Kaiser Daily HIV/AIDS Report - Mon, 2 Apr 2001
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* Merck AIDS Vaccine Slows Progression to AIDS in Monkeys, Does Not
Prevent Infection
* Poor Nations' Health Systems Must Be Built Up to Benefit from
Cheap, Available Drugs
* South African Women Note Country's 'Frankness' in Discussing Sexu-
ality, HIV/AIDS
* Nigeria Faces 'Dilemma' in Discussing Safe Sex
* Kenyan Minister Claims to Have Healed Thousands of AIDS Patients,
New York Times Reports
--
Merck AIDS Vaccine Slows Progression to AIDS in Monkeys, Does Not
Prevent Infection
Merck & Co. scientists announced yesterday at an AIDS conference in
Keystone, Colo., that a common cold virus has proven to be an "effec-
tive vehicle to deliver a potent anti-AIDS vaccine to monkeys," the
Philadelphia Inquirer reports. At a closed-door meeting on "AIDS Vac-
cines in the New Millenium," scientists announced that the vaccine,
delivered in "disarmed" adenovirus, did not block HIV infection nor
rid the body of infection, but suppressed the virus to levels "too
low to be detected," allowing HIV-infected monkeys to remain healthy
for more than a year (Collins, Philadelphia Inquirer, 4/2). Twenty-
one monkeys were infected with an "especially nasty" combination of
HIV and simian immunodeficiency virus, the monkey counterpart to HIV.
The virus "quickly" manifested and generated 100 million virion cop-
ies per cubic centimeter of blood. Of the six control monkeys that
were not given any vaccine, five developed AIDS-like illnesses and
four have died, according to John Shriver, Merck's director of vac-
cine research. None of the monkeys given the adenovirus vaccine have
developed any "AIDS-like" illnesses and the amount of virus in the
bloodstream has been reduced to about 500 copies per cubic centime-
ter. Shriver warned that the studies are "very early," and that it is
"impossible to predict" whether any of Merck's experimental vaccines
will work in humans (Sternberg, USA Today, 4/2).
Using the Gag Gene
The vaccine is an improved version of one detailed by company scien-
tists last year. Working with "relatively new" knowledge of the in-
teraction between HIV and the human immune system, researchers became
"convinced" that an effective vaccine "must" stimulate the release of
CD8+ cells, or "killer T cells," specific immune cells that can "seek
out" HIV-infected cells and "destroy" them, thereby "squelching the
virus' ability to replicate and spread." Researchers learned that
proteins produced by three of HIV's major genes stimulated a killer T
cell response, but the gene known as gag was the most effective
stimulator. Researchers first injected monkeys with the genes alone,
an approach called "naked DNA," but the genes alone were not generat-
ing the "strong response" for which researchers had hoped. Last year,
researchers "stitched" the genes into a deactivated adenovirus, which
is unable to cause colds. Researchers hoped they could "harnes[s]"
the adenovirus' "natural viral action" to deliver the DNA to immune
cells in order to trigger the release of the killer T cells (Wald-
holz, Wall Street Journal, 4/2). Adenovirus was chosen because it
typically invades dendritic cells, cells that play a "pivotal" role
in immune response because they "pick up" invading viruses and
"alert" other immune cells into response. They are found in all parts
of the body, including mucosal cells in the vagina, making them "po-
tentially very important" in fighting sexual transmission of HIV
(Philadelphia Inquirer, 4/2). In all, researchers tested five vac-
cines, each containing the gag gene. In addition to the adenovirus
vaccine, one vaccine used gag in vaccinia virus, the virus used in
the original smallpox vaccine, and three vaccines used the naked DNA
approach with or without booster shots of adjuvants. The naked DNA
approach with a booster of an adjuvant called CRL-1005 produced an
immune response "similar" to but "less dramatic" than the adenovirus
vaccine.
