Date: Wed, 21 Feb 1996 10:00:38 +0500 From: ghmcleaf{CONTRACTOR/ASPEN/ghmcleaf}%NAC-GATEWAY.ASPEN@ace.aspensys.com Subject: CDC AIDS Daily Summary 02/21/96 AIDS Daily Summary February 21, 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 ************************************************************ "Genentech Inc. Forms a Firm for HIV Drug" "Chiron Will Pay About $120 Million For 49 Percent of Hoechst's Vaccine Business" "A Vaccine for AIDS at Least 5 Years Away" "'Dreaded-Disease' Policies Rise, But Some Say They're No Cure" "Recurrent Varicella-Zoster Virus Infections Common in HIV-Positive Children" "Skin Cancer and HPV 16 Infection Linked in AIDS Patient" "Origin and Interstate Spread of a New York City Multidrug-Resistant Mycobacterium Tuberculosis Clone Family" "Jobs at Risk for HIV-Infected Doctors" "A Kinder, Gentler War Against Hepatitis B" "An Epidemic's Evolution" ************************************************************ "Genentech Inc. Forms a Firm for HIV Drug" Wall Street Journal (02/21/96) P. B6; King, Ralph T. Genentech Inc. announced that it has created a separate company, Genevax Inc., to develop its HIV vaccine, gp1120. The new company will ask for $18 million from private investors for a pivotal-phase clinical trial for the vaccine. Genentech will contribute a total of $2 million, giving it a 25 percent stake in the firm whose research will be supervised by Donald Francis, a public health expert who supervised the gp120 research at Genentech. Genentech had spent more than $50 million on gp120, and had more than 100,000 doses ready for a trial that was halted in June 1994 when funding from the National Institutes of Health (NIH) was refused. A Genentech spokesman explained that forming the new company provided a way to perform the trial without government involvement. Last week NIH announced a new plan for AIDS vaccine development which included the use of a version of gp120 made by Chiron Corp. Related Story: Investor's Business Daily (02/21/96) P.A1 "Chiron Will Pay About $120 Million For 49 Percent of Hoechst's Vaccine Business" Wall Street Journal (02/21/96) P. B6; King, Ralph T.; Moore, Stephen D. Chiron has agreed to buy 49 percent of Hoechst's vaccine business for about $120 million, a move that should make it one of the top five vaccine suppliers worldwide and a strong player in Germany where the Hoechst subsidiary--Behringwerke AG--is based. The transaction will also make European vaccine markets more accessible to the biotechnology firm, which currently has several promising vaccines in development--including vaccines for genital herpes and cytomegalovirus--as well as new vaccines for hepatitis B and whooping cough already on the market. Hoechst, which is seeking to streamline its health-care operations, may form research alliances with Chiron in areas such as gene therapy and combinatorial chemistry. Under the terms of the agreement, Chiron will have an option to acquire the remaining 51 percent stake between 1998 and 2001. Related Story: New York Times (02/21) P. D5 "A Vaccine for AIDS at Least 5 Years Away" Philadelphia Inquirer (02/19/96) P. C1; Vedantam, Shankar AIDS researchers say there is little hope for an AIDS vaccine, which would be the only way to successfully deal with the disease, in the next five years. Anthony Fauci, director of the National Institute for Allergies and Infectious Diseases, said that even the AIDS vaccine furthest along in trials "will not be ready until 2001 or 2002," if it proves safe and effective. A vaccine prepares the immune system for infection, and wipes out the virus before a person gets sick. Therapeutic drugs, which are too expensive to be widely relied upon, have never eliminated a major disease. In addition, HIV's ability to rapidly mutate makes vaccine development especially difficult. Also, drug companies have been hesitant to pursue a vaccine because of the technical difficulty and financial risk involved. AIDS is a particular threat to the developing world, where about 90 percent of new infections now occur. The vaccine with the most potential was developed by Pasteur Merieux-Connaught to defend against HIV-type B, the strain most common in the United States. Scientists are unsure whether a vaccine could protect against more than one strain of the virus, though Fauci said that if the vaccine proved successful, it would be fairly easy to make similar vaccines for others HIV types. "'Dreaded-Disease' Policies Rise, But Some Say They're No Cure" Wall Street Journal (02/21/96) P. C1; Jeffrey, Nancy Ann "Limited benefit" health insurance policies to cover cancer, heart disease, and hospital stays are being offered in employee-pay-all programs, usually as supplements to an employer's comprehensive health plan. Consumer advocates warn against policies that cover a specific disease, however they note hospital-stay policies can be beneficial for seriously ill individuals. American Family Life Assurance Co., or Alfac Inc., offers two hospital plans which pay $100 or $200 a day for the first 30 days in the hospital and $200 or $400 a day for the next 150 days. The benefits are usually paid in cash, and can be used for food, rent, a private hospital room, or anything else not covered by regular insurance. For example, David Petersen, president of Affording Care, a nonprofit in New York, has been in the hospital for 44 days since testing positive for HIV in 1988. He pays $1,400 a year for six hospital policies, and has used the benefits to help pay his monthly $7,000 drug bill. Other methods of paying for disease costs include disability insurance, accelerated death benefits, and very high-deductible health insurance. "Recurrent Varicella-Zoster Virus Infections Common in HIV-Positive Children" Reuters (02/20/96) Varicella-zoster virus infection in HIV-infected children tends to be recurrent and persistent. Hospitalization and morbidity are often attributed to the disease in these children, according to researchers at the Harbor-UCLA Medical Center in Torrance, Calif. Dr. Margaret Keller led the study of 117 cases of varicella-zoster infection in 73 HIV-positive children and found that 53 percent had recurrent episodes of infection. Keller's team also found that the number of episodes of varicella-zoster infection was strongly associated to low CD4+ cell counts. Keller concluded that new preventative and therapeutic therapies