Date: Tue, 27 Dec 1994 11:03:14 -0500 From: "JOHN FANNING, CDC NAC" AIDS Daily Summary December 27, 1994 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, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1994, Information, Inc., Bethesda, MD ************************************************************ "Epitope Receives FDA Approval to Sell AIDS Test That Uses Saliva, Not Blood" "Hopkins Will Study AIDS Drug" "Fundamental Research at Risk" "HUD Cutbacks Endanger Public Housing for HIV, AIDS Patients" "China Sets Up First National Sex Study Group" "Former Aide Sues Hospital in Firing over HIV Tattoo" "HIV Testing in Prison: What's the Controversy?" "The Duesberg Phenomenon" "Strategy of Hope: Small, Rapid Viral-Load Trials" "Clinton and AIDS" ************************************************************ "Epitope Receives FDA Approval to Sell AIDS Test That Uses Saliva, Not Blood" Wall Street Journal (12/27/94) P. B4; Richards, Bill After three and a half years of review, the Food and Drug Administration (FDA) has given approval to Epitope Inc. to begin marketing the first test to use saliva rather than blood to detect HIV. The test, called OraSure, is also the first to be cleared by the FDA for collecting oral specimens for disease diagnosis of any type. Supporters of the test claim that a saliva-sample test would increase the number of people tested. The test, which comes in kit form and takes about two minutes to administer, has two components: a treated cotton pad on a stick to collect saliva, and a specific test to analyze the specimen for HIV antibodies. In a statement on Friday, the FDA said Epitope's oral HIV test is less accurate than blood samples. The oral tests show false negatives in one to two of every 100 individuals with HIV and false positives for two out of every 100 without HIV, added the agency. The FDA also placed several restrictions on Epitope's test: the test system may be bought and distributed only through doctors and administered only by people trained in its use; the test is not intended for home use; and it may be used for diagnosis only, not to screen blood donors. Epitope plans to begin marketing the HIV test kits within six weeks. Related Stories: Baltimore Sun (12/24) P. 3A; Washington Post (12/24) A7 "Hopkins Will Study AIDS Drug" Baltimore Sun (12/27/94) P. 1B; Selby, Holly Researchers at Johns Hopkins University are beginning two studies that explore ways of extending the benefits of a life-prolonging medication called Bactrim to AIDS patients. Bactrim, a sulfa-based antibiotic, is used to prevent and treat pneumocystitis carinii pneumonia (PCP), an opportunistic infection that attacks people with severely damaged immune systems. Unlike AZT, Bactrim is used to treat the complications that arise when the virus reaches an advanced stage. While many doctors call the drug the most broadly effective treatment available for people in the later stages of HIV infection, approximately half of the recipients cannot tolerate the medication. Manufactured by Roche Laboratories, Bactrim is the trade name for trimethoprim-sulfamethoxazole, which is also made by Burroughs Wellcome under the name Septra. The two studies will try to find alternatives to Bactrim and a method of building patients' tolerance to the drug. "Fundamental Research at Risk" Washington Post (12/27/94) P. A1; Rensberger, Boyce Scientists say that basic science, which focuses on learning more about how nature works, is the most misunderstood form of research. The National Science Foundation, which was established to support basic science, has been told to divert more of its money to applied science, which provides more immediate, practical results. Many scientists, however, say that without basic science to expand the body of knowledge, science cannot continue to produce practical benefits. Contrary to most research, the scientific response to AIDS is different. Although billions of dollars have been spent during the past decade on AIDS research, a cure remains out of sight. Some scientists claim that the amount of money appropriated for AIDS research is more than is needed to support the best research. The money is often allotted for mediocre proposals, while scientifically superior projects in basic science or aimed at other diseases go underfunded. William Paul, head of the Office of AIDS Research at the National Institutes of Health, disagrees, saying that applications for AIDS research grants have about the same "unacceptably low" chance of success as grants in other biomedical fields. Early in the epidemic, before much funding was targeted at the disease, basic science showed that a retrovirus was the cause of AIDS. Progress against AIDS has slowed since then because there has not been enough knowledge provided by basic science to support much further progress. "HUD Cutbacks Endanger Public Housing for HIV, AIDS Patients" Chicago Tribune (12/26/94) P. 1-7; McRoberts, Flynn In an effort to restructure and spare itself from elimination, the U.S. Department of Housing and Urban Development (HUD) has proposed combining all its public and assisted housing into three programs. Most of the specific programs and subsidies would be phased out over a five-year period in favor of certificates to individuals and grants designed to create more affordable housing and more economic development. Many fear, however, that the changes will endanger the emerging movement known as special needs housing. One of the public housing projects facing elimination, for example, is the San Miguel Apartments, Chicago's first city-financed housing for people with AIDS. Formerly a crack house, the building was converted into a 71-unit building for people with HIV and AIDS. "It's very frightening," said Bill McMillan, an HIV-positive resident of the San Miguel. "It's a blow to people with HIV, AIDS and other disabilities, senior citizens and poor people." Edwin Eisendrath, the HUD secretary's Midwest representative, said that "specific programs targeted to one group or another would not be part of the new" approach, which will include a Clinton offer to cut at least $800 million from HUD to help pay for his proposed tax cut. "China Sets Up First National Sex Study Group" Reuters (12/26/94) In the face of widespread ignorance about sex, rising prostitution, and venereal disease, China has initiated its first national sex study organization. The China Association for Sexology will study sex medicines, sex education, sexual psychology, sexual