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Conference turris::womannotes-v1

Title:ARCHIVE-- Topics of Interest to Women, Volume 1 --ARCHIVE
Notice:V1 is closed. TURRIS::WOMANNOTES-V5 is open.
Moderator:REGENT::BROOMHEAD
Created:Thu Jan 30 1986
Last Modified:Fri Jun 30 1995
Last Successful Update:Fri Jun 06 1997
Number of topics:873
Total number of notes:22329

334.0. "Aids Information" by MAY20::MINOW (It's only rock and roll) Fri Jun 12 1987 09:53

The enclosed three responses to this note are from Craig Werner's
monthly Aids posting on Usenet.  I'll replace them as Craig
issues new versions.

So as not to clutter the note with extraneous disucssion, I've set
it NOWRITE.

Martin.

T.RTitleUserPersonal
Name
DateLines
334.1Aids information, July 1987MAY20::MINOWJe suis Marxist, tendance GrouchoMon Jul 20 1987 09:50236
Here is the latest Aids informational message (as posted by
rhea::decwrl::"decvax!philabs!aecom!werner" to the Usenet
sci.med.aids newsgroup).  I believe that new or changed
information is marked by a ' in column 1.

Martin.

'* 	Please do not followup this article. Post all queries on AIDS as
'* original postings to the newly created newsgroup sci.med.aids only. 
'* However, note, that by and large, the net is generably neither a fruitful 
'* nor a reliable source of AIDS information, although the situation has
'* improved somewhat with the sci.med.aids moderation scheme.
'
'The following are reliable sources of information on AIDS:
'	Centers for Disease Control (CDC) 1-800-342-AIDS (404-329-1290 in GA)
'	U.S. Public Health Service  1-800-447-AIDS  (202-646-8182 in DC)
'	American Association of Physicians for Human Rights
'		P.O Box 14366, San Francisco CA 94114
'		415-558-9353 (415-673-3189 in Bay Area)
'	National Gay & Lesbian Task Force   1-800-221-7044 (212-741-5800 in NY)
'		80 5th Ave, Suite 1601, NY NY 10011
'	The recently published Surgeon General's report is available
'	free from the U.S. Public Health Service by writing:
'		AIDS / Box 14252 / Washington DC 20044
'	Also I must highly recommend the following special issue of
'		New Scientist: 26 Mar 1987 113:36-59.
'	
	In 1976, a San Francisco prostitute died from a rare form of
pneumonia. Later testing showed that hers was the first known death
attributable to the Acquired Immune Deficiency Syndrome in the U.S.
'	The Acquired Immune Deficiency Syndrome (AIDS) has been diagnosed in 
'30,396 persons in the United States with 17,338 deaths as of Feb. 6, 1987. 
'56% of the adults and 61% of the children diagnosed with AIDS have died,
'including over 79% of those patients diagnosed before January 1985.
'
'	In the first 22 weeks of this year, there were 7,446 (5,289 in the same
'period last year) reported cases of AIDS.
'	This compares to 331,997 (350,375) reported cases of
'Gonorrhea, 14,066 (10,830) cases of Syphillis, and 8,409 (8,669) cases
'of Tuberculosis.
	In all of 1986, 13,008 new cases were reported (compared to 
8,355 in 1985) 
	In perspective, there were 896,383 (883,826) reported cases of
Gonorrhea, 27,559 (26,868) cases of Syphillis, and 22,575 (22,144) cases
of Tuberculosis in the year 1986 (1985).
	(Many of the above statistics from the US Centers for Disease
Control's Morbidity and Mortality Weekly Report.)

	Although the United States has the highest number of AIDS cases,
AIDS has been reported in 113 countries.  Of the over 50,000 cases
reported to WHO, about two-thirds have been in the United States.  
Canada and Brazil each have just over 1000 cases.  In the Americas,
as of June 1, 1987, 23 Central American and Caribean countries 
(includes Haiti) have reported 1,411 cases and 12 South American
countries (including Brazil) have reported 1,980 cases. All 27 European
countries have reported cases, with the largest number in France (1,617).
In Asia, 18 countries have reported 150 cases. In Africa, 27 countries
have reported 4,570.  The per capita incidence in Africa approaches that 
of American cities, with an epidemiology resembling that of other 
sexually transmitted diseases.

