-----===[[[ A I D S w i r e D I G E S T 03.08.93 ]]]===----- Blood Untreated Despite HIV Data * Toronto Globe and Mail (03.05.93), P. A1 Picard, Andre In 1984, the Canadian government was aware that 55 percent of Canadian hemophiliacs contracted HIV through contaminated blood products, but proceeded to use unscreened blood that was "already in the pipeline," according to recently released documents. The documents, obtained through Access to Information and compiled by the Canadian Hemophilia Society, also stated that the government knew in early 1985 that four in every 100,000 blood donors were infected, but continued to allow blood transfusions even though it didn't test the blood for HIV until late that year. David Page, president of the Canadian Hemophilia Society, said Thursday night, "This new information backs up our conclusion that the workings of the Canadian blood system have to be investigated in depth." About 1,000 Canadians contracted HIV as a result of the bureaucratic delays. These included 733 hemophiliacs and 231 blood- transfusion recipients who have received compensation from Ottawa. The new findings bolster accusations by victims that poor communication between bureaucratic agencies and an insufficient administrative structure worsened the problem, which lead the infection of hundreds more people. The Commons subcommittee on health issues is currently investigating the Canadian blood system. The documents revealed last Thursday will be presented at that committee this Thursday night. Targeting Urged in Attack on AIDS * New York Times (03.07.93), P. 1 Kolata, Gina Some AIDS experts say that the epidemic in the United States can be virtually eliminated, even without a vaccine or wonder drug, by prevention efforts that target 25 to 30 U.S. neighborhoods with high rates of HIV infection. Experts have previously maintained that everyone is at risk of contracting HIV, so messages encouraging less risky behavior should be widely broadcast. Some of these experts still say that because HIV has spread throughout the country, it is ineffective to focus on a few neighborhoods. But other experts argue otherwise. They say the pattern of HIV's spread and the success of programs that have concentrated primarily on affected groups and neighborhoods could be used to help curb the spread of the fatal virus. The new view of the pattern of the disease's spread has resulted from a recent analysis by a committee of the National Research Council that indicates AIDS is ravaging a handful of neighborhoods while leaving most of the nation untouched. The report, "The Social Impact of AIDS," released in February, stated the epidemic was "settling into spatially and socially isolated groups and possibly becoming endemic in them." Also, data from the United States and abroad show that it is possible to reverse the course of an AIDS epidemic or even prevent one if efforts are intense and narrowly focused. These efforts have been successful even among supposedly fractious populations like IV-drug users. National Briefs: Drug Abusers Buy Clean Needles * Boston Globe (03.05.93), P. 8 IV-drug users are purchasing more clean needles and may be sharing them less frequently as a result of new Connecticut laws that have legalized needle purchase and possession, federal health officials said Thursday. Last year, the state eliminated laws that required a prescription to buy needles. Among 124 drug users the Center for Disease Control interviewed, 19 percent said they bought clean needles at a pharmacy in June, either illegally or because they somehow obtained a prescription. Approximately 74 percent bought potentially contaminated needles on the street. But by November, 41 percent of the 124 drug users were purchasing clean needles, compared with 59 percent who bought them on the street. Many D.C. Students Take Advantage of Condom Giveaway * Washington Post (03.08.93), P. D5 As a part of an intense effort to thwart the spread of HIV among Washington, D.C., high school students, more than 10,000 condoms have been distributed since October, when school nurses started making the prophylactics available. The condoms were obtained by about 1,100--or 7 percent--of the students at public high schools. According to district health officials, 2 percent of the city's senior high students would request condoms in the early years of the distribution program. The effort has also allowed nurses to detect unrelated health problems in students such as alcohol and drug abuse, mental illness, and sexually transmitted diseases, said Mary Ellen Bradshaw, chief of the District's Bureau of School Health Services. Superintendent Franklin L. Smith said before the school year began that he would permit parents to advise school nurses not to give condoms to their children, and to tell them if their children requested condoms. But Public Health Commissioner Mohammad Akhter said the program would be undermined if nurses did not ensure the students' confidentiality. Caitlin Ryan, chief of the city's Agency for HIV/AIDS, said last week that she has only received one letter from a parent complaining about the condom program. Before students may receive condoms, they must attend two school assemblies about health issues, including AIDS. In addition, they must undergo a counseling session with a school nurse. AIDS Fears Boost Child Prostitution Trade, Experts Say * Reuters (03.04.93) Pleming, Sue (Brussels) Children are being lured into prostitution at younger ages, partly as a result of clients' fear of contracting HIV from older prostitutes, according to human rights advocates. Wassyla Tamzali, head of UNESCO's program for women's rights, said, "The children being traded are getting younger and younger. Even children as young as 12 years old are being sold for prostitution." A conference entitled "Trafficking in Women and Human Rights" was to be held on Saturday in Brussels. The conference was sponsored by the U.N. cultural body UNESCO, and coincided with International Women's Day. Janice Raymond, an American academic and leader of the umbrella pressure group Coalition Against Trafficking in Women, said the emergence of AIDS has resulted in a dramatic rise in child prostitution. "Sexual exploitation used to be rare in children, but with AIDS about, child virgins have become very popular. They are seen as AIDS-free and get a good price," said Raymond. Raymond's group has requested a new international convention to halt all types of sexual exploitation of women and children. The convention will be presented to the Brussels conference, and Raymond hopes it will soon be implemented by the United Nations to replace outdated legislation on trafficking in human beings. Manila Slams Cardinal Sin for Attack on Condoms * Reuters (03.05.93) (Manila) Roman Catholic Cardinal Jaime Sin was accused of being impractical by the Philippine government because of his opposition to the use of the condom as a means to thwart the spread of HIV and as a family planning device. Presidential spokesperson Annabelle Abaya said, "He would want to protect the teachings of the Church ... but there is a huge gap between practical and theoretical application." Sin assailed the government of President Fidel Ramos on Thursday, saying it was sacrificing moral values to solve the country's economic and political dilemmas. However, Abaya said the government is only trying ensure that Filipinos know that condoms are provided as a family planning approach and to help curb the spread of HIV. Sin's speech to businessmen was the latest criticism by the Roman Catholic Church protesting official policies it says oppose the moral traditions of this predominantly Roman Catholic country. Sin has said that controlling the spread of HIV is a good idea but promoting the use of condoms could encourage promiscuity. Health Secretary Juan Flavier has revealed that nearly 36,000 Filipinos are believed to be HIV- positive and he warned there could be a crisis in five years. Researchers Produce Antibody That Targets HIV Enzyme * United Press International (03.06.93) (Tokyo) A Japanese research team has announced the discovery of an antibody that targets an enzyme responsible for spreading HIV, the Kyodo News Service reports. Professor Jo Chiba, an immunologist at the Science University of Tokyo, and researchers from the National Institute of Health and Ube Industries Ltd. revealed their findings at a meeting of the Japan Health Sciences Foundation's Tokyo headquarters. The discovery is still in the test tube stage, the researchers said, but it could prove to be effective in the diagnosis of AIDS and development of a new treatment. The researchers have submitted an application for a patent on the findings. Because the newly developed antibody combines with the enzyme at different parts of the DNA molecule than other drugs, the researchers said it can be used against HIV that has developed tolerance to AZT. The team developed the monoclonal antibody by infecting a laboratory mouse with a virus produced by inserting a gene from the enzyme into the substance used in the production of raw vaccine, and then produced several types of monoclonal antibodies based on the cells from the mouse. After combining the antibodies with the enzyme taken from HIV, one of the monoclonal antibodies showed an ability to virtually inhibit the action of the enzyme, the researchers said. Pa. Reconsiders Asking Labs to Report Low T-Cell Counts * American Medical News (02/22.93) Vol. 36, No. 