The San Francisco Examiner; Wednesday, January 28, 1998
Lisa M. Krieger of the Examiner Staff

Consistent with earlier findings in adults, researchers have found that a genetic mutation in some children can slow the progression of HIV disease, according to a report in Wednesday's issue of the Journal of the American Medical Association.

The so-called "Delta 32" mutation in the gene, which makes a receptor on immune cells called CCR5, does not protect against mother-to-infant transmission of HIV, according to French researchers.

But it does help keep them healthy, longer: only 9 percent of infected 3-year-old children with the mutation had symptoms of HIV disease, compared to 28 percent of children without the mutation. By age eight, 51 percent of children with the mutation had symptoms, compared to 89 percent of those without the mutation.

Of the children with the mutated gene, all but one were heterozygous, meaning they received a copy from just one parent. Only one child was homozygous, (received the mutated gene from both parents) - and was not born infected with HIV. The tantalizing possibility of inherited HIV immunity cannot be proven, however, by this case alone.

The mutation is extremely rare in African and Asian people, but present in about one of six whites.

Scientists last year noted that adults with resistance to AIDS have the same Delta 32 mutation. Those lacking both normal copies of the CCR5 gene do not become infected with HIV despite repeated exposure. Those with one missing copy of the CCR5 gene can become infected but take years longer to progress into AIDS.

Resistance also has been seen in people with a different genetic mutation, named m303, on one copy of the same gene and a Delta 32 mutation on the other copy of the CCR5 gene.

A mutation on a second gene has also been found to inhibit the disease progression of HIV. People with a mutation in a gene called CCR2 develop AIDS up to four years later than patients who have the normal CCR2 gene.

The altered genes account for about 30 percent of the long-term survivors of HIV infection. This suggests that still other gene mutations exist that protect against HIV, the researchers said. What's so important about these genes? They are responsible for making the protein receptors on human cells - it is through these protein receptors that HIV enters and infects the cells. Presumably, a mutation causes a defect that impairs the ability of HIV to cause infection.

"This observation further underscores the importance of CCR5 in HIV disease progression," write physicians Thomas R. O'Brien and James J. Goedert of the National Cancer Institute in Bethesda, Md., in an accompanying editorial.

"The impact of genetic factors may be more important or more easily detected when HIV infection occurs perinatally, perhaps because children have less variability in other factors that alter prognosis, or because the timing of initial infection is more precisely known," they write. The varying ethnic distribution of the mutations suggests that they might be a relatively recent phenomena strongly favored by evolution, perhaps because they offer protection against other infectious agents as well, the doctors speculate.

Screening for these genes is not recommended because even if they are found, discontinuing therapy might not be safe, according to O'Brien and Goedert.

It is possible, however, that a patient's response to anti-viral agents is, in part, genetically determined, they note. Or perhaps a patient's genetic profile alters the risk of acquiring an opportunistic infection. If so, these factors would influence therapy.

Scientists are now working to find a way to block CCR5 or inhibit expression of the gene.

"Hopes are high that insights into the role of chemokine receptors in HIV will provide another therapeutic leap for both children and adults," write O'Brien and Goedert.

Back to work

New treatment therapies and increased services contributed to the successful job placement of 482 HIV-positive workers last year - a 60 percent increase in job placements over the last two years, according to the nonprofit group ABC Positive Resource Center. "One-fifth of the placements were for full-time permanent employment," reported executive director Paul Causey. "Some people with AIDS and HIV are doing well enough to make these kinds of placements possible."

ABC Positive Resource Center offers workshops in skills building, computer training, job placement and benefits counseling. Call (415) 558-9845 or (415) 928-1448 for more information on services. Employers with jobs to offer may call (415) 928-1448.

Jump in cases

Between 1991 and 1996, new AIDS cases rose twice as fast among older people as they did among young adults, according to federal officials.

That suggests that older adults may not be protecting themselves against the disease and that their doctors aren't looking for it, the Centers for Disease Control and Prevention said. In 1996, 6,400 AIDS cases were diagnosed in the United States among people 50 and older, up 22 percent from 5,260 new cases in 1991, the CDC reported.

New AIDS cases for the 13-to-49 age group rose 9 percent in the same period, from 46,000 cases to 50,300.

The CDC said most older adults who got AIDS in the early days of the epidemic probably contracted it through a tainted blood transfusion. Now, more are being infected by unprotected sex and by injecting drugs.

. . . . . .Date . . . . . .reported. . Cases. . Deaths S.F.. . . .1/1 . . . . 24,962. 16,9999Calif.. . .1/1 . . . .104,638 . 66,263 U.S.. . . .1/1 . . . .612,078 .379,258 WHO(rprtd) 1/1 . . .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.

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 www.examiner.com / aidsweek / aidsweek.html

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