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Hemophiliacs Demand Answers as AIDS Toll Rises *
New York Times (05/10/93), P. A1
Navarro, Mireya

The many hemophiliacs who have contracted HIV have requested a
Congressional investigation to determine why they were not told to stop
using blood-clotting products after the first AIDS cases among
hemophiliacs were reported in 1982. In addition, HIV-positive
hemophiliacs have recently been conducting demonstrations and planning a
national litigation strategy to fight for their case. The manufacturers
of clotting products argue that as soon as HIV was detected, they took
steps to purify the factor or kill the virus. The infected hemophiliacs
are also ending their isolation by joining forces with some of the most
effective AIDS advocacy groups, which can deliver large numbers of
supporters and share their expertise in holding effective
demonstrations. Approximately 10,000 hemophiliacs were infected with HIV
through blood clotting factors by 1985, which was about 70 percent of
the total hemophiliac population in the United States at the time,
according to the Centers for Disease Control. Federal health officials
from the CDC say there have been no HIV infections from clotting factor
since 1987, after measures were taken to ensure the safety of the blood
supply. Lawsuits filed by HIV-positive hemophiliacs against factor
manufacturers and the American Red Cross claim that the defendants
failed to warn them of the dangers of using these blood-clotting
products. Others charge that blood purification methods that could have
helped control the epidemic were not implemented. CDC officials say that
by last December there were 2,426 AIDS cases reported among
hemophiliacs.

Related Story: Washington Post (05/10) P. B1.


Gays Report Active, Happy, Safe Sex Lives *
Toronto Globe and Mail (Canada) (05/07/93), P. A8
Mickleburgh, Rod

Overall, Canadian homosexual men are sexually active but practice safe
sex, according to a new study released by the Canadian AIDS Society. The
survey involved 4,803 men in 35 cities across Canada, and was conducted
at 125 gay bars, bathhouses, and community dances during 1991 and 1992.
It was the first large-scale survey of the sexual behavior of Canadian
gay men and discovered that about 50 percent had six or more partners in
the past year. Also, more than 80 percent enjoyed their sex life,
including 46.5 percent who enjoyed it "very much." About 77 percent
consistently practiced safer sex. Those who said they had changed their
sexual practices as a result of AIDS constituted more than 80 percent of
the respondent population. "The results of this survey show that
significant change has taken place in gay men's attitudes and sexual
behaviors since the arrival of AIDS. Our prevention education programs
are working," said Rene Raymond, chairman of the Canadian AIDS Society.
Even though the results were promising, those involved with the study
said they still are concerned that nearly 23 percent of gay men rarely
use condoms during anal intercourse, with the highest proportion of
these under 25 years old. The study also revealed that 65 percent of the
respondents had been tested for HIV. Among those tested, 18.2 percent
were positive, or 11.2 percent of the entire group of participants. In
Canada, a total of 7,769 AIDS cases had been reported as of April 1.
About 78 percent of the AIDS cases involved gay or bisexual contact.


Malaysia Tree, Now Lost, Slowed HIV *
Boston Globe (05/07/93), P. 3

An effective compound against HIV that was isolated from a Malaysian gum
tree in 1991 is no longer available, according to a paper released
Thursday by Rep. Gerry Studds (D-Mass.). Researchers from the National
Cancer Institute's center in Maryland found that the compound, derived
from twigs from the gum tree, blocked the spread of HIV-1. They
subsequently sent biologists back to Malaysia for more samples from the
tree. However, when they arrived at the swamp, the tree was gone. The
paper said that no tree found since has produced the same compound. Dr.
John Cardellina, a co-author of the paper, said, "We have a very good
idea. It's very promising. To say it's definitely going to be a cure is
jumping way ahead of the game." But Cardellina said that testing
suggested that the compound could more than control the disease. "The
emphasis is on eradicating the virus in the patient," he said. The tree
was a member of the gutti-ferae family of gum producing trees. The type,
known as calophyllum lanigerum, was discovered in a swamp on the
Malaysian island of Sarawak. More than two pounds of twigs, bark, and
fruit were collected from the tree by researchers. NCI researchers
reduced saplike material in the tree to a compound, calanolide A. When
tested against HIV-1, the new compound was "100 percent effective" in
inhibiting the spread of HIV. The study's findings were published last
year after peer review by the Journal of Medicinal Chemistry.


AIDS Instructor Fired at Academy *
Boston Globe (05/07/93), P. 19

Backed by President Clinton for his aggressive AIDS prevention course, a
Worcester Academy teacher in Worcester, Mass., was suspended from his
part-time teaching post last week and will not be returning next year.
Michael A. Quercio, who is HIV-positive and openly gay, has implemented
an unconventional approach to teaching about AIDS. As a result of his
occasional use of profanity in the classroom and permitting students to
do the same, and his decision to publicly criticize the school's
administration in a speech earlier this year, Quercio has lost his job
at the private school. The AIDS education course taught by Quercio used
music, art, and open discussion to teach high school students about the
dangers of the disease.


Federal Government Off Hook in Case of Family
Infected With AIDS Virus *
United Press International (05/07/93)

(Minneapolis, MN) The federal government is not responsible for a
Minnesota family's infection with HIV, according to a ruling by a
federal judge on Thursday. U.S. District Judge Harry McLaughlin decided
that the government is protected from legal action under federal law,
which precluded a trial that was expected to begin this week. The case
will now go to the 8th U.S. Circuit Court of Appeals. Doug Simon, 27,
claimed the government was at fault in 1982 for neglecting to adequately
screen blood donors while he was on active duty with the Minnesota Army
National Guard. In addition, Simon accused the government of failing to
warn him that he was at high risk for exposure to HIV. Simon alleges
that he contracted HIV through a tainted blood transfusion while he was
in an Army hospital during basic training at Fort Benning, Ga. The virus
was subsequently transmitted to his wife, Nancy, and to their daughter,
either in the womb or through breast feeding. After Simon developed
AIDS, he was forced to quit his job as a painter and dry waller. He
currently takes medication to fight off infections, but suffers from a
brain infection. Nancy Simon, who has AIDS-related complex, said, "I
want people to be aware of what this illness does and what happens
because of the blood we got. We should have been informed."


Victim of AIDS-Infected Dentist Says 'Thank God He's Dead' *
Reuters (05/07/93)
McMullan, Dawn

(West Palm Beach, FL) A teenager from Jensen Beach, Fla., revealed
Friday that she was the sixth patient of the Florida dentist with AIDS
to test positive. Sherry Annette Johnson, 18 years old, said she
discovered she was infected late last year when she tried to join the
Navy. "I had been told that you cannot get it from a health care worker.
I found that to be wrong," said Johnson. When asked by reporters about
how she felt about her dentist, Dr. David Acer, she said, "Let's just
thank God he's dead." Acer died of AIDS in 1990, one month after he
informed his patients that he had the disease and encouraged them to get
tested. The Centers for Disease Control says that Acer is the only
health care worker in the United States known to have transmitted HIV to
his patients. Only about half of Acer's estimated 2,200 former patients
have been tested for HIV, and state officials are trying to let the rest
of his patients know that they also should get tested. Johnson hoped to
keep her identity a secret, but it became impossible once the CDC
released its finding Thursday that another of Acer's patients had
contracted HIV. Johnson said she had her teeth cleaned and filled by
Acer during a three-year period beginning in 1987, but no invasive
procedures were performed. A lawsuit was filed by Johnson's family
against CIGNA Dental Health of Florida, Inc., the insurance company that
sent her to Acer. Johnson said that she had never had a blood
transfusion, injected drugs, or contracted a sexual disease.


