Date: Tue, 01 Mar 1994 09:42:46 -0500 (EST) From: "ANNE WILSON, CDC NAC" Subject: CDC AIDS DAILY SUMMARY 03/01/94 AIDS Daily Summary March 01, 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 "Exercise and Immunity: AIDS" Washington Post (Health) (03/01/94) P. 16 (Krucoff, Carol) Growing evidence suggests that exercise may boost the immune system and guard against a slew of illnesses--an effect that some researchers say can enhance the life of immunocompromised people, including AIDS patients. For those who are infected with HIV but remain asymptomatic, moderate exercise appears to improve mental health and delay disease progression. New research will examine the exact mechanisms through which exercise exerts this effect. Immune system tissues directly respond to stress hormones, and physical activity can blunt or suppress the stress response, says Mark Nash, a researcher at the University of Miami School of Medicine. "Also, certain cells of the immune system respond to individual bouts of exercise. These include natural killer cells, the body's first line of defense against viral invaders," he says. The number of natural killers increases 150 to 300 percent immediately following high-intensity exercise, says Nash, who adds, "Not only are there more soldiers armed for the fight, but their killing capacity also increases." Although this increase in natural killers only occurs during and immediately after exercise, it can have lasting impact. "Obstacle-Strewn Road to Rethinking the Numbers on AIDS" New York Times (03/01/94) P. C3 (Altman, Lawrence K.) Federal health officials once again are tackling the formidable task of determining how many Americans are infected with HIV, and it appears that the current estimate of 1 million will drop. That estimate, reported in 1989 by the Centers for Disease Control and Prevention, has been criticized as too high or not high enough, depending on the critic. The CDC plans to make a new estimate in July and, in preparation, the agency invited independent experts to meet last week and review data. Most estimates ranged from 600,000 to 800,000. The new estimate could have critical health, political, and economic ramifications. Identifying the national trend in HIV infection and pinpointing geographic areas where the virus is concentrated is crucial to preparing budgets, developing public health policy, evaluating the success of prevention programs, and identifying research needs and priorities. While CDC officials say the new estimate will be based on the best available scientific data, an estimate lower than 1 million will surely spark more criticism. Some fear that the public and government will view the epidemic as less of a threat and reduce financing for education and prevention. It is clear, however, that AIDS is not going away, even if the CDC estimate is lower. "From Amin to AIDS, Ugandan Cleric Fights" Philadelphia Inquirer (03/01/94) P. B6 (Vedantam, Shankar) Yona Okoth, the Anglican archbishop of Uganda, is in the United States in a bid to raise money for an AIDS project in his country, where some 10,000 people contract AIDS each month. Archbishop Okoth is seeking $700,000 to finance a model clinic, create an office for a medical director to oversee the anti-AIDS campaign, hire 40 nurses, and bring palliative drugs and medicines into Uganda. Like many other countries, Uganda first responded to AIDS with denial. Now, the Anglican church is on the frontline of the battle against the disease, and is using its network of rural parishes to dispense AIDS education and safe sex messages. Archbishop Okoth notes that his country has had to struggle with cultural practices and sexual taboos in addition to a dearth of resources and manpower. About one in 10 people in Uganda's population of 18 million is HIV-positive. In Kampala, the capital and a major city, the virus infects one in three. "There isn't anybody in Uganda who hasn't lost someone to AIDS," says Archbishop Okoth. "Philippines Urged to Ban Blood Sales" Reuters (03/01/94) Manila, Philippines--In the wake of a national study showing that some of the blood used for transfusions is contaminated with syphilis and possibly HIV, Philippine Health Secretary Juan Flavier has called for a law banning Filipinos from selling their blood. Flavier urged Congress to immediately pass legislation requiring hospitals to transfuse blood only from voluntary donors. "We should not allow selling of blood," Flavier said. "We are a nation of 65 million people and we have an endless source of blood supplies." In a government study released Monday, doctors reported that as much as 70 percent of blood supplies kept in hospitals and commercial blood banks came from paid donors, most of whom were poor. More than 4 percent of the blood samples taken from state and private blood banks was infected, the study found. Of 426 blood packs, 14 contained hepatitis B, one contained syphilis, and another was strongly suspected of being tainted with HIV. The investigation was prompted by concerns over the increasing number of HIV-positive Filipinos. About 30,000 are thought to carry the virus and another 121 have developed AIDS. "Study Shows AIDS Prevention Needs of 'Men of Color'" United Press International (02/28/94) San Francisco--AIDS programs targeting gay and bisexual "men of color" are severely underfunded, according to a new study from the Centers for Disease Control and Prevention. The study found that while gay and bisexual African-Americans, Hispanic-Latinos, Asian Pacific Islanders, and Native Americans together account for one-third of the infected men studied, no more than 13 percent of available funding was allocated to AIDS prevention programs targeting these groups. "This document is a long overdue assessment of the impact of HIV disease on gay men of color," said Steve Lew, Asian co-chair of the Campaign for Fairness. "Federal and local