SEPTEMBER 1998

NUMBER ONE

Why Get Tested?
AIDS IS A FRIGHTENING DISEASE, BUT TODAY WE HAVE NEW therapies and approaches that are keeping many people with HIV healthy. The key is action and information. The first and most important step you can take is to find out whether you've been exposed to HIV and what you can do to stay healthy and protect yourself and your loved ones. New therapies can attack the virus, while vitamins, good nutrition, and exercise play a critical role in keeping your body strong.

• Having HIV and having AIDS are not the same thing. HIV is a virus that attacks the immune system, eventually causing a range of illnesses that are called acquired immune deficiency syndrome, or AIDS. You can have HIV and remain healthy for many years, but without treatment most people will eventually get sick.

• An HIV-antibody blood test is commonly used to see whether you've been exposed to the virus. This test looks for HIV antibodies, special proteins produced by the body to fight HIV. Home-testing kits measure HIV antibodies in blood, urine, and saliva. Most HIV-antibody tests use the ELISA method of detection, which is 99 percent accurate; a more sensitive Western Blot test is used to confirm a positive result.

• A positive test result means you've been exposed to HIV; it doesn't mean you have AIDS. If you test positive, you should plan to see a doctor familiar with HIV and consider other tests for HIV and treatment options to prevent the onset of disease (see "Play Your Hand").

• A negative test result means you haven't been exposed to the virus or that it's too early to tell. It takes from two weeks to six months for antibodies to develop after a person is exposed to HIV. A negative result does not protect you against future infection.

• Counseling is an important aspect of getting an HIV test. A trained counselor can address your fears and help you prepare for getting the results. You'll need support. If you test positive, there are many resources available to help you cope with the daily challenge of living with HIV (see "Vital Resources").

FLASHES

Testing 1, 2, 3
CAN'T HANDLE THE STRESS OF WAITING TWO WEEKS for HIV test results? Maybe 10 minutes would be more like it. A new rapid test for HIV antibodies, by MurexCorp, that is 98 percent accurate and delivers results in a few minutes has been approved by the FDA. The test can be used in doctor's offices and clinics. Advocates think the rapid test could be particularly useful in high-prevalence areas.

Recently, the Centers for Disease Control changed its official policy on HIV screening tests to allow early disclosure of results to individuals at very high risk for HIV infection: pregnant women in labor with no history of prenatal care, health-care workers who have experienced needle-stick or other high-risk incidents, and patients at TB and STD clinics. The CDC's recommendation is expected to be adopted by the Food and Drug Administration, which will open up the market to more rapid HIV screening tests.

Several other rapid tests are being developed. A "dot blot" or "immunoblot" test produces a colored dot on a solid surface that indicates a positive HIV result. Another uses a dipstick attached to a comb-like device. There are also "dried blood spot" tests for HIV that may be useful for testing newborns when blood samples can't be refrigerated. Stored samples can be retroactively tested.

Finally, if blood gives you the creeps, saliva- and urine-based tests are also available and are highly accurate. A note of caution: Home testing, although reliable, provides only telephone counseling; in-person counseling is preferred by HIV advocates.

PCP-Mutations
PNEUMOCYSTIS CARINII PNEUMONIA (PCP) REMAINS a leading killer among people with HIV. That's why PCP prophylaxis, or preventive therapy, is recommended for people whose T-cell count falls below 200-300.

But the drugs used to treat PCP don't work for everyone, and now researchers think they know why. A team at the University of Michigan Medical Center found two genetic mutations in the bug that causes PCP; the mutations may be responsible for the drug failures among people with HIV, particularly those who took a class of preventive meds called "sulfa" drugs, which includes Bactrim.

Looking ahead, British researchers at the Raigmore Hospital recently developed a new "hemi-nested" polymerase chain reaction (PCR) test for PCP that can be completed in a single day and is more sensitive than the standard PCP PCR test now used. They suggest using the new test along with the standard test to definitively diagnose PCP in immuno-compromised people.

Move Over, Methadone
"HEROIN MAINTENANCE" IS THE HOT NEW BUZZWORD in drug-treatment circles-legally prescribing the drug to hardcore addicts. In a June meeting in New York, experts listened as Swiss social scientist Ambrose Uchtenhagen-dubbed "the pope of drug-policy research"-described a three-year study of 1,100 hardcore heroin addicts. The results: Heroin maintenance slowed the spread of HIV, reduced crime, decreased homelessness, and increased employment among addicts. A U.S. pilot program is even scheduled to begin in Baltimore soon. Unfortunately, advocates say, the "Just Say No" era of U.S. federal policy toward drugs shows no sign of ending.

That leaves LAMM. In case you missed it, there's an alternative to methadone maintenance for heroin addiction. LAMM (levomethadyl acetate hydrochloride) is an FDA-approved opiate drug that reduces heroin use by 90 percent among treated patients, according to a Journal of the American Medical Association report last year. LAMM needs to be taken only three times a week, making it easier to use than the daily methadone treatment.