Teen Survey: Fear of AIDS Best Reason for Safe Sex *
United Press International (05/07/93)

(New York) Most teenagers believe that fear of contracting HIV infection
is the best reason for practicing safe sex, according to Good
Housekeeping magazine. A telephone survey of 505 boys and 508 girls
found that 73 percent said they believe high schools should distribute
condoms to students. About 67 percent of the respondents said that the
media makes sexual activity seem more acceptable to teens than teens
really believe it is. When asked what was the best reason not to have
sex, 60 percent said the threat of HIV infection, 25 percent said fear
of pregnancy, 8 percent said the belief that sex before marriage is
wrong, and 4 percent said not being in love. A total of 59 percent of
the respondents said teens who have sex were having it with the same
partners, and 29 percent said different partners. The survey was
commissioned by Good Housekeeping and "CBS This Morning."


Blood Bank Must Divulge Donor Name" *
American Medical News (05/03/93) Vol. 36, No. 17, P. 17

The Pennsylvania Supreme court ruled in June 1992 that a blood bank must
reveal the name of a blood donor who tested positive for HIV and whose
blood was transfused into a patient who subsequently developed AIDS. In
October 1984, a patient received multiple transfusions of blood and
blood products. But in August 1985, the blood bank learned that the
blood donor was HIV-positive. The blood bank waited ten months before
telling the hospital of the potential contamination of the patient's
blood products. In November 1986, the patient was being treated for
respiratory ailments and was diagnosed with AIDS. The hospital then
informed her about the tainted blood. Within two months her husband and
6-year-old son tested HIV-positive. On July 3, 1988, the patient died of
AIDS. Before trial, the patient's lawyer filed a motion to force the
blood bank to divulge the name and last known address of the donor. The
trial court ordered the blood bank to reveal the information; an
appellate court reversed the decision. But on another appeal, the
Supreme Court said the discovery ordered by the trial court was
permissible and did not infringe upon the donor's right to privacy. Many
cases with similar factual circumstances have been decided in the
opposite way where protection of donor identity prevailed. But the court
said the patient's estate was entitled to production of the donor for
anonymous questioning on the screening process used by the blood bank
and was allowed access to anonymous HIV test results of any other
recipients of that donor's blood. The court said the ruling did not
violate the physician-patient privilege or the constitutional right to
privacy.


HIV Seroconversion After Occupational Exposure
Despite Early Prophylactic Zidovudine Therapy *
Lancet (04/24/93) Vol. 341, No. 8852, P. 1077

Although AZT was taken within an hour of exposure to HIV, a health-care
worker still became infected with the virus, according to a study
published in the April 24 issue of the Lancet. A 22-year-old female AIDS
patient was receiving treatment for cerebral toxoplasmosis at the time
of the incident. Her CD4 count was fewer than 50/uL for the previous 10
months and she had been taking AZT for 18 months. She collapsed, and
during resuscitation an intravenous cannula was inserted by a doctor.
As the used introducer, which was contaminated with fresh blood, was
being discarded by the health-care worker, she sustained a deep
penetrating injury to her left arm. The health-care worker was a 59-
year-old female heterosexual with no other known risk factors for HIV.
She took an oral dose of 250 mg of AZT 1 hour after the incident, with a
further 250 mg given 1 hour later.  She subsequently completed a six-
week regimen of AZT 250 mg four times daily with no reported side-
effects. She tested HIV-positive on day 56 after the incident. One of
the causes of this infection was that the AIDS patient was at the end-
stage of disease, and therefore was likely, despite treatment with AZT,
to have had a high level of HIV in her blood. It was also possible that
the AIDS patient's strain of the virus was resistant to AZT. In
addition, the virus from the health-care worker was significantly less
sensitive than those obtained from individuals who did not take AZT.
Without virus isolation from the AIDS patient, it is impossible to
confirm that transfer of resistant virus by injury took place, but the
researchers strongly suggest such an interpretation.


Viral Dynamics in Primary HIV-1 Infection *
Lancet (04/24/93) Vol. 341, No. 8852, P. 1099
Piatak, M. et al

Varying conclusions about the degree to which plasma virus decreases in
association with HIV seroconversion and the likely importance of
neutralizing antibodies were reached, according to M. Piatak Jr. et al.
of the Genelabs Incorporated in Redwood City, Calif. The researchers
examined six patients longitudinally from the time of initial
presentation with symptomatic primary HIV-1 infection for up to 791
days, with assays that directly quantify total plasma virus by
competitive RNA polymerase chain reaction (PCR), infectious plasma virus
by endpoint dilution culture, and p24 antigen by standard and immune
complex dissociation. The quantitative competitive PCR (QC-PCR) retains
the sensitivity of standard PCR, while using competitive titration for
accurate assay. Culturable virus in plasma was decreased to undetectable
levels coincident with seroconversion in five of six patients, and was
significantly reduced in the sixth. But despite decreases in total
plasma virus levels by QC-PCR of up to 236-fold that closely paralleled
declines in culturable virus, plasma virion-associated RNA remained
readily detectable throughout the full follow-up in all six patients.
The demonstration by competitive PCR, including QC-PCR, of persistence
of plasma viremia through seroconversion and resolution of primary HIV-1
infection emphasizes the complexities of HIV-1 pathogenesis and the
difficulty in ascribing a role to neutralizing antibodies or cytotoxic
lymphocytes in early viral clearance, since the former generally cannot
be found and the latter still allow viral replication in plasma, the
researchers conclude.


May 11, 1993


Female Condom Approved for Market *
New York Times (05/11/93), P. C5
Leary, Warren E.

The Food and Drug Administration approved the first female condom
yesterday, even though there were questions about its efficacy in
preventing pregnancy and protecting against sexually transmitted
diseases. The move was announced by the condom's manufacturer, Wisconsin
Pharmacal of Jackson, Wis., and confirmed by the FDA. The device would
be shipped to doctors offices, clinics, and facilities treating sexual
diseases in about eight to ten weeks, said the manufacturer. Wisconsin
Pharmacal said it intends to make the female condom, known as Reality,
available nationwide by the end of this year. The Reality condoms would
be priced at $2.50 each. The device is essentially a polyurethane sheath
that lines the vagina. It is about six and a half inches long, and is
held in place by two flexible plastic rings, one at the cervix and one
outside the body. The condom is intended for one act of intercourse. The
agency's approval was contingent upon the company's inclusion of
labeling that stressed that male latex condoms seemed to be better
protection against pregnancy and disease. One statement reads: "If you
are not going to use a male latex condom, you can use Reality to help
protect yourself and your partner." While more than six months of
testing in the United States showed that Reality protected against
pregnancy to some degree, the rate of conceptions among those using the
product was higher than with other barrier methods. FDA said this
information had to be mentioned on the label. Wisconsin Pharmacal
attributes the high pregnancy rate to improper use of the condom by
women in the study, and said that it would be much lower if the product
had been used correctly.

Related Stories: Washington Post (05/11) P. A5; Baltimore Sun (05/11) P.
9A.


