HICNet Medical News Digest      Sun, 02 Jan 1994        Volume 06 : Issue 59

Today's Topics:

  AIDS Daily News Summaries

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Date: Sun, 02 Jan 94 08:55:35 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: AIDS Daily News Summaries
Message-ID: <cR9iFc10w165w@stat.com>

                              AIDS Daily Summary

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 1993, Information, Inc.,
Bethesda, MD

          "Merck Steps Up Work on an AIDS Drug Following 'Promising'
                                Initial Trials"
           Wall Street Journal (12/20/93) P. B5  (Waldholz, Michael)

     Because initial human trials of an experimental AIDS drug proved
promising, Merck & Co. plans to step up its development of the  drug, known as
L-735,524.  The drug blocks the activity of an  enzyme that is essential for
HIV replication.  Scientists believe that deactivating the enzyme, known as
protease, can prevent the  virus from spreading beyond an infected cell.  In
recent years,  several companies have developed drugs which block protease
activity, but those therapies have proven unsuccessful outside of the
laboratory.  Merck's several small trials, however, indicate  that daily oral
doses of L-735,524 achieved levels in the blood  considered high enough to
affect viral replication--one of the  major shortcomings of earlier efforts.
In addition, one study of 10 AIDS patients found that administration of the
Merck drug  reduced the amount of measurable virus in patients' bloodstreams
by 70 percent.  Company officials do caution that the trial  results, though
encouraging, are still very preliminary.  They  are also cautious, for fear
that new, prolonged studies may show  that use of L-735,524 may produce drug-
resistant strains of HIV.

          "Initial Clinical Results for New AIDS Treatment Reported"
                            PR Newswire (12/14/93)

     Rockville, Md.--Advanced Biotherapy Concepts, Inc., has completed initial
clinical testing of a innovative new AIDS therapy.  The  treatment is
different in that, instead of HIV, it targets an  unusual form of alpha
interferon that is affiliated with HIV  disease progression and advancement to
AIDS, and may also be  linked to HIV replication.  The procedure passes a
patient's  plasma through an extracorporeal immunosorbent column containing
antibodies that neutralize and capture the interferon.  The  process was
tested on four patients during the trial conducted at the University of
Nebraska Medical Center.  The procedure,  conducted in five consecutive daily
treatments, was  well-tolerated by all four patients, and the device
successfully  absorbed interferon from the patients' plasma.  Two patients
showed reduced HIV viral loads in their plasma after treatment,  and two
displayed a significant reduction in tumor necrosis  factor--a known HIV
indicator.  The initial study is the first  phase in the development of the
research company's anti-cytokine  therapy for AIDS, said Dr. Simon Skurkovich,
president and  founder of Advanced Biotherapy Concepts, Inc.  He said that by
adding other antibodies to the absorption device, the procedure  could be used
to remove any combination of cytokines implicated  in HIV replication and
immune dysregulation in AIDS.  The company is now preparing a submission to
the Food and Drug Administration for permission to expand testing and remove
other cytokines.

             "CDC Tries Preventing AIDS by Tailoring the Message"
            American Medical News (12/13/93) Vol. 36, No. 46, P. 17

     The U.S. government is searching for new ways to increase condom  use as
a means of preventing the spread of AIDS.  A survey of  some 700 clinic
patients treated for sexually transmitted  diseases found that most, while not
using condoms, were  considering them.  The government's aim is to tailor
counseling  so as to reach those who can be convinced to protect  themselves--
for example, women who are hesitant to discuss condom use with their primary
sex partners.  In that study, far more  women than men were in the
"contemplative" stage, meaning they  were considering regular use of a condom
with their main  partners.  Men, however, were in the "precontemplative"
phase,  meaning they rarely used condoms and harbored no intention of  using
them on a regular basis.  "We've tried simple educational  messages and
suspect that they're not very helpful," said Mary  Kamb, an epidemiologist at
the Centers for Disease Control and  Prevention.  "But maybe we have not been
approaching counseling  correctly."  She said the next study will enroll 6,000
people  across the nation to compare the effectiveness of the broader  AIDS
prevention with tailored messages to increase condom use.

