Relative resistance to HIV-1 infection of CD4 lymphocytes from persons who remain uninfected despite multiple high-risk sexual exposure.

Some individuals remain uninfected with human immunodeficiency virus type-1 (HIV-1) despite multiple high-risk sexual exposures. We studied a cohort of 25 subjects with histories of multiple high-risk sexual exposures to HIV-1 and found that their CD8+ lymphocytes had greater anti-HIV-1 activity than did CD8+ lymphocytes from nonexposed controls. Further studies indicated that their purified CD4+ lymphocytes were less susceptible to infection with multiple primary isolates of HIV-1 than were CD4+ lymphocytes from the nonexposed controls. This relative resistance to HIV-1 infection did not extend to T-cell line-adapted strains, was restricted by the envelope glycoprotein, was not explained by the cell surface density of CD4 molecules, but was associated with the activity of the C-C chemokines RANTES, MIP-1alpha, and MIP-1beta. This relative resistance of CD4+ lymphocytes may contribute to protection from HIV-1 in multiply exposed persons.

Helping patients to reduce their risk of acquiring sexually transmitted disease.

This monthly series was developed from the AOA Task Force on AIDS Writers' Workshop, held August 16 to 18, 1991, in New York. The workshop was sponsored by an education grant from Burroughs Wellcome. It will provide brief clinical updates and perspectives on the human immunodeficiency virus (HIV). Readers may request tear sheets from the AOA editorial offices.

PIP: Counseling patients about sexually transmitted disease (STD) prevention is imperative to primary care. Physicians have a tendency not to discuss STDs, however. The AIDS epidemic makes STD counseling very essential. In the US, heterosexual adolescents and heterosexual women suffer from the highest increase in HIV infections rates. AIDS 1st struck the homosexual community which has reduced the incidence of all STDs including HIV infection by counseling and condom use. Thus physicians should speak to their patients frankly about STD prevention including the details of how to use a condom properly regardless of their STD and HIV status. They should also promote sex education of younger people before they become sexually active. The only way to not acquire STDs is to practice sexual abstinence. Another safe way to prevent STDs is a monogamous relationship between uninfected partners. If a partner was sexually active in the past, he/she should undergo serologic testing to determine STD and HIV status. Each sexually active individual not in a monogamous relationship must practice risk reduction behavior to prevent transmission of STDs and HIV. The best condom to use is a latex condom with a tip and lubricated with the spermicide nonoxynol-9. Users must put on the condom on an erect penis before it comes in contact with any mucus regardless of the mucous origin. The man should withdraw the condom protected penis while still erect. Physicians should stress to younger or sexually less experienced people the difference between contraception and prophylaxis. They should also inform all patients that anal intercourse is the riskiest sexual activity. Vaginal intercourse, fellatio, and cunnilingus also pose sizable risk of STD and HIV transmission. Physicians must remind patients to be extra careful during oral or anal intercourse and that condoms can leak. They must remember that low risk groups do not exist, but low risk behaviors do.