Expert Panel Backs Quick Approval of Drug to Help AIDS Patients *
Reuters (05/10/93)

Panel recommends hastened approval of the antibiotic clarithromycin for
treatment of a common opportunistic infection of AIDS known as
mycobacterium avium complex. The move by the FDA committee came on a 9-3
vote after a day of testimony on an application for the drug's approval
filed by Abbott Laboratories. Abbott already markets the antibiotic for
use against respiratory tract infections in adults, under the brand name
Biaxin. The FDA typically follows the panel's recommendations, but there
was no immediate indication of when it might give its approval to the
use of Biaxin for AIDS patients. Mycobacterium avium complex is
experienced in 50-75 percent of AIDS patients, and causes night sweats,
diarrhea, and wasting. Often, it is the immediate cause of death in
those with late stage HIV disease.


40 Percent of Children Who Have a Parent
With AIDS Don't Even Know It *
Business Wire (05/10/93)

(New York) About 100,000 children are living in families with HIV
infection, and about 40 percent of those who have a parent with AIDS are
not aware of it, according to a report in the June issue of Sassy
magazine. "In New York City alone, there are about 20,000 kids who've
lost their mothers to AIDS," says the magazine. According to the report,
about 5,000 people contract HIV every day, which is one infection every
18 seconds. Nearly 10 million children worldwide will become orphaned by
AIDS by the end of the decade. Among children who have lost their
mothers to AIDS, 80 percent are Latino or African-American. The majority
of AIDS orphans are from single-parent families already experiencing
poverty, and often drugs and violence. By the year 2000, one in four
foster children are likely to be in foster care because of AIDS.


Condoms to Be Sold on Comedy Call-In Show *
United Press International (05/10/93)

(Los Angeles) The first condom stores in the United States will be the
first businesses to sell their safe-sex devices on television. Although
condoms were previously sold discreetly behind pharmacy counters, they
will be offered for sale later this month on Comedy Central cable
network's new telemarketing show, "The 800 Club." The show is a home
shopping program with a twist--each commercial with toll-free ordering
numbers is followed by a host's humorous demonstration or endorsement of
the product. Among the channel's 20 debut advertisers is the Safer Sex
Kit, sold at CONDOMania stores in New York and Los Angeles. The kits are
equipped with a variety of condoms and other protective devices intended
to prevent the spread of HIV infection. According to CONDOMania founder
Adam Glickman, the AIDS issue is a serious matter, but the methods to
encourage condom use can be funny. The kit, which costs $19.95, includes
instructions on how to use the items, in addition to advice on how to
convince a reluctant partner to use them. Glickman says CONDOMania and
the kit are examples of the marketing of "the information of your family
doctor and the frankness of Dr. Ruth." Some of the proceeds of the Safer
Sex Kits will be donated to AIDS organizations in New York and Los
Angeles.


Condom Rapist Goes on Trial in Texas *
Reuters (05/10/93)

(Austin, TX) The rape case in which a woman being raped asked the
attacker to wear a condom to prevent HIV infection went to trial on
Monday. In September, a grand jury refused to indict Joel Rene Valdez,
the so-called "condom rapist," saying the victim's request that he wear
a condom during the alleged attack implied consent. The decision spurred
widespread outrage. The Travis County district attorney's office decided
to take the case to a new grand jury after the initial grand jury ruling
incited a courthouse demonstration and dozens of phone calls opposing
the decision. Testimony is scheduled to begin today when the alleged
victim takes the stand. If Valdez is convicted, he faces a jail term of
5 to 99 years. Lynn Thompson Hass, the executive director of the Austin
Rape Crisis Center, said it was not uncommon for rapists to wear
condoms, but usually not at the victim's demand. She said one rapist,
still at large after committing seven sexual assaults in Austin since
1986, wears a condom during his attacks. Hass, who organized much of the
protest against the first grand jury decision, said that the grand jury
apparently did not see the woman as a victim because of common
misconceptions about rape. Asking the rapist to wear a condom does not
constitute consent, but is rather an attempt to protect against the
disease and gain "a little bit of power over" the attacker, said Hass.


AIDS Tests Flunk Out *
USA Today (05/10/93), P. 10A

Mandatory HIV testing of America's health care workers would do little
to ensure the safety of patients, write the editors of USA Today. On
Friday, the sixth patient of Dr. David Acer, the Florida dentist with
AIDS, revealed that she also is infected with HIV. Sherry Johnson, who
contracted the virus from Dr. Acer, wants to lobby for mandatory testing
of all health-care workers to protect other patients from a similar
situation. However, the editors note, testing is not as effective as
Johnson believes. The Centers for Disease Control has found only six
patients of more than 16,000 HIV-positive health-care professionals who
contracted HIV, and all are Dr. Acer's patients. It still remains
unclear how Acer transmitted the virus to his patients, and
investigators have not ruled out intentional infection. But aside from
the cases with Dr. Acer, the chance of contracting HIV from a health-
care worker remains quite low--one in 260,000 to 2.6 million. The chance
of being struck by lighting is one in 30,000 over a lifetime. Testing
every health-care worker for HIV every day would provide no guarantees.
The virus may not present itself until several weeks or months. The cost
of the testing would also be exorbitant. At $50 to $100 per test, even
testing every three months would cost $900 million to $1.8 billion a
year--for little or no protection from the disease. What would be more
effective is strict adherence to universal safety procedures that
include use of gloves, gowns, masks, and sterilizing sharp instruments
in order to prevent infection of patients. These measures would offer
better assurance than HIV testing, the editors conclude.


Keeping Tabs *
Economist (04/24/93-04/30/93) Vol. 327, No. 7808, P. 88

APREX has created a product to address the problem of tuberculosis
patients completing their drug therapy. Medication management system
(MEMS) places a digital watch into the cap of a pill bottle. The cap
registers each time the pill bottle opens. Doctors' computers can
receive the data from the watch during patients' checkup visits. This
method allows doctors to know whether the patient takes the correct
amount of drugs at the correct time. Originally, APREX used its system
to monitor patients in clinical trials and to provide pharmaceutical
companies with information about the doctors conducting the tests. About
100 TB patients use the system, adding to the 30,000 worldwide patients
taking pills from MEMS. MEMS has resulted in the slower development of
drug resistance. Another benefit appears to be cost-savings. The
National Pharmaceutical Council estimates that patients failing to
complete drug treatment raise hospital costs in the United States by as
much as $10 billion annually. Other companies have begun researching
electronics in different forms of drug treatment.

Changes in Sexually Transmitted Disease Rates After HIV
Testing and Posttest Counseling, Miami, 1988 to 1989 *
American Journal of Public Health (04/93) Vol. 83, No. 4, P. 529
(Otten, Mac W. et al.)

Because patients from a sexually transmitted disease (STD) clinic who
tested negative for HIV had an increased risk for an STD, posttest
counseling must be improved, write Mac W. Otten Jr. et al. of the
Centers for Disease Control in Atlanta, Ga. The researchers examined the
association between testing and posttest counseling and changes in risky
behavior of STD clinic patients in Miami, Fla., by using infection with
a sexually transmitted disease as an objective measure of risky
behavior. Comparisons were made of the percentage of patients who had a
positive gonorrhea culture (or any STD) in the 6 months before and after
HIV counseling and testing. Those 331 patients counseled about a
positive HIV test had a percentage of gonorrhea of 6.3 before and 4.5
after posttest counseling (a 29 percent decrease). For the 666 patients
counseled about a negative test, the percentage with gonorrhea was 2.4
before and 5.0 after posttest counseling (106 percent increase). By
using any STD as the outcome, patients who tested positive for HIV had a
12 percent decrease, and patients who tested negative had a 103 percent
increase after counseling. These findings indicate a need to reevaluate
sexually transmitted disease and HIV counseling in this clinic and to
determine the effects of counseling and testing in other clinics, the
researchers conclude.


