Path: utzoo!utgpu!jarvis.csri.toronto.edu!mailrus!iuvax!cica!tut.cis.ohio-state.edu!gem.mps.ohio-state.edu!apple!usc!ucla-cs!rock%lighthouse%pyrdc%wubios@uunet.UU.NET From: rock%lighthouse%pyrdc%wubios@uunet.UU.NET (Roger Rock Rosner) Newsgroups: sci.med.aids Subject: Washington HIV News: V1N2, 2/3 Message-ID: <28609@shemp.CS.UCLA.EDU> Date: 29 Oct 89 01:58:05 GMT Sender: news@CS.UCLA.EDU Lines: 601 Approved: aids@cs.ucla.edu Archive-number: 1417 *************************************************************************** EDUCATION/SERVICES - Table of Contents February 1989 - Vol 1, No 2 The Numbers Game Corrections Options+ discusses HIV Book Review: "AIDS: Second Edition" AZT may cause vitamin B12 deficiency Pharmacy offers HIV-related drugs at wholesale prices Dental Clinic available Healthway offers discount "Shortcuts:" How to get a handicapped parking permit Aerosolized pentamidine clinic begins LifeLink will benefit from Romanovsky & Phillips concert *************************************************************************** THE NUMBERS GAME What's in a number? Every day, we are surrounded with numbers: driver's license number, social security number, lots of phone numbers, and so on. These days, the most frightening and most confusing numbers are the ones we get back from our doctors. What does it mean if my T4 cells are at 452 per cubic millimeter? Should I care if my helper/suppressor ratio is 0.2? Is a lymphocyte count of more than 2,000 good or bad? In this article, we'll attempt to answer some of the questions about The Numbers Game. A lot of the furor over T4 counts has been exaggerated. You will quickly discover that there are no absolutes when it comes to HIV. Some doctors will tell you that T4 counts of less than 500 mean you should take AZT; others will want to wait until the count drops below 200. Some people have become diagnosed with full-blown AIDS with T4 cell counts of greater than 500; others have lived for years, without getting any of the major opportunistic infections, with T4 cell counts in the teens and twenties. Another problem is that there are considerable variations in results even between different labs, and that for many labs these tests are not well standardized.* Some past protocols were famous for having every participating hospital across the country send their blood samples to the same lab on the west coast, and that lab always had counts 50 to 100 cells/mm^3 lower than local labs. What exactly do all these numbers mean? Let's look at each of them individually. ------------------------------ WHITE BLOOD CELLS (WBC) Normal value: 4,000 - 10,000 per cubic millimeter There are several different types of white blood cells. They are produced by your bone marrow and lymphoid tissues (your lymph glands, with the most easily identified ones located around your neck, under your armpits, and around your groin). White blood cells play a vital role in your immune system, because they are the soldiers that destroy invading cells, viruses, and organisms. People with AIDS often have a lowered WBC count. White blood cells can be divided into two major varieties: agranular and granular. Agranular cells include the small, medium and large lymphocytes and the monocyte, which together account for approximately 20 to 25 percent of the White Blood cells. The granular cells, also known as leukocytes, are of three types: neutrophils, eosinophils, and basophils. ------------------------------ LYMPHOCYTES (LYMPHS) Normal value: 1,000 - 3,000 per cubic millimeter Lymphocytes are a type of white blood cell, and they are among the most important cells affected by HIV. These are the cells responsible for identifying foreign invaders (antigens) as being "non-self," or not part of your body's normal make-up. They then stimulate the destruction and elimination of the antigen (sound the alarm and call for the troops). Two major classes of lymphocytes are the T and the B lymphocytes. ------------------------------ T4 CELLS Normal value: approximately 600 - 1200 per cubic millimeter Your T-lymphocytes are a family of cells which play a vital role in your immune system. The T-lymphocytes do not produce antibodies, but they control the cells which do by sending out chemical messages. The T4 cells (also called "helper/inducer cells") act like a security guard who calls the cops when it detects intruders. The T4 cells cause your immune system to start attacking invading viruses, parasites, tumors, and fungi. HIV interferes with your T4 cells by taking them over and using their chemical components to reproduce (like "Invasion of the Body Snatchers"), by binding groups of T4 cells together into a big, useless clump called syncytia, and by bursting T4 cells during a blowout burst of reproduction (see "A Layman's Guide to HIV" in the December, 1988 issue). By rendering your T4 cells ineffective, or just outright destroying them, HIV interferes with your immune system and leaves you open to opportunistic infections (like blind- folding or killing the security guard so you can rob