Date: Fri, 29 Mar 1996 10:13:54 +0500 From: ghmcleaf{CONTRACTOR/ASPEN/ghmcleaf}%NAC-GATEWAY.ASPEN@ace.aspensys.com Subject: CDC AIDS Daily Summary 03/29/96 AIDS Daily Summary March 29, 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 ************************************************************ "Pediatrician May Have Spread TB" "Cancer Drugs to Get FDA Review" "Some Blood Cells Resistant to AIDS Virus" "AIDS Community Coping With a Big Cut in Funding" "Physicians Taking A Closer Look at HIV Clearance by Neonates" "HIV Subtypes and Disease Transmission: Scientists Taking a Hard Look at the Data" "Japan Haemophiliacs in Out-of-Court Settlement" "HIV-1 Dynamics in Vivo: Virion Clearance Rate, Infected Cell Life-Span, and Viral Generation Time" "'Shoe Leather Therapy' Is Gaining on TB" "Drug of Choice" ************************************************************ "Pediatrician May Have Spread TB" Philadelphia Inquirer (03/29/96) P. B2 An Allentown, Pa., pediatrician may have spread tuberculosis (TB) in a local hospital. Nearly 1,400 patients who stayed at Sacred Heart Hospital from Nov. 1 to Feb. 14 are at risk of exposure from Nestor Rios, health officials said Wednesday. Parents are being notified by letters, and officials are recommending skin tests, chest X-rays, and nine months of treatment with an antibiotic for children. No active infectious cases of TB have been found, but 71 people did have the bacteria in their bodies. Rios' medical license has been suspended pending an investigation that he disregarded requests to wear a mask after being diagnosed. Related Story: USA Today (03/29) P. 10A "Cancer Drugs to Get FDA Review" Wall Street Journal (03/29/96) P. B1; Stout, Hilary; McGinley, Laurie In a move to give new cancer therapies the same expediency granted AIDS drugs, the Food and Drug Administration (FDA) is revising its approval process for cancer drugs. Officials hope the changes, expected to be announced Friday by President Clinton and to go into effect at once, will cut FDA review time of new cancer drugs by more than half, from an average of about 12 months to six months. Changes made in 1992 to speed approvals of drugs for life-threatening illnesses led to the rapid approval of the new AIDS drugs called protease inhibitors, including one developed by Merck & Co. which was approved in only six weeks. Some cancer activists say the disease has not gotten as much attention as AIDS because AIDS activists have been more organized and politically active. Related Story: USA Today (03/29) P. 1A "Some Blood Cells Resistant to AIDS Virus" USA Today (03/29/96) P. 2D Some people with blood cells that are unusually resistant to HIV may avoid infection with the virus despite repeated exposure to it, a new study suggests. In these people, the cells usually targeted by HIV seem to actively resist infection, perhaps by having a high production of virus-fighting chemicals. In laboratory tests, the resistant cells required about 200 times the normal dose of HIV to become infected, reported researcher William A. Paxton of the Aaron Diamond Research Center and New York University School of Medicine. A separate study found a link between certain immune system genes and the amount of time HIV-infected individuals can go before developing AIDS. Men with the best genetic profiles were AIDS-free some seven years longer than men with the least favorable profiles, reported Richard Kaslow of the University of Alabama at Birmingham. "AIDS Community Coping With a Big Cut in Funding" Philadelphia Inquirer (03/29/96) P. B1; Santiago, Denise-Marie The AIDS community in Philadelphia is trying to cope with the announcement that it will lose $1.8 million of federal funding for AIDS services. The region will get 19 percent less under the Ryan White Title I Act in the 1996 fiscal year, reducing funding from $9.8 million to $7.95 million. The city's office on AIDS has already cut $431,000, mostly in administrative costs, and the city will contribute $156,000 to continue existing services through the beginning of May. AIDS activist David Fair said the cuts mean "an already dysfunctional system is getting worse." Last fall, city health officials said the number of AIDS cases had been under-reported, costing the area $2.7 million in federal funding over the previous two years. One kind of funding under the Ryan White Act is based on the number of AIDS cases in the region. Supplemental funding, meanwhile, is distributed on a competitive basis, based on applications from different regions. The Philadelphia region's supplemental funding was cut from $5.7 million last year to $3.8 million in 1996. "Physicians Taking A Closer Look at HIV Clearance by Neonates" Reuters (03/28/96) Several cases of infants who were perinatally infected with HIV and subsequently tested HIV-negative have been reported since Yvonne J. Bryson of the University of California at Los Angeles first reported the phenomenon. Bryson estimates that about 24 cases have been documented, but said she does not know how the infants clear the virus. She also said it would be surprising if the same clearance did not occur in adults. Adults, however, are not tested in the same way that infants born to HIV-positive women are. Bryson says she expects testing of infants to become more rigorous in light of the clearance cases. "HIV Subtypes and Disease