AIDS Daily Summary October 27, 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 "Gene Map of AIDS Key Will Help Research--Doctors" Reuters (10/27/93) (da Silva, Wilson) Sydney--Australian scientists say they have cloned and genetically mapped the CD26 co-receptor molecule that was identified only days ago by French researchers as the key that allows HIV to enter and infect human cells. Geoff McCaughan, associate professor of Sydney's Royal Prince Alfred Hospital, says his research team conducted what they believe is the first complete mapping of CD26, and the Australian researchers say they will provide the map to AIDS scientists. The next step, they say, is to closely examine the genetic structure of CD26, in hopes of revealing a weakness that would provide insight into the development of a drug able to prevent the AIDS virus from invading healthy cells. If the molecule is indeed the key to HIV infection, French researchers at the Pasteur Institute suggest that the genetic map may allow them "to target these as a way of reducing the number of CD26 molecules expressed, thereby reducing the risk of HIV infection," says McCaughan. His research team had been studying the molecule's relationship with liver disease. After the French researchers' discovery, the Australians are trying to match differences in the genetic structure of CD26 with how the virus affects AIDS patients. McCaughan says variations might explain why some people develop the disease shortly after infection, some take years, and others seem to maintain immunity. "Specialists Cast Doubt on New AIDS Findings" Reuters (10/26/93) (Yanowitch, Lee) Marne La Coquette, France--After French researchers at the Pasteur Institute claimed on Monday to have solved the mystery of how AIDS penetrates and infects human cells, the celebration of the discovery was overshadowed by the doubts cast by specialists, who said that findings would help understand the virus, but not necessarily lead to a vaccine. Ara Hovanessian, head of the Pasteur team, said the researchers had isolated a co-receptor molecule called CD26, which serves as a portal allowing the AIDS virus to invade the cell. Hovanessian presented the findings at a symposium of international AIDS experts, where many specialists expressed doubt about the use of the discovery in developing a vaccine. "Every discovery must be confirmed by someone else," said Marc Girard, head of vaccine research at the Institute. "As long as it is not confirmed, it is not valid." Although Girard conceded that perhaps one day a treatment might be developed that could block CD26 activity, it is still not know whether the molecule has an important or indispensable function to the human body. Another problem with Hovanessian's research is that there are cells that HIV may infect via receptors other than CD4 and CD26, said Pierre Fillipi, who studies AIDS-generated brain lesions. If this held true, CD26 would not be a viable target for prevention or treatment. If, however, later results confirm Hovanessian's current hypothesis, scientists could use genetic manipulation to place CD4 and CD26 receptors on laboratory mice, thus providing an animal model that AIDS researchers desperately need and have long awaited. "New Hope Zoning Board Approves Residence for HIV-Infected People" Philadelphia Inquirer (10/27/93) P. B5 (Schiavo, Christine) Last night in the Philadelphia area, the New Hope Zoning Hearing Board approved the conversion of an old house in the tiny Pennsylvania borough into a home for eight HIV-positive residents. Four board members voted unanimously to deny an appeal by about 10 neighbors who wished to block the zoning permit, which was issued about two months ago to the Family Service Association (FSA) of Bucks County. The nonprofit counseling organization plans to buy the house and renovate it into a group home to be called Bucks Villa, where eight HIV-infected people who are dependent on Social Security can live independently. The issue divided the small community, and a small band of neighbors appealed on the grounds that the planned residence resembles a nursing home, which is not allowed on less than an acre of land. They also cited noise, traffic, and a decline in property values as the basis for their appeal. The FSA, however, contends that denying the permit would violate federal fair housing laws. The organization has received a grant of $900,000 from the Department of Housing and Urban Development, some of which will be used to purchase and renovate the home, and the remainder of which will subsidize rents over the next 20 years. "34,000 Condoms Were Distributed in '92 at 7 City High Schools" Philadelphia Inquirer (10/27/93) P. B3 (Hollman, Laurie) Approximately 34,000 condoms were dispensed to high school students at seven public school "health resource centers" in Philadelphia last year, according to a report presented yesterday at a hearing by the Family Planning Council of Southeastern Pennsylvania. More than one-fourth of those enrolled at the seven schools--2,895 students--made 10,676 trips to the centers to receive counseling on a wide array of subjects, including AIDS. Students left the centers with condoms 63 percent of the time. More than two years ago, the Philadelphia Board of Education decided to permit condom distribution in schools as part of a