hicn medical news part cut here call for employers to keep information about the hiv status of health care workers confidential but doctors who know of an hiv positive colleague who has not sought advice must inform the employing authority and the appropriate professional regulatory body the guidelines also emphasize the significance of notifying all patients on whom an invasive procedure has been done by an infected health care worker a model letter to patients who have come into contact with such an individual is provided along with suggestions for health officials on how to deal with the media in addition a u k advisory panel on hiv infection in health care workers has been formed to provide specific occupational recommendations to those treating such patients properties of an hiv vaccine nature vol no p volvovitz franklin and smith gale the questions raised by moore et al about recombinant gp envelope glycoprotein precursor from hiv produced by microgenesys are advantages rather than disadvantages write franklin volvovitz and gale smith of microgenesys in meriden conn moore et al says that gp in a baculovirus expression system does not bind strongly to the cd receptor and that this recombinant gp does not stimulate the same antibodies as the hiv virus does in natural infection but vaccination with recombinant gp in patients infected with hiv broadens hiv specific envelope directed immune responses including crossreactive antibodies to gp epitopes and cd and cd cytotoxic t cell responses volvovitz and smith claim that they never intended their gp molecule to be identical to the native protein antibody responses against native hiv proteins including the types described by moore et al exist in nearly all aids patients but do not prevent hicnet medical newsletter page volume number april progression of hiv disease in addition the binding of gp or gp antibody complexes to cd has been shown to interfere with antigen specific activation of cd cells and trigger programmed cell death in vitro which may contribute to the pathogenesis of hiv infection the absence of cd binding by the microgenesys gp vaccine may therefore be viewed as an added safety feature phase i studies have demonstrated stable cd counts stimulation of cytotoxic t cells and the suggestion of restoration of immune function based on these and other clinical results microgenesys gp was chosen by researchers at the karolinska institute in sweden for the first phase iii vaccine therapy studies conclude volvovitz and smith hiv infection breast milk and hiv transmission lancet vol no p mok jacqueline there are still more questions than answers regarding hiv positive women breastfeeding their babies writes jacqueline mok of the lancet the anti infective properties of milk are well documented while the numbers of leukocytes concentrations of lactoferrin and iga and lymphocyte mitogenic activity decline sharply during the first two to three months of lactation to barely detectable levels lactoferrin and iga then increase from three to twelve months with percent of total iga in milk being secretory iga breastfeeding protects infants against gastrointestinal and respiratory illnesses in both normal and uninfected children born to hiv positive mothers the italian national registry of aids discovered that breastfed hiv infected children had a longer median incubation time months than bottlefed infants months breastfed children also had a slower progression to aids there is no agreement on which antibodies offer protection against hiv infection studies of the biological properties of milk from hiv infected women showed the presence of igg and iga antibodies against envelope glycoproteins as well as iga antibodies against core antigens binding of hiv to the cd receptor can be inhibited by a human milk factor in the developing world where infectious disease and malnutrition contribute significantly to infant mortality breast milk is still the best food for infants regardless of the mother s hiv status transmission might be restricted by breastfeeding after colostrum and early milk have been expressed and discarded the possibility remains that breast milk could protect the infant who is already infected with hiv at birth and may even delay progression to aids concludes mok absence of hiv transmission from an infected dentist to his patients journal of the american medical association vol no p dickinson gordon m et al if universal precautions are practiced the risk of hiv transmission from dentist to patient appears to be infinitesimal write gordon m dickinson hicnet medical newsletter page volume number april et al of the university of miami school of medicine in miami fla the researchers contacted all patients treated by a dentist with aids and attempts were made to contact all patients for hiv testing living patients with newly detected hiv infection were interviewed and dna sequence analysis was performed to compare genetic relatedness of their hiv to that of the dentist death certificates were obtained for deceased patients and the medical records of those with diagnoses suggestive of hiv disease or drug abuse and those dying under the age