From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 7/28/92
Note: non-commercial reproduction.
Archive-Number: 5795
Organization: UCLA, Computer Science Department
Date: Tue, 28 Jul 92 08:15:24 PDT

                         AIDS Daily Summary
                           July 28, 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 
Clearinghouse, or any other organization.  Reproduction of this text is 
encouraged; however, copies may not be sold.  Copyright 1992, 
Information, Inc., Washington, DC 
************************************************************************
"Dendritic Cells Exposed to Human Immunodeficiency Virus Type-1  
Transmit a Vigorous Cytopathic Infection to CD4 T Cells" Science 
(07/17/92) Vol.257, No.5068, P.383 (Cameron, Paul U. et al.)
     Dendritic cells can act as a catalyst in the transmission of a  
cytopathic infection like HIV, according to Paul U. Cameron and  
colleagues at Rockefeller University in New York, N.Y.  The  scarcity of 
infected CD4 cells in HIV-positive patients contrasts with the greatly 
reduced numbers and function of these  lymphocytes.  A pathway is 
described in which dendritic cells  carry HIV to uninfected T cells, 
amplifying the cytopathic  effects of small amounts of virus.  After 
exposure to HIV-1,  dendritic cells continue to present superantigens 
and antigens,  forming clusters with T cells that are driven to 
replicate.   Infection of the dendritic cells cannot be detected, but 
the  clustered T cells form syncytia, release virions, and die.   
Mucosal and airway dendritic cells may carry and present HIV to  
responding T cells at the same time as the T cells are activated  by 
other environmental antigens carried by dendritic cells.   Dendritic 
cells that carry HIV-1 may facilitate the lysis and  loss of antigen 
specific CD4 T cells in AIDS.  Transmission  through dendritic cells is 
more efficient than through other  antigen-presenting cells.  This may 
be due to the potency of  dendritic cells in activating large numbers of 
CD4 T cells, the  researchers conclude. 

 "C.D.C. is Embarrassed by its Tardy Response to AIDS-Like Illness" New 
York Times (07/28/92), P. C3  (Altman, Lawrence K.)
     The Centers for Disease Control considered the international AIDS 
conference in Amsterdam last week an embarrassment because they  had 
ignored two basic principles of public health--the quick  review of 
cases of a new condition to elucidate their cause and  the rapid 
communication with the public and researchers to allay  fear about the 
potential threat.  The cases involve a syndrome in which symptoms of 
AIDS appear without any detectable HIV  infection.  The panic is over 
the threat to the nation's blood  supply from what may be a new AIDS-
like virus and over how such a virus might spread.  The meeting made it 
clear that the CDC  waited too long to respond to doctors' reports of 
such cases.   Though the centers had recorded six cases over the past 
two  years, their sole report on them was presented last spring at a  
Colorado meeting with severely restricted news coverage.  The CDC 
authors, Dr. Thomas J. Spira and Bonnie M. Jones, said that "HIV  may 
not be the only infectious disease of" immunodeficiency.   However, they 
did not discover a cause, and their abstract was  not read by many 
researchers who were aware of such cases and who were aggressively 
investigating a possible new virus. Related  Story: Baltimore Sun 
(07/28) P. 3A 

"New Test May Facilitate Detection of AIDS Virus" Chicago Tribune 
(07/28/92), P. 1-6  (Campbell, Michael)
     A new method will make HIV detectable earlier and more  accurately, 
according to an announcement at meetings of the  American Association 
for Clinical Chemistry at McCormick Place.   Researchers have developed 
a test that can identify a single  HIV-positive white blood cell among 
100,000 healthy ones, by  streamlining a complex technique called 
polymerase chain reaction (PCR).  Dr. Joan Spadoro of Roche Molecular 
Systems Inc. said  that although the process still needs approval from 
the Food and  Drug Administration, she hopes it will be available in the 
U.S.  by late 1993 and this fall in Europe.  The new test uses PCR  
technology, which can form millions of copies of genetic material but 
before could only be used in specialized laboratories, and  can be 
conducted with simpler devices, increasing its  practicality for 
community-based medical centers.  The primary  benefit of PCR is that it 
permits direct testing for HIV soon  after infection.  Most conventional 
tests search for antibodies  elicited in response to the virus, but the 
antibodies may not be  detectable for up to six months after infection. 

