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·    Subject: HICN605 Medical Newsletter Part 1/6

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Volume  6, Number  5                                            March  8, 1993

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                         Editor: David Dodell, D.M.D.
    10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA
                          Telephone [phone]
                              FAX [phone]

Compilation Copyright 1993 by David Dodell,  D.M.D.  All  rights  Reserved.
License  is  hereby  granted  to republish on electronic media for which no
fees are charged,  so long as the text of this copyright notice and license
are attached intact to any and all republished portion or portions.

The Health Info-Com Network Newsletter is  distributed  biweekly.  Articles
on  a medical nature are welcomed.  If you have an article,  please contact
the editor for information on how to submit it.  If you are  interested  in
joining the automated distribution system, please contact the editor.

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                       T A B L E   O F   C O N T E N T S


1.  Comments & News from the Editor
     From the Editor: Scanner/OCR Fund & CDC MMWR Reports (new info) ......  1

2.  Centers for Disease Control - MMWR
     [5-Mar-93] HIV Testing Services in Acute-Care Hospital Settings ......  3
     Comparison of Early and Late Latent Syphilis .........................  5
     Tetanus Fatality .....................................................  8
     Impact of Legislation on Needle and Syringe Purchase/Possession ...... 11

3.  Dental News
     License Granted to Dental Products that will Remineralize Teeth ...... 15
     Dental Researchers Report Novel Approach Treating Arthritis .......... 17

4.  AIDS News Summaries
     AIDS Daily Summary Feb 16, 1993 to March 5, 1993 ..................... 19

5.  Clinical Alerts from National Institues of Health
     Alert: DDI and DDC for HIV infection ................................. 40

6.  Announcements of Studies/Research
     Tamoxifen Breast Cancer Prevention Trial Information ................. 44

7.  General Announcments
     Discussion List for Chronic Fatique Syndrome ......................... 79



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                        Comments & News from the Editor
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          Words from the Editor: Scanner/OCR Fund & CDC MMWR Reports


First, I would like to thank everyone who has sent in a donation for the
Mednews OCR/Scanner Fund.  The total is now at $623.  We are more than half
way to our goal.

For our new subscribers, I am trying to raise enough money to buy a good
flatbed scanner to scan in new articles and news releases for the newsletter.
Cost for a new scanner is approximately $1000.  To prevent boring our old
readers, please write to [e-mail] if you have specific questions.

I have sent everyone individually thank you notes, but some email has bounced.
If you see your name below, but did not receive a thank you note, please drop
me a line.

If you would like to send in a contribution, mail a check to:

                                 David Dodell
                      10250 North 92nd Street, Suite 210
                      Scottsdale, Arizona 85258-4599  USA

Thank you to the following individuals whose contributions I just received:

Chris Spirito
Louis Harris
William Landry
Judy Sproles
David Dorward
Laura Larsson
George Hazzard
Jack Cross
R.K. Wright
Edward Taxin
Kriss and Betsy Davis
Mark Dixon
Franz Piribauer
Clark University
Robert Robison



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Volume  6, Number  5                                            March  8, 1993

My source for the MMWR has finally arrived direct from the Centers for Disease
Control.  Since I will no longer have to relay on a third-party source, the
MMWR should be back to a regular column of the newsletter.

Again, thank you for all the contributions sent so far.

David Dodell
Editor, HICNet Medical Newsletter



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Volume  6, Number  5                                            March  8, 1993



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                      Centers for Disease Control - MMWR
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                          MMWR 42(08) March 05, 1993
            Recommendations for HIV Testing Services for Inpatients
                and Outpatients in Acute-Care Hospital Settings
            =======================================================
     CDC has published revised recommendations for human immunodeficiency
virus (HIV) counseling and testing of patients in acute-care hospital settings
(1).* These recommendations update previous CDC guidelines published in 1987
(2) and strengthen the recommendation for hospitals to assess the rate of HIV
infection among their patient populations and to develop HIV-testing programs
that assist infected patients in obtaining HIV-related treatment and
prevention services. The revision was prompted by information regarding both
the rates of previously unrecognized HIV infection among persons admitted to
some acute-care hospitals and the potential medical and public health benefits
of recognizing HIV infection in persons who have not developed acquired

immunodeficiency syndrome (AIDS).
     CDC recommends that hospitals and associated clinics encourage health-
care providers to routinely ask patients in nonemergency settings about their
risks for HIV infection. Patients at risk should be offered HIV counseling and
testing services with informed consent obtained in accordance with local laws.
In addition, hospitals with an HIV-seroprevalence rate of at least 1% or an
AIDS diagnosis rate greater than or equal to 1.0 per 1000 discharges (3)
should strongly consider adopting a policy of offering such services routinely
to patients aged 15-54 years. These services should be structured to
facilitate confidential, voluntary patient participation and should include
pretest information about the testing procedures, appropriate posttest
counseling for infected patients and those at increased risk, and referral of
HIV-infected persons for medical evaluation.  Persons who decline HIV testing
or who consent to testing and are found to be infected must not be denied
needed health care or provided suboptimal care.
     The recommendations emphasize that HIV counseling and testing programs
should not be used as a substitute for universal precautions or other
infection-control techniques and underscore the importance of effective and
ongoing collaboration between acute-care providers and health departments to
improve HIV-related prevention and treatment services.

                                  References

1. CDC. Recommendations for HIV testing services for inpatients and
outpatients in acute-care hospital settings and technical guidance on HIV
counseling. In: Recommendations and reports (January 15). MMWR 1993;42(no. RR-
2):1-6.

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2. CDC. Public Health Service guidelines for counseling and antibody testing
to prevent HIV infection and AIDS. MMWR 1987;36:509-15.

3. Janssen RS, St. Louis ME, Satten G, et al. HIV infection among patients in
U.S. acute-care hospitals: strategies for the counseling and testing of
hospital patients. N Engl J Med 1992;327:445-52.

* Single copies of the recommendations will be available from the CDC National
AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003; telephone (800)
458-5231.


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Volume  6, Number  5                                            March  8, 1993

        Comparison of Early and Late Latent Syphilis -- Colorado, 1991
        ==============================================================
     Latent syphilis (i.e., the presence of serological evidence for syphilis
without clinical manifestations) is divided into early latent (EL less than
1-year's duration) and late latent (LL more than 1-year's duration) stages
(1). LL syphilis, which is often associated with low nontreponemal test (e.g.,
rapid plasma reagin RPR) titers and is presumed to have been acquired in the
distant past, is not routinely included in syphilis surveillance reports and
analyses. Although a separate classification of "unknown latent syphilis" has
been proposed (1), in practice, duration is unknown for nearly all syphilis
cases that are classified as LL. This report compares EL and LL syphilis cases
in Colorado during 1991 and demonstrates substantial overlap in their
characteristics.
     Colorado EL and LL syphilis cases reported in 1991 were abstracted for
information on age, sex, racial/ethnic group, and serologic test results
(RPR). Persons aged greater than or equal to 60 years with RPR titers less
than or equal to 16 were not included among LL cases, because these are
usually closed administratively without investigation by disease-control
staff.
     Serologic and demographic data were available for 33 (94%) of 35 EL and
92 (91%) of 101 LL cases reported in 1991. Females composed 17 (52%) EL and 35
(38%) LL cases. Blacks composed 13 (39%) EL and 28 (30%) LL cases; whites
composed seven (21%) EL and 28 (30%) LL cases; Hispanics composed 30% of both
EL and LL cases.
     Of patients with EL syphilis, 27 (82%) had RPR titers greater than or
equal to 8; 40 (43%) patients with LL syphilis also had RPR titers greater
than or equal to 8 (Figure 1). The percentage of cases with RPR titers greater
than or equal to 32 was 42% for EL and 18% for LL. The median age group was
25-29 years for EL and 30-34 years for LL patients. Of patients with EL
syphilis, 28 (85%) were aged less than or equal to 39 years; 70 (76%) patients
with LL syphilis were also in this age range (Figure 2). Based on the
combination of both RPR titer greater than or equal to 8 and age less than or
equal to 39 years, 32 (35%) patients with LL syphilis were similar to the
majority of EL patients.

Reported by: KA Gershman, MD, HIV/STD Surveillance Program, RE Hoffman, MD,
State Epidemiologist, Colorado Dept of Health. Clinical Research Br, and
Surveillance and Information Systems Br, Div of Sexually Transmitted Diseases
and HIV Prevention, National Center for Prevention Svcs, CDC.

Editorial Note: The division of latent syphilis into early and late stages is
based on treatment and public health considerations; a previous study of
untreated syphilis indicated that most secondary relapses (mucocutaneous
lesions) occurred during the first year after infection (2). In the United
States, since the 1960s, the early latent stage has been defined as 1 year

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Volume  6, Number  5                                            March  8, 1993

from the onset of infection.  In practice, latent syphilis is classified as EL
with evidence that a person acquired infection during the previous 12 months
based on 1) a nonreactive serologic test for syphilis or a fourfold rise in
titer from a previous serologic test for syphilis during the previous 12
months; 2) a history of symptoms consistent with primary or secondary syphilis
without a history of treatment in the previous 12 months; or 3) a history of
sexual exposure to a partner with confirmed or presumptive primary, secondary,
or early latent syphilis and no history of treatment during the previous 12
months. If none of these criteria are met, a case of latent syphilis is
classified as LL; the duration of infection is usually unknown.
     Public health surveillance for syphilis is based on reported cases of
primary and secondary (P&S) or early (P&S plus EL) syphilis.  Because a
substantial proportion of persons with infectious P&S syphilis do not seek
medical attention despite symptoms (3), reporting that includes EL cases
presumably reflects the true incidence of syphilis during the previous 12
months more accurately than does reporting of P&S syphilis alone. The findings
in this report that the age and serologic titer patterns of LL and EL syphilis
patients are similar suggest that a substantial number of LL case-patients may
have acquired infection during the previous 12 months, even though information
was inadequate to classify these cases as EL. Based on these findings, the
actual number of EL cases in Colorado could be more than twofold greater than
what is recognized.
     Limitations in knowledge about the natural history of nontreponemal test
titers in untreated syphilis precludes use of these tests to assess duration
of infection. Although peak titers are reached during the first year of
untreated infection, data on their rate and variability of subsequent decline
are limited (4).
     For monitoring morbidity trends and evaluating control programs, the
category P&S syphilis may be optimal, especially when focusing on patients
voluntarily seeking care with signs or symptoms (5). The detection of EL and
LL syphilis cases is more dependent on active case-finding conducted by STD
programs, including partner notification and serologic screening. Although the
division of latent syphilis cases into EL and LL stages has been useful for
treatment and partner notification, the findings in this report suggest this
classification is problematic for use in surveillance.

References

1. CDC. Case definitions for public health surveillance. MMWR 1990;39(no. RR-
13).

2. Sparling PF. Natural history of syphilis. In: Holmes KK, March PA, Sparline
PF, Wiesner PJ, eds. Sexually transmitted diseases. New York: McGraw-Hill,
1990:214.


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3. Brown WJ, Donohue JF, Axnick NW, Blount JH, Ewen NH, Jones OG.  Syphilis
and other venereal diseases. Cambridge, Massachusetts: Harvard University
Press, 1970:41.

4. Hart G. Syphilis tests in diagnostic and therapeutic decision making. Ann
Intern Med 1986;104:368-76.

5. CDC. Epidemic early syphilis -- Montgomery County, Alabama, 1990-1991. MMWR
1992; 41:790-4.



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                        Tetanus Fatality -- Ohio, 1991
                        ==============================
     In August 1991, the Ohio Department of Health received a report of a
fatal case of tetanus. This report summarizes the investigation of this case.
     On July 21, 1991, an 80-year-old woman sought treatment in the emergency
department of a hospital in central Ohio because of a stiff jaw and dysphagia.
On examination, she had slightly slurred speech and difficulty opening her
mouth but no difficulty breathing. A wood splinter from a forsythia bush had
been lodged in her left shin approximately 1 week; the wound site was
erythematous and draining purulent material. The emergency room physician
diagnosed tetanus and admitted the woman to the hospital. Treatment included
tetanus immune globulin (3000 units) and tetanus toxoid (0.5 cc) and
intravenous clindamycin because of a reported history of penicillin allergy.
     The patient had no history of any previous tetanus vaccinations.  She had
been treated at an undetermined time in the 1960s for an infected wound
associated with a fractured ankle. In addition, she had sought medical care
periodically for treatment of hypertension and other medical problems.
     The patient's clinical status gradually deteriorated, and mechanical
ventilation was required because of increasing generalized rigidity. During
the ensuing 2-week period, she was treated for tremors, muscle spasms,
abdominal rigidity, apnea, pneumonia, and local infection from her leg wound.
Despite aggressive treatment, the patient died on August 5.
     As a result of this case, a public health nurse, serving as part of the
Occupational Health Nurses in Agricultural Communities (OHNAC) project *,
instituted communitywide educational activities to increase tetanus
vaccination coverage among adults. Following these educational efforts, from
August 1991 through July 1992, the number of adults receiving tetanus
vaccination from the county health department increased 51% ** over the
previous 12 months (79 vaccinations compared with 52, respectively).

Reported by: M Fleming, Grady Memorial Hospital; A Babcock, Delaware County
Health Dept, Delaware; A Migliozzi, MSN, TJ Halpin, MD, State Epidemiologist,
Ohio Dept of Health. Div of Surveillance, Hazard Evaluations, and Field
Studies, National Institute for Occupational Safety and Health; Div of
Immunization, National Center for Prevention Svcs, CDC.

Editorial Note: The risk for tetanus is greater in older (aged greater than or
equal to 60 years) persons who lack protective levels of antitoxin (1,2).
Although tetanus is preventable through adequate vaccination, 117 cases of
tetanus were reported to CDC during 1989 and 1990 (3 ). Supplemental
information available for 110 of these cases indicates the case-fatality rate
was 24%. Of 109 persons for whom age was known, 63 were aged greater than or
equal to 60 years.  Of the 37 persons in this age group for whom vaccination
status was known, 34 (92%) were inadequately vaccinated (CDC, unpublished
data, 1992).

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Volume  6, Number  5                                            March  8, 1993

     Tetanus toxoid is a highly effective vaccine. Protective levels of serum
antitoxin are generally maintained for at least 10 years in properly
vaccinated persons (4). After completion of the primary vaccination series,
booster doses of tetanus toxoid, combined with diphtheria toxoid (as Td) every
10 years are recommended by the Advisory Committee on Immunization Practices,
the American College of Physicians, the American Academy of Family Physicians,
and the American Academy of Pediatrics.
     This report and others underscore the consequences of missed
opportunities for vaccination (3). Although the patient in this report had
numerous prior contacts with the health-care system, she had no history of
vaccinations against tetanus. Of the 57 persons with tetanus in 1989 and 1990
for whom vaccination status was known, 45 (79%) reported ever having received
less than or equal to 2 doses of tetanus toxoid. In addition, of the 12 who
had sought medical care for their injuries and for whom tetanus toxoid was
indicated, 11 were not vaccinated (3).
     Wounds such as that described in the patient in this report are common in
persons with tetanus and may not be considered sufficiently severe by the
person to warrant a visit to a health-care provider.  In 1989 and 1990, only
27 (31%) of 86 persons with tetanus and a clear antecedent acute injury sought
medical treatment for their wounds (3). Therefore, internists, family
practitioners, occupational physicians and other primary health-care providers
who treat adults should use every opportunity to review the vaccination status
of their patients and administer Td and other indicated vaccines as
appropriate.

References

1. CDC. Tetanus--Rutland County, Vermont, 1992. MMWR 1992;41:721-2.

2. CDC. Summary of notifiable diseases, United States, 1991. MMWR 1992;40(no.
53):47.

3. Prevots R, Sutter RW, Strebel PM, Cochi SL, Hadler S. Tetanus surveillance
-- United States, 1989-1990. In: CDC surveillance summaries (December 11).
MMWR 1992;41(no. SS-8):1-9.

4. ACIP. Diphtheria, tetanus, and pertussis: recommendations for vaccine use
and other preventive measures -- recommendations of the Immunization Practices
Advisory Committee (ACIP). MMWR 1991;40 (no. RR-10).

* OHNAC is a national surveillance program conducted by CDC's National
Institute for Occupational Safety and Health that has placed public health
nurses in rural communities and hospitals in 10 states (California, Georgia,
Iowa, Kentucky, Maine, Minnesota, New York, North Carolina, North Dakota, and
Ohio) to conduct surveillance of agriculture-related illnesses and injuries

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Volume  6, Number  5                                            March  8, 1993

that occur among farmers and farm workers and their family members. These
surveillance data are used to reduce the risk for occupational illness and
injury in agricultural populations.

** The 51% increase in vaccinations may underestimate the total effect of this
intervention because it does not include persons who obtained vaccinations
from private physicians or from providers in neighboring counties.


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Volume  6, Number  5                                            March  8, 1993

                Impact of New Legislation on Needle and Syringe
                 Purchase and Possession -- Connecticut, 1992
                ===============================================
     Human immunodeficiency virus (HIV) and other bloodborne pathogens are
transmitted among injecting-drug users (IDUs) through the reuse and sharing of
contaminated needles and syringes (NSs) (1).  Of the 689 acquired
immunodeficiency syndrome (AIDS) cases reported in Connecticut in 1992, 413
(60%) were associated with injecting-drug use. To help reduce IDUs' use of
contaminated NSs, Connecticut enacted laws effective July 1, 1992, that allow

the purchase without a prescription of up to 10 NSs at one time in pharmacies
and the possession of up to 10 clean NSs.* Before this date, purchase and
possession of NSs without a prescription had been illegal in Connecticut. This
report presents preliminary information from the first 5 months of an ongoing
evaluation to determine whether the new laws affected pharmacy-based NS sales,
IDUs' reported knowledge of the laws and places to obtain NSs, and law
enforcement officers' risk for needlestick injuries.

