Subject: CDC Summary 2/26/93 Date: Fri, 26 Feb 1993 11:07:17 PST (248 lines) Archive-Number: 285 From: Billi Goldberg Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary February 26, 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 ====================================================================== "Around the Region: Hospital Acknowledges Use of Suspected Tainted Blood" Washington Post (02/26/93), P. D3 Five units of donated blood at Suburban Hospital in Bethesda, Md., were mishandled last year when they were transfused into patients, even though the blood preliminarily tested positive for HIV or hepatitis, according to hospital administrators. Officials said subsequent tests proved the blood was not infected and that none of the five patients who received those units contracted either disease. However, officials conceded they did not know the blood was disease-free at the time of the transfusions. As a consequence of the mishandling, one laboratory worker was fired and four were disciplined. Last September, the oversight was revealed during a routine record check of the hospital's blood bank by Federal Drug Administration inspectors. The inspectors discovered that one unit had initially tested HIV-positive and four others tested positive for the virus that causes hepatitis. Hospital officials said yesterday that since the FDA discovery, they have performed periodic blood tests of the donors and four of the recipients, and all have tested negative for both diseases. The fifth recipient died of unrelated injuries two days after the transfusion. ====================================================================== "AIDS Activists Back Needle Exchange" Boston Globe (02/25/93), P. 25 (Hernandez, Efrain) In an effort to emphasize Massachusetts' reluctance to implement needle exchange programs to curb the spread of HIV infection among drug addicts, AIDS activists gathered in Boston on Wednesday to promote the benefits of such programs. The third North American Syringe Exchange Convention in Boston aims to draw attention to Massachusetts as one of fewer than a dozen states that prohibit the sale and possession of hypodermic needles and syringes without a prescription, thereby preventing needle exchange programs from being established, according to Larry Kessler, executive director of the AIDS Action Committee of Massachusetts. More than 100 AIDS activists, health department officials, and researchers from across the country are expected to attend the convention, which runs through Saturday. Conference attendees will share experiences with needle exchange programs and examine the approaches that work best, said conference organizer Dave Purchase. Critics of the programs are concerned that such an effort would promote drug use and attract substance abusers to neighborhoods where needles are distributed. But representatives for Gov. William Weld and Boston Mayor Raymond Flynn said that both officials back some form of supervised needle exchange programs, although Legislative approval is needed before programs can be implemented. Among the estimated 40,000 IV-drug users in the state, about 40 percent are infected with HIV, according to activists' and state officials' projections. ====================================================================== "State Panel Urges Regulations for Sex Clubs" New York Times (02/26/93), P. B3 (Navarro, Mireya) The New York state AIDS Advisory Council recommended yesterday that New York City shut down commercial sex establishments if they are reluctant to comply voluntarily with state health regulations designed to reduce the transmission of HIV. The council said in a written report that such places pose "a substantial risk" for transmission of HIV, as well as sexually transmitted diseases. However, it added that the establishments could also be used to educate patrons on the risks of unprotected sex. The panel advised that it be mandatory for businesses to display educational materials and distribute condoms. The panel's recommendations will be submitted to the city's Department of Health as it determines how to regulate the clubs. The focus on voluntary compliance contrasts with the approach the city took in the mid-80's. From 1985 to 1987, New York City closed seven businesses, ranging from a gay bathhouse to a heterosexual "swingers club," after inspectors discovered patrons paying entrance fees and then engaging in oral and anal sex. Such acts were in violation of regulations adopted by the New York State Public Health Council in 1985 prohibiting "high risk" sexual activity in public places. The restrictions give health officials the authority to shut down such businesses as "a public nuisance dangerous to the public health." The council recommended yesterday that the law add vaginal intercourse without a condom to the list of high-risk sexual activities. The council also suggested that regulations distinguish between sex with a condom and without, and define sex without a condom as high risk. ====================================================================== "As Their Life Expectancy Grows, So