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Issue #225: April 16, 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 AIDS, AIDS Patient Care and STDs, Antimicrobial Agents and Chemotherapy, Clinical Infectious Diseases, Journal of the American Medical Association, Journal of Infectious Diseases, Reuters, Sexually Transmitted Diseases.
In This Issue:
PA to hold HIV reporting hearing next Thursday
PWAs may benefit from anabolic steroids
Depression seen as factor in poor adherence
Diarrhea still a problem despite advances
"Sperm-washing" suggested for HIV-discordant couples
New NNRTI improves effect of AZT
Group for PWAs with hepatitis C set
July conference set on families and HIV
Penn sets series of talks on AIDS in Africa, US
WTP plans Bowling Party April 25th
CORRECTION TO LAST WEEK'S AIDS FUND ARTICLE
PA to hold HIV reporting hearing next Thursday
The Pennsylvania Department of Health will hold another in its series of statewide hearings on whether or not to use name or code reporting of HIV infection in Philadelphia next Thursday, April 22nd. The Philadelphia hearing will be held from 1-4 p.m. and 6-9 p.m. at Children's Hospital of Philadelphia. Those interested in testifying should called 610-378-4351 to register.
The hearings have been scheduled in part in response to a recommendation from Philadelphia health commissioner Estelle Richman and the city's AIDS Activities Coordinating Office, which recommended them after a series of hearings in Philadelphia sponsored by the city showed almost unanimous opposition locally to the use of names in the new HIV reporting system expected to be announced by the state later this year.
The Philadelphia Board of Health has recommended to the state that it implement a "unique identifier" system, rather than actual names, once it requires that new HIV infections be reported to state health officials. The Allegheny County Board of Health, which oversees public health services in Pittsburgh and surrounding areas, is expected to endorse a coded reporting system as well.
Federal officials have asked each state to initiate HIV reporting systems this year, and while they have said they will support any kind of reporting programs, they have also clearly indicated their preference for names reporting systems. Most advocates and people with HIV/AIDS have opposed names reporting, saying that it risks confidentiality violations and may discourage some people from getting tested.
Public hearings on HIV reporting are being conducted in eight different locations in Pennsylvania. At the hearings, the state health department opens with a ten-minute presentation on HIV reporting options and surveillance activities, and then begins to hear testimony.
As fastfax went to press, all of the afternoon slots for testimony had been filled, and only evening session slots were available. Those testifying will be allowed only five minutes to testify, although longer written statements are permitted.
An individual requiring reasonable accommodations in accordance with The American With Disabilities Act of 1990 (ADA) should specify such accommodations when registering. Written testimony can also be submitted without attending the hearing by sending it to the Division of HIV/AIDS (PO Box 90, Harrisburg, PA 17108) Attention: Joseph Pease or E-mailed to The deadline for the submission of written testimony is 5:00 PM, April 30, 1999.
PWAs may benefit from anabolic steroids
The results of two studies published in the April 14th issue of the Journal of the American Medical Association show that anabolic steroid treatment can increase lean body mass in dialysis patients and in men with HIV-related weight loss.
In the first study, Dr. Kirsten L. Johansen and colleagues, of the University of California at San Francisco, evaluated 29 dialysis patients with evidence of malnutrition. The patients received 100 mg of nandrolone or placebo by intramuscular injections, which were administered once a week for 6 months.
"What we found was that the treatment resulted in an increase in lean body mass, associated with improvements in functional status," Dr. Johansen told Reuters Health. Patient responses on a questionnaire also indicated reduced levels of fatigue, she added.
Walking and stair-climbing time decreased from 36.5 seconds to 32.7 seconds in the nandrolone group, while it increased in the placebo group from 38.7 seconds to 42.1 seconds, the study group determined. Nandrolone was generally well tolerated throughout the 6-months study period.
Dr. Johansen said that her group is planning a follow-up study in which measurements of strength and functional status will be refined. "And we're also planning on assessing the effects [of nandrolone] in combination with exercise," she said.
