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Date:         Fri, 11 Dec 1992 13:44:39 -0700
From:         MJ STODDARD <STODDARD@ARIZVMS.BITNET>
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I thought this publication of interest, and hadn't seen it before,
so will this once post it to MEDLIB.  Subscription information is
included in the text.

            MJ Stoddard         Stoddard@ccit.arizona.edu
                   Arizona Health Sciences Library
                        University of Arizona
            602/626-2925 (voice)       602/626-2831 (fax)

======= Begin Newsletter ================================
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From: listserv@stat.UUCP
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------------- cut here -----------------
Volume  5, Number  5                                          December  5, 1992

              +------------------------------------------------+
              !                                                !
              !              Health Info-Com Network           !
              !                    Newsletter                  !
              +------------------------------------------------+
                         Editor: David Dodell, D.M.D.
    10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA
                          Telephone +1 (602) 860-1121
                              FAX +1 (602) 451-1165

Compilation Copyright 1992 by David Dodell,  D.M.D.  All  rights  Reserved.
License  is  hereby  granted  to republish on electronic media for which no
fees are charged,  so long as the text of this copyright notice and license
are attached intact to any and all republished portion or portions.

The Health Info-Com Network Newsletter is distributed  bimonthly.  Articles
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:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

                       T A B L E   O F   C O N T E N T S


1.  Centers for Disease Control - MMWR
     [25 Nov 92] Unintentional Deaths from Carbon Monoxide Poisoning .......  1
     Trends Years of Potential Life Lost Before Age 65 Among Whites/Blacks .  4

2.  AIDS News Summaries
     AIDS Daily Summary ....................................................  7

3.  AIDS Statistics
     HIV/AIDS Surveillance Report CentersforDiseaseControl October, 1992 ... 15

4.  Articles
     Genetic Defects Identified in Alzheimer's Disease ..................... 51
     Treating Depression also may Treat Cardivascular Disease .............. 56






Health InfoCom Network News                                           Page    i
Volume  5, Number  5                                          December  5, 1992



:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
                      Centers for Disease Control - MMWR
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

                          Centers for Disease Control
                     Morbidity and Mortality Weekly Report
                 Courtesy of Karen Fleming, Epidemiologist II
                     Arizona Department of Health Services

                                Current Trends
       Unintentional Deaths from Carbon Monoxide Poisoning -- Michigan,
                                   1987-1989

     Deaths from unintentional carbon monoxide (CO) poisoning in the United
States result primarily from exposure to motor-vehicle  exhaust and occur more
often during the cold months of the year and  in northern and midwestern
states (1-3). In Michigan, from 1987  through 1989, 103 deaths were related to
unintentional CO  poisoning. To identify approaches for prevention of
unintentional  CO poisoning in Michigan, the Michigan Council on Injury
Control (MCIC) studied death records and medical examiner (ME) records to
determine the manner of deaths related to unintentional CO poisoning in that
state from 1987 through 1989. This report  summarizes findings of the
investigation.
     MCIC used the Michigan Department of Public Health's statewide  death
registry to identify all death records from 1987 through 1989  with underlying
cause of death listed as International Classification of Diseases, Ninth
Revision (ICD-9) E codes 868.0-  868.9 (CO or other utility gas). MCIC then
selected as cases Michigan residents who died in the state during 1987-1989
and whose  cause of death was recorded as unintentional (i.e., not suicide or
homicide). Deaths involving fires were excluded.
     A total of 121 deaths attributable to unintentional poisoning by CO or
other utility gas were identified; records for each case  were then requested
from the county MEs. Of these, 22 were excluded, including nine that were
associated with fires or  miscoded, eight that were identified by the ME as
suicide, and four  that occurred outside Michigan; for one case, no death
record was  found. Four additional deaths that fit the case definition but
that  did not appear on the original case list were identified; two of the
four cases involved couples of whom only one of the pair appeared on the
original list, and the remaining two cases were  identified during a manual
review of ME records from a large urban county.
     Of the 103 deaths that were both unintentional (determined by review of
the case report) and involved CO poisoning, 83 (81%) were  among males.
Exposure to motor-vehicle exhaust caused 69 (67%) deaths, and 34 (33%) were
attributed to home-heating devices or  other sources.
     Motor-vehicle-related deaths occurred most often among persons  aged 25-