8, P. 30 Pennsylvania health authorities are re-examining a new AIDS policy that calls for laboratories to report the names of people with low T-cell counts. The policy, which began on Jan. 4, has been suspended by Philadelphia's health commissioner, Dr. Robert K. Ross. The state had asked that medical labs voluntarily disclose to state health officials the name, address, age, sex, and race of anyone with fewer than 200 T- cells per cubic milliliter. The reason the state proposed such a policy is because an accurate count of all people with AIDS affects the state's ability to receive its share of federal funding for treatment of the disease. Opponents of the policy claim the reporting will deter people from being tested for HIV. They also cite a separate law that makes it illegal to reveal confidential information related to a person's HIV condition. Kathy Lieber, spokeswoman for the Pennsylvania Department of Health, said the controversy incited a review of the policy. Dr. Ross said Philadelphia would consider devising a reporting approach that protects people's identities. Scott Burris, counsel to the American Civil Liberties Union's AIDS and Civil Liberties Project, said it would be illegal for labs to provide the state with the names of people with low T-cell counts. Pennsylvania's Act 148 states that it is illegal to reveal confidential information, such as test results, associated with a person's HIV infection. News in Brief: International * Advocate (02/23.93) No. 623, P. 31 Mandatory HIV testing of foreigners was recently proposed in Europe and Southeast Asia. Conservative foreign aid minister Carl-Dieter Spranger of Germany incited protests from the opposition Social Democrats and a German human rights group by recommending that asylum seekers from countries with high prevalences of HIV infection, such as those in Africa and Asia, should be required to test for HIV infection before being admitted into Germany. The human rights group Pro Asyl said that Spranger's plan was "racist." Cornelia Sonntag, spokeswoman for the Social Democrats, said the testing could only bolster prejudices against asylum seekers, who are often targets of neo-Nazi aggression. Similarly, The Saigon Newsreader reported that HIV tests will be mandatory for prostitutes, prisoners, drug addicts, homosexuals, and foreigners seeking permission to spend more than three months in Vietnam. The report also said that citizens who are found to be HIV-positive will not be allowed to marry. Illustrating AIDS Taboos * Progressive (02.93) Vol. 57, No. 2, P. 15 Metz, Holly An inmate HIV educator at the Women's Correctional Institution in Delaware has developed a comic book targeted directly at women in prison. Using prison jargon and describing the challenges of prison life, the 12-page comic book, "Before I Used to Be Scared," addresses issues like the ostracism that HIV-positive inmates face. Suzanne Triano, the comic book's author, who was recently paroled after nine-and-a-half years, said, "There's so much prejudice against people with AIDS in the prison. And the language that's used to describe women afflicted with this is so demeaning." She says the comic book is intended to ease stress in a closed environment already overwhelmed by tension and distrust. "Before I Used to Be Scared" uses humor to provide non-judgmental safe-sex messages. Triano says she developed the comic book because the few pamphlets that educated women about AIDS did not address the special needs of women in prison. While the percentage of incarcerated women who categorize themselves as lesbians or bisexuals is very low, Triano says, "over 80 percent of the women in prison are engaged in lesbian relationships at one time or another in their incarceration. So there's a lot of unprotected activity going on, which needs to be addressed." The warden at the Women's Correctional Institution, Paul Howard, worked with Triano to produce and distribute the comic book she proposed. However, the warden cannot provide the plastic wrap, condoms, dental dams, or rubber gloves that the comic recommends for safer sex, because it is illegal to do so under state law. Messages About AIDS Reach Some, Not All * American Pharmacy (02.93) Vol. NS33, No. 2, P. 7 Two recent reports indicate that not all high-risk groups are grasping anti-AIDS messages. A nationwide telephone survey of more than 10,000 heterosexuals aged 18-75 revealed that 15-31 percent of the respondents were at some risk for HIV infection in the past one to five years. But only 17 percent of the respondents with multiple sex partners reported using condoms all the time. Of those with sex partners in high-risk groups, only 12.6 percent used condoms all the time, and only 10.8 percent of untested transfusion recipients always used condoms. Those reporting sex with multiple partners were more likely to be white or African American young male adults than Hispanic, unmarried, or highly educated individuals. The researchers stated that public health messages about AIDS prevention seem to be reaching heterosexuals with multiple sex partners "to some extent," especially young adults, but are not reaching middle-aged and elderly adults or people who have received blood transfusions. In a separate study conducted by researchers at the Medical College of Wisconsin in Milwaukee, it was discovered that about one-third of some 1,800 homosexual men studied in 16 small cities performed unprotected anal intercourse an average of eight times during a two-month period. Most of these were outside of monogamous relationships. While 90 percent of men who had protected anal intercourse described their HIV risk over the last two months as none or slight, 77 percent of those who had unprotected anal intercourse incorrectly described their risk as none or slight. These findings emphasize the need for more aggressive anti-AIDS efforts. New Theory Suggests Cell Regulator May Hold the Key to Fighting AIDS * New York Times (03.09.93), P. C3 Kolata, Gina Two groups of researchers have hypothesized that by killing numbers of CD8 cells in AIDS patients they could boost the number of CD4 cells produced and help strengthen AIDS patients' immune systems, according to papers published in the current issue of the Journal of the Acquired Immune Deficiency Syndrome. When people become infected with HIV, they slowly and uncontrollably lose one class of white blood cells, the CD4 T cells, while a second class of cells, called CD8 cells, remain unaffected. The two groups appear to have different roles, with the CD8 cells presumably suppressing immune responses while CD4 cells incite them. Dr. Leonard Adleman of the University of Southern California, author of the current report, and immunologist Dr. Joseph B. Margolick and his colleagues from the Johns Hopkins University in Baltimore independently observed that HIV-positive people maintain a normal number of T cells, but as HIV infection develops, the ratio of CD4 cells in the mix declines. As the AIDS patient becomes more ill, there are fewer and fewer CD4 cells and an increasing amount of CD8 cells. This finding led Dr. Adleman, working with Dr. David Wofsy of the University of California--San Francisco, and Dr. Margolick and his colleagues to suggest their hypothesis. They believe the immune system cannot tell the difference between a loss of CD4 cells and a loss of T cells in general. It only senses T cells are lacking and replaces them with new ones in the normal proportions. If this hypothesis is correct, it might be possible to replenish the immune system by removing some of the CD8 cells. White House Again Defends Bush's Policy on Haitians * New York Times (03.09.93), P. A16 Sontag, Deborah The Clinton administration defended the Bush administration's restrictive position on the HIV-positive Haitian refugees for the second time in court yesterday, although President Clinton criticized that policy during his campaign. The trial that began yesterday in Federal District Court in Brooklyn will reveal the fate of 264 Haitians who have been detained at the U.S. Naval Base in Guantanamo, Cuba, for about 16 months. The Haitians had left their country in late 1991 and intended to enter the United States as applicants for political asylum. However, they were never released from the camp because either they or their family members tested positive for HIV. In court, the Haitian attorneys will contend that it is illegal to detain the refugees indefinitely solely on the basis of HIV infection, or treat them differently than others who seek asylum. Although government attorneys did not give an opening argument yesterday, the department has argued in the past that immigration and civil rights laws do not apply to the Haitians at Guantanamo. The Haitians' attorneys are expected to have medical experts testify that it is scientifically unsound to confine people who are HIV-positive in the same quarters. Harold Koh, a law professor at Yale University who is a lawyer for the Haitians, said that the lifetime cost of treating the HIV-positive refugees in the United States would be much less than the annual cost of maintaining their Guantanamo base, which is projected at $55 million. The Haitians' lawyers are also scheduled to summon a former military commander of the Haitians' camp, who said in pretrial testimony that he feels the detention camp should be closed. Trenton Votes to Control Sex Education * New York Times (03.09.93), P. B1 Gray, Jerry The New Jersey Assembly