dmcanzi@watserv1.waterloo.edu (David Canzi) (07/18/90)
Medical News for Week Ending July 15, 1990
Copyright 1990: USA TODAY/Gannett National Information Network
Reproduced with Permission
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July 10, 1990
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MARRIAGE OFF-LIMITS TO SOME:
Alcoholics, drug addicts and people with AIDS are banned from marrying in
Mexico, following legislative approval of civil code reforms. Also included in
the ban are people suffering from syphilis, mental disorders or any incurable
disease.
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July 11, 1990
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RED CROSS UNDER FIRE:
The Red Cross says a report by the FDA that it mishandled record-keeping
and investigations of AIDS-virus contamination may "needlessly alarm" the
public about the safety of the blood supply. The FDA report shows Red Cross
officials in Washington, D.C., knew of 230 people who got AIDS after blood
transfusions, but reported only four to national headquarters and none to the
FDA.
INFANT AIDS DEATHS TO SKYROCKET:
AIDS will become the fifth leading cause of death in women ages 15 to 44 by
1991 if deaths continue at the current rate, says the Centers for Disease
Control. AIDS deaths in children are likely to skyrocket since women infected
with HIV a major source of infection in infants. The number of women who die
from AIDS is not high, but the rate of increase is higher than other causes of
death.
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July 12, 1990
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HBV SPREADS FAST AMONG GAY MEN:
Hepatitis B represents a serious health threat to homosexual men, according
to a study in Wednesday's Journal of the American Medical Association. Gay men
are at least 8.6 times more likely to be infected with the hepatitis B virus
(HBV) through sexual transmission than they are of being infected by the human
immunodeficiency virus (HIV), says a medical expert.
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Dental News
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News from the National Institute of Dental Research
ORAL KAPOSI SARCOMA LINKED TO SEXUALLY TRANSMITTED DISEASES
The presence of oral Kaposi's sarcoma (KS) in some HIV-infected homosexuals
may be linked to a past history of sexually transmitted diseases, say
researchers at the Oral AIDS Center at the at the University of California,
San Francisco (UCSF). Kaposi's sarcoma-the most common tumor associated with
AIDS-is seen more frequently among homosexual and bisexual males than any
other group at high risk of developing AIDS.
Between 1985 and 1989, researchers at the UCSF Oral AIDS Center, funded by
NIDR, examined a group of 112 AIDS patients with Kaposi's sarcoma. Twenty of
these patients had developed oral Kaposi's sarcoma before developing Kaposi's
sarcoma on their skin; 30 of these patients had developed oral and skin
Kaposi's sarcoma simultaneously.
Kaposi's sarcoma maybe the first and only clinically detectable evidence of
HIV infection and its presence is considered to be extremely valuable in the
diagnosis of AIDS. Prior to the onset of the AIDS epidemic, KS was a
malignancy that mainly occurred in older men, usually appearing as red or
purple nodules on the lower extremities. In AIDS patients, the most common
site for KS to occur is on the face, hand and neck, or in the mouth-
particularly on the palate and gums. The oral form of KS appears as pale
purple to red, flat or nodular lesions that occur single or in patches. The
lesions cause discomfort in patients and often require treatment such as
surgery, chemotherapy, or radiation.
Risk Assessed
UCSF dentist Dr. Caroline Dodd, together with her colleagues Dr. Deborah
Greenspan, Ms. Sharon Kidd, Dr. David Feigal, and Dr. John Greenspan,
compared the history of sexually transmitted diseases between the two patient
groups with KS. Among the patients who developed oral Kaposi's sarcoma prior
to developing KS of the skin, 54 percent had prior Hepatitis B, 26 percent
syphilis, 57 percent gonorrhea, 21 percent gentital warts, and 37 percent
Herpes simplex. Among those who developed oral and skin KS simultaneously, 41
percent had prior Hepatitis B, 38 percent syphilis, 22 percent gonorrhea, 8
percent genital warts, and 25 percent Herpes simplex.
Results from the study indicate that the risk for developing oral Kaposi's
sarcoma is significantly increased among patients with a past history of
sexually transmitted diseases. The highest risk is associated with a past
history of gonorrhea and genital warts, which result in a 2.6 and 2.64 greater
chance, respectively, of developing oral KS. A past history of syphilis,
however, did not appear to lead to increased risk. These results raise the
possibility of a sexually transmitted agent as a cofactor for the development
of oral Kaposi's sarcoma.
