The Washington Blade; January 30, 1998
Lisa Keen

Two papers published in the February issue of Nature Medicine shed some new light on the process. First, Dutch and British researchers report that the "most rapid recovery" of CD4 cells occurs during the first three weeks after the initiation of triple-drug therapy, and most of the cells "recovered" during this time are memory cells -- those trained to attack a specific infection. But this increase after initiation of therapy is not due to the production of new cells, but rather the "redistribution" of cells which had been "trapped" in the body's lymph tissue. And after those first three weeks, CD4 cell recovery continues but at a dramatically slower rate, or, as the report put it "virtually zero" cells per day.

"[O]ur data provide evidence that the long-term repopulation of newly produced [naive cells] is a much slower process than was generally anticipated," wrote the researchers. They suggest the evidence indicates that it may not be possible to completely restore the immune system "or [it] may take a long time."

The second study, from researchers in France, reported on a group of about a dozen patients who experienced "apparent normalization of the CD4 repertoire" following treatment -- both in the numbers and diversity of CD4 cells. They said their study "suggest[s] it could be possible to expand CD4 cells" back to normal size and variety "if HIV is controlled, even if [HIV is] not eradicated."

An editorial in Nature Medicine said the studies demonstrate the importance of not only using triple-drug therapies but also of finding therapies to reconstitute the immune system. The journal noted the findings also explain why the response to triple-drug therapy "is better in patients with the lowest CD4 counts."

In brief ...

FIGHTING MAC: University of Texas researchers reported Jan. 23 that intermittent dosing of clarithromycin can be effective in treating and preventing mycobacterium avium complex (MAC) in the lungs. The study, reported by Reuters, involved 55 patients who had MAC but did not have HIV infection. Another study, by researchers at Kuzell Institute in San Francisco, reported Jan. 20 that MAC is able to develop resistance to clarithromycin more often than it is to another drug, azithromycin.

GENETIC BREAKTHROUGH: Nobel laureate David Baltimore and colleagues reported in the British journal Nature last week that they have discovered that one gene inside the AIDS virus is responsible for turning on a cloaking system that prevents the body's immune system from recognizing the HIV-infected cells and attacking them. The gene controls the "nef" protein which turns on the cloaking system. If scientists can develop a drug to disable that gene, noted Associated Press, it may provide a new strategy for fighting HIV infection.

DELIRIUM DEVELOPING: The December issue of AIDS Patient Care and STDs warned that delirium is a "common yet underidentified" problem for people with AIDS. According to Reuters news service, the report came from researchers at the University of Washington who found that almost 50 percent of 137 patients with AIDS had suffered at least one episode of delirium, a condition marked by difficulty maintaining attention, "disordered thinking," and/or a feeling of confusion. The report noted that the condition is treatable and has been associated with fever, some infections, and changes in medication.

BIG CONFERENCE NEXT WEEK: What has become the biggest annual conference on scientific news in AIDS research -- the Retrovirus Conference --opens in Chicago Sunday. Last year's conference yielded reports showing the first consensus growing for very early treatment using triple-drug therapies that include a protease inhibitor. Early rumors suggest the conference this year will focus on new, improved ways of delivering drugs to patients. (The International Conference on AIDS is no longer held in the United States because of the U.S. policy against foreign visitors with HIV infection without special permits. The International Conference is being held this June in Switzerland.)

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