AIDS Care on the Rise
A higher percentage of African Americans and Latinos are receiving AIDS care than was the case only a couple of years ago, but the gap between men and women is not closing nearly as rapidly, according to a new study by Rand researchers.
The uninsured and those relying on Medicaid also received poorer care than those with private insurance, and patients who contracted the virus via intravenous drug use or heterosexual contact were less likely to receive adequate care than gay males, Dr. Martin F. Shapiro and his colleagues reported in Wednesday’s Journal of the American Medical Assn.
In a random sample, more than 2,000 patients in the 48 contiguous states were interviewed in 1996, 1997 and 1998 as part of the HIV Cost and Services Utilization Study, supported by the federal government and private industry. The study, the largest of its kind, confirmed the widely held belief that many groups of patients were not receiving adequate care in 1996. But it also indicated that progress is being made. Such care includes the use of antiretroviral drugs and protease inhibitors, recent visits to a physician and care that prevented the need for hospitalization.
In 1996, when the study began, only 29% of HIV-positive people were receiving adequate treatment, according to the standards established by the researchers. Two years later, the percentage had climbed to 47%.
A much larger percentage was receiving at least some treatment, however. In 1998, 88% of infected whites were receiving protease inhibitors, the powerful drugs that have sharply cut the death rate from AIDS, for example. But 84% of Latinos and 80% of blacks were receiving them.
Rethinking a Link to Protease Inhibitors
Many HIV-positive people successfully treated with combinations of drugs have developed abnormal accumulations of fat--a condition called lipodystrophy--such as “buffalo humps” on the back of their neck and “protease pouches” on their abdomens. As the names imply, most physicians have assumed that the lipodystrophy is a side effect of treatment with the powerful protease inhibitors. But new data suggest that it may be associated with the HIV infections.
Dr. Andrew Carr of St. Vincent’s Hospital in Sydney, Australia, reported Sunday at a San Diego lipodystrophy meeting on a study of 220 HIV-positive patients. Fourteen of them, he told the meeting, suffer from lipodystrophy even though they had never taken protease inhibitors. Other researchers, such as Dr. Steven Grinspoon of Massachusetts General Hospital in Boston, have recently reported similar findings, suggesting that it is not the drugs that are causing the problem, but something associated with the viral infection.
MRI Shows Promise as Angiogram Substitute
Magnetic resonance imaging could soon replace angiograms for diagnosing clogged arteries, Boston researchers reported Tuesday in Circulation: Journal of the American Heart Assn. Angiography involves threading a thin catheter through arteries to release a dye near the site of the suspected blockage. Recovery requires the patient to lie still for about six hours, and the procedure entails a small risk of bleeding, heart attack and stroke.
Magnetic resonance imaging, which uses powerful magnets, has not been highly successful in the past because it required patients to hold their breath 30 to 40 times for 16 to 20 seconds each time. Even then, the images were often not good enough to identify a blockage.
But Dr. Warren Manning and his colleagues at Beth Israel Deaconess Medical Center said tests of a new variant called three-dimensional coronary magnetic resonance angiography in eight patients worked just as well as conventional angiograms. Because the new instrument is more sensitive, patients can breathe normally and the entire procedure is completed in less than 30 minutes.
The cost, they added, is less than a quarter of the cost of a conventional angiogram.
Researchers Dispute Decade-Old Treatment
A 10-year-old mistake in the medical literature is leading many physicians to mistreat a life-threatening condition that affects tens of thousands of hospitalized patients each year, according to researchers from Houston’s Baylor College of Medicine and UC San Francisco. The condition is hyponatremic encephalopathy, a swelling of the brain caused by low salt levels in the bloodstream. It can cause permanent nerve damage, seizures, respiratory failure and death.
The obvious treatment would seem to be to increase salt levels by intravenous infusion, but a decade-old report claimed that such infusions cause brain swelling. But it is the low salt levels themselves that cause the swelling, not the infusion, Dr. J. Carlos Ayus of Baylor and Dr. Allen I. Arieff of UCSF reported in Wednesday’s Journal of the American Medical Assn.
In a decadelong study on 53 women, they found that all patients who received an early infusion of salt had a complete recovery, while those who received no infusion died or suffered permanent brain injury. Ayus and Arieff estimated that the condition is treated incorrectly about half the time.
New Drug Tested on Eye Inflammation
In a small preliminary study, researchers at the National Institutes of Health have found that a new drug can successfully treat uveitis without the complications associated with existing treatments. Uveitis is a severe eye inflammation that affects children and young adults. It is now treated with daily administration of powerful steroids and other drugs that suppress the immune system, but these drugs can cause decreased kidney function, cataracts, glaucoma and brittle bones.
The new drug, given once a month, is a monoclonal antibody that selectively blocks a key component in the immune attack on the eye. The team reported in Tuesday’s Proceedings of the National Academy of Sciences that nine of 10 patients treated with the new drug had minimal side effects, no recurrence of the disease and no loss of vision.
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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