                 "Montagnier's AIDS Report Covers All Angles"
        Nature (12/09/93) Vol. 366, No. 6455, P. 496  (Butler, Declan)

     Luc Montagnier of the Institut Pasteur in France, assigned to  assess the
French battle against AIDS, recently presented prime  minister Edouard
Balladur with a comprehensive review full of  sensible, and surprising,
recommendations.  Much of the report  proposes changes to the National AIDS
Research Agency (ANRS),  which Montagnier denounced as a "ghetto" with no
sufficient ties  to other areas of scientific research or AIDS programs.  He
recommends that the agency be absorbed into INSERM, the national  medical
research organization.  He also suggests that the agency  establish a fund of
several million dollars to support  non-mainstream AIDS research.  In
addition, the report recommends that all AIDS patients be allowed access to
promising drugs  before they are approved, but suggests investigations into
illegal clinical trials.  Montagnier also urges the government to create an
interministerial committee to coordinate all efforts  against the epidemic,
including research.  Only one-tenth of the  report, surprisingly, addresses
research issues.  The rest  touches on prevention, health-care, training, and
the special  problems surrounding drug addicts, prisoners, and women.  These
areas required Montagnier to engage in extensive consulting,  raising
speculations that he may be angling for a position as  national AIDS
coordinator.

                           "Breast Feeding and HIV"
       Lancet (12/11/93) Vol. 342, No. 8885, P. 1437  (Ziegler, John B.)

     Breast feeding has been identified since 1985 as a means of  transmitting
the AIDS virus from an infected mother to her  infant.  In developed
countries, most women who are aware of  their HIV-positive status at the time
of delivery will choose not to breast feed.  In Africa, where breast feeding
is crucial to  child survival, HIV-infected mothers will breast feed anyway.
This may, therefore, account for the high rates of perinatal  transmission
that are found in sub-Saharan countries as opposed  to in Europe.  The
alternative is bottle feeding, which is  dangerous as well.  The World Health
Organization and UNICEF  recommend that all mothers, including those with HIV,
in  environments where there is a high rate of infant mortality  associated
with infectious disease or malnutrition breast feed  their babies.  The
consensus seems to be that both bottle and  breast feeding can pose some risk
for HIV transmission.  So which method should a mother choose?  A simple
comparison of the risks  of mortality from infection linked to bottle feeding
and the  risks of contracting HIV through breast feeding would offer some
guidance about which method to choose, but such data is not yet  available.
Until this information is known, it is best to try to determine the risk of
bottle feeding vs. that of acquiring HIV  during breast feeding for each
infant using the estimate of 1 in  7 for the latter.  Even in areas where
infants die of infectious  diseases, some mothers may still be able to bottle
feed safely.

            "Newly Approved Drug Fights Pneumonia Related to AIDS"
                       Washington Post (12/21/93) P. A4

     The Food and Drug Administration has approved a new treatment to  help
AIDS and otherwise immunocompromised patients combat  pneumocystis carinii
(PCP), a deadly pneumonia parasite.  U.S.  Bioscience has been given
permission to market trimetrexate  glucuronate as an alternative therapy for
PCP which, as the most  common life-threatening infection linked to AIDS
disease, affects as much as 80 percent of the AIDS population.  The
intravenous  drug, assigned the brand name of Neutrexin, must be taken
simultaneously with a second drug called leucovorin.  The second  drug
protects normal cells while the trimetrexate attacks the  parasite, which
invades the lungs of AIDS patients.  According to FDA spokesperson Arthur
Whitmore, Neutrexin is "another weapon in the arsenal" against AIDS.  There
are currently three other drugs to fight PCP on the market.  U.S. Bioscience
said that candidates for Neutrexin include the estimated one-third to one-half
of AIDS patients who must stop taking one of the other three treatments,
trimethoprimsulfamethoxazole, because of adverse side effects.   Patients
taking the new drug must consult frequently with doctors and have blood counts
monitored twice weekly.   Related Story:  Philadelphia Inquirer (12/21) P. C1

                   "Modest Advances Seen With 2 AIDS Drugs"
            New York Times (12/21/93) P. C7  (Altman, Lawrence K.)

