AIDS Daily Summary March 16, 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 ************************************************************ "Storing One's Own Blood for Surgery Strains Medical Resources, Study Says" "Mandatory Disclosure Would Create False Security" "Women Who Are Pregnant Should Be Routinely Tested" "AIDS Project Swaps 75,000 New Syringes" "Three Drugs Found Effective Against AIDS Infection" "Biocontrol Hyperthermia Treatment Succeeds" "Bars, Liquor Stores Closed Down in Djibouti" "NIH Research Agenda" "HIV in the Elderly: Not Just from Transfusion" "Has AIDS Won?" ************************************************************ "Storing One's Own Blood for Surgery Strains Medical Resources, Study Says" Wall Street Journal (03/16/95) P. B6; Rundle, Rhonda L. The increasingly popular practice of autologous donation--or banking one's own blood for possible use during surgery--is expensive, strains medical resources, and offers little benefit to society, a new study concludes. The study, published in this week's New England Journal of Medicine, analyzes a medical procedure that many blood banks and physicians began to promote in the early 1980s after stories spread about people who became infected with HIV through a blood transfusion. In light of the improvements in the safety of the blood supply over the past decade, however, autologous blood may be a poor use of scarce medical resources, according to Dr. Jeff Etchason, the study's lead author, a staff physician at the West Los Angeles Veterans Affairs Medical Center. An editorial that accompanies the study, however, says that "the peace of mind that comes from having control over the risk of AIDS and other potentially harmful effects of transfusion is immeasurable." The study concludes that the incremental cost-effectiveness of autologous blood, expressed as dollars per quality-adjusted year of life saved, ranged from $235,000 to more than $23 million. "Mandatory Disclosure Would Create False Security" Philadelphia Inquirer (03/15/95) P. A13; Patrick, Al; Gold, Marla When it comes to celebrities with AIDS, the medical facts are often a sidebar to the main story about how they contracted HIV, write Al Patrick and Marla Gold in the Philadelphia Inquirer. The best way to protect oneself from the disease is to act as if everyone else is potentially infected. Mandatory disclosure for people with AIDS would be the worst way to fight the disease, contend Patrick and Gold. If all people who knew they were HIV-positive disclosed their status, they write, it would only promote a false sense of security. Many people do not know they are infected, which leads to the issue of mandatory testing. Greg Louganis, for example, pushed the bounds of human resilience when he completed the dive during the Olympics after having hit his head on the diving board, and won another gold medal, despite the incredible pressure of the competition and his HIV infection. The thought of losing another athlete--another human being--to AIDS is overwhelming, but the thought of continued discrimination and irresponsibility despite the 400,000 Americans with AIDS and the thousands more who have HIV is enraging, conclude the authors. "Women Who Are Pregnant Should Be Routinely Tested" Philadelphia Inquirer (03/15/95) P. A13; Caplan, Art There are three compelling reasons for the mandatory HIV testing of pregnant women, writes Art Caplan in the Philadelphia Inquirer. Studies have shown that AZT, when taken early during a pregnancy, can reduce by two-thirds the number of HIV-infected newborns. Quick treatment with AZT just after birth may prevent transmission. Another route through which a mother, who does not know she is HIV-positive, can transmit HIV to her child is by breastfeeding. About 4 million women give birth in the United States each year. Testing each of them for HIV would cost about $100 million, but the cost of caring for one baby with HIV is, conservatively, $35,000 per year. As those children live an average of 10 years, each child born with HIV represents $350,000 in health-care costs. It, therefore, makes sense to spend the money mandatory testing would require. The antidote for the fear and the stigma associated with HIV and AIDS, and the way to be sure that lives are saved, is to require that every pregnant woman receive HIV testing and counseling, concludes Caplan. "AIDS Project Swaps 75,000 New Syringes" Milwaukee Sentinel (03/14/95) P. 5A; Manning, Joe Seventy-five thousand used syringes were exchanged for clean ones during the first year of Lifepoint, the Milwaukee AIDS Project's needle exchange program, according to figures released by the organization on Monday. Lifepoint had expected to exchange only about 41,000 needles by this point, said Doug Nelson, executive director of the AIDS Project. Nelson said the program tries to get intravenous drug users into treatment for their addictions. Until they decide to seek treatment, however, Lifepoint attempts to keep the addicts from becoming infected with HIV. Two full-time needle exchange workers reached more than 4,000 users during the first year, Nelson said. The majority of the participants in the program are from Milwaukee, but intravenous drug users from other cities and rural areas of Wisconsin are also exchanging needles. The program has also helped drug addicts learn about HIV, how drug use increases the risk of becoming infected, and how they can avoid the risks of contracting the disease and transmitting it to others. "Three Drugs Found Effective Against AIDS Infection" Reuters (03/15/95) In a recent study, Dr. Samuel Bozzette and