays? You're surprised that the bus driver quit taking the AIDS medicine you prescribed _ even though the main side effect was diarrhea?
``We're talking about reaching ... people who might not have had a meal since noon yesterday, and they're still sitting in the clinic'' for four hours because the doctor overbooked, complained Debra Hickman of Baltimore's Sisters Together and Reaching.
Then came the thorny issue of preventing and treating HIV in prisons. ``Our men are in the jails. They do come home to their wives and girlfriends,'' warned a California AIDS worker, describing one reason HIV infection is growing fast among black women.
Nor do many black doctors specialize in AIDS, complained a Colorado nurse who described herself as the only black AIDS health worker in her town. White doctors ``do care, but they don't understand when I say, 'Patients don't trust you.'''
President Clinton has declared AIDS among minorities a crisis.
The administration is spending $156 million this year and seeking $171 million next year to fight back.
But Clinton last year refused to use federal money to buy clean needles for drug addicts, one way to prevent HIV's spread. Frustrated at the ban, administration doctors urged local communities Thursday to raise the money themselves for needle exchanges.
And critics questioned if the government's work is fair: One new program calls for 35 percent of AIDS research sites to be in minority communities, but two-thirds of new infections now occur in those communities.
The conference's main goal was to empower workers on the front lines of AIDS, providing information and resources to help their communities, said Cornelius Baker of the National Association of People With AIDS.
He said, ``We need to make care more culturally appropriate. Maybe clinics need Sunday hours, or you could give health care at church after Sunday services.''
And grass-roots doctors who don't often get to the fancy international AIDS meetings hungered for the latest data, questioning experts on which drugs to use.
``We can be flexible,'' said Dr. Joel Gallant of Johns Hopkins University. Not everyone needs that much-publicized but expensive ``protease inhibitor'' cocktail right away, he said. Newly infected patients with low HIV levels might be all right not starting drugs for a while. Got a patient who won't swallow 15 pills a day? Some new drugs require far fewer.
But there were no easy solutions.
Take Gallant's advice for doctors to test even newly diagnosed patients' blood to see if their HIV will resist certain drugs. The immediate response: Medicaid and other programs don't pay for those tests, so how can we use them?
Tuesday, February 9, 1999
GENEVA (AP) -- Thailand has given the go-ahead for the first large-scale AIDS vaccine trial in a developing country, the U.N. agency in charge of fighting AIDS announced Tuesday.
Some 2,500 intravenous drug users in the Thai capital of Bangkok will take part in the four-year trial of the AIDSVAX vaccine, made by VaxGen Inc. of Brisbane, Ca.
Although about 30 possible vaccines are being developed, officials said AIDSVAX is the first to advance to large-scale testing intended to see whether it truly prevents AIDS infections. Last June, an AIDS vaccine study began in the United States with 5,000 volunteers. The vaccine being tested in Thailand is different from the product used in the United States, to match the different strains of HIV that exist in Thailand.
Jose Esparza, leader of the vaccine team at UNAIDS, said Thai volunteers would also receive education and counseling to try to reduce the levels of HIV infection. About 5 percent of the group would normally become infected every year, he said. Half the volunteers will receive the vaccine while the other half will be given a placebo. The test will cost up to $9 million, with most of the money coming from VaxGen. Inc.
Administering of the vaccine will begin within the next few weeks, and the first results are expected in about 30 months. A number of small-scale tests have been carried out in other developing countries.
On Monday, the U.S. National Institutes of Health announced the testing another possible vaccine in Uganda. The yearlong study is enrolling 40 healthy adults at low risk of getting HIV; 20 will get the experimental vaccine. Researchers in Uganda will monitor safety reactions and immune system changes to see if the vaccine has anti-HIV potential. If so, larger studies could follow.
By Daniel Haney--AP--February 8, 1999
Where did the AIDS virus come from? Scientists think they have traced its origin to the long-suspected source: chimpanzees.
In a presentation Sunday, researchers from the University of Alabama at Birmingham said they have convincing proof that the virus has spread on at least three separate occasions from chimpanzees to people in Africa. One of these cross-species transmissions was the start of the epidemic that now infects about 35 million people worldwide.
Chimps, which have probably carried the virus for hundreds of thousands of years, apparently do not get sick from it. Figuring out why could be important. "This is excellent science with biological and virological importance. If we understood how the chimp has dealt with this infection over time, that could have implications for human medicine," said Kevin DeCock, an AIDS expert at the U.S. Centers for Disease Control and Prevention in Atlanta.
While chimps have long been suspected as the source, "there have been a lot of loose ends that made people uncomfortable drawing that conclusion," said Beatrice Hahn.
