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Issue #217: February 19, 1999
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 Archives of Internal Medicine, Antimicrobial Agents and Chemotherapy, Associated Press, Journal of Medicinal Therapy, Medical Tribune News Service, Neurology, Reuters, United Press International.
In This Issue:
Plant extracts may inhibit HIV
Rare movement disorder linked to HIV for first time
Common soap may work as microbicide
Low salt in saliva may protect against HIV
Definition controversy resolved by Commission vote
WTP seeks info on funder administrative costs
AIDS group wins CA discrimination case
Texas AIDS Ride causes Philly-like controversy
Nevada insurers told to report PWA names
Federal court bars HIV+ boy from karate class
Nurse claims he was fired over AIDS
Synthetic versions of chemicals extracted from plants used by Bolivian shamans to treat various illnesses appear to inhibit the ability of HIV to infect healthy cells in laboratory testing, according to researchers at the University of California at Irvine.
If found to be effective in humans, these chemicals could one day be developed into drugs used to fight HIV disease. A report on the research appears in the latest issue of the Journal of Medicine Therapy.
Several years ago, Dr. Joseph Bastien, an anthropology professor at the University of Texas at Arlington, brought back 60 of some 900 plants that Kallawaya shamans in Bolivia have used for centuries to treat disease.
Dr. Manfred Reinecke, professor of chemistry at Texas Christian University in Fort Worth, made extracts of the plants and tested them for chemical activity against a variety of diseases, including infections such as malaria.
At the same time, Dr. W. Edward Robinson, Jr., associate professor of pathology and microbiology at the University of California at Irvine, and colleagues began testing the same extracts against HIV. From the most promising extracts, Robinson created seven synthetic chemicals, called analogues, that appear to inhibit HIV by acting against the HIV enzyme integrase. Integrase helps HIV to spread by integrating the infectious virus into the DNA of healthy cells.
Anti-AIDS cocktails now prescribed to patients target the other two enzymes, HIV protease and HIV reverse transcriptase, but a successful drug to combat the integrase enzyme has eluded researchers.
In an interview with Reuters Health Information Service, Robinson said he is still tinkering with the synthetic chemicals to try to improve them, but he anticipates that clinical trials could begin in humans in about 2 years. "We'd like to see them added to the current drug cocktails that inhibit HIV protease and HIV reverse transcriptase to see if patients do better with a compound that also fights HIV integrase," he said.
Unlike the chemical cocktails currently used by AIDS patients, the analogues that battle HIV integrase do not appear to be toxic to cells and may therefore be better tolerated.
Nearly one third of the drugs available today are extracts from plants, including aspirin, which originated from the bark of the willow tree. Some of Robinson's chemical compounds are based on plant extracts from the chicory herb.
Rare movement disorder linked to HIV for first time
A movement disorder usually associated with multiple sclerosis, stroke and other neurological conditions could be a sign of HIV infection - perhaps even the first sign, Canadian researchers warn.
For people with the disorder, which is called paroxysmal dyskinesia, movement is intermittently difficult and painful.
Dr. Seyed M. Mirsattari, a neurology resident at the University of Manitoba in Winnipeg, Canada, and his colleagues reported the first series of HIV-infected patients with paroxysmal dyskinesias recently in the journal Neurology.
"When people think about paroxysmal dyskinesias, they always think about possible causes," Mirsattari said. "The message we're trying to give is, you should be aware that HIV could also do this, and perhaps a screening test for HIV in the right setting might be helpful."
Among the six AIDS patients with paroxysmal dyskinesias, the average age of onset for the movement disorder was 34.5 years, according to the Canadian researcher.
"We had one patient who only had this [paroxysmal dyskinesia] as one of the earliest manifestations of his illness without having other neurological manifestations," Mirsattari said.
Theories about the cause of paroxysmal dyskinesias in patients with HIV include malfunctioning of the chemicals that help transmit nerve impulses or lack of blood flow to the brain, Mirsattari explained. HIV infection may also affect calcium metabolism in certain parts of the nervous system, which could lead to paroxysmal dyskinesias.
