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Health InfoCom Network News                                            Page 15
Volume  6, Number  1                                          January 13, 1993
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                                    Columns
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"Prevalence of HIV-Infected Syringes During a Syringe-Exchange  Program" New
England Journal of Medicine (12/24/92) Vol. 327, No. 26,  P. 1883  (Heimer,
Robert et al.)

     A needle-exchange program can significantly reduce the rate of  HIV-1
infection among IV-drug users, write Robert Heimer et al.  of the Yale
University School of Medicine in New Haven, Conn.   The researchers evaluated
a needle-exchange program in New Haven  operated by the city's health
department.  The program allows  IV-drug users four opportunities a week to
exchange their used  syringes on a one-for-one basis for clean, attached
syringe-needle combinations.  The syringes returned were tested  with the
polymerase chain reaction for HIV-1 proviral DNA as  proof of use by an HIV-
positive IV-drug user.  Before the start  of the program, the rate of infected
needles was determined for  two sources.  A total of 160 syringes not
distributed through the program that were returned as the program began were
randomly  selected and tested.  The rate of HIV-1 in these needles was 68
percent.  Another 180 syringes returned through an illegal  exchange that
operated once a week were tested and had a  prevalence of infection of 63
percent.  Between Nov. 14, 1990,  and December 31, 1991, the researchers
tested 1860 randomly  selected needles distributed through the needle-exchange
program. At first, the rate of HIV-1 proviral DNA was not different from  that
in the 160 needles tested before the program began.  But by  the third month
of program operation, the rate had fallen to 57  percent.  In subsequent
months, the rate stabilized, approaching  a steady-state level of 43 percent.
The researchers found no  changes in the demographic characteristics or drug-
use habits of  newly enrolled clients that could account for the reduction in
the rate of HIV-1 proviral DNA in the needles.

******************************************************************

                              AIDS Daily Summary
                    December 21, 1992  --  January 8, 1993

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

 "Drug May Help Slow Progression of AIDS, Early Studies Suggest" Wall Street
Journal (12/21/92), P. B7

     The onset of AIDS may be slowed by the drug thymopentin when  used in
combination with AZT, according to Immunobiology Research  Institute, a
Johnson + Johnson unit.  The data on thymopentin,  also known as TP5, is
currently being discussed by the company  and the Food and Drug
Administration.  Marcus Conant, a San  Francisco AIDS physician, said the
study followed the progress of 173 patients who received AZT plus TP5, and 179
who were  administered AZT plus a placebo.  Patients were subsequently
observed for development of AIDS, from a state of being  asymptomatic to AIDS-
related complex (ARC), from ARC to AIDS, or  from AIDS to death.  Dr. Conant
said that after 48 weeks three  people in the TP5 group had worsened, while 16
people in the  control group had worsened.  A company spokesman said TP5 is a
synthetic hormone that imitates the active portion of the natural hormone
thymopoientin, which is believed to incite the body's  immune system.  The
drug, which is given as an injection three  times a week, has the advantage of
low toxicity in patients who  receive it, said Dr. Conant.  Tests are
continuing on TP5 in an  attempt to determine whether giving the immune-
booster can, in  fact, stabilize patients.  The early findings are promising,
but  far from conclusive, said Dr. Conant.

"Detection of HIV-1 DNA Sequences in Pre-Ejaculatory Fluid" Lancet (12/12/92)
Vol. 340, No. 8833, P. 1469   (Ilaria, Gerard et al.)

