Tag Archives: New York University School of Medicine

Should the “New” Russian HIV Strain Cause Concern?

test-tubes

There has been a lot of play in the press recently about a “new and more virulent strain of HIV” (Daily Mail, Oct. 17) that appears to be spreading quickly in parts of Russia and Central Asia.

According to the epidemiological reports, this new recombinant form of HIV-1 — called 02_AG/A — is spreading at a faster rate than the dominant subtype, HIV-1 A. Moreover, the prevalence rate in some parts of Siberia have spiked by as much as 700% in the past five years, with nearly one out of every 180 persons infected.

Of these, 50% can be attributed to 02_AG/A.

What’s causing the most concern among global health officials is the fact that Eastern Europe and Central Asia are the two areas in the world where HIV infections are actively increasing.

The question is whether this “new” HIV strain is the cause of the increase. Is it as virulent as some are claiming, or are there other factors playing a key role (e.g., social, behavioral)?

Looking at the epidemic up-close, injection drug users and their sexual partners still remain the major drivers for the epidemic in the majority of Russian regions. A steady drug trade from Central Asia through the western borders of Russia — combined with increases in migratory labor and international travel — have likely contributed to the genetic diversity in the regional HIV pool.  Over time, this gave rise a recombinant form of HIV that appears to be more “fit” than other forms of HIV, allowing it to predominate.

But does this, in and of itself, mean that 02_AG/A is a “meaner, scarier” version of HIV, able to infect more easily than other HIV strains?

In truth, the fact that it has spread so quickly, taking a leading position in some regions, does warrant concern. One study conducted by the New York University School of Medicine suggests that 02_AG/A is able to replicate nearly 1.5 times faster than parental subtype A. Simply put, the replication rate may allow the virus to “build traction” more quickly in an effected host, far in advance of an immune response.

But what all of this doesn’t suggest is that 02-AG/A is any more or less deadly than other forms of HIV. In fact, a four-year study by the University of Montepelier in France showed that the 02_AG strain (which predominates in Cameroon and West-Central Africa) does not differ from other forms of HIV in the region, either in terms of survival, disease progression, or CD4 cell decline.

However, none of this can downplay the fact that, unless Russian health authorities act now, the spread of 02_AG/A may thwart any effort to stave the alarming HIV infection rates in the region… or the spread the virus to other regions and continents.

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Can Blood Transfusions Cure HIV?

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In a different take on health and HIV related questions, Gawker reader, Michael, asks the question, “can massive blood transfusions be used to treat HIV”?

THE QUESTION:

Is it possible to cure, or at a minimum delay the effects of, HIV by simultaneously drawing infected blood and transfusing in ‘clean’ blood into the patient? You would still have tainted blood in the system, but wouldn’t this turn the clock back a bit in regard to how much of the virus is in the person’s blood stream?”

Here’s what doctors say on EXTREME blood transfusions as a fix for HIV

Dinesh Raoassistant professor, David Geffen School of Medicine at UCLA:

Not a bad question actually. The issue is that the virus infects T cells and these reside both in the blood and in tissues, such as the lymph nodes and the gastrointestinal tract. So even if one were to entirely rid the blood of the virus (which would be really difficult to accomplish), there would be other sites such as those I mention that would still have “reservoirs” of virus. Add to this the difficulty and potential complications of doing the blood exchange, which is done for certain other conditions… And you have a sufficiently bad benefit/harm ratio to make the procedure untenable.

Michael SaagDirector, Center for AIDS Research, University of Alabama at Birmingham:

Evidence for most infectious disorders is detected in the blood. This does not mean that the blood is the location of the infection. In the case of HIV, most / all of the virus replication occurs in lymphoid tissue (gut, spleen, lymph nodes), NOT in the bloodstream. Blood is simply a place were we can readily detect it. And while blood can transmit HIV, it is because the virus is present in blood not because it is replicating there. Therefore, removing ‘infected’ blood and replacing it with ‘clean’ is like taking a cup of water from the ocean and then pouring in a cup of fresh water in the hopes you would make the ocean a very large freshwater lake!

Michael Polesassociate professor, NYU School of Medicine:

The short answer is that it wouldn’t work. HIV is a retrovirus and, as such, integrates it’s reverse transcribed DNA into the host cell genome. That DNA will sit dormant in a lymphocyte until the cell dies. as such, there will be plenty of cells that contain HIV DNA sitting around, not just in the blood stream, but in the tissues, most notably the intestines. Even if you could replace all of the peripheral blood through transfusion, additional lymphocytes would be in the tissues and would continue to produce virus, which would just infect the cells that you have transfused in.

Patrick Fogartyassistant professor of medicine, University of Pennsylvania:

I can think of a few reasons why the approach you mentioned would not work, including that HIV infection is not a process that is confined to the intravascular space (meaning inside the blood vessels). The tissue through which the infection gained access to the body (needle stick, mucous membrane) would be contaminated with virus as would the regional lymph nodes, which drain these tissues. So exchanging the blood volume wouldn’t purge the body of the virus.

Ian Frankprofessor of medicine and Director, Clinical Core, University of Pennsylvania Centre for AIDS Research:

There is no way to delay the effects of AIDS by removing infected blood and transfusing in uninfected blood. HIV replicates predominantly in a type of lymphocyte called a CD4+ T cell, or a helper T cell. About 2% of the CD4+ T cells in our bodies are circulating in the blood. The rest are in our intestines or in lymph nodes scattered around our body. Therefore, even if we could remove all of the HIV infected lymphocytes in our blood, the vast majority of the cells infected by HIV would not be removed, and HIV would still be reproducing in those cells.

Hope that is understandable. [Ed.: lol]

THE VERDICT: No, you can’t cure (or even ameliorate) HIV/ AIDS with blood transfusions, because the virus hangs out elsewhere in the body, and would just reinfect the new blood.

Original article via Gawker

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Discussion:

Have you read any interesting articles about measures to halt, or cure HIV/AIDS.  Why do you think the answer has baffled scientists for so long.  Do you think they’ll ever be a cure, or a vaccine for HIV, and when do you think HIV will begin to become part of history, rather than a current medical condition.  Comments are open for two weeks.

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