endorsed legislation yesterday requiring sex education courses to stress sexual abstinence as "the only completely reliable means" of preventing sexually transmitted diseases, including HIV infection. The vote of 54-7 makes New Jersey one of only a few states to dictate to school districts statewide just how sex education should be executed. It also signified a shift in the sex-education curriculum from local school board meeting to the floor of the State House. The bill passed by the Assembly, known as the AIDS Prevention Act of 1993, still must obtain approval in the state Senate, and Gov. Jim Florio must sign it before it becomes a law. However, following a five-year battle led by Assemblywoman Marion Crecco, a Republican from Bloomfield, there seems to be enough support in both chambers not only to pass the bill, but to override Florio's veto if he opposes it. A spokesman for the governor said that he believed abstinence should be discussed in sex-education classes, but he was concerned about the Legislature's attempt to dictate the curriculum. The bill, however, does not include any penalties for school districts that don't adhere to its provisions. Critics of the bill say it is unrealistic to expect that young people are not having sex. But Marion Crecco argued that opponents of her bill were attempting to confuse the issue. "This bill does not prohibit or restrict the teaching of safe sex. The problem is that abstinence is not being stressed, " she said. A Miffed Harrison-Jones Halts HIV-AIDS Program Collaboration * Boston Globe (03.06.93), P. 19 Canellos, Peter S. Boston Schools Superintendent Lois Harrison-Jones abruptly canceled the collaboration between the school system and the Health and Hospitals Department for HIV-AIDS education in city schools, after she was angered by comments made by Health and Hospitals Commissioner Judith Kurland on Friday. Officials from the School Department and Health and Hospitals had worked for months to develop a joint approach to HIV-AIDS issues, linking the classroom curriculum and services in the school clinics. On Wednesday, Harrison-Jones announced the initial results of the collaboration, which required students to be counseled it the classroom to abstain from sex, but to also be given information through the clinics about condoms and other ways to avoid HIV infection. Harrison-Jones announced the results through two press releases: one on letterhead of the Boston School Department, and another on blank letterhead that referred reporters to the Health and Hospitals Department. Kurland said she was puzzled when reporters called her and assumed the blank release had been sent from her department. After discovering that the release had come from Harrison-Jones, Kurland said she sought and received an apology from the superintendent for not confronting Kurland's office about the release. However, after Harrison-Jones read Kurland's depiction of events in the newspaper, she became incensed and canceled the collaboration. Transfusions' Effects on AIDS Patients * Washington Post (Health) (03.09.93), P. 5 Herman, Robin Even though the medical community has concentrated on protecting the blood supply from HIV-tainted blood, mounting evidence suggests that for AIDS patients, receiving a blood transfusion may actually accelerate the development of the disease. A study published in the February issue of the journal Transfusion demonstrates a strong link between transfusions and shortened survival time for patients who received a kind of transfusion called packed red cells within three months after their official diagnosis with AIDS. A frequent AIDS-related complication is progressively worsening anemia, which is treated with a transfusion. But scientists are unsure why transfusions might have an adverse effect on people such as AIDS patients, who are immune suppressed. Donated blood, even when properly typed and distributed to people without AIDS, can sometimes elicit an immune system reaction. Harold S. Kaplan, director of transfusion medicine at the University of Texas- Southwestern Medical Center, and Eleftherios C. Vamvakas, a research fellow in transfusion medicine at the Mayo Clinic, conducted the study, and collected their data by looking at the records of AIDS patients at New York's Bellevue Hospital in the 1980s. The researchers stress that their study does not prove cause and effect, but indicates a need for a comparison study of AIDS patients who do and do not receive transfusions. In addition, their findings cannot be applied to all AIDS patients because their subjects were a distinct group, primarily minorities in a low socioeconomic class who were not receiving AZT. Condom Firm Prevails on Showing the Colors * Washington Post (03.09.93), P. A8 Howe, Robert F. Although the U.S. Patent and Trademark office refused to register a proposed condom logo that resembled the American flag last year, saying it would "scandalize" the public, an appellate ruling approved the condom. It ruled that the red, white, and blue condom pennant logo is "in no way" scandalous and that designer Jay Critchley's apparent "belief that the use of condoms is a patriotic act" should be commended. Rachel Blue, the patent lawyer who rejected the registration request for Old Glory Condom Corp. last May, said yesterday that the reversal would not be appealed. Critchley, an artist and AIDS activist from Provincetown, Mass., applauded the decision, filed last week by the Trademark Trial and Appeal Board and disclosed yesterday. "The real scandal is not my trademark, but the fact that the examining attorney was more scandalized by a trademark than by the AIDS crisis to which I sought to respond," said Critchley in a prepared statement. Even though the three-member appellate panel recognized that some people might be offended by the Old Glory logo, it praised Critchley's seemingly sincere attempt to fight AIDS. Related Story: Philadelphia Inquirer (03.09) P. A6 A Hero With Something to Prove * Los Angeles Times (03.07.93), P. A1 Stolberg, Sheryl Jonas Salk, the founder of the polio vaccine, is currently conducting research to find a cure for AIDS. His work on the AIDS vaccine began seven years ago after Salk retired from his laboratory at the scientific institute he founded in La Jolla, Calif. He and his colleagues hope to soon present the Food and Drug Administration with the results of a nationwide test of his "therapeutic vaccine" for HIV which treats already-infected individuals. If the FDA grants approval to the Salk Immunogen, it could be available to AIDS patients by the end of this year or early 1994, under a new federal approval policy that permits the marketing of drugs for HIV-positive people, while testing continues. Therefore, Salk's vaccine could be the first therapeutic or preventive vaccine to reach the marketplace. In addition, Salk, at age 78, could become a hero all over again, but for treating AIDS this time. Dennis Carlo, the chief scientist at Immune Response Corp., the Carlsbad biotechnical company that Salk helped found to produce the Salk Immunogen, said, "How many scientists get the chance to do something twice in a lifetime? I think that of anybody, he has a very good chance of doing it." Among all of the AIDS vaccines in progress, not one scientist is using Salk's approach, which involves using a killed form of HIV, mostly because no other researcher believes it will be effective. Antibodies to Mycoplasma Penetrans in HIV-Infected Patients * Lancet (02/27.93) Vol. 341, No. 8844, P. 557 Taylor-Robinson, David and Ainsworth, Jonathan Mycoplasma penetrans could behave as a commensal without producing antibody, but flourish to do so under the immunosuppressive influence of HIV, if mycoplasma is widely prevalent in the entire population, not just in homosexuals, write David Taylor-Robinson and Jonathan Ainsworth of St. Mary's Hospital in London, U.K. In the Nov. 28 issue of the Lancet, Dr. Wang et al. demonstrate that 35.4 percent of 444 HIV-positive subjects had serum antibody to M. penetrans, measured by enzyme-linked immunosorbent assay (ELISA) compared with only 0.4 percent of 893 HIV-negative subjects. In addition, about 40 percent of patients with or dying of AIDS were mycoplasma-antibody positive. Wang and colleagues consider the mycoplasma to be uniquely associated with HIV-1 infection and AIDS and not to be commensal or simple opportunist. But omission of information makes interpretation difficult. A total of 85 of the HIV-positive patients who died of AIDS were homosexuals, and Taylor-Robinson and Ainsworth assume that most of the 234 HIV-positive patients are homosexuals, presumably male. But it is unclear whether most of those who have antibody to the mycoplasma are homosexuals. If most of the 336 patients attending sexually transmitted disease clinics are heterosexual and male, then it seems M. penetrans resides mostly among homosexuals. It is possible that the association with HIV/AIDS is an illusion and that the real association is with homosexuality. As a result of homosexual activity, M. penetrans could spread to other anatomical sites and have a greater chance of stimulating antibody and so account for the findings of Wang and co-workers, conclude the researchers. Mandatory Testing for HIV * Journal of the American Medical Association (03.03.93) Vol. 269, No. 9, P. 1115 Harris, Clifford J. Mandatory testing for HIV should be enforced because voluntary testing is not effective at thwarting the spread