[Music]
Good afternoon once again and thank you for
staying with us. We've gotten to the point in
our discussion where all the presenters have joined us for
further live discussion. Uh We'll be taking your phone
calls on the on any questions you have about AIDS,
what you've heard so far. Questions about specific
problems, issues, questions that have come up in
your mind. The number is their on screen.
We'll leave it up during the entire presentation. It's
1-800-222-9703. Briefly we had made reference in
our first presentation to several uh works that are involved
with AIDS. We want to get those up on
the screen once again for you to write down.
If you didn't get a chance to get them that
first time, we'll see if we get those up
in just a second references that were made. The
monthly AIDS surveillance report at the Centers for Disease Control
in Atlanta Georgia. That's where you can write for
that. Also the WHO report which was also referred
to the guidelines on sterilization and disinfection methods against HIV.
That's where to write to it. WHO 20
Ave Appia. Excuse me. I can't read that too well.
1211 in Geneva 27 in Switzerland. Give you
a second on that. And also the research on
survival of HIV outside the body that from the Journal
of the American Medical Association JAMA for short. Uh
And there are the specific references volume 255 the
page numbers and when it was published April 11th 1986.
And if you have any further questions about that,
if you can't find that in your materials,
you can always call the Tech campus and we'll we'll
come up with those for you in reference to
the teleconference. We have with us, as I said,
the earlier presenters. And let me introduce them
to you now, beginning with Steve Shepherd, who
is the regional AIDS coordinator for the Virginia State Health
Department. Moving on next we have Janet Taper Virginia
Tech extension nutrition specialist. Richard Keeling is the president
of the American College Health Association. We talked with
him earlier live. Next is Joyce Clark, a
lecturer in biochemistry at Virginia Tech, one of the
first presenters in our program next to his doctor Charles
Schleupner, ahead of the infectious disease folks at the
Veterans Administration Hospital in Salem and an associate professor of
medicine at UVA. And finally,
Tom Sitz, Associate professor of biochemistry at Virginia Tech.
Again, we'll be taking your questions, we'll
have that number up on the screen. It's an
800 number so there is no charge. Please call
us with your specific questions. Let me, however,
begin things with uh maybe some of the questions
that have come up in people's minds that maybe we
haven't answered to your satisfaction yet. And Dr. Schleupner
Schleupner, let me start with you um about the
the outlook. Why is the outlook for the vaccine
a vaccine development so poor? Why why don't we
have a miracle cure for this? Perhaps better stated
calling be questionable at this point certainly. Um we
have assumed a couple of things in the production of
the current vaccine trials. First of all, we
presume that I think is Dr. Clark mentioned in her
discussion that the G. P. 120 the
surface glycoprotein is the important protein against which antibody should
be made. And many of the vaccines that are
being tested involve that surface like a protein. Uh
we also know and I think she also mentioned in
her discussion that there is a variability from patient to
patient in terms of the surface lack of protein that
is produced in viruses that multiply and given person,
uh, they take on the surface characteristics to a
small extent at least of the individual and whom they
are produced. At least that is the interpretation
when we find that the antigenicity, the or
the, the way the body sees this virus after
it's produced in one given individual may look a little
different than the virus produced in another given individual.
So in attempting to produce a vaccine against the glycoprotein
harvested from a given virus strain, it may or
may not be protected to start with. In other
words, that may or may not be the important
component of the virus that would render the person immune.
And additionally, there may be sufficient variation that
it may not be totally protected. So that is
one perspective, at least for why these vaccines may
be difficult to produce. And one other perspective is
that the clinical trials that are ongoing are going first
of all, to need to involve thousands of patients.
One cannot obviously expose these patients to HIV deliberately
to test the efficacy of the vaccine. So we're
going to have to rely upon large numbers of individuals
who have been immunized and who of their own volition
or by accident become exposed through clinical encounters, personal
encounters. So it's it's going to involve some time
in order to determine efficacy if indeed we're on the
right track to start with. Okay, Dr. Sitz, you had
comment? It's also been some studies with chimpanzees
where they've injected a common in glycoprotein 1 0 and
the chimpanzees did develop antibody tigers. But when they
were challenged with HIV, they found out this actually
enhanced infectivity the chimpanzee and probably because of the uptake
uh of the virus by the macrophage. The antibiotics
were buying to the HIV and a macrophage will come
along and take it up. We now know the
macrophages very central to the early development of disease in
humans. This has put quite a question mark on
somebody's prototype vaccines. Okay, we do have questions
coming in. Let's go to our first phone caller.
Go ahead please. Hi, this is Connie
Bill from Peter Virginia and we'd like to know what
is the position of the Virginia Department of Health in
terms of reporting HIV positivity and is it going to
be planned to mandate information to be reported? Thank
you. Shepherd, I guess you get that one.
Well currently HIV is not reportable. The law
has changed I believe. I have not read the
law uh and I don't want to comment on it
until I do, but after it's passed and I
get it, I believe that well Dr. Keeling has
worked on that. The committee that made those recommendations
about the reporting and I'll defer to him. Okay
Dr Keeling. The legislation as enacted requires that
physicians who care for people with positive tests, report
the identity of those people with positive tests that would
go into effect July one of this year. Uh
That was probably the most controversial single piece of the
deliberations of the Special Legislative Study Commission on AIDS that
the General Assembly established and was one of the few
recommendations in which there was significant split in the opinion.
