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Issue #232: June 4, 1999
FASTFAX is available by fax in the 215 and 610 area codes at no cost, by mail anywhere for 20.00 per year, by calling 215-545-6868, and on the fastfax index page. Information in fastfax is drawn mostly from secondary sources; people living with HIV/AIDS should share information of interest to them with their primary care provider before making treatment choices. For more information on HIV medications and treatments, contact Kiyoshi Kuromiya of the Critical Path AIDS Project, 215-545-2212 or by email to The presence of the name or image of any individual in fastfax should not be construed as an indication of their HIV status or sexual preference unless specifically stated. Questions or comments should be directed to Editor, fastfax, 425 S. Broad St., Phila., PA 19147-1126 or by email to
In This Issue:
"Weak virus" disappointing as basis for vaccine
HIV progresses rapidly in children of AZT-treated mothers: study
IL-2 said to flush HIV out of hiding
Anal cancer tests recommended for HIV+ gays
One in four blacks view HIV as federal plot
Forgery tied to bathhouse issue
Parr leaves Prevention Point, new director sought
Several people in Australia who contracted a weakened form of HIV in the early 1980s are beginning to show AIDS-like damage to their immune systems, a development that has disappointing implications for the development of a vaccine.
Between 1980 and 1984, 13 people in Australia received blood donated by an HIV-infected man, and eight of them caught the virus. When none got sick, researchers analyzed the virus and found that it was missing a working copy of a gene called nef, which boosts HIV reproduction.
Some researchers had hoped that a vaccine modeled on this weak virus could be an effective AIDS vaccine, protecting people for life without making them sick. The idea would be to create a vaccine using a weakened version of HIV that is missing nef and probably other genes, as well. Studies in monkeys suggest that this may protect animals from getting the simian version of AIDS.
However, some of the Australians now appear to show weakening immune defenses. Of the donor and five surviving transfusion recipients, three have falling levels of helper T cells, a hallmark of AIDS damage. In January, the donor whose blood infected the others began taking AIDS drugs because of his low blood count.
The Australians are known as the Sydney Blood Bank Cohort. A report on them was published in the New England Journal of Medicine by Jennifer C. Learmont and others from the Australian Red Cross Blood Service.
In an accompanying editorial, Drs. Kathleen L. Collins of the University of Michigan and Gary J. Nabel of the National Institutes of Health said the experience provides "another cautionary note" about the use of a live but weakened HIV strain as a vaccine.
Two of the patients have died since 1994 at ages 77 and 83, of causes unrelated to HIV, and one patient, who had the autoimmune disorder lupus erythematosus died at age 22 of causes "possibly related to HIV," according to the report.
The five surviving recipients are symptom-free without the help of antiretroviral drugs, 14 to 18 years after becoming infected with the virus.
This argues strongly that this HIV-1 strain is significantly weakened compared to other HIV-1 strains, for which the average time to progression to AIDS has ranged from 7 to 11 years, according to the report.
Two out of three patients with undetectable levels of the virus in their blood have had a decline in CD4 cells, immune system cells targeted by the virus. And CD4 counts have declined as well in the three people who do have detectable levels of virus in their blood.
These results have significant implications for the use of live attenuated strains of HIV as vaccines, according to an editorial by Dr. Kathleen Collins from the University of Michigan Medical Center in Ann Arbor, and Dr. Gary Nabel from the National Institutes of Health in Bethesda, Maryland.
"If large populations of uninfected persons were given this virus," they write, "there would almost certainly be unacceptable risks. On the other hand, if the virus could be further attenuated without loss of (its ability to stimulate an immune response), this approach might still be feasible."
"The main question is whether adequate attenuation would eliminate the efficacy of such a vaccine," Collins and Nabel point out.
The Australian researchers agree. "Finding a balance between replication of the virus and protection," they conclude, "is a critical issue if attenuated strains of HIV-1 are to be considered as the basis of a live attenuated vaccine." (Reuters, Associated Press)
HIV progresses rapidly in children of AZT-treated mothers: study
Italian investigators have reported that infants vertically infected with HIV whose mothers received zidovudine during pregnancy have a more rapid progression of HIV infection compared with children of untreated mothers.
