European Stars and Stripes (Newspaper) - June 19, 1990, Darmstadt, Hesse Continued from Page 13 pregnant. It was an Accident but she really wanted a baby. Soon after she had an abortion. Quot i just could t take the risk a Mary says. Quot i have to wait awhile to see what she shakes her head sadly. She says it does no to make sense. She looks and feels healthy. She s not sure exactly when she was infected but it had to be More than four years ago when she quit shooting heroin. Despite efforts to fix up her life Mary can t repair the damage by the human immunodeficiency virus to her immune system. Quot i take at. I take care of myself and i can t give up Quot Mary says. Quot All those people who just give up when they hear they re his positive won t they feel stupid if they find a cure in a couple of years Quot she scans medical journals regularly hoping for a study some Day that shows it s possible to completely protect a fetus against transmission of the aids virus. Mary a Story is one that would have been rare just five years ago when Only a few dozen aids cases were reported on Long Island and most of those were homosexual or bisexual men. But Nassau and Suffolk s caseload totalled 1,398 in May and the majority of cases reported in the past three years Are no longer Gay men. They re in drug users like Mary infected by sharing dirty Needles. And increasingly they re women. More than half of Long islands female aids patients Are current or former intravenous drug users infected by dirty Needles. There also is another growing group of infected women that was exposed to the virus through heterosexual Contact experts say. Heterosexual Contact accounts for 29.8 percent of Long islands female aids cases a percentage that keeps edging up each month. But the number of female cases resulting from heterosexual Contact a 68 so far on Long Island a is so Small that some women Don t realize they have aids even after they Start feeling really sick. Quot its got to shake women up Quot said or. Mark Kaplan chief of infectious diseases at North time running out Shore University Hospital. Quot heterosexual transmission to females occurs regularly when a bisexual Man or heroin addict has a wife or steady at North Shore doctors keep a patient registry that shows that 20 percent of bisexual males with his infections have passed the disease to their wives. Even More troubling 45 percent of male heterosexual intravenous drug users have passed the virus to their wives. As a result 41.4 percent of the 256 his positive female patients treated at the Hospital have been exposed through heterosexual Contact. Another trend partially related to the increase in female aids cases is instances of More than one aids Case in a family typically an infected Mother who passed the disease to an unborn child. The Long Island association for aids care reports that 11 percent of its current caseload about 77 cases is composed of families where More than one member is his positive most of which Are Mother to child. A North Shore University Hospital based study showed in 1988 that of 106 his positive women who were undergoing regular counselling about the risks of pregnancy 10 of those women still had 11 pregnancies within 18 months. One pregnancy resulted in an his infected baby. Two of those women also subsequently infected male sexual partners. Kaplan says that despite the Best counselling efforts Quot we got three new As medical treatments improve doctors say they Are seeing More people living longer with with aids virus. Dan for instance says he was infected with the virus sometime in the late 1970s, after he dropped out of High school and started shooting heroin with friends. And although he already has seen Many of those friends die a he counts eight so far on his Long slim fingers a Dan himself has not yet been diagnosed As having aids. Although he a had pneumonia three times in As Many years Dan is classified As having arc a aids related Complex. Quot so far i be been pretty Lucky Quot he says. But he s worried that his Luck is running out. When he says Quot in a not going to be Here Long Quot it is Clear he is talking not about his tenure in the Hospital but his lifespan. New complications by Lawrence k. Altman new York times the array of infections and cancers that strikes people with aids is undergoing a shift that will affect patients their doctors and the ability of the health care system to Cope with the rising number of aids cases. In gains already made against the disease drugs Are helping people live months or even years longer and Are gradually controlling the pneumonia that was originally the most devastating infection to strike aids patients. But this Progress has led to a new plateau of complications. During the precious extra time granted them More people with aids Are now falling prey to several cancers and a bewildering array of secondary infections that most victims in the