From: matthew@ooc.uva.nl (Matthew Lewis)
Subject: Conference paper - Monday, part 1
Note: non-commercial reproduction.
Keywords: aids conference 1992 Amsterdam
Archive-Number: 5737
Organization: Center for Innovation and Cooperative Technology, University of Amsterdam
Date: 20 Jul 92 20:28:50 GMT

Hello all,

The following is the opening issue of the conference 
newspaper.  Thanks to unrestrained cooperation from the 
organizers of the conference, we (HIVNET Amsterdam) have 
been given permission to post the paper, on sci.med.aids as 
well as the Fido AIDS/ARC echo.

I got the paper as an Xpress(tm) document, and had to pull 
it apart article by article.  I just hope I did not miss 
anything.  We will be posting the paper the same day that 
it appears in Amsterdam every day during the Conference.

*** PLUG MODE ON ****
HIVNET is a grassroots initiative, started by a group of 
volunteers in Amsterdam two years ago, with the goal of 
setting up a network of systems to provide information 
about AIDS and HIV, as well as encouraging similar 
initiatives in other countries.  Thanks to the generosity 
of the dutch Aids Fund and the University of Amsterdam, we 
now have a two-line system in Amsterdam and a system in the 
south of the Netherlands.  We connect to various systems on 
the AEGIS network in the US, as well as to Usenet for 
sci.med.aids.  Anyone interested in more information can 
mail to (internet) hivnet@ooc.uva.nl or (fido) 2:280/413

*** PLUG MODE OFF *** (thanks for the attention :-)

*********************************************************
Activists launch attack on drug pricing
by Cindy Patton

The American pharmaceutical company, Astra, came in for 
heavy criticism during yesterday's opening ceremony from 
both speakers and audience. Richard Rochen, a member of ACT 
UP Boston, one of three people living with AIDS designated 
to speak at the opening ceremony, said Astra, makers of 
foscarnet, the drug used to combat cytomegalovirus 
infection in people with HIV, had "told people they only 
have six months to live" and were overcharging for the 
drug.
Foscarnet, a "cheap simple chemical available since the 
1970s," said Rochen, "is now the most expensive AIDS drug 
in the world." He called for an international boycott of 
all drugs produced by the company except foscarnet, until 
the company lowers its prices for the drug. "Doctors and 
dentists can help the most: don't use Xylocaine [an Astra 
product], use the generic drugs in non-emergencies."
During the ceremony, activists walked silently around the 
room with signs says "Astra is killing us" and knocked over 
the company's booth in the trade room, scattering the 
company's printed materials and posting stickers saying, 
"Lower foscarnet's price."
An Astra spokesman said: "The irony is that many of the 
same folks who trashed the booth are on Astra's community 
board." 
Astra was not the only target for the speakers. Many of 
them condemned the American immigration restrictions which 
caused the conference to be relocated to Amsterdam. Tomas 
Fabregas, an HIV-positive member of ACT UP San Francisco, 
who has lived in the US since 1979 but is not a US citizen, 
announced his flight and time of arrival in the US and 
said: "I challenge George Bush to stop me from returning 
from Amsterdam to America. There is not much we can do 
about AIDS, but this we can do  -  we can put an end to this 
hypocritical law."
Harvey Fineberg, dean of the Harvard School of Public 
Health, said, "The wrong policy is still in place", while 
activists walked quietly around the room carrying signs in 
a dozen languages saying, "HIV knows no borders".
Michael Merson, director of the WHO's Global Programme on 
AIDS, one of the conference's major sponsors, said that the 
GPA had over the past year reviewed projects around the 
world, resulting in revision to the Global AIDS Plan, 
recently endorsed by the delegates to the World Health 
Assembly. "People are made vulnerable to HIV by social 
factors like poverty, discrimination and the subordinate 
status of women," Merson said. He added that 15,000 women 
are infected with HIV every week, "equalling or surpassing 
the number of men, a dismal kind of equality." The updated 
strategy "insists on empowerment of women".
Jonathan Mann, chair of this year's conference, said "our 
current vision of AIDS is outdated" and based on the 
limited knowledge of the early days of the pandemic. 
Acknowledging that the earlier approach, which saw AIDS as 
"a separate, unique and isolated health problem", may have 
been necessary to gain worldwide attention to the disease, 
Mann said we must now see AIDS in the larger contexts of 
unequal access to health care, education and employment. 
Mann proposed a system of "Blue Parties organized around 
health like the Green Party is organized around the 
environment. We have identified the conditions that 
underlie and fuel the spread of AIDS. Do we just watch it, 
or find ways to cope?"
*********************************************************
AIDS 'is not an autoimmune disease'
by William Check

HIV infects many more CD4 cells than scientists have 
previously realised, recent research suggests. 
A study presented yesterday at a symposium organised by The 
Wellcome Foundation may put paid to theories that AIDS is 
an autoimmune disease, invoked to explain the destruction 
of CD4 cells in HIV infection. 