There are serious opinions that requiring name reporting will
deter people from being tested. We'll have to work
wait and see if that's how it works out.
Okay. I thought there was some physician option there.
Currently there is physician option. The current law
says that physicians may report based on their assessment of
individual situation as the law is rewritten, it now
says physicians, that's a complete the governor has not
yet signed. That law has, Governor has not
signed. So that's true. We haven't gotten around
to the sayings yet that that will be somewhat offset
by the, uh, addition of sites where anonymous
testing can be done. So the anonymous test sites
will not have to report because they can't report name.
It's very likely that we'll see an increase in
people going to anonymous test sites if that law really
is signed by the governor. Because that's going,
we know from our experience in Roanoke City at the
health department that when we didn't have anonymous testing there,
we had very few people coming in to be
evaluated. And as soon as we went to totally
anonymous testing, no name, no number nothing.
The numbers quadrupled at least. Okay, that's a
good point. We do have another question coming in
on a phone call, phone caller. Go ahead
please. I'm calling from south boston Virginia. We
have a question. It's your handout materials on AIDS
101 on page C23 of that material. In the
second paragraph it states the virus can only live for
2-3 minutes. But then in the teleconference we heard
different views about how long the virus can survive.
Uh which is correct. We heard something like 15
days maybe at room temperature straight of course the presentation
doctor doctor to tell you that we especially put that
into teleconference because we feel there's been a lot of
misinformation given about the survival of the virus, particularly
the statements that will explode and it's very fragile that
we looked in the literature and that's what we came
up with that particular test, which of course was
for a health care or actually a scientific setting where
they were using very, very high titus. Uh
you wouldn't expect the virus to dry out in a
few minutes because of this lipid membrane. So intuitively
you would say that was incorrect. So I would
tend to have more confidence with the published data In
the German publication in 1986. So the three different
examples that were given, you feel are more days
at room temperature, acres solution and As a dry
solution, it was three days again there they were
using very, very high concentrations much higher than you
find in a person's blood. That really is an
important point Paul. Because the concentrations in that particular
paper that were utilized were probably 10,000 fold above at
a minimum guesstimate at least. And it is a
guesstimate. I admit that above what we find in
the blood or what we estimate is in the bloodstream
. And when you talk about there being residual virus
that is still potentially infectious uh after X number of
days, when you put so much of it out
, You can still make a comment that 99,
of it wasn't activated by that time too. So
you have to put that in perspective vis a vis
the small concentrations very small in saliva, which is
the only body fluid likely to contaminate surfaces in the
general environment. Uh blood is not going to be
a common contaminant and hopefully in the health care setting
, at least when it is a contaminant, it'll
be adequately disaffected. I'd like to add a contaminant
in the common environment. Also be semen. My
people have intercourse seem is not always spilt in the
vagina. It's often still on the skin. But
another important point is that this is clean able,
as far as bleaches and common detergents will take care
of that sort of thing. We do have another
phone call. Go ahead, please. Yes,
this is sort of a theoretical question. Uh,
the most of the people who have been speaking have
been speaking about state schools or public schools. Our
question has to do with what about the religiously oriented
schools who maybe have a little more difficulty confronting some
of those issues? What kinds of things would you
tell us to do to get to our boards and
some of our our campus leaders? Why should they
have feel, pardon me, a more difficult time
dealing with those issues? I don't understand that.
Sometimes religious orientation prohibits certain people from talking specifically about
condoms or advocating what we know is necessary, safe
sex. Well, I have given a number of
talks in religious settings, in the presence of various
ministers and priests who readily would agree with your comment
. One can certainly not advocate promiscuity, extramarital sex
, whatever you turn one wants to use from a
religious standpoint. But I think the most sage comment
that I've ever heard is if you're going to make
a choice to have an extramarital or or adulterous relationship
, whatever term one wants to use from a religious
standpoint, then please use a condom. And that
is just sound advice. And I think anyone who
is concerned about another individual uh, can make that
comment without regard to religious background, Doctor Killing.
As president of the Association that deals with all sorts
of colleges, you must have some thoughts about this
. Yeah, I do. I think that we
have to recognize that there are varieties of human experience
, varieties of human educational institutions. The variety of
transmission of HIV though is not great. And what
happens to people on religious campus is the same thing
is what happens to people on a secular campus.
We just like to look at it in different ways
. It's particularly a problem for us and educating students
on religiously based campuses, because often the mindset on
the campus is so much that they should not,
for example, be sexually active, that we tend
to pretend or convince ourselves that they're not. We
have lots of survey data that says that's not the
case. And I think we should assume that students
in most settings are likely to be at risk that
we should provide information the best way we can often
that's a matter of fitting facts into an acceptable context
of values and there's no reason not to do that
. What I'm afraid we do that we should not
do is stick our heads in the sand and pretend
that students in a religious setting are different than students
and other settings. That's a very good point.
