-----====[[[[ A I D S w i r e D I G E S T 01.18.93 ]]]]====----- Jailing of Man With AIDS Spurs Legal Debate * New York Times (01.18.93), P. B5 A Chatham, N.Y., man with AIDS who bit an emergency services worker was charged with second-degree attempted murder and first-degree reckless endangerment for biting the worker. However, questions have been raised about how the legal system deals with AIDS patients. On Nov. 27, Johannes Brete was acting irrationally, according to his roommate. The roommate subsequently called the Columbia County Sheriff's Department for medical assistance. When a Emergency Services Technician arrived to help, Brete called out, "I'm dying. I'm HIV. You'll all be killed." The emergency worker has since tested negative for HIV. The issue is whether Brete should have been charged with a crime because his lawyer, William F. Lally, said he believed his client was having a "psychotic episode" at the time of the incident. AIDS advocates claim that other factors are involved such as fear and discrimination toward AIDS patients. William Dobbs, an attorney from New York City and an advocate for AIDS patients, said that defendants and prisoners with AIDS are more apt to face difficulties outside major urban areas. Chatham is approximately 30 miles southeast of Albany. Brete was not arrested until Dec. 16, after undergoing treatment for pneumonia at the Albany Medical Center. Nancy McKenzie, executive director of Health Policy Advisory Center in New York City and author of "The AIDS Reader," said that the AIDS Institute, part of the New York State Health Department, was currently trying to get Brete out of the psychiatric prison while the case moves through the legal system. Univax to Begin Work on HIV Antibody * Baltimore Sun (01.19.93), P. 11C The Food and Drug Administration has allowed Univax Biologics Inc. of Rockville, Md., to start inoculating healthy volunteers with Genentech Inc.'s HIV vaccine and subsequently extracting their plasma to develop a new product. Univax Biologics is attempting to create a polyclonal antibody that could be given to health-care workers, AIDS babies, or others who require short-term protection against HIV infection. Also, the product might be used as a therapeutic treatment for AIDS patients, to help slow the disease's development. Once the volunteers have been inoculated, they will donate blood to Univax. If the volunteers develop antibodies to HIV as expected, Univax will then turn those antibodies into the polyclonal antibody product. Within the next two weeks, the companies are scheduled to begin inoculating the volunteers. Genentech, of San Francisco, Calif., is starting the second phase of tests on its gp 120 HIV vaccine, but is still quite far from applying for FDA approval to use the vaccine. If Genentech's vaccine is not successful in lifelong protection against HIV, the Univax product could be effective. The polyclonal antibody is only designed to provide immunity for several weeks. WHO-AIDS Associated Press (01.15.93) (Geneva) The World Health Organization revealed Friday that the number of reported AIDS cases throughout the world increased to more than 600,000 by the end of 1992, yet the actual total was probably four times as high. The number of AIDS cases in the United States totaled 242,146--more than one-third of the world's total--as the number of cases reported in Africa rose sharply. WHO said on Thursday that the number of U.S. AIDS cases would escalate to me than 500,000 by 1995, with 385,000 deaths. The agency disclosed that approximately 13 million people had contracted HIV infection, and there had been about 1 million new HIV infections in the last six months. The report involves statistics through September. The numbers are the cumulative total of AIDS cases reported by national authorities to WHO since it began recording AIDS cases in 1981. The report did not indicate how many people have died of AIDS. The agency said a total of 611,589 cases of AIDS had transpired since 1981, which is about 10,000 higher than its earlier report in June. WHO said there were large increases in Africa in countries including Kenya, Uganda, and Tanzania. It also said that France had the highest total number of AIDS cases in Europe with 21, 487, followed by Spain with 14,991. WHO emphasized that the reported number of cases was a "relatively crude indicator" of worldwide trends due to poor diagnoses and underreporting, particularly in developing countries. It said the actual number of worldwide AIDS cases was about 2.5 million. Vestar to Provide Daunoxome to Patients With...* PR Newswire (01.14.93) (San Dimas, CA) Vestar, Inc. announced Thursday that it has launched a limited program to provide DaunoXome (R) free to AIDS patients with advanced Kaposi's sarcoma (KS), who have not had success with other cytotoxic treatments. Vestar is now expanding production of DaunoXome, its proprietary liposomal formulation of the anticancer drug daunorubicin, and hopes to begin limited shipments of the product immediately for this program. The DaunoXome program is based on a clinical protocol submitted to the Food and Drug Administration, involving a limited number of hospitals. PACT, a clinical research group based in St. David's, Penn., will coordinate patient and physician requests for the drug nationwide. Findings from Phase II clinical trials suggest that DaunoXome may be an significant addition to the treatment regimen for AIDS patients with KS. Dr. Michael E. Ross, Vestar's executive vice president of medical/regulatory affairs, said, "This new investigational program provides access to patients who are not eligible to participate in that Phase III program, while simultaneously advancing the clinical development and regulatory status of the product." In previous clinical trials involving more than 150 patients with advanced KS who were treated with DaunoXome, more than 60 percent had a partial response and several others had their disease inhibited. The company is currently performing Phase III trials of DaunoXome in Kaposi's sarcoma, and is supplying the product in Europe on a named-patient basis prior to full regulatory approval. This program will have no impact on the Phase III trials now underway in the U.S. L.A. AIDS Cases Increasing Among Some High Risk Groups * United Press International (01.15.93) (Los Angeles, CA) The rate of AIDS cases among Los Angeles County tuberculosis patients, intravenous drug users, and homosexual black males, is rising, reports a study released Friday. The study was conducted by the Los Angeles County Department of Health Services, and discovered drastically high cases of AIDS among homosexual adolescent males, the homeless, and Native Americans. The study demonstrated a disproportionate prevalence of HIV infection among black women in