------------- cut here ----------------- limits of AZT's efficacy and now suggest using the drug  either sequentially  with other drugs or in a kind of AIDS  treatment "cocktail" combining a number  of drugs to fight the  virus all at once.  "Treating people with AZT alone  doesn't  happen in the real world anymore," said Dr. Mark Jacobson of the   University of California--San Francisco.  Also, with recent  findings  indicating that HIV replicates rapidly in the lymph  nodes after infection,  physicians may begin pushing even harder  for early treatment of HIV-infected  patients. ==================================================================      "New Infectious Disease Push" American Medical News (04/05/93) Vol. 36, No.  13, P. 2        The Center for Disease Control will launch a worldwide network to track  the spread of infectious diseases and detect drug-resistant or new strains in  time to help prevent their spread.  The network is expected to cost between  $75 million and $125 million but is  an essential part of the Clinton  administration's health reform  plan, according to the CDC and outside  experts.  The plan will  require the CDC to enhance surveillance of disease in  the United  States and establish about 15 facilities across the world to   track disease.        =====================================================================                                   April 13, 1993       =====================================================================    "NIH Plans to Begin AIDS Drug Trials at Earlier Stage" Nature (04/01/93) Vol.  362, No. 6419, P. 382  (Macilwain, Colin)    HICNet Medical Newsletter                                              Page 42 Volume  6, Number 10                                           April 20, 1993       The National Institutes of Health has announced it will start  treating  HIV-positive patients as soon as possible after  seroconversion, resulting  from recent findings that show HIV is  active in the body in large numbers  much earlier than was  previously believed.  Anthony Fauci, director of the  U.S.  National Institute of Allergy and Infectious Diseases (NIAID),  said,  "We must address the question of how to treat people as  early as we possibly  can with drugs that are safe enough to give  people for years and that will  get around microbial resistance."  He said any delay would signify questions  over safety and  resistance rather than a lack of funds.  Fauci, who co- authored  one of the two papers published last week in Nature, rejects the   argument by one of his co-authors, Cecil Fox, that the new  discovery  indicates that "$1 billion spent on vaccine trials" has been "a waste of time  and money" because the trials were started  too long after the patients were  infected and were ended too  quickly.  John Tew of the Medical College of  Virginia in Richmond claims that the new evidence strongly backs the argument  for  early treatment of HIV-infected patients.  AIDS activists  welcomed the  new information but said the scientific community  has been slow to understand  the significance of infection of the  lymph tissue.  "We've known about this  for five years, but we're  glad it is now in the public domain," said Jesse  Dobson of the  California-based Project Inform.  But Peter Duesberg, who   believes that AIDS is independent of HIV and is a result of drug  abuse in the  West, said, "We are several paradoxes away from an  explanation of AIDS--even  if these papers are right."       ======================================================================                                    April 14, 1993      ======================================================================     "Risk of AIDS Virus From Doctors Found to Be Minimal" Washington Post  (04/14/93), P. A9        The risk of HIV being transmitted from infected health-care   professionals to patients is minimal, according to new research  published in  today's Journal of the American Medical Association  (JAMA).  This finding  supports previous conclusions by health  experts that the chance of  contracting HIV from a health care  worker is remote.  Three studies in the  JAMA demonstrate that  thousands of patients were treated by two HIV-positive  surgeons  and dentists without becoming infected with the virus.  The  studies  were conducted by separate research teams in New  Hampshire, Maryland, and  Florida.  Each study started with an  HIV-positive doctor or dentist and  tested all patients willing to participate.  The New Hampshire study found  that none of the  1,174 patients who had undergone invasive procedures by an   HIV-positive orthopedic surgeon contracted HIV.  In Maryland, 413 of 1,131  patients operated on by a breast surgery specialist at  Johns Hopkins Hospital  were found to be HIV-negative.  Similarly  in Florida, 900 of 1,192 dental   HICNet Medical Newsletter                                              Page 43 Volume  6, Number 10                                           April 20, 1993  patients, who all had been  treated by an HIV-positive general dentist, were  tested and found to be negative for HIV.  