NewsNight Maryland; 111

World AIDS Day comes home to Marilyn. Is there a way to make the killer disease go into hiding. That. Is. Just like. With Baba. And Camilla good. Good evening to look at the statistics may at first be misleading. Maryland has one of the nation's highest proportions of AIDS patients in the country. But the state is also a leader in the nation when it comes to prestigious institutions treating those patients and working to cure the disease. On tonight's edition of NEWSNIGHT Marilyn the state of the AIDS patient in 1997. Have researchers found a way to scare the virus into permanent hiding. And tonight's newsmaker a long time fixture on Maryland's political front Senator Barbara Mikulski. But first it's time to check in our news making headlines around the state and in the district tonight with Nate Howard who's in for Jeff's Elkan. Nate thanks Kamila Good evening everyone. World AIDS Day signals a temporary change in the way Maryland handles calls to the AIDS information hotline. Now starting this week

all calls to the Maryland line will be referred to the National AIDS hotline. State officials are currently seeking a new vendor to handle calls. That number is 1 800 342 AIDS extension 2 4 3 7. Again that's 1 800 3 4 2 2 4 3 7 extension 2 4 3 7. A top zoning official rejects Montgomery County's controversial plan to build a conference center in Bethesda. Now the problems focus around an undefined plan to handle increased traffic around the White Flint metro station 60 million dollar endeavor is one of county executive Doug Duncan top priorities. Now Marylanders like their privacy according to the NBA more than 1000 motorists a day are taking advantage of a new law allowing licensed drivers to keep their records private before September 1st of this year anyone could obtain driver's license information for a $5 fee. Hagerstown residents are blaming it on El Nino. The nearly legendary storm front is credited with breaking rain records in the western Maryland region. More than four inches of

rain fell in the first seven days of November alone. That's it from the NEWSROOM. Now back to IN THE STUDIO. Thank you. It's estimated that in the city of Baltimore alone 14000 people are living with AIDS. It's also estimated half of them aren't receiving any kind of care for the disease. Many of those with HIV and AIDS some who lost loved ones to it gathered today at a quilt signing at the University of Maryland Medical Center. It's all part of the NAMES Project the huge quilt bearing the names of those who died of AIDS. Some say science isn't doing enough for the AIDS patient. Others have a very different point of view. Medications so-called drug cocktails have worked wonders for some. Tonight one man's story of how science and medicine have mixed for a better quality of life. Jim how are you how are you. You ok. You've been in a very short time James ball's health has taken a lot of sharp turns. Four years ago he learned he was infected with the virus that causes AIDS in the succeeding

months he developed an eye infection characteristic of the disease. Then last year he struggled through a life threatening case of pneumonia. It was after that that doctors put him on a combination of medicines that has given hope to thousands of people with AIDS. So it's been a tremendous improvement. People in from life from the from the right for people who are dealing with us. And. Those who are involved in this and bringing it to this level they are in. You know there's there are words that can express the appreciation now to stay healthy. Ball must take a long list of pills every day. The so-called cocktail of drugs anti-retroviral is and the newer protease inhibitors. He also takes a fourth medicine. Oh it's still experimental. The first time I took it it was a little get a little queasy and chills but then after that it just moved into place. Going to take to get used to a couple of days in the past few years have seen dramatic developments against AIDS.

For the first time since the beginning of the epidemic cases are declining nationally and in Maryland although the state still has one of the highest rates in the country ranking fifth behind Washington D.C. New York Florida and New Jersey. It's particularly high in the black population. But the recent development of new medicines offers hope that the infection isn't the death sentence it once was. In fact some researchers were hoping the virus could be eliminated from some patients by now. That hope has proved premature. Researchers at Johns Hopkins went looking for evidence that the virus could lie dormant inside the body's infection fighting T-cells. And the question was Is there any reservoir for the virus in these people or can it persist in a silent form in their cell. To answer that question scientists needed a large number of purified T cells to study. That's where Joseph Margolick slab and a sophisticated device called a psych Tom came in and you can see that population indicated by the density of the

dots. Each dot is this hour where their color is brighter. Means more cells using the flow cytometry we could select out the resting T helper cells and eliminate the others. And that led to a very curious specimen which could be used for the tests that were done looking for HIV in the cells. Unfortunately HIV can establish a state of silent infection in these memory T-cells and there since their biological function is to persist for a long period of time. This allows the virus to have a fairly stable reservoir inside of these memory cells and to persist in these memory cells for weeks months years even if that means that the triple drug therapy as effective as it is at lowering the virus level can't entirely eliminated. It was something we all hoped would be true but I think most of us were

telling our patients that unless unless something happened to prove us wrong we would be using these drugs for life and to keep the virus in check. It's vital that people with AIDS maintain the rigorous routine of pill taking that has become a big problem for many patients such as I.V. drug users. The implications are serious in that if people don't adhere to these therapies not only do the therapies not work for them but they're at risk for developing resistant strains of the virus that could be passed from them to other people. And that's a real serious problem. If you want these drugs to last you for decades if you want to become elderly AIDS patient without having any problems from HIV you've got to take them streamline religiously I don't know of another disease that's quite where the therapy is quite so demanding even for highly organized people like Jim Ball. We developed it as part of your life as a normal part of your routine. And you know don't make it that though it's something you have to be frightened about. Just do it.