their childbearing years. The rate of infection among these women was 11 times higher than the rate of infection among Hispanic women and more than 20 times higher than the rate of infection among white women in the same age group. Within the last three years, the proportion of AIDS cases among the population as a whole has more than doubled, according to the survey. Approximately one in 200 county residents are HIV-positive. The survey also showed that since the beginning of the epidemic more than 17,000 county residents have contracted HIV, while most of them have died. The rate of HIV infection among tuberculosis patients was 10 percent and can be partly attributed to the homeless, who are already at a high risk for AIDS. Peter Kerndt, director of the county's AIDS Epidemiology Program, said the information should be sued to develop programs aimed at those groups. The study recommends street-based HIV testing programs, bleach, needle and condom distribution programs, and improved follow-up services for those who test positive for HIV. Study Shows Few Doctors Discuss AIDS With Patients * United Press International (01.15.93) Wasowicz, Lidia (San Francisco, CA) Even though widely known guidelines urge physicians to discuss AIDS with their patients, only 20 percent of patients report ever doing so, according to a nationwide survey published in the January issue of the Archives of Family Medicine. The survey involved 1,312 patients. The most alarming discovery was that only 23 percent of those who identified themselves as being in a high-risk group for contracting HIV had addressed AIDS with a doctor. Among those surveyed, 26 percent said their chances of contracting HIV were "high" or "medium." A total of eight percent reported being in a high-risk group, indicating they had multiple sex partners, used IV-drugs, or were gay or bisexual men. Barbara Gerbert of the University of California--San Francisco recommended more discussion between physicians and patients to prevent the spread of sexually transmitted diseases and to encourage early testing and treatment of HIV-positive patients. The U.S. Preventive Services Task Force and the American Medical Association developed strong recommendations in 1989 that doctors assess patients' risk for sexually transmitted diseases, including AIDS. The U.S. Public Health Service hopes that by the year 2000, 90 percent of doctors in areas with high rates of AIDS cases will routinely provide HIV-risk assessment and risk- reduction counseling. The study discovered the number of doctors and patients who talked about AIDS increased only 5 percent between 1988 and 1991--from 15 to 20 percent. The study also revealed that when AIDS was discussed, the conversation was initiated by the patient 51 percent of the time. A Lost Generation Newsweek (01.18.93) Vol. 121, No. 3, P. 16 Ansen, David et al. The death of dancer Rudolf Nureyev is one more addition to the long list of artists who have died of AIDS. Although it was never publicly disclosed, for years rumors circulated that Nureyev was dying of AIDS. In every aspect of culture--dance, theater, literature, music, design, fashion, art, television, movies--AIDS continues to devastate. While all lives are irreplaceable, the death of an artist leaves a void that exudes past the circle of loved ones. A single death creates a cultural chain reaction. Gordon Davidson, artistic director of the Mark Taper Forum in Los Angeles, which recently produced Tony Kushner's epic theatrical response to AIDS, "Angels in America," said, "The problem, aside form the horror of the deaths, is that the system by which we encounter art is a system of passing things down, and when you break the circuit the way it is being broken by AIDS, the damage my be irreparable." The average age of death from AIDS in the United States is 35, according to one study. But most of the work that hangs in the Museum of Modern Art is by artists older than 35, which indicates a great loss of artistic talent. The epidemic, of course, has not just affected the world of art, but it is more prevalent and more visible there and has an impact on everyone the culture touches. Also, another reason why the world of art has become the center of the epidemic is that it has been more willing to address the subject, to use its visibility in order to raise awareness. Several artists are afraid that the media gives a convoluted view of AIDS, which allows the public to believe because one is not gay or artsy then one is immune from AIDS. News in Brief: Switzerland * Advocate (01.12.93) No. 620, P. 31 Controlling the spread of HIV infection in the Third World will cost at least $2 billion--20 times more than the $120 million a year currently spent, the World Health Organization reported on Nov. 30. WHO officials contended that developed nations, like the United States, should help fund these countries or they could risk suffering the aftershocks of the Third World collapse. "Either we come up with the money for prevention or we spend a lot more later without having a choice," said Michael H. Merson, WHO's AIDS program chief. The argument results from The Global AIDS Policy Coalition projections that by the end of the century, 4.7 million people will have died of AIDS and 24 million will be HIV-positive--90 percent of them from developing nations. Merson said, "Thailand estimates the minimum cost of the epidemic to that country alone by the end of the century will be $9 billion." He added, "When you have an economic cost like this to the developing world, it has to have an impact on the developed world." That is why the developed world should "be a major source" of money to combat the disease, he said. News in Brief: The Philippines * Advocate (01.12.93) No. 620, P. 32 A condom promotion program established by the Philippine government to thwart the spread of HIV infection was called "irresponsible and immature" by the country's most prominent Roman Catholic leader. Cardinal Jaime L. Sin of Manila said the new government policy may be a viable "short-term" solution, but "we close our ears to the voice of morality only at our peril." Sin's reaction emerged as President Fidel Ramos disclosed the formation of a national AIDS council and proposed a foundation to assist AIDS patients. Doc Must Reveal AIDS? * National Law Journal (01.11.93) Vol. 15, No. 19, P. 6 A federal judge ruled on Dec. 29 that a physician with AIDS is not permitted to recover damages from the Federal Bureau of Investigation (FBI), which prohibited him from performing medical examinations of its agents after the group discovered that the doctor was HIV- positive. Matthew Coles of the American Civil Liberties Union of Northern California, which represented the physician, said that U.S. District Judge Charles A. Legge's ruling appears