HLA-B27 and HIV/AIDS

[Guest guest]

Dear Group,

After reading several conflicting articles relating to HLA B27 and HIV/AIDS,

I am completely confused. Maybe there is someone in the group that has

genetic/medical background who can clear up the confusion? Several years ago,

there

was a doctor in our group....and he mentioned that many patients who were

HIV...developed spondyloarthropathies. Maybe the sentence from the 1st copied

article below...explains the paradox:

" Children who inherited B27 from the mother were rapid progressors; those who

inherited B27 from the father were slow progressors. "

1.) <<In the second portion of the talk, Dr. presented new

information on the role of HLA-restricted immune responses and viral escape

mutants. HLA

B27 is associated with a good outcome in HIV infection, perhaps because B27

positive individuals target an important peptide epitope in gag. He reasoned

that when a mother was B27-positive, her virus would have a chance to evolve

into escape mutants. Since infants receive an allele for B27 from either the

mother or the father, they reasoned that if the infant inherited B27 from the

father, the virus would not have escaped from B27-directed CTL. Conversely, if

they inherited the B27 allele from the mother, the virus they were infected with

would have mutated to escape from this response. In fact, this is exactly what

they found. Children who inherited B27 from the mother were rapid

progressors; those who inherited B27 from the father were slow progressors. This

is one

of the most striking demonstrations of the clinical impact of viral evolution

to escape from immune control. The work needs to be confirmed across a variety

of HLA loci and ethnic groups. Over time, the virus may evolve in specific

regions to more effectively escape from immune control. However, the

implications

for vaccine development are potentially striking. Moreover, since HLA loci

vary by ethnic group and region, it may effect the response of specific vaccines

in different parts of the world.>>

http://www.thebody.com/confs/ias2001/pavia5.html

2.) <<Reactive arthritis is the most common inflammatory arthritis observed

among HIV-infected black African populations, and is not associated with HLA

B27. The African patients with spondylarthropathy related to HIV infection are

mainly male and are usually more than 30 years of age at rheumatic disease

onset. In a significant proportion of the patients, spondylarthropathy develops

before HIV infection has been recognized. Peripheral arthritis with predominant

lower limb involvement is far more often observed, whereas sacroiliac or

axial involvement is rare and the disease is often severe (<A

HREF= " http://www.rheuma21st.com/archives/#8 " >8</A>).

This review of sub-Saharan Africa has important clinical implications in

medical practice. HLA B27, because of its rarity and virtual lack of association

with the observed cases of spondylarthropathy in this population, cannot be

used as an aid to clinical diagnosis of spondylarthropathy in black Africans.

Conversely, HIV infection is increasingly showing such a strong association with

reactive arthritis, psoriatic arthritis, and undifferentiated

spondylarthropathy in sub-Saharan African populations that almost every patient

with acute or

chronic inflammatory arthritis may need to be tested for possible HIV

infection.

HIV, REITER AND PSORIATIC ARTHROPATHY

The overlap of Reiter's syndrome and psoriatic arthritis, which is seen in

many HIV patients, is intriguing. In many individuals HIV-associated psoriasis

and Reiter's syndrome may represent a continuous spectrum of the same disease.

HIV infection and its associated spondylarthritis, reactive arthritis, and

psoriatic arthritis are emerging as a serious worldwide public health problem,

particularly in the developing world.>>

http://www.rheuma21st.com/archives/cutting_dequeker_hiv.html

[Guest guest]

Janet, the reason I'm so interested in the link with HLA B27 and AIDS...is

because of my grandson who has AIDS and Hepatitis C. His mother is one of my

daughters who has AS....and is HLA B27+. There are quite a few abstracts

concerning this connection....but they are way over my head. It seems the

articles are

mostly talking about mothers who have HIV....and who have had a child...and

the virus mutates and is harder to treat with the anti virals. They say that it

would be hard to get a vaccine because of this. If you find anything...please

sent...so I can share with my daughter. I would like to give them a little

more hope, if possible. They pretty much live for that. Sincerely, Connie

[Guest guest]

Connie,

This is very interesting. Thank you for sharing these. The information

about the difference in HIV resistance between mother-inherited HLA-B27 vs.

father-inherited HLA-B27 is absolutely fascinating. I am positive I

inherited HLA-B27 from my father, so that's encouraging to me. I had heard

about the link between HLA-B27 and resistance to HIV in a Spondylitis

Association publication and then Dr. Reveille (hopefully I spelled that

right) spoke about it at a patient conference I attended about 2 years ago.

I think I'm remembering right that it was Dr. Reveille. Anyway, there was

no mention of the distinction between mother and father inherited HLA B27.

The immune system is so complicated, nothing seems to be simple.

I think the other articles you provided are talking about something

completely separate. That there is a spondyloarthopathy disease that arises

in HIV-infected Africans that is not associated with HLA-B27 and is a

distinct disease that shares characteristics of our disease in terms of

symptoms but is of a different origin and causation than our disease. I

think that is a completely separate and unrelated issue from HIV resistance

in HLA-B27+ people.

You come up with the best stuff, Granny. Keep sharing so we can keep

learning.

God Bless,

Janet in SF

ReA since 1973; diagnosed 1997; HLA-B27+

[Guest guest]

Janet, this will knock your socks off or make your eyes roll and glass

over....like mine are doing about now. LOL It's late (past my bedtime) and

that

can be dangerous....I think I've found something that I finally can understand

about this HLA link/AIDS....But.......then I'll get up tomorrow morning...and

not be able to see this fine discovery. Here are the two papers that somewhat

came down to my level of comprehension. TeeHee. They're recent, so that is

good....I guess. It's a very interesting subject...and I will be sending these

on

to my daughter. Thank you for opening the discussion.