------------
AIDS Summary
------------

*** What is Acquired Immune Deficiency Syndrome? ***
	AIDS is a consequence of infection with a retrovirus that specifically
infects cells carrying the CD4 (OKT4) protein.  These include white blood cells
of the Helper T-cell lineage.  Infection with this virus, officially
designated Human Immunodeficiency Virus (HIV), although previously
referred to as HTLV-III, LAV, ARV, and several other designations, 
is not by itself fatal. However, the virus impairs the immune system
of the host to allow opportunistic infections. Opportunistic infections are
infections with organisms generally incapable of causing disease in healthy
individuals, but which can be fatal in immunocompromised persons.
	Cellular Determinant 4 (CD4), which acts as the receptor for the
AIDS virus entry into the cell, is found predominately on Helper T-cells, and
is in fact crucial for this help to occur. It is said that if a virus had to
pick one molecule in the immune system that would do the most damage by
its absence, the CD4 molecule is it.  The CD4 molecule is also expressed
on some Killer T-cells, Macrophages (Mononuclear phagocytes), in an unknown 
cell type in the brain, and has recently been reported to be expressed in low
quantities in human colorectal cells.
	The actual diagnosis of AIDS is made according to a very strict
case definition set up by the Centers for Disease Control (CDC). The diagnosis
of AIDS is a pathological diagnosis and requires a biopsy. Evidence
of infection and illness not meeting the strict case definition is called
AIDS-related complex (ARC). Asymptomatic infection is also possible.
It is not clear at this time what percentage of each group will progess,
however, once the diagnosis of full-blown AIDS is made, the mortality
approaches 100% by 5 years after diagnosis.
	A revised definition of AIDS recently proposed would increase the
number of cases approximately 25% by reclassifying some patients currently
diagnosed as having AIDS-related complex (ARC).
	It is also known that virtually all AIDS patients, if they live
long enough will develop changes in mental status. In most cases, these
are due to opportunistic infections of the nervous system. However, in 
some cases it is due to a direct CNS infection by the virus itself. 

*** What is the virus? ***
	The Virus is an RNA virus that upon infecting a cell reverse 
transcribes itself into a DNA and stably inserts into the cell's DNA,
using the cell's machinery to produce RNA copies of its genome as well as
viral proteins.  The mechanism by which the virus actually kills the cell
has not been elucidated. It appears, however, to be a much more complex
process than the popular "cellular burnout" scenario.  
	Robert C. Gallo has proposed that the virus acts in-vivo not
so much by directly killing the cells it infects so much as preventing
their clonal expansion in response to an immune stimulation.
	The virus that causes AIDS appears very similar to the virus
STLV-III, which infects the African Green Monkey without causing
disease, as well as the virus HTLV-IV, which infects humans without
causing disease.  Two other viruses capable of causing AIDS are the
recently isolated LAV-2 and SRB.  They are all closely related, and belong 
to the Lentivirus family of Retroviruses, which also includes the sheep
Visna virus and the horse EIAV. A Lentivirus, designated FTLV, that causes 
AIDS-like symptoms in cats was also recently identified. 

*** How is it spread? ***
	AIDS is spread by direct transfer of infected bodily fluids.  Infection
via blood and semen have been proven.  The virus has also been isolated 
rarely and in small quantities from saliva and tears, but no cases to date 
have been definitely linked to these routes of transmission.  Similarly, 
no evidence suggests that AIDS is transmitted by casual contact, or 
even household contact, or by insect vectors. In fact, a growing body of 
negative evidence suggests otherwise.
	Similarly the virus cannot exist free for an extended period of time
(> 20 minutes or so), and is killed by routine sterile procedures (including 
autoclaving and dilute chlorine bleach).
	In short, it appears to have the same pattern as transmission as
Hepatitis B virus, but is much less contagious.  

*** Can it be cured? ***
	At this time, great strides have been made in the understanding of
the causative virus, as well as the treatment of the superimposed
opportunistic infections.  The average survival time from diagnosis has
been gradually and steadily increasing, but at this current time, there is
no way of successfully reversing the underlying immune deficiency.
	Recent clinical trials with 5-Azidothymidine (AZT) appear to slow 
the progression of the disease and improve quality of life in a defined 
subset of patients, although the drug is not without side-effects.  A 
special AZT hotline has been set up  by the National Institutes of Health
at (800)-843-9388. AZT has recently been approved under the trade name
Retrovir, although it is, at present, extremely expensive, and in limited
supply. 
	Similar promising results have been acheived with the antiviral
drug Ribavirin, however both it and AZT can only slow the progression
of the disease, not provide a cure, and each has toxic side effects.
Ribavirin has not yet been approved for use by the FDA, and in fact
followup studies have cast doubt on its efficacy.
	It has also recently been reported that although Ribavarin
and AZT each inhibit the virus at unique steps, they are antagonistic
rather than synergistic, and cannot be used in combination.
	Work on recombinant and/or synthetic vaccines has also proceeded
rapidly, but none has yet advanced far enough for human trials, and there
are no suitable animal models to test vaccine candidates.

*** Who is at risk? ***
	Due to the nature of its transmission, AIDS has so far been limited 
to certain defined risk groups. These are: Sexually active homosexual males,
Intravenous Drug Abusers, Hemophiliacs and others who received contaminated
blood products, the sexual partners of the above, and children born to
infected women. Recent immigrants from areas where AIDS is common (including
Haiti and Central Africa) also represent a disproportionate number of 
United States cases.
	NOTE, HOWEVER, THAT INCLUSION WITHIN A RISK GROUP IS NOT IN AND 
OF ITSELF AN INCREASED RISK, BUT IS MERELY AN EPIDEMIOLOGICAL TOOL to 
predict exposure to the virus, i.e.  a gay male who has been celibate 
since 1977 is at no increased risk of developing AIDS. Similarly, merely
being Haitian is not a priori, a risk factor for developing AIDS.

