Notes from the expanding AIDS front.

Notes from the expanding AIDS front

Recent announcements from scientific and policy-makinggroups fighting the spread of AIDS have added to the complex picture of the fatal disease. Two reports tie AIDS to an increased incidence of tuberculosis and to a second virus, while others raise more questions about AIDS testing.

In an editorial note in the May 1 MORBIDITY AND MORTALITYWEEKLY REPORT, the Centers for Disease Control (CDC) in Atlanta suggests that the unexpected rise in the number of tuberculosis patients in the United States may be due to AIDS patients infected with both the virus causing AIDS and the bacterium causing tuberculosis. The 1986 total of 22,575 tuberculosis cases reported to the CDC marked a 1.7 percent increase over the 1985 figures.

Until 1985, the incidence of tuberculosis had been decliningsteadily, and the 1986 increase is "the first substantial rise' in tuberculosis cases since national reporting of tuberculosis began in 1953, say authors of the report. They suggest that public health departments match AIDS and tuberculosis registries, and offer AIDS testing to patients with tuberculosis.

A second retrovirus--closely related to the HIV-1 virusknown to cause AIDS--may also cause the disease and prompt a second epidemic, say scientists from France and Portugal. Led by Luc Montagnier of the Institut Pasteur in Paris, the research team reports in the May 7 NEW ENGLAND JOURNAL OF MEDICINE that the HIV-2 virus has been isolated from 30 African AIDS patients treated in Lisbon.

At a March meeting in San Francisco, Montagnier hadannounced the genetic mapping of the so-called HIV-2 virus, isolated from patients without AIDS in West Africa (SN: 3/7/87, p.151). After finding the virus in two AIDS patients, the scientists began searching for it in others suffering from the disease. The latest study found that blood from the 30 patients with HIV-2 infection did not cross-react with the HIV-1 virus, suggesting HIV-2 was in fact causing the disease.

Although the HIV-2 virus may not have moved beyond Africa,the authors express concern that current diagnostic tests used worldwide to screen blood and patients for the HIV-1 virus are incapable of detecting the newly described virus. Also, methods being used to prepare antiviral vaccines do not include antigenic components from HIV-2. Montagnier and his coauthors conclude that "it appears clear that HIV-2 . . . is the cause of AIDS in some West Africans and that a new AIDS epidemic is possible (but not yet documented) in West Africa.' They call for large-scale epidemiologic studies to assess the spread of the virus to other areas.

In an announcement last week, the White House said aspecial presidential commission will be created to study policy aspects of AIDS and advise the President on AIDS-related matters. Reagan said the disease "is clearly one of the most serious health problems facing the world community.' One of the issues the panel may scrutinize is the question of mandatory testing for infection with the AIDS virus, which has killed more than 20,000 in the United States.

On April 30, the Food and Drug Administration approved anew commercial test kit for AIDS based on the "Western blot' immunoassay, which is considered more specific in detecting the AIDS virus than the currently used immunoassay screening method. The new test should eliminate the problem of false positive results sometimes seen with the current test. While AIDS testing technology advanced, government officials were arguing last week over how screening should be implemented. Surgeon General C. Everett Koop restated his position that mandatory AIDS tests are unnecessary, while Secretary of Education William J. Bennett said he supports mandatory testing among some groups, including immigrants and prisoners.