From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 1/21/93
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 8
Organization: unspecified
Date: Thu, 21 Jan 93 07:54:19 PST

                         AIDS Daily Summary
                         January 21, 1993 
 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 

 "U.S. Set  Back in Vote on W.H.O. Chief" New York Times (01/21/93), P. 
A8  (Altman, Lawrence K.)
     The World Health Organization, which coordinates worldwide  anti-
AIDS efforts, reelected the current head of the group,  despite an 
aggressive diplomatic effort by the United States and  its European 
allies to unseat him.  The WHO's executive board  voted 18-to-13 to 
recommend Japanese physician Hiroshi Nakajima  over a rival candidate 
Dr. Mohammed Abdelmoumene, an Algerian who was supported by the United 
States, Canada, and the European  Community.  In the effort to oust Dr. 
Nakajima, one State  Department memorandum asserted that the Japanese 
Government had  resorted to "aggressive tactics, including the pursuit 
of votes  in exchange for favors" in its attempt to defend him.  The 
vote  by the executive committee is expected to be confirmed at the  
annual assembly of WHO's 181 members in May.  Dr. Nakajima has  lead the 
United Nation's agency for five years.  Critics said  that while WHO had 
long had many first-rate health-care workers  on its staff, there were 
fewer appointments of such high-caliber  people during Dr. Nakajima's 
administration.  Morris Abram, the  United States representative to the 
United Nations in Geneva,  argued, "It is essential that this agency be 
well and efficiently managed."  Abram reaffirmed the United States' 
continuing support for WHO and added that the nation's "long-standing 
commitment to  the World Health Organization transcends any 
personalities or  leadership."

"Capturing the Strained Social Life of Manhattan" New York Times 
(01/21/93), P. C15  (Holden, Stephen)
     A new comedy at the WPA Theater in New York is about a gay man in 
his mid-30's who is tired of negotiating safe sex and decides to  become 
celibate.  The play, "Jeffrey," was written by Paul  Rudnick.  The title 
character, Jeffrey, estimates that he has had about 5,000 sexual 
encounters but remained HIV-negative.  He  says, "I'm not promiscuous.  
It's such an ugly word.  I'm cheap." The play exhibits the strained 
social tenor of Manhattan life as  it is currently lived, writes critic 
Stephen Holden.  Holden adds that the "desperate, brittle tone of the 
hilarity underscores the ghastly sense of the absurd that the AIDS 
epidemic has brought to hyper-sophisticated Manhattan society."  Aside 
from the humor,  "Jeffrey" copes with questions of life, death, and 
erotic  partnership that many other people face as well.  The play's  
other main character, Steve (Tom Hewitt), is a bartender whom  Jeffrey 
meets in a gym and who could be his soul-mate.  However,  Steve is HIV-
positive, and Jeffrey fears of getting involved with someone who could 
become ill and die at any moment.  Other  sketches in the play are 
satirical and stress the complexities of safe sex. 

"AIDS Spreading Faster in French Overseas Territories" Reuters 
(01/20/93)
     Paris--AIDS has emerged as the leading killer of young adults in  
France's overseas territories, where the rate of infection is  higher 
than on the mainland, according to French Overseas Radio  (RFO).  RFO 
conducted a survey which revealed that 931 cases had  been reported 
among 2.3 million people living in French Guiana,  the Indian Ocean 
island of La Reunion, and the Caribbean islands  of Martinique and 
Guadeloupe.  Misleading information and poverty have contributed to the 
disease's spread.  However, RFO said the  AIDS statistics appeared to be 
unreliable because of inadequate  health facilities in the territories.  
AIDS prevention efforts  such as the distribution of condoms were also 
more difficult to  implement because of the local traditional values 
which oppose  their use.  In addition, AIDS patients in the territories 
are  more hesitant to publicly disclose their condition because of its 
association with homosexuality, which is not as widely accepted  in the 
overseas territories as it is in mainland France.

