AIDS Daily Summary Wednesday, July 3, 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 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 ****************************************************** "Precious Pills: New AIDS Treatment Raises Tough Question of Who Will Get It" "Report Says AIDS May Curtail African Growth" "All Day, Every Day, A Global Forum on AIDS" "AIDS Fighters See Ray of Hope" "The Battle's Big Gun: Protease Inhibitors" "Science Meets Nature in AIDS Study" "A Victory in Funding AIDS Treatment" "New Advances Toward Effective Protease Inhibition of HIV" "The Risk of Transfusion-Transmitted Viral Infections" ****************************************************** "Precious Pills: New AIDS Treatment Raises Tough Question of Who Will Get It" Wall Street Journal (07/03/96) P. A1; Waldholz, Michael While protease inhibitors, the new class of AIDS drugs, offer the promise of healthier and longer lives for people with the disease, the cost of the treatment is a major concern. A three-drug combination, which can lower the viral load in patients to undetectable levels, can cost between $12,000 and $16,000 a year. The therapy also requires careful and consistent dosing, and experts worry that drug-resistant strains of HIV could develop if patients miss even a few days worth of treatment. For these very reasons, doctors at Harlem Hospital in Manhattan say they will not prescribe the drugs to some patients. Providing the drugs for eligible patients may be difficult as demand grows, though President Clinton has said he is committed to the cause. New York, which has allocated $9 million of federal AIDS funds for the protease inhibitors, could see the cost for the drugs reach $120 million a year. Medicaid currently provides the drugs for its recipients, but some private insurers and managed care companies restrict coverage to patients with advanced disease. "Report Says AIDS May Curtail African Growth" New York Times (07/03/96) P. A5 Despite the devastating impact of AIDS on the world's population, a new report says that if birth rates in some developing countries are maintained, world population could reach 100 billion by the end of the century. The Population Reference Bureau reported on Tuesday that the AIDS epidemic in parts of Africa will dampen population growth there much more than was previously thought. The report said that sub-Saharan Africa's population will be 1.25 billion by 2025--100 million less than it would have been without the impact of AIDS. "It now seems quite likely that AIDS will alter the demographic prospects of some 20 to 30 countries" in Africa, with Botswana, Kenya, Malawi, Uganda, Zambia, and Zimbabwe being the most affected, the report concluded. "All Day, Every Day, A Global Forum on AIDS" New York Times (07/03/96) P. C7; Rifkin, Glenn An ongoing global AIDS forum on the Internet, designed to allow an exchange of AIDS information for health care workers in developing countries, was launched last week by the Satellife Inc., a nonprofit organization based in Boston. AIDS researchers from the Harvard AIDS Institute and Harvard School of Public Health, the European AIDS Commission, the Uganda Viral Research Institute, and the All-India Institute of Medical Sciences collaborated to create the Program for Collaboration Against AIDS and Related Epidemics (Procaare). The project is to be operated like a professional medical conference, providing a low cost way for health care workers and researchers to exchange information on the spread, treatment, and prevention of AIDS. Procaare's World Wide Web site can be reached at http://www.healthnet.org/procaare.html. "AIDS Fighters See Ray of Hope" Washington Times (07/03/96) P. A12; Osterman, Cynthia As the beginning of the 11th International Conference on AIDS in Vancouver nears, the AIDS research community is in an optimistic mood, buoyed by major advances is treating the disease. The meeting, which will begin on Sunday, will be the largest ever, attracting some 15,000 researchers, policy-makers, patients, activists, and journalists. The mood will likely be that of cautious optimism, a change from the atmosphere of disappointment that has pervaded previous meetings. While protease inhibitors have shown promise for managing the disease, questions still remain about their long-term effectiveness and the virus' potential to become resistant to them. "The Battle's Big Gun: Protease Inhibitors" USA Today (07/03/96) P. 1D; Painter, Kim AIDS patients, researchers, and doctors are optimistic about the promise of protease inhibitors, which some say may make AIDS a manageable disease. Three of the new drugs are on the market, and several others are on the way. The treatments are not effective for everyone, they have side effects, and no one knows how long they will work or which combination of drugs is best. Patients responding well to the drugs, however, say they have new hope for healthier and longer lives. "Science Meets Nature in AIDS Study" Toronto Globe and Mail (07/02/96) P. A6; Immen, Wallace While patients increasingly seek alternative treatments for AIDS, from acupuncture to Chinese herbal medicines to tai chi, researchers studying the use of such therapies are hard-pressed to come up with evidence that they are effective. A study of alternative therapies led by Carlo Calabrese at Bastyr University, an alternative medical school in Seattle, will be presented, along with similar studies, at the International Conference on AIDS in Vancouver next week. Calabrese's study currently consists of a survey of AIDS patients' use of alternative therapies, with a follow-up study planned of any that show promise. Patients seeking alternative therapy are advised to stop smoking, using drugs, or consuming alcohol, and to take vitamins and exercise. "A Victory in Funding AIDS Treatment" Toronto Globe and Mail (07/02/96) P. A6; Matas, Robert Michael O'Shaughnessy, director of the British Columbia Center for Excellence in HIV/AIDS, has been influential in persuading the provincial government to provide new AIDS drugs almost as soon as they are available. British Columbia will spend about $15 million on AIDS drugs this year as a result, up from $1 million in 1992. O'Shaughnessy's center, which operates out of St. Paul's Hospital in Vancouver, was created in 1991 to evaluate the AIDS epidemic in the province. It was later given authority to distribute drugs for HIV and has enrolled about 1,600 patients who receive the drugs in exchange for information about the AIDS community. "New Advances Toward Effective Protease Inhibition of HIV" Reuters (07/02/96) HIV can develop resistance to currently approved protease inhibitors, but researchers report in the July issue of Nature Medicine new ways to counteract this resistance. Thomas Gingeras of Affymetrix in Santa Clara, Calif. and colleagues analyzed the protease genes of different subtypes of HIV found in patients before protease inhibitors were used. The researchers found that many mutations linked to protease inhibitor resistance had already existed in these patients, suggesting that therapy should be started before viral replication results in a variety of strains. In a second study, led by Dale J. Kempf of Abbott Laboratories, researchers report that resistance to the protease inhibitor ritonavir increased in direct proportion to the appearance of nine specific mutations in the protease gene. "The Risk of Transfusion-Transmitted Viral Infections" New England Journal of Medicine (06/27/96) Vol. 334, No. 26; P. 1685; Schreiber, George B.; Busch, Michael P.; Kleinman, Steven H.; et al. To estimate more accurately the risk of contracting HIV and other viruses from a blood transfusion, George B. Schreiber of Westat, Inc. in Rockville, Md., and colleagues calculated an estimate that incorporated the risk of receiving blood donated before the virus could be detected. Donations made during this "window period," the time between infection and when the body begins producing detectable antibodies, pose the greatest threat to transfusion recipients. The researchers calculated rates of seroconversion among blood donors for HIV, human T-cell lymphotropic virus (HTLV), hepatitis C (HCV), and hepatitis B (HBV) from 1991 to 1993. Only people who donated blood more than once and whose blood passed all screening tests were included. Risks were then determined from estimates of the length of the window period for each virus. The risk of receiving HIV- or HTLV-infected blood was found to be two per million donations. The estimated risk was five times greater for HCV and eight times greater for HBV. The researchers also report that viral antigen and nucleic acid testing for HIV would be expected to detect from seven to 12 HIV-infected but seronegative donations per 12 million screened units. The AIDS Daily News will not be published on Thursday, July 4, 1996, in observance of Independence Day. Publication will resume on Friday, July 5.