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From: [email protected] (David Dodell)
Subject: HICN611 Medical News Part 4/4
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call for employers to keep information about the HIV status of health-care
workers confidential. But doctors who know of an HIV-positive colleague who
has not sought advice must inform the employing authority and the appropriate
professional regulatory body. The guidelines also emphasize the significance
of notifying all patients on whom an invasive procedure has been done by an
infected health-care worker. A model letter to patients who have come into
contact with such an individual is provided, along with suggestions for
health officials on how to deal with the media. In addition, a U.K. advisory
panel on HIV infection in health-care workers has been formed to provide
specific occupational recommendations to those treating such patients.
==================================================================
"Properties of an HIV 'Vaccine'" Nature (04/08/93) Vol. 362, No. 6420, P. 504
(Volvovitz, Franklin and Smith, Gale)
The questions raised by Moore et al. about recombinant gp160 envelope
glycoprotein precursor from HIV-1 produced by MicroGeneSys are advantages
rather than disadvantages, write Franklin Volvovitz and Gale Smith of
MicroGeneSys in Meriden, Conn. Moore et al. says that gp160 in a baculovirus
expression system does not bind strongly to the CD4 receptor, and that this
recombinant gp160 does not stimulate the same antibodies as the HIV-1 virus
does in natural infection. But vaccination with recombinant gp160 in
patients infected with HIV-1 broadens HIV-1 specific envelope-directed immune
responses, including crossreactive antibodies to gp160 epitopes and CD4 and
CD8 cytotoxic T-cell responses. Volvovitz and Smith claim that they never
intended their gp160 molecule to be identical to the native protein. Antibody
responses against native HIV-1 proteins, including the types described by
Moore et al., exist in nearly all AIDS patients but do not prevent
HICNet Medical Newsletter Page 42
Volume 6, Number 11 April 25, 1993
progression of HIV disease. In addition, the binding of gp120 or gp120-
antibody complexes to CD4 has been shown to interfere with antigen specific
activation of CD4 cells and trigger programmed cell death in vitro, which
may contribute to the pathogenesis of HIV infection. The absence of CD4
binding by the MicroGeneSys gp160 vaccine may therefore be viewed as an added
safety feature. Phase I studies have demonstrated stable CD4 counts,
stimulation of cytotoxic T cells, and the suggestion of restoration of immune
function. Based on these and other clinical results, MicroGeneSys gp160 was
chosen by researchers at the Karolinska Institute in Sweden for the first
phase III vaccine therapy studies, conclude Volvovitz and Smith.
==================================================================
"HIV-1 Infection: Breast Milk and HIV-1 Transmission" Lancet (04/10/93) Vol.
341, No. 8850, P. 930 (Mok, Jacqueline)
There are still more questions than answers regarding HIV-1-positive
women breastfeeding their babies, writes Jacqueline Mok of the Lancet. The
anti-infective properties of milk are well documented. While the numbers of
leukocytes, concentrations of lactoferrin and IgA, and lymphocyte mitogenic
activity decline sharply during the first two to three months of lactation to
barely detectable levels, lactoferrin and IgA then increase from three to
twelve months, with 90 percent of total IgA in milk being secretory IgA.
Breastfeeding protects infants against gastrointestinal and respiratory
illnesses, in both normal and uninfected children born to HIV-positive
mothers. The Italian National Registry of AIDS discovered that breastfed HIV-
1 infected children had a longer median incubation time (19 months) than
bottlefed infants (9.7 months). Breastfed children also had a slower
progression to AIDS. There is no agreement on which antibodies offer
protection against HIV-1 infection. Studies of the biological properties of
milk from 15 HIV-1 infected women showed the presence of IgG and IgA
antibodies against envelope glycoproteins, as well as IgA antibodies against
core antigens. Binding of HIV-1 to the CD4 receptor can be inhibited by a
human milk factor. In the developing world, where infectious disease and
malnutrition contribute significantly to infant mortality, breast milk is
still the best food for infants, regardless of the mother's HIV status.
Transmission might be restricted by breastfeeding after colostrum and early
milk have been expressed and discarded. The possibility remains that breast
milk could protect the infant who is already infected with HIV at birth and
may even delay progression to AIDS, concludes Mok.
==================================================================
"Absence of HIV Transmission From an Infected Dentist to His Patients" Journal
of the American Medical Association (04/14/93) Vol. 269, No. 14, P. 1802
(Dickinson, Gordon M. et al.)
