-----===[[[ A I D S w i r e D I G E S T 07.12.93 ]]]===----- Where AIDS and Money Cross Paths: Gays and Minorities Dispute How Funds Are Divided Up * Washington Post (07/11/93), P. A1 Goldstein, Amy Disputes are emerging among various AIDS organizations in the United States over federal funds to help the growing number of communities affected by the epidemic. As the federal government allotted $850 million in AIDS subsidies into communities nationwide, tensions have worsened and are producing a second generation of debate over how and by whom the war against AIDS will be fought. AIDS activists and other community leaders claim that schisms have been formed among the politically powerful homosexual community, perceived to be predominantly white; groups of black gay and bisexual men who do not identify with the larger gay community; and organizations that want to serve heterosexual AIDS patients such as women, children, and IV-drug users. The rifts result in part from the change in the epidemic's demographics. The epidemic began in the United States in the earlyJ1980s mainly among gay and bisexual men, but the rate of new HIV infections is now highest among heterosexual IV-drug users and their sexual partners, who are disproportionately minorities. Gertrude Hunter, president of the Huser Institute, formed in 1988 to help fledgling minority groups develop the ability to deliver human services, said, "This is one of the last battles in the civil rights movement--determining who provides [AIDS] services to the African American community." Jeff Levy, director of the lobbying group the AIDS Action Council, said a similar struggle "is reenacting itself in every city in the country." District Replaces AIDS Chief * Washington Post (07/10/93), P. B1 Goldstein, Amy The chief of the Washington, D.C., AIDS agency was fired and two other city health officials suspended after an internal investigation concluded they had improperly directed a contract away from a clinic linked to the Nation of Islam, according to city sources. D.C. Commissioner of Public Health Mohammad Akhter dismissed Caitlin Ryan, chief of the Agency for HIV/AIDS, after completing a probe into complaints that she had meddled with a bid by the Abundant Life Clinic to implement an AIDS public information campaign. Ryan said Friday that she had been told of "an adverse action" against her, and she said, "When the facts are out, I will be exonerated." She added, "What has occurred here has profoundly disrupted the AIDS program in the District of Columbia, a city that has the highest incidence of AIDS in the country. The real losers in such a disruption are people with HIV/AIDS ... and I will do everything I can to ensure the effort is put back on track as soon as possible." The dispute that spurred her dismissal began a month ago, when Abdul Alim Muhammad, director of the Abundant Life Clinic in Northeast Washington, sent a letter to Mayor Sharon Pratt Kelly, arguing that Ryan had interfered with the clinic's bid "in a most notorious fashion, literally coercing members of the review panel to alter the award results." A source familiar with the report said it stated that Ryan had improperly told a four-person contract review panel that she had "reservations" about Abundant Life's ability to carry out the media campaign. AIDS--Hemophiliacs * Associated Press (07/09/93) Connell, Christopher (Washington, DC) Health and Human Services Secretary Donna E. Shalala has called for an extensive investigation of how thousands of hemophiliacs contracted HIV from tainted blood products a decade ago. Hemophiliacs and their families have argued that companies knowingly distributed contaminated blood products between 1982 and 1984 before a test was developed to screen blood for HIV. Because the clotting factor used by hemophiliacs was not screened for HIV until 1985, Senators Robert Graham (D-Fla.), Edward Kennedy (D-Mass.), and Rep. Porter Goss (R-Fla.) had asked Shalala to demand a probe by the department's inspector general. Shalala said that she has decided instead to ask that the project be undertaken by the prestigious Institute of Medicine, an arm of the National Academy of Sciences. Shalala said in a letter dated July 1 that was released by Graham's office on Friday, "I agree that it would be useful to gain a more complete understanding of the events that occurred in that period regarding the use of blood and blood products for transfusion and for treatment of those with hemophilia." She added, "Such a review would give us better insight into how medical knowledge and practice contribute overall to public health decisions regarding disease transmission in the earliest stages of an epidemic." She said the U.S. blood supply is "the safest in the world," but said the results of the study "could be helpful in strengthening capacities to insure the safety of the nation's blood supply against new challenges in the future." Canada Watch: Manitoba to Compensate Hemophiliacs * Toronto Globe and Mail (Canada) (07/09/93), P. A7 Manitoba has added itself to the list of Canadian provinces that will compensate hemophiliacs who contracted HIV through contaminated blood, announced Health Minister Don Orchard on Thursday. Orchard, who was initially reluctant to compensate the hemophiliacs, said he changed his mind because several other provinces have revealed they were willing to provide aid since a four-year federal program expired in April. France--Syringe Machine * Associated Press (07/09/93) (Nimes, France) A machine that exchanges used syringes for clean ones has been installed in Nimes, France, as a part of the city's anti-AIDS efforts. Mayor Jean Bousquet said, "It's not a distributor, it's an exchanger. This doesn't concern making it easier to get a syringe, but making sure one isn't thrown on the ground or just anywhere." The machine, which was made available on Thursday for 24-hour-a-day service, provides a kit containing an unused syringe, a piece of alcohol-soaked cotton, a condom, and a container for a used syringe. The machine is the first of its kind in France, and was launched in a town of 128,000 people with an estimated 500 regular IV-drug users. According to authorities in the Provence-Alpes-Cote d'Azur region that includes Nimes, 43.4 percent of regional AIDS cases are linked with IV drugs. Adria Announces Finalization of Mycobutin Co-Promotion Agreement * PR Newswire (07/09/93) (Dublin, OH) Adria Laboratories has announced that it has come to an agreement with SmithKline Beecham to co-promote Adria's recently approved prescription drug Mycobutin to treat an AIDS- related illness. Mycobutin is the only drug approved for the prevention of Mycobacterium Avium Complex (MAC), a life- threatening bacterial infection common in people with late- stage HIV disease. Under the agreement, SmithKline Beecham's hospital sales force of 230 people will join in the promotion efforts for Mycobutin in cooperation with the Adria sales force of 139 individuals. Fernando da Costa, president of the Kabi Phamracia/Farmitalia Carlo Erba U.S. organization to which Adria Laboratories belongs, said, "The finalization of the agreement with SmithKline Beecham is gratifying. Their sales