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HICNet Medical News Digest Sun, 11 Sep 1994 Volume 07 : Issue 45
Today's Topics:
AIDS Daily News Summary, Part 1
AIDS Daily News Summary Part 2
+------------------------------------------------+
! !
! Health Info-Com Network !
! Medical Newsletter !
+------------------------------------------------+
Editor: David Dodell, D.M.D.
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Compilation Copyright 1994 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
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joining the automated distribution system, please contact the editor.
Associate Editors:
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Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden
Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA
Lawrence Lee Miller, B.S. Biological Sciences, UCI
Dr K C Lun, National University Hospital, Singapore
W. Scott Erdley, MS, RN, SUNY@UB School of Nursing
Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF
Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of Medicine
Martin I. Herman, M.D., LeBonheur Children's Medical Center, Memphis TN
Stephen Cristol, M.D., Dept of Ophthalmology, Emory Univ, Atlanta, GA
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FAX Delivery = Contact Editor for information
----------------------------------------------------------------------
Date: Sun, 11 Sep 94 08:33:36 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: AIDS Daily News Summary, Part 1
Message-ID: <PqVHsc30w165w@stat.com>
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, and the CDC
Clearinghouse should be cited as the source of this information.
Copyright 1994, Information, Inc., Bethesda, MD
In this issue:
************************************************************
"U.S. Official to Shift Funds Toward Basic AIDS Research"
"Pushing for Tests of AIDS Vaccines"
"AIDS Gene Therapy Hits Virus, Helps Body"
"New Drugs Said to Show Promise in Fight Against the
AIDS Virus"
"AIDS-Related Diagnostic Tools Start to Help in
Understanding the Disease"
"AIDS Conference Concludes Without Promise of Hope"
"AIDS Summit Ends With a Last Look at Weight of Prejudice"
"An Anti-HIV Vitamin"
"HIV And Anal Cancer; Anal Pap Smears, Early Treatment,
Recommended for High-Risk Men & Women"
"High HIV Levels Raise Risk to Newborns, 2 Studies Show"
"HIV Patients Appear Vulnerable to Bloodstream Infections"
"D.C. AIDS Program Offers 3 New Drugs"
"First Oral Vaccine Study Launched in Baltimore & Rochester, NY"
"Weighing HIV Vaccine Trials"
"Lack of Behaviour Studies Is Hampering AIDS Prevention"
"Racial Differences in the Use of Drug Therapy for HIV Disease"
"Reverse Logic: Smart Drugs Target HIV and a Herpes Virus"
"From the FDA: Combination Tuberculosis Drug Approved"
************************************************************
"U.S. Official to Shift Funds Toward Basic AIDS Research"
New York Times (08/10/94) P. A9
(Pollack, Andrew)
Dr. William E. Paul, federal coordinator of AIDS research in the
United States, announced at the 10th International Conference on
AIDS that he would shave spending on clinical trials of potential
new drugs and allocate more money for the "revitalization and
expansion" of basic AIDS research. As efforts to develop new
treatments and vaccines for the disease encounter one hurdle
after another, scientists are forced to return to basic research
in order to learn more about HIV and how it destroys the body's
immune system, said researchers attending the conference. Paul
said his goal is to boost by 20 percent the amount spent on basic
research in response to grant proposals from scientists, instead
of projects decided upon by the government. He said the
government would, however, continue to support efforts to develop
vaccines, but would concentrate on second-generation vaccines
using new mechanisms. Related Story: Los Angeles
Times--Washington Edition (08/10) P. A1
"Pushing for Tests of AIDS Vaccines"
USA Today (08/10/94) P. 1D
(Levy, Doug)
Scientists participating at the 10th International Conference on
AIDS this week in Yokohama, Japan, are trying to convince
American health authorities that candidate vaccines are ready for
large-scale testing. Early studies indicate that at least two
experimental vaccines--from Genentech Inc. in San Francisco,
Calif., and Biocene Co. in Emeryville, Calif.,--show promise.
But National Institute of Allergy and Infectious Diseases
Director Anthony S. Fauci contends that the time has not yet come
for expanded human trials, saying they "may have little chance of
working" and could impart a false sense of security upon
volunteers. Only wider trials can provide the answers to crucial
questions about whether or not a vaccine works, and why, argues
Dani Bolognesi of Duke University. Related Story: Los Angeles
Times--Washington Edition (08/10) P. A1
"AIDS Gene Therapy Hits Virus, Helps Body"
United Press International (08/10/94)
(Kelly, Janis)
On Wednesday, Dr. Flossie Wong-Staal and Dr. Philip Greenburg
presented research that could help in the fight against AIDS.
