From: bigoldberg@igc.apc.org (Billi Goldberg)
Newsgroups: sci.med.aids
Subject: CDC Summary 11/18/92
Date: 18 Nov 92 15:48:10 GMT
Article-I.D.: cs.1992Nov18.162059.4998
Organization: unspecified
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6469


                      AIDS Daily Summary
                       November 18, 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 
************************************************************************
 "U.S. Blood Blamed for Cases of AIDS" Toronto Globe and Mail 
(11/17/92), P. A4  (Picard, Andre) 
The transmission of HIV-positive blood to nearly 800 Canadian 
hemophiliacs could have been prevented if Canada had produced its own 
blood products instead of importing them from the United States, 
according to the head of the Canadian Red Cross. Secretary-general 
George Weber announced yesterday that the Red Cross backs a proposed 
independent investigation into Canada's tainted-blood controversy.  He 
said what is especially needed is a "public examination of the decision-
making process and the performance of 13 governments in that process."  
But federal Health and Welfare Minister Benoit Bouchard opposes any type 
of public inquiry, and says the government fulfilled its obligation 
toward hemophiliacs with HIV by launching a compensation program in 
1989.  Weber emphasized that the Canadian Red Cross has "nothing to 
hide," and he indicated that the improper decisions made in the past 
were primarily the responsibility of the federal and provincial 
governments and their bureaucrats.  Recently, the Canadian Hemophilia 
Society made similar allegations, claiming bureaucratic foot-dragging 
and an emphasis on economics instead of public health concerns 
contributed to the infection of hemophiliacs.  Over 40 percent of 
Canadian hemophiliacs have tested HIV-positive.  Experts agree that most 
of those people were infected by blood products and plasma imported from 
the U.S. in the early 1980s--before Canada started heat-treating blood 
to kill HIV and before testing for HIV became mandatory. 

"Suit Over AIDS Victim's Death Is Allowed" Wall Street Journal 
(11/18/92), P. B13 (Lambert, Wade and Woo, Junda) 
Parents of a man who died of AIDS can sue their son's longtime sex 
partner for allegedly infecting him with HIV, a New York state judge 
ruled.  The lawsuit is one of the first in which an HIV-positive person 
has been accused under a wrongful death law of transmitting HIV.  The 
New York case involved the parents of Anthony Blanco, who died in 
September, 1990.  They accused John Sullivan, their son's lover of 15 
years, of fraudulently and negligently hiding that he was positive for 
HIV.  Sullivan claimed in court documents that he was unaware of his 
infection until a year before Blanco's death.  He also said that his 
partner was an IV-drug user before the two men met, and that Blanco was 
sexually promiscuous during their relationship. Sullivan said that the 
suit be dismissed because the parents, Mamie and Joseph Blanco, would be 
able to prove that he transmitted the virus to their son.  However, 
State Judge Louis Sangiorgio didn't rule on the merits of the case, but 
he said the suit should be allowed to proceed.  The judge said that 
although there had been no other court order in the state which has 
ruled on whether HIV transmission could fall under the wrongful-death 
statute, judges in other cases have allowed suits by sex partners "for 
wrongful transmission of sexually transmitted diseases on theories of 
either fraud or negligence."  Since Blanco could have sued his partner 
for damages for transmission of HIV, the surviving parents can sue for 
wrongful death, ruled Judge Sangiorgio.