organization is widely recognized in the industry as very professional and highly successful. As a result, we expect to improve our ability to educate the physician community and people with AIDS about MAC disease and the importance of prevention." New Tests on Dextran Sulphate Disclosed * Business Wire (07/09/93) (Boynton Beach, FL) Preliminary in vitro testing conducted on behalf of Polydex Pharmaceuticals Limited of its patented high molecular weight dextran sulphate, in injectable form, has suggested an efficacy in preventing the spread of HIV, according to Doctors Lionel Resnick and Mariano Busso of Mt. Sinai Hospital in Miami. It is believed that the drug will have minimal toxicity. Thomas C. Usher, chairman of Polydex, warned that additional testing remained to be done before a pre-IND application was submitted to the U.S. Food and Drug Administration. Usher also remarked upon an item from the July 2, 1993, "Wall Street Whispers" regarding the combination of Polydex' dextran with AZT and clarified that no imminent announcement of a joint venture with Burroughs Wellcome was anticipated. What Drugs, When? * American Medical News (07/05/93) Vol. 36, No. 2, P. 2 Staver, Sari Due to revelations about the limited efficacy of AZT and questions about when and how to prescribe antiviral drugs, many physicians attending the Ninth International Conference on AIDS became uneasy about the future of AIDS treatments. Two large studies on AZT presented at the conference disputed the long- held belief in the United States that AZT should be used in HIV-positive patients whose CD4 counts are below 500. The European Concorde study followed more than 1,700 HIV-positive asymptomatic patients. It found that early use of AZT does not extend life in AIDS patients. In addition, Veterans Administration Study 298 compared early and delayed AZT treatment in mildly symptomatic patients with CD4 levels of 200 to 500. The study showed that after four years no significant benefit from early treatment was found. But Dr. Kenneth Mayer, an infectious-disease specialist at Brown University Medical School in Providence, R.I., said the studies may indicate that early AZT treatment is beneficial for some patients but not others. He said those who did not respond to AZT could have a more virulent, syncytium-inducing strain of HIV, or an AZT- resistant strain of the virus. The AIDS conference provided no progress reports on trials of D4T, as likely to be the next approved antiviral. What may have been the most discouraging revelations were that TAT antagonist drugs did not demonstrate significant antiviral activity. In order for research to be more efficient, answers must come more quickly. Dr. Mayer recommends that the federal government act as a "broker" to facilitate cooperation with pharmaceutical companies in comparing trial results for various drugs. Some HIV Patients Benefit From Combo Therapy * American Medical News (07/05/93) Vol. 36, No. 25, P. 29 Staver, Sari Two-drug combination therapy is more effective than monotherapy in treating some HIV-positive patients, according to a study released at the Ninth International Conference on AIDS in June. The study found that people with relatively healthy immune systems benefit by a combination of AZT and DDC, but those with more advanced disease do not. Principal investigator Dr. Margaret Fischl, of the University of Miami, said that AIDS Clinical Trials Group 155 is the first national study to compare single-agent with combination therapy. The study revealed that patients with advanced HIV disease who have received prolonged therapy with AZT have similar clinical outcomes whether they continue taking AZT alone or switch to DDC or to a combination of DDC and AZT. The findings are based on data from 991 patients, all of whom had been administered AZT for six months or longer and had CD4 counts of 300 or less. They were randomly assigned to AZT, DDC, or a combination. Patients with CD4 counts of 150 to 300 who received combination therapy were less inclined to develop an AIDS-related condition or die than those taking AZT alone. However, patients in this subgroup who took DDC alone did about as well as those who took AZT alone or the combination regimen. Side effects were observed for patients entering the study with CD4 counts of less than 50. The most common was a reduction in neutrophils, seen in 41 percent of the AZT group, 35 percent of the combination group, and 18 percent of the DDC group. Since the side effects may transcend the drug combination's benefits, Dr. Fischl said she would investigate the idea of discontinuing antiviral therapy in patients with advanced disease. Agenda: Swish and Spit * Advocate (07/13/93) No. 633, P. 15 The Florida dentist with AIDS who transmitted HIV to six of his patients is believed by some to have done so deliberately, according to various news articles published in early June. David Lewis, a University of Georgia researcher who has studied the case of Dr. David Acer, said, "Whether it's scientifically valid or not, it is definitely the most prevalent theory today, at least in the dental community." The case of Sherry Johnson, who revealed in May that she became infected with HIV after being treated by Acer, may have also furthered speculation. Although Acer, who died of AIDS in 1990, performed invasive procedures on the other five patients, he only filled a cavity for Johnson. Moreover, investigators have noted that after studying thousands of patients of 57 HIV-positive dentists, they could not find another case in which a patient contracted HIV through dental work, invasive or not. Doug Feldman, an associate professor at the University of Miami's medical school said he believes Acer "took a needle and syringe, drew his own blood into it, and deliberately injected it directly into his patients' mouths with the anesthetic. My mind was made up before, but the facts surrounding the sixth victim [Johnson] cement it even stronger." Before dying, Acer vehemently denied endangering his patients lives. Also, the murder theory's critics note that none of Acer's patients remembered seeing a blood-filled syringe. They said developing such a plot would have been unlike Acer, whom they described as a gentle man who cooperated with federal investigators during the final days of his life. July 13, 1993 Panel Suggests Kindergarten AIDS Classes * Washington Times (07/13/93), P. B1 Wagner, Arlo In an effort to prevent further HIV infections among teenagers, a Montgomery County, Md., panel yesterday said the county should implement a comprehensive AIDS education program, including classes as early as kindergarten. Also, the task force suggested that the county school system order an outside review of its AIDS education program and that it study the "feasibility of a condom availability program in junior and senior high schools." The task force said yesterday that HIV infection continues to spread in Montgomery County in epidemic proportions. Dr. Harold D. Gabel, task force co-chairman and director of the county's Health Department, said that approximately 7,000 county residents are HIV-positive, with most of them unaware of their condition. Since the first case