From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 10/5/92
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6276
Organization: unspecified
Date: Mon, 5 Oct 92 07:49:19 PDT

B.                         AIDS Daily Summary
                         September 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 
************************************************************************
 "Feasibility of AIDS Vaccine in Doubt" Chemical and Engineering News 
(09/21/92) Vol. 70, No. 38, P. 17
     Attempts to develop a vaccine against HIV are destined for  
failure, according to Albert B. Sabin, the now-retired  microbiologist, 
who developed the oral polio vaccine.  Sabin says AIDS vaccine research 
neglects the fact that HIV-specific  neutralizing antibodies and cell-
mediated immunity-- which  vaccines stimulate--are ineffective against 
HIV-positive cells  that do not carry viral antigens on their surfaces.  
These cells, which are abundant in human semen and blood, have been 
found to  be key players in the transmission of HIV.  Because the most  
common and efficient form of HIV transmission is by receptive  anal 
intercourse, studies of candidate AIDS vaccines in which  inoculated 
animals are challenged by intravenous administration  of virus or HIV-
positive cells are meaningless, contends Sabin.   During this type of 
intercourse, colorectal cells are probably  infected directly by HIV-
positive white blood cells, he says, and neither antibodies nor cell-
mediated immunity can safeguard  against infection.  "The available data 
provide no basis for  testing any HIV vaccine in human beings either 
before or after  infection," writes Sabin.  He indicates that the 
biggest  challenge facing AIDS researchers is to find ways to identify 
and kill HIV-positive cells without harming normal cells. 

"Pediatric AIDS Studied at Adults' Expense" Washington Post (10/05/92), 
P. A1  (Gladwell, Malcolm)
     The National Institutes of Health is redirecting AIDS research  
funds from adults with the disease to children with AIDS.   
Consequently, pediatric AIDS now accounts for about 40 percent of the 
federal budget for testing new AIDS treatments, even though  less than 2 
percent of the nation's 230,000 AIDS patients are  children.  NIH 
spending on new AIDS drugs for children is now 34  times as high per 
patient as for adults.  As a result of the new  funding allocations, 
medical facilities treating adult AIDS  patients have experienced 
significant reductions in their  budgets.  The diversion of funds 
signifies the new political  clout of the pediatric AIDS lobby, in 
addition to Congress' far  greater enthusiasm for funding research to 
benefit children  instead of drug users or gay men, who comprise the 
majority of  the AIDS population.  However, this shift, which was 
mandated by  Congress two years ago, has prompted sharp criticism from 
many  AIDS researchers and NIH officials.  According to critics, the  
way in which AIDS affects adults and children is so different  that new 
drugs have to be tested separately in each population,  and taking money 
out of adult programs to fund children's  programs only impedes efforts 
to find effective new drugs for the vast majority of AIDS patients.  Dr. 
Anthony S. Fauci, head of  the NIH's AIDS research effort, said, 
"Pediatric AIDS research is important.  But I think the balance of our 
spending on it is  disproportional.  You just have to look at the 
numbers." 

"Schools Grapple With AIDS Issues" Christian Science Monitor (10/05/92), 
P. 12  (Walters, Laurel Shaper)
     The level of urgency and controversy over AIDS education in  public 
schools has risen significantly since the epidemic  started.  Debra 
Haffner, executive director of the Sex  Information and Education 
Council of the United States in  Washington, D.C., said, "The AIDS 
epidemic has caused a  willingness on the part of school systems and 
parents to be more  explicit with young people rather than less."  
Surgeon General C. Everett Koop recommended in 1986 that all public 
schools in the  nation establish AIDS education "at the lowest grade 
possible."   Currently, 34 states mandate AIDS education, while 14 
states  encourage it.  But across the country, parents, teachers, and  
AIDS educators are debating exactly how much emphasis should be  put on 
abstinence from sex as the best means to avoid HIV  infection.  In New 
York City, the board of education passed a  resolution requiring that 
all AIDS education in the city's  schools stress abstinence as the most 
effective means to avoid  HIV infection.  However, several AIDS 
educators contend that it  is unrealistic to talk to students about 
abstaining from sex.   According to a study released earlier this year 
by the Centers  for Disease Control, 72 percent of high school seniors 
say they  are sexually active.  Moreover, 94 percent of American parents  
support AIDS education and 80 percent advocate teaching students  about 
the preventive uses of condoms, according to a poll  conducted by the 
Harvard Program on Public Opinion and Health Care.