the museum). There is a wide variation in the individual response of your T4 cells to HIV, and exactly what your T4 counts mean is very unclear. However, studies have shown that 43 percent of people with less than 300 T4 cells per cubic millimeter developed AIDS over a three-year study period, compared with five percent of people with over 550 T4 cells/mm^3. The Walter Reed staging system for tracking HIV infection uses a criteria of fewer than 400 T4 cells/mm^3 as a significant indicator of the state of your immune system; other research shows that patients with T4 counts of less than 150 cells/mm^3 are at substantially higher risk for developing full-blown AIDS. Recent research seems to indicate that it is the trend of your T4 cell counts--steady, increasing, declining, or sharply declining--that is a better measure of the state of your immune system than the absolute count value of cells per cubic millimeter. This is yet another reason why ongoing monitoring of your health is important. As stated above, there is a lot of debate about exactly what having a certain number of T4 cells means. It is important to keep in mind that it is your overall health and immune system status which is really important-- the numbers can go hang. If your numbers are low but you aren't sick, don't panic. Similarly, just because your numbers are high doesn't necessarily mean that you can sit complacent. A long talk with your doctor about your OVERALL state of health, the result of evaluating a lot of different tests, not just your T4 counts, is much more informative. Between you and your doctor, you can plan a strategy for your total health care. ------------------------------ T8 CELLS Normal value: approximately 150 - 600 per cubic millimeter While the T4 cells scream for the cops to kill the invaders, the T8 cells (also called "suppressor/cytotoxic cells") act to reverse the process. They calm things down in your body after the T4 cells get things jumping. These cells also kill tumor cells, and kill cells infected with viruses. The normal ratio in your body of T4 "helper" cells to T8 "suppressor" cells is about 2:1 (2.0). After devastation of your T4 "helper" cells by HIV, however, that ratio can change radically in the other direction, to about 1:5 (0.2) or worse. This also helps explain why your immune system gets destroyed by HIV: with reduced numbers of T4 "helper" cells, but normal numbers of T8 "suppressor" cells, your immune system is told to stop working by the T8 cells before it ever receives the message to get going from the T4 cells. ------------------------------ B LYMPHOCYTES Normal Immunoglobin values: IgG: 650 - 1600 milligrams per decaliter IgA: 65 - 415 milligrams per decaliter B lymphocytes are the cells that produce substances called antibodies. Each antibody exactly matches a specific antigen (foreign cell component), much like a specific key fits a specific lock. (Think of assassins, each with their own specific target to kill.) There are five classes of antibodies, which are also known as immunoglobulins. Each class has a different role in the immune defense system, and they have names like IgG, IgM, and IgA. It has been found that the levels of IgG and IgA are elevated in people with AIDS. Why this happens remains a mystery, although it is might be due to faulty regulation of antibody production by the B cells. ------------------------------ NATURAL KILLER CELLS (NK CELLS) Normal value: greater than 50 lytic units per 10 million cells Natural killer cells are a type of lymphocyte that attack and destroy tumor cells and cells that have been infected by viruses. They are called "natural" killers because they go into action without additional stimulation (unlike other cells, which require your T4 cells to signal that they should do something). People with AIDS usually have decreased activity of NK cells. The cells often fail to react without stimulation, although their numbers may be normal. Some researchers are trying to use interferons (alpha, beta, gamma, etc.) to stimulate the activity of the NK cells in an attempt to overcome whatever portion of HIV infection is inhibiting them, and return them to their normal attack mode. ------------------------------ POLYMORPHONUCLEAR CELLS (POLYS OR NEUTROPHILS) Normal value: 2,500 - 5,000 per cubic millimeter Polys are mature white blood cells that eat bacteria and foreign matter in your blood. Neutrophils make up 40 to 80 percent of the leukocytes in your blood. When your total poly count is less than 500 per cubic millimeter, you are at an increased risk for bacterial and certain fungal infections. Although AIDS patients usually have a normal poly count, some medications given to fight HIV can cause a decrease in your poly count. ------------------------------ LIVER ENZYMES Normal value:SGOT: 0 - 50 units per ml SGPT: 0 - 50 units per ml Measuring the enzymes that are in your blood which are produced by your liver is a way of measuring how well your liver is working. If your liver enzymes (two such enzymes are SGOT and SGPT) are