From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: VA Summary 3/27/92
Note: non-commercial reproduction.
Archive-Number: 5904
Organization: UCLA, Computer Science Department
Date: Sat, 15 Aug 92 08:19:24 PDT

This AIDS Information Newsletter was obtained from the HIV/AIDS Info
BBS (714) 248-2836.  It is the best source of AIDS Info available.
************************************************************************
                   AIDS INFORMATION NEWSLETTER
                   Michael Howe, MSLS, Editor
                     AIDS Information Center
                VA Medical Center, San Francisco
                     (415) 221-4810 ext 3305
                         March 27, 1992 
                 SPECIAL TOPIC ISSUE:  NUTRITION 
               FDA'S EATING DEFENSIVELY BROCHURE 
The CDC National AIDS Clearinghouse will again be distributing the Food 
and Drug Administration's brochure titled "Eating Defensively: Food 
Safety Advice for Persons With AIDS."  (Full text of the brochure is 
reprinted below.) 
               Single copy free of charge
               2 - 10 copies  = $5.00
               11 - 25 copies = $6.00
               26 - 50 copies = $6.50
               Limited to 50 copies per order 
Prepayment is required.  NAC accept's check or money order, government 
purchase order, Visa or Mastercard.  Please remit payment to: 
                CDC National AIDS Clearinghouse
                P.O. Box 6003
                Rockville, Maryland  20849-6003 
If you have further questions, or would like additional ordering 
information, call NAC's toll-free number, (800) 458-5231. 

                       EATING DEFENSIVELY:
            FOOD SAFETY ADVICE FOR PERSONS WITH AIDS 
 Bacteria and Food Poisoning 
     "It must have been something I ate!" How many times do people say 
this following a bout of nausea, upset stomach, cramps, diarrhea, or 
vomiting?
     Indeed, these can be the symptoms of food poisoning-illness caused 
by eating food on which harmful bacteria have grown.  The bacteria that 
cause food poisoning are difficult to detect by a food's appearance, 
taste or smell.  But they can cause illnesses ranging from mild to very 
severe and even life-threatening.  The human body ordinarily is well-
equipped to deal with these bacteria, but individuals with weakened 
immune systems--such as those with acquired immune deficiency syndrome 
(AIDS) and those infected with the human immunodeficiency virus (HIV)--
can be at far greater risk of serious illness.  Because of their 
weakened immune systems, these individuals are more susceptible to 
contracting a food-borne illness.  Once contracted, these infections, 
with their severe vomiting and diarrhea, can be difficult to treat and 
they can come back again and again.  This can further weaken the immune 
system and hasten the progression of HIV infection and be fatal for 
persons with AIDS.
     Since most food-borne illnesses result from improper handling of 
food, persons with AIDS or HIV infection can help protect themselves by 
following basic food safety guidelines.  Applying these guidelines when 
buying, preparing and storing food, along with having a basic knowledge 
of the most common harmful bacteria and the food on which they are found 
or can grow, can allow persons with AIDS to eat defensively while 
choosing a nutritious diet.
     People cannot get AIDS from food.  The food safety advice in this 
brochure is intended to help persons with HIV infection to reduce the 
risk of food poisoning, thereby avoiding an illness that could worsen 
their condition or even cause death.  While many kinds of bacteria can 
cause food poisoning, three are the most prevalent threat to persons 
with AIDS and HIV infection.  These are Campylobacter, Listeria and 
Salmonella.
     The symptoms of Campylobacter infection (campylobacteriosis) 
include acute abdominal pain, diarrhea (which can be watery or contain 
blood), nausea, headache, muscle pain, and fever.  Symptoms can begin 2 
to 5 days after eating contaminated food and generally last 7 to 10 
days. Campylobacter bacteria are most commonly found in raw or 
undercooked poultry, unpasteurized milk, and  non-chlorinated water.
     Listeriosis, the disease caused by Listeria, is characterized by 
flu-like symptoms of chills, fever and headache, sometimes accompanied 
by nausea and vomiting.  These early symptoms can appear 2 to 30 days 
after exposure and can be followed by bacteremia (a bloodstream 
infection), meningitis (an inflammation of the membranes covering the 
spinal cord and brain), or  encephalitis (an inflammation of the brain 
itself).  Foods found to contain Listeria are unpasteurized milk and 
cheeses, raw or undercooked meat, poultry, and fish.
