Subject: CDC Summary 2/11/93 Date: Thu, 11 Feb 1993 07:35:23 PST (251 lines) Archive-Number: 181 From: Billi Goldberg Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary February 11, 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 ====================================================================== "Puzzling AIDS-Like Illness Not Believed to Be New Virus" Washington Post (02/11/93), P. A3 The mysterious AIDS-like condition that was reported at last July's Eighth International Conference on AIDS in Amsterdam probably has many different causes and almost definitely does not result from a single new virus, according to conclusions from several studies. Many researchers at the conference told of patients who had many classic symptoms of AIDS but were not HIV-positive. The main sign was significantly low levels of T-cells. The cases prompted controversy and raised the possibility that some unidentified virus was on the loose, causing a new form of AIDS. The condition was subsequently named idiopathic CD4 T- lymphocytopenia, or ICL. Researchers published six reports on the condition, featured in Thursday's New England Journal of Medicine, and determined that ICL is rare. A total of 111 U.S. cases have been reported, but the Centers for Disease Control discovered only two when it reviewed 230,179 cases in its AIDS files. The syndrome is not contagious because spouses and acquaintances of victims have not contracted it, and it does not appear to be spread through blood transfusions. Several of the cases may have resulted from bacteria, fungi, and other parasites. The illness has been present at least since 1983 and probably much longer, but was not identified because tests for T-cells have only been available for a few years. The researchers said there is no reason to believe that a single virus is responsible for most cases. Scott D. Holmberg of the CDC, co-author of one of the studies, said, "The cases represent a hodgepodge of different clinical and immunological entities," rather than one disease. Related Story: New York Times (02/11) P. A23; Los Angeles Times--Washington Edition (02/11) P. A1; Baltimore Sun (02/11) P. 17A ====================================================================== "Haitians Hope Strike Will Open Safe Haven" Washington Post (02/11/93), P. A4 (Duke, Lynne) The more than 200 Haitian refugees held at the Guantanamo Bay Naval Base in Cuba were yesterday in their 13th day of a hunger strike, which is expected to continue until the Clinton administration considers lifting an immigration ban against HIV-positive individuals. The Haitians are protesting against the ban and the prison-like conditions that have kept them at the base for months. Many refugees said they feel they have no choice but to strike to make themselves heard. Although they are unsure whether such extreme measures will be effective, they said they are willing to die trying. Among the 267 refugees, 215 are HIV-positive, including one child and 15 of the 19 pregnant women. The refugees feel that President Clinton must eliminate the ban because he promised to do so in his campaign and through spokesmen this week. American immigration authorities decided early last year that these refugees had plausible claims of political asylum from persecution at home. More than 10,000 of their compatriots who tested HIV-negative were allowed to enter the United States in the months following the September 1991 coup that toppled the democratically elected presidency of Jean-Bertrand Aristide. A trial is scheduled for March 8 at U.S. District Court in Brooklyn, N.Y., to determine whether the refugees have the right to legal counsel and whether the ban should be lifted. If the trial occurs before the ban is lifted, the Clinton administration could be left defending a Bush administration policy with which it claims to disagree. Related Story: Los Angeles Times--Washington Edition (02/11) P. A2 ====================================================================== "Hong Kong Says China AIDS Screening Ineffective" Reuters (02/10/93) Hong Kong--The policy of random HIV testing in China is ineffective, said Hong Kong health chief Elizabeth Wong on Wednesday. The colony will confer about the spot-checks with Chinese officials. For several years China required long-term foreign residents to be tested for HIV. However, late last year the country announced it was extending the screening to include frequent visitors. Authorities in the southern Chinese city of Guangzhou claim that any visitor who has arrived from overseas and has been to the mainland more than 12 times in a year can be forced to provide a blood sample on the spot. Hong Kong AIDS welfare workers consider the policy a violation of human rights, and legislators in the colony on Wednesday urged Wong to make a formal protest to China. Wong said discussions would be held, but provided few details. When asked whether Hong Kong would press for all of its residents to be exempted from the tests, Wong said, "All ideas will be offered for discussion." Hong Kong residents, several of whom have relatives or businesses in southern China, are the most abundant visitors to the mainland. More than 