Subject: CDC Summary 2/2/93 Date: Tue, 02 Feb 1993 10:23:19 PST (246 lines) Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD Archive-Number: 78 AIDS Daily Summary February 2, 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 ====================================================================== "Dentists at Greater Risk for Hepatitis Than AIDS Infection" United Press International (02/02/93) (Wasowicz, Lidia) San Francisco--The risk of dentists becoming infected with hepatitis is more than 50 times higher than that for HIV, according to a researcher attending the Second International Workshop on the Oral Manifestations of HIV Infection. Eli Capilouto, associate professor at the Lister Hill Center for Health Policy at the University of Alabama, said he examined the chance of infection with either hepatitis B virus (HBV) or HIV, through a needle stick or a prick with a sharp instrument. "I calculated the cumulative annual risk for HIV infection for dentists is 3 per 100,000," said Capilouto. He added, "But hepatitis B--because of its much higher prevalence--carries a greater chance of transmission, 16 per 10,000. That means a typical dentist in a typical population is over 50 times more likely to be infected from HBV than HIV." This comparison applies only to dentists who have not been vaccinated against hepatitis. Capilouto chose midrange statistics for his calculations resulting from various data. While estimates differ greatly, the middle-of-the-road figures show that 700,000 of the 249 million Americans are infected with HIV, or 0.28 percent. But for hepatitis, the number of Americans infected with HBV is about 1 million, or 0.4 percent. While death from AIDS is almost inevitable, a dentist is 1.5 times more likely to die from HBV than an HIV infection, said Capilouto. He made his conclusions after using national surveys that show an average dentist has a total of 2,800 annual visits from patients. Capilouto discovered that out of 10,000 visits, 12 patients carry the risk of infection with either virus. ====================================================================== "Health-Care Safety Rules" Wall Street Journal (02/02/93), P. B6 A federal appeals court in Chicago ruled that new workplace-safety guidelines intended to protect health-care workers from hepatitis B and HIV infection are valid. The appeals court rejected a challenge by the American Dental Association (ADA), which contended that it was unfair to apply the rules to all health-care workers when some are more likely to be exposed to infection than others. The court admitted that the rules, instituted by the Occupational Safety and Health Administration last year, might be expensive to follow and unneeded in some situations, but it maintained that they are valid. The guidelines involve standards for protective clothing and workplace cleanliness, and they mandate that employers provide free, confidential HIV tests to workers exposed to infection. The new rules will cost the health-care industry $813 million, according to OSHA. However, industry representatives and the appeals court indicated the cost could be even higher. The Seventh U.S. Circuit Court of Appeals said the ADA and others arguing the rule had not shown that the benefits were outweighed by the costs. Dissenting Judge John L. Coffey questioned whether OSHA rather than government health agencies should be regulating health care. He said, "I am forced to assume that because of the excessive media coverage regarding the AIDS virus, fueled by one single episode involving Kimberly Bergalis in Florida contracting AIDS from her dentist, OSHA decided to promulgate this over-expansive rule." The ADA is considering a rehearing or a Supreme Court review and is asking Congress to revise the rules. ====================================================================== "Pa. Expands Coverage of HIV Drugs" Philadelphia Inquirer (02/02/93), P. B3 (Motley, Wanda) Pennsylvania welfare officials yesterday extended the number and types of AIDS drugs available to sick people who depend on state assistance to receive medication. Officials said that 10 additional drugs, including antibiotics and anti-HIV drugs, will be provided under Pennsylvania's Special Pharmaceutical Benefits Program. The program is funded with $2.5 million from federal and state sources, and covers only four drugs used in the treatment of AIDS. AIDS activists applauded the decision by the Department of Public Welfare, but said the expansion was long overdue and in some ways imprudent. They said that most of the newly covered medications have been widely prescribed for the last several years. In addition, AIDS advocates chastised the state for its handling of the program, which approves only specific name drugs rather than families of drugs. "With the technology developing so rapidly, it's limiting the potential benefit for persons living with AIDS by restricting them to specific brand names," said Bruce Flannery, a spokesman for ActionAIDS in Philadelphia. However, Welfare Department spokeswoman Mary Ellen Bolish said the state could not afford the