The Washington Blade - Friday, May 7, 1999
Lisa Keen

In the study, published in the May issue of Nature Medicine, researchers from UT and from the National Institutes of Health studied 14 people who had HIV infection but whose conditions were not deteriorating as expected, and 16 who were deteriorating. None of these 30 people had taken any antiviral drugs. They compared these patients to 26 people with HIV who had been taking combination therapy for between one month and two years ù 15 of those had been on therapy "long-term" and 11 for less than six months ù and to 10 people who were not HIV-infected. They found that 63 percent of the untreated patients still had CD4 cells that were trained to attack HIV, while none of the 15 who had been on "long-term" therapy had such cells. Also the patients who had been on therapy "long-term" had many fewer CD4 cells against HIV than patients who had been on therapy for six months or less.

The data, noted the researchers, "strongly support the conclusion" that CD4 cells specific to attacking HIV "are progressively lost -- with prolonged viral suppression" on antiviral drugs. They did not conclude that it is the antiviral drugs that are causing the reduction in CD4 cells, but rather speculated that the drugs might be having an effect on the immune system that, over time, leads to the decrease in cells. This effect, whatever it is, "might contribute to the rapid resumption of viral replication after [combination therapy] is discontinued -- and certainly does not facilitate efforts to æcure' the infection in such [people] so that [therapy] might eventually be discontinued."

Both this study and one suggesting that currently available drugs would have to be taken for at least 60 years to eradicate the virus from the body (reported in the April 30 Blade) conclude that a vaccination against HIV might be a critical component of fighting HIV infection.

Study: Some can stop taking PCP preventive

A group of researchers from Switzerland say it "appears to be safe" for a person with HIV who is taking antiviral drugs and has pushed his or her CD4 cell count above 200 to stop taking drugs to prevent the development of pneumocystis carinii pneumonia.

The scientists followed 262 patients whose CD4 cell counts were above 200 for about a year and who stopped taking the preventive medication upon entering this study. After a year, only nine patients had resumed taking the medication and two patients had died, but none of the patients had developed pneumonia. Their conclusion, published in the April 29 New England Journal of Medicine: Stopping the preventive therapy "appears to be safe in HIV-infected patients who are receiving combination antiretroviral treatment and who have had a sustained increase in their CD4 counts to at least 200 cells per cubic millimