Date: Fri, 25 Feb 1994 09:38:07 -0500 (EST) From: "ANNE WILSON, CDC NAC" Subject: CDC AIDS DAILY SUMMARY 02/25/94 AIDS Daily Summary February 25, 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 "New York AIDS Panel Encourages Doctors to Test Pregnant Women" New York Times (02/25/94) P. A1 (Navarro, Mireya) Concerned that it would jeopardize the privacy rights of new mothers, a New York State panel of AIDS advisors yesterday rejected a controversial proposal to identify HIV-positive newborns. The panel instead recommended that physicians be required to "strongly encourage" all pregnant women and new mothers to be tested for the virus, in hopes of administering early care to babies who are infected. Although the Health Department--for the purpose of tracking the disease--currently tests all babies born in the state, the tests are anonymous and neither doctor nor patient knows the results. Identifying the infant, however, would be parallel to testing the mother without her consent, since a positive test for the child means the mother is infected. In this light, the proposal clashed with strict state HIV-testing laws which require written consent. Four doctors on the panel who disagreed with the final recommendations countered that recent advances in treatment make it possible, through early identification, to prolong the lives of infected babies. "INS May Ease AIDS Ban for Gay Games" Washington Post (02/25/94) P. A8 In anticipation of the 15,000 foreign athletes and spectators who are expected to attend the Gay Games this spring in New York, the Immigration and Naturalization Service may be compelled to waive a visa rule prohibiting HIV-positive travelers from entering the United States. INS spokesman Duke Austin says his agency will draft guidelines. "The State Department has asked us to develop some options on how we would admit these people on some sort of broad waiver of their inadmissibility," he confirms. Austin cites the U.S. policy as one that denies visas to anyone who is infected with a "communicable disease of public health significance," including HIV. The restriction has been condemned in the past by AIDS activists. Bill Clinton pledged during his presidential campaign that he would abandon the policy, but thus far has been unsuccessful in pushing the change through Congress. Participants and spectators from more than 40 countries are expected to attend the Gay Games, which take place June 18-25. Related Story: New York Times (02/25) P. B4 "Scientists Say Mutant HIV Strains Could Resist Their Promising Drug" Philadelphia Inquirer (02/25/94) P. A9 (Collins, Huntly) HIV may be able to develop mutant strains resistant to Merck & Co.'s promising new drug, report researchers with the firm. Known as L-524, the drug inhibits the protease enzyme that allows infected cells to produce a new, infectious virus. In preliminary safety trials of 10 patients, L-524 reduced the amount of measurable virus in the patients' blood by an average of 70 percent in just 12 days. After about 12 weeks, however, the first three patients began showing small increases in viral RNA, the genetic material of HIV. "The degree of resistance is not enormous," says Edward M. Scolnick, president of Merck Research Laboratory in West Point, Pa. "But we're not looking for a drug that brings incremental benefits; we are looking for quantum benefits." Although the scientists find the development disappointing, they say they will continue testing the drug with increased doses in clinical trials involving 60 patients. Merck has, however, put on hold plans to conduct large-scale testing of the drug on thousands of people. "We have to fully understand what's going on before we proceed," said Emilio Emini, the company's leading AIDS researcher. In addition, Merck hopes to test L-524 in combination with other drugs, such as AZT. "Red Cross to Set Up Blood-Handling College in Fairfax County" Washington Post (02/25/94) P. A16 (Seaberry, Jane) The American Red Cross will establish a national college in Fairfax County, Va., to train workers in the most recent blood-handling techniques. "We will produce through education a standardization of performance not possible any other way," said Red Cross President Elizabeth Dole. "Our college will have rigorous tests before certification so that the patches and pins worn by Red Crossers will serve as emblems of excellence in the industry." The college will offer courses in handling blood that will last weeks, even months. Scheduled to begin by summer, the Blood Services Training College is part of a three-year-old, multimillion-dollar campaign to improve the Red Cross's blood collection and distribution program. The agency--which collects, tests, and distributes half of the nation's blood supply--has been criticized in recent years for violations of blood safety laws and regulations at collection and testing facilities. The criticism has compounded fears that viruses like AIDS and hepatitis B might be transmitted via tainted blood. The college, according to Karen Shoos Lipton, acting senior vice president for the Red Cross's biomedical services, "is critical to the effectiveness of our new quality assurance program." "India-AIDS" Associated Press (02/24/94) New Delhi, India--Hardly any of the funds that were allocated last year to campaign against the spread of AIDS in India have been used, reports Indian Health Minister B. Shankaranand. On Wednesday, he informed Parliament that only 13 percent of the money budgeted by the federal government in 1993 to help states fight the AIDS epidemic has been spent. The money was to be used for establishing blood banks and testing centers, and educating high-risk groups about the disease. But, for example, the state of Maharashtra--which includes Bombay, India's biggest city--did not use any of the $450,000 it was given, said Shankaranand. The country has been identified by the World Health Organization as the AIDS crisis point of the next century, with an estimated 1.6 million Indians already infected with HIV. "Europe Knew of AIDS-Tainted Blood in 1983--Deputy" Reuters (02/17/94) (Yanowitch, Lee) Paris--A French deputy last week accused Western