Faculty Bibliography

Scientists have recently found that the strain of the avian influenza virus, known as A(H5N1), seems firmly rooted among domesticated ducks and wildlife and so cannot be wiped out by culling, quarantines and other standard measures alone, [Joseph Domenech] said. The vaccines are made by killing the A(H5N1) virus. Like most other vaccines, the avian flu vaccines are not 100 percent effective. They protect against symptoms. But a small percentage of healthy vaccinated animals exposed to the virus can still become silently infected and excrete the virus, although in smaller amounts than sick birds. Scientists believe that the benefits of vaccinating outweigh its risks because the amount of virus that the recipient animal excretes. So the measure 'decreases tremendously' the amount of virus that can circulate on farms and elsewhere, Domenech said. But he and other scientists urged health officials to monitor for evidence of potential harm to people. In making such analyses, he said, scientists 'must compare vaccinating to doing nothing.' There are two marketed vaccines, and Chinese and Indonesian scientists have developed others. Indonesia has vaccinated 21 million birds, initially using a Chinese vaccine derived from virus isolated in Indonesia, said Dr. Anak Agung Gde Putra, director of regional veterinary laboratories in Bali. Then Indonesia switched to a vaccine made in Indonesia, Agung said. The government is providing the vaccine free to small commercial poultry companies and to subsistence farmers with backyard chickens

Scientists have recently found that the strain of the avian influenza virus, known as A(H5N1), seems firmly rooted among domesticated ducks and wildlife and so cannot be wiped out by culling, quarantines and other standard measures alone, Dr. [Joseph Domenech] said. He spoke at a meeting attended by health officials from 10 Asian countries that the F.A.O. convened in part to deal with a resurgence of avian influenza in China, Thailand and Vietnam this month and the virus's continuing spread in Indonesia. At the same time, many influenza experts and public health officials fear a scenario in which an individual becomes infected with both the A(H5N1) avian virus and a human influenza virus. Under such circumstances, the viruses could swap genes to create a new virus to cause a global epidemic that would be difficult to control. The vaccines, however, are not magic bullets. Each dose costs about five cents, and each bird may need up to three doses. Because the vaccines must be injected, the major cost is from administering them. Participants stressed the urgent need for a vaccine that birds and animals can swallow. The vaccines are made by killing the A(H5N1) virus. Like most other vaccines, the A(H5N1) vaccines are not 100 percent effective

The Bangkok AIDS conference, the largest so far, drew more than 17,000 delegates. Science took a back seat to the concurrent sessions on social, economic, legal, policy-making and other aspects of AIDS. In a jocular yet serious AIDS prevention effort on the eve of the conference, [Peter Piot] went to a Bangkok tollbooth to hand to drivers the condoms that are the main weapon in controlling the spread of HIV. The tollbooth scene was a variant on a Thai police program, known as cops and rubbers. 'No one was embarrassed, and some asked for more condoms,' Piot told me of the experience that he shared with Mechai Viravaidya, a Thai senator whose efforts to promote condom use helped prevent millions of Thais from getting infected over the past decade. The transformation of the AIDS conferences from austere scientific meetings to mammoth jamborees results from two main factors. One is that AIDS has become one of the worst epidemics in history, killing more than 20 million people, mostly in Africa. Second, the themes of the meetings and the thrust of the demonstrations have evolved from a failure to cure the disease to a failure to deliver the treatments now available

The Bangkok AIDS conference, the largest so far, drew more than 17,000 delegates. Science took a back seat to the concurrent sessions on social, economic, legal, policy-making and other aspects of AIDS. At the time of the Atlanta conference the AIDS virus had yet to be named HIV. There were no effective antiretroviral drugs. Leading AIDS scientists and top government officials had promised that a vaccine was months away. It has yet to come. The United States contributes more money for AIDS than any other country. Yet participants in Bangkok harshly criticized the Bush administration for doing too little, emphasizing a policy of abstinence, and severely restricting the number of government scientists allowed to attend the conference. Two U.S. agencies, the Centers for Disease Control and Prevention and the National Institutes of Health, have been strong forces in earlier conferences. Yet the Bush administration did not allow some scientists from these agencies to travel to Bangkok to discuss their papers that had been accepted for presentation

Three elephants depicted on the conference logo became an unintentional symbol of the boisterous political circuses that AIDS conferences have become. The conference's circus atmosphere even affected top public health leaders like Dr. Peter Piot, who directs the United Nations AIDS program. The transformation of the AIDS conferences from austere scientific meetings to mammoth jamborees is due to two main factors. One is that AIDS has become one of the worst epidemics in history, killing more than 20 million people so far, mostly in Africa. Second, conferences are now less focused on a failure to find a cure for the disease and more on the failure to deliver the many treatments now available. At the time of the Atlanta conference the AIDS virus had yet to be named H.I.V. There were no effective anti-retroviral drugs. Some doctors were shunning AIDS patients. Hospital workers left meals at their doors. Many others feared they might become infected from casual contact despite epidemiological evidence to the contrary. Fewer than 10,000 cases were reported in the United States, mostly among gay men, injecting drug users and hemophiliacs. But the case count was doubling every six months

