Subject: CDC AIDS DAILY SUMMARY 03/04/94 Date: Fri, 04 Mar 1994 09:15:49 CST (237 lines) Approved: phil (J. Philip Miller) Archive-number: 13270 From: "ANNE WILSON, CDC NAC" Note: Copyright 1994, Dan R. Greening. Non-commercial reproduction allowed. Copyright 1993, Information, Inc., Bethesda, MD AIDS Daily Summary March 04, 1994 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, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1993, Information, Inc., Bethesda, MD "AIDS Work at a Nation of Islam Clinic Is Questioned" New York Times (03/04/94) P. A18 While the $213,000 in AIDS funding awarded to the Abundant Life Clinic in Washington, D.C., is not the largest federal contract, it may well be the most controversial. The clinic, operated by the Nation of Islam's Dr. Abdul Alim Muhammad, treats symptoms of AIDS with low-dose alpha interferon, a therapy whose value has been challenged by government scientists. In a study of patients at Abundant Life Clinics in Washington and New York, Muhammad and another doctor, Barbara Justice, found that 82 percent of AIDS patients receiving low-dose alpha interferon experienced increased appetite, weight gain, and other improvement. The Final Call, the newspaper of the Nation of Islam, has heralded the drug as a cure for AIDS. But the National Institutes of Health has asserted that clinical trials of low-dose alpha interferon, which was developed in 1990 by doctors in Kenya, indicated that the treatment "provides no benefits in fighting HIV, or in improving the immune systems of those infected." Another study, conducted over 60 weeks in Uganda in 1991 and 1992, supported the NIH statement by concluding that there was no appreciable difference in the symptoms of AIDS patients given low-dose interferon and those given a placebo. But because the drug has demonstrated promising results in treating hepatitis, measles, and other diseases, NIH said it will conduct pilot studies of the treatment to determine if clinical trials are necessary. "AIDS Groups Lambaste NIH for 'Gay Gene' Search" Washington Times (03/04/94) P. A8 (Price, Joyce) Some AIDS advocacy groups are among those criticizing research by the National Cancer Institute that is searching for both a "gay gene" and for possible genetic causes of Kaposi's sarcoma, a cancer once prevalent among homosexuals with AIDS. In general, the medical community is skeptical that heredity is a factor in the disease. Some of the nation's leading AIDS experts, including Dr. Peter Hawley, medical director of the Whitman-Walker Clinic, and Dr. John Bartlett, chief of infectious disease at Johns Hopkins Medical Institutions, say there is convincing medical evidence to suggest Kaposi's sarcoma is sexually transmitted. They also note that the condition is much less prevalent than it was earlier in the AIDS epidemic, which raises more concerns over the NCI research. "With the limited dollars that are available [for AIDS research], it seems kind of wasteful to spend money on a wild-goose chase," says Steve Michael, spokesman for ACT-UP D.C. "You have to set priorities, and KS seems to be a peculiar priority. The bottom line is that it's disappearing." "Prominent AIDS Physician Has Licence Suspended" Toronto Globe and Mail (Canada) (03/02/94) P. A7 (Mickleburgh, Rod) The license of Dr. Maurice Genereux, a Toronto doctor with the largest AIDS practice in Canada, has been suspended for nine months following his guilty plea to six charges of sexual misconduct involving his patients. Four of the complainants were being treated for HIV when the incidents occurred. While the misconduct did not involve intercourse, Genereux--who is gay--admitted to inappropriately touching or fondling the genitals of his patients. The College of Physicians and Surgeons of Ontario, which originally sought to permanently revoke Genereux's license to practice, at the last minute opted to pursue only a suspension. According to College lawyer Michelle Fuerst, this was due in part to the large number of patients who specifically sought out Genereux for his expertise in the AIDS field. There were also concerns that other AIDS doctors in Toronto would be unable to accommodate Genereux's large number of patients were his license to be revoked. "Dr. Genereux does provide a service to the public" by treating HIV/AIDS patients," said Fuerst. "The evidence is that he is capable of doing it in a caring and compassionate way...He does have a contribution to make, and there are patients who want to access his services." For 15 months after his return to practice, however, a third person will be present during all examinations conducted by Genereux. "Thailand to Start AIDS Vaccine Tests With WHO Help" Reuters (03/03/94) (Birsel, Robert) Bangkok--With the help of the World Health Organization, Thailand may soon initiate testing of experimental AIDS vaccines, announced Michael Merson, executive director of the agency's Global Programme on AIDS. Earlier this month, Thailand's National AIDS Prevention and Control Committee granted approval for testing to begin on two trial vaccines, said Udomsil Srisangnam, Thailand's deputy minister of public health. Health officials believe that because of its high number of new HIV cases as well as its well-developed public health infrastructure, Thailand is an ideal testing ground for AIDS vaccines. If initial trials for safety and immunogenicity yield promising results, large-scale testing for the ability to prevent HIV transmission could begin. Merson said it would take at least three years to test a vaccine and it was unlikely that one would be ready for broad public use before the year 2000. "City OKs Drug Coupons" Houston Chronicle (03/03/94) P. 30A The Houston City Council on Wednesday voted for the use of $7,500 in state grant money to buy certificates from a fast-food chain to encourage drug users to follow up on HIV and other health tests. Under the measure, the city's Health and Human Services Department will pay half price for the $1 coupons, which officials plan to distribute to intravenous drug users who return for results and treatment following diagnostic tests. Health officials hope the coupons will double the return rate of drug addicts tested for HIV, tuberculosis, and other