AWARE A Publication of Twin States Women's Network

| Return to AWARE Newsletters | Return to TSWN Home Page |

March/April 2001 Volume 10, Issue 2 Inside this Issue Twin States News Finding a Dentist in VT Opinion: Morality or Death What is Brain Fog? Calendar HIV/HCV Updates WHATS NEW With Twin States HURRY! REGISTRATION ENDS APRIL 5th FOR MAY COUPLES RETREAT TSWN is accepting applications for the Couples Retreat until April 5th. The retreat is May 4th-6th at the Golden Stage Inn in Proctorsville, VT for heterosexual couples where one or both partners are infected with HIV or HCV. The cost is $25. You do not have to be married or living together to qualify as a couple. You will meet new friends, attend workshops, relax, eat wonderful food, and remember why you're a couple. We have exclusive use of the inn, so confidentiality is not an issue. Space is limited and there is a waiting list so please call 888-338-TSWN before sending in the form on page 9. 6th ANNUAL WOMEN'S RETREAT SET FOR JUNE 29TH - JULY 2ND The 6th Annual Women's Retreat will be held on Friday, June 29th through July 2nd, 2001. The 3-day workshop will be held at the Blue Gentian Lodge in Londonderry, Vermont. The Lodge features a swimming pool, hot tub, rec room, and TVs in every room. As usual there will be a variety of workshops and activities to educate, entertain and rejuvenate body, mind and spirit. The cost is $50 for the 3-day retreat, which includes food, lodging and workshops. First-time participants are eligible for $40 scholarships. The registration fee is $10 for all attendees. Partial payments are accepted at any time. Space is limited, so please register early to reserve your spot. For more information call 888-338-TSWN. To register, fill out the form on page 9. DEALS ON WHEELS! The Good News Garage In Burlington, VT has provided more than 400 cars to needy locals such as welfare mothers, artists and retirees since July 1996. Patrons donate the vehicles and clients pay for the $800 to $1500 in repairs that make the cars roadworthy. Lutheran Social Services and government grants provide major funding. For more information, call the Good News Garage at 877-Give-AUTO (448-3288). BABY NEWS We're happy to announce the birth of Vivienne's granddaughter - Linaea Vivienne was born on February 20th. Congratulations! IN MEMORIUM This issue of AWARE is dedicated to the memory of Lynn Grissaffi who died on March 5, 2001. Lynn attended Women's Retreat last year and will always be remembered for being a motorcycle mama with a great sense of humor who entertained us not only while she was awake but also while she was sound asleep! Return to top GRIN & BEAR IT: FINDING A DENTIST IN VT Whether one calls them their pearly whites or a set of choppers, your teeth are very important to you and your nutrition. Without them we could not chew, the first step to digestion. They also tell a story of who you are, and give you personality. In the past, only the wealthy could afford to have their teeth straightened. But, today orthodontists are not as expensive and more of us can have perfect smiles. But we have to take care of them too. Let's face it. HIV+ women are busy. We have our ID doctors, OBGYN, and if we have children, then we have a pediatrician, a children's dentist and maybe even an orthodontist. Where can we find the time and strength to get to the dentist for ourselves? I'm here to tell you that it is something you cannot put off until next month. Do it now! In Vermont I have found it increasingly difficult to find an available dentist and finding one that takes Medicaid is nearly impossible. I had an excellent dentist for 3 years in Bennington. Then, as the company changed from CHP to Kaiser to yet a third company, I was dropped when they no longer took Medicaid. It took countless telephone calls, pouring through the yellow pages, and always the same answers. "We are not taking new patients" or "No, we do not take Medicaid". I called my social worker at PATH (the new name for ANFC/welfare) in Bennington. She did not have a list of providers and told me to call BROC. I thought this was strangely unacceptable. BROC helps people with utility bills and such, and I knew that they would be of no help. I called the Vt. State Dental Society instead. I spoke with a very nice woman but she also did not have a list of providers. Then I called the Department of Health in Burlington. Somewhere in that dizzying day of telephoning, I was told to call the main number for PATH in Waterbury. They gave me yet another number for the Department of Health Access. Here I did get help from a very nice gentleman. If you have Vermont Medicaid and cannot find a doctor or dentist that will take you, call the Department of Health Access at 1(800) 250 -8427. Now don't you think that my social worker should have known that? I also found out that Dr.Lasapanara in Burlington and the VA hospital