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Thursday, June 5, 2003

POLITICS AND POLICY
========================================
1. Congressional Delegation Visits South Africa, Examines AIDS Issues


DRUG ACCESS
========================================
2. Eli Lilly Forms Partnership To Help Developing Countries Produce Generic
TB Drugs To Combat AIDS, TB Epidemics

3. Brazilian Model for Providing HIV/AIDS Drugs 'Heralded,' But May Not
Work 'Everywhere,' NPR's 'Morning Edition' Reports


PUBLIC HEALTH & EDUCATION
========================================
4. American Journal of Public Health Publishes Second Issue Dedicated to
LGBT Health, Including HIV/AIDS


SCIENCE & MEDICINE
========================================
5. Heart Transplant Successful in HIV-Positive Individual, NEJM Case Report
Says

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POLITICS AND POLICY

1. Congressional Delegation Visits South Africa, Examines AIDS Issues

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18092

A 14-person congressional delegation on Saturday returned from a one-week
trip to South Africa, where they held discussions with U.S. officials in
the country, visited HIV/AIDS treatment and orphan programs in Soweto and
discussed AIDS in the workplace, AllAfrica.com reports. The delegation,
comprised of six Republicans and eight Democrats, was joined by a 21-person
delegation from the Washington, D.C.-based Faith and Politics Institute, a
group committed to "provid[ing] space for moral reflection for
politicians," according to AllAfrica.com. The group visited Gugulethu
Township and spoke to HIV-positive people at the J.L. Zwane Center. In
addition, the delegates discussed the management of company-sponsored AIDS
prevention and treatment programs with DaimlerChrysler's South African
subsidiary (Cobb, AllAfrica.com, 6/2). DaimlerChrysler in 2001 established
a health plan to provide free antiretroviral drugs to its employees and
their families (Kaiser Daily HIV/AIDS Report, 6/19/2001). Rep. Amo
Houghton (R-N.Y.), who led the delegation, said, "We're trying to put into
perspective history and the future. ... Every time you come, you pick up
something" (AllAfrica.com, 6/2).

DRUG ACCESS

2. Eli Lilly Forms Partnership To Help Developing Countries Produce Generic
TB Drugs To Combat AIDS, TB Epidemics

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18093

Eli Lilly today plans to announce a four-year partnership with WHO, CDC,
HHS, the Bill & Melinda Gates Foundation, Harvard University and Purdue
University to transfer $70 million in technology to help companies in
China, India, South Africa and Russia produce and sell their own supplies
of two older Lilly antibiotics to combat tuberculosis, the Wall Street
Journal reports (Chase, Wall Street Journal, 6/5). All of the countries
are "threatened by dual epidemics of AIDS and TB," according to USA Today
(Sternberg, USA Today, 6/5). The TB bacterium is present in about 33% of
the world's population, but people with HIV are 30 times more likely to
develop active TB than HIV-negative individuals because of their weakened
immune systems. Of the 8.2 million new TB cases in 2000, at least 9% were
among HIV-positive people (Kaiser Daily HIV/AIDS Report, 7/9/2002). As
part of the partnership, Lilly will transfer the rights to generic drug
companies to produce capreomycin and cycloserine, two drugs used to treat
multidrug-resistant tuberculosis. In addition, the company will donate its
manufacturing technology to Shasun Chemicals & Drugs Ltd. in India,
Zhejiang Hisun Pharmaceutical Co. Ltd. in China, New Heights in South
Africa and a company in Russia that has yet to be determined. In exchange,
the companies must agree to limit the price of the generics to 20% over
cost (Wall Street Journal, 6/5). Lilly has also awarded Harvard a
one-year, $1 million grant to train Russian doctors on how to administer
the drugs (USA Today, 6/5). Working under a similar grant, scientists at
Purdue will be responsible for training the foreign companies to produce
the drugs under the "strict" manufacturing guidelines of the FDA, the
Journal reports.

