-----===[[[ A I D S w i r e D I G E S T 03.15.93 ]]]===----- AIDS Policy Director Post Put 'On Hold' as President Ponders Duties, Details" * Washington Post (03/15.93), P. A17 Kamen, Al The federal "AIDS czar" position still has not been filled, largely because it is unclear how President Clinton wants it to function. Decisions are still being made regarding job descriptions, duties, authority, staff, and office location. It is undetermined, for example, whether the White House or Health and Human Services will house the post. The AIDS czar is expected to be part of the domestic policy staff, working under domestic policy adviser Carol Rasco. However, Health and Human Services Secretary Donna Shalala will most likely have some control over that operation and has been screening candidates. Those who are being considered for the AIDS czar position include Kristine M. Gebbie, former director of the Washington state health department; Mark D. Smith, vice president of the Kaiser Family Foundation; Lee Smith, vice president of Levi Strauss Co.; and New York City Health Commissioner Margaret Hamburg. Warnings of HIV Didn't Spare Gang Rape Victim * Chicago Tribune (03/12.93), P. 1-3 Sloan, Paul A woman who was recently raped warned the attackers that she was infected with HIV, said police. Gary Police Detective William Burns said Thursday, "They slapped her in the face and told her she was just saying that to get them to stop." However, she wasn't just saying it, she actually was HIV- positive. People who work with rape victims say that it is not unusual for rapists not to believe a claim from a victim, such as being HIV-positive. The woman told police she was walking to a store on March 5 when she was asked for directions by a man. Consequently, he shoved a 3-inch pocket knife against her abdomen and forced her into a car. She was taken to a house in Gary, and there she said she was raped repeatedly and given no food or drink for more than two days. She was beaten several times, hit in the face, back, and stomach. Finally, about 64 hours later, the attackers released her. One of the attackers, Michael Petty, has been charged with rape and confinement. The other men are still being sought by police. A national poll of rape-crisis counselors conducted last fall discovered that being infected with HIV was the fastest-growing concern among rape victims. However, the chance of a rapist contracting the virus from the victim is minimal, experts say. Women are nine times more likely to contract the virus from a man than vice versa, according to some studies. Dr. Ron Sable, a co-founder of the AIDS program at Cook County Hospital in Illinois, said the risk could be greater in a rape because the violence involved might prompt injuries. MD Suspended 2 Months in HIV Case * Toronto Globe and Mail (03/12.93), P. A6 Mickleburgh, Rod and Downey, Don A Toronto physician who neglected to tell one of his patients that the patient was infected with HIV has been given two reprimands and a provisional, two-month suspension of his medical license after being found guilty late last year of professional misconduct. The charges against Stanley Bain, a former president of the College of Physicians and Surgeons of Ontario, were a result of his treatment of patient Kenneth Pittman, who died not knowing he had contracted HIV through a tainted blood transfusion. While Dr. Bain knew that Pittman might have received HIV-tainted blood, he refused to tell his patient because he believed the news would devastate him. In addition, he believed that Pittman was not having sexual relations with his wife, when he actually was. Pittman subsequently tested HIV-positive. The college disciplinary committee which heard the case said Dr. Bain failed his patient "in two crucial respects," by not seeking advice from AIDS experts before making his decision and by not making sure Pittman had not infected others. The committee demanded that two reprimands be recorded against Dr. Bain--one for not telling Pittman about his possible condition, and another for neglecting to inform public health officials about his potential HIV status, as required by the province's Health Protection Act. Ottawa to Spend $211-Million in Battle Against AIDS * Toronto Globe and Mail (03/12.93), P. A7 York, Geoffrey The Canadian government will allot $211 million for AIDS education and research over the next five years--an increase from what it was spending earlier, but much less than the amount suggested by AIDS experts. The government has agreed to spend $42.2 million annually to fight AIDS, compared to an average of $37.3 million in each of the past three years. Health Minister Benoit Bouchard said, "It's never enough, I understand that, but it's what we can do. It's about a 10- percent increase, which is maybe modest, but we have to keep in mind the pressures on the system for many other diseases." Bouchard said the additional funds are a major commitment by the government "at a time of serious economic restraint," when other departments are expected to cut their budgets. However, the government's decision was immediately assailed by AIDS groups and opposition politicians who requested a minimum of $55 million in annual spending on AIDS. The new five-year plan calls for the government to spend $6.2 million a year on prevention education, $17.8 million on AIDS research, $9.8 million for community organizations, $5.4 million for care and treatment, and $3 million for coordination and other efforts. Dr. Martin Schecter, national co-director of the Canadian Association for HIV Research, said he was displeased with Bouchard's announcement, but said the move is "a good first step" for the government's AIDS efforts. Being Rational About AIDS * Washington Post (03/14.93), P. C7 Will, George F. If personal behavior is altered, the AIDS epidemic will resultingly be curbed, writes columnist George F. Will. In the United States, the epidemic is largely centralized in perhaps 30 neighborhoods nationwide. If there is change in behavior in those locations, then the epidemic will be thwarted. AIDS has been particularly troubling because the country had come to believe that it was no longer susceptible to mass infectious disease. "But modernity actually abetted the epidemic," says Will. The spread of the disease has been aided by homosexuality, prostitution, and drug use--all related to behavior. And much of this high-risk behavior is highly prevalent in a few small areas. A New York Times article published last week stated that the AIDS epidemic "can be all but stamped out," without a wonder drug or vaccine, if risky behavior is changed. The approach would involve concentrating on the prevention of such behavior in 25 to 30 neighborhoods nationwide, in such cities as New York, Miami, Los Angeles, San Francisco, Houston, Newark, and Camden, N.J. But the article said that among the measures public health officials want to implement in those neighborhoods are some that many conservatives object to, including clean needle exchanges and explicit sex education. Nevertheless, political hindrances to rational AIDS policies involve much more than just conservatism. Therefore, until there is an abundance of AIDS treatments, the epidemic will remain less a scientific challenge than a test of personal behavior, concludes Will. City Health Center Opens Family [AIDS] Clinic * PR Newswire (03/10.93) (Philadelphia) A $110,000 check was expected to be presented to the Strawberry