The epidemiological data is as follows:
	60% of adult AIDS victims are white, 25% Black, 14% Hispanic.
	90% are between the ages of 20-49, 93% are men.
	Gay men with no history of drug abuse account for 66% of all 
cases, Gay drug abusers, 8% (total gay = 74%), Heterosexual drug 
abusers, 17% (15% of male cases and 51% of female), Hemophiliacs, 1%,
Sexual Partners of those infected (2% of males and 27% of females), and 
Transfusion associated, 2% (1% of males, 10% of females).
	Among children, 20% are white, 57% black, 22% Hispanic. 55% are male.
	79% of children were born to infected mothers, 13% are transfusion
associated, 6% are hemophiliacs.
	Numbers may not add up to 100% due to incomplete reporting.
	Blacks and Hispanics accounted for 22% and 14% of the male cases,
respectively, but 52% and 20% of the female cases.  The relative risk
for Black and Hispanic women is 13.3 and 11.1 times higher than for
white women.  The cumulative incidence among Blacks and Hispanics is
3 times as much as their proportional population. 
'	AIDS has been reported in all 50 states, but over 3/4 of all cases
'have occurred in just 4: New York, Florida, New Jersey, and California.
'Female AIDS patients have been reported in 41 states, pediatric cases
'in 29 states. 

'*** How to avoid AIDS? ***
'	Since over 99% of AIDS cases are linked to sexual or direct 
'parenteral (Blood and body fluids, includes IV drug use) transmission, 
'CELIBACY AND AVOIDANCE OF INTRAVENOUS DRUG USE WILL EFFECTIVELY REDUCE 
'ONE'S CHANCE OF CONTRACTING AIDS TO NEAR ZERO, especially since blood 
'products are now screened for contamination.
'	Given the general unpopularity of complete celibacy, the use of
'condoms in combination with spermicides, and other measures to avoid 
'exchange of bodily fluids (by which is usually meant semen and
'blood), and stable monogamous relationships will provide relative
'but not absolute protection. The term "Safe Sex" is, in this
'regard, a bit of a misnomer, since while adhering to so-called "Safe Sex"
'guidelines considerably reduces one's chance of infection, it does
'not reduce it to zero. 
'	To put it plainly, the fewer sexual partners you have, 
'the lower your risk of contracting AIDS by sexual contact.
'	Avoiding shared razors and toothbrushes has also been suggested, 
'as these may be contaminated with blood.
'	Donated blood is now screened for contamination, and the risk
'from of contracting AIDS by this route is nearly as low as it was in 1977.
'	There is absolutely NO RISK of contracting AIDS by DONATING blood.
'This belief has caused a critical shortage of blood in this country. 
'Therefore, if you are healthy, have not used IV drugs or engaged in
'sex with a male homosexual/bisexual since 1977, and have not engaged in
'prostitution, or have not had sex with a prostitute in at least six
'months, contact your local Red Cross to become a blood donor, please.
'
*** About the poster ***
	Craig Werner is a frequent poster of original articles to net.med.
He is currently a NIH medical scientist trainee, has completed the two
years of medical school basic science and passed the National Medical
Boards - Part I, and is now doing research on the molecular genetics of
human filarial parasites, with the goal of eventually developing a 
synthetic vaccine. By the time the dust settles after the turn of
the decade, he will hold a Masters degree in Microbiology and Immunology,
an MD, and a PhD.
-- 
	        Craig Werner   (future MD/PhD, 3 years down, 4 to go)
	     [email protected] -- Albert Einstein College of Medicine
              (1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517)
                     "Satis multum illius nunc circum fertur."


334.2The epidemology of AidsMAY20::MINOWJe suis Marxist, tendance GrouchoMon Jul 20 1987 09:5484
In his monthly Aids posting, Craig Werner mentioned in passing a special
issue on Aids in the New Scientist, 26 March 1987.  In addition to some
beautiful photographs (by Lennart Nilsson, who is probably best known
for his series on foetal development), there are several fascinating
articles on "The Science of Aids".

Perhaps the most interesting -- in that the information hasn't been
discussed in other articles -- is on mathematical models on the spread
of the disease.  The article is too dense to be adequatly summarized.
With apologies for errors, then, the following is an abridged quotation
from the article.  I have not noted editorial changes.  Please do not
criticize this article from my posting -- read it first.

   The rate at which the virus spreads depends on the probability of
   transmission (B) for the particular type of relationship between the
   infectious person and the person susceptable (for example, heterosexual
   man to woman, infected person to nurse drawing blood, etc.) and the
   "effective average" number (C) of such contacts with susceptable individuals.