                   Investigation of Pharmacy-Based NS Sales

     In June 1992, eight pharmacies in Hartford, a city of 139,739 (1990 U.S.
Census), were enrolled in a sentinel surveillance system to monitor pharmacy-
based NS sales. For 1992, the annual incidence of AIDS in Hartford was 86
cases per 100,000 residents. All sentinel pharmacies were located in
neighborhoods where injecting-drug use was reported to be prevalent. Monthly
prescription and nonprescription NS sales for each participating pharmacy were
monitored beginning July 1992.
     By November 1992, six (75%) of the eight pharmacies were selling
nonprescription NSs. The number of nonprescription NSs sold by these
pharmacies increased steadily each month through October 1992 (480 in July;
856, August; 1143, September; and 1560, October).
     In the two pharmacies not selling nonprescription NSs in November,
pharmacists reported they had sold nonprescription NSs when the law went into
effect, but cited IDU-related incidents (i.e., a used syringe was found on a
shelf and an IDU disrupted business) in their pharmacy as the reason for now
refusing to sell.  IDUs' Knowledge of Laws and Places to Obtain NSs
     During August-November 1992, staff members at three HIV counseling and
testing sites, two correctional facilities, and two drug-treatment centers in
Connecticut interviewed active IDUs using a standard questionnaire. Active
IDUs were defined as persons who reported using a needle or syringe to inject
drugs into their veins, into their muscles, or under their skin during June
1992 and who reported using injected drugs during the 30 days preceding the
interview. IDUs were asked about their knowledge of the new laws and NS-
purchasing practices during the 30 days preceding the interview and during the
30 days before the laws became effective.
     Of 124 active IDUs, 68 (55%) reported they were aware they could both

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Volume  6, Number  5                                            March  8, 1993

purchase and possess clean NSs. An additional 26 (21%) IDUs were aware they
could legally purchase NSs but did not know they could legally possess them.
Thirteen (59%) of the 22 IDUs who were not aware of either law were men
interviewed in correctional facilities.
     More IDUs reported purchasing NSs from a pharmacy during August-October
(51 41%) than during June (23 19%). This change included 27 IDUs who began
purchasing from a pharmacy and two IDUs who reported not purchasing from a
pharmacy after the new laws went into effect (p<0.001, sign test, matched-pair
analysis). Those purchasing NSs during June may have been IDUs with diabetes,
made illegal pharmacy purchases, or recalled inaccurately their purchasing
during that time. Fewer IDUs reported purchasing NSs on the street during
August-October (73 59%) than during June (92 74%); four IDUs reported they
began purchasing and 24 reported they did not purchase on the street (p<0.001,
sign test). However, of all methods to obtain NSs, purchases on the street
(59%) were reported more often than purchases from pharmacies (41%). The
prevalence of NS sharing was unchanged -- during both periods, approximately
36% of IDUs reported at least one episode of NS sharing.
     In November 1992, four focus groups were held in Hartford with a total of
34 active IDUs to address issues regarding NS use and purchasing practices.
Participants reported that many IDUs changed their NS-purchasing practices in
July and began purchasing from pharmacies. Approximately two thirds of the
IDUs attending the meetings were aware that clean NS possession was legal and
reported they were now more likely to carry NSs with them on the street. Focus
group participants reported that NS-sharing episodes were less frequent after
the new laws went into effect.

            Law Enforcement Officers' Risk for Needlestick Injuries

     To determine whether Hartford police officers were at greater risk for
needlestick injuries after the new laws went into effect --because IDUs
reported that they were more likely to carry NSs on the street -- Occupational
Safety and Health Administration-mandated reports of occupational injuries and
illnesses were reviewed for reports of needlestick injury among police
officers. Needlestick injury rates among officers were similar during the 3
months before and after July 1 (two needlestick injuries in 423 arrests for
opium, cocaine, or NS possession versus one in 478 arrests, respectively).

Reported by: Hartford Dispensary; Regional Network of Programs; Chemical
Dependency Unit, Community Health Svcs; Hartford Police Dept; AIDS Program,
Hartford Health Dept. AIDS Program, Bridgeport Health Dept. AIDS Program,
Waterbury Health Dept. Health Svcs Div, Connecticut Dept of Correction. B
Weinstein, MPH, AIDS Section, JL Hadler, MD, State Epidemiologist, Connecticut
Dept of Health Svcs.  Div of Field Epidemiology, Epidemiology Program Office;
Clinical Research Br, and Behavioral and Prevention Research Br, Div of
Sexually Transmitted Diseases and HIV Prevention, National Center for

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Volume  6, Number  5                                            March  8, 1993

Prevention Svcs; Office of HIV/AIDS, Office of the Director, CDC.

Editorial Note: In July 1991, the National Commission on AIDS recommended
removing legal barriers to the purchase and possession of NSs as part of a
strategy for reducing the spread of HIV among IDUs unable or unwilling to
enter drug treatment (2 ). Statutes in 44 states and the District of Columbia
place criminal penalties on the possession and distribution of NSs (drug
paraphernalia laws), and the sale of NSs without a medical prescription are
prohibited in 10 states and the District of Columbia (needle prescription
laws) (3).  Although IDUs in some localities have begun to clean their NSs and
to decrease NS sharing in response to the AIDS epidemic (4,5), NS sharing
continues, reflecting the limited availability of NSs and the established
practices of injecting-drug use (5-7).
     Because the number and proportion of HIV infections related to injecting-
drug use in Connecticut are high, efforts to prevent HIV infection among IDUs
and their sex partners have been broad and include street outreach and drug-
treatment-based education to encourage safer sex and injection practices,
comprehensive drug treatment, HIV counseling and testing, and legalizing the
availability of sterile NSs. In July 1990, the Connecticut legislature
legalized needle exchange in New Haven, and in May 1992, the legislature
approved and funded additional needle-exchange programs in Hartford and
Bridgeport. Connecticut legislators also amended the state's needle
prescription and drug paraphernalia statutes. Legalizing over-the-counter
purchase of up to 10 NSs potentially expanded IDUs' access to sterile needles
to include pharmacies in Connecticut that might choose to sell nonprescription
NSs. Allowing possession of up to 10 clean NSs might encourage IDUs to carry
their own NSs, thereby decreasing the likelihood of unsafe NS sharing.
     A follow-up questionnaire survey of active IDUs is being conducted to
determine whether the behaviors reported in these preliminary findings have
changed and to better characterize NS-purchasing practices, NS ownership, and
patterns of NS usage as IDUs' knowledge of the new laws becomes more
widespread. One issue being explored is the discrepancy between questionnaire
results indicating that no change occurred in NS-sharing practices while focus
groups indicated that NS-sharing episodes decreased. The increase in the
number of nonprescription NSs sold by sentinel pharmacies in Hartford probably
reflects NS purchasing by IDUs but might also represent a shift from
prescription to nonprescription sales to persons with diabetes or those who
use NSs for medical purposes. To better define pharmacists' knowledge,
attitudes, and practices regarding nonprescription NS sales, pharmacists will
be interviewed in person and be surveyed by mail during 1993.

References
--------- end of part 1 ------------
·    Subject: HICN605 Medical Newsletter Part 2/6

1. Schoenbaum EE, Hartel D, Selwyn PA, et al. Risk factors for human
immunodeficiency virus infection in intravenous drug users. N Engl J Med

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Volume  6, Number  5                                            March  8, 1993

1989;321:874-9.

2. National Commission on Acquired Immune Deficiency Syndrome. The twin
epidemics of substance use and HIV. Washington, DC: National Commission on
Acquired Immune Deficiency Syndrome, July 1991:10-1.

3. Gostin L. The needle-borne epidemic: causes and public health responses.
Behavioral Sciences and the Law 1991;9:287-304.

4. CDC. Coordinated community programs for HIV prevention among intravenous-
drug users -- California, Massachusetts. MMWR 1989;38: 369-74.

5. Selwyn PA, Feiner C, Cox CP, Lipshutz C, Cohen RL. Knowledge about AIDS and
high-risk behavior among intravenous drug users in New York City. AIDS
1987;1:247-54.

6. DesJarlais DC, Friedman SR, Sotheran JL, Stoneburner R. The sharing of drug
injection equipment and the AIDS epidemic in New York City: the first decade.
In: Battjes RJ, Pickens RW, eds. Needle sharing among intravenous drug
abusers: national and international perspectives. Washington, DC: US
Department of Health and Human Services, Public Health Service, Alcohol, Drug
Abuse, and Mental Health Administration, 1988. (NIDA research monograph no.
80).

7. Grund JPC, Kaplan CD, Adriaans NFP. Needle sharing in the Netherlands: an
ethnographic analysis. Am J Public Health 1991;81:1602-7.

* Connecticut General Statutes, Sections 21a-65, 21a-240, 21a-267, 1992. Under
the new laws, pharmacies are permitted, but not required, to sell NSs without
a prescription.



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::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
                                  Dental News
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

               First License Granted to Produce Dental Products
                         that will Remineralize Teeth
                                     -----
                   NIDR Research Digest by Roger Rensberger

The National Institute of Standards and Technology has granted a patent
license to a U.S. dental materials manufacturer to produce dentifrice products
using a new method to remineralize teeth. The method was developed by a NIST
researcher with support from the National Institute of Dental Research. The
manufacturer plans to use the remineralization method to develop toothpastes,
chewing gum, and other dental products that can help repair early cavities,
restore decalcified areas, and make teeth less sensitive to hot and cold.

The exclusive license to produce products with the patented remineralization
process was granted to Enamelon Inc., of Yonkers, N.Y., by the American Dental
Association Health Foundation (ADAHF) at the National Institute of Standards
and Technology

The remineralization method was invented by research chemist Dr. Ming S.  Tung
of the Paffenbarger Research Center at NIST. The remineralization patent is
held by the American Dental Association Health Foundation, sponsor of the 64-
year-old Paffenbarger Research Center.

                      Use of Amorphous Calcium Phosphate

Dr. Tung's remineralization method uses amorphous calcium compounds, or a
carbonate solution, that crystallize to form hydroxyapatite, the primary
mineral in teeth and bone. The aim of remineralization is to disperse
hydroxyapatite into the tooth structure to prevent further tooth decay and
restore the tooth to its original form. Enamelon's products will contain the
amorphous calcium phosphate that causes the remineralization process to take
place.

In the past, commercialization of a solution for remineralization has been
prevented by problems such as instability, slow diffusion and reaction time,
and surface precipitation. The process patented by the ADAHF contains calcium
Phosphate that overcomes these problems and remineralizes the tooth rapidly.

                              FDA Approval Needed

The initial period of the exclusive license agreement with Enamelon will be

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Volume  6, Number  5                                            March  8, 1993

extended to a date three years after the manufacturer has demonstrated that
the remineralizing material has been physically and chemically stabilized for
storage and marketing, similar to other dentifrices or chewing gums.

Some of the materials will require clinical testing to receive Food and Drug
Administration approval for marketing the products to dental professionals and
the public.

The remineralization method developed by Dr. Tung is a prime example of how
dental materials research conducted at NIST supports the safe, efficient, and
economical use of materials for the benefit of consumers and practicing
dentists," said John A. Tesk, leader of the NIST Dental and Medical Materials
Group.

The NIST dental materials program is a cooperative activity involving
researchers from the institute's Polymers Division, research associates from
the ADAHF, NIDR, and industry, and guest scientists from leading dental
schools.



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Volume  6, Number  5                                            March  8, 1993

                           NEWS FROM NIDR - 03/07/93
       -----------------------------------------------------------------
                                   03/03/93
        DENTAL RESEARCHERS REPORT NOVEL APPROACH FOR TREATING ARTHRITIS

Scientists have successfully treated arthritic rats by blocking the action of
molecule that regulates the body's response to infection or tissue injury.
The molecule is called transforming growth factor-beta (TGF-beta).  When an
antibody that inhibits TGF-beta (anti-TGF-beta) was injected directly into the
animals' joints, arthritis symptoms were greatly reduced.

This finding could have applications for treating arthritis, periodontal
diseases, and other chronic inflammatory disorders, said Dr. Sharon Wahl of
the National Institute of Dental Research, who led the study.  She cautioned,
however, that the use of antibodies for therapy has inherent problems, but
added that these studies serve as a prototype for local administration of
other TGF-beta antagonists currently under development.

TGF-beta is a multifunctional molecule that plays a pivotal role in switching
the immune system on and off.  In the early stages of an infection, TGF-beta
is secreted by white blood cells and acts as a signal that attracts other
white cells and stimulates them to fight the infection.  As the infection
subsides, TGF-beta reverses its role and suppresses the activity and
recruitment of white cells.

However, in chronic disease situations such as arthritis, the normal cycle of
events does not occur and TGF-beta continues to attract white cells.  It is
the excessive accumulation of white cells that produces red, swollen joints
and eventually leads to tissue and bone destruction.

Scientists examined rats with experimentally induced arthritis to determine
the therapeutic effect of anti-TGF-beta, which specifically binds to TGF-beta
and blocks its activity.  Rats were first injected with a bacterial cell
preparation that produces symptoms that mimic human rheumatoid arthritic.
Without additional treatment, the rats experience an acute form of arthritic

that appears within 24 hours and is characterized by swelling of the joints
and feet and redness of the overlying skin.

The acute phase subsides within several days, and after a period of two to
three weeks, the disease enters the chronic stage. This phase is identified by
joint deformity brought on by the gradual destruction of cartilage and bone
replacement with connective tissue containing large numbers of white bloods
cells.

Rats receiving a single injection of anti-TGF-beta into a hind ankle just

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Volume  6, Number  5                                            March  8, 1993

prior to injection with the bacterial cell preparation experienced a
significant reduction in both acute and chronic forms of arthritis.  Acute
symptoms were reduced by over 75 percent and chronic symptoms by over 60
percent.  Moreover, when anti-TGF-beta was administered only after the chronic
disease phase had begun, arthritis symptoms were still reduced by almost 70
percent.

According to Dr. Wahl and her associates, anti-TGF-beta works by interrupting
the cycle of white cell migration into the joints. The researchers feel that
this antibody and other TGF-beta inhibitors may provide a mechanism for
treating arthritis and other chronic inflammatory diseases.

The study was conducted by Drs. Sharon Wahl, Janice Allen, Gina Costa, and
Henry Wong of the National Institute of Dental Research in Bethesda, Maryland,
and Dr. James Dasch of Celtrix Pharmaceuticals, Inc. in Santa Clara,
California.  The results were reported in the January 1993 issue of the
Journal of Experimental Medicine.



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Volume  6, Number  5                                            March  8, 1993



::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
                              AIDS News Summaries
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

               AIDS Daily Summary Feb 16, 1993 to March 5, 1993
                              AIDS Daily Summary

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.  Copyright 1992, Information,
Inc., Bethesda, MD

     =====================================================================
                               February 16, 1993
     =====================================================================

"U.S. Starts Initial Human Tests on New Type of AIDS Vaccine" Los Angeles
Times (02/14/93), P. A7

     On Friday, the federal government began preliminary human trials  of an
AIDS vaccine, which researchers hope will protect against  several strains of
HIV.  The National Institute of Allergy and  Infectious Diseases (NIAID) said
researchers would first give the vaccine to 36 healthy volunteers to test its
safety and the  immune system response of the participants.  The vaccine is
manufactured by United Biomedical Inc. of Hauppauge, N.Y.  It is  a so-called
"peptide vaccine," based on a laboratory-synthesized  protein fragment, or
peptide.  An agency AIDS researcher,  Margaret Johnston, said, "Peptide
vaccines have two particular  strengths: They are inexpensive and relatively
easy to modify, to include new mixtures of peptides and those from different
HIV  strains."  There are at least five genetically distinguishable  strains
of HIV, according to research.  The NIAID said United  Biomedical eventually
wants to develop a vaccine involving a mix  of peptides that would provide
protection against all strains of  the AIDS virus.

=====================================================================

"New Research Shows HIV and Cancer Genes May Be Blocked" United Press
International (02/15/93)

     Cleveland--A new drug may inhibit cancer and viral infections,  including
HIV, according to recent research conducted by the  Cleveland Clinic and the
National Institutes of Health, and  published in the Monday issue of the
Proceedings of the National  Academy of Sciences.  The drug, 2-5A-antisense,

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Volume  6, Number  5                                            March  8, 1993

causes the  breakdown of unwanted messenger RNA.  Messenger RNA determines
which protein will be made in the cell.  Therefore, when the  unwanted RNA is
broken down, the gene cannot function.  Dr.  Robert Silverman of the Cleveland
Clinic's Cancer Biology  Department said, "The research is in its very early
stages.  But  our results are exciting.  This method takes a much more
targeted approach to treating viral infections and cancer."  The approach
reported uses a modified "antisense," which is a piece of DNA  that seeks out
and binds with messenger RNA.  Attached to the  antisense is an enzyme
activator, known as 2-5A.  The antisense  binds to the unwanted messenger RNA,
which is then killed by the  activated enzyme.  The report states, "In any
virus, the genes  have a sequence unique in nature.  In theory, we can make an
antisense that will bind only to the virus RNA without binding to human RNA,
thereby destroying the virus without harming the  person."  Silverman warns
that the findings have been in cell  extracts, not within animals or people.
But he said the  researchers still consider the results quite promising.

=====================================================================

"Unexplained Opportunistic Infections and CD4+ T-Lymphocytopenia  Without HIV
Infection" New England Journal of Medicine (02/11/93) Vol. 328, No. 6,  P. 373
(Smith, Dawn K., et al.)

     The mysterious AIDS-like condition without evidence of HIV  infection
that has recently been reported appears to be rare and  not transmissible,
write Dr. Dawn K. Smith and colleagues of the  Centers for Disease Control in
Atlanta, Ga.  Researchers  conducted investigations to determine the
demographic, clinical,  and immunologic features of patients with idiopathic
CD4+  T-lymphocytopenia (ICL); whether the syndrome is epidemic or
transmissible; and its possible causes.  The researchers reviewed 230,179
cases in the CDC AIDS Reporting System and performed  interviews, medical
reviews, and laboratory analyses of blood  specimens from adults and
adolescents who met the CDC definition  of ICL.  The patients' sexual
contacts, household contacts, and  persons who had donated blood to them were
also tested.  The  researchers interviewed 31 of the 47 patients identified
with  ICL, as well as 23 of their contacts.  A total of 18 patients had one or
more risk factors for HIV infection: seven had hemophilia, six had engaged in
homosexual sex, six had received blood  transfusions, and two had had
heterosexual sex partners who were  at risk for HIV infection.  The other 29
patients had no risk  factors for HIV infection.  When blood from 28 patients
was  tested, eight were found to have T-cell counts of less than 300  cells
per cubic millimeter, and 6 had fewer than 250 T-cells per  cubic millimeter.
The researchers determined that 10 sex  partners, three household contacts,
and four children of the ICL  patients, as well as six persons who had donated
blood to the  patients, were immunologically and clinically normal.


Health InfoCom Network News                                            Page 20
Volume  6, Number  5                                            March  8, 1993

     ====================================================================
                               February 17, 1993
     ====================================================================

"Effort to Manufacture Artificial Blood is Thwarted" Los Angeles Times--
Washington Edition (02/17/93), P. B7   (Maugh, Thomas H.)