Whatever its origins, HIV is a recent affliction of people. At last year's Conference on Retroviruses and Opportunistic Infections, David Ho and others from the Aaron Diamond AIDS Research Center at Rockefeller University presented evidence that the virus probably first infected humans in the 1940s or early '50s.
At the opening of this year's meeting, Hahn made the case that this event almost certainly occurred in west equatorial Africa when someone caught the virus from a chimp, perhaps after killing the animal for food.
Hahn said her team nailed down the connection by analyzing frozen tissue saved from a chimp named Marilyn that died from complications of childbirth at a U.S. Air Force primate center 14 years ago.
The chimp version of the AIDS virus - the microbe now thought to be the grandfather of HIV - is called SIVcpz. It is extremely rare among chimps in U.S. lab colonies, apparently because these animals are removed from the wild as babies and so are never exposed to the virus sexually.
Until recently, SIVcpz had been isolated only three times. The fourth turned up when a colleague cleaning out a lab freezer ran across Marilyn's specimens and sent them to Hahn. Her team was able to perform various kinds of genetic analysis that were unavailable when the chimp died. Then the Alabama team used molecular analysis techniques to study all four examples of the virus.
They found that three of the four were genetically extremely similar to the human AIDS virus. They included one gene, called vpu, that also is part of HIV but not of other AIDS-like viruses that infect monkeys. All three samples came from Pan troglodytes troglodytes, which is one of the four subspecies of chimp in Africa. These animals live in Cameroon, Equatorial Guinea, Congo and Central African Republic, the region where AIDS is thought to have started. The fourth sample, much less like HIV, came from another subspecies of chimp that is native to East Africa.
Among humans, there are three major groups of HIV, code-named M, N and O. M is the variety that has spread around the world, while N and O are seen only in west-central Africa. The natural habitat of Pan troglodytes troglodytes exactly overlaps the area where these three groups were first recognized. The researchers believe that each group arose from a separate chimp-to-human transmission of SIVcpz.
"We conclude that this subspecies is the natural host and reservoir for HIV-1," the AIDS virus, said Hahn, whose work is also being published in this week's issue of the journal Nature. She said a French team, headed by Phillippe Mauclere of the Pasteur Institute, recently found three more chimps infected with SIVcpz at a game sanctuary in Cameroon. One sample has been genetically analyzed and it, too, closely resembles HIV.
November 11, 1998 --Reuters Sydney, Australia
Australian scientists said on Wednesday they had created a breakthrough vaccine which enables monkeys to fight off the HIV virus, and plan to start testing it in humans next year. "It looks good so far. We just hope that it holds up when we get a chance to test it (in humans)," Dr Alistair Ramsay, an immunologist at Australian National University, told Reuters. Researchers in Canberra and Melbourne separately administered two vaccines, one to prime the immune system and another to boost it into action, before infecting four monkeys with the HIV virus.
The monkeys were initially infected but produced large numbers of "killer T cells" to clear the virus from their system within weeks. Four unvaccinated monkeys contracted the virus, which causes AIDS in humans but not in monkeys. The body's T cells are its first line of defence against infection, targeting and destroying foreign invaders. The researchers described their work in a scientific paper published in the U.S.-based Journal of Virology on Wednesday.
The researchers from the ANU, the Australian government's Commonwealth Scientific and Industrial Research Organisation (CSIRO) and Macfarlane Burnett Centre, combined two immunization methods, neither of which is effective on its own. First, "DNA immunisation" introduced a modified HIV gene into the monkeys' skin cells and stimulated their immune systems. Then, a few weeks later, "viral immunisation" introduced the same HIV "gag" gene in a harmless fowl-pox vector vaccine, producing a sharp surge in the number of T cells. When the macaque monkeys were then infected with HIV the T cells multiplied even further and began to attack cells infected by the virus.
The World Health Organisation says up to 40 million people around the world are living with the AIDS virus, with Africa the worst-affected continent but Asia also facing a pandemic. The disease killed an estimated 2.3 million people last year. Ramsay said AIDS vaccine teams around the world were focusing on the "CD8 T cells"-- but the Australian effort was the first to use the dual vaccine procedure to boost them.
The Australian team plans to use the fowl-pox vaccine in a therapeutic trial on HIV carriers in Sydney and Melbourne next year to see if the vaccine could help ward off AIDS, he said. Then it hopes to start overseas trials on non-infected humans, probably in Southeast Asia. The team hopes to win U.S. funding, probably from the U.S.-based International AIDS Initiative, which helps speed the development of candidate vaccines, Ramsay said. "We would hope to be in clinical trials within two years-- and we'd know within three to five years if it worked," he said.
