NetNews Usenet Archive 1992 #31/NN_1992_31.iso/spool/sci/med/aids/2169

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Subject: CDC Summary 12/29/92
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                    AIDS Daily Summary
                     December 29, 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

 "Cheaper Drugs More Effective in AIDS Cases" Journal of Commerce
(12/29/92), P. 7A
     The Pneumocystis carinii pneumonia (PCP) experienced in AIDS
patients can be more effectively treated with daily tablets of  two
cheaper drugs than with the more expensive treatment of  inhaling the
drug pentamidine.  However, the less expensive  treatment also has
drawbacks, according to studies published in  the New England Journal of
Medicine.  While the cheaper  treatment, trimethoprim-sulfamethoxazole,
may be more effective,  the risk of side effects is higher and
eventually may force some  HIV-positive patients into more extensive
therapy.  A team of  researchers led by Dr. Margriet M.E. Schneider of
the University  Hospital in Utrecht, the Netherlands, conducted one test
on 215  subjects who previously had not suffered from PCP.  They
discovered that 11 percent of the patients receiving aerosolized
pentamidine developed PCP.  Of those AIDS patients who received  the
less expensive combination of trimethoprim-sulfamethoxazole,  there were
no cases of PCP.

"States Face Drop in Federal Backing of AIDS Prevention" New York Times
(12/29/92), P. A1  (Pear, Robert)
     The federal government announced that it is cutting state funds
designated for AIDS prevention programs.  Consequently, many  states are
curtailing services even as there is a rising demand.  State officials
have complained to the Bush administration about  the cuts, but federal
health officials said there was little they could do because Congress
had limited the amounts available.   According to federal officials,
$129 million is provided for  grants to states for AIDS prevention next
year, compared with  $143.7 million this year and $159 million in 1991.
They said the states were receiving less money because Congress had
specified  more for private "community-based groups."  The controversy
is  emerging now because federal health officials have started
revealing exactly how much money states can expect.  Although
President-elect Clinton promised in his campaign to allocate more money
for AIDS prevention, he could not make significant  increases without
asking Congress to appropriate new money for  fighting AIDS.  The money
that federal heath officials are now  allotting for the 1993 calendar
year is part of Congress'  appropriations for the 1993 fiscal year,
which has already begun. Federal funds comprise the vast majority, at
least 75 percent, of state spending for AIDS prevention programs.
Federal officials  noted three reasons for the cuts: a general shortage
of money,  the diversion of money to other health programs, and
disagreement about the proper balance between prevention and treatment
of  AIDS.   Related Story: Baltimore Sun (12/29) P. 1A

"New Definition to Raise AIDS Numbers" Washington Post (12/29/92), P. A8
     The Centers for Disease Control's new definition of AIDS will  take
effect on Friday, January 1, and will cause thousands more  HIV-positive
Americans to be considered to have the disease.   Activists and
physicians are expecting a higher demand for  treatment and social
services as more of those infected are  included in the definition.
During 1993, a total of 90,000  Americans are expected to be diagnosed
with the disease,  according to the CDC.  With the current definition
about 50,000  Americans are diagnosed annually with the disease.
Approximately 242,000 Americans have been diagnosed with AIDS and
160,000 have  died.  Following intense protests by activists, who
charged that  the CDC has been ignoring AIDS symptoms experienced only
in women and IV-drug users, the agency adopted the new definition.  The
current definition considers one to have AIDS if he or she  experiences
one of 23 AIDS-related illnesses.  Included in the  new definition are
pulmonary tuberculosis, recurrent pneumonia,  and invasive cervical
cancer, which are more common among women  and IV-drug users.  The CDC
says what is more important is the  fourth new indicator: a decline in
the level of the body's CD4  cells to 200 per cubic millimeter.  James
Buehler, acting deputy  director of the CDC's AIDS division, said that
while about 1  million Americans are HIV-positive and as many as 190,000
are  estimated to have CD4 counts below 200, most are unaware that  they
have HIV or have never had a CD4 test, he said.  The first  reports
using the new definition will be released at the end of  January, "but
to really see the effects of this definition we're  going to need to
experience it throughout 1993," said Buehler.   Related Story:
Philadelphia Inquirer (12/29) P. B6

