Date: Thu, 09 Jun 1994 09:14:29 -0400 (EDT) From: "ANNE WILSON, CDC NAC" AIDS Daily Summary June 09, 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 ************************************************************ "City, State, 4 HMOs Join to Keep Betak Open" "The Renaissance Man as Radical" "Landmark AIDS Trial Jury Deliberates" "Columbia Laboratories Signs U.S. Agreement With Lake Pharmaceutical to Market Its Newest Product, Advantage 24" "The First Search for the Source" "Good News and Bad News About AZT" "Zidovudine for the Prevention of HIV Transmission From Mother to Infant" "Suppression of HIV Production in Resting Lymphocytes by Combining Didanosine and Hydroxamate Compounds" "Bereavement Reactions" "HIV Vaccine Trials: Will Intravenous Drug Users Enroll?" ************************************************************ "City, State, 4 HMOs Join to Keep Betak Open" Philadelphia Inquirer (06/09/94) P. B1; Collins, Huntly In a move to save Philadelphia's only exclusive AIDS nursing home from immediate closure, the city, state, and four health maintenance organizations agreed to donate more than $200,000 to help Betak meet its payroll at least through next month. The news brought an end to the 17-day hunger strike of a handful of activists who protested the nursing home's potential closing. After July, officials expect to fashion a permanent solution to the facility's financial woes, including the possibility of a new owner for the 43-bed home. Lutheran Home, which has been subsidizing Betak, is plagued by its own financial troubles, and says it can no longer underwrite the facility's $2.8 million annual budget. "The Renaissance Man as Radical" Philadelphia Inquirer (06/09/94) P. F1; Collins, Huntly Kiyoshi Kuromiya, the 51-year-old editor of "Critical Path," a newsletter that dispenses treatment information to some 9,500 people, is the liaison that bonds hundreds of AIDS advocates in Philadelphia. Despite his own HIV infection, Kuromiya is unflagging in his efforts. A founding member of ACT UP, he runs a computer bulletin board for AIDS patients and operates a "community medicine chest," a supply of recycled drugs retrieved from the cabinets of patients who have died or switched to other drugs. Kuromiya also uses his own personal phone number as a 24-hour AIDS hotline--which receives calls from all over the country, at all hours of the day. He is also one of a handful of activists who sit on the government's AIDS Clinical Trials Group, a network of 1,200 scientists, doctors, and other professionals who oversee federally sponsored trials of experimental AIDS drugs. "Landmark AIDS Trial Jury Deliberates" United Press International (06/08/94) The first jury ever asked to decide whether AIDS discrimination is a breach of federal law continues deliberations today in the case of a Fremont, Ohio, hospital accused of violating the Americans with Disabilities Act by refusing to admit an AIDS patient. A lawyer representing the estate of Fred Charon asked the Toledo federal jury to order Fremont Memorial Hospital and the admitting physician to pay $1 million in damages, while attorneys for the hospital and for Dr. Charles Hull maintained that Charon received the best possible medical care with his transfer from Fremont to Medical College Hospital in Toledo. Hull admitted to saying "... once you get an AIDS patient, you'll never get him out," but said he meant only that a seriously ill AIDS patient could die in a small community hospital not equipped to treat the disease. "Columbia Laboratories Signs U.S. Agreement With Lake Pharmaceutical to Market Its Newest Product, Advantage 24" Business Wire (06/08/94) Columbia Laboratories Inc., a U.S.-based pharmaceutical firm, has signed a letter of intent with Lake Pharmaceutical concerning marketing of its Advantage 24 product, a sustained-release contraceptive gel. Columbia intends to grant Lake Pharmaceutical exclusive U.S.-marketing rights of Advantage 24, whose benefits include slow-release characteristics that allow the spermicide to remain effective for up to 24 hours. Considering Lake's distribution capabilities, Columbia president and CEO Norman M. Meier said the gel would be widely available by the end of 1995, and would be "positioned to fully benefit when studies demonstrate the effectiveness of Advantage 24 on the prevention of chlamydia and the AIDS virus." "The First Search for the Source" Toronto Globe and Mail (06/08/94) P. A16; Mickleburgh, Rod Hospitals in Canada, where more than 1,000 blood transfusion recipients became infected with HIV, announced on Monday that they intend to track down everyone who received the procedure from 1978 to 1985, when the Red Cross began to screen donated blood for the virus. Under the trace-back procedure, when a blood transfusion patient develops HIV, the patient's hospital gives the Red Cross the code numbers of blood units donated to the patient. The Red Cross then tries to contact all of the involved donors to urge them to undergo HIV testing. This method is largely based on protocol developed in 1985, according to Col. Neville Robinson. As administrator of Vancouver's Red Cross Blood Transfusion Center, Robinson led that year's investigation into the source of HIV-contaminated blood that infected two blood transfusion recipients. Operation 300, as it was called, was 150 days spent trying to contact the 301 donors to the first infected patient and the 17 donors linked to the second patient. The detective work meant hours of telephone work at a time when fear of AIDS had gripped the public. "Good News and Bad News About AZT" U.S. News & World Report (05/16/94) Vol. 116, No. 19, P. 88 Recent studies with AZT have brought both triumph and disappointment to the AIDS battle. In a recent trial of AZT in HIV-positive, pregnant women, scientists at the National Institutes of Health calculated that those who took the