If universal precautions are practiced, the risk of HIV transmission
from dentist to patient appears to be infinitesimal, write Gordon M. Dickinson
HICNet Medical Newsletter Page 43
Volume 6, Number 11 April 25, 1993
et al. of the University of Miami School of Medicine in Miami, Fla. The
researchers contacted all patients treated by a dentist with AIDS and
attempts were made to contact all patients for HIV testing. Living patients
with newly detected HIV infection were interviewed, and DNA sequence analysis
was performed to compare genetic relatedness of their HIV to that of the
dentist. Death certificates were obtained for deceased patients, and the
medical records of those with diagnoses suggestive of HIV disease or drug
abuse and those dying under the age of 50 years were examined in detail.
There were 1,192 patients who had undergone 9,267 procedures, of whom 124
were deceased. An examination of the death certificates of patients
identified five who had died with HIV infection, all of whom were either
homosexuals or IV-drug users. The researchers were able to detect 962 of the
remaining 1,048 patients, and 900 agreed to be tested. HIV infection was
reported in five of the 900 patients, including four who had clear evidence
of risk factors for the disease. One patient who had only a single
evaluation by the dentist denied high-risk behavior. Comparative DNA sequence
analysis showed that the viruses from the dentists and these five patients
were not closely related. The study suggests the potential for HIV
transmission from a general dentist to his patients is minimal in a setting
in which universal precautions are strictly observed, conclude Dickinson et
al.
================================================================
April 22, 1993
================================================================
"AIDS Patients are Susceptible to Recurrences of TB, Study Says" Washington
Post (04/22/93), P. A13
Tuberculosis can strike AIDS patients more than once, which makes the
resurging health hazard harder to control, according to a study published in
today's New England Journal of Medicine. People who contract TB usually
develop an immunity that protects them if they are exposed to the bacteria
again. But a person whose immune system is depleted may not be able to fight
off a new TB infection, doctors found. Peter M. Small of the Howard Hughes
Medical Institute at Stanford University, director of the study, said that in
order to protect against reinfection, it may be necessary for some people to
use TB medicines permanently. The study examined the genetic makeup of TB
bacteria and how the germs changed over time in 17 patients at Kings County
Hospital in New York.
================================================================
"HIV-1 Infection: Breast Milk and HIV-1 Transmission" Lancet (04/10/93) Vol.
341, No. 8850, P. 930 (Mok, Jacqueline)
There are still more questions than answers regarding HIV-1-positive
women breastfeeding their babies, writes Jacqueline Mok of the Lancet. The
anti-infective properties of milk are well documented. While the numbers of
HICNet Medical Newsletter Page 44
Volume 6, Number 11 April 25, 1993
leukocytes, concentrations of lactoferrin and IgA, and lymphocyte mitogenic
activity decline sharply during the first two to three months of lactation to
barely detectable levels, lactoferrin and IgA then increase from three to
twelve months, with 90 percent of total IgA in milk being secretory IgA.
Breastfeeding protects infants against gastrointestinal and respiratory
illnesses, in both normal and uninfected children born to HIV-positive
mothers. The Italian National Registry of AIDS discovered that breastfed HIV-
1 infected children had a longer median incubation time (19 months) than
bottlefed infants (9.7 months). Breastfed children also had a slower
progression to AIDS. There is no agreement on which antibodies offer
protection against HIV-1 infection. Studies of the biological properties of
milk from 15 HIV-1 infected women showed the presence of IgG and IgA
antibodies against envelope glycoproteins, as well as IgA antibodies against
core antigens. Binding of HIV-1 to the CD4 receptor can be inhibited by a
human milk factor. In the developing world, where infectious disease and
malnutrition contribute significantly to infant mortality, breast milk is
still the best food for infants, regardless of the mother's HIV status.
Transmission might be restricted by breastfeeding after colostrum and early
milk have been expressed and discarded. The possibility remains that breast
milk could protect the infant who is already infected with HIV at birth and
may even delay progression to AIDS, concludes Mok.
================================================================
"HIV and the Aetiology of AIDS" Lancet (04/10/93) Vol. 341, No. 8850, P. 957
(Duesberg, Peter)
Because there is no proof that HIV is the cause of AIDS, the hypothesis
that drug use leads to AIDS will hopefully become a hindrance to the
physiologically (AZT) and psychologically (positive AIDS test) toxic public
health initiatives, writes Peter Duesberg of the University of California--
Berkeley. In the Lancet's March 13 issue, Schechter et al. call Duesberg's
hypothesis that injected and orally used recreational drugs and AZT lead to
AIDS, "a hindrance to public health initiatives." However, their hypothesis
that HIV is the cause of AIDS has not attained any public health benefits.
