HICN609 Medical News Part 4/4 
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 HICN609 Medical News Part 4/4

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HIV from patients than vice versa.  In the United  States, some surgical
personnel may be facing a 2 percent per  year risk of contracting HIV.  Over a
professional lifetime of 35 years, more than half such surgeons would become
infected with  HIV.  The U.K. General Medical Council's recommendations that  
doctors who discover that a colleague is HIV-positive should  report the
result to the authorities violates patient  confidentiality.  Therefore,
doctors' civil liberties are  jeopardized, concludes Ellis.
"HIV {*filter*} Test Counseling" American Medical News (03/22/93-03/29/93) Vol. 36,
No. 12,  (special insert)

     The American Medical Association (AMA) has developed its second  edition
of physician guidelines for HIV {*filter*} test counseling.   The guidelines urge
physicians to educate the public and provide  patients with specific
counseling on the HIV antibody {*filter*} test. The AMA says that the ELISA
(enzyme-linked immunosorbent assay)  is the most widely used HIV test.  But
for someone to be  considered to be HIV-positive, results of three tests
conducted  on the same serum specimen must be reactive.  These confirmatory  
tests include the Western Blot, the radioimmuno precipitation  assay (RIPA),
and the indirect immunofluorescence assay (IFA).   The AMA states that HIV
tests should be readily available for  anyone requesting testing.  Also,
doctors should encourage  voluntary HIV testing for anyone whose history or
clinical status suggests risk for HIV infection.  Pretest procedures include  
providing HIV education; providing information about the test;  conducting
risk assessment, including sex and drug history; and  counseling about risk
reduction.  The pretest counseling should  be conducted face-to-face and
should involve the discussion of  the medical, psychological, and social
implications of HIV  testing.  Adolescents and women have special
considerations  regarding HIV that should be addressed, such as women's more  
ambiguous manifestations of HIV infection.  The AMA supports  routine HIV
testing, which is the testing of all patients  regardless of their risk.  But

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such testing should involve  consent that can be provided as part of the
general consent for  treatment.  Every patient should subsequently be informed
of his  or her test results, according to the AMA.

                                 April 7, 1993

"Army to Test AIDS Drug Despite Objections" Washington Post (04/07/93), P. A1  
(Squires, Sally)

     The Department of Defense yesterday confirmed that it expects to  test a
therapeutic AIDS vaccine made by MicroGeneSys of Meriden,  Conn., even though
federal health officials and top AIDS  researchers objected to the trial.  
Yesterday marked the deadline for preventing the controversial $20- million
trial of the  vaccine from being conducted.  The vaccine, gp160, is a
substance made from part of the outer coating of HIV.  The Defense  Department
has a large system of medical facilities, and plays a  key role in AIDS drug
research, including trials on civilians.   However, the choice of which {*filter*}
to test is traditionally made  by researchers at the National Institutes of
Health (NIH).  But  in the case of gp160, Congress bypassed NIH last fall and  
approved both the vaccine and the funding level to be used in the trial.  The
trial was subsequently mandated by an amendment to  the defense appropriations
bill passed last fall.  The amendment  stated that the trial should proceed
unless the NIH director, the commissioner of the cooking.net">food and Drug Administration,
and the  secretary of defense unanimously decide not to allow it within  six
months of the bill's passage.  Last Thursday letters were  sent to Defense
Secretary Les Aspin and House Appropriations  Committee Chairman William H.
Natcher (D-Ky.) from NIH Director  Bernadine P. Healy and FDA Commissioner
David A. Kessler, who  recommended that the trial be conducted only if it
involved  testing of other therapeutic vaccines now under development.  
However, Army spokeswoman Sgt. Dawn Kilpatrick said yesterday  that regardless
of the recommendations, "the Army has decided to  test only the gp160
[MicroGeneSys] vaccine."
"Laser {*filter*} Test" Associated Press (04/05/93)

     Little Rock, Ark.--Because taking a {*filter*} sample can be quite  risky,
Russian and American researchers say they have devised a  way to take a sample
by substituting a laser beam for the sharp  steel lancets.  Charles Vestal,
chairman of Venisect Inc. of  Little Rock, Ark., said, "We're going to change
the whole  industry."  The company refined a device that was once a Soviet  
military secret.  Although lasers are currently used in surgery,  the new
technique allows a laser to make a minuscule opening--up  to 0.5 millimeters
in diameter and 0.5 millimeters deep.  The  hole is large enough to permit the

