-----===[[[ A I D S w i r e D I G E S T 02.22.93 ]]]===----- "Bill Seeks to Coordinate NIH Research on AIDS * Washington Post (02.22.93), P. A4 Brown, David The question of whether or not a more centralized AIDS research effort would help put an end to the AIDS epidemic is currently being raised by researchers. Last week, the Senate passed a bill that would give more power to the National Institutes of Health's Office of AIDS Research (OAR) and make its director, if not a "czar," then at the very least an official with unprecedented authority over how the government spends money studying the disease and searching for a cure. The bill requires the office to develop an overall budget for AIDS research and eventually acquire major influence in the decisions of what scientific questions will be most researched- -and funded. But many scientists are skeptical that central planning will lead to better science and are fearful that a new AIDS coordinating office will add another layer to the NIH bureaucracy and possibly slow the pace of research. The proposal was written into the Senate version of the NIH Revitalization Bill by Sen. Edward M. Kennedy (D-Mass.). A House subcommittee will consider a similar bill on Tuesday. The Senate bill calls for the OAR to have a full-time director with no other responsibilities at NIH and an advisory council of scientists and lay people. The director would decide what is the best balance of basic and applied research and how much should be done inside and outside the NIH. The OAR director would have full authority over the AIDS budget, which could not be altered by the head of NIH or the secretary of Health and Human Services. Engineered Blood Factor for Clotting Passes Tests * Journal of Commerce (02.22.93), P. 9A A genetically engineered form of a blood clotting factor has been found to be safe and effective in a long-term test of children with the most severe type of hemophilia, according to a report published in Thursday's New England Journal of Medicine. People who suffer from hemophilia A lack what is known as factor VIII. Approximately 1 in 10,000 males are born with hemophilia A, but females rarely suffer from the condition. Factor VIII has previously been extracted from donated blood. But filtering out deadly viruses, including HIV, has been difficult even though significant progress has been made in attempts to distinguish blood-borne illnesses. The study shows that genetically engineered factor VIII made by Miles Inc. was safe among infant test subjects, a group selected because they had never received any treatment for hemophilia. The safety and efficacy of the engineered factor VIII among patients previously treated for hemophilia have been proven in earlier studies. An additional 75 patients have now been treated and the entire group has been followed for a longer period. The researchers examined 95 hemophiliacs given the genetically engineered factor VIII between Jan. 1 1989, and July 1, 1992. The median age of the subjects at the time of first treatment was about nine months. The treatment demonstrated its effectiveness in every case with only three reports of minor side effects in the 3,315 times it was administered. Forgotten in World of AIDS * Los Angeles Times (02.21.93), P. A1 Schoch, Deborah Although women account for a small percentage of AIDS cases in the United States, they are contracting the disease at a much quicker pace then men. Women comprise 27,000--or 11 percent-- of the 250,000 AIDS cases reported nationwide since 1981. But they are becoming infected at a higher rate than men, often through heterosexual sex--the fastest-growing means of infection among women. The Center for Disease Control reported last year that the number of newly reported AIDS cases among women was 9 percent higher than the year before, compared to a 2.5 percent increase in new cases among men. However, women lack the support network that the male homosexual population has established over the last decade. Women often suffer their disease alone, due to the lack of medical attention to their unique problems. Because few doctors would expect middle-class women to have AIDS, it makes it that much more difficult for infected women to find help. In addition, some don't discover for years that they have HIV infection because their doctors don't consider them at-risk. Now, as gay men did a decade ago, women are beginning to start their own support groups. More than a dozen women's support groups have emerged across Los Angeles, Calif. One of them, the Hermosa Beach group, consists mostly of middle-class women who kept their illness a secret. These women are considered lucky, because most have health insurance, giving them access to private physicians. Also, most have husbands or partners, and some have children. The support group was formed in the summer of 1991 under the sponsorship of Women at Risk, a small foundation that now operates two other groups in Santa Monica and San Luis Obispo. The Sharp Edge of Hope and Fear * New York Times (02.21.93), P. 29 Navarro, Mireya Since new findings were reported last week that a potentially promising strategy could inhibit HIV's spread, a familiar hopefulness was exhibited by many AIDS patients. Phone lines were inundated with calls from thousands of people asking how they can enroll in the trials to test the therapy or where they can buy the drugs to try them on their own. The news dominated discussions in support groups, medical offices, and social gatherings where people with HIV meet. The latest research finding was a report that a combination of three drugs prevents HIV from replicating in test tubes. The three drugs--AZT, DDI, and an experimental one, nevirapine--attack an enzyme that makes copies of the virus's genetic material. This forces HIV to try to evade the drugs through a number of mutations that are incompatible with replication, thereby rendering it incapable of spreading. Officials from the National Institutes of Health in Bethesda, Md., said drug trials were expected to begin by July. But on Friday, more than 100 patients had signed up at New York Hospital-Cornell Medical Center in New York City, which says it plans on being one of the locations for the test. Dr. Daniel Hoth, director of the AIDS division for the National Institute of Allergy and Infectious Diseases, which is planning the drug trials, said Friday that the drug is not available for sale or importation because it is still in the experimental phase worldwide. Dr. Hoth added that medial sites for the trials or their number have not yet been selected. He did say that parallel trials for children are currently being developed. Students Get Chance to Compare Condoms * United Press International (02.22.93) (Dekalb, IL) The student health service at Northern Illinois University will be providing 5,000 gift packs of condoms containing seven brands, along with a form asking students to evaluate them as part of the university's safe-sex campaign. The effort, called the Great Condom Rating Contest, begins Monday and runs through Friday. The ratings are also a change from the way the health service has traditionally tried to encourage condom use. The health service previously relied on radio spots. Condoms used for the contest were donated by condom manufacturers, who will receive the data collected from the ratings contest. University Health Service Director Michael Haines said, "Many people think that all condoms are alike. If they have a bad experience with the first one they try, they write them all off." He added, "We're not saying students must use all seven and provide us with a detailed analysis. We're trying to introduce students to the idea that there is more than one type of condom." Although it is unclear exactly how many of the 24,500 students would participate in the contest, 78 percent of students claim they are sexually active. But Scott Stoking, a campus minister at Christian Campus Ministry, mentioned that condoms are not 100 percent effective against preventing infection with sexually transmitted diseases (STDs). However, Haines said the health service has promoted condoms and safe sex since 1989, and the rate of students with STDs has dropped by half, from 8 percent to 4 percent. The Illinois Post-Secondary HIV Prevention Project helped sponsor the event by providing a $1,000 grant to the university. Business Responds to AIDS Program--December 1992- February 1993 * Morbidity and Mortality Weekly Report (02.12.93) Vol. 42, No. 5, P. 95 Since the Business Responds to AIDS (BRTA) program was begun on Dec. 1, 1992 by the Centers for Disease Control, business and labor groups, the media, state and local health agencies, and