Subject: CDC Summary Date: 4/1/93 (254 lines) From: National AIDS Info Clearinghouse Copyright 1993, Information, Inc., Bethesda, MD AIDS Daily Summary April 1, 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 1993, Information, Inc., Bethesda, MD "Clinton Set Back on an AIDS Post" New York Times (04/01/93), P. A17 (Berke, Richard L.) The Clinton administration was shocked yesterday when it learned that its first choice for federal AIDS coordinator would not take the position. Health Commissioner of New York City Margaret Hamburg told Clinton staff members that she would not accept the job, even though it had not been formally offered to her. Her decision came as somewhat of an embarrassment for White House officials, who had been telling reporters that Clinton would select her for the post. Sources close to Dr. Hamburg said she was very interested in the position at first, but subsequently chose not to take it because she is pregnant and did not think she could not care for the baby properly if she had the pressing demands of the job, which would include heavy travel. But other sources said she had also wanted to be ensured that she would be given the appropriate authority in the position. Dr. Hamburg's decision is unfortunate for President Clinton, who has already been accused of taking too long to choose an AIDS coordinator, and has been questioned about his commitment to the fight against AIDS. Administration officials said the president did not have an alternative candidate selected yet, but would not have to start all over with the selection process. Dr. Hamburg was a top contender for the post for more than a month. According to White House officials, the president had decided he wanted someone who had been deeply involved in health care rather than a political figure. "AIDS Toll Likely to Top 25 Million, Editors Told" Baltimore Sun (04/01/93), P. 4A (Birch, Douglas) The number of people dying of AIDS worldwide will exceed 25 million by 1997, according to predictions by a Johns Hopkins University medical researcher. Dr. John G. Bartlett, an AIDS expert and the head of infectious diseases at Hopkins Hospital, told the American Society of Newspaper Editors in Baltimore this week that, "You probably want to know if there's a cure ahead, a vaccine, a light at the end of the tunnel. Based on where we've been with this organism, I have to be pessimistic." He added that researchers are likely to slow progression of the disease in infected people, making it a "manageable" illness like diabetes. However, HIV may attack and mutate too quickly to be defeated altogether, he said. The plague called the Black Death in the 14th century claimed the lives of about 25 million people in Europe. Approximately 25 percent of the continent's population may have died in what was widely deemed the most deadly epidemic on record. However, the outcome of the AIDS epidemic is expected to be worse. "1 in 5 in U.S. Have Sexually Caused Viral Disease" New York Times (04/01/93), P. A1 (Barringer, Felicity) More than one in five people in the United States are infected with a sexually transmitted disease (STD), according to a study released yesterday by the Alan Guttmacher Institute. The study said that even more Americans were likely to become infected with an STD at some point in their life, and that these diseases would have the most profound effect in women and people under the age of 25. The report stated that 12 million new STDs occur each year, with two-thirds of them among people under 25, and one-quarter among teenagers. Although the information on the rate of STDs has been available to health experts, it has been largely ignored, in part as a result of the public's emphasis on AIDS. The study discovered that STDs affect women disproportionately, both because women tend to show fewer symptoms and because federal and state programs to fight such diseases tend to be in clinics that primarily treat men. The researchers have detected about 50 infections and syndromes that are sexually transmitted. The most common is chlamydia, a bacterial infection that infects 4 million people a year. The report also said that teenagers and blacks have a higher rate of STDs because "these groups are more likely than whites and older Americans to be unmarried and therefore to have multiple sexual partners. In addition, teenagers who begin sexual activity earlier are more likely to have multiple partners." Moreover, the study said those infected with STDs are more susceptible to HIV. Several of the STDs are also associated with the same social factors as HIV, including the use of crack cocaine, which increases the number of addicted women willing to trade sex for drugs. "NYC Threatens to Boycott Astra Pharmaceuticals to Protest AIDS Drug's Cost" United Press International (03/31/93) New York--The City of New York announced Wednesday that it may boycott Astra Pharmaceutical Products Inc. to protest the exorbitant price of its AIDS drug Foscavir. One year's supply of Foscavir, which treats cytomegalovirus, costs about $30,000. The steep cost led Dr. Billy Jones, head of the city's Health and Hospital Corp.