Joe Jacques HIV/AIDS Update

Spring 2001 Issue

 Headlines

• Message From the Editor - I have often heard it said that HIV patients are in very good shape. They are suffering from fewer opportunistic infections...
• Message from the IHV - It is with great sadness that we announce the passing on May 3, 2001, of our dear friend Joseph Jacques, PhD...
• Thoughts on New and Future Therapies - New Ways to Treat and Attack HIV
• Women's Issues - Bristol-Myers-Squibb has issued a Dear Healthcare Professional letter, warning that pregnant women may be at increased risk...
• HELPFUL HINTS
• The Positive Corner - From Adapt Cares - Bon Secours Baltimore Health System
• Your Thoughts - Excerpts from What is Life? What is Love?
• Things We Need to Know

Message From the Editor by Joseph Jacques

I have often heard it said that HIV patients are in very good shape. They are suffering from fewer opportunistic infections and live longer than those infected before the development of powerful anti-retroviral therapy. The benefits to those who are doing well on therapy are mitochondrial damage; lipid abnormalities, where women develop large breasts and skinny legs, and humps on the back of the neck, and men develop obesity and humps; peripheral neuropathy, which is very painful; diabetes; cardiac problems; a host of arthritic conditions; and many other painful, uncomfortable, and depressing side effects.
There isn't a day that goes by while doing my research that I see another side effect reported and I say to myself- "Here we go again." There also is more interesting news. Less than 20% of us are able to achieve and maintain undetectable levels for more than 3 years. "Among patients on treatment, the majority have side effects that often lead to treatment stoppages, which lead to pre-treatment viral rebound and disease progression."
Many HIV patients continue to have detectable levels of virus and experience some degree of drug resistance. Yet, they are able to do well clinically; they are able to work and live full, productive and useful lives. This suggests that an even small amount of suppression of the virus is connected to some immune recovery and clinical benefit. As researchers work to develop new medications and new classes of drugs, (see Current and New Therapies) we need to find ways to better use the drugs at hand now, such as reducing some of the side effects. I often wonder whether my life now is better than it was some years ago. I must try to live in almost constant pain. HIV is a "chronic disease," and completely understanding how to manage it is still a long way away.
HIV treatment needs long-term suppression of virus reproduction. Very importantly, viral suppression demands the patient's willingness to try to absolutely adhere to the medications. No ands, ifs, or buts. That is why we so urgently need the discovery and development of natural, non-toxic, inborn molecules to treat this difficult and resistant infection.

Message from the IHV

It is with great sadness that we announce the passing on May 3, 2001, of our dear friend Joseph Jacques, PhD., a long-time supporter of the Institute of Human Virology and an advocate for everyone in the Baltimore community living with HIV.
Dr. Jacques, a cancer survivor, came to Baltimore for treatment in 1984 then stayed to organize and promote human welfare in the community. He served as chairman of -- and helped to form -- the Community Advisory Board, a diverse outreach arm of the IHV's Clinical Care and Research Division.
A teacher by training, Jacques has been instrumental in educating the Baltimore community about the need for medical care and prevention, encouraging city residents living with HIV to seek out care at the IHVs Evelyn Jordan Center. According to Dr. Robert Redfield, director of the IHVs Clinical Division, impact on the Baltimore community will be felt for years to come. He will be truly missed, but remembered daily by those he touched. Those of us whom he trained will continue his work until the epidemic has ended.
Given the high infectivity rates for HIV-1, it is hoped that these advantages, coupled with optimistically anticipated high efficacy results, will suffice to sway the balance in mankind's favor.

Thoughts on New and Future Therapies

In this regular column, we will highlight some of the new ways to treat and attack HIV
The FDA has approved a new hepatitis C drug, Peg-Intron. The drug from Schering-Plough and Enzon is a form of Schering's Intron A that is injected only once a week.

The Journal of the American Chemical Society recently published a study by researchers who have discovered a molecule that can stop one of the key parts of HIV. They hope the molecule will be able to stop the spread of HIV by attacking the buildup of HIV protease, which creates the proteins that provide the invasion corridor for the virus. They remind us that the finding is not a cure, but could be a way to manage the spread of HIV and delay the diagnosis of AIDS. United Press International (www upi corn) (01/25/01)

Osteonecrosis, bone pain, is a new problem in HIV patients, and it seems to be connected to the use of highly active anti-retroviral therapy (HAART), according to a report published in the December 2000 issue of Clinical Infectious Diseases. The authors are not sure what is the cause, but believe it is linked to the use of protease inhibitors. They state that health care providers should be aware of this association with osteonecrosis, particularly with people using HAART. They believe that it's happening will be more frequent. Here we go again.

