-----===[[[ A I D S w i r e D I G E S T 06.07.93 ]]]===----- Global AIDS Community Gathers for Conclave * Los Angeles Times--Washington Edition (06/07/93), P. A2 Stolberg, Sheryl The Ninth International Conference on AIDS will open today in Berlin, Germany, and is expected to draw a record 12,000 attendees. It is considered by some to be a chaotic circus, but by others, an essential opportunity to learn the latest findings in AIDS research. What makes the meeting so disordered is that everyone from scientists to AIDS activists to patients with the disease attend and express their views. By purely scientific standards, few breakthroughs are reported at the annual conferences. Also, the majority of the researchers who participate would rather publish their discoveries in science journals than wait to announce them in the chaotic atmosphere of the conference. Anthony Fauci, the leading AIDS expert of at the U.S. National Institutes of Health said, "The real science is not going to be any big surprises." However, the Ninth International Conference on AIDS is about much more than science. It is a place for doctors, patients, laboratory scientists and social counselors to receive updates on important, if minor, developments in research. Moreover, the conference is a way for those involved in the fight against AIDS to estimate how far they have come and how far they must go in their efforts. The conference this week is expected to concentrate on recent controversies over when to administer drugs to AIDS patients, as well as on the attempts of researchers to determine why some people can live for years after being infected with HIV. Related Story: New York Times (06/06) P. 20. A Shot in the Arm for Vaccine Problems * Washington Post (06/07/93), P. A3 Thompson, Larry Some vaccines actually cause the disease they are meant to prevent, but a new type of approach may solve this problem. The new method may have maximum safety as well as a response strong enough to inhibit the spread of HIV infection. The vaccine uses what is called "naked DNA," which is not surrounded by the virus' outer protein envelope, and is fundamentally different from previous approaches. Rather than using dead or weakened viruses, the new vaccines contain only a harmless piece of a virus' genetic material to achieve a similarly strong response. Unlike a whole-celled organism, a virus is basically a ball of DNA or RNA covered by a protein coat. "Naked DNA" vaccine produces an immune reaction as strong as the live vaccines, but apparently without the risk. Researchers at the University of Pennsylvania recently used a "naked DNA" vaccine to elicit the kinds of immunity in mice that should block HIV infection in humans. Since mice cannot contract HIV, the scientists could not directly test whether the vaccine would protect them against the disease. The team of researchers, along with Apolon, a biotech company in Malvern, Pa., have started to test the vaccine's ability to inhibit infection in primates by simian immunodeficiency virus (SIV), the monkey version of HIV. David Wiemer of the Wistar Institute of the University of Pennsylvania said that so far, the DNA vaccines appear to be safe. WHO Official to Seek $2.5 Billion a Year From Developed World for AIDS Fund * Wall Street Journal (06/07/93), P. B7 Chase, Marilyn A leading official from the World Health Organization will propose at the opening session of the Ninth International Conference on AIDS in Berlin today that industrialized countries invest a total of $2.5 billion a year in AIDS prevention in the developing world. Michael Merson, director of the World Health Organization's AIDS program, argues that the move would spare millions of lives and save about $90 billion in costs by the year 2000. He said that in the last year, about 500,000 people have contracted HIV and later developed AIDS, bringing the global epidemic's official toll to 2.5 million. According to Dr. Merson, those AIDS cases will triple, and the number of infected people--now estimated at 14 million--will increase to 40 million. He added that if the money was provided it could reduce the new HIV infection rate by half, and prevent immeasurable suffering during this decade. Sixth AIDS Case Leads Investigators to Murder Theory * United Press International (06/06/93) (Miami) The recently disclosed case of a sixth patient who contracted HIV from the Florida dentist with AIDS is raising questions that Dr. David Acer could have intentionally infected his patients before he died in 1990, according to a report in the Miami Herald on Sunday. Sherry Johnson revealed on May 6 that she was the sixth patient infected by Acer. There are no records of her visits but she said the only work that was performed by Acer in the 15 visits were for fillings. In the other five cases of infected patients, invasive procedures that have a higher risk of HIV transmission were performed. The procedures used on Johnson were not nearly as intrusive as the other cases, said Harold Jaffe, director of AIDS research at the Centers for Disease Control. But Tom Liberti, administrator of the AIDS program of the Florida Department of Health and Rehabilitative Services, said, "The only evidence we have to support the theory of criminal intent is the lack of evidence supporting any of the other theories. We will probably never know the answer." Other doctors have their own theories about how the HIV transmission took place. Doug Feldman, a medical anthropologist and associate professor at the University of Miami's School of Medicine, said, "I think he took a needle and syringe, drew his own blood into it and deliberately injected it directly into his patients' mouths with the anesthetic." Last year, Edward Parsons, a friend of 2Acer's, said there could be a motive for murder because Acer was upset that America was ignoring the AIDS epidemic. But investigators note that none of Acer's staff remembers any suspicious activity that would support the criminal intent theory. Experts Say AIDS Spreading Into Adolescent Population * United Press International (06/05/93) Mangasarian, Leon (Berlin) AIDS is spreading into adolescent groups worldwide and young people need to learn about he disease before they become sexually active if the pandemic is to be thwarted, according to medical experts who spoke at a one-day seminar organized by the American Medical Association to launch the Ninth International Conference on AIDS. Dr. Karen Hein, professor of Pediatrics at Albert Einstein College of Medicine and director of the Adolescent AIDS Program at New York's Montefiore Medical Center, said that while teens only comprise 1 percent of all U.S. AIDS cases, they have the highest rates for other sexually transmitted diseases. Dr. Michael Merson, director of the World Health Organization's Global Program on AIDS, said, "The way to prevent the spread of AIDS is to target education of young people to prevent the infections." He and other experts emphasized that AIDS education must be given to young people before they first engage in sexual activity. Mariella Baldo, a senior AIDS researcher at WHO, said programs that only stress sexual abstinence are not effective and programs for AIDS education should employ more peer leaders to get safe-sex messages across to youths. Women With AIDS on Birth Control, Pregnant More Likely to Infect Partner * United Press International (06/05/93) Mangasarian, Leon (Berlin) An HIV-positive woman may be more inclined to infect a sexual partner if she is pregnant, takes birth control pills, or has cervical ectopy, according to researchers from the University of Seattle who disclosed their findings in advance of this year's International AIDS conference. A study involving 97 HIV-positive women in Narobi, Kenya, revealed the increased risk factors. Woman on oral contraceptives were found to be about 12 times more likely than others to "shed" HIV from genital tract secretions, said David Clemetson, the lead author of the article that will be published in this week's Journal of the American Medical Association. Pregnant women were 4.5 times more likely and those with cervical ectopy were five times more likely to transmit HIV. Cervical ectopy is a condition in which the thin cervix layer is more exposed and susceptible to infection than normal. "The presence of these factors could be association not only with increased HIV transmission to sexual partners, but also with transmission to [babies] at the time of delivery," said Clemetson. Univax Files PLA to Market WinRho SD For Severe Blood Disorder * Business Wire (06/03/93) (Rockville, MD) Univax Biologics on Thursday said that it has submitted a Product License Application with the Food and Drug Administration for approval to market WinRho SD in the United States for treatment of a severe blood disorder that affects about 11 percent of HIV-positive individuals. The primary indications in the WinRho SD application include the treatment of idiopathic thrombocytopenic purpura (ITP) and ITP secondary to HIV infection. ITP is a condition of the blood characterized by abnormally low platelet levels and risks of excessive bleeding and bruising. About 137,000 people suffer from ITP each year in the United States, 120,000 of which have infections that are secondary to HIV. In phase III clinical trials, WinRho SD increased platelet counts in all subgroups to levels above the treatment threshold. WinRho SD is a hyperimmune intravenous human polyclonal antibody preparation produced by stimulating plasma donors with Rh-positive red blood cells, a process similar to that used to prepare antibody products for protection against hepatitis B. Dr. W. Scott Harkonen, Univax's