Subject: CDC Summary 3/11/93 Date: Thu, 11 Mar 1993 08:07:16 PST (242 lines) Archive-Number: 382 From: Billi Goldberg Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary March 11, 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 ===================================================================== "Debunking Doubts That H.I.V. Causes AIDS" New York Times (03/11/93), P. B13 (Kolata, Gina) A team of California researchers has disproved a theory claiming that recreational drug use, and not HIV, is the cause of AIDS. The scientists reported in a commentary published today in Nature that their research shows no relationship between recreational drug use, excluding IV-drugs, and the development of AIDS. The research team was led by Dr. Michael S. Ascher, an immunologist at the California Department of Health Services, and Dr. Warren Winklestein Jr., an epidemiologist at the University of California--Berkeley. Dr. Ascher and colleagues wrote their paper in response to a challenge by Tom Bethell, a media fellow at the Hoover Institution at Stanford University, to compare people who used drugs with those who didn't and to determine whether those who took drugs had a higher incidence of AIDS. Bethell wrote in an article in the San Francisco Chronicle of the theory proposed six years ago by Dr. Peter H. Duesberg, a molecular biologist at the University of California--Berkeley. Duesberg argues that HIV is not the cause of AIDS and that the drug AZT speeds, rather than slows, the depletion of the immune system. Bethell asked why no research had been done on this hypothesis. Therefore, Dr. Ascher et al. retested their hypothesis of the analysis of the San Francisco Men's Study, a group of 1,034 randomly selected single men who lived in San Francisco and were 25-54 years old in 1984, when the study began. The researchers found that homosexuals and heterosexuals in the study were equally likely to use drugs. However, 26 percent of homosexuals developed AIDS, whereas none of the heterosexuals did. All of the men were infected with HIV, but there was no link between drug use and AIDS. Related Story: Wall Street Journal (03/11) P. B5 ===================================================================== "In the Nation: House Favors Ban on Entry of HIV-Infected" Baltimore Sun (03/11/93), P. 13A The controversial ban on HIV-positive foreigners seeking admittance into the United States is likely to be passed by the House, which could defeat the Clinton administration on the issue, Democratic aides admitted yesterday. Debate on the restrictive policy emerged as the House considered a measure authorizing spending for the National Institutes of Health. A vote on the ban is scheduled for today, and congressional Democratic aides said that it is expected to be passed. The Senate overwhelmingly passed a similar bill last month, after adding an amendment prohibiting HIV-positive foreigners from immigrating to the United States. During his campaign, President Clinton vowed to eliminate the ban already in place. ===================================================================== "Emergency Room Misses Women's HIV" USA Today (03/11/93), P. 1D (Painter, Kim) Many HIV-positive patients, particularly women, were not recognized as having the condition in Bronx emergency rooms, according to a new study published in the American Journal of Public Health. The report adds evidence that HIV in women is not being detected, which leads to missed chances for treatment. Mayris Webber of Montefiore Medical Center said, "HIV and AIDS in the eyes of most physicians is still a male problem, but it is not." Emergency room charts of 2,102 patients were examined and HIV tests were conducted on 856 blood samples left over from other tests. The researchers found that health- care workers had identified 20 of 52 HIV-infected men, but only 7 of the 40 women with the disease. Also, only 11 percent of the women and 16 percent of the men in the emergency room were asked anything about high-risk behavior. Most of the questions were about drug use, and not about sex. This is unusual for an area where heterosexual transmission of HIV is common, and women are more likely than men to contract HIV through sex. ===================================================================== "Director Leaving Disease Centers" New York Times (03/11/93), P. B12 (Hilts, Philip J.) Dr. William Roper, chief of the Centers for Disease Control, resigned yesterday as a part of a continuing effort by the Clinton administration to remove some of the Bush administration's top health appointees. Dr. Roper was asked to step down by Secretary of Health and Human Services Donna E. Shalala on Tuesday, according to HHS officials. His resignation will take effect on June 30, and a successor has not yet been named. What caused the HHS to request the resignation were Roper's markedly uncontroversial policies on AIDS prevention, which included an anti-AIDS advertising campaign that was considered weak by opponents. The