NetNews Usenet Archive 1992 #16/NN_1992_16.iso/spool/sci/med/aids/1559

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Subject: CDC Summary 7/28/92
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                         AIDS Daily Summary
                           July 28, 1992
 The Centers for Disease Control (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
Clearinghouse, or any other organization.  Reproduction of this text is
encouraged; however, copies may not be sold.  Copyright 1992,
Information, Inc., Washington, DC
************************************************************************
"Dendritic Cells Exposed to Human Immunodeficiency Virus Type-1
Transmit a Vigorous Cytopathic Infection to CD4 T Cells" Science
(07/17/92) Vol.257, No.5068, P.383 (Cameron, Paul U. et al.)
     Dendritic cells can act as a catalyst in the transmission of a
cytopathic infection like HIV, according to Paul U. Cameron and
colleagues at Rockefeller University in New York, N.Y.  The  scarcity of
infected CD4 cells in HIV-positive patients contrasts with the greatly
reduced numbers and function of these  lymphocytes.  A pathway is
described in which dendritic cells  carry HIV to uninfected T cells,
amplifying the cytopathic  effects of small amounts of virus.  After
exposure to HIV-1,  dendritic cells continue to present superantigens
and antigens,  forming clusters with T cells that are driven to
replicate.   Infection of the dendritic cells cannot be detected, but
the  clustered T cells form syncytia, release virions, and die.
Mucosal and airway dendritic cells may carry and present HIV to
responding T cells at the same time as the T cells are activated  by
other environmental antigens carried by dendritic cells.   Dendritic
cells that carry HIV-1 may facilitate the lysis and  loss of antigen
specific CD4 T cells in AIDS.  Transmission  through dendritic cells is
more efficient than through other  antigen-presenting cells.  This may
be due to the potency of  dendritic cells in activating large numbers of
CD4 T cells, the  researchers conclude.

 "C.D.C. is Embarrassed by its Tardy Response to AIDS-Like Illness" New
York Times (07/28/92), P. C3  (Altman, Lawrence K.)
     The Centers for Disease Control considered the international AIDS
conference in Amsterdam last week an embarrassment because they  had
ignored two basic principles of public health--the quick  review of
cases of a new condition to elucidate their cause and  the rapid
communication with the public and researchers to allay  fear about the
potential threat.  The cases involve a syndrome in which symptoms of
AIDS appear without any detectable HIV  infection.  The panic is over
the threat to the nation's blood  supply from what may be a new AIDS-
like virus and over how such a virus might spread.  The meeting made it
clear that the CDC  waited too long to respond to doctors' reports of
such cases.   Though the centers had recorded six cases over the past
two  years, their sole report on them was presented last spring at a
Colorado meeting with severely restricted news coverage.  The CDC
authors, Dr. Thomas J. Spira and Bonnie M. Jones, said that "HIV  may
not be the only infectious disease of" immunodeficiency.   However, they
did not discover a cause, and their abstract was  not read by many
researchers who were aware of such cases and who were aggressively
investigating a possible new virus. Related  Story: Baltimore Sun
(07/28) P. 3A

"New Test May Facilitate Detection of AIDS Virus" Chicago Tribune
(07/28/92), P. 1-6  (Campbell, Michael)
     A new method will make HIV detectable earlier and more  accurately,
according to an announcement at meetings of the  American Association
for Clinical Chemistry at McCormick Place.   Researchers have developed
a test that can identify a single  HIV-positive white blood cell among
100,000 healthy ones, by  streamlining a complex technique called
polymerase chain reaction (PCR).  Dr. Joan Spadoro of Roche Molecular
Systems Inc. said  that although the process still needs approval from
the Food and  Drug Administration, she hopes it will be available in the
U.S.  by late 1993 and this fall in Europe.  The new test uses PCR
technology, which can form millions of copies of genetic material but
before could only be used in specialized laboratories, and  can be
conducted with simpler devices, increasing its  practicality for
community-based medical centers.  The primary  benefit of PCR is that it
permits direct testing for HIV soon  after infection.  Most conventional
tests search for antibodies  elicited in response to the virus, but the
antibodies may not be  detectable for up to six months after infection.