"Sports Doctor Shares Personal AIDS Tragedy to Deliver Vital  Message" 
USA Today (01/20/93), P. 5C  (Woodward, Steve)
     Leading American skaters will gather this week to compete at the  
U.S. Figure Skating Championships, but will also take in some  valuable 
information about AIDS.  Steve McQueen, a Salt Lake City physician and 
chairman of the U.S. Figure Skating Association's  (USFSA) sports 
medicine committee, will speak to the sport's best and brightest and 
enlighten them, in detail, about the  complications of AIDS.  McQueen's 
brother died of AIDS at the age of 47.  Despite an influx of 
controversial reports of  AIDS-related deaths among Olympic-caliber male 
skaters in Canada  and Europe, the top U.S. competitors have been spared 
losses.   The USFSA has acknowledged the growing AIDS threat throughout  
society by incorporating AIDS awareness into its drug education  program 
for national-level skaters.  Since the annual U.S.  Championships gather 
top skaters in all age groups--343 are  registered for this week's 
nationals--the event provides an ideal venue for addressing the AIDS 
issue.  McQueen said, "Like a lot  of younger people, [skaters] feel 
this is something that may not  concern them.  With more cases [of AIDS] 
showing up among  skaters, we think we have to be even more open."  Last 
December,  a report in the Calgary Herald had mentioned 40 skaters and  
coaches in North America who have AIDS.  But the USA's most  renowned 
male skaters of recent generations--Scott Hamilton,  Brian Boitano, and 
Paul Wylie--claim they can't name one serious  competitor in the U.S. 
who has AIDS or has died of the disease.   McQueen hopes to dispel all 
of the myths about the disease among  the skating community. 

"HIV Viraemia and Seroconversion" Lancet (01/09/93) Vol. 341, No. 8837, 
P. 113  (Lu, Wei et al.)
     The disappearance of infectious viruses in plasma during and  after 
seroconversion does not suggest the clearance of cell-free  HIV, write 
Wei Lu et al. of the Universite de Paris V, in Paris,  France.  Dr. 
Ariyoshi and colleagues report in the Nov. 21 Lancet that the first 
autologous isolate-specific neutralizing antibody  activity was not 
detectable during seroconversion, but recognized after seroconversion 
and increased with time.  They indicate that humoral factors are not 
responsible for the suppression of  primary viraemia in early HIV 
infection because a rapid decline  in infectious virus titre in plasma 
around the time of  seroconversion was not coincident with the 
appearance of  isolate-specific neutralizing activity.  Ariyoshi et al. 
were  misled by several inaccurate interpretations of the data.  They  
use the neutralization assay that allows the titration of the  specific 
virus-free neutralizing antibodies.  The virion-combined neutralizing 
antibodies would not be detected by the assay.   Also, the neutralized 
viruses in plasma would not be detectable  in an infectious viral 
culture.  Therefore, a double-negative  result for both assays might 
suggest either no virus and no  antibody or a virus-antibody equilibrium 
event.  The high  concentrations of total free viral particles during 
and after  seroconversion, together with the rapid decrease of high-
titre  viremia, indicates a rapid loss of viral infectivity other than  
virus itself.  The specific neutralizing antibody response seems  to be 
the most direct mechanism that can account for the rapidly  suppressing 
infectivity of primary viremia in early HIV  infection, the researchers 
conclude. 

"HIV Progression and Immune Activation" Lancet (01/09/93) Vol. 341, No. 
8837, P. 113   (Ludlam, C.A., and Steel, C.M.)
     Patients with A1B8DR3 and/or systemic lupus erythematosis (SLE)  
have immune systems of increased activity which allows HIV  replication 
to proceed faster, possibly because of an increased  density of CD4 
receptors on lymphocytes, write C.A. Ludlam and  C.M. Steel of the Royal 
Infirmary and Western General Hospital,  respectively, in Edinburgh, 
U.K.  In the Oct. 10 issue of the  Lancet, Dr. Learmont and colleagues 
report long-term asymptomatic HIV infection in five of six recipients of 
blood from a single  donor who has been symptom-free for 10 years.  The 
one recipient  who developed  AIDS and died of Pneumocystis carinii 
pneumonia  after 4.3 years had SLE.  They conclude that the prednisolone 
he  was administered resulted in immunosuppression, which allowed  more 
rapid progression to AIDS, and mention an additional patient with SLE 
treated with immunosuppression who fared poorly after  HIV infection, to 
support their hypothesis.  However, Ludlam and  Steel believe there is 
another explanation for the rapid  progression in individuals with SLE, 
an autoimmune disorder  strongly linked with the HLA haplotype A1B8DR3.  
The presence of  this haplotype in non-SLE patients infected with HIV is  
associated with a more rapid drop in CD4 counts and clinical  
progression of HIV disease, and this has been confirmed by  others.  
Ludlam and Steel believe patients with SLE progress more rapidly because 
their immune systems are hyperactive.  Thus,  immunosuppressive therapy 
immediately after initial HIV infection may be an appropriate option.  
Nevertheless, additional studies  are warranted to define why 
individuals with HLA A1B8DR3 progress rapidly after HIV infection, 
conclude the researchers. 

