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HICNet Medical News Digest      Mon, 04 Sep 1995        Volume 08 : 
Issue 31

Today's Topics:

  AIDS Summary File 1
  AIDS Summary File 2
  Heart Attack, Allergy Connection Nothing to Sneeze At
  Insulin Resistance/Potential for CVD in Mexican-American
  Common "K" May Offer Easy Way to Prevent High Blood Pressure
  Smoking Accelerates Arterial Thickening
  Beta-Blockers: Not Just for Blood Pressure Anymore

             +------------------------------------------------+
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                             Associate Editors:

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       Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden

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             Lawrence Lee Miller, B.S. Biological Sciences, UCI

            Dr K C Lun, National University Hospital, Singapore

             W. Scott Erdley, MS, RN, SUNY@UB School of Nursing

      Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF

  Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of 
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----------------------------------------------------------------------

To: hicnews
cc: Dr David Dodell <david@stat.com>

                     AIDS Daily Summary

The Centers for Disease Control and Prevention (CDC) National AIDS
Clearinghouse makes available the following information as a public
service only. Providing this information does not constitute endorsement
by the CDC, the CDC Clearinghouse, or any other organization. 
Reproduction
of this text is encouraged; however, copies may not be sold, and the CDC
Clearinghouse should be cited as the source of this information.
Copyright 1995, Information, Inc., Bethesda, MD

     In this issue
     ****************************************************************
     "Tuberculosis Knowledge Among New York City Injection Drug Users"
     "Treatment of HIV-Associated Kaposi's Sarcoma with Paclitaxel"
     "Energy Expenditure and Wasting in HIV Infection"
     "The Cost-Effectiveness of Voluntary Counseling and Testing of
      Hospital Patients for HIV"
     "Risk Factors for Tuberculosis in HIV-Infected Persons"
     "Failure of T-Cell Homeostasis Preceding AIDS in HIV-1 Infection"
     "Therapies Outside the Mainstream"
     "Interleukin-2 as Therapy for HIV Disease"
     "Reducing the Impact of Opportunistic Infections in Patients
      with HIV Infection"
     "Preventing AIDS: Have We Lost Our Way?"
     "Oral Manifestations of HIV Infection"
     "The Effects of Vitamin A Supplementation on the Morbidity of
      Children Born to HIV-Infected Women"
     "Seizure Associated with Zidovudine"
     ****************************************************************

     "Tuberculosis Knowledge Among New York City Injection Drug Users"
     American Journal of Public Health (07/95) Vol. 85, No. 7, P. 985;
     Wolfe, Hannah;  Marmor, Michael;  Maslansky, Robert et al.

     Between November 1992 and February 1993, as part of a cohort
study of HIV infection among injection drug users, Wolfe et al.
recruited nearly 500 members of New York City methadone
maintenance treatment programs to assess their knowledge of
tuberculosis (TB).  More than 30 percent of this group reported
having tested positive to a tuberculin skin test in the past.
Almost all subjects identified TB as an airborne infection, and
more than 50 percent also identified possible indirect methods of
transmission.  Seventy-five percent did not understand the
difference between infection and active disease, but those who
reported a history of skin test reactivity were two times more
likely to comprehend the distinction.  A total of 40 percent of
those surveyed did not understand the necessity of medication
adherence.  The majority, however, did understand that TB is
potentially fatal, and realized that HIV-infected persons are
more susceptible to it.  The study's authors concluded that these
misunderstandings--which could be the result of faulty TB
education and overgeneralization of knowledge about HIV--may
contribute to the fear and confusion that hamper TB control
efforts


     "Treatment of HIV-Associated Kaposi's Sarcoma with Paclitaxel"
     Lancet (07/01/95) Vol. 346, No. 8966, P. 26
     Saville, M. Wayne; Lietzau, Jill;  Pluda, James M.

     Saville et al. conducted a phase II trial to determine whether
the drug paclitaxel (Taxol), which is active against various
carcinomas, is effective against AIDS-related Kaposi's sarcoma
(KS).  The drug's cellular target is similar to that of vinca
alkaloids, which are active against KS.  Although none of the 20
patients achieved a complete response, 13 had a partial response.
All six of the patients who had received prior systemic treatment
responded, as did the five with pulmonary Kaposi's sarcoma.  The
other six remained stable, while just one progressed.  The most
common dose-limiting toxic effect was neutropenia.  Novel toxic
effects included late fevers, rash, and eosinophilia.  The
authors say their findings suggest that paclitaxel is active
against HIV-associated KS, including in those patients with
aggressive disease, advanced AIDS, and previous receipt of
systemic therapy.


     "Energy Expenditure and Wasting in HIV Infection"
     NEJM (07/12/95) Vol. 333, No. 2, P.83
     Macallan, Derek C.;  Noble, Carole;  Baldwin, Christine et. al.

     To determine the contribution of total energy expenditure to
weight changes in patients with HIV-related wasting, Macallan et
al. performed more than 50 tests of energy metabolism in
HIV-infected men at various stages of the disease.  The results
of the tests were compared with the rate of weight gain or loss.
The average total energy expended was 2750 kilocalories (kcal)
per day, give or take 650 kcal, which is no more than that
expended by healthy men.  The researchers observed a significant
positive relation between total energy expenditure and the rate
of weight change.  During rapid weight loss, therefore, total
energy expenditure fell to 2180 kcal per day, which is primarily
the result of reduced exercise.  In addition, they observed that
in periods of rapid weight loss, people infected with HIV used
less energy.  The key determinant of weight loss in HIV-related
wasting, the authors concluded, was reduced energy intake--not
increased energy expenditure, as some have suggested.


