http://www.buddhistaidsproject.org/March2000.html

 

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BAP News: March, 2000

Week Ending March 25, 2000

Please see other Buddhist AIDS Project (BAP) pages at www.gst.net/~bap, including "Events", "Resources", "Links", "Library",and "Bookstore".

Buddhist News

March and April retreats and workshops at San Francisco Zen Center, Green Gulch Farm, Spirit Rock Meditation Center, San Francisco Gay Buddhist Fellowship; "Buddhism at Millenium's Edge" -- April Talks/Day Long Workshops; Coming up in April: Five Day Residential Vipassana Meditation Retreat for Gay, Lesbian, Bisexual and Transgender Participants at Spirit Rock Meditation Center; also coming up in April: Zen Hospice Project's " Caregiver Volunteer Training" -- Please apply now if interested; NEW Book, April, 2000: Finding a Joyful Life in the Heart of Pain, by Darlene Cohen, (Shambhala). Darlene co-leads the weekly Mindfulness Meditation Group for people living with chronic or life-threatening illnesses at Zen Hospice Project; Many new and upcoming Workshops and Retreats listed for the Pacific Northwest.

HIV/AIDS News

Special Section: "HIV and Depression"

TREATMENT: Beat the Blues
By Maia Szalavitz, POZ Magazine, March, 2000, www.poz.com

It doesn't take a brain surgeon to defeat depression. But you do have to get yourself help.

Depressed people often resist getting treatment, and HIVers are no exception. In addition to "I'm not crazy," "It's my own fault I'm miserable," "Nothing's gonna help" and other routine rationalizations, HIVers have a special zinger to fling at folks who tell them to get over it: "You'd be miserable, too, with a life-threatening virus." Well, get over it -- untreated depression has serious health effects and can even shorten your life, not to mention just being a big bummer. What might surprise the downcast is the news that depression is very treatable.

One common but often-overlooked cause of depression in men (and some women) with HIV is low testosterone. So HIVers should have their levels checked as part of any evaluation for depression. A study at Columbia University found that three-quarters of HIV-positive men with major depression who had deficient or even "low normal" testosterone levels showed improvement "equal to that achieved with standard antidepressants" when given supplements of the hormone.

Other contributors to depression are overall malnutrition or deficiencies of B vitamins (especially B-6 and B-12), very common in HIVers. And since nutrient-level blood tests are unreliable, eating better and adding a potent B complex plus extra B-12 (by nasal gel or injection) are worth trying.

If the depression is diagnosed as mild or moderate, everything from psychotherapy to exercise to pets can help. The main issue is: Can you mobilize to take these actions? If you can get yourself to your support group, the gym or the dog run, all well and good. But if, as Emily Carter describes in "Woman on the Verge," even finding a pair of clean socks in the morning (or late afternoon) looms as an overwhelming task -- you may need to start an antidepressant.

Phil Bialer, MD, who started the AIDS psychiatry unit at Beth Israel Medical Center in New York City, advises that even before you shop for St. John's Wort or start a daily jogging routine, first get a psychological evaluation. "It's a very complicated illness," Bialer says. "It's important to have a mental-health worker as part of your treatment team." Many practitioners recommend weekly visits with a psychiatrist, psychologist or social worker for four weeks, with at least one 30-minute consult every month thereafter. Ongoing monitoring is especially important if your treatment of choice is pharmacological.

The chart below features the best available meds and techniques to battle the blues. Whether picking and sticking to one or mixing and matching, keep your doctor or therapist informed. Bring this chart to your next visit and discuss your preferences. "I feel confident that for almost 90 percent of my patients, we can find something that works," Bialer says.

TREATMENT BENEFITS/ CAUTIONS:
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram)
Generally fewer side effects than tricyclic antidepressants (see below). Can cause loss of sexual desire and function, appetite suppression and headaches. Some on the drugs feel "speeded up"; others, slowed down and fatigued. Watch for interactions with HIV meds, particularly ritonavir (Norvir).

TRICYCLIC ANTIDEPRESSANTS

Norpramin (desipramine), Pamelor (nortriptyline), Tofranil (imipramine), Sinequan (doxepine)
Also can help with chronic pain, reduce insomnia, increase appetite. Side effects such as sedation, constipation, dry mouth, irregular heart beat. Watch for interactions with HIV meds, particularly ritonavir.

OTHER ANTIDEPRESSANTS
Serzone (nefazodone), Remeron (mirtazapine), Wellbutrin (buproprion), Effexor (venlafaxine), Desyrel (trazodone)
Serzone and Remeron are particularly helpful with sleep, and (along with Wellbutrin) reduce sexual function less than do SSRIs or Effexor. Wellbutrin helps in quitting smoking. Remeron may cause weight gain. Effexor may cause agitation, insomnia and sexual dysfunction. Desyrel may cause painful erection requiring medical help. Wellbutrin in high doses or with ritonavir may cause seizures. Watch for interactions with other HIV meds.

>>>To unlock the secret of maximizing antidepressant and antiretroviral power, the right combo is key
Nothing is simple when you're HIV positive. Though many meds are now available for treating depression, HIVers must take special care when adding any drug to an already-complex regimen. And drug interactions aren't the only concern: Lifestyle factors such as stress, drinking and recreational drug use, and intake of herbs and supplements can all influence the effectiveness and side effects of antidepressants.

Matt Harrison (name changed), an HIV-positive ad exec in New York City, is a veteran of depression battles. Since he'd previously vanquished the blues with the help of Paxil (a drug in the SSRI class), his HIV doctor thought it was the obvious choice when Harrison recently began slipping back into the pits. At first, Harrison resisted -- the drug had knocked down his sex drive and potency -- but the doc said he could switch after a month to the less-libido-lowering Serzone. While Paxil worked as a stopgap, Harrison worried that the Serzone would mess with his four-drug HAART regimen. Indeed, the switch -- and, Harrison believes, his stress-filled days of late nights and lots of coffee, booze and sugar -- resulted in a manic episode that (among other disruptions) wreaked havoc with his HIV-med schedule.

Since drug interactions often hinge on uncontrollable factors ranging from genetic makeup to liver function, it's often hard to guess which meds make a good match. There are no hard and fast rules. "Virtually all antidepressants can be used with antiretrovirals," says Phil Bialer, MD, founder of the AIDS psychiatry program at Beth Israel Medical Center in New York City, "but you have to monitor closely for safety." Harrison found that consulting with an HIV-savvy psychopharmacologist was well worth the cost. Suspecting that the interaction between Serzone and his HIV meds was one element of his problem, she substituted Wellbutrin, which, for Harrison, lived up to its name.

In the interaction stakes, Norvir (ritonavir) leads the antiretroviral pack, followed by Crixivan (indinavir), and some HIVers have problems with other HIV meds. So for everyone on HAART, Dan Karasic, MD, associate clinical professor of psychiatry at the University of California at San Francisco, suggests reducing the normal starting dose of an antidepressant by one-half to two-thirds and then gradually raising it until reaching an effective level. "Ritonavir can increase blood levels of SSRIs by triple or more," Karasic says, explaining that this may increase side effects but is not dangerous. However, with tricyclic antidepressants, an overdose can cause heart problems, so more caution is needed. Karasic discourages using Wellbutrin with ritonavir since the resulting elevated Wellbutrin can cause seizures.

During the first few weeks on any antidepressant, be alert for new symptoms. With SSRIs (such as Prozac, Zoloft and Paxil), mild diarrhea, nausea, light-headedness and even minor hallucinations are not out of the ordinary, especially in the first few days when the body is reacting to its new brain chemistry. But if during the first month you experience extreme anxiety, uncomfortable "speediness," panic, severe diarrhea or worsening of side effects from other meds, contact your doctor. "It's really important to learn how to identify possible side effects," Harrison says of his own manic moment. Knowing that he had recently started Serzone, he was able to recognize that the elation, sped-up speech and inappropriate reactions were a drug effect, and to seek help.

Bialer says that although there are often adjustment problems, a review of his patients' charts showed that 89 percent were able to successfully take antidepressants with their AIDS meds. For sexual side effects, Bialer sometimes adds Viagra, though the dose must be lowered for people taking protease inhibitors, particularly Norvir and Crixivan, to avoid potentially dangerous effects on the heart.

Choosing a first antidepressant for someone on HAART is tricky. Bialer recommends either Effexor or Celexa, which cause fewer interaction problems and overall side effects than other selections. However, both drugs can also produce sexual dysfunction. Karasic stresses the importance of doctor-patient communication. For many HIVers, he says, potential interactions may be less important than whether a drug tends to depress libido, cause insomnia or spark weight loss. Ultimately, as with the decision about antiretrovirals, it's up to you to do your own risk/benefit calculus.

PSYCHOSTIMULANTS
Ritalin (methylphenidate), Dexedrine (dextroamphetamine), Cylert (pemoline)
Work almost immediately. Help with fatigue and mood. Also useful for attention deficit disorder, which can be a part of depression. Risk of dependence, but need not be avoided by all with addiction history. Can cause insomnia, appetite loss, overstimulation, increased heart rate and post-dosing fatigue.

TESTOSTERONE REPLACEMENT --(patches or creams preferred; injections not recommended)
Many cases of HIV-related depression and loss of sex drive are related to low testosterone levels. Requires blood test to determine testosterone level (see Raging Hormones, April 1999). If dose too high, can have such side effects as aggression or (for women) masculinization.

INTERPERSONAL PSYCHOTHERAPY
Research on HIVers finds that this therapy works. Improves relationships, coping. Severe depression may require drugs as well.

COGNITIVE OR BEHAVIORAL PSYCHOTHERAPY
Has the most research support of all talk therapies for improving mood. Severe depression may require drugs as well.

SUPPORT GROUPS
(in-person or online)
Studies show that in-person support improves mental and physical health; those in similar situations can offer new insights and coping skills. In-person: if you're too depressed to go out, not a useful resource. Online: no data on antidepressant value; lacks full benefit of human contact.

ACUPUNCTURE
Two controlled studies show dramatic improvements, plus relief from anxiety-related symptoms. Full benefit requires once- or twice-weekly visits to acupuncturist for a period of time.

ST. JOHN'S WORT HERB
(most potent forms: freeze-dried flower and leaf or 0.3% hypericin extract)
According to numerous controlled European studies, generally as effective as some antidepressant drugs for mild to moderate depression, with far less toxicity. High doses can induce painful sensitivity to sunlight. Can't use with SSRIs or MAO inhibitors. Use with caution in combo with protease inhibitors and NNRTIs. Varying quality.*

SAMe
(S-adenosyl-methionine, an amino acid derivative)
European research finds that this nutrient, important to brain and liver function, can have antidepressant effects. No evidence of toxicity, but little data in general. Expensive, varying quality.*

BACH FLOWER REMEDIES
(essences from 38 flowering plants, diluted in an alcohol base, taken in a cup of water; several indicated for various types of depression; can be used in combos)
According to many alternative practitioners, can balance negative feelings and stress, and may help reduce emotional barriers to health maintenance; effects occur any time from immediately to two weeks; nontoxic; inexpensive; FDA-regulated for quality control. No data showing effectiveness for depression. For those with alcohol sensitivity, need to further dilute in water (which doesn't reduce effectiveness).