Mansion Health Center in Philadelphia on Friday in support of the Care Plus Clinic, a new program designed to serve families affected by HIV/AIDS in North Philadelphia. Alicia Beatty Tee, project director for The Circle of Care, a Philadelphia-based group coordinating services to families affected by HIV/AIDS, was to present the check at an open house for the Care Plus Clinic. Tee said, "With the opening of the Care Plus Clinic, Philadelphia is leading the way in establishing community-based, cost-effective, and convenient programs to serve women and their families who are affected by [AIDS]." Esther Chernak, M.D., project director for the Care Plus Clinic, said, "Given the city's funding crisis, we couldn't have opened this clinic without support from The Circle of Care." Currently, the Care Plus Clinic serves 12 families. The services provided include primary health care, prenatal and well-baby care, a family support group, family planning, HIV counseling and testing, and education on prevention. The Circle of Care, established in 1990, coordinates health and social services to more than 430 Philadelphia families affected by the disease. AIDS May Be Treatable With Antibodies From Other Disease * PR Newswire (03/12.93) (Atlanta) An antibody extracted from people with mixed connective tissue disease (MCTD) can slow the infection rate of HIV, according to a new study conducted by researchers from the University of Southern California--Los Angeles Medical Center. MCTD is an immune system ailment which causes the body to mistake normal proteins for foreign invaders. This disease incorrectly incites the production of potent antibodies. MCTD induces the body to mistakenly produce massive amounts of antibodies against a protein called 70K, which closely resembles a protein of HIV. Dr. Angeline Douvas and her colleagues at the medical center took the antibodies from people with MCTD and used them to attack the similar HIV protein. In laboratory tests, antibodies from individuals with MCTD initially produced to react to 70K successfully attacked proteins found on the surface of HIV. Douvas told rheumatologists attending a meeting of the American College of Rheumatology in Denver, "This discovery is particularly encouraging for combating [AIDS] in pregnant women who are HIV- positive, where we hope to slow the infection to prevent the virus from spreading from mother to fetus." She added, "The infection-slowing process of these antibodies may also be useful treatment for adults with [AIDS]." Douvas hopes to eventually produce the antibody in the laboratory, creating an endless supply of the infection-slowing protein, as well as obtaining antibodies from human donors. CDC Reports False-Positive Blood Tests * United Press International (03/12.93) (Atlanta) A study has verified previous findings that associate flu shots with false-positive test results for three diseases, including HIV infection. The Centers for Disease Control reported Thursday that there is "no risk of contracting any viral infection" from flu vaccines, but they may result in false-positive tests for HIV, HTLV-1, and hepatitis C. The link between recent influenza immunizations and temporary false- positive tests for antibodies to multiple viruses was first reported in 1991. The federal agency said test kits for hepatitis C and HIV were changed early last year to reduce the possibility of false positive results. But similar changes have not been used for HTLV-1 test kits. The most recent study conducted by the American Red Cross linked 15 flu vaccinations with false positive tests for HTLV-1, but there were no false- positive test results for HIV. The study was conducted in the Badger region, which includes parts of Illinois, Iowa, Michigan, Minnesota, and Wisconsin. Suit Seeks to Exclude AIDS Health Coverage * National Law Journal (03/15.93) Vol. 15, No. 28, P. 6 Attorneys for a health benefits plan filed a lawsuit on March 1 that seeks a declaration that its exclusion of coverage for HIV/AIDS-related conditions does not infringe upon the Americans With Disabilities Act. According to some lawyers, their approach--seeking a declaratory judgment rather than appealing a previous ruling by the U.S. Equal Employment Opportunity Commission--is quite unusual. Roger M. Levin of New York's Levin & Weissman, who represents the welfare fund, expects to defeat a decision by the regional office of the EEOC, which in January determined that the fund had violated the ADA by refusing to pay for Terrence Donaghey Jr.'s medical expenses for HIV-related treatments. Under the suit, the court should determine that the self-funded plan's exclusion was allowed under an exemption to the ADA. Donaghey's attorney, Cary LaCheney of New York Lawyers for the Public Interest Inc.., said that Levin could just as well have submitted an appeal with the EEOC. "He's obviously doing everything he can to head this off at the pass," she said. LaCheney also said she will look into the issue of whether the suit is premature. David A. Copus of the Washington, D.C., office of Jones, Day, Reavis & Pogue, a leading expert on the ADA who represents management, said, "An answer finding that this is a violation of the law would radically transform the provision of health care in this country." Impact of New Legislation on Needle and Syringe Purchase and Possession--Connecticut, 1992 * Morbidity and Mortality Weekly Report (03.05.93) Vol. 42, No. 8, P. 145 The episodes of needle and syringe sharing among IV-drug users decreased after new Connecticut laws were enacted July 1, 1992, which were designed to help reduce the rate of HIV-infection among this population. The laws allow the purchase and possession of up to 10 needles and syringes (NSs) without a prescription. During August-November 1992, staff members at three HIV counseling and testing sites, two correctional facilities, and two drug-treatment centers in Connecticut interviewed active IV-drug users. Among the 124 active IV-drug users surveyed, 68 (55 percent) reported they were aware they could both purchase and possess clean NSs. Another 26 (21 percent) IV-drug users were aware they could legally purchase NSs but did not know they could legally possess them. About 41 percent of the IV-drug users reported purchasing NSs from a pharmacy during August-October, whereas only 19 percent did so during June. Those IV-drug users buying NSs during June may have had diabetes, made illegal pharmacy purchases, or recalled inaccurately their purchasing during that time. Fewer IV-drug users reported purchasing NSs on the street during August- October (59 percent) than during June (74 percent); four IV- drug users reported they began purchasing and 24 reported they did not purchase on the street. Four focus groups were held in Hartford, Conn., in Nov. 1992 with a total of 34 active IV-drug users to address issues regarding NS use and purchasing practices. About two-thirds of the IV-drug users attending the meetings were aware that clean NS possession was legal and reported they were now more apt to possess NSs with them on the street. CDC Warns of HIV-Related Viruses * Washington Post (03/16.93), P. A5 People infected with HTLV-I or HTLV-II, both similar to HIV, should use the same AIDS-like precautions in order to avoid infecting others, according to the Centers for Disease Control. The CDC reported in an article published in today's issue of Annals of Internal Medicine that infection with the two viruses is rare in