The Washington Blade - Friday, January 29, 1999
Lisa Keen

Reminiscent of the hype over the theory of "eradicating" AIDS that was promoted by New York researcher David Ho in 1996, the Journal quoted Ho again this year as saying that "now we know it is" possible to stop drugs and have the patient's immune system fight off HIV successfully. But Ho was a little more cautious this time, noting that "this is all very, very early research" and that it is currently a "research avenue" only. Ho said he "would not suggest this as a treatment direction for doctors or their patients."

More details about the few research projects that are under way to study this potential strategy are expected to be reported at the annual weeklong conference for AIDS medical researchers that begins this Sunday in Chicago. But the Journal did report that Italian researcher Franco Lori believes the strategy may be to suspend therapy occasionally as a way of "teaching" the immune system how to control HIV.

Meanwhile, though researchers have become somewhat pessimistic now about the prospects for completely "eradicating" HIV from the body, they haven't given up hope and some updates are expected next week in reports on this area of research, too.

Double protease-double nuke combo looks good

Last year, some studies began suggesting that four drugs may be better than three. This month, researchers from Denmark report that a combination of two protease inhibitors and two nucleoside analogs is more successful in getting patients' viral loads below 200 than the standard three-drug combination using one protease inhibitor and two nucleoside analogs. And the study, which involved almost 300 patients, provides the first documentation that the four-drug combination is "superior" for patients who have had no previous antiviral treatment.

Reporting in the Jan. 14 issue of the journal AIDS, the researchers noted that a four-drug combination of saquinavir-ritonavir plus two nucleoside analogs (usually AZT-3TC) got 82 patients' viral loads to below 200 after six months. Combinations using two "nukes" with only ritonavir or indinavir got 67 percent and 71 percent, respectively, below 200.

The four-drug combination was even more successful for patients who had not previously taken antiviral drugs: 89 percent of so-called "na ve" patients went below 200, while only 57 percent of the ritonavir-combo and 63 percent of the indinavir-combo patients went below 200.

In brief

HERPES ZOSTER INCIDENCE SHOOTS UP: Researchers from Spain reported in the December issue of the Clinical Infectious Diseases journal that they noticed a "high incidence of herpes zoster" in patients "shortly after addition of a protease inhibitor" to their antiviral regimens. The outbreaks included both first episodes for some patients and recurrent episodes for others, and most occurred between one and four months after initiation of treatment with a protease inhibitor and did not seem to be associated with either CD4 counts or viral loads. About 14 percent of the 193 patients studied had outbreaks ù "twice higher than that [incidence rate] previously described before the introduction of antiviral therapy with protease inhibitors." The researchers suggest doctors anticipate such outbreaks and consider providing patients with preventive medications against herpes.

THALIDOMIDE HELPS ULCERS: Doctors at the Southern California Permanente Medical Group reported in the December issue of the AIDS Patient Care and STDs journal that thalidomide is an effective treatment for HIV-related ulcers of the colon and rectum. Their recommendation was based on success with two patients who had not responded to other therapies.

PROZAC FOR PWAs?: The well-known anti-depressant drug Prozac may help people with HIV who suffer from lingering depression, according to a report in the January issue of the American Journal of Psychiatry. The report, from the New York State Psychiatric Institute, was based on a study of the use of Prozac (also known by its generic name fluoxetine) to treat depression in 87 people with HIV infection. The researchers noted, however, that some patients became increasingly unwilling to take Prozac as their numbers of other medications grew.
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