Subject: CDC Summary 3/9/93 Date: Tue, 09 Mar 1993 07:52:37 PST (302 lines) Archive-Number: 358 From: Billi Goldberg Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary March 9, 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 ====================================================================== "New Theory Suggests Cell Regulator May Hold the Key to Fighting AIDS" New York Times (03/09/93), P. C3 (Kolata, Gina) Two groups of researchers have hypothesized that by killing numbers of CD8 cells in AIDS patients they could boost the number of CD4 cells produced and help strengthen AIDS patients' immune systems, according to papers published in the current issue of the Journal of the Acquired Immune Deficiency Syndrome. When people become infected with HIV, they slowly and uncontrollably lose one class of white blood cells, the CD4 T cells, while a second class of cells, called CD8 cells, remain unaffected. The two groups appear to have different roles, with the CD8 cells presumably suppressing immune responses while CD4 cells incite them. Dr. Leonard Adleman of the University of Southern California, author of the current report, and immunologist Dr. Joseph B. Margolick and his colleagues from the Johns Hopkins University in Baltimore independently observed that HIV-positive people maintain a normal number of T cells, but as HIV infection develops, the ratio of CD4 cells in the mix declines. As the AIDS patient becomes more ill, there are fewer and fewer CD4 cells and an increasing amount of CD8 cells. This finding led Dr. Adleman, working with Dr. David Wofsy of the University of California--San Francisco, and Dr. Margolick and his colleagues to suggest their hypothesis. They believe the immune system cannot tell the difference between a loss of CD4 cells and a loss of T cells in general. It only senses T cells are lacking and replaces them with new ones in the normal proportions. If this hypothesis is correct, it might be possible to replenish the immune system by removing some of the CD8 cells. ====================================================================== "White House Again Defends Bush's Policy on Haitians" New York Times (03/09/93), P. A16 (Sontag, Deborah) The Clinton administration defended the Bush administration's restrictive position on the HIV-positive Haitian refugees for the second time in court yesterday, although President Clinton criticized that policy during his campaign. The trial that began yesterday in Federal District Court in Brooklyn will reveal the fate of 264 Haitians who have been detained at the U.S. Naval Base in Guantanamo, Cuba, for about 16 months. The Haitians had left their country in late 1991 and intended to enter the United States as applicants for political asylum. However, they were never released from the camp because either they or their family members tested positive for HIV. In court, the Haitian attorneys will contend that it is illegal to detain the refugees indefinitely solely on the basis of HIV infection, or treat them differently than others who seek asylum. Although government attorneys did not give an opening argument yesterday, the department has argued in the past that immigration and civil rights laws do not apply to the Haitians at Guantanamo. The Haitians' attorneys are expected to have medical experts testify that it is scientifically unsound to confine people who are HIV-positive in the same quarters. Harold Koh, a law professor at Yale University who is a lawyer for the Haitians, said that the lifetime cost of treating the HIV-positive refugees in the United States would be much less than the annual cost of maintaining their Guantanamo base, which is projected at $55 million. The Haitians' lawyers are also scheduled to summon a former military commander of the Haitians' camp, who said in pretrial testimony that he feels the detention camp should be closed. ====================================================================== "Trenton Votes to Control Sex Education" New York Times (03/09/93), P. B1 (Gray, Jerry) The New Jersey Assembly endorsed legislation yesterday requiring sex education courses to stress sexual abstinence as "the only completely reliable means" of preventing sexually transmitted diseases, including HIV infection. The vote of 54-7 makes New Jersey one of only a few states to dictate to school districts statewide just how sex education should be executed. It also signified a shift in the sex- education curriculum from local school board meeting to the floor of the State House. The bill passed by the Assembly, known as the AIDS Prevention Act of 1993, still must obtain approval in the state Senate, and Gov. Jim Florio must sign it before it becomes a law. However, following a