Joining us now to discuss the breakthroughs in AIDS treatments are Dr. David block associate professor of epidemiology at Johns Hopkins University. AIDS researcher Dr. Robert Cilla Cano and James Ball who is living with AIDS and a member of the Northern Virginia HIV consortium. Good evening thank you for joining us. Mr. BALL Could you show us the medications you take. Sure can. I have four drugs that are part of the clinical trials of the new trials that have just started at Hopkins. These are protease And if you read rotation Hibbard anti-retroviral and there's these are vitamins two other drugs three TC and the other one is zero at 40 milligrams. New fees have been standard since the beginning this is the protease inhibitor and these are vitamins which I have to take as well. How often how often during the course of the day are you taking opiates a protease inhibitor you have to take three times a day

four tablets three times a day and you have to space them out approximately eight hours apart you have to watch your meal intake. Technically you can take these one hour after you have your meal and you pretty much you have to stay with it if you expect it to be effective so you have a pretty rigid schedule you have absolutely because of the cost. I mean this is only part of it. These are hydroxyzine there's a whole series of things that I have to take. Well what can you describe the condition you you were in before you were started on the drug cocktail. Well before I started on the cocktail I had developed pneumonia in one night in early 1996 and it was quite serious. I mean it was I was laid up for about two and a half months after that. I recovered from the Monia and then I wound up with retinitis which afflicts the ICM vein and I had to have a catheter inserted and that was a liquid transfusion of against like liver

I had dead in me for about two months. Then I developed pneumonia again in May. That's just to say it started with the trials and we had to stage the use of the medication because of the problems of the liver studies and its impact on the blood. Doc so it kind of how what really is the drug cocktail. Drug cocktails a combination of protease inhibitors which are drugs that inhibit the maturation of the virus and inhibitors of reverse transcriptase which is an enzyme that is converts the viral genetic information from RNA into DNA and in combination they can essentially stop replication of the virus in many patients they can essentially completely stop it. This was a huge breakthrough when that when they started being announced certainly at the Vancouver AIDS Conference and yes it raised a lot of hopes. Yes I think there is a very good reason for optimism. As I said these drugs can stop the virus in

its track essentially and in many patients. The only thing that is left is indicated by our recent research is cells that were infected prior to the time the patient went on therapy. So that if the patient can maintain this drug regimen there is no reason to expect that they can't continue to do well for a very long period of time. Dr. Block Why is the rate of infection in Maryland so high. The rate of infection in Maryland is very high it's very high compared to some of the surrounding states and I think a lot of that has to do with injection drug use I think that's been one of the leading groups with transmission of HIV in the state. Is is that also the highest rate of people giving it to other people as well or. Well that's been true from the beginning of the epidemic that if there's going to be transmission into the heterosexual community that's been seen to be coming from

the injection drug users. One of the things that's been done in the state of Maryland about that was to have a needle exchange program that was set up to be able to provide sterile needles and to collect dirty needles. In Baltimore that's been operating since 1994 and I'm really very glad to report that the rate of HIV infection since 1994 has been coming down. So there have been a number of other prevention efforts by a number of different groups and I think we're beginning to see some impact here and in Maryland. How are the clean needles distributed. Well there's two vans that go out from the Baltimore City Health Department and starting in about a week. There will be two pharmacies in West Baltimore that are deputized as needle exchange sites that have injection drug users that come up register for the program and then they're provided in exchange for dirty needles brand new clean sterile needles that they can use.

The idea is to get the dirty needles out of circulation. But it's also to provide the new sterile needles for injection and to have the continuous contact with individuals so that over time you can establish rapport and to be able to link people with services which is I think one of the key elements that we're going to need to have working with this population. Dr. silicone How can you summarize what your research which was just reported found. Yes we looked in patients who had taken the sort of cocktail that Mr. Ball was taking and who had responded very well who had no virus detectable in the blood by standard methods for up to two and a half years. And we looked to see if we could find a residual form of the virus a reservoir in a certain type of T-cell known as a memory C4 cell which we'd expected might contain this reservoir. And in fact we found that these patients still

