The researcher David Zagury who has conducted a series of AIDS vaccine trials over
the last few years has been cleared of charges that he acted without the approval
of the French ethics committee for his research in France; Nature
350: 546; Science
252: 203; BMJ
302: 930. Because of criticism of his research ethics the US Government support
for the trials in African countries had been suspended; JAMA
265: 2648-9. The NIH committee is still discussing the issue. Following the clearance
from French authorities, there were several deaths in treated patients reported.
The deaths occured last year, so that a new enquiry is being launched; Science
252: 501-2, NS
(27 April 1991), 9. Two patients may have developed a fatal vaccinia infection after
receiving the vaccine which includes "inactivated" vaccinia. On another possible
therapeutic method, see M.Zeira et al., "Full-length CD4 electroinserted in the erythrocyte
membrane as a long-lived inhibitor of infection by HIV", PNAS
A general comment on the ethical issues and political issues in the future AIDS research (see p.53 in this issue), and vaccine trials is in NS (27 April 1991), 5 & 25-9. An even more controversial experiment could be the innoculation of AIDS patients with live HIV as a vaccine. The particular HIV is thought to be a nonpathogenic form of the virus, so it may compete with the pathogenic form in the patients; NS (13 April 1991), 10. The results are mixed, but the reaction is even more mixed to the ethicality of such trials! The results were published in Lancet only as a short letter, saying the results could be obtained by writing to the journal or researchers; Lancet 377: 731.
The French Government has banned the AIDS vaccine trials of researcher David Zagury in France; Science 252: 1608; NS (22 June 1991), 18, Nature 352: 180. For a background see EEIN 1: 45. A comment on the NIH ethics report on this case is in NS (27 July 1991), 12; Nature 352: 269. The reason for the ban was questions about the safety of the recombinant vaccinia virus used. On the results of human testing of another putative AIDS vaccine see SA (Aug 1991), 14. Another putative vaccine has failed to be effective in preventing sexual transfer of HIV in monkeys; NS (6 July 1991), 24. Another approach, using soluble recombinant CD4 protein has protected chimps against HIV infection; R.H.R. Ward et al., "Prevention of HIV-1 IIIB infection in chimpanzees by CD4 immunoadhesin", Nature 352: 434-6; see also P. Putkonen et al., "Prevention of HIV-2 and SIVsm infection by passive immunisation in cynomolgous monkeys", Nature 352: 436-8; p.376-7; NS (3 Aug 1991), 15. A review on the prospects for a HIV vaccine is in FASEB J. 5: 2406-11.
There are many problems being encountered in the treatment and screening for AIDS,
which can be a model for future screening in general. The HIV epidemic is acting
as a catalyst for discussions about some ethics, in the same way that genetics can
do. In view of this and the importance because of the growing numbers involved, some of
the papers regarding AIDS will be mentioned, to keep us up-to-date in this area also.
A summary of the current state of HIV infection is normally found in the WHO publication, World Health .. A recent summary is in Science 252: 372-3. About 1 million people are suffering from AIDS, and about 8-10 million infected, from WHO estimates. The cases are not well documented, so that the official figures are less. On AIDS in Thailand see MJA 154: 282-4. On HIV testing in India see NS (20 April 1991), 12. On HIV in children see Lancet 337: 1030; BMJ 302: 921-2; JAMA 265: 2652. They are trying voluntary programs to encourage brothels to use condoms. Book reviews on the history of AIDS are in Science 252: 453, 985-6. Comments on the issues are in NEJM 324: 1498-1504.
A paper on HIV counseling is in Lancet 337: 950, see also BMJ 302: 801-2. A letter on the preferences of HIV-infected patients on aggressive or palliative care was surveyed in the USA, see NEJM 324: 1140. 54% prefered palliative care, 29% prefered an aggressive approach even if it would involve more pain. One social effect of HIV testing policy is in J. McKillip, "The effect of mandatory premarital HIV testing on marriage: the case of Illinois", AJPH 81: 650-3. The laws in other US states are also mentioned, as is the marriage of couples in neighbouring states to avoid the screening. The USA has reversed its earlier decision to open up immigration for foreigners infected with HIV; NS (8 June 1991), 14. This will be fought again, because it is discriminating and may even discourage people from taking HIV tests. WHO has decided to withdraw support for the Jan. 1992 AIDS conference in Boston.
Letters on HIV testing in pregnancy are in Lancet 337: 1218: 9. See also M.Grimm et al., "Prevalence of HIV infection in childbearing women in the United States", JAMA 265: 1704-8, and JAMA 265: 1798-9 & 1805. On the mechanism of transfer, through the placenta, see NS (1 June 1991), 20.
There is a special supplement to the May issue of the American J. Public Health on the New York HIV seroprevalence project (c.70pp.). See also AJPH 81; 561-2. The results of anonymised HIV testing in Britain are in BMJ 302: 1229. On other comments on HIV testing see Nation's Health (Feb 1991), 4; (March 1991), 1, 17, 24; and the HCR (March/April 1991), 7-11. For a general view that physicians have an obligation to treat the sick, and the ethical arguments underlying this see N.Daniels, "Duty to treat or right to refuse?", HCR (March/April 1991), 36-46.
A case on the hospital testing for AIDS in employees in a US Court of Appeals found that a hospital could dismiss a worker who refused to give blood for a HIV test; AJLM XVII: 181-3. A letter on hospital testing policies appears in JAMA 265: 1685. See a meeting description in the Nation's Health (April 1991), 15. A commentary on the risk of contracting HIV infection in the course of health care is in JAMA 265: 1872-3, see also JAMA 265: 2337-8; NEJM 324: 1504-8; and B.Gerbert et al. (1991) "Possible health care professional-to-patient HIV transmission. Dentist's reactions to a Centers for Disease Control Report", JAMA 265: 1845-8. Most dentists thought that if dentists are infected with HIV they should refrain from work. The results of a survey of HIV infection among orthopedic surgeons is in JAMA 265: 2779-80, and for HIV in US army reserve health workers JAMA 265: 2826-30.
On scientific ethics. A paper S.Wain-Hobson et al., "LAV revisited: origins of the early HIV-1 isolates from Institut Pasteur", Science 252: 961-5, describes the origin of the first HIV to be isolated. Gallo of the NIH has finally admitted that the HIV that he isolated in 1984 really came from the Pasteur Institute; NS (8 June 1991),14; Nature 351: 267, 426-7; Science 252: 771. It has long been suspected. This means that more of the currently equally shared patent should go to the Pasteur Institute. Gallo personally earns about US$100,000 annually from his share of the roylaties on HIV tests!
Possible trials of an AIDS vaccine in pregnant women in the USA are being considered, but vaccine manufacturers are concerned about possible liability claims should any fetus be harmed as a side-effect; BMJ 303: 665; NS (31 Aug 1991), 11. There is also a trial underway to test whether AZT affects HIV transmission. More on the Zagury AIDS vaccine trials in Rwanda is in Nature 353: 4; and the apparent confusion of the NIH about regulations on clinical trials overseas; BMJ 303: 329-30. Meanwhile the efficacy of an AIDS vaccine trial that reportedly had worked in macaque monkeys, is now under suspicion, so that prospective human trials in the U.K. will be delayed; Nature 353: 287; NS (21 Sept 1991), 14. On AIDS vaccines see JAMA 266: 763-4; BMJ 303: 872.
A summary of the conclusions of a U.K. MRC Working Party report on AIDS vaccine trials is reproduced in the BME (Nov 1991), 9-11. An international meeting on AIDS vaccine suggests that the first major trials by major organisations may be in 1995 or later; Science 254: 647, though the vaccine is still to be developed. There may still be earlier trials elsewhere, in Zaire, Uganda, Rwanda, Thailand and Brazil; BMJ 303: 1219-20. The ethical issues are still being examined, because of the variety of people's involved. See also Genetic Research 58: 177-8, for a book review; TIBTECH 9: 124-31, on CD4 antigen; Biotechnology 9: 779; MJA 155: 403-6; and on tougher FDA regulations for AIDS vaccines; Science 254: 1105; and see the section on AIDS later in this issue.
A review on the development of HIV vaccines is in Biotechnology 10: 24-9. It is written in a market orientated tone, and lists some of the current commercial research projects in pursuit of this goal, in addition to the patents. The Zagury case in France may be over and he has been exonerated by the French physician's licensing body of the charges made against him due to the treatment of patients with a putative AIDS vaccine; Science 255: 280. On a possible future AIDS drug Ro 24-7429 see Science 255 (1991), 1715.
vaccine trials have begin in some high risk populations; Science
258 (1992), 1729; and in infants whose mothers are HIV-infected; Science
258 (1992), 1568-70. The debate on the choice of which vaccines should be tested
is in Biotechnology
10 (1992), 1521; Science
259: 752-3. Although infants can not give consent, a typical HIV-infected infant
will die at two years of age - the progress being much faster than in adults. Some
researchers believe that the old approach using live weakened virus as a vaccine
needs to be reexamined; Science
258 (1992), 1880-1.