comprehensive sex-education campaign that emphasizes abstinence. Students cannot receive condoms without first receiving counseling on responsible sexual behavior and condom use. The program was hotly debated from the start, and opposition still exists. There are also concerns about whether the centers are actually modifying teenage sexual behavior. At the four-and-a-half hour hearing, speakers made recommendations on how to make the program more effective. The hearing was sponsored by the City Council's Committee on Education, which seeks to ensure that the health centers are effective in preventing AIDS and other sexually transmitted diseases among adolescents. "Females Shouldn't Downplay AIDS Risk" St. Louis Post-Dispatch (10/26/93) P. 2D (Donohue, Paul) AIDS is a predominantly male disease in both America and Canada, says Dr. Paul Donohue, but the demographics are shifting rapidly. Women now account for 11 to 12 percent of reported AIDS cases in the United States, a figure significant enough to consider the disease a real threat to the female gender. The male-female distribution of the virus is about 50-50 worldwide, cites Donohue. However, if the current trend in America continues, Donohue fears that ratio may soon apply to this country as well. And any woman who dismisses AIDS as only a male disease should re-evaluate her thinking, contends Donohue. "Zimbabwe May Muzzle Witchdoctors AIDS Claims" Reuters (10/24/93) Harare--Because they are a threat to the government's campaign to curb the spread of AIDS, claims of traditional healers that they know a cure may be silenced by a government-ordered news blackout. Witch doctors are profiting from the epidemic sweeping Zimbabwe, so the government may invoke a law banning the promotion of cure claims, says Health Minister Timothy Stamps. The law prohibits promotion of "any medicine, appliance, or article for the alleviation or cure of any venereal disease or diseases affecting the generative organs or functions or any complaint arising from or relating to sexual intercourse." In the past few months, witch doctors have announced a cornucopia of herbal cures fro the deadly virus, but the government has dismissed them, saying that they need to be scientifically proven first. Of Zimbabwe's population of 10 million, some 800,000 people are infected with the AIDS virus. "Study Shows AIDS Patients Need Change in Care System" United Press International (10/24/93) (Wasowicz, Lidia) San Francisco--Turf wars, limited resources, and narrow goals that characterize the current system often interfere with AIDS services, say scientists, who urge a more centralized approach to the disease. Studies in Oakland, Calif., and Baltimore, Md., demonstrated a lack of coordination among many small care providers, where many functions were duplicated and others were not available at all. In many communities, dozens of small, independent organizations provide a single service, such as meals or housing, to a targeted segment of the population, like blacks, women, hemophiliacs, or gays. Studies also indicate that, unlike larger, multi-service providers who are willing to pool resources and offer a greater range of services, small providers do little or no referrals and rarely share resources. "Little effort is put into coordinating service delivery with others," says Thomas Rundall, professor of public health at the University of California, Berkeley. "AIDS patients often have to find and coordinate services on their own or go without. They may not know what they really need, much less where to get it." "AIDS Counseling" Associated Press (10/26/93) (Davis, Amanda) A retired financial planner infected with HIV spoke at a recent AIDS conference in Kansas City about how AIDS patients can manage the burden on their financial situations. "The most common mistake HIV-positive people make is not doing anything," declares John Darragh. Because only 6.1 percent of people with full-blown AIDS live more than five years, time is of the essence. Lifetime medical costs run about $100,000, but expensive treatments, hospital stays, and home care can raise that figure to as much as $1 million. Many sources provide protection to help defray these costs, says Darragh, listing government entitlements, job benefits, and health and life insurance as examples. But because health insurance does not generally cover travel expenses associated with treatment and drugs, it's crucial to have disposable income readily available. Darragh recommends that AIDS patients keep open lines of credit by paying bills on time, and by opening new credit card accounts. He also suggests that people with AIDS can tap into retirement money. "Many guys have 401k plans that you can't touch till you're over 65," explains Darragh. "But if there's a medical emergency, they can take the money out without penalty and put it in a fixed-income investment and take the income." While life insurance may seem pointless for someone not expected to live very long, some policies provide quick cash through viatical settlements--selling policies fro 50 to 70 percent of their face value--or accelerated benefits. "Politics and AIDS Research" Washington Post (10/26/93) P. A16 The editors of the Washington Post offer some criticism of Congress for its slow response concerning clinical testing of the controversial