had in their T cells a form of the virus that was persisting. It was a in a silent state of infection it wasn't causing really any problem for the patient wasn't developing resistance to the drugs. But it was persisting and that raises the possibility that if patients go off their AP this reservoir could sort of rekindle the infection. But the numbers of these cells were very small. Unfortunately they just don't seem to be decaying or disappearing and at a very rapid rate. During this period of latency is the virus transmittable. Uh that's not clear I think. And we should ask Dave but I think that the drugs dramatically reduce the chances of transmission and certainly that's that's been seen in the case of maternal fetal transmission thocht thought. I think the expectation is that the risk of transmission should be reduced substantially. One of the concerns I think that people have is that if you have a person that starts on

the combination therapy and they feel better are they going to. Limit you know stop the risk reduction activities. You know saying well the viral load has gone down and might that pose a risk of transmission I think that's a concern that some people have. And so when people are on therapy and they do feel better I think it's very important also remember that you know the virus may not be completely gone and that it's important to continue to be careful. This is a big issue now in health circles there was a big conference on it last week in Washington about compliance How often do you find Mr Ball yourself forgetting skipping a dose. And sometimes it made it would be foolish not to indicate that you know do you have a lapse but you usually pick up right away if you miss one you pretty sure you're not going to miss it again at least for a while. And you keep makes this particular you gotta keep it a place where you know where it's available. We have in the car

a dresser you can have an extra body to keep it in the kitchen. It's always there to remind you that you have to do this. One of the public health implications of say noncompliance of lapses. It doesn't go beyond say an individual developing a resistant strain. Well I think there's some concerns about that that if a person were to not be compliant with therapy that they may develop a resistance to the medications and that if they were to then transmit to another person transmitting a resistant form that. You know you start losing the ability to be able to have the successes that we've seen recently. If lapses do occur does anyone know how quickly the virus bounces back from its latent stage back to an active stage that's not clear yet because no one has been on this therapy for a long period of

time has gone off therapy and been followed in a really controlled way I mean there are anecdotal reports of patients stoppings therapy for reasons of toxicity and so forth and the rebound is quite rapid in a matter of weeks. There are two or three rare reported cases where patients didn't rebound and it's not clear what the explanation is. Does your research suggest that. That you could keep the virus. Dormant long enough so that the natural T-cell through the natural course of events would simply die and be replaced and then you'd be eliminating the virus that way. Yes we're what we're hoping the cells like most other cells in the body do die and turn over and are replaced at some some rate. And we're hoping that patients can stand therapy long enough for this reservoir to completely disappear we're trying to measure Now how long that will be. Unfortunately in looking over the course of two to two and a half years we don't see much drop. So that

suggests it's going to be a matter of several years before this reservoir decays completely. Mr. BALL How do you feel now. Much better than I did last year. You know it'll play a fair amount of vitality and I'd like to do things accomplished things. I'm a politically active and do some volunteer work. I think that the point of fatigue is usually reached in the afternoon and then you have to slow down the stop. Can you estimate how much this is costing. We did a survey on this. The total cost. If you put a price tag on a lot of this is somewhere between 25 and 20 a thousand dollars a year it's over. Is it all covered. Some of it is covered. OK but no one quick final question what are the prospects for soon for a vaccine. Against AIDS.

Any idea I think we've made much more progress in terms of drug therapy than than we have in terms of vaccine and the vaccine is a very difficult problem. But there are lots of new ideas and I think it's it's going to be possible but we haven't made the kind of. Really profound breakthrough that we have with the protease inhibitors. Well thank you all very much for joining us. Straight ahead Senator Barbara Mikulski Camillo sits down one on one with the Maryland newsmakers. When we return. Two shows two perspectives on you. Why do people feel. The levels of power. Joy medical intuitive caring made for two special shows that focus on both your physical attention. On NPT.

From the world's most prized treasure. The news. Today. Thank you. Thank you. She's been a figurehead for Maryland's political scene for a quarter of a century. Tonight's

newsmaker Senator Barbara Mikulski. Senator thank you for joining us. You know I want to go back to our earlier discussion on AIDS just briefly talk about what is the status of AIDS funding. Well right now we're working on two fronts one research to find a cure and that's being done it and University of Maryland Dr Gallo's project and Hopkins we've increased funding by a billion dollars. Then the service component was talked about social services prevention and community education. We've also That's the Ryan White program. And we've got one billion dollars in the budget this year to really try to provide services who have Dade and education to prevent what. What FDA reform. Well FDA is something I'm real proud of because we did it on a bipartisan basis. We changed the FDA wrote rules from being bureaucracy oriented to patient oriented. We've streamlined the regulatory process so biologics pharmaceuticals can

