Date: Tue, 06 Sep 1994 09:19:40 -0400 (EDT) From: "ANNE WILSON, CDC NAC" Subject: CDC AIDS DAILY SUMMARY 09/06/94. AIDS Daily Summary September 06, 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 ************************************************************ "How a Flu Molecule Stands on its Head To Infect Human Cells" "Immunology: 'Vaccine Cocktail' Lifts Hopes" "A Measure for Death: Potential Years Lost" "HIV Risk Factor Shifting in Inner Cities" "AIDS Grants" "Publicizing AIDS Data Early and Often" "Cocaine and HIV Prevalence in an Alcohol Treatment Center" "Human Growth Hormone Reverses Wasting in Clinical Trial" "Infectious Diseases in Competitive Sports" "Japanese AIDS Activists Adopt a Milder Form of Protest" "Regulating Syringe Exchange Programs: A Cautionary Note" ************************************************************ "How a Flu Molecule Stands on its Head To Infect Human Cells" New York Times (09/06/94) P. C3; Hilchey, Tim Researchers Frederick M. Hughson from Harvard, Per A. Bullough from Britain's Medical Research Council, and John J. Skehel from the National Institute for Medical Research in London announced the results of their collaborative study in the journal Nature last week. Their key discovery was the structure of the protein hemagglutinin on the surface of the flu virus after it is bonded to a target cell. The researchers said that these findings could be important in understanding other viruses, including HIV. Dr. Wiley said, "if you understood the fundamental mechanism of fusion, you might understand something not just about one virus, but about lots of different viruses, for example, measles virus, HIV-1, and flu." "Immunology: 'Vaccine Cocktail' Lifts Hopes" Washington Post (09/05/94) P. A2 Raul Andino of the University of California at San Francisco and colleagues published findings in the Sept. 2 edition of Science magazine indicating the possible discovery of a 'vaccine cocktail' that could be effective against many diseases. Andino inserted particles from other viruses into a polio virus and injected the manipulated virus into laboratory animals. Four weeks after a second injection, mice produced antibodies against both polio and HIV and a monkey produced antibodies within two weeks after an injection. Andino cautions that the results are "very preliminary" and said that testing on humans will not be possible until at least two more years of research have been completed. "A Measure for Death: Potential Years Lost" Washington Post--Health (09/06/94) P. 5; Colburn, Don Because of the leading causes of death in this country have wide disparities in the average age of the affected group, public health experts have devised a new measure that is weighted toward causes of death in young people. The new measure is called YPLL-65, which stands for "years of potential life lost before age 65." For example, a man who dies at 20 years old would account for a loss of 45 years on the new scale while a 55-year old would represent a 10-year loss. The Centers for Disease Control and Prevention announced last week that AIDS is one of only two causes of death to significantly increase the YPLL-65 count between 1980 and 1981. "HIV Risk Factor Shifting in Inner Cities" Washington Post--Health (09/06/94) P. 5; Evans, Sandra A study conducted at the Harlem Hospital Center and published in August's Archives of Pediatrics and Adolescent Women indicates that sexual transmission may have overtaken intravenous drug use as the primary HIV risk factor in the inner cities. The researchers found that only 21 percent of the HIV-positive women who gave birth at the hospital in 1989 reported intravenous drug use compared to 61 percent of the women with AIDS in New York City between 1981 and 1993. The researchers explained that possible factors in the results include the time lapse between HIV infection and the onset of AIDS and the fact that the average age of the HIV-infected mothers with a history of intravenous drug use was 10 years older than that of the mothers who had never used drugs. The report advocates routine HIV testing of pregnant women and cites recent findings that the administration of zidovudine during pregnancy can greatly reduce the risk of HIV transmission to the fetus. "AIDS Grants" USA Today (09/02/94) P. 2D NIH will divide $25 million in grants between six institutions to research alternative treatments aimed at strengthening the immune system and genetically attacking HIV. Human trials must begin by at least the third year of the four-year grants. The six institutions include the Fred Hutchinson Cancer Research Center in Seattle, the New England Medical Center in Boston, the University of Michigan, Stanford University, and the University of Pennsylvania. "Publicizing AIDS Data Early and Often" Science (08/19/94) Vol. 265, No. 5175, P. 1023; Stone, Richard Officials at the National Institutes of Health are considering the creation of an electronic bulletin board for information and results sharing among scientists conducting AIDS research. Scientists would post non-peer-reviewed abstracts on the Internet. The goal would be to reduce the amount of money being spent on unpromising AIDS research because results were not forthcoming in the scientific literature. AIDS researchers have mixed feelings about the proposal: while some favor it, others worry about the danger of information falling into the hands of those unable to consider it in the proper light. "Cocaine and HIV Prevalence in an