     Researchers have reported modest advances in drug treatment of  two
common and serious complications of AIDS.  The first is an  improvement in the
oral form of the drug ganciclovir, which is  being developed to treat
cytomegalovirus (CMV) retinitis, a  potentially blinding eye infection.
Researchers found that  enough of the oral form of ganciclovir got into the
body to  suppress growth of CMV significantly without many adverse side
effects.  Current drug therapy for CMV retinitis is intravenous  only and
requires the patient to keep a tube in place of a vein,  so the oral form of
the drug carries strong promise of a better  lifestyle for these patients.
The other advancement was observed in fluconazole, a drug to treat invasive
and superficial fungal  infections in AIDS patients.  Most recent studies
showed that  fluconazole delayed the onset of fungal infections in AIDS
patients with CD4 counts under 200, doing so notably better than  another drug
called clortrimazole.  The two advancements were  reported at a scientific
meeting in Washington, D.C., sponsored  by the National Foundation for
Infectious Diseases and the  American Society for Microbiology.

         "Cryopharm Demonstrates Potent Viral Decontamination of Blood
                                   Products"
                           Business Wire (12/17/93)

     Pasadena, Calif.--CP-38, the proprietary psoralen molecule of  Cryopharm
Corp., has demonstrated its ability to eliminate  platelets, which are
critical human blood components of viral  contaminants--including HIV.  When
added to human platelet  concentrates, CP-38 reduced model viruses by as much
as 1  million-fold compared to untreated samples.  There was little  effect on
the function of platelets, which are essential to  clotting.  Psoralens are
naturally occurring molecules that  insert themselves into viral nucleic
acids, a fundamental  component of all viruses.  Because red blood cells and
platelets  do not contain nuclear DNA, they are virtually unaffected by  CP-
38.  Once the compound is entwined in the nucleic acid  backbone of the DNA
helix and exposed to ultraviolet light, a  chemical reaction occurs that
breaks the two backbones of the  helix, thus completely inactivating the virus
while sparing the  surrounding blood cells.  Studies have shown the compound
to be  non-toxic at sufficient levels to achieve maximum viral  inactivation.
"Given the growing international concern about the safety of human blood
products, we believe that Cryopharm's viral inactivation technologies may
offer a simple, efficient, and  cost-effective method to significantly
increase the safety of  these products from blood-borne viruses such as HIV
and  hepatitis," said Carl E. Brooks, president and chief executive  officer
of Cryopharm.

                "CDC to Launch New HIV Prevention Initiatives"
       American Medical News (12/13/93) Vol, 36, No. 46, P. 10  (Staver,
                                     Sari)

     The Centers for Disease Control and Prevention, in response to an
independent panel's critical review of HIV-prevention programs  administered
by the federal agency, announced several new  initiatives.  The first is a new
public-information campaign  called a "prevention marketing initiative" that
will target  people under age 25 who are practicing unsafe sex.  The program,
set to kick off before the end of the year, will include a  national media
campaign and demonstration projects conducted  jointly with local groups.  In
addition, a new public-service  campaign will be launched.  This initiative
will feature explicit messages about preventing sexual transmission of HIV,
which are  scheduled for broadcast at the beginning of next year.  The third
initiative, effective as of Jan. 1, involves proposed new  procedures for
review of federally funded AIDS-prevention  materials.  Under the policy,
recipients of CDC money to produce  or distribute such material will be able
to designate local  groups to review them.  It will, therefore, no longer be
necessary to have materials reviewed by government-appointed  groups, which
has been an instrumental factor in blocking the  distribution of sexually
explicit materials.