     A significant proportion of HIV-1 positive men will have  detectable
levels of HIV-1 DNA sequences in pre-ejaculatory  fluid, write Gerard Ilaria
et al. of the New York  Hospital-Cornell Medical Center in New York, N.Y.  The
researchers conducted a study involving 14 HIV-1-positive men and 2 HIV-
negative controls who provided pre-ejaculatory fluid  specimens.  The
specimens consisted of 100-500 ul viscous fluid  with white blood cells (WBC)
and occasional epithelial cells, but no spermatozoa, although no man was
azoospermic.  Specimens from  6 of the 14 men (43 percent) tested repeatedly
positive for HIV-1 DNA sequences in pre-ejaculatory fluid.  Negative controls
tested repeatedly negative.  Mean age and serum CD4 counts were not
significantly different for men who tested positive or negative  for HIV-1 DNA
sequences in pre-ejaculatory fluid.  Ejaculated  semen is produced by the
prostate, seminal vesicles, vasa  deferentia, epididymides, and testes,
whereas pre-ejaculatory  fluid is produced by the urethral and bulbourethral
glands.  The  role of these glands is unknown, but may be related to
prevention of urogential infection--suggested in part by the finding of
lymphoid cells in the mucosa of the bulbourethral glands.   Seminal fluid
contains measurable amounts of HIV-1 DNA and RNA,  thought to be predominantly
linked with WBC fraction as well as  cell-free seminal fluid.  The anatomical
source of HIV-positive  WBC in seminal fluid is unknown.  The researchers
conclude that  the WBC in pre-ejaculatory fluid contributes to HIV-1
transmission.

******************************************************************

 "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.

******************************************************************


"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.

******************************************************************

"Unimed Wins FDA Approval on AIDS Drug" Chicago Tribune (12/23/92), P. 3-3
(Morris, Steven)

     The Food and Drug Administration granted approval Tuesday to the
marketing of Marinol, a drug that fights the weight loss experienced by AIDS
patients.  The FDA granted Unimed Inc. of Buffalo Grove, Ill., approval under
the orphan drug provision, which allows the company to have exclusive
marketing rights to this specific use for seven years.  In the 1980s, the
orphan drug law was passed to encourage firms to develop drugs for ailments
suffered by small numbers of patients.  Unimed has marketed Marinol since 1985
as a treatment for nausea and vomiting in chemotherapy patients.  Scott
Broder, senior vice president of sales and marketing, said, "Sales will grow
rapidly now that it's spread out through the growing field of AIDS."  The
drug, which stimulates the appetite, "offers a means for AIDS patients to
wenhance the quality of their lives," he said.  The active ingredient in
Marinol is a synthetic marijuana agent called delta-9-tetrahydrocannibinol
(THC).  A physician must prescribe the treatment, which is taken in capsule
form. Related Story: Journal of Commerce (12/24) P. 7A

******************************************************************

"Men's Disclosure of HIV Test Results to Male Primary Sex Partners" American
Journal of Public Health (12/92) Vol. 82, No. 12, P. 1675  (Schnell, Daniel J.
et al.)

     Although it is believed that undergoing HIV testing leads to disruption
of an important relationship and may discourage men  from being tested, an
encouraging rate of disclosure of  serostatus and a low rate of relationship
disruption has been  found, according to Daniel J. Schnell et al. of the
Centers for  Disease Control in Atlanta, Ga.  The researchers examined
disclosure of HIV antibody status to a main sex partner and the impact on the
relationship in men who have sex with men and who are enrolled in the AIDS
Community Demonstration Projects cohorts.  Between 1987 and 1990, 1,684
participants had made an initial visit and first return visit to one of four
sites: Dallas, Texas; Denver, Colo.; Long Beach, Calif.; and Seattle,  Wash.
It was found that 89 percent of both seronegative and  seropositive men
disclosed the results to their main sex  partners.  In addition, 70 percent of
the seronegative men and 82 percent of the seropositive men who did disclose
their results reported that the relationship remained "as strong as ever"
after six months.  Most men who did not reveal their test results to their
main partner reported being "single" after six months.  The findings indicate
that more homosexual/bisexual men may get tested since there was such a low
rate of relationship disruption reported, conclude Schnell et al.

