SEPTEMBER 1998

NUMBER ONE

Recombinant HIV: A New Threat

IMAGINE A CRUDE, CHILD-LIKE DRAWING OF A SUN with a few large rays. That's the picture of HIV that Dutch virologist Jaap Goudsmit recently drew on a chart during the World AIDS Conference in Geneva to show how HIV is steadily evolving into subtypes that differ genetically from the two main viral types, labeled Group O and Group M. There are Group M subtypes lettered A through H, and as HIV mutates, new mutant or "recombinant" virus subtypes are being created. Filling in his drawing of the star, Goudsmit added new rays until the picture became a dense cluster that represents the continual pattern of HIV's evolution.

It''s long been known that HIV mutates once every time it reproduces-a billion times a day. Some mutations help the virus survive, while others cripple it. If someone becomes co-infected with two HIV subtypes, the viruses may recombine through what Goudsmit calls "viral sex" to produce mutant or hybrid offspring that carry genes from each parent virus. That's happened in southwest China, where a recombinant strain made of subtype B/C is spreading. In Russia too, a new mini-epidemic is linked to an A/B recombinant strain. These mutated viruses are often stronger than the parent and may eventually become dominant. It's survival of the fittest once again.

What does all this mean for human survival? If we don't slow HIV's spread, Goudsmit warns, we face new epidemics caused by recombinant HIV. That's why we urgently need to develop a protective vaccine against HIV that can generate a broad range of immune responses to the many viral subtypes.

On Our Cover

Cover girl Chloe Dzubilo, 37, lives in New York City and is a U.S.-born white Russian (and as tasty as the drink). She's been living with HIV for 11 years and is a fierce needle-exchange activist, and transgendered rock 'n' roll glamazon.

All that label busting is still easier than her HIV-med regimen, though. "I feel like not living with HIV would be nice," she says, laughing. For her, rule No. 1 for living with HIV is empowerment: "I make all the decisions," she says firmly. "If I'm not cool emotionally with any of the medications, then they're not gonna be any good. I have to be accepting of the lifestyle of taking meds and not be resistant to it. The bottom line is that it's usually when I'm pissed off about all of it that I don't feel like taking care of myself. I don't want to be that high maintenance. I'd rather maintain other parts of myself"-she laughs again-"like my skin or something."

By educating herself and waiting until she was ready to handle a tough drug regimen, she feels she did the least damage to her body. Her own strategy is holistic, balancing a good diet, herbs, and vitamins with a potent three-drug antiviral cocktail (3TC, d4T and Viramune) that leaves her shaken, not stirred. After nearly three years on combination HIV therapy, she says, "Numbers-wise, it's helped me, and I certainly feel healthier than I've felt in a long time. But I'm glad I didn't jump right away on the protease paddy wagon, 'cuz it's all sort of a prison."

Her advice to others? Don't forget to live and play. "Buy a lot of glitter and pat it on your eyes first thing in the morning-it's good for your endorphins. Empower yourself with the word tacky. And sing. All day. That's what I do."