GOOD DIET AND NUTRIENT SUPPLEMENTS (esp.
B-6 & B-12)
If depression has a nutritional cause, can help. No side effects. Supplements mean taking yet more pills, or in the case of B-12, nasal gel or injections.

EXERCISE
(such as yoga, running, bicycling, swimming or even walking)
Releases body's natural pain-relievers, boosts mood and promotes relaxation. Can cause fatigue if too strenuous. May be difficult to do if depression has undercut your self-motivation.

PET OWNERSHIP Pets provide unconditional love; research shows people with pets live longer, have better moods and more normal blood pressure. Need care, food.

RESOURCES
These are great guides to your adventure in brain chemistry:
The HIV Drug Book, compiled by Project Inform (Pocket Books/New York City)
The Handbook of Psychiatric Drugs, by Bernard Salzman, MD (Henry Holt & Co./NYC)
The Essential Guide to Psychiatric Drugs, by Jack Gorman, MD (St. Martin's Griffin/NYC)
Beyond Prozac: Brain-Toxic Lifestyles, Natural Antidotes and New Generation Antidepressants, by Michael J. Norden, MD (ReganBooks/NYC)
The "Depression" chapter of The Encyclopedia of Natural Medicine, by Michael Murray, ND, and Joseph Pizzorno, ND (Prima Publishing/Rocklin, CA).

Note:

In addition to the above skillful means of responding to HIV related depression, the Buddhist AIDS Project recommends considering a regular and gentle practice of Mindfulness Meditation, as well described by San Francisco's Zen Hospice Project which offers a weekly meditation practice and support group for people living with HIV and other serious illnesses, www. zenhospice.org.

From Zen Hospice Project Meditation Group description:

"Mindfulness meditation practice is a path to freedom."

It loosens the grip of conditioning and bridges the gap between the mind and heart. Meditation can be thought of as a powerful tool which nurtures greater awareness, clarity and acceptance. With practice, it can cultivate in us an appreciation for the fullness of each moment that we are alive regardless of the conditions we face.

Mindfulness provides a simple and effective way for getting ourselves unstuck, back in touch with our innate wisdom, compassion and vitality.

Recognizing the possibilities for people living with serious illness, we created this unique group to encourage a sense of mutual support and exploration among those facing common issues. In addition to instruction and periods of practice, talks or discussions, we will address the constant change that accompanies illness; the challenge of healing; coping with chronic pain, stress and loss; and our relationship to the unknown.

DRAWING ON A 2500 YEAR OLD TRADITION, this style of mindfulness meditation is direct and accessible and does not conflict with any religions or scientific belief. It is a kind and practical way of coming into contact with the precarious yet precious nature of our lives.
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More HIV/AIDS News -- March 18 - 25, 2000...

This abstract is from the CDC NCHSTP Daily News Update for March 20,2000
Strategies for Long-Term Success in the Treatment of HIV Infection
Journal of the American Medical Association, www.jama.com (03/08/00) Vol. 283, No. 10, P. 1329
by Gallant, Joel E.

The advent of highly active antiretroviral therapy (HAART) has made HIV a chronic, manageable disease if treatment is carefully prescribed and followed. The hypothetical treatment of a 39-year old woman who switched drugs frequently and did not fully adhere to her regimen shows the dangers of developing resistance to the drugs through nonadherence. The woman exhausted her choices of AIDS drugs fairly early in her disease because of this and also because of her physician's lack of knowledge. Author Joel E. Gallant, from the Johns Hopkins University School of Medicine in Baltimore, notes that expert care should be given to designing a treatment regimen that will be fully followed and tolerable. Without this required expertise, regimens become less effective because of cross-resistance between the three drug classes. Genotypic and phenotypic resistance assays can help determine an effective salvage regimen if cross-resistance occurs. The assays do not work for everyone, however. Viral load testing is now useful in determining a patient's status in relation to a CD4 cell count. The goal of suppression of viral replication remains for drug regimens, and it is up to the patient and a qualified physician to make informed choices for reaching this goal.

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Project Inform: New Anti-HIV Therapies
Quick Sheet, September 1999,

Please see www.projectinform.org , "New Files, March 20, 2000"

TABLE OF CONTENTS
Introduction
New Protease Inhibitors
New Non-Nucleoside Reverse Transcriptase Inhibitors
New Nucleoside and Nucleotide
Analogue Reverse Transcriptase Inhibitors
New Targets
On The Horizon
Commentary

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WARNING: Heart Beat
By Lark Lands, POZ Magazine, February, 2000

Another bump has arisen on the HAART road to PWA recovery. First there was the flood of reports of previously healthy protease-takers developing skyrocketing blood fats (triglycerides and cholesterol). Then came stories of heart attacks. Now there's research suggesting a possible mechanism by which protease inhibitors (PIs) might help cause those attacks. University of Wisconsin scientists recently found that in PWAs on PIs, the lining of the blood vessels (the endothelium) may not be functioning properly, thus heightening the risk of heart attack. Ultrasound mapping of blood flow through the brachial artery in the upper arms of 21 HIVers on PIs found significantly impaired responses to changing blood levels. While stressing that the findings are preliminary, the researchers are calling for closer heart-health monitoring of PI-takers, plus the possible use of blood-fat­lowering agents to reduce cardiac risk.

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HIV pioneer foresees vaccine, better treatments in near future
by Ryan Gierach, for Frontiers Magazine, March, 2000

In an interview with Frontiers, Luc Montagnier, a doctor at the forefront of research since he codiscovered HIV, spoke about his book Virus, published by W.W. Norton & Co. in January. He also addressed the state of AIDS at the start of the new millennium, challenged the persistent belief among some that HIV doesn't cause AIDS and issued an optimistic view on the chances of defeating the disease.

Ryan Gierach: Why should people pick up your book?

Luc Montagnier: Of course, anybody who is interested in how this all came about, the history of AIDS, would be interested in this book for several reasons.

First, the book is a description of the discovery of AIDS and sheds light on the importance of cooperation between scientists and governmental agencies around the world in addressing the public health. This becomes much more important with movement of peoples around the globe—AIDS simply could not have happened 100 years ago.

Also, people need to know that AIDS is not over. Yes, highly active anti- retroviral therapy (HAART) does extend lives, but we know that is no cure. In 95 percent of the world, HAART is unthinkably expensive, and only available in the West. Africa and Asia simply don't have the resources to treat the virus.

That is why, and we come to another reason to read this book, we must find a vaccine. At the same time, we must seek out a way to provide treatment to those who suffer from HIV on those continents.

Ryan Gierach: Why so much focus on a vaccine?

Luc Montagnier: Past experience has shown vaccination to be the most effective, fastest and least costly means of uprooting an epidemic. So it was with smallpox and so too it will soon be with polio.

Ryan Gierach: What is the outlook for treatments?

Luc Montagnier: I am investigating a way to aggressively treat HIV with HAART. Perhaps an intensive HAART akin to chemotherapy for cancer for six to 12 months and then using immunotherapy, which is a kind of vaccine in which we re-introduce the virus to boost the immune system's ability to deal with it. Even six months of HAART is beyond the reach of most people in these parts of the world, but there are people who can afford it and we hope to put together trials of this soon.

Ryan Gierach: What about social co-factors? You heard Dr. Bolan mention mental illness and substance abuse.

Luc Montagnier: Co-factors are many things: social and economic and biological. We see that these problems, along with promiscuity and unsafe sex, advance the disease. We are interested in those who have the disease but also in whom it does not advance.

Still, the importance of maintaining good mental and physical health in HIV patients cannot be overstated. There is a direct link between the immune system's ability to defend the body against disease and the nervous system's efficiency. Stress and mental depression cause immune suppression, even in those where the virus is not present.

Ryan Gierach: How do you go about identifying co-factors?

Luc Montagnier: That is where our new research facilities fit in. We have three at present and hope to broaden the effort by expanding that number to include this facility (the Jeffrey Goodman Clinic). We operate one in Paris, one in the Ivory Coast (in) Africa, and one in New York City at Queens College. We need a diverse sampling; we look for large populations of HIV-asymptomatic patients. This clinic is a perfect fit. Of course, we would need to bring in the equipment, but it is not large, and we would train the researchers and clinicians to do the work. We are looking at tests that tell us how the disease advances and why, it seems in some, it does not.

Ryan Gierach: What other treatment ideas are percolating?

Luc Montagnier: We think that we can find drugs with longer half-lives, meaning fewer and less costly dosing. That would be a boon in Africa.

Ryan Gierach: Recently, an organization has formed here in Los Angeles, co-opting ACT UP's name and claiming HIV does not cause AIDS and that doctors are poisoning their patients with HAART. What are your reactions to their assertions?

Luc Montagnier: ACT UP—Larry Kramer's ACT UP—did important work forcing the world to create a vast infrastructure to deal with this epidemic. These people surely do not share that positive vision. They are dangerous to us all because they keep people from testing for and treating their illness. This leads to many more infections, as we see today in the youths who do not hear or listen to prevention messages. These people are fools, for not treating HIV. It is most often fatal. HAART is not perfect, but we have saved countless lives with it, provided a real and full life to tens of thousands more who can now work and play and create and have children because of it. We are saving the social fabric with treatment. We, at least, are doing something to deal with HIV. They are denying it and even trying to destroy the good work done by others.

Ryan Gierach: What about the future?

Luc Montagnier: (It) is bright and clouded. In the West, we have new drugs and treatment advances coming rapidly, if now incrementally. We see that a vaccine might be possible, though it is many years, if not decades, away. In Africa and Asia, the rate of infection is horrifying. Twenty-five percent in Zimbabwe! Nearly as high in the surrounding countries. In Asia, China is only now admitting that the disease exists in its population. India has at least 400,000 infections and probably many millions more. The attitude of many countries' governments seems much as it once seemed here in the West: Let them die. But infectious diseases such as HIV do not go away with the first or second waves of deaths; the circle spreads wider and wider until the country is hobbled, as in Zimbabwe. There are storms on the horizon. We must act.

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The River Runs Through It
Contaminated polio vaccines started AIDS in Africa in the '50s.

A National Enquirer headline? No. It's the premise of a big new book

fueling an old controversy among researchers.

By Timothy XX Burton, POZ Magazine, March, 2000

Could a human error in 1950s medical research be the cause of the massive global catastrophe of AIDS?

A highly controversial book positing just such a theory has been kicking up dust in the AIDS research world since its release last September. The River: A Journey to the Source of HIV and AIDS (Little, Brown and Company/Boston), written by British medical researcher and former BBC correspondent Edward Hooper, proposes that HIV emerged from a contaminated batch of experimental oral polio vaccine (OPV) administered to Africans in the late 1950s. After largely favorable coverage in the British media, the book's recent U.S. reception has been mixed, with AIDS researchers lining up on both sides of the debate. (One surprise was an in-depth, sympathetic article by The New York Times' conservative medical reporter Lawrence Altman, MD.) The institute that first produced the vaccine responded by promising to test its old vaccine stocks. But Hooper says that since other labs manufactured almost two-thirds of the supply used in Africa, there must be a more thorough search for vaccine samples -- and for research records, especially because key documents have strangely disappeared.