program if it involved families of drugs. The program serves Pennsylvanians who earn too much to be eligible for Medicaid, but less thanJ$30,000 annually for families and $25,000 for individuals. The new drugs available include Videx, Hivid, Zovirax, Foscavir, Cipro, Bactrim/Septra, Dapsone, Mycelex, Nizoral, and Diflucan. The program already provides AZT, Pentamidine, Alpha- Interferon, and Ganciclovir. ====================================================================== "Pa. Reviews AIDS Policy for Labs" Philadelphia Inquirer (02/02/93), P. A1 (Collins, Huntly) Pennsylvania health authorities announced yesterday that they would reexamine the controversial new AIDS policy that asks laboratories to report by name people with low white blood cell counts. Due to pressure from AIDS activists, Philadelphia's health commissioner, Dr. Robert K. Ross, said the city would immediately suspend its implementation of the state policy, which began on Jan. 4. "The city has not adequately explored the alternatives [to name-based reporting]," said Dr. Ross. The controversy involves the state's request that medical laboratories voluntarily report to state health officials the name, address, age, sex, and race of anyone who has fewer than 200 T-cells per cubic milliliter of blood. Because of the new federal definition of AIDS, which states that T-cell levels under 200 could indicate that a person has the disease, Pennsylvania made its move accordingly. State officials have said they would use the names to contact patient's physicians, reminding them of their legal obligation to report anyone with AIDS. In order for the state to receive its share of federal funding of AIDS, an accurate count of all AIDS patients needs to be obtained. However, critics argue that revealing the names is illegal under a state law that protects the privacy rights of HIV-positive individuals. The law, known as Act 148, requires that no one can reveal confidential information, such as test results, related to a person's infection with HIV. Critics also argue that naming people with low T-cell counts will discourage them from being tested and treated for AIDS. ====================================================================== "Philippines Warned of AIDS Crisis" Reuters (02/01/93) Manila--The AIDS case rate in the Philippines is starting to resemble that of Thailand, said Philippine Health Secretary Juan Flavier on Monday. The chief government supporter on the use of condoms told a forum on family planning, "If we don't do anything today, five years from now we will be where Thailand is today--1,500 HIV infections per day or about half a million infections a year." Flavier said there had already been 368 reported cases of HIV infection in the country. He added that unreported cases could total as much as 36,000. Among the 368 HIV-positive individuals, 89 developed full-blown AIDS, and 62 of the AIDS patients have died. Flavier has aggressively pushed the use of condoms to thwart the spread of HIV in the largely Roman Catholic nation. He was condemned by church leaders who oppose artificial contraception and was criticized for condoning sexual promiscuity by urging the use of condoms. "The fact is promiscuity came ahead of condoms," said Flavier in response. "Be good. If you can't be good, be careful. If you can't be careful, use condoms," he said. ====================================================================== "WHO Calls on Companies to Fund AIDS Prevention" Reuters (01/31/93) Davos, Switzerland--The World Health Organization (WHO) official responsible for the agency's Global Program on AIDS encouraged business leaders on Sunday to invest in programs to prevent the spread of HIV infection. WHO's Michael Merson told a news conference at the annual World Economic Forum, "Money spent now on changing behavior to slow the spread of infection will return billions of dollars of lost income and health care expenditure in the economy." He added that direct costs of AIDS to health and welfare services worldwide were already using up about $5 billion a year. In addition, the direct costs of the epidemic through lost productivity, lost markets, and the cost of training new workers to replace those lost to the disease could be up to 10 times greater. Merson said companies could help combat the disease by educating staff about AIDS at the workplace and by supporting research into prevention and care of those infected with HIV. He said companies could also support government and community AIDS "prevention and care" efforts, both by donating money and seconding staff to provide practical assistance. He said, "In the United States, average treatment costs for an AIDS patient are around $100,000, so by preventing 10 people from becoming infected a company health scheme will save $1 million." A study had demonstrated that Thailand had health-care costs to as much as between $615 and $1,000 a year. However, indirect costs to the economy through premature death of adults in the prime of their working years was nearly $22,000 per death. ====================================================================== "Stretched Thin: Jump in AIDS Caseload Puts the Squeeze on State and Local Agencies" Advocate (02/09/93) No. 622, P. 18 (Akin, Scott R.) The federal government's new definition of AIDS, put into effect on Jan. 1, is expected to double the caseload and will severely strain AIDS services, according to AIDS activists. Cornelius Baker, director of public policy and education for the National Association of People With AIDS, a Washington, D.C.