'Best Route'


The partnership is the result of four years of lobbying by Paul Farmer,
founder of Partners in Health and a professor in the Program in Infectious
Disease and Social Change in the Department of Social Medicine at Harvard
Medical School, and Jim Kim, director of the the Harvard infectious disease
and social change program and a co-founder and trustee of Partners in
Health. Farmer and Kim said that similar joint ventures "may provide the
best route to affordable access to drugs," according to the Journal. "If
(Lilly) can show other big pharma companies how to be better corporate
citizens, then we'd have a better shot at taking on the plagues of the
poor," Farmer said (Wall Street Journal, 6/5). HHS Secretary Tommy
Thompson, who is expected to announce the partnership in Geneva today at a
board meeting for the Global Fund to Fight AIDS, Tuberculosis and Malaria,
said, "If we can get drugs into these countries with drug-resistant TB,
we'll be able to control epidemics that are growing at an alarming rate"
(USA Today, 6/5).
3. Brazilian Model for Providing HIV/AIDS Drugs 'Heralded,' But May Not
Work 'Everywhere,' NPR's 'Morning Edition' Reports

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18094

NPR's "Morning Edition" today reports on WHO's selection of Brazil, a
country whose approach to HIV/AIDS has "long been heralded" as a model for
the developing world for its universal provision of free antiretroviral
drugs, to assist in the development of the health agency's HIV/AIDS
treatment strategy (Wilson, "Morning Edition," NPR, 6/5). Brazil's AIDS
program director Paulo Teixeira in May announced that newly elected WHO
Director-General Jong Wook Lee at the WHO annual assembly in Geneva asked
him to assist in the development of the agency's five-year antiretroviral
treatment strategy. Brazil negotiates discounted pricing for the drugs or,
if unable to negotiate a satisfactory price, begins local production of
generic copies of the drugs (Kaiser Daily HIV/AIDS Report, 5/21). Lee has
said that he would fulfill WHO's promise to provide three million
HIV-positive people in resource-poor countries with antiretroviral drugs by
2005 (Kaiser Daily HIV/AIDS Report, 5/23). NPR reports that "not everyone
is convinced that Brazil's model can work everywhere" because the country
has a per capita income "considerably more" than most developing countries,
an HIV prevalence "much lower" than sub-Saharan Africa and a functioning
health care system. The NPR segment includes comments from Dr. Anthony
Fauci, head of NIH's National Institute of Allergy and Infectious Diseases;
Dr.William Foege, a senior fellow at the Bill & Melinda Gates Foundation;
and Teixeira ("Morning Edition," NPR, 6/5). The full segment is available
online in RealPlayer.

PUBLIC HEALTH & EDUCATION

4. American Journal of Public Health Publishes Second Issue Dedicated to
LGBT Health, Including HIV/AIDS

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18095

The American Journal of Public Health this month released its second issue
in two years focusing on lesbian, gay, bisexual and transgender health,
including several articles on HIV/AIDS. The journal's editorial team is
"dedicated to addressing the breadth of HIV/AIDS issues -- from health and
human rights and international financing of treatment to domestic programs
centered around needle exchange and violence prevention -- ... focus[ing]
on the particular needs of vulnerable communities and why public health
approaches have remained stubbornly ineffective in marginalized
populations," Editor-in-Chief Mary Northridge writes in an introduction
(Northridge, American Journal of Public Health, June 2003). In addition to
several studies and literature reviews on HIV/AIDS, the issue contains the
following opinion pieces:

* Michael Gross, "When Plagues Don't End": Health care experts have
"little more today than we had two decades ago" to prevent the spread of
HIV, Michael Gross, the journal's associate editor for HIV/AIDS and
lesbian-gay-bisexual-transgender health and the lead editor for the June
issue of AJPH, writes in an editorial. Gross says that the public health
community needs "new biomedical technologies as well as rigorous assessment
and effective translation and dissemination of behavioral approaches that
never were adequately developed and implemented in the first place to
address the prevention needs" of men who have sex with men. "Perhaps most
important, somehow we need to immunize prevention science, programs and
policies against stigma, political opportunism and sanctimony," Gross
concludes (Gross, American Journal of Public Health, June 2003).