The stakes for the AIDS community are high. If the theory pans out, it could offer key clues to HIV's genetic evolution that may prove valuable in designing a preventive vaccine. Plus, the lessons learned about possible pitfalls of vaccine manufacture could enrich medical science as a whole. Perhaps most important, a clear resolution could satisfy our profound need to know the origins of a devastation so vast as to seem beyond human meaning.

Most AIDS researchers agree that HIV evolved from a closely related simian immunodeficiency virus (SIV) that somehow jumped the species barrier from primate -- specifically, an African chimpanzee -- to human. Yet the question of how that happened has fueled a heated debate. The predominant view is that a "natural transfer" of some sort occurred, most likely by the transmission of SIV through the butchering or eating of "bush meat." But in The River's 850 pages of text and 174 pages of footnotes, Hooper lays out the case that from 1957 to 1960 an unknown proportion of the OPVs administered to more than one million residents of three then-Belgian colonies -- now Congo (formerly Zaire), Rwanda and Burundi -- may have been accidentally contaminated with SIV from the primate kidneys in which the vaccines were prepared. "I am 97 percent persuaded that this hypothesis has merit," says Hooper, who conducted hundreds of interviews and inspected thousands of documents over a nine-year period. (His earlier book, Slim, explored the East African AIDS crisis.)

Not surprisingly, the researcher whose mistake is alleged to be responsible for the 33 million HIV infections worldwide leads the chorus of those who dismiss the theory. "This is an untenable hypothesis," argues Hilary Koprowski, MD, PhD, who developed the vaccine while directing the Wistar Institute, a medical research center in Philadelphia, "and there is absolutely no way to prove or even consider the possibility that it took place."

Koprowski was a pioneer -- along with the more famous Jonas Salk and Albert Sabin -- of vaccines designed to quash the polio epidemics that panicked the world in the 1940s and '50s. While Salk pursued an inactivated (killed) polio virus vaccine, Sabin and Koprowski each chose to pursue the live, attenuated (weakened) virus approach. Each raced to gain U.S. government acceptance of his design. In 1956, Koprowski came up with an OPV he named "CHAT." Even the name reflects the current controversy: The vaccine developer says it was an abbreviation of the name of the patient from whom he extracted the polio virus used, but Hooper believes -- partly based on Sabin's use of "ch" in the title of one of his vaccines to indicate that the virus had been passed through a chimp's gut -- that it may also stand for "chimpanzee-attenuated" or "chimp adapted and tested."

Koprowski initially tested the vaccine in children of inmates at a women's prison in New Jersey. When those children showed no ill effects after two months, Koprowski sought larger testing grounds. He found them in the Belgian Congo, where in 1957 -- with the colonial authorities' permission and both U.S. government and private funding -- he oversaw the administration of 2,500 doses of CHAT to local residents. Far quicker than was customary, he proceeded to give vaccines to 215,000 more people in East Africa's Ruzizi Valley, and ultimately -- before ending the program in 1960 -- to more than a million citizens of Congo, Rwanda and Burundi. But Sabin won out: After vaccinating 55 million people in worldwide trials, his OPV was licensed in 1961 by the U.S. Public Health Service and made standard, thus replacing the already approved Salk inactivated vaccine.

Polio vaccines at the time (and, in many cases, today) were made in a tissue culture, or layer of cells, consisting of minced primate kidneys, in which the polio virus could be massively reproduced. The attenuation process weakened the virus so that it would not harm the vaccine recipient, but would still induce the formation of antibodies that would (it was hoped) prevent a future infection if the person was exposed. But by the late 1950s, researchers had found various primate viruses, thought to be harmless, that had made their way into various types of polio vaccines. SIV itself was not discovered until the 1980s, but another simian virus, SV-40 -- known to cause cancer in laboratory hamsters -- was found in 1960 to have contaminated millions of doses of Sabin's and Salk's vaccines. Many years later, researchers found SV-40 in human lung and brain tumors, and a study uncovered a staggering 13-fold greater rate of brain tumors in children of women who received the Salk vaccine.

Hooper's thesis is that some batches of CHAT used in Africa were prepared from SIV-infected chimp kidneys, and that recipients of those vaccines -- many of them children -- swallowed a cocktail of weakened polio virus and one or more strains of SIV. The virus then spread through sexual contact from the original recipients into the local populations, from which it fanned out across the continent and finally the globe.

Hooper freely acknowledges that this scenario remains unproven, and takes pains to include an appendix in The River listing 27 points of evidence for, and four against, the theory. Among the favorable points, Hooper lists these: that a remarkable 64 percent of the sites of the first (1962 to 1980) retrospectively diagnosed AIDS cases in Africa came from the same towns and villages where the CHAT vaccine had been administered; that the earliest known sample of HIV, found in frozen blood drawn from a Congolese man in 1959, coincides in place and time with a major CHAT campaign; that no sample of HIV-positive blood has been found anywhere dating from before 1959, two years after mass CHAT vaccinations began; and that Koprowski's Congolese scientific camp housed some 400 chimpanzees native to the region, which were used for unspecified polio vaccine experiments.

Countering this hypothesis, Hooper lists these facts: that no CHAT vaccine sample has yet been found to contain either SIV or HIV (he points out that the only such test run so far -- by the Swedish Institute for Infectious Disease Control in 1995, at his request -- came back negative, although he adds that the hypothesis does not contend that all vaccine batches were tainted); that theories involving reused hypodermic needles and tainted blood transfusions could theoretically also explain how a handful of hunters infected by chimps could have begun to spread the virus; and that "despite much circumstantial evidence," there is no "hard proof" that common chimps were ever used in CHAT's manufacture.

Koprowski, now 85, categorically denies that he used African chimp kidneys as a tissue culture. He insists that CHAT was made with kidneys of rhesus macaque primates from India and the Philippines. "There is no trace of anything like AIDS in kidneys from Asiatic monkeys," Koprowski says, adding that the chimps at his camps were only used to test the vaccines before human use.

But Hooper writes that in 1992, after an earlier version of the theory first hit the media, Koprowski was quoted as giving at least four different responses as to what type of simian species was used, before finally settling on the Asian variety with which he has stuck ever since.

Normally, such a simple scientific detail could be easily checked by reading the medical literature of that period. Researchers routinely list the species used for vaccine production. Yet Hooper's exhaustive search for all journal articles and conference presentations about CHAT by Koprowski found an unexplained absence of this information. Thus, the author had to rely on detective work, such as tracking down the fate of the camp's chimps (since the fate of most had never been documented), interviewing octogenarian CHAT researchers and their survivors, and searching their journals -- all of which added circumstantial evidence suggesting that some chimps' kidneys were used for vaccine production.

Also lending credence to suspicions of a cover-up is the mysterious disappearance of key relevant documents. Hooper writes that the Belgian state archives' "polio correspondence" for the crucial period of 1956 to 1958 can no longer be found. And when interviewed by Hooper (and POZ), Koprowski said that all his files on CHAT had been "lost in a move" by Wistar.

Of course, critical evidence could come from the few CHAT samples still held in various labs' freezers. Although Koprowski wrote in a 1992 letter to the journal Science that there was "no vaccine stored" at Wistar, the institute announced last November that it would allow two samples "that might be related to the Congo trials" to be tested by two labs of their choosing, asserting that the results should end the controversy. Wistar's chief administrative officer, Clayton Buck, MD, acknowledges that the release of The River spurred the decision, but adds, "We agreed to that in 1992, so it's not new."

In March of that year, Rolling Stone had published a lengthy investigative feature by freelance writer Tom Curtis, which -- building on several medical journal articles -- first put forward the OPV/HIV theory in the popular media. The story quickly generated major media coverage. In response to the furor, Wistar convened a six-member panel (which included the soon-to-be AIDS star David Ho, MD) that acknowledged the theory's plausibility, but deemed its likelihood "extremely low." Koprowski sued Rolling Stone for libel. The case was finally settled out of court, with the magazine printing a short "clarification" in 1993 that simply restated the absence of definitive proof for the theory.

The Wistar committee report also called for tests of frozen CHAT samples to resolve the contamination dispute. Buck says Wistar sought help from the Centers for Disease Control and Prevention (CDC), which agreed to do the testing only if a second lab did so too, in order to buttress its credibility. Finding another lab proved unsuccessful, he says.

Hooper calls Wistar's recent announcement "a most welcome development, even if testing really should have taken place back in 1992." However, he argues for the critical importance of testing samples not only for SIV and HIV, but also for genetic evidence of the species from which the vaccine was derived. Hooper has proposed that to ensure fairness, a panel of independent scientists join Wistar in deciding which samples, labs and tests to use.

Hooper's book actually proposes 17 specific investigations or experiments that could be conducted to test the hypothesis. For example, he says, Belgian laboratories -- which produced 70 percent of the CHAT doses administered in Africa -- could look for other samples of this vaccine, and a broad international search could be initiated for "any documents or protocols relating to the manufacture or testing of CHAT vaccine." He also suggests that AIDS researchers search stored human blood and tissue samples from before 1956 to see if any contain HIV, a finding that "would clearly weaken -- though not destroy -- the OPV/AIDS hypothesis." And he has separately invited lab technicians of the era to come forward with information.

But some AIDS researchers maintain that current evidence has already undermined this theory. "The hypothesis is a theoretically interesting possibility that needs to be checked out," says Beatrice Hahn, a leading AIDS researcher and professor of medicine at the University of Alabama at Birmingham. "But I would also say, 'It did not happen this way.'" Last February, Hahn coauthored a headline-grabbing article in the journal Nature that claimed HIV evolved from the SIV of a chimpanzee subspecies found only in West Central Africa -- 1,000 miles from the Congolese rainforest that was home to the different chimp subspecies used in Koprowski's camp. She also says that geneticists have dated the origin of HIV as prior to 1950. "I can only go by the weight of evidence," Hahn says, "and that on my plate would be a natural transfer of some sort."

Hooper replies that Hahn's research was based on comparing only a single SIV-positive chimp from Congo with three others from West Central Africa, and that further testing of Congolese chimps is needed. Research in this area is already underway, he adds. As for the genetic dating theory, he notes in the book that one of the experts who has proposed an earlier date for the introduction of SIV to humans, Paul Sharp, PhD, professor of genetics at England's University of Nottingham, has conceded that this date was calculated on the presumption of a single chimp-to-human crossover. A mass transfer by means such as a vaccine, he acknowledged, would allow for a later first appearance of the virus in humans.

Omar Bagasra, MD, a specialist in recombinant DNA and genetic engineering, lends support to Hooper's arguments. Bagasra, a professor of biology at Lincoln University, near Oxford, Pennsylvania, authored HIV and Molecular Immunity, a 1999 book on the origin of AIDS and prospects for an HIV vaccine. "The natural transfer theory is completely out of whack," he says. Noting that Africans have eaten primates for thousands of years, he asks, "How come we didn't start this epidemic many, many years ago?" He thinks the OPV/AIDS theory meshes well with the available knowledge of viral evolution.

