Date: Wed, 28 Feb 1996 11:29:17 +0500 From: gharaghs{CONTRACTOR/ASPEN/gharaghs}%NAC-GATEWAY.ASPEN@ace.aspensys.com Subject: CDC AIDS Daily Summary 2/28/96 AIDS Daily Summary February 28, 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 1995, Information, Inc., Bethesda, MD ************************************************************ "Study Finds Clue on HIV Transmission" "Japanese Blood Controversy" "Nurse with H.I.V. Emphasizes Safety" "Proposed French AIDS Drug Lottery Under Attack" "Overexpression of Fas Antigen Seen in Advanced HIV Infection" "New Guidelines for PCP Prophylaxis in HIV Positive Children Proposed" "HIV-Positive Substance Abusers Frequently Require Psychoactive Drug Treatment" "Resistance to Protease Inhibitors" "Computer Censorship Law, ACLU Test Case, Begin February 8" ************************************************************ "Study Finds Clue on HIV Transmission" Washington Times (02/28/96) P. A6 A new study reveals that a HIV-infected pregnant woman's level of HIV RNA provides a strong indicator of the risk that she will transmit the virus to her child. The study, reported in the Journal of the American Medical Association, also concludes that the HIV drug AZT may reduce an infected pregnant woman's HIV RNA level before delivery to levels about the same as those in women who did not transmit the virus to their babies. Related Story: Los Angeles Times--Washington Edition (02/28/96) P.B2 "Japanese Blood Controversy" Washington Post (02/28/96) P. A22 A leading Japanese pharmaceutical company, which is being sued along with the government and four other drug makers by HIV-infected hemophiliacs, has acknowledged that it filed a false report about when it withdrew untreated blood products from the market. Green Cross Corp. disclosed that it had shipped the untreated products for three to 10 months after the date given in a report to the Health and Welfare Ministry in 1987. Naoto Kan, Health and Welfare Minister, said the ministry now believes that the final withdrawal of the untreated blood products may have taken one year longer than Green Cross had claimed. Related Story: Financial Times (02/28/96) P.6 "Nurse with H.I.V. Emphasizes Safety" New York Times (02/28/96) P. A15; Hilchey, Tim Lynda Arnold, a nurse at Community Hospital in Lancaster, Pa., was infected with HIV three and a half years ago, when a patient's sudden move forced a needle she was using in his arm into her palm. Today, Arnold and her colleagues are launching a national campaign to urge hospitals to adopt safer needle systems, which might have prevented her accident. Arnold says the campaign will not endorse specific products, but will encourage the use of many safer needle systems at "little or no increase in total costs." Dr. Janine Jagger, of the International Health Care Worker Safety Research and Resource Center at the University of Virginia, claims that self-sheathing blood-drawing needles would prevent "at least 80 percent of all transmissions of bloodborne pathogens to the nation's health care workers." Forty-six cases of job-related HIV transmission were documented as of July 1995, according to the AIDS Surveillance Report by the Centers for Disease Control and Prevention. "Proposed French AIDS Drug Lottery Under Attack" Reuters (02/27/96) In France, AIDS activists criticized on Tuesday a government plan to use a lottery to choose a small group of AIDS patients to receive a new drug. Junior Health Minister Herve Gaymard said the government would try to make Abbott Laboratories' protease inhibitor Ritonavir available to all patients, and that a lottery would be used only if there is not enough of the drug available. The government, which will receive the drug next month, said it will only have enough initially to treat about 100 patients. About 18,000 AIDS patients in France could benefit from the drug, according to officials. AIDS action group, ACT-UP, criticized the lottery, noting that the drug was available in unlimited quantities in the United States. Gaymard said that France would receive 1,000 doses in April, 2,000 in May, and 3,000 in June, and that the lottery would only be used as a last resort. "Overexpression of Fas Antigen Seen in Advanced HIV Infection" Reuters (02/27/96) The overexpression of Fas antigen on T cells increases with HIV infection, says Dr. Franco Silvestris of the University of