|
 |
|
|
|
Issue #204: November 20, 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 articles in this issue include Kaiser Daily HIV/AIDS Report, National Institute of Allergy and Infectious Diseases, New England Journal of Medicine, Pittsburgh Post-Gazette, Reuters, San Francisco Chronicle, The Wall Street Journal, United Press International.
IL-2 +HAART may reduce amount of "hidden" virus
PWAs on HAART may be taking sexual risks: study
Heart disease linked to protease drugs
Sustiva controversies continue
Commission delays minority debate, elects interim co-chair
Researcher fights Allegheny for office space
HIV+ inmate ordered to wear hood in court
PWA "banished" from PA town loses appeal
IL-2 +HAART may reduce amount of "hidden" virus
Adding interleukin-2 (IL2) -- an immune system stimulating drug -- to traditional HIV treatment may reduce the amount of virus hiding out in "resting" immune cells in the blood and lymph tissue, according to preliminary results of a small study.
Such dormant cells, in addition to areas in the brain, testes and elsewhere, may act as reservoirs for HIV that are difficult to eradicate with drug treatment.
Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), presented the study at the annual meeting of the Infectious Diseases Society of America.
Fauci, in conjunction with Dr. Tae-Wook Chun and colleagues at NIAID, looked at 26 HIV-positive patients, 12 of whom received a combination of three or more antiretroviral drugs including a protease inhibitor, and 14 of whom received the drugs plus IL-2 -- a naturally occurring protein that stimulates the growth of resting T cells. All 26 patients had undetectable amounts of virus in the blood after treatment.
The researchers collected 10 to 20 million resting CD4 positive T cells from the IL-2 treated group, and in 6 of the subjects could detect no HIV that was capable of reproducing. Typically, people who are treated for 2 to 3 years with traditional drug therapy have undetectable amounts of virus in the blood, but still have replication-competent HIV in resting T cells.
When the researchers collected very large amounts of cells (330 million per person) from these patients, three people still had no signs of the virus. At least one of those three who were tested did not have viable HIV even in samples taken from lymph nodes, a common reservoir for the virus.
In contrast, the 12 people treated with standard drug therapy alone consistently had HIV in their resting T cells.
"To our knowledge, these are the first examples of the failure to isolate virus from HIV-infected individuals despite culture of a large group of (cells) and examination of lymphoid tissue," Fauci said.
Dr. Fauci stressed the preliminary nature of the findings, but observed that, up to now, virus has invariably been cultured from resting CD4+ T cells in patients on 2 to 3 years of HAART with undetectable plasma loads. So the fact that virus could not be cultured in three patients on HAART plus IL-2 is new.
"There are many other potential reservoirs in the body," he said. "We've looked at two major ones -- peripheral blood and lymphoid tissue. But the virus could be lurking in the brain, in the gut, in the testes - we don't know."
"The 'real proof of the pudding' is what happens when you take these people off drugs and you follow them for a couple of years," he continued. And his group is planning to do just that. "We have a protocol that we've put before the Institutional Review Board, (and) it's on its way to getting approved. Hopefully, by the beginning of next year, we can start taking patients off drugs."
However, even after patients go off drugs, he cautioned, they will still need to be closely followed for a couple of years, with researchers studying their blood and tissues for evidence of virus.
Fauci told United Press International, "We have a written a protocol in which patients who have no sign of virus in the blood would have their medication withdrawn to see if the virus will continue to be suppressed." Still, he said, "I personally believe the virus will come back."
He said the virus could be lurking in "persistent, recalcitrant reservoirs in the body" -- the lymph system, including hard to access gut-associated lymph tissue, the spinal fluid, the brain and the reproductive system.
In a handful of cases, doctors and patients have tested the theory that by driving the virus below detectable levels, the virus cannot replicate. In most of these cases, the virus has rebounded.
Fauci said, "A couple of years ago I wouldn't have even considered taking patients off medication. Now," Fauci told UPI, "we have so many good drugs available that I think we could use another regimen of drugs to put a patient back into re-suppression of virus if there was a rebound."
Despite the risks, Fauci said patients are willing to stop taking medication and test the theory that eradicating HIV from the blood is sufficient to prevent re-emergence of the infection. Although the HAART regimen has been successful in driving down the levels of virus in the blood, there are serious side effects associated with the treatments, including diabetes, kidney stones and development of unsightly fat deposits on the back, shoulder and abdomen.