[Mechai Viravaidya] is Thailand's most prominent AIDS educator, having received international recognition in the 1990s for promoting Thailand's condom effort, which was credited with saving millions of lives. The program aims to strengthen bonds between infected and uninfected people. As the uninfected realize that those with HIV have repaid their loans and made new ones possible, attitudes about discrimination become more enlightened and the stigma of AIDS is lessened, Mechai said. Now that countries are spending about $6 billion a year on treatment and prevention, and drug companies have lowered the costs of antiretroviral drugs, [Peter Piot] said, 'it is our collective responsibility to make the money work for people.' Conference leaders and AIDS activists also said that protests at earlier conferences had helped move a number of unpopular issues like homosexuality, needle use and prostitution into the mainstream. In Asia, where an estimated 7.2 million people are infected with HIV, the epidemic is being fueled by members of two marginalized groups, participants said: drug users and prostitutes

The loans average about $300 each and are short-term, from 6 to 12 months. To qualify, applicants with H.I.V. must become business partners with an uninfected person, said the organizer, Mechai Viravaidya. Mr. Mechai, who is Thailand's most prominent AIDS educator, having received international recognition in the 1990's for promoting Thailand's condom effort that is credited with saving millions of lives. The program aims to strengthen bonds between infected and uninfected people. As uninfected people realize that H.I.V.-infected people paid back their loans and made new ones possible, attitudes become more enlightened, Mr. Mechai said. He said that about 1,000 business partners had received loans since the program began two and a half years ago

The former president of South Africa was found to have tuberculosis while in prison, where he spent 27 years for opposing the former apartheid regime before his release in 1994. 'We cannot win the battle against AIDS if we do not also fight TB,' [Nelson Mandela] said at a news conference Thursday. 'TB is too often a death sentence for people with AIDS.' Mandela has acknowledged that as president, he did not recognize the severity of the AIDS epidemic in South Africa, which now leads the world with 5.3 million people infected with HIV, the virus that causes the disease. Since Mandela left office, he has embraced the fight and has pushed his successor, Thabo Mbeki, to confront HIV and tuberculosis. After doctors told Mandela that it would take four months to cure his tuberculosis, he told his friends in prison about the diagnosis. He said: 'My friends objected to me sharing my personal affairs. But I consoled them and told them that the doctors and hospital staff knew about my status and I therefore had no reason to hide this information from those close to me.' Mandela said he took the same steps of disclosing his more recent case of prostate cancer. 'I knew that once people were aware of the effects, they would support me,' Mandela said. Mandela said it was a blessing that 'the world has made defeating AIDS a top priority.' But an additional fight against tuberculosis is required, he said

Since he left office, he has embraced the fight and has pushed his successor, Thabo Mbeki, to confront H.I.V. and tuberculosis. In some regions, tuberculosis causes as many as half the deaths among H.I.V.-infected people, making it the most fatal illness among people with AIDS, according to the World Health Organization. Mr. [Nelson Mandela] said he spoke about his case of tuberculosis because he felt that the disease was ignored and to help the Bill and Melinda Gates Foundation open a $44.7 million program for research into the control of tuberculosis in communities where there are many cases of H.I.V. He said that prison doctors diagnosed his case of tuberculosis and determined it would take four months to cure. Tuberculosis was prevalent even before the AIDS epidemic began to take hold in 1981. But now more people are dying from tuberculosis than ever, according to United Nations figures. Of the estimated 1.6 million deaths that tuberculosis causes each year, one-fourth occur among H.I.V.-infected people. Worldwide, as many as 50 percent of H.I.V.-infected people develop tuberculosis

Of the 12,058 adults that Medecins sans Frontieres has treated with antiretroviral drugs in 21 countries in Africa, Central America and Asia since 2002, 6,861 received fixed-dose combinations. Since March, 80 percent of the group's new AIDS patients have received fixed-dose combinations. Among the fixed-dose combination recipients, the probability of survival after one year was calculated as 82.4 percent, [Alexandra Calmy] reported. About 60 percent of the deaths occurred within the first three months after therapy began. The deaths occurred largely among patients so ill that the antiretroviral therapy began too late to protect them from the infections that often kill patients as a complication of AIDS. Among the 6,861 fixed-dose combination recipients, there was a significant rise in the number of immune cells, known as CD-4 cells, that are destroyed by the AIDS virus. The CD-4 count rose by an average of 137 cells within in a year, in about half the patients. Because of logistical reasons in treating patients in slums and rural areas in countries like Malawi with bad roads and poor transportation, Medecins sans Frontieres does not routinely monitor each patient with the tests that measure the amount of virus in the blood. Doctors in developed countries routinely use such tests, known as viral loads, to determine the effectiveness of therapy