Dr. Maurizio de Martino of the University of Florence and members of the Italian Register for HIV Infection in Children conducted a retrospective study of 216 children who were perinatally infected with HIV between 1992 and 1997. Thirty-eight of the infants' mothers had received zidovudine monotherapy during pregnancy and 178 had received no antiretroviral drugs.
The investigators compared the probability of HIV disease progression and 3-year survival in these 2 infant groups. They adjusted the data for year of birth, maternal variables at delivery, birthweight, and treatment, such as antiretroviral and prophylactic therapy.
Dr. de Martino's group found that the 38 HIV-infected children with mothers who were treated with zidovudine had a "...higher probability of developing severe disease" compared with the other children. These children also had a higher probability of severe immune suppression and lower survival.
These findings need to be confirmed with "...virologic studies (on timing of infection, viral load, HIV genotype, phenotype, and antiretroviral drug resistance) in mother-child pairs who fail prophylaxis," they report in the May 28th issue of AIDS.
In the meantime, they believe that these infants need to be quickly diagnosed and are candidates for aggressive antiretroviral therapy and HIV genotyping to help determine the optimal antiretroviral regimen. (Reuters)
IL-2 said to flush HIV out of hiding
Researchers say that they have struck another blow against HIV, although the stressed their results are only preliminary.
They said they had teased out one of the hiding places of the virus, allowing strong drugs to then attack the virus and clear much of it from the systems of patients.
Two HIV patients treated with an immune system compound known as IL-2 have no detectable trace of the virus anywhere in their bodies, although the researchers say they do not believe the patients are cured.
Cocktails of strong drugs can keep HIV at bay. These mixes of three or more drugs, known as highly active antiretroviral therapy, or HAART, can suppress all activity of the virus.
But HIV attacks immune cells, which have many specialized functions. The main cells it attacks, CD4 T-cells, have a special subset whose job is to remain latent in the body.
These so-called memory T-cells can last for decades.
When HIV attacks a cell, it injects its genetic material and forces the cells to start pumping out copies of the virus instead of splitting like normal cells do. HAART attacks only this active stage of the virus, interfering with the replication.
But the memory T-cells are inactive, so if they are infected the virus can hide in there from the drugs. Even after years of taking drugs, enough of the virus lurks in such places to reignite an active HIV infection.
So scientists have been looking for ways to flush out the latent virus. Tae-Wook Chun and colleagues at the National Institute of Allergies and Infectious Diseases (NIAID) and at several universities had found in test-tubes that immune system signaling chemicals known as cytokines could activate the resting T-cells and make them vulnerable to HAART.
"IL-2 can directly activate resting CD4 T-cells," they wrote in a report in the journal Nature Medicine.
"The combination of IL-2, IL-6 and TNF-alpha substantially increases the proliferation of resting CD4 T-cells, as well as viral replication in latently infected, CD4 T-cells."
Just administering IL-2 alone can prompt production of all three cytokines, they added.
So they tried it in people. Of 26 HIV patients, 14 underwent HAART plus IL-2, while 12 received HAART alone for an average of about 20 months. All 26 patients had responded well to the HAART, which had kept the virus at undetectable levels for at least 6 months. But studies have shown such patients have HIV lurking in so-called reservoirs such as the resting CD4 cells.
After the 20 months, Chun and colleagues ran a battery of tests on the volunteers to see if they could find any traces of the virus anywhere in their bodies.
All the patients who got IL-2 had lower levels of the virus than patients who got HAART alone.
In three of the patients, no virus could be found in the resting CD4 cells in their blood, and in two of them the virus could not be found hiding in the lymph nodes, either.
"However, this study does not prove that virus has been eradicated in these patients," Chun's team said.
"There are many potential reservoirs of HIV in the body that have not been examined, including the brain, gut-associated lymphoid tissue, bone marrow, testes and other organs."
AIDS specialists David Cooper and Sean Emery of the University of New South Wales in Sydney, Australia agreed that the study would have to be duplicated in larger groups and with more careful controls before any suggestion could be made that IL-2 should be routinely added to HAART.
"Eradication of HIV clearly remains an elusive goal for therapy at present," they wrote.
