Friday, May 16, 2008

• Second Peace Corps Volunteer Reports Being Discharged After Testing HIV-Positive, Washington Post Reports

Second Peace Corps Volunteer Reports Being Discharged After Testing HIV-Positive, Washington Post Reports
[May 16, 2008]

      Washington Post columnist Stephen Barr on Friday examined the case of a second Peace Corps volunteer who said she was discharged from service after testing HIV-positive. Rebecca Coulborn, a former volunteer in Burkina Faso, said she was required to leave her post immediately in 2001 after she tested positive for the virus.

Coulborn spoke about her case after reading an April 28 Post article on former Peace Corps volunteer Jeremiah Johnson, who was discharged from his post in Ukraine after he was diagnosed with HIV.

In a May 7 letter responding to a previous letter from the American Civil Liberties Union, the Peace Corps said Johnson was the first case of a volunteer "to our knowledge" who wanted to continue service after testing HIV-positive, the Post reports.

However, Coulborn, an epidemiologist at the University of Michigan, said that she "did not want to be medically separated" from the agency. According to Coulborn, she was told that it was "Peace Corps policy. If you did test HIV-positive, you were medically separated" from service. She said, "I really thought it was their policy to automatically separate people" with HIV/AIDS, adding, "I felt for a long time that this was something done to me that was wrong, and very unethical."

During her Peace Corp service, Coulborn provided health education in a village of 800 people in Burkina Faso. She said she thinks she contracted HIV when helping a person who had been injured in a bicycle accident. According to Barr, Coulborn did not expect her HIV-positive test result. However, Barr writes that Coulborn was more surprised when the local agency medical officer, following instructions from headquarters, told her "to pack up [her] stuff and not expect to return."

Coulborn said that she remains in good health and has not had to start antiretroviral therapy, adding that she believes she "could have completely and totally served out my term as a Peace Corps volunteer." Being forced to leave her assignment "was devastating," she said, noting that her departure ended ongoing and upcoming projects for the village. "Testing positive for HIV should not disqualify you from serving your country internationally," Coulborn said.

Amanda Beck, Peace Corps press director, said the statement about Johnson being the first volunteer who wanted to continue his service was "based on personal knowledge of the currently serving Peace Corps staff members," who generally turnover every five years under the agency's staffing policies. "Our primary concern is that Peace Corps volunteers receive the best medical care and treatment possible," Beck said, adding, "In the case of HIV, the Peace Corps Office of Medical Services has historically determined that the best testing, evaluation and treatment for volunteers is available from specialists in the United States." Beck said that 75,000 U.S. citizens have served in the Peace Corps since 1989 and that 36 have tested HIV-positive during or at the close of their service.

Under a Peace Corps general policy, if a volunteer develops a medical condition that cannot be resolved within 45 days, he or she is medically separated from the agency. Initial evaluation and treatment for HIV can take from three to six months -- meaning that Peace Corps volunteers who are HIV-positive experience what ACLU calls automatic separation, Barr writes.

According to Barr, the Peace Corps in its letter to ACLU said that its policy "appears to be evolving." The letter said that the agency "is now committed to extending the individualized assessments in these types of cases to include whether a newly infected volunteer could be reasonably accommodated and either kept at post or sent to another post in lieu of medical separation." It added that it "cannot commit to a guarantee of reassignment" (Barr, Washington Post, 5/16).

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NPR Program Features Discussions on Efforts To Promote Condom Distribution in Prisons To Reduce Spread of HIV
[May 16, 2008]

      NPR's "News & Notes" on Thursday included two discussions about the spread of HIV in prisons and efforts to promote condom distribution to inmates.

In the first segment, Keith DeBlasio, a former inmate who contracted HIV in prison, and Lovisa Stannow, executive director of Stop Prisoner Rape, discussed the spread of HIV through rape and consensual sex in prisons. Stannow, whose group supports the distribution of condoms in prisons, said, "It's a public health issue, and it's also a human right issue," adding that "incarceration simply should not lead to serious illness and premature death."

Stannow also discussed the federal Prison Rape Elimination Act, which was passed in 2003, "News & Notes" reports. She said, "It may not have trickled down yet to the actual facility level, but we certainly see a much more serious discussion among corrections administrators and lawmakers and policymakers, that even five years ago you would still hear wardens and prison managers claim that sexual abuse was not really a problem. And we don't hear that any more." She added, "The question is now, how do we address the problem?" (Chideya [1], "News & Notes," NPR, 5/15).

In the second segment, the Rev. Dorris Green, director of community affairs for the AIDS Foundation of Chicago, discussed the group's support of HIV screening and condom distribution in Illinois prisons. According to "News & Notes," the "state of Illinois has been resistant" to the proposals.

Green said the group is working on "educating our legislators about HIV" and sex in prisons, adding, "We have a hard time here in this state convincing our legislators that people are actually having sex in prison." The group also is developing a demonstration project that could include condom distribution in a state prison, she said (Chideya [2], "News & Notes," NPR, 5/15).

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Health Ministers To Discuss Issues Surrounding Drug Patents, Access at World Health Assembly
[May 16, 2008]

      Health ministers from countries worldwide next week at the World Health Assembly will discuss issues surrounding patents and access to drugs for diseases such as HIV/AIDS in developing countries, Reuters UK reports. The World Health Organization has "struggled to find a way" to encourage the development of effective and low-cost drugs for diseases that affect developing countries, according to Reuters UK. A WHO draft plan to address the issue was rejected two years ago by the pharmaceutical industry and low-income nations, and an intergovernmental group earlier this month could not agree on alternatives to the current patent system.