vice president of medical and regulatory affairs, said, "Because WinRho SD is produced from plasma donors with Rh-positive red blood cells, it contains very high levels of specific antibodies which permits smaller required dosage levels and a shorter infusion time than comparable antibody therapies; five minutes versus several hours." AIDS Fear Spawns Mask Venture But So Far, Sales Are Sparse * Warfield's Business Record (05/28/93-06/04/93) Vol. 8, No. 22, Hinebaugh, Cathy Anne Arundel County, Md., last year passed a law requiring restaurants, bars, and theaters, as well as public meeting places and county-owned buildings, to display resuscitation masks and gloves to encourage people to perform cardiopulmonary resuscitation during an emergency. The Anne Arundel law was passed in response to increasing concerns among emergency medical personnel and the general public that they could contract diseases like HIV and hepatitis B while performing CPR. County Council Chairman David Boschert, who proposed the measure, claims the masks will let people administer CPR without being worried about the potential for infection. Under the law--modeled after similar legislation in New York City-- businesses and facilities used as public meeting places must buy two masks, one adult-and one child-size. They must be posted like a fire extinguisher, making them easily accessible. Prompted by the law, a Baltimore company has developed a mask and glove kit to protect people who administer CPR. Mask-Line opened its doors last January and was recently incorporated. Founder Joe Wassil hopes to get approval by August of his patent for a metal box containing protective masks, gloves, and an alarm. Mask-Line's CPR mask stations cost $160 each and include CPR instructions. But Wassil says sales are poor, partly because county officials are implementing the law too slowly. Comparison of Atovaquone (566C80) With Trimethoprim- Sulfamethoxazole to Treat Pneumocystis Carinii Pneumonia in Patients With AIDS * New England Journal of Medicine (05/27/93) Vol. 328, No. 21, P. 1521 Hughes, Walter et al. Atovaquone, a hydroxynaphthoquinone compound proven to work against Pneumocystis carinii pneumonia (PCP), offers a useful alternative to trimethoprim-sulfamethoxazole for AIDS patients who cannot tolerate that treatment or who fail to respond to it, write Walter Hughes et al. of the St. Jude Children's Research Hospital in Memphis, Tenn. The researchers conducted a double-blind, multicenter study of patients with AIDS and mild or moderately severe PCP. The subjects were randomly assigned to 21 days of orally administered treatment three times daily with either atovaquone (750 mg) or trimethoprim (320 mg) plus sulfamethoxazole (1600 mg). Of the 322 patients with histologically confirmed PCP, 160 received atovaquone and 162 received trimethoprim-sulfamethoxazole. Of those who could be examined for therapeutic efficacy, 28 of 138 patients given atovaquone (20 percent) and 10 of 146 patients given trimethoprim-sulfamethoxazole (7 percent) did not respond. Treatment limiting adverse effects required a change of therapy in 11 patients in the atovaquone group (7 percent) and 33 patients in the trimethoprim-sulfamethoxazole group (20 percent). Therapy involving only the initial drug was effective and free of side effects in 62 percent of those given atovaquone and 64 percent of those given trimethoprim- sulfamethoxazole. Within four weeks of the completion of treatment, there were 11 deaths in the atovaquone group, 4 of which were due to PCP, and 1 death in the trimethoprim- sulfamethoxazole group. PCP can be treated by atovaquone, which is less effective than trimethoprim-sulfamethoxazole but has fewer adverse effects. AIDS Advocates Focus on Whether CDC Dollars Make Sense * Nation's Health (05/93-06/93) Vol. 23, No. 5, P. 1 Experts who object to the way the Centers for Disease Control allocates HIV prevention funds are joining forces to ensure that funding is given to community-based groups. These groups, which most directly address high-risk populations, are stretched to the limit by the expanding epidemic but are frequently the last to receive prevention funding. An outside advisory committee to the CDC on HIV prevention has launched an extensive review of how the CDC spends prevention funds, with a final report expected by late summer. Meanwhile, Rep. Nancy Pelosi (D-Calif.) in March introduced the Comprehensive HIV Prevention Act of 1993, which addresses the lack of prevention funds for community-based organizations. Pelosi said that given that the nation faces at least 40,000 new cases of HIV infection this year, federal, state, and local prevention efforts need to be renewed. The bill would designate the Assistant Secretary for Health as the leader in setting priorities for the Public Health Service's HIV prevention program. It would also establish the Secretary's Advisory Council on HIV prevention to make budget and prevention plan recommendations. The measure would restructure the CDC's efforts, adding a new Office of HIV Prevention that would authorize a federal program and grants for collecting data on where new HIV infections are most likely to occur. If the bill is passed, it would appropriate $175 million for such activities, and encourage the CDC to enhance local, state, and regional studies on the emerging trends in HIV infection. Another $175 million would be used to establish a national counseling and testing program. June 8, 1993 $2.5 Billion a Year Urged to Curb AIDS Cases * Washington Post (06/08/93), P. A17 Brown, David New HIV infections expected worldwide by the year 2000 could be halved if the global AIDS community would invest $2.5 billion a year in the disease, according to a prediction by a World Health Organization official revealed yesterday at the Ninth International Conference on AIDS in Berlin. The conference opened yesterday with nearly 16,000 researchers, health-care workers, activists, and journalists. Dr. Michael Merson, director of the WHO's global program on AIDS, said that the $2.5 billion "is an investment on which the returns would be huge." WHO projects that about 13 million adults and 1 million infants have contracted HIV since the disease was first detected in the early 1980s. Without the additional funding, about 20 million more cases will emerge in developing countries by the end of the decade. Merson said that with more aggressive promotion of condom use, treatment of venereal diseases, and other interventions, new adult infections could be cut to 10 million. However, an official from the World Bank said that AIDS may not be the most severe threat to life worldwide. "I would submit that the mortality from AIDS argues against [its having] any degree of priority relative to smoking, TB, and control of diarrheal diseases," said Dean T. Jamison. He added, however, that the World Bank has examined WHO's estimates and agrees that increased spending on AIDS now would be useful, in part because of "rapidly declining cost effectiveness" of health interventions once infection occurs. Related Stories: New York Times (06/08) P. C6; Philadelphia Inquirer (06/08) P. A3; Baltimore Sun (06/08) P. 6A. AIDS Meeting Opens With Call for Compassion * Journal of Commerce (06/08/93), P. 6A The Ninth International Conference on AIDS in Berlin began yesterday with calls for worldwide compassion toward AIDS patients. German President Richard von Weizsaecker opened the conference by emphasizing a need for more compassion and less moralizing toward AIDS patients around the world. "Society must not split into healthy and sick people and brand those infected and sick as dangerous or contaminated. We should protect ourselves from infection and not from infected fellow human beings," said Weizsaecker. He added, "Prevention is only possible in a climate free of false moralizing." Michael Merson, director of the World Health Organization's AIDS program, said in an opening address, "Overall, I would have to say that the global response to the pandemic is still inadequate and unrealistic." Jonathan Mann, the former head of the WHO program who now serves as the head of the Harvard AIDS Institute in Cambridge, Mass., remarked, "Rich nations are turning away from coordinated and multilateral efforts; major international organizations are having difficulty agreeing on their respective roles and responsibilities." Meanwhile, members of ACT-UP blockaded the entrance of the conference Monday and scattered cobblestones across the lobby to protest a travel ban on AIDS patients imposed by some countries, including the United States. AIDS Researcher Outlines New Concept of Selectively Boosting Immune System * Wall Street Journal (06/08/93), P. B6 Chase, Marilyn AIDS researchers should focus on new drugs that would selectively strengthen the beneficial cells in the immune system, while thwarting those that deplete the immune system, according to U.S. AIDS researcher Anthony S. Fauci. It is known that HIV causes the demise of the immune system. However, HIV may also incite hyperactive or so-called autoimmune reactions, in which the body's defense system attacks itself. Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, said yesterday at the Ninth International Conference on AIDS, "Immune responses are part of a vigorous defense against AIDS, but they can also enhance AIDS." He urged scientists to research new immune system-modulators that exploit recent discoveries about the mysterious phases of AIDS's destruction of the body, including findings on how HIV replicates in the lymph nodes. In order to strengthen the good defenses of the immune system, Fauci said he is testing the immune boosting protein IL-2, currently sold by Cetus Corp. for kidney cancer. IL-2 was found to boost levels of T-cells when taken in combination with an antiviral drug in an eight-patient pilot study, said Fauci. In addition, Fauci said he is eager to seek drugs that block certain natural proteins believed to have a role in accelerating virus production, as a way to halt the potentially self-destructive powers of the immune system. Poll Finds Knowledge About AIDS Increasing * New York Times (06/08/93), P. C5 Kagay, Michael R. An increasing number of adult Americans know more about AIDS, know someone with HIV infection or AIDS, and have acted to prevent contracting the disease themselves, according to the latest New York Times/CBS News Poll. Among the 1,347 adults interviewed, 49 percent said they had taken steps to protect themselves from HIV infection, including limiting their number of sexual partners, having safer sex, and abstaining from sex. Single people younger than 45 were most likely to alter their behavior (72 percent), followed by blacks (70 percent), and people living in large urban areas (60 percent). It was found that one-third of American adults, or 34 percent, know at least one person who has died of AIDS, who currently has AIDS, or who has tested HIV-positive. Moreover, self-professed knowledge about the disease has increased. In 1985, only 11 percent said they knew "a lot" about AIDS. But by 1989, that figure increased to 31 percent, and rose to 40 percent by 1991 and 45 percent in the latest survey. However, the poll did show that some people remain confused about the risk of HIV infection while donating blood. Although 67 percent said someone could not contract HIV "when they donate their own blood to a blood bank," 28 percent said someone could contract the virus from doing so. Diane Colasanto, president of Princeton Survey Research Associates, said the misperception could be associated with needles. The large increase in public concerns about AIDS that occurred in 1989 after media coverage about reducing the spread of HIV infection by reducing the use of shared needles may have led individuals to perceive all needles as dangerous, she said. How Safe Is a Dentist's Office? * Washington Post (Health) (06/08/93), P. 5 Many Americans are concerned about the potential of HIV transmission in a dentist's office, according to a recent survey sponsored by the American Dental Hygienists' Association. The telephone interview involved 1,013 adults and found that 83 percent are very or somewhat concerned about infection control. However, only 10 percent said they took the initiative to ask office staff about protective measures. Fewer than half--45 percent--of the respondents said they worried specifically about being exposed to HIV while receiving dental care. About 84 percent did express confidence that dental specialists took their patients' concerns about protection from infection seriously, even though only 18 percent said they were given a description of what the office does to ensure safety. The survey also found that 86 percent of the respondents want their dentists or hygienists to tell them more about office procedures to prevent transmission of infection. Nearly 76 percent of survey participants would pay more for increased protection measures, and 43 percent acknowledged that dental providers have a higher risk of contracting HIV than their patients. The Dilemma of AIDS Treatment * Washington Post (Health) (06/08/93), P. 7 Melillo, Wendy Because there are still several unknowns about the effectiveness of AZT and other antiviral drugs in regard to prolonging the lives of AIDS patients, many people with the disease are seeking other options. A recent European study disproved the theory that using AZT early in the course of disease would prolong life. Although the AIDS epidemic has been around for 12 years, the efficacy of antivirals like AZT, DDI, and DDC are still limited, and each therapy can cause serious side effects. The toxicity of the drugs has caused many AIDS patients to seek alternative therapies, such as vitamins, herbs, and acupunture, to combat the disease. Some AIDS patients have ignored treatment altogether. One woman with the disease said she is confused by all of the conflicting messages about which drugs are effective. She said, "Right now, I am choosing quality of life by not dealing with all the hassles of taking medications, the nauseousness, the diarrhea, the vomiting. But am I shortening my life? I guess I will never know." Due to the desire for alternative medicines, buyers' clubs have become popular places to obtain drugs not yet approved by the Food and Drug Administration. Yet the alternative treatments are not without flaws. Some make claims that are untrue because they have not been scientifically tested. Ron Mealy, the executive director of the Carl Vogel Center, a buyers' club in Washington, D.C., said, "People with HIV have become superb medical consumers, and the people who come here want to know if there has been any data published on a specific therapy. These people are less likely to be taken in by scams." Antisense Compound Shows Promise as AIDS Treatment * Business Wire (06/04/93) Results from a study on a promising new in-vitro compound to combat AIDS will be presented at the Ninth International Conference in Berlin, Germany, this week. GEM 91 is an antisense oligonucleotide designed to suppress viral replication of HIV. By concentrating on a gene sequence believed to be highly invariant in most known HIV-1 strains in infected cells isolated from AIDS patients, GEM 91 has proven its efficacy in inhibiting the spread of the virus. Draft AIDS Care Guidelines for Doctors Released by AMA * United Press International (06/05/93) Mangasarian, Leon (Berlin) The American Medical Association on Saturday issued draft guidelines for physicians on diagnosing and treating HIV infection. The draft rules were released at this year's Ninth International Conference on AIDS in Berlin. "There is the perception that advances in HIV care are occurring too rapidly for the average physician to keep current, but the rapid changes are happening more in treatment of opportunistic infections that occur in a patient in the end stages of AIDS," said Dr. Paul Volberding of the University of California--San Francisco, chairman of the AMA Advisory Group on HIV Early Care Guidelines. The final guidelines, which he said would be issued soon after the conference on AIDS begins Monday, explain which tests should be done while caring for an HIV-positive individual, which questions need to be asked about the patient's medical history, and which conditions could signal infection. Volberding said, "Many doctors are still not comfortable getting the necessary sexual and drug-use history of patients." The guidelines also include advice on how to deal with HIV in women. "These guidelines will give physicians the knowledge and reassurance they need to treat all facets of HIV care in its early stages," said Volberding. More Women-Controlled AIDS Prevention Methods Needed--WHO * Reuters (06/05/93) Johnson, Cynthia (Berlin) Pharmaceutical companies should conduct more research into agents that women can use to protect themselves from HIV, World Health Organization officials said Saturday at a briefing hosted by the American Medical Association before Monday's start of the Ninth International Conference on AIDS. Dr. Michael Merson, director of the WHO's Global Program on AIDS, said, "If you asked me to pick the two or three top research areas in this epidemic, high on the list would be the development of an inexpensive microbicide or virucide that women could use in the vagina to protect themselves from HIV infection and other sexually transmitted diseases." Dr. Joep Lange, head of clinical research and drug development at the WHO's AIDS program, said, "What we really need is to get the big, research-based pharmaceutical companies--like Bristol- Myers and Roche--interested in this area. What you really want is the brains developing anti-retrovirus systems to work on virucides." The recommendations stem from the increasing rate of HIV infection among women, who now account for five of every 11 new infections among adults. According to the WHO, by the year 2000 the rate of infection will be the same for men and women. In addition, as more women become infected, so do infants. About one out of three children born to HIV-positive mothers will also contract HIV. Even though condoms are recommended as the primary means of HIV prevention, several women have trouble convincing their partners to use them. Microbicides and virucides would enable women to protect themselves without their partner's knowledge. Sexual Behavior and Condom Use--District of Columbia, January-February, 1992 * Morbidity and Mortality Weekly Report (05/28/93) Vol. 42, No. 20, P. 390 Although the number of persons with multiple sex partners in Washington, D.C., who reported always using condoms was higher than in a national sample, condom use was still not widespread. The Washington, D.C., Commission of Public Health (CPH) conducted a telephone survey of DC residents aged 18-45 between January and February 1992. The questions asked addressed HIV- related knowledge, number of sex partners, and condom use during the year preceding the survey. It was found that 25 percent of respondents reported having had two or more sex partners during the previous 12 months. Those who were not in a steady relationship accounted for 55 percent of the respondent population and those who self-rated their HIV risk as "high" or "medium" comprised 55 percent and were more inclined to report multiple