Another ANU scientist, Professor Ian Ramshaw, said current weapons against AIDS-- condoms to avoid infection or a cocktail of drugs to fight it-- were either too expensive or for various reasons too hard to distribute in the Third World.Ê "A vaccine is the only answer," Ramshaw said. "The advantage of our system is it is very cheap and does not require refrigeration which can be a major difficulty in tropical countries. The vaccine will cost only a few cents per shot and can be administered without expensive equipment or training."
NEW YORK -November 3, 1998
An experimental drug cut the level of the AIDS virus in patients' blood by as much as 99 percent in two weeks, according to the preliminary results of a study. That is as potent as currently approved drugs, which can drive the virus down to undetectablelevels when taken longer. The experimental drug, called T-20, showed the 99-percent reductions in the four patients who took the highest dose. The drug sabotages HIV's machinery for penetrating into the body's cells, a different strategy from that used in approved HIV medications.
Unlike the standard medications, T-20 wouldn't work as a pill, and was given by injection to the 16 patients in the two-week study. Results are reported in the November issue of the journal Nature Medicine by scientists at the University of Alabama at Birmingham, the drug company Trimeris Inc. of Durham, N.C., and elsewhere. Trimeris is developing T-20.
In an accompanying editorial, Dr. Douglas Richman of the University of California, San Diego, cautioned that much more study will be needed to assess how useful T-20 might be. Scientists will have to investigate side effects when T-20 is taken long-term, as well as the possibility that HIV will become resistant to the drug, he wrote.
Hanoi, September 10, 1998 (Reuters) -
A growing number of people in Vietnam have been infected with the Human Immunodeficiency Virus (HIV), which has now spread to all but two of the country's provinces. The official from the National AIDS Protection Committee said statistics showed 10,119 cases of HIV, while more than 1,240 people had full-blown AIDS, or Acquired Immune Deficiency Syndrome. She said a further 674 people had died from AIDS.
Vietnam has 58 provinces while the capital Hanoi, Danang in the centre of the country and southern Ho Chi Minh City have province-like status. The two provinces free of HIV are in remote northern areas. Unofficial estimates put the number of people carrying HIV, which leads to AIDS, much higher.
At the beginning of 1996, Vietnam officially had 3,375 people infected with HIV. The country, home to 78 million people, has a thriving prostitution industry and a problem with drug use. Although the government has launched public propaganda and education campaigns to prevent AIDS, discussions of sexual matters remain taboo across the largely rural country.
September 10, 1998: AIDS Breakthrough (AP) Molecular biologists may have discovered how AIDS suddenly can erupt into a catastrophic illness after lurking for years as a low-grade infection. New research by a nationwide team of scientists suggests that the human immunodeficiency virus eventually attacks a class of disease-fighting cells produced by the immune system that were thought to be impervious to attack by the virus. The results, which have been limited so far to test-tube experiments, could provide drug makers with a new target for drugs designed to keep the virus in check, as well as vaccines aimed at preventing infection.
Researchers said the attack on this different group of immune cells, known as CD8 T cells, triggers an explosion of cell death that exhausts the immune system and leaves the body vulnerable to pneumonia and other secondary infections that typically kill most AIDS patients.
The new study was published in the latest issue of the journal Nature. Exactly how AIDS affects the CD8 cells remains unclear, though. Researchers said one possibility is that the virus reduces the immune system's "social control" over its own powerful cells. The disruption to this precise chemical balance triggers a potentially fatal domino effect that not only leaves the body vulnerable to infection, but also may contribute to the loss of brain cells that causes AIDS-related dementia and other debilitating side effects.
For several years, scientists have known that HIV readily infects one type of immune cell known as the CD4, or helper T cell, by locking onto a protein on its surface and breaching its cell wall. The CD8 cells were thought to have better protection. Yet in the latter stages of AIDS, CD8 cells start dwindling rapidly, too.
Researchers said their experiments show that a strain of HIV that usually evolves late in the course of infection latches onto a particular surface protein of the CD8 cell known as CXCR4. But unlike in CD4 cells, the virus does not actually take over its cellular machinery.
Instead, they report, when the virus latches onto the CXCR4 protein the CD8 cell sees the change as a kind of a death signal and commits suicide. The cell death process is complex, and quickly involves an array of other cell types that soon may subvert the entire immune system and lead to full-blown AIDS symptoms, said lead author Georges Herbein of the Picower Institute for Medical Research in Manhasset, N.Y. Because CD8 cells are thought to limit the spread of the infection, the failure of CD8 function could contribute to the development of AIDS.
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