Subject: CDC Summary 2/17/93 Date: Wed, 17 Feb 1993 07:41:59 PST (301 lines) Archive-Number: 232 From: Billi Goldberg Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary February 17, 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 ==================================================================== "Survey Finds a Third of Firms Have Policies on Workers With AIDS, HIV" Boston Globe (02/16/93), P. 43 (Brudney, Juliet F.) Approximately one-third of 535 mid-to-large-size companies surveyed nationwide have implemented anti-AIDS policies, according to The Wyatt Company, a human resources consulting firm. These programs included employee education, training for managers, one-to-one counseling, and referrals. Dr. John Bunker, a Wyatt consultant, said the policies usually condemn discrimination against people with HIV infection or AIDS, and state that reasonable accommodations will be made to help employees stay on the job as long as they can continue to perform essential functions. Moreover, confidentiality issues are discussed in most company policies. DAKA International, which owns restaurant chain Fuddruckers, was one of the companies surveyed. It requires all employees to attend a session on how HIV is contracted, and how to prevent it. Managers must attend half- to full-day training sessions that address company commitments, state and federal laws prohibiting discrimination and harassment of employees with AIDS or HIV, and the employer's obligation to provide reasonable accommodations. Also, an 800 information-and-referral telephone number is about to be established for internal use only. Polaroid is another company that provides an aggressive anti-AIDS program. It has considered prevention through education its major goal since its AIDS program was launched in 1987. In addition to educating employees, Polaroid has an information office equipped with multi-media materials that offers education sessions for employees' families and friends. The corporation and Polaroid Foundation fund home care, peer-led support groups, and other direct services. ==================================================================== "Chronicle: Randy Shilts, Whose Best-Seller About AIDS is Headed for HBO, Says He Has the Disease" New York Times (02/17/93), P. B4 Randy Shilts, the author of the book "And the Band Played On," yesterday revealed that he has AIDS. The best-selling book discussed the progression of AIDS from an obscure and largely ignored condition to a nationwide epidemic. Shilts disclosed his condition in an interview conducted late last week and printed yesterday in The San Francisco Chronicle. Shilts said he learned of his HIV-positive status in 1985, "on the day that I pulled the last sheet from the typewriter of 'And the Band Played On.'" Shilts said that he decided not to reveal his condition publicly until now because he was afraid that it might diminish the effectiveness of his reporting for The San Francisco Chronicle. "Every gay writer who tests positive ends up being an AIDS activist, and I didn't want to end up being an activist. I wanted to keep on being a reporter." Shilts has recently completed his third book, "Conduct Unbecoming: Gays and Lesbians in the Military." As he was nearing completion of the book, he suffered a collapsed lung that forced him to stop writing. Friends and associates helped him finish it. Currently, he is recuperating and in physical therapy and an undisclosed location. A television version of "And the Band Played On" will be aired on HBO in late summer, and is expected to involve several celebrity actors. ==================================================================== "Effort to Manufacture Artificial Blood is Thwarted" Los Angeles Times- -Washington Edition (02/17/93), P. B7 (Maugh, Thomas H.) The production of an artificial blood product has encountered an unexpected hindrance that may seriously postpone its commercialization, said a University of California--San Diego physician at a meeting of the American Association for the Advancement of Science. While researchers from the four companies conducting clinical trials on the artificial bloods have not disclosed the preliminary findings from their trials, enough information has been released to allow observers to figure out the cause of the difficulties, said Dr. Robert M. Winslow, a professor of medicine at UC-San Diego who was formerly in charge of the U.S. Army's efforts to develop an artificial blood. Participants in the clinical trials of the artificial bloods have reported various unexpected side effects, including chest pains, back pains, nausea, and hypertension. What seems to be the cause is nitric oxide (NO), which interacts with