     "The Cost-Effectiveness of Voluntary Counseling and
      Testing of Hospital Patients for HIV"
     JAMA (07/12/95) Vol. 333, No. 2, P. 129
     Lurie, Peter;  Avins, Andrew L.;  Phillips, Kathryn A. et al.

     In response to letters to the editor published in the Journal of
the American Medical Association written by members of the Johns
Hopkins University School of Medicine and the Centers for Disease
Control and Prevention (CDC), Lurie et al. state that--contrary
to the letters' assertion--they are aware of the existence of
universal safety precautions.  Their research concluded that
inpatient HIV screening for the purpose of preventing health care
worker infection was not cost-effective, but that it could be
cost-effective in areas of 1 percent seroprevalence or more.  The
analyses were based in three diverse hospitals, and reflect the
reality of adherence to universal safety measures, rather than an
idealized version of compliance, Lurie et al. assert.  It seems
unlikely, they conclude, that the study will be interpreted as
implying that the CDC endorses inpatient HIV testing for
preventing the infection of health care
professionals--particularly when it was stated that "the CDC has
explicitly rejected this position."


     "Risk Factors for Tuberculosis in HIV-Infected Persons"
     JAMA (07/12/95) Vol. 274, P. 143
     Antonucci, Giorgio;  Girardi, Enrico; Raviglione, Mario C. et al.

     Antonucci et al. conducted a multicenter cohort study in Italy to
evaluate factors predictive of active tuberculosis (TB).  In this
article, they analyze how demographic, clinical, and laboratory
characteristics influence the risk of TB in HIV-infected persons.
They found that being tuberculin-positive, anergic, or having a
CD4 lymphocyte count either less than 20 or between 20 and 35
were indicators significantly associated with the risk of TB.  In
the three groups of patients with different levels of skin
responsiveness, the incidence of TB increased as the level of CD
lymphocytes decreased.  Such factors as age, sex, place of
residence, HIV transmission category, and antiretroviral therapy
were not associated with an increased risk of the disease.  By
considering both skin test reactivity and CD4 lymphocyte count,
HIV-infected patients' risk of TB can be more precisely measured.
The researchers propose that regular skin tests in
tuberculin-negative nonanergic individuals can be useful in
identifying those who are at high risk for active disease.


     "Failure of T-Cell Homeostasis Preceding AIDS in HIV-1 Infection"
     Nature Medicine (07/95) Vol. 1, No. 7, P. 674
     Margolick, Joseph B.;  Munoz, Alvaro;  Donnenberg, Albert D.

     Many have theorized about "blind" T-cell homeostasis--that a
constant level of T lymphocyte cells is maintained independent of
CD4 or CD8 phenotype.  In a recent study, Margolick et al.
confirm the relatively constant T-cell counts of HIV-1-infected
gay men who have not developed AIDS for as many as eight years
after seroconversion.  It was observed, however, that
seroconverters who did develop AIDS had rapidly decreasing T-cell
levels for approximately two years before full-blown AIDS
developed.  These findings indicate that homeostasis failure may
be a key factor in HIV disease progression.  The researchers
conclude that, in light of the high rate of T-cell turnover in
HIV-1 disease, blind T-cell homeostasis may augment HIV
pathogenesis through a CD8 lymphocytosis that interferes with the
regeneration of lost CD4 T cells.


     "Therapies Outside the Mainstream"
     Washington Post (Health) (08/01/95) P. 10
     Herman, Robin

     Increasingly, Americans frustrated with their standard medicine
are discovering "alternative" or "unconventional" treatments that
have been shunned by the higher-tech medical world.  As methods
that involve massage therapists, homeopaths, herbalists spread,
so has the concern that some treatments may not have been
sufficiently tested, and thus may be ineffective or even harmful.
But most people who use alternative therapies are adding them to
their usual health care.  According to James Gordon of the
Georgetown University School of Medicine, the two major groups of
people who seek such treatments are those who just do not feel
good and those "people who have come to the limits of traditional
Western medicine for chronic illness or life-threatening
conditions."  Studies, for example, have found that as many as 50
percent of HIV-infected people are using unconventional
treatments.  Some of the more problematic therapies involve the
ingestion of pills and potions that supposedly prevent disease or
boost the immune system.  These remedies are largely unregulated
and are outside the control of the Food and Drug Administration
because they are described as supplements and do not claim to
cure disease.


     "Interleukin-2 as Therapy for HIV Disease"
     NEJM (07/20/95) Vol. 333, No. 3, P. 192
     Lane, H. Clifford;  Kovacs, Joseph A.

     There is a complex association between activation of the immune
system and levels of viral replication, write Lane and Kovacs in
response to letters to the editor published in the New England
Journal of Medicine.  For example, activation of CD4 T
lymphocytes by interleukin-2 (IL-2) can bring about cell division
and an increased number of cells.  Activation of CD8 cells by
IL-2 can lead to increased immunity against viral infections.
The overall effect of IL-2 in a given patient, therefore, is a
function of many variables.  The authors, however, state that the
main point of their March 2 article was that it is possible to
induce and maintain a polyclonal expansion of CD4 T lymphocytes
in some HIV-infected individuals using intermittent courses of
IL-2.


     "Reducing the Impact of Opportunistic Infections in Patients
      with HIV Infection"
     JAMA (07/26/95) Vol. 274, No. 4, P. 347
     Kaplan, Jonathan E.;  Masur, Henry;  Jaffe, Harold W. et al.

