THIS WEEK, researchers from New York University reported that a
triple combination of anti-AIDS drugs was still keeping the
virus in check in some patients after two years, twice as long
as previously reported.
The study, released at a scientific meeting in Toronto,
suggests that at least in some people the new AIDS drug
cocktails may have lasting effectiveness.
But a second study reported by UC-San Francisco's Dr. Steven
Deeks found that the therapy worked in only half of HIV
patients, reinforcing the view that the regimen is not
The two reports paint a mixed picture of where the AIDS
epidemic is headed. While many patients have prospects for a
healthy future, others are in dire need of newer and better
The seemingly conflicting outcomes of the two studies reflect
the differences in their subjects and treatment approach.
The first study involved patients in a rigorously controlled
clinical trial who had not yet been exposed to many drugs. They
were given two new drugs at once, to go along with the AZT they
already were taking.
The second study looked at patients in a public clinic who, in
general, had been sicker to start with, had more severely
damaged immune systems, carried higher levels of the AIDS
virus, had already been through a long series of ineffective
single-drug treatments for HIV and may not have adhered
perfectly to the treatment schedule.
Although a genetic comparison of the viruses in the two
different groups of patients has not been performed, it is
likely that the HIV carried by those in the first group is
vulnerable to therapies, while the virus in the second group is
resistant, said scientists at the conference.
Patients in both trials were on triple-combination therapy:
AZT, 3TC and one of a new class of anti-HIV agents called
protease inhibitors. In the first trial, sponsored by Merck &
Co., the protease inhibitor used was indinavir, known by the
trade name Crixivan. In the second trial, a variety of
different protease inhibitors was used.
The first study found that after taking the three drugs for 100
weeks, 22 of 28 (79 percent) patients still had no detectable
HIV in their blood, said Dr. Roy Gulick, assistant professor of
clinical medicine at the New York University School of
"This shows that you really can control HIV infection in a lot
of patients for as long as two years," Gulick said at the
annual Interscience Conference on Antimicrobial Agents and
Chemotherapy in Toronto.
"The million-dollar question is: How long will this last?" he
The study is significant because it offers the longest look yet
at the effectiveness of the triple therapy in suppressing HIV
to immeasurable levels.
Equally encouraging, Gulick said, is evidence that the
three-drug cocktail helped patients rebuild the immune systems
that let them ward off disease. Patients taking the drug
cocktail experienced a rapid rise in CD4 immune cells over the
first six months, then a slower continued rise in cells during
the 1-1/4 years that followed.
Although the patients have no signs of HIV in their blood,
Gulick said it was premature to conclude that the drugs had
completely wiped out the patients' infection. It is likely, he
said, that traces of virus still remain hidden in certain
The second study, also reported at the medical conference
Monday, found that many patients outside carefully controlled
clinical settings didn't fare nearly as well. After just six
months, the triple-drug therapy failed in 53 percent of "real
world" patients in San Francisco.
"The public has gotten the feeling that the epidemic is over,
that these drugs are having this tremendous effect, with people
who were on their death bed doing great," said Deeks, the
author of the study. "Many people are going back to work . . .
and in all likelihood they're going to live forever as long as
they continue to take their drugs.
"But there's a whole group of patients - up to half - now
showing evidence of drug failure. Those people in all
likelihood are not going to respond very well to other protease
inhibitors, and we as researchers have to be very vigilant and
develop other options for those people," Deeks said.
Dr. Jerome Groopman, chief of experimental medicine at Boston's
Beth Israel-Deaconess Medical Center, agreed: "It's a real
advance, but it's not a cure. . . . If that misconception makes
us passive about developing new drugs, we'll have set ourselves
*Two-thirds of all Americans infected with HIV already know it.
Researchers from the U.S. Centers for Disease Control and
Prevention estimate that about 775,000 Americans carry HIV, and
at least 500,000 have been tested and know their status.
*Researchers have statistically linked declining AIDS death
rates with the use of combination therapies.
The first weak protease inhibitor became available in late
1995, and in 1996 there arrived two stronger ones that are now
mainstays of treatment. In an analysis of almost 3,000
patients, Dr. Scott Holmberg of the CDC found that through
1995, the death rate among these patients averaged 7 percent
every three months, but by the third quarter of 1996 the death
rate had fallen to 3 percent. In the final three months of
1996, it was just 2 percent.
*The U.S. Food and Drug Administration has approved the first
pill that combines two popular AIDS drugs, AZT and 3TC.
People infected with HIV now have to take more than a dozen
pills a day. This new pill, called Combivir by manufacturer
Glaxo Wellcome, will cut six pills out of the daily regimen.
James Tetzlaff, an artist, photographer and graphic designer
with Design Vectors in San Francisco . . . Edward P. Schottman,
45, who loved all aspects of the arts, from grand opera to
full-body Japanese tattoo . . . Joseph Taro Vega, 46, a singer
and active member of a Bay Area cabaret who produced the local
shows "A Whole Lotta Bessie in Me," "Fascination" and
"Surviving the Crunch," in St. Louis . . . Scott M. Woods, 45,
who enjoyed baking, biking, skating and collecting records, in
. . . . . .Date
. . . . . .reported. . Cases. . . Deaths
S.F.. . . .9/1 . . . . 24,611 . . 16,878
Calif.. . .9/1 . . . .102,574 . . 65,463
U.S.. . . .9/1 . . . .581,429 . .362,004
WHO(rprtd) 9/1 . . .8,400,000 . 6,400,000
Figures are cumulative since June 1981. Government officials
now compile and release statistics quarterly, not monthly.
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