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collection of a small {*filter*}  sample, and it heals exactly like other tiny
punctures.  The  researchers claim the laser, which would not touch {*filter*}, may  
help allay fears about spreading disease through needles and  other sharp
objects.  Dr. Milton Waner, clinical director of the  University of Arkansas
for Medical Sciences Biomedical Research  Laboratory, said that if a patient
is infected with a {*filter*}-borne disease like HIV, "the contaminated lancet or
needle poses a  serious threat to others who come in contact with it."  But
the  laser is much safer and cheaper than steel lancets.  The laser  was first
invented in the late 1970s by scientists at the General Physics Institute of
the Russian Academy of Sciences.  Last year, Vestal discovered that the
technique was available for commercial development in the West.
"Where the AIDS Virus Hides Away" Nature (03/25/93) Vol. 362, No. 6418, P. 287  
(Maddox, John)

     Because of the new findings that HIV replicates in the lymph  nodes while
in the so-called latent period, Professor Peter  Duesberg of the University of
California--Berkeley may want to  change his position, writes John Maddox of
Nature.  Duesberg has  held that drug taking is responsible for AIDS, and not
HIV.  Most viruses are DNA viruses, which ordinarily replicate within cells  
by hijacking the preexisting machinery of DNA transcription and  translation.  
But the genomes of retroviruses, like HIV, by  contrast, consist of RNA.  
Those of the lentiviruses, of which  HIV is one, come equipped with a gene
specifying a reverse  transcriptase (for converting RNA into the complementary
DNA).   While the RNA genome may be used, as if it were one of the  infected
cell's own messenger molecules, to generate the proteins that would allow an
intact virus particle to be regenerated, by  far the more efficient means of
replication is that DNA  complementary to the viral RNA should be incorporated
in the  genome of the cell, where it will serve as a template for the  
production of its own genomic RNA and thus for intact viral  particles.  
Duesberg claims that it is difficult to recover  helper T lymphocytes, whose
attrition for many patients indicates the onset of overt AIDS, virus particles
that might plausibly  infect others.  The new findings show that the virus is
alive and well in the lymph nodes, among other locations, of those infected
with HIV.  The recent revelations suggest that, nevertheless, the alternatives
for AIDS patients are even less justifiable than  seemed likely a few years
ago.  Duesberg should now admit the  possibility that he has been mistaken,
concludes Maddox.
"Where Has HIV Been Hiding?" Nature (03/25/93) Vol. 362, No. 6418, P. 292  
(Temin, Howard M. and Bolognesi, Dani P.)

     The two new studies published in Nature which found that HIV  replicates
in the lymph nodes while in the asymptomatic period  stress that HIV infection
is a very complicated process and that  it will require the perseverance of

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science to gain sufficient  knowledge to control the virus, write Howard M.
Temin and Dani P. Bolognesi of the University of Wisconsin--Madison and Duke  
University Medical Center in Durham, North Carolina,  respectively.  The study
conducted by Pantaleo et al. used  polymerase chain reaction (PCR) to show
that in asymptomatic  HIV-infected patients there are many infected cells in
the lymph  nodes.  Embretson et al. complete their earlier work combining  PCR
and in situ hybridization with autoradiography to demonstrate that a high
fraction of cells, about a quarter, in germinal  centers of lymph nodes are
infected, and that these cells tend  not to be expressing viral RNA.  The
issue of the percentage of  latently infected cells notwithstanding, it can be
concluded from the reports that secondary lymphoid organs are solidly infected  
with HIV.  Both reports also point out that virus particles are  carried
probably passively by follicular dendritic cells but in a form that is likely
to be infectious for other HIV target cells,  especially T-cells, that
circulate through these organs.  In  addition, these reports suggest that a
more centralized AIDS  research effort should examine cohorts of HIV-positive
persons  and carefully quantify, in different tissues at different times  
after infection, cells containing infectious provirus, cells  containing
defective provirus, cells containing early viral RNA,  cells containing late
viral RNA, and the load of free virus,  conclude Temin and Bolognesi.

