-----====[[[[ A I D S w i r e D I G E S T 01.04.93 ]]]]====----- Ethics of Giving AIDS Advice Troubles Catholic Hospitals * New York Times (01.03.93), P. 1 Navarro, Mireya Catholic hospitals are having trouble dealing with AIDS education because they oppose most of what public officials suggest as the best means to avoid infection, such as condom use and the cleaning of dirty IV-needles. St. Vincent's Hospital in New York City abruptly canceled its events planned to observe World AIDS Day early last month. Hospital administrators objected to most of the educational material to be distributed in the lobby, claiming it encouraged the use of condoms and referred to behaviors that "were not in keeping with the teachings of the Catholic Church." The hospital's AIDS workers were confused about the administration's decision because the same brochures and pamphlets had been allowed in previous years. In cities like New York, which leads the nation in reported AIDS cases, Catholic institutions, with heavy financial support from the government, have been major providers of care to AIDS patients. But due to moral obligations, the church has resisted teaching prevention messages widely recommended by public health officials. According to church officials, the only morally correct way to prevent HIV infection is by avoiding drugs and by practicing fidelity within marriage and abstinence outside it. But public health officials say they find themselves somewhat uncertain over how far to push the hospitals to provide HIV prevention information. Catholic institutions were among the first to exhibit compassion for AIDS patients, and provide 36 percent of nursing-home care for AIDS patients in New York. More AIDS Patients Resistant to AZT * Washington Post (01.01.93), P. A9 Increasing numbers of AIDS patients are exhibiting early resistance to AZT, and scientists claim there is an imminent need to develop new treatments to fight HIV infection. Wendell T.W. Ching of the UCLA School of Medicine conducted a blood test study which appears in Friday's edition of the Proceedings of the National Academy of Sciences. He said blood tests are indicating more numbers of AIDS patients who have never taken AZT but are infected with a virus that is naturally resistant to the drug. "Some of the patients may have gotten the virus from other patients who had been taking AZT and who are now transmitting the resistant virus," said Ching. He added that earlier studies concluded that AZT resistance was a result of long- term use of the drug. But the new study shows that resistance may transpire naturally, even in patients who have never taken AZT, and that the resistant virus can spread from a patient who has taken the drug to another who had been disease-free. Ching said that the increase in the AZT- resistant virus may not have been found earlier due to the way blood tests were conducted. He said that researchers typically draw blood from HIV- positive people and then culture the sample until the population of the virus has increased. While this occurs, there is a change in the relative numbers of different strains of the HIV, which appears to hide the dominance of AZT-resistant strains. Ching and his colleagues corrected the problem by drawing blood from patients and testing for different strains of HIV before the virus had a chance to grow new generations. Technique May Fight Disease by Reversing Instructions to Cells * Washington Post (01.04.93), P. A3 Rensberger, Boyce A type of genetic engineering is being performed by scientists who are seeking a cure for AIDS and other maladies. The technique is called "antisense" technology because it tells cells to do the opposite of what one of their genes is instructing them to do. For example, genetic instruction could be a message coming from a strain of HIV that has fooled a blood cell into making new HIV strains. The antisense technique makes it possible to send another message that cancels the gene's instruction before the cell can act on it. The process has been shown to inhibit the proliferation of viruses in cultured cells infected with HIV, herpes, and cervical cancer. The antisense technology inhibits the essential middle step in the series of events by which genes control cells. Each gene holds coded instructions telling the cell how to assemble raw materials to make a protein molecule. The genetic instruction is transcribed into a temporary replica called messenger RNA. This molecule delivers the code to one of the cell's protein factories--a ribosome--outside the nucleus. This apparatus reads the messenger RNA's code and assembles the given protein. The antisense technique is intended to kill the messenger RNA before it can be read by a ribosome. This is accomplished by putting into the cell a synthetic form of DNA that will bind to the targeted RNA molecules but not to other messenger RNA segments carrying different instructions needed by the cell. The synthetic DNA binds because it carries a genetic message, which is virtually a mirror image of the RNA's message. AIDS Concern and Threat Grow in China, Says Magazine * United Press International (01.04.93) (Beijing) Fear of AIDS is becoming prevalent in China, but government efforts are neglecting to educate the country about the disease, according to the government English-language weekly magazine Beijing Review. The known numbers of AIDS cases in China are relatively small. Last month, health officials reported that 969 Chinese were infected with HIV. Overall, 12 people have AIDS--nine of whom have died. However, health experts are concerned that there are many more unidentified cases of HIV infection because of China's strict legal and social attitudes toward people with high-risk behavior. The magazine quoted Wan Yanhai, head of the Beijing hotline team sponsored by the Chinese Institute of Health Education, who cautioned that "current efforts to educate the public are far from adequate and place too much emphasis on morality." The magazine said large hospitals are often overwhelmed with questions from the public about whether mosquitoes can spread HIV or whether a person can be infected through casual contact. The magazine said, "Such widespread lack of knowledge exactly constitutes a hidden danger for the spread of the disease." Wan requested the expansion of AIDS hotlines to other cities, the education of high-risk groups, and more contacts with foreign health experts. The Beijing Review said that "the rate of infection could explode among high- risk groups if preventive measures are not taken." Medicaid Costs Major Concern for State Government * United Press International (01.02.93) (Indianapolis) The Clinton administration and Indiana lawmakers are expected to give health care reform more attention. A commission appointed by Indiana Governor Evan Bayh completed three years of study in November and issued a 700-page strategy for state health care reform. The 1993 General Assembly in Indiana is expected to require hospitals to offer voluntary HIV testing to all patients, and create a new health care program for low-income people who aren't eligible for Medicaid. Expanded AIDS Definition Called 'Lifeline' for Thousands * United Press International (12/31/92) New York--The new federal AIDS surveillance definition was enacted on Friday, and one family health agency called the change "a lifeline" for thousands of HIV-positive Americans. Jane Johnson, vice president of the Planned Parenthood Federation of America, said, "The broader definition for AIDS focuses attention on the importance of testing for HIV and increases the probability that more women, particularly poor women, with HIV will more promptly be diagnosed and treated." The new definition will help qualify a person considered to have AIDS for vital public entitlement programs and will result in health care providers providing better care for such patients. Acyclovir Annual Price Cap for Some Patients, $2,500; Registration Required * AIDS Treatment News (12/18/92) No. 165, P. 3 James, John S. Burroughs Wellcome Co. announced Dec. 7 that it will cap the price of acyclovir (Zovirax) for AIDS patients who pay for the drug themselves. Those people who use more than 730 grams (which costs about $2,500 wholesale) in a single calendar year will receive up to 730 grams additional at no cost for the remainder of the year. The new program begins January 1. Therefore, those who are using a continuous high-dose acyclovir and paying for their own medication should immediately register, through their physician or other health- care provider, so that their acyclovir use can be monitored and credited toward the cap. However, the program is only for patients who do not have third-party coverage for their acyclovir use. The cost of using acyclovir regularly at high doses can be $5,000 per year or more, creating financial difficulties or making the drug unavailable to patients for whom it was prescribed. AIDS activists from several organizations had negotiated with Burroughs Wellcome for ten months seeking a reduction in price. However, the company agreed to a price cap, said Dr. Andrew Zysman of ACT- UP/Golden Gate. Dr. Zysman said, "The