And beyond offering an explanation of how the epidemic started, Bagasra argues that proof of the OPV/HIV theory could be very good news for a potential HIV vaccine. He postulates that some still-living CHAT recipients whose vaccines were contaminated with SIV might be carrying -- due to the attenuation process involved in producing the vaccine -- a weakened strain of SIV or HIV that has afforded them long-term immunity. Bagasra is planning an expedition to the Congo this summer, where -- using lists Hooper has compiled -- he hopes to locate and test the blood of CHAT recipients for such attenuated HIV, which might be a key component in the creation of an HIV vaccine. Bill Hamilton, a Royal Society professor at Oxford University and an acknowledged expert in evolutionary biology, concurs that such an expedition could spark a crucial breakthrough.

Hooper sees even greater benefits if the theory proves correct -- avoiding similar scientist-created accidental catastrophes. "In an age when new, potentially risky medical interventions are being proposed -- human cloning, the transplantation of animal organs and cells into humans, the testing of live HIV vaccines -- it is surely timely to think long and hard about the implications of this story," he says.

Meanwhile, the controversy rages on. This May, the Royal Society (a prestigious body of British researchers) will call the key players on all sides of this controversy to a London conference for a wide-ranging discussion of the theory. Perhaps they may agree on further testing, or even achieve some common ground.

So The River, while not resolving the question of how HIV originated, may push forward the search for its source. If the wellspring of the virus could be located, there's no telling how that knowledge might alter the course of medical history.

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This abstract is from the CDC NCHSTP Daily News Update for March 21, 2000
An Improbable Theory on AIDS Is Put to the Test
New York Times (www.nytimes.com) (03/21/00) P. D1
by Altman, Lawrence K.

Three laboratories in the United States and Europe will start testing soon samples of an experimental polio vaccine tested in the Belgian Congo in the 1950s to determine if it was accidentally made with chimpanzee tissues that could have contained the ancestor of HIV. The Wistar Institute in Philadelphia made the experimental vaccine and has kept drops of it frozen since 1957. The tests follow the publication of a theory in Edward Hooper's book, "The River," that an oral polio vaccine in the Congo started the spread of HIV to humans; however, scientists do not expect conclusive evidence proving or disproving the theory. In part, this is because no one knows whether the samples being tested are the same as the vaccine that was actually administered in the Congo. The scientists will test coded samples, the actual identities of which will only be known to the independent lab and an independent committee of scientists appointed by Wistar. The code will only be revealed after the study is complete.

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POZ Magazine, "WORLD BEAT", March 2000

Chew the Stat

The United Nations Program on HIV/AIDS (UNAIDS) released new stats just in time for the yearly World AIDS Day media feeding frenzy. Chief among the worrisome, headline-making trends: More than 40 percent of new HIV infections in 1999 were women, and in Africa there are now six poz women for every five poz men. "Ten years ago, it was hard to make people listen when we were saying AIDS wasn't just a man's disease," UNAIDS executive director Peter Piot said. "Today, we see evidence of the terrible burden women now carry in Africa's epidemic."

Some numbers:
5.6 million were infected in 1999 (of which more than 40 percent were women), bringing the number of total worldwide HIVers to 33.6 million.

2.6 million people died of AIDS in 1999.

African girls age 15 to 19 are five to six times more likely to be poz than their male peers.

In Russia, nearly half of all reported infections since the beginning of the epidemic were recorded in the first six months of 1999.

Brazil shelled out $300 million for antiretroviral treatment in 1999, but equivalent expenditures saved some $136 million in hospitalization costs in the two previous years.

New methods for tracking infection rates in India allowed UNAIDS to downscale previous estimates by 800,000 HIVers -- bringing the total number to about 4 million -- still more than any other country.


"NEG" News
After the installation of a new filtering program on school computers, New York City students received "access denied" messages when logging on to websites with info about safer sex and AIDS.

China's first televised PSA advocating condoms to prevent HIV ran for two days in December before being pulled off the air by the government, which cited a national law forbidding ads for sex products.

Kenyan President Daniel Arap Moi will not change his position blocking condom distribution, a stance that continues to draw fire from local activists (see Poz, opposite).

" POZ" News
Giving condoms to teens in sex ed was more successful than an abstinence-only curriculum and did not contribute to youth having sex sooner, according to an American Medical Association committee.

Rep. Richard Gephardt (D-MO) announced in December that the U.S. will contribute $9 million to South African AIDS programs in 2000, four times the amount given last year.

Kenya's government announced the formation of a National AIDS Council and will start education programs in schools and colleges later this year (see Neg, opposite

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Week Ending March 18, 2000

Please see other Buddhist AIDS Project (BAP) pages at www.gst.net/~bap, including "Events", "Resources", "Links", "Library",and "Bookstore".

Buddhist News

Ram Dass at Grace Cathedral, March 12, and "Buddha Blues" with Ron Jones, March 15; March and April retreats and workshops at San Francisco Zen Center, Green Gulch Farm, Spirit Rock Meditation Center, San Francisco Gay Buddhist Fellowship; "Buddhism at Millenium's Edge" -- March Talks and Workshop with Lama Surya Das; Coming up in April: Five Day Residential Vipassana Meditation Retreat for Gay, Lesbian, Bisexual and Transgender Participants at Spirit Rock Meditation Center; also coming up in April: Zen Hospice Project's " Caregiver Volunteer Training" -- Please apply now if interested; NEW Book, April, 2000: Finding a Joyful Life in the Heart of Pain, by Darlene Cohen, (Shambhala).. Darlene co-leads the weekly Mindfulness Meditation Group for people living with chronic or life-threatening illnesses at Zen Hospice Project; Many new and upcoming Workshops and Retreats listed for the Pacific Northwest.

HIV/AIDS News:

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Special Section: "Oral Sex and HIV: Researchers Clarify Data"

From the HIV InSite web page:

Though some researchers estimate the proportion of HIV infections due to oral sex is probably 1% or less, other researchers claim the true percentage could be as high as 4% to 5%. And while we attribute 2.4% of the new HIV infections in our study to oral sex, even an estimate as low as 1% would still translate into 6 or 7 new cases of HIV infection due to oral sex each year in San Francisco alone (based on the estimate that 650 men who have sex with men become HIV-infected each year in San Francisco.)
Source; Paul O'Malley, Program Manager HIV Research San Francisco Department of Public Health

Abstract from 7th Conference on Retroviruses and Opportunistic Infections:
San Francisco: Oral sex associated with 7.8% of new HIV infections in study population (abstract 473)
Hecht and colleagues investigated reported cases of oral HIV transmission (to receptive partners in male-male oral sex) in a cohort of 102 persons with primary HIV infection (average age 34 years; 75% white). Of 19 cases where the route of acquisition appeared to be oral sex, 3 could not be classified because of inadequate additional information and 8 were reclassified due to other potential route of exposure. Of the remaining 8 (7.8% of 102), 2 reported having had only oral sex, 4 reported having anal sex, but only with protection, and 2 reported having unprotected anal sex, but only with a partner whom the investigators documented as HIV negative.

This study illustrates that oral sex as a mode of HIV transmission is probably over-reported by this study's subjects. Nevertheless, receptive oral sex appears to account for a few percent of cases of HIV infection among men having sex with men (MSM) in recent years. Even a low rate of transmission per event could account for a significant number of new HIV infections. This study adds to the evidence supporting a small but non-negligible risk of HIV transmission to the receptive partner in male-male oral sex.

Follow-up Reporting on "Oral Sex and HIV Study":
With all the alarming reports recently about the study showing that oral sex carries a higher risk of transmitting HIV than originally thought, one important detail was missing. The reports were that, in the "most definitive study to date," researchers found that eight out of 102 Gay and bisexual men most "likely" acquired HIV through oral sex (seven as the recipient partner, one as the insertive partner). A previous study by the U.S. Centers for Disease Control and Prevention calculated the risk of oral transmission, for the receptive partner when the top does not use a condom, as 0.04 percent per contact -- a risk that was the lowest for all sexual practices but "not without risk." In all those news reports, nobody discussed to what extent, if any, the eight men who contracted HIV through oral sex were suffering from ulcers or gum disease. The presence of bleeding gums, scratches, and ulcers is known to facilitate HIV‚s ability to enter the bloodstream. The detail was not on the poster at the Retrovirus Conference, not in the press release issued by the CDC, and was not known readily by the University of California_San Francisco researcher who was taking questions about the study at the conference. But that researcher, Rick Hecht, did, at the Blade‚s request, look up the information back at his office, and this week he responded: "About half did have gum disease or an oral ulcer." Thus, it would seem that "about half" of the eight out of 102 men did have an additional risk factor for contracting HIV through oral sex, suggesting that about 4 percent of men contracted HIV that way -- a percentage more in line with previous studies. It is worth noting again, however, that even before the study stirred up new attention for the risk of transmitting HIV through oral sex, most AIDS prevention messages have urged men to use a condom -- and women to use dental dams -- when engaging in oral sex. "There is nothing in this study that should make us change our message about HIV transmission," said Gay Men‚s Health Crisis official Ronald Johnson in a Feb. 2 press release. "We have consistently been telling the public for many years that oral sex can possibly result in HIV transmission but that the risk is much smaller than the risk of unprotected anal intercourse." The GMHC press release noted that the Gay clinic received an increased number of calls following news reports last week from the Retrovirus Conference in San Francisco. In related news, another poster at the Retrovirus conference indicated last week that some men with HIV "shed" virus through their semen even when they are asymptomatic. The study, from the University of Pittsburgh, examined the blood and semen of 18 men with HIV infection every week for 10 weeks. Five of the men never showed HIV in their semen, five always had HIV detectable in their semen, and the remaining eight men had HIV detectable 70 percent of the time. -- Lisa Keen, Washington Blade

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From: TheBody.com --"HIV and Oral Health Forum"

Question:
Has anyone ever contracted HIV through: oral sex; kissing?. Is it possible to get HIV from any of those 2 activities?

Dr. Reznik's Response:
There have been documented cases of transmission of HIV via oral intercourse. Kissing is a safe activity and is not considered a risk for transmission of HIV.

For further information on the risk of HIV transmission via oral intercourse, please access the following articles which are located in the HIVdent Internet project
"Oral Transmission of HIV: A review of the Evidence" , http://www.hivdent.org/_private/Oralman.html

"HIV Transmission by Oral Sex" , http://www.hivdent.org/oralm/oralmhtbos022000.htm

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From: Gay.com Message Boards: "Oral sex and HIV transmission"
To participate in this online discussion, please join Gay.com at http://www.gay.com and look under "Postive Living"

One Message Thread: "With recent findings linking HIV transmission to oral sex, will you change your safe-sex practices? Or is wearing a condom during oral sex too unsavory?"

Chris99 - 08:30am Feb 15, 2000 PST (# 9 of 49)
Having become HIV positive from oral sex I wanted to weigh in with my thoughts. Number1- If you have gum disease or chronic mouth sores, oral sex is HIGH RISK. That is how I became infected, whether the guy comes in your mouth or not. Number2- Do NOT brush or FLOSS your teeth within 4 hours of knowing you may be "doing it". Use mouthwash. Number 3-Using listerine before hand will tip you off to whether or not you have inflamed gums because it will be uncomfortable and sting a little when you use it. Number 4-Assume all your partners are HIV positive, no matter what they tell you!!

