AIDS Daily Summary December 16, 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 "4 People Infected With H.I.V. in Doctor's Office in Australia" New York Times (12/16/93) P. B14 (Altman, Lawrence K.) In what is believed to be the first instance of patient-to-patient transmission of HIV in a health-care setting, the AIDS virus has been passed from one patient to four others at an Australian surgeon's office, Australian health officials reported. According to an investigation, the unidentified doctor, who has not become infected, failed to sterilize all of his equipment after performing surgeries to remove skin lesions on five patients on the same day in November 1989. The source of the infection was a homosexual man, who has since died of AIDS, officials at the New South Wales Health Department disclosed. The virus was transmitted to four women who, they say, had no known risk factors for infection. Australian health officials believe the surgeon operated on the gay man first, but have no proof because appointment records were not kept. Officials say there is compelling evidence, though, that the transmission did indeed occur in the doctor's office. "The possibility that five people with HIV, four of them women, two in their 80's, would by chance all attend a doctor on a particular day in 1989 is five in a trillion," declared one Australian health official. "In other words, impossible." Dr. Harold Jaffe of the Centers for Disease Control and Prevention said that the transmission was "almost certainly a breach in infection control." Health officials say the surgeon discarded most items after use, but failed to sterilize all of the equipment. He has not changed his infection control precautions since 1989. Related Story: USA Today (12/16) P. 1D "AIDS Victim's Mother is Awarded $175,000" Philadelphia Inquirer (12/16/93) P. B3 (Caba, Susan) Funeral director John M. Price did not want the body of an AIDS patient inside his facility, so he led the mother of the deceased man to believe that an empty, closed casket held the remains of her son when his body was, in fact, outside of the funeral parlor. A Philadelphia Common Pleas Court awarded Louise Purdy $175,000 for the pain and suffering caused by that switch, as well as $100,000 in punitive damages. Price was ordered to refund the $2,000 Purdy paid for her son's service. "To think that my son was outside while we was praying over him inside ... that hurt," said Purdy. "I just felt, I don't know, violated." She says she knew her son was dying of AIDS when she approached Price in 1988 and asked if he accepted "AIDS bodies." Price incorrectly informed Purdy that closed-casket memorial services were required by law for AIDS patients and that, otherwise, the funeral service would be like all others. Purdy says she realized at the end of the service, when Price dismissed the need for pallbearers and locked the funeral home without bringing out the coffin, that she had not just prayed over her son's body. Price, who has operated his business for 39 years, said that he has always "tried to treat the different publics as we should." He said his employees have handled plenty of AIDS bodies since the Purdy funeral and followed precautions to avoid infection. "Man With AIDS Convicted of Assault" Washington Post (12/16/93) P. D9 A federal jury has found a 27-year-old man with AIDS guilty of assault with a dangerous weapon for biting two correctional officers during a visit to the Lorton Correctional Complex last summer. Jeffrey Wayne Sturgis of Washington, D.C., drew blood when he bit one officer on the thumb and another on the arm during a struggle that erupted when the officers attempted to search him for illegal substances. Sturgis was, in fact, trying to smuggle drugs into the prison and has been convicted on three related charges. The U.S. District Court in Alexandria, Va., chose, however, not to convict Sturgis of assault with intent to kill, the charge sought by the prosecution. Sturgis testified that he did not know he was infected with the AIDS virus and that he bit the officers in self-defense, not to kill them. Assistant U.S. Attorney Mark Hulkower, however, presented medical records indicating that Sturgis had been aware of his infection since 1990. He said it was too soon to determine whether the officers have contracted the disease. Sturgis faces as many as 39 years in jail, and is scheduled for sentencing in February. "AIDS--Blood" Associated Press (12/16/93) Washington--French researchers report that passive immunotherapy--swapping blood plasma rich in antibodies between AIDS patients--appears to significantly slow progression of the disease. Those giving blood did not appear to suffer, and those receiving it seemed to benefit. The approach dramatically reduced the number of new AIDS symptoms in patients who had already developed advanced disease, the researchers said. However promising, the approach does have one major obstacle: the limited blood supply. The availability of blood plasma from AIDS donors "is the main limiting factor" of the approach, confirms Dr. Jean-Jacques Lefrere, a co-author of the study. Regular donations from 150 people were needed to conduct the study of 86 patients. In the study, doctors removed blood plasma from people with AIDS and gave it to study participants. Half received antibody-rich plasma, while the other half received plasma from uninfected donors. Doctors tracked the number of new AIDS symptoms that surfaced over the course of the study, finding 18 new symptoms in 16 patients in the AIDS-antibody group and 50 new symptoms in 27 patients in the comparison group. Overall, those in the comparison group were three times more likely than antibody patients to develop new AIDS symptoms. "In US Court, Anti-AIDS Group Argues for Condom Ads on MBTA" Boston Globe (12/15/93) P. 31 (Rakowsky, Judy) The Boston-based AIDS Action Committee argued on Tuesday in U.S. District Court that the state transit agency's ban on condom ads is a violation of the First Amendment's guarantee of free speech. James R. Reardon, a lawyer for the Massachusetts Bay Transportation Authority, countered that guidelines do not permit the display of ads that feature graphic representations of sexual conduct. The authority must protect minors who ride public trains and buses, said Reardon. Reed Witherby, a lawyer representing the activist group, disagreed. "If a young person is old enough to understand the references in the ad, they have more of a tendency to protect him by receiving that message," he said. U.S. District Judge Rya W. Zobel is expected to rule on the AIDS group's bid for a preliminary injunction ordering the MBTA to post the ads, although she did not