AIDS drug progress hailed, prices lamented
Crixivan/AZT/3TC combo reduces virus "below limit of detection"
Abbott says Ritonavir reduces mortality
Scientists say milk-based compound stops HIV spread
ddI/d4T combination said to reduce viral load
Scientists induce AIDS in a chimpanzee
Report credits AZT for drop in newborn HIV rates
AIDS spreading fastest among young blacks, straights
"Snapshot" of NY epidemic presented
Deaths from AIDS in U.S. outpace new HIV infections
Doctor's AIDS knowledge linked to patients' survival
Other stories:
Researchers criticize peer review process for AIDS trials
Kids' HIV/AIDS training programs censored
HIV Commission elects co-chairs
Mental patients decry managed care
Advocates, Clinton disagree on impact of HIV military ban
AIDS fears drop in U.S., poll shows
New trial orders after judge orders HIV "precautions"
AIDS drug progress hailed, prices lamented
People with AIDS and doctors who treat them were heartened by major advances in treatment announced at the Third Conference on Retroviruses and Opportunistic Infections in Washington this week, but are afraid that high prices will place them out of reach for many.
"The news is very good, but please give us the means to provide these substantial advances in therapy to our patients," 20 researchers affiliated with prominent hospitals and universities wrote in an open letter to hospitals, insurers, and state and federal governments.
Scientists at the conference presented research on protease inhibitors that seem to control the virus when combined with other antiviral medicines already on the market.
Those results -- including Merck's Crixivan and Abbott's Ritonavir -- are still preliminary, with only a few months worth of data and limited numbers of patients.
Problems with mutation and drug resistance that have made AIDS so frustrating and perplexing could yet emerge.
But overall, scientists, doctors and patients alike were encouraged about the prospects for life-prolonging treatments available within months. The Food and Drug Administration is expected to act swiftly to approve the treatments.
But a "cocktail" of several antiviral drugs costs thousands of dollars a year. Retail prices of the new protease inhibitors are not yet known, but activists and physicians do not expect them to be cheap, and some say AIDS patients could be faced with $12,000 to $18,000 a year in bills just for prescription medicines.
Those sums would be even more of an obstacle to poor people infected by HIV.
"We finally have something to tell people -- get tested and get treated. This is not just a matter of option and opinion anymore, there are treatments," said Dr. Charles Farthing of the AIDS Healthcare Foundation of Los Angeles. "But most patients can't afford them," he said.
However, several activist groups who met with reporters at the conclusion of the week-long conference did not blame the drug companies, as was common earlier in the epidemic. In fact, drug companies and activist groups jointly sent a letter to House Speaker Newt Gingrich urging more government funding.
They want more done through Medicaid, through the Ryan White Act that helps communities fight AIDS, and through other public health programs. Many federal health programs have seen funds squeezed in the Congressional budget battles.
"My job is to help the science -- the NIH isn't the right place to figure out drug pricing," National Institute of Health AIDS office director William Paul said in an interview at the conclusion of the week-long conference. NIH works on research and does not set national health insurance policy.
But Paul agreed that the costs could be a problem -- in the industrial and developing worlds. And however encouraging the drug findings were, he said, the key to combating the epidemic remains prevention.
"We heard a lot about drugs," he said of the conference. "We didn't hear a lot about vaccines."
Crixivan/AZT/3TC combo reduces virus "below limit of detection"
Preliminary results from an ongoing, larger study with Merck's investigational protease inhibitor Crixivan (Indinavir sulfate) in triple combination with two other AIDS medications showed that levels of HIV in the bloodstream were reduced to levels below the limit of detection of the assay used (500 copies/ml) in six of the seven patients who have completed six months of treatment. The triple combination reduced median virus levels by more than 99 percent (2.0 log10 copies/ml).
Among patients taking Crixivan alone, 44 percent (4 of 9) had HIV reduced to these levels (500 copies/ml) after at least six months, compared to none of the patients taking the two other AIDS medications, AZT plus 3TC.
The study compared the triple combination with Crixivan, Crixivan alone, and AZT (Retrovir) plus 3TC (Epivir) in patients who had previously taken AZT.
