AIDS Daily Summary December 12, 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 ************************************************************ "Facing Budget Queries" "AIDS Patterns Shifting: Half-Million U.S. Cases" "New AIDS Drugs' Aim Is 'Buying Time'" "Inmates: The 'Other' AIDS Patients" "AIDS Researcher Says Africa to Get Prevention Help" "Thailand Weighs AIDS Vaccine Tests" "HIV Mars Heart Development" "AIDS Update: HIV Information On-Line" "New AIDS Treatment Article Series Available" ************************************************************ "Facing Budget Queries" New York Times (12/12/95) P. C11; Hilts, Philip J. As new head of the National Cancer Institute (NCI), one of the issues Dr. Richard Klausner must address is AIDS research spending. A report from the Gay Men's Health Crisis (GMHC) claims that about $172 million, or 81 percent of the institute's $212 million AIDS research budget, was intramural--$68 million more than reported by the NCI. Klausner recently conceded that the institute's early figures were wrong, and estimated that 1994's AIDS intramural research total was $128 million. The GMHC report--which was prepared by member Derek Link--criticized the intramural research because it lacked proper documentation, management, peer review, and strategic planning. Link also said that portions of the budget were so unclear that it was not possible to determine how the funds were being spent. Klausner, who said he was quite surprised at the chaos he found in the intramural research accounting at the NCI, said a complete audit is now being conducted. Klausner added that he was reforming the advisory committee system so that a greater number of outside reviewers can review work from any of the national health institutes. "AIDS Patterns Shifting: Half-Million U.S. Cases" Washington Post (Health) (12/12/95) P. 5; Colburn, Don More than 500,000 cases of AIDS had been reported to the U.S. Centers for Disease Control and Prevention (CDC) as of November 1995. Sixty-two percent, or some 311,000, of those individuals have died. Although men who have sex with men still account for the greatest proportion of AIDS cases, that number is decreasing. Groups accounting for a growing number of AIDS cases include injection drug users and heterosexuals. "The increase in AIDS cases resulting from heterosexual transmission also is reflected in the increase in cases reported among women," the CDC noted. The disease continues to disproportionately affect some racial and ethnic minorities. Among American blacks and Hispanics, the rates for AIDS cases are six times higher and three time higher, respectively, than those for whites, who now represent less than half of the nation's AIDS cases. Worldwide, the World Health Organization estimates that 18 million adults and 1.5 million children have HIV, and that there have been 4.5 million cases of AIDS. "New AIDS Drugs' Aim Is 'Buying Time'" Miami Herald (12/11/95) P. 1C; Jacobs, Sandra The U.S. Food and Drug Administration approved on Thursday the protease inhibitor saquinavir, which is now being sold by Hoffmann-La Roche under the brand name Invirase. This new class of AIDS drugs works by inhibiting the production of the enzyme required for HIV replication. Protease drugs are not a cure for AIDS, but they are expected to become an integral part of an anti-HIV strategy that involves combining multiple drugs to slow disease progression. The plan is to attack HIV in as many vulnerable spots as possible, which is critical because HIV mutates rapidly and thus becomes resistant to any one drug. AIDS researchers, however, are worried that resistance to one protease inhibitor may lead to resistance to others. Hoffmann-La Roche says it does not predict that such resistance will be a problem. Another problem with regimens of drugs is the cost. Several insurance companies and Medicaid will not pay for more than one drug. The wholesale price for one year's supply of saquinavir is $5,800, though the patient may receive financial assistance from the manufacturer if qualified. "Inmates: The 'Other' AIDS Patients" Boston Globe (12/11/95) P. 29; Kong, Dolores Some public health and prisoners' advocates are concerned that the national commitment to fight HIV inside prisons may be wavering. Prisons in the Northeast, for example, have reported HIV infection rates of 20 percent. During the last few years, prisons in Massachusetts and some other states have significantly improved their HIV prevention and AIDS services, though some worry that this progress could be hindered by the increasingly troubled relationship between public health and correctional mandates. Former