AIDS Daily Summary January 5, 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 1994, Information, Inc., Bethesda, MD ************************************************************ "Virus Linked to Muscle Tumors in AIDS Victims" "Cardinal Describes 'Profound Reconciliation' with Former Accuser" "Manila Health Minister an Unlikely Agent of Satan" "Frenchmen Have More Sex than Most--Playboy Survey" "Cyclospora Infection in Adults Infected with HIV: Clinical Manifestations, Treatment, and Prophylaxis" "Bacterial Bronchitis and Bronchiectasis in Human Immunodeficiency Virus Infection" "Mycobacterium Avium in the AIDS Patient: An Analysis Using the Epidemiologic Paradigm" "The Care of Injection-Drug Users with HIV Infection" "Knowledge, Attitudes, Beliefs and Behaviors (KABB) Surveys" "A Helping Hand" ************************************************************ "Virus Linked to Muscle Tumors in AIDS Victims" Reuters (01/04/95) The Epstein-Barr virus may play a role in causing muscle tumors in young people who have AIDS. While the study does not prove that the virus which is responsible for infectious mononucleosis actually causes the tumors, it suggests that the virus is somehow involved. A companion study found traces of the Epstein-Barr virus in muscle tumors that had appeared in children who immune systems had been chemically suppressed as part of their treatment following a liver transplant. In each study, the researchers found that the tumors came from one mutated cell in smooth muscle, which surrounds blood vessels and tissues of the gut. The cells all showed signs of viral infection. Children with AIDS or who have had transplants have an unusually high chance of developing the tumors, known as leiomyomas and leiomyosarcomas. The first research team found remnants of the virus in tumors taken from patients with AIDS, but no copies of the Epstein-Barr virus in smooth muscle tumors taken from HIV-negative patients. The other study found traces of the virus in three liver transplant recipients, ages 18 months to five years. "Cardinal Describes 'Profound Reconciliation' with Former Accuser" Washington Post (01/05/95) P. A7; Walsh, Edward One of the nation's most respected clergymen, Cardinal Joseph Bernadin, met privately last week with Steven J. Cook, the man who leveled and later retracted sexual abuse charges against him. Bernadin said the two experienced the most "profound reconciliation" he has ever seen during his 43 years as a priest. Cook made a "simple, direct, and deeply moving" apology for the accusation of sexual abuse. The cardinal also said of Cook, who has AIDS, that "it was very evident that he was in precarious health." Cook claimed, in a November 1993 lawsuit, that he was "repeatedly and continually" sexually abused in the late 1970s by the Rev. Ellis N. Harsham, a priest at the St. Gregory Seminary in Cincinnati. The $10 million suit alleged that on at least one occasion, Harsham "delivered" Cook to the private quarters of Bernadin, then archbishop of Cincinnati, who also abused him. Three months later, Cook asked that the charges against Bernadin be dropped because he could "no longer be sure that his memories of the abuse by the cardinal are true or accurate." "Manila Health Minister an Unlikely Agent of Satan" Reuters (01/04/95); McIntosh, Alistair While opinion poles regularly rate Philippine Health Secretary Juan Flavier one of the most popular government figures and his ministry one of its most effective, the Roman Catholic Church hierarchy has spent much of 1994 condemning him because of his support of artificial family planning methods, particularly the condom. Flavier, who was publicly denounced as an agent of Satan at a Catholic rally, said, "It's very hard for me to understand" the church's attitude. While Flavier is trying to help the poor have a choice when it comes to family planning, he is also trying to slow the spread of HIV. Officially, there have been just under 600 people identified as HIV-infected in the Phillipines, and approximately 100 deaths. Experts, however, believe there is massive under-reporting because of the stigma attached to AIDS. "Frenchmen Have More Sex than Most--Playboy Survey" Reuters (01/04/95) The Playboy International Sex Survey has determined that French men have sex the most frequently. The survey, to be published in the February 1995 edition of Playboy magazine, asked its readers how and what they do during sex; where and with whom they do it; and whether AIDS has changed their behavior. The magazine found that most men--90 percent in Brazil, 81 percent in France, 78 percent in Greece, 75 percent in the United States, and 70 percent in Japan--are worried about sexually transmitted diseases (STDs). Poles are the least concerned about STDs. A total of 57 percent of American men said they have had more than 11 sexual partners--the highest in the survey and more than the 33 percent reported in the University of Chicago "Sex in America" survey released in 1994. Among other findings, Playboy discovered that Brazilians visit prostitutes more than in other countries; most German men leave birth control to their partner; and Japanese men most frequently use condoms. "Cyclospora Infection in Adults Infected with HIV: Clinical Manifestations, Treatment, and Prophylaxis" Journal of the American Medical Association (12/28/94) Vol. 272, No. 24, P. 1884c At a clinic in Haiti, researchers studied stool samples from HIV-seropositive adults who had diarrhea to determine the prevalence and clinical manifestations of Cyclospora in HIV-infected Haitians as well as to evaluate therapy and prophylaxis. The patients, who had had diarrhea for at least three weeks, were treated with trimethoprim-sulfamethoxazole given orally for 10 days. One-third of the 2,400 patients seropositive for HIV had a history of chronic or intermittent diarrhea. Forty-three patients, who had diarrhea and Cyclospora infection, were found to have symptoms indistinguishable from those seen in patients with isosporiasis or cryptosporidiosis. Diarrhea stopped in all patients and results from stool samples were negative within two and a half days