move more quickly into clinical practice maintaining safety. We must maintain safety. So it took us three years to do it. President Clinton signed the log last week and I believe things will be able to move more into clinical practice expeditiously. You mentioned a favorite word in politics partisan bipartisan partisan politics in Congress. Do you think the public is fed up with it. I think not only the public fed up with it I think a lot of the people in Congress are fed up with it. When we came back last year I was fed up with the big Pourquoi of the year. Tarte and I called up my friend Senator Kay Bailey Hutchinson a conservative Republican from Texas and said you know it's got to begin with us and let's bring the women together. So we started meeting once a month when issues we focused on the women's health agenda like breast cancer mamá graphy standards. And we said we would come together and not quite politics with a woman's health agenda. And guess what. We've had enormous success at it. So you going to try to

market that to the other members of Congress. Well I think we do it selectively we did FDA on a bipartisan basis. But I'll tell you where we really need to come together and that's one campaign finance reform. Let's talk a little bit about that you have back that and yet you're Worchester hoping to get 3 million for your election next year an election the political pundits right now are saying that you are a shoo in for but that could also be the kiss of death this is it is a lot of politicians no. Is there a contradiction there. Well when Camilla first of all one week of TV in the Baltimore metropolitan area is one hundred fifty four thousand dollars one with one network shows in the Washington area is one hundred and eighty thousand dollars. So if I want to be when television just for three weeks to talk about my record encourage people to support me. That's one million box right there. And I haven't sent out one mailing or hired any

staff. So I think people don't realize how expensive it is but it's not what we raise. It's how we get it. I'm for campaign reform limits so you would quite some limit when how would someone who could spend so they can buy election limits based on population. And then I would try to give TV vouchers for raising money from donors and in-state. But isn't the problem right now it's the soft money contributions. Well there is a lot of problems one of which is foreign money and I'm all for banning foreign money the so-called soft money. And people don't know soft money hard money. They just know it's too much money and they're worried about too much influence. But I will tell you all 45 Democratic senators voted for campaign finance reform and we need the other party to come together because whether you were for a Democrat or a Republican I'm concerned that the largest voting bloc will be the no shows because people are just being disgusted and I believe we should have kind of let's all do it together get

that behind us and then focus on issues like making sure Social Security is solvent. I want to touch on that in just a minute but I want to just one more question about the campaign finance reform or related to it. As you know Attorney General Janet Reno is expected to announce tomorrow tomorrow whether she's going to call for a special prosecutor to look in to fund raising by the President and Vice President Al Gore. Why do you think a special prosecutor is called for two do you think. Are you satisfied with the way the special prosecutor law is being used. Is it being used the way Congress intended. Well I'm looking forward to the journey. Attorney General's report. I knew she wanted to do it today but she'd been really ill with a will. I have very serious reservations about the special prosecutor role and let me tell you why it is open ended so we can go on for years and years and years. The way they're looking at Whitewater Cisneros narrows. Second it puts out unlimited money they can spend whatever they want. They already spent 20 million dollars on

Whitewater and we don't even have a raft to show for it. Second they can use unlimited number of FBI. So basically you're saying that I think it should have a time limit. I think it should have a special focus and then just like a grand jury grand juries has rules. Let's go by some of the parallel worlds so that we do have an independent prosecutor when we need it. But it doesn't become open ended in a political weapon. You mentioned some of the issues that Congress should be focusing on next year. What are some of the issues you you think the Maryland delegation should focus on you've mentioned Social Security. Sure I'd like working with the Maryland knowing Gration and the people should know. You know no matter how we vote for example Bobby Ehrlich might vote differently on a balanced budget amendment than I would Wayne Gilchrest my food different way you one expanding IRA's I might have a different methodology. But when it comes to. Working from Maryland we check our party hat at the door and we go to work for example. Well saving the jobs at the Coast Guard shipyard the Coast Guard wanted to close it

down. I was in the trench protection committee and I went really charging ahead to save it. Senator Sarbanes was there when your crush the Republican who represents Curtis Bay got all the public works people involved and guess what. We now have the yard open and we have worked over there for the next three to five years and it's cos we work together. We have about a minute left Could you give me and just a basic laundry list of issues you think that their delegation should focus on right straight for the old timers I think we need to make sure we have Social Security that's solvent and make sure that Medicare is solvent for young families I think we have to really give up on making sure higher education is affordable like that tuition tax credit. I also think that with people worried about schools we can't have a national curriculum or Big Brother in public education. But the federal government could strengthen teachers colleges the way we've improved medical schools and I think we have about 15 minutes left. You're a mystery writer and you're going to be on TV. Yeah.

What's it feel like to have for what you get. I can't believe it. I wrote a mystery novel with a journalist from The L.A. Times called capital offense and it was way out eager paperback and now it's going to be on the way. Yes. Judith Light is going to. Play it. Looks like that's if they're never of 90 then OK I'm going to have a new hairdo and then even a new waist time. OK Senator Barbara Mikulski and that's all for this edition of NEWSNIGHT Marilyn join us tomorrow as we take you on a life tour of Maryland's technology a technological future for Bob I'll teach you myself. Thanks for watching.