BOSTON (Reuters) - Two studies offer new evidence that people
with the AIDS virus can safely stop taking
drugs designed to prevent deadly pneumonia as long as their
immune systems have rebounded with the help of the "AIDS
cocktail" of protease inhibitors.
The findings, reported in Thursday's New England Journal of
Medicine , suggest that as long as the number
of infection-fighting cells known as CD4 lymphocytes does not
fall below 200 per cubic millimeter of blood, the AIDS-related
pneumonia known as Pneumocystis carinii will not appear.
The researchers said such patients are also unlikely to develop
pneumonia even if tests show the human immunodeficiency virus
(HIV) -- the virus that causes AIDS -- is still detectable in
the blood or if they have already survived one bout of
pneumonia, which puts them at a higher-than-average risk for
developing it again.
Previous studies have reached a similar conclusion and an
accompanying editorial said the results were good news for AIDS
patients in the developed world.
"The consistency of the results ... is reassuring," wrote Dr.
Pierre-Marie Girard of the Saint Antoine Medical Facility in
Paris in an accompanying editorial.
The editorial added, however, that the studies underscored the
huge disadvantages faced by AIDS patients in poor countries,
who cannot afford the cocktail of drugs.
In Africa, where some 25 million of the world's 35 million AIDS
patients live, most have no hope of accessing the most
effective treatments for AIDS even though Western drug
companies have started to cut prices.
"All these studies are good news for people living with HIV,"
Girard said, "but they also make the gulf in treatment between
rich and poor countries even more glaring and unacceptable."
In a similar study two years ago doctors from the Bern Hospital
in Switzerland reported in the Journal that none of the 262
volunteers taken off pneumonia-preventing drugs developed
AIDS-related pneumonia as long as their CD4 counts remained
That same year, a task force of the U.S. Public Health Service
and the Infectious Diseases Society of America advised doctors
they could stop giving drugs to prevent the pneumonia if the
white blood cell counts rose.
Before the development of the combination of drugs known as the
"AIDS cocktail," AIDS-related pneumonia ultimately afflicted
about 80 percent of patients whose CD4 counts dropped below
200. It often killed them.
In one of the new Journal studies, conducted in 1998 and 1999
at 19 Spanish public hospitals, a research team led by Dr. Juan
C. Lopez Bernaldo de Quiros at Hospital Gregorio Maranon in
Madrid took 300 volunteers off the medicines designed to
prevent AIDS-related pneumonia.
They stayed off the medicine as long as their CD4 counts
remained above 200.
Another 287 AIDS patients were kept on the pneumonia-preventing
Nobody in either group, 38 percent of whom had the AIDS virus
circulating in their blood, contracted Pneumocystis carinii
pneumonia, whether or not they had had it before.
The second study, led by Bruno Ledergerber at Zurich University
Hospital in Switzerland, came to a similar conclusion after
studying 325 people from October 1996 through January 2000, all
of whom had already recovered from one bout of AIDS-related