in White River Junction will take Medicaid and HIV+ patients. For me that would be 3 to 4 hours of driving just to get my teeth cleaned. There is a shortage of dentists and doctors in Vermont because of insurance issues. There is a high cost of living here for new doctors who find that other states are better to set up practice in. For example, it took me 7 months to get an OBGYN appointment with a doctor I have been seeing for 10 years! Rob at the VTPWAC reminded me of the DCAP program. This is a Vermont Department of Health dental assistance program for low income HIV+ people. You can get an application and learn about the program by calling Mike Bassett at 1-800-464-4343. If you are not covered by any dental insurance, or use up the allotted amount from Medicaid, DCAP may be able to help. Plan now to get yourself an appointment and make sure you don't cancel. It could take as long as 6 months to get an appointment. Once you become a patient, then you can get on a rolling schedule to take care of cavities before the pain starts and maintain that flashy smile. Many people tend to shy away from doctors in general and some neglect their teeth out of fear of the dental hygienist or because of a bad experience in the chair. Sometimes, it's because of money, or the "If it's not broken or doesn't hurt then why fix it" mentality. Prevention of cavities and gum disease starts in childhood. One thing you can do for your child is to teach them proper dental hygiene and get them used to regular visits to the dentist. This will save them a lot of pain and money throughout their lives. There is a medical study going on right now that is trying to prove a link between gum disease (gingivitis) and heart disease. Not only do beer, wine, soda and candy cause tooth decay but also medications. For people who are HIV+ these drugs are saving lives but they can also damage your teeth. One more thing. Don't forget to floss. The little plastic disposable flossies are great. You don't have to wrap the string around your fingers and contort your mouth into painful shapes. So go ahead. Smile! It feels good! Return to top OPINION: GIVE US MORALITY OR GIVE US DEATH By Jim Pickett From the Test Positive Aware Network September/October 2000 HIV is being spread by HIV positive people. Admittedly, this is no news flash, but it seems as though we forget this very basic fact regarding this very infectious disease. It takes two to have sex; it takes one to pass along the lovely and enchanting virus that causes AIDS. Of course, before you start to screech, it takes two to be responsible and safe during sexual activity, it takes two to make smart decisions, or dumb ones. But it only takes one to infect. It only takes one. We all need to take ownership of safe sex. It is, or should be, of paramount concern to all of us regardless of serostatus. But, still, the fact remains, that two negatives cannot infect the other. A positive must be in the equation. Sadly, HIV prevention work has sorely overlooked the targeting of positives, for a couple of reasons. One being that, well, once you're positive, there ain't no more prevention happening for you, my dear, and two, the whole issue of stigmatization, demonization, and blaming that might and probably will happen. Well, screw stigma! Target me! Target me and every other positive person on earth -- it's the only way we'll contain this disease, if not end it. I'm tough, I can take it. And ya know, it's not about blame, it's about practicality, it's about facts, however cold and hard they may be. Remember, there is no cure. Remember, the treatments are often worse than the disease itself. Remember, it takes a positive person to infect -- it will take a positive person, it will take positive people, to stop infecting. Stop neglecting us. The Centers for Disease Control and Prevention estimate that close to 900,000 people in the U.S. are HIV positive, and that approximately one-third of that number, 300,000 or so; do not know their status. Mildly put, that's highly problematic. Everybody needs to get their ass in for testing -- for their own health and for the health of others. Studies are proving that people who know their status have more responsible, more safe sex. That means fewer infections. What really disturbs me, however, are the people who do know they're positive and continue to have unsafe sex. Yes, it takes two. But, again, it takes only one to infect. We justify our behavior, saying, "Well, he didn't want to use a condom, he must be poz too." We say, "Well, if he's so stupid, if he's so foolish, let him get it, and let me get mine." We say, "Well, things were moving too fast, and before we knew it . . ." I am talking about gay men, for that is what I am and that is what I know, but I suspect these rationalizations and excuses cut across all sexual boundaries. Where is our compassion, our human compassion for