By Maggie Fox, Health and Science Correspondent, Reuters News Service. A designer protein that stops the AIDS virus from breaking and entering might provide another weapon into the arsenal against HIV. The researchers said they had made a protein that prevents the virus from attaching itself to the cells it attacks. Their protein, if and when it becomes a drug, would join the new category of HIV drugs known as entry inhibitors. The protein, called 5-Helix, might work against a range of viruses including the flu. Dr. Peter Kim who was at the Howard Hughes Medical and Whitehead Institutes at the Massachusetts Institute of Technology, who led the research, said the protein was a long way from being tested in humans. 5-Helix, which is too large to be absorbed orally, would be injected
Italian scientists working on an AIDS vaccine are reaching a stage where the vaccine would be ready for human testing. "Phase I (of human testing) is already in an advanced phase we hope to start this summer," Dr. Barbara Ensoli, head of virology at Italy's National Health Institute, told Reuters in an interview. Ensoli, who worked with Robert Gallo, one of the fathers of AIDS research, said the start of testing would be done in Italy's two largest cities, Rome and Milan. Ensoli, who spent 12 years in the US working as a researcher under Gallo, says her vaccine could prove to work against all types of HIV. It targets the viruses' tat gene. Of course, we all wish her success. By Julia Hancock, Reuters NewMedia - Friday, January 18, 2001.

Reactivation of Hepatitis B seen in HIV infected patients after starting HAART. Apparently it can cause reactivation of hepatitis B virus replication and development of acute hepatitis, according to researchers in Germany. Dr. Christoph Mangold of the Bernhard-Nocht-Institut for Tropenmedizin in Hamburg advises that clinicians be alert to hepatitis B virus replication after beginning HAART. And so it goes again. 2001-01-22 19:30:2 1 EST (Reuters Health).

Clinical tests are suspended on a promising AIDS drug by Pfizer in late stage human trials of capravirine, a potential giant AIDS medicine. This decision was made after the medication in dogs showed inflamed blood vessels, or vasculitis. Pfizer said none of the 650 human patients in six clinical trials of capravirine had any evidence of vasculitis. Most patients will end the trial and continue on other treatments, but those who are doing well with the drug and have failed other therapies will remain on the drug. Pfizer will monitor both groups. Wall Street Journal (wsj.com) (01/26/01)

This abstract is from the CDC NCHSTP Daily News Update for January 26, 2001. New Scientist (www.newscientist.com) (12/16/00) Vol. 168, No. 2269, P. 12 by Philip Cohen. At a recent convention of the American Society of Hematology in San Francisco, chemists from Vitex - a Massachusetts drug company-presented results from the first human trials of a new blood cleansing drug. Their researchers developed a drug, called Inactin, that is able to penetrate cell membranes and the protein shells of viruses to release a positively charged assault targeting negatively charged DNA and RNA nucleus, making the molecule unable to function.
They believe that treatment with Inactin can effectively decrease the amount of impurity of the blood by viral or bacterial poisons by the rate of 10,000 times or more. As the number of persons living with AIDS continues to grow, the need for research dealing particularly with men and women and children becomes more complicated. It must center on the production and development of HIV. It must be able to see the signs of that disease and it must be able to identify the laboratory markers of HIV. The treatment of HIV has greatly increased, but there are new data showing particular relationships between gender, race, viral load, and T4 cell counts. These findings may be important in the future for the management of HIV in women and African American and Latino individuals.