Injection of HIV Genes Elicits Immune Response *
Chemical & Engineering News (05/03/93) Vol. 71, No. 18, P. 42

Mice injected with genes from HIV-1 exhibit humoral and cellular immune
responses that would be advantageous in a preventive AIDS vaccine. David
B. Weiner of the University of Pennsylvania School of Medicine and the
Wistar Institute, Philadelphia, led a team of researchers who inoculated
mice with a plasmid that contained the genes for the HIV-1 envelope
glycoprotein gp160 and the HIV-1 Tat and Rev proteins. They discovered
that the mice produced antibodies that neutralized HIV-1 infection and
inhibited HIV-1-mediated fusion of lymphocytes, a process in HIV
infection. In addition, the mice produced cytotoxic T cells specific for
gp160-expressing target cells, suggesting that the cellular offshoot of
the immune system was also incited by the inoculation. According to the
researchers, the technique, "which combines the positive aspects of
immune stimulation inherent in live attenuated vaccines with the safety
of recombinant subunit vaccines, could have wide application in humans
and animals."


May 12, 1993


U.S. and 37 Others Press U.N. to Unify Battle Against AIDS *
New York Times (05/12/93), P. A10

Because of a lack of money and infighting within the United Nations, the
United States and 37 other countries are concerned that AIDS efforts are
suffering, and the countries are pushing for a restoration of
international efforts to fight the epidemic. Yesterday a proposal was
released at the World Health Organization's annual meeting that called
for a United Nations AIDS program to coordinate the work of agencies
like WHO, the United Nations Children's Fund, and the United Nations
Development Program. The proposal, to be debated this week, requests
that Dr. Hiroshi Nakajima, Director General of WHO, report within nine
months on the potential of a unified program. U.N. officials said that
because of the extensive support, the resolution was likely to be
approved by the 185-nation assembly. "In the United States one person
dies every 19 minutes of AIDS and 130 people are infected every day,"
said the U.S. Surgeon General, Antonia Novello. She added, "We need more
coordination, not competition." Dr. Michael Merson, head of WHO's Global
Program on AIDS, said WHO had received only $4 million this year and
could continue its work only with borrowed money until promised funds
are provided. The agency's $73-million budget anti-AIDS efforts this
year comes completely from voluntary donations, with governments allowed
to pay what they want and determine how it is spent. In addition to
donations to WHO, wealthier governments frequently give money, condoms,
and equipment to poorer countries in bilateral deals or through other
U.N. agencies. However, there have been frequent reports of rivalry,
duplication of efforts, and bureaucratic delays in the U.N. system.


Smokers With HIV Get AIDS More Rapidly, Researchers Find *
Baltimore Sun (05/12/93), P. 11A

Smoking can hasten the progression from HIV infection to full-blown
AIDS, according to a new report published in Friday's medical journal
AIDS. Dr. Richard Nieman, who led a team of British researchers studying
smoking and AIDS, said, "If you have an HIV infection and you smoke, you
are more likely to get full-blown AIDS." He added that previous research
had shown a connection between smoking and AIDS, but his research
demonstrated that smoking actually encouraged the onset of the disease.
"There are lots of studies that show that smoking is particularly common
in gay men and intravenous drug users. It was thought that people who
smoked were [also] more likely to take risks in their sex lives," said
Dr. Nieman. He and other researchers from St. Mary's Hospital in London
studied the progression of HIV infection to AIDS in 84 HIV-positive
patients between 1986 and 1991. The patients were in various stages of
HIV infection, but none had AIDS. Among the group of patients, 43 were
smokers and 41 were not. The nonsmokers had never smoked
or had quit at least one year before diagnosis with HIV infection. "The
smokers developed AIDS at a median of 8.17 months," said Dr. Nieman,
while nonsmokers took an average of 14.5 months to develop AIDS. "We
think it's because of the effects that smoking has on the immune
system," he said. "There is established research over the past 10 to 15
years that smoking does a lot of things to the same sort of cells that
HIV also affects," said Dr. Nieman.


Vestar Introduces New Tuberculosis Drug Amikacin *
PR Newswire (05/11/93)

(Baltimore, MD) Pharmaceutical company Vestar of San Dimas, Calif.,
announced yesterday that MiKasome, its liposomal formulation of the
antibiotic amikacin, has demonstrated substantial activity against drug-
resistant tuberculosis, for which there is no current treatment. In
vitro data suggested that in a tuberculosis model resistant to
traditional chemotherapeutics, including amikacin, MiKasome produced a
several thousandfold killing effect. Amikacin is an aminoglycoside
antibiotic that is used against many infections. Its use, however, has
been limited by a high degree of toxicity, including kidney damage and
hearing loss at effective doses. Dr. Roger J. Crossley, Vestar chairman,
president, and CEO, said, "Because tuberculosis is spread through casual
contact, the general population is at risk. We're extremely encouraged
to see such activity against drug-resistant tuberculosis by MiKasome,
and we plan to advance the clinical development of the product as
rapidly as possible." Officials noted that based on the encouraging data
on MiKasome from preclinical trials conducted with Vestar's research
partner AmpliMed, preliminary human clinical trials of the drug are
expected to begin in the next few months.


ADB to Boost Funds to Fight AIDS in Africa *
Reuters (05/12/93)
Tudor, Gill

(Abidjan, Ivory Coast) The African Development Bank expects to allot
more money to combat Africa's AIDS epidemic, which is making the world's
most indigent continent even poorer, according to bank sources.
Officials at the African Development Bank symposium on AIDS and
Development held yesterday said more money to fight the disease would be
addressed at the bank's annual meeting this week in the Ivory Coast
capital of Abidjan. One official said, "We can't say yet exactly what
projects will be funded, whether it'll be loans or grants, or what part
of the bank group it will come from." Tuesday's symposium continued in
the direction set by a ground-breaking declaration by the Organization
of African Unity last June, in which involved African leaders pledged
for the first time to take aggressive action in battling a disease that
is believed to have infected more than 7.5 million Africans. ADB vice-
president Ferhat Lounes told delegates the bank has already provided a
grant for an immunological laboratory in Zaire's capital Kinshasa, and
money to equip blood transfusion facilities in Togo and Ivory Coast.
Lounes said the annual cost of fighting AIDS would be more than the
total health budget of all countries in Africa, and would require an
increase in cash to help control the epidemic. A paper prepared for the
symposium by a committee of major development agencies, including the
ADB, World Bank, and branches of the United Nations, said Africa needed
to find innovative ways of raising money for preventing and fighting
AIDS. The paper said African governments could raise money by taxing
alcohol, cigarettes, and luxury goods, and could introduce or expand
health insurance with contributions from employers.


Elton John Pledges More Cash for AIDS Fight *
Reuters (05/11/93)

(London) Singer Elton John promised to give the proceeds from two big
concerts he held in London this week to an AIDS charity he established
last year. In addition to the proceeds, his sponsor, cosmetics firm
Revlon, will donate money that may together total more than 1 million
pounds ($1.58 million), according to concert organizers. Elton John
said, "This is a terrible disease. I want to do whatever I can to help
fight against this disease." Also, proceeds from his latest single
"Simple Life" will also be given to help fund AIDS research. John
contributed more than 1 million pounds to the foundation that he started
last November, and has become one of the world's leading AIDS advocates.