900 people are HIV-positive in China, and more than 300 have been identified in Hong Kong. ====================================================================== "AIDS Surgery" Associated Press (02/09/93) (Antczak, John) Los Angeles--A technician who was cut by a scalpel that came in contact with HIV-positive blood was awarded $102,500 on Thursday in a lawsuit against an HIV-positive patient who did not disclose her condition before the operation. A Superior Court jury ruled that patient Jan Lustig committed fraud and negligent infliction of emotional distress on surgical technician Diane Boulais. Even though Boulais has tested HIV-negative thus far, her attorney told jurors that she lives in fear of the disease developing in later months. Boulais said, "I am thrilled. It is a message that will help all health care workers." Lustig's attorney, Evan Wolfson, said the decision would be appealed. Boulais alleged that Lustig, a clinical psychologist from Vancouver, Wash., concealed her HIV-positive status because she knew no surgeon would perform breast reduction surgery on her as a result. The lawsuit says Lustig arranged for a breast reduction operation at The Breast Center in suburban Van Nuys, Calif., in 1991. She signed papers claiming she had no medical problems and wasn't being treated or observed for any illness. Boulais was helping remove stitches from Lustig when a scalpel nicked her finger, cutting it deeply. Subsequently, Lustig admitted she was HIV-positive, said Boulais' lawyer, Rex Beaber. Lustig said she had approached other physicians for the surgery but was rejected when they learned she was infected. "I was withholding information that was personal and private. I don't consider withholding information a lie. To me a lie is done with evil intent," she said in her testimony. ====================================================================== "AIDS Activists Protest at Hoffman-La Roche U.S. Headquarters" Reuters (02/09/93) Nutley, N.J.--AIDS activists protested against Swiss pharmaceutical company Hoffman-La Roche's reluctance to provide an experimental medicine for AIDS patients by chaining themselves to the gates of the company's U.S. headquarters, police said. Approximately 75 activists from ACT-UP/New York and Treatment Action Group secured themselves to the gates of the facility, said Ann Marie Nicolette of the office of emergency management in Nutley. A spokesman for the demonstrators said they were fighting against Hoffman-La Roche's failure to sufficiently test its experimental therapy TAT inhibitor. The spokesman said that Hoffman-La Roche has "dragged its feet" on testing the experimental agent and that after five years and $2.8 million in government subsidies, there is still no data on the effect of the medicine in humans. The activists explained that the TAT inhibitor prevents replication of already-infected cells, instead of protecting completely against HIV infection. Hoffman-La Roche said in a statement that its researchers feel the criteria for safety and efficacy have not been met for either of its two AIDS compounds--a TAT antagonist and an HIV-proteinase inhibitor--to allow them to be available on a widespread basis. Police said some of the activists were arrested, but did not elaborate on how many. ====================================================================== "Inhibition of HIV-1 Infectivity by Zinc-Ejecting Aromatic C-Nitroso Compounds" Nature (02/04/93) Vol. 361, No. 6411, P. 473 (Rice, William G. et al.) The design of zinc-ejecting compounds that target retroviral zinc fingers signifies a new technique in the chemotherapy of AIDS, write William G. Rice et al. of the National Cancer Institute--Frederick Cancer Research and Development Center in Frederick, Md. Retroviral nucleocapsid and gag-precursor proteins from all known strains of retroviruses contain one or two copies of an invariant sequence that is populated with zinc in mature particles. Modification of cysteine or histidine residues results in defective packaging of genomic viral RNA and formation of non-infectious particles, making these structures potentially attractive targets for antiviral therapy. The researchers recently reported that aromatic C-nitroso ligands of poly (ADP-ribose) polymerase preferentially destabilize one of the two zinc-fingers with concomitant loss of enzymatic activity, coincidental with selective cytocidal action of the C-nitroso substituted ligands on cancer cells. Based on the occurrence of (3Cys, 1His) zinc-binding sites in both retroviral nucleocapsid and gag proteins and in poly (ADP-ribose) polymerase, the researchers concluded that the C-nitroso compounds may also have antiretroviral effects. The researchers demonstrated that two such compounds, 3-nitrosobenzamide and 6-nitroso-1,2 benzopyrone, inhibit infection of HIV-1 in human lymphocytes and also eject zinc from isolated HIV-1 nucleocapsid zinc fingers and from intact HIV-1 virions. ====================================================================== "Sulfadiazine Shortage: Buyers' Club Has Drug" AIDS Treatment News (02/05/93) No. 168, P. 1 (James, John S.) Because the drug sulfadiazine's only U.S. manufacturer was forced