"We must be sure that the clinical application of these results actually makes a difference to the health of people with HIV infection," they added. (Reuters)
Just as use of Pap smears has led to a dramatic drop in cervical cancer, so screening for anal cancer among HIV-positive gay and bisexual men would save many lives at a reasonable cost, according to a new study published in the Journal of the American Medical Association.
The study predicts that use of a simple and inexpensive procedure, comparable to a Pap smear, would lead to both early detection of pre-cancerous lesions among high-risk men and allow for early treatment of a type of cancer known as anal squamous cell cancer.
About 35 HIV-negative gay men per 100,000 develop this form of anal cancer every year, according to available statistics. Among HIV-positive gay men, the rate is estimated to be about twice as high.
By comparison, about 40 women per 100,000 contracted cervical cancer every year in the U.S. before the Pap smear was in widespread use. Today, only about eight women per 100,000 get cervical cancer. The hope is that a simple, early screening procedure for anal squamous cell cancer would lead to a similar drop in disease and death.
"Unlike other cancers in HIV-positive men, this cancer is potentially preventable," said Joel Palefsky, M.D., professor of laboratory medicine at the University of California-San Francisco and senior author of the JAMA paper. No one knew that cervical cancer was preventable before the use of Pap smears as a screening aid became widespread in the 1960s, Palefsky adds.
Leader of the study and first author on the JAMA paper is Sue Goldie, M.D., M.P.H., assistant professor of health policy and decision science in the department of health policy and management at Harvard School of Public Health.
The new study draws on scientific information gained from cervical cancer screening and is based on epidemiological data from large samples of at-risk men in San Francisco and Seattle. The researchers predict that annual anal Pap smear screenings, along with follow-up biopsies and surgeries for those whose screenings warrant them, would cost about $16,000 US per year of life gained, adjusted for quality of life. By comparison, annual mammography has been reported to cost approximately $120,000 US per year of life gained.
According to the study's projections, screening annually would be the most beneficial and cost-effective strategy. Screening less frequently would be less effective at detecting cancer or precancerous lesions, while screening more often would provide little added benefit for its higher cost.
The brief procedure involves inserting a swab into the anal canal and removing it. It causes mild discomfort. The study does not conclude that practitioners should immediately begin offering the simple screening procedure.
"This study provides an important piece of additional evidence that anal Pap screening should be done for this at-risk population," Palefsky said. "However, before we proceed, we must first replicate the data we have from Seattle and San Francisco in other populations, to be able to dismiss the possibility that the disease pattern in these cities is unique."
Also, more health workers will need to be trained, both in performing biopsies when the screening test shows abnormal cells, and in surgical procedures to treat the precancerous lesions, the study notes. At present, surgery for this cancer is difficult and expensive. (JAMA)
In a recent survey of African Americans, more than one-quarter said they believed that AIDS was caused by a man-made virus developed by the federal government to kill black people.
Anecdotal reports by healthcare workers have indicated that many African Americans suspect that AIDS is part of a federal government conspiracy, according to a report in the May issue of the journal Preventive Medicine.
In addition, reports in two prominent black publications and discussion on a popular black television program have suggested that HIV prevention programs are really part of a genocidal government plan against African Americans.
To investigate the extent of AIDS-related conspiracy beliefs, Dr. Elizabeth A. Klonoff of California State University, San Bernardino, and Dr. Hope Landrine of the Public Health Foundation asked 520 African American adults the following question: "HIV/AIDS is a man-made virus that the federal government made to kill and wipe out black people. How much do you agree with the above statement?"
While the majority of the respondents (50.8%) disagreed with this statement, 14.3% reported that they "totally agreed" and 12.2% reported that they "agreed somewhat." Another 23% reported that they were undecided.
The researchers conducted the census in middle- and working-class areas of San Bernardino County, California, and participants were paid $10 for filling out the anonymous survey.
Men were 3.5-times more likely to endorse an AIDS conspiracy theory compared with women, an unexpected finding. In particular, the researchers noted that respondents who were "culturally traditional male college graduates who have experienced frequent racial discrimination throughout their lives" were more likely to believe in an AIDS conspiracy theory. They also found that conspiracy beliefs were unrelated to income.
