Subject: CDC Summary 3/12/93 Date: Fri, 12 Mar 1993 07:26:33 PST (247 lines) Archive-Number: 391 From: Billi Goldberg Note: Copyright 1993, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary March 12, 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 =================================================================== "Prominent AIDS Researcher Paints Bleak Outlook" Chemical & Engineering News (03/01/93) Vol. 71, No. 9, P. 29 (Baum, Rudy) As many as 1 billion people could become infected with HIV by the year 2025, and it is unknown whether a cure for AIDS or a vaccine to prevent HIV infection will ever be developed, predicts William A. Haseltine, a prominent AIDS researcher at the Dana-Farber Cancer Institute in Boston, Mass. He spoke at the annual meeting of the American Association for the Advancement of Science recently held in Boston. Haseltine said there has never been an extensive, systematic study of blood samples in the U.S. to determine how many people have become infected with HIV. He said that due to the lack of such data, "all efforts to educate people about AIDS are done blind." Haseltine's prediction regarding the lack of a vaccine that will lead to the infection of 1 billion people were based from the progress of the disease over the past decade. He said, "Projecting that 20 percent of major world populations will be infected with HIV by 2025 is not unreasonable." He also said, "We have only a fraction of the knowledge that is necessary to cope with AIDS. We can't tell you when we will have a cure for AIDS," or even a vaccine. Haseltine recommends that an ideal "curative therapy" for AIDS should restore full-term life expectancy for HIV-positive people. It should also eliminate the ability of HIV-infected people to infect others, and it should destroy functional HIV genetic information in people infected with the virus. Haseltine's outlook for the future of the epidemic is quite disheartening. He concluded, "We're in this for the rest of our lives, the rest of our children's lives." =================================================================== "House, Like Senate, Votes to Ban H.I.V. Immigrants" New York Times (03/12/93), P. A11 (Clymer, Adam) The House yesterday voted to ban HIV-positive foreigners from being admitted into the United States, a move that followed the Senate's decision. Even though the House voted an overwhelming 356-to- 58, the decision came on a parliamentary device of no real authority, and it was unclear what the legislative result will be. The vote came on a motion to instruct conferees on a medical research bill to accept the ban the Senate voted for last month. Although conferees seldom consider themselves required to follow such directives, the House majority made it likely that some form of the ban would survive a House- Senate conference. President Clinton has indicated that he wants to eliminate the ban, which under current policy is imposed by regulation, not legislation. However, the Clinton administration did not attempt in any way to lobby against the House vote, apparently considering the issue lost from the start. The vote on the ban of HIV-infected foreigners was even more one-sided than the vote on the underlying bill, a popular bill to expand the authority of the National Institutes of Health in order to put more emphasis on women's health issues and to put financial authority in the institute's Office of AIDS Research. The immigration ban was backed by 185 Democrats and 171 Republicans, and opposed by 57 Democrats and one independent. The medical research legislation, which would allow spending of up to $6.6 billion in the fiscal year beginning next Oct. 1, was adopted on a vote of 283 to 131. It was supported by 225 Democrats, 57 Republicans, and one independent, and rejected by 16 Democrats and 115 Republicans. Related Stories: Washington Post (03/12) P. A13; Philadelphia Inquirer (03/12) P. A16; Los Angeles Times--Washington Edition (03/12) P. A5 =================================================================== "Judge Orders Better Care for Homeless With H.I.V." New York Times (03/12/93), P. B3 (Navarro, Mireya) A New York State Supreme Court judge has ruled that homeless people with asymptomatic HIV infection in New York City must be housed with certain minimum standards. However, advocates for the homeless claim the ruling will force the city to remove this group from the city's shelters. The lawsuit was filed by the Coalition for the Homeless against the city and the state about five years ago. Judge Edward H. Lehner discovered that current city attempts to protect this population from tuberculosis and other contagious conditions do not go far enough. He directed the city to put this group in rooms with four or fewer people where beds are at least eight feet apart, and said the city must also give them residences that have sufficient ventilation and separate bathrooms and dining areas. But Virginia G. Shubert, the plaintiff's lawyer, said, "Not a single facility in the city meets these standards. The only logical response for the city is to expand eligibility for private housing to