diseases. "AIDS Czar Makes Battle a Priority for All Americans" Houston Chronicle (03/03/94) P. 26A (SoRelle, Ruth) National AIDS Policy Coordinator Kristine Gebbie wants to make the fight against AIDS a priority for all Americans--even those who believe the disease is not their problem. She insists that everyone is at risk, therefore, everyone should be included. On a visit to Houston this week, Gebbie called her meetings with local activists "part of a continuing effort to get acquainted and get in touch" with AIDS advocates nationwide. As federal AIDS czar, Gebbie meets with community groups to make sure that women, as well as ethnic and racial minorities--who are often left out of the process--realize that they have a role in planning how to battle the epidemic in their communities. Gebbie has no budgetary authority, nor the power to set policy. "But I have the authority of the White House in dealing with Cabinet departments," she says. "I can say the president asked me to check up on this." "Japan Faces New Questions on HIV in Blood" Nature (02/17/94) Vol. 367, No. 6464, P. 584 (Swinbanks, David) A television documentary transmitted by the Japan Broadcasting Corporation (NHK) has renewed controversy over the country's delay in introducing heat-treated blood coagulants. In a move that resulted in the HIV infections of thousands of Japanese hemophiliacs, Japan did not permit the use of coagulants treated with heat to kill HIV until 1985--more than two years after they debuted in the United States. The NHK broadcast revealed the strongly opposing views of officials at the Ministry of Health and Welfare, and scientists advising the government on how to deal with AIDS. Atsuaki Gunji, head of a division of the ministry's pharmaceutical affairs bureau, announced in 1983 that the ministry was willing to circumvent regulations and allow the emergency import of heat-treated products. Takeshi Abe, head of an AIDS study group established by the division, opposed that notion out of fear that doctors would be blamed for any side effects from use of the heat-treated products, which had not undergone clinical trials in Japan. Abe's argument won out and the ministry decided to continue use of non-heat-treated coagulants while conducting clinical trials of heat-treated ones for nearly the next two years. The NHK also reported incidents in 1983 that might have alerted the study group to the imminent threat of AIDS, but for unknown reasons, no action was taken. "Spectre of AIDS Haunts Reports of Sick Cows" Nature (Great Britain) (02/17/94) Vol. 367, No. 6464, P. 585 (Clayton, Julie) Great Britain's Independent on Sunday newspaper reported "the first case of bovine AIDS in Britain," a claim that government officials are playing down. A herd of cows on a Cheshire dairy farm is suffering from symptoms such as nerve degeneration, weight loss, mouth ulcers, and respiratory infections. Two of eight cows have tested positive for antibodies to bovine AIDS (BIV) on the ELISA, western blot, and immunofluorescence tests, while the others have tested positive on just one or two of the tests. Despite attempts by the government to minimize the significance of reports linking the illness to AIDS in humans, local companies are refusing to handle meat from the herd or allow milk to be used for pig-feed. Joe Brownlie of the Institute of Animal Health in Berkshire, whose team is conducting tests on the herd, says he does not expect BIV to pose any threat to humans. It is unable to grow in human cell culture, and two "needle-stick" injuries in the United States have failed to infect humans. "HIV Testing and Blood Recipients" Lancet (Great Britain) (02/19/94) Vol. 343, No. 8895, P. 478 (McMenamin, James J. et al.) McMenamin et al. share concerns over the possibility of HIV transmission in transfusion recipients, but feel Frerichs and Seymour's advocacy of salivary HIV testing for everyone who has received a transfusion is unreasonable. McMenamin et al. cite three major difficulties with this approach, the first of which is the tremendous financial burden it would place on any health service. Second, they predict that many recipients would likely reject the offer of testing. Finally, a telephone answering machine acting in the role of counselor by delivering HIV test results is not good medical practice. McMenamin et al. offer an alternative approach, in which blood transfusion centers retrospectively identify at-risk recipients by considering the fate of previous donations from newly-diagnosed HIV-positive donors. This can be done, they say, by maintaining good records. Recording a donated unit's unique identification number in a patient's casenotes should be obligatory, contend McMenamin et al. Opinion data should be collected and monitored, but only with the guaranteed confidentiality of the donor. This method, conclude McMenamin et al., is just as sensitive as salivary testing, but far less costly. "Mental Health Assessment of Persons With HIV" Journal of the Association of Nurses in AIDS Care (10/93-12/93) Vol. 4, No. 4, P. 36 (Baumann, Steven L.) Providing accurate mental health assessments of people with HIV is an essential part of quality nursing care, particularly in the later stages of disease when the patient is likely to experience frequent changes in mental status. Changing mental status needs to monitored on an ongoing basis by skilled and culturally proficient healthcare providers. Stigma, however, combined with the psychological, physical, familial and socio-cultural processes active in the HIV experience can block nurse-patient communication. Physical, cognitive, and affective symptoms often overlap in HIV patients, also making assessment more difficult. The history of the duration and severity of these symptoms, taking into account the context of the patient's life and culture, is often useful in distinguishing what process is primarily involved. Use of the current information and a few simple neuropsychological tests can help nurses avoid some of the more common problems in mental health assessment of HIV patients. The limitations of such approaches must, however, be considered and should be complemented by more extensive neurological, radiologic, and laboratory tests on a periodic basis.