mory is adding to a growing body of knowledge about AIDS. At the recent Fifth Conference on Retroviruses and Opportunistic Infections in Chicago, Emory researchers' presentations included progress on new anti-AIDS drugs, tests to detect HIV earlier in newborns, and preventive antibiotic therapy to reduce common infections in AIDS patients. One of the most promising announcements regarded FTC, a new drug that appears to shut down the ability of the AIDS virus to reproduce. In an ongoing Phase I/II trial on a small group of patients, FTC significantly reduced the viral load of HIV-1 in plasma at the first two dose levels - without harming healthy cells. FTC was developed by Emory researchers Dennis Liotta and Woo-Baeg Choi in collaboration with Raymond Schinazi and is licensed to Triangle Pharmaceuticals based in Durham, N.C. Preclinical results show that FTC's in vitro activity against HIV-1 is consistently greater than that of 3TC, another antiviral neucleoside analog. FTC also shows potent in vitro activity against hepatitis B. Schinazi also is conducting preclinical in vitro research with the nucleoside D-D4FC, which has demonstrated favorable virologic and pharmacologic properties against HIV and hepatitis B. A new assay called Amp-RT quantitatively detects reverse transcriptase (RT), an enzyme associated with HIV-1 particles. A million times more sensitive than conventional RT assays, Amp-RT may identify HIV infection in newborns during the first two weeks of life - two weeks earlier than current tests. Because medications that treat HIV infection are potentially toxic and difficult to administer to newborns, earlier diagnostic and prognostic information could be critically important, says Emory researcher Ronald Reisler. David Rimland, Emory professor of medicine and director of the Georgia Research Center on AIDS and HIV at the Atlanta VA Medical Center, reported that preventive antibiotics greatly reduced the incidence of disseminated Mycobacterium avium complex. DMAC is the most common bacterial infection in people with HIV in the United States. In his study of 1,600 AIDS patients treated with rifabutin and azithromycin, DMAC incidence declined from 11.6 cases per 100 in 1994 to one case per 100 in 1997.

In a recent Emory/CDC study, Emory investigator Richard Hengel and his colleagues found that in HIV-positive patients receiving therapy with protease inhibitors, the immune system was able to replenish both "naive" and "memory" CD4+T cells. Memory cells remember exposure to a specific antigen and react if exposed again. Naive cells are available to react to new exposures. Without them, HIV-positive patients may be unable to fight new infections. Assistant professor of medicine Jeffrey Lennox reported that HIV-1 virus found in the female genital tract is produced in the vagina and is slightly different from HIV-1 produced in the blood. In four studies of HIV-1 in vaginal secretions, he determined that the virus was produced vaginally and was not simply leaking into vaginal secretions through the blood. "Since HIV-1 in the vagina is an important source of transmission to babies and to men in heterosexual relationships, obviously we want to try to reduce the amount of that virus," Lennox says. Developers of anti-HIV vaccines would also need to take into account any significant differences between viruses in the blood and in genital secretions. And going back to the very beginning, Andre J. Nahmias, professor of pediatrics, and his colleagues announced that a sample of HIV-1-seropositive blood plasma collected in 1959 in Africa and stored at Emory, represents the earliest known authenticated case of HIV-1 infection in the world. This report provides substantial evidence for the entry of HIV-1 into the human population at least ten years earlier than previously believed. For details, see the Woodruff Health Sciences Center's web page: www.emory.edu/WHSC/HSNEWS/hsnews.html.

From the Director Closing the AIDS Loop Stronger Together In Changing Times David Blake: Catalyst for Strategic Planning Making Primary Care a Primary Focus Meeting the Needs of the Elderly High Stakes under the Gold Dome Clinic Restructuring Further Unites Emory Healthcare In Praise of Staying Focused