From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 1/4/93
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6711
Organization: unspecified
Date: Mon, 4 Jan 93 08:23:45 PST

                     AIDS Daily Summary
                       January 4, 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 

 "Ethics of Giving AIDS Advice Troubles Catholic Hospitals" New York 
Times (01/03/93), P. 1  (Navarro, Mireya)
     Catholic hospitals are having trouble dealing with AIDS education 
because they oppose most of what public officials suggest as the  best 
means to avoid infection, such as condom use and the  cleaning of dirty 
IV-needles.  St. Vincent's Hospital in New York City abruptly canceled 
its events planned to observe World AIDS  Day early last month.  
Hospital administrators objected to most  of the educational material to 
be distributed in the lobby,  claiming it encouraged the use of condoms 
and referred to  behaviors that "were not in keeping with the teachings 
of the  Catholic Church."  The hospital's AIDS workers were confused  
about the administration's decision because the same brochures  and 
pamphlets had been allowed in previous years.  In cities like New York, 
which leads the nation in reported AIDS cases, Catholic institutions, 
with heavy financial support from the government,  have been major 
providers of care to AIDS patients.  But due to  moral obligations, the 
church has resisted teaching prevention  messages widely recommended by 
public health officials.   According to church officials, the only 
morally correct way to  prevent HIV infection is by avoiding drugs and 
by practicing  fidelity within marriage and abstinence outside it.  But 
public  health officials say they find themselves somewhat uncertain 
over how far to push the hospitals to provide HIV prevention  
information.  Catholic institutions were among the first to  exhibit 
compassion for AIDS patients, and provide 36 percent of  nursing-home 
care for AIDS patients in New York. 

"More AIDS Patients Resistant to AZT" Washington Post (01/01/93), P. A9
     Increasing numbers of AIDS patients are exhibiting early  
resistance to AZT, and scientists claim there is an imminent need to 
develop new treatments to fight HIV infection.  Wendell T.W.  Ching of 
the UCLA School of Medicine conducted a blood test study which appears 
in Friday's edition of the Proceedings of the  National Academy of 
Sciences.  He said blood tests are indicating more numbers of AIDS 
patients who have never taken AZT but are  infected with a virus that is 
naturally resistant to the drug.   "Some of the patients may have gotten 
the virus from other  patients who had been taking AZT and who are now 
transmitting the resistant virus," said Ching.  He added that earlier 
studies  concluded that AZT resistance was a result of long-term use of  
the drug.  But the new study shows that resistance may transpire  
naturally, even in patients who have never taken AZT, and that  the 
resistant virus can spread from a patient who has taken the  drug to 
another who had been disease-free.  Ching said that the  increase in the 
AZT-resistant virus may not have been found  earlier due to the way 
blood tests were conducted.  He said that  researchers typically draw 
blood from HIV-positive people and  then culture the sample until the 
population of the virus has  increased.  While this occurs, there is a 
change in the relative  numbers of different strains of the HIV, which 
appears to hide  the dominance of AZT-resistant strains.  Ching and his 
colleagues corrected the problem by drawing blood from patients and 
testing  for different strains of HIV before the virus had a chance to  
grow new generations. 

"Technique May Fight Disease by Reversing Instructions to Cells" 
Washington Post (01/04/93), P. A3  (Rensberger, Boyce)
     A type of genetic engineering is being performed by scientists  who 
are seeking a cure for AIDS and other maladies.  The  technique is 
called "antisense" technology because it tells cells to do the opposite 
of what one of their genes is instructing them to do.  For example, 
genetic instruction could be a message  coming from a strain of HIV that 
has fooled a blood cell into  making new HIV strains.  The antisense 
technique makes it  possible to send another message that cancels the 
gene's  instruction before the cell can act on it.  The process has been  
shown to inhibit the proliferation of viruses in cultured cells  
infected with HIV, herpes, and cervical cancer.  The antisense  
technology inhibits the essential middle step in the series of  events 
by which genes control cells.  Each gene holds coded  instructions 
telling the cell how to assemble raw materials to  make a protein 
molecule.  The genetic instruction is transcribed  into a temporary 
replica called messenger RNA.  This molecule  delivers the code to one 
of the cell's protein factories--a  ribosome--outside the nucleus.  This 
apparatus reads the  messenger RNA's code and assembles the given 
protein.  The  antisense technique is intended to kill the messenger RNA 
before  it can be read by a ribosome.  This is accomplished by putting  
into the cell a synthetic form of DNA that will bind to the  targeted 
RNA molecules but not to other messenger RNA segments  carrying 
different instructions needed by the cell.  The  synthetic DNA binds 
because it carries a genetic message, which  is virtually a mirror image 
of the RNA's message. 