                                 April 8, 1993

"Wellcome's Defense Fails to Dispel Doubts About AZT" Journal of Commerce
(04/08/93), P. 7A

     The manufacturer of AZT defended the drug Wednesday with data  indicating
that early use in HIV infection could enhance the  chances of survival.  
However, Burroughs Wellcome's effort only  incited controversy.  Wellcome's
investors, unimpressed with the  company's contentions, dropped shares again
as a result of fears  of another round of negative publicity for the drug.  
Peter  Cartwright, pharmaceutical analyst at stockbroker William de  Broe,
said, "They didn't come up with anything very new, nor did  they put on a
knock-out defense of their position.  They handled  it very badly."  These
incidents follow the "Concorde" study,  published in The Lancet last week,
which indicates that AZT has  no significant effect on the development of
AIDS.  Paul Fiddian,  Wellcome's clinical virology head, claimed that a full
analysis  of the Concorde study conducted in Europe would demonstrate that  
early treatment with AZT could improve survival rates in AIDS  patients.  
However, industry experts said Wellcome's argument  surrounds its on-going
belief that the level of CD4 cells is a  conclusive marker in the progression
of the disease.  Preliminary results of the study showed patients taking AZT
before full-blown AIDS had more CD4 cells, but it found no proof that they

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lived  longer.  Concorde researchers said their discoveries raise  questions
on the validity of CD4 cell counts to measure benefits  of AIDS treatments.  
Professor Richard Peto of the Clinical Trial Service Unit in Oxford said it
would probably take several more  years and more extensive trials to reach
final conclusions about  the net effects of early use of AZT.   Related Story:
Investor's Business Daily (04/08) P. 3
"Is AZT a False Hope?" Time (04/12/93) Vol. 141, No. 15, P. 25

     Although the AIDS drug AZT is given to asymptomatic HIV-positive  
patients to delay the onset of full-blown AIDS, it may not have  to be
prescribed so early in the course of disease.  Several  studies have
demonstrated that AZT can postpone the onset of  symptoms, though it does not
prevent or cure the disease.  But  the largest and longest-term study ever
conducted has found the  opposite to be true.  A three-year European study
reported in the current issue of the Lancet discovered that patients infected  
with HIV who take AZT even though they exhibit no symptoms of  AIDS progress
at the same rate of disease as those who do not  take AZT early on.  But the
discovery does not question AZT's  benefits for those who already have
symptoms, and it is being  examined with skepticism by some AIDS researchers.  
Moreover, a  single study won't change conventional therapeutic regimens.  But
it does raise questions about prescribing such an expensive drug, and
indicates that the search for new AIDS {*filter*} will be pursued  more vigorously
than ever.

                                 April 9, 1993

"Controversial Plan to Test Single AIDS Drug Said to Be Canceled" Washington
Post (04/09/93), P. A4  (Squires, Sally)

     The Defense Department plan that spurred controversy over a $20  million
trial of an experimental AIDS vaccine has apparently been canceled, sources
say.  The scheduled drug trial had angered many researchers because Congress
bypassed the advice of federal  scientists and required that the Army test
only VaxSyn, made by  MicroGeneSys, after an extensive lobbying effort by the
drug  company.  On Tuesday, the deadline for stopping the project  expired.  
But White House officials called a meeting on Wednesday morning involving
Edward Martin, acting assistant secretary for  health affairs at the Defense
Department, as well as National  Institutes of Health Director Bernadine Healy
and cooking.net">food and Drug  Commissioner David A. Kessler.  The meeting, held at the  
Pentagon, addressed how to expand the clinical trials to include  other
therapeutic AIDS vaccines now in the pipeline.  Health and  Human Services
Secretary Donna E. Shalala said yesterday at a  news briefing that an

