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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