partners. Men were found to be more likely than women (35 percent versus 15 percent) and blacks were more likely than whites (28 percent versus 20 percent) to report having had two or more partners. About 40 percent of respondents reported always using condoms, and 34 percent reported never using condoms. Of those sexually active persons not in a steady relationship, 65 percent reported always using condoms, and 11 percent reported never using condoms. Among those who reported having had two or more sex partners, 59 percent reported always using condoms, and 9 percent reported never using condoms. Also, 70 percent of men who had two or more sex partners reported always using condoms, compared with 37 percent of women. These findings can be used to determine target groups for public health education messages promoting condom use. What Causes the Immune System Collapse Seen in AIDS? * Science (05/28/93) Vol. 260, No. 5112, P. 1256 Cohen, Jon Although it is still unknown how HIV leads to the depletion of CD4 cells, there are three prominent theories among AIDS researchers. Some researchers believe that HIV itself may kill the cells, while others believe that HIV may call in other elements of the immune system to kill the cells. Alternately, the virus may somehow incite the cells of the immune system to destroy themselves. The simplest theory is direct killing by HIV. The virus is believed to induce "lysis" (causing infected cells to implode or burst) or it might cause cells to fuse together into clumps called syncytia. The biggest flaw with this theory is that little HIV can be detected in the blood during the time when damage is occurring in CD4 populations. Other researchers believe that HIV infection may somehow cause another set of immune cells known as killer cells to eliminate uninfected CD4 cells. It is also possible that even more exotic destructive immunologic processes are unleashed because parts of HIV mimic parts of immune cell molecules. If a prominent theory called apoptosis, the programmed death in cells, is true, HIV can cause CD4 cells to self-destruct. Terri Finkel of the National Jewish Center for Immunology in Denver is researching apoptosis. A molecule that may be involved is the gp120. It is already known that in the blood HIV sheds gp120, which can bind to CD4 receptors. Finkel has demonstrated that the apoptosis switch might be given when two gp120-CD4 complexes are "crosslinked' by an antibody that binds the two gp120s. The crosslinking, Finkel believes, sends a chemical message to the CD4 cell, preparing it to commit suicide the next time it meets a foreign pathogen. June 9, 1993 H.I.V. Immunity Discussed at Berlin Conference * New York Times (06/09/93), P. A7 Altman, Lawrence K. Some prostitutes in Nairobi, Kenya, have evaded HIV infection despite exposure to the virus through frequent unprotected sex with HIV-positive men, according to a report released yesterday at the Ninth International Conference on AIDS in Berlin. These cases of HIV-free women are of profound scientific interest to researchers, who think that clues to how they avoided HIV infection could lead to the development of vaccines and other therapies. The study found 29 prostitutes who avoided infection for two to eight years even though more than 10 percent of their clients were probably infected with HIV. Dr. Frank Plummer, a Canadian scientist who headed the research team from the University of Manitoba and the University of Nairobi, said the infection resistance displayed by the prostitutes had an immunologic or genetic base and that no unusual sexual practice or other factor could be identified to explain it. The finding has raised questions that cell-mediated immunity may play a far more important role in protecting against HIV than previously believed. Popular U.S. Treatment for HIV Is Challenged by European Study * Washington Post (06/09/93), P. A4 Brown, David The anti-AIDS drug AZT helps asymptomatic HIV-positive patients for only about a year, and neither slows the development of full-blown AIDS nor extends life, according to details of a European trial on AZT presented yesterday at the Ninth International Conference on AIDS in Berlin. The conclusions came from a French and English study called the "Concorde" that involved more than 1,700 asymptomatic HIV-infected patients. The preliminary results from the study were first indicated in a letter to the British journal Lancet in April. The Concorde trial is the largest and longest study of AZT, and lasted about three years. A lead researcher in the study said that the measurement of CD4 cells as an indicator of clinical benefit in treatment trials--a common practice in the accelerated testing of AIDS drugs in the United States--may be very misleading. Investigator Maxime Seligmann of the Hopital Saint Louis in Paris said the study addresses only the use of AZT in symptom- free patients, and it does not question the drug's effectiveness in patients with AIDS-related symptoms. But the findings are expected to prompt a reassessment of a common practice among American doctors, in which AZT is prescribed after a person's CD4 count falls below 500 cells per microliter of blood, regardless of symptoms. Related Stories: Financial Times (06/09) P. 1; Philadelphia Inquirer (06/09) P. A1. Teens Misunderstand AIDS Protection * Baltimore Sun (06/09/93), P. 3A Roughly half of sexually active high school students claim that they use condoms for birth control, but many neglected to use them to protect against HIV infection when other means of birth control were available, according to a survey conducted by the Centers for Disease Control and presented yesterday at the Ninth International Conference on AIDS in Berlin. The survey involved 12,272 students at 137 high schools in the United States and found a high rate of sexual activity among teenagers. About 54 percent said they had sexual intercourse, but by the time the students were seniors in high school that number rose to two-thirds, said Janet Collins of the CDC. A total of 48 percent said they used a condom the last time they had sex, but the figure dropped to 19 percent for couples using birth control pills to prevent pregnancy. This indicates that students understand the significance of using birth control but don't understand the purpose of using condoms for preventing HIV infection, the survey found. Collins said yesterday at the AIDS conference, "The disease prevention issue is not high enough on the agenda to use the condom in addition to the birth control pill." But she said the findings were promising because "it shows we can get young people to use condoms." Progress Is Shown in Race for HIV Drug * Wall Street Journal (06/09/93), P. B8 AIDS research reports released at the Ninth International Conference on AIDS this week have sparked some of the highest hopes in a field that has become increasingly dismal in recent years. The research involves drugs that inhibit the action of an enzyme called protease that is critical to HIV replication. About 12 companies are currently conducting research on finding a protease inhibitor, including Roche Holding Ltd., Merck & Co., DuPont Merck Pharmaceutical Co, Abbot Laboratories, and Monsanto Co.'s Searle unit, as well as small companies like Vertex Pharmaceuticals and Vical Pharmaceuticals Inc. The protease enzyme serves as a kind of chemical scissors that performs a key step in HIV's manufacture of new infectious particles. At the conference, Vertex Pharmaceuticals of Cambridge, Mass., presented research on an entire class of compounds that appear compact enough to reach infected cells in amounts large enough to block viral reproduction. Scientist Roger Tung said his company's drug worked against HIV in cultured cells, but also against fresh virus samples taken from patients. Although Vertex is believed to have the smallest and simplest molecule, it is Roche which has the longest track record in human clinical trials thus far. DuPont Merck also revealed a small-size protease drug candidate that has so far been "well tolerated" by humans, and has spurred little if any drug resistance by mutant viruses. Researchers said they are awaiting early validation of the protease inhibitors tomorrow when English, Italian, and French scientists report their clinical tests of the Roche drug. Genentech, Chiron Report Advances in Research Toward an AIDS Vaccine * Wall Street Journal (06/09/93), P. B8 Chase, Marilyn AIDS vaccine researchers presented their findings yesterday at the International AIDS Conference in Berlin. Two biotechnology companies showed that immunizing healthy volunteers against one strain of HIV created antibodies in the blood that also react against different strains. The companies, Genentech Inc. of San Francisco, Calif., and Chiron Corp. of Emeryville, Calif., used gene-spliced copies of the virus in their vaccines. Genentech's vaccine against an HIV strain called MN, tested in 57 volunteers, sparked antibodies that neutralized the virus introduced into blood samples extracted from people who had been injected with the vaccine. The antibodies neutralized not only MN but also a second strain called SF2. In addition, the vaccine had no side effects, said Robert Belshe, a researcher at St. Louis University. Chiron's vaccine, which was made from a piece of the SF2 virus strain, also produced antibodies that neutralized not only SF2, but a French strain known as LAI, said James Kahn, a researcher at the University of California and San Francisco General Hospital. Dr. Kahn said the antibodies from volunteers might be subsequently infused into infected people, as an experiment in "passive immunization"--a sort of