WHO spokesperson Bill Kean said that health ministers attending the May 19-24 WHA will work to resolve the issues that have hindered progress regarding intellectual property. Some development advocates also see the WHA as an opportunity to address drug access, including the World Trade Organization's Trade-Related Aspects of Intellectual Property Rights agreement. "It's now up to the World Health Assembly in May to translate bold ideas into concrete action," Medecins Sans Frontieres said in a statement, adding, "What we need to see is a wider, more ambitious framework" for research and development, and "political leadership, in particular from WHO."

Harvey Bale, director of the International Federation of Pharmaceutical Manufacturers and Associations, said that strong health infrastructures, efficient markets and proper regulations also are needed to ensure treatment access. "It is important to have a stable, enabling policy environment in each of these areas to ensure a sustained flow of new medicines for the benefit of patients worldwide," he said (MacInnis, Reuters UK, 5/14).

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Researchers Discover Another 'Viral Reservoir' For HIV Where Virus Remains Infectious
[May 16, 2008]

      Researchers at Brigham Young University and the Johns Hopkins School of Medicine have discovered a human cell "reservoir," called follicular dendritic cells, that allows HIV to stay in an infectious state and not respond to antiretroviral drugs, the Deseret Morning News reports. The research, which was funded by NIH and the American Foundation for AIDS Research, will be published in the June issue of the Journal of Virology.

According to the Morning News, researchers have long believed that there are reservoirs in the body that allow HIV to remain in an infectious state despite treatment. FDCs are the third reservoir to be identified. The other two reservoirs are macrophages and CD4+ T cells infected with a latent form of HIV. FDCs store material needed to maintain antibodies in the immune system and release proteins to trigger production of certain antibodies if they become low.

Greg Burton, professor of chemistry and biochemistry at BYU, and colleagues discovered FDCs by analyzing samples from HIV-positive people. The researchers discovered that FDCs, which are located in lymph nodes, trap HIV on their services. The trapped HIV does not show behavior -- such as replicating or mutating -- that is targeted by antiretrovirals and, therefore, is able to avoid the drugs, according to Burton.

The researchers found several forms of HIV on FDC surfaces, suggesting that the virus does not mutate but acquires new samples over time. The researchers established a time frame for each version of the virus and sequenced the individual HIV genomes from the FDCs to compare with samples from other cells. According to the study, HIV takes advantage of FDCs' ability to create new versions of the virus by staying active, avoiding treatment that could eradicate the virus and by infecting other cells.

Burton said that although FDCs can store the virus and reignite HIV infection, the cells potentially could provide scientists with the information necessary to develop treatments to target stored HIV versions on FDCs. "If we could go in and perhaps flush it from the surface of the cell, we might decrease dramatically the amount of virus that could perpetuate infection," Burton said.

The researchers added that it is possible that potential treatments derived from the research could be used to treat other conditions, such as allergy and autoimmune disease. The researchers are applying for an NIH grant to develop a way to attack HIV stored in FDCs, according to the Morning News (Collins, Deseret Morning News, 5/13).

An abstract of the study is available online.

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Effectiveness of Antiretroviral Therapy Causing 'Complacency' Among High-Risk Groups, Opinion Piece Says
[May 16, 2008]

      HIV/AIDS clinicians and scientists have been "witness to a transformation in disease management that is virtually unprecedented in the history of medicine," Mark Wainberg, director of McGill University's AIDS Centre at Jewish General Hospital, and Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS, write in a National Post opinion piece. According to the authors, antiretroviral drugs "now enable HIV-[positive] individuals to survive indefinitely with good quality life." However, an "unintended consequence" of the development of antiretrovirals has been to "convince thousands of members of vulnerable populations that an [HIV-positive] status may not be harmful," they add.

According to Wainberg and Montaner, numbers of AIDS-related deaths have "drastically dropped" since the introduction of the first successful antiretroviral regimens in the mid-1990s. Yet it "now appears as though these successes may be responsible for growing numbers" of new HIV cases among injection drug users, men who have sex with men and other vulnerable groups, they note.

The authors write that HIV/AIDS experts should "confront the reality" that achievements in antiretroviral therapy have led to "complacency in regard to high-risk sexual behavior that, in turn, has resulted in steep rises in numbers of new cases." They add, "Clearly, we have to do a much better job in regard to public health, if we are to have any chance at limiting the spread of HIV."

In addition, some "physicians now often proclaim that HIV disease has been converted into a chronic manageable condition and that the use of [antiretrovirals] to prolong life is akin to the use of insulin by diabetics or anti-hypertension medications by people at risk of coronary disease or stroke," according to the authors.

According to Wainberg and Montaner, one way to address this issue is to "make sure that vulnerable individuals understand" that antiretrovirals might not "work as well as we would like them to." Although the drugs are effective at blocking replication of the virus, there is "growing evidence" that HIV-positive people are more susceptible to a number of cancers and other conditions that are "rare in the general population," they write.

Wainberg and Montaner add that the "most likely explanation" for this evidence is that the virus causes "irreparable damage to the immune system, weakening natural surveillance systems that defend against cancer." They conclude, "Perhaps it is fear of cancer and not HIV itself that will encourage people at risk to desist from high-risk sexual behavior and lead over time to reductions in numbers of new cases of HIV transmission" (Wainberg/Montaner, National Post, 5/15).

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