-----===[[[ A I D S w i r e D I G E S T 03.01.93 ]]]===----- Patents: Glove Designed for Medical Work * New York Times (03.01.93), P. D2 Chartrand, Sabra A newly-developed glove can protect health-care workers from sticking themselves with tainted needles. The device is made of leather with a pore size smaller than the diameter of a needle, and it has a second layer of leather over the glove's thumb, index finger, and middle finger. Most accidental needle sticks occur on the thumb, forefinger, and in the area between the thumb and forefinger, said Joseph A. Stern, a biologist in Hampton, Va. Although used needles should be disposed of without being touched, Stern said studies show that health-care workers often return used needles to their plastic packaging before discarding them. He said, "That's where many of the sticks come from." The patent for the glove cites a study of 202 New York city surgeons which found that 86 percent reported sticking themselves at least once a year, mostly in the index finger. The layered leather glove could further protect against such accidents. The glove is available with an optional fingertip opening, allowing technicians who draw blood to easily feel for a patient's veins. This flap can be reclosed before the technician handles the needle. Stern said, "It's a little awkward, because you have a second layer of material, making it not quite as flexible as latex gloves. But if all students in medical school used it, by the time they got out to practice medicine they would be accustomed to it." J&J Unit to Test New AIDS Drug in Mix With Others * Wall Street Journal (03.01.93), P. B8 Waldholz, Michael A new anti-AIDS drug is currently being tested in humans by scientists at Johnson & Johnson 's Belgian drug research operation. The drug, called alpha-APA, has been effective in inhibiting HIV replication in test tube studies. Also, in initial human tests, the drug appeared safe. However, the drug's developers said in an interview last week that the drug doesn't appear to be effective against HIV infection on its own, and will be tested later this year in combination with other antiviral AIDS drugs already available or being tested. The researchers who are developing alpha-APA at Janssen Pharmaceutica in Beerse, Belgium, said the drug functions in a manner similar to a class of experimental drugs developed by Merck & Co. and Boehringer Ingelheim Corp., to which HIV subsequently became resistant. The Janssen researchers reported their findings in today's issue of the Proceedings of the National Academy of Science. The report said test tube studies indicate that HIV will also develop quick resistance to alpha- APA if used alone. The alpha-APA drug and those developed by Merck and Boehringer Ingelheim function by blocking the action of reverse transcriptase, an enzyme crucial to the life cycle of HIV. Hemophilia Drug * Associated Press (02.25.93) (Washington) A blood-clotting drug has received Food and Drug Administration approval to be used by patients with hemophilia A, according to its manufacturer, Miles Inc. of West Haven, Conn. The company said that the FDA has approved sale of a drug called Kogenate that prevents bleeding. Kogenate replaces a substance called factor VIII that is absent or in short supply in the blood of patients with hemophilia A. The blood will not clot naturally without the factor, and uncontrolled bleeding will result. Miles revealed that Kogenate was produced through the use of recombinant DNA techniques. This approach involves altering the genes of a bacteria to force it to make the desired substance. Hemophiliacs previously were treated only with factor VIII that had been removed from human blood. This technique entails the processing of thousands of units of blood for one dose of the factor. In the 1980s, before blood could be screened for HIV, many hemophiliacs contracted HIV through contaminated factor VIII injections. Kogenate prevents anyone from becoming infected with HIV because it is synthetic. France Offers Full State Health Cover for AIDS * Reuters (02.26.93) (Paris) All AIDS patients and people with HIV infection in France will be fully compensated for their disease by the country's state social security system, Health Minister Bernard Kouchner announced Friday. "We have decided to offer 100 percent health cover to all HIV-positive people who want it, as of today," said Kouchner. He added that the patient's condition would remain confidential. Condom distribution machines will also be installed in high schools, said Education and Culture Minister Jack Lang. "More than 50 percent of high school students say they have sexual relations. It's a fact ... protecting kids from this deadly risk is imperative," said Lang. Last week, a special panel of doctors recommended the compensation plan, which has also been a major demand of AIDS activists. France has one of the highest rates of HIV infection in Europe. As of September 1992, the country had 24,000 diagnosed AIDS cases and as many as 200,000 people infected with HIV. The announcement allayed the fears of many AIDS activists, who worried that the center-right government likely to win power next month would implement unfavorable policies such as mandatory HIV testing. AIDS, however, is not mentioned in the opposition's manifesto, and it is unknown what the new government's policy and response to Kouchner's plan would be. Clinton Delays Naming 'AIDS Czar' * New York Times (02.28.93), P. 24 Berke, Richard L. President Clinton still has not fulfilled his campaign promise to appoint an "AIDS czar" because of differences among his advisers over how the position should be structured and who should get the job. According to White House officials, Clinton still expects to appoint a coordinator of federal efforts to fight AIDS, called an "AIDS czar." However, the time it is taking to fill the post has led AIDS activists to conclude that Clinton has not made fighting AIDS a top priority. Several senior White House officials have revealed that two likely candidates for the position are New York City Health Commissioner Margaret A. Hamburg and Gov. Lowell P. Weicker Jr. of Connecticut. Hamburg is considered a policy expert who is acquainted with the nuances of health care but has no political experience. Weicker, a former Republican and now an independent, was an outspoken supporter of anti-AIDS efforts while he was in the Senate. He is more well-known than Hamburg, and is viewed as someone who would travel the nation lobbying the issue. Among those involved in the debate over the position are Donna E. Shalala, the Secretary of Health and Human Services, and Bob Hattoy, who addressed the Democratic National Convention about his HIV infection and is now working in the White House personnel office. Administration officials said they were struggling to determine how to pay for the position, because Clinton has promised to reduce White House staff. A possible solution would be to include the position in the budget of the Department of Health and Human Services, say officials. Weicker Ducks Questions About Becoming U.S. AIDS Policy Head * New York Times (03.01.93), P. B7 Reports that Connecticut Gov. Lowell P. Weicker Jr. may be appointed as the Clinton Administration's AIDS czar have not been confirmed by the governor, according to Lieutenant Gov. Eunice S. Groark. She said yesterday that she had asked the governor last week about reports that President Clinton was considering him for the federal AIDS czar position. Groark said, "He went 'Hmmmm,'" and added nothing more. She also said that she was unaware of Weicker's contacts with the Clinton administration, aside from reports of his having been considered for other high-ranking positions. She said, "There was no great comment about it," between Weicker and herself. "I wouldn't read very much into that. I think he would be a likely candidate," she added. Beth