From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 9/8/92
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6123
Organization: unspecified
Date: Tue, 8 Sep 92 22:43:24 PDT

                         AIDS Daily Summary
                         September 8, 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 Death of Physician Alarms Town" Washington Post (09/06/92), P.A25 
(Anstett, Patricia and Pollak, Lisa)
     A small town in Michigan is currently disturbed by the recent  death of 
an osteopathic physician with AIDS who occasionally  performed surgery.  Just 
a week after he treated patients, Alton  Padgitt died of AIDS, which has 
frightened and confused some  people who were familiar with him as one of 
North Branch's few  family doctors.  Padgitt left his practice on Aug. 20, and 
a week later he died at the University of Michigan Medical Center.  His  death 
emphasizes the national controversy over whether  HIV-positive health-care 
workers should care for patients.  The  state health department predicts that 
as many as 1,000  health-care workers in Michigan may be HIV-positive and that 
many of them may be unaware of it.  Health officials from the state  and 
county met on Thursday with 350 to 400 townspeople to address concerns about 
Padgitt's condition.  David Johnson, who is  supervising a state health 
department investigation of Padgitt's  death, vowed to provide more answers 
and HIV tests for anyone who is concerned about possible infection.  It is 
still undetermined  whether Padgitt had adhered to infection control 
procedures and  whether he or his personal doctor had consulted experts, as 
state guidelines require, to monitor his work. 

"Bloody Scuffle Leaves Pair With AIDS Fears" Philadelphia Inquirer (09/07/92), 
P. B2
     A couple from Reading, Pa., said they will have to be tested for  HIV for 
up to two years due to a bloody fight between the husband an HIV-positive 
intruder.  Last week in Berks County Court,  the intruder, James Smithton, was 
acquitted of criminal trespass  and reckless endangerment charges.  Judge 
Calvin E. Smith also  dismissed a summary charge of criminal mischief.  
Smithton used a "justification" defense saying to the jury that he was running

from a gang of men when he tried to smash his way through the  front door at 
Richard and Donna Hinkles' house.  Richard Hinkle  said he had just arrived 
home from work after midnight as James  Smithton broke the glass in the front 
door, sending bloody  fragments flying through the living room.  While the 
intruder  leaned through the broken glass and attempted to unlock the door  
from the inside, Hinkle punched him.  The two struggled in the  door and 
Hinkle cut his arm on some of the broken glass.  He also picked up a sliver of 
glass and stabbed Smithton with it, cutting his own hand in the process.  As 
Richard Hinkle was being treated in an ambulance in front of their home, 
police took Donna Hinkle  to identify Smithton, who had been arrested.  There 
she overheard police and ambulance attendants say that Smithton was HIV  
positive.  Donna Hinkle has tested HIV-negative twice so far, and her husband 
is due for his second test this week. 

"The Comforts of Home for Kids With HIV" Boston Globe (09/04/92), P. 71  
(Pappano, Laura)
     A new home for children with AIDS will open in Boston later this  month.  
It is called the Kirk Scharfenberg House for Children  With AIDS, in honor of 
the Boston Globe editor who died of cancer July 27.  The house was built by 
the city as part of Mayor  Raymond Flynn's "Rebuilding Boston" campaign, and 
will be donated to the Children's AIDS Program later this month.  The house is

located on the premises of the Boston Specialty and  Rehabilitation Hospital, 
and cost $1.2 million to build.  It was  completed earlier this summer as a 
replacement for the dark wing  of Boston City Hospital, where HIV-positive 
children have been  treated since the first-in-the-nation program was 
initiated in  1987.  CAP director Thelma Hyatt said the new establishment will

almost double the number of children the city can help, allowing  day care 
access for up to 20 children and around-the-clock care  for up to 12.  
Interior designer Charles Spada coordinated the  project, which will open to 
the public as a design show house for five days beginning Sept. 12.  The $5 
entrance fee will be given  to a house maintenance fund. 

"Church Tests Faith of Cleric Touched by AIDS" New York Times (09/08/92), P. 
A1  (Hilts, Philip J.)
     The Rev. Scott Allen, whose wife and two sons were HIV-positive,  
experienced overwhelming rejection within his own church.  He and his family 
were discouraged from attending Baptist churches  because his wife and 
children were HIV-positive.  Allen's wife  became infected via a tainted blood 
transfusion during a pregnancy in 1982, before blood was tested for the virus.

She and her  infant son, Bryan, have died of AIDS since then.  The older son,  
Matthew, now 10, is still alive.  Both children were infected in  their 
mother's womb.  What Allen and his family have experienced  since 1985 has 
sent him outside the church to look for solace.   "My case proves that you 
don't have to be gay to be kicked out,"  said Allen.  Allen got so tired of 
rejection that he stopped  trying to find a welcoming church for himself and 
his family,  quit his ministry, and began to work on projects for the  
Christian Life Commission, an educational body of the General  Baptist 
Convention of Texas.  In 1989, he was appointed by  Congress to serve on the 
National Commission on AIDS.  One of his jobs with the Christian Life 
Commission from 1985-1990 was to  find churches that would accept people with 
AIDS into their  congregations.  He succeeded more frequently in finding 
churches  for infected adults who were willing to be quiet about their  HIV-
positive status.