     The production of an artificial blood product has encountered an
unexpected hindrance that may seriously postpone its  commercialization, said
a University of California--San Diego  physician at a meeting of the American
Association for the  Advancement of Science.  While researchers from the four
companies conducting clinical trials on the artificial bloods  have not
disclosed the preliminary findings from their trials,  enough information has
been released to allow observers to figure out the cause of the difficulties,
said Dr. Robert M. Winslow, a  professor of medicine at UC-San Diego who was
formerly in charge  of the U.S. Army's efforts to develop an artificial blood.
Participants in the clinical trials of the artificial bloods have reported
various unexpected side effects, including chest pains,  back pains, nausea,
and hypertension.  What seems to be the cause is nitric oxide (NO), which
interacts with artificial blood,  Winslow said.  The hemoglobin in the
artificial blood is leaking  out of blood vessels and into the surrounding
tissues, where it  binds NO tightly, inhibiting its vasorelaxant properties,
said  Winslow.  Consequently, the blood vessels constrict, causing the
unusual symptoms.  The problem could be very hard to solve  because NO binds
with the hemoglobin at the same molecular  location that oxygen does.  Any
efforts to prevent the binding  will most likely restrict hemoglobin's oxygen-
carrying capacity.


====================================================================

"Idiopathic CD4+ T-Lymphocytopenia--Immunodeficiency Without  Evidence of HIV
Infection" New England Journal of Medicine (02/16/93) Vol. 328, No. 6,  P. 380
(Ho, David D. et al.)

     It remains undetermined whether idiopathic CD4 T-lymphocytopenia  (ICL)
is new, transmissible, or acquired, write David D. Ho et  al. of the Aaron
Diamond AIDS Research Center in New York, N.Y.   Patients recently diagnosed
with severe CD4 T-lymphocytopenia but without evidence of HIV infection have
spurred a national  surveillance network to investigate such cases.  The
researchers  examined 12 patients with CD4 T-lymphocytopenia who were referred
by three U.S. cities.  The patients (10 men and 2 women) ranged  in age from
30 to 69 years.  A total of eight had risk factors  for HIV infection.  The
clinical conditions were heterogeneous:  five patients had opportunistic
infections, five had syndromes of unknown cause, and two had no symptoms.  Two
patients died from  severe complications of their immunodeficiency.  The

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Volume  6, Number  5                                            March  8, 1993

patients'  lowest CD4 T-lymphocyte counts ranged from three to 308 per cubic
millimeter.  Three patients had complete or partial spontaneous  reversal of
the CD4 T-lymphocytopenia.  Concomitant CD8  T-lymphocytopenia was found in
three patientsJand abnormal  immunoglobulin levels were found in five.
Multiple virologic  studies by serologic testing, culture, and polymerase
chain  reaction were completely negative for HIV in all patients.  The
researchers found that the 12 patients with ICL appear to be
epidemiologically, clinically, and immunologically heterogeneous. Although the
conditions experienced in the ICL patients resemble  AIDS, HIV infection was
not detected.  The cause of ICL is  unknown, the researchers conclude.

====================================================================

"Projections of the Number of Persons Diagnosed With AIDS and the Number of
Immunosuppressed HIV-Infected Persons--United States,  1992-1994" Journal of
the American Medical Association (02/10/93) Vol. 269,  No. 6, P. 733

     The Centers for Disease Control recently released new estimates  of the
number of persons in the United States who will initially  be diagnosed with
an illness included in the 1987 AIDS  surveillance case definition during
1992-1994.  About 58,000  Americans had AIDS during 1991 as defined by the
1987 AIDS  definition.  Between 1992-1994, the number of persons who have
illnesses meeting these criteria is expected to rise by only a  few percent
annually, with about 85 percent of those persons  being reported to the CDC
with cases of AIDS.  The rate of  increase in reported AIDS cases in persons
who contracted HIV via heterosexual contact is expected to be higher than that
in  persons who contracted the virus through homosexual/bisexual  contact or
IV-drug use.  The CDC predicts that, as of January  1993, an additional
120,000 to 190,000 Americans had HIV-related  severe immunosuppression.  Not
all of these persons were aware of their HIV infection, however, and of those
who know their HIV  infection status, not all have had a T-cell count.  If the
AIDS  definition went unchanged, about 50,000 to 60,000 reported AIDS  cases
would have been expected in 1993.  The new definition of  AIDS that includes
HIV-related severe immunosuppression should  increase reported cases by about
75 percent.  The effect of this  expansion on the number of reported cases is
estimated to be  smaller in later years because in 1993 many prevalent as well
as  incident cases of immunosuppression will be reported as the  expanded
surveillance case definition is used.  Reported AIDS  cases may decrease from
1993 through 1994, according to the CDC.

====================================================================

 "Multicenter Clinical Trials of AIDS Vaccines Scheduled to Get  Under Way in
Coming Months" Journal of the American Medical Association (02/10/93) Vol.
269,  No. 6, P. 725  (Marwick, Charles)

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Volume  6, Number  5                                            March  8, 1993


     HIV-negative volunteers at high risk of infection areJbeing  recruited
for nationwide clinical trials of two AIDS vaccines.  A total of about 320
male and female volunteers aged 18-60 years  old will be involved.  However,
some officials from the National  Institutes of Health project that it will be
at least two more  years before full-scale vaccine trials are conducted.  The
two  vaccines will be tested in five American centers: Johns Hopkins
University Center for Immunization, Baltimore, Md.; St. Louis  (Mo.)
University School of Medicine; University of Rochester  (N.Y.) Medical Center;
Vanderbilt University Medical Center,  Nashville, Tenn.; and the University of
Washington School of  Medicine in Seattle.  The two vaccines have already
undergone  safety testing, and do  not appear to produce unwanted side
effects.  The trials will test the ability of two recombinant  proteins made
from the HIV envelope protein gp160 to boost  protective antibodies and
possibly cytotoxic T-lymphocyte  responses, says Daniel Hoth, MD, director of
the AIDS division at the National Institute of Allergy and Infectious
Diseases.   Volunteers will be counseled to avoid high-risk behaviors linked
with HIV transmission.  They will be assigned randomly to receive one of the
vaccines or a placebo.  Three intramuscular injections will be given--an
initial injection and then two boosters at one  and six months.  One vaccine,
genetically engineered by Genentech Inc., uses the HIV-1 MN strain.  The
other, made by Biocine, uses the closely related HIV-1 SF-2 strain.  The two
vaccines are  equipped with adjuvants to further potentiate an immune
response.

====================================================================
"TB Control Guidelines Cause Coast-to-Coast Confusion" American Medical News
(02/08/93) Vol. 36, No. 6, P. 1   (Voelker, Rebecca)

     Due to the lack of a national plan to prevent tuberculosis  transmission,
federal, state, and regional health officials have  developed conflicting
respiratory-protection guidelines.  The  suggested measures range from
protective surgical masks to the  cumbersome powered air respirators proposed
last year by the  National Institute for Occupational Safety and Health.  But
in  its current draft guidelines, the Centers for Disease Control  backs away
from the NIOSH-recommended respirators because of  opposition from both health
professionals and hospital  administrators.  Despite the tighter facial fit of
the  respirators, the CDC says, "There is not sufficient scientific  evidence
to support" their routine use.  The agency instead  suggests that protective
surgical masks and valveless dust and  mist respirators are sufficient for
minimum protection.  CDC  spokeswoman Kay Golan said, "NIOSH was required by
law to assess  the risk and make recommendations so that no worker suffers.
They were prohibited from considering cost or feasibility when  they made
their recommendations."  But if the NIOSH  recommendations are adopted in a
federal OSHA standard, they  could become legally enforceable.  Dr. Michael

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Volume  6, Number  5                                            March  8, 1993

Tapper, chairman  of the AIDS/TB committee of the Society for the Hospital
Epidemiologists of America, attended a meeting at the CDC in  Atlanta
concerning its first round of revisions to the 1990  guidelines for TB control
in health-care settings.  He said that  consensus based on science is
desperately needed to dispel the  confusion.
    ======================================================================
                               February 18, 1993
    ======================================================================

"Drug Combination Stops AIDS Virus Reproduction" Washington Post (02/18/93),
P. A3

     A drug strategy has been developed that inhibits HIV from reproducing in
a test tube, according to a report published in Thursday's issue of Nature by
researchers from the Massachusetts General Hospital and the Harvard Medical
School in Boston.  The technique involves a combination of three drugs: AZT,
ddI, and a third compound called pyridinone.  All three drugs attack a single
enzyme, called reverse transcriptase, which HIV needs to reproduce.  If the
approach is found to also block the spread of HIV in people, a patient's
immune system might be able "to at least keep the virus in control for long
periods of time, and  perhaps forever," said Martin Hirsh, one of the
researchers in  the study.  However, he and other researchers warn that it
will  take experiments in humans to determine if the technique is  actually
effective.  HIV can mutate to produce subtle alterations in the enzyme that
yield resistance to individual drugs.   Yung-Kang Chow, one of the
researchers, said the concept behind  the "convergent combination therapy" was
that the virus would be  unable to resist a triple attack.  In addition,
thwarting the  spread of the enzyme might prevent the virus from developing
drug-resistant strains, said Chow.  The researchers infected  blood cells with
HIV, then waited a week until HIV reproduction  was at its peak.  At this
point, they added the three-drug  combination.  After 35 days, the infection
was no longer  detectable.  After 49 days of treatment the drugs were
discontinued, and no HIV reproduction was evident for the next 45 days.  The
three-drug combination will be tested in a study of  people with advanced-
stage HIV infection beginning this spring.   Related Stories: New York Times
(02/18) P. A1: Philadelphia  Inquirer (02/18) P. A3
======================================================================

"TB Drugs" Associated Press (02/16/93)  (Johnson, Linda A.)

     Trenton, N.J.--Responding to a resurgence of tuberculosis cases  that
resist therapy, federal health officials are reintroducing  three drugs that
pharmaceutical firms stopped marketing.   Bristol-Myers Squibb will introduce
the first anti-microbial  drug, its injectable form of isoniazid, which should
be on the  market within 10 days.  The FDA asked the pharmaceutical

Health InfoCom Network News                                            Page 24
Volume  6, Number  5                                            March  8, 1993

manufacturers to resume production of the three tuberculosis  drugs because of
the public health threat that tuberculosis now  poses.  The companies stopped
selling the drugs in 1990, because  they were not producing profits.
    ======================================================================
                               February 22, 1993
    ======================================================================
"Bill Seeks to Coordinate NIH Research on AIDS" Washington Post (02/22/93), P.
A4  (Brown, David)

     The question of whether or not a more centralized AIDS research  effort
would help put an end to the AIDS epidemic is currently  being raised by
researchers.  Last week, the Senate passed a bill that would give more power
to the National Institutes of Health's Office of AIDS Research (OAR) and make
its director, if not a  "czar," then at the very least an official with
unprecedented  authority over how the government spends money studying the
disease and searching for a cure.  The bill requires the office  to develop an
overall budget for AIDS research and eventually  acquire major influence in
the decisions of what scientific  questions will be most researched--and
funded.  But many  scientists are skeptical that central planning will lead to
better science and are fearful that a new AIDS coordinating  office will add
another layer to the NIH bureaucracy and possibly slow the pace of research.
The proposal was written into the  Senate version of the NIH Revitalization

Bill by Sen. Edward M.  Kennedy (D-Mass.).  A House subcommittee will consider
a similar  bill on Tuesday.  The Senate bill calls for the OAR to have a
full-time director with no other responsibilities at NIH and an  advisory
council of scientists and lay people.  The director  would decide what is the
best balance of basic and applied  research and how  much should be done
inside and outside the NIH. The OAR director would have full authority over
the AIDS budget,  which could not be altered by the head of NIH or the
secretary of Health and Human Services.
======================================================================
"Engineered Blood Factor for Clotting Passes Tests" Journal of Commerce
(02/22/93), P. 9A

     A genetically engineered form of a blood clotting factor has been found
to be safe and effective in a long-term test of children  with the most severe
type of hemophilia, according to a report  published in Thursday's New England
Journal of Medicine.  People  who suffer from hemophilia A lack what is known
as factor VIII.   Approximately 1 in 10,000 males are born with hemophilia A,
but  females rarely suffer from the condition.  Factor VIII has  previously
been extracted from donated blood.  But filtering out  deadly viruses,
including HIV, has been difficult even though  significant progress has been
made in attempts to distinguish  blood-borne illnesses.  The study shows that
genetically  engineered factor VIII made by Miles Inc. was safe among infant
test subjects, a group selected because they had never received  any treatment

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Volume  6, Number  5                                            March  8, 1993

for hemophilia.  The safety and efficacy of the  engineered factor VIII among
patients previously treated for  hemophilia have been proven in earlier
studies.  An additional 75 patients have now been treated and the entire group
has been  followed for a longer period.  The researchers examined 95
hemophiliacs given the genetically engineered factor VIII between Jan. 1 1989,
and July 1, 1992.  The median age of the subjects at the time of first
treatment was about nine months.  The treatment demonstrated its effectiveness
in every case with only three  reports of minor side effects in the 3,315
times it was  administered.
    ======================================================================
                               February 23, 1993
    ======================================================================
"Tortuous Route to an AIDS Vaccine" USA Today (02/23/93), P. 4D  (Painter,
Kim)

     Although there are several AIDS vaccines currently in clinical  trials,
it could be 10 to 15 years before one could be used in  large numbers of
people.  Dr. Bernadine Healy, director of the  National Institutes of Health,
said at a recent New York  Symposium on AIDS vaccines, "I think it's fair to
say no one of  these vaccines in early testing ... appears to stand out."
However, she says she is optimistic about the prospects for  therapeutic
vaccines, which help people who are already  HIV-positive.  Most vaccines
being studied--for both preventative and therapeutic uses--are made with
pieces of HIV that cannot  cause illness.  These vaccines appear to be safe
and boost immune responses in volunteers.  Yet no one knows whether these
responses can protect humans from actual HIV infection.   Moreover, scientists
don't know what an effective response is.   One promising method was tested in
a recent monkey study.   Harvard Medical School researcher Ronald Desrosiers
gave healthy  monkeys live simian immunodeficiency virus, the monkey form of
HIV, weakened by the removal of one gene.  The monkeys contracted HIV but did
not become ill.  Subsequently, they received massive  doses of real SIV and
stayed healthy--indicating that the altered virus allowed their immune systems
to resist infection.  While  the finding may be promising, no other approach
is so risky.  The worst-case scenario is that a live weakened virus could
quickly  switch to a deadly form.  Desrosiers is more concerned that  weakened
viruses might cause cancer or a delayed form of AIDS  several years after
vaccination.  He said the first human trial  would have to be small and might
take many years.
======================================================================
"AIDS and the Changing Face of Pneumonia" Washington Post (Health) 02/23/93),
P. 12  (Colburn, Don)

     The AIDS epidemic has had a dramatic impact on the pattern of  pneumonia
cases in hospital intensive care units.  Pneumocystis  carinii pneumonia
(PCP), once one of the rarest types of  pneumonia, is currently the most

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Volume  6, Number  5                                            March  8, 1993

common AIDS-related condition.   Frederick L. Ruben, a lung specialist at the
University of  Pittsburgh School of Medicine and University Montefiore
Hospital  in Pittsburgh, said, "Before, the only time it was seen was in
severely malnourished children or kidney transplant patients.   Even
infectious disease specialists wouldn't see a case in five  years.  Now you
can't go a week without seeing a case."   According to a recent study at a
community hospital in San  Francisco, the AIDS epidemic "has profoundly
affected the  spectrum of pneumonia in intensive care units."  Of the 1,854
patients treated in the hospital's ICU over a three-year period,  one out of
seven had pneumonia.  Of those, 29 percent were  HIV-positive.  PCP accounted
for more cases--28 percent--than any other type of pneumonia in the San
Francisco ICU study, which was published in the Western Journal of Medicine
last December.  In  all 74 cases of PCP, the patient was also infected with
HIV.  But four previous studies of pneumonia in ICUs during the 1980s had  no
reported cases of PCP.  The study demonstrated a sharp  contrast in the age
pattern, also.  Before the AIDS epidemic,  fatal pneumonia struck mainly the
elderly or very young children. But in the San Francisco study, older
pneumonia patients had a  much higher survival rate.  The difference is the
direct impact  of the AIDS epidemic, which affects mostly young and middle-
aged  people.
======================================================================
"Two Firms Collaborate on Hemophilia Project" Baltimore Sun (02/23/93), P. 11D
(Bowie, Liz)

     Genetic Therapy Inc. and CytoTherapeutics Inc. have signed an  agreement
to collaborate on research to discover a new way to  deliver a treatment for
hemophilia B.  CytoTherapeutics has made  a semipermeable polymer membrane
that could be implanted in a  patient's body to deliver a drug.  Genetic
Therapy has  genetically modified cells that produce a protein called Factor
IX to treat hemophilia.  The two companies seek to combine the  technologies,
which will allow Genetic Therapy's protein to be  slowly released through
CytoTherapeutics' membrane.
======================================================================
"In the Nation: 10 Sites Tentatively Set for New AIDS Therapy" Baltimore Sun
(02/23/93), P. 9A

     Federal health officials announced yesterday that 10 research  sites were
tentatively named to host human trials of the AIDS  therapy which uses a
combination of three drugs to inhibit the  spread of HIV.  Research has
demonstrated that the therapy can  block a key enzyme in the development of
HIV, although the  treatment's safety and efficacy in humans is undetermined.
The  sites being considered for the trials are Albert Einstein  University in
Bronx, N.Y.; Cornell University in New York; the  Harvard University
consortium of Boston, Mass.; Northwestern  University  in Chicago, Ill.; the
University of Alabama in  Birmingham; the University of California--San Diego;

Health InfoCom Network News                                            Page 27
Volume  6, Number  5                                            March  8, 1993

the  University of Colorado in Denver; Florida's University of Miami;  the
University of Minnesota in Minneapolis; and the University of Southern
California in Los Angeles.  The National Institutes of  Allergy and Infectious
Diseases said the trials are expected to  begin in the spring.
    ======================================================================
                               February 24, 1993
--------- end of part 2 ------------
·    Subject: HICN605 Medical Newsletter Part 5/6
Colorado Cancer Research Program
Denver, Colorado

  Aurora Presbyterian Hospital . . . . . . . . . .303-360-3028

  Presbyterian/St. Luke's Medical Center . . . . .303-869-2037

  Porter Memorial Hospital . . . . . . . . . . . .303-777-6877

  Rose Medical Center. . . . . . . . . . . . . . .303-320-7142

  Saint Joseph Hospital. . . . . . . . . . . . . .303-866-8600

  Swedish Medical Center . . . . . . . . . . . . .303-788-4636


CONNECTICUT

University of Connecticut
Hartford, Connecticut


Health InfoCom Network News                                            Page 55
Volume  6, Number  5                                            March  8, 1993