The U.S. government spends $4 billion annually, but no vaccine, no therapy,
no prevention, and no AIDS control have resulted from work on this
hypothesis. Schechter et al. conclude that HIV has a key role in CD4
depletion and AIDS based on epidemiological correlations with antibodies
against HIV and with self reported recreational drug use among homosexuals
from Vancouver. However, their survey neglects to disprove Duesberg's drug-
AIDS hypothesis, because it does not provide controls--i.e., confirmed drug-
free AIDS cases--and because it does not quantify drug use and ignores AZT
use altogether. To refute Duesberg's hypothesis Schechter would have to
produce a controlled study demonstrating that over a period of up to 10 years
HIV-positive patients who use recreational drugs or AZT or both have the same
AIDS risks as positives who do not do so. The 10 year period is claimed by
HICNet Medical Newsletter Page 45
Volume 6, Number 11 April 25, 1993
proponents of the HIV hypothesis to be the time needed for HIV to cause AIDS.
Alternatively, they could show that HIV-free individuals who have used drugs
for 10 years never get AIDS-defining illnesses, concludes Duesberg.
================================================================
"Rapid Decline of CD4+ Cells After IFNa Treatment in HIV-1 Infection"
Lancet (04/10/93) Vol. 341, No. 8850, P. 959 (Vento, Sandro et al.)
Interferon (IFN), which induces autoantibodies and autoimmune diseases
in some settings, may hasten CD4 T-cell loss in some HIV-1 infected
individuals through the amplification of harmful "autoimmune" reactions,
write Sandro Vento et al. of the A. Pugliese Hospital in Catanzaro, Italy.
The researchers report three asymptomatic HIV-1 infected individuals with
hepatitis C Virus related chronic active hepatitis (CAH) who had a rapid,
profound decline of CD4 cells after IFN. All three patients throughout the
observation were consistently negative for serum HIV p24 antigen and had
circulating antibodies to p24. Sera from all three patients, obtained at the
end of IFN treatment and testing in enzyme-linked immunosorbent assay,
contained high titres of antibodies reacting to a sequence located in the
aminoterminal of the beta chain of all human HLA class II antigens,
homologous to a sequence located in the carboxy terminus of HIV-1 gp41.
These autoantibodies, which also recognize "native" class II molecules and
may contribute to the elimination of CD4 T cells "in vivo", were at low tires
(50-100) in all three patients six months after stopping IFN. Such
autoantibodies were not detected in 28 other patients with HIV infection and
HCV related CAH treated with IFN and who did not experience CD4 T-cell loss
in some HIV-1 infected individuals through the amplification of harmful
"autoimmune" reactions. The subjects had A1; B8; DR3; and B35, DR1 HLA
antigen combinations which are linked with a more rapid fall in CD4 cell
counts and clinical progression of HIV-1 disease. IFN can induce a very
rapid decline of CD4 cells and should be used cautiously in patients with
these HLA haplotypes, the researchers conclude.
================================================================
April 23, 1993
================================================================
"TB Makes a Comeback" State Government News (04/93) Vol. 36, No. 4, P. 6
(Voit, William and Knapp, Elaine S.)
Although tuberculosis was once believed to be eliminated in the United
States, it is emerging again among the homeless, AIDS patients, immigrants,
minorities, and prisoners. Dr. Lee B. Reichman, professor of medicine at the
University of New Jersey Medical School and president of the American Lung
Association, said, "Right now, it's a big city problem, but potentially it's
everyone's problem." The ALA predicts that 10 million Americans are infected
with TB, and about 10 percent of them will develop the disease because their
immune systems are depressed, especially those with AIDS or HIV. Gene
HICNet Medical Newsletter Page 46
Volume 6, Number 11 April 25, 1993
Tammes, a Centers for Disease Control expert, said that is why the CDC has
issued guidelines warning hospitals and institutions not to mix AIDS with TB
patients. State health officials believe the TB is also spreading because
those who are most susceptible are the least likely to follow through with
treatment. In addition, the increase is attributed to a shortage of public
health services. In New York City, TB is an epidemic "because the number of
cases is increasing faster than we can treat people," said Dr. George
Diferdinando, director of the New York State TB Control. According to
Diferdinando, curbing the spread of TB entails keeping 85 percent or more of
diagnosed TB cases in treatment. About 40 percent of infected New York City
residents don't complete therapy. When TB patients don't finish taking their
medication, multi-drug resistant TB can develop, which requires taking more
expensive drugs and can take two years instead of the normal six months to
treat.
