Date: Wed, 24 Apr 1996 11:12:10 +0500 From: "Flynn Mclean" Subject: CDC AIDS Daily Summary 04/24/96 AIDS Daily Summary April 24, 1996 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 National AIDS Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC National AIDS Clearinghouse should be cited as the source of this information. Copyright 1996, Information, Inc., Bethesda, MD ************************************************************ "An AIDS Cure or a False Hope? Disputed Drug Starts NIH Test" "U.S. Checks Phoenix Company for Lapses in Handling Blood" "Merck's Chairman Talks Up AIDS Drug at Annual Meeting" "Senate Votes 100 to 0 for Health Bill" "D.C. Gets Help in Effort to Revamp Health Care" "Poll on Blood Finds Anxiety" "HIV Infection Remains Stable Among STD Patients" "Influence of Combinations of Human Major Histocompatibility Complex Genes on the course of HIV-1 Infection" "Pneumococcal Infectious Arthritis in Two HIV Infected Patients" "Palliative Care and HIV, Part II: Systemic Manifestations and Late-Stage Issues" ************************************************************ "An AIDS Cure or a False Hope? Disputed Drug Starts NIH Test" Washington Post (04/24/96) P. D1; Goldstein, Amy After a five-year debate involving racial, religious, and medical issues, the National Institutes of Health is launching a nationwide clinical trial of a drug that has been called an AIDS cure by Nation of Islam leaders but has been rejected by NIH scientists. The drug, known as low-dose interferon or Kemron, has become popular among some African Americans who favor alternative medicine and has become the focus of some African Americans who say they have suffered discrimination by the U.S. research community. One of the three Washington, D.C., sites that will participate in the trial is the Abundant Life Clinic, an AIDS clinic run by the Nation of Islam's health minister Abdul Alim Muhammad. Muhammad, who treats his patients with interferon instead of approved drug treatments, has become a prominent figure in AIDS policy, attacking the federal government's lack of support for interferon research. Some doctors said Tuesday that they thought NIH had given in to political pressure brought by the black physicians. NIH officials said they decided to go ahead with the trial to try to resolve the debate about the efficacy of the drug. Related Story: Washington Times (04/24) P. A3 "U.S. Checks Phoenix Company for Lapses in Handling Blood" New York Times (04/24/96) P. A6 The Food and Drug Administration has identified blood safety problems at United Blood Services, which supplies blood to hospitals in 18 states, since 1994. The agency announced a consent decree Monday, which requires the company to spend $16 million on improving the safety of its products. The FDA found that blood donors were not properly questioned about possible risk of infection with an infectious disease and that the company did not always follow instructions for testing blood for certain viruses. Although the FDA has not learned of any instances where improperly screened blood was also not properly tested, FDA deputy commissioner Mary Pendergast noted that "it's a possibility; we're not certain," adding that the government is investigating some reports from patients who fear they were exposed to HIV or hepatitis. "Merck's Chairman Talks Up AIDS Drug at Annual Meeting" Wall Street Journal (04/24/96) P. B2 Raymond V. Gilmartin, chairman of Merck & Co., focused on the company's new AIDS drug at the firm's annual meeting Tuesday, emphasizing that Merck has its own promising supply of new drugs and does not need to merge to grow. Gilmartin termed Crixivan, the new drug, "one of Merck's greatest accomplishments." The drug renders HIV virtually undetectable in about 40 percent of patients, a Merck official said. The drug is effective in more than 90 percent of patients when combined with AZT and 3TC, he added. "Senate Votes 100 to 0 for Health Bill" Washington Post (04/24/96) P. A1; Havemann, Judith The Senate voted unanimously to pass a bill Tuesday that would make it easier for people with chronic diseases and those switching jobs to retain health insurance coverage. Congress, however, remains divided over the measure, which will be the subject of a House-Senate conference committee. The Senate bill included a provision to allow dying individuals, like people with AIDS, to cash in their life insurance policies while still living. An especially controversial provision of the Senate's legislation would require insurance policies to offer "parity" of coverage for mental and physical illnesses. "D.C. Gets Help in Effort to Revamp Health Care" Washington Post (04/24/96) P. D3; Schneider, Howard Washington, D.C., Mayor Marion Barry announced on Tuesday a plan to revolutionize the city's suffering health care system. Former D.C. public health commissioner Mohammad N. Akhter will lead the effort. Barry noted that the city spends almost a third of its budget on health care but still faces many serious health problems, including high rates of AIDS and infant mortality. The