     With new knowledge of the environmental sources of opportunistic
pathogens, ways to reduce exposure, and the role of
chemoprophylaxis, a practical strategy for preventing
opportunistic infections in HIV-infected people has become
particularly important.  The U.S. Public Health Service, with the
Infectious Diseases Society of America, is now publishing
comprehensive guidelines to prevent such infections.  Previous
efforts dealt with Pneumocystis carinii, Mycobacterium
tuberculosis, and Mycobacterium avium-intracellulare complex, and
focused on chemoprophylaxis.  The new patient- and
pathogen-oriented guidelines provide background information and
recommendations for clinicians and patients on the behavioral
shifts, drug therapies, and immunizations that are most likely to
be effective, safe, and cost-effective.  The guidelines also
discuss the relative importance of several prevention measures
and attempts to integrate them.


     "Preventing AIDS: Have We Lost Our Way?"
     Lancet (07/29/95) Vol. 346, No. 8970, P. 262
     Lifson, Alan R.

     Although the best way to curb AIDS is by preventing the
transmission of HIV, millions of people already test positive for
the virus, notes Alan R. Lifson in the British medical journal
The Lancet.  Prospective studies have demonstrated that years can
pass between HIV infection and the emergence of related
infections and disorders.  Two findings, however, now challenge
the theory that HIV resides for years in a quiescent phase.  The
first is that active viral replication occurs in the lymphoid
system well before significant replication is evident in the
peripheral circulation.  The second finding is that HIV
replication occurs continuously in vivo at high rates, which
results in the rapid turnover of CD4 cells.  These findings,
along with others, suggest that AIDS should not be considered a
separate entity from HIV infection, that current reliance on
reverse transcriptase inhibitors needs to be re-evaluated, and
that HIV-related opportunistic infections need to be prevented.
As more becomes known about HIV, Lifson concludes, it is
important to refrain from concentrating on one strategy to the
exclusion of others, and that whatever preventative strategies
are developed are useful to the millions of infected persons as
well.


      "Oral Manifestations of HIV Infection"
      NEJM (08/03/95) Vol. 333, No. 5, P. 328
      Seldin, Edward B.

     "Oral Manifestations of HIV Infection," edited by John S.
Greenspan and Deborah Greenspan, is a service to both the medical
and dental fields, in part because it marks an interdisciplinary
effort to identify often-ignored medical and dental aspects of
HIV and AIDS.  The chapters--which were contributed by
participants in the Second International Workshop on the Oral
Manifestations of HIV Infection--include descriptions of
specialized dental facilities that have been built for the
treatment of AIDS patients, as well as formal reports from
research laboratories.  The majority of the chapters are grouped
according to the clinical manifestations of HIV or AIDS in the
oral cavity, such as candidiasis, salivary-gland disease, and
Epstein-Barr virus.  One particularly interesting section
contains six chapters on periodontal disease in the context of
HIV or AIDS.  Overall, the book clearly conveys a sense of
urgency in regards to HIV and its path of destruction.


     "The Effects of Vitamin A Supplementation on the Morbidity of
      Children Born to HIV-Infected Women"
     AJPH (08/95) Vol. 85, No. 8, P.1076
     Coutsoudis, Anna;  Bobat, Raziya A.;  Coovadia, Hoosen M. et al.

     To determine the effects of vitamin A supplementation on the
morbidity of children born to HIV-infected women, Coutsoudis et

_
                                                                                              

al. conducted a randomized, placebo-controlled study of 118
infants in Durban, South Africa.  Among all the children, the
vitamin A supplemented group had a reduced average morbidity.
The rates of morbidity for those receiving supplementation were
lower for almost every condition when assessed individually.
Also in the supplemented group, all diarrhea was reduced by 29
percent, diarrhea lasting more than 7 days was reduced by 38
percent, and hospital admissions for diarrhea declined by 77
percent.  Among the 85 children whose HIV status was known,
diarrhea-related morbidity was almost reduced by half in the
supplemented HIV-infected group.  Vitamin A, however, had no
effect on diarrheal morbidity in the uninfected children.  The
researchers concluded that, in a population where vitamin A
deficiency is not endemic, vitamin A supplementation for the
children of HIV-infected women appeared to be beneficial and to
reduce morbidity.  This benefit was particularly diarrheal
morbidity among HIV-infected children.


     "Seizure Associated with Zidovudine"
     Lancet (08/12/95) Vol. 346, No. 8972, P. 452
     D'Silva, Marisa; Leibowitz, David;  Flaherty, John P.

     In a letter to the editor published in the Lancet, D'Silva et al.
report the incidence of a generalized seizure related to the
prophylactic use of zidovudine.  After receiving a large-caliber
contaminated needlestick injury from an HIV- and hepatitis
C-infected individual, a man was given intramuscular
immunoglobulin and tetanus toxoid, and oral zidovudine.  The
zidovudine therapy was continued three to four times daily.
During the next few days, the patient complained of nausea,
anorexia, and emesis--which were treated with ondansetron--as
well as exercise intolerance, dull occipital headaches, and
insomnia.  Six days after the needlestick, he experienced a
generalized seizure.  The patient had never suffered seizures or
adverse drug reactions before, but he had had several concussions
from childhood accidents.  The zidovudine was abandoned, and no
other seizures took place.  More than one year later, the patient
remains negative for both HIV and hepatitis C.  Although it is
still not clear whether zidovudine caused the seizure, the
potential for severe toxicity should be considered when
recommending unproven treatment, the authors note.