much of the United States. However, it has become more prevalent in some U.S. cities and other countries. Those infected with HTLV-I and HTLV-II should refrain from donating blood, sharing needles, or breast-feeding children, and should consider using condoms to prevent sexual transmission of the viruses, the CDC said. The two human T-cell lymphotropic virus strains are associated with HIV, which was formerly known as HTLV-III. While HTLV-I can cause fatal illnesses like leukemia, HTLV-II has not been clearly linked with any disease. The CDC said blood tests recently developed, but available only for research, have shown more promise in identifying the two viruses than tests now available. The article said that in the United States, about 16 of every 100,000 blood donors are infected with either HTLV-I or HTLV-II, in roughly equal numbers. HTLV-I infection has been found in clusters of black people from the southeastern United States and in immigrants in Brooklyn, N.Y., who are from parts of the world where the virus is endemic. HTLV-II is believed to be transmitted by similar routes but is most prevalent among IV-drug users in the United States and Europe, and some Indian populations in Panama, Florida, and New Mexico. As Isolation of Racism Eases, South Africa Confronts AIDS * New York Times (03/16.93), P. A1 Keller, Bill Although South Africa had ample time to thwart the spread of the AIDS epidemic, now the disease's spread in the country is similar to that in most other African nations. The slow spread of HIV southward from its equatorial epicenter and the social quarantine developed by the sanctions against the apartheid government, AIDS experts said, meant South Africa had time to see the danger coming and stop it. However, this has not happened, and HIV has colonized South Africa as much as it has the rest of the continent, spurred by apartheid beliefs such as neglect, fatalism, and mistrust. Conservative estimates state that 300,000 South Africans, mostly black heterosexuals, are infected with HIV and at least 300 new people contract the virus every day. About 5,000 people have full-blown AIDS. Malcolm Steinberg, who oversees AIDS programs for the South Africa Medical Research Council, said, "South Africa has moved from the pre-epidemic to the epidemic phase, the point where the curve rises rapidly." Despite the warning, South Africa still has neglected to implement an aggressive anti-AIDS campaign. A strong puritanical streak in South Africa has prohibited mandatory AIDS education in schools and has inhibited the advertising of condoms, even though the government distributes free condoms by the millions. Peter Doyle of Metropolitan Life Ltd. predicts that by the year 2000, 3 million South Africans--more than 10 percent of the adult population--will be HIV-positive and 160,000 will have AIDS. Caring for those with HIV/AIDS will use up to three-fourths of the national health budget, according to a study by the Medical Research Council. S.F. to Provide Clean Needles to Drug Users * Los Angeles Times--Washington Edition (03/16.93), P. B1 Paddock, Richard C. San Francisco Mayor Frank Jordan has announced a state of emergency so that the city can distribute clean needles to IV- drug users as an effort to curb the spread of HIV infection among this group. The move, announced Monday, defies California law that makes the distribution of hypodermic needles without a prescription illegal. The action also would make San Francisco the first California city to provide public funds for a needle exchange program and deride a state law. Jordan cited the attempts of underground groups operating outside the law, which have shown that trading clean needles for used ones can significantly reduce the spread of HIV. A four-year volunteer needle exchange program conducted by Prevention Point has become so successful that it has no more private funds and would have stopped distribution Monday without help from the city, said Jordan. But Kassy Perry, spokeswoman for Gov. Pete Wilson, said the governor's legal staff is examining whether San Francisco is able to override state law by putting a state of emergency into effect. Wilson vetoed a bill supported by San Francisco and AIDS activists that would have made a needle exchange program legal. The governor and other critics claim that such a program would condone IV-drug use and undermine law enforcement agencies. In addition, the governor argues that the effectiveness of needle exchange programs in curbing HIV is unproven. D.C. Changes Rules on Death Certificates * Washington Post (Health) (03/16.93), P. 6 Kaplow, Bobby The city of Washington, D.C., last weekend revised the guidelines about who can pronounce death for patients in hospice programs and allowed the death certificate copies to be issued without listing a cause of death. The move comes after the urging of two health care professionals who work with cancer and AIDS patients. The bill, which became a law on Saturday after being signed by Mayor Sharon Pratt Kelly, permits registered nurses to make a pronouncement of death if a patient had earlier received a prognosis of less than six months to live and was receiving in-home treatment. Only physicians were permitted to pronounce deaths before the law was enacted. The second part of the bill is intended to help family members by providing them with the option of having the cause of death stated on copies of the death certificate--a public record that they must often use to settle estate matters, such as property transfers. Zail S. Berry, medical director of the Hospice of Washington and an assistant professor of Health Care Sciences at George Washington University, said the stigma that accompanies death from some diseases, especially AIDS, led her to lobby for the new legislation. "I'm frequently asked by families to lie on the death certificate. The vast majority of its uses have nothing to do with the cause of death. And a lot of people are being faced with revealing information that is irrelevant." But the new law still requires that the original death certificate, which is kept on file by the District government, record the cause of death and related information for public health purposes. Jackson Is Arrested in New York Sit Down * Washington Post (03/16.93), P. B2 Jesse L. Jackson was arrested yesterday along with 41 others in a New York demonstration to protest the detainment of HIV- positive Haitians at the U.S. Naval base in Guantanamo Bay, Cuba. Jackson, an elected lobbyist on behalf of D.C. statehood, was arrested after he sat down in the middle of Fifth Avenue as the demonstration was ending. He and four others were charged with resisting arrest and ordered to appear in court April 3, said police. The remaining 36 protesters were indicted with civil disobedience. Infectious Diseases Sweep Through St. Petersburg * Reuters (03/14.93) (Moscow) A threatening increase in deaths from infectious diseases has occurred as a result of people's fears of contracting HIV when they receive vaccinations, according to health officials in St. Petersburg. Gennady Kolesnikov, the city's deputy chief medical officer, said the increase in deaths from tuberculosis, hepatitis, diphtheria, and other infections has become a "national disaster," reported the Itar- Tass news agency on Saturday. "We know the reason--a refusal to have injections, a fear of [AIDS]," it quoted Kolesnikov as saying. The spread of diphtheria is most alarming--over last