From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 12/22/92
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6666
Organization: unspecified
Date: Tue, 22 Dec 92 07:52:57 PST

                    AIDS Daily Summary
                     December 22, 1992 
 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 

 "Officials Cite Increase in AIDS Patients Who Delay Treatment" 
Washington Post (12/22/92), P. D3  (Greene, Marcia Slacum)
     There has been a sharp increase in new AIDS patients who already  
have symptoms when they receive treatment for the first time,  according 
to officials from the Whitman-Walker Clinic in  Washington, D.C.  Some 
are even so ill that they must be sent  directly to hospital emergency 
rooms.  Health officials say that  AIDS patients may be postponing 
treatment for several reasons  including lack of insurance, denial, or 
unwarranted hopelessness. Peter Hawley, the clinic's medical director, 
said, "We can extend people's lives by a couple of years if we see them 
early.  If we  see them late, there may not be anything we can do for 
them.   It's alarming to see so many people wait until they're sick."   
Blood tests conducted in fiscal 1992 for the clinic's 818 new  patients 
showed that 39 percent of them had fewer than 200  T-cells compared with 
18.9 of the new patients in fiscal 1991.   D.C. General Hospital's 
center for AIDS patients is also  witnessing an increase in new patients 
with lower T-cell counts.  Director Dolph Druckman projected that 40 
percent to 50 percent  of the center's 240 new patients last year had T-
cell counts  below 200.  Whitman Walker's patients were mostly gay men 
in the  early 1980s.  In fiscal 1992, which ended in September, the  
clinic experienced an increase in heterosexual patients, IV-drug  users, 
women, and minorities.  Also, more than half of the  patients were not 
covered under health insurance, compared with  fewer than one-fourth of 
its patients in the early 1980s.   Whitman-Walker Director Jim Graham 
said the growing number of  patients delaying treatment is a result, in 
large part, to the  ineffectiveness of AIDS education efforts. 

"Synthetic Blood Clotter for Hemophilia Licensed" Washington Post 
(Health) (12/22/92), P. 5  (Herman, Robin)
     A genetically-engineered substitute for the human blood-clotting  
protein called factor 8 has been licensed by the Food and Drug  
Administration for the treatment of people with hemophilia.  Last week, 
Baxter Healthcare Corp. began shipping Recombinate to  distributors for 
control of excessive bleeding by people with  hemophilia A, which only 
occurs in males.  People with hemophilia currently receive injections of 
natural factor 8, extracted from  the pooled blood of thousands of blood 
donors.  This practice  resulted in the transmission of HIV to least 80 
percent of people with severe hemophilia in the early 1980s, and 
hepatitis to more  than 90 percent.  The laboratory-produced form of 
factor 8 does  not carry human viruses.  However, its introduction will 
not have the effect it might have had years ago, before donated factor 8  
was made safer by more sensitive blood-screening tests for HIV  and 
hepatitis, and new purification and viral inactivation  techniques.  
Nevertheless, the National Hemophilia Foundation and others back the 
product because of its guaranteed safety, which  might make people more 
willing to use it not just to stop  bleeding but also as a preventive 
measure.  FDA Commissioner  David A. Kessler, said, "The production of 
factor 8 by  recombinant DNA technology eliminates even the theoretical  
possibility of the transmission of viruses from plasma."  Yet  Alan 
Brownstein, executive director of the hemophilia foundation, is worried 
about the exorbitant price of the substitute.  A  person with severe 
hemophilia would have to pay more than $82,000 a year for the new 
product, based on pricing figures provided by  Baxter, he said. 

"Sex, Pregnancy, and Condoms (for Women)" Washington Post (Health) 
(12/22/92), P. 14  (Rovner, Sandy)
     The first device that will allow women to protect themselves  
against sexually transmitted diseases (STDs), including AIDS, is  still 
awaiting marketing approval from the Food and Drug  Administration.  The 
female condom, when used correctly, is  basically unseen and unfelt for 
both partners, according to  survey results of the women who tested it 
for the FDA studies.   Also, when used properly, the REALITY condom is 
95 percent  effective in preventing pregnancies.  Protection against 
STDs was not specifically tested in the research.  This would indicate  
that some subjects might be exposing themselves and the  requirements 
for the studies were careful to exclude any people  who might be at risk 
for such diseases.  However, the marketers  of the female condom, 
Wisconsin Pharmacal, say that because of  its impermeability and its 
barrier design, correct usage would  protect against STDs and AIDS.  The 
condom is significant because women often find it difficult to address 
condom usage among their sex partners.  Women frequently ignore the 
advice about STDs and  AIDS when they fear that such a request will 
shatter a mood or  meet with resistance from their partners, who may 
object to the  feel of the condom or the lack of trust from the women.  
But the  potential efficacy in preventing disease led an advisory panel 
of the FDA to recommend approval earlier this month, even though the 
pregnancy failure rate was a little higher than had been  expected.  The 
FDA is expected to make its decision soon, and the advisory committee's 
advice is generally considered pivotal.  The non-reusable condom would 
cost about $2.50, whereas male condoms  cost between 50 cents and $1 
each. 

