                     AIDS Daily Summary 
                      August 23, 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


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"The Bittersweet Music of Life"
"TB Screening Questioned"
"When a Mother Has HIV"
"Human-Milk Banks Booming as Fears Ease"
"Gilead Sciences Begins Phase II Study of..."
"Clinicians Not Providing Necessary Pain Relief for AIDS 
Patients"
"A Controlled Trial of Zidovudine in Primary Human 
Immunodeficiency Virus Infection"
"AIDS Update: A Drag on Your Health"
"Start Making Sense"
"Enriching the Final Days"
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"The Bittersweet Music of Life"
Washington Post (08/23/95) P. C1;  Crews, Chip
     The members and music of the San Francisco Gay Men's Chorus will 
be honored tonight in a documentary on Cinemax.  The San 
Francisco chorus is the first of its kind; there are now 140 
similar choruses worldwide.  However, the AIDS epidemic has hit 
the chorus aggressively, and more than 150 members have died and 
nearly half of the 225 current members are infected with HIV.  
Tonight's program, which was filmed during the 1992 season, 
features four members who tell their stories.  Gary, for example,
once wanted to be a star, but now struggles with degenerated hips
and can only get around on crutches.  Steven takes care of AIDS 
patients in a hospital and has learned to keep new acquaintances 
at a distance.  "I say to myself, 'I'll see you die.  Or you'll 
see me die,'" he explains.  On a brighter note, the film also 
shows the chorus heading off to perform at the meeting of the Gay
and Lesbian Association of Choruses and dancing up a storm at an 
AIDS dance-athon.
      
"TB Screening Questioned"
Washington Post (08/23/95) P. A2
     Despite the fact that the incidence of tuberculosis (TB) has 
increased in recent years, a new study concludes that the cost of
mass screening of schoolchildren is greater than the value of the
results.  The researchers suggest instead that youths at high 
risk for TB, such as immigrants, be targeted.  In the current 
issue of the Journal of the American Medical Association, a team 
led by Janet C. Mohle-Boetani of the California Department of 
Health Services reports their findings after studying mass TB 
screenings in Santa Clara County between 1992-1993.  They 
determine that it costs about $16,400 to treat a case of TB, and 
contact and test those who might have been exposed, but that the 
additional expense of mass screening was nearly $35,000 for each 
case prevented outside of the high-risk group.
      
"When a Mother Has HIV"
Wall Street Journal (08/23/95) P. A13;  Gromada, Karen Kerkhoff; 
Quadro, Kathleen;  Deal, Lee Ann
     Research does not support the claim that "mother's milk is a 
prime carrier of HIV," writes Karen Kerkhoff Gromada--president 
of the International Lactation Consultant Association, in  
response to a recent Wall Street Journal editorial entitled 
"Sacrificing Babies on the Altar of Privacy."  Gromada notes that
the primary carriers of HIV are tainted blood and semen and that 
the Occupational Safety and Health Administration does not list 
breast milk among its "potentially infectious materials."  She 
concludes that mother's milk is an important source of disease 
protection and nutrition for most human babies.  In a separate 
letter to the editor, Dr. Kathleen Quadro questions why the 
Centers for Disease Control and Prevention (CDC) would perform 
HIV testing on infants and not inform the parents or doctors, and
asks whether this is "in keeping with our medical calling?"  
Finally, a third letter from Lee Ann Deal, executive director of 
La Leche League, points out that while the CDC maintains its 
position that HIV-infected women should not breast-feed, the 
World Health Organization has recommended that breast-feeding be 
promoted and supported in all populations.  The benefits of human
milk and breast-feeding have to be weighed against the dangers of
artificial infant-feeding and not-yet-clear risk of HIV 
transmission through breast milk, she concludes.
      
"Human-Milk Banks Booming as Fears Ease"
Washington Post (08/22/95) P. A1;  Finn, Peter
     After nearly having been eliminated by the risk of AIDS, 
human-milk banking has made a comeback as safety measures have 
decreased concerns of viral infections.  In fact, Georgetown 
University's Community Human Milk Bank estimates it will receive 
nearly 1,000 ounces of milk in 1996, compared with a total of 
just over 150 ounces in 1992 and 1993.  In North America, there 
has been no documented instance of HIV transmission through donor
human milk, although one case was reported in Kenya last year.  
Milk banking stems from the age-old practice of wet nursing, in 
which lactating women were hired to feed other babies.  The 
practice reached its peak, however, just as AIDS became a threat.
In 1985, a report detailed the case of a breast-fed child who 
became HIV-infected with no other probable cause of transmission 
than his mother's milk.  The Centers for Disease Control and 
Prevention urged HIV-positive women to be advised against 
breast-feeding.  Many milk banks closed as mothers became afraid.
In 1990, however, a set of standards was developed on how to 
select donors and how to treat and store milk.  One recent donor,
for example, had her blood tested for several viruses--including 
HIV--and then later, her pooled milk was pasteurized and cultured
to detect bacteria.
      
"Gilead Sciences Begins Phase II Study of..."
Healthwire (08/22/95)
     Gilead Sciences Inc. announced on Tuesday that it has initiated a
Phase II study of an intravitreous formulation of its cidofovir 
treatment for relapsing cytomegalovirus (CMV) retinitis in AIDS 
patients.  The study will evaluate the safety, tolerance, and 
efficacy of differing dosages of the drug when it is injected 
directly into the eye's inner chamber.  Gilead's most advanced 
product candidate for treatment of CMV retinitis is Vistide, or 
cidofovir intravenous.  The company hopes to submit a new drug 
application for Vistide in the latter part of this year.
      
