CLINTON SIGNS AIDS Funding Bill INTO LAW
President Clinton signed into law the Global AIDS and Tuberculosis Relief Act of 2000 in late August, launching what the White House calls the "latest U.S. effort in the long-term fight against HIV/AIDS and its related threat of tuberculosis." For the Administration's fiscal year 2001, which began October 1, the bill authorizes funding international HIV/AIDS initiatives; new funding for the Global Alliance for Vaccines and Immunization and the International AIDS Vaccine Initiative; and the creation of a World Bank AIDS Trust Fund.

For fiscal year 2001 the bill authorizes:

• $300 million for USAID development assistance programs, including primary prevention and education, voluntary testing and counseling, prevention of mother-to-child transmission, and care for those living with HIV or AIDS;
• $50 million for GAVI and $10 million for IAVI to accelerate the development and delivery of vaccines; and
• $60 million for international TB control.

Clinton is also asking Congress for an increase of $100 million—to $342 million—for international AIDS prevention and care in fiscal year 2001. Funds will be targeted to the countries where the disease is most widespread, particularly in sub-Saharan Africa. Priorities include stepped-up primary AIDS-prevention efforts; care and treatment for those infected; care for children orphaned by AIDS; and strengthening the public health infrastructure that can prevent and control the disease.

In his State of the Union Address earlier this year, Clinton announced the Millennium Vaccine Initiative, which would accelerate the development of malaria, TB, and AIDS vaccines—vaccines for which there is an enormous need, the White House says, but little market incentive for industry to develop.

The initiative calls for:

• $50 million in the president's 2001 budget as a contribution to the vaccine purchase fund of the Global Alliance for Vaccines and Immunization;
• "presidential leadership" to ensure that the World Bank and other multilateral development banks dedicate an additional $400 million to $900 million annually of their low-interest-rate loans to health care services;
• significant increases in basic research on diseases that affect developing nations;
• a $1 billion tax credit for sales of vaccines for malaria, TB, and AIDS to accelerate their development and production.

Global
      HIV
 INFECTIONS
   SURPASS
      34 MILLION

The Joint United Nations Programme on AIDS's "Report on the Global HIV-AIDS Epidemic," released in June, estimates the world population living with HIV (as of December 1999).

Survival Rates
AFTER PNEUMOCYSTIS PNEUMONIA
IMPROVE FOR AIDS PATIENTS
HIV-infected patients with Pneumocystis carinii pneumonia—the most common opportunistic infection among individuals with AIDS—are almost twice as likely to survive severe respiratory failure if given mechanical ventilation therapy than they were five to seven years ago, researchers report. The finding means that doctors need to take such improvements in outcomes into account when making decisions on beginning or withdrawing ventilation in these patients, the authors write in the American Journal of Respiratory and Critical Care Medicine. "I think that for families and patients who are facing the decision as to whether to go on the ventilator, the data would suggest that the survival is better than we thought it was," says study lead author J. Randall Curtis, associate professor of medicine at the University of Washington in Seattle.

Curtis and colleagues conducted a random analysis of the hospital records of 1,660 HIV-positive patients over the age of 18 who received care for pneumocystis pneumonia between January 1995 and December 1997 in more than 70 hospitals located in New York, Los Angeles, Miami, Chicago, Seattle, Tennessee, and Arizona. The investigators found that 14% of the patients were admitted to an intensive care unit during their hospital stay and that 9% received mechanical ventilation for respiratory failure. The research team notes that of those patients receiving ventilation for less than two weeks, almost 40% survived and were ultimately discharged from the hospital—compared with the lower estimated survival rate of approximately 20% between 1992 and 1995. They also found that while survival rates dropped to 17% if the treatment lasted beyond a two-week period, this figure is again higher than previous studies indicated.

Clinton Appoints
Sandra Thurman as
Presidential AIDS Envoy
President Clinton has named Sandra Thurman, director of the White House Office of National AIDS Policy, as the presidential envoy for AIDS cooperation. The position was created to coordinate U.S. efforts on AIDS as a worldwide health issue. The position has gone unfilled for months because of infighting among various White House agencies over whose aegis the position should fall under. In appointing Thurman, Clinton said that she "will use America's growing efforts [against AIDS] as leverage to encourage other countries to expand financial commitments, to step up prevention efforts, and to increase access to care and treatment worldwide."