are needed to deal with the infection. "Skin Cancer and HPV 16 Infection Linked in AIDS Patient" Reuters (02/20/96) Evidence of a relationship between human Papillomavirus infection and squamous cell carcinoma in an AIDS patient was reported by Dr. Hunter Maclean and colleagues at the Western General Hospital in Scotland. There, a 42-year-old AIDS patient was diagnosed with squamous cell carcinoma on the eyelid. The researchers identified the human Papillomavirus infection using polymerase chain analysis, noting that squamous cell carcinoma is the third most common malignancy in HIV patients. Maclean therefore recommends that the carcinoma be considered in the diagnostic tests for HIV patients with eyelid lesions. "Origin and Interstate Spread of a New York City Multidrug-Resistant Mycobacterium Tuberculosis Clone Family" Journal of the American Medical Association (02/14/96) Vol.275, No.6, P. 452; Bifani, Pablo J.; Plikaytis, Bonnie B.; Kapur, Vivek; et al. The resurgence of tuberculosis (TB) in the United States can be attributed to the AIDS epidemic, immigration from countries where TB is prevalent, and the discontinuation of TB control measures. A number of drug-resistant strains of the disease have been identified in New York City, and the number of TB patients in the city has tripled from 1978 through 1992. In this study, Bifani et al. analyzed multidrug-resistant strains of TB to determine if they were new genetic clones of Mycobacterium tuberculosis or unrelated organisms. Samples of M. tuberculosis were taken from 1,943 patients in New York and samples of multidrug-resistant isolates were taken from six patients elsewhere in the United States. Multidrug-resistant isolates of M. tuberculosis were found in 273 New York City patients as well as patients from Florida, Nevada, and Georgia. The strains of tuberculosis found in these patients were closely related at the molecular level. According to the researchers, the data suggest that these organisms are the product of a single ancestral M. tuberculosis cell. Numerous strains of bacteria have resulted from the sequential clonal expansion of this one cell. Cases of multidrug-resistant TB associated with HIV have a mortality rate of up to 90 percent. "Jobs at Risk for HIV-Infected Doctors" American Medical News (02/05/96) Vol.39, No.5, P. 1; Kent, Christina Five years after Florida dentist David Acer was found to have transmitted HIV to his patients, the debate about whether HIV-positive health care workers should be allowed to continue to work with patients continues. The incident led to the development of new policies that some argue are unfair to HIV-infected health care workers. Medical and public health experts say that the risk of an HIV-infected health care worker spreading the virus to patients is small. The Acer case is the only known instance of a professional infecting a patient. The Centers for Disease Control and Prevention instituted a policy in 1991 that states that HIV-infected health care workers should avoid any "exposure-prone" procedures not approved by a panel of experts that has reviewed their case. The American Medical Association argued that there was no scientific basis for identifying such procedures. Medical groups also objected to the provision suggested by Congress that health care workers who perform such procedures be required to tell patients if they are HIV-positive. Most state policies do not require such notification. Health care workers feel that disclosing their HIV status could lead to job discrimination. Fear of discrimination could also prevent workers from reporting on-the-job infections. "A Kinder, Gentler War Against Hepatitis B" Science News (02/03/96) Vol.149, No.5, P. 69; Travis, J. Cytotoxic T lymphocytes (CTLs) kill viruses by attaching themselves to infected cells and releasing toxins that kill the cell and the virus. Francis Chisari of the Scripps Research Institute has found that, in fighting hepatitis B, CTLs release compounds that stimulate infected cells to destroy the virus, leaving the cell itself intact. A vaccine for hepatitis B exists, but it is not widely available. To determine CTLs mechanism of action, Chisari and his colleagues developed mice that make the virus. They found that injecting the mice with CTLs that target the cells producing the viral proteins causes the mice to almost rid themselves of the virus. The CTLs killed only about 5 percent of the targeted cells, leading researchers to conclude that the CTLs recognize infected cells and release two compounds that stimulate antiviral activity in them. The stimulated cells make proteins that disrupt the virus' ability to replicate. Chisari says that human cells may try to inhibit the virus in a similar way and that what they now know about the CTLs' role against hepatitis B could be applied to other viruses, including HIV. "An Epidemic's Evolution" Newsweek (02/05/96) Vol.127, No.6, P. 72; Will, George F. In Newsweek magazine, columnist George F. Will writes that good news about the AIDS epidemic in America is, according to data from Philip Rosenberg, published in Science magazine, that the previous estimate of the incidence of AIDS was too high and that the epidemic is slowing down. The bad news is that the incidence is still high and that the epidemic is now spreading to new segments of the population. The AIDS epidemic started in the white homosexual male population in the late 1970s and early 1980s, centered in large cities. Now the epidemic is increasing in racial minority populations and women, and is spreading to rural areas, especially in the South. It is spreading increasingly through drug use and heterosexual sex, despite aggressive public education about the disease. The fact that AIDS has become endemic is surprising, Will notes, because HIV is difficult to acquire and almost completely preventable. Hopes for fighting AIDS lie in the fact that the epidemic is driven by behavior that can be changed. But, comparing AIDS to lung-cancer and other smoking-related diseases lessens that hope. Smoking involves the pull of nicotine, as AIDS often involves sex and drug use. Thirty-two years after the first surgeon general's warning linking smoking and cancer, smoking has become less common, but has also become concentrated in the poor and under-educated populations, a trend that AIDS appears to be following, Will concludes.