Fauci said his comments were filled with caveats because: "I'm very uncomfortable in saying that we have eradicated the virus. I would not be surprised if the virus comes back in patients if we stop medication."
Twelve of the 26 subjects in the study released by NIAID received HAART, a combination of three or more antiretroviral drugs including a protease inhibitor, and the remaining 14 received HAART plus IL-2, administered either intravenously or subcutaneously.
The patients on HAART plus IL-2 received doses of IL-2 totaling 3 to 18 million IU per day for 5 days, followed by a rest period of 8 weeks or longer.
In a subset of 6 of the 14 subjects receiving IL-2 plus HAART, no replication-capable HIV was detected when the researchers cultured 10 to 20 million resting CD4+ T cells from each patient using the standard assay.
When much larger numbers of cells were cultured from these six subjects, up to 330 million cells per person, using a "super" assay, no replication-competent HIV was detected in three patients, Dr. Fauci told meeting attendees.
Dr. Fauci's group then performed a lymph-node biopsy on two of the three patients treated with IL-2 plus HAART who had no detectable HIV in resting CD4+ T cells. In the one patient for whom the results are available, they were unable to isolate replication-competent from any tissues they examined.
The investigators consistently found replication-competent HIV in resting CD4+ T cells from all 12 subjects who received HAART alone.
The different results between the two treatment groups were "...clearly statistically significant," Dr. Fauci told the audience. "To our knowledge, these are the first examples of the failure to isolate virus from HIV-infected individuals, despite culture of a large group of PBMCs and examination of lymphoid tissue."
Each group of patients in this cross-sectional study had a comparable mean time of duration on HAART, which was about 20 months, he continued. Most of the 26 patients were chronically infected when they began HAART, and only about three were in the primary stage of HIV infection.
Dr. Fauci's group is pursuing data on the pathogenesis underlying these findings. The researchers are attempting to determine the mechanism responsible for the diminishing cell reservoir, and whether either HIV-infected cells are activated and purged or patient immunity is enhanced.
People living with HIV who are being treated with protease inhibitors may be less concerned about practicing safe sex than those not being treated with the drugs, according to a new collaborative study.
Researchers at Emory University's Rollins School of Public Health, the University of Alabama at Birmingham School of Public Health and the U.S. Centers for Disease Control and Prevention studied sexually active persons living with HIV and found that those treated with protease inhibitors were more likely to report inconsistent condom use compared to persons not treated with protease inhibitors.
Ralph DiClemente, Ph.D., Emory professor of behavioral sciences and health education, presented the research at an American Public Health Association meeting.
The study included a cross section of persons living with HIV attending six public clinics in non-urban Alabama communities. Within the study group, sexually active patients being treated with protease inhibitors were approximately two and a half times more likely to engage in risky sex (use condoms less than half the time while having sex) compared to patients not being treated with protease inhibitors.
Even more alarming, according to Dr. DiClemente, was the finding that patients using protease inhibitors were also more likely to report "never" using condoms during sexual intercourse. Even after controlling for factors such as age, race, education, and other AIDS defining conditions, patients treated with protease inhibitors were significantly more likely to report engaging in risky sex. There were significant differences, however, by sexual preference.
Within the study group, men who had sex with men (MSM) and were being treated with protease inhibitors were 3.8 times more likely to report condom use less than half the times they engaged in sexual intercourse compared to MSM not being treated with protease inhibitors. MSM using protease inhibitors were 5.4 times more likely to report "never" using condoms during sexual intercourse. Similar findings were not observed for heterosexual men or women.
"Men having sex with men may have had more exposure to (initial media reports about the drugs) and been more aware and attuned to medical progress," DiClemente suggested as a reason for the pronounced difference in sexual behavior among the groups. "So when the first words came down about how effective these drugs were, this may have affected these men more than (it affected) men having sex with women, or than women in these rural areas."
As the use of antiretroviral medications, including protease inhibitors, has revolutionized the clinical management of HIV, protease inhibitors have become an integral component of the clinical strategy to treat HIV infection. "Given that many HIV-infected individuals will be treated with protease inhibitors, these unanticipated consequences are disturbing and suggest a need for further in-depth study," said Dr. DiClemente.
The investigators hope to undercover the motives for engaging in risky sex among protease inhibitor users as well as to facilitate education and counseling of clinical providers and patients to prevent high-risk behavior.
