Newsday - February 3, 1999
Laurie Garrett - Staff Correspondent

The finding is one of three highlighted at the sixth Conference on Retroviruses and Opportunistic Infections that experts say should raise new concern about controlling the spread of HIV. Researchers also found disturbing levels of drug-resistant viruses being passed from person to person worldwide, and differences in survival rates within the United States based on access to health insurance.

The new gene mutation was announced by Dr. Leon Kostrikis and John Moore of the Aaron Diamond AIDS Research Center in Manhattan. In an interview, Moore said the defect is related to a cell receptor - called ccR5 - that's used as an entryway for Human Immunodeficiency Virus.

Although some Caucasians have mutations that protect them from infection by eliminating their ccR5 receptors, the beneficial mutation has not been seen in people of African descent. Sadly, Moore said, the reverse has now been determined: About 20 percent of African-descendant Americans carry the 356-T mutation, which somehow (the biological details are yet undetermined) manipulates their ccR5 receptors in a way that makes them highly vulnerable to HIV.

Preliminary results of further study indicate that the mutation is also widespread in West Africa, the researchers said.

Kostrikis found the 356-T mutation through genetic analysis of 1,500 babies born to HIV-positive mothers: About 250 of the babies were also HIV-positive. And the majority of those who were infected were black and had the 356-T mutation.

Dr. Victoria Johnson, of the University of Alabama, addressed the issue of drug-resistant HIV by describing a case in which a baby was born infected with a strong strain of HIV that was highly resistant to two key drugs and mildly resistant to six more, essentially leaving the child untreatable.

The mother's HIV was highly multi-drug resistant as a result of her eight years of sporadic treatment. Johnson said the case argues against a long-held hypothesis that highly mutated, drug-resistant viruses might be weak, having given up their lethal characteristics in exchange for drug resistance.

Several surveys presented at the conference also suggested that the odds of sexually acquiring a drug-resistant form of HIV in the United States may be around 10 percent.

For instance, Dr. Daniel Boden of Aaron Diamond studied HIV found in 70 new-infected people, 55 of them New Yorkers. Overall, he said, 11.4 percent of them were infected with drug-resistant forms of the virus, which, "clearly compromises treatment."

But Boden's boss, Dr. David Ho, cautioned in an interview that "we don't know the impact of those mutations on subsequent treatment," so it would be premature to conclude whether this finding is cause for concern.

While drug resistance is most likely to appear where anti-HIV medicines are in widespread use, an analysis offered yesterday found that the disease can - even in the absence of any such drugs - become naturally resistant to a key class of medicines called protease inhibitors.

Dr. Danuta Pieniazek of the Federal Centers for Disease Control and Prevention in Atlanta, carried out genetic analysis of more than 300 viruses from 17 countries, including some in Africa, Latin America and Asia where protease inhibitors are not available. She discovered that up to 85 percent of all HIV may have genes that make the individual virus strains more or less resistant to certain drugs. For instance, one wild strain found in the Ivory Coast in Africa and another from Brazil were naturally cross-resistant to all protease inhibitors, she said.

"The public health implications are that there is a certain background of naturally occurring mutations," said Dr. Harold Jaffe of the CDC. "Those vary around the world, and may mean that drug therapies need to be tailored to local gene profiles."

Also yesterday, scientists unveiled data that suggested that many people in the United States remain unable to afford anti-HIV therapy that has been considered the standard for Americans.

The CDC estimates that 600,000 to 900,000 Americans are HIV-positive. But a large multi-site study conducted by Dr. Michael Bozette of the University of California in San Diego found that only about 335,000 Americans are currently getting treatment for HIV infection; about 80 percent of them receive anti-HIV drug cocktails.

Bozette said the treatment discrepancy could at least partially be excused because the individuals are not aware of their HIV status. But he pointed out that 25 percent of Americans getting HIV treatment receive their care in emergency rooms only, meaning treatment results from acute episodes of illness that require immediate attention.

HIV care bills currently total $6.7 billion a year in America, Bozette said, or 1 percent of the nation's total health expenditures. More than half of that price tag goes toward anti-HIV drugs, which commonly cost between $5 to $16 per pill, taken in regimens that call for 10 to 20 pills per day. The high costs of drugs are cited in patient surveys as the No. 1 reason for avoiding treatment, particularly among the 20 percent of all American HIV patients who lack health insurance or Medicaid.

Canada's national health-care system has managed to contain drug costs through mass purchasing directly from manufacturers. Nevertheless, the HOPE Research Center in Toronto reported this week that average annual drug cocktail costs are running between $13,000 to $17,000 per year per patient. At Johns Hopkins University Hospital the costs were higher still: The average monthly Medicaid bill last year was $2,159, more than 60 percent of that being drug costs.

A survey conducted by the San Francisco Department of Health found that among 513 HIV-positive individuals, 42 percent were not currently taking appropriate medications, citing lack of health insurance as the cause.
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