From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: Sentinel Article 11/12/92
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6449
Organization: unspecified
Date: Thu, 12 Nov 92 00:02:34 PST

The following article was printed in the San Francisco Sentinel on 
Thursday, November 12, 1992. It is being posted with the permission of 
the author, Charles R. Caulfield.
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                 NEW CONTROVERSY OVER HIV AND SUNTANNING
                      by Charles R. Caulfield

A complaint was filed with the California State Board of Medical 
Examiners on September 21, against Marcus Conant, MD, a clinical 
professor of Dermatology at UCSF, and director of what he acknowledges 
to be the "largest private AIDS Clinic in the world." Dr. Conant was 
kind enough to talk with the Sentinel in order to respond to this 
charge.

     The complaint, filed  by Billi Goldberg, a familiar DNCB treatment 
activist in San Francisco, alleges that Conant recommends immune 
suppressive therapies for dermatological manifestations of HIV disease 
such as psoriasis and a disorder known as eosinophilic folliculitis,  
and in doing so trades long term health for superficial short-term 
results. The matter in question surround Conant's recommendation that 
his HIV patients who experience excessive discomfort caused by psoriasis 
may gain some relief from exposure to ultraviolet (UV) light. This is in 
contrast to what is generally believed to be the harmful effects of UV 
radiation on the immune system. A personal response from Dr. Conant to 
answer Goldberg's complaint states:

     "I have recommended controlled exposure to ultraviolet light, 
stressing to the patient that he or she should be certain that they tan 
only without obtaining enough UV light to burn." An article in the 
August 28, 1992 issue of the highly respected journal Science states 
that "a significant proportion of HIV-infected individuals have 
dermatological conditions that may be candidates for PUVA (psoralen 
ultraviolet-A light) therapy, which could do more harm than good if it 
really activates latent HIV in the langerhan cells of the skin." Most 
researchers in the field were reported in the Science article to feel 
that a side effect of the DNA damage caused by UV type A radiation is 
the activation of HIV expression.

     Conant responded in an interview with this reporter that in 
situations in which the patient's quality of life is so severely 
impaired by the problems caused by AIDS psoriasis, and other treatments 
are not an option--due to the even more immunosuppressive side effects 
of other conventional therapies--he would not advise against moderate 
exposure to sunlight (which contains both UV-A and UV-B light waves) to 
obtain some degree of symptom relief.

     Goldberg countered this with the reference to an article published 
by Conant in the July 1992 issue of the journal Dermatological Clinics,  
entitled "Future Issues in AIDS". In the same issue, leading 
Dermatological authority Madelaine Duvic states "in vitro studies show 
that ultraviolet light activates HIV gene expression, and we have seen 
patients develop Kaposi's Sarcoma while receiving ultraviolet 
irradiation." pp.525 - 526. 

     The October 16, 1992 edition of San Francisco based AIDS Treatment 
News stated that current research demonstrates that people with HIV are 
strikingly unaware of this risk, and that they were 3 times more likely 
to use a sunbed regularly than HIV negative individuals, believing that 
a suntan would improve their health.

     Conant stressed that he was certain to caution his patients of the 
danger of burning, but experts do not agree as to the volume of exposure 
to UV-A light needed to activate dormant HIV. He also stated that the 
recommendation could only be made after soberly weighing the risks of 
exposure against the quality of life impairment caused by the skin 
problems themselves. Other treatments useful in treating HIV psoriasis 
include high dose AZT (1200 to 1500 mg. per day), and topical steroid 
drugs, both of which have their own immune suppressive side effects.

     "Physicians are really in a quandary regarding this matter," Conant 
stated. "It is difficult for us to draw the line where quality of life 
is so inhibited that long terms risks can be assumed in order to obtain 
immediate symptom relief."

     The recent AIDS Treatment News article on the danger of UV 
radiation, closes with the conclusion by the author, John S. James, that 
"it is important to warn the community, even while we wait for 
definitive information. Nobody knows why HIV disease progresses much 
faster in some people than in others. If ultraviolet light, among other 
factors, contributes to faster disease progression, it probably would 
have escaped notice."

     The higher concentrations of tanning salons in the Castro and other 
gay-dense local neighborhood highlights the degree to which the gay 
community is targeted as customers by this industry. It is important 
that the HIV positive population be aware of the largely held medical 
consensus that HIV's destruction of the immune system may be accelerated 
by something over which they have a great deal of control.

     Conant, who provides a monthly educational forum on HIV disease 
treatment, will give an overview on Dermatological Manifestations of HIV 
Disease in December. This will correspond with a Dermatological 
Conference to be held in San Francisco that week. Conant stated that he 
was hopeful that other dermatologists in AIDS clinical practice would 
participate in a panel discussion outlining their approaches to such 
topics as UV light therapies in the immune compromised host.

     When asked about his willingness, should the opportunity arise, to 
accept an appointment in the Clinton administration, such as AIDS Czar, 
or Associate Director of NIH AIDS Research, Conant stated that it would 
be difficult to give up the practice of medicine, which he has enjoyed 
for the last 29 years, "but I believe I could do a lot of good, using 
novel incentives for pharmaceutical company research in AIDS 
therapeutics, such as the availability of longer patents on approved 
medications, and acceleration of the approval process for AIDS drugs, 
which could be motivating factors in new drug development."

     Conant has unparalleled clinical experience in HIV treatment, and 
is a co-founder of the San Francisco AIDS Foundation. Another candidate 
who is reportedly being considered is Dr. Mervyn Silverman, former San 
Francisco Health Director and more recently Executive Director of the 
American Foundation for AIDS Research. Silverman recently resigned his 
position with AmFAR, which was believed by some to make himself appear 
more available should his candidacy be considered.
Newsgroups: sci.med.aids