elevated, it means that your liver function is impaired. If the impairment is severe, you could be in serious risk of liver failure. Your liver is responsible for cleaning out the blood--removing the impurities and harmful substances. There are many reasons your liver function could be having problems: viruses (like Hepatitis A, Hepatitis B, Hepatitis non-A-non-B, Epstein-Barr Virus, Cytomegalovirus, etc.), chemicals, bacteria, drugs (both legal and illegal), and alcohol. Hepatitis is an inflammation of the liver, which can inhibit its ability to function. If serious enough, you can start to become jaundiced (which means your skin and eyes turn yellow). Alcohol has a very adverse effect on the liver, both because it is poisonous to your liver, and because it can cause a build up of fatty deposits within the liver, reducing the capacity of the liver to process your blood. Every year, there are approximately 4,500 deaths in the United States due to alcohol-induced cirrhosis of the liver (a condition in which the normal liver tissue is replaced by useless scar tissue). Drinking alcohol while you are recovering from any form of hepatitis is a real recipe for trouble. ------------------------------ ERYTHROCYTES Normal value: Adult Men: 5,000,000 per cubic millimeter Adult Women: 4,500,000 per cubic millimeter Erythrocytes are your red blood cells. They contain hemoglobin, which is what gives your blood its characteristic red color, and is also what carries oxygen from your lungs out to the cells in your body that need it, and carbon dioxide back to your lungs. If your erythrocyte count is markedly decreased, you are anemic. Severe anemia causes people to look pale and have a pasty complexion. Transfusions are often given to people to help counteract anemia. AZT and some other medications used to fight HIV can also cause reductions in the erythrocyte counts, as can internal bleeding. ------------------------------ PLATELETS Normal value: 140,000 - 440,000 per cubic millimeter Platelets are small irregular bodies that exist in large numbers in your blood. They are not actually cells, but are cell fragments that originate in your bone marrow and then break off to float around in your blood. Platelets change their shape and weave together tiny fibers to form clots when your blood vessels are injured or become exposed. A low platelet count could cause your blood to have difficulty clotting. (Note that clotting is an extremely complex process, requiring a very esoteric sequence of events to happen in an exact manner. Many other things, including a deficiency in Vitamin K or a coagulation disorder like hemophilia, can also cause problems with the clotting process.) ------------------------------ p24 ANTIGEN Normal value: 0, not present Much debate has raged over the usefulness of the p24 antigen test. p24 is one of the core proteins surrounding the RNA strands at the heart of HIV. If there are detectable amounts of p24 in your blood, it seems to mean that there is HIV active in your blood, too. The latest research guess is that patients show a high level of p24 right after infection, and then low or unmeasurable levels of p24 while HIV is in its dormant stage. The researchers believe that if high levels of p24 occur again, it is a signal that HIV has begun active replication in high numbers, and is indicative that the person may get full-blown AIDS within a short time. ------------------------------ PHYTOHEMMAGLUTININ (PHA) Normal response by T4 cells in the test tube: greater than 20,000 counts per minute PHA is a "mitogen," a substance which stimulates the division of a lymphocyte to form two new lymphocytes. It is used to measure a non- specific response of all T cells in a test tube to determine how well your overall immune system is doing. A person with AIDS usually has a decreased response due to a decreased number of T cells. ------------------------------ TETANUS TOXOID (TT) Normal response by T4 cells in the test tube: greater than 5,000 counts per minute Tetanus toxoid is an antigen (foreign substance) used to measure the response of your T4 cells to it specifically in the test tube. Most people have had tetanus immunizations (remember your mother threatening that you would get lock-jaw if you didn't have a tetanus booster after stepping on a nail on the playground?), so your T4 cells should recognize TT as an antigen and stimulate an immune response. The T4 cells of a person with AIDS lose their ability to function in this manner. Another way of testing for a response to TT is to inject a tiny amount just under the skin of the upper arm (this is called an intradermal injection). This pushes the skin up, producing a round, slightly raised area. The response of a person with a normal immune system is a reddened hard spot which appears within 48 hours. Most people with AIDS do not show a response. ------------------------------ While test results are important, and are giving us valuable insight into the course of HIV infection, they are neither infallible nor absolute. The