another living being? We would not knowingly run over someone with our car, why would we knowingly participate in sex that would put another person, another living being, at risk for a harrowing, deadly (and totally preventable) disease? There are so many reasons. We need to examine them, closely, and we need to start a dialogue, many dialogues, and keep them going ad nauseum. This brings me to those two nasty words so many of us are afraid of, and indeed, loathe -- morals and ethics. We need to reclaim them from the right-wing horror shows that have bastardized them and made them these big, bad bugaboos. Morals and ethics need not be about hate and judgment, for they are simply about the distinction between right and wrong, about objectively defined principles regarding human conduct -- about doing the right thing, about treating another as you would have them treat you, about being nice to each other in coffee shops, and in the bushes. Hey, being moral doesn't mean being a Sex Nazi or a Good-Time Gestapo. I can have loads of anonymous sex in bathhouses and bushes and truck stops, tons of sweaty, hot, delightful, animal, grunting, heaving, lusty sex, with complete and total strangers, and do so morally and ethically. Yes, I can. How? By protecting the warm body I am enjoying. By protecting the warm body that is mine. I do that by insisting on safer sex. If the person does not want to go along, sorry, no hot sex in the city tonight. But ya know what? It's the right thing to do, the moral, ethical thing to do. What is immoral is the callous disrespect of another. A friend, a gay PWA (person with AIDS) who has worked in prevention for many years in California, says, "Yeah, but fact is that changing community norms happens slowly, over time. Imagine how difficult it would be to reclaim something as tainted as the concepts of 'moral' or 'ethical.' As soon as someone hears it, their first thought is 'judgment' and then they shut down." Yeah, but . . . sounds like a battle I am willing to fight. Editor's Note: There is currently an HIV Stops with Me campaign in Boston and San Francisco primarily for men who have sex with men. However, the pledge campaign is one that is relevant to all, regardless of sexual orientation or gender, "Let's show the world that we've had enough of HIV! If you want to become part of the movement to stop HIV (both within your own body and from spreading to others), take the HIV Stops With Me Pledge: "I pledge to take responsibility for myself and my community by keeping myself healthy and by not transmitting HIV to anyone else." You can also check out http://www.hivstopswithme.org Return to top WHAT IS BRAIN FOG? By Marilyn J. Kerr RN Note: We're hearing from more and more women that they are having trouble remembering things. Something seems to be interfering with the intellectual functioning. These could be symptoms of HCV, HIV, fibromyalgia, chronic fatigue syndrome (CFS) and other viral illness. One woman told us that at her HCV support group, a man with a college education was tested as having an IQ of 80 and that everyone in the support group expressed problems remembering. Referred to as Brain Fog or CRAFT (Can't remember a f'ing thing), it can be highly disturbing. In the article below, the author, Marilyn Kerr, RN, is a person living with CFS. She runs a website for people with CFS/Fibromyalgia at http://www.geocities.com/HotSprings/6028/. In her article "What is Brain Fog?" she provides some insight as to what causes might be and what might be helpful. If you want to know more about what she's tried and what she's found helpful, please refer to her webpage. Also note that there are listservs and on-line chat groups for persons who are experiencing these problems. One of the first things that makes us realize that there is something wrong with us is the inability to perform intellectually like we once did. We seemingly accept the increasing pain, the muscles spasms, the insomnia, but when we keep forgetting our own phone number, red flags go up. We lose things - misplace others - on a route we know, we get lost - we forget where we're going - shopping lists lose their importance because we keep forgetting to bring them - we lose our car in parking lots time and time again - we come home from shopping and realize we bought the exact same things the day before. We forget friends' names. We stop in mid-conversation because we've forgotten what we were talking about. We start using gadgets and date books in order to keep track of our normal daily to-do list. If we handle our own checkbook, we gradually have more and more trouble with it. Even taking a shower is a major effort because we don't remember whether we've rinsed the shampoo out of our hair - we lose the washcloth - we forget whether we rinsed those hard-to-reach areas. What were once functions that we handled without thought, we now have