  Hartford Hospital
  Hartford, Connecticut. . . . . . . . . . . . . .203-524-2193

  Mount Sinai Hospital
  Hartford, Connecticut. . . . . . . . . . . . . .203-286-4699

  St. Francis Hospital and Medical Center
  Hartford, Connecticut. . . . . . . . . . . . . .203-548-5323

  Middlesex Memorial Hospital
  Middletown, Connecticut. . . . . . . . . . . . .1-800-548-2394

  New Britian General Hospital
  New Britian, Connecticut . . . . . . . . . . . .203-224-5660

  University of Connecticut Health Center
  Farmington, Connecticut. . . . . . . . . . . . .203-679-4900


DISTRICT OF COLUMBIA

Georgetown University
  V.T. Lombardi Cancer Research Center
Washington, D.C. . . . . . . . . . . . . . . . . .202-342-2400


DELAWARE

Medical Center of Delaware

  CMC Research Office
  Newark, Delaware . . . . . . . . . . . . . . . .302-731-8116

  Beebe Hospital
  Lewes, Delaware. . . . . . . . . . . . . . . . .302-645-8487

  Nanticoke Hospital
  Seaford, Delaware. . . . . . . . . . . . . . . .302-629-0260

  St. Francis Hospital
  Wilmington, Delaware . . . . . . . . . . . . . .302-421-4300
                                                  (press 1)


FLORIDA

Health InfoCom Network News                                            Page 56
Volume  6, Number  5                                            March  8, 1993



Baptist Regional Cancer Center
Jacksonville, Florida. . . . . . . . . . . . . . .904-348-7073

South Florida Breast Cancer Prevention Trial
Miami Beach, Florida . . . . . . . . . . . . . . .305-674-2868

Florida Hospital
Orlando, Florida
(See Duke University, North Carolina). . . . . . .407-897-5763


GEORGIA

Atlanta Breast Cancer Prevention Program
  at Northside Hospital
Atlanta, Georgia . . . . . . . . . . . . . . . . .404-303-3355

Atlanta Community Women's Health Project
Atlanta, Georgia

  Atlanta Regional CCOP

     Cobb Hospital and Medical Center. . . . . . .404-732-4640

     Kennestone Hospital . . . . . . . . . . . . .404-429-7518

     South Fulton Medical Center . . . . . . . . .404-669-4594

     St. Joseph's Hospital . . . . . . . . . . . .404-851-7116

  Emory University . . . . . . . . . . . . . . . .404-248-4617
  Grady Hospital CCOP. . . . . . . . . . . . . . .404-616-6166

University of Kentucky Consortium/
  Lexington Clinic
Morehouse School of Medicine
 Atlanta, Georgia . . . . . . . . . . . . . . . . .404-752-1567

----------------------------------------------------------------------------


        TELEPHONE NUMBERS IN THE UNITED STATES - BY STATE
                        HAWAII - MICHIGAN

Health InfoCom Network News                                            Page 57
Volume  6, Number  5                                            March  8, 1993




HAWAII


Cancer Research in Hawaii
Honolulu, Hawaii . . . . . . . . . . . . . . . . .808-586-2979


ILLINOIS

Carle Cancer Center BCPT
Champaign-Urbana, Illinois . . . . . . . . . . . .1-800-446-5532
                                                       Or
                                                  217-355-6817
  Oncology/Hematology Associates of
    Central Illinois
  Peoria, Illinois . . . . . . . . . . . . . . . .1-800-793-2262

Central Illinois CCOP

  Memorial Medical Center
  Springfield, Illinois. . . . . . . . . . . . . .217-788-4444

  Decatur Memorial Hospital
  Decatur, Illinois. . . . . . . . . . . . . . . .217-875-3228

Illinois Cancer Center
Chicago, Illinois. . . . . . . . . . . . . . . . .312-986-7047

  Evanston Hospital
  Evanston, Illinois . . . . . . . . . . . . . . .708-570-2100

  Hinsdale Hematology Oncology Associates
  Hinsdale, Illinois . . . . . . . . . . . . . . .708-654-1790

  Lutheran General Hospital
  Park Ridge, Illinois . . . . . . . . . . . . . .708-696-8650

  McNeal Cancer Center
  Berwyn, Illinois . . . . . . . . . . . . . . . .708-795-3195

  Michael Reese-Humana Hospital
  Chicago, Illinois. . . . . . . . . . . . . . . .312-791-3341

Health InfoCom Network News                                            Page 58
Volume  6, Number  5                                            March  8, 1993


  Northwestern University Cancer Center
  Chicago, Illinois. . . . . . . . . . . . . . . .312-908-9068

  Oncology Care Center
  Belleville, Illinois . . . . . . . . . . . . . .618-236-1000
                                                  ext. 139

  Rockford Clinic
  Rockford, Illinois . . . . . . . . . . . . . . .815-968-0051
                                                   ext. 2345

  St. John's Cancer Institute
  Springfield, Illinois. . . . . . . . . . . . . .217-544-6464
                                                       ext. 5385

  Swedish American Hospital

  Rockford, Illinois . . . . . . . . . . . . . . .815-968-2500

  University of Illinois at Chicago
  Chicago, Illinois. . . . . . . . . . . . . . . .312-996-5949

Illinois Masonic Cancer Center
Chicago, Illinois. . . . . . . . . . . . . . . . .312-296-5338
                                                       Or
                                                  312-296-7236

  Mercy Hospital and Medical Center
  Chicago, IL. . . . . . . . . . . . . . . . . . .312-567-2600

  St. Francis Hospital
  Evanston, IL . . . . . . . . . . . . . . . . . .708-492-7115

  Illinois Masonic Community Health Center
  Chicago, IL. . . . . . . . . . . . . . . . . . .312-296-7454

  Hispano Care, Inc.
  Chicago, IL. . . . . . . . . . . . . . . . . . .312-296-7678

  Masonicare, Inc.
  Chicago, IL. . . . . . . . . . . . . . . . . . .312-296-7166

  IMMC/Dept. of OB/GYN
  Chicago, IL. . . . . . . . . . . . . . . . . . .312-296-7041


Health InfoCom Network News                                            Page 59
Volume  6, Number  5                                            March  8, 1993

  IMMC/Dept. of Ambulatory Care
  Chicago, IL. . . . . . . . . . . . . . . . . . .312-296-7062

  Piel BCPT
  Chicago, IL. . . . . . . . . . . . . . . . . . .312-549-5400

  Currie BCPT
  Chicago, IL. . . . . . . . . . . . . . . . . . .312-288-3310

  St. Elizabeth Hospital
  Chicago, IL. . . . . . . . . . . . . . . . . . .312-278-2000
 . . . . . . . . . . . . . . . . . . . . . . . . .ext. 5907

  Loyola Medical Center
  Maywood, IL. . . . . . . . . . . . . . . . . . .708-216-4762

  University of Illinois
  Chicago, IL. . . . . . . . . . . . . . . . . . .312-996-5162

  Progressive Care
  Chicago, IL. . . . . . . . . . . . . . . . . . .312-774-0042

Rush Medical College
Chicago, Illinois. . . . . . . . . . . . . . . . .312-563-2057

University of Chicago
Chicago, Illinois. . . . . . . . . . . . . . . . .312-702-3183
                                                       Or
                                                  312-702-0921

SEE INDIANA:  Galesburg Clinic

SEE IOWA:  United Medical Center


INDIANA


Hoosier Oncology Group
Indianapolis, Indiana. . . . . . . . . . . . . . .1-800-227-2345

  Galesburg Clinic
  Galesburg, Illinois. . . . . . . . . . . . . . .1-800-428-4963
  WUMC - Barnard Cancer Center
  St. Louis, Missouri. . . . . . . . . . . . . . .314-362-5252

Health InfoCom Network News                                            Page 60
Volume  6, Number  5                                            March  8, 1993



IOWA

Cedar Rapids Oncology Project CCOP
Cedar Rapids, Iowa . . . . . . . . . . . . . . . .319-365-5241

  United Medical Center
  Moline, Illinois . . . . . . . . . . . . . . . .309-757-2000

University of Iowa
Iowa City, Iowa. . . . . . . . . . . . . . . . . .319-356-2778

SEE SOUTH DAKOTA:  Sioux-Land Hematology Oncology


KANSAS

University of Kansas Medical Center
Kansas City, Kansas. . . . . . . . . . . . . . . .913-588-4092

Wichita CCOP
Wichita, Kansas. . . . . . . . . . . . . . . . . .316-268-8222
                                                       Or
                                                  316-268-5784


KENTUCKY

University of Kentucky Consortium/
  Lexington Clinic
Lexington, Kentucky. . . . . . . . . . . . . . . .606-255-6841
                                                  ext. 4994

University of Kentucky Medical Center
Clinical Research Program
Markey Cancer Center
Lexington, Kentucky. . . . . . . . . . . . . . . .606-257-5207

University of Kentucky Consortium/
  Lexington Clinic
King's Daughter Hospital
Ashland, Kentucky. . . . . . . . . . . . . . . . .606-327-4535
                                                       Or
                                                  606-327-4630

Health InfoCom Network News                                            Page 61
Volume  6, Number  5                                            March  8, 1993


University of Kentucky Consortium/
  Lexington Clinic
Graves Gilbert Clinic
Bowling Green, Kentucky. . . . . . . . . . . . . .502-781-5111
                                                  ext. 127

University of Kentucky Consortium/
  Lexington Clinic, Cancer Care Center
St. Elizabeth's Medical Center
Edgewood, Kentucky . . . . . . . . . . . . . . . .606-344-5550

University of Louisville
Louisville, Kentucky . . . . . . . . . . . . . . .502-588-5245

  Oncology Associates
  Knoxville, Tennessee . . . . . . . . . . . . . .615-523-2024

  The Tennessee Breast Center
  Maryville, Tennessee . . . . . . . . . . . . . .615-984-9282


LOUISIANA


CCOP, Alton Ochsner
New Orleans, Louisiana . . . . . . . . . . . . . .504-838-3708

(Also has sites in Mississippi)


MAINE


East Maine Medical Center
Clinic for Cancer & Blood Disorders
Bangor, Maine. . . . . . . . . . . . . . . . . . .207-945-7481


MARYLAND


University of Maryland Medical Center
Baltimore, Maryland. . . . . . . . . . . . . . . .1-800-492-5538
                                                       Or

Health InfoCom Network News                                            Page 62
Volume  6, Number  5                                            March  8, 1993

                                                  410-328-5224

  Greater Baltimore Oncology Center
  Baltimore, Maryland. . . . . . . . . . . . . . .410-828-3706

  Johns Hopkins Hospital
  Baltimore, Maryland. . . . . . . . . . . . . . .410-955-4765

  Sacred Heart Oncology Clinic
  Cumberland, Maryland . . . . . . . . . . . . . .301-759-5075



MASSACHUSETTS

Boston University Medical Center
Boston, Massachusetts. . . . . . . . . . . . . . .617-638-8260
                                                       Or
                                                  617-638-8261

  Brockton Hospital
  Boston, Massachusetts. . . . . . . . . . . . . .508-941-7979

  Lahey Clinic
  Burlington, Massachusetts. . . . . . . . . . . .617-273-8989

  St. Ann's Hospital
  Fall River, Massachusetts. . . . . . . . . . . .508-675-5688

  University of Massachusetts Medical Center
  Worcester, Massachusetts . . . . . . . . . . . .508-856-2424
                                                    or
                                                  508-856-3902

Dana-Farber Cancer Institute
Boston, Massachusetts. . . . . . . . . . . . . . .617-732-2177

  Harvard Community Health Plan
  Boston, Massachusetts. . . . . . . . . . . . . .617-421-1375

  Faulkner Breast Center
  Boston, Massachusetts. . . . . . . . . . . . . .617-732-2177

  Miriam Hospital
  Providence, Rhode Island . . . . . . . . . . . .617-732-2177


Health InfoCom Network News                                            Page 63
Volume  6, Number  5                                            March  8, 1993

The Breast Health Center
New England Medical Center Hospital
Boston, Massachusetts. . . . . . . . . . . . . . .617-350-8159

  Lawrence Memorial Hospital of Medford
  Medford, Massachusetts . . . . . . . . . . . . .617-396-9250
                                                  ext. 1820
  Southwood Community Hospital/Norwood Hospital
  Norfolk & Norwood, Massachusetts . . . . . . . .1-800-458-0228


MICHIGAN

Michigan State University
East Lansing and Bay City, Michigan. . . . . . . .517-336-2616

  CCOP Kalamazoo
  Kalamazoo, Michigan. . . . . . . . . . . . . . .616-383-4823

University of Michigan
Ann Arbor, Michigan. . . . . . . . . . . . . . . .313-936-9943

  Henry Ford Hospital
  Detroit, Michigan. . . . . . . . . . . . . . . .313-876-1046

  Saginaw Cooperative Hospitals
  Saginaw & Bay City, Michigan . . . . . . . . . .1-800-541-3939

  Grand Rapids Clinical Oncology Program
  Grand Rapids, Michigan
  Holland, Michigan
  Battlecreek, Michigan
  Traverse City, Michigan
  Big Rapids, Michigan . . . . . . . . . . . . . .616-732-8889

Wayne State University
Detroit, Michigan. . . . . . . . . . . . . . . . .313-745-9590


----------------------------------------------------------------------------

        TELEPHONE NUMBERS IN THE UNITED STATES - BY STATE
                   MINNESOTA - NORTH CAROLINA



Health InfoCom Network News                                            Page 64
Volume  6, Number  5                                            March  8, 1993


MINNESOTA

Hennepin County Medical Center
Minneapolis, Minnesota . . . . . . . . . . . . . .612-347-4262

Metro-Minnesota BCPT Center
St. Louis Park, Minnesota. . . . . . . . . . . . .1-800-227-2345

  Abbott-Northwestern Hospital
  Minneapolis, Minnesota . . . . . . . . . . . . .612-874-4444

  Fairview Riverside Medical Center
  Minneapolis, Minnesota . . . . . . . . . . . . .612-371-6200

  Fairview Southdale Hospital
  Edina, Minnesota . . . . . . . . . . . . . . . .612-371-6200

  Health One Mercy Hospital
  Coon Rapids, Minnesota . . . . . . . . . . . . .612-336-6100

  Health One Unity Hospital
  Fridley, Minnesota . . . . . . . . . . . . . . .612-336-6100
  Methodist Hospital
  St. Louis Park, Minnesota. . . . . . . . . . . .612-932-5700

  Health East Midway Hospital
  St. Paul, Minnesota. . . . . . . . . . . . . . .612-221-2273

  Health East St. Joseph's Hospital
  St. Paul, Minnesota. . . . . . . . . . . . . . .612-221-2273

  United Hospital
  St. Paul, Minnesota. . . . . . . . . . . . . . .612-336-6100

  Health East St. John's Hospital
  Maplewood, Minnesota . . . . . . . . . . . . . .612-221-2273

  North Memorial Medical Center
  Robbinsdale, Minnesota . . . . . . . . . . . . .612-520-5155

  Rice Memorial Hospital
  Willmar, Minnesota . . . . . . . . . . . . . . .612-231-4570

The Duluth Clinic, Ltd.

Health InfoCom Network News                                            Page 65
Volume  6, Number  5                                            March  8, 1993

Duluth, Minnesota. . . . . . . . . . . . . . . . .218-725-3456

  Midelfort Clinic, Ltd.
  Eau Claire, Wisconsin. . . . . . . . . . . . . .715-839-5296

  Thunder Bay Regional Cancer Centre
  Thunder Bay, Ontario . . . . . . . . . . . . . .807-343-1610
                                                  ext. 1675
MISSISSIPPI

See Louisiana, Ochsner Clinic


MISSOURI

Ellis Fishel Cancer Center
Columbia, Missouri . . . . . . . . . . . . . . . .314-882-8545

Midwest Cooperative Group Outreach Program
Kansas City, Missouri. . . . . . . . . . . . . . .816-932-3590

  St. Luke's Hospital
  Kansas City, Missouri. . . . . . . . . . . . . .816-932-2085

  Kansas City Clinical Oncology Program
  Baptist Medical Center
  Kansas City, Missouri. . . . . . . . . . . . . .816-276-7834

  Ozarks Regional CCOP
  Springfield, Missouri. . . . . . . . . . . . . .417-885-6444

St. Louis/Cape Girardeau CCOP
  Christian Hospital Northeast/Northwest
  St. Louis, Missouri. . . . . . . . . . . . . . .314-355-2300
                                                  ext. 5733
                                                       Or
                                                  314-355-2500
                                                  ext. 5733

  Depaul Health Center
  St. Louis, Missouri. . . . . . . . . . . . . . .314-344-7995

  St. John's Mercy Medical Center
  St. Louis, Missouri. . . . . . . . . . . . . . .314-569-6540


Health InfoCom Network News                                            Page 66
Volume  6, Number  5                                            March  8, 1993

  St. Joseph's Hospital
  St. Louis, Missouri. . . . . . . . . . . . . . .314-966-1659

  Southeast Missouri Hospital
  Cape Girardeau, Missouri . . . . . . . . . . . .1-800-455-4636


  St. Francis Medical Center
  Cape Girardeau, Missouri . . . . . . . . . . . .314-339-6886

SEE INDIANA:  WUMC - Barnard Cancer Center


MONTANA

Montana Breast Cancer Prevention Group
Billings, Montana. . . . . . . . . . . . . . . . .406-259-2245


NEBRASKA

Creighton Cancer Center
Omaha, Nebraska. . . . . . . . . . . . . . . . . .1-800-858-7475
                                                           (RISK)


NEVADA

Southern Nevada Cancer Research Foundation
Las Vegas, Nevada. . . . . . . . . . . . . . . . .702-384-5608


NEW HAMPSHIRE

Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire . . . . . . . . . . . . . .603-650-5284


NEW JERSEY

SEE PENNSYLVANIA:  Memorial Hospital of Burlington County
                   and Saint Francis Medical Center

NEW MEXICO

University of New Mexico Cancer Center

Health InfoCom Network News                                            Page 67
Volume  6, Number  5                                            March  8, 1993

Albuquerque, New Mexico. . . . . . . . . . . . . .505-277-3839


NEW YORK

Central New York Breast Cancer Prevention Group
Syracuse, New York . . . . . . . . . . . . . . . .315-446-8205

Glens Falls Hospital
Glens Falls, New York. . . . . . . . . . . . . . .1-800-724-4425

Mary Imogene Bassett Hospital
Cooperstown, New York. . . . . . . . . . . . . . .607-547-3800

North Shore University Hospital
Manhasset, New York. . . . . . . . . . . . . . . .516-562-8255

Roswell Park Cancer Institute
Buffalo, New York. . . . . . . . . . . . . . . . .716-845-7667
                                                    or
                                                  1-800-767-9355
                                                       (ROSWELL)

Special Surveillance Breast Program
Memorial Sloan Kettering Cancer Center
New York, New York . . . . . . . . . . . . . . . .212-639-5877

Strang Cancer Center
New York, New York . . . . . . . . . . . . . . . .212-734-5625

St. Vincent's Hospital/Guttman
New York, New York . . . . . . . . . . . . . . . .212-229-9355


NORTH CAROLINA

Duke University Medical Center
Durham, North Carolina . . . . . . . . . . . . . .919-684-2995

  Florida Hospital
  Orlando, Florida . . . . . . . . . . . . . . . .407-897-5763

East Carolina University
Greenville, North Carolina . . . . . . . . . . . .1-800-722-3281
                                                  ext. 2391

Health InfoCom Network News                                            Page 68
Volume  6, Number  5                                            March  8, 1993


Southeast Cancer Control Consortium, Inc.
Goldsboro, North Carolina. . . . . . . . . . . . .919-580-0000

Southeast Cancer Control Consortium, Inc.
Hickory, North Carolina. . . . . . . . . . . . . .704-324-9550

Southeast Cancer Control Consortium, Inc.
Greensboro, North Carolina . . . . . . . . . . . .919-379-4183

Southeast Cancer Control Consortium, Inc.
Asheville, North Carolina. . . . . . . . . . . . .704-253-0969

Southeast Cancer Control Consortium, Inc.
Raleigh, North Carolina. . . . . . . . . . . . . .919-783-3105

Southeast Cancer Control Consortium, Inc.
Winston-Salem, North Carolina. . . . . . . . . . .919-760-0122

Southeast Cancer Control Consortium, Inc.
Presbyterian Hospital
Charlotte, North Carolina. . . . . . . . . . . . .1-800-755-7563
                                                       Or
                                                  704-384-4111

Southeast Cancer Control Consortium, Inc. (SCCC)
Carolinas Medical Center
Charlotte, North Carolina. . . . . . . . . . . . .704-355-3789

University of North Carolina
  Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina. . . . . . . . . . . .1-800-862-8660

Cape Fear Valley Medical Center
  Fayetteville, North Carolina . . . . . . . . . .919-323-6910



--------- end of part 5 ------------
·    Subject: HICN605 Medical Newsletter Part 4/6
patients had used ZDV an average of 14 months, whereas those failing ZDV had
used it an average of 23 months.  Approximately 66% of patients had a prior
AIDS diagnosis.  The median CD4+ cell count of the enrolled patients was very
low, 37 cells per cubic millimeter.  The use of concomitant medications at
baseline was similar in the two groups.

