Subject: CDC Summary 2/5/93 Date: Fri, 05 Feb 1993 14:46:53 PST (271 lines) Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD Archive-Number: 117 AIDS Daily Summary February 5, 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 ====================================================================== "Research Group Says AIDS Epidemic Will Have Little Effect on U.S." New York Times (02/05/93), P. A12 The National Research Council has found that although thousands of people have died from AIDS and there is currently a sense of emergency about the disease, the AIDS epidemic will have little impact on the lives of most Americans. The National Research Council's study, released yesterday, said that AIDS was concentrated among homosexuals, drug users, and the poor and undereducated--so-called "socially marginalized groups" with "little economic, political, and social power." Consequently, the council said that AIDS "will disappear," not because, like small pox, it will have been eliminated, but because those who continue to be affected by it are "socially invisible, beyond sight and attention of the majority population." The council is part of the National Academy of Sciences, a private organization funded by Congress to provide scientific advice to the federal government. The study concluded that public health officials will return to more conventional practices, including HIV testing, after initially abandoning them. The report said that AIDS has evoked an awareness that involves a wider acceptance of measures that help promote "safe sex," including the use of condoms. The study said that while AIDS has strained health-care resources in some communities, most areas have been able to take in the new patients. The effect of AIDS on clinical research has led to fewer restrictions on the testing of drugs for lethal diseases, the council found. However, the study said that as the epidemic becomes more centralized in poor communities, the resources for voluntary efforts may decrease. Related Stories: Baltimore Sun (02/05) P. 1A; Los Angeles Times--Washington Edition (02/05) P. A1; Philadelphia Inquirer (02/05) P. A3 ====================================================================== "Clinton Will Drop Travel Ban on HIV Patients" Los Angeles Times-- Washington Edition (02/05/93), P. A6 (Lauter, David and Cimons, Marlene) President Clinton wants to eliminate the controversial prohibition against HIV-positive foreigners entering the country, the White House said Thursday, but administration officials conceded that quick action is not likely. George Stephanopoulos, the President's communications director, said that he could not provide a date for abolishing the rule because the government has not yet reviewed its Haiti policy. Approximately 270 Haitians, most of whom are infected with HIV, are being detained at the U.S. naval base at Guantanamo Bay in Cuba, even though they have been approved for political asylum. Clinton advisers indicated that the president is not eager to start a controversy over another gay-related issue, as he did recently over the military ban on gays. Therefore, the administration will not take action on the policy toward Haiti until later this year. The ban on HIV-positive foreigners was instituted in 1987 by the Reagan administration. Health experts have repeatedly contended that AIDS--unlike highly infectious tuberculosis--should not disqualify a foreign immigrant because the disease cannot be contracted through the air or through casual contact. Dr. James O. Mason, the former assistant secretary of Health and Human Services who opposed the ban on HIV-positive foreigners, quietly signed off on removing the ban after the presidential election and sent a directive for final approval to the White House budget office, according to government sources. However, Stephanopoulos said the issue would be referred to the Justice Department for review before a final decision is made. ====================================================================== "Japanese Electronics Firm Reports Biological Discovery" Washington Post (02/05/93), P. F3 (Blustein, Paul) A Japanese electronics company has developed an antibacterial material that is believed to possess antiviral properties that could be effective against viruses such as HIV. Matsushita Electric Industrial Co., the maker of Panasonic, Technics, and other electronic products, has found a new substance that can deactivate HIV in a test tube. The company said it will "make the substance available for research." Last spring, Matsushita researchers developed the Amenitop agent, an antibacterial powder with special properties that allow it to be mixed into plastics. The company was attempting to develop a process for making its appliances, such as electric dish dryers, free of bacteria. The researchers thought that if Amenitop were mixed into the plastic, the appliance wouldn't spread bacteria to dishes the way other brands can. Later in the year, Matsushita introduced an Amenitop-laced cordless phone and personal fax machine. Subsequently, the company conducted joint research with an Osaka University professor, Shigeharu Ueda, to determine if Amenitop was effective against bacteria and viruses. They found that Amenitop is indeed "effective in inactivating" certain viruses, including HIV and herpes, in the test tube. Matsushita spokeswoman Jane Sweeney said regarding the finding, "Well, we're into speculation here. But HIV, you know, can only be transmitted through bodily fluids.... So, it's very, very speculative..." ====================================================================== "Many