According to Bloomberg News, Durham, North Carolina, January 29th, Trimeris Inc. and Roche Holding AG's experimental HIV drug, T-20, seems to be useful to patients who have failed therapy by other drugs. This was reported in a new study. T-20 belongs to a class of drugs called fusion inhibitors or "entry inhibitors," which prevent the virus from entering the cells the virus attacks. Trimeris also is working on another "entry inhibitor" called T-1249. The drugs, which are available now, keep HIV from reproducing inside human cells, but it is impossible for them to stop all viral action. Thus, HIV will change itself and become resistant to even the most powerful drug combinations. Currently these two drugs must be delivered to the body via injection.
Triangle Pharmaceuticals, Inc. made public on February 5th that its once-daily drug Coviracil (Emtricitabine, FTC) is as effective as Lamivudine (3TC) in HIV infected patients receiving triple therapy combination regimens. (Study protocols FTC302/303). Lamivudine must be taken twice daily.

Bloomberg News reported on January 29, 2001 that Merck has gotten approval for Cancidas, the first of a new class of anti-fungal drugs. The drug gives doctors the ability to attack aspergillus, a fungus not destroyed by older drugs, one of which is amphotericin B, which has been associated with kidney damage. Cancidas is the first of two Merck drugs that could be approved by the FDA this year developed to treat infectious diseases. The second is an antibiotic called Invanz. Merck also is testing Cancidas against another fungus, candida, which attacks many HIV patients.

Women's Issues

Bristol-Myers-Squibb has issued a Dear Healthcare Professional letter, warning that pregnant women may be at increased risk of fatal lactic acidosis when prescribed the combination of the HIV drugs Zerit (stavudine) and Videx or Videx EC (didanosine) with other anti-viral agents.

Lactic Acidosis happens when the bodies cells are unable to convert food into usable energy, the US Food and Drug Administration explained in a recently issued news release. The condition causes excess acid to accumulate in the body, potentially damaging vital organs, such as the liver and pancreas.

The company issued the warning regarding the drug combination following reports of the deaths of three pregnant women who were taking Zerit and Videx with other anti-viral medications to treat HIV, the FDA said. (Reuters Health) 2001-05 18:50 14 EST

The use of nonoxynol-9 (N-9)-containing products causes rapid loss of the outer layers of skin cells during rectal intercourse, according to Dr. David M. Phillips and associates from the Population Council in New York, NY. His teams findings support last years study results of Columbia Laboratories, spermicide Advantage-S, which contains nonoxynol-9 as its active ingredient. The users of this product not only failed to reduce the rates of HIV transmission, but also actually appeared to increase the likelihood of HIV infection. Contraception. 2000; 62: 149-154 (Reuters Health) 2001-01-05 15:45:21 EST. This information also is very important for men who have sex with men.

The American College of Obstetricians and Gynecologists (ACOG) has issued a new policy that supports routine voluntary testing of pregnant women in the US for HIV. Along with its new policy, ACOG has made public a new educational effort to help doctors inform their patients about HIV screening and treatment, using pamphlets, posters and tear pads. JAMA (www.jama.com) (06/28/00) Vol. 283, No.24, P.

Beta Carotene (vitamin A) deficiency may contribute to the development of cervical neoplasia in women infected with HIV, according to a report in the October 2000 Journal of Infectious Diseases. Dr. Audrey French, from Rush Medical College in Chicago, Illinois, and associates, measured serum retinol concentrations and examined cervical problems and human papilloma virus (HPV) at the same time with detection results in 1,314 women enrolled in the Womens Interagency HIV Study. Beta-carotene deficiency, detected in 15.5% of the women was independently connected to a history of injection drug use, pregnancy, and lower serum albumin levels, the authors stated. This rate compares with a 1.69% level of beta-carotene deficiency among women in the National Health and Nutrition Examination Survey. J.Infect Dis. 2000; 182: 1084- 1089. (ReutersHealth) 2000-10-06 18:34:06 EDT

FOR LADIES ONLY

This is the list of commonly known gynecological infections that we have to deal with and their symptoms.

Bacterial Vaginosis:
Signs and symptoms: Unusual fish smelling discharge from the vagina, itching or irritation.

Trichomoniasis:
Signs and symptoms: Smelly, greenish-yellow discharge

Vaginal Candidiasis (yeast infection):
Signs and symptoms: Intense itching either in the vagina or on the skin or the outside, White thick discharge or clear and watery discharge, unusual (bleach-like) smell.

HPV (Human Papilloma Virus, (Genital Warts):
Signs and symptoms: Tiny pink or red swelling in the genital area, or around the rectum that grow quickly. Severe warts close together can take on a cauliflower shape. They can be very painful. Genital warts also can be internal in the vagina, cervix, uterus, or anus and you may not know they are there.