------------------------------

To: hicnews
cc: Dr David Dodell <david@stat.com>

                     AIDS Daily Summary

The Centers for Disease Control and Prevention (CDC) National AIDS
Clearinghouse makes available the following information as a public
service only. Providing this information does not constitute endorsement
by the CDC, the CDC Clearinghouse, or any other organization. 
Reproduction
of this text is encouraged; however, copies may not be sold, and the CDC
Clearinghouse should be cited as the source of this information.
Copyright 1995, Information, Inc., Bethesda, MD

     In this issue
     ****************************************************************
     "Benefits of HIV Screening of Blood Transfusions in Zambia"
     "New Roles for AZT?"
     "A Comparison of Immediate with Deferred Zidovudine Therapy..."
     "Mixed Results with Octreotide for AIDS-Related Diarrhea"
     "No Cheers for Baboon to AIDS Patient Xenotransplant"
     "Cancer Drug May Join the AIDS Arsenal"
     "Natural History of HIV-1 Cell-Free Viremia"
     "HIV-Associated Diarrhea and Wasting"
     "Resisting AIDS: Another Vaccine Approach"
     "Wasting Syndrome--Affordable Treatments"
     "Guidelines for Management of HIV Infection with Computer-Based
      Patient's Record"
     "New Antiviral Drug Could Slow AIDS-Related Blindness"
     ****************************************************************

     "Benefits of HIV Screening of Blood Transfusions in Zambia"
     Lancet (07/22/95) Vol. 346, No. 8969, P. 225
     Foster, Susan; Buve, Anne

     Although blood transfusion continues to be a major path of HIV
transmission in developing countries, testing for the virus is
often expensive, and dependable donor support is hard to secure.
Foster and Buve examined the cost and benefits of screening blood
for HIV.  They used data obtained at a district hospital in
Zambia, where HIV seroprevalence among blood donors was nearly 16
percent.  At the Monze District Hospital in 1991, more than 1,000
transfusions were given and approximately 150 cases of
transfusion-related HIV infection were averted.  Overall, the HIV
screening cost U.S. $4745, while the cost per case of HIV
prevented was $31.62.  This protection for the community served
by the hospital cost $0.03 per person.  The researchers estimate
that 3,625 undiscounted healthy years of life were saved, of
which nearly 70 percent were in children under six.  The cost was
$1.32 per year of life preserved.  In sum, the savings from blood
screenings exceed the costs of screening by a factor of between
2.7 and 3.5.  Therefore, the authors feel that it is critical to
maintain both financial and political support for the HIV
screening of blood for transfusions.


     "New Roles for AZT?"
     Science (07/14/95) Vol. 269, No. 5221, P. 163

     Recent scientific reports have hinted at additional uses of the
AIDS drug AZT--including for two diseases that involve an
abnormal proliferation of cells, leukemia and psoriasis.  In an
article in the New England Journal of Medicine, researchers from
the University of Southern California reported that they tested a
combination of AZT and interferon-alpha in 19 patients who had an
extremely lethal form of adult T cell leukemia-lymphoma.  Four
were also HIV-positive.  According to the researchers, 11
patients had "major responses" to the treatment, including five
total remissions.  The scientists suggested that the fast-growing
cancer cells are targeted because they absorb the most AZT.
Another study, published in the June issue of the Journal of the
American Academy of Dermatology, reported that AZT cleared up
most of the psoriasis in four of 12 patients.  One researcher
from the University of Texas at Houston theorized that AZT, which
disables a key enzyme that HIV needs to copy itself, may slow
skin cell reproduction.  Both teams hope to further test these
treatments in larger, controlled trials.


     "A Comparison of Immediate with Deferred Zidovudine Therapy
      for Asymptomatic HIV-Infected Adults with CD4 Cell Counts of
      500 or More per Cubic Millimeter"
     NEJM (08/17/95) Vol. 333, No. 7, P. 401
     Volberding, Paul A.; Lagakos, Stephen W.; Grimes, Janet M. et al.

     To assess the clinical benefits of zidovudine in asymptomatic
HIV patients who have CD4 counts greater than 500, Volberding et
al. compared immediate zidovudine therapy to deferred therapy in
such patients.  The participants were randomly assigned either
zidovudine or a placebo, though the study was modified with
open-label treatment two years later for those people whose CD4
levels fell below 500.  After 6.5 years, there was no significant
difference in AIDS-free survival or overall survival in the
deferred-therapy group, compared to the low-dose or high-dose
group of zidovudine.  However, the two immediate therapy groups
did experience a slower decrease of CD4 cells than the deferred
group.  Although side effects were rare, the high-dose zidovudine
group experienced more severe anemia and granulocytopenia than
the deferred group.  The researchers concluded that zidovudine
slows the decline of CD4 cells in symptom-free, HIV-infected
adults with more than 500 CD4 cells, but does not extend either
AIDS-free or overall survival.  The results, therefore, do not
necessarily justify the standard use of zidovudine monotherapy in
this group.


     "Mixed Results with Octreotide for AIDS-Related Diarrhea"
     AIDS Clinical Care (08/95) Vol. 7, No. 8, P. 68

     A multicenter study of the somatostatin analogue octreotide
for the treatment of diarrhea produced mixed results.  Nearly 130
AIDS patients were given octreotide or a placebo subcutaneously
three times a day.  After 21 days, 46 percent of the octreotide
group had achieved the goal of a 30 percent decrease in stool
weight, compared to 36 percent of the placebo group.  The two
groups had similar reductions in bowel-movement frequency.
Although patients with idiopathic diarrhea--diarrhea lasting more
than 13 weeks, body weight under 60 kg, or CD4 levels below
50--showed a better response to the treatment, the differences
between the two groups remained nonsignificant.  During the
open-label phase, the octreotide dose was increased, and after
eight weeks, both stool weight and bowel-movement frequency
decreased significantly.  Even though the results of the
controlled study were disappointing, the open-label results
indicate that longer-term treatment at higher doses could be
effective.


