                     AIDS Daily Summary 
                       March 19, 1996

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
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Copyright 1996, Information, Inc., Bethesda, MD


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"Panel Backs Retinitis Drug; Gilead Stock Recovers Some"
"Testing Begins on AIDS Therapy Developed by Dr. Salk"
"Experience of Doctor Vital To AIDS Patient"
"Tuberculosis, Uncontrolled"
"Impaired Immune Response After Hib Vaccination in HIV-Positive 
Infants"
"Merck Discounts Its New Protease Inhibitor"
"EEOC Permits Limited Disclosure of Employee HIV Status"
"Faint Hope for Drug to Tackle Deadly Tuberculosis"
"Routine Immunization in HIV: Helpful or Harmful?"
"Europe's Drug Lottery"
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"Panel Backs Retinitis Drug; Gilead Stock Recovers Some"
New York Times (03/19/96) P. D5;  Fisher, Lawrence M.
     Shares of Gilead Sciences Inc. dropped more than 20 percent 
Friday following news that the company's drug Vistide, being 
reviewed for treatment of cytomegalovirus (CMV) retinitis in AIDS
patients, caused tumors in lab rats.  By the end of the day, 
however, it was revealed that the drug had not caused cancers in 
monkeys or humans, and a Food and Drug Administration panel 
recommended the drug's approval.  Experts expect the drug to be 
approved later this year, marking the first approval for Gilead 
and the first for a new class of drugs called nucleoside analogs.
According to analysts, the market for Vistide may be limited by 
its severe side effects, namely kidney damage, though it can be 
lessened with the drug probenecid and intravenous hydration.  
Vistide's greatest advantage over foscarnet and ganciclovir, the 
two current drugs for CMV retinitis, is perhaps that a dose lasts
longer, and a patient would thus require fewer infusions.
      
"Testing Begins on AIDS Therapy Developed by Dr. Salk"
Baltimore Sun (03/19/96) P. 2A
     Researchers at the University of California at San Francisco are 
set to begin testing in about 3,000 patients the drug Remune, an 
AIDS therapy developed by vaccine pioneer that attempts to boost 
the immune system.  Often called a "therapeutic vaccine," Remune 
is the first immune system-based AIDS therapy to be tested at 
this level.
      
"Experience of Doctor Vital To AIDS Patient"
Washington Post--Health (03/19/96) P. 5;  Colburn, Don
     A new study has found that AIDS patients of primary care doctors 
who are inexperienced at treating the disease die about a year 
sooner than those whose doctors are highly experienced.  The 
study, conducted by researchers at the University of Washington, 
was based on the cases of 403 AIDS patients treated by primary 
care doctors at Group Health Cooperative of Puget Sound between 
1984 and mid-1994.  The 125 doctors were divided into three 
groups depending on their experience with AIDS, and researchers 
compared how long different doctors' patients survived after 
diagnosis.  They concluded that experience is especially 
important in treating AIDS, a highly complex and relatively new 
viral infection.
      
"Tuberculosis, Uncontrolled"
New York Times (03/19/96) P. A22
     In a New York Times editorial, the authors support spending to 
control tuberculosis (TB), now the leading infectious killer of 
adults despite available treatment.  TB kills some three million 
people a year, and is the leading killer of people with AIDS, the
editors note.  Most TB cases are not treated, and once begun, 
treatment programs are often not completed, allowing 
drug-resistant strains to develop.  Medicine must be taken for 
six months, and when health workers ensure that it is, under 
directly observed therapy, 95 percent of TB patients can be cured
for only $11 per case in the developing world.  The World Bank 
and the World Health Organization (WHO) have increased their 
budgets for TB, but most areas of the world are still 
inadequately treated.  The WHO estimates that over the next 10 
years, industrialized countries must spend $100 million a year to
control TB--an investment which the editors claim "seems 
unconscionable" not to make.
      
"Impaired Immune Response After Hib Vaccination in HIV-Positive 
Infants"
Reuters (03/18/96)
     HIV-positive infants have a weaker response to vaccines because 
they are born with both humoral and cellular immunity 
impairments.  Dr. Vicki B. Peters at Mount Sinai in New York and 
colleagues vaccinated 18 HIV-positive infants with a complete 
series of Haemophilus influenzae type b (Hib) vaccine, and a 
booster dose of another Hib vaccine.  They found that 
HIV-positive infants had a lower immune response to the vaccines 
than healthy infants.  Peters concluded HIV-infected infants may 
need additional doses of vaccine to provide long-term protective 
antibody response.
      