ECSTASY
MAY CAUSE
Depression
A study out of Toronto seems to confirm what many have guessed about the party drug ecstasy: Use of the illegal drug depletes serotonin levels in the brain, The Toronto Sun reports. Serotonin is an important neurotransmitter that is linked to mood, appetite, sleep, and emotions. Low levels of it have been linked to depression. As part of their study, which was published in the scientific journal of the American Academy of Neurology, researchers performed an autopsy on a 26-year-old man who died of a drug overdose. The results showed a 50% to 80% reduction in his serotonin. There is enough evidence to suggest that considerable caution should be exercised with the drug. "It's not as benign as we thought," says researcher Tonia Seli.

The subject of the autopsy had used ecstasy for nine years and in the last month of his life had started using cocaine and heroin as well. Starting at age 17 he had used ecstasy once a month. Then by his mid 20s he started taking the drug several nights a week.

Gonorrhea Rates Are Rising
A 50-state survey conducted by the Centers for Disease Control and Prevention has found that gonorrhea rates climbed 9% in 1998 after a 12-year decline. "There do seem to be some real increases in the overall number of gonorrhea cases due to unsafe sexual behavior," says Debra Mosure, an epidemiologist at the CDC. The number of cases grew from 121.8 per 100,000 in 1997 to 132.9 per 100,000 in 1998. The number of cases had declined 64% from 1985 to 1997. The Midwest showed the highest rate of increase. Rates among gay and bisexual men were generally reported to be rising in most states, including two states—Alaska and New Hampshire—that reported an overall decline in gonorrhea cases. Health officials say the information is worrisome, since gonorrhea infection can increase the likelihood of HIV transmission between sexual partners.

CONGRESSMEN ASK FOR GOVERNMENT PROBE INTO
Condoms COATED WITH NONOXYNOL-9
Two Republicans in the House sent a letter to David Walker, the comptroller general of the General Accounting Office, in late August to determine the number of condoms containing nonoxynol-9 purchased either directly or indirectly by the federal government through grants given to various agencies and then to calculate the number of new HIV infections that may have been caused through such distribution.

"While scientific data released last month in Durban, South Africa, concluded that nonoxynol-9 enhances the risk of HIV transmission, this is not new information," wrote Rep. Tom Coburn and Rep. Joseph Pitts. "A 1989 study showed that the probability of infection occurring was greater among those who used nonoxynol-9 than those in a placebo group who did not. Subsequent to the 1989 publication there have consistently been studies showing this same adverse consequence. According to the most recent study, investigators found that 15% of women using condoms with nonoxynol-9 had become HIV-infected."

The congressmen noted that they were "gravely concerned" that the U.S. government "may have been involved in promoting an unsafe practice," specifically the funding, distribution, and promotion of condoms with nonoxynol-9 in the United States and elsewhere. "If the U.S. government made thousands, or tens of thousands, of men and women more susceptible to acquiring this disease," they wrote to Walker, "then we have done a huge disservice to people throughout the world."

Insect Bite MAY HELP IN AIDS TREATMENT
A Southeast Asian insect is being examined by researchers as a possible key to treating AIDS, The Times of London reports. The bite of the insect larva known as a chigger causes scrub typhus, which leads to a dramatic drop in HIV levels in the blood. "As far as we are concerned, this is an important and real observation that could lead to the development of either an AIDS treatment or a vaccine," says Sanjeev Krishna, a senior research fellow in infectious diseases at St. George's Hospital in south London. "Subsequent results have made us more confident."

According to a study in the journal Lancet that followed ten patients admitted to hospitals with scrub typhus, two of the patients had undetectable levels of the virus in their blood two weeks after admission. A month after admission, the patients' viral loads had risen but were still lower than before they contracted scrub typhus. The viral loads of all ten patients were significantly lower than those of a control group of five AIDS patients who did not have scrub typhus. "No infectious agent had been shown to reduce HIV-1 viremia in patients with AIDS," says George Watt, MD, who made the discovery. "These findings may lead to novel strategies against AIDS at a time when no vaccine is in sight."

FOUR-DRUG ANTIRETROVIRAL REGIMEN
SHOWS BETTER RESULTS
Early results of a pediatric AIDS clinical trials group led by Dr. Andrew Wiznia of the Jacobi Medical Center in New York suggest that regimens of four-drug highly active antiretroviral therapy may work better than the typical combinations of three drugs. Wiznia examined 181 antiretroviral-experienced children, according to a report in the journal AIDS Research and Human Retroviruses, and each was given one of four regimens containing stavudine plus two or three other drugs. The 24-week results of the study show that fewer children maintained virological suppression than expected, with only 51% attaining undetectable HIV RNA copy numbers and 58% achieving HIV RNA suppression. After 24 weeks more patients receiving four drugs had undetectable HIV RNA than patients on the other regimens, suggesting that an aggressive therapy could suppress the virus more quickly during the induction phase.