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News & Notes

July 1997

Ho's Cure Hopes

Time Magazine's 1996 "Man of The Year," Dr. David Ho of New York's Aaron Diamond Center, is predicting that two or three years of anti-HIV treatment may result in the total eradication of HIV from the body of someone who is infected with the virus, according to a study published in the journal Nature in May. Using a computer model, Dr. Ho and colleagues assert that the day will arrive when aggressive antiviral treatment will stop HIV from infecting new cells in the body and those cells that are infected will die off, leaving the body virus-free. "It would be wrong to believe that we are close to a cure for AIDS," Ho nevertheless cautions. "However, recent advances in treatment and pathogenesis do warrant a close examination of the feasibility of eradicating HIV from an infected person."

Another study by Dr. Ho and his team looked at what happens to immune system cells that are not as swift to die, so-called HIV "hold outs" -- cells in lymph nodes for example. Antiviral treatment causes a two-phase reduction in HIV: Viral levels drop precipitously after treatment begins, then fall much more slowly. The research team determined the lifespan of the "hold-out" cells and estimated that 2.3 to 3.1 years of aggressive antiviral therapy might eliminate the virus entirely, but it could take longer if HIV is also lurking in harder-to-reach parts of the body. Only time (and more research) will tell if there may be a third phase of viral infection involving HIV taking up residence in even more slow-dying and remote cells of the body. Currently, there is no evidence that HIV has been wiped out from any patient who is on antiviral therapy.

The only way to determine this is to stop therapy and see if HIV can be detected again -- something researchers, physicians, and patients are reluctant to do. The Aaron Diamond team has not asked patients to halt therapy, but some San Francisco doctors who did have seen a rebound in HIV infection. "A blunt personal view is never to think that you've outsmarted HIV: It should be obvious if, and when, eradication is achieved," editorialized Dr. Simon Wain-Hobson of the Pasteur Institute in Paris in the issue of Nature in which Dr. Ho published his study. "HIV can clearly be put down by therapy," Dr. Wain-Hobson wrote. "So might it even bow out? Cross your fingers." We are.


T-Cell Diversity Lost in Late Stages

Researchers at the National Institute of Allergy and Infectious Diseases (NIAID) have found that not only do T-cell counts drop over the course of HIV infection, but the diversity of T-cell types that fight specific foreign invaders actually shrinks. And though antiviral therapy may achieve overall increases in T-cell counts, it does not restore their diversity, appearing instead to boost only the types of cell present when treatment began, according to a study published in the May issue of Nature Medicine.

"Our findings argue for treatment early in disease, before elements of the immune system are significantly depleted," said Dr. H. Clifford Lane, NIAID's clinical director and senior author of the study. "Our data also suggest that drugs to prevent opportunistic infections may remain important even for patients with CD4+ T-cell counts that are rapidly increasing in response to therapy, because these individuals may be missing parts of their CD4+ T-cell repertoires."

Co-author Dr. Mark Connors, of NIAID's Laboratory of Immunoregulation, adds: "The loss of CD4+ T-cells is a qualitative as well as a quantitative one."

Using molecular techniques, the researchers demonstrated that T-cell diversity begins to decline when levels fall to 150-200 in an HIV-infected person. The decline accelerates when the count drops to 50. Researchers noted that even when T-cell levels were boosted by therapy to 200, diversity was not restored. "Think of a person's CD4+ T-cell clones as tiles in a Scrabble game," Dr. Lane illustrates. "As disease progresses, not only does an HIV-infected person have fewer tiles, but also fewer different tiles. If a person loses the letter, 'z', they will be unable to spell out the word 'zebra.' However, if they have enough other tiles, they may still be able to describe a zebra by spelling a 'horse-like animal with black and white stripes."

Life Insurance for the HIV-Positive? Who'd Have Thought It?

In what is undoubtedly the first commercial recognition that AIDS is not a death sentence, a small midwestern insurance company, Guarantee Trust Life Insurance of Glenview, Illinois, announced on April 15 that it would begin offering life insurance to qualifying people with HIV. The 60-year-old company's president, Richard S. Holson III, said the move was made because "we believe many otherwise healthy HIV-positive individuals are more appropriately viewed as having a treatable chronic illness rather than a terminal disease." A number of restrictions will mean that these policies -- which provide coverage ranging from $25,000 to $250,000 -- will be available to a limited number of people with HIV. For the first 90 days, policies will only be sold to HIV-positive people in the company's home state of Illinois.