Health InfoCom Network News                                             Page  1
Volume  5, Number  5                                          December  5, 1992

44 years (4.3 per million population compared with 2.4 per million for all
ages) and from September through April (78%) (Figure 1). Of the deaths
attributed to motor-vehicle exhaust, 64% occurred in a closed garage; of the
49 persons tested for blood  alcohol concentration (BAC), 35 (71%) had a BAC
of greater than or equal to 0.01 g/dL (Table 1). Of the 42 persons who were
tested for  drugs, five (12%) were positive. Of the deaths not related to
motor  vehicles, the rate was highest for persons aged greater than or  equal
to 65 years (2.7 per million population compared with 1.1 per  million for all
ages); 87% of these deaths occurred during November-March.

Reported by:

MA Gregor, MHA, Michigan Council on Injury Control, Grand Rapids; G Van
Amburg, MPH, Office of the State Registrar; JC Thrush, MPH, Injury Research
and Control Section, KR Wilcox, Jr, MD, State Epidemiologist, Michigan Dept of
Public Health. Air  Pollution and Respiratory Health Br, Div of Environmental
Hazards  and Health Effects, National Center for Environmental Health, CDC.

Editorial Note:

In the United States, deaths attributed to unintentional CO poisoning
decreased from 1979 through 1988 by approximately 63 deaths per year (from
1513 to 878) (4). However,  because CO is colorless, odorless, and
nonirritating, its presence is not easily detected and remains a substantial
health risk. Early  symptoms of exposure include headache, dizziness,
weakness, nausea,  visual disturbances, and confusion; with prolonged
exposure, coma  and death may result (4-6).
     The findings in this study underscore the seasonal patterns in
unintentional CO-related deaths and the predominance of deaths related to
exposure to motor-vehicle exhaust (1-3). In Michigan, most of these motor-
vehicle-related deaths occurred in a closed  garage, suggesting that many
persons may not be aware of the danger  of CO exposure. In addition, the
findings indicate an increased  risk for motor-vehicle-related deaths for
young persons and an increased rate of death from other CO sources (e.g.,
faulty  home-heating systems) for older persons.
     Public health measures to prevent death from unintentional CO poisoning
have included improvements in home-heating appliances and  their installation
and maintenance, stricter occupational exposure standards, improvements in
ventilation in new buildings, prevention  education, and improvements in
treatment for acute poisoning such  as the use of hyperbaric oxygen. Further
educational efforts should  be directed toward young drivers, particularly
males, and toward the elderly or others living in homes with possibly
obstructed chimneys and old heating systems, including homes that use butane
and kerosene space heaters, wood stoves, and charcoal grills. In addition, the
relation between alcohol consumption and risk for CO poisoning, especially

Health InfoCom Network News                                             Page  2
Volume  5, Number  5                                          December  5, 1992

motor-vehicle-related risk, should be  emphasized in driver's education
courses and other programs.
     Recent advances in technology have improved the effectiveness of CO
detection devices in preventing unintentional CO poisoning.  Older CO
detection devices measured only CO concentration; however,  newer CO detection
devices are able to measure cumulative CO exposure, which is a more useful
measure of health risk. Underwriters Laboratories has recently implemented a
standard (UL  2034) for certifying CO detectors for home use (7).

References:

1. Cobb N, Etzel R. Unintentional carbon monoxide-related deaths in  the
United States, 1979-1988. JAMA 1991;266:659-63.

2. Baron RC, Backer RC, Sopher IM. Unintentional deaths from carbon  monoxide
in motor vehicle exhaust: West Virginia. Am J Public  Health 1989;79:328-30.

3. Baron RC, Backer RC, Sopher IM. Fatal unintended carbon monoxide poisoning
in West Virginia from nonvehicular sources. Am J Public  Health 1989;79:1656-
8.

4. Thom SR, Keim LW. Carbon monoxide poisoning: a review. Clinical Toxicology
1989;27:141-56.

5. CDC. Carbon monoxide levels in indoor tractor-pull events-- Manitoba,
Canada. MMWR 1990;39:743-5.

6. Meredith T, Vale A. Carbon monoxide poisoning. Br Med J 1988;296:77-8.

7. Underwriters Laboratories. UL 2034: Standard for single and multiple
station carbon monoxide detectors. 1st ed. Northbrook,  Illinois: Underwriters
Laboratories, Inc, April 30, 1992.