cap, while a start, does not go far enough. A workable solution would be an annual cap of $2,000 per patient, which would continue to generate great profits, while making acyclovir more accessible." He added that many physicians in public health settings "are unable to suggest the use of acyclovir because it would bankrupt their clinic's budget; hence patients will not be able to benefit." Protective Effects of a Live Attenuated SIV Vaccine With a Deletion in the Nef Gene * Science (12/18/92) Vol. 258, No. 5090, P. 1939 Daniel, Muthiah et al. Live attenuated HIV-1 may also be the most potent, effective vaccine for the prevention of AIDS, write Muthiah D. Daniel et al. of the New England Regional Primate Research Center, Harvard Medical School, in Southborough, Mass. Vaccine protection against HIV and simian immunodeficiency virus (SIV) in animal models is proving to be a difficult task. The problem is largely attributable to the persistent, unrelenting nature of HIV and SIV infection once infection is initiated. SIV with a constructed deletion in the auxillary gene nef replicates poorly in rhesus monkeys and appears to be nonpathogenic in this normally susceptible host. Rhesus monkeys vaccinated with live SIV deleted in nef were completely protected against challenge by intravenous inoculation of live, pathogenic SIV. Concern for safety is likely to be the main issue for the eventual development of the deletion approach. In addition to nef, other genetic elements can be deleted from HIV-1 to help guarantee long- term safety. The use of deletion mutants eliminates the possibility of reversion and helps to guarantee the safety of inoculation with the attenuated virus. Deletion of nef or of multiple genetic elements from HIV may provide the means for creating a safe, effective live attenuated vaccine to protect against AIDS, conclude the researchers. AIDS Vaccines: Is Older Better? * Science (12/18/92) Vol. 258, No. 5090, P. 1880 Cohen, Jon Although researchers have previously considered an AIDS vaccine made from attenuated virus as being far too dangerous, many are rethinking the conventional vaccine approach. Several AIDS researchers know the power of attenuated virus vaccines, but they fear that even a weakened version of the evasive HIV could lead to fatal infection. Many researchers have believed that the only effective vaccine would be genetically engineered pieces of HIV, but that high-tech approach isn't working well. However, an experiment involving attenuated virus has reproduced some striking results. Ronald Desrosiers and his colleagues at Harvard's New England Regional Primate Research Center vaccinated four rhesus monkeys with a weakened form of simian immunodeficiency virus (SIV) and protected them from infection for more than two years. But Desrosiers said long-term safety concerns are worrisome. "It will take 10 or 15 years of safety testing before we can be comfortable putting this into thousands of people." Before the live, attenuated method could be seriously considered for use in humans, at least three safety concerns would have to be addressed. First, the HIV in an attenuated vaccine could revert to a virulent state. Second, even if the vaccine did not cause AIDS, it might cause cancer. And third, a virus that initially appears safe might, decades later, turn out to cause disease. Philip Berman of Genentech, a company working on genetically-engineered AIDS vaccines, warns that SIV is different from HIV and that monkey data may not apply to humans. Cellular Proteins Bound to Immunodeficiency Viruses: Implications for Pathogenesis and Vaccines * Science (12/18/92) Vol. 258, No. 5090, P. 1935 Arthur, Larry O. et al. Cellular proteins linked with immunodeficiency viruses play a primary role in infection and pathogenesis, write Larry O. Arthur et al. of the National Cancer Institute--Frederick Cancer Research and Development Center in Frederick, Md. Cellular proteins associated with immunodeficiency viruses were identified by determination of the amino acid sequence of the proteins and peptides present in sucrose density gradient-purified HIV-1, HIV-2, and simian immunodeficiency virus (SIV). B2 microglobulin (B2m) and the a and B chains of human lymphocyte antigen (HLA) DR were present in virus preparations at one-fifth the concentration of Gag on a molar basis. Antisera to HLA DR, B2m as well as HLA class I precipitated intact viral particles, suggesting that these cellular proteins were physically associated with the surface of the virus. Whether the cellular proteins are components of the viral envelope acquired during budding or are acquired after budding by specific associations is an important mechanistic consideration that can now be addressed. It is likely that immune responses to HLA DR, HLA class I, or B2m (or to all three cellular proteins) were involved in the protection against SIV infection after immunization with uninfected human cells. These proteins should be considered in elucidation of the steps involved in infection, design of vaccines, preparation of experimental virus- challenge stocks, and determination of the pathological mechanisms of immunodeficiency viruses, the researchers conclude. Tests Show Infection by AIDS Virus Affects Greater Share of Cells * New York Times (01.05.93), P. C3 Kolata, Gina Researchers have found that more human cells are actually latently infected with HIV, which helps explain how the entire immune system is eventually destroyed. In 1986, it was believed that only 1 in 1,000 white blood cells were infected with the virus. But now, researchers are finding that 10, 20, even 30 percent of white blood cells may carry HIV, in addition to other cells. As a result, researchers conclude that direct infection with HIV should be sufficient to explain the destruction of the immune system in AIDS patients. The polymerase chain reaction (PCR) can be used to examine HIV by using enzymes to copy fragments of genes 100,000 to a million times, making it easier for researchers to study. PCR is usually performed in the test tube, with enzymes added to raw DNA. But recently it became possible to use cells themselves as miniature test tubes, making holes in the cells, diffusing reagents for PCR, and letting the biochemical reaction multiply copies of HIV that are hidden in the cell's DNA. In a paper in the current issue of the Proceedings of the National Academy of Science, Dr. Ashley Haas and colleagues from the University of Minnesota reported using a variant of PCR to examine tissue from a lung tumor taken from an HIV- positive patient. They discovered that as many as 15 to 20 percent of the white blood cells surrounding the tumor were latently infected with HIV. Regarding drugs to treat HIV infection, Dr. Haas said, "I'm not sure we can ever prevent activation." It makes more sense, he said, to attempt to inhibit HIV when it tries to emerge from a cell, perhaps by blocking a crucial viral enzyme. Inmates With AIDS Long for Death at Home * New York Times (01.05.93), P. A1 Clines, Francis X. The leading cause of death in the New York State prison system is AIDS, and the newly enacted early release program for AIDS patients is not effective enough, according to some critics. The program was enacted last summer after being approved by the state legislature. Critics say the program is being implemented too slowly and is not allowing enough prisoners with AIDS to die at home with their families. However, state officials implementing the program insist that, because of security and medical concerns, they can only allow an annual release of possibly 25 of their dying AIDS prisoners, whereas there are about 18 deaths a month from AIDS. Only six inmates have so far been paroled earlier than normal under the program. Nancy Mahon of the Correctional Association of New York said that 15 state inmates died during the application process--more than have been released to die. She argues that dozens of inmates' families want to use the program, but the slow pace is proof of the state's determination to let out only a token few prisoners in their final days of life to minimize the risk that someone relapses into criminal behavior. Thomas A. Coughlin 3d, the state Commissioner of Corrections, admits to start-up problems, but says the legislature's conservative approach must be exhibited in the program. "It was never intended as a way to let all the people go who are HIV- positive and are going to die of AIDS some day," he said. Mahon contends that over half of the more than 200 inmates who die of AIDS in New York State prisons annually could be released if the program were properly administered. For Teens at Risk, Talk Isn't Cheap * Baltimore Sun (01.05.93), P. 1D Yakutchik, Maryalice Because teenagers must be spoken to in depth about high-risk behavior, the American Medical Association has developed a list of guidelines to facilitate discussion. Dr. Marianne Felice, director of adolescent medicine at the University of Maryland, said, "Certainly the things killing teenagers are preventable." She believes that talking to teens about their health is just as important as any examination. The AMA agrees, and recently released