Dr David Ho, of the Aaron Diamond HIV Research Center in 
New York City told the symposium he had found these 
theories convoluted and unsatisfying. 
He said: "My message today is that viral load (in HIV-
infected people) is high, and that we ought to think of 
AIDS as a viral disease and to treat it as such."
There are two important implications if viral replication 
is the key event in the destruction of CD4 cells, Ho said. 
One is that, "If we had the ideal antiretroviral agent, and 
if resistance were not a problem, we would use the agent as 
early as possible after infection." 
Implication
The second implication is that "something extremely 
effective is controlling viral replication" during the long 
latent period between infection and appearance of symptoms. 

Ho has preliminary evidence for a decline in cellular 
immunity directed against the virus, a decline of CD4 
cells, the rise of viral replication and the appearance of 
symptoms in some patients.
Initial studies had shown that only one in 10,000 or fewer 
CD4 cells were infected, too low to explain their fall.
But with the help of sensitive detection techniques - in 
vitro cultures and analysis with the polymerase chain 
reaction - Ho and his colleagues found that, in patients 
with AIDS, between one in 40 and one in 200 CD4 cells were 
making HIV, much higher than previously thought. In 54 HIV-
positive people at various stages of disease, viral load 
clearly increased with disease progression.

*********************************************************
HIV-positive women set their agenda
by Janis Kelly

HIV-infected women yesterday presented a list of demands to 
the international AIDS conference - the first such list to 
be developed entirely by HIV-positive women. They prepared 
the list at the International Pre-Conference Workshop on 
Women Living with HIV/AIDS, held in Amsterdam last week and 
attended by 51 seropositive women from 29 countries. The 
group's statement included demands for more local and 
international self-help groups; less stereotypic treatment 
by the media; more attention to the psychosocial and 
medical effects of the virus on women; more alternative 
treatments; services to relieve isolation and meet the 
basic needs of women with HIV; reproductive rights, 
including the right to choose to have children or to 
terminate a pregnancy; care for the children of women with 
HIV and recognition of seropositive women's importance as 
parents; better training of health care providers about the 
needs of HIV-positive women; and economic support for 
seropositive women in developing countries.The demand for 
more access to clinical trials included a new idea: that 
the decision to risk damage by the drug being tested to a 
developing fetus be left up to the seropositive woman.  
Concern over the potential teratogenic effects of 
experimental drugs has been one reason used by drug 
companies to explain the exclusion of women from clinical 
studies.  Two specific concerns discussed at the subsequent 
meeting for conference attenders on Women's Issues were the 
absence of any sessions dealing with oral sex or with 
menstruation.
*********************************************************
Coffins hammer home disgust at travel bans
by William Check

More than 500 people marched yesterday through the centre 
of Amsterdam in protest at countries which have travel 
restrictions on HIV-infected people. Delivering black 
coffins to the doors of embassies and other buildings 
associated with various countries, they called on the 
countries to "open borders now".
The demonstration began in the Westermarkt, site of the 
triangular pink marble Homo-monument, a tribute to those 
persecuted for their sexual preference. Forty black coffins 
were lined up in the square. 
ACT UP members, many of them wearing black T-shirts reading 
"No Border" staged several "die-ins" on the way to the RAI 
centre, lying down in the middle of the road to symbolise 
the many friends they had lost. 
David Teigeler of ACT UP Amsterdam, one of the organizers, 
said immigration restrictions on HIV-infected people were 
killing people.Environmental concerns have become a 
political issue, he said, and he would like politicians to 
talk about HIV, too. "It seems not yet to be on their 
agenda, which I regret."
On the AIDS conference, Tiegler said: "There's something I 
would 

like scientists to understand. They are not just doing it 
for themselves or to get some prize. It's not just a 
scientific task. It's a human task."