'Condom Rape' Accuser Says She Sought to Avoid AIDS, Pregnancy *
Reuters (05/11/93)

(Austin, TX) The victim of the so-called "condom rapist" testified
yesterday that she begged her attacker to use a condom during the rape
in order to protect herself from HIV infection and pregnancy. Joel Rene
Valdez went to trial Monday for aggravated sexual assault in a case that
received international attention when a grand jury refused to indict him
last year on the grounds that the victim's request that he wear a condom
implied consent. The woman testified that when the knife-wielding
attacker demanded that she lie on her bed, "I knew there wasn't much I
could do to prevent what was happening and so I tried to protect myself
from getting pregnant or AIDS, so I asked him to wear a condom." She
said that when she told the attacker she was afraid of contracting HIV,
he replied, "I ain't got AIDS," but then agreed to wear a condom. Valdez
has said that the victim's insistence that he use a condom indicated
that she consented to sex. Valdez said in an October jail interview,
"There was no rape to it. She's the one who gave me the condoms. If she
didn't want to, why would she give me the condoms?" The victim said that
after Valdez raped her, he removed the condom. She then pleaded with him
to put on another one before he subsequently sodomized her.


For AIDS Treatment, Vaccines, Now Think Genes *
Journal of the American Medical Association
(05/05/93) Vol. 269, No. 17, P. 2189
Goldsmith, Marsha F.

Even though there have been several advances in AIDS research, as a
whole, researchers still do not know enough about AIDS in order for a
successful vaccine to be developed, according to Dr. William Haseltine,
chief of the Division of Human Retrovirology, Dana-Farber Cancer
Institute in Boston, Mass. Haseltine spoke at the annual meeting of the
American Association for the Advancement of Science, which was held in
Boston. He said, "Do you want to know my guess for the chance that any
of these vaccines that we're trying now will work? Zero." He said that
much of AIDS research is "a mistake in the allocation of resources,"
because the chances of developing an effective vaccine are so small.
Haseltine said that multimodal therapy is becoming the most promising
treatment for AIDS/HIV patients. He also said, "I think gene therapy may
hold at least a theoretical possibility of a once-in-a-lifetime
intervention that can forever after control the subsequent disease." He
mentioned several areas that are worthy of researchers' attention. They
all involved the insertion of novel genes into human beings to create an
environment that is unfavorable to viral replication. One new approach
blocks viral attachment to CD4 receptors, thereby preventing infection.
The idea is to inject into the body genes that flood the system with
CD4-like molecules that will attract the virus but at the same time
defeat it. Another way to fight HIV involves the insertion of the tat
protein, which upregulates gene expression and replication through
interaction with another part of the viral genome.


Local Peri-Lesional Therapy With rhGM-CSF for Kaposi's Sarcoma *
Lancet (05/01/93) Vol. 341, No. 8853, P. 1154
Boente, Paulo et al.

Early chemotherapy to treat initial lesions of Kaposi's sarcoma (KS) in
AIDS patients can alter the manifestation's course, write Paulo Boente
et al. of the Oncology Clinic Hospital and Infectious Disease Clinic
Hospital in Bahia, Brazil. But toxicity, including drug-induced
immunosuppression, is limiting. Local radiotherapy is used for single
accessible lesions. An intralesional sclerosing agent in oral mucosal
lesions of KS has been recommended. The researchers describe clearing of
KS lesions after local injections of recombinant human granulocyte-
macrophage colony-stimulating factor (rhGM-CSF). This was used because
of its inflammation-promoting potential and the role of immunological
mechanisms in the control of KS. A 46-year-old homosexual man with AIDS
had KS lesions on his arms, thorax, and abdomen since 1991. Skin biopsy
showed histopathological features typical of KS. The lesions spread
progressively over the body and two large lesions appeared on the foot.
After three courses of vinblastine 6 mg/m(2) with vincristine 2 mg on
alternate weeks over six weeks, partial flattening of the thorax lesions
was observed, but the foot lesions did not change. During the 3 months
following chemotherapy, the lesions continued to grow and inhibited
walking. One ampoule containing 400 ug rhGM-CSF was injected at multiple
sites around the right sole lesion. Several days later, the lesion was
surrounded by erythema and signs of inflammation. After 10 days the
lesion disappeared and a fibrotic cicatricial reaction was noted. The
treatment had no side effects, and the lesions have not recurred six
months after the local treatment, the researchers conclude.


Clinton Proposes More Money for AIDS, Breast Cancer, TB *
American Medical News (05/03/93) Vol. 36, No. 17, P. 12

President Clinton hopes to nearly double federal funds allotted to
cities with high rates of AIDS cases. Clinton has proposed that overall
AIDS spending next year will be $2.7 billion. A total of $658 million of
that money would pay for the Ryan White Act, which provides emergency
relief to cities with large AIDS caseloads. This money is $310 million
more than was earmarked for AIDS in fiscal year 1993. Helen Fox of the
National Minority AIDS Task Force said, "It's a wonderful starting
point." Health and Human Services Secretary Donna Shalala dispelled
arguments that attention to other diseases has been ignored due to the
focus on AIDS and women's health. "There's no evidence of that," she
said. HHS also allotted an additional $10 million next year, for a total
of $46 million, to fight the resurgence of tuberculosis.


AIDS vs. Confidentiality *
Governing (05/07/93), P. 16
Sylvester, Kathleen

The revised federal definition of AIDS was welcomed by state and local
governments which believed that they would obtain more federal AIDS
funding provided on the basis of need. However, for state health
officials, collecting data about some of the AIDS cases has been a
complex situation. The new definition added pulmonary tuberculosis,
recurrent bacterial pneumonia, invasive cervical cancer, and a CD4 count
of fewer than 200 cells to be considered as an AIDS case. Since the test
for CD4 cells is conducted in a laboratory, various state health
departments want to use medical labs as a reporting source. AIDS
epidemiologists in Pennsylvania requested that labs begin reporting such
cases--including patients' names--directly to the state. But AIDS
activists said this violated the state's AIDS confidentiality law. They
told of potential discrimination and fear of exposure that might deter
people from getting tested early. Soon after, Pennsylvania officials
withdrew their request, and now are seeking other alternatives,
including a change in the confidentiality law. Nevertheless, Oregon
health officials expected such a problem and appear to have solved it by
using a system of "unique identifiers." Labs must report CD4 test
results to the state, but they should do so using a coded number system.
State health officials then contact the physicians who ordered the tests
for more information about the patients. The Oregon system has thus far
been effective and without complaints. Yet Dr. John Ward of the Centers
for Disease Control says other states are still developing their
reporting systems, and it may be several months before they have the
issue resolved.


May 13, 1993


AIDS Activists Picket Local Hotel *
Philadelphia Inquirer (05/13/93), P. B2
Bauers, Sandy

AIDS activists protested in front of the Sheraton Great Valley Hotel
yesterday in Chester County, Pa., in support of a former employee who
alleges he was fired after he tested positive for HIV and began
suffering from AIDS-related conditions. The former employee, Robert
Shover of Downingtown, and the activists said they intended the protest
to emphasize the widespread insensitivity in the suburbs toward AIDS
patients. The activists at the demonstration included members of ACT-UP
and representatives of the Chester County AIDS Support Services. One of
the activists said, "Every couple of weeks there's somebody from one of
the suburban counties telling about the nightmare situations they've
come across." He added that because of the dearth of activists in the
suburbs, residents of these communities "are not really open and
receptive to dealing with AIDS issues .... There is homophobia. This is
just one way that we can, at last, respond." Shover said he launched the
protest to draw attention to the AIDS problem in Chester County. He said
he started working for the hotel in October 1990. In 1991, he told his
boss he was infected with HIV, and in October he began experiencing
related symptoms. He developed a type of leukemia and in January 1992
his spleen had to be removed. The following July he was fired, he says,
two weeks before the Americans with Disabilities Act was enacted. But a
lawyer with the AIDS Law Project said the longstanding state Human
Relations Act provides the same protections. A lawyer for the Sheraton
said the hotel has filed a denial of Shover's allegations with the Human
Relations Commission.