to consciously review before they occur. We laugh about it. We learn to "cover" the errors with laughter. But we're embarrassed and silently start questioning our own sanity. We worry about brain tumors and Alzheimer's because we know the problem is far more extensive than other people are seeing. As Janet, a member said, "I can no longer rely on me!" If we tell our doctor about our problems, we are often easily placated by the doctor's words. "Everybody starts having trouble as they get older." "No, you don't have Alzheimer's - just Fibromyalgia Syndrome", "Oh, you're just depressed." We take comfort from such dismissals. We really don't want to believe that something is really wrong with our brain. So we joke about it with each other - further dismissing its importance. Someone once said, "If it wasn't for brain fog, I wouldn't get any exercise!" But something is wrong. This is not the everyday forgetfulness that everyone experiences from time to time. This is a 24-hour, 7 day-a-week continual struggle to appear and act normally. It's been proven by SPECT and PET scans of the brain. It really IS all in our heads - and it's real. Unfortunately, the full extent of our brain fog may not be known until a moment of clarity. That moment may be as simple as finding your "lost" glasses on the end of your nose, or as complicated as finding out years later that you made a stupid little mistake when you filed your taxes. What part of the brain controls all these things? Most often cited is the right temporal lobe. In plainer English, that's the section in the area of the right temple. Here's what doctors are saying: Dr. M. Yunus: Cerebral blood flow imaging by SPECT (single photon emission computerized tomography) and PET (positron emission tomography), as well as topographic brain mapping with evoked responses using BEAM (brain electrical activity mapping) have been reported to be abnormal in a large majority of patients with CFS, showing a pattern different from normal controls and those with depression. Findings of the above imaging and topographic tests suggest an abnormality of several anatomic regions of the brain in CFS, including the temporal lobe, prefrontal cortex, and limbic structures (hippocampus, amygdala and cyngulate gyrus), perhaps on the basis of neurohormonal dysfunctions. Abnormalities by magnetic resonance imaging (i.e., areas of high signal intensity) have also been described in CFS, but their significance needs to be determined by further controlled studies. Results of SPECT, PET, BEAM or MRI studies specifically in FMS have not been reported, but a good number of patients with CFS who had these tests carried out with abnormal results also had fibromyalgia. Excerpted from "Chronic Fatigue Syndrome and Fibromyalgia Syndrome: Similarities and Differences" by Muhammad B. Yunus, MD, University of Illinois College of Medicine at Peoria, Peoria, Illinois Dr. Samuels: But we're talking about CFIDS or chronic dysfunctional diseases; you can span every physiological system in the body. The SPECT scan on the brain shows flow and function. If the temporal lobes are mismatched, you can be sure there will be trouble with memory, recall and concentration. If the frontal lobes are poorly lit, you will see depression. Excerpted from Dr. Samuels Speaks Dr. Seastrunk: Why does brain injury become a factor years later? CFS is not a psychological illness but is physical with psychological overlays such as stress. Brain dysfunction is associated with abnormal behavior. Dr. Seastrunk developed a questionnaire, called the organic evaluator, for his patients that includes questions involving abnormal olfactory hallucinations (smells and tastes that aren't there); visual distortions (colors, spots, sparkles in outer portion of visual field indicates temporal lobe is injured); oscillopsia (vibration or oscillation of visual field); unable to understand when people are talking to you (left temporal lobe dysfunction); wrong word is used during conversation or go blank in the middle of the sentence; auditory hallucinations (hear noises, clicks, or someone calling your name while the television is on or while taking a shower or using a hair dryer); dizziness (temporal lobe dysfunction); and gastrointestinal dysfunction. 95% of the CFS/MCS patients who take Dr. Seastunk's questionnaire have demonstrable brain pathology. Cognitive dysfunction is a right temporal lobe phenomenon. Multiple mood swings; trouble sleeping are all temporal lobe abnormalities. Temporal lobe is responsible for understanding what we hear, retrieving and restoring our memories even though the patient may feel they have difficulty with their memory. The problem is actually the retrieval of this information. The card catalog is there but the PWC can't find the right word. Not being able to find the word or you forget what you are going to do, or blocking, is a left temporal lobe phenomena. 