AIDS Daily Summary April 2, 1996 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 National AIDS Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC National AIDS Clearinghouse should be cited as the source of this information. Copyright 1996, Information, Inc., Bethesda, MD ************************************************************ "Gene Therapy and AIDS" "FDA Approves the Testing of Drug for AIDS Patients" "Blood Banks Adopt Stricter AIDS Test" "The Tuberculosis Emergency" "Mild Cytologic Atypia Associated with CIN in HIV-Positive Women" "Human Herpes Virus 6 Linked to Disease Progression in AIDS Patients" "Major Opportunistic Infections Are Developing Later in HIV Disease Progression" "Invasive Pneumococcal Disease in a Cohort of Predominantly HIV-1 Infected Female Sex Workers in Nairobi, Kenya" "Home HIV Tests Raise Issues of Counseling, Prevention" "Face to Face with TB" ************************************************************ "Gene Therapy and AIDS" Washington Post (04/02/96) P. A6 A new study suggests that gene therapy may be able to keep critical immune cells active in HIV-infected individuals. In the study, which is reported in the Proceedings of the National Academy of Sciences, T cells usually attacked by HIV were removed from three HIV-positive patients, genetically modified with an antiviral gene, and returned to the patients. The procedure kept the T cells alive four to five times longer than the unmodified cells. The therapy may be able to prolong the time before an HIV-infected person develops AIDS, said author Gary Nabel of the Howard Hughes Medical Institute at the University of Michigan. Related Story: USA Today (04/02) P. 2D "FDA Approves the Testing of Drug for AIDS Patients" Wall Street Journal (04/02/96) P. B5 Unimed Pharmaceuticals Inc. said its drug to treat HIV wasting syndrome has been cleared for testing by the Food and Drug Administration. The new product, Androgel-DHT, will be tested in Phase II clinical trials at Beth Israel Hospital in Boston. The drug also qualifies for orphan-drug status, which would give Unimed exclusive rights to sell the drug for a number of years if it is approved. "Blood Banks Adopt Stricter AIDS Test" Washington Post--Health (04/02/96) P. 6; Squires, Sally As of March 14, some U.S. blood banks are beginning to use an expensive new test that is more sensitive at detecting HIV. The new test detects p24 antigens, proteins on the surface of HIV, while the standard tests detect human immune system cells that are made by the body in response to the virus. The risk of getting HIV from a blood transfusion in the United States has dropped from 6 in every 100,000 donations in 1993 to 1 in 450,000 in 1995. Researchers from the Centers for Disease Control and Prevention and the American Red Cross estimate that the new test will decrease the risk to 1 in every 660,000 donations. In addition, the new test will detect HIV about 16 days after infection, while the old test takes about 22 days. The Food and Drug Administration says that since 1989, four cases of HIV infection have been the result of blood donations that tested negative for HIV. The new test is required for all blood banks by June 14. "The Tuberculosis Emergency" Toronto Globe and Mail (04/01/96) P. A12 In a Toronto Globe and Mail editorial, the authors urge countries to follow World Health Organization (WHO) tuberculosis recommendations and increase resources spent on battling the disease. TB, the cause of one-quarter of all preventable deaths in developing countries, infects 30 percent of homeless people using downtown shelters in Toronto, according to a new study. Furthermore, the disease has been increasing in parts of Africa and Asia as a result of AIDS, which weakens the body's defense to infection. New drug-resistant strains of TB are also appearing and spreading, infecting an estimated 50 million people worldwide. Although drugs for TB are effective and cheap, they must be taken for at least six months and many patients do not complete the therapy, thereby allowing drug-resistant strains to develop. Patients receiving directly observed treatment, in which health workers watch patients to make sure they take their medicine, have a 95 percent cure rate. The WHO says, however, that most TB patients are not supervised, especially in Third World countries. The editorial concludes that the WHO's recommendation to double the money allocated for TB, which would add $350 million to the cause, is worth the expense. "Mild Cytologic Atypia Associated with CIN in HIV-Positive Women" Reuters (04/01/96) A study of 453 HIV-positive women and 401 controls revealed an association between mild cytologic atypia and cervical intraepithelial neoplasia (CIN). In the multicenter study, conducted by Thomas C. Wright Jr. of Columbia University, 112 HIV-positive women developed mild cytologic atypia, compared with 36 control subjects without HIV. CIN was found in 38 percent of the 112 HIV-infected women, compared to 14 percent of the 36 HIV-negative women. The HIV-positive women with mild cytologic atypia were 2.7 times more likely to have CIN and 12 percent of the Pap smears from