* David Malebranche, "Black Men Who Have Sex With Men and the HIV Epidemic:
Next Steps for Public Health": In order to improve HIV prevention and
outreach among black MSM, public health researchers must conduct research
in a more "culturally appropriate" manner; research the differences in how
sexual partners are selected and behavioral risks assessed among BMSM
versus other MSM; and recognize the increased infectivity resulting from
higher rates of other sexually transmitted diseases among BMSM, David
Malebranche, a professor at the Emory University School of Medicine, writes
in an editorial. "Our understanding of infectiousness and susceptibility
among BMSM must be informed by considerations of the interactions between
the immune system, psychology, culture and social context, including the
health care setting ... [which may] hel[p] to perpetuate rather than
ameliorate the HIV epidemic," Malebranche concludes (Malebranche, American
Journal of Public Health, June 2003).

SCIENCE & MEDICINE

5. Heart Transplant Successful in HIV-Positive Individual, NEJM Case Report
Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18096

An HIV-positive patient who has been diagnosed with AIDS but has the virus
under control can successfully undergo a heart transplant and recover
without serious side effects, according to researchers who report on the
case of one such individual in today's issue of the New England Journal of
Medicine, Reuters Health reports (Mulvihill, Reuters Health, 6/4). While
organ transplants for HIV-positive individuals were routinely denied in the
past due to the complicated interaction of drugs used to suppress the
immune system to prevent rejection of the organ and drugs needed to combat
HIV, a 2002 study found that kidney and liver transplants can be as
successful in HIV-positive people as in HIV-negative people (Kaiser Daily
HIV/AIDS Report, 8/30/2002). The case report describes the case of Dr.
Robert Zackin, a 39-year-old man who was diagnosed with AIDS in March 1992
and successfully underwent heart transplantation on Feb. 4, 2001. Advances
in HIV treatment can "dramatically dela[y] the progression" of the disease,
resulting in an increase in mortality due to organ failure among
HIV-positive people and therefore a need for organ transplants, the
authors, including Zackin, write. "If HIV-infected patients are now
expected to live long and productive lives when they are successfully
treated, then they should not be penalized for the advances in medicine
that may allow them to benefit from transplantation," the authors state,
adding that it "continues to be critical to report ongoing clinical trials
as well as individual cases" involving organ transplants among HIV-positive
individuals (Calabrese et al., NEJM, 6/5). Dr. Gregory Curfman, executive
editor of NEJM, said, "This was a benchmark kind of study." He added that
the report should prompt the medical community to discuss the issue of
organ transplantation in HIV-positive individuals.

Expanding Possibilities


Research has begun to show that HIV infection does not necessarily affect
the success or failure of organ transplantation in HIV-positive patients,
according to Reuters Health. Most of the transplants among the
HIV-positive population so far have involved kidney and liver transplants.
NIH is currently conducting a study of 150 kidney transplants and 125 liver
transplants in HIV-positive people, according to the study authors (Reuters
Health, 6/4). "Liver and kidney transplants showed it was feasible," Dr.
Leonard Calabrese of the Cleveland Clinic, who was lead author of the
study, said, adding, "We've gone from giving people a pat on the back and
watching them die 20 years ago, to being able to treat infections, to now
having the prospect of transplanting a vital organ such as a heart"
(Reuters, 6/4). This case report, along with other studies on organ
transplantation in HIV-positive patients, "provides hope" that some people
with HIV/AIDS can benefit from a transplant, and it "opens up the
possibilities of synergy and progress" in transplantation, HIV treatment,
immunology, pharmacology and public policy, Drs. Michelle Roland and Diane
Havlir of the AIDS Division of the Positive Health Program at the
University of California-San Francisco, write in an accompanying
perspective piece (Roland/Havlir, NEJM, 6/5).

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