From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 1/8/93
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6736
Organization: unspecified
Date: Fri, 8 Jan 93 07:48:58 PST

                     AIDS Daily Summary
                       January 8, 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 

 "Rare Compassionate Glimpse of Homosexuality in China" United Press 
International (01/08/93)  (Schweisberg, David R.)
     Beijing--Although homosexuality was believed to be eradicated in 
China after the 1949 communist revolution, economic and social  
liberalizations, along with the threat of AIDS, have begun to  prompt 
more open discussion.  The Beijing Weekend, a state-run  newspaper, ran 
an article on homosexuality in China, which is an  unusual topic for the 
state media to address, and is usually  discussed in negative terms.  
The article said China's National  Health Education Institute, which has 
led government AIDS  awareness campaigns, last November established 
"Men's World," an  unprecedented support group for gay men in the 
capital.  The  group meets to address AIDS prevention and other problems  
experienced by homosexuals, whose biggest fear is being  discovered as 
homosexuals.  They experience a constant struggle  in protecting their 
secret and their social status.  The article  mentioned that gays' 
sensitivity was emphasized in late December  at a meeting sponsored by 
Men's World.  The gathering erupted in  turmoil when some of the two 
dozen men attending hurled chairs  and "stormed out" after a 
photographer took pictures of them.   The article did not cite any 
statistics, but homosexuality in  Chinese cities is known to be far more 
common than is officially  acknowledged.  In addition, the number of 
AIDS patients  nationwide is believed to be much higher than the 969 
cases  reported by the Chinese government. 

"Findings on Baboon-to-Human Liver Transplant Released" United Press 
International (01/07/93)
     Pittsburgh--The surgeons who performed the world's first  baboon-
to-human liver transplant on an HIV-positive man reported  Thursday that 
four drugs have been combined effectively to  prevent the type of 
rejection seen most often in cross-species  transplantation.  Dr. 
Andreas Tzakis, a University of Pittsburgh  Medical Center surgeon who 
helped perform the transplant, said,  "Our drug cocktail of FK506, 
cyclophosphamide, prostaglandin, and prednisone was more effective in 
preventing rejection than we  actually anticipated."  The surgeons 
reported in the British  medical journal The Lancet that the 
transplanted liver functioned normally throughout most of the 
recipient's life and the  patient's biochemical function was sustained 
with the baboon  liver without apparent side effects.  But, they added, 
an  undetected formation of "sludge" in the liver's bile ducts and  
complications of immunosuppression with an otherwise effective  
combination of drugs contributed to the patient's death.  Sludge  is a 
semi-solid substance comprised of cholesterol and bile  pigments.  The 
transplant was performed on a 35-year-old  HIV-positive man with 
hepatitis B infection on June 28, 1992.   The man lived 71 days after 
the transplant before dying Sept. 6  from bleeding around the brain.  
The medical center is examining  about 10 patients as possible 
candidates for the second such  transplant.  All of the patients have 
life-threatening hepatitis  B infection. 

"Life Goes on For Kellie Martin After Wrenching Scenes on AIDS" USA 
Today (01/08/93), P. 3D  (Graham, Jefferson)
     The ABC TV series "Life Goes On" will air a three-part segment on 
AIDS, which begins Sunday at 7 P.M.  Jesse, an HIV-positive  teenager, 
will develop AIDS.  Jesse, played by Chad Lowe, is the  boyfriend of 
Becca, who is played by Kellie Martin.  Regarding  the AIDS segments, 
Martin said, "They were the hardest scenes  I've ever been in.  They 
made me dig down deep--I don't have a  lot of life experience to draw 
from at 17.  It wasn't easy, but  it was quite a challenge."  Martin 
said there will be no death  scene for Jesse.  "Chad's far too good of 
an actor to be killed  off," she said. "I would be shocked if that 
happened."  Acting  out the AIDS scenes taught Martin that AIDS is "one 
of the  scariest things in life, and how important it is to be there to  
offer support."  The AIDS arc involves Becca and Jesse going "as  far as 
they can possibly go and be safe," by spending the night  together, 
which Martin says is more like a slumber party than  anything sexual.