of AIDS in the county emerged in 1983, about 700 people have been diagnosed with the disease and 441 have died of it. Russ Henke, coordinator of health education in county schools, said, "Family life and human sexuality" classes start in kindergarten, but county students are not currently taught about AIDS prevention until the fifth grade. He added that condoms are only shown in high school sex education classes. County Executive Neal Potter said any AIDS education program should focus on teenage drinking and television, since drinking lowers inhibitions and television appears to have a large impact on teenagers' behaviors. NBC Poll Finds Support for Teenage Contraception * Reuters (07/12/93) (Washington, DC) Most adults favor the distribution of contraceptives to high school students, according to a nationwide survey issued Monday. The poll, which is expected to be aired Tuesday on the television program "Dateline NBC," revealed that 57 percent of the 1,004 adults surveyed supported contraceptive distribution in the schools, while 37 percent opposed it and 4 percent were unsure. The survey, conducted between April 17-20 as part of a monthly NBC/Wall Street Journal poll, discovered lower support among older Americans. Among those aged 50 or older, only 48 percent supported distribution, while 70 percent of the 18- to 34-year-olds endorsed it. The survey's findings come in advance of Senate confirmation hearings of President Clinton's nominee for surgeon general, Dr. Jocelyn Elders. Elders is a strong advocate of sex education and the availability of contraceptives for teenagers. Elders, who is currently serving as Arkansas state health director, is expected to face difficult questioning at Friday's Senate confirmation hearing. In the "Dateline NBC" interview with Jane Pauley, Elders said, "We'd all like children to be abstinent. And I support abstinence," but added, "When we look at sexually transmitted diseases, look at AIDS, look at teen pregnancy, we know that children are not being abstinent." We've Got an AIDS Czar, Now What? * PR Newswire (07/12/93) (Washington, DC) The newly appointed White House AIDS policy coordinator will assume her responsibilities just in time to oversee the federal response to a key turning point in the AIDS epidemic, according to Daniel T. Bross, executive director of the AIDS Action Council. If the federal AIDS czar, Kristine Gebbie, is equipped with active and vocal support from President Clinton and a committed responsiveness to the community-based groups that have been at the forefront of the epidemic, her own strong public health background could help her develop a new campaign against AIDS. Bross suggests that because of Gebbie, the Clinton administration can and must immediately establish the planning and focused research proposed in the NIH Revitalization Act, beginning with an appointment of a head of the Office of AIDS Research and continuing through provision of additional resources to implement a plan developed with community input. The administration must comply with requests for a national conference on AIDS prevention in order to build a nationwide consensus on the need to significantly boost efforts to stop the unnecessary 40,000 to 80,000 new HIV infections each year. In addition, the Clinton administration must eliminate the connection of HIV infection with substance abuse by integrating HIV-related issues in all aspects of substance abuse prevention and treatment programs and by moving toward treatment on demand for active substance abusers. Moreover, all people with HIV infection should be guaranteed the care they need through full funding of the services provided under the Ryan White CARE Act and through expanded Medicaid coverage for indigent people with HIV infection, Bross concludes. First Female Condoms to Be Shipped This Week * United Press International (07/12/93) (Jackson, WI) The Reality female condom will be shipped this week to selected organizations, according to the condom's manufacturer, Wisconsin Pharmacal Co. The device, also called the vaginal pouch, was approved by the Food and Drug Administration in May. It is designed to provide protection for women against sexually transmitted diseases and birth control. The first shipments are expected to go to the Philadelphia Department of Health, AIDS Project Los Angeles, Children's Hospital in Los Angeles, Family Health International, and Planned Parenthood chapters in New York and New Jersey. Public health experts are hoping that the distribution of the female condom will help reduce the risk of HIV infection to women, who many times feel they cannot demand that their male sexual partners use condoms. Judie Klapholz, director of education and training for AIDS Project Los Angeles, said, "Our case managers will offer them to female clients who have asked for options besides the male condom. We will also distribute them in our women and HIV workshops." Klapholz added, "It's providing women with an option--giving them a sense of control when it comes not only to sexually transmitted diseases but pregnancy as well." "Catholic Church Attacks Condom Program" Reuters (07/12/93) (Tegucigalpa, Honduras) A Honduras health ministry program that distributes condoms to prevent the spread of HIV infection was condemned by the country's Catholic Church, which said the effort will only promote "living in sin and fornication." The health ministry announced that it was distributing the condoms to thwart the spread of HIV infection, which is highly prevalent in Honduras. About 2,867 people in the country have contracted the disease since 1985, more than any other Central American nation. In its weekly bulletin, FIDES, the Catholic Church called the condom-distribution plan "immoral," and clerics are condemning it from the pulpit. Tegucigalpa Archbishop Oscar Andres Rodriguez chastised the government in his Sunday sermon for "fomenting promiscuity instead of promoting responsible sexual behavior." Approximately 90 percent of Honduras residents identify themselves as Catholics. AIDS Research Sends Patients From Hope to Despair * American Medical News (07/05/93) Vol. 36, No. 25, P. 14 Culhane, Charles AIDS research revelations can cause patients to continually battle feelings of hope and fear, according to researcher Dr. Michael Gottlieb, who spoke at a recent AIDS research and treatment symposium sponsored by the Institute of Advanced Studies in Immunology and Aging. "Its a roller coaster propelled in part by the way newsmakers release their findings and the press covers them," said Gottlieb, assistant clinical professor of medicine at the University of California--Los Angeles School of Medicine. He added, "Health care providers, like myself, must deal with the fallout." He said that when patients hear of discouraging news like that HIV hides in lymph nodes or studies that question the efficacy of AZT, they lose hope. But at the same time, when patients hear of encouraging findings with a three-drug combination therapy, they fantasize about being cured. "That hope quickly crumbles when patients find out that there is only a small chance they can participate in early drug trials and that the third drug will not