Conflicting Data Show HIV Prevention Efforts at a ‘Crossroads,’ Conference Speakers Say

The fight against HIV/AIDS in the United States has reached a "transition point," Dr. Helene Gayle, who will soon retire as head of the CDC's National Center for HIV, STD, and TB Prevention, said yesterday in her closing remarks to the Second National HIV Prevention Conference in Atlanta, Newsday reports. "We don't have far to go to see the impact HIV is having on our lives. It's all around us," she added. Cornelius Baker, head of the Whitman-Walker Clinic, Washington, D.C.'s largest HIV services organization, said that the "conflicting data" announced at this week's conference have left him with "mixed emotions." CDC researchers on Monday presented data that indicates that AIDS cases and AIDS-related deaths have leveled off and on Tuesday researchers from the CDC and Kaiser Permanente presented two separate studies indicating that 40% of HIV-positive people do not learn of their status until they begin showing signs of AIDS. However, other studies revealed at the conference this week showed that efforts to reduce HIV infection rates among IV drug users through needle-exchange programs are working and that the rate of vertical transmission is falling. "I'm not quite clear what we're saying and what the overall impact is going to be with time," Baker said of the mixed news, adding that HIV/AIDS prevention is at a "crossroads." Baker, representatives of the National Association of People With AIDS and officials from four other national AIDS groups gave their endorsement to the CDC's target of cutting new HIV infections to 20,000 per year by 2005, a plan that is expected to cost $300 million per year. "As we pursue this discussion of prevention, we have to think about the impact it will have on people's lives," Baker cautioned.

Findings from the Conference
Findings from yesterday's closing sessions of the National HIV Prevention Conference are summarized below:

• Treatment with antiretroviral drugs may not decrease a person's infectiousness, according to arguments presented yesterday. In a study released last year, Dr. Tom Quinn of Johns Hopkins University School of Medicine found a "correlation between viral loads and the risk of transmitting HIV sexually." Quinn and colleagues studied a "large number" of Ugandan couples in which only one partner was infected with HIV. Based on infection rates, they concluded that people with a viral load above 50,000 copies per milliliter of blood were 12 times more likely to transmit the virus to their partner than those with a viral load below 1,500 copies per milliliter of blood. A group of 138 Harvard faculty members advocated "widespread" treatment of Africans based on those findings, saying that treatment would "help slow the continent's epidemic" by reducing viral loads. However, Dr. Kenneth Mayer of Brown University yesterday challenged the applicability of Quinn's findings because the low viral loads in the Ugandans were not the result of treatment but the result of how their immune systems "were somehow managing to control the virus." But Quinn stuck by his findings and said that the "widespread use" of antiretroviral therapy may "slow" the American epidemic if all Americans with viral loads above 10,000 copies per milliliter were receiving treatment (Garrett, Newsday, 8/16).
• The results of two separate "preliminary" vaccine trials in monkeys are "promising," according to data presented yesterday. Dr. Raul Andino of the University of California-San Francisco reported that a vaccine for simian immunodeficiency virus, a primate virus similar to HIV, has "for the first time" kept a primate from being infected vaginally by SIV. The vaccine, made of genetic material from SIV and "several strains of poliovirus," was administered to seven macaques. Those monkeys and 12 controls were vaginally infected with SIV and then monitored for 48 weeks. At the end of the 48 weeks, all vaccinated monkeys "remained healthy," with two showing "no evidence of infection" and four exhibiting "substantial protection." White blood cells with "SIV-specific responses" were found in three of the seven vaccinated monkeys. However, all of the control monkeys were infected and six had developed clinical AIDS by 48 weeks. In a separate study, researchers from Emory University immunized rhesus macaques with a "series of high- or low-dose vaccinations." The monkeys were then infected rectally with SIV. All of the vaccinated monkeys became infected, but the 20 who received the high-dose vaccine were able to "best control" the virus with 19 of the 20 exhibiting barely detectable levels of the virus. According to researcher Harriet Robinson, the NIH will begin human trials of the vaccine early next year. "We definitely will have an AIDS vaccine. With experience we will have better vaccines than those we know how to make now -- but what we have now should make a real difference to the world epidemic," she added. Also at the conference, Dr. Donald Francis, president of VaxGen, announced that his company has recruited 5,418 human volunteers for a phase III trial of AIDSVAX B/B. The "first interim analysis for effectiveness" will begin later this year with results late next year, he added (Hitt, Reuters Health, 8/15).
• According to two studies presented yesterday, prejudice against people with HIV/AIDS and misconceptions about how the virus is spread remain "common" in the United States. The first study, conducted by Dr. Dogan Eroglu of the CDC, found that 7% of more than 2,300 respondents agreed with the statement "people with HIV are dirty," and 9% agreed with the statement "people with HIV should be ashamed." Those most likely to agree with the statement were males, minorities and people over the age of 65. In the second survey, presented by Danni Lentine of the Research Triangle Institute, researchers found that 40% of 6,000 people surveyed thought there was "some likelihood" that a person could contract HIV by drinking from a glass used by an HIV-positive person. A "similar percentage" also said they would be "concerned" if they found out that their grocer had AIDS. In addition, 19% said that those who acquired HIV through sex or drug use "deserved it." Lentine said the "stigmatizing attitudes" were more likely to be shared by those who were "misinformed" about HIV transmission. Those agreeing with the statements were more likely to be male and over the age of 55, and they were more likely to be white. Differences in how the questions were asked may account for the discrepancies in answers, she said, adding, "Stigma is so complicated. But I do think people should try and get to know someone with HIV and realize that we are all human beings and should be compassionate" (Hitt, Reuters Health, 8/15).