of years were examined in detail there were patients who had undergone procedures of whom were deceased an examination of the death certificates of patients identified five who had died with hiv infection all of whom were either homosexuals or iv drug users the researchers were able to detect of the remaining patients and agreed to be tested hiv infection was reported in five of the patients including four who had clear evidence of risk factors for the disease one patient who had only a single evaluation by the dentist denied high risk behavior comparative dna sequence analysis showed that the viruses from the dentists and these five patients were not closely related the study suggests the potential for hiv transmission from a general dentist to his patients is minimal in a setting in which universal precautions are strictly observed conclude dickinson et al april aids patients are susceptible to recurrences of tb study says washington post p a tuberculosis can strike aids patients more than once which makes the resurging health hazard harder to control according to a study published in today s new england journal of medicine people who contract tb usually develop an immunity that protects them if they are exposed to the bacteria again but a person whose immune system is depleted may not be able to fight off a new tb infection doctors found peter m small of the howard hughes medical institute at stanford university director of the study said that in order to protect against reinfection it may be necessary for some people to use tb medicines permanently the study examined the genetic makeup of tb bacteria and how the germs changed over time in patients at kings county hospital in new york hiv infection breast milk and hiv transmission lancet vol no p mok jacqueline there are still more questions than answers regarding hiv positive women breastfeeding their babies writes jacqueline mok of the lancet the anti infective properties of milk are well documented while the numbers of hicnet medical newsletter page volume number april leukocytes concentrations of lactoferrin and iga and lymphocyte mitogenic activity decline sharply during the first two to three months of lactation to barely detectable levels lactoferrin and iga then increase from three to twelve months with percent of total iga in milk being secretory iga breastfeeding protects infants against gastrointestinal and respiratory illnesses in both normal and uninfected children born to hiv positive mothers the italian national registry of aids discovered that breastfed hiv infected children had a longer median incubation time months than bottlefed infants months breastfed children also had a slower progression to aids there is no agreement on which antibodies offer protection against hiv infection studies of the biological properties of milk from hiv infected women showed the presence of igg and iga antibodies against envelope glycoproteins as well as iga antibodies against core antigens binding of hiv to the cd receptor can be inhibited by a human milk factor in the developing world where infectious disease and malnutrition contribute significantly to infant mortality breast milk is still the best food for infants regardless of the mother s hiv status transmission might be restricted by breastfeeding after colostrum and early milk have been expressed and discarded the possibility remains that breast milk could protect the infant who is already infected with hiv at birth and may even delay progression to aids concludes mok hiv and the aetiology of aids lancet vol no p duesberg peter because there is no proof that hiv is the cause of aids the hypothesis that drug use leads to aids will hopefully become a hindrance to the physiologically azt and psychologically positive aids test toxic public health initiatives writes peter duesberg of the university of california berkeley in the lancet s march issue schechter et al call duesberg s hypothesis that injected and orally used recreational drugs and azt lead to aids a hindrance to public health initiatives however their hypothesis that hiv is the cause of aids has not attained any public health benefits the u s government spends billion annually but no vaccine no therapy no prevention and no aids control have resulted from work on this hypothesis schechter et al conclude that hiv has a key role in cd depletion and aids based on epidemiological correlations with antibodies against hiv and with self reported recreational drug use among homosexuals from vancouver however their survey neglects to disprove duesberg s drug aids hypothesis because it does not provide controls i e confirmed drug free aids cases and because it does not quantify drug use and ignores azt use altogether to refute duesberg s hypothesis schechter would have to produce a controlled study demonstrating that over a period of up to years hiv positive patients who use recreational drugs or azt or both have the same aids risks as positives who do not do so the year period is claimed by hicnet medical newsletter page volume number april proponents of the hiv hypothesis to be the time needed for hiv to cause aids alternatively they