******************************************************************

"Selected Behaviors That Increase Risk for HIV Infection, Other  Sexually
Transmitted Diseases, and Unintended Pregnancy Among  High School Students--
United States, 1991" Morbidity and Mortality Weekly Report (12/18/92) Vol. 41,
No. 50, P. 945

     A significant percentage of American students engage in behaviors that
simultaneously put them at risk for HIV infection, sexually transmitted
diseases, and unintended pregnancy, write the Centers for Disease Control.
Data were collected from two school-based components of the CDC's Youth Risk
Behavior Surveillance System: state and local Youth Risk Behavior Surveys
(YRBSs) conducted by departments of education in 23 states and 10 cities
during  April-May 1991 and the national YRBS conducted during the same
period.  The survey obtained a sample of 12,272 students  representative of
students in grades 9-12 in the 50 states and  the District of Columbia.  Risk
behaviors addressed in the survey include having sexual intercourse, having
sexual intercourse with multiple sex partners, IV-drug use, not practicing
contraception, and not using condoms.  Among the participants in the state and
local surveys, 33-79 percent reported ever having had sexual  intercourse; 54-
78 percent reported being currently sexually  active; and 8-46 percent
reported having had sexual intercourse  with four or more partners during
their lifetime.  In 27 of the  28 sites, male students were more likely than
female students to  report ever having had sexual intercourse and having had
four or  more sex partners during their lifetime.  In 26 of 28 sites,  female
students were more likely than male students to report  being currently
sexually active.  In all sites, 5 percent or less of male and female students
reported IV-drug use.  Also, 28-53  percent of participants reported they or
their partner had used a condom at last sexual intercourse, the CDC concludes.

Health InfoCom Network News                                            Page 23
Volume  6, Number  1                                          January 13, 1993

******************************************************************

"Trials Set in High-Risk Populations" Science (12/11/92) Vol. 258, No. 5089,
P. 1729  (Cohen, Jon)

     The National Institute of Allergy and Infectious Diseases  recently
announced that it is launching a trial of two preventive HIV vaccines that
will be administered to people considered to be at high risk of HIV infection
in addition to those at low risk.   Small-scale tests of preventive vaccines,
conducted over the past six years, have included only volunteers from low-risk
groups.   The placebo-controlled, Phase II trial will involve 330  uninfected
volunteers at five different university medical  centers.  The volunteers will
include drug users, people with  sexually transmitted diseases, and
minorities.  The test will  assess whether people at high risk and minorities
have different  responses from the healthy whites who dominated the earlier
trials.  NIAID's Patricia Fast, a trial coordinator, said that  some high-risk
uninfected subjects may already have been exposed  to HIV, an exposure that
might have altered their immune systems. Because the new trial will enroll
hundreds instead of dozens of  people, safety problems with the vaccines are
also more likely to emerge.  Both vaccines in the trial are genetically
engineered  versions of the HIV surface protein called gp120.  It is still
undetermined when a Phase III trial in thousands of people at  high-risk,
which is the most conclusive test of AIDS vaccine  efficacy, will take place.

 "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.

"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

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"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."

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##################################################################
Date: Sat, 23 Jan 93 22:17:30 CST
From: [e-mail] (HB)
To: [e-mail]
Subject: yet more[[e-mail]: HICN601 Newsletter Part 2/4]

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Date: 13 Jan 1993 00:26:20 -0700 (MST)
From: David Dodell <[e-mail]>
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Health InfoCom Network News                                            Page 15
Volume  6, Number  1                                          January 13, 1993
"More AIDS Patients Resistant to AZT" Washington Post (01/01/93), P. A9