artificial blood, Winslow said. The hemoglobin in the artificial blood is leaking out of blood vessels and into the surrounding tissues, where it binds NO tightly, inhibiting its vasorelaxant properties, said Winslow. Consequently, the blood vessels constrict, causing the unusual symptoms. The problem could be very hard to solve because NO binds with the hemoglobin at the same molecular location that oxygen does. Any efforts to prevent the binding will most likely restrict hemoglobin's oxygen-carrying capacity. ==================================================================== "People and Places: Belgium Launches Condom Campaign" Baltimore Sun (02/17/93), P. 2A The condom is being strongly promoted in an anti-AIDS advertising campaign in Belgium, a predominantly Roman Catholic country. Social Affairs Minister Leona Detiege said that Belgians use condoms less than half as often as other Europeans. The condom was prohibited in Belgium until 1973, and advertising was under strict regulation until 1984. The new promotional campaign, called "Zet 'm Op"--which means both "put it on" and "go for it" in Dutch--will be featured in advertising on radio, television, and in cinemas. ==================================================================== "Senate Tackles AIDS Controversy" United Press International (02/17/93) (Gerstel, Steve) Washington--Senate Republicans have waged a major debate with President Clinton over his campaign pledge to eliminate the ban that prohibits HIV-foreigners from entering the United States. Senate Republican leader Robert Dole said Tuesday he would introduce an amendment to legislation re-authorizing the National Institutes of Health that would make the anti-immigration policy a law. However, Clinton had not signed the executive order to lift the ban. Health and Human Services Secretary Donna Shalala said it is still being reviewed, and Dole did not offer his amendment. But Dole's top deputy, Sen. Alan Simpson (R-Wyo.) said the proposal to lift the ban calls into question two things--are HIV-positive immigrants "a public health risk" and "do they become a public charge." Sen. Simpson said these questions and others call for thorough study before consideration is given to lifting the ban, and added that too frequently "we do something out of emotion, fear, guilt, yes, racism--and it's not always the right thing." Simpson said that among the 45,000 immigrants allowed into the United States, 20 percent are infected with HIV. The immigrants he spoke of are thought to be from Haiti, but Simpson did not specify. He said the United States should continue the ban but provide waivers for family reasons and enable those with AIDS to participate in conferences held in the United States. Among the 267 Haitians held at Guantanamo Bay, Cuba, 215 are infected with HIV; the others are their spouses and children. Of those Haitians, 10 have full-blown AIDS. ==================================================================== "Princess of Wales Attacks Britain for AIDS Prejudice" United Press International (02/16/93) London--Princess Diana of Wales told a London conference on AIDS Tuesday that fear and ignorance were the cause of the alienation of people with HIV or AIDS in Britain. She spoke of the social problems, prejudice, intolerance, and British reluctance that isolated AIDS patients from their families. "All too soon we all will know someone with AIDS.... How will we treat them? With compassion and care, or fear and rejection?" she asked. The princess told of the loneliness and isolation people with AIDS experience and described her meeting with one woman dying of the disease who had been rejected by her family. "Her wasted hand reached out for help. She'd been abandoned by her family, who saw her as an unbearable embarrassment and disgrace," said Diana. She added, "Still I am meeting patients like her, rejected by family and past friends, leaving them with the fear of not being able to find someone to share their emotional overload and physical disablement and ultimately their death." The princess called for British people to eliminate the barriers and overcome the prejudice and abandonment they inflict on people with AIDS. ==================================================================== "Ashe-AIDS Endowment" Associated Press (02/13/93) Memphis, Tenn.