        "A Prospective Study of Diarrhea and HIV-1 Infection Among 429
                               Zairian Infants"
        New England Journal of Medicine (12/02/93) Vol. 329, No. 23, P.
                        1697  (Thea, Donald M. et al.)

     AIDS is often characterized by persistent diarrhea in adults, but the
cause and its effect on HIV-infected children is still  largely unknown--
especially in Africa, where it is the leading  cause of mortality among
children with HIV.  Thea et al.  conducted a study of 429 infants in Zaire
born to both  HIV-positive and HIV-negative mothers to determine the incidence
of persistent diarrhea.  HIV-infected infants, compared to  uninfected babies,
had greater incidence rates for acute,  recurrent, and persistent diarrhea.
Persistent diarrhea  developed in 11 infected babies, all but one of whom
died.  It  also developed in 19 uninfected infants, all but one of whom
survived.  Using a multivariate model, Thea et al. found that  persistent
diarrhea was independently linked with symptomatic HIV infection in the
mother.  The incidence of persistent diarrhea in uninfected babies born to
HIV-positive mothers was nearly double  that of uninfected infants born to
HIV-negative mothers, and the  risk increased if the mother died, even among
uninfected  offspring.  Notable growth impairment, bouts of acute diarrhea,
and severe immunosuppression often preceded the onset of  persistent diarrhea.
The data indicates that maternal health is  an important risk factor for
diarrheal morbidity in infants.   Thea et al. propose that diarrheal morbidity
was associated with  the ability of the mother to care for her baby and
maintain  infant hygiene and nutrition.  The implication, say the
researchers, is very important considering the estimated 5.5  million AIDS
orphans that will be living in Africa by the turn of the century.

          "Expanded IND for AIDS Immune Reconstitution Cell-Transfer
                           Therapy Submitted to FDA"
                           Business Wire (12/21/93)

     Fort Lauderdale, Fla.--Center for Special Immunology (CSI), a  subsidiary
of Health Professionals Inc. (HPI), has submitted an  Investigational New Drug
Application to the Food and Drug  Administration for a Phase I clinical trial
of its Immune  Reconstitution Cell-Transfer Therapy.  The treatment involves
monthly infusions of licensed human intravenous immune globulin  followed by
closely-matched peripheral blood lymphocytes from an  HIV-negative donor,
generally a close relative.  The patient is  usually in the late stages of
AIDS disease, and is maintained on  antiretroviral and prophylactic therapy
against opportunistic  infections.  The results of a pilot clinical program
provide some support for expanded study.  "The Immune Reconstitution Treatment
Program was developed by physicians affiliated with CSI in an  effort to help
their patients with late stage AIDS who had failed conventional therapies and
for whom there was no acceptable  alternative therapy," said HPI's chairman
and CEO, William M.  Reiter.  "Cell transfer and expansion therapies have the
potential to fill an urgently needed and critical role in  evolving AIDS
therapies."

                             "Stalking a Vaccine"
            Washington Technology (12/02/93) Vol. 8, No. 17, P. 25
                               (Brendler, Beau)

     While most potential AIDS vaccines focus on the outer "envelope"  of HIV
made up of proteins and able to change 1,000 faster than  the second fastest
virus, Cel-Sci Corp. of Alexandria, Va., is  taking an out-of-the-mainstream
approach.  The company's vaccine, HGP-30, was the first in the world to
concentrate on the core of  HIV, but is still a relative unknown.  It is based
on a protein  in the core of the virus that does not change throughout its
strains and is a synthetic copy of the core protein so that it  cannot cause
AIDS in healthy people.  Early trials indicated that the vaccine produced
killer T-cells, which destroy AIDS-infected  cells before they take over the
body.  Other studies observed  immune responses triggered by the vaccine.  In
addition, blood  immunized with the drug and placed in mice without an immune
system showed a 75 percent rate of protection.  Cel-Sci has  entered into a
joint venture with Alpha 1 Biomedicals to oversee  the AIDS research.

