Gay Men's Health Crisis: Treatment Issues, Volume 7 no. 7 July/August, 1993
David Gold

Tap water in American cities may pose risks to PWAs, according to several recent reports. A study presented at the General Meeting of the American Society for Microbiology suggests that drinking water in Los Angeles may be a source of Mycobacterium avium intracellulare (MAI), as well as other mycobacteria. The study found non-tuberculous mycobacteria in all hospital water supplies sampled, 34 of 40 home water samples, and eleven of thirteen reservoir samples. MAI was found in nine of ten hospital water supplies, eleven of 40 home samples, and five of thirteen reservoir samples.

The Report of the Expert Panel on New York City's Water Supply (1993) noted that potentially infectious levels of Cryptosporidium and Giardia, two serious intestinal parasites, were found in the city's water supply. Furthermore, the panel noted that measures to protect the city's water supply from these pathogens, such as an improved filtration system, were unlikely to be implemented within the next ten years.

As many as 200,000 residents may have developed cryptosporidiosis in Milwaukee this spring due to contamination of that city's water supply. The contamination is believed to have been caused by drainage from cattle and dairy farms into the municipal water system. There is no effective treatment for cryptosporidiosis and in PWAs with low CD4 cells the disease can become chronic and life- threatening. The Milwaukee AIDS Coalition reports that 48 percent of 404 PWAs surveyed experienced symptoms suggestive of cryptosporidiosis during the period. In addition, twelve PWAs were admitted to hospital and three died from dehydration due to diarrhea, according to a report in The Lancet (4/24/93; 341:1084). As Treatment Issues goes to press, New York City officials reported July 27 that potentially infectious levels of E. coli bacteria were found in the water supplies of two neighborhoods: parts of the West Village and Chelsea and parts of the Lower East Side. They advise boiling water for cooking or drinking at least three minutes before use. They warn the elderly, young children, and people with HIV to exercise extra caution.

Larry Waites, a San Francisco physician, recommended in his regular column in The Advocate, a national gay newsmagazine, that PWAs with CD4 counts under 100 or those with recurrrent bowel problems drink only bottled water. If bottled water is too expensive, he advises tap water be boiled and then stored in containers which have been washed with hot soapy water, rinsed, and allowed to dry completely.

Correction

In "HIV Therapeutic Vaccines: The Next Phase" (Treatment Issues, June 1993) the chart Therapeutic Vaccines in Clinical Trials incorrectly described the HGP-30 vaccine as derived from the LAI strain. HGP is derived from the SF2 strain of HIV.

Self-Care Manual for HIV-Positive Inmates

The Treatment Education Program of AIDS Project Los Angeles produced Be Good to Yourself, a self-care manual for inmates with living with HIV. Copies are available free of charge by calling Stephan Korsia at 213/962-1600 ext. 270.

TAG Publishes Drug Company Report Card

The Treatment Action Group (TAG) released its Annual Drug Company Report Card. Copies are available by sending a stamped self- addressed envelope to TAG, 147 Second Avenue, Suite 601, New York, NY 10003. Donations are welcome.

Parvovirus Linked To Anemia

A recent report from the University of Iowa (Journal of Infectious Diseases July, 1993. 101-105) further suggests that parvovirus B19 can persistently infect people with AIDS, resulting in bone marrow suppression and anemia. The researchers analyzed patients who entered the ddI expanded access due to AZT intolerance, particularly severe anemia. They found that four of five patients who entered the program with severe anemia while on AZT had persistent viremia. They suggest that parvovirus B19 infection, which can be treated with intravenous immunoglobulin, should be considered in people with AIDS, particularly when cytopenias occur.

Severe Toxicities and Deaths in Hepatitis B Drug Trial

A phase II clinical trial for fialuridine (FIAU), a nucleoside analog being studied for chronic, active hepatitis B, was halted due to severe liver or hepatic toxicities. Three patients required liver transplants, reportedly because of the drug's damage to the liver. Two of these subsequently died and one is still awaiting a transplant. The drug was under development by Eli Lilly. This episode points to the real risks that often accompany enrolling in clinical trials for unapproved therapies. PWAs must consider many complex factors when deciding whether to enroll in any study. The invaluable contribution so many have made by entering clinical trials for new therapies with unknown risks must be acknowledged and appreciated.

Resistant Enterococci, New Threat in New York Hospitals

Enterococci are bacteria which cause serious urinary or gastrointestinal infections, and in some cases death, if the bacteria enter the blood stream. Antibiotic use may predispose to enterococcal infections; antibiotics kill off "good" bacteria in the intestine which allows "bad" bacteria, like enterococci, to grow. Also, enterococci can be transmitted between patients in hospitals; enterococci account for 12 percent of hospital acquired infections. No curative therapy exists for enterococci. Vancomycin is the most widely used treatment for enterococci. A new study reported in The Lancet (July 10, 1993. 76-79) noted the wide-scale emerge of vancomycin-resistant enterococci in New York City hospitals. The first report of a vancomycin-resistant enterococcus isolated from a patient occurred in 1988. By October, 1991, 38 hospitals in New York had reported vancomycin-resistant enterococci. The authors suggest further surveillance of resistance patterns, contact isolation, strict hand washing for hospitals, and reduced use of vancomycin and cephalosporins.

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