The Florida researchers, led by  Gordon  M. Dickinson of the University of Miami School of Medicine, said,  "This study indicates that the risk for transmission of HIV from  a general  dentist to his patients is minimal in a setting in  which universal  precautions are strictly observed."   Related Story: Philadelphia Inquirer  (04/14) P. A6  ======================================================================    "Alternative Medicine Advocates Divided Over New NIH Research  Program" AIDS  Treatment News (04/02/93) No. 172, P. 6  (Gilden, Dave)        The new Office of Alternative Medicine at the National Institutes of  Health has raised questions about the NIH's commitment to an  effort that uses  unorthodox or holistic therapeutic methods.  The OAM is a small division of  the NIH, with its budget only at $2  million dollars compared to more than $10  billion for the NIH as  a whole.  In addition, the money for available  research grants is even smaller.  About $500,000 to $600,000 total will be  available this year for 10 or 20 grants.  Kaiya Montaocean, of the Center  for  Natural and Traditional Medicine in Washington, D.C., says  the OAM is afraid  to become involved in AIDS.  "They have to look successful and there is no  easy answer in AIDS," she said.    There is also a common perception that the  OAM will focus on  fields the NIH establishment will find non-threatening,  such as  relaxation techniques and acupuncture.  When the OAM called for  an  advisory committee conference of about 120 people last year,  the AIDS  community was largely missing from the meeting.  In  addition, activists'  general lack of contact with the Office has  added suspicion that the epidemic  will be ignored.  Jon  Greenberg, of ACT-UP/New York, said, "The OAM advisory  panel is  composed of practitioners without real research experience.  It   will take them several years to accept the nature of research."    Nevertheless,  Dr. Leanna Standish, research director and AIDS  investigator  at the Bastyr College of Naturopathic Medicine in  Seattle, said, "Here is a  wonderful opportunity to fund AIDS  research.  It's only fair to give the  Office time to gel, but  it's up to the public to insist that it's much, much  more [than  public relations]."  ======================================================================    "Herpesvirus Decimates Immune-cell Soldiers" Science News (04/03/93) Vol. 143,  No. 14, P. 215   (Fackelmann, Kathy A.)        Scientists conducting test tube experiments have found that  herpesvirus- 6 can attack the human immune system's natural killer cells.  This attack  causes the killer cells to malfunction,  diminishing an important component in  the immune system's fight  against diseases.  Also, the herpesvirus-6 may be a  factor in  immune diseases, such as AIDS.  In 1989, Paolo Lusso's research   found that herpesvirus-6 attacks another white cell, the CD4  T-lymphocyte,  which is the primary target of HIV.  Lusso also  found that herpesvirus-6 can   HICNet Medical Newsletter                                              Page 44 Volume  6, Number 10                                           April 20, 1993  kill natural killer cells.   Scientists previously knew that the natural  killer cells of  patients infected with HIV do not work correctly.  Lusso's   research represents the first time scientists have indicated that natural  killer cells are vulnerable to any kind of viral attack,  according to Anthony  L. Komaroff, a researcher with Harvard  Medical School.  Despite the test-tube  findings, scientists are  uncertain whether the same result occurs in the  body.  Lusso's  team also found that herpesvirus-6 produces the CD4 receptor   molecule that provides access for HIV.  CD4 T-lymphocytes express this surface  receptor, making them vulnerable to HIV's attack.   Researchers concluded that  herpesvirus-6 cells can exacerbate the affects of HIV.       ======================================================================                                    April 15, 1993       ====================================================================     "AIDS and Priorities in the Global Village: To the Editor" Journal of the  American Medical Association (04/07/93) Vol. 269,  No. 13, P. 1636  (Gellert,  George and Nordenberg, Dale F.)        All health-care workers are obligated and responsible for not  only  ensuring that politicians understand the dimensions of  certain health  problems, but also to be committed to related  policies, write George Gellert  and Dale F. Nordenberg of the  Orange County Health Care Agency, Santa Ana,  Calif., and the  Emory University School of Public Health in Atlanta, Ga.,   respectively.  Dr. Berkley's editorial on why American doctors  should care  about the AIDS epidemic beyond the United States  details several reasons for  the concerted interest that all  countries share in combating AIDS.  