AIDS Daily Summary December 10, 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 "Natural Protein Is Found to Reignite Cells' Failing Immune Response to HIV" Wall Street Journal (12/10/93) P. B5 (Chase, Marilyn) A natural blood protein is able to restore the declining immune response of cells taken from carriers of the AIDS virus, finds a new laboratory study. Most white blood cells of HIV patients fail to launch a normal immune response when exposed to invaders. But when the protein interleukin-12 (IL-12) was added to cell cultures, the immune system was enhanced, said researchers. In a study of blood taken from 47 HIV-infected subjects, IL-12 was found to improve a number of immune reactions, including significant increases in T-lymphocyte and in the number of killer cells, as well as the release of a flood of other immune-boosting agents like gamma interferon and interleukin 2. The study's findings support an emerging theory about how HIV cripples the immune system, and how this effect might be delayed or reversed. IL-12, believe the researchers, may spark an effective type 1 response, which involves vigorous and effective response by immune cells. "Our findings imply that in HIV infection, a type 1 response can be restored [in the test tube] by IL-12," said Dr. Gene M. Shearer of the Experimental Immunology Branch of the National Cancer Institute, who conducted the study along with colleague Mario Clerici and others at the National Institutes of Health and Lackland Air Force Base in Texas. "Whether we'll be able to bring patients back to [type 1], or simply take people [in the early stage] and hold them there, will require human trials." IL-12 , manufactured by Boston-based biotech firm Genetics Institute Inc., is scheduled to begin human clinical trials in the first half of next year. Related Story: New York Times (12/10) P. A22 "British Paper and Science Journal Clash on AIDS" New York Times (12/10/93) P. A9 (Schmidt, William E.) The Sunday Times, London's most popular Sunday broadsheet, is committed to challenging the orthodox. The paper's coverage of the AIDS epidemic, however, has prompted criticism from government health officials, AIDS organizations, and scientists, who accuse the publication of betraying the public trust and misleading its 4 million readers into believing they are not at risk for the disease. Among other things, the Times insists that the AIDS epidemic in Africa is a myth, that HIV is not the cause of AIDS, and that the disease does not pose a serious health threat to heterosexuals. In a rare editorial, Nature--a London-based international science journal--blasted the Sunday Times for publishing AIDS stories that are "seriously mistaken, and probably disastrous." The journal announced that it was so concerned about the paper's "unbalanced" and "selective" reporting on AIDS that it would now monitor and critique the coverage. The column came in response to charges by the Times that Nature and other scientific journals and mainstream newspapers practice "self-imposed censorship" by refusing to give more coverage to those who challenge HIV as the cause of AIDS. In addition, the Times has challenged the use of antiviral drugs to fight AIDS and the reliability of AIDS testing. These, as well as the paper's claims that the AIDS crisis has been blown out of proportion, are drawn in part from dissident theories on the putative cause of AIDS, which most government and research organizations have dismissed as scientifically unsound. "AIDS Drug Research" New York Times (12/10/93) P. A34 (Kogan, Richard Jay) The statement of Health and Human Services Secretary Donna E. Shalala that "not a single new drug application for an anti-retroviral drug" is before the Food and Drug Administration is a misleading one, contends Richard Jay Kogan, president of Schering-Plough Corporation in Madison, N.J., in a letter to the editors of the New York Times. Shalala's comments could lead readers to believe that the pharmaceutical agency is lax in its anti-AIDS research effort, and that important drug research is conducted by the government, not the industry, he says. For the past seven years, however, research-based drug companies have increased the number of new AIDS-related medications and vaccines in development, notes Kogan. Seventy-four firms presently have 103 treatments in human clinical trials or awaiting FDA approval, he says. "Rare HIV Antibody Response May Help Develop Vaccine--Study" Reuters (12/09/93) (Brothers, Caroline) London--A previously unknown antibody response to the AIDS virus has been discovered, and could be an important step toward developing a vaccine, announced U.S. researchers writing in the medical journal the Lancet. The researchers said they found a handful of patients who had HIV antibodies in their urine, but not in their blood. They believe those patients have developed a rare type of immunity to HIV infection. Dr. Howard Urnovitz, founder of the U.S.-based Calypte biomedical research firm, worked with Dr. Gene Shearer and Dr. Mario Clerici of the National Cancer Institute to test some 1,800 people for HIV. They found seven who tested positive only in the urine test. "Our first major conclusion was that you can have antibodies in urine and not in blood--one of the first examples of compartmentalism of immune response," he said. Compartmentalism is thought to occur when the body evolves a localized response to infections specific to each tissue site. "Because they showed this unique immunity, the suggestion was made that perhaps they have a systemic immunity to the virus ... which happens independently of antibody immunity," explained Urnovitz. He speculated that the discovery of cell-mediated immunity to HIV in urine suggests that vaccine development should concentrate on cell-mediated immunity, rather than the development of an