published by We The People Living with AIDS/HIV of the Delaware Valley, Inc.
Feds say 22,175 in region have HIV
Hemophiliac suit settled for $600 million
Beta-Carotene said to show no benefit to PWAs
Weekly fluconazole said to prevent candida
Groups unite on new drug therapies
Canadian projects AIDS cost in "human capital"
72% of region's HIV+ are people of color
HRSA made the projections in collaboration with the U.S. Centers for Disease Control and Prevention, which maintains a database of all reported cases of diagnosed AIDS in the U.S. The HRSA projection is its first effort to get an idea of the number of those both living with HIV infection and those formally diagnosed with AIDS. It was provided to the Philadelphia HIV Commission earlier this summer.
The HRSA report indicates that a little over 5,000 of the 22,175 people with HIV have been diagnosed with AIDS. About 42% of those formally considered to have AIDS are in that category only because their CD4+ counts are less than 200, according to the report, with the remaining 58% diagnosed based on an opportunistic infection.
Overwhelmingly, according to the HRSA projections, people living with HIV or AIDS in the region are people of color. According to the report, 72% of all people with HIV/AIDS are African American, Latino, Asian or Native American; 69% of those formally diagnosed with AIDS are reported to be people of color. The projection says that, in 1997, 13,550 African Americans will be living with HIV disease; 2,245 Latinos; 70 Asians; and 30 Native Americans. Whites account for 6,280 of the HIV/AIDS incidence, according to the projections.
HRSA's figures support the belief that the proportion of men who have sex with men who have HIV or AIDS, when compared to non-gay transmission categories, continues to decline. The report says that 56% of HIV/AIDS cases are heterosexual injection drug users, hemophiliacs, or those who say they were infected through heterosexual activity, blood transfusions, or other factors.
Women, according to HRSA, represent a little over 18% of the region's cases of HIV and AIDS. HRSA projects that 83% of women with HIV/AIDS in the region are women of color.
The report says that there are only 190 pediatric cases of HIV infection or AIDS in the region, 78% of them among people of color.
Housing study suggests 3% annual increase
Utilizing the HRSA projections as well as a formula developed by CDC epidemiologist Scott D. Holmberg, MD, MPH, AIDS housing specialist Ellen Alpert has projected that the number of HIV infections in the Philadelphia region is likely to increase by about 3% each year for the rest of the decade, after accounting for those who will die from HIV/AIDS or other causes.
In an article earlier this year in the American Journal of Public Health, Holmberg projected that each year, there would be an 11% increase in new HIV infections in the Philadelphia area.
Relying on statistical analysis, Alpert's conclusions -- which are included in a draft of an AIDS housing needs assessment commissioned by the Philadelphia Office of Housing and Community Development and scheduled for release later this summer -- assume that an individual with HIV is, on average, most likely to have a life expectancy of 13 years after infection. This means that approximately 8% of those living with HIV infection or AIDS will die each year. Holmberg's 11% with new infections, minus the 8% death rate, would result in an overall increase of about 3% each year, Alpert notes.
David Fair, former director of the city's AIDS Activities Coordinating Office, and Daniel Fife, MD, AACO's first epidemiologist, collaborated with Alpert in producing the needs assessment.
Hemophiliac suit settled for $600 million
A federal court has given preliminary approval to an estimated $600 million settlement between four drug companies that made blood products for hemophiliacs in the United States and a group of patients who became infected with HIV, the companies said.
Lawyers for Alpha Therapeutic Corp., Armour Pharmaceutical Co., Baxter Healthcare Corp. and Bayer Corp. had worked for months with representatives of hemophiliacs to come to an agreement.
"We are pleased with the Court's decision to approve the settlement offer. The agreement represents an enormous amount of work and cooperation among all parties, and will give significant support to members of the hemophilia community who have been affected by this tragedy," the companies said in a statement
In addition the firms will pay an estimated $40 million in lawyers fees and court costs, said Guy Esnouf, spokesman for the companies. Based on figures from the Centers for Disease Control, the companies are expecting about 6,000 claimants to apply, he said.
People with hemophilia who used blood clotting factor concentrates processed and distributed by the companies from 1978 through 1985 and who are HIV infected are potentially eligible for $100,000 per person as part of the settlement.
The agreement would also benefit the survivors of those infected as well as their spouses, family members and others who contracted HIV as a result of their relationship with a qualifying hemophiliac, Esnouf said.
Under the order entered by Judge John F. Grady of the U.S. District Court for the Northern District of Illinois, Esnouf said formal notice of the settlement will be widely disseminated in newspaper advertisements paid for by the companies.
Individuals who believe they are entitled to the settlement must file a claim form that will be distributed with the notice.
Earlier, Japanese hemophiliacs who had contracted HIV through blood products received payments of $450,000 in a court-imposed settlement. In that case, the Japanese government contributed 40 percent of the payments. Alpha Therapeutic, Armour Pharmaceutical, Baxter and Bayer were all part of the Japanese settlement.
Beta-Carotene said to show no benefit to PWAs
Although previous reports have suggested beta-carotene can boost the immune system, an Oregon team is not recommending high-dose supplementation for HIV-positive patients.
