Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
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The courts are divided on whether the Americans with Disabilities Act (ADA) and the Rehabilitation Act apply to State prisoners. The debate of whether disabled inmates are entitled to the same programs and services as nondisabled inmates will be addressed in court cases in Alabama and Pennsylvania. The U.S. Supreme Court will hear Pennsylvania Department of Corrections v. [Name removed] to determine whether Federal disability-rights laws apply to State prisons. In the case, the inmate was denied access to a boot camp program because of his hypertension. The 11th U.S. Circuit Court of Appeals will hear [name removed] v. [Name removed], an Alabama case involving the question of whether mandatory HIV testing and segregation are permissible if it serves a prison's interests in protecting uninfected prisoners. Both cases have major implications for HIV-positive inmates.
AIDS Policy Law 1998 Feb 20
PMID:Two major prison cases poised for court review. 1136 93

The U. S. Supreme Court questioned Paul Tufano, a Pennsylvania general council member, in a case involving whether prisoners are exempt from the Americans with Disabilities Act (ADA). The case, brought by former inmate [name removed] [name removed] against the Pennsylvania Department of Corrections, claimed that because [name removed] suffered from hypertension he was prevented from participating in a boot camp program or other programs that might have led to an earlier release. As a result, [name removed] was incarcerated a year longer than he might have been. Pennsylvania's position is that prisoners are exempt from the ADA. However, under sharp questioning by several justices, Tufano agreed that the statute does apply to prison employees and visitors. The verdict could have wide-ranging implications for prisoners with HIV. Circuit courts have been divided on the issue of what a public entity is and whether the ADA applies. A decision is expected by June 30.
AIDS Policy Law 1998 May 15
PMID:Justices challenge notion that prisons are exempt from ADA. 1136 33

Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), Dr. John Bartlett, Chief of Infectious Diseases at Johns Hopkins University, and Dr. Eric Goosby, Director of the Office of AIDS/HIV Policy, examine and explore concerns raised by the Public Health Service guidelines for antiretroviral therapy. Dr. Goosby cites that there is little known clinically about any drug interactions between protease inhibitors and methadone and negative reactions have not been reported. Dr. Fauci and Dr. Bartlett indicate that fat redistribution occurs when using protease inhibitors and dissipates when they are discontinued. Dr. Fauci believes that changing the therapy causes no harm to the patient based on the length of time the patient was on the previous therapy. Dr. Bartlett is concerned that patients with a history of alcoholism generally have difficulty maintaining a consistent treatment regimen. Patients with HIV with concurrent illnesses need to be cautious about drug-drug interactions, particularly involving newer drugs. Dr. Goosby is not aware of a link between hypertension and protease inhibitors, although there is a connection between protease inhibitors and hyperglycemic reactions. Added concerns are voiced about temporary interruptions in treatment, and their effect on long-term management of HIV. The guidelines advise that patients in this situation should stop all treatment for the necessary period, and resume the full therapy when possible. Finally, Dr. Goosby advises counseling the patient regarding the consequences of missed doses and the risks of limiting future alternatives. If the patient is unable to follow the treatment plan, Dr. Goosby suggests discontinuing therapy until the patient can manage the regimen.
AIDS Alert 1998 May
PMID:Experts clarify issues raised by combination therapy. 1136 15

Reports of metabolic disorders, such as diabetes mellitus and hyperlipidemia, occurring during treatment with protease inhibitor (PI) regimens are prompting patients and providers to try to better understand the links between these disorders and antiretroviral treatments. The Food and Drug Administration (FDA) first reported PI-associated diabetes in June 1997. Diabetes mellitus can be managed by controlling diet and exercise, or by supplementing treatment with oral hypoglycemic drugs. Hypertriglyceridemia has also been associated with PI therapies, and is apparent even in patients experiencing good results from antiretroviral therapy. Treatment for hypertriglyceridemia encompasses monitoring diet and exercise, limiting alcohol, watching hypertension, and quitting smoking. Patients at higher risk for pancreatitis can consider using lipid-lowering drugs and fibric acid derivatives. Alterations in fat distribution have also been linked to PI use, particularly in the back of the neck and upper back, and abdominal area. Researchers have seen evidence of anomalous fat distribution in some patients prior to PI treatment. Management has not consistently been remedied by diet and exercise. Sustaining overall health, reducing blood lipids, and controlling risk factors for cardiovascular disease need to be implemented. Unless the abnormalities are severe and potentially harmful to the patient, it is not commonly recommended to change the PI treatment.
AIDS Clin Care 1998 Jun
PMID:Metabolic complications of antiretroviral therapies. 1136 97