to shut down production, an acute shortage of the drug has emerged in New York, Boston, and many other areas of the country. Sulfadiazine is part of the first-line treatment for toxoplasmosis, often experienced in AIDS patients, and a shortage could become life-threatening to such individuals. The Centers for Disease Control has acquired a small supply (enough for fewer than 70 patients), and is rationing it for emergency use, especially for infants with congenital toxoplasmosis. The CDC is requesting Food and Drug Administration approval to import more from Canada. However, even when an adequate emergency supply is obtained, issuance of the drug will entail considerable paperwork for each patient, which is usually an impossibility for public clinics. Moreover, it could take up to a year for commercial supplies to be restored. Nevertheless, the drug is plentiful and inexpensive abroad. The products available in other countries have not been explicitly approved by the FDA for U.S. sale, and there is no available procedure to give emergency permission for their importation. Both doctors and patients should be aware that sulfadiazine from Europe is available through the PWA Health Group, a New York "buyers' club" which has helped people import personal-use quantities of AIDS drugs not available in the United States. The group will ship the drug, but requires a prescription and the use of its own order form. The PWA Health Group is also attempting to find a way for the CDC to directly provide bulk supplies of the drug for hospitals and clinics. ====================================================================== "TP-5: Thymus Hormone Trial Suggests Benefit" AIDS Treatment News (02/05/93) No. 168, P. 2 (Gilden, Dave) Proof that the thymus gland is severely damaged during HIV infection has led to research on using thymus hormone replacement therapy as a way to compensate for the damage. Thymus hormones are proteins that influence the development of immune system T-cells in the thymus gland. In addition, they strengthen immune function in mature T- cells in the blood and lymph. Although the exact role of the hormones in AIDS treatment is undetermined, several experiments suggest that injecting thymus hormones can increase the numbers of various T-cell subpopulations. By improving the activity of the immune system's killer cells, they may increase these cells' ability to target and destroy cells infected with HIV. Three injectable thymus hormone derivatives are now in formal trials as AIDS therapies--TP-5 (thymopentin), THF (thymic humoral factor) and thymosin. No side effects have been cited for any of them. A study by AIDS physician Dr. Marcus Conant and his colleagues compared TP-5 against a placebo for 48 weeks in 354 asymptomatic HIV-infected subjects. The study was double blind. All of the study participants took AZT, and they started out with T-cell counts of between 200 and 500. For the study volunteers who had been taking AZT longer than six months, protection against early symptoms of HIV infection was apparent, though hard to quantify exactly. In this 235-person subgroup, 14 volunteers on placebo developed symptoms versus only four of those on TP-5. TP-5's sponsor, Johnson & Johnson, is currently preparing an expanded access program, but it will be at least two years before TP-5 will be federally approved. ====================================================================== "HIV, AIDS, and Africa" Lancet (02/06/93) Vol. 341, No. 8841, P. 366 (Ramsay, Sarah) A change in emphasis has been noted in the World Bank, which recently issued a report recommending that prevention efforts for sexually transmitted diseases in African nations should not just focus on HIV infection. This is significant because the World Bank has limited its lending to areas where AIDS is most prevalent on the continent. The authors of the report have re-evaluated and updated the Bank's 1988 Africa region agenda for action and request greater coordination of work on HIV and AIDS through existing programs, such as those encouraging safe motherhood and population control. In addition, the Bank's attention to AIDS must not result in a drain on resources from other curable diseases and from much needed long-term efforts to build health systems. AIDS programs supported by donors, for example, tend to offer higher salaries, and this diverts the already scarce help from other essential health-care activities. For African countries where the infection rate is already endemic, the authors stress that governments should develop approaches now to deal with the economic and social impact of the surge in adult mortality during the next 10-15 years. This means that an increasing number of African doctors treating HIV-positive patients will soon have to cope with a growing number of AIDS patients. The World Health Organization has issued a book that describes current guidelines on management and diagnosis of the disease, and calls for inexpensive laboratory tests. However, the authors mention that introduction of widespread testing would require outpatient facilities and follow-up procedures for asymptomatic HIV- positive people, which could be expensive.