Southwest China Opens More Methadone Clinics, Persons With HIV/AIDS Face Downside of Living Longer, Preventing AIDS Through Animation

Southwest China Opens Methadone Clinics in Border Areas to Prevent Spread of HIV
Yunnan Province opened 7 mobile methadone treatment clinics last year in rural areas along the drug-producing Golden Triangle (Xinhua News Agency. January 5, 2008). The area, which borders Laos, Burma, and Vietnam, has a high burden of heroin use. Methadone substitution treatment is intended to prevent drug users from injecting heroin and thus avoid HIV exposure through syringes.

The southwestern province intended to open 22 new clinics in 2007 but only managed to set up 14, said Zhang Ruimin, deputy director of the Yunnan Provincial Institute for Drug Abuse. That brought the province's total number of methadone clinics to 67, including 8 mobile clinics, Zhang said.

Most of the province's HIV-positive persons are drug users, according to Yunnan's AIDS prevention and control bureau.

"Methadone treatment is an effective way to prevent HIV from spreading among drug users," said Zhang. "However, those drug addicts in rural areas usually have a slim chance of receiving methadone treatment." China began offering methadone treatment in 2003 and has more than 500 methadone clinics, which treated 95,000 patients by the end of last year. [CDC HIV/Hepatitis/STD/TB Prevention News Update, Monday, January 7, 2008]

Persons With HIV/AIDS Face Downside of Living Longer
Several unexpected medical conditions among long-term HIV-infected patients are challenging the perception that the disease is manageable but chronic, according to patients, doctors, and scientists (Gross J. New York Times. January 6, 2008). To date, there have been only small, inconclusive studies on age-related health conditions and AIDS, partly because in the era before robust treatments were available patients with HIV/AIDS died quickly.

To many experts, some conditions seem to be both premature and disproportionate among long-term HIV-infected persons, including cardiovascular disease, high cholesterol levels, diabetes, certain cancers, osteoporosis, and depression. In 2006, an AIDS Community Research Initiative study involving 1000 long-term survivors from New York City found unusually high rates of depression and isolation. The Multicenter AIDS Cohort Study, which has monitored 2000 volunteers nationwide for the past 25 years, holds promise of a comprehensive look at medical, rather than psychological, issues among the HIV-infected population.

No study has yet explained HIV-infected patients' unusual incidence of osteoporosis, a disease that is otherwise rarely seen in middle-aged men. Many experts believe avascular necrosis-the death of cells due to inadequate blood supply-among these patients is caused by the corticosteroids used in treating them for pneumonia early in the disease course.

Cardiovascular disease, diabetes, and high cholesterol levels are associated with lipodystrophy, which redistributes fat in many patients with HIV/AIDS. Statins used to treat hypercholesterolemia have their own risk, especially for those with abnormal liver function, and many older HIV-infected patients have liver disease from injection drug use and alcohol abuse. In addition, the more medications a patient takes, the greater the "chance of something else going wrong," said Dr Sheree Starrett, the medical director of Manhattan's Rivington House, a residence for AIDS patients. [CDC HIV/Hepatitis/STD/TB Prevention News Update, Wednesday, January 9, 2008]

HIV Research Opens Up Potential Targets for Drugs
A study published January 10, 2008, identified at least 273 proteins the human cell produces that HIV requires to enter a host and replicate (McNeil DG Jr. New York Times. January 11, 2008).

In the study, geneticist Dr Stephen J. Elledge and colleagues at Harvard Medical School in Boston used tens of thousands of short interfering RNAs (siRNAs), each a bit of genetic code that blocks the creation of a protein made by a human cell. The team introduced HIV to about 21,000 samples of cells-each sample blocked from producing a protein.

If HIV could reproduce normally in a sample, the missing protein was not considered one the virus needed. Through this process, the researchers found there were 273 human proteins without which HIV would not reproduce normally; only 36 of the proteins had been previously identified as necessary to HIV. Many proteins identified by the study are known to be important to the immune system.

An advantage to a potential treatment targeting human proteins is that HIV presumably would be unable to develop immunity to them, said Elledge. But blocking human proteins could be fatal. Among HIV drugs, only the CCR5 entry inhibitor targets a human protein to block HIV from replicating.

"It remains to be seen if any of these proteins they identified are useful clinically," said Dr Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. "This is hypothesis-generating, not hypothesis-solving. It creates a lot of work-someone has to go down each of these pathways."

There are undoubtedly other proteins HIV needs in order to reproduce, "but the majority of the ones we found are highly likely to play a role in HIV propagation," said study coauthor Dr Abraham L. Brass.

The full report, "Identification of Host Proteins Required for HIV Infection Through a Functional Genomic Screen," was published online in Science Express (2008;doi:10.1126/science.1152725). [CDC HIV/Hepatitis/STD/ TB Prevention News Update, Friday, January 11, 2008]

Preventing AIDS Through Animation
A doctoral student worked with her advisors at Stanford University's School of Education and with overseas physicians to create an animated tutorial to teach young Asians about HIV/AIDS. Offered in different versions targeting youths in India and Asia, the program uses the occasion of a student's visit to the doctor to give the facts about the disease (Pennell A. Palo Alto Weekly [Calif]. January 1, 2008).

"This is a way you can teach about AIDS education without being so sexually explicit, so it fits an abstinence-only curriculum," said Piya Sorcar, who began working on the project in the summer of 2006. On a visit to India, she found that students were exposed to many prevention messages, but the facts were not getting through. For instance, having learned that fluids can transmit HIV, "students were scared of all fluids. So they were scared of water, and they were scared of saliva," Sorcar said.

Sorcar examined the latest research on how people learn to change their behavior. Acting on a suggestion by a Korean businessperson, she sought support from the South Korean Ministry of Science and Technology, which put her in touch with local doctors and animators.

The curriculum is now part of Sorcar's doctoral work, and she continues to refine it with input from focus groups. More than 90% of 423 Indian students who viewed it said they learned more from it than from AIDS instruction in school or on television.

Visit www.interactiveteachingaids.org. to view the materials [CDC HIV/Hepatitis/STD/TB Prevention News Update, Thursday, January 3, 2008]