The Washington Blade; Friday, April 17, 1998
Lisa Keen

A letter published in the April 9 issue of the New England Journal of Medicine suggests that just boosting the number of CD4 cells in a person with HIV helps the patient fight off opportunistic infections, even if his or her viral load remains very high.

Dr. Stuart Levitz at the Boston Medical Center reported on two patients with AIDS who had failed two combination therapies (AZT-ddI-d4T-3TC, then AZT-3TC-indinavir) and then on a third, "salvage," therapy (one patient took ddI-3TC-d4T-nelfinavir, the other took ddI-d4T-squinavir-ritonavir). The salvage therapies produced only a "modest" decrease in viral load but showed "dramatic increases" in the number of CD4 cells (which fight infections) -- from 30 and 40 cells each to 528 and 375. And though each had suffered various opportunistic infections earlier, "[n]either patient has had further opportunistic infections" since beginning the salvage therapies more than a year ago.

Doctors typically advise patients to change regimens if viral loads do not drop significantly fairly early on after initiation. But these results, coupled with the fact that patients have only 13 antivirals approved for use, said Levitz, suggest "[i]t may be premature for one to change antiretroviral therapy solely on the finding of a detectable viral load."

In brief ...

LYMPHOMA RISKS: A report at last week's AIDS Malignancy Conference at the National Cancer Institute suggests that Gay men -- whether they have HIV or not -- are at increased risk for a particularly virulent type of non-Hodgkin's lymphoma. While the risk for the general population of developing the Burkitt's form of NHL is about 3 percent, for Gay men with HIV it is 19 percent and for Gay men without HIV it is 11 percent. The risk increased in Gay men without HIV if they engaged in rimming or if they had genital warts, genital herpes, or syphilis. Researchers from the University of California-San Francisco making the report said the increased risk for Gay men "may be related to lifestyle factors . . . or bacterial infection." Of Gay men with HIV who develop NHL, 80 percent develop a less aggressive "large cell" form.

HERPES INCIDENCE HIGH: A report in the April 2 New England Journal of Medicine indicates that 37 percent of men participating in the San Francisco Men's Health Study had Human Herpes Virus-8 infection, which is a suspected cause for Kaposi's sarcoma. According to the researchers, from San Francisco General Hospital, signs of the HHV-8 were found in none of the heterosexual men in the study. Among the Gay men in the study, the HHV-8 was particularly prevalent among those who had had sexually transmitted diseases and was more prevalent among those with more sex partners.

TACKLING GONORRHEA: A commentary in the March 28 Lancet suggested that a relatively new antibiotic called trovafloxacin is as effective as the current standard of treatment of gonorrhea, ofloxacin. The essay says the new drug may also help address a growing concern that the microbe that causes the sexually transmitted disease is developing resistance to ofloxacin. The presence of sexually transmitted diseases is believed to both expedite transmission of HIV and worsen the condition of people who have HIV.

BAD NEWS FOR TRANSPLANTS: The possibility of repairing an AIDS patient's immune system through transplants of bone marrow from baboons took a hard hit in the April issue of Nature Medicine magazine. A report from the U.S. Centers for Disease Control and Prevention indicated that at least four cases have been identified in which humans have been infected with an AIDS-like virus specific to baboons and other primates.

HIGH-TECH HELP: Poz magazine's May issue touts the potential benefit of using a computerized pill-dispenser which has compartments to hold five different medications and beep when it's time to take one. Called MedManager, it also prepares a monthly report of your pill-taking adherence. For more information, call PolyPharm at (248) 380-1388, ext. 10.

HIV DRUG BOOK: Poz also recommends the revised version of Project Inform's HIV Drug Book, which pictures most pills and gives the latest information on their side effects, food interactions, and more.

FOOD WITH INDINAVIR: Speaking of food interactions, and of Poz magazine, the May issue carries a chart prepared by the American Dietetic Association showing foods that can be eaten when taking the protease inhibitor indinavir without diminishing the drug's effect. Among the many choices identified are Kellogg's Rice Krispies Treats (store-bought or homemade), popcorn (without butter), English muffin (without the butter or margarine, but jam's OK), a Powerbar, or a bagel (without . . . well, you get the picture).

POZ MAGAZINE: This is the most practical magazine for people with HIV, presenting a good stash of news-you-can-use monthly. It's available on newsstands or by subscription (free to people who can't afford the $24.95 cost per year). For more information, call 1-800-973-2376.

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Always watch for outdated information. This article first appeared in 1998. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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