"School Condom Program Proposed" Washington Post (12/29/92), P. B3
(Bates, Steve)
     The Alexandria, Va., PTA Council has requested that the school
system distribute condoms to high school students who want them,  as an
effort to prevent HIV infection and teenage pregnancy.  If  the PTA
Council's proposal is endorsed, Alexandria would become  the first
suburban Washington, D.C., public school system to  provide condoms to
students.  Schools in Washington began  distributing condoms this school
year at all high schools and  several junior highs under a controversial
program.  Although  Alexandria School Board members will be presented
with the PTA  Council proposal next week, education officials say they
will  move cautiously with it.  School Board Chairman Angie Godfrey
said, "We're going to take it seriously.  I don't imagine us  making a
decision right away."   She added that the School Board  will probably
hold public hearings on the idea and solicit input  from a school health
advisory committee.  Sexually transmitted  diseases, including HIV, are
an increasing problem in the school  system.  The PTA proposal calls for
school personnel who are  trained in HIV counseling and education be
authorized to  distribute condoms to students in grades nine through 12.
It  suggests that classroom AIDS education start as early as
kindergarten and be given a greater focus in the middle and high
schools.  In addition, the proposal requires abstinence to be
emphasized as a means of preventing the spread of HIV infection.

"Michigan Redefines AIDS by Adding Indicative Diseases" Chicago Tribune
(12/28/92), P. 1-3
     The number of AIDS cases in Michigan is estimated to rise 50
percent after the new Centers for Disease Control definition of  AIDS
takes effect Jan. 1.  The new definition will increase the  number of
diseases that indicate an HIV-positive person has AIDS. It will also
consider anyone who tests positive for HIV and has a CD4 count below 200
as having AIDS.  According to health  officials, the new standard
indicates an increased AIDS awareness and greater expertise.  Jim Kent,
a Michigan Health Department  epidemiologist, said there were about 750
Michigan residents with AIDS in 1992.  The new guidelines will add
pulmonary  tuberculosis, recurring pneumonia, and invasive cervical
cancer  to the list of 23 diseases that define an HIV-positive person as
having AIDS.

"Aztec Club Allowed to Sell Tickets to Event Billed as AIDS  Benefit"
Philadelphia Inquirer (12/29/92), P. B3  (Rosenberg, Amy S.)
     The Pennsylvania Attorney General's office announced yesterday
that the Aztec Club in Philadelphia may resume selling $150  tickets to
a New Year's Eve party that is being promoted as a  benefit for AIDS
research.  The club had been prohibited from  selling tickets as of last
Tuesday after questions were raised by local AIDS groups about how much
money would be left for charity  after a total of $137,000 in expenses
was paid.  But yesterday  the club officially registered its New Years
Aid Foundation as a  nonprofit foundation with the state's Bureau of
Charitable  Organizations, stating its intention to raise money for AIDS
research, AIDS patient care, and children with the disease.
Spokespeople for the Aztec blamed local AIDS groups for  disrupting the
benefit plans because of "greed."  Marketing  director Rick Miller said
the party's proceeds would now benefit  Total AIDS Support Services in
Glenside, Pa., and possibly Search Alliance In Los Angeles, a research
group.  He said they had each been guaranteed $7,500 from the benefit.
Philadelphia  groups--Action AIDS and the AIDS Task Force--said they
decided  not to get involved with the event after discovering the costs
involved and the intention to direct much of the proceeds to  groups
outside of Philadelphia.  Miller said that the club  expected to raise
more than $150,000 for the AIDS groups involved through ticket sales, an
art auction, sweatshirt sales, and  corporate donations.

"Comparison of Saliva and Serum for HIV Surveillance in  Developing
Countries" Lancet (12/19-26/92) Vol. 340, No. 8834/8835, P. 1496
(Frerichs, Ralph R. et al.)
     Saliva is a safe and effective alternative to serum for HIV
antibody testing with enzyme-linked immunosorbent assays (ELISAs) in
developing countries, write Ralph R. Frerichs et al. of the  University
of California--Los Angeles AIDS Prevention and Control Program.  The
researchers conducted a field study in Myanmar  (formerly Burma) to
evaluate saliva as an alternative to detect  the frequency of HIV
infection in a surveillance program of  high-risk and low-risk sentinel
groups.  The researchers  collected duplicate vials of saliva and serum
from 479 high-risk  and 1,039 low-risk subjects.  One vial of each pair
was examined  blind in two laboratories: one in the United States and
the other in Myanmar.  The U.S. laboratory followed World Health
Organization confirmatory strategy III with three different  enzyme-
linked immunosorbent assays (ELISAs), while the laboratory in Myanmar
followed strategy I with one ELISA.  Serum testing in  the U.S. was the
gold standard.  The Cambridge ELISA with saliva  was a more effective
surveillance device for describing the  frequency of subjects with HIV
antibodies than the serum ELISA  supplied to Myanmar by WHO.

