From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 1/7/93
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6731
Organization: unspecified
Date: Thu, 7 Jan 93 08:08:53 PST

                        AIDS Daily Summary
                          January 7, 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 

 "Ballet Icon Nureyev Dead" Washington Post (01/07/93), P. A1  (Weil, 
Martin)
     Rudolf Nureyev, a master of dance whose technical virtuosity and  
passionate intensity changed ballet dancing in the 31 years since his 
defection from the Soviet Union, died yesterday in Paris at  the age of 
54.  Michel Canesi, his physician, said Nureyev died  of "a cardiac 
complication following a cruel illness," but did  not expound upon 
specifics or give the place of death.  In recent years, Nureyev's 
physical condition had deteriorated  dramatically.  There were 
widespread rumors--never  confirmed--throughout the professional dance 
community that  Nureyev had AIDS.  He was known for his extreme passion 
in dance  and his willingness to place art above all.  Nureyev left the  
Soviet Union in 1961 and danced with the ballet of the Marquis de 
Cuevas.  He made his London debut with Fonteyn and the Royal  Ballet in 
"Giselle."  Nureyev made guest appearances with at  least 25 companies 
from Denmark to Australia, and choreographed  classics like "Romeo and 
Juliet" and "The Nutcracker.  He also  made several films, including 
"Romeo and Juliet" and "Swan Lake." He became artistic director of the 
Paris Opera Ballet in 1983,  and after six years became the company's 
principal choreographer. He made his U.S. debut last summer as a 
conductor with American  Ballet Theater.  On Oct. 8 Nureyev made his 
final appearance on  stage at the Paris premiere of "La Bayadere," for 
which he had  provided new choreography.  Appearing ill and requiring 
help to  walk, he blinked back tears as the audience gave him a 10-
minute  ovation. Related Story: New York Times (01/07) P. A1 

"Clinic Widens Its Reach to AIDS in Md. Suburbs" Washington Post 
(01/07/93), P. B8  (Goldstein, Amy)
     Washington, D.C.'s largest provider of AIDS services announced  the 
opening of a satellite office in Hyattsville, Md., yesterday, signifying 
the first time the clinic has branched into the  Maryland suburbs.  The 
Whitman-Walker Clinic's new office on New  Hampshire Avenue is funded 
mainly through federal grants, and is  expected to provide counseling, 
pharmacy services, a buddy  system, and transportation to the several 
hundred people with  AIDS in suburban Maryland.  The office is located 
on the border  of Prince George's and Montgomery counties, the suburban 
Maryland jurisdictions with the highest rates of AIDS cases.  Jim 
Graham,  Whitman-Walker's executive director, said, "We wish none of 
this  was necessary.  We wish we could contract rather than expand, but 
the epidemic is raging in our city and our region."   Approximately 
1,000 people in Prince George's County and 600 in  Montgomery County 
have developed full-blown AIDS since the  epidemic began in 1981.  
During the same time, about 4,000 AIDS  cases were reported in 
Washington and almost 1,300 in Northern  Virginia.  Graham said the new 
office will prompt a grass-roots  AIDS movement in Maryland that will 
boost the number of  volunteers and help the clinic acquire state and 
county  subsidies.  The new center, with a 1993 budget of $186,000, will  
provide anonymous HIV tests, sponsor education programs, and  attempt to 
track down people with AIDS who are not obtaining  sufficient medical 
care. 