these women were classified as high-grade. Wright believes the high prevalence of CIN in this group indicates a need for colposcopy referral. "Human Herpes Virus 6 Linked to Disease Progression in AIDS Patients" Reuters (04/01/96) Human herpesvirus 6 (HHV-6) plays an important role in the progression of HIV infection, a new study says. Konstance Kehl Knox and colleagues at the Medical College of Wisconsin at Milwaukee report that HIV appears to use HHV-6 as a tool for destruction. The researchers took lymph node samples from 10 HIV-positive patients and HIV-negative controls. The samples from those with HIV contained a large number of cells that were actively infected with HHV-6, while none of the samples from the HIV-negative patients were infected with HHV-6. Knox theorized that HIV infection may be dependent on activation by HHV-6, and that drugs to block HHV-6 and HIV simultaneously in the early stages of HIV infection could slow or stop the progression to AIDS. "Major Opportunistic Infections Are Developing Later in HIV Disease Progression" Reuters (04/01/96) Opportunistic infections and AIDS-related cancers are developing at a more advanced stage of immunosuppression than previously reported, according to new analysis by Johns Hopkins researchers. Compared with late 1980s estimates, the incidence of Pneumocystis carinii pneumonia (PCP) and Kaposi's sarcoma have decreased. Richard D. Moore and colleagues analyzed data from more than 1,200 HIV patients who were treated at an urban university clinic between July 1989 and April 1995. The most common opportunistic disease was Candida esophagitis, followed by PCP, Mycobacterium avium complex bacteremia, cytomegalovirus and AIDS dementia complex. The least common complications were non-Hodgkin's lymphoma, M. tuberculosis, progressive multifocal leukoencephalopathy, and cryptosporidiosis. "Invasive Pneumococcal Disease in a Cohort of Predominantly HIV-1 Infected Female Sex Workers in Nairobi, Kenya" Lancet (03/16/96) Vol. 347, No. 9002, P. 718; Gilks, Charles F.; Ojoo, Sylvia A.; Ojoo, Josephine C.; et al. To assess the interaction of pneumococcal disease and HIV infection in sub-Saharan Africa, Charles F. Gilks, of the Center for Tropical Medicine at Oxford University, and colleagues followed a group of 719 female sex workers in Nairobi between 1989 and 1992. Of the total, 587 were seropositive and 132 remained seronegative. Among those who were HIV positive, 79 had pneumococcal disease, compared to just one in the HIV seronegative group. The researchers were surprised that pneumococcal disease, not tuberculosis, was the earliest serious complication in the HIV-infected women, as well the most common. The overall risk for developing pneumococcal disease with HIV infection was 17.8. The incidence rate in seropositive women was 42.5 per 1000 person-years, while the recurrence rate was 264 per 1000 person-years. According to the researchers, pneumococcus is an early, yet relatively treatable complication of HIV infection in sub-Saharan Africa. "Home HIV Tests Raise Issues of Counseling, Prevention" American Medical News (03/18/96) Vol. 39, No. 11, P. 10; Shelton, Deborah L. A 1992 National Health Interview Survey found that 8 percent of Americans said they would probably take an HIV test within the year for reasons other than blood donation, insurance, or military service. One-third of them said they would rather use a home collection kit than visit a physician or clinic. As the Food and Drug Administration considers three companies' applications to sell HIV home test kits, the South Carolina legislature is considering a bill to allow the sale of such kits. Public health officials in the state oppose the home test kits because they say the kits would make it more difficult to track HIV and provide counseling and referrals, and partner notification. Although the state requires doctors and laboratories to report by name people who test positive for HIV, the requirement would be waived under the proposed bill. Texas has already passed a law that requires home HIV test kits to be sold as part of a package of services, including pre- and post-test counseling, testing by a qualified facility, verification of positive results, and verbal notification of results to the person tested, with referrals for care and treatment if needed. "Face to Face with TB" Federal Times (03/18/96) Vol. 32, No. 6, P. 13; Rivenbark, Leigh Mary Ann Goeller, a Social Security Administration claims representative, believes she contracted tuberculosis (TB) from a customer she interviewed at work. The customer had HIV and TB and was coughing during their interview in her small cubicle. Goeller tested positive for TB, and was treated aggressively for a year to prevent active TB from developing. Social Security paid for her initial test, while workers' compensation paid for her time away from work for monthly tests and doctor visits. Goeller now wants to warn other federal workers to protect themselves while working. Furthermore, she believes that Social Security should protect its employees by allowing them to wear masks or by requiring customers with TB to wear masks.