Breakthrough may lead to more effective HIV treatments
TPAC seats new Board, officers
RAAC recommends defunding of prevention programs
Mandatory CD4 name reporting still on city's agenda
FIGHT enrolls for new nutrition trial
AIDS researchers have announced they had found clues to how some people manage to resist HIV in three studies lauded as a leap forward in understanding how to fight the illness.
The studies centered on chemicals that block HIV, and on how HIV gets into cells in the first place.
Scientists say they have found a second receptor -- a type of door the virus uses to get into the cells it infects. HIV needs at least two of these receptors to infect the immune system cells it targets.
The studies, two in the scientific journal Nature and one in Science, found the second receptor was that for proteins known as chemokines. People who have a built-in resistance to HIV produce the chemokines in abundance, they said.
"Our understanding of HIV infection has leapt forward with these two previously unrelated facets," Robin Weiss and Paul Clapham, HIV specialists at the Institute of Cancer Research in London, wrote in a commentary.
"The papers show that in order to infect a cell, not only does HIV have to adsorb (stick) to the CD4 receptor on the cell surface, a well-established point of entry, (but) it must also needs the help of a second receptor known as CC-CKR-5."
Like any other virus, HIV is a simple bag of genetic material. It infects a cell by first hooking on to it and then injecting its genetic material.
It turns the cell into a miniature virus factory, pumping out more copies of the virus. The beta chemokines seem to stop HIV from latching on to the cell in the first place.
Hongkui Deng of the Howard Hughes Medical Institute at New York University and colleagues knew that people who resist HIV produce higher than normal amounts of chemokines, which are involved in immune system response.
These HIV-resistant few take a very long time to progress to full-blown AIDS or do not develop HIV infection at all, despite repeated exposure.
Deng's group found three chemokines in particular were involved -- they are known as RANTES, MIP-1alpha and MIP-1beta.
They also knew that, although HIV uses the CD4 receptor to get into cells, this was not enough. Looking for the second receptor, they identified CC-CKR-5 -- the receptor for the chemokines.
Tatjana Dragic of the Aaron Diamond AIDS Research Center at Rockefeller University in New York and colleagues sponsored by Progenics Pharmaceuticals were doing similar research at the same time and found the same thing.
They tested cells from two people who seemed resistant to HIV. They found the three chemokines MIP-1a, MIP-1b and RANTES seemed to work in combination
"The simplest explanation of our results is that the binding of certain beta-chemokines to their receptor(s) prevents, directly or otherwise, the fusion of HIV-1 with CD-4 cells," they wrote in Nature.
Weiss, who helped discover the first CD4 receptor 12 years ago, said the studies opened up a new era of AIDS research.
"Knowing more about this crucial second step to infection, the first being binding to CD4, may help find drugs, inhibitors, treatments that would block this step," he said in a telephone interview.
But he said simply injecting HIV patients with the chemokines would probably not be enough.
"Just having them floating around in the blood, I don't think is terribly useful," he said. "It's probably what's happening inside cells that's important."
TPAC seats new Board, officers
The Philadelphia AIDS Consortium (TPAC), the southeastern Pennsylvania region's Ryan White Title II Planning Coalition, seated a new board of directors and elected interim officers at its annual meeting held on June 12th.
The new group, consisting of twenty-nine members (half of which are people living with HIV/AIDS) who roughly represent the demographics of the HIV epidemic, is the outcome of years of complaints from the community charging that TPAC was too bogged down with conflict of interest to make decisions appropriately about services to people living with HIV/AIDS. As a result of the past difficulties, TPAC lost most of its planning money last year when its role as the Title I planning council was moved to the newly created HIV Commission, which is also comprised of 50% people living with HIV/AIDS.
With regard to representation of communities of color, people with HIV/AIDS, women and sexual minority people, the new TPAC Board is the most diverse and representative in the group's history. Six seats remain to be filled with guarantee appropriate Latino and suburban representatives.
