Date: Tue, 15 Mar 1994 09:20:37 -0500 (EST) From: "ANNE WILSON, CDC NAC" Subject: CDC AIDS DAILY SUMMARY 03/15/94 IDS Daily Summary March 15, 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 "FDA Approves Drug for Kids With HIV" Washington Post (Health) (03/15/94) P. 5; Evans, Sandra The Food and Drug Administration has granted approval for the use of Gamimune N to treat HIV-positive children. The Miles Inc. brand name for immune globulin intravenous (IGIV), the agent is made to treat immune disorders. Some doctors began treating children with HIV with Gamimune N more than 10 years ago on an experimental basis, and a recent government poll suggests that as many as 20 percent may now be receiving the therapy. Although physicians reported favorable results, the FDA did not approve use of IGIV until presented with research from the National Institute of Child Health and Development (NICHD). "There was a lot of controversy [before the NICHD studies], because it is an expensive treatment," said Lynne Mofenson, an AIDS researcher at the institute. "Our studies showed clear benefit." What the studies showed was that HIV-infected children receiving Gamimune N developed 41 percent fewer serious bacterial infections and required 37 fewer hospitalizations than those receiving a placebo. Mofenson stressed that IGIV is intended for use with other treatments, such as Bactrim or AZT. She noted that FDA approval may encourage more doctors to use the treatment for children with HIV who experience recurrent infections, and will force insurers to bear the cost. As of September 1993, there were 4,906 American children under age 13 infected with HIV. "Phila. Ordered to Redesign Its Policies on AIDS" Philadelphia Inquirer (03/15/94) P. B1; Collins, Huntly In a move toward major reform, the Centers for Disease Control and Prevention is requiring Philadelphia, Los Angeles, New York, San Francisco, Chicago, and Houston, as well as state health departments around the nation, to draft comprehensive plans to prevent the spread of HIV. The CDC will use the plans, to be developed by local and state health officials in conjunction with community members most at risk, as the basis for awarding an estimated $400 million in 1995 for HIV prevention. The cities and states will have to set objective criteria for measuring whether proposed prevention programs are actually effective in changing people's behavior; little attempt has been made to do so in the past. Critics have complained that past federally-funded HIV counseling, testing, and education programs have not been effective. Previous programs also were often criticized for failing to target populations in which HIV was spreading most quickly, such as minority and low-income communities. Mary Willingham, an HIV official at the CDC, noted that the new requirements represent "a step forward in the planning of culturally competent and scientifically sound HIV prevention services." "AIDS Tests Ordered for Philippine Prisoners" Reuters (03/15/94) Prisoners at the Philippines' state penitentiary have been ordered to undergo HIV testing following newspaper reports that an infected bar dancer was smuggled into the facility to have sex with wealthy inmates, officials said. Prison chief Vicente Vinarao said that after those 78 prisoners were examined, homosexual inmates would be the next group targeted for HIV testing. The Filipino government says that 475 people in the country have been diagnosed as HIV-positive, but in actuality, tens of thousands more could be infected. "Canadian Mother Wins $368,000 in AIDS Damages" Reuters (03/14/94); Willmer, Tanya A Canadian judge ordered the Canadian Red Cross Society, the Toronto Hospital, and physician Stanley Bain to pay more than $500,000 in damages to Rochelle Pittman after ruling that they were negligent in failing to notify Pittman's husband, Ken, that he was given HIV-contaminated blood during surgery in 1984. The mother of four subsequently contracted the virus from her husband, who died in 1990. The case drew national attention because of its implications for an estimated 1,000 HIV-positive Canadians who also were infected through tainted blood distributed in the early 1980s. Today was the deadline for those HIV patients to accept or reject a compensation package offered by Canadian authorities that requires them to waive all rights to litigation. More than 725 of the 850 or so eligible HIV patients have accepted the package. According to Bonnie Tough, a lawyer for the Canadian Hemophilia Society, the decision by Ontario Court Justice Susan Lang will probably discourage other tainted blood patients from taking legal action. Although Lang awarded damages to Pittman, she failed to find the defendants negligent in giving the infected blood. "Justice Lang ... is saying she is not prepared to find that the screening methods employed by the Red Cross in 1984 were negligent," said Tough. "Researchers Say There's More to AIDS Than HIV" Reuters (03/11/94); Johnson, Cynthia Scientists at the Pasteur Institute in Paris are among a group of researchers worldwide who believe there is a little-known group of micro-organisms, which cause a wide spectrum of illnesses, that play a critical role in the progression of AIDS. The micro-organisms include a variety of viral, bacterial, and otherwise infective "co-factors" which may trigger HIV multiplication, eventually crippling the immune system. The theory could explain the