>From: "ANNE WILSON, CDC NAC" >Subject: CDC AIDS Daily Summary 12/23 >Date: Tue, 28 Dec 1993 13:51:22 GMT AIDS Daily Summary December 23, 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 "Funding Misuse Puts Brazil AIDS Program at Risk" Reuters (12/22/93) (Schomberg, William) Rio de Janeiro--Brazil, the country with the fourth largest number of AIDS cases worldwide, has jeopardized a $250-million loan from the World Bank to fight AIDS because health authorities may have misappropriated a portion of the funds. Officials in Rio de Janeiro used an initial infusion of cash to pay off debts, report non-governmental groups. "It was a technical error," concedes Rio de Janeiro health secretary Astor de Mello. "The state will pay the sum in question." But health watchdog organizations insist that the state purposely used $60,000 to eliminate outstanding debts to an AIDS treatment supplier. "This is not just a technical mistake, it's criminal," declares a representative of the Rio de Janeiro Doctors Association. "It puts the whole program at risk." Under the loan agreement, the World Bank will loan Brazil $250 million over three years for prevention and treatment of AIDS. But if evidence of misuse of the fund is discovered, the agreement can be canceled. Rio was to have been the first Brazilian state to receive the funds, but now its AIDS program has been halted as investigation continues. "U.S. Study Shows Women Taking Steps Against AIDS" Reuters (12/22/93) Washington--American women are taking greater precautions to avoid AIDS, reports a new study from the U.S. National Center for Health Statistics. Data from nearly 6,000 women in 1990 indicate that 18 percent of sexually active women in the United States are making changes, including increased use of condoms. The study reports that 22 percent of women aged 15 to 44 said their partners used condoms either to prevent disease or avoid pregnancy. Although condom use has gone up, the study also notes that partners who use condoms only do so approximately 50 percent of the time. Only 10 percent said they used condoms with every act of intercourse. The reason for this inconsistent use is unclear, says Dr. William Mosher, a lead researcher. "State AIDS Spending Up; Average Hospital Stay Down" Boston Globe (12/22/93) P. 28 (Kong, Dolores) Between 1988 and 1991, the total amount of money paid to hospitals for treatment of AIDS patients came close to doubling in Massachusetts, but the length of hospital stays for AIDS patients declined, according to the first in a series of state reports on the impact of the disease on the health care system. The AIDS report, issued by the state Public Health Council, calculates that in 1991 the hospital charges stemming from treatment of AIDS were $63.3 million, approximately 1 percent of the state's total hospital fees. Compared to other patients in 1991, those with HIV/AIDS were hospitalized for an average of two days longer for each bout of sickness, costing an additional $4,000 per stay. As AIDS treatments have improved, infected patients have been able to leave hospitals sooner, with the average stay falling from 11.8 days in 1988 to 9.4 days in 1991. Shorter hospital stays do not necessarily mean lower costs, however. Average charges for each AIDS patient's day in the hospital jumped by 30 percent between 1988 and 1991. The study also tracked changing insurance trends, which showed that the number of discharged AIDS patients covered by private HMOs dropped from 38 percent to 30 percent over the three-year period. Medicaid coverage rose from 38 percent to 44 percent, and Medicare grew from 5 percent to 9 percent. "Researchers at Colorado-Based Biotechnology Firms Take on AIDS Virus" Knight-Ridder/Tribune Business News (12/21/93) (Sheeler, Jim) A cluster of biotechnology companies in Boulder, Colo., where scientists slice, splice, and otherwise torture HIV, seems to be at the core of the research against AIDS. "It's more [research] than you'll find anyplace between St. Louis and San Francisco, and I hope it continues to grow," says Robert "Chip" Schooley, head of the infectious disease division of the University of Colorado. Using the university as a springboard, these small but ambitious and innovative firms are using gene therapy, molecular biology, and natural substances in an attempt to combat the AIDS virus. And while the Food and Drug Administration is a reason to groan for most biotechnology executives, the Boulder firms at the forefront of the AIDS battle are leaving the bureaucratic anxieties until later. They say they are happy working in their own streamlined business. Boulder companies currently engrossed in AIDS research include Ribozyme Pharmaceuticals Inc., NeXagen Inc., Hauser Chemical Research Inc., and Amgen Boulder Inc. "Endgame for MicroGeneSys Vaccine Trial?" Science (12/10/93) Vol. 262, No. 5140, P. 1635 Top health leaders have written a letter to Congress objecting to a $20 million trial of MicroGeneSys' AIDS vaccine. The letter follows a bill that would stop the trial if the secretary of defense, the FDA commissioner, and the NIH director opposed the tests in writing. In 1992, lobbyists convinced Congress to provide $20 million to the Department of Defense to study the company's gp160 vaccine. Many researchers fought against the measure. After talking with officials of the FDA, DOD, and NIH, Rep. Henry Waxman (D-Calif.) added an amendment on the Defense Appropriations bill that would allow the three agencies to stop the trial if they found it scientifically weak. Last month, Ruth Kirschstein, who was acting director of the NIH, and FDA Commissioner David Kessler stated their reasons for opposing the trial. Once completed, the joint letter went to Donna Shalala, secretary of Health and Human Services. Shalala will probably approve the letter. However, the DOD has changed their minds about the trial several times in the last year. Yet, Anthony Fauci, leading AIDS official at the NIH, notes the DOD agreed with the letter. "Surgery Okay for HIV Patients" AIDS Alert (12/93) Vol. 8, No. 12, P. 195 Elective surgery for HIV patients can be successful despite increased complications associated with the virus, says a Los Angeles