NetNews Usenet Archive 1992 #31/NN_1992_31.iso/spool/sci/med/aids/2155

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Subject: CDC Summary 12/22/92
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                    AIDS Daily Summary
                     December 22, 1992
 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.  Copyright 1992, Information, Inc., Bethesda, MD

 "Officials Cite Increase in AIDS Patients Who Delay Treatment"
Washington Post (12/22/92), P. D3  (Greene, Marcia Slacum)
     There has been a sharp increase in new AIDS patients who already
have symptoms when they receive treatment for the first time,  according
to officials from the Whitman-Walker Clinic in  Washington, D.C.  Some
are even so ill that they must be sent  directly to hospital emergency
rooms.  Health officials say that  AIDS patients may be postponing
treatment for several reasons  including lack of insurance, denial, or
unwarranted hopelessness. Peter Hawley, the clinic's medical director,
said, "We can extend people's lives by a couple of years if we see them
early.  If we  see them late, there may not be anything we can do for
them.   It's alarming to see so many people wait until they're sick."
Blood tests conducted in fiscal 1992 for the clinic's 818 new  patients
showed that 39 percent of them had fewer than 200  T-cells compared with
18.9 of the new patients in fiscal 1991.   D.C. General Hospital's
center for AIDS patients is also  witnessing an increase in new patients
with lower T-cell counts.  Director Dolph Druckman projected that 40
percent to 50 percent  of the center's 240 new patients last year had T-
cell counts  below 200.  Whitman Walker's patients were mostly gay men
in the  early 1980s.  In fiscal 1992, which ended in September, the
clinic experienced an increase in heterosexual patients, IV-drug  users,
women, and minorities.  Also, more than half of the  patients were not
covered under health insurance, compared with  fewer than one-fourth of
its patients in the early 1980s.   Whitman-Walker Director Jim Graham
said the growing number of  patients delaying treatment is a result, in
large part, to the  ineffectiveness of AIDS education efforts.

"Synthetic Blood Clotter for Hemophilia Licensed" Washington Post
(Health) (12/22/92), P. 5  (Herman, Robin)
     A genetically-engineered substitute for the human blood-clotting
protein called factor 8 has been licensed by the Food and Drug
Administration for the treatment of people with hemophilia.  Last week,
Baxter Healthcare Corp. began shipping Recombinate to  distributors for
control of excessive bleeding by people with  hemophilia A, which only
occurs in males.  People with hemophilia currently receive injections of
natural factor 8, extracted from  the pooled blood of thousands of blood
donors.  This practice  resulted in the transmission of HIV to least 80
percent of people with severe hemophilia in the early 1980s, and
hepatitis to more  than 90 percent.  The laboratory-produced form of
factor 8 does  not carry human viruses.  However, its introduction will
not have the effect it might have had years ago, before donated factor 8
was made safer by more sensitive blood-screening tests for HIV  and
hepatitis, and new purification and viral inactivation  techniques.
Nevertheless, the National Hemophilia Foundation and others back the
product because of its guaranteed safety, which  might make people more
willing to use it not just to stop  bleeding but also as a preventive
measure.  FDA Commissioner  David A. Kessler, said, "The production of
factor 8 by  recombinant DNA technology eliminates even the theoretical
possibility of the transmission of viruses from plasma."  Yet  Alan
Brownstein, executive director of the hemophilia foundation, is worried
about the exorbitant price of the substitute.  A  person with severe
hemophilia would have to pay more than $82,000 a year for the new
product, based on pricing figures provided by  Baxter, he said.

"Sex, Pregnancy, and Condoms (for Women)" Washington Post (Health)
(12/22/92), P. 14  (Rovner, Sandy)
     The first device that will allow women to protect themselves
against sexually transmitted diseases (STDs), including AIDS, is  still
awaiting marketing approval from the Food and Drug  Administration.  The
female condom, when used correctly, is  basically unseen and unfelt for
both partners, according to  survey results of the women who tested it
for the FDA studies.   Also, when used properly, the REALITY condom is
95 percent  effective in preventing pregnancies.  Protection against
STDs was not specifically tested in the research.  This would indicate
that some subjects might be exposing themselves and the  requirements
for the studies were careful to exclude any people  who might be at risk
for such diseases.  However, the marketers  of the female condom,
Wisconsin Pharmacal, say that because of  its impermeability and its
barrier design, correct usage would  protect against STDs and AIDS.  The
condom is significant because women often find it difficult to address
condom usage among their sex partners.  Women frequently ignore the
advice about STDs and  AIDS when they fear that such a request will
shatter a mood or  meet with resistance from their partners, who may
object to the  feel of the condom or the lack of trust from the women.
But the  potential efficacy in preventing disease led an advisory panel
of the FDA to recommend approval earlier this month, even though the
pregnancy failure rate was a little higher than had been  expected.  The
FDA is expected to make its decision soon, and the advisory committee's
advice is generally considered pivotal.  The non-reusable condom would
cost about $2.50, whereas male condoms  cost between 50 cents and $1
each.