ousting of Dr. Roper also indicates a shift in the government's attack on AIDS. The new approach is expected to include prevention efforts that address sexuality directly, and programs of early treatment that may be costly, experts in and out of the Clinton administration say. Jeffrey Levi, political director of the AIDS Action Council, said the removal of Dr. Roper "is an opportunity to depoliticize the AIDS program at the Centers for Disease Control." He added, "Dr. Roper allowed politics to stand in the way of explicit prevention programs as well as setting policy on how to treat doctors and nurses who are infected with HIV." The CDC had written draft guidelines explaining that HIV-positive health-care workers could continue to practice after review of their cases by a medical board. However, after a call from Sen. Orrin G. Hatch (R-Utah), Dr. Roper "shredded that policy and added that health care workers still need to get informed consent from the patient," said Levi. ===================================================================== "Japanese Mushroom Helps Block AIDS Says Researcher" United Press International (03/11/93) Tokyo--A Japanese mushroom can help inhibit HIV and can also restrain breast cancer, according to a researcher in Kobe, Japan. Prof. Hiroaki Namba of Kobe Women's College of Pharmacy discussed both trials conducted among AIDS patients in the United States and tests on mice with the Kyodo News Service Thursday. He said the tests demonstrated that a polysaccharide called glucan extracted form the mushroom, called maitake, incites action in helper T-cells. Namba said, "It remains unknown why glucan from the maitake mushroom activates the body's immune functions. But given its effectiveness against symptoms of AIDS, it could be used for the treatment of AIDS patients together with anti-AIDS drugs." Namba worked with two American physicians to perform trials involving 26 AIDS patients, aged 20-40, to determine if glucan would activate helper T-cells. The AIDS patients were administered powdered maitake and glucan tablets, weighing three grams each, daily for two weeks in April 1992, Kyodo reported. The number of T-cells increased in 13 patients, and they stopped decreasing in the other 13. In some instances the number of T-cells doubled. A report on Namba's study is expected to be presented at a meeting of the Japan Society of Pharmacy in Osaka, reported the news service. ===================================================================== "Bill Would Boost Research on Women's Health Problems" United Press International (03/11/93) (Shepard, Robert) Washington--Debate has been opened in the House over a bill intended to eliminate the "blindspot" in medical research on women's health problems, which is similar to a bill vetoed by the Bush administration. The legislation, scheduled to receive a final vote today, also would legalize President Clinton's order allowing federally supported medical research that uses fetal tissue from abortions. The three-year, $21.3-billion bill would boost spending for breast, cervical, and prostate cancer research, as well as research on osteoporosis, and would mandate that all clinical research trials involve women and minorities. The measure also seeks to increase research on AIDS by giving the National Institutes of Health's Office of AIDS Research more authority. ===================================================================== "Thousands of Women Bombard AIDS Helpline" Reuters (03/07/93) London--Telephone lines at two hospitals were inundated with calls from thousands of women concerned that they may have contracted HIV from a British doctor who was recently diagnosed with the disease. Approximately 3,500 women contacted a hospital in Chatham, southeast England, after special hotlines were established to counsel former patients of gynecologist and obstetrician Terence Shuttleworth. Another 80 women arrived at the hospital seeking advice and 76 decided to be tested for HIV. A total of 2,500 calls were received at a private hospital where the doctor worked. Shuttleworth, diagnosed as HIV- positive last week, was believed to have treated up to 17,000 women over the past 10 years, but health officials said the chance of HIV transmission to patients was minimal. "Only those who have had gynecological surgery are the ones who may need to seek further information," said Dr. Ann Palmer, director of public health at the Medway Health Authority. According to health officials, Shuttleworth was involved in operations on nearly 6,000 women during the 10-year period. Hospitals have provided confidential HIV testing for all women who request it. ===================================================================== "AIDS--Fighting Back" Associated Press (03/08/93) New York--Although there are several different kinds of AIDS vaccines that are currently in clinical trials, not one researcher who spoke at a recent forum on AIDS vaccine and immune system therapies could name the vaccine that is most