The impact of AIDS on state and local health departments: issues and a few answers.

Owing to large differences in the incidence of AIDS (acquired immunodeficiency syndrome) and in public health resources and priorities, the impact of AIDS on state and local health departments has been variable. Nonetheless, health departments everywhere are being held responsible for surveillance and control of the HIV (human immunodeficiency virus) epidemic which we believe requires, at minimum, convenient, free HIV testing and counseling; expanded HIV services in sexually transmitted diseases clinics and substance treatment centers; locally oriented AIDS information/education; notification of persons unknowingly exposed to HIV; restrictive measures for HIV-infected persons who, after counseling, persist in exposing others; regulation or closure of public establishments in which HIV transmission is likely to result; and confidential reporting of all HIV test results to public health departments. In Colorado new legislation was passed to require reporting of HIV test results, to provide the reports with near absolute protections against unauthorized disclosure, and to modify quarantine statues to incorporate rights to due process, appeals, and confidentially. States in which there is a legal basis for discrimination against gay men will need to rectify this problem first. There is no evidence that reporting of HIV infections in Colorado has adversely affected the rate at which persons with HIV risk behaviors volunteer to be tested. For Denver and Colorado Departments of Health, more than 70 per cent of the estimated $2,796,000 expended in AIDS activities during 1987 was federal.     

Knowledge of phosphorus compared with other nutrients in maintenance dialysis patients.

OBJECTIVE: This study's objective was to assess knowledge of phosphorus compared with other nutrients in patients undergoing maintenance dialysis (MD). DESIGN: We compared knowledge of phosphorus vs. other nutrients important to the MD diet (potassium, sodium, and protein) in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). We further measured gender, age, education level, and functional health literacy to assess correlations in patient nutrient knowledge. Nutrient knowledge was measured using a 25-item Chronic Kidney Disease Knowledge Assessment Tool for Nutrition (CKDKAT-N), and functional health literacy was measured using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). SETTING AND PATIENTS: Patients received maintenance outpatient PD or HD at Wisconsin Dialysis, Inc. (Madison, WI). MAIN OUTCOME MEASURE: The main outcome measure was knowledge of phosphorus vs. knowledge of potassium, sodium, and protein. RESULTS: Forty-seven MD patients participated in the study (29 undergoing HD, 18 undergoing PD, 30 males, 17 females, average age of 58.6 (SD, 13.8) years, and average grade level of 1.4 (SD, 2.6) years of post-secondary education). Thirty-five participants had adequate health literacy, 4 had marginal health literacy, and 8 had inadequate health literacy. The CKDKAT-N scores ranged from 6-21 for 25 items, with a mean score of 13 (SD, 2.91). Knowledge of phosphorus compared with knowledge of other nutrients was poor (0.38 vs. 0.72, P = .003). In a comparison of HD vs. PD patient knowledge, both phosphorus (0.37 vs. 0.42, P = .231) and other nutrients (0.69 vs. 0.80, P = .115) were the same. CONCLUSION: Despite regular dietary instruction, patients undergoing MD have a poor knowledge of dietary phosphorus content, compared with knowledge of other nutrients important in chronic kidney disease. Interestingly, there was no difference in nutrition knowledge when comparing PD and HD patients, despite differences in education level and health literacy between groups.     

Pharmacokinetics of the 13C labeled anticancer agent temozolomide detected in vivo by selective cross-polarization transfer

The anticancer agent temozolomide labeled with ¹³C (8-Carbamoyl-3-13C-methylimidazo-[5,1-d]-1,2,3,5-tetrazin-4-(3H)-one), was noninvasively detected in subcutaneous RIF-1 tumors by a selective cross polarization ¹³C NMR method, at a field strength of 9.4T. Pharmacokinetics of the drug, at a dose of 150 mg/kg, were determined for intravenous and intraperitoneal modes of administration (three animals per mode). The half-life of the drug in the tumors was approximately 60 min. The uptake and clearance of the drug, however, varied significantly between individual hosts, for both modes of administration. These results demonstrate the feasibility of obtaining pharmacokinetics of anticancer agents for individual tumors without the need for a label that might modify drug activity (e.g., fluorine). The variability of the in vivo measurements, even within the same tumor model, demonstrates the necessity of directly monitoring the tumor to evaluate drug pharmacokinetics.     

Phase II trials of fosquidone (GR63178A) in carcinoma of the breast, head and neck, ovary and melanoma.

