Subject: CDC Summary 3/17/93 Date: Wed, 17 Mar 1993 11:32:10 PST (233 lines) Archive-Number: 471 From: Billi Goldberg Note: Copyright 1993, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary March 17, 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 ===================================================================== "Rethinking AIDS" Wall Street Journal (03/17/93), P. A14 (Root- Bernstein, Robert) The National Research Council report on AIDS challenged the conventional wisdom concerning the disease, writes Robert Root- Bernstein for the Wall Street Journal. The report indicated that certain geographic areas and risk groups, including gay men, drug addicts, and the malnourished and poor, are prone to HIV infection and AIDS. The interesting thing about the National Research Council report, says Root-Bernstein, is that it failed to address a number of scientific and medical implications directly. If everyone is not equally susceptible to AIDS, then factors other than HIV should determine who becomes infected. In looking at prostitutes, for instance, most who are infected with HIV are also drug users. Cases of sexually-acquired HIV among non-drug-using prostitutes are virtually unknown. Also, of the hemophiliacs infected with HIV between 1981 and 1984, only 1,500 cases of AIDS have been reported. Neither prostitutes nor hemophiliacs have become vectors in the spread of the disease, as was initially suspected. Data from studies of prostitutes and hemophiliacs indicates that healthy, drug-free people do not get AIDS. Those who do get the disease may have risk factors including semen- induced autoimmunity following unprotected anal intercourse, blood transfusions, multiple and concurrent infections, chronic use of drugs, prolonged use of antibiotic and antiviral drugs, and malnutrition. Ultimately, eliminating risk factors for HIV-infected people can be more effective in preventing the development of AIDS than treating HIV, concludes Root-Bernstein. ===================================================================== "Treating AIDS in the Family" Philadelphia Inquirer (03/17/93), P. G1 (Collins, Huntly) Philadelphia's new family AIDS clinic, Care Plus, aims to treat HIV-infected families who live in the nearby drug-infested neighborhood where AIDS has already claimed hundreds of lives, most of which have been African American. Since the its opening in January, 33 people from 13 extended families have sought care at the clinic. Those numbers are expected to grow as AIDS continues to ravage the city's minority poor. Care Plus provides everything an AIDS patient can expect, including HIV testing, primary-care treatment, medicine, psychological counseling, support groups, and information about social services. Care Plus also offers homemaker service for those unable to get to the clinic. The Care Plus clinic is located in the Strawberry Mansion health center. ===================================================================== "AIDS and Children: Too Quiet a Tragedy" USA Today (03/17/93), P. 9A (Shahid, Sharon) In an interview with Sharon Shahid of USA Today, Dr. Arye Rubinstein discussed the spread of HIV infection among women. Rubinstein noted that the ratio of those infected with AIDS is now shifting. In the United States, 10 percent of those infected are women, but in the Bronx, about a third are women, most of whom acquired the disease through heterosexual transmission and IV drug use. Babies then acquire the disease from their mothers during pregnancy, during delivery, or through breast feeding. Eliminating IV-drug use among women and preventing the spread of the disease through heterosexual contact is necessary, said Rubinstein. While there has been a decline in infection among the homosexual population, among IV-drug-using and drug-using communities the infection rate has not decreased. An HIV- infected mother can be treated with antiviral agents, antibodies, and vaccines during pregnancy to help reduce her virus load or to help her immune system to avoid passing the virus to her fetus. Pediatric AIDS is a massive social burden, said Rubinstein, and many children with AIDS don't really understand what the word means. "As they grow up and reach the age of about 7 or 8, they start understanding the implications. They understand that they're not going to grow up," Rubinstein said. ===================================================================== "Cambridge, Mass.