Ennes Littrell of ActionAIDS, a member of the new TPAC board, is quoted in this week's Au Courant as saying, "Well, I think we have enormous challenges in front of us right now and one of the things that I will be looking forward to is our (becoming cohesive) and being able to respond to those tasks that we need to get done very quickly. I think it's a great group of people. I think the nominating committee did a wonderful job."
Also at the meeting interim officers were elected for the period of six months to serve the group through an interim process of setting up the organization's new bylaws and committee structure, and to begin orientation for new and old members alike. Elected to the position of President was Joe Cronauer, an openly HIV-positive Board member from We The People. Elected Treasurer was Alan Edelstein, who served as Treasurer for the previous TPAC Board.
TPAC's new Board members are: Paul Alexander, Rita Anderson, Gary Bailey, Catherine Balsley, Alicia Beatty Susie Birenbaum, Kieth Burress, Richard Byrd, Joe Cronauer, J. Blair Durant, Alan Edelstein, Michael Fraschetta, Ray Hayes, Judy Henderson, Michael Hinson, Kiyoshi Kuromiya, Ennes Littrell, Richard Liu, Karen Lyons, Jeff Maskovsky, The Rev. Patrick H. Maye, Jena Nottingham, Arthur Osbourne, Steve Pina, Kevin Pleasant, Nurit Shein, Jane Shull, Nadine Tucker-Dorn and Leonard West.
RAAC recommends defunding of prevention programs
The Resource Allocations Advisory Committee (RAAC), which makes allocations recommendations for the city for HIV/AIDS programs, has recommended the defunding of several programs considered key to the delivery of prevention services in the Philadelphia region. The defunded agencies were advised of their funding cuts only ten days before they had expected new contracts to be awarded.
The recommendations were for Pennsylvania "106" money administered by The Philadelphia AIDS Consortium (TPAC) and designated for use in HIV prevention services in Southeastern Pennsylvania. The funds have traditionally been considered "ongoing" funds by local providers, which means once they are awarded the recipients -- barring any unusual circumstances -- expect the funds to continue from fiscal year to fiscal year. Given that information, providers of services hire employees and build infrastructures to support the delivery of services that they are contracted to provide.
This year, however, the State required that the money be put up for a competitive process through which other service providers could compete for the money along with those who already have it. The result has been that somewhere around ten programs currently being funded by the 106 money will end effective July 1st as new prevention programs are begun.
Among the programs losing their funding are the Attic, a sexual minority youth AIDS prevention case management program at Voyage House, youth outreach projects of the Youth Health Empowerment Project, and youth programs at the GALAEI Project.
The defunding situation is considered unusual because even in a competitive process the current providers of services are usually given preference to continue their existing services over new services, since the staff and infrastructure to provide the existing services are already in place, saving the time and cost of starting up a new program. No evaluations of existing programs were considered by the RAAC in its decisions.
In an agreement with Health Commissioner Estelle Richman made before the new TPAC Board was seated, TPAC agreed to ratify the decisions as presented by RAAC, if RAAC agreed for "this time only" to review the proposals. This left the new TPAC Board, which was in place for less than a week, with a decision of ratifying the recommendations or having no one funded at all while the group scrambled to try to find someone else to review the proposals. The contract are scheduled to begin on July 1st.
Another potential outcome of not ratifying the decisions, according to Joe Cronauer, President of the TPAC Board, "...was that the State, given the old TPAC's record for bad allocations processes, might react to the non-ratification by pulling all of the money from TPAC and giving it to the new HIV Commission, which would mean having all of our eggs in one basket and RAAC making all of the funding recommendations no matter what the community thought. In the meantime, TPAC has set up a special committee to help us avoid this problem again by searching for an outside, conflict-free and independent alternative to RAAC for making funding allocations recommendations." RAAC is also the group used by the HIV Commission for allocations recommendations for Ryan White Title I money.
"It's not that there's anything wrong with the new services funded," according to Cronauer, "It's just that it's not a good thing at all for an already unstable system to suddenly defund current services that people living with and at risk for contracting HIV are already depending on."