AIDS organizations have reported that it is effective in providing a background for development of workplace anti-AIDS policies. BRTA is a public and private collaboration comprised of five components: policy development; training for supervisors and union leaders; HIV education for employees; HIV education for employees' families; and community service and employee volunteerism. In October and November 1991, advance information on the BRTA teleconference was sent to 35,000 corporations with communication systems that could receive the broadcast. After the broadcast, the BRTA teleconference was reported on stations in 64 of the nation's largest 75 television markets and in major newspapers. It has been found that communities in nearly 33 states and the District of Columbia have used the BRTA teleconference as a means to involve local business leaders with public health and AIDS groups to promote HIV workplace education. About 1,500 managers from a national insurance company watched the broadcast at 165 sites through an in-house corporate television network. The BRTA Resource Service at the CDC's National AIDS Clearinghouse received 3,047 requests for assistance from Dec. 1, 1992 through Feb. 5, 1993. During the same time period, the Resource Service also received orders for 1,844 managers kits to be used in HIV education for employees. Those groups contacting the Resource Service included small businesses, state and local health agencies, large multinational and national corporations, and labor organizations. Heterosexual Transmission of HIV: To the Editor * Journal of the American Medical Association (02.17.93) Vol. 269, No. 7, P. 870 Rodrigues, Laura C. and Moreno, Claudia Garcia Safe sex should be practiced at all times among women who do notJwish to become pregnant, and conditions should be created to make this possible for women, write Dr. Laura C. Rodrigues and Dr. Claudia Garcia Moreno of the University of London in England. The authors write that they are pleased to see a feature in the medical literature in the Journal of the American Medical Association discussing the right health education message, but this might not be enough to protect women against HIV infection. Dr. Guinan's assertion that a comprehensive program to prevent HIV infection in women should stress "having one lifetime partner" fails to be realistic, the authors say. If most heterosexual intercourse involving infected individuals took place in stable relationships, long- term partners would be most at risk from unprotected sex. A study in Sweden found that 53 heterosexual partners of people with HIV infection were infected--32 by steady partners and 21 by casual partners. In the United Kingdom, 80 percent of women with heterosexually contracted HIV were infected by a long-term partner. The emphasis on promiscuity and prostitution in research on AIDS and women, especially in Africa, may reflect an interest in women as transmitters, rather than recipients, of infection. The focus on monogamy ignores the fact that a growing number of men are infected, and mostly not through heterosexual contact. The emphasis on monogamy can also give women a false sense of security--making women believe they do not need to practice safe sex because they only have one partner, conclude Rodrigues and Garcia Moreno. Heterosexual Transmission of HIV: In Reply * Journal of the American Medical Association (02.17.93) Vol. 269, No. 7, P. 870 Guinan, Mary E. Safe sex is not clearly defined in Drs. Rodrigues and Garcia Moreno's letter to the editor, and therefore their recommendations are unclear, writes Dr. Mary E. Guinan of the Centers for Disease Control in Atlanta, Ga. The risk of HIV infection increases with the number of sex partners. Children should be educated that having intercourse with multiple partners is unhealthy and they should also know how to protect themselves if they choose to have sex. Both of these messages should be heeded by adults, also. Which one to emphasize depends on the particular clinical situation, but neither message should be avoided, concludes Dr. Guinan. AIDS Hits Blacks and Latinos Hard, Commission Says * Advocate (02.23.93) No. 623, P. 23 Coward, Cheryl The National Commission on AIDS reported on Jan. 11 that the spread of HIV among black and Latino communities is becoming rampant, and urged the federal government to stop considering AIDS as a disease of gay white men and start treating it as an ethnic issue. The report states that blacks and Latinos account for 46 percent of all known AIDS cases in the United States, although they only comprise 21 percent of the American population. The reported number of new AIDS cases increased 11.5 percent among Hispanics and 10.5 percent among blacks between 1990 and 1991, the report said. However, the number of reported cases among whites dropped 0.5 percent during the same period. The commission said, "The cumulative effects of racial discrimination, the chronic lack of access to resources, and the resulting underdevelopment of community infrastructures have had lasting effects." Raul Yzaguirre, president of the National Council of La Raza, a Latino Political group, said the report was "a long-awaited acknowledgment from the federal government that AIDS poses a special challenge to minorities. We commend the commission for recognition that the spread and virulence of the AIDS epidemic among minorities reflect not a predisposition but rather the result of a complex set of factors." The report also urged the federal government to take immediate action to deal with AIDS among Asian-Americans and Native Americans, even though these groups are not currently disproportionately affected by the disease. Dossier: Move Over, Elvis * Advocate (02.23.93) No. 623, P. 9 The U.S. Postal Service will release an AIDS awareness postal stamp at some point this year, but no definite date has been disclosed. Jean Ann Hlavacek, a Madison, Wis., resident who has lobbied the U.S. Postal Service to issue the stamp for the past six years, designed the stamp in 1986. She obtained support from several members of Congress, former U.S. Surgeon General C. Everett Koop, National Commission on AIDS Chair Dr. June Osborn, and actor Jimmy Stewart. But Hlavacek says, "the stamp had to be placed before the committee more than a dozen times before approval came through." Even though the postal service says the stamp will be used some time this year, it has not confirmed whether Hlavacek's design will be used. Nevertheless, Hlavacek says the stamp will use the words prevention, research, education and compassion, which are all part of her design. Uganda, Scarred by AIDS, Turns to Its Youth * New York Times (02.23.93), P. A1 Lorch, Donatella Due to the rampant spread of HIV infection in Uganda, about 1.5 million to 2 million children have been left without fathers. Most of these have also lost their mothers. Many orphans survive and educate themselves on their own. A 1991 census of the Rakai and Masaka districts showed that one child in four was an orphan. The Ugandan government has been reluctant to establish orphanages because it believes this to be economically and socially impractical. The aim in such a poor country, where more than 85 percent of the residents farm, is to keep the AIDS orphans on their land--their only insurance for the future. After grandparents die, community residents take care of the orphans. But AIDS orphans are only one devastating aspect of the epidemic in Uganda. The Ugandan government predicts that 9 percent of Uganda's 16.7 million people are infected with HIV. The Ugandan AIDS Control Program projected in December a total of about 38,500 cases of AIDS--up 17,000 from the year before. Godwill Asiimwe-Okiror, an epidemiologist for the program, said the figure might be closer to 380,000. However, only 30 percent of Ugandans are in regular contact with health-care professionals. The disease has changed much of Uganda's social life. Kampala's brothels have been closed, and truck stop hotels on the main highways where prostitutes were abundant are now hurting for business. The Agency for International Development expects to distribute five million condoms in Uganda in 1993, which actually is not a lot when the statistics are considered. Tortuous Route to an AIDS Vaccine * USA Today (02.23.93), P. 4D Painter, Kim Although there are several AIDS vaccines currently in clinical trials, it could be 10 to 15 years before one could be used in large numbers of people. Dr. Bernadine Healy, director of the National Institutes of Health, said at a recent New York Symposium on AIDS vaccines, "I think it's fair to say no one of these vaccines in early testing ... appears