"Boom in Do-It-Yourself Blood Transfusions" Washington Post (Health) 
(09/08/92), P. 10  (Herman, Robin)
     There has been a recent increase in the amount of autologous  blood 
donated before elective surgery.  The American Red Cross,  the American 
Association of Blood Banks, and individual hospitals say that the safest blood 
donated is one's own blood.  This  autologous donation is the best way to 
reduce the risks inherent  in blood transfusion.  Although blood banks stress 
how safe the  blood supply currently is, there is always a very small risk of  
serious or fatal diseases, transmitted or caused by blood  transfusions.  
Providing autologous donation is quickly becoming  the standard of care in 
hospitals where just ten years ago the  practice was almost unknown.  The Red 
Cross collected about  212,000 autologous donations last year--a 50 percent 
increase  over the previous year.  Autologous blood currently accounts for  5 
percent of all blood units transfused in the U.S., while ten  years ago it was 
less than 1 percent.  Surgeons also use machines that salvage and return blood 
shed during an operation, give  patients hormones that help them produce red 
blood cells faster  after an operation, and basically allow patients to remain 
more  anemic after surgery that was once acceptable.  Moreover,  biotechnology 
companies are working on genetically-engineered  hemoglobin substitutes that 
could temporarily replace lost blood.

"Designated Donors Can Also Pose Risks" Washington Post (Health) (09/08/92), 
P. 11  (Herman, Robin)
     Directed blood donations--those from friends or family--can be  just as 
risky as blood from an anonymous donor.  Approximately 10 percent of 
Children's National Medical Center's blood supply  comes through these 
"directed donations," said Louis DePalma,  assistant director of the blood 
bank.  But the Red Cross and  other blood experts say there is no proof that 
directed donations are any safer than donations from a volunteer blood supply 
that  is screened for HIV.  The American Red Cross and the American  
Association of Blood Banks therefore discourage this practice.   DePalma said, 
"Although the Children's Hospital believes that  there is no advantage in 
directed donor blood with respect to  conventional volunteer donor blood, the 
service is offered to  parents wishing to use it."  Children's policy is much 
like that  of many hospitals that provide direct donor services to meet some 
state laws and community pressures.  Terri Craddock, supervisor  of blood 
donor services for Fairfax Hospital, said, "We have  found a higher incidence 
of positive test results with our  directed donor population than with our 
general donor  population."  Transfusion experts also indicate that using  
donations from a blood relative actually increases the risk of  graft-vs.-host 
disease, which can be fatal. 

"Ganciclovir/Foscarnet for Cytomegalovirus Meningoencephalitis in AIDS" Lancet 
(08/29/92) Vol. 340, No. 8818, P. 559  (Enting, Roelien)
     Ganciclovir and foscarnet therapy to treat CMV  memingoencephalitis in 
AIDS patients may be of some benefit,  write Roelien Enting et al. of the 
University of Amsterdam in  Amsterdam, Netherlands.   The clinical aspects of 
cytomegalovirus (CMV) encephalitis in AIDS are not constant.  Neurological  
symptoms may include meningeal signs, disorientation, short-term  memory loss, 
apathy, dementia, coma, seizures, or brainstem  involvement.  Cerebrospinal 
fluid (CSF) examination is commonly  normal.  In a 36-year-old man with AIDS 
who was on ganciclovir  for CMV retinitis and who had a 10 day history of 
progressive  frontal headaches, nausea, vomiting, and fever, computed  
tomography of the brain showed generalized atrophy and  periventricular 
contrast enhancement.  A diagnosis of CMV  meningoencephalitis was made.  
Ganciclovir was increased to 5  mg/kg twice a day intravenously.  
Subsequently, retrograde and  anterograde amnesia became obvious, and he 
became progressively  obtunded.  Intravenous Foscarnet 60 mg/kg three times a 
day  significantly improved his condition.  He became alert, and the  
headache, nausea, vomiting, and fever gradually disappeared.  Six weeks later 
the doses of foscarnet and ganciclovir were lowered,  the patient's health 
deteriorated, and he died two weeks after he and his family decided to stop 
medication. 

