From: "ANNE WILSON, CDC NAC" AIDS Daily Summary November 12, 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 "AIDS Vaccine Are Ineffective in Key Lab Tests" Philadelphia Inquirer (11/12/93) P. A16 Candidate AIDS vaccines that once showed promise have failed critical laboratory tests, an event that may delay large-scale trials, according to researchers. Three vaccines had produced neutralizing HIV antibodies in tests against laboratory strains of the virus. When tested against fresh virus taken from the blood of actual patients, however, the vaccines did not lead to disease protection. The second tests are considered a more realistic evaluation of candidate vaccines because the general population contracts HIV strains that differ slightly from the ones used in lab tests. Antibodies that attack one strain may not be as effective against another variant, and the AIDS virus is known for its ability to mutate rapidly. Studies of the three vaccines were conducted by Duke University, Walter Reed Army Institute of Research, and the Chiron Corp. in California. "State Supreme Court Hears Challenge to 1989 AIDS Law" Chicago Tribune (11/11/93) P. 1-3 (Grady, William) The Illinois Supreme Court Wednesday heard arguments for and against a state AIDS law penalizing infected persons for deliberately spreading the virus. The 1989 legislation allows prosecutors to file criminal felony charges against anyone who is aware of their positive HIV status and participates in any activity that contributes to transmission of the virus, including intimate contact, blood donation, or sharing of dirty needles. "There is no rational basis for what the legislature did here," contended Michael L. Closen, a professor at John Marshall Law School in Chicago and an attorney who also challenges the constitutionality of the AIDS law. Closen said the language of the statute is so ambiguous that HIV-infected people could face charges for seeking medical care. Gerry Arnold, a staff lawyer for the state appellate prosecutor's office, noted that two defendants had been charged with violating the law by having sex, and countered that the statute was not vague in terms of that behavior. "Sexual intercourse is generally acknowledged as a means of transmitting HIV," he said. Only a handful of people have been charged under the law and, thus far, judicial review has been mixed. "Canada AIDS Toll Is Highest Ever" Boston Globe (11/11/93) P. 15 Statistics indicate that a record number of Canadians died from AIDS in 1992, and experts warned that the incidence of infection continues to increase. Nationally, 1,078 people died from the disease last year--the first time since the country's first AIDS diagnosis in 1979 that the annual death toll has topped 1,000. "Those who thought the epidemic was leveling off and going away were mistaken," said Don Sutherland of the Laboratory Center for Disease Control in Ottawa. Data gathered by that institute indicates that a total of 5,801 Canadians have been lost to AIDS. "French Group Fighting AIDS Wasted Money, Auditor Says" Toronto Globe and Mail (Canada) (11/11/93) P. A18 The French Agency for the Fight Against AIDS squandered funds, bungled a condom-distribution program, and paid executives inflated salaries, disclosed state auditors yesterday in a report leaked to newspapers. According to the auditors, the organization used money designated for hemophiliacs to cover its own expenses, and two of four chairmen received salaries far above legal standards. The report also said that the government agency, which was established in 1989, had ceased to maintain accounts by early this year. The information sparked anger in anti-AIDS groups, and a dozen activists stormed and wrecked the agency's office. Agency head Jean de Savigny dismissed the findings, explaining that his accountant has been on leave since early 1993, that the money from the hemophiliac fund had been borrowed for a few weeks with the knowledge of the health ministry, and that his $200,000 salary had been approved by the ministry. He also denied that the organization was forced to destroy 400,000 condoms last year after health officials deemed the brand as substandard. "The report mainly mentions sins of the agency's youth, its first two years," said de Savigny. "What is important is the prevention of AIDS, and, thanks to the AFLS and my predecessors, we have a wide mobilization in France." "Blood Scandal Closes 2nd German Company" New York Times (11/11/93) P. A3 The closing of a second blood products company in Germany helped to advance the country's scandalous HIV scare. The reported failure of the Osterode-based Haemoplas company to test all plasma units has resulted in the HIV infection of at least two people. The firm was ordered to suspend operations the day after its products were recalled from 69 hospitals. Walter Hill, the Social Welfare Minister of Lower Saxony, said that there is no evidence to support claims that Haemoplas knowingly sold contaminated