Life Haunted by Prospect of AIDS, Widow Tells Court *
Toronto Globe and Mail (Canada) (05/12/93), P. A10
Downey, Donn

The wife of a Canadian man who died of AIDS without knowing about his
condition told a Toronto court yesterday that she fears developing AIDS-
related conditions, because she, too, has tested HIV-positive. "No
matter what people tell me, I know it's going to happen," said Rochelle
Pittman. She and her four children are suing Dr. Stanley Bain, her
husband's doctor, as well as the Canadian Red Cross Society and the
Toronto General Hospital. They are seeking compensation for negligence
in the death of Kenneth Pittman in March 1990, and allege that he
received an HIV-infected blood product when he underwent surgery at the
hospital in 1984. Rochelle Pittman said, "There's not a day you can
forget about having this virus." She said she is especially afraid of
going blind or developing dementia, adding that she plans to do her best
to pick a kinder way of dying. She told Madam Justice Susan Lang of the
Ontario Court's General Division that her HIV status has caused her to
feel contaminated. She said she also felt betrayed by Dr. Bain, who in
May 1989 had reason to believe Kenneth Pittman might have AIDS after he
learned from the Toronto Hospital that the blood donor for Pittman
subsequently tested HIV-positive. Rochelle Pittman said Dr. Bain did not
mention it to her husband, adding, "I could not imagine that he could
have known that and not informed us." She said after her husband died
and she found out he had AIDS, she was reluctant to get tested because
she was still grieving over his death, and was afraid of the potential
stigma she might face.


AIDS Shatters Teen's World *
USA Today (05/13/93), P. 3A
Moss, Desda

The sixth patient who contracted HIV from her dentist, Dr. David Acer,
was identified by the media on Friday as Sherry Annette Johnson. Dr.
Acer, currently the only health-care worker in the country known to have
infected patients with HIV, treated Johnson from 1987 to 1989. Sherry
Johnson, 18 years old, discovered her infection when she tested positive
for HIV at a military physical. Despite fears of isolation, she has
received the support of friends, co-workers, and the community, her
family says. When she returned to school on Monday she received cards
and flowers from friends, teachers, and acquaintances. Because the
Centers for Disease Control reported on Thursday that a sixth patient of
Acer's had contracted HIV from him, Johnson felt that she should
disclose her identity before the media discovered who she was. Five of
Johnson's six former sexual partners have tested HIV negative and the
sixth is being sought. In 1990, officials notified 2,500 of Acer's
patients to get tested for HIV. Because three of her family members
tested negative for HIV, Johnson believed she wasn't at risk. She said
she plans to be a staunch advocate of the passage of a bill for
mandatory HIV testing of health-care workers. The legislation was
designed by Kimberly Bergalis, a patient of Acer's who died of AIDS.
Johnson said, "I have a cause to fight for."


How Virus Was Transmitted Remains a Puzzle *
USA Today (05/13/93), P. 3A
Davis, Robert

Exactly how the only American health-care professional to transmit HIV
to six of his patients actually managed to infect the individuals is
still unknown. Approximately 19,000 other patients of two HIV-infected
surgeons and another dentist have all tested negative for the virus.
"Why it happened in this practice and not in so many others is still a
mystery," says Harold Jaffe, director of the HIV/AIDS division of the
Centers for Disease Control. Dr. David Acer of Stuart, Fla., died of
AIDS in 1990. Five of Acer's patients, who subsequently tested HIV-
positive, had undergone invasive procedures like root canals and tooth
extractions while under his care. But the most recent case, involving
Sherry Annette Johnson, did not involve any invasive procedures. Dr.
Acer cleaned Johnson's teeth and filled her cavities between 1987 and
1989. The other infected patients of Acer's include Kimberly Bergalis,
who died of AIDS in 1991; Richard Driskill, 33, of Indiantown, Fla., who
is very ill; Barbara Webb, 67, a former teacher who speaks on AIDS
awareness; Lisa Showmaker, 36, who lives in Bloomfield Township, Mich.;
and John Yecs, who has sued Acer's estate. Jaffe says that how HIV was
transmitted in these cases will remain undetermined until "somebody
comes forward who saw what he did or somebody the dentist told about
what he did." Although these cases are unfortunate, they have raised
consciousness on how health-care workers protect themselves and others
from blood-borne diseases. Measures like wearing gloves and eye shields,
and using more strict sterilization techniques to prevent the spread of
disease have become more common.


AIDS Researcher to Join Maryland Firm *
United Press International (05/12/93)

(Boston) Renowned AIDS researcher William Haseltine announced Wednesday
that he will resign from his job at the Dana Farber Cancer Institute in
Boston, Mass., to become the chief executive officer of a Maryland
biotechnology company. Haseltine, whose work involves pioneering
research into viral causes of cancer and HIV, will become chairman of
the board of directors of Human Genome Sciences Inc. in Rockville, Md.
Officials at Dana Farber said Haseltine is leaving his post as chief of
the Division of Human Retrovirology, and will take a two-year leave of
absence from the institute and Harvard University. Haseltine is also
editor-in-chief of the Journal of Acquired Immunodeficiency Syndrome and
a director of the American Foundation for AIDS Research (AmFAR).


Irish AIDS Adverts Spark Controversy Over Condoms *
Reuters (05/12/93)

(Dublin, Ireland) An Irish advertising effort promoting condom use as a
means to prevent HIV infection has incited controversy in the
predominantly Roman Catholic country between the state broadcasting
service and the government. Production of the government-ordered
advertising campaign was to begin on Wednesday, but staff members said
the work was canceled after senior executives at the RTE broadcasting
service had second thoughts about the advertisements' proposed content.
RTE said a decision on the future of the ads had not yet been made.
Health Minister Brendan Howlin was quoted as saying that the ad campaign
would proceed. According to press reports, RTE executives believe that
other ways of preventing HIV infection, such as abstinence and limiting
the number of sexual partners, should be stressed in addition to the use
of condoms. The campaign was to feature media personalities and student
leaders encouraging the sexually active to use condoms to prevent
infection with HIV. Posters and newspaper advertisements were expected
to be used as well. Under Irish law, condoms were once prohibited, but
legislative changes enacted last year now make them widely available in
shops, but not in vending machines.


Montagnier to Assess French AIDS Effort *
Nature (05/06/93) Vol. 363, No. 6424, P. 9

French co-discoverer of HIV, Luc Montagnier of the Pasteur Institute in
Paris, has been named to lead a panel examining France's anti-AIDS
efforts. A report on the country's efforts against the epidemic is due
in August. The magnitude of Montagnier's assignment--to analyze social
and public health issues as well as current research--has incited
speculation that the government may appoint him to a new position as
national AIDS coordinator. "The government considers that more needs to
be done," says Montagnier. While he hopes to keep an open mind,
Montagnier has denounced the government in the past for not getting
involved in more research outside the mainstream and for not giving
Africa more attention. He and Frederico Mayor, director general of
UNESCO, created the World Foundation for Research and Prevention of AIDS
in January of this year.


