The Washington Blade - Friday, February 26, 1999
Lisa Keen

The implications are important for such matters as oral sex. Some experts warn that transmission of HIV by oral sex is still a worrisome possibility because they have seen cases where the only known risk factor has been oral sex. The Texas research team suggested "speculatively" how infection through oral sex might happen. They noted that "oral sex may permit transmission if the volume of [the insertive partnerÆs] seminal fluid is sufficient to protect infected [immune cells in his semen] from [the natural killing properties of saliva] by restoring [salt] to the recipientÆs saliva."

AIDS appearing at higher CD4 counts

A study in Australia of the CD4 counts of people when they are diagnosed with full-blown AIDS has found that their CD4 counts are higher since the widespread use of protease inhibitors.

Before the use of such triple-drug combinations, the U.S. Centers for Disease Control identified the typical CD4 count at AIDS diagnosis at below 200. In the years just before protease inhibitors, patients were being diagnosed with AIDS at lower CD4 counts. Now the researchers say, in the Feb. 4 journal AIDS, patients have higher CD4 counts at diagnosis.

"The most likely explanation," they wrote, "is probably that those HIV-infected people who receive [protease combinations] à are also the people who receive and comply with [preventive] treatments [against AIDS-defining opportunistic infections.] A second possibility is that [combination therapy] has resulted in increased numbers of people with HIV living for much longer periods with higher CD4 counts than would otherwise have been the case."

In brief ...

LIFTING WEIGHTS: Short-term, high intensity workouts with weights can "significantly increase" lean body mass and, in a patient with HIV, his or her overall strength, says a report in the Feb. 4 issue of the journal AIDS. The study, conducted by researchers in Boston, tested the benefits of an eight-week workout plan followed by an eight-week self-selected exercise plan. The training also helped patients drop fat, an increasingly common phenomenon among those taking protease inhibitors.

WATCHING CD8 FALL: Many doctors rely on the ratio of CD4 cells to CD8 cells to monitor the status of their patients with HIV. Researchers from Norway, reporting in the Feb. 4 issue of the medical journal AIDS, say they believe it may be more helpful to watch for a "rapid fall" in CD8 counts to predict the onset of full-blown AIDS. Importantly, they noted that this seems true only in patients who are not taking antiviral therapy.

WATCHING CD8, PERIOD: A report from a multinational team, in the Feb. 5 issue of the journal Science, indicates that CD8 cells "play an important role in controlling viral replication in both primary and chronic" infection, though the study was done on monkeys only. A deficiency of CD8 cells in primary infection resulted in uncontrolled HIV replication and a "rapid progression of disease." In chronic infection, a CD8 deficiency resulted in a burst of HIV replication.

PREDICTING DEMENTIA: Researchers from Johns Hopkins University, UCLA, and other centers report in the February issue of Neurology that patients with viral loads greater than 30,000 at baseline are more than eight times more likely to develop HIV-related dementia. Dementia risk was also higher for patients with a CD4 count of less than 200 at baseline.

FIGHTING DEADLY PML: Researchers at 10 universities around the country reported this month that the use of triple-drug combinations with protease inhibitors has brought about "significant gains" in the survival of patients developing the opportunistic infection PML (progressive multifocal leukoencephalopathy). "Until recently, the prognosis of PML was à so dismal that efforts to treat these patients outside of research programs were often forsaken," noted the researchers in the February issue of Neurology. But the researchers noted that patients on such combinations survived about 46 weeks while patients not on the combinations survived only about 11 weeks.
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