Weinstein, the director of AIDS programs in the State Department of Health Services, said Weicker's name had been mentioned in conversations among her counterparts in other states. "People have known for a while that he has been mentioned as a candidate," she said. Support for AIDS Project * Financial Times (03.01.93), P. 10 Summers, Diane A training video that addresses concerns about AIDS has been developed by Terrence Higgins Trust in the United Kingdom, in partnership with a coalition of large companies. Those corporations which support the training project include IBM, Marks and Spencer, Unilever, Kingfisher, and WH Smith. In addition to the video, the project has published an AIDS training manual and briefing notes, covering basic medical information, recruitment issues, confidentiality, pensions, first aid, and travel abroad. Also, the Society of Occupational Medicine has produced an AIDS booklet that covers many of the same issues, and provides a good introduction to the disease. Although European companies have been slower to address AIDS in the workplace, the latest training material should create more interest in the issue. Mixed Sentiments * American Medical News (02.22.93) Vol. 36, No. 8, P. 22 Americans seem to be more accepting of HIV-positive health-care workers who remain on the job, according to a study published in the Archives of Internal Medicine. Researchers from the University of California--San Francisco found that 54 percent of those surveyed in 1991 said HIV-positive surgeons should stop working, whereas, in 1988, the figure was 59 percent. Those who disapproved of infected physicians who continued to work dropped from 45 percent to 39 percent, and for dentists the percentage dropped from 52 percent to 47 percent. The 1991 survey involved 1,350 adults, of whom 85 percent supported mandatory HIV testing for surgeons. About 79 percent of the respondents favored such testing for all physicians, and 78 percent for dentists. Although 93 percent said health-care workers should be compelled to disclose their HIV-positive status to patients, only 6 percent said they had ever been told. AIDS Patient Claims Hospital Violated ADA, 'Dumping' Law * American Medical News (02.22.93) Vol. 36, No. 8, P. 13 McCormick, Brian An AIDS patient who alleges he was discriminated against when being admitted to a hospital has filed suit saying the hospital violated two laws. The case has prompted an influx of independent government reviews. Officials are attempting to find out whether the patient's transfer from Memorial Hospital in Fremont, Ohio, violated the Americans With Disabilities Act or the 1986 Emergency Medical Treatment and Active Labor Act, also known as the "anti-dumping" law. The hospital and the doctor say that the lawsuit is unwarranted because the patient received sufficient care. The providers claim that the patient, Fred Charon, was transferred because the hospital was ill- equipped to treat his rare skin disorder, not because of his HIV status. Charon filed suit last year against the hospital and Dr. Charles Hull, who was supervising the emergency department when Charon sought treatment in April 1992. Charon was first diagnosed with toxic epidermal necrolysis when he was first admitted to the ED. The diagnosis was subsequently changed. Charon was transferred to the Medical College of Ohio Hospital in Toledo, nearly an hour away. The complaint says that AIDS was the reason. A note in the medical record quotes Dr. Hull as ordering the transfer saying "If you get an AIDS patient in the hospital, you will never get him out." Dr. Hull said, "Optimal treatment of this patient called for a burn unit, which we don't have. It also required specialists--such as a dermatologist and an infectious disease specialist--which we don't have." However, a lawyer representing Charon through the American Civil Liberties Union said the hospital was fully capable of treating Charon's condition. HIV, AIDS Sufferers Seek Shelter * Chicago Tribune (03.01.93), P. 1-7 Griffin, Jean Latz There has been a recent increase in calls to private and public agencies in the Chicago area from people with HIV or AIDS who are in need of housing--either an emergency overnight stay or long-term shelter. Kupona Network, a Chicago social service agency for HIV-positive African-Americans, is seeking shelter for 450 people already, and the number is rising "by leaps and bounds," said case manager J.D. Detwyler. "We have added 50 new clients since the first of the year," he noted. Sally Edwards, dispatch clerk with the Department of Human Services, said she gets three to four calls per week from HIV-positive people who have no place to sleep. She said the rate is up from only about one call a month a year ago. Some officials attribute the increase of calls to more people becoming infected with HIV, in addition to an increase in poverty. One couple who came to Detwyler for help were advised by him to apply for a Section 8 low-income housing grant because their income was not enough to pay for the rental of an apartment. But Detwyler said Section 8 certificates are limited, and it can take three to four months for HIV-infected people to receive supplemental Social Security benefits--money that could help them pay the rent for a small apartment. District Bars AIDS Curriculum * New York Times (03.02.93), P. B6 Dillon, Sam A Queens, N.Y., school district that has argued with Schools Chancellor Joseph A. Fernandez in the past over a multicultural teaching guide said yesterday that it was prohibiting classroom use of an AIDS curriculum developed by Fernandez's staff and approved last year by the central Board of Education. Mary A. Cummins, the president of School District 24, said in a letter to Fernandez that her board did not approve of the AIDS curriculum in part because of its references to anal sex in the section targeted at fifth and sixth graders. Cummins said the section, which details how the disease is transmitted, was unsuitable for elementary school students. She said in a statement, "If the Chancellor thinks parents are going to let him subject their children to that sort of filth, he's badly mistaken." Cummins added, "He's in for another fight and another defeat." Her letter and statement may be an attempt to force Fernandez into another public debate now that his authority has been threatened by last month's decision by the New York City Board of Education not to extend his contract after June 30. Since 1987, state education laws have mandated that elementary schools educate all students, starting in kindergarten, about AIDS. The seven-member board approved a revised AIDS education curriculum written by Fernandez's staff last June, which was distributed in October to community school districts. China--AIDS * Associated Press (02.27.93) Biers, Dan (Beijing) An AIDS hotline in China is attempting to educate a nation which has traditionally been prudish. The hotline was established last April and demonstrates the uphill struggle the nation of 1 billion faces as it tries to prevent HIV infection from becoming epidemic. The number of people with HIV infection in China has increased from four in 1988 to about 1,000 now. Approximately three-fourths of those infected are drug users, but health officials are concerned about HIV spreading through sexual contact. Wan Yanhai, who runs the hotline, said the largest problem is that China's government has yet to implement an aggressive health education campaign to fight the disease. The hotline was established by the China Health Education Research Institute as an attempt to break social barriers by allowing people to get information anonymously. Wan said the number of callers has risen to an average of eight to ten per day. About nine out of 10 callers are men, and 15 percent of them say they are homosexuals. Wan said many people fear that others will find out that they have called the hotline. "Some are concerned we'll tell friends, family, or police," he added. The hotline is intended to provide basic information about AIDS to each caller in order to battle widespread ignorance. Wan has answered questions on whether HIV can be contracted through swimming, eating, or shaking hands with foreigners, or by a mosquito bite. Hotline counselors try to get as much information as possible about the callers for institute records, with the exception of their names. However, asking questions sometimes angers the callers, who will then end the conversation. A Defiant Casualty of the War on AIDS * Los Angeles Times--Washington Edition (03.01.93), P. B10 Getlin, Josh A renowned physician who fought for more AIDS funding in the 1980s has turned down a position as head of the Centers for Disease Control in Atlanta offered to him by President Clinton's transition team. Dr. Don Francis is known as a brilliant health professional who had mobilized early reaction to the epidemic, and a straight talker who knew how to make an impact. Regarding the job offer by the transition team, Francis said, "I'm far too angry to work in the system now, especially after what I've been through in the last 19 years." When politicians were reluctant to do anything about AIDS, Francis blew the whistle. He started working for the U.S. Public Health Service 20 years ago, but AIDS changed him. Many of his earlier recommendations concerning AIDS have become reality today. These include expanded HIV testing, safeguards on the nation's blood supplies, and early medical intervention for those infected with HIV. Francis decided by the mid-1980s that the Reagan Administration would not allot money for serious research. Therefore, he switched his efforts toward prevention programs. He proposed a $32-million program called Operation AIDS Control, which was rejected. He left the CDC in 1985 because of that rejection, and served as the agency's liaison to California's AIDS programs through February 1992. Now he continues to work as a private consultant. Francis said the U.S. needs to raise money for an AIDS vaccine. He also said that early intervention programs for HIV-positive people, which he helped create, should be federally funded. Francis said, "I fought this battle as long as I possibly could, and everybody has limits. Even me." Gay Cleric Comes Out and Joins AIDS Battle * Baltimore Sun (03.01.93), P. 1B Durai, Melvin The Rev. David F. Shipley, who had kept his HIV-positive status a secret within his church, has decided that hiding his condition and his homosexuality is not as important as educating others about the disease. Shipley serves as minister of the Otterbein Memorial United Methodist Church in Hampden, Md. He also travels to churches, high schools, and universities, saying: "There is no such thing as safe sex; only safer sex." According to Shipley, many clergymen oppose his urging teenagers to use condoms and believe he is condoning premarital sex. However, Shipley said, "I don't think teenagers should be condemned to die simply because they don't listen to the message of the church." Shipley said that he decided to disclose his illness when a friend and former class mate asked him to speak about AIDS at a church. "I told myself, 'I have a life-threatening disease. These may be my last years and I don't want to spend them hiding the fact that I am gay,'" said Shipley. The Rev. Roger Gench, Brown Memorial's pastor, said Shipley's AIDS education attempts were "absolutely critical." He added, "We don't know folk for whether they are gay or straight, but what kind of people they are inside." Shipley said he is hopeful that scientists will find a cure for AIDS, but if it doesn't happen in time to save him, then he hopes he at least helped save other people's lives. AIDS Groups Struggle Financially * Los Angeles Times--Washington Edition (03.01.93), P. B3 Boxall, Bettina Due to the vast numbers of AIDS organizations and the lack of donations in Los Angeles, many local AIDS agencies are struggling to stay afloat. There are about 150 AIDS service groups in Los Angeles county, but there is an increasing feeling that there are too many. It is also believed that the competitiveness between the groups should be replaced with cooperation. Moreover, volunteers who are often motivated by compassion rather than expertise are finding that they need increasing sophistication and fund-raising savvy to keep their organizations functioning. Approximately 40,000 Los Angeles county residents are infected with HIV, and about 17,000 have AIDS. Public spending on AIDS care in the county has risen from $9 million in 1985 to $75 million this year as the AIDS population continues to grow. However, only about 25 percent of the money goes to community-based organizations, according to county figures. The rest pays for county clinic and hospital facilities. As a result, most AIDS groups rely heavily on--and are competing most intensely for--private donations. Even though there is a wide variety of AIDS groups, there is a general consensus that they need to target other donors. Mary Nalick, executive director of All Saints AIDS Service Center in Pasadena, said, "A lot of the gay community is tapped out. We do need to identify new and different folks." AIDS advocates hope that the Clinton administration's promise to increase funding for AIDS will not only boost the amount of government funds, but also put AIDS into the mainstream and spur more donations. Shalala Backs Reorganization * Science (02.12.93) Vol. 259, No. 5097, P. 889 Cohen, Jon Secretary of Health and Human Services Donna Shalala recently expressed support for a Senate bill addressing the reorganization of the National Institutes of Health's Office of AIDS Research (OAR). The proposal has incited opposition from some scientists and NIH officials who argue that it would add another layer of bureaucracy to AIDS research. The Senate proposal is designed to improve planning and coordination of AIDS research at the 21 NIH institutes by giving the OAR more authority over NIH's AIDS budget and establishing a discretionary fund for the OAR director to use at his or her discretion. Those who oppose the Senate bill include NIH directors, who on Jan. 22 sent a memo to NIH Director Bernadine Healy addressing their fears that the budget process would be "severely disrupted" by the proposed changes which "may inadvertently be detrimental" to AIDS and non-AIDS research. Healy sent the memo to Shalala, who subsequently showed it to members of the House subcommittee on health and the environment. She told the subcommittee that although she doesn't think "a reorganization alone will yield improvements in science necessarily," HHS backs the bill because it hopes that a strengthened OAR will elicit "a clearer view of where we're going." She added that if the plan backfires and hampers AIDS research, "we will be the first ones back here at this table to tell you that we have a structure that doesn't work." Use of Evolutionary Limitations of HIV-1 Multidrug Resistance to Optimize Therapy * Nature (02.18.93) Vol. 361, No. 6413, P. 650 Chow, Yung-Kang et al. Convergent combination therapy may be beneficial to the treatment of HIV-1 infections and in post-exposure prophylaxis, write Yung-Kang Chow et al. of the Massachusetts General Hospital and Harvard Medical School in Boston, Mass. Certain drug combinations may prevent the co-existence of adequate reverse transcription function and multi-drug resistance (MDR). Retroviral drug resistance is conferred only by mutations in its own genome and is limited by genome size. Therefore, combination drugs directed against the same essential viral protein may thus prevent HIV-1 MDR, whereas the conventional approach of targeting different HIV-1 proteins for combination therapy may not. This is because genomes with resistance mutations in different HIV-1 genes might recombine