concentration of poverty in the city is part of the problem, but the system, which is currently inefficiently organized, overly generous, and unproductive, is also to blame, Barry said. Akhter, a senior adviser in the U.S. Department of Health and Human Services, vowed to make visible changes within six months. "Poll on Blood Finds Anxiety" Toronto Globe and Mail (04/23/96) P. A4; Picard, Andre Only 7 percent of Canadians would want to receive blood from the country's Red Cross if they needed a blood transfusion and had a choice, a new poll shows. The poll results indicate that the tainted blood tragedy has influenced public opinion and has left more Canadians scared of getting blood than of dying during surgery. The poll also reflected Canadians' desire for alternatives to transfusions of donated blood, including self-donated blood, blood donated by a relative, and drugs that would make transfusion unnecessary. "HIV Infection Remains Stable Among STD Patients" Reuters (04/23/96) The rate of HIV infection among patients with sexually transmitted diseases (STDs) is fairly stable over all transmission groups, a European study shows. Dr. Laurence Meyer and colleagues studied more than 4,000 patients treated at an STD clinic in Paris. The researchers found no significant trend in HIV prevalence in the different transmission groups, although HIV prevalence was 2.5 times higher among heterosexual patients from Africa or the Caribbean than among those from other countries. The researchers also found that despite a decrease in both the overall STD rate and HIV rate among patients under the age of 25, overall HIV incidence did not decrease, at least among homosexual and bisexual males. "Influence of Combinations of Human Major Histocompatibility Complex Genes on the Course of HIV-1 Infection" Nature Medicine (04/96) Vol. 2, No. 4, P. 405; Kaslow, R.A.; Carrington, M.; Apple, R.; et al. The various patterns of progression from HIV infection to AIDS are associated with immunoregulatory host factors, including products of major histocompatibility (MHC) genes, known as HLA genes in humans. R.A. Kaslow at the University of Alabama and colleagues analyzed genetic information from two groups of homosexual men. The research identified products of HLA Class I, class II, and transporter genes, and resulted in an HLA profile that predicted time from HIV-1 infection to the onset of AIDS. The profile identified a sixfold difference between those with the shortest and longest time from infection to AIDS. The authors claim that the results of the study uphold current beliefs about control of antigen processing by HLA genes and could affect the immunopathogenesis of HIV-1. "Pneumococcal Infectious Arthritis in Two HIV Infected Patients" Journal of the American Medical Association (04/17/96) Vol. 275, No. 15, P. 1142o Researchers at the Hopital Bichat in France report two cases of septic arthritis due to pneumococci in non-hemophiliac HIV-positive patients. In one case, a drug addict who had undergone a splenectomy developed a hip joint infection during an episode of meningitis due to pneumococci. The second case concerned the knee joint of a woman who developed pneumococcal pneumonia after a trip to Zaire. In both cases, the joint infection developed after antibiotic treatment had begun. In HIV-infected individuals, joint infections--while rare when compared with other types of immunodepression--can occur in all stages of the disease. Seventy-five cases have been documented, some 10 percent of which are related to pneumococci. "Palliative Care and HIV, Part II: Systemic Manifestations and Late-Stage Issues" AIDS Clinical Care (04/96) Vol. 8, No. 4, P. 27; Reiter, Gary S.; Kudler, Neil R. The last stages of HIV infection are marked by increasing pain, gastrointestinal discomfort, and depression. These conditions should be treated aggressively with restorative and prophylactic therapies, write Reiter and Kudler in AIDS Clinical Care. Patients who are bedridden or are suffering from an inflammatory or infiltrative process may suffer from somatic or visceral pain, which can be treated with analgesics. Patients with chronic pain and a history of narcotic abuse are not likely to develop addictions to opiates, and narcotics can be prescribed. Meanwhile, the authors note that neuropathic pain, characterized as burning and tingling, is treated with tricyclic antidepressants and antiepileptic drugs. Also, depression, which affects up to 30 percent of HIV patients, should be treated with the selective serotonin reuptake inhibitors. Nausea and vomiting--often brought on by opportunistic infections, neoplasms, and medications--can be treated in AIDS patients, while diarrhea can usually be treated with over-the-counter agents. The authors note that as a patient approaches death, talking with the patient, providing physical contact, and encouraging spiritual reflection can be beneficial. They suggest that current hospice care for AIDS patients be improved, predicated on patient preference, ease of administration, and minimization of side effects.