year, there have been 845 cases, 15 of them fatal. The death rate from TB among children and adolescents has risen by almost half, while a third of the children in the city have had no vaccinations. Tass reported that an emergency anti-epidemic team has been established to deal with the problem. Faces of AIDS on Trading Cards * American Medical News (03.01.93) Vol. 36, No. 9, P. 30 A set of trading cards promoting AIDS awareness are expected to be released this month, but not without controversy. Catherine Yronwode, co-owner of Eclipse Enterprises, said, "There have been people who thought that these cards had a morbid cast to them." The Rock Hudson card, for example, lists career highlights and ends with a paragraph on his 1985 revelation that he had AIDS and his ensuing death. The AIDS cards also feature Magic Johnson and Arthur Ashe, in addition to researchers seeking a cure for AIDS. Every card in the 12-pack includes a condom. Bob DeMoss of the Colorado Springs-based Focus on Family, is concerned that by promoting "condoms to the level of bubble gum you reduce the specialness of sex to that of a casual handshake." Other critics were worried that the cards feature some people who did not publicly disclose their HIV/AIDS-status. San Francisco AIDS Foundation spokesman Joe Ferra is also concerned about the privacy issue, but was pleased to see that condoms and medical information were included in the packets of cards. Yronwode said 15 percent of the proceeds from the cards will be given to Broadway Cares- Equity Fights AIDS, a New York-based group that provides grants to HIV-positive people in the entertainment industry. A Disappointing Decade of AIDS * Nature (03.04.93) Vol. 362, No. 6415, P. 13 Maddox, John Although there has been little progress in AIDS research in the past decade, such research should not be abandoned, writes columnist John Maddox. To understand the pathogenesis of AIDS is an even more significant goal now than when it was thought there might be an upcoming vaccine. The search for AIDS drugs which possibly work in conjunction with AZT is promising but quite slow. Maddox suggests it should be the pharmaceutical industry's responsibility to improve on the methods of treating the secondary infections which AIDS patients experience, but the frequency of Kaposi's sarcoma in some AIDS patients is not, as yet, understood. AIDS patients demand that there should be a more vigorous effort to treat secondary infections. That means for researchers to acknowledge that AIDS will be around for some time and that we must learn to live with it as safely as we can. Therefore, the condom is no longer just a contraceptive but a medicine. To recognize it as such calls for a greater capacity of openness about sexual practices than many people can tolerate. There is also an imminent need to address the anger of AIDS patients, which means to make sure that AIDS patients are dealt with sympathetically and respectfully, and that they are given the best care that can be afforded. This does not suggest that AIDS patients are more deserving of care than people with other fatal illnesses. It is just that they are "victims of a common fallacy of just a decade ago, the belief that fatal infections had either been eliminated or would soon be eliminated," concludes Maddox. France: AIDES Wants Aid for AIDS * Lancet (03.06.93) Vol. 341, No. 8845, P. 624 Bader, Jean-Michel The largest private association for AIDS patients and prevention of the disease has entered the pre-elections campaign in France with an effort directed at politicians. The group is seeking to know whether the future government will make AIDS a public health priority, and whether it will implement 21 recommendations regarding health budgets, medical information, help for patients, clinical trials of new drugs, etc. A total of 1,600 posters and a series of advertisements in the national press are being published this week. AIDES advertisements will be broadcast on radio network Radio Tele Luxembourg free of charge. In addition, many magazines have given the association free ad space. A public opinion poll funded by AIDES found the pre-electoral climate to be favorable--89 percent of French people believe the government should make AIDS one of its next priorities. Rethinking AIDS * Wall Street Journal (03/17.93), P. A14 Root-Bernstein, Robert The National Research Council report on AIDS challenged the conventional wisdom concerning the disease, writes Robert Root- Bernstein for the Wall Street Journal. The report indicated that certain geographic areas and risk groups, including gay men, drug addicts, and the malnourished and poor, are prone to HIV infection and AIDS. The interesting thing about the National Research Council report, says Root-Bernstein, is that it failed to address a number of scientific and medical implications directly. If everyone is not equally susceptible to AIDS, then factors other than HIV should determine who becomes infected. In looking at prostitutes, for instance, most who are infected with HIV are also drug users. Cases of sexually-acquired HIV among non-drug-using prostitutes are virtually unknown. Also, of the hemophiliacs infected with HIV between 1981 and 1984, only 1,500 cases of AIDS have been reported. Neither prostitutes nor hemophiliacs have become vectors in the spread of the disease, as was initially suspected. Data from studies of prostitutes and hemophiliacs indicates that healthy, drug-free people do not get AIDS. Those who do get the disease may have risk factors including semen- induced autoimmunity following unprotected anal intercourse, blood transfusions, multiple and concurrent infections, chronic use of drugs, prolonged use of antibiotic and antiviral drugs, and malnutrition. Ultimately, eliminating risk factors for HIV- infected people can be more effective in preventing the development of AIDS than treating HIV, concludes Root- Bernstein. Treating AIDS in the Family * Philadelphia Inquirer (03/17.93), P. G1 Collins, Huntly Philadelphia's new family AIDS clinic, Care Plus, aims to treat HIV-infected families who live in the nearby drug-infested neighborhood where AIDS has already claimed hundreds of lives, most of which have been African American. Since the its opening in January, 33 people from 13 extended families have sought care at the clinic. Those numbers are expected to grow as AIDS continues to ravage the city's minority poor. Care Plus provides everything an AIDS patient can expect, including HIV testing, primary-care treatment, medicine, psychological counseling, support groups, and information about social services. Care Plus also offers homemaker service for those unable to get to the clinic. The Care Plus clinic is located in the Strawberry Mansion health center. AIDS and Children: Too Quiet a Tragedy * USA Today (03/17.93), P. 9A Shahid, Sharon In an interview with Sharon Shahid of USA Today, Dr. Arye Rubinstein discussed the spread of HIV infection among women. Rubinstein noted that the ratio of those infected with AIDS is now shifting. In the United States, 10 percent of those infected are women, but in the Bronx, about a third are women, most of whom acquired the disease through heterosexual transmission and IV drug use. Babies then acquire the disease from their mothers during pregnancy, during delivery, or through breast feeding. Eliminating IV-drug use among women and preventing the spread of the disease through heterosexual contact is necessary, said Rubinstein. While there has been a decline in infection among the homosexual population, among IV- drug-using and drug-using communities the infection rate has not decreased. An HIV-infected mother can be treated with antiviral agents, antibodies, and vaccines during pregnancy to help reduce her virus load or to help her immune system to avoid passing the virus to her fetus. Pediatric AIDS is a massive social burden, said Rubinstein, and many children with AIDS don't really understand what the word means. "As they grow up and reach the age of about 7 or 8, they start understanding the implications. They understand that they're not going to grow up," Rubinstein said. Cambridge, Mass.