Wong-Staal's research group has put genes into cells that destroy
the RNA of the HIV virus, creating cells that can successfully
fight the virus even after it has gotten in. Greenburg and his
associates at the Hutchinson Cancer Center in Seattle are trying
to fight AIDS by manipulating the genes in CD8 white blood cells
so that they do not require the presence of CD4 cells, the cells
destroyed by the virus, in order to multiply. Greenburg has also
developed a method of growing large numbers of white blood cells
that specifically kill the AIDS virus.
"New Drugs Said to Show Promise in Fight Against the AIDS Virus"
New York Times (08/11/94) P. A16
(Pollack, Andrew)
A new class of drugs called protease inhibitors could be the
newest weapon in the war against AIDS, scientists said in
Yokohama, Japan, on Wednesday, but the usefulness of these drugs
is questionable. There are now about six versions of protease
inhibitors being tested on patients and about 20 others in early
development, but these drugs are not a cure for AIDS. At most,
they can prolong a patient's life or delay the onset of AIDS
after HIV infection, although even this effect is short-lived
because the virus develops a resistance to protease inhibitors
after a few months. Many researchers hope that a combination of
protease inhibitors with other drugs will make it more difficult
for the virus to develop such a resistance.
"AIDS-Related Diagnostic Tools Start to
Help in Understanding the Disease"
Wall Street Journal (08/11/94) P. B6
(Hamilton, David P.)
New AIDS-related diagnostic tools, known as direct-viral assays,
are providing an unprecedented peek at how the disease invades
and destroys the human body. Researchers have previously
assessed the progression of HIV infection primarily through
observance of cells and proteins in a patient's immune system--a
method that has not proven useful to researchers seeking the best
time to initiate treatment with antiviral drugs that interfere
with HIV replication. Direct-viral assays, however, measure the
quantity of HIV in the blood by counting RNA molecules produced
by the virus during replication. This approach may be helpful in
monitoring the efficacy of drugs that directly attack HIV, and
also may alert clinicians when a therapy begins to lose potency.
The one big problem with the new diagnostic tools is that it has
not yet been clearly shown that the level of HIV is directly
correlated to the symptoms of disease.
"AIDS Conference Concludes Without Promise of Hope"
Baltimore Sun (08/12/94) P. 4A
A summary of the 3,500 reports presented this week at the 10th
International Conference on AIDS yielded the same gloomy
conclusion: There is no cure, no vaccine, and no effective
treatment for AIDS--and there won't be any time in the near
future. "Anyone with HIV won't find much solace in this
meeting," said Dr. Mervyn Silverman, president of the American
Foundation for AIDS Research. Organizers of the Yokohama, Japan,
conference warned the 12,000 participants from the beginning not
to expect any great revelations, and rightly so. If any one
theme emerged from the conference, it was the need to return to
the blackboard, to the basics of HIV and the body's response to
it. Related Stories: Philadelphia Inquirer (08/12) P. A2; New
York Times (08/12) P. A1; Investor's Business Daily (08/12) P. A1
"AIDS Summit Ends With a Last Look at Weight of Prejudice"
USA Today (08/12/94) P. 3D
(Levy, Doug)
The 10th International Conference on AIDS concluded Thursday in
Yokohama, Japan, as participants reflected on the scientific and
social progress--and lack thereof--since the AIDS onslaught began
in 1981. As conference-goers inside of the Pacifico Yokohama
conference center discussed avenues to end discrimination against
AIDS patients, only two Japanese people outside braved the
potential for discrimination and publicly acknowledged their
infection. Japan reports only hundreds of AIDS cases. In the
closing ceremonies of the conference, ACT UP activist Andrew
Velez led a brief demonstration targeting nations who deny entry
to HIV patients.
"An Anti-HIV Vitamin"
Science (07/15/94) Vol. 265, No. 5170, P. 314
Studies have demonstrated that HIV-positive pregnant women
transmit the virus to their infants 10 to 40 percent of the time,
provoking questions as to why some babies become infected and
others do not. A recent study in Malawi suggests that vitamin A
deficiency, which is known to compromise the immune system, may
influence whether pregnant women pass HIV on to their babies.