     Salmonellosis is the illness that can develop from eating foods 
containing salmonella bacteria.  It is characterized by flu-like 
symptoms, possibly accompanied by nausea, vomiting, abdominal cramps, 
and diarrhea.  Symptoms can develop 6 to 48 hours after exposure and 
last up to a week.  Food most often associated with salmonellosis 
include raw or under cooked meat, poultry, fish,  and eggs. 
Shopping for Food 
     For persons with AIDS, it is especially important to read food 
labels to select foods that pose the least risk of food poisoning. For 
example, all milk and cheese products should have the word "pasteurized" 
on the label.  Products that contain any raw or undercooked meat or 
dairy products should be avoided, as well as products with a "sell by" 
or "best used by" date that has passed. 
     It is a good idea to put packaged meat, poultry or fish into a 
plastic bag before placing it in the shopping cart.  This prevents 
drippings from coming in contact with other foods and thus reduces the 
risk of cross-contamination-bacteria from one food contaminating another 
food. 
     The sale of food products with damaged packaging, the unsafe 
displaying of products (such as cooked shrimp on the same bed of ice as 
raw seafood), workers with poor personal hygiene, and unsanitary store 
conditions can add to the risk of food-borne illness.  Not only should 
consumers avoid purchasing food products sold under such conditions, but 
the conditions should be reported to local health authorities. 
     After shopping, get chilled and frozen foods into the refrigerator 
or freezer as soon as possible.  Storing them in a warm car or office or 
even just carrying them around for a couple of hours can raise the 
foods' temperature enough to allow bacteria to grow.  
At Home  
     Most cases of food poisoning are caused by improper food handling 
or preparation in the home.  Keeping shelves, counter tops, 
refrigerators, freezers, utensils, sponges, and towels clean is one of 
the best ways to prevent bacterial contamination of food at home.  It is 
especially important to wash all utensils and your hands with soap and 
hot water after handling one food and before handling another.  This 
helps prevent cross-contamination in which, for example, bacteria in raw 
meat could be transferred to other foods, such as salads or vegetables.  
For the same reason, wooden cutting boards should not be used for 
cutting raw meat, poultry or fish.  Plastic boards are easier to clean 
and sanitize.  Fresh fruits and vegetables should be thoroughly washed 
with water and refrigerated to reduce spoilage.  The temperature in a 
refrigerator should be maintained at or below 40 degrees Fahrenheit and 
food  should be stored in covered containers. 
     Properly cooking food is another important guard against food 
poisoning. Heat kills bacteria.  Most cookbooks give appropriate cooking 
times and temperatures for different foods.  A meat thermometer should 
be used to ensure complete cooking.  A minimum temperature of 140 
degrees Fahrenheit is necessary to kill bacteria.  When reheating 
leftovers or heating partially cooked foods, a minimum temperature of 
165 degrees Fahrenheit is necessary. 
     Never eat raw eggs or foods that contain them.  Pasteurized eggs 
should be used in place of shell eggs when making homemade ice cream, 
eggnog and mayonnaise.  When cooking eggs, make sure that the yolk and 
white are firm, not runny.  Here are cooking times and temperatures: 
     Scrambled - 1 minute at medium stovetop setting (250 F for electric 
frying pans) 
     Sunny side - 7 minutes at medium setting (250 F) or cook covered 4 
minutes at 250 F  
     Fried, over easy - 3 minutes at medium setting (250 F) on one side, 
then turn and fry for another minute on the other side   
     Poached - 5 minutes in boiling water   
     Boiled - 7 minutes in boiling water. 
     Microwave cooking requires special precautions.  Most microwave 
recipes include a "standing time" after the cooking period to ensure 
that a proper temperature is reached throughout the food.  Also, many 
microwave dishes must be removed from the oven and stirred from time to 
time-again, ensuring thorough cooking.  It is particularly important to 
heat pre-cooked foods or leftovers thoroughly, whether in a microwave or 
conventional oven.  
Eating Out  
     Restaurants, like grocery stores, are required to follow sanitation 
guidelines established by state and local health departments to ensure 
cleanliness and good hygiene.  Persons with AIDS need to avoid the same 
foods in restaurants that they would avoid at home.  Always order food 
well-done; if it is served medium or rare, send it back.  A good way to 
determine doneness is to cut into the center of a steak, hamburger, or 
other piece of meat.  If it is the least bit pink or bloody, it needs 
more cooking.  Fish should be flaky, not rubbery, when cut.  