be made available through the FDA's expanded-access program," said Gottlieb. He added that doctors need more gender-specific information on hormonal changes that might transpire as a result of HIV and the drugs used to treat the disease. Also, Gottlieb said, "Pharmaceutical companies remain reluctant to commit resources to AIDS drug trials in children, and to manufacture drug formulations that can be studied in kids." An Old New Drug for AIDS * Time (07/12/93) Vol. 142, No. 2, P. 49 Gorman, Christine The once-banned sedative thalidomide is believed to have some clinical benefit in slowing the onset of AIDS. Thalidomide was found to cause birth defects in European children whose mothers took the drug in the early 1960s. Therefore, the Food and Drug Administration prohibited the drug from being marketed in the United States. However, an experiment started in 1992 by researchers at Rockefeller University revealed that thalidomide can fight AIDS-related illnesses. A team of researchers led by immunologist Gilla Kaplan gave thalidomide to a dozen patients in New York City and Thailand after laboratory results showed that the drug could suppress HIV in cells grown outside the body. Following four to six weeks of therapy, some of the patients gained between 10 and 30 lbs. and their fevers had faded. Although no one thinks thalidomide can cure AIDS, researchers hope the drug can slow the development of the disease and extend life for AIDS patients. In the original test tube trials, which were reported last week in the Proceedings of the National Academy of Sciences, the drug seemed to prevent some, but not all, HIV-positive cells from producing any new copies of the virus. Thalidomide was able to do this by inhibiting a naturally occurring substance called tumor necrosis factor (TNF). In HIV-positive people, TNF promotes the production of the virus. Kaplan said, "We thought that if we could inhibit TNF, then maybe we could decrease some of the clinical symptoms of AIDS." While some early findings are promising, Kaplan does not yet know whether thalidomide has reduced the amount of HIV in her patients. Update: Mortality Attributable to HIV Infection/AIDS Among Persons Aged 25-44 Years--United States, 1990 and 1991 * Morbidity and Mortality Weekly Report (07/02/93) Vol. 42, No. 25, P. 481 AIDS is the third leading cause of death among young adults aged 25-44 in the United States, and prevention efforts should be focused on this group, write the Centers for Disease Control. In 1991, 29,850 Americans died of AIDS-related complications. Among these, 3 percent were younger than 25 years; 74 percent were 25-44 years old; and 23 percent were over 45 years old. AIDS was found to be the ninth leading cause of death overall, accounting for 1 percent of all deaths, and the third leading cause of death of people aged 25-44, constituting 15 percent of deaths in this age group. Although death rates from most other leading causes declined or remained relatively stable for men and women aged 25-44, the death rate for AIDS steadily increased. The death rate from AIDS in 1991 for men aged 25-44 was seven times that for women in this age group, but since 1985, proportionate increases in the rate were greater for women than for men. Also, the rates of AIDS deaths were higher for blacks and Hispanics--particularly Hispanics of Puerto Rican origin--than for other racial/ethnic groups and is consistent with reported rates for the prevalence of AIDS. The disparities in risk among racial/ethnic groups may indicate social, economic, behavioral, or other factors, rather than race/ethnicity directly. Moreover, AIDS' effect on death patterns is even greater in many large cities than in the total U.S. population. In 64 out of 172 cities with populations of at least 100,000, AIDS was the leading cause of death among men aged 25-44 years, and the ninth leading cause of death among women in the same age group. July 14, 1993 Md. Extends Old Weapon Against TB * Baltimore Sun (07/14/93), P. 1B Bor, Jonathan In an effort to curb the spread of tuberculosis, Maryland health officials revealed new regulations yesterday to boost their authority in quarantining TB patients who are reluctant to take their medicine. The new rules, which took effect last week, also require doctors to offer TB skin-testing to all HIV- positive patients. Health Secretary Nelson J. Sabatini, who announced the rules yesterday, said he was especially concerned about diagnosing TB among HIV-positive people because their suppressed immune systems make them more susceptible to the infection. The health officials view quarantines and skin- testing as necessary measures to keep TB from exploding into a public health crisis, as it has in other large metropolitan areas. Officials said they wanted to ensure that Maryland remained relatively free of TB strains that are resistant to conventional drugs. The multidrug-resistant strains of TB develop in patients who stop taking their medication before completing the entire regimen. Dr. Ebenezer Israel, director of epidemiology and disease control for the state Department of Health and Mental Hygiene, said quarantines will only be instituted as a last resort. He said that if a patient refuses to comply, then a court order will be sought. Officials take the step of quarantining about once a year. Patients who are quarantined are confined in hospitals to limit their contact with others. There were 451 reported cases of tuberculosis in Maryland in 1991 and 442 in 1992. There have been a total of three cases of multidrug-resistant TB in the state, but none occurred this year. Related Story: Washington Post (07/14) P. C2. Polydex Reports Progress on AIDS Drug Research * Business Wire (07/13/93) (Boynton Beach, FL) Polydex Pharmaceuticals Ltd. announced Tuesday its progress in anti-AIDS therapies. It is currently working on Cytochalasin D, which has demonstrated in vitro that it has a "potent anti-HIV effect." Cytochalasin D represents a new approach to AIDS treatment because it is a naturally occurring compound, whereas the commonly used AZT is a synthetic compound. Cytochalasin D, a fungal metabolite produced by an organism, inhibits the spread of HIV by preventing infected cells from producing and releasing the virus. AZT, in contrast, works by preventing cells from becoming infected. Polydex has conducted in vitro and toxicity tests that demonstrate the material is less toxic than AZT. Dr. Lionel Resnick, a renowned AIDS researcher, said that the efficacy of Cytochalasin D is nearly the same as that of AZT. However, it is believed that the body will not build up an immunity to Cytochalasin D and weaken its effectiveness over time, as is the case with AZT. Polydex has filed a U.S. patent on a Dextran and AZT compound, and independent laboratory results confirm that the new complex performs in vitro at a comparable level with AZT against HIV-infected cells. It is believed that a substantial reduction in toxicity occurs since Dextran acts as a slow release mechanism for AZT, a factor that may well reduce adverse effects of AZT. Additional tests are underway and results are expected soon. AIDS Discrimination Suits Settled * United Press International (07/13/93) (New York, NY) As a result of discrimination complaints, a landlord and a neighbor of a Queens, N.Y., family with foster children with AIDS have agreed to pay into educational funds for the children in settlement, it was revealed Tuesday. According to Human Rights Commissioner Dennis deLeon, the neighbor threatened to move if the family wasn't evicted from an apartment in Astoria, while the landlord subsequently evicted the family. The family of seven included one child with AIDS who subsequently died after the eviction and another who was found to be HIV-positive, said deLeon. The landlord agreed to start an $8,000 trust fund for the education of the family, along with $3,250 contributed from the neighbor for the same fund, said deLeon. In addition, the landlord agreed to comply with the city's Human Rights Law in the future and donate $450 to the Windham AIDS Program in Willimantic, Conn. The neighbor donated $500 to the Queens County AIDS Center in memory of the child who died of the disease. What the AIDS Czar Can't Do * New York Times (07/14/93), P. A19 Foreman, Christopher H. Despite the outstanding public-health credentials of Kristine M. Gebbie, the newly appointed federal AIDS czar, AIDS policy coordination cannot address most of the primary challenges the epidemic presents, writes columnist Christopher H. Foreman Jr. A coordinator cannot increase knowledge about HIV, which is what is needed to stop the virus from spreading. Moreover, there has never been a true cure discovered for any viral disease. The main hindrance preventing the Food and Drug Administration from approving more anti-AIDS drugs is not weak coordination, but the fact that only a few drugs are submitted for approval. Regarding AIDS education, the problem is not poor organization, but whether the disease should be viewed as a public health matter or a moral issue. AIDS is not only about disease control but also about rights and confidentiality. Also, it is unavoidably connected with sex and reveals our lack of a moral consensus. As far as AIDS-related health care is concerned, coordination is not the main problem either. The real problems are the lack of money and effective anti-AIDS drugs. Foreman says it is inappropriate to put the blame of the troubling AIDS epidemic on coordination, when political persuasion is the real heart of the matter. The effectiveness of the AIDS czar will depend on how accurately she deals with the difficult balance between prodding and protecting the real AIDS czar, the President, concludes Foreman. A Condom With Your Coffee? * Reuters (07/13/93) (Nice, France) Condoms will this year be offered to vacationers who dine in cafes and bars on the French Riviera. About a million condoms are expected to be distributed in 200 cafes, beach bars, and night clubs along the Mediterranean seaboard beginning Wednesday as a part of the national anti-AIDS campaign, organizers announced Tuesday. People will be able to obtain condoms by asking a waiter or waitress for a "cafe branche" (plugged-in coffee) and the condom will be delivered along with the cup. Christmas in July? 'A Shy Rabbit's Heart' Ornament to Raise Funds for AIDS Fight * Business Wire (07/13/93) (New York, NY) The renowned American Christmas ornament designer Christopher Radko has proposed giving the profits from a special ornament, "A Shy Rabbit's Heart," to help the fight against AIDS. Radko believes the ornament will raise $350,000 for AIDS organizations, including God's Love We Deliver, the Los Angeles Homestead and Hospice Shelter, the Elizabeth Taylor Foundation for AIDS, and Gift for Life. The ornament is in the shape of a silver bunny holding a red ribbon inside a golden heart, and is hand-blown and hand-painted. Radko replaces about half of the 450 ornaments in his catalog every year. He decided last year to start his own effort against AIDS. He said, "At Christmas, we think about others, our families, friends, and the extended family of humanity worldwide. We are all in this struggle together. There is no more pressing concern today than the AIDS epidemic." 'Invisible' Epidemic Now Becoming Visible as HIV/AIDS Pandemic Reaches Adolescents * Journal of the American Medical Association (07/07/93) Vol. 270, No. 1, P. 16 Goldsmith, Marsha F. The newest group affected by the AIDS epidemic is teenage girls, according to the director of the Adolescent AIDS Program at Montefiore Medical Center in Bronx, N.Y. Dr. Karen Hein, who is also professor of pediatrics and associate professor of epidemiology and social medicine at Albert Einstein College of Medicine in Bronx, made her statements at the American Medical Association's recent two-day Early Intervention Conference. She said the number of 13- to 21-year-olds in the United States who have contracted HIV has increased by 77 percent in the last two years. Within this age group, half of the HIV transmission occurs through heterosexual intercourse. Dr. Hein said that doctors are now learning more about HIV-infected teenagers as they become ill and enter HIV programs. But she and her colleagues in the Montefiore program--the nation's largest, with 90 HIV-positive adolescents involved--believe that less than five percent of the infected teens nationwide are in the age-specific programs that can best serve them. Hein said some of the findings at Montefiore included: a wide variation in the number of sex partners, with half of the girls having fewer than five life-time partners; all of the girls were totally unaware of their HIV risk and could understand what put them at risk only in retrospect; the major risk factor was so-called survival sex--trading sex for food, shelter, or crack cocaine; and finally, not one of the young women in the program was able to convince her partner to use a condom on a regular basis. Hein concluded that it is time for prevention and medical service efforts to collaborate "and look at prevention in light of the fact that HIV is well established in the teen community." In-Vitro Synthesis of Antibodies to Toxoplasma Gondii by Lymphocytes From HIV-1-Infected Patients * Lancet (07/03/93) Vol. 342, No. 8862, P. 22 Vendrell, Jean-Pierre et al. AIDS patients who experience neurological abnormalities may benefit from toxoplasma-specific in-vitro antibody because it could serve as a useful biological marker for the diagnosis of toxoplasmic encephalitis, write Jean-Pierre Vendrell et al. of the Centre Hospitalier Regional et Faculte de Medeince in Montpellier, France. The researchers examined toxoplasma- specific in-vitro antibody production by peripheral blood lymphocytes (PBL) in 124 HIV-positive adults. PBL from 20 of 21 patients with cerebral toxoplasmosis demonstrated spontaneous in-vitro secretion of antibodies to Toxoplasmosa gondii antigens. Of 103 HIV-positive patients without symptoms of toxoplasmosis, PBL from 19 produced toxoplasma-specific antibodies in vitro; 5 of these patients, who discontinued prophylaxis for toxoplasmic encephalitis, showed in-vitro antibody production 3-15 months before the diagnosis of toxoplasmic encephalitis. Specific antibody production could help distinguish between intracranial mass lesions caused by T gondii reactivation and