Early treatment for HIV: the time has come

Article Abstract:

The AIDS (acquired immunodeficiency disease syndrome) epidemic has yet to be felt in its full intensity. Blood testing has shown that millions of individuals world-wide are infected by the presumed causative agent, the human immunodeficiency virus, or HIV. Many extremely careful studies have now given the medical world a clear but grim future of the epidemic. Approximately half of all individuals now infected with HIV will, during the course of a 10-year period, develop AIDS. Of the remaining individuals, most if not all will eventually develop serious complications or will succumb to the infection. It thus becomes extremely important to determine the ideal time to begin treating the infection. Zidovudine, also referred to as AZT, is an antiviral medication that has been shown to delay the advance of AIDS and to give some protection to infected individuals against the other opportunistic infections which accompany HIV infection. The current approach to treatment with zidovudine has been to delay treatment until relatively late in the process, and to use as an important criterion for initiating treatment the decline of a cell population of a subclass of white blood cell (CD4+ lymphocyte). A report in the April 5, 1990 issue of the New England Journal of Medicine has shown that early treatment with zidovudine at a dose level that produces relatively few side effects can result in a significant delay of symptoms and progression of the infection. This large scale multi-center study also shows the value of clinical trials, and establishes that the process of scientific investigation can be carried out in a morally acceptable manner. It is hoped that the value of early treatment will also encourage individuals at risk to seek early HIV blood testing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Dosage and administration, HIV antibodies

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HIV revealed: toward a natural history of the infection

Article Abstract:

The human immunodeficiency virus type 1 is the known causative agent of acquired immunodeficiency syndrome (AIDS). The infection can be detected by various means before any symptoms develop; the person is considered seropositive if the virus is detectable in the blood. When symptoms do develop, the infected patient usually passes through a period of incomplete development of the disease called AIDS-related complex, or ARC, before going on to exhibit all the manifestations of AIDS itself. Which factors determine the progress of the viral infection remains unclear; however, recent research presented in the New England Journal of Medicine establishes that the production of virus continues throughout the AIDS infection and that the stage of the condition is related to the level of virus replication. The level of virus in plasma is a better index of the progression of the disease than is the count of white blood cells that carry the HIV virus. Other recent studies suggest that the infectiousness of the illness is also directly related to the level of virus. Thus therapies that act to decrease the rate of viral replication may also decrease the rate of transmission. If the results of the research can be substantiated, the serum level of virus may prove to be an important indicator of the status of the infection and a means of measuring the effectiveness of new therapies including experimental drugs. However, these studies fail to point out how changes in blood virus levels of patients relate to levels of the virus in semen and vaginal fluid, and such studies should be encouraged. These studies present a new ability to measure and to assess the level of HIV and its association with progression of the disease.

Diagnosis, Identification and classification, AIDS-related complex

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Lessons from people with nonprogressive HIV infection

Article Abstract:

The condition of long-term survivors of HIV-1 infection, those who remain healthy and have normal CD4+ lymphocyte counts ten years after HIV infection, may offer insight to the disease that can aid in finding a cure. Most long-term survivors' immune systems continue to function, but it cannot be said whether the immune system fights the progression of HIV or if the lack of HIV progression has spared the immune system. Different strains of the virus may explain the lack of progression, but because some of these different strains do progress in some patients, no conclusion can be drawn. The discovery of genetic defects in the HIV in one long-term survivor suggests that in at least this case the cause of non-progression has been located. Because an HIV infected person rarely becomes infected with a second strain of the virus, it is possible that a nonprogressive strain of the virus may someday be used as a vaccine.

Editorial, Physiological aspects, Development and progression, HIV patients

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