"India: Disquiet About AIDS Control" Lancet (12/19-26/92) Vol. 340, No.
8834/8835, P. 1533   (Mangla, Bhupesh)
     The Indian Ministry of Health and Family Welfare has provided
about $100 million for the National AIDS Control (NACO) project  in the
Eighth Five-Year (1992-97) plan for health.  The amount  comprises more
than 15 percent of the nation's health budget,  putting AIDS second only
to malaria, for which a little more than 19 percent has been allotted.
The majority of the sum for AIDS  control is a loan from the World Bank.
WHO is allocating $1.5  million by way of technical expertise.  The
National AIDS Control Organization, created in August to implement the
control program, supports unlinked anonymous testing over mandatory
testing.   However, the medical community, which is fearful of
nosocomial  spread of infection, is divided on this issue.  Also, the
safety  of the blood supply in India is questionable.  Since 1989, when
antibodies to HIV were found in some indigenously produced blood
products, attempts to prevent contamination of blood have  occurred.
But earlier this year at a meeting convened by India's Prime Minister,
plans for the AIDS control programs contained no  mention of the safety
of blood and blood products.  The plans  were resubmitted for review.
Now, NACO has allocated $30 million for blood safety.  Because the cost
of testing by ELISA is less  than $1 per sample, the sum should be
sufficient to screen all  the 2 million units collected each year.  Yet
NACO says that it  cannot be responsible for the practice in commercial
blood banks, which supply 29 percent of the blood collected in the
country.

"Malabsorption of Antituberculosis Medications by a Patient With  AIDS"
New England Journal of Medicine (12/17/92) Vol. 327, No. 25,  P. 1819
(Berning, Shaun E. et al.)
     Although it could appear that an HIV-positive patient has a  drug-
resistant strain of tuberculosis, it actually means that the patient has
not been absorbing medications properly, write Shaun  E. Berning et al.
of the National Jewish Center for Immunology  and Respiratory Medicine,
in Denver, Colo.  An HIV-positive male  health-care worker from New York
City was recently referred to  the National Jewish Center for Immunology
and Respiratory  Medicine.  The patient received isoniazid, rifampin,
pyrazinamide, and ethambutol from May 1991 to April 1991, with
defervescence and weight gain.  But in April 1992 fevers,
lymphadenopathy, and weight loss developed.  The patient  underwent
biopsy of a supraclavicular node; the specimen was  later positive for
M. tuberculosis on smear and culture.  The  patient was found to have an
eight-year history of three to five  loose stools per day, without gross
diarrhea.  This result was  consistent with a malabsorptive disorder.
Capreomycin and  clofazimine were added to the drug regimen.  These
concentrations suggested clinically important malabsorption of the
medications.  The assays were repeated to confirm the results.  The
results of  the culture of the auxiliary-node biopsy specimen obtained
in  April 1992 revealed resistance only to isoniazid and  streptomycin.
The dosages were adjusted, and the patient was  discharged with
instructions to take rifampin, pyrazinamide, and  ethambutol.  The
researchers conclude that the patient had a  recrudescence of TB due to
malabsorption of his medications, not  to recently acquired drug
resistance.

"AIDS: Of Mice and Men" Advocate (12/29/92) No. 619, P. 70  (Solomon,
Nancy)
     The four-year-old ban on fetal-tissue research is expected to be
lifted by President-elect Bill Clinton's new secretary of health  and
human services.  For many years researchers have been  implanting thymus
tissue from human fetuses into mice that, due  to a genetic defect, are
born without an immune system.  Such  mice have successfully developed
human immune systems and can  therefore be infected with HIV.  The mice
are called SCID-hu, for severe combined immune deficient with a human
immune system.   Proponents say the research will pave the way for
thymus  transplants that could bolster the immune systems of AIDS
patients.  Fetal tissue research provides unique advantages  because the
immature cells grow fast once transplanted and have  less chance of
rejection than adult organs.  The ban on fetal  tissue thwarted research
on thymus transplants in AIDS patients.  In 1987, John Dwyer reported in
the Archives of Internal Medicine that he had transplanted thymus tissue
into 15 people in the late stages of AIDS.  A total of 8 of the subjects
experienced a  temporary repopulation of T cells.  He said that he
doubted the  transplants would replenish the immune system but using the
transplants along with a virus-blocking agent deserves additional study.
Some scientists say that it will take genetic engineering for thymic
transplants to be effective.  But Joseph Rossi, a  molecular geneticist
with the Beckman Research Institute at City  of Hope, California, said,
"If they have AIDS and you put in  naive cells, they're attacked by HIV.
You could do an immune  reconstitution if you could genetically alter
the naive cells to  be resistant to HIV.  That's the only way to do it
in my mind."