to mandate that doctors disclose their HIV status if their patients request them to do so. AIDS Enters the Office * Financial Times (01.20.93), P. 8 Harrison, Barbara Although a few American companies have instituted AIDS education campaigns, most firms lag behind in establishing any anti-AIDS efforts. Approximately 1 million Americans are HIV-positive, making AIDS the second leading cause of death for men aged 25-44 and the sixth leading cause for women aged 25-44. This age group accounts for more than 50 percent of the U.S. workforce. More than two-thirds of companies with between 2,500-5,000 employees and about one in 12 companies with fewer than 500 employees have had a worker with HIV or AIDS. Therefore, the Centers for Disease Control has established a "Business Responds to AIDS " program. The agency has prepared a manager's kit and a labor leader's kit to give step-by-step guidelines on how to develop an HIV/AIDS policy and an education program. The kits make recommendations regarding health insurance issues, in addition to counseling and educational services. It also includes a section on what the Americans with Disabilities Act means to companies. It says that companies cannot deny an HIV-positive individual a job because insurance costs may increase. Also, job applicants cannot be forced to undergo an HIV test. And firms cannot release workers with HIV or AIDS if they are able to perform the "essential functions" of a job given "reasonable accommodation" to their disability. Digital Equipment Corporation was one of the corporate pioneers which established an AIDS education program in 1987. Paul Ross, Digital's manager of its HIV/AIDS program, feels that allaying the fears of infected and uninfected alike is crucial to avoid workplace problems. Europe Starts to Face HIV Issue * Financial Times (01.20.93), P. 8 Abrahams, Paul et al. European-based companies have been slow to deal with AIDS in the workplace, as opposed to their U.S. counterparts. A primary reason is that the disease has spread more slowly in Europe than North America. For example, 3,995 people in the U.K. have died of AIDS since 1982. Most of the firms that have addressed the problem early have been branches of U.S. multinationals or U.K.-based groups with subsidiaries in Africa and Asia. Glenys Rowe, an independent consultant on HIV and AIDS implications for businesses, says that more businesses are now beginning to face the issue. Approximately half of the companies that contemplate adopting an anti-HIV policy do not do so, but incorporate the issue into existing health policies. They fear that a specific policy would lead to discrimination. Rowe said that one of the most promising programs is the launch of the U.K. Corporate HIV + AIDS Project. It's goal is to produce a number of briefing sheets on various policy issues when considering the impact of HIV and AIDS on businesses. The French Agency for the Fight against AIDS recently surveyed more than 1,000 company personnel directors and found that one in 10 firms had HIV-positive workers. A total of one in four companies had implemented prevention programs. However, the 80 percent of companies which had not already established any program said they saw no reason to do so in the future. Evidence suggests that the risk are minimal for heterosexuals who do not inject drugs, do not visit brothels, and do not holiday in Thailand and other "sex-tourist" hot-spots. Recent figures state that homosexual/bisexual men comprise 65 percent of new AIDS cases and IV- drug users account for 15 percent. Young Men Dominate AIDS Victims in Singapore * Reuters (01.16.93) (Singapore) Most new AIDS cases in Singapore occur among young men who had sex with prostitutes, and an additional 55 people were found to be infected with HIV last year, the Health Ministry reports. The Sunday Times newspaper quoted ministry figures as demonstrating that three out of four of all Singaporean AIDS patients were single and four out of five were between the ages of 20 and 39. Among the 55 new HIV-positive individuals--49 men and six women--about 70 percent contracted HIV through heterosexual relations with prostitutes and 96 percent through sexual contact. In 1991, there were 42 newly detected HIV cases, and 17 in 1990. According to the Health Ministry, 37 Singaporeans died of AIDS as of January 1 and there were 158 other people found to be infected with HIV. The number of foreigners infected with HIV increased from 28 in 1991 to 61 in 1992. AIDS Prevention * Associated Press (01.16.93) Kennedy, Dana (New York) After the federal government announced that it would cut state funds for AIDS prevention, a New York outreach worker began to worry about where teenage prostitutes in Times Square will get condoms. Ines Robledo, who works with Streetwork, a drop-in center that provides AIDS counseling to homeless teenagers and some adults, said, "They're going to give up hope without us." She said they are more concerned about where they are going to sleep and eat, rather than whether they are going to infect others or themselves. Federal officials recently revealed that Congress has allotted only $129 million for grants to states for AIDS prevention this year, compared with $143.7 million last year and $159 million in 1991. Terri Lewis, director of the AIDS and Adolescent Network, said, "This is the most appalling thing the government has done in the history of this epidemic. Many centers are going to close down, which means people won't get the services they need and more and more people will get infected." One prostitute said that many men won't use condoms and a lot of prostitutes won't dispute it. Monay Johnson, a 24-year-old transvestite prostitute, said he tries to use condoms with customers but often is to tired. He added that when he is using crack he usually forgets about it altogether. Streetwork is part of Victim Services Agency, and its budget for fiscal year 1993 is just over $1 million--including about $170,000 from the federal government, said Marin Gazzaniga, a Victims Services spokeswoman. The remainder comes from a combination of state, city, and private funds. One of Six in Zimbabwe has AIDS Virus--Study * Reuters (01.18.93) (Harare) Nearly 1.5 million residents of Zimbabwe, a sixth of the country's population, have contracted HIV, according to a survey published on Monday. The survey, commissioned by the Commercial Farmers' Union, said Zimbabwe's economy could experience a lack of skilled labor if infection rates continued at present levels. Zimbabwe has 40,000 confirmed AIDS cases reported in a population of 10.2 million. AIDS Education * Associated Press (01.18.93) Neergaard, Lauran (Atlanta, GA) Parents and school systems nationwide are debating about how to educate students about AIDS and at what age. John