of the lethal virus, writes Dr. Clifford J. Harris of Cigna Healthplan of Phoenix, Arizona. The Centers for Disease Control and others predict that more than 1 million Americans are infected with HIV, but most of them do not know they are infected. Health- care workers must direct their attention to the asymptomatic HIV-positive person who, once identified, can be educated not to spread the virus and to identify contacts who can be tested. Those who test HIV-negative would receive the best education on how to protect themselves from the disease. And those testing HIV-positive would be helped by receiving earlier medical care and instructed how not to spread the virus. Therefore, HIV must be mandatory for identified contacts. The public needs to be informed about the epidemic. The American public cannot depend on a medical miracle to end this plague. The mortality and morbidity of the AIDS crisis far outweighs those of any war or past tragedy. Political correctness should be ignored when it comes to the AIDS issue. Health-care workers should urge for mandatory HIV testing programs, pass the laws, lobby the politicians, and demand responsible action now. It is the least we can do, concludes Dr. Clifford. Magnetic Resonance Spectroscopy May Offer Early Look at HIV Disease-Mediated Changes in Brain * Journal of American Medical Association (03.03.93) Vol. 269, No. 9, P. 1084 Skolnick, Andrew A. Proton magnetic resonance (MR) spectroscopy may help scientists learn about the effects of human immunodeficiency virus (HIV) on the central nervous system, results from a preliminary study have indicated. The study showed that MR spectrascopy may detect biochemical changes in brains of HIV-infected people who show no symptoms of AIDS or evidence of neurocognitive dysfunction. MR provides spectral patterns that are like "a collection of fingerprints of the various biochemical compounds present in the brain,'' said Robert E. Lenkinski, associate professor of radiology at the University of Pennsylvania School of Medicine. He said the spectral patterns may help scientists understand the pathophysiology of diseases of the central nervous system, including AIDS. The majority of HIV-infected patients will experience some neuropsychiatric symptoms that result from the virus entering the brain. In the late stages of AIDS, magnetic resonance imaging may indicate atrophy of gray matter of the brain followed by injury to its white matter. However, scientists cannot detect when damage to the central nervous system begins, Lenkinski said. Obtaining Drug for AIDS-Related Toxoplasmosis * Journal of American Medical Association (03.03.93) Vol. 269, No. 9, P. 1086 Skolnick, Andrew A. AIDS patients may again take sulfadiazine, a sulfa drug to treat toxoplasmosis, under a Centers for Disease Control program called Investigational New Drug. The FDA granted the CDC permission to import sulfadiazine to make the drug available to doctors at no cost until a domestic market source can be re-established. Production of the drug stopped in the United States in October 1992, and the only major manufacturer left no inventory supplies. Doctors can now receive a six-week supply so they may treat acute toxoplasmosis infection in AIDS patients, in patients with ocular disease, and in infected pregnant women, said Dennis Juranek, chief of epidemiology activity at the CDC's Division of Parasitic Diseases. The CDC will offer physicians a two-month supply of the drug for congenitally infected infants and maintenance therapy for AIDS patients. Doctors who treat prophylaxis of toxoplasmosis will not have access to the drug, Juranek said. Clinics will be asked to provide the CDC with patient information to enroll patients. Large hospitals that want to treat several patients should designate one doctor to be responsible for all the terms of the program, Juranek said. Update: 11th Circuit Upholds AIDS Cap Under Self-Insured Health Plan * Business Insurance (03.08.93) Vol. 27, No. 10, P. 1 The 11th U.S. Circuit Court of Appeals decided that self- insured Storehouse Inc. had reserved the right to amend its health-care plan, and that former employee and AIDS patient Richard Owens therefore could not sue for discrimination when his benefits were reduced from a maximum of $1 million to $25,000. A lawyer for the plaintiff said the decision "wasn't a surprise" since the case was almost identical to Greenburg v. H.H. Music Co., the case which the Supreme Court refused to review last November. Both rulings said that the change in benefits was needed for the company's financial stability and that there was no discrimination against AIDS patients because the cost cap could have been applied to any serious and costly illness. Surgeons Risk Suits by Hiding AIDS * Baltimore Sun (03/10.93), P. A1 West, Norris P. HIV-positive surgeons in Maryland must reveal their status to patients before performing operations if they wish to avoid lawsuits, according to a ruling by the state's highest court yesterday. The decision stated that health professionals infected with HIV may be held liable if they neglect to reveal their conditions. Yesterday's decision reversed a lower court ruling on lawsuits filed against the estate of Dr. Rudolph Almaraz, a Johns Hopkins Hospital surgeon who died of AIDS in 1990. Hopkins sent letters to approximately 1,800 former patients of Dr. Almaraz's after his death to inform them that the surgeon had AIDS, and to ensure them that their risk for contracting the virus was minimal. The lawsuits were filed by two women who had been operated on by Dr. Almaraz and feared that they may have contracted HIV during breast surgery. The two women tested negative but still filed suit. The unanimous ruling by the Court of Appeals was based on a policy statement implemented in July 1991 by the American Medical Association. According to the statement, physicians should be tested for HIV and disclose their status to a public health official if the result is positive. Dr. Hamilton Moses III, Hopkins' vice president for medical affairs, said the institution urges all its health-care professionals to be tested for HIV and to reveal their status to the hospital. But he said current state prohibits hospitals from mandating such testing. Paul F. Strain, a lawyer for the hospital, said surgeons have always been required to disclose any risks in medical procedures. He said the court's ruling permits juries to determine whether a doctor's HIV status should be part of that disclosure. Hard-Hit Minorities to Get AIDS Grants * New York Times (03/10.93), P. B3 New York state health officials announced yesterday that they would allot $3.9 million in grants for prevention programs in black and Hispanic neighborhoods. The move is a result of criticism for the state's delays in the anti-AIDS programs among minorities. The funding will be given to 24 organizations that work to curb the spread of HIV among black and Hispanic people. Dr. Mark Chassin, the state health commissioner, said during an Albany news conference, "To halt this devastation, we must help minority communities marshal the resources, both human and financial, needed to bring the HIV epidemic under control." Black and Hispanic people currently account for about 64 percent of New York state's AIDS cases, but they only comprise 25 percent of the population, according to the State Health Department. Dr. Chassin mentioned that $3 million of the AIDS grants will be provided to 14 minority-operated social service groups, which will make a range of AIDS prevention and support services available. New York City to Detain Patients Who Fail to Finish TB Treatment * New York Times (03/10.93), P. A1 Navarro, Mireya The New York City Health Department yesterday implemented rigid rules for detaining tuberculosis patients who are reluctant to complete their treatment on their own. The move indicates the possible confinement of patients for more than a year. The rules are designed to thwart the spread of TB and the deadly drug-resistant strains of the disease that manifest in patients who repeatedly start and stop treatment. It can take between six months and two years to cure most strains of the disease. The city's most recent policy has been to confine recalcitrant TB patients to hospitals for the few weeks of treatment necessary to eliminate contagion. However, the new regulations are designed to ensure that patients who have demonstrated a pattern of ending treatment when they are released continue their medication until they are completely cured. City officials indicated that long-term detentions could start as early as next month, when the Health and Hospitals Corporation plans to open a 25-bed unit at Goldwater Memorial Hospital on Roosevelt Island for this purpose. The Board of Health officials also adopted due process protections for detained patients, including the right to an attorney paid by the city and to a court hearing. The new regulations also mandate that the health commissioner obtain a court order within two months of the detention--or within five days of a request for release from the patient--and come to court every three months to prove continued need for the order with "clear and convincing evidence." Singapore Requires AIDS Test for Foreigners * Reuters (03.08.93) (Singapore) HIV tests must be conducted on all foreigners seeking permanent resident status in Singapore, according to an immigration department spokeswoman. The spokeswoman said Monday that the test