From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 1/6/93
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6721
Organization: unspecified
Date: Wed, 6 Jan 93 07:44:40 PST

                       AIDS Daily Summary
                         January 6, 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 

 "New Definition for AIDS Arrives, Bringing New Concerns" New York Times 
(01/06/93), P. B3  (Navarro, Mireya)
     The new federal definition of AIDS is prompting New York health  
officials and AIDS advocates to debate over how to guarantee not  only 
an accurate count of new AIDS cases, but also  confidentiality and 
timely medical treatment for infected  patients.  The new definition, 
which went into effect New Year's  Day, is expected to almost double the 
number of new cases  reported nationwide this year and provide a better 
means for  health officials to track the epidemic.  However, AIDS 
advocates  are concerned the way in which the city and state keep track 
of  those AIDS cases might prevent some infected individuals from  
obtaining treatment.  These advocates worry that current  proposals will 
endanger the confidentiality of patients and  discourage them from 
seeking care.  State health department  officials claim that they are 
developing regulations to establish a new reporting system and that they 
do not expect to implement  any changes until at least next month.  
State and city officials  are calling for laboratories that test blood 
to identify new  cases, instead of relying on hospitals and doctors as 
they have  done in the past, because these tend to be less thorough.  
Mark  Barnes of the New York City Department of Health said that the  
current system, in which health care facilities and doctors  report AIDS 
cases to health departments, which then report them  to the Centers for 
Disease Control, misses about 17 percent of  actual cases.  This 
indicates that the city is losing federal  money for AIDS that is 
allocated on the basis of need.  Officials insist that the new method 
will not bypass doctors, who are still needed to confirm that patients 
are infected with HIV. 

"MedImmune Shares Fall 17 Percent on Merck's AIDS Drug Review" Wall 
Street Journal (01/06/93), P. B6
     Stock shares for MedImmune dropped more than 17 percent yesterday 
after the biotechnology company revealed that Merck + Co. is  reviewing 
whether to continue a collaboration on a potential AIDS vaccine.  
However, MedImmune executives said the market  overreacted to the news.  
MedImmune said late Monday that  unexpected discouraging results in 
animal laboratory studies have prompted Merck to reexamine the 
development program for the AIDS  vaccine, MEDI 488.  MedImmune added 
that Merck will decide within the next two months whether to continue 
the program.  Merck would not comment on the matter, citing its policy 
of declining comment on research that hasn't been published in peer-
reviewed journals. MedImmune closed at $19.25, off $4, in national over-
the-counter  trading.  Merck shares were quoted at $43.125, down 75 
cents in  late trading on the New York Stock Exchange.  MedImmune  
executives said that the uncertainty over the future of MEDI 488  
apparently caused investors to ignore two promising developments  that 
the company disclosed regarding later-stage products. 

"Condoms for Everyone?  Hardly" Chicago Tribune (01/05/93), P. 2-1  
(Precker, Michael)
     Despite increased AIDS awareness and greater availability of  
condoms, the U.S. condom industry is not growing significantly.   Sharon 
Sullivan, sales administration manager for Ansell, which  makes the 
Lifestyles condom, said, "The market as a whole seems  to be pretty 
static.  Our sales are growing, but it's chipping  away at other 
brands."  She added that, "A lot of people still  have the mentality 
that 'nothing can happen to me.'"  Condom  industry officials state that 
condom use escalated in the mid-  and late 1980s, but leveled off.  
Today it is difficult to  assemble a solid set of sales figures because 
of free condom  distribution programs, mail-order sales, vending 
machines, sexual paraphernalia shops, and other unconventional 
retailers,  including discount sales.   Information Resources Inc., a 
Chicago market research company, found that overall condom sales  
increased 5 percent in 1992, after rising 9 percent in 1991.   However, 
A.C. Neilsen Co., which also tracks the industry, said  that the 
increase was one percent in 1992, after a 4 percent  decrease in 1991.  
Both research companies used only store-bought condom data.  As the 
figures differ, so do interpretations of  what they may indicate.  Jane 
Johnson, vice president of Planned  Parenthood Federation of America, 
said that although there is  more AIDS awareness there really hasn't 
been a significant change in people's sexual behavior.  She cites 
teenage pregnancy rates,  steady increases in sexually transmitted 
diseases among teens and HIV infections among heterosexuals, plus a 
survey showing that  millions of people still partake in unprotected 
sex. 

