# Highlights

## Veterans Health Administration

> March 24, 2003
>
> **Body's Own Antibodies May Drive New Strains of HIV**
>
> VA researchers have provided the first detailed look at how human
> antibodies may actually drive human immunodeficiency virus (HIV) to
> mutate and escape detection by the immune system. The findings,
> reported online March 18 in the *Proceedings of the National Academy
> of Sciences,* may be key in efforts to develop an effective AIDS
> vaccine. So far, scientists have been unable to design a vaccine that
> induces antibodies capable of neutralizing the rapidly mutating virus.
>
> The researchers also found that patients infected with HIV rapidly
> develop a strong antibody response against the virus. But the same
> antibodies tasked with recognizing and disabling the germ appear to
> force its ongoing evolution into new strains that dance around the
> antibody response and continue to replicate.
>
> "The neutralizing antibodies are exerting a very strong selective
> pressure on the virus, and the virus is continually mutating to avoid
> it," said Richman. "The bad news is that the virus is always staying a
> step ahead, and the neutralizing antibody response can't control it."
>
> They cloned virus from the blood of HIV patients and combined it with
> a gene that makes luciferase, the light-emitting enzyme found in
> fireflies. The enzyme helped the researchers track virus replication.
> The genetically engineered virus from each patient was incubated with
> antibody-containing plasma from the same patient. This procedure was
> repeated periodically over 39 months so the researchers could test
> antibodies from different times against virus from different times.
>
> Most patients developed a high concentration of antibodies to HIV
> within a few months. The antibodies continually evolved in their
> ability to recognize different protein shapes on the outer coating of
> the virus. However the virus consistently evolved faster than the
> antibody response, developing new protein structures on its surface,
> so antibodies from previous months' samples were ineffective in
> neutralizing new virus from the same patient. The study was the first
> to track this virus-antibody "cat-and-mouse game" over time.
>
> **Unproven Prostate Cancer Screening More Popular Than Valuable Colon
> Test**
>
> VA researchers have found that the proven benefits of colon screening
> have little influence on the majority of men aged 50 and older that
> are getting checked for cancer. A Centers for Disease Control and
> Prevention survey of over 49,000 men found 75 percent aged 50 and
> older reported having undergone prostate-specific antigen (PSA)
> testing at least once, but only 63 percent had undergone colorectal
> cancer screening.
>
> Author Dr. Brenda Sirovich of the VA Cancer Outcomes Group in White
> River Junction, Vt., and VA Drs. Lisa Schwartz and Steven Woloshin
> suspect that men may not be aware that PSA testing hasn't been proven
> to reduce mortality from prostate cancer. They say men need to know
> which tests are most likely to be beneficial and that these findings
> may enhance conversations between physicians and their patients. The
> findings appeared in the March 19 issue of the *Journal of the
> American Medical Association*.
>
> **VA Physician Receives Excellence Award**
>
> Dr. Jacqueline G. Parthemore, chief of staff and medical director for
> VA San Diego Healthcare System (VASDHS), recently received the 2002
> American Hospital Association (AHA) Federal Healthcare Executive Award
> for Excellence.
>
> Dr. Parthemore has promoted strategic planning in line with national
> and local priorities and has led the way in performance improvement.
> She has championed innovative health care delivery, state-of-the-art
> technology and information systems and clinical excellence. Her
> success is indicated by top scores for VASDHS from the Joint
> Commission of Accreditation of Healthcare Organizations, receipt by
> VASDHS of the highest ratings in VHA for seven of nine categories of
> inpatient satisfaction with care, establishment of the San Diego
> Center for Patient Safety in collaboration with VASDHS' academic
> affiliate, rapid implementation of computerized medical record and
> bar-coding medication dispensing systems, development of tertiary
> services in electrophysiology, CT surgery, neurosurgery, the
> construction of a state-of-the-art ICU and Procedure Center, and the
> development of 5 community-based outpatient clinics.