Date: Wed, 28 Dec 1994 12:49:06 -0500 From: awilson@smtpinet.aspensys.com (Wilson, Anne) AIDS Daily Summary December 28, 1994 The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse makes available the following information as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1994, Information, Inc., Bethesda, MD ************************************************************ "Study: Women With AIDS Die Faster Than Men" "A Rare Mix of Tenants" "Rough Treatment for AIDS" "Patients of British AIDS Surgeon Warned" "Non-Cytolytic CD8 T-Cell Anti-HIV Responses in Primary HIV-1 Infection" "A Comparison of Calculated Energy Requirements to Measured Resting Energy Expenditure in HIV-1-Infected Subjects" "Needle-Exchange Programs Backed" "Medical Briefs: Aspirin and Its HIV Effects" "AIDS: Is There a Turnaround in Sight?" "Care and Prevention: Hand in Hand" ************************************************************ "Study: Women With AIDS Die Faster Than Men" Washington Post (12/28/94) P. A7 A University of Minnesota study has found that HIV-infected women have shorter survival rates than men who are HIV-infected. The study, which followed both men and women at health centers around the United States, showed that women with HIV were 33 percent more likely to die than men who were comparably ill. The researchers, led by epidemiologist Sandra L. Melnick, said there was no apparent medical reason for the difference. Women, however, may wait until they are sicker before seeking treatment, or they may receive different treatment, the researchers speculated. Twice as often in women as in men, death was the first sign of HIV progression, while the first signs of disease progression in men were likely to be bouts of pneumonia or fungal infections. The study is not only the largest and longest to explore the differences in HIV disease between genders, but also one of the most representative. Fifty percent of the subjects were black or Hispanic and 20 percent were women. The study's scope included information on homelessness and poverty, both of which are important elements in life expectancy for people with HIV, said Renslow Sherer, director of the Cook County HIV Primary Care Center in Chicago. Related Stories: New York Times (12/28) P. C10; Baltimore Sun (12/28) P. 3A "A Rare Mix of Tenants" New York Times (12/28/94) P. B1; Foderaro, Lisa W. Common Ground Community, a nonprofit housing and economic development organization, owns and manages the former Times Square Hotel in New York City. Once one of the most notorious welfare hotels, it has become a kind of social experiment where AIDS patients, formerly homeless people, mentally ill individuals, and working people all live together in the newly restored building. The two groups that provide a range of social services for the residents, Common Ground and the Center for Urban Community Services, are trying to prove that single-room-occupancy hotels can be saved, and that they can become more than dumping grounds for people with problems. While they saw the clear reasons for offering low-rent apartments to working people, they also knew the mix of tenants would be healthy for their clients. "Most of our special-needs tenants have never lived in a place where they had examples of people who got up in the morning and went to work, people whose lives functioned," said Rosanne Haggerty, executive director of Common Ground. Although the some nearby businesses initially had doubts, the plan has been enthusiastically supported. Money for social services has come from sources including the city's Division of AIDS Services, the Department of Homeless Services, and the federal Department of Housing and Urban Development. "Rough Treatment for AIDS" Boston Globe (12/26/94) P. 52; Lewis, Diane E. HIV patients from around the country have stories of either receiving insufficient treatment or of being denied medical care--which is a violation of federal and state laws as well as of professional and ethical standards requiring fair treatment for all patients. The Gay and Lesbian Advocates and Defenders (GLAD) and the AIDS Action Committee have drafted a bill in Massachusetts that would link licensure of all health professionals to mandatory AIDS education and training. The groups believe that stiff penalties would prevent bias from occurring. Physicians, however, say they have the right to recommend specialized care to clients who require it, and that a referral should not be seen as an attempt to deny treatment to a patient. The American Medical Association's (AMA) guidelines dictate that a physician may not ethically refuse treatment to a patient whose condition is within his realm of expertise just because the patient has HIV. The AMA also says that a doctor should be free to choose whom they serve and, if unable to perform services required by patients with HIV or AIDS, should make referrals. Many AIDS activists say that too many medical professionals are using that guideline as a loophole to avoid treating HIV patients. "Patients of British AIDS Surgeon Warned" Reuters (12/24/94) Medical officials in Scotland have started tracing patients who may have been exposed to HIV by an infected surgeon. A hotline for worried patients was filled with calls soon after the doctor's name was released. A leading ear specialist, George Browning, agreed to be publicly named to narrow the list of past patients who may need reassurance. Officials of the Greater Glasgow Health Board emphasized that there has not been one recorded instance worldwide of a patient being infected by a surgeon. While several patients of a Florida dentist were found to be HIV-infected after the dentist died of AIDS, there is controversy over whether he infected them or