   In the early phase of the epidemic, the number of people infected rises
   exponentialy, doubling at a rate equal to B*C.  Because Aids is transmitted
   sexually, promiscuous people are both more likely to give and to get
   the virus.  So, the way C is calculated is crucial.  It is not simply
   the mean number of partners, rather it is the square of the number of
   partners divided by the mean: C = M + s^2/M, where M is the mean and
   s^2 the variance of the statistical distribution of new partners per
   unit time.  Consider a population of homosexual men among whom 50% are
   relatively monogamous, acquiring new partners at the rate of roughly 1
   per year, while the remaining 50% have around 19 new partners each year.
   The mean number of partners is 10, but the "effective average" is 18
   (C = .5*(1 + 361)/10), which is significantly higher.

   We know neither B nor C for HIV infection.  But in the US and Europe,
   cases of infection seem to be doubling every 8-12 months, which corresponds
   to the product B*C having a value of around 1 per year.  Other data suggests
   that C may be arund 10 per year (for homosexual en in large cities in
   developed countries) and B (the probablity of transmission) around 0.1.

   To model the epidemic, we also need to know know how long people are
   infectious (D, the average duration).  With all this information, we
   could then calculate the "basic reproductive rate", R, defined as the
   number of new infections produced, on average, by an infected individual
   in a susceptible population (R = B*C*D).  This is important because
   the infection will spread if R is greater than 1, but not otherwise.
   Some people infected with HIV may remain infectious for five years or
   more, shich suggests that R is 5 or more among homosexual men in large
   cities, making it more "intrinsically spreadable" than smallpox.

   Among heterosexuals, the epidemology is complicated by separate
   probabilities (male to female vs female to male) and different
   rates of acquiring new sexual partners.  Take a hypothetical example.
   Suppose that all men are moderately promiscuous, having around 4 new
   female partners per year, while the female population is more varied:
   90% have 1 new male partner, while 10% have on average 31 new partners.
   This difference in effective averages could explain the equal sex
   ratios for AIDS cases in Africa (the larger effective average number
   of partners caused by female prostitution counterbalances the greater
   probability of male->female transmission.

   "At present, we  know too little to decide whether the R [basic
   reproductive rate] for heterosexual transmission will fall below or
   above 1 -- values greater than 1 mean thre will be a major epidemic."

From the conclusion to the article -- abstracted:

  Hopes of halting the spread of AIDS rest on persuading people to change
  their sexual habits.  "Safe sex" (condoms, etc.) can reduce the probability
  of transmitting the virus.  Reduction in the rates at which people acquire
  new sexual partners reduces the rate at which new infections are produced.
  Unfortunately, our estimate of the basic reproductive rate of HIV infections
  among homosexual men in developed countries suggests that there must be
  substantial changes if we are to halt this epidemic.  The basic reproductive
  rate for heterosexually trnasmitted HIV in developed countries may, however,
  be substantially lower.  It may, therefor, be amenable to being reduced below
  1 by such cultural changes.  The kind of constructively aggressive programme
  of public education now being launched in Britain, although not on anything
  like the same scale in the US, face the difficulty that they aim to change
  behavior among young people just entering the sexual arena.  Mechanisms
  of denial are strong, and it seems easy for poeople genuinely to believe
  one thing, yet do another.

From Anderson, Roy, and Robert May.  Plotting the Spread of AIDS.  New
Scientist, 26 March 1987.  54-59.

334.3VIKING::TARBETMargaret MairhiWed Aug 12 1987 10:4996
    The informational article below is offered by a member of the file who
    wishes [for reasons that I must admit I don't quite grasp] to remain
    anonymous at this time. 
    
    						=maggie
     
    =====================================================================

Article 117 of sci.med.aids:
Newsgroups: sci.med.aids
Subject: Re: Get AIDS by Oral Contact?
Summary: No risk associated with oral sex.
Keywords: HIV AIDS oral sex felatio
Date: 7 Aug 87 23:20:18 GMT
Reply-To: herschko%[email protected] (Stephen Jay Herschkorn)
Organization: University of California, Berkeley
Lines: 76

In article <[email protected]> [email protected] (Chris Tilt) writes:

>--->    Seeking information re: AIDS via oral contact.
>
>   While it has been well publicized that AIDS can be transmitted
>by sexual contact, I have not seen information regarding contraction
>of the disease by oral contact. [...]
>In addition, how "safe" is oral sex?

I have already submitted one posting on this subject.  In brief, findings
from the San Francisco Men's Health Study indicate that there is no risk
of HIV transmission associated with receptive oral intercourse, even with
ejaculation.  The references are

	Lyman D et. al. JAMA 1986;255:1703.
	Winkelstein W et. al. JAMA 1987;257:321-25.

In addition to this study and the others I mentioned in my previous
posting, I have come across at least two more studies which support this
conclusion.  The Multicenter AIDS Cohort Study has found that of 147
participants who reported having oral receptive intercourse but no anal
intercourse, *none* serocoverted.  The reference is

	Kingsley LA et. al. Lancet 1987;i:345-49.