"Clinton Urged to Fight AIDS" Philadelphia Inquirer (11/18/92), P. A12 
President-elect Bill Clinton must lead the nation in its efforts to 
fight AIDS, former Secretary of Health, Education, and Welfare Joseph 
Califano said yesterday to the National Commission on AIDS.  Califano 
referred to Clinton's campaign promise to boost spending in research, 
prevention, and treatment of AIDS, and said, "President Clinton has the 
moral obligation to deliver on his promises."  Califano served as former 
President Jimmy Carter's health secretary for two years and was a top 
aide to President Lyndon B. Johnson in the 1960s.  On Oct. 29, Clinton 
pledged to give AIDS a high priority.  "We have still not done enough as 
a nation to stop the spread of AIDS or to help those who are living with 
it," he said.  The commission expects to submit recommendations to 
Clinton on how to deal with the epidemic in early January.  Daniel Boss 
of the AIDS Action Council, a Washington, D.C.-based lobbying group, 
said that until a vaccine was developed, national prevention programs 
were the only way of curbing the spread of HIV.  He added that the 
president must exhibit as much compassion for AIDS patients as for those 
affected by other maladies.  Mathilde Krim, chairwoman of the American 
Foundation for AIDS Research, requested that Clinton eliminate 
government bans on homosexuals in the military and admit people with HIV 
infection into the country.  She also demanded increased spending on 
AIDS research. 

"Around the Nation: Anti-AIDS Law Tested in Courts" Washington Post 
(11/18/92), P. A2 
A Louisiana case is believed to be the first constitutional challenge to 
a law that prohibits the transmission or the intentional exposure of HIV 
infection to others.  A total of 25 states have similar laws, but 
prosecutors rarely applied them until recently.  Salvadore Gamberella is 
on trial for allegedly violating Louisiana's 5-year-old law against 
exposing anyone to HIV infection.  The American Civil Liberties Union 
filed a motion to have the charges dismissed based on the fact that the 
law is too ambiguous and infringes the Constitution's equal protection 
clause.  Gamberella is accused of allegedly exposing a former girlfriend 
and their child to AIDS by having sex with the women without disclosing 
his HIV-positive status.  Gamberella could face as many as 20 years in 
prison and a $10,000 fine if he is convicted. 

"Flynn Again Rejects Condom Ordinance" Boston Globe (11/17/92), P. 29  
(Rezendes, Michael) 
Boston Mayor Raymond Flynn has vetoed for the second time a  measure 
that would require some restaurants and bars to install  condom vending 
machines.  Flynn's decision has fueled the City  Hall controversy over 
AIDS prevention.  Flynn, in a veto message  filed on Friday, based his 
opposition to the legislation on a  range of legal and policy issues.  
He said that the ordinance,  which is sponsored by City Councilor David 
Scondras, would  infringe upon the First Amendment free speech rights of 
bar and  restaurant owners who do not want to sell condoms.  Flynn also  
said that he does not feel that enlisting city government in an  attempt 
to distribute condoms more widely will reduce the spread  of HIV.  
Scondras argued that Flynn's free speech argument is  "grasping at 
straws," and added that he believes the mayor vetoed the measure because 
"he's uncomfortable with the issue of condoms and sex."  Similar 
legislation sponsored by Scondras was adopted  by the Council and vetoed 
by Flynn previously this year.  The  Council failed to gain enough votes 
to overrule Flynn's veto.   However, Scondras said he will persevere in 
filing versions of  the condom vending machine legislation until Flynn 
changes his  mind.

"Experienced Personnel Keep AIDS Patients Alive Longer" United Press 
International (11/18/92) 
Chicago--AIDS patients who attend hospitals with the most  experience in 
dealing with AIDS are likely to live longer,  according to a new study 
published Tuesday in the Journal of the  American Medical Association.  
Dr. Valerie Stone and colleagues  at the Boston University School of 
Medicine said that AIDS  patients were more than twice as likely to die 
in low-experience  hospitals or within 30 days of discharge when 
compared to  hospitals more familiar with HIV infection and its 
complications. The researchers said in the study, "This finding is not 
because  of greater severity of illness, differences in discharge 
patterns of terminally ill or less intensive use of resources.  Rather 
it  may be because of differences in quality of care."  During 1987.  
Hospitals were categorized as having a high level  of AIDS experience if 
they discharged more than 43 people with  AIDS per 10,000 discharges in 
the sample year.  Eight hospitals  out of the 40 studied were in this 
category.  The researchers  said, "Even after controlling for multiple 
patient-level and  hospital-level variables, the relative risk of death 
was more  than twice as high at hospitals with lower AIDS familiarity 
than  at hospitals more experienced with AIDS care."  The study said  
the results may support policies to establish regional AIDS care  
referral networks, which would channel people with AIDS to more  
centralized services staffed by specially trained medical  personnel. 