                                    Results

                                 Main Endpoint

Disease progression, including death, occurred in 156 ddI patients and 150 ddC
patients (rate per 100 person years:  92.3 for ddI vs 86.4 for ddC; relative
risk = 0.93, p-value = 0.56).  Thus, there is no statistically significant
difference between the two treatments based on this endpoint.  The ddI group
reported 100 deaths while the ddC group had 87 and the difference between the
groups is approaching, but does not reach, a statistically significant level
(relative risk 0.76, p-value = 0.072).

There were small, not statistically significant differences in several
characteristics with known prognostic value for progression of HIV disease and
survival: number of CD4+ cells, AIDS diagnosis and Karnofsky score.  These
small baseline imbalances in important prognostic factors between the two
groups, especially for Karnofsky score, indicate that the ddC group may have
been, by chance, slightly more ill than the ddI group.  It may be difficult to
distinguish the effect of the treatments under study from any inherent
differences in those baseline characteristics.  Adjusted analysis is done in
order to make sure that any differences in outcome have not been influenced by
those random baseline differences.

When analysis of these results was performed adjusting for these prognostic
characteristics, the risk of progression of disease including death is in the
direction of favoring ddC, although still not statistically significant (p =
0.11).  The adjusted risk of death alone, however, does indicate an advantage
for ddC (p = 0.002).

Health InfoCom Network News                                            Page 41
Volume  6, Number  5                                            March  8, 1993


Disseminated Mycobacterium avium infection (MAI) infection was the most common
non-fatal first event in both treatment groups (ddI=24 vs ddC=27), with
Pneumocystis carinii pneumonia (PCP) and candidiasis following.  Longitudinal
analysis of data on CD4+ cells show that the average change after 2 months for
those receiving ddI was significantly greater than for those receiving ddC.
Between months 2 and 18, CD4+ cell counts declined in both groups.

                                   Toxicity

While on initial study drug, at least one adverse experience was reported by
67% of patients on ddI and 66% on ddC.  Many  patients had multiple adverse
experiences.  Although the number and rates for patients with at least one
adverse experience were similar in the two groups, the nature of these
experiences were different.  Peripheral neuropathy was seen significantly more
frequently in patients receiving ddC (32 on ddI vs 69 on ddC, p<0.001), while
stomatitis occurred only in ddC (8 patients).  Pancreatitis was seen only in
patients on ddI (4 patients).  Diarrhea (48 vs 9, p<0.001) and abdominal pain
(16 vs 7, p=0.030) occurred significantly more often in patients receiving ddI
than in those receiving ddC.

                                  Conclusions

The findings of the ddI/ddC study may offer a new therapeutic option to
clinicians treating patients with advanced HIV disease.  For patients in this
study, those who have failed or are intolerant of ZDV, ddC was found to be at
least as efficacious as ddI in delaying disease progression and death.  The
results of this study suggest that ddC is an acceptable alternative
monotherapy to ddI in patients intolerant of or failing on ZDV; ddC
monotherapy delays clinical progression at least as long as ddI, and may
provide a survival advantage.  Since the majority of patients (66 percent
overall) experienced disease progression with either treatment and the
differences in outcome are not large, the toxicity profiles of these two drugs
will be important to consider when choosing antiretroviral treatment for an
individual patient.

The results of this study, along with other recently released studies, provide
additional information on the choice of antiretroviral agents for treatment of
persons with HIV infection.  The results of the CPCRA ddI/ddC study are not
intended to answer questions about the use of these therapies in previously
untreated patients, the relative benefit of nucleoside therapy versus no
nucleoside therapy in patients who have failed or are intolerant of ZDV, or
the use of either ddI or ddC in patients who tolerate or derive benefit from
ZDV.  Other ongoing or recently completed studies address those questions.  In
order to guide clinicians in the integration of the results of these studies

Health InfoCom Network News                                            Page 42
Volume  6, Number  5                                            March  8, 1993

into their clinical practice, the Division of AIDS of NIAID will sponsor a
conference on the state-of-the art of antiretroviral therapy in HIV infection.
This conference is planned for summer 1993.

For more information about the CPCRA ddI/ddC study, please call
1-800-TRIALS-A.

Health InfoCom Network News                                            Page 43
Volume  6, Number  5                                            March  8, 1993



::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
                       Announcements of Studies/Research
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

             Tamoxifen Breast Cancer Prevention Trial Information
 ============================================================================

            Q and A About the Breast Cancer Prevention Trial (1/93)


               Questions and Answers About the BCPT Trial (1/93)


1.   What is the Breast Cancer Prevention Trial?

 The Breast Cancer Prevention Trial or BCPT is a clinical trial
 designed to see whether taking the drug tamoxifen (trade name
 Nolvadex) can prevent breast cancer in women who are at an
 increased risk of developing the disease.  The BCPT will also
 determine whether taking tamoxifen decreases the number of
 heart attacks and reduces the number of bone fractures in these
 women.  Researchers with the National Surgical Adjuvant Breast
 and Bowel Project (NSABP) are conducting the study in centers
 across the United States and Canada.  The study is funded by
 the National Cancer Institute, the U.S. government's lead
 agency for cancer research.


2.   What is a clinical trial?

 A clinical trial is a research study conducted with people.
 There are many types of clinical trials.  They range from
 studies to prevent, detect, diagnose, and treat a disease to
 studies of the psychological impact of the disease and ways to
 improve a patient's comfort and quality of life.


3.   Who is eligible to participate in the BCPT?

 Two groups of women are eligible to participate in the study:
 women 60 years of age and older are eligible based on their age
 alone, while women between the ages of 35 and 59 will be
 eligible if they are at sufficiently increased risk for
 developing breast cancer.


Health InfoCom Network News                                            Page 44
Volume  6, Number  5                                            March  8, 1993


4.   Why are women 60 years of age or older eligible for the BCPT
     based on age alone?


 Many diseases, including breast cancer, occur more often in
 older persons.  The risk of developing breast cancer increases
 with age, so it is more common to find breast cancer in women
 over 60 years of age.  The risk of heart disease also increases
 with age, and tamoxifen may be of benefit in reducing risk for
 developing this disease.


5.   What determines increased risk of breast cancer for women
     aged 35 to 59?

 To participate in the trial, women 35 to 59 years of age must
 have a risk of developing breast cancer within the next five
 years that is equal to or greater than the average risk of a
 60-year-old woman.  This increased risk is determined in one of
 two ways:

 A woman must have other risk factors, in addition to her age,
 that combine to place her at increased risk for breast cancer.
 This risk is determined by a computer calculation based on the
 following factors:

 -     number of first-degree relatives (mother, daughters, or
       sisters) who have been diagnosed with breast cancer;

 -   whether a woman has any children and her age at the
     first delivery;

 -   the number of times a woman has had breast lumps
     biopsied, especially if the tissue was shown to have a
     condition known as atypical hyperplasia; and

 -   the woman's age at her first menstrual period.

                               OR

 A woman must have been diagnosed with the noninvasive breast
 cancer, lobular carcinoma in situ, a condition that greatly
 increases her chance of developing invasive breast cancer.



Health InfoCom Network News                                            Page 45
Volume  6, Number  5                                            March  8, 1993

6.   Are there other factors that affect eligibility for the
trial?

 Certain existing health conditions may affect a woman's
 eligibility for the trial.  For example, women at increased
 risk for blood clots are not able to participate.  Also, women
 who are taking hormone replacements for menopausal symptoms and
 women using oral contraceptives cannot take part in the trial
 unless they stop taking these medications.  Those who stop
 taking these hormones are eligible for the trial three months
 after they discontinue the drugs.


7.   Are pregnant women allowed to participate in this trial?

 Women who are currently pregnant or who plan to become pregnant
 are not eligible to participate.  Premenopausal women partici-
 pating in the BCPT must use some method of birth control other
 than oral contraceptives ("the pill") while taking tamoxifen.
 Oral contraceptives may change the effects of tamoxifen and may
 also affect the risk of breast cancer.


8.   Will every woman in the trial receive tamoxifen?

 The 16,000 women who will participate in the BCPT will be
 randomized (selected by chance) to receive either tamoxifen or
 a placebo (an inactive pill that looks like tamoxifen).  In a
 process known as "double-blinding," neither the participant nor
 her physician will know which pill she is receiving.  Setting
 up a trial in this way allows researchers to clearly see what
 the true benefits and side effects of tamoxifen may be without
 the influence of other factors.


9.   What is the dose of tamoxifen and how long will it be given?


 All women in the trial will take two pills a day for five
 years, either a 20-milligram dose of tamoxifen (two 10 mg
 pills) or a placebo.


10.  How much will the tamoxifen cost?


Health InfoCom Network News                                            Page 46
Volume  6, Number  5                                            March  8, 1993

 There is no charge to participants for the tamoxifen or
 placebo.  The company that manufactures tamoxifen, ICI
 Americas, Inc., Wilmington, Del., is providing both the
 tamoxifen and the placebo without charge.


11.  Are women required to have any medical exams?

 Participants are required to have blood tests, a pelvic exam,
 mammogram, and physical exam before they are accepted into the
 study.  Women 55 years of age and older will need to have an
 electrocardiogram, or ECG (a test to measure the heart's
 muscular activity), in addition to the other tests.  These
 tests will be repeated at intervals during the study.


12.  Who will pay for these medical exams?

 Physician or medical test costs will be charged to the partici-
 pant in the same fashion as if she were not part of the trial;
 however, the costs for these tests may be covered by a number
 of insurance companies.  For women over 55, the required
 electrocardiograms will be done at no cost.  Every effort will
 be made to contain the costs specifically associated with
 participation in this trial.


13.  What are the responsibilities of a woman participating in
this trial?

 Women entering the Breast Cancer Prevention Trial need to be
 committed to it for at least five years.  Throughout the course
 of the study, participants will have several responsibilities.
 Daily for five years, women need to take two pills.  Partici-
 pants must also report any side effects they experience to the
 investigators, and must obtain periodic followup examinations.
 At the time of these exams, participants also will be required
 to complete some forms and questionnaires.  Every effort will
 be made to make followup appointments convenient and to ensure
 that all the women who participate in the trial feel comfort-
 able with their involvement.


14.  How can women enroll in the trial?


Health InfoCom Network News                                            Page 47
Volume  6, Number  5                                            March  8, 1993

 Women who are interested in participating in the trial should
 contact the center nearest to them.  To locate the nearest
 center in the United States, a woman can call the NCI's Cancer
 Information Service at 1-800-4-CANCER (1-800-422-6237) or the
 American Cancer Society's Cancer Response System at 1-800-ACS-
 2345.

 In Canada, participating centers can be located by calling:  in
 British Columbia and the Yukon, 1-604-879-2323; in Ontario, 1-
 800-263-6750; in Quebec, 1-800-361-4212; and in other areas, 1-
  416-387-1153.

---------------------------------------------------------------------------

   Questions and Answers About Tamoxifen (1/93)




1. What is tamoxifen?

 Tamoxifen is a drug, taken by mouth as a pill, that has been
 used for almost 20 years to treat patients with advanced breast
 cancer.  Since 1985 it has also been recommended in the United
 States for "adjuvant," or additional, therapy following
 radiation and/or surgery for early stage breast cancer.


2. How does tamoxifen work in treating breast cancer?

 One way that tamoxifen works in breast cancer is to interfere
 with the activity of estrogen, a female hormone that promotes
 the growth of cancer cells in the breast.  Because tamoxifen
 works against the effects of estrogen on breast cancer cells,
 it is often called an "anti-estrogen."  As a treatment, the
 drug slows or stops the growth of these cancer cells.  As
 adjuvant therapy, tamoxifen has been shown to help prevent the
 original breast cancer from returning.


3. Why is tamoxifen now being tested to prevent breast cancer?

 Research has shown that taking tamoxifen as adjuvant therapy
 for breast cancer may also prevent the development of new
 cancers in the opposite breast.  Evidence from these and other


Health InfoCom Network News                                            Page 48
Volume  6, Number  5                                            March  8, 1993

 studies suggests that tamoxifen may have beneficial prevention
 qualities in healthy women who do not yet have breast cancer.


4. Does tamoxifen affect other parts of the body besides breast
   tissues?

 While tamoxifen acts against the effects of estrogen in breast
 tissues, it acts like estrogen in other body systems.  For
 example, because it acts like estrogen, women who take
 tamoxifen may have many of the beneficial effects of estrogen
 replacement therapy, such as a lowering of blood cholesterol
 and a slowing of bone loss that may lead to osteoporosis.


5. Can tamoxifen cause side effects?

 Like most medications, whether over-the-counter medications,
 prescription drugs, or drugs in clinical trials, tamoxifen may
 cause side effects.

 For example, in a recent NSABP breast cancer study where women
 with breast cancer took either tamoxifen or a placebo, the side
 effects experienced more often by women taking tamoxifen were
 hot flashes and vaginal discharge.  Women in both groups
 reported sometimes having side effects--even though the placebo
 itself would not cause any symptoms.  The side effects that
 some women in both groups reported included:  vaginal dryness,
 itching, or bleeding; menstrual irregularities; depression;
 loss of appetite; nausea and/or vomiting; dizziness; headaches;
 and fatigue.

 Participants in the BCPT will have all their side effects
 monitored and will receive periodic physical exams.  Treatments
 that may minimize or eliminate most side effects will be avail-
 able.


6. Does tamoxifen cause a woman to begin menopause?

 Tamoxifen does not cause a woman to begin menopause.  In most
 women taking the drug, the ovaries continue to function
 normally and produce female hormones (estrogens) in the same or
 slightly increased amounts.  Because tamoxifen does not cause a
 woman to begin menopause, there is a chance that pregnancy

Health InfoCom Network News                                            Page 49
Volume  6, Number  5                                            March  8, 1993

 could occur.  This is why all premenopausal women participating
 in this trial must use some method of birth control other than
 oral contraceptives while taking tamoxifen.


7. Does tamoxifen cause blood clots?

 Data from large clinical trials suggest that there is a small
 increase in the number of blood clots in breast cancer patients
 taking tamoxifen, particularly if they are also receiving other
 anticancer drugs (chemotherapy).  The total number of women who
 have experienced blood clots while taking tamoxifen is small.
 Women who have had blood clots in the past may not be eligible
 to participate in this trial.


8. Does tamoxifen cause any other serious side effects?

 Before a woman agrees to participate in the Breast Cancer
 Prevention Trial, a health professional will fully discuss the
 potential benefits and risks from the drug and medical
 procedures that will be used.

 The potential benefits and side effects of tamoxifen are
 frequently due to its estrogen-like effects.  Estrogens are
 known to increase the risk of endometrial cancer, and there are
 reports from several large clinical trials showing that breast
 cancer patients taking tamoxifen have an increased risk of
 endometrial cancer.  Endometrial cancer frequently causes
 bleeding and is usually diagnosed in its early stages--when
 treatment by surgery alone is effective.  The endometrial
 cancers that have occurred during studies of women taking
 tamoxifen have all been found in very early stages.
 Because of some association between estrogens (particularly
 oral contraceptives) and liver cancer, there has also been some
 concern that tamoxifen may cause liver cancer.  No liver
 cancers have been reported in trials in which women took a 20
  mg/day dose of the drug (the dose given in the BCPT).  In
  studies in which women took 40 mg of tamoxifen daily, there
  have been two reports of liver cancer as well as a few reports
  of liver complications.  Based on the current available
  information, tamoxifen has not been shown to be the cause of
  the liver complications or the liver cancer.  However, to
  ensure the safety of the women who participate in the BCPT,
  blood tests to check liver functions will be done at regular

Health InfoCom Network News                                            Page 50
Volume  6, Number  5                                            March  8, 1993

  intervals.