We do have another phone call. Go ahead please
peter Virginia. Again. What is currently being done
in Virginia to advance HIV AIDS education into the elementary
and middle school public health curriculum. And how could
the public further the pressure on the state's education departments
to hold classes about AIDS? Okay, doctor I
sit on the Roanoke County School board committee parent committee
because I am a parent there as well and that
actually has already come down. The medical advisory committee
to the state Board of Health has advised the Commissioner
of Health to encourage the Board of Education or the
state Education Commissioner to have family enhanced family life planning
and that planning would include information discrete information two Children
in the public school setting. Indeed, that has
been promulgated by the Department of Health within the state
of Virginia. Presently, the school board committees in
the various locales throughout the state are considering such programs
. I have a meeting tonight, for example,
to attend concerning that in Roanoke County. I'm sure
there are other meetings similar to this going on throughout
the state right now for the adoption of this program
next, during the next school years, beginning in
September of uh, of 89. Let me,
let me get Janet in here and twist the question
around a little bit. What about families trying to
teach Children uh, that a brother or sister or
some other relative may be dying of AIDS? Is
that have you found that to be a particular problem
in terms of dealing dealing with family orientation with an
AIDS patient? Not not really because, you know
, typically the individuals that we're dealing with, you
know, often are single individuals and a family situation
tends to be a little bit um more rare.
But you know, as I said earlier, even
if you look at books that have been written,
there's not that much that has been written dealing with
how young young people might address it. But I
think if individuals just look at a death or a
serious illness, how they would react to that,
whatever that was in the family situation and include the
child in that experience, as they would try to
do in any situation. I think we do have
another phone call, I believe. Go ahead please
. Yes. I'm calling from stand and was wondering
if dR Keeling could elaborate on what other changes in
the law of taking place concerning HIV infection and reporting
the law as as enacted. And again, let
me emphasize that we're talking here about a whole process
and the governor's signature is not yet on these bills
, but the laws passed by the General Assembly this
past session would do a number of different things.
The only thing specifically in terms of reporting is the
what we alluded to earlier concerning reporting of people with
positive tests. Beyond that, though, the legislation
explicitly authorizes the Department of Health to do contact tracing
for people who have AIDS or have positive tests.
The law also establishes up to five regional resource centers
for both preparation of health care providers and providing services
, provides for some direct grants to community agencies and
organizations to fund specific targeted aids education efforts. The
law also provides for testing and certain other situations without
specific informed consent of a patient. For example,
if a patient is the source of an injury to
health care worker. Testing may be done without the
permission essentially of a patient and vice versa. The
healthcare workers the source of an injury to a patient
. Similarly, it otherwise establishes very strict guidelines for
confidential information, lists specific categories within which information can
and cannot be released and provides penalties for willing violation
of that statute. All right, I'm sure we're
gonna be hearing more from the General Assembly in the
years to come on this particular issue. We do
have another phone call. Go ahead. Please phone
caller. Go ahead. This is Ingrid lee jeans
and a little from the Hampton roads area with the
mutations of the HIV over the years. Is the
HIV more violent, more infectious today than say five
years ago. Okay, well I think I think
that's a big question. I don't think we know
. I think there's some limit limited evidence within a
given person that as the virus is evolving is becoming
more psychopathic. But in terms of the epidemic and
transmission between people we don't know at the moment.
And that indeed is a very important issue in terms
of predicting the progression of this epidemic is whether it
will become more psychopathic or less psychopathic. Dr Sloper
one report that came out about a week ago or
two weeks ago in the morbidity and mortality weekly Report
, which is the Centers for Disease Control publication.
Was that over the past six months or so?
It's been noted that several isolates, I forget.
The exact number may have been seven or eight isolates
from patients who are taking a C. T.
On a long term basis for a minimum of six
months had been shown to become relatively resistant to act
. The implications of that for the future are really
unknown at present. The recommendations are maintained that patients
be maintained be given a ct despite the fact that
there are organs that the virus may have. May
show that resistance in the test to see whether or
not this will have any relevance in the long term
to other patients. On a ct is unclear at
this time. All right. We do have another
question. Go ahead please. Yes I'm calling from
Battle Creek michigan and we're wondering if Dr Taper has
any sense of what percentage of people with AIDS are
supported emotionally by their family as opposed perhaps of going
it alone or depending on support groups. Um Yeah
I don't really have a feel for what percentage.
Um right now, I think there is a large
percent of people who feel they are very alone and
a lot of people that we talk with um you
know, are experiencing that they feel, as we
said earlier, just very, very isolated and a
lot of times they just don't know where to turn
. And I think that's one of the reasons then
that families, individuals who have experienced the same situation
have um off their own initiative, then begun to
develop organizations or support groups for those families. Um
so those are their, you know, people who
may just not be aware of them, but um
you know, so there's information in the packet on
that um or just contacting um Local Health Department,
local AIDS Task Force just to try to access those
support groups because they are there and there really isn't
a need for people to feel as isolated as they
are feeling perhaps. All right, thank you.
We do have another phone call. Go ahead,
please. We Hi. Hi. Um how should
adults treat Children in situations at school or for each
camp when there's an injury and blood is involved?
The teachers ensure unsure if they should treat the child
and put themselves at risk. Okay, dr Sloper
this is a question that we wrestled with on the
AIDS Medical Advisory Committee concerning daycare centers and other settings
where Children might become injured. Unfortunately in the past
, there really hasn't been um sufficient uh perspective given
to teachers, uh and to other professionals in the
school setting concerning adequate disinfection of blood spills and how
to handle such injuries. We normally look at a
child as with caring I and just want to rush
in and help them and clearly that's usually appropriate.
