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ELISA and different HIV subtypes
Nov 11, 1996

Dear Dr. Sowadsky, I am working in an environment with a lot of foreign students and recent immigrants to the U.S. We have a few questions for you. Thank you for taking the time to answer them:

What is the difference between HTLV-1 and HIV? How many different subtypes of HIV-1 and HIV-2 are there? On what basis are distinctions made? What is the global distribution of these subtypes? Are ELISA tests the same worldwide? Would an ELISA test in France, Brazil, Thailand, Uganda or India do exactly the same thing as one here in the U.S? Or do different countries "fine-tune" their ELISA tests to the HIV subtype prevalent in their part of the world? Would "fine-tuning" the ELISA test (if there is such a thing) make that test less able to detect other kinds of HIV subtype antibodies? Would antiviral therapies developed and used in the U.S be useful for individuals infected by HIV subtypes other than the one prevalent in our country? How seriously do virologists and other AIDS researchers take the benefits and viability of non-western medicine? Has there been any attempt to systematically evaluate- using our western scientific methods- the possible benefits of let us say, traditional Chinese medicine or the Indian Ayurvedic medicine And my personal question: Does "acute viral syndrome" accelerate the process of seroconversion? That is, could one say "the more acute the syndrome, the greater or faster the production of HIV antibodies"? Also, would the presence of another unrelated infection- a throat infection for example- at the time of HIV infection hasten seroconversion and lead to faster production of antibodies to HIV? Thank you for your consideration. We look forward to your responses.

Response from Mr. Sowadsky

Thank you for your questions.

What is the difference between HTLV-1 and HIV?

HTLV-I stands for Human T-Lymphotropic Virus Type 1. This virus is transmitted the exact same way as HIV, and infects the same cells of the body as HIV (namely CD4 cells). HTLV-I is commonly confused with HIV, since years ago, HIV was called HTLV-III in the USA. HTLV-I does not cause AIDS!

Whereas HIV kills off CD4 cells, HTLV-I transforms CD4 cells into cancer cells. Cancer cells grow uncontrolled in large numbers, and don't function properly. HTLV-I causes Adult T-Cell Leukemia/Lymphoma (ATL). Both AIDS and Leukemia are associated with malfunctioning immune systems. Not all people with HTLV-I infection will get ATL, but in those that do, the Leukemia is often fatal. This form of Leukemia may not become symptomatic until literally decades after infection with the HTLV-I virus.

This virus also causes HTLV-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP). This is a neurological condition causing a variety of neurological symptoms, including lower limb weakness, loss of bladder control, low back pain, and sensory abnormalities such as tingling, a pins and needles sensation, or a burning sensation.

The only mass screening for HTLV-I in the USA is in the American Blood supply. Because the risk factors for acquiring HTLV-I are the same as HIV and Hepatitis B virus, persons at risk for HTLV-I are deferred from donating blood or organs.

How many different subtypes of HIV-1 and HIV-2 are there? On what basis are distinctions made? What is the global distribution of these subtypes?

In all honesty, I don't keep track of how many types of HIV strains exist for both HIV-1 and HIV-2. Distinctions are made primarily at the molecular and genetic level. Some strains are resistant to various antiviral drugs. The important thing to remember is that each of these strains is transmitted the same way, and they all cause the same disease.

Are ELISA tests the same worldwide? Would an ELISA test in France, Brazil, Thailand, Uganda or India do exactly the same thing as one here in the U.S? Or do different countries "fine-tune" their ELISA tests to the HIV subtype prevalent in their part of the world? Would "fine-tuning" the ELISA test (if there is such a thing) make that test less able to detect other kinds of HIV subtype antibodies?

The test should be essentially the same wherever you go. However, there are different tests specifically for HIV-1 and HIV-2. These tests should pick up an infection, regardless of the subtype or strain. The rare exception is the Group O strain of HIV-1, which may or may not be detected on currently available tests. However, the tests are being revamped to better detect Group O strains of HIV-1. Group O is extremely rare worldwide, and is primarily found in Western and Central Africa. Other than the Group O strain, it would be very unusual for the currently available tests not to pick up various strains of the HIV viruses.

Would antiviral therapies developed and used in the U.S be useful for individuals infected by HIV subtypes other than the one prevalent in our country?

At the present time, treatments are geared for HIV itself, and I am not aware of changes in treatment protocols based on the HIV subtype or strain. In the vast majority of cases, the clinician/physician will not even know the subtype or strain of HIV, since we do not routinely test for the strain of HIV that a person has.

How seriously do virologists and other AIDS researchers take the benefits and viability of non-western medicine? Has there been any attempt to systematically evaluate- using our western scientific methods- the possible benefits of let us say, traditional Chinese medicine or the Indian Ayurvedic medicine?

Alternative Therapies are being studied more and more when it comes to treating persons with AIDS. One must be very careful of Alternative Therapies however, since many claims about how well they work are often unsubstantiated. There are however some clinical trials being done to look at how well some Alternative Therapies work. Many persons with AIDS use Alternative Therapies in addition to traditional treatments. It's very important not to combine these 2 treatments without the knowledge of the physician. This is because there is a potential for drug-interaction between traditional and alternative treatments. However, many patients feel uncomfortable discussing Alternative Therapies with their physician. Many patients fear that the physician will get upset with them for trying Alternative Treatments. Some states in the USA have board certified physicians in Homeopathic and Alternative Therapies (Nevada is an example).

And my personal question: Does "acute viral syndrome"accelerate the process of seroconversion? That is, could one say "the more acute the syndrome, the greater or faster the production of HIV antibodies"? Also, would the presence of another unrelated infection- a throat infection for example- at the time of HIV infection hasten seroconversion and lead to faster production of antibodies to HIV?

I am not aware of any studies that have directly looked at this issue. Since there is such variability from person to person in regard to Acute Viral Syndrome, it's hard to say if there is a relationship or not between severity of the syndrome, and time of seroconversion. The time of seroconversion can also greatly vary from person to person, which complicates the study of this relationship even further. Therefore, we can only say that Acute Viral Syndrome tends to occur within the first month or so after infection, and seroconversion can take up to 6 months to occur. Also, the severity of Acute Viral Syndrome can vary greatly from person to person.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide). Rick Sowadsky MSPH CDS



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