Therapy with Crixivan also improved CD4 counts, causing a median increase in CD4 counts of 146 cells/mm3 in patients taking the triple combination with Crixivan and a median increase of 98 cells/mm3 in patients taking Crixivan alone. In patients taking AZT and 3TC, CD4 cell counts increased by a median of 22 cells/mm3. Patients in the study began with a median CD4 cell count of 142 cells/mm2.
The impact of Crixivan alone or in combination with other antiviral medicines on progression of HIV disease, opportunistic infections, and survival are not known yet, but such studies are under way.
"In my opinion, the impact on viral levels of indinavir in combination with two other antiretroviral medications in this study," according to Dr. Roy Gulick, of The New York University School of Medicine, who presented the study, "supports the theory that, by adding a potent protease inhibitor to other drugs, we may be able to reduce the virus to very low levels and significantly suppress its replication. These results should be studied further to determine the impact on clinical outcomes."
To be eligible for enrollment, patients had to be HIV-positive and have 50-400 CD4 cells and more than 20,000 copies/ml of virus in the bloodstream. They also had to have taken AZT for at least six months. The study's patients were randomized to one of three arms: Crixivan alone, Crixivan plus AZT plus 3TC, and AZT plus 3TC.
Abbott says Ritonavir reduces mortality
Abbott Laboratories released data at the conference indicating that mortality was reduced by approximately one-half among advanced AIDS patients who received its experimental HIV protease inhibitor ritonavir for up to seven months, compared to those who received placebo.
"The results from this large-scale clinical study demonstrated greater clinical benefit for advanced AIDS patients receiving ritonavir-containing treatment regimens compared to those not receiving ritonavir as part of their therapy regimen," says Andre Pernet, Ph.D., vice president of pharmaceutical research and development at Abbott Laboratories.
The randomized, double-blind, placebo-controlled study followed a total of 1,090 patients at 67 investigational sites in the United States, Canada, Europe and Australia. All patients entering the study had advanced AIDS with CD4 cell counts of less than 100. In the study, ritonavir 600 mg or placebo was administered twice daily and was added to existing approved nucleoside therapy, if any. Patients were followed for up to seven months.
Thirteen percent of the 543 patients who received ritonavir died or had disease progression, compared with 27 percent of the 547 patients who received placebo. Disease progression was defined as the onset of a new AIDS-related illness. The mortality rate among patients receiving ritonavir was 4.8 percent -- approximately half that of the 8.4 percent mortality rate among patients not receiving ritonavir.
Ritonavir was generally well-tolerated in the study. The most common side effects were diarrhea, nausea, vomiting, fatigue and a tingling sensation around the mouth.
"It's significant that, in addition to showing improvement based on surrogate markers (e.g., CD4 cell count) in previous studies, ritonavir, with these data, now demonstrates improvement in clinical endpoints as well. This is a first among drugs in this class," says Dr. Pernet.
Abbott filed a New Drug Application with the FDA on Dec. 21, 1995, seeking clearance for ritonavir for the treatment of advanced AIDS. Ritonavir is the second protease inhibitor for which an NDA has been filed.
Results of a worldwide clinical trial released at the conference demonstrate the clinical benefit of the combination of Videx (didanosine, ddI) with AZT in treating HIV.
The results of the European and Australian Delta Trial confirm the findings of a previous large-scale trial, AIDS Clinical Trials Group (ACTG) 175.
The Delta Trial, which involved more than 3,000 patients, two-thirds of whom had not received prior antiretroviral therapy, evaluated the clinical benefit of three therapies: ddI plus AZT, ddC plus AZT and AZT alone (monotherapy). Started in 1992 and completed in late 1995, the results of this study revealed that combination therapy produced significant long-term survival benefits over AZT monotherapy. Among patients who had not experienced an AIDS-defining event prior to the study, ddI plus AZT significantly delayed progression to AIDS or death as compared to AZT alone or the combination of ddC plus AZT.
Another trial, conducted by Dr. Robert Schooley of the University of Colorado, also studied ddI plus AZT, ddC plus AZT and AZT alone in patients without prior antiretroviral therapy. This also found that ddI plus AZT significantly delayed progression of disease and prolonged survival in comparison to AZT monotherapy or the combination of ddC and AZT which gives similar results as AZT alone.