The other study was done recently in the Netherlands.  Dr.  Rob Tielman
conveyed to me in a personal conversation that they also found no risk
associated with oral sex.  He said he would send me the citation, but
unfortunately, he didn't. (All I know is that it's in Dutch somewhere.  I
couldn't find it in Biological Abstracts under his name.)

Two other reports also agree with these findings:

	Jeffries E et. al. Can Med Assoc J 1985;132:1373-77.
	Schechter MT et. al. Lancet 1986;i:379.

To be fair, I should remark on a study that concludes there *is* a risk associ-
ated with oral receptive intercourse with ejaculation. The reference is

	Mayer KH et. al.  Am J Med 1986;80:357-63.

As opposed to the other studies, this study is a case-control study, i.e,
it starts by classifying men by their serostatus and then investigates how
the behavioral history of the two groups differ.  Such a study is less
forceful in its conclusions than a cohort study in general. (The other
studies were cohort studies - that is, they first classified seronegative
men by behavior and followed them in time.) Also in contrast to the other
studies, Mayer et. al. did not separate out men who had or had not had
anal intercourse.

In reading Mayer et. al., I find that his numbers do not agree from table
to table, and they does not explain the discrepancies.  Furthermore, if
one takes the numbers as they have presented them and computes odds ratios
(which the authors never do), one finds that there is *no* risk associated
with oral intercourse.  I thus do not understand how the authors came to
their conclusions, and would tend to dismiss them. (Another of their
findings is "Receptive anal exposure to ejaculate was *marginally*
[emphasis mine] associated with HTLV-III seropositivity.")

In summary, based on the by now numerous studies I have encountered and on
personal conversations with health care practitioners, I feel quite secure
that there is very little (if any) risk of HIV transmission associated
with oral receptive intercourse.  In fact, I am somewhat irked that the
this practice is still advertised as unsafe, e.g., in Koop's statement on
the net.  I am convinced that there are some deep political issues at work
here, but that's more than I care to go into right now.*

--------------
Stephen J. Herschkorn                   [email protected]
Department of Industrial Engineering and Operations Research, and
Survey Research Center
University of California, Berkeley

[*The above statistics do show how poor a route for passage the mouth is,
but risk is best defined not by statistics, but as probability times
consequences compared to benefits.  TL]


334.4Aids info from UsenetMAY20::MINOWJe suis marxiste, tendance GrouchoMon Dec 14 1987 15:03398
Here are several informative articles on Aids, taken from Usenet.

Newsgroups: sci.med.aids
Path: decwrl!labrea!rutgers!husc6!linus!philabs!aecom!werner
Subject: What is AIDS: original definition
Posted: 13 Dec 87 05:46:10 GMT
Organization: Albert Einstein Coll. of Med., NY
Approved: [email protected]
 
[As I am currently archiving and removing from my account most of the files
that I have accumulated, I am taking this time to repost some articles that
may be of interest, and will, in the future be relatively unavailable.]
 
Original definition of AIDS (2 files)
-------------------------------------
 
 
::::::::::::::
defin.aids
::::::::::::::
	The case definition of the Acquired Immune Deficiency Syndrome
(AIDS) predates the discovery of the presumed causative agent (HIV),
so is defined clinically and pathologically.  The following diagnoses,
in the absence of another cause of immune deficiency (such as immuno-
suppressive drugs, or certain cancers), constitutes a probable diagnosis
of AIDS:
 
1. Bilateral interstitial pneumonitis
	(including Pneumocystis carinii pneumonia)
2. Oral-esophageal candidiasis
3. Chronic mucocutaneous herpes simplex infection
4. Disseminated Cytomegalovirus infection
5. Extrapulmonary infection by atypical mycobacteria
	(esp. Mycobacterium avium-intracellulare)
6. Cryptococcal meningitis
7. Cryptosporidium enteritis
8. Salmonella bacteremia
9. Disseminated strongyloidiasis
10. Toxoplasma gondii infection
11. Disseminated Kaposi's sarcoma
 
	In addition, Total T-lymphocyte counts and counts of helper T-cells
should be depressed, with a resulting inversion of the Helper/Supressor
lymphocyte ratio.
 
	Currently, there are proposals to expand the above list to 
include illnesses which are clearly HIV-related, but not currently
classified as AIDS.
 
::::::::::::::
cdcsdef.aids
::::::::::::::
CDC Surveillance Definition of AIDS
(revised August 1986)
 
The Acquired Immune Deficiency Syndrome, as defined for reporting purposes:
 
1. A disease, at least moderately predictive of a defect in cell-mediated
immunity, occuring in a person with no known cause for diminished resistance
to that disease.  Such diseases include Kaposi's Sarcoma (KS), Pneumocystis
carinii pneumonia (PCP) and other serious opportunistic infections (*)
 
	(*) These infections include specified syndromes INVOLVING SPECIFC
	ANATOMIC SITES due to one or more of the following agents: candidiasis,
	cryptococcosis, cytomegalovirus, nocardiosis, strongyloidiasis,
	toxoplasmosis, or atypical mycobacteriosis (species other than
	tuberculosis or lepra); esophagitis due to candidiasis,
	cytomegalovirus, or herpes simplex virus; progressive multifocal
	leukoencephalopathy; chronic enterocolitis (more than four weeks)
	due to cryptospororidiosis; or unusually extensive mucocutaneous
	herpes simplex of more than five weeks duration.
 