European governments of disregarding critical advice a decade ago that AIDS could be spread through blood transfusions. "No one paid attention to the recommendations at the time, and no one warned the patients," said Socialist deputy Jean-Yves Le Deaut. "They didn't think AIDS was important enough." Le Deaut was secretary of a parliamentary investigative commission on AIDS under the last Socialist regime. He asserted that the French government and the Council of Europe warned health authorities in June 1983 that blood products could be contaminated with AIDS, and suggested measures to avoid its transmission. Le Deaut published 10-year-old documents from the Council of Europe and the French government which support his contentions. The Council of Europe circular urged officials to "provide all blood donors with information on AIDS so that those who belong to groups at risk do not donate blood." The French document, dated 3 days before the Council's, expressed the same concerns. "The problem in France was that the population at risk was not taken into account," said Le Deaut. "And in 1983, that was the one thing we were able to do." He noted that, instead, the French continued to collect blood in prisons and from other at-risk populations. "If France has such a high rate of AIDS now, that's the reason," Le Deaut said. France has the largest number of AIDS cases in Europe. "AIDS Digest: And in Brief..." Washington Blade (02/11/94) Vol. 25, No. 6, P. 31 The wholesale price of a 200 milligram dose of acyclovir, an antiviral drug used to treat herpes infection in HIV patients, shot up 13 percent in 1993, according to a report from the U.S. Senate Special Committee on Aging. The wholesale price for all seven formulations of the drug, which is sold as Zovirax, rose by an average of 6.8 percent, said a spokesperson from Zovirax manufacturer Burroughs Wellcome. "New Guidelines Encourage Primary Care for Patients With Early HIV Infection" Journal of the American Medical Association (02/16/94) Vol. 271, No. 7, P. 487 (Marwick, Charles) Although there is no cure for the disease, the life of HIV-positive individuals can be prolonged and overt disease can be delayed if infection is detected early and appropriate treatment is initiated. Federal AIDS experts say that to achieve this, primary care physicians and other health care providers must get involved in caring for HIV patients. To promote their participation, the Agency for Health Care Policy and Research (AHCPR) has issued a clinical practice guideline. "Evaluation and Management of Early HIV Infection" provides physicians with the information they need to offer early, appropriate care to HIV-positive patients, rather than referring them to "expensive specialists." Dr. Philip R. Lee, assistant secretary for health, says primary care providers must be encouraged to treat HIV patients because "there are not enough infectious disease specialists to care adequately for the growing number of people living with HIV." He adds that internists, family doctors, and pediatricians can all use the guidelines to manage HIV patients at less cost and greater convenience. Available in Spanish and English and endorsed by 19 medical organizations, the AHCPR guideline is scheduled for wide distribution among hospitals and medical groups. "It's a Wrap" Advocate (02/22/94) No. 649, P. 29 (Bull, Chris) The final draft of the Concorde study, the most comprehensive inquiry ever into the efficacy of AZT, is being prepared for publication. Because preliminary results presented last April suggest that the drug does little to delay the progression of AIDS, physicians warn that the final conclusions--which are expected to mirror the originals--are likely to leave many questions about AZT's effectiveness unanswered. A spokesperson for Burroughs Wellcome Co., the drug's manufacturer, insists that the company's position on AZT as an AIDS treatment will likely remain unchanged despite the Concorde study. Observers of AZT sales, however, predict that publication of the final report will have much of the same effect as the preliminary results: a call for stepped-up development of alternative treatments and a decline in use of the drug. Physicians say they are looking to another study, known as the Compact study, to provide clearer information about the efficacy of HIV. The Concorde study is a British-French project that followed some 1,800 HIV-positive subjects, half of whom were administered AZT and the remaining half of whom received placebos. The study compared the rate at which the two groups developed AIDS. "HIV Infection in Vietnam" Lancet (Great Britain) (02/12/94) Vol. 343, No. 8894, P. 410 (Tran Hien, Nguyen and Wolffers, Ivan) The first systematic epidemiological surveys of HIV infection among specific populations in Vietnam, including intravenous drug addicts and commercial sex workers, have been conducted over the past two months. The polls are a crucial step in developing an appropriate AIDS policy for Vietnam, where little was known about dissemination of the virus until recently. The first HIV case was reported in 1990; 11 more were identified in 1992. By November 1993, there were 957 infected people in Vietnam--57 of whom had AIDS, and 18 of whom had died. Until that year, Vietnamese policy viewed the disease as an outside threat. National campaigns cautioned against the risk of contracting AIDS from foreigners, and initiated efforts to stamp out prostitution and drug use. The merger of the vertical programs for AIDS, prostitution, and drug abuse has increased the stigma of infected people and caused confusion at the regional level. Sexual and HIV education and surveillance have been placed under the control of the same authorities responsible for anti-drug and prostitution activities. Local needle exchange and condom distribution programs have met with difficulty because some authorities interpret these measures as endorsement of drug use and prostitution. Both activities hasten the spread of AIDS, but as long as their participants are seen only as social deviants who are at risk of being arrested or isolated, they will not take part in surveillance or education programs.