AIDS Daily Summary October 26, 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, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1993, Information, Inc., Bethesda, MD "HIV Infection Mechanism Discovered" Washington Post (10/26/93) P. A13 Researchers at France's Pasteur Institute claim to have discovered how the AIDS virus penetrates and infects blood cells, a finding which could have major implications in the development of a vaccine. The team said it found a "co-receptor" molecule called CD26, which was identified several years ago, but whose function remained a mystery. According to the researchers, CD26 is used by all strains of the virus as a gateway into blood cells. Although they have known for years that HIV adheres to surface receptor molecules known as CD4, scientists still did not know how the virus actually got inside the cells to contaminate them, said Ara Hovanessian, head of the Pasteur Institute team. "The presence and functioning of the CD26 molecule are indispensable for the infection and spread of the virus in the CD4 cells," said a statement from the Institute. "In viral infections, the CD4 serves as the contact point for viral particles, while CD26 serves as the main door." The existence of this second receptor molecule sheds light on possible strategies to develop a vaccine that will "lock out" HIV, said the researchers. "The AIDS virus has always managed to have the key to open the CD4 receptor lock," said Hovanessian. "We hope to be able to develop drugs capable of jamming the CD26 lock so that the AIDS key will no longer fit." Because every strain of the disease uses CD26 to infect cells, researchers hope to develop a universal vaccine. Related Story: New York Times (10/26) P. C1; Wall Street Journal (10/26) P. B18; Philadelphia Inquirer (10/26) P.A7; Washington Times (10/26) P. A3 "8 Counties' AIDS Fight Gets Boost" Chicago Tribune (10/25/93) P. 1-3 (Thomas, Jerry) Until recent times, many residents and officials in the Chicago collar counties refused to acknowledge that HIV/AIDS was a major health concern in their areas, and those who had contracted the virus had to travel long distances and be treated in secrecy to receive primary care and medicine. As the number of persons infected has climbed in the collar counties, however, attitudes have changed as well. AIDS experts from across Illinois met at a seminar last week, where it was announced that eight northeastern counties would now be eligible for federal funding that has been available primarily to Chicago, which will now be obliged to share the money from the Ryan White Care Act. Between January 1981 and September 1993, there were 18,566 people infected with HIV in Cook County, compared to only 1,164 in the collar counties. The city and suburbs have different purposes outlined for the funding. While the city is already underfunded and overwhelmed with patients, the suburbs are trying to implement basic services, such as counseling and referral. "Texas Health Officials Recall 3 Million Condoms" United Press International (10/25/93) Austin, Texas--State health officials in Texas yesterday recalled about 3 million condoms made in Thailand and distributed throughout the state by agency contractors. The condoms, which may be defective, were distributed under the brand names Fame, Bulldog, and Prestige, said David Smith, state health commissioner. "We're issuing this recall to protect consumers from a potentially ineffective and harmful product," said Smith. "Consumers should be reassured that other brands of condoms are safe and effective." State health officials learned that, although previous shipments by the same Thai manufacturer were found to be faulty and not allowed to be imported, the Food and Drug Administration did not sample the new shipment of condoms. Smith says the recall proves that "even the few defective condoms that escaped the federal system can be quickly discovered and removed from the market." He added that the department will replace the condoms and reimburse the state for all related costs. "Good Nutrition May Delay Onset of AIDS" United Press International (10/25/93) San Francisco--Good nutrition, combined with a daily multivitamin, may stall the development of AIDS in a significant percentage of HIV-positive men, according to a study presented yesterday at a major health meeting. The large, long-term followup of some 300 San Francisco men infected with the virus indicated that multivitamin use seemed to protect nearly a third of them from the onset of full-blown AIDS over a six-year time frame. Researchers from the University of California, Berkeley, said that specific nutrients from food and supplements also appeared to be protective. While doctors need more studies to corroborate their findings, they advise infected persons, in the meantime, to eat food high in vitamins and minerals, and to take a daily multivitamin. "CDC Study Finds Five Transfusion-Related AIDS Cases Per Year" United Press International (10/25/93) Miami Beach, Fla.--Since screening for HIV began in 1985, very few people have become infected with the virus via blood transfusions, according to experts at the Centers for Disease Control and Prevention. The rate of transfusion-related AIDS cases rose steadily from 1978 to 1984, then fell dramatically when testing began in 1985, said the CDC. Officials report that between 1986 and 1991, the number of such cases may have been as low as five per year. "While the risk of getting AIDS from a transfusion is not zero, this study corroborates other CDC research and published data indicating that the risk is extremely low," said Dr. Arthur J. Silvergleid, president of the American Association of Blood Banks. A total of 4,619 individuals are believed to have been infected through the blood supply. Each year in the United States, about 4 million people receive blood transfusions. "Poll Finds Ignorance on HIV Test" United Press International (10/24/93) Tokyo--Only one in five Japanese adults know that tests cannot determine HIV status until at least three months have passed since having sex, according to a poll by the National Federation of Health Insurance Societies. The survey questioned 2,000 randomly selected individuals, and found that 41 percent of the respondents believe they should take an HIV test soon after having unprotected sex. Another 21 percent said that taking an HIV test two weeks after