AIDS Daily Summary May 17, 1994 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 1994, Information, Inc., Bethesda, MD "Coping With HIV" Washington Post (Health) (05/17/94) P. 14; Siwek, Jay Because of rapid changes in AIDS research, it is particularly important for HIV patients--more so than patients of other illnesses--to be aware of their condition and how to treat it. If infected with HIV, family physician Dr. Jay Siwek recommends a series of steps to remain abreast of the condition and its treatment. Establishing a long-term relationship with a health care provider is the first step, he says. Then, learn all about HIV infection and AIDS. Periodically, a patient's CD4 level should be checked and, if the count becomes low, the doctor should recommend medicine to treat both the HIV and prevent other types of infection. Immunization shots will help prevent other infections as well, according to Siwek. Patients should also get checked for syphilis and other infections that are transmitted through sex or shared needles. Siwek advises women to have regular Pap smears, for the risk of cervical cancer and other pelvic problems is amplified with HIV infection. And, of course, there is always the risk of transmitting the virus to a baby. Finally, recommends Siwek, HIV patients should consider enrolling in an AIDS clinical treatment trial, joining a support group, or subscribing to a publication devoted to people living with HIV. "Across the USA: North Carolina" USA Today (05/17/94) P. 9A In Buies Creek, N.C., today, representatives from Campbell University will appear in court to fight federal efforts to force the school to reinstate an HIV-positive instructor. Campbell denies government accusations that it wrongfully dismissed the teacher because he has AIDS. If the allegations are true, the university will be in violation of the Americans With Disabilities Act. "Officially, Indonesia Has 263 HIV Cases" Reuters (05/17/94) Indonesia announced on Tuesday that it has 263 cases of HIV infection, but ministers and aid workers there argue that the actual figure could be 200 times higher than that. The official Antara news agency quoted the director general for Medical Services as saying that 50 of the 263 HIV carriers have developed AIDS. However, Coordinating Minister for Health and Social Services Azwar Anas said that for every documented patient, "there could be between 100 and 200 behind every one of them." The country has been preparing to launch measures to counter what it fears may be an epidemic comparable to that of regional neighbors, such as Thailand. "Concern About Privacy ..." Wall Street Journal (05/17/94) P. A1; Harper, Lucinda According to a study by the American Civil Liberties Union, the majority of people polled believe that employers should have access to the employment and education records of applicants. While most people said employers did not have the right to know employees' racial designations or sexual orientations, they did feel employers should have the right to know whether an applicant is HIV-positive. "Risk Groups Targeted in AIDS Fight" Chicago Tribune (05/16/94) P. 1-7; Wilson, Terry Borrowing strategies from the marketing arena, federal authorities and community organizations hope to alter deep-rooted behavior in people who are at high risk for HIV/AIDS. Fred Kroger, director of the National AIDS Information and Education Program for the Centers for Disease Control, says the centers are working with community groups in Portland, Ore., Chicago, Phoenix, Nashville, San Francisco, and New York to determine the highest-risk populations in each area and develop prevention-oriented approaches. "Sexual behaviors are far more complex to change than immunization behaviors," says Kroger. "Getting people to a clinic for a shot is a lot easier than getting them to change their lifestyle. It's going to take very concerted efforts by many people, and it's not going to happen overnight." Surveys indicate that many people are aware of the threat of AIDS and how to avoid it; however, motivating people to take these steps and continue to do so is difficult, according to Kroger. "Scientists Sabotaging AIDS Gene" Houston Chronicle (05/16/94) P. 8B; King, Warren Targeting two of the proteins most crucial to HIV, scientists hope to stop the virus in its tracks by throwing monkey wrenches into its genetic machinery. Researchers at Houston's Baylor College of Medicine insert into HIV-infected cells a gene that inhibits the ability of the virus to reproduce. Just as HIV gets its reproductive machinery up and going, the gene produces a protein that short-circuits it. John Belmont and five colleagues found their laboratory success with a combination of purposely flawed versions of two proteins made by HIV to ensure its survival. "Tat" turns on the HIV, gets the genetic machinery started, and tells it to keep going, while "Rev" causes the virus to change gears and begin making the structural parts of new HIV. Researchers at the University of Michigan and the University of Southern California discovered that altered versions of Tat and Rev slow down the virus, and the Baylor group extended the research by constructing "Trev," a gene that has the same effect on HIV as Tat and Rev, but has the more lasting effect of halting HIV in already-infected cells. While this type of gene therapy is effective only in the laboratory right now, its creators hope within the next year to initiate trials in infected babies of mothers carrying HIV. "We want to do it in patients as quickly as possible," says Belmont, director of the project and associate professor of molecular and human genetics at Baylor. "It could give us some real answers and a basis on which to improve." "India Tests Herbal Drugs for AIDS Treatment" United Press International (05/16/94) The government-funded Indian Council of Medical Research, India's top medical body, says it will begin AIDS-related clinical trials involving ancient Indian herbal drugs said to stop the spread of HIV. A task force chose 10 drugs for clinical experiments in patients who have tested HIV-positive. The council will investigate whether the drugs curb the spread of AIDS in the human body. The drugs were selected from the ancient Indian school of Ayurvedic medicine, which uses herbal and root extracts for treatment of chronic diseases. "Administration of Aerosol Pentamidine: A Program Design" Journal of the Association of Nurses in AIDS Care (03/94-04/94) Vol. 5, No. 2, P. 41; O'Hara, Constance M.; Anton, William R.; Gormley, Francis X. Pneumocystis carinii pneumonia is the most common opportunistic infection diagnosed in HIV patients, note O'Hara et al. of the University of Washington Medical Center. For patients with constitutional symptoms, CD4 counts below 200, or who have a history of PCP but cannot tolerate oral therapies, aerosolized pentamidine is the preferred prophylactic treatment. AP has minimal side effects and a convenient once-a-month regimen, which increases the likelihood of patient compliance. Successful treatments, however, are subject to the skill and training of the professionals administering AP, thoroughness of patient teaching, and patient compliance. Safety of administration is a priority for both patients and healthcare providers. Because of the risk of exposure to mycobacterium tuberculosis, patients should be tested for TB before AP treatment is initiated. The staff must adhere to universal precautions at all times, and administer treatment in an appropriately ventilated area. The AP program at UWMC, which centers around a multidisciplinary team approach, yields a high rate of patient compliance. O'Hara et al. believe the essential components of UWMC's program can be adapted to most clinical offices, agencies, or institutions.