Date: Mon, 5 Feb 1996 11:16:16 +0500 From: ghmcleaf{CONTRACTOR/ASPEN/ghmcleaf}%NAC-GATEWAY.ASPEN@ace.aspensys.com Subject: CDC AIDS Daily Summary 02/05/96 AIDS Daily Summary February 5, 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 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 1996, Information, Inc., Bethesda, MD ************************************************************ "Drugs too Pricey for Patients?" "Can Post-Traumatic Stress Arise From Office Battles?" "Repeal Sought of HIV Provision in Defense Bill" "U.S. Experts Warn of Honduras AIDS Risk to Women" "Congress Takes Steps to Speed FDA Approval of New Medicine" "Healing a Wound Over AIDS" "Case Contends AIDS Infection by Dental Tools" "Toward an Understanding of the Correlates of Protective Immunity to HIV Infection" "Was HIV Present in 1959?" "Antibiotic-Resistant Bacteria Take Hold in California" ************************************************************ "Drugs too Pricey for Patients?" Philadelphia Inquirer (02/05/96) P. A1; Collins, Huntly While new, more powerful AIDS drugs are expected to be approved for marketing in the United States in a few months, they may be too expensive for the tens of thousands of uninsured AIDS patients who rely on special state funds. Gary Rose, an official at the AIDS Action Council, said the high cost of these new drugs may create a two-tiered system, separating those who can afford private insurance and those who cannot. The Clinton Administration has said it will try to increase federal funding for AIDS drugs, but has not yet received support from Congress. Last week, scientists reported positive results for new drugs classified as protease inhibitors. The first of this new class costs about $5,800 a year, and the new studies show that a combination of such drugs is most effective against the virus. Patients may have to take these medications for many years. The federal Agency for Health Care Policy estimates that the average lifetime cost of treating an AIDS patient is more than $119,000. "Can Post-Traumatic Stress Arise From Office Battles?" Wall Street Journal (02/05/96) P. B1; McMorris, Frances A. Post-traumatic stress disorder is most commonly associated with combat flashbacks experienced by Vietnam veterans. It is now being raised in job discrimination cases, medical malpractice and other liability claims. One example of the condition is in the case of Raymond Machesney, a former priest who learned his doctor had wrongly identified him as HIV-positive after seven years of having undergone treatment for the disease. In his medical-malpractice suit, Machesney sought damages for post-traumatic stress disorder. The doctor's lawyer argued, however, that the disorder could have been caused by other factors, such as leaving the priesthood. A federal jury in Washington, D.C., awarded Machesney $4.1 million last year, although a judge later reduced the amount to $2 million. "Repeal Sought of HIV Provision in Defense Bill" Baltimore Sun (02/03/96) P. 5A A bipartisan coalition of U.S. lawmakers is seeking to repeal a provision in the Defense authorization bill to force the discharge of all military members with HIV. Rep. Peter Torkildsen (R-Mass.) said he has filed a bill to repeal the ban, on which lawmakers would need act within six months, at which time the discharges would go into effect. Rep. Robert Dornan (R-Calif.) sponsored the discharge provision, saying that people in the military with HIV cannot be sent abroad or to combat, and should not be allowed to serve. On Friday, Dornan said that as many as half the service members with HIV are former drug addicts. "U.S. Experts Warn of Honduras AIDS Risk to Women" Reuters (02/03/96) Honduras has been the Central American nation hardest hit by the AIDS epidemic, and U.S. researchers say that the country may be suffering from a particularly potent strain of HIV that is especially dangerous to women. The Health Ministry said that 7,664 Hondurans have been infected with HIV since 1985, and 995 have died. That represents 60 percent of the total number of people with HIV in all of Central America. The rate of women infected is unusually high at 36 percent. Researchers from Harvard University and the World Health Organization have been taking blood samples, especially from HIV-infected women, said Winslow Klaslala, a professor at the University of Miami. The scientists will look for HIV sub-type B, which is known to be highly aggressive and adaptable. "Congress Takes Steps to Speed FDA Approval of New Medicine" Washington Times (02/05/96) P. A6 Hearings on an FDA reform bill sponsored by Sen. Nancy Kassebaum (R-Kan.) are slated for February. The new bill would require the FDA to shorten review times, tell pharmaceutical companies exactly how to test new medicines, and farm out its work to private drug-review companies if it cannot meet the new approval deadlines of four months for "priority" therapies for fatal or untreatable diseases and six months for other products. The bill also permits some therapies approved for sale in certain foreign countries to be marketed in the United States before receiving official FDA approval. Under this provision, drug firms could petition for automatic sale if the FDA has not reviewed a therapy within six months. "Healing a Wound Over AIDS" Miami