say how soon she would come to a decision. "AIDS--Crack" Associated Press (12/15/93) (Neergaard, Lauran) Washington--Smoking crack cocaine places young Americans, especially women, at high risk for contracting AIDS because they are apt to have frequent, unsafe sex while under the influence of the drug, reports a new study by the Centers for Disease Control and Prevention. Perturbed by statistics indicating that the virus is increasing nearly four times as fast in women than men, the CDC is trying to discover why--despite safe-sex education targeting women--heterosexual contact has bypassed intravenous drug use as the primary cause of infection in women. This latest study, which examined 2,323 drug users from inner-city areas for two years, offers non-IV drugs as one explanation. Among those who had never injected drugs, male crack users were 1.5 times as likely to have had more than 20 partners or sell sex than those who did not smoke crack. But female users who smoked crack were six times as likely as non-users to have had more than 20 partners, 15 times as likely to sell sex, and four times as likely to have other sexually transmitted diseases, which facilitate AIDS transmission. Blood tests showed that crack smokers who had never used IV drugs were at least twice as likely as non-crack smokers to have HIV. Intravenous drug users were still the group most likely to be infected. "AIDS Vaccine Could Embolden HIV Viruses" Reuters (12/14/93) San Francisco--Some experimental vaccines designed to prevent and combat the AIDS virus may, in fact, make it easier for certain viruses to infect a person, say researchers. Vaccines under current development focus on the outside envelope coat of HIV, to which an immunized person responds by producing immune system antibodies that bond to HIV and deactivate it. Studies at the University of California at San Francisco suggests that some of these antibodies, instead of deactivating immunodeficiency viruses, either neutralize them, enhance them, or have no effect whatsoever. This can occur because of the ability of HIV to mutate--or undergo genetic changes--which result in the creation of new strains, some of which resist the body's immune response, said Jay Levy, head of the research team. The studies show that genetically different strains of HIV responded differently to a single species of antibody, suggesting that it is possible for a vaccine to stimulate production of antibodies that neutralize one strain while making it easier for other strains to cause infection. "Study Says Drugs May Inhibit Replication of AIDS Virus" Reuters (12/14/93) Boston--Researchers at the Dana-Farber Cancer Institute reported their discovery of a new combination of drugs that could potentially inhibit HIV replication. The test-tube study, say the researchers, revives hopes for the anti-AIDS drugs called tat inhibitors. This class of drug attacks HIV by targeting a protein produced by the tat gene, necessary for the reproduction of HIV. The new compound was made of Hoffman-LaRoche's Ro24-7429 and pentoxifylline, which is manufactured by several companies. The drugs were tested in human T lymphocytes into which the tat gene was inserted. "In this experimental system, the drugs proved 100 times more effective at inhibiting tat expression than either drug did by itself," said the researchers. The team also expressed hopes that the compound could achieve antiviral effects without excessive toxicity, a factor that plagued previous studies. The next step, say the researchers, is to test the compound in infected human T cells. "If the drugs prevent the virus from making copies of itself, they could become candidates for testing in AIDS patients," they speculated. "Young African Women Particularly Vulnerable to AIDS" Reuters (12/14/93) Marrakesh, Morocco--Young African women are especially vulnerable to the AIDS virus because they are subject to the sexual exploitation of older men, reports an AIDS official. "Reports on the numbers of AIDS cases in African countries suggest that young women are at higher risk of acquiring HIV than women in any other age group," said Debrework Zewdie, deputy director of the World Health Organization's AIDS control bureau in Nairobi. She cited the example of a 15-year-old girl who needed a job to help support her family after her father died. "She turned to a friend of her father's. This older man helped find her a job, but asked her for sexual favors in return," Zewdie recounted. The girl became pregnant, and discovered that both she and her baby were infected with HIV. In negating the factors that expose young African girls to HIV infection, Zewdie said that "the challenge is to reduce women's economic dependence on men through education, vocational training, legal and social measures, and most of all by targeting men in all walks of life." The United Nations Development Program estimates that 70 percent of all women worldwide infected with HIV are between the ages of 15 and 25. "AIDS Policy: Two Divisive Issues" Journal of the American Medical Association (11/24/93) Vol. 270, No. 20, P. 2436 (Stryker, Jeff et al.) A report by the National Research Council (NCR) on the social impact of AIDS concludes that, despite the tremendous devastation that AIDS has delivered, the epidemic has had minimal influence on some key institutions of American life. The report further explains that a "major reason for this limited response is the concentration of the epidemic in socially marginalized groups." The NCR raises the question of whether current strategies, which focus on the "universality of risk among all people," should be adjusted to favor more targeted approaches. Jeff Stryker and Dr. Ronald Bayer, study director and panel member of the NCR project, respectively, chastise Dr. June E. Osborn and Dr. David E. Rogers of the National Commission on AIDS for what they consider a narrow-minded criticism of the report. Stryker and Bayer suggest that Osborn and Rogers more deeply explore what the relationship should be between epidemiology and public policy on AIDS. Is the current prevention policy in the United States suffering because it embraces a "scattershot" approach that strays from the epidemiological reality, they ask. Osborn and Rogers respond by insisting that the report leaves too many Americans with the impression that--unless they are among the poor or homeless or ill--they no longer need to be concerned about AIDS. The report, they contend, implies that the disease will evaporate into the socially marginalized groups for whom some do not care anyway. Osborn and Rogers concur that targeted approaches in areas high in HIV infection should be combined with more global efforts.