Richard Semba and colleagues at Johns Hopkins School of Hygiene
and Public Health, in collaboration with John Chiphangwi from
Malawi Medical College, measured the vitamin A levels in 333
HIV-infected mothers-to-be. The babies were tested for HIV after
birth. Semba et al. found that women who did not transmit the
virus had vitamin A levels averaging 1.07 per liter, while women
who did not transmit HIV had levels of vitamin A averaging only
0.86 per liter--a level that is considered deficient. It is
uncertain how vitamin A might affect maternal-infant HIV
transmission, but Semba is drafting plans for studies to test the
theory that treating HIV-positive pregnant women with vitamin A
might decrease transmission rates.
"HIV And Anal Cancer; Anal Pap Smears, Early Treatment,
Recommended for High-Risk Men & Women"
AIDS Treatment News (07/22/94) P. 2
(Smith, Denny)
Joel Palefsky, M.D. and his staff at the University of
California has been surveying possible increases in precancerous
changes in anal tissue that might occur in people who have both the
human papilloma virus(HPV), which causes genital and anal warts,
and HIV. His observations, boosted by other similar studies,
start from the idea that HPV may cause some abnormal anal cells,
called dysplasia; then those cells may later turn into actual
tumors, or neoplasia. Some researchers think that co-infection
with HIV might increase the rate of dysplasia. Dr. Palefksy's
staff looked at the cancer registry statistics for San Francisco,
and saw the rate of reported anal cancer was higher in communities
that had a greater number of people who are HIV-positive. Now,
there are indications that HPV/HIV co-infection is strongly
linked with neoplasia in the cervix(cervical intraepithelial
neoplasia, or CIN), and in the anus(anal intraepithelial
neoplasia, or AIN). In one of Palefsky's AIN studies of men , he
discovered that 11 percent of the HIV-positive group had AIN, as
compared to 2 percent of the control group. AIN can be detected
using Pap smears of anal cells. Most AIDS care providers don't
furnish this test, but data from studies might change this. Dr.
Palefsky recommends annual AIN screens for all HIV-positive
people with CD4 counts below 500, women with a history of
virulent CIN, and all men who have a history of being the
receptive partner in anal sex.
"High HIV Levels Raise Risk to Newborns, 2 Studies Show"
New York Times (08/17/94) P. C8
(Altman, Lawrence K.)
Two new studies show that the chance of an HIV-positive pregnant
woman infecting her baby with HIV increases with the amount of
the virus in her blood. The studies, conducted at the New York
State Health Department and New York University, are said to be
the first to measure the amount of HIV in a mother and her
child's blood throughout pregnancy and into the infant's first
months of life. Doctors have yet to determine why only one in
four babies born to HIV-positive mothers is infected with the
virus. The authors of the studies believe that finding the
answer could lead to preventing all transmissions between a
mother and her baby. The health department study also found that
pregnancy did not worsen AIDS in the women--a result that
contradicts previous studies.
"HIV Patients Appear Vulnerable to Bloodstream Infections"
AIDS Alert (07/94) Vol. 9, No. 7, P. 103
The high rate of bloodstream infections in hospitalized HIV
patients highlights the need for health care workers to follow
proper techniques for central line site preparation, say
officials at the Centers for Disease Control and Prevention. A
study of HIV patients in five medical centers indicates that
primary bloodstream infections are the most common nosocosmial
infection among HIV patients, with two-thirds of the infections
being traced to central lines. Improper techniques contributing
to central line infections would include the failure to wash
hands or wear gloves, failure to clean the site with an
antiseptic, and failure to check the site for inflammation. The
most common pathogens associated with line infections in HIV are
Staphyloccus aureus, enterococchi, and Pseudomonas aeruginosa.
"D.C. AIDS Program Offers 3 New Drugs"
Washington Post (08/16/94) P. B6
The District of Columbia has added diphenoxylate and atropine
(Lomotil), dronabinol (Marinol), and megestrol acetate (Megace)
to its list of free medications given to AIDS patients without
medical insurance. According to Peter Hawley, medical director
of the Whitman-Walker Clinic, Lomotil is an appetite stimulant,
Marinol is a diarrhea prevention treatment, and Megace is a
steroid that helps patients to gain weight.