Health InfoCom Network News                                             Page  3
Volume  5, Number  5                                          December  5, 1992

Topics in Minority Health
       Trends in Years of Potential Life Lost Before Age 65 Among Whites
                    and Blacks -- United States, 1979-1989

     The reduction of preventable deaths among minority populations in the
United States is a national health objective for the year 2000 (1). One
measure used to assess progress toward this objective is years of potential
life lost before age 65 (YPLL-65), which measures the impact of deaths
occurring in years preceding 65 years of age and emphasizes the effects of
deaths among younger persons (2). This report compares trends in YPLL-65 among
U.S. whites and blacks from 1979 through 1989.
     To assess these trends, race- and sex-specific YPLL-65 rates  for death
from all causes were calculated for 1979 through 1988 and  combined with
recently available data on YPLL-65 in 1989 (3). The  contributions of specific
causes of death in 1979 and 1989 were  analyzed among white and black males
and females. Other  racial/ethnic groups were not examined because of
limitations in comparable census information.
     From 1979 to 1989, the rate of YPLL-65 (per 1000 population)  decreased
for white males (from 76.3 to 65.3 [14.4%]) and white  females (from 39.7 to
34.0 [14.4%]) (Fig- ure 1). For blacks, the  YPLL-65 rate decreased from 1979
through the mid-1980s, then began to increase. For black males, the rate
decreased from 142.1 in 1979  to a low of 121.7 in 1984 and increased to 141.8
in 1989; for black  females, the rate decreased from 79.2 in 1979 to a low of
68.9 in  1985 and increased to 74.3 in 1989 (Figure 1).
     Among white males, unintentional injuries were the leading  cause of
YPLL-65 in both 1979 and 1989, followed by diseases of the  heart, malignant
neoplasms, and suicide; in 1989, human  immunodeficiency virus (HIV) infection
replaced homicide as the  fifth leading cause of YPLL-65 (Table 1).  In 1989,
among black males, homicide replaced unintentional injury as the leading cause
of YPLL-65, and HIV infection matched malignant neoplasms as the fourth
leading cause of YPLL-65 (Table 1). Among white females, the relative ranking
of four leading causes of YPLL-65 remained  unchanged from 1979 to 1989:
malignant neoplasm was the leading  cause, followed by unintentional injuries,
diseases of the heart,  and suicide; in 1989, homicide replaced
cerebrovascular diseases as  the fifth leading cause of YPLL-65 (Table 1).
Among black females, the relative ranking of the first four leading causes of
YPLL-65 remained unchanged from 1979 to 1989; malignant neoplasm was the
leading cause, followed by diseases of the heart, unintentional  injuries, and
homicide; in 1989, HIV-associated deaths replaced  cerebrovascular disease as
the fifth leading cause of YPLL-65.
     In 1989, the YPLL-65 rate ratio for males compared with females was 1.9
both for whites and for blacks (Table 1). The  YPLL-65 rate ratio for blacks
compared with whites was 2.2 for both  males and females in 1989; from 1979 to
1989, the rate ratio of  YPLL-65 for blacks compared with whites increased by
10% among females and 16% among males.

Health InfoCom Network News                                             Page  4
Volume  5, Number  5                                          December  5, 1992


Reported by:

Applications Br, Div of Surveillance and Epidemiology, Epidemiology Program
Office; Office of the Associate Director for  Minority Health, Office of the
Director, CDC.

Editorial Note:

