From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 12/29/92
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6686
Organization: unspecified
Date: Tue, 29 Dec 92 08:15:35 PST

                    AIDS Daily Summary
                     December 29, 1992 
 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 

 "Cheaper Drugs More Effective in AIDS Cases" Journal of Commerce 
(12/29/92), P. 7A
     The Pneumocystis carinii pneumonia (PCP) experienced in AIDS  
patients can be more effectively treated with daily tablets of  two 
cheaper drugs than with the more expensive treatment of  inhaling the 
drug pentamidine.  However, the less expensive  treatment also has 
drawbacks, according to studies published in  the New England Journal of 
Medicine.  While the cheaper  treatment, trimethoprim-sulfamethoxazole, 
may be more effective,  the risk of side effects is higher and 
eventually may force some  HIV-positive patients into more extensive 
therapy.  A team of  researchers led by Dr. Margriet M.E. Schneider of 
the University  Hospital in Utrecht, the Netherlands, conducted one test 
on 215  subjects who previously had not suffered from PCP.  They  
discovered that 11 percent of the patients receiving aerosolized  
pentamidine developed PCP.  Of those AIDS patients who received  the 
less expensive combination of trimethoprim-sulfamethoxazole,  there were 
no cases of PCP. 

"States Face Drop in Federal Backing of AIDS Prevention" New York Times 
(12/29/92), P. A1  (Pear, Robert)
     The federal government announced that it is cutting state funds  
designated for AIDS prevention programs.  Consequently, many  states are 
curtailing services even as there is a rising demand.  State officials 
have complained to the Bush administration about  the cuts, but federal 
health officials said there was little they could do because Congress 
had limited the amounts available.   According to federal officials, 
$129 million is provided for  grants to states for AIDS prevention next 
year, compared with  $143.7 million this year and $159 million in 1991.  
They said the states were receiving less money because Congress had 
specified  more for private "community-based groups."  The controversy 
is  emerging now because federal health officials have started  
revealing exactly how much money states can expect.  Although  
President-elect Clinton promised in his campaign to allocate more money 
for AIDS prevention, he could not make significant  increases without 
asking Congress to appropriate new money for  fighting AIDS.  The money 
that federal heath officials are now  allotting for the 1993 calendar 
year is part of Congress'  appropriations for the 1993 fiscal year, 
which has already begun. Federal funds comprise the vast majority, at 
least 75 percent, of state spending for AIDS prevention programs.  
Federal officials  noted three reasons for the cuts: a general shortage 
of money,  the diversion of money to other health programs, and 
disagreement about the proper balance between prevention and treatment 
of  AIDS.   Related Story: Baltimore Sun (12/29) P. 1A 

"New Definition to Raise AIDS Numbers" Washington Post (12/29/92), P. A8
     The Centers for Disease Control's new definition of AIDS will  take 
effect on Friday, January 1, and will cause thousands more  HIV-positive 
Americans to be considered to have the disease.   Activists and 
physicians are expecting a higher demand for  treatment and social 
services as more of those infected are  included in the definition.  
During 1993, a total of 90,000  Americans are expected to be diagnosed 
with the disease,  according to the CDC.  With the current definition 
about 50,000  Americans are diagnosed annually with the disease.  
Approximately 242,000 Americans have been diagnosed with AIDS and 
160,000 have  died.  Following intense protests by activists, who 
charged that  the CDC has been ignoring AIDS symptoms experienced only 
in women and IV-drug users, the agency adopted the new definition.  The  
current definition considers one to have AIDS if he or she  experiences 
one of 23 AIDS-related illnesses.  Included in the  new definition are 
pulmonary tuberculosis, recurrent pneumonia,  and invasive cervical 
cancer, which are more common among women  and IV-drug users.  The CDC 
says what is more important is the  fourth new indicator: a decline in 
the level of the body's CD4  cells to 200 per cubic millimeter.  James 
Buehler, acting deputy  director of the CDC's AIDS division, said that 
while about 1  million Americans are HIV-positive and as many as 190,000 
are  estimated to have CD4 counts below 200, most are unaware that  they 
have HIV or have never had a CD4 test, he said.  The first  reports 
using the new definition will be released at the end of  January, "but 
to really see the effects of this definition we're  going to need to 
experience it throughout 1993," said Buehler.   Related Story: 
Philadelphia Inquirer (12/29) P. B6 