The findings suggest that many people taking the drugs have misconceptions about the medications. This may be due in part to the fact that initial press reports about the drugs were overly optimistic, he said. When the drugs were introduced a few years ago, he added, a major news magazine ran an article with the headline, "AIDS Cure?"
In light of the findings, healthcare workers need to ensure that patients taking antiretroviral drugs realize that the drugs are not a cure, that they can still infect sexual partners with the virus, and that they must take precautions during sex, DiClemente said.
Given the potential consequences of these findings, more study is warranted, he added.
Two cases of heart disease in HIV-infected patients that were thought to result from side effects of antiretroviral medications were reported at the 4th International Congress on Drug Therapy in HIV Infection.
Dr. Brian Gazzard and his team at London's Chelsea and Westminster Hospital described the cases of two HIV-1 infected males who developed 'premature' coronary artery disease while on protease inhibitors.
The first, a 41-year-old, experienced an inferior myocardial infarction 12 months after commencing indinavir. The second, a 56-year-old, developed symptoms of unstable angina pectoris 8 months after initiation of treatment with nelfinavir.
Although the researchers question a causal relationship between therapy for HIV and development of heart disease, Dr. Gazzard has observed elevated serum cholesterol levels in 30% of his patients who are taking a protease inhibitor compared with 6% of those not taking this class of drugs. He advises careful monitoring of lipid abnormalities in this patient population.
Reviewing the evidence linking protease inhibitors to lipid abnormalities and lipodystrophy, Dr. David Cooper, of the National Centre in HIV Epidemiology and Clinical Research, St Vincent's Hospital, Sydney, Australia, noted that protease inhibitor-associated lipodystrophy has been linked with increasing circulating triglyceride and cholesterol concentrations. He also told conference participants that HIV-1 protease has homology with two binding proteins, LRP and CRABP-1, which are involved in lipid metabolism.
However, Dr. Cooper also said that lipodystrophy has been reported in patients not taking antiretroviral therapy, and in those receiving antiretrovirals, but not protease inhibitors.
The latest figures from the UK Adverse Drug Reactions Reporting Scheme, also presented in Glasgow, show a total of 64 reported cases of lipodystrophy in UK HIV-infected patients. Of these, four were not receiving protease inhibitors.
All were taking stavudine and lamivudine, and two were also taking nevirapine. Analysis of all drugs taken by the 64 patients with lipodystrophy showed that 56 were taking stavudine and 44 lamivudine, most often in combination, in addition to a protease inhibitor.
Ritonavir was the protease inhibitor most frequently associated with hyperlipidemia, and indinavir was associated with most reports of lipodystrophy, followed by ritonavir, and saquinavir. Two patients with hyperlipidemia were reported to have developed a myocardial infarction, although both had other risk factors for MI.
Meanwhile, an Italian study indicates that heart problems among people with HIV may be more related to action of the virus itself than to antiviral medications, according to a report in the October 15, 1998 edition of The New England Journal of Medicine.
Researchers in Italy studied 952 people with HIV who had not yet developed physical symptoms of illness. They found that 8 percent showed some signs of "dilated cardiomyopathy," a heart disease in which the heart muscle loses some of its ability to pump because the left ventricle has become dilated. The problem was more prevalent in patients with CD4 counts below 400.
Their conclusion: The heart disease seen in people with HIV "may be related either to a direct action of HIV" on heart tissue or to an indirect action. They recommend that a "careful cardiologic evaluation should be made to detect early involvement of the heart in HIV positive patients." Those patients with heart disease, noted the researchers, may then be helped with conventional treatments.
In an unprecedented action, AIDS Drug Assistance Programs in California, New York and four other large states are refusing to pay for a pricey new HIV therapy unless its manufacturer agrees to significant discounts.
Sustiva, produced by Wilmington's DuPont Co., is expected to gain wide use as an addition to the dozen other AIDS treatments on the market, especially since it can be taken just once a day.
But Sustiva is notably expensive even compared with other anti-HIV drugs. It will cost wholesalers $3,920 per year, almost twice the price of two other drugs already on the market that work through a similar mechanism.
