Date: Tue, 08 Feb 1994 09:07:46 -0500 (EST) From: "ANNE WILSON, CDC NAC" Subject: CDC AIDS DAILY SUMMARY 02/08/94 AIDS Daily Summary February 08, 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 1993, Information, Inc., Bethesda, MD "Protectionist France Delayed U.S. AIDS Test--Paper" Reuters (02/08/94) Paris--The French newspaper Liberation yesterday published documents that appear to prove that, in 1985, the government intentionally delayed the marketing of a life-saving American AIDS test to protect a rival French product still under development. Despite the fact that 100 to 200 people were being infected each month in France via blood transfusions, senior government officials imposed a six-month delay, according to Liberation, which quoted official documents. According to the paper, American firm Abbott requested that its new blood-screening test for AIDS be marketed in France in January 1985. At that time, a subsidiary of France's Pasteur Institute was developing its own test, but was far from being ready to market it. So, French authorities banded together to block Abbott's test, for what Liberation called purely protectionist reasons. The paper printed letters written by Francois Gros, scientific adviser to then prime minister Laurent Fabius, which indicated that he was well aware of the risks from blood transfusions, but was anxious to prevent the American test from "flooding the French market." Abbott's test was finally authorized in France on July 23, 1985--more than six months after the company filed its initial request. "Fox Joins Big 3 in Banning Condom Ads From Kid Fare" Chicago Tribune (02/07/94) P. 2-7 When the government unveiled its new AIDS prevention public service announcements, all four major television networks said they would accept the ads. ABC, NBC, and CBS all said immediately, however, that they would decline to air the ads other than late in prime time. Fox did not make such a statement at the time, but the network has now announced that it will take into consideration the makeup of the audience when scheduling the spots, according to Helen Boehm, vice president of Public Service and Children's Network for Fox. For example, she said, a show with a large children's following, such as "The Simpsons," is not likely to carry any of the ads, which promote condom use and abstinence. A program like "Beverly Hills, 90210," however, might feature the spots. The bottom line is that flat-out kids' programs are off-limits for the safe sex ads. "State Miffed at AIDS Program Delay" Boston Globe (02/07/94) P. 13 (Murphy, Sean P.) Disturbed by repeated delays in setting up a needle exchange program to help stem the spread of AIDS, state public health officials in Massachusetts last week advised a city agency to step down if it is unable to implement the program quickly. "We suggested that, if they couldn't initiate the program, then perhaps somebody else should be brought in to do it," State Public Health Commissioner David H. Mulligan said of the Boston Department of Health and Hospitals. According to Mulligan, the program is already six to eight weeks behind schedule and, in the meantime, infection is spreading. State epidemiologists estimate that there are seven new HIV infections in the state each day--half of which are transmitted by needles. Approximately 10,000 intravenous-drug users are already thought to be infected. "The virus isn't waiting for us," said Mulligan. "To preserve life, we have to do this." City officials have assured him that the red tape that delayed the program has been cleared. In addition, the Boston Department of Health and Hospitals announced the appointment of Rhoda Creamer to head the clean needle oprogram. "Celgene and NIH to Evaluate Synovir in HIV Patients" Business Wire (02/07/94) Warren, N.J.--Celgene Corp., a biotechnology firm, has entered into a clinical trials agreement with the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health, to evaluate Synovir in HIV-infected patients. Under the pact, NIAID will sponsor clinical trials by way of the AIDS Clinical Trials Group. Preclinical research funded by Celgene showed that Synovir, or thalidomide, inhibited activation of the virus in the peripheral blood mononuclear cells of 16 out of 17 patients with advanced HIV infection or AIDS. Researchers believe Synovir may significantly delay progression of the disease. "The objectives of this study will be to assess the safety and patients' tolerance of daily oral doses of Synovir and to obtain pharmacokinetic data as well as initial data on anti-viral markers and viral burden," said Dr. Mary Ann Luzar, executive director of the AIDS Clinical Drug Development Committee of NIAID. The trials will be randomized, placebo-controlled studies. As part of an overall immune therapeutics program, Celgene intends to sponsor human clinical trials to evaluate Synovir in the treatment of cachexia, the wasting syndrome linked to AIDS and related disorders. "AIDS-Stricken Filmmaker Derek Jarman in Hospital" Reuters (02/07/94) London--British filmmaker Derek Jarman, known for his motifs on homosexuality and the devastation caused by AIDS, has been hospitalized in serious condition following a long, personal battle with the disease. The 52-year-old filmmaker was admitted 12 days ago after his condition deteriorated further, according to a spokesperson for St. Bartholemew's hospital in central London. "He is still serious, but stable," she said. Jarman, a homosexual activist, learned of his HIV-positive status in 1986 and, since then, has twice been hospitalized for long periods with severe AIDS-related illnesses. His films include "Blue," a personal reflection on AIDS which debuted last year. "AIDS Review Asked" National Law Journal (01/31/94) Vol. 16, No. 22, P. 6 A Minneapolis clinic and the estate of a physician who died of AIDS-related causes have asked the state Supreme Court to review a Court of Appeals decision ruling that, in order to sue for damages, former patients only need to show that they were in the "zone of danger." Palen Clinics in Minneapolis and Columbia Heights and Dr. Philip Benson are faced with lawsuits filed by 56 former patients. "Changing Times Bring Uncertainty for Ryan White CARE Act" Nation's