================================================================
"Increasing Frequency of Heterosexually Transmitted AIDS in Southern
Florida: Artifact or Reality?" American Journal of Public Health (04/93) Vol.
83, No. 4, P. 571 (Nwanyanwu, Okey C. et al.)
The alarmingly high rate of heterosexually acquired AIDS cases in
southern Florida was partially related to misclassification of risk, write
Okey C. Nwanyanwu et al. of the Centers for Disease Control in Atlanta, Ga.
The researchers investigated 168 such AIDS cases from Broward and coastal
Palm Beach counties. All of these cases attributed to heterosexual
transmission reported sexual contact with bisexual men, injecting drug users,
or persons born in countries where heterosexual contact is the primary route
of HIV transmission. Medical records of patients, in addition to records
from social services, HIV counseling and testing centers, and sexually
transmitted disease (STD) clinics were reviewed. If no other HIV risk factor
was found from medical record review, patients were interviewed using a
standardized questionnaire. Once STD clinic and other medical records were
reviewed, 29 men and 7 women were reclassified into other HIV transmission
categories. After adjustments were made for the reclassification, the
percentage of AIDS cases reported from Palm Beach and Broward counties
between January 1, 1989, and March 31, 1990, that was attributed to
heterosexual transmission decreased from 10 percent to 6 percent among men
and from 33 percent to 28 percent among women. While the percentage of
heterosexually transmitted AIDS cases in southern Florida decreased after
adjustment was made for reclassified cases, it still remained above the
national average, the researchers conclude.
HICNet Medical Newsletter Page 47
Volume 6, Number 11 April 25, 1993
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
AIDS Statistics
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
World Health Organization, Geneva
Organisation mondiale de la Sante, Geneve
WEEKLY EPIDEMIOLOGICAL RECORD
RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE
15 January 1993 - 68th Year
ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)
DATA AS AT 31 December 1992
SYNDROME D'IMMUNODEFICIENCE ACQUISE (SIDA)
DONNEES AU 31 Decembre 1992
NUMBER DATE OF
OF CASES REPORT
COUNTRY/AREA - NOMBRE DATE
PAYS/TERRITOIRE DE CAS DE
NOTIFI-
CATION
AFRICA - AFRIQUE
Algeria - Algerie 92 31.08.91
Angola 514 24.09.92
Benin - Benin 247 31.03.92
Botswana 353 30.06.92
Burkina Faso 1,263 20.03.92
Burundi 6,052 20.03.92
Cameroon - Cameroun 1,407 05.10.92
Cape Verde - Cap-Vert 52 08.02.92
Central African Republic -
Republique centrafricaine 1,864 20.03.92
Chad - Tchad 382 17.09.92
Comoros - Comores 3 11.03.92
Congo 3,482 30.01.92
Cote d'Ivoire 10,792 09.03.92
Djibouti 265 17.12.92
Egypt - Egypte 57 17.12.92
Equatorial Guinea -
Guinee equatoriale 13 16.05.92
Ethiopia - Ethiopie 3,978 11.11.92
HICNet Medical Newsletter Page 48
Volume 6, Number 11 April 25, 1993
Gabon 215 31.05.92
Gambia - Gambie 180 25.02.92
Ghana 3,612 01.07.92
Guinea - Guinee 338 20.03.92
Guinea-Bissau - Guinee-Bissau 189 13.07.92
Kenya 31,185 01.10.92
Lesotho 64 31.03.92
Liberia - Liberia 28 31.03.92
Libyan Arab Jamahiriya -
Jamahiriya arabe libyenne 7 17.12.92
Madagascar 2 06.11.92
Malawi 22,300 02.12.92
Mali 1,111 17.07.92