drug were only one third as likely to transmit the virus to their babies as were those who took a placebo. Another finding, however, suggests that while AZT has demonstrated clear benefit to most patients who are already sick, the common practice of prescribing AZT before a patient exhibits symptoms of disease does not ultimately prolong life. In fact, according to the study, the side effects from taking the drug--including chronic nausea and fatigue--may outweigh its short-term benefits. The finding has left HIV patients in a "catch-22" situation: either to cope with the side effects of taking AZT in order to delay sickness, or to wait before taking the drug, possibly bringing illness on earlier. A panel of experts convened by the National Institutes of Allergy and Infectious Diseases suggests that AZT use be dictated by CD4 levels. Those with counts under 200 should take the drug. Patients with counts between 200 and 500 should consult a physician. And those with CD4 counts over 500--about half the normal level--should not take AZT, says the panel. "Zidovudine for the Prevention of HIV Transmission From Mother to Infant" Journal of the American Medical Association (05/25/94) Vol. 271, No. 20, P. 1567 Although preliminary results of a trial of zidovudine to prevent HIV transmission from mothers to their babies showed a 67.5% risk reduction, the findings were subject to at least four limitations. First, the study did not measure the efficacy of zidovudine among women whose T cell counts were below 200. Nor did it assess the efficacy of zidovudine among women who had previously used the drug for extended periods and may have developed zidovudine-resistant strains of HIV. The study also did not evaluate risk in the first trimester of pregnancy. Third, the study failed to assess the independent or relative contributions of the antepartum, intrapartum, or treatment of the infant; therefore, the efficacy and side effects of zidovudine regimens restricted to only one or two of these treatment periods were unknown. Finally, the study has not yet yielded any information about long-term side effects for the infants and mothers treated with zidovudine. "Suppression of HIV Production in Resting Lymphocytes by Combining Didanosine and Hydroxamate Compounds" Lancet (05/21/94) Vol. 343, No. 8908, P. 1292; Malley, Serge D.; Grange, Jacques M.; Hamedi-Sangsari, Farid et al. Although the currently available AIDS drugs zidovudine, didanosine, and zalcitabine exhibit strong HIV inhibition in vitro in long-term dividing cell lines and activated peripheral blood mononuclear cells, they are only partially effective in suppressing viral replication in AIDS patients. Malley et al. suggest that it is the non-dividing "resting" cells that should be targeted for antiviral activity, since quiescent peripheral T lymphocytes may be an important and inducible HIV reservoir in infected persons. The researchers evaluated the anti-HIV activity of the three drugs and found them, alone or in combination, unable to fully inhibit viral production or protect the cells from the cytopathic effect of viral replication. The drugs were then tested in combination with hydroxamates, known for their inhibitory effect on ribonucleotide reductase in replicating cells. Didanosine in combination with '-hydroxamate (DAH) or hydroxyurea (HU) yielded a synergistic effect resulting in complete suppression of viral production, total protection against the cytopathic effect induced by viral replication, and non effect on the cells' ability to replicate normally after treatment. Trials are slated for May. "Bereavement Reactions" Focus (05/94) Vol. 8, No. 6, P. 7; Neugebauer, R.; Williams, J.B.W.; Rabkin, J.G. et al. New York City researchers who interviewed 84 HIV-negative and 123 HIV-positive gay and bisexual men in 1988 and 1989 found no connection between loss and depressive symptoms for either serostatus group. Participants were subjected to medical, psychiatric, and psychosocial examinations. Half of the group had experienced at least one loss since the onset of the epidemic; more than 20 percent had suffered a loss within the six months prior to the interview. Neither level of depressive symptoms nor rate of diagnosed depressive disorder was linked to the number of losses the subject had endured. This lack of association held for both seropositive and seronegative men, and held on three different depression scales. "HIV Vaccine Trials: Will Intravenous Drug Users Enroll?" American Journal of Public Health (05/94) Vol. 84, No. 5, P. 761; Meyers, Kathleen; Metzger, David S.; Navaline, Helen et al. A number of HIV vaccines are currently in phase I/II clinical trials, and as this work progresses towards phase III studies, a relevant practical question emerges. As of yet, little work has been done to outline the issues surrounding recruitment and retention of volunteers for HIV vaccine trials. Crucial is the need to determine whether individuals at high risk, particularly intravenous drug users, will participate. To assess the willingness of addicts to participate in vaccine trials, Meyers et al. analyzed the results of questionnaires completed by 257 IV drug users. The subjects were asked about risk behaviors, interest in vaccine trials, and other vaccine-related information. Meyers et al. discovered that 30 percent of the subjects did not even know what a vaccine was. Of those that did, however, 52 percent expressed willingness to be one of the first to participate in a preventive HIV vaccine trial. Twenty-two percent, however, said they would probably increase needle-sharing if they were vaccinated. The findings suggest that some in-treatment drug users would enroll for preventive HIV vaccine efficacy trials, but that education and counseling would be required to make sure participants fully understand the trial's purposes, methods, risks, and benefits.