Lighting the Way: Tuberculosis Sufferers Are Getting Glowing
Help From the Firefly *
Time (05/17/93) Vol. 141, No. 20, P. 25

Conventional approaches to treat certain strains of tuberculosis may
take up to 18 weeks to elicit results. But researchers from the Albert
Einstein College of Medicine have developed an assay that apparently
cuts the time in half. The researchers report in the journal Science
that they inserted the same gene that makes fireflies glow into tissue
samples taken from TB patients. This gene directs production of a light-
emitting enzyme called luciferase. Within two hours, the cultures are
glowing. At that time, several drugs are introduced. If a specific
strain of TB is susceptible to the drug, the light dims and goes out. If
the TB is resistant, the culture keeps glowing.


Profits and Good PR? *
Business Week (05/17/93) No. 3319, P. 87
Roush, Chris

Providing AIDS disability insurance for health-care workers could prove
lucrative for insurance companies, in addition to boosting their public
relations. Insurers have, for some time, avoided offering explicit AIDS
coverage for health-care workers, though the disease is included in many
umbrella disability polices. Insurers considered the risks too large and
difficult to quantify. But now, at least two dozen companies have
recently released or are developing disability polices aimed at health-
care workers at risk of contracting HIV. The policies cover health-care
workers even if they don't contract the disease on the job. Because the
chance of getting infected is so small, this could be profitable for the
companies. The American Hospital Association's insurance unit says that
1,000 hospitals have expressed interest in such a policy. Also, the
Health Insurance Association is scheduled to recommend a basic AIDS
disability policy for its members to sell later this year. Among the 1.5
million Americans infected with HIV, only 36 are health-care workers who
were infected on the job. Also, out of 5.6 million health-care workers
in the nation, only 8,000 are HIV-positive. But such coverage is not
without risk. Some industry experts point to the $1.3 billion in
payments from life- and health-insurance coverage in 1991 as a result of
AIDS cases. The total benefits paid to AIDS patients since 1986 is $4.9
billion. One company, ITT Hartford Life Insurance Co., requires a six-
month wait before enrollees can receive benefits. "We did not want to
get a lot of small groups with known claims essentially buying a policy
to get benefits," said one executive.


May 14, 1993


Condom Defense Is Rejected in Austin Sex Assault Case *
Washington Post (05/14/93), P. A2
Pressley, Sue Anne

The so-called "condom rapist" was convicted by a jury in Austin, Texas,
yesterday for aggravated sexual assault after he claimed that a woman
had consented to have sex when she asked him to wear a condom in order
to protect herself from HIV infection. The case received national
attention last fall when a Travis County grand jury refused to convict
Joel Rene Valdez for the Sept. 16 incident. More than 100 protesters
marched outside the county courthouse, in objection to the ruling. The
victim, Elizabeth Xan Wilson, said that Valdez entered her bedroom
wielding a knife. "I knew there wasn't much I could do to prevent what
was going to happen. I thought maybe I could protect myself from dying
from AIDS," said Wilson. She said that Valdez refused to wear a condom
at first, claiming he did not have AIDS, but agreed reluctantly to wear
one after she said, "How do you know that I don't?" Valdez said in his
testimony Wednesday that Wilson agreed to have sex with him. He said she
"told me to do her a favor" and use a condom. Valdez's lawyer seemed to
minimize the condom issue in closing arguments yesterday. He claimed
that Valdez was drunk when he approached the woman and that he is
"borderline retarded" with a below-average IQ that led him to interpret
her condom request as consent. Although Valdez has no prior criminal
record, he could be sentenced to life in prison.

Related Story: New York Times (05/14) P. A12.


Quebec Ruling Denies Hemophiliacs Right
to Lawsuit Over Infected Blood *
Toronto Globe and Mail (Canada) (05/13/93), P. A6
Picard, Andre

The Quebec Court of Appeal has stopped an attempt by Canadian
hemophiliacs infected with HIV from the country's tainted-blood scandal
to launch a class-action suit against the provincial government and the
Canadian Red Cross Society. The court upheld a lower court ruling that
the action could not go to trial because it was filed too late. The
provisions of the Quebec Civil Code require that civil suits be filed
within three years of a plaintiff's realization that he or she has been
wronged. Michel Savonitto, the lawyer in the case, said that rare
circumstances may be grounds for appeal to the Supreme Court of Canada,
but the decision will not be made until the full written text of the
Quebec Court of Appeal judgment is issued next month. The tainted-blood
scandal in Canada caused more than 1,000 hemophiliacs and transfusion
patients to contract HIV before mandatory testing of blood was
implemented in late 1985. The House of Commons subcommittee on health
issues is expected to suggest that a full public inquiry into the
scandal be executed. In 1989, the federal government provided $120,000
to each person who contracted HIV in the scandal. A total of 1,062 HIV-
positive people have applied for the money, and 943 have received
payments, under the condition that the federal government be absolved of
legal responsibility. However, the provinces, which were responsible for
the blood system at the time of the scandal, never followed through with
compensating those who became infected.


Prospects Dim for Therapeutic AIDS Vaccine, Research Shows *
Reuters (05/13/93)
Riordan, Teresa

(Washington) The number of infected cells in HIV-positive individuals is
much higher than was once believed, researchers announced Thursday. This
new evidence makes a potential therapeutic vaccine seem somewhat out of
reach. Steven Wolinsky, an AIDS researcher from Northwestern University
Medical School, said, "The prospects for a therapeutic vaccine are now
less promising. But it shows we should redouble our efforts for a
preventive vaccine." In designing a way to detect the progression of HIV
infection, Wolinsky and a team of researchers from the medical school
found that HIV was present in up to about 10 percent of the cells of
HIV-positive people. Earlier testing indicated that the virus was in as
few as one in every 10,000 blood cells, a fraction of 1 percent. While
the number of cells is much higher than researchers previously thought,
the virus is latent in most of the cells. A therapeutic vaccine would
enable the body to recognize the virus in order to fight it. However,
when the infection is dormant, the body's immune system does not know
that HIV is present. Conventional methods used to detect the progression
of HIV infection either harm cellular structure or require complicated
microscopic analysis by trained researchers. The new process used by the
researchers employs a fluorescent genetic probe that attaches itself to
the genetic material inside blood cells walls through a molecular
process. A laser light can then be used to detect the cells to which the
fluorescent probes have attached themselves. Wolinsky's study will be
published in Friday's issue of the journal Science.


Scientists Unlock Secret of Key AIDS Molecule *
Reuters (05/13/93)

(London) A significant advance in AIDS research has been made by
scientists from Britain's Medical Research Council who outlined the
complete structure of the molecule used by HIV, according to a paper
published in the journal Science. The researchers said Thursday that
they had unlocked the remaining mystery of the CD4 antigen, a key
protein present on the surface of white blood cells. Three years ago,
American researchers mapped the first half of the molecule, a so-called
receptor to which HIV binds in order to enter and infect a cell. "It
will help our understanding of how the whole system is organized--it's
another piece in the jigsaw," said Dr. Neil Barclay of the MRC's
Cellular Immunology Unit. Because the complete structure is now
available, researchers will be able to develop models of the CD4
antigen, furthering their understanding of how the protein interacts
with HIV and also with other cells in the immune system.