A review of malaria transmission-blocking vaccines is in TIBTECH 10 (1992), 388-91. Adult immunisation with acellular pertusis vaccine is recommended following a placebo-controlled double-blind trial; JAMA 269: 53-6. A report about development of the hepatitis A vaccine is in MJA 157 (1992), 345. The organisation Rotary International has started funding efforts to ensure that polio is erradicated from the world by the year 2005; JAMA 269: 15-6. A letter asking about the sustainibility of universal childhood vaccination is in Lancet 341: 58. This follows recent declines in vaccination rates in 13 African countries. A review of childhood immunisation is in NEJM 327 (1992), 1794-1800. As reported previously (EEIN 3: 2), researchers are attempting to produce hepatitis vaccine in banana to be an oral vaccine; Science 258: 1878.
A review of the laws in the USA regarding tuberculosis is L.O. Gostin, "Controlling the resurgent tuberculosis epidemic: A 50-state survey of TB statutes and proposals for reform", JAMA 269: 255-61. A book review of interest to the treatment of TB patients in the past is in JAMA 269: 531. B. Healy of the NIH has transferred a further US$12.5 million into TB research this year; Science 259: 886. This follows reports calling for more funding, JAMA 269: 187-8, 91, 95; see also Science 259: 167. In some regions of the the UK also, notification rates for TB are rising, BMJ 306: 221-2. BCG vaccination at age 13 years is debated in BMJ 306: 222-3.
A summary of a paper on the public acceptability of vaccination in Saudi Arabia, published in Ann Saudi Med. , is in JAMA 268 (1992), 3422. High public support for the immunisation goals was observed. In Zaire, providing transport to clinics would increase the rates; World Health (Sept. 1992), 24. In the USA, Congress is attempting to simplify the booklets that explain immunisation; JAMA 268 (1992), 3413. Inner city residents show low perception of a need; Clinical Pediatrics 32: 2-7. A Canadian study of the language that mothers prefer in vaccination brochures is in CMAJ 147 (1992), 1013-7.
It is known that a child who catches measles from a family member is twice as likely to die as one who catches measles from an unrelated person. This is because of the MHC antigens, and an extension of this idea may explain why so many people in the Americas died as a result of introduced diseases; Science 258 (1992), 1739-40. People in South America have very closely related MHC antigens, with much less diversity than in other parts of the world. Therefore a virus or bacteria spreading from one to another host is already adapted to evading the immune system of the new host. An editorial on the continual rise and fall of different diseases in human history is in Lancet 341: 151-2. A review of viral genetic variation in hepatitis B is in Lancet 341: 349-53.
The US Immigration Department continues to list HIV infection as a disease which can
ban entry to the USA, despite assurances that it would be off the list. This has
meant the the 1992 AIDS conference will probably not be held in Boston; BMJ
302: 1360; Nature
351: 682. There are claims that the UK Government has a hidden HIV ban on immigration;
(6 Jul), 17.
The latest results from the anonymised HIV testing in the UK are commented on in Lancet 337: 1572-3, and are reported in two papers; A.E. Ades et al., "Prevalence of maternal HIV-1 infection in Thames Regions: results from anonymous unlinked neonatal testing", Lancet 337: 1562-5; D.M. Tapin et al., "Prevalence of maternal HIV infection in Scotland based on unlinked anonymous testing of newborn babies", Lancet 337: 1565-7. They tested for HIV antigens transmitted in utero from infected mothers. The obstetricians were only aware of maternal HIV infection in 20% of the cases where infants were positive for HIV. The prevalence of antiHIV-1 in newborn babies at the beginning of 1991 in inner areas of London is 1 in 500. On the time of viral transmission see A. Ehrnst et al., "HIV in pregnant women and their offspring: evidence for a late transmission", Lancet 338: 203-7.
See D.E. Bloom & S. Glied, "Benefits and costs of HIV testing", Science 252: 1798-1804, for a look from the employers perspective. The results suggest that it is not cost effective for most private companies to perform such tests. A letter on the ethics of such research is in CMAJ 144: 1603-4. A paper on the treatment choices and ethics for infants at risk for HIV is in JAMA 265: 2976-81. A letter on antenatal HIV testing is in BMJ 302: 1400.
A special issue of the FASEB J. (Vol 5, No. 10, July 1991) includes about 110 pp. of articles on HIV and AIDS. On the science of HIV infection see NS (29 June 1991), 19. A summary of the 7th annual AIDS conference is in Science 252: 1779. See also Lancet 338: 86-7. The Journal of Pediatrics has published a 42 pp. supplement entitled "Guidelines for the care of children and adolescents with HIV infection", in the July issue. A series of articles are presented. The difficulty of disclosing test results to patients in India is noted in NS (3 Aug 1991), 10.
The case involving the transmission of HIV from the Florida dentist to 3 of his patients is commented on in JAMA 266: 23-4. An editorial on surgeons at the risk of HIV contamination during operations is in JRSM 84: 327-8. On possible compulsory HIV testing for US health workers see NS (27 Jul), 12; and on voluntary guidelines see BMJ 303: 205-6. The AMA rejects such testing; BMJ 303: 77. See also J.L. Gerberding, "Reducing occupational risk of HIV infection", Hospital Practice (15 June 1991), 103-8, which reports on the policy at San Francisco General Hospital for isolation of body substances.
Important is the use of screening for HIV infection in blood used for blood donation. A paper; M.P. Busch et al., "Evaluation of screened blood donations for HIV-1 infection by culture and DNA amplification of pooled cells", NEJM 325: 1-5; found that the probability that a screened donor will be positive for HIV-1 is about 1 in 61, 171! The city used was San Francisco. A French case where HIV-infected blood was mixed for use in transfusion is commented on in NS (15 June 1991), 14; BMJ 303: 8-9. In France blood donation is declining, for a number of reasons; BMJ 303: 153.
Comments on AIDS in Asia are in BMJ 302: 1557; Nature 351: 682; NS (22 June 1991), 18. On AIDS cases in the USA see JAMA 265: 3226-8, and on the need for the world to wake up, see Nature 351: 682. On the growing spread of AIDS via heterosexual contact see NS (27 Jul), 17-8. See also R.M. Anderson et al., "The spread of HIV-1 in Africa: sexual contact patterns and predicted demographic impact of AIDS", Nature 352: 581-9; R. Brookmeyer, "Reconstruction and future trends of the AIDS epidemic in the United States", Science 253: 37-42. On the idea of making a risk of HIV infection country comparison table for travellers see NS (17 Aug 1991), 8.
The continued US policy for refusing entry to immigrants with HIV has meant that the
8th International AIDS conference has been shifted from the USA to Amsterdam; Nature
353: 96, 199; Science
253: 845; Lancet
338: 751; BMJ
303: 462, 665.
The question of HIV testing for health workers has been a major issue of debate. It represents compulsory screening, and is thus regarded as unethical by many. The US Center for Disease Control Recommendations for preventing HIV transmission from health care workers is in JAMA 266: 771-6. See also JAMA 266: 1134-7, 1935-6; Lancet 338: 683-4; BMJ 303: 325-6, 351-2; NEJM 325: 888-9. In Germany, the health care minister has said that if workers do not voluntary take tests, a compulsory law will be introduced; Lancet 338: 375.
The question of HIV testing and obtaining medical insurance in the U.K. is raised in BME (Aug 1991), 6-7; Lancet 338: 306. The request for the results of HIV tests by insurance companies could result in people avoiding having HIV tests, which will be detrimental. On a campaign in Britain to raise the awareness about the rights of HIV-infected and AIDS patients see BMJ 303: 540-1. In the US, the Center for Disease Control is urging hospitals to test all new patients for HIV; NS (28 Sept 1991), 13. On counselling patients before an HIV test see BMJ 303: 905-7; and after a positive test MJA 155: 142, and on informed consent for HIV testing see CMAJ 145: 518-20, 616-7.
The French scandal on the use of HIV-contaminated blood in blood banks asks why the use of HIV-testing was delayed for 5 months so that a French test could be used instead of the earlier US test; Nature 353: 197; Lancet 338: 809-10. In India many blood banks are contaminated by HIV-infected blood (only 5% of blood is screened), from professional donors who have been rejected from clinics where there is screening; Lancet 338: 436-7.
On how to slow the spread of HIV see Lancet 338: 608-13; on AIDS in Romania, Lancet 338: 645-9; on self-destructing syringes see Lancet 338: 438-9; on Asian cases JAMA 266: 1048-53; on forecasting the epidemic see Science 253: 852-4; SA (Sept 1991), 18-9; see also NEJM 325: 806-8, 809-11; BMJ 303: 803, Social Science & Medicine 33: 749-64, 771-82. On HIV and cocaine see BMJ 303: 330.
The proposed US public survey on sex behaviour, that would obtain useful information for developing prevention strategies and information campaigns, has been stopped; Nature 353: 371; BMJ 303: 263; Science 253: 502, 1483. The recommendations of an American working party on how to do ethical research on AIDS are reproduced in the BME (Sept 1991), 8-11. The US government has redefined people who have AIDS, to be based on the count of CD4 lymphocytes; Nature 352: 653. On the spread of HIV-1 in Africa see a review in Nature 352: 581-8. On the relatively low rate of female to male transmission of HIV see JAMA 266: 1664-7. On heterosexual transmission see JAMA 266: 1695-6.