It should  be noted that while AIDS leads in hastening global health interdependence, it  is not  the only illness doing so.  Diseases such as malaria and many   respiratory and intestinal pathogens have similarly inhibited the economic  development of most of humanity and acted to marginalize large populations.   Berkley mentions the enormous social and  economic impact that AIDS will have  on many developing countries, and the increased need for international  assistance that will  result.  Berkley also cites the lack of political  aggressiveness  toward the AIDS epidemic in its first decade.  But now there  is a new administration with a promise of substantial differences in  approach  to international health and development in general, and  HIV/AIDS in  particular.  Vice President Al Gore proposes in his  book "Earth in the  Balance" a major environmental initiative that includes sustainable  international development, with programs to  promote literacy, improve child  survival, and disseminate  contraceptive technology and access throughout the  developing  world.  If enacted, this change in policy could drastically   change the future of worldwide health.  ====================================================================    "AIDS and Priorities in the Global Village: In Reply" Journal of the American   HICNet Medical Newsletter                                              Page 45 Volume  6, Number 10                                           April 20, 1993  Medical Association (04/07/93) Vol. 269,  No. 13, P. 1636  (Berkley, Seth)        Every nation should tackle HIV as early and aggressively as    possible  before the disease reaches an endemic state, even at a  cost of diverting less  attention to some other illnesses, writes  Seth Berkley of the Rockefeller  Foundation in New York, N.Y., in  reply to a letter by Drs. Gellert and  Nordenberg.  Although it is true that diseases other than AIDS, such as  malaria and  respiratory and intestinal illnesses, have similarly inhibited   economic development in developing countries and deserve much  more attention  than they are getting, Berkley disagrees with the  contention that AIDS is  receiving too much attention.  HIV  differs from other diseases, in most  developing countries because it is continuing to spread.  For most endemic  diseases, the  outcome of neglecting interventions for one year is another  year  of about the same level of needless disease and death.  But with  AIDS  and its increasing spread, the cost of neglect, not only in  disease burden  but financially, is much greater.  Interventions  in the early part of a  rampantly spreading epidemic like HIV are  highly cost-effective because each  individual infection prevented significantly interrupts transmission.  Berkley  says he agrees  with Gellert and Nordenberg about the gigantic social and   economic effects of AIDS and about the need for political  leadership.  But he  concludes that not only is assertive  political leadership needed in the  United States for the AIDS  epidemic, but even more so in developing countries  with high  rates of HIV infection and where complacency about the epidemic   has been the rule.                      HICNet Medical Newsletter                                              Page 46 Volume  6, Number 10                                           April 20, 1993    ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::                                AIDS/HIV Articles ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::              First HIV Vaccine Trial Begins in HIV-Infected Children                                 H H S   N E W S      ********************************************************************                  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES                                 March 29, 1993           First HIV Vaccine Therapy Trial Begins In HIV-Infected Children   The National Institutes of Health has opened the first trial of experimental  HIV vaccines in children who are infected with the human immunodeficiency  virus (HIV), the virus that causes AIDS.   The trial will compare the safety of three HIV experimental vaccines in 90  children recruited from at least 12 sites nationwide. Volunteers must be HIV- infected but have no symptoms of HIV disease.   HHS Secretary Donna E. Shalala said this initial study can be seen as "a  hopeful milestone in our efforts to ameliorate the tragedy of HIV-infected  children who now face the certainty they will develop AIDS."   Anthony S. Fauci, M.D., director of the National Institute of Allergy and  Infectious Diseases and of the NIH Office of AIDS Research, said the trial "is  the first step in finding out whether vaccines can help prevent or delay  disease progression in children with HIV who are not yet sick."  