"AIDS Concern and Threat Grow in China, Says Magazine" United Press 
International (01/04/93)
     Beijing--Fear of AIDS is becoming prevalent in China, but  
government efforts are neglecting to educate the country about  the 
disease, according to the government English-language weekly  magazine 
Beijing Review.  The known numbers of AIDS cases in  China are 
relatively small.  Last month, health officials  reported that 969 
Chinese were infected with HIV.  Overall, 12  people have AIDS--nine of 
whom have died.  However, health  experts are concerned that there are 
many more unidentified cases of HIV infection because of China's strict 
legal and social  attitudes toward people with high-risk behavior.  The 
magazine  quoted Wan Yanhai, head of the Beijing hotline team sponsored 
by  the Chinese Institute of Health Education, who cautioned that  
"current efforts to educate the public are far from adequate and  place 
too much emphasis on morality."  The magazine said large  hospitals are 
often overwhelmed with questions from the public  about whether 
mosquitoes can spread HIV or whether a person can  be infected through 
casual contact.  The magazine said, "Such  widespread lack of knowledge 
exactly constitutes a hidden danger  for the spread of the disease."  
Wan requested the expansion of  AIDS hotlines to other cities, the 
education of high-risk groups, and more contacts with foreign health 
experts.  The Beijing  Review said that "the rate of infection could 
explode among  high-risk groups if preventive measures are not taken." 

"Medicaid Costs Major Concern for State Government" United Press 
International (01/02/93)
     Indianapolis--The Clinton administration and Indiana lawmakers  are 
expected to give health care reform more attention.  A  commission 
appointed by Indiana Governor Evan Bayh completed  three years of study 
in November and issued a 700-page strategy  for state health care 
reform.  The 1993 General Assembly in  Indiana is expected to require 
hospitals to offer voluntary HIV  testing to all patients, and create a 
new health care program for low-income people who aren't eligible for 
Medicaid. 

"Expanded AIDS Definition Called 'Lifeline' for Thousands" United Press 
International (12/31/92)
     New York--The new federal AIDS surveillance definition was  enacted 
on Friday, and one family health agency called the change "a lifeline" 
for thousands of HIV-positive Americans.  Jane  Johnson, vice president 
of the Planned Parenthood Federation of  America, said, "The broader 
definition for AIDS focuses attention on the importance of testing for 
HIV and increases the  probability that more women, particularly poor 
women, with HIV  will more promptly be diagnosed and treated."  The new 
definition will help qualify a person considered to have AIDS for vital  
public entitlement programs and will result in health care  providers 
providing better care for such patients. 

"Acyclovir Annual Price Cap for Some Patients, $2,500;  Registration 
Required" AIDS Treatment News (12/18/92) No. 165, P. 3  (James, John S.)
     Burroughs Wellcome Co. announced Dec. 7 that it will cap the  price 
of acyclovir (Zovirax) for AIDS patients who pay for the  drug 
themselves.  Those people who use more than 730 grams (which costs about 
$2,500 wholesale) in a single calendar year will  receive up to 730 
grams additional at no cost for the remainder  of the year.  The new 
program begins January 1.  Therefore, those who are using a continuous 
high-dose acyclovir and paying for  their own medication should 
immediately register, through their  physician or other health-care 
provider, so that their acyclovir  use can be monitored and credited 
toward the cap.  However, the  program is only for patients who do not 
have third-party coverage for their acyclovir use.  The cost of using 
acyclovir regularly  at high doses can be $5,000 per year or more, 
creating financial  difficulties or making the drug unavailable to 
patients for whom  it was prescribed.  AIDS activists from several 
organizations had negotiated with Burroughs Wellcome for ten months 
seeking a  reduction in price.  However, the company agreed to a price 
cap,  said Dr. Andrew Zysman of ACT-UP/Golden Gate.  Dr. Zysman said,  
"The cap, while a start, does not go far enough.  A workable  solution 
would be an annual cap of $2,000 per patient, which  would continue to 
generate great profits, while making acyclovir  more accessible."  He 
added that many physicians in public health settings "are unable to 
suggest the use of acyclovir because it  would bankrupt their clinic's 
budget; hence patients will not be  able to benefit." 