Associated neurologic findings in patients included tremor, migraines, damage to peripheral nerves, psychosis, painful leg cramps and problems with speech. Two patients were diagnosed with HIV dementia.
As with other patients with the movement disorder, patients in the Canadian study received tranquilizing drugs known as benzodiazepines, especially clonazepam, but the drugs were beneficial in only three of the six patients.
It is possible that newer antiretroviral therapies may be effective against paroxysmal dyskinesias in patients with HIV, according to Mirsattari. The study was conducted from 1991 until 1994, before the newer therapies were available, he noted.
Dr. Cheryl H. Waters, chief of the division of movement disorders at the University of Southern California in Los Angeles, said that although she has never treated a patient with HIV who has a movement disorder, she is aware that cases have been reported.
"I think [these researchers] want us to recognize that if you have a movement disorder that's paroxysmal - that is, it comes in bursts or is intermittent - that it can be a manifestation of an HIV-associated neurological dysfunction," she said.
Waters noted that paroxysmal dyskinesias are an uncommon form of movement disorder. "A paroxysmal movement disorder is extraordinarily rare," she said. "But in all movement disorders, you have to think about your differential diagnosis, and HIV is certainly something to be considered. The first thing you have to do is get a history to see if the person is at risk at all."
Common soap may work as microbicide
A common detergent found in shampoo and toothpaste can kill not only HIV but the viruses that cause cervical cancer and herpes infection, researchers have announced.
The compound, sodium dodecyl sulfate or SDS, can also kill the bacteria that cause chlamydia, the most commonly sexually transmitted disease, said Mary K. Howett and colleagues at Penn State University medical center in Hershey, Pennsylvania.
While the researchers are trying to play down premature excitement about the compound, it is the first to work against not only HIV, herpes and chlamydia, but also the human wart virus blamed for cervical cancer.
If the compound could be developed into a product that women could use to protect themselves from these sexually transmitted diseases, millions could escape lingering deaths, the researchers said.
Toothpaste in particular contains high levels of SDS, but Howett said women seeking to protect themselves from disease should not try to use toothpaste or shampoo.
"Products on the market now are not formulated for the genital tract, won't stay in the genital tract," she said.
"This has to be formulated into a gel or a cream," added Dr. Penny Hitchcock of the National Institute of Allergy and Infectious Diseases, whose office helped fund the study. "It would be six to 12 months before it could be tested in women."
Experts say a microbicide would be the answer for people whose partners will not use condoms, and is vital for women in developing countries especially.
"For the third world, this is the answer because they are not going to get retrovirus combination therapy (the drugs that keep AIDS at bay) and they are not going to get a vaccine for a long time," Howett said in a telephone interview.
Hitchcock said it was especially important that SDS could kill the wart virus, known as human papilloma virus or HPV.
HPV is blamed for virtually all cases of cervical cancer, which kills 250,000 women globally every year.
"HPV is so prevalent that in one study we did with the University of Washington, in the first year of sexual activity, one out of four women became infected with HPV," Hitchcock said.
The women had, on average, only 1.2 sexual partners, which means most of them had only had sex with one man -- yet they became infected with an incurable virus.
Women with HPV infection often have abnormal Pap smears -- the check used to detect developing cervical cancer. If caught by a Pap smear cervical cancer is one of the most treatable cancers, but Hitchcock said many women in developing countries do not get Pap smears.
She estimated that since the start of the AIDS epidemic, five million women have died of cervical cancer. Fourteen million people have died of AIDS.
It is also important that the compound works against herpes, she said. "We now estimate about 60 million Americans have genital herpes," Hitchcock said.
"There's been a 30 percent increase since the start of the AIDS epidemic, and that increasingly has been in adolescents, particularly white adolescent males. I don't want to diminish the HIV but these other two viruses are really important."
Writing in the journal Antimicrobial Agents and Chemotherapy, Howett, who worked with teams at several other universities including the University of North Carolina, said SDS killed the three viruses and the chlamydia bacteria, did not irritate the vaginas of rabbits and in general seemed non-toxic to animals.