effective. The forum was sponsored by the Gay Men's Health Crisis and the Community Research Initiative on AIDS. Federal researcher Margaret Johnston said that about 10 experimental therapeutic vaccines have started testing in HIV-positive people. She said the results show that six of the vaccines incite an immune system response and they appear safe. But there are no definite results yet available on the other four, she said. Also, there is no notable indication that the vaccines can reduce the amount of HIV in the blood, said Johnston. Moreover, what is largely unanswered is whether these vaccines can actually help an HIV-positive individual's health. The reactions elicited during some of the candidate vaccines included creation of antibodies and responses by defensive white blood cells. The majority of vaccines were intended to stimulate the immune system by presenting a particular HIV protein or a piece of a protein. One vaccine that is different is the Salk vaccine, which uses a killed whole HIV that is stripped of a major protein called gp120. Research has shown that the Salk vaccine can incite a wide variety of antibodies that bind specifically to different virus proteins, and strengthen the response of immune system cells to HIV. National Institutes of Health director Bernadine Healy said testing several vaccine candidates is warranted because "no one candidate at this point has proven to be superior, and because these products are inherently different." ===================================================================== "Inhibition of Rev-Mediated HIV-1 Expression by an RNA Binding Protein Encoded by the Interferon-Inducible 9-27 Gene" Science (02/26/93) Vol. 259, No. 5099, P. 1314 (Constantoulakis, Pantelis et al.) Determining the function of RBP9-27 may result in a better understanding of the mechanism of interferon action during HIV-1 infection, write Pantelis Constantoulakis et al. of the National Cancer Institute-Frederick Cancer Research and Development Center in Frederick, Md. Interferon blocks expression of HIV-1 through unknown mechanisms. A gene inducible by interferon-a (IFN-a) and interferon-y (IFN-y) was isolated by screening of a human complementary DNA library for proteins binding to the Rev-responsive element (RRE) of HIV-1. The product of this gene, RBP9-27, was shown to bind RNA in vitro and to inhibit HIV-1 expression after transfection into human cells. Therefore, RBP9-27 is a cellular factor that antagonizes Rev function. These findings indicate an interferon-induced antiviral mechanism operating through the induction of RNA binding proteins such as RBP9-27. HIV-1 may use inhibition by IFN to down-regulate its own expression. This may lead to the restricted expression of HIV-1 in different cell types. Lentiviral replication strategy involves negative regulatory steps considered important for the generation of chronic, active infections by these viruses. Additional understanding of RBP9-27 function may offer insight into virus-cell interactions and into the development of therapeutic strategies for AIDS prevention, the researchers conclude. ===================================================================== "Low Frequency of Neurosyphilis in HIV-Infected Individuals" Lancet (02/27/93) Vol. 341, No. 8844, P. 571 (Esselink, Rianne et al.) Neurosyphilis, usually defined as neurological symptoms combined with a positive cerebrospinal fluid-Venereal Disease Research Laboratory (CSF-VDRL) test, is a rare HIV-related condition, write Rianne Esselink et al. of the University of Amsterdam in Amsterdam, Netherlands. The risk groups for acquiring syphilis and HIV largely overlap, and there may be interactions between Treponema pallidum and HIV in individuals infected with both organisms. In addition, the diagnosis of neurosyphilis in this group of patients may be difficult, because the VDRL test may be negative in CSF in patients with viable T pallidum in the CSF. Rates of neurosyphilis varied between 1.5 percent in inpatients with AIDS to 3.3 percent in HIV-positive individuals with neurological symptoms. Among all patients with reactive serum syphilis tests, 9.1 percent had reactive CSF-VDRLs. The researchers examined the records of all 663 HIV-positive individuals evaluated for neurological problems between 1982 and 1992 to assess the frequency of neurosyphilis. It was found that in 342 (52 percent) patients, CSF was examined at least once for various reasons. CSF samples were not regularly, but frequently, tested for syphilis with VDRL and T pallidum haemaglutination assay (TPHA) tests. In neurosyphilis, both tests are usually positive in the CSF. Among the 258 CSF samples tested, only 1 (0.4 percent) had a positive VDRL test. Regardless of this low incidence, prudent evaluation of HIV-positive patients with unexplained neurological problems and repeated serological (and CSF) testing for syphilis in this group is suggested, so that a treatable neurological infection is not overlooked, conclude Esselink et al.