GAPS: Guidelines for Adolescent Preventative Services. GAPS includes 24 recommendations for doctors suggesting that they as well as parents shift their concentration from physical ailments to behavioral issues and from treatment to prevention. GAPS suggests that adolescents aged 11-21 have annual "preventative service visits." The list of high- risk behaviors among adolescents is becoming more and more severe. According to the Centers for Disease Control and the AMA, about 54 percent of high school students have had sexual intercourse, 19 percent with four or more partners. But only 48 percent of those sexually active report condom use. Also, 440 adolescents were diagnosed with AIDS in the 1980s. Dr. Oscar Taube, chairman of the Committee on Adolescents of the Maryland Chapter, American Academy of Pediatrics, said a physician or parent will not condone high-risk behavior just by addressing it with teens. "If you ask and nothing is going on, you've done no harm, except perhaps to cause someone to blush a little," he said. The main goal of GAPS is to encourage physicians to allot time to discuss high-risk behavior with each patient. Merck Reconsiders Pact With MedImmune * Washington Post (01.05.93), P. D2 Sugawara, Sandra Merck + Co. has reviewed its agreement with MedImmune Inc. to make a drug that fights the virus that causes AIDS because of disappointing preliminary experiments. Merck will study the program in the next two months before a decision can be made to proceed. In November, MedImmune and Merck announced a plan to develop a drug using a human monoclonal antibody, MedImmune's MEDI 488. That announcement gave MedImmune a boost in its stock to $52.75, up from $9.25 six months earlier. Merck has also worked with MedImmune on its AIDS vaccine using a tuberculosis vaccine called BCG. The project continues since its announcement in 1990, although it is still in the early research stages. According to MedImmune spokesman Anthony Russo, the firm rarely issues public statements on preliminary findings, but project with Merck received so much attention last year that the company decided to release the information. MedImmune announced the findings yesterday, and also said it applied for FDA approval of a drug that treats child pneumonia. Mother Dying of AIDS Struggles to Find Home for Son * Baltimore Sun (01.05.93), P. 3A Wasserman, Joanne Rosemary Holmstrom, who is dying of AIDS, is looking for a good home to adopt her HIV-negative son. Holmstrom has been infected with HIV since 1986, and is trying to find a home for her son, C.J., before she dies. Because she is estranged from her family and wary of the foster care system, she has made her own journey to find C.J. a home where he will be loved as much as she loves him. She also wants to know the parents and them to know her, "so they can pass on who I am to my son," she said. Hundreds of people have responded to her request, which was published in the New York Daily News two weeks ago. She said the telephone rings almost nonstop with offers to appear on television shows. She has received hundreds of letters and Federal Express packages. She said she must "categorize the letters-- I have to find some way to sort them out: single parents, couples, gay, straight." But as a result of the publicity, C. J. has been teased and condemned by other children at school. He has said that he does not want to return to school. One woman in the neighborhood planned to have her son tested for HIV because, "my boy used to play with C.J., and what about blood?" Holmstrom responded, "Doesn't anyone listen? C.J. doesn't have AIDS." He has tested negative for the virus four times. She said that she is overwhelmed by her efforts to find him a home, but she and C.J. have yet to discuss the issue of her death. Midwest Report: Lesbian Lawmaker Seeks Help for AIDS Sufferers * Chicago Tribune (01.04.93), P. 1-3 Wisconsin should provide in-home care and services for more AIDS patients, according to the state legislature's first avowed lesbian. State Rep.- elect Tammy Baldwin (D-Madison) said the services are needed because of the lack of assistance she has witnessed for friends and others with the disease. "A number of people who I worked closely with or cared deeply about have died of AIDS. It's hard to lose people you love to any disease. I have similar feelings about cancer," she said. Baldwin, a Dane County supervisor and an attorney, was one of six openly homosexual political candidates nationwide who won the Nov. 3 elections, according to the Washington-based Gay and Lesbian Victory fund. Woman's Suit Says Hospital Denied Treatment Over AIDS Fear * United Press International (01.04.93) Mount Clemens, Mich.--A lawsuit has been filed against doctors and nurses at Mount Clemens General Hospital who wrongly suspected a Detroit-area woman of having AIDS and refused to treat her two years ago. Deborah Wright filed a suit against the hospital last week seeking more than $10,000 in damages. Her suit is based on an August ruling by the Michigan Supreme Court, which said discrimination based on the perception that someone has AIDS breaches the state Handicappers' Civil Rights Act. Kenneth Hylton Jr., Wright's lawyer, said Wright has a depressed immune system and went to the hospital on her physician's advice for an injection to bolster her immune system to prevent chicken pox, which her son developed. However, Hylton said that when Wright arrived at the hospital she was asked why she needed such an injection and whether she had AIDS or HIV infection. He said she was told that the medication was not available. "They denied her treatment," Hylton said, adding that the hospital "perceived her to be a person with an immune system disorder ... possibly AIDS ... then showed her the door." Wright said in her suit that she does not have AIDS or HIV infection. Hospital spokesman Doug Czajkowski said Mount Clemens General's policy is to care for any patient, regardless of condition. However, he did not comment on the lawsuit. The Angry Politics of Kemron * Newsweek (01.04.93) Vol. 121, No. 1, P. 43 Hager, Mary Two years ago, U.S. officials discounted a Kenyan researcher's claims that he discovered a protein that might cure AIDS as invalid. Recently, the same health officials requested a new study of the treatment after receiving pressure from the Nation of Islam and other groups. Critics say that the drug should not have high testing priority because of its low prospects. The low-dose interferon, natural chemicals that cells use to fight infection, was originally used as treatment for respiratory diseases in cattle by Joseph Cummins. Unlike doctors who prescribe large doses of interferon to fight diseases, Cummins uses a low-dosage to attack illnesses in humans and animals, and with positive results. Cummins provided Davy Koech of Kenya a powdered form of his drug for administering on Koech's AIDS patients. Koech announced success of the drug within two months and named the drug Kemron. He said 99 out of 101 patients who took the drug became outwardly healthy, and he said some regained some lost immune cells while blood in others eliminated HIV in scans. Opponents argue that Koech did not test Kemron on untreated patients and could not conclude Kemron as an AIDS cure. Company Time * Village Voice (12/29/92) Vol. 37, No. 52, P. 19 Smart, Theo Hoffmann-La Roche announced that it waits for results of stalled studies on a drug to treat AIDS. Animal studies have produced too many side effects, stopping the testing. A tat gene inhibitor, unlike other anti-virals on the market, stops replication of the virus and ceases all viral activity in infected cells. However, researchers have tested the drug for over a year and still has insufficient data because no testing period has lasted more than two weeks. Despite plans to hold three large trials of the drug, HLR has only begun the one that government officials co-sponsored. HLR, on the other hand, said it has to analyze toxicity in animals before beginning new tests. The monkeys became anorexic, according to the data. Darien Wilson, spokeswoman for HLR, puts the blame of the delay on the pharmacokinetics of the drug while opponents question HLR's interest in this drug. NIH has also tried to quicken the results of the research, but HLR did not provide NIH the information. HLR maintains that slight variations in a compound can cause changes in toxicity and effectiveness and researchers cannot pinpoint a date when they produce treatments. Reform of Federal AIDS Research Proposed to New Administration, Congress * AIDS Treatment News (12/18/92) No. 165, P. 3 Griffith, Keith The Clinton transition team is seriously considering a reform package that could result in dramatic changes in the way the federal government conducts AIDS research at the National Institutes of Health. The reforms are still being developed before the new administration is inducted in January. Proponents view the reforms as being critical if President-elect Clinton is to follow his campaign promise to concentrate more on AIDS issues. Representatives from Treatment Action Group (TAG), AIDS Action Council (AAC), and Human Rights Campaign Fund (HRCF) have conducted high level meetings at NIH regarding the reform package. The reform packages include a series of 24 proposals that would suggest centralizing all AIDS research programs at NIH under the authority of the Office of AIDS Research (OAR). Gregg Gonsalves, spokesman for TAG, said, "We want the OAR to have increased budgetary and administrative authority." He added, "Right now there are 21 institutes, centers, and divisions, at NIH that supervise AIDS research, and we would like OAR to have a single budget line for themselves and to distribute money instead of going through 21 directors who decide where it goes." Gonsalves and colleague Mark Harrington, both of TAG, conducted a comprehensive study of the NIH AIDS program earlier this year. They found that NIH experiences gaps in research, that redundancy is much too common, and that there is virtually no strategic planning. OAR, which was formed in 1988 by Congress to monitor federal research at NIH, was never given enforcement of powers to carry out its mission. The reforms would require the OAR to report directly to the NIH director and work with the newly created "AIDS Czar." New Definition for AIDS Arrives, Bringing New Concerns * New York Times (01.06.93), P. B3 Navarro, Mireya The new federal definition of AIDS is prompting New York health officials and AIDS advocates to debate over how to guarantee not only an accurate count of new AIDS cases, but also confidentiality and timely medical treatment for infected patients. The new definition, which went into effect New Year's Day, is expected to almost double the number of new cases reported nationwide this year and provide a better means for health officials to track the epidemic. However, AIDS advocates are concerned the way in which the city and state keep track of those AIDS cases might prevent some infected individuals from obtaining treatment. These advocates worry that current proposals will endanger the confidentiality of patients and discourage them from seeking care. State health department officials claim that they are developing regulations to establish a new reporting system and that they do not expect to implement any changes until at least next month. State and city officials are calling for laboratories that test blood to identify new cases, instead of relying on hospitals and doctors as they have done in the past, because these tend to be less thorough. Mark Barnes of the New York City Department of Health said that the current system, in which health care facilities and doctors report AIDS cases to health departments, which then report them to the Centers for Disease Control, misses about 17 percent of actual cases. This indicates that the city is losing federal money for AIDS that is allocated on the basis of need. Officials insist that the new method will not bypass doctors, who are still needed to confirm that patients are infected with HIV. MedImmune Shares Fall 17 Percent on Merck's AIDS Drug Review * Wall Street Journal (01.06.93), P. B6 Stock shares for MedImmune dropped more than 17 percent yesterday after the biotechnology company revealed that Merck + Co. is reviewing whether to continue a collaboration on a potential AIDS vaccine. However, MedImmune executives said the market overreacted to the news. MedImmune said late Monday that unexpected discouraging results in animal laboratory studies have prompted Merck to reexamine the development program for the AIDS vaccine, MEDI 488. MedImmune added that Merck will decide within the next two months whether to continue the program. Merck would not comment on the matter, citing its policy of declining comment on research that hasn't been published in peer-reviewed journals. MedImmune closed at $19.25, off $4, in national over-the-counter trading. Merck shares were quoted at $43.125, down 75 cents in late trading on the New York Stock Exchange. MedImmune executives said that the uncertainty over the future of MEDI 488 apparently caused investors to ignore two promising developments that the company disclosed regarding later- stage products. Condoms for Everyone? Hardly Chicago Tribune (01.05.93), P. 2-1 Precker, Michael Despite increased AIDS awareness and greater availability of condoms, the U.S. condom industry is not growing significantly. Sharon Sullivan, sales administration manager for Ansell, which makes the Lifestyles condom, said, "The market as a whole seems to be pretty static. Our sales are growing, but it's chipping away at other brands." She added that, "A lot of people still have the mentality that 'nothing can happen to me.'" Condom industry officials state that condom use escalated in the mid- and late 1980s, but leveled off. Today it is difficult to assemble a solid set of sales figures because of free condom distribution programs, mail-order sales, vending machines, sexual paraphernalia shops, and other unconventional retailers, including discount sales. Information Resources Inc., a Chicago market research company, found that overall condom sales increased 5 percent in 1992, after rising 9 percent in 1991. However, A.C. Neilsen Co., which also tracks the industry, said that the increase was one percent in 1992, after a 4 percent decrease in 1991. Both research companies used only store- bought condom data. As the figures differ, so do interpretations of what they may indicate. Jane Johnson, vice president of Planned Parenthood Federation of America, said that although there is more AIDS awareness there really hasn't been a significant change in people's sexual behavior. She cites teenage pregnancy rates, steady increases in sexually transmitted diseases among teens and HIV infections among heterosexuals, plus a survey showing that millions of people still partake in unprotected sex. In Prison for Being a Haitian With HIV * Chicago Tribune (01.05.93), P. 1-11 Quindlen, Anna It would make more sense for the United States to incarcerate people who commit crimes, rather than refugees infected with HIV, writes columnist Anna Quindlen. Silieses Success, a Haitian refugee, gave birth to her first baby while detained at Guantanamo Bay, Cuba. Not knowing that she was infected with HIV, Success passed the virus on to her baby, who later died. She has been put in prison, despite the fact that she has been charged with no crime. She is in jail only because she is HIV positive, contends Quindlen. Success' son died at Walter Reed Hospital in Washington, D.C., where he and his mother had been sent from Guantanamo when his health deteriorated. But afterward Success became somewhat of an immigration problem. Because the United States is one of the few countries that excludes HIV-positive foreigners as public health risks, her blood test made her inadmissible for entry. However, she was already in the country, and had a case for political asylum because her parents, who supported the ousted President Jean-Bertrand Aristide, were murdered. The United States is insensitive to these Haitians and considers them faceless black problems, says Quindlen. President-elect Clinton has vowed to change the policy that repatriated Haitians without determining whether they had legitimate cases for asylum, and has said that he will eliminate HIV infection as a barrier to immigration. Yet Success will have to wait. She should be set free for both her own sake and for ours, so that we can imprison people who do wrong, instead of those who are merely ill, concludes Quindlen. Federal Judge to Consider Renaming AIDS Suit Against Magic Johnson * United Press International (01.05.93) (Kalamazoo, MI) A federal judge will determine Wednesday whether to replace Magic Johnson's fake name, "Richard Roe," with his real one in a lawsuit against him. The suit was filed by an East Lansing woman last October who claims that Johnson infected her with HIV. The woman, known in the suit as "Jane Doe," sued on behalf of herself and daughter "Infant Doe." She said that Magic Johnson infected her during a one-night stand in 1990. The woman claims she wrote Johnson a letter in August 1992 about her accusation, according to an affidavit filed with U.S. District Judge Richard Enslen. Johnson filed his own affidavit, stating that he is Richard Roe but denying any memory of receiving the woman's letter. Johnson objects to the woman's request to retitle the suit with his name but not hers. His attorneys argue in court documents that if he is publicly added to the case title, the woman should be as well. Lawyers for both sides blame the each other for revealing Johnson's identity to the news media. New Software Available for Physicians' Offices and Community-Based Research * AIDS Treatment News (12/18/92) No. 165, P. 4 James, John S. A medical-office and research software system is now available for community-based research organizations and for medical-records management in physicians' offices and clinics. The system, called Medsys, was developed over the last five years by the nonprofit National Community Research Initiative (NCRI). Medsys is easy to use- -it automates the maintenance of patients' charts, produces custom patient flowsheets on demand, and assists in other functions including