earlier stages of the epidemic did not live to get. Most of these infections were seen in some patients Early in the epidemic but Are now emerging in greater Force. However some infections Are taking on puzzling forms that pose a wholly new Challenge to the medical profession. Since aids first appeared in 1981, a lung infection pneuma Cystis Carinio pneumonia or pc has been the initial condition upon which the diagnosis of aids was usually made. Pc is also the leading cause of death from aids. Now the drug regimens of at aerosol Zed pent Maidine and Bactria that health officials have recommended in the last year Are staving off Many cases of pc. When aids is now diagnosed there is a greater Chance it is based on a wider variety of complications. They include a number of cancers secondary infections that have a predilection for patients with weakened immune systems muscle weakness nervous system disorders and striking Levels of wasting. infections of the Eye which can cause blindness for example Rose from 0.2 percent As the initial symptom of aids in 1983 to 2.4 percent in 1989, the Federal centers for disease control in Atlanta said. Wasting increased from 6.6 percent in 1987 to 19.7 percent in 1989. Pneuma Cystis and other infections Are also changing the Way they cause illness by appearing in unusual patterns and Sites in the body. Quot aids has changed dramatically in the last few months because the strategy of prescribing prophylactic drug treatment against pc is working for those who Start treatment Early enough Quot said or. Merle a. Sande chief of Medicine at san Francisco general Hospital. Quot aids is a different disease than it was last the new clinical face of aids has important implications for patients doctors and the health care system. For patients it is yet another hurdle to overcome in battling a lethal disease. There is More suffering As some aids patients have developed two or More types of cancer. For doctors diagnoses can be More difficult. Sometimes what looks like a spreading infection on a rays turns out to be a cancer. The change also has costly implications for the health care system. The chief Factor now complicating treatment of aids is an upsurge in cancer. Nineteen experts interviewed said Kaposi a Sarcoma Lymphomas cancers of the Lymph system and squamous cell carcinomas of the skin were an important and growing problem in aids. Quot aids related cancers Are being seen in increasing numbers Quot said or. Samuel a. Broder head of the National cancer Institute in Bethesda my Quot cancer is emerging As the biggest new Challenge in the treatment of he said a fresh research approach was needed to find effective treatments for the tutors. Patients with aids related cancers and other complications Are often very ill and require prolonged treatment in hospitals with combinations of toxic drugs that often make them sicker. Zapping aids by Malcolm Gladwell Washington Post a t the Root of the intensive worldwide search for a vaccine against aids is a Tim. Idea the Only thing sufficiently diabolic defeat the aids virus May be them j itself a combining some of the most sophisticated too inf genetic engineering with principles of Vir Loov that 1 Back 200 years to Edward Jenner s first smallpox vaccine scientists Are hoping to create a version of the human immunodeficiency virus that looks enough lib the real thing to provoke the body into Mountin a protective immune defense but different enough that it will cause none of the diseases devastating effects just How this task will be accomplished is not yet Clear. There Are at least 44 approaches to making a vaccine under study by at least 67 research groups in least six countries. But there is no guarantee the Effort will succeed Given the extraordinary complexity of the virus. Still after several years of disappointing results a series of successful tests of experimental vaccines in animals Over the past few months have buoyed the spirits of researchers and revived Hope that an effective vaccine can be made. Until recently it was not Clear that any vaccine could induce a protective effect. A the concept of protective immunity has now begun to be established a Anthony s. Fauci director of the National institutes of allergy and infectious diseases told a meeting of aids researchers a year ago i say that. Now i think that scientists Are at least reasonably confident that a vaccine will be developed in the 1990s.