to stand out." However, she says she is optimistic about the prospects for therapeutic vaccines, which help people who are already HIV- positive. Most vaccines being studied--for both preventative and therapeutic uses--are made with pieces of HIV that cannot cause illness. These vaccines appear to be safe and boost immune responses in volunteers. Yet no one knows whether these responses can protect humans from actual HIV infection. Moreover, scientists don't know what an effective response is. One promising method was tested in a recent monkey study. Harvard Medical School researcher Ronald Desrosiers gave healthy monkeys live simian immunodeficiency virus, the monkey form of HIV, weakened by the removal of one gene. The monkeys contracted HIV but did not become ill. Subsequently, they received massive doses of real SIV and stayed healthy-- indicating that the altered virus allowed their immune systems to resist infection. While the finding may be promising, no other approach is so risky. The worst-case scenario is that a live weakened virus could quickly switch to a deadly form. Desrosiers is more concerned that weakened viruses might cause cancer or a delayed form of AIDS several years after vaccination. He said the first human trial would have to be small and might take many years. AIDS and the Changing Face of Pneumonia * Washington Post (Health) (02.23.93), P. 12 Colburn, Don The AIDS epidemic has had a dramatic impact on the pattern of pneumonia cases in hospital intensive care units. Pneumocystis carinii pneumonia (PCP), once one of the rarest types of pneumonia, is currently the most common AIDS-related condition. Frederick L. Ruben, a lung specialist at the University of Pittsburgh School of Medicine and University Montefiore Hospital in Pittsburgh, said, "Before, the only time it was seen was in severely malnourished children or kidney transplant patients. Even infectious disease specialists wouldn't see a case in five years. Now you can't go a week without seeing a case." According to a recent study at a community hospital in San Francisco, the AIDS epidemic "has profoundly affected the spectrum of pneumonia in intensive care units." Of the 1,854 patients treated in the hospital's ICU over a three-year period, one out of seven had pneumonia. Of those, 29 percent were HIV-positive. PCP accounted for more cases--28 percent-- than any other type of pneumonia in the San Francisco ICU study, which was published in the Western Journal of Medicine last December. In all 74 cases of PCP, the patient was also infected with HIV. But four previous studies of pneumonia in ICUs during the 1980s had no reported cases of PCP. The study demonstrated a sharp contrast in the age pattern, also. Before the AIDS epidemic, fatal pneumonia struck mainly the elderly or very young children. But in the San Francisco study, older pneumonia patients had a much higher survival rate. The difference is the direct impact of the AIDS epidemic, which affects mostly young and middle-aged people. Two Firms Collaborate on Hemophilia Project * Baltimore Sun (02.23.93), P. 11D Bowie, Liz Genetic Therapy Inc. and CytoTherapeutics Inc. have signed an agreement to collaborate on research to discover a new way to deliver a treatment for hemophilia B. CytoTherapeutics has made a semipermeable polymer membrane that could be implanted in a patient's body to deliver a drug. Genetic Therapy has genetically modified cells that produce a protein called Factor IX to treat hemophilia. The two companies seek to combine the technologies, which will allow Genetic Therapy's protein to be slowly released through CytoTherapeutics' membrane. Dr. Condom Gets Scant Protection From Critics * Los Angeles Times--Washington Edition (02.23.93), P. C5 Drogin, Bob President Fidel Ramos of the Philippines unexpectedly named a little-known rural health expert as his secretary of health last summer. Juan M. Flavier has since evoked controversy throughout the country. The reason for opposition against Flavier in a predominantly Roman Catholic country is his unprecedented aggressiveness in attacking the AIDS epidemic and promoting birth control. Consequently, Flavier has been condemned by the nation's churches. He has been labeled "condom pusher" and "moral pollutant" in editorials. But Flavier says he welcomes the criticism because it may publicize his campaign for contraceptives. The Philippines has 368 confirmed cases of HIV infection, including 89 cases of full-blown AIDS. However, Flavier said the actual total is probably at least 10 times higher. He said a full-scale epidemic is "still preventable." Therefore, he decided to implement an anti-AIDS program that involves the distribution of condoms and safe-sex information. Catholic leaders have condemned condoms as a "simplistic and evasive" approach to AIDS that creates a "false sense of complacency." The anti-AIDS program will focus on the country's urban red-light districts, military camps, universities, returning overseas workers, and truck drivers. And blood banks will soon be registered. Flavier said, "Times are changing. No matter what they say, AIDS is a reality ... My message is be good. If you can't be good, be careful. If you can't be careful, use a condom." In the Nation: 10 Sites Tentatively Set for New AIDS Therapy * Baltimore Sun (02.23.93), P. 9A Federal health officials announced yesterday that 10 research sites were tentatively named to host human trials of the AIDS therapy which uses a combination of three drugs to inhibit the spread of HIV. Research has demonstrated that the therapy can block a key enzyme in the development of HIV, although the treatment's safety and efficacy in humans is undetermined. The sites being considered for the trials are Albert Einstein University in Bronx, N.Y.; Cornell University in New York; the Harvard University consortium of Boston, Mass.; Northwestern University in Chicago, Ill.; the University of Alabama in Birmingham; the University of California--San Diego; the University of Colorado in Denver; Florida's University of Miami; the University of Minnesota in Minneapolis; and the University of Southern California in Los Angeles. The National Institutes of Allergy and Infectious Diseases said the trials are expected to begin in the spring. Chronicle: A Death From AIDS Inspires a Book and Activism * New York Times (02.23.93), P. B4 Brozan, Nadine A book will be published next week that addresses the author's feelings about her brother's death from AIDS. Barbara Lazear Ascher wrote "Landscape Without Gravity: A Memoir of Grief," based on her feelings about the death of her brother, Robert Allen Lazear Jr., in 1989 at age 31. But writing the book did not seem enough for her. She said, "I tried to think over a long period of time how I could somehow use the book to do something bigger for the AIDS effort." She said she would not donate proceeds from the sales of the book. "The first printing goes to pay the advance and there would be nothing left for AIDS," she said. Lazear Ascher made a donation to the Gay Men's Health Crisis, and in return 10 days ago she received a red metal pin that was a replica of the AIDS ribbon. "As soon as I saw it, I knew what I was going to do." She added, "I bought $500 worth of pins from GMHC, and when my publishers heard what I was doing, they said they would match it." When 160 people who buy the book in any of six shops in Manhattan--Books and Company, the Corner Bookstore, Madison Avenue Bookshop, Burlington Books, Endicott Booksellers, and Shakespeare & Company--they will receive a pin, also. When the pins run out, regular red ribbons will be given to purchasers of the book. The AIDS Disaster Unfolding in Asia * Business Week (02.22.93) No. 3306, P. 52 Barnathan, Joyce The rampant spread of HIV in Thailand may soon be representative of Asia and could have an acute effect on economic development. It is common for men in Thailand to routinely visit prostitutes, but they are contracting HIV in large numbers as a result. As many as 600,000 Thais are infected with HIV already out of a population of 57 million, and up to 1,200 new cases are expected daily. Thailand may be a model for the rest of Asia. The World Health Organization estimates that nearly 40,000 adults already have developed symptoms of AIDS in Asia. WHO also projects that more than 1 million adults in Asia will become infected with HIV each year, exceeding the infection rate in Africa. But there are still a lot of misconceptions of AIDS. People in China have reportedly burned money and paintings handled by people with AIDS. And a study of 1,000 Asian employees of a large international bank demonstrated that 20 percent believed AIDS was a