those caused by other processes such as lymphoma or progressive encephalitis, thus limiting the need for brain biopsy. Moreover, toxoplasma-specific in-vitro antibody production is exhibited several months before the onset of encephalitis, the researchers conclude. Pitfalls in the Care of Patients With Tuberculosis * Journal of the American Medical Association (07/07/93) Vol. 270, No. 1, P. 65 Mahmoudi, Artin and Iseman, Michael D. Drs. Artin Mahmoudi and Michael D. Iseman have analyzed documents of pulmonary tuberculosis patients in a referral center between 1989 and 1990 to determine the management decisions that may have been linked to acquiring drug resistance. The physicians used practice standards set by the American Thoracic Society, the Centers for Disease Control and Prevention, and the American College of Chest Physicians as measurement guides against the management decisions. Both doctors wanted to see if management made any mistakes that led to treatment failure. Errors were found in 28 cases out of 35 study patients, averaging 3.93 mistakes per patient. Common mistakes included the addition of a single drug to a failing regimen, failure to pinpoint pre-existing or acquired drug resistance, beginning an inadequate primary treatment, failure to pinpoint and address noncompliance, and unsuitable isoniazid preventive treatment. The multi-drug resistance acquired through management mistakes led to prolonged hospitalizations, therapy with more toxic drugs, and high-risk resectional surgery. This extra therapy expenditures averaged $180,000 per patient. July 15, 1993 AIDS: It's Not About 'Us vs. Them' * Washington Post (07/15/93), P. A27 Graham, Jim The fight against AIDS should not be seen as homosexuals versus heterosexuals or blacks versus whites, but should fought as a single concerted effort, writes Jim Graham, executive director of Washington, D.C.'s Whitman-Walker Clinic. A July 7 article by Courtland Milloy was disturbing because it emphasized in divisive fashion the issues of race, gender, and sexual orientation regarding anti-AIDS efforts, says Graham. Milloy used phrases like "fierce lesbian warrior" and "loyal gay cabal" in proposing that Washington, D.C.'s AIDS resources should be distributed according to race and sexual orientation. However, says Graham, AIDS is not about sexual preference or the color of one's skin. None of that is relevant as much as the quality of care available to people in desperate need of help. Reading Milloy's column, a person would think that there were few, if any, black AIDS services in the District. This is not the case. The city hosts one of the premier efforts to address the needs of children with AIDS--Grandma's House. Moreover, Milloy's article does not mention of the Inner City AIDS Network and the significant contribution it makes to street outreach and prevention. There is also IMPACT-D.C., a city-funded AIDS service agency providing help primarily to African Americans with AIDS. Predominantly black churches in the city have outreach ministries that reach this population, as well. Anti-AIDS groups must work together, minimize the divisiveness, and concentrate efforts on the real enemy, which is AIDS itself, concludes Graham. Swatch Watches and Magic Johnson to Raise $1 Million for Charity * United Press International (07/14/93) (Los Angeles, CA) Former Los Angeles Lakers basketball star Magic Johnson and Swatch watches revealed plans on Wednesday to work together to raise more than $1 million for AIDS-related causes and inner-city youth programs. Johnson is expected to host three fund-raising parties, and Swatch will contribute a percentage of earnings from its new Swatch stopwatch. The funds generated from the effort will benefit the Magic Johnson Foundation, which provides money for both AIDS programs and inner-city youth projects. The campaign will fund Swatch Creative Arts Centers at the Challengers Boys & Girls Club in South Los Angeles, the Off the Street Club in Chicago, and the Creative Arts Workshops for Kids in New York. Regarding the campaign, Johnson said, "If ever we're going to rebuild L.A., it's going to take companies like Swatch who give not only their money, but their time." "Rock the Vote's Patrick Lippert Dies of AIDS" United Press International (07/14/93) (Los Angeles, CA) The executive director of last year's Rock the Vote voter registration effort died Tuesday of AIDS. Patrick Lippert was 35 and died at the Daniel Freeman Marina Hospital in Marina Del Rey, Calif. Actress Meg Ryan, who was a close friend of Lippert's, said, "He was an idealistic man and he lived that way. On top of all these other things, he was so relentlessly optimistic, and he inspired that in a lot of people." In 1991, Lippert was diagnosed with AIDS, but he did not disclose his condition to more than a few people until mid- 1992. He worked on several projects almost until the his death, including an Oscar-night fund-raiser for the Elton John AIDS Foundation and a record by 10,000 Maniacs that will benefit Rock the Vote. Pneumocystis Carinii Pneumonia During Primary HIV-1 Infection * Lancet (07/03/93) Vol. 342, No. 8862, P. 24 Vento, Sandro, et al. Pneumocystis carinii pneumonia (PCP) can be experienced in primary HIV-1 infection, and it is important to note this so that such cases are not misdiagnosed as AIDS, write Sandro Vento et al. of the "A Pugliese" Hospital in Catanzaro, Italy. The researchers examined three patients with severe CD4 lymphocytopenia (62-91 cells/uL) and inverted CD4/CD8 ratios (0.13-0.15) who developed PCP during symptomatic, primary HIV-1 infection. Within four months that symptoms had been exhibited, the patients' CD4 counts and CD4/CD8 ratios returned to normal. Between 29 and 48 months after contracting HIV-1 infection, the patients showed no signs or symptoms of progression to AIDS. While the mechanisms leading to effective control of HIV-1 replication in primary infection remain to be determined, the researchers' findings indicate that these mechanisms can be activated even after a high degree of clinically relevant immunosuppression has been reached, and that CD4 cell depletion is easily reversible in peripheral blood. Therefore, PCP can occur in primary HIV-1 infection, and profound CD4 lymphocytopenia can revert to normal without antiretroviral therapy, the researchers conclude. Pulmonary Tuberculosis in HIV-Infected Patients as Criterion for AIDS in Europe * Lancet (07/03/93) Vol. 342, No. 8862, P. 50 Cayla, Joan A. et al. Pulmonary tuberculosis in HIV-infected patients should be a criterion for AIDS only if immunosuppression is demonstrated by a negative tuberculin skin test and/or low CD4/CD8 ratio, write Joan A. Cayla et al. of the Institut Municipal de la Salut in Barcelona, Spain. The European Center for the Epidemiological Monitoring of AIDS recently urged all European countries to adopt its expanded AIDS case definition, which includes pulmonary TB, recurrent pneumonia within twelve months, and invasive cervical cancer in HIV-positive patients. In Barcelona, both AIDS and TB are monitored with active epidemiological surveillance. In 1991, the rate of TB was 67 per 100,000 residents, and AIDS was 26 per 100,000. The