Kappers of the National Association of People with AIDS, said, "This has polarized people because they think it's a morality issue. If they could see someone dying of this disease, they would see the immorality in not teaching about it." The debate has occurred in New York regarding what to teach in each grade which stalled the state from implementing AIDS education in the nation's largest school district until five years after lawmakers mandated it in 1987. Also, the Michigan Board of Education rejected a proposed wait-until- marriage approach. In South Carolina, some parents are requesting that lawmakers stop the Education Department from using "AIDS-Buster" kits--equipped with a rubber model of a penis for condom demonstrations--with high risk teens in pregnancy clinics and juvenile shelters. But the most recent controversy has emerged in Georgia, where hundreds of parents are protesting a state plan to increase sex and AIDS education. Georgia students get anywhere from two days to a few weeks of sex education in high school; the class is often an elective. The governor vetoed a bill last year that would have curbed the courses and asked the state Board of Education to strengthen the curriculum. The school board suggested that fifth- graders be taught "some of the ways to prevent the spread of communicable diseases." Critics say that suggests that students would get explicit lessons on anal and oral sex and condoms--educators vehemently deny it. Georgia has about 6,000 AIDS cases--ranking seventh in the nation--along with at least 16,400 HIV infections. TMP/SMX Prophylaxis for Toxoplasmic Encephalitis * American Pharmacy (01.93) Vol. NS33, NO. 1, P. 87 Covington, Timothy R. and Hurd, Peter D. Low doses of trimethoprim-sulfamethoxazole (TMP-SMX) appear to be more effective prophylaxis against toxoplasmic encephalitis when compared to pentamidine in AIDS patients with a history of Pneumocystis carinii pneumonia (PCP), according to a study conducted by A. Carr et al. published in the Annals of Internal Medicine. Toxoplasmic encephalitis is a frequently occurring neurologic complication of HIV infection with early mortality as high as 16 percent and residual neurological impairment of 40-50 percent. The study analyzes the efficacy of low-dose TMP-SMX as primary prophylaxis against toxoplasmic encephalitis versus pentamidine in HIV-positive patients with a history of PCP. A total of 60 patients received TMP-SMX during the three-year study period, and 95 received pentamidine as secondary prophylaxis against PCP. None of the 60 patients in the TMP-SMX group and no patients in the seronegative for Toxoplasma gondii developed toxoplasmic encephalitis. In the pentamidine-treated group, 12 of 36 seropositive patients developed toxoplasmic encephalitis. No cases of toxoplasmic encephalitis developed during the observation period. The median time to develop PCP in the 12 seropositive patients in the pentamidine-treated group was 460 days. Low-dose TMP-SMX offers the advantage of being simple, convenient, and safe and it may protect an AIDS patient from developing both toxoplasmic encephalitis and PCP, the researchers conclude. Corticosteroids for HIV Esophageal Ulcerations * American Pharmacy (01.93) Vol. NS33, No. 1, P. 87 Covington, Timothy R. and Hurd, Peter D. Oral corticosteroid therapy is effective when used to treat HIV- related esophageal ulcerations, write C.M. Wilcox and D.A. Schwartz in a study featured in the American Journal of Medicine. The study assesses the safety and efficacy of oral prednisone therapy in managing HIV-associated idiopathic esophageal ulcerations. Esophageal ulceration was confirmed by clinical, endoscopic, and pathologic criteria in HIV-positive individuals. Prednisone was administered to 12 patients at an oral dose of 40 mg per day, tapering 10 mg per week, for a total of one month of therapy. Endoscopy was performed within one week of completion of therapy. The mean duration of esophageal symptoms was found to be 2.9 weeks. A total of 10 of the 12 patients receiving the steroid had AIDS. Also, 11 of the 12 patients had complete relief of symptoms, usually in the first week of therapy. The study revealed that the oral steroid regimen was well-tolerated. Mild asymptomatic Candida esophagitis was detected in the patients on follow-up endoscopy. No systemic opportunistic infections were documented during or within one month of the completion of therapy. The researchers conclude that controlled studies should be conducted to determine optimal dose and duration of therapy and ultimate safety and efficacy. Noticeboard: Didanosine and ACTG 116A * Lancet (01.09.93) Vol. 341, No. 8837, P. 109 The National Institutes of Allergy and Infectious Diseases has released findings from a study by the AIDS Clinical Trials group that addresses whether duration of previous AZT therapy influences the efficacy of didanosine. The trial (ACTG 116A) comprised the second part of a study that analyzed the efficacy and toxicity of didanosine in patients with AIDS, AIDS-related complex, or asymptomatic HIV infection. Of the patients who had not taken AZT before, didanosine was less effective than AZT at preventing progression of HIV disease to a new AIDS-related illness. In patients who had received 8-16 weeks of AZT, didanosine was the more effective drug. A total of 119 patients who took 8 or fewer weeks of AZT had inconclusive data. Patients receiving low-dose didanosine had fewer episodes of pancreatitis, the most serious side-effect of didanosine therapy, than those receiving the higher dose. Last year, the results from the first part (ACTG 116B/117) of the study protocol were published. Kahn et al. discovered that low-dose didanosine postponed progression of HIV disease in patients with ARC and asymptomatic HIV infection who had received AZT for at least 16 weeks. The subjects in the ACTG trial differed from those in the Alpha trial, in which patients were intolerant of AZT. The results that show 500 mg/day didanosine (400 mg/day in tablet form) is safer than the higher dose, and that it is more effective than AZT in patients who have received 8-16 weeks of AZT, support its use in urgently needed studies of alternating vs. simultaneous nucleoside analog regimens and in trials combining nucleosides with other drug categories. U.S. Set Back in Vote on W.H.O. Chief * New York Times (01.21.93), P. A8 Altman, Lawrence K. The World Health Organization, which coordinates worldwide anti-AIDS efforts, reelected the current head of the group, despite an aggressive diplomatic effort by the United States and its European allies to unseat him. The WHO's executive board voted 18-to-13 to recommend Japanese physician Hiroshi Nakajima over a rival candidate Dr. Mohammed Abdelmoumene, an Algerian who was supported by the United