Date: Fri, 12 Jul 1996 11:00:58 -0400 From: "Flynn Mclean" Subject: CDC AIDS Daily Summary 07/12/96 AIDS Daily Summary July 12, 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 ****************************************************** "AIDS Conferees Debate How Early to Offer New Drugs" "AIDS Therapy Faces a Turning Point" "Scientists Display Substantial Gains in AIDS Treatment" "Health Plans to Cover New AIDS Drugs But Issues of Cost, Treatment Remain" "Many See Hope in AIDS Meeting; Marketers Also See Opportunity" "Many AIDS Patients Opt for Suicide" "Firm Fired HIV Positive Employee Over Illness, Suit Charges" "AIDS Activists Disrupt Meeting of Researchers" "A Shot in the Dark" "Progress Report: Prophylaxis and Therapy for MAC" ****************************************************** "AIDS Conferees Debate How Early to Offer New Drugs" Wall Street Journal (07/12/96) P. B1; Waldholz, Michael Throughout the 11th International Conference on AIDS this week, researchers discussed how soon newly-infected HIV patients should be treated with protease inhibitors, costly new drugs that have been able to reduce the amount of virus to undetectable levels. Treating the estimated 800,000 Americans with HIV could cost at least $5 billion a year and increase the risk of HIV developing resistance to the drugs, but Aaron Diamond AIDS Center scientist David Ho says that his studies support treatment at the first sign of infection. In a current study, 12 patients were treated early and have no detectable virus after a year. Ho wants to remove the therapy and see if the virus comes back or if it is still hiding in certain tissues of the body. Doctors who treat poor patients say the debate over early treatment is meaningless for them because their patients cannot afford the costly drugs. "AIDS Therapy Faces a Turning Point" Washington Post (07/12/96) P. A1; Brown, David As the 11th International Conference on AIDS ended Thursday, researchers tempered the positive news about promising new drugs with caution that a cure is still not in sight. Studies presented at the meeting demonstrated the ability of protease inhibitors, combined with other drugs, to reduce the amount of HIV in the bloodstream to undetectable levels for up to two years. Scientists are considering whether drug therapy could be stopped in patients who have no detectable HIV. However, before stopping treatment, doctors would offer to biopsy a patient's lymph node, where the virus may still be growing. If a cure is not found, infected people may be able to live longer lives through long-term virus suppression. Survival may depend on how soon treatment is started, however. "Scientists Display Substantial Gains in AIDS Treatment" New York Times (07/12/96) P. A1; Altman, Lawrence K. Data from several studies of new AIDS treatments were released on Thursday at the 11th International Conference on AIDS. The researchers who conducted the trials, however, cautioned that the findings could not be deemed a cure. Two studies involved combinations of drugs, including AZT, 3TC and the protease inhibitor ritonavir; in both trials, patients' viral loads were reduced to undetectable levels for long periods of time. While the new treatments are extremely promising, experts note that the virus could develop resistance to the new drugs--just as it has to older ones--or patients could prove to be unable to tolerate the harmful effects of the drugs over an extended period. "Health Plans to Cover New AIDS Drugs But Issues of Cost, Treatment Remain" Wall Street Journal (07/12/96) P. A3; Winslow, Ron While health insurers and managed care plans say they will pay for the costly new protease inhibitors for patients with HIV, the potential cost for the drugs could vary widely. Researchers are debating how soon patients should be treated with the drugs, a factor that could affect cost dramatically. The drugs cost at least $12,000 a year, and a test to monitor patients costs another $1,000. Moreover, early treatment would increase both the number of patients being treated and the cost to insurers. Concerns may be exaggerated, though, considering that the drugs help improve the health of seriously ill patients and thus save money on hospital stays and antibiotics. Tim Westmoreland of the Georgetown University Law Center noted that protease inhibitors may actually save money for health plans that pay for both prescription-drug benefits and hospital care. "Many See Hope in AIDS Meeting; Marketers Also See Opportunity" Wall Street Journal (07/12/96) P. B1; Tanouye, Elyse The 11th International Conference on AIDS held in Vancouver, British Columbia, this week was sponsored by drug makers and other companies eager to display their products. According to Graeme White, the conference's corporate relations manager, pharmaceutical firms and other sponsors contributed nearly a third of the $11 million cost of holding the event. While many conference attendees merely picked up their free Abbott Laboratories' tote bags and eagerly stood in line at the Gilead Sciences booth to get a free water