-based Therion to Work With Harvard on AIDS Vaccine" Knight-Ridder (03/17/93) (Rosenberg, Ronald) Boston--Yesterday, Terion Biologics Corp. announced an agreement in which it will license from Harvard University a "live" AIDS vaccine technology. Exact terms of the deal were not disclosed. In the agreement, however, Therion and Harvard researchers will collaborate to test a number of virus strains in an attempt to produce a vaccine that triggers an immune response without also causing long-term health disorders. Therion will use the Harvard vaccine technology, which uses weakened live strains of the HIV virus, with its own proposed AIDS vaccines. Therion is likely to be the first company to begin human studies of live virus vaccines that offer long-lasting protection against infection. The company announced yesterday that its own live genetically-engineered TBC-3B vaccine would be used in human clinical safety studies before July, under a grant from the Vaccine Branch of the National Institute of Allergy and Infectious Disease. "We have felt for a long time that the best approach for AIDS vaccine was to mimic the live vaccine approaches that have historically worked in measles, mumps, polio and rubella," said Therion CEO Dennis L. Panicali. Most of the other biotechnology and pharmaceutical firms working on AIDS vaccines are using "dead" genetically-engineered portions of the AIDS virus, an not a live version of the whole virus. Live virus strains have been avoided because of their potential safety risks. However, Harvard Medical School researchers led by Dr. Ronald Desrosiers recently announced a successful test of an AIDS vaccine in monkeys. "We want to learn from [Desrosier's] vaccine and improve our own vaccines," said Panicali. ===================================================================== "Glaser: 'Keep Putting One Foot in Front of the Other'" USA Today (03/17/93), P. 9A (Shahid, Sharon) Elizabeth Glaser, wife of actor/director Paul Michael Glaser, has worked to educate the public about how AIDS affects children for the past four and a half years. Glaser was exposed to HIV during the birth of her daughter in 1981, when she received seven pints of HIV- contaminated blood. Glaser unwittingly passed the virus to her daughter through breast feeding, and then passed it to her son three years later. Glaser, in 1989, co-founded the Pediatric AIDS Foundation, which is seeking to find means of preventing the transmission of AIDS from mother to newborn, in addition to identifying and funding pediatric AIDS research around the world. "It's certainly optimistic for a new mother who has just found out that her young child is infected to know that my son is 8 years old and doing well. Initially, people thought that all children with AIDS would die by the time they were 2," said Glaser. Although she has "very few T-cells," Glaser remains healthy and says she is leading an active and productive life. ===================================================================== "No More Treating Teens Like Children" USA Today (03/17/93), P. 1D (Carroll, Nicole) Adolescent medicine experts say doctors who treat teenagers need to begin considering the special problems teenagers face, such as AIDS, in addition to routine medical care. Of polled 9th through 12th grade adolescents, 54 percent reported having had sex, and 55 percent said they did not use a condom when they last had intercourse. However, fewer than 1 percent of the medical exams conducted in 1990 featured AIDS counseling. "Teens are a ticking time bomb. If all you're doing is checking hearts and lungs, you're missing a powerful chance to make a difference," said Dr. Lonnie Zeltzer. Doctors say insurance plans generally do not cover preventative care, and many teenagers are reluctant to seek help for sensitive problems, particularly if parents can find out. "This is one of the only areas where we really haven't made a lot of headway in prevention. Mortality of adolescents isn't going down like in other age groups," said Dr. Suzanne Riggs, director of adolescent medicine at Rhode Island Hospital. Riggs suggests establishing doctor/teen rather than doctor/parent relationships. Riggs also emphasizes the importance of confidentiality. ===================================================================== "Conference: Resistance to HIV Infection" Lancet (03/06/93) Vol. 341, No. 8845, P. 624 (Rowe, Paul M.) A research conference held on Feb. 25-27 and sponsored by the National Institutes of Health on Immunologic and Host Genetic Resistance attempted to identify and generalize three groups of individuals who are exceptions to the rules of being healthy. The first group consists of those who have been exposed to HIV but not infected; the second group are those who are infected but do not lose enough CD4 cells to go below 200u/L; and the third group are those who progress (CD4 counts fall below 200u/L) but who did not develop symptoms of stage IV AIDS. It appears that there is a dose-response element to resistance to HIV infection. No recipient of a transfusion of fresh whole HIV-tainted blood remains