Date: Thu, 17 Mar 1994 09:14:51 -0500 (EST) From: "ANNE WILSON, CDC NAC" Subject: CDC AIDS DAILY SUMMARY 03/17/94 AIDS Daily Summary March 17, 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 1993, Information, Inc., Bethesda, MD "Side Effects of AZT Cast Doubts on Value" Washington Post (03/17/94) P. A3 Severe side effects resulting from the use of AZT may outweigh the benefits of taking the anti-AIDS drug, thereby challenging its value, according to researchers. In a study in the New England Journal of Medicine, researchers observed that while early use of AZT may delay development of disease symptoms, it also increases the likelihood that serious side effects will reduce the quality of life for AIDS patients. They found this to be true even among those patients who would benefit most from AZT therapy. Delaying AZT treatment until the disease progresses is a reasonable option for some patients, the researchers concluded. "If side effects are likely to interfere with daily functioning, delaying therapy might be a reasonable alternative," said the study's chief author, William Lenderking of the Harvard School of Public Health. "However, for a patient who highly values delaying disease progression and is willing to put up with negative side effects, initiating therapy is the best course." The research team based their conclusions on an analysis of data from a 1990 study of 1,338 patients. They found that the amount of time elapsed before disease progression was virtually the same in patients receiving AZT and those receiving a placebo. Related Stories: New York Times (03/17) P. B8; Baltimore Sun (03/17) P. 14A. "HIV Care Differs for Blacks, Study Says" Philadelphia Inquirer (03/17/94) P. A19; Collins, Huntly HIV-positive blacks are less likely than their white counterparts to receive life-prolonging medications, finds a study from Johns Hopkins University. Researchers said the federally-funded study emphasizes the need to improve clinical care for blacks, who represent a disproportionate chunk of the nation's AIDS population. The study looked at 838 outpatients at an AIDS clinic, who had all been examined by other doctors before they came to the clinic. Researchers found that, among the patients who may have benefited from AZT, only 48 percent of the blacks received the drug, while 63 percent of the whites were given it. Similarly, 82 percent of the white patients, but only 48 percent of the blacks, were receiving medication to treat a type of pneumonia often fatal to people with AIDS. The racial disparities in drug treatment occurred regardless of patient income level or whether they had health insurance. Dr. Richard D. Moore, an associate professor of medicine at John Hopkins and head of the study, said it was not apparent what caused the differences, but he ruled out institutional racism. Instead, he said, blacks may have received less follow-up care after their original HIV diagnosis. He said blacks also may have greater distrust of the medical establishment and may be less likely to take prescribed medication. The findings indicate the need for innovative approaches to reach these patients, most of which were low-income residents of inner cities. "By 1 Vote, Senate Allows Needle-Exchange Pilot" Baltimore Sun (03/17/94) P. 5B The Maryland Senate yesterday passed a bill, by the narrowest of margins, that would allow Baltimore to implement a pilot needle-exchange program that advocates say will curb the spread of AIDS. The bill was defeated Monday night after receiving only 23 votes, just one vote shy of the constitutional majority required to pass the Senate. Supporters revived the bill yesterday and Sen. Beatrice Tignor, who endorsed the legislation but was absent from the Senate on Monday, submitted the crucial 24th vote for the program. If made into law, the bill would allow the city to open several clinics to service 750 to 1,000 intravenous drug users, who could exchange as many as 10 dirty needles at a time for clean ones. The city-funded program would cost an estimated $160,000. Seventy percent of new HIV infections in Baltimore are attributed to injection-drug use. Dr. Peter Bellenson, the city's health commissioner, predicted that the needle-exchange could avoid 13 cases of HIV infection in the first year alone. "AIDS Groups' Insurance Rates Soar" Toronto Globe and Mail (03/16/94) P. A3; Breckenridge, Joan In the wake of skyrocketing long-term disability rates, AIDS organizations in Canada have demanded that the federal and provincial governments force insurance companies to provide affordable coverage. The groups refuse to pay the new rates, claiming that the conditions under which insurance is being offered to their employees are discriminatory. The groups' new employees are obliged to undergo HIV testing, and those with positive test results will be denied coverage, said Russell Armstrong, national programs director for the Canadian AIDS Society. The groups, which are committed to hiring people with HIV or AIDS, are now "unable to offer meaningful employment because we cannot provide employees with benefits," said Armstrong. Charles Black, vice president of insurance operations for the Canadian Life and Health Insurance Association, said that the rates were not discriminatory, but the best that could be offered considering the risk assumed by insuring people in such a high-risk group. The new rates were offered by a consortium of companies that agreed to insure the AIDS organizations after the firm that used to service them went out of business. Individual insurers refused to cover them. Although he could not confirm rumors that the new rate was $4,600 per person per year, he conceded that the amount was "definitely substantial." "Tainted-Blood Lawsuits to Continue" Toronto Globe and Mail (03/16/94) P. A3; Picard, Andre A landmark case has been settled and the deadline for acceptance of