Klonoff and Landrine suggest further study, in part to determine if knowledge of the infamous Tuskegee study is playing a role in HIV conspiracy beliefs among the black population. In that study, conducted earlier this century, black men in the South were not told they had syphilis or treated for the disease so researchers could study the progress of the disease.
The authors conclude that "AIDS-conspiracy beliefs among blacks must be acknowledged and addressed in culturally tailored AIDS prevention and education programs."
"It is important to note that blacks who endorsed... AIDS-conspiracy views did not differ in their degree of residential racial segregation, religiosity, or distrust of whites in general... and so these issues may be less important in culturally tailoring programs than blacks' cultural ties and experiences with racism," Klonoff and Landrine conclude. (Reuters)
A public health official in San Francisco this month accused an ACT UP chapter there of forging a letter, recently sent to an official at the U.S. Centers for Disease Control and Prevention, to falsely report that AIDS and sexually transmitted diseases were no longer threats in that city.
Robert Kohn, senior epidemiologist in the San Francisco health department's Division of STD Control, said he believes the falsified letter was an effort by the AIDS protest group ACT UP! San Francisco to sway public opinion about whether bathhouses in that city should be reopened. The San Francisco health department closed the bathhouses in 1984, stating that they were a threat to public safety, but the issue has recently become a topic of controversy again in that city.
ACT UP San Francisco is considered a "renegade" chapter by most other ACT UP organizations in the country, including ACT UP Golden Gate, the major ACT UP grouping in San Francisco.
The two-page letter, dated May 11, appears to be printed on official stationery used by the city and county of San Francisco's Department of Public Health. The Washington Blade received a copy in Washington, D.C., on May 21 that carried a postage stamp and appeared to be postmarked from San Francisco on either May 10 or May 19 (the post office mark was not completely legible).
The alleged signer of the letter is Dr. Mitchell Katz, the department's openly Gay health director. Katz said he learned about the letter when editors at the San Francisco Chronicle called him about it because, he said, they suspected it was a forgery.
Kohn said he had given ACT UP! San Francisco some of the statistics that appeared in the letter.
"ACT UP started calling me, and I gave them these statistics," Kohn said, referring to some accurate information which he said the forged letter contains. "Then they started trying to refute the argument that there's a public health problem."
The letter does not mention the bathhouse controversy, and ACT UP members in San Francisco said they did not write the letter but that they agree with its contents.
"I am happy to report more encouraging news that shows a continuation in the dramatic annual decreases in AIDS and all sexually transmitted diseases (STDs)," the letter states. It also notes that "San Francisco is presently experiencing the lowest STD rates since reporting began in 1955."
ACT UP! San Francisco is leading an effort to collect signatures on a petition to have the bathhouse issue put before voters in November 1999. The ballot initiative proposed by the grassroots coalition seeks to repeal health department rules that ban private rooms in Gay sex clubs and that require club staff members to ensure that no one is engaging in unsafe sex. Proponents of the initiative must gather 10,200 valid signatures on the petition by July 6 to have it qualify for the November 1999 ballot.
"I had nothing to do with that letter," said Dave Pasquarelli, a member of ACT UP! San Francisco since 1994. "But I'm glad to see it happen, to be honest."
The forged letter is addressed to Dr. Helene Gayle, director of the CDC's National Center for HIV, STD, and TB Prevention in Atlanta. A staff member in Gayle's office said Gayle has been in Africa for several weeks and has not seen the forged letter yet.
After learning about the letter, Katz wrote a letter to Gayle on May 13 in which he clarified information about the rates of AIDS and sexually transmitted diseases in San Francisco.
"I am writing to notify you that the correspondence dated May 11, 1999, was not issued from my office," Katz wrote. "The existence of this letter was just brought to my attention by editors of the San Francisco Chronicle newspaper, who received a copy and correctly suspected the forgery."
A spokesperson for Katz told the Blade that he was not planning to take legal action against the author of the letter because he does not know who created it.
In his May 13 letter to Gayle, Katz also said that, even though the incidence of AIDS cases and the number of AIDS deaths in San Francisco peaked in 1992 and have been declining steadily since then, "there remains much to do."