"Harvard Offers Hospital Workers AIDS Insurance" New York Times 
(10/04/92), P. 33
     Harvard University and its affiliated hospitals announced Friday  
that their 50,000 doctors, nurses, medical students, and other  workers 
would be given $100,000 if they contract HIV while  working.  The 
university predicts that the insurance program will pay an average of 
one claim a year.  Harvard officials said  because people usually stay 
healthy for several years after  infection, those claiming the insurance 
benefit would be able to  continue working and their identities would 
remain confidential.  In addition, the workers would receive the money 
as well as other medical, disability, and workers' compensation 
benefits, said the officials.  But Dr. Robert Gifford, associate dean 
for education  at Yale Medical School, said, "A hundred thousand dollars 
doesn't go too far.  It sounds great on the surface, but it's 
conceivable that it could be less than you need."  The Centers for 
Disease  Control has reported 31 cases of occupational exposure to the  
virus, while the infection of 65 others was suspected of being  job-
related.  In an employee brochure, Harvard stated industry  projections 
of the risk of occupational HIV infection for  health-care workers as 
less than 1 in 10,000.  Harvard employees  who are infected on the job 
must report any suspected exposure  and undergo HIV testing within five 
days.  Because symptoms of  AIDS take weeks to develop, the initial test 
must be  HIV-negative.  Therefore, if additional tests are positive, the  
employee is to be paid $100,000. 

"Early Detection of Antibodies to HIV-1 by Third-Generation Assays" 
Lancet (09/26/92) Vol. 340, No. 8822, P. 770 (Zaaijer, H.L. et al.)
     Third-generation assays may identify early anti-HIV responses  
while the western blot is still negative and the HIV-antigen test is 
positive, write H.L. Zaaijer et al. of the Central Laboratory  of the 
Netherlands Red Cross Blood Transfusion Service in  Amsterdam, the 
Netherlands.  Third-generation immunoassays for  detection of antibody 
to HIV have reduced the interval between  infection and antibody 
detection.  The researchers compared the  sensitivity of one second-
generation and two third generation  anti-HIV enzyme immunoassays (EIAs) 
with the results from  HIV-antigen testing and western blot.  A total of 
1,045  western-blot confirmed anti-HIV positive samples were tested with 
a detection rate of 100 percent for all three EIAs.  The  detection rate 
in 36 samples drawn from different persons in  early stages of HIV 
infection was 89 percent for the second  generation EIA and 94 percent 
for both third-generation EIAs.   The researchers discovered, by 
carefully selecting seroconversion panels that included sampling 
intervals during seroconversion of  one week or less, that both third-
generation EIAs detected  seroconversion on average 5 days earlier than 
did the  second-generation assay.  Western blot is frequently used to  
confirm HIV infection.  In six out of 10 seroconversions, one or  both 
third-generation EIAs were reactive before any band appeared in the 
western blot.  An HIV-antigen test should be performed on  third-
generation EIA positive, western blot-negative samples, the researchers 
conclude. 