prescriptions, laboratory, specialists and referrals, and scheduling. The system keeps almost all patient data in a compatible, computerized form so that records can be combined from different practices and clinics for retrospective studies. In addition, it greatly cuts the work of identifying patients within a practice who are eligible for a prospective clinical trial. Medsys operates on a local area network of DOS computers. Also, physicians can access the system by telephone from home, or by portable computers while traveling, giving them complete access to patient records in an emergency, even during nights or weekends. The system is sold commercially by Medical Office Management Systems (MOMS), a for- profit group. MOMS sells Medsys for $25,000, which includes installation and training, with an annual $2,500 additional maintenance fee. This does not include the cost of the computers that need to be purchased before installation. A Controlled Trial of Trimethoprim-Sulfamethoxazole or Aerosolized Pentamidine for Secondary Prophylaxis of Pneumocystis Carinii Pneumonia in Patients with the Acquired Immunodeficiency Syndrome * New England Journal of Medicine (12/24/92) Vol. 327, No. 26, P. 1842 Hardy, W. David et al. Trimethoprim-sulfamethoxazole is more effective in treating AIDS patients who are taking AZT than aerosolized pentamidine in conventional doses for the prevention of recurrent pneumocystis infection, write W. David Hardy et al. of the National Institute of Allergy and Infectious Diseases in Bethesda, Md. The researchers conduced a comparative, open-label trial between July 25, 1988 and November 27, 1990 in 310 adult AIDS patients who had recently recovered from an initial episode of PCP and had no treatment- limiting toxic effects of trimethoprim-sulfamethoxazole or pentamidine. All of the patients were treated with AZT and were randomly assigned to receive either 800 mg of sulfamethoxazole and 160 mg of trimethoprim once daily or 300 mg of aerosolized pentamidine administered every four weeks by jet nebulizer. There were 14 recurrences of PCP in the trimethoprim- sulfamethoxazole group, as compared with 36 recurrences in the aerosolized- pentamidine group. The projected recurrence rates at 18 months were 11.4 percent with trimethoprim-sulfamethoxazole and 27.6 percent with pentamidine. The risk of a recurrence was 3.25 times higher in the pentamidine group. There were no significant differences between the groups in survival or in hematologic or hepatic toxicity. There were 19 serious bacterial infections in the trimethoprim-sulfamethoxazole group and 38 in the pentamidine group. A policy of selecting trimethoprim- sulfamethoxazole whenever possible may reduce morbidity, frequency of hospitalization, and medical care costs, the researchers conclude. Rapid HIV Tests: Two for the Price of One * Lancet (12/19-26/92) Vol. 340, No. 8834/8835, P. 1541 Zhang, Xiang et al. Rapid HIV tests can be reused after testing samples that do not contain antibodies to HIV, write Xiang Zhang et al. of the University of Maryland School of Medicine in Baltimore. Two panels of 60 HIV confirmed positive and 40 HIV negative sera from individuals in the United States and Central Africa were tested with two rapid HIV assays immediately after testing of HIV negative samples by the same device. Assays included the SUDS (Murex) and Genie (Genetic Systems) microparticle filtration tests. Both tests incorporate mixtures of viral lysates and synthetic peptides of HIV, and are done in 10 minutes or less. Both tests accurately detected all HIV positive and negative sera, even though the devices had been used before to test HIV negative samples. Also, reactivities were equivalent to those obtained with the devices used once only. But the SUDS test required that the reaction time be extended to 4 minutes rather than the recommended 2 minutes when testing samples only once. Each device can be used up to five times (SUDS) with negative sera and still adequately detect positive sera. Reusing rapid test devices provides substantial savings, potentially decreasing the cost by at least half. This savings would be best achieved when testing samples from a low-risk population, in which most samples are negative. However, the reuse of cartridges still requires extra use of kit reagents, and will not result in significant savings unless excess reagents are supplied. The performance must be confirmed with a larger number of samples from both high-risk and low-risk populations before the use of these devices for re- testing can be considered fully, the researchers conclude. Reliability of Western Blotting for the Confirmation of HIV-1 Seroconversion * Lancet (12/19-26/92) Vol. 340, No. 8834/8835, P. 1541 Simon, Francois et al. Western blotting (WB) lacks sensitivity during seroconversion and should no longer be considered the gold standard for serological diagnosis of HIV infection, write Francois Simon and colleagues of the Hopital Bichat- Claude Bernard in Paris, France. The researchers followed the timing of seroconversion in 27 patients between April 1990 and October 1992. In eight of these, all of whom had symptoms, the first available serum samples were negative by WB, but contained neutralizable p24 antigen or were repeatedly positive with at least one EIA test, or both. A total of 10 of the 11 samples were positive for p24 antigen; the other sample remained negative after acid dissociation. Later sequential samples from these eight patients showed a characteristic seroconversion pattern in WB. Among the two first generation EIA tests, neither was positive, and the second-generation tests based on recombinant antigens were positive in only one patient. Both second generation tests based on synthetic peptides were positive in three patients. The third generation tests were highly sensitive since both were positive for 6 of the 11 samples, and gave reproducible overflow reactivity in 2 of these. Three samples remained negative with all EIA tests; the only marker of infection was serum p24 antigen; the EIA antibodies tests became positive only after 1, 4, and 5 days. The detection and confirmation of HIV- 1 infection should be based on the use of several EIA tests, together with the detection of p24 antigen during the initial phase of primary HIV-1 infection, the researchers conclude. Ballet Icon Nureyev Dead * Washington Post (01.07.93), P. A1 Weil, Martin Rudolf Nureyev, a master of dance whose technical virtuosity and passionate intensity changed ballet dancing in the 31 years since his defection from the Soviet Union, died yesterday in Paris at the age of 54. Michel Canesi, his physician, said Nureyev died of "a cardiac complication following a cruel illness," but did not expound upon specifics or give the place of death. In recent years, Nureyev's physical condition had deteriorated dramatically. There were widespread rumors--never confirmed--throughout the professional dance community that Nureyev had AIDS. He was known for his extreme passion in dance and his willingness to place art above all. Nureyev left the Soviet Union in 1961 and danced with the ballet of the Marquis de Cuevas. He made his London debut with Fonteyn and the Royal Ballet in "Giselle." Nureyev made guest appearances with at least 25 companies from Denmark to Australia, and choreographed classics like "Romeo and Juliet" and "The Nutcracker. He also made several films, including "Romeo and Juliet" and "Swan Lake." He became artistic director of the Paris Opera Ballet in 1983, and after six years became the company's principal choreographer. He made his U.S. debut last summer as a conductor with American Ballet Theater. On Oct. 8 Nureyev made his final appearance on stage at the Paris premiere of "La Bayadere," for which he had provided new choreography. Appearing ill and requiring help to walk, he blinked back tears as the audience gave him a 10-minute ovation. Related Story: New York Times (01.07) P. A1 Clinic Widens Its Reach to AIDS in Md. Suburbs * Washington Post (01.07.93), P. B8 Goldstein, Amy Washington, D.C.'s largest provider of AIDS services announced the opening of a satellite office in Hyattsville, Md., yesterday, signifying the first time the clinic has branched into the Maryland suburbs. The Whitman- Walker Clinic's new office on New Hampshire Avenue is funded mainly through federal grants, and is expected to provide counseling, pharmacy services, a buddy system, and transportation to the several hundred people with AIDS in suburban Maryland. The office is located on the border of Prince George's and Montgomery counties, the suburban Maryland jurisdictions with the highest rates of AIDS cases. Jim Graham, Whitman-Walker's executive director, said, "We wish none of this was necessary. We wish we could contract rather than expand, but the epidemic is raging in our city and our region." Approximately 1,000 people in Prince George's County and 600 in Montgomery County have developed full-blown AIDS since the epidemic began in 1981. During the same time, about 4,000 AIDS cases were reported in Washington and almost 1,300 in Northern Virginia. Graham said the new office will prompt a grass-roots AIDS movement in Maryland