From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 11/20/92
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6481
Organization: unspecified
Date: Fri, 20 Nov 92 21:20:15 PST

                       AIDS Daily Summary
                        November 20, 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 
************************************************************************
 "No Need of Inquiry Now, Says Bouchard" Toronto Globe and Mail 
(11/19/92), P. A21 (York, Geoffrey and Picard, Andre)
     Canadian Health Minister Benoit Bouchard announced yesterday that 
he has not disregarded the possibility of a full inquiry into the 1980s 
distribution of HIV-infected blood products. Opposition MPs demanded an 
independent inquiry in the House of Commons, but Bouchard said he is not 
yet convinced that one is needed.  An assistant to Bouchard said the 
Health Minister contacted the Canadian Red Cross on Tuesday to show his 
willingness to cooperate in any review it makes of the events of the 
1980s.  The Red Cross said yesterday that it is "willing to assist in an 
open examination" of the blood program in Canada. In the Commons, 
Liberal MP David Dingwall said that 43 percent of Canada's hemophiliacs 
have contracted HIV as a result of tainted clotting products.  He added 
that there is no "plausible reason" for the government to oppose an 
independent inquiry.  Bouchard has repeatedly rejected the notion that 
the fault lies with the federal government, and claims that Ottawa 
fulfilled its obligation to hemophiliacs when it offered a compensation 
program for those who had been infected with the tainted blood products. 
Canadian hemophiliacs and blood-transfusion patients have filed at least 
80 lawsuits, claiming damages in excess of $350 million. According to 
Canadian Red Cross Society secretary-general George Weber, these legal 
and medical issues can be better dealt with in the courts than through a 
major public inquiry. 

"Teens' Risky Sex Declines; HIV Awareness Increases" Philadelphia 
Inquirer (11/20/92), P. A2  (Neergaard, Lauran)
    The high percentage of American teenagers engaging in risky sexual 
behavior is slowly declining, and schools are increasing education about 
AIDS, federal officials from the Centers for Disease Control reported 
yesterday.  The statistics from the CDC report came from yearly surveys 
of about 12,000 teenagers, conducted in 1989, 1990, and 1991, said Lloyd 
Kolbe, the CDC's director of adolescent and school health.  The report 
said that 54 percent of teenagers surveyed in 1991 said they had had 
sexual intercourse--down from 59 percent in 1989.  Those who said they 
had two or more partners decreased from 40 percent to 35 percent. Also, 
19 percent reported four or more partners--a decrease from 24 percent in 
1989.  But between 1990 and 1991, condom use was up two percentage 
points to 48 percent.  In 1989, students were not asked about condoms.  
Students under age 15 reported the highest increase in condom use--57 
percent, up from 46 percent.  The report discovered that 83 percent of 
students received some sort of HIV education at school last year--up 
from 54 percent in 1989. Even though there is no way to know how much of 
the decline in teen sex is due to school efforts, the CDC urged schools 
to begin education about HIV in kindergarten and intensify it by the 
ninth grade.  Kolbe said that it does not mean that kindergartners 
should be educated about condoms.  He added, "In the early grades, it's 
important that young people start to understand that they can influence 
their own health." Related Stories: Baltimore Sun (11/20) P. 24A; USA 
Today (11/20) P. 1A 

"Business Urged to Spearhead AIDS Fight" Washington Times (11/20/92), P. 
C1  (Munroe, Tony)
     Businesses have all but neglected the AIDS epidemic and must move 
past fears to take an active role in fighting the disease, according to 
speakers at the two-day Business and Labor Conference on AIDS in 
Washington, D.C.  The National Leadership Coalition on AIDS sponsored 
the conference.  Only a handful of employers--many being large 
corporations with huge resources--have begun to educate employees about 
HIV.  However, the majority of U.S. companies have done little either to 
inform employees or to address their concerns, said the speakers.  Lee 
C. Smith, corporate vice president at San Francisco-based Levi Strauss + 
Co. and chairman of the National Leadership Coalition  on AIDS, said, 
"The workplace is one of the few locations that  adults can receive this 
potentially life-saving information."  He added that "there is a fear of 
AIDS.  AIDS is not a popular  disease."  From AIDS diagnosis to death, 
it costs between $75,000 to $100,000 to treat an HIV-positive person, 
say several sources. The primary reason business has not taken an 
aggressive stance on AIDS is because the disease is perceived as an 
issue for  homosexuals and because many companies, especially small  
businesses, are fearful that the cost of insuring HIV-positive  workers 
will be too high, speakers at the conference said.   Former tennis 
champion Arthur Ashe, who contracted HIV through  open heart surgery, 
attended the meeting and said, "I think what  is keeping businesses from 
being a bit more proactive about  getting involved" is that "there are 
not enough heterosexual  examples in place ... to mainstream the 
discussion." 