Guarantee Trust plans to expand across the country once it gauges the response and gets its administrative machinery up and running. But even then the policies will not be available in New York -- the state with the strictest insurance regulations in the nation -- as Guarantee Trust is not licensed to do business there. Policies will also be denied to those who became infected through injection drug use. Company executives believe drug use creates incalculable risks for the company, including the chance that drug users won't take their health-sustaining medications. Moreover, qualifying individuals must be under 49 years of age, have T-cell counts above 400, and an average viral load that has not exceeded 5,000 in during the past 12 months. The final restriction, of course, is one of economics: policies will be available only to those who can afford them -- and they are not cheap.

While a fairly healthy 30-year-old non-smoking man pays $55 a month for $50,000 worth of coverage, the same man, if he were HIV-positive, would pay $300 a month. For maximum coverage of $250,000, the monthly price tag for someone with HIV is $1,500. Since 1970, Guarantee Trust has been selling life insurance coverage to high-risk clients who have been rejected by other insurers. The company currently has one million customers and some 400,000 policies in place; it has placed no cap on the number of policies it will offer to people with HIV. "We would expect that, while this is the first [life insurance for people with HIV], there will be others," said Ken Vest of the American Council of Life Insurers in Washington, D.C. "It fills a need." But State Farm and Allstate, two of the country's largest insurers, say they have no plans to offer life insurance to people with HIV.

Au Revoir Paris, Hello Flushing, Says Dr. Luc Montagnier, HIV Co-Discoverer

The co-discoverer of HIV and one of Europe's leading scientists, Professor Luc Montagnier, has accepted a newly endowed professorship at Queens College in Flushing, New York -- the first to be offered by that institution -- and plans to move to New York from Paris in October. Once in Queens, Professor Montagnier, 64, will begin building and running a new AIDS research institute that Queens College will construct with corporate and private funding and government matching funds. Under the new contract, Montagnier will continue to run a lab at the Pasteur Institute, and will remain president of the World Foundation for AIDS Research and Prevention, a nonprofit group based in Paris, with which the new institute will be affiliated. Although some scientists were surprised by the announcement, Montagnier says it is a natural move for him.

"New York is the center of this disease," he said. "There are already many skilled scientists working there and also so many patients. I am very glad that Queens College has allowed me to start this in New York, which has the highest incidence of AIDS in the United States." Montagnier's new institute, to be named the Center for Molecular and Cellular Biology, will focus on developing AIDS vaccines as well as new treatments that patients would not have to take indefinitely. His new center will join a small group of such centers around the country devoted to AIDS research, including the Aaron Diamond AIDS Research Center in Manhattan, directed by Dr. David Ho, and the Institute of Human Virology at the University of Maryland, headed by Montagnier's longtime rival, Dr. Robert Gallo. Queens College was founded in 1937. It has the reputation of being among the best four-year colleges in the CUNY system. Because the college does not have a medical school or hospital, Montagnier's new institute will form clinical affiliations with patient clinics in the United States and abroad to conduct a wide range of research. :

Cell Penetration Mystery Race is On!

A heated scientific race was recently run between research teams of structural biologists at the Whitehead Institute for Biomedical Research, Harvard's Howard Hughes Medical Institute and Cornell University Medical College to unlock the molecular mysteries of how HIV infects cells. Finishing neck and neck, the teams at Whitehead and Harvard, both in Cambridge, Massachusetts, have found the precise mechanism by which HIV enters host T-cells: a harpoon-like protein that fuses with the membranes of immune system cells. Findings were published on May 18 in the journal Cell by Dr. Peter S. Kim and colleagues at the Whitehead Institute, while those by Dr. C. Wiley and team at Harvard were submitted to the journal Nature the week before, though notyet printed. The Cornell team placed third, but everyone's a winner because the discovery is expected to have important implications for future AIDS drug design.

Essentially, the harpoon-like protein is compressed like a spring until some event triggers its release. The protein, called gp41, apparently does not undergo the constant changes that occur in other regions of the viral envelope To speed the drug discovery process, Dr. Kim and the team at Whitehead are making precise three-dimensional information about gp41 widely available to other scientists through the Protein Data Bank maintained at New York's Brookhaven Laboratory.

Now that's sportsman-like behavior. Go team!

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This article was provided by Body Positive. It is a part of the publication Body Positive.