                     AIDS Daily Summary 
                       May 13, 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 National AIDS 
Clearinghouse, or any other organization. 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 1996, Information, Inc., Bethesda, MD
     
     
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"Offer To Be Rejected in HIV Case"
"HIV-Positive Student Suing School System"
"Schmoke, Morella, Studds To Receive Awards for AIDS 
Leadership" "Clinical Drug Trials Can Let Patients Try 
State-of-Art Therapies"
"AIDS To Take Heavy Toll on Malawi--World Bank" 
"10,000 March in Paris Anti-AIDS Rally"
"A Meta-Analytic Evaluation of the Polymerase Chain Reaction for 
the Diagnosis of HIV Infection in Infants"
"Ritonavir: First to Prolong Survival" 
"Managing HIV-Related Diarrhea"
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"Offer To Be Rejected in HIV Case"
Philadelphia Inquirer (05/13/96) P. A1;  Shaw, Donna
     A $640 million settlement offered to HIV-positive
hemophiliacs by four drug companies who marketed blood products 
infected with HIV will be rejected as being too low, 
representatives of the hemophiliacs said.  The companies agreed 
to the settlement last month, but leaders of the 8,000 to 10,000 
infected hemophiliacs say the offer is not enough.  They say that 
new evidence shows that the companies used plasma donations from 
people who were known to have hepatitis and that the government 
did nothing to stop them.  The hemophiliacs question why they 
should accept less than the $420,000 offered to each of Japan's 
HIV-infected hemophiliacs.  The two groups will meet today in 
Philadelphia to discuss the settlement.
     
"HIV-Positive Student Suing School System" 
Washington Post (05/11/96) P. C1;  Beyers, Dan
     An HIV-infected teenager has filed suit against the
Montgomery County, Md., public school system because a teacher 
disclosed his infected status to other students.  The suit says 
that the student, identified as "Courageous Youth," transferred 
from the school system as a result, and it caused him to lose "an 
opportunity to enjoy a few precious years of normal childhood."  
The youth is seeking $100,000 in compensatory and punitive 
damages.  It has been the school system's policy since 1986 to 
respect the privacy of HIV-positive students, but a teacher told 
students on Dec. 12 that they should not share lip balm with 
"Courageous Youth" because he has HIV.  The infected teen was not 
at school that day.  School officials had been notified of the 
student's condition in hopes that they would help him and had 
repeatedly asked that the student tell classmates that he was 
infected, but it is not clear how the teacher became aware of the 
youth's infection.
     
"Schmoke, Morella, Studds To Receive Awards for AIDS 
Leadership" Baltimore Sun (05/13/96) P. 3B
     Baltimore Mayor Kurt L. Schmoke, Rep. Constance A.
Morella (R-Md.) and Rep. Gerry E. Studds (D-Mass.) will be among 
those receiving AIDS Action National Leadership Awards in 
Washington, D.C., today.  Schmoke will be honored for 
establishing a needle exchange program in Baltimore, and Morella 
and Studds will be recognized for voting 100 percent in support 
of AIDS-related legislation.
     
"Clinical Drug Trials Can Let Patients Try State-of-Art 
Therapies"
Wall Street Journal (05/13/96) P. B1;  Chase, Marilyn
     Clinical trials provide a way for many people to try new 
therapies when conventional remedies are not adequate and to 
contribute to medical knowledge.  Patients participating in 
clinical trials should be cautious and should understand the 
risks involved, because although the studies are held to many 
standards of safety, patients are still sometimes harmed.  The 
intense health care provided is an advantage for patients, who 
receive close monitoring of their health during the study and 
have the opportunity to receive a potential cure.  Mark Frey of 
San Francisco saw clinical trials as a way to get treated for HIV 
while providing information to advance medical science.  People 
considering participating in a clinical trial should factor into 
their decision the time and energy involved, the possible side 
effects, as well as other safety concerns.
     
"AIDS To Take Heavy Toll on Malawi--World Bank" 
Reuters (05/11/96)
     The World Bank predicted in a new report that about 2
million people in Malawi will be infected with HIV by the year 
2000.  About 1.1 million people, of the 11 million in Malawi, are 
now infected.  The death toll is expected to cause the average 
life span to decrease from 57 years to 33 years.  About 100,000 
people will have AIDS, and 350,000 children will lose their 
parents to the disease, the report says, noting that the losses 
would result in a dramatic decrease in the gross domestic product 
between 2000 and 2010.  The southern African country, the ninth 
poorest in the world, would not be able to handle the financial 
burden of an AIDS epidemic.  In 1994, the rate of HIV infection 
among pregnant women was about 33 percent, and in prostitutes, 
the rate ranged from 70 percent to 98 percent.
     