It is less toxic, she said, than nonoxynol-9, a widely used spermicide that can also kill viruses in test tubes but which has not been proved to kill HIV when used in animals. And nonoxynol-9 does not touch HPV.
She said SDS is widely used in laboratories to pull apart viruses that scientists want to study. "That's what made us think about it," she said.
Low salt in saliva may protect against HIV
The lack of salt in human saliva may be the reason HIV is rarely spread by kissing, biting, coughing or through dental treatment, according to a study published in the journal Archives of Internal Medicine.
Researchers at the University of Texas Medical Branch at Galveston found in test-tube studies that saliva rapidly inactivates more than 90% of HIV-infected blood cells, exploding the virus into harmless components and blocking the production of HIV and other viruses in those cells.
Saliva is only one-seventh as salty as most other fluids in the body, and infected blood cells exposed to low-salt solutions take on extra fluid, which causes them to die, according to Dr. Samuel Baron, who led the research team. In fact, "saliva of infected individuals usually contains only noninfectious components of HIV.... Only 1% to 5% of patients' saliva contains infectious HIV although they all carry virus in their blood," they write.
Although saliva's low salt content may protect during kissing, saliva can be overwhelmed by the salty fluids of breast milk or seminal fluid, which allow the infected cells to survive and transmit virus.
Baron's team also notes that although HIV is normally not present in the mouths of most patients, the findings suggest that under certain circumstances -- if, for example, a patient's mouth also is filled with blood -- healthcare workers could be infected. And based on these findings, the investigators suggest that it could be potentially hazardous for dentists and technicians to irrigate patients' mouths with salt water because that could allow HIV-infected cells to survive.
Baron and colleagues acknowledge that their conclusions are based on a very small study and should be repeated by other researchers. Currently, they are testing various compounds, such as bile detergents which occur naturally in the body, to see if they might destroy HIV-infected cells in the same way saliva does.
Definition controversy resolved by Commission vote
After months of sometimes-bitter conflict between its minority caucuses and its Care Committee, the full HIV Commission has voted to adopt a proposal which defines how an agency may qualify for designation as a "minority organization" in those instances when AIDS funding is targeted to such groups.
The Commission first adopted a definition of "minority organization" in April of 1997, based on a recommendation of We The People in its report on the HIV care needs of African Americans in Philadelphia. The issue was revisited when the city's AIDS Activities Coordinating Office (AACO) reported that it was having difficulty using the definition, because some smaller minority organizations were affiliated with larger funding conduits that themselves did not meet the definition.
However, it was later found that the existing definition fit appropriately for 95 percent of the organizations seeking the classification.
The new definition is similar to the 1997 version, but includes a clearer definition of "cultural competency" and clarifies that minority organizations affiliated with larger groups can still meet the definition if they have a minority-dominated Advisory Board.
Other requirements included in the definition are that an organization have a majority of people of color on their Boards of Directors and among their executive, management and service delivery staff, and serve a clientele that are racial or ethnic minorities.
While AACO has said that it seeks to target AIDS funding to qualified minority organizations whenever possible - almost 75 percent of region's AIDS cases are among African Americans and Latinos - the Commission has not usually required that any specific portion of the funding it regulates be directly targeted to minority organizations.
In another matter, AACO reported that it had had to reallocate over $150,000 in last year's Title I grant to the region because of underspending among the agencies originally awarded the funds. The largest area of underspending was in the category called "psychosocial services," which underspent by almost $70,000, and in emergency needs funds of over $28,000. The underspending in emergency needs funds is believed to relate to cash flow problems at the agencies distributing the funds. AACO, the Philadelphia AIDS Consortium, and the Office of Housing and Community Development have announced a plan to centralize the distribution of emergency needs funds in order to alleviate the problem, they announced last month.
WTP seeks info on funder administrative costs
In an effort to determine how much money is being spent on administering the agencies which distribute public AIDS funds in the region, We The People's board of directors has requested "specific information about costs related to certain administrative functions related to oversight, planning, and distribution of public resources" at the AIDS Activities Coordinating Office (AACO), The Philadelphia AIDS Consortium (TPAC), and The Philadelphia EMA HIV Commission.