States, Canada, and the European Community. In the effort to oust Dr. Nakajima, one State Department memorandum asserted that the Japanese Government had resorted to "aggressive tactics, including the pursuit of votes in exchange for favors" in its attempt to defend him. The vote by the executive committee is expected to be confirmed at the annual assembly of WHO's 181 members in May. Dr. Nakajima has lead the United Nation's agency for five years. Critics said that while WHO had long had many first-rate health-care workers on its staff, there were fewer appointments of such high-caliber people during Dr. Nakajima's administration. Morris Abram, the United States representative to the United Nations in Geneva, argued, "It is essential that this agency be well and efficiently managed." Abram reaffirmed the United States' continuing support for WHO and added that the nation's "long-standing commitment to the World Health Organization transcends any personalities or leadership." Capturing the Strained Social Life of Manhattan * New York Times (01.21.93), P. C15 Holden, Stephen A new comedy at the WPA Theater in New York is about a gay man in his mid-30's who is tired of negotiating safe sex and decides to become celibate. The play, "Jeffrey," was written by Paul Rudnick. The title character, Jeffrey, estimates that he has had about 5,000 sexual encounters but remained HIV-negative. He says, "I'm not promiscuous. It's such an ugly word. I'm cheap." The play exhibits the strained social tenor of Manhattan life as it is currently lived, writes critic Stephen Holden. Holden adds that the "desperate, brittle tone of the hilarity underscores the ghastly sense of the absurd that the AIDS epidemic has brought to hyper-sophisticated Manhattan society." Aside from the humor, "Jeffrey" copes with questions of life, death, and erotic partnership that many other people face as well. The play's other main character, Steve (Tom Hewitt), is a bartender whom Jeffrey meets in a gym and who could be his soul-mate. However, Steve is HIV-positive, and Jeffrey fears of getting involved with someone who could become ill and die at any moment. Other sketches in the play are satirical and stress the complexities of safe sex. AIDS Spreading Faster in French Overseas Territories * Reuters (01.20.93) (Paris) AIDS has emerged as the leading killer of young adults in France's overseas territories, where the rate of infection is higher than on the mainland, according to French Overseas Radio (RFO). RFO conducted a survey which revealed that 931 cases had been reported among 2.3 million people living in French Guiana, the Indian Ocean island of La Reunion, and the Caribbean islands of Martinique and Guadeloupe. Misleading information and poverty have contributed to the disease's spread. However, RFO said the AIDS statistics appeared to be unreliable because of inadequate health facilities in the territories. AIDS prevention efforts such as the distribution of condoms were also more difficult to implement because of the local traditional values which oppose their use. In addition, AIDS patients in the territories are more hesitant to publicly disclose their condition because of its association with homosexuality, which is not as widely accepted in the overseas territories as it is in mainland France. Sports Doctor Shares Personal AIDS Tragedy to Deliver Vital Message * USA Today (01.20.93), P. 5C Woodward, Steve Leading American skaters will gather this week to compete at the U.S. Figure Skating Championships, but will also take in some valuable information about AIDS. Steve McQueen, a Salt Lake City physician and chairman of the U.S. Figure Skating Association's (USFSA) sports medicine committee, will speak to the sport's best and brightest and enlighten them, in detail, about the complications of AIDS. McQueen's brother died of AIDS at the age of 47. Despite an influx of controversial reports of AIDS-related deaths among Olympic-caliber male skaters in Canada and Europe, the top U.S. competitors have been spared losses. The USFSA has acknowledged the growing AIDS threat throughout society by incorporating AIDS awareness into its drug education program for national-level skaters. Since the annual U.S. Championships gather top skaters in all age groups--343 are registered for this week's nationals--the event provides an ideal venue for addressing the AIDS issue. McQueen said, "Like a lot of younger people, [skaters] feel this is something that may not concern them. With more cases [of AIDS] showing up among skaters, we think we have to be even more open." Last December, a report in the Calgary Herald had mentioned 40 skaters and coaches in North America who have AIDS. But the USA's most renowned male skaters of recent generations- -Scott Hamilton, Brian Boitano, and Paul Wylie--claim they can't name one serious competitor in the U.S. who has AIDS or has died of the disease. McQueen hopes to dispel all of the myths about the disease among the skating community. HIV Viraemia and Seroconversion * Lancet (01.09.93) Vol. 341, No. 8837, P. 113 Lu, Wei et al. The disappearance of infectious viruses in plasma during and after seroconversion does not suggest the clearance of cell-free HIV, write Wei Lu et al. of the Universite de Paris V, in Paris, France. Dr. Ariyoshi and colleagues report in the Nov. 21 Lancet that the first autologous isolate-specific neutralizing antibody activity was not detectable during seroconversion, but recognized after seroconversion and increased with time. They indicate that humoral factors are not responsible for the suppression of primary viraemia in early HIV infection because a rapid decline in infectious virus titre in plasma around the time of seroconversion was not coincident with the appearance of isolate-specific neutralizing activity. Ariyoshi et al. were misled by several inaccurate interpretations of the data. They use the neutralization assay that allows the titration of the specific virus-free neutralizing antibodies. The virion-combined neutralizing antibodies would not be detected by the assay. Also, the neutralized viruses in plasma would not be detectable in an infectious viral culture. Therefore, a double-negative result for both assays might suggest either no virus and no antibody or a virus- antibody equilibrium event. The high concentrations of total free viral particles during and after seroconversion, together with the rapid decrease of high-titre viremia, indicates a rapid loss of viral infectivity other than virus itself. The specific neutralizing antibody response seems to be the most direct mechanism that can account for the rapidly suppressing infectivity of primary viremia in early HIV infection, the researchers conclude. HIV Progression and Immune Activation Lancet (01.09.93) Vol. 341, No. 8837, P. 