The second study, which focused on 24 eugonadal men with HIV-1-related weight loss, was conducted by a multicenter team led by Dr. Alison Strawford of the University of California in Berkeley.
The subjects received intramuscular injections of testosterone to suppress endogenous hormone production. They concurrently underwent an 8-week regimen of progressive resistance exercise and were randomized to oral doses of oxandrolone at 20 mg per day or placebo.
At follow-up, Dr. Strawford's group found that all 22 subjects who completed the study had "significant nitrogen retention and increases in [lean body mass], weight, and strength." However, the "gains were significantly greater in the oxandrolone group than in the placebo group." Treated subjects also exhibited significant declines in HDL cholesterol compared with the placebo group.
Whether or not the subjects were also receiving a protease inhibitor did not appear to affect the results. "This is an important point because weight gain after initiation of protease inhibitor therapy usually takes place through the accumulation of body fat, but our goal in patients with HIV-related weight loss is to build up the lean tissue," senior investigator Dr. Mark K. Hellerstein commented in a press release.
"Perhaps the most important finding of this study is that extremely high dosages of androgens were not required for a significant beneficial interaction with [progressive resistance exercise]," Dr. Strawford's group points out in the paper. The 20-mg daily dose of oxandrolone has previously been shown to be well-tolerated with long-term use, the investigators say.
In an editorial, Dr. Adrian Sandra Dobs of the Johns Hopkins University School of Medicine in Baltimore, Maryland concludes that, until additional studies have been completed, "it is still reasonable to take a conservative approach" to the therapeutic use of androgenic anabolic steroids.
Dr. Dobs does recommend that "measures to maintain energy intake and to increase resistance exercises needed to increase body mass should be a routine part of clinical care" for patients with muscle wasting.
HIV-infected women have a higher rate of lower genital tract infection, according to a report by members of the Women's Interagency HIV Study (WIHS), who also found that the symptoms of sexually transmitted diseases (STDs) become more pronounced as HIV disease progresses.
The data were obtained from a cross-sectional US study involving 2,058 women with HIV infection and 567 women who were HIV-negative. Dr. Ruth M. Greenblatt, of the University of California in San Francisco, and a multicenter US team evaluated the prevalence of and risk factors for STDs in this cohort, which included subjects from 23 sites.
With the exception of bacterial vaginosis and chlamydia, the HIV-positive women were more likely than the HIV-negative women to have a history of STDs, Dr. Greenblatt's group reports in the March issue of Sexually Transmitted Diseases. "Both HIV status and CD4 lymphocyte count were associated with evidence of genital ulcerations, warts, and vaginal candidiasis."
Overall, the investigators found that "CD4 lymphocyte depletion was the factor most closely associated with the expression of chronic viral infections."
Based on these findings, the authors recommend that HIV-infected women "receive careful gynecologic evaluations and care to minimize the occurrence of lower genital tract symptoms and potential sequelae of STDs."
Meanwhile, a multicenter team reports correlations between plasma HIV levels and HIV vaginal load, along with significant reductions in both after antiretroviral therapy. They therefore suggest that successful antiretroviral therapy may reduce the "risk of perinatal and heterosexual transmission by lowering vaginal virus load."
Dr. Clyde E. Hart of the Centers for Disease Control and Prevention in Atlanta and colleagues evaluated data from the 52 HIV-infected women enrolled in the Emory Vaginal Ecology Study of HIV Infection. They assessed the correlation between plasma and genital tract HIV levels using a quantitative-competitive reverse-transcriptase polymerase chain reaction (QC-PCR) assay, "because of its greater sensitivity in detecting and quantifying HIV-1 in genital tract samples from HIV-1-infected women than a commercially available assay."
This enabled measurement of the "proportion of virus load in the lower genital tract from cervical mucus and the cell-free and cell-associated fractions of vaginal secretions," they explain in the April issue of the Journal of Infectious Diseases.