30% of people with panic disorder have focal brain injury as a cause according to Dr. Seastrunk's tests. Deja Vu, the feeling of having been there before, is a temporal phenomenon. Deja Vu, the feeling of being lost while driving your usual way home, is also a temporal lobe phenomena (the temporal lobe has fired). Migraine or migraine equivalents may also be a result of brain injury. Excerpted from a lecture by Dr. Jay Seastrunk, Psychiatrist- 6/1/97 CFIDS Conference Dr. Goldberg: What is causing the basal-constriction in the cerebral arteries? With a cold you will feel spacey, foggy, tired; yet a cold is a virus that doesn't go to the brain. While fighting the virus, the immune system releases cytokines and neuropolypeptides that shutdown blood flow. This has come out of good conferences in Europe attended by 10 or 11 laureates in the room and is now a well-accepted physiologic explanation. This is a normal process our bodies go through when we have a cold. With CFS, our bodies are doing this all the time inappropriately. Excerpted from a lecture by Dr. Michael Goldberg, MD at the 6/1/97 CFIDS Conference. Dr. Goldstein: CFS patients are prone to overestimate their cognitive abilities. Their making of new memories is extremely fragile and disrupted by proactive interference. They do not benefit from memory cues. The making of new memories is easily disturbed by increasing the amount of information presented. From "Chronic Fatigue Syndromes: The Limbic Hypothesis."Dr. Jay Goldstein, 1993 Why do we get brain fog? What causes it? What part of our disease creates this cognitive dysfunction? The following is a review of some of the major components of it. Leaky Gut Syndrome: "In addition to the creation of food allergies by the leaky gut, the bloodstream is invaded by bacteria, fungi and parasites that, in the healthy state, would not penetrate the protective barrier of the gut. These microbes and their toxins, if present in large enough amounts, can overwhelm the liver's ability to detoxify. This results in symptoms such as confusion, memory loss, brain fog." Dr. Zoltan Rona, Toronto. Immune Dysfunction: "The evidence suggests a reciprocal relationship of the immune and sleep-wake systems. Interference either with the immune system (e.g. by a viral agent or by cytokines such as alpha-interferon or Interleukin 2) or with the sleeping-waking brain system (e.g. by sleep deprivation) has effects on the other system and will be accompanied by the symptoms of the chronic fatigue syndrome." "Fibromyalgia, sleep disorder and chronic fatigue syndrome." 1993 Moldofsky H Viral: "Virally infected patients are more likely to show cognitive impairment and other symptoms of sub-cortical brain dysfunction." Stealth Virus Testing Center for Complex Infectious Diseases HPA axis dysfunction: "His clinical evidence states that the symptoms associated with Persian Gulf illnesses appear to be caused by abnormalities in the hypothalamus portion of the brain, which controls many bodily functions. When the hypothalamus malfunctions patients can experience chronic fatigue, fibromyalgia, peripheral neuropathy, arthritic esthesiopathy, chronic diarrhea and bloating, and respiratory problems. "In terms of Neuropsychiatric phenomena they have memory problems decreased cognitive ability, agitation, compulsive behaviors and obsessive thoughts, vulnerability to mental destabilization and a generally minimal stress tolerance. In my own experience they have subtle but consistent neurological problems like clumsiness, visual disturbance and attention difficulties." "Persian Gulf Illness: Is It All Just 'In Their Heads?' New Report Shows Evidence of Brainstem Encephalitis In Gulf War Veterans" William E. Baumzweiger, M.D. "SPECT scans show anterolateral and dorsolateral hypoperfusion, the right hemisphere worse than the left. The right hemisphere deals mostly with novel situations and uses norepinephrine. Norepinephrine is crucial to cognitive novelty. The left hemisphere deals mostly with repetitive, well-routined, pre-learned activities and uses mainly dopamine. Dopamine is critical to cognitive routinization. Flu-like illnesses are known to deplete brain nor- epinephrine. Regional cerebral blood flow is consistently found to decrease after exercise or any activity that makes the patient worse, for example doing calculations. PET scans show activation of the dorsolateral prefrontal cortex along with decreased regional cerebral blood flow to the left angular gyrus, part of the neural network involved with tasks that require "willed action". Hypoperfusion and malfunctioning of the inferior parietal cortex leads to inappropriate sensations, behavior and emotions." "Betrayal By The Brain: The Neurological Basis of CFS, Fibromyalgia Syndrome and Related Neural Network Disorders." Dr. Jay Goldstein. So what do you do? Perhaps you're still working and