disease that only affected homosexuals or Westerners. But today most governments understand that their own cultural and social habits, such as prostitution, have formed a breeding ground for what is now an overwhelmingly heterosexual disease. However, most governments avoid implementing aggressive anti-AIDS programs for cultural, religious, and political reasons. Companies in Asia are expected to be hit hard by the epidemic if they suddenly begin to lose experienced workers to AIDS, and they may have to rethink the entire operating climate in the Asian Pacific region. Students: If School Won't Distribute Condoms, We Will * American Medical News (02.15.93) Vol. 36, No. 7, P. 20 Students in a suburb of Milwaukee, Wis., say that if their school does not distribute condoms on demand, then they will do it themselves. Kathryn Lounsberry, a freshman at Shorewood High School, said, "All of us have friends who are not virgins anymore, and that's why we're doing this. This is a serious problem. Kids are having unprotected sex." Lounsberry, as well as five other students, came before a school board committee in December 1992 to request that the school health office provide condoms to students who want them. If their proposal is approved, the school would be the first in Wisconsin to make condoms available to students. If it is rejected, the students expect to ask Planned Parenthood of Wisconsin for free condoms and then distribute them. Later this month, the school board's Health and Human Relations Committee will consider the students' request. An alternative proposal by the students will be discussed by the Shorewood Board of Health that requests that the Shorewood Health Department distribute the condoms. Seattle Plans Distribution * American Medical News (02.15.93) Vol. 36, No. 7, P. 20 The Seattle School Board recently voted to allow condoms to be distributed in three high school health clinics starting in April. Unanimous support was also given toward distributing condoms at two other high schools where health clinics are scheduled to open this spring, and to put condom dispensers in its seven other high schools without clinics. In addition, an updated health and sex education program that stresses abstinence for grades nine through 12 was endorsed by the board. Condoms will be provided the first year by the county health department. But after that, the district will work with King County and outside companies to obtain supplies. The Seattle public school district is the first in Washington to implement a condom distribution program. Survey Says Sex Is Back as Young and Old Put Fears Aside * Reuters (02.22.93) (New York) Sex is making a comeback in the United States despite the looming AIDS crisis, according to a new study. "The Janus Report on Sexual Behavior," which is believed to be the first in-depth look at American sexual mores since the 1940s Kinsey Report, examined the changes in sexual attitudes and practices in America in the early 1980s and early 1990s. It involved nearly 8,000 people aged 18 to 80 who were followed over a nine-year period. After a bout of abstinence and prudence prompted by the fear of AIDS and other sexually transmitted diseases (STDs), mainstream Americans have resumed active sexual lifestyles, causing what the study considers a "second sexual revolution." The survey found that 62 percent of American men and 66 percent of women aged 18 to 26 were currently having more sex than they were three years ago. About 48 percent of single men and 45 percent of single women claimed to have become more sexually active at a time when the AIDS epidemic had taken hundreds of thousands of lives. While 80 percent of the men and women surveyed said they were concerned about contracting an STD, AIDS is considered "primarily a problem of the poor and gay communities," according to the study. The report found that an increasing number of children aged 10-12 are having full sexual relations--18 percent of boys and 6 percent of girls had intercourse by age 14. Women with the highest level of education had the greatest number of sex partners--twice as many as any other group of women. Also, 10 percent of men and 4 percent of women had sexual relations with more than 100 partners, the study revealed. French AIDS Lobby Warns Right Off Forced HIV Tests * Reuters (02.23.93) (Paris) French AIDS patients have initiated a campaign against mandatory HIV testing and other measures they believe a center- right government may implement if it comes to power next month. ACT-UP is coordinating a joint effort by AIDS organizations in France. A center-right coalition, expected to win power in next month's parliamentary elections, did not mention the AIDS epidemic in its election platform. Spokeswomen for the two coalition parties said that neither had an official stance on mandatory HIV testing. Politicians on both the left and right have supported mandatory testing as the only way to determine the impact of the epidemic. ACT-UP officials said leading center-right politicians had told them that they supported required HIV testing and suggested that legal guarantees on the confidentiality of medical records may not be possible for HIV- positive individuals. But enforced testing and a lack of confidentiality will discourage people most at risk from seeking advice and treatment, according to AIDS activists. The campaign is collecting signatures for a nine-point Charter Against AIDS and is planning a rally in Paris on March 6. The AIDS campaign also intends to draw attention to demands for increased government funding for AIDS prevention and care. France has one of the highest AIDS case loads in Europe, with 24,000 diagnosed with the disease as of September 1992, and an estimated 12,5000-13,500 deaths, according to official data. Nearly 150,000 to 250,000 French people may be infected with HIV. AIDS Threat to China's Richest Province * Reuters (02.23.93) (Beijing) The AIDS epidemic may have a significant impact on the wealthiest province in China as a result of the increased use of IV-drugs, reported the China Daily on Tuesday. A total of 55 people have tested HIV-positive in Guandong out of a population of 63 million, according to a local official. About two-thirds of the HIV-positive individuals were local Chinese, most of whom were infected while traveling overseas. Others were drug addicts, said the official. Heroin and opium flowing from the poppy fields of southeast Asia to the West goes through Hong Kong and Macau, close to where Guandong is located in southern China. The province's wealth has given rise to a huge prostitution industry that accommodates both foreign travelers and local Chinese, homosexual and heterosexual. JLast week, the People's Daily newspaper quoted a Guandong official as saying that the province would step up its HIV testing program for foreigners seeking admittance. But officials in Hong Kong question whether such testing would be effective in thwarting the spread of HIV and fear it might elicit a false sense of security among those who test HIV-negative. Guandong currently tests frequent travelers at random, which has proven to be a large nuisance. The province began its HIV testing of the population in the mid 1980s. China has a total of 890 HIV- infected residents, most of them in the Yunnan province on the Burma border. Amid Uproar, China Halts AIDS Testing of Visitors * Reuters (02.23.93) (Beijing) China on Tuesday discontinued its HIV testing of visitors arriving in the southern Guandong province, after receiving strong opposition from Hong Kong, the British colony's media reported. Border officials in the provincial capital Guangzhou and at the Hong Kong border admitted to the suspension, but neglected to say why or for how long it would be in effect. This month, officials began random HIV testing of travelers. Hong Kong media reported that China's health ministry declined to comment on the move, saying a statement would be released after discussions on Wednesday between Beijing officials and Hong Kong Health Secretary Elizabeth Wong. Business and medical communities in the British colony have condemned the random tests, claiming they are ineffective, insensitive, inconvenient--and potentially dangerous if border stations collect blood samples with used needles. Even more alarming is that the mandatory HIV tests apply to anyone visiting China more than 12 times a year, a obligation which critics say unfairly burdens Hong Kong's tens of thousands of frequent visitors. Wong said she would pressure China to re- evaluate the program. "Our mission is to reflect Hong Kong people's concern to the Chinese authorities, to better understand China's arrangements