The board noted that "each of the organizations from which we have requested this information has publicly expressed its desire to keep administrative costs related to HIV/AIDS services to a minimum in order to enhance the availability of financial resources that more directly benefit people living with and at risk of HIV/AIDS." In a letter to the agencies' directors, the group said, "We hope you will recognize that our effort here is merely to collect data which might be helpful in determining the most efficient way of managing these resources at a time when they face significant reductions related to governmental budget constraints and the increasing demand for HIV/AIDS services in our community.
WTP's board said that "the information we request is in the public domain, and that refusing to provide it in a reasonable time would not be consistent with federal, state or local regulations." A similar request sent to the three agencies several months ago has so far been ignored.
"As the largest coalition of people living with HIV/AIDS in the region, it is our belief that we have a specific interest in this information and the right to provide you with our input as to its implications." The board said that prior to any public discussion of its findings, it would share its analysis with you and provide the agencies with an opportunity for feedback and input.
AIDS group wins CA discrimination case
The State of California has agreed to a $250,000 settlement of a federal lawsuit brought by AIDS Healthcare Foundation (AHF), the nation's largest HIV/AIDS medical provider.
AHF filed the lawsuit in Federal Court, Central District of California in May 1997 following an ongoing and widespread pattern of punishment and surveillance of AHF by the Department that the group said was prompted by AHF's outspoken political advocacy on behalf of people with HIV/AIDS.
"We have frustrated the State's effort to silence us. These bullies will just have to pick on someone who won't fight back," said Michael Weinstein, AIDS Healthcare Foundation president. "I am confident that our new Governor, Gray Davis, will end the mean-spiritedness and abuses of power that were a hallmark of the Wilson era," referring to former GOP governor Pete Wilson, who was defeated in the election of last November.
According to the settlement, AHF will receive a $250,000 payment from the state for its legal fees. The agreement also forces the state to return the licenses for AHF's two residential care facilities and four outpatient clinics to Los Angeles County DHS jurisdiction from Orange County.
Intimidating providers was a hallmark of the regime under State Health Director Kim Belshe, a Wilson appointee, the group charged. They charged that, in a move designed to punish AHF for its political advocacy, DHS Director Brenda Klutz ordered that the required oversight of AHF by the DHS be transferred from its Los Angeles County office to its Orange County office. Klutz conceded that this decision to transfer was made because she had learned that the "staff of AHF, including its President, Michael Weinstein, were very active and effective at lobbying," according to an AHF statement.
The DHS controversy was compounded when DHS officials refused to explain why they had transferred AHF's licenses to Orange County until compelled to do so by court order. When finally forced to reveal the true reasons for the transfer, Klutz stated that the Department repeatedly lied to AHF in order to "avoid embarrassment" for Michael R. Gaddy, Chief of the Department's Provider Certification Unit, and other lower level DHS staff involved.
The group released what it said was a DHS e-mail which referred to an "AHF situation alert" and asked, "how do we account for the heavy political support that (Michael) Weinstein (the President of AHF) holds?" It further stated that DHS had a confidential position regarding AHF and its activities.
During the controversy, AHF was cited for limiting admission to its AIDS hospice to people with AIDS, in violation of federal anti-discrimination guidelines.
"This settlement is a victory for the First Amendment," said AHF's Weinstein. "This settlement allows AHF to do what it does best: care for those with HIV and AIDS."
AHF serves over 5,000 low-income Greater Los Angeles patients at 4 out-patient and 2 residential facilities; the WomensCare Center; through Positive Healthcare; AHF's Research Division, and through AHF's Treatment=Life Division featuring the WEHO Lounge, one of the nation's first coffee house/HIV testing and information center.
Texas AIDS Ride causes Philly-like controversy
One of the largest AIDS charity events in Texas history ended in photogenic glory last fall, with several hundred bicyclists streaming into Dallas after a 575-mile jaunt that raised nearly $3 million in donations.
Organizers have confirmed, however, that 85 percent of the proceeds was swallowed by expenses - for everything from office space and advertising to the for-profit producer's $280,000 fee. The 15 percent left for beneficiaries is far below both projections and industry standards for such activities.