Do Needs of AIDS Patients" Washington Times (02/26/93), P. A1 (Goldberg, Karen) As a result of the longer life expectancy among AIDS patients, more treatment, both physical and mental, is also required. Bob Howard, spokesman for the Centers for Disease Control, said the life expectancy for HIV-positive people has increased as a record number of HIV cases have developed into full-blown AIDS. Many of the opportunistic infections that accompany AIDS would have killed a patient much more quickly five years ago, according to Dr. Robert Thomas, a Washington, D.C., physician specializing in HIV. "When I was a resident [in 1987] people were looking at 18 months to live after an AIDS diagnosis. Now I tell them three to five years." Aside from medical services, longer-living AIDS patients need social, legal, and psychological assistance. The District's Whitman Walker Clinic, the city's main provider of services for AIDS patients, is having a difficult time keeping its food bank stocked. Barbara Chinn, Whitman- Walker's deputy chief program officer, said the food bank "is serving 600 clients a month now. This time last year, it was 300. I'd say in another year it will be 900." Approximately 2,000 volunteers work for Whitman-Walker--an all-time high. The clinic has 30 support groups, nine housing facilities, and three satellite offices, including the new Max Robinson Center. The CDC's Howard said, "What we are seeing now is the maturing of the epidemic. More people are presenting with AIDS, and that is a reflection of what went on eight years ago. We have already seen a leveling off in that category [homosexuals], but it is other areas like heterosexuals and IV-drug users, we are still concerned about." ====================================================================== "Three Centers Plan Human Test of New AIDS Therapy" Reuters (02/24/93) (Zengerle, Patricia) Pittsburgh--Researchers from the University of Pittsburgh Medical Center announced on Wednesday they were preparing to launch human trials of an encouraging new three-drug AIDS therapy recently shown to inhibit HIV in a test tube. The human trials will be funded by Merck & Co, which makes one of the drugs being tested. The research sites include the University of Pittsburgh, the University of Pennsylvania in Philadelphia, and Brown Miriam Hospital in Providence, R.I. This trial will apparently precede by at least several weeks the beginning of government-supported human testing of a similar treatment this spring. The 24-week study in Pittsburgh will involve 30 to 40 individuals infected with HIV, who will be separated into two groups. The first group will receive AZT initially. The other group will receive AZT and a Merck drug called L-661. After two months of therapy, both groups will also begin to receive the AIDS drug ddI. L-661 is part of a new class of experimental drugs known as non-nucleosides, which have shown promise in blocking the replication of HIV in test tubes when used in combination with AZT and ddI. The University of Pittsburgh researchers said their trial would start as soon as 30 to 40 volunteers, who must meet several criteria, are enrolled. ====================================================================== "Off-Label Reimbursement Denial: Major Survey Begins" AIDS Treatment News (02/19/93) No. 169, P. 8 A poll to determine the impact of reimbursement denials on obtaining optimum care of AIDS is currently being mailed to physicians who specialize in HIV/AIDS treatment. The survey, called ComPACT2 (Community Partnership in AIDS/HIV Clinical Trials) is being executed by San Francisco's Community Consortium, an association of over 200 health-care workers in the San Francisco area. The study is funded by the American Association for AIDS Research (AmFAR). The survey was sent with an explanation that says, "The aim of ComPACT2 is to determine the extent to which there are reimbursement denials when drugs to treat the medical complications of HIV disease are used for 'off-label' indications. We are primarily interested in the extent to which insurers deny reimbursement for off-label drug use and the extent to which providers alter the way they treat HIV-related conditions because of difficulties in obtaining adequate reimbursement for off- label drugs use." The physicians were selected at random because of the need to poll a representative sample of physicians who care for patients with HIV. The survey asks questions about details of patient characteristics, current medications, and HIV-related conditions for the last three HIV patients the doctor had seen before completing the questionnaire. It also asks for first-line and second-line treatments for HIV and for a number of opportunistic infections. The findings will be examined and provided to all participants. Moreover, there are plans to assemble a public policy panel with experts from government agencies, AIDS organizations, and insurance companies to review the results and make reimbursement recommendations to the U.S. Public Health Service. ====================================================================== "Cardiac