Date: Wed, 04 May 1994 09:32:03 -0400 (EDT) From: "ANNE WILSON, CDC NAC" AIDS Daily Summary May 04, 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 "Clue on How Newborns Get AIDS" United Press International (05/03/94); Wasowicz, Lidia Infants born to HIV-positive mothers may become infected by swallowing genital secretions in the birth canal during delivery, report scientists at the University of California at Los Angeles. Previous studies indicate that newborns contract HIV during pregnancy through the infected mother's placenta, after birth through breast milk, and during delivery, somehow, but the UCLA researchers say this is the first time this mechanism for infection during delivery has been identified. Their study suggests that some babies not infected during pregnancy contract the virus during birth by swallowing cervical-vaginal secretions. HIV was present in the cervical-vaginal secretions of five of 24 women studied. Two of 16 babies tested positive in stomach secretions following birth, suggesting that they may have been infected by swallowing fluids containing the deadly virus. "The significance of these findings is that, for the first time, HIV was isolated from [stomach secretions] of infants born to HIV-positive mothers, indicating the virus was transmitted via swallowing, and not via the placenta during pregnancy, says Dr. Karin Nielsen, the study's lead author, adding that it is interesting to note that the only two infants who had HIV in their gastric juices became infected. "In pregnant HIV-infected women, the presence of HIV in genital secretions during labor and delivery may be an important factor for transmission to the newborn infant," Nielsen concludes. "Schaefer's Veto Targets" Baltimore Sun (05/04/94) P. 18A The editorial staff of the Baltimore Sun applauds Maryland Gov. William Donald Schaefer for signing a bill that will allow the city of Baltimore to implement a pilot needle-exchange program in an effort to halt the spread of AIDS. While the governor has made it clear that he personally does not approve of free needle exchanges, the Sun appreciates the "courage" Schaefer showed by recognizing that the AIDS crisis demands some unusual responses. "It is easy to say no, stay the same, don't take any chances, not be progressive," the governor said at this week's bill-signing session in Annapolis. Still, Schaefer took the other route, giving Baltimore Mayor Kurt L. Schmoke permission to experiment with an unorthodox approach to try to reduce the number of HIV-positive addicts among the city's drug-user population of 48,000. "AIDS Cases Quadruple in Year in Sao Tome" Reuters (05/04/94) The number of people confirmed to have AIDS in the African island state of Sao Tome and Principe quadrupled from 300 a year ago to about 1,200 currently. The number of AIDS cases rose following tests of suspected carriers conducted with the help of the World Health Organization and the Pasteur Institute in France, said Antonio Lima, the Sao Tome government's director of health services. Thus far, he said, 13 individuals were known to have died from AIDS. The Sao Tome government has mounted an AIDS awareness program to warn people about the deadly disease--which is transmitted there primarily through sexual activity--and condoms are available to the entire population at no cost. Still, many people have not taken the message seriously, Lima said. "NYCLU Urges Civil Liberties Agenda" United Press International (04/03/94) An 89-page report by the New York Civil Liberties Union says the new city administration needs to take specific measures to tackle the recurring problems of its citizens, including racial discrimination, poor education, and health issues. The report, which was sent to Mayor Rudolph Giuliani, City Council, and community groups, included 41 recommendations. Among them was the expansion of school-based health clinics, including condom distribution programs. The NYCLU also expressed support for broader funding for HIV/AIDS education and, specifically, reinstatement of the AIDS unit within the city Commission on Human Rights. "Chicago Restaurateurs Battle AIDS" Nation's Restaurant News (04/18/94) Vol. 28, No. 16, P. 11 The Illinois Restaurant Association will act as principal sponsor of Chicago's first Dining Out for Life, a fundraiser to generate money for AIDS prevention, education, and care-giving programs. By donating a percentage of their receipts on May 5, participating restaurants aim for a goal of $100,000. Organizers hope to attract 100 participating restaurants and as many as 15,000 patrons. The fundraiser is modeled after a Philadelphia event. Similar programs have also cropped up in Atlanta and Baltimore, and even more cities are expected to hold their own benefits soon. "SSA to Revise Rules for Disability Benefits" Washington Blade (04/22/94) Vol. 25, No. 16, P. 29 The U.S. Social Security Administration this