after beginning oral trimethoprim-sulfamethoxazole therapy. Twelve of 28 patients who were followed for one month or more developed recurrent symptomatic cyclosporiasis, which promptly responded to trimethoprim-sulfamethoxazole therapy. The researchers concluded that Cyclospora infection is common in HIV-infected Haitians, responds to therapy with trimethoprim-sulfamethoxazole, and has a high recurrence rate that can largely be prevented with long-term trimethoprim-sulfamethoxazole prophylaxis. "Bacterial Bronchitis and Bronchiectasis in Human Immunodeficiency Virus Infection" Journal of the American Medical Association (01/04/95) Vol. 273, No. 1, P. 4f Researchers noticed an increased incidence of bacterial bronchitis and bronchiectasis among their HIV-infected patients. They discovered 18 episodes of bacterial bronchitis in 10 patients. Bacterial bronchitis was defined by a Gram's stain showing an abundance of neutrophils with a predominance of one or more bacteria and by a confirmatory sputum culture. Bronchiectasis was diagnosed by a bronchogram and computed tomography (CT) in one patient and only CT in two more. The most common pathogens in the bacterial bronchitis episodes were Haemophilus influenzae, Streptococcus pneumoniae, and Pseudomonas aeruginosa. Although there were frequent recurrences, antibiotic therapy was usually successful. The researchers concluded that recurrent bacterial bronchitis should be added to the list of bacterial infections that occur with increased frequency with HIV infection. Repeated bacterial bronchial may lead to bronchiectasis, which may be more common in HIV infection than generally thought. "Mycobacterium Avium in the AIDS Patient: An Analysis Using the Epidemiologic Paradigm" Hospital Pharmacy (12/94) Vol. 29, No. 12, P. 1090; Gourley, Greta K.; Corbett, Cathy E.; Brown, James R. et al The most common systemic bacterial infection found in AIDS patients is disseminated infection with Mycobacterium avium complex (MAC). Based on diagnosis by blood culture, the annual infection rate is approximately 15 to 20 percent. During the susceptibility period, the first stage of MAC, the disease has not yet developed. The second stage, pathogenesis, represents the reaction of the host to the stimulus produced in the first stage. The focus of the final period, advanced disease, is the continuation of the treatment regimen and disability limitations. While tertiary prevention often plays a lesser role in infectious disease because infection less often results in permanent disability or death, diagnosis of MAC may come at such an advanced stage of AIDS that a decision is made not to begin therapy. Because of the extremely infectious nature of MAC, it is critical that therapeutic issues such as appropriate susceptibility tests, ethical guidelines, duration of treatment, and optimal dosages be addressed. "The Care of Injection-Drug Users with HIV Infection" New England Journal of Medicine (12/29/94) Vol. 331, No. 26, P. 1773; O'Connor, Patrick G.; Selwyn, Peter A.; Schottenfeld, Richard S. In response to letters to the editor, O'Connor et al write that Drs. Selbovitz and Zide-Selbovitz raise the important issue of oral health among HIV-infected injection drug users. Those who are HIV-infected are more susceptible to oral candidiasis, a variety of viral infections, neoplastic lesions, and other lesions such as aphthous ulcers. Substance abuse has been linked to oral and pharyngeal disease. Physicians caring for HIV-infected injection drug users should take a history of oral symptoms and perform a careful oral, head, and neck examination. Several efforts are being made to educate health care professionals about issues related to HIV and substance abuse. "Knowledge, Attitudes, Beliefs and Behaviors (KABB) Surveys" United States Conference of Mayors: AIDS Information Exchange (12/94) Vol. 11, No. 5, P. 1 Knowledge, Attitudes, Beliefs, and Behaviors (KABB) surveys--designed to assess the knowledge, attitudes, beliefs, and behaviors of a given target population--can be a critical factor in a successful community HIV prevention needs assessment. The surveys can measure how much a specific population knows about HIV and whether that knowledge has changed behaviors. Survey results can also demonstrate the deficiencies in a community's HIV prevention services by exploring the needs of underserved populations and identifying barriers that prevent people from receiving the HIV prevention messages. A KABB survey should be population-sensitive. For example, cultural and social attitudes within the Asian and Pacific Islander (API) community toward illness, drug use, and sexuality--especially homosexuality--present barriers to effective HIV prevention. There are also more than 70 API languages spoken in some U.S. cities, which necessitates collaboration with the target population and the agencies that serve that population. A well-designed survey includes appropriately-structured questions, proper population sampling, and measures of statistical validity and reliability. "A Helping Hand" Adweek (12/19/94) Vol. 31, No. 51, P. 18; Voight, Joan Inspired by a former colleague who is HIV-positive, Rachel Gaunt, a partner at Sampson & Moore advertising agency in San Francisco, devotes much of her free time to local AIDS projects. In November, for example, she joined about 30 other volunteers to transform the old Ross Pharmacy in San Anselmo, Calif., into a center where people with HIV and AIDS can go for advice, treatment, and support. Gaunt is also an emotional support counselor with the Marin AIDS Project. While most counselors care for one client at a time, she has two--spending anywhere from one to four hours a week with each. Gaunt's compassion stems from a close friendship with a former colleague, Barney Pina. A hemophiliac who became HIV-infected through tainted blood, Pina found the old drugstore and decided to convert it into a nonprofit community center--called The Positive Center--for people with AIDS and other life-threatening diseases. "This work helps you to be open to the natural phenomenon of dying, that it is a part of life," says Gaunt.