The Washington Blade; Friday, April 24, 1998
Lisa Keen

Experts have been saying for many years that casual household contact with a person with HIV is not risky. A study in the March issue of the journal Clinical Pediatrics provided additional documentation for that advice. The study, by the U.S. Centers for Disease Control and Prevention and others, gave the HIV antibody test to members of 22 families in which there was a child who had HIV infection. In each household, no one knew the child had HIV infection for an average of four years and, thus, took no special precautions that would have reduced the possibility of transmission. Despite the unfettered interaction -which included kissing, caring for nosebleeds, and various other activities (some of which "could theoretically" transmit HIV) - no family member tested positive for HIV infection.

The authors of the study said the results support the participation of children with HIV in childcare programs outside the home. But they also noted that HIV has been transmitted to household contacts of children with HIV in "rare" cases and suggested household members continue to take precautions to avoid contact with the blood and body fluids of the family member with HIV.

**Gauging when to switch combos

Researchers at Abbott Laboratories report this month that doctors and patients might get some indication of how long a combination therapy will succeed by taking note of the patient's viral load measurement after about 12 weeks on therapy.

Reporting in the March 26 issue of the journal AIDS, the researchers report that while a patient's viral load measurement before treatment and the magnitude of his or her viral load drop initially are "modestly" good predictors of how well he or she is going to do on that therapy, the stronger predictor is how far the viral load drops ultimately. That bottom line - or "nadir," as the researchers refer to it - is defined as the lowest viral load that is reached before the viral load begins to steadily increase. This nadir, noted the researchers, is usually reached after about three months on a combination therapy. The viral load at the "nadir," they say, "represents the degree of persistent low-level viral replication" occurring and, thus, the higher the viral load at nadir, the less time the therapy will be likely to succeed. Although the study was based on 29 patients and requires further investigation, the Abbott researchers say, their results suggest it may be useful to measure a patient's viral load "through weeks 12-16."

In brief ...

ORAL LESIONS STUDY OPEN: NIH's National Institute of Dental Research is enrolling people with HIV and mouth sores for a study of a topical application of a gel form of thalidomide. For more information, call 1-800-411-1222.

SPEED USE SURVEYED: An AIDS group in San Francisco surveyed 253 men who identified as Gay or bisexual in San Francisco dance clubs and bars over two weekends and found that 41 percent acknowledged using crystal methamphetamine (speed) during the previous six months. Three-fourths of this subgroup had engaged in sex while on speed. Ninety-one percent of the 253 men had taken an HIV antibody test and 10 percent of those were positive for HIV infection. The group conducting the survey, the Stop AIDS Project, is waging a campaign to educate Gay men about the dangers of drug use and HIV transmission.

EYE ON VISION: While all eyes have been on cytomegalovirus retinitis in people with HIV infection, researchers from the University of California-San Francisco report in the March issue of AIDS Patient Care and STDs that even more patients suffer from other infections of the retina. The most common, according to the researchers, is "cotton-wool spots," which occurs in 45 to 77 percent of patients with AIDS. According to a Reuters report on the study, the researchers found that people with HIV infection can experience vision difficulties even when their CD4 counts are above 500 and recommend doctors test for early visual loss.

HOPKINS GUIDE TO LIVING: The Johns Hopkins AIDS Clinic has just released a fact-filled, easy-to-digest book for people with HIV. The book is organized to provide information to help people make decisions from the point at which they realize they may have HIV infection through the various complicated options they have for managing the illness. Among other things, it helps readers weigh whom to tell about their HIV infection, describes the wide range of drugs available for therapy, explains the pros and cons and how-tos of participating in clinical trials, and notes how to tell the difference between thrush and oral hairy leukoplakia. The 422-page paperback, called The Guide to Living with HIV Infection ($15.95), was prepared by John Bartlett, a professor of medicine, and Ann Finkbeiner, a science writer and teacher, both at Hopkins.

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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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