"Bristol-Myers Squibb is extremely encouraged by the results of these trials," said Laurie Smaldone, M.D., Vice President, Infectious Disease, Clinical Research, Bristol-Myers Squibb Pharmaceutical Research Institute. "We are seeing strong evidence that VIDEX, which also plays an important role as monotherapy, is an integral component of promising combination therapy that has been shown to provide long-term clinical benefit."
The results of the Delta Trial confirm the results of ACTG 175, which showed that ddI plus AZT combination therapy and ddI alone were superior to AZT monotherapy. Delta is a larger trial than ACTG 175 and specifically examined therapeutic benefits in terms of delaying progression of AIDS and prolonging survival, but did not include an evaluation of ddI alone.
Scientists say milk-based compound stops HIV spread
Researchers have discovered a compound derived from cow's milk that stops the transmission of HIV, a finding they hope could be used to develop a cheap means of preventing spread of the disease.
Scientists at the New York Blood Center said they found in laboratory experiments that a chemically modified version of a protein found in cow's milk blocks HIV transmission in human cells.
The compound could eventually be formulated into a foam or cream applied topically before sex to provide a barrier against infection, they said. It could be used with condoms for additional protection and also be a source of protection for women which does not require the cooperation of the male partner.
But at least a year of further studies, including tests in monkeys, is needed before initial tests of the compound can be started in humans, said Dr. Robert Neurath, head of the blood center's Laboratory of Biochemical Virology who led the study.
"We would expect that it could be used for preventing both heterosexual and homosexual transmission of the virus if the animal experiments and preliminary clinical trials pan out," Neurath told a news conference.
The researchers found that the compound, named B69, binds to receptor sites on CD4 cells that are targets for sexual transmission of the HIV virus. By occupying the CD4 receptor sites, the compound blocks the virus from binding with the cells and prevents infection, they said. The findings were being published in the journal Nature Medicine.
Because it is derived from an inexpensive and widely available source, the compound could be especially useful in lesser developed countries, Neurath said.
New York Blood Center President John Adamson said the center had filed for patents for the compound and was seeking corporate collaborators to help fund further research.
ddI/d4T combination said to reduce viral load
Scientists at the conference said that interim trial results showed that a combination of two existing HIV drugs had significant benefits in fighting HIV.
The drugs, studied at the University of Texas Medical Branch at Galvaston, were Zerit (stavudine, d4T) and Videx (ddl, didanosine), both made by Bristol-Myers Squibb Co.
Lead researcher Richard Pollard said in a statement that interim results of the trials, funded by Bristol-Myers, showed the combination produced significant effects on key signs of HIV therapy effectiveness.
He said the trials on 75 HIV-infected patients showed that the combination produced a substantial reduction in viral load which appeared to be prolonged, and an increase in CD4 cells for as long as one year.
Changes in the count of CD4 cells, an immune response marker, and antiviral activity are widely considered to be early indicators of HIV therapy effectiveness. Polland said "the study is an important step in our efforts to evaluate available AIDS therapies."
He added that he was extremely optimistic about the potential benefits of the combination and that his team would continue to research those benefits, and other treatments.
In a telephone news conference, Polland said the results of the trials suggested they could be pursued with a larger patient population.
He added that the patients in the trials who gained from the combination therapy would be in line for continued therapy when the trial ended.
Pollard said it was too early to predict what the combination therapy might mean for survival, but on the basis of the early results the therapy did seem to produce prolonged effects in fighting HIV.
Scientists induce AIDS in a chimpanzee
Scientists have reported that for the first time a chimpanzee infected with HIV has developed symptoms of AIDS.
The research was conducted by Francis Novembre and colleagues at the Yerkes Regional Primate Research Center at Emory University.
Although monkeys have been infected with an AIDS-like virus and used in research, chimps had been thought to be resistant to AIDS.
The Emory team infected the chimpanzee with one form of HIV 11 years ago and injected another form of the virus two years later, in 1987.
Soon after the initial exposure, scientists were able to detect the virus in the animal. In subsequent years it showed a decline in CD4 cells, followed by a recovery, and then another decline in May 1993. A fall in CD4 cells indicates deterioration in the immune system.