"Alpha 1 Biomedicals, SciClone Pharmaceuticals To ..." PR Newswire 
(01/07/93)
     Bethesda, Md.--SciClone Pharmaceuticals and Alpha Biomedicals  
received FDA marketing approval to export Thymosin alpha 1 to  Mexico 
for clinical trial treatment against hepatitis B.  David  Kershenobich 
will be lead investigator in Phase III clinical  trials, enrolling 100 
patients in the study.  Currently, Alpha  Biomedicals, a company that 
develops drugs to fight immune  disorders, is undergoing a similar trial 
in America for Thymosin  alpha 1 as well as one in Italy.  The company 
anticipates Italian testing results later this year, while the U.S. 
findings are due  the first half of 1994.  In addition, the company is 
testing  Thymosin alpha 1 combined with interferon for hepatitis C  
treatments, and will combine the drug with AZT and PEG-IL2 to  determine 
results against AIDS. 

"Flynn Joins Suit Against Council on Condom Law" Boston Globe 
(01/06/92), P. 19  (Canellos, Peter S.)
     Controversy emerged Tuesday in Boston between the mayor and the  
City Council over a city ordinance requiring large bars and  restaurants 
to allow condom vending machines on their premises.   The two sides were 
admitted as parties on opposite sides of the  lawsuit over the matter.  
Last month, the City Council overrode  Mayor Raymond Flynn's veto of the 
measure, which indicates that  the ordinance is city law.  But Flynn 
claims the council has no  statutory authority to address licensing 
issues and that the  ordinance is "a legal nullity," according to the 
city's  corporation counsel, Albert Wallis.  When the Massachusetts  
Restaurant Association sued to overturn the ordinance, Wallis  supported 
Flynn and refused to defend it.  Consequently, the  council was appalled 
that the city's leading attorney would  refuse to defend the ordinance, 
and hired its own lawyer to  defend itself.  As the council took the 
role of defendant, Wallis moved to have Flynn join the case as a 
plaintiff Tuesday in  Suffolk Superior Court.  Various city AIDS groups, 
who argue that the ordinance will save lives by making condoms readily 
available to couples contemplating unprotected sex, joined the council 
in  defending the measure.  Wallis said state law grants authority  
solely to the mayor, and that "the council's actions in passing  an 
action of dubious legality is what provoked this controversy.  The 
restaurant association should have sued the council in the  first place.  
The mayor considers the policy a legal nullity and  has taken no steps 
to enforce it."  Councilor Charles Yancey  (Dorchester) chastised Wallis 
for backing Flynn and said it  "causes a major constitutional crisis."

"The Young and the Reckless" Newsweek (01/11/93) Vol. 121, No. 3, P. 60   
(Gelman, David et al.)
     Although the rate of HIV infection among homosexuals as a whole  
may be decreasing, it is not decreasing in the younger gay  population 
in urban areas.  This resurgence of HIV infection is  partly due to the 
free-wheeling gay night life.  What is more  alarming is that evidence 
suggests a growing generation gap in  AIDS awareness--the younger gay 
community is apparently engaging  in high-risk sex in substantially 
higher numbers than their  elders.  Young homosexuals are more likely to 
have had multiple  partners and unprotected anal sex, according to 
recent studies.   A U.S. Department of Health survey found that the 
highest  prevalence of HIV infection is among gay men aged 17-25.  The  
Centers for Disease Control found that AIDS cases between  homosexual 
men aged 13 to 29 increased upward last year, in  defiance of the 
overall trend downward.  It is apparent that the  safe-sex message is 
not registering with this younger homosexual  population.  The 
"stereotypical view" is that HIV affects mainly  "older men with 
mustaches who go to leather bars," said a study  conducted by the Center 
for AIDS Prevention Studies (CAPS) of the University of California--San 
Francisco.  Young gays are somewhat sheltered, since many of them have 
never met anyone with AIDS or  witnessed a friend their age die of the 
disease.  According to  CAPS researchers, closeted young gays sometimes 
feel so isolated  they don't see much of a reason to protect themselves 
against  disease.  Studies have also found that facts alone are not 
enough to alter behavior.  Researchers say that what brings about change 
is perception of what seems to be the accepted way of doing  things. 