methods used to collect results are subject to errors, and we still have much to learn about their meaning. In consultation with your doctor, test results should be used to help you decide what your course of action for pursuing treatment should be. Bear in mind, however, that low scores are not a guarantee of swift death, and neither are high scores grounds for indefinite complacency. ------------------------------ Much of the material contained in this article was derived from material supplied by the National Institutes of Health/National Institute of Allergy and Infectious Diseases, Laboratory of Immunoregulation. Grateful acknowledgment is made of both their permission to use their material, and their assistance in reviewing this article for accuracy. ------------------------------ NOTES: * On the other hand, there are research labs with well-developed standards, who report accurate, reproducible cell counts, and use these counts as part of a "staging system" to indicate the progression of HIV disease. Notable among these labs is the Walter Reed Army Institute of Research, which has developed the Walter Reed Staging System. ------------------------------ REFERENCES: AIDS: Etiology, Diagnosis, Treatment, and Prevention (Second Edition). Vincent T. DeVita, Jr., Samuel Hellman, and Steven A. Rosenberg, Editors. J.B. Lippincott Company, Philadelphia, Pennsylvania. 1988. Pages 48-50, 112-117, 216-217. McGraw-Hill Encyclopedia of Science & Technology (Sixth Edition), Volume 2. McGraw-Hill Book Company, New York, NY. Pages 620-631. "Bodily Harm: The Health Effects of Excessive Drinking" by Evelyn Zamula. FDA Consumer, May 1986. **************************************************************************** **************************************************************************** CORRECTIONS In "A Layman's Guide to HIV" (December, 1988), a few things were incorrect. The article implied that an individual HIV is a single strand of RNA surrounded by proteins; actually the HIV consists of two identical strands of RNA surrounded by proteins. The first sidebar explanation of DNA replication on page three is correct, stating that the pairing of bases is such that adenosine will only bind with thymidine, and cytosine will only bind with guanine. The second time DNA replication is mentioned on page five, the article stated that adenosine will only bind with cytosine, and thymidine will only bind with guanine. This is incorrect, as are the bases labeled inside the figures. **************************************************************************** **************************************************************************** OPTIONS+ DISCUSSES ALTERNATIVES OPTIONS+, the HIV alternatives group, meets monthly to discuss aspects of HIV infection, provide mutual emotional support, and to provide a relaxed social outlet for people with HIV. The next meeting will be on Thursday, February 16th, and will discuss different people's experiences undergoing drug testing protocols. The following meeting will be on Thursday, March 16th, and will focus on macrobiotics. Both meetings will be held at St. John's Lafayette Square Church, 1525 H Street, N.W. (take the McPherson Square Metro stop, White House exit). The meetings run from 7:30 p.m. to approximately 9:00 p.m. For more information, please call 229-0882 (evenings). **************************************************************************** **************************************************************************** BOOK REVIEW "AIDS: Etiology, Diagnosis, Treatment and Prevention (Second Edition)." Edited by Vincent T. DeVita, Jr., Samuel Hellman, and Steven A. Rosenberg. Reviewed by W. Howard Cyr This is by far the most complete treatment of AIDS from a scientific, clinical, and public health view point. For the most part, this large (nearly 500 pages) book is a medical text, but one that is surprisingly easy to read. All of the most well known researchers in the United States are authors, which include 57 scientists, practitioners, epidemiologists, and others involved in studying HIV or in providing care to patients with HIV disease. There are two foreign authors, Dr. Lurhuma from Zaire and Dr. Daniel Zagury of France, who worked together on a vaccine for HIV. There are twenty-eight chapters broken down into three major parts, one dealing with the structure and genetics of the virus, one with HIV disease and the different therapeutic options, and the last dealing with public health concerns of disease transmission and prevention. This thorough treatment of AIDS has been edited by Drs. DeVita and Rosenberg, both associated with the National Cancer Institute of NIH, and by Dr. Hellman of the University of Chicago. The charts, graphs, and diagrams are clear and add significantly to each chapter. The book is copyrighted in 1988, but some of the chapters were finished in late 1987, as evidenced by the data shown for numbers of cases of AIDS. I have to admit that the first part on virology does not have the beautifully illustrated pictures and diagrams