                     AIDS Daily Summary 
                     September 06, 1994

The Centers for Disease Control and Prevention (CDC) National AIDS
Clearinghouse makes available the following information as a public
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Copyright 1994, Information, Inc., Bethesda, MD

"How a Flu Molecule Stands on its Head To Infect Human Cells"
New York Times (09/06/94) P. C3;  Hilchey, Tim
     Researchers Frederick M. Hughson from Harvard, Per A. Bullough 
from Britain's Medical Research Council, and John J. Skehel from 
the National Institute for Medical Research in London announced 
the results of their collaborative study in the journal Nature 
last week.  Their key discovery was the structure of the protein 
hemagglutinin on the surface of the flu virus after it is bonded 
to a target cell.  The researchers said that these findings could
be important in understanding other viruses, including HIV.  Dr. 
Wiley said, "if you understood the fundamental mechanism of 
fusion, you might understand something not just about one virus, 
but about lots of different viruses, for example, measles virus, 
HIV-1, and flu."
      
"Immunology: 'Vaccine Cocktail' Lifts Hopes"
Washington Post (09/05/94) P. A2
     Raul Andino of the University of California at San Francisco and 
colleagues published findings in the Sept. 2 edition of Science 
magazine indicating the possible discovery of a 'vaccine 
cocktail' that could be effective against many diseases.  Andino 
inserted particles from other viruses into a polio virus and 
injected the manipulated virus into laboratory animals.  Four 
weeks after a second injection, mice produced antibodies against 
both polio and HIV and a monkey produced antibodies within two 
weeks after an injection.  Andino cautions that the results are 
"very preliminary" and said that testing on humans will not be 
possible until at least two more years of research have been 
completed.
      
"A Measure for Death: Potential Years Lost"
Washington Post--Health (09/06/94) P. 5;  Colburn, Don
     Because of the leading causes of death in this country have wide 
disparities in the average age of the affected group, public 
health experts have devised a new measure that is weighted toward
causes of death in young people.  The new measure is called 
YPLL-65, which stands for "years of potential life lost before 
age 65."  For example, a man who dies at 20 years old would 
account for a loss of 45 years on the new scale while a 55-year 
old would represent a 10-year loss.  The Centers for Disease 
Control and Prevention announced last week that AIDS is one of 
only two causes of death to significantly increase the YPLL-65 
count between 1980 and 1981.
      
"HIV Risk Factor Shifting in Inner Cities"
Washington Post--Health (09/06/94) P. 5;  Evans, Sandra
     A study conducted at the Harlem Hospital Center and published in 
August's Archives of Pediatrics and Adolescent Women indicates 
that sexual transmission may have overtaken intravenous drug use 
as the primary HIV risk factor in the inner cities.  The 
researchers found that only 21 percent of the HIV-positive women 
who gave birth at the hospital in 1989 reported intravenous drug 
use compared to 61 percent of the women with AIDS in New York 
City between 1981 and 1993.  The researchers explained that 
possible factors in the results include the time lapse between 
HIV infection and the onset of AIDS and the fact that the average
age of the HIV-infected mothers with a history of intravenous 
drug use was 10 years older than that of the mothers who had 
never used drugs.  The report advocates routine HIV testing of 
pregnant women and cites recent findings that the administration 
of zidovudine during pregnancy can greatly reduce the risk of HIV
transmission to the fetus.
      
"AIDS Grants"
USA Today (09/02/94) P. 2D
     NIH will divide $25 million in grants between six institutions to
research alternative treatments aimed at strengthening the immune
system and genetically attacking HIV.  Human trials must begin by
at least the third year of the four-year grants.  The six 
institutions include the Fred Hutchinson Cancer Research Center 
in Seattle, the New England Medical Center in Boston, the 
University of Michigan, Stanford University, and the University 
of Pennsylvania.
      
"Publicizing AIDS Data Early and Often"
Science (08/19/94) Vol. 265, No. 5175, P. 1023;  Stone, Richard
      Officials at the National Institutes of Health are considering 
the creation of an electronic bulletin board for information and 
results sharing among scientists conducting AIDS research.  
Scientists would post non-peer-reviewed abstracts on the 
Internet.  The goal would be to reduce the amount of money being 
spent on unpromising AIDS research because results were not 
forthcoming in the scientific literature.  AIDS researchers have 
mixed feelings about the proposal: while some favor it, others 
worry about the danger of information falling into the hands of 
those unable to consider it in the proper light.
      
