Subject: CDC Summary 3/22/93 Date: Mon, 22 Mar 1993 11:39:37 PST (220 lines) Archive-Number: 474 From: Billi Goldberg Note: Copyright 1993, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary March 22, 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 ===================================================================== "AIDS Case Numbers Rise Under New Federal Rules" New York Times (03/22/93), P. B3 (Navarro, Mireya) As a result of the new federal definition of AIDS, cases of the disease in New York increased 58 percent in the first two months of 1993, compared with the same period last year. Although the numbers of new AIDS cases were high, federal officials expected them to nearly double. New cases increased 63 percent nationwide in January and February, compared with the same period in 1992. Officials from the Centers for Disease Control said that the early 1993 figures are incomplete because states are still adjusting to the increased reporting workload under the expanded definition. New York City had a reported total of 47,185 AIDS cases by last month, which is the highest number in the nation. Officials from the city health department predict that they have yet to count more than half of the cases that meet the new AIDS definition because they are still hiring more staff. Dr. Pauline Thomas, director of the New York City Health Department's AIDS surveillance office, said even without the new, more-inclusive definition, AIDS cases in the city were increasing and rose 11 percent in 1992 over the previous year. Nationwide, there were 12,243 new AIDS cases reported in the first two months of the year. Among these, 4,996, or 41 percent, were reported under the new definition. About 95 percent of the cases that qualified under the new definition were reported because of low CD4 counts. Health officials in New York and other states are creating a system that would require the laboratories that conduct CD4 counts to report the cases directly to health departments, just as hospitals, doctors, and clinics currently do. This process would be faster and more accurate. ===================================================================== "Study Suggests Alcohol Affects Response to HIV" Washington Post (03/21/93), P. A5 Drinking alcohol may impair the body's ability to fight HIV, according to a new study published in the current Journal of Infectious Diseases. Omar Bagasra, lead author of the study, said, "Even casual consumption of alcohol stimulates replication of the AIDS virus in cell cultures." Bagasra said alcohol, which generally depresses the body's immune system, may increase the chance of infection in people who drink alcohol as many as 36 hours before being exposed to the virus. In a test tube, researchers from the Thomas Jefferson University combined white blood cells of 60 healthy people and HIV. The volunteers had been drinking up to 10 alcoholic beverages over the weekend. The scientists discovered that HIV quickly replicated and invaded the CD4 lymphocytes. It also prevented "killer" cells, the CD8 lymphocytes, from attacking infected cells and inhibiting the disease. The coauthor of the study, Roger Pomerantz, said earlier studies have demonstrated that alcohol affects all white blood cells, but that CD8 cells are especially vulnerable. He said, "CD8 is one of the factors that holds HIV at bay. Because alcohol suppresses the function of these cells, the AIDS virus appears to progress relatively unchallenged." ===================================================================== "Red Cross Urges Probe of Blood System" Toronto Globe and Mail (03/19/93), P. A2 The Canadian Red Cross has called for a public inquiry to renew confidence in the country's blood-management system. The Canadian blood supply is one of the safest in the world, but fears should be allayed by an impartial body of experts such as the Royal Society of Canada, Red Cross officials told a House of Commons committee. Stephen Vick, a Red Cross spokesman, denied that tainted blood products were knowingly administered to hemophiliacs in the 1980s, as has been alleged by some members of the Canadian Hemophilia Society. "No one would knowingly distribute something that was infected--not in the past, not in the present. I mean, there would be absolutely no reason for doing that," said Vick. He mentioned that the Red Cross' decisions were based on information available at the time. In April 1985, it was unclear whether heat treatment of HIV-tainted blood was effective. But it is now known that the process is effective in killing HIV, and the Red Cross is being condemned for failing to order heat-treated products earlier than it did in March 1985. Vick said, "Hindsight is marvelous. Unfortunately, people at the time were facing partial and sometimes incorrect information." He added that the proposed public inquiry should not review what happened in the 1980s because doing so could cause bias in court cases. Instead, the review should concentrate on how the current blood-management system can be enhanced, said Vick. ===================================================================== "U.S. Drafting Global Epidemic Battle Strategy" Los Angeles Times-- Washington Edition (03/22/93), P. A1 (Cimons, Marlene) A major plan to combat future epidemics is being drafted by federal health officials who are concerned about growing reports of infectious disease outbreaks. Health officials from the Centers for Disease Control said they are also concerned about increasing evidence that many bacteria are manifesting a resistance to standard antibiotics because the drugs have been widely used in recent years. In a summary of the proposed plan, the CDC cautioned that "a new virus that emerges in the developing world is only a short airline flight from the United States." In addition, drug-resistant bacteria "can spread rapidly as a result of overcrowding, homelessness, and poor infection-control practices," said the summary. The CDC will conduct a special meeting today in Atlanta with infectious disease experts to address the proposals, which are still being developed, the agency said. The CDC plan said more resources on the state and federal levels will be needed to enhance surveillance efforts, both in the United States and abroad, to detect problems before they get out of control. The plan would entail a network of 15 locations worldwide, staffed with epidemiologists and laboratory personnel who would be responsible for studying and identifying infectious disease problems in those regions. Moreover, the plan said the CDC itself will need more infectious disease experts, citing a 12.5 percent decrease in such experts during the last decade (excluding AIDS specialists). The plan also advises that