This report indicates an increasing disparity in early death between whites
and blacks in recent years. The greatest  disparities in rates (as reflected
by rate ratios) are for homicide, HIV infection, and cerebrovascular disease.
These race- specific differences in rates and rank ordering of causes of YPLL-
65 may reflect, in part, differences in socioeconomic status  and health-care
access and use (4,5).
     YPLL-65 is a summary measure of premature mortality (i.e.,  deaths among
persons aged less than 65 years) and contrasts with crude mortality statistics
that are dominated by deaths among the  elderly (2). Overall, white/black
differences in YPLL-65 are consistent with other measures of death (e.g., life
expectancy,  crude mortality, and age-specific mortality) (6). With the
exception of suicide, death rates (including YPLL-65) are higher for blacks
than whites for the leading causes of death.
     Although summary measures are used commonly for making general
comparisons between groups, one limitation of summary measures is  their
potential to mask variation within populations. For example, while death rates
are higher for blacks than whites in each age  group less than 65 years, rate
ratios vary substantially by age  (6). Public health response to excess
mortality may thus require analysis of age-specific rates for different
conditions.
     Several approaches have been outlined to reduce premature mortality among
targeted populations. For example, CDC has recently  developed a framework to
assist communities in the design, implementation, and evaluation of programs
to prevent youth  violence; the framework includes approaches to restrict
access to  firearms and teach nonviolent conflict resolution.* HIV-prevention
programs must address cultural and socioeconomic factors such as poverty,
underemployment, and poor access to the health-care system; CDC supports
community-based organizations in the operation  of HIV-prevention programs
(7), works with health departments, and funds local and national minority
organizations involved in  HIV-prevention programs. To lower risk from
cerebrovascular disease  in blacks, the National Institutes of Health has
recommended steps to reduce hypertension and obesity (8). Finally, the
Secretary's Task Force on Black and Minority Health has recommended that
research and intervention programs be targeted to the specific needs and
characteristics of minority communities (4).


Health InfoCom Network News                                             Page  5
Volume  5, Number  5                                          December  5, 1992

References:

1. Public Health Service. Healthy people 2000: national health promotion and
disease prevention objectives--full report, with commentary. Washington, DC:
US Department of Health and Human  Services, Public Health Service, 1991; DHHS
publication no.  (PHS)91-50212.

2. CDC. Premature mortality in the United States: public health  issues in the
use of years of potential life lost. MMWR 1986;35(no.  2S).

3. NCHS. Health, United States, 1991. Hyattsville, Maryland: US  Department of
Health and Human Services, Public Health Service,  CDC, 1992; publication no.
(PHS)92-1232.

4. US Department of Health and Human Services. Report of the Secretary's Task
Force on Black and Minority Health. Washington, DC: US Department of Health
and Human Services, 1985.

5. American Medical Association Council on Ethical and Judicial  Affairs.
Black-white disparities in health care. JAMA  1990;263:2344-6.

6. NCHS. Advance report of final mortality statistics, 1989. Hyattsville,
Maryland: US Department of Health and Human Services, Public Health Service,
CDC, 1992. (Monthly vital statistics report;  vol 40, no. 8, suppl 2).

7. CDC. HIV/AIDS prevention: facts about HIV/AIDS and  race/ethnicity.
Atlanta: US Department of Health and Human Services, Public Health Service,
1992.

8. National Institutes of Health. Detection, evaluation, and treatment of high
blood pressure. Bethesda, Maryland: US Department  of Health and Human
Services, Public Health Service, 1988; NIH publication no. 88-1088.













Health InfoCom Network News                                             Page  6
Volume  5, Number  5                                          December  5, 1992



:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
                              AIDS News Summaries
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

                       AIDS Daily Summary

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
************************************************************************
"Federal Agency Announces Start of Human Tests of AIDS Vaccines" New
York Times (12/02/92), P. B9  (Hilts, Philip J.)
     The National Institutes of Health announced yesterday that it was
ready to start testing AIDS vaccines in people at high risk of
contracting HIV.  The experiment will involve only 320 patients, who
will be given two different vaccines at medical centers in five cities.
The small-scale trial will probably not produce a clear answer about the
efficacy of the vaccine, because too few people are included.  However,
the experiment is a necessary first step to tests in which thousands of
uninfected volunteers in several nations will receive the vaccines.  Dr.
Anthony Fauci, director of the National Institute of Allergy and
Infectious Diseases, said, "We are really asking questions about the
safety of vaccines in people who are at high risk.  If people do become
infected will the vaccine accelerate or retard the disease?  Will people
who are at high risk have a different reaction in their immune systems
than the people who are not at risk?"  In addition, Dr. Fauci said that
he did not expect a full-scale trial of vaccines against HIV infection
until at least 1995. Those involved in the trials will include both
homosexual and heterosexual men and women, among them people who may be
currently having sex with someone who is HIV-positive.  The two vaccines
used in the trial are the first to have finished preliminary tests and
are manufactured by Genentech Inc. and Biocine.  Both use parts of two
HIV strains common in the U.S. Since they do not include the whole
virus, they cannot cause HIV, but it is hoped that they will spur a
strong protective reaction in recipients.

