Date: Fri, 14 Jun 1996 17:45:36 -0400 From: "Flynn Mclean" Subject: CDC AIDS Daily Summary 06/14/96 AIDS Daily Summary June 14, 1996 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 National AIDS Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC National AIDS Clearinghouse should be cited as the source of this information. Copyright 1996, Information, Inc., Bethesda, MD ****************************************************** "New Drug 'Cocktails' Mark Exciting Turn in the War on AIDS" "Across the USA: Florida" "TB, Measles Outbreak Reported in Liberia" "Infectious Disease Control Plan Gets High-Level Backing" "Birth Canal Cleansing Fails to Deter AIDS--Study" "Many Injection Drug Users Uninformed About HIV Transmission Risks" "Celgene to File for Synovir by End of Year" "Rifampin Resistant TB Reported in HIV-Positive Patient" "Importance of Age at Infection With HIV-1 for Survival and Development of AIDS in UK Haemophilia Population" "Sounding Board: AIDS Prevention--Sexual Ethics and Responsibility" ****************************************************** "New Drug 'Cocktails' Mark Exciting Turn in the War on AIDS" Wall Street Journal (06/14/96) P. A1; Waldholz, Michael Combination therapy, including a protease inhibitor and two drugs based on AZT, is showing promise for many AIDS patients. This has led some experts to the conclusion that AIDS may soon be seen as a long-term, manageable disease. After years of development and testing, scientists may have found the appropriate combination of drugs to control HIV. In a new approach that researchers hope may be a cure, scientists are targeting newly infected patients, rather than those in the advanced stages of disease. Martin Markowitz of Aaron Diamond AIDS Research Center claims that the effort "will answer the question of whether HIV infection can be eradicated in man." Nearly 60,000 Americans and 10,000 more people in other countries have already received the new drugs, the first of which was approved in mid-December. The cost of the drugs and possible side effects are drawbacks to the therapy, but many in the AIDS community are optimistic about the recent advances. "Across the USA: Florida" USA Today (06/14/96) P. 9A For the first time ever, doctors in Florida are now required to report the names of HIV-positive individuals to public health officials, according to the state's new AIDS disclosure law. "TB, Measles Outbreak Reported in Liberia" Washington Times (06/14/96) P. A18 An outbreak of tuberculosis and measles has sent 16,000 Liberians to the U.S. Embassy residential compound in Monrovia for treatment. Varsay Cooper, a physicians' assistant working at the Red Cross-sponsored clinic at the compound, said that clinic workers see at least four new cases every day and that many people have contracted the communicable diseases. "Infectious Disease Control Plan Gets High-Level Backing" Washington Post (06/13/96) P. A27 A two-year-old program to stop the worldwide spread of infectious diseases received a $26 million budget increase on Wednesday. The boost would expand the Centers for Disease Control and Prevention's Infection Center, which has been directing the 12-year-old effort. The center's budget would increase from $18.4 million to $44.4 million to help create a "global surveillance system," including a worldwide computer system linking poor countries with medical researchers. Moreover, the CDC would expand its regional infectious disease center system, which would grow from 4 centers to 10. Also to be expanded is a surveillance network to track emerging and re-surfacing germs. "Birth Canal Cleansing Fails to Deter AIDS--Study" Reuters (06/13/96) Cleansing the birth canal with disinfectant did not prevent a mother from transmitting HIV to her infant, National Cancer Institute researchers report today in the medical journal Lancet. Robert Biggar and colleagues in the United States and Malawi conducted case studies in which they cleaned out the birth canals of infected women just before delivery. The procedure did not prevent the transmission of HIV from mother to child, and the researchers suggest that a different antiseptic might be more effective. "Perhaps birth canal exposure is not a major contributor to perinatal infection risk," they wrote. "Many Injection Drug Users Uninformed About HIV Transmission Risks" Reuters (06/13/96) Besides drug sharing, many injection drug users have other drug-related risk behaviors for HIV infection, researchers at the University of Colorado report. Stephen Koester and colleagues found that the sharing of drug injection paraphernalia, including water, drug-mixing containers, and drug filters was twice as prevalent as sharing of syringes. They also discerned that heroin injectors were at the greatest risk of contracting HIV through risky injection practices. Individuals who received some community HIV prevention education reported a lower rate of injection-related risk behaviors. "Celgene to File for Synovir by End of Year" Reuters (06/13/96) Celgene will seek Food and Drug Administration approval for its drug Synovir (thalidomide) by the end of the year. The company will first seek approval for the drug as a treatment for leprosy and will then seek acceptance to market the drug for AIDS-related wasting. A trial of Synovir for AIDS-related wasting, which affects some 100,000 AIDS patients, is expected to be completed by the end of the summer. Celgene hopes to have the drug approved for both applications by September 1997. "Rifampin Resistant TB Reported in HIV-Positive Patient" Reuters (06/13/96) Using rifabutin for the prophylactic treatment of tuberculosis in AIDS patients may lead to rifampin-resistance, researchers reported in Thursday's issue of the New England Journal of Medicine. Rifabutin and rifampin are related drugs used to treat bacterial infections. William Bishai and colleagues report that a 35-year-old HIV-positive man given rifabutin to prevent a second tuberculosis infection was found to have a rifampin-resistant strain of the bacterium. Bishai said the case demonstrates that adherence to recommended guidelines, which call for screening patients for active tuberculosis before starting rifabutin prophylaxis, is critical. "Importance of Age at Infection With HIV-1 for Survival and Development of AIDS in UK Haemophilia Population" Lancet (06/08/96) Vol. 347, No. 9015; P. 1573; Ewart, David W.; Giangrande, Paul L. F.; et al. While infection with HIV-1 later in life has been associated with a shorter time to development of AIDS, adequate studies have not been done to determine the degree of difference between patients infected in infancy and those infected in old age. To evaluate this difference, British researcher Sarah C. Darby, of the Imperial Cancer Research Fund in Oxford, and colleagues studied the role of age at infection in the entire population of hemophiliacs in the United Kingdom. Their sample consisted of 1,216 HIV-1 infected hemophiliacs, with age at infection ranging from 8 months to 79 years. The researchers found that survival was strongly related to age at time of infection. Among the survivors after 10 years, 86 percent had been infected before the age of 15, 72 percent between the ages of 15 and 34, 45 percent between the ages of 35 and 54, and 12 percent at or after age 55. The authors say that the differences in survival times are not explained by deaths expected in the absence of HIV infection. They conclude that age at infection should be considered in further studies of disease progression. "Sounding Board: AIDS Prevention--Sexual Ethics and Responsibility" New England Journal of Medicine (06/06/96) Vol. 334, No. 23; P. 1540; Bayer, Ronald Since the beginning of the AIDS epidemic, questions of sexual ethics have become increasingly important. The responsibilities of an HIV-infected individual had to be considered, ranging from wearing a condom to informing past and present partners. Condom use was advocated for everyone--infected or not--because it was the only way to ensure self-protection. From one perspective, it was seen as the infected person's moral obligation to inform sex partners of one's infection. Many states even made laws imposing criminal penalties against those whose actions could result in HIV transmission. This idea was opposed, however, for fear that distinguishing the infected from the uninfected would lead to discrimination. The principle of self-protection removed responsibility from those with HIV, although by the late 1980s and early 1990s, calls for self-disclosure began to be heard. Consideration of personal responsibility leads to the question of whether or not an infected person is obligated to tell their partner. Because people may be infected without knowing they are, some experts have recommended that even couples in long-term relationships use condoms, because the idea of trust "disempowers" partners.