Cronauer said also that some TPAC board members have complained that the RAAC is not capable of making fair evaluations of funding proposals, while others have blamed the leadership of the old TPAC board for failing to implement the RFP process itself fairly and providing poor advice to the RAAC on how it should evaluate the proposals.
Several community leaders, including Cronauer, urged the HIV Commission at its recent meeting to set aside some newly available Ryan White money to fund some of the programs just defunded through the 106 process. Although prevention programs cannot be funded by Ryan White money, some of the programs that were defunded provide both care and prevention services so might qualify for partial funding through either funding stream. Also some HIV contracts funded by city general funds might be shifted to "fit in" these defunded programs, according to the these community leaders present at the Commission meeting.
The Commission will be meeting again the first week in July to discuss their funding priorities.
Mandatory CD4 name reporting still on city's agenda
The city's proposal to require labs to report by name anyone who has a CD4 count of 200 or below is still "on hold," but remains a possibility as the deadline of June 30th for community counter-proposals draws near.
Several months ago the city held a "community meeting" to get input into their idea of requiring all labs in the city to report by name to the city AIDS office anyone who had a CD4 count of 200 or below, which is part of the federal government's definition of AIDS. At the meeting, however, city Health Commissioner Estelle Richman, AACO director Jesse Milan and AACO epidemiologist Dr. Erica Gollub announced their plans to implement the system as soon as possible.
Strong community opposition to the plan convinced Commissioner Richman to postpone the action and solicit community alternatives to the plan, which the city claims will boost AIDS reporting and lead to greater funding for the city's AIDS programs. The deadline for community responses is June 30th.
Community leaders -- lead among them Critical Path director Kiyoshi Kuromiya and We The People director Joe Cronauer -- sharply criticized the plan as unworkable and fraught with potential breaches of confidentiality. Additionally, according to Cronauer, "The plan won't lead to any increase in AIDS reporting because individuals who have the option will simply go outside the city for the tests in order to avoid having their names laying in a pile of lab reports at AACO. Given AACO's reputation around confidentiality, I might be making a visit to Bensalem myself."
The Philadelphia AIDS Consortium (TPAC) also criticized the plan, noting that the city claims that the tracking of thousands of lab reports, calling medical providers to confirm an AIDS diagnosis, and checking the names against the already existing AIDS registry will not cost the city any additional human or other resources. The city requires that any proposal for an alternative system also be "cost neutral." If AACO has enough employees to absorb this large of an additional workload, noted several AIDS activists, then they must have a lot of free time on their hands right now.
Circulating around the city is another potential block to the city's plan -- an authorization form from a patient to their doctor explicitly disallowing the use of the patient's name on any of their lab work sent in to a Philadelphia lab. The authorization does allow for the use of a "provider-generated unique identifier," which is a code that a medical provider would assign to a patient's lab work that is known to the provider but not to the lab in order to maintain confidentiality. This concept is one of several currently being considered by TPAC for proposal to the city as a cost neutral method of getting the information while maintaining confidentiality.
Other potential proposals from TPAC include the use of a system-wide unique identifier system, the creation of a study to see if the mandatory reporting of CD4 counts by labs will increase AIDS reporting in the first place, and doctor education to reinforce AIDS reporting by doctors as required by law.
FIGHT enrolls for new nutrition trial
Philadelphia FIGHT is enrolling a clinical trial which will test whether food supplements, like Sustacal and Ensure, will prevent people from experiencing severe weight loss, known as wasting syndrome. The trial is for people who have less than 100 t-cells, and who have not recently lost weight. The importance of this trial is that it will help determine whether nutritional supplements actually keep people from experiencing wasting, and whether this, in turn, will lead to better survival for people with AIDS.
Everyone participating in the trial will receive free food supplements. For more information, please call Philadelphia FIGHT at 215/985-4448, or write them at 1233 Locust Street, 5th Floor; Philadelphia, PA 19107.