"Rendell Frees the Way for Drug Needle Swap" Philadelphia Inquirer 
(07/28/92), P. A1  (Collins, Huntly)
     Mayor Ed Rendell of Philadelphia yesterday announced his  
endorsement of a citywide clean-needle-exchange program for  IV-drug 
users.  But in subsequent hours, the state officials  threatened to stop 
the program, claiming that could infringe upon state law banning the 
distribution of drug paraphernalia.  Kathy  Liebler, spokeswoman for the 
Pennsylvania Department of Health,  said, "The action the city has taken 
appears to be a violation of the Controlled Substance, Drug Device, and 
Cosmetic Act, and we  are looking at options for enforcement."  She did 
not give  details on the exact options, including the possibility that 
the  state would arrest AIDS activists who expect to give out clean  
needles in exchange for tainted ones this Saturday in Kensington. ACT-UP 
members have quietly conducted needle swap programs there  every 
Saturday since November; they distribute clean needles,  bleach kits, 
condoms, and literature about AIDS and drug  treatment programs to some 
300 IV-drug users.  Rendell's'  executive order calls for the city 
government to officially  advocate needle exchange, thus permitting it 
to expand to other  locations in the city.  The city's approval of the 
program could  also provide more money sought by the group operating the  
exchange. 

"Ex-Primier is Cited in French AIDS Case" Philadelphia Inquirer 
(07/28/92), P. A2  (McDowell, Patrick)
     Criminal complaints were filed yesterday by lawyers against  former 
Premier Laurent Fabius and two former ministers of France  for allegedly 
permitting HIV-infected blood to be administered to hemophiliacs.  
Fabius, former Social Affairs Minister Georgina  Dufoix, and former 
Deputy Health Minister Edmond Herve testified  Friday at the trial of 
four former health officials blamed for  infecting 1,000 hemophiliacs in 
1985.  Herve said he was aware  that the blood supplies were 
contaminated with HIV.  Some of  those who contracted HIV from the blood 
products took the witness stand yesterday for the first time in the six-
week-old trial,  detailing how their lives had been ruined since 
becoming  infected.   The charges were made first four years ago by  
families of the 1,000 hemophiliacs who contracted HIV in March  through 
October 1985.  The current defendants argue that they  have been made 
into scapegoats for regulations that were  implemented by government 
ministers.  The panel is scheduled to  announce a verdict in October.  
Related Story: Financial Times  (0728) P. 2 

"AIDS Testing Aids Insurers" Philadelphia Inquirer (07/28/92), P. F1  
(Burkins, Glenn)
     Because of the soaring number of AIDS claims, most life insurance 
companies are requiring high-risk applicants to be tested for  HIV.  
Anyone who tests positive for HIV would be rejected from a  coverage.  
While insurance industry officials assert such a  practice has slowed 
the influx of AIDS-related claims, which last year totalled about $1.2 
billion, opponents of testing say  "people with HIV are subject to 
discrimination.  Moreover, they  are subject to stigma and unpleasant 
encounters, even violence."  AIDS testing is allowed by insurance 
regulators in every state  and testing advocates say the tests are 
necessary to protect the  industry from fraudulent claims.  They contend 
that without  testing, a life-insurance applicant could hide the fact 
that he  or she was HIV-positive.  The majority of companies test  
applicants between the ages of 19-45, because most AIDS patients  fall 
within this range.  In most cases, once a policy is released it cannot 
be rescinded, even if the person later tests positive  for HIV.  
However, if a person with HIV lies about his or her HIV status, the 
policy could be terminated, even after the person has died. 

"AIDS Notebook: US May Soon Have 82,000 AIDS Orphans" Boston Globe 
(07/27/92), P. 28
     By the year 2000, the number children and adolescents who become  
orphaned as a result of AIDS will grow more than twofold, from  about 
40,000 to 82,000, reported David Michaels of New York's  City University 
medical school, speaking at the international  AIDS conference in 
Amsterdam. 

"AIDS Notebook: Educators--Let Kids Meet AIDS Patients" Boston Globe 
(07/27/92), P. 28
     A successful means to educate teenagers about AIDS is to allow  
them to meet young people with the disease, recommended educators at the 
international AIDS conference in Amsterdam.  "No school  kid is going to 
listen to some silver-haired science teacher  talking about cell counts 
and seropositives," said Pedro Zamora,  an 20-year old AIDS patient who 
spoke at the conference.   She  added, "AIDS education has to be more 
about involvement and less  about lectures."   Zamora was the only 
speaker with AIDS at a  seminar on AIDS education in schools at the 
conference.  Peter  Aggleton, a professor of education at the University 
of London,  said AIDS patients who have accepted the disease are much 
more  effective at addressing the subject with children than many  
educators, who may be more self conscious. 