Pelvic Inflammatory Disease (PID):
Signs and symptoms: Severe pain and tenderness in lower abdomen sometimes with fever and vomiting.

Herpes:
Signs and symptoms: Painful or itchy blisters or ulcers on the skin, or in the vagina or rectum.

Chlamydia:
Signs and symptoms: Often women have no symptoms of Chlamydia. You may experience burning with urination or lower abdominal pain.

Syphilis:
Signs and symptoms: The initial infection is characterized by painless, hard red sores on or around the skin of the genitals, anus, or mouth. Hair loss, sore joints, rash (especially on hands and bottom of feet), swollen lymph nodes, and weight loss are later signs.

Gonorrhea:
Signs and symptoms: Vaginal discharge in some people, burning, frequent urination. Often the symptoms are very mild in women, but may be similar to the symptoms described in the PID section.

A new report suggests that although some women infected with HIV, or at risk for infection, may feel isolated and depressed, many do not receive the very important mental health care. According to the report, published with an accompanying commentary in the Journal of the American Medical Women's Association (2001;56:4-10), only about two-thirds of the women got such services.

A treatment study putting together cesarean section with AZT prophylaxis, known as the reduced Berlin regimen, is very effective in preventing HIV-1 vertical transmission and is safe for the infant, according to a report published in the December 22, 2000 issue of AIDS.

Many new mothers do not know that HIV can be transmitted through breastfeeding and do not know that anti-retroviral drugs can prevent perinatal HIV transmission, according to report findings published in the January issue of Obstetrics and Gynecology. The data suggest that public health efforts need to teach women about how to prevent perinatal transmission. The study also showed that women had considerable distrust of government and the scientific community regarding the HIV-AIDS epidemic. It was decided that women, particularly those who have not finished high school, need public health efforts to increase knowledge and to gain more trust of public health officials.

Widely used non-spermicidal lubricants may have previously unsuspected anti-HIV effects, according to research presented at HIV DART 2000: Frontiers in Drug Development for Antiretroviral Therapies held at Isla Verde, Puerto Rico. In the study presented, Samuel Baron and associates from the University of Texas Medical Branch at Galveston, checked the ability of FDA-approved over the counter (OTC) lubricants sold for use during sexual intercourse, to inhibit HIV activity. Of the 22 products that were examined, four (Astroglide, KY-Liquid, Vagisil and viAmor) were highly effective against HIV-infected leukocytes suspended in the seminal fluid and against cell free HIV. According to Mike Youle, MBChB, from the Royal Free Hospital in London, United Kingdom, this study may open the doors to a practical approach to investigate the usefulness of simple OTC lubricants in prevention of HIV transmission.

HELPFUL HINTS

People who have goals for which they actively strive live longer and enjoy a better quality of life.

Crossword puzzles, computer games, returning to school, and writing your autobiography are all good ways to make sure that the most important "muscle" in your body gets exercised.
W Short-term stress helps redistribute the body's immune cells where they are needed. Chronic stress, however, depresses the immune system.

Timothy McCall, MD and Boston internist says that coffee, tea, and other caffeinated drinks, such as cola, contribute to a variety of medical troubles from intestinal ulcers to anxiety and insomnia. Most teas contain caffeine, but at lower levels. Drink instead black (ordinary) tea and especially green tea, which contain natural antioxidants that help fight inflammation and reduce the risk for heart attack and cancer. Also, he says, that red meat in particular is high in saturated fat, which contributes to many ailments from heart disease to colon cancer. Consider instead, hot dogs, burgers, and sausage made from soy protein. Boca burgers are very good.

One large source of chlorophyll is green tea. Researchers at Case Western Reserve University in Cleveland, Ohio recently reported that green tea applied topically shows both anti-inflammatory and anti-carcinogenic properties. (Arch Dermatol 00;136(8):989- 94). In other words along with the benefits you get from drinking green tea you also can benefit from applying it directly to your skin.

Elderberry herb fights viral illnesses including flu, cold, or herpes. In a study conducted in Israel during a flu outbreak in 1993, 90% of people who took a standardized elderberry extract were cured within three days. The typical dosage before meals is one-half teaspoon of liquid elderflower extract or 2 to 3 cups of elderflower tea.