"Clinicians Not Providing Necessary Pain Relief for AIDS 
Patients"
AIDS Alert (08/95) Vol. 10, No. 8, P. 97
     At a pain management workshop in Atlanta, experts said that 
despite the fact that AIDS patients experience the same intensity
and frequency of pain as cancer patients, they seldom receive 
sufficient medication to ease their pain.  "Pain in AIDS is 
dramatically undertreated and is associated with significant 
functional and psychological morbidity," said associate attending
psychiatrist Dr. William Breitbart of the Memorial 
Sloan-Kettering Cancer Center.  One study of pain in HIV-infected
men found that nearly 40 percent of asymptomatic patients 
complained of pain, a figure which soared to 80 percent as they 
entered the advanced stages of AIDS.  HIV-related headaches, 
herpes simplex, peripheral neuropathy, and back and throat pain 
were among the most common reported sources of pain.  The most 
frequent reasons for mismanagement of pain in people with AIDS 
are clinicians' incapacity to adequately access the pain and the 
failure to prescribe strong opioids to late-stage AIDS patients 
for fear that they will become addicted.  Patients also put up 
barriers to adequate pain management.  Many, noted Breitbart, are
afraid that admitting their pain would detour the treatment 
process.  According to Breitbart, care providers should employ a 
team approach that recognizes pharmacological and 
non-pharmacological methods and considers psychosocial issues.
      
"A Controlled Trial of Zidovudine in Primary Human 
Immunodeficiency Virus Infection"
New England Journal of Medicine (08/17/95) Vol. 333, No. 7, P. 
408;  Kinloch-De Loes, Sabine;  Hirschel, Bernard J.;  Hoen, 
Bruno; et al.
     A recent study investigates the effect of antiretroviral 
treatment when administered during the primary stage of infection
with the human immunodeficiency virus.  Patients were treated 
with either zidovudine or placebo for six months.  Disease 
progression was found to be far less frequent in the group that 
received zidovudine.  The results showed that the antiretroviral 
therapy preserves immune functions, improves long-term prognosi, 
and increases the CD4 cell count.
      
"AIDS Update: A Drag on Your Health"
Men's Health (09/95) Vol. 10, No. 7, P. 48
     Scientists at the Centers for Disease Control and Prevention 
(CDC) have discovered that HIV-infected smokers are more likely 
to catch certain diseases than HIV-positive people who do not 
smoke.  According to the CDC, smokers are at an increased risk 
for bacterial pneumonia, oral candidiasis, and oral hairy 
leukoplakia.
      
"Start Making Sense"
POZ (08/95-09/95) No. 9, P. 40;  Staley, Peter
     The idea that every person with HIV should have access to any 
potentially effective drug is very appealing, writes Peter 
Staley, who describes himself in POZ magazine as a "typical 
self-empowered person living with HIV."  It seems almost 
patriotic to demand universal access to such experimental drugs, 
he notes.  The AIDS self-empowerment movement, however, appears 
to be shifting from the goal of extending life for as many people
as possible to individuals saving themselves.  The change became 
apparent last summer when the early results of a small Phase II 
study of Hoffmann-La Roche's saquinavir showed that a triple 
combination of AZT, ddC, and saquinavir increased CD4 levels more
than regimens of either AZT and saquinavir or AZT and ddC.  After
learning that Roche planned to ask for permission to file for 
accelerated access, the Treatment Action Group (TAG) urged the 
Food and Drug Administration to delay the approval of the 
combination drug and suggested instead a large study using a 
placebo.  Staley--a cofounder of TAG--writes that in order to 
prolong life for as many people as possible, research must be 
balanced with the desire for reliable data on the treatment's 
ability to extend life.  A large, simple trial would allow 
everyone to take whatever antiretrovirals they would have been 
taking outside the trial, without requiring everybody to take 
AZT, while offering the possibility of switching over to receive 
the protease inhibitor later, if qualified.
      
"Enriching the Final Days"
U.S. News & World Report (08/21/95) Vol. 119, No. 8, P. 56;  
Sherrid, Pamela
     Although many companies that buy life insurance policies from the
terminally ill are reputable, a U.S. News & World Report 
investigation discovered a less scrupulous side of the viatical 
settlement industry--one that is marked by conflicts of interest,
lack of disclosure, and nonexistent or ineffectual regulation.  
For example, one of the largest viatical firms, Texas-based Life 
Partners Inc., is flagrantly defying regulators in some states by
operating without a license.  Some practices are becoming more 
unusual.  Not too long ago, some firms would promise to pay the 
entire policy purchase price when the deal closed, but in the end
would make only a small payment.  "They were assuming a person 
with AIDS dementia wouldn't be able to come after them," said 
David Ganon of New York City-based Life Entitlements, which 
recently agreed to donate 3 percent of the face value of all life
insurance policies that the company buys from Washington, D.C., 
area residents to the Whitman-Walker Clinic, the region's leading
AIDS treatment facility.  Meanwhile, the National Association of 
Insurance Commissioners passed a model law and regulatory 
language last year that bars viatical firms from offering 
finder's fees to anyone providing medical, legal, or financial 
planning services to a policy seller.  Only a dozen states, 
however, have laws in place--not all of which contain the 
provision.  The reality of AIDS in gay communities has produced a
fair amount of sophistication about viatical settlements among 
policy vendors, but outside this community the settlements are 
far more subject to abuse because they are new and the lack of 
knowledge, therefore, is greater.
      
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