prison health care workers say that tension is evident in Massachusetts, where doctors' public health advocacy must fight prison officials' objectives of incarceration, punishment, and cost containment. Next week, Dr. Anne De Groot, the head of the HIV clinic at the women's prison in Framingham, Mass., and Ronald Bogard, co-chairman of the Incarcerated Populations Work Group, will discuss the issue with White House AIDS policy advisor Patricia S. Fleming and other advocates. "AIDS Researcher Says Africa to Get Prevention Help" Reuters (12/10/95); Kizito, Edmond Prevention is the best method of fighting HIV, according to AIDS researcher Luc Montagnier, who said on Sunday that he was establishing AIDS education centers in Africa. "Education on AIDS prevention should be intensified and emphasized," he explained to an African AIDS conference. Montagnier added, "Research should also be done into African herbal treatment with a view of finding ways of controlling AIDS." Montagnier, who is chairman of the World Foundation for AIDS Research and Prevention, said his organization would open several AIDS pilot centers around the world, whose principal role would be AIDS training and blood testing. The World Health Organization estimates that more than 11 million African adults and 1 million children are infected with HIV, though experts say that these figures show only registered cases and underestimate the true infection rates. "Thailand Weighs AIDS Vaccine Tests" Science (11/10/95) Vol. 270, No. 5238, P. 904; Cohen, Jon Thailand is emerging as the most important AIDS vaccine test-site in the world. "There's probably more going on here than anywhere," notes epidemiologist William Heyward of the U.S. Centers for Disease Control and Prevention. In the coming years, tests and research in Thailand could help determine the efficacy of first-generation vaccines, as well as settle some scientific debates over how best to proceed with vaccine development. Currently, no definite plans are in action to stage large-scale efficacy trials in the southeast Asian country, but teams of Thai researchers and scientists from two San Francisco-area companies--Genentech and Biocine--are laying the foundations for such work. Thailand has become the focus of HIV vaccine research, in part, because of its large, growing number of infections. Johns Hopkins University epidemiologist Kenrad Nelson, a principal investigator of an NIH-funded team that is helping prepare Thailand for AIDS vaccine efficacy trials, feels that Thai decision-makers are much less capricious than those in the United States. "If [the Thais] decide to study something, they carry through," Nelson explains. In addition, Thailand offers a relatively stable government, a long history of staging collaborative vaccine efficacy trials with the West, and an educated and culturally homogenous population. "HIV Mars Heart Development" Science News (12/02/95) Vol. 148, No. 23, P. 380; Seachrist, Lisa Researchers at Harvard Medical School have concluded that a child born to an HIV-infected mother is predisposed to developmental heart problems. Led by Steven Lipshultz, the scientists studied some 400 infants born to HIV-positive women, and discovered that 12 percent of these children experienced such heart disorders as heart wall and valve defects and poor pumping function. In the general population, just 0.8 percent of children are born with these defects. The Harvard researchers did not say that HIV causes the defects, but Lipshultz noted that HIV-infected women could have drug, alcohol, or nutrition problems that obstruct fetal heart development. "AIDS Update: HIV Information On-Line" Men's Health (12/95) Vol. 10, No. 10, P. 44 Many people are concerned that efforts to censor "indecent" material on the Internet or services such as America Online could hamper HIV education attempts. Derek Gordon of the San Francisco AIDS Foundation, which intends to launch a World Wide Web site, explained, "Almost everything we do might involve frank discussions of sex and sexuality." "New AIDS Treatment Article Series Available" AIDS Treatment News (11/17/95) No. 235, P. 1; James, John S. Boston's nonprofit Search for a Cure has introduced "Reasons for Hope," a series of monthly articles that explain advanced practical treatment choices for AIDS to persons who are newly diagnosed, or who do not have an extensive background in AIDS treatment. The series features an easy reading level, yet the articles highlight such treatment methods as combination therapy and protease inhibitors. Forthcoming articles may consider immune-based therapies, nutrition, and alternative treatments.