A study in Rwanda has shown that mother's appear to transfer HIV to babies via breast feeding; P. van de Perre et al., "Postnatal transmission of HIV Type 1 from mother to infant", NEJM 325: 593-8; Nature 353: 2; see also S. Allen et al., "HIV infection in Urban Rwanda", JAMA 266: 1657-63. This means that the transmissibility of HIV via breast feeding has been shown, after some debate about its likelihood. On maternal HIV tests see Lancet 338: 386. On AIDS in children see JAMA 266: 770; CMAJ 145: 198-9, and on counseling families with HIV-infected children see Nursing Times 87 (2 Oct 1991), 38-40.
The debate on whether HIV is the only necessary cause of AIDS continues; see PNAS 88: 3060-4; Science 253: 1138-41; Nature 353: 297; NS (14 Sept 1991), 22, (5 Oct 1991), 7, 9-10 . A weak link between onset of AIDS and certain HLA alleles has been claimed; J.AIDS 4: 814; NS (24 Aug 1991), 19. See also Lancet 338: 940.
On counseling patients before an HIV test see BMJ
303: 1133-4, 1478. Denmark have banned the use of HIV tests by insurance companies,
and other countries may follow, but should HIV testing be a special case?; Lancet
338: 1212. Most AIDS patients appear to be pleased with their physicians in the
UK; M.M. Kochen et al., "How do patients with HIV perceive their general practitioners?",
303: 1365-8. See reviews on testing; D.L. Higgins et al., "Evidence for the effects
of HIV antibody counseling and testing on risk behaviors", JAMA
266: 2419-29; E.M. Sloand et al., "HIV testing. State of the art", JAMA
266: 2861-6. A recent US court case involving HIV testing of a defendant is in Amer. J. Law & Medicine
XVII: 318-9. The UK prison policies on segregating inmates with HIV and hepatitis
B virus infections are under review; BMJ
303: 1354. Mandatory testing in the USA, of people entering US Job corps or the
military, is criticised in JAMA 266: 2430-1.
On HIV positive doctors see Lancet 338: 1462-3; NEJM 325: 1406-11. Some physicians may have attitude problems that hinder care of HIV-infected patients; JAMA 266: 2837-42.
A new prospective AIDS drug, Nevirapene (BI-RG 587, Boehringer), has been found to block the replication of HIV by interfering with the action of reverse transcriptase. It has passed lab and animal testing and is in clinical trials in Australia, Italy and the Netherlands; NS (23 Nov 1991), 19. On AIDS drug's approval by the FDA see Science 254: 1113. On AZT; NEJM 325: 1311-3. AZT can work for people of every race, yet minority groups in the USA are under-represented in drug testing trials; JAMA 266: 2709-12, 2750-1.
In France, the government has announced that it will compensate people that were infected with HIV-infected blood; EEIN 1:80;BMJ 303: 1091, 1156-7, 1417-8; Nature 354: 425. The issue has been a major scandal, and three officials have been charged; Nature 353: 781. Ten German haemophilic patients that were infected with HIV are receiving compensation from the producer of the blood clotting factor preparation; BMJ 303: 1352-3.
A call for partner notification is made in Lancet 338: 1112-3, especially because HIV-infected persons can benefit from treatment with drugs to delay the onset of AIDS, and also it would benefit the society as people become aware that they are infected and slow its spread to others. In Sweden this policy has been used with good results; J. Giesecke et al., "Efficacy of partner notification for HIV infection", Lancet 338: 1096-1100. On mucosal transmission of HIV; Nature 353: 709.
AIDS prevention may be aided by treating other sexually transmitted diseases; BMJ 303: 1150-1. On Australian teenagers awareness of sexually transmitted diseases see survey results in MJA 155: 325-8. See also NEJM 325: 1368-70. The prevalence of Hepatitis B in a prenatal US population has been measured; JAMA 266: 2852-5.
On AIDS prevention in the USA see Lancet 338: 1264; JAMA 266: 2801-2; Nature 354: 103, and among drug users; Social Science & Medicine 33: 977-83; and on care of HIV-infected women; JAMA 266: 2253-8. The WHO AIDS program is discussed in Science 254: 511-2, with the prediction that by the year 2000 there will be more Asians than Africans infected with the disease. On AIDS in Africa; BMJ 303: 1151-2; in Australia; MJA 155: 297-300; in USA; JAMA 266: 2221-2, 2387-91. Recent controversy erupted in Japan over the provocative posters that have been produced to try to warn people of catching AIDS. There is however, very little education about AIDS and it is still seldom seen in any newspaper, despite the fears of the spread via prostitution.
On the biological strategy of HIV, and tricks used which may allow it to evade the immune system; Nature 354: 262, 433-4, 439-40, R.E. Phillips et al., "HIV genetic variation that can escape cytotoxic T cell recognition", Nature 354: 453-9; M.A. Garcia-Blanco & B.R. Cullen, "Molecular basis of latency in pathogenic human viruses", Science 254: 815-20, see also p. 798-800, 921; JAMA 266: 2186. Epidemiological data on the latency is in C.A. Lee et al., "Progression of HIV disease in a haemophilic cohort followed for 11 years and the effect of treatment", BMJ 303: 1093-6; P. Simmonds et al., "Determinants of HIV disease progression: six-year longitudinal study in the Edinburgh haemophilia/HIV cohort", Lancet 338: 1159-63. Treatment seems to be reducing the progression of the disease. Also on HIV see Nature 453; NS (14 Dec 1991), 20.
The Japanese government has decided to increase the funding of AIDS prevention and education programs. It has been very slow in approaching AIDS, maybe at last it releases its importance, especially given the promiscuity of Japanese businessmen in Japan and abroad. The real number of HIV-infected persons in Japan is estimated to be about 8600, though officially the latest figure is 2008. The government will attempt to protect privacy more, to encourage more people to take tests. They also reported a case of a patient developing AIDS only 8 months after HIV infection (similar to reported cases in France and Holland where the virus appears to attack the immune system at a 3 times faster rate than normal).
The law can be used to enforce behaviours of people with infectious diseases, but it does not appear to work well for sexually-transmitted diseases; BMJ 304: 891-2. See also; NEJM 326: 703-5. It appears that many HIV infected people do not inform past sexual partners of their infection risk; Public Health Reports 107: 100-9. A study suggesting that women are about twice as likely to get HIV from men via heterosexual intercourse is BMJ 304: 809-13. Ways to counsel HIV positive haemophilic men who wish to have children is discussed in BMJ 304: 829-30.
The debate concern HIV-infected medical personnel continues with N. Daniels, "HIV-infected professionals, patient rights, and the 'switching dilemma'", JAMA 267: 1368-71; B. Lo & R. Steinbrook, "Health care workers infected with the HIV. The next steps", JAMA 267: 1100-5. The Florida dentist HIV transmission case has been settled out of court, though there are other unresolved issues of the case Science 255: 392-4, 787.
The relationship between intravenous drug use and acquiring AIDS is discussed in JAMA 267: 1631-6, 1666-7. On the transmission of HIV via seronegative tissue donors see NEJM 326: 726-32. Book reviews of AIDS in Africa are in Nature 356: 393-4. US public opinion and AIDS is presented in JAMA 267: 981-6. The origins of AIDS is still as matter of speculations, as discussed in Science 255: 1505; Lancet 339: 600-1. The definition of AIDS in Europe is explained in Lancet 339: 671, they are not accepting the new US definition; JAMA 267: 973-5. The routes of HIV infection in the UK are in BMJ 304: 402, and the seroprevalence of women attending antenatal clinics in St. Thomas's hospital, London are shown in Lancet 339: 364.
The Victorian government in Australia has announced that it will provide compensation for all people who medically acquired HIV and AIDS; Lancet 339: 419. It is being debated in Australia, because it calls such people "innocent" victims, while critics ask whether other AIDS patients are "guilty" victims. The duty to attend upon sick people, and to treat all people with HIV is discussed in JAMA 267: 1467-9.
Methods to prevent neonatal herpes, including the use of condoms in sex during pregnancy for carriers of herpes simplex virus are discussed in NEJM 326: 946-7, 916-20. A survey of behaviour of condom use is J.-P. Moatti et al., "Determinants of condom use among French heterosexuals with multiple partners", AJPH 81: 106-9. The US Centers for Disease Control has abandoned its pans for an AIDS survey; Science 255: 264.
Several papers report attempts to make vaccines ; NS (22 Feb 1992), 12; Nature 355: 684-6, 728-30; Science 255: 456-9. The relationship of profit motives and AIDS drugs research by pharmaceutical companies is debated in AJLM XVII (1991), 363-410. The use of AZT (zidovudine) is discussed in S. Vella et al., "Survival of zidovudine-treated patients with AIDS compared with that of contemporary untreated patients", JAMA 267: 1232-6; Lancet 339: 805-6; BMJ 304: 402, 456-7. The French government is seeking to receive all of the US$20 million in HIV test royalties the US government has received, because of the research showing that French researchers were the first discoverers of HIV as a cause of AIDS, and the Robert Gallo of the NIH in the USA used French virus to develop such tests; BMJ 304: 660; Science 255: 792.
In the UK , home HIV test kits have been banned ; BMJ 304: 864. The Dept. of Health banned advertising, supplying or selling any such kit for use without the aid of a medical practitioner. In the US, such kits are being produced. Insurance in the UK and HIV testing is discussed in Lancet 339: 682-3. AMA policy on HIV testing is in JAMA 267: 792.