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AIDS Policy Chief Cautions That Epidemic Not Over/Push to renew law allotting funds for patient care
The San Francisco Chronicle - Thursday, March 16, 2000
David Perlman, Chronicle Science Editor

Warning that complacency over the AIDS epidemic is mounting in America, President Clinton's AIDS policy chief called yesterday for swift renewal of the law that provides millions of dollars to care for needy patients with the deadly infection.
"Far too many policymakers yearn to believe that the worst is behind us," said Sandra Thurman, director of the White House Office of National AIDS Policy. "But the sobering truth is that this pandemic is far from over. In fact, it is just beginning."

Thurman was the major speaker yesterday at the opening of the 12th National HIV/AIDS Update Conference, an annual meeting in San Francisco where AIDS advocacy groups, patient care workers, physicians and researchers gather to share the latest information on progress in therapy and prevention.

Federal law, known as the Ryan White Care Act, now provides more than $1.6 billion a year for medical care for the poorest AIDS patients. Passed 10 years ago and named for an Indiana boy with hemophilia who campaigned for public understanding of the disease, the act will expire this year unless it is renewed by Congress within the next two months.

President Clinton has already sought an additional $1.6 billion in federal funds for AIDS research and $700 million to find and apply the most effective prevention methods in the most hard-hit communities, Thurman said.

One of these is to end the federal ban on needle exchange, which Thurman agreed has been proved as a method for curbing the spread of AIDS among injection drug users.

"The blinding ignorance born of racism, sexism and homophobia still feeds this epidemic," Thurman said. "And we know that as AIDS continues its march more deeply into poor communities, drug use puts a growing number at risk and makes the dialogue related to needle exchange all the more important."

As she called on AIDS groups to push harder for the renewal of the Ryan White Act, Thurman said the nonpartisan measure has been hugely successful.

"It has created a continuum of care that is both compassionate and cost-effective -- one that saves both lives and money," she said.

Last year alone, Thurman said, the Ryan White Act helped provide the latest drug therapy to more than 100,000 poor people living with HIV infections and AIDS, and has served an estimated 500,000 people with other forms of care -- more than 60 percent of them poor. The act, she said, has cut the length of costly hospital care for AIDS patients by at least 30 percent, reduced AIDS mortality by 70 percent and curbed mother-to-child transmission of the AIDS virus during childbirth by 70 percent.

But the epidemic's disastrous effects are still falling disproportionately on the poor, women, minorities and drug addicts, Thurman said. The number of deaths from AIDS in the United States, for example, is declining three times faster for men than for women, and three times faster among white men and women than for African Americans. And while racial and ethnic minorities make up one-quarter of the U.S. population, they account for more than half of all AIDS cases and a growing proportion of new infections by HIV, the AIDS virus. "And though we have made progress in reducing infections and deaths among the larger gay community," Thurman said, "we know that for young gay men -- and particularly young gay men of color -- the epidemic is getting worse, not better."

The AIDS Update Conference, sponsored by the American Foundation for AIDS Research, will continue through tomorrow with intensive workshops focusing on virtually all the problems affecting people with AIDS or HIV infection.

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This abstract is from the CDC NCHSTP Daily News Update for March 17, 2000
Many at Risk Called Unafraid of AIDS
Sacramento Bee Online (www.sacbee.com) (03/16/00)
by Hubert, Cynthia

The 12th annual HIV and AIDS Update Conference in San Francisco highlighted the fact that many of the people most at risk for HIV infection have become complacent about contracting the disease, as death rates have declined in recent years. Dr. Mervyn Silverman, chairman of the conference, and others said that news of better treatments and a lack of emphasis on prevention are contributing to the complacency. One study found that 87 percent of young Americans feel they are not at risk for HIV, although 25 percent of new infections occur among people 25 years of age and younger. In addition, a study of 3,000 gay men between the ages of 15 and 25 revealed that 41 percent had recently participated in unprotected sex. Although new AIDS drugs can help people live longer, the drugs have potent side effects and they do not help everyone. Patricia Fleming, the former White House AIDS policy director, emphasized the importance of prevention and asserted that the government needs to spend more on prevention efforts, including the promotion of needle exchange programs.

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High-Risk Behaviors Persist in HIV-Infected Primary Care Patients
Reuters Health Information Services (03/15/00)

Dr. Emily Erbelding and colleagues from Johns Hopkins University have found that HIV-infected patients being treated in primary care settings have a high prevalence of asymptomatic sexually transmitted diseases (STDs) and often exhibit high-risk sexual behavior, confirming the need for routine STD screening. The 10-month study of 691 HIV-infected patients revealed that heterosexual sex and injection drug use were the most common sources of HIV transmission among the women, while homosexual sex and injection drug use were the most common modes of transmission for the male participants. Nearly 58 percent of the subjects were sexually active within the last 90 days, and over 7 percent had multiple sexual partners in the past month. The report, published in the February 18 issue of AIDS (2000;14:297-301), also found that the overall prevalence for having either chlamydia or gonorrhea within the past 12 months was 7.5 percent.

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NCHSTP Daily News Update for March 16,2000
Genes Are Patentable; Less Clear Is if Finder Must Know Their Role
Wall Street Journal (www.wsj.com) (03/16/00) P. A1
by Waldholz, Michael

Summary:
Human Genome Sciences (HGS) received in February a U.S. patent on a gene, CCR5, that HIV uses to infect cells. This announcement sent HGS shares flying, and has sparked a debate regarding the value of the patent. Scientists fear that the patent could block important AIDS research, and drug companies hope that HGS cannot demand money that arises from marketed drugs that block HIV's access to the gene. The larger question of who owns the human genome continues as well. Some drug makers and intellectual property lawyers note that HGS' patent does not mention AIDS; HGS asserts, however, that its press release regarding the new patent was correct. HGS discovered the gene and filed for a patent five years ago, but the gene's role as biochemical gateway for HIV when infecting cells was not learned until several months later, by four independent research teams who then applied for their own patents. Many researchers believe that HGS CEO William Haseltine is unfairly claiming a gene whose specific role and value in HIV was identified by other researchers.

Full Article:

At 8:13 a.m. on Feb. 16, a news release from Human Genome Sciences Inc. crossed the news wires, and instantly its shares began soaring in premarket trading. The company said it had just received a U.S. patent giving it commercial ownership of a gene that HIV, the AIDS virus, exploits when it infects a cell.
The news excited a hyperbolic Wall Street already powering biotech shares to unprecedented highs, and within two days, HGS shares had leapt 41%, adding $3.8 billion to the little company's value. The news release also got the attention of a lot of big drug companies and academic scientists. They feared that HGS's commercial custody of the gene meant it could conceivably block important research into AIDS, or more likely demand a slice of a rich market that may someday arise from drugs blocking HIV's access to the gene.

The company's claim has since set off a furious debate questioning the validity and value of the patent. That, coupled with a biotech-stock fall this week set off by an ambiguous statement on gene patenting from President Clinton and British Prime Minister Tony Blair, has taken a little of the steam out of HGS's stock, although it remains far above its year-ago level.

But more important, both events have thrown into sharp focus a critical question -- legal and, some would say, moral -- of the biotech age, one that will affect drug development for years: Who exactly owns the genome, the collection of all 100,000 or so human genes? And more specifically, can companies using new computerized gene-sleuthing technologies make an exclusionary patent claim to stretches of DNA without knowing their precise function in the body?

After examining HGS's patent, some drug makers and intellectual-property lawyers say its proprietary gene claim is far less valuable than the company indicates. They note that, contrary to what the investing public naturally surmised from the news release, the patent says nothing about AIDS. A close look at the release and the patent shows that the announcement -- tossed into a superheated climate for biotech stocks -- was at the least confusing. "I thought the press release was misleading," says Sharon Seiler, a biotech analyst at Punk, Ziegel & Co., New York. "I think the value of the patent in regard to HIV is pretty close to zero." HGS says the news release was accurate.

As Dr. Seiler and others point out -- and as HGS's hard-charging chief executive, William Haseltine, acknowledges -- when HGS uncovered the gene and filed for a patent in 1995, it had no idea the gene was the long-sought biochemical gateway used by HIV to infect cells. That was discovered about six months later, without help from HGS, by four independent research teams, all of which had been searching for the HIV gateway gene for years. The four teams subsequently applied for their own patents, none of them yet issued.

These teams, whose collaborators include competing gene-hunting companies, argue that identifying the gene's function in HIV makes their patent declarations at least as valuable as HGS's and maybe more so. "The press release would lead you to believe that HGS appreciated the role the gene plays in HIV, and that simply is not true," says Mark Boshar, a lawyer at Millennium Pharmaceuticals Inc., a Cambridge, Mass., HGS rival.

Besides the broad issue of gene ownership, the patent battle is important because the gene is central to promising new HIV medicines now being developed by Schering-Plough Corp., Pfizer Inc. and several other drug companies. The debate is one of the first glimmers of the legal quagmire that awaits gene researchers in trying to protect years of costly work. Each of the several hundred gene patents issued to date could face a similar challenge from researchers who someday will find out more about the medical usefulness of those genes than the patent holders themselves know.

Academic and corporate scientists are racing to decode the entire sequence of DNA, the molecule that contains the chemical recipe of all human genes and, therefore, the entire physical blueprint for all human life. The race entails a major spat between the Human Genome Project, an international public-private consortium, and publicly owned DNA-sequencing companies.

This AIDS-gene saga has enough twists and turns to fill its own book. And Human Genome Sciences' role would probably be only a chapter, and a small one at that, if not for the current fracas over gene ownership. The story involves the labs of such HIV luminaries as Robert Gallo and David Ho and the solving of a long-held AIDS mystery as to why a small fraction of people exposed to the virus don't get sick.

One of its plots begins in the early 1990s with an especially clever gene-isolating invention by J. Craig Venter, at the time a relatively obscure scientist at the U.S. National Institutes of Health and now president of Celera Genomics Group. Dr. Venter figured out that he could quickly sift out a gene from the indecipherable jumble of DNA by identifying specific chemical fingerprints left behind in cells by genes when they are turned on by the body. Cells switch on genes to make proteins, which carry out the moment-to-moment functions of life. Disease often arises when genes are defective and fail to properly produce their assigned proteins. Drug makers want to know the identity of such disease-related genes because this can provide a guide to attacking an illness at its underlying biological cause, and targets for new kinds of powerful medicines.

In 1993, venture capitalists lured Dr. Venter from NIH to help form HGS, whose business plan was to use the invention to find previously unknown genes, patent them and sell the commercial rights for their use to drug makers. Dr. Haseltine, a swashbuckling Harvard researcher, was recruited to be chief executive of the company, based in Rockville, Md. In the summer of 1995, HGS fished out the full DNA structure of a gene, later dubbed CCR5, that it believed would make a good target for medicines against a wide range of ills, among them arthritis, allergies and viral infections.