"Rendell Frees the Way for Drug Needle Swap" Philadelphia Inquirer
(07/28/92), P. A1  (Collins, Huntly)
     Mayor Ed Rendell of Philadelphia yesterday announced his
endorsement of a citywide clean-needle-exchange program for  IV-drug
users.  But in subsequent hours, the state officials  threatened to stop
the program, claiming that could infringe upon state law banning the
distribution of drug paraphernalia.  Kathy  Liebler, spokeswoman for the
Pennsylvania Department of Health,  said, "The action the city has taken
appears to be a violation of the Controlled Substance, Drug Device, and
Cosmetic Act, and we  are looking at options for enforcement."  She did
not give  details on the exact options, including the possibility that
the  state would arrest AIDS activists who expect to give out clean
needles in exchange for tainted ones this Saturday in Kensington. ACT-UP
members have quietly conducted needle swap programs there  every
Saturday since November; they distribute clean needles,  bleach kits,
condoms, and literature about AIDS and drug  treatment programs to some
300 IV-drug users.  Rendell's'  executive order calls for the city
government to officially  advocate needle exchange, thus permitting it
to expand to other  locations in the city.  The city's approval of the
program could  also provide more money sought by the group operating the
exchange.

"Ex-Primier is Cited in French AIDS Case" Philadelphia Inquirer
(07/28/92), P. A2  (McDowell, Patrick)
     Criminal complaints were filed yesterday by lawyers against  former
Premier Laurent Fabius and two former ministers of France  for allegedly
permitting HIV-infected blood to be administered to hemophiliacs.
Fabius, former Social Affairs Minister Georgina  Dufoix, and former
Deputy Health Minister Edmond Herve testified  Friday at the trial of
four former health officials blamed for  infecting 1,000 hemophiliacs in
1985.  Herve said he was aware  that the blood supplies were
contaminated with HIV.  Some of  those who contracted HIV from the blood
products took the witness stand yesterday for the first time in the six-
week-old trial,  detailing how their lives had been ruined since
becoming  infected.   The charges were made first four years ago by
families of the 1,000 hemophiliacs who contracted HIV in March  through
October 1985.  The current defendants argue that they  have been made
into scapegoats for regulations that were  implemented by government
ministers.  The panel is scheduled to  announce a verdict in October.
Related Story: Financial Times  (0728) P. 2

"AIDS Testing Aids Insurers" Philadelphia Inquirer (07/28/92), P. F1
(Burkins, Glenn)
     Because of the soaring number of AIDS claims, most life insurance
companies are requiring high-risk applicants to be tested for  HIV.
Anyone who tests positive for HIV would be rejected from a  coverage.
While insurance industry officials assert such a  practice has slowed
the influx of AIDS-related claims, which last year totalled about $1.2
billion, opponents of testing say  "people with HIV are subject to
discrimination.  Moreover, they  are subject to stigma and unpleasant
encounters, even violence."  AIDS testing is allowed by insurance
regulators in every state  and testing advocates say the tests are
necessary to protect the  industry from fraudulent claims.  They contend
that without  testing, a life-insurance applicant could hide the fact
that he  or she was HIV-positive.  The majority of companies test
applicants between the ages of 19-45, because most AIDS patients  fall
within this range.  In most cases, once a policy is released it cannot
be rescinded, even if the person later tests positive  for HIV.
However, if a person with HIV lies about his or her HIV status, the
policy could be terminated, even after the person has died.

"AIDS Notebook: US May Soon Have 82,000 AIDS Orphans" Boston Globe
(07/27/92), P. 28
     By the year 2000, the number children and adolescents who become
orphaned as a result of AIDS will grow more than twofold, from  about
40,000 to 82,000, reported David Michaels of New York's  City University
medical school, speaking at the international  AIDS conference in
Amsterdam.

"AIDS Notebook: Educators--Let Kids Meet AIDS Patients" Boston Globe
(07/27/92), P. 28
     A successful means to educate teenagers about AIDS is to allow
them to meet young people with the disease, recommended educators at the
international AIDS conference in Amsterdam.  "No school  kid is going to
listen to some silver-haired science teacher  talking about cell counts
and seropositives," said Pedro Zamora,  an 20-year old AIDS patient who
spoke at the conference.   She  added, "AIDS education has to be more
about involvement and less  about lectures."   Zamora was the only
speaker with AIDS at a  seminar on AIDS education in schools at the
conference.  Peter  Aggleton, a professor of education at the University
of London,  said AIDS patients who have accepted the disease are much
more  effective at addressing the subject with children than many
educators, who may be more self conscious.