immune-booster for people who are already infected. EEOC Rules Target Bias in Insuring the Disabled * Wall Street Journal (06/09/93), P. B8 The Equal Employment Opportunity Commission has adopted interim rules to enforce parts of the Americans With Disabilities Act which deal with insurance-related discrimination against employees with AIDS and other health problems. The rules state that employers and insurers must provide the same coverage for disabled workers as is provided for their coworkers, that differences in coverage are only permitted in bona fide employer-provided health insurance plans, and that employers cannot make staffing decisions based on the impact an employees' or dependent's health may have on insurance plans. The rules will remain in effect while more comprehensive rules are developed. Related Stories: New York Times (06/09) P. A1; Washington Post (06/09) P. A14. Using Herpes Is One Approach to Fighting AIDS * USA Today (06/09/93), P. 1D Painter, Kim AIDS researchers are considering using a part of the herpes virus to fight HIV infection. AIDS researcher Robert Gallo's lab at the National Cancer Institute has discovered that a herpes virus called HHV-7--a virus not yet known to cause any disease--infects the same cells that HIV does and uses the same molecular entrance to get into the cells. According to Gallo, the virus might somehow be used to prevent entry by HIV, which has been done in the test tube. Gallo says he's not "seriously proposing using virus to inhibit virus," but might use parts of HHV-7 as inhibiting agents--a technique that should guarantee safety even if HHV-7 is subsequently linked to a disease. U.S. Ordered to Free HIV-Infected Haitians * Washington Post (06/09/93), P. A1 Duke, Lynne A U.S. District Court judge in New York yesterday ordered Attorney General Janet Reno to immediately release 158 Haitian refugees from an "HIV prison camp" at the U.S. Naval Base in Guantanamo Bay, Cuba. Judge Sterling Johnson Jr. of the Eastern District of New York said the Haitians are being held in "the kind of indefinite detention usually reserved for spies and murderers." In his 53-page ruling that strongly condemned the Bush and Clinton administrations, he also ruled that Immigration and Naturalization Service (INS) officials acted illegally when they attempted to process the Haitians' claims for asylum without giving them legal counsel. The Haitians were considered to be credible candidates for political asylum but were not allowed admittance into the United States because immigrants with HIV infection are banned. The refugees have been detained for as long as 20 months under U.S. military guard although they "are neither criminals nor national security risks," said Johnson. He also wrote that denying their release has been an "abuse of discretion" by the government. White House and the Justice Department officials did not have an immediate comment on the ruling beyond saying that it is being reviewed. One Justice official said the government is likely to comply with the judge's order to free the Haitians but still appeal its right to process asylum applicants outside the territorial United States without having to go through refugee attorneys. Johnson chastised the government for realizing that its medical facilities at the base were not adequate while repeatedly refusing to bring sick refugees to the United States for better care. Related Stories: Baltimore Sun (06/09) P. 3A; Philadelphia Inquirer (06/09) P. A1. Prevention Is Best AIDS Cure for Now, Researcher Says * Journal of Commerce (06/09/93), P. 9A The AIDS epidemic cannot be eradicated yet, and therefore worldwide efforts should concentrate on slowing its spread, according to a leading researcher at the Ninth International Conference on AIDS. Peter Lamptey, director of an AIDS prevention program financed by the U.S. Agency for International Development (AID), said that because a cure is not likely in this century, the only way the disease can be controlled is through prevention. He said, "Some programs have been successful, but not enough is being done. We're still chasing the epidemic." Lamptey, author of a study on prevention programs, said some major steps have been made toward slowing the spread of HIV in 40 countries where the AID's AIDS Control and Prevention Project was active. The five-year, $168-million U.S. government plan is intended to help establish HIV prevention programs by providing governments and agencies with technical assistance and funds. Virus 'Decoy' May be Key to AIDS Vaccine * Toronto Globe and Mail (Canada) (06/07/93), P. A1 Hess, Henry A technique that could revolutionize vaccine development and yield the ideal weapon against HIV infection has been discovered by researchers from the University of California-- Los Angeles. The revolutionary method creates a decoy that exactly resembles live HIV, but cannot cause illness. Because the body's defenses react to a virus' protein coating, not the virus' harmful genetic core that enables it to copy itself inside cells, the method uses the coating on a synthetic core to fool the immune system. The decoy primes the immune system to recognize and destroy a real virus, but with no threat of infection if something goes wrong. If the process is effective, it would enable vaccine makers to produce perfectly targeted vaccines. Dr. Nir Kossovsky, a UCLA pathologist who heads the research team that discovered the process, said the key is its ability to product an exact--but harmless--replica of the target virus. Thus far, studies of the decoy vaccine have been encouraging. Data being reported at the AIDS conference in Berlin this week suggest that in experiments using mice, guinea pigs, and rabbits, exposure to the decoy triggered an immune reaction against HIV that was equal to, and in some cases stronger than, the reaction to exposure to the actual virus. Repligen Set to Test Vaccine for HIV Virus * Boston Globe (06/07/93), P. 46 Rosenberg, Ronald Pharmaceutical firm Repligen Corp. of Cambridge, Mass., was expected on Monday to announce the beginning of a 20-patient safety trial of its proposed therapeutic vaccine for HIV- positive patients. Repligen President Sandford D. Smith said the vaccine is intended to prolong the life of HIV-positive patients by equipping their immune systems with antibodies designed to neutralize the virus. Symptoms related to AIDS usually don't appear in HIV-positive patients for an average of seven years. The Repligen vaccine would extend their lives beyond this incubation period. Repligen is the second company to conduct human trials of a therapeutic vaccine. Immune Response is working with Rhone-Poulenc Rorer, the U.S. unit of the French drug and chemical giant Rhone Poulenc SA, on a vaccine that has gone through two major clinical trials. The U.S. unit will market the vaccine if it receives Food and Drug Administration approval. Both Repligen and Immune Response are expected to discuss their respective vaccines on Wednesday at the Ninth International Conference on AIDS in Berlin. Repligen will employ X-ray crystallography to demonstrate its pre- clinical results on how certain antibodies neutralize HIV. Immune Response is scheduled to describe its recently completed 103-person, two-year trial. AIDS Activists Says Basic Research Is Underfunded * Nature (Great Britain) (06/03/93) Vol. 363, No. 6428, P. 388 Macilwain, Colin Even though there is additional U.S. government funding for AIDS, research does not address the critical basic work on the pathogenesis of the disease, according to a new report by AIDS activist organization Treatment Action Group (TAG). Last year, TAG made recommendations that were adopted by Congress last month in the reform of the National Institutes of Health's Office of AIDS Research. TAG expects a year-long effort to generate greater support of research on the pathogenesis of AIDS and other suggestions in its report, to be published at the Ninth International Conference on AIDS in Berlin. The report, based on interviews with 36 AIDS researchers in the United States, also demands a further shift in research away from test tube work toward investigations that deal with humans. According to TAG, recent work such as that by NIH's Anthony Fauci on the lymph node reflects a welcome move back to the study of the pathogenesis of the disease in the body. The work should be extended to find out why some HIV-positive people with high CD4 cell counts develop AIDS while others register low counts but show no symptoms, and why some people directly exposed to HIV manage to resist infection. The TAG report also contends that the best way to find a cure for AIDS is to put more of the $1.3 billion that the U.S. government spends on AIDS into investigator-initiated individual grants known as R01 awards. Report author Gregg Gonsalves said that the ability of large research facilities to foster support for large clinical trials has given them an unfair advantage over individual researchers desperate for funds. June 10, 1993 AIDS Vaccine Trials Viewed With Caution * Washington Post (06/10/93), P. A15 Brown, David Large-scale studies of preventive AIDS vaccines may start as early as 1995, but they may yield more information to scientists than benefits to subjects. At the Ninth International Conference on AIDS in Berlin yesterday, the most prominent topic addressed was the promise and pitfalls of AIDS vaccines. Because there are still so many unknowns about what can protect a person from HIV infection, even the best-designed vaccines of the near future will almost certainly serve as research probes, even if they also happen to protect some people from infection. Duke University