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San Francisco Examiner
AIDSWEEK: Suppressed HIV still lurks in body
Lisa M. Krieger of the Examiner Staff
September 17, 1997
THIS WEEK, a new study suggests that anti-HIV drugs that lower the virus to undetectable levels leave a silent infection in patients' immune systems that can rebound dangerously if the expensive treatment is ever stopped.

The study looked at nine of 13 patients who had been taking drugs for a year, all of whom had undetectable levels of HIV in their blood.

In all nine, scientists found evidence of the virus hiding in "resting cells" of the immune system - white blood cells known as CD4 T-cells, reported Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Though combining protease inhibitors into a drug cocktail has produced dramatic improvements in the health of patients, this latest study dims hope that the "latent reservoir" of infection can be eradicated, said Fauci, speaking at a weeklong conference by the University of Maryland's Institute for Human Virology in Baltimore.

The idea that drugs could cure AIDS has been championed by Dr. David Ho, a prominent researcher in New York. Based on a mathematical model, Ho said the virus could be eradicated in three years.

Ho plans to take several patients off their drugs and monitor them for a resurgence of virus. The patients have been on the drugs two years.

But Fauci said the projection of a three-year cure was based on the mistaken assumption that "you can completely shut off viral replication."

The anti-viral drugs are capable of suppressing HIV in cells producing the virus, but not inactive ones. One approach would be to create a drug to turn on the dormant cells.

"We're not in the mode of being able to eradicate those cells," Fauci said.

Treatment updates

Two studies of new anti-viral drugs were presented at this week's meeting of the Infectious Disease Society of America, held in San Francisco:

*A new formulation of saquinavir, one of the protease inhibitor drugs that have helped revolutionize HIV treatment, gives a stronger response than the older Invirase, according to manufacturer Hoffmann-La Roche.

The current version of saquinavir has been disappointing. But the new soft-gel formulation, called Fortovase, has 10 times the potency of the version now on the market, Roche said.

When given in triple-combination therapy, the drug helped lower blood levels of the HIV virus to below detectable limits, scientists working with Roche told a meeting of the Infectious Disease Society.

Roche has asked for Food and Drug Administration approval to market the drug and expects it by the end of the year.

*Tests of a new anti-viral agent DMP266, named Sustiva, offer preliminary evidence that the drug can help patients resistant to other treatments.

Researchers found that a single dose of the drug, combined with the protease AIDS drug indinavir (Crixivan), performed about as well as existing treatments that require the combined use of three or four drugs.

The drug belongs to a class of anti-viral medicines called non-nucleoside reverse transcriptase inhibitors. The first drug in this class, called nevirapine, was approved by federal regulators last year.

Although these agents work much like the older AIDS drugs AZT, DDC, DDI and D4T - by inhibiting an enzyme called reverse transcriptase that is needed by HIV to reproduce - it is in a different class of medicines because its chemical composition is different.

This new class is not causing doctors as much excitement as did a flurry of protease inhibitors approved last winter. Protease inhibitors are a different kind of drug that targets a second enzyme, vital to another step in the HIV life cycle.

Manufacturers have received permission from the federal government to give Sustiva to AIDS patients who have not responded to other treatments.

AIDS climbing in women

*Federal epidemiologists report there was a 63 percent increase in the number of women diagnosed with AIDS in the United States from 1991 to 1995.

By the end of 1995, 67,400 women had been diagnosed with the disease, almost 20 percent of the total AIDS cases in the United States, the report from the Centers for Disease Control and Prevention said.

The greatest increases were among women who acquired the disease through heterosexual contact, added the study, published in Wednesday's Journal of the American Medical Association.

*People who are disabled or taking expensive AIDS or HIV drugs could return to work and keep Medi-Cal benefits under a bill on its way to the governor's desk.

The Assembly voted unanimously to support the bill, sponsored by Assemblywoman Carole Migden, D-San Francisco.

The toll

Christopher J. Campbell, a 1985 graduate of S.F. State University who was a real estate agent with Hartford Properties, a former member of the Gay Men's Chorus, and a volunteer for the AIDS education groups Community Awareness Against Violence and Positively Speaking . . . Kevin Lee Petersen, 30, an accomplished softball player who played with teams in Santa Rosa and San Francisco, attending tournaments in the U.S. and Canada.

...........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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