AIDS Daily Summary August 17, 1995 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 1995, Information, Inc., Bethesda, MD ************************************************************ "Early Use of AIDS Drug Is Termed Ineffective" "India Seen as Ground Zero in Spread of AIDS to Asia" "BioChem Shareholders Put Their Faith in 3TC" "New Strategies Against Virus" "Across the USA: Ohio" "Marvin Kristal, Worker's Comp Lawyer and AIDS Activist" "Alan Jackson Tops Country Music Nominees" "Foreign Aid Cuts Threaten National and International Health, Experts Say" "CPCRA to Use Viral Load as Markers for Treatment" "The Effects of Vitamin A Supplementation on the Morbidity of Children Born to HIV-Infected Women" ************************************************************ "Early Use of AIDS Drug Is Termed Ineffective" New York Times (08/17/95) P. A15 A new long-term study of more than 1,600 HIV-infected individuals reveals that early treatment with AZT does not help prevent AIDS. In The New England Journal of Medicine, Dr. Paul Volberding of San Francisco General Hospital and his team in the AIDS Clinical Trials Group report that there was essentially no difference in the death rate of asymptomatic patients who had more than 500 CD4 cells and received AZT, and in patients who received the drug only after their CD4 level fell below 500. In addition, AZT did not retard the development of AIDS symptoms. The researchers conclude that AZT "is not routinely indicated until the CD4 cell count declines below 500 per cubic millimeter," but warned that the results should not be applied to patients who have more than 500 CD4 cells and symptoms of AIDS. However, a second smaller study published in the medical journal found that HIV-infected patients who received AZT early on were less likely to develop some HIV-related illnesses. Related Stories: Washington Post (08/17) P. A3; USA Today (08/17) P. 1D "India Seen as Ground Zero in Spread of AIDS to Asia" Washington Post (08/17/95) P. A20; Anderson, John Ward India has more HIV carriers than any other country, according to some estimates. "Many experts now believe that India will soon have the unfortunate distinction of being the AIDS capital of the world," says Columbia University economist and AIDS specialist David Bloom. The World Health Organization and the Indian government estimate that there are about 80,000 cases of AIDS in the country and 1.5 million people who are infected with HIV. Experts, however, predict that by the year 2000, 1 million will have AIDS and 5 million will be HIV-positive. Although AIDS came late to Asia compared to the rest of the world, it is now rushing into an undeveloped region with an undereducated people, who represent more than half of the total world population. The disease is spreading primarily through heterosexual contact, as well as injection drug use and professional blood donors. Truckers are especially important "because they are the link between the general population and the high-risk groups," such as prostitutes, said Asha Rao of the Bhoruka Research Center for Hematology and Blood Transfusion. "BioChem Shareholders Put Their Faith in 3TC" Financial Times (08/17/95) P. 14; Simon, Bernard Montreal-based BioChem Pharma and its shareholders are putting their faith in 3TC, which appears to block HIV with fewer dangerous side effects than other drugs, and in lamivudine, which has been called a breakthrough hepatitis B therapy. This year, the company's shares have skyrocketed from $12.25 to nearly $32 on the Nasdaq over-the-counter market. The company now has a $1.5 billion market value, despite sales of less than $73 million in 1994 and losses in each of the last five years. Yet Larry Woods of the Niagara Hedge Fund in southern Ontario has urged his clients to sell their BioChem shares due to concerns ranging from skimpy real-life clinical trials of 3TC to the risk that the market may be limited by using 3TC in combination instead of individually. "New Strategies Against Virus" USA Today (08/17/95) P. 1D A new understanding of how HIV functions is stimulating the search for a treatment. Although scientists used to think that HIV slowly worked its way through the immune system, a recent study indicates that HIV attacks aggressively and does not let up. Dr. David Ho of the Aaron Diamond AIDS Research Center in New York City says that administering potent antiviral drugs before HIV has an opportunity to reproduce many times over and develop drug-resistant strains may increase the immune system's ability to survive. "Across the USA: Ohio" USA Today (08/17/95) P. 9A The Supreme Court of Ohio has ruled that a woman who was mistakenly told she had HIV cannot sue despite the fact that she suffered emotionally. The justices said that not every wrong is