to develop MDR. The researchers tested whether combinations of mutations giving rise to single-agent resistance might further compromise or even abolish viral replication, and if multidrug-resistant virus could be constructed. Certain combinations of mutations conferring resistance to AZT, ddI, and pyridinone are incompatible with viral replication. These findings suggest that evolutionary limitations exist to restrict development of MDR. Furthermore, elimination of reverse transcription by convergent combination therapy may also limit MDR, the researchers conclude. A 'Manhattan Project' for AIDS? * Science (02.19.93) Vol. 259, No. 5098, P. 1112 Cohen, Jon While Bill Clinton was campaigning for the presidency, he promised a "Manhattan Project" for AIDS, but now that he is in office he still has not elaborated on what it would entail. Although some ideas by activists and researchers have yet to be widely circulated, several influential scientists are supporting the Manhattan Project concept. Proponents of the project contend that if the government stepped in and aggressively directed the scientific effort, redundancy would be eliminated, gaps in research would be filled, cooperation would be enhanced, and answers would emerge much more quickly. However, critics claim that not enough is known about HIV at the level of basic science to implement a goal-oriented project like the one that led to the making of an atomic bomb. They also say that any effort to do so could impede scientific creativity needed to develop a cure or a vaccine. Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases--which receives 43 percent of the NIH's AIDS research budget--said, "The science base isn't there for a Manhattan Project for AIDS." But he adds that he would support additional coordination among the branches of the government, which he believes the incoming AIDS czar will address. Johnson and Johnson Belgian Unit in HIV Drug Trials * Reuters (03.02.93) (Brussels) American pharmaceutical firm Johnson and Johnson's Belgian subsidiary Janssen Pharmaceutica, announced yesterday it had tested an AIDS drug that stopped the replication of one strain of HIV in the test tube. However, HIV developed resistance to the drug, alpha-APA, when used by itself. Janssen said it began tests on HIV-positive patients and had discovered that alpha-APA was well absorbed by the body and had few adverse side effects. Other tests are being conducted to determine whether the drug blocks the spread of HIV in the body. The alpha-APA compound inhibits the action of reverse transcriptase, which can lead to the development of full-blown AIDS. The drug company said that like similar agents, alpha-APA was effective against the strain of HIV called HIV-1, but not against HIV-2. Janssen is planning clinical trials to test the efficacy of combinations of alpha-APA and other drugs. "These studies will indicate whether such combinations of drugs will inhibit the multiplication of the virus for a longer period and prevent resistance," said the company. Other companies conducting similar studies have found that the virus developed resistance when used with reverse transcriptase inhibitors. They subsequently used combinations of inhibitor drugs and AZT to overcome the problem. Philippine Armed Forces to Undergo AIDS Tests * Reuters (03.02.93) (Manila) The Philippines' military chief of staff yesterday ordered the country's 160,000 armed forces to be tested for HIV after a marine selected to serve with U.N. forces in Cambodia was found to be infected with the virus. Armed forces spokesman Colonel Benjamin Enrile said, "The chief of staff ordered everybody to be tested to be sure." The HIV testing are to begin immediately and will be performed by the main military hospital in Manila. Armed forces Chief of Staff General Lisandro Abadia said HIV tests would become part of the annual medical examination of all military officers and enlisted men. The HIV-infected marine was immediately withdrawn from a 68-man Philippine navy contingent to be sent to help control a U.N.- brokered ceasefire agreement in Cambodia. Approximately 30,000 Filipinos are believed to be infected with HIV, and about 300 have full-blown AIDS, according to Philippine health officials. Egypt Reports 356 AIDS Cases * Reuters (03.02.93) (Cairo) A total of 356 people in Egypt have AIDS. Of those individuals, 188 are Egyptians and 168 are foreigners, a health official reported Tuesday. Since 1986, 48 people have died of AIDS in Egypt, the health official said. At a seminar in December, Health Minister Ragheb Dwidar disclosed the total number of reported AIDS cases in Egypt as 344, including 186 Egyptians and 158 foreigners. Ahmed Seif al-Nasr, a health ministry official, told the seminar that this was only "the tip of the iceberg," because not all of Egypt's 58 million people have undergone testing for HIV. Calif. Proposal Would Outlaw AIDS Discrimination in Health Insurance * United Press International (03.02.93) (Sacramento, CA) Legislation introduced on Tuesday in California would make it illegal for health-insurance companies to discriminate against policyholders with AIDS and other maladies. The bills were proposed by Assembly Speaker Willie Brown (D-San Francisco) and state Sen. Art Torres, (D-Los Angeles). At a news conference, proponents of the legislation said that insurers often discriminate against policyholders with HIV or AIDS by rescinding their coverage when they file a claim. The bills by Brown and Torres would prohibit the practice of "post claims underwriting," in which coverage is unilaterally canceled after a claim because of allegations that the policyholder misrepresented information on the enrollment form. The new measures would institute a single standardized medical history form to be used by all health insurance companies, which would protect cons_i2rs f.+R,b%U=UM 9j|misleading health questions that can produce answers that give insurers the pretext to cancel coverage after a claim is filed. The legislation would guarantee workers the right to supplemental Medicare coverage if they lose their jobs and their insurance coverage because of illness. In addition, the bills would prevent insurers from testing applicants for HIV without their consent. AIDS Top Killer of Forsyth Residents 20-39, Officials Say * Winston-Salem Journal (02.26.93), P. 13 Stinneford, Karen AIDS was the leading cause of death among Forsyth County, N.C., residents between the ages of 20 and 39 in 1991--outstripping car accidents, violence, or cancer, state officials recently announced. The disease was also the top killer in that age group in five other North Carolina counties. Theresa Klimko, an epidemiologist with the state Department of Environment, Health, and Natural Resources, said AIDS was the third-leading cause of death statewide for the age group. This was particularly surprising to officials and AIDS activists because in 1990, AIDS was only the seventh-leading cause of death among 20- to 39-year-olds statewide. A total of 22 Forsyth County residents in this age group died of AIDS in 1991. The next leading cause of death was homicide. According to state statistics, black men were five times more likely to die from AIDS than white men, and black women were 15 times more inclined to die from the disease than white women. Klimko said the six urban counties may be feeling the impact of AIDS now, but the rest of the state isn't far behind. "In North Carolina, the AIDS epidemic started in the metropolitan counties. It is now spreading more in the rural counties, but those counties won't see AIDS deaths go up greatly (for) years," she said. This delay is due to the disease's latency period, which can last up to 10 years before a person develops full-blown AIDS. Red Faces in White Coats * Business Week (03.08.93) No. 3308, P. 37 Smith, Geoffrey Although the outcome of a recent study that used a three-drug