&Quot every vaccine from smallpox to polio to measles works on the same principle. When the human body is infected by a virus or bacterium the immune system will erect such Strong defences against the attack that if the microbe returns the body generally will have become immune to it 1nursing s disease7 by Lisa Levitt Ryckman associated press in 1984, Ellen Altmanns Boss at Laguardia Hospital in new York told her she was spending too much time assisting a Man who had aids. The physicians were angry with her and worried she was going to catch the disease by being in the same room with him so often. So she did the Only thing she Felt she could do. Page 14 a a a the stars and stripes said exclusive her is Are Yon to Haver catch so a ten ignorant since Ellen Art profess ii lives Are inc Rahl colleague taking01 else War a said said pm newly of aids virus Tow heart of the human immunodeficiency virus his is its sat of genes which command infected cells to make new copies of the virus. The genes Are packaged inside a Core of two shells each made of a specific kind of protein. Enclosing these is an envelope consisting of a membrane in which is embedded a third kind of protein it in turn is attached to a fourth protein. Enzyme that makes a dam copy of rna genes membrane vaccine strategies vaccines must contain some or All of the infectious agent s proteins because they Are what stimulate the immune system to attack. There Are several possible ways to present the proteins. 1. Whole killed virus cannot reproduce in the body but carries the full array of proteins. 2. Genetically altered live virus can reproduce multiplying the sheer Quantity of proteins but theoretically cannot cause disease. 3. Subunit of virus contains Only one or More viral proteins. Genes made Ofrona Core protein p21 Core protein p24 envelope protein a>120 Washington Post Johnstone Quinan. With aids r vaccines exploit this by provoking the body with a a i evincing a but harmless a copy of a virus triggering Strong enough immune response to defend against e real virus if and when it comes. The simplest Way to do this is to use the virus itself As vaccine after treating or Quot killing Quot it in some Way so at it looks the same to the body but can no longer use disease. This was the approach used in constructing a vaccine r polio and a number of other childhood diseases and is a strategy that has shown some Promise against ids. In the past year for example two researchers working Dependently have shown that Rhesus monkeys ovulated with a vaccine made from whole killed Simian Mun deficiency virus a a close Cousin of aids that tests monkeys a can be protected against infection f those experiments were welcomed As promising but by were hardly conclusive. Siv is not his and monkeys Are not humans. More to the Point the pediments were done under fairly Ideal conditions. Because killed virus vaccines Are biologically inert by have Only a one time effect of raising an immune spouse before the vaccine fades away. The searchers chose the moment when the monkeys Mune defences were at their strongest to inject them ill the virus. The strategy worked. But under real conditions the ids virus is unlikely to attack Only when the body s Mune system is at its strongest. And with aids unlike Ith other diseases even a momentary lapse in the by s defences can be fatal. Quot once this virus gets its foot in the door once it infects one cell its there for life Quot said Rene Desrosiers researcher at Harvard medical school and one of the Laders in the aids vaccine Field. Quot to make a vaccine Fiat works it will have to protect you absolutely against Fife Tion. That a something a vaccine has never done Desrosierss solution is to use the whole virus but not to kill it. Rather by genetic manipulation he would like to cripple it in some critical Way. Such a vaccine would still spread throughout the body like a real virus invading cells and replicating itself Over and Over. It just would not be harmful. Quot if you have a live virus in a non virulent form one that s in the individual replicating the individual is going to respond just As they would to a natural infection Quot Desrosiers said a you can t beat Mother but using a live virus raises new safety questions. What if for example after years of mutating within the body As his does in a real infection the crippled virus reverts to its natural state what if it combines with the same viruses it is attempting to guard against to create an even deadlier Strain and would the Public accept being inoculated with a live version of the aids virus Given this problem numerous researchers have chosen to focus their attention on specific pieces of the virus which obviously cannot cause disease by themselves but May be Able to persuade the body to mount an immune response. Added in my resignation Quot Ellen hem a i be decided to work Ith patients with Quot Iso was astounded. Quot what it Aren t you afraid you want Lily someday. You re going to Ling Quot raid Quot Ellen said. Quot in a just not Lime before aids had a name Altmann have built their and sometimes personal a caring for people with the fatal lease. They Are both nurses 3t seven years spouses for five Hob it seemed at times no one specially nursing s disease Quot now the head nurse for the d aids unit at Lenox Hill p 19,1990 nurses de and Ellen Altmann with their son have built professional a and sometimes