that will boost the number of volunteers and help the clinic acquire state and county subsidies. The new center, with a 1993 budget of $186,000, will provide anonymous HIV tests, sponsor education programs, and attempt to track down people with AIDS who are not obtaining sufficient medical care. Schaefer Will Disband AIDS Council, Shift Work * Baltimore Sun (01.07.93), P. 1A Smith, C. Fraser Maryland Gov. William Donald Schaefer announced yesterday that his Advisory Council on AIDS would be disbanded and its work would be transferred to his Drug and Alcohol Advisory Council. His decision has provoked anger and criticism from AIDS activists. The governor claims he wants a more aggressive fight against AIDS in Maryland, one that more sharply concentrates on education and prevention. Schaefer said he expects that AIDS issues will be dealt with more vigorously by Dr. Neil Solomon, head of the drug and alcohol panel, and he added, "many AIDS cases are drug related." But many found the governor's plan distressing. Garey Lambert, vice chairman of AIDS Action in Baltimore, said, "It's a grave mistake," to shift the panel's work. He added that the governor will jeopardize the importance of the group when the AIDS "epidemic is growing faster than many want to recognize." Also, a member of the AIDS panel sharply criticized the wisdom of this approach. Dr. John F. Bartlett, chief of the Division of Infectious Diseases at the Johns Hopkins University, said the governor's drug and alcohol advisory council has virtually no expertise in AIDS. Dr. Bartlett said he questions whether the governor understands the effectiveness of the state's AIDS-fighting resources or the ability of Maryland's health department in winning AIDS research grants. Dr. Solomon said he would attempt to get "the best brains available" to work on AIDS issues, but added, "This is not a field I am an expert in at all." Dr. Bartlett said that he is not sure he wants to continue working on the AIDS panel. 12.2 Percent of Argentine Inmates Are Found to Have AIDS * Chicago Tribune (01.06.93), P. 1-4 A total of one in eight prisoners in Argentina's federal prison system has AIDS, according to a report released Monday night by the Federal Prison Service. The report said 12.2 percent of the 4,500 inmates in its jails have AIDS. It added that if the current AIDS case rate remains constant, in 10 years 45 percent of the prison population could develop AIDS. Justice undersecretary Carlos Loturco told the private news agency Diarios y Noticias that 23 prisoners who are very ill have asked President Carlos Menem to grant them clemency. Menem offered pardons to a dozen prisoners with AIDS after they were found chained to their beds in a Buenos Aires hospital ward used as a jail sick bay. Funding Cut for Gay Teen Hotline United Press International (01.06.93) (Indianapolis, IN) A national hotline for gay and lesbian teenagers based in Indianapolis, Ind., will experience federal funding cuts that will significantly reduce the number of calls it can handle. Christopher Gonzalez of Indianapolis Youth Group said the timing is unfortunate because demand for the service has been growing. The hotline is intended to assist AIDS patients and to educate others on how to prevent HIV. Indiana's cuts total $220,000. The hotline acquired $32,000 in federal funding in 1992, but will get only $10,000 in 1993. Gonzalez said his organization expected that there would not be a repeat of a $20,500 grant it received last year, but the additional reductions in funding were a surprise. He said the counselors have been receiving about 1,000 calls a month, but now the group will only be able to handle about 700. Aside from the hotline, the group offers education and outreach programs to adolescents. Gonzalez said teens have the largest need for information on AIDS. 1993 Nucleoside-Analog Trial Results Expected * AIDS Treatment News (01.01.93) No. 166, P. 3 Tate, Larry Further developments in the clinical trials of nucleoside-analogs and combinations of them are expected in 1993. The first development will be the long-awaited release of data from AIDS Clinical Trials Group (ACTG) 116A, a study comparing AZT to ddI in people who have used AZT for fewer than four months. This will compare the two drugs as a primary therapy and suggest which drug patients starting anti-HIV therapy should use. It should be known by mid-January whether ddI is more effective, less effective, or about the same as AZT. Those participating have T-cell counts less than 300, but the findings might apply to people starting treatment at all T- cell levels. Results from the ACTG 019 should be available as early as February, if not, then by early spring. This trial compared AZT to placebo in people who started with varying T-cell counts--about half of them over 500. Information on the group who started with counts over 500 should provide the clearest answer from any U.S. study on the value of AZT in people in early stages of infection. If AZT delays disease development in this group, there could for the first time be an FDA-approved therapy for people with T-cell counts over 500. Another study, ACTG 155, which compared AZT to a combination of AZT and ddC in people with fewer than 200 T- cells, will have available data by late spring. If the findings show an advantage for the combination, the current label indications for AZT/ddC use may be clarified and strengthened by the FDA. The trials of 3TC are moving slower. Currently, it is in late dose-ranging studies and is expected to begin large Phase II comparative studies in the spring. VIIth International Conference on AIDS in Africa * AIDS Treatment News (01.01.93) No. 166, P. 7 Heyman, Jason The Seventh International Conference on AIDS in Africa was held in Yaounde, Cameroon, from Dec. 8-11. The tone, however, was somewhat murky. The primary issue addressed was HIV prevention and how efforts in Africa are hurting due to a lack of resources. Michael Merson, the director of the World Health Organization's Global Program on AIDS, said, "There have already been over 7.5 million infections in adults [in Africa] since the start of the pandemic, close to 4 million of them in women." There was very little discussion on treatments used for HIV infection. But HIV-2 was discussed in detail at the conference. HIV-2 has come to be known as the virus of developing countries and has not been given the attention that HIV-1 has received. It was revealed that HIV-2 is much less likely to be transmitted from mother to child. Sy El Hadj Amadou, the African Secretary of the International Council of AIDS Service Organizations (ICASO) delivered a speech at the conference which drew a connection between the failure of prevention efforts and the lack of AIDS treatments available to Africans. He said that as a consequence of the African AIDS community's defeatist attitude towards access to treatment, and the West's view of Africa as hopeless, all anti-AIDS efforts are seen as weak and not taken seriously by the public. The only treatment discussed in any detail was PCM-4, a little- known alternative treatment made from extracts of pig spleen and Siberian genseng, Eleutherococcus senticosus. Currently, it is being researched in the United States and Uganda, and is sold in buyers' clubs and health-food stores. Israel: Rethinking of Entry Restrictions * Lancet (01.02.93) Vol. 341, No. 8836, P. 42 Naparstek, Yaakov and Morag, Abraham The Israeli Ministry of the Interior's recent decision to prohibit the entry of HIV-positive foreigners into the Israel has prompted controversy among the public and in the Knesset. Exactly how the restriction-- intended to keep the rate of HIV infection low (now 1,000 HIV- positive people and 230 AIDS patients in a population of more than 4 million)--is to be executed is unclear. A statement by an applicant that he or she does not have AIDS could satisfy the restriction. Also, it is possible that the applicant will have to produce a medical certificate or undergo a blood test for HIV infection. The debate over the restriction is between groups who object to it on human rights grounds and supporters who claim it protects public health, and those who believe the regulation is useless and that the main effort should be invested in public education. Tourists who visit for less than three months at a time and Arab citizens from the occupied territories will not be affected. Regarding new immigrants, the issue is even more problematic. The "Law of Return" allows for every Jew to become an Israeli citizen whenever he or she wishes. Therefore, a positive test would not prevent Jews from entering the country. But since a quarter of the HIV- positive people in Israel are immigrants from African countries, where the prevalence is very high, testing and counseling must be performed in confidence. It is undetermined whether the proposed restriction will prevent the spread of HIV in Israel, and due to the controversy, authorities have decided to reassess their approach to the problem. Noticeboard: Think Globally, Act Locally * Lancet (01.02.93) Vol. 341, No. 8836, P. 45 The controversy over whether HIV is actually the cause of AIDS