Dr. Hart's group reports that in "blood plasma and vaginal secretions, the amounts of cell-free and cell-associated HIV-1 RNA were highly correlated." They also found a negative correlation between CD4+ T lymphocyte counts and cell-free HIV-1 RNA levels in plasma and vaginal secretions.
And as observed with blood plasma, "initiation of antiretroviral therapy significantly reduced the amount of HIV-1 RNA in vaginal secretions."
Dr. Hart's group recommends additional research to "determine if antiretroviral therapy reduces virus load to low or undetectable levels in vaginal secretions over long periods." If so, "strategies to prevent heterosexual transmission will need to focus more on early identification and treatment of HIV-1-infected adults."
Depression seen as factor in poor adherence
HIV-infected peoples who report intense symptoms, especially higher levels of depression, are less likely to be adherent to antiretroviral therapy compared with those with less intense symptoms and greater feelings of well-being.
These conclusions are reported by Dr. William L. Holzemer of the University of California in San Francisco and colleagues in the March issue of AIDS Patient Care and STDs.
Using a descriptive survey design, Dr. Holzemer's multicenter team evaluated 3 self-reported independent measures of adherence in 420 HIV-infected patients. These included "medication nonadherence," "follows provider advice," and "missed appointments." The subjects were men and women over the age of 18 years treated for HIV infection in seven US cities.
The researchers also assessed the subjects for the following 5 sets of variables: "physiological and biological factors, symptom status, functional status, general health perceptions, and overall quality of life."
They found that "HIV-positive clients with higher symptom scores, particularly depression, were more likely to be nonadherent to medication, not to follow provider advice, and to miss appointments."
Conversely, patients who were more likely to adhere to treatment and follow provider advice reported that they had a meaningful life, felt comfortable and well cared for, believed they used their time wisely and took time for important things.
Dr. Holzemer's group found that age, gender, ethnicity, or history of injection drug use had no apparent influence on patient adherence.
They conclude that "symptom control, particularly the management of depression, appears to be key to creating the capacity for adherence." In addition, clinicians may be able to help patients improve adherence by better understanding how patients perceive their environment.
Diarrhea still a problem despite advances
While the prevalence of HIV-related diarrhea attributable to opportunistic infections has declined with the availability of highly active antiretroviral therapy (HAART), chronic diarrhea as a side effect to the new drugs has become an important problem, according to a report in the April issue of Clinical Infectious Diseases.
In both developed and developing countries diarrhea has "dominated the clinical picture of patients with advanced HIV," Drs. Marinka Kartalija and Merle A. Sande of the University of Utah in Salt Lake City point out. In their report, the physicians review the spectrum of diarrhea-related illness in HIV-infected patients in the context of the new antiretroviral therapies.
The number of HIV-infected patients who undergo endoscopic evaluation for chronic diarrhea has declined in the last 4 years, and the percentage of "patients diagnosed with an enteric opportunistic infection has fallen precipitously," they note.
Recent reports also indicate that many patients who receive HAART experience complete and sustained resolution of a variety of opportunistic infections. The physicians therefore predict that there will be "dramatic changes in the incidence and etiology of chronic diarrhea in patients with advanced AIDS."
Specifically, they believe that more cases of chronic diarrhea will occur as an adverse effect of antiretroviral drugs than from opportunistic pathogens or HIV infection itself.
Diarrhea is a potential adverse effect of most antiretroviral drugs, they continue. For example, diarrhea has been reported in up to 30% of patients taking nelfinavir, 28% of patients taking didanosine, and 18% of those receiving lamivudine. Some studies find that "up to 40% of patients receiving combinations of antiretroviral agents will experience moderate-to-severe diarrhea, significantly complicating treatment."
The physicians conclude that chronic diarrhea will "remain one of the most troublesome clinical manifestations of HIV infection."
"Sperm-washing" suggested for HIV-discordant couples
HIV-discordant couples, in which the man is HIV-infected and the women is not, who wish to conceive a child might be able to do so more safely through a process of "sperm-washing" followed by artificial insemination, according to UK investigators.