By the way, I have Iain's (my grandson) pictures in our RISG group

photo albums. He's taking his daily vitamin/mineral/fiber milkshake...he has to

take two of these at one time. In the other photo, Iain is teaching his nephew

to play golf. His nephews look up to Iain...as they would a young father or

older brother. It was Iain's dream to have a wife and many kids. He would have

made a good father and he treats his mother with great respect. Please pray for

him when ever you think of him. I'll update his pictres so you will get to

know him better. A miracle has brought him this far. Hopefully, my daughter and

I gave him something that will help his body fight this terrible disease.

Sincerely, Connie

<A HREF= " http://aidscience.org/science/1410.html " >Science -- Mc and

Klenerman 296 (5572): 1410</A>

<A

HREF= " http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s572494.htm " >Health

Report - 3/6/2002: Important New Work On AIDS</A>

[Guest guest]

Hi Connie, in simple English, the second study says that there is no relation

between getting HIV and the spondy family of diseases. The third study

happened first and theorized that there was a connection between HIV and the

onset

of spondylitis. However, the second study happened later and disproved the

third study's thesis. According to the second study, there is no " continous

spectrum " between the two diseases because the patients studied had symptoms of

both spondylitis and AIDs but the patients were predominately HLA-B27

negative.

The first study deals with infants. Infants who get AIDs from their mothers

develop the disease more slowly when the father is HLA-B27 positive. This is

where it gets complicated. The effect does not seem to occur when the mother

is HLA-B27 positive because the AIDs virus has already had a chance to evolve

against the mother's antibodies and it is the evolved virus which is resistant

to antibodies that is passed along to the infant. Therefore the infant

develops AIDs faster. The author is saying that antibodies created by HLA-B27

gene

from the father kicks in after the infant is born and does indeed produce

effective AIDs antibodies. Because these particular antibodies are created

after

birth, their existence and effectiveness can be measured. After a period of

time the HIV virus does adapt in the infant and again renders the antibodies

ineffective. However for a period of time there is an effective antibody which

scientists can study and therefore could potentially lead to an effective

vaccine.

At least that is what I think they are saying. Matt

[Guest guest]

Thank you, Matt. It just is so confusing. I sent the articles and the links

below....on to my daughter. My daughter's stepbrother is an HIV/AIDS specialist

in Calif. (isn't this a coincidence?) and he is linking up with Iain's doctor

in Miami. They are treating him very aggressively (which is somewhat

controversial), so they know the virus load and particular virus he has so they

can

fight it with the right drugs. We didn't know that there were so many mutated

virus for AIDS. That's why it makes it almost impossible to make a vaccine for

it. Everyone has a different strain. Iain's pictures are on the photo link RISG

. One picture shows him drinking his homemade milkshake of minerals,

vitamins and fiber. He has to drink two of these daily! Another picture is Iain

showing his nephew how to play golf. Iain wanted to have many children. He is

one of the sweetest boys (26 years old) ever. It is so important to advise your

young people (he was 16 at the time he acquired HIV). Please tell them to

avoid risky behavior and tell them about Iain. He was oblivious that he carried

the virus for 10 years. His girlfriend of 5 years, does not have the virus,

nor hepatitis C. God had to have been watching over her. Iain's body is full of

tattoos. Most kids at 16 think they will live forever, no matter what they do.

Appreciate prayers for Iain and his mother, Eileen.

Here are the links I found last night. It is put into layman's terms...so we

can get a glimpse of what they are discovering. Best regards, Connie

<A

HREF= " http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s572494.htm " >Health

Report - 3/6/2002: Important New Work On AIDS</A>

<A HREF= " http://aidscience.org/science/1410.html " >Science -- Mc and

Klenerman 296 (5572): 1410</A>

[Guest guest]

This is too funny, or not so funny after all. I'm sorry I sent the very same

links I sent last night. As I said, it was late and my mind does funny things

I have no knowledge of!!! I do things automatically after a certain hour. LOL

Please forgive. Connie

[Guest guest]

Granny,

You keep finding the best articles. You know, it's so interesting I had

always speculated that HLA-B27+ people might be more prone to giving each

other something. And, this seems to confirm that viruses tend to spread

among people of the same HLA type. So, there is an advantange for certain

things for us because we have a rarer HLA type. But, if we had sex with

another HLA-B27+ person who had a rare form of HLA-B27 mutated HIV we would

almost certainly catch it.

I remember a couple years ago when I went to the spondylitis patient

conference, it seemed like everyone in the room was HLA-B27+. There was a

lot of discussion of it. That night I started feeling sick and subsequently

came down with a combination severe strep throat and sinus infection. It

was a particularly difficult to cure strep throat. I remember thinking you

know it could be a little dangerous to get all those HLA-B27+ people

together in one place because if someone brought in a virus or bacteria that

HLA-B27 is poor at handling, it would spread like wildfire. That was just

intuition but your articles seem to confirm that possibility.

It's so interesting, thank you for sharing all this. I will pray for Iain.

I'm so sorry for your family's illnesses. I hope the scientists are close

to figuring all this out in a way that can help your family, especially

Iain.

God Bless,

Janet in SF