Katz noted that health officials estimate there are still about 500 new HIV infections each year in San Francisco.
In his letter to Gayle, Katz noted that community surveys also indicate an increase in unsafe sexual behavior among Gay and bisexual men.
Gustavo Suarez, spokesperson for the San Francisco AIDS Foundation, said the Foundation's position on the issue is that it is concerned about behavior and not with whether a given venue exists or not.
Erick Brown, director of prevention at New Village, an HIV prevention and education project of the San Francisco-based Black Coalition on AIDS, said his organization has not taken a stance on the bathhouse issue and has no plans to do so.
"Our stake in this is not as high as it is in other parts of the community," he said.
But Brown said that forging a letter to shape a political debate could be detrimental to the entire Gay community.
"It takes away some of the community's credibility," he said, "even if we don't know who did it."
James Nguyen, a spokesperson for the Stop AIDS Project in San Francisco, said that organization has not publicly stated its position on the bathhouse issue yet. "Our hope is to continue the discussion among community members," he said, "because it's a hot issue and many people have different feelings."
Suarez said a forged letter, similar to the one at the San Francisco health department, was circulated about the San Francisco AIDS Foundation on April 5. It contained the name of Pat Christen, the executive director of the San Francisco AIDS Foundation, and a series of claims about changes at the foundation. Like Katz, Christen did not take legal action but wrote a letter clarifying incorrect information contained in the forged letter. (Washington Blade)
Parr leaves Prevention Point, new director sought
Julie Parr, executive director of Prevention Point Philadelphia, the state's only syringe exchange program and among the largest such programs in the nation, announced her resignation this week. She joins David Acosta, founder and executive director of the Gay and Lesbian Latino AIDS Education Initiative (GALAEI), as the second leader of a major area AIDS organization to resign over the past month.
PPP has announced that is immediately conducting a search for a new executive director. In a statement, the group said that "PPP is a growing and dynamic organization with a strong staff and Board of Directors, and which sees thousands of people for syringe exchange every year. We also provide a variety of ancillary services such as HIV testing/counseling, medical clinics and support groups. Qualified candidates will be exceptional managers with an understanding of harm reduction philosophy. The Director is responsible for staff supervision, fiscal and physical plant management, program development, grant writing, acting as public spokesperson, and collaborating effectively with a range of stakeholders (i.e. participants, evaluators, politicians, Department of Health officials, community leaders, volunteers and staff). The Executive Director will be expected to have a thorough understanding of harm reduction, knowledge about disease prevention among drug users, and a strong commitment to promoting the health and civil rights of drug users."
PPP is also seeking a half-time Community Organizer. "The Organizer will be responsible for mobilizing and maintaining community and political support for syringe exchange and related services in Philadelphia; participating in state-wide efforts to increase syringe access; and developing leadership among current and former syringe exchangers and supporters. Qualified candidates will have an understanding of Philadelphia and Pennsylvania stakeholders, proven capacity to implement effective advocacy strategies and campaigns, and a commitment to the continuation of syringe exchange as a means of preventing HIV and blood borne diseases among drug users."
Prevention Point will be accepting resumes and interviewing for the positions as of June 14th, 1999.
Please mail resumes to Annet Davis-Vogel, Vice-Chair, Prevention Point Board of Directors, 333 West Girard Avenue, Philadelphia, PA 19123.
On Saturday, June 19, 1999, AIDS Services In Asian Communities (ASIAC) will be holding it's first fundraiser, "Day & Night", which will feature a fashion show fundraiser showcasing up and coming fashion design talent in the East Coast. The show will also be hosted by Ms. Sianni Lee of KYW - 3 News. The event will be held at the Clarion Suites Chinatown,
1010 Race Street, Philadelphia, on Saturday, June 19, 1999, from 8 pm - 11 pm.
Tickets will be $25 advance & $35 at the door.
Ticket reservations & payment arrangements can be made by calling ASIAC @ (215) 563- 424 ext 10.
Since 1995, ASIAC's mission has been to provide culturally sensitive and language appropriate HIV related services to the Asian & Pacific Islander communities of Philadelphia and it's surrounding counties.