--A pediatric AIDS research endowment of $1.25 million named for tennis legend Arthur Ashe will be given to St. Jude Children's Research Hospital. The announcement came during the Kroger- St. Jude International tennis tournament on Saturday. J. Wayne Richmond, executive vice president of the IBM-ATP Tour, said, "One call to Arthur and he was quickly on board. He worked up to 48 hours before his death to make this happen." IBM-ATP was previously called the Association of Tennis Professionals. The Racquet Club of Memphis, site of the tournament, Kroger, and the IBM-ATP Tour Charities are involved in raising the money for the $1.25 million contribution. Ashe recorded a videotape about the effort days before his death. St. Jude is part of the AIDS Clinical Trials Group--a network of 24 pediatric and 28 adult AIDS research units nationwide. ==================================================================== "Fearful of AIDS, China Lifts Veil on Homosexuality" United Press International (02/17/93) (Leicester, John) Beijing--Although the Chinese government previously denied that homosexuality existed and jailed anyone suspected of being gay, the AIDS epidemic has forced officials to try to lure them back. Officials at the National Health Education Institute in China established "Men's World," a support group for gay men, last year. The authorities hoped that Chinese homosexuals could be educated about the risks of HIV infection before it devastates gay communities as it has in the West. Currently, only 3 of the 969 reported cases of HIV infection have been among gay men, but health officials claim these figures are misleading. Wan Yanhai, an official at the institute and a pioneer in AIDS prevention work among gay men, said, "I think in reality the number could be much higher, [and] it is definitely going to rise." In 1991, a study was conducted among homosexuals which found that just 3.9 percent "knew a lot" about AIDS. But most believed AIDS posed no risk and only 6 percent had ever used condoms, even though they may have had hundreds of sex partners. What was more alarming was that 25 percent of the 96 men surveyed were found to have a sexually transmitted disease, which increases the chance of HIV transmission. "Men's World" plans on implementing a gay counseling hotline and center in Beijing and AIDS hotlines in Shanghai and Canton, distributing condoms and training gay men as educators who would use their knowledge of China's secretive gay communities to instruct on HIV prevention. ==================================================================== "Idiopathic CD4+ T-Lymphocytopenia--Immunodeficiency Without Evidence of HIV Infection" New England Journal of Medicine (02/16/93) Vol. 328, No. 6, P. 380 (Ho, David D. et al.) It remains undetermined whether idiopathic CD4 T-lymphocytopenia (ICL) is new, transmissible, or acquired, write David D. Ho et al. of the Aaron Diamond AIDS Research Center in New York, N.Y. Patients recently diagnosed with severe CD4 T-lymphocytopenia but without evidence of HIV infection have spurred a national surveillance network to investigate such cases. The researchers examined 12 patients with CD4 T-lymphocytopenia who were referred by three U.S. cities. The patients (10 men and 2 women) ranged in age from 30 to 69 years. A total of eight had risk factors for HIV infection. The clinical conditions were heterogeneous: five patients had opportunistic infections, five had syndromes of unknown cause, and two had no symptoms. Two patients died from severe complications of their immunodeficiency. The patients' lowest CD4 T-lymphocyte counts ranged from three to 308 per cubic millimeter. Three patients had complete or partial spontaneous reversal of the CD4 T-lymphocytopenia. Concomitant CD8 T-lymphocytopenia was found in three patientsJand abnormal immunoglobulin levels were found in five. Multiple virologic studies by serologic testing, culture, and polymerase chain reaction were completely negative for HIV in all patients. The researchers found that the 12 patients with ICL appear to be epidemiologically, clinically, and immunologically heterogeneous. Although the conditions experienced in the ICL patients resemble AIDS, HIV infection was not detected. The cause of ICL is unknown, the researchers conclude. ==================================================================== "Projections of the Number of Persons Diagnosed With AIDS and the Number of Immunosuppressed HIV-Infected Persons--United States, 1992-1994" Journal of the American Medical Association (02/10/93) Vol. 269, No. 6, P. 733 The Centers for Disease Control recently released new estimates of the number of persons in the United States who will initially be diagnosed with an illness included in the 1987 AIDS surveillance case definition during 1992-1994. About 58,000 Americans had AIDS during 1991 as defined by the 1987 AIDS definition. Between 1992-1994, the number of persons who have illnesses meeting these criteria is expected to rise by only a few percent annually, with about 85 percent of those persons being