Warning: Ultraviolet Light May Stimulate HIV

A recent article in Science (August 28, 1992, pages 1211-
1212) reviewed current evidence from test-tube and animal studies
that ultraviolet light -- including sunlight, tanning studios,
and medical treatment for certain skin conditions -- might help
stimulate activity by HIV which otherwise was latent in infected
cells. While there is no conclusive proof of harm at this time,
study after study has found evidence of HIV activation after UV
exposure in laboratory cells or in genetically altered
mice.(1,2,3,4) (AIDS TREATMENT NEWS published an earlier warning
about ultraviolet light in issue #58, June 3, 1988, after a
laboratory study(4) found that ultraviolet light could increase
the activity of HIV genes as much as 150 times.)

No comparable human study has been done. But one study of
herpes(5) (not HIV) found that 71 percent of 38 patients
developed a recurrence of lip herpes when exposed to ultraviolet
light with a placebo sunscreen; by contrast, with the same
ultraviolet exposure with real sunscreen, none of 35 patients
developed the recurrence.

An early epidemiological study of seasonality of AIDS(6) by
researchers at the U. S. Centers for Disease Control might be
relevant. It found a 12 percent difference in AIDS diagnosis
with the peak in the summer (when there is most exposure to
ultraviolet in sunlight) and trough in the winter. Pneumocystis
and Kaposi's sarcoma also showed a peak in the summer and trough
in the winter; CMV as a subsequent diagnosis, however, had a peak
in the spring and trough in the fall. But the paper concluded
that "there is no important seasonality in the onset of AIDS"
(apparently because the 12 percent difference was not considered
large enough, and ultraviolet light was not a concern at that
time), and the study has been remembered as a negative result.

One study in England(7) found that people with HIV were
strikingly unaware of the risk; they were almost three times as
likely to use a sunbed regularly than HIV-negative controls. The
researchers also found that two thirds of the HIV-positive group
believed that a suntan would improve their health. They noted
that "those with HIV infection must be made aware that there is a
potential for further immunosuppression and viral activation from
ultraviolet radiation and they should be advised to avoid undue
recreational exposure."

Comment

Enough is known now to suggest that the risk of ultraviolet
light to persons with HIV may be serious; 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.

When ultraviolet is used for medical treatment, the risk
should be considered in balancing the benefits and drawbacks of
therapy. The bigger concern is sun exposure and tanning studios
(which are often targeting the gay community as customers).
Dermatologists have long warned the public against unnecessary
ultraviolet exposure, to avoid damage to the skin. Persons with
HIV should know that they may be at greater risk.

References

1. Vogel J, Cepeda M, Tschachler E, Napolitano LA, Jay G. UV
activation of human immunodeficiency virus gene expression in
transgenic mice. JOURNAL OF VIROLOGY. January 1992; volume 66,
number 1, pages 1-5.

2. Morrey JD, Bourn SM, Bunch TD, and others. In vivo
activation of human immunodeficiency virus type 1 long terminal
repeat by UV type A (UV-A) light plus psoralen and UV-B light in
the skin of transgenic mice. JOURNAL OF VIROLOGY. September
1991; volume 65, number 9, pages 5045-5051.

3. Stein B, Kramer M, Rahmsdorf HJ, Ponta H, Herrlich P. UV-
induced transcription from the human immunodeficiency virus type
1 (HIV-1) long terminal repeat and UV-induced secretion of an
extracellular factor that induces HIV-1 transcription in
nonirradiated cells. JOURNAL OF VIROLOGY. November 1989; volume
63, number 11, pages 4540-4544.

4. Valerie K, Delers A, Bruck C, and others. Activation of
human immunodeficiency virus type 1 by DNA damage in human cells.
NATURE. May 5, 1988; volume 333, pages 78-81.

5. Rooney JF, Bryson Y, Mannix ML, and others. Prevention of
ultraviolet-light-induced herpes labialis by sunscreen. THE
LANCET. December 7, 1991; volume 338, pages 1419-1422.

6. Peterman TA, Byers RH. Seasonal Variations in AIDS and
Opportunistic Diseases. International Conference on AIDS,
Washington, D. C., June 1987 [abstract # WP. 42].

7. Flegg PJ. Potential risks of ultraviolet radiation in HIV
infection. International Journal of STD and AIDS. January 1990;
volume 1, pages 46-48.