"French Senate Asks Ex-Premier's Trial in HIV Affair" Boston Globe 
(12/21/92)
     The French Senate decided yesterday to abide by the  recommendation 
of the National Assembly and put former prime  minister, Laurent Fabius, 
on trial for the scandal involving  HIV-infected blood products.  The 
upper house vote cleared the  way for Fabius, now leader of the 
governing Socialist Party, and  two former ministers to stand trial 
before a parliamentary High  Court on charges of neglecting to assist 
persons in danger.  The  Socialists took the legal action in the 
parliament after  controversy among the public greeted their decision to 
stop  similar action last week.  The motion says that former social  
affairs ministers, Georgina Dufoix, and former health minister,  Edmond 
Herve, should also stand trial.  The Assembly and Senate  resolutions 
will be submitted to the Supreme Court, which will  determine whether 
there are sufficient grounds to bring the three former ministers to a 
trial.  Fabius served as prime minister in  1985 when 1,200 hemophiliacs 
contracted HIV from a blood product  that had not been heated, even 
though this process for destroying the virus was known.  Since then, 300 
have died.  According to  Fabius, he was unaware that the blood products 
might have been  tainted with HIV. 

"With AIDS Care" New York Times (12/22/92), P. A20  (Homenick, Maureen 
A.)
     Waiting for legislative approval for efforts to thwart the spread 
of tuberculosis among all infected individuals will only delay  and 
divert initiatives to serve those people who directly seek  help from 
clinics, writes Maureen Homenick, executive director of the Momentum 
Project in New York City.  Tougher measures to fight the rampant spread 
of tuberculosis are requested by a panel  reporting to the United 
Hospital Fund in the New York Times on  Nov. 30.  However, one of the 
most immediate and effective  opportunities to fight TB is being 
dangerously overlooked.  Due  to the likelihood that HIV-positive people 
and other high-risk  groups will develop active cases of TB, it appears 
that the most  effective approach is to integrate programs directly 
observed  therapy, education, and prevention into current service 
programs  for those individuals.  Several well-established community-
based  groups serving HIV-infected clients are willing to administer  
these programs and already attract a constituency that is  infected or 
at risk.  Those needing assistance could obtain it  while using other 
services that treat the whole person and  include incentives that meet 
other, basic needs.  City and state  resources could be more effectively 
used in such programs that  monitor treatment, concludes Homenick. 

"Beyond the Red Ribbons" Baltimore Sun (12/22/92), P. 1D  (Seigel, 
Jessica)
     Although AIDS has been a touchy subject to address in Hollywood  in 
the past, AIDS-related issues have recently received more  support 
throughout the industry.  One group, Hollywood Supports,  was created in 
response to the dying words of actor Brad Davis,  who kept his AIDS 
condition a secret for fear he would not get  work.  He accused 
Hollywood of hypocrisy for throwing money at  AIDS programs while 
simultaneously discriminating against  HIV-positive people.  Hollywood 
Supports co-founder Sidney  Sheinberg, president of MCA, said he has 
been disappointed that  only one other company, Viacom, has followed his 
lead this year  in extending health benefits to domestic partners of 
employees.   This allows people to receive treatment who might otherwise 
not  be covered.  Extending benefits may encourage many people who are 
sick to seek the best treatments available.  In Hollywood, major  movie 
producers have felt in the past that movies dealing with  AIDS would 
repel audiences, but that has changed as executives  have approved a 
wave of big-name films about the epidemic.  Aaron Spelling, the high-
powered television producer, is expected to  make a TV movie based on 
Randy Shilts' book "And the Band Played 
 On," which chronicles the epidemic's spread in the United States. 
"Pediatric AIDS Vaccine Trials Set" Science (12/04/92) Vol. 258, No. 
5088, P. 1568  (Cohen, Jon)
     Human vaccine trials intended to stop the transmission of HIV  from 
mothers to infants to treat infected children will be  launched within 
the next six months by federal agencies.   Pregnant women and children 
are ideal subjects for trials that  aim to determine whether an AIDS 
vaccine works.  Researchers need a population that shows high infection 
rates and develops AIDS  soon after becoming infected to gather sound 
data quickly.  Some  30 percent of the 6,000 children born to HIV-
positive mothers in  the United States each year become infected, and if 
those  children were not treated, 50 percent of them would progress to  
AIDS within 2 years.  The primary sponsor of the trials is the  National 
Institute of Allergy and Infectious Diseases (NIAID),  which will 
implement five placebo-controlled trials in the next  six months.  Also, 
the Walter Reed Army Institute of Research and the National Cancer 
Institute expect a trial among infected  children.  These small initial 
tests will concentrate on safety  and immune responses.  Trials on 
efficacy will come later.  One  study will involve vaccinating newborns 
within 3 days of birth.   Scientists hope the vaccine can prevent 
infection by prompting  the immune system to destroy HIV before the 
virus can replicate.  Another vaccine trial will be in children with 
established  infections, in order to expand the immune response and keep 
the  virus in check, which could prolong or even prevent the onset of  
AIDS. 