for HIV tests ... and to explore ways of minimizing inconvenience to travelers, particularly for frequent travelers from Hong Kong," said Wong. Local officials revealed Tuesday that the number of reported HIV cases stood at 340. Obituaries: Robert Rafsky, 47, Media Coordinator for AIDS Protesters * New York Times (02.23.93), P. B7 Howe, Marvine Robert Rafsky, a renowned AIDS activist and public relations executive, died of AIDS on Saturday at New York University Medical Center. Rafsky was a senior vice president of Howard J. Rubenstein & Associates, the New York City public relations firm, from 1982 to 1989. He left the firm in 1989 to devote full time to helping ACT-UP become the leading AIDS protest group in the nation. While serving as the media coordinator of ACT-UP/New York, Rafsky helped focus attention on the AIDS epidemic. He also was a member of ACT-UP's treatment action group, in which he was involved in efforts to hasten federal approval of AIDS drugs and helped convince drug manufacturers to reduce prices and improve distribution. Last March, Rafsky was televised challenging Bill Clinton during a Democratic fundraiser about the candidate's AIDS policies. He asked, "What are you going to do about AIDS? We're dying!" At the time of Rafsky's death, he was working on an autobiography about his work as an AIDS activist tentatively titled, "A Letter to Sara," a reference to his daughter. Related Story: Washington Post (02.23) P. B7; Philadelphia Inquirer (02.24) P. F8 Hemacare Acquires Exclusive U.S. National Rights... * Business Wire (02.22.93) (Los Angeles) HemaCare Corp. announced Monday that its restricted license for Passive Hyperimmune Therapy (PHT), a potential treatment for AIDS, has been extended from California to the entire United States through a new contract with Medicorp Inc. HemaCare obtained a license in December 1989 that was restricted to the state of California, and it has been conducting clinical trials on the therapy since January 1991. Hal Lieberman, HemaCare's president and chief executive officer, said, "This expansion of the PHT license facilitates our ability to go forward with national clinical trials and subsequent national commercialization pending FDA approval." HemaCare has been developing and testing PHT since 1990 and holds certain proprietary rights and orphan drug status for the product. A HemaCare Phase I/II clinical study of PHT demonstrated that the treatment is non-toxic and may improve the survival in recipients of the drug by boosting their immune systems. The company is currently awaiting approval by the California State Department of Health Services, Food and Drug Branch, of a Phase III extension of the PHT study, which would allow treatment of up to 1,000 AIDS patients. Aside from providing mobile therapeutic hemapheresis services to hospitals, HemaCare makes blood-component products produced using hemapheresis technology and comprehensive donor-screening methods that decrease patient risk of contracting hepatitis, HIV, and other blood-borne diseases through transfusions. S. Africa OKs Condom Ads * Advertising Age (02.15.93) Vol. 64, No. 7, P. I-6 Barnes, Kathleen The highly conservative South Africa Broadcasting Corp. (SABC) has implemented a condom advertising campaign and has received very few complaints. The first condom ad was broadcast in December after an intense debate among network trustees. The only ads accepted so far have been for London Rubber Co.'s Durex brand. Barry Kaye-Eddie, the agency's executive chairman, said, "We saw SABC advertising people continuously. We feel it is quite morally wrong to not put people in a position of knowing that using a condom provides protection." SABC executives finally agreed, citing the AIDS epidemic and the need for population control in South Africa. Following a great deal of discussion, the SABC board issued a ruling permitting some condom advertising. The board mandated that the condom spots be aired only after 9 p.m., and that audience reaction would be "closely monitored." Durex is the only brand currently being advertised on SABC's TV-1, targeted largely at white viewers, and SABC's CCB, which is directed at a predominantly black audience. The three 20-second spots are prudent, and the word "condom" is never mentioned in any of the ads. The President: Hedging an AIDS Pledge? * Newsweek (02.22.93) Vol. 121, No. 8, P. 6 President Clinton may be backing off his campaign promise to lift the ban on HIV-positive foreigners seeking admittance into the United States. Regardless of the recent reports that the president would soon eliminate the 1987 ban on U.S. travel and immigration by people who are infected with HIV, White House sources say Clinton is more likely to hedge his promise. The sources say he will permit free movement to tourists, but will keep the restriction against immigrants. Following controversy over gays in the military, the sources say, the White House didn't want to risk another messy dispute just as Clinton was about to reveal his economic package. The news that Clinton would follow through with his campaign pledge came from a memo leaked by the Department of Health and Human Services. White House Press Secretary Dee Dee Myers confirmed it and cited Clinton's campaign booklet, "Putting People First." However, after signs of protest on Capitol Hill, White House aides quickly announced that whoever leaked the memo was "stupid or ill motivated." Idiopathic CD4+ T-Lymphocytopenia--Four Patients With Opportunistic Infections and No Evidence of HIV Infection * New England Journal of Medicine (02.11.93) Vol. 328, No. 6, P. 393 Duncan, Robert A. et al. Although lifelong suppressive therapy is recommended for many AIDS-related conditions, it is unclear whether similar principles apply to patients with idiopathic CD4+ T- lymphocytopenia (ICL), write Robert A. Duncan et al. of Boston City Hospital and University Hospital Boston University School of Medicine in Boston, Mass. Four patients without major risk factors for HIV infection were examined, each of whom was presented with severe opportunistic infections and was found to have ICL. The opportunistic infections experienced by the ICL patients included Pneumocystis carinii pneumonia (PCP), cryptococcal meningitis, and histoplasma-induced brain abscess. During 10 to 68 months of observation, none of the four patients had evidence of infection with HIV type 1 or 2 or human T-cell lymphotropic virus type I or II on the basis of epidemiologic, serologic, or polymerase-chain-reaction studies or culture, nor was there any detectable reverse transcriptase activity. While all of the patients had severe persistent CD4 T-lymphocytopenia (range 12 to 293 cells per cubic millimeter), the CD4 cell count progressively declined in only one and was accompanied by multiple opportunistic infections. All four patients had substantially reduced numbers of circulating CD8+ T cells, natural killer cells, or B cells. These four patients had ICL with opportunistic infections but no sign of HIV infection. Instead of the progressive, selective depletion of CD4 T cells characteristic of HIV infection, some patients with ICL have stable CD4 T cell counts accompanied by decreases in the levels of several other lymphocyte subgroups, the researchers conclude. Questions Raised About AIDS Case * Los Angeles Times--Washington Edition (02.25.93), P. A6 Cimons, Marlene A report published yesterday in the British journal Nature raised questions about whether a Florida dentist who died of AIDS--accused in a highly publicized case of infecting five patients with HIV--actually was the source of transmission. Ronald W. DeBry, an evolutionary biologist in Florida State University's department of biological science and one of the researchers in the report, said, "We are not saying that the dentist did not infect the patients--we're saying you really can't prove it one way or the other." The case of Dr. David Acer was the only reported instance of HIV transmission from an infected health professional to a patient since the AIDS epidemic began in 1981. Officials from the Centers for Disease Control, who conducted the first investigation and have concluded that Acer was the source, criticized the Nature report, saying that it ignores significant additional proof that points to the dentist. The CDC investigation indicated that none of the five infected patients had any known high risk behaviors that would have made them more vulnerable to infection. DeBry and his colleagues used molecular sequencing techniques in the study and analyzed viral samples obtained from all of Acer's infected patients. They also compared these samples to known information about the