not. Under British guidelines, Browning will no longer operate on patients, although he will be able to continue consulting and teaching. "Non-Cytolytic CD8 T-Cell Anti-HIV Responses in Primary HIV-1 Infection" Lancet (12/17/94) Vol. 344, No. 8938, P. 1671; Mackewicz, Carl E.; Yang, Limei C.; Lifson, Jeffrey D. et al While acute HIV infection is accompanied by a significant increase in virus titres that soon fall, the role of humoral and cellular immunity is not clear in the control of virus replication. Researchers studying seven HIV-infected patients found that a non-cytolytic CD8 T-cell response preceded seroconversion. The response was inversely related to the level of plasma viremia in some of the subjects. During follow-up, only two patients developed neutralizing antibodies. The results suggest that cellular immune responses, reflected by non-cytolytic CD8 cell anti-HIV activity, may control viral replication soon after replication. "A Comparison of Calculated Energy Requirements to Measured Resting Energy Expenditure in HIV-1-Infected Subjects" Journal of the Association of Nurses in AIDS Care (11/94-12/94) Vol. 5, No. 6, P. 30; Anderson, Robin; Grady, Christine; Ropka, Mary HIV-infected individuals are particularly susceptible to nutritional changes, such as weight loss and malnutrition. To compare calculated energy need of HIV-infected patients to measured energy consumption, researchers studied 20 HIV-positive patients. The subjects, who were part of clinical drug trials conducted by the National Institute of Allergy and Infectious Diseases, underwent indirect calorimetry measurements. Energy requirements for the subjects were also calculated using the Harris Benedict Equation (HBE), a multiparameter linear regression formula for calculating resting energy expenditure. The findings suggest that calculating energy expenditure for HIV-infected people using a standard formula such as HBE consistently underestimates actual energy expenditure in this population. "Needle-Exchange Programs Backed" American Medical News (12/19/94) Vol. 37, No. 47, P. 8; Hearn, Wayne American Medical Association (AMA) delegates to the AMA Interim Meeting voted to encourage needle-exchange programs as an effective method of reducing the spread of HIV, AIDS, and other diseases in drug users who otherwise would share infected needles. The delegates also supported the study of compassionate prescribing of therapeutic components of marijuana. The original version of the measure called for studying marijuana prescribing as a means to relieve the pain associated with diseases such as cancer and AIDS. The final version, however, limited the evaluation to "noninhaled" preparations of cannabinoids--the components of marijuana that are believed to contain therapeutic properties--because of concerns about the health risks of smoking marijuana, the difficulty of constructing single and double-blind studies for smoked marijuana, and concern that such an action would be seen as endorsing legalization or decriminalization. Finally, the delegates approved a measure supporting further study of "harm reduction" strategies such as decriminalization, needle-exchanges, and methadone maintenance. "Medical Briefs: Aspirin and Its HIV Effects" Advocate (12/13/94) No. 670, P. 37 Researchers in New York City are conducting a study to examine the effects of high-dose aspirin intake on HIV. They are trying to determine whether aspirin reduces the viral load carried by the patients. Previous studies have found that in the laboratory, aspirin inhibits the activation of a nuclear factor that has a role in coordinating chemical messenger communications between cells. "AIDS: Is There a Turnaround in Sight?" Health (11/94-12/94) Vol. 8, No. 7, P. 22; Hastings, John; Long, Patricia; Mason, Michael In New York City, prevention has proved to be an effective measure in the battle against AIDS. Sociologist Martina Morris and AIDS researcher Laura Dean conducted a study to determine how much safe sex is necessary to reduce HIV infections in gay men. Morris and Dean entered data obtained from a seven-year survey of 1,025 homosexuals in New York into a computer program that predicts trends in HIV prevalence based on behavior. They found that gay men have reduced the rate of new infections to the "epidemic threshold," the mass that HIV needs to perpetuate itself in the community. If gay men continue to practice safe sex, HIV should slowly become less common. Morris, however, admitted that it could be decades before the rate drops from the estimated 50 percent in New York and San Francisco to less than 5 percent. "Care and Prevention: Hand in Hand" Focus (11/94) Vol. 9, No. 12, P. 1; Coates, Thomas A wide range of psychosocial findings was presented at this summer's Tenth International Conference on AIDS. Stefano Bertozzi of the World Health Organization's Global Programme on AIDS, for example, discussed how the burden of caring--especially in developing countries--falls to households and not to professionals. Psychosocial interventions should concentrate on ways to ease the burden. Presentations at the conference also endorsed the value of school-based prevention programs, but questioned the need and efficacy of interventions for all students. Prevention strategies for women continued to emphasize power dynamics and coercion. Cynthia Gomez reported the incidence of sexual coercion among unmarried Latino women in the United States. More than 70 percent of the women who had sex with men in the prior year reported that their partners insisted on sex when the women were not interested. Topics that were not discussed in public 10 years ago are being talked about more commonly now; these conversations are leading to progress.