is part of a medical examination which all applicants for permanent residence must take. Singapore introduced the mandatory HIV tests for foreign work permit- holders on Jan. 1. Foreigners who earn $910 a month or less must hold a work permit, while other employees need an employment pass. Before the January ruling, HIV testing was limited to foreign maids in Singapore. Since January, at least six work permit-holders have tested HIV-positive and have been repatriated, say local newspapers. Health ministry figures issued early this year reported that 37 people had died of AIDS as of Jan. 1, while 158 others were infected with HIV. The number of foreigners who tested HIV-positive increased to 61 last year from 28 in 1991. AIDS Safeguards Failed, Court Told * Toronto Globe and Mail (03.09.93), P. A14 Downey, Donn The Canadian Red Cross had failed to protect a man who died of AIDS after contracting HIV through a tainted blood transfusion, according to an attorney who spoke to the Ontario Court's General Division on behalf of the man's widow Monday. Kenneth Pittman died of AIDS-related causes in March of 1990, after he received HIV-positive blood from a donor who, the court was told, later conceded that he had had homosexual contact without knowing that he was putting himself at risk. Pittman's wife Rochelle learned this September that she contracted the virus from her husband and is now suing the Canadian Red Cross, the Toronto Hospital, and family doctor Stanley Bain. Her attorney, Kenneth Arenson, tried to convince Madam Justice Susan Lang to hear evidence of two other donors who were gay and also donated HIV-positive blood that subsequently infected the recipients. Arenson requested that the court hear the testimony, which is recorded on videotape. He said the tape shows one man testifying that he had "many, many homosexual encounters" over a span of eight years up to 1982, but had abstained from sex for about two years by the time he donated blood in December of 1984. Arenson said at that time, the Red Cross had published a brochure warning of the potential risk of homosexual sex. However, the man claims he never saw the brochure and continued to donate blood, unaware of any possible consequences. The second man donated blood in September 1983 after the Red Cross had distributed two press releases about the association between HIV and gay sex, but the man never knew about the connection. Judge Lang was scheduled to decide on the relevance of the evidence of the two donors yesterday. Spain--Hemophiliacs * Associated Press (03.09.93) (Madrid, Spain) Hundreds of HIV-positive hemophiliacs who contracted the virus through tainted blood products provided by the government demanded yesterday that Prime Minister Felipe Gonzalez meet with them and make more than $174 million available for compensation. The Spanish Hemophilia Federation indicated it would sue the government if Gonzalez did not meet with its representatives by Wednesday. Although there was no immediate reaction from the prime minister's office, a health official said the government was willing to contemplate compensating the HIV-positive hemophiliacs. According to the federation, 1,147 Spanish hemophiliacs--42 percent of the hemophiliac population--had contracted HIV through contaminated blood products. It also said 416 have died of AIDS. The federation says government health officials continued to provide HIV-infected blood products between 1983 and 1985, even though there is evidence that heat treatment would have prevented infection. Spain did not begin testing blood products for HIV until after that time. Marcos Pena, the secretary- general for health, said the government was willing to discuss compensation but declined to elaborate. "I don't want to monetarize the discussion of hemophiliacs in public. But economic compensation for individuals is undoubtedly the most adequate solution within the realistic possibilities," said Pena. Japan Insurers Ponder Compulsory AIDS Tests * Reuters (03.09.93) (Tokyo) Japanese life insurance companies announced Tuesday that they are considering mandating HIV tests for policy applicants. A spokesman for the Life Insurers Association, an industry group, said, "We have started a broad study because it has become an issue that cannot be ignored." An industry committee would consider whether all those applying for policies should undergo an HIV test, said the spokesman. He added that the panel would not make a hasty decision and its guidelines would not be binding. A total of 543 Japanese were reported with AIDS by the end of 1992, and 2,551 were infected with HIV, according to government statistics. The total number of those who have died of AIDS was 298. Agency Given Fine on Worker Safety * New York Times (03.09.93), P. B2 The Connecticut State Division of Occupational Safety and Health has fined the State Department of Mental Retardation $24,000 for violating workplace safety regulations concerning AIDS, hepatitis B, and other blood-born pathogens. After inspecting the Hartford Center in Newington, state OSHA officials found that the department did not provide proper masks, gloves, or gowns for employees exposed to infected patients and that workers did not receive vaccines or safety training. The department has since begun following the regulations, which became effective last July. Teen AIDS * Associated Press (03.06.93) Siegel, Lee (Los Angeles) The majority of young people who are sexually active or who use drugs do not believe they are at risk for HIV infection, and health officials need to find new ways of educating them about the disease, according to a new report. The report was released Friday and was conducted by the Los Angeles County Adolescent HIV Consortium, which interviewed 81 providers of AIDS-related services and 36 youths during 12 intense discussion groups. The consortium is operated by county health officials and Childrens Hospital. The report said condoms should be provided for teens and young adults in schools, jails, and prisons. It recommended aggressive anti- AIDS education efforts that focus on homosexual and bisexual youths, runaways, and minority adolescents with diverse cultures and languages. Dr. Marvin E. Belzer of Childrens Hospital Los Angeles and chairman of the consortium, said, "The major finding of the report is a little bit scary: youths don't seem to see themselves at risk. All youth seem to consider HIV someone else's problem regardless if they're gay or straight." American teenagers and those in their early 20s comprise less than 5 percent of AIDS cases nationally--about 10,000 cases as of September. However, the report cautioned that AIDS cases grew 62 percent in that age group from 1989 to 1991, and only 15 percent to 31 percent of them routinely use condoms during sex. It also said that about 70 percent of 18-year-olds are sexually active. HIV Cases Rising Among Vietnamese, Officials Say * Reuters (03.05.93) (Hanoi, Vietnam) The number of HIV-positive individuals in Vietnam is growing, according to health officials. They said 43 Vietnamese residents, mostly prostitutes or drug addicts, were among the 118 HIV-positive cases confirmed by early March, an increase from 79 at the end of 1992. A total of 35 of the Vietnamese lived in the commercial center of Ho Chi Minh City, and 67 of the 75 infected foreigners were Thai fishermen. The actual number of HIV-infected Vietnamese is likely to be higher than the most recent confirmed figure, based on blood tests of 150,000 people since 1987, said officials from the National Committee for AIDS Protection. The first case of HIV infection was reported in Vietnam in December 1990; but by the end of 1992 eight Vietnamese and 71 foreigners were reported as testing HIV-positive. Didanosine and ACTG 116A * Lancet (02/27.93) Vol. 341, No. 8844, P. 570 Higgins, S. et al. Because there was no survival advantage from switching from AZT to DDI to treat HIV infection, it cannot be considered effective, write S. Higgins et al. of the University Hospital of South Manchester in Manchester, U.K. In the Jan. 9 issue of the Lancet, the editors discuss the AIDS Clinical Trials Group (ACTG) 116A test of continued AZT versus switching to DDI in HIV infection. The editors state that 500 mg daily of DDI is more effective than 600 mg of AZT in those who have received AZT for 8-10 weeks. But this statement contradicts Lipsky's report (Jan. 2 issue) and the original article. While there were substantially fewer AIDS-related conditions in the DDI 500 mg daily arm than the continued AZT 600 mg daily ram, mortality did not noticeably differ between the three treatment groups. Moreover, two patients had fatal pancreatitis in the higher dose DDI arm--a well-recognized side effect. In the original study, the baseline characteristics demonstrate that those randomized to continue with AZT actually started the study with 13-18 CD4 cells/uL fewer than the DDI groups, and this difference may have worked in favor of DDI. The original study researchers report, "The benefit from didanosine [DDI] may simply demonstrate the advantage of changing from one effective nucleoside to another." Therefore, a survival benefit is essential for a drug to be considered effective at treating HIV infection, Higgins et al. conclude. Debunking Doubts That H.I.V. Causes AIDS * New York Times (03/11.93), P. B13 Kolata, Gina A team of California researchers has disproved a theory claiming that recreational drug use, and not HIV, is the