approach to inhibit HIV-spread in vitro was promising, it may have raised false hopes. Yung-Kang Chow headed the study conducted by researchers at Massachusetts General Hospital (MGH) which claimed to have possibly found the "Achilles' heel" of HIV. After reports of the study circulated throughout the media, thousands of calls overwhelmed AIDS hotlines, drug companies, and doctors' offices nationwide. HIV-positive patients lined up to be enrolled in a national trial of the three-drug approach involving 200 patients that is expected to begin this summer. Dr. Martin S. Hirsch, a prominent MGH AIDS researcher who supervised Chow's research, said the reaction to the study has been "devastating." He says he wishes the study had not "been blown out of all proportion." But Chow and Hirsch intended to prevent the hype. When they announced the study's findings they emphasized that the results were only achieved in a test tube and could easily fail in humans. But some scientists say that Chow and Hirsch neglected to reveal an important detail: The three-drug approach worked with only certain strains of HIV--variations of HIV-1--but it didn't work against other strains. Dr. William S. Haseltine, a leading AIDS researcher at Harvard University, said, "I doubt they found the Achilles' heel--there are probably lots of Achilles' heels." While Chow says his three-drug technique "is the best approach we have yet," it should be understood that the most important trials, those of humans, have yet to begin. HIV Vaccine Enters Clinical Trial Stage * American Medical News (03.01.93) Vol. 36, No. 9, P. 25 The first large-scale clinical trial of an AIDS vaccine has been launched in Sweden and will last six years. The trial will be testing VaxSyn made by MicroGeneSys Inc. The therapeutic vaccine has exhibited its ability to stabilize or reduce the amount of virus in an HIV-positive person, incite an immune response, and stop the loss of CD4 cells. The trial in Sweden is the last test MicroGeneSys must undergo before it can begin commercial production of the vaccine. Cheaper Way to Make AZT * American Medical News (03.01.93) Vol. 36, No. 9, P. 25 A less expensive process for making AZT has been developed by a Japanese company. The pharmaceutical company Kobayashi Koryo makes thymidine, a key ingredient of AZT, using heat evaporation, a process that is up to 50 percent cheaper than the current fermentation method, said company officials. The trading concern Kanematsu Corp. expects to start selling thymidine to drug companies in India and Brazil by the end of the year. HIV Clue Announced * American Medical News (03.01.93) Vol. 36, No. 9, P. 25 A chemical transformation in cells that helps explain how HIV spreads has been discovered by researchers at the Webb-Warring Institute in Denver, Colo. According to the scientists, HIV quells production of a vital enzyme called superoxide dismutase. The researchers are testing human cell cultures to elucidate if a drug can inhibit HIV's ability to suppress the enzyme. If they are able to safeguard the enzyme's levels in cells, the time HIV stays inactive could be prolonged. In the News: AIDS in Ethiopian Community Is Focus of Health Seminar * Washington Post (03.04.93), P. D.C. 1 A free seminar will be held this Saturday at the University of the District of Columbia that will address AIDS in Ethiopia and in the Washington Ethiopian Community. The issues discussed will include approaches for fighting AIDS, treatment of HIV infection, and the psychological effects of the disease on those who have it and their families. We Shouldn't Exclude Immigrants With H.I.V. * New York Times (03.04.93), P. A24 Gostin, Lawrence O. Instead of concentrating our efforts on preventing HIV-positive people from entering the United States, we should dedicate ourselves to the principles of justice, scientific cooperation, and a global response to the AIDS epidemic, writes Lawrence O. Gostin, executive director of the American Society of Law, Medicine, & Ethics. The New York Times editorial on Feb. 20, "Immigrants Infected With AIDS," supports the Senate decision to exclude HIV-positive immigrants. The editorial is based on public health and financial cost grounds. However, it neglects to acknowledge human rights that could be violated as a result of such exclusion. This policy is based not on risk the HIV- positive people pose to others, but rather on their serologic status. This type of discrimination punishes a great majority of those who will behave safely, as well as the few who will not. The ban against HIV-positive people affects only those who otherwise have a right to reside in the United States because of family or other close ties. Therefore, the policy interferes with family unity. The Haitian refugees who are detained at Guantanamo Bay, Cuba, fear danger in their home country, but may be denied entry into the U.S. simply because of their HIV-positive status. This policy will not reduce the abundance of infection in the world, nor will it provide more resources for education and counseling. If cost were the actual reason for this policy, the United States would have included all those with chronic costly diseases like heart disease, cancer, and kidney disease. It is ironic that the United States, which has probably exported more cases of HIV infection than any other nation, should establish such an exclusionary policy, concludes Gostin. Miss America Crusades Against AIDS * USA Today (03.04.93), P. 1D Painter, Kim The 1992 Miss America, Leanza Cornett, promised to discuss AIDS wherever she went, and she has followed through on her promise--much to the delight of many AIDS organizations and even the Miss America Organization. Leonard Horn, the group's chief executive, said, "We feel very strongly that the young lady who is Miss America should be a true role model, interested in some of the troublesome issues that face our world." Before she was crowned, Cornett had worked as a volunteer at AIDS service organizations in Orlando, Fla. She said, "I had friends who were infected and affected, and I was frustrated because so little was being done." She eventually gave safer sex seminars and worked at a home for HIV-positive children. During the televised Miss America Pageant, Cornett wore the symbolic red ribbon and discussed AIDS awareness. "I was really proud," she said. Cornett continues to wear the red ribbon every day. She was asked to talk on Christian talk show The 700 Club a few weeks ago. She said, "They weren't necessarily interested in my platform, but I managed to turn around the interview and talk about it. And I said, 'As Christians, we can't ignore this any longer. People are dying.'" When she does discuss AIDS at the various places she is asked to speak, she says, "Fight AIDS, not people with AIDS." She also emphasizes the importance of abstinence, but acknowledges that many people do engage in sexual activity. Consequently, she tells them, "If you're going to do it, do it as safely as you can and that means condoms." AIDS Fails to Change French Sex Habits--Survey * Reuters (03.03.93) (Paris) Only about one-sixth of French adults have used more caution while engaging in sexual relations since the AIDS epidemic began, and 56 percent dislike condoms, according to a survey released Wednesday. A government agency dedicated to fighting AIDS conducted the survey, which showed 84 percent of the French population had made no changes in their sexual behavior, even though sex is one of the primary ways the virus is transmitted. About 56 percent of respondents said condoms "killed off romance." The survey involved 20,000 people, and is likely to heighten concern in a country with one of the highest rates of AIDS cases in Europe. Approximately 250,000 French people are infected with HIV, and more than 13,000 people have died. Among those who have slept with more than one person in the last year, the survey