From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 11/5/92
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6415
Organization: unspecified
Date: Thu, 5 Nov 92 08:40:16 PST

                         AIDS Daily Summary
                          November 5, 1992 
 The Centers for Disease Control (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 
************************************************************************
 "AIDS Patients Taking Treatment Reins" Washington Post (11/05/92), P. 
D.C. 1  (Schneider, Howard)
     A buyer's club in Washington, D.C., is just one of many  facilities 
that have emerged in major cities in the last 10 years to help AIDS 
patients obtain drugs that have not yet been  federally approved.  The 
Carl Vogel Foundation in Northwest  Washington offered DDC a year before 
the drug received Food and  Drug Administration approval.  Anyone who 
wants the controversial drug Immunex, developed in Kenya but still 
needing FDA approval,  could likewise buy it from the foundation's small 
inventory of  pharmaceuticals, vitamins, food supplements, and herbal  
treatments.  The sales are legal and nonprofit at the foundation. 
Because the organization operates on a nonprofit basis, it also  offers 
lower prices, which is important because purchases made at the 
foundation are not covered by insurance.  Equally  important  to the 
club's small staff and clientele is that the sales are  letting AIDS 
patients take control of their treatment regimens,  instead of letting 
the medical establishment do so.  Many feel  that doctors have been too 
slow to try new ideas.  The foundation and other buyer's clubs attempt 
to bridge the gap between  "establishment" medicine and potentially 
ineffective "bootleg"  therapies by searching for new drugs that seem to 
have validity.  The clubs find ways to dispense these drugs independent 
of FDA  reviews or a doctor's willingness to write a prescription.  The  
Carl Vogel Foundation also keeps a small research library and has a 
consulting nutritionist on the staff to help clients design  their own 
therapies. 

"U.S. Investigates AIDS Researcher" New York Times (11/05/92), P. A28  
(Meier, Barry)
     A top AIDS researcher is under investigation by the Department of 
Defense after allegations that he may have exaggerated the  therapeutic 
effects of an experimental AIDS vaccine.  Dr. Robert  Redfield of the 
Walter Reed Army Institute of Research is being  probed because of 
statements he made this year that the use of  the vaccine, a protein 
known as gp-160, had lowered blood levels  of HIV in some infected 
patients, said Major Rick Thomas, a  spokesman for the Defense 
Department.  The vaccine, the first  approved by the Food and Drug 
Administration for testing in  people, is intended to help the immune 
system fight an already  established HIV-infection.  Major Thomas said 
the accusations  about Dr. Redfield were brought by fellow researchers.  
He added  that the military's inquiry will review all research performed 
by the Army on gp-160.  Initial tests demonstrated that the vaccine  was 
safe and indicated that it might stabilize the HIV-related  conditions.  
The controversy started at the International  Conference on AIDS held 
this summer in Amsterdam, where Dr.  Redfield reported lowered HIV 
levels in a small number of  patients treated with gp-160.  However, in 
August, researchers  associated with Redfield reviewed the same data and 
saw no  decrease in viral blood levels, according to a memorandum 
written at the time by Dr. William McCarthy of the Henry M. Jackson  
Foundation for the Advancement of Military Medicine in Rockville, Md.  A 
subsequent review of the same data by an Army  epidemiologist also found 
no reduced HIV levels, said Dr. McCarthy. 

"Johnson: Cut Made Difference" Washington Post (11/05/92), P. B1  
(Cotton, Anthony)
     Magic Johnson's decision to retire again from the Los Angeles  
Lakers was based on the reaction his teammates and opposing  players had 
when he incurred a cut during his last game.   Interviewed for 
Thursday's "Prime Time Live" on ABC, Johnson said that after he was cut 
above his right wrist during the exhibition game against the Cleveland 
Cavaliers in Chapel Hill, N.C., on  Friday, he "could see the fear upon 
people's faces."  Johnson  originally retired from the National 
Basketball Association a  year ago because he tested positive for HIV.  
But on Sept. 29 he  announced his return to the league.  However, in the 
last few  weeks he has been the center of controversy over how he 
acquired  HIV and the reaction of other NBA players, at least two of 
whom  have expressed concern about playing with Johnson.  The NBA  
requires any HIV-positive athlete who is cut to leave the game  
immediately, receive treatment, and stay out until the bleeding  stops.  
Johnson went back into the game wearing a wrist band  covering the cut.  
Johnson indicated that as he was being treated by trainer Gary Vitti, 
other players and writers near the Lakers  bench were seemingly "looking 
out the corner of their eyes."    Vitti disagreed and said, "I'll tell 
you exactly what happened.   One player said, 'Earvin you've got a cut 
on  your arm.'  One of  the refs looked over at him and asked, and 
Earvin said he didn't. A little later there was time out and that's when 
he saw the cut  and he was treated.  There wasn't anybody freaking out 
or  anything like that." 

