Date: Wed, 21 Dec 1994 09:33:49 -0500 From: "JOHN FANNING, CDC NAC" AIDS Daily Summary December 21, 1994 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 1994, Information, Inc., Bethesda, MD ************************************************************ "U.N. Denounces Aid Agency Leaving Refugee Camps" "FDA Grants Hemocleanse Approval to Expand Hyperthermia Trials for AIDS Patients" "Voluntary HIV Counseling and Testing of Hospital In-Patients to Protect Health Care Workers Is Not Cost-Effective, UCSF Study Finds" "In Va., Having a Say in Dying" "BART Launches Multi-Faceted Community Outreach Programs for the Holidays" "Nevirapine Triple Combination: Preliminary Results Released Nov. 17" "AIDS and Antibiotic Abuse" "Home Is Where the Money Is" "CDC Reorganization Prompts Concern" "The Elections: What AIDS Organizations Need to Do Now. Interview with Tom Sheridan, Sheridan Associates" ************************************************************ "U.N. Denounces Aid Agency Leaving Refugee Camps" Reuters (12/21/94); Bedford, Julian The United Nations High Commissioner for Refugees (UNHCR) has denounced Medecins San Frontieres' (MSF-Doctors Without Borders) decision to leave Rwandan refugee camps in Tanzania, calling it a callous publicity stunt before Christmas. The French wing of MSF announced Tuesday that it would pull out of the camps because aid was supporting the authority of Rwandan killers. MSF France also noted that the refugees were better fed than the Tanzanian population and that the flood of international aid was excessive. Chris Bowers, spokesman for the UNHCR, said he doubted the sincerity of the decision to leave and MSF's justification for it. "Are they really suggesting that we should not give these people a proper diet?" He asked. "Are they really suggesting we should not give AIDS instruction and try and find ways of combating AIDS? Do they want more people to die from AIDS?" Bowers asked. "FDA Grants Hemocleanse Approval to Expand Hyperthermia Trials for AIDS Patients" PR Newswire (12/20/94) The Food and Drug Administration (FDA) has granted Hemocleanse, Inc. conditional approval to expand its clinical investigation of the use of the BioLogic-HT machine in the whole body hyperthermia (WBHT) treatment of patients with AIDS. An initial study was conducted in July with three patients treated at 42 degrees Celsius and three patients treated at 40 degrees Celsius. The expanded study will involve 30 participants--20 who receive treatment at either 40 or 42 degrees Celsius and 10 control patients who receive no treatment. WBHT has been used as a treatment for certain kinds of cancers since the 1960s. The BioLogic-HT system induces a high artificial fever, while controlling necessary blood chemistries, thus diminishing the risks to the patient. Patients from the initial study have had very encouraging results. The expanded study will begin in February 1995. "Voluntary HIV Counseling and Testing of Hospital In-Patients to Protect Health Care Workers Is Not Cost-Effective, UCSF Study Finds" Business Wire (12/20/94) A new cost-effectiveness study done by the University of California at San Francisco (UCSF) found that there is no justification for voluntary HIV testing of hospital in-patients to prevent HIV-infection of health care workers. The researchers found that screening in-patients to detect infection may be cost effective when a significant number of the patients are HIV-infected. There are, however, ethical and policy concerns that must be adequately addressed before any large-scale counseling and testing program can be supported. The study was prompted by recommendations from the Centers for Disease Control and Prevention in 1993 to consider using voluntary HIV testing and counseling programs for in-patients between the ages of 15 and 54 in certain acute care hospitals in the United States. The researchers determined that if all in-patients were offered HIV counseling and testing, only 3.6 health care worker HIV infections would be prevented each year. The annual program cost would be $2.7 billion, or $753 million per infection averted. "In our view, this is not sufficiently cost-effective to justify testing to protect health care workers from HIV infection," said lead author Peter Lurie, of the UCSF Center for AIDS Prevention Studies. "In Va., Having a Say in Dying" Washington Post (12/20/94) P. A1; Hall, Charles W. At a time when physician-assisted suicide has sparked great controversy, medical professionals and those who counsel the terminally ill say that passive euthanasia, in which a patient is allowed to die through the withholding of medical treatments, has become far more common with much less debate. AIDS patient Andy Moore, for example, is obtaining the Do Not Resuscitate form, which will allow him to die with dignity. Over the last four years, 24 states have quietly approved laws that allowed seriously ill patients to reject cardiopulmonary resuscitation by paramedics. Court rulings have also opened up many other forms of passive euthanasia, such as withdrawing antibiotics to patients, presenting families with difficult decisions about when to let a relative die. Since 1992, Virginia has issued more than 30,000 Do Not Resuscitate forms. State officials are planning a public awareness campaign, after a expansion of the law in July makes non-terminal patients with chronic illnesses eligible. Specialists on dying say the Do Not Resuscitate issue has provoked little debate because it stems from the legal principle that a person can refuse treatment even if that refusal may be fatal. "BART Launches Multi-Faceted Community Outreach Programs for the Holidays" Business Wire (12/20/94) As part of an effort to be a part of the communities it serves, BART has designed a multi-faceted outreach program to help the less fortunate during the holiday season. One part of the program is "With Love: From BART," a toy and gift drive for children with HIV or AIDS. There are hundreds of children and families in the San Francisco Bay area who live with the emotionally and financially draining disease. The presents will be given to patients and their families at Oakland Children's