The situation in China is summarised in Liu Ben-Ren, "Legal regulations of AIDS detection and administration in P.R. China", IJB 3: 25-7. Included in the regulation are "once a doubtful AIDS patient is found, the unit must make diagnosis, report, give treatment". There appears to be confusion between the word AIDS patient and HIV-infected person. The Chinese regulations appear to enforce HIV testing.
In Thailand, which has a very large AIDS problem, associated with its huge sex industry, the AIDS program has been toned down because of its dampening effect on the tourist industry; BMJ 304: 1264; Newsweek (29 June 1992), 10-16.
The test stock for testing HIV vaccines in the USA has been contaminated by another HIV strain, which means delays in proposed tests while a pure stock is redeveloped; Science 256: 1387. On construction of AIDS vaccines see PNAS 89: 3879-83.
As noted above, DDC has been licensed by the FDA in the USA to treat HIV. The results of a epidemiological study in the USA suggesting that early treatemnt with AZT improves survival and slows onset of AIDS is N.M.H. Graham et al., "The effects on survivial of early treatment of human immunodeficiency virus infection", NEJM 326: 1037-42.
The results of investigations of patients who have been treated by HIV-infected health care workers are discussed in JAMA 267: 2864; C-Y. Ou et al., "Molecular epidemiology of HIV transmission in a dental practice", Science 256: 1165-71, 1155-2, 1130-1. The results of DNA analysis suggest that the dentist contaminated five patients with HIV. The case of a UK surgeon found to be HIV infected is reported in BMJ 304: 1204, his patients have been notified by letter in case they want to have HIV tests, this is the third time in Britain. The risk of transmission of HIV through a single inoculation injury is estimated to be 1: 275; BMJ 304: 1258-9. On ethical issues see F. Rosner et al., "Ethical considerations concerning the HIV-positive physician", NY State J. Medicine 92: 151-5. The US government will let individual states determine laws on what HIV-infected health workers must do; NY Times (16 June 1992), C7.
On the transmission of AIDS see; BMJ 304: 1506-7; and on mother to child transmission the results of a European Collaborative Study are in Lancet 339: 1007-12. The importance of transmission via breast milk is still to be established. The incidence of heterosexually transmitted HIV in Britain is discussed in BMJ 304: 1125-6; and in the USA, JAMA 267: 1917-9. The relationship between sexual behaviour, smoking and HIV infection in Haitian women is reported in JAMA 267: 2062-6. See also M.J. Rosenberg et al., "Barrier contraceptives and sexually transmitted diseases in women: a comparison of female-dependent methods and condoms", AJPH 82: 669-74. Females receive more protection from contraceptive sponges or diaphragms then from male condoms, suggesting that these methods also need to be promoted. A study of female prostitutes in the USA suggests that they should be vaccinated with hepatitis B vaccine; JAMA 267: 2477-81. The attitudes of parents in Italy and USA to sex education is reported in JAMA 267: 2160, 2163. A bill for paroling dying AIDS patients who are convicts in New York was recently passed; BMJ 304: 935. The AIDS patients charter is discussed in NS (6 June 1992), 21-2.
The recording of HIV status on police computers in Britain is debated in BMJ 304: 995-6, 1243. A comparison of the care that AIDS patients receive compared to other hospital patients is in JAMA 267: 2482-6. The changing AIDS definition is discussed in JAMA 267: 2737-8; Lancet 339: 1298-9. The debate over whether HIV-infected persons' HIV statuts should be told to their sexual partners is renewed in the UK following the death of a woman with HIV infected in that way; Times (23 June 1992), 3.
The debate over whether HIV is the cause of AIDS is being discussed by more people; Nature 357: 188-9; Lancet 339: 1286-7; and on the origins of HIV see Lancet 339: 867-8. Meanwhile, five family groups for HIV have been reported, increasing the previous estimated number of groups; Science 256: 966.
In the UK, as in many countries, people who die from AIDS may have another cause of death recorded on their death certificate. This phenomenon is not novel to AIDS. It is debated in Dispatches 2(3), 6-7. The views of HIV infected persons in the UK on the use of advance directives are reported in Dispatches 2(30, 8-10.
The attitudes of health carers to treating HIV-infected persons is reported in M.F. Shapiro et al., "Resident's experiences in, and attitudes toward, the care of persons with AIDS in Canada, France and the United States", JAMA 268: 510-5. There was more reluctance to treat patients in the USA than in France and Canada. At a recent conference it was remarked that the reluctance of health workers to care for the sick is a significant symptom of the decline in morals of caring in recent times. The counseling and testing of patients in US hospitals is surveyed in NEJM 327: 445-52. A survey of the occupational blood contact and HIV infection in orthopedic surgeons in the USA found that blood contact was common, but transmission rates of HIV low; JAMA 268: 489-94, 601. Another attitude study is R.A. Keenylside et al., "Attitudes to tracing and notifying contacts of people with HIV infection", BMJ 305: 165-8. On partner notification; NEJM 327: 435-7.
Methods to prevent heterosexual transmission of HIV are discussed in JAMA 268: 184, 520-3, 477-82; BMJ 304: 1605-9, 305: 70-1, 259-60, 364. The British government decided not to introduce a law to criminalise the spreading of HIV, like laws in some Australian and US states; BMJ 305: 11. See Science 257: 615.
The testing for HIV is the subject of D.M. Tappin & F. Cockburn, "Ethics and ethics committees: HIV serosurveillance in Scotland", JME 18: 43-6; NEJM 327: 486-8. Canadian guidelines on such research are in CMAJ 146: 1743-4. A letter on detection of HIV from newborn screening programs is NEJM 326: 1703. The BMA has resolved that testing for HIV should not be a routine investigation; BMJ 305: 196. A letter on the British police computer records, which include HIV status is in BMJ 304: 1635-6. On insurance and HIV tests in the UK; BMJ 304: 1692. A review on policies for HIV and hepatitis B infected workers is Occupational Health Review (April/May 1992), 12-14. Increased use of HIV forensic tests is occurring so people can find who to blame for transmission;NS (11 July 1992), 5
Global strategies to arrest the flow of HIV were debated at the VIII International Conference on AIDS; JAMA 268: 445-6; Nature 358: 367; Lancet 340: 147-8; BMJ 305: 209; but it cannot be perfect; NEJM 327: 492-4. The global AIDS data report is in Weekly Epidemiological Record 67 (2 July 1992), and WHO will issue 6-monthly reports in the future. Thailand's AIDS campaign is being relaunched, as political leaders change, and they have said they do not want the 1 billion sex industry; BMJ 305: 211.
Uganda is to host an AIDS vaccine trial , in attempts to boost the immunity of people already infected with HIV; Science 257: 742. Results of vaccine trials on animals are in Science 256: 1687-90, 1632; Biotechnology 10: 633, 840; PNAS 89: 5872-6.
There is increasingly more research on AIDS associated with why people stay well, to develop vaccines and treatments; Science 257: 152-4; NS (8 Aug 1992), 16. Studies on the mechanism of HIV action include; Science 256: 1766, 257: 478; Nature 358: 495-9; NS (13 June 1992), 42-6; (18 July 1992), 31-5; (1 Aug 1992), 8-9 Some cases of AIDS have been reported without HIV infection; BMJ 305: 271, 325-6. A third virus causing AIDS was reported at the Amsterdam meeting; Science 257: 604-5; NS (25 July 1992), 6-7. Comments on whether liability fears are delaying AIDS drug trials is in Science 257: 316-7.
In Japan , more patients infected with HIV from blood transfusions are claiming compensation from the Ministry of Health and Welfare for its failure to screen blood and using imported blood. There has still not been any award to such persons of families of deceased. There was a proposal to establish a hospice for AIDS patients but it is criticised by patients as discrimination; Yomuiri Shimbun (2 Sept 1992), 30. Papers on the risks of transmission are in NEJM 327: 419-21. On the Australian compensation see Lancet 339: 1615. AIDS and US politics is debated in Lancet 340: 105-6; BMJ 305: 136.
The Board of Education in New York has voted to require people who teach about AIDS in schools to say that they will "devote substantially more time and attention to abstinence than to other methods of prevention". In an editorial in Nature 359: 2, they call this thinking of the dark ages. The question is whether it is going to be understood by the listeners, and whether it will be effective against transmission of AIDS. In some cultures it may be effective, with ethical and religious support, however, it may be too late to attempt to change teenagers sexual behaviour when it has become a social norm in some cities. While efforts should be made to promote "family values" in the short-term moves are needed to reduce HIV transmission. A study from the UK is A.J. Hunt et al., "HIV infection in a cohort of homosexual and bisexual men", BMJ 305: 561-2.
In Japanese schools there has been some controversy regarding giving out free condoms. Considering that this is the first year that sex education has been introduced into the school curriculum across Japan, it is not surprising that there are some schools which disagree with the issuance of free condoms. One school asked students to give back condoms that had been distributed, with 90/135 students complying. Due to the limited availability of the contraceptive pill in Japan, condoms are a major form of contraception, and have been available in stores for many years. The funding for AIDS research in Japan may increase dramatically, five-fold, in Japan in 1993; Nature 358: 699. In the current fiscal year, Y900 million will be spent in Japanese schools and universities on AIDS education.
