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Issue #177: May 17, 1998
fastfax is available by fax in the 215 and 610 area codes at no cost, or by mail anywhere for $20.00 per year, by calling 215-545-6868, and by E-mail by contacting and type the message SUBSCRIBE in the message section. Sources for some information in this issue include AIDS, Journal of the American Medical Association, Reuters, Science.We The People to seek new director
Mutations may explain failure of PCP treatments
Black Caucus calls for "AIDS emergency"
Scientists find switch that counterattacks HIV
Durability of HIV therapy still unknown
Teen boys at higher risk of HIV
June Wellness schedule announced
We The People to seek new director
We The People's board of directors announced this week that Curtis Osborne, who has served as interim executive director of the organization since last May, will leave that post on June 30th. Osborne had assumed the position when former WTP director Joe Cronauer left to become interim co-director of the AIDS Activities Coordinating Office.Robert Capone, who currently serves as We The People's Education Director, will replace Osborne as interim director on July 1st. The board said it will conduct a search for a new director beginning next month.
At a meeting on May 13th, the board voted on the staff changes as a result of concerns about communications problems between the staff and the board, as well as complaints from We The People members about changes to the operations of We The People's Life Center, which is a drop-in center for people living with HIV/AIDS. The board was also concerned that Osborne did not have the fundraising skills required for the permanent director's job, especially in light of recent cuts in some city funding for WTP programs.
Board president Marvin Crawford said that the board felt the need to act on the director's position because of new pressures resulting from the implementation of The Village Project, a new federally-funded HIV prevention case management project jointly run by WTP and three other organizations, and the coming opening of Marlton Court, a new 25-unit apartment building for low-income people with AIDS in West Philadelphia.
Crawford thanked Osborne for helping We The People through the last year, which was more difficult because of the need to redefine some WTP programs in light of changes in city and federal regulations for public funding. "Curtis came in at a time when we needed a strong leader to help us," especially in light of Cronauer's unplanned departure, Crawford said.
Crawford also said that he was angered by "ridiculous and unfounded rumors" which have spread in the AIDS community as a result of the board's action. "There has been absolutely no issue about honesty or integrity in this process," he said. "Nobody has stolen or mismanaged any money and no one has mis-used their position at We The People. Curtis is an honest man who did a good job, and the only reason we need to make a change is that we believe we need someone with stronger fundraising and administrative skills."
Melody Crawford, WTP's Life Center Coordinator, had previously announced her resignation by the end of May. She will be replaced on an interim basis in that position by Warren Hunt, who previously served as WTP's Crisis Intervention Case Manager. Ellis Morrison, a former WTP board member, will manage WTP's Positive Voices Outreach Team during the transition period.
Mutations may explain failure of PCP treatments
Despite prophylactic treatment with sulfa and sulfone drugs, some people with AIDS still develop Pneumocystis carinii pneumonia (PCP). Now, a multicenter group reports the first evidence "...that mutations in the P. carinii DHPS gene, the sulfa and sulfone drug target, are associated with sulfa prophylaxis failure in AIDS patients."Dr. Powell Kazanjian of the University of Michigan Medical Center evaluated portions of the gene for P. carinii DHPS in preserved specimens obtained from 27 HIV-positive patients diagnosed with PCP. Most of the subjects had AIDS and seven of these patients were on PCP prophylaxis with sulfa or sulfone drugs. The investigators' findings appear in the May 7th issue of AIDS.
Dr. Kazanjian's group found mutations at two amino acid positions, which are believed to be involved in substrate and sulfa binding. "Mutations were observed in five (71%) out of seven isolates from AIDS patients receiving sulfa/sulfone as prophylaxis compared with only two (15%) out of 13 specimens from AIDS patients who [were not receiving prophylaxis]," they write. In addition, they observed no mutations in the isolates from seven HIV-negative controls not on prophylaxis.
"The importance of this study is that it documents mutations in pneumocystis in HIV/AIDS patients," Dr. Kazanjian comments in a University of Michigan press release. "It is possible that the mutations may lead to resistance to sulfa in pneumocystis."
Larger studies are needed to confirm these findings, the researchers point out. However, "...the results of this study underscore the need for the development of new agents for the prophylaxis and therapy of PCP."
Black Caucus calls for "AIDS emergency"
The Congressional Black Caucus (CBC) has asked Donna Shalala, Secretary of Health and Human Services, to declare the HIV/AIDS epidemic in the African American community a "public health emergency," according to a CBC press release.On Monday, Congresswoman Maxine Waters, D-California, CBC chairwoman, held a meeting in Washington, DC, to drawn attention to the alarming increase in HIV/AIDS in the African American community. The CBC meeting consisted of more than 20 public health workers, AIDS activists and representatives from across the nation. The goal was to assess the current situation and to determine the steps needed to deal with this crisis, Rep. Waters said.
Rep. Waters also quoted figures from a recent survey on African Americans conducted by the Kaiser Family Foundation. As previously reported by Reuters Health, 43% of new AIDS cases in 1996 were among African Americans, while African Americans only make up 12% of the US population. "AIDS is now the leading cause of death among African Americans, age 25 to 44," Rep. Waters continued.
