Date: Fri, 18 Nov 1994 09:01:41 -0500 (EST) From: "JOHN FANNING, CDC NAC" AIDS Daily Summary November 18, 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 ************************************************************ "AIDS Increasing at Slower Pace than Initially Feared; New Definition Led to Skew" "The TV Column" "Mothers, Babies in Partnership Against AIDS" "Tainted Blood and Violated Privacy" "Helping Charities the Latest Trend among Fashion Models" "Sensitivity of United States HIV Antibody Tests for Detection of HIV-1 Group O Infections" "What is MAC? How Serious Can It Be?" "Pediatric HIV Reclassified to Improve Diagnosis, Treatment" "Park's New Fight" "Dancing in Death's House" ************************************************************ "AIDS Increasing at Slower Pace than Initially Feared; New Definition Led to Skew" Baltimore Sun (11/18/94) P. 29A Although a revised definition of AIDS caused an increase in the number of cases reported, the Centers for Disease Control and Prevention (CDC) says the AIDS epidemic is growing at a slower rate. Dr. John Ward, chief of the CDC's AIDS surveillance branch, said, however, that the expanded definition "dumped into the system" many people who did not actually qualify as new cases. While the old definition diagnosed patients with AIDS when they had any of 23 indicator diseases, the new definition--which took effect Jan. 1, 1993--lists severely suppressed immune systems, as well as three more diseases as indicators of AIDS. Up 3 percent from 1992, the CDC says that there were 61,800 AIDS cases diagnosed in 1993. Diagnosed cases were counted separately from reported cases in 1992. The increase continued a downward trend in the rate of growth, said Ward. The new definition has created difficulties in the interpretation of AIDS trends. "The best way to track the disease is by the number of cases diagnosed, not by the number of reports you get in your mailbox," Ward explained. The CDC predicted that the number of new cases in 1994 would be below 1993's figures, once the initial impact of the expanded definition lessens. Related Story: Washington Times (11/18) P. A5 "The TV Column" Washington Post (11/18/94) P. F6; Carmody, John As part of its 1994 AIDS Prevention Campaign, the Whitman-Walker Clinic in Washington, D.C., has kicked off a new television ad campaign. The 30-second commercial, which will be shown on seven different stations, advocates HIV testing, condom use, and safer sex. "Mothers, Babies in Partnership Against AIDS" St. Louis Post-Dispatch (11/17/94) P. 6B Although scientists believe that maternal-infant transmission can be almost completely prevented, there is a drawback to the findings that support this theory, write the editors of the St. Louis Post-Dispatch. Pregnant women would have to be tested for HIV. Those who test positive would have to follow a rigorous schedule of medication to prevent HIV transmission. While a debate has erupted over the ethics of mandatory testing, another point has been obscured. Even if a woman is tested, there is no guarantee that she will follow the treatment regimen. Many of the women at risk for AIDS receive no prenatal care anyhow, and those who do are not always offered a voluntary HIV test or information about it. The pregnant women have to be a part of the medical or public-health system to take advantage of the prevention methods. In order for the treatment to work, the women need to receive early and regular attention. Commitment to a healthy baby will ensure that they maintain the treatment. The health of pregnant women--especially poor and uneducated women--and that of their babies' depends on an increased outreach and education effort, concludes the Post-Dispatch. "Tainted Blood and Violated Privacy" Toronto Globe and Mail (11/14/94) P. A14 Mr. Justice Douglas Carruthers of the Ontario Court's General Division ruled last week that the Canadian Red Cross must release the names of HIV-infected former blood donors to health officials. The judgment, write the editors of the Toronto Globe and Mail, poses a serious threat to the privacy rights of all Canadians. They question Carruthers' argument that the measure is necessary for the "health and well-being of our society." The benefit of telling the individuals that they are infected appears minimal, says the Globe, especially compared to the risks. The number of donors who are infected is low, and informing them that they are HIV-positive may not alter their behavior. What is to stop the government from testing other groups at risk? Permitting blood testing without the donors' consent and informing them of the results without their consent, leaves the door wide open. At a time when it is more important than ever, the Toronto Globe and mail