"A Survey of Occupational Blood Contact and HIV Infection Among  
Orthopedic Surgeons" Journal of the American Medical Association 
(07/29/92) Vol. 268,  No. 4, P. 489  (Tokars, Jerome I. et al.)
     No evidence of HIV infection was found among surgeons without  
nonoccupational risk factors who participated in a serosurvey,  write 
Jerome I. Tokars et al. of the Centers for Disease Control. A voluntary, 
anonymous HIV serosurvey was conducted at the 1991  annual meeting of 
the American Academy of Orthopedic Surgeons in  Anaheim, Calif.  Also, a 
mail survey of orthopedic surgeons was  distributed five months before 
the annual meeting.  Among the  7,147 eligible orthopedists at the 
meeting, 3,420 participated.   Of the participants, 87.4 percent 
reported a blood-skin contact  and 39.2 reported a percutaneous blood 
contact in the previous  month.  Also, 3.2 percent of the serosurvey 
participants reported an injury at some time in their career with a 
sharp object  tainted with the blood of an HIV-positive patient.  Among 
the  3,267 participants who reported nonoccupational risk factors for  
HIV infection, none tested positive for HIV.  In addition, of the 108 
participants with reported nonoccupational HIV risk factors,  two were 
infected with HIV.  The high rates of self-reported  blood contact 
emphasize the significance of compliance with  infection control 
standards and the development of new techniques and equipment to 
minimize the risk of exposures to blood during  invasive procedures. 

"Population-Based Monitoring of an Urban HIV/AIDS Epidemic" Journal of 
the American Medical Association (07/29/92) Vol. 268,  No. 4, P. 495  
(Rosenberg, Philip S. et al.)
     Strict monitoring of the AIDS epidemic is needed to focus efforts 
to reduce the incidence of HIV infection, write Dr. Philip  Rosenberg et 
al. of the National Cancer Institute in Rockville,  Md.  Between the 
epidemic's start in 1980 and January 1, 1991,  one in 57 Washington, 
D.C., men aged 20-64 years developed AIDS.  AIDS prevalence in the 
District of Columbia was projected to  increase by 34 percent between 
1990 and 1994, unlike the rest of  the nation.  Models of HIV infection 
incidence indicated two  epidemic waves of about equal size.  The first, 
which transpired  in men who have sex with men, peaked during 1982 
through 1983.   The second began in the mid-1980s among IV-drug users 
and  heterosexuals.  Among Washington residents aged 20-64 years,  
approximately 0.3 percent of white women, 2.9 percent of white  men, 1.6 
percent of black women, and 4.9 percent of black men  were living with 
HIV as of January 1, 1991.  The predictions are  consistent with survey 
data.  Among black childbearing women in  their 20s, rates of HIV 
doubled to 2 percent between the fall of  1989 and the spring of 1991.  
From military applicant data, it  was projected that more than 5 percent 
of black men born between  1951 and 1967 were HIV positive.  In the 
sentinel hospital, rates of HIV among male patients aged 25-34 years 
were 11.3 percent in  white men and 16.9 percent in black men. 

"High Risk of Active Tuberculosis in HIV-Infected Drug Users with 
Cutaneous Anergy" Journal of the American Medical Association (07/29/92) 
Vol. 268,  No. 4, P. 504  (Selwyn, Peter A. et al.)
     HIV-positive patients who are anergic are at high risk for  
developing active tuberculosis, especially in a population with a known 
high prevalence of latent TB infection, write Dr. Peter A.  Selwyn et 
al. of the Albert Einstein College of Medicine in  Bronx, N.Y.  Anergic 
subjects and tuberculin reactors who were  HIV-positive were compared by 
HIV disease status and CD4 T cell  levels.  Of those HIV-positive 
participants, anergic subjects had more advanced HIV disease and fewer 
CD4 cells compared with  tuberculin reactors, even though neither 
clinical status nor CD4  cell counts consistently predicted anergy.  
Five of 68 anergic  subjects who were HIV-positive and none of 52 
anergic subjects  who were HIV-negative or of unknown HIV serological 
status  developed active TB throughout the study period.  The TB rate  
among anergic subjects who were HIV-positive was 6.6 cases per  100 
person-years.  Among 25 HIV-positive tuberculin reactors who  did not 
receive or complete 12 months of isoniazid prophylaxis,  TB prevalence 
was 9.7 cases per 100 person-years, as compared  with the rate among 
anergic HIV-positive individuals.  A  decreased rate of active TB was 
found in HIV-positive tuberculin  reactors receiving 12 months of 
isoniazid chemoprophylaxis,  compared with untreated or partially 
treated subjects, the  researchers note. 