In Japan there are fears that many of the annual 700,000 travellers to Thailand will lead to rapid growth in AIDS cases. Some companies have been educating employees who go on foreign trips. In Ibaraki prefecture, 90% of AIDS cases are foreigners. This has lead to some discrimination problems, and education is urgently needed. The first time that AIDS patients who got HIV from sexual intercourse have openly said so, was this year. Free testing in Tokyo is being offered.
Many hospitals have said that they are not prepared to treat patients with AIDS, and a hospital in Sendai recently refused to admit a pregnant women who refused a blood test for HIV; Yomiuri Shimbun (10 Oct 1992), 31. Tsukuba University Hospital has said that it will still treat people who refuse HIV tests. The Ministry of Health and Welfare has said it is illegal to discriminate against HIV-infected or AIDS patients, as AIDS is not the same as a controlled infectious disease. There comment follows cases of hotels refusing to accept guests who were HIV infected; Yomiuri Shimbun (29 Sept 1992), 31.
The positive effect of celebrity announcements on AIDS and behaviour is surveyed in S.C. Kalichman & T.L. Hunter, "The disclosure of celebrity HIV infection: Its effects on public attitudes", AJPH 82: 1374-6. In Japan also celebrities are being involved in AIDS education, though only a few are HIV infected.
The relationship between blood donation and virus transmission is the subject of a letter in Lancet 340: 677. The risks of AIDS transmission from blood transfusions in West Africa are still very high; D. Savarit et al., "Risk of HIV infection from transfusion with blood negative for HIV antibody in a west African city", BMJ 305: 498-501. The use of computers for interviews for screening blood donors is reported in S.E. Locke et al., "Computer-based interview for screening blood donors for risk of HIV transmission", JAMA 268: 1301-5. Two book reviews of AIDS are in Nature 359: 491-2; Science 257: 1975-6.
In Scotland heterosexual intercourse has become the most common source of HIV; BMJ 305: 670. A paper reporting the incidence of HIV among prostitutes to be 2.5% in Glasgow is BMJ 305: 801-4. The sexual behaviour of US women in 1988 is reported in survey results in AJPH 82: 1388-94. The commercial exploitation of fears of HIV transmission are discussed with regard to faceshields for cardiopulmonary resuscitation in Lancet 340: 456-7. A comprehensive HIV prevention program in the USA is discussed in JAMA 268: 1444-7. The relationship between increasing HIV and the collapse of communism in Eastern Europe is discussed in NS (22 Aug 1992), 11-2; and AIDS in Romania is reviewed in Amer. J. Med. Sciences 304: 188-91.
A special liability bill, to limit liability for companies who develop AIDS vaccines in the USA has been introduced to encourage research; Science 257: 1035. A commentary on AIDS vaccines and immunotherapy is in Biotechnology 10: 1086-7. There is criticism of AIDS vaccine research in NS (19 Sept 1992), 8. A live genetically engineered vaccine for the monkey model of HIV is reported to work better than other vaccines; NS (12 Sept 1992), 7. They deleted one gene from the virus. An AIDS vaccine trial in Thailand, involving collaboration between Japan and Thailand is reported in NS (12 Sept 1992), 7. A US Army trial of an AIDS vaccine is criticised in NS (5 Sept 1992), 6. Letters on the subject of early use of AZT and survival rates with HIV are in NEJM 327: 814-6; and the advantages of switching from AZT to didanosine are reported in J.O. Kahn et al., "A controlled trial comparing zidovudine with didanosine in HIV infection", NEJM 327: 581-7.
The ethical issues of clinical trials and AIDS are discussed in an Institute of Medical Ethics Working Party report on the Ethical implications of AIDS, "AIDS, ethics, and clinical trials", BMJ 305: 699-701. The legal view on whether knowledgeable "HIV transmission" should be a crime is discussed in Lancet 340: 543, 678. A Danish case debating this issue is reported in Lancet 340: 719-20, which also involves the disclosure of medical records to the police. Chinese students returning home for holidays or for good in China may be forced to undergo HIV testing and give a blood sample (personal communication from a Chinese student who was required to give a blood sample).
HIV testing is compared from private and public health sectors in Oregon, USA in JAMA 268: 1251-2. The use of publicly funded HIV counseling and testing in the USA in 1991 is reviewed in JAMA 268: 1519-20. About 2 million tests were performed. The legal implications on the use of DNA sequencing to determine the "donor" of the HIV strain is discussed in NS (10 Oct 1992), 49. The use of confidential, named HIV tests in Scottish prisons is reported in Lancet 340: 907-8. On scientific issues and testing see AJPH 82: 1370-3; JAMA 268: 1015-7.
World-wide physician's views on AIDS are reported in JAMA 268: 1237-46. AIDS in Africa, a new book, is reviewed in JAMA 268: 1325. Letters on the subject of death certificates and HIV infection are in BMJ 305: 647-8. A French doctor, the former head of the French National Blood Transfusion Center, was sentenced to 4 year's prison on October 23rd for allowing contaminated blood to be given to 1200 hemophiliacs. The costs of providing HIV-clean blood are still too great for many nations, in India or Africa; NS (5 Sept 1992), 20-1. One sample in India among professional blood donors found that 172/200 were HIV positive.
A letter on transmission of HIV-associated tuberculosis to health care workers is in Lancet 340: 682; and on the high likelihood of needlestick injuries see Lancet 340: 640-1. AIDS and the medical student is the topic of an essay in JAMA 268: 1189, 1192-3; see also JAMA 268: 1253-4, 1541.
The debate about the possible third AIDS-related virus (EEIN 2: 63) is in Science 257: 1032-4. It nows appears that there isn't a third virus; Nature 358: 619; JAMA 268: 1235-6, 1252, 1254-5; Lancet 340: 422, 475. Unusual behaviour of HIV, namely symptomless AIDS and HIV transmission from seronegative donors, are reported in Lancet 340: 863-7; NEJM 327: 564-5; JAMA 268: 847. The relationship of HIV to polio vaccines is the subject of a letter in Science 257: 1024-7; and the link to tuberculosis is in Bulletin of WHO 70: 515-26; JAMA 268: 1581-7. Links between smoking and HIV infection are discussed in JAMA 268: 1539-40.
In Japan , a telephone survey on the 28-29 November by NHK with 1,800 people over 20 years of age (with 1,488 responding) looked at attitudes to HIV-infected people. Asked whether they would see friends after they knew they were HIV positive, 41% said they would continue to see them regularly, 43% said they would see them less often and 11% said they would stop seeing them. Of those who would see their friends less often or no more, the figures were higher for those who did not understand the method of transmission (based on some knowledge questions about AIDS); NHK Television Main News Program, 7pm, 30 Nov. The local Ibaraki prefecture government has decided to give out 45,000 free HIV test vouchers to all the 20 year olds on the special holiday "coming of age" day on 15 January; Yomiuri Shinbun (11 Dec 1992), 30. The prefecture government has special celebrations for all the people who will turn 20 years old in in this year - so will take the opportunity to give these vouchers. Ibaraki has the highest HIV rate, after Tokyo.
Many health workers in Japan are refusing to treat AIDS patients, basically due to lack of understanding of the transmission. The same debate has occured in other countries in the past, with fears of contracting HIV (EEIN 2: 65). Comments on how to lessen the number of needlesticks are in Science 258: 34; and on protection from HIV and hepatitis in body fluids see BMJ 305: 1337-43; Lancet 340: 1279. The potential of cross-contamination with dental equipment suggests several changes in dental practice; Lancet 340: 1252-4; 1259-60.
A new book looking in an international way at policies regarding AIDS is David L. Kirp & Ronald Bayer, eds., AIDS in the Industrialized Democracies. Passions, Politics, and Policies, (New Brunswick, N.J., Rutgers University Press 1992, 393pp.). It includes comprehensive chapters on the contrasting approaches used in Australia, Britain, Canada, Denmark, France, Germany, Japan, The Netherlands, Spain, Sweden, and USA. It can be recommended for anyone interested in AIDS, and also for those interested in the way that different countries and societies have responded to it. The ethical issues however may be similar, basically to seek to educate against discrimination, and the need for education to aid prevention of spread. The experience described in the book, and the further experience as this decade unfolds, is useful in developing policies to combat AIDS and can also be applied to other diseases, including testing for genetic diseases.
The positive effect of celebrity disclosure of HIV status on the number of young people undergoing HIV tests in the USA is shown in NEJM 327: 1389; AJPH 82: 1483-9. In the USA about 43 million have had HIV tests, but still many more are needed among high risk groups; AJPH 82: 1533-5.
The negative case of the convicted French doctors who continued to permit the use of HIV-contaminated blood is in Nature 359: 759, 764; 360: 99; Science 258: 735, 1302; BMJ 305: 1046, 1177. The scandal may spread to politicians. A similar case may occur in Denmark; BMJ 305: 1116-7; NS (31 Oct 1992), 8. A letter on Thai screening of blood for the p24 HIV antigen is in Lancet 340: 1041. In New Zealand , the government has ordered an inquiry into why up to 30 hemophiliacs received blood clotting factor 9 infected with hepatitis C virus, after the country started screening for the virus in July; NS (28 Nov 1992), 10.