But there is, as you imply some risk with
that. Um, it is probably prudent to have
access to some disposable gloves in the school setting,
whether they're going to be accessible in every classroom,
whether that's appropriate is another issue that could be decided
at the local level, but that coupled with the
use of diluted bleach is, I'm sure has been
mentioned 1 to 10 dilution of hypochlorite solution, which
is bleach. Household bleach works very well with disinfecting
the virus or a blood spill. Should there be
any virus really, or virtually any virus present in
the blood? Certainly HIV the one we're concerned about
the same comments pertain to Hepatitis B, which is
an unknown and it is also in our population.
So I think that we need to gain a better
perspective towards disinfection not only in the school setting,
but probably at the workplace, which has also been
ignored. Okay, another caller, Go ahead please
. I'm calling from South boston Virginia Again several weeks
ago on a tv news program, there were a
number of Children shown with AIDS. The newscaster stated
that the sad ending of the story is that these
Children have now infected their mothers. How is this
possible? And just a note these Children were not
all infants. We saw a little shuttering here.
It was dr Schluter to start with. I know
of only one instance where apparently a hemophiliac child has
infected the mother and that child apparently did So through
the mother's rather cavalier approach to handling diapers that were
soiled with body fluids. That is an undocumented circumstance
where that has happened. Ah I don't know how
, I don't know the circumstances of the situation you
describe, but it is while I can't say impossible
, it's very, very unlikely that those Children infected
the mother. That does sound right. Let me
go to doctor Sitz. Well, there was a
situation in Russia where 27 Children were infected through contaminated
needles And it was four mothers became infected from the
Children through breath beating. So this was a case
of mother of breast being becoming affected from the child
. But in terms of it being a commonplace thing
. No, from what we know. Oh,
good worker workers from town, I have two questions
I would like to ask because the life been so
busy. Number one question is if an eight page
has no medical insurance and needs treatment and all family
and community resources have been exhausted, Can he or
she receive any federal assistance Since AIDS is a disability
? Can one get I and become Medicaid eligible?
And the second question is celebrities have sponsored fundraising for
AIDS. How can an AIDS patient access to this
? Thank you very much. Doctor shopping around the
first part of the question anyway. Well, our
experience in roanoke has been that when patients clearly it
do not have the financial wherewithal to pay for health
care delivery. First of all, most physicians who
were involved will decide to cancel out any personal expenses
that are incurred by them in terms of their labor
effort and taking care of those patients. Secondly,
there, as you and your question stated, there
is a real concern about acquiring assistance from the state
or federal government for these patients and it can be
acquired. It usually takes up to six months to
acquire that assistance. And in the meantime, fortunately
in our community, at least we have local social
organizations, churches, for example, that are assuming
the cost of medications and other expenses other than the
physician care for these patients until the Medicare or Medicaid
takes over. Clearly, if social services have been
exhausted and the patient is without any source. That
is a clear dilemma and one has to then ask
, is the patient eligible for care through some other
channel? But it's a very difficult situation. I
would recommend that that patient go to the local AIDS
project, as in the case of rolling up the
renegades project and discuss the problems with them. They
have resources that might be potentially available. Okay.
Mr. Shepard. Yeah. A. C.
T. Has also provided patients who cannot afford it
under certain circumstances through a federal program, through local
health department. Starting in with the health department,
I guess to be the best place to start as
any. Certainly in terms of finding a good place
to start the second part of the question, I'm
not sure anybody's going to be able to answer that
, except let me go ahead and refer you to
the floppy disk that's included in the packets that have
been distributed. It has a number of national AIDS
hotline contacts. Uh, and as far as individual
celebrities sponsoring a specific organization, that's probably your best
contact for finding out what the resources are, how
to get a hold of of the money resources that
might be available along that line. Uh we do
have another phone call. Go ahead please Ingrid lesion
against from the Hampton Roads area. The incubation period
seven years for males and eight years for females is
just both for adults and Children. Uh, it
was one part of the problem in doing these latency
periods is trying to determine the time of infection.
But there have been some studies reported where people were
infected from blood transfusions and what they found there is
that young Children, I think it was under four
years of age, uh latency period. They're from
infection to some symptoms is about two years, very
short period of time. We've also seen this when
Children are born. In fact, they seem to
develop symptoms very quickly. Uh in males, adult
males, I think in that particular study, they
reported about six years latency period and Women, adult
women were running up about uh that was close to
nine years, 8-9 years older people from blood transfusions
developed symptoms earlier. So it's a lot of variation
depending upon sex and age. Yeah, it was
just a recent study of our cohort in san Francisco
, actually, of homosexual men, where they were
reporting actually a 10 year latent period. So this
latent period in adults appears to be lengthening. And
I think when we when we think about Children we
have to remember that the immune system is still not
fully developed. So as DR SITS mentioned, they
tend to develop symptoms much, still put doctors.
Most of the pediatric cases are in fact clustered within
the first two years of life. If you look
past that point, there's a major drop off in
terms of the frequency of of AIDS uh in children.
Additionally, I should also comment that I propose
to Dr. Clark and Dr. Sitz comments asked is probably
going to have an impact in that incubation period.
Indeed, what the comment that Dr Clark made about
this Prolonged incubation period now they're seeing maybe up to
10 years at least. May in part be at
least a reflection of ACDC given to patients prior to
the onset of AIDS, during the phase, when
they have our core even prior to that time.