AIDS vaccine gp160. About this time last year, they recall, Congress appropriated $20 million for the Department of Defense to conduct accelerated tests of the drug, although the usual preliminary work had not been completed or evaluated. Leaders in AIDS research, specifically the scientists at the National Institutes of Health and the Food and Drug Administration, had not requested authority for accelerated tests; in fact, they objected to the drug not only because they had not been consulted, but because they doubted that gp160 was any more promising than a host of similar drugs that had not warranted fast-track testing. Conceding to these objections, Congress mandated that if the NIH director, FDA commissioner, and secretary of defense all were against the tests, they wouldn't be conducted. They did all agree, as did the White House AIDS Office and some AIDS advocacy groups, say the editors. Despite this overwhelming rejection of accelerated testing of gp160, the Senate chose not to act. If rerouted, the $20 million would go to the general AIDS research budget of the Defense Department. Decisions on which drugs warrant testing and which are safe and effective should be made by scientists, not legislators and lobbyists, asserts the Post. The editors note that the experts concur on the issue of gp160, and contend that Congress should respect their recommendations. "Good Medicine?" Advocate (10/19/93) No. 640, P. 16 President Clinton's proposed plan for health care reform has earned the praise of AIDS advocates. "There are three areas where the proposal looks good to us," said Daniel T. Bross, executive director of the AIDS Action Council, a lobbying group. "The prescription drug coverage looks like it will cover most AIDS drugs. In the area of civil rights protections and confidentiality, it looks good also. Finally, the federal benefits package allows for home health care, which is particularly important for people with AIDS." The plan would offer all Americans a basic menu of health care services; those not on the menu would be paid for out of the individual's own pocket. For this reason, according to Ruth Finkelstein, director of policy for the Gay Men's Health Crisis in New York, an AIDS service group, "there may be a lot of out-of-pocket expenses for people with AIDS because their medical needs are so much greater than the average person's." Bross cautions that, because the plan may not be passed until late next year, or not at all, its final draft may differ significantly from Clinton's proposal. "Congress is going to try to take it apart, and we have to focus on keeping the good parts of the plan intact," he said. "The Taking of Free Condoms in a Drug Abuse Treatment Clinic: The Effects of Location and Posters" American Journal of Public Health (10/93) Vol. 83, No. 10, P. 1466 (Amass, Leslie et al.) Injecting drug use and unprotected sex are two of the primary behavioral risk factors contributing to the steady transmission of the AIDS virus. Condom use is the most powerful tool currently available to prevent transmission during sex. Amass et al. report that, while treatment can reduce drug use and needle sharing, drug abuse treatment programs can also help reduce high-risk sexual activity by drug addicts by promoting and providing condoms. A study was conducted by Amass et al. to determine the impact of distribution location and poster prompts for free condoms. For six months, condoms were available at a drug abuse treatment clinic alternately with and without poster prompts and in the clinic's private restroom or in the public waiting area. Results showed that, while poster prompts did not affect condom taking, 381 percent more condoms were taken from the restroom location than from the waiting room. More free condoms will be taken from a private rather than a public setting, concluded Amass et al, suggesting that distribution location is critical in promoting the taking of free condoms in a public clinic. "Reducing the Cost of HIV Antibody Testing" Lancet (Great Britain) (10/02/93) Vol. 342, No. 8875, P. 866 (Tamashiro, Hiko and Heymann, David) Tamashiro and Heymann defend their suggestion that use of a second and third enzyme-linked immunosorbent assay (ELISA) or a simple-rapid test to confirm HIV infection is as sensitive and specific as western blot strategies. Their work was questioned by Simon and Brun-Vezinet, who were concerned that the proposed strategy was inadequate and debated whether the results of such tests should be disclosed to patients. The critics also suggested that seroconversion may be the cause of discrepant results of first and second tests, and that a p24 antigen test should be conducted in that case. The authors once again stress that the second and third tests should be similar to the first, thus reducing the probability of a false negative. While they agree that a p24 antigen test would be effective in determining results, Tamashiro and Heymann say that it may not be a viable option in resource-poor countries. They suggest a two-week wait and then another test from another blood sample to check for discrepant results. They also continue to support a serum-pooling strategy, which they believe is better that a strategy recommending individual testing in areas that lack supplies for HIV testing. ------- End of Forwarded Message