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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

       

http://www.aidsinfobbs.org/library/cdcsums/1997/1193

Subject: CDC AIDS Daily Summary
Date: Tue Sep 30 07:31:04 PDT 1997 (247 lines)
From: National AIDS Info Clearinghouse
Copyright 1997, Information, Inc., Bethesda, MD
                     AIDS Daily Summary



                     September 30, 1997



The CDC National Center for HIV, STD, and TB Prevention makes 
available the following information as a public service only. 
Providing this information does not constitute endorsement by the 
CDC. 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 1997, 
Information, Inc., Bethesda, MD.
"Condoms in School Said Not to Affect Teen-Age Sex Rate" 
"Setbacks for Many on Drugs for AIDS"
"U.S. Unit Says FDA Clears Combivir Tablet for AIDS" 
"AZT Not Needed in AIDS Cocktails"
"U.S. Awards Grants to Study AIDS Vaccines" 
"Experts: Delay in Sex-Disease Vaccines"
"Transmission of a Highly Drug-Resistant Strain (Strain W1) of 
Mycobacterium Tuberculosis"
"Transmission of Mycobacterium Tuberculosis by a Fiberoptic 
Bronchoscope"
    
"Tuberculosis Infection After Bronchoscopy"
"Request for Comments on Guidelines for the Use of Antiretroviral 
Agents in Pediatric HIV Infection"
"U.S. Drafts Guidelines on Treating Children With HIV" 
"Condoms in School Said Not to Affect Teen-Age Sex Rate" 
New York Times (09/30/97) P. A1; Richardson, Lynda
     A new analysis of school districts in New York City and
Chicago suggests that AIDS education programs which include easy 
access to condoms do not increase rates of sexual activity, but 
do increase use of condoms.  The study, conducted by researchers 
from New York University as part of a three-year evaluation of 
New York City's AIDS Education program, was mainly funded by the 
Robert Wood Johnson Foundation.  It compared rates of condom use 
and sexual activity among teenagers attending New York City 
public schools--where condoms are available--to those of students 
in Chicago school districts, where condoms are not a part of AIDS 
education programs.  According to researchers, providing condoms 
in schools is "a low-cost, harmless addition" to HIV prevention 
efforts.  The study's findings will be published in this month's 
issue of the American Journal of Public Health.
"Setbacks for Many on Drugs for AIDS" 
New York Times (09/30/97) P. C4



     On Monday, doctors at the Interscience Conference on
Antimicrobial Agents and Chemotherapy in Toronto said that new
AIDS treatments are beginning to fail in about half of those
undergoing treatment.  "Over the past year, we have had a
honeymoon period," said researcher Steven Deeks.  "The epidemic
will likely split in two, and for half the people, we will need
new therapeutic options."  Dr. Deeks presented data from an AIDS
clinic, operated by the University of California at San
Francisco, at San Francisco General Hospital. This data showed a
return to detectable virus levels in 53 percent of 136
HIV-positive patients, most of whom had experienced an initial
drop in virus levels to an undetectable point after beginning
protease inhibitor therapy.  Doctors say the resurgence could be
a sign the virus is adapting to survive the new treatments, or
merely a result of patients not following the required dosing
schedules consistently.
    
"U.S. Unit Says FDA Clears Combivir Tablet for AIDS" 
Wall Street Journal (09/30/97) P. B6
     The Food and Drug Administration has approved Glaxo Wellcome 
Inc.'s Combivir tablet, which contains two of the more popular 
AIDS drugs and allows HIV-positive patients to reduce the 
complexity of their multidrug regimens.  Glaxo said it will 
charge wholesalers and distributors $7.18 per tablet of Combivir, 
which contains AZT, marketed under the name Retrovir; and 3TC, 
marketed as Epivir.  The company expects the tablets to be on 
pharmacy shelves by mid-October.
"AZT Not Needed in AIDS Cocktails"
United Press International (09/29/97); Susman, Ed
     Research presented at the American Society for
Microbiology's infectious disease conference in Toronto suggests 
that AZT may no longer be necessary in multi-drug cocktails used 
to fight HIV.  Researchers compared three triple-therapy regimens 
and found all treatments equally effective in reducing virus in 
the blood by more than 95 percent.  Patients treated without AZT, 
however, experienced fewer side effects.  The combinations tested 
comprised AZT, 3TC and indinavir; d4t, 3TC, and indinavir; and 
d4T, ddI, and indinavir.
"U.S. Awards Grants to Study AIDS Vaccines" 
Reuters (09/29/97)
     The National Institute of Allergy and Infectious
Diseases announced Monday it has awarded grants totaling $11.8 
million to 49 research projects that will study vaccines to fight 
HIV.  The researchers will examine the structure of the virus and 
the body's immune response, genetic engineering of animals for 
testing, and ways to help the body better recognize proteins 
displayed outside the virus.  NIAID Director Dr. Anthony Fauci 
noted: "The 49 grants we are funding will explore creative 
approaches to vaccine design and involve many investigators new 
to AIDS research."
"Experts: Delay in Sex-Disease Vaccines"
United Press International (09/29/97); Smith, Michael
     Scientists said Monday that research to find vaccines
against sexually transmitted diseases has been slowed by a lack 
of support from the government and the public.  Speaking at an 
infectious disease conference sponsored by the American Society 
for Microbiology, Justin Radolf of the University of Texas 
Southwestern Medical Center noted that "there are still segments 
of our society that are not convinced of the value" of vaccines 
against syphilis, gonorrhea, herpes, and the like.  Although 
National Institutes of Health officials actively support such 



