Date: Tue, 3 Jan 1995 15:24:46 +0500 From: awilson@smtpinet.aspensys.com (Wilson, Anne) AIDS Daily Summary January 3, 1995 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 ************************************************************ "Gambian Women May Have Rare AIDS Immunity" "AIDS Is Brought Sadly Home to Canada's Indians" "Blood Test of AIDS Prevents Many Infections" "Way of the World in '95: Will a Cure Be Found for AIDS?" "Making Days Live in Face of Death" "Man with AIDS Gets 10 Years for Raping Boy" "More Alberta Women Infected with AIDS" "Survival and Disease Progression According to Gender of Patients with HIV Infection" "Mother to Child Transmission of Zidovudine-Resistant HIV-1" "...As Tighter Research Links Urged" *********************************************************** "Gambian Women May Have Rare AIDS Immunity" Reuters (01/03/95); Fox, Maggie British doctors say they have found a group of Gambian prostitutes who seem to have some kind a natural immunity to HIV, the virus that causes AIDS. Dr. Sarah Rowland-Jones, an immunologist at the Institute of Molecular Medicine in Oxford, reported that the women--regular visitors to a British-run clinic--were known prostitutes who did not use condoms on a regular basis. "We know they have been infected with the virus but we can't find it now," said Rowland-Jones. "They probably get exposed to HIV at least once a month." The six women all had T-cells specific to HIV. T-cells "are probably the main reason that people stay well for as long as they stay well during HIV infection," Rowland-Jones added. The women have shown no sign of HIV infection and are very healthy. "The best hope is that they have cleared it but it is possible that they have a low-level infection that we cannot find," she said. The doctors will start working with researchers in Nairobi, who reported in October 1993 that 25 prostitutes seemed to have developed a natural immunity to HIV. Related Story: Financial Times (01/02) P. 11 "AIDS Is Brought Sadly Home to Canada's Indians" New York Times (01/03/95) P. A4; Farnsworth, Clyde H. Canada's native leaders have issued a warning that AIDS is reaching epidemic proportions in their communities. Dr. Jay Wortman, an AIDS consultant for Canada's Health Ministry, says AIDS has reached a level in the native community that is comparable to "the crisis situation experienced by the homosexual population a few years ago." Although statistics from one year ago showed only 93 cases among the 1 million natives out of more than 9,000 cases in an overall population of 27.4 million, health officials believe that many other cases among natives are unreported or undiagnosed. "Natives are reluctant to talk about sex and sexuality," said Dr. David Des Jardins, executive director of the Feather of Hope Aboriginal AIDS Prevention Society of Edmonton and Calgary. "It brings up old wounds since many were abused sexually as children," a problem which experts say was partially caused by living in close quarters under difficult conditions. Two other problems are the low self-esteem many Indians suffer when forced to live hand-to-mouth in bigger towns and cities and the strong disapproval of homosexuality in the native community--which makes in difficult for many to come forward. "Blood Test of AIDS Prevents Many Infections" Washington Post (Health) (01/03/95) P. 15; DiBacco, Thomas; Boodman, Sandra G.; Colburn, Don et al The development of a blood test to detect HIV infection was "an incredible public health breakthrough," according to Anthony Fauci, chief of the National Institute of Allergy and Infectious Diseases. The Food and Drug Administration approved the ELISA HIV-antibody detection test in 1985. Prior to that, thousands of people had become HIV-infected after receiving transfusions from infected donors--many of whom did not even know they were infected. Hemophiliacs were especially hard hit. As many as half of the 20,000 hemophiliacs in the United States may have become infected between 1980 and 1985. More than 2,700 have been diagnosed with AIDS. Only about 20 cases of transfusion-related HIV infection have been documented nationwide since 1985, however. The risk of HIV infection from a blood transfusion is now estimated to be one in 225,000 for people receiving a single unit of blood. The test has made even more of a difference in other countries. For example, in some African cities, 10 percent of the population is HIV-positive. "I shudder to think what the infection prevalence would be in these countries without the test," said Fauci. "Way of the World in '95: Will a Cure Be Found for AIDS?" Financial Times (01/02/95) P. 11; Cookson, Clive Although after 10 years of research costing billion of dollars, the available treatments for HIV and AIDS can do little more than delay symptoms for a few months. There have, however, recently been some exciting developments. Researchers have discovered the structure of a significant enzyme, called HIV integrase, which is a promising target for new anti-HIV drugs. There is clinical proof that combinations of two or more anti-HIV drugs have a more powerful and longer-lasting effect than any one drug. Such discoveries are raising hopes among AIDS researchers that there will be a breakthrough in 1995--such as a treatment that works better than AZT, or the first HIV vaccine. Related Story: Washington Post (Health); (01/03) P. 15 "Making Days Live in Face of Death" New York Times (01/02/95) P. 25; Lee, Felicia R. In every major city, health care workers such as Deborah Sollod--the clinical nurse manager at the Robert Mapplethorpe Residential AIDS Treatment Facility in New York City--are facing an increasingly common type of AIDS patient: the poor drug addict with a range of social problems. Health care professionals, therefore, now must be concerned with not only medical bills and miracle cures, but food stamps, drug treatments, and housing. The epicenter of the AIDS epidemic with more than 70,000 cases, most of the new cases in New York City