"Schaefer Will Disband AIDS Council, Shift Work" Baltimore Sun 
(01/07/93), P. 1A  (Smith, C. Fraser)
     Maryland Gov. William Donald Schaefer announced yesterday that  his 
Advisory Council on AIDS would be disbanded and its work  would be 
transferred to his Drug and Alcohol Advisory Council.   His decision has 
provoked anger and criticism from AIDS  activists.  The governor claims 
he wants a more aggressive fight  against AIDS in Maryland, one that 
more sharply concentrates on  education and prevention.  Schaefer said 
he expects that AIDS  issues will be dealt with more vigorously by Dr. 
Neil Solomon,  head of the drug and alcohol panel, and he added, "many 
AIDS  cases are drug related."  But many found the governor's plan  
distressing.  Garey Lambert, vice chairman of AIDS Action in  Baltimore, 
said, "It's a grave mistake," to shift the panel's  work.  He added that 
the governor will jeopardize the importance  of the group when the AIDS 
"epidemic is growing faster than many  want to recognize."  Also, a 
member of the AIDS panel sharply  criticized the wisdom of this 
approach.  Dr. John F. Bartlett,  chief of the Division of Infectious 
Diseases at the Johns Hopkins University, said the governor's drug and 
alcohol advisory council has virtually no expertise in AIDS.  Dr. 
Bartlett said he  questions whether the governor understands the 
effectiveness of  the state's AIDS-fighting resources or the ability of 
Maryland's  health department in winning AIDS research grants.  Dr. 
Solomon  said he would attempt to get "the best brains available" to 
work  on AIDS issues, but added, "This is not a field I am an expert in 
at all."  Dr. Bartlett said that he is not sure he wants to  continue 
working on the AIDS panel. 

"12.2 Percent of Argentine Inmates Are Found to Have AIDS" Chicago 
Tribune (01/06/93), P. 1-4
     A total of one in eight prisoners in Argentina's federal prison  
system has AIDS, according to a report released Monday night by  the 
Federal Prison Service.  The report said 12.2 percent of the  4,500 
inmates in its jails have AIDS.  It added that if the  current AIDS case 
rate remains constant, in 10 years 45 percent  of the prison population 
could develop AIDS.  Justice  undersecretary Carlos Loturco told the 
private news agency  Diarios y Noticias that 23 prisoners who are very 
ill have asked  President Carlos Menem to grant them clemency.  Menem 
offered  pardons to a dozen prisoners with AIDS after they were found  
chained to their beds in a Buenos Aires hospital ward used as a  jail 
sick bay. 

"Funding Cut for Gay Teen Hotline" United Press International (01/06/93)
     Indianapolis--A national hotline for gay and lesbian teenagers  
based in Indianapolis, Ind., will experience federal funding cuts that 
will significantly reduce the number of calls it can handle. Christopher 
Gonzalez of Indianapolis Youth Group said the timing  is unfortunate 
because demand for the service has been growing.   The hotline is 
intended to assist AIDS patients and to educate  others on how to 
prevent HIV.  Indiana's cuts total $220,000.   The hotline acquired 
$32,000 in federal funding in 1992, but will get only $10,000 in 1993.  
Gonzalez said his organization  expected that there would not be a 
repeat of a $20,500 grant it  received last year, but the additional 
reductions in funding were a surprise.  He said the counselors have been 
receiving about  1,000 calls a month, but now the group will only be 
able to  handle about 700.  Aside from the hotline, the group offers  
education and outreach programs to adolescents.  Gonzalez said  teens 
have the largest need for information on AIDS. 

"1993 Nucleoside-Analog Trial Results Expected" AIDS Treatment News 
(01/01/93) No. 166, P. 3  (Tate, Larry)
     Further developments in the clinical trials of nucleoside-analogs 
and combinations of them are expected in 1993.  The first  development 
will be the long-awaited release of data from AIDS  Clinical Trials 
Group (ACTG) 116A, a study comparing AZT to ddI  in people who have used 
AZT for fewer than four months.  This  will compare the two drugs as a 
primary therapy and suggest which drug patients starting anti-HIV 
therapy should use.  It should be known by mid-January whether ddI is 
more effective, less  effective, or about the same as AZT.  Those 
participating have  T-cell counts less than 300, but the findings might 
apply to  people starting treatment at all T-cell levels.  Results from 
the ACTG 019 should be available as early as February, if not, then  by 
early spring.  This trial compared AZT to placebo in people  who started 
with varying T-cell counts--about half of them over  500.  Information 
on the group who started with counts over 500  should provide the 
clearest answer from any U.S. study on the  value of AZT in people in 
early stages of infection.  If AZT  delays disease development in this 
group, there could for the  first time be an FDA-approved therapy for 
people with T-cell  counts over 500.  Another study, ACTG 155, which 
compared AZT to  a combination of AZT and ddC in people with fewer than 
200  T-cells, will have available data by late spring.  If the  findings 
show an advantage for the combination, the current label indications for 
AZT/ddC use may be clarified and strengthened by  the FDA.  The trials 
of 3TC are moving slower.  Currently, it is  in late dose-ranging 
studies and is expected to begin large Phase II comparative studies in 
the spring. 