"French Senate Asks Ex-Premier's Trial in HIV Affair" Boston Globe
(12/21/92)
     The French Senate decided yesterday to abide by the  recommendation
of the National Assembly and put former prime  minister, Laurent Fabius,
on trial for the scandal involving  HIV-infected blood products.  The
upper house vote cleared the  way for Fabius, now leader of the
governing Socialist Party, and  two former ministers to stand trial
before a parliamentary High  Court on charges of neglecting to assist
persons in danger.  The  Socialists took the legal action in the
parliament after  controversy among the public greeted their decision to
stop  similar action last week.  The motion says that former social
affairs ministers, Georgina Dufoix, and former health minister,  Edmond
Herve, should also stand trial.  The Assembly and Senate  resolutions
will be submitted to the Supreme Court, which will  determine whether
there are sufficient grounds to bring the three former ministers to a
trial.  Fabius served as prime minister in  1985 when 1,200 hemophiliacs
contracted HIV from a blood product  that had not been heated, even
though this process for destroying the virus was known.  Since then, 300
have died.  According to  Fabius, he was unaware that the blood products
might have been  tainted with HIV.

"With AIDS Care" New York Times (12/22/92), P. A20  (Homenick, Maureen
A.)
     Waiting for legislative approval for efforts to thwart the spread
of tuberculosis among all infected individuals will only delay  and
divert initiatives to serve those people who directly seek  help from
clinics, writes Maureen Homenick, executive director of the Momentum
Project in New York City.  Tougher measures to fight the rampant spread
of tuberculosis are requested by a panel  reporting to the United
Hospital Fund in the New York Times on  Nov. 30.  However, one of the
most immediate and effective  opportunities to fight TB is being
dangerously overlooked.  Due  to the likelihood that HIV-positive people
and other high-risk  groups will develop active cases of TB, it appears
that the most  effective approach is to integrate programs directly
observed  therapy, education, and prevention into current service
programs  for those individuals.  Several well-established community-
based  groups serving HIV-infected clients are willing to administer
these programs and already attract a constituency that is  infected or
at risk.  Those needing assistance could obtain it  while using other
services that treat the whole person and  include incentives that meet
other, basic needs.  City and state  resources could be more effectively
used in such programs that  monitor treatment, concludes Homenick.

"Beyond the Red Ribbons" Baltimore Sun (12/22/92), P. 1D  (Seigel,
Jessica)
     Although AIDS has been a touchy subject to address in Hollywood  in
the past, AIDS-related issues have recently received more  support
throughout the industry.  One group, Hollywood Supports,  was created in
response to the dying words of actor Brad Davis,  who kept his AIDS
condition a secret for fear he would not get  work.  He accused
Hollywood of hypocrisy for throwing money at  AIDS programs while
simultaneously discriminating against  HIV-positive people.  Hollywood
Supports co-founder Sidney  Sheinberg, president of MCA, said he has
been disappointed that  only one other company, Viacom, has followed his
lead this year  in extending health benefits to domestic partners of
employees.   This allows people to receive treatment who might otherwise
not  be covered.  Extending benefits may encourage many people who are
sick to seek the best treatments available.  In Hollywood, major  movie
producers have felt in the past that movies dealing with  AIDS would
repel audiences, but that has changed as executives  have approved a
wave of big-name films about the epidemic.  Aaron Spelling, the high-
powered television producer, is expected to  make a TV movie based on
Randy Shilts' book "And the Band Played
 On," which chronicles the epidemic's spread in the United States.
"Pediatric AIDS Vaccine Trials Set" Science (12/04/92) Vol. 258, No.
5088, P. 1568  (Cohen, Jon)
     Human vaccine trials intended to stop the transmission of HIV  from
mothers to infants to treat infected children will be  launched within
the next six months by federal agencies.   Pregnant women and children
are ideal subjects for trials that  aim to determine whether an AIDS
vaccine works.  Researchers need a population that shows high infection
rates and develops AIDS  soon after becoming infected to gather sound
data quickly.  Some  30 percent of the 6,000 children born to HIV-
positive mothers in  the United States each year become infected, and if
those  children were not treated, 50 percent of them would progress to
AIDS within 2 years.  The primary sponsor of the trials is the  National
Institute of Allergy and Infectious Diseases (NIAID),  which will
implement five placebo-controlled trials in the next  six months.  Also,
the Walter Reed Army Institute of Research and the National Cancer
Institute expect a trial among infected  children.  These small initial
tests will concentrate on safety  and immune responses.  Trials on
efficacy will come later.  One  study will involve vaccinating newborns
within 3 days of birth.   Scientists hope the vaccine can prevent
infection by prompting  the immune system to destroy HIV before the
virus can replicate.  Another vaccine trial will be in children with
established  infections, in order to expand the immune response and keep
the  virus in check, which could prolong or even prevent the onset of
AIDS.