                             "Buckeyballs and HIV"
                    Discover (12/93) Vol. 14, No. 12, P. 22

     Buckyballs, soccer ball-shaped molecules fascinating scientists  around
the globe, and HIV, the virus that leads to AIDS, seem an  unlikely pair.  But
researchers at the University of California  at San Francisco claim buckyballs
are able to cripple the enzyme  machinery essential for the AIDS virus to
reproduce.  Buckyballs  could possibly act as inhibitors of HIV protease, an
enzyme of  the virus necessary for HIV replication.  Simon Friedman, a
graduate student of chemistry at UCSF, decided to test the idea  by using
modified buckyballs, called fulleroids, to enable  himself to work in the
aqueous environment of a living cell.   When he mixed a solution of fulleroids
with HIV protease, he  found no evidence that the HIV protease had been
clipping the  original polyprotein in two, as it should have been doing.
Researchers at Emory University decided to expand the experiment. They
discovered that fulleroids actually block HIV from  reproducing in cultures of
infected white blood cells, without  harming healthy cells.  Whether
buckyballs will ever be developed into a practical treatment for AIDS is
uncertain, for many other  substances have been shown to disable HIV in the
lab.  The true  test is whether buckyballs can do the same, and do so safely,
in  the human body of a person infected with the AIDS virus--a  question that
will take years to resolve.

                               "Medical Briefs"
                      Advocate (12/28/93) No. 635, P. 36

     Upjohn Laboratories has produced a drug that has been found in  the
laboratory to be an effective HIV-inhibiting protease during  the late stages
of viral replication.  The drug, U-75875,  dramatically decreased HIV
replication in both monocytes and  chronically infected cells.  Other drugs
tested were only  effective in newly infected cells.  A report on the study
proposes that the use of protease inhibitors alone or with  another drug is
important for HIV therapy.

         "Pharmacists' Role in Preventing and Treating HIV Infection"
       American Pharmacy (12/93) Vol. NS33, No. 12, P. 38  (Noormohamed,
                         Saleem and Ferguson, Kristi)

     Pharmacists are among the most accessible and most respected of  health
care professionals.  Because they are knowledgeable about  drugs and educated
to endorse health and prevent disease,  pharmacists are perfectly poised to
have a positive influence on  the AIDS epidemic.  They do, in fact, have
several roles in the  fight against the disease.  First and foremost,
pharmacists must  provide accurate and up-to-date information.  In addition,
they  need to monitor drug therapy in both hospital and outpatient
environments, including agents that are obtained on the black  market,
vitamins and minerals, and other unsubstantiated cures  and treatments that a
patient might be taking.  It is also  critical that pharmacists counsel HIV
patients on proper condom  use, as well as educate the public on how the virus
is  transmitted and what behaviors are risky.  It is equally  imperative that
pharmacists encourage AIDS testing for all  individuals who may be at risk for
the virus.  Finally, ethical  guidelines that apply to other health care
professionals also  apply to pharmacists, who must keep all patient
information  completely confidential.  In general, pharmacists must promote
the best possible health care for infected patients.

         "Counseling Adolescents for HIV Testing Takes Time, Insight"
                   AIDS Alert (12/93) Vol. 8, No. 12, P. 186

     More and more adolescents are voluntarily seeking HIV testing.   Denial
and an inability to fully comprehend the consequences of  an HIV test may
demonstrate the need for several counseling  sessions.  Topics of discussion
should include the differences  between HIV and AIDS, how the virus affects
the immune system,  how appearance does not reflect infection, the difference
between confidential and anonymous testing, state testing and reporting  laws,
and how unprotected intercourse is the primary means of  transmission.  The
main goal of counseling is to develop a  rapport with the adolescent, who may
be discussing these issues  with an adult for the first time, and to eliminate
myths that  adolescents may have, the most common of which are that an  HIV-
positive test result means immediate death and that only  "bad" people become
infected.  Counselors must also assess a  patient's frame of mind and support
system.  If there is a risk  of the adolescent becoming suicidal, then it is
better to wait.   Delivering positive test results requires straghtforward
communication--although supportive and caring--and the counselor  should be
prepared to help the patient verbalize feelings and  avoid destructive ways of
acting out anger, fear, and  helplessness.J Grief, coping, risk reduction, and
empowerment are the main issues faced after the test.