113 Ludlam, C.A., and Steel, C.M.) Patients with A1B8DR3 and/or systemic lupus erythematosis (SLE) have immune systems of increased activity which allows HIV replication to proceed faster, possibly because of an increased density of CD4 receptors on lymphocytes, write C.A. Ludlam and C.M. Steel of the Royal Infirmary and Western General Hospital, respectively, in Edinburgh, U.K. In the Oct. 10 issue of the Lancet, Dr. Learmont and colleagues report long-term asymptomatic HIV infection in five of six recipients of blood from a single donor who has been symptom-free for 10 years. The one recipient who developed AIDS and died of Pneumocystis carinii pneumonia after 4.3 years had SLE. They conclude that the prednisolone he was administered resulted in immunosuppression, which allowed more rapid progression to AIDS, and mention an additional patient with SLE treated with immunosuppression who fared poorly after HIV infection, to support their hypothesis. However, Ludlam and Steel believe there is another explanation for the rapid progression in individuals with SLE, an autoimmune disorder strongly linked with the HLA haplotype A1B8DR3. The presence of this haplotype in non-SLE patients infected with HIV is associated with a more rapid drop in CD4 counts and clinical progression of HIV disease, and this has been confirmed by others. Ludlam and Steel believe patients with SLE progress more rapidly because their immune systems are hyperactive. Thus, immunosuppressive therapy immediately after initial HIV infection may be an appropriate option. Nevertheless, additional studies are warranted to define why individuals with HLA A1B8DR3 progress rapidly after HIV infection, conclude the researchers. Microsporidia Infection in Patients with the Human Immunodeficiency Virus and Unexplained Cholangitis * New England Journal of Medicine (01.14.93) Vol. 328, No. 2, P. 95 Pol, Stanislas et al. Infection of the biliary tract with E. bieneusi is related to and may be the cause of AIDS-related cholangitis, write Dr. Stanislas Pol et al. of the Unite d'Hepatologie, Hopital Laennec in Paris, France. The researchers evaluated eight HIV-positive homosexual men who were referred because of cholangitis for which no causative agent had been found by standard tests. All of the patients received abdominal ultrasonography and endoscopic ultrasonography or endoscopic retrograde cholangiopancreatography with collection of bile from the common bile duct. One patient had transhepatic biliary catherization, and two others had cholecystectomy. Bile samples, duodenal- and liver-biopsy specimens, and gallbladder tissue were examined by light and electron microscopy. All eight patients with unexplained AIDS- related cholangitis had biliary microsporidiosis. Intraepithelial E. bieneusi spores and supranuclear plasmodia were identified in the six duodenal-biopsy specimens. May-Grunwald-Giemsa staining of bile samples showed free forms of microsporidia in all eight patients, and the presence of E. bieneusi was confirmed by electron microscopy. E. bieneusi was also detected in ductal biliary cells on a liver biopsy, in one common-bile-duct smear, and in gallbladder epithelium in two patients. Four patients were found to have associated but previously undetected biliary or duodenal cryptosporidiosis, whereas another had biliary infection associated with cytomegalovirus. E. bieneusi infection of the biliary tract could account for at least some of the cases of AIDS-related cholangitis that are not explained by cryptosporidium or cytomegalovirus infection. New Ideas and Dark Holes * Advocate (01.12.93) No. 620, P. 49 Delaney, Martin The federal government must stop funding studies of drugs that have limited efficacy, such as AZT, ddI, and ddC, and start funding promising new approaches so they can soon become practical, clinically useful drugs, writes Martin Delaney, executive director of Project Inform, a non-profit gay community foundation that supplies AIDS treatment information. One encouraging approach called the leucine zipper is designed to stop HIV from infecting cells by blocking mechanisms that the virus uses to link up with cells. It was named such because it is composed of identical amino acids in a repeating chain, which some believe resembles the chain of little metal tabs that make up a zipper. The new product seemingly provides one side of the zipper, while the other side is provided by a structure on the outer core of HIV. It proved effective in laboratory tests by completely blocking further infection by HIV. Another promising technique was developed by AIDS researcher Flossie Wang- Staal and her colleague, Arnold Hempel. They reported that they have succeeded in creating a molecule thatJliterally slices up the virus' genes, which control all its activities. If genes are eradicated or severely damaged, the virus is weakened and unable to reproduce or further any damage. A third approach developed by Dennis Burton uses monoclonal (man-made) antibodies, which are cloned in great numbers from a single antibody to fight against disease and link up with and block HIV. All three of these new methods will be meaningless unless they are quickly developed into real products that are ready for human testing and treatment, concludes Delaney. Study Finds DDC Effective by Itself Against AIDS * Los Angeles Times--Washington Edition (01.22.93), P. A4 Cimons, Marlene A new study that is expected to be released today has found that DDC is as effective--and possibly more so--than DDI in AIDS patients who are unable to tolerate AZT, according to sources familiar with the research. The National Institute for Allergy and Infectious Diseases is scheduled to release the study, which is the first to demonstrate that DDC is beneficial when used alone. The study involved 467 patients and took place between December 1990 and September 1992. About two-thirds of the patients had been diagnosed as having full- blown AIDS, said sources. The study was sponsored by the institute's Community Programs for Clinical Research on AIDS, a research program based in primary health-care settings like private doctors' practices and substance abuse clinics. The researchers investigated disease developments, including the onset of AIDS-related illnesses and deaths, and found them almost the same among groups taking DDI or DDC. The study revealed that survival time was slightly longer among patients on DDC. There were 100 deaths in the DDI group, compared to 87 in the DDC group. A memo summarizing the research said, "DDC was found to be at least as efficacious as DDI in delaying disease progression, including death, and may provide a survival advantage." The findings could lead to a new treatment option for AIDS patients who cannot tolerate AZT. Food and Drug Administration Commissioner