2. Diagnoses are considered to fill the case definition only if based on
sufficiently reliable methods (generally histology or culture).
 
	[That is, in most cases, history is not enough for a diagnosis
	 of AIDS to fulfill the CDC criteria -- CW]
 
3. In adults with HIV seropositivity, additional diseases include
disseminated histoplasmosis (not confined to lungs or lymph nodes),
diagnosed by culture, histology, or antigen detection; isosporiasis,
causing chronic diarrhea (over one month), diagnosed by histology
or stool microscopy; bronchial or pulmonary candidiasis, diagnosed
by microscopy or characteristic white plaques of bronchial mucosa 
(not by culture alone); non-Hodgkin's Lymphoma of high-grade pathologic
type (diffuse, undifferentiated) and of B-cell or unknown phenotype,
diagnosed by biopsy; histologically confirmed KS in patients 60 years
or older.
 
4. Lymphoreticular malignancies, diagnosed more than three months after any
of the above diagnoses, will no longer be excluded as AIDS cases.
 
-- 
	        Craig Werner   (future MD/PhD, 3 years down, 4 to go)
	     [email protected] -- Albert Einstein College of Medicine
              (1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517)
     "I never knew there was anything wrong with me till I met Dr. Hackenbush."

Newsgroups: sci.med.aids
Path: decwrl!labrea!rutgers!husc6!linus!philabs!aecom!werner
Subject: Advice on how to avoid AIDS
Posted: 13 Dec 87 05:50:07 GMT
Organization: Albert Einstein Coll. of Med., NY
Approved: [email protected]
 
[As I am currently archiving and removing from my account most of the files
that I have accumulated, I am taking this time to repost some articles that
may be of interest, and will, in the future be relatively unavailable.]
 
-------------------------------------
How to avoid AIDS
 
	By and large, AIDS is spread in only two ways: by Blood (as in
transfusion, or via contaminated needles) and by Sex.
	Blood banks now screen for contaminated blood, so this can
presume to become a rarer means of transmission.  Intravenous (IV)
Drug Abusers (usually addicted to heroin) are still a problem, which 
I won't address as it can get incredibly complicated.
 
	Sexual transmission accounts for most of the cases of AIDS to date,
and is the means by which it may spread to the population at large.  Of
the roughly 30,000 cases of AIDS diagnosed to date, less than 4% of them
are due to heterosexual transmission, and most of these cases are in
minority females who acquired it from their drug-addicted male lovers,
or who worked as Prostitutes.
	While this is a very small percentage, what worries people is
that in terms of total numbers, this is roughly the same number of
Homosexual men who had been diagnosed by 1981.
 
	Currently most cases of AIDS are in men, hence by the power of
numbers, women should be the most careful, but that does not take
the responsibility away from their male partners.
	Early AIDS infection usually has no symptoms.  It is possible 
to transmit AIDS between initial infection and seroconverting to
Antibody-positive.  People who test Antibody-positive should be
presumed to be infectious even if they show no symptoms of AIDS.
 
	The only absolutely effective way to avoid AIDS is
		Don't Have Sex.
	Some people, however, find this unacceptibly harsh.
 
	The only absolutely Safe Sex 
		is mutually monogamous sex between two unifected
	partners.
 
	Relatively safe sex can be acheived by the use of:
		1. Condoms (latex)
	and 	2. Spermicides
	Of these two, condoms are probably superior, but
	the two methods together are better than either alone. 
 
		The risk of having an infected sexual partner
	increases with the number of partners, hence keep the
	number of partners down and be selective.
 
		Then, of course, there is playing the odds. If I
	were a homosexual male in a major urban center (where
	prevalence of infection can approach 50% among the risk
	group), I'd consider not having sex for a decade or so.
		Similarly, if I were a woman, I'd stay clear of
	bisexual men and drug users.  In fact, I'd consider
	staying clear of any man who has had a large number of
	sexual partners.
		As a rule, I'd never even think of patronizing a
	prostitute.
 
	Note, however, that I am not trying to spread hysteria.  In
fact, the majority of the United States population is NOT at risk for
becoming infected.  The virus may be infectious, but it is very weakly
communicable. Caution is called for, but not paranoia or panic.
 
 
-- 
	        Craig Werner   (future MD/PhD, 3 years down, 4 to go)
	     [email protected] -- Albert Einstein College of Medicine
              (1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517)
"If you think you might faint, don't worry; you can always go into psychiatry."