The company knew this because by analyzing the gene's DNA sequence -- the specific order of thousands of chemical subunits that make up genes -- HGS scientists realized that the gene was used by the body to make one of a large family of proteins that are targeted by some widely used medicines, including the ulcer drug Zantac, the allergy fighter Claritin and the migraine drug Imitrex.

"We have a total of 150" of the genes, says Dr. Haseltine. "Because we knew the class of proteins was so important to medicine, we searched through the genome for them all, and we have since cloned and filed patents on them." In its 1995 patent application for the gene, HGS said the protein the gene makes was a receptor, or docking site, on immune-system cells. HGS said it believed that other proteins and even viruses probably latched onto the receptor in order to interact with the cells, and that blocking the site might form the basis for a wide range of medicines.

But except for filing this with the U.S. Patent Office, HGS didn't publicize the work. It didn't publish the gene in a scientific journal for other researchers to use, nor did it present its information in any scientific forum, as had been the policy of most academics, especially those whose research was funded by the NIH. Why? HGS by then had signed a deal worth $125 million to provide its gene database exclusively to SmithKline Beecham PLC, the big British pharmaceutical company; the value of that deal was based on SmithKline's ability to have a jump on other researchers or drug companies.

Unknown to Dr. Haseltine, however, numerous HIV laboratories were in a furious dash to find the exact same gene, though none of the scientists were aware that HGS already had found it.

For years, scientists were mystified by reports of gay men who said they had been exposed HIV but were impervious to its effects. "We all thought these folks might offer a key to fighting" AIDS, says Dr. Ho, who directs the Aaron Diamond AIDS Research Center in New York. "Something about these people's biology made them immune to infection, and we figured if we could find it out maybe we could mimic it with a drug or vaccine."

The scientists believed the immunity was probably due to inheritance of a particular version of a gene that everyone carries, a variant containing some special virus-blocking characteristic.

The breakthrough came, coincidentally, in several episodes within a few months of HGS's patent filing. In the late fall of 1995, Dr. Gallo, renowned as the co-discoverer of HIV, reported that years of research at his Baltimore lab had identified a group of long-sought proteins, called chemokines, that naturally block HIV from slipping into T-cells -- important soldiers in the immune system that come under attack by the invading AIDS virus. While Dr. Gallo argued that the chemokines themselves might serve as the basis for new AIDS drugs, other AIDS scientists got to thinking that his finding might lead them to the gene variant they sought.

Discovery in Brussels

That notion was cemented by two other reports released without fanfare within weeks of each other in early 1996. In a research article in February of that year, Marc Parmentier and his colleagues at Brussels University said they had found a T-cell receptor gene. They said it probably was the receptor used by Dr. Gallo's chemokines to snag onto the T-cells.

Dr. Parmentier had actually isolated the gene several years earlier, but he was unaware of HGS's filing and took his time publishing the gene discovery until his team had figured out that it was a chemokine receptor. "If I knew I was in a race for such a valuable gene, I might have published something sooner," he says.

Nonetheless, the university filed in March 1996 for international patents for the gene, which haven't yet been issued, though the rights to it have been licensed to Euroscreen SA, a Brussels biotech firm. Pierre Nokin, Euroscreen's chief executive, says he believes "our patent is the first that claims a role for CCR5 in HIV and will certainly be an important competing patent with that of HGS and others, when issued."

The first suggestion that Dr. Parmentier's discovery might be the long-sought immunity-conferring gene came, also by coincidence, that same month. It involved Edward Berger, an AIDS researcher at the National Institute of Allergies and Infectious Disease. Using Dr. Gallo's work as a guide, he uncovered what he thought was the doorway gene, calling it fusin because it helped HIV fuse to target cells.

When Dr. Berger discussed his work at a science gathering in Santa Fe, N.M., in February 1996, "all hell broke loose," says Thomas Doms, a virologist at the University of Pennsylvania. Within weeks, scientists realized that fusin was indeed an HIV entryway gene -- but not the one used most commonly by the virus. So, scientists quickly began testing Dr. Parmentier's very-similar gene to see if it was the main HIV entrance. "It was one heck of an exciting race," says Dr. Doms.

The race reached a climax in June 1996 when four different research teams -- those of Drs. Parmentier, Ho and Berger and one from Harvard and a company that was later acquired by Millennium -- simultaneously published their finding that Dr. Parmentier's gene, now formally named CCR5, was the HIV gateway receptor. All four groups then filed for separate U.S. patents that, while making different claims, had one common element: They went farther than HGS had and identified the gene's precise role in HIV and exactly how the gateway works. This distinction is at the heart of the gene-patent dispute surrounding HGS's recent announcement.

The final proof came from screening the HIV-resistant gay men. Each of them had an inherited mutation to CCR5. That meant they were immune to HIV because the cell gateway was broken, literally jammed shut by the gene defect.

"What got us so very excited right away was that despite having a gene mutation, these men were healthy in every other way," says Christopher Mirabelli, head of R&D research at Millennium. "It meant that you could develop a drug to block the receptor and you weren't likely to cause deleterious side effects. Nature had already given us that proof in the form of the infection-resistant men."

Drug Candidates

Within weeks, several drug makers began testing potential drugs in their gigantic chemical libraries to see if any could safely block the HIV doorway in people in whom the gene wasn't defective. This January, Schering-Plough said it was about to begin the first human tests of a CCR5 inhibitor. And Glaxo Wellcome PLC, Merck & Co., Pfizer, Bristol-Myers Squibb Co. and a small Tarrytown, N.Y., company called Progenics Pharmaceuticals Inc., all have CCR5 drugs in the works. That's why HGS's February announcement sent shivers down drug makers' spines -- it suggested that HGS possibly held some rights to their experimental drugs. In its release, HGS said it received a patent "on a human gene that produces what is believed to be the critical entry point for the AIDS virus," additionally pointing out that the gene was a prime target for new AIDS drugs. Nowhere did the company state that its patent didn't even mention HIV or that other research groups probably would be issued competing patents. By the end of trading the next day, Feb. 17, investors, assuming HGS was the sole discoverer of CCR5, had sent HGS shares flying.

But contrary to what some people believe, HGS's claim to the receptor doesn't date back to when the patent was first filed. It is, as Dr. Haseltine acknowledges, effective only as of February, when it was approved by the Patent Office.

That means researchers using the gene prior to February don't have to buy a license from HGS unless they are continuing to work with it. Any scientist who begins using it now might have to pay HGS, Dr. Haseltine believes. He suggests such a license might amount to something less than 10% of a drug's future revenue.

Not so, say officials at Schering-Plough. Although the company is a subscriber to HGS's database, Schering says it never used it to find its experimental drug. In addition, patent attorneys say HGS's claim may be weaker than those made by the other AIDS scientists. That's because those other patents, if issued, will make much more specific claims about the gene's ultimate medical usefulness. Incyte's Patents

It's this issue of whether a patent should go to the researcher who uncovers a gene's function -- or to someone who simply uncovers a gene's existence -- that is central to the current debate addressed in part by the Clinton-Blair statement Tuesday. Incyte, for instance, has more than 375 patents and has filed for 6,500 more for genes it discovered using Dr. Venter's gene-isolating technique. But Incyte, which like HGS hasn't published its gene discoveries because it's more interested in selling rights to use them to drug makers, has only a vague idea of what many of the genes do.

Some worry that allowing patents on genes whose function is only surmised will make scientists reluctant to take on the difficult task of figuring out the genes' precise role in the human body. But others, notably at Pfizer, say patent protection provided through licenses from gene hunters bolsters their willingness to develop drugs based on genes.

In fact, the Patent Office is tightening its rules pertaining to genes, saying it no longer will issue a patent for a gene unless the discoverer can describe in some detail what it does. The effect of this change on Incyte or HGS still isn't known. Dr. Haseltine agrees that final determination of whether drug makers must license his patent may require lengthy negotiations or even court fights, and he says all parties may have to cross-license.

Finally, many gene-hunting scientists, especially in academia, feel the HGS patent is unfair, in that the work underlying the discovery simply used a lot of computerized software, rather than years of investigation, to find the gene and its likely involvement as one of a host of receptor genes. In a nutshell, their argument is that if it weren't for the other researchers homing in on the gene's specific role in HIV, Dr. Haseltine's early patent would have continued to languish and be essentially worthless.

Dr. Haseltine, once an academic himself, is sympathetic but says he is just playing by existing patent rules, which give highest claims to the person who finds something first. "I would imagine Dr. Berger must feel like a great detective who after many years tracks down a murderer, only to find the fellow already has been incarcerated by someone else for a different crime," Dr. Haseltine says. "I think that sums up the situation pretty well."

--Ralph T. King Jr. contributed to this article.

Write to Michael Waldholz at michael.waldholz@wsj.com3

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AIDS Update confab this week, by Katie Szymanski, Bay Area Reporter, March 9, 2000

Whether you're an activist with a seat at the policy table, a treatment educator, or an HIV-positive street radical, the 12th annual National HIV/AIDS Update conference hosted by the American Foundation for AIDS Research has something for everyone.

Amfar's conference, which takes place March 14-17 at the Bill Graham Civic Auditorium in San Francisco, aims to increase awareness of the newest options in treatment, prevention, and advocacy through workshops and seminars. The theme for this year's conference, "HIV/AIDS at the Crossroads, Confronting Critical Issues," will focus attention on the issues at the forefront of today's epidemic.

Over 2,000 people are expected to attend and/or present, including health care providers, physicians, pharmacists, nurses, community-based HIV/AIDS service organizations, social service providers, mental health professionals, members of local public health agencies, hospital planning and service providers, elected and non-elected community leaders, state and local government representatives, volunteers, and people living with HIV/AIDS.

Conference presentations will feature the latest HIV/AIDS research and the experience of those affected by the research findings. Populations to be addressed include adolescents, the elderly, substance abusers, women, men, and communities of color. Intensive session and workshop topics include social work and HIV/AIDS, the psychological distress of infection, grant-writing for service providers, harm reduction techniques, HIV and hepatitis co-infection, how to create a newsletter, and promoting testing among youth.

Abstract topics include clinical management, increasing drug adherence for substance abusers, and preventing violence against women. Special events run throughout the conference, such as a wine and cheese gathering, a poster exhibit, and a reception with Olympic gold medalist Greg Louganis.

With the wide range of topics and experts under one roof, Amfar's conference could offer a unique opportunity for cutting-edge knowledge and networking to all who attend.

Individual registration fees are between $185 and $325, and continuing education credits are available. For more information, or to receive a registration form, visit www.nauc.org or call (514) 874-1998.

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Health-AIDS: AIDS virus strains are mutating -- raises test, treatment worries
Agence France-Presse - Friday, March 10, 2000

MONTPELLIER, France, March 10 (AFP) - French and African researchers said Friday that strains of the AIDS virus were mutating, a development with potentially alarming repercussions on testing and treatment for the infection.
Scientists at the Research Institute for Development (IRD) in Montpellier said they had found that two strains of the Type 1 human immunodeficiency virus (HIV), previously thought to be genetically far apart, had combined together.

There are two main types of HIV virus, the precursor to acquired immune deficiency syndrome (AIDS).

HIV-1, the most widespread, has three strains -- M, N and O -- that each have different characteristics.