From January people visiting Israel for more than 3 months will need to be tested for HIV and if they are positive they will be limited to 3 months stay; NS (14 Nov 1992), 12. The largest group will be Palestinians from Israeli-occupied territories. For the last 6 months prospective immigrants have been forced to take HIV tests, and those with positive tests refused entry. A Canadian view on HIV screening and the cost of AIDS among immigrants is in CMAJ 147: 1132, 1163-76. In Britain people may still be asked on applications for life insurance whether they have had a HIV test (+ or -), despite government criticism; BMJ 305: 902-3, 1093. The Supreme Court in Illinios has upheld a law requiring convicted prostitutes be tested for HIV (People v. Henrietta Adams, HCR 22 (6),48). The US Supreme Court has said that an employer can reduce the health benefits of AIDS patient's, which many believe to conflict with the American's with Disabilities Act which outlaws discrimination; Lancet 340: 1278.
One in 11 Kenyans (9%) are reportedly infected with HIV; BMJ 305: 1244. HIV screening results are reported in JAMA 268: 1999-2000, 2147, 51. Real HIV infection rates in Russia are discussed in Lancet 340: 1089-90. A report on AIDS protests in India is in NS (21 Nov 1992), 7; (14 Nov 1992), 6. India is making and selling AZT at 15 rupees (30 pence) a dose - considerably cheaper than in the USA. Persons with AIDS do have an increased rate of suicide in the USA, seen in JAMA 268: 2066-8.
French public support introduction of condom -vending machines into schools, with a poll at the end of November showing 83% think it is a good idea. Other countries have also introduced more vending machines. A survey on the use of condoms in the USA is J.A. Catania et al., "Prevalence of AIDS-related risk factors and condom use in the United States", Science 258: 1101-6. Lifestyle and sexual behaviour surveys from France and Britain are reported in Nature 360: 407-9, 410-12; 397-8. A method to look for sample biases in responses to sexual behaviour surveys is in AJPH 82: 1506-12. On condom use also see AJPH 82: 1459-61, 1490-4, 1536-8, 1563-5; BMJ 305: 1105; JAMA 268: 1653. Letters against a Nature editorial criticising the New York education department's announcement that abstinence is the best AIDS prevention are in Nature 360: 10. In the UK general practioners are finding difficulty in giving out condoms; BMJ 305: 1314. Methods to protect women are discussed in AJPH 82: 1473-8, 1479-82; JAMA 268: 1814-6; and on female to male transmission see JAMA 268: 1855-7; F&S 58: 667-9. There is some evidence to suggest there can be HIV transmission across the placenta; Lancet 340: 1157-8. A paper reporting the insemination of HIV negative women with processed semen of HIV positive men without HIV transmission to 15 babies is in Lancet 340: 1317-9.
The definition of AIDS in the USA (all those who are both seropositive for HIV and have a CD4 T-lymphocyte count less than 200/ul) is discussed in Lancet 340: 1151, 1199-1201; AJPH 82: 1462-3. The use of alpha-interferon as an AIDS treatment is being reconsidered in the USA; Nature 359: 660-1; NS (7 Nov 1992), 7; BMJ 305: 1243-4. On AIDS vaccine trials see the above section on vaccines. The testing of AIDS therapies is discussed in Science 258: 388-90; JAMA 268: 1987-92; Lancet 340: 1346-8. Review of a French book on AIDS is in Int. Digest Health Legislation 43: 678-80. Progression of untreated HIV-1 infection before AIDS is reported in AJPH 82: 1538-41; JAMA 268: 2662-6; NS (7 Nov 1992), 7. Also on AIDS see AJPH 82: 1465-70; BMJ 305: 1018-9, 1159;JAMA 268: 2698-9; Lancet 340: 943-4; NEJM 327: 1104-7, 1460, 1529-30. On tuberculosis due to AIDS see NS (24 Oct 1992), 41-2; (28 Nov 1992), 7.
The use of a ribozyme (catalytic RNA) to lower HIV expression is working in human tissue culture experiments, reducing the level of HIV to about 25% of untreated cells; GEN (Dec 92), 34. A research study suggesting the inhibitory action of AZT on HIV may be enhanced about 10-fold in the presence of the cytokine GM-CSF is discussed in GEN (Jan 1993), 3. A report asking whether antibodies are the best method of protection against AIDS is SA (Dec 1992), 21-2. Notes of AIDS vaccine tests were listed in the Vaccine section above. Trials of HIV immune globulin to protect infants of HIV-infected mothers are also discussed in JAMA 269: 17. Papers looking at the action of anti-AIDS drugs, zalcitabine, didanosine, and zidovudine (AZT) include: NEJM 327 (1992), 1598-9; Lancet 341: 30-2; and on the social consequences, Health & Social Work 17 (1992), 253-60. The changing AIDS definition is discussed in Lancet 340 (1992), 1414. The HIV pathogenesis model which includes latent virus is being challenged; Biotechnology 11: 16-7. The action of viruses in moving human genes may actually mean that viruses can be used as a resource of important human genes; Science 258 (1992), 1731-2.
A US Supreme Court case that upheld the constitutionality of mandatory HIV testing of convicted prostitutes is reviewed in AJLM XVIII (1992), 276-9. The social work issues from mandatory screening are important, and social workers are urged to use justice to fight against mandatory screening in Health & Social Work 17 (1992), 308-12. The importance of non-discrimination in AIDS is stressed in a book by the former-director of the WHO AIDS program, J.M. Mann, in Lancet 341: 24-5. The case for confidentiality for mothers with HIV is debated in SSM 36: 195-202; and the New York state law on confidentiality is described in NY State J. Medicine 92 (1992), 545-6. The rights of Asian hepatitus B carriers in the USA is discussed in SSM 336: 203-16. A comparison of saliva and serum testing for HIV in Myanmur (Burma) found saliva the more effective test; Lancet 340 (1992), 1496-9; 341: 381-2. A confidential HIV testing program in Rwanda was found to result in increased condom usage; JAMA 268: 3338-43. Rapid HIV tests are compared in Lancet 340 (1992), 1541. On HIV in Africa see Lancet 341: 366; SSM 36: 429-39; and in Thailand see BMJ 305 (1992), 1431.
Israel's restrictions on residence for HIV carriers (EEIN 3: 9) is being rethought, and may only need a statement not a test; Lancet 341: 42. The US policy on entry of HIV infected persons is under review, but the Senate voted with a clear majority against relaxing the entry requirement which may make it more difficult for President Clinton to remove the ban as he had promised; Time (22 Feb 1993). A call for US physicians to care about HIV in the whole world is in JAMA 268 (1992), 3368-9.
The recognition of women's rights in Africa may be needed to halt the spread of HIV; NS (19 Dec 1992), 9. On ethical issues of HIV in Africa see SSM 36: 175-94. Thailand's efforts have been increased; BMJ 305 (1992), 1385. India has decided to spend 15% of its health budget on AIDS in the years 1992-7; Lancet 340 (1992), 1533-4. A review of surveys of AIDS knowledge in general populations is in SSM 336: 509-24. On the sexual behaviour surveys in the UK, France and the USA (EEIN 3: 8); BMJ 305 (1992), 1447-8, 1452-3; Lancet 340 (1992), 1441-2.
Following the French court case where officials who continued use of HIV-infected blood were infected (two are appealing), French officials have now started to be concerned about the use of human growth hormone preparations that contained the prions that resulted in Creutzfeldt-Jakob disease in recipients; Science 258 (1992), 1571-2. A UK study suggesting that blood transfusion is not a major risk factor for this disease is in Lancet 341: 205-7. Comments on prion diseases are in BMJ 306: 288.
Hepatitis C is a serious disease, untreatable and fatal. Risk factors are being identified, but it is uncommon to be sexually transmitted; JAMA 269: 361-5. In New Zealand a controversy has arisen over the presence of the virus, and its transmission to several people in blood products after routine screening was introduced in mid-1992; NZ Medical Association Newsletter (8 Dec 1992), 1, 4; Lancet 341: 363.
The heterosexual transmission rate in a rural Florida community is reported in NEJM 327 (1992), 1704-9. Among pregnant women, 5.1% had HIV. The rate in Washington D.C. was less; JAMA 269: 472-3. It is estimated that by the end of 1995, AIDS will have orphaned 24600 children and 21000 adolescents in the USA; JAMA 268 (1992), 3456-61, 3478-9. High school students in the USA continue to show risky behaviour; JAMA 269: 329-30. The prevalence of infected syringes in a syringe exchange program is reported in NEJM 327 (1992), 1883-4. A social program to reduce the risk of HIV transfer among female partners of injection drug users is described in Health & Social Work 17 (1992), 261-72. Book reviews are in NS (12 Dec 1992), 44-5.
The rate of HIV transmission to health care workers in Australia was found to be very low; MJA 157 (1992), 592-5. In the USA, a total of 69 health care workers are reported that may have acquired HIV from occupation, yet most do not report exposure to blood; JAMA 268 (1992), 3294. Letters on how to avoid contracting HIV are in BMJ 306: 335-6. In Japan , there have been 68 incidents involving needle sticks with contaminated serum, but only one case, of a mother being infected, has lead to virus transmission. However, a survey by the Japan Hospital Association has reported that 40% of hospitals refuse HIV positive patients; Yomuiri Shinbun (16 Feb 1993), 26. In the USA there is a legal as well as ethical duty to treat, J. Cohen, "Access to medical care for HIV-infected individuals under the Americans with Disabilities Act: A duty to treat", AJLM XVIII (1992), 233-50. The transmission of HIV-associated tuberculosis to health workers is discussed in Lancet 340 (1992), 1412.