CBC members highlighted some areas of AIDS health care delivery that need attention. Some of their recommendations include the integration of substance abuse treatment with HIV prevention and care, development of a strategy to deal with HIV-positive prison populations and creation of a comprehensive strategy to combat anti-gay bias. The group also condemned the Clinton Administration for approving syringe exchange strategies but prohibiting the use of federal funds to support them.
Other important areas include targeting HIV/AIDS resources to African American women and children, the fastest growing group with new HIV infection, and encouraging more healthcare professionals and researchers to serve African American communities.
"This is only the beginning of our efforts," Rep Waters continued. "We must exert the political will necessary to take on HIV/AIDS in those communities where it is reaching epidemic proportions. This is a national crisis."
Scientists find switch that counterattacks HIV
Researchers have announced that they have found a chemical signal that acts as a "master switch" to turn on the body's immune defenses against HIV and other invaders.Knowing more about this mechanism could help efforts to develop a vaccine against HIV, Dr. Richard Kornbluth and colleagues at the University of California San Diego said.
"This is potentially important information to incorporate in efforts to design an HIV vaccine, giving us a focus for boosting the body's own natural response system at the earliest possible stage of HIV infection, in order to prevent the destruction of the immune system," Kornbluth said in a statement.
The switch, known as the CD40 ligand, starts a cascade of immune reactions, they wrote in a report in the Proceedings of the National Academy of Sciences. First CD40 stimulates the
macrophages, immune cells that scavenge up invaders. The macrophages produce beta-chemokines, immune system signaling chemicals.
These chemokines protected another kind of immune cell, the CD4 T-cell, from infection by HIV, Kornbluth's group wrote.
To get into a T-cell, HIV uses some of the same receptors, or chemical doorways, as chemokines -- especially RANTES. So if the chemokine gets there first, it effectively can block the doorway.
That is what happened, according to Kornbluth. "This pathway may play a role in anti-HIV immunity," the researchers wrote.
"The discovery of CD40L as a master switch in the immune system was one of the most important recent developments in studies of the human immune system," Kornbluth added.
"Our findings indicate that when this switch is turned on, specific cells make proteins which appear to prevent HIV from infecting T-cells, and which also seem to recruit more immune cells to the site of infection as reinforcements to the developing immunological battlefield."
They said their findings also had implications for cancer, chronic inflammatory conditions such as Crohn's disease and lupus, as well as atherosclerosis or clogging of the arteries and multiple sclerosis.
Durability of HIV therapy still unknown
Despite the real and dramatic effects of highly active antiretroviral therapies for HIV infection, limitations are becoming apparent, according to two prominent AIDS experts based in San Francisco General Hospital in California.In the May 6th issue of the Journal of the American Medical Association, Drs. Paul A. Volberding and Steven G. Deeks summarize some of the salient issues concerning antiretroviral therapy that currently confront clinicians.
In early 1996, they note, the results of the Merck 035 protocol, a pivotal phase 2 study, indicated that treatment with two nucleoside reverse transcriptase inhibitors and a protease inhibitor could suppress HIV RNA to undetectable levels. After the results were announced, combination treatment became the standard of care.
While 80% of patients who remained in the Merck 035 study for 2 years maintained undetectable plasma HIV RNA levels, the question of the moment is how long the clinical effects of highly active antiretroviral therapy will last, Dr. Volberding said.
"It seems to me that we have proven beyond any reasonable doubt that these therapies can be strikingly effective," he pointed out. "The clinical situation right now among patients who are on therapy is typically quite good. The patients are feeling well, they're not developing opportunistic infections, [and] their CD4 counts have increased."
The central question is how long can this continue, because many of these patients who are doing well have failed therapy, in a virologic sense, in that they're not maintaining strict control over HIV replication, he explained.
"At this point, we don't really have many patients who are starting to fail immunologically," Dr. Volberding continued. "In fact, the patients that we have really are still doing quite well, so we're desperate for this answer."
In patients with established infection, at 3 to 6 months after the initial infection, "...the evidence isn't very encouraging in terms of curability," he continued. At this point, it appears that "...there is enough ongoing replication even in the presence of aggressive therapy that cure or eradication is unlikely," he continued.
"I think the emerging focus in the area of potential eradication is on acute infection; finding those patients who have just gotten infected." Dr. Volberding said his team at San Francisco General is very involved in this effort, and a large trial of this type is currently being planned.
In 1996, researchers began to investigate the feasibility of eradicating HIV using highly active antiretroviral therapy in patients still in the acute stages of HIV infection Drs. Volberding and Deeks write in their review. Using mathematical models, researchers predicted that HIV eradication could be accomplished within 1-to-3 years.
"This optimism has been challenged by several recent observations, including reports that a small proportion of resting CD4 memory cells from treated patients with undetectable plasma HIV RNA levels harbor integrated replication competent HIV proviral DNA, and that the half-life of these cells may be on the order of months to years," they commented.