uninfected. Also, about 10 percent of those who continue to engage in high-risk sexual and drug- related behavior remain uninfected. While several studies demonstrate that these selected individuals remain seronegative, and non-viraemic, their peripheral blood cells proliferate and release IL-2 in response to HIV peptides, which suggests exposure to HIV antigens. Doses required to infect different individuals may vary by more than 1000- fold, and some of the resistance mechanisms may be post reverse transcription. In addition, the presence in HIV-resistant individuals of cell-mediated immune responses to highly conserved parts of the virus indicates that protective immunity could be based on cell- mediated rather than humoral mechanisms. The conference concluded that some aspects of resistance are clearly genetic, but healthy immune systems seem less susceptible to HIV infection, and presence of other infections may promote acquisition and acceleration of HIV infection. ===================================================================== "Idiopathic CD4+ T-Lymphocytopenia: A Quantitative View" Lancet (03/06/93) Vol. 341, No. 8845, P. 636 (Reichert, T.A.) The incidence of idiopathic CD4+ T-lymphocytopenia (ICL) in HIV- negative individuals may be the result of a natural statistical variation, writes T.A. Reichert of Becton Dickinson in Franklin Lakes, N.J. CD4+ lymphocyte counts in whites have a normal distribution. If this characterization can be extended to very low CD4+ percentages/counts, then about 1:2 in every 1,000 white adults will have CD4 percentages below the ICL threshold (20 percent of lymphocytes). Since the distribution for females is about one-third of an SD higher than that for males, this hypothesis would predict that the female/male ratio in ICL should be less than 1:0, and ideally, about 0:36. Because the absolute numbers of all lymphocytes are raised in young children, a condition defined in terms of percentage of lymphocytes is likely not to have the same clinical effect in that group. Young children with less than 300 CD4+/uL should become rare, because the mean CD4+ count is about 200/uL. A total of 68 cases of ICL have been reported, one of which was found in 2,388 HIV-negative homosexual men in the Multicenter AIDS Cohort Study. No cases of idiopathically low CD4+ have been reported in children. The geographical distribution of existing cases seems inconsistent with the idea of a single transmissible agent, and without predisposing factors, any such agent would be expected to affect each sex equally. At a rate of 1:2/1,000, there would be at least 300,000 cases of ICL in the United States alone. This indicates that ICL is easily the most common form of immunodeficiency. Doctors may want to consider ICL in all patients with unexplained opportunistic infections, concludes Reichert. ===================================================================== "Recommendations for HIV Testing Services for Inpatients and Outpatients in Acute-Care Hospital Settings" Morbidity and Mortality Weekly Report (03/05/93) Vol. 42, No. 8, P. 157 Hospitals and associated clinics should urge health-care workers to regularly ask patients in nonemergency settings about their risks for HIV infection, according to new guidelines published by the Centers for Disease Control. The revised guidelines were spurred by information concerning both the rates of previously undetected HIV infection among persons admitted to some acute-care hospitals and potential medical and public health benefits of recognizing HIV infection in persons who have not yet developed AIDS. The CDC suggests those patients who are found to be at risk for HIV should be offered counseling and testing services with informed consent obtained in agreement with local laws. Moreover, hospitals with a rate of HIV infection of at least 1 percent or an AIDS diagnosis rate of less than 1.0 per 1,000 discharges should strongly consider adopting a policy of offering such services routinely to patients aged 15-54 years. The services should be designed to ease confidential, voluntary patient participation and should include pretest information about the testing procedures, appropriate post-test counseling for HIV-positive patients and those at high risk, and referral of HIV-positive persons for medical evaluation. Those patients who don't wish to be tested or those who are found to be infected after testing, must not be denied health care or provided inadequate care. The guidelines stress that HIV counseling and testing programs should not be substituted for universal precautions and emphasize the significance of effective and continuous cooperation between acute-care providers and health departments to enhance HIV-related prevention and treatment services.