From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 8/27/92
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6042
Organization: unspecified
Date: Thu, 27 Aug 92 23:20:48 PDT

                        AIDS Daily Summary
                          August 27, 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 
Clearinghouse, or any other organization.  Reproduction of this text is 
encouraged; however, copies may not be sold.  Copyright 1992, 
Information, Inc., Bethesda, MD 
************************************************************************
 "Switching Drugs is Found to Help in AIDS Cases" New York Times 
(08/27/92), P. B7  (Angier, Natalie)
    AIDS patients who take AZT could benefit by switching after  several 
months to didanosine (DDI), according to a study  published in today's 
New England Journal of Medicine.  The  findings indicate that people in 
early stages of infection with  HIV should not rely completely on AZT, 
but rather should be  placed on low doses of DDI after about 16 weeks of 
AZT treatment. Currently, patients are often administered AZT until they 
develop severe side effects or show signs of resistance to the  
medication, at which point other drugs may be tried.  The new  
discovery, however, showed a clear advantage to switching over to DDI 
before any signs of intolerance to the standard drug.   Patients in the 
study who had been taking AZT and who were put on 500 mg a day of DDI 
encountered fewer opportunistic infections  and had higher white blood 
cell counts.  These findings suggest  the individuals had stronger 
immune systems than patients who  either stayed on AZT or who were 
assigned a higher dose of DDI.   The lead author of the study, Dr. James 
O. Kahn of San Francisco  General Hospital, and his colleagues feel that 
a lower dose of  DDI is more effective than a higher one because 
patients tolerate it better and can take it longer.  Despite these 
promising  findings, researchers still do not see any survival advantage 
in  switching drugs. 

"Straight Talk on Tough Teen Issues" USA Today (08/27/92), P. 3D  
(Roush, Matt)
    Two television programs, airing on local stations beginning this  
week and running through mid-September, are targeted at educating teens 
about pressing issues.  The week of Sept. 14, MTV will air  the program 
"Mountain! Get Out of My Way," which features  talk-show host Montel 
WIlliams.  The program is a poignant and  extensive survey of topics 
ranging from AIDS to drug abuse.   "Mountain!" is designed to prompt its 
audience into action, and  includes profiles of teens, parents, and 
community leaders who  are helping troubled youth.  Another program in 
which AIDS is the primary focus, "Understanding HIV; Does Teen America 
Know the  Facts?", gives a frank discussion on HIV prevention and  
education.  It features "Beverly Hills, 90210's" Ian Ziering and  
Gabrielle Carteris, Tempestt Bledsoe of "The Cosby Show," and  Chad 
Lowe, who plays an HIV-positive teen on "Life Goes On."  In  addition, a 
gay activist tells his story of how he was infected  at age 16 by an 
older man who knew he was HIV-positive. 

"HIV No Longer Sounds School Alarms" Chicago Tribune (08/26/92), P. 1-1  
(Donato, Marla)
     Parents of children attending elementary school in two suburban  
areas of Chicago will receive pamphlets about AIDS and an  announcement 
that a child in their respective district is  infected with HIV.  The 
letters mailed to parents in Park Forest  and Orland Park are not 
supposed to create public hysteria but do indicate the growing number of 
school-age children who have been  exposed to HIV.   Donna Jemilo, 
superintendent of the district,  said, "We decided to be pro-active and 
educate the community.  If the information that we had an HIV-positive 
student in the  district were to slip out later, then we would have to 
be in a  reactive mode."  While the letter did not identify the student 
or which of the district's six schools the child was attending,  
Jemilo's letter ensured parents that their children were not at  risk.  
Moreover, Jemilo is expected to conduct meetings Wednesday to discuss 
the issue with teachers, staff, and parents.  A  similar community 
meeting was scheduled for Sept. 8 by Orland  Park Elementary District 
135 administrators.  Superintendent  Thomas Pauley conducted a news 
conference Tuesday to announce the presence of the district's first HIV-
positive student.  He also  sent out packets of information to 3,500 
district households. 