"Controversy Over Definition of AIDS Cases Continues" Nation's Health 
(09/92) Vol. 22, No. 9, P. 1
     Debate between the Centers for Disease Control and AIDS activists 
over the AIDS case definition has been going on for several  months.  
Beliefs that the expanded definition would not be  available until after 
the Presidential election were spurred when officials from the 
Department of Health and Human Services  retreated from a review of the 
AIDS cases definition and when, in June, CDC Director William Roper 
delayed its release.  Currently, the issue is how the new definition 
could be expanded to more  adequately capture the fastest growing AIDS 
population in the  U.S.--women and drug users.  State and local health 
department  officials told congressional investigators that the draft  
definition will increase the number of CDC-defined AIDS cases by  36 
percent to 135 percent.  Health officials claim that the new  definition 
will more accurately specify those who are severely  immunocompromised 
due to HIV infection.  But AIDS activists claim that the CDC should 
broaden the AIDS definition to include  various clinical conditions 
found in the presence of HIV  infection, including cervical cancer or 
cervical dysplasia,  pulmonary tuberculosis and recurrent bacterial 
pneumonia.  Marion Banzhaf of New Jersey Women and AIDS Network says the 
T-cell  tests would only be performed when a health-care worker suspects  
underlying HIV-related immunodeficiency.  A patient with a T-cell count 
below 200 with recurrent bacterial pneumonia, may not  receive an AIDS 
diagnosis unless the practitioner is aware of the relationship between 
HIV and that illness, she said.

"CDC Pushes 'Obscene' Test for New AIDS Messages" Nation's Health 
(09/92) Vol. 22, No. 9, P. 5
     Public health centers that use AIDS education materials must  
submit to a new "obscene" standard in order to receive funds from 
federal sources for their projects, according to the Centers for  
Disease Control.  The CDC spends about $350 million a year on  AIDS 
education and prevention efforts--$40 million of that is  targeted at 
local community groups.  On June 15, the CDC said all educational 
materials produced by grant recipients must be  examined before local 
review panels to guarantee that they are  not obscene and do not 
"promote or encourage directly homosexual  or heterosexual activity or 
intravenous substance abuse."  The  materials must also encourage 
abstinence as the best means to  avoid HIV infection.  The new rules 
replace criteria developed in 1986 that allowed review panels to reject 
materials that are  "offensive to the majority of adults in a 
community."  A New York U.S. District Court judge in May overrode that 
standard as "vague and unconstitutional."  The Gay Men's Health Crisis, 
a New York  AIDS-service organization was involved in the case.  CDC 
Director William Roper, MD, said the use of federal tax money to produce  
materials that are locally considered obscene "is an  inappropriate use 
of the people's tax dollars." 

"Mason Says Anti-TB Efforts to Cost More Than Planned" Nation's Health 
(09/92) Vol. 22, No. 9, P. 5
     The federal government may have to spend much more money in  fiscal 
1993 than expected on attempts to control tuberculosis,  due to the 
growing number of TB cases in the U.S. and new strains of the virus that 
are drug-resistant.  HHS Assistant Secretary  for Health James Mason, 
MD, wrote in a July 2 letter to House  Energy and Commerce Health 
Subcommittee Chairman Henry Waxman  (D-Calif.) that it could cost up to 
$515 million a year to cover  efforts to control the continuing outbreak 
of TB.  Mason  indicated that he has put together a task force to combat 
the TB  problem but the Department but has yet to determine the 
"relative contributions" necessary from federal, state, and local  
governments in addressing its control.  For fiscal 1993, which  begins 
October 1, HHS has requested $40.4 million for a TB  program operated by 
the Centers for Disease Control--about $20  million more than was spent 
in fiscal 1992.

"Delay of OSHA Rule Sought" Nation's Health (09/92) Vol. 22, No. 9, P. 5
     Physicians should be given more time by the Department of Labor  to 
comply with standards to protect health-care workers against  exposure 
to HIV and other bloodborne infections, according to  doctors' groups.  
Though the rules were enacted in July,  physicians want at least six 
more months to comply with them.   The American Society of Internal 
Medicine said the current rules  are "too broad," and is looking to 
modify them.  ASIM and other  doctors' groups contend that the 
profession is attempting to deal with many regulations imposed on them 
at once.  The American  Medical Association is seeking a year-long 
delay. 

/
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