-based Therion to Work With Harvard on AIDS Vaccine * Knight-Ridder (03/17.93) Rosenberg, Ronald (Boston) Yesterday, Terion Biologics Corp. announced an agreement in which it will license from Harvard University a "live" AIDS vaccine technology. Exact terms of the deal were not disclosed. In the agreement, however, Therion and Harvard researchers will collaborate to test a number of virus strains in an attempt to produce a vaccine that triggers an immune response without also causing long-term health disorders. Therion will use the Harvard vaccine technology, which uses weakened live strains of the HIV virus, with its own proposed AIDS vaccines. Therion is likely to be the first company to begin human studies of live virus vaccines that offer long- lasting protection against infection. The company announced yesterday that its own live genetically-engineered TBC-3B vaccine would be used in human clinical safety studies before July, under a grant from the Vaccine Branch of the National Institute of Allergy and Infectious Disease. "We have felt for a long time that the best approach for AIDS vaccine was to mimic the live vaccine approaches that have historically worked in measles, mumps, polio and rubella," said Therion CEO Dennis L. Panicali. Most of the other biotechnology and pharmaceutical firms working on AIDS vaccines are using "dead" genetically- engineered portions of the AIDS virus, an not a live version of the whole virus. Live virus strains have been avoided because of their potential safety risks. However, Harvard Medical School researchers led by Dr. Ronald Desrosiers recently announced a successful test of an AIDS vaccine in monkeys. "We want to learn from [Desrosier's] vaccine and improve our own vaccines," said Panicali. Glaser: 'Keep Putting One Foot in Front of the Other' * USA Today (03/17.93), P. 9A Shahid, Sharon Elizabeth Glaser, wife of actor/director Paul Michael Glaser, has worked to educate the public about how AIDS affects children for the past four and a half years. Glaser was exposed to HIV during the birth of her daughter in 1981, when she received seven pints of HIV-contaminated blood. Glaser unwittingly passed the virus to her daughter through breast feeding, and then passed it to her son three years later. Glaser, in 1989, co-founded the Pediatric AIDS Foundation, which is seeking to find means of preventing the transmission of AIDS from mother to newborn, in addition to identifying and funding pediatric AIDS research around the world. "It's certainly optimistic for a new mother who has just found out that her young child is infected to know that my son is 8 years old and doing well. Initially, people thought that all children with AIDS would die by the time they were 2," said Glaser. Although she has "very few T-cells," Glaser remains healthy and says she is leading an active and productive life. No More Treating Teens Like Children * USA Today (03/17.93), P. 1D Carroll, Nicole Adolescent medicine experts say doctors who treat teenagers need to begin considering the special problems teenagers face, such as AIDS, in addition to routine medical care. Of polled 9th through 12th grade adolescents, 54 percent reported having had sex, and 55 percent said they did not use a condom when they last had intercourse. However, fewer than 1 percent of the medical exams conducted in 1990 featured AIDS counseling. "Teens are a ticking time bomb. If all you're doing is checking hearts and lungs, you're missing a powerful chance to make a difference," said Dr. Lonnie Zeltzer. Doctors say insurance plans generally do not cover preventative care, and many teenagers are reluctant to seek help for sensitive problems, particularly if parents can find out. "This is one of the only areas where we really haven't made a lot of headway in prevention. Mortality of adolescents isn't going down like in other age groups," said Dr. Suzanne Riggs, director of adolescent medicine at Rhode Island Hospital. Riggs suggests establishing doctor/teen rather than doctor/parent relationships. Riggs also emphasizes the importance of confidentiality. Conference: Resistance to HIV Infection * Lancet (03.06.93) Vol. 341, No. 8845, P. 624 Rowe, Paul M. A research conference held on Feb. 25-27 and sponsored by the National Institutes of Health on Immunologic and Host Genetic Resistance attempted to identify and generalize three groups of individuals who are exceptions to the rules of being healthy. The first group consists of those who have been exposed to HIV but not infected; the second group are those who are infected but do not lose enough CD4 cells to go below 200u/L; and the third group are those who progress (CD4 counts fall below 200u/L) but who did not develop symptoms of stage IV AIDS. It appears that there is a dose-response element to resistance to HIV infection. No recipient of a transfusion of fresh whole HIV-tainted blood remains uninfected. Also, about 10 percent of those who continue to engage in high-risk sexual and drug- related behavior remain uninfected. While several studies demonstrate that these selected individuals remain seronegative, and non-viraemic, their peripheral blood cells proliferate and release IL-2 in response to HIV peptides, which suggests exposure to HIV antigens. Doses required to infect different individuals may vary by more than 1000-fold, and some of the resistance mechanisms may be post reverse transcription. In addition, the presence in HIV-resistant individuals of cell- mediated immune responses to highly conserved parts of the virus indicates that protective immunity could be based on cell-medicated rather than humoral mechanisms. The conference concluded that some aspects of resistance are clearly genetic, but healthy immune systems seem less susceptible to HIV infection, and presence of other infections may promote acquisition and acceleration of HIV infection. Idiopathic CD4+ T-Lymphocytopenia: A Quantitative View * Lancet (03.06.93) Vol. 341, No. 8845, P. 636 Reichert, T.A. The incidence of idiopathic CD4+ T-lymphocytopenia (ICL) in HIV-negative individuals may be the result of a natural statistical variation, writes T.A. Reichert of Becton Dickinson in Franklin Lakes, N.J. CD4+ lymphocyte counts in whites have a normal distribution. If this characterization can be extended to very low CD4+ percentages/counts, then about 1:2 in every 1,000 white adults will have CD4 percentages below the ICL threshold (20 percent of lymphocytes). Since the distribution for females is about one-third of an SD higher than that for males, this hypothesis would predict that the female/male ratio in ICL should be less than 1:0, and ideally, about 0:36. Because the absolute numbers of all lymphocytes are raised in young children, a condition defined in terms of percentage of