Until now, conventional thinking was that these groups were so divergent -- genetically more than 50 percent dissimilar -- that there was no risk of recombination between them.

But researchers at the IRD's retrovirus laboratory, working with counterparts in the West African country of Cameroon, said they had isolated and identified a live strain that had combined from group M and group O.

"We found a patient in Cameroon who had been infected by the two strains and, against all our expectations, we found that the two strains had merged, forming a new variant," the head of the team, Martine Peeters, told AFP.

"This supposes that even viruses which are genetically far apart can mix and form a completely new variant."

The discovery, reported in a US publication, the Journal of Virology, could have grave implications in how the AIDS virus is spread, as well as the conventional methods for testing and treating it, she said.

"At the moment, group O is rare. But the fact that it can recombine with another virus may change its characteristics and make it more virulent," she said. Another problem is screening. Because O is rare, viruses in this group sometimes cannot be detected using commercially-available test kits, and they are resistant to certain anti-retroviral treatments.

Cameroon has been the theatre of a previous landmark discovery in AIDS research. It was there that a French researcher, Francois Simon, first identified the group N strain in September 1998.

Group N is genetically close to a virus that prevails in chimpanzees, leading to speculation that humans contracted it from eating ape meat. The HIV strain that is most prevalent in western countries is Group M.

The other type of AIDS virus, HIV-2, is mainly prevalent in Africa's Great Lakes region.

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AIDS: Still Searching
New York (www.newyorkmag.com) (02/07/00) Vol. 35, No. 5, P. 37
by Kinetz, Erika

The last major breakthrough in AIDS drug research, the development of the highly active antiretroviral therapy (HAART), does not always do what its creators had hoped at its inception five years ago. Dr. David Ho and Dr. Martin Markowitz have found that HAART, while extending the comfort periods and the lives of AIDS patients, cannot rid the body of the virus. Also, the drugs do not help everyone. Hope may be on the way, however. Markowitz will begin trials at the Aaron Diamond AIDS Research Center of three new drugs that appear to work better with fewer side effects than those currently on the market. Meanwhile, three other drugs in various stages of development are radically different in approach: two fusion inhibitors are being tested on humans, and one drug that prevents the virus from attaching itself to cells may reach the clinical trial stage this year. Other potential changes include once-per-day doses, rather than the complicated and difficult three to five doses per day, stopping HAART treatments while HIV is at low levels and letting the immune system fight back, and vaccines to help the immune system in the battle after HAART is discontinued.

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Maine Medicaid to cover HIV
by Bob Roehr, Bay Area Reporter, March 9

The state of Maine will expand Medicaid coverage to people who are HIV-positive but do not yet have a diagnosis of AIDS. It is the first state to do so. The Health Care Finance Administration, which administers both Medicaid and Medicare, granted Maine a waiver for the change last month.

AIDS advocates have been fighting for this expansion of coverage for years. They thought they had won the political battle in April 1997 when Vice President Al Gore voiced his support. But that fall an administration study found that expansion would not be "revenue neutral." In other words, it would cost money. White House support vanished.

When advocates challenged assumptions made in that analysis, the Clinton administration responded that it might grant a Medicaid waiver to states proposing expansion of demonstration projects. A handful of state Medicaid agencies looked at creating such waiver programs. Maine submitted its proposal last spring, and revised it significantly in the fall to take HCFA concerns into account.

The Maine plan – announced February 24 – will begin in September and run for five years. To qualify, one must be HIV-positive and have an annual income of less than three times the federal poverty level, which is about $25,000 a year for a single person living in Maine. State officials estimate that about 300 people will qualify.

"One down, 49 more states to go," said Claudia French, acting executive director of AIDS Action in Washington, in welcoming the news. The group has led the fight for expansion.

"Increasing access for a handful of people in Maine is a great step for those people," said Terje Anderson, policy director for the National Association of People With AIDS. "But we need to figure out how to turn this into a national effort."

He praised the state for its initiative and HCFA for standing firm on no enrollment cap and for requiring nearly a full benefits package rather than a stripped down version as initially proposed.

"These applications are hard, they're complex, they take a lot of activity within different parts of state government to make it happen," said Anderson. Massachusetts is preparing a waiver application and at one point so was California. "The fear is that we are not going to get a lot of other applications submitted."

Conditions also have changed since the push for expanded access to Medicaid began. It is no longer so clear that early intervention with currently available therapy is the route to go. Associated side effects also are a factor.

Other ways for some people with HIV to gain access to Medicaid have opened up, said Tom McCormack. He is an expert on entitlement programs and author of The AIDS Benefits Handbook.

The 1997 Balanced Budget Act and the Work Incentives Improvement Act, signed on December 17, 1999, "allow states to give Medicaid cards to people who are working and who are clinically disabled." Other options allow the "pre-disabled and ex-disabled" to gain access to Medicaid, even without a diagnosis of AIDS. Income requirements for these provisions are $43,000 or higher at the discretion of each state.

McCormack sees utilization of these new provisions as the best and easiest ways to gain access to care for those who are working.

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HIV side effects and aging
by Bob Roehr, Bay Area Reporter, March 9

"HIV patients are, thankfully, getting older because of the effect of antiretroviral therapy," Dr. William Powderly told the seventh Conference on Retroviruses and Opportunistic Infections. "They also face long-term issues of aging" that may be confused with or compounded by HIV, the therapies used, or a synergy of both factors.

High triglycerides, high cholesterol, a lowering of HDL the so-called "good cholesterol," and mitochondrial damage – "What are the links between these side effects and long term survival with HIV and the drugs used to treat it?" asked Powderly, a researcher at Washington University in St. Louis.

"It is clear that protease inhibitors in and of themselves are linked to increases in triglycerides and cholesterol, that one of the NNRTIs (Sustiva) is linked to cholesterol," said Dr. Carl Grunfeld, a researcher at the University of California at San Francisco. "There is a debate as to whether or not these drug therapies for HIV are linked to insulin resistance independent of changes in fat. It is likely that changes in fat will contribute to insulin resistance."

The emerging picture remains one more of questions than of answers. An increase in one or even several risk factors for a disease may not have much clinical significance absent other traditional risk factors. The classic example is the heart attack, where a family history of such episodes seems to act as a multiplier of other risks, increasing their predictive value, versus a patient with the same set of risks except the family history.

Despite what is not known about long term side effects of therapy and medical problems associated with aging, switching from a protease inhibitor- to a NNRTI-based combination improved metabolic perimeters in most studies. And it seems that many of the medical conditions, once identified, are ameliorable to standard therapeutic approaches.

Osteoporosis: and/or osteopenia is the most recent side effect to be associated with HIV disease and its treatment. It is a lessening of bone density that occurs with age, which increases the risk of fractures, and is most commonly associated with elderly women. This metabolic complication appears to be independent of others.

Dr. Pablo Tebas and colleagues at Washington University studied the bones of 100 HIV infected patients. Those on regimens containing protease inhibitors (64 people) had a 21 percent rate of severe osteoporosis while those on non-protease combinations showed an incidence of only 6 percent. The conclusion was supported by a parallel study in Australia. Neither sample was large enough to identify differences between individual drugs within the protease class.

But correlation does not necessarily prove causation. The fact that one group of patients was on a regimen that did not include protease inhibitors suggests that their disease may not have been as advanced, that they may have been infected with HIV for a shorter period of time.

Osteoporosis is a very slow-developing medical condition. The fact that it was more likely to appear in the long-term infected suggests that the virus itself may play some role in promoting the condition, as may total time on therapy, with specific drugs or classes of drugs adding their own contributions to the synergy.

Powderly said that by summer they hope to have a better sense of what is causing the osteoporosis. It may be deficiencies in absorption of calcium and vitamins that help build up bones, or it may be in an increased rate of depletion of bone. Those are the two major processes in the dynamics of this living tissue.

Statins: Hyperlipidemia – elevated blood levels of cholesterol and triglycerides that increase the risk for heart attack and stroke – is increasingly associated with extended use of combination therapy. Diet, exercise, and a family of drugs known as "statins" are used to treat the condition.

The liver processes both protease inhibitors and statins through the same pathway, so there was concern that one drug might influence blood concentrations of the other.

Researchers found some effect when atorvastatin or simvistatin were used with ritonavir/saquinavir. They suggested that those statins either not be used, or the doses should be reduced to avoid toxicity. Further research on determining the best doses needs to be done. The dose of pravastatin probably does not need to be reduced.

Mitochondrial toxicity: Australian researcher Dr. David Cooper described a group of patients with lactic acidosis, a blood toxicity that can be caused by a failing liver. "It is a well known but uncommon complication of chronic nucleoside therapy. What was striking in this group of patients is that they were severely lipodystrophic."

"It gives us a further clue and provides us circumstantial evidence that maybe the nucleoside toxicity is not just on the liver and muscle as we have seen previously, but may also be extended to fat. That obviously is conjecture," Cooper concluded.

But it seems to support a hypothesis put forward more than a year ago by Dutch researcher Kees Brinkman. He proposed that mitochondria – a sub unit of the cell often called its "power pack" – can insert molecules of the RT class of drugs into its DNA when it replicates. Mitochondria has less capacity to correct this type of mistake than does the principal DNA of the cell. These insertions may slowly poison the mitochondria and in turn the cell.

There is also a suggestion that coinfection with hepatitis C might play a role in increasing the liver's susceptibility to damage.

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Week Ending March 11, 2000

Please see other Buddhist AIDS Project (BAP) pages at www.gst.net/~bap, including "Events", "Resources", "Links", "Library",and "Bookstore".

Buddhist News

Ram Dass at Grace Cathedral, March 12, and "Buddha Blues" with Ron Jones, March 15; March and April retreats and workshops at San Francisco Zen Center, Green Gulch Farm, Spirit Rock Meditation Center, San Francisco Gay Buddhist Fellowship; "Buddhism at Millenium's Edge" -- March Talks and Workshop with Lama Surya Das; Coming up in April: Five Day Residential Vipassana Meditation Retreat for Gay, Lesbian, Bisexual and Transgender Participants at Spirit Rock Meditation Center; also coming up in April: Zen Hospice Project's " Caregiver Volunteer Training" -- Please apply now if interested.

HIV/AIDS News

Gays embraced at second black AIDS conference;
Jackson takes public HIV test at D.C. clinic
by Kai Wright, The Washington Blade, March 3, 2000

The moment’s weight almost got lost in the hullabaloo of celebrity, but last week saw an historic moment for black Gay people and black people living with HIV. One of the most influential religious and political leaders in the history of black America sat down in a Gay community health clinic — newly headed by a black Gay man and located in one of the nation’s most visibly black cities — and publicly took an HIV antibody test.

With that action, the Rev. Jesse Jackson’s message, and the message that refrained during a related two-day conference on AIDS in the black community, was simple: The battle against AIDS is not over; its frontline has just moved.