says it is too bad that Judge Carruthers does not realize the importance of medical privacy. "Helping Charities the Latest Trend among Fashion Models" Knight-Ridder/Tribune Business News (11/16/94) Cindy Crawford and other models have formed an AIDS charity, Determined Involved Supermodels Helping to End Suffering (DISHES). In a benefit for pediatric AIDS patients, the group's first event was at skating rink on Tuesday. Other projects include a 1995 swimsuit calendar and an exercise video. "Sensitivity of United States HIV Antibody Tests for Detection of HIV-1 Group O Infections" Lancet (11/12/94) Vol. 344, No. 8933, P. 1333; Schable, Charles; Zekeng, Leopold; Pau, Chou-Pong et al Certain European HIV screening tests do not always detect the highly divergent group O strains of HIV-1, which were first discovered in central Africa. Researchers tested eight serum samples from likely group O infections from Cameroon with 10 HIV tests licensed by the U.S. Food and Drug Administration. While the assays based on synthetic peptides or recombinant antigens did not detect at least one of the infections, the tests based on whole-virus lysate antigens performed better. Although screening tests for HIV antibodies are only one of many measures to ensure the safety of the U.S. blood supply, there is potential for divergent HIV strains to infect people living in the United States and to remain undetected by current antibody tests. Current tests should be modified judiciously to correct for inadequacies in sensitivity. "What is MAC? How Serious Can It Be?" Advocate (11/15/94) No. 668, P. 44; Cohan, Gary R. One of the most serious and life-threatening AIDS complications is mycobacterium avium complex (MAC). The disease comes from the same family as tuberculosis and is commonly found in soil, food, dust, and water. Untreated MAC makes an AIDS patient look and feel as if he were dying from the disease. During the 1980s, MAC--which tends to afflict people with advanced HIV infection and fewer than 100 T cells--usually resulted in death. It is now considered manageable and largely preventable with drugs such as rifabutin. Taken in daily 300-mg. doses, the drug reduces by 50 percent to 70 percent the chances that a person will develop MAC. There are some concerns about potential resistance to single-drug MAC prophylaxis with rifabutin. Two- to five-drug combinations can effectively control active MAC infection in most patients. "Pediatric HIV Reclassified to Improve Diagnosis, Treatment" AIDS Alert (11/94) Vol. 9, No. 11, P. 156 The Centers for Disease Control and Prevention (CDC) has revised its definition of HIV for children under age 13. Based on new knowledge of HIV progression in children, the changes will update and simplify the coding process for the estimated 7,000 to 8,000 children in the United States who are infected each year. "The reclassification helps obtain the same information that was requested before but attaches to it a greater precision, because the knowledge base allows us to add the CD4 counts and try to place the stage of immunodeficiency in terms of something measurable," said Catherine Wilfert, a consultant for the classification update. For example, HIV-infected or perinatally exposed children are classified into one of four clinical categories based on signs, symptoms, or diagnoses related to HIV infection. In addition to the revision, the CDC has updated the 1987 AIDS surveillance case definition for children under 13 to reflect more concrete definitions for HIV encephalopathy and HIV wasting disease. "Park's New Fight" Advocate (11/15/94) No. 668, P. 20 Middleweight boxer Lamar Parks is HIV-infected. He abruptly canceled his March 4 title bout with World Boxing Council champ Gerald McClellan because of his deteriorating health. Parks won five South Carolina Golden Gloves championships and three Southeast regional titles as an amateur. As a pro, he was 28-1 and would have earned $150,000 from the title fight. "Dancing in Death's House" Newsweek (11/07/94) Vol. 124, No. 19, P. 66; Shapiro, Laura Since November 1992, Bill T. Jones, a choreographer living with HIV, has traveled to 11 cities around the United States to conduct what he calls survival workshops. He videotapes the four-hour sessions with groups of people, ages 11 to 75, who have life-threatening illnesses such as HIV or ovarian cancer. Jones has incorporated words and gestures from the meetings into material for an original dance called "Still/Here". The performers illustrate the stories of the workshop participants. They dance among television monitors placed on the stage that feature video and audio excerpts of the workshops. "Still/Here" opened in Lyon, France, in September and will tour the United States through April.