Date: Mon, 13 May 1996 11:07:09 -0400 From: "Flynn Mclean" Subject: CDC AIDS Daily Summary 05/13/96 AIDS Daily Summary May 13, 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 ************************************************************ "Offer To Be Rejected in HIV Case" "HIV-Positive Student Suing School System" "Schmoke, Morella, Studds To Receive Awards for AIDS Leadership" "Clinical Drug Trials Can Let Patients Try State-of-Art Therapies" "AIDS To Take Heavy Toll on Malawi--World Bank" "10,000 March in Paris Anti-AIDS Rally" "A Meta-Analytic Evaluation of the Polymerase Chain Reaction for the Diagnosis of HIV Infection in Infants" "Ritonavir: First to Prolong Survival" "Managing HIV-Related Diarrhea" ************************************************************ "Offer To Be Rejected in HIV Case" Philadelphia Inquirer (05/13/96) P. A1; Shaw, Donna A $640 million settlement offered to HIV-positive hemophiliacs by four drug companies who marketed blood products infected with HIV will be rejected as being too low, representatives of the hemophiliacs said. The companies agreed to the settlement last month, but leaders of the 8,000 to 10,000 infected hemophiliacs say the offer is not enough. They say that new evidence shows that the companies used plasma donations from people who were known to have hepatitis and that the government did nothing to stop them. The hemophiliacs question why they should accept less than the $420,000 offered to each of Japan's HIV-infected hemophiliacs. The two groups will meet today in Philadelphia to discuss the settlement. "HIV-Positive Student Suing School System" Washington Post (05/11/96) P. C1; Beyers, Dan An HIV-infected teenager has filed suit against the Montgomery County, Md., public school system because a teacher disclosed his infected status to other students. The suit says that the student, identified as "Courageous Youth," transferred from the school system as a result, and it caused him to lose "an opportunity to enjoy a few precious years of normal childhood." The youth is seeking $100,000 in compensatory and punitive damages. It has been the school system's policy since 1986 to respect the privacy of HIV-positive students, but a teacher told students on Dec. 12 that they should not share lip balm with "Courageous Youth" because he has HIV. The infected teen was not at school that day. School officials had been notified of the student's condition in hopes that they would help him and had repeatedly asked that the student tell classmates that he was infected, but it is not clear how the teacher became aware of the youth's infection. "Schmoke, Morella, Studds To Receive Awards for AIDS Leadership" Baltimore Sun (05/13/96) P. 3B Baltimore Mayor Kurt L. Schmoke, Rep. Constance A. Morella (R-Md.) and Rep. Gerry E. Studds (D-Mass.) will be among those receiving AIDS Action National Leadership Awards in Washington, D.C., today. Schmoke will be honored for establishing a needle exchange program in Baltimore, and Morella and Studds will be recognized for voting 100 percent in support of AIDS-related legislation. "Clinical Drug Trials Can Let Patients Try State-of-Art Therapies" Wall Street Journal (05/13/96) P. B1; Chase, Marilyn Clinical trials provide a way for many people to try new therapies when conventional remedies are not adequate and to contribute to medical knowledge. Patients participating in clinical trials should be cautious and should understand the risks involved, because although the studies are held to many standards of safety, patients are still sometimes harmed. The intense health care provided is an advantage for patients, who receive close monitoring of their health during the study and have the opportunity to receive a potential cure. Mark Frey of San Francisco saw clinical trials as a way to get treated for HIV while providing information to advance medical science. People considering participating in a clinical trial should factor into their decision the time and energy involved, the possible side effects, as well as other safety concerns. "AIDS To Take Heavy Toll on Malawi--World Bank" Reuters (05/11/96) The World Bank predicted in a new report that about 2 million people in Malawi will be infected with HIV by the year 2000. About 1.1 million people, of the 11 million in Malawi, are now infected. The death toll is expected to cause the average life span to decrease from 57 years to 33 years. About 100,000 people will have AIDS, and 350,000 children will lose their parents to the disease, the report says, noting that the losses would result in a dramatic decrease in the gross domestic product between 2000 and 2010. The southern African country, the ninth poorest in the world, would not be able to handle