In the Pennsylvania Department of Corrections v. [Name removed], the U.S. Supreme Court unanimously ruled that correctional facilities are subject to the provisions under the Americans with Disabilities Act (ADA); this ruling has broad implications for prisoners with HIV infection. When [name removed] was denied admission to a motivational boot camp program at the prison due to hypertension, he sued, claiming that his rights under the ADA had been violated. The Court rejected Pennsylvania's argument that eligibility and participation, as used in Title II of the ADA, imply voluntariness and, therefore, do not apply because inmates are being held against their will. The Court further rejected the argument that the ADA excluded prisoners because the act doesn't specifically mention them. This decision may aid in a case that is before the 11th Circuit Court regarding inmates with HIV having the right to equal access to services. Oral arguments on the 11th Circuit Court case will be heard on September 10, 1998.
AIDS Policy Law 1998 Jun 26
PMID:U.S. Supreme Court rules ADA applies to correctional facilities. 1136 15

The U.S. Supreme Court will review three cases related to whether the Americans with Disabilities Act (ADA) applies to those people whose disabilities are reduced by drugs or medical devices. The employees in these cases claim that their medical conditions, such as high blood pressure or a vision impairment, are disabilities as defined by the ADA. As a result, the employees argue, firing them should be a violation of the ADA. The outcomes could have implications for people with HIV, assuming medical advances make HIV a manageable chronic problem. Details of each case are presented.
AIDS Policy Law 1999 Feb 05
PMID:Supreme Court to hear trio of ADA employment cases. 1136 68

Disability-rights advocates are considering a "legislative fix" to address some of the problems resulting from three recent U.S. Supreme Court rulings concerning the Americans with Disabilities Act (ADA). The Court ruled mitigating measures such as corrective lenses and medications, must be taken into account when determining a plaintiff's disability. Plaintiff's did not qualify for ADA employment protection if their conditions, nearsightedness, monocular vision, and high blood pressure, were correctable. There are risks associated with trying to address the Court's rulings through legislation; efforts to change the ADA could backfire and harm persons who really need protection. Another concern is that legislation would face difficulty in Congress, where the prevailing view is that the ADA already has plenty of protections.
AIDS Policy Law 1999 Jul 23
PMID:Court rulings prompt talk about amending the ADA. 1136 84

Legal experts say that although three recent U.S. Supreme Court cases on mitigating measures may change the way the American with Disabilities Act (ADA) is applied, they should not affect HIV employment discrimination claims. The court held in June that corrective lenses and medications must be considered when determining whether a plaintiff is disabled with regard to the ADA. Two cases involved vision impairments and one involved high blood pressure. The employers in each case argued that the impairment was not a disability and therefore not subject to ADA protection. Employers welcomed the rulings, and disability-rights groups expressed alarm. Plaintiff's attorneys who specialize in AIDS law said the rulings probably will not affect their clients because living with HIV carries a stigma and HIV infection limits many life activities.
AIDS Policy Law 1999 Jul 23
PMID:'Mitigating measures' cases won't affect HIV plaintiffs. 1136 7

Three cases filed under the Americans with Disabilities Act (ADA) and claiming discrimination against employees with physical impairments were heard by the U.S. Supreme Court in April 1999. The court's ruling could affect the statute's protection of HIV-positive people using antiretroviral therapy. The first case involves a vehicle mechanic who was fired after his employer discovered his high blood pressure, for which he takes medication, was over the limit for the type of job he held. A second ADA case involves twin sister pilots who applied for jobs with United Air Lines Inc. and were rejected because their uncorrected vision failed United's minimum standards for global pilots. In a third ADA case, a truck driver with monocular vision was fired by his employer for failing to meet Department of Transportation (DOT) standards. Decisions for the three cases are expected by late June 1999.
AIDS Policy Law 1999 May 14
PMID:Mitigating measures cases now in Supreme Court's hands. 1136 51

Use of the commonly prescribed protease inhibitor Crixivan appears to result in a bizarre adverse effect, despite its desirable effects on T-cell count and viral load. This adverse effect is more common in women than men, and includes the following symptoms: (1) limb wasting, (2) fat gain in the torso, (3) breast enlargement, (4) skin thinning, (4) vein enlargement, (5) irregular periods, (6) high blood pressure and high blood glucose, (6) fatigue, and (7) decreased sex drive. It is believed that 5 to 10 percent of patients taking Crixivan suffer from some of these symptoms, but the percentage would probably be much higher if the number of women alone were studied. Some physicians have been unsupportive about complaints of these symptoms, and have told their patients to exercise or that the changes may be due to aging. One suggestion for dealing with these symptoms is to get body composition measurements prior to starting a protease-containing regimen. Exercise continues to remain important, primarily to prevent wasting. However, dieting is not recommended since it does not reduce the fat deposits and it does contribute to wasting of the limbs. If the symptoms become intolerable, a change in regimen may be needed.
Newsline People AIDS Coalit N Y 1998 Sep
PMID:The new body of AIDS: Crixivan bellies, legs, and humps. 1136 90


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