"10,000 March in Paris Anti-AIDS Rally" 
Reuters (05/12/96)
     About 10,000 people participated in a march in Paris on
Sunday to raise money for AIDS patients.  Politicians, artists, 
and people with AIDS were among those participating in the 
carnival-like event which moved from the Charlety stadium to the 
Champs de Mars by the Eiffel Tower.  A similar anti-AIDS rally 
last year raised more than $200,000 and helped increase public 
awareness of the disease.  France has the highest rate of HIV 
infection in Europe, with 200,000 individuals infected.
     
"A Meta-Analytic Evaluation of the Polymerase Chain Reaction for 
the Diagnosis of HIV Infection in Infants"
Journal of the American Medical Association (05/01/96) Vol. 275, 
No. 17, P. 1342;  Owens, Douglas K.;  Holodniy, Mark;  McDonald, 
Thomas W.; et al.
     To determine the efficacy of the polymerase chain reaction
(PCR), Dr. Douglas K. Owens of the Veterans Affairs Health Care 
System in Palo Alto, Calif. and colleagues conducted a 
meta-analysis of 32 published studies of PCR for perinatally 
acquired HIV infection.  The median reported sensitivity was 91.6 
percent, and the median specificity was 100 percent.  The joint 
sensitivity and specificity was higher in older infants than in 
neonates.  For infants at low risk of perinatal transmission, the 
positive predictive value for PCR was found to be 55.8 percent in 
neonates and 83.2 percent in older infants.  The authors conclude 
that PCR is one of the best available tests for HIV diagnosis of 
infants but note that it is not definitive and should be 
interpreted and followed up carefully.  The researchers suggest 
delaying PCR until after the neonatal period or repeating PCR on 
independent samples 30 to 60 days later to reduce test errors.
     
"Ritonavir: First to Prolong Survival"
Journal of the International Association of Physicians in AIDS 
Care (04/96) Vol. 2, No. 4, P. 38;  MacDougall, David S.
     Ritonavir is the first protease inhibitor proven to prolong 
survival in advanced AIDS patients.  Studies in the mid-1980s 
suggested that HIV protease may be responsible for some of the 
virus' pathogenic effects.  Early protease inhibitors were 
designed to inhibit HIV protease function, but most had low 
bioavailability and were eliminated quickly.  Research on HIV 
protease's structure led scientists to search for a specific 
inhibitor that would block the enzyme's activity.  Scientists 
from Abbott Laboratories designed and tested more than 2,000 
compounds, eventually leading to the development of ritonavir.  
In clinical trials, the drug was found to cause a rapid, 
significant initial decline in viral load and an increase in CD4 
cells.  A study of ritonavir with zidovudine and ddC demonstrated 
the success of the combination in reducing and sustaining 
undetectable viral load levels and increasing CD4 cell counts.  
Ritonavir was also found to be more effective than ZDV alone.  
The first proof of ritonavir providing survival benefits was 
found in a study in which the drug was added to volunteers' 
current therapies.  Preliminary studies suggest that ritonavir 
may increase blood levels of saquinavir, and both Abbott and 
Hoffmann-La Roche have plans to conduct a clinical trial of a 
combination of the two drugs.
     
"Managing HIV-Related Diarrhea"
Nutrition for Life (04/96) Vol. 1, No. 2, P. 1
     Diarrhea, which is caused by pathogens, malabsorption, and 
tumors, affects at least 50 percent of AIDS patients.  To 
identify the cause of diarrhea, a stool culture for bacteria, 
tests for C. difficile toxins and parasites, and a smear for 
cryptosporidium, cyclospora, and Mycobacterium should be 
performed.  Treatment seeks to reduce the diarrhea, and relieve 
the patient of fever, chills, or abdominal cramps.  Pathogens 
should be treated with the proper anti-infective drugs.  For 
nonspecific diarrhea, Imodium is used for initial therapy, along 
with fiber, the BRAT diet (bananas, rice, applesauce, and toast), 
and psyllium.  The results of upper or lower GI tract endoscopy 
and biopsy are not usually valuable enough to merit the 
discomfort and cost they incur, and should be used when patients 
are unresponsive to simple treatment or when a patient has a 
fever or bloody stools.  Dietary changes, including use of the 
lactase enzyme and aged/cultured milk for lactose intolerance, 
can also reduce diarrhea.  A sensitivity to dietary fat is also 
common, and limiting intake can be useful, though carbohydrates 
should be added to prevent weight loss.  Furthermore, bile acid 
sequestrants, which can help a patient tolerate fat, should be 
tried before going on a fat-restricted diet.
     
     