Bari. Silvestris' study confirmed that the Fas pathway has a role in increasing the lymphocyte apoptosis during the HIV infection. He and his colleagues studied the Fas antigen in peripheral lymphocytes and the extent of apoptosis in cells from 59 HIV-positive patients. According to Silvestris, the mechanism by which HIV-1 infection promotes Fas-mediated apoptosis of T cells is still unclear, but the results support the connection between the susceptibility of T cells to apoptosis and Fas expression. "New Guidelines for PCP Prophylaxis in HIV Positive Children Proposed" Reuters (02/27/96) Pneumocystis carinii pneumonia (PCP) is the most common serious opportunistic infection in HIV-infected children, and the incidence of PCP among infants with HIV who do not receive prophylaxis is about 12 percent in the first year of life. Current guidelines for prophylaxis of PCP in children with HIV were developed in 1991 by the National Pediatric and Family HIV Resource Center. Data from the Centers for Disease Control and Prevention shows, however, that no significant declines in PCP rates occurred in children after the guidelines were implemented. The guidelines were modified last year, and now recommend the commencement of PCP prophylaxis for all HIV-exposed children at four to six weeks of age. Prophylaxis for HIV-exposed infants should continue for one year, or until HIV infection is ruled out. In children one year old or older, CD4 cell counts should be used to determine if PCP prophylaxis is needed. The new guidelines also stress the importance of early identification of infants exposed to HIV and maternal education during pregnancy about PCP prophylaxis. "HIV-Positive Substance Abusers Frequently Require Psychoactive Drug Treatment" Reuters (02/27/96) Psychopharmacologic treatment is suggested for nearly 75 percent of HIV-infected substance abusers who are diagnosed with a psychiatric disorder. Dr. Steven Batki of San Francisco General Hospital has found no evidence that these drugs are harmful to the immune system. In his study, 52 of 66 patients on methadone maintenance who had a psychiatric disorder were prescribed "at least one" psychiatric drug. Psychoactive drugs were the second most commonly prescribed drug type. Batki found that benzodiazepines are useful for acute anxiety, common in HIV patients. For severe depression, he says psychostimulants may also be useful, although treatment with all psychotropics must be monitored. "Resistance to Protease Inhibitors" Lancet (02/10/96) Vol.347, No.8998, P. 383 Researchers may be able to help doctors treat AIDS patients with protease inhibitors thanks to new studies of HIV resistance to the drugs. Scientists at the Aaron Diamond AIDS Research Center in New York have identified specific locations on the HIV protease gene where drug resistance-causing mutations occur. With this new information, experts now advise doctors to be aggressive with the drugs, not to skip doses, and to stick to the dosage scheduled. The scientists said that combining protease inhibitors may keep the mutation dominance from happening. "Computer Censorship Law, ACLU Test Case, Begin February 8" AIDS Treatment News (02/09/96) No.240, P. 8; James, John S. Under the computer censorship provisions of the new Communications Act of 1995, it is a felony punishable by five years in prison for anyone in the United States to receive an "obscene" communication by computer. A person does not need to know that the communication is legally obscene, only that it is sexually oriented. AIDS organizations did not have an opportunity to lobby against the bill, but they now can act to challenge the law. Three AIDS groups, the Critical Path AIDS Project in Philadelphia, AIDS Education Global Information System, and The Safer Sex Page, have signed on as plaintiffs in a test case that the ACLU is bringing against the provisions. Much of the law may be found to be in violation of the First Amendment. AIDS groups should find ways to publish information, by targeted e-mail distribution, for example, in ways that do not break the law. It is not yet clear how the law will be enforced, but it will probably be used against those involved with pornography, and possibly against individuals and organizations targeted for their political views. Well-organized mass movements are necessary to defend the rights provided by the First Amendment.