'Good Stuff' Down the Road
"This [research] is the manifestation of what we in the field have
been saying: We have good stuff in the pipeline," Anthony Fauci, di-
rector of the National Institute of Allergy and Infectious Diseases,
said. Two other research groups -- one at Emory University and one at
Harvard Medical School -- have achieved "similar" results, but the
Merck project is the only one to use a "cell-mediated immunity" ap-
proach (Brown, Washington Post, 4/2). Merck's vaccine is still in the
early stages and faces "at least" three years of safety trials before
it can move into large-scale efficacy trials, which may take an addi-
tional three to five years to complete. Merck plans to continue test-
ing the adenovirus vaccine and the naked DNA/adjuvant approach, as
well as an approach that "prime[s]" the immune system with naked DNA
before administering the adenovirus, which yielded the study's "best"
results. Small human trials are being conducted in several U.S. medi-
cal centers to determine whether "double inoculation" is safe. The
ultimate goal of HIV vaccine research is to block the virus from
"ever taking hold," John Moore, a vaccine researcher at Weill Medical
College-Cornell University, said. But researchers have not determined
how to produce an antibody response to "stimulate" the necessary com-
bination of "neutralizing antibodies" and killer T cells (Wall Street
Journal, 4/2). A vaccine that prevented infection would still "likely
have a major effect on the spread of the virus" because epidemiologi-
cal evidence shows that people with lower viral levels are "less
likely" to transmit the virus (Philadelphia Inquirer, 4/2).
--
Poor Nations' Health Systems Must Be Built Up to Benefit from Cheap,
Available Drugs
The benefit of getting more and cheaper AIDS drugs for poorer nations
could be derailed unless those countries' public health systems are
strengthened, American and African experts say, the New York Times
reports. Representatives of American foundations and African health
officials say that "ineffective distribution or misuse" of the drugs
could lead to new strains of drug-resistant HIV. The Times reports
these concerns in advance of two "major" meetings to be held in Af-
rica this month that will highlight drug distribution and use, among
other issues surrounding the pandemic. African experts and American
donors will meet April 18 to April 20 in Kampala, Uganda, and an Af-
rican regional meeting on AIDS will be held from April 25 to April 27
in Abuja, Nigeria. In addition, a special "high-level" U.N. General
Assembly session on AIDS will take place in June.
Preparing for Wide Use
The Times reports that while countries such as Uganda and Senegal
have been "leader[s]" in strengthening their public health and infor-
mation systems, "many countries in Africa and Asia do not have simi-
lar services" (Crossette, New York Times, 4/1). In Malawi, for exam-
ple, there are only two doctors per 100,000 people, the Boston Globe
reports (Donnelly, Boston Globe, 4/1). The Associated Press reports
that the African continent would have to "undergo a construction
revolution" before a comprehensive drug administration program could
begin, building roads to remote villages and laboratories to analyze
blood samples. "Most people do not even have enough food to help them
digest AIDS drugs, or a clean glass of water to wash down the pills,"
the Associated Press adds (Associated Press, 4/2). But the Globe
notes that there no formal plans to build such an infrastructure yet
exist, adding, "No one has an accurate cost estimate. There is no
country-by-country analysis of what needs to be done. In fact, there
is no analysis of what needs to be done in even a single country in
sub-Saharan Africa" (Boston Globe, 4/1).
Fears of Resistance
In addition, the Times reports that many public health officials are
concerned that people need to be taught to take the "new AIDS drugs
correctly," which could be a "big burden" to governments and local
health authorities. Dr. Gordon Perkin, director of the global health
program of the Seattle-based Bill & Melinda Gates Foundation, said,
"There's a lot of concern about compliance -- that if you don't get
large numbers of people taking [the drugs] consistently and cor-
rectly, you risk the probability of getting a resistant strain of HIV
emerging. Just like antibiotics" (New York Times, 4/1). Resistant
strains could also emerge if African governments temporarily run out
of money to buy medicines, the Associated Press reports. "You'd be
better off taking the money that you'd use making antiretrovirals
available across the country and pouring it into prevention programs
across the country," Dr. Robert Carter, an American working in Zam-
bia, said, adding that focusing so much attention on medicating all
AIDS patients is "simply irresponsible" (Associated Press, 4/2).
'Opportunity for Corruption'
Arthur Mbanefo, Nigerian ambassador to the United States, also said
there exists a "great opportunity for corruption in making, selling
or distributing AIDS drugs." According to experts in Nigeria, studies
have found that over-the-counter sales of pills often are "fraudulent
or substandard." Furthermore, organizers of the U.N. special session
say they "want to move the conference beyond the issues of drug
prices and accessibility." Penny Wensley, Australian ambassador to
the United Nations, said, "There's no doubt that access to drugs is
important for huge numbers of people who are suffering from HIV/AIDS
and are currently unable to afford them. But we have to deal with
this in a comprehensive and sustainable manner. At this special ses-
sion, we've got to galvanize the community, we've got to mobilize re-
sources." She added, "We have to look at distribution systems. We
have to look at health infrastructure, and we have to look at quality
control. We have to make sure that there are continuing incentives
for research" (New York Times, 4/1).