governments have ignored or underfunded appropriate HIV prevention programs targeting gay men of color." The study recommends substantial increases in funding for programs targeting, or designed, developed, or implemented by gay and bisexual men of color. "AIDS Sufferer Jailed for Syringe Robberies" Reuters (02/28/94) London--A British man with AIDS received a 30-month prison sentence on Monday for robbing victims in what he said was an effort to raise money to find a cure for the disease. Paul Muldownie, 24, informed his robbery victims that a syringe he brandished held tainted blood. He also threatened them with a blood-soaked knife. Following a string of hold-ups on one day in December, Muldownie was overpowered by three men he had threatened to kill. Defense lawyers said their client committed the robberies to generate funds for an AIDS charity. He learned on Monday that he has less than four years to live, they said. "Biloxi Police Are Criticized for List of HIV-Infected" Washington Blade (02/18/94) Vol. 25, No. 7, P. 21 (Walsh, Sheila) Police in Biloxi, Miss., are under fire for maintaining a list of the city's HIV-infected residents. According to the Gulfport Sun-Herald, Biloxi Police Chief Tommy Moffet confirmed that his department did keep such a list, "presumably" to protect paramedics and police officers who "frequently come into contact with the virus." Todd Emerson, founder of the G.L. Friendly Community Center, expressed concern that, after hearing about the list, people will avoid HIV testing. Reports of the list first emerged after Clyde Hall filed suit against the city for invasion of privacy after his name was placed on the list and remained there even when he informed officials that he had tested negative for the virus. Hall also testified that police employees subjected him to "hatred and contempt, ridicule, and humiliation" by telling mutual friends that his name was on the list. According to the Sun-Herald, Moffet identified four police employees and one Department of Parks and Recreation employee who knew of the list. The Mississippi Gay and Lesbian Task Force has issued a list of demands in response to the list, including destruction of the list. They are also asking for a full investigation to identify polices officers involved in maintaining the list, as well as free, anonymous HIV testing statewide. "From the Agency for Health Care Policy and Research" Journal of the American Medical Association (02/16/94) Vol. 271, No. 7, P. 492 (Clinton, J. Jarrett) Although it will be helpful to a wide range of providers servicing HIV patients, the Agency for Health Care Policy and Research clinical practice guideline for managing HIV infection is especially designed for family physicians and other primary care providers. The evaluation and management of early HIV infection are within the professional jurisdiction of these primary care providers and do not require the services of a specialist. The AHCPR guideline is not comprehensive, rather it focuses on selected issues of particular significance to practice in a primary care environment. The guide includes discussions on disclosure counseling; evaluation and care of adults, adolescents, infants, and children; and coordination of care, among other topics. "Diarrhea Associated With Clostridium Difficile in AIDS Patients Receiving Rifabutin" Lancet (Great Britain) (02/12/94) Vol. 343, No. 8894, P. 417 (McBride, Michael O. et al.) A recent report described the benefits of prophylaxis for mycobacterium avium complex (MAC) infection in HIV/AIDS patients, but failed to discuss an important factor, say McBride et al. of St. Mary's Hospital in London. Antibiotic-associated diarrhea and colitis have been reported with most broad-spectrum antibiotics, including rifampicin. Although it has not been named in any published report on these symptoms, rifabutin is a derivative of rifamycin S which displays a wide range of in vitro activity against bacteria similar to that seen with rifampicin. McBride et al. used rifabutin to treat 22 HIV-positive patients known or thought to have MAC infections. Four of the patients developed Clostridium difficile-associated diarrhea; in two, the condition culminated in pseudomembranous colitis. The occurrence of this complication has serious implications for prophylactic regimens. MAC infections are common among immunocompromised patients, and there appears to be an increase in the incidence of C difficile-associated diarrhea in patients receiving rifabutin compared with a group of as severely immunocompromised patients not taking the drug. Because the incidence of antibiotic-associated diarrhea/colitis with rifabutin is unknown, McBride et al. caution against its widespread use until this association is clarified. "HIV/AIDS: Knowledge and Attitudes of Accident and Emergency Healthcare Professionals" Journal of the Association of Nurses in AIDS Care (10/93-12/93) Vol. 4, No. 4, P. 7 (Bell, Pam F. et al.) Accident and emergency departments are no doubt the frontline of public hospital services. In Australia, however, the knowledge of and attitudes toward HIV/AIDS by healthcare professionals in these departments are poor. Bell et al. conducted a study of 111 healthcare professionals in three New South Wales hospitals. The goal was to measure knowledge and attitudes of healthcare professionals in terms of HIV transmission, educational experience and practice, and changes in social behavior related to the risk of HIV infection. The results suggested that participants with low knowledge of HIV/AIDS tap the media as their major source of education. Accident and emergency personnel with low knowledge had greater fear of infection, while those with high knowledge were less concerned. The findings imply that quality care for people with HIV/AIDS requires programs that provide correct information, as well as address the fear of infection.