     "No Cheers for Baboon to AIDS Patient Xenotransplant"
     Lancet (08/05/95) Vol. 346, No. 8971, P. 369
     Thompson, Clare

     The xenotransplant of baboon bone marrow into an AIDS patient has
several transplant scientists worried.  The operation, they
argue, is severely flawed and has little experimental
justification.  "The likelihood that this will work is extremely
small," claims surgeon Hugh Auchincloss of Massachusetts General
Hospital.  "The difficult procedure will probably hasten [the
patient's] death and not prevent it."  The transplant is based on
the assumptions that the baboon marrow is HIV-resistant, and that
"facilitator cells" will allow engraftment without the
development of graft-versus-host disease (GVHD).  Suzanne
Ildstad--one of the two scientists involved in the
procedure--plans to isolate the facilitator, stem, and T cells
from the baboon bone marrow; filter out the T cells, which are
thought to be the cause of GVHD; repackage the stem and
facilitator cells; and transplant them into the patient.  The
problem with the concept, however, is that Ildstad is the only
one who has been able to identify the facilitator T cells.  These
and other technical questions should have been answered by animal
experimentation, some opponents say.


     "Cancer Drug May Join the AIDS Arsenal"
     JAMA (08/16/95) Vol. 274, No. 7, P. 523
     Voelker, Rebecca

     The cancer drug hydroxyurea may not be a success in itself, but
researchers claim it is particularly effective in fighting HIV
when used in combination with the nucleoside analogue didanosine
(ddI).  Dr. Franco Lori, director of the new Research Institute
for Genetic and Human Therapy (RIGHT) in Italy, is trying to
determine why HIV-1 does not replicate in quiescent cells.
According to Lori, his hypothesis that focused on the lack of
deoxynucleoside triphosphates (dNTPs) was correct.  "When HIV
enters a quiescent cell, there is not enough food to survive," he
explains.  Research published in the journal Science later showed
that in vitro anti-HIV activity is increased without additional
toxicity when hydroxyurea is used with ddI.  Lori thinks that
hydroxyurea may reduce problems related to drug resistance.  When
used with ddI, he says, hydroxyurea lessens viral replication so
significantly that there is less virus able to mutate, which
could potentially delay the onset of ddI-resistance.  In addition
to Lori's trial, which has a U.S. counterpart that began testing
last month, hydroxyurea research is also being conducted in
France and other U.S. locations.


     "Natural History of HIV-1 Cell-Free Viremia"
     JAMA (08/16/95) Vol. 274, No. 7, P. 554
     Henrard, Denis R.;  Phillips, Jack F.;  Muenz, Larry R. et al.

     In an attempt to characterize the natural history of viremia with
HIV and its relationship with disease progression, Henrard et al.
studied 42 homosexual men who seroconverted to HIV-1 in the
early- to mid-1980s.  The subjects were tested each year for
quantitative virion-associated HIV-1 RNA, p24 antigen, and CD4
cells.  During the course of the study, the HIV-1 RNA levels
remained stable; only 14 percent of the subjects had at least
10-fold increases in the three to 11 years of follow-up.  Both
univariate and multivariate analyses revealed that initial and
subsequent HIV-1 RNA levels, p24 antigenemia, and a percentage of
CD4 cells were independently predictive of disease progression to
AIDS.  The findings indicate that there is a balance between
HIV-1 replication and efficacy of immunologic response that is
created soon after infection and continues through the
asymptomatic phase of the disease.  The faulty immunologic
control of HIV-1 infection, therefore, could be as important as
the rate of viral replication in assessing survival free from
AIDS.  HIV-1 RNA levels may be effective markers for predicting
clinical outcome, the authors conclude, because the individual
stable levels of viremia were established soon after infection.


     "HIV-Associated Diarrhea and Wasting"
     Lancet (08/05/95) Vol. 346, No. 8971, P. 352
     DuPont, H.L.; Marshall, G.D.

     DuPont and Marshall present the case of a 34-year-old Hispanic
bisexual male who, nearly four years after his HIV diagnosis,
began to experience bothersome diarrhea without fever.  The
diarrhea persisted for more than a year, despite treatment with a
number of drugs.  The two primary explanations for this
HIV/AIDS-related problem are opportunistic enteric infection and
HIV enteropathy.  Approximately half of the patients with
AIDS-related diarrhea are diagnosed with an infectious agent.
DuPont and Marshall's patient was infected with a member of the
order Microsporidia.  He was treated with metronidazole without
effect, though it has occasionally been useful in relieving
illness related to microsporidiosis.  This patient illustrates
several of the clinical problems associated with HIV, diarrhea,
and wasting.  The illness is generally prolonged.  In addition,
the cause may not always be obvious, and may often involve a
complex interaction between infection by enteric pathogens and
intestinal immune defects.  Because the cause can vary, the
authors conclude that it may be necessary to conduct numerous
evaluations and to use combinations of both specific and
non-specific drugs to improve quality of life and provide relief.