deserving of a legal solution. "Marvin Kristal, Worker's Comp Lawyer and AIDS Activist" Miami Herald (08/16/95) P. 4B; Franco, Debra AIDS activist Marvin Jon Kristal died of AIDS on Saturday at age 46. A partner in the Miami law firm Druckman, Kristal, and Breslow since 1976, Kristal provided free legal help to poor AIDS patients, helping them navigate the web of bureaucracy to obtain benefits. "He was beneficial in getting word to the community that services are available," according to Sandra Druckman, wife of Kristal's partner, Ira Druckman. "He recognized this disease was a scourge on all of society, not just the gay community." In addition, Kristal served as the first chairman for ANTRA--a fundraising branch of the University of Miami's School of Medicine--and was a member of the board for Action to Aids, offering pro bono legal services. Kristal is survived by his parents and his sister. "Alan Jackson Tops Country Music Nominees" Miami Herald (08/16/95) P. 10A; Cohen, Howard Traditionalist Alan Jackson led the pack on Tuesday with six nominations for the 29th Annual Country Music Association Awards. Host Vince Gill is competing for Entertainer of the Year against multiple-nominee Reba McEntire and her poignant AIDS awareness song "She Thinks His Name Was John." "Foreign Aid Cuts Threaten National and International Health, Experts Say" Nation's Health (08/95) Vol. 25, No. 7, P. 5 Some public health experts claim that U.S. budget cuts to several international health programs could perpetuate countries' differences in health care and access. In July, the House passed the Foreign Aid appropriations bill which would eliminate $230 million, or nearly 40 percent, from current international health programs. The only programs to remain untouched are AIDS and Child Survival. Analysts say that the others would be cut by as much as 95 percent. Such budget cuts could seriously hinder the recommendations made by the National Science and Technology's Committee on International Science in its recent report, "Emerging and Re-emerging Infectious Diseases." In the report, experts detailed the continuing danger of infectious diseases and the importance of surveillance and research in fighting them. "CPCRA to Use Viral Load as Markers for Treatment" AIDS Alert (08/95) Vol. 10, No. 8, P. 105 The Community Programs for Clinical Research on AIDS (CPCRA) has designed a protocol that will for the first time use viral load measurements in making treatment determinations. "Other studies have looked at the role of viral burden, but this would be the first to make treatment changes based on viral burden," said the director of the AIDS Research Consortium of Atlanta and chairperson of the CPCRA study, Melanie Thompson, of the two-year trial that is scheduled to begin this month. Viral load testing has not been approved for commercial use and its benefits have not been confirmed, but some doctors and their patients are using a diagnostic tool for "research" purposes. Ultimately, viral-load testing could increase the ability to predict the clinical outcome of drugs. For now, however, viral load's connection to clinical outcome is mostly speculative. "There is a glimmer that maybe reducing viral load improves clinical outcomes," said the National Institute of Allergies and Infectious Diseases' Lawrence Deyton, who feels that Thompson's trial may provide some of the answers needed to reach a conclusion. "The Effects of Vitamin A Supplementation on the Morbidity of Children Born to HIV-Infected Women" American Journal of Public Health (08/95) Vol. 85, No. 8, P. 1076; Coutsoudis, Anna; Bobat, Raziya A.; Coovadia, Hoosen M. et al. To determine the effects of vitamin A supplementation on the morbidity of children born to HIV-infected women, Coutsoudis et al. conducted a randomized, placebo-controlled study of 118 infants in Durban, South Africa. Among all the children, the vitamin A supplemented group had a reduced average morbidity. The rates of morbidity for those receiving supplementation were lower for almost every condition when assessed individually. Also in the supplemented group, all diarrhea was reduced by 29 percent, diarrhea lasting more than 7 days was reduced by 38 percent, and hospital admissions for diarrhea declined by 77 percent. Among the 85 children whose HIV status was known, diarrhea-related morbidity was almost reduced by half in the supplemented HIV-infected group. Vitamin A, however, had no effect on diarrheal morbidity in the uninfected children. The researchers concluded that, in a population where vitamin A deficiency is not endemic, vitamin A supplementation for the children of HIV-infected women appeared to be beneficial and to reduce morbidity. This benefit was particularly diarrheal morbidity among HIV-infected children.