notice you are unable to even grasp the simplest part of those new forms you have to use. Perhaps people are noticing that glazed-over look you have as you struggle to understand a new instruction. Maybe you've overdrawn your checking account again - despite superhuman efforts on your part to prevent it. Maybe you're watching the Weather Channel because it's the only channel that makes sense. You're forgetting to take the garbage out. The list is endless on how this cognitive dysfunction can affect your life. Your personality is changing. You're no longer as spontaneous as you used to be because everything coming into your brain has to be sifted for importance - for nuances you used to catch easily. You're struggling to react appropriately to everyday situations - and it's a constant effort that adds to stress. The good news is that Brain fog is reversible, or, at least, the progression can be halted with medications. There are anecdotal messages on the lists on various herbs and medications that have helped. Co-enzyme Q10 150mg a day seems to help many people, including myself. Gingko Biloba has adherents. Dr. Lapp says low dose Ritalin seems to jump-start the brain (and I find that to be true). NADH helps some people. Neurontin may help with lessening of brain fog. Because our brain fog is under-diagnosed by our local doctors, there's very little research on treating it - especially in FMS. However, please don't feel that there isn't something that can't be done. I can vouch for that. The medications listed above do help, and are worthy of you and your doctor discussing the issue. Return to top GENERAL & HIV/HCV UPDATES WOMEN ACCOUNT FOR INCREASING NUMBER OF AIDS CASES While women represented about 1 in 20 AIDS cases in the US in 1986, they now represent almost 1 in 5 cases of the disease, according to a report published in the March 7th issue of The Journal of the American Medical Association. Dr. Shannon L. Hader and colleagues from the CDC, report that women accounted for 6.7% of all AIDS cases in 1986, but this percentage grew to 18% by 1999. Of the new cases of AIDS reported in US women in 1998, 41% occurred in southern states, 61% of cases occurred in blacks, and 38% were from heterosexual transmission of HIV. Many women did not identify or report a known risk factor for HIV infection. It is thought that half or more of these women were infected through heterosexual contact. ``In general, rates of HIV-associated illness are similar in women and men,'' the researchers report. However, women seem to be less likely than men to be taking antiretroviral drugs, possibly because HIV-infected women may have other problems, including drug use and depression. Hader and colleagues believe that continued HIV research is needed. But, they add, ``emphasis should also be placed on applying existing knowledge about HIV prevention and treatment in women by enhancing use of available health services and including greater use of antiretroviral therapy options, treating depression and drug use, facilitating educational efforts, and providing social support to reduce competing needs that prevent women from taking control of HIV prevention and treatment.'' 2001; 285:1186. EIGHTH ANNUAL CONFERENCE ON RETROVIRUSES AND OPPORTUNISTIC INFECTIONS Among the findings presented at this February conference was the fact that an increasing number of persons, newly diagnosed with HIV, have a drug resistant strain of the virus. More evidence was presented on different strains of HIV being transmitted between persons that were already infected. If you are HIV + and engage in un- protected sex, or share needles with someone you can pick up another strain of the virus, as well as another sexually transmitted disease. The conference also had papers on HCV transmission among men who have sex for men (MSM). While the incidence of sexual transmission of HCV is still being questioned, data presented indicates that sexual practices, such as fisting and anal intercourse, can transmit HCV. STUDIES LOOK AT INTERRUPTION IN TAKING MEDS: Martin Markowitz studied 15 newly infected subjects who stopped taking their medications on their own and found that only three patients were able to keep their virus at low levels, while the others experienced declines in CD4 cell counts and saw declines in immune system improvements that the therapy had helped them attain. Meanwhile, Dr. Bruce Walker, found that after just one instance of stopping therapy, four of 14 patients were able to keep their virus under control. Walker also reported that with more cycles on and off therapy, more patients were able to control HIV, and after a second treatment interruption, patients were able to control the virus for longer periods of time--an average of six months after the second interruption, versus just one month after the first time they interrupted their AIDS treatments. CYCLING AIDS DRUGS