Liquids, good nutrition, bed rest, and aspirin help control the symptoms of the flu. Ask your doctor about antiviral drugs that are now available for influenza - amantadine (Symmetrel), rimantadine (Flumadine), oseltamavir (Tamiflu), and zanamivir (Relenza).
The human intestinal tract is home to trillions of bacteria. Two species in particular - Lactobacillus acidophilus and Bifidobacterium (bifidus or bifidum) help protect our health in many ways.

They limit growth of the fungus Candida albicans, which can cause health problems like eye, nail, vaginal, and throat infections, and thrush.

They prevent food poisoning by producing natural antibiotics to control salmonella and other intestinal diseases.

They synthesize vitamins A and K. Vitamin A helps maintain good vision and healthy skin. Vitamin K assists blood clotting and bone formation.

They synthesize B vitamins, which help fight psychological and physical stress.

They help to facilitate the absorption of minerals and break down proteins into amino acids, which are used to make and repair hormones and enzymes and, maintain bone structure.

They facilitate digestion by breaking down lactose in dairy products and they help regulate bowel movements and help to prevent diarrhea.

They help prevent cancer by limiting the growth of bacteria that produce cancer- causing nitrates.

They also metabolize and eliminate carcinogens, such as pesticides.

Cooked carrots are more nutritious than raw ones. Antioxidant levels increased more than 34% after they were cooked - and continued to increase while the vegetables were kept at 104 degrees F for one week. Heating softens carrot tissue, allowing the release of antioxidants attached to cell walls. This process also may occur in other vegetables. One great example is garlic. So says Luke Howard, PhD, associate professor of food science, University of Arkansas, Fayetteville. His study was published in the Journal of Agriculture and Food Chemistry.

Eating moderate amounts of nuts daily for eight weeks can lower LDL (bad) cholesterol levels by 10 %, a recent study has shown. The monounsaturated and polyunsaturated fats in the nuts are responsible for this effect. Studies with pecans, almonds, and walnuts have shown these results. Nuts also are high in heart-healthy fiber, vitamin E, copper, and magnesium. (Wanda Morgan, PhD, RD, Associate Professor of Human Nutrition and Food Science, New Mexico State University, Las Cruces. Her study was published in the Journal of the American Dietetic Association.

Italian potency diet helps improve a man's sexual performance. Developed by researchers in Abruzzo, the plan forbids fried eggs, bacon, and other greasy foods. It identifies instead citrus fruits, garlic, tomatoes and other vegetables, whole grains, and liver.

Three herbs to help prevent or shorten the duration of the flu are Astragalus, which is safe to take as a daily immune booster; Echinacea, when taken only as needed and not as a daily tonic; and, elderberry, which research suggests can cut the duration of symptoms by up to one half.

In a study of 55 women aged 60 to 71, those with impaired hearing had lower blood levels of vitamin B-12 and folate than those with normal hearing. Those women above 55 should take a multivitamin supplement with 25 mcg of B-12 and 400 mcg of folate (folic acid). American J. Clin. Nutr. 69:564. 1999.

Women who ate at least six servings of spinach, kale, and other green leafy vegetables a week had roughly half the risk of ovarian cancer compared to women who ate less than two servings a week. Amer. J. Epidem. 149:21, 1999.

Anyone who received blood before 1992 should be tested for Hepatitis C. Up to 10% of Americans who had a blood transfusion before 1992 may be infected. This includes a percentage of women who got a transfusion after undergoing a cesarean section. Sherry Marts, PhD, scientific director. Society for Women's Health Research, Washington, DC.

For easier pregnancy, wear supportive shoes, work out to strengthen hip muscles and to prevent the pregnancy waddle, and, sleep on your side with one pillow between your knees, another under your abdomen, and hug a third- Cynthia Markel Feldt. PT, American Physical Therapy Association, Alexandria, Virginia, www.apta.org

Don't wait for hot foods to cool before refrigeration. The sooner cooked food is refrigerated, the sooner potentially harmful bacteria growth will stop

The Positive Corner

From Adapt Cares - Bon Secours Baltimore Health System

I'd like to take this opportunity to let the HIV community and those individuals who provide HIV services know what a wonderful and caring human being you are. For everybody out there reading this article, Joe took time out of his busy schedule to come to our organization at Bon Secours Baltimore ADAPT Cares to facilitate a HIV education/support group. This group routinely convenes quarterly for individuals involved in out-patient Methadone maintenance therapy treatment. The wealth of information that Joe provided on medical treatment and services, mental health issues, and the use of herbs and vitamins to enhance HIV therapy was invaluable. I wish you nothing but GODSPEED!!! ... Sherrie C. Todd, LCAD-C, Coordinator

Your Thoughts

Excerpts from: What is Life? What is Love?

