AIDS Daily Summary August 23, 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 ************************************************************ "The Bittersweet Music of Life" "TB Screening Questioned" "When a Mother Has HIV" "Human-Milk Banks Booming as Fears Ease" "Gilead Sciences Begins Phase II Study of..." "Clinicians Not Providing Necessary Pain Relief for AIDS Patients" "A Controlled Trial of Zidovudine in Primary Human Immunodeficiency Virus Infection" "AIDS Update: A Drag on Your Health" "Start Making Sense" "Enriching the Final Days" ************************************************************ "The Bittersweet Music of Life" Washington Post (08/23/95) P. C1; Crews, Chip The members and music of the San Francisco Gay Men's Chorus will be honored tonight in a documentary on Cinemax. The San Francisco chorus is the first of its kind; there are now 140 similar choruses worldwide. However, the AIDS epidemic has hit the chorus aggressively, and more than 150 members have died and nearly half of the 225 current members are infected with HIV. Tonight's program, which was filmed during the 1992 season, features four members who tell their stories. Gary, for example, once wanted to be a star, but now struggles with degenerated hips and can only get around on crutches. Steven takes care of AIDS patients in a hospital and has learned to keep new acquaintances at a distance. "I say to myself, 'I'll see you die. Or you'll see me die,'" he explains. On a brighter note, the film also shows the chorus heading off to perform at the meeting of the Gay and Lesbian Association of Choruses and dancing up a storm at an AIDS dance-athon. "TB Screening Questioned" Washington Post (08/23/95) P. A2 Despite the fact that the incidence of tuberculosis (TB) has increased in recent years, a new study concludes that the cost of mass screening of schoolchildren is greater than the value of the results. The researchers suggest instead that youths at high risk for TB, such as immigrants, be targeted. In the current issue of the Journal of the American Medical Association, a team led by Janet C. Mohle-Boetani of the California Department of Health Services reports their findings after studying mass TB screenings in Santa Clara County between 1992-1993. They determine that it costs about $16,400 to treat a case of TB, and contact and test those who might have been exposed, but that the additional expense of mass screening was nearly $35,000 for each case prevented outside of the high-risk group. "When a Mother Has HIV" Wall Street Journal (08/23/95) P. A13; Gromada, Karen Kerkhoff; Quadro, Kathleen; Deal, Lee Ann Research does not support the claim that "mother's milk is a prime carrier of HIV," writes Karen Kerkhoff Gromada--president of the International Lactation Consultant Association, in response to a recent Wall Street Journal editorial entitled "Sacrificing Babies on the Altar of Privacy." Gromada notes that the primary carriers of HIV are tainted blood and semen and that the Occupational Safety and Health Administration does not list breast milk among its "potentially infectious materials." She concludes that mother's milk is an important source of disease protection and nutrition for most human babies. In a separate letter to the editor, Dr. Kathleen Quadro questions why the Centers for Disease Control and Prevention (CDC) would perform HIV testing on infants and not inform the parents or doctors, and asks whether this is "in keeping with our medical calling?" Finally, a third letter from Lee Ann Deal, executive director of La Leche League, points out that while the CDC maintains its position that HIV-infected women should not breast-feed, the World Health Organization has recommended that breast-feeding be promoted and supported in all populations. The benefits of human milk and breast-feeding have to be weighed against the dangers of artificial infant-feeding and not-yet-clear risk of HIV transmission through breast milk, she concludes. "Human-Milk Banks Booming as Fears Ease" Washington Post (08/22/95) P. A1; Finn, Peter After nearly having been eliminated by the risk of AIDS, human-milk banking has made a comeback as safety measures have decreased concerns of viral infections. In fact, Georgetown University's Community Human Milk Bank estimates it will receive nearly 1,000 ounces of milk in 1996, compared with a total of just over 150 ounces in 1992 and 1993. In North America, there has been no documented instance of HIV transmission through donor human milk, although one case was reported in Kenya last year. Milk banking stems from the age-old practice of wet nursing, in which lactating women were hired to feed other babies. The practice reached its peak, however, just as AIDS became a threat. In 1985, a report detailed the case of a breast-fed child who became HIV-infected with no other probable cause of transmission than his mother's milk. The Centers for Disease Control and Prevention urged HIV-positive women to be advised against breast-feeding. Many milk banks closed as mothers became afraid. In 1990, however, a set of standards was developed on how to select donors and how to treat and store milk. One recent donor, for example, had her blood tested for several viruses--including HIV--and then later, her pooled milk was pasteurized and cultured to detect bacteria. "Gilead Sciences Begins Phase II Study of..." Healthwire (08/22/95) Gilead Sciences Inc. announced on Tuesday that it has initiated a Phase II study of an intravitreous formulation of its cidofovir treatment for relapsing cytomegalovirus (CMV) retinitis in AIDS patients. The study will evaluate the safety, tolerance, and efficacy of differing dosages of the drug when it is injected directly into the eye's inner chamber. Gilead's most advanced product candidate for treatment of CMV retinitis is Vistide, or cidofovir intravenous. The company hopes to submit a