month proposed changes that would wipe out disparities in age, education, and work experience when determining eligibility for disability benefits. Under the proposed new rules, a 25-year-old and a 55-year-old would be judged in the same light, said Matthew Miller, an associate professor at Fordham University School of Social Security. Rep. Andy Jacobs (D-Ind.), chairman of the House Ways and Means subcommittee on Social Security, said in a statement that the SSA has been plagued by inadequate staffing and an increasing pile of disability applications. The SSA recently denied benefits to an AIDS patient in Indianapolis, saying that he was able to work, said Jacobs' statement. The letter of denial arrived the same day the man died. "FDA Guidance on Sharps Injury Prevention Could Lead to Standard for New Technology" AIDS Alert (04/94) Vol. 9, No. 4, P. 1 The Food and Drug Administration, under increasing pressure from health care employee unions, is taking measures that could set a standard for sharps injury prevention devices, according to an agency official. The FDA on May 5 will convene an expert panel to discuss a guidance document indicating the agency's expectations on the design and testing of needle safety devices. "It [a standard] is not a sure thing yet but I think this is a big first step to getting further control over that group of products and getting a better handle on appropriate design criteria," said Tim Ulatowski, the FDA's associate director for general devices. In the meantime, the transition to anti-needlestick devices in hospitals is being accelerated by pressure from health care unions. "Differential Survival of Patients With AIDS According to the 1987 and 1993 CDC Case Definitions" Journal of the American Medical Association (04/20/94) Vol. 271, No. 15, P. 1197; Vella, Stefano; Chiesi, Antonio; Volpi, Antonio et al. To evaluate the impact of the 1993 Centers for Disease Control and Prevention's expanded case definition for AIDS on the number of cases and on survival of infected patients, Vella et al. conducted a retrospective analysis of data from a prospective cohort study of 3,515 patients enrolled in the Italian National Registry of Zidovudine-Treated Patients between July 1987 and December 1991. According to the new classification system, the number of AIDS cases in the study sample would increase by 188 percent. The researchers did find, in fact, that application of the new definition resulted in a substantial increase in the number of cases. The primary finding, however, was that the survival estimate of patients under the 1993 definition is notably longer than that of individuals classified under the previous definition. Using the 1987 definition, median survival for study participants was two years, but 53 percent were still alive after 57 months under the new definition. The team also discovered that survival was highly dependent on clinical status among those patients with CD4 counts below 200. Individuals who were asymptomatic, or who had symptoms but no AIDS-defining clinical conditions, had significantly better survival outcomes than those with clinical AIDS. Vella et al. suggest that CD4 count is a reasonable predictor of duration of survival, but the presence of a clinical AIDS-defining condition plays a major role as well. The findings have important implications for health planners and anyone involved in the care and counseling of AIDS patients, conclude Vella et al. "Motherless Child" American Medical News (04/18/94) Vol. 37, No. 15, P. 11; Pinkney, Deborah Shelton The AIDS epidemic will leave between 72,000 and 125,000 American children and adolescents motherless by the end of the decade, calculates Dr. David Michaels, an epidemiologist at City University of New York Medical School. "Unless increased attention and resources are devoted to this vulnerable group, a social catastrophe is unavoidable," he says. Few orphans are themselves infected with the deadly virus, since children born with HIV usually die within the first four years of life. But the Centers for Disease Control and Prevention estimates that 93,000 to 112,000 healthy children will be born to HIV-positive mothers between 1992 and the year 2000. Despite these projections, little is being done and, ironically, a recent medical breakthrough could worsen the situation. A new study found that AZT lowered the risk of perinatal transmission of HIV to less than 10 percent. "My first reaction to this was joy at the thought of children who will be spared this disease," comments Dr. Blake Caldwell, a CDC medical epidemiologist. "But the second thought was of the number of children who will now be born uninfected and lose their mothers." AIDS orphans must confront feelings of shame, stigma, and isolation, yet a recent study by the Orphan Project found that these children are lacking services, in particular mental health and bereavement services.