Last March the animal developed chronic diarrhea and infections that are a hallmark of AIDS. Scientists found telltale signs of AIDS through a lymph biopsy as well.
Researchers have been working with primates in an attempt to understand how HIV leads to the disease AIDS.
Report credits AZT for drop in newborn HIV rates
The number of babies born infected with HIV has decreased significantly in some areas thanks to a 1994 study, researchers have reported.
The study showed that AZT may reduce transmission of HIV from mothers to children if given during pregnancy and just after birth.
Evidence that the strategy may work was presented at the Third Conference on Retroviruses and Opportunistic Infections in Washington, D.C. In North Carolina, for example, the infection rate in children of HIV positive mothers dropped from 21 percent in 1993 to 8.5 percent in 1994. The University of North Carolina at Chapel Hill's Susan Fiscus reports that the rate of transmission in babies who were treated was less than 6 percent, compared to 19 percent in untreated infants.
Similar trends were found in other areas, but Robert Biggar of the National Cancer Institute cautions that the result may not be found throughout the country.
AIDS spreading fastest among young blacks, straights
The AIDS epidemic in the United States is spreading faster among young people and heterosexuals, researchers from the National Cancer Institute have reported.
More women than men are being infected, and heterosexual infection has tripled since the start of the epidemic which has infected between 600,000 and 700,000 people in the United States. About 50,000 people died from AIDS in the last year, said Dr. Robert Goedert, acting chief of the viral epidemic branch of NCI in Bethesda, Md. "Nearly the same number of new infections occurred in the same time," he said.
"There is no slowing of the epidemic," Goedert said. "It's in the process of spreading to young people and heterosexuals -- people who have traditionally been considered outside the epidemic." The numbers of new infections among homosexual white men has fallen by 70 percent, Goedert said, and even among intravenous drug users there has been a 30 percent reduction in new cases when rates from 1987 to 1992 are compared to the early years of the epidemic, 1981 to 1986.
Goedert said he is concerned that although numbers of infected heterosexuals are still low, risk to the immense uninfected population is increasing. He said, the tripling of the infection rate is independent of drug use; it's due to unsafe acts among heterosexuals.
Dr. Robert Biggar from Goedert's NCI branch reported at the conference that new studies of the AIDS epidemic found:
--About 3 percent of black men and 1 percent of black women in their 30s are infected with HIV.
--During the period 1987 to 1992, the hardest hit age group were those in their late 20s.
--AIDS rates were highest in black men. Equal numbers of black men were infected through homosexual acts and through drug use. Biggar said his study pointed out that "prevention should be especially targeted toward young minority groups, who should be warned of the risks of unprotected homosexual acts as well as drug use and heterosexual acts."
"Snapshot" of NY epidemic presented
Twice as many crack users are infected with HIV than others who seek help at sexually-transmitted disease clinics, New York City Health Department researchers have reported.
However, fewer substance abusers treated at hospitals were HIV-infected than in past years. Researchers also reported 1.1 percent of AIDS cases involved health care workers.
In a series of reports presented at the conference, researchers outlined a statistical snapshot of the AIDS epidemic in New York City.
The percentage of documented crack users infected with HIV was 16 percent, more than twice as much as the non-users of crack cocaine who presented themselves at a city clinic to treat a sexually-transmitted disease between 1990 and 1994, said Christopher Murill of the Office of AIDS Research in the Bureau of Disease Intervention Research.
Murrill and his colleagues tested 2,558 consecutive users of crack. In addition to the higher prevalence of HIV infection, the researchers found that 40 percent of the crack users were women, 95 percent were non-white, 51 percent were between the ages of 25 to 34, and 12 percent had used intravenous drugs. Sixty-four percent had a sexually- transmitted disease.
In a second study, researchers noted a decline in the numbers of HIV- infected people who were treated at city hospitals for substance abuse. In 1991, 105 male drug users tested positive for HIV, representing 25 percent of substance abusers treated in hospitals. That contrasts with 1994, when the percentage of infected men had fallen to 16 percent.