strain that infected Acer, even though they did not have an actual sample from the dentist. The strains of HIV were then compared to "control" samples obtained from HIV-positive individuals in Florida who had no known connection to Acer. They discovered that "there is not enough difference between the dental group sequences and the control sequences to prove that these [dental] sequences are a separate set," said DeBry. Related Story: Baltimore Sun (02.25) P. 17A Sexually Transmitted Diseases Down in State * Boston Globe (02.24.93), P. 23 Kong, Dolores The rate of sexually transmitted diseases (STDs) in Massachusetts dropped in 1992 for the second year in a row. However, teenagers and minorities continue to be at a higher risk, according to a new report. Although syphilis cases decreased by more than 30 percent, gonorrhea by 40 percent, and chlamydia by 10 percent, there were no statistics on HIV infection. But public health officials believe the decline in the STDs indicates that people are using condoms and practicing safer sex--a change that could also help curb the spread of HIV. The new figures will help AIDS prevention, because the sooner people get treated for infection with an STD, the less inclined they will be to have a genital sore that facilitates the transmission of HIV. Nevertheless, public health officials warn that if the statistics are a true representation, many teenagers, especially non-whites, do not seem to be affected by safe sex messages. A state Department of Education annual survey found that condom use by sexually active high school students increased from 30 percent a few years ago to 58 percent in 1992. It also discovered that in 1992, 70 percent of high school senior boys and 67 percent of high school senior girls reported having had sexual intercourse at least once, but only 49 percent of them reported using a condom in their latest sexual encounter. Among sexually active ninth graders, 75 percent reported using a condom during the last sexual encounter. Public health commissioner David Mulligan said that some of the progress so far can be attributed to his department's teen health program, which provides condoms in schools. Prostitute Infected by HIV Tells of Sex With Thousands * Baltimore Sun (02.25.93), P. 4A An Israeli prostitute who tested HIV-positive in 1991 never returned to the hospital to learn her results, and has since had sex with thousands of men, according to the daily Yedioth Ahronoth, an Israeli newspaper. Rachel Nissani, 23, of Tel Aviv, discovered she tested positive a month ago after a second blood test. Nissani said that since her first HIV test in January 1991, she has had sex with at least six men a day to finance a heroin habit, therefore exposing thousands of men and their subsequent sex partners to the virus. Nissani said she would sue both Ichilov Hospital, where the 1991 test was conducted, and the Health Ministry for negligence, because they did not try hard enough to find her. Dr. David Goldray, director-general of Ichilov, said the hospital tried to locate Nissani after the 1991 test, but she never showed up at the drug treatment center she gave as an address. Nissani underwent the first HIV test because she wanted to enter a drug treatment center, and the test was a condition for being accepted. She resorted to drugs again, but never returned to learn her test results. In another attempt to get off of heroin, Nissani took an HIV test a month ago at a different hospital and was told that she was infected with HIV. Vestar Files for Approval of AIDS-Related Kaposi's Sarcoma Treatment * United Press International (02.24.93) (San Dimas, CA) Vestar Inc. announced Wednesday that it has submitted a new-drug application to the Food and Drug Administration for DaunoXome, its drug that treats AIDS-related Kaposi's sarcoma. DaunoXome has been distributed in Europe to individual patients by Vestar, but the company has not yet received approval to market the drug. Among all of the cancers that are associated with AIDS, Kaposi's sarcoma is the most common. The disease causes lesions of the skin, mucous membranes, and lymph nodes, and often progresses to internal organs, including the lungs and gastrointestinal tract. Kaposi's sarcoma is experienced in approximately 15 percent or more of AIDS patients. Filipino Condom-Users Get Sex Discount * Reuters (02.24.93) (Manila) Due to the threat of AIDS, several prostitutes in the Philippine city of Cebu are offering half-price discounts to clients who will use a condom, according to a Wednesday report in a Manila newspaper. Customers who fail to use a condom must pay the full rate or face rejection, said the Philippine Daily Inquirer. Health Secretary Juan Flavier has implemented a campaign promoting the use of condoms to thwart the spread of HIV infection, despite strong opposition from the country's most predominant religion--the Roman Catholic church. While only 368 people are reported as HIV-positive in the Philippines, officials project the actual figure to be in excess of 36,000. Among those infected, 63 have died of AIDS. Foreign Delegates at German AIDS Congress Worry About Safety * Reuters (02.24.93) (Berlin) Some AIDS experts from foreign countries who plan to attend the 1993 world AIDS conference in Berlin, Germany, are concerned that they could be attacked by German racists, conference organizers said on Wednesday. The organizing committee made a statement saying that everything would be done to guarantee the safety of participants at the 9th annual AIDS congress from June 7 to 11. About 15,000 delegates and 1,000 journalists are expected to attend the meeting. The organizing committee said, "We are getting concerned questions from some countries if the stay in Berlin and Germany will be safe in view of attacks on foreigners." A total of 17 lives were lost last year as a result of right-wing violence in Germany. Congress president Karl Otto Habermehl of the Free University in Berlin said, "I am deeply shaken at the criminal and extremist attacks in our country. We cannot deny them. But we know they have been condemned by the vast majority of our population." Expanded European AIDS Case Definition * Lancet (02.13.93) Vol. 341, No. 8842, P. 441 Ancelle-Park, Rosemary et al. Because of the importance of having a common AIDS case definition in Europe, all European countries should implement the new expanded AIDS case definition, write Rosemary Ancelle- Park et al. of the Hopital National de Saint-Maurice in Saint Maurice, France. The European Center for the Epidemiological Monitoring of AIDS gathered experts in public health and epidemiology participating in the AIDS Prevention and Control Research Program of the European Community in Jan. 1993. The attendees discussed the case definition of AIDS for surveillance purposes in Europe, following the introduction of an expanded surveillance case definition in the United States. The 1993 U.S. revised definition adds pulmonary tuberculosis, recurrent pneumonia and invasive cervical cancer to its list of 23 conditions defining AIDS. Also, it added HIV-positive people who have a CD4+ count under 200 to the list. In 1991, European countries decided that HIV-positive people should not be defined as having AIDS based on CD4 counts alone because of concerns over the accurateness of AIDS surveillance based solely on the degree of immunosuppression, biases that would be introduced in comparing AIDS exposure categories, and possible negative psychological effects on asymptomatic HIV-positive patients. Also, access to medical care in Europe is not based on a person meeting an AIDS definition. After meeting with AIDS surveillance representatives in 38 European countries, this position was reconfirmed by the expert group. The possible inclusion of the three opportunistic infections that the U.S. added to its AIDS definition were examined. It was decided that the addition of these illnesses was valuable for epidemiologic purposes. Orogenital Sex and Risk of Transmission of HIV * Lancet (02.13.93) Vol. 341, No. 8842, P. 441 Spencer, Brenda Recommending to the public that orogenital sex is unsafe is without a question theoretically correct, but the use/efficacy of a method depends not only on its biological efficiency but also on its acceptability to the user, writes Brenda Spencer of the Hopital de Bicetre in Le Kremlin-Bicetre, France. In the Dec. 12 issue of the Lancet, correspondents report that HIV-1 has been detected in the pre-ejaculatory fluid, and conclude that this fluid is therefore a potential vector for sexual transmission of HIV. But these findings bring into question what the chance is that the presence of HIV-1 in the mouth will result