     "Resisting AIDS: Another Vaccine Approach"
     Technology Review (07/95) Vol. 98, No. 5, P. 23
     Shearer, Gene M.;  Clerici, Mario

     Seeking evidence of cellular response to HIV, Shearer and
Clerici's team at the National Cancer Institute (NCI) studied a
group of high-risk people who showed no traditional signs of
infection with the virus.  They found that between 35 and 65
percent of the various subsets of the group showed evidence in
their white cells of "cellular immune activity."  The team then
tried to determine whether an AIDS vaccine should depend on the
body's cellular immune response, instead of the antibody
response.  Several labs--including the one at NCI--have noted
changes in the types of cytokines produced before an HIV-infected
person progresses to full-blown AIDS.  Cytokines are the proteins
that regulate the immune system.  The NCI lab found that
production of the type of cytokines that primarily promote a
cellular immune response falls before a person develops AIDS,
while the output of cytokines that enhance an antibody response
increases.  It was also found that most of the HIV-infected
people who progress to AIDS quickly produce more of the second
type of cytokines, whereas long-term nonprogressors produce far
more of the first type.  The concept of a type 1-to-type 2 shift
in most HIV-infected individuals has prompted researchers to
consider treating them with type 1 cytokines, with other
molecules that cause the body to increase type 1 cytokine
production, or with antibodies to type 2 cytokines.


     "Wasting Syndrome--Affordable Treatments"
     AIDS Treatment News (07/07/95) No. 226, P. 6
     James, John S.

     There are inexpensive treatments for AIDS wasting syndrome, which
is defined as the extreme loss of lean body mass not due to
obvious causes such as nutritional deficiency or intestinal
infection.  Early data indicates that most patients can be
successfully treated using these approaches.  One affordable
treatment for non-severe, AIDS-related weight loss is
testosterone enanthate, when used in combination with an exercise
program.  The drug has not been proven in clinical trials, but
according to Dr. Marcus Conant in San Francisco, it has offered
good results.  Conant's team has found that people with true
wasting respond very well to human growth hormone.  Fourteen of
16 severely wasting patients gained weight with the hormone,
after finding no success with the approved treatments Megace and
Marinol.  Ketotifen is another possibility for treatment, though
not much research has been done yet on using it for AIDS-related
wasting.  It is believed to be very safe, and is used widely in
Europe for asthma and allergies.  A third possibility is
thalidomide, which is now available though an "underground
compassionate access" program through the PWA Health Group in New
York or Healing Alternatives in San Francisco.  The two
FDA-approved drugs for AIDS-related wasting are expensive, and
their effectiveness for increasing lean body mass is
controversial.


     "Guidelines for Management of HIV Infection with
      Computer-Based Patient's Record"
     Lancet (08/05/95) Vol. 346, No. 8971, P. 341
     Safran, Charles; Rind, David M.;  Davis, Roger B. et al.

     Safran et al. studied more than 100 physicians and nurse
practitioners to determine the efficacy of electronic medical
records when used for HIV patients.  The scientists examined the
clinicians' response times to the situations that caused alerts
and reminders, the number of ambulatory visits, and
hospitalization.  They found that the average response time to
the 388 alerts in the control group was 52 days, while the
intervention group's median response time to 303 alerts was 11
days.  The average response times to 432 reminders in the
intervention group and 360 reminders in the control group were
114 days and more than 500 days, respectively.  Although the
system had no effect or difference on visits to the primary care
practice; admission rates; admissions for pneumocystosis; visits
to the emergency room; or survival, there was a dramatic increase
in the number of visits outside of the primary care
practice--which is due to an increased rate of opthalmology
visits.  Overall, the researchers concluded that computer medical
records helped clinicians treating HIV patients adopt new
practice guidelines more rapidly and more thoroughly.


     "New Antiviral Drug Could Slow AIDS-Related Blindness"
     American Medical News (07/17/95) Vol. 38, No. 26, P. 23

     Cidofovir--the first of a new class of antiviral drugs--appears
to help AIDS patients ward off the blinding cytomegalovirus
infection, according to manufacturer Gilead Sciences.  The drug's
potential is beginning to draw attention to nucleotide analogs to
fight AIDS-related infections, as well as HIV, experts say.  "We
believe this class of drugs does confer some real advantages to
patients," says Gilead's Dr. Howard Jaffe.  Nucleotide analogs,
cousins to nucleoside analogs such as AZT, have a chemical
structure that allows them to enter any cell and begin working
without having to be "turned on," explains Dr. Arnold Friedland
of St. Jude's Children's Hospital.  Tests show that cidofovir
fought blindness progression for 120 days, compared to just 50
days for the current treatment, says Jaffe.  As a result of this
success, Gilead has begun early human testing of an oral HIV
therapy that would work similarly, although results are years in
the future.