Doctors in Mass. Help HIV Patients Track Partners" Boston Globe (02/04/93), P. 1 (Tye, Larry) Due to the lack of the state's resources for tracking needle- sharing and sexual partners of HIV-positive patients, several Massachusetts doctors do the tracking themselves in cooperation with their patients. The Massachusetts Medical Society is currently pressing the Department of Public Health to improve its partners notification program. Although the health commissioner opposes such an idea, some of his staff claim that lives could be saved if they were provided with more information on people with HIV and more freedom to trace their sex and needle-sharing partners. Dr. Nicholas J. Fiumara, who until 1984 ran the Health Department's communicable and venereal disease program and now runs the sexually transmitted disease clinic at the New England Medical Center, is one of the physicians who conducts his own sex/drug partner tracing. "I interview all my patients and ask that they bring in their sexual contacts. I do it routinely and have been since 1985." He added, "Among medical groups there is a consensus that these people should be interviewed for contacts, the sexual contact should be examined, and if they're infected, they should be treated." While many doctors do their own contact-tracing, they are not trained in the techniques and "if they divulge information to someone they know is at risk, they can be sued by the patient; they face criminal charges," said Dr. William Callahan, president of the Massachusetts Medical Society. In addition, he said that in order to be effective, contact-tracing should be done through public health workers, who "are trained, they're qualified, and they're confidential." ====================================================================== "Newspaper Says 72 Have Died of AIDS in Russia" Reuters (02/03/93) Moscow--A total of 72 people have died of AIDS in Russia in the seven years since the first case was identified, according to the evening newspaper Izvestia. The paper said 611 people are infected with HIV, and 92 people have full-blown AIDS. Epidemiologist G. Pankova said that 18 adults and 43 children had died from AIDS in the Commonwealth of Independent States (CIS), which includes most of the states of the now defunct Soviet Union. In the late 1980s, Russia experienced scandals involving hospitals that re-used needles and ignored basic health guidelines. More than 100 children were among those who contracted HIV in 1989 after they were infected with tainted blood. Former Russian Health Minister Andrei Vorobyov said in March that thorough testing for HIV had helped control the number of Russians infected with the disease. He announced that the government had implemented a three-year anti-AIDS program and said the estimates of a drastic rise in HIV infections had not been fulfilled. ====================================================================== "Japan--AIDS Drug" Associated Press (02/04/93) Tokyo--A Japanese company has announced that it has found a less expensive way to develop AZT. Kanematsu Corp. expects to begin selling thymidine, a primary ingredient in AZT, made by the new technique by the end of this year. The compound will be sold to drug companies that will subsequently use it to make AZT. Kanematsu spokesman Yoshikazu Tsugawa said the agent will be made by Kobayashi Koryo, a pharmaceutical company, using a process that is up to 50 percent less expensive than the conventional method. Tsugawa said thymidine is currently made through fermentation, while the new process developed by Kobayashi Koryo uses heat evaporation. He said, "There are many people around the world, particularly in poorer countries, who can't afford the medicine. Bringing the price down should make it available to many more people." He added that Kanematsu expects to concentrate on markets in India and Brazil. ====================================================================== "Sexual Risk Behaviors of STD Clinic Patients Before and After Earvin "Magic" Johnson's HIV-Infection Announcement--Maryland, 1991-1992" Morbidity and Mortality Weekly Report (01/29/93) Vol. 42, No. 3, P. 45 Former basketball star Magic Johnson's announcement that he tested HIV-positive prompted behavioral change throughout society. A study by the Centers for Disease Control found that people were inclined to be more selective when choosing a sexual partner and tended to have fewer partners after Johnson's announcement. The study involved 283 people attending a sexually transmitted diseases (STDs) clinic in a Maryland suburb of Washington, D.C., during the 14 weeks before and the 14 weeks after Johnson revealed his HIV-positive status. Among the participants, 186 (66 percent) were interviewed during the 14-week preannouncement (July 29- Nov. 1, 1991) and 97 (34 percent) during the 14 week postannouncement period (Nov. 11, 1991-Feb. 14, 1992). Overall, 87 (31 percent) had had one or more STDs during the previous 12 months; 220 (78 percent), two or more sex partners during the previous 12 months; and 157 (55 percent), 10 or more sex partners during the previous 10 years. The CDC found no significant differences in patients' reports of condom use in vaginal sex during the previous 3 months. But substantially fewer patients in the post-announcement period than the preannouncement period reported having had either "one- night stands" (20 percent versus 31 percent) or three or more sex partners of the opposite sex (21 percent versus 32 percent) during the previous 3 months. ====================================================================== "Differences