---------------------------------------------------------------------------

   Other Important Questions About the BCPT (1/93)




1.   Why is the Breast Cancer Prevention Trial so important?

 This year, over 180,000 women in the United States alone will
 be diagnosed with breast cancer, and more than 46,000 will die
 of the disease.  For many years, women at increased risk for
 developing breast cancer have had no way to reduce their risk.
 Women have to rely on examinations such as monthly breast self-
 examinations, frequent checkups, and periodic mammograms to
 detect breast cancer in its earliest stages.  Doctors sometimes
 suggest that certain women at very high risk have a preventive
 (prophylactic) mastectomy, which is surgery to remove breast
 tissue before cancer develops.  The operation does not always
 guarantee that breast cancer will be avoided, because it is
 almost impossible to remove all the breast tissue.

 If tamoxifen is successful in preventing breast cancer, women
 at increased risk for developing the disease will have a choice
 other than more frequent exams or major surgery.  Tamoxifen may
 be able to reduce by one-third or more the number of breast
 cancers that occur in women at increased risk.  In addition,
 tamoxifen may decrease the risk of heart attacks by lowering
 blood cholesterol.  However, in order to give women this
 choice, tamoxifen must be tested in a large clinical trial to
 determine if the benefits outweigh any risk.


2.   How could a healthy woman benefit from participating in the
     BCPT?

 The decision to take part in any clinical trial is an individu-
 al one.  Researchers hope that tamoxifen will prevent breast
 cancer from occurring in those women receiving it in the trial.
 Women will also benefit from regular mammograms and checkups,
 which can help detect breast cancer in its earliest stages.
 They will also benefit from the state-of-the-art medical care
 they receive from the health professionals involved in the

Health InfoCom Network News                                            Page 51
Volume  6, Number  5                                            March  8, 1993

 trial.  At each clinical center where women can be enrolled,
 nurses and physicians will explain important information about
 the trial and will discuss any questions a potential partici-
 pant may have.

3.   What is the National Surgical Adjuvant Breast and Bowel
     Project?

 The National Surgical Adjuvant Breast and Bowel Project is a
 large group of cancer researchers who receive funding and
 support from the U.S. National Cancer Institute.  The more than
 6,000 physicians, nurses, and other medical professionals in
 the NSABP are located in over 250 medical centers throughout
 the United States and Canada.
 NSABP was founded in 1958 and has been a leader in breast
 cancer research.  The results of clinical trials conducted by
 NSABP researchers have been the dominant force in altering the
 standard surgical treatment of breast cancer from mastectomy to
 lumpectomy plus radiation.  This group was also the first to
 demonstrate that adjuvant therapy could alter the natural
 history of breast cancer, thus increasing survival rates.

 To date, more than 30,000 women who have had breast cancer have
 participated in treatment clinical trials conducted by NSABP
 investigators.  A clinical trial to prevent breast cancer is a
 logical next step for this research group.

============================================================================

    Tamoxifen Breast Cancer Prevention Trial Information

    2. Breast Cancer Prevention Trial Referral Information (7/92)


The Breast Cancer Prevention Trial is being conducted at over 270
sites across the United States and Canada.  Referral information
has been arranged alphabetically by state so that the closest
participating organization can be located.



Breast Cancer Prevention Trial (BCPT) with Tamoxifen

Telephone Contact List



Health InfoCom Network News                                            Page 52
Volume  6, Number  5                                            March  8, 1993

MAIN TELEPHONE NUMBERS

United States. . . . . . . . . . . . . . . . . . .1-800-4-CANCER
                                                       Or
                                                  1-800-ACS-2345

Canada
  British Columbia/The Yukon . . . . . . . . . . .604-879-2323

  Ontario. . . . . . . . . . . . . . . . . . . . .1-800-263-6750

  Quebec . . . . . . . . . . . . . . . . . . . . .1-800-361-4212

  Other Regions. . . . . . . . . . . . . . . . . .416-387-1153



        TELEPHONE NUMBERS IN THE UNITED STATES - BY STATE
                        ALABAMA - GEORGIA


ALABAMA

Baptist Medical Center
Birmingham, Alabama. . . . . . . . . . . . . . . .1-800-421-2065
                                                       Or
                                                  205-581-9800

University of Alabama at Birmingham
  Cancer Center
Birmingham, Alabama. . . . . . . . . . . . . . . .205-934-1338

University of South Alabama
Mobile, Alabama. . . . . . . . . . . . . . . . . .205-460-6474


ARIZONA

Arizona Cancer Center
Tucson, Arizona. . . . . . . . . . . . . . . . . .602-626-4100

  Tucson Breast Center
  Tucson, Arizona. . . . . . . . . . . . . . . . .602-326-6267

  Greater Phoenix CCOP

Health InfoCom Network News                                            Page 53
Volume  6, Number  5                                            March  8, 1993

  Phoenix, Arizona . . . . . . . . . . . . . . . .602-239-6797

  Maricopa Medical Center
  Phoenix, Arizona . . . . . . . . . . . . . . . .602-267-5508


CALIFORNIA

Bay Area Cancer Control Consortium CCOP
San Francisco, California. . . . . . . . . . . . .1-800-283-9765

City of Hope National Medical Center
Duarte, California . . . . . . . . . . . . . . . .1-800-934-5555

Harbor-UCLA Medical Center Research
  and Education Institute
Torrance, California . . . . . . . . . . . . . . .310-533-2217

Kaiser Permanente CCOP
San Diego, California. . . . . . . . . . . . . . .619-528-6325

Long Beach Memorial Breast Center
Long Beach, California . . . . . . . . . . . . . .1-800-638-1900

  Saddleback Breast Cancer Center
  Saddleback Memorial Medical Center
  Orange County, California. . . . . . . . . . . .714-859-2660

Los Angeles Oncologic Institute at
  St. Vincent Medical Center
Los Angeles, California
Other Sites:  Los Angeles Intake Center
              San Gabriel Valley Intake Center
              Inland Empire Intake Center. . . . .1-800-499-5264
                                                       Or
                                                  213-484-7086

Norris Cancer Hospital
Los Angeles, California. . . . . . . . . . . . . .1-800-498-6666
                                                       Or
                                                  213-224-6929

San Joaquin Valley CCOP
Fresno, California . . . . . . . . . . . . . . . .209-221-5614


Health InfoCom Network News                                            Page 54
Volume  6, Number  5                                            March  8, 1993

St. Mary Medical Center/Long Beach Community Hospital

  Long Beach Community Hospital
  Long Beach, California . . . . . . . . . . . . .1-800-554-2844

  St. Mary Medical Center
  Los Angeles County and Orange County, California1-800-377-7040

Stanford University Breast Cancer
  Prevention Center
Palo Alto, California. . . . . . . . . . . . . . .415-723-8686

Sutter Breast Cancer Center
Sacramento, California . . . . . . . . . . . . . .1-800-524-7475
                                                           (RISK)

University of California, LA
Los Angeles, California. . . . . . . . . . . . . .310-825-9502

U.C. Davis Cancer Center
Sacramento, California . . . . . . . . . . . . . .1-800-547-2278
                                                           (BCPT)
COLORADO

--------- end of part 4 ------------


---
      Internet: [e-mail]                  FAX: [phone]
      Bitnet: ATW1H@ASUACAD                     FidoNet=> 1:114/15
                Amateur Packet ax25: [e-mail]
---
 * PCB/UseNet Gateway from Sparkware #3


∙HEADER:USENET

Path: channel1!uupsi!psinntp!rpi!gatech!asuvax!ennews!stat!david
From: [e-mail] (David Dodell)
Newsgroups: sci.med
Subject: HICN605 Medical Newsletter Part 4/6
Message-ID: <[e-mail]>
Date: Mon, 08 Mar 93 22:30:37 MST
Reply-To: [e-mail] (David Dodell)
Distribution: world
Organization: Stat Gateway Service, WB7TPY
Lines: 708
==============================================================================
Date: 03-10-93 (14:29)           Number: 20974     Channel 1(R) Communica
  To: ALL                        Refer#: NONE
From: DAVID DODELL                 Read: YES
Subj: HICN605 MEDICAL NEWSLETTE    Conf: (1659) med
------------------------------------------------------------------------
·  Newsgroup: sci.med
· Message-ID: <[e-mail]>
·    Subject: HICN605 Medical Newsletter Part 6/6

------------- cut here -----------------
---------------------------------------------------------------------------

        TELEPHONE NUMBERS IN THE UNITED STATES - BY STATE
                      NORTH DAKOTA - TEXAS




Health InfoCom Network News                                            Page 69
Volume  6, Number  5                                            March  8, 1993

NORTH DAKOTA

St. Luke's Hospital CCOP
Roger Maris Cancer Center
Fargo, North Dakota. . . . . . . . . . . . . . . .701-234-5842


OHIO

Columbus CCOP
Columbus and Springfield, Ohio
  Community Hospital of Springfield
  Doctors Hospitals
  Grant Medical Center
  Medical Center of Chillicothe
  Mercy Medical Center of Springfield
  Mount Carmel Hospitals
  Park Medical Center. . . . . . . . . . . . . . .614-443-2267

Ohio State James Cancer Hospital
Columbus, Ohio . . . . . . . . . . . . . . . . . .614-293-8892

  Riverside Regional Cancer Institute
  Columbus, Ohio . . . . . . . . . . . . . . . . .614-566-4321

Northeast Ohio Breast Cancer Prevention
  Trial Group
Cleveland, Ohio. . . . . . . . . . . . . . . . . .1-800-686-2278
                                                           (BCPT)

The Dayton Clinical Oncology Program
Kettering, Ohio. . . . . . . . . . . . . . . . . .513-296-7278

Toledo Community Hospital Oncology Program
Toldeo, Ohio . . . . . . . . . . . . . . . . . . .419-255-5433

University of Cincinnati
Cincinnati, Ohio . . . . . . . . . . . . . . . . .513-558-2278
                                                         (BCPT)

University of Kentucky Consortium/
  Lexington Clinic
The Christ Hospital Cancer Center
Cincinnati, Ohio . . . . . . . . . . . . . . . . .513-369-2859


Health InfoCom Network News                                            Page 70
Volume  6, Number  5                                            March  8, 1993


OKLAHOMA

Cancer Center of the Southwest
Baptist Medical Center of Oklahoma
Oklahoma City, Oklahoma. . . . . . . . . . . . . .1-800-327-2273
                                                       Or
                                                  405-946-2273

Saint Francis Hospital
Natalie Warren Bryant Cancer Center
Tulsa, Oklahoma. . . . . . . . . . . . . . . . . .1-800-695-9501
                                                       Or
                                                  918-494-4500


OREGON

Columbia River Oncology Program
Portland, Oregon . . . . . . . . . . . . . . . . .503-230-6853

SEE WASHINGTON:  Kaiser Permanente


PENNSYLVANIA

Albert Einstein Cancer Center
Philadelphia, Pennsylvania . . . . . . . . . . . .1-800-355-8269
                                                       Or
                                                  215-456-3500

Bryn Mawr Cancer Center
Bryn Mawr, Pennsylvania. . . . . . . . . . . . . .215-526-3800

Fox Chase Network/Affiliates
Fox Chase Cancer Center
Philadelphia, Pennsylvania . . . . . . . . . . . .215-728-2792

  Delaware County Memorial Hospital
  Drexel Hill, Pennsylvania. . . . . . . . . . . .215-284-8448

  Memorial Hospital of Burlington County
  Mount Holly, New Jersey. . . . . . . . . . . . .609-265-7555

  Montgomery Hospital

Health InfoCom Network News                                            Page 71
Volume  6, Number  5                                            March  8, 1993

  Norristown, Pennsylvania . . . . . . . . . . . .215-270-2700

  North Penn Hospital
  Lansdale, Pennsylvania . . . . . . . . . . . . .215-361-4950

  Paoli Memorial Hospital
  Paoli, Pennsylvania. . . . . . . . . . . . . . .215-648-1636

  Polyclinic Medical Center
  Harrisburg, Pennsylvania . . . . . . . . . . . .717-782-6678

  Saint Francis Medical Center
  Trenton, New Jersey. . . . . . . . . . . . . . .609-599-5790

  Saint Mary Hospital
  Langhorne, Pennsylvania. . . . . . . . . . . . .215-750-5300

  The Reading Hospital and Medical Center
  Reading, Pennsylvania. . . . . . . . . . . . . .215-378-6512

Geisinger Medical Center - Breast Clinic
Danville, Pennsylvania . . . . . . . . . . . . . .1-800-622-2515

Lehigh Valley Hospital
Allentown, Pennsylvania. . . . . . . . . . . . . .215-778-2290

  Grand View Hospital
  Sellersville, Pennsylvania . . . . . . . . . . .215-453-4690

  Norristown Regional Cancer Center
  Norristown, Pennsylvania . . . . . . . . . . . .215-278-2500

  Pottstown Memorial Medical Center
  Pottstown, Pennsylvania. . . . . . . . . . . . .215-327-7480

Mercy Hospital
Scranton, Pennsylvania . . . . . . . . . . . . . .717-348-7673
                                                       Or
                                                  717-348-7940

University of Pennsylvania Cancer Center
Philadelphia, Pennsylvania . . . . . . . . . . . .1-800-777-8176

Western Pennsylvania BCPT Project
  NSABP Adjuvant Therapy Center

Health InfoCom Network News                                            Page 72
Volume  6, Number  5                                            March  8, 1993

  Pittsburgh, Pennsylvania . . . . . . . . . . . .412-624-6221

  Allegheny CCOP
  Pittsburgh, Pennsylvania . . . . . . . . . . . .412-359-6190


RHODE ISLAND

SEE MASSACHUSETTS:  Miriam Hospital


SOUTH CAROLINA

Greenville Memorial Hospital
Greenville, South Carolina . . . . . . . . . . . .1-800-998-9080
                                                       Or
                                                  803-455-3315

Southeast Cancer Control Consortium, Inc. (SCCC)
Greenwood, South Carolina. . . . . . . . . . . . .803-227-4457

Southeast Cancer Control Consortium, Inc. (SCCC)
Columbia, South Carolina . . . . . . . . . . . . .1-800-775-2287

Southeast Cancer Control Consortium, Inc. (SCCC)
Florence, South Carolina . . . . . . . . . . . . .803-667-2376
                                                       Or
                                                  803-678-5101

Southeast Cancer Control Consortium, Inc. (SCCC)
Charleston, South Carolina . . . . . . . . . . . .803-577-2276


Spartanburg CCOP
Spartanburg, South Carolina. . . . . . . . . . . .803-560-6810


SOUTH DAKOTA

Sioux Community Cancer Consortium
Dakota Midwest Cancer Institute
Sioux Falls, South Dakota. . . . . . . . . . . . .605-331-3257

  Sioux-Land Hematology Oncology
  Sioux City, Iowa . . . . . . . . . . . . . . . .712-252-3403


Health InfoCom Network News                                            Page 73
Volume  6, Number  5                                            March  8, 1993


TENNESSEE

Southeast Cancer Control Consortium, Inc. (SCCC)
Kingsport, Tennessee . . . . . . . . . . . . . . .615-224-5592

Thompson Cancer Center
Knoxville, Tennessee . . . . . . . . . . . . . . .1-800-388-3313
                                                       Or
                                                  615-541-4966
  Centennial Medical Center
  Nashville, Tennessee . . . . . . . . . . . . . .615-342-3760

SEE KENTUCKY:  Oncology Associates and The Tennessee Breast
Center


TEXAS

Baylor-Charles A. Sammons Cancer Center
Dallas, Texas. . . . . . . . . . . . . . . . . . .1-800-422-9567

M.D. Anderson
Houston, Texas . . . . . . . . . . . . . . . . . .713-792-8515

Scott & White Hospital and Clinic/
  Texas A&M University School of Medicine
Temple, Texas. . . . . . . . . . . . . . . . . . .1-800-551-8858
                                                       Or
                                                  817-774-5888

University of Texas Health Science Center
San Antonio, Texas . . . . . . . . . . . . . . . .512-567-5750


---------------------------------------------------------------------------

        TELEPHONE NUMBERS IN THE UNITED STATES - BY STATE
                        UTAH - WISCONSIN


UTAH

Utah Cancer Center
Salt Lake City, Utah . . . . . . . . . . . . . . .801-581-4048

Health InfoCom Network News                                            Page 74
Volume  6, Number  5                                            March  8, 1993

                                                       Or
                                                  801-581-5052


VERMONT

Vermont Cancer Center
Burlington, Vermont. . . . . . . . . . . . . . . .802-656-4414


VIRGINIA

Massey Cancer Center
Medical College of Virginia Hospitals
Richmond, Virginia . . . . . . . . . . . . . . . .1-800-925-8821

  James River Clinic
  Newport News, Virginia . . . . . . . . . . . . .804-766-1905

Southeast Cancer Control Consortium, Inc.
Danville, Virginia . . . . . . . . . . . . . . . .804-793-0047

Southeast Cancer Control Consortium, Inc.
Martinsville, Virginia . . . . . . . . . . . . . .703-666-7827


WASHINGTON

Northwest CCOP/Virginia Mason CCOP
Northwest CCOP/Tacoma General Hospital
Tacoma, Washington . . . . . . . . . . . . . . . .206-594-1461

  St. Joseph Hospital
  Tacoma, Washington . . . . . . . . . . . . . . .206-627-4101
                                                       ext. 5524

  St. Peter Hospital
  Olympia, Washington. . . . . . . . . . . . . . .206-493-7281

  Capital Medical Center
  Olympia, Washington. . . . . . . . . . . . . . .206-754-5858
                                                  ext. 2433
  Virginia Mason Medical Center CCOP
  Seattle, Washington. . . . . . . . . . . . . . .206-223-6742


Health InfoCom Network News                                            Page 75
Volume  6, Number  5                                            March  8, 1993

  Kaiser Permanente
  Portland, Oregon . . . . . . . . . . . . . . . .503-282-8421
                                                       Or
                                                  503-249-3315

Puget Sound Oncology Consortium
Fred Hutchinson Cancer Research Center
Seattle, Washington. . . . . . . . . . . . . . . .206-667-6544


WEST VIRGINIA

BCPT in West Virginia:  Charleston and Morgantown
  Charleston Area Medical Center
  Charleston, West Virginia. . . . . . . . . . . .304-348-9523
                                                       Or
                                                  304-348-9541
  West Virginia University
  Morgantown, West Virginia. . . . . . . . . . . .304-293-3515
                                                       Or
                                                  304-293-4500


WISCONSIN

CCOP Marshfield Clinic
Marshfield, Wisconsin. . . . . . . . . . . . . . .1-800-358-3844
                                                       Or
                                                  715-389-3844

Milwaukee Breast Cancer Prevention Trial
Milwaukee, Wisconsin . . . . . . . . . . . . . . .414-283-6814

Wisconsin Comprehensive Cancer Center
Madison, Wisconsin . . . . . . . . . . . . . . . .1-800-622-8922
                                                       Or
                                                  608-262-5223

SEE MINNESOTA:  Midelfort Clinic, Ltd.


