Subject: CDC Summary 1/21/93 Date: Thu, 21 Jan 1993 07:54:19 PST (217 lines) Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD Archive-Number: 8 AIDS Daily Summary January 21, 1993 The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse makes available the following information as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold. Copyright 1992, Information, Inc., Bethesda, MD "U.S. Set Back in Vote on W.H.O. Chief" New York Times (01/21/93), P. A8 (Altman, Lawrence K.) The World Health Organization, which coordinates worldwide anti- AIDS efforts, reelected the current head of the group, despite an aggressive diplomatic effort by the United States and its European allies to unseat him. The WHO's executive board voted 18-to-13 to recommend Japanese physician Hiroshi Nakajima over a rival candidate Dr. Mohammed Abdelmoumene, an Algerian who was supported by the United States, Canada, and the European Community. In the effort to oust Dr. Nakajima, one State Department memorandum asserted that the Japanese Government had resorted to "aggressive tactics, including the pursuit of votes in exchange for favors" in its attempt to defend him. The vote by the executive committee is expected to be confirmed at the annual assembly of WHO's 181 members in May. Dr. Nakajima has lead the United Nation's agency for five years. Critics said that while WHO had long had many first-rate health-care workers on its staff, there were fewer appointments of such high-caliber people during Dr. Nakajima's administration. Morris Abram, the United States representative to the United Nations in Geneva, argued, "It is essential that this agency be well and efficiently managed." Abram reaffirmed the United States' continuing support for WHO and added that the nation's "long-standing commitment to the World Health Organization transcends any personalities or leadership." "Capturing the Strained Social Life of Manhattan" New York Times (01/21/93), P. C15 (Holden, Stephen) A new comedy at the WPA Theater in New York is about a gay man in his mid-30's who is tired of negotiating safe sex and decides to become celibate. The play, "Jeffrey," was written by Paul Rudnick. The title character, Jeffrey, estimates that he has had about 5,000 sexual encounters but remained HIV-negative. He says, "I'm not promiscuous. It's such an ugly word. I'm cheap." The play exhibits the strained social tenor of Manhattan life as it is currently lived, writes critic Stephen Holden. Holden adds that the "desperate, brittle tone of the hilarity underscores the ghastly sense of the absurd that the AIDS epidemic has brought to hyper-sophisticated Manhattan society." Aside from the humor, "Jeffrey" copes with questions of life, death, and erotic partnership that many other people face as well. The play's other main character, Steve (Tom Hewitt), is a bartender whom Jeffrey meets in a gym and who could be his soul-mate. However, Steve is HIV- positive, and Jeffrey fears of getting involved with someone who could become ill and die at any moment. Other sketches in the play are satirical and stress the complexities of safe sex. "AIDS Spreading Faster in French Overseas Territories" Reuters (01/20/93) Paris--AIDS has emerged as the leading killer of young adults in France's overseas territories, where the rate of infection is higher than on the mainland, according to French Overseas Radio (RFO). RFO conducted a survey which revealed that 931 cases had been reported among 2.3 million people living in French Guiana, the Indian Ocean island of La Reunion, and the Caribbean islands of Martinique and Guadeloupe. Misleading information and poverty have contributed to the disease's spread. However, RFO said the AIDS statistics appeared to be unreliable because of inadequate health facilities in the territories. AIDS prevention efforts such as the distribution of condoms were also more difficult to implement because of the local traditional values which oppose their use. In addition, AIDS patients in the territories are more hesitant to publicly disclose their condition because of its association with homosexuality, which is not as widely accepted in the overseas territories as it is in mainland France. "Sports Doctor Shares Personal AIDS Tragedy to Deliver Vital Message" USA Today (01/20/93), P. 5C (Woodward, Steve) Leading American skaters will gather this week to compete at the U.S. Figure Skating Championships, but will also take in some valuable information about AIDS. Steve McQueen, a Salt Lake City physician and chairman of the U.S. Figure Skating Association's (USFSA) sports medicine committee, will speak to the sport's best and brightest and enlighten them, in detail, about the complications of AIDS. McQueen's brother died of AIDS at the age of 47. Despite an influx of controversial reports of AIDS-related deaths among Olympic-caliber male skaters in Canada and Europe, the top U.S. competitors have been spared losses. The USFSA has acknowledged the growing AIDS threat throughout society by incorporating AIDS awareness into its drug education program for national-level skaters. Since the annual U.S. Championships gather top skaters in all age groups--343 are registered for this week's nationals--the event provides an ideal venue for addressing the AIDS issue. McQueen said, "Like a lot of younger people, [skaters] feel this is something that may not concern them. With more cases [of AIDS] showing up among skaters, we think we have to be even more open." Last December, a report in the Calgary Herald had mentioned 40 skaters and coaches in North America who have AIDS. But the USA's most renowned male skaters of recent generations--Scott Hamilton, Brian Boitano, and Paul Wylie--claim they can't name one serious competitor in the U.S. who has AIDS or has died of the disease. McQueen hopes to dispel all of the myths about the disease among the skating community. "HIV Viraemia and Seroconversion" Lancet (01/09/93) Vol. 341, No. 8837, P. 113 (Lu, Wei et al.) The disappearance of infectious viruses in plasma during and after seroconversion does not suggest the clearance of cell-free HIV, write Wei Lu et al. of the Universite de Paris V, in Paris, France. Dr. Ariyoshi and colleagues report in the Nov. 21 Lancet that the first autologous isolate-specific neutralizing antibody activity was not detectable during seroconversion, but recognized after seroconversion and increased with time. They indicate that humoral factors are not responsible for the suppression of