"Doctor Disputes Risk of Sex in Video Booths" Philadelphia Inquirer 
(08/27/92), P. B1  (Copeland, Larry)
    The alleged sex acts that took place in three Philadelphia  
bookstores poses minimal-risk for transmission of HIV, according  to a 
Philadelphia physician with a large AIDS practice.  Dr.  Frederick 
Nicholas Ifft of the Southeast Health Center testified  yesterday at a 
hearing before Common Pleas Court Judge Alex  Bonavitacola.  He said, 
"Most of the activity that goes on in  adult bookstores would have to be 
described as low-risk for HIV  transmission.  I think the [Pennsylvania] 
Attorney General's  Office is doing a grave public health...misservice 
by implying  AIDS is transmitted...in a variety of ways in which it is 
not  transmitted."  Ifft's testimony occurred on the second day of a  
hearing on whether to eliminate the current temporary restraining order 
that shut down video-viewing booths in the three  bookstores.  On July 
29, Attorney General Ernie Preate Jr. filed  the injunction citing the 
spread of HIV and other sexually  transmitted diseases.  He argued that 
patrons have unprotected  sex with men in adjoining booths through 
"glory holes" in the  walls, facilitating the spread of diseases.  
Bonavitacola  announced yesterday that he would decide early next week 
on  whether the stores' video sections are to remain closed pending a 
hearing on the state's request to close the bookstores entirely  for one 
year as a public nuisance.

"Tennis Rallies Round Ashe" Washington Post (08/27/92), P. B11  (Finn, 
Robin)
    Tennis greats playing in the U.S. Open are also joining former  
tennis champion Arthur Ashe's fight against AIDS.  Nine  top-ranked 
stars, including Jim Courier and Monica Seles, will be featured on 
Sunday in an exhibition to benefit Ashe's new  Foundation for the Defeat 
of AIDS.  The exhibition will begin a  15-month effort that is expected 
to raise $5 million.  Ashe's  project has won collective cooperation 
from the players and  executives of the men's and women's tours in 
addition to the  International Tennis Federation, the sport's governing 
body, and  the United States Tennis Association.  Ashe, who announced he 
has AIDS on April 8, said, "I guess I've received such a positive  
response from the players because I've been one of them and  because 
tennis is a global sport and this is a nasty, worldwide  malady."  He 
added, "What happened with tuberculosis may happen  with AIDS if we 
don't start educating and mobilizing against it." Ashe indicated that he 
and his wife, Jeanne, had planned to ask  for some commitment for their 
project from the tennis community,  "even before the April 8 
announcement.  But I didn't know the  Foundation would spark this kind 
of synergy in the tennis world.  That's a rare thing."  All players in 
the main Open draw are  expected to wear a red ribbon centered by a tiny 
yellow tennis  ball, as a logo of support for Ashe. 

"Legal Beat: HIV-Infected Blood Recipient Can Sue Donor, Appeals  Court 
Rules" Wall Street Journal (08/27/92), P. B8  (Anders, George)
    The Sixth U.S. Court of Appeals in Cincinnati, Ohio, ruled that  the 
recipient of HIV-infected blood may sue the donor, despite  the fact 
that the identity of the donor was revealed in  violation of a lower-
court order.  While the lower-court order  protecting the donor's 
identity was upheld by the appeals court,  it said that in barring the 
blood recipient from suing after  learning the donor's identity, the 
judge went too far.  The blood recipient, Cheryl Coleman, sued the 
American Red Cross--which had provided the blood for her August 1984 
transfusion--for  negligence, and requested the identity of the donor.  
Though the  trial judge ordered the donor's records to be turned over 
with  the name withheld, one record inadvertently included the donor's  
Social Security number.  Coleman's attorney used this information to 
trace the donor's identity.  According to the federal appeals  court, 
Coleman's right to sue the donor outweighs concerns of the Red Cross 
that the suit should not be allowed because it would  discourage future 
donors. 

"Noticeboard: Consulting About Children With HIV" Lancet (08/15/92) Vol. 
340, No. 8816, P. 422
    The Eighth International Conference on AIDS held in Amsterdam  last 
month raised some disturbing issues about the difficulties  HIV-positive 
children and those who care for them encounter.  An  Italian study 
demonstrated, for instance, that among a cohort of  perinatally HIV-
infected children, 23 percent were now attending  primary school.  The 
researchers decided that urgent guidelines  were needed for those 
responsible for the psychological support,  welfare, and education of 
these children.  The United Kingdom  Department of Health has recently 
issued guidelines to Local  Authority Social Service departments 
regarding the services for  children who are both infected and affected 
by HIV.  The new  guidelines stress four important topics.  A violation 
of  confidentiality may have especially distressing consequences to  the 
child and family because of the stigma linked with HIV  infection.  A 
child or the child's parents will have to give  full-informed consent in 
order for HIV status to be disclosed.   Coordination and communication 
with other agencies is essential  to provide effective care.  Moreover, 
the staff treating these  children must also be given support and 
training in what can be  quite a stressful working atmosphere.