puzzling question of why it can take from a few months to more than a decade for a person to graduate from HIV infection to full-blown AIDS disease. And, if these co-factors do trigger the onset of AIDS, finding ways to kill them may prove to be less complex and less expensive than developing anti-HIV drugs. "Ballet Stars Honor Nureyev in AIDS Charity Gala" Reuters (03/13/94); Baker, Sue International ballet stars performed Sunday in tribute to legendary dancer Rudolf Nureyev, who died in January 1993 after a long battle with AIDS-related wasting illness. The Russian-born dancer, hailed as the greatest of his generation, discovered his condition in 1984, but kept it secret out of fear that he would be denied entry to the United States under a law barring infected people, said his physician Michel Canesi, as quoted by a French newspaper. Proceeds from the gala event honoring Nureyev, which totaled $149,000, will benefit the AIDS charity Crusaid. "Condom Condemnation" Advocate (03/08/94) No. 650, P. 15 During an audience he granted on Jan. 29, Pope John Paul II told a group of 250 Italian Catholic pharmacists to stop selling condoms. The pope said that, despite the existence of "certain forms of illness which spread with impressive speed," it is not permissible "to seek economic profit through distributing products that debase man." Franco Caprino, head of the Italian pharmacists association Federfarma, said he was "dumbfounded" by the Pope's request. "I believe, as do most governments around the world, that the use of the condom is very important to prevent infection in the fight against AIDS," he said. "Doctors Urged to Offer More HIV Tests" American Medical News (03/07/94) Vol. 37, No. 9, P. 15 Physicians should offer HIV tests to all patients and obtain more information about their sexual histories, advise the American College of Physicians and the Infectious Diseases Society of America. In an update of a 1988 policy paper on HIV infection, the two groups point out that medical advances are staving off the onset of AIDS, and that more early detection is needed. Drugs like AZT have been shown to prolong the time between HIV infection and AIDS symptoms. Once patients are diagnosed with AIDS, their survival time has increased from under a year to 20 months, writes the paper's author, Dr. Theodore C. Eickhoff of the University of Colorado in Denver. "Voluntary testing is particularly important to diagnose current illness and identify asymptomatic infected people who could benefit from treatment," he says. The two medical groups, writing in the Annals of Internal Medicine, recommended that doctors offer HIV tests to all patients, saying patients may forget or deny high-risk behavior. Patients must, however, receive counseling and assurance that their test results will be confidential, says the paper. "Human Herpesvirus 6 in AIDS" Lancet (03/05/94) Vol. 343, No. 8897, P. 555; Lusso, Paolo; Gallo, Robert C. Robert C. Gallo and Paolo Lusso of the National Cancer Institute first isolated human herpesvirus 6 (HHV-6) in the laboratory in 1986 from patients with lymphoproliferative disorders and AIDS. New research, conducted by Knox and Carrigan, show that HHV-6 infection is active and disseminated in AIDS patients. HHV-6 was expressed in the lung, liver, kidney, spleen, and lymph node tissues taken from all nine patients studied. Gallo and Lusso found similar data via a polymerase chain amplification. The results of these two studies, they say, provide in-vivo evidence that suggest that HHV-6 has a catalytic role in the progression of HIV infection. With the latest data, it is now known that HHV-6 stimulates the release of HIV-activating cytokines and induces de novo expression of the major HIV receptor CD4 in mature CD8 T lymphocytes and natural killer cells, thus increasing the range of cells vulnerable to infection. There is now little doubt that HHV-6 can be reactivated in people with compromised immune systems and may sometimes act as a legitimate opportunistic pathogen. It is further implied that HHV-6, once reactivated in the course of HIV infection, may have a negative impact on the immune system and hasten progression of the disease. Longitudinal studies of HHV-6 replication in HIV patients are critical to establish a solid connection with disease progression, say Lusso and Gallo. "Surveillance Programs Must Monitor HIV Cases, Behaviors" AIDS Alert (02/94) Vol. 9, No. 2, P. 21 The Centers for Disease Control's AIDS surveillance program is top-notch, but its value is still limited, say epidemiologists. The subcommittee assigned to monitor the HIV/AIDS epidemic concludes that the CDC has not placed enough emphasis and resources into the "front-end" of the epidemic, such as monitoring HIV infections and behavioral science research that may help the agency identify and respond to behaviors that lead to infection in specific communities. In general, monitoring such behaviors is woefully inadequate at the national, state, and local level. The lack of a comprehensive and integrated system to monitor sexual and drug use behaviors among the general population, persons at risk, and infected persons severely impedes the development of effective prevention programs," the subcommittee reports. "We need to better understand the culture of drug use, and the factors that promote or interfere with the ability to negotiate safe sex," confirms subcommittee chairwoman Dr. Julie Gerberding.