The Washington Blade - November 26, 1999
Lisa Keen

Currently available therapies attack the AIDS virus only during some part of its replication cycle inside an immune cell that has been activated to attack an infection. Inside the inactivated cells, the virus is able to evade the drugs. Many experts have urged that people with HIV start antiviral therapy as early as possible but at least before the body starts producing antibodies -- within about two weeks to a month after infection. The theory behind the timing has been that early therapy might prevent HIV from entering some immune cells and other hiding places in the body and, thus, make complete eradication a more reachable goal.

The finding published in the Nov. 12 issue of the journal Science -- that HIV enters the inactivated T-cells within three days -- makes that goal seem more difficult to reach than earlier believed.

An even more troubling finding of the Minnesota study is that the AIDS virus can replicate inside these inactive cells.

"This study identifies a source of cells that are invulnerable to current therapies," said lead author Ashley Haase.

Meanwhile, a study from London says that men with HIV who take only nucleoside analogs for a long time may not be able to eliminate HIV from their semen even after they begin taking combinations of drugs that include protease inhibitors. The finding, published in the October issue of the Sexually Transmitted Infections journal, adds more support for the strategy promoted by most AIDS experts these days -- that people with HIV should "hit hard, hit early" with drug therapy and take protease inhibitors. The strategy has been around for several years now but debate over its wisdom has continued throughout.

Hormones cited in abnormal fat distribution

A study from France suggests a new theory on the abnormal fat distribution problem in some patients taking protease inhibitors: It "may be due" to the antiviral drugs producing an imbalance of certain "steroid hormones," including sex hormones and a hormone that helps convert proteins to carbohydrates. The researchers speculated that the study might lead to a therapy supplement that includes steroids. The full report is in the Nov. 12 issue of the journal AIDS.

In an earlier issue of AIDS (Oct. 22), researchers from Boston reported that short-term treatment with a "recombinant growth hormone" (rhGH) improved the abnormal fat distribution problems of 10 patients. The researchers noted, however, that the therapy would "modulate but not correct the underlying metabolic deficit, as the body shape changes do not totally resolve and may recur after the cessation of therapy with rhGH."

In brief ...

AVOIDING PNEUMONIA: A research team led by Dr. Wafaa El-Sadr of the Harlem Hospital Center reported last month that patients with HIV who have trouble taking a daily dose of Trimethoprim-Sulfamethoxazole (TMP-SFX) to ward off the opportunistic infection pneumocystis carinii pneumonia can get "similar rates" of protection by taking the drug only three times a week. The study is published in the October issue of the journal Clinical Infectious Diseases.

DIRECTORY OF TRIALS: The American Foundation for AIDS Research (AmFAR) launched this month an online version of its comprehensive directory of HIV treatments. At www.amfar.org, patients can look up the absolute latest on antiviral drugs, immune boosters, and drugs to fight opportunistic infections. The language is sometimes heavy on medical and scientific lingo but generally very useful. New to the directory this year is a section in clear-to-understand language on how to understand laboratory test results. Coincidentally, a study in the October issue of Clinical Infectious Diseases also reported that patients with "greater knowledge of their treatment regimen had better adherence, had fewer [side effect] complaints, and coped more effectively with the demands of their regimens." Free copies of the print version are available by calling (800) TRIALS-A. Ask for the AmFAR HIV/AIDS Treatment Directory, Vol. 10, No. 1.

NUTRITION TALK: The Carl Vogel Foundation is sponsoring a dinner talk Thursday, Dec. 2, from 7 to 8:30 p.m. on nutrition-related problems, such as fat accumulation and wasting. The presentation will take place at the Sea Catch Restaurant on 31st Street in Georgetown. Space is limited. For more information, call (202) 638-0750.

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