Subject: CDC Summary 3/5/93 Date: Fri 05 Mar 1993 16:28:41 GMT (259 lines) Archive-Number: 332 From: igc.apc.org!bigoldberg (Billi Goldberg) Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary March 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 ==================================================================== "Hospitals Told to Test for HIV" Washington Post (03/05/93), P. A3 Hospitals with significant numbers of AIDS cases should offer HIV testing to all persons admitted or treated in emergency rooms, federal health officials announced yesterday. The Centers for Disease Control issued guidelines that require voluntary testing for HIV to be routine in about 600 hospitals--11 percent of the nation's total--mostly in urban areas. The results of the tests would be kept confidential and people could not be denied care because they objected to being tested for HIV. Secretary of Health and Human Services Donna Shalala said, "These recommendations will help people learn of their HIV status and get early treatment. They will also be able to take precautions to protect loved ones." A toll-free hotline for physicians and other health care physicians will also be provided by the HHS to answer questions about treating patients with HIV/AIDS. The new CDC guidelines advise hospitals to offer voluntary testing to everyone between the ages of 15 to 54 admitted to the hospital or treated in the emergency room, clinics, or other outpatient departments. The agency encourages testing in hospitals with rates of infection of at least 1 percent or in the event that one in 1,000 discharged patients has AIDS. The tests would reveal more than two-thirds of HIV-positive persons in those age groups hospitalized for conditions other than HIV/AIDS, according to the CDC. ==================================================================== "Six More Sites Named for AIDS Therapy Test" Journal of Commerce (03/05/93), P. 5A Six additional locations where human trials of a new AIDS treatment will be conducted were tentatively named yesterday by the National Institutes of Health. The new sites are Indiana University in Indianapolis, Mount Sinai Hospital in New York, the University of California--San Diego, the University of Cincinnati, the University of North Carolina--Chapel Hill, and the University of Pennsylvania in Philadelphia. ==================================================================== "Mass. Jury Supports Dentist in AIDS Case" Journal of Commerce (03/05/93), P. 8A An oral surgeon was not responsible for a patient's contraction of HIV through a contaminated blood transfusion in 1982, according to a ruling issued this week by a jury in Massachusetts' Suffolk County Superior Court. Dr. Donald F. Booth, the defendant in the medical malpractice case, could have been liable for millions of dollars in damages if found guilty of the effects of the transfusion performed by his staff. He was the only one out of eight defendants to take his case before a jury. The other defendants agreed to pay a cumulative total of $2.2 million to plaintiff Katherine Perera. The physician's dental malpractice coverage was through Chubb Group of Insurance Cos., Warren, N.J., under a program in association with the American Dental Association. The insurance program was dropped in 1984. ==================================================================== "MedImmune, Merck Revise AIDS Research Accord" Washington Post (03/05/93), P. B1 (Southerland, Daniel) Biotechnology company MedImmune Inc. of Gaithersburg, Md., yesterday announced that it has reaffirmed its alliance with Merck & Co. under an agreement that requires Merck to resume paying for some research to develop an anti-HIV drug. The new agreement calls for Merck, one of the world's largest pharmaceutical firms, to continue its own research on a new antibody developed by MedImmune. However, the arrangement will delay funding of further research by MedImmune on other antibodies until better results are provided. In November 1991, MedImmune and Merck announced that Merck would fund research on a drug that uses MedImmune's MEDI 488, a human monoclonal antibody, to thwart the spread of HIV. But early this year, MedImmune reported that Merck was reevaluating the collaboration before determining whether to proceed with developing the drug, because of disappointing "unexpected research results." Merck said in yesterday's announcement that if early clinical trials of MEDI 488 are completed and if Merck subsequently decides to proceed with the program, Merck will reinstate the research funding to MedImmune and deferred money will be paid. Wayne Hockmeyer, chief executive of MedImmune, said he was satisfied with Merck's review of the program. Nevertheless, he warned that due to the complex nature of HIV and its genetic variability, his firm believes any expectations for MEDI 488 to be highly speculative. MedImmune is also continuing its ongoing work with Merck on early research into an AIDS vaccine. ==================================================================== "Suit to Decide if Disabilities Act Bars Refusal to Pay for AIDS Care" Wall Street Journal (03/05/93), P. B4 (Woo, Junda) The Mason Tenders District Counsel Welfare Fund is contesting charges from two beneficiaries and the Equal Employment