cause of AIDS. The scientists reported in a commentary published today in Nature that their research shows no relationship between recreational drug use, excluding IV-drugs, and the development of AIDS. The research team was led by Dr. Michael S. Ascher, an immunologist at the California Department of Health Services, and Dr. Warren Winklestein Jr., an epidemiologist at the University of California--Berkeley. Dr. Ascher and colleagues wrote their paper in response to a challenge by Tom Bethell, a media fellow at the Hoover Institution at Stanford University, to compare people who used drugs with those who didn't and to determine whether those who took drugs had a higher incidence of AIDS. Bethell wrote in an article in the San Francisco Chronicle of the theory proposed six years ago by Dr. Peter H. Duesberg, a molecular biologist at the University of California--Berkeley. Duesberg argues that HIV is not the cause of AIDS and that the drug AZT speeds, rather than slows, the depletion of the immune system. Bethell asked why no research had been done on this hypothesis. Therefore, Dr. Ascher et al. retested their hypothesis of the analysis of the San Francisco Men's Study, a group of 1,034 randomly selected single men who lived in San Francisco and were 25-54 years old in 1984, when the study began. The researchers found that homosexuals and heterosexuals in the study were equally likely to use drugs. However, 26 percent of homosexuals developed AIDS, whereas none of the heterosexuals did. All of the men were infected with HIV, but there was no link between drug use and AIDS. Related Story: Wall Street Journal (03/11) P. B5 In the Nation: House Favors Ban on Entry of HIV-Infected * Baltimore Sun (03/11.93), P. 13A The controversial ban on HIV-positive foreigners seeking admittance into the United States is likely to be passed by the House, which could defeat the Clinton administration on the issue, Democratic aides admitted yesterday. Debate on the restrictive policy emerged as the House considered a measure authorizing spending for the National Institutes of Health. A vote on the ban is scheduled for today, and congressional Democratic aides said that it is expected to be passed. The Senate overwhelmingly passed a similar bill last month, after adding an amendment prohibiting HIV-positive foreigners from immigrating to the United States. During his campaign, President Clinton vowed to eliminate the ban already in place. Emergency Room Misses Women's HIV * USA Today (03/11.93), P. 1D Painter, Kim Many HIV-positive patients, particularly women, were not recognized as having the condition in Bronx emergency rooms, according to a new study published in the American Journal of Public Health. The report adds evidence that HIV in women is not being detected, which leads to missed chances for treatment. Mayris Webber of Montefiore Medical Center said, "HIV and AIDS in the eyes of most physicians is still a male problem, but it is not." Emergency room charts of 2,102 patients were examined and HIV tests were conducted on 856 blood samples left over from other tests. The researchers found that health-care workers had identified 20 of 52 HIV-infected men, but only 7 of the 40 women with the disease. Also, only 11 percent of the women and 16 percent of the men in the emergency room were asked anything about high-risk behavior. Most of the questions were about drug use, and not about sex. This is unusual for an area where heterosexual transmission of HIV is common, and women are more likely than men to contract HIV through sex. Director Leaving Disease Centers * New York Times (03/11.93), P. B12 Hilts, Philip J. Dr. William Roper, chief of the Centers for Disease Control, resigned yesterday as a part of a continuing effort by the Clinton administration to remove some of the Bush administration's top health appointees. Dr. Roper was asked to step down by Secretary of Health and Human Services Donna E. Shalala on Tuesday, according to HHS officials. His resignation will take effect on June 30, and a successor has not yet been named. What caused the HHS to request the resignation were Roper's markedly uncontroversial policies on AIDS prevention, which included an anti-AIDS advertising campaign that was considered weak by opponents. The ousting of Dr. Roper also indicates a shift in the government's attack on AIDS. The new approach is expected to include prevention efforts that address sexuality directly, and programs of early treatment that may be costly, experts in and out of the Clinton administration say. Jeffrey Levi, political director of the AIDS Action Council, said the removal of Dr. Roper "is an opportunity to depoliticize the AIDS program at the Centers for Disease Control." He added, "Dr. Roper allowed politics to stand in the way of explicit prevention programs as well as setting policy on how to treat doctors and nurses who are infected with HIV." The CDC had written draft guidelines explaining that HIV- positive health-care workers could continue to practice after review of their cases by a medical board. However, after a call from Sen. Orrin G. Hatch (R-Utah), Dr. Roper "shredded that policy and added that health care workers still need to get informed consent from the patient," said Levi. Japanese Mushroom Helps Block AIDS Says Researcher * United Press International (03/11.93) (Tokyo) A Japanese mushroom can help inhibit HIV and can also restrain breast cancer, according to a researcher in Kobe, Japan. Prof. Hiroaki Namba of Kobe Women's College of Pharmacy discussed both trials conducted among AIDS patients in the United States and tests on mice with the Kyodo News Service Thursday. He said the tests demonstrated that a polysaccharide called glucan extracted form the mushroom, called maitake, incites action in helper T-cells. Namba said, "It remains unknown why glucan from the maitake mushroom activates the body's immune functions. But given its effectiveness against symptoms of AIDS, it could be used for the treatment of AIDS patients together with anti-AIDS drugs." Namba worked with two American physicians to perform trials involving 26 AIDS patients, aged 20-40, to determine if glucan would activate helper T-cells. The AIDS patients were administered powdered maitake and glucan tablets, weighing three grams each, daily for two weeks in April 1992, Kyodo reported. The number of T- cells increased in 13 patients, and they stopped decreasing in the other 13. In some instances the number of T-cells doubled. A report on Namba's study is expected to be presented at a meeting of the Japan Society of Pharmacy in Osaka, reported the news service. Bill Would Boost Research on Women's Health Problems * United Press International (03/11.93) Shepard, Robert (Washington) Debate has been opened in the House over a bill intended to eliminate the "blindspot" in medical research on women's health problems, which is similar to a bill vetoed by the Bush administration. The legislation, scheduled to receive a final vote today, also would legalize President Clinton's order allowing federally supported medical research that uses fetal tissue from abortions. The three-year, $21.3-billion bill would boost spending for breast, cervical, and prostate cancer research, as well as research on osteoporosis, and would mandate that all clinical research trials involve women and minorities. The measure also seeks to increase research on AIDS by giving the National Institutes of Health's Office of AIDS Research more authority. Thousands of Women Bombard AIDS Helpline * Reuters (03.07.93) (London) Telephone lines at two hospitals were inundated with calls from thousands of women concerned that they may have contracted HIV from a British doctor who was recently diagnosed with the disease. Approximately 3,500 women contacted a hospital in Chatham, southeast England, after special hotlines were established to counsel former patients of gynecologist and obstetrician Terence Shuttleworth. Another 80 women arrived at the hospital seeking advice and 76 decided to be tested for HIV. A total of 2,500 calls were received at a private hospital where the doctor worked. Shuttleworth, diagnosed as HIV- positive last week, was believed to have treated up to 17,000 women over the past 10 years, but health officials said the chance of HIV transmission to patients was minimal. "Only those who have had gynecological surgery are the ones who may need to seek further information," said Dr. Ann Palmer, director of public health at the Medway Health Authority. According to health officials, Shuttleworth was involved in operations on nearly 6,000 women during the 10-year period. Hospitals have provided confidential HIV testing for all women who request it. AIDS--Fighting Back * Associated Press (03.08.93) (New York) Although there are several different kinds of AIDS vaccines that are currently in clinical trials, not one researcher who spoke at a recent forum on AIDS vaccine and immune system therapies could name the vaccine that is most effective. The forum was sponsored by the Gay Men's Health Crisis and the Community Research Initiative on AIDS. Federal researcher Margaret Johnston said that about 10 experimental therapeutic vaccines have started testing in HIV-positive people. She said the results show that six of the vaccines incite an immune system response and they appear safe. But there are no definite results yet available on the other four, she said. Also, there is no notable indication that the