"The Hidden Cost of AIDS: Selling Sex Does Not Pay" U.S. News + World 
Report (07/27/92) Vol. 113, No. 4, P. 52
     The AIDS epidemic is spreading rapidly through Thailand,  prompting 
fear in employers, workers, and the government.  While  the first case 
of AIDS emerged in the country in 1984, roughly 1  percent of all Thais 
are now HIV-positive--twice the U.S. rate,  according to projections by 
the local Population Development  Association.  In addition, more than 
1,000 Thais contract HIV  every day.  Researchers at the Harvard AIDS 
Institute estimate  that by the turn of the century, the total number of 
Thais with  HIV will escalate to between 2-4 million in a current 
population  of 58 million.  The epidemic will also have a huge impact on 
the  country's economy, which has averaged a 7.5 percent growth rate  
over the last 10 years.  The health care bill for treating AIDS  
patients in Thailand could increase from around $1 million today  to 
between $20 million and $65 million annually by the year 2000. The 
largest sector of the Thai economy to suffer will be the $5  billion 
tourism industry.  Already, the industry is shrinking as  foreigners 
begin to fear for their health.  Yet the government  and the business 
community are now attempting to halt the spread  of the epidemic.  AIDS 
education has been established as a part  of the school curriculum and 
all radio and television stations  air AIDS prevention messages. 

"The Hidden Cost of AIDS: Driving Blindly Into an Epidemic" U.S. News + 
World Report (07/27/92) Vol. 113, No.4, P. 54
     Because truck drivers in India solicit sex from prostitutes along 
their routes, the country is headed toward a disastrous increase in AIDS 
cases.  At almost every roadside eatery, and even at some state tax 
checkpoints, prostitutes prepare for the truckers.   Consequently, the 
truck routes that wind across India have  facilitated the spread of HIV 
in the subcontinent.  While  official statistics report that only 125 
Indians have AIDS, an  uncounted 6,000 people are now believed to be 
dying of the  disease in the country--in addition to 500,000 to 1 
million  people who are HIV-positive.  Although the nation's leaders  
virtually ignore the epidemic, the World Bank estimates that 1  million 
AIDS-related deaths could cost India up to $1.6 billion  in medical 
bills and $8.4 billion in lost income by the end of  the century.  More 
than 75 percent of the truck drivers in the  country use prostitutes, 
and while nearly all of the truckers  have contracted sexually 
transmitted diseases, few use condoms.   The first attempt to check 
India's truck drivers for HIV last  February found that about 6 percent 
tested positive for HIV.  The medical profession has even been apathetic 
regarding AIDS.  A  clinic that was designed to provide counseling for 
HIV and AIDS  patients was closed within two hours because the doctors 
were  afraid they would lose their patients. 

"Hospitals Finding Ways to Encourage Injury Reporting" AIDS Alert 
(07/92) Vol. 7, No. 7, P. 103
     Since the Occupational Safety and Health Administration has  
demanded that health-care facilities develop exposure-control  
regulations and document staff injuries, hospitals are looking  for ways 
to encourage employees to report exposures to HIV.  Many workers do not 
report exposures to hospital personnel, due to  concerns about 
confidentiality, the burden of reporting  mechanisms, and reluctance to 
take occupational injuries  seriously.  In a study of underreporting, 
nurse epidemiologist  Holly Wainwright and colleagues of MacNeal 
Hospital in Berwyn,  IL., found that of 538 respondents, 46 percent 
reported having  had at least one needle stick during their career and 
23 percent  reported having one or more injuries in the last two years.  
The  survey demonstrated that only 30 percent of the injuries had been 
reported, with physicians reporting only 2.5 percent of their  injuries 
and each of the other groups reporting about 50.  A lack of perceived 
risk related to the exposure was the most common  reason for not 
reporting, the study found.   Wainwright feels  that the survey led to 
increased awareness about the significance of reporting injuries among 
the hospital's staff. 

"New HIV Test Gets Results in 10 Minutes" Nation's Health (07/92) Vol. 
22, No. 7, P. 24
     The Food and Drug Administration recently approved an HIV test  
that will only take 10 minutes to detect antibodies to the virus  and 
can be used in hospitals, bloodbanks, emergency situations  and doctor's 
offices.  The test's manufacturer, Murex  Corporation, said the new 
procedure is quicker than conventional  laboratory screening techniques 
and calls for no special devices  and only minimal staff training.  The 
company said positive test  results from the SUDS HIV-1 Test should be 
verified by other  types of test kits.  Conventional tests can take up 
to three  hours to perform.  Public health officials urge that 
counseling  be offered for those who test positive with the test.  Murex 
is  also developing rapid tests to detect HIV-2 antibodies. 

Newsgroups: sci.med.aids