Opportunity Employment Commission that it violated the Americans with Disabilities Act by discriminating against AIDS patients when it cut their health benefits. The self-insured medical plan, which is under jurisdiction of the federal government rather than the state, says that the action was the result of economic considerations and that routine physicals, dental and eye care, and organ transplants were cut along with AIDS treatment. The fund also maintains that benefit trusts aren't covered by the ADA. Mark Scherzer, a lawyer who specializes in AIDS cases, worries that unclear wording in the ADA and the Employee Retirement Income Security Act leaves room for varied interpretations. He says, "Although there are reasonable arguments under the [antidiscrimination act], I'm not confident at all that we'll succeed." Another problem for plaintiffs is that some benefits were cut off before the ADA went into effect. Their lawyers argue that the discrimination is continuing because the benefits are still being denied. ==================================================================== "School Panel Gets 2 AIDS Proposals" Boston Globe (03/04/93), P. 30 (Nealon, Patricia) The adoption of a more comprehensive AIDS prevention curriculum that emphasizes sexual abstinence was recommended Wednesday night by Boston School Superintendent Lois Harrison-Jones. In addition, the city's Department of Health and Hospitals proposed associating the new curriculum with condom distribution and counseling in school-based health facilities. The two recommendations, presented to the curriculum subcommittee of the School Committee, would enhance the Boston school system's response to the AIDS epidemic, which AIDS activist groups have criticized as inadequate. The proposal that condoms be distributed to school students in school-based health centers--with parental permission and counseling--demonstrates the first time the department has approved condom distribution inside city schools. Also, the policy represents Harrison-Jones' belief that school personnel should not be involved in condom distribution, said School Department spokesman Larry Faison. Judith Kurland, commissioner of health and hospitals, said the recommendations were an outcome of a close-working relationship between school and health officials over the past year. Aside from mandating parental permission, the proposed condom distribution plan requires that no School Department employees be involved in handing out condoms. The condoms would only be provided during a primary care visit that involves education and counseling, and distribution would not interfere with class instruction. The package, which also includes adoption of two new curricula stressing abstinence, needs the approval of the full School Committee before it can be implemented. ==================================================================== "In the Age of AIDS, Sex Clubs Proliferate Again" New York Times (03/05/93), P. B1 (Navarro, Mireya) Sex establishments are reemerging in New York City even after city health officials cracked down on commercial sex clubs as an attempt to fight HIV infection several years ago. Officials are now seeking new approaches to regulate sex as the AIDS epidemic continues to spread. Instead of closing the establishments, as officials have done in the past, they are taking a more conciliatory approach, asking sex clubs to monitor themselves. The officials say that the clubs, which provide anonymous sex to patrons, can actually help thwart the spread of HIV if patrons can be convinced to practice safer sex. The resurgence of commercial sex establishments contradicts the belief that both homosexuals and heterosexuals are becoming more conservative in their sexual behavior due to fears of HIV. The city officials said they know of about 50 sex clubs currently operating in the city, about two-thirds of which are gay clubs and the rest heterosexual. The clubs are legal, but laws in the state prohibit sexual activities that pose a high risk of HIV transmission in public areas. Oral and anal sex are legally defined as high-risk activities in New York. The city officials said that the city's Health Department is likely to adhere to the recommendations of the AIDS Advisory council, a state panel that last week said the city should close the establishments only after the places are given a chance to monitor themselves. Among other suggested actions, the panel said that the clubs should be forced to distribute condoms, train monitors to supervise sexual activity, and provide adequate lighting. ==================================================================== "Students Hold Hunger Strike to Protest U.S. Haitian Policy" United Press International (03/04/93) New Haven, Conn.