A total of 91 eligible patients with metastatic cancer have been treated in a series of phase II trials of the novel pentacyclic pyrroloquinone, fosquidone. Tumour types were breast (24), ovary (25), head and neck (21) and melanoma (21). All patients, except those with melanoma had received prior chemotherapy. The drug was given intravenously as a 20 min infusion, at the dose of 120 mg/m2 on days 1 to 5 of a 3 week cycle. Treatment was well tolerated; the only significant side-effects being mild headaches and generalised musculo-skeletal pains. Response was assessed after 2 cycles of therapy. Only one patient (with head and neck cancer) achieved an objective partial response, lasting 6 weeks. A total of 12 patients demonstrated stable disease for a median duration of 15 to 20 weeks. Using this schedule of administration, fosquidone has no significant antitumour activity in this group of tumours.     

Endobronchial HIV associated lymphoma.

A 27 year old HIV infected man presented with two days of haemoptysis. Flexible bronchoscopy revealed a large carinal mass partially obstructing the left and right main stem bronchi. Rigid bronchoscopy was required to make the diagnosis of large cell immunoblastic lymphoma.     

2'-Chlorodeoxyadenosine: evaluation of a novel predominantly lymphocyte selective agent in lymphoid malignancies.

2''-Chlorodeoxyadenosine (2CDA) is a purine analogue selectively active against both resting and dividing lymphoid cells. Twenty-one patients with a variety of previously treated lymphoid malignancies received a total of 41 courses of 2CDA (0.1-0.15 mg/kg/day over 7 days continuous intravenous infusion) on compassionate grounds. The profile of the patient population was as follows: low grade non-Hodgkin''s lymphoma (NHL) = 8, intermediate grade NHL = 2, transformed (intermediate grade NHL) = 6, Hodgkin''s disease = 1, lymphoplasmacytoid NHL = 3 and lymphoblastic NHL = 1. The overall response rate was 53%, with three patients attaining complete remission (CR) and eight partial remission (PR). Three of 16 patients with primary resistant or resistant recurrent disease entered either CR (1) or PR (2). Ten patients had no response or progressive disease. The latter group was comprised of patients who had extensively pre-treated lymphoplasmacytoid tumours and/or poor performance status (WHO grades 2-4). The median duration of response is 6 months (range 1 to 12 months). Treatment was well tolerated and the chief toxicities were leucopenia and thrombocytopenia which were most pronounced when there was bone marrow involvement. As a result of dose limiting myelotoxicity, a dose escalation to 0.15 mg/kg/day was possible on just three occasions. These data confirm other reports of the activity of 2CDA in low grade NHL and indicate it may have activity in Hodgkin''s disease. There was no demonstrable activity in poor performance status patients or those with extensively pre-treated lymphoplasmacytoid tumours.     

Diagnosis of pulmonary Kaposi's sarcoma with fiberoptic bronchoscopy and endobronchial biopsy. A report of five cases

Fiberoptic bronchoscopy is a major tool in the diagnostic evaluation of pulmonary disease in patients with the Acquired Immune Deficiency Syndrome. Multiple opportunistic infections and Kaposi's sarcoma affect the lung in this disorder. In contrast to opportunistic infections, Kaposi's sarcoma is rarely reported to be diagnosed by means of bronchoscopy. This report describes five of seven patients in whom endobronchial lesions consistent with submucosal involvement by the tumor were seen, and Kaposi's sarcoma was diagnosed without complication. Kaposi's sarcoma must be considered in the differential diagnosis of pulmonary disease in patients with a proven extrapulmonary tumor focus, and fiberoptic bronchoscopy is the initial diagnostic procedure of choice. Endobronchial Kaposi's sarcoma may be a marker for parenchymal involvement by the tumor. Diagnosis of endobronchial Kaposi's sarcoma can be an important factor in decisions regarding therapy.     

Epitope-specific impairment of production of antibody against merozoite surface glycoprotein 1 of Plasmodium falciparum in symptomatic patients with malaria

We analyzed the relationships between levels of antibody specific for merozoite surface glycoprotein-1 (MSP1) of Plasmodium falciparum and clinical manifestations in humans. We prepared recombinant MSP1 proteins representing block 3 (M3), block 6 (M6), blocks 1–6 (M1/6), and block 17. When we divided the slide-positive individuals in Guadalcanal into symptomatic and asymptomatic groups, the former group showed lower IgG levels against M6 and block 17, but not against M3, than did the asymptomatic group (P < 0.01). The possibility of nonspecific suppression was unlikely, given that the levels of antibody against poliomyelitis virus observed in the two groups were almost the same. Among the IgG subclasses tested, production of cytophilic IgG₃ seemed to be dominant. When we analyzed epitopes recognized by antibodies against block 17, a peptide (SSSNFLGIS) was preferentially recognized by sera from asymptomatic individuals. These results suggest that clinical symptoms occurring during falciparum malaria seem to be associated with the development of levels of antibody against particular epitopes on MSP1, which is under the control of an immunoregulatory mechanism. Received: 1 October 1999 / Accepted: 21 October 1999