Subject: CDC Summary 2/25/93 Date: Thu, 25 Feb 1993 08:36:56 PST (227 lines) Archive-Number: 279 From: Billi Goldberg Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary February 25, 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 ===================================================================== "Questions Raised About AIDS Case" Los Angeles Times--Washington Edition (02/25/93), P. A6 (Cimons, Marlene) A report published yesterday in the British journal Nature raised questions about whether a Florida dentist who died of AIDS--accused in a highly publicized case of infecting five patients with HIV--actually was the source of transmission. Ronald W. DeBry, an evolutionary biologist in Florida State University's department of biological science and one of the researchers in the report, said, "We are not saying that the dentist did not infect the patients--we're saying you really can't prove it one way or the other." The case of Dr. David Acer was the only reported instance of HIV transmission from an infected health professional to a patient since the AIDS epidemic began in 1981. Officials from the Centers for Disease Control, who conducted the first investigation and have concluded that Acer was the source, criticized the Nature report, saying that it ignores significant additional proof that points to the dentist. The CDC investigation indicated that none of the five infected patients had any known high risk behaviors that would have made them more vulnerable to infection. DeBry and his colleagues used molecular sequencing techniques in the study and analyzed viral samples obtained from all of Acer's infected patients. They also compared these samples to known information about the strain that infected Acer, even though they did not have an actual sample from the dentist. The strains of HIV were then compared to "control" samples obtained from HIV-positive individuals in Florida who had no known connection to Acer. They discovered that "there is not enough difference between the dental group sequences and the control sequences to prove that these [dental] sequences are a separate set," said DeBry. Related Story: Baltimore Sun (02/25) P. 17A ===================================================================== "Sexually Transmitted Diseases Down in State" Boston Globe (02/24/93), P. 23 (Kong, Dolores) The rate of sexually transmitted diseases (STDs) in Massachusetts dropped in 1992 for the second year in a row. However, teenagers and minorities continue to be at a higher risk, according to a new report. Although syphilis cases decreased by more than 30 percent, gonorrhea by 40 percent, and chlamydia by 10 percent, there were no statistics on HIV infection. But public health officials believe the decline in the STDs indicates that people are using condoms and practicing safer sex-- a change that could also help curb the spread of HIV. The new figures will help AIDS prevention, because the sooner people get treated for infection with an STD, the less inclined they will be to have a genital sore that facilitates the transmission of HIV. Nevertheless, public health officials warn that if the statistics are a true representation, many teenagers, especially non-whites, do not seem to be affected by safe sex messages. A state Department of Education annual survey found that condom use by sexually active high school students increased from 30 percent a few years ago to 58 percent in 1992. It also discovered that in 1992, 70 percent of high school senior boys and 67 percent of high school senior girls reported having had sexual intercourse at least once, but only 49 percent of them reported using a condom in their latest sexual encounter. Among sexually active ninth graders, 75 percent reported using a condom during the last sexual encounter. Public health commissioner David Mulligan said that some of the progress so far can be attributed to his department's teen health program, which provides condoms in schools. ===================================================================== "Prostitute Infected by HIV Tells of Sex With Thousands" Baltimore Sun (02/25/93), P. 4A An Israeli prostitute who tested HIV-positive in 1991 never returned to the hospital to learn her results, and has since had sex with thousands of men, according to the daily Yedioth Ahronoth, an Israeli newspaper. Rachel Nissani, 23, of Tel Aviv, discovered she tested positive a month ago after a second blood test. Nissani said that since her first HIV test in January 1991, she has had sex with at least six men a day to finance a heroin habit, therefore exposing thousands of men and their subsequent sex partners to the virus. Nissani said she would sue both Ichilov Hospital, where the 1991 test was conducted, and the Health Ministry for negligence, because they did not try hard enough to find her. Dr. David Goldray, director-general of Ichilov, said the hospital tried to locate Nissani after the 1991 test, but she never showed up at the drug treatment center she gave as an address. Nissani underwent the first HIV test because she wanted to enter a drug treatment center, and the test was a condition for being accepted. She resorted to drugs again, but never returned to learn her test results. In another attempt to get off of heroin, Nissani took an HIV test a month ago at a different hospital and was told that she was infected with HIV. ===================================================================== "Vestar Files for Approval of AIDS-Related Kaposi's Sarcoma Treatment" United Press International (02/24/93) San Dimas, Calif.--Vestar Inc. announced Wednesday that it has submitted a new-drug application to the Food and Drug Administration for DaunoXome, its drug that treats AIDS-related Kaposi's sarcoma. DaunoXome has been distributed in Europe to individual patients by Vestar, but the company has not yet received approval to market the drug. Among all of the cancers that are associated with AIDS, Kaposi's sarcoma is the most common. The disease causes lesions of the skin, mucous membranes, and lymph nodes, and often progresses to internal organs, including the lungs and gastrointestinal tract. Kaposi's sarcoma is experienced in approximately 15 percent or more of AIDS patients. ===================================================================== "Filipino Condom-Users Get Sex Discount" Reuters (02/24/93) Manila--Due to the threat of AIDS, several prostitutes in the Philippine city of Cebu are offering half-price discounts to clients who will use a condom, according to a Wednesday report`t$ a Manila newspaper. Customers who fail to use a condom must pay the full rate or face rejection, said the Philippine Daily Inquirer. Health Secretary Juan Flavier has implemented a campaign promoting the use of condoms to thwart the spread of HIV infection, despite strong opposition from the country's most predominant religion--the Roman Catholic church. While only 368 people are reported as