"Microsporidia Infection in Patients with the Human  Immunodeficiency 
Virus and Unexplained Cholangitis" New England Journal of Medicine 
(01/14/93) Vol. 328, No. 2, P. 95 (Pol, Stanislas et al.)
     Infection of the biliary tract with E. bieneusi is related to and 
may be the cause of AIDS-related cholangitis, write Dr. Stanislas Pol et 
al. of the Unite d'Hepatologie, Hopital Laennec in Paris,  France.  The 
researchers evaluated eight HIV-positive homosexual  men who were 
referred because of cholangitis for which no  causative agent had been 
found by standard tests.  All of the  patients received abdominal 
ultrasonography and endoscopic  ultrasonography or endoscopic retrograde 
cholangiopancreatography with collection of bile from the common bile 
duct.  One patient  had transhepatic biliary catherization, and two 
others had  cholecystectomy.  Bile samples, duodenal- and liver-biopsy  
specimens, and gallbladder tissue were examined by light and  electron 
microscopy.  All eight patients with unexplained  AIDS-related 
cholangitis had biliary microsporidiosis.   Intraepithelial E. bieneusi 
spores and supranuclear plasmodia  were identified in the six duodenal-
biopsy specimens.   May-Grunwald-Giemsa staining of bile samples showed 
free forms of microsporidia in all eight patients, and the presence of 
E.  bieneusi was confirmed by electron microscopy.  E. bieneusi was  
also detected in ductal biliary cells on a liver biopsy, in one  common-
bile-duct smear, and in gallbladder epithelium in two  patients.  Four 
patients were found to have associated but  previously undetected 
biliary or duodenal cryptosporidiosis,  whereas another had biliary 
infection associated with  cytomegalovirus.  E. bieneusi infection of 
the biliary tract  could account for at least some of the cases of AIDS-
related  cholangitis that are not explained by cryptosporidium or  
cytomegalovirus infection. 

"New Ideas and Dark Holes" Advocate (01/12/93) No. 620, P. 49  (Delaney, 
Martin)
     The federal government must stop funding studies of drugs that  
have limited efficacy, such as AZT, ddI, and ddC, and start  funding 
promising new approaches so they can soon become  practical, clinically 
useful drugs, writes Martin Delaney,  executive director of Project 
Inform, a non-profit gay community  foundation that supplies AIDS 
treatment information.  One  encouraging approach called the leucine 
zipper is designed to  stop HIV from infecting cells by blocking 
mechanisms that the  virus uses to link up with cells.  It was named 
such because it  is composed of identical amino acids in a repeating 
chain, which  some believe resembles the chain of little metal tabs that 
make  up a zipper.  The new product seemingly provides one side of the  
zipper, while the other side is provided by a structure on the  outer 
core of HIV.  It proved effective in laboratory tests by  completely 
blocking further infection by HIV.  Another promising  technique was 
developed by AIDS researcher Flossie Wang-Staal and her colleague, 
Arnold Hempel.  They reported that they have  succeeded in creating a 
molecule thatJliterally slices up the  virus' genes, which control all 
its activities.  If genes are  eradicated or severely damaged, the virus 
is weakened and unable  to reproduce or further any damage.  A third 
approach developed  by Dennis Burton uses monoclonal (man-made) 
antibodies, which are cloned in great numbers from a single antibody to 
fight against  disease and link up with and block HIV.  All three of 
these new  methods will be meaningless unless they are quickly developed  
into real products that are ready for human testing and  treatment, 
concludes Delaney. 

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