Netherlands revises HIV coordination efforts

Netherlands revises HIV coordination efforts

FDA advised to license three anti-HIV agents WHO calls for control of Netherlands revises HIV coordination efforts aircraft pests The Dutch Nation...

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FDA advised to license three anti-HIV agents

WHO calls for control of

Netherlands revises HIV coordination efforts

aircraft pests

The Dutch National Committee against AIDS (NCAB), which was set up in 1987 for 4 years and then had its term extended for another 4 years, is to be disbanded. Some of its functions will be distributed . among other bureaus, such as those concerned with alcohol and drugs, migrants, and health education, but most will be taken on by the AIDS Fund, which distributes subsidies to various organisations. : In its final report, the NCAB notes that the number of AIDS patients registered in the Netherlands has been much lower than expected. By mid-1995, 3609 had been registered, 1340 of whom were still alive. HIV-infections are not notifiable in the Netherlands, but from the number of AIDS cases, NCAB estimates that there were 6000 HIV-infected persons (without AIDS) alive in mid-1995. 500 new HIV

The US Food and Drug Administracalling on health and airport: authorities, airlines, and general practition’s antiviral advisory committee last tioners to renew vigilance on transmission week recommended fast-track licensing to of disease through insects and rodents carInvirase (saquinavir, Hoffman-LaRoche). WHO is

ried in aircraft. The call was issued after 5 days of meetings by 35 experts on disinfection of aircraft. Disinfection is mandatory in over half of all countries handling . international flights. Over the past 15 years, some 64 cases of malaria, two fatal, have been diagnosed in western Europe among persons who had never left the country but who were working either at airports or within a radius of about 8 km. Initial diagnoses in some were infections such as instances influenza. Current cases of dengue in New York are being investigated. Japanese encephalitis is also suspected of having’; been transmitted in similar manner. The experts regarded as equally efficainfections are expected a year, compared cious the three spraying procedures in with 750-1000 for the 1980s. Thus one NCAB recommendation is that the num- general use-"blocks away" (doors shut, ber of specialist AIDS hospitals planned aircraft taxiing), "top of descent" (as pilot (11) can be reduced, as can the number of starts descent), and during maintenance. specialist nursing homes (29). NCAB has Updated recommendations to be pubalso recommended that: : lished shortly will, as hitherto, not be . a fund for uninsured HIV-infected legally binding. The result is that somepeople be set up to reimburse them for times an aircraft goes from a necessary drugs; : where spraying is forbidden to a destina. the new-drugs approval process be tion where it is compulsory. : accelerated for anti-HIV agents; "We must encourage measures to pre: . the government guarantees the quality vent mosquitoes breeding in and around of the AIDS and HIV surveillance airports", said Dr Radovan Plestina, of the WHO Poisonings Prevention and Treatprogramme started in 1994; . the government steps up its monitoring ment Unit. Many flights from the tropics, of how the confidentiality of HIV test . he pointed out, were timed to leave results is kept; : between dusk and midnight, the hours of "buddy-care" . the be . when mosquitoes were most active. : system : Although there was certainly the possisupported nationwide; . financial support for nurse AIDS bility of plague being spread by rats or consultants in hospitals be increased; mice with infected fleas on them, he • public information campaigns be con- : regarded rodents in aircraft, not that rare, the NCAB admits that tinued, although . as representing a greater danger by eating there is no scientific evidence that preveninsulation and disconnecting control tion helped in lowering AIDS prevalence. cables from the cockoit.:

Myers Squibb) superior to zidovudine, it recommended traditional FDA approval for this nucleoside analogue previously given accelerated approval for use as treatment of patients who had not responded to or are intolerant to zidovudine. If marketed, Zerit would be indicated for treatment of HIV in zidovudine-experienced patients with a notation that it is equivalent but not necessarily superior to zidovudine. In a third action, the committee recommended accelerated approval for Glaxo Wellcome’s Epivir (lamivudine, 3TC), also a nucleoside, for use in combination with zidovudine for the treatment of adults and children with HIV infection. The approval for saquinavir is in combination with zidovudine or zalcitabine (ddC). In the saquinavir plus zidovudine group, the most beneficial results were seen in zidovudine-naive patients, but in the saquinavir-plus-zalcitabine group the AZT-experienced patients showed the best results. However, Dr Fred Valentine, the panel chairman, and other members said they expect that the "small magnitude" of the increase in CD4 cells and the reduction in viral load make it unlikely that the clinical effects will be as great as hoped for. Committee members also had reservations about the saquinavir’s poor bioavailability and the possibility that patients could develop resistance to it and to future protease inhibitors. Unlike nucleosides, which attack the virus early in the replication cycle, protease inhibitors attack later stages.

Marjanke Spanjer

Harry Nelson






It is the first of six protease inhibitors now undergoing human trials to reach committee review. Although the committee did not find Zerit (stavudine, d4t, Bristol-

The difference seems to be extremely News in Brief minor-of the several hundred aminoacid Canada’s costly blood inquiry Mere building blocks making up the acetyl"tinkering" with Canada’s blood system choline receptor, only a few attach to won’t prevent another blood contaminaKipling’s Jungle Book teaches children that certain toxins in snake venom, and mona mongoose’s "business in life was to fight tion tragedy because the system is gooses and snakes differ from venomunworkable and lacks accountability, conand eat snakes". Now we are told why a animals in four of these. susceptible only can do Natl Acad Sci cluded a Can$353 000 study commisso mongoose (Proc Only two of these four are crucial for the USA 1995; 92: 10801-805). sioned by the Krever inquiry into the attachment, while the other two regulate In mongooses, the structure of the the degree of the binding. Yet even this safety of Canada’s blood. The report proacetylcholine receptor differs from that of slight difference in molecular structure is posed options for radical reform. Meanother animals and of human beings. As a sufficient for disrupting the venom attachwhile, Justice Horace Krever has asked for result, snake venom simply bounces off ment, protecting Kipling’s Rikki-tikki-tavi a second extension on the deadline for the muscle cells of these small mammals, and other mongooses from the snakes’ completion of his inquiry that would push the bill for the commision to$14-3causing them no harm. The same strucbites. deadly tural difference in the receptor is found in million, or nearly five times the original allocation, and extend the Dec 31 reportsnakes, making them immune to various snake venoms.:Rachelle H B Fishman ing deadline to Sept.30, 1996.

Molecular answer to Jungle Book question