"First Oral Vaccine Study Launched in
Baltimore and Rochester, NY"
AIDS Alert (08/94) Vol.8, No. 9, P. 119
Johns Hopkins University in Baltimore and the University of
Rochester (NY) are recruiting 16 healthy, uninfected volunteers
to participate in the first study of an oral AIDS vaccine
designed to prevent sexual transmission of HIV. The single-dose
Multicomponent Global AIDS Vaccine consists of a time-released
powder mixed with a bicarbonate of soda solution, which is
swallowed. The vaccine stimulates production of IgA, a secretory
antibody critical to the immune system. "The best protection
against infection of mucosal membranes is mucosal immunity,
because IgA antibodies located there attack organisms before they
can penetrate the body," says Dr. Jack Lambert, clinical director
of AIDS vaccine research at the John Hopkins Medical
Institution's Center for Immunization Research.
"Weighing HIV Vaccine Trials"
Science (08/05/94) Vol. 265, No. 5173, P. 735
(Holden, Constance)
The World Health Organization will hold a meeting in September to
debate the merits of conducting large-scale clinical HIV vaccine
trials--which some researchers say do not have much of a chance
of being proven effective. The meeting follows the June decision
of the National Institutes of Allergy and Infectious Diseases
head Anthony Fauci not to proceed with large-scale trials of two
HIV vaccines. He admits, however, that a different set of
circumstances might have swayed him in favor of holding the
trials. "If we had the dynamics of the epidemic seen in
Thailand," he explains, "that would tip the balance in favor of
going forward." Genentech Inc. and Biocine Inc., the
manufacturers of the two vaccines of the delayed U.S. trials, are
now considering conducting efficacy trials in Thailand.
"Lack of Behaviour Studies Is Hampering AIDS Prevention"
Nature (08/04/94) Vol. 370, No. 6488, P. 316
(Gavaghan, Helen)
The United States should allocate federal funds to conduct a
national survey that would fill the gaps in existing knowledge
on sexual practices and intravenous drug use, and their
correlation to HIV infection, says a panel of experts assembled
by the Institute of Medicine. Past requests for federal funds
for any survey including questions about sexual practices have
been opposed by strong conservatives and the religious right,
therefore, previous sex surveys were conducted only with the help
of private funding. The dearth of knowledge on sexual practices
and drug use, according to a report by the panel, is creating
roadblocks in efforts to prevent the spread of the disease.
"Without the information from such a survey, we all feel
profoundly crippled in attempts to devise effective prevention
messages," explains Mindy Thompson-Fullilove, a member of the IOM
panel. She says anti-AIDS messages commissioned by the Public
Health Service have not been adequately candid, frequent, or
well-targeted.
"Racial Differences in the Use of Drug Therapy for HIV Disease"
N.E.J.M. (08/04/94) Vol. 331, No. 5, P. 333
(Simon, Paul A.; Sorvillo, Frank J.; Lapin, Richard K.)
In Moore et al.'s study at an HIV clinic in Baltimore, the
findings suggested that black patients were less likely than
white patients to have received previous antiretroviral therapy
or prophylaxis against Pneumocystis carinii pneumonia (PCP).
Although Moore et al. gathered data from patient reports and
"accompanying medical records when available," Simon et al. note
that the researchers did not report the extent to which patients'
reports were validated by reviews of medical records. Simon and
his colleagues conducted data in Los Angeles County similar to
the Baltimore data. They discovered, however, that a significant
number of patient reports conflicted with the information on
their medical records. This discrepancy--patients saying they
had not received a treatment, while their records indicated that
they had--occurred more frequently among blacks and foreign-born
Latinos than among whites and U.S.-born Latinos. Simon et al.
suggest that Moore's conclusions may have been biased and are
potentially misleading. The differences, they said, may reflect
poor communication between health care provider and patient, or
between patient and research interviewer.
"Reverse Logic: Smart Drugs Target HIV and a Herpes Virus"
Science News (08/06/94) Vol. 146, No. 6, P. 88
(Fackelmann, Kathy A.)
