PR Newswire; Tuesday November 25, 12:25 pm Eastern Time

VA is recognized as a leader in the study and state-of-the-art treatment of AIDS. It has been the nation's largest single source of AIDS care since the beginning of the epidemic in the U.S., having cared for more than 27,000 AIDS patients. Today, 150 VA facilities treat about 16,000 patients with HIV or AIDS each year.

In addition, VA has four specialized centers for research on AIDS -- Atlanta; Durham, N.C.; New York; and San Diego -- and VA scientists across the country last year received nearly $27 million from VA and other sources to support more than 260 studies on diagnosis, treatment and prevention of the disease. In 1987 and 1988, VA established specialized AIDS clinical treatment units at its New York, Miami, San Francisco, and West Los Angeles medical centers.

The Joint United Nations Programme on HIV/AIDS has devoted the 1997 campaign for World AIDS Day to raising awareness about the plight of children affected by the disease. It estimates that by the end of this year, about one million children under the age of 15 will be living with the virus, and within a decade AIDS will be a major cause of death among children.

Because most children acquire the virus from HIV-positive mothers, an adult-oriented health-care system such as VA's has an important role to play in improving the knowledge and sense of responsibility of both men and women about HIV prevention, and by increasing women's access to antiviral drug regimens that can cut the risk of mother-to-child transmission.

World AIDS Day 1997 comes as the VA health-care system is expanding its emphasis on primary and outpatient care. Outpatient services are a growing part of AIDS care and present greater opportunities to treat and counsel HIV- positive veterans and those at risk of developing HIV.

Some VA facilities will mark World AIDS Day with special displays, distribution of literature, or other educational programs.

Recent research by VA investigators includes the development of new tests for antiviral drug evaluation and identifying a connection between an AIDS- associated virus and the bone marrow cancer multiple myeloma.

VA researchers also have published their discovery that dormant HIV hides in immune system cells even after drug therapy has suppressed the virus to virtually undetectable levels in a patient's bloodstream. Another project showed that monocytes, a type of immune system cell infected by the AIDS virus, cause the brain's nerve cells to destroy themselves, which could lead to new blood tests to detect the onset of AIDS dementia and help scientists test treatments to prevent it.

AIDS TREATMENT AND RESEARCH: Fact Sheet

Acquired Immune Deficiency Syndrome (AIDS) was first recognized in the United States in 1981. A debilitating, often fatal disease, AIDS represents the most severe manifestation of infection with a retrovirus widely known as HIV (Human Immunodeficiency Virus). Reporting in VA began in 1983 when 61 patients were treated in VA's health-care system.

WORKLOAD AND TREATMENT

VA, the nation's largest single source of AIDS care, provided treatment to 12,636 individuals with HIV infection and AIDS through July 1, 1997. Of those patients, 2,421 were treated in VA medical centers for the first time. Cumulatively, VA has treated more than 27,000 cases of AIDS.

Clinical guidance on the appropriate use of new therapies has been developed by a VA group of leading clinical and research experts from across the country. VA's guidelines include recommendations on promising new drugs against HIV, including protease inhibitors and the use of combination anti- retroviral treatment and viral load measurements. These efforts also have encompassed recommendations for preventing and treating opportunistic infections in HIV and AIDS patients, conditions which can flourish when the immune system is suppressed by the underlying disease. In the past, the approach of American medicine generally was to initiate AIDS treatment when HIV-positive patients exhibited signs of extreme illness, but the goal of treatment today begins with bringing the virus to undetectable levels. Newer pharmaceutical combinations, or cocktails, have been prolonging life for at least one or two years. The antiretroviral therapy is expensive, but the guidelines stress that several studies have demonstrated that many of these costs are offset by decreased hospitalization, illness and death rates.

VA's guidelines require that all 11 of the current antiretroviral drugs be made available at each facility, offer guidance for choosing the best combinations, and provide recommendations to minimize and deal with drug resistance. These steps reflect VA's commitment to technology transfer, taking knowledge gained from its world-class research program in such areas as viral load monitoring and applying it to clinical care.

VA health-care teams provide care to these veterans in a number of settings, including specialty and primary care outpatient clinics, inpatient units, home-based hospital care and hospice settings. Under VA's research program, some patients may choose to be treated in a research protocol.

TRAINING

VA conducts national training programs and teleconferences on timely issues related to prevention and treatment of HIV/AIDS and patient health education. During fiscal year 1997, teleconferences were held on occupational exposure to blood-borne pathogens and opportunistic infections. In addition, a conference to update physicians on clinical care of HIV/AIDS patients was held. VA routinely trains new and replacement counselors at VA medical centers who have primary responsibility for educating patients in preventive measures and for providing pre- and post-HIV antibody test counseling.

SPECIAL CARE MODELS

In addition to the medical and health-care services available at all facilities, VA has four AIDS clinical units designed to serve as models for innovative delivery of health-care services and medical treatment throughout the system. These clinical units are located at medical centers with large numbers of veterans with HIV infection or AIDS -- New York, Miami, Los Angeles and San Francisco. The models of care vary from dedicated inpatient units to an outpatient model which integrates inpatient services on general medical units. Each model uses a multidisciplinary team approach for coordinated and comprehensive inpatient and outpatient care.

RESEARCH

VA conducts wide-ranging research in AIDS, from basic studies of the mechanisms of AIDS to clinical trials and assessments of the costs of patient care. Special research initiatives are a critical part of VA's response to AIDS. Four special centers for AIDS research -- Atlanta; Durham, N.C.; New York; and San Diego -- are part of VA's efforts to improve the diagnosis, treatment, and prevention of the disease. Research there includes studies of the bacterial and mycobacterial complications of HIV infection, the epidemiology and clinical effects of resistance to antiretroviral drugs, and markers of clinical progression of the disease.

Scientists at the special centers and at other VA medical centers across the country last year received nearly $27 million in funding from VA and other sources to support more than 260 studies. Recent research advances by VA investigators include:

* The discovery by researchers including a VA team in San Diego that dormant HIV hides in immune system cells even after drug therapy has suppressed the virus to virtually undetectable levels in a patient's bloodstream. This indicates that suppressive therapy must continue indefinitely until scientists learn how to eliminate the reservoir of virus.

* Studies by investigators in Los Angeles and Durham, N.C., that showed blood levels of HIV and the count of the T cells targeted by the virus provide reliable indications of the effectiveness of drug treatment for AIDS. The findings could help accelerate approval of drugs for HIV treatment.

* The discovery by San Francisco researchers that monocytes, a type of immune system cell infected by the AIDS virus, induce the brain's nerve cells to destroy themselves. This could lead to new blood tests to detect the onset of AIDS dementia and help scientists test treatments to prevent it.

VA's large network of medical centers and clinics and its stable patient population provide an established system for large clinical trials, historical studies, drug treatment trials, and vaccine studies. In seeking better understanding of AIDS, VA also works closely with many other organizations. These include VA-affiliated universities, the National Institutes of Health (NIH), the Centers for Disease Control and Prevention, the Department of Defense, the AIDS Research Consortium, the NIH-funded Community Program on Clinical Research on AIDS, and the Food and Drug Administration. Increased collaboration and interaction among these organizations enhances opportunities to discover new and better treatments.

SOURCE: U.S. Department of Veterans Affairs

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