lymphocytes is likely not to have the same clinical effect in that group. Young children with less than 300 CD4+/uL should become rare, because the mean CD4+ count is about 200/uL. A total of 68 cases of ICL have been reported, one of which was found in 2,388 HIV-negative homosexual men in the Multicenter AIDS Cohort Study. No cases of idiopathically low CD4+ have been reported in children. The geographical distribution of existing cases seems inconsistent with the idea of a single transmissible agent, and without predisposing factors, any such agent would be expected to affect each sex equally. At a rate of 1:2/1,000, there would be at least 300,000 cases of ICL in the United States alone. This indicates that ICL is easily the most common form of immunodeficiency. Doctors may want to consider ICL in all patients with unexplained opportunistic infections, concludes Reichert. Recommendations for HIV Testing Services for Inpatients and Outpatients in Acute-Care Hospital Settings * Morbidity and Mortality Weekly Report (03.05.93) Vol. 42, No. 8, P. 157 Hospitals and associated clinics should urge health-care workers to regularly ask patients in nonemergency settings about their risks for HIV infection, according to new guidelines published by the Centers for Disease Control. The revised guidelines were spurred by information concerning both the rates of previously undetected HIV infection among persons admitted to some acute-care hospitals and potential medical and public health benefits of recognizing HIV infection in persons who have not yet developed AIDS. The CDC suggests those patients who are found to be at risk for HIV should be offered counseling and testing services with informed consent obtained in agreement with local laws. Moreover, hospitals with a rate of HIV infection of at least 1 percent or an AIDS diagnosis rate of less than 1.0 per 1,000 discharges should strongly consider adopting a policy of offering such services routinely to patients aged 15-54 years. The services should be designed to ease confidential, voluntary patient participation and should include pretest information about the testing procedures, appropriate post-test counseling for HIV-positive patients and those at high risk, and referral of HIV-positive persons for medical evaluation. Those patients who don't wish to be tested or those who are found to be infected after testing, must not be denied health care or provided inadequate care. The guidelines stress that HIV counseling and testing programs should not be substituted for universal precautions and emphasize the significance of effective and continuous cooperation between acute-care providers and health departments to enhance HIV-related prevention and treatment services. Area to Forgo $1 Million in AIDS Funds * Philadelphia Inquirer (03/18.93), P. B1 Collins, Huntl The Philadelphia area was denied the $3.5 million in federal funds it sought to expand medical services for poor people with AIDS, and settled instead for $2.5 million from the Ryan White CARE Act. The city expected to receive the full amount after having done well in last year's competition for the annual grants. Jeremiah J. White Jr., president of the AIDS Consortium of Philadelphia's board, said he hoped the city could recover its loss through supplemental funds promised by the Clinton administration via the Ryan White program. Some speculate that officials were afraid of a perceived conflict of interest on the AIDS consortium board. Baltimore Takes a Cue From AIDS, Honors Murder Victims With a Quilt * Baltimore Sun (03/18.93), P. 1B Siegel, Eric A special Memorial Quilt, patterned after the AIDS quilt and honoring Baltimore's hundreds of murder victims, will be officially unveiled at 6 p.m. Tuesday at a reception at the Department of Education. Those in attendance will include Mayor Kurt L. Schmoke. Like the AIDS quilt, the Memorial Quilt is a continuing endeavor in which other families can add panels at no expense. Tentative plans have the quilt being placed in a victim-witness assistance unit waiting room on the city courthouse's fourth floor. A similar quilt being created by a support group linked with the Baltimore County State's Attorney's Office will also be unveiled at the same time. The AIDS Ban * Richmond Times-Dispatch (03/17.93), P. A8 The editors of the Richmond Times-Dispatch applaud the House of Representatives' vote to prohibit AIDS-infected immigrants from entering the United States. They point out that immigrants with other infectious diseases, like syphilis, are similarly banned, and assert that those suffering with AIDS should also be included. The editorial voiced support for Tom Bliley, Virginia's 7th District Congressman, who originated the motion. Sensible Needle Exchange * Baltimore Sun (03/18.93), P. 18A The editors of the Baltimore Sun have called on Maryland's General Assembly to pay special attention to a bill that, if approved, will create a pilot needle exchange program for intravenous drug users in Baltimore City. The editors cite several disturbing statistics to support their stand. Specifically, they contend that 42 percent of all Baltimore City AIDS cases are the result of illegal drug injections, and that 185 of the 200 children now being treated for HIV infection in the city's AIDS clinics were the result of injection drug use. The editors say that the proposed program would be carefully designed and closely monitored so as to not encourage drug use. They point to New Haven's needle exchange program as an example of how such a plan can be successful in getting used needles off the streets. Therion Will License Harvard AIDS Vaccine * Journal of Commerce (03/18.93), P. 7A Therion Biologics Corp. unveiled an agreement to license from Harvard University a "live" AIDS vaccine process that is considered promising. Therion, based in Cambridge, Mass., will work together with Harvard researchers to test a mix of virus strains for a vaccine that prompts an immune response but does not result in unforeseen long-term disorders. Therion is likely to be the first company to begin human studies based on live virus vaccines that are developed to provide long-lasting protection against infection. Better Treatments, Longer Lives * Time (03/22.93) Vol. 141, No. 12, P. 50 Making small advances in the treatment of secondary infections is a primary strategy of those trying to prolong the lives of AIDS patients. Drugs, such as AZT and ddI offer temporary treatments for HIV. In 1987, scientists found a treatment to prevent pneumocystis pneumonia, a secondary infection responsible for about 33 percent of AIDS deaths. At that time, doctors gave AIDS patients a drug called pentamidine. Now, the scientists have found pentamidine can reduce the recurrence of the pneumocystis when sprayed directly into the lungs. Bactrim and Septra are the trade names of an antibiotic that can effectively prevent the disease. Researchers have also made progress in developing a treatment for Mycobacterium avium complex (MAC), a disease similar to tuberculosis. The FDA has approved rifabutin, a drug that decreases by 65 percent the chance an AIDS patient will develop MAC. HIV can also affect the central nervous system, but some drugs can be partially or completely effective. Bactrim can prevent parasites that cause toxoplasmosis in the brain. Amphotericin B can fight against cryptococcal meningitis, a fungal infection of the brain, without causing nausea if administered in smaller doses