"Around the World: French Blood Reform" Washington Post (11/05/92), P. 
A18
     In an attempt to end a scandal over HIV-tainted blood  
transfusions, the French government approved a bill to regulate  blood 
banks and made a move to allow ministers to face justice.   The cabinet 
approved a bill imposing rigid state regulations on  the blood bank 
system to restore public confidence in  transfusions after some 1,200 
hemophiliacs contracted HIV in 1985 from contaminated blood products.  
In addition, Prime Minister  Pierre Beregovoy said the government would 
support a  constitutional amendment that facilitates the process of 
bringing ministers to justice for offenses allegedly made while they 
held  office.  Related Story: New York Times (11/05) P. A19 

"Quebec Judge Refuses to Order AIDS Test" Toronto Globe and Mail 
(11/04/92), P. A4  (Picard, Andre)
     A Quebec Court judge has denied a request to force a man charged  
with sexually assaulting a woman to undergo an HIV test before  going to 
trial.  Judge Yvon Roberge ruled Tuesday that no law  allows such an 
order and that the Canadian Charter of Rights and  Freedoms protects the 
accused from unreasonable search and  seizure, such as an HIV test.  In 
addition, he said there is no  proof that the accused might be HIV-
positive other than the fact  that he is in a high-risk group because he 
is a prison inmate.   The Crown had defended a 46-year-old woman who was 
fearful of  contracting HIV from the accused.  Yet even a promise that 
the  AIDS test would not be used as evidence in the case was not  enough 
to convince the court.  The 28-year-old man indicted in  the case 
refused to submit voluntarily to an HIV test, claiming  it would 
infringe upon his right to be presumed innocent.  Crown  Attorney Henry 
Keyserlingk was unhappy with the ruling, but said  he hoped that the 
highly publicized legal matter would draw the  attention of legislators.  
Keyserlingk, who made the request to  the court based on the provisions 
of a 1988 provincial law  intended to guarantee that the concerns of 
victims are heard in  court, said the decision demonstrates that the law 
needs to be  updated.  He added that it is no more outrageous to demand 
an HIV test from a suspect in a sexual-assault case than it is for a  
suspect in a robbery to be fingerprinted.  The Crown Attorney  said he 
would study the ruling before determining whether to  appeal it. 

"Midwest Briefing: City Considers Tattoo Restriction" Chicago Tribune 
(11/04/92), P. 1-3
     A tattoo artist's request to work in a tavern has prompted the  
City Council of Beloit, Wis., to consider a new law regulating  
conditions under which the skin designs can be applied.  The  council 
began discussing the measure, which would license and  regulate tattoo 
parlors.  The law would call for all tattoo  artists to post a warning 
sign that tattooing has been associated with the transmission of AIDS 
and hepatitis B.  The ordinance,  based on one enacted in Green Bay, 
Wis., will need one more  reading at the council's Nov. 16 meeting 
before a vote, according to a spokesman. 

"Is Routine p24 HIV Antigen Screening Justified in Thai Blood Donors?" 
Lancet (10/24/92) Vol.340, No.8826, P.1041 (Nuchprayoon, Chaivej et al.)
     The use of the p24 HIV antigen screening in addition to  
conventional HIV testing is the best alternative for Thailand  rather 
than a donor self-exclusion program, write Chaivej  Nuchprayoon et al. 
of the Thai Red Cross Society in Bangkok,  Thailand.  The researchers 
studied the necessity of p24 antigen  testing and the conventional HIV 
tests to curb HIV infection  through transfusions.  The study arose from 
the high prevalence  of HIV-infected Thai blood donors as compared with 
blood donors  in the USA and Europe, where a lower prevalence of HIV 
antibodies indicates HIV antigen testing to be less cost-effective.  A 
total of 125,472 units of blood was studied and collected from healthy  
volunteer donors between Sept. 1, 1991, and Feb. 28, 1992.   Testing for 
HIV was done with the Abbott Commander System with  the Abbott 
recombinant anti-HIV-1 plus two-sandwich enzyme  immunoassay or the 
Wellcozyme anti-HIV-1 plus two-sandwich enzyme linked immunosorbent 
assay.  Donors who tested positive for p24  HIV antigen but negative for 
HIV tests would be called for a  repeat anti-HIV test within 3 months to 
determine if they  developed antibodies.  Among the donations screened 
for HIV, 508  were repeatedly reactive and confirmed by western blot.  
Among  the donations tested for p24 HIV antigen, 86 were initially  
reactive.  Of those, 18 remained positive after neutralization,  
representing 0.014 percent of total donations.  The rate of HIV  
infection in p24 HIV antigen tests was 1 per 18,000 donors.   Based on 
current usage of about 1 million units of blood and  blood components 
from 800,000 collections per year in Thailand,  additional p 24 HIV 
antigen screening would prevent at least 60  cases of post-transfusion 
HIV infection in the country annually. 