"Kinetic Studies of the Mechanism of Thrombocytopenia in Patients With 
Human Immunodeficiency Virus Infection" New England Journal of Medicine 
(12/17/92) Vol. 327, No. 25,  P. 1779  (Ballem, Penny J. et al.)
     Infection of megakaryocytes may be an important factor in  HIV-
related thrombocytopenia, causing decreased platelet  production, write 
Penny J. Ballem et al. of St. Paul's Hospital  and the University of 
British Columbia in Vancouver, British  Columbia, Canada.  The 
researchers examined the survival of  In-labeled autologous platelets 
and performed platelet imaging in 24 men with isolated HIV-related 
thrombocytopenia (16 who  received no treatment and 8 who received AZT).  
Mean platelet  survival was significantly decreased in both the 
untreated and  the AZT-treated patients with HIV-related 
thrombocytopenia, as  compared with the normal controls.  Mean platelet 
survival was  also substantially reduced in the HIV-positive patients 
with  normal platelet counts.  But imaging studies revealed no evidence 
of increased clearance of autologous platelets in the liver or  spleen 
in any of these groups.  Mean platelet production was  significantly 
depressed in the untreated patients with  thrombocytopenia as compared 
with the healthy controls.  However, mean platelet production was 
significantly increased in the men  treated with AZT, both in those with 
thrombocytopenia and in  those without thrombocytopenia.  While there 
was a moderate  decrease in platelet survival in HIV-positive subjects, 
these  patients, despite platelet counts, also had decreased production  
of platelets, possibly as a result of viral infection of the  
megakaryocytes.  The researchers concluded that AZT seems to  improve 
platelet production. 

"No Liability for HIV From Transfusion" American Medical News (12/14/92) 
Vol. 35, No. 46, P. 16
     A federal trial court in Texas recently ruled that the federal  
government was not at fault for HIV transmitted to a patient  during a 
coronary artery bypass graft.  The patient had severe  cardiac disease 
that mandated surgical intervention.  While in  surgery, the patient 
received a transfusion of HIV-positive  blood.  The patient was not told 
of the risk of HIV from a  transfusion; there was no test to detect HIV 
in blood, or the  availability of autologous or directed transfusion 
programs.  The trial court considered the patient's claims to be based 
on  negligence in collecting and screening blood products.  But  
regarding informed consent, the court said that Texas law states  that 
the doctor had an obligation to reveal risks or hazards that could have 
influenced a reasonable person in making the decision  to give or 
withhold consent to surgery.  A reasonable person  would not have 
refused the necessary cardiac surgery in order to  avoid the minimal 
risk of contracting HIV.  The patient testified he would not have 
consented to an autologous blood transfusion.   The court said that 
because of the lack of an HIV test, there was no way to establish 
conclusively that a directed blood donation  would have lowered the risk 
of receiving tainted blood.  The  court ruled in favor of the government 
on the informed consent  claim. 

"Pre-Ejaculatory Fluid as Potential Vector for Sexual  Transmission of 
HIV-1" Lancet (12/12/92) Vol. 340, No. 8833, P. 1470   (Pudney, Jeffrey 
et al.)
     Pre-ejaculatory fluid can contain HIV-positive cells, write  
Jeffrey Pudney et al. of Harvard Medical School in Boston, Mass.  The 
researchers examined smears form pre-ejaculatory fluid  samples of HIV-1 
seronegative and seropositive men for known  HIV-1 host cells and HIV-1- 
antigen positive cells.  A total of  11 samples from six HIV-negative 
men and 12 samples from nine  HIV-positive donors were examined.  White 
blood cells (WBC) were  detected with a panel of monoclonal antibodies 
and HIV-1 antigen  positive cells with a cocktail of monoclonal 
antibodies against  specific HIV-1 proteins with visualization by  
immunocytochemistry.  Samples from seropositive donors were  separated 
into two groups depending on whether or not spermatozoa were present.  
Among 4 sperm-free samples from four donors, three contained HIV-1-
positive cells.  For the samples with sperm from  five donors, three 
donors produced pre-ejaculatory fluid that  contained HIV-1-positive 
cells.  HIV-antigen-positive cells were  found in samples from symptom-
free and symptomatic men, and from  men on AZT or not.  In-vitro HIV 
culture studies in combination  with epidemiological studies are needed 
to determine the  infectious potential of pre-ejaculatory fluid.  Until 
then, it  should be considered that pre-ejaculatory fluid is potentially  
infectious, and mucosal exposure to the fluid should be avoided  through 
protected sex, the researchers conclude. 

Newsgroups: sci.med.aids