vaccines can reduce the amount of HIV in the blood, said Johnston. Moreover, what is largely unanswered is whether these vaccines can actually help an HIV-positive individual's health. The reactions elicited during some of the candidate vaccines included creation of antibodies and responses by defensive white blood cells. The majority of vaccines were intended to stimulate the immune system by presenting a particular HIV protein or a piece of a protein. One vaccine that is different is the Salk vaccine, which uses a killed whole HIV that is stripped of a major protein called gp120. Research has shown that the Salk vaccine can incite a wide variety of antibodies that bind specifically to different virus proteins, and strengthen the response of immune system cells to HIV. National Institutes of Health director Bernadine Healy said testing several vaccine candidates is warranted because "no one candidate at this point has proven to be superior, and because these products are inherently different." Inhibition of Rev-Mediated HIV-1 Expression by an RNA Binding Protein Encoded by the Interferon- Inducible 9-27 Gene * Science (02/26.93) Vol. 259, No. 5099, P. 1314 Constantoulakis, Pantelis et al. Determining the function of RBP9-27 may result in a better understanding of the mechanism of interferon action during HIV- 1 infection, write Pantelis Constantoulakis et al. of the National Cancer Institute-Frederick Cancer Research and Development Center in Frederick, Md. Interferon blocks expression of HIV-1 through unknown mechanisms. A gene inducible by interferon-a (IFN-a) and interferon-y (IFN-y) was isolated by screening of a human complementary DNA library for proteins binding to the Rev-responsive element (RRE) of HIV-1. The product of this gene, RBP9-27, was shown to bind RNA in vitro and to inhibit HIV-1 expression after transfection into human cells. Therefore, RBP9-27 is a cellular factor that antagonizes Rev function. These findings indicate an interferon-induced antiviral mechanism operating through the induction of RNA binding proteins such as RBP9-27. HIV-1 may use inhibition by IFN to down-regulate its own expression. This may lead to the restricted expression of HIV-1 in different cell types. Lentiviral replication strategy involves negative regulatory steps considered important for the generation of chronic, active infections by these viruses. Additional understanding of RBP9-27 function may offer insight into virus- cell interactions and into the development of therapeutic strategies for AIDS prevention, the researchers conclude. Low Frequency of Neurosyphilis in HIV-Infected Individuals * Lancet (02/27.93) Vol. 341, No. 8844, P. 571 Esselink, Rianne et al. Neurosyphilis, usually defined as neurological symptoms combined with a positive cerebrospinal fluid-Venereal Disease Research Laboratory (CSF-VDRL) test, is a rare HIV-related condition, write Rianne Esselink et al. of the University of Amsterdam in Amsterdam, Netherlands. The risk groups for acquiring syphilis and HIV largely overlap, and there may be interactions between Treponema pallidum and HIV in individuals infected with both organisms. In addition, the diagnosis of neurosyphilis in this group of patients may be difficult, because the VDRL test may be negative in CSF in patients with viable T pallidum in the CSF. Rates of neurosyphilis varied between 1.5 percent in inpatients with AIDS to 3.3 percent in HIV-positive individuals with neurological symptoms. Among all patients with reactive serum syphilis tests, 9.1 percent had reactive CSF-VDRLs. The researchers examined the records of all 663 HIV-positive individuals evaluated for neurological problems between 1982 and 1992 to assess the frequency of neurosyphilis. It was found that in 342 (52 percent) patients, CSF was examined at least once for various reasons. CSF samples were not regularly, but frequently, tested for syphilis with VDRL and T pallidum haemaglutination assay (TPHA) tests. In neurosyphilis, both tests are usually positive in the CSF. Among the 258 CSF samples tested, only 1 (0.4 percent) had a positive VDRL test. Regardless of this low incidence, prudent evaluation of HIV-positive patients with unexplained neurological problems and repeated serological (and CSF) testing for syphilis in this group is suggested, so that a treatable neurological infection is not overlooked, conclude Esselink et al. House, Like Senate, Votes to Ban H.I.V. Immigrants * New York Times (03/12.93), P. A11 Clymer, Adam The House yesterday voted to ban HIV-positive foreigners from being admitted into the United States, a move that followed the Senate's decision. Even though the House voted an overwhelming 356-to-58, the decision came on a parliamentary device of no real authority, and it was unclear what the legislative result will be. The vote came on a motion to instruct conferees on a medical research bill to accept the ban the Senate voted for last month. Although conferees seldom consider themselves required to follow such directives, the House majority made it likely that some form of the ban would survive a House-Senate conference. President Clinton has indicated that he wants to eliminate the ban, which under current policy is imposed by regulation, not legislation. However, the Clinton administration did not attempt in any way to lobby against the House vote, apparently considering the issue lost from the start. The vote on the ban of HIV-infected foreigners was even more one-sided than the vote on the underlying bill, a popular bill to expand the authority of the National Institutes of Health in order to put more emphasis on women's health issues and to put financial authority in the institute's Office of AIDS Research. The immigration ban was backed by 185 Democrats and 171 Republicans, and opposed by 57 Democrats and one independent. The medical research legislation, which would allow spending of up to $6.6 billion in the fiscal year beginning next Oct. 1, was adopted on a vote of 283 to 131. It was supported by 225 Democrats, 57 Republicans, and one independent, and rejected by 16 Democrats and 115 Republicans. Related Stories: Washington Post (03/12) P. A13; Philadelphia Inquirer (03/12) P. A16; Los Angeles Times--Washington Edition (03/12) P. A5 Judge Orders Better Care for Homeless With H.I.V. * New York Times (03/12.93), P. B3 Navarro, Mireya A New York State Supreme Court judge has ruled that homeless people with asymptomatic HIV infection in New York City must be housed with certain minimum standards. However, advocates for the homeless claim the ruling will force the city to remove this group from the city's shelters. The lawsuit was filed by the Coalition for the Homeless against the city and the state about five years ago. Judge Edward H. Lehner discovered that current city attempts to protect this population from tuberculosis and other contagious conditions do not go far enough. He directed the city to put this group in rooms with four or fewer people where beds are at least eight feet apart, and said the city must also give them residences that have sufficient ventilation and separate bathrooms and dining areas. But Virginia G. Shubert, the plaintiff's lawyer, said, "Not a single facility in the city meets these standards. The only logical response for the city is to expand eligibility for private housing to anyone with HIV disease." Nevertheless, in his March 4 ruling, the judge said HIV-infected homeless people who are ill are not entitled to the same private housing given to those with AIDS. City attorneys disclosed yesterday that they will appeal the ruling. Also, Shubert said the defendants are considering an appeal in the hope of obtaining the same treatment for those people sick with HIV as is provided for those with AIDS. AIDS Test Sought for Dying Father * Toronto Globe and Mail (03/11.93), P. A14 Downey, Donn Two days before a Toronto man died of AIDS, his physician downplayed the possibility that he may have the disease, according to the man's son, who testified on Wednesday. Thomas Pittman said that on March 18, 1990, his sister Kathleen asked Dr. Stanley Bain whether their father, Kenneth Pittman, might have AIDS. According to Thomas, the man replied, "Why would you think or suggest that?" Subsequently, Dr. Bain agreed to have Pittman's blood tested, which turned out to be positive for the virus. Thomas' mother, Rochelle, who tested HIV-positive in August of 1990, his brother Mark, and his sisters Kathleen and Kelly are suing Dr. Bain, the Canadian Red Cross, and the Toronto Hospital for $2,085,000, claiming that Kenneth was given HIV-tainted blood when he received a transfusion in 1984. Thomas Pittman testified in the Ontario Court's General Division that the doctors at North York General Hospital, where his father died, were ambiguous about his condition. He added that they were very conservative about treating his father. Thomas said his father had revealed to him as late as January 1990 that he enjoyed an active sex life with his wife. When asked whether Thomas' father may have had an extramarital affair to cause him to contract HIV, Thomas said, "I have no doubt in my own mind that this is out of the question." British Announce Review of Health Care HIV Guidelines * United Press International (03/11.93) (London) The British government announced an immediate examination of guidelines on HIV-positive health-care workers Thursday after reports aired of a health authority concealing the AIDS-related death of