If these  vaccines prove to be safe, more sophisticated questions about their  therapeutic potential will be assessed in Phase II trials.   The Centers for Disease Control and Prevention estimates 10,000 children in  the United States have HIV.  By the end of the decade, the World Health  Organization projects 10 million children will be infected worldwide.   The study will enroll children ages 1 month to 12 years old.  NIAID, which  funds the AIDS Clinical Trials Group network, anticipates conducting the trial  at nine ACTG sites around  the country and three sites participating in the  ACTG but funded by the National Institute of Child Health and Human  Development.   Preliminary evidence from similar studies under way in infected adults shows  that certain vaccines can boost existing HIV-specific immune responses and   HICNet Medical Newsletter                                              Page 47 Volume  6, Number 10                                           April 20, 1993  stimulate new ones.  It will be several years, however, before researchers  know how these responses affect the clinical course of the disease.   The results from the pediatric trial, known as ACTG 218, will be examined  closely for other reasons as well.  "This trial will provide the first insight  into how the immature immune system responds to candidate HIV vaccines," said  Daniel Hoth, M.D., director of NIAID's division of AIDS.  "We need this  information to design trials to test whether experimental vaccines can prevent  HIV infection in children."   In the United States, most HIV-infected children live in poor inner-city  areas, and more than 80 percent are minorities, mainly black or Hispanic.   Nearly all HIV-infected children acquire the virus from their mothers during  pregnancy  or at birth.  An infected mother in the United States has more than  a one in four chance of transmitting the virus to her baby.  As growing  numbers of women of childbearing age become exposed to HIV through injection  drug use or infected sexual partners, researchers expect a corresponding  increase in the numbers of infected children.   HIV disease progresses more rapidly in infants and children than in adults.   The most recent information suggests that 50 percent of infants born with HIV  develop a serious AIDS-related infection by 3 to 6 years of age.  These  infections include severe or frequent bouts of common bacterial illnesses of  childhood that can result in seizures, pneumonia, diarrhea and other symptoms  leading to nutritional problems and long hospital stays.   At least half of the children in the trial will be 2 years of age or younger  to enable comparison of the immune responses of the younger and older  participants.  All volunteers must have well-documented HIV infection but no  symptoms of HIV disease other than swollen lymph glands or a mildly swollen  liver or spleen.  They cannot have received any anti-retroviral or immune- regulating drugs within one month prior to their entry into the study.   Study chair John S. Lambert, M.D., of the University of Rochester Medical  School, and co- chair Samuel Katz, M.D., of Duke University School of  Medicine, will coordinate the trial assisted by James McNamara, M.D., medical  officer in the pediatric medicine branch of NIAID's division of AIDS.   "We will compare the safety of the vaccines by closely monitoring the children  for any side effects, to see if one vaccine produces more swollen arms or  fevers, for example, than another," said Dr. McNamara.  "We'll also look at  whether low or high doses of the vaccines stimulate immune responses or other  significant laboratory or clinical effects."   He emphasized that the small  study size precludes comparing these responses or effects among the three   HICNet Medical Newsletter                                              Page 48 Volume  6, Number 10                                           April 20, 1993  products.   The trial will test two doses each of three experimental vaccines made from  recombinant HIV proteins.  These so-called subunit vaccines, each genetically  engineered to contain only a piece of the virus, have so far proved well- tolerated in ongoing trials in HIV-infected adults.   One vaccine made by MicroGeneSys Inc. of Meriden, Conn., contains gp160--a  protein  that gives rise to HIV's surface proteins--plus alum adjuvant.   Adjuvants boost specific immune responses to a vaccine.  Presently, alum is  the only adjuvant used in human vaccines licensed by the Food and Drug  Administration.   Both of the other vaccines--one made by Genentech Inc. of South San Francisco  and the other by Biocine, a joint venture of Chiron and CIBA-Geigy, in  Emeryville, Calif.--contain the major HIV surface protein, gp120, plus  adjuvant.  The Genentech vaccine contains alum, while the Biocine vaccine  contains MF59, an experimental adjuvant that has proved safe and effective in  other Phase I vaccine trials in adults.   A low dose of each product will be tested first against a placebo in 15  children.  