a compensation package has passed, but lawsuits filed by recipients of AIDS-contaminated blood will continue in Canada. Although 826 AIDS patients have so far accepted the provincial-territorial assistance offer, the final number will be slightly higher. As many as 40 lawsuits, however, may proceed, according to an informal survey of lawyers. Most of those who have decided to continue with litigation are people who were found ineligible for the provincial package. Known as the secondary-infected, these AIDS patients contracted HIV through sexual contact or birth, or are ineligible for the federal package because they were infected after 1989. "AIDS--Attorney" Associated Press (03/17/94); Buzbee, Sally Streff A superior court judge in San Diego ruled against Martin Caprow, a gay attorney who claims he was fired from his firm because he has AIDS. Caprow, 37, contended that he was laid off from Frank & Freedus in April 1992--two weeks after he disclosed his condition to an office manager--to keep health care costs low. But Eric Freedus, part-owner of the San Diego firm, said the decision to let Caprow go was made in January 1992, because business was bad and Caprow was not performing to expectations. Judge Vincent DiFiglia wrote that Caprow was a "victim of the economy," not of discrimination. "Harry Kondoleon, 39, Playwright and Novelist Who Wrote of AIDS" New York Times (03/17/94) P. D21; Collins, Glenn Harry Kondoleon, an author and playwright who in recent years dedicated his work to the portrayal of the devastation of AIDS, died from the disease yesterday at age 39. His plays include "Zero Positive," "Love Diatribe," and "Half Off." His second and final novel, "Diary of a Lost Boy," a chronicle of the demise of a gay man with AIDS, was published by Alfred A. Knopf just last month. Kondoleon was the recipient of multiple awards and honors, including a 1993 Obie for "The Houseguest." Kondoleon is survived by his parents and a sister. "AIDSLine" Advocate (03/08/94) No. 650, P. 19; Cohan, Gary R. Physicians who suddenly seem cranky, depressed, exhausted, and dysfunctional may be suffering from physician burnout. No doctor is immune to this medical epidemic, and HIV care providers especially are at risk. Some of the particularly stressful aspects of HIV care include being overworked, making decisions in uncertain circumstances, confronting death on a daily basis, and observing the destructiveness of disease progression. Some doctors also dwell on the youth of patients, experience "grief overload," feel therapeutically impotent, and overidentify with patients. In addition, there is the fear of contagion and other occupational risks. HIV/AIDS patients who notice the symptoms in their doctors should try to discuss these observations. Patients must, however, be careful not to mistake normal stress and tension that arise in patient-doctor relationships as solely the fault of the doctor. It can be difficult to recognize that the anxiety produced by HIV infection may be displaced onto others, the most convenient person being the doctor. "CDC Must Change Messages to Meet Needs of Second Decade" AIDS Alert (02/94) Vol. 9, No. 2, P. 22 Ineffective HIV prevention messages have resulted from government censorship and the absence of a strategic communications plan, according to an external review of the national health agency's efforts by the subcommittee charged with improving public understanding of the epidemic. Specifically, says the committee, the Centers for Disease Control and Prevention has failed to aggressively promote the value of condoms in preventing HIV infection, leading nongovernmental organizations to launch their own campaigns. The panel blames political influences--including that of Congress--for "delayed" and "bland" messages. "Government campaign efforts to date have failed to provide explicit information on how HIV is transmitted," the report concludes. "If the climate of censorship continues, the CDC should not invest in public service announcements." Responding to the criticism, Dr. James Curran, associate director of the CDC's Division of HIV/AIDS, points to the new marketing initiative promoting condom use as reflective of changes already being made by the CDC. In the coming decade, the subcommittee advises that the agency must be a more aggressive advocate for its own, as well as the public's best interest. The CDC should also shift its prevention focus from the general public to specific populations most affected by the epidemic, says the subcommittee. "Disseminated Active HHV-6 Infections in Patients With AIDS" Lancet (03/05/94) Vol. 343, No. 8897, P. 577; Knox, Konstance Kehl; Carrigan, Donald R. Human herpesvirus 6 (HHV-6) can reactivate in immunocompromised hosts and cause severe pneumonitis and marrow suppression in bone marrow transplant recipients. HIV patients now represent an immunocompromised population at risk for developing serious HHV-6 infections, and HHV-6 is now being considered as a cofactor in the pathogenesis of AIDS. Konstance K. Knox and Donald R. Carrigan of the pathology department at the Medical College of Wisconsin found HHV-6 infected cells in the lung, lymph-node, spleen, liver, and kidney tissues obtained at necropsy from nine AIDS patients. The infection rate was significantly higher than that for cytomegalovirus. Lung infection with HHV-6 was severe enough in one patient to account for fatal pneumonitis. The findings reflect the potential for HHV-6 to cause fatal pneumonitis in adults with AIDS. Respiratory failure is the primary cause of mortality among AIDS patients and idiopathic pneumonitis is the main cause of death in 5-10 percent of these patients. HHV-6 may account for some of these deaths, say Knox and Carrigan. They conclude that HHV-6 is an important pathogen for people with AIDS, but note that HHV-6 infections are treatable with ganciclovir and foscarnet.