"VIIth International Conference on AIDS in Africa" AIDS Treatment News 
(01/01/93) No. 166, P. 7  (Heyman, Jason)
     The Seventh International Conference on AIDS in Africa was held  in 
Yaounde, Cameroon, from Dec. 8-11.  The tone, however, was  somewhat 
murky.  The primary issue addressed was HIV prevention  and how efforts 
in Africa are hurting due to a lack of resources. Michael Merson, the 
director of the World Health Organization's  Global Program on AIDS, 
said, "There have already been over 7.5  million infections in adults 
[in Africa] since the start of the  pandemic, close to 4 million of them 
in women."  There was very  little discussion on treatments used for HIV 
infection.  But  HIV-2 was discussed in detail at the conference.  HIV-2 
has come  to be known as the virus of developing countries and has not 
been given the attention that HIV-1 has received.  It was revealed  that 
HIV-2 is much less likely to be transmitted from mother to  child.  Sy 
El Hadj Amadou, the African Secretary of the  International Council of 
AIDS Service Organizations (ICASO)  delivered a speech at the conference 
which drew a connection  between the failure of prevention efforts and 
the lack of AIDS  treatments available to Africans.  He said that as a 
consequence  of the African AIDS community's defeatist attitude towards 
access to treatment, and the West's view of Africa as hopeless, all  
anti-AIDS efforts are seen as weak and not taken seriously by the 
public.  The only treatment discussed in any detail was PCM-4, a  
little-known alternative treatment made from extracts of pig  spleen and 
Siberian genseng, Eleutherococcus senticosus.   Currently, it is being 
researched in the United States and  Uganda, and is sold in buyers' 
clubs and health-food stores. 

"Israel: Rethinking of Entry Restrictions" Lancet (01/02/93) Vol. 341, 
No. 8836, P. 42  (Naparstek, Yaakov  and Morag, Abraham)
     The Israeli Ministry of the Interior's recent decision to  prohibit 
the entry of HIV-positive foreigners into the Israel has prompted 
controversy among the public and in the Knesset.   Exactly how the 
restriction--intended to keep the rate of HIV  infection low (now 1,000 
HIV-positive people and 230 AIDS  patients in a population of more than 
4 million)--is to be  executed is unclear.  A statement by an applicant 
that he or she  does not have AIDS could satisfy the restriction.  Also, 
it is  possible that the applicant will have to produce a medical  
certificate or undergo a blood test for HIV infection.  The  debate over 
the restriction is between groups who object to it on human rights 
grounds and supporters who claim it protects public  health, and those 
who believe the regulation is useless and that  the main effort should 
be invested in public education.  Tourists who visit for less than three 
months at a time and Arab citizens  from the occupied territories will 
not be affected.  Regarding  new immigrants, the issue is even more 
problematic.  The "Law of  Return" allows for every Jew to become an 
Israeli citizen  whenever he or she wishes.  Therefore, a positive test 
would not  prevent Jews from entering the country.  But since a quarter 
of  the HIV-positive people in Israel are immigrants from African  
countries, where the prevalence is very high, testing and  counseling 
must be performed in confidence.  It is undetermined  whether the 
proposed restriction will prevent the spread of HIV  in Israel, and due 
to the controversy, authorities have decided  to reassess their approach 
to the problem. 