is "pointless" and only incites the "denial and complacency that have hampered our global control efforts," according to Dr. Michael Merson, director of the World Health Organization's Global Program on AIDS at a meeting entitled HIV and AIDS: Where Next? The U.K. Government hosted the meeting during its presidency of the European Community. Approximately 200 new cases of AIDS emerge daily in Europe. Merson says anti-AIDS programs in Europe should be modeled after current programs now implemented in the Netherlands and Switzerland. These programs are based on public openness about sexuality, incorporation of sexual health into school curricula, social support for drug users, and the ready availability of condoms. Concentrating on high- risk populations like IV-drug users and homosexual men is important, but an "illusion of safety" among the rest of the community must be avoided. Also, behavior modification should be encouraged instead of only stressing abstinence as a means to prevent HIV infection. Prof. Peter Piot of WHO said that new research on plastic condoms and vaginal viricides was needed. But most of these new methods still put the burden of protection on the woman. Dr. Stefano Vella of the Instituto Superiore diSanita, Rome, Italy, stressed that it would be "impossible to achieve complete eradication of virus from an infected individual." Therefore, research into treatment should be targeted at making HIV infection a chronic manageable disease with only a limited morbidity. Drug Profiles: Zalcitabine and Didanosine * Lancet (01.02.93) Vol. 341, No. 8836, P. 30 Lipsky, James J. Researchers have not determined the effects of zalcitabine and didanosine against the HIV virus. HIV, like other retroviruses, contains genetic information in RNA, reversing the sequence of DNA into RNA, causing it to make more viral RNA and proteins. This replication causes T-cells to die because they are the most affected. The drugs are intended to interrupt replication by stopping reverse transcriptase and viral DNA synthesis. Using its own normal analogue, zalcitabine can change the anti-viral effects while deoxyinosine has no effect on didanosine. The study also found that didanosine has irregularities under acidic conditions, so it is treated with a buffering agent and pharmacists suggest the drug should be taken on an empty stomach. The half-life of zalcitabine is extended in patients with renal failure because the kidneys eliminate most of it. Despite these basic findings, scientists have not made any strong conclusions. Degree of illness, previous and current medications, drug dosages, and drug paths all can have an effect on the study's results. The researchers have found a few toxic effects from the use of zalcitabine including sensorimotor neuropathy. Xerostomia Associated with Didanosine * Lancet (12/19-26/92) Vol. 340, No. 8834/8835, P. 1542 Valentine, Chris et al. Xerostomia is not a direct result of the use of didanosine (DDI) to treat AIDS, write Chris Valentine et al. of the Royal Brompton National Heart and Lung Hospital in London, U.K. Dodd and colleagues report in the Sept. 26 issue of the Lancet on the association between DDI treatment and xerostomia. But the true incidence of xerostomia associated with DDI is probably considerably less than the 35 percent figure suggested by Dodd et al. Xerostomia has been reported as a feature of HIV infection, and their group has previously reported salivary gland abnormalities in HIV- positive patients before DDI was in clinical use. Because DDI is available in the United States to treat AIDS in combination with AZT, these patients will usually have a more advanced stage of HIV infection in which there may be a higher incidence of xerostamia. Data presented at the Eighth International Conference on AIDS suggest that this effect is due to the drug rather than stage of infection. Dodd et al. do not mention whether their study design allowed them to address the question of whether the apparent difference in resting saliva production between their patients receiving DDI and those not may be a result of the effect of stage of HIV infection rather than the effect of DDI. Dodd et al. state that DDI is exerting its effect on resting salivary flow by causing a neuropathy which reduces the normal sympathetic flow to the gland. However, the researchers conclude it is, instead, more likely that the effect is more similar to the well-documented effect of DDI on the pancreas. Rare Compassionate Glimpse of Homosexuality in China * United Press International (01.08.93) Schweisberg, David R.) Beijing--Although homosexuality was believed to be eradicated in China after the 1949 communist revolution, economic and social liberalizations, along with the threat of AIDS, have begun to prompt more open discussion. The Beijing Weekend, a state-run newspaper, ran an article on homosexuality in China, which is an unusual topic for the state media to address, and is usually discussed in negative terms. The article said China's National Health Education Institute, which has led government AIDS awareness campaigns, last November established "Men's World," an unprecedented support group for gay men in the capital. The group meets to address AIDS prevention and other problems experienced by homosexuals, whose biggest fear is being discovered as homosexuals. They experience a constant struggle in protecting their secret and their social status. The article mentioned that gays' sensitivity was emphasized in late December at a meeting sponsored by Men's World. The gathering erupted in turmoil when some of the two dozen men attending hurled chairs and "stormed out" after a photographer took pictures of them. The article did not cite any statistics, but homosexuality in Chinese cities is known to be far more common than is officially acknowledged. In addition, the number of AIDS patients nationwide is believed to be much higher than the 969 cases reported by the Chinese government. Findings on Baboon-to-Human Liver Transplant Released * United Press International (01.07.93) (Pittsburgh, PA) The surgeons who performed the world's first baboon- to- human liver transplant on an HIV-positive man reported Thursday that four drugs have been combined effectively to prevent the type of rejection seen most often in cross-species transplantation. Dr. Andreas Tzakis, a University of Pittsburgh Medical Center surgeon who helped perform the transplant, said, "Our drug cocktail of FK506, cyclophosphamide, prostaglandin, and prednisone was more effective in preventing rejection than we actually anticipated." The surgeons reported in the British medical journal The Lancet that the transplanted liver functioned normally throughout most of the recipient's life and the patient's biochemical function was sustained with the baboon liver without apparent side effects. But, they added, an undetected formation of "sludge" in the liver's bile ducts and complications of immunosuppression with an otherwise effective combination of drugs contributed to the patient's death. Sludge is a semi- solid substance comprised of cholesterol and bile pigments. The transplant was performed on a 35-year-old HIV-positive man with hepatitis B infection on June 28, 1992. The man lived 71 days after the transplant before dying Sept. 6 from bleeding around the brain. The medical center is examining about 10 patients as possible candidates for the second such transplant. All of the patients have life-threatening hepatitis B infection. Life Goes on For Kellie Martin After Wrenching Scenes on AIDS * USA Today (01.08.93), P. 3D Graham, Jefferson The ABC TV series "Life Goes On" will air a three-part segment on AIDS, which begins Sunday at 7 P.M. Jesse, an HIV-positive teenager, will develop AIDS. Jesse, played by Chad Lowe, is the boyfriend of Becca, who is played by Kellie Martin. Regarding the AIDS segments, Martin said, "They were the hardest scenes I've ever been in. They made me dig down deep--I don't have a lot of life experience to draw from at 17. It wasn't easy, but it was quite a challenge." Martin said there will be no death scene for Jesse. "Chad's far too good of an actor to be killed off," she said. "I would be shocked if that happened." Acting out the AIDS scenes taught Martin that AIDS is "one of the scariest things in life, and how important it is to be there to offer support." The AIDS arc involves Becca and Jesse going "as far as they can possibly go and be safe," by spending the night together, which Martin says is more like a slumber party than anything sexual. Alpha 1 Biomedicals, SciClone Pharmaceuticals To ... * PR Newswire (01.07.93) (Bethesda, MD) SciClone Pharmaceuticals and Alpha Biomedicals received FDA marketing approval to export Thymosin alpha 1 to Mexico for clinical trial treatment against hepatitis B. David Kershenobich will be lead investigator in Phase III clinical trials, enrolling 100 patients in the study. Currently, Alpha Biomedicals, a company that develops drugs to fight immune disorders, is undergoing a similar trial in America for Thymosin alpha 1 as well as one in Italy. The company anticipates Italian testing results later this year, while the