Findings from this study were presented in March at the 68th General Session
of the IADR/AADR in Cincinnati, Ohio.
TRAINING VIDEO AVAILABLE ON INFECTION CONTROL IN DENTAL SETTING
"Infection control in the Dental Setting," an instructional video program and
training manual, in now available to dentists and their health care teams
providing information on optimum infection control in dental settings. The
program presents the best approaches for managing the risk of infection while
still maintaining quality patient care services. Production and distribution
of the program is a collaborative effort by the NIDR, the Department of
Veterans Affairs (VA), the American Dental Association (ADA), the Centers for
Disease Control (CDC), and the Food and Drug Administration (FDA).
The emergence of the AIDS epidemic and the continuing problem of hepatis B
virus (HBV) have led to increased awareness of the need for stringent
infection control in dental setting. Although hepatitis B virus is the major
infectious occupational hazard among all health care professions -
approximately 18,000 health care workers become infected with the virus each
year-all bloodborne pathogens are of concern to health care workers. Exposure
to blood may occur through puncture wounds, cuts of abrasions in the skin, or
mucous membrane contact.
The program contains three videotapes, an accompanying workbook, a self-
assessment checklist of current infection control practices, goal setting
worksheets, appendices, a list of resources for further study, and a post-test
for continuing education credit.
A free copy of the program has been distributed to state and local dental
societies; dental schools; dental hygiene, assisting and laboratory technician
training programs: state and local health directors; and all VA facilities
throughout the country.
Availability
"Infection Control in the Dental Setting" may be ordered from the National
Audio Visual Center in Capitol Heights, MD by calling 800-638-1300. The cost
of the program is $75; each additional set may be purchased for $45. Members
of the American Dental Association may purchase copies from the ADA by calling
800-621-8099.
ORAL AIDS RESEARCH TO BE SUBJCT OF TRAINING COURSE
NIDR and the Fogarty International Center (FIC) will sponsor a two-day
international AIDS training course, June 18-19th, at the University of
California, San Francisco (UCSF). The seminar will be held just prior to the
VI International Conference on AIDS in San Francisco, June 20-24th.
In cosponsoring the program, "Oral AIDS Research: Clinical and Laboratory
Skill," NIDR and FIC plan to instruct scientists from developing countries in
recognizing, diagnosing, and treating the oral manifestations of AIDS. Dr.
John S. Greenspan, Director of the Oral AIDS Center at UCSF, will head the
course which consists of two parts: lectures and slide presentations by
international experts in AIDS; and clinical evaluation of AIDS patients at the
UCSF Oral Aids Center.
The seminar enables clinicians from developing countries to learn from a small
group of experienced, international faculty in a setting ideally suited to
studying AIDS. NIDR and FIC hope that those who participate in the course
will then share the knowledge they have gained with others in their respective
countries. Researchers also hope to reach agreement on minimal essential data
for epidemiological studies related to AIDS and to establish future
international collaborative studies.
Information about the training program may be obtained by writing to: Dr. John
S. Greenspan, University of California, San Francisco, Department Stomatology,
Box 0512, San Francisco, CA 94143.
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Articles
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The French Connection, II
An International AIDS dispute is Reborn
(c) 1990, Newsweek, Inc. All Rights Reserved. Reprinted by permission.
NEWSWEEK, April 2, 1990, p 65.
Three years ago, one of the nastier disputes in modern science seemed at last
to resolve itself. At the urging of their governments and peers, the world's
two leading AIDS researchers. Dr. Robert Gallo of the National Cancer
Institute (NCI) and Dr. Luc Montagnier of the French Institut Pasteur sat
down in a Frankfurt hotel room and agreed to share credit for identifying the
virus responsible for the AIDS epidemic. The agreement resolved a high-stakes
patent lawsuit by apportioning the royalties from AIDS blood tests. And it
seemed to guarantee both men a shot at immortality by giving them equal
billing in a "brief historical summary" of the breakthrough.