"New AIDS Disability Rule May Come Soon, Official Says" United Press 
International (11/18/92) 
Washington--New rules that could hasten Social Security  disability 
benefits to HIV-positive patients will most likely be  released before 
the Bush administration leaves office, according  to officials.  Dr. 
James O. Mason, assistant secretary of the  Health and Human Services 
department, told the National  Commission on AIDS Tuesday that officials 
expected to complete  the new regulations before the administration 
leaves office.  "We would not want to promulgate something that would be  
controversial and that President-elect Clinton would reverse as  soon as 
we put out," said Mason.  Dr. David Rogers, vice chairman of the AIDS 
commission, said, "This needs the fast track and not  the bureaucratic 
track."  The new regulations were introduced in  December 1991 to better 
define and facilitate eligibility for  Social Security disability 
payments for HIV-positive individuals. AIDS advocates have long argued 
that too many people are rejected for benefits and it takes too long for 
those who qualify to  receive their benefits.  James Brown of the Social 
Security  Administration said, "The final regulations have been written 
and are under review process now." He indicated that a law prohibited 
him from revealing any details, but he did say that "a lot of  people 
will be delighted with the definition."

"Hepatitis C Viraemia With Normal Liver Histology in Symptomless  HIV-1 
Infection" Lancet (11/07/92) Vol. 340, No. 8828, P. 1161   (Vento, 
Sandro et al.) 
HIV-1-positive individuals may be healthy carriers of hepatitis C virus 
(HCV), write Sandro Vento et al. of the "A. Puliese"  Hospital in 
Catanzaro, Italy.  Dr. Alberti and colleagues suggest in the Sept. 19 
Lancet that serum HCV-RNA is a marker of liver  disease in subjects with 
antibodies to HCV, independent of  alanine aminotransferase (ALT) values 
and challenge the idea of  the existence of true healthy carriers of 
HCV.  The researchers  investigated 19 subjects with HIV-1 antibodies, 
no symptoms or  signs of liver disease, and persistently normal serum 
ALT values. A total of 11 subjects had been IV-drug users, 4 were 
homosexual  men, and 4 were female sex partners of HIV-1-positive  
individuals.  None of these 19 subjects had HIV-1-p24  antigenaemia 
(EIA).  A total of 12 subjects were CDC stage II  (symptom-free) of HIV 
infection; the remaining 7 were CDC III  (lymphadenopathy syndrome).  
The average CD4 positive lymphocyte  count was 392--11 participants with 
fewer than 500 CD4 cells had  taken AZT for 6-17 months.  By using a 
recombinant immunoblotting assay, anti-C22 and anti-C33c reactivity was 
shown in all 19  subjects, with co-existing anti-C100 positivity in 
eight.  Serum  HCV-RNA was positive in all 19 subjects.  Percutaneous 
liver  biopsy was done on the same day that serum samples were obtained, 
and specimens were tested for HCV-RNA.  Liver histology was  normal in 8 
cases and showed slight changes in 2, chronic  persistent hepatitis in 
5, and chronic active hepatitis in 4.  It is still undetermined whether 
HIV co-infection affects the rate  of HCV replication and why AZT 
treatment, which is linked with  remission of HCV-induced chronic active 
hepatitis in patients  with high ALT values, has no such effect in 
subjects with normal  ALT. 