"Does Drug Interaction Cause Failure of PCP Prophylaxis With  Dapsone?" 
Lancet (01/02/93) Vol. 314, No.8836, P. 48  (Huengsberg, Mia)
     There is no relation between dosage of dapsone and prophylaxis  
failure, write Mia Huengsberg et al. of the St. Thomas' Hospital  in 
London, U.K.  Dapsone has been used as a treatment against  Pneumocystis 
carinii pneumonia (PCP) in HIV-positive patients.   But there is concern 
about failure of dapsone prophylaxis due to  drug interaction.  
Didanosine and rifampicin interact with  dapsone, which is rendered 
insoluble at neutral gastric pH.  The  researchers use dapsone as a 
second-line treatment for PCP.   Between April 1990 and October 1992, 6 
patients on dapsone  prophylaxis developed PCP 1-25 months later, 
whereas another 19  patients used dapsone for at least three months and 
have not  developed PCP.  The researchers did not find a difference in 
drug intake between the two groups.  Also, there was no difference  
between the groups in dapsone dosage.  Because the sample size of the 
retrospective study is small, it is difficult to meaningfully compare 
the statistics.  But the researchers conclude that they  cannot confirm 
a correlation between dapsone's failure as a  prophylactic agent and co-
medication that increases gastric pH. 

"Acquired Resistance to Clarithromycin as Combined Therapy in  
Mycobacterium Avium Intracellulare Infection" Lancet (01/02/93) Vol. 
341, No. 8836, P. 53   (De Wit, Stephane et al.)
     The role of clarithromycin against Mycobacterium avium  
intracellulare (MAI) infection in AIDS patients is not yet  determined 
and further research of combined therapy is needed,  write Stephane De 
Wit et al. of St. Pierre University Hospital in Brussels, Belgium. The 
researchers describe an AIDS patient with  systemic MAI infection in 
whom resistance to clarithromycin  appeared despite combined therapy 
with clofazimine.  A  40-year-old homosexual man was presented in 
September 1991 with  high temperature, dyspnoea, dry cough, weight loss, 
and  diarrhea--CD4 count was 15 u/l.  Pneumocystis carinii and  
mycobacteria were found in the blood and bone marrow after a 4  weeks 
culture.  P carinii pneumonia was treated with dapsone plus trimethoprim 
and mycobacterial infection with a combination of  rifampicin, 
isoniazid, amikacin, ethambutol, and clofazimine.   Subsequent 
identification and in-vitro susceptibility testing  documented MAI 
sensitive to clarithromycin.  Initial treatment  was changed to 
clofazimine 100 mg per day and high-dose  clarithromycin 1000 mg twice 
daily.  Blood cultures became  negative after 1 month of therapy and 
remained negative for me  than 5 months.  Clofazimine was discontinued 
after 5 months  because of skin hyperpigmentation; about 3 weeks later 
the  patient was admitted with high temperature and anemia.   
Clarithromycin was stopped, and rifabutin, isoniazid amikacin,  and 
ethambutol were given, with a favorable clinical response.   The patient 
died four months later of disseminated  cytomegalovirus infection.  
Although studies of combination  therapy is warranted, dual therapy may 
not be sufficient to avoid emergence of M avium resistant strains, the 
researchers conclude.

"Prevalence of HIV-Infected Syringes During a Syringe-Exchange  Program" 
New England Journal of Medicine (12/24/92) Vol. 327, No. 26,  P. 1883  
(Heimer, Robert et al.)
     A needle-exchange program can significantly reduce the rate of  
HIV-1 infection among IV-drug users, write Robert Heimer et al.  of the 
Yale University School of Medicine in New Haven, Conn.   The researchers 
evaluated a needle-exchange program in New Haven  operated by the city's 
health department.  The program allows  IV-drug users four opportunities 
a week to exchange their used  syringes on a one-for-one basis for 
clean, attached  syringe-needle combinations.  The syringes returned 
were tested  with the polymerase chain reaction for HIV-1 proviral DNA 
as  proof of use by an HIV-positive IV-drug user.  Before the start  of 
the program, the rate of infected needles was determined for  two 
sources.  A total of 160 syringes not distributed through the program 
that were returned as the program began were randomly  selected and 
tested.  The rate of HIV-1 in these needles was 68  percent.  Another 
180 syringes returned through an illegal  exchange that operated once a 
week were tested and had a  prevalence of infection of 63 percent.  
Between Nov. 14, 1990,  and December 31, 1991, the researchers tested 
1860 randomly  selected needles distributed through the needle-exchange 
program. At first, the rate of HIV-1 proviral DNA was not different from  
that in the 160 needles tested before the program began.  But by  the 
third month of program operation, the rate had fallen to 57  percent.  
In subsequent months, the rate stabilized, approaching  a steady-state 
level of 43 percent.  The researchers found no  changes in the 
demographic characteristics or drug-use habits of  newly enrolled 
clients that could account for the reduction in  the rate of HIV-1 
proviral DNA in the needles.  

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