new drug application for Vistide in the latter part of this year. "Clinicians Not Providing Necessary Pain Relief for AIDS Patients" AIDS Alert (08/95) Vol. 10, No. 8, P. 97 At a pain management workshop in Atlanta, experts said that despite the fact that AIDS patients experience the same intensity and frequency of pain as cancer patients, they seldom receive sufficient medication to ease their pain. "Pain in AIDS is dramatically undertreated and is associated with significant functional and psychological morbidity," said associate attending psychiatrist Dr. William Breitbart of the Memorial Sloan-Kettering Cancer Center. One study of pain in HIV-infected men found that nearly 40 percent of asymptomatic patients complained of pain, a figure which soared to 80 percent as they entered the advanced stages of AIDS. HIV-related headaches, herpes simplex, peripheral neuropathy, and back and throat pain were among the most common reported sources of pain. The most frequent reasons for mismanagement of pain in people with AIDS are clinicians' incapacity to adequately access the pain and the failure to prescribe strong opioids to late-stage AIDS patients for fear that they will become addicted. Patients also put up barriers to adequate pain management. Many, noted Breitbart, are afraid that admitting their pain would detour the treatment process. According to Breitbart, care providers should employ a team approach that recognizes pharmacological and non-pharmacological methods and considers psychosocial issues. "A Controlled Trial of Zidovudine in Primary Human Immunodeficiency Virus Infection" New England Journal of Medicine (08/17/95) Vol. 333, No. 7, P. 408; Kinloch-De Loes, Sabine; Hirschel, Bernard J.; Hoen, Bruno; et al. A recent study investigates the effect of antiretroviral treatment when administered during the primary stage of infection with the human immunodeficiency virus. Patients were treated with either zidovudine or placebo for six months. Disease progression was found to be far less frequent in the group that received zidovudine. The results showed that the antiretroviral therapy preserves immune functions, improves long-term prognosi, and increases the CD4 cell count. "AIDS Update: A Drag on Your Health" Men's Health (09/95) Vol. 10, No. 7, P. 48 Scientists at the Centers for Disease Control and Prevention (CDC) have discovered that HIV-infected smokers are more likely to catch certain diseases than HIV-positive people who do not smoke. According to the CDC, smokers are at an increased risk for bacterial pneumonia, oral candidiasis, and oral hairy leukoplakia. "Start Making Sense" POZ (08/95-09/95) No. 9, P. 40; Staley, Peter The idea that every person with HIV should have access to any potentially effective drug is very appealing, writes Peter Staley, who describes himself in POZ magazine as a "typical self-empowered person living with HIV." It seems almost patriotic to demand universal access to such experimental drugs, he notes. The AIDS self-empowerment movement, however, appears to be shifting from the goal of extending life for as many people as possible to individuals saving themselves. The change became apparent last summer when the early results of a small Phase II study of Hoffmann-La Roche's saquinavir showed that a triple combination of AZT, ddC, and saquinavir increased CD4 levels more than regimens of either AZT and saquinavir or AZT and ddC. After learning that Roche planned to ask for permission to file for accelerated access, the Treatment Action Group (TAG) urged the Food and Drug Administration to delay the approval of the combination drug and suggested instead a large study using a placebo. Staley--a cofounder of TAG--writes that in order to prolong life for as many people as possible, research must be balanced with the desire for reliable data on the treatment's ability to extend life. A large, simple trial would allow everyone to take whatever antiretrovirals they would have been taking outside the trial, without requiring everybody to take AZT, while offering the possibility of switching over to receive the protease inhibitor later, if qualified. "Enriching the Final Days" U.S. News & World Report (08/21/95) Vol. 119, No. 8, P. 56; Sherrid, Pamela Although many companies that buy life insurance policies from the terminally ill are reputable, a U.S. News & World Report investigation discovered a less scrupulous side of the viatical settlement industry--one that is marked by conflicts of interest, lack of disclosure, and nonexistent or ineffectual regulation. For example, one of the largest viatical firms, Texas-based Life Partners Inc., is flagrantly defying regulators in some states by operating without a license. Some practices are becoming more unusual. Not too long ago, some firms would promise to pay the entire policy purchase price when the deal closed, but in the end would make only a small payment. "They were assuming a person with AIDS dementia wouldn't be able to come after them," said David Ganon of New York City-based Life Entitlements, which recently agreed to donate 3 percent of the face value of all life insurance policies that the company buys from Washington, D.C., area residents to the Whitman-Walker Clinic, the region's leading AIDS treatment facility. Meanwhile, the National Association of Insurance Commissioners passed a model law and regulatory language last year that bars viatical firms from offering finder's fees to anyone providing medical, legal, or financial planning services to a policy seller. Only a dozen states, however, have laws in place--not all of which contain the provision. The reality of AIDS in gay communities has produced a fair amount of sophistication about viatical settlements among policy vendors, but outside this community the settlements are far more subject to abuse because they are new and the lack of knowledge, therefore, is greater.