But that was three years ago. Today, thanks largely to a pair of articles
published by the Chicago Tribune, history is again up for grabs. In the first
article, a 50,000-word opus published last November, reporter John Crewdson
did his own analysis and concluded that the virus Gallo used to develop a
blood test in 1984 was derived from samples that had been sent to him months
earlier by Montagnier's team in Paris. In a new article; Crewdson suggests
that Gallo's former superiors amassed strong evidence to that effect during a
1985 investigation, then ignored their own findings. The articles are now at
the center of an official probe of Gallo's AIDS research, and National
Institutes of Health (NIH) spokesmen refused to comment on the controversy.
Gallo, who has previously maintained that he isolated the AIDS virus without
relying on the French sample, says he welcomes the chance to clear his name.
Because the identification of the AIDS virus was more a process than an event,
assigning credit is no simple matter. During the early 1980s, Gallo's team
suspected that AIDS was caused by a leukemia virus called HTLV-I. Montagnier
and his colleagues pursued a different virus they called LAV. The Paris team
sent Gallo a sample of LAV shortly after they isolated it in January 1983, but
Gallo continued to argue publicly that HTLV-I or HTLV-II, a similar virus, was
the likely culprit.
In the spring of 1984, Gallo announced that he had found the probable cause of
AIDS. In a press conference and a series of papers, he and his co-workers
described a new virus, designated HTLV-III, and said they had developed a
blood test to screen for it. Scientists soon found that although
AIDS viruses vary widely in genetic structure, the one Gallo had unveiled with
such fanfare was virtually identical to the one he'd received from Paris. So,
when the U.S. Patent Office awarded the blood-test patent to Gallo and the
government, Pasteur officials (who had already filed an application of their
own) objected. Whether by accident or design, they said, Gallo had
appropriated their work. Gallo's superiors at the NIH and the Department of
Health and Human Services (HHS) offered no confessions, and by December 1985
the dispute had blossomed into a lawsuit.
Chains of command: The Chicago Tribune's latest story concerns a review that
NIH and HHS conducted in the fall of 1985, as the Justice Department geared up
to argue Gallo's case. Crewdson maintains that documents were later withheld
from Pasteur's lawyers, despite their request under the Freedom of Information
Act for all relevant materials. The documents among them a 10-page report
that former NCI official Peter Fischinger prepared for HHS suggest to Crewdson
that "critical facts about what happened in Gallo's lab were progressively
misstated or withheld altogether as the information traveled up the NIH and
HHS chains of command and ultimately reached the Justice Department."
Fischinger says he does not know whether his report was given to Institut
Pasteur's lawyers or not. And Gallo insists that the basic facts were known to
both sides during the negotiations that led to the settlement of the patent
dispute.
Crewdson isn't sharing the documents themselves. But the Tribune story does
suggest that the 1985 effort was less than rigorous. After polling other
scientists about the uncanny similarity of Gallo's and Montagnier's viruses,
Crewdson says Fischinger wrote Gallo a memo. He raised the concern of some
scientists that "informed virologists" would draw "certain obvious
conclusions." The obvious conclusion, it seems, would be that Gallo's viral
samples were somehow mingled in the laboratory with those from the Institut
Pasteur. Last week Montagnier suggested that might be the case. "I stand by
the hypothesis of laboratory contamination. I've told Dr. Gallo many times
that he should recognize there was contamination," Montagnier told a re-
porter. He said, "It would be no dishonor for him to recognize a laboratory
contamination." Fischinger said the similarity "will be reconsidered in the
current investigation . It deserves a thorough look. "
Prof. Maxime Schwartz, director of the Institut Pasteur, talked last week of
finding out whether the government's "suppression" of the memos might enable
Pasteur to break the 1987 settlement and claim full rights to the AIDS test.
But Michael A. Epstein, a U.S. lawyer for Pasteur, says he sees no reason to
reopen the case. The Fischinger documents may have been hidden, he says, but
the underlying evidence was all available at the time of the settlement.
Gallo shared that sentiment, and wondered aloud why the press and the
Parisians were still gunning for him.
Geoffrey Cowley with Mary Hager in Washington and Ruth Marshall in Paris
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Volume 3, Number 26 July 17, 1990
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David Canzi