"Antibody-Capture Particle-Adherence Test for Antibody to HIV-1  in 
Urine" Lancet (11/07/92) Vol. 340, No. 8828, P. 1161   (Lim, W.L. and 
Cheng, K.C.) 
While the IgG antibody-capture particle-adherence test (GACPAT)  is 
economical and simple for use in large-scale anti-HIV  screening, it can 
give a high number of false positive reactions  in urine samples from 
IV-drug users, write W.L. Lim and K.C.  Cheng of the Queen Mary Hospital 
in Pokfulam, Hong Kong.  The  researchers had used the GACPAT for 
antibody to HIV-1 on urine  samples from IV-drug users attending 
methadone clinics in Hong  Kong.  Among the 1,259 samples, 66 (5.2 
percent) were initially  and 37 (2.9 percent) were repeatedly reactive.  
Among the 37  repeatedly reactive samples, only seven remained reactive 
after  being heated in a water bath at 60 degrees Celsius for 20  
minutes.  As controls, concurrently heat-treated urine samples  from 
confirmed HIV-positive individuals did not show any change  in endpoint 
titres.  The seven repeatedly reactive samples were  negative by 
antibody-capture enzyme immunosorbent assay and  western blot.  Heat 
treatment of repeatedly reactive samples  removed non-specific reactions 
in most samples.  The nature of  the heat-labile substance in the urine 
of IV-drug users that  causes the non-specific reaction remains to be 
determined. 

"More Widespread and Earlier HIV Testing Is Urged" American Medical News 
(11/16/92) Vol. 35, No. 43, P. 9   (Staver, Sari) 
More people should be encouraged to get tested for HIV, despite  the 
lack of resources for counseling and early intervention, said Dr. Donald 
Francis, a recently retired federal health official.   At the Fifth 
National AIDS Update Conference in San Francisco,  Dr. Francis stressed 
the significance of identifying more  HIV-positive individuals to 
generate the "political force" needed to obtain additional funding for 
research and treatment.  He said that those who receive early treatment 
will probably extend their lives.  Dr. Francis, a former senior medical 
epidemiologist at  the Centers for Disease Control and now an HIV 
consultant based  in Hillsborough, Calif., said that patients who test 
HIV-positive should receive sufficient counseling and treatment.  But he  
admitted that such services are not available even for all those  who 
have been diagnosed with HIV infection.  Testing should be  performed in 
hospitals, doctor's offices, public health clinics,  jails, and prisons, 
he said.  Settings like emergency departments are less desirable, but 
should be used in places such as New York City's South Bronx, where the 
emergency department serves as  primary care physician to many low-
income residents.  He added  that as many as one-fourth of patients who 
come to these  departments are infected with HIV.  The government 
currently  believes that at least 110,000  HIV-positive people do not 
know  they are infected.  Dr. Francis projects that 40,000 to 80,000  
new people nationwide become infected with HIV annually.  He said that 
although testing and counseling programs seem to be costly,  at least 
$100,000 could be saved from each new HIV transmission  prevented.

"Cost of Lifetime AIDS Treatment Up" American Medical News (11/16/92) 
Vol. 35, No. 43, P. 9   (Staver, Sari) 
The costs of treating HIV-positive patients throughout their  lifetime 
are slowly increasing, according to speakers at the  Fifth National AIDS 
Update Conference held in San Francisco.  The speakers repeatedly 
mentioned the difficulty in predicting costs  accurately because of 
problems in measuring expenses and  comparing studies.  Dr. Peter Arno, 
a health economist in the  epidemiology and social medicine department 
at Albert Einstein  College of Medicine, said that national data 
indicate that  lifetime-care costs for AIDS patients were between 
$82,000 and  $187,000 in 1991, a slight increase from the previous year.  
The  total cost of treating HIV patients in the United States will  
reach $10 billion this year, representing 1.25 percent of health  care 
expenditures, said Dr. Arno.  It is estimated to reach $15.8 billion by 
1995.  Those factors that contribute to the rising  health care costs 
include inflation, improved survival, and more  aggressive outpatient 
treatment.  The average length of hospital  stays has greatly decreased 
for patients with HIV infection;  longer survival means that patients 
now average six stays,  compared with four several years ago.  In 
addition, outpatient  care now comprises an increased proportion of 
total medical costs at about 62 percent, up from 55 percent in 1989, 
said Robert  Padgug, director of health policy development at Empire 
Blue  Cross-Blue Shield in New York City.  Moreover, prescription  
prices have contributed to increasing costs.  Dr. Arno said that  over 
the past decade, prices rose at three times faster than  general 
inflation. 
Newsgroups: sci.med.aids