-based lobbying group, said, "The federal government hasn't responded by creating policies that recognize the greater expanse of the disease." AIDS experts argue that a lack of planning and preparation by federal, state, and local governments continued throughout the approximately two years that the Centers for Disease Control spent disputing the expansion. Dr. James Ward, acting chief of the surveillance branch of the CDC's HIV-AIDS division, said the impact on local health care resources should be limited because people who are considered as having AIDS are not significantly more ill than they were before the definition took effect. However, Jim Singleton, an epidemiologist in the California State AIDS office, said that once people learn that they have what is considered AIDS in the new definition, "they may be more likely to seek treatment" than when they were just HIV-positive. Public hospitals providing AIDS treatment may be inundated with even more patients, but that does not make much of a difference since they were already overwhelmed, said Dennis Andrulis, president of the National Public Health and Hospital Institute. Catherine Lynch, a policy associate at the New York City AIDS Service group Gay Men's Health Crisis, said the CDC, "can define AIDS any way it wants, but if people can't get to a doctor, it doesn't mean anything." ====================================================================== "Ensuring Proper AIDS Treatment" Business Insurance (02/01/93) Vol. 27, No. 5, P. 17 (Woolsey, Christine) "Waiting for the first case of AIDS before starting an education program is like waiting to create a fire evacuation program when you smell smoke," says Paul A. Ross, corporate manager of the HIV/AIDS program at Digital Equipment Corp. Ross, who is the entire staff of the five-year-old AIDS Program Office, currently oversees educational programs and consults with management and personnel to assess the incidence and emerging issues of the disease at the company. But by March, Digital should have finalized standards of care for HIV and AIDS patients. The guidelines were developed by Ross and the 85 Health maintenance organizations that serve Digital's employees after Ross conducted a survey which showed mixed reactions concerning healthcare from HIV/AIDS patients who had switched from the company's managed indemnity plan to the HMOs. The program has already saved Digital money. Ross says, "The average cost of our HIV cases ranged from $90,000 to $120,000 from diagnosis to death. Our costs now are about $80,000 or less per case, while the average cost for companies our size is still about $120,000." Because of this cost efficiency, the program has not been cut, while many other company functions have been eliminated. ====================================================================== "Children With Pulmonary TB Respond Well to Drug Therapy" AIDS Alert (01/93) Vol. 8, No. 1, P. 5 HIV-positive children with pulmonary tuberculosis, including those with drug-resistant strains, can be effectively treated. Drug therapy was successful in 10 HIV-infected children with pulmonary TB who were studied at the Children's Hospital of New Jersey in Newark--one of whom had multidrug-resistant TB. There were no TB recurrences or TB-related deaths after 14.2 months. Children with non-resistant strains of TB responded well to treatment with isoniazid (INH), rifampin, and/or pyrazinamide (PZA). The child with the drug-resistant form of TB was treated with a combination of five medications: INH; rifampin; PZA; streptomycin; and ethambutol. Dr. George McSherry, assistant professor of clinical pediatrics at the University of Medicine and Dentistry--New Jersey Medical School in Newark, said due to the increased prevalence of drug-resistant TB in Newark and surrounding regions, the facility's protocol now requires HIV-positive children to receive a combination of three drugs as initial therapy. He added that they usually start children with pulmonary or extrapulmonary TB on INH, rifampin, and PZA until the sensitivity reports are returned. Since HIV destroys the body's ability to react to purified protein derivative (PPD), not all children with HIV have positive PPD skin tests. Therefore, in children who are suspected of having TB or of being exposed to TB, additional testing such as a chest X-ray or lung biopsy may be needed. McSherry said that children who are suspected of having TB but who have a negative PPD are treated, regardless. "Most HIV-positive children with TB in this series had typical pulmonary TB, most had some degree of PPD reactivity, and all were successfully treated," said McSherry.