"Co-Trimoxazole Versus Dapsone-Pyrimethamine for Prevention of  
Pneumocystis Carinii Pneumonia" Lancet (10/31/92) Vol. 340, No.8827, 
P.1099 (Coker, Richard J. et al.)
     Alternative PCP prophylaxis regimens offering systemic protection 
from disseminated pneumocystosis and perhaps toxoplasmosis would  be 
valuable and neither twice nor three times weekly regimens of  dapsone-
pyrimethamine is sufficient, write Richard J. Coker et  al. of St. 
Mary's Hospital in London, U.K.  The researchers  compared the efficacy 
of three times weekly dapsone-pyrimethamine in both the primary and 
secondary prevention of PCP, with  co-trimoxazole three times weekly.  A 
total of 226 patients  entered the study of the trial PCP prophylaxis.  
Those  participants had a CD4 count less than 200, or symptoms of HIV  
disease.  All patients received either co-trimoxazole three times weekly 
or dapsone and pyrimethamine three times weekly.  A total  of 84 
patients received co-trimoxazole, and 142 received  dapsone-
pyrimethamine.  Prophylaxis was primary in 189 patients;  the remaining 
37 had had a previous episode of PCP.  PCP occurred in 19 patients, 17 
of whom were taking dapsone-pyrimethamine.   The study was discontinued 
after 4 months because of this  unusually large number of cases of PCP 
in the  dapsone-pyrimethamine treated group.  All seven patients  
receiving secondary prophylaxis who developed PCP were taking  dapsone-
pyrimethamine.  The researchers found that low-dose,  three times weekly 
intermittent co-trimoxazole to be the first  choice prophylactic agent.  
The 12 percent 4-month frequency of  PCP on three times weekly dapsone-
pyrimethamine indicates that  this regimen is less effective than other 
suggested PCP  prophylaxis agents, the researchers conclude. 

"Levamisole Treatment in HIV-Infected Zambian Children" Lancet 
(10/31/92) Vol. 340, No. 8827, P. 1099 (Garzon, M. Castro et al.)
     Because levamisole is the only available and affordable treatment 
in Africa, additional clinical trials are warranted for its  efficacy in 
fighting HIV/AIDS, write M. Castro Garzon et al. of  the San Francisco y 
Concepcion in Havana, Cuba.  Levamisole  reduces the frequency, 
duration, and severity of disease episodes in patients with certain 
primary immune deficiency diseases or  recurrent chronic infections.  
Therefore, levamisole should fight the immunodepressive aspects of HIV 
infection.  A single-blind  placebo-controlled trial of levamisole was 
conducted in 100  HIV-infected children aged less than 1 up to 14 years.  
Among 50  HIV-positive newborn babies, 2 became seronegative at 6 
months.   None of the patients had clinical AIDS when therapy started.   
Patients were selected so that age and immunology results were  
redistributed identically among the two groups.  Cell-mediated  immunity 
was assessed by the method of Borut et al., with  cutaneous induration 
of 4 mm diameter or less indicating impaired immunity.  The test was 
positive in a similar proportion of the  patients in the levamisole and 
control groups.  Levamisole was  administered as syrup 5 mg/ml or as 150 
mg tablets.  At the end  of the trial, the proportion of levamisole-
treated children with  a positive Borut test had increased to 53 
percent.  Mortality was substantially reduced after levamisole, as was 
the average number of infections per year.  Progression to permanent 
lymphadenopathy was 1 versus 6 cases (levamisole vs. placebo); to AIDS-
related  complex, 4 versus 13 cases; and to full AIDS, 2 versus 11 
cases.  Side effects were mild--mainly anorexia, nausea, and metallic  
taste, the researchers said. 

"Nurses, Lab Workers Report Most Occupational Infections" AIDS Alert 
(11/92) Vol. 7, No. 11, P. 167
     While various health-care workers are at risk for occupationally  
acquired HIV infection, nurses and clinical laboratory workers  comprise 
the largest percentage of cases reported to the Centers  for Disease 
Control.  Among the 31 cases of reported occupational HIV transmission, 
24 (77 percent) are either laboratory workers  or nurses.  Also, among 
the 65 reported cases of possible  occupational HIV transmission, 23 or 
55 percent are either  laboratory workers or nurses.  Dr. Carol 
Ciesielski of the CDC's  division of HIV/AIDS said, "What we have seen 
from this and other data is that, clearly, blood is the fluid that is 
the most  important for occupational transmission and most of the 
injuries  have occurred by needlesticks."  The new figures were 
presented  at the Eighth International Conference on AIDS, held recently 
in  Amsterdam.  The CDC has added a category for occupationally  
infected workers to clarify the number of such workers, and to  have 
that number in a place that is readily available to the  public, said 
Ciesielski.  Among the reported seroconversions, six workers developed 
AIDS.  According to Ciesielski, the average  time from exposure to AIDS 
progression among those workers was  just 21 months.  However, she 
emphasizes that the data should not be interpreted to indicate that 
occupationally exposed workers  progress to AIDS faster than other risk 
groups.  In addition, she says that 84 percent of the exposures were a 
result of  percutaneous injuries and 13 percent had mucocutaneous 
exposures. One worker had both a percutaneous and mucocutaneous 
exposure. 

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