Subject: CDC Summary 2/1/93 Date: Mon, 01 Feb 1993 08:30:05 PST (237 lines) Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD Archive-Number: 66 AIDS Daily Summary February 1, 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 ======================================================================= "AIDS Tracking Request Raises Privacy Issues" Washington Post (01/31/93), P. A19 The Pennsylvania Department of Health announced that it wants medical laboratories to report the names of patients with white blood- cell counts low enough to indicate potential AIDS cases. But critics argue that such reporting violates individuals' rights to privacy and may deter people from undergoing testing and treatment for AIDS. The health department's request, released on Jan. 4, was drafted to better gauge the spread of HIV infection under the new federal definition of the disease. Laboratories were asked to report the patient's name, address, age, sex, and race. State officials mentioned that the labs were being encouraged to provide the information, but compliance was not mandatory. Francis J. Stoffa Jr., executive director of the AIDS Task Force, said, "It's abhorrent. This is statistics at the expense of privacy and the confidence that people require to come forward to get early intervention and treatment." In addition, critics said the new reporting could result in mistaken identification of AIDS among people who experience other disorders affecting white blood cells. However, Bobby Jones, state director of AIDS epidemiology, said all names would be kept confidential. He added that the program could help determine the number of AIDS cases across the state by pushing physicians to report them more effectively. ======================================================================= "Advertising: Turning a New Page, Playboy Takes Up the Fight Against AIDS" New York Times (02/01/93), P. D6 (Elliott, Stuart) Playboy magazine is taking an unprecedented move this month to support the Design Industries Foundation for AIDS, known as Diffa, which has raised more than $10 million for AIDS-related causes since 1984. Although the amount to be given by fund-raising and in-kind contributions like employees' time and services is uncertain, it could eventually reach seven figures. George W. Slowik Jr., Diffa's chairman in New York and publisher of the trade magazine Publishers Weekly, said, "Playboy can have tremendous impact in terms of broadening the types of individuals and organizations that will pay attention to the issue." In the past, publications have avoided AIDS issues, because they fear being labeled as gay and losing readers and advertisers, according to AIDS groups. Michael S. Perlis, Playboy's president and publisher in New York said, "We're a magazine about men and all the pursuits that men enjoy, so we've always believed in communication about all things sexual. That means AIDS is something for us to talk about. We want to alert people that safety and responsibility are an important part of sexuality in the 90's." This month's issue of Playboy has a full-page advertisement, produced by the magazine and running space donated by the magazine, promoting a T-shirt design competition. The T-shirts with the winning design will be sold through Playboy's pages, and all proceeds will be donated to Diffa. Also, on Feb. 10, a "Valentine Day's for Couples Only" party in New York, sponsored by Playboy, will benefit Diffa. In future issues, the magazine will feature candid safe-sex ads in donated space. ======================================================================= "D.C.'s New Death Row" Washington Post (01/31/93), P. C1 (Mencimer, Stephanie) The Washington, D.C., Department of Corrections should provide a compassionate release program for inmates with AIDS, while educating prisoners on how to prevent HIV infection, writes columnist Stephanie Mencimer. To incarcerate a person in the District costs about $23,300 a year. But an AIDS patient who needs acute medical care can cost the system more than $60,000 a year. What is worse is the projected 3,000 HIV-prisoners who have not yet developed AIDS and who will need medical care within the next decade. Even though it is six years into the war on drugs, which came with tough mandatory minimum sentences, D.C. prisons are now overwhelmed with high-risk people. A Department of Corrections study that will be issued this month says that more than 20 percent of all D.C. inmates are HIV-positive. That is compared to one- tenth of 01 percent of the public at large, according to Keesler King, director of Whitman-Walker Clinic's AIDS education program. Dr. William Hall, assistant director of health services for the D.C. Department of Corrections, predicts that as many inmates will die of AIDS this year as in all the previous years combined. Prisoners with AIDS do not obtain adequate medical care in the prisons. If a ward is already full of inmates