orthopedic surgeon, who bases this claim on his experiences operating on over 100 such patients. About 20 percent of all AIDS patients require some form of surgery, says Dr. James Luck Jr., clinical professor in the Department of Orthopedic Surgery at the University of Southern California School of Medicine. Infection and impaired healing are concerns following surgery, but Luck's experiences dictate that asymptomatic HIV patients "appear to have zero increase in risk of delayed wound healing or infection following an orthopedic procedure." Post-surgical complications can be avoided by preoperative planning and testing. Physicians should consider CD4 counts, history of opportunistic infections, serum albumen level, skin anergy, and nutritional state as well as general health before agreeing to perform elective surgery, Luck says. "HIV-positive patients may require elective surgery to improve the quality of life, just as it does for other patients," he says. "Medical Combat Gear" Longevity (12/93) Vol. 6, No. 1, P. 22 (Berger, Warren) Aside from the isolated case of one Florida dentist, there have been no documented cases of patients infected with the AIDS virus by health care professionals. In fact, several studies have reassured that chances of doctor-patient transmission is minimal if proper precautions are heeded. This has done little, however, to alleviate the uneasiness felt by doctors, dentists, and patients alike. In response, health-care marketers are introducing a slew of new products designed to prevent accidental transmission, as well as transmission between patients and health-care professionals. Among the new products is Viro Glove from Knight Industries of Pompano Beach, Fla. Viro Glove is actually a cream which forms an antiseptic barrier that kills HIV for as much as six hours, according to studies. Designed to be worn under latex gloves, Viro Glove provides added protection in case there is a tear in the latex glove--something that is easy to miss. As for protecting the rest of the body, doctors--especially surgeons--are beginning to suit up like astronauts. Surgical helmets and fluid-proof operating gowns are becoming increasingly popular. Not only is the health-care uniform getting a makeover, so too are the tools. One company now offers a needle with an inner sliding cannula to sheath its point immediately after use. Other "safe needles" are in development. "Flack for Quacks" Genre (12/93-01/94) No. 15, P. 74 (Scarsella, Anthony) Americans spend billions of dollars each year on health-care treatments that are ineffective, worthless, or just plain dangerous, says Dr. Anthony Scarsella. HIV-positive persons, he adds, are especially vulnerable to so-called miracle cures. According to one study, over 100 questionable or fraudulent AIDS treatments were offered in the United States last year. Scarsella says the government cannot be depended upon to effectively regulate them, so AIDS patients must learn to question these treatments themselves. He offers guidelines on how to avoid getting ripped off. Beware of back-yard chemists whose "cure" works not only on HIV, but on cancer, multiple sclerosis, acne, and other conditions, warns Scarsella. Also be wary of treatments whose researchers are foreign and cannot be verified. Scarsella says to be suspicious of those who claim that their product is being suppressed because it threatens big business, and to be skeptical of those who insist that the medical establishment is out to get them. Another warning sign, he notes, is when a promoter attacks the integrity of all those who question him. Finally, says Scarsella, be cautious of entrepreneurship. Find out if they have marketed other treatments for AIDS, or other hard-to-treat illnesses. Remain skeptical about miracle treatments and cures, says Scarsella, and your health and bank account will be better off. "Medical Briefs" Advocate (12/28/93) No. 645, P. 36 Aztec, a new AZT-based AIDS drug manufactured by Vertex Laboratories Inc., will enter a Phase II double-blind randomized study with AZT at several sites across the country. Aztec is unique in that it requires a twice-daily dose of a controlled-release formulation that has proven to be more tolerable and have fewer side effects than the immediate-release formulation that is currently available. "Zidovudine in Asymptomatic HIV Infection" New England Journal of Medicine (12/16/93) Vol. 329, No. 25, P. 1895 (Phillips, Andrew N. and Saben, Caroline A.) Cooper et al. conclude that the benefits of zidovudine last more than two-and-a-half years in asymptomatic HIV patients with CD4 counts over 400. Andrew Phillips and Caroline Saben of the Royal Free Hospital School of Medicine in London question the validity of Cooper et al.'s "on treatment" approach to analysis, in which data were censored three months after the end of blinded treatment. This approach, say Phillips and Saben, should be supplemented with analyses in which follow-up information is not censored. These analyses should consider the original primary end point for the trial--AIDS--as well as end points later adopted. Cooper et al. do not even acknowledge whether AIDS developed by the end of the trial in approximately half of the subjects, 308 of whom withdrew, note Phillips and Saben. The implied tendency of patients about to reach an end point to withdraw from the trial, they speculate, could actually have created a bias in favor of zidovudine. Given the widespread belief that the drug's effects are limited, any suggestion that this time frame is longer should be supported with the demonstration of a statistically significant difference in risk between zidovudine and a placebo, considering the number of years at risk following two years of treatment. The small number of patients with end points after longer than two years cast doubt, say Phillips and Saben, that such a difference was ever present. Therefore, they conclude, the suggestion that the beneficial effects of zidovudine last longer than two-and-a-half years is not justified based on the results presented. HOLIDAY NOTICE...The AIDS Daily Summary will not publish on Friday, December 24, 1993. Publication will resume on Monday, December 27, 1993.