"Merck Discounts Its New Protease Inhibitor"
Reuters (03/18/96)
     Merck and Co. has announced plans to sell its newly approved drug
Crixivan, or indinavir, at a discount.  The cost of Crixivan will
be $12 per day, compared to that of Roche's protease inhibitor 
Invirase, which sells for $15.89 per day.  Merck said it will 
provide Crixivan free to some patients, and will help others find
sources of reimbursement for the drug.
      
"EEOC Permits Limited Disclosure of Employee HIV Status"
Reuters (03/18/96)
     Employers can "allow" first-aid workers to be informed that an 
injured worker has AIDS only if the information is necessary to 
protect the employee's health, according to the Equal Employment 
Opportunity Commission's (EEOC) interpretation of the Americans 
with Disabilities Act.  The EEOC noted, however, that first-aid 
workers should routinely attempt to protect themselves from 
exposure to blood or body fluids, so disclosure of an employee's 
HIV-positive status should not be necessary to protect the first 
aid worker.
      
"Faint Hope for Drug to Tackle Deadly Tuberculosis"
Reuters (03/15/96);  Harris, Paul
     Glaxo Wellcome, one of the few major pharmaceutical companies 
working on the development of new drugs against tuberculosis 
(TB), says its research is in its early stages.  According to Ken
Duncan, head of Glaxo's Action TB research project--a five-year 
cooperation scheme with academic institutions--a new drug is 
"still a number of years off."  Glaxo researchers are exploring 
several approaches to combating the disease, including the 
development of drugs to boost the body's immune system and attack
the whole TB bacteria.  Paul Nunn, chief of the World Health 
Organization's research and surveillance unit for TB, says he 
finds Glaxo's work encouraging, but criticizes the drug industry 
overall for ignoring certain compounds known to be effective in 
combating TB because of high development costs and the prospect 
of low profits.
      
"Routine Immunization in HIV: Helpful or Harmful?"
AIDS Clinical Care (02/96) Vol. 8, No. 2, P. 11;  Singer, Mary;  
Sax, Paul
     Vaccines for pneumococcus, influenza, hepatitis B virus (HBV), 
and Haemophilus influenzae type-B (Hib) are recommended for 
patients with HIV, yet new evidence indicates that some 
vaccinations may stimulate HIV replication, note Mary Singer and 
Paul Sax of Brigham and Women's Hospital in AIDS Clinical Care.  
The use of vaccines has been reevaluated, however there is little
conclusive data on their efficacy and potential harm.  The 
authors note, for example, that HIV-infected individuals are at 
an increased risk for pneumococcal disease, but that the actual 
clinical efficacy of the vaccine in HIV patients is unknown.  One
study of pneumococcal and influenza vaccination in HIV found the 
pneumococcal vaccine to be cost-effective, but did not consider 
any adverse effects it could have on HIV progression.  Influenza 
vaccination was not found to be as cost-effective.  Meanwhile, 
between 35 percent to 80 percent of HIV patients are either 
immune to or are chronic carriers of HBV and are therefore not 
candidates for vaccination.  Vaccination is recommended for those
found to be HBV seronegative or not chronic carriers, even though
the antibody response to the vaccine is suboptimal in 
HIV-infected people.  Also, HIV patients have a higher incidence 
and severity of H. influenza infection, but the efficacy of the 
Hib vaccine is unknown.  According to the authors Singer and Sax,
further studies are needed to determine the efficacy of vaccines 
for people with HIV and the short-and long-term effects of 
immunization on viral load.
      
"Europe's Drug Lottery"
Journal of the International Association of Physicians in AIDS 
Care (02/96) Vol. 2, No. 2, P. 33;  Alcorn, Keith
     Widely varying policies regarding the distribution of protease 
inhibitors within several European Union countries adversely 
impacts patients, contends Keith Alcorn in the Journal of the 
International Association of Physicians in AIDS Care.  Alcorn 
notes that although German doctors can easily obtain the drug 
saquinavir from international pharmacies, doctors in the United 
Kingdom have had to wait for approval from the Medicines Control 
Agency of a compassionate release program.  The bureaucracy in 
Spain, where local ethical agencies have delayed the approval of 
3TC, can be even more cumbersome.  Some patients at hospitals 
there have been waiting more than six months to receive the drug.
In France, meanwhile, 3TC has been approved by the 
L'Authorisation Temporaire d'Utilisation, but only for patients 
who meet certain conditions, such as having CD4 counts over 50.  
According to Alcorn, the disparity in policies is the result of a
system which is concerned only with bringing treatments to 
market, without any consideration to the compassionate use 
aspects of pharmaceutical availability.
      
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