"How Safe is BCG Vaccination in Children Born to HIV-Positive  Mothers?" 
Lancet (08/15/92) Vol. 340, No. 8816, P. 434   (Athale, Uma H. et al.)
    Zambian children should be immunized with BCG vaccine at 1 year  of 
age, because by then full-blown AIDS or HIV infection will be  evident 
and provide the basis for exclusion from immunization,  write Uma H. 
Athale et al. of the University Teaching Hospital in Lusaka, Zambia.  
National policy in Zambia requires that every  infant must receive BCG 
immunization at birth, and only those  with full-blown AIDS are exempt, 
given it is possible to diagnose neonatal AIDS when facilities are 
limited.  However, the  protective value of BCG is disputable.  BCG may 
have serious  effects in an immunocompromised host.  About 15-25 percent 
of the pregnant women in East and Central Africa are infected with  HIV-
1, and about 30-40 percent of infected women can transmit the infection 
to the fetus.  Therefore, it can be predicted that 5-10 children out of 
every 100 births will be infected with HIV-1.   These statistics will 
increase, due to the rampant progress of  the HIV-1 epidemic in East and 
Central Africa.  The rate of HIV  infection at University Teaching 
Hospital is 25 percent in  inpatients aged 6 months to 5 years, while 
37-50 percent of  pediatric and 60 percent of adult patients with 
tuberculosis were infected with HIV-1.   BCG could disseminate in an  
immunocompromised host, and it is difficult to detect AIDS in  newborn 
babies, conclude Athale et al. 

"Contribution of Maternal Viral Load to HIV-1 Transmission" Lancet 
(08/15/92) Vol. 340, No. 8816, P. 435   (Ariyoshi, K. et al.)
    There is no relation between maternal infectious viral load in  
plasma or in PBMCs and outcome of HIV transmission to the child,  write 
K. Ariyoshi et al. of the St. Mary's Hospital Medical  School in London, 
United Kingdom.  The European Collaborative  Study on HIV-1 (April 25--
Lancet) has demonstrated that  detectable p24-antigenaemia and low CD4 
counts are risk factors  for mother-to-child transmission of HIV-1.  
These observations  indicate that maternal viral load might be relevant 
to HIV-1  transmission.  HIV-1 load in plasma and peripheral blood  
mononuclear cells (PBMC) were examined in six HIV-1 positive  mothers at 
St. Mary's Hospital.  No association was found between maternal 
infectious viral load and outcome of transmission to the child.  
However, there is an association between CD4 number and  plasma 
viraemia--patients with CD4 counts above 200 are only  rarely viraemic 
by infectious assays.  The relation found between p24 antigen and 
transmission may not involve the quantity of  infectious virus.  The 
researchers found no difference in HIV  transmission rate between the 
mothers with CD4 count of less than 400 and 400-699 in the study, and 5 
mothers whose CD4 count was  greater than 700 transmitted HIV to their 
infants.  Therefore,  infectious virus titres in peripheral blood do not 
correlate with mother-to-child transmission of HIV. 

"Physicians Urged to Report Moderate to Severe Immune Deficiency  Cases 
Without Evidence of HIV Infection" Journal of the American Medical 
Association (08/19/92) Vol. 268,  No. 7, P. 847  (Goldsmith, Marsha)
    Last month reports of an AIDS-like illness without evidence of  HIV 
infection were released at the Eighth International  Conference on AIDS 
in Amsterdam.  The reports raised questions of whether a virus is 
involved and if it is contagious.  Dr. James  W. Curran, director of the 
HIV/AIDS programs at the Centers for  Disease Control in Atlanta, Ga., 
said, "Prior to the meeting,  there were a half dozen or so cases of 
moderate to severe immune  deficiency in the absence of HIV infection 
reported in the  medical literature.  At this conference, due to a lot 
of  premeeting publicity about these cases, several physicians have  
come together and described several more cases of moderate to  severe 
immune deficiency with severe opportunistic infections in  some persons 
who have the HIV-type risk factors and some who do  not."  To get a 
better understanding of the problem, Dr. Curran  says, "the CDC is 
working with investigators at the National  Institutes of Health 
[Bethesda, Md.] and the World Health  Organization [Geneva, Switzerland] 
to conduct laboratory  studies."  He added, "We would like physicians to 
report cases of moderate to severe immune deficiency with CD4 levels at 
or near  250 or less in the absence of HIV infection to the CDC and 
their  state health departments." 

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