"A Survey of Occupational Blood Contact and HIV Infection Among
Orthopedic Surgeons" Journal of the American Medical Association
(07/29/92) Vol. 268,  No. 4, P. 489  (Tokars, Jerome I. et al.)
     No evidence of HIV infection was found among surgeons without
nonoccupational risk factors who participated in a serosurvey,  write
Jerome I. Tokars et al. of the Centers for Disease Control. A voluntary,
anonymous HIV serosurvey was conducted at the 1991  annual meeting of
the American Academy of Orthopedic Surgeons in  Anaheim, Calif.  Also, a
mail survey of orthopedic surgeons was  distributed five months before
the annual meeting.  Among the  7,147 eligible orthopedists at the
meeting, 3,420 participated.   Of the participants, 87.4 percent
reported a blood-skin contact  and 39.2 reported a percutaneous blood
contact in the previous  month.  Also, 3.2 percent of the serosurvey
participants reported an injury at some time in their career with a
sharp object  tainted with the blood of an HIV-positive patient.  Among
the  3,267 participants who reported nonoccupational risk factors for
HIV infection, none tested positive for HIV.  In addition, of the 108
participants with reported nonoccupational HIV risk factors,  two were
infected with HIV.  The high rates of self-reported  blood contact
emphasize the significance of compliance with  infection control
standards and the development of new techniques and equipment to
minimize the risk of exposures to blood during  invasive procedures.

"Population-Based Monitoring of an Urban HIV/AIDS Epidemic" Journal of
the American Medical Association (07/29/92) Vol. 268,  No. 4, P. 495
(Rosenberg, Philip S. et al.)
     Strict monitoring of the AIDS epidemic is needed to focus efforts
to reduce the incidence of HIV infection, write Dr. Philip  Rosenberg et
al. of the National Cancer Institute in Rockville,  Md.  Between the
epidemic's start in 1980 and January 1, 1991,  one in 57 Washington,
D.C., men aged 20-64 years developed AIDS.  AIDS prevalence in the
District of Columbia was projected to  increase by 34 percent between
1990 and 1994, unlike the rest of  the nation.  Models of HIV infection
incidence indicated two  epidemic waves of about equal size.  The first,
which transpired  in men who have sex with men, peaked during 1982
through 1983.   The second began in the mid-1980s among IV-drug users
and  heterosexuals.  Among Washington residents aged 20-64 years,
approximately 0.3 percent of white women, 2.9 percent of white  men, 1.6
percent of black women, and 4.9 percent of black men  were living with
HIV as of January 1, 1991.  The predictions are  consistent with survey
data.  Among black childbearing women in  their 20s, rates of HIV
doubled to 2 percent between the fall of  1989 and the spring of 1991.
From military applicant data, it  was projected that more than 5 percent
of black men born between  1951 and 1967 were HIV positive.  In the
sentinel hospital, rates of HIV among male patients aged 25-34 years
were 11.3 percent in  white men and 16.9 percent in black men.

"High Risk of Active Tuberculosis in HIV-Infected Drug Users with
Cutaneous Anergy" Journal of the American Medical Association (07/29/92)
Vol. 268,  No. 4, P. 504  (Selwyn, Peter A. et al.)
     HIV-positive patients who are anergic are at high risk for
developing active tuberculosis, especially in a population with a known
high prevalence of latent TB infection, write Dr. Peter A.  Selwyn et
al. of the Albert Einstein College of Medicine in  Bronx, N.Y.  Anergic
subjects and tuberculin reactors who were  HIV-positive were compared by
HIV disease status and CD4 T cell  levels.  Of those HIV-positive
participants, anergic subjects had more advanced HIV disease and fewer
CD4 cells compared with  tuberculin reactors, even though neither
clinical status nor CD4  cell counts consistently predicted anergy.
Five of 68 anergic  subjects who were HIV-positive and none of 52
anergic subjects  who were HIV-negative or of unknown HIV serological
status  developed active TB throughout the study period.  The TB rate
among anergic subjects who were HIV-positive was 6.6 cases per  100
person-years.  Among 25 HIV-positive tuberculin reactors who  did not
receive or complete 12 months of isoniazid prophylaxis,  TB prevalence
was 9.7 cases per 100 person-years, as compared  with the rate among
anergic HIV-positive individuals.  A  decreased rate of active TB was
found in HIV-positive tuberculin  reactors receiving 12 months of
isoniazid chemoprophylaxis,  compared with untreated or partially
treated subjects, the  researchers note.