primary viraemia in early HIV infection because a rapid decline in infectious virus titre in plasma around the time of seroconversion was not coincident with the appearance of isolate-specific neutralizing activity. Ariyoshi et al. were misled by several inaccurate interpretations of the data. They use the neutralization assay that allows the titration of the specific virus-free neutralizing antibodies. The virion-combined neutralizing antibodies would not be detected by the assay. Also, the neutralized viruses in plasma would not be detectable in an infectious viral culture. Therefore, a double-negative result for both assays might suggest either no virus and no antibody or a virus-antibody equilibrium event. The high concentrations of total free viral particles during and after seroconversion, together with the rapid decrease of high- titre viremia, indicates a rapid loss of viral infectivity other than virus itself. The specific neutralizing antibody response seems to be the most direct mechanism that can account for the rapidly suppressing infectivity of primary viremia in early HIV infection, the researchers conclude. "HIV Progression and Immune Activation" Lancet (01/09/93) Vol. 341, No. 8837, P. 113 (Ludlam, C.A., and Steel, C.M.) Patients with A1B8DR3 and/or systemic lupus erythematosis (SLE) have immune systems of increased activity which allows HIV replication to proceed faster, possibly because of an increased density of CD4 receptors on lymphocytes, write C.A. Ludlam and C.M. Steel of the Royal Infirmary and Western General Hospital, respectively, in Edinburgh, U.K. In the Oct. 10 issue of the Lancet, Dr. Learmont and colleagues report long-term asymptomatic HIV infection in five of six recipients of blood from a single donor who has been symptom-free for 10 years. The one recipient who developed AIDS and died of Pneumocystis carinii pneumonia after 4.3 years had SLE. They conclude that the prednisolone he was administered resulted in immunosuppression, which allowed more rapid progression to AIDS, and mention an additional patient with SLE treated with immunosuppression who fared poorly after HIV infection, to support their hypothesis. However, Ludlam and Steel believe there is another explanation for the rapid progression in individuals with SLE, an autoimmune disorder strongly linked with the HLA haplotype A1B8DR3. The presence of this haplotype in non-SLE patients infected with HIV is associated with a more rapid drop in CD4 counts and clinical progression of HIV disease, and this has been confirmed by others. Ludlam and Steel believe patients with SLE progress more rapidly because their immune systems are hyperactive. Thus, immunosuppressive therapy immediately after initial HIV infection may be an appropriate option. Nevertheless, additional studies are warranted to define why individuals with HLA A1B8DR3 progress rapidly after HIV infection, conclude the researchers. "Microsporidia Infection in Patients with the Human Immunodeficiency Virus and Unexplained Cholangitis" New England Journal of Medicine (01/14/93) Vol. 328, No. 2, P. 95 (Pol, Stanislas et al.) Infection of the biliary tract with E. bieneusi is related to and may be the cause of AIDS-related cholangitis, write Dr. Stanislas Pol et al. of the Unite d'Hepatologie, Hopital Laennec in Paris, France. The researchers evaluated eight HIV-positive homosexual men who were referred because of cholangitis for which no causative agent had been found by standard tests. All of the patients received abdominal ultrasonography and endoscopic ultrasonography or endoscopic retrograde cholangiopancreatography with collection of bile from the common bile duct. One patient had transhepatic biliary catherization, and two others had cholecystectomy. Bile samples, duodenal- and liver-biopsy specimens, and gallbladder tissue were examined by light and electron microscopy. All eight patients with unexplained AIDS-related cholangitis had biliary microsporidiosis. Intraepithelial E. bieneusi spores and supranuclear plasmodia were identified in the six duodenal- biopsy specimens. May-Grunwald-Giemsa staining of bile samples showed free forms of microsporidia in all eight patients, and the presence of E. bieneusi was confirmed by electron microscopy. E. bieneusi was also detected in ductal biliary cells on a liver biopsy, in one common- bile-duct smear, and in gallbladder epithelium in two patients. Four patients were found to have associated but previously undetected biliary or duodenal cryptosporidiosis, whereas another had biliary infection associated with cytomegalovirus. E. bieneusi infection of the biliary tract could account for at least some of the cases of AIDS- related cholangitis that are not explained by cryptosporidium or cytomegalovirus infection. "New Ideas and Dark Holes" Advocate (01/12/93) No. 620, P. 49 (Delaney, Martin) The federal government must stop funding studies of drugs that have limited efficacy, such as AZT, ddI, and ddC, and start funding promising new approaches so they can soon become practical, clinically useful drugs, writes Martin Delaney, executive director of Project Inform, a non-profit gay community foundation that supplies AIDS treatment information. One encouraging approach called the leucine zipper is designed to stop HIV from infecting cells by blocking mechanisms that the virus uses to link up with cells. It was named such because it is composed of identical amino acids in a repeating chain, which some believe resembles the chain of little metal tabs that make up a zipper. The new product seemingly provides one side of the zipper, while the other side is provided by a structure on the outer core of HIV. It proved effective in laboratory tests by completely blocking further infection by HIV. Another promising technique was developed by AIDS researcher Flossie Wang-Staal and her colleague, Arnold Hempel. They reported that they have succeeded in creating a molecule thatJliterally slices up the virus' genes, which control all its activities. If genes are eradicated or severely damaged, the virus is weakened and unable to reproduce or further any damage. A third approach developed by Dennis Burton uses monoclonal (man-made) antibodies, which are cloned in great numbers from a single antibody to fight against disease and link up with and block HIV. All three of these new methods will be meaningless unless they are quickly developed into real products that are ready for human testing and treatment, concludes Delaney.