Okay, before we get on to the next question
from our callers, I do want to ask one
question about one of one of the focuses of the
conference, but I'm touched on too much and that's
community action. Doctor Tabor, I guess you've seen
in terms of the Tidewater project, what can be
done in terms of community action? Could you talk
about that project a little bit? I'm sure we
have been approached by the AIDS Crisis Task Force in
in Tidewater and the specific requests they had from us
at that point in time was to develop materials related
to nutritional care of individuals and they have been dealing
with families who just said, you know, I
just want to have a book that I can open
and know how I can can feed this person.
Um And the Tidewater um AIDS Crisis Task Force is
made up of a wide number of individuals from the
community. Um people from the State Health Department ministers
, um individuals who work directly with gay population etcetera
. And um what we did for them then was
to develop two manuals. Um one for health professionals
working with individuals and then one for um families or
AIDS patients themselves. And one of the things that
that they wanted us to stress was that in this
situation where individuals are feeling so powerless to change a
situation um that if they have can have control of
something um it gives them back um Some of the
power over their own lives and and nutrition may be
a way that they can do that. So we
did develop two manuals. And right now those are
being tested in the Tidewater area, I would guess
in terms of maybe people being a little bit fearful
of government as some people are sort of local task
force that maybe or private with the ministers and that
sort of thing might be a place to turn for
families. Yeah, I think very, very much
that those are people that they will turn to for
practical advice tips on coping, etcetera. Okay,
okay. Another phone call. Go ahead please.
Yes. We've been wondering if there are any studies
indicating sexual behavior changes in the heterosexual population, for
instance, has the use of condoms increased in the
United States? Start doctor Keeling. We talked about
that a little bit before. Yeah. There are
actually not many encouraging things that the sales of condoms
as a sort of market indicator have been actually quite
flat. And condom manufacturers who anticipated a large surge
in condom sales and saw one back about two years
ago, have now seen a gradual plateau and then
actually flattening dropping condom sales. This is interpreted by
most people who deal with AIDS prevention as evidence that
the large general population, whatever that is large,
general population does not take this risk particularly seriously.
The other hand, there are some behavior studies involving
young people in particular which by their own report of
what they do. Self report studies say that they
are changing what they do. And there are some
studies of the frequency was actually transmissible diseases among college
students are the same age people out of college,
which also suggests at least some differences. But I
don't think in the information that I see at least
that we could say that there are wholesale changes in
behavior occurring in the general population. Okay, doctor
ah I'd like to add a comment or perspective from
the STD clinic setting or the sexually transmitted disease clinic
setting probably two years ago. If we saw a
patient walk into the clinic who had syphilis, we
would assuming that patient were male. We would assume
that that patient work were gay, male, homosexual
. It's very evident from numerous studies in san Francisco
and other areas of the country. Uh prospective studies
following gay males as I think the caller implied that
the gay population clearly has changed their approach to sexual
behavior. There's no question about it. However,
now in roanoke I can say at least we have
seen an upsurge in the frequency of syphilis among heterosexuals
. And it's of concern to me that the heterosexual
community hasn't gotten the message that indeed they are just
as much at risk. Maybe not as much that's
an exaggeration but they are at risk for acquisition of
HIV and clearly obviously at risk for syphilis. Or
is it going to take getting to the point where
it affects so much of a percent of that particular
population before anything is done by the heterosexual population.
I certainly hope not. I think the problem is
that people feel as if they are immune it's not
going to affect them because they don't travel in this
or that circle or whatever such that their friends and
or sexual partners are infected and indeed one does not
know who is or is not infected among one's friends
. Yeah I just want to say that rising syphilis
is not just a local phenomenon that virtually every state
on the East Coast has had a rise in syphilis
. And most people attribute that to heterosexual. Uh
population who are using drugs Either I. V.
Drugs or crack. That's anecdotal at this time.
Um You know the population that's using it, But
it is heterosexual population. All right. We have
another phone call. Go ahead please Williamsburg Area concerning
newborns that are born to Children of positive mothers.
Do they convert to negative if they are not themselves
infected? And if so when what is the date
beyond which you can be reasonably certain the infant if
they would have converted has converted? Thanks Steve.
You're not in your head. I'll let you Well
, I can't give an exact figure. I'm sure
the doctors could do that. But approximately half of
Children born to mothers who are HIV infected will be
infected. Now. Many Children uh at birth may
have a positive test not to their own antibody,
but the antibody from their mother. Over time this
antibody should disappear If the baby is not infected himself
. The figure I have is about 16 or 18
months, something like that. By then, it
should be a certainty. No, no. Somebody
who's not even this, like, like me might
might think that that's what that that the baby is
curing itself of AIDS. That's obviously not the case
. What's happening there. Dr Gupta Well, there
is a test that's available now for research purposes only
where we can actually evaluate a child or another individual
who may potentially be infected, where we're actually looking
for anti viral antigen in their bloodstream. That test
can be applied to a to a newborn whose mother
was infected and who which newborn also has an antibody
test that's positively elissa is positive. That is not
a foolproof test at this point. It is not
licensed for that purpose at this time. Um But
it is one way of looking at that child,
another way of looking at that child, I should
say uh to gain some comfort that maybe the child
is not infected. But the statistics that Steve sites
are unfortunately true. It's a 5050 chance. Okay
, Dr Clark I just like to add to the
roster of test that you mentioned. There is another
test, a direct test for the viral for the
viral DNA. It's called a PcR test. And
that is not as you know yet licensed. But
I understand that the right technology company that's developed it
has licensed the laboratory in santa Monica California which is
doing these tests with the physician son in the blood
because that a voice. All this ambiguity about the
positive test and the baby being something to do to
the mother's antigens. That really avoids the ambiguity.
