Faculty Bibliography

The new guidelines, written by a federal panel and due to be announced on Monday, represent a major philosophical shift in treating H.I.V., the AIDS virus. The aggressive approach to treating H.I.V. was adopted shortly after protease inhibitor drugs were marketed and then combined with older drugs in 1996. These drug cocktails, which suppress the amount of H.I.V. in the blood beyond levels that tests could detect, led to substantial responses, with many AIDS patients getting off their deathbeds or going back to work. And many experts advocated early treatment for healthy infected people to prevent damage to the immune system. A second change relates to the H.I.V. blood level as measured by two tests. The panel urged delaying therapy until the H.I.V. level exceeds 30,000 per milliliter in the so-called branched DNA test (instead of the previously recommended 10,000) and 55,000 in the so-called Polymerase Chain Reaction test (instead of 20,000)

The aggressive approach to treating HIV was adopted shortly after protease inhibitor drugs were marketed and then combined with older drugs in 1996. These drug cocktails, which suppress the amount of HIV in the blood beyond levels that tests could detect, led to substantial responses, with many AIDS patients getting off their deathbeds or going back to work. And many experts advocated early treatment for healthy infected people to prevent damage to the immune system. Studies show that the drug cocktails do not cure HIV, and when infected people stop therapy, the virus rebounds, making lifetime therapy necessary. A second change relates to the HIV blood level as measured by two tests. The panel urged delaying therapy until the HIV level exceeds 30,000 per milliliter in the branched DNA test (instead of the previously recommended 10,000) and 55,000 in the Polymerase Chain Reaction test (instead of 20,000)

The aggressive approach to treating HIV was adopted shortly after protease inhibitor drugs were marketed and then combined with older drugs in 1996. These drug cocktails, which suppress the amount of HIV in the blood beyond levels that tests can detect, led to substantial improvement, with many AIDS patients getting off their deathbeds or going back to work. Studies show that the drug cocktails do not cure HIV, and when infected people stop therapy, the virus rebounds, making lifetime therapy necessary. More recently, concern has grown over nerve damage, weakened bones, unusual accumulations of fat in the neck and abdomen, diabetes and a number of other serious side effects of therapy. Many people have developed dangerously high levels of cholesterol and other lipids in the blood, raising concern that HIV-infected people might face another epidemic - of heart disease

The panel, convened by the Department of Health and Human Services and the Henry J. Kaiser Family Foundation, still recommends therapy for anyone who develops symptoms of AIDS. Therapy should also be given to people whose blood tests show they have been infected for less than six months, in the belief that early treatment might strengthen the immune system's ability to fight the virus, the panel says. The aggressive approach to treating HIV was adopted shortly after protease inhibitor drugs were marketed and then combined with older drugs in 1996. These drug cocktails, which suppress the amount of HIV in the blood beyond levels that tests could detect, led to substantial responses, with many AIDS patients getting off their deathbeds or going back to work. And many experts advocated early treatment for healthy infected peopleto prevent damage to the immune system

AIDS has orphaned 12 million children in Africa, nearly triple the number of political refugees and displaced persons there, and millions more are expected to be orphaned in coming years, a leading epidemiologist told the opening session of an AIDS meeting here tonight. That is impossible for most orphans. With 25 million Africans infected with H.I.V., the AIDS virus, family members who traditionally would have taken in an orphaned relative are themselves too sick, already care for too many other children of their own and for orphans, or have died from AIDS. Street children roam many communities, increasing the threat of crime and political instability, Dr. [Kevin DeCock] said. The enormousness of the African AIDS orphan problem derives from the fact that even more African women than men are infected with H.I.V. Elsewhere, more men than women have AIDS because transmission is primarily by high-risk groups like gay men and injecting drug users

The gene is called p53. Since Dr. [Arnold J. Levine] co-discovered it in 1979 with a British researcher, Dr. David Lane of the University of Dundee, a mutated form of p53 has been identified in about 55 percent of human cancers, including most major ones. ''The p53 gene is the single most commonly mutated gene in cancers of humans,'' Dr. Levine, 61, said at a news conference at the New York Academy of Sciences in Manhattan. Dr. Lane, asked for comment, congratulated Dr. Levine, his friend, for winning the award, but said ''it is clearly a matter of historic record'' that his paper describing the p53 gene was published before Dr. Levine's. Dr. Lane said, ''It would be inappropriate for the prize to be awarded for the discovery of the p53 protein,'' but ''entirely appropriate'' for any other chosen criteria

Potentially, Dr. [Salim Yusuf] said, the drug might benefit many patients who are not now taking it. If every American who needed it received it, 50,000 to 100,000 of them might potentially escape heart attacks and strokes, and the lives of 5,000 to 10,000 might be saved each year, said Dr. Yusuf, who directs the division of cardiology at McMaster University. The drug costs $2 to $3 a day. In the syndrome, not enough blood can flow to nourish the heart because the coronary arteries are blocked by fatty deposits from the underlying condition, atherosclerosis. A heart attack can result unless urgent therapy is given. In the United States, people experience about 1.5 million episodes of acute coronary syndrome a year, Dr. Yusuf said. Dr. Yusuf's study, the largest and longest of acute coronary syndrome, involved more than 12,500 patients in 428 hospitals in 28 countries. Half the participants received standard therapy, which includes aspirin; the other half received standard therapy plus one clopidogrel pill a day

Potentially, [Salim Yusuf] said, the drug may benefit a great many Americans who are not taking it. If every American patient who needed it received it, 50,000 to 100,000 of them might potentially escape heart attacks and strokes, and the lives of 5,000 to 10,000 might be saved each year, said Yusuf, director of cardiology at McMaster University

Scientists have long searched for another Aspirin in hopes of improving treatment for heart disease and other conditions. But several drugs that were initially touted as a 'super Aspirin' failed in rigorous studies. Dr. Christopher P. Cannon, a cardiologist at the Brigham and Women's Hospital in Boston, said clopidogrel is 'the best news since Aspirin -- this is really a super Aspirin that lives up to its name.' Dr. [Valentin Fuster] said that clopidogrel was not a miracle drug but one like Aspirin and others that collectively have had a significant effect in improving heart disease care

Dr. [Jonathan S. Reiner], who has taken the one-day training course for the gamma radiation technique, said he would have transferred Mr. [Dick Cheney] to a nearby hospital that offered such treatment if he believed his patient needed it. Many cardiologists not connected with the case have said that by not being irradiated, Mr. Cheney is being subjected to a higher possibility of another angioplasty and hospital stay. But the critics did not say that Mr. Cheney received bad medical care; most said the decision was a tossup in his type of blocked stent. Mr. Cheney could still get the radiation, if needed. After Mr. Cheney, 60, complained to him about ''a little chest burning'' on March 5, Dr. Reiner said he told his patient to go to [George Washington]. There, the doctor inserted a tube into an artery in Mr. Cheney's thigh, threaded it into the coronary arteries surrounding his heart, and took angiogram X-rays that found one end of the stent was nearly blocked in the diagonal artery, which was three millimeters in diameter Using an ultrasound device, Dr. Reiner then examined the blocked stent and said he ''was encouraged'' to find that the affected area was short (one to two millimeters in length) and limited to a specific point in the stent that otherwise was clear. At a news conference just after completing the procedure on March 5, Dr. Reiner said that Mr. Cheney had at least a 40 percent chance of needing another angioplasty within six months because of a second restenosis. But Dr. Reiner said that on Friday a researcher told him that he would soon report a study that showed a 20 percent restenosis rate for Mr. Cheney's type of problem