five-year battle led by Assemblywoman Marion Crecco, a Republican from Bloomfield, there seems to be enough support in both chambers not only to pass the bill, but to override Florio's veto if he opposes it. A spokesman for the governor said that he believed abstinence should be discussed in sex-education classes, but he was concerned about the Legislature's attempt to dictate the curriculum. The bill, however, does not include any penalties for school districts that don't adhere to its provisions. Critics of the bill say it is unrealistic to expect that young people are not having sex. But Marion Crecco argued that opponents of her bill were attempting to confuse the issue. "This bill does not prohibit or restrict the teaching of safe sex. The problem is that abstinence is not being stressed, " she said. ====================================================================== "A Miffed Harrison-Jones Halts HIV-AIDS Program Collaboration" Boston Globe (03/06/93), P. 19 (Canellos, Peter S.) Boston Schools Superintendent Lois Harrison-Jones abruptly canceled the collaboration between the school system and the Health and Hospitals Department for HIV-AIDS education in city schools, after she was angered by comments made by Health and Hospitals Commissioner Judith Kurland on Friday. Officials from the School Department and Health and Hospitals had worked for months to develop a joint approach to HIV-AIDS issues, linking the classroom curriculum and services in the school clinics. On Wednesday, Harrison-Jones announced the initial results of the collaboration, which required students to be counseled it the classroom to abstain from sex, but to also be given information through the clinics about condoms and other ways to avoid HIV infection. Harrison-Jones announced the results through two press releases: one on letterhead of the Boston School Department, and another on blank letterhead that referred reporters to the Health and Hospitals Department. Kurland said she was puzzled when reporters called her and assumed the blank release had been sent from her department. After discovering that the release had come from Harrison- Jones, Kurland said she sought and received an apology from the superintendent for not confronting Kurland's office about the release. However, after Harrison-Jones read Kurland's depiction of events in the newspaper, she became incensed and canceled the collaboration. ====================================================================== "Transfusions' Effects on AIDS Patients" Washington Post (Health) (03/09/93), P. 5 (Herman, Robin) Even though the medical community has concentrated on protecting the blood supply from HIV-tainted blood, mounting evidence suggests that for AIDS patients, receiving a blood transfusion may actually accelerate the development of the disease. A study published in the February issue of the journal Transfusion demonstrates a strong link between transfusions and shortened survival time for patients who received a kind of transfusion called packed red cells within three months after their official diagnosis with AIDS. A frequent AIDS- related complication is progressively worsening anemia, which is treated with a transfusion. But scientists are unsure why transfusions might have an adverse effect on people such as AIDS patients, who are immune suppressed. Donated blood, even when properly typed and distributed to people without AIDS, can sometimes elicit an immune system reaction. Harold S. Kaplan, director of transfusion medicine at the University of Texas-Southwestern Medical Center, and Eleftherios C. Vamvakas, a research fellow in transfusion medicine at the Mayo Clinic, conducted the study, and collected their data by looking at the records of AIDS patients at New York's Bellevue Hospital in the 1980s. The researchers stress that their study does not prove cause and effect, but indicates a need for a comparison study of AIDS patients who do and do not receive transfusions. In addition, their findings cannot be applied to all AIDS patients because their subjects were a distinct group, primarily minorities in a low socioeconomic class who were not receiving AZT. ====================================================================== "Condom Firm Prevails on Showing the Colors" Washington Post (03/09/93), P. A8 (Howe, Robert F.) Although the U.S. Patent and Trademark office refused to register a proposed condom logo that resembled the American flag last year, saying it would "scandalize" the public, an appellate ruling approved the condom. It ruled that the red, white, and blue condom pennant logo is "in no way" scandalous and that designer Jay Critchley's apparent "belief that the use of condoms is a patriotic act" should be