NetNews Usenet Archive 1993 #3/NN_1993_3.iso/spool/sci/med/aids/2245

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From: Billi Goldberg <[e-mail]>
Subject: Disease Progression and CTLs in AIDS
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Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
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The following article was printed in the San Francisco Sentinel on
Thursday, January 21, 1993. There are no restrictions on reproduction of
this article according to the author Charles R. Caulfield and the San
Francisco Sentinel.

***********************************************************************
            Cytotoxic T-Cells and Disease Progression in AIDS
                       by Charles R. Caulfield

CD4 T-Lymphocytes have long been considered the most significant markers
of disease progression in AIDS with declines in their number being
considered predictive of the onset of opportunistic infections. It was
considered a breakthrough in AIDS research when CD4 T-Cell numbers were
allowed to substitute for death in clinical trials, gaining them the
dubious title of "surrogate markers."

Recent research at state of the art research centers indicates that CD8
T-cells, also known as cytotoxic lymphocytes play a most crucial role in
determining the immune status of the patient. Despite this, many
physicians in clinical practice are reticent to let go of outdated
measurements of disease progression in AIDS. Currently the most widely
used laboratory predictors of disease progression have been the P-24
antigen and antibody tests, beta 2 microglobulin, CD4 counts and
neopterin levels, all of which are drawn from the blood. And yet it is
clearly recognized by the medical community that the bulk of the viral
infection, and that of the pathogens which are opportunistic in AIDS,
reside primarily in the mucous membranes of the body, making blood
laboratory evidence of dubious value.

The importance in maintaining CD8 counts is only recently becoming
widely recognized in AIDS treatment. Two submissions for presentations
at next years 9th International Conference on AIDS in Berlin, drawn from
research in two entirely different fields of study have as their closing
statements that a halting of disease progression is associated over
periods of time with stable CD8 counts, despite possible declines in
numbers of CD4s, even in some cases to zero. It is speculated in both
papers that this may be a common denominator in long term survival as
has been the long-held position of Dr. Jay Levy of UCSF.  But patients
seldom ask their physicians for their CD8 counts,  and physicians seldom
offer the information, even though it could afford the patient the
option of considering a therapy aimed at  increasing the numbers of and
stabilizing these critical cells.

Several approaches to increasing the numbers of CD8s in symptomatic
individuals are under investigation. A KS treatment called CD8
expansion, in which CD8 T-Cells are removed from the blood and
cultivated in culture by adding the protein interleukin is currently
fully enrolled and underway in San Francisco.  Another means of doing
this is by modifying the body's biological response. Topical application
of DNCB  has been consistently shown to nontoxically raise CD8 counts
and natural killer cells among compliant patients, which would explain
why this drug is receiving increasing attention among patients and
physicians around the world.

What is needed is the technology to measure viral replication in
mucosal tissue and in the lymphatic system where the greatest
populations of virus and other pathogens reside. The science exists, in
what is known as polymerase technology. A laboratory test called the
Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) is the gold
standard in determining the activity of the virus in the tissues, and
therefore has incomparable value in assessing the effectiveness of drugs
intended to interfere with viral replication. In addition to this, a
subset of T-lymphocytes known as CD38s, which are in fact immature CD8s,
have been shown to correspondingly increase in numbers with the clinical
decline of the patient.

Why are these laboratory tests not being utilized in everyday use, even
at leading Medical Centers? Many researchers, scientists and activists
realize that this is one of the most critical issues in turning around
12 years of bungling, and getting on the right track toward finding
effective treatments quickly.  It is certain that there are those
pharmaceutical industry profiteers who will not take too kindly to a
revisionism resulting from what is currently being discovered in
immunology.

Our morbid preoccupation with certain 'magic' numbers in CD4 counts was
certainly fostered back in 1987, when Burroughs-Wellcome set 200 CD4 as
the required T-cell decline to qualify for AZT. Most current antiviral
therapies for HIV use blood tests to evaluate their effectiveness, yet
the substantial viral load is not in the bloodstream. It would appear
that some very influential organizations and institutions would have a
vested interest in disregarding the newest data, and using their
enormous influence to see to it that most other people do the same.
When it's life vs. profit, guess who wins.
************************************************************************

Charles Caulfield is a staff writer for the San Francisco Sentinel and
was a board member of The National Association of People with AIDS
(NAPWA) for five years. Charles was diagnosed in 1984 with PCP and has
maintained his health through the use of safe and natural therapies and
positive life changes. His works have appeared in the PWA Newsline, and
Being Alive.