              "HIV Transmission: Women's Risk from Bisexual Men"
         American Journal of Public Health (12/93) Vol. 83, No. 12, P.
                        1757  (Wood, Robert W. et al.)

     A recent analysis of AIDS surveillance data by the AIDS  Prevention
Project of the Seattle-King County Department of  Public Health in Washington
state found that men identifying  themselves as bisexuals and men identifying
themselves  homosexuals differed in several ways.  The study, which involved
5480 men who reported having sex with another man since 1977,  found that
self-reported sexual identity was an important  indicator of sexual encounters
with women and HIV positive  status.  Of the sample, 77 percent said they were
gay and  reported almost no sex with females in the past year.  Thirteen
percent said they were bisexual, and 8.4 percent identified  themselves as
straight.  Self-described gays had the highest rate of HIV seroprevalence.
Straight-identified men reported the  highest number of female partners and
were less likely to be  infected, although the seroprevalence was still
disturbingly  high.  Men calling themselves bisexuals, however, posed the most
risk of HIV infection to women, while gays and straights exposed  equal
numbers of women.  Bisexual men and straight men were also  more likely to
inject drugs, a contributing element to the AIDS  epidemic.  The study
suggests that increased attention should  focus on men who have sex with men
and use intravenous drugs.

                       "A Slippery Defence Against HIV"
          Lancet (12/18/93-12/25/93) Vol. 342, No. 8886/8887, P. 1500
                               (Thompson, Clare)

     Mucosal-associated lymphoid tissue accounts for the largest area  of
immunologically active tissue in the body, the busiest of  which is mucosa of
the gastrointestinal tract, which is  perpetually dealing with pathogens
picked up in food.  Ways of  using this area for host defense have not been
extensively  explored, but the possibilities for immunotherapy against
diseases of the mucosal surface are significant.  One of the most exciting new
applications is a possible vaccine for HIV.  Lehner  et al. theorize that
stimulation of secretory IgA in the body  areas most at risk for HIV
transmission, such as the vaginal,  rectal, and genitourinary mucosa, will
prevent the virus from  crossing the epithelium and entering the
immunologically active  area below.  The researchers also hope for a general
action on  mucosal-associated lymphoid tissue.  If their theory is correct,
IgA antibodies directed at the gut could produce secretory IgA  antibodies in
the respiratory, salivary, and genital areas, as  well as other mucosal sites.
While they sound promising, one  must view these theories with caution.  The
strategy depends  heavily on at least one crucial factor: if the vaginal,
rectal,  or genital epithelium is torn in any way, increased secretory IgA
will be fruitless.  If the primed T and B cells in the epithelium act as a
second line of defense, however, the future of mucosal  vaccination is even
more promising.

          "Clinical Manifestations of AIDS in the Era of Pneumocystic
                                 Prophylaxis"
        New England Journal of Medicine (12/23/93) Vol. 329, No. 26, P.
                       1922  (Hoover, Donald R. et al.)

     Pneumocystic carinii pneumonia once occurred in as much as 75  percent of
the AIDS population.  Prophylactic regimens against  the infection are not
known to alter HIV or immune function, nor  do they protect against other
AIDS-related conditions--except  toxoplasmosis--or directly alter the patho-
psychologic processes  leading to other AIDS-related illnesses.  By preventing
or  delaying death from p. carinii pneumonia, however, prophylaxis  does shift
the clinical manifestations of HIV infection from p.  carinii pneumonia to
illnesses that occur when immune function is more suppressed.  Researchers
must now determine what other  AIDS-related conditions should be targeted for
further  prophylaxis and treatment.  Hoover et al., therefore, conducted a
study of 844 men with AIDS.  The results indicated that  prophylaxis could
delay the onset of the first AIDS-related  illness by six months to a year.
The study also concluded that  only four--myobacterium avium, esophagus
candidiasis, wasting  syndrome, and cytomegalovirus disease--out of thirteen
AIDS-related conditions were observed to surface more often in  patients who
received prophylaxis against p. carinii pneumonia  than in those who did not.