"In Prison for Being a Haitian With HIV" Chicago Tribune (01/05/93), P. 
1-11  (Quindlen, Anna)
     It would make more sense for the United States to incarcerate  
people who commit crimes, rather than refugees infected with HIV, writes 
columnist Anna Quindlen.  Silieses Success, a Haitian  refugee, gave 
birth to her first baby while detained at  Guantanamo Bay, Cuba.  Not 
knowing that she was infected with  HIV, Success passed the virus on to 
her baby, who later died.   She has been put in prison, despite the fact 
that she has been  charged with no crime.  She is in jail only because 
she is HIV  positive, contends Quindlen.  Success' son died at Walter 
Reed  Hospital in Washington, D.C., where he and his mother had been  
sent from Guantanamo when his health deteriorated.  But afterward 
Success became somewhat of an immigration problem.  Because the  United 
States is one of the few countries that excludes  HIV-positive 
foreigners as public health risks, her blood test  made her inadmissible 
for entry.  However, she was already in the country, and had a case for 
political asylum because her parents, who supported the ousted President 
Jean-Bertrand Aristide, were  murdered.  The United States is 
insensitive to these Haitians and considers them faceless black 
problems, says Quindlen.   President-elect Clinton has vowed to change 
the policy that  repatriated Haitians without determining whether they 
had  legitimate cases for asylum, and has said that he will eliminate  
HIV infection as a barrier to immigration.  Yet Success will have to 
wait.  She should be set free for both her own sake and for  ours, so 
that we can imprison people who do wrong, instead of  those who are 
merely ill, concludes Quindlen.

"Federal Judge to Consider Renaming AIDS Suit Against Magic  Johnson" 
United Press International (01/05/93)
     Kalamazoo, Mich.--A federal judge will determine Wednesday  whether 
to replace Magic Johnson's fake name, "Richard Roe," with his real one 
in a lawsuit against him.  The suit was filed by an  East Lansing woman 
last October who claims that Johnson infected  her with HIV.  The woman, 
known in the suit as "Jane Doe," sued  on behalf of herself and daughter 
"Infant Doe."  She said that  Magic Johnson infected her during a one-
night stand in 1990.  The woman claims she wrote Johnson a letter in 
August 1992 about her  accusation, according to an affidavit filed with 
U.S. District  Judge Richard Enslen.  Johnson filed his own affidavit, 
stating  that he is Richard Roe but denying any memory of receiving the  
woman's letter.  Johnson objects to the woman's request to  retitle the 
suit with his name but not hers.  His attorneys argue in court documents 
that if he is publicly added to the case  title, the woman should be as 
well.  Lawyers for both sides blame the each other for revealing 
Johnson's identity to the news  media. 

"New Software Available for Physicians' Offices and  Community-Based 
Research" AIDS Treatment News (12/18/92) No. 165, P. 4  (James, John S.)
     A medical-office and research software system is now available  for 
community-based research organizations and for  medical-records 
management in physicians' offices and clinics.   The system, called 
Medsys, was developed over the last five years by the nonprofit National 
Community Research Initiative (NCRI).   Medsys is easy to use--it 
automates the maintenance of patients'  charts, produces custom patient 
flowsheets on demand, and assists in other functions including 
prescriptions, laboratory,  specialists and referrals, and scheduling.  
The system keeps  almost all patient data in a compatible, computerized 
form so  that records can be combined from different practices and 
clinics for retrospective studies.  In addition, it greatly cuts the 
work of identifying patients within a practice who are eligible for a  
prospective clinical trial.  Medsys operates on a local area  network of 
DOS computers.  Also, physicians can access the system by telephone from 
home, or by portable computers while traveling, giving them complete 
access to patient records in an emergency,  even during nights or 
weekends.  The system is sold commercially  by Medical Office Management 
Systems (MOMS), a for-profit group.  MOMS sells Medsys for $25,000, 
which includes installation and  training, with an annual $2,500 
additional maintenance fee.  This does not include the cost of the 
computers that need to be  purchased before installation. 