"Protective Effects of a Live Attenuated SIV Vaccine With a  Deletion in 
the Nef Gene" Science (12/18/92) Vol. 258, No. 5090, P. 1939   (Daniel, 
Muthiah et al.)
     Live attenuated HIV-1 may also be the most potent, effective  
vaccine for the prevention of AIDS, write Muthiah D. Daniel et  al. of 
the New England Regional Primate Research Center, Harvard  Medical 
School, in Southborough, Mass.   Vaccine protection  against HIV and 
simian immunodeficiency virus (SIV) in animal  models is proving to be a 
difficult task.  The problem is largely attributable to the persistent, 
unrelenting nature of HIV and SIV infection once infection is initiated.  
SIV with a constructed  deletion in the auxillary gene nef replicates 
poorly in rhesus  monkeys and appears to be nonpathogenic in this 
normally  susceptible host.  Rhesus monkeys vaccinated with live SIV  
deleted in nef were completely protected against challenge by  
intravenous inoculation of live, pathogenic SIV.  Concern for  safety is 
likely to be the main issue for the eventual  development of the 
deletion approach.  In addition to nef, other  genetic elements can be 
deleted from HIV-1 to help guarantee  long-term safety.  The use of 
deletion mutants eliminates the  possibility of reversion and helps to 
guarantee the safety of  inoculation with the attenuated virus.  
Deletion of nef or of  multiple genetic elements from HIV may provide 
the means for  creating a safe, effective live attenuated vaccine to 
protect  against AIDS, conclude the researchers.

"AIDS Vaccines: Is Older Better?" Science (12/18/92) Vol. 258, No. 5090, 
P. 1880  (Cohen, Jon)
     Although researchers have previously considered an AIDS vaccine  
made from attenuated virus as being far too dangerous, many are  
rethinking the conventional vaccine approach.  Several AIDS  researchers 
know the power of attenuated virus vaccines, but they fear that even a 
weakened version of the evasive HIV could lead  to fatal infection.  
Many researchers have believed that the only effective vaccine would be 
genetically engineered pieces of HIV,  but that high-tech approach isn't 
working well.  However, an  experiment involving attenuated virus has 
reproduced some  striking results.  Ronald Desrosiers and his colleagues 
at  Harvard's New England Regional Primate Research Center vaccinated 
four rhesus monkeys with a weakened form of simian  immunodeficiency 
virus (SIV) and protected them from infection  for more than two years.  
But Desrosiers said long-term safety  concerns are worrisome.  "It will 
take 10 or 15 years of safety  testing before we can be comfortable 
putting this into thousands  of people."  Before the live, attenuated 
method could be  seriously considered for use in humans, at least three 
safety  concerns would have to be addressed.  First, the HIV in an  
attenuated vaccine could revert to a virulent state.  Second,  even if 
the vaccine did not cause AIDS, it might cause cancer.   And third, a 
virus that initially appears safe might, decades  later, turn out to 
cause disease.  Philip Berman of Genentech, a  company working on 
genetically-engineered AIDS vaccines, warns  that SIV is different from 
HIV and that monkey data may not apply to humans.

"Cellular Proteins Bound to Immunodeficiency Viruses:  Implications for 
Pathogenesis and Vaccines" Science (12/18/92) Vol. 258, No. 5090, P. 
1935   (Arthur, Larry O. et al.)
     Cellular proteins linked with immunodeficiency viruses play a  
primary role in infection and pathogenesis, write Larry O. Arthur et al. 
of the National Cancer Institute--Frederick Cancer  Research and 
Development Center in Frederick, Md.  Cellular  proteins associated with 
immunodeficiency viruses were identified by determination of the amino 
acid sequence of the proteins and  peptides present in sucrose density 
gradient-purified HIV-1,  HIV-2, and simian immunodeficiency virus 
(SIV).  B2 microglobulin (B2m) and the a and B chains of human 
lymphocyte antigen (HLA) DR were present in virus preparations at one-
fifth the concentration of Gag on a molar basis.  Antisera to HLA DR, 
B2m as well as HLA  class I precipitated intact viral particles, 
suggesting that  these cellular proteins were physically associated with 
the  surface of the virus.  Whether the cellular proteins are  
components of the viral envelope acquired during budding or are  
acquired after budding by specific associations is an important  
mechanistic consideration that can now be addressed.  It is  likely that 
immune responses to HLA DR, HLA class I, or B2m (or  to all three 
cellular proteins) were involved in the protection  against SIV 
infection after immunization with uninfected human  cells.  These 
proteins should be considered in elucidation of the steps involved in 
infection, design of vaccines, preparation of  experimental virus-
challenge stocks, and determination of the  pathological mechanisms of 
immunodeficiency viruses, the  researchers conclude. 

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