Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.
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The San Francisco Examiner - Wednesday, April 30, 1997
Lisa M. Krieger of the Examiner Staff
This discovery is critical to progress against HIV. What it tells us is that therapies such as anti-viral drugs or interleukin-2 - which raise CD4 cell count - seem to boost only the type of cells that are present when therapy begins and may not be able to reconstitute the broad spectrum of normal immunity.
For complete protection, what is important is not just the number of CD4 cells, but the type of cells as well. If some elements of the immune are missing, there are "holes" in the body's defense against disease, scientists believe.
This argues for treatment early in disease, before these important elements of the immune system are depleted, said Dr. H. Clifford Lane, clinical director of the National Institutes of Allergy and Infectious Disease, lead author of the study.
It also suggests that drugs to prevent opportunistic infection may remain important even when CD4 counts rise. "These individuals may be missing part of their CD4 cell repertoires," said Lane.
In the future, knowing a person's repertoire of cell types - not just their raw number of cells - might allow doctors to better predict susceptibility to disease, according to Lane's team.
Researchers have been puzzling over why, given the potency of new therapies and skyrocketing CD4 counts, patients continue to succumb to infection. They also have noticed that HIV-infected people don't respond to invaders they were exposed to in the past, such as vaccine antigens. It is as if the immune system has lost parts of its memory - which, this research suggests, it has.
"The reduced ability of their immune systems to recognize certain antigens are probably key to the development of immunodeficiency in these people," said co-author Dr. Mark Connors of NIH. The finding tells doctors that a CD4 count of 200 "on the way down" toward advanced AIDS is likely to be very different from a CD4 count of 200 "on the way up," with therapy, Connors said. Along the way, important types of cells have been lost and not recreated, he said.
However, Lane suggested that even patients with advanced disease and a narrow range of CD4 cells might be able to mount adequate immune responses if anti-viral therapy reduced HIV replication to very low levels. Perhaps other cells can perform some of the jobs of those that are missing, he said.
The results are reported in the May issue of the journal Nature Medicine.
Stronger HIV Seen
HIV may have become more aggressive in recent years, eroding the immune system faster and causing a quicker progression from infection to full-blown disease, an Italian study suggests.
The heightened virulence was most obvious in patients whose infection by HIV was detected after December 1989, report scientists in the May issue of the British Medical Journal.
People infected in the late '80s were more than twice as likely to progress to AIDS within three years, compared to those infected in the early '80s, the study found.
A leading U.S. AIDS scientist said that while he hadn't seen the Italian research, the results sounded plausible.
"It wouldn't be surprising, given the way microbes emerge to be resistant, that you could have a strain which would be multidrug-resistant and potentially quite virulent," said Dr. Jerome Groopman of Beth Israel Deaconess Medical Center in Boston.
Events
*The 14th International AIDS Candlelight Memorial and Mobilization will be observed worldwide on Sunday. The event, held in 357 cities, honors the memory of those who have died of AIDS and demonstrates support for people living with HIV.
In San Francisco, participants will gather at 8 p.m. at Castro and Market streets, then walk in a candlelight procession to United Nations Plaza. A ceremony will be held outdoors from 9 to 10 p.m. To volunteer, call (415) 863-4676.
*The Stop AIDS Project and Q Action are sponsoring several upcoming events: "I'm With Stupid," a discussion about relationships, from 7 to 9 p.m. next Tuesday; "Community Forum: Can We Really Bridge the Generation Gap?," a talk about differences and commonalities, from 7 to 9:30 p.m. May 8; and "I'm Beautiful, Dammit!" , a discussion about how men see themselves and one another, from 7 to 9 p.m. May 14. Free.
Call (415) 431-2ACT or (415) 621-7177 for locations, reservations or more information.
* "An Eye To The Future," a symposium on the new life choices in the changing age of AIDS, sponsored by the Conant Foundation, will be held from 2 to 5 p.m. May 10, UCSF Medical Science Bldg., Room HSW 300, 513 Parnassus Ave. Free, but reservations advised. Call (415) 643-1822.
* "Thinking About Returning To Work?" , a workshop about the legal, financial, social and emotional issues involved in the decision, will be held May 17 by AIDS Health Project. For details, call (415) 476-6448.
* "Strategies for Pain Management in HIV Disease," a forum with three doctors and sponsored by the Conant Foundation, will be held at 6:30 p.m. May 19, ANA Hotel, Metropolitan Ballroom, 50 Third St. Free. Call (415) 643-1833.
The toll
William K. Mahannah, 60, first chief counsel of Mission Community Legal Defense. During the Vietnam War era, he practiced criminal defense law in Germany, representing military personnel. He later joined Mission Community Legal Defense, a nonprofit organization providing free legal services to Latinos in San Francisco, then became the first law editor of the legal newspaper The Recorder. . . . John Dodson, 48, born in Ontario and who, as a teen, pedaled tourists around the Montreal World's Fair on a bicycle rickshaw. He later worked in bank management in Vancouver and then at Floordesigns in San Francisco.
Date
reported / Cases / Deaths
S.F. 4/1 23,974 16,692
Calif. 4/1 99,908 64,137
U.S. 4/1 548,102 343,000
WHO(rprtd) 4/1 8,400,000 6,400,000
Figures are cumulative since June 1981. Government officials now compile and release statistics quarterly, not monthly.
To contribute to AIDSweek, call (415) 777-7867. AIDSweek columns are available on the Internet at http://www.examiner.com/aidsweek/aidsweek.html
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