showed that 30 percent of men and 50 percent of women had never used a condom during sex. However, more than 90 percent acknowledged that penetrative sex was potentially risky. The underlying problem was that most French people do not believe they are at risk for HIV infection. AIDS Campaign Groups Accuse French Rail of Secret Testing * Reuters (03.02.93) (Paris) Two AIDS activist groups accused the French state rail company SNCF of testing some of its employees without obtaining their consent. ACT-UP said in a statement that one case involved an employee who was tested for HIV two years ago, but was never told. He tested positive, and now he is in danger of losing his job, said ACT-UP. The group added that some of its members went to the office of SNCF director Jacques Fornier on Tuesday and demanded an explanation. SNCF officials were not available for immediate comment on the matter. "The risk of violation of privacy is very real. When these practices are accompanied by sanctions in the workplace, they become unacceptable discrimination," ACT-UP said. Another activist group, AIDES, also said that SNCF was involved in what it claimed was a recent increase in cases of secret HIV testing. The group did not elaborate further. Hong Kong to Lower Taxes, Increase Spending * United Press International (03.03.93) (Hong Kong) The colony of Hong Kong revealed plans Wednesday to transform its enormous budget surplus for 1992-1993 into a deficit to lower or eliminate income taxes for 90 percent of taxpayers and increase spending on roads and AIDS prevention efforts. Financial Secretary Hamish Macleod said in his budget speech in the Legislative Council that the estimated 1992-93 surplus of $2.6 billion will result in a deficit of $436 million in the next fiscal year beginning April 1. Expenditures are predicted to be $19.4 billion and revenues $18.9 billion. The Emergence of Drug-Resistant Tuberculosis in New York City * New England Journal of Medicine (02/25.93) Vol. 328, No. 8, P. 521 Frieden, Thomas R. et al. AIDS patients are more likely to be infected with drug- resistant tuberculosis and are more likely to die if infected with these organisms, write Thomas R. Frieden et al. of the Centers for Disease Control in Atlanta, Ga. The researchers gathered information on every patient in New York City with a positive culture for Mycobacterium tuberculosis during April 1991. Among the 518 patients with positive cultures, 466 (90 percent) had isolates available for testing. A total of 33 percent of these patients had isolates resistant to one or more antituberculosis drugs, 26 percent had isolates resistant to at least isoniazid, and 19 percent had isolates resistant to both isoniazid and rifampin. Among the 239 patients who had received antituberculosis therapy, 44 percent had isolates resistant to one or more drugs and 30 percent had isolates resistant to both isoniazid and rifampin. Of the patients who had never been treated, the proportion with resistance to one or more drugs increased from 10 percent in 1982-1984 to 23 percent in 1991. Patients who had never been treated and who were HIV-positive or reported IV-drug use were more inclined to have resistant isolates. Among AIDS patients, those with resistant isolates were more likely to die during follow-up through January 1992. A history of antituberculosis treatment was the strongest indicator for the presence of resistant organisms. Improvements in TB-control programs and in social and economic conditions are greatly needed and can promote the control of both TB and the emergence of drug-resistant organisms, conclude the researchers. More Disclosure of AIDS in Celebrities * New England Journal of Medicine (02/25.93) Vol. 328, No. 8, P. 583 Carrino, Amy Fairchild and Bayer, Ronald Even though there was a rise in HIV testing among the public after celebrities such as Magic Johnson and Arthur Ashe disclosed their HIV/AIDS-related conditions, the increase was not among high-risk individuals, write Amy Fairchild Carrino and Ronald Bayer of the Columbia University School of Public Health in New York, N.Y. In the Nov. 5 issue of the New England Journal of Medicine, Gellert and colleagues wrote about the benefits of the disclosures of HIV-infection by celebrities, claiming that "such disclosures have an impressive effect on the public health." They demonstrated graphically that anonymous HIV testing increased significantly after the disclosure, voluntary or involuntary of the HIV status of celebrities. Nevertheless, their graph exhibits not only the increase in testing after such disclosures, but also the number of tests that were positive. The line for the number of positive tests stays constant throughout the period of observation--1985 through 1992--regardless of the fluctuations in testing. This finding suggests that such disclosures increase testing among those at low-risk for HIV infection, but not among those at high risk. Despite the number of people tested, the number of positive tests remains the same. What is more alarming, is rather than suggesting an increased public awareness of the risk of HIV, their data indicate that public health campaigns have not effectively educated about HIV and that the population is still vulnerable to hysteria. Public awareness in the form of hysteria cannot be interpreted as a positive outcome of disclosure by celebrities, conclude Carrino and Bayer. Dental HIV Transmission? * Nature (02/25.93) Vol. 361, No. 6414, P. 691 DeBry, Ronald W. et al. The case of the Florida dentist who allegedly infected five of his patients needs to be examined more closely with another dataset from some other region of the HIV genome, write Ronald W. DeBry et al. of the Florida State University in Tallahassee, Fla. Ou et al. recently reported that the dentist did indeed transmit the virus to his five patients. Population genetics indicate that a rapidly evolving marker can develop strong geographical substructure. Therefore, an appropriate null hypothesis is that the patients independently acquired similar variants within the local community. The dental transmission hypothesis entails that a branch on the viral phylogenetic tree lead to the dental group alone and not include any controls. But in phylogenetic terms, the dental group must be monophyletic. The null hypothesis would be rejected if a tree with a monophyletic dental group is significantly better supported than any tree with controls intermixed within the dental group. The researchers tested the hypotheses using new sequences from the dental patients and a new set of regional controls. This selection is justified: the dental group should be monophyletic compared to any controls. In addition, the test is biased in favor of accepting the dental transmission hypothesis because the controls in both studies were obtained at clinics about 90 miles from the dentist's practice area. The researchers conclude that the available data are consistent with both the dental transmission hypothesis and the null hypothesis and do not yet distinguish between the two. The AIDS Crisis: Learning From Mistakes * Financial World (03.02.93) Vol. 162, No. 5, P. 46 San Francisco is viewed as the nation's model for humane and cost-effective AIDS treatment because of its aggressive response to the epidemic in the early 1980s. The city assembled a continuum of services that could keep people out of hospitals, except when necessary. Also, the City and County of San Francisco Department of Public Health ensured that those dealing with the epidemic knew one another and talked regularly. Consequently, a study published in 1986 in the Journal of the American Medical Association estimated lifetime hospital costs of an AIDS patient in San Francisco to be about $41,500, versus $60,000 to $75,000 nationwide. But as the numbers of AIDS patients grew, so did the number of community organizations eager to help. Every minority group