personal a lives around caring for people with aids. Hospital on Manhattan supper East Side. Quot i could work in a doctors office i could work in a lab i could work in surgery i could work in maternal child health where a lot of things Are mostly Happy. Quot but i think this is really the essence of if aids is nursing s disease As the Altmanns believe it is because medical technology has made so Little headway against it. Nursing care can make a difference can help keep a person with the full blown disease out of the Hospital. But few drugs have any Impact on the inexorable ravages of the virus. Quot i think this is a particularly insane profession very strenuous where you re always facing insurmountable Odds Quot said de 36, who works in the nursing end of aids research running drug trials for the Community research initiative. Quot working in a Field like this keeping that separation Between personal and professional keeping some control Over your life it really is a skill. A lot of people do Burn out. But to stay in it you really have to develop those boundaries for there have been Many times in their lives when the boundaries Between their personal and professional lives have disappeared lost in their passion for their cause. After Ellen resigned she and de went to St. Clares a Small aging roman Catholic Hospital tucked into Manhattan a Tough Hellas Kitchen neighbourhood. There in the City a first dedicated aids unit they worked 14-hour Days creating what would become a Model for other hospitals. The two of them were the entire nursing staff a pair with distinctly different yet complementary styles. She s intense matter of fact a doer who exudes Confidence and competence he a More easy going a Low key observer who seems quietly self assured. They also were newlyweds spending 24 hours a Day together supporting each other fighting the Tough fight and Loving it. Quot we spent More time together working than we Ever have Quot Ellen said. Quot we were fighting for a cause together something we were both committed Quot it was a tremendous task and a thankless Job quoted said. Quot but by doing it by putting ourselves in that situation we got the Opportunity to learn How the system really works How to Start a new program and make it fit into a Hospital that a very resistant to at first the doctors would t come to their floor the housekeepers would t come the a Ray technicians would t come. The Kitchen served patients meals on paper trays. The fear was palpable. Gradually that changed. As the years passed staffers who had resented mandatory aids education classes that Ellen taught began asking for them. What never changed was the relative youth of the patients Many of them vital people at the height of their careers and the inevitability of their deterioration. Quot we both ended up getting involved with special patients who for one reason or another became very close to us Quot Ellen said. Quot we were Able to support each other through their As patients have become their friends Over the years so some of their friends have become patients. For months the Altmanns took turns nursing a Friend who required daily care. They were the Only ones he would allow administer his twice daily intravenous medication. Either de or Ellen would visit him in the morning before work and the other would come in the evening. They kept their Home stocked with in supplies in Case he was visiting their Queens neighbourhood. Quot we never made any plans that did t include seeing him or communicating with him in some Way Quot Ellen said. Quot we restricted our lives based on How he was feeling because we always wanted to be available. Quot it was really stressful and there were times we were angry. We have gotten so involved a but How could we not Quot she said adding that their care helped the Friend avoid two or three hospitalizations. He died in january. Quot i Don t regret any of it Quot Ellen said. A even though at times it seemed overwhelming for him to be so dependent on us and us to have All our social plans revolved around his care i would not have done it any still the Days Are gone when they would unhesitatingly dedicate every spare minute to aids care with Little thought to their personal lives. Now de spends two Days a week at Home with their 20-month-old son Joshua and Ellen makes it a Point to work regular hours and spend evenings and weekends with her family. But the nature of their work a the intensity of the demands the inevitability of death a Means they always will need to look to each other for special support. Quot when you re talking to a Friend who is not a nurse and they ask what do you do i can to possibly answer Ellen said. Quot i can talk to you for weeks and weeks and weeks and you still understand All the things i do As a nurse. And de Quot sometimes quoted said a just a couple of words and i know exactly what she s going the stars and stripes a a a Page 15