------------------------------


_
                                                      

To: hicnews

HEART ATTACK, ALLERGY CONNECTION NOTHING TO SNEEZE AT

  The type of cell responsible for the symptoms of allergies
and allergic asthma also may play a key role in triggering
heart attacks.
  Mast cells are the source of allergy and asthma symptoms
because of the chemicals they contain, such as histamine.
What happens in the case of an allergic reaction is that a
foreign protein, such as a pollen molecule, locks onto an
antibody that sits on the surface of the mast cell. This
causes a series of reactions that result in the breakdown of
the cell membrane, releasing the chemical contents allergists
refer to as the mediators of allergy and asthma symptoms.
  But researchers at the Wihuri Research Institute in
Helsinki, Finland, have discovered that activated mast cells
also are concentrated at the edge of fatty deposits that clog
the arteries feeding the heart muscle with blood. These fatty
deposits are known as atherosclerotic plaques.
  Petri T. Kovanen, M.D., Ph.D., and his associates theorize
that mast cells "actively participate in the destabilization
and ensuing rupture: if these atherosclerotic plaques,
contributing to the development of heart attack. Their
research report was published in the October 1994 issue of
the AHA journal Circulation.
  Activated mat cells secrete enzymes that can break down the
protein components of the "Fibrous cap" that covers plaque.
Rupture of the cap increases the chances that a blood clot
will form there.
  The scientists compared normal an diseased sections of
coronary arteries from 32 autopsy patients who ranged in age
from 13 to 67 years. They tested the arteries for the
presence of two enzymes that degrade the cap proteins.
  They found that the density of activated mast cells at the
edges of the plaques was 50 times higher than in non-diseased
arteries.
  These finding, Kovanen and his colleagues report, strongly
suggest the mast cell is directly involved in the often fatal
final event of coronary atherosclerosis.
  Other studies have implicated other immune system
components--white blood cells called macrophages--in the
development of heart attacks.
  What is activating mast cells and macrophages? Kovanen
suggests that chemicals in cigarette smoke might be part of
the problem. Cigarette smoke, he says, increase blood levels
of the mast-cell activating antibody, which is called
immunoglobulin E, or IgE. "Smoking might make mast cells more
prone to release their chemicals."
  The term mast cell comes from the German "mastung," which
means well-fed.

Association Vol. 5, No. 2 Spring 1995
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To: hicnews

INSULIN RESISTANCE AND THE POTENTIAL FOR CVD SEEN IN MEXICAN-
AMERICAN CHILDREN

  Mexican-American children may have a greater chance of
developing a blood chemistry syndrome associated with
increased risk of heart disease in adults.
  "Having insulin resistance may precede the development of
diabetes. And there is evidence that high insulin levels
promote atherosclerosis, the depositing of fatty materials
that narrow blood vessels and increase the likelihood of
heart attack," says David C. Goff, M.D., Ph.D., assistant
professor of epidemiology an medicine at the University of
Texas at Houston School of Public Health and School of
Medicine.  Insulin resistance is a condition in which the
body makes insulin but cannot use it efficiently to
metabolize, or break down, dietary sugar. The result is high
insulin levels and often high blood sugar levels. High blood
levels of insulin also can contribute to high blood pressure,
a risk factor for heart disease and a major risk factor for
stroke.
  Goff and his associates studied 191 Mexican-American
children and 179 non-Hispanic white children who were eight
to nine years old. They measured the children's height,
weight and blood pressure and analyzed fasting blood samples.
The researchers also sent questionnaires to the children's
homes to get a family medical history.
  They looked at five factors associated with insulin
resistance: blood insulin levels, triglycerides (a form of
blood fat), systolic blood pressure (the pressure in the
arteries created by the heartbeat), body mass index (a
measure of obesity) and levels of high-density lipoprotein
cholesterol (HDL-C, the so-called "good" cholesterol that
helps clear other cholesterol from the blood).
  Blood insulin levels were 34 percent higher in the Mexican-
American children.
  "We also saw lower HDL-C but higher triglycerides, higher
systolic blood pressure and greater body mass index in the
Mexican-American children," says Goff. "The pattern was
exactly the pattern one would expect to see in the insulin
resistance syndrome in adults."
  The scientists also found that 34 percent of the Mexican-
American children had four to five adverse risk factors,
while only 16.8 percent of the non-Hispanic white children
had multiple risk factors.
  "We still don't know from this study if these differences
are related to genetic or environmental influences,
especially diet and physical activity," Goff explains, "But
this may be a way to identify children who may be at
particularly high risk for cardiovascular disease as adults."
  Goff presented this information at the AHA's Scientific
Sessions in Dallas in November 1994.

Association Vol. 5, No. 2 Spring 1995
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------------------------------

To: hicnews

"COMMON K" MAY OFFER EASY, CHEAP WAY TO PREVENT HIGH BLOOD
PRESSURE

  Taking in extra potassium may offer a safe, simple and
inexpensive way to prevent high blood pressure in some
African-Americans.
  A three-week course of oral potassium supplements reduced
blood pressure in 43 African-Americans with acceptable or
"normal," blood pressure. In contrast, average blood pressure
in the 44 health African-Americans who received a placebo, or
medically inactive substance, did not change, Frederick L.
Brancati, M.D., reported at the AHA's 67th Scientific
Sessions in Dallas.
  "The results of this study also suggest that a prudent diet
should include foods that are high in potassium," says
Brancati, assistant professor of medicine and epidemiology at
the Johns Hopkins Medical Institutions in Baltimore.
"Increased dietary potassium intake could help prevent high
blood pressure in high-risk individuals."
  Examples of foods high in potassium are bananas, dried
fruits, potatoes and orange juice.
  At the beginning of the study, dietary potassium from food
in both groups was similar to the national average of 50-60
milliequivalents (mEq) daily and somewhat higher than the
norm for African-Americans (who generally consume less
dietary potassium than do whites). During the study, all 87
participants followed a low-potassium diet that contained no
more than 40 mEq of potassium daily.
  After three weeks, systolic blood pressure decreased by 6.9
points in people who received the potassium supplements, and
diastolic pressure fell by 2.5 points. IN the placebo group,
neither measurement changed.
  Systolic blood pressure is a measure of the force generated
by the heartbeat and is the first number in a blood pressure
reading. Diastolic blood pressure refers to the pressure when
the heart rests between beats, and it is the second number.
  According to the AHA there is no "ideal" blood pressure.
For most adults a reading no higher than 140/90 millimeters
of mercury indicates a mild blood pressure. But risk of heart
attack, stroke and kidney disease rises steadily with
increasing blood pressure.
  The mechanism by which potassium supplementation affects
blood pressure remains unclear, notes Brancati. One prominent
theory suggests that potassium affects the tone or tension in
small blood vessels. Another theory traces the element's
effects to kidney function and the elimination of water and
salt.
  Compared to whites, African-Americans have a much higher
risk of developing high blood pressure. Overall, more than 28
percent of all African-Americans have high blood pressure,
and the condition affects nearly 70 percent of African
Americans aged 65 and older.