Dr. Gregg O. Coodley and colleagues at the Oregon Health Sciences University in Portland evaluated 72 HIV-positive patients who were randomly assigned to oral beta-carotene at 60 mg three times daily or placebo. All of the patients also received a multivitamin supplement over the 3-month study period. Dr. Coodley monitored all patients for T-cell quantitative subsets, natural killer cells, HIV p24 antigen, beta-carotene concentrations and other factors. "Except for serum beta-carotene concentration, there were no statistically significant differences...between the treatment...and placebo...groups at baseline or after either one or three months of treatment," he reported. "Earlier studies suggesting that beta-carotene supplementation increased levels of immune cells in HIV-infected patients were not replicated in this study."
He also found that the "...results were not affected whether the patient was in a subgroup that was taking antiretrovirals or not, nor whether they had a baseline CD4 count greater or less than 200 [per microliter]." Therefore, Dr. Coodley concludes the results "...do not support the use of pharmacological supplementation with high doses of beta-carotene in HIV-infected patients."
Weekly fluconazole said to prevent candida
A report in Treatment Issues, a publication of Gay Men's Health Crisis in New York, notes that vaginal yeast infections ("candidiasis" caused by the yeast species Candida albicans) were a special problem for women with HIV. The report also noted that such women seemed to have more oral and esophageal candidiasis than HIV- positive men.
A recently concluded trial conducted in women by the government-sponsored Community Programs for Clinical Research on AIDS (CPCRA) has found that 200 mg of fluconazole taken weekly can cut the risk of developing oral/throat or vaginal yeast infections by half, according to GMHC. The effect on yeast in the esophagus could not be determined because of its low rate of occurrence during the study.
This placebo-controlled trial, known as CPCRA 010, enrolled 323 women with CD4 counts less than 350 (average CD4 count: 199).
The median time on study medication was sixteen months for those receiving fluconazole and ten months for those on placebo.
Use of fluconazole to prevent fungal or yeast infections has been widely shunned because of the risk of developing drug-resistant microbes. Such resistance would render fluconazole useless for the valuable treatment role it now performs. In CPCRA 010, however, the incidence of fluconazole-resistant candidiasis was low and equal in both the fluconazole and placebo arms. But although weekly fluconazole reduced the frequency with which Candida albicans was isolated in vaginal secretions, there was increased isolation of closely related, though less pathogenic species of yeast.
The researchers concluded that weekly fluconazole could have a useful role in preventing recurrent mucosal candida infection in women. In the study, women with a recent history of repeated vaginal candidiasis had a significantly higher risk of new episodes. The women who had previously had candida in the mouth, pharynx or esophagus were at higher risk for another infection in those areas, as were women who had AIDS or used one of the standard preventive drugs for Pneumocystis carinii pneumonia.
Trial on CMV drug halted
Testing of a drug for the treatment of an AIDS-related eye infection has been halted after federal health officials determined it was having no effect on the disease.
The National Eye Institute, part of the National Institutes of Health, announced that national testing of the drug MSL 109 for treatment of CMV retinitis was stopped after the clinical study had enrolled 209 of a planned 325 patients.
An independent data and safety monitoring board recommended that the study be discontinued after it was found that MSL 109 did not alter the course of the CMV retinitis infection, federal health officials said.
Patients enrolled in the study had received either MSL 109 or a placebo. The drug, designed to act like a natural antibody against CMV, was used as a supplement to the primary therapy against the virus.
For patients receiving the drug, the median time to progression of the retinitis was 65 days, the study found. For those receiving placebo, the median time of progression was 66 days.
There was also a slightly higher rate of death among patients with recurrent CMV retinitis who were taking the new drug. But a statement from the eye institute said that the meaning of the difference in death rate was unclear because there was a lower than expected mortality rate among patients taking the placebo.
CMV retinitis is caused by an organism called cytomegalovirus. About 40 percent of AIDS patients develop this infection. The disease can destroy the retina, an organ at the back of the eye that collects light and is essential for vision.
CMV is a common organism, but it is typically controlled by people with healthy immune systems. For people with weak or ineffective immune systems, such as those with AIDS, the virus poses a serious threat.
The MSL 109 clinical study was being conducted at 15 centers in 10 states.
Linda Distlerath, an official at Merck, said the group will try to "facilitate and coordinate" several clinical trials in the next few years. The group's goal is to determine which drug combinations are most effective, at what point therapy should begin, and what can be done to avoid the development of drug resistance. The group, to be called the Forum for Collaborative HIV Research, has met five times and announced the partnership this month after a meeting with Vice President Gore.
Canadian projects AIDS cost in "human capital"
The economic impact of AIDS, which often kills people in their most productive years, was recently discussed at the 11th International conference on AIDS in Vancouver.
John McCallum, chief economist for the Royal Bank of Canada, said that, as of 1995, $8 billion in Canadian human capital had been destroyed by the disease. This includes the value of education, training, skills, and entrepreneurial talents lost when a person with AIDS dies. McCallum said that the cumulative incidence of AIDS would at least nearly double between now and the year 2000, and again in the following 10 years. This would equate to a total of $30 billion in lost human capital in Canada by 2010, he said.