                  "Zidovudine in Asymptomatic HIV Infection"
        New England Journal of Medicine (12/16/93) Vol. 329, No. 25, P.
              1895  (Phillips, Andrew N. and Saben, Caroline A.)

     Cooper et al. conclude that the benefits of zidovudine last more  than
two-and-a-half years in asymptomatic HIV patients with CD4  counts over 400.
Andrew Phillips and Caroline Saben of the Royal Free Hospital School of
Medicine in London question the validity  of Cooper et al.'s "on treatment"
approach to analysis, in which  data were censored three months after the end
of blinded  treatment.  This approach, say Phillips and Saben, should be
supplemented with analyses in which follow-up information is not  censored.
These analyses should consider the original primary  end point for the trial--
AIDS--as well as end points later  adopted.  Cooper et al. do not even
acknowledge whether AIDS  developed by the end of the trial in approximately
half of the  subjects, 308 of whom withdrew, note Phillips and Saben.  The
implied tendency of patients about to reach an end point to  withdraw from the
trial, they speculate, could actually have  created a bias in favor of
zidovudine.  Given the widespread  belief that the drug's effects are limited,
any suggestion that  this time frame is longer should be supported with the
demonstration of a statistically significant difference in risk  between
zidovudine and a placebo, considering the number of years at risk following
two years of treatment.  The small number of  patients with end points after
longer than two years cast doubt,  say Phillips and Saben, that such a
difference was ever present.  Therefore, they conclude, the suggestion that
the beneficial  effects of zidovudine last longer than two-and-a-half years is
not justified based on the results presented.

            "Biaxin Listed as Treatment for AIDS-Related Infection"
                     Wall Street Journal (12/29/93) P. B4

     Abbott Laboratories Inc. of Abbott Park, Ill., has received  approval
from the Food and Drug Administration to offer its  antibiotic Biaxin as a
treatment for disseminated mycobacterium  avium complex (MAC), an AIDS-related
condition.  Disseminated MAC is the most common systemic bacterial infection
observed in AIDS  patients.  According to Abbott, Biaxin, the brand name for
clarithromycin, is the first drug to receive FDA permission to  treat the
infection.  The company reported study results  indicating that Biaxin reduces
the MAC organism in the blood.

              ""Renegade" HIV Immunity Hypothesis Gains Momentum"
        Lancet (12/18/93-12/25/93) Vol. 342, Nos. 8886 & 8887, P. 1544
                               (Horton, Richard)

     American AIDS researchers face a dilemma.  Recent evidence  suggests that
billions of dollars spent developing vaccines based on HIV envelope proteins
may have been wasted as scientists  abandon these candidates in favor of cell-
mediated immunity (CMI) approaches.  Gene Shearer of the National Cancer
Institute  recently presented results which imply that individuals exist who
have been exposed to HIV, but remain seronegative.  Shearer  offers four
possible explanations.  First, there never was an  infection, so CMI is
irrelevant.  Second, there was infection,  but the virus died.  Third, virus
was present, but was destroyed  through cell-mediated immunity.  Finally, CMI
controlled viral  infection.  Shearer concluded that previous exposure to
small  doses of the AIDS virus shields against infectious inoculums of  virus
through CMI.  These conclusions were supported by evidence  from a recombinant
gp160 trial indicating that low-dose antigen  exposure selectively activates
CMI and not antibody production.   Shearer further determined that strong CMI
combined with a  dominant type I cytokine profile, is critical in delaying
progression to AIDS.




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End of HICNet Medical News Digest V06 Issue #59
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---
Editor, HICNet Medical Newsletter
Internet: david@stat.com                 FAX: +1 (602) 451-6135
Bitnet  : ATW1H@ASUACAD



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