                  TELEPHONE NUMBERS FOR CANADA




Health InfoCom Network News                                            Page 76
Volume  6, Number  5                                            March  8, 1993

B.C. Cancer Agency
Vancouver, British Columbia. . . . . . . . . . . .604-822-7997

Cross Cancer Institute
Alberta, Canada. . . . . . . . . . . . . . . . . .403-492-8784

Tom Baker Cancer Centre
Calgary, Alberta . . . . . . . . . . . . . . . . .403-670-2492

Credit Valley Hospital
Mississauga, Ontario . . . . . . . . . . . . . . .416-820-4040

Hamilton Regional Cancer Center
Hamilton, Ontario. . . . . . . . . . . . . . . . .416-575-6348

Toronto Hospital
Toronto, Ontario . . . . . . . . . . . . . . . . .416-340-3196

Women's College Hospital
Toronto, Ontario . . . . . . . . . . . . . . . . .416-961-3433

Jewish General Hospital/St. Mary's Hospital
Montreal, Quebec . . . . . . . . . . . . . . . . .514-340-7562

  St. Mary's Hospital

  Montreal, Quebec . . . . . . . . . . . . . . . .514-342-5630

Royal Victoria Hospital
Montreal, Quebec . . . . . . . . . . . . . . . . .514-843-1572

  Montreal General Hospital
  Montreal, Quebec . . . . . . . . . . . . . . . .514-937-7813

   Queen Elizabeth Hospital
   Montreal, Quebec . . . . . . . . . . . . . . . .514-485-5134

 University of Montreal
 Hotel Dieu de Montreal
 Montreal, Quebec . . . . . . . . . . . . . . . . .514-849-7346
                                                          (SEIN)
                                                        Or
                                                   514-843-2611
                                                   ext. 4951

 Quebec BCPT Center

Health InfoCom Network News                                            Page 77
Volume  6, Number  5                                            March  8, 1993

 Quebec City, Quebec. . . . . . . . . . . . . . . .418-682-7394

 Manitoba Cancer Treatment and Research
   Foundation
 Winnipeg, Manitoba . . . . . . . . . . . . . . . .204-787-4148
                                                        Or
                                                   204-787-4160

 SEE MINNESOTA:  Thunder Bay Regional Cancer Center


Health InfoCom Network News                                            Page 78
Volume  6, Number  5                                            March  8, 1993



::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
                             General Announcments
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

                 Discussion List for Chronic Fatique Syndrome
            From: "Roger Burns, CFS-MED Moderator" <[e-mail]>

                                 Announcement

An Internet discussion list (CFS-MED) has been created to enable physicians to
discuss medical research and clinical issues regarding chronic fatigue
syndrome (CFS), usually known outside of the USA as myalgic encephalomyelitis
(ME).  CFS/ME can be difficult to diagnose, and available treatments are not
widely known.  Discussions on CFS-MED will hopefully increase knowledge within
the medical community about this important illness.  The list is moderated.
CFS/ME is an illness characterized by debilitating fatigue and a variety of
flu-like symptoms.  The illness is also known as chronic fatigue immune
dysfunction syndrome (CFIDS), and in the past it has been known as chronic
Epstein-Barr virus (CEBV).

To subscribe to CFS-MED, send the following command to LISTSERV@NIHLIST or to
[e-mail]:

     SUB CFS-MED your_full_name

where "your_full_name" is your name.  For example:

     SUB CFS-MED William Harvey M.D.

Please remember that CFS-MED is a LISTSERV list, so that administrative
commands (such as SUBSCRIBE, etc.) must be sent to LISTSERV@nodename, whereas
messages for posting to the list must be sent to CFS-MED@nodename.

Note that the CFS-NEWS Electronic Newsletter is also available for
subscription at the same LISTSERV.  CFS-NEWS emphasizes medical news about
CFS, and is issued between 1 and 4 times each month. Additionally, there is a
CFS-L general discussion list where patients and others exchange information,
also at the same LISTSERV.


@NUMCALLS@@DLBYTES@@INCONF@@NUMTIMESON@@EXPDATE@@HOMEPHONE@@DATAPHONE@Roger Burn
Moderator, CFS-MED medical list
Editor, CFS-NEWS Chronic Fatigue Syndrome Electronic Newsletter
List-owner, CFS-L discussion

Health InfoCom Network News                                            Page 79
·    Subject: HICN605 Medical Newsletter Part 3/6

"Idiopathic CD4+ T-Lymphocytopenia--Four Patients With  Opportunistic
Infections and No Evidence of HIV Infection" New England Journal of Medicine
(02/11/93) Vol. 328, No. 6,  P. 393  (Duncan, Robert A. et al.)

     Although lifelong suppressive therapy is recommended for many  AIDS-
related conditions, it is unclear whether similar principles apply to patients
with idiopathic CD4+ T-lymphocytopenia (ICL),  write Robert A. Duncan et al.
of Boston City Hospital and  University Hospital Boston University School of
Medicine in  Boston, Mass.  Four patients without major risk factors for HIV
infection were examined, each of whom was presented with severe  opportunistic
infections and was found to have ICL.  The  opportunistic infections
experienced by the ICL patients included Pneumocystis carinii pneumonia (PCP),
cryptococcal meningitis,  and histoplasma-induced brain abscess.  During 10 to
68 months of observation, none of the four patients had evidence of infection
with HIV type 1 or 2 or human T-cell lymphotropic virus type I or II on the
basis of epidemiologic, serologic, or  polymerase-chain-reaction studies or
culture, nor was there any  detectable reverse transcriptase activity.  While
all of the  patients had severe persistent CD4 T-lymphocytopenia (range 12 to
293 cells per cubic millimeter), the CD4 cell count progressively declined in
only one and was accompanied by multiple  opportunistic infections.  All four
patients had substantially  reduced numbers of circulating CD8+ T cells,
natural killer  cells, or B cells.  These four patients had ICL with
opportunistic infections but no sign of HIV infection.  Instead  of the
progressive, selective depletion of CD4 T cells  characteristic of HIV
infection, some patients with ICL have  stable CD4 T cell counts accompanied
by decreases in the levels  of several other lymphocyte subgroups, the
researchers conclude.
     =====================================================================
                               February 25, 1993
     =====================================================================
"Questions Raised About AIDS Case" Los Angeles Times--Washington Edition
(02/25/93), P. A6   (Cimons, Marlene)

     A report published yesterday in the British journal Nature raised
questions about whether a Florida dentist who died of  AIDS--accused in a
highly publicized case of infecting five  patients with HIV--actually was the
source of transmission.   Ronald W. DeBry, an evolutionary biologist in
Florida State  University's department of biological science and one of the

Health InfoCom Network News                                            Page 28
Volume  6, Number  5                                            March  8, 1993

researchers in the report, said, "We are not saying that the  dentist did not
infect the patients--we're saying you really  can't prove it one way or the
other."  The case of Dr. David Acer was the only reported instance of HIV
transmission from an  infected health professional to a patient since the AIDS
epidemic began in 1981.  Officials from the Centers for Disease Control,  who
conducted the first investigation and have concluded that  Acer was the
source, criticized the Nature report, saying that it ignores significant
additional proof that points to the dentist.  The CDC investigation indicated
that none of the five infected  patients had any known high risk behaviors
that would have made  them more vulnerable to infection.  DeBry and his
colleagues used molecular sequencing techniques in the study and analyzed
viral  samples obtained from all of Acer's infected patients.  They also
compared these samples to known information about the strain that infected
Acer, even though they did not have an actual sample  from the dentist.  The
strains of HIV were then compared to  "control" samples obtained from HIV-
positive individuals in  Florida who had no known connection to Acer.  They
discovered  that "there is not enough difference between the dental group
sequences and the control sequences to prove that these [dental]  sequences
are a separate set," said DeBry.   Related Story: Baltimore Sun (02/25) P. 17A
=====================================================================
"Vestar Files for Approval of AIDS-Related Kaposi's Sarcoma  Treatment" United
Press International (02/24/93)

     San Dimas, Calif.--Vestar Inc. announced Wednesday that it has  submitted
a new-drug application to the Food and Drug  Administration for DaunoXome, its
drug that treats AIDS-related  Kaposi's sarcoma.  DaunoXome has been
distributed in Europe to  individual patients by Vestar, but the company has
not yet  received approval to market the drug.  Among all of the cancers  that
are associated with AIDS, Kaposi's sarcoma is the most  common.  The disease
causes lesions of the skin, mucous  membranes, and lymph nodes, and often
progresses to internal  organs, including the lungs and gastrointestinal
tract.  Kaposi's sarcoma is experienced in approximately 15 percent or more of
AIDS patients.
=====================================================================
"Expanded European AIDS Case Definition" Lancet (02/13/93) Vol. 341, No. 8842,
P. 441   (Ancelle-Park, Rosemary et al.)

     Because of the importance of having a common AIDS case definition in
Europe, all European countries should implement the new  expanded AIDS case
definition, write Rosemary Ancelle-Park et al. of the Hopital National de
Saint-Maurice in Saint Maurice,  France.  The European Center for the
Epidemiological Monitoring  of AIDS gathered experts in public health and
epidemiology  participating in the AIDS Prevention and Control Research
Program of the European Community in Jan. 1993.  The attendees discussed  the
case definition of AIDS for surveillance purposes in Europe,  following the

Health InfoCom Network News                                            Page 29
Volume  6, Number  5                                            March  8, 1993

introduction of an expanded surveillance case  definition in the United
States.  The 1993 U.S. revised  definition adds pulmonary tuberculosis,
recurrent pneumonia and  invasive cervical cancer to its list of 23 conditions
defining  AIDS.  Also, it added HIV-positive people who have a CD4+ count
under 200 to the list.  In 1991, European countries decided that  HIV-positive
people should not be defined as having AIDS based on CD4 counts alone because
of concerns over the accurateness of  AIDS surveillance based solely on the
degree of  immunosuppression, biases that would be introduced in comparing
AIDS exposure categories, and possible negative psychological  effects on
asymptomatic HIV-positive patients.  Also, access to  medical care in Europe
is not based on a person meeting an AIDS  definition.  After meeting with AIDS
surveillance representatives in 38 European countries, this position was
reconfirmed by the  expert group.  The possible inclusion of the three
opportunistic  infections that the U.S. added to its AIDS definition were
examined.  It was decided that the addition of these illnesses  was valuable
for epidemiologic purposes.
=====================================================================
"Orogenital Sex and Risk of Transmission of HIV" Lancet (02/13/93) Vol. 341,
No. 8842, P. 441  (Spencer, Brenda)

     Recommending to the public that orogenital sex is unsafe is  without a
question theoretically correct, but the use/efficacy of a method depends not
only on its biological efficiency but also  on its acceptability to the user,
writes Brenda Spencer of the  Hopital de Bicetre in Le Kremlin-Bicetre,
France.  In the Dec. 12 issue of the Lancet, correspondents report that HIV-1
has been  detected in the pre-ejaculatory fluid, and conclude that this  fluid
is therefore a potential vector for sexual transmission of  HIV.  But these
findings bring into question what the chance is  that the presence of HIV-1 in
the mouth will result in infection  of the receptive partner.  One of the most
difficult things in  health education is how to manage uncertainty about risk-
-as  suggested by the confusion as to what defines safe sex.  There  have been
both extremes to the risk of oral HIV transmission.  At the 1990 AIDS
conference in Montreal, one stand displayed a  poster recommending to gay men
that they engage in oral rather  than anal sex, whereas another ran a video
for adolescents  advising that deep kissing may present a risk of infection.
The  latter position neglects to consider the possibility that, faced  with a
multitude of differing recommendations, the individual may fail to comply with
any.  Some people have asked whether the  belief that orogenital sex carries a
high risk of transmission  yields an increase in unprotected anal sex.  The
formulation of  safer sex guidelines should consider psychological factors
along  with any new laboratory discoveries, concludes Spencer.
     =====================================================================
                               February 26, 1993
    ======================================================================
"As Their Life Expectancy Grows, So Do Needs of AIDS Patients" Washington

Health InfoCom Network News                                            Page 30
Volume  6, Number  5                                            March  8, 1993

Times (02/26/93), P. A1  (Goldberg, Karen)

     As a result of the longer life expectancy among AIDS patients,  more
treatment, both physical and mental, is also required.  Bob  Howard, spokesman
for the Centers for Disease Control, said the  life expectancy for HIV-
positive people has increased as a record number of HIV cases have developed
into full-blown AIDS.  Many of the opportunistic infections that accompany
AIDS would have  killed a patient much more quickly five years ago, according
to  Dr. Robert Thomas, a Washington, D.C., physician specializing in  HIV.
"When I was a resident [in 1987] people were looking at 18  months to live
after an AIDS diagnosis.  Now I tell them three to five years."  Aside from
medical services, longer-living AIDS  patients need social, legal, and
psychological assistance.  The  District's Whitman Walker Clinic, the city's
main provider of  services for AIDS patients, is having a difficult time
keeping  its food bank stocked.  Barbara Chinn, Whitman-Walker's deputy  chief
program officer, said the food bank "is serving 600 clients a month now.  This
time last year, it was 300.  I'd say in  another year it will be 900."
Approximately 2,000 volunteers  work for Whitman-Walker--an all-time high.
The clinic has 30  support groups, nine housing facilities, and three
satellite  offices, including the new Max Robinson Center.  The CDC's  Howard
said, "What we are seeing now is the maturing of the  epidemic.  More people
are presenting with AIDS, and that is a  reflection of what went on eight
years ago.  We have already seen a leveling off in that category
[homosexuals], but it is other  areas like heterosexuals and IV-drug users, we
are still  concerned about."
======================================================================
"Three Centers Plan Human Test of New AIDS Therapy" Reuters (02/24/93)
(Zengerle, Patricia)

     Pittsburgh--Researchers from the University of Pittsburgh Medical Center
announced on Wednesday they were preparing to launch human trials of an
encouraging new three-drug AIDS therapy recently  shown to inhibit HIV in a
test tube.  The human trials will be  funded by Merck & Co, which makes one of
the drugs being tested.  The research sites include the University of
Pittsburgh, the  University of Pennsylvania in Philadelphia, and Brown Miriam
Hospital in Providence, R.I.  This trial will apparently precede  by at least
several weeks the beginning of government-supported  human testing of a
similar treatment this spring.  The 24-week  study in Pittsburgh will involve
30 to 40 individuals infected  with HIV, who will be separated into two
groups.  The first group will receive AZT initially.  The other group will
receive AZT and a Merck drug called L-661.  After two months of therapy, both
groups will also begin to receive the AIDS drug ddI.  L-661 is  part of a new
class of experimental drugs known as  non-nucleosides, which have shown
promise in blocking the  replication of HIV in test tubes when used in
combination with  AZT and ddI.  The University of Pittsburgh researchers said

Health InfoCom Network News                                            Page 31
Volume  6, Number  5                                            March  8, 1993


their trial would start as soon as 30 to 40 volunteers, who must meet  several
criteria, are enrolled.
======================================================================
"Cardiac Structure and Function in HIV-Infected Children" New England Journal
Of Medicine (02/18/93) Vol. 328, No. 7,  P. 513  (Lewis, William and Dorn,
Gerald W.)

     Toxicity from AZT may be related to the development of  cardiomyopathy,
write William Lewis and Gerald W. Dorn of the  University of Cincinnati
Medical Center in Cincinnati, Ohio.  In  the Oct. 29 issue of the New England
Journal of Medicine,  Lipshultz et al. reported on cardiac dimensions and
function in  HIV-positive children and concluded that progressive left
ventricular dilation occurred independently of any effect of AZT. However,
Lewis and Dorn disagree with that conclusion.  Ejection  performance was
normal in Lipshultz's patients at the start of  AZT therapy but was depressed
after therapy.  Ejection  performance declined, but contractility was
unchanged.  The  causative factor appeared to be an increase in afterload
despite  increased posterior-wall thickness and left ventricular mass.   End-
systolic wall stress is related directly to end-systolic left ventricular
pressure and dimension and is related inversely to  wall thickness.  Because
end-systolic blood pressure was reported to be normal throughout the study,
end-systolic dimension must  have increased.  Since ejection performance, not
intrinsic  myocardial contractility, is the primary determinant of clinical
status, the data suggest that AZT can worsen the development of  dilated
cardiomyopathy in HIV-positive children.  But no data  from endomyocardial
biopsies were included.  The lack of  characteristic endomyocardial
morphologic changes would support  the authors' thesis that AZT had no cardiac
toxicity, but no  pertinent information was provided, conclude Lewis and Dorn.
======================================================================
"India: Zidovudine Production" Lancet (02/20/93) Vol. 341, No. 8843, P. 485
(Mangla, Bhupesh)

     Indian pharmaceutical company Cipla Laboratories has begun  manufacturing
and marketing a lower-cost AZT in 100 mg capsules  with the brand name
Zidovir-100.  The company is challenging  Burroughs Wellcome's Retrovir
because its price is significantly  cheaper.  This is good news for developing
countries which can't  afford the $3 per 100 mg capsule of Retrovir.  A study
by the  United Nations Development Program (UNDP) shows that the cost of
drugs will be a large determinant affecting the economic impact  of AIDS in
developing countries.  India may have to spend $1.6  billion on AIDS by the
year 2000.  Cipla was able to make its  drug cheaper with the help of the
Indian Institute of Chemical  Technology (IICT) in Hyderabad.  IICT, a
government-funded  laboratory, has made the most of India's patent laws,
according  to which pharmaceutical products can be granted only process
patents.  Therefore, a drug enjoying a product patent outside  India can be

Health InfoCom Network News                                            Page 32
Volume  6, Number  5                                            March  8, 1993

manufactured in the country made by a process  different from that used by the
original patent holder.  Dr. A.V. Rama Rao, ICCT director, said, "Our aim is
to make the drug  available at a low price to all the needy countries, whose
populace cannot afford the Burroughs Wellcome product.  Quality  wise there is
no difference between Burroughs and us.  In the  international markets, we all
have to meet the same standards."   Drug companies in the United States have
been enraged by the fact that India can get hold of U.S. patents.  But AZT
falls into a  gray area--it was discovered originally, not by Burroughs
Wellcome, but by the U.S. National Cancer Institute as an  anti-cancer
treatment.
======================================================================
"Rapid HIV Tests" Lancet (02/20/93) Vol. 341, No. 8843, P. 502   (Wannan, Gary
J. and Cutting, William A.M.)