--Several Yale Law School students have begun a hunger strike to protest the U.S. policy toward HIV-positive Haitian refugees. The hunger strike started Wednesday. Organizers said that more than 30 students would be involved in the strike, and dozens more are fasting for several days to demonstrate their opposition to the policy. They also said students were ready to continue the hunger strike indefinitely. Second-year law student Emily Zweibel said, "All we are asking is for Mr. Clinton to use his discretion as president to allow these refugees in on humanitarian grounds, if nothing else." Demonstrators have established makeshift "concentration camps" in the halls of the school, to represent what they say are poor conditions at the Guantanamo Bay Naval Base in Cuba, where about 264 Haitians are being detained. The students also built an 8- by 16-foot barbed wire fence in the main corridor of one of the law school's buildings. Margareth Etienne, a first-year law student from New York City, said she visited Guantanamo in December and was "disgusted" by what she witnessed. Etienne, who was born in Haiti, argued that the policy of excluding refugees infected with HIV from the United States is based on discrimination against race and people with the disease. "If this were any other group of people, we believe this would not be happening." She said that the students plan on continuing to strike until President Clinton closes the camps and admits the refugees to the United States. ==================================================================== "A Shot in the Arm for TB Research" Science (02/12/93) Vol. 259, No. 5097, P. 886 (Watson, Traci) Nearly a decade since tuberculosis began making its resurgence, the government has started giving research into the disease a higher priority. NIH Director Bernadine Healy intends to improve funding for TB research by reallocating money among the NIH institutes. Healy told the Clinton administration that this year, she will provide $12.5 million more than planned for research on mycobacterium, including new diagnostic techniques and treatments. About $9.2 million of the funding will come from cutting other NIH programs. Although the increase will make the funding for TB research $37 million in 1993, Healy also seeks to obtain emergency money from Congress through lobbying efforts. She hopes increased congressional spending on TB research will attract more scientists to study the disease. However, congressional members said getting more money from Congress will prove difficult with President Bill Clinton's pressure to cut governmental spending. Healy claims additional funding is imperative because the number of TB cases increased 18 percent between 1985 to 1991, and many of the new cases are resistant to existing drugs. ==================================================================== "Triple Teaming the Deadly AIDS Virus" U.S. News & World Report (03/01/93) Vol. 114, No. 8, P. 60 (Brink, Susan) The recent finding that three drugs used in combination were effective in attacking HIV in the test tube is encouraging for future research, even if this method is not effective in humans. Yung-Kang Chow, a little-known AIDS researcher, developed the three-drug approach, which is intended to force the virus to profusely mutate until it destroys itself. Chow and colleagues at Massachusetts General Hospital combined AZT and ddI with either pyridinone or nevirapine. The chemical mix either overwhelmed the virus or forced it to mutate so fast and furiously it couldn't replicate itself. By adding a third agent--either pyridinone or nevirapine--to the AZT/ddI combination, Chow et al. managed to compel HIV to mutate three times simultaneously in an attempt to survive. Three quick mutations are more than the virus can tolerate in the test tube. The new approach, called "convergent combination therapy," is an extreme departure from the traditional method of treating HIV infection, in which researchers have attempted to disable the virus at various stages in the disease's development. But the researchers are cautious about the new strategy's clinical potential, warning that any practical benefit from this research could be years away. The National Institutes of Health is currently forming clinical trials of the drug combination expected to begin no later than July. Although the research is preliminary, it helps reinforce the idea that AIDS might someday be controlled by a combination of drugs. ==================================================================== "Playing Chess With Reverse Transcriptase" Nature (02/18/93) Vol. 361, No. 6413, P. 588 (Richman, Douglas D.) Scientists are researching the possibility of making the human immunodeficiency virus (HIV) inviable by introducing mutations for drug-resistance. Chemotherapy for HIV patients prolongs their disease- free interval. However, this nucleoside treatment, using AZT, ddC, and ddI, only reduces the virus replication but doesn't completely suppress it. These drugs work by inhibiting the viral enzyme. The disease continues to progress, which may result from emergence of viral mutants with less susceptibility to the treatment drugs. A second class of possible inhibitors of HIV-1 replication also stops reverse transcriptase (RT). Several chemically distinct non-nucleoside compounds share properties, including low toxicity, high potency, synergy with nucleoside agents, and excellent pharmacokinetic properties. However, the resistant mutants of HIV indicate that the non-nucleoside reverse transcriptase inhibitors may possess a weak element when used as drugs. Although reducing the amounts of virus replication and increasing CD4 lymphocyte counts, the drugs dissipated after one month, which is about the same time as the appearance of the mutants.