and followed by fluconazole. Are Some People Immune to AIDS? * Time (03/22.93) Vol. 141, No. 12, P. 49 Gorman, Christine Researchers have discovered that some patients infected with HIV seem to resist the onset of AIDS, according to a recent study. However, scientists still do not know why this happens. At least 5 percent of the estimated 1 million people infected with HIV may never show symptoms of AIDS, the survey suggests. The study may help scientists discover a vaccine for AIDS. The researchers have found that resistance to the disease is not directly linked to proper diets, the lack of drug use, stress, or the absence of other sexually transmitted diseases. Scientists now believe that the resistance may result from peculiarities of the immune system or genetic factors. From the study, scientists have noticed that the patients without symptoms have stable CD4 counts above 500. The normal level of CD4 cells is 1,200, and patients have an increased risk of contracting a secondary illness if the level of CD4 cells falls below 200. The immunologists believe that those patients with CD4 counts above 500 have weak strains of HIV that strain immune systems, but not to the point that they succumb to infections. The immune systems develop the ability to fight against more powerful strains. Report on AIDS Impact Draws Intense Criticism * Advocate (03.09.93) No. 624, P. 25 Bull, Chris The recent release of a report by the National Research Council (NRC) evoked anger among AIDS advocates because its conclusion stated that AIDS was concentrated among socially marginalized groups and was likely to have little impact on American institutions. AIDS groups fear that public concern about the disease may be fading. David Rogers, cochairman of the National Commission on AIDS, said, "Many of us who have been working at the barricades on this disease have been trying to say that it is a crisis. Now this capable crew of people comes in with the blinders on and tells everyone not to worry anymore because it's only marginalized people who are affected." The report, "The Social Impact of AIDS in the United States," said those people most affected by AIDS are "beyond sight and attention of the majority of the population." The NRC is the research division of the National Academy of Sciences, a scientific group that is funded by the government and private sources. NRC chairman Albert R. Jonsen, a professor of medical history and ethics at the University of Washington in Seattle, said that the report is more of an AIDS awareness tactic, and many of the report's critics had misinterpreted its discoveries. He said, "The way we want people to read this report is that the epidemic appears to be getting worse in racial minority communities, which have fewer resources than the gay community to fight the disease. This is a disturbing new trend of social injustice we are trying to point out. We're not saying it's a good thing that people are not paying attention." News in Brief: New Jersey * Advocate (03.09.93) No. 624, P. 26 A New Jersey AIDS group is being investigated by the consumer affairs division of the state attorney general's office for allegations of financial misconduct, division officials said Jan. 27. The AIDS Research Foundation, which raises its money by placing 4,500 plastic canisters across the state, was accused of using only 8.5 percent of the funds it raises for AIDS service or research groups. The organization told donors that 68 percent of the funds were used for AIDS causes. The group's founder, Russell Frontera, denied the funds were misused but conceded that the 68 percent disbursement rate was not reached. Teens Living With HIV Warn Others to Be Wary * Philadelphia Inquirer (03/19.93), P. B6 Collins, Huntly More than 50 teens gathered yesterday at Drexel University for a "town meeting" about AIDS. Most of the students were from public schools in Philadelphia, and held discussions with each other for three hours on Drexel's student-run radio station, WKDU-FM. Since 1981, when the AIDS epidemic started, there have been just 19 reported instances of full-blown AIDS among Philadelphia teenagers between the ages of 13 and 19. But those statistics hide the long latency period of HIV. Both students and adults who took part in yesterday's discussions stressed that open talk about sex at home and in schools is vital in preventing the spread of the disease. Several teenagers also talked about the various ways they contracted the virus, and their own denial after they discovered they were HIV-positive. The town meeting was sponsored by WKDU-FM in combination with the AIDS Adolescent Education Project and the Black Lutheran Community Development Corp. The show will be rebroadcast in April on radio and on Drexel's Channel 54, which Philadelphia cable subscribers may receive. New Test Accurately Measures AIDS Virus Even in Early Stage Patients--Reported in Science * Business Wire (03/18.93) (Redwood City, CA) A new way to sensitively and accurately determine the amount of circulating virus (viral load) present in the blood of people who have the AIDS virus is discussed in Thursday's issue of Science. The new method is called Quantitative Competitive Polymerase Chain Reaction (QC-PCR), and was developed by a group at Genelabs Technologies Inc. The method was used to test 66 patients in collaborative studies involving researchers at the nationally designated University of Alabama at Birmingham AIDS Center. QC-PCR might help in the evaluation of HIV vaccines, the monitoring of HIV-positive patients, and in basic studies aimed at providing more information about the biology of HIV and AIDS. The new method gives researchers a better way of accurately measuring viral load, including determining virus levels in people in whom the virus cannot be discovered by pre-existing methods. Jeffrey D. Lifson, M.D., vice president of the HIV & Exploratory Research at Genelabs and senior author of the paper, said, "There is an urgent need for new ways to rapidly evaluate the effectiveness of antiviral treatments in HIV-infected patients without having to wait for the development of traditional clinical endpoints like serious worsening of the disease or death." The Oprah Winfrey Show Gives Atlanta AIDS Hospice Situation a National Forum * PR Newswire (03/16.93) The popular "Oprah Winfrey Show" taped a satellite remote from Georgia's Elysium House on Wednesday. The AIDS hospice has come under fire for housing up to six dying AIDS patients at a time. The episode will air across the United States on Tuesday, March 23, 1993. Spread of HIV-2 Feared in India United Press International (03/18.93) (New Delhi, India) HIV-2, a second strain of the AIDS virus, has been recorded in India's port cities, and could soon spread to the country's inland regions. Arab visitors have had to shoulder most of the blame for the high level of prostitution in the city of Bombay. A recent study showed that at least 30 percent of all Bombay prostitutes were HIV-infected. HIV-2 is predominantly found in west African nations, with only sporadic cases having been reported in the United States and Europe. India remains one of the countries in the Asia-Pacific region that is most threatened by large-scale HIV epidemics. Context Effects on Responses to Questions About AIDS * Public Opinion Quarterly (Winter 1992) Vol. 56, No. 4, P. 515 Colasanto, Diane et al. Although the public was more knowledgeable about HIV transmission in 1988, there were