could show that hiv free individuals who have used drugs for years never get aids defining illnesses concludes duesberg rapid decline of cd cells after ifna treatment in hiv infection lancet vol no p vento sandro et al interferon ifn which induces autoantibodies and autoimmune diseases in some settings may hasten cd t cell loss in some hiv infected individuals through the amplification of harmful autoimmune reactions write sandro vento et al of the a pugliese hospital in catanzaro italy the researchers report three asymptomatic hiv infected individuals with hepatitis c virus related chronic active hepatitis cah who had a rapid profound decline of cd cells after ifn all three patients throughout the observation were consistently negative for serum hiv p antigen and had circulating antibodies to p sera from all three patients obtained at the end of ifn treatment and testing in enzyme linked immunosorbent assay contained high titres of antibodies reacting to a sequence located in the aminoterminal of the beta chain of all human hla class ii antigens homologous to a sequence located in the carboxy terminus of hiv gp these autoantibodies which also recognize native class ii molecules and may contribute to the elimination of cd t cells in vivo were at low tires in all three patients six months after stopping ifn such autoantibodies were not detected in other patients with hiv infection and hcv related cah treated with ifn and who did not experience cd t cell loss in some hiv infected individuals through the amplification of harmful autoimmune reactions the subjects had a b dr and b dr hla antigen combinations which are linked with a more rapid fall in cd cell counts and clinical progression of hiv disease ifn can induce a very rapid decline of cd cells and should be used cautiously in patients with these hla haplotypes the researchers conclude april tb makes a comeback state government news vol no p voit william and knapp elaine s although tuberculosis was once believed to be eliminated in the united states it is emerging again among the homeless aids patients immigrants minorities and prisoners dr lee b reichman professor of medicine at the university of new jersey medical school and president of the american lung association said right now it s a big city problem but potentially it s everyone s problem the ala predicts that million americans are infected with tb and about percent of them will develop the disease because their immune systems are depressed especially those with aids or hiv gene hicnet medical newsletter page volume number april tammes a centers for disease control expert said that is why the cdc has issued guidelines warning hospitals and institutions not to mix aids with tb patients state health officials believe the tb is also spreading because those who are most susceptible are the least likely to follow through with treatment in addition the increase is attributed to a shortage of public health services in new york city tb is an epidemic because the number of cases is increasing faster than we can treat people said dr george diferdinando director of the new york state tb control according to diferdinando curbing the spread of tb entails keeping percent or more of diagnosed tb cases in treatment about percent of infected new york city residents don t complete therapy when tb patients don t finish taking their medication multi drug resistant tb can develop which requires taking more expensive drugs and can take two years instead of the normal six months to treat increasing frequency of heterosexually transmitted aids in southern florida artifact or reality american journal of public health vol no p nwanyanwu okey c et al the alarmingly high rate of heterosexually acquired aids cases in southern florida was partially related to misclassification of risk write okey c nwanyanwu et al of the centers for disease control in atlanta ga the researchers investigated such aids cases from broward and coastal palm beach counties all of these cases attributed to heterosexual transmission reported sexual contact with bisexual men injecting drug users or persons born in countries where heterosexual contact is the primary route of hiv transmission medical records of patients in addition to records from social services hiv counseling and testing centers and sexually transmitted disease std clinics were reviewed if no other hiv risk factor was found from medical record review patients were interviewed using a standardized questionnaire once std clinic and other medical records were reviewed men and women were reclassified into other hiv transmission categories after adjustments were made for the reclassification the percentage of aids cases reported from palm beach and broward counties between january and march that was attributed to heterosexual transmission decreased from percent to percent among men and from percent to percent among women while the percentage of heterosexually transmitted aids cases in southern florida decreased after adjustment was made for reclassified cases it still remained above the national average the researchers conclude hicnet medical newsletter page volume number april