Twenty-nine women drug users, representing 28 percent of hospitalized substance abusers, were HIV positive. In 1994, the number of infected women dropped to 13 percent.
Overall health department researchers found that 18.4 percent of drug abuse patients were HIV positive; compared to 7.7 percent of those treated for alcohol abuse.
In a third study, researchers looked at the number of health care workers among the 78,207 adult AIDS cases and found that 829 people, 1.1 percent, held positions as doctors, dentists, nurses, hospital workers or health care technicians. Of that group, 86 percent were classified as engaging in activities that put them at high risk for AIDS; the rest, 116 people had no identified risk factor for AIDS.
The study revealed that 152 physicians -- all but 12 had high risk activities -- had AIDS. Other health care workers with AIDS included 28 dentists; 149 nurses; 152 health aides; 67 clinical laboratory technicians; 114 other technicians; 60 hospital administrators; 18 emergency medical technicians; 51 housekeepers; 18 dieticians and 30 therapists.
Deaths from AIDS in U.S. outpace new HIV infections
Since 1993, the number of Americans that die of AIDS each year has surpassed the number of new infections by 10,000 to 20,000. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the epidemic is starting to wane.
Fauci was responding to a report by Dr. Robert Biggar of the National Cancer Institute, who estimates that 60,000 Americans die of AIDS each year and 40,000 are becoming infected with HIV. Biggar says the plateau is the result of people in high-risk groups taking precautions to protect themselves from infection. Biggar said, however, that new infections are rising among young people, especially minorities and heterosexuals.
Troy Petenbrink, of the National Association of People with AIDS, says he finds it hard to believe that the new infection rate is lower than the AIDS death rate.
Doctor's AIDS knowledge linked to patients' survival
An AIDS patient's survival is directly linked to how much his doctor knows about treating the disease, according to a study reported at the conference.
The study, conducted by researchers at the University of Washington, looked at the survival of more than 400 AIDS patients treated by 125 primary-care doctors from 1984 to 1994 at a health maintenance organization in Seattle. It found that after the disease was diagnosed, the median survival of the most experienced doctors' patients was 26 months, compared to 14 months for patients of doctors with the least experience with AIDS. The study found a decreasing risk of death for each successive patient a doctor treated. The areas where experienced doctors were attentive were monitoring of the patients immune cell count, prescribing drugs for pneumocystis carinii pneumonia, and in providing aggressive anti-HIV therapy.
In a second study reported at the meeting, researchers at the New York City and New York State health departments reported an increased incidence of invasive cervical cancer in women with HIV.
Researchers criticize peer review process for AIDS trials
Some members of the largest AIDS drug testing network, the adult AIDS Clinical Trials Group (ACTG), say the peer reviewers who decide their funding are not knowledgeable enough to make such decisions. The peer review process generated some concern last year when researchers objected to the reviewers decisions. Some researchers say the original review panels are too sanitized against insider influence, and therefore comprised of nonexperts.
The funding agency, the National Institute of Allergy and Infectious Disease, admits it had trouble finding reviewers who did not have some conflict of interest, but that 80 percent of the people selected had M.D.s, PhD.s, or both. Researchers were unhappy with the reviewers' rankings, however, and concluded that they did not know enough about AIDS research to make the best decisions. The reviewers, though, say the applications that got lower rankings were just not as good as others. The NIAID reconsidered the rankings and expanded the number of research sites to be funded This restored funding for some of the disappointed researchers, including a group at Harvard that had helped start the program 8 years ago.
Kids' HIV/AIDS training programs censored
The January issue of Youth Today reports that Red Cross president Elizabeth Dole has instructed staffers to downplay the use of condoms in AIDS prevention training and presentations for youth, and to stress abstinence instead.
Moreover, Dole has toned down other aspects of the Red Cross' basic AIDS education program - like drawings of a penis deemed "too realistic" and sexual content in a Red Cross-produced video on AIDS.
As the incidence of AIDS continues to rise among young adults, health experts regard the inability to frankly discuss condoms and sex as a dangerous setback in HIV/AIDS prevention campaigns.
"Schools are scared to death of the issue of HIV and AIDS," Secretary of Health and Human Services Donna Shalala told Youth Today. "Yet you're not going to convince people in conservative communities to allow youth access to [this] information."