research, he said, "they have to answer to elected people." 
Lawrence Corey of the University of Washington agreed with 
Radolf's contention, noting that STD vaccines "are not something 
people are out there championing."  Corey said that a large part 
of the problem stems from difficulties involved in manufacturing 
these kind of vaccines and the lack of profit that results.
"Transmission of a Highly Drug-Resistant Strain (Strain W1) of 
Mycobacterium Tuberculosis"
Journal of the American Medical Association (10/01/97) Vol. 278, 
No. 13, P. 1073; Agerton, Tracy; Valway, Sarah; Gore, Betty; et 
al.
     A review of a 1995 outbreak of multidrug-resistant
tuberculosis (MDR TB) in eight patients in South Carolina has 
revealed that inadequate cleaning and disinfection of a 
bronchoscope used on one MDR TB-positive patient led the 
outbreak. The source case, Patient 1, had been living in New 
York, where he was hospitalized in 1991 during an MDR TB (strain 
W1) outbreak due to nosocomial transmission. Patients 2 through 5 
were either family or friends of Patient 1. However, while the 
fifth patient lived in the same town as Patient 7, Patients 6 and 
8 lived in two different towns, and no community link could be 
established between the two groups. Following extensive hospital, 
laboratory, and bronchoscopy reviews, the researchers ultimately 
found the source of contamination--a discovery that they say was 
possible only because it involved strain W1, an extremely 
resistant strain of Mycobacterium tuberculosis that is not 
usually seen outside of New York State.
"Transmission of Mycobacterium Tuberculosis by a Fiberoptic 
Bronchoscope"
Journal of the American Medical Association (10/01/97) Vol. 278, 
No. 13, P. 1093; Michele, Theresa M.; Cronin, Wendy A.; Graham, 
Neil M.H.; et al.
     A traditional and molecular epidemiologic investigation
suggests that a contaminated bronchoscope is the most likely link 
of infection between two individuals who were diagnosed with 
Mycobacterium tuberculosis six months apart.  An ongoing 
restriction fragment length polymorphism (RFLP) study of TB 



isolates from the two patients revealed a unique and identical 
10-banded IS6110 RFLP pattern.  The only identifiable link
between the first patient, a non-U.S. born adult referred for
evaluation of a four-month-long cough and fever; and the second,
an elderly adult with facial swelling and dyspnea without
previously documented tuberculin status, was treatment at the
same hospital.  Both patients received bronchoscopies with the
same instrument in the same room with no intervening
bronchoscopies, and instrument cleaning and disinfection



procedures did not comply with national guidelines.  The
findings, the researchers note, emphasize the continuing need for
care in endoscope cleaning.
"Tuberculosis Infection After Bronchoscopy"
Journal of the American Medical Association (10/01/97) Vol. 278, 
No. 13, P. 1111; Wenzel, Richard P.; Edmond, Michael B.
     Implementation and monitoring of adequate guidelines for 
bronchoscope cleaning and disinfection are essential to the 
control of tuberculosis in the United States, write Drs. Richard 
Wenzel and Michael Edmond in an editorial in the Journal of the 
American Medical Association.  Some 460,000 patients undergo 
fiberoptic bronchoscopy in the U.S. each year.  If 1 to 5 percent 
of all these procedures are performed on patients with TB and are 
followed by another procedure with the same instrument, and if 10 
percent of those instruments are inadequately disinfected,
between 460 and 2,300 individuals will be exposed to the pathogen
each year.  Wenzel and Michael note there is considerable cause
for concern given the current rate of eight cases of TB per
100,000 Americans.  The authors say that regional surveillance,
such as the system used by the Centers for Disease Control and
Prevention and the South Carolina TB registry to trace the source
of such a TB outbreak, is effective for understanding the
epidemiology of infection.  The major issue, however, is hospital
protocol for instrument cleaning.  
"Request for Comments on Guidelines for the Use of Antiretroviral 
Agents in Pediatric HIV Infection"
AIDS Treatment Information Service (ATIS) (09/30/97)
     The Health Resources and Services Administration (HRSA) is
requesting comments from all interested parties on the following
document: Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection. The document was developed by
specialists in the care of HIV-infected infants, children and



adolescents, family members of HIV-infected children, and
governmental agency representatives at a meeting in July convened
by the National Pediatric and Family HIV Resource Center (NPHRC),
HRSA, and the National Institutes of Health (NIH). While the
pathogenesis of HIV infection and the general virologic and
immunologic principles underlying the use of antiretroviral
therapy are similar for all HIV-infected individuals, there are
therapeutic and management considerations that are unique to
HIV-infected infants, children, and adolescents. This document
addresses the pediatric-specific issues related to antiretroviral
treatment and provides general guidelines to physicians caring
for infected children and adolescents.  Comments on the proposed
guidelines must be received on or before Wednesday, October 29,
1997, to ensure that HRSA will be able to consider the comments
in preparing the final guidelines. Written comments should be
submitted to: The HIV/AIDS Treatment Information Service, P.O.
Box 6303, Rockville, MD 20849-6303. Only written comments will be
accepted.  After consideration of the comments, the final
document will be published in the Centers for Disease Control and
Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR).
The Guidelines are available in Portable Document Format (PDF)
from ATIS, http://www.hivatis.org/.
"U.S. Drafts Guidelines on Treating Children With HIV" 
Reuters (09/29/97)
        New guidelines from the U.S. Department of Health and 
Human Services recommend giving potent drug combinations to 
infants born HIV positive as soon as possible to prevent disease 
progression.  The guidelines were established by 64 experts on 
treating HIV-infected children and are being published for 
comment before they are made national policy.  "These guidelines 
will fill an important gap in our knowledge by recognizing the 
unique treatment needs of infants, children, and adolescents 
living with HIV," said Health and Human Services Secretary Donna 
Shalala in a statement.  "With early testing and aggressive 
treatment, infected children will live longer, more normal
lives."
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