And I don't know whether dr keeling knows are they
going to use that in the random survey of neo
Nate's which the they're doing across the U. S
. Or are they going to be using the Eliza
? They're going to use the Liz a standard that
they're gonna spot us. There is a concern with
the PcR because from what I've heard and I again
have not seen this in print. But more recent
word is that there is some question about reputable Itty
in that the slightest bit of contamination of the materials
used to evaluate a particular serum specimen for PcR reactivity
may cause a false positive test. So unfortunately it
is like many other laboratory tests not foolproof doctor.
It's not foolproof. But in terms of that cross
over the laboratory in santa Monica that's using this is
using what they call a P. Three facility.
Which really minimizes this what you what you mentioned crossover
contamination. So I think the main advantage of PCR
test and I'm I'm looking forward to when it might
be licensed is that it avoids this ambiguity, which
you have with the allies of this long negative window
period. It sounds like there's a lot of fine
tuning yet to go on. A lot of fine
tuning to go. Okay. Commercial use frightening.
Let's move on to the next question. Go ahead
and call her. I have two questions from the
down link at Virginia Tech. Um, one of
them has to do with the body fluids and the
spread of the virus blood is understood. But what
about salama? Perspiration, tears, skin oils and
also regarding dental work and patient safety from patient to
patient. What's the right? So what are the
rights as a dental consumer? The second question is
, um, the understanding that AIDS causes a breakdown
of the immune system. So a person may die
of any type of disease or sickness. But the
question says, did I hear correctly that it causes
organic brain damage? And what are the other side
effects? Okay. Question number one. As far
as body fluids, what I guess there's ones we
know positively have have an effect and ones were basically
I guess. Well let me get one of you
to comment about body fluids. Dr Clark can I
just start on this? And I think the doctor
slapped because the virus has been found in almost anybody
through that you can mention, but it's been found
most consistently in blood and semen, vaginal secretions,
christians and mother's milk and also much higher concentrations in
saliva is less commonly found. And it's found in
much lower concentrations. So I get the great debate
about kissing will remain a great debate and one of
the major problems in this and I think DR SITS
alluded to it is that up to now we have
not had an animal model on which to test transmission
because the only other animal that can be infected with
the AIDS virus is a chimpanzee and they're in short
supply and actually they don't go on to develop AIDS.
I don't know whether Dr. Sitz wants to comment
on the mouse models, mice models, there's a
couple of mouse models that are being developed, one
where they transplant the human immune system into a mouse
and that may be particularly I don't know if that
will be very useful in terms of looking at transmission
routes will certainly be he was born testing particularly drug
development and also maybe perhaps vaccine development. Okay uh
touch, just from a practical standpoint dR Clark is
totally correct your comments about saliva for example. And
those comments, I think you'll agree to apply to
things like tears and sweat etcetera. Uh I think
the test is in the pudding if you will.
And when you look at prospective studies, both in
the United States and in Zaire, um of family
settings where you have a child, one child who
is infected with the virus with or without AIDS and
siblings who are uninfected and follow those families for prolonged
periods of time, you find that none of the
siblings, or at least with rare exception to the
siblings become infected from the other siblings or at least
apparently so. So in the very closest of human
setting, short of the sexual partner setting, we
find very little evidence for any transmission and clearly those
body fluids are exchanged at times. You know,
as well as I that Children would use the same
toys and put them in their mouths, etcetera,
potentially contaminated with the other saliva. Another part of
that question was the incidents and in dental offices,
for example, I to boil it down to a
quick question, would the standard precautions of rubber gloves
and masks? Pretty much take care of any sort
of problems that might arise in that situation? Sure
, Surely the dental associations, both locally and nationally
, have taken very strong positions that dentists should assume
the role of wearing gloves to protect themselves and thereby
protect other patients, because it is clearly clearly occurs
that we know that there's blood uh frequently in the
dental setting from the patient, but it is possible
also for the dentist, him or herself to become
nick and spill blood into the patient's mouth. So
for the protection of all parties, uh, dentists
have virtually universally now assumed the use of rubber gloves
, which are disposable and discarded between patient uh between
patients and the other part of the question. If
I can remember all this was getting into the breakdown
of the immune system, and the specific reference was
to organic brain damage. If you want to comment
on that Clark, I think that's something that's been
lately recognized, in fact, was that it was
suffering from the symptoms of brain damage in the early
early stages of this epidemic, we're not actually recognized
as having AIDS. Uh The virus is introduced to
the brain probably through the infected microfibers and exactly the
exact side of pathology, I don't think we understand
, but from my my reading, the brains of
persons who are infected to go on to develop this
end stage of AIDS related demand. You may look
like the brains of Alzheimer's patients. And I saw
a recent publication two weeks ago. I think it
was in the The Lancet about autopsy of patients who
died of AIDS and 90% of them had some defect
in the brain had lesions and tumors from that.
Okay, Dr kelly. Yeah. I I agree
with Dr Clark's comments. I think that it's clear
that the spectrum of involvement in the nervous system is
large, that the frequency with which that happens is
great. I only want to be sure that we
don't mislead our listeners. There has been a lot
of mythology around about this where people say, well
, since these people have a virus in the brain
and that might make their brains not work as well
. Isn't that a reason to quarantine people or isn't
that a reason to discriminate against them or whatever?