"School Condom Program Proposed" Washington Post (12/29/92), P. B3  
(Bates, Steve)
     The Alexandria, Va., PTA Council has requested that the school  
system distribute condoms to high school students who want them,  as an 
effort to prevent HIV infection and teenage pregnancy.  If  the PTA 
Council's proposal is endorsed, Alexandria would become  the first 
suburban Washington, D.C., public school system to  provide condoms to 
students.  Schools in Washington began  distributing condoms this school 
year at all high schools and  several junior highs under a controversial 
program.  Although  Alexandria School Board members will be presented 
with the PTA  Council proposal next week, education officials say they 
will  move cautiously with it.  School Board Chairman Angie Godfrey  
said, "We're going to take it seriously.  I don't imagine us  making a 
decision right away."   She added that the School Board  will probably 
hold public hearings on the idea and solicit input  from a school health 
advisory committee.  Sexually transmitted  diseases, including HIV, are 
an increasing problem in the school  system.  The PTA proposal calls for 
school personnel who are  trained in HIV counseling and education be 
authorized to  distribute condoms to students in grades nine through 12.  
It  suggests that classroom AIDS education start as early as  
kindergarten and be given a greater focus in the middle and high  
schools.  In addition, the proposal requires abstinence to be  
emphasized as a means of preventing the spread of HIV infection. 

"Michigan Redefines AIDS by Adding Indicative Diseases" Chicago Tribune 
(12/28/92), P. 1-3
     The number of AIDS cases in Michigan is estimated to rise 50  
percent after the new Centers for Disease Control definition of  AIDS 
takes effect Jan. 1.  The new definition will increase the  number of 
diseases that indicate an HIV-positive person has AIDS. It will also 
consider anyone who tests positive for HIV and has a CD4 count below 200 
as having AIDS.  According to health  officials, the new standard 
indicates an increased AIDS awareness and greater expertise.  Jim Kent, 
a Michigan Health Department  epidemiologist, said there were about 750 
Michigan residents with AIDS in 1992.  The new guidelines will add 
pulmonary  tuberculosis, recurring pneumonia, and invasive cervical 
cancer  to the list of 23 diseases that define an HIV-positive person as  
having AIDS. 

"Aztec Club Allowed to Sell Tickets to Event Billed as AIDS  Benefit" 
Philadelphia Inquirer (12/29/92), P. B3  (Rosenberg, Amy S.)
     The Pennsylvania Attorney General's office announced yesterday  
that the Aztec Club in Philadelphia may resume selling $150  tickets to 
a New Year's Eve party that is being promoted as a  benefit for AIDS 
research.  The club had been prohibited from  selling tickets as of last 
Tuesday after questions were raised by local AIDS groups about how much 
money would be left for charity  after a total of $137,000 in expenses 
was paid.  But yesterday  the club officially registered its New Years 
Aid Foundation as a  nonprofit foundation with the state's Bureau of 
Charitable  Organizations, stating its intention to raise money for AIDS  
research, AIDS patient care, and children with the disease.   
Spokespeople for the Aztec blamed local AIDS groups for  disrupting the 
benefit plans because of "greed."  Marketing  director Rick Miller said 
the party's proceeds would now benefit  Total AIDS Support Services in 
Glenside, Pa., and possibly Search Alliance In Los Angeles, a research 
group.  He said they had each been guaranteed $7,500 from the benefit.  
Philadelphia  groups--Action AIDS and the AIDS Task Force--said they 
decided  not to get involved with the event after discovering the costs  
involved and the intention to direct much of the proceeds to  groups 
outside of Philadelphia.  Miller said that the club  expected to raise 
more than $150,000 for the AIDS groups involved through ticket sales, an 
art auction, sweatshirt sales, and  corporate donations. 

"Comparison of Saliva and Serum for HIV Surveillance in  Developing 
Countries" Lancet (12/19-26/92) Vol. 340, No. 8834/8835, P. 1496   
(Frerichs, Ralph R. et al.)
     Saliva is a safe and effective alternative to serum for HIV  
antibody testing with enzyme-linked immunosorbent assays (ELISAs) in 
developing countries, write Ralph R. Frerichs et al. of the  University 
of California--Los Angeles AIDS Prevention and Control Program.  The 
researchers conducted a field study in Myanmar  (formerly Burma) to 
evaluate saliva as an alternative to detect  the frequency of HIV 
infection in a surveillance program of  high-risk and low-risk sentinel 
groups.  The researchers  collected duplicate vials of saliva and serum 
from 479 high-risk  and 1,039 low-risk subjects.  One vial of each pair 
was examined  blind in two laboratories: one in the United States and 
the other in Myanmar.  The U.S. laboratory followed World Health  
Organization confirmatory strategy III with three different  enzyme-
linked immunosorbent assays (ELISAs), while the laboratory in Myanmar 
followed strategy I with one ELISA.  Serum testing in  the U.S. was the 
gold standard.  The Cambridge ELISA with saliva  was a more effective 
surveillance device for describing the  frequency of subjects with HIV 
antibodies than the serum ELISA  supplied to Myanmar by WHO. 