researchers determined the impact of the inclusion of pulmonary TB in HIV-positive cases as a criterion for AIDS reporting. The increase in AIDS cases was 17 percent in 1991 and 23 percent in 1992. In European countries with a high rate of HIV and Mycobacterium TB co-infection, the new definition would substantially boost the AIDS rate. Spain would continue showing the highest rate of HIV infection in Europe. While AIDS diagnosis must imply immunodeficiency, this does not always apply in the HIV-positive patient with pulmonary TB, since some show no clear immunosuppression. Such is the case for about 50 percent of the researchers' patients. The hypothetical restriction of the European definition to pulmonary TB patients in the presence of immunodeficiency may halve the calculated increases of 17 percent and 23 percent. However, major interest in the European expanded definition will hopefully promote better control of HIV and pulmonary TB, conclude Cayla et al. Agenda: Condoms 2, Church 0 * Advocate (07/13/93) No. 633, P. 18 Surprising calls for condom use recently came from France and Ireland--two predominantly Roman Catholic countries. Andre Collini, the Roman Catholic archbishop of Toulouse, France, encouraged condom use in an unusual challenge to the teachings of Pope John Paul II, who emphasizes that abstinence as the only protection against AIDS. "If one cannot change one's sexual habits, then one does not have the right not to use a condom, because that would mean becoming an agent of death," said Collini, "and the [Fifth} Commandment says, 'Thou shall not kill.'" In a separate issue, the Irish parliament rejected last-minute pleas from the Roman Catholic Church and passed a bill eliminating age restrictions for condom sales and allowing the devices to be sold in vending machines. The measure is still pending in the Senate. No News Is Bad News * Advocate (07/13/93) No. 633, P. 24 Bull, Chris The outcome of the Ninth International Conference on AIDS in Berlin held in June was gloomy because of presentations which supported the theory that AIDS will not be eradicated from the earth any time soon. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Robert Gallo, director of the tumor cell biology laboratory at the National Cancer Institute, agreed for the first time that antiviral drugs alone will not be enough to stop the spread of HIV because of the virus' complexity. Fauci said the benefits of many anti-AIDS drugs are very limited. In addition, Gallo reversed his early support of antiviral therapy for AIDS, claiming that because new strains of HIV are becoming resistant to existing drugs, scientists should now focus on other avenues of research. Fauci recommended that the next phase of treatment should come from "using agents that might block certain aspects of [HIV] activation without compounding immunosuppression" in combination with agents that would inhibit the replication and spread of HIV "by putting the cells of the immune system into a state of total activation." Walter Dowdle, director of vaccine development for the Centers for Disease Control, said even if a vaccine is made, it will take years and billions of dollars to distribute it around the world. "We must take care to make sure that the public understands that AIDS will not go away even if a vaccine is developed," said Dowdle. June Osborn, chairwoman of the National Commission on AIDS, said regarding AIDS treatment, "There is no magic bullet that can be shot off to make it all be over. If the conference helped us all get over that illusion, we are all better off." July 16, 1993 D.C. Fires 2 Officials in Mishandling of AIDS Contract * Washington Post (07/16/93), P. B5 Goldstein, Amy Due to alleged improper handling of a bid on an AIDS contract with a clinic connected to the Nation of Islam, two Washington, D.C., health officials were fired yesterday, according to city sources. D.C. Commissioner of Public Health Mohammad Akhter informed Floyd H. Agostinelli and Elizabeth D. Kilpatrick yesterday of their dismissals, after an internal probe into complaints that they had inappropriately directed a contract for an AIDS education campaign away from the Abundant Life Clinic, said sources. The dismissals came less than one week after Akhter dismissed Caitlin Ryan, chief of the District's AIDS agency, and suspended two other agency administrators involved in the contract. The controversy that led to the dismissals began last month when Abdul Alim Muhammad, director of the Abundant Life Clinic in Washington and health minister in the Nation of Islam, protested to Mayor Sharon Pratt Kelly that Ryan had inappropriately intervened in the clinic's contract proposal. The complaint spurred an investigation conducted by the D.C. Department of Human Services. A source familiar with the case said investigators concluded that Ryan had violated city rules by attending a meeting of the contract review panel when she was not a panel member. But Kilpatrick, who knew Ryan should not have attended the meeting, had allegedly arranged it where the contract was discussed and involved Ryan, said the source. Investigators found that Agostinelli advised lowering the panel's rating of the Abundant Life proposal to guarantee that the contract was awarded to another bidder, the source said. Hearings on Surgeon General Nominee Postponed * Washington Post (07/16/93), P. A1 Schwartz, John Hearings scheduled for today to confirm President Clinton's nominee for Surgeon General will be delayed due to emerging questions regarding her finances, according to a Senate committee. The Clinton administration has been prepared to defend Joycelyn Elders, the Arkansas health official whose views on sex education and abortion rights have made her nomination controversial. However, various attacks on her business dealings Thursday seemed to surprise senior administration officials. Consequently, Sen. Don Nickles (D- Okla.) requested a delay of the hearings before the Senate Labor and Human Resources Committee yesterday. Nickles cited a recently settled lawsuit concerning the National Bank of Arkansas, for which Elders was a board member. Critics have also argued that while awaiting her appointment, she has been receiving paychecks as Arkansas' state health director and as a federal consultant to the U.S. Department of Health and Human Services, which is considered "double dipping." But an HHS spokeswoman disputed the claim and said the consulting fees were earned on Elders' vacation days accrued while serving in her Arkansas post. In announcing the postponement of the hearings until July 23, a joint statement from Sens. Edward M. Kennedy (D-Mass.) and Nancy Landon Kassebaum (R-Kan.), said, "The additional time will enable the committee to obtain and review banking documents in the possession of the controller of the currency." Yesterday White House communications director Mark Gearan said President Clinton is "unequivocal in his support for Elders" and that the administration sees no problem with the delay. China Orders AIDS Screening of Blood Supplies * Reuters (07/15/93) Parker, Jeffrey (Beijing) Chinese health officials have directed all blood banks to screen donated blood for