Herald (02/02/96) P. 1B; Jacobs, Sandra Haitian and American doctors addressed the controversial AIDS stigma attached to Haitians in the early 1980s at a conference on Thursday. Thirteen years ago, U.S. researchers held meetings with Haitian doctors who felt their country was being stigmatized as a source of the AIDS epidemic, before enough about the disease was known. Now that scientists know how HIV is spread, theories about genetic disposition and geography have been debunked as explanation of early cases of AIDS among Haitians. In the early 1980s, Haitians were identified in the United States as a high-risk group and they were banned from donating blood. The Haitian risk category was removed in 1984, but the federal government was criticized for temporarily banning 200 HIV-positive Haitian refugees from entering the U.S. Many Haitians also felt they never received an apology from the U.S. government or their medical colleagues. "Case Contends AIDS Infection by Dental Tools" Boston Globe (02/02/96) P. 19; Roche, B.J. James Sharpe, a convenience store owner in Massachusetts who learned he was HIV-positive six years ago, is bringing a medical malpractice suit against his dentist, alleging that he was infected by contaminated dental equipment. The lawsuit says that the dentist had ignored recommendations by dental associations and the federal government to heat-sterilize, or autoclave, his instruments between patients. Sharpe's lawyer says he will present research that shows the virus can survive in the lubricants used in the equipment, if it is not sterilized by heat. Richard H. Price, a spokesman for the American Dental Association, warned that such findings can cause an undue panic in the public. He says that a 1995 survey found that 92.5 percent of dentists heat-sterilize their instruments between patients. "Toward an Understanding of the Correlates of Protective Immunity to HIV Infection" Science (01/19/96) Vol.271, No.5247, P. 324; Haynes, Barton F.; Pantaleo, Giuseppe; Fauci, Anthony S. Three patterns have been found in people with HIV. About 10 percent, called "rapid progressors," develop AIDS within 2 years to 3 years after infection. About 5 percent to 10 percent are "nonprogressors," and are asymptomatic after 7 years to 10 years. The remaining HIV-infected population consists of "typical progressors," who are expected to develop AIDS within about 10 years of infection. Nonprogressors show an immune response to HIV that is quantitatively and qualitatively better than the immune response in rapid progressors. Recent studies have shown that the viral load established early in the infection predicts how the disease will develop and that a small viral load predicts long survival. Still unknown is whether a small viral load in nonprogressors is associated with an HIV strain that has low pathogenicity, or an especially effective immune response, or both. Another issue the authors say merits further study is the role of a person's genetic background in determining the rate of progression of AIDS. "Was HIV Present in 1959?" Lancet (01/20/96) Vol.347, No.8995, P. 189; Bailey, Andrew S.; Corbitt, Gerald In a letter to the editor of the journal Lancet, Andrew Bailey and Gerald Corbitt, virologists at the Manchester Royal Infirmary, respond to an article by T. Zhu and D. Ho in the journal Nature which questioned whether HIV was actually found in a man who died in 1959 with AIDS-like symptoms, as Bailey and Corbitt published in the Lancet in 1990. They agree that the virus found was modern and that the tissue was probably contaminated in their lab, but they take issue with how Ho dealt with the problem. Bailey and Corbitt say they were surprised when Ho suggested that the tissue samples they provided to him were taken from two different people. Further tests of their original samples and of new samples taken from the body, Bailey and Corbitt say, have not substantiated this claim. They do conclude that Ho's research agrees with their own finding that the virus is modern and was a result of contamination. However, they say that the patient's symptoms at his death would today "be regarded as strongly indicative of underlying HIV infection. If this was not the case, what was the underlying cause of this man's disease and subsequent death?" "Antibiotic-Resistant Bacteria Take Hold in California" American Medical News (01/15/96) Vol.39, No.3, P. 18 A bacterium that is resistant to antibiotics that has killed people in hospitals on the East Coast seems to be taking hold in California and is responsible for one death. Vancomycin-resistant enterococcus (VRE) is not a problem for people in good health, but can cause life-threatening infections in people with weakened immune systems, like AIDS patients. There are no drugs to treat the bacteria. "We're going back to the preantibiotic era," said Dr. David Stevens, chief of infection control at Santa Clara Valley Medical Center. Overuse of antibiotics in the past 50 years has been blamed for the ability of some strains of organisms to develop resistance to them. VRE spreads through direct contact, and could spread easily in a hospital or nursing home if care-givers are not aware of it. Soap kills the bacteria, so health care providers are taking more care to wash their hands to combat infection.