anyone with HIV disease." Nevertheless, in his March 4 ruling, the judge said HIV-infected homeless people who are ill are not entitled to the same private housing given to those with AIDS. City attorneys disclosed yesterday that they will appeal the ruling. Also, Shubert said the defendants are considering an appeal in the hope of obtaining the same treatment for those people sick with HIV as is provided for those with AIDS. =================================================================== "AIDS Test Sought for Dying Father" Toronto Globe and Mail (03/11/93), P. A14 (Downey, Donn) Two days before a Toronto man died of AIDS, his physician downplayed the possibility that he may have the disease, according to the man's son, who testified on Wednesday. Thomas Pittman said that on March 18, 1990, his sister Kathleen asked Dr. Stanley Bain whether their father, Kenneth Pittman, might have AIDS. According to Thomas, the man replied, "Why would you think or suggest that?" Subsequently, Dr. Bain agreed to have Pittman's blood tested, which turned out to be positive for the virus. Thomas' mother, Rochelle, who tested HIV- positive in August of 1990, his brother Mark, and his sisters Kathleen and Kelly are suing Dr. Bain, the Canadian Red Cross, and the Toronto Hospital for $2,085,000, claiming that Kenneth was given HIV-tainted blood when he received a transfusion in 1984. Thomas Pittman testified in the Ontario Court's General Division that the doctors at North York General Hospital, where his father died, were ambiguous about his condition. He added that they were very conservative about treating his father. Thomas said his father had revealed to him as late as January 1990 that he enjoyed an active sex life with his wife. When asked whether Thomas' father may have had an extramarital affair to cause him to contract HIV, Thomas said, "I have no doubt in my own mind that this is out of the question." =================================================================== "British Announce Review of Health Care HIV Guidelines" United Press International (03/11/93) London--The British government announced an immediate examination of guidelines on HIV-positive health-care workers Thursday after reports aired of a health authority concealing the AIDS-related death of one of its doctors. Health Secretary Virginia Bottomley told legislators that the current regulations needed to be reviewed to determine what additional steps could be taken to enforce ethical duties among health-care workers "where they may be at risk of passing infection on." Bottomley said, "All health care workers who believe they may have any condition, including HIV infection, which might put their patient's safety at risk must seek medical advice. They must put their patient's safety first." However, she rejected mandatory testing of health-care professionals, saying it did not exist anywhere in the world and there was no basis for it. She indicated that health-care workers entering the National Health Service and the private health sector--especially those involved in surgery or invasive medical procedures--would be required to read the guidelines and confirm they understood them. Chief Medical Officer Dr. Kenneth Calman and representatives of the General Medical Council will meet to examine the policy, which will be issued later this month, said Bottomley. Calman has said that it is not necessary for HIV-positive health-care workers to stop working. The review of the government HIV guidelines comes after the case of a Kent gynecologist who tested HIV-positive and a junior doctor at a Welsh health authority who died of an AIDS-related condition. =================================================================== "Israel Tries to Calm AIDS Scare" United Press International (03/11/93) Jerusalem--Israeli health officials said Tuesday that they would notify the patients of an HIV-positive Tel Aviv surgeon who performed surgery without knowledge of his condition to allay fears of potential transmission of the virus. The doctor, whose name is undisclosed, is the third of six missing persons found by the Health Ministry since it set up new guidelines two weeks ago for locating people who have tested HIV-positive. The health officials said they would tell the patients of the doctor that there is no need to worry because there have been no reported cases of doctor-to-patient HIV transmission in Israel. The doctor tested positive for HIV in August when he applied for a life insurance policy, but he never learned of the results. The life insurance company rejected him from being covered without telling him why. He learned he was infected with HIV earlier this week when he received the results of a second test. A total of 225 Israelis have been diagnosed with AIDS since 1981, and 982 have tested positive for HIV, the Health Ministry said. The Israeli government has recently devised new ways to thwart the spread of HIV in the country. It implemented a measure that will prohibit the entrance of HIV-positive immigrants from Western countries. It has also eliminated a tax on imported condoms to promote safe sex and is