Between Anonymous and Confidential Registrants for HIV Testing--Seattle, 1986-1992" Morbidity and Mortality Weekly Report (01/29/93) Vol. 42, No. 3, P. 53 While people seeking anonymous or confidential HIV testing reported similar risk factors, confidential registrants were more likely than anonymous registrants to test positive for HIV, according to a study conducted by the AIDS Prevention Project (APP), which is part of the Seattle-King County Department of Public Health. APP clients have been offered a choice in how they register since 1986--either confidentially (using names) or anonymously (using an identified code). Between June 1986 through March 1992, the APP collected demographic, behavioral, and clinical data on 9,993 persons seeking HIV testing. Among the 9,310 persons who were tested and for whom follow-up information was available, the percentage who returned for results (93.7 percent) did not differ by sex. Of the 6,841 men who were tested and for whom follow-up information was available, there were no differences in the proportions of anonymous or confidential registrants who did not return for results. But of the women who were tested and for whom follow-up information was available, 73 (7.8 percent) of 930 confidential registrants and 86 (5.6 percent) of 1,530 anonymous registrants did not return for results. It was found that both men and women who registered anonymously were older, better educated, and more apt to report middle-or upper-income levels and were less likely to test HIV-positive. Men who tested anonymously were somewhat more inclined to report having had sex with other men. Women tested anonymously were more likely to report heterosexual contact as the primary risk factor. ====================================================================== "Mycoplasma Fermentans in Individuals Seropositive and Seronegative for HIV-1" Lancet (01/30/93) Vol. 341, No. 8840, P. 271 (Katseni, Vassiliki et al.) There is no link between infection by the mycoplasma and the stage of AIDS, CD4 count, or HIV-1 load, according to Vassiliki L. Katseni et al. of the St. Mary's Hospital Medical School in London, U.K. Mycoplasmas have been believed to serve as a co-factor to explain various unknown features of infection by HIV. The researchers sought Mycoplasma fermentans by means of a semi-nested polymerase chain reaction (PCR) in samples of peripheral-blood mononuclear cells (PBMC), throat swabs, and urine samples from 117 HIV-positive patients (of whom 114 were homosexual men). M. fermentans was found in 12 (10 percent) PBMC samples, 15 (23 percent) of 65 throat samples, and 4 (8 percent) of 55Jurine samples form the HIV-positive subjects. The organism was found in similar proportions among 73 HIV-negative patients recruited from a sexually transmitted diseases clinic (9 percent, 20 percent, and 6 percent, respectively); again, most of the men (40 of 50) in this group were homosexual. This suggests that M. fermentans is part of the normal flora of the throat and genitourinary tract, isolated rarely because of the insensitivity of culture techniques. The researcher's culture procedure is a hundred to a thousand times less sensitive than the PCR. The high sensitivity of the PCR increases the chance of false-positive results, but the researchers negative controls in each assay remained negative--the proportion of samples positive was similar for each batch tested, and repeated tests produced the same results. These findings do not eliminate the potential that the mycoplasmal infection could influence the speed of disease progression, the researchers conclude. ====================================================================== "Total Lymphocyte Count as a Prediction of Absolute CD4 Count and CD4 Percentage in HIV-Infected Persons" Journal of the American Medical Association (02/03/93) Vol. 269, No. 5, P. 622 (Blatt, Stephen P. et al.) When a doctor must evaluate an HIV-positive individual without a recent CD4 count, the combination of clinical data and the total lymphocyte count (TLC) may allow a reasonable estimation of the vulnerability of that individual to opportunistic infection, write Stephen P. Blatt et al. of the Military Medical Consortium for Applied Retroviral Research in San Antonio, Texas. The researchers conducted a study of 828 patients with no prior history of AZT use, from January 1985 through July 1991. The sensitivity, specificity, and likelihood ratio (LR) of the TLC, in the range of 1,000 to 2,000 CD4 T-cells, in predicting an absolute T-cell count less than 200 or a CD4 percentage less than 20 percent were calculated. It was found that the TLC between 1,000-2,000, appears to be a useful predictor of significant immunosuppression as measured by a T-cell count less than 200 in HIV- positive persons. The LR for a given TLC value and the pretest probability of immunosuppression can be used to determine the posttest probability of significant immunosuppression in individual patients. For instance, a patient with a TLC less than 1,500 and a pretest probability of 16 percent, the posttest probability of a low T-cell count increases to 53 percent. But a TLC greater than 2,000 in an individual with a pretest probability of 30 percent will decrease the posttest probability of a low T-cell count to less than 4 percent. Physicians should find these data effective in helping estimate the risk of opportunistic infection among HIV-positive persons who present with syndromes that are potentially compatible with opportunistic infection but who have not had a prior T-cell analysis.