"Improperly Sterilized Dental Gear Can Harbor AIDS Virus" United Press 
International (11/20/92)  (Levy, Douglas A.)
     Washington--HIV can be transmitted by dental tools as well as  
other medical equipment that is not properly sterilized,  according to 
researchers.  David Lewis, a microbiologist at the  University of 
Georgia in Athens reported a study on how dental  tools can pick up HIV 
from an infected patient.  Some  disinfecting methods, he explained, 
fail to eliminate the risk of HIV transmission to another patient.  He 
said that the proper  sterilization technique, however,--heating tools 
with pressurized steam--reduces the risk to zero.  However, Lewis said 
there is  similar infection potential with other medical devices used 
for  invasive procedures, especially with endoscopes.  Lewis said that 
the problem is that widely used disinfectant solutions do not  reach 
every part of various medical tools.  Heat treating tools  should be 
required, he said.  "[Chemical treatments] don't get  into the nooks and 
crannies," said Lewis, adding that lubricants  used on dental drill 
parts actually repel the chemical  disinfectants and may keep them from 
reaching some viral material transmitted from an infected patient.  
Lewis and his colleagues  tested dental tools used to treat two HIV-
positive patients and  one healthy patient.  They concluded in their 
report published in the British medical journal the Lancet, "Our 
results, from  laboratory and clinical studies, show that high speed 
dental  handpieces and prophylaxis angles take up and expel patient  
materials and so can potentially transfer infectious agents from  one 
patient to another." 

"Taylor Voices AIDS Cares as Eco-Hero" USA Today (11/20/92), P. 3D  
(Gable, Donna)
     Elizabeth Taylor will join forces with animated environmental  
heroes Captain Planet and the Planeteers in addressing the topic  of 
AIDS among children.  Taylor will provide the voice for the  animated 
character Donna, a mother whose teen son tests  HIV-positive.  Taylor 
said, "I am delighted to be part of a  project like Captain Planet and 
the Planeteers, which ... teaches children how they can be part of the 
solution."  The episode  shows how misinformation and fear can prompt 
prejudice against a  person with AIDS.  It airs Saturday and Sunday on 
TNT and TBS.   Scott Sassa, Turner Entertainment Group president, said, 
"We are  urging parents to watch the episode with their children and  
discuss the issue of AIDS and HIV as a family." 

"Kaposi's Sarcoma Trial Recruiting: TNP-470 (AGM-1470)" AIDS Treatment 
News (11/06/92) No. 162, P. 1  (James, John)
     Human testing has begun at the U.S. National Cancer Institute for a 
new treatment for Kaposi's sarcoma (KS).  The treatment is  called TNP-
470 (formerly called AGM-1470) and prevents the growth of new blood 
vessels--KS is linked with excessive growth of blood vessels.  Those 
eligible for the trial must be HIV-positive and  have KS, but with no 
evidence of pulmonary or gastrointestinal  KS.  They should be 
ambulatory and at least well enough to care  for themselves.  Also, they 
should have taken a stable dose of  antiretroviral therapy for at least 
a month.  The trial has  strict exclusions including criteria for 
hematological  abnormalities such as hemoglobin less than 9, ANC less 
than  1,000, platelets less than 100,000 or APTT or PT greater than 120 
percent of normal, or known bleeding disorders.  Applicants are  also 
excluded if they have pulmonary KS, active bleeding or  critically 
located KS, or life-threatening KS which is responsive to other 
treatments.  As many as 48 participants will be  recruited--two are 
enrolled so far.  The drug is given  intravenously, during one hour, 
every other day.  Eight dosage  levels will be tested with three to six 
patients at each level,  unless toxicity prevents the higher doses from 
being tried.  The  reason for the two-week break is that new drugs are 
not usually  tested in humans for longer than the animal toxicity trials 
have  been conducted--in this case four weeks.  The FDA permitted a  
six-week test after the break since there was no sign of any  cumulative 
toxicity in the animals. 