"Noticeboard: Think Globally, Act Locally" Lancet (01/02/93) Vol. 341, 
No. 8836, P. 45
     The controversy over whether HIV is actually the cause of AIDS is 
"pointless" and only incites the "denial and complacency that  have 
hampered our global control efforts," according to Dr.  Michael Merson, 
director of the World Health Organization's  Global Program on AIDS at a 
meeting entitled HIV and AIDS: Where  Next?   The U.K. Government hosted 
the meeting during its  presidency of the European Community.  
Approximately 200 new  cases of AIDS emerge daily in Europe.  Merson 
says anti-AIDS  programs in Europe should be modeled after current 
programs now  implemented in the Netherlands and Switzerland.  These 
programs  are based on public openness about sexuality, incorporation of  
sexual health into school curricula, social support for drug  users, and 
the ready availability of condoms.  Concentrating on  high-risk 
populations like IV-drug users and homosexual men is  important, but an 
"illusion of safety" among the rest of the  community must be avoided.  
Also, behavior modification should be encouraged instead of only 
stressing abstinence as a means to  prevent HIV infection.  Prof. Peter 
Piot of WHO said that new  research on plastic condoms and vaginal 
viricides was needed.   But most of these new methods still put the 
burden of protection  on the woman.  Dr. Stefano Vella of the Instituto 
Superiore  diSanita, Rome, Italy, stressed that it would be "impossible 
to  achieve complete eradication of virus from an infected  individual."  
Therefore, research into treatment should be  targeted at making HIV 
infection a chronic manageable disease  with only a limited morbidity. 

"Drug Profiles: Zalcitabine and Didanosine" Lancet (01/02/93) Vol. 341, 
No. 8836, P. 30  (Lipsky, James J.)
     Researchers have not determined the effects of zalcitabine and  
didanosine against the HIV virus.  HIV, like other retroviruses,  
contains genetic information in RNA, reversing the sequence of  DNA into 
RNA, causing it to make more viral RNA and proteins.   This replication 
causes T-cells to die because they are the most  affected.  The drugs 
are intended to interrupt replication by  stopping reverse transcriptase 
and viral DNA synthesis.  Using  its own normal analogue, zalcitabine 
can change the anti-viral  effects while deoxyinosine has no effect on 
didanosine.  The  study also found that didanosine has irregularities 
under acidic  conditions, so it is treated with a buffering agent and  
pharmacists suggest the drug should be taken on an empty stomach. The 
half-life of zalcitabine is extended in patients with renal  failure 
because the kidneys eliminate most of it.  Despite these  basic 
findings, scientists have not made any strong conclusions.  Degree of 
illness, previous and current medications, drug  dosages, and drug paths 
all can have an effect on the study's  results.  The researchers have 
found a few toxic effects from the use of zalcitabine including 
sensorimotor neuropathy. 

"Xerostomia Associated with Didanosine" Lancet (12/19-26/92) Vol. 340, 
No. 8834/8835, P. 1542   (Valentine, Chris et al.)
     Xerostomia is not a direct result of the use of didanosine (DDI)  
to treat AIDS, write Chris Valentine et al. of the Royal Brompton 
National Heart and Lung Hospital in London, U.K.  Dodd and  colleagues 
report in the Sept. 26 issue of the Lancet on the  association between 
DDI treatment and xerostomia.  But the true  incidence of xerostomia 
associated with DDI is probably  considerably less than the 35 percent 
figure suggested by Dodd et al.  Xerostomia has been reported as a 
feature of HIV infection,  and their group has previously reported 
salivary gland  abnormalities in HIV-positive patients before DDI was in 
clinical use.  Because DDI is available in the United States to treat 
AIDS in combination with AZT, these patients will usually have a more  
advanced stage of HIV infection in which there may be a higher  
incidence of xerostamia.  Data presented at the Eighth  International 
Conference on AIDS suggest that this effect is due  to the drug rather 
than stage of infection.  Dodd et al. do not  mention whether their 
study design allowed them to address the  question of whether the 
apparent difference in resting saliva  production between their patients 
receiving DDI and those not may be a result of the effect of stage of 
HIV infection rather than  the effect of DDI.  Dodd et al. state that 
DDI is exerting its  effect on resting salivary flow by causing a 
neuropathy which  reduces the normal sympathetic flow to the gland.  
However, the  researchers conclude it is, instead, more likely that the 
effect  is more similar to the well-documented effect of DDI on the  
pancreas. 
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