Association
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SMOKING ACCELERATES ARTERIAL THICKENING, INCREASES RISK OF
HEART ATTACK AND STROKE

  Smoking cigarettes is like putting your blood vessels into
a time machine headed into the future.
  As people age, the walls of their arteries gradually
thicken.  Research published in the December 1994 issue of
the AHA journal Circulation shows that cigarette smoking
accelerates this process by more than a decade.
  By adding the equivalent of 10 years of aging to their
arteries, smokers are increasing their risk of stroke and
heart attack.
  Grethe S. Tell, Ph.D.,M.P.H., professor of epidemiology at
Bowman Gray School of Medicine in Winton-Salem, N.C., and her
colleagues, analyzed data from ultrasound exams of the
carotid arteries of 5,116 people older than 64. They found
"clinically significant" (50 percent or more of the artery's
width) narrowing of these major blood vessels in 4.4 percent
of people who had never smoked, 7.3 percent of former smokers
and 9.5 percent of current smokers.
  Ultrasound imaging is a non-invasive technique that uses
high frequency sound waves to help produce images of the
body's interior.
  Located in the neck, the carotid arteries carry blood to
the brain. If narrowed by atherosclerosis--a condition of
arteries characterized by deposits of fat, cholesterol and
other substances--a stroke may result.
  The carotids are important and very easy to examine with
ultrasound, Tell says. "We know that what we find in the
carotids is a reflection of what's happening elsewhere in the
body."
  "The difference in internal carotid wall thickness between
current smokers and nonsmokers was greater than the
difference associated with 10 years of age among never-
smoking participants," the scientists wrote in their report.
  Until now there have been some doubts as to whether smoking
is harmful in older people, Tell says. "But we found smoking
has bad effects even among the elderly. People who continue
to smoke in old age have more clogged arteries than people
who don't."
  The men and women who participated in this study were
selected from Medicare eligibility lists from Allegheny
County (Pittsburgh), Pa; Forsyth County, N.C.; Sacramento
County, Calif.; and Washington County, Md.
  The scientists say there is "abundant evidence" that
cigarette smoking causes atherosclerosis. Cigarette smoking
is firmly established as a risk factor for coronary heart
disease, peripheral vascular disease and stroke, Tell and her
associates note.
  Their study, which is part of the Cardiovascular Health
Study, is designed to determine if asymptomatic disease
detected with ultrasound progresses less in people who quit
smoking.

Association Vol. 5, No. 2 Spring 1995
---
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------------------------------

To: hicnews

BETA-BLOCKERS: NOT JUST FOR BLOOD PRESSURE AND HEART RATE
ANYMORE

  In the October 1994 issue of the AHA journal Circulation,
and analysis of about two dozen studies that involved more
than 2,300 patients showed a promising treatment for
congestive heart failure, which hospitalized more than
800,000 Americans in 1992.
  The new therapy? Beta-blocker drugs, which have been around
since the 1960s.
  Beta-blockers block a portion of the adrenergic nervous
system, slowing the heart rate and reducing blood pressure.
The class of drugs gets its name from the beta receptors,
proteins on the surface of heart cells that control the
uptake of nervous system chemicals that, in turn, control the
force and rate of the heartbeat.
  Eric Eichhorn, M.D., of the University of Texas
Southwestern Medical Center at Dallas and the Dallas VA
Medical Center, says, "We've found that beta-blockers are not
just slowing down the rate of progression of heart failure,
but actually reversing some of the damage."
  Congestive heart failure is a disease process in which the
heart muscle becomes damaged or overworked, and is unable to
pump out all the blood that returns to it. Hundreds of
thousands of new cases occur each year and it is the most
frequent cause of hospitalization in people age 65 and older.
  In related research, Ake Hjalmarason, M.D., of the
University of Goteborg, Sweden, and his colleagues found that
chronic treatment with the beta-blocker metroprolol could
reduce the need for heart transplantation in patients with
severe heart failure from a condition called idiopathic
dilated cardiomyopathy.
  And a trial called CIBIS (Cardiac Insufficiency Bisoprolol
Study) shows that beta-blockers appear to have a favorable
impact on the survival of patients with heart failure. In
CIBIC 320 patients in nine countries received the beta-
blocker bisoprolol while 321 patients received a placebo, a
medically inactive substance. But Eichorn says the CIBIS
trial did not include enough patient to tell if treatment
with beta-blockers really had an impact on survival. He is
the principal investigator of BEST (Beta-blocker Evaluation
of Survival Trial), which began in January 1995 and hopes to
gain enough statistical power from at least 2,800 patients
over five years to answer the question about survival.
  Many people who develop heart failure have had coronary
heart disease and have undergone coronary angioplasty or
bypass surgery earlier in life. But their disease has
progressed and their hearts have begun to fail. Other causes
of heart failure include the cardiomyopathies (structural
problems of heart muscle) and viral infections.

Association Vol. 5, No. 2 Spring 1995
---
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Telephone: +1-602-860-1121
FAX      : +1-602-451-1165


------------------------------

End of HICNet Medical News Digest V08 Issue #31
***********************************************


---
Editor, HICNet Medical Newsletter
Internet: david@stat.com                 FAX: +1 (602) 451-6135

                                                                                                  