There is very good data. Very good data that
says that prior to the time of serious illness.
People with HIV infection in the spinal cord and brain
do not have significantly different neurologic psychological abnormalities as compared
to people who don't have HIV infection. So we
don't need to use the fact of brain infection as
a reason to fear people who sir positive dr slow
. But I just want to echo Richard's comments.
The it takes fairly subtle psychodynamic testing or psychological testing
to pick up the abnormalities that occur quite early.
Indeed the in terms of day to day functions,
neurologic dysfunction doesn't really occur until the later phases of
the illness in most cases with rare exceptions. Okay
another phone call. Go ahead please. Calling from
Hampton Roads again. For women who are talking about
the HIV positive or not. What are the recommendations
we're making to them if they want to breastfeed particular
when you think of those who have been substance abusers
, okay uh substance abuse and and tested HIV positive
, they don't know if they're HIV. Absolutely.
Well I think the appropriate counselling would be that if
a woman acknowledges the fact that she is in a
high risk group for acquisition of HIV infection, such
as you say, mentioned a former drug abuser,
that individual first of all should consider being tested prior
to conception. Clearly it places the child at some
risk or possible concept is at some risk. If
one is infected it's 50 50 risk we believe so
it would be wise to be tested prior to conception
if indeed that did not occur and the woman were
wanted to know the answer to the question of infection
. Clearly it should be done at any time that
that question arises if a woman is infected with HIV
and the child fortunately was not infected prior to birth
. Then we advise clearly that that woman not breast
feed that child because the risk would be too great
to the child. Okay, do we have another
phone call? This is Jacksonville florida. What is
the status of the trials for Children? Okay.
Status of a team doctor Schlukebir. Now, the
I only know that those trials are ongoing and I
don't know any data on that. Rich, are
you aware of any at this point? The only
thing I know of charlie is that in the very
preliminary stuff that I've heard of is that's very encouraging
. Especially regarding the developmental defects and neurologic abnormalities of
Children. I have not heard anything very promising about
survival extension. There's always a comment that a cT
is beginning in a number of prophylactic situations. For
example, the NIH Now, workers who expose the
blood or maybe in a laboratory setting. I think
two breaks or something like this or being those two
bays et for six weeks with the idea of this
may prevent them from becoming infected. This is probably
based on some animal studies with some related viruses.
Where is this going to work in humans or not
things a little too early to tell. Okay,
we do have another phone call. Go ahead please
. Hello, I'm calling from Jonesville Virginia. And
my question is Since approximately 90 per 6% of all
hemophiliacs in this country have contracted the AIDS virus from
blood and blood products. Usually a HF and our
crowd precipitate. Can you explain the survival of the
virus in these products? Especially since HF is a
dehydrated product and crowd is usually frozen from A month
up to maybe 12 months, Three fraser questionable.
But nobody 96% of those who have contracted AIDS have
gotten it from blood. That's not my question.
I know, but just rephrase that. But anyway
, as far as the issues she raised Dr.
Well, I think the 1st 1st point is that
she's stating that the hemophiliacs of all hemophiliacs in the
country, a large percentage and she's quoting 96% have
acquired HIV infection. I haven't heard quite that high
percentage at all. But whatever the percentage is clearly
there at risk, those products prior to our understanding
of the mechanism of transmission, uh, clearly contained
the virus and it survived the various desiccation processes and
the freezing. What has been done subsequently is that
those products are now heated and the heating process does
destroy the virus. Um, it clearly did survive
those. And I'm not sure if I can explain
physical chemically, maybe Tom or Joyce are better able
than I to explain the physical chemical reason for the
survival. But it did. Well, the reason
in the first place didn't disrupt the viral membrane.
That's one. And I think the other procedure did
not involve heating. That's right. There was another
one of those products was heated for one hour at
56°.. In this study that Joyce had referred to
earlier, they found out they had the heat for
three hours and 56° to completely inactivate the virus 1960
. Now now I think even going to a higher
temperature but I believe now that factor has actually been
microbial is synthesized. Yeah, well some of us
have been produced by recounting the United Technologies techniques.
So the question of viral infections that didn't involve at
all. Okay, Stevie, it's something else to
be as unscientific as possible. Um I don't even
know, I can't even attribute this. But in
the last two weeks I have heard of a new
study on this group that should significantly uh a smaller
percentage of of infections than than we heard here.
In other words, something we've been able to isolate
and get the problem worked on and if not solved
at least addressed in a big way better today than
it was. Okay, very good. Uh we
have another phone call. Go ahead please. I'm
calling from Sue ST Marie Ontario Canada. And our
question is if someone is tested positive for the HIV
virus, is there any measure to increase the immune
system? For example, by diet? Let's uh
let's address diet first. How is your nutritional program
worked out? Is that a consideration? Well they
no, I mean, okay, first of all
, no, you're not going to really enhance the
the immune system um by diet. I mean you're
not going to be able to cure this particular disease
with diet, I think um the things that that
you can look at um you know with diet are
that um you're just you're helping the individual um to
remain healthy for as long as possible to stay healthy
for as long as possible. And the idea there
is really to to help them to remain more self
sufficient um and to care for themselves perhaps for a
longer period of time before they may become more totally
dependent on other individuals. I would not want to
say. I mean, I would not say um
that you could ever use diet to enhance immune system
function and and perhaps to cure the disease. There
are some some reports out that that do in a
sense say that and individuals, you know, we'll
look at macrobiotic diets, et cetera. Um,
and I think you have to be very, very
skeptical skeptical of some of those reports. Um,
and I think with some of those, you don't
want to destroy a person's hope and say, you
know, that's that's totally crazy to try that type
of approach. But I think to be very,
very realistic about it, diet is not going to
be a cure for it at all. Okay.