Transmission: Scientists Taking a Hard Look at the Data" Reuters (03/28/96) Scientists gathered in Berlin this week for a two-day workshop organized by the Joint United Nations Program on HIV/AIDS (UNAIDS) to discuss the effects of various subtypes of HIV on the AIDS epidemic worldwide. Recent findings have suggested that some HIV subtypes are more easily transmitted via heterosexual contact. Dr. Peter Piot, director of UNAIDS, said prevention methods will remain the same, regardless of the ease of transmission of various viral subtypes. The AIDS epidemic is moving slowly in North America and Europe, but is spreading rapidly in Africa and Asia, where most cases are heterosexually transmitted. Harvard researcher Max Essex has shown that HIV subtypes-E and -C are more likely to be spread heterosexually, but the epidemic in different parts of the world is not always as expected. In Africa, the epidemic has been worsened by the prevalence of other STDs, while in Southeast Asia, the prevalence of STDs is lower and HIV-E has spread rapidly regardless. Also, HIV in the Caribbean is spread primarily through heterosexual sex, but the cases mostly involve HIV-B. Prevention campaigns may be revised to target specific populations at risk. "Japan Haemophiliacs in Out-of-Court Settlement" Reuters (03/29/96) Japanese hemophiliacs infected with HIV through contaminated blood products accepted an out-of-court settlement Friday, ending their seven-year legal dispute against the government and five drug companies. Under the agreement, the 458 plaintiffs will each receive a one-time payment of $424,000, and those with full-blown AIDS will receive additional monthly payments of $1,415. The pharmaceutical companies involved include Green Cross Corp., Baxter Ltd., and Bayer Ltd. Between 1,800 and 2,000 hemophiliacs are believed to have been infected by the tainted blood products. "HIV-1 Dynamics in Vivo: Virion Clearance Rate, Infected Cell Life-Span, and Viral Generation Time" Science (03/15/96) Vol. 271, No. 5255, P. 1582; Perelson, Alan S.; Neumann, Avidan U.; Markowitz, Martin; et al. To track the dynamics of HIV in vivo, as well as the impact of a protease inhibitor, David Ho of the Aaron Diamond AIDS Research Center in New York and colleagues used a mathematical model and viral load data from five infected individuals. Ritonavir was given to five infected patients, and the resulting HIV-1 RNA plasma concentrations were measured. The patients showed similar patterns of viral decay--an initial lag followed by an exponential decline. The delay is explained by the mechanism of protease inhibitors, which make newly produced viruses noninfectious but do not inhibit already infected cells or previously produced viruses. The researchers concluded that the rapid replication of HIV-1 accounts for more than 99 percent of the plasma viruses in infected individuals and the high destruction rate of CD4 cells. They therefore suggest that an effective AIDS treatment should detectably lower the viral load in plasma within a few days. Furthermore, they recommend early and aggressive combination therapy because HIV replicates rapidly, noting that more information is needed about the decay rate of long-lived virus-producing cells and the activation rate of cells carrying viruses. "'Shoe Leather Therapy' Is Gaining on TB" Journal of the American Medical Association (03/13/96) Vol. 275, No. 10, P. 743; Voelker, Rebecca About 1,200 public health outreach workers in U.S. cities go door-to-door to track down poor, homeless, or mentally ill tuberculosis (TB) patients, conducting directly observed therapy (DOT) to ensure that each patient takes their medication. DOT is an important strategy to control the spread of TB, because without the outreach workers, many patients would not complete their treatment program, and would contribute to the rise and spread of drug-resistant disease. The Centers for Disease Control and Prevention (CDC) notes that a resurgence in TB has caused 54,000 more cases since the mid-1980s than would have occurred if previous TB morbidity patterns had continued. To handle the epidemic, funds for the CDC's TB project increased from $5 million in 1986 to $114.9 million in 1995. Much of the additional money went to outreach programs, which now employ an estimated 1,000 to 1,200 workers nationwide. Now, the CDC says, deaths from TB are starting to decrease, as the number of patients who complete treatment increases. "Drug of Choice" Insight (03/11/96) Vol. 12, No. 10, P. 17; Goode, Stephen Peter Duesberg believes that treatment with the commonly used AIDS drug AZT is the worst thing for AIDS patients. He says that the drug is too damaging for people with the disease, because their bodies have been harmed by drug abuse. In his book, "Inventing the AIDS Virus," Duesberg compares a disease known as SMON, which broke out in Japan in the 1950s, to AIDS. "For 15 years the syndrome was mismanaged by the Japanese science establishment, in which virtually all research efforts were controlled by virus hunters. Ignoring strong evidence to the contrary, researchers continued to assume the syndrome was contagious and searched for one virus after another," he states. Scientists eventually found that SMON was not caused by a virus, but by the misuse and overuse of the drug clioquinol for treating stomach disorders.