Ridge finally succeeds in draconian Medicaid cuts
AZT again said to reduce HIV births
Protein found that lets HIV invade
Immunizations raise production of HIV
CDC ties most hetero AIDS cases to drug use
Hemophiliacs to reject settlement offer
House gears up for FY '97 appropriations
Military HIV discharge to stand
New rules require $150 co-pay from disabled PWAs
Under the legislation passed Wednesday and signed into law Thursday, disabled people covered by the state's Medical Assistance program -- including people with HIV/AIDS -- will be required to spend $150 annually from their disability income toward their medical care. The co-payment is the equivalent of 2.5% of the total annual income of most people with AIDS receiving Social Security Supplemental Income (SSI), which averages $497 per month.
The co-payment provision will wipe out a $7 per month increase -- $84 per year -- instituted just five months ago for SSI recipients in Pennsylvania.
An earlier proposal to eliminate the "spend-down" provision of the Medicaid program -- which allows people on disability to automatically qualify for Medicaid once their medical bills bring their incomes down to Medicaid-eligible levels -- apparently is not included in the new Medicaid proposals.
The $2 million reduction in the Special Pharmaceuticals Benefits Program, which is not part of the state Medicaid program, remains in the Governor's 1997 budget proposal, which still needs to be adopted by the legislature.
Some legislators said that they hoped to weaken the Governor's Medicaid cutback through the budget debate.
The Ridge plan was called devastating to the city, which now must face the prospect of increased social service costs; hurtful to its poor, who lose more in benefits than any area of the state; and potentially punishing to its job market, heavily reliant on the health care industry.
Democratic House Leader H. William DeWeese told the Philadelphia Daily News that Ridge's cuts will cost 40,000 to 50,000 health care jobs statewide. A Wharton School study, sponsored by the Hospital Association of Pennsylvania, said that the state may lose 54,000 jobs over five years as a result of the reduction in Medicaid funding for health care for the poor.
The new law represents a major political victory for Ridge, who, despite having a GOP-controlled Legislature, has had difficulty in getting his agenda adopted.
Originally proposed in February and somewhat softened by legislative leaders, the welfare bill narrowly passed both House and Senate on Wednesday.
It slices $210 million in health care benefits from 220,000 single poor people aged 21 to 59, and requires a new $150-a-year deductible for hospital services for another 186,500 poor people.
It hits Philadelphia hard: 72,000 poor Philadelphians lose care -- 70,000 of them poor, unemployed African-Americans. Philadelphia hospitals stand to lose $116 million a year in state-paid medical fees.
Mayor Rendell, lobbying against the measure, called it neither welfare reform nor medical cost-containment, but "merely a shortsighted attempt to reduce social spending."
It takes effect immediately, although its impact won't be felt for several months, pending review by federal health officials.
Ridge called it "the most dramatic welfare reform in Pennsylvania history."
Rep. Harold James, chairman of the Pennsylvania Legislative Black Caucus, called the cuts a matter of life and death. He suggested Ridge might face "indictment" for homicide and that those voting for the cuts could be indicted for "conspiracy."
Rep. Elinor Z. Taylor, R-Chester County, said the measure is "not mean-spirited but an understanding welfare reform is long overdue."
It passed the Senate 26-23. All Philadelphia's senators, every Democrat and two Republicans -- Sens. Frank Salvatore of Philadelphia and Clarence Bell of Delaware County -- voted against the measure. All other Republicans present voted for it.
In the House, it passed 103-93 with some Democratic support. All Philadelphia Democrats and two Philadelphia Republicans -- Reps. Dennis O'Brien and John Taylor -- voted against it.
Philadelphia Republican Reps. John Perzel, Chris Wogan and George Kenney voted for the bill.
The bill also changes residency requirements for all welfare from two months to a year; requires welfare recipients to seek work; eliminates welfare after two years unless at least part-time work is involved, and requires minors to stay in school and live at home or with an adult relative.
AZT again said to reduce HIV births
by Brian Bergstein
CHICAGO (AP) -- HIV-positive women who took AZT while pregnant were significantly less likely to deliver babies with the virus, researchers said this week.