The Wall Street Journal reports that a coalition of ADAPs told DuPont its price was unacceptable and the states simply wouldn't pay for the drug. The ADAPs' concern reflects a growing worry that expensive new HIV therapies -- which will push average monthly ADAP budgets from $52 million in FY 1996 to $700 million in FY 2000 -- are outstripping the resources of the programs that bring the therapies to the neediest patients.
William Arnold, co-chair of the ADAP Working Group, said, "We're worried the drug companies are taking advantage of this program with their pricing policies. DuPont's higher-than-expected price for Sustiva is going to force some ADAPs to turn away eligible people. The ADAPs decided to take a stand."
New York ADAP head Lanny Cross said, "We pretty much paid whatever the companies charged until we ran out of money each year. We want to offer Sustiva -- it's a very good drug - but we just can't simply pay whatever price they charge."
DuPont, noting that ADAPs already receive a federally mandated 15% discount, contends that it deserves to charge a premium for Sustiva because it is more potent than other HIV drugs, and because the company needs to recoup development costs and fund research on future treatments. The company offered ADAPs an additional 5% discount, but the six holdout states said that wasn't good enough.
Arnold said, "These ADAPs have waiting lists because they can't even pay for the drugs they offer now. How are they going to afford Sustiva?" The Journal reports that DuPont wants to avoid setting a precedent, especially in light of the pressure ADAPs have applied to Glaxo Wellcome PLC to provide a discount for two of its upcoming HIV drugs.
Meanwhile, We The People and ACT UP Philadelphia are planning a World AIDS Day demonstration on December 1st to protest the high price of Sustiva. The demonstration will take place at DuPont's headquarters in Wilmington and in Philadelphia.
"Worldwide, millions of people with HIV die because of the high prices drug companies charge for life saving treatment," an ACT UP statement said. "DuPont Pharmaceuticals sacrifices bodies for profits."
ACT UP said that "DuPont's greed has excluded programs that amount to 20% of the US AIDS drug market."
Rob Capone, interim director of We The People, told fastfax, "We've had it. We're tired of being the ones who suffer while these profiteers try to rape the ADAP programs. This drug didn't cost any more to develop than the other drugs in its class. There is absolutely no justification for the outrageous price they're asking."
Capone went on to say, "On this year's World AIDS, We The People will not mourn those who have passed through quiet remembrance. We will fight for those being denied the chance to survive."
We The People and ACT UP will demand a 50% price cut for Sustiva in a Philadelphia press conference at the State Office Building, Broad and Spring Garden Streets, at 10:00 a.m. on December 1st. The press conference will be followed at 10:30 a.m. by a bus trip to DuPont's Wilmington headquarters for a rally and civil disobedience. That event will take place on Rodney Square, 11th & Market Streets in Wilmington, beginning at 12:30 p.m.
Lunch will be provided to those who take the bus from Philadelphia. To reserve a free bus seat, call 215-731-1844
An expected debate on how to define a "minority organization" for the purpose of targeting Ryan White Care Act funding was postponed by the Philadelphia HIV Commission this week, because most of the group's Philadelphia members were late in arriving to the South Jersey meeting site.
Most Commission meetings are held in center city Philadelphia, but periodically meetings are held in suburban Philadelphia counties to make it easier for non-city residents to attend. The large group of Philadelphia representatives on the Commission, who traveled to the meeting by bus, arrived too late for the group to finish its regular agenda.
Up for discussion at this meeting was a controversial proposal from the Commission's Care Committee to jettison the existing definition of "minority organization" and replace it with a weaker definition used by Philadelphia city government in encouraging business with minority contractors. The Care Committee acted after complaints from officials of the AIDS Activities Coordinating Office (AACO) that the Commission's existing definition - which emphasizes historical links to communities of color as well as a majority of executive staff and board members from the minority community being served - was too stringent for AACO to effectively implement.
Since 1993, Philadelphia's Ryan White CARE Act planning councils have made the expansion of AIDS service capacity of organizations based in minority communities a high priority. Even with this priority effort, however, the majority of federal AIDS care funds awarded in the region still go to organizations without historical ties to the minority communities which comprise the largest proportion of people with HIV/AIDS in the area.
Under Philadelphia's minority business guidelines, a minority organization is simply one in which a majority ownership is people of color, women or people with disabilities. For a non-profit organization, this means a majority of at least one on the organization's board of directors. Unlike the existing Commission definition, the city's minority business guideline does not require that the minority control be in the hands of people from the community receiving the service, but any individual who qualifies as a member of a racial minority group or who suffers from a disability or is a woman is counted toward the measurement.