commended. Rachel Blue, the patent lawyer who rejected the registration request for Old Glory Condom Corp. last May, said yesterday that the reversal would not be appealed. Critchley, an artist and AIDS activist from Provincetown, Mass., applauded the decision, filed last week by the Trademark Trial and Appeal Board and disclosed yesterday. "The real scandal is not my trademark, but the fact that the examining attorney was more scandalized by a trademark than by the AIDS crisis to which I sought to respond," said Critchley in a prepared statement. Even though the three-member appellate panel recognized that some people might be offended by the Old Glory logo, it praised Critchley's seemingly sincere attempt to fight AIDS. Related Story: Philadelphia Inquirer (03/09) P. A6 ====================================================================== "A Hero With Something to Prove" Los Angeles Times (03/07/93), P. A1 (Stolberg, Sheryl) Jonas Salk, the founder of the polio vaccine, is currently conducting research to find a cure for AIDS. His work on the AIDS vaccine began seven years ago after Salk retired from his laboratory at the scientific institute he founded in La Jolla, Calif. He and his colleagues hope to soon present the Food and Drug Administration with the results of a nationwide test of his "therapeutic vaccine" for HIV which treats already-infected individuals. If the FDA grants approval to the Salk Immunogen, it could be available to AIDS patients by the end of this year or early 1994, under a new federal approval policy that permits the marketing of drugs for HIV-positive people, while testing continues. Therefore, Salk's vaccine could be the first therapeutic or preventive vaccine to reach the marketplace. In addition, Salk, at age 78, could become a hero all over again, but for treating AIDS this time. Dennis Carlo, the chief scientist at Immune Response Corp., the Carlsbad biotechnical company that Salk helped found to produce the Salk Immunogen, said, "How many scientists get the chance to do something twice in a lifetime? I think that of anybody, he has a very good chance of doing it." Among all of the AIDS vaccines in progress, not one scientist is using Salk's approach, which involves using a killed form of HIV, mostly because no other researcher believes it will be effective. ====================================================================== "Antibodies to Mycoplasma Penetrans in HIV-Infected Patients" Lancet (02/27/93) Vol. 341, No. 8844, P. 557 (Taylor-Robinson, David and Ainsworth, Jonathan) Mycoplasma penetrans could behave as a commensal without producing antibody, but flourish to do so under the immunosuppressive influence of HIV, if mycoplasma is widely prevalent in the entire population, not just in homosexuals, write David Taylor-Robinson and Jonathan Ainsworth of St. Mary's Hospital in London, U.K. In the Nov. 28 issue of the Lancet, Dr. Wang et al. demonstrate that 35.4 percent of 444 HIV- positive subjects had serum antibody to M. penetrans, measured by enzyme-linked immunosorbent assay (ELISA) compared with only 0.4 percent of 893 HIV-negative subjects. In addition, about 40 percent of patients with or dying of AIDS were mycoplasma-antibody positive. Wang and colleagues consider the mycoplasma to be uniquely associated with HIV-1 infection and AIDS and not to be commensal or simple opportunist. But omission of information makes interpretation difficult. A total of 85 of the HIV-positive patients who died of AIDS were homosexuals, and Taylor-Robinson and Ainsworth assume that most of the 234 HIV-positive patients are homosexuals, presumably male. But it is unclear whether most of those who have antibody to the mycoplasma are homosexuals. If most of the 336 patients attending sexually transmitted disease clinics are heterosexual and male, then it seems M. penetrans resides mostly among homosexuals. It is possible that the association with HIV/AIDS is an illusion and that the real association is with homosexuality. As a result of homosexual activity, M. penetrans could spread to other anatomical sites and have a greater chance of stimulating antibody and so account for the findings of Wang and co-workers, conclude the researchers. ====================================================================== "Mandatory Testing for HIV" Journal of the American Medical Association (03/03/93) Vol. 269, No. 9, P. 1115 (Harris, Clifford J.) Mandatory testing for HIV should be enforced because voluntary testing is not effective at thwarting the spread of the lethal virus, writes Dr. Clifford J. Harris of Cigna Healthplan of Phoenix, Arizona. The Centers for Disease Control and others predict that more than 1 million Americans are infected with HIV, but most