HIV, but they warn that a lack of money would slow down the introduction of the nationwide screening effort. The move signifies the increased concern about the safety of blood supplies. Although the rate of AIDS cases in China is relatively low, it is believed to be growing rapidly. Sun Xinghua, an AIDS prevention specialist at the Ministry of Public Health, said that the ministry had released a nationwide circular requiring all blood donating facilities to begin testing donated blood for HIV. He said the chances of contracting the virus via donated blood were extremely low, but China must implement the same safeguards adopted in the West. Sun said full implementation could take a long time, as a result of logistic and financial limitations. In addition, there is more concern in the country about screening for hepatitis C virus. Sun said he was not aware of any cases of HIV transmission through tainted blood transfusions. Nevertheless, health officials in Shanghai said last week one case of HIV was being investigated. The ministry has recorded more than 1,000 cases of HIV infection, but has only a dozen cases of people with full-blown AIDS--nine of whom have died. Approximately one-third of HIV-infected Chinese are IV-drug users in southern Yunnan province bordering southeast Asia's opium-growing Golden Triangle. However, an increasing number of cases of sexual transmission are being connected to prostitution, which has recently escalated as economic reforms have made people wealthier. New HIV Treatment Guidelines Offer Flexibility on AZT * American Medical News (07/12/93) Vol. 36, No. 26, P. 5 Staver, Sari New guidelines for treating HIV-positive adult patients have been provided by an independent panel appointed by the federal government. The recommendations, revealed after a three-day conference at the National Institutes of Health in Bethesda, Md., offer more flexibility than the previous treatment guidelines issued in 1990. Under the new guidelines, initiation of AZT treatment is no longer recommended for all asymptomatic HIV-positive patients whose CD4 cell counts fall below 500. Physicians may continue to monitor patients for immune system depletion, at which point drug treatment should begin. The guidelines suggest initiating drug therapy in symptomatic infected patients with CD4 counts below 500. Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said the guidelines are not required but will help physicians and patients "make the most informed decisions about whether to begin, change, or combine therapies." The guidelines stress that patients and doctors should develop a treatment plan together. The 18-member panel recommends that AZT be used in patients with no prior antiviral treatment. Using AZT in conjunction with DDI or DDC may be also be considered, even though clinical trials have not conclusively proven clinical benefit from combination therapy. For AIDS patients who cannot tolerate AZT, the panel suggests discontinuing therapy if CD4 counts exceed 500; switching to DDI at 50 to 500 CD4 counts; and switching to DDI or DDC, or stopping treatment when levels are below 50. Burroughs Sues Over Patent Right to AIDS Drug * American Medical News (07/12/93) Vol. 36, No. 26, P. 14 The manufacturer of the anti-AIDS drug AZT is currently involved in a trial that could determine whether generic drug makers are permitted to make a less expensive version of AZT. Burroughs Wellcome is trying to prevent any violation of its exclusive patent right to produce AZT. The drug company argues that its researchers developed AZT and that the patents give the company a monopoly on it until the year 2005. But generic drug companies argue that federal money and personnel were a substantial part of the development of AZT, and that no one company should have exclusive rights to it. The National Institutes of Health backs the generic companies. Burroughs Wellcome had filed suit against Barr Laboratories Inc. of Panoma, N.Y., and Novopharm, a Canadian company, after they asked the U.S. Food and Drug Administration to allow them to make AZT. A ruling against Burroughs Wellcome could mean a version of AZT that is cheaper than the $2,200-a-year wholesale cost currently charged by the company. Revenues totaling $388 million worldwide on AZT were generated in Burroughs Wellcome's last full year of sales, including $195 million in the United States. Physicians Not Fazed by AZT Guidelines * Nature (07/08/93) Vol. 364, No. 6433, P. 93 Macilwain, Colin The guidelines on when to administer AZT to HIV-positive patients issued by a panel of the U.S. National Institute of Allergy and Infectious Diseases has drawn little controversy among physicians. The new guidelines replace the ones issued in 1990, which recommended routine prescription of AZT in all patients whose CD4 counts were below 500. The panel still suggests antiretroviral drugs for AIDS patients who present symptoms of AIDS, with AZT recommended as the first line of treatment. However, for patients who have low CD4 counts but no actual symptoms, the panel suggests that physicians decide on what the proper prescription drug is that should be administered. Doctors working with HIV-positive patients in major U.S. cities claim that the guidelines will have little impact on their current practice of not prescribing AZT to patients on the basis of low CD4 cell counts alone. Dr. Donald Abrams, assistant director of AIDS practice at the San Francisco General Hospital, said, "I've always been somewhat cautious about prescribing these drugs. The guidelines won't change my practice at all." Dr. Abrams criticizes the panel for neglecting to say anything about the need for additional clinical trials to establish better treatment options. According to Spencer Cox of the New York-based Treatment Action Group, the guidelines will mainly affect small-town America and inner-city clinics where patients may receive little personal attention. CDC Offers New Guidance on Drug-Resistant TB * American Medical News (07/12/93) Vol. 36, No. 26, P. 1 Voelker, Rebecca The Centers for Disease Control and Prevention has issued new guidelines in an effort to stop further spread of drug- resistant tuberculosis. Doctors should begin all TB patients on a four-drug program of isoniazid, rifampin, pyrazinamide, and either streptomycin or ethambutol, the CDC said. All patients should be closely watched because failure to finish the regimen results in the development of drug resistance. The four-drug treatment can cure about 95 percent of TB patients if strictly observed when therapy begins, the center added. Ethambutol or streptomycin reduces the time needed to ensure that patients are not contagious. The CDC announcement occurred when Pfizer Pharmaceuticals Inc. decided to begin U.S. production of streptomycin again. Company officials halted production because of sterility problems in large supplies from a foreign manufacturer. TB cases resistant to at least one drug have been noted nationwide. In New York, 19 percent of cases showed drug resistance to isoniazid and rifampin, the two most powerful TB drugs, according to the CDC. 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 07.12.93 ]]]===----- .