The report was reminiscent of the results of the Philadelphia-DC AIDS Ride several years ago, which lost almost 90 percent of the money raised to expenses and led to the cancellation of future Rides in the area.
Tanqueray Texas AIDS Ride organizers are promising to cut expenses and attract more participants so that a second incarnation of the event, set for October, is more successful.
No thanks, says a major contingent of service organizations that took part in 1998.
"We trusted them, and we got screwed," said Byron C. Trott, executive director of the Gay and Lesbian Community Center in San Antonio. His group is one of 10 from the South Texas city to refuse further participation.
The ride's privately held producer, Pallotta Teamworks of Los Angeles, aims "to make money for themselves and not to provide help for people with AIDS," Mr. Trott said. Pallotta says it can do both.
Chris Cole, national director of Pallotta's AIDS rides, told the Dallas Morning News that he understands agencies' reluctance to put up another year's "seed money" after the 1998 disappointment. (About three dozen agencies statewide, led by the Resource Center of Dallas, paid a refundable deposit of $600,000 last year; they are splitting proceeds according to the amount each advanced.)
Mr. Cole stressed that even the 15 percent return is good money. "They couldn't have done anywhere near that by putting their money in the bank or the stock market," Mr. Cole said.
Many other Texas nonprofits plan to push ahead with Pallotta, said Resource Center of Dallas spokesman Steve Hawkins.
"We feel like this is something of a long-term investment," Mr. Hawkins said. "It takes awhile for an event of this magnitude to build."
A similar fund-raising disappointment in Philadelphia three years ago led the Pennsylvania attorney general to accuse Pallotta of misrepresentation. The company paid a $110,000 fine but admitted no wrongdoing.
Mary Beth O'Hara Osborne, the Pennsylvania prosecutor, said that she was disappointed to hear of the situation in Texas.
"They certainly seemed to want to do things right," said Ms. Osborne, who's now Pennsylvania's chief deputy attorney general. "They told us it would be a real learning experience."
In a later interview with the Los Angeles Times, Pallotta's president struck a different chord. Asked what he'd learned from the Pennsylvania fight and subsequent controversy in Florida, Daniel Pallotta reportedly replied: "No more than Kevin Costner learned by doing Waterworld ."
Pennsylvania officials estimated that Mr. Pallotta had a 1995 salary of approximately $325,000. Mr. Cole said that he didn't know his boss' salary and considered it "none of my business."
He said Pallotta generally projects that it will return about 50 percent of proceeds to participating charities, as it projected in Texas last year.
Even that rate is unimpressive to Daniel Borochoff, president of the National Institute of Philanthropy. He urges a minimum of 65 percent.
His advice to potential donors: "Forget the bike ride and give the money right to the group you want to help."
But Dallas rider Michael Milliken - who raised $11,800 last year, more than four times the minimum required - said he'd be back in the saddle this fall.
"I'm in for the long run," he said, expressing optimism that increased participation would mean a higher rate of return. He also pointed to an intangible benefit: increased awareness of AIDS in small towns along the route.
Nevada insurers told to report PWA names
The Nevada Health Division has voted to require life insurers to inform the state health office if potential policy holders test positive for HIV; AIDS; hepatitis A, B and C; syphilis and tuberculosis.
Life insurance companies do blood tests on all prospective policy holders. Nevada law requires that tests that turn up communicable diseases be released to the state, but the tests are done in laboratories in Kansas, which does not release names of those who test positive for such diseases. Currently, Kansas officials inform Nevada officials only that communicable disease cases exist.
Now life insurance companies will carry the responsibility of giving Nevada health officials names of people who test positive for the seven communicable diseases listed in the new policy.
The new regulation will take effect in 30 days.
Originally Dr. Randall Todd, state epidemiologist chief, wanted insurance companies to report 66 communicable diseases. At the request of board member Dr. Frank Nemec, the list was narrowed.
"This was a valid compromise," Todd said. "The list hits the diseases the insurance companies mostly test for."