wanted its own AIDS organization, which began to quickly use up city funds. Nevertheless, other cities were able to learn from San Francisco's mistakes. When Seattle sought to improve its AIDS efforts, it emulated much of what San Francisco pioneered, but avoided allowing too many AIDS service groups. Only two agencies in Seattle have the specific role of providing case managers. The city prevented a proliferation of small agencies by creating a coalition consisting of a limited number of major players, including an umbrella group for minorities. The Seattle-King County Department of Public Health made sure all the groups worked together to predict where the city was heading, much like San Francisco. Hospital charges per AIDS patient dropped from $13,000 in 1984 to under $10,000 at the end of 1989. Also, the mean lengths of hospital stays dropped from 18.4 days to 9.5 days, whereas the national average in 1989 was 16.3 days. Hospitals Told to Test for HIV * Washington Post (03.05.93), P. A3 Hospitals with significant numbers of AIDS cases should offer HIV testing to all persons admitted or treated in emergency rooms, federal health officials announced yesterday. The Centers for Disease Control issued guidelines that require voluntary testing for HIV to be routine in about 600 hospitals- -11 percent of the nation's total--mostly in urban areas. The results of the tests would be kept confidential and people could not be denied care because they objected to being tested for HIV. Secretary of Health and Human Services Donna Shalala said, "These recommendations will help people learn of their HIV status and get early treatment. They will also be able to take precautions to protect loved ones." A toll-free hotline for physicians and other health care physicians will also be provided by the HHS to answer questions about treating patients with HIV/AIDS. The new CDC guidelines advise hospitals to offer voluntary testing to everyone between the ages of 15 to 54 admitted to the hospital or treated in the emergency room, clinics, or other outpatient departments. The agency encourages testing in hospitals with rates of infection of at least 1 percent or in the event that one in 1,000 discharged patients has AIDS. The tests would reveal more than two-thirds of HIV- positive persons in those age groups hospitalized for conditions other than HIV/AIDS, according to the CDC. Six More Sites Named for AIDS Therapy Test * Journal of Commerce (03.05.93), P. 5A Six additional locations where human trials of a new AIDS treatment will be conducted were tentatively named yesterday by the National Institutes of Health. The new sites are Indiana University in Indianapolis, Mount Sinai Hospital in New York, the University of California--San Diego, the University of Cincinnati, the University of North Carolina--Chapel Hill, and the University of Pennsylvania in Philadelphia. Mass. Jury Supports Dentist in AIDS Case * Journal of Commerce (03.05.93), P. 8A An oral surgeon was not responsible for a patient's contraction of HIV through a contaminated blood transfusion in 1982, according to a ruling issued this week by a jury in Massachusetts' Suffolk County Superior Court. Dr. Donald F. Booth, the defendant in the medical malpractice case, could have been liable for millions of dollars in damages if found guilty of the effects of the transfusion performed by his staff. He was the only one out of eight defendants to take his case before a jury. The other defendants agreed to pay a cumulative total of $2.2 million to plaintiff Katherine Perera. The physician's dental malpractice coverage was through Chubb Group of Insurance Cos., Warren, N.J., under a program in association with the American Dental Association. The insurance program was dropped in 1984. MedImmune, Merck Revise AIDS Research Accord * Washington Post (03.05.93), P. B1 (Southerland, Daniel) Biotechnology company MedImmune Inc. of Gaithersburg, Md., yesterday announced that it has reaffirmed its alliance with Merck & Co. under an agreement that requires Merck to resume paying for some research to develop an anti-HIV drug. The new agreement calls for Merck, one of the world's largest pharmaceutical firms, to continue its own research on a new antibody developed by MedImmune. However, the arrangement will delay funding of further research by MedImmune on other antibodies until better results are provided. In November 1991, MedImmune and Merck announced that Merck would fund research on a drug that uses MedImmune's MEDI 488, a human monoclonal antibody, to thwart the spread of HIV. But early this year, MedImmune reported that Merck was reevaluating the collaboration before determining whether to proceed with developing the drug, because of disappointing "unexpected research results." Merck said in yesterday's announcement that if early clinical trials of MEDI 488 are completed and if Merck subsequently decides to proceed with the program, Merck will reinstate the research funding to MedImmune and deferred money will be paid. Wayne Hockmeyer, chief executive of MedImmune, said he was satisfied with Merck's review of the program. Nevertheless, he warned that due to the complex nature of HIV and its genetic variability, his firm believes any expectations for MEDI 488 to be highly speculative. MedImmune is also continuing its ongoing work with Merck on early research into an AIDS vaccine. Suit to Decide if Disabilities Act Bars Refusal to Pay for AIDS Care * Wall Street Journal (03.05.93), P. B4 Woo, Junda The Mason Tenders District Counsel Welfare Fund is contesting charges from two beneficiaries and the Equal Employment Opportunity Employment Commission that it violated the Americans with Disabilities Act by discriminating against AIDS patients when it cut their health benefits. The self-insured medical plan, which is under jurisdiction of the federal government rather than the state, says that the action was the result of economic considerations and that routine physicals, dental and eye care, and organ transplants were cut along with AIDS treatment. The fund also maintains that benefit trusts aren't covered by the ADA. Mark Scherzer, a lawyer who specializes in AIDS cases, worries that unclear wording in the ADA and the Employee Retirement Income Security Act leaves room for varied interpretations. He says, "Although there are reasonable arguments under the [antidiscrimination act], I'm not confident at all that we'll succeed." Another problem for plaintiffs is that some benefits were cut off before the ADA went into effect. Their lawyers argue that the discrimination is continuing because the benefits are still being denied. School Panel Gets 2 AIDS Proposals * Boston Globe (03.04.93), P. 30 Nealon, Patricia The adoption of a more comprehensive AIDS prevention curriculum that emphasizes sexual abstinence was recommended Wednesday night by Boston School Superintendent Lois Harrison-Jones. In addition, the city's Department of Health and Hospitals proposed associating the new curriculum with condom distribution and counseling in school-based health facilities. The two recommendations, presented to the curriculum subcommittee of the School Committee, would enhance the Boston school system's response to the AIDS epidemic, which AIDS activist groups have criticized as inadequate. The proposal that condoms be distributed to school students in school-based health centers--with parental permission and counseling-- demonstrates the first time the department has approved condom distribution inside city schools. Also, the policy represents Harrison-Jones' belief that school personnel should not be involved in condom distribution, said School Department spokesman Larry Faison. Judith Kurland, commissioner of health and hospitals, said the recommendations were an outcome of a close-working relationship between school and health officials over the past year. Aside from mandating parental