"India: Disquiet About AIDS Control" Lancet (12/19-26/92) Vol. 340, No. 
8834/8835, P. 1533   (Mangla, Bhupesh)
     The Indian Ministry of Health and Family Welfare has provided  
about $100 million for the National AIDS Control (NACO) project  in the 
Eighth Five-Year (1992-97) plan for health.  The amount  comprises more 
than 15 percent of the nation's health budget,  putting AIDS second only 
to malaria, for which a little more than 19 percent has been allotted.  
The majority of the sum for AIDS  control is a loan from the World Bank.  
WHO is allocating $1.5  million by way of technical expertise.  The 
National AIDS Control Organization, created in August to implement the 
control program, supports unlinked anonymous testing over mandatory 
testing.   However, the medical community, which is fearful of 
nosocomial  spread of infection, is divided on this issue.  Also, the 
safety  of the blood supply in India is questionable.  Since 1989, when   
antibodies to HIV were found in some indigenously produced blood  
products, attempts to prevent contamination of blood have  occurred.  
But earlier this year at a meeting convened by India's Prime Minister, 
plans for the AIDS control programs contained no  mention of the safety 
of blood and blood products.  The plans  were resubmitted for review.  
Now, NACO has allocated $30 million for blood safety.  Because the cost 
of testing by ELISA is less  than $1 per sample, the sum should be 
sufficient to screen all  the 2 million units collected each year.  Yet 
NACO says that it  cannot be responsible for the practice in commercial 
blood banks, which supply 29 percent of the blood collected in the 
country. 

"Malabsorption of Antituberculosis Medications by a Patient With  AIDS" 
New England Journal of Medicine (12/17/92) Vol. 327, No. 25,  P. 1819  
(Berning, Shaun E. et al.)
     Although it could appear that an HIV-positive patient has a  drug-
resistant strain of tuberculosis, it actually means that the patient has 
not been absorbing medications properly, write Shaun  E. Berning et al. 
of the National Jewish Center for Immunology  and Respiratory Medicine, 
in Denver, Colo.  An HIV-positive male  health-care worker from New York 
City was recently referred to  the National Jewish Center for Immunology 
and Respiratory  Medicine.  The patient received isoniazid, rifampin,  
pyrazinamide, and ethambutol from May 1991 to April 1991, with  
defervescence and weight gain.  But in April 1992 fevers,  
lymphadenopathy, and weight loss developed.  The patient  underwent 
biopsy of a supraclavicular node; the specimen was  later positive for 
M. tuberculosis on smear and culture.  The  patient was found to have an 
eight-year history of three to five  loose stools per day, without gross 
diarrhea.  This result was  consistent with a malabsorptive disorder.  
Capreomycin and  clofazimine were added to the drug regimen.  These 
concentrations suggested clinically important malabsorption of the 
medications.  The assays were repeated to confirm the results.  The 
results of  the culture of the auxiliary-node biopsy specimen obtained 
in  April 1992 revealed resistance only to isoniazid and  streptomycin.  
The dosages were adjusted, and the patient was  discharged with 
instructions to take rifampin, pyrazinamide, and  ethambutol.  The 
researchers conclude that the patient had a  recrudescence of TB due to 
malabsorption of his medications, not  to recently acquired drug 
resistance. 

"AIDS: Of Mice and Men" Advocate (12/29/92) No. 619, P. 70  (Solomon, 
Nancy)
     The four-year-old ban on fetal-tissue research is expected to be 
lifted by President-elect Bill Clinton's new secretary of health  and 
human services.  For many years researchers have been  implanting thymus 
tissue from human fetuses into mice that, due  to a genetic defect, are 
born without an immune system.  Such  mice have successfully developed 
human immune systems and can  therefore be infected with HIV.  The mice 
are called SCID-hu, for severe combined immune deficient with a human 
immune system.   Proponents say the research will pave the way for 
thymus  transplants that could bolster the immune systems of AIDS  
patients.  Fetal tissue research provides unique advantages  because the 
immature cells grow fast once transplanted and have  less chance of 
rejection than adult organs.  The ban on fetal  tissue thwarted research 
on thymus transplants in AIDS patients.  In 1987, John Dwyer reported in 
the Archives of Internal Medicine that he had transplanted thymus tissue 
into 15 people in the late stages of AIDS.  A total of 8 of the subjects 
experienced a  temporary repopulation of T cells.  He said that he 
doubted the  transplants would replenish the immune system but using the  
transplants along with a virus-blocking agent deserves additional study.  
Some scientists say that it will take genetic engineering for thymic 
transplants to be effective.  But Joseph Rossi, a  molecular geneticist 
with the Beckman Research Institute at City  of Hope, California, said, 
"If they have AIDS and you put in  naive cells, they're attacked by HIV.  
You could do an immune  reconstitution if you could genetically alter 
the naive cells to  be resistant to HIV.  That's the only way to do it 
in my mind." 

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