Joann Waiters, counsel for the American Council of Life Insurance, argued that a person's personal physician should be the one reporting the results and that hepatitis is too broad of a disease and may not be communicable.
Federal court bars HIV+ boy from karate class
A Richmond area karate school can bar an HIV-positive teenager from its classes because he poses a "significant risk" to the other children who participate in combat-style classes that occasionally draw blood, a federal appeals court has ruled.
The 4th U.S. Circuit Court of Appeals found that although the Americans With Disabilities Act prohibits discrimination against people with AIDS, the law does not require U.S.A. Bushidokan, in Colonial Heights, to accept Michael Montalvo, now 14, for its Japanese-style sparring classes.
Judge Paul V. Niemeyer wrote for the unanimous three-judge panel that while the chance that Michael would bleed and then transmit the virus is low, the consequences are so severe that the risk outweighs the law's protections.
"People who are HIV-positive face great personal and social challenges...which...only reinforces the view Michael's classmates should not be subjected to any significant risk of HIV transmission," Niemeyer wrote.
Michael was 12 when he joined the karate school. The owners barred him from class after learning from another student of his infection.
The Montalvos, who have since moved out of Virginia because they believe public disclosure of Michael's infection led to discrimination, plan to appeal to the U.S. Supreme Court, said their attorney, Steven H. Aden, litigation director for the Charlottesville-based Rutherford Institute.
"They want to make a point that people with HIV do not have bubonic plague," Aden said. "They have a serious but manageable illness that is not communicable in regular society or even the close quarters of a karate school."
Michael's doctor, who specializes in pediatric AIDS, had approved karate classes for the boy, and no case of sports-related HIV transmission has ever been reported, said Kathryn Bina, spokeswoman for the Centers for Disease Control and Prevention in Atlanta.
But Nathaniel M. Collier III, attorney for the karate school, said the school's owners, James P. and Donna Radcliffe, believed that Michael's disease posed a real problem because of their style of teaching. "We are very happy with the decision," Collier said. The students "fight on a nightly basis without pads. Kids get cut up and scratched," Collier said. "A lot of times, they'll follow up a blow with a wrestling move and by the time you separate them, both kids will have blood on them."
A U.S. District Court judge agreed last year with the karate school, and the appeals court upheld his decision.
The decision drew criticism from AIDS groups, which said it reflects fear rather than legitimate health concerns. "Communities are right to be concerned about HIV, but cases like this distract from giving young people the information they need and give a false sense of how it is transmitted," said Daniel Zingale, of D.C.-based AIDS Action. © Copyright 1999 The Washington Post Company
Nurse claims he was fired over AIDS
A Florida nurse who claims he was fired because he had AIDS has filed a $1.4 million lawsuit against his former employer.
John Casselberry didn't tell officials at North Broward Rehabilitation and Nursing Center that he had AIDS when he was first hired. By law, he didn't have to disclose it, and the hospital could not legally ask.
Casselberry said he was promoted to a supervisory post and granted three separate pay raises. When he applied for intermittent personal medical leave, he disclosed that he was HIV-positive.
Last June, he said he was feeling ill, laid his head on his desk and was immediately fired for sleeping on the job.
Casselberry is suing Ventas Inc., which owns the Fort Lauderdale facility. He contends the company violated the federal Family and Medical Leave and Rehabilitation acts and a state law prohibiting discrimination in public facilities and employment for people with AIDS.
Louisville, Ky.-based Vencor Inc., which operates the facility, refused to comment on the specific allegations in the lawsuit. In a written statement, it maintained Casselberry was fired for not being able to do his job.
The We The People Board of Directors will host the semi-annual We The People membership meeting on Thursday, April 15, 1999, at St. Mary's Church, 1831 Bainbridge Street, beginning with dinner at 5:30 p.m.
At this meeting, members will elect several new members to the Board of Directors. Nominations are being accepted until March 31st, and women are especially encouraged to apply. To be considered for board membership, submit a resume or letter to WTP by that date, addressed to We The People, Nominations Committee, 425 South Broad Street, Philadelphia, PA 19147-1126. Fax nominations can be made to 215-545-8437.
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