--
South African Women Note Country's 'Frankness' in Discussing Sexual-
ity, HIV/AIDS
A "sexual revolution" in South Africa is "underway," with more South
Africans realizing the need to discuss sex and HIV/AIDS openly, mem-
bers of the Women's Health Project of South Africa told activists
gathered in Boston Thursday. The Boston Globe reports that Ndivhuwo
Selinah Masindi, one of the group members, said that religious groups
in South Africa "have realized that [counseling] abstinence is not
effective." Group member Zanele Hlatshwayo added that South Africans
have a "sense of empowerment" that resulted from the end of apart-
heid, giving many in the country a feeling that "anything is possi-
ble, including reducing HIV." However, the resulting "frankness"
about sexuality and fighting HIV are "lacking" in the United States,
Hlatshwayo said. "I expected the United States to be even more open
about issues of sexuality. ... I'm surprised. I find Americans very
conservative," she said. Masindi added that Americans "shrink away"
from "certain words" associated with sexuality. The members of the
women's health project hope to spur women to "have control over and
decide freely and responsibly on matters related to sexuality." In
their native South Africa, the women are currently focused on trying
to "prod" the country's criminal justice system to "deal effectively"
with sex crimes (Mishra, Boston Globe, 3/30).
--
Nigeria Faces 'Dilemma' in Discussing Safe Sex
A conflict over radio advertisements alerting Nigerian youth to the
"dangers" of unsafe sex illustrates that Nigeria "still struggles
with straight talk about sex," Agence France-Presse reports. In
March, a series of radio commercials aimed at informing young people
about the consequences of unsafe sex were pulled from the air after a
complaint by the state-run Advertising Practitioners Council of Nige-
ria. The council objected to the ads' "near-the-knuckle language,"
stating that the commercials violated a broadcasting code that barred
broadcasts "offensive to public feeling ... or disrespectful to human
dignity." After talks among the health ministry, government officials
and the nongovernmental organization that co-sponsored the campaign,
the advertisements are expected to be aired again soon but with some
of the language "toned down," ministry officials said. However,
Rhythm FM, a Lagos-based radio station, earlier this year began air-
ing its own safe-sex campaign by opening and ending its news broad-
casts with a series of warnings about HIV/AIDS. Jacob Akinyemi-
Johnson, a spokesperson for the station, said, "We have a responsi-
bility as a radio station for enlightening the community. AIDS is a
plague that could wipe out an entire generation of Nigerians." He
said that the "difficulties" surrounding the subject of sex in Nige-
ria could be "overcome." "[P]eople understand what we are saying," he
said. However, the country's "cultural ... sensitivities" and "power-
ful" Islamic and Roman Catholic traditions make the open discussion
of sex a "dilemma," Agence France-Presse reports (Cunliffe-Jones,
Agence France-Presse, 3/30).
--
Kenyan Minister Claims to Have Healed Thousands of AIDS Patients, New
York Times Reports
Thousands of Kenyans with HIV/AIDS are seeking the assistance of the
"charismatic" Rev. John Nduati and his Church of God's Power to heal
them, the New York Times reports. Nduati, a Protestant minister who
says he began healing people at age 10, claims that he has cured
thousands of Kenyans -- residents of a nation that "has become noto-
rious for AIDS quackery" -- of AIDS, the "mainstay of his ministry."
Of Kenya's 29 million residents, about 2.3 million have HIV, the
Times reports. On a recent Sunday, 161 people with HIV came to a ser-
vice, seeking healing. During the service, Nduati healed Francis Ma-
nene, a 41-year-old with AIDS, saying, "You are mighty and wonderful
and there is no other God like you. This brother has a bad disease.
He would like to be healed. Change him from positive to negative, and
he will live to glorify your name." Nduati "dismisses any suggestion
that the healing is not real" and claims he can produce hundreds of
people with documentation proving their healing. He added that "his
credibility [is] bolstered by the fact that his services [are] free."
He said, "I want this country to be like Switzerland. Free from cor-
ruption and free from criminals. ... If I were supported, I [would]
reach the whole world. And they [would] be healed" (Fisher, New York
Times, 4/1).
--
The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org,
a free service of The Henry J. Kaiser Family Foundation, by National
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.
--
Cecilia Snyder
mailto:csnyder@ccmc.org
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