Doctor Sitz, there's been some studies in africa where
people are suffering from a fairly severe malnutrition to be
prominent protein malnutrition, where the disease seems to develop
faster. And they also know these patients immune systems
can become fairly compromised by very severe malnutrition, which
hopefully doesn't impact on most of the patients that are
dealt with here in United States. Uh, I
think the question or the caller asked additional questions.
I may be wrong, but there are a number
of immune stimulants that have been used. Chemical stimulants
I have experienced with only one of them, but
none of them has worked well or repeatedly or been
shown to efficacious lee have benefit to the patient in
the long run. Okay, we do have another
phone call. Go ahead please. Yes, my
name is marty, Yes Bird and I'm from Gaffney
south Carolina. The question that I have is after
a person dies of AIDS when it makes it to
the funeral home? How long is the AIDS virus
living? Uh, and what is the danger of
the person there at the funeral home? As far
as and bombing procedures? Okay, doctor, sooner
on the state of Virginia, I can't speak for
other states, but I would imagine that there are
similar laws in at least some states. It is
now a requirement that the body be labeled that there
was a blood borne infection or specifically that blood born
born infection stated so that the undertaker can take,
quote special precautions end quote in handling the body.
Um The chemicals that are used to treat a body
after the patient's death clearly shouldn't activate the virus and
there should be no risk at all. Once that
body has been involved, I'm gonna move on to
the next question of starting to run out of time
. Go ahead. Phone caller. Yes. This
is Deidre Schaefer calling from Alfred State College in Alfred
new york. I have a two part question one
are there if any side effects in an individual using
and the second part is will they have to take
the rest of their lives? Okay. That's dr
Subra well there are a myriad of side effects from
the use of A. G. T. I
think I've heard them all now. Because of my
patients complaints. The most common ones are nausea vomiting
. Some people complain that it causes the same kind
of muscle aches that the virus does seem to produce
as well. Some people have headaches, insomnia,
a myriad of complaints that the patient themselves may have
. Additionally I've seen the ill effects on the blood
system. Uh white blood cell counts can be driven
down farther than they're already driven down with the virus
. Additionally the bone marrow does not produce red blood
cells and many of some of my patients at least
have required transfusion while they're receiving act in order to
maintain them. So there are a myriad of ill
effects from this drug. It is not a cure
all by any means. It's a two edged sword
at best and there's basically no option for the rest
of their lives at this time. That's right.
That was the other part of the question. Doctor
only to add that. It is not even clear
that it would be useful for the rest of their
lives. The durability of the response to a ct
does not seem to be infinite. That doesn't seem
that it will work forever and ever. And if
the toxicity is not limiting then the usefulness maybe.
Okay, we're down to a minute. We'll try
to take one more question. Go ahead please.
I'm calling from west Virginia University, Morgantown west Virginia
and the question is, does everyone form antibodies within
3 to 6 months after contact with the AIDS virus
? Or is it possible that a number of years
could pass after infection? But without positive test results
and Say five years after infection just results become positive
assuming that there has been no other AIDS virus contact
during that five year period. You were shaking your
head just say briefly. I think for most people
this period for producing antibodies between three and six months
, but there are reports of one reported up to
year and I have seen reports where they use the
pcR test to determine whether a person's infective. I've
seen winter periods of 2.5 years. How common that
is? We don't know. I don't know.
Doctor said place. It was saying comments. Okay
, do we have one more question please? Yes
. Hi. I'm calling from michigan um in light
of the fact that our next one of the highest
groups that we're gonna be see infected or the heterosexuals
and specifically poor women. Is this going to have
any impact that you know of right away on the
Medicaid laws to prohibit abortion? Since that seems to
me to be one of the options that will be
necessary to offer women who are HIV infected? Excuse
me, HIV infected. That's a tough question.
With less than a minute left. Doctors want to
, first of all, let me say that we're
not sure that this epidemic is burgeoning ahead in the
heterosexual community. We just have concerns because the heterosexual
community does not seem to be abiding by what we
would accept as safe sexual practices necessarily concerning the Medicaid
laws. That is such a tough issue to deal
with. It is full of or replete with so
many social overtones that I couldn't begin to handle that
one. Okay, that's good because we're out of
time anyway. I want to thank all the calls
that came in from all over the country and also
like to thank all our guests today for joining us
both live and and take presentations earlier. And thank
you for joining us joining us in this teleconference on
AIDS. Thank you. And good Day. Yeah
. Mhm. Mhm, mm. Mhm. Yeah
. Yeah. Oh. Mhm. Yeah. No
. Okay. Yeah. Mm. Mhm. Mhm
. Mhm. Yeah. Yeah. Yeah. Mm
. Mhm. Yes. Mhm. Yeah. Yeah 1061 --> A:middle L:90% .