"Immunologic Aspects of Diseases of the Eye: Acquired Immunodeficiency
Syndrome" Journal of the American Medical Association (11/25/92) Vol.
268, No. 20, P. 2869  (Friedlaender, Mitchell H.)
     AIDS is commonly linked with ocular disorders, writes Mitchell H.
Friedlaender in a primer on Allergic and Immunologic Diseases in the
Journal of the American Medical Association.  Cotton-wool exudates are

Health InfoCom Network News                                             Page  7
Volume  5, Number  5                                          December  5, 1992

the most common ocular symptoms, but they may be seen in eye conditions
other than AIDS.  They have the same appearance as those seen in lupus
erythematosus, but it is not known whether the cotton-wool spots of AIDS
have a similar pathogenesis.  AIDS patients may develop Kaposi's sarcoma
of the conjunctiva or lids in addition to cotton-wool spots, as well as
chorioretinitis associated with any one of a number of different
opportunistic pathogens.  Optic manifestation of infections with
cytomegalovirus are the most important, but those associated with
Cryptococcus, Toxoplasma, or Candida may also occur.  Because cotton-
wool spots and cytomegalovirus retinitis are early signs of AIDS, the
ophthalmologist may be the first physician to alert the patient to the
existence of this serious disorder, concludes Friedlaender.

"HIV Instruction and Selected HIV-Risk Behaviors Among High School
Students--United States, 1989-1991" Morbidity and Mortality Weekly
Report (11/20/92) Vol. 41, No. 46, P. 866
     A growing percentage of American high school students are receiving
AIDS education and discussing the related issues with their parents,
according to a study by the Centers for Disease Control.  The CDC
conducted three national school-based surveys among high school students
that addressed HIV-risk behavior and school-based AIDS education.  The
three surveys were the 1989 Secondary School Student Health Risk Survey
(SSSHRS), which covered HIV-related knowledge, beliefs, and behaviors,
and 1990 and 1991 Youth Risk Behavior Surveys (YRBS) that addressed HIV-
related issues and other selected risk behaviors.   Since the 1989
survey did not include questions about condom use and injecting drug use
(IDU), these behaviors were compared only for 1990 and 1991.  The
percentage of students who received HIV education in school increased
substantially during 1989-1991 (from 54 to 83 percent), as did the
percentage of students who discussed AIDS with parents or adults in
their families.  In addition, in each year, students who reported
receiving HIV education in school were substantially more inclined than
those who did not receive instruction to report discussing AIDS with
their parents or other adults in their families.  Between 1989-1991,
significant declines occurred in the percentages of students who
reported ever having had sexual intercourse (59 to 54 percent), having
two or more sex partners during their lifetime (40 to 35 percent), and
having four or more sex partners during their lifetime (24 to 19
percent).  The rate of condom use did not change substantially, and
rates of IDU did not change.

"AIDS Community Demonstration Projects: Implementation of Volunteer
Networks for HIV-Prevention Programs--Selected Sites, 1991-1992"
Morbidity and Mortality Weekly Report (11/20/92) Vol. 41, No. 46, P. 869
     Community interventions for HIV prevention are able to recruit and

Health InfoCom Network News                                             Page  8
Volume  5, Number  5                                          December  5, 1992

keep active volunteers to work within hard-to-reach groups and provide
HIV-prevention messages in their respective communities, according to
the Centers for Disease Control.  The CDC has developed and maintained
volunteer networks among populations that are difficult to reach for HIV
prevention.  The projects have used community-level campaigns to promote
HIV prevention among groups like IV-drug users and homosexuals who don't
identify themselves as one.  The intervention goal is to increase condom
use and bleach use among persons at high risk by changing the attitudes,
perceived risk, self-efficacy, and social norms of these groups.
Volunteers have disseminated and explained materials and served as
trainers, role models, or opinion leaders in the targeted communities.
Training sessions introduced the volunteers to the project, provided
them with basic information about HIV and AIDS, and engaged them in role
playing.  The volunteers distributed media materials as well as condoms
and bleach to high-risk, hard-to-reach persons within the same
community.  The number of active volunteers during the first 12 months
for all sites increased 82.6 percent (from 138 to 252). Among the 138
volunteers who were recruited during the first month of intervention,
101 remained active in the sixth month; of these, 85 remained active at
12 months.  However, the retention rate for project volunteers, who
generally are from low socioeconomic backgrounds, was higher at 12
months (61 percent) than that for volunteers who actively volunteered at
mainstream AIDS-service organizations (50 percent).