U.S. findings are due the first half of 1994. In addition, the company is testing Thymosin alpha 1 combined with interferon for hepatitis C treatments, and will combine the drug with AZT and PEG- IL2 to determine results against AIDS. Flynn Joins Suit Against Council on Condom Law * Boston Globe (01.06/92), P. 19 Canellos, Peter S. Controversy emerged Tuesday in Boston between the mayor and the City Council over a city ordinance requiring large bars and restaurants to allow condom vending machines on their premises. The two sides were admitted as parties on opposite sides of the lawsuit over the matter. Last month, the City Council overrode Mayor Raymond Flynn's veto of the measure, which indicates that the ordinance is city law. But Flynn claims the council has no statutory authority to address licensing issues and that the ordinance is "a legal nullity," according to the city's corporation counsel, Albert Wallis. When the Massachusetts Restaurant Association sued to overturn the ordinance, Wallis supported Flynn and refused to defend it. Consequently, the council was appalled that the city's leading attorney would refuse to defend the ordinance, and hired its own lawyer to defend itself. As the council took the role of defendant, Wallis moved to have Flynn join the case as a plaintiff Tuesday in Suffolk Superior Court. Various city AIDS groups, who argue that the ordinance will save lives by making condoms readily available to couples contemplating unprotected sex, joined the council in defending the measure. Wallis said state law grants authority solely to the mayor, and that "the council's actions in passing an action of dubious legality is what provoked this controversy. The restaurant association should have sued the council in the first place. The mayor considers the policy a legal nullity and has taken no steps to enforce it." Councilor Charles Yancey (Dorchester) chastised Wallis for backing Flynn and said it "causes a major constitutional crisis." The Young and the Reckless * Newsweek (01.11.93) Vol. 121, No. 3, P. 60 Gelman, David et al. Although the rate of HIV infection among homosexuals as a whole may be decreasing, it is not decreasing in the younger gay population in urban areas. This resurgence of HIV infection is partly due to the free- wheeling gay night life. What is more alarming is that evidence suggests a growing generation gap in AIDS awareness--the younger gay community is apparently engaging in high-risk sex in substantially higher numbers than their elders. Young homosexuals are more likely to have had multiple partners and unprotected anal sex, according to recent studies. A U.S. Department of Health survey found that the highest prevalence of HIV infection is among gay men aged 17-25. The Centers for Disease Control found that AIDS cases between homosexual men aged 13 to 29 increased upward last year, in defiance of the overall trend downward. It is apparent that the safe-sex message is not registering with this younger homosexual population. The "stereotypical view" is that HIV affects mainly "older men with mustaches who go to leather bars," said a study conducted by the Center for AIDS Prevention Studies (CAPS) of the University of California--San Francisco. Young gays are somewhat sheltered, since many of them have never met anyone with AIDS or witnessed a friend their age die of the disease. According to CAPS researchers, closeted young gays sometimes feel so isolated they don't see much of a reason to protect themselves against disease. Studies have also found that facts alone are not enough to alter behavior. Researchers say that what brings about change is perception of what seems to be the accepted way of doing things. Does Drug Interaction Cause Failure of PCP Prophylaxis With Dapsone? * Lancet (01.02.93) Vol. 314, No.8836, P. 48 Huengsberg, Mia There is no relation between dosage of dapsone and prophylaxis failure, write Mia Huengsberg et al. of the St. Thomas' Hospital in London, U.K. Dapsone has been used as a treatment against Pneumocystis carinii pneumonia (PCP) in HIV-positive patients. But there is concern about failure of dapsone prophylaxis due to drug interaction. Didanosine and rifampicin interact with dapsone, which is rendered insoluble at neutral gastric pH. The researchers use dapsone as a second-line treatment for PCP. Between April 1990 and October 1992, 6 patients on dapsone prophylaxis developed PCP 1-25 months later, whereas another 19 patients used dapsone for at least three months and have not developed PCP. The researchers did not find a difference in drug intake between the two groups. Also, there was no difference between the groups in dapsone dosage. Because the sample size of the retrospective study is small, it is difficult to meaningfully compare the statistics. But the researchers conclude that they cannot confirm a correlation between dapsone's failure as a prophylactic agent and co- medication that increases gastric pH. Acquired Resistance to Clarithromycin as Combined Therapy in Mycobacterium Avium Intracellulare Infection * Lancet (01.02.93) Vol. 341, No. 8836, P. 53 De Wit, Stephane et al. The role of clarithromycin against Mycobacterium avium intracellulare (MAI) infection in AIDS patients is not yet determined and further research of combined therapy is needed, write Stephane De Wit et al. of St. Pierre University Hospital in Brussels, Belgium. The researchers describe an AIDS patient with systemic MAI infection in whom resistance to clarithromycin appeared despite combined therapy with clofazimine. A 40-year-old homosexual man was presented in September 1991 with high temperature, dyspnoea, dry cough, weight loss, and diarrhea--CD4 count was 15 u/l. Pneumocystis carinii and mycobacteria were found in the blood and bone marrow after a 4 weeks culture. P carinii pneumonia was treated with dapsone plus trimethoprim and mycobacterial infection with a combination of rifampicin, isoniazid, amikacin, ethambutol, and clofazimine. Subsequent identification and in- vitro susceptibility testing documented MAI sensitive to clarithromycin. Initial treatment was changed to clofazimine 100 mg per day and high-dose clarithromycin 1000 mg twice daily. Blood cultures became negative after 1 month of therapy and remained negative for me than 5 months. Clofazimine was discontinued after 5 months because of skin hyperpigmentation; about 3 weeks later the patient was admitted with high temperature and anemia. Clarithromycin was stopped, and rifabutin, isoniazid amikacin, and ethambutol were given, with a favorable clinical response. The patient died four months later of disseminated cytomegalovirus infection. Although studies of combination therapy is warranted, dual therapy may not be sufficient to avoid emergence of M avium resistant strains, the researchers conclude. Prevalence of HIV-Infected Syringes During a Syringe- Exchange Program * New England Journal of Medicine (12/24/92) Vol. 327, No. 26, P. 1883 Heimer, Robert et al. A needle-exchange program can significantly reduce the rate of HIV-1 infection among IV-drug users, write Robert Heimer et al. of the Yale University School of Medicine in New Haven, Conn. The researchers evaluated a needle-exchange program in New Haven operated by the city's health department. The program allows IV-drug users four opportunities a week to exchange their used syringes on a one-for-one basis for clean, attached syringe-needle combinations. The syringes returned were tested with the polymerase chain reaction for HIV-1 proviral DNA as proof of use by an HIV- positive IV-drug user. Before the start of the program, the rate of infected needles was determined for two sources. A total of 160 syringes not distributed through the program that were returned as the program began were randomly selected and tested. The rate of HIV- 1 in these needles was 68 percent. Another 180 syringes returned through an illegal exchange that operated once a week were tested and had a prevalence of infection of 63 percent. Between Nov. 14, 1990, and December 31, 1991, the researchers tested 1860 randomly selected needles distributed through the needle- exchange program. At first, the rate of HIV-1 proviral DNA was not different from that in the 160 needles tested before the program began. But by the third month of program operation, the rate had fallen to 57 percent. In subsequent months, the rate stabilized, approaching a steady-state level of 43 percent. The researchers found no changes in the demographic characteristics or drug-use habits of newly enrolled clients that could account for the reduction in the rate of HIV-1 proviral DNA in the needles. NOTE: Compilation by Michael Tidmus : AIDSwire. All rights reserved. Permission is granted to republish on electronic media for which no fee is charged, provided the complete text of this notice is attached to any republished portion or portions. * From the AIDS Daily Summary. The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse has made this information available as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold. Copyright 1992, Information, Inc., Bethesda, MD. -----====[[[[ A I D S w i r e D I G E S T 01.04.93 ]]]]====----- .