sociology, and venereal disease protection. While association president Wang Guangchao gave no details, cases of AIDS are on the rise in China and officials say that screening is far from effective. After decades of puritan communist ideology, many Chinese are embarrassed to discuss sex and teachers are unwilling to give talks to students about human reproduction. "Former Aide Sues Hospital in Firing over HIV Tattoo" Philadelphia Inquirer (12/24/94) P. A10 John Baldetta, a former nursing aide, is suing Harborview Medical Center because hospital officials fired him for displaying a tattoo, "HIV POSITIVE," on his forearm and for discussing AIDS with patients. Baldetta claims that the hospital violated federal laws, including the Americans With Disabilities Act, as well as his constitutional rights. The medical center fired Baldetta in January 1993 when he refused to keep the tattoo covered and would not stop informing patients who asked about AIDS issues. Hospital officials said Baldetta could impede the recovery of some patients who might worry about contracting HIV from him. Baldetta said he had a right to display his tattoo and he never discussed AIDS unless asked by patients. Related Story: Washington Post (12/24) P. A2 "HIV Testing in Prison: What's the Controversy?" Lancet (12/17/94) Vol. 344, No. 8938, P. 1650; Diamond, Jan In a Lancet commentary, Jan Diamond of Merrithew Memorial Hospital in Martinez, Calif., wonders whether HIV testing in prisons remains controversial. While the debate during the 1980s focused on mandatory testing for inmates and segregation of those who tested positive, the latest emphasis is on ways to increase voluntary testing and to improve the medical care of infected prisoners. Prison officials contend that protection--of the infected and uninfected inmates and of the correctional staff--is their main concern. The Centers for Disease Control and Prevention (CDC), however, has not found any instances of HIV infection or AIDS in correctional staff due to work-related transmission. Fifteen of the 16 U.S. prisons that conduct mandatory HIV testing do not segregate the HIV-infected inmates, which does not justify claims for any protective efforts. To maximize the effectiveness of voluntary testing and maintain the trust between staff and inmates, HIV testing should be performed by non-correctional staff. Anonymous testing should be considered. Testing must be followed by counseling, education, and good medical care, and interventions known to reduce transmission--such as condom distribution--should be adopted. "The Duesberg Phenomenon" Science (12/09/94) Vol. 266, No. 5191, P. 1642; Cohen, Jon Peter Duesberg, a retrovirologist at the University of California, claims that such factors as illicit drug use and AZT cause AIDS. While most mainstream AIDS researchers ignore Duesberg's ideas, he has a vocal group of supporters. Among them are Nobel Prize winner Kary Mullis and Robert Willner, the doctor who recently pricked his finger with a bloody needle he had just stuck into an HIV-infected man to prove that HIV is not the cause of AIDS. This publication conducted a three-month investigation into Duesberg's claims, interviewing more than 50 supporters and detractors. The study concluded that there is extensive evidence in hemophiliacs--the group that Duesberg acknowledges provides the best case for the HIV hypothesis--that HIV causes disease and death. According to some AIDS researchers, HIV now satisfies the classic postulates of disease causation established by Robert Koch. The study also found that while Duesberg cites the AIDS epidemic in Thailand as confirmation of his theories, the role of HIV is confirmed instead. Finally, neither AZT nor illicit drugs cause the immune deficiency characteristic of AIDS. Duesberg, who has difficulty obtaining grants because of views, said that he would alter his views if he found one article that suggested to him he was wrong. "Strategy of Hope: Small, Rapid Viral-Load Trials" AIDS Treatment News (11/18/94) No. 211, P. 1; James, John S. At the New Directions in Antiviral Chemotherapy conference in November, Dr. Douglas Richman--a leading AIDS researcher--spoke of the value of small, rapid trials to look for antiviral activity in people. "In a two-week study, you can show whether a drug works or doesn't work," said Richman. He also spoke of evidence that if the viral load--as measured by HIV RNA--could be kept down, the immune system could spontaneously recover. These ideas are gaining strength in the professional community, he said. There is debate in the issue because some say that it is not proven that reducing and keeping down the plasma HIV RNA will benefit the patient. The same people base their own thoughts and plans on the assumption that lowering the viral load is the central goal. Richman and most other professional researchers only speak of the drugs being manufactured by pharmaceutical companies: natural products, traditional medicines used in cultures around the world, and readily available prescription drugs are not considered for potential HIV treatments. HIV resistance to antiviral drugs is also a problem. Small, rapid trials allow many leads to be followed up quickly, and new combinations to be developed rapidly. "Clinton and AIDS" New Republic (12/26/94) No. 4,171, P. 7 From the beginning of the AIDS epidemic, politics have obstructed sane public health, write the editors of the New Republic. The conservatives' discomfort with sex halted a response and the liberals' oversensitivity to minorities and civil liberties stalled some measures. President Clinton has only partially broken the pattern. He has marked AIDS spending in research, treatment, and prevention a priority in both budgets. For fear of political incorrectness, however, President Clinton has not highlighted the black or minority crisis, or the rise in infections among young gay men. In contrast to the president and both parties, the Centers for Disease Control and Prevention (CDC) last year put out a series of condom ads and gave control of prevention funds to local councils, who have a better sense of what works on the streets. These efforts still do not reach the minority youths and drug users at risk. The editors of the New Republic believe the government should promote more explicit education on sexually transmitted diseases that facilitate HIV transmission and on the dangers of drug use, as well as push for more effective clean needle distribution.