large increases in misinformation among several demographic subgroups with respect to one knowledge item: whether or not it was possible to contract HIV by donating blood, according to a survey by Eleanor Singer et al. published in the Public Opinion Quarterly in 1991. Moreover, by 1989 the percentage of people believing that HIV could be contracted by donating blood had increased dramatically, from 28.9 percent in October 1988 to 43.5 percent in November 1989, the 1988 survey being done with personal interviews, the 1989 survey by telephone. Perceptions about HIV transmission were measured in both surveys by a question asking respondents to evaluate nine different methods of transmission. In previous tests, the question about donating blood had routinely been asked after the one about blood transfusion. But in November 1989, the questions about transmission were randomly rotated for every respondent. Those who were asked first about donation were more inclined to say that contracting HIV is possible via donation than those who were asked about donation after transfusion. Therefore, clarifying and counteracting respondents' misperceptions about the risks of donating blood are necessary to elicit correct responses, the researchers say. Living With the Epidemic--The Tragedy in Africa * American Nurse (03.93) Vol. 25, No. 3, P. 20 Kirkpatrick, Sharon M More effective approaches to AIDS education, prevention, and/or treatment need to be found, or the future will not be bright for sub-Saharan Africa, writes Sharon M. Kirkpatrick, PhD, RN, president of the Missouri Nurses Association. The World Health Organization says sub-Saharan Africa continues to have the highest prevalence of AIDS, with an estimated one million AIDS cases and another 6.5 million HIV-positive cases. The children feel the profound impact of AIDS both directly and indirectly. About 750,000 infants are HIV-positive; another 10-15 million children under age 10 are projected to be orphaned as a result of AIDS by the year 2000. UNICEF states that HIV-positive infants develop full-blown AIDS more quickly than adults and are often the first indication that the virus is within the family. One of the reasons for the rampant spread of HIV in Africa is traditions related to polygamy. Another belief states that women are expected to remarry quickly when they are widowed. If the husband died of AIDS and the widow is HIV- positive, than the virus has the potential to be spread further by exposing another person when the woman remarries. Many African health-care workers have said they see little change in sexual behavior, despite warnings of the risks of HIV infection. For some, economic considerations discourage behavioral changes because condoms are too expensive for most villagers to use. Other Africans seem to have a fatalistic outlook, believing AIDS will be an inevitable part of their future. Even though there are several excellent programs being implemented in many areas, the fight against AIDS appears to be making little or no progress in most places, concludes Kirkpatrick. Dronabinol Approved for Use in Anorexia Associated With Weight Loss in Patients With AIDS * Journal of the American Medical Association (03/17.93) Vol. 269, No. 11, P. 1361 Nightingale, Stuart L. The Food and Drug Administration has endorsed a supplemental new drug application for dronabinol that treats anorexia associated with weight loss in AIDS patients. The new finding is based on clinical studies involving AIDS patients, in which the appetite-stimulation effect of dronabinol was carried out for up to 5 months. Dronabinol is chemically synthesized tetrahydrocannabinol, the main active ingredient in marijuana. In 1985, dronabinol was initially approved as an antiemetic for treatment of nausea and vomiting related to cancer chemotherapy. But in January 1991, dronabinol was given Orphan Drug status for appetite stimulation in AIDS patients with weight loss problems. Orphan Drug status gives financial incentives to a sponsor for developing treatments for diseases or conditions affecting fewer than 200,000 people in the United States. As a result of the potential for abuse, dronabinol remains a Schedule II controlled substance. The approved product labeling mentions that doctors and pharmacists should use the same care in prescribing and accounting for dronabinol as they would with morphine sulfate or other drugs controlled under Schedule II. The Drug Enforcement Administration announced a new policy to monitor dronabinol for diversion and illicit use at the time of dronabinol's initial approval and control in Schedule II. News in Brief: Wisconsin * Advocate (03.09.93) No. 624, P. 27 Forced HIV testing of rape suspects does not infringe on the privacy rights contained in the Wisconsin constitution, ruled state district court judge Janine P. Geske on Jan. 26. Geske said that by allowing victims of sexual assaults "access to all of the relevant information regarding her HIV status and her alleged attacker's status, the courts are allowing a reasonable and minimal intrusion upon an accused sexual offender." The judge revealed the decision in a case involving John S. Benson, a rape suspect who is confined in the Milwaukee county jail. Benson's lawyers said they would not appeal the ruling and Benson would undergo the testing. But Doug Nelson, executive director of the Milwaukee AIDS Project, said that "no one would rely on the HIV test of another individual to access their own HIV status. Victims of sexual assault must obtain their own tests." Milwaukee assistant district attorney Donald Jackson said that in the year since the forced-testing law was enacted, county prosecutors have used it fewer than ten times. AIDS Patient Care Challenges Nursing * American Nurse (03.93) Vol. 25, No. 3, P. 1 Cassetta, Robin A. As the AIDS epidemic spreads to all segments of society, nurses will face the challenge of caring for a growing number of AIDS patients. AIDS education is imperative to guarantee safety for health care workers and adequate care for patients. Mia Taylor, RN, nurse clinician and case manager at the McAuley Clinic in Grand Rapids, Mich., said, "HIV/AIDS can't be a specialty anymore; all nurses and physicians need to be educated in HIV/AIDS." The increasing rate of HIV infection among the public will demand a movement toward community care in order to maintain a continuity of care for AIDS patients. Nurses are the primary source of support and education to the friends and family of the AIDS patient, and must educate the community to help provide the AIDS patient with a high quality of life. Nurses must also learn to handle the specific needs of AIDS patients including psychosocial, employment, emotional, and financial needs. To address all of these needs, multi- disciplinary teams of health-care workers can be effective. Health-care workers can avoid having a similar problem develop somewhere else by addressing a problem from all aspects of treatment. Moreover, nurses must be updated on all of the recent developments in AIDS research and treatment to ensure the best care for their patients. Taylor said by long-term caregiving and by educating others, nurses can find the reward of "personal satisfaction in knowing that these patients are very discriminated against, have a terminal illness and although we cannot cure them, we can improve their quantity and quality of life." 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 03.15.93 ]]]===----- .