of them do not know they are infected. Health-care workers must direct their attention to the asymptomatic HIV-positive person who, once identified, can be educated not to spread the virus and to identify contacts who can be tested. Those who test HIV-negative would receive the best education on how to protect themselves from the disease. And those testing HIV- positive would be helped by receiving earlier medical care and instructed how not to spread the virus. Therefore, HIV must be mandatory for identified contacts. The public needs to be informed about the epidemic. The American public cannot depend on a medical miracle to end this plague. The mortality and morbidity of the AIDS crisis far outweighs those of any war or past tragedy. Political correctness should be ignored when it comes to the AIDS issue. Health- care workers should urge for mandatory HIV testing programs, pass the laws, lobby the politicians, and demand responsible action now. It is the least we can do, concludes Dr. Clifford. ====================================================================== "Magnetic Resonance Spectroscopy May Offer Early Look at HIV Disease- Mediated Changes in Brain" Journal of American Medical Association (03/03/93) Vol. 269, No. 9, P. 1084 (Skolnick, Andrew A.) Proton magnetic resonance (MR) spectroscopy may help scientists learn about the effects of human immunodeficiency virus (HIV) on the central nervous system, results from a preliminary study have indicated. The study showed that MR spectrascopy may detect biochemical changes in brains of HIV-infected people who show no symptoms of AIDS or evidence of neurocognitive dysfunction. MR provides spectral patterns that are like "a collection of fingerprints of the various biochemical compounds present in the brain,'' said Robert E. Lenkinski, associate professor of radiology at the University of Pennsylvania School of Medicine. He said the spectral patterns may help scientists understand the pathophysiology of diseases of the central nervous system, including AIDS. The majority of HIV-infected patients will experience some neuropsychiatric symptoms that result from the virus entering the brain. In the late stages of AIDS, magnetic resonance imaging may indicate atrophy of gray matter of the brain followed by injury to its white matter. However, scientists cannot detect when damage to the central nervous system begins, Lenkinski said. ====================================================================== "Obtaining Drug for AIDS-Related Toxoplasmosis" Journal of American Medical Association (03/03/93) Vol. 269, No. 9, P. 1086 (Skolnick, Andrew A.) AIDS patients may again take sulfadiazine, a sulfa drug to treat toxoplasmosis, under a Centers for Disease Control program called Investigational New Drug. The FDA granted the CDC permission to import sulfadiazine to make the drug available to doctors at no cost until a domestic market source can be re-established. Production of the drug stopped in the United States in October 1992, and the only major manufacturer left no inventory supplies. Doctors can now receive a six- week supply so they may treat acute toxoplasmosis infection in AIDS patients, in patients with ocular disease, and in infected pregnant women, said Dennis Juranek, chief of epidemiology activity at the CDC's Division of Parasitic Diseases. The CDC will offer physicians a two- month supply of the drug for congenitally infected infants and maintenance therapy for AIDS patients. Doctors who treat prophylaxis of toxoplasmosis will not have access to the drug, Juranek said. Clinics will be asked to provide the CDC with patient information to enroll patients. Large hospitals that want to treat several patients should designate one doctor to be responsible for all the terms of the program, Juranek said. ====================================================================== "Update: 11th Circuit Upholds AIDS Cap Under Self-Insured Health Plan" Business Insurance (03/08/93) Vol. 27, No. 10, P. 1 The 11th U.S. Circuit Court of Appeals decided that self-insured Storehouse Inc. had reserved the right to amend its health-care plan, and that former employee and AIDS patient Richard Owens therefore could not sue for discrimination when his benefits were reduced from a maximum of $1 million to $25,000. A lawyer for the plaintiff said the decision "wasn't a surprise" since the case was almost identical to Greenburg v. H.H. Music Co., the case which the Supreme Court refused to review last November. Both rulings said that the change in benefits was needed for the company's financial stability and that there was no discrimination against AIDS patients because the cost cap could have been applied to any serious and costly illness.