--which oversees public hospitals and emergency-medical services--to caution that some AIDS patients cannot afford Astra's drug. The drug's price is high because doctors must administer it intravenously. Dr. Jones said in a memo to Mayor David Dinkins, "I have expressed my concerns to the president of Astra in an attempt to address this issue more directly. At this time, his response indicates an unwillingness to increase access to Foscavir." HHC spokesman Norman Katz said the city currently purchases $238,000 worth of Astra drugs annually, including $97,000 worth of Foscavir. However, Katz said that unless the city reaches an accord with Astra on the drug's price, HHC would boycott the Swedish company's products as existing drug contracts expire. Dinkins indicated he supported the boycott, claiming such a protest seemed important "in a time when there is heightened awareness of health-care costs and talk of health-care reform." But the mayor said the city would still buy Foscavir for patients who need it. An Astra spokesman from the U.S. headquarters in Westborough, Mass., said company president Lars Bildman "tried to arrange a meeting and never was able to talk to Dr. Billy Jones." In addition, she said that only 1,500 people nationwide use Foscavir, which generates a relatively small $27 million in annual income. "Insurer Not Liable in Hudson Case, Court Rules" Los Angeles Times--Washington Edition (04/01/93), P. B1 (Weinstein, Henry) An insurance company is not required to reimburse the estate of the late Rock Hudson for a multimillion-dollar settlement with the actor's former lover, according to a ruling by the federal appeals court in San Francisco. The U.S. 9th Circuit Court of Appeals decided Wednesday that Hudson's failure to disclose his AIDS-related condition in order to induce Marc Christian to engage in "high-risk sex" with him for eight months was "inherently harmful" behavior. Therefore, Aetna Casualty and Surety Co.'s obligation to pay claims under Hudson's homeowner's policy was voided. The ruling signifies another landmark in an increasing body of law that is developing out of the AIDS epidemic, said legal experts. David Bacon, a Los Angeles lawyer who specializes in insurance cases, commended the decision. "It is going to be a decision of increasing importance. As the AIDS disease spreads ... you will see more and more litigation in this area." However, J. Craig Fong, a lawyer with the Lambda Legal Defense and Education Fund, a gay rights group, said he believed the ruling might "contribute to AIDS hysteria." Circuit Judge Cynthia Holcomb Hall said, "It is undisputed that Hudson knew that he was infected with AIDS virus, and that he intentionally misrepresented and concealed his condition ..." "An AIDS Hospice Threatens to Close" Philadelphia Inquirer (04/01/93), P. B1 (Collins, Huntly) A Philadelphia AIDS hospice expects to close in June unless it raises enough funds to make up for a major shortfall in state money. Betak, a home for 43 AIDS patients, is one of only two such homes in the city that serve as hospices for AIDS patients. Betack, which has a waiting list of more than 30 people, was opened in January 1992 in the city's Mount Airy section. It is considered a crucial need for poor people with AIDS who otherwise might be left to die on the streets. The Rev. Arnold L. Tiemeyer, president of Lutheran Home at Germantown, the nonprofit organization that owns Betak, said yesterday that the agency's board had decided to shut down Betak as of June 1, unless the state allots at least another $250,000 this year. ACT-UP/Philadelphia, which occupied the Betak facility twice to convince the state to fund it, scheduled an emergency meeting for Monday to deal with the predicament. Tiemeyer said the $250,000 was necessary to account for the gap between the $665,000 promised by the state health officials and a grant of only $415,000. The $415,000 was not only below what Betak had been relying on, but it was supposed to help the facility through an