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. 10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA Telephone +1 (602) 860-1121 FAX +1 (602) 451-1165 Internet: mednews@stat.com Bitnet: ATW1H@ASUACAD Mosaic WWW: http://biomed.nus.sg/MEDNEWS/welcome.html 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 the editor for information on how to submit it. If you are interested in joining the automated distribution system, please contact the editor. Associate Editors: E. Loren Buhle, Jr. Ph.D. Dept. of Radiation Oncology, Univ of Pennsylvania 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 Subscription Requests = mednews@stat.com anonymous ftp = vm1.nodak.edu; directory HICNEWS 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: 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: 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. ------------------------------ End of HICNet Medical News Digest V07 Issue #45 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-1165 Bitnet : ATW1H@ASUACAD