Washington Blade - September 28, 2001
Erin O'Briant

A mathematical model decried by one AIDS activist predicts a large number of drug-resistant HIV strains in San Francisco by 2005.

Jeff Graham of AIDS Survival Project said, "it's important to keep in mind that this is only one study."

Meanwhile, research published in the New England Journal of Medicine indicates that the little-known -- and apparently harmless -- hepatitis G virus may slow the progression of HIV.

"I think it's so important when we hear studies like this that are picked up by the mainstream media to always look to them as the potential of good or bad news," cautioned Jeff Graham, executive director of the AIDS Survival Project in Atlanta.

Drug resistance in 2005

Forty-two percent of HIV infections in San Francisco may be drug-resistant by 2005, up from a possible 28.5 percent of current infections, predicts a team of researchers led by Dr. Sally M. Blower, a professor of biomathematics at the University of California at Los Angeles. The work of the team is published in the current issue of the journal Nature Medicine.

Estimating the current rate of drug resistance at 28.5 percent, the group used a mathematical formula to calculate its likely increase over the next few years.

The scientists calculated the increase in drug-resistant HIV since 1997 and used that to extend their forecast into the future.

The primary reason for the increase, they said, is the development of drug resistance in the virus during treatment. The transmission of drug-resistant strains remains low, they said, estimating that it will account for just 16 percent of new HIV cases by 2005.

"The good news is that transmission of drug-resistant HIV will not become a major public health problem," Blower said in a statement. "The bad news is that the prevalence of drug-resistant HIV is already high and will continue to substantially increase."

San Francisco AIDS activist Michael Petrelis called Blower's work "scary propaganda," adding, "We've seen these stories before from Dr. Blower. She creates math models that really aren't based on reality."

Petrelis conceded that increasing drug resistance may be an issue, but added that such models do not constitute proof of a serious problem. "Based on previous scary mathematical models created by Dr. Blower that didn't prove true, I think it's another example of how researchers have too much time on their hands," he said.

Another long-time activist also urged caution. "The entire issue of resistance is a growing concern to the AIDS community," said Graham of AIDS Survival Project. "However, it's important to keep in mind that this is only one study and to not panic."

According to the UCLA researchers, some physicians may unwittingly contribute to the drug-resistant HIV epidemic if they don't recognize the risks associated with inconsistent or incorrect use of the medications.

"These drugs are as dangerous as chemotherapy," said Dr. James Kahn of the University of California at San Francisco, a co-author of the paper. "General practitioners should not be using them. You really need a skilled HIV specialist to prescribe the medications and closely monitor the patient's adherence and response to treatment."

Graham and others said pharmaceutical companies and community groups are working to educate health care providers and AIDS patients on preventing drug resistance.

Hepatitis G could help

Few people involved in the fight against AIDS had heard of hepatitis G before research published in the New England Journal of Medicine this month showed that infection with the virus may slow the progression of AIDS. The newly recognized virus is apparently harmless and is transmitted through the blood, though little else is known about it.

The new research appears to confirm previous studies, which have suggested that patients live longer when co-infected with HIV and the hepatitis G virus.

"Over the years there have been so many studies that at first look made it seem that we were just around the corner from a major breakthrough," Graham said. He believes the hepatitis G research is "another piece in the puzzle" of how to treat and possibly cure HIV and AIDS.

What isn't known is exactly how the virus inhibits HIV. Researchers said if they could figure that out, it might lead to new treatments for AIDS.

In the meantime, they warned patients against intentionally infecting themselves.

"If we can identify the path [hepatitis G] is taking to inhibit HIV, then we're well on the way to making this something practical," said one of the researchers, Dr. Jack Stapleton of the Iowa City Veterans Affairs Medical Center and the University of Iowa.

"HIV infection is just as serious a medical condition in 2001 as it was in 1981," said Graham. "This is not a disease that anyone wants to contract, it is a life-challenging if not life-threatening illness. ... Certainly hepatitis of whatever variety is not a disease that people want to go out and put themselves at risk of contracting."

-- The Associated Press contributed to this report.

Vaccines may boost immune system

PHILADELPHIA (AP) -- Vaccines intended to protect people from getting AIDS may also work as a treatment for those already infected, boosting their immune system so they can temporarily stop taking AIDS drugs.

Information released at an AIDS vaccine conference in Philadelphia early this month is the first to hint that therapeutic vaccines may be an effective strategy when combined with standard AIDS drugs.

One such potential vaccine, Aventis Pasteur's ALVAC-HIV, has been given to more than 1,900 people worldwide and will enter large-scale testing to prevent AIDS next summer. The vaccine consists of a harmless canary pox virus that is genetically engineered to carry several genes that make HIV proteins.

Normally, when people stop taking their AIDS drugs, the virus can reproduce again rampantly, producing billions of new copies. By exposing the immune system in advance to HIV proteins, experts hope it will mount a vigorous defense against the re-emerging virus, knocking it down to acceptably low levels.

At the meeting, called AIDS Vaccine 2001, Dr. Martin Markowitz of the Aaron Diamond AIDS Research Center in New York City described the first results of this strategy using ALVAC-HIV. The study was conducted on patients who began taking AIDS drugs within four months of becoming infected with HIV.

Thirteen of them took four doses of the vaccine before stopping their AIDS medicines, while five others stopped treatment without being vaccinated.

The researchers were disappointed that the virus returned to detectable levels in all the vaccinated volunteers. Nevertheless, virus levels fell back down to low levels in six of the vaccinated patients, compared with just one of those who was not vaccinated.

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