ON AND OFF APPEARS TO DO NO HARM: A study of 10 patients suggests that it may be possible for some HIV-positive patients to cycle their drug therapies on and off with few or no negative effects. Although the study is small, Dr. Anthony S. Fauci noted, "This is a big deal to people. These people are positively inclined to being off-drug 50 percent of the time." Fauci initiated the study with the hopes that HIV patients could be weaned off the drug therapies for extended periods of time. A study of 24 patients who had a two-months on, one-month-off treatment cycle found that in most patients, the virus rebounded during the non-treatment month. In a companion experiment that had cycles of seven days on and seven days off, the virus remained fully suppressed during the off weeks. However, HIV was detected in the bloodstreams of two patients soon after they failed to restart their treatments. DRUGS CUT MOTHER TO CHILD HIV TRANSMISSION: Dr. Alexjandro Dorenabum reported a dramatic drop in U.S. mother-to-infant HIV transmissions as the result of antiretroviral drug use. Findings from the Pediatric AIDS Clinical Trials Group 316 indicate that with antiretroviral drugs, the transmission rate has dropped to about 1.5 percent. The researchers followed over 1,500 pregnant women and found that of the 17 HIV-infected infants born during the study, nine tested positive for HIV at birth, suggesting that transmission took place before delivery. It was also noted that the addition of nevirapine to the pregnant women's drug therapies did not decrease transmission rates any more than a placebo. ONCE DAILY INDINAVIR/RITONAVIR SUPPRESSES HIV, INCREASES CD4: A combination of the protease inhibitors, indinavir and ritonavir, as once daily treatment was as successful as standard indinavir treatment on reducing viral load of HIV-infected patients. Dr. Saah reported the preliminary results of a 48-week study of the use of the combination to simplify treatment regimens. "We are still in a dose finding phase of the study. " He reported the 24-week data of the open label, phase II study in which 1,200 mg of indinavir and 200 mg of ritonavir were given to patients once a day. They also received stavudine and lamivudine twice a day. About 87.5 percent of the patients achieved an undetectable viral load by week 24. SOLID ORGAN TRANSPLATION IN HIV DISEASE: HIV-infected patients with end-stage kidney or liver disease who meet standard transplant criteria, have an undetectable plasma HIV-1 RNA level for 3 months, a CD4+T-cell count of >200 cells/mL (kidneys) or >100 cells/mL (livers) for 6 months, and no history of opportunistic infection/neoplasm (OIs) are eligible. 5 patients have received 2 livers (hepatitis C [HCV]) and 5 kidneys (hypertension, diabetes, HIV-associated nephropathy). Median baseline CD4+T-cell count = 510. All are alive at a median of 138 days (62-216). HCV infection recurred rapidly in the liver patient, who required re-transplantation and a kidney. There have been no opportunistic infections. 2 cases of kidney rejection occurred, one requiring tacrolimus/steroid therapy. Diabetes mellitus developed in this patient. Viral loads have remained undetectable in all patients on therapy and have remained low when therapy was held for intolerance (>3 months) or delayed graft function (2 weeks). CD4+T-cell counts fell to a mean of 314 cells/mL and are now at a median of 102 cells/mL below baseline. Mild anal atypia due to HPV infection developed at week 4 in 1 patient with a normal baseline. Cyclosporine doses have been low in those on PIs and typical in those on NNRTIs. PI/NNRTI levels have been affected but remain within adequate ranges. There has been no evidence of impaired graft function or HIV clinical, virologic or significant immunologic disease progression. These initial findings have prompted the creation of a multi-site study that will more definitively address safety and efficacy in the context of a growing need and limited resources. AIDS COMPLICATION BELIEVED DUE TO LONG USE OF DRUGS: Prolonged use of anti-AIDS cocktails, and not a single drug, probably caused patients to develop unusual fat deposits on the upper back. Lipodystrophy is a distressing side effect of the anti-AIDS cocktail. It causes so-called ``buffalo humps'' on the upper back and potbellies, referred to as protease paunch. The research by Dr. Esteban Martinez shows lipodystrophy increases with age, sex and use of a mixture of anti-AIDS drugs. ``Our study suggests that the risk of lipodystrophy is mainly related to the total exposure to HAART (highly active antiretroviral therapy) and only to a lesser degree to specific antiretroviral drugs.'' Martinez and his colleagues studied nearly 500 HIV patients who started HAART, consisting of two nucleoside reverse transcriptase inhibitors and at least one protease inhibitor. 