Health (01/94) Vol. 24, No. 1, P. 28 In the dark about where Clinton's proposed health plan will lead, federal health officials are struggling with the task of planning for categorical grant programs, among them the Ryan White CARE program. Designed to improve the quality and access to care for HIV-infected people and their families, the act is up for reauthorization in 1995. The Health Resources and Services Administration (HRSA) will, by April, make recommendations to the U.S. Public Health Service, which will then submit a legislative package to Congress by fall 1994--about the same time that Congress will consider the health care reform. "We must make sure services are not lost in the transition," says Stephen Bowen of HRSA. Although it is heralded as one of the few successes in the history of AIDS, HRSA is being urged to improve the act. Jay Coburn of the AIDS Action Council, for instance, called on the agency to conduct a comprehensive review of the program in the wake of the changing demographics of AIDS and disputes between state and city grantees. And Moises Agosto of the National Minority AIDS Council urged federal regulators to create a better vehicle for minorities to receive treatment and research information. Other groups have recommendations as well. Although competition for grant money is common, advocates concur that it will probably intensify in the coming year as grantees express concern about the future of their programs. "Reducing the Risk of AIDS in High School Students: Lifelong Monogamy Is the Moral Solution" Journal of the American Medical Association (01/29/94) Vol. 271, No. 3, P. 195 A recent article by Walter and Vaughn demonstrates a statistical difference in attitude and behavior changes between students with no formal AIDS education and students who attended a special six-session AIDS prevention curriculum. According to Dr. Glenn P. Dewberry, Jr., the study has several flaws. The only "type" of monogamy that is truly linked to a reduced risk of contracting AIDS is extended or lifelong mutually monogamous relationships. Therefore, says Dewberry, it is difficult to see the relevance of the self-reported, 3-month, monogamous activity of a teenager. He also cites Hearst and Hulley, who say that "encouraging the use of condoms may in some circumstances even be harmful, if it gives a false sense of security in a high-risk situation." Dewberry also invokes Hearst and Hulley to question Walter and Vaughn's definition of a high-risk partner only in terms of use of parenteral drugs. This also limits the relevance of their findings because, as said by Hearst and Hulley, to truly avoid high-risk partners, "one must rule out sex with prostitutes, casual sex, and indeed, much of what many people consider to be normal heterosexual behavior." Dewberry says that, in general, he disagrees with the entire premise of Walter and Vaughn's article, which is that somewhere there is a "miraculous curriculum" and that research must continue until it is found. Dewberry contends that the solution to the moral crisis will not be found in the public education system, but in parental involvement. "Case Managers Increase Attention to HIV Pain Management" AIDS Alert (01/94) Vol. 9, No. 1, P. 9 As the lives of AIDS patients are prolonged, case managers must manage more of their clients' symptoms, including pain. Anticipation is crucial to pain management in HIV-infected patients, say experienced AIDS case managers. Instead of responding to patient complaints of pain late in the course of the disease, case managers can help clients maintain a healthy lifestyle and avoid some of the pain that increases as the disease progresses, says Karl Thorn, a case manager in private practice and consulting in California. Most pain experienced by HIV patients stems from AIDS-related opportunistic infections, which must be treated intermittently throughout the course of the illness. Suzanne Combs, a nurse manager for Managed Health Care, a home infusion therapy provider in Atlanta, notes that pain management generally is not formally incorporated in the health care plan until the end stages of disease. Providers and case managers are seeking to treat infections more aggressively and reduce pain-related problems before they begin jeopardizing the lives of the patient, she says. The most common types of pain observed in HIV patients include chest pain, headaches, rheumatological problems, rectal pain, and skin lesions. Other problems include oral lesions, abdominal pain, respiratory pain, and peripheral neuropathy. "CDC Chief: Doctors Have Role in New HIV Campaign" American Medical News (01/24/94-01/31/94) Vol. 37, No. 4, P. 20 (Satcher, David) The Prevention Marketing Initiative, a bold, new, government-sponsored campaign that aims to curb HIV infection among young people aged 18 to 25, reflects the responsibility of health officials to educate America's youth about the health risks linked to their sexual behavior, says Dr. David Satcher, director of the Centers for Disease Control and Prevention. A series of AIDS prevention public service announcements are scheduled to begin airing on prime time television this month. Some, Satcher notes, encourage young people to abstain from sexual activity, while others preach correct and consistent condom use, and still others target minority communities. However, he says, a comprehensive and focused HIV prevention effort cannot rely solely on the media. Satcher says that public health officials are also mobilizing community support and leadership. He contends that effective efforts to prevent TB, HIV, and other sexually transmitted diseases must be closely coordinated with medical and social services for those who are infected or at high risk. Private physicians can improve the situation by routinely engaging in frank discussions with patients about HIV risk factors. Satcher praises the AIDS prevention policy of the American Medical Association, which "encourages physicians to educate their patients about the role of condom use in reducing the risk of sexually transmitted disease." Individual doctors as community leaders, says the CDC director, offer a weapon to fight HIV transmission and their contributions will save lives.