     Order fried eggs cooked on both sides instead of sunny side up, and 
avoid scrambled eggs that look runny.  Caesar salad should also be 
avoided since it contains raw eggs.  If unsure about the ingredients in 
a particular dish, ask before ordering. 
     Raw seafood poses a serious risk of food poisoning for persons with 
AIDS. Raw shellfish, like raw meat and poultry, should be assumed to 
harbor harmful bacteria. Oysters on the half shell, raw clams, sushi and 
sashimi should not be eaten.  Lightly steamed seafood, such as mussels 
and snails, should also be avoided.  
Traveling Abroad  
     Not all countries have the same high standards of hygiene and 
sanitation as the United States, so persons with AIDS should take 
additional precautions when traveling abroad. 
     Boil all water before drinking.  Drink only beverages made with 
boiled water or canned or carbonated bottled drinks.  Ice, too, should 
be made only from boiled water.  Avoid uncooked vegetables and salads.  
All fruit should be peeled.  Eat cooked foods while they are still hot. 
      A good rule of thumb is "Boil it, cook it, peel it, or forget it."  
     While food poisoning can usually be treated with rest and plenty of 
fluids until solid food can be eaten again, persons with AIDS or HIV 
infection may experience prolonged and more serious symptoms requiring a 
doctor's care. 
     If a consumer or doctor believes that an attack of food poisoning 
was related to a particular food or restaurant, the local health 
department or the Food and Drug Administration should be contacted.  
Reporting the incident to health officials can help others avoid serious 
illness. 
     These food safety guidelines for persons with AIDS or HIV infection 
are no different than those recommended for anyone.  But, in the case of 
persons with AIDS or HIV infection, contaminated food can have more 
serious consequences. 
     There are other high-risk groups-such as cancer patients, 
diabetics, transplant recipients, infants, pregnant women, and the 
elderly-who should also give special attention to these guidelines.  For 
individuals in these high-risk groups, maintaining a nutritious diet is 
of great importance.  Cooking and eating defensively need not interfere 
with a nutritious diet.  But not being aware of the hazards and not 
taking appropriate steps to reduce the risk of food poisoning can be 
life-threatening.  
 MEAD JOHNSON INTRODUCES LIPISORB(TM) FOR PATIENTS WITH AIDS, CYSTIC 
FIBROSIS, AND OTHER DISEASES ASSOCIATED WITH FAT MALABSORPTION  
Mead Johnson Enteral Nutritionals has introduced Lipisorb(TM), a 
nutritional product with a unique formulation -- specially designed for 
patients with fat malabsorption.  
It is estimated that 30 to 60 percent of all AIDS patients experience 
fat malabsorption in the course of their illness. Fat malabsorption also 
is a problem for many patients with cystic fibrosis, inflammatory bowel 
disease, and short bowel syndrome. Manifestations of fat malabsorption 
include diarrhea, steatorrhea (excess fat in the feces), abdominal 
discomfort, and weight loss.  
Lipisorb powder is a nutritionally complete formula providing a fat 
blend of 86% medium chain triglycerides (MCT) oil and 14% corn oil. 
Medium chain triglycerides are readily absorbed by patients with fat 
malabsorption and have been clinically proven to diminish the serverity 
and incidence of diarrhea and abdominal discomfort. The product's corn 
oil fat content supplies essential fatty acids.  
Lipisorb provides at least 100% of the U.S. RDA's (Recommended Daily 
Allowances) for protein, vitamins and minerals in each 2000 calories. It 
can be used to supplement a diet or as a complete source of nutrition. 
Thus, it may help in meeting the three primary goals for good 
nutritional management of AIDS patients, established by the Task Force 
on Nutrition Support in AIDS: to preserve lean body mass; to provide 
adequate amounts of all nutrients; and to  minimize symptoms of 
malabsorption.  
LIpisorb(TM) is an over-the-counter nutritional product which can be 
administered orally or by tube feeding. It is available in 1 lb. cans 
and can be purchased at pharmacies and drug stores. Lipisorb has a 
pleasant vanilla flavor for good patient acceptance and compliance. 
Patients should consult their physicians before adding Lipisorb to their 
diets.  
Representatives from Mead Johnson Enteral Nutritionals are promoting the 
product to physicians and dietitians. In addition to providing product 
information to healthcare professionals, the company has prepared 
patient support materials including a question and answer brochure on 
fat malabsorption and a booklet of recipes using Lipisorb. (Release from 
Bristol Myers, January 3, 1991). 