 "NIH Endorses Human Trials Hill Ordered for AIDS Drug" Washington Post
(12/03/92), P. A4
     An advisory panel to the National Institutes of Health yesterday
ratified plans for national AIDS vaccine trials, but criticized a
congressional move that mandates the trials.  The advisory committee
unanimously granted approval to a plan that will test the vaccine widely
among HIV-positive people.  The trials of the vaccine, called gp160, had
not been endorsed through normal scientific evaluation at NIH.  In
October, Congress included funding of $20 million for testing the
vaccine in the Defense Department appropriation bill.  It passed after
successful lobbying by the vaccine's manufacturer, MicroGeneSys Inc. of
Meriden, Conn.  The bill specifies that the trial could be stopped if
the NIH, the Food and Drug Administration, and the Defense Department
decided within six months that a trial of gp160 was not appropriate.  A
special committee selected by NIH Director Bernadine P. Healy met twice
last month and finally decided to recommend to the director that she
approve a trial that would include gp160 along with one or two other
vaccines. The advisory committee vote yesterday supported that
recommendation.  Regardless of the decision, the advisory panel
chastised the action of Congress in mandating a human drug trial,
suggesting that testing of drugs should be based on science and  not on

Health InfoCom Network News                                             Page  9
Volume  5, Number  5                                          December  5, 1992

a political process.  Healy said it caused potential  danger because
political action based on lobbying was determining what drugs could be
tested.  She added that such testing should  be based on scientific
merit.   Related Stories: New York Times (12/03) P. B12; Philadelphia
Inquirer (12/03) P. A22

"High Rate of Condom Use in France, HIV Testing in Britain" United Press
International (12/03/92)
     Washington--Approximately 80 percent of French 18- and  19-year-
olds use condoms, but many people of all ages in Britain  and France are
still at risk for HIV infection, according to two  surveys published in
the British journal Nature.  The two studies of sexual behavior in
Britain and France were issued Wednesday.   They found that many men and
women at risk for HIV infection had  altered their behavior because of
the disease.  The French  researchers said, "Young people change
partners more frequently  than older people but are less likely to have
more than one  sexual partner at any one time."  It was discovered also
that  younger French people were most likely to use condoms.  A total
of 18 percent of men and 11 percent of women reported using a  condom
during their last intercourse, and condom use was 2.5  times more
frequent during sex with a casual partner, the study  found.  The
researchers said that women were 3.1 times more  likely to use a condom
if they were having sex with a new  partner.  Of 18- and 19-year-olds,
condom use was 79.8 percent  among males and 48 percent among females.
The survey of British  sexual behavior found that 4 percent of men and 3
percent of  women had been tested for HIV in the past five years.  The
report found that single people were reporting a larger number of sexual
partners in the past year and younger people were reporting more
partners.  Dr. Anne Johnson  of University College in London and  her
colleagues said, "Our study indicates many of those at high  risk for
HIV infection have perceived this risk and have already  undergone HIV
antibody testing, but that more than half remain  untested."

"Canada's Estimates of AIDS Cases Low" Toronto Globe and Mail
(12/01/92), P. A1  (Mickleburgh, Rod)
     Canada's total number of AIDS cases has been underestimated by
nearly 45 percent, according to the country's leading AIDS  expert.  Dr.
Donald Sutherland, head of HIV-AIDS epidemiology for the Laboratory
Center for Disease Control in Ottawa, said 1992  may witness the highest
number of cases in a single year since  the first case was recorded in
Canada in 1980.  Sutherland  revealed new statistics emphasizing the
spread of HIV in Canada,  taking into consideration for the first time
statistical  estimates of delayed reporting of AIDS cases and cases that
were  never reported.  His revised tally predicts there were actually
9,299 cases of AIDS in Canada by the end of 1991.  The number is