This approach to conception has been suggested as a safer alternative to unprotected intercourse in HIV-discordant couples. However, there has been much controversy over whether or not spermatozoa can be infected with HIV, a key factor in the safety of this approach.
To further investigate this, Dr. Jill W. Gilmour of the Chelsea and Westminster Hospital and colleagues in London collected semen samples from HIV-positive men. Dr. Gilmour's group evaluated the samples after separating them into spermatozoa, non-sperm cells and plasma fractions.
Most, but not all, samples came from men on HAART. However, plasma viral levels were variable, and only two men had no detectable plasma HIV RNA. On the other hand, "all spermatozoa were negative for viral RNA or proviral DNA," they report in the April 16th issue of AIDS.
"Spermatozoa did not express significant levels of CD4, CCR5 or CXCR4, suggesting that they are unlikely to be major targets for HIV infection." The investigators also noted a poor correlation between HIV levels in the blood and in the semen.
These findings indicate that the "primary reservoir for HIV RNA in semen is the seminal plasma and [non-sperm cells]." And by washing the spermatozoal fraction, HIV RNA levels can be reduced to below detectable levels, which ranged from between 20 and 80 copies/mL in the samples.
Based on these data, Dr. Gilmour's group would therefore "recommend 'sperm-washing' followed by insemination as a safer alternative to natural conception for HIV-discordant couples wishing to have children."
New NNRTI improves effect of AZT
When used in combination with zidovudine (AZT), the nonnucleoside reverse transcriptase inhibitor UC781 appears to overcome AZT resistance in HIV and to delay the development of viral resistance to both drugs.
AZT and UC781 have very similar antiretroviral potencies, Dr. Gadi Borkow of the Lady Davis Institute for Medical Research in Montreal and colleagues explain. The two drugs therefore provide a useful system to investigate the interaction between these two types of drugs in inhibiting HIV replication.
Dr. Borkow's team evaluated the effectiveness of the two drugs when used alone and when used in combination against "wild type" HIV, AZT-resistant HIV, and UC781-resistant HIV. Their findings appear in the February issue of Antimicrobial Agents and Chemotherapy.
They found that a combination of UC781 and AZT showed success in inhibiting the replication of AZT-resistant virus, "implying that UC781 can restore antiviral activity to AZT against AZT-resistant HIV." They point out that this did not occur when the combination of AZT plus nevirapine was used.
Dr. Borkow's group also found that the combination of UC781 plus AZT "significantly delayed" the development of HIV resistance compared with the use of either drug alone.
However, AZT plus UC781 did not act to inhibit the replication of either wild-type virus or UC781-resistant HIV.
Group for PWAs with hepatitis C set
The first meeting of the Philadelphia HIV/Hepatitis C Working Group will be held on Monday, April 26, from 3 pm - 5 pm, at Philadelphia FIGHT, 5th Floor Conference Room, 1233 Locust Street.
The group is being formed to develop responses to the HIV/Hepatitis C crisis, which is said to affect almost one in three people living with HIV disease.
The guest speaker at the first meeting will be James Learned of Hepatitis Action & Advocacy Committee (HAAC) in New York City.
Proposed goals for the new working group include:
--To assess the current status of research, treatment, care of Hepatitis C; support for people with Hepatitis C; and funding of these activities;
--To identify gaps/problems in the research/treatment/support system
--To identify approaches in other regions and states to address these needs
--To develop an advocacy and/or intervention plan to begin to address these needs.
For more information, call Gary Bell, BEBASHI, at 215-769-3561 or
July conference set on families and HIV
The Office of AIDS Research, National Institute of Mental Health, the National Institutes of Health, and the University of Pennsylvania will sponsor a conference on the "Role of Families in Preventing and Adapting to HIV/AIDS, from July 21 - 23, 1999, in Philadelphia.
The conference is designed to present research findings on family processes and HIV disease.