HIV-positive in the Philippines, officials project the actual figure to be in excess of 36,000. Among those infected, 63 have died of AIDS. ===================================================================== "Foreign Delegates at German AIDS Congress Worry About Safety" Reuters (02/24/93) Berlin--Some AIDS experts from foreign countries who plan to attend the 1993 world AIDS conference in Berlin, Germany, are concerned that they could be attacked by German racists, conference organizers said on Wednesday. The organizing committee made a statement saying that everything would be done to guarantee the safety of participants at the 9th annual AIDS congress from June 7 to 11. About 15,000 delegates and 1,000 journalists are expected to attend the meeting. The organizing committee said, "We are getting concerned questions from some countries if the stay in Berlin and Germany will be safe in view of attacks on foreigners." A total of 17 lives were lost last year as a result of right-wing violence in Germany. Congress president Karl Otto Habermehl of the Free University in Berlin said, "I am deeply shaken at the criminal and extremist attacks in our country. We cannot deny them. But we know they have been condemned by the vast majority of our population." ===================================================================== "Expanded European AIDS Case Definition" Lancet (02/13/93) Vol. 341, No. 8842, P. 441 (Ancelle-Park, Rosemary et al.) Because of the importance of having a common AIDS case definition in Europe, all European countries should implement the new expanded AIDS case definition, write Rosemary Ancelle-Park et al. of the Hopital National de Saint-Maurice in Saint Maurice, France. The European Center for the Epidemiological Monitoring of AIDS gathered experts in public health and epidemiology participating in the AIDS Prevention and Control Research Program of the European Community in Jan. 1993. The attendees discussed the case definition of AIDS for surveillance purposes in Europe, following the introduction of an expanded surveillance case definition in the United States. The 1993 U.S. revised definition adds pulmonary tuberculosis, recurrent pneumonia and invasive cervical cancer to its list of 23 conditions defining AIDS. Also, it added HIV-positive people who have a CD4+ count under 200 to the list. In 1991, European countries decided that HIV-positive people should not be defined as having AIDS based on CD4 counts alone because of concerns over the accurateness of AIDS surveillance based solely on the degree of immunosuppression, biases that would be introduced in comparing AIDS exposure categories, and possible negative psychological effects on asymptomatic HIV-positive patients. Also, access to medical care in Europe is not based on a person meeting an AIDS definition. After meeting with AIDS surveillance representatives in 38 European countries, this position was reconfirmed by the expert group. The possible inclusion of the three opportunistic infections that the U.S. added to its AIDS definition were examined. It was decided that the addition of these illnesses was valuable for epidemiologic purposes. ===================================================================== "Orogenital Sex and Risk of Transmission of HIV" Lancet (02/13/93) Vol. 341, No. 8842, P. 441 (Spencer, Brenda) Recommending to the public that orogenital sex is unsafe is without a question theoretically correct, but the use/efficacy of a method depends not only on its biological efficiency but also on its acceptability to the user, writes Brenda Spencer of the Hopital de Bicetre in Le Kremlin-Bicetre, France. In the Dec. 12 issue of the Lancet, correspondents report that HIV-1 has been detected in the pre- ejaculatory fluid, and conclude that this fluid is therefore a potential vector for sexual transmission of HIV. But these findings bring into question what the chance is that the presence of HIV-1 in the mouth will result in infection of the receptive partner. One of the most difficult things in health education is how to manage uncertainty about risk--as suggested by the confusion as to what defines safe sex. There have been both extremes to the risk of oral HIV transmission. At the 1990 AIDS conference in Montreal, one stand displayed a poster recommending to gay men that they engage in oral rather than anal sex, whereas another ran a video for adolescents advising that deep kissing may present a risk of infection. The latter position neglects to consider the possibility that, faced with a multitude of differing recommendations, the individual may fail to comply with any. Some people have asked whether the belief that orogenital sex carries a high risk of transmission yields an increase in unprotected anal sex. The formulation of safer sex guidelines should consider psychological factors along with any new laboratory discoveries, concludes Spencer. ===================================================================== "Blood-Product Firm Liable" American Medical News (02/15/93) Vol. 36, No. 7, P. 20 A federal jury last month determined that a blood products company was negligent in the death of a hemophiliac boy from AIDS, and it awarded his family more than $2 million in damages. The parents of Jason Christopher, the 11-year-old who died of AIDS in February 1992, argued that their son contracted HIV through contaminated blood products made by Armour Pharmaceuticals. They alleged that the company knowingly allowed HIV-tainted blood to be transmitted by not issuing warnings that there was a risk of infection. Approximately 20,000 Americans have hemophilia, and half are estimated to be infected with HIV. The lawyer for the Christophers said the verdict would urge blood products companies to settle claims from hemophiliacs who believe they contracted HIV from tainted products. Attorneys for Armour Pharmaceuticals said they have not yet determined whether to appeal what they consider a "sympathy verdict." ===================================================================== "Dossier: Latex Goes Limp" Advocate (02/23/93) No. 623, P. 10 While a steady growth of condom sales occurred for more than a decade, sales of prophylactics are now slowing down. A.C. Neilsen, which tracks the condom industry, said that condom sales increased by only 1 percent in 1992 after double-digit growth each year for most of the 1980s. Condom manufactures believe the decline is due to a number of factors, including television networks' ban on condom advertising and the heavy distribution of free condoms by AIDS education organizations. However, David Eng, a spokesman for the New York City AIDS service group Gay Men's Health Crisis, sees a more alarming trend. "Many people are so used to hearing about AIDS that they just don't think they need to protect themselves.... It speaks to the government's inability to get the educational message out that everyone needs to use a condom every time they have sex."