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Volume  5, Number  5                                          December  5, 1992

substantially higher than the Health and Welfare's most recent  AIDS
Update report of 6,477.  The new statistics indicate that  there will
have been more than 11,000 cases of AIDS reported in  Canada by the end
of 1991, including a record 1,846 new cases  during the current year.
Sutherland stressed that his figures  are estimates but insisted they
are far more accurate than those  listed in the Health and Welfare's
quarterly reports, which count only reported AIDS cases.  Sutherland's
division conducted a  complex statistical analysis, including viewing
death  certificates, to determine as accurately as possible how many
AIDS cases are never reported and how many are seriously delayed  in
being reported.  Dr. Sutherland said AIDS is not listed as the cause of
death in about 15 percent of those who die of the  disease, possibly
because of the stigma associated with it.

"Inhibition of Furin-Mediated Cleavage Activation of HIV-1  Glycoprotein
gp160" Nature (11/26/92) Vol. 360, No. 6402, P. 358   (Hallenberger,
Sabine et al.)
     HIV inhibitors reduce the infectivity of the virus and may
therefore have the potential to stop the spread of infection in  an
organism, write Sabine Hallenberger et al. of the  Phillips-Universitat
Marburg in Marburg, Germany.  The envelope  glycoprotein of HIV
initiates infection by mediating fusion of  the viral envelope with the
cell membrane.  Fusion activity  entails proteolytic cleavage of the
gp160 protein into gp120 and  gp41 at a site containing several arginine
and lysine residues.   Activation at basic cleavage sites is observed
with many membrane proteins of cellular and viral origin.  The
researchers recently  discovered that the enzyme activating the
haemagglutinin of fowl  plague virus (FPV), an avian influenza virus, is
furin.  Furin, a subtilisin-like eukaryotic endoprotease has a substrate
specificity for the consensus amino-acid sequence  Arg-X-Lys/Arg-Arg at
the cleavage site.  Here, the researchers  demonstrate that the
glycoprotein of HIV-1, which has the same  protease recognition motif as
the FPV haemagglutinin, is also  activated by furin.  In addition, the
researchers present  evidence that peptidyl-chloromethyl ketones that
have the  Arg-X-Lys/Arg-Arg motif and which are specific inhibitors of
furin interfere with cleavage of the HIV glycoprotein and hence  its
activation and formation of infectious virus particles.   Furthermore,
the inhibitors prevent shedding of gp120 from the  surface of infected
cells, which is also suspected to play a role in viral pathogenesis, the
researchers conclude.

"Brain Chemical Changes Might Predict Onset of AIDS" United Press
International (12/03/92)
     Chicago--A sophisticated imaging procedure may be able to identify
chemical changes in the brains of asymptomatic HIV-positive individuals,

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Volume  5, Number  5                                          December  5, 1992

researchers reported Thursday at the 78th Scientific Assembly and Annual
Meeting of the Radiological Society of North America.  The changes may
signal progression toward AIDS and may be helpful in evaluating and
developing therapies for the disease, said Dr. Robert E. Lenkinski,
associate professor of radiology at the University of Pennsylvania in
Philadelphia.  Lenkinski said, "Previous studies have shown that full-
blown AIDS is accompanied by atrophy, or dying, of the gray matter in
the brain.  Our study shows early signs of biochemical changes in
individuals who are positive for the HIV virus but have no clinical
symptoms of AIDS."  The technique, known as magnetic resonance
spectroscopy, could then be used to track development of the disease,
providing researchers with an approach to evaluate the efficacy of
treatment, he said.  "It is theorized that when neurons in the brain are
destroyed, membranes are disrupted, leading to increased levels of
[certain chemicals] in the brain," said Lenkinski.  "It has been
reported...that the first symptom of AIDS may be loss of neuro-cognitive
function, such as short-term memory loss.  Our findings suggest a
biochemical basis for understanding these symptoms," concluded
Lenkinski.