Topics will include family processes associated with the epidemiology and high risk behaviors of family members; family configuration and functioning as predictors of adaptation at different stages of HIV/AIDS; stress and coping strategies mobilized by families infected and affected by HIV and AIDS; family issues of multiple losses, death, bereavement, child custody and permanency planning; models for mental health services for families with a life-threatening disease; and strategies for analyzing family data.
Secondary objectives are to attract more family researchers to AIDS research; generate new ideas and collaborations; and develop research initiatives for HIV/AIDS family-oriented research.
For more information on the conference, contact Loretta Sweet Jemmott, Ph.D., Director of the Center for Urban Health Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104,215 898-6373; 573-9193 (FAX); or Willo Pequegnat, Ph.D., Associate Director for Prevention and Translational Research, Office of AIDS Research, NIMH, NIH, 6001 Executive Boulevard, Rm. 6209, MSC 9619, Bethesda, Maryland 20892-9619, 301 443-6100; 443-9719 (FAX); email: wpequegn@nih.gov.
Penn sets series of talks on AIDS in Africa, US
The University of Pennsylvania's "Interdisciplinary Dialogues on AIDS," sponsored by the Penn Center for AIDS AND HIV Research, will hold a series of lectures and workshops in the coming weeks on issues related to the HIV epidemic in Africa and in the U.S.
The first in the series, on the topic of "AIDS Education & HIV Prevention In Africa and the U.S.," will feature a panel discussion involving Dr. Susan Watkins, of the University's Sociology Department; Dr. Loretta Sweet-Jemmott (Nursing); Dr. David Metzger, of the VA Medical Center; Dr. William Eric Perkins, of Penn's African-American Studies Department; and Dr. George Woody, of the VA Medical Center. It will take place on Wednesday, April 21st, from 4-6 p.m., in Room 17 of Logan Hall on the southeast corner of 36th Street and Locust Walk.
On Wednesday, April 28th, the topic will be "Care & Treatment of People Living with HIV/AIDS in Africa & the U.S." Speakers include Dr. Bonnie O'Connor, of Penn's Folklore Dept. and a well-known advocate of complementary and alternative therapies in AIDS care; Dr. Marc Micozzi of the Philadelphia College of Physicians; Dr. Steven Feierman of Penn's Department of History & Science of Sociology; and Regina Oliver of the School of Nursing.
This event will also take place in Logan Hall, Room 17, from 4-6 p.m.
On May 5th, the dialogue concludes with a talk on "The Politics of AIDS" by Paul Farmer, MD, PhD, of Harvard Medical School. Dr. Farmer is the author of "AIDS and Accusation: Haiti a Geography of Blame," and Co-Editor of "Women, Poverty and AIDS: Sex, Drugs, and Structural Violence." Dr. Farmer's talk will take place on Wednesday, May 5th, from 5:30 to 7:30 p.m., at Penn's Dunlop Auditorium. The event will be followed by a reception for Dr. Farmer.
For more information, call Tonya Nicole Taylor at (215) 898-7461 or email to Further information about the Interdisciplinary Dialogue on AIDS in Africa can be found on the Internet at http://www.sas.upenn.edu/~tonyat/Dialogue.html.
WTP plans Bowling Party April 25th
We The People will sponsor a bowling party for people with HIV/AIDS, their friends and families on Sunday, April 25th, from 1:00 to 6:00 p.m. at St. Monica's Lanes, located at 16th and Shunk Streets in South Philadelphia.
Tickets, which are $8, are available at We The People's Life Center at 425 South Broad Street or by phone at 215-545-6868. A raffle drawing offering cash prizes up to $150 and other gifts will also be held, with tickets for the drawing available at $1.00 each.
For more information, call 215-545-6868.
In last week's issue of fastfax (#224), the amount of money raised at the 1998 AIDS Walk which was retained by the AIDS Fund for administrative expenses was reported incorrectly, due to a typographical error. The correct amount is approximately $50,000. fastfax sincerely apologizes for this error.
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