     Multiple uses of the HIV-CHEK test gave results as accurate as  single
use of the test, write Gary J. Wannan and William A.M.  Cutting of the
University of Edinburgh in Edinburgh, U.K.  With  the HIV-CHEK method, antigen
from HIV-1 and HIV-2 are  incorporated in the membrane on the top of a small
block.  Buffer is passed through the membrane followed by a serum or plasma
sample from the person to be tested, then by gold conjugate and a wash
solution.  In positive cases a red-spot color reaction  develops on the
membrane within 10 minutes.  The researchers  discovered that they could put
samples from at least 6 patients  through the membrane before adding the gold
conjugate and wash  solutions and still get a positive result if any subject
was  infected.  The researchers tested samples from 491 pregnant women and
revealed that multiple use was just as accurate as single use of the test.  In
areas where the rate of HIV is low, it is  possible to screen between 4 and 10
blood donors, pregnant women, or individuals in a population screening program
with a single  HIV-CHEK.  Because the HIV-CHEK tests cost about 3 pounds
sterling per test, in an area where the rate of HIV infection is  less than 4
percent, the multiple sample screening method can  save about 2,400 pounds
sterling for every 1000 individuals  tested.  Even though the findings are
encouraging, there still is a great need for an accurate and inexpensive test
to detect HIV  antibodies, conclude Wannan and Cutting.
    ======================================================================
                                 March 2, 1993
    ======================================================================

"Shalala Backs Reorganization" Science (02/12/93) Vol. 259, No. 5097, P. 889
(Cohen, Jon)

     Secretary of Health and Human Services Donna Shalala recently  expressed
support for a Senate bill addressing the reorganization of the National
Institutes of Health's Office of AIDS Research  (OAR).  The proposal has
incited opposition from some scientists  and NIH officials who argue that it

Health InfoCom Network News                                            Page 33
Volume  6, Number  5                                            March  8, 1993

would add another layer of  bureaucracy to AIDS research.  The Senate proposal
is designed to improve planning and coordination of AIDS research at the 21
NIH  institutes by giving the OAR more authority over NIH's AIDS  budget and
establishing a discretionary fund for the OAR director to use at his or her
discretion.  Those who oppose the Senate  bill include NIH directors, who on
Jan. 22 sent a memo to NIH  Director Bernadine Healy addressing their fears
that the budget  process would be "severely disrupted" by the proposed changes
which "may inadvertently be detrimental" to AIDS and non-AIDS  research.
Healy sent the memo to Shalala, who subsequently  showed it to members of the
House subcommittee on health and the  environment.  She told the subcommittee
that although she doesn't think "a reorganization alone will yield
improvements in science  necessarily," HHS backs the bill because it hopes
that a  strengthened OAR will elicit "a clearer view of where we're  going."
She added that if the plan backfires and hampers AIDS  research, "we will be
the first ones back here at this table to  tell you that we have a structure
that doesn't work."
======================================================================
"Use of Evolutionary Limitations of HIV-1 Multidrug Resistance to Optimize
Therapy" Nature (02/18/93) Vol. 361, No. 6413, P. 650   (Chow, Yung-Kang et
al.)

     Convergent combination therapy may be beneficial to the treatment of HIV-
1 infections and in post-exposure prophylaxis, write  Yung-Kang Chow et al. of
the Massachusetts General Hospital and  Harvard Medical School in Boston,
Mass.  Certain drug  combinations may prevent the co-existence of adequate
reverse  transcription function and multi-drug resistance (MDR).   Retroviral
drug resistance is conferred only by mutations in its  own genome and is
limited by genome size.  Therefore, combination drugs directed against the
same essential viral protein may thus  prevent HIV-1 MDR, whereas the
conventional approach of targeting different HIV-1 proteins for combination
therapy may not.  This  is because genomes with resistance mutations in
different HIV-1  genes might recombine to develop MDR.  The researchers tested
whether combinations of mutations giving rise to single-agent  resistance
might further compromise or even abolish viral  replication, and if multidrug-
resistant virus could be  constructed.  Certain combinations of mutations
conferring  resistance to AZT, ddI, and pyridinone are incompatible with
viral replication.  These findings suggest that evolutionary  limitations
exist to restrict development of MDR.  Furthermore,  elimination of reverse
transcription by convergent combination  therapy may also limit MDR, the
researchers conclude.
    ======================================================================
                                 March 3, 1993
    ======================================================================
"Johnson and Johnson Belgian Unit in HIV Drug Trials" Reuters (03/02/93)


Health InfoCom Network News                                            Page 34
Volume  6, Number  5                                            March  8, 1993

     Brussels--American pharmaceutical firm Johnson and Johnson's  Belgian
subsidiary Janssen Pharmaceutica, announced yesterday it  had tested an AIDS
drug that stopped the replication of one  strain of HIV in the test tube.
However, HIV developed  resistance to the drug, alpha-APA, when used by
itself.  Janssen  said it began tests on HIV-positive patients and had
discovered  that alpha-APA was well absorbed by the body and had few adverse
side effects.  Other tests are being conducted to determine  whether the drug
blocks the spread of HIV in the body.  The  alpha-APA compound inhibits the
action of reverse transcriptase,  which can lead to the development of full-
blown AIDS.  The drug  company said that like similar agents, alpha-APA was
effective  against the strain of HIV called HIV-1, but not against HIV-2.
Janssen is planning clinical trials to test the efficacy of  combinations of
alpha-APA and other drugs.  "These studies will  indicate whether such
combinations of drugs will inhibit the  multiplication of the virus for a
longer period and prevent  resistance," said the company.  Other companies
conducting  similar studies have found that the virus developed resistance
when used with reverse transcriptase inhibitors.  They  subsequently used
combinations of inhibitor drugs and AZT to  overcome the problem.
======================================================================
"HIV Vaccine Enters Clinical Trial Stage" American Medical News (03/01/93)
Vol. 36, No. 9, P. 25

     The first large-scale clinical trial of an AIDS vaccine has been
launched in Sweden and will last six years.  The trial will be  testing VaxSyn
made by MicroGeneSys Inc.  The therapeutic vaccine has exhibited its ability
to stabilize or reduce the amount of  virus in an HIV-positive person, incite
an immune response, and  stop the loss of CD4 cells.  The trial in Sweden is
the last test MicroGeneSys must undergo before it can begin commercial
production of the vaccine.
======================================================================
"Cheaper Way to Make AZT" American Medical News (03/01/93) Vol. 36, No. 9, P.
25

     A less expensive process for making AZT has been developed by a  Japanese
company.  The pharmaceutical company Kobayashi Koryo  makes thymidine, a key
ingredient of AZT, using heat evaporation, a process that is up to 50 percent
cheaper than the current  fermentation method, said company officials.  The
trading concern Kanematsu Corp. expects to start selling thymidine to drug
companies in India and Brazil by the end of the year.
======================================================================
"HIV Clue Announced" American Medical News (03/01/93) Vol. 36, No. 9, P. 25


     A chemical transformation in cells that helps explain how HIV  spreads
has been discovered by researchers at the Webb-Warring  Institute in Denver,
Colo.  According to the scientists, HIV  quells production of a vital enzyme

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Volume  6, Number  5                                            March  8, 1993

called superoxide dismutase.  The researchers are testing human cell cultures
to elucidate if a drug can inhibit HIV's ability to suppress the enzyme.  If
they  are able to safeguard the enzyme's levels in cells, the time HIV  stays
inactive could be prolonged.
     ====================================================================
                                 March 5, 1993
     ====================================================================

"Hospitals Told to Test for HIV" Washington Post (03/05/93), P. A3

     Hospitals with significant numbers of AIDS cases should offer HIV testing
to all persons admitted or treated in emergency rooms,  federal health
officials announced yesterday.  The Centers for  Disease Control issued
guidelines that require voluntary testing  for HIV to be routine in about 600
hospitals--11 percent of the  nation's total--mostly in urban areas.  The
results of the tests  would be kept confidential and people could not be
denied care  because they objected to being tested for HIV.  Secretary of
Health and Human Services Donna Shalala said, "These  recommendations will
help people learn of their HIV status and  get early treatment.  They will
also be able to take precautions  to protect loved ones."  A toll-free hotline
for physicians and  other health care physicians will also be provided by the
HHS to  answer questions about treating patients with HIV/AIDS.  The new  CDC
guidelines advise hospitals to offer voluntary testing to  everyone between
the ages of 15 to 54 admitted to the hospital or treated in the emergency
room, clinics, or other outpatient  departments.  The agency encourages
testing in hospitals with  rates of infection of at least 1 percent or in the
event that one in 1,000 discharged patients has AIDS.  The tests would reveal
more than two-thirds of HIV-positive persons in those age groups  hospitalized
for conditions other than HIV/AIDS, according to the CDC.
====================================================================
"Six More Sites Named for AIDS Therapy Test" Journal of Commerce (03/05/93),
P. 5A

     Six additional locations where human trials of a new AIDS  treatment will
be conducted were tentatively named yesterday by  the National Institutes of
Health.  The new sites are Indiana  University in  Indianapolis, Mount Sinai
Hospital in New York,  the University of California--San Diego, the University
of  Cincinnati, the University of North Carolina--Chapel Hill, and  the
University of Pennsylvania in Philadelphia.
====================================================================
"A Shot in the Arm for TB Research" Science (02/12/93) Vol. 259, No. 5097, P.
886  (Watson, Traci)

     Nearly a decade since tuberculosis began making its resurgence,  the
government has started giving research into the disease a  higher priority.

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Volume  6, Number  5                                            March  8, 1993

NIH Director Bernadine Healy intends to improve funding for TB research by
reallocating money among the NIH  institutes.  Healy told the Clinton
administration that this  year, she will provide $12.5 million more than
planned for  research on mycobacterium, including new diagnostic techniques
and treatments.  About $9.2 million of the funding will come from cutting
other NIH programs.  Although the increase will make the  funding for TB
research $37 million in 1993, Healy also seeks to  obtain emergency money from
Congress through lobbying efforts.   She hopes increased congressional
spending on TB research will  attract more scientists to study the disease.
However,  congressional members said getting more money from Congress will
prove difficult with President Bill Clinton's pressure to cut  governmental
spending.  Healy claims additional funding is  imperative because the number
of TB cases increased 18 percent  between 1985 to 1991, and many of the new
cases are resistant to  existing drugs.
====================================================================
"Triple Teaming the Deadly AIDS Virus" U.S. News & World Report (03/01/93)
Vol. 114, No. 8, P. 60   (Brink, Susan)

     The recent finding that three drugs used in combination were  effective
in attacking HIV in the test tube is encouraging for  future research, even if
this method is not effective in humans.  Yung-Kang Chow, a little-known AIDS
researcher, developed the  three-drug approach, which is intended to force the
virus to  profusely mutate until it destroys itself.  Chow and colleagues  at
Massachusetts General Hospital combined AZT and ddI with  either pyridinone or
nevirapine.  The chemical mix either  overwhelmed the virus or forced it to
mutate so fast and  furiously it couldn't replicate itself.  By adding a third
agent--either pyridinone or nevirapine--to the AZT/ddI  combination, Chow et
al. managed to compel HIV to mutate three  times simultaneously in an attempt
to survive.  Three quick  mutations are more than the virus can tolerate in
the test tube.  The new approach, called "convergent combination therapy," is
an  extreme departure from the traditional method of treating HIV  infection,
in which researchers have attempted to disable the  virus at various stages in
the disease's development.  But the  researchers are cautious about the new
strategy's clinical  potential, warning that any practical benefit from this
research  could be years away.  The National Institutes of Health is
currently forming clinical trials of the drug combination  expected to begin
no later than July.  Although the research is  preliminary, it helps reinforce
the idea that AIDS might someday  be controlled by a combination of drugs.
====================================================================
"Playing Chess With Reverse Transcriptase" Nature (02/18/93) Vol. 361, No.
6413, P. 588   (Richman, Douglas D.)

     Scientists are researching the possibility of making the human
immunodeficiency virus (HIV) inviable by introducing mutations  for drug-
resistance.  Chemotherapy for HIV patients prolongs  their disease-free

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Volume  6, Number  5                                            March  8, 1993

interval.  However, this nucleoside treatment, using AZT, ddC, and ddI, only
reduces the virus replication but  doesn't completely suppress it.  These
drugs work by inhibiting  the viral enzyme.  The disease continues to
progress, which may  result from emergence of viral mutants with less
susceptibility  to the treatment drugs.  A second class of possible inhibitors
of HIV-1 replication also stops reverse transcriptase (RT).  Several
chemically distinct non-nucleoside compounds share properties,  including low
toxicity, high potency, synergy with nucleoside  agents, and excellent
pharmacokinetic properties.  However, the  resistant mutants of HIV indicate
that the non-nucleoside reverse transcriptase inhibitors may possess a weak
element when used as  drugs.  Although reducing the amounts of virus
replication and  increasing CD4 lymphocyte counts, the drugs dissipated after
one  month, which is about the same time as the appearance of the  mutants.
    ======================================================================
                                 March 4, 1993
    ======================================================================
"The Emergence of Drug-Resistant Tuberculosis in New York City" New England
Journal of Medicine (02/25/93) Vol. 328, No. 8,  P. 521  (Frieden, Thomas R.
et al.)

     AIDS patients are more likely to be infected with drug-resistant
tuberculosis and are more likely to die if infected with these  organisms,
write Thomas R. Frieden et al. of the Centers for  Disease Control in Atlanta,
Ga.  The researchers gathered  information on every patient in New York City
with a positive  culture for Mycobacterium tuberculosis during April 1991.
Among  the 518 patients with positive cultures, 466 (90 percent) had  isolates
available for testing.  A total of 33 percent of these  patients had isolates
resistant to one or more antituberculosis  drugs, 26 percent had isolates
resistant to at least isoniazid,  and 19 percent had isolates resistant to
both isoniazid and  rifampin.  Among the 239 patients who had received
antituberculosis therapy, 44 percent had isolates resistant to  one or more
drugs and 30 percent had isolates resistant to both  isoniazid and rifampin.
Of the patients who had never been  treated, the proportion with resistance to
one or more drugs  increased from 10 percent in 1982-1984 to 23 percent in
1991.   Patients who had never been treated and who were HIV-positive or
reported IV-drug use were more inclined to have resistant  isolates.  Among
AIDS patients, those with resistant isolates  were more likely to die during
follow-up through January 1992.  A history of antituberculosis treatment was
the strongest indicator for the presence of resistant organisms.  Improvements
in  TB-control programs and in social and economic conditions are  greatly
needed and can promote the control of both TB and the  emergence of drug-
resistant organisms, conclude the researchers.
======================================================================
"Dental HIV Transmission?" Nature (02/25/93) Vol. 361, No. 6414, P. 691
(DeBry, Ronald W. et al.)

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Volume  6, Number  5                                            March  8, 1993


     The case of the Florida dentist who allegedly infected five of  his
patients needs to be examined more closely with another  dataset from some
other region of the HIV genome, write Ronald W. DeBry et al. of the Florida
State University in Tallahassee, Fla. Ou et al. recently reported that the
dentist did indeed transmit  the virus to his five patients.  Population
genetics indicate  that a rapidly evolving marker can develop strong
geographical  substructure. Therefore, an appropriate null hypothesis is that
the patients independently acquired similar variants within the  local
community.  The dental transmission hypothesis entails that a branch on the
viral phylogenetic tree lead to the dental group  alone and not include any
controls.  But in phylogenetic terms,  the dental group must be monophyletic.
The null hypothesis would be rejected if a tree with a monophyletic dental
group is  significantly better supported than any tree with controls
intermixed within the dental group.  The researchers tested the  hypotheses
using new sequences from the dental patients and a new set of regional
controls.  This selection is justified: the  dental group should be
monophyletic compared to any controls.  In addition, the test is biased in
favor of accepting the dental  transmission hypothesis because the controls in
both studies were obtained at clinics about 90 miles from the dentist's
practice  area.  The researchers conclude that the available data are
consistent with both the dental transmission hypothesis and the  null
hypothesis and do not yet distinguish between the two.
Volume  6, Number  5                                            March  8, 1993



::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
               Clinical Alerts from National Institues of Health
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

                                CLINICAL ALERT
        IMPORTANT THERAPEUTIC INFORMATION ON TREATMENT OF HIV INFECTION


Health InfoCom Network News                                            Page 39
         IN HIV-INFECTED PATIENTS WHO ARE INTOLERANT OF OR HAVE FAILED
                              ZIDOVUDINE THERAPY
                           Released February 1, 1993

                           Purpose of this Document

This document provides information on the results of a recently completed
clinical trial that compared ddI and ddC in HIV-infected patients who were
intolerant of or who had failed zidovudine therapy.  Application of these
results beyond this specific patient population can not be supported by this
study.  The study was conducted by the Terry Beirn Community Programs for
Clinical Research on AIDS (CPCRA), which is part of the National Institute of
Allergy and Infectious Diseases of the National Institutes of Health.  This
information is provided to you, as a health care practitioner, to serve as
preliminary information while a manuscript is being readied for submission to
a peer-reviewed medical journal.

                          Introduction and Background

The CPCRA was established in 1989 to involve community physicians and their
patients in studies of treatments for HIV.  A unique feature of this program
is its community-based focus for evaluating the effectiveness of a broad
spectrum of therapies and treatment regimens.  The CPCRA is comprised of 17
research units, consisting of consortiums of primary care physicians and
nurses, located in 13 U.S. cities.  These research units represent a
significant geographic, racial and risk group diversity.  Through this
diversity, the CPCRA extends greater opportunity for participation in clinical
research to those persons underrepresented in traditional, university-based
HIV studies.

                                 Study Design

The CPCRA ddI/ddC study was designed to answer the important clinical question
of which one of the currently available nucleoside analogues should be given
to a patient who can no longer tolerate or has failed ZDV therapy.  The study
was an open-label comparison of ddI and ddC with progression of disease,
including death, and tolerance of the study drugs as the main endpoints.

The CPCRA ddI/ddC study opened in December 1990 and enrolled 467 patients by

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Volume  6, Number  5                                            March  8, 1993

September 20, 1991, exceeding target accrual three months earlier than
projected.  All patients were followed for at least one year after the last
patient was enrolled.  The protocol ended follow-up on September 20, 1992.

                               Study Population

Study Population: 230 patients were randomized to receive ddI and 237 to
receive ddC.  Ten percent of the patients were women and two-thirds were
white.  Nearly a quarter of the patients enrolled had a history of injection
drug use.  The average age was 38 years.  Approximately 63% of patients were
ZDV intolerant, 48% of them because of hematologic intolerance.  Intolerant
--------- end of part 3 ------------