But in another study, some pregnant, HIV-positive women offered AZT by a New York City hospital were either afraid of the drug or failed to complete their prescriptions.
"These studies highlight areas where we need to work harder," said Dr. R.J. Simonds, a pediatrician who specializes in HIV-AIDS prevention at the federal Centers for Disease Control and Prevention in Atlanta.
The two studies were published in The Journal of the American Medical Association.
In the first, 5.7 percent of the infants born to 87 HIV-positive women who took AZT were HIV+. Of 106 HIV-positive women who didn't take AZT, 18.9 percent of the children were positive.
It was conducted in urban and rural areas of North Carolina, where five major teaching hospitals are cooperating to treat HIV-positive expectant mothers, said Dr. Susan Fiscus, a microbiology and immunology professor at the University of North Carolina at Chapel Hill who led the study.
That cooperation allowed doctors to identify and treat an estimated 90 percent of all HIV-exposed children in the state in the last quarter of 1994, Fiscus said.
"What may work in North Carolina may not work in New York or other parts of the country," she said.
That was evident to doctors at Bronx Lebanon Hospital Center in New York who studied 49 pregnant women with HIV in 1994 and 1995. The doctors offered the women AZT after telling them the drug had lowered by two-thirds the rate of infant HIV infection in a 1994 study by the National Institutes of Health.
Of the 46 who completed their pregnancies, only 24 mothers chose to take the drug and took it as prescribed. Twelve women who said they would take the AZT failed to do so properly, often because of addictions to illegal drugs.
The study said that some of the women who chose not to take AZT cited potential side effects and the drug's effectiveness.
Because so few women completed the treatment, the resulting group was too small to accurately measure how well the AZT worked in reducing the number of infants who were infected.
The doctors who wrote both studies urged broader HIV testing of pregnant women. CDC researchers have said about 1,600 HIV-positive babies are born annually.
Protein found that lets HIV invade
Government researchers have announced that they think they have solved a 10-year-old AIDS mystery, finding a chemical password that lets HIV get inside a human cell.
A protein nicknamed fusin may be the long-sought molecule, opening new avenues for developing drug treatments, not to mention basic understanding, said co-discover Edward Berger from the National Institute of Allergy and Infectious Diseases.
The search began in the 1980s. First, scientists found that HIV latches onto cells with a particular molecule, called CD4, on its surface. However, by 1986, researchers realized the CD4 receptor alone is not enough for infection. The virus also needs some mysterious cofactor, the chemical equivalent of a password, to break through the defenses, fuse with the cell and invade its interior.
As the quest for the cofactor dragged on, several candidates have been proposed, but none is widely accepted.
In the journal Science, Berger and colleagues describe how sensitive new lab techniques and an open-ended approach convinced them that fusin is a cofactor for one group of HIV viruses.
Dr. Anthony Fauci, director of NIAID, said, "There's no question that this is correct." He called the new evidence "very compelling" and "pretty clear-cut."
Berger's lab took an open-ended approach, starting with a chemical "library" that contained all the genes of a human cell known to be vulnerable to the AIDS virus. To zero in on the cofactor gene in that vast array of genetic material, Berger's lab used a fake virus, a culture of cells and a very sensitive test for virus infection.
He likened the process of narrowing down candidates to "taking a haystack and dividing it into 100 bales," figuring out which one probably held the needle and dividing that one 100 sub-bales. By working with smaller and smaller subdivisions of the genetic material, researchers finally found their "needle," a gene for a protein that allowed viral infection in cells that previously had repelled attacks.
Fusin, the missing cofactor, turned out to come from a gene that five other labs had already cloned but set aside as irrelevant to their particular purposes.
Fusin belongs to a huge group of chemicals called G protein-coupled receptors. Fusin's many relatives include chemicals playing a role in the light-sensitivity in the eye and in the brain's response to opium like substances.
What binds to fusin however is still a mystery. "It's an orphan receptor," Berger said. "We don't know what its normal function is."
He has discovered that fusin works as a cofactor with a group of HIV viruses called T-cell tropic, which become common in the bloodstream about the time an infected person starts to develop symptoms. Other groups of HIV viruses may have different cofactors, he said.