intercourse could produce precise diagnosis about infection. Lack of knowledge about the test could, however, falsely convince a person testing negative before the three-month waiting period has ended that he or she has not been infected, said a federation official. That faulty assumption, the official continued, could have "horrible" consequences for the individual's sex partners. Only 19 percent of respondents said that HIV tests conducted after three months following sex could produce accurate diagnoses. "San Francisco: NAC Trial Recruiting" AIDS Treatment News (10/01/93) No. 184, P. 7 Herzenberg Laboratory at Stanford University is now recruiting for participants in an eight-week trial of NAC (N-acetylcysteine). The goal of the study is to determine whether oral NAC can replenish glutathione levels in the T cells of HIV-infected persons. Low glutathione levels are often characteristic of HIV infection, and it is thought that these low levels may cause T cells to function less efficiently and cause faster HIV replication. Volunteers may not already be taking NAC, OTC, cysteine, or glutathione, and must meet other medical requirements. "Is It OK to Lick It?" Advocate (10/19/93) No. 640, P. 7 Postmaster General Marvin Runyon says he "can't believe there would be any controversy" about it, yet activists appear to be dissatisfied with the new AIDS awareness postal stamp that is being prepared for its Dec. 1 debut. One objection is the stamp design itself. It features the global symbol of a folded red ribbon, while many activists preferred the no-AIDS symbol designed by a Wisconsin nurse. The primary complaint, however, is that Runyon and the postal service have declined to sell the stamp for more than its face value, so that proceeds might benefit the fight against AIDS. "Alternative Treatment Library Available" AIDS Treatment News (10/01/93) No. 184, P. 6 The Jon Greenberg Library of Alternative Treatments for HIV Disease, an anthology of information on alternative AIDS therapies, is now available from AIDS Project Los Angeles (APLA). Steven Korsia compiled the collection, working closely with Jon Greenberg, who died this summer, to gather data for the publication. In a preface, Korsia cautions readers that many of the proposed treatments presented are actually not advised at all, and that each individual must determine the validity of each therapy. Among the treatments described are blue-green algae, traditional oriental medicine, colloidal silver, garlic, licorice, shark cartilage, mistletoe, and polio vaccines. Copies of the publication are available free to nonprofit organizations, and at a cost of $30 to all others. "Assessment of Laboratory Reporting to Supplement Active AIDS Surveillance--Colorado" Morbidity and Mortality Weekly Report (10/01/93) Vol. 42, No. 38, P. 749 The surveillance case definition for AIDS was expanded in January to include HIV-infected adolescents and adults with CD4 counts lower than 200, pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer. In preparing for the implementation of these new criteria, the Colorado Department of Health (CDH) assessed the usefulness of lab reports of CD4 test results as a supplement to existing procedures for AIDS surveillance in that state. The CDH conducted tests in two Colorado labs that perform CD4 testing, and compared these tests with CDH records of people with the AIDS virus. The surveillance at these two labs identified a significant number of AIDS cases defined by the new case definition. At one lab, 23 percent of persons with CD4 test results had HIV or AIDS, but had not previously been reported by CDH; the figure was 6.5 percent at the other lab. Of 108 previously unreported cases of infection, 85 percent were identified through record reviews indicating an HIV diagnosis in medical records, but without a lab report of an HIV test. Without CD4 testing, these patients probably would have remained unreported until being hospitalized for an opportunistic infection, or until death. The findings suggest that AIDS case surveillance may be enhanced by lab reports of CD4 testing, with provider follow-up or medical record review. Active case identification is critical in ensuring timely and complete disease reporting. "Zidovudine-Resistant Variants of HIV-1 in Brain" Lancet (Great Britain) (10/02/93) Vol. 342, No. 8875, P. 865 (Stefano, Mariantonietta et al.) Position changes of amino acids in the reverse-transcriptase (RT) of HIV have been associated with the development of zidovudine-resistant strains in the blood. Just hours after administration of zidovudine, the drug concentration in cerebrospinal fluid (CSF) is half that found in plasma. It is uncertain if the resistant variants emerge in the brain as well. If they do, Stefano et al. thought it would be important to discover if resistance is defined by the same RT mutations found in blood isolates, especially since patients taking zidovudine clinically improve AIDS-related conditions of neurological and psychiatric natures. HIV was isolated from blood and CSF of four patients. Resistant strains developed both in the blood and in the brain compartment 12 to 29 months later. Stefano et al. concluded that drug-resistant HIV strains can be found in the brain compartment of patients taking zidovudine, and that the mutations linked to the resistance in CSF isolates are identical to those in blood isolates. "Primary Infection With Zidovudine-Resistant HIV" New England Journal of Medicine (10/07/93) Vol. 329, No. 15, P. 1123 (Hermans, P. et al.) Hermans et al. challenge the conclusions of Erice et al., who described an HIV-positive patient with a primary infection that showed resistance to zidovudine. Erice et al. suggested that isolates that are resistant to nucleoside analog drugs are associated with a higher virulence or modified immune response. After their subsequent study of the isolates of five acute HIV patients with resistant strains, Hermans et al. clinically did not observe any longer duration or greater severity of symptoms in the subjects. Nor could they find any evidence to support the conclusions of Erice et al. Hermans et al. reported that the frequency of such primary zidovudine-resistant strains is still unknown, but that they are probably more frequent than previously thought. The researchers said that these findings have implications for clinical trial design. ------- End of Forwarded Message