vaccine researcher Dani P. Bolognesi told the conference that the scientific community should engage in clinical trials of vaccines even as laboratory research continues to try to solve the enigma of what happens as soon as HIV infection manifests. More than 1,000 volunteers have participated in vaccine trials so far. The purpose of these trials has been to determine the safety and biological effect of various "candidate" vaccines. Not one of the 18 studies has attempted to learn whether people at high risk of HIV infection are protected by the vaccines. The World Health Organization has chosen Uganda, Rwanda, Brazil, and Thailand, which all have extremely high rates of HIV-infection, as sites for large vaccine trials. Also, the United States is expected to be included in some of the experiments among high-risk groups. If an experimental vaccine is given to very high-risk persons, results might be obtained in only a few years. Related Story: Baltimore Sun (06/10) P. 12A. Hopes Are Dashed on AIDS Therapy * New York Times (06/10/93), P. A16 Altman, Lawrence K. The renowned developer of the polio vaccine, Dr. Jonas Salk, presented findings on his experimental immunotherapy for HIV- positive patients yesterday at the Ninth International Conference on AIDS in Berlin. However, the results received little praise from many of the AIDS researchers attending the conference. Dr. Alexandra M. Levine of the University of Southern California--Los Angeles, spoke on behalf of the Salk team and reported the result of immunization among 103 asymptomatic HIV-positive patients in nine medical centers in the United States. Dr. Levine said that the Salk immunotherapy slowed the progression in the amount of HIV among treated patients compared to those who were not administered the immunotherapy. The Salk team claimed that the reduced amount of virus was beneficial because the amount of virus generally increases as the immune system depletes, and that the findings correlate with those reported recently by Dr. Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases in Bethesda, Md. But Dr. Fauci was among the AIDS experts who questioned the significance of the findings, claiming that the differences were small and that the researchers were not certain about the meaning of the results of certain tests. "The findings were statistically significant, but not overly impressive," he said. However, Dr. Fauci acknowledged the new research was "a step in the right direction." Related Stories: Philadelphia Inquirer (06/10) P. A1; Los Angeles Times (06/10) P. A2; Wall Street Journal (06/10) P. B7. Wellcome Defends AZT, Says Combined Drugs Best * Journal of Commerce (06/10/93), P. 5A Fixsen, Rachel The British pharmaceutical firm that manufactures AZT defended the drug from reports of its ineffectiveness in treating HIV infection, and said that a combination of drugs now appears to be the best therapy in the early stages of infection. At the Ninth International Conference on AIDS in Berlin, Wellcome PLC argued against the claims of a European study of AZT, which questions its efficacy when used in the early stages of HIV infection. On Tuesday, the European research group had reaffirmed findings that early use of AZT neither prolonged life of AIDS patients nor slowed the onset of the disease. However, Wellcome contended that the study proved the drug worked and cited several studies such as the major U.S. trial ACTG 019, which demonstrated that AZT delays illness and helps strengthen the immune system. Also, Wellcome said the European study was in line with other tests conducted in the 1980s, which had used only one drug to fight HIV infection. Yet most AIDS cases now are treated with a combination of drugs because researchers believe this might be a better technique. "The most critical point ... is that no currently available monotherapy (use of one drug) will provide as long-lasting benefit as we would all desire," said David Barry, vice president of Burroughs Wellcome, the U.S. arm of the group. White House to Obey Order to Admit HIV-Infected Haitians * Washington Post (06/10/93), P. A30 Duke, Lynne The Clinton administration announced yesterday that it will comply with a federal judge's order and allow HIV-positive Haitian refugees held at the U.S. Naval Base at Guantanamo Bay, Cuba, into the United States. Some of the refugees had been held at the base for as long as 20 months after fleeing Haiti following a September 1991 military coup that overthrew Jean Bertrand-Aristide, Haiti's first elected president. Attorneys for the Haitians said that about half of the refugees have relatives who are U.S. residents. Those who cannot join family will be placed through two charities. On Tuesday, Judge Sterling Johnson Jr. of the Eastern District of New York ordered the release of the refugees, claiming that their medical status does not justify the "indefinite detention" to which they have been subjected. All of the refugees were believed to have credible claims for political asylum in the United States, but subsequent HIV tests showed they were positive for the virus, which prevented them from being admitted into the country. White House spokeswoman Dee Dee Myers said yesterday that the policy toward HIV-positive Haitians "predated the Clinton administration." In addition, she said the Justice department will continue to review Johnson's ruling and possibly appeal. The appeal would not affect the movement of the refugees. While U.S. law forbids immigrants with communicable diseases including HIV infection, special "humanitarian paroles" can be granted by the attorney general. Decline Is Reported in Certain Diseases * New York Times (06/10/93), P. B3 The New York City Health Department yesterday revealed that there has been about a 25- percent drop in sexually transmitted diseases (STDs) in the city. The decline in cases is proof that messages of safe sex are getting through to New Yorkers and especially adolescents, the Health Department said. The most recent department figures show that the number of syphilis cases reported by medical laboratories and clinics in New York City fell 21 percent to 12,524 in 1992, compared with 15,828 in 1991. Gonorrhea and other STDs have also declined sharply since the peak of the epidemic in the late 1980s. "We think people are beginning to take care of themselves, using protective measures like latex condoms," said Dr. Benjamin A. Mojica, director of the Health Department's Bureau of Sexually Transmitted Disease Control. However, health experts said they doubted the drop in STDs indicated a substantial slowing of the spread of HIV infection, because the disease is spreading fastest among IV-drug users. Study Points to Immune Cell as Key to AIDS Survival * United Press International (06/09/93) (Berlin) An immune cell that seems to inhibit HIV from multiplying may lead to the longer survival of AIDS patients, according to researchers from the University of California--San Francisco who reported their findings yesterday at the international AIDS conference. They discovered the specialized cell that prevents HIV from transforming into more destructive and resistant forms. Dr. Jay Levy of UCSF said his ongoing studies of HIV-positive patients who have survived at least 10 years with no major immune cell loss may provide clues to ways of extending the activity of the virus-inhibiting cells. The cell identified by Levy and his team is an activated form of a group of lymphocytes called CD8+ immune cells. Aside from inhibiting HIV's replication, these activated cells destroy other HIV-positive cells. "It is important to pursue treatment strategies that stimulate the cellular immune response against HIV, including the development of therapeutic vaccines and of drugs that modulate the immune response and sustain CD8+ antiviral activity," said Levy. He added that if the cell's effect can be boosted and prolonged, the virus might be eradicated or suppressed by the patient's own immune response or might succumb to further treatments before resistant virus forms emerge. Levy and colleagues discovered the CD8+ cells make a previously unknown cytokine, which is a type of protein secreted by the immune system's T cells. Studies demonstrated that long-term survivors maintained high numbers of activated cells. Surgeon General: Heterosexuals, Women Increasingly Hit by AIDS * United Press International (06/10/93) (Washington, DC) Heterosexual AIDS cases rose about 42 percent between 1990 and 1992, and the disease is infecting growing proportions of women and people who live in rural areas, according to a report issued Thursday by U.S. Surgeon General Antonia Novello. The report said that by the end of 1992, about 170,000 people had died of AIDS, "nearly three times more than died in the Vietnam War." About nine percent of the total AIDS cases reported in 1992 were among heterosexuals, and 39 percent of women with AIDS were heterosexual. Approximately 100,000 women are HIV-positive, and nearly half of all AIDS cases in women have been reported within the last two years. The report said that most of children diagnosed with AIDS since 1985 have lived outside New York, Newark, and Miami--cities with large HIV infection rates. Novello called for more aggressive AIDS/HIV education efforts in schools and homes. Health Insurance Ruling to Hit Small Employers * New York Times (06/10/93), P. D2 Freudenheim, Milt The new federal guidelines announced yesterday by the Equal Employment Opportunity Commission, which require employers to prove that their health insurance policies do not discriminate against employees or dependents with AIDS or other costly diseases, will affect small