From: matthew@ooc.uva.nl (Matthew Lewis)
Subject: Conference newspaper - Thursday 23 July - part 1
Note: non-commercial reproduction.
Archive-Number: 5773
Organization: Center for Innovation and Cooperative Technology, University of Amsterdam
Date: 24 Jul 92 12:45:57 GMT

Hello All,

Here is the Conference Newspaper, Thursday 23 July. This paper 
comes to you courtesy of HIVNET, a Dutch organisation that has set 
up a network of BBS systems to spread information about HIV and 
AIDS. The paper is available due to the kind cooperation of the Aids 
Congress Foundation.

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

Women criticise Curran

By Simon Rozendaal
Female activists yesterday interrupted a talk by James Curran from 
the Centers for Disease Control in the US. They shouted and waved 
banners saying: "Women don't get AIDS, they just die from it". They 
were protesting about the CDC's official definition of AIDS which, 
according to the demonstrators, excludes many women with AIDS 
from proper health care and social benefits.
Bea Hanson from ACT UP New York told World AIDS News that 
pelvic infections and cervical cancers, which she believes are 
typical opportunistic infections and cancers, are not included on 
the CDC's list of 23 opportunistic infections which qualify patients 
for a diagnosis of AIDS. "Therefore women all over the world are 
being diagnosed too late as having AIDS."
Curran agreed to listen to the complaints and followed the women 
to the ACT UP office at the conference. There he was sharply 
questioned by angry activists. A member from ACT UP Amsterdam 
told Curran that the CDC's definitions influence what happens in 
Europe, too. Most countries regard the American definitions as a 
standard. "A lot of women in Europe are dying of AIDS without ever 
getting the diagnosis because of your reluctance to change it," she 
said.
Curran responded that the CDC had plans to broaden the 
definitions to include, among other new criteria, a CD4-count of 
below 200. But this proposal had been postponed because his 
superiors in Washington DC had received 12,000 letters in protest. 
Curran said: "These were letters from you or your friends, saying 
that we should not change the definitions until we have free 
medical care in the US, and it made the administration conclude 
that there obviously was no consensus." 
Curran predicted that the problem of the definition will require a 
national consensus meeting of health authorities in the US. Such a 
meeting would have to wait till after the presidential elections in

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

Costs of AIDS 

By Janis Kelly
The costs of caring for people with HIV or AIDS are rising faster 
than had been anticipated, and resources for fighting the epidemic 
- particularly funding for prevention programmes - are not keeping 
pace. 