"Kinetic Studies of the Mechanism of Thrombocytopenia in Patients With
Human Immunodeficiency Virus Infection" New England Journal of Medicine
(12/17/92) Vol. 327, No. 25,  P. 1779  (Ballem, Penny J. et al.)
     Infection of megakaryocytes may be an important factor in  HIV-
related thrombocytopenia, causing decreased platelet  production, write
Penny J. Ballem et al. of St. Paul's Hospital  and the University of
British Columbia in Vancouver, British  Columbia, Canada.  The
researchers examined the survival of  In-labeled autologous platelets
and performed platelet imaging in 24 men with isolated HIV-related
thrombocytopenia (16 who  received no treatment and 8 who received AZT).
Mean platelet  survival was significantly decreased in both the
untreated and  the AZT-treated patients with HIV-related
thrombocytopenia, as  compared with the normal controls.  Mean platelet
survival was  also substantially reduced in the HIV-positive patients
with  normal platelet counts.  But imaging studies revealed no evidence
of increased clearance of autologous platelets in the liver or  spleen
in any of these groups.  Mean platelet production was  significantly
depressed in the untreated patients with  thrombocytopenia as compared
with the healthy controls.  However, mean platelet production was
significantly increased in the men  treated with AZT, both in those with
thrombocytopenia and in  those without thrombocytopenia.  While there
was a moderate  decrease in platelet survival in HIV-positive subjects,
these  patients, despite platelet counts, also had decreased production
of platelets, possibly as a result of viral infection of the
megakaryocytes.  The researchers concluded that AZT seems to  improve
platelet production.

"No Liability for HIV From Transfusion" American Medical News (12/14/92)
Vol. 35, No. 46, P. 16
     A federal trial court in Texas recently ruled that the federal
government was not at fault for HIV transmitted to a patient  during a
coronary artery bypass graft.  The patient had severe  cardiac disease
that mandated surgical intervention.  While in  surgery, the patient
received a transfusion of HIV-positive  blood.  The patient was not told
of the risk of HIV from a  transfusion; there was no test to detect HIV
in blood, or the  availability of autologous or directed transfusion
programs.  The trial court considered the patient's claims to be based
on  negligence in collecting and screening blood products.  But
regarding informed consent, the court said that Texas law states  that
the doctor had an obligation to reveal risks or hazards that could have
influenced a reasonable person in making the decision  to give or
withhold consent to surgery.  A reasonable person  would not have
refused the necessary cardiac surgery in order to  avoid the minimal
risk of contracting HIV.  The patient testified he would not have
consented to an autologous blood transfusion.   The court said that
because of the lack of an HIV test, there was no way to establish
conclusively that a directed blood donation  would have lowered the risk
of receiving tainted blood.  The  court ruled in favor of the government
on the informed consent  claim.

"Pre-Ejaculatory Fluid as Potential Vector for Sexual  Transmission of
HIV-1" Lancet (12/12/92) Vol. 340, No. 8833, P. 1470   (Pudney, Jeffrey
et al.)
     Pre-ejaculatory fluid can contain HIV-positive cells, write
Jeffrey Pudney et al. of Harvard Medical School in Boston, Mass.  The
researchers examined smears form pre-ejaculatory fluid  samples of HIV-1
seronegative and seropositive men for known  HIV-1 host cells and HIV-1-
antigen positive cells.  A total of  11 samples from six HIV-negative
men and 12 samples from nine  HIV-positive donors were examined.  White
blood cells (WBC) were  detected with a panel of monoclonal antibodies
and HIV-1 antigen  positive cells with a cocktail of monoclonal
antibodies against  specific HIV-1 proteins with visualization by
immunocytochemistry.  Samples from seropositive donors were  separated
into two groups depending on whether or not spermatozoa were present.
Among 4 sperm-free samples from four donors, three contained HIV-1-
positive cells.  For the samples with sperm from  five donors, three
donors produced pre-ejaculatory fluid that  contained HIV-1-positive
cells.  HIV-antigen-positive cells were  found in samples from symptom-
free and symptomatic men, and from  men on AZT or not.  In-vitro HIV
culture studies in combination  with epidemiological studies are needed
to determine the  infectious potential of pre-ejaculatory fluid.  Until
then, it  should be considered that pre-ejaculatory fluid is potentially
infectious, and mucosal exposure to the fluid should be avoided  through
protected sex, the researchers conclude.