reported to the CDC with cases of AIDS. The rate of increase in reported AIDS cases in persons who contracted HIV via heterosexual contact is expected to be higher than that in persons who contracted the virus through homosexual/bisexual contact or IV-drug use. The CDC predicts that, as of January 1993, an additional 120,000 to 190,000 Americans had HIV-related severe immunosuppression. Not all of these persons were aware of their HIV infection, however, and of those who know their HIV infection status, not all have had a T-cell count. If the AIDS definition went unchanged, about 50,000 to 60,000 reported AIDS cases would have been expected in 1993. The new definition of AIDS that includes HIV-related severe immunosuppression should increase reported cases by about 75 percent. The effect of this expansion on the number of reported cases is estimated to be smaller in later years because in 1993 many prevalent as well as incident cases of immunosuppression will be reported as the expanded surveillance case definition is used. Reported AIDS cases may decrease from 1993 through 1994, according to the CDC. ==================================================================== "Multicenter Clinical Trials of AIDS Vaccines Scheduled to Get Under Way in Coming Months" Journal of the American Medical Association (02/10/93) Vol. 269, No. 6, P. 725 (Marwick, Charles) HIV-negative volunteers at high risk of infection areJbeing recruited for nationwide clinical trials of two AIDS vaccines. A total of about 320 male and female volunteers aged 18-60 years old will be involved. However, some officials from the National Institutes of Health project that it will be at least two more years before full- scale vaccine trials are conducted. The two vaccines will be tested in five American centers: Johns Hopkins University Center for Immunization, Baltimore, Md.; St. Louis (Mo.) University School of Medicine; University of Rochester (N.Y.) Medical Center; Vanderbilt University Medical Center, Nashville, Tenn.; and the University of Washington School of Medicine in Seattle. The two vaccines have already undergone safety testing, and do not appear to produce unwanted side effects. The trials will test the ability of two recombinant proteins made from the HIV envelope protein gp160 to boost protective antibodies and possibly cytotoxic T-lymphocyte responses, says Daniel Hoth, MD, director of the AIDS division at the National Institute of Allergy and Infectious Diseases. Volunteers will be counseled to avoid high-risk behaviors linked with HIV transmission. They will be assigned randomly to receive one of the vaccines or a placebo. Three intramuscular injections will be given--an initial injection and then two boosters at one and six months. One vaccine, genetically engineered by Genentech Inc., uses the HIV-1 MN strain. The other, made by Biocine, uses the closely related HIV-1 SF-2 strain. The two vaccines are equipped with adjuvants to further potentiate an immune response. ==================================================================== "TB Control Guidelines Cause Coast-to-Coast Confusion" American Medical News (02/08/93) Vol. 36, No. 6, P. 1 (Voelker, Rebecca) Due to the lack of a national plan to prevent tuberculosis transmission, federal, state, and regional health officials have developed conflicting respiratory-protection guidelines. The suggested measures range from protective surgical masks to the cumbersome powered air respirators proposed last year by the National Institute for Occupational Safety and Health. But in its current draft guidelines, the Centers for Disease Control backs away from the NIOSH-recommended respirators because of opposition from both health professionals and hospital administrators. Despite the tighter facial fit of the respirators, the CDC says, "There is not sufficient scientific evidence to support" their routine use. The agency instead suggests that protective surgical masks and valveless dust and mist respirators are sufficient for minimum protection. CDC spokeswoman Kay Golan said, "NIOSH was required by law to assess the risk and make recommendations so that no worker suffers. They were prohibited from considering cost or feasibility when they made their recommendations." But if the NIOSH recommendations are adopted in a federal OSHA standard, they could become legally enforceable. Dr. Michael Tapper, chairman of the AIDS/TB committee of the Society for the Hospital Epidemiologists of America, attended a meeting at the CDC in Atlanta concerning its first round of revisions to the 1990 guidelines for TB control in health-care settings. He said that consensus based on science is desperately needed to dispel the confusion.