Newsgroups: sci.med.aids
Path: decwrl!labrea!rutgers!gatech!bloom-beacon!husc6!linus!philabs!aecom!werner
Subject: The "Mosquitos Don't Transmit AIDS" posting
Posted: 13 Dec 87 06:06:08 GMT
Organization: Albert Einstein Coll. of Med., NY
Approved: [email protected]
 
[As I am currently archiving and removing from my account most of the files
that I have accumulated, I am taking this time to repost some articles that
may be of interest, and will, in the future be relatively unavailable.]
 
 
>Keywords: Mosquitoes and malaria, Needles and Syringes, Reality
>Summary: AIDS cannot be spread by mosquitoes
>
> What information exist on possible transmission of AIDS by the   
> following vectors?
>   
>    1. Insect, Mosquito or other?
>			       Ernie Patterson & Ted Stevens
 
	First let me talk about malaria, which is clearly spread by mosquitoes.
The parasite is taken up during a blood meal, matures and mates in the 
mosquito's gut, and the offspring penetrate the gut wall and swim into
the mosquito salivary glands, so that several weeks later, they swim out
when the mosquito bites again.  Only certain strains of mosquito are
capable of carrying disease, the rest are resistant to the infection. And
only certain species live long enough to bite twice.
	Note well, that there is no physical connection between the
probiscus coming in and the salivary glands going out. The sporozooites
(in malaria) and L3 (in filaria) have to do some impressive moving
around.
 
	Now let me talk about Junkies, Intravenous Drug Abusers in more
polite company.  Most of them, in order to get the full fix, will pull
back on their syringe and wash it out several times with their own blood.
This is what is then shared and refilled. The heroin, as used, is blood 
red.  
	By contrast, of the thousand or so documented uncomplicated 
needle sticks on patients with AIDS, none of the doctors, nurses, or 
medical students has yet turned antibody positive.   The well-publicized
six cases have all had extinuating circumstances. (translated as lots
more blood than you'd ever get from even a needle stick)
	[Actually, I think the number is now 1 seroconversion from
a needle stick, and 15 cases from more extensive exposure.]
	Therefore, one can almost make the claim that nobody has ever 
caught AIDS from a dirty needle.  It's not the needle, it's the entire
syringe that's the problem.
 
	Now then, once you know the above, it's hard to even consider
insect-borne transmission of AIDS.  It flies in the face of biology 
and experience.
 
	However, here's more negative evidence.  In Africa, where AIDS
is almost as prevalent as it is in New York and San Francisco, there
are two groups that have most of the cases: children under 3, born to
infected mothers, people in the 18-30 age group, most of whom are in
the cities and have had an above average number of sexual partners.
	By contrast, malaria hits hardest in the 5-15 age group.  
	If AIDS were transmitted by mosquitoes, one would expect there
to be a high correlation.  Instead there is almost no overlap.  This
argues against a relationship.
	[Actually, there is a slight overlap, but it is due to the
fact that those children with severe malaria develop a potentially
fatal anemia, which requires a blood transfusion. They get AIDS
secondary to the transfusion, not to the malaria.]
 
	I hope this posting is sufficient to settle this question once
and for all, and I encourage you to pass it around to all your friends
who might ever possibly worry about such things.
 
[The bracketed comments are new. Otherwise the posting is as it
 was when first posted in 1986]
-- 
	        Craig Werner   (future MD/PhD, 3 years down, 4 to go)
	     [email protected] -- Albert Einstein College of Medicine
              (1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517)
           "Someone write me a letter. I need to know that I'm still alive."

Newsgroups: sci.med.aids
Path: decwrl!labrea!rutgers!gatech!bloom-beacon!husc6!linus!philabs!aecom!werner
Subject: Flowchart Definition of AIDS : current definition
Posted: 13 Dec 87 06:09:21 GMT
Organization: Albert Einstein Coll. of Med., NY
Approved: [email protected]
 
[As I am currently archiving and removing from my account most of the files
that I have accumulated, I am taking this time to repost some articles that
may be of interest, and will, in the future be relatively unavailable.]
 
 
----------------------------------------------------
Flow diagram for revised CDC case definition of AIDS
----------------------------------------------------
 
		Laboratory evidence of HIV infection (App. I)
   ______________________________|_______________________
   |				 |			|
Unknown 	              Positive		      Negative
   |				 |			|
   |			Has any disease in		|
   |			Section I.B or II.A	Are there other
   |			been definitively	 causes of 
   |			diagnosed? (App. II)	immunodeficiency?
   |		    	// 	 |			|	 \\
   |		Yes= AIDS        NO			NO	Yes= Not a case
   |				 |			|
   |			Has any disease in		Has
   |			Section II.B been	Pneumocystis carinii
   |			presumptively 		  pneumonia been
   |			diagnosed (App. III)    definitively diagnosed?
   |			//	|		 //	 |
   |		Yes = AIDS	NO     	    Yes = AIDS   NO
   |				Not a case		 |
   |						     Has any other
   |						disease in Section I.B
Are there					    been definitely	
other causes					  diagnosed (App. II)
of immunodeficiency?					 |	 \\
(Section 1.A)				                YES     No = not a case
   |	   \\						 |
  NO        Yes = not a case				Is the
   |						T-helper lymphocyte
Has any disease					  count < 400/mm^3
in Section I.B 						 |	 \\
been definitively				         |	No = not a case
diagnosed (App. II)				     Yes = AIDS
   |	  \\
   |	   No = not a case
Yes = AIDS
_____________________________________________________________________________
_____________________________________________________________________________
 