antibody. "Dependents to Undergo AIDS Testing in Abu Dhabi" Reuters (12/09/93) Abu Dhabi--In order to obtain or renew residency permits, all expatriates living in Abu Dhabi must be tested for the AIDS virus, announced officials. The new measure, which for the first time includes spouses and dependents over age 18, began on Wednesday, reported the Gulf News daily paper. The largest of the seven states that comprise the United Arab Emirates, Abu Dhabi previously requested AIDS-free certificates only from expatriates working in the emirate, while their families were granted residence permits without testing. "Czech--AIDS" Associated Press (12/09/93) Prague, Czech Republic--The Czech government will dole out $26,000 in compensation to HIV patients who contracted the virus through medical treatment. Of the 30 people to receive compensation, 14 are hemophiliacs and 16 got the disease through blood transfusions, reported the Lidove Noviny daily paper. All of the patients contracted HIV before compulsory testing of blood donors was mandated in 1987, and two have already died, the daily said. According to official figures, there are 166 HIV-infected people in the Czech Republic, but experts fear that the true number is much higher. "Medical Briefs" Advocate (11/30/93) No. 643, P. 33 Use of anabolic steroids as treatment of HIV and related conditions has increased. Using standardized instruments for depression, anxiety, and mental-status examinations, patients participating in a double-blind placebo-controlled trial reported various side effects associated with such prescriptions. Patients should be aware that there are mood changes linked with steroid use, including increased anger, violent feelings, fatigue, insomnia, distractibility, irritability, mood swings, euphoria, forgetfulness, and confusion. "Perinatal HIV Transmission Dependent on Stage of Disease" AIDS Alert (11/93) Vol. 8, No. 11, P. 177 While some factors of perinatal transmission of HIV remain a mystery, a new study indicates that the stage of a mother's infection can alter the chances of transmission to her fetus from 7 percent to 71 percent. The study identifies four major risk factors involved in mother-child HIV transmission, including high CD8 counts, low CD4 counts, p24 antigenemia, and placental membrane inflammation. Of 40 infants born to women with no risk factors, only three, or 7 percent, became infected, compared to 38 percent in women with at least one of the risk factors. The study also found that the highest risk for transmission of the AIDS virus is in the abbreviated initial phase of disease. When p24 antigen is present in the mother's blood, the risk of the baby contracting the virus is as high as 71 percent, say researchers. The p24 antigen is a component of HIV and is produced as part of viral replication. "An AIDS Treatment From Canada" Business Week (11/29/93) No. 3348, P. 126 In the not-too-distant past, it was not unusual for stock to suddenly skyrocket at the mere suggestion that it was associated with an AIDS-related product. While that trend has all but died away, some pros are purchasing stock from Quebec-base Biochem Pharma because of its link to an experimental AIDS drug, 3TC. The company's stock traded on the NASDAQ at 9 in mid-October, but has climbed to over 11. Some predict that the stock could reach 20 over the course of the next year. The fact that 3TC was approved by the Food and Drug Administration for the "compassionate use" program is one reason for the optimism, they say. America's program, similar to Canada's, permits physicians to provide 3TC at no cost to infected patients who do not respond to or are unable to tolerate other AIDS treatments, like AZT. The drug "tricks" the virus into using the wrong molecular "building block" to duplicate itself, according to a Biochem vice-president of therapeutic research. In addition, 3TC, which can also be used to treat hepatitis B, does not produce the adverse side effects often associated with other therapies. Clinical tests of the drug are targeted for completion by early 1994, at which time approval will be sought to market 3TC in the United States. "Oral Contraceptive Use and Infectivity of HIV-Seropositive Women" Journal of the American Medical Association (11/17/93) Vol. 270, No. 19, P. 2298 (Morrison, Charles S. and Schwingl, Pamela J.) Clemetson et al. found a correlation between oral contraceptive (OC) use and detection of HIV DNA in cervical, but not vaginal, secretions. They conclude that their data supports the theory that OC use, as well as cervical ectopy and pregnancy, increases the infectivity of HIV-positive women. While recognizing the importance of the study and its implications, Charles S. Morrison and Pamela J. Schwingl, PhDs, of Family Health International in Research Triangle Park, N.C., offer some adjustments that would improve the results of the study. Clemetson and colleagues found HIV DNA in 33 percent of cervical samples and 17 percent of vaginal samples, then presented odds ratios determined from a multivariate analysis. However, say Morrison and Schwingl, the odds ratio in a cross-sectional sampling design is valid estimate of risk ratio only if the probability of disease is rare--less than .10. Given the cross-sectional sampling of the study and that the incidence of disease is not rare (33 percent), Morrison and Schwingl suggest that the prevalence ratio would be a better measure of the strength of association. They calculate that the estimated strength of the bivariate association between OC use and HIV DNA detection is only a third as strong when the prevalence ratio is used. In addition, the link between OC use and HIV DNA included only eight subjects. Given the significance of the issue, Morrison and Schwingl suggest that a re-analysis be conducted enrolling more OC users and undertaking a prospective study design.