"The Hidden Cost of AIDS: Selling Sex Does Not Pay" U.S. News + World
Report (07/27/92) Vol. 113, No. 4, P. 52
     The AIDS epidemic is spreading rapidly through Thailand,  prompting
fear in employers, workers, and the government.  While  the first case
of AIDS emerged in the country in 1984, roughly 1  percent of all Thais
are now HIV-positive--twice the U.S. rate,  according to projections by
the local Population Development  Association.  In addition, more than
1,000 Thais contract HIV  every day.  Researchers at the Harvard AIDS
Institute estimate  that by the turn of the century, the total number of
Thais with  HIV will escalate to between 2-4 million in a current
population  of 58 million.  The epidemic will also have a huge impact on
the  country's economy, which has averaged a 7.5 percent growth rate
over the last 10 years.  The health care bill for treating AIDS
patients in Thailand could increase from around $1 million today  to
between $20 million and $65 million annually by the year 2000. The
largest sector of the Thai economy to suffer will be the $5  billion
tourism industry.  Already, the industry is shrinking as  foreigners
begin to fear for their health.  Yet the government  and the business
community are now attempting to halt the spread  of the epidemic.  AIDS
education has been established as a part  of the school curriculum and
all radio and television stations  air AIDS prevention messages.

"The Hidden Cost of AIDS: Driving Blindly Into an Epidemic" U.S. News +
World Report (07/27/92) Vol. 113, No.4, P. 54
     Because truck drivers in India solicit sex from prostitutes along
their routes, the country is headed toward a disastrous increase in AIDS
cases.  At almost every roadside eatery, and even at some state tax
checkpoints, prostitutes prepare for the truckers.   Consequently, the
truck routes that wind across India have  facilitated the spread of HIV
in the subcontinent.  While  official statistics report that only 125
Indians have AIDS, an  uncounted 6,000 people are now believed to be
dying of the  disease in the country--in addition to 500,000 to 1
million  people who are HIV-positive.  Although the nation's leaders
virtually ignore the epidemic, the World Bank estimates that 1  million
AIDS-related deaths could cost India up to $1.6 billion  in medical
bills and $8.4 billion in lost income by the end of  the century.  More
than 75 percent of the truck drivers in the  country use prostitutes,
and while nearly all of the truckers  have contracted sexually
transmitted diseases, few use condoms.   The first attempt to check
India's truck drivers for HIV last  February found that about 6 percent
tested positive for HIV.  The medical profession has even been apathetic
regarding AIDS.  A  clinic that was designed to provide counseling for
HIV and AIDS  patients was closed within two hours because the doctors
were  afraid they would lose their patients.

"Hospitals Finding Ways to Encourage Injury Reporting" AIDS Alert
(07/92) Vol. 7, No. 7, P. 103
     Since the Occupational Safety and Health Administration has
demanded that health-care facilities develop exposure-control
regulations and document staff injuries, hospitals are looking  for ways
to encourage employees to report exposures to HIV.  Many workers do not
report exposures to hospital personnel, due to  concerns about
confidentiality, the burden of reporting  mechanisms, and reluctance to
take occupational injuries  seriously.  In a study of underreporting,
nurse epidemiologist  Holly Wainwright and colleagues of MacNeal
Hospital in Berwyn,  IL., found that of 538 respondents, 46 percent
reported having  had at least one needle stick during their career and
23 percent  reported having one or more injuries in the last two years.
The  survey demonstrated that only 30 percent of the injuries had been
reported, with physicians reporting only 2.5 percent of their  injuries
and each of the other groups reporting about 50.  A lack of perceived
risk related to the exposure was the most common  reason for not
reporting, the study found.   Wainwright feels  that the survey led to
increased awareness about the significance of reporting injuries among
the hospital's staff.

"New HIV Test Gets Results in 10 Minutes" Nation's Health (07/92) Vol.
22, No. 7, P. 24
     The Food and Drug Administration recently approved an HIV test
that will only take 10 minutes to detect antibodies to the virus  and
can be used in hospitals, bloodbanks, emergency situations  and doctor's
offices.  The test's manufacturer, Murex  Corporation, said the new
procedure is quicker than conventional  laboratory screening techniques
and calls for no special devices  and only minimal staff training.  The
company said positive test  results from the SUDS HIV-1 Test should be
verified by other  types of test kits.  Conventional tests can take up
to three  hours to perform.  Public health officials urge that
counseling  be offered for those who test positive with the test.  Murex
is  also developing rapid tests to detect HIV-2 antibodies.