 
Section I.A Diagoses that exclude AIDS:
---------------------------------------
 
1. High dose or long term system corticosteroid of other
	immunosupressive therapy.
2. Any of the following:
	Hodgkin's Disease, non-Hodgkin's lymphoma (outside of brain)
	lymphocytic leukemia, multiple myeloma
	any other cancer of lymphoreticular or histiocytic tissue
	angioimmunoblastic lymphadenopathy
3. Genetic immunodeficiency
	and/or acquired immunodeficiency atypical of HIV infection
		(for example, acquired hypogammaglobulinemia)
_____________________________________________________________________________
 
I.B Indicator diseases that constitute a diagnosis of AIDS:
     (independent of laboratory evidence of HIV infection)
-----------------------------------------------------------
 
1. Candidiasis of the esophagus, trachea, bronchi, or lungs
2. Cryptococcus, extrapulmonary
3. Cryptosporidiosis with diarrhea persisting greater than 1 month
4. cytomegalovirus disease of an organ other than liver, spleen,
	or lymph nodes in a patient greater than 1 month of age.
5. Herpes simplex virus infection causing a mucocutaneous ulcer that
	persists more than 1 month; or bronchitis, pneumonitis, or
	esophagitis for any duration affecting a patient greater than
	1 month of age.
6. Kaposi's sarcoma affecting a patient less than 60 years of age
7. Lymphoma of the brain (primary) affecting a patient less than 60
	years of age.
8. Lymphoid interstitial pneumonia and/or pulmonary lymphoid hyperplasia
	(LIP/PLH complex) affecting a child less than 13 years of age.
9. Mycobacterium avium complex or Mycobacterium kansasii disease, 
	disseminated (at a site than or in addition to lungs, skin,
	or cervical or hilar lymph nodes.)
10. Pneumocystis carinii pneumonia
11. Progressive multifocal leukoencephalopathy
12. Toxoplasmosis of the brain affecting a patient greater than
	1 month of age.
 
____________________________________________________________________________
 
II.A Medical conditions defined as AIDS only
	in the presence of evidence of HIV infection
     -----------------------------------------------
1. bacterial infections, multiple and recurrent (any combination of at least
	two within a 2-year period), of the following types affecting a 
	child less than 13 years of age: septicemia, pneumonia, meningitis,
	bone or joint infection, or abcess of an internal organ or body
	cavitiy (excluding otitis media or superficial skin or mucosal
	abcesses), caused by Haemophilus, Streptococcus (including 
	pneumococcus), or other pyogenic bacteria.
2. Coccidioidomycsis, disseminated (at a site other than or in addition to
	lungs or cervial or hilar lymph nodes)
3. HIV encephalopathy (also called "HIV dementia", "AIDS dementia," or
	"subacture encephalitis due to HIV.") [descr. in App. II]
4. Histoplasmosis, disseminated (at a site other than or in addition to
	lungs or cervical or hilar lymph nodes)
5. Isosporiasis with diarrhea persisting greater than 1 month.
6. Kaposi's sarcoma at any age.
7. Lymphoma of the brain (primary) at any age.
8. Other non-Hodgkin's lymphoma of B-cell or unknown phenotype and
	the following histologic types:
	a. small noncleaved lymphoma (Burkitt, or non-Burkitt)
	b. Immunoblastic sarcoma
	Note: Lymphomas are not included here if they are of T-cell
		immunologic phenotype or if their histologic type is
		not described or is described as "lymphocytic,"
		"lymphoblastic," "small cleaved," or "plasmacytoid
		lymphocytic"
9. Any mycobacterial disease caused by mycobacteria other than tuberculosis
	disseminated (at a site other than or in addition to lungs, skin,
	or cervical or hilar lymph nodes)
10. disease caused by M. tuberculosis, extrapulmonary (involving at least
	one site outside the lungs, regardless of whether there is
	concurrent pulmonary involvement)
11. Salmonella (nontyphoid) septicemia, recurrent.
12. HIV wasting syndrome (emaciation, "slim disease") [descr. App. II]
 
	
-- 
	        Craig Werner   (future MD/PhD, 3 years down, 4 to go)
	     [email protected] -- Albert Einstein College of Medicine
              (1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517)
 "..pursuing Dharma, Artha, and Kama (although not nearly enough of the last)."