Date: Thu, 7 Mar 1996 10:01:58 +0500 From: ghmcleaf{CONTRACTOR/ASPEN/ghmcleaf}%NAC-GATEWAY.ASPEN@ace.aspensys.com Subject: CDC AIDS Daily Summary 03/07/96 AIDS Daily Summary March 7, 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 ************************************************************ "AIDS Council Likely to Back Needle Programs" "Victims of Tainted Blood May Not Live to See Report" "States Fight to Limit Federal Courts' Power Over Medicaid" "White House: More AIDS Education Needed" "HIV Strain Resistant to New Protease Inhibitors" "Late-Stage AIDS Patients Susceptible to Pseudomonas Aeruginosa Infection" "HIV Prevalence High Among Male Teens Who Have Homosexual Encounters" "DNA Vaccine Set to Tackle HIV Infection" "The Rolling Uncertainties of Antiprotease Prescribing" "Drug Program Revived" ************************************************************ "AIDS Council Likely to Back Needle Programs" New York Times (03/07/96) P. B6; Preston, Jennifer The Governor's Advisory Council on AIDS in New Jersey is expected to recommend that the state allow needle exchange programs and the sale of syringes without prescriptions, in an attempt to reduce the transmission of HIV among injection drug users. Gov. Christine Todd Whitman has opposed such programs, but the panel she appointed to evaluate them has decided to recommend that the Governor support changing the law. Most members of the advisory council said they were swayed by studies which show that needle exchanges slow the spread of HIV among injection drug users. David Troast, chairman of the council, said his opposition to needle exchanges was reversed when he visited one such program in the Bronx as well as when he saw a study that found that needle-sharing was reduced by 40 percent in Connecticut after a 1992 law allowed drug stores to sell syringes without prescriptions. Connecticut is one of five states that has such a law. Related Story: USA Today (03/07/96) P.9A "Victims of Tainted Blood May Not Live to See Report" Toronto Globe and Mail (03/06/96) P. A3; Picard, Andre Justice Horace Krever, the judge leading the inquiry into Canada's tainted blood incident, says the commission's report may be delayed by months, possibly years. More than 1,200 hemophiliacs and transfusion recipients were infected with HIV from contaminated blood and blood products between 1980 and 1985. Krever made this prediction in a letter to the Clerk of the Privy Council following a government lawyer's announcement that the lawsuit being brought by the federal government, provinces, the Canadian Red Cross, and pharmaceutical companies would not interfere with the completion of the inquiry. The suit is an attempt to keep Krever from making any findings of wrongdoing, and contends that such findings could be used in civil or criminal cases against them. The inquiry has compiled more than 300 potential findings of misconduct, which consumer advocates say are important to the case and do not imply any legal liability. Such groups say delaying the report, which had a deadline of Sept. 30, 1996, hurts the public's faith in the blood system. "States Fight to Limit Federal Courts' Power Over Medicaid" Washington Post (03/07/96) P. A27; Havemann, Judith The Medicaid reform plan proposed by U.S. governors includes a provision to ban individual Medicaid beneficiaries--or their doctors, hospitals, and nursing homes--from suing states in federal courts. Costly court battles inspired the provision, which was criticized by Rep. John Dingell (D-Mich.) Wednesday at a hearing. Dingell said that prohibiting the suits would "eliminate the effective enforcement of federal rights." States pay 20 percent to 50 percent of the total costs of Medicaid, and argue that the courts interfere with state activities. In 1989, for example, the Missouri state legislature tried to ban Medicaid payments for AZT, an expensive AIDS drug, but the courts ruled that the state had to pay. "White House: More AIDS Education Needed" Miami Herald (03/06/96) P. 17A U.S. teens are contracting HIV at the rate of more than one an hour, and the White House said Tuesday that more AIDS education is needed. The White House Office of AIDS Policy issued a report urging strong AIDS education for children, so that when they later have sex or use drugs, they will know how to protect themselves. For some young people, like 24-year-old Lam Duckim, the report is more government talk and no action. Duckim, who is HIV-positive, said "this report isn't really doing something for youth. There is a need for accountability." While most U.S. school districts provide some AIDS education, many do not include discussions of sexual intercourse, homosexuality, bisexuality, and condom use. Furthermore, the report did not suggest how to reach gay teens, noted the Los Angeles Gay & Lesbian Center. The center said that some 60 percent of AIDS cases among men under age 25 are due to unsafe homosexual sex. To improve AIDS education in Florida, legislators are considering a system in which school districts would compete for AIDS education grants. "HIV Strain Resistant to New Protease Inhibitors" Reuters (03/07/96) Some HIV-infected patients, who have not been treated with the new protease inhibitors, have already developed strains of the virus that are resistant to the new drugs, report researchers at the University of California at Los Angeles. Dr. Andrew Kaplan and colleagues say that nearly one-third of 246 protease coding sequences from 12 HIV-positive patients had mutations that seemed to