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announcement describing the new agreement  would be provided in 24 hours.  
According to some sources, the  trial will be expanded to include two other
therapeutic vaccines  and a placebo.  The appropriations amendment approved by
Congress last fall required that the trial proceed unless the NIH  director,
the commissioner of the FDA, and the secretary of  defense unanimously agreed
not to proceed within six months of  the bill's passage.  On April 1, Kessler
and Healy wrote letters  to Defense Secretary Les Aspin suggesting that the
trial be  expanded to include other {*filter*}.  Yesterday, Healy's spokeswoman  
said "all three parties seemed to be headed in the same  direction."  Related
Story: Washington Times (04/09) P. A4
"{*filter*} Milk May Transmit HIV, Journal Reports" Reuters (04/07/93)

     London--HIV-positive mothers could transmit the infection to  their
babies through {*filter*} milk, according to a study published  Thursday in The
Lancet.  However, these women should not  discontinue {*filter*}-feeding their
babies, another report said.   The first report discovered that if a mother's
milk contained  HIV-positive cells, it was likely her baby would also become  
infected.  Dr. Philippe Van de Perre of the AIDS Reference  Laboratory in
Kigali examined the {*filter*} milk of 215 HIV-positive women who had just given
birth.  "Presence of HIV-infected cells  in milk taken 15 days after birth was
strongly predictive of HIV  infection in children," the report said.  However,
this did not  conclusively mean that {*filter*} milk transmitted HIV to the child.  
"Because there is no way of distinguishing HIV infection acquired in the
uterus from that acquired during or after birth, this  study can only report
an overall risk of transmission from mother to baby," the study added.  In a
separate report, Dr. Jacqueline  Mok of City Hospital in  Edinburgh said
{*filter*} milk is important  for protecting children against malnutrition and
infectious  diseases.  She said it was imperative that women in countries  
where malnutrition and infection lead to child deaths continue  {*filter*}-feeding
their babies.
"AIDS Moves to 5th Place as Killer of Young People" United Press International
(04/09/93)  (Taylor, Charles S.)

     Atlanta--AIDS is now the fifth leading cause of premature death  of
Americans aged 65 and under, according to a report by the  Centers for Disease
Control.  The federal agency said Thursday  that during 1991, the last year
for which statistics are  available, AIDS replaced birth defects as the number
five cause  of premature death for younger Americans.  Previously, AIDS had  
been ranked sixth as an early cause of death, or, as the CDC  considers it,
the cause of "years of potential life lost before  age 65."  The disease
appeared for the first time in national  health statistics in 1987, when it
was categorized as a major  cause of death of young people.  It ranked seventh
that year and  moved up to sixth place in 1988.  It remained there until

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moving  to fifth place in 1991.  Between 1989 to 1990, the largest  increases
in premature deaths were for HIV/AIDS, at 12.7 percent, and suicide/{*filter*},
at 6.5 percent.  The CDC reports that there have been 253,448 cases of AIDS in
the United States and 171,890  deaths as of Dec. 31, 1992.
"Tuberculosis Prevention in Drug-Treatment Centers and  Correctional
Facilities--Selected U.S. Sites, 1990-1991" Morbidity and Mortality Weekly
Report (03/26/93) Vol. 42, No. 11, P. 210

     About 87,000 inmates released each year from U.S. drug treatment  centers
(DTCs) and 133,000 federal and state correctional  facility inmates (CFs) may
have latent tuberculosis infection,  according to the Centers for Disease
Control.  The CDC awarded  money to 25 state and city health departments in
1989 to support  TB testing and administration of preventive therapy, as well
as  with HIV counseling and testing in DTCs and CFs.  The project  found that
among the 40,823 persons enrolled in the target  facilities from program
initiation through December 1991, 30,808  were from 114 DTCs and 10,015 were
from six CFs in the 23 areas  for which data was available.  The CDC project
detected 26  previously unreported active TB cases and 145 persons with  
suspected TB.  All 21 people with active TB cases and with known  HIV status
were HIV-positive.  Among the 124 persons with  suspected TB for whom HIV
status was known, 61 were HIV-positive. The report found that the prevalence
of skin-test positivity was  higher among HIV-negative persons, suggesting
that HIV-induced  anergy might be obscuring the true prevalence of tuberculin  
positivity among those clients tested.  The CDC concludes that  since there is
such a high risk of HIV infection in person in  DTCs and CFs, there is a need
for longer preventive therapy among HIV-infected persons, and HIV counseling
and testing should be  offered to all persons in these settings.

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