one of its doctors. Health Secretary Virginia Bottomley told legislators that the current regulations needed to be reviewed to determine what additional steps could be taken to enforce ethical duties among health- care workers "where they may be at risk of passing infection on." Bottomley said, "All health care workers who believe they may have any condition, including HIV infection, which might put their patient's safety at risk must seek medical advice. They must put their patient's safety first." However, she rejected mandatory testing of health-care professionals, saying it did not exist anywhere in the world and there was no basis for it. She indicated that health-care workers entering the National Health Service and the private health sector-- especially those involved in surgery or invasive medical procedures--would be required to read the guidelines and confirm they understood them. Chief Medical Officer Dr. Kenneth Calman and representatives of the General Medical Council will meet to examine the policy, which will be issued later this month, said Bottomley. Calman has said that it is not necessary for HIV-positive health-care workers to stop working. The review of the government HIV guidelines comes after the case of a Kent gynecologist who tested HIV-positive and a junior doctor at a Welsh health authority who died of an AIDS-related condition. Israel Tries to Calm AIDS Scare * United Press International (03/11.93) (Jerusalem) Israeli health officials said Tuesday that they would notify the patients of an HIV-positive Tel Aviv surgeon who performed surgery without knowledge of his condition to allay fears of potential transmission of the virus. The doctor, whose name is undisclosed, is the third of six missing persons found by the Health Ministry since it set up new guidelines two weeks ago for locating people who have tested HIV-positive. The health officials said they would tell the patients of the doctor that there is no need to worry because there have been no reported cases of doctor-to-patient HIV transmission in Israel. The doctor tested positive for HIV in August when he applied for a life insurance policy, but he never learned of the results. The life insurance company rejected him from being covered without telling him why. He learned he was infected with HIV earlier this week when he received the results of a second test. A total of 225 Israelis have been diagnosed with AIDS since 1981, and 982 have tested positive for HIV, the Health Ministry said. The Israeli government has recently devised new ways to thwart the spread of HIV in the country. It implemented a measure that will prohibit the entrance of HIV- positive immigrants from Western countries. It has also eliminated a tax on imported condoms to promote safe sex and is continuing to examine its polices to urge more people to get tested for HIV. Japan Hospital Refuses to Operate on AIDS Woman * Reuters (03/11.93) (Tokyo) A Japanese public hospital denied treatment to a woman from southeast Asia when tests showed she was infected with HIV, according to Japanese newspaper reports. The 22-year-old woman was taken to a private hospital in Yamanashi prefecture on December 16, suffering from lower spinal fractures after she fell to the ground from the second floor of the bar where she worked, reports said. Due to inadequate facilities, she was transferred to a public hospital in the area five days later. The public hospital refused to operate when it was told by the first hospital that the woman was HIV-positive, the reports said. Newspapers quoted the public hospital as claiming it had decided not to perform the operations because it was unsure how to conduct such procedures on AIDS patients. It added that the patient's chances of full recovery were small even if the operation were conducted. The patient was subsequently moved to a third hospital before leaving Japan for home on Feb. 22, without being operated on and suffering from paralysis of the lower half of her body, the reports said. Preventive Health Care for Adults With HIV Infection * Journal of the American Medical Association (03.03.93) Vol. 269, No. 9, P. 1144 Jewett, John F. and Hecht, Frederick M. Due to the specific needs of HIV-positive patients in different stages of disease, a comprehensive care program should be adopted for all persons infected with the virus, write John F. Jewett and Frederick M. Hecht of the Brigham and Women's Hospital and Children's Hospital in Boston, Mass. The researchers have found the efficacy of some preventive measures: primary and secondary Pneumocystis carinii pneumonia prophylaxis; secondary prophylaxis of Cryptococcus, Toxoplasma, and cytomegalovirus infections; tuberculin testing, with chemotherapy for individuals with positive test results; syphilis screening; Papanicolaou tests; educational measures to reduce the transmission of HIV and other infections; T- lymphocyte monitoring; and antiretroviral therapy in selected patients. Recommended measures of potential, but less certain, efficacy include vaccines to prevent influenza, Haemophilus influenzae, pneumococcal, and hepatitis B infections; prophylaxis for recurrent esophageal and vaginal candidiasis; primary prophylaxis of Mycobacterium avium complex; tuberculosis prophylaxis for anergic, high-risk individuals; routine physical examination; screening for gonorrhea and Chlamydia in high-risk women; monitoring Toxoplasma titers, complete blood cell counts, and serum chemistry values; attempting to maintain weight through nutritional interventions; and exercise. Some approaches call for additional study before they can routinely be recommended, including vitamin and mineral supplementation; specific nutritional diets; and laboratory tests, other than CD4 counts, for monitoring disease development, the researchers conclude. Insemination of HIV-Negative Women With Processed Semen of HIV-Positive Partners * Lancet (02/27.93) Vol. 341, No. 8844, P. 570 Edlin, Brian R. and Holmberg, Scott D. HIV-discordant couples (those in which the man is HIV-positive and the woman is not) should be aware of the risks of infection through experimental inseminations, write Brian R. Edlin and Scott D. Holmberg of the Centers for Disease Control in Atlanta, Ga. In a study published in the Nov. 28 Lancet by Dr. Semprini et al, they conclude that the lack of HIV transmission during their artificial insemination attempts in HIV-discordant couples is "reassuring," and indicate that this outcome is used in counseling such couples to "give them hope of having healthy babies." But Edlin and Holmberg express concern that Semprini et al.'s conclusion may be overstated and suggest that doctors might give false hope to such couples. Semprini et al. neglect to mention that insemination of semen that had been processed with the intent of removing infectious HIV has been associated with transmission of HIV. Application of the Poisson distribution to Semprini's data yields a rate of 6.25 transmissions per 100 inseminations. This finding should be considered if their data are used to counsel HIV-discordant couples. Also, Semprini and colleagues provide no information about the state of HIV infection, CD4 counts, antiretroviral therapy, or degree of white cells in semen of their 29 donors. Recovery of HIV from semen is greater from donors who have more advanced infection, lower CD4 counts, no antiretroviral therapy, and white blood cells in their semen. Among the 85 couples from whom their 29 men were selected, 92 percent had no symptoms of AIDS, AIDS-related complex, or advanced immunosuppression. Therefore, using this data to represent all men with HIV infection may not be warranted, conclude Edlin and Holmberg. Prominent AIDS Researcher Paints Bleak Outlook * Chemical & Engineering News (03.01.93) Vol. 71, No. 9, P. 29 Baum, Rudy As many as 1 billion people could become infected with HIV by the year 2025, and it is unknown whether a cure for AIDS or a vaccine to prevent HIV infection will ever be developed, predicts William A. Haseltine, a prominent AIDS researcher at the Dana-Farber Cancer Institute in Boston, Mass. He spoke at the annual meeting of the American Association for the Advancement of Science recently held in Boston. Haseltine said there has never been an extensive, systematic study of blood samples in the U.S. to determine how many people have become infected with HIV. He said that due to the lack of such data, "all efforts to educate people about AIDS are done blind." Haseltine's prediction regarding the lack of a vaccine that will lead to the infection of 1 billion people were based from the progress of the disease over the past decade. He said, "Projecting that 20 percent of major world populations will be infected with HIV by 2025 is not unreasonable." He also said, "We have only a fraction of the knowledge that is necessary to cope with AIDS. We can't tell you when we will have a cure for AIDS," or even a vaccine. Haseltine recommends that an ideal "curative therapy" for AIDS should restore full-term life expectancy for HIV-positive people. It should also eliminate the ability of HIV-infected people to infect others, and it should destroy functional HIV genetic information in people infected with the virus. Haseltine's outlook for the future of the epidemic is quite disheartening. He concluded, "We're in this for the rest of our lives, the rest of our children's lives." 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 03.08.93 ]]]===------ .