And there is frustration with the restrictions amid the organization's ranks. Patricia Terrell, senior youth associate of the Red Cross' HIV/AIDS Education Program, says many state governments want "abstinence only" in the presentations, and so are cleansed of what they deem unacceptable material for children. "Red Cross chapters continually mention more restrictions on content than there used to be. We're going backward in this country when we can't even mention the "C" [condom] word."
Richard Sorian, director of public affairs at the White House Office of National AIDS Policy, says President Clinton has asked for a report on the incidence of HIV among adolescents and recommendations for ways to address the rising rates of infection among young people.
Sorian said the report, due out in late January, will highlight the "great work" of peer educators and will expand upon recommendations provided to the President in May 1995 by youth participants of the National Youth Summit on HIV Prevention and education.
HIV Commission elects co-chairs
The Philadelphia Commission on HIV/AIDS, the region's HIV/AIDS planning body for federal Ryan White Title I money, elected co-chairs at its January 29th meeting. The co-chairs will lead the Commission into creating planning and priorities for the use of Title I money to meet the needs of individuals living with HIV disease in Philadelphia's nine-county area.
Named to the positions were Ted Kirk, PhD, and Guy Weston. Kirk is a clinical psychologist and thanatologist (death and dying specialist). He is also a gay man living with HIV disease since 1987, and serves on the We The People Board of Directors. Dr. Kirk has worked in both the public mental health setting and private practice, and has provided educational seminars on HIV infection and related topics to various audiences, and describes himself as having a "strong personal and professional commitment to meeting the needs of persons with HIV and AIDS."
Weston is the executive director of Ecumenical Information AIDS Resource Center (EIARC), an interfaith HIV/AIDS education ministry in Philadelphia. He was co-founder and president of Mercer County HIV Consortium and co-founder of Mercer County's New Jersey Title IIIb Early Intervention Program. He has conducted numerous training workshops on cross-cultural issues, HIV prevention counseling, and HIV instructor training. He describes himself as a "surviving partner, African American, gay, and a resident of Burlington County, New Jersey."
In other business, the Commission passed new by-laws which will govern its operations into the future. Additionally, the group began discussing its overall budget for the year, which is about $731,000. The money will be used by the Commission itself, as well as its two sub-committees -- the Community Planning Group, which does planning for prevention education and counseling and testing, and the Care Committee, which does planning for the care of people living with HIV disease. Portions of the budget will be earmarked to pay for staff and overhead, as well as for the hiring of consultants to work with the groups to do needs assessments for various populations to help better meet their needs.
The Commission was created in September of 1995 by Health Commissioner Estelle Richman as a result of the city wresting Ryan White Title I money away from the Philadelphia AIDS Consortium (TPAC) amid allegations from several communities and organizations of conflicts of interest and incompetency leading to the corruption of the planning process, as well as allegations of TPAC's insensitivity to the needs of minority communities, poor people and people living with HIV disease.
As reported in last week's fastfax, the Board of Directors of TPAC is still locked in battle over what the future direction of that organization will be. Many members of the board believe that the organization should give up control of Ryan White Title II money, which it allocates on behalf of the state Department of Health. These board members cite several reasons, including the expense of unnecessarily duplicating the Title I planning process at the HIV Commission, and conflict of interest issues on the TPAC board (many members of the TPAC board who participate in the planning process are employed by agencies which ultimately receive funding from the process -- a violation of state guidelines).
Yet other board members believe that the organization should try to retain control of the Title II money as well as what organizations ultimately receive funding from the process. A recent vote by the organization on whether it should continue to exist narrowly passed by a vote of 17-15 -- with 34 board members not voting.
Mental patients decry managed care
Many patients and psychotherapists are complaining that, in the name of saving money, managed-care companies are denying essential mental-health services, and that as a result, psychiatric problems are getting worse, according to a report in The New York Times.
The charges are serious enough that the consumer-affairs agencies of California and Rhode Island have begun investigations of how managed-care companies handle psychiatric claims.