Application of a similarly weakened guideline by the Philadelphia AIDS Consortium, which allocates Ryan White Title II funds, resulted in most historically-minority organizations previously funded by the Consortium suffering severe reductions in their Title II funding earlier this year.
The city's minority business guidelines also allow white groups to subcontract as little as 15% of their funding to minority contractors in order to be approved for city funding. The minority guidelines, monitored by the city's Minority Business Enterprise Council, are usually applied aggressively in construction and capital projects, but are usually ignored in the award of social and health service funding. Non-profit organizations were for many years ineligible for certification as minority contractors, although that policy was revised to include non-profits about three years ago.
While the Commission debate was expected to focus on Ryan White funding, it might also apply to funding for AIDS prevention programs, which have traditionally been guided by a much more expansive definition issued by the U.S. Centers for Disease Control and Prevention. The CDC definition of a minority organization is similar to that currently in use by the Commission, which the Care Committee now seeks to overturn.
Most minority AIDS advocates have opposed attempts to water down the existing definition of "minority organization" by relying solely on majority ownership, since some organizations which communities of color have experienced as not culturally competent to deliver services to their communities have simply added people of color to their boards of directors in order to qualify for funding targeted to minority groups. Several historically minority organizations have claimed that watering down the minority definition is merely an attempt to prevent them from building their own service capacity as the epidemic becomes one primarily of people of color in the Philadelphia region.
Almost 75% of those living with HIV/AIDS in the city of Philadelphia are believed to be people of color, although the majority of Ryan White funding is concentrated on organizations that are led by whites.
AACO has noted that there are relatively few minority providers who are willing to utilize Ryan White funding in some service categories, in particular primary medical care.
Last year, We The People and other groups issued a report entitled The Time to Act is Now: A Report on the Direct Care Needs of African Americans Living with HIV/AIDS in Philadelphia, which called for an investment of Ryan White funds to encourage more minority medical providers to serve people living with HIV disease in the region. While no action was taken on that recommendation last year, AACO and the Commission's African American Caucus recently initiated discussions on developing the project for the coming year, according to WTP President Marvin Crawford.
In other business, the Commission elected Michael Hinson, Executive Director of The Colours Organization, as one of its two co-chairs, to fill the unexpired portion of the term vacated by Mick Maurer, who resigned as co-chair several weeks ago. Hinson defeated two white candidates, including We The People's Interim Director Rob Capone, for the position.
After the election, Capone said, "Maybe now we can fix the Commission. Michael knows the problems with this body and has a keen sense of how to fix them. We share many of the same views so I'm confident that he will move the process forward in a positive direction."
Hinson's election means that for the first time, both Commission co-chairs are people of color.
While Philadelphia AIDS clinicians at the former Allegheny hospitals seem to have averted, for the time being at least, any major adverse impact from the bankruptcy of the big hospital system, things are not going so well for a researcher in suburban Philadelphia.
With attempts to reach an eleventh-hour agreement with her landlord failing, Dr. Suzanne Ildstad plans to go to federal court in Pittsburgh to fight for her laboratory space.
It will be the second time that Ildstad has sought court protection for her research facility. This time, the former University of Pittsburgh researcher is bringing some patients along, including Jeff Getty, the AIDS patient and activist who three years ago volunteered for an experimental baboon bone marrow transplant to restore his immune system.
Ildstad's attorney, Morton R. Branzburg of Philadelphia, has asked U.S. Bankruptcy Court Judge M. Bruce McCullough to prevent the Allegheny Health Education and Research Foundation (AHERF) from rejecting the doctor's employment contract and the lease for her lab in suburban Philadelphia.
AHERF wants to reject the lease as part of its effort to reorganize Allegheny University of the Health Sciences. The university's eastern operations are being scaled down to stem financial losses. Ildstad's lab was deemed too expensive.
DuPont Merck Pharmaceutical Co., which owns the building that houses Ildstad's lab, has notified the doctor that it needs to take over the space on Dec. 1 for its own research projects.
But Ildstad maintains a move will harm her research.
She is scheduled to move into a new building at the University of Louisville in September and wants DuPont to let her stay in a portion of her existing lab until then.
An attorney for AHERF's creditors indicated that he thought Ildstad and her landlord could reach a compromise, but Branzburg said yesterday that DuPont had not changed its position.