"Dual-Target Inhibition of HIV-1 in Vitro by Means of an Adeno-
Associated Virus Antisense Vector" Science (11/27/92) Vol. 258, No.
5087, P. 1485 (Chatterjee, Saswati et al.)
     The adeno-associated virus (AAV) seems to be an ideal vector for
use in antiretroviral gene therapy, write Saswati Chatterjee et al. of
the National Institute of Allergy and Infectious Diseases in Rockville,
Md.  The researchers used an AAV vector encoding an antisense RNA to
transduce stable intracellular resistance to HIV-1 in human hemopoietic
and non-hemopoietic cell lines.  The antisense targets are present in
all HIV-1 transcripts and include the TAR sequence, which is critical
for transcription and virus replication, and the polyadenylation signal.
Cell lines expressing antisense RNA showed up to 95 percent inhibition
of gene expression directed by the HIV-1 long terminal repeat and
greater than 99 percent reduction in infectious HIV-1 production, with
no detectable cellular toxicity.  AAV does not prevent superinfection, a
property that allows for infection with several different vectors or
multiple rounds of infection with the same vector.  Due to their
efficient transcription and inability to recombine with HIV-1, AAV
vectors represent a promising form of anti-retroviral gene therapy.  For
the treatment of human AIDS, it may be necessary to confer intracellular
resistance to progenitor bone marrow cells that give rise to the
renewable targets (T-lymphocytes, monocytes, and macrophages) of HIV-1
infection.  Autologous AAV vector-transduced bone marrow stem cells
could then be used to repopulate the immune system with HIV-resistant
cells.  If AAV vectors are safe and effective in animal models, the

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Volume  5, Number  5                                          December  5, 1992

human trial may then be indicated, the researchers conclude.

"Risk Reduction in Sexual Behavior: A Condom Giveaway Program in a Drug
Abuse Treatment Clinic" American Journal of Public Health (11/92) Vol.
82, No. 11, P. 1536  (Calsyn, Donald A. et al.)
     Male clients attending a drug abuse treatment clinic will take,
retain, and use condoms when various condoms are provided throughout the
clinic, according to Donald A. Calsyn and colleagues from the Veterans
Affairs Medical Center in Seattle, Wash.  The researchers conducted a
study to assess the effectiveness of a free condom distribution program
in an outpatient drug abuse treatment clinic.  All men receiving
outpatient drug abuse treatment at the VA Medical Center during December
1989 and remaining in treatment until May 1990 were qualified for the
study.  Just before and four months after initiation of a condom
giveaway program, a questionnaire regarding sexual behavior and condom
acquisition was administered to 103 men at the clinic.  Jars were filled
with a variety of condoms and were displayed in every clinic room.  Most
condoms were taken from the men's rest room (47.8 percent), the
dispensary waiting room (26.6 percent), the group therapy room (11.3
percent), and the women's rest room (4.4 percent).  A total of 10.1
percent were taken from staff offices.  A total of 56 patients (60
percent) of the clients reported taking condoms during the intervention.
The number of clients possessing condoms increased from 61 (59.2
percent) to 71 (76.1 percent) at follow-up.  Also, the mean use of
condoms for vaginal intercourse activity increased from 20.3 percent of
events initially to 33.7 percent at follow-up, conclude Calsyn et al.

"The Reporting of HIV/AIDS Deaths in Women" American Journal of Public
Health (11/92) Vol. 82, No. 11, P. 1500  (Buehler, James W. et al.)
     The wide ranges of underlying-cause-of-death vital records and AIDS
surveillance among women reflect the potential role of both HIV
infection and drug use in contributing to excess mortality, write James
W. Buehler and colleagues from the Centers for Disease Control in
Atlanta, Ga.  The researchers conducted the study to assess the
completeness of vital statistics and case reports of AIDS in measuring
HIV-related mortality in women aged 15-44.  They used vital records to
reveal the number of deaths attributed to HIV infection and excess
deaths due to causes that have increased along with the HIV epidemic.
It was found in 1988 that in women aged 15-44 there were 1,365 deaths
with HIV infection listed as the underlying cause, 202 deaths with HIV
infection listed as an associate cause, and 149 excess deaths due to
conditions highly related to HIV infection.  Also, there were 780 excess
deaths as a result of causes that may have been related to HIV infection
or illicit drug use.  Among the deaths that occurred in 1988, 1,532 were
reported through AIDS surveillance.  Consequently, underlying-cause-of-

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Volume  5, Number  5                                          December  5, 1992
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