Structure and Function in HIV-Infected Children" New England Journal Of Medicine (02/18/93) Vol. 328, No. 7, P. 513 (Lewis, William and Dorn, Gerald W.) Toxicity from AZT may be related to the development of cardiomyopathy, write William Lewis and Gerald W. Dorn of the University of Cincinnati Medical Center in Cincinnati, Ohio. In the Oct. 29 issue of the New England Journal of Medicine, Lipshultz et al. reported on cardiac dimensions and function in HIV-positive children and concluded that progressive left ventricular dilation occurred independently of any effect of AZT. However, Lewis and Dorn disagree with that conclusion. Ejection performance was normal in Lipshultz's patients at the start of AZT therapy but was depressed after therapy. Ejection performance declined, but contractility was unchanged. The causative factor appeared to be an increase in afterload despite increased posterior-wall thickness and left ventricular mass. End- systolic wall stress is related directly to end-systolic left ventricular pressure and dimension and is related inversely to wall thickness. Because end-systolic blood pressure was reported to be normal throughout the study, end-systolic dimension must have increased. Since ejection performance, not intrinsic myocardial contractility, is the primary determinant of clinical status, the data suggest that AZT can worsen the development of dilated cardiomyopathy in HIV-positive children. But no data from endomyocardial biopsies were included. The lack of characteristic endomyocardial morphologic changes would support the authors' thesis that AZT had no cardiac toxicity, but no pertinent information was provided, conclude Lewis and Dorn. ====================================================================== "India: Zidovudine Production" Lancet (02/20/93) Vol. 341, No. 8843, P. 485 (Mangla, Bhupesh) Indian pharmaceutical company Cipla Laboratories has begun manufacturing and marketing a lower-cost AZT in 100 mg capsules with the brand name Zidovir-100. The company is challenging Burroughs Wellcome's Retrovir because its price is significantly cheaper. This is good news for developing countries which can't afford the $3 per 100 mg capsule of Retrovir. A study by the United Nations Development Program (UNDP) shows that the cost of drugs will be a large determinant affecting the economic impact of AIDS in developing countries. India may have to spend $1.6 billion on AIDS by the year 2000. Cipla was able to make its drug cheaper with the help of the Indian Institute of Chemical Technology (IICT) in Hyderabad. IICT, a government-funded laboratory, has made the most of India's patent laws, according to which pharmaceutical products can be granted only process patents. Therefore, a drug enjoying a product patent outside India can be manufactured in the country made by a process different from that used by the original patent holder. Dr. A.V. Rama Rao, ICCT director, said, "Our aim is to make the drug available at a low price to all the needy countries, whose populace cannot afford the Burroughs Wellcome product. Quality wise there is no difference between Burroughs and us. In the international markets, we all have to meet the same standards." Drug companies in the United States have been enraged by the fact that India can get hold of U.S. patents. But AZT falls into a gray area--it was discovered originally, not by Burroughs Wellcome, but by the U.S. National Cancer Institute as an anti-cancer treatment. ====================================================================== "Rapid HIV Tests" Lancet (02/20/93) Vol. 341, No. 8843, P. 502 (Wannan, Gary J. and Cutting, William A.M.) Multiple uses of the HIV-CHEK test gave results as accurate as single use of the test, write Gary J. Wannan and William A.M. Cutting of the University of Edinburgh in Edinburgh, U.K. With the HIV-CHEK method, antigen from HIV-1 and HIV-2 are incorporated in the membrane on the top of a small block. Buffer is passed through the membrane followed by a serum or plasma sample from the person to be tested, then by gold conjugate and a wash solution. In positive cases a red-spot color reaction develops on the membrane within 10 minutes. The researchers discovered that they could put samples from at least 6 patients through the membrane before adding the gold conjugate and wash solutions and still get a positive result if any subject was infected. The researchers tested samples from 491 pregnant women and revealed that multiple use was just as accurate as single use of the test. In areas where the rate of HIV is low, it is possible to screen between 4 and 10 blood donors, pregnant women, or individuals in a population screening program with a single HIV-CHEK. Because the HIV-CHEK tests cost about 3 pounds sterling per test, in an area where the rate of HIV infection is less than 4 percent, the multiple sample screening method can save about 2,400 pounds sterling for every 1000 individuals tested. Even though the findings are encouraging, there still is a great need for an accurate and inexpensive test to detect HIV antibodies, conclude Wannan and Cutting.