Current antiretroviral drugs interfere with replication of human immunodeficiency
virus (HIV). A promising strategy for the development of new anti-HIV drugs
is to target steps in the process of viral entry into host cells.
Restoration of immune function after antiretroviral therapy is variable
and often incomplete, even when HIV replication is controlled. In this trial
of interleukin 2 (IL-2) as an adjunct to antiretroviral therapy in patients
at an intermediate stage of HIV infection, Davey and colleaguesArticle found that
after 1 year, patients who received combination therapy had a significantly
greater mean percentage increase in CD4 cell counts and a greater reduction
in plasma HIV RNA levels than patients who received antiretroviral therapy
alone. Lederman and ValdezArticle review factors that influence the extent of immune
restoration and the long-term survival of patients receiving antiretroviral
therapy. In an editorial, Blankson and SilicianoArticle discuss limitations of highly
active antiretroviral therapy and how immunomodulatory actions of IL-2 may
complement this therapy.
The effect of antiretroviral therapy on the survival of children with
HIV infection has been limited to data from clinical trials. In this analysis
of population-based data from children with perinatally acquired HIV infection,
de Martino and colleagues report that survival for children in the 1996-1997
birth cohort was significantly longer than for cohorts born between 1981 and
1995. Survival was unchanged between calendar periods 1981 to 1989 and 1990
to 1995, but increased significantly in calendar period 1996-1998. Double
combination therapy was associated with a 30% decrease in the risk of death
compared with no antiretroviral therapy, and triple combination therapy, with
a 70% decrease.
Studies in the late 1980s suggested that the HIV epidemic among men
who have sex with men had peaked, but most men in these studies were aged
30 years or older. The Young Men's Survey, a cross-sectional survey conducted
from 1994 through 1998 in 7 metropolitan areas, sampled men aged 15 to 22
years in public venues frequented by men who have sex with men. Valleroy and
colleagues report that the overall prevalence of HIV infection in the survey
sample of 3492 men who have sex with men was 7.2%. Factors strongly associated
with HIV infection included black and mixed or other race; having ever had
anal sex with a man; or having had sex with 20 or more men.
In this population-based analysis, Biggar and colleagues linked data
from 4954 children aged 14 years and younger at AIDS diagnosis to cancer registry
data in 11 US geographic areas. One hundred twenty-four children (2.5%) were
identified as having cancer before, at, or after AIDS onset. The most frequently
occurring cancer was non-Hodgkin lymphoma (100 cases), followed by Kaposi
sarcoma (8 cases), leiomyosarcoma (4 cases), and Hodgkin disease (2 cases).
For all cancer types identified, the number of observed cancers among children
with AIDS during the 2 years after AIDS onset exceeded the expected number
of cancers based on population rates.
Direct viral detection with nucleic acid amplification testing (NAT)
on small pools of blood donor specimens is being evaluated as a blood donation
screening measure to improve detection of infectious units donated after infection
of the donor but before seroconversion has occurred. In a case study of 2
individuals who became infected with HIV after transfusion with blood products
from 1 donor that tested negative for HIV antibodies and p24 antigen, Ling
and colleaguesArticle determined that NAT screening of single rather than of pooled
units would be necessary to detect the small viral load in the infected donation.
Trends in the rates of viral infections among blood donors between 1991 and
1996, reported by Glynn and colleaguesArticle, support the effectiveness of donor
screening practices. In an editorial, KleinArticle considers the costs of additional
measures to improve blood safety in a system in which the risk of transmission
of viral infection is already extremely low.
"To die of AIDS in Africa is an intensely humiliating ordeal, slow .
. . obscene." From "I Held Him in My Arms and Wept."
As the 13th International Conference on AIDS convenes this week in South
Africa, the host country's HIV/AIDS
epidemic—described in a recent report
as "the impending catastrophe"—is in the spotlight.
For your patients: Avoiding diseases transmitted by blood and body fluids.
This Week in JAMA. JAMA. 2000;284(2):145. doi:10.1001/jama.284.2.145