Dr Fred Hellinger of the US Agency for Health Care Policy and 
Research told the session on Measuring and Modelling Economic 
Impact that the cumulative cost in the US of treating everyone with 
HIV is expected to rise 48%, from US$10.3 billion to US$15.2 
billion, between 1992 and 1995. This increase will be due both to 
the rise in number of cases of AIDS and HIV infection and to 
increased use of services by those people. 
Hellinger's 1992 data, which are the most recent available 
anywhere, show that the yearly cost of treating a person with AIDS 
(PWA) in the US rose from US$32,000 last year to US$38,300 this 
year. The average cost of treating HIV without AIDS rose from 
US$5,100 to US$10,000. Hellinger said that the two main reasons 
were a dramatic increase in use of outpatient services and the 
arrival of several new and very expensive drugs, such as G-CSF for 
neutropenia (US$1,000 per week), erythropoietin for anaemia 
(US$200 per week) and ddI (US$40 per week).
Hellinger said: "The use of outpatient services is much higher than 
we expected, with PWAs having 31 visits per year and 
asymptomatic individuals with HIV having 25 visits per year. 
Furthermore, at any given time, an asymptomatic HIV-infected 
patient takes an average of three medications, and a PWA takes 
eight. US health budget decisions are being made on the basis of 
data from 1989 or 1990, and this is inadequate. Our data show that 
a PWA in the US may easily be spending US$3,000 or US$4,000 
per month just on drugs."
Dr Daniel Tarantola of the Harvard School of Public Health in 
Boston put these vast sums in a more global context. Tarantola said 
that the yearly costs for treating a PWA ranged in 1991 from 
US$32,000 in the US to US$393 in subSaharan Africa. Tarantola 
and associates in the Global AIDS Policy Coalition estimate that the 
total annual cost for caring for PWAs is now somewhere between 
US$2.6 billion and US$3.5 billion. Although more than half of these 
people are in Africa, only 1.5-2% of money for direct care is spent 
there.    
Funds available for prevention are even more unbalanced. 
SubSaharan Africa has 60% of the HIV-infected people in the world 
but accounts for only 2.8% of the US$1.2 billion spent on AIDS 
prevention programmes in 1990-91, Tarantola said. Asia, with 
more than half of the world's total population, accounts for less 
than 1% of the expenditure on prevention programmes. 
Tarantola added: "This does not take into account the unmeasurable 
costs - the cost of fear, anger and grief. The cost of inequity and 
discrimination. The cost of premature death. And the long-term 
cost of a pandemic which does not receive the attention it 
deserves."
To illustrate the latter point, he said that while the global direct 
costs of AIDS prevention, care and research in 1991 were less than 
US$7.6 billion, global military expenditures were US$923 billion, 
global health expenditures were US$824 billion, and tobacco 
company earnings were US$15 billion.
Tarantola's study also established that annual per capita gross 
national product (GNP) is a good proxy for the annual inpatient and 
outpatient costs of caring for PWAs. Costs ranged from 83% of per 
capita GNP in Thailand to 153% of per capita GNP in the US.

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

Scientists half agree with Salk's vaccine 

By William Check
Scientists here agreed with one part of Jonas Salk's theory for an 
anti-HIV vaccine, described in yesterday's edition of World AIDS 
News - his emphasis on cell-mediated immunity. But none was 
willing to go along with Salk in saying that a successful vaccine 
must block the humoral response. 
Jay Levy, of the University of California, San Francisco, said: "We 
knew from the start that cellular immunity is extremely important, 
particularly in this disease where virus-infected cells carry the 
infection. Not everyone appreciates that. Jonas Salk can give it the 
emphasis it needs." 
Levy said that Gene Shearer of the National Institutes of Health had 
also suggested yesterday that the TH1 response alone (see 
yesterday's paper for explanation) would be completely protective. 
"But that's a big leap," Levy said. 
Emilio Emini, of Merck Sharp & Dohme Research Laboratories, 
said: "A prophylactic HIV vaccine must elicit an immune response 
that will prevent establishment of long-term persistent infection." 
This probably means completely preventing viral replication. "To 
my mind, the only arm of the immune system that can do that is 
the humoral response." 
The vaccine must establish a strong standing immune response, 
because memory cells cannot react quickly enough, Emini added. 
Robert Redfield, of the Walter Reed Army Institute for Research, 
said that Salk's idea is "not anything new. Lots of us recognise the 
importance of TH1 and TH2." Asked about Salk's idea that a vaccine 
must block the TH2 response, Redfield said: "I don't agree with 
that at all." He has been testing a vaccine in HIV-positive people 
that provokes both cellular and humoral immunity. Vaccine 
recipients have had stable T cell numbers for more than three 
years. "How many patients [who have received Salk's inactivated 
virus vaccine] are still alive and have T4 cells above 400?" Redfield 
asked. 
A vaccine that protects against a retrovirus that fatally infects cats, 
feline leukemia virus, behaves like Salk's proposed vaccine in that 
no neutralising antibody appears, said William Haseltine, of 
Harvard's Dana Farber Cancer Institute. "But I don't think that's 
going to be the case for HIV," he said. He thinks there will be a role 
for   humoral immunity in protecting against HIV. "We know that 
you can protect chimpanzees against homologous strains [of 
retrovirus] by vaccines that produce high antibody," Haseltine said. 
"The same is true for SIV." 