For additional information contact:  Mead Johnson Enteral Nutritionals, 
2400 West Lloyd Expressway, Evansville, IN 47721- 0001.  Telephone:  
(812) 429-5000. 
Mead Johnson has also published (1990) a 21 page booklet entitled 
"Nutritional Care of the Patient with AIDS."   
Editor's Note:  The release reprinted above is provided for information 
purposes only and does not constitute an endorsement by anyone 
associated with the Department of Veterans Affairs. 
Another company to contact for information about nutrition and AIDS is: 
Norwich Eaton Pharmaceutical, 17 Eaton Avenue, Norwich, NY 13815-0231. 
Telephone:  (607) 335-2271. 

       NEW CLINICAL TRIAL FOR HIV-WASTING SYNDROME BEGINS  
     A new clinical trial for persons with the HIV-wasting syndrome is 
opening to enrollment this week at sites of the Division of AIDS 
Treatment Research Initiative (DATRI).  DATRI is one of three national 
AIDS clinical trials networks supported by the National Institute of 
Allergy and Infectious Diseases.  
     HIV-wasting syndrome, also known as cachexia, is characterized by 
severely debilitating weight loss and affects approximately 16 percent 
of persons with AIDS.  The syndrome is of particular concern because it 
can exacerbate an AIDS patient's illness and increase the risk of death.  
     The new clinical trial will examine the safety and effectiveness of 
two oral drugs , dronabinol and megestrol acetate, administered along 
and in combination, for the treatment of HIV wasting syndrome.  Previous 
studies have suggested that both drugs stimulate the appetite and 
reverse weight loss among persons with HIV.  
     "Patients with AIDS are more likely to die if their body weight 
falls below a certain level,"  says Anthony S. Fauci, M.D., NIAID 
Director. "Medications that increase the appetite and slow or reverse 
weight loss may prolong survival and could have an important role in the 
care of persons with HIV."   
     Dronabinol (trade name, Marinol) is a synthetically manufactured 
version of the active substance in marijuana, THC or delta-9-
tetrahydrocannabinol.  It was approved in 1985 for the oral treatment of 
nausea and vomiting association with cancer chemotherapy.  Megestrol 
acetate, also called megace, is a  synthetic hormone used for the 
treatment of advanced breast cancer. 
      Investigators hope to enroll in the study 56 patients who have 
lost more than 10 percent of their body weight since becoming infected 
with HIV, and whose weight has continued to drop in the previous three 
months. Participants will be randomly assigned to one of four groups, 
and will take medication for twelve weeks.  The first group will take 
dronabinol twice a day, with lunch and dinner.  The second will take 
megestrol acetate once a day, at lunch.  Persons in groups three and 
four will take either a high or a low dose of megestrol acetate at 
lunch, as well as dronabinol at lunch and supper.  
     The eight sites that will enroll patients in this study are: 
     o    University of Maryland at Baltimore (Baltimore, MD) 
     o    University of Kansas School of Medicine (Wichita, KS) 
     o    Washington University School of Medicine (St. Louis, MO) 
     o    Tulane University School of Medicine (New Orleans, LA) 
     o    SUNY Health Science Center at Brooklyn (Brooklyn, NY) 
     o    New England Medical Center Hospitals/Tufts University  
          (Boston, MA) 
     o    University of Rhode Island College of Pharmacy         
          (Providence, RI) 
     o    The Research and Education Group (Portland, OR)  
     DATRI is one of three NIAID networks established to test new 
therapies for patients with HIV in clinical trial at sites around the 
United States.  The other two are the AIDS Clinical Trials Group and the 
Community Programs for Clinical Research on AIDS.  Established in 1991, 
DATRI allows NIAID to rapidly address critical questions about new 
therapeutic agents and novel treatment  approaches.   
     Dronabinol is manufactured by Unimed, Inc./Roxane Laboratories, 
Inc. Megace is manufactured by Bristol-Myers Company. For enrollment 
information and eligibility requirements for this protocol, known as 
DATRI 004, call 1-800-TRIALS-A, Monday through Friday, 9 a.m. to 7 p.m., 
eastern time. 
(UPDATE from the Office of Communications, National Institute of Allergy 
and Infectious Diseases National Institutes of Health, March 18, 1992. 

Newsgroups: sci.med.aids