in infection of the receptive partner. One of the most difficult things in health education is how to manage uncertainty about risk--as suggested by the confusion as to what defines safe sex. There have been both extremes to the risk of oral HIV transmission. At the 1990 AIDS conference in Montreal, one stand displayed a poster recommending to gay men that they engage in oral rather than anal sex, whereas another ran a video for adolescents advising that deep kissing may present a risk of infection. The latter position neglects to consider the possibility that, faced with a multitude of differing recommendations, the individual may fail to comply with any. Some people have asked whether the belief that orogenital sex carries a high risk of transmission yields an increase in unprotected anal sex. The formulation of safer sex guidelines should consider psychological factors along with any new laboratory discoveries, concludes Spencer. Blood-Product Firm Liable * American Medical News (02.15.93) Vol. 36, No. 7, P. 20 A federal jury last month determined that a blood products company was negligent in the death of a hemophiliac boy from AIDS, and it awarded his family more than $2 million in damages. The parents of Jason Christopher, the 11-year-old who died of AIDS in February 1992, argued that their son contracted HIV through contaminated blood products made by Armour Pharmaceuticals. They alleged that the company knowingly allowed HIV-tainted blood to be transmitted by not issuing warnings that there was a risk of infection. Approximately 20,000 Americans have hemophilia, and half are estimated to be infected with HIV. The lawyer for the Christophers said the verdict would urge blood products companies to settle claims from hemophiliacs who believe they contracted HIV from tainted products. Attorneys for Armour Pharmaceuticals said they have not yet determined whether to appeal what they consider a "sympathy verdict." Dossier: Latex Goes Limp * Advocate (02.23.93) No. 623, P. 10 While a steady growth of condom sales occurred for more than a decade, sales of prophylactics are now slowing down. A.C. Neilsen, which tracks the condom industry, said that condom sales increased by only 1 percent in 1992 after double-digit growth each year for most of the 1980s. Condom manufactures believe the decline is due to a number of factors, including television networks' ban on condom advertising and the heavy distribution of free condoms by AIDS education organizations. However, David Eng, a spokesman for the New York City AIDS service group Gay Men's Health Crisis, sees a more alarming trend. "Many people are so used to hearing about AIDS that they just don't think they need to protect themselves.... It speaks to the government's inability to get the educational message out that everyone needs to use a condom every time they have sex." Around the Region: Hospital Acknowledges Use of Suspected Tainted Blood * Washington Post (02.26.93), P. D3 Five units of donated blood at Suburban Hospital in Bethesda, Md., were mishandled last year when they were transfused into patients, even though the blood preliminarily tested positive for HIV or hepatitis, according to hospital administrators. Officials said subsequent tests proved the blood was not infected and that none of the five patients who received those units contracted either disease. However, officials conceded they did not know the blood was disease-free at the time of the transfusions. As a consequence of the mishandling, one laboratory worker was fired and four were disciplined. Last September, the oversight was revealed during a routine record check of the hospital's blood bank by Federal Drug Administration inspectors. The inspectors discovered that one unit had initially tested HIV-positive and four others tested positive for the virus that causes hepatitis. Hospital officials said yesterday that since the FDA discovery, they have performed periodic blood tests of the donors and four of the recipients, and all have tested negative for both diseases. The fifth recipient died of unrelated injuries two days after the transfusion. AIDS Activists Back Needle Exchange * Boston Globe (02.25.93), P. 25 Hernandez, Efrain In an effort to emphasize Massachusetts' reluctance to implement needle exchange programs to curb the spread of HIV infection among drug addicts, AIDS activists gathered in Boston on Wednesday to promote the benefits of such programs. The third North American Syringe Exchange Convention in Boston aims to draw attention to Massachusetts as one of fewer than a dozen states that prohibit the sale and possession of hypodermic needles and syringes without a prescription, thereby preventing needle exchange programs from being established, according to Larry Kessler, executive director of the AIDS Action Committee of Massachusetts. More than 100 AIDS activists, health department officials, and researchers from across the country are expected to attend the convention, which runs through Saturday. Conference attendees will share experiences with needle exchange programs and examine the approaches that work best, said conference organizer Dave Purchase. Critics of the programs are concerned that such an effort would promote drug use and attract substance abusers to neighborhoods where needles are distributed. But representatives for Gov. William Weld and Boston Mayor Raymond Flynn said that both officials back some form of supervised needle exchange programs, although Legislative approval is needed before programs can be implemented. Among the estimated 40,000 IV-drug users in the state, about 40 percent are infected with HIV, according to activists' and state officials' projections. State Panel Urges Regulations for Sex Clubs * New York Times (02.26.93), P. B3 Navarro, Mireya The New York state AIDS Advisory Council recommended yesterday that New York City shut down commercial sex establishments if they are reluctant to comply voluntarily with state health regulations designed to reduce the transmission of HIV. The council said in a written report that such places pose "a substantial risk" for transmission of HIV, as well as sexually transmitted diseases. However, it added that the establishments could also be used to educate patrons on the risks of unprotected sex. The panel advised that it be mandatory for businesses to display educational materials and distribute condoms. The panel's recommendations will be submitted to the city's Department of Health as it determines how to regulate the clubs. The focus on voluntary compliance contrasts with the approach the city took in the mid-80's. From 1985 to 1987, New York City closed seven businesses, ranging from a gay bathhouse to a heterosexual "swingers club," after inspectors discovered patrons paying entrance fees and then engaging in oral and anal sex. Such acts were in violation of regulations adopted by the New York State Public Health Council in 1985 prohibiting "high risk" sexual activity in public places. The restrictions give health officials the authority to shut down such businesses as "a public nuisance dangerous to the public health." The council recommended yesterday that the law add vaginal intercourse without a condom to the list of high-risk sexual activities. The council also suggested that regulations distinguish between sex with a condom and without, and define sex without a condom as high risk. As Their Life Expectancy Grows, So Do Needs of AIDS Patients * Washington Times (02.26.93), P. A1 Goldberg, Karen As a result of the longer life expectancy among AIDS patients, more treatment, both physical and mental, is also required. Bob Howard, spokesman for the Centers for Disease Control, said the life expectancy for HIV-positive people has increased as a record number of HIV cases have developed into full-blown AIDS. Many of the opportunistic infections that accompany AIDS would have killed a patient much more quickly five years ago, according to Dr. Robert Thomas, a Washington, D.C., physician specializing in HIV. "When I was a resident [in 1987] people were looking at 18 months to live after an AIDS diagnosis. Now I tell them three to five years." Aside from medical services, longer-living AIDS patients need social, legal, and psychological assistance. The District's Whitman Walker Clinic, the city's main provider of services for AIDS patients, is having a difficult time keeping its food bank stocked. Barbara Chinn, Whitman-Walker's deputy chief program officer, said the food bank "is serving 600 clients a month now. This time last year, it was 300. I'd say in another year it will be 900." Approximately 2,000 volunteers work for Whitman-Walker--an all- time high. The