Six diseases are the targets of the vaccine development program in India. The project involves 12 national research institutions and two private companies, Indian Immunologicals and Bharat Biotech, which are both based in Hyderabad, India. Targets of the program are AIDS, cholera, Japanese encephalitis, malaria, rabies, and tuberculosis. In a report in the journal Nature Medicine, K. S. Jayaraman notes that a single agency--the Department of Biotechnology (DBT)--will oversee the project. According to Jayaraman, DBT secretary Manju Sharma predicts the deployment of cholera and rabies vaccines by the year 2002. An oral recombinant cholera vaccine recently proved safe in Phase I trials at the Institute of Microbial Technology, Chandigart, and a promising DNA vaccine for rabies is in late preclinical development at the Indian Institute of Science, Bangalore. The AIDS vaccine initiative, underway at the All India Institute of Medical Sciences, New Delhi, will use a poxvirus construct expressing HIV-I subtype C, the strain most prevalent on the Indian subcontinent. N. K. Vinayak, head of the DBT medical division, told Jayaraman that the HIV vaccine would be ready for animal studies in a year. Funding for the program seems small by Western standards: $4 million over 3 years.
This article presents the resource-poor women facing a difficult dilemma of making choices regarding breast-feeding. Findings showed that there were 1600 perinatal HIV infections in resource-poor settings such as sub-Saharan Africa. Even prior to zidovudine interventions, a doubling HIV infection risk was found in both HIV-exposed and breast-fed infants, particularly in the first 5 months after birth. Because of these findings, the WHO recommends voluntary HIV testing and counseling for all pregnant women. A study documents that a neonate with nevirapine treatment was found to reduce transmission to about 50%. Further research is needed on infectious unit in breast milk, role of host immunity and genetics, identification of protective factors in breast milk and factors affecting HIV viral load, breast conditions and breast milk substitutes.
The US Centers for Disease Control and Prevention (CDC) recently reported an outbreak of HIV infection among a group of young women in rural Chautauqua county, New York, who apparently contracted HIV from a single, highly infectious man. Although the index case refused to donate blood for analysis, 13 of the 47 women who had sex with the man became infected. The 10 primary contacts who provided blood samples for analysis were infected with highly similar viruses. The 13 women who apparently acquired HIV from the index case had sex with 84 secondary contacts. The resulting AIDS scare led to the counseling and HIV testing of approximately 1400 people in the county, which led to the identification of other HIV-infected individuals unrelated to the index case. The 31% rate of infection transmitted by the index case suggests that HIV can be spread rapidly by only a few individuals. It used to be thought that a person is most likely to transmit HIV either during acute infection, before the immune system has fully responded to the virus, or late in infection when the immune system has been destroyed. Neither sexually transmitted diseases nor IV drug use was associated with HIV transmission in this cluster of cases.
In a double-blind, crossover study to determine how men decide if they like a specific type or brand of condom, 194 men rated 3765 condoms as 61% favorable, 31% neutral, and 8% unfavorable. The men found less favor with condoms that were too loose, too tight, too short, or too hard to apply. Unfavorable ratings were also given if the condom slipped or broke. In general, men with larger penises rated condoms less favorably. Condoms that seemed to be well-lubricated throughout use found more favor. The study concluded that resistance to adoption of consistent condom use could be reduced through better condom design and manufacture.
In Uganda, 33% of hospital admissions are HIV related, 10.2-21.8% of women presenting for antenatal care are infected with HIV, and AIDS accounts for more than half of excess adult mortality. The need for a vaccine against HIV is nowhere more evident than in Uganda and attitude surveys among potential HIV vaccine trial cohorts indicate that at least 75% of potential subjects would participate. The country has been preparing for vaccine efficacy trials for the past several years. The Minister of Health for Uganda stated during a plenary address to the Eighth Annual Meeting of the National Cooperative Vaccine Development Groups for AIDS held February 11-15, 1996, in Bethesda, Maryland, that Uganda is ready to provide subjects for HIV vaccine trials in return for health care services. More precisely, in exchange for the right to test HIV vaccines in communities, vaccine development firms would be expected to provide health care, drugs, counseling, and condoms. The minister further stated Uganda's intention to be involved in the planning, assessment, and implementation of clinical trials. Such trials must be sensitive to cultural and social norms. Moreover, any vaccines resulting from research in Uganda must be made available to its citizens.