plasma. But state officials assert that the company neglected to test each plasma unit, as is required by law. One state health official said that common practice at Haemoplas was to screen only the first unit donated by any given commercial donor. Haemoplas director, Frank Giesbert, reported that his company was responsible for infecting three patients. Since 1989, a total of six German cases of infection have been transmitted through blood products tainted with the AIDS virus. Related Story: Toronto Globe and Mail (11/11) P. A18. "2,000 Video Stores Gear Up for 'Penny for AIDS' Fundraising Drive" Chicago Tribune (11/11/93) P. 2-3 (Liebenson, David) This month, all video retailers and industry-related companies are being asked to participate in "A Penny for AIDS," a fundraising effort that asks for a one-cent donation for each videocassette or laserdisc rented or bought between Nov. 24 and International AIDS Awareness Day, Dec. 1. "It's not a gala fundraiser," says campaign chairman Larry Klingman. "We've designed it so that everybody can make a contribution without any one major group carrying the load." Klingman projected that, with 50 percent participation, the organization could raise $1 million. Over 2,000 retailers have committed to the project, which is being sponsored by the Video Industry AIDS Action Committee. They will join studios, vendors, distributors, and manufacturers. Even cable and broadcast TV--which compete directly with the video industry--will get involved by airing public service announcements featuring celebrities such as Mario Van Peebles, Hulk Hogan, and Fabio. The AIDS Action Committee was founded in 1989 in response to what was perceived as inaction by the government against the disease. It services 35 national and community-based AIDS organizations, for which it has raised some $500,000. "Poll Trends: AIDS--An Update" Public Opinion Quarterly (Spring 1993) Vol. 57, No. 1, P. 92 (Rogers, Eleanor Singer et al.) Rogers et al. gathered over 100 national AIDS surveys and analyzed the data, which fell between January 1987 and July 1992. The resulting summary of public opinion about AIDS reflects several major trends of the past decade. One is the steady increase in public knowledge and concern about AIDS, with almost 100 percent of the population now understanding how the virus can and cannot be transmitted. Concern about the disease as a personal health threat, however, has not increased since the mid-eighties. Secondly, Americans have altered behavior--including increased condom use--because of concerns about AIDS. The third trend suggests that attitudes about who should be tested, including immigrants, prisoners, couples applying for marriage licenses, people in high-risk categories, food handlers, hospital patients, tourists, and children entering school, have remained relatively stable over the years. But, the percentage of people urging sexual partner tracing increased steadily, as did the percentage of people who had themselves been tested. A shift in public perception of AIDS as a community health problem rather than a civil rights issue indicates a fourth trend. There has been a decline in the number of people who feel infected individuals should be quarantined. Three in four in 1991 felt that employees with AIDS should be allowed to continue working--a 65 percent increase from 1985. Rogers et al. identify a fifth trend that marks a change in attitudes toward people with AIDS and funding of AIDS research. From 1987-89, a prevalent attitude was that AIDS was punishment for declining moral standards; that percentage dropped slightly in 1991. Also, people were less inclined to feel compassion for infected persons if they contracted the virus through homosexuality or drug use. Finally, the vast majority of people feels that public spending on AIDS should be increased. "The Clinical Challenge of the HIV Epidemic in the Developing World" Lancet (Great Britain) (10/23/93) Vol. 342, No. 8878, P. 1037 (Gilks, Charles F.) The developing world now carries the greatest burden of the HIV epidemic and will continue to do so in the future. Clinical research and surveillance in such countries revolve around AIDS--an approach which can breed powerlessness and hopelessness. By contrast, it is early death from HIV disease, not rapid progression to AIDS, that is most common in developing countries. If focus is shifted from AIDS to HIV, a different analysis emerges. Finally, a positive message can be relayed that something can be done, for many HIV-related diseases can be effectively treated in even the poorest of countries. This switch on concentration should also boost counseling, and raise staff morale and motivation. Mortality rates can be reduced if health caregivers focus on improving the outcome of all patients ill with common treatable infections, whether they are HIV-positive or HIV-negative. To accomplish this, health ministries need to reappraise goals and reallocate resources accordingly. Other suggestions