New classes of antiretroviral drugs for HIV infection are needed, Dr. Volberding continued in his interview. HIV integrases, fusion inhibitors, the so-called "zinc finger" inhibitors are among some of the classes currently under investigation. "We're fortunate, in a sense, that there are some candidates." The problem is that the development of these drugs is not progressing rapidly.
Dr. Volberding hopes that companies that have made progress will to continue to work to develop these new agents, but he expressed some concern that many of these companies are small. He believes it would be useful if some larger companies could get involved.
Teen boys at higher risk of HIV
A new, more private computer-aided survey technique of high risk behavior among teenage boys may have unmasked a far higher level of potential exposure to HIV infection than earlier polls have suggested.Using this technique, researchers found that three or four times the number of teenage boys reported male-male sex, injection drug use, and sexual contact with intravenous drugs users, than other surveys have revealed. The report appeared in the journal Science.
The researchers looked at sexual behavior, drug use and violence, and included conduct, such as homosexual relationships that boys might be reluctant to tell an interviewer.
"Our findings indicate that this new technology encourages more complete reporting of these risk behaviors than traditional survey techniques," said Charles F. Turner, lead author for the article and Director of the Program in Health and Behavior Measurement for the Research Triangle Institute in Washington.
The number of boys reporting more accepted behavior, such as boy-girl sexual contact or drinking alcoholic beverages, was in line with what had been found in the past, Turner said.
They interviewed 1,729 black, white and Hispanic boys, ages 15 to 19 years old, about their sexual behavior, drug use and violence. The technique allowed the boys to listen to spoken questions over headphones and answer by pressing numbered keys on a laptop computer.
This was designed to both eliminate the potential embarrassment of telling an interviewer about their behavior, but also allowed responses from those who were not sufficiently literate to read, understand and follow directions on a written survey.
Results showed that reporting so-called stigmatized behavior, such as male to male sexual contact, use of needles with certain kinds of street drugs or sexual contact with intravenous drug users, correlated more closely with such reports by adults when asked about their own adolescence. Figures obtained using traditional face-to-face interviewing and paper and pencil written surveys usually were lower than those from polls of adults talking about their teenage years, Turner said.
"Our findings suggest there has been significant underreporting of these behaviors," Turner said. "We think wider application of this method could improve the reporting of stigmatized behaviors."
Therapists in the field are not surprised that teenagers are more reluctant to talk about these subjects, but note that the findings show they will have to be more diligent and patient when interviewing patients.
"As a clinician we pay attention to these kinds of numbers in terms of reinforcing the idea that you can't sit back and wait for people to tell you," Dr. Henry Gault, a spokesman for the American Academy of Child and Adolescent Psychiatry and a psychiatrist in private practice in Northbrook, Ill., said. "You have to be more assertive in a gentle, sensitive way in getting these things out."
June Wellness schedule announced
June workshops in the "Maintaining Wellness Series" sponsored by ActionAIDS' ACT Program have been announced by series coordinator Kevin D. Greene. All workshops are participatory with pre-registration required, Greene said.This month's offerings include:
Wednesday, June 24th @7:00 p.m. - 9:00 p.m.
Dr. Frank Wyatt, Naturopath. According to Dr. Wyatt there are ways to test your herbs, vitamins, and other nutritional supplement to make sure they are the right ones for you. Do you have questions about what to take? Come learn information that can keep you from guessing and help you to make a smart decision. Knowledge plus right action = optimum health! Pre-registration is required!
June 1, 8, 22, 29 @ 3:00 p.m. - 5:00 p.m.
"Qi Gong Series" - "Qi Gong is the art of developing vital energy for health, vitality, mind expansion and spiritual cultivation." How can you have more energy, shake off depression, and decrease some of those aches and pains? Qi Gong! This class is powerful! Daily Practice gives best results.
Mondays, June 1, 8, 22, 29 @ 6:00 -- 7:30 P.M.
Reiki Sharing: Come experience a Reiki Treatment!
Reiki is a form of healing energy used to promote wellness. This "laying on of hands" technique will cause deep relaxation, decrease anxiety, pain, and stress. *If you are interested in learning Reiki we need to hear from you!
Thursday June 4, 11, 25 @ 6:00 - 7:30
Easy Yoga- Energizing and Calming! Yoga is a system of stretching and breathing that improves your health.
Tuesday, June 2, 9, 16, 23, 30, 1998 @ 5:30 - 7:30 p.m.
"Unlimited Power" -- Tapes #16-18
Want to improve your perspective on life? Try a new experience of learning to communicate better with yourself and others. Anthony Robbins is the best selling author of "Unlimited Power," and other success focused technology. Come listen, learn and relax.
For more information or to pre-register call Kevin D. Greene, ACT Program Coordinator @ (215)981-3330. 1216 Arch Street, 6th Floor, Philadelphia, PA 19107. Monthly schedule information is on voice-mail and the web: www.actionaids.org.
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