*********************************************************
Dendritic cell debate hots up
By Janis Kelly

Several types of immune cells that come under the name 
"dendritic cells" hold the key to both initial and long-
term HIV infection, according to studies to be presented at 
this week's meeting. Most of these studies are attempts to 
explain why the immune system falls apart in AIDS even 
though relatively few T cells are actually infected with 
the virus.  Which of the "dendritic" cells do what, 
however, is a matter of fierce dispute.  
In this week's Science,  Dr Ralph Steinman and associates 
from Rockefeller University, New York have published  an 
expanded version of information presented at previous AIDS 
meetings.  They suggest that peripheral blood (PB) 
dendritic cells carry the virus into lymph nodes, where it 
destroys CD4  lymphocytes.  According to this hypothesis, 
the PB dendritic cells are not themselves infected by the 
virus but somehow still facilitate the progressive T-cell 
destruction characteristic of AIDS.
This idea was disputed at a meeting earlier this year in 
Amsterdam, at which researchers from William Haseltine's 
group at the Dana-Farber Research Institute in Boston, 
Massachusetts, presented evidence that PB dendritic cells 
can be infected. According to Dr Johannes Gerdes of the 
Borstel Scientific Institute, Germany, the Haseltine data 
were "convincing" but still do not explain the long latency 
period.  Gerdes' group will present evidence this week that 
the important cell reservoirs for HIV are another group of 
immune cells, the follicular (F) dendritic cells.  
Gerdes says: "Personally, I suspect that the PB dendritic 
cells may be the route by which the virus gets into the 
immune system. However, Schmidt and others have shown that 
when you examine the lymph nodes, you do not find HIV in 
the T zone.  The virus is in the germinal center, inside 
and on follicular dendritic cells."
The F dendritic cells present antigens to the B-cell 
system. Gerdes' work shows that normal F dendritic cells 
can be infected with HIV and can produce more virus able to 
infect T cells.  He proposes that the actual destruction of 
these T cells is done by macrophages in the germinal 
centers of the lymph nodes. In this case, each new clone of 
T cells, which expand when activated in the lymph node, 
would be eliminated by the macrophages, and this process 
would continue until too few T cells remain to support 
adequate immunity.
Gerdes warns: "If this hypothesis is correct, the strategy 
for vaccine development must be completely revised.  The 
virus is sitting at the central immune control post. 
Killing or inactivating the follicular dendritic cells will 
produce an immune collapse as bad as that caused by HIV."
----------------------------------------------
Sidebar: Who's Who in Dendritics
Follicular dendritic dells: antigen-presenting cells for 
the B-cell system, which governs humoral immunity.  They 
are found only in the germinal centers of the spleen and 
lymph nodes, where they present antigens to B cells, 
leading to the development of B-cell responses, 
particularly immunologic memory.
Peripheral blood dendritic cells: antigen-presenting cells 
that help initiate T-cell mediated immune responses.  They 
travel through the lymph as "veiled cells" carrying 
antigens, then settle in the lymph nodes.
Lymph node dendritic cells: Also called interdigitating 
reticular cells. They settle in nodes and present antigen 
to the sensitive T cells, some of which are always passing 
through.
    
*********************************************************
The making of an AIDS conference
By Cindy Patton and Wim Zeijlemaker

The AIDS pandemic, and the conference dedicated to 
reporting work on it, have grown beyond what anyone 
imagined at the first international conference, held in 
Atlanta in 1985. Sadly, since that first meeting the 
pandemic has taken millions of lives, as well as 
devastating those who care for and about the infected 
persons. But the pandemic has also forced a most remarkable 
joint effort of individuals, communities, countries and 
transnational organizations. These collaborations have 
rarely been easy: people living with HIV have fought with 
clinicians and researchers, with the growing number of AIDS 
service organisations, and, more recently, with activist 
organisations as well. 

Criticism
Researchers have criticized their governments and each 
other; governments have criticized transnational 
organizations and each other. As the epidemic's only 
central place of meeting for the many different regional 
and topical concerns, the international AIDS conferences 
have faced their share of criticism from all sides. This 
year's conference tried to address both longstanding and 
immediate criticisms in a variety of ways.
Most obviously, the conference moved from Boston to 
Amsterdam to show how seriously those involved in all 
levels of AIDS research, policy and activism, take the 
demand that no person with HIV face discrimination. 
Although enormously important as a gesture of solidarity, 
moving the conference was only the most obvious of a 
variety of attempts to respond to the changing needs of 
people involved in the social and scientific aspects of the 
epidemic.
Organising among people living with HIV and activists has 
risen dramatically in the past few years, and with it, the 
complaint that the international AIDS conferences have not 
had enough input from those closest to the disease and its 
effects. 

Groundwork
This year's organising committee formed a special Community 
Liaison Committee to create better connections between 
groups of gay men and lesbians, people with HIV and local 
organisations in the developing world. Hilary Rao, director 
of communications for the VIII International AIDS 
Conference, says, "The previous few conferences laid the 
groundwork for communication between scientific interests 
and the people who actually have HIV. We developed those 
relationships even more to get those most affected by HIV 
to be able to say what kinds of research and policy would 
be most helpful to them." In addition, conference 
organizers worked with a variety of groups - from sex 
workers to HIV-positive women to clinicians - to create 
pre-conference forums and activities. These will enable 
participants to communicate with others sharing their 
concerns before, during and after the conference proper. 
Maria de Bruyn, of the AIDS Coordination Bureau at the 
Amsterdam Royal Tropical Institute, says: "Perhaps the most 
innovative aspect of this conference is the framework for 
followup afterwards."

(article continues in part 2)
	
-- 
Matthew Lewis, University of Amsterdam		Grote Bickersstraat 72
+31-20-52 51 220				1013 KS  Amsterdam
Internet: matthew@ooc.uva.nl			The Netherlands
Newsgroups: sci.med.aids