17% of the patients developed some type of lipodystrophy over 18 months. Women had a higher risk of getting the condition than men, and homosexuals and heterosexuals were also more prone to suffer from it than intravenous drug users. NO ADVERSE EFFECTS SEEN IN INFANTS AFTER SHORT COURSE AZT: New research reveals that after 18 months, short-course zidovudine treatment administered during late pregnancy appears to have no significant side effects on infants born to HIV-positive women. Dr. J. Simonds of the Centers for Disease Control and Prevention and colleagues with the Bangkok Collaborative Perinatal HIV Transmission Study Group studied the outcomes of children born to 393 HIV+ women. The pregnant women were randomized to receive a treatment regimen of either zidovudine or a placebo starting at 36 weeks of pregnancy, and 55 of the 395 children born were infected with HIV. There were no major adverse reactions related to the short-course zidovudine therapy, although it remains unknown whether adverse events will develop as use of the regimen becomes more widespread or after several years of follow-up. ROLE OF HGV IN PATIENTS WITH HIV AND HEPATITIS 38 adult patients with HIV and chronic HBV coinfections as well as 61 adult patients with chronic HBV infection without HIV infection were studied. Patients co-infected with HCV were excluded from the study. HGV infection was documented in 21 out of 38 patients (55.3%) with HIV and chronic HBV coinfection (group 1), which was significantly higher (p < 0.001) than in those with HBV infection alone (9 out of 61 patients, 14.8%) (group 2). Presence of HGV RNA was associated with milder HIV status (higher CD4+cell count) and more severe HBV status (higher ALT level). HCV VIREMIA AT DELIVERY A RISK FACTOR FOR TRANSMISSION: The risk of mother-to-infant transmission of the hepatitis C virus (HCV) is associated with the presence of maternal HCV viremia at delivery and a high maternal viral load, according to a report in the Jan. issue of the Pediatric Infectious Disease Journal. DAILY INTERFERON ALFACON-1 PLUS RIBAVIRIN APPEARS PROMISING: An accelerated, daily regimen of interferon alfacon-1 (Infergen, Amgen) plus treatment with a standard, widely used antiviral agent is a promising treatment option for patients infected with the hepatitis C virus (HCV. The new approach uses daily, or "induction," interferon dosing instead of the standard three-times-weekly regimen. It also relies on the antiviral drug ribavirin to help keep the virus away once it has been largely eliminated. Daily dosing is thought to increase the effectiveness of interferons, which modulate the body's immune responses. Earlier research on interferon alfacon-1 had suggested that daily 9 mcg or 15 mcg doses may be more effective against HCV infection, but also as safe and well tolerated as the conventional regimen of 9 mcg three times per week. A separate group of studies indicated that the addition of ribavirin to a different form of interferon (interferon alfa2b) might eliminate HCV from the bloodstream more effectively than interferon alone. Whether the combination regimen produces a sustained response will have to await completion of the 48-week data analysis. Daily combination therapy appears about as safe as interferon alfacon-1 alone and may prove to be a promising treatment option for patients with HCV infection. VALUE OF LIVER BIOPSY IN CHRONIC HCV CONFIRMED: According to researchers, data indicates that a liver biopsy is necessary in the majority of HCV patients to establish the stage of liver disease, the prognosis and the appropriate management for that condition. This data may be important in the struggle to establish the standard of care for the evaluation and treatment of hepatitis C. In this study, the researchers reviewed the records of 126 Hep C+. The researchers found that most patients required a biopsy, since less invasive assessments or markers to detect the level of disease activity and to establish the stage of the liver disease, including the presence or absence of fibrosis or inflammation, were not predictive of findings on biopsy. Some patients can avoid biopsy if they have a high cirrhosis discriminant score. The cirrhosis discriminant score employed in this study established a score based upon three blood tests, the patients platelet count, alanine transaminase (ALT) and aspartate transaminases (AST) ratio, and international normalized ratio of the prothrombin time (INR). This score has been found to be highly accurate at predicting a finding of cirrhosis on liver biopsy. The researchers also found that other potential diagnoses were less common than suspected and that none of the other diagnoses made on liver biopsy would have significantly affected treatment options. The researchers concluded that liver biopsy is safe. Of the 126 biopsies performed, and the most frequent complication was mild pain in the area of the biopsy site. Return to top