Mauritania - Mauritanie 36 19.07.92
Mauritius - Maurice 11 29.02.92
Morocco - Maroc 121 17.12.92
Mozambique 538 10.10.92
Namibia - Namibie 311 20.03.92
Niger 497 07.02.92
Nigeria - Nigeria 184 12.03.92
Reunion - Reunion 65 20.03.92
Rwanda 8,483 12.11.92
Sao Tome and Principe -
Sao Tome-et-Principe 11 03.07.92
Senegal - Senegal 648 09.03.92
Seychelles --- 18.02.92
Sierra Leone 40 20.03.92
Somalia - Somalie 13 17.12.92
South Africa -
Afrique du Sud 1,316 30.06.92
Sudan - Soudan 650 17.12.92
Swaziland 197 08.07.92
Togo 1,278 03.04.92
Tunisia - Tunisie 114 17.12.92
Uganda - Ouganda 34,611 01.11.92
United Republic of Tanzania -
Republique-Unie de
Tanzanie 34,605 31.05.92
Zaire - Zaire 18,186 14.05.92
Zambia - Zambie 6,556 15.10.92
Zimbabwe 12,514 31.03.92
TOTAL 211,032
HICNet Medical Newsletter Page 49
Volume 6, Number 11 April 25, 1993
AMERICAS - AMERIQUES
Anguilla 6 10.12.92
Antigua and Barbuda -
Antigua-et-Barbuda 6 10.12.92
Argentina - Argentine 1,820 10.12.92
Bahamas 934 10.12.92
Barbados - Barbade 315 10.12.92
Belize 53 10.12.92
Bermuda - Bermudes 199 10.12.92
Bolivia - Bolivie 49 10.12.92
Brazil - Bresil 31,364 10.12.92
British Virgin Islands -
Iles Vierges
britanniques 4 10.12.92
Canada 6,889 10.12.92
Cayman Islands - Iles Caimanes 13 10.12.92
Chile - Chili 573 10.12.92
Colombia - Colombie 2,957 10.12.92
Costa Rica 419 10.12.92
Cuba 137 10.12.92
Dominica - Dominique 12 10.12.92
Dominican Republic -
Republique dominicaine 1,809 10.12.92
Ecuador - Equateur 224 10.12.92
El Salvador 382 10.12.92
French Guiana -
Guyane francaise 232 10.12.92
Grenada - Grenade 32 10.12.92
Guadeloupe 182 10.12.92
Guatemala 273 10.12.92
Guyana 333 10.12.92
Haiti - Haiti 3,086 10.12.92
Honduras 1,976 10.12.92
Jamaica - Jamaique 361 10.12.92
Martinique 227 10.12.92
Mexico - Mexique 11,034 10.12.92
Montserrat 1 10.12.92
Netherlands Antilles and Aruba -
Antilles neerlandaises et
Aruba 110 10.12.92
Nicaragua 31 10.12.92
Panama 388 10.12.92
Paraguay 51 10.12.92
Peru - Perou 614 10.12.92
HICNet Medical Newsletter Page 50
Volume 6, Number 11 April 25, 1993
Saint Kitts and Nevis -
Saint-Kitts-et-Nevis 37 10.12.92
Saint Lucia - Sainte-Lucie 48 10.12.92
Saint Vincent and the
Grenadines - Saint-
Vincent-et-Grenadines 41 10.12.92
Suriname 122 10.12.92
Trinidad and Tobago -
Trinite-et-Tobago 1,085 10.12.92
Turks and Caicos Islands -
Iles Turques et
Caiques 25 10.12.92
United States of America -
Etats-Unis d'Amerique 242,146 10.12.92
Uruguay 310 10.12.92
Venezuela 2,173 10.12.92
TOTAL 313,083
ASIA - ASIE
Afghanistan --- 17.12.92
Bahrain - Bahrein 3 31.03.92
Bangladesh 1 30.11.92
Bhutan - Bhoutan --- 30.11.92
Brunei Darussalam -
Brunei Darussalam 2 19.12.91
Burma see Myanmar -
Birmanie voir Myanmar
Cambodia - Cambodge --- 31.10.92
China(a) - Chine(a) 11 28.04.92
Cyprus - Chypre 24 17.12.92
Democratic People's Republic
of Korea - Republique
populaire democratique
de Coree --- 30.11.92
Hong Kong 61 26.09.92
India - Inde 242 30.11.92
Indonesia - Indonesie 24 30.11.92
Iran (Islamic Republic of) -
Iran (Republique
islamique d') 56 17.12.92
Iraq 7 17.12.92
Israel - Israel 192 17.12.92
HICNet Medical Newsletter Page 51
Volume 6, Number 11 April 25, 1993
Japan - Japon 508 04.12.92
Jordan - Jordanie 24 17.12.92
Kuwait - Koweit 7 17.12.92
Lao People's Democratic Republic -
Republique democratique
populaire lao 1 23.04.92
Lebanon - Liban 35 17.12.92