     Increasing numbers of AIDS patients are exhibiting early  resistance to
AZT, and scientists claim there is an imminent need to develop new treatments
to fight HIV infection.  Wendell T.W.  Ching of the UCLA School of Medicine
conducted a blood test study which appears in Friday's edition of the
Proceedings of the  National Academy of Sciences.  He said blood tests are
indicating more numbers of AIDS patients who have never taken AZT but are
infected with a virus that is naturally resistant to the drug.   "Some of the
patients may have gotten the virus from other  patients who had been taking
AZT and who are now transmitting the resistant virus," said Ching.  He added
that earlier studies  concluded that AZT resistance was a result of long-term
use of  the drug.  But the new study shows that resistance may transpire
naturally, even in patients who have never taken AZT, and that  the resistant
virus can spread from a patient who has taken the  drug to another who had
been disease-free.  Ching said that the  increase in the AZT-resistant virus
may not have been found  earlier due to the way blood tests were conducted.
He said that  researchers typically draw blood from HIV-positive people and
then culture the sample until the population of the virus has  increased.
While this occurs, there is a change in the relative  numbers of different
strains of the HIV, which appears to hide  the dominance of AZT-resistant
strains.  Ching and his colleagues corrected the problem by drawing blood from
patients and testing  for different strains of HIV before the virus had a
chance to  grow new generations.

******************************************************************

"AIDS Vaccines: Is Older Better?" Science (12/18/92) Vol. 258, No. 5090, P.
1880  (Cohen, Jon)

     Although researchers have previously considered an AIDS vaccine  made
from attenuated virus as being far too dangerous, many are  rethinking the
conventional vaccine approach.  Several AIDS  researchers know the power of
attenuated virus vaccines, but they fear that even a weakened version of the
evasive HIV could lead  to fatal infection.  Many researchers have believed
that the only effective vaccine would be genetically engineered pieces of HIV,
but that high-tech approach isn't working well.  However, an  experiment
involving attenuated virus has reproduced some  striking results.  Ronald
Desrosiers and his colleagues at  Harvard's New England Regional Primate
Research Center vaccinated four rhesus monkeys with a weakened form of simian
immunodeficiency virus (SIV) and protected them from infection  for more than
two years.  But Desrosiers said long-term safety  concerns are worrisome.  "It
will take 10 or 15 years of safety  testing before we can be comfortable
putting this into thousands  of people."  Before the live, attenuated method
could be  seriously considered for use in humans, at least three safety
concerns would have to be addressed.  First, the HIV in an  attenuated vaccine
could revert to a virulent state.  Second,  even if the vaccine did not cause
AIDS, it might cause cancer.   And third, a virus that initially appears safe
might, decades  later, turn out to cause disease.  Philip Berman of Genentech,
a  company working on genetically-engineered AIDS vaccines, warns  that SIV is
different from HIV and that monkey data may not apply to humans.

******************************************************************

 "Tests Show Infection by AIDS Virus Affects Greater Share of  Cells" New York
Times (01/05/93), P. C3  (Kolata, Gina)

     Researchers have found that more human cells are actually  latently
infected with HIV, which helps explain how the entire  immune system is
eventually destroyed.  In 1986, it was believed  that only 1 in 1,000 white
blood cells were infected with the  virus.  But now, researchers are finding
that 10, 20, even 30  percent of white blood cells may carry HIV, in addition
to other  cells.  As a result, researchers conclude that direct infection
with HIV should be sufficient to explain the destruction of the  immune system
in AIDS patients.  The polymerase chain reaction  (PCR) can be used to examine
HIV by using enzymes to copy  fragments of genes 100,000 to a million times,
making it easier  for researchers to study.  PCR is usually performed in the
test  tube, with enzymes added to raw DNA.  But recently it became  possible
to use cells themselves as miniature test tubes, making  holes in the cells,
diffusing reagents for PCR, and letting the  biochemical reaction multiply
copies of HIV that are hidden in  the cell's DNA.  In a paper in the current
issue of the  Proceedings of the National Academy of Science, Dr. Ashley Haas
and colleagues from the University of Minnesota reported using a  variant of
PCR to examine tissue from a lung tumor taken from an  HIV-positive patient.
They discovered that as many as 15 to 20  percent of the white blood cells
surrounding the tumor were  latently infected with HIV.  Regarding drugs to
treat HIV  infection, Dr. Haas said, "I'm not sure we can ever prevent
activation."  It makes more sense, he said, to attempt to inhibit HIV when it
tries to emerge from a cell, perhaps by blocking a  crucial viral enzyme.

******************************************************************
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