"A Controlled Trial of Trimethoprim-Sulfamethoxazole or  Aerosolized 
Pentamidine for Secondary Prophylaxis of Pneumocystis Carinii Pneumonia 
in Patients With the Acquired Immunodeficiency  Syndrome" New England 
Journal of Medicine (12/24/92) Vol. 327, No. 26,  P. 1842  (Hardy, W. 
David et al.)
     Trimethoprim-sulfamethoxazole is more effective in treating AIDS  
patients who are taking AZT than aerosolized pentamidine in  
conventional doses for the prevention of recurrent pneumocystis  
infection, write W. David Hardy et al. of the National Institute  of 
Allergy and Infectious Diseases in Bethesda, Md.  The  researchers 
conduced a comparative, open-label trial between July 25, 1988 and 
November 27, 1990 in 310 adult AIDS patients who had recently recovered 
from an initial episode of PCP and had no  treatment-limiting toxic 
effects of trimethoprim-sulfamethoxazole or pentamidine.  All of the 
patients were treated with AZT and  were randomly assigned to receive 
either 800 mg of  sulfamethoxazole and 160 mg of trimethoprim once daily 
or 300 mg  of aerosolized pentamidine administered every four weeks by 
jet  nebulizer.  There were 14 recurrences of PCP in the  trimethoprim-
sulfamethoxazole group, as compared with 36  recurrences in the 
aerosolized-pentamidine group.  The projected  recurrence rates at 18 
months were 11.4 percent with  trimethoprim-sulfamethoxazole and 27.6 
percent with pentamidine.  The risk of a recurrence was 3.25 times 
higher in the pentamidine group.  There were no significant differences 
between the groups  in survival or in hematologic or hepatic toxicity.  
There were 19 serious bacterial infections in the trimethoprim-
sulfamethoxazole group and 38 in the pentamidine group.  A policy of 
selecting  trimethoprim-sulfamethoxazole whenever possible may reduce  
morbidity, frequency of hospitalization, and medical care costs,  the 
researchers conclude. 

"Rapid HIV Tests: Two for the Price of One" Lancet (12/19-26/92) Vol. 
340, No. 8834/8835, P. 1541   (Zhang, Xiang et al.)
     Rapid HIV tests can be reused after testing samples that do not  
contain antibodies to HIV, write Xiang Zhang et al. of the  University 
of Maryland School of Medicine in Baltimore.  Two  panels of 60 HIV 
confirmed positive and 40 HIV negative sera from individuals in the 
United States and Central Africa were tested  with two rapid HIV assays 
immediately after testing of HIV  negative samples by the same device.  
Assays included the SUDS  (Murex) and Genie (Genetic Systems) 
microparticle filtration  tests.  Both tests incorporate mixtures of 
viral lysates and  synthetic peptides of HIV, and are done in 10 minutes 
or less.   Both tests accurately detected all HIV positive and negative  
sera, even though the devices had been used before to test HIV  negative 
samples.  Also, reactivities were equivalent to those  obtained with the 
devices used once only.  But the SUDS test  required that the reaction 
time be extended to 4 minutes rather  than the recommended 2 minutes 
when testing samples only once.   Each device can be used up to five 
times (SUDS) with negative  sera and still adequately detect positive 
sera.  Reusing rapid  test devices provides substantial savings, 
potentially decreasing the cost by at least half.  This savings would be 
best achieved  when testing samples from a low-risk population, in which 
most  samples are negative.  However, the reuse of cartridges still  
requires extra use of kit reagents, and will not result in  significant 
savings unless excess reagents are supplied.  The  performance must be 
confirmed with a larger number of samples  from both high-risk and low-
risk populations before the use of  these devices for re-testing can be 
considered fully, the  researchers conclude. 

"Reliability of Western Blotting for the Confirmation of HIV-1  
Seroconversion" Lancet (12/19-26/92) Vol. 340, No. 8834/8835, P. 1541   
(Simon, Francois et al.)
     Western blotting (WB) lacks sensitivity during seroconversion and 
should no longer be considered the gold standard for serological  
diagnosis of HIV infection, write Francois Simon and colleagues  of the 
Hopital Bichat-Claude Bernard in Paris, France.  The  researchers 
followed the timing of seroconversion in 27 patients  between April 1990 
and October 1992.  In eight of these, all of  whom had symptoms, the 
first available serum samples were  negative by WB, but contained 
neutralizable p24 antigen or were  repeatedly positive with at least one 
EIA test, or both.  A total of 10 of the 11 samples were positive for 
p24 antigen; the other  sample remained negative after acid 
dissociation.  Later  sequential samples from these eight patients 
showed a  characteristic seroconversion pattern in WB.  Among the two 
first generation EIA tests, neither was positive, and the  second-
generation tests based on recombinant antigens were  positive in only 
one patient.  Both second generation tests based on synthetic peptides 
were positive in three patients.  The third generation tests were highly 
sensitive since both were positive  for 6 of the 11 samples, and gave 
reproducible overflow  reactivity in 2 of these.  Three samples remained 
negative with  all EIA tests; the only marker of infection was serum p24  
antigen; the EIA antibodies tests became positive only after 1,  4, and 
5 days.  The detection and confirmation of HIV-1 infection should be 
based on the use of several EIA tests, together with  the detection of 
p24 antigen during the initial phase of primary  HIV-1 infection, the 
researchers conclude. 

Newsgroups: sci.med.aids