I want to tell you a brief story about the woman I was and the woman I am now.. The woman I was had a marriage for sixteen years and three children. The woman I am now is a single mom.

During my marriage, there was nothing but problems, arguments, a lot of hurt, pain, and much loneliness. While the years passed, my marriage became worse and the children were out of control. My husband fell heavily into drugs. My children and I were in much fear of my husband...I cried all the time, I felt sorry for myself. Then I actually started hating my husband because of how my life turned out. I cried out to God so many times. I felt God wasnt listening to me... Then one day I found people who cared about me and showed me the love I needed. They introduced me to a friend who I can always call on, Jesus....That was the happiest day of my life...Years went by and I kept learning more about God. When 1994 came, suddenly there was a big fall. I discovered I was infected with the HIV virus. That revelation caused me to be angry with God. I had trusted him so much to protect me...I realized that God had allowed the devil to proceed in order to bless other people for his glory...

Things We Need to Know

A 47 year old AIDS patient gained 15 pounds after six months of treatment with insulin shots, according to a report by researchers from the University of Arizona College of Medicine and the VA Medical Center in Phoenix. It found that the man, who lost 20 pounds and was always fatigued even though he was receiving antiviral drugs and receiving B-12 and testosterone injections, weighed 140 pounds after three months of daily insulin shots and 147 pounds after 6six months. Also, his T-4 cell count rose while he received the insulin; and dropped after the shots stopped. The report in AIDS Patient Care and STDs (2000; 14:575-579) showed that the patient reported no bad effects from the insulin.

Many HIV-infected individuals are at risk for depression. Many feel powerless by the very great changes in their lives. Increasing amounts of research show that HIV patients have more bad effects from depression. Studies also show that "psychological factors affect disease progression in HIV." Depression is connected with low immune responses, disease progression, lowered survival, and lower quality of life and can lead to faster progression to AIDS. We need to be aware of these findings and report to our doctors any depressed feeling we may have.
New statistics from the Centers for Disease Control and Prevention show that gonorrhea is increasing in the US for the first time in 25 years. The increase may be the result of better AIDS treatment, whereby some people mistakenly believe high-risk behavior may not bring the bad consequences it once did. So people do not practice safe sex.

A two-year study by Dutch researchers shows that AIDS patients experience minor to severe pain related to the disease and in many cases pain management is inadequate. Tell me about it.

Up until this time the generally accepted idea has been that HIV infected people have suffered unrepairable damage to the immune system so that they are never going to be able to recognize and control the virus. Recent studies show this idea to be false. According to the results of two studies led by Dr. Kendall A. Smith of Cornell University, which were printed in the November '99 issue of HIV Clinical Trials, it was found that chronically infected patients who receive interrupted highly active anti-retroviral therapy (HAART) and daily low dose IL-2 show antiviral reactivity.

In a news release recently put out, Prodigene, a biopharmaceutical and industrial protein company located in College Station, Texas, said it received a two-year grant from the NIH to produce an edible vaccine against the virus that causes AIDS. The vaccine to be developed would come from transgenic genetically enhanced corn. Yes. Imagine eating corn flakes and becoming vaccinated against HIV. Prodigene's Dr. Joseph Jilka said, "Numerous studies have shown that viral and bacterial toxins can be expressed and correctly processed in transgenic plants to yield immunologically active antigens." He goes on to say that "plant based vaccines offer numerous advantages over standard vaccines in terms of 'safety, economy, stability, versatility, and efficacy."

Corn was selected as its potential vector for the vaccine because "corn can be grown in vast quantities and shipped over long distances at normal temperatures."

HIV-infected Medicaid recipients with unstable housing may be receiving less adequate health care than those who are stably housed. New York researchers report in the October '99 issue of the Journal of General Internal Medicine.