entire year. The state appropriated the same amount last year to cover Betak's expenses for six months. In addition, Tiemeyer said that Betak has not yet seen "one cent" of the $415,000, which was provided by the state in February for the fiscal year that began last July 1. "HIV Vaccination Dilemma" Nature (03/18/93) Vol. 362, No. 6417, P. 212 (Sabin, Albert B.) There is no scientific evidence that any of the experimental vaccines against SIV or HIV, some of which are scheduled for use in large-scale human trials, have any protective effect against natural modes of transmission in previously uninfected or latently infected hosts, writes renowned polio researcher Dr. Albert B. Sabin. In their commentary in Nature, Ada et al. discussed a paper by Sabin on the improbability of effective vaccination against HIV because of its intracellular transmission and rectal (or vaginal cervical) port of entry. Neither antibodies nor cell-mediated immunity (CMI) is effective against intracellular transmission of HIV infection. Ada et al. said that "cells in the donated semen already expressing viral antigen could fuse with host cells (gp120/CD4 interaction), and thus be recognized by both classes I MHC restricted CTLs resulting from the vaccination and alloreactive CTLs." But the flaw in this argument is that there is a "novel way" by which HIV-infected lymphocytes have been demonstrated to be capable of rapidly transferring infectious virus, either HIV RNA or chromosomally integrated HIV cDNA, in HIV-positive cells by cell-to-cell contact without using CD4 receptors. Ada and colleagues also said that "to delay or not to perform such trials for the reason proposed by Dr. Sabin would be disastrous for the increasing numbers of people exposed to the risk of infection." Sabin concludes that what is dangerous is continuing the current inadequate methods of study of HIV and SIV vaccines, and to carry out large-scale tests in humans of vaccines without sufficient evidence that such vaccines can protect natural infection with adequate doses of intracellular virus. "Testing Times" Economist (03/20/93-03/26/93) Vol. 326, No. 7803, P. 90 Clinical-trial researchers have developed three methods to improve clinical testing procedures. Currently, trials use small homogeneous groups of test subjects under strict controls. Small trials of drugs that only offer mild improvements over existing drugs often lead to inconclusive results, and many small trials are necessary to notice the differences. People with fatal diseases, such as AIDS, find that beneficial drugs may not be available because trials turn up inconclusive results, creating delays in drug approvals. However, AIDS researchers have found that they can reduce the length of clinical trials by using surrogate markers, which are measurements showing the progression of the disease. The use of surrogate markers allows researchers to determine the effectiveness of a drug without waiting for the disease to run its course, as was the case with ddi and ddc that used levels of CD4 as a marker. Another test procedure uses small trials to test for toxicity. Researchers then administer the safe drugs to patients while doctors and drug firms monitor the patients' progress to determine the effectiveness of the drugs. A third testing method, known as randomised heterogeneous mega-trials, uses a large number of subjects with different backgrounds in bias-free trials. "AIDS: Donors Dictate Third-World Strategy" Lancet (03/20/93) Vol. 341, No. 8847, P. 764 (Murmu, L.R.) By industrialized countries' emphasizing AIDS research on vaccine and drug development, AIDS-related problems such as prostitution, poverty, and labor migration are clearly ignored, writes L.R. Murmu of the All India Institute of Medical Sciences in New Delhi, India. Even though poverty is identified as a key factor in the AIDS epidemic, research has not been concentrated on the understanding of such social problems. The absence of critical inquiry makes these problems seem to be prevalent and come from nowhere. Rather than seek for ways to change the political conditions that subject women to the degradation of prostitution, for example, the Indian government's AIDS effort unwittingly provides for healthier prostitutes. Also, the use of dirty needles for immunizations is a common practice in developing countries, which has a real potential to spread HIV. Until there is a focus on how easily curable health problems go untreated, a cure for AIDS will be virtually meaningless to the populations of most developing countries, concludes Murmu.