aids statistics world health organization geneva organisation mondiale de la sante geneve weekly epidemiological record releve epidemiologique hebdomadaire january th year acquired immunodeficiency syndrome aids data as at december syndrome d immunodeficience acquise sida donnees au decembre number date of of cases report country area nombre date pays territoire de cas de notifi cation africa afrique algeria algerie angola benin benin botswana burkina faso burundi cameroon cameroun cape verde cap vert central african republic republique centrafricaine chad tchad comoros comores congo cote d ivoire djibouti egypt egypte equatorial guinea guinee equatoriale ethiopia ethiopie hicnet medical newsletter page volume number april gabon gambia gambie ghana guinea guinee guinea bissau guinee bissau kenya lesotho liberia liberia libyan arab jamahiriya jamahiriya arabe libyenne madagascar malawi mali mauritania mauritanie mauritius maurice morocco maroc mozambique namibia namibie niger nigeria nigeria reunion reunion rwanda sao tome and principe sao tome et principe senegal senegal seychelles sierra leone somalia somalie south africa afrique du sud sudan soudan swaziland togo tunisia tunisie uganda ouganda united republic of tanzania republique unie de tanzanie zaire zaire zambia zambie zimbabwe total hicnet medical newsletter page volume number april americas ameriques anguilla antigua and barbuda antigua et barbuda argentina argentine bahamas barbados barbade belize bermuda bermudes bolivia bolivie brazil bresil british virgin islands iles vierges britanniques canada cayman islands iles caimanes chile chili colombia colombie costa rica cuba dominica dominique dominican republic republique dominicaine ecuador equateur el salvador french guiana guyane francaise grenada grenade guadeloupe guatemala guyana haiti haiti honduras jamaica jamaique martinique mexico mexique montserrat netherlands antilles and aruba antilles neerlandaises et aruba nicaragua panama paraguay peru perou hicnet medical newsletter page volume number april saint kitts and nevis saint kitts et nevis saint lucia sainte lucie saint vincent and the grenadines saint vincent et grenadines suriname trinidad and tobago trinite et tobago turks and caicos islands iles turques et caiques united states of america etats unis d amerique uruguay venezuela total asia asie afghanistan bahrain bahrein bangladesh bhutan bhoutan brunei darussalam brunei darussalam burma see myanmar birmanie voir myanmar cambodia cambodge china a chine a cyprus chypre democratic people s republic of korea republique populaire democratique de coree hong kong india inde indonesia indonesie iran islamic republic of iran republique islamique d iraq israel israel hicnet medical newsletter page volume number april japan japon jordan jordanie kuwait koweit lao people s democratic republic republique democratique populaire lao lebanon liban macao malaysia malaisie maldives mongolia mongolie myanmar nepal nepal oman pakistan philippines qatar republic of korea republique de coree saudi arabia arabie saoudite singapore singapour sri lanka syrian arab republic republique arabe syrienne thailand thailande turkey turquie united arab emirates emirats arabes unis viet nam yemen yemen total europe albania albanie austria autriche belarus belarus belgium belgique bulgaria bulgarie czechoslovakia tchecoslovaquie denmark danemark finland finlande hicnet medical newsletter page volume number april france germany allemagne greece grece hungary hongrie iceland islande ireland irlande italy italie latvia lettonie lithuania lituanie luxembourg malta malte monaco netherlands pays bas norway norvege poland pologne portugal romania roumanie russian federation federation de russie san marino saint marin spain espagne sweden suede switzerland suisse united kingdom royaume uni yugoslavia b yougoslavie b total oceania oceanie american samoa samoa americaines australia australie cook islands iles cook federated states of micronesia etats federes de micronesie fiji fidji french polynesia polynesie francaise guam kiribati mariana islands iles mariannes marshall islands iles marshall nauru new caledonia and dependencies hicnet medical newsletter page volume number april nouvelle caledonie et dependances new zealand nouvelle zelande niue palau papua new guinea papouasie nouvelle guinee samoa solomon islands iles salomon tokelau tonga tuvalu vanuatu wallis and futuna islands iles wallis et futuna total world total total mondial a the above statistics relating to china do not include cases of aids in the province of taiwan les statistiques ci dessus se rapportant a la chine ne comprennent pas cas de sida dans la province de taiwan b refers to republics and areas of the former socialist federal republic of yugoslavia bosnia and herzegovina croatia macedonia montenegro serbia slovenia se refere aux republiques et territoires de l ancienne republique federative socialiste de yougoslavie bosnie herzegovine croatie macedoine montenegro serbie slovenie hicnet medical newsletter page cut here this is the last part internet david stat com fax bitnet atw h asuacad fidonet amateur packet ax wb tpy wb tpy az usa na