the financial burden of an AIDS epidemic. In 1994, the rate of HIV infection among pregnant women was about 33 percent, and in prostitutes, the rate ranged from 70 percent to 98 percent. "10,000 March in Paris Anti-AIDS Rally" Reuters (05/12/96) About 10,000 people participated in a march in Paris on Sunday to raise money for AIDS patients. Politicians, artists, and people with AIDS were among those participating in the carnival-like event which moved from the Charlety stadium to the Champs de Mars by the Eiffel Tower. A similar anti-AIDS rally last year raised more than $200,000 and helped increase public awareness of the disease. France has the highest rate of HIV infection in Europe, with 200,000 individuals infected. "A Meta-Analytic Evaluation of the Polymerase Chain Reaction for the Diagnosis of HIV Infection in Infants" Journal of the American Medical Association (05/01/96) Vol. 275, No. 17, P. 1342; Owens, Douglas K.; Holodniy, Mark; McDonald, Thomas W.; et al. To determine the efficacy of the polymerase chain reaction (PCR), Dr. Douglas K. Owens of the Veterans Affairs Health Care System in Palo Alto, Calif. and colleagues conducted a meta-analysis of 32 published studies of PCR for perinatally acquired HIV infection. The median reported sensitivity was 91.6 percent, and the median specificity was 100 percent. The joint sensitivity and specificity was higher in older infants than in neonates. For infants at low risk of perinatal transmission, the positive predictive value for PCR was found to be 55.8 percent in neonates and 83.2 percent in older infants. The authors conclude that PCR is one of the best available tests for HIV diagnosis of infants but note that it is not definitive and should be interpreted and followed up carefully. The researchers suggest delaying PCR until after the neonatal period or repeating PCR on independent samples 30 to 60 days later to reduce test errors. "Ritonavir: First to Prolong Survival" Journal of the International Association of Physicians in AIDS Care (04/96) Vol. 2, No. 4, P. 38; MacDougall, David S. Ritonavir is the first protease inhibitor proven to prolong survival in advanced AIDS patients. Studies in the mid-1980s suggested that HIV protease may be responsible for some of the virus' pathogenic effects. Early protease inhibitors were designed to inhibit HIV protease function, but most had low bioavailability and were eliminated quickly. Research on HIV protease's structure led scientists to search for a specific inhibitor that would block the enzyme's activity. Scientists from Abbott Laboratories designed and tested more than 2,000 compounds, eventually leading to the development of ritonavir. In clinical trials, the drug was found to cause a rapid, significant initial decline in viral load and an increase in CD4 cells. A study of ritonavir with zidovudine and ddC demonstrated the success of the combination in reducing and sustaining undetectable viral load levels and increasing CD4 cell counts. Ritonavir was also found to be more effective than ZDV alone. The first proof of ritonavir providing survival benefits was found in a study in which the drug was added to volunteers' current therapies. Preliminary studies suggest that ritonavir may increase blood levels of saquinavir, and both Abbott and Hoffmann-La Roche have plans to conduct a clinical trial of a combination of the two drugs. "Managing HIV-Related Diarrhea" Nutrition for Life (04/96) Vol. 1, No. 2, P. 1 Diarrhea, which is caused by pathogens, malabsorption, and tumors, affects at least 50 percent of AIDS patients. To identify the cause of diarrhea, a stool culture for bacteria, tests for C. difficile toxins and parasites, and a smear for cryptosporidium, cyclospora, and Mycobacterium should be performed. Treatment seeks to reduce the diarrhea, and relieve the patient of fever, chills, or abdominal cramps. Pathogens should be treated with the proper anti-infective drugs. For nonspecific diarrhea, Imodium is used for initial therapy, along with fiber, the BRAT diet (bananas, rice, applesauce, and toast), and psyllium. The results of upper or lower GI tract endoscopy and biopsy are not usually valuable enough to merit the discomfort and cost they incur, and should be used when patients are unresponsive to simple treatment or when a patient has a fever or bloody stools. Dietary changes, including use of the lactase enzyme and aged/cultured milk for lactose intolerance, can also reduce diarrhea. A sensitivity to dietary fat is also common, and limiting intake can be useful, though carbohydrates should be added to prevent weight loss. Furthermore, bile acid sequestrants, which can help a patient tolerate fat, should be tried before going on a fat-restricted diet.