requiring specialized care, AIDS patients must be shackled to a bed in a regular hospital room with a 24-hour armed guard at the door--even prisoners who are so near death they couldn't possibly escape. Not only could the city find considerable savings in releasing inmates with AIDS, but it would also relieve the strain that they put on the criminal justice system, concludes Mencimer. ======================================================================= "U.S. Tuberculosis Cases Increasing Alarmingly" United Press International (02/01/93) (Wasowicz, Lidia) San Francisco--Tuberculosis is reappearing in the United States and the list of those infected is growing by more than 20,000 each year, according to an expert who spoke at the four-day Second International Workshop on the Oral Manifestations of HIV Infection. Dr. John Molinari, chairman of the Department of Biomedical Sciences at the University of Detroit Mercy School of Dentistry, said, "The annual increase of 20,000 new cases--plus an additional 1,000 per year--was not counted on by the U.S. Public Health Service, which had set the year 2010 for the total eradication of the disease." He said there is "potential for a major explosion" in the number of infections from TB. "Mycobacterium Tuberculosis poses significantly different risks from those of the blood-borne microbes that cause hepatitis and AIDS. The current trends are very disconcerting," noted Molinari. He said the resurgence of TB is partly due to the influx of immigrants from Third World countries where the disease runs rampant and also due to the spread of HIV infection and poverty. Molinari told dentists to take protective measures even though they face a much smaller risk than hospital or nursing home workers who come in prolonged contact with undiagnosed patients. A total of 200 health-care workers have tested positive in TB skin tests at one facility alone, although none have shown symptoms. Because only five percent of infected people show any signs of the disease during the first 12 months, many of the remaining 95 percent may not even know they are contagious. He said another 10 percent will develop symptoms over the next two years, but the rates among HIV-positive patients are much higher. ======================================================================= "Brain Biopsy for Intracranial Mass Lesions in AIDS" Lancet (01/23/93) Vol. 341, No. 8839, P. 242 (Martinez, Esteban) While brain biopsy should not be used on random AIDS patients with intracranial mass lesions, the more defined the indications are for brain biopsy, the more effective this diagnostic procedure will be, write Esteban Martinez et al. of the Hospital Clinic i Provincial in Barcelona, Spain. A Nov. 7 Lancet editorial on brain biopsy for intracranial mass lesions in AIDS says that primary prophylaxis for toxoplasma encephalitis might be effective. But there are no conclusive data on how effective it would be. Also, primary prophylaxis for toxoplasma encephalitis is not widely accepted. Whether an AIDS patient with intracranial mass lesions should be treated empirically with antiotoxoplasma drugs will depend on several individuals and geographical characteristics. The number of CD4 cells per uL, the presence of previous positive serological rests for Toxoplasma gondii, and the number of lesions on compared tomography or magnetic resonance imaging should all be considered. The patient's clinical status will decide whether biopsy would establish a definite diagnosis if non-invasive procedures had failed to do so. Moreover, routine necropsy in AIDS patients would establish the aetiology of intracranial mass lesions in an individual and the prevalence of various causes in a specific AIDS population as well as its relation to immunity status or other epidemiological factors, the researchers conclude. ======================================================================= "Violation of Disabilities Act?" American Medical News (01/25/93) Vol. 36, No. 4, P. 01 (McCormick, Brian) A Philadelphia-area physician has filed a lawsuit under the Americans with Disabilities Act (ADA) and is believed to be the first such professional to do so. The orthopedic surgeon, known only as John Doe, accuses Philadelphia's Mercy Health Corp. of infringing upon the law's anti-discrimination provisions, which consider HIV infection to be a disability. Dr. Doe's HIV-infected status was first learned by officials at Mercy Catholic Medical Center after one of his colleagues disclosed it in 1991. The hospital subsequently obtained permission under a Pennsylvania law to inform Dr. Doe's patients of a possible exposure risk and offer them HIV testing. After conducting a "look back" study, Mercy Catholic suspended Dr. Doe's privileges. Hospital medical staff officials later decided to reinstate those privileges without restrictions, if Dr. Doe posed no substantial risk to patients. However, last July the hospital