Fauci said firmly, "There's more than one (cofactor)."
The study of cofactors opens a new line of investigation for another of the great puzzles of AIDS: why a very small number of people do not get infected despite repeated exposure to the virus. One possible explanation is that they have nonworking cofactors.
Immunizations raise production of HIV
Tetanus shots can spark a dramatic jump in the amount of virus produced in the bodies of people infected with HIV, U.S. government researchers have discovered.
The findings, to be published in the New England Journal of Medicine, may explain why frequent bouts of illness seem to make HIV more aggressive, especially in parts of the world where people are frequently exposed to viruses, bacteria and parasites.
The research by Dr. Sharilyn K. Stanley and her colleagues at the National Institute of Allergy and Infectious Diseases involved giving tetanus booster vaccinations to 23 people, 13 of whom were infected with HIV but were not showing symptoms. The bodies of those infected with HIV started churning out between two and 36 times more copies of the virus.
The Stanley team then took blood samples from the 10 non-infected patients and discovered that the blood cells of seven of the 10 volunteers became easier to infect with HIV after the tetanus shot.
The finding does not mean that HIV-infected people should stop receiving immunizations, Stanley and her colleagues said, as the protection produced by vaccination far outweighs the short-term increase in HIV production in the body.
But the discovery "underscores the diabolical nature of HIV, because the body's normal system of protecting itself from an invader revs up HIV production as well," she said. "The patients with the strongest immune system had the largest increases in virus."
Among those infected with HIV and vaccinated, the amount of the virus in their bodies peaked after about 13 days, the scientists found. The effect disappeared after six weeks.
In an editorial in the Journal, Dr. Warner C. Greene of the Gladstone Institute of Virology and Immunology in San Francisco said the findings, which are similar to the results seen in people vaccinated against the flu and hepatitis B, could be revealing new routes for medical researchers to explore in their quest for an effective treatment against HIV.
For one thing, he said, it may demonstrate the importance of staying healthy after being infected with the virus.
Every time someone develops an unrelated disease that the immune system has to fight off, Greene said, it may spark the virus to make copies of itself and "accelerate the pace of HIV infection."
CDC ties most hetero AIDS cases to drug use
Intravenous drug users are continuing to contract HIV infection and are spreading it to their heterosexual partners, accounting for most cases of the disease among women and
heterosexual men, federal health officials said this month.
The U.S. Centers for Disease Control and Prevention (CDC) said that 85 percent of the 17,686 AIDS cases reported last year among heterosexual men and 66 percent of the 10,777 cases among women were linked to intravenous drug use.
"That means that either they are intravenous drug users themselves or they are sex partners of intravenous drug users," said Dr. Allyn Nakashima, a medical epidemiologist for the CDC.
AIDS cases among drug users are increasing at a rate of about 4 percent a year, the CDC said. But cases among the heterosexual partners of drug users rose 9 percent among women and 17 percent among men between the first half of 1994 and the same period in 1995.
The CDC said that 35 percent of all of the 74,180 AIDS cases reported in 1995 year were associated with injecting-drug abuse, while male homosexual activity remained the biggest factor, accounting for most of the rest of the cases. "The bulk of the AIDS epidemic is still among gay men," Nakashima said. He said that the gay cases were also increasingly concentrated among people of color.
Half of the last year's AIDS cases linked to drug use occurred among blacks, 25 percent among whites and 24 percent among Hispanics, the CDC said.
The racial disparity in AIDS cases associated with intravenous drug abuse has widened in recent years. "Back in 1988 we were seeing about a 12-fold difference in rates," Nakashima said.
In 1995, the rate was about 14 times higher among blacks than among whites.
"The rate is about 50 per 100,000 in blacks and 3.5 per 100,000 in whites," Nakashima said.
Of a total 513,486 AIDS cases reported since the outbreak of the disease through the end of 1995, the CDC attributed 184,359 AIDS cases to the use of injected drugs. Of those, 161,891 were among the drug users themselves, 18,710 occurred among their heterosexual sex partners and 3,758 were children whose mothers were drug users or sex partners of drug users.