"Detection of HIV Markers May Lead to Improved Therapy" American Medical News 
(08/31/92) Vol.35, No.32, P.3 (Staver, Sari)
     New markers which detect HIV strains will help researchers and  
clinicians fine-tune the timing of antiviral therapy in  HIV-positive 
patients, say AIDS experts.  The markers identify  HIV variants that usually 
precede the development of declines in  CD4 lymphocytes and clinical decline.  
Researchers believe the  tests will be effective in determining the optimal 
time to begin  or switch antiviral therapy.  In addition, the tests are 
expected to assist in examining the efficacy of drugs, both in clinical  
trials and, subsequently, in practice.  At the Eighth  International 
Conference on AIDS, Dr. Thomas C. Merigan Jr.,  professor of medicine at 
Stanford University School of Medicine,  reported that a mutation in the HIV-1 
reverse transcriptase at  codon position 215 is a marker for impending 
depletion of the  immune system.  He discussed a study that reviewed the 215 
codon  sequence on the HIV RT gene from 39 patients enrolled in an AZT  
clinical trial.  After 34 months on AZT, 17 patients with the  mutation had a 
50 percent mean decrease in CD4 cell counts, said  Dr. Merigan.  The 21 
patients with no mutation had a mean 11  percent increase in CD4 cells.  
Patients with the mutation had a  greater viral burden, in addition to 
increased resistance to AZT, Dr. Merigan said.

"New Antiviral Drug May Expand AIDS Treatment Options" American Medical News 
(08/31/92) Vol. 35, No. 32, P. 42  (Staver, Sari)
     AIDS patients who cannot tolerate or have had unsuccessful  treatment 
with AZT, DDI, or DDC, may soon be able to use a new,  less toxic antiviral 
compound.  Officials from Bristol Myers  Squibb Co. say they have submitted an 
application with the Food  and Drug Administration for the new drug, D4T, to 
be distributed  at no cost under the new federal "parallel track" program.   
Bristol hopes the application will be approved by the end of the  summer.  If 
the FDA agrees, D4T, a dideoxynucleoside analogue,  will be the first drug 
approved under the parallel track, a  program similar to the "expanded access" 
program, in which  promising drugs for life-threatening diseases are 
distributed  free while final efficacy trials are still being conducted.   
Under both programs, the government can withdraw the product  based on results 
from ongoing trials.  During the Eighth  International Conference on AIDS in 
Amsterdam in July, Bristol  researcher Dr. Lisa Dunkle said that in various 
phase I/II trials of D4T, patients' CD4 cell counts improved and remained at 
higher levels longer than has been seen in patients taking other  antivirals, 
she said.  The median duration of CD4 increase was 84 weeks in patients 
responding to D4T, compared with the 24 to 30  weeks observed in clinical 
trials of AZT, DDI, and DDC. 

"A Controlled Trial Comparing Continued Zidovudine With  Didanosine in Human 
Immunodeficiency Virus Infection" New England Journal of Medicine (08/27/92) 
Vol. 327, No. 9,  P. 581  (Kahn, James O. et al.)
     Switching treatment from AZT to 500 mg a day of didanosine (DDI)  seems 
to slow the development of HIV disease, write James O. Kahn et al. of the San 
Francisco General Hospital and the University  of California--San Francisco.  
The efficacy of AZT may decline  with prolonged use in AIDS patients.  The 
efficacy of switching  anti-HIV treatment from AZT to DDI was examined by the  
researchers.  A total of 913 AIDS patients who had tolerated AZT  for at least 
16 weeks participated in the study.  The patients  had less than 300 CD4 cells 
per cubic millimeter of asymptomatic  HIV infection with less than 200 CD4 
cells per cubic millimeter.  They were randomly designated to receive 600 mg 
per day of AZT,  750 mg per day of DDI, or 500 mg per day of DDI.  There were  
substantially fewer AIDS-related illnesses and deaths occurring  among the 298 
volunteers assigned to 500 mg per day of DDI than  among the subjects who 
continued to receive AZT.  With the  greater dose of DDI, 750 mg, there was no 
distinguished benefit  over AZT.  The efficacy of DDI was not associated with 
the  duration of previous AZT treatment.  In the two DDI groups there  were 
improvements in the number of CD4 cells and in p24 antigen  levels, as 
compared with the AZT group. 

"Rising Toll From AIDS in Japan Prompts Big Jump in Spending" Nature 
(08/27/92) Vol. 358, No. 6389, P. 699  (Swinbanks, David)
     Responding to the significant increase in the number of reported  cases 
of HIV infection in Japan this year, the Ministry of Health and Welfare 
recently requested a fivefold budget increase in  fiscal year 1993 to fight 
AIDS.  Almost half of the 10.3 billion  yen requested would be allotted for 
research, with the rest  invested in public education, screening, treatment, 
and  counseling.  According to critics, however, the larger budget  falls far 
short of what is needed.  This year the government will spend only a little 
more than 2 billion yen (US $16 million) in  the battle against AIDS.  The 
official total of Japan's AIDS case rate is just under 500, yet many cases are 
believed to go  unreported because of fear of discrimination.  But in the 
first  six months of this year, 226 new cases of HIV infection were  reported-
-nearly the same number as in the entire last year.   Although most AIDS cases 
previously consisted of homosexuals and  hemophiliacs, many of the newly 
infected are heterosexuals, which has prompted increased support.  About half 
of the budget, 4.8  billion, would go to research and the development of drugs 
and  vaccines.  The request still has to be screened by the Ministry  of 
Finance and approved by the Diet, but such requests rarely  undergo 
substantial change. 

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