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

Crack jacks up HIV risk

By William Check
Smoking crack promotes transmission of HIV, according to results 
presented at yesterday's session on Alcohol, Other Drugs and HIV 
Infection.
Brian Edlin, of the Centers for Disease Control in the US presented 
data for street youths aged 18 to 29 in San Francisco, Miami and 
New York City. Gay males and IV drug users were excluded. Those 
who smoked crack were three times more likely to be seropositive 
than those who did not (17% against 6%).
Two behaviours were related to increased seroprevalence among 
crack smokers. One was whether the person had ever received 
money or drugs for sex. Secondly, seropositive crack smokers were 
more likely to have genital ulcers through which the virus could 
enter.
In a second study, Sander Genser of the National Institute on Drug 
Abuse presented data on crack smokers in eight American cities. 
She found that in sex-for-money-for-crack exchanges, "compulsive 
drug use" caused all money to be spent on drugs. Women who 
engaged in sex for crack ormoney were desperate for drugs and 
would have sex for very small units of crack.  
Oral sores made these women even more vulnerable to HIV 
infection. The seroprevalence rate was about 10%. Genser says this 
population needs to be specially targeted for interventions.

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

Blood screening too costly for some nations

By Wim Zeijlemaker
It seemed as though transfusion-associated AIDS could become a 
thing of the past once HIV-antibody screening became available in 
the mid-1980s. But HIV infection from transfusions continues to be 
a problem, especially in developing nations, participants heard at 
Monday's session on transmission of HIV through blood and blood 
products.
Scott Holmbert of the Centers for Disease Control (CDC) in the US 
said that the CDC has revised its figures for the numbers of people 
infected from blood which had been screened between 1985 and 
1990 from 4.8% to 0.5%, making the overall risk of acquiring HIV 
from screened blood about 1 in 225,000 donations. 
The main problem in industrialized countries is the interval after 
infection but before antibody can be detected; the so-called 
"window period". Lyle Peterson of the CDC said the average time 
from infection to detectable antibody is about      45 days. 
Because of this lag, interviews to discourage potential donors at 
high risk have been introduced. However, there has been concern 
that donors may be reluctant to disclose their risks in face-to-face 
interviews. 
Steven Locke of Harvard Medical School in Cambridge, US, found 
that "interviews" conducted by computer were more reliable than 
personal interviews. In India, systems for discouraging potential 
donors at high risk in India proved unacceptable, because if all 
donors reporting high-risk criteria were eliminated, up to 32% of 
donors would be unsuitable. 
Blood screening programmes in the developing countries face 
financial and technical barriers, said Dr Heessen of Bugando 
Medical Center in Tanzania. In Heessen's field trial of the accuracy 
of rapid screening kits in small clinics in Africa, he found that 
Immunocomb, HIV-Chek and Testpack compared favourably with 
tests by ELISA and Western Blot carried out on the same blood 
samples in the Netherlands. 
However, Ybe Smit, who works at a rural mission hospital in 
Tanzania where there are 2,000 transfusions a year, found that HIV-
Chek gave a 50% false-positive rate. Smit said that kits were still 
difficult to obtain, expensive (at $3.00 each) and often arrived after 
their expiry date. Blood supplies in Asian countries are heavily 
reliant on paid donors drawn from high-risk populations. According 
to Dr Bhimani of the Indian Health Organization in Bombay, HIV 
incidence in this population has been found to be as high as 86%. 
In 1989, 75% of the blood products manufactured in India were 
HIV-positive, Bhimani said.

-- 
Matthew Lewis, University of Amsterdam		Grote Bickersstraat 72
+31-20-52 51 220				1013 KS  Amsterdam
Internet: matthew@ooc.uva.nl			The Netherlands
Newsgroups: sci.med.aids