bottle, some AIDS activists protested the commercial hype of the event, marching through the aisles while chanting, "We die. You make money," and putting down roach motels at the Roche Holding booth while waving signs that said "Greed Infestation." According to one drug company executive, however, the commercial hubbub was "extraordinarily subdued," compared with meetings of such groups as the American Heart Association, where celebrities often pitch products. "Many AIDS Patients Opt for Suicide" Miami Herald (07/11/96) P. 9A; Haney, Daniel Q. People with AIDS commonly attempt suicide and doctors seem increasingly willing to assist them, according to survey results presented Wednesday. Failed suicides are frequent, because physician-assisted suicide is illegal in most places, but surveys show that doctors and nurses are more willing to bend or break the rules to help patients end their pain. Thomas Mitchell of the University of California at San Francisco reported that 53 percent of 114 San Francisco-area AIDS specialists surveyed said they had helped patients end their lives by writing prescriptions for narcotic overdoses. Five years ago, 28 percent of doctors said they would probably help in a suicide. "Firm Fired HIV Positive Employee Over Illness, Suit Charges" Chicago Tribune (07/11/96) P. 1-7; O'Connor, Matt Robert Viola, who served as a board member of AIDS Care, a residence for homeless AIDS patients in Chicago, was sued by a former employee for firing him because he thought the man had developed AIDS. Patrick N. Martinez says he told Viola previously that he had HIV and that Viola wrongly believed a case of bronchitis indicated that Martinez had developed full-blown AIDS. When Martinez returned to work after being ill, Viola confronted Martinez with the information and tried to force him to quit. Viola fired him the next month. Martinez says he believes Viola was concerned about the potentially high health care costs to his company. Jim Flosi, founder and president of AIDS Care, said that such allegations are completely out of character for Viola, noting that he has volunteered many hours and offered the services of his marketing, communications, and graphics design firm to the cause. "AIDS Activists Disrupt Meeting of Researchers" Boston Globe (07/11/96) P. 8; Knox, Richard A. A small group of AIDS activists from ACT-UP San Francisco disrupted a meeting at the 11th International Conference on AIDS Wednesday, throwing red liquid that broke glassware and soaked the clothes of participants. The protest was one of many at the conference, but the first violent disruption. The protesters were apparently upset about the toxicity of AZT. "A Shot in the Dark" Discover (06/96) Vol. 17, No. 6, P. 66; Cohen, Jon Thailand, a country particularly hard-hit by AIDS, is preparing for the world's first large clinical trial of an HIV vaccine. The country began experiencing an explosive HIV epidemic in 1988, and unlike the epidemic in the United States and Europe, 90 percent of the people infected were heterosexuals. Researchers found a new strain of HIV, subtype E, in northern Thailand and suspected it was more easily transmitted through heterosexual sex than the more common subtype B. A panel at the National Institute of Allergy and Infectious Diseases recommended in 1994 that efficacy trials of the Biocine and Genentech vaccines begin, but the trials were delayed indefinitely. That same year, a World Health Organization panel approved beginning vaccine trials in hard-hit developing countries. Genentech had a large supply of vaccine, but it was designed for subtype B. The company began testing the vaccine in a small number of Thai drug users who were infected with subtype B. Even as this trial was being prepared, though, subtype E was spreading rapidly among drug users. Biocine hopes to start a trial of a subtype E vaccine this fall and is working on a vaccine for both subtypes that may enter a trial by the end of 1997. "Progress Report: Prophylaxis and Therapy for MAC" AIDS Clinical Care (06/96) Vol. 8, No. 6; P. 45; Currier, Judith Several studies in the past year have reported advances in the prophylaxis and treatment of disseminated Mycobacterium avium complex (MAC), a common cause of morbidity and mortality in patients with advanced HIV infection. Rifabutin was the first agent shown to reduce the incidence of disseminated MAC, but further analysis of favorable studies showed no survival benefit. Clarithromycin has been shown to improve survival by 33.1 percent, although resistance was also found to develop to the drug. Studies showed that both daily clarithromycin and weekly azithromycin are better than rifabutin for MAC prophylaxis, but the relative effect of the two is difficult to determine. Clarithromycin appears to be slightly more effective, although resistance was more commonly associated with it than with azithromycin. To treat MAC, therapy with a macrolide and at least one other agent is currently recommended, although some studies have suggested that a three-drug combination may be more beneficial.