AIDS Treatment News #161, October 16, 1992
John S. James
No comparable human study has been done. But one study of herpes(5) (not HIV) found that 71 percent of 38 patients developed a recurrence of lip herpes when exposed to ultraviolet light with a placebo sunscreen; by contrast, with the same ultraviolet exposure with real sunscreen, none of 35 patients developed the recurrence.
An early epidemiological study of seasonality of AIDS(6) by researchers at the U. S. Centers for Disease Control might be relevant. It found a 12 percent difference in AIDS diagnosis with the peak in the summer (when there is most exposure to ultraviolet in sunlight) and trough in the winter. Pneumocystis and Kaposi's sarcoma also showed a peak in the summer and trough in the winter; CMV as a subsequent diagnosis, however, had a peak in the spring and trough in the fall. But the paper concluded that "there is no important seasonality in the onset of AIDS" (apparently because the 12 percent difference was not considered large enough, and ultraviolet light was not a concern at that time), and the study has been remembered as a negative result.
One study in England(7) found that people with HIV were strikingly unaware of the risk; they were almost three times as likely to use a sunbed regularly than HIV-negative controls. The researchers also found that two thirds of the HIV-positive group believed that a suntan would improve their health. They noted that "those with HIV infection must be made aware that there is a potential for further immunosuppression and viral activation from ultraviolet radiation and they should be advised to avoid undue recreational exposure."
Comment
Enough is known now to suggest that the risk of ultraviolet light to persons with HIV may be serious; it is important to warn the community, even while we wait for definitive information. Nobody knows why HIV disease progresses much faster in some people than in others. If ultraviolet light, among other factors, contributes to faster disease progression, it probably would have escaped notice.
When ultraviolet is used for medical treatment, the risk should be considered in balancing the benefits and drawbacks of therapy. The bigger concern is sun exposure and tanning studios (which are often targeting the gay community as customers). Dermatologists have long warned the public against unnecessary ultraviolet exposure, to avoid damage to the skin. Persons with HIV should know that they may be at greater risk.
References
1. Vogel J, Cepeda M, Tschachler E, Napolitano LA, Jay G. UV activation of human immunodeficiency virus gene expression in transgenic mice. JOURNAL OF VIROLOGY. January 1992; volume 66, number 1, pages 1-5.
2. Morrey JD, Bourn SM, Bunch TD, and others. In vivo activation of human immunodeficiency virus type 1 long terminal repeat by UV type A (UV-A) light plus psoralen and UV-B light in the skin of transgenic mice. JOURNAL OF VIROLOGY. September 1991; volume 65, number 9, pages 5045-5051.
3. Stein B, Kramer M, Rahmsdorf HJ, Ponta H, Herrlich P. UV- induced transcription from the human immunodeficiency virus type 1 (HIV-1) long terminal repeat and UV-induced secretion of an extracellular factor that induces HIV-1 transcription in nonirradiated cells. JOURNAL OF VIROLOGY. November 1989; volume 63, number 11, pages 4540-4544.
4. Valerie K, Delers A, Bruck C, and others. Activation of human immunodeficiency virus type 1 by DNA damage in human cells. NATURE. May 5, 1988; volume 333, pages 78-81.
5. Rooney JF, Bryson Y, Mannix ML, and others. Prevention of ultraviolet-light-induced herpes labialis by sunscreen. THE LANCET. December 7, 1991; volume 338, pages 1419-1422.
6. Peterman TA, Byers RH. Seasonal Variations in AIDS and Opportunistic Diseases. International Conference on AIDS, Washington, D. C., June 1987 [abstract # WP. 42].
7. Flegg PJ. Potential risks of ultraviolet radiation in HIV infection. International Journal of STD and AIDS. January 1990; volume 1, pages 46-48.
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