that are found in the October issue of Scientific American, and people who are interested in only that part of AIDS or HIV would probably do well to stick to that resource. But this book goes far beyond the subject matter covered in the Scientific American articles, particularly with its in-depth coverage of testing (Elisa, Western blots, PCR, etc.), opportunistic infections, neurological complications, Kaposi's sarcoma, drug treatments, vaccine development, and AIDS in different groups (Gay men, pediatric cases, Africans, intravenous drug users, heterosexuals, etc.). Several of my colleagues have examined this text and agree that it is the best single source of information on the various aspects of AIDS. Even those who are not rigorously trained in biological sciences have found this text readable, although some chapters are more so than others. Again, those chapters dealing with the structure and genetic control of HIV tend to be the most difficult, and for some may be impossible. For those in research, in medical practice, and in AIDS education, this is a most valuable text. For those less trained, I suggest spending some time looking at the book before investing in it. On the negative side, this is an expensive text, costing about $52.00 and it is not readily available at your nearby bookstore. I purchased mine at the NIH bookstore, located in the Clinical Center (Building 10) on the NIH campus. (I have not checked to see if this book is available at other university bookstores, such as the bookstore in the student center at George Washington University.) The book is published by the J.B. Lippincott Company of Philadelphia. ------------------------------ W. Howard Cyr has a Ph.D. in biophysics, is a commissioned officer of the Public Health Service, and is the AIDS Coordinator for the Office of Science and Technology of the Center for Devices and Radiological Health of the Food and Drug Administration. **************************************************************************** **************************************************************************** AZT MAY CAUSE VITAMIN B12 DEFICIENCY Scientists from the National Institutes of Health and the University of Miami reported in the New England Journal of Medicine and Lancet that patients who are taking AZT often show signs of vitamin B12 and folic acid defiencies. It is recommended that anyone who is taking AZT have his or her doctor monitor B12 and folic acid levels, and consider taking supplements, either orally or through shots. **************************************************************************** **************************************************************************** PHARMACY OFFERS DRUGS AT WHOLESALE PRICES The Whitman-Walker Clinic recently opened a pharmacy which provides services to all persons who are HIV positive. The pharmacy can fill prescriptions for medications used to treat HIV-related conditions. The pharmacy cannot fill prescriptions for controlled substances such as pain medications. The pharmacy is open on Tuesday and Thursday evenings from 6:00 - 9:00 p.m. Your primary physician must telephone in your prescription at 483-1726 before your prescription can be filled. The costs for medications are set at the prevailing wholesale prices. Because of this, prices may fluctuate. Some drugs offered through the pharmacy are available at a significantly lower price than those available through commercial pharmacies. Payment for medication must be in the form of cash, credit cards (VISA, MasterCard, American Express), or personal checks in small amounts. No third-party payments will be accepted. In order to use the pharmacy, a person must: 1. be HIV positive; 2. have a physician call in the prescription at 483-1726; 3. be able to pay for medication in cash or by credit card or personal check; 4. be able to pick up prescriptions during pharmacy hours. For more information, contact the Whitman-Walker Clinic's Medical Services department at 797-3530. **************************************************************************** **************************************************************************** DENTAL CLINIC AVAILABLE TO PEOPLE WITH AIDS AND ARC The Whitman-Walker Dental Clinic provides treatment to people who are HIV positive and who are having difficulty obtaining dental services from outside dentists or who are unable to pay for outside dental services. The Dental Clinic is open, by appointment only, on Mondays from 1:00 - 5:00 p.m., Wednesdays 6:00 - 8:30 p.m., and Fridays 9:00 a.m. - 12:00 p.m. Preference is given to PWAs and emergencies. The clinic is unable to provide crowns or denture services. There is no limit to the number of visits. There is no charge for services; however, donations are suggested. The suggested donation amounts vary depending on the type of services provided. In order to receive dental services you must be HIV positive or have an AIDS or ARC diagnosis, and make an appointment by either coming in and speaking with the medical receptionist or by calling 