involve intravenous drug users. The new patients are increasingly blacks and Hispanics whose illness is compounded by drug addiction, poverty and emotional problems. For those who care for AIDS patients, turnover and burnout are high in AIDS nursing homes and in AIDS wards across the country. "Personally, I have a hard time with it. I don't like going to visit them in the hospital. You fall in love with them. Just because you're a nurse doesn't mean it's easy," says Sollod. She took the job because of a desire to help and because it offered an chance to go into management. "This was like a stepping stone to the AIDS community...There aren't a lot of people dedicating their career to it," she concludes. "Man with AIDS Gets 10 Years for Raping Boy" Philadelphia Inquirer (12/31/94) P. A7 Zachary Halsell, who is HIV-infected, was sentenced to 10 years in prison for raping an eight-year-old boy. Halsell, 29, plead guilty on Thursday to attempted murder, intentional exposure to AIDS, aggravated sexual assault of a child, and indecency with a child in exchange for the 10-year sentence. If convicted on all charges, he could have faced life in prison. The boy has tested negative for HIV. "More Alberta Women Infected with AIDS" Toronto Globe and Mail (12/30/94) P. A4 Barry Breau, the executive director of the AIDS Network of Edmonton Society, said that an increasing number of women in Alberta, Canada, are becoming infected with AIDS and it will mean that more babies are born with the disease. Last year, doctors confirmed that three Alberta babies contracted AIDS in their mothers' wombs. "They are certainly the first cases we've seen in Alberta, but this has happened across the country--in Toronto, in Montreal, Vancouver," he said. Breau advised that would-be mothers examine the sexual histories of their partners and be tested for AIDS themselves before getting pregnant. "Survival and Disease Progression According to Gender of Patients with HIV Infection" Journal of the American Medical Association (12/28/94) Vol. 272, No. 24, P. 1915; Melnick, Sandra L.; Sherer, Renslow; Louis, Thomas A. et al To compare disease progression and mortality between HIV-infected men and women, Melnick et al studied 768 women and 3779 men at 17 community-based centers participating in the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). The women studied were more likely to be younger, African-American or Hispanic, and more likely to have a history of injection drug use than men. The relative risk for death among women compared with men was 1.33 and for disease progression was 0.97. While women were at increased risk of bacterial pneumonia, they were at a reduced risk for Kaposi's sarcoma and oral hairy leukoplakia. The increased risk of death and bacterial pneumonia for women compared to men was primarily found among women with a history of intravenous drug use. Women are at an increased risk of death but not disease progression, the study concluded. Both men and women had were similarly at risk for opportunistic infections, but women were at an increased risk for bacterial pneumonia. The researchers suggest that the findings may reflect differences in access to health care and standard treatments or different socioeconomic status and social support for women compared to men. "Mother to Child Transmission of Zidovudine-Resistant HIV-1" Lancet (12/24/94-12/31/94) Vol. 344, No. 8939/8940, P. 1771; Siegrist, Claire-Anne; Yerly, Sabine; Kaiser Laurent et al Siegrist et al report the first case of neonatal infection by zidovudine-resistant HIV-1. An HIV-1-infected woman with a CD4 cell count of 176, recurrent herpes simplex, and severe cervical dysplasia received zidovudine for 15 months. Treatment was stopped shortly before pregnancy, but re-introduced two weeks before delivery in hopes of reducing the risk of transmission. Zidovudine was administered during labor and to the infant for the first six weeks of its life. At one week, the infant showed a weakly positive p24 antigenaemia. When the baby was three months old, early and severe HIV-1 infection was confirmed. Tests of frozen samples from the mother revealed a viral genotype of reverse transcriptase codon 215, and measures of the infant's serum showed a 215 mutant HIV-1 genotype. The 215 mutant codon was present in the mother's system before pregnancy, which suggests the long persistence of the mutant strains even in the absence of drug pressure. The detection of p24 antigen at seven days supports in utero rather than late perinatal transmission. The authors recommend that until previously treated mothers and infants can be safely offered combined therapies, that zidovudine alone should not be prescribed without first showing the absence of drug-resistant variants. "...As Tighter Research Links Urged" Nature (12/15/94) Vol. 372, No. 6507, P. 587; Lehrman, Sally Following an evaluation of HIV services and prevention, a task force created by the city and county of San Francisco on the HIV epidemic has concluded that AIDS researchers need to work more closely with those providing services and developing policy. While the group emphasized the importance of research in all areas of the city's response to the epidemic, it urged researchers at the University of California, San Francisco to work with community-based organizations. The task force asked the Department of Health to establish research priorities, disseminate information, and increase research funding. Michael S. Ascher, acting chief of the California State Virus Laboratory, agrees that interaction between researchers and service providers is necessary for studies to be relevant to the community. Researchers also need to work harder to address the changing demographics of AIDS as more women, homeless people and minorities become HIV-infected, said the group. The report concluded that the lack of funding, the changing nature of the epidemic, and the growing need for long-term services are threatening the quality of San Francisco's system of AIDS care.