David A. Kessler said the agency would examine the data and "consider revising the [DDC] label," and would contemplate "urging insurance companies to pay for single agent use." Doctor: 'Mystery AIDS' Defies Testing * Philadelphia Inquirer (01.22.93), P. A2 Collins, Huntly The mysterious AIDS-like illness found in the United States may be caused by an unusual variant of HIV that is not detectable by conventional laboratory tests, said a leading AIDS researcher yesterday. Dr. Jeffrey Laurence, head of AIDS research at Cornell University, said that the number of people with this variant appeared to be exceedingly small. There is no proof that the virus is transmitted from one person to another through blood or sexual intercourse the way HIV is, he added. Laurence, who spoke to medical staff at Hahnemann University in Philadelphia, was among a group of researchers who reported puzzling HIV cases at July's International AIDS conference in Amsterdam. The researchers found patients who tested HIV-negative in laboratory tests but who had AIDS-like symptoms, including severely depressed immune systems. Since the conference, the Centers for Disease Control has detected 68 such cases of the AIDS-like illness, known as idiopathic CD4 T- lymphocytopenia. Laurence reported five cases of the condition last summer, and has found 12 additional ones since that time. He said the mysterious cases may be caused by a virus that is similar to HIV-1. He based his belief on preliminary evidence from two patients. Pictures of the patients' cells, taken with an electron microscope, showed virus particles like HIV-1, said Laurence, and research demonstrated that the genetic makeup of the particles closely resembled that of HIV. While the virus is similar to HIV, it may be different enough not to be detected on conventional lab tests. Laurence urged that more advanced tests be developed. Boost for AIDS Drugs * Financial Times (01.22.93), P. 8 Abrahams, Paul Stock shares for Burroughs Wellcome rose sharply last week after reports of a positive trial for AZT. The trial was conducted by the National Institutes of Allergy and Infectious Diseases, which compared AZT with DDI in HIV-infected patients with late-stage disease. The study demonstrated that AZT was more effective in delaying the progress of AIDS among patients who had not previously used the drug. The trial was conducted from October 1989 to May 1992 and involved 617 patients. Among the 380 AIDS patients who had not taken AZT before, 18 percent developed a new, previously undiagnosed, AIDS-related illness or died within a year, compared with 31 percent taking 750 mg of DDI, and 29 percent on a 500 mg dose. But for those who had used AZT for eight to 16 weeks before, DDI proved more effective. For this group, 33 percent taking AZT developed a new AIDS-related condition or died within a year, compared with 11 percent on 500 mg of DDI, and 17 percent on 750 mg. The study showed that the two drugs had mixed side-effect profiles. Those taking AZT were more likely than those on DDI to experience lowered blood cell counts. Those on a 750 mg dose of DDI were more likely to develop pancreatitis than those on a 500 mg dose or AZT. The trial suggests that combination therapy will play an increasingly important role in treating HIV-related disease. France's Fabius Wants Trial to Clear His Name * Reuters (01.20.93) (Paris) Former French prime minister Laurent Fabius asked to be tried by a parliamentary High Court to vindicate himself from a scandal in which 1,200 French hemophiliacs contracted HIV from contaminated blood. Fabius, who served from 1984 to 1986 and is currently first secretary of the ruling Socialist Party, said he hoped that judges would not decide that too much time had elapsed for a trial to be held. In 1985, the hemophiliacs were infected by HIV-tainted transfusions before controls to screen and purify the blood stocks were introduced. Last month, members of both houses of parliament decided that Fabius and two other former ministers should be tried by the High Court on charges of neglecting to assist persons in danger. A panel of judges will convene today to determine whether there are grounds for a trial. Fabius has argued that he was not responsible for the incident because scientific knowledge about AIDS was more limited at the time. He said that if a time limit is established by the judges considering his case, he will return to parliament to press his case for a trial. Chiron Diagnostics Appoints Jean-Paul Bonn Vice ...* Business Wire (01.20.93) (Emeryville, CA) Chiron Corp. announced Wednesday that it appointed Jean-Paul Bonn as vice president, sales and marketing, for Chiron Diagnostics. This appointment is significant because Bonn has previously coordinated European marketing and new business development of AIDS and hepatitis products for Ortho Diagnostic Systems Inc., a unit of Johnson + Johnson, which has a joint business in blood screening products for HIV and hepatitis with Chiron. Before joining Ortho, Bonn worked at E.I. Du Pont de Nemours + Co. Inc., where he held a series of management positions. Some of his responsibilities included the development of new tests for HIV and HIV-1/2, clinical evaluations, product registrations, and distribution agreements. William G. Gerber, president of Chiron Diagnostics, said, "Jean-Paul has a strong technical background and is particularly familiar with the research community and diagnostic market for hepatitis and AIDS in Europe." He added, "Our tests are designed to be used to monitor therapy by quantifying the amount of virus present in patients. We have begun the process of establishing the utility of these tests for hepatitis C, hepatitis B, and AIDS treatment with opinion leaders. Jean Paul is ideally suited to lead this effort, and has the added advantage of being able to work effectively with our colleagues at Ortho to coordinate these separate but complementary businesses." Some Library Patrons Want Gay-Lesbian Magazine Removed * United Press International (01.21.93) (Goshen, OH) The gay-lesbian magazine The Advocate has evoked controversy in a small Cincinnati-area community, where patrons of a local library want officials to remove the publication from library shelves. Dave Macksam, director of the Clermont County Public Library, said three people have filed written requests to have library staff examine the magazine. He said, "We try to look at reading interests on a community basis. It was the opinion of the staff at the branch that there was a reading audience for it." One of the complaints about The Advocate was that it was "inappropriate material" for the library. However, Barbara Galik, assistant university librarian for information and research services at Miami University and Northern Kentucky University, argued, "The