the CDC work with the National Institutes of Health to expand laboratory and research endeavors, so that researchers can better understand new or newly identified organisms. ===================================================================== "HHC's Ryan White AIDS Funds Come Up Short for New York City, Newark" United Press International (03/19/93) (Byron, Peg) New York--City health officials angrily denounced recent federal awards of millions of dollars in Ryan White AIDS funds Friday, claiming they slighted minorities and areas ridden with poverty, homelessness, and drug additions. New York City received less than half of the funds it requested through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990--for a total of about $15 million. Newark, N.J., was given no money at all. However, San Francisco received approximately the same size award as New York, although New York has about five times the number of AIDS cases. A total of $91 million was given to 25 different municipalities nationwide, without any public announcement, on March 5 by the Health Resources and Services Administration of the Department of Health and Human Services. An HRSA spokesman said that an outside consulting group decided on the award choices, based in part on whether an applicant had spent all its funds from the previous year. Mark Roebuck, the spokesman, said New York and Newark fared the worst among the grant recipients, even though he added that none got as much as requested. The money is designed to pay for AIDS drugs, services, housing, and prevention in a year when the new expanded AIDS definition is expected to add about 40 percent more qualified patients to AIDS caseloads in many cities. A high-ranking state health official in Albany, N.Y., said, "The bottom line is that this loss of funds will translate into deaths for individuals who will not get services they would otherwise have." ===================================================================== "House Weighs in on NIH AIDS Research" Science (03/05/93) Vol. 259, No. 5100, P. 1387 A bill that would dramatically restructure the way the National Institutes of Health (NIH) plans and funds AIDS projects ran into some difficulties last week. The bill did survive, however, and is close to coming on the House floor for a vote. The NIH-AIDS legislation gained momentum on February 18, when the Senate approved a bill that would move overarching control of AIDS research from separate NIH institutes to a stronger Office of AIDS Research (OAR) within NIH. On February 24, the House approved an amendment by Representative Henry Waxman (D- Calif.) that bestowed similar power to OAR, but the House bill differed significantly from the Senate's on a few major points. The Senate wants the discretionary fund to contain 25 percent of new AIDS money NIH collects each year, while the House proposed a hard figure of $100 million. The House version also insists that OAR must allocate money to various NIH institutes within 30 days of receiving the funds, in an attempt to reduce fears that OAR would slow the rate of research. As Science went to press, the NIH bill was up before a vote of Representative John Dingell's (D-Mich.) Committee on Energy and Commerce, in a prelude to a full vote by the House. ===================================================================== "The Future of Aids" Newsweek (03/22/93) Vol. 121, No. 12, P. 47 (Cowley, Geoffrey) Dr. Brett Tindall, an AIDS researcher at the University of New South Wales, says, "We know that HIV causes AIDS. We also know that a few patients remain well for long periods, but we've never known why. Is it the vitamins they take? Is it some gene they have in common? Work suggests it has more to do with the virus. I think we've found a harmless strain." Paul Ewald, an evolutionary biologist at Amherst College, argues in his upcoming book that HIV may have infected people for decades, even centuries, in a form that was benign. He follows its virulence to the social upheavals during the 1960s and 1970s which increased its range and aggressiveness within the body. Shifting conditions could drive a normally non-aggressive parasite towards virulence, or vice versa. There is evidence that HIV was not always so deadly. Rather, when people's sexual contacts expanded as a result of urbanization, fresh hosts were more available, and thus infected hosts became more dispensable. If Ewald is correct, the process can be reversed by decreasing the number of hosts available, namely through clean needles and condoms. Studies suggest that through safer sex, gay communities have decreased the number of new infections five- to tenfold. There are also indications that in the same population, during the same period, the virus has grown less noxious. By disturbing rain forests and other wilderness areas, however, new viruses might be stirred up and allowed to develop into epidemic killers. Two examples are the Ebola virus and HTLV. ===================================================================== "Position Statements Explore HIV Issues" American Nurse (03/93) Vol. 25, No. 3, P. 12 Because of the intricate issues associated with the AIDS epidemic, the American Nurses Association has issued new position statements that concentrate on women, correctional inmates, and the HIV-positive nurse's ethical obligations and disclosure. The ANA emphasizes that training is essential for clinicians and health-care workers to increase their knowledge in HIV risk assessment and gynecological developments of HIV infection and disease in women. The ANA endorses increased research in: HIV prevention for women; the etiology of HIV in women; the care and treatment of infected women; and the recruitment of women for clinical drug trials. The association acknowledges that the actions of nurses must be in compliance with the state and federal laws regulating AIDS/HIV and supports the strict adherence to the Centers for Disease Control Guidelines (July 1991) and the Occupational Safety and Health Administration Standard (1991) for patient and care giver protection from transmission of HIV infection. The ANA believes that nurses who carry a blood-borne infection should voluntarily avoid exposure-prone invasive procedures that have been epidemiologically associated with HIV. The ANA emphasizes that the HIV-positive nurse and nursing personnel have a right to have their HIV-status kept confidential. The ANA also believes there is no reason to isolate HIV- positive inmates from others based solely on their HIV status. The association recommends AIDS education be provided to all staff and inmates in jails, prisons, and juvenile confinement facilities. The ANA also stresses that HIV-positive inmates be protected by confidentiality rules.