businesses more than companies with at least 100 workers, who can spread the risk throughout a larger group. Spokespersons for small-business organizations indicated that the new rules may force some firms to drop health care benefits altogether, although they also said that the action may increase pressure to reform the national health care system. Christopher Bell, a Washington attorney and co- author of the Americans With Disabilities Act, said that the rules will make it more expensive for employers to prove that they don't discriminate than to simply provide coverage. Under the new policy statement, the EEOC filed a lawsuit yesterday charging Mason Tenders Local 23 with violating the ADA by denying benefits to an employee with AIDS. AIDS Survival Doubles * United Press International (06/08/93) (Berlin) People diagnosed with AIDS in the 1990s are likely to live twice as long as those diagnosed with the disease in 1984, said Lisa Jacobson of the Johns Hopkins School of Public Health at the Ninth International Conference on AIDS. Jacobson said improved treatment of AIDS-defining illnesses, as well as anti- viral drugs like AZT, DDI, and DDC, have helped to lengthen lives. The findings are from the federally funded Multicenter AIDS Cohort Study, which has followed more than 5,000 homosexual or bisexual men with HIV infection or at risk for infection since 1984 in Baltimore, Chicago, Los Angeles, and Pittsburgh. Half of the men with AIDS in 1984 and 1985 lived for less than one year after AIDS was diagnosed, whereas average survival was more than 26 months in 1990 and 1991. The greatest survival gain was among male AIDS patients with Pneumocystis carinii pneumonia, the most common opportunistic infection among people with AIDS. Age at the time of diagnosis did not appear to affect survival times, the researchers said. Researcher Calls for More Sex Education * United Press International (06/08/93) (Berlin) Sex education for young people is essential in the fight against AIDS and other sexually transmitted diseases, according to Anke A. Ehrhardt of the New York State Psychiatric Institute and Columbia University, who spoke Tuesday at the Ninth International Conference on AIDS. Ehrhardt said that HIV is spreading among teenagers worldwide at increasing rates and a growing number of people with AIDS in the United States contracted the disease in their teens. Ehrhardt said studies indicate that exposure to formal sex education has no consistent effect on the potential that a teenager will begin to engage in sexual activity. The studies do demonstrate that sex education has a positive effect on contraceptive use and disease prevention. She suggested that the rise of the AIDS epidemic is linked with the fact that sexual activity is beginning at much younger ages. A 1990 Centers for Disease Control study conducted among teenagers in the United States and western Europe showed that the average age of first intercourse is 16.1 years for boys and 16.9 years for girls. Also, one-third of male students and one-fifth of female students start having sex before age 15, said Ehrhardt. Although teenage sexual activity is similar in the United States and western Europe, there are vast differences in how responsibly sex is practiced, as European nations have a policy explicitly advocating sex education, a positive attitude toward sex, and availability to birth control. "Sex education needs to include a positive attitude towards sexuality, promotion of healthy gender behavior, and a tolerance of sexual diversity," she said. AIDS Research: The Mood is Uncertain * Science (05/28/93) Vol. 260, No. 5112, P. 1254 Cohen, Jon The AIDS research community is in the midst of many changes. AIDS researchers who discounted alternative therapies as a way to combat the disease are beginning to take them seriously, while treatments that once seemed ineffective have become, at the very least, interesting. This open-mindedness is based on the fact that no cure or vaccine exists. A Science magazine survey of 150 AIDS researchers found that although there have been several revelations about the disease, the new knowledge is undermining assumptions held only a year ago. While AZT was once assumed to be effective in prolonging the onset of AIDS among asymptomatic HIV-positive patients, new data suggest the drug is probably of minimal help to this population. The survey also found that several researchers who once believed that almost all the damage caused by HIV could be explained by the virus' direct killing of cells now think indirect mechanisms must also be responsible. Even the measurement of CD4 cells, believed to mark the progress of AIDS, has been devalued. Furthermore, researchers who made significant success with experimental AIDS vaccines in monkey trials have discovered that their success could not be duplicated--and may even be due to artifacts. In order to conduct more effective research, an overall AIDS research strategy may soon have to be established, despite opposition from many researchers who believe it defeats the purpose of science. June 11, 1993 Detailed U.S. AIDS Report Offers Hints, Warnings * Baltimore Sun (06/11/93), P. 3A U.S. Surgeon General Antonia Novella released a report Thursday documenting a rise in the heterosexual spread of AIDS in the United States. The report indicates that 39 percent of reported AIDS cases in women in 1992 were attributable to heterosexual contact, an increase of 42 percent since 1990. The report was released at the Ninth International Conference on AIDS, and will be distributed to the American public through state and public health agencies and community groups. The report also contains detailed instructions on using condoms. Development of Live-Virus AIDS Vaccine Urged * Los Angeles Times--Washington Edition , P. A2 Stolberg, Sheryl The World Health Organization has decided to recommend that scientists develop a vaccine to prevent AIDS. The decision is viewed as extremely risky, since many researchers have felt it would be too dangerous to inject humans with even a crippled form of the deadly virus. Dr. Robert Gallo, a prominent AIDS researcher, argued against the recommendation, saying the risk is "astronomical." Anthony Fauci, the top AIDS official at the U.S. National Institutes of Health, said that while the U.S. government is not opposed to financing research on live-virus vaccines, top priority will continue to go to safer, genetically engineered vaccines. World Health Organization officials note they must deal with the rapid spread of AIDS in the developing world, which accounts for more than 80 percent of HIV-infected people. AIDS Link to V.D. Becomes Clearer * New York Times (06/11/93), P. A6 Altman, Lawrence K. Researchers at the international meeting on AIDS in Berlin, Germany, stated that greater efforts against all sexually transmitted diseases would help curtail the spread of H.I.V. The link between sexually transmitted diseases and AIDS has been clarified by studies showing that gonorrhea and chancroid can increase the risk of H.I.V. transmission a hundredfold. This risk is increased because the inflammation normally increases the production of infection-fighting lymphocytes and other white blood cells, the key target of the AIDS virus. Additionally, genital infections increase white blood cells in semen and vaginal secretions, making an HIV-positive partner infected with another sexual disease more likely to infect the other partner. Roche Unveils New AIDS Treatment * Financial Times (Great Britain) (06/11/93), P. 4 Abrahams, Paul Roche has issued preliminary information suggesting that its new treatment is just as effective as Wellcome's AZT and more effective when combined with other drugs. The drug, called Ro- 31-8959, uses protease inhibitor technology and works by affecting the making of an enzyme necessary for HIV to replicate effectively. Virus material without the enzyme seems not to be contagious. Three European studies have indicated that the drug produced dramatic increases in CD4 levels. CD4 cells are the immune cells destroyed by AIDS. Almost 200 patients participated in the studies, and their CD4 cells rose in both early and later phases of the disorder. Also, researchers reported that the patients tolerated the drug extremely well in all three experiments at effective doses. The results helped counteract the negative findings regarding AZT as presented earlier this week at the Ninth Annual International AIDS Conference in Berlin. In Italy, scientists tested AZT by itself and with the protease inhibitor. 