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Query: UMLS:C0020538 (hypertension)
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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.
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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.
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PMID:Experts clarify issues raised by combination therapy. 1136 15

Anti-HIV drug therapy can sometimes cause unusual fat distribution problems on the neck or stomach, referred to as truncal obesity syndrome. Researchers are studying recombinant Human Growth Hormone (Serostim) to see if people developing truncal obesity syndrome can take this drug. Serostim is approved by the Food and Drug Administration (FDA) and is expensive. Its effect in treating the unusual fat distributions or combating high cholesterol levels, hypertension, or hyperglycemia is unknown. Clinical trial referral information is provided.
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PMID:Growth hormone for protease paunch? 1136 22

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.
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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.
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PMID:Supreme Court to hear trio of ADA employment cases. 1136 68

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.
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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.
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PMID:Mitigating measures cases now in Supreme Court's hands. 1136 51

There is growing concern that the metabolic complications associated with HIV and antiretroviral therapy may lead to accelerated coronary artery disease (CAD). Traditional cardiovascular risk factors, such as hypertension, hyperlipidemia, diabetes mellitus, and visceral fat accumulation, are increasingly seen in HIV patients receiving HAART. These factors are in addition to nonreversible risk factors, such as male sex, age greater than 40 years, and family history of premature CAD. Patients may also be smokers and may have a sedentary lifestyle, both of which predispose to significant CAD. In older patients and those with other risk factors, there may be an accentuation of these risk factors by HAART, although these factors also occur in young patients with no other risk factors. It is still unknown whether the factors predispose HIV patients to accelerated cardiovascular disease. Short-term studies, including 2 large cross-sectional studies, do not show an increased risk of cardiovascular complications or cardiac death, but longer follow-up is needed to answer such questions effectively. Even if patients are not at increased risk for cardiovascular disease, they are at least at the same risk as HIV-negative, age-matched persons with similar risk factors. It is, therefore, pertinent to identify and effectively manage those risk factors that can be modified.
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PMID:HIV and cardiovascular risk factors. 1159 42

Liver transplantation for infants and children has been available in South Africa for more than a decade. Current concerns have shifted from an initial target of early post-transplant survival to quality of life in the long term. Since 1985, 175 infants and children have been assessed, with 104 accepted for transplantation. Fifty have had orthotopic liver transplants (OLTx), 48 (3 retransplants) in Cape Town and 2 abroad. Biliary atresia was the most frequent diagnosis (52%) followed by acute liver failure (ALF) (16%). Waiting list mortality has remained high (15%), particularly for the ALF group (50%). Thirty-four patients survive 1 month--14 years post-transplant. Early post OLTx mortality was low (7%) but late morbidity and mortality (23%) were mainly due to viral infection: de novo hepatitis B (5 patients, 2 deaths), EBV-related post-transplantation lymphoproliferative disease (PTLPD) (6 patients, 4 deaths) and CMV disease (9 patients, 4 deaths). Tuberculosis prophylaxis, required in 6 cases, resulted in major morbidity in 1. Hypertension requiring medication along with some compromise of renal function has been present in all but 2 patients. However, all those of school-going age (20) attend school normally and remain in good health and only 3 of the survivors have abnormal liver function tests. Successful liver transplantation is possible in a developing country with limited resources. Scarcity of virus-free donors (HBV and HIV) leading to waiting list mortality and infrequent retransplantation along with long-term consequences of immunosuppression (infection, lymphoma and renal toxicity) remain problems.
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PMID:Liver transplantation in children--the Red Cross War Memorial Children's Hospital experience. 1142 62

This review summarizes the biology of thrombopoietin (TPO) in childhood. Studies on TPO and its receptor (c-mpl) have improved the understanding of inherited and acquired thrombocytopenias in childhood. Data are presented in this review regarding the molecular biology of TPO, differences in cellular effects on megakaryopoiesis, the regulation of TPO production, and TPO concentrations in health and disease. For neonatal thrombocytopenia, the focus is on early-onset thrombocytopenia associated with maternal diabetes, pregnancy-induced hypertension, intrauterine growth retardation, hypoxia, and sepsis. Fetal alloimmune thrombocytopenia allows insight into the biology of TPO when fetal megakaryopoiesis is chronically stimulated. In the thrombocytopenia absent radii syndrome and congenital amegakaryocytic thrombocytopenia, thrombocytopenia is caused by a disorder in the signal transduction at the c-mpl level and respectively directly on c-mpl. TPO concentrations in other inherited thrombocytopenias such as Fanconi anemia, Shwachman syndrome, Wiskott-Aldrich syndrome, and Bernard-Soulier syndrome are discussed. For acquired thrombocytopenias, data on TPO in aplastic anemia, immune thrombocytopenia, human immunodeficiency virus infection, and liver disease are given. Possible indications for a treatment with recombinant TPO in childhood are discussed, but the criteria to identify patients who would benefit need detailed evaluation.
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PMID:Thrombopoietin in thrombocytopenias of childhood. 1144 55


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