The CDC said that while the highest rates of illness from AIDS associated with intravenous drug use are in the Northeast, the increase in that region has slowed. The number of drug-related AIDS cases in the South and West is continuing to increase however.
Hemophiliacs to reject settlement offer
A $640 million settlement offered to HIV-positive hemophiliacs by four drug companies who marketed blood products infected with HIV will be rejected as being too low, representatives of the hemophiliacs said. The companies agreed to the settlement last month, but leaders of the 8,000 to 10,000 infected hemophiliacs say the offer is not enough. They say that new evidence shows that the companies used plasma donations from people who were known to have hepatitis and that the government did nothing to stop them. The hemophiliacs question why they should accept less than the $420,000 offered to each of Japan's HIV-infected hemophiliacs. The two groups will met this week in Philadelphia to discuss the settlement.
House gears up for FY '97 appropriations
from the AIDS Action Council
Congress is completing work on overall budget funding levels for FY 97. Once that is complete, the House Labor/HHS and VA/HUD subcommittees will begin work on their FY '97 Appropriations bills.
The two Appropriations subcommittees responsible for developing the two bills that fund AIDS programs are the Labor/HHS and VA/HUD subcommittees. The Labor/HHS Appropriations bill funds: 1) The Ryan White CARE Act (including the new Title V) 2) AIDS prevention at the Centers for Disease Control and Prevention and 3) AIDS Research at the National Institutes of Health. The VA-HUD Appropriations bill funds HOPWA and McKinney HAG (Homeless Assistance Grants).
Each subcommittee holds hearings, takes testimony from the community, experts, and members of congress, then drafts and debates the funding levels for each program in its bill; marks it up; passes it on to the full Appropriations committee for consideration and a vote. From there the bill proceeds to the House floor for a full vote.
Once the House has finished, the Senate begins the same process. After the full Senate votes on its versions of the bills, the House and Senate bills are "conferenced" to settle any differences between the two and eventually result in final appropriations bills. These are referred to as conference reports.
AIDS activists are lobbying for the following funding increases in the 1997 U.S. budget:
--$153.3 million increase for HIV Prevention at the Centers for Disease Control and Prevention. "Without a preventive vaccine, our only hope of halting HIV transmission is through comprehensive, community-based, targeted AIDS prevention programs funded by the CDC. CDC, in partnership with state and local health departments, also plays a critical national role in monitoring the course of the epidemic," said a statement issued by the AIDS Action Council.
--$359.3 million increase for Care Services through the Ryan White CARE Act.
The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act provides critical care and care-related services to people living with HIV/AIDS in all fifty states, Puerto Rico and the territories. The CARE Act also provides training and education to health care providers on HIV/AIDS care.
--$79 million increase for Housing Opportunities for People with AIDS (HOPWA).
Stable, affordable housing helps prevent the early onset of illness, avoiding unnecessary and costly hospitalizations, and maintains quality of life for HIV-infected individuals and their families. In FY 95 HOPWA was funded at $171 million and served 66 jurisdictions. In FY 96 it was funded at the same level, to be distributed among 76 jurisdictions. It is imperative that funding for this program be increased in the FY 97 VA/HUD appropriations bill to meet the needs of current and new jurisdictions.
The Philadelphia region has seen a $200,000 reduction in its HOPWA funding levels since last year. The current HOPWA funding level for the nine-county region is slightly less than $2.7 million.
--$157 million increase for AIDS Research at the National Institutes of Health (NIH) in a consolidated budget administered by the Office of AIDS Research (OAR).
Military HIV discharge to stand
A requirement that the military discharge service members with HIV will remain in a defense bill after opponents gave up a bid to stop it this week, according to the Associated Press.
The sudden decision to pull an amendment striking the HIV discharge provision from the defense bill deprived conservatives of what they expected to be a lopsided vote of support for a proposal written by Rep. Robert Dornan, R-Calif.
The Senate unanimously supported the repeal of Dornan's law and the Senate Armed Services Committee earlier this month recommended equal treatment for service members with any illness that prevents them from deploying overseas. The bill also included language to re-establish the outright ban on gays in the military.