28 New AIDS Cases Reported in Wisconsin * Chicago Tribune (06/10/93), P. 1-3 During May, officials Wednesday announced confirmation of 28 new AIDS cases in Wisconsin. The total number of AIDS reached 1,884 since 1982, the state said. In the same period, 20 people died from AIDS, making the death toll 966, according to Gerald Whitburn, secretary of the Department of Health and Social Services. Last year, Wisconsin had a total of 1,225 confirmed AIDS cases and 746 deaths from the illness. Doctors Study HIV Tie to Some Skin Diseases * Journal of Commerce (06/11/93), P. 7A AIDS patients are more likely to contract one of several skin diseases, especially as the ailment progresses, new research has discovered. Boston physicians studied the medical records of 684 people with HIV. The records showed that people with HIV visited doctors five times more often for normal inflammatory skin illnesses than people without the virus. Trimethoprim and sulfamethoxazole are probably the drugs with a side effect on the skin. About 43 percent of those who took them contracted some form of skin ailment, the researchers noted. Various manufacturers produce trimethoprim and sulfamethoxazole. French Say HIV Carriers Have Right to Normal Lives * Reuters (06/09/93) (Paris) A poll by the CSA Institute regarding attitudes toward AIDS indicated that about 95 percent of French people polled feel people infected with HIV have a right to a normal social life. The poll said only 1 percent of those polled thought people carrying HIV should be quarantined, and 4 percent had no opinion. Of those polled, 83 percent said they thought HIV carriers should have more opportunity to express themselves through the media, while most French people thought privacy about HIV infection should be respected. Of those questioned, 83 percent said they thought a person's partner should be told, while the figures fell to 63 percent for family members, 25 percent for friends, and 14 percent for co-workers. France has one of Europe's highest rates for the disease. About 250,000 people carry the disease and 13,000 people have died from it. U.S. Charges Union Health Plan Biased Against AIDS * Reuters (06/10/93) Frank, Jacqueline (Washington, DC) The federal government filed a lawsuit against the Mason Tenders District Council's Welfare Fund for refusing a worker coverage for treatment of AIDS. The suit was filed one day after the government ruled employers and health insurance plans may not discriminate against workers with AIDS or other disabilities. According to Equal Employment Opportunity Chairman Tony Gallegos, the lawsuit and rules will be used to help settle cases investigating discrimination in health plans. Terrence Donaghey Jr., the worker in the Mason Tenders suit, was refused coverage for AIDS treatment. The Mason Tenders plan, in 1991, was changed to block payment for any AIDS- related illness, including the viruses, bacterial, and fungal infections Donaghey contracted. "The Commission in its suit against Mason Tenders is asserting that the AIDS exclusion in the Fund Plan discriminates against individuals because of their disability," said the agency. Health plan officials would not comment. Under the Americans with Disabilities Act, companies that provide employees with health care coverage must do so for all employees, regardless of their health. Furthermore, employers cannot refuse to hire someone because they or a family member have a condition requiring medical treatment. While the act allows some forms of discrimination, employers must prove that discrimination falls under the law. Skin Disease Found Higher in People with HIV * Reuters (06/10/93) (Boston, MA) A study reported in the New England Journal of Medicine indicates that people infected with HIV are much more prone to a number of skin diseases, especially as the virus progresses. A team of doctors from Boston examined the medical records of 684 people infected with HIV, and determined that the number of visits to the doctor for common and inflammatory skin conditions was five times higher than for people without the virus. Side effects of drugs used to treat the virus may be to blame, said the research team. The combination of trimethoprim and sulfamethoxazole were most likely to produce the side-effects. Of the people who took the drug, 43 percent developed some form of skin disease, said the researchers. Community Program Reduces HIV Risk Among Young Gay Men * Business Wire (06/09/93) (Berlin, Germany) A University of California, San Francisco, study indicates that HIV prevention and safe sex messages are optimally effective when tailored for the group at which they are aimed and delivered by peers. In the first eight months of a UCSF-directed outreach program in Oregon, the rates of unsafe sex by gay and bisexual men were reduced by more than 10 percent. "Many young gay men perceive AIDS to be a problem mainly of older gay men," said the UCSF Center for AIDS Prevention Studies' Katherine C. Haynes Sanstad. While the gay community has been very successful in reducing high risk behaviors since the AIDS epidemic began, researchers say young men engage in unsafe sex at frightening rates, while few of them attend AIDS prevention activities, said Sanstad. UCSF researchers found that young gay men in the Eugene community attempted to teach about safe sex to their peers at parties and bars. Project members later launched social events where they were able to distribute information about safe sex. Researchers evaluated the program four months after its start and then about a year later. Of those polled in the first survey, 41 reported engaging in unprotected anal intercourse, while only 30 percent reported doing so in the second survey. In a comparable study conducted among a similar population in Santa Barbara, the rate was stable throughout the eight months. The study authors say it could be used successfully for other high risk groups. Saliva AIDS Test Cut Risks for Health Workers * Reuters (06/10/93) (Berlin) Health workers who take saliva samples in place of blood samples to test for HIV infection could reduce the danger of accidentally contracting the virus. A paper at the Ninth International Conference on AIDS indicated that about 100 health workers are thought to have accidentally caught the virus during the testing process. Of those infections, about 85 percent came from needle pricks while taking blood, reports Carol Ciesielski of the U.S. Centers for Disease Control and Prevention. Unlike blood testing, saliva testing does not require needles. Saliva also does not carry HIV in a form that can easily infect another person, said University of Los Angeles scientist Ralpha Frerichs. Frerichs also noted that disposing of needles used for HIV testing in developing countries is frequently difficult. A device to test and collect saliva is manufactured by Saliva Diagnostic Systems Inc. The test could be useful in that more people may be willing to submit to saliva tests than blood tests, providing a more accurate estimate of the extent of the epidemic. HIV TKO: The Gloves Come Off in a Fight for Mandatory HIV Antibody Testing of all Professional Boxers * Advocate (06/01/93) No. 630, P. 32 Bull, Chris Because the world featherweight champion tested HIV-positive, he was stripped of his title, and the pressure soon mounted for mandatory HIV testing of professional boxers. Ruben Palacio's HIV-positive status was disclosed by the British Boxing Board of Control on April 16 the day before he was expected to defend his World Boxing Organization title against Briton John Davidson. The fight was canceled, and Palacio, who had compiled a 45-11 record during his 12-year career, was sent home to Columbia. Only a week after Palacio's test results were revealed, the World Boxing Association (WBA), the world's largest international boxing association, said it was considering requiring HIV antibody testing of boxers before all fights, beginning with a May 22 heavyweight-title bout between defending champion Riddick Bowe and Jesse Ferguson in Seattle. WBA chief legal counsel Jimmy Binns said, "I don't think we can delay getting boxers tested any longer. In boxing there is a probability, if not a certainty, that infected boxers will infect other boxers, referees, trainers, or people at ringside. In some of these fights there is blood flying everywhere and we have a responsibility to make sure that no one is infected." However, civil libertarians said mandatory HIV testing may violate federal antidiscrimination laws as well as state laws in California, New York, and New Jersey, three of the states where many fights are held. In addition, spokesman for the Centers for Disease Control Kent Taylor said, "The only known route of transmission is through intravenous drug use and unsafe sex, and that's where prevention activities should be focused, not on sports." Swapping Secrets: Combination Drug Therapies Push the World's Biggest Pharmaceutical Companies Into an Unusual Alliance * Advocate (06/01/93) No. 630, P. 34 Gallagher, John A total of 15 of the world's largest pharmaceutical companies recently agreed to collaborate on research efforts to develop anti-AIDS drugs, but the move drew only restrained applause from AIDS activists. Derek Hodel, treatment issues director at the AIDS Action Council, a Washington, D.C., lobbying group, said, "It's taken them forever to get it off the ground. It looks like a good idea, but it's awfully late, and it looks a little tepid." The drug companies' announcement of the Inter- Company Collaboration for AIDS Drug Development came on April 19. The firms indicated that the consortium will meet about six times a year. Food and Drug Administration commissioner Dr. David Kessler called the collaboration "a welcome step toward needed coordination in a vital area of research." Dr. Mathilde Krim, founding co-chairwoman of the American Foundation for AIDS Research, said member companies may be able to use the consortium to seek uses for experimental drugs that they would otherwise have abandoned, since it will allow firms to ascertain more easily whether their drugs are effective when paired with a competitor's." If the collaborative endeavor extends its work to review drugs designed to boost the immune system and battle opportunistic infections, "it could be a very big step forward indeed," said Krim. However, Michael Becker, a member of the Treatment Action Group, a New York AIDS-research advocacy organization, said he was concerned that the shared information will be limited to products being tested, not to basic research about how HIV manifests and mutates in the body. 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 1993, Information, Inc., Bethesda, MD. -----===[[[ A I D S w i r e D I G E S T 06.07.93 ]]]===----- .