include delegating hospital priority to those with treatable infections, and encouraging those with specific symptoms to seek treatment early. "Are HIV-Infected Injection Drug Users Taking HIV Tests?" American Journal of Public Health (10/93) Vol. 83, No. 10, P. 1414 (Reardon, Juan et al.) Regardless of sexual orientation, intravenous drug users account for 14.8 percent of AIDS cases in California. HIV testing for these drug users has been recommended as a strategy for curbing the spread of the virus. To evaluate infection knowledge among infected IV drug users and acceptance of confidential testing among that population, Reardon et al. conducted a study of 810 injecting drug addicts entering treatment in Costa County, Calif. The researchers gathered data on acceptance, previous testing, drug use, and demographics. Of the sample, 105--or 13 percent--were infected, and 58 already knew they were infected. The other 47 were infected but did not realize it. Black injection drug users represented a higher rate of infection, but were less likely to already know of their infections. Reardon et al. concluded that "in-clinic" HIV testing is highly acceptable, and most infected patients in treatment will learn their HIV status. Voluntary testing is, however, very likely to yield significant underestimates of the true rate of infection among the intravenous drug population. "AIDSLine" Advocate (11/02/93) No. 641, P. 33 (Cohan, Gary R.) For AIDS patients who suffer from nausea, abnormal weight loss, or abnormal loss of appetite, the drug dronabinol may relieve these symptoms. Prescribed under the brand name Marinol and approved by the Food and Drug Administration since 1985, the drug is a synthetic version of THC, the active ingredient in marijuana. In several clinical studies, Marinol improved appetite, decreased nausea, and increased weight by more than four pounds after eight weeks. The "high" associated with marijuana use was quite mild and lasted only four to six hours, although the appetite-stimulating effects lasted for 24 hours or more. The drug is produced in capsule form so that it is taken orally, not smoked. Many patients claim to feel better only after smoking actual marijuana, and there is currently a movement before the FDA to lighten restrictions on the drug so that doctors can prescribe it for medical purposes. Dr. Gary R. Cohan says that, while it's true that smoking marijuana does allow more THC to enter the bloodstream, smoking is not a healthy activity, particularly for a person who has immunocomprimised lungs. "HIV-Related Knowledge and Precautions Among Michigan Nurses" American Journal of Public Health (10/93) Vol. 83, No. 10, P. 1438 (Schillo, Barbara A. and Reischl, Thomas M.) Schillo and Reischel undertook a study to determine HIV-related knowledge and precautionary behaviors in registered nurses in Michigan. The random sample of 1,530 RNs completed surveys in 1989. The results indicated that, while almost all of the respondents were well-informed of known viable routes of HIV transmission such as needlesticks, many reported misconceptions about unproven avenues of transmission like skin-to-skin contact or being sneezed on by an infected patient. In terms of universal precautions, more than a quarter of the sample said that they did not use gloves each time they handled blood and body fluids, or treated a bleeding patient. Most failed to wear protective eyewear and gowns, but nearly all reported use of puncture-resistant containers for disposal of sharp instruments. Less than half of nurses who used needles to treat patients followed the proper procedure for recapping needles, and one out of 10 reported sticking themselves with used needles. This lack of universal precautions may be explained by respondent complaints of barriers that make it more difficult to use protective measures. The nurses said protective equipment was awkward, poorly constructed, not readily available, and that gloves were not the right size. These findings support the need for continued and intensified efforts to educate nurses so that they may provide quality care while engaging in precautionary behavior and being aware of risk of exposure to the AIDS virus. "Quantitative Detection of HIV-1 Drug Resistance Mutations by Automated DNA Sequencing" Nature (10/14/93) Vol. 365, No. 6447, P. 671 (Larder, B.A. et al.) Larder et al. conducted comparisons of manual and automated DNA sequencing to determine the ability of each in distinguishing mutation detection in mixtures of HIV-1 sequences. Use of an automated system with fluorescent-labeled sequencing primers proved most effective in detecting mixtures of HIV-1 drug resistance mutations. The technology has a wide range of possibilities for clinical research, including the identification, quantitation, and visualization of heterozygote mixtures, as well as the analysis of drug resistance mutations and other heterozygote analyses involving DNA sequencing. ------- End of Forwarded Message