colleagues at the University of California at San Diego found that dapsone, aerosolized pentamidine, and a combination of trimethoprim and sulphamethoxazole were each effective against AIDS-related pneumonia. The study, which was co-authored by Dr. William Powderly of Washington University, is published in Thursday's New England Journal of Medicine. Powderly conducted a second trial comparing fluconazole and clotrimazole lozenges. He found that fluconazole was three times more effective against AIDS-related fungal infections than the clotrimazole. "Biocontrol Hyperthermia Treatment Succeeds" Reuters (03/15/95) On Wednesday, Biocontrol Technology Inc. announced that its IDT Inc. subsidiary, in conjunction with HemoCleanse Inc., had successfully treated 10 people with AIDS in its second Food and Drug Administration (FDA)-approved clinical trial of a whole-body extracorporeal hyperthermia treatment. Each patient received two treatments within four days, which, according to the company, was the first time that two hyperthermia treatments had been administered on a single patient in so short a time span. Biocontrol said that all 10 patients did remarkably well during and immediately after the treatments. HemoCleanse's BioLogic-HT system, which is used to monitor and regulate body chemistries during the procedure, performed above expectations. In a total of 30 treatments, the BioLogic-HT system had eliminated the side effects. Biocontrol said it intends to apply to the FDA, under the agency's expedited review process for AIDS, to market the BioLogic-HT system, which is made by HemoCleanse. "Bars, Liquor Stores Closed Down in Djibouti" Reuters (03/15/95) In a drive against alcoholism, drugs, and AIDS, approximately 85 bars and shops selling alcohol in Djibouti closed on Wednesday under government orders. The government ordered the stores to close after allowing a six-week reprieve at the request of their Ethiopian owners to give them more time to enter other businesses. Interior Ministry Secretary-General Ali Mallow said the move was an attempt to protect young people from alcoholism, drugs, and AIDS, as well as to curb prostitution, which was banned in 1979. "NIH Research Agenda" American Medical News (03/06/95) Vol. 38, No. 9, P. 12 As one step toward a major re-examination of AIDS research priorities, William E. Paul--the director of the Office of AIDS Research (OAR) at the National Institutes of Health--in February appointed molecular biologist and cancer researcher Dr. Arnold Levine to head a panel of scientists who will develop a new research agenda. At last summer's International Conference on AIDS, Paul said that while a great deal of money had gone into clinical trials, not enough had been spent on basic research. "The OAR is committed to a strategy that allows both a rededication to fundamental research on HIV and AIDS, and the maintenance of efficient efforts in the spheres of drug discovery, clinical trials, vaccine development, and behavior modification," Paul wrote recently in Science magazine. "HIV in the Elderly: Not Just from Transfusion" AIDS Clinical Care (03/95) Vol. 7, No. 3, P. 25 Two small studies add to the data known about the small, but growing population of HIV-infected people who are aged 60 or older. The first study analyzed the charts of 27 men and 5 women ages 60 to 83 at an inner-city Atlanta hospital. In 15 of the 20 cases where the source was known, HIV was transmitted through sex or injection drug use. Transfusion was the cause in only three cases. Diagnosis was frequently delayed because the patients were not considered to be at risk for HIV. The second study looked at serum samples taken from 170 elderly patients who died between 1992 and 1993 at Harlem Hospital in New York. The researchers found evidence of HIV infection in 6 percent of the men and 9 percent of the women. Once again, most or all of the cases were unsuspected, and many of the patients had no known risk factors. Clinicians should be aware of the potential for HIV in the elderly and should take a sexual history regardless of age. There is evidence that older sexually active people--including those with HIV risk factors--have much lower rates of condom use than younger people. "Has AIDS Won?" New York (02/20/95) Vol 28, No. 8, P. 31; Horowitz, Craig There is increasing dissatisfaction among those in the AIDS activist and scientific communities. "I've essentially had it," said Peter Staley, one of the country's leading AIDS activists. "I get no gratification or inspiration from this work anymore. Every month it's a new battle, and the battles now are usually intra-community." And although there have been AIDS-related medical advances, there has been an amazing lack of progress. A vaccine is believed to be years away. The four drugs approved by the Food and Drug Administration for treatment are all toxic and none works particularly well. "Here's one little virus that has had over a billion dollars a year spent on it for years by the government and who knows how much by the pharmaceutical industry. So there is the sense that we should be farther along," said Nobel laureate Dr. David Baltimore of MIT. Some $1.3 billion of the National Institutes of Health's (NIH) $11 billion budget is devoted to AIDS research. Many people, however, have questioned--in both practical and philosophical terms--the way the money is spent. Dr. William Paul, director of NIH's Office of AIDS Research, recently called for a "re-examination of the entire NIH AIDS research endeavor," and said he was forming a commission that over the next year will rethink AIDS research.