"Cocaine and HIV Prevalence in an Alcohol Treatment Center"
Journal of the American Medical Association (08/10/94) Vol. 272, 
No. 6, P. 435;  Epstein, Ronald;  Avins, Andrew L.;  Woods, 
William J. et. al.
     Dr. Ronald Epstein of the University of Rochester in New York 
challenges a study on HIV in an urban public alcohol treatment 
center that was published in the Journal of the American Medical 
Association by Dr. Andrew Avins and colleagues.  In concluding 
that HIV was much more common in the urban setting than among the
general population, Epstein argues that the study fails to 
examine the independent contribution of non-injection cocaine use
to increased HIV seroprevalance.  Concomitant cocaine and alcohol
use is common in the urban crack cocaine culture, he contends 
and, given the large number of study patients who indulge in both
alcohol and cocaine, it is impossible to measure the independent 
contributions of each.  Epstein says that a more accurate 
conclusion of Avins' study would be that using alcohol and 
non-injection drugs together is associated with an increased 
prevalence of HIV infection.  Avins et al. respond by stating 
that no individual drug was strongly associated with HIV 
infection, and emphasized that "the distinction between the urban
alcoholic and the drug user is beginning to blur."  The 
researchers conclude it is important that alcohol treatment 
providers for this population "recognize the polysubstance-using 
habits of their clients and tailor their programs accordingly."
      
"Human Growth Hormone Reverses Wasting in Clinical Trial"
AIDS Treatment News (08/19/94) No. 25, P. 1;  James, John S.
     A study sponsored by Serono Laboratories Inc. has shown that 
human growth hormone can reverse the drastic weight loss that 
kills many patients with advanced AIDS.  The growth hormone, 
currently marketed as Protropin by Genentech Inc. and Humatrope 
by Eli Lilly and Co., is the first treatment that has been proven
to consistently increase lean body mass, says principal 
investigator Dr. Morris Schambelan of San Francisco General 
Hospital.  Serono has its own growth hormone approved in 50 
countries.  Following the expiration of exclusivity provisions in
the Orphan Drug Act, Serono's product will be available in the 
United States once it receives FDA approval for treatment of 
growth-hormone deficiency.  Although the hormone is very 
expensive, a strong case for reimbursement due to medical 
necessity can be made based on the study.  Serono is currently 
sponsoring another trial of the drug which will focus on its 
safety.
      
"Infectious Diseases in Competitive Sports"
Journal of the American Medical Association (08/10/94) Vol. 272, 
No. 6, P. 436;  Dorman, John M.
     In a letter to the editors of the Journal of the American Medical
Association, Dr. John M. Dorman of Stanford University elaborates
on a recent article by the Centers for Disease Control and 
Prevention on infectious diseases in competitive sports.  Dorman 
notes that although the article did include a short section on 
HIV transmission in the sports world, it failed to address 
hepatitis B virus, which is transmitted in precisely the same 
manner.  Moreover, hepatitis B is about 100 times more 
concentrated in the blood than is HIV, and is considered 
proportionately more contagious.  Therefore, Dorman suggests, 
vaccination for hepatitis B may be a good idea for athletes.  He 
agrees, however, that it is probably more likely that a player 
would contract both HIV and hepatitis B off the court or field 
than on it.  Dorman also stresses the warnings of the original 
authors that both viruses may by transmitted through the use of 
injectable steroids..
      
"Japanese AIDS Activists Adopt a Milder Form of Protest"
Science (08/19/94) Vol. 265, No. 5175, P. 1029;  Cohen, Jon
     Japanese AIDS activists are not as visible or outspoken as their 
American counterparts, despite their belief that the government's
official statistics on HIV and AIDS are well below actual 
numbers.  The official figures are low because Japanese citizens 
are frequently afraid to be tested for HIV because of a law 
requiring doctors to report to the Ministry of Health any patient
who poses "a risk to society"; for those who are already infected
with HIV, there is the fear of being quarantined in one of the 
AIDS hospices that the government is planning to build in 1995.
      
"Regulating Syringe Exchange Programs: A Cautionary Note"
Journal of the American Medical Association (08/10/94) Vol. 272, 
No. 6, P. 431;  Des Jarlais, Don C.;  Paone, Denise;  Friedman, 
Samuel R. et al.
      The predominant mode of HIV transmission in the United States is
through intravenous drug use.  Syringe-exchange programs (SEPs), 
which are designed to reduce the risk of HIV infection by 
providing clean needles to drug users, have been shown to be 
effective in other countries and could be useful in the United 
States. However, for such programs to work on a large scale, 
service must be broadened and three principles must be 
considered, write Des Jarlais et al. in a letter to the Journal 
of the American Medical Association.  First, the authors feel 
that too much regulation--particularly when enacted as a 
concession to those opposing SEPs on philosophical grounds--will 
seriously reduce the effectiveness of the programs.   
Additionally, SEP organizers should not require that services 
other than supplying clean injection equipment be provided 
without additional funding.  Lastly, regulations on SEPs should 
not be codified into laws that will be difficult to change as 
more information about how to improve SEPs becomes available.
      