continuing to examine its polices to urge more people to get tested for HIV. =================================================================== "Japan Hospital Refuses to Operate on AIDS Woman" Reuters (03/11/93) Tokyo--A Japanese public hospital denied treatment to a woman from southeast Asia when tests showed she was infected with HIV, according to Japanese newspaper reports. The 22-year-old woman was taken to a private hospital in Yamanashi prefecture on December 16, suffering from lower spinal fractures after she fell to the ground from the second floor of the bar where she worked, reports said. Due to inadequate facilities, she was transferred to a public hospital in the area five days later. The public hospital refused to operate when it was told by the first hospital that the woman was HIV-positive, the reports said. Newspapers quoted the public hospital as claiming it had decided not to perform the operations because it was unsure how to conduct such procedures on AIDS patients. It added that the patient's chances of full recovery were small even if the operation were conducted. The patient was subsequently moved to a third hospital before leaving Japan for home on Feb. 22, without being operated on and suffering from paralysis of the lower half of her body, the reports said. =================================================================== "Preventive Health Care for Adults With HIV Infection" Journal of the American Medical Association (03/03/93) Vol. 269, No. 9, P. 1144 (Jewett, John F. and Hecht, Frederick M.) Due to the specific needs of HIV-positive patients in different stages of disease, a comprehensive care program should be adopted for all persons infected with the virus, write John F. Jewett and Frederick M. Hecht of the Brigham and Women's Hospital and Children's Hospital in Boston, Mass. The researchers have found the efficacy of some preventive measures: primary and secondary Pneumocystis carinii pneumonia prophylaxis; secondary prophylaxis of Cryptococcus, Toxoplasma, and cytomegalovirus infections; tuberculin testing, with chemotherapy for individuals with positive test results; syphilis screening; Papanicolaou tests; educational measures to reduce the transmission of HIV and other infections; T-lymphocyte monitoring; and antiretroviral therapy in selected patients. Recommended measures of potential, but less certain, efficacy include vaccines to prevent influenza, Haemophilus influenzae, pneumococcal, and hepatitis B infections; prophylaxis for recurrent esophageal and vaginal candidiasis; primary prophylaxis of Mycobacterium avium complex; tuberculosis prophylaxis for anergic, high-risk individuals; routine physical examination; screening for gonorrhea and Chlamydia in high- risk women; monitoring Toxoplasma titers, complete blood cell counts, and serum chemistry values; attempting to maintain weight through nutritional interventions; and exercise. Some approaches call for additional study before they can routinely be recommended, including vitamin and mineral supplementation; specific nutritional diets; and laboratory tests, other than CD4 counts, for monitoring disease development, the researchers conclude. =================================================================== "Insemination of HIV-Negative Women With Processed Semen of HIV- Positive Partners" Lancet (02/27/93) Vol. 341, No. 8844, P. 570 (Edlin, Brian R. and Holmberg, Scott D.) HIV-discordant couples (those in which the man is HIV-positive and the woman is not) should be aware of the risks of infection through experimental inseminations, write Brian R. Edlin and Scott D. Holmberg of the Centers for Disease Control in Atlanta, Ga. In a study published in the Nov. 28 Lancet by Dr. Semprini et al, they conclude that the lack of HIV transmission during their artificial insemination attempts in HIV-discordant couples is "reassuring," and indicate that this outcome is used in counseling such couples to "give them hope of having healthy babies." But Edlin and Holmberg express concern that Semprini et al.'s conclusion may be overstated and suggest that doctors might give false hope to such couples. Semprini et al. neglect to mention that insemination of semen that had been processed with the intent of removing infectious HIV has been associated with transmission of HIV. Application of the Poisson distribution to Semprini's data yields a rate of 6.25 transmissions per 100 inseminations. This finding should be considered if their data are used to counsel HIV- discordant couples. Also, Semprini and colleagues provide no information about the state of HIV infection, CD4 counts, antiretroviral therapy, or degree of white cells in semen of their 29 donors. Recovery of HIV from semen is greater from donors who have more advanced infection, lower CD4 counts, no antiretroviral therapy, and white blood cells in their semen. Among the 85 couples from whom their 29 men were selected, 92 percent had no symptoms of AIDS, AIDS-related complex, or advanced immunosuppression. Therefore, using this data to represent all men with HIV infection may not be warranted, conclude Edlin and Holmberg.