Hospital, The University of California San Francisco Medical Center, The Hope Project, and Bridge for Kids. "Nevirapine Triple Combination: Preliminary Results Released Nov. 17" AIDS Treatment News (11/18/94) No. 211, P. 6; James, John S. Preliminary results of a study of the "convergent combination" approach to antiviral treatment were released in November. The subjects--who had at least six months prior treatment with AZT, ddI, or ddC--randomly received AZT and ddI, or AZT plus ddI plus nevirapine. Nevirapine is an experimental HIV treatment that, when used alone, has a very strong anti-HIV effect initially but one that diminishes as the virus develops resistance to the drug. After 48 weeks, the researchers found that patients who received all three drugs had 25 percent higher T-helper counts than those who only received AZT and ddI. The ineffectivity of peripheral blood mononuclear cells (PBMCs) was reduced by 50 percent more in the triple combination group. There were no indications of survival or disease-progression benefit for those who received the triple combination. Seventeen percent of those participants died or experienced HIV disease progression. The triple combination also produced more side effects than only AZT and ddI. In a commentary, AIDS Treatment News concluded that the results suggest the necessity of more flexible research strategies, with many small, rapid trials to quickly assess promising leads. "AIDS and Antibiotic Abuse" Futurist (11/94-12/94) Vol. 28, No. 6, P. 58 In "The Plague Makers," author Jeffrey A. Fisher describes how an overuse of antibiotics could be a contributing factor to AIDS. Fisher believes that extended and excessive use of drugs such as tetracycline may suppress the immune system to the point that unusual forms of Mycoplasma bacteria develop. The bacteria interacts with HIV to eventually cause AIDS. "We have to be suspicious of the role of HIV in the development of AIDS...It is clearly time for us to focus on the co-factors, especially antibiotics," says Fisher. The antibiotic-related model, he says, would explain why the incubation period of AIDS takes years; why HIV existed as a relatively benign disease in Africa up until recently; and why there is a small, but growing, number of AIDS patients who are HIV-negative. The negative role that antibiotics play in other diseases must be researched further, Fisher warns. "Home Is Where the Money Is" Advocate (12/13/94) No. 670, P. 32; Bull, Chris In an Oct. 26 letter to the Food and Drug Administration (FDA), the National Lesbian and Gay Health Association (NLGHA) alleged that pharmaceutical giant Johnson & Johnson had unduly influenced FDA officials concerning an experimental HIV home test and illegally funneled millions of dollars to prominent AIDS advocates and public-health officials. Some AIDS activists, however, claim that the NLGHA is trying to delay the approval process of the test. Bruce Decker of the Health Policy and Research Foundation--an advocacy group that supports home HIV testing--said, "NLGHA has had plenty of time to voice its concerns...This is nothing more than an effort to delay and confuse a very clear process." NLGHA called for an inquiry into Direct Access Diagnostics (DAD)--the Johnson & Johnson subsidiary that developed the HIV home test--and its employment of former surgeon general C. Everett Koop and Sean Strub--the publisher of "POZ", a bimonthly AIDS magazine--to promote the product. Although NLGHA claims that several other AIDS activists and organizations have accepted Johnson & Johnson's money for promotional activities, the groups have denied the accusation. Under federal law, it is illegal for companies to promote or advertise products that have not received full FDA approval. "CDC Reorganization Prompts Concern" Science (11/25/94) Vol. 266, No. 5189, P. 1313; Thompson, Larry The Centers for Disease Control's (CDC) plans to consolidate its AIDS activities into a single center has some AIDS activists worried. The center is already responsible for tuberculosis and sexually transmitted diseases. Activists are also concerned because the move will shift responsibility for the disease from the CDC director's office to a lower level in the agency's hierarchy. The reorganization will consolidate approximately 80 percent of the funds and staff devoted to AIDS, which are currently scattered throughout the CDC, into the National Center for Prevention Services. Basic science labs used for studying HIV will continue to be a part of the CDC's National Center for Infectious Diseases. Currently, the hundreds of CDC employees who work with AIDS often report to more than one person, which results in confusion, stress, and difficulties in accountability. In response to a letter written Nov. 18, Jack Jackson--the CDC's associate director for management--said, "Whoever leads this center will report directly to [CDC Director] Dr. Satcher. Dr. Satcher remains committed to HIV prevention." "The Elections: What AIDS Organizations Need to Do Now. Interview with Tom Sheridan, Sheridan Associates" AIDS Treatment News (11/18/94) No. 211, P. 7; James, John S. In light of the November elections, AIDS Treatment News interviewed Tom Sheridan, a professional lobbyist, AIDS organizer, and founder of the Sheridan Group--a government and public-relations organization--to find out what people concerned about AIDS should do. Sheridan said there are three levels of organization that should begin immediately: internal organization, grassroots organization, and political organization. "AIDS advocates need to think about retooling our resource pool, and have real political resources available for friends, and some resources to fight our enemies," he added. "One of the biggest losses concerns our institutional base of support," Sheridan said. He wondered whether key people in the House and Senate will be able to keep their jobs. He also said that it is necessary "to join ranks and avoid being caught up in competitive--zero-sum gain--discussions on AIDS priorities." Sheridan concluded that activists must not compete against each other--at a program level, at a community level, or at a national level.