Scientists Find New Treatment for AIDS Cancer *
Reuters (05/13/93)

(London) A new treatment for AIDS-related Kaposi's Sarcoma has benefited
three out of five patients, according to a report in the journal the
Lancet. Researchers from the Los Angeles Oncologic Institute said in the
report that they used microscopic capsules of fat to transport medicine
directly to infected cells. Kaposi's Sarcoma, a form of cancer, is one
of the most prominent opportunistic infections associated with AIDS. The
researchers added to the earlier findings that liposomes, or tiny fat
spheres, can lock onto lesions caused by the cancer. The scientists
injected the liposomes with the drug daunorubicin and injected them into
the patients. "Compared with conventional chemotherapy, use of liposomes
loaded with therapeutic agents is less toxic and more effective in
experimental tumors," said the article. Patients experienced vomiting
less frequently, and 15 of the 24 patients who could be analyzed
exhibited complete or partial remission of their tumors. The researchers
concluded, "Liposomal daunorubicin might be the treatment of choice in
many patients with HIV-associated Kaposi's Sarcoma."


Study Finds Hormone Can Reduce Blood Transfusions *
Reuters (05/13/93)

(London) By injecting a genetically engineered hormone into patients
undergoing surgery, the need for blood transfusions for such patients
can be reduced by half, according to a report by Canadian researchers in
the Lancet. The hormone, erythropoietin, was inserted into patients
about to undergo hip replacement surgery. About 23 percent of the
patients given erythropoietin for 14 days before surgery needed blood
transfusions, compared with 46 percent of the patients given a placebo.
More than 200 people participated in the study, and all were given iron
supplements. "Erythropoietin therapy was well tolerated and reduced the
need for blood transfusion in patients undergoing total hip joint
replacement," said the researchers. Erythropoietin has been proven to
boost hemoglobin in anemic patients with diseases such as AIDS and
cancer. The findings are significant because doctors are seeking
alternatives to blood transfusions in order to prevent the chance of
patients contracting HIV or hepatitis.


TB Cases Up 20 Percent Since 1985 *
United Press International (05/13/93)
Taylor, Charles S.

(Atlanta. GA) There has been a 20 percent increase in the number of
tuberculosis cases reported during the seven year period since 1985,
with most cases transpiring among immigrants and HIV-positive people,
said federal health officials Thursday. There was a total of 26,673
cases of TB reported last year in the 50 states and the District of
Columbia, marking an increase of 385 cases, or 1.5 percent, over the
26,288 cases reported in 1991. Dr. Alan Bloch, a medical epidemiologist
with the Centers for Disease Control, emphasized that the slight
increase in the number of TB cases in 1992 from 1991 was no reason to
become optimistic about the disease's future. "The message to take home
is that TB in the United States is still on the increase. TB is still
continuing to rise," he said. The largest increases in TB cases are
among Hispanic, black, and Asian immigrants and people with HIV
infection. The death rate from TB in some HIV-positive patients is as
high as 70 percent to 90 percent, said Bloch. The CDC and other health
agencies have reported that TB is becoming more and more resistant to
three primary drugs, and Bloch said a recent study demonstrated that
about 14 percent of TB cases are resistant to one or more drugs.
However, 86 percent of TB infections are still susceptible to currently
available drugs. "Treatment of most cases of TB in this country with
available drugs will still result in a cure," said Bloch.


Update: Investigations of Persons Treated by HIV-Infected
Health-Care Workers--United States *
Morbidity and Mortality Weekly Report
(05/07/93) Vol. 42, No. 17, P. 329

Among the 58 practices of HIV-infected health-care professionals
investigated, the only reported cases of health-care worker-to-patient
transmission was of the same dental practice in Florida, according to a
report by the Centers for Disease Control. The CDC conducted HIV tests
among 19,036 patients treated by 57 HIV-positive health-care workers in
the United States. No HIV-positive persons were reported among 11,529
patients tested from the practices of 46 infected health-care workers.
For the remaining 11 health care workers, 7507 patients were tested, and
92 HIV-positive patients were found. Follow-up investigations were
completed for 86 (94 percent) of the patients. Eight patients were
documented to be infected before being treated by an HIV-positive
health-care worker; 54 had established risk factors for HIV; 19 may have
had other opportunities for exposure to HIV; and five had no risks
identified. Investigations are in progress for six patients of two
health-care workers. But the only known reported cases of health-care
worker-to-patient HIV transmission involved six patients of a Florida
dentist. The sixth patient was only recently found when she was seeking
admittance into the military and tested HIV-positive. It was found that
she had no other confirmed exposures to HIV infection. Moreover, her DNA
sequence analysis showed her HIV strain had a high degree of similarity
to that of the dentist and the five other infected patients. However,
her case was different from the other five because she did not undergo
dental extractions or root canal therapy, which has a higher risk of
transmission.


Lethal Blood: A Formal Search Begins for AIDS Virus Carriers *
MacLean's (Canada) (05/03/93) Vol. 106, No. 18, P. 40
Jenish, D'Arcy

In an effort to be the first Canadian hospital to inform patients of the
risk of infection with HIV-tainted blood products, the Hospital for Sick
Children in Toronto sent a letter on April 15 notifying young people who
had heart surgery between 1978 and 1985 to get tested for HIV. Dr. Susan
King, assistant director of the hospital's HIV/AIDS comprehensive care
program, said that the hospital realized in the mid-1980s that some
patients may have been infected but it was not until late last year,
after receiving various calls from worried parents, that the hospital's
medical advisory board agreed to implement a formal notification
program. The risk of having contracted HIV through blood transfusions
has been projected by some experts as one in 1,400, while others
estimate it at one in 10,000. Members of Special Hearts, a support group
established in 1987 for parents of children born with major heart
defects, chastised the hospital for waiting so long to tell parents of
the possible problem. The Hospital for Sick Children says that initially
at least, there was no compelling reason to warn the parents. At that
time, a person infected with HIV would develop AIDS within two years and
die quickly, so doctors felt it would be of little benefit to notify
patients. King said that the hospital is still not directly notifying
all those who received transfusions. However, since the oldest of the
patients are now capable of transmitting HIV through sexual activity,
she said, it has decided to contact physicians of the 1,700 children who
received transfusions while undergoing open heart surgery and ask them
to alert the children's parents.


Association of Tuberculosis Infection With Increased Time
in or Admission to the New York City Jail System *
Journal of the American Medical Association
(05/05/93) Vol. 269, No. 17, P. 2228
Bellin, Eran Y. et al.

The New York City jail system needs more public attention regarding the
tuberculosis epidemic because it was found that the longer an inmate is
incarcerated, the greater his or her chances of contracting TB are,
write Eran Y. Bellin et al. of the Montefiore Medical Center in Bronx,
N.Y. The researchers used a cohort of 2,636 tuberculin skin test-
negative inmates incarcerated in 1985 matched against the Tuberculosis
Registry of New York City. The researchers determined time spent in jail
by reviewing the computer records of the New York City inmate
Information System. Conditional logistic regression modeling was
performed to establish the association of jail time with the development
of TB. A total of 60 inmates developed TB by May 15, 1992. Eighty-five
percent of these had pulmonary TB. While inmates with TB spent a mean of
8.1 months in jail and 40.8 months in the community, only nine of the 60
cases were diagnosed during an incarceration. If a multidrug-resistant
TB isolate enters the jail, it could be efficiently transmitted
throughout the city. Univariate analysis detected the number of jail
admissions, age greater than or equal to 30 years, and assignment to a
methadone detoxification unit as significant in predicting TB.
Multivariate modeling detected these same variables and jail time as
significant. It was found that one year of jail time increased the odds
of TB to 2.2. By observing sputum-positive inmates to ensure compliance
with treatments and educate them to seek ongoing care in the community
upon release from jail, the jail system may be eliminated as an
amplification site for the city's TB epidemic.


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.

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