permission, the proposed condom distribution plan requires that no School Department employees be involved in handing out condoms. The condoms would only be provided during a primary care visit that involves education and counseling, and distribution would not interfere with class instruction. The package, which also includes adoption of two new curricula stressing abstinence, needs the approval of the full School Committee before it can be implemented. In the Age of AIDS, Sex Clubs Proliferate Again * New York Times (03.05.93), P. B1 Navarro, Mireya Sex establishments are reemerging in New York City even after city health officials cracked down on commercial sex clubs as an attempt to fight HIV infection several years ago. Officials are now seeking new approaches to regulate sex as the AIDS epidemic continues to spread. Instead of closing the establishments, as officials have done in the past, they are taking a more conciliatory approach, asking sex clubs to monitor themselves. The officials say that the clubs, which provide anonymous sex to patrons, can actually help thwart the spread of HIV if patrons can be convinced to practice safer sex. The resurgence of commercial sex establishments contradicts the belief that both homosexuals and heterosexuals are becoming more conservative in their sexual behavior due to fears of HIV. The city officials said they know of about 50 sex clubs currently operating in the city, about two-thirds of which are gay clubs and the rest heterosexual. The clubs are legal, but laws in the state prohibit sexual activities that pose a high risk of HIV transmission in public areas. Oral and anal sex are legally defined as high-risk activities in New York. The city officials said that the city's Health Department is likely to adhere to the recommendations of the AIDS Advisory council, a state panel that last week said the city should close the establishments only after the places are given a chance to monitor themselves. Among other suggested actions, the panel said that the clubs should be forced to distribute condoms, train monitors to supervise sexual activity, and provide adequate lighting. Students Hold Hunger Strike to Protest U.S. Haitian Policy * United Press International (03.04.93) (New Haven, CN) Several Yale Law School students have begun a hunger strike to protest the U.S. policy toward HIV-positive Haitian refugees. The hunger strike started Wednesday. Organizers said that more than 30 students would be involved in the strike, and dozens more are fasting for several days to demonstrate their opposition to the policy. They also said students were ready to continue the hunger strike indefinitely. Second-year law student Emily Zweibel said, "All we are asking is for Mr. Clinton to use his discretion as president to allow these refugees in on humanitarian grounds, if nothing else." Demonstrators have established makeshift "concentration camps" in the halls of the school, to represent what they say are poor conditions at the Guantanamo Bay Naval Base in Cuba, where about 264 Haitians are being detained. The students also built an 8- by 16-foot barbed wire fence in the main corridor of one of the law school's buildings. Margareth Etienne, a first-year law student from New York City, said she visited Guantanamo in December and was "disgusted" by what she witnessed. Etienne, who was born in Haiti, argued that the policy of excluding refugees infected with HIV from the United States is based on discrimination against race and people with the disease. "If this were any other group of people, we believe this would not be happening." She said that the students plan on continuing to strike until President Clinton closes the camps and admits the refugees to the United States. A Shot in the Arm for TB Research * Science (02/12.93) Vol. 259, No. 5097, P. 886 Watson, Traci Nearly a decade since tuberculosis began making its resurgence, the government has started giving research into the disease a higher priority. NIH Director Bernadine Healy intends to improve funding for TB research by reallocating money among the NIH institutes. Healy told the Clinton administration that this year, she will provide $12.5 million more than planned for research on mycobacterium, including new diagnostic techniques and treatments. About $9.2 million of the funding will come from cutting other NIH programs. Although the increase will make the funding for TB research $37 million in 1993, Healy also seeks to obtain emergency money from Congress through lobbying efforts. She hopes increased congressional spending on TB research will attract more scientists to study the disease. However, congressional members said getting more money from Congress will prove difficult with President Bill Clinton's pressure to cut governmental spending. Healy claims additional funding is imperative because the number of TB cases increased 18 percent between 1985 to 1991, and many of the new cases are resistant to existing drugs. Triple Teaming the Deadly AIDS Virus * U.S. News & World Report (03.01.93) Vol. 114, No. 8, P. 60 Brink, Susan The recent finding that three drugs used in combination were effective in attacking HIV in the test tube is encouraging for future research, even if this method is not effective in humans. Yung-Kang Chow, a little-known AIDS researcher, developed the three-drug approach, which is intended to force the virus to profusely mutate until it destroys itself. Chow and colleagues at Massachusetts General Hospital combined AZT and ddI with either pyridinone or nevirapine. The chemical mix either overwhelmed the virus or forced it to mutate so fast and furiously it couldn't replicate itself. By adding a third agent--either pyridinone or nevirapine--to the AZT/ddI combination, Chow et al. managed to compel HIV to mutate three times simultaneously in an attempt to survive. Three quick mutations are more than the virus can tolerate in the test tube. The new approach, called "convergent combination therapy," is an extreme departure from the traditional method of treating HIV infection, in which researchers have attempted to disable the virus at various stages in the disease's development. But the researchers are cautious about the new strategy's clinical potential, warning that any practical benefit from this research could be years away. The National Institutes of Health is currently forming clinical trials of the drug combination expected to begin no later than July. Although the research is preliminary, it helps reinforce the idea that AIDS might someday be controlled by a combination of drugs. Playing Chess With Reverse Transcriptase * Nature (02/18.93) Vol. 361, No. 6413, P. 588 Richman, Douglas D. Scientists are researching the possibility of making the human immunodeficiency virus (HIV) inviable by introducing mutations for drug-resistance. Chemotherapy for HIV patients prolongs their disease-free interval. However, this nucleoside treatment, using AZT, ddC, and ddI, only reduces the virus replication but doesn't completely suppress it. These drugs work by inhibiting the viral enzyme. The disease continues to progress, which may result from emergence of viral mutants with less susceptibility to the treatment drugs. A second class of possible inhibitors of HIV-1 replication also stops reverse transcriptase (RT). Several chemically distinct non-nucleoside compounds share properties, including low toxicity, high potency, synergy with nucleoside agents, and excellent pharmacokinetic properties. However, the resistant mutants of HIV indicate that the non-nucleoside reverse transcriptase inhibitors may possess a weak element when used as drugs. Although reducing the amounts of virus replication and increasing CD4 lymphocyte counts, the drugs dissipated after one month, which is about the same time as the appearance of the mutants. 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 03.01.93 ]]]===------ .