The U.S. Centers for Disease Control and Prevention estimates that more than half of new HIV infections in 1998, the latest year for which data is available, were among African Americans — who account for only 13 percent of the U.S. population. Sex between men continues to be the largest risk factor for HIV transmission, with 60 percent of all documented infections having occurred through men having sex with men. But among white Gay and bisexual men, HIV prevalence has been on a steady decline — plummeting by an estimated 50 percent between 1988 and 1993. Meanwhile, among blacks, the trend has been upward. In a January report, the CDC announced that for the first time men of color accounted for the majority (52 percent) of new HIV infections among Gay and bisexual men in 1998.

These are the statistics that brought Jackson to Whitman-Walker Clinic’s Anacostia site on Feb. 24 and brought over 1,000 participants to a Washington, D.C., meeting of the minds on AIDS and black people. Joined by White House AIDS czar Sandy Thurman and actor Dennis Haysbert of CBS’s Now and Again, Jackson took an oral HIV test in front of a room crammed with television cameras and reporters. He urged other black community leaders to join him.

"When it was first seen, it was seen as a white Gay disease," Jackson said after his test, "to allow people to believe it’s them and not us. So much shame and stigma attached to it. People disowned their children. Misinformation abounded. … But that was the fear and the taboo."

Jackson said his taking of the test was aimed at combating this taboo and urging his fellow leaders into doing the same.

"All of us can go public testing. The minister should take the test in the pulpit Sunday morning. … Remove the taboo," he preached. "We should not have comfort, because this disease is a killer and on the attack."

Jackson, who spoke at length on the need for greater testing and treatment for people in prison, went as far as to suggest mandatory HIV testing for all Americans. When Thurman and others expressed discomfort with this notion, Jackson stressed that test results and any subsequent treatment should be strictly confidential, but maintained that he feels strongly all Americans need to know their HIV status.

"We need to encourage people to be tested," Thurman tentatively interjected following his remarks. "But we do think, while there’s a mandatory reason for us all to get tested, we do have some concerns about mandatory testing."

Jackson’s perhaps rhetorical flourish on mandatory testing somewhat overshadowed the symbolic weight of the moment, but longtime AIDS and Gay activist Phill Wilson sought to regain focus with an anecdote that quieted the room. He described an evening during Jackson’s 1984 presidential campaign that the then-candidate spent with 25 black Gay activists in Chicago. Wilson said he is the only one from that meeting still alive.

"That speaks to what this is about," Wilson concluded. "It’s about what’s happening to our folks."

Following last year’s conference on AIDS in the black community, many black Gays were asking whether they are included in "our folks." This year, conference organizers made it clear that they are. After Jackson’s Whitman-Walker appearance, Wilson and CDC’s Helene Gayle, director of the National Center for HIV, STD, and TB Prevention, addressed the full conference and described the unique issues confronting Gay and bisexual men in the community.

Characterizing the health of Gays in the black community as "an area that I feel particularly passionate about," Gayle, a black woman, warned the audience, "If we really truly are committed to stopping the spread of HIV in the African American community, we have to talk about this issue."

"We can’t continue to see young men die as a result of our fear, our stigma, our homophobia as a community," Gayle pleaded.

The January CDC report revealing increasing infection rates among black Gay and bisexual men also suggested that trouble accepting a Gay identity among that population, as a result of homophobia, may be in part causal. The report noted a study in which 24 percent of black men with HIV who have sex with men still identified themselves as heterosexual, compared to 6 percent of whites.

But in an impassioned speech that was regularly interrupted by shouts and applause, Wilson rejected the notion that there is greater homophobia in the black community. He said the real issue is the degree to which black Gays are willing to tolerate it or not.

"We’re often willing to give anything to hold onto the illusion of sanctuary" within the community, Wilson said in a speech primarily directed at black Gay people.

"We are not going to stop or slow down the spread of HIV and AIDS until we begin to be able to be who we are wherever we are," he said, challenging black Gays not to shy away from either their Gay or black identities when in straight black or white Gay environments. "Our places in our communities are our birthrights, but we have to claim them."

The tone of Wilson’s speech was typical of those in the opening hours of the Feb. 24 and 25 gathering. While the ostensible purpose was to arm individual leaders with tangible information to take back to their local communities, many clearly saw the event as something of a spiritual rally as well. As moderator Stephen Thomas of Emory University noted after Jackson’s speech at the conference, many of the presentations would abandon pure science and address more social issues.

U.S. Secretary of Health and Human Services Donna Shalala opened the conference. She pledged the administration’s continued commitment to funding efforts targeting the black community, highlighting the Congressional Black Caucus-initiated Minority AIDS Initiative. Established last year, that initiative earmarks $245 million dollars for programs explicitly targeting communities of color. Shalala also highlighted the administration’s increased funding on African AIDS programs.

But Jackson, while commending those efforts, said in his address, "I’m also aware of how long it takes to empty Lake Michigan a teaspoon at a time. … We need more money more quickly."

AIDS activists have criticized the administration for flat-lining funding for the initiative in the president’s 2001 budget proposal sent to Congress in February.

Organizers said the conference almost doubled in size compared to last year’s event. Bristol-Myers Squibb Company funded the $500,000 gathering, which was officially sponsored by Johns Hopkins University’s School of Medicine.

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Safe sex decision-making
by Paul Kunsberg, Bay Area Reporter, March 9, 2000

What exactly is the San Francisco AIDS Foundation trying to say in its recent sex advertising campaign? The posters, an array of body parts with no identity and a headline that says, "How Do You Know What You Know?" are an indirect and whispered approach to a situation in the community that is of epic proportion. The sub-headline is directed at HIV-negative men and says something innocuous like, "I'm negative and I thought he was too." The advertising dances around issues that are so troublesome and hard to talk about, one of the city's greatest bastions in the HIV crisis cannot even find the right words or images.

There is a new look in some of the faces in this community. It is the new face of HIV. It is the face of someone who somehow looks healthy and positive at the same time. It is my face. New issues related to HIV have gradually begun manifesting themselves in the appearance of some people who are infected.

We wanted to believe that it was over. We wanted to rest on the laurels of new drugs and good press. HIV has become tedious and we are all tired of it. My face is a reminder that the happy ending has not come yet. We can now walk down the street and those that are even somewhat savvy in matters of HIV can tell that some people "look" positive. Generally speaking it has not been a well-received look. Additionally, people are making decisions about safe sex based on perceptions of what they now think it looks like to have HIV. With the same energy as the community is using to reject the evidence they see in a face like mine, they are hurling themselves once again into a frenzy of unsafe sexual practices. Young men are becoming newly infected. The San Francisco AIDS Foundation should have put my face on its posters – or one like mine – next to that of someone who has not been affected by lipodystrophy and then asked the question: "How Do You Know What You Know?"

The trend in the community bears examination. An HIV-negative man owes it to himself to make informed decisions about the kind of sex he chooses to have. There are facts, not philosophies or politics, to consider when making these decisions, just a few basics really:

o There is no cure for HIV
o Not everyone who has HIV looks like it
o Lipodystrophy can affect anyone – not just old-timers who have cycled through a lot of drugs
o The ultimate long term use of the drugs is unknown
o HIV is readily transmitted through unprotected anal sex

These are facts. They warrant consideration. It can't be over just because we want it to be.

In the HIV-positive community, where unsafe sex is rampant, the decision-making process seems to be driven by hostility, indifference to medical warnings, and to some degree a sense of futility. The message in SFAF's safe sex campaign is not directed to this community at all. Meanwhile, HIV-positive men are turning their backs to warnings of mutations, drug resistance, and super viruses, as well as other sexually transmitted diseases that can be particularly challenging to those with suppressed immune systems. The HIV-positive community seems to be throwing caution to the wind as it rejects the facts that exist in relationship to safe sex decision-making.

As a veteran of the war what I see going on in the community is troublesome. There is a lull in the storm that could be only just that. Why are we taking even the slightest chance? I have great concerns for what could be if the tide is not turned. The process of examining the issues involved in safe sex decision-making is complicated and multi-faceted. It can only begin if we start facing it and discussing it. We have to start talking honestly and openly about what is happening in this community and many others. Safe sex advertising campaigns should stimulate these conversations and thought processes. We all face challenges and temptations and the conflicts are real and pertinent. The fact that some of us now look HIV-positive is hard to talk about. Unfortunately there is no other way and talk is just the beginning.

HIV/AIDS agencies will attempt to put together future campaigns targeted at safe sex decision-making. I hope that when they do, they will have the courage to be direct and look into the face of HIV rather than sidestepping obvious pertinent issues. And, if anyone would like to photograph me as part of their message, I'm available.

Paul Kunsberg, a San Francisco resident, is gay and HIV-positive.

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"Action Point": Homeless in San Francisco Now Have Better Access to Help

Lacking a stable living environment, many individuals living with HIV are unable to begin or maintain the difficult battery of medicines designed to fight HIV. In San Francisco, 30 percent of homeless or marginally housed people with HIV have been prescribed HAART (Highly Active Anti-Retroviral Therapy) but, with a treatment regimen of two to 15 pills, two to three times per day, with or without meals, it has been difficult for them to complete their daily regimen.

But an innovative new collaboration between the HIV Services and Treatment Support Department of the S.F. AIDS Foundation and the San Francisco Department of Public Health was created to help.The program, called Action Point, is designed to support symptomatic HIV-positive clients in gaining access to HAART, to assist clients to adhere effectively to the complicated regimen, and to reduce the chaos and increase stability in their lives.

Since opening a store-front site in the South of Market in July, 1999, Action Point staff have assisted several hundred clients with referral and counseling services, social service needs and medical care, including lab tests. Program services are available to clients Monday through Saturday and the site even provides a place program participants can store their medications.

The site is staffed with a part-time medical director, two public health nurses, one physician/acupuncturist, a part-time pharmacist and case managers from the S.F. AIDS Foundation. Lab work to monitor CD4's and viral loads is done regularly.

--Reported by the San Francisco AIDS Foundation

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HIV Stays in Semen After Drug Therapy
Researchers reported on a study that found HIV genetic material in the semen of HIV-positive men taking Highly Active Antiretroviral Therapy (HAART). Because HAART can lower blood viral loads to undetectable levels, some had hoped that a similar decrease would be seen in the semen. The findings suggest that people can still transmit HIV even if they have an undetectable blood viral load.

--Reported by theSan Francisco AIDS Foundation.

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Week Ending March 4, 2000

Please see other Buddhist AIDS Project (BAP) pages at www.gst.net/~bap, including "Events", "Resources", "Links", "Library",and "Bookstore".

Buddhist News:

March and April retreats and workshops at San Francisco Zen Center, Green Gulch Farm, Spirit Rock Meditation Center, San Francisco Gay Buddhist Fellowship; "Buddhism at Millenium's Edge" -- March Talks and Workshops with Jon Kabat-Zinn and Lama Surya Das; Coming up in April: Five Day Residential Vipassana Meditation Retreat for Gay, Lesbian, Bisexual and Transgender Participants at Spirit Rock Meditation Center; also coming up in April: Zen Hospice Project's " Caregiver Volunteer Training" -- Please apply now if interested.; CBS Healthwatch.com and many newly listed San Francisco Bay Area resources.

HIV/AIDS News: "Oral sex and HIV", plus other important news...

From the HIV InSite web page:

Though some researchers estimate the proportion of HIV infections due to oral sex is probably 1% or less, other researcher