board overruled the physicians. They told Dr. Doe he could perform "invasive procedures" only if his patients signed consent forms indicating they had been informed of his condition. Dr. Doe filed suit in late November after months of attempting to negotiate a settlement that did not include such notification. But hospital officials claim they were justified and within the law. Dr. Doe sued under Section I of the ADA, which prohibits discrimination in employment, and under Section III, which prevents public accommodations from discriminating against the disabled. In addition, he filed a complaint with the Equal Employment Opportunity Commission under the ADA. ======================================================================= "Availability of Sulfadiazine--United States" Journal of the American Medical Association (01/27/93) Vol. 269, No. 4, P. 461 Requests for the drug sulfadiazine/trisulfapyrimidine (triple sulfa) were given to the Centers for Disease Control by pharmacies nationwide between Dec. 6-12, 1992. Sulfadiazine and triple sulfa are sulfa drugs frequently used in combination with pyrimethamine for the treatment of central nervous system toxoplasmosis in patients with AIDS and newborns with congenital infections. A telephone survey was conducted by the CDC and the Food and Drug Administration because of the requests. It was conducted among all pharmaceutical manufacturers approved to make these drugs and several major distributors that in the past were suppliers of the two sulfa drugs. It was found that were no large inventories of either drug available from major distributors. Until a commercial source of sulfadiazine is fully restored, doctors should consider using clindamycin in combination with pyrimethamine for the treatment of acute toxoplasmosis in AIDS patients. This combination has been reported to be similar in efficacy to pyrimethamine and sulfadiazine in the treatment of acute toxoplasmic encephalitis in such patients. For secondary treatment there is no consensus on an acceptable alternative, but a combination approach may be better than single-agent regimens. The CDC has acquired a small supply of sulfadiazine/triple sulfa that will be provided for persons with acute disease who cannot tolerate clindamycin and for congenitally infected infants. Those doctors who wish to obtain a three-week supply of triple sulfa or sulfadiazine from the CDC for such patients must give the CDC an abbreviated medical history, a Toxoplasma antibody titer, and reasons why clindamycin could not be administered. ======================================================================= "News in Brief: Ohio" Advocate (01/26/93) No. 621, P. 25 The U.S. Department of Health and Human Services announced on Dec. 17 that Memorial Hospital in Fremont, Ohio, could be disqualified from receiving reimbursements under the Medicare program because it allegedly refused treating a man with AIDS. Federal officials said the hospital's action violated the Americans With Disabilities Act, which forbids discrimination based on disability. However, hospital officials do not feel they violated the law. ======================================================================= "News in Brief: International" Advocate (01/26/93) No. 621, P. 31 HIV infection may be spreading uncontrollably throughout many parts of the world, according to medical experts. William Haseltine, human retrovirology division chief at Harvard University's Dana-Farber Cancer Institute, said that nearly 5 million Americans could have AIDS or be infected with HIV by the year 2000. HIV could infect more than 01 billion people--one fifth of the world's population--in the decades following the year 2000, said Haseltine. Statistics by the World Health Organization indicate that HIV infection has been reported in almost all nations, and full-blown AIDS in 164. Dr. Michael Merson, AIDS program chief at WHO, said, "The next two to three years are critical. We are running out of time when we can make an impact, especially in Asia." Physicians at WHO estimate that 1.2 million Asians contracted HIV by mid-1992, compared with 675,000 six months earlier. They also say the epidemic seems as if it's ready to spread rampantly throughout Asia--much as it did in Africa 10 years ago. WHO projected in December that most of the 10 million children that AIDS will have orphaned by the year 2000 will be from sub-Saharan Africa. However, the Global AIDS Policy Coalition, an advocacy group, said in its annual report, issued in late 1992, that several countries seem to be apathetic about trying to control AIDS in the Third World. Developed countries spending to fight AIDS in developing nations has been static since 1986. About eight times more was spent in 1991 on AIDS prevention in North America than in the entire developing world, and six times more was spent in Europe, despite statistics showing the growing AIDS problem in the Third World.