"Anger at Women's History Study Delay" AIDS Treatment News (11/06/92) 
No. 162, P. 3  (Solomon, Nancy)
     A two-year delay of a study that could help understand the  
progression of HIV disease in women is impeding attempts to  extend the 
lives of women with AIDS, according to doctors,  researchers, and 
activists.  The National Institutes of Health  promised a natural 
history study of women with HIV during the  December 1990 Women and HIV 
Conference in Washington D.C.   However, the Request for Applications 
(RFA), the governmental  process that allows researchers to apply for 
funding and  participation in the study, has not been issued.  Dr. 
Judith  Cohen, an epidemiologist who studies HIV in women at the  
University of California--San Francisco, said, "We could have  good 
answers by now.  While we waited last year, 10,000 more  women were 
diagnosed."  The National Institute of Allergies and  Infectious 
Diseases (NIAID) is organizing the women's study,  called the Women's 
Interagency HIV Study, and has allotted $5  million for 1993.  According 
to a nurse in the epidemiology  branch, the RFA was just approved by the 
head office at the NIH  and it should be published by mid-November at 
the earliest.   Miriam Galbraith, a nurse consultant for NIAID, who is 
the deputy project officer for the study, said, "It just takes a long 
time  for RFA to go through the approval process.  The idea has to be  
approved before writing the RFA itself."  Once the study is  approved, 
it would continue to recruit women as soon as they  learn they are HIV-
positive and monitor their health for four  years. 

"Brain Biopsy for Intracranial Mass Lesions in AIDS" Lancet (11/07/92) 
Vol. 340, No. 8828, P. 1135
     Central nervous system (CNS) disorders with a poor outlook in  AIDS 
patients including primary CNS lymphoma and progressive  multifocal 
leucoencephalopathy have gained prominence, write the  editors of the 
Lancet.  There is no simple and accurate way to  distinguish between 
these different pathological conditions.  For example, in 95 percent of 
cases, acute toxoplasma encephalitis is a reactivation of previous 
infection with little or no change in  serological variables or parasite 
concentrations.  Therefore,  treatment for toxoplasma is often begun 
experimentally and may be unwarranted.  Brain biopsy is usually 
undertaken when a mass  lesion has not responded to at least one week's 
antitoxoplasma  therapy, has an atypical scan appearance, or is 
producing  neurological instability.  Any treatment algorithm that 
includes  a brain biopsy must consider the balance between an 
individual's  quality and quantity of life.  Few reported studies 
address this  issue, although it seems wiser to consider biopsy in 
patients  with reasonably well-maintained CD4 lymphocyte counts and no  
previous AIDS diagnosis than in those with end-stage disease.   Some 
data indicate that brain biopsy should be reserved for CNS  mass lesions 
that occur during early AIDS.  Patients with early  AIDS should receive 
empirical antitoxoplasma treatment, with a  view to biopsy if there is 
no response after two weeks.  Patients with late disease should also be 
given antitoxoplasma therapy,  but should undergo biopsy only in 
exceptional circumstances.   Although brain biopsy itself is a safe 
procedure, science's  inability to treat either progressive multifocal  
leucoencephalopathy or CNS lymphoma argues against its regular  use in 
AIDS patients in late disease when antitoxoplasma therapy  has failed.

"Issues in HIV Testing in Developing Countries" Lancet (11/14/92) Vol. 
340, No. 8829, P. 1218
     The United Kingdom National and International Non-Governmental  
Organization (NGO) AIDS Consortium held a seminar on Nov. 5 to  address 
the difficulties in testing for HIV in developing  countries.  Those 
agencies that were represented at the seminar  included NGOs, ministries 
of health, technical and ethical  interest groups, and the WHO Global 
Program on AIDS.  The most  prominent issue discussed was the inability 
of developing  countries to guarantee the quality of all blood used in  
transfusions.  For instance, it is projected that as much as 30  percent 
of all blood supplies in India is untested.  While there  was general 
agreement on the need and conditions for the  screening of blood, 
diagnostic testing raised complex questions  that did not elicit any 
concrete answers.  However, experienced  field program planners believe 
that knowledge is a powerful tool  in changing behavior and a 
prerequisite for community involvement in plans that incorporate care 
and prevention.  However,  voluntary and anonymous testing in 
conjunction with counseling,  offered by various NGOs, is a sought-after 
service.  One result  has been post-test clubs which offer continuous 
support, with  members taking an active role in peer education.  
Consortium  members agreed that the seminar should signify the beginning 
of a process and that work should continue to develop guidelines on  
justification and preconditions for testing, provision versus  promotion 
of testing, and implementation. 

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