The flu vaccination is associated with a mildly decreased hazard of progression to AIDS-defining opportunistic illness, according to results of a 10-year study involving more than 25,000 HIV-infected individuals. In the December 1st, '99, issue of AIDS, Dr. Patrick Sullivan and his associates report that none of their findings show any long-term detrimental effects associated with the vaccine.

The investigators conclude, therefore, "Physicians should not withhold influenza vaccine from HIV-infected persons because of concerns about long-term detrimental effects of increased viral replication." By the same token, we should all seek to get vaccinated.

From the Washington Post (www.washingtonpost.com) 12/21/00, pA16 comes the following news report: "Bristol-Myers Squibb's employee Christmas party was disrupted on Wednesday afternoon by a group of AIDS activists. The protesters shouted accusations that the firm was involved in price gouging practices for it's new AIDS drug, Videx. The demonstrators were able to enter the drug maker's building, but were quickly evicted by security personnel. The activists were apparently concerned with the price of a new formulation of Videx that is easier to take and has fewer adverse effects to the gastrointestinal tract."

Nearly 1 in 5 people in the US have a "stigmatizing" attitude toward people with HIV infection, according to the Centers for Disease Control and Prevention. In a national public opinion survey taken over the Internet, a total of 18.7% of people who answered it agreed with the statement "Persons who got AIDS through sex or drug use have gotten what they deserve." The survey also showed that those who were misinformed about how HIV is transmitted were likely to show a stigmatizing attitude. The survey conducted in August and September 2000, was sent to a national sample of 5,641 adults who had been offered Internet access and equipment in exchange for participation in weekly surveys.

"Stigmatizing responses were more common among men (21.5%), persons aged 55 years or older (30%), those with only a high school education (22.1%), those with an income less than $30,000 (23.4%), and those in poorer health compared with others (23.6%)," according to the report. Dr. Helene Gayle, director of CDC's National Center for HIV, STD and TB Prevention, advised that the whole community must play a role in changing people's attitudes.

"Community groups, the faith community, parents, schools - the whole range of different parts of our society that impact people's attitudes about issues can impact people's attitudes about HIV," she said.

Macready Norra of United Press International (www.upi.com) (12/21/2000), reports that in a position paper of the American Dietetic Association (ADA) and Dieticians of Canada that efforts to improve nutrition should be a part of overall health care given to HIV-infected individuals. Importantly, the groups recommended medical nutrition therapy and nutrition counseling. Also, ADA spokesman Dr. Keith Ayoob mentions that food and water safety issues should be stressed.

Before leaving office, President Clinton signed a bill that provides the Ryan White CARE Act over $1 billion a year for AIDS prevention and treatment.

At a public hearing on HIV, Baltimore health commissioner Peter Beilenson said he would turn over the responsibility of keeping count of the city's HIV cases to state health officials. "I'm not confident we're doing it adequately," he said. Last October, the Maryland AIDS Administration provided a report that was critical of the Baltimore Health Department's HIV/AIDS monitoring. The study said cases of AIDS and exposure to HIV are being under-reported in the city, and that might affect federal funding. The head of the state AIDS administration noted that of the 2,111 new HIV cases reported in Maryland in 1999, nearly 60% were in Baltimore.

According to an article in the Journal of Acquired Immune Deficiency Syndromes (www.jaids.com) (12/15/00), Vol.25, No 2, p S105, Rotheram-Borus MJ, Newman PA, Etzel MA, the past 15 years have brought new technologies, biomedical advances, and policy shifts, which in turn have created new challenges and opportunities for service providers, policy makers, and researchers in the identification of HIV+ persons. The researchers from the University of California at Los Angeles tell us that to ensure effective HIV testing we should increase the number of high-risk patients tested, minimize the time between infection and detection, increase testing assessibility and ability, increase the proportion of people who receive their HIV test results, and increase the number of HIV+ patients linked to care. Tell us something new.

Many persons with HIV infection prefer to use the emergency department to care for new symptoms, even if they have a primary care provider. This is especially true for African Americans, the poor, and patients with psychological symptoms, according to California researchers. This means primary care physicians who take care of HIV infected patients must look carefully at how they behave when they provide access to their patients. They comment that the use of health care is a cultural, social, behavior and that different racial and ethnic groups learn to use health care differently.