Macao 2 03.11.92
Malaysia - Malaisie 46 25.05.92
Maldives --- 30.11.92
Mongolia - Mongolie 1 30.11.92
Myanmar 16 30.11.92
Nepal - Nepal 12 30.11.92
Oman 27 17.12.92
Pakistan 25 17.12.92
Philippines 80 07.10.92
Qatar 31 17.12.92
Republic of Korea -
Republique de Coree 10 19.11.92
Saudi Arabia - Arabie saoudite 46 17.12.92
Singapore - Singapour 43 05.08.92
Sri Lanka 20 30.11.92
Syrian Arab Republic -
Republique arabe syrienne 19 17.12.92
Thailand - Thailande 909 30.11.92
Turkey - Turquie 89 17.12.92
United Arab Emirates - Emirats
arabes unis 8 17.12.92
Viet Nam --- 28.04.92
Yemen - Yemen --- 17.12.92
TOTAL 2,582
EUROPE
Albania - Albanie --- 30.09.92
Austria - Autriche 828 30.09.92
Belarus - Belarus 6 30.09.92
Belgium - Belgique 1,224 17.12.92
Bulgaria - Bulgarie 16 17.12.92
Czechoslovakia - Tchecoslovaquie 32 17.12.92
Denmark - Danemark 1,072 17.12.92
Finland - Finlande 112 17.12.92
HICNet Medical Newsletter Page 52
Volume 6, Number 11 April 25, 1993
France 21,487 17.12.92
Germany - Allemagne 8,893 17.12.92
Greece - Grece 689 17.12.92
Hungary - Hongrie 105 17.12.92
Iceland - Islande 22 17.12.92
Ireland - Irlande 294 17.12.92
Italy - Italie 14,783 17.12.92
Latvia - Lettonie 2 30.09.92
Lithuania - Lituanie 2 30.09.92
Luxembourg 55 17.12.92
Malta - Malte 25 17.12.92
Monaco 9 17.12.92
Netherlands - Pays-Bas 2,330 17.12.92
Norway - Norvege 283 17.12.92
Poland - Pologne 118 17.12.92
Portugal 1,007 17.12.92
Romania - Roumanie 2,073 17.12.92
Russian Federation - Federation
de Russie 94 30.09.92
San Marino - Saint-Marin 1 17.12.92
Spain - Espagne 14,991 17.12.92
Sweden - Suede 743 17.12.92
Switzerland - Suisse 2,691 17.12.92
United Kingdom - Royaume-Uni 6,510 17.12.92
Yugoslavia(b) - Yougoslavie(b) 313 30.09.92
TOTAL 80,810
OCEANIA - OCEANIE
American Samoa - Samoa americaines --- 18.11.92
Australia - Australie 3,615 02.12.92
Cook Islands - Iles Cook --- 18.02.92
Federated States of Micronesia -
Etats federes de Micronesie 2 01.09.92
Fiji - Fidji 4 28.11.91
French Polynesia - Polynesie francaise 27 28.11.91
Guam 10 13.09.91
Kiribati --- 08.11.91
Mariana Islands - Iles Mariannes 4 14.10.92
Marshall Islands - Iles Marshall 2 18.03.91
Nauru --- 17.12.92
New Caledonia and Dependencies -
HICNet Medical Newsletter Page 53
Volume 6, Number 11 April 25, 1993
Nouvelle-Caledonie et
dependances 22 26.08.92
New Zealand - Nouvelle-Zelande 348 03.11.92
Niue --- 18.02.92
Palau --- 15.10.92
Papua New Guinea - Papouasie-
Nouvelle-Guinee 45 10.08.92
Samoa 1 18.02.92
Solomon Islands - Iles Salomon --- 19.12.91
Tokelau --- 18.02.92
Tonga 2 24.07.92
Tuvalu --- 22.11.92
Vanuatu --- 08.06.92
Wallis and Futuna Islands - Iles
Wallis et Futuna --- 27.05.91
TOTAL 4,082
WORLD TOTAL -
TOTAL MONDIAL 611,589
(a) The above statistics relating to China do not include 48 cases of AIDS in
the Province of Taiwan. -- Les statistiques ci-dessus se rapportant a la Chine
ne comprennent pas 48 cas de SIDA dans la province de Taiwan.
(b) Refers to Republics and areas of the former Socialist Federal Republic of
Yugoslavia: Bosnia and Herzegovina; Croatia; Macedonia; Montenegro;
Serbia; Slovenia. -- Se refere aux republiques et territoires de l'ancienne
Republique federative socialiste de Yougoslavie: Bosnie-Herzegovine; Croatie;
Macedoine; Montenegro; Serbie; Slovenie.
HICNet Medical Newsletter Page 54
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