clinic has 30 support groups, nine housing facilities, and three satellite offices, including the new Max Robinson Center. The CDC's Howard said, "What we are seeing now is the maturing of the epidemic. More people are presenting with AIDS, and that is a reflection of what went on eight years ago. We have already seen a leveling off in that category [homosexuals], but it is other areas like heterosexuals and IV- drug users, we are still concerned about." Three Centers Plan Human Test of New AIDS Therapy * Reuters (02.24.93) Zengerle, Patricia (Pittsburgh, PA) Researchers from the University of Pittsburgh Medical Center announced on Wednesday they were preparing to launch human trials of an encouraging new three-drug AIDS therapy recently shown to inhibit HIV in a test tube. The human trials will be funded by Merck & Co, which makes one of the drugs being tested. The research sites include the University of Pittsburgh, the University of Pennsylvania in Philadelphia, and Brown Miriam Hospital in Providence, R.I. This trial will apparently precede by at least several weeks the beginning of government-supported human testing of a similar treatment this spring. The 24-week study in Pittsburgh will involve 30 to 40 individuals infected with HIV, who will be separated into two groups. The first group will receive AZT initially. The other group will receive AZT and a Merck drug called L-661. After two months of therapy, both groups will also begin to receive the AIDS drug ddI. L-661 is part of a new class of experimental drugs known as non-nucleosides, which have shown promise in blocking the replication of HIV in test tubes when used in combination with AZT and ddI. The University of Pittsburgh researchers said their trial would start as soon as 30 to 40 volunteers, who must meet several criteria, are enrolled. Off-Label Reimbursement Denial: Major Survey Begins * AIDS Treatment News (02.19.93) No. 169, P. 8 A poll to determine the impact of reimbursement denials on obtaining optimum care of AIDS is currently being mailed to physicians who specialize in HIV/AIDS treatment. The survey, called ComPACT2 (Community Partnership in AIDS/HIV Clinical Trials) is being executed by San Francisco's Community Consortium, an association of over 200 health-care workers in the San Francisco area. The study is funded by the American Association for AIDS Research (AmFAR). The survey was sent with an explanation that says, "The aim of ComPACT2 is to determine the extent to which there are reimbursement denials when drugs to treat the medical complications of HIV disease are used for 'off-label' indications. We are primarily interested in the extent to which insurers deny reimbursement for off-label drug use and the extent to which providers alter the way they treat HIV-related conditions because of difficulties in obtaining adequate reimbursement for off-label drugs use." The physicians were selected at random because of the need to poll a representative sample of physicians who care for patients with HIV. The survey asks questions about details of patient characteristics, current medications, and HIV-related conditions for the last three HIV patients the doctor had seen before completing the questionnaire. It also asks for first- line and second-line treatments for HIV and for a number of opportunistic infections. The findings will be examined and provided to all participants. Moreover, there are plans to assemble a public policy panel with experts from government agencies, AIDS organizations, and insurance companies to review the results and make reimbursement recommendations to the U.S. Public Health Service. Cardiac Structure and Function in HIV-Infected Children * New England Journal Of Medicine (02.18.93) Vol. 328, No. 7, P. 513 Lewis, William and Dorn, Gerald W. Toxicity from AZT may be related to the development of cardiomyopathy, write William Lewis and Gerald W. Dorn of the University of Cincinnati Medical Center in Cincinnati, Ohio. In the Oct. 29 issue of the New England Journal of Medicine, Lipshultz et al. reported on cardiac dimensions and function in HIV-positive children and concluded that progressive left ventricular dilation occurred independently of any effect of AZT. However, Lewis and Dorn disagree with that conclusion. Ejection performance was normal in Lipshultz's patients at the start of AZT therapy but was depressed after therapy. Ejection performance declined, but contractility was unchanged. The causative factor appeared to be an increase in afterload despite increased posterior-wall thickness and left ventricular mass. End-systolic wall stress is related directly to end- systolic left ventricular pressure and dimension and is related inversely to wall thickness. Because end-systolic blood pressure was reported to be normal throughout the study, end- systolic dimension must have increased. Since ejection performance, not intrinsic myocardial contractility, is the primary determinant of clinical status, the data suggest that AZT can worsen the development of dilated cardiomyopathy in HIV-positive children. But no data from endomyocardial biopsies were included. The lack of characteristic endomyocardial morphologic changes would support the authors' thesis that AZT had no cardiac toxicity, but no pertinent information was provided, conclude Lewis and Dorn. India: Zidovudine Production * Lancet (02.20.93) Vol. 341, No. 8843, P. 485 Mangla, Bhupesh Indian pharmaceutical company Cipla Laboratories has begun manufacturing and marketing a lower-cost AZT in 100 mg capsules with the brand name Zidovir-100. The company is challenging Burroughs Wellcome's Retrovir because its price is significantly cheaper. This is good news for developing countries which can't afford the $3 per 100 mg capsule of Retrovir. A study by the United Nations Development Program (UNDP) shows that the cost of drugs will be a large determinant affecting the economic impact of AIDS in developing countries. India may have to spend $1.6 billion on AIDS by the year 2000. Cipla was able to make its drug cheaper with the help of the Indian Institute of Chemical Technology (IICT) in Hyderabad. IICT, a government-funded laboratory, has made the most of India's patent laws, according to which pharmaceutical products can be granted only process patents. Therefore, a drug enjoying a product patent outside India can be manufactured in the country made by a process different from that used by the original patent holder. Dr. A.V. Rama Rao, ICCT director, said, "Our aim is to make the drug available at a low price to all the needy countries, whose populace cannot afford the Burroughs Wellcome product. Quality wise there is no difference between Burroughs and us. In the international markets, we all have to meet the same standards." Drug companies in the United States have been enraged by the fact that India can get hold of U.S. patents. But AZT falls into a gray area--it was discovered originally, not by Burroughs Wellcome, but by the U.S. National Cancer Institute as an anti-cancer treatment. Rapid HIV Tests * Lancet (02.20.93) Vol. 341, No. 8843, P. 502 Wannan, Gary J. and Cutting, William A.M. Multiple uses of the HIV-CHEK test gave results as accurate as single use of the test, write Gary J. Wannan and William A.M. Cutting of the University of Edinburgh in Edinburgh, U.K. With the HIV-CHEK method, antigen from HIV-1 and HIV-2 are incorporated in the membrane on the top of a small block. Buffer is passed through the membrane followed by a serum or plasma sample from the person to be tested, then by gold conjugate and a wash solution. In positive cases a red-spot color reaction develops on the membrane within 10 minutes. The researchers discovered that they could put samples from at least 6 patients through the membrane before adding the gold conjugate and wash solutions and still get a positive result if any subject was infected. The researchers tested samples from 491 pregnant women and revealed that multiple use was just as accurate as single use of the test. In areas where the rate of HIV is low, it is possible to screen between 4 and 10 blood donors, pregnant women, or individuals in a population screening program with a single HIV-CHEK. Because the HIV-CHEK tests cost about 3 pounds sterling per test, in an area where the rate of HIV infection is less than 4 percent, the multiple sample screening method can save about 2,400 pounds sterling for every 1000 individuals tested. Even though the findings are encouraging, there still is a great need for an accurate and inexpensive test to detect HIV antibodies, conclude Wannan and Cutting. 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 02.22.93 ]]]===------ .