In Japan , on the 15 January the Ministry of Health and Welfare talked for the first time officially with AIDS patients; Yomuiri Shinbun (15 Jan 1993), 31. A survey of AIDS in Japan; Yomuiri Shinbun (15 Jan 1993), 13, reported that cancer is still the most frightening disease, chosen by 50%, but AIDS is second at 20%, from a list of 13 diseases.
The Dept. of Defense and the NIH in the USA have convened separate panels to ask how to spend a US$20 million grant for AIDS vaccine tests (EEIN 3: 17); Science 259: 752-3. The grant was given to sponsor a trial using a gp160 vaccine made by the company, MicroGeneSys; Science 260: 19. The NIH did not think it was appropriate to allocate a specific product, rather the NIH should decide. They are deciding which vaccines to test. In a recent move, the gp160 vaccine has been withdrawn by the company in a comparative trial of three vaccines - a move that is criticised by the NIH because it will avoid competition with two other vaccines; Nature 362: 277; Science 259: 1821-2. In May a trial on newborn babies is expected to commence in the USA; NS (20 Feb 1993), 9. An editorial in Nature 362: 576; criticises any vaccine trial as a waste of money. Also on vaccines, Nature 362: 212, 503-6.
Recent data; Nature 362: 355, suggests that within a few weeks of infection, HIV has seeded the lymph nodes and is present in the blood, so that a therapeutic vaccine may be too late. On the mechanism see NEJM 328: 327-35; Nature 361: 588-9, 650-4, 362: 103-4, 287, 292-3, 355-8, 359-62; Biotechnology 11: 421; Lancet 341: 820; SA (March 1992), 22-3; JAMA 269: 1084; NS (27 March 1992), 17; Science 259: 1749-54. Another strategy to attempt to combat AIDS has been suggested - that of concentrating drugs against the reverse transcriptase enzyme, that is needed for replication. The cases of AIDS without HIV remain mysterious; NEJM 328: 373-9, 380-5, 386-92, 393-8, 429-31; BMJ 306: 477. The cases do not appear to be due to another virus. It has now been a decade of research on AIDS, and it is still to be cured; Nature 362: 13.
Discussion of the idea of a huge AIDS research project is in Science 259: 1112-4; NS (20 March 1992), 11; (3 April 1993), 14-5. The NIH has announced that it intends to commence drug trials in HIV infected persons as soon as it is known, in efforts to curb HIV earlier in its attack in the body; Nature 362: 382; JAMA 269: 1144-53. The need for a new drug; Nature 362: 396, is even stronger following reports of the ineffectiveness of AZT ; Lancet 341: 889; Nature 362: 483, 493; Science 260: 157. AZT may still have some uses in people who have AIDS disease, but it does not help those who are only HIV-infected. The final outcome will be the same whether they use it or not, so they don't need to take it until they actually get AIDS. The production of AZT in India is underway, at cheap cost; Lancet 341: 485. They plan to export the drug to other countries. Some people appear to be immune to AIDS, and certainly there are individual differences in lag time; Time (22 March 1992), 41-3; Lancet 341: 624.
In the UK there has been increasing debate about HIV testing of health care workers ; BME (March 1992), 1; BMJ 306: 798, 933. On dental transmission evidence see Nature 361: 691, and on a surgeon with AIDS see Amer. J. Medicine 94: 93-5. The debate also continues in the USA, and several case histories are in JAMA 269: 1795-1801, 1802-6, 1807-11, 1843-4. On transmission of hepatitis B via a finger-stick device see NEJM 328: 969.
A test allowing identification of free HIV in blood within three hours has been developed by university researchers (UCSF) in the USA; GEN (1 Mar), 32. They use an ELISA test for the core p24 antigen of HIV; NEJM 328: 297-302; Lancet 341: 502. It is suggested for use in neonates born to infected mothers. In France there is more controversy about HIV testing, following the closure of a company that used pooled tests and the revelation that the government blood screening lab has also used the cheaper method; NS (27 March 1992), 11.
The adverse Arab attitudes to AIDS and under reporting of AIDS are discussed in Lancet 341: 884-5. The continuing stigma associated with AIDS is reported in survey results in AJPH 83: 574-7, and US public awareness of the availability of HIV testing was surveyed in AJPH 83: 525-8. In a US study about a quarter of the men and one third of the women who had been notified that they had HIV had symptoms of depression; AJPH 83: 534-9. In a US clinic the rate of sexually transmitted diseases decreased in HIV positive patients, but increased in those who tested negative, suggesting a need for better counseling; AJPH 83: 529-33.
The ethics of confidentiality for AIDS patients and HIV carriers is discussed in JME 18 91992), 173-9; JAMA 269: 1094, 6, 1115; AJPH 83: 496-7. The problems and approaches in telling a child that they have AIDS are discussed in HCR 23(2), 6-12. The issue of AIDS deception by doctors is discussed in JME 18 91992), 180-5. In India AIDS will remain a non-notifiable disease in order to protect confidentiality; Lancet 341: 684. Also on ethics and testing see AJPH 83: 597-8.
A prison sentence does seem appropriate for convicted transmitters of HIV virus, who willingly continue unprotected sex; Lancet 341: 751-2; NS (20 Feb 1993), 5. However, the prison environment is a high risk place for HIV; NS (20 Feb 1993), 12-3. There have been changes in the habits of injecting drug users in Scotland; BMJ 306: 693. On the sexual habits of drug users in the UK, which are similar to the general public, see Nature 361: 504-5. On sexual behaviour see BMJ 306: 582-3. However, unsafe sex and HIV transmission has increased again in homosexual men in the UK, following the initial decline; BMJ 306: 426-8. Comments on efforts in Africa to get safer sex habits are in NS (27 Feb 1993), 12-3. A paper on the risk factors associated with HIV among male prostitutes is AJPH 83: 79-83; and the AIDS knowledge among poor women in the USA is surveyed in AJPH 83: 65-71. Also on sex and HIV see JAMA 269: 734; BMJ 306: 792; Lancet 341: 863-4; Biology of Reproduction 48: 431-45; AJPH 83 (April 1993). The new female condom was discussed in the birth control section above, it is also seen as a boost to preventing HIV transmission; AJPH 83: 498-500.
In Japan , a survey of new company recruits found that 85-7% of them would be happy to work next to people who had HIV; Yomiuri Newspaper (30 March 1992), 30. 50% did say that they had some resistance, but it was OK, while 30% said that they would try to look out if they could help them. In April special AIDS prevention books were distributed to all the national university staff in Japan. The real number of HIV-infected people in Japan is estimated to be 23,220, 8 times the official figure. However, the real figure is hard to predict. Hospitals continue to turn patients away if they have HIV, and recently a Thai woman ended up being paralysed because she was moved to 3 hospitals over several days, all refusing to treat her (though some not openly citing HIV), so that it became too late to perform surgery. She is suing them from Thailand.
The US Senate voted 76 to 23 to continue a ban on entry restrictions for HIV infected persons in the USA, reflecting public opinion, and against the wishes of President Clinton and many in the medical community who see no benefit from the ban; Lancet 341: 620-1. The global needs of AIDS research are emphasised in statements by US government officials; JAMA 269: 1636-7, yet their policy is discriminatory. A US National Research Council Report has angered some people because of its conclusion that most Americans are not at threat from AIDS, and that the impact will be small; Lancet 341: 429-30; BMJ 306: 674-5. It says those at risk are in "marginalised social groups", so the impact will be small on others, but, we should be attempting to reduce such margins.
Book reviews on the subject of AIDS are in NEJM 328: 448-52. On the history of the AIDS virus and scientific discovery see Science 259: 1809.
In China a new AIDS vaccine is being tried; NS (29 May 1993), 7; Lancet 306: 1564-5. It is also being tried in Thailand . In India trials of a US vaccine are also expected; Nature 363: 294. In the USA, the US$20 million given to the Dept. of Defense, that raised controversy for six months (see previous issues), has been transferred to the NIH, who will choose how to spend the grant; Lancet 341: 1014; Nature 363: 294. In general on trials see BMJ 306: 947-8. The use of a simple and harmless HIV-1 as a vaccine is suggested in PNAS 90: 4419-20. Also on vaccine trials see Lancet 341: 1406; Science 260: 757, 1323-7. A general review is B.F. Haynes, "Scientific and social isues of HIV vaccine development", Science 260: 1279-86.
On the result that AZT is not a help to HIV-infected persons, NS (10 April 1993), 4; BMJ 306: 1016-7; Lancet 306: 949-50. Reviews of HIV therapy are NEJM 328: 1686-95; Science 260: 1286-93; Biological Reviews 68: 265-89; SA (May 1993), 8-11. In Japan researchers at Calpus Food Industry and at Hokkaido University claim to have made a peptide from the HIV protein CD4 which inhibits cell invasion by HIV; GEN (15 April 1993), 28.
