[Letter to Anthony Fauci from ACT UP]

AIDS Coalition To Unleash Power

April 22, 1993

VIA TELECOPY (301-496-5349)
Dr. Anthony Fauci
Director
National Institutes of Allergy and Infectious Diseases
Department of Health & Human Services
National Institutes of Health
Bethesda, Maryland 20892
Dear Dr. Fauci:
Recently, members of the Treatment and Data Committee of ACT UP attended
conferences on HIV pathogenesis In Bethesda and Albuquerque. We have been following
your studies of the lymph system and the decay in the architecture of lymph nodes during
the course of HIV infection.
We are interested In treatments, possibly stage-dependent, to clear HIV trapped
in the processes of follicular dendritic cells (FDCs). We understand that you are trying
zidovudine (AZT) as an approach to clear early HIV Involvement. We have several
questions regarding the use of AZT:
1) Since antigen trapping by FDCs is a common immune response In
Infection, what is HIV's role in lymph node deterioration? Is HIV a primary
cause or a secondary effect in the decay?
2) The Initial trapping in FDC processes is extracellular, therefore there is no
reverse transcription. What, then, is the rationale for the use of AZT?
3) In light of the Concorde results and the VA study that Indicate no benefit
from early AZT use even at high dosages, what impact has this had on
your endeavor? Especially If your approach is Indirect through clearance
of Infection through other tissues/organs.
4) Are you considering other alternatives? Perhaps N-acetyl cysteine? If not,
why not?
5) If, as you suggest, the HIV is opsonized with antibodies and complement,
why is the virus not degraded? By what mechanism does the T-cell
interact with these opsonized viruses?
6) Have you determined what events occur when T-cells infiltrate the
(a) Are they being partially signalled by the FDC, inducing
anergy and subsequent programmed cell death/apoptosis or
(b) is there evidence of direct infection passing the HIV from the
FDC to CD4+ lymphocytes? or

-Q
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