articles in there are quite good. If you want up-to-date information on AIDS and AIDS research that is the place to get it. We've had no complaints." Betsy Gressler, president of Stonewall Cincinnati, a gay and lesbian group, said the magazine does not contain sexually explicit photos or advertisements, but does provide information on fashion, music, and books, and also shows positive homosexual role models. "In a lot of rural areas, having access to magazines such as The Advocate is the only link to the gay and lesbian community that a lot of people have. I think any attempt to have it removed is an attempt at censorship," said Gressler. The Geography of AIDS * Atlantic Monthly (01.93) Vol. 271, No. 1, P. 90 Gould, Peter and Kabel, Joseph Recent technology has allowed computers to model maps of the progress of the AIDS epidemic, which can be helpful as a means of education. In the early years of the epidemic, geographic information was hard to obtain because doctors thought that disclosing it might threaten the confidentiality of people's medical records. But now, AIDS cases can be reported on an appropriate geographic basis without any possibility of revealing identities, and most states today publish data on AIDS cases by county or by zip code. Researchers give the computer the number of AIDS cases in each county; the computer gives complex formulas to predict their likely distribution throughout the county. Also, the colors on the AIDS map represent geometric steps, which can capture the great variation in incidence for each location. For example, a map of Ohio will show different colors for rates of AIDS cases. The prevalence of AIDS tends to intensify in confined areas before more remote locales are infected. But maps with a predictive capability have not yet been used in epidemiology in any systematic capacity, even though the ability to predict the course of epidemics could help health-care planners in many ways. Several hospitals and health-care facilities are already overwhelmed with AIDS cases, and planning new or expanded facilities requires decisions about where to obtain scarce medical resources. In addition, maps can be motivating when animated. Teenagers and young adults are very difficult to reach in educating behavioral change. Therefore, viewing an AIDS prevalence map might help them understand that the danger of AIDS is everywhere. Delayed Trial of HIV Immune Globulin to Protect Infants of Infected Mothers Is Likely to Resume * Journal of the American Medical Association (01.06.93) Vol. 269, No. 1, P. 17 Cotton, Paul Abbott Laboratories will no longer pursue blocking a trial of a product that may prevent the transmission of HIV from infected mothers to their infants. The group has dropped its demands to be exempt from liability in the trials of HIV Immune Globulin (HIVIG). But it may still be a full year from when a National Institutes of Health-sponsored multicenter trial was supposed to start to when the trial actually does commence. Abbott sold all rights to its HIVIG to North American Biologicals Inc., of Miami, Fla., "including raw materials, some manufacturing equipment, the know-how, everything," as of Nov. 4, according to Abbott spokeswoman Traci Lance. Mark Rosenbaum, an attorney with the American Civil Liberties Union, said it was a "textbook case" of promissory estoppel contract law, except that in this case "thousands of infants' lives and the progress of AIDS research were at stake." He said that liability "never was the real reason" for blocking the trials, as the "so-called risk" was the same when Abbott first proposed the study as when the company raised the issue two years later. Abbott had said that it needed complete indemnification because HIVIG, purified antibodies from healthy persons infected with HIV, might possibly increase the chance of a baby becoming infected. Although Abbott sold everything to North American Biologicals Inc., the NIH is reviewing applications from at least one other producer of HIVIG, the New York Blood Center, to supply it for the trial. If North American Biologicals wins, the trial could begin in the spring because phase-1 studies of the former Abbott product are completed. Cats and Toxoplasmosis Risk in HIV-Infected Adults * Journal of the American Medical Association (01.06/92) Vol. 269, No. 1, P. 76 Wallace, Mark R. et al. The presence of toxoplasmosis in an adult HIV-infected population is unusual and appears unrelated to cat ownership or exposure, write Mark R. Wallace et al. of the U.S. Naval Hospital in San Diego, Calif. Serial toxoplasma antibody results were available for 723 patients. A total of 70 patients (9.7 percent) were positive on their initial screen; the seronegative patients were tested annually for 1 to 5 years (mean duration of follow-up, 2.1 years). Only 13 patients (2.0 percent) who were initially seronegative acquired antibodies to Toxoplasma gondii. None of the patients who seroconverted developed clinical disease. A pet history was available on 12 of 13 patients who seroconverted; only one (8.3 percent) had owned or lived in a household with a cat during the period of seroconversion. The calculated attributable risk of cat ownership/exposure for toxoplasmosis seroconversion in this population is -2.9 per 100 persons annually. Cat owners who are initially seronegative for toxoplasmosis can be assured that their pets pose them no major risk for seroconversion and possible subsequent toxoplasmic encephalitis. But patients who own cats would continue to be advised to exercise reasonable caution while emptying or otherwise working with litter boxes, as close contract with cat feces is an established means of transmission in certain settings. Daily emptying of litter boxes in addition to prompt handwashing can serve to further prevent the risk of toxoplasmosis in those who empty litter boxes, the researchers conclude. FDA OKs New Fast-Track Blood Infection AIDS Drug * American Medical News (01.18.93) Vol. 36, No. 3, P. 19 The first drug to treat a blood infection in patients with advanced AIDS has been approved by the Food and Drug Administration. The drug, rifabutin, has been on a fast track through the FDA since an advisory committee gave approval last February. Clinical tests have exhibited the efficacy of rifabutin in blocking or delaying Mycobacterium avium complex, or MAC, which occurs in about 25 percent of patients in late stages of AIDS. The trials, performed on 1,100 AIDS patients, revealed that the drug decreased the rate at which patients developed MAC by almost half. Its side effects include rash and gastrointestinal symptoms, muscle and joint aches, discolored urine, and a decrease in certain white blood cells, said the FDA. 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 01.18.93 ]]]]====----- .