Faculty Bibliography

A Cuban government health official said the week of Jun 27, 1993 that the mysterious epidemic that has afflicted more than 46,000 people has apparently peaked. However, the cause of the disease, which impairs vision and damages nerves, continues to baffle international scientists

Researchers throughout the world now recognize the desperate need for new drugs and they are pursuing a number of leads. But until such drugs are found, health officials are left with prevention as the best line of defense against HIV. The two most effective barriers are preventing other sexually transmitted diseases, like gonorrhea, syphilis and chancroid, which promote acquiring HIV, and impeding the spread of HIV among drug abusers. Making headway on these measures, both of which are politically fraught, is among the many challenges that Kristine Gebbie faces in becoming Washington's long-awaited AIDS czar. Elsewhere in the world AIDS is hitting hardest in Africa and Asia, where the overwhelming majority of HIV infections are spread through heterosexual sex. Yet throughout the world political leaders have largely ignored pleas from medical leaders to increase financing for treating and preventing sexually transmitted diseases. Swedish health officials have reduced the incidence of sexually transmitted diseases to among the lowest in the world, and a dividend has been a very low incidence of HIV infection. Experts say that among the reasons AIDS therapy is bleaker than predicted is that they have been hampered by too many variables in evaluating studies of AZT and its pharmacological cousins, ddI and ddC. The studies often have different criteria for entry, test different amounts of drug for people at different stages of HIV infection and AIDS, vary in the length of followup of volunteers, and set different criteria for stopping the trials. 'All the studies are right, and the problem is how to put all the pieces together into a clear picture,' which is impossible 'because all the pieces do not exist,' said Dr. Douglas Richman, an infectious disease expert at the University of California at San Diego

In a report being published Wednesday, researchers in New York City said that thalidomide could block the growth of HIV, the virus that causes AIDS, in test tubes and, in very limited tests of humans, seemed to relieve some of the severe symptoms of AIDS. Dr. [Gilla Kaplan]'s team is now testing thalidomide in more rigorously controlled studies in larger, but still small groups. And federally financed scientists elsewhere are testing thalidomide for the kind of mouth ulcers that often develop in AIDS, [Anthony S. Fauci] said. The report about thalidomide comes in the wake of bleak news about AZT's effectiveness in treating HIV. Thalidomide is one of about 400 substances that scientists are studying for their ability to thwart HIV, health officials said. The research on thalidomide is also part of a new approach that scientists are exploring to modify the body's immune system

The sedative thalidomide, which was found to cause severe birth defects in the early 1960s, is now being explored for use in treating AIDS, tuberculosis and other disorders. In a report in the Jul 1, 1993 issue of Proceedings of the National Academy of Sciences, researchers said that thalidomide could block the growth of HIV in test tubes and appears to relieve some of the severe symptoms of AIDS

In a report published yesterday, researchers said thalidomide could block the growth of HIV, the virus that causes AIDS, in test tubes and, in very limited tests of humans, seemed to relieve some of the severe symptoms of AIDS. [Gilla Kaplan]'s team is now testing thalidomide in more rigorously controlled studies in larger, but still small groups. And federally financed scientists elsewhere are testing thalidomide for the kind of mouth ulcers that often develop in AIDS, [Anthony S. Fauci] said

Researchers throughout the world now recognize the desperate need for new drugs and they are pursuing a number of leads. But until such drugs are found, health officials are left with prevention as the best line of defense against H.I.V. The two most effective barriers are preventing other sexually transmitted diseases, like gonorrhea, syphilis and chancroid, which greatly increase the risk of acquiring H.I.V., and impeding the spread of H.I.V. among drug abusers. Making headway on these measures, both of which are politically fraught, is among the many challenges that Kristine M. Gebbie faces in becoming Washington's long-awaited AIDS czar. In issuing preliminary new guidelines last weekend, Dr. [Merle A. Sande]'s panel said that AZT remains the first-line drug against H.I.V. But in a major shift from recommendations set by a similar panel in 1990, the new ones say that treatment with AZT is no longer necessarily recommended for early H.I.V. infection, long before symptoms from full-fledged AIDS develop. To doctors accustomed to curing most infectious diseases with antibiotics, progress seems slow. Antibiotics usually work only if the patient has strong immune defenses, and H.I.V. severely damages the immune system. In addition, they caution, H.I.V. is a viral disease, and few drugs are effective against viral infections that, like H.I.V., affect the entire body

[Merle A. Sande] also said that his panel's proposals are likely to lead to a reduction in the number of HIV-infected people who take AZT. Federal health officials have estimated that one million Americans are infected with HIV. Sande said his panel was not told how many people are now taking AZT. For symptomless HIV-infected patients with CD-4 counts above 300 whose condition appears stable and who are now taking AZT, the panel said that therapy should continue. However, Sande said that from the recommendations, stopping AZT for such people would be a medically sound and logical conclusion. For those who experience progression of AIDS despite AZT therapy, the panel recommended switching from AZT to ddI, a drug made by Bristol-Myers Squibb. The panel also cautiously supported use of more than one anti-HIV drug, either in combination or in sequence

In an interview, Dr. [Merle A. Sande] also said that his panel's proposals were likely to lead to a reduction in the number of H.I.V.-infected people who take AZT. One million Americans are infected with H.I.V., Federal officials say. The panel did not know how many people were now taking AZT, Dr. Sande said. For H.I.V.-infected patients who exhibit no symptoms, have CD-4 counts above 300 and appear to be in stable condition, and who are now taking AZT, the panel recommends that the therapy continue. But Dr. Sande said stopping AZT for such people would also be a medically sound decision. Dangers of Stopping Unknown For those who with progressive AIDS symptoms despite AZT therapy, the panel recommended switching from AZT to ddI, a pharmacological cousin made by Bristol-Myers Squibb. The panel also cautiously supported the use of more than one anti-H.I.V. drug, either in combination or in sequence, although it said the benefits were not proven. The recommendations also say treatment with AZT, ddI and ddC, a drug made by Hoffmann-La Roche, can be stopped if the drugs are not effective or are too toxic

The new guidelines emphasize that patients and doctors should decide together about when and how to treat HIV by focusing on the patient's views about drug therapy, personal health and other factors that vary in each case. The guidelines recognize that individuals respond to AZT differently, and that before starting AZT therapy in each case there should be a full discussion of its benefits and risks, such as bleeding and anemia. [Merle A. Sande] also said his panel's proposals are likely to lead to a reduction in the number of HIV-infected people who take AZT. Federal health officials have estimated that 1 million Americans are infected with HIV. Sande said his panel was not told how many people are now taking AZT. The panel said therapy should continue for symptomless HIV-infected patients now taking AZT whose CD-4 counts are above 300 and whose condition appears stable. However, Sande said stopping AZT for such people would be a medically sound and logical conclusion based on the recommendations

[Merle A. Sande] also said his panel's proposals are likely to lead to a reduction in the number of HIV-infected people who take AZT. Federal health officials have estimated that 1 million Americans are infected with HIV. Sande said his panel was not told how many people are taking AZT. For symptomless HIV-infected patients with CD-4 counts above 300 whose condition appears stable and who are now taking AZT, the panel said therapy should continue. Sande said stopping AZT for such people would be a medically sound and logical conclusion from the recommendations. For those who experience progression of AIDS despite AZT therapy, the panel recommended switching from AZT to ddI, a drug made by Bristol-Myers Squibb. The panel also cautiously supported use of more than one anti-HIV drug, either in combination or in sequence