On politics of AIDS research see Nature 363: 101, 388; JAMA 269: 2898-900; Newsweek (21 June 1993), 49; Lancet 341: 1336. Drug companies have said that they will join forces to find a cure; Science 260: 482. HIV virus lasts for some time in water; AEM 59: 1437-43. The life span of smokers with HIV is about half that of non-smokers according to a study in St Mary's Hospital, London. A special issue of the Journal Science looks at the unanswered questions in AIDS; Science 260: 1219, 1254-92; on the mechanism see also Nature 363: 109, 391-2; Science 260: 292-3, 1705-8; NEJM 328: 1192-3; JAMA 269: 2876-9.
Predictions of the increase in AIDS in Europe are in Nature 363: 393-4. The number of AIDS cases in Europe due to heterosexual intercourse is in NS (5 June 1993), 11, 12. Some results from a recent US sex survey are presented in Family Planning Perspectives (April 1993),; NS (24 April 1993), 7; Science 260: 615. Statistical methods to monitor AIDS are in NS (12 June 1993), 22-3. The problems of AIDS and tuberculosis are reviewed in AJPH 83: 649-54; JAMA 269: 2865-8. Blood transfusions and HIV are discussed in Lancet 341: 1465-6; Archives of Diseases in Children 68: 521-4; Nature 363: 491; JAMA 269: 2892-4.
More papers are appearing on the issue of HIV-infected health care workers. The UK has issued guidelines; Lancet 341: 952; BMJ 306: 1013-4, 1023, 1201-2. Other papers include: AJOG 168: 1344-9; JAMA 269: 2622-3. A sixth AIDS case has been traced to a Florida dentist; Science 260: 897. A trial by an HIV-infected person to see a dentist found that it is difficult in London; Lancet 341: 1032.
Insurers in different countries, Australia, USA, UK, Canada, Denmark, France and the Netherlands have different policies; BMJ 306: 1495-8. A group of Japanese life insurance companies is debating how to prevent HIV-infected persons from becoming policy holders. They may consider compulsory HIV tests for all applicants. A study in the USA suggests that HIV-infected patients under private insuyrance live a 130 days longer than those under government medicine; JAMA 269: 2832.
The use of universal HIV testing is debated in BMJ 306: 1144-5, 1479-80. Confidentiality is discussed in Lancet 341: 1059-60, 1350, 1527. On counseling and taking HIV tests see AJPH 83: 701-4, 705-10; JAMA 269: 2071-6; NEJM 328: 1715-7. A scientific review of HIV antibody tests calls for a reappraisal of their use against HIV; Biotechnology 11: 696-707.
In Japan AIDS continues to be given much attention in the media. In a case in may at the University of Tsukuba Hospital, a man was tested for HIV without his consent after his wife said that she had told him. The problem was that they could not speak English or Japanese, and the doctors could only trust the wife. She had tested HIV positive and wanted to test him before telling him, because she was scared of the reaction; Yomiuri Shinbun (20 May 1993), 27. This case is also disturbing because the newspaper reported details which could threaten the privacy of the couple, though nationalities were not revealed. The story was leaked by an anonymous insider, perhaps not with the interests of the couple at heart. The Tsukuba hospital is one of the hospitals that accepts HIV infected patients, many others in Japan do not.
A review of phase III trials for AIDS vaccines is Nature 364: 489-90. The debate over the US Army trial of a gp160 vaccine may continue, but the decision has been made for the Army to go ahead with their US$20 million clinical trial solely using a vaccine made by one company, MicroGene Sys, to the dismay of many AIDS researchers; Nature 364: 374, 751; BMJ 307: 221. Some positive results from another vaccine are in D.H. Schwartz et al., "Induction of HIV-1 neutralising and syncytium-inhibiting antibodies in uninfected recipients of HIV-1iiiB rgp120 subunit vaccine", Lancet 342: 69-73.
The Australian and European Concorde study showing that early treatment with AZT does not prolong life of AIDS patients (EEIN 3: 51) has resulted in several changes to medical practice. An expert panel in the US has advised US doctors to consult with patients, and delay giving AZT to patients who are outwardly healthy; Nature 364: 93. Wellcome, the maker of AZT, has released a contrary result from a smaller trial, NEJM 329: 297-303, 351-2, 346-7; and the debate continues, JAMA 270: 295; NS (7 Aug 1993), 4; BMJ 306: 1631-2; Lancet 341: 1587-8; Science 260: 1712-3.
Letters on the screening of immigrants to Canada for HIV are in CMAJ 148: 2107-8. Earlier in the year the British Columbia committee agreed with testing, CMAJ 148: 1188. The legal and ethical issues of the Haitians infected with HIV that were delayed entry into the USA while the policy was being redebated are in JAMA 270: 563-4; NEJM 329: 589-92.
A US court has ordered an ex-wife should pay US$18 million to her husband for knowingly infecting him with HIV; Associated Press (27 Aug 1993). The use of sequence data for tracing the origin of HIV reliably needs careful choice of HIV sequence, Nature 364: 766. On the risks of HIV infection from health care workers, BMJ 307: 205; Lancet 341: 1659. On treating HIV infected dental patients, Lancet 342: 119. The CMA policy statement on HIV infection in the workplace is CMAJ 148: 1800A-D. On HIV in Scottish jails, BMJ 307: 151, 147-8, 228-31.
HIV testing policies and practises in UK insurers are discussed in BMJ 307: 204; some do and some don't, and some do "quietly". A call for HIV tests in pregnant women in India is in Lancet 342: 379. On HIV testing in children see CMAJ 148: 759-61; NEJM 329: 60-2. In Australia , the University of New South Wales has issued a policy to protect the rights and privacy of any one infected, and stating that it does not require HIV testing. A WHO paper calling for reducing the costs of HIV antibody tests is Lancet 342: 87-90. France has banned 9 types of HIV tests as unreliable, Lancet 342: 356-7; Science 261: 679.
Programs to lower the risks of transmission of hepatitis and HIV in Canada are reviewed in CMAJ 148: 1747-52. HIV infection in Canadian hemophilia patients is under review: Lancet 341: 1653-4, 342: 40-1; Science 260: 1586. The French appeals court has sent Dr J.P. Allain and Dr M. Garetta to jail in the HIV infection of hemophilias, because of slowness in introducing heat treatment of plasma (though France was by no means the last to introduce this!); Lancet 342:L 232-3; BMJ 307: 220-1; Science 261: 422; Nature 364: 267-9, 476. There is also debate in Japan and the government has started to pay a token reimbursement to hemophilia patients infected with HIV; Lancet 341: 1585-6; Nature 364: 181.
AIDS policy in the USA and the National Commission on AIDS is discussed in JAMA 270: 298, 494-5. AIDS is becoming the number one killer of young people in much of the USA; JAMA 270: 16-9, 305, 760-1. On sex behaviour and AIDS see Bulletin of WHO 71: 397-412; SSM 37: 401-12, 661-70; BMJ 307: 25, 356-62; AJOG 168: 1833-8. AIDS in South Africa is rising greatly, NS (14 Aug 1993), 7; and in Africa, NS (26 June 1993), 40; Lancet 341: 1625-6.
Comments on the role of HIV in AIDS are in Biotechnology 11: 955-6; Nature 364: 96; Science 260: 1705-8. A report that thalidomide inhibits HIV replication in a cell line is PNAS 90: 5974-8. Trials of oral alpha- interferon are being tried in the USA after unconvincing results in Africa, Science 260: 1880. Results of what was a promising AIDS therapy have been withdrawn; Nature 364: 468, 679. The estimated lifetime cost of treating a person from time of infection with HIV to death in the USA is US$119,000 , a price which is reducing with less time spent in hospital; JAMA 270: 474-8. The secretary of the US Dept. of Health and Human Services D. Shalala still refuses to discuss HIV royalties with the French even though the NIH scientist Gallo is known to have used French virus isolate; Science 261: 19.
A review of phase III trials for AIDS
364: 489-isolate; Science
261: 19. More news on the MicroGene Sys - US Department of Defense trial is in Science
261: 1107. On the trials of vaccines in HIV-infected pregnant women see FDA Consumer
(Sept 1993), 8. On HIV transmission and cesarean sections, Lancet
The UK General Medical Council revised statement on ethical issues of HIV infection is in BME (Aug 1993), 8-11. Among other things, any health worker infected with HIV should seek specialist advice. Advice from the UK Central Council for Nursing, Midwifery and health Visiting on AIDS is in BME (Sept 1993), 8-11. On confidentiality for doctors with HIV, BMJ 307: 566. Calculated risks for HIV transmission from infected health care workers are in JAMA 270: 1543-6. Risks of HIV transfer in prison are discussed in letters in BMJ 307: 622-3, 681.
A review and view on how to develop testing policies is R. Colebunders & P. Ndumbe, "Priorities for HIV testing in developing countries", Lancet 342: 601-2. Reducing the costs of antibody testing should be a priority of scientists; Lancet 342: 866. Another comment on the care for HIV is Lancet 342: 726-8.
A study of question answering style which may affect interpretation of sexual behaviour surveys is in Nature 365: 437-440. The results of two US surveys on encouraging HIV antibody testing for people at high risk suggest better promotion is needed; JAMA 270: 1576-80. A survey of HIV in two Thai military camps is in JAMA 270: 955-60.
The drug ddC has been recommended to be approved for use in AIDS treatment on its own, by the FDA advisory committee, Nature 365: 378. The number of AIDS cases newly reported in 1992 in the USA was 47095, a 3.5% increase over 1991; JAMA 270: 930, 33-4.