In Massachusetts, a group of mental-health therapists and patients are suing the Blue Cross/Blue Shield plan over what Dr. Frederick Schiffer, a Harvard psychiatrist who has taken the lead in the suit, says is an "extensive, covert system of deceptions, disincentives and intimidations that effectively prevent many patients from receiving the advertised mental-health benefits."
According to Schiffer, when the company acquired another health plan, Bay State Health Care, it led subscribers to believe they still could have 20 sessions of psychotherapy, as had been the case before. In fact, the company took steps to discourage people from getting the promised benefit.
Though conditions have improved since the lawsuit was filed, Schiffer said, many therapists who worked for the plan have said in court documents that "almost all patients were granted six sessions of treatment, but that if the therapist requested more, they would be intimidated by being told, `We don't want long-term therapy, and we'll drop you from our list of psychotherapists if you insist on more sessions.' "
A much cited study in the debate was conducted in 1993 by Rand Corp., tracking the outcomes over a two-year period of 617 patients treated for depression in a variety of health plans. The study found that among the more seriously ill patients, the worst outcomes were for those treated in health plans where cost limits meant fewer treatment sessions.
A 1994 study of 854 psychotherapy patients found that while acute symptoms of distress, such as intense anxiety, improved early in therapy, in three-quarters of patients it took about a year of psychotherapy to lift chronic symptoms, such as feeling worthless. Led by Dr. Kenneth Howard, a psychologist at Northwestern University, the study shows a "dose-response" relationship between the length of psychotherapy and its effectiveness. That relationship seems to have been borne out by a survey conducted among almost 4,000 readers of Consumer Reports magazine and reported in the December issue of the journal American Psychologist by Martin Seligman, a psychologist at the University of Pennsylvania. In the survey, readers who said they had stayed in treatment with a mental-health specialist for longer than six months fared better than those whose treatment period was shorter.
Advocates, Clinton disagree on impact of HIV military ban
President Clinton's spokesman said last week that the men and women Congress wants discharged from the armed forces because they carry HIV would retain their full medical and dental benefits.
"They won't face any lack of support," said White House press secretary Mike McCurry. "They'll be in a situation similar to other military retirees."
McCurry said the administration will work closely with allies on Capitol Hill "to pursue legislation that would reverse this policy and do so ... within the six-month period before it takes effect." The discharge order was inserted in the $265 billion defense authorization bill signed by Clinton Friday. 1,049 male and female service members would have to be discharged within six months under the terms of the bill.
AIDS activists challenged the White House assertion that service members who leave on "involuntary discharge" because they carry HIV will get the same medical benefits as others who retire from the military or leave on medical discharges.
The Human Rights Campaign, which follows gay rights and AIDS issues, contends that those with the virus may find it difficult to get health care services, and their family members will lose health benefits altogether.
"It singles out men and women with HIV and treats them differently from service members with other diseases," said Winnie Stachelberg, the group's health policy advisor.
A spokesman for the U.S. Office of National AIDS Policy confirmed that view, saying that family members will lose benefits, unlike other military retirees, and that the HIV carriers will get government health care only on a "space available" basis instead of the higher priority level, "space required."
AIDS fears drop in U.S., poll shows
Americans' fear of contagion from HIV has declined sharply in the past decade, a survey has showed.
The ABC News poll showed only 17 percent of those queried said they were afraid they might become infected with HIV, the least in a decade of polling.
Concern about the transmission of HIV by casual contact peaked at 29 percent five years ago, according to the telephone survey of 509 adults.
The poll was sparked by the return to professional basketball of Los Angeles Laker star Magic Johnson, who had left the game after learing that he was HIV positive.
Seventy four percent of respondents approved of Johnson's return, and most of them said they approved strongly, the poll showed.
New trial orders after judge orders HIV "precautions"
The Massachusetts Appeals Court has ruled that "precautions" taken by Berkshire Superior Court Judge Charles Alberti Jr. to keep a defendant from using his HIV-infected blood to escape or to cause a mistrial were too extreme.
Alberti had ordered that the defendant be held in leg irons during his trial and that he be separated from his lawyer by a table and a stack of books. The Appeals Court set aside the conviction and ordered a new trial. The defendant told the woman he allegedly raped that he had HIV, but it was never confirmed.