A new category of drugs, called antisense drugs, may be able to
target a specific disease without causing significant side
effects, but neither the efficacy nor the safety of such drugs
has yet been proven. An antisense drug is made from a sequence
of nucleotides that mirrors that of a target nucleic acid, such
as RNA, causing the two to stick together and cancel out the
protein. Hybridon has developed an antisense AIDS treatment
called Gem 91, which is supposed to resist degradation so that it
will maintain effectiveness even after it gets inside an
HIV-infected cell. Test-tube studies of Gem 91 showed that it
shut down replication of the virus for more than 80 days in
HIV-infected human cells, as reported by Sudhir Agrawal, chief
scientific officer at Hybridon, in the May 1, 1993 Proceedings of
the National Academy of Sciences. Agrawal's results give hope
that antisense drugs can provide a virtual cure for HIV if they
can halt the virus's ability to duplicate until the immune system
can contain the disease. Isis Pharmaceuticals has developed
another antisense compound to fight CMV, which often causes a
blinding eye infection in AIDS patients. Antisense compounds
could be very profitable for drug companies, enabling them to
switch from one antisense compound to another to treat a
different condition without changing their core chemistry group.
"From the FDA: Combination Tuberculosis Drug Approved"
J.A.M.A. (08/03/94) Vol. 272, No. 5, P. 344
The Food and Drug Administration has granted approval to a
cocktail of rifampin, isoniazid, and pyrazinamide for the
treatment of tuberculosis. Health experts expect the triple
therapy to reduce the number of patients who do not adhere to the
standard long-term multidrug regimen for treating TB--a problem
that has been a public health concern for years. The combination
drug is also expected to guard against unintentional overdosing
or underdosing of any component drug, and protect against
selective discontinuation of one or more of the component drugs.
All of these factors should decrease the chance for emerging
drug-resistant TB.
------------------------------
Date: Sun, 11 Sep 94 08:34:14 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: AIDS Daily News Summary Part 2
Message-ID: <RRVHsc31w165w@stat.com>
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, and the CDC
Clearinghouse should be cited as the source of this information.
Copyright 1994, Information, Inc., Bethesda, MD
In this issue:
************************************************************
"Questions and Answers: Smoking Cessation in Patients With HIV"
"What Heterosexual Adults Believe About Condoms"
"Medical Care for Injection-Drug Users With Human
Immunodeficiency Virus Infection"
"HIV Therapy: An Pharmacist's Guide to Understanding"
"AIDS Chief Promises a Shift Towards Basic Research"
"Stavudine (d4T) for HIV"
"HIV Home Testing Fraught With Potential Problems"
"Zidovudine and the Quality of Life"
"AIDS Prevention Programs Do Work"
************************************************************
"Questions and Answers: Smoking Cessation in Patients With HIV"
JAMA (08/17/94) Vol. 272, No. 7, P. 564
(Chaisson, Richard E.)
Conflicting studies have made it unclear whether cigarette
smoking hastens progression of AIDS among HIV patients, notes Dr.
Richard E. Chaisson of Johns Hopkins University. Because it has
been linked to rapid depletion of CD4 cells, and an increase in
respiratory tract infections among infected persons, Chaisson
says smoking tobacco and other substances is clearly correlated
with important causes of sickness and death in HIV-positive
individuals. Previously, however, some clinicians treating HIV
patients did not address the importance of smoking cessation
because they assumed the long-term health effects of smoking were
not relevant in patients whose immune systems were seriously
crippled by AIDS. Now, says Chaisson, it is evident that smoking
cessation does offer short-term health benefits to HIV patients.
The most harmful effects of smoking are caused by smoke and its
components; therefore, he concludes, interventions--including
nicotine replacement therapy--are warranted to reduce the
incidence of smoking in HIV patients.
"What Heterosexual Adults Believe About Condoms"
N.E.J.M. (08/11/94) Vol. 331, No. 6, P. 406
(Choi, Kyung-Hee; Rickman, Richard; Catania, Joseph A.)
Using data from a telephone poll of residents in 23 urban areas
in the United States with a high prevalence of AIDS, Catania et
al. surveyed 5,331 heterosexual adults aged 18 to 49 about their
beliefs concerning condoms. Most acknowledged condoms as an
effective method for prevention of sexually transmitted diseases.