Alcohol Treatment Center" Journal of the American Medical Association (08/10/94) Vol. 272, No. 6, P. 435; Epstein, Ronald; Avins, Andrew L.; Woods, William J. et. al. Dr. Ronald Epstein of the University of Rochester in New York challenges a study on HIV in an urban public alcohol treatment center that was published in the Journal of the American Medical Association by Dr. Andrew Avins and colleagues. In concluding that HIV was much more common in the urban setting than among the general population, Epstein argues that the study fails to examine the independent contribution of non-injection cocaine use to increased HIV seroprevalance. Concomitant cocaine and alcohol use is common in the urban crack cocaine culture, he contends and, given the large number of study patients who indulge in both alcohol and cocaine, it is impossible to measure the independent contributions of each. Epstein says that a more accurate conclusion of Avins' study would be that using alcohol and non-injection drugs together is associated with an increased prevalence of HIV infection. Avins et al. respond by stating that no individual drug was strongly associated with HIV infection, and emphasized that "the distinction between the urban alcoholic and the drug user is beginning to blur." The researchers conclude it is important that alcohol treatment providers for this population "recognize the polysubstance-using habits of their clients and tailor their programs accordingly." "Human Growth Hormone Reverses Wasting in Clinical Trial" AIDS Treatment News (08/19/94) No. 25, P. 1; James, John S. A study sponsored by Serono Laboratories Inc. has shown that human growth hormone can reverse the drastic weight loss that kills many patients with advanced AIDS. The growth hormone, currently marketed as Protropin by Genentech Inc. and Humatrope by Eli Lilly and Co., is the first treatment that has been proven to consistently increase lean body mass, says principal investigator Dr. Morris Schambelan of San Francisco General Hospital. Serono has its own growth hormone approved in 50 countries. Following the expiration of exclusivity provisions in the Orphan Drug Act, Serono's product will be available in the United States once it receives FDA approval for treatment of growth-hormone deficiency. Although the hormone is very expensive, a strong case for reimbursement due to medical necessity can be made based on the study. Serono is currently sponsoring another trial of the drug which will focus on its safety. "Infectious Diseases in Competitive Sports" Journal of the American Medical Association (08/10/94) Vol. 272, No. 6, P. 436; Dorman, John M. In a letter to the editors of the Journal of the American Medical Association, Dr. John M. Dorman of Stanford University elaborates on a recent article by the Centers for Disease Control and Prevention on infectious diseases in competitive sports. Dorman notes that although the article did include a short section on HIV transmission in the sports world, it failed to address hepatitis B virus, which is transmitted in precisely the same manner. Moreover, hepatitis B is about 100 times more concentrated in the blood than is HIV, and is considered proportionately more contagious. Therefore, Dorman suggests, vaccination for hepatitis B may be a good idea for athletes. He agrees, however, that it is probably more likely that a player would contract both HIV and hepatitis B off the court or field than on it. Dorman also stresses the warnings of the original authors that both viruses may by transmitted through the use of injectable steroids.. "Japanese AIDS Activists Adopt a Milder Form of Protest" Science (08/19/94) Vol. 265, No. 5175, P. 1029; Cohen, Jon Japanese AIDS activists are not as visible or outspoken as their American counterparts, despite their belief that the government's official statistics on HIV and AIDS are well below actual numbers. The official figures are low because Japanese citizens are frequently afraid to be tested for HIV because of a law requiring doctors to report to the Ministry of Health any patient who poses "a risk to society"; for those who are already infected with HIV, there is the fear of being quarantined in one of the AIDS hospices that the government is planning to build in 1995. "Regulating Syringe Exchange Programs: A Cautionary Note" Journal of the American Medical Association (08/10/94) Vol. 272, No. 6, P. 431; Des Jarlais, Don C.; Paone, Denise; Friedman, Samuel R. et al. The predominant mode of HIV transmission in the United States is through intravenous drug use. Syringe-exchange programs (SEPs), which are designed to reduce the risk of HIV infection by providing clean needles to drug users, have been shown to be effective in other countries and could be useful in the United States. However, for such programs to work on a large scale, service must be broadened and three principles must be considered, write Des Jarlais et al. in a letter to the Journal of the American Medical Association. First, the authors feel that too much regulation--particularly when enacted as a concession to those opposing SEPs on philosophical grounds--will seriously reduce the effectiveness of the programs. Additionally, SEP organizers should not require that services other than supplying clean injection equipment be provided without additional funding. Lastly, regulations on SEPs should not be codified into laws that will be difficult to change as more information about how to improve SEPs becomes available.