Twelve children will be assigned at random to be immunized with the  experimental vaccine, and three children will be given adjuvant alone,  considered the placebo.  Neither the health care workers nor the children will  be told what they receive.   If the low dose is well-tolerated, controlled testing of a higher dose of the  experimental vaccine and adjuvant placebo in another group of 15 children will  begin.   Each child will receive six immunizations--one every four weeks for six  months--and be followed-up for 24 weeks after the last immunization.    For more information about the trial sites or eligibility for enrollment, call  the AIDS Clinical Trials Information Service, 1-800-TRIALS-A, from 9 a.m. to 7  p.m., EST weekdays.  The service has Spanish-speaking information specialists  available.  Information on NIAID's pediatric HIV/AIDS research is available  from the Office of Communications at (301) 496- 5717.    NIH, CDC and FDA are agencies of the U.S. Public Health Service in HHS. For  press inquiries only, please call Laurie K. Doepel at (301) 402-1663.     HICNet Medical Newsletter                                              Page 49 Volume  6, Number 10                                           April 20, 1993             NEW EVIDENCE THAT THE HIV CAN CAUSE DISEASE INDEPENDENTLY               News from the National Institute of Dental Research  There is new evidence that the human immunodeficiency virus can cause disease  independently of its ability to suppress the immune system, say scientists at  the National Institues of Health.   They report that HIV itself, not an opportunistic infection, caused scaling  skin conditions to develop in mice carrying the genes for HIV.  Although the  HIV genes were active in the mice, they did not compromise the animals'  immunity, the researchers found.  This led them to conclude that the HIV  itself caused the skin disease.   Our findings support a growing body of evidence that HIV can cause disease  without affecting the immune system, said lead author Dr. Jeffrey Kopp of the  National Institute of Dental Research (NIDR).  Dr. Kopp and his colleagues  described their study in the March issue of AIDS Research and Human  Retroviruses.   Developing animal models of HIV infection has been difficult, since most  animals, including mice, cannot be infected by the virus.  To bypass this  problem, scientists have developed HIV-transgenic mice, which carry genes for  HIV as well as their own genetic material.   NIDR scientists created the transgenic mice by injecting HIV genes into mouse  eggs and then implanting the eggs into female mice.  The resulting litters  contained both normal and transgenic animals.   Institute scientists had created mice that carried a complete copy of HIV  genetic material in l988.  Those mice, however, became sick and died too soon  after birth to study in depth.  In the present study, the scientists used an  incomplete copy of HIV, which allowed the animals to live longer.   Some of the transgenic animals developed scaling, wart-like tumors on their  necks and backs.  Other transgenic mice developed thickened, crusting skin  lesions that covered most of their bodies, resembling psoriasis in humans.  No  skin lesions developed in their normal, non-transgenic littermates.   Studies of tissue taken from the wart-like skin tumors showed that they were a  type of noncancerous tumor called papilloma. Although the papillomavirus can  cause these skin lesions, laboratory tests showed no sign of that virus in the  animals.   Tissue samples taken from the sick mice throughout the study revealed the  presence of a protein-producing molecule made by the HIV genetic material.    HICNet Medical Newsletter                                              Page 50 Volume  6, Number 10                                           April 20, 1993  Evidence of HIV protein production proved that the viral genes were "turned  on," or active, said Dr. Kopp.   The scientists found no evidence, however, of compromised immunity in the  mice:  no increase in their white blood cell count and no signs of common  infections.  The fact that HIV genes were active but the animals' immune  systems were not suppressed confirms that the virus itself was causing the  skin lesions, Dr. Kopp said.   Further proof of HIV gene involvement came from a test in which the scientists  exposed the transgenic animals to ultraviolet light.  The light increased HIV  genetic activity causing papillomas to develop on formerly healthy skin.   Papilloma formation in response to increased HIV genetic activity proved the  genes were responsible for the skin condition, the scientists said.  No  lesions appeared on normal mice exposed to the UV light.   The transgenic mice used in this study were developed at NIDR by Dr. Peter  Dickie, who is now with the National Institute of Allergy and Infectious  Diseases.   Collaborating on the study with Dr. Kopp were Mr. Charles Wohlenberg, Drs.  