Fifty-four percent, however, feared the condom would fail, 41
percent said the device reduced pleasure, 37 worried about losing
their partner's trust by suggesting condom use, and 21 percent
reported feeling uncomfortable about putting on condoms. Based
on these responses, Catania et al. recommend that instructions
depicting correct condom use be widely distributed and that
publicity materials eroticize condom use. The team also suggests
that condoms be more easily available through the mail and
vending machines. Training and counseling, they said, are needed
to increase sexual sensation with condoms. And, although they
may not offer 100 percent protection against HIV, consistent use
of condoms will certainly curb the spread of the disease.
"Medical Care for Injection-Drug Users With Human
Immunodeficiency Virus Infection"
N.E.J.M. (08/17/94) Vol. 331, No. 7, P. 450
(O'Connor, Patrick G.; Selwyn, Peter A.; Schottenfeld, Richard S.)
Intravenous drug use has emerged as an important risk factor for
HIV infection, which has become quite prevalent among the user
populations in North and South America, Europe, and Southeast
Asia. In providing care to infected injection-drug users,
physicians must address important clinical and psychosocial
issues related to both substance abuse and HIV. IV drug users
experience a range of HIV-related complications that differ
somewhat from those experienced by other segments of the HIV
population, for example, a high frequency of HIV-related
tuberculosis, sexually transmitted diseases, hepatitis, and
pyogenic bacterial infections. Clinicians must also be trained
to recognize not only the patterns of HIV-related disease among
injection drug users, but also realize that the many effects of
substance abuse and HIV infection--such as weight loss, fatigue,
fever, night sweats and other symptoms--are similar and,
therefore, can complicate diagnosis. A distinct set of
interventions should be incorporated into routine preventive
health care for HIV-infected IV drug users, including referral
for treatment of substance abuse and drug interactions.
"HIV Therapy: An Pharmacist's Guide to Understanding"
American Druggist (08/94) Vol. 210, No. 4, P. 53
(Tejani, Shamim)
As the rate of HIV infection continues to increase, it is
becoming more important for pharmacists to contribute to public
HIV/AIDS education. Pharmacists should inform patients about HIV
transmission routes, safety precautions, disease progression, and
therapies. One of the pharmacist's most important roles is to
counsel HIV patients on proper use and monitoring of medications.
Presently, there are four FDA-approved antiretroviral agents:
zidovudine from Burroughs Wellcome, didanosine and stavudine from
Bristol-Myers Squibb, and zalcitabine from Roche. Zidovudine, or
AZT, appears to increase average survival after AIDS diagnosis
from less than nine months to more than two years. It is,
however, associated with a number of side effects including
anemia, nausea, vomiting, headache, and fatigue. AZT may also
increase the toxicity of drugs that are nephrotoxic, cytotoxic,
myelosuppressive, or metabolized by glucuronidation. Didanosine
(ddl) is recommended for use in patients over 6 months old who
have advanced HIV infection, cannot tolerate AZT, or have
clinically deteriorated while on AZT. This drug can cause
peripheral neuropathy, potentially fatal acute pancreatitis, and
hepatic failure, as well as GI disturbances, insomnia, rash, CNS
depression, arthritis, dizziness, and seizures. Zalcitabine,
which is associated with peripheral neuropathy and pancreatitis,
is indicated only in conjunction with AZT for patients who
continue to decline while receiving AZT alone. For patients who
do not respond to, or are intolerant of other antiretrovirals,
stavudine received FDA approval on July 4, 1994. Finally,
immunomodulators such as Wellcome's interferon alfa stimulate the
immune system's ability to fight HIV and, therefore, may help to
stave off opportunistic infections.
"AIDS Chief Promises a Shift Towards Basic Research"
Nature (08/18/94) Vol. 370, No. 6490, P. 494
(Swinbanks, David)
Describing basic research as "the engine that will drive the
entire AIDS research enterprise forward," William E.
Paul--director of the Office of AIDS Research at NIH--announced
that the United States will realign its fight against the disease
to focus on such broad-based research. He reaffirmed NIH's
commitment to clinical research, but said it will be redesigned
to make it "more complete, coherent, and cost-effective." He
also appealed to the pharmaceutical industry to help assume the
financial burden of large phase III clinical trials. According
to Paul, the inadequacy of current treatments that target the
virus itself--such as AZT--are the result of a lack of
understanding of the virus itself. A broader approach would be
adopted to develop new agents that intervene in the
immunopathogenesis of HIV, as well as to discover new
methods--like gene therapy--to attack the virus.