797-3533. **************************************************************************** **************************************************************************** HEALTHWAY OFFERS DISCOUNT Healthway, a health and natural food store with five branches in Northern Virginia, is offering a 25 percent discount on vitamins to people who are HIV infected. Healthway features vitamins, natural organic foods, fresh organic produce, dried fruit, natural cosmetics and body care products, natural remedies, natural versions of snacks, rices, grains, frozen dinners, vegetables, spring water, bulk foods, and many other items. For more information, ask for the store manager (Wally at Arlington, Cheryl at Annandale, Melinda at Fairfax, Marcy at Springfield, or Gretchen at Manassas) or call Cheryl at 354-7782. **************************************************************************** **************************************************************************** SHORTCUTS How to get a handicapped parking permit Washington, Maryland, and Virginia all make parking permits available to handicapped persons. There are two types of permits which allow parking in spaces restricted to handicapped individuals. One is a permit for those who, due to their handicap, cannot drive. This permit is for use by the person providing transportation to the handicapped individual. The other permit is for use by an individual who is handicapped, but can drive. In order to obtain a permit, the handicapped person should contact the Division of Motor Vehicles (DMV) which serves the area in which he/she lives. That office will send the necessary application form to their home. The form can also be obtained in person at the DMV. The application requires identifying information on the applicant, as well as a signed statement from his/her physician which verifies that the applicant has a condition which warrants obtaining the permit. The completed form must be returned to the DMV, which will issue the appropriate permit. **************************************************************************** **************************************************************************** AEROSOLIZED PENTAMIDINE CLINIC BEGINS The Whitman-Walker Clinic recently announced the formation of a clinic for the administration of aerosolized pentamidine. Note that they are not providing the pentamidine itself (although it can be obtained through the Clinic pharmacy), but are providing the machinery (called nebulizers) which turns the pentamidine into a fine mist which can then be inhaled. Inhaled pentamidine has been shown to be very effective in preventing the recurrence of pneumocystis pneumonia. Nebulizers are fairly expensive (several hundred dollars each), so this clinic provides a low-cost or no-cost basis for people to receive prophalaxis (preventative measures) against pneumocystis cariini pneumonia. However, as the clinic is only able to provide services to a total of 48 patients, participation in the clinic is limited to individuals who have already had one episode of pneumocystis pneumonia or who have T4 counts below 200. The clinic is open, by appointment only, on Tuesdays and Thursdays from 9:00 a.m. - 12:00 noon. There is no charge for treatment; however, a donation of $10 per visit is suggested. In order to receive pentamidine treatment at the clinic you must: 1. have had one episode of pneumocystis pneumonia or have a T4 count below 200; 2. have a written referral from your physician addressed to the Whitman- Walker Clinic, requesting pentamidine treatment; 3. provide your own pentamidine (the clinic will aerosolize it and provide administration); 4. contact the clinic to schedule an appointment for treatment by calling 797-3533. If you have any questions, you can contact Dr. Basil Vareldzis at 797-3534. **************************************************************************** **************************************************************************** LIFELINK WILL BENEFIT FROM ROMANOVSKY & PHILLIPS CONCERT The George Washington University Lesbian and Gay People's Alliance and Program Board are presenting Romanovsky & Phillips in concert on Sunday, March 19th, at the Dorothy Betts Marvin Theatre at G.W., located at 800 21st Street, N.W., Washington, D.C. Romanovsky & Phillips have been described as a "gay Smothers Brothers," with music ranging from folk to comedy to ballads. Their unique style encompasses everything from do-wop to reggae. Proceeds from the concert will benefit LifeLink, the D.C. Coalition of People with AIDS. Ticket prices are $7.00 in advance and $11.00 at the door for G.W. students, and $10.00 in advance and $14.00 at the door for everyone else. Tickets are available at Lambda Rising, both branches of Lammas, the G.W. Marvin Center, and the House of Musical Traditions in Takoma Park. For more information or reservations, call 994-7590. *************************************************************************** Copyright (C) 1988,1989 by Washington HIV News, all rights reserved. Permission is granted for non-commercial use only.