Nickolas Dorfman, Joseph Bryant, Abner Notkins, and Paul Klotman, all of NIDR;  Dr. Stephen Katz of the National Cancer Institute; and Dr. James Rooney,  formerly with NIDR and now with Burroughs Wellcome.                      HICNet Medical Newsletter                                              Page 51 Volume  6, Number 10                                           April 20, 1993                 Clinical Consultation Telephone Service for AIDS                                 H H S   N E W S                  ********************************************                  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES                                   March 4, 1993        HHS Secretary Donna E. Shalala today announced the first nationwide  clinical consultation telephone service for doctors and other health care  professionals who have questions about providing care to people with HIV  infection or AIDS.       The toll-free National HIV Telephone Consulting Service is staffed by a  physician, a nurse practitioner and a pharmacist. It provides information on  drugs, clinical trials and the latest treatment methods.  The service is  funded by the Health Resources and Services Administration and operates out of  San Francisco General Hospital.       Secretary Shalala said, "One goal of this project is to share expertise  so patients get the best care.  A second goal is to get more primary health  care providers involved in care for people with HIV or AIDS, which reduces  treatment cost by allowing patients to remain with their medical providers and  community social support networks.  Currently, many providers refer patients  with HIV or AIDS to specialists or other providers who have more experience."       Secretary Shalala said, "This clinical expertise should be especially  helpful for physicians and providers who treat people with HIV or AIDS in  communities and clinical sites where HIV expertise is not readily available."       The telephone number for health care professionals is 1-800-933-3413, and  it is accessible from 10:30 a.m. to 8 p.m. EST (7:30 a.m. to 5 p.m. PST)  Monday through Friday.  During these times, consultants will try to answer  questions immediately, or within an hour.  At other times, physicians and  health care providers can leave an electronic message, and questions will be  answered as quickly as possible.       Health care professionals may call the service to ask any question  related to providing HIV care, including the latest HIV/AIDS drug treatment  information, clinical trials information, subspecialty case referral,  literature searches and other information.  The service is designed for health  care professionals rather than patients, families or others who have alternate  sources of information or materials.       When a health care professional calls the new service, the call is taken  by either a clinical pharmacist, primary care physician or family nurse  practitioner.  All staff members have extensive experience in outpatient and  inpatient primary care for people with HIV-related diseases.  The consultant  asks for patient-specific information, including CD4 cell count, current  medications, sex, age and the patient's HIV history.       This national service has grown out of a 16-month local effort that   HICNet Medical Newsletter                                              Page 52 Volume  6, Number 10                                           April 20, 1993  responded to nearly 1,000 calls from health care providers in northern  California.  The initial project was funded by HRSA's Bureau of Health  Professions, through its Community Provider AIDS Training (CPAT) project, and  by the American Academy of Family Physicians.       "When providers expand their knowledge, they also improve the quality of  care they are able to provide to their patients," said HRSA Administrator  Robert G. Harmon. M.D., M.P.H.  "This project will be a great resource for  health care professionals and the HIV/AIDS patients they serve."       "This service has opened a new means of communication between health care  professionals and experts on HIV care management," said HRSA's associate  administrator for AIDS and director of the Bureau of Health Resources  Development, G. Stephen Bowen, M.D., M.P.H.  "Providers who treat people with  HIV or AIDS have access to the latest information on new drugs, treatment  methods and therapies for people with HIV or AIDS."       HRSA is one of eight U.S. Public Health Service agencies within HHS.                           AIDS Hotline Numbers for Consumers                    CDC National AIDS Hotline -- 1-800-342-AIDS                   for information in Spanish - 1-800-344-SIDA           AIDS Clinical Trials (English & Spanish) -- 1-800-TRIALS-A                        HICNet Medical Newsletter                                              Page 53  ------------- cut here ----------------- -- This is the last part ---------------