"Stavudine (d4T) for HIV"
American Pharmacy (08/94) Vol. 34, No. 8, P. 9
The FDA has granted approval to Bristol-Myers Squibb's anti-HIV
drug Stavudine because it was shown to be effective on a
surrogate endpoint and satisfied an unmet medical need. Like the
other three approved HIV antivirals, stavudine is a nucleoside
analog thought to slow the progression of the virus by blocking
replication. It is indicated for patients with advanced HIV who
cannot tolerate or do not benefit from other drugs. In October
1992, the FDA made stavudine the first drug to receive "parallel
track" status, meaning that it became available before approval.
The predominant side effect reported was peripheral neuropathy
with symptoms including numbness, tingling, or pain in the hands
or feet. The safety of stavudine use has not been investigated
in elderly patients, children, pregnant women, or women who are
breast-feeding.
"HIV Home Testing Fraught With Potential Problems"
AIDS Alert (08/94) Vol. 9, No. 8, P. 107
As the Food and Drug Administration contemplates approval of HIV
home testing kits, it must grapple with not only safety and
reliability issues, but also with a number of public health
concerns. The agency is worried, for example, that other members
of a household may be exposed to contaminated blood or kit
materials. In addition, users may not collect blood adequately,
which could compromise the quality of the test. Another concern
arises when consumers call to retrieve their results. The FDA is
concerned that telephone counseling may obstruct a counselor's
ability to gauge a tester's reaction to test results, and that a
negative experience with a home test may deter them from seeking
professional testing. Officials also find themselves in a
quandary regarding anonymity. Not only do conflicts arise in
states that require name HIV reporting and partner notification,
but anonymous testing would effectively prohibit follow-up
testing if the test was performed improperly, or if a user
received a false test result and the laboratory could not contact
them. Finally, there are concerns that home testing could foster
nonconsensual testing, such as a parent forcing a child to
undergo testing.
"Zidovudine and the Quality of Life"
N.E.J.M. (08/04/94) Vol. 331, No. 5, P. 332
(Berman, Daniel S.; Wenglin, Barry D.; Lenderking, William R. et al.)
Drs. Daniel S. Berman and Barry D. Wenglin challenge Lenderking
et al.'s conclusions that the side effects of zidovudine make its
use questionable in treating HIV patients. They contend that
"zidovudine alone or combined with other therapy, with proper
monitoring and dosages, has an important role in the treatment of
HIV disease." Lenderking and colleagues agree with that
statement, but note that Berman and Wenglin's affinity for early
initiation of zidovudine treatment is based upon their belief
that adverse reactions to the drug are unimportant compared with
disease progression. If a patient assigns full value to the
period after an adverse event and no value to the time after
disease progression, then Lenderking et al. say it is likely that
zidovudine therapy provides more quality, symptom-free time.
They add, however, that media reports suggest duration of side
effects outweighs the benefits of delaying disease progression.
Lenderking et al. appreciate the chance to clarify their
conclusion, which is that neither extreme reflects the proper
course of action for every patient, but that physicians should
consider patients' preferences about side effects and quality of
life when contemplating zidovudine therapy.
"AIDS Prevention Programs Do Work"
Issues in Science and Technology (Summer 1994) Vol. 10, No. 4, P.16
(Curran, James W.; Holtgrave, David R.; Guinan, Mary E.)
Curran et al. refute the contentions of Philipson et al. that HIV
prevention programs are ineffective. Philipson et al.'s economic
model, say Curran and colleagues, is based on faulty reasoning.
In their article, "Why AIDS Prevention Programs Don't Work," the
authors argue that humans learn about the risks of HIV infection,
and respond by altering their own behavior in a timely fashion.
Studies indicate, however, that HIV counseling and testing
reduces high-risk behavior among HIV-positive individuals, but
has little measurable effect among uninfected persons. This is
the opposite of what Philipson et al.'s economic model predicts.
Additional studies show that well-designed HIV prevention
programs can modify HIV-related risk behaviors in homosexual men,
intravenous drug users, serodiscordant couples, and minority
urban male youth. This experimental evidence, concludes Curran
et al., demonstrates the effectiveness of HIV prevention
programs, while Philipson et al.'s economic model is not
supported by existing empirical data.
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End of HICNet Medical News Digest V07 Issue #45
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Editor, HICNet Medical Newsletter
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