be resistant to the virus. If some of the viruses in a patient are resistant to the drug, Kaplan said, the virus has "a huge head start." "Late-Stage AIDS Patients Susceptible to Pseudomonas Aeruginosa Infection" Reuters (03/06/96) Four cases studies of community-acquired Pseudomonas aeruginosa infection in late-stage AIDS patients suggest an increase in P. aeruginosa infection as a late manifestation of advanced AIDS, said Dr. Orlando Schaening and colleagues of the Maimonides Medical Center and SUNY in Brooklyn, N.Y. Schaening recommends that a secondary prophylaxis for AIDS patients with documented Pseudomonas infection be considered. In an editorial accompanying the study, which was published in the journal Infectious Medicine, Barry Sieger of the Orlando Regional Medical Center notes that AIDS patients require frequent antibiotic treatments, which promotes bacterial overgrowth and superinfection with fairly resistant pathogens, like Pseudomonas. "HIV Prevalence High Among Male Teens Who Have Homosexual Encounters" Reuters (02/13/96) A national survey of young homosexual and bisexual men revealed that 7 percent are infected with HIV. Five percent of the men aged 15 to 19 and 9 percent of those aged 20 to 22 were HIV-positive, and 38 percent of those surveyed reported having had unprotected anal sex within the previous six months. Linda Valleroy of the Centers for Disease Control and Prevention (CDC) led the survey and presented the findings at the annual meeting of the American Association for the Advancement of Science in Baltimore. Valleroy called the prevalence of unprotected anal sex "alarming, given that these young men grew up in an era of HIV awareness." The CDC's John M. Karon suspects that young men underestimate the risk of getting HIV because they assume that only older men are infected. Data on the epidemiology of HIV/AIDS was also presented at the meeting, and HIV infection was reported to be the leading cause of death among men aged 25 to 44 and the fourth leading cause of death among women in that age group. The World Health Organization reported more than one million cases of AIDS in 192 countries in 1995, but estimates that more than 4.5 million cases have occurred globally. "DNA Vaccine Set to Tackle HIV Infection" Science News (02/17/96) Vol. 149, No. 7, P. 100; Travis, J. The Food and Drug Administration (FDA) has granted researchers at the University of Pennsylvania and the biotech firm Apollon permission to inject a DNA derived vaccine into healthy, HIV-negative volunteers. In recent years, researchers have found that injecting a gene into an animal provokes a positive immune response to the protein that gene encodes. The new study, the first conducted with the hope of preventing HIV infection, is expected to determine the safety of such an injection. The vaccine involved is made from a gene that codes for one of the proteins that form the surface of HIV and should therefore generate HIV antibodies and activate HIV-killing immune cells. The FDA agreed to the trial because the cancer and HIV-infected patients previously injected with DNA have experienced no significant side effects thus far. "The Rolling Uncertainties of Antiprotease Prescribing" Journal of the International Association of Physicians in AIDS Care (02/96) Vol.2, No.2, P. 6; Mascolini, Mark The first protease inhibitor, Hoffmann-LaRoche's Invirase (saquinavir), has been approved, and at least four others are in various stages of development. The variety of drugs becoming available can be potentially confusing to clinicians, as they are left to themselves to interpret the results of new studies. Currently, Roche is working on a new formulation of saquinavir because of the existing version's low bioavailibility. Meanwhile, Abbott's Norvir (ritonavir) and Merck's Crixivan (indinavir) are both now in phase III trials and could be approved this summer. In addition, patients are being enrolled for phase II/III trials of Agouron's nelfinavir, and Vertex/Glaxo Wellcome began a phase I/II study of its VX-478/141W94 late last year. Protease inhibitors work best when combined with nucleoside analogs, and in some cases have resulted in viral load decreases to undetectable levels. However, treatment with one protease inhibitor can induce resistance to others, complicating decisions about beginning therapy with one drug and switching to a more promising one later. The cost of the new drugs adds another problem for treatment. A combination of saquinavir, zidovudine, and 3TC (lamivudine), for example, costs $11,830 wholesale per year. Researchers advise that combining a high dose of a protease inhibitor with one or more nucleoside analogs is the best strategy to slow the virus. "Drug Program Revived" Washington Blade (02/16/96) Vol.27, No.7, P. 1; Fox, Sue Washington D.C.'s program to provide AIDS drugs to low-income patients was recently shut down for three days due to a lack of funding, but is once again functioning. The city government brought the service back by paying off old bills and redirecting $115,000 in leftover federal AIDS support to the D.C. CARE Consortium, which runs the program. The city's agency for HIV/AIDS is now working on ways to ward off another closure. At the time of the shutdown, the program was owed about $222,000 in federal funds. In addition, December's payment was late, thereby delaying the disbursement of funds. Using the recent payments, the service will probably have enough money to operate through March, and will receive new funds in April.