A spokesman for DuPont could not be reached for comment by the Pittsburgh Post-Gazette, which originally published this story, but the company has offered to assist Ildstad in a move to new space, the paper reported.
Ildstad, however, insists any move before next fall will disrupt her research for six months.
The problem, according to Dr. David J. Tollerud, Ildstad's husband and the associate director of her Institute for Cellular Therapeutics, is that all labs moving into new space need months to recertify their equipment with the Food and Drug Administration.
The tests by Ildstad's lab are key to evaluating a new approach to helping patients receive solid organ transplants.
A California prisoner living with HIV was ordered to wear a mesh hood to court on November 16th after the judge expressed fear he would "spit his HIV-infected saliva at anyone near him."
Benjamin Pedro Gonzalez, 39, was ordered into the hood, which resembles a bee-keepers' bonnet, after a string of violent outbursts including punching and stabbing one of his own attorneys and slicing another inmate with a razor blade.
Gonzalez, a former ranch hand, is accused of butchering a woman from Livermore, California, in 1992 and has been called "the most violent offender" in northern California's Alameda County, the San Francisco Chronicle said.
"This defendant is an extremely manipulative, inventive and devious person," Superior Court Judge Jeffrey Horner said in court recently. "He is able to exploit even a momentary lapse in security."
Horner ordered the hood out of fear Gonzalez would "use his saliva as a weapon," the Chronicle said, noting that during pretrial hearings the prisoner appeared with mucus hanging from his beard. A court official confirmed the judge's order.
Along with the hood, Gonzalez will appear in court with his hands chained to a wooden chair and his feet affixed to the floor. No one -- not even his court-appointed attorney -- will be sitting near him, the Chronicle said.
After some three years of legal discussion over Gonzalez' mental competence to face separate murder charges in Oakland, Los Angeles and New York, Horner in July determined he had been faking mental illness and ordered him to stand trial for the 1992 murder of Barbara Muszalski.
Prosecutors have said they will seek a sentence of 30 years to life in prison if Gonzalez is convicted.
The U.S. Supreme Court has turned down an appeal by a transsexual who says a Pennsylvania judge banished him for life from his hometown after he tested positive for HIV.
Raul Valentin argued that he should be allowed to pursue a federal civil rights lawsuit against the judge who he says "unlawfully sentenced him to life away from his home and family."
"It's the most outrageous case of abuse I've ever seen," Valentin's lawyer, Don Bailey, said before the court's action.
The Supreme Court let stand lower court rulings that said the judge had full immunity from Valentin's case.
Valentin was arrested in Lebanon, in 1987 after an altercation at a local swimming pool. A transsexual who had been taking injections to enhance his breast size, Valentin was wearing a bikini at the time.
A local magistrate sentenced him to 30 days in jail for disorderly conduct. While in jail, he was tested and found to have HIV disease.
Valentin said he then was taken before a different judge, G. Thomas Gates of the Court of Common Pleas, who ordered him to leave town and never come back.
According to Valentin, Gates said that if he ever returned, the judge would find other charges to bring against him and would see that he was sent to state prison.
Valentin said police took him to the bus station and gave him a one-way ticket to New York City. He remained there and now lives in a hospice on Staten Island.
Valentin sued Gates in 1997, but a federal judge in Pennsylvania threw the case out. Judges have absolute immunity from being sued over judicial acts they take in matters over which they have jurisdiction, the judge ruled.
The state judge's "general jurisdiction over criminal matters" was enough to give him immunity, U.S. District Judge William Caldwell said. Because Valentin "complains about being sentenced, he must have dealt with the judge in his judicial capacity," Caldwell added.
The judge also denied Valentin's request to overturn Gates' order, saying his only remedy in federal court is to file a separate action challenging the constitutionality of the order. Valentin also could ask the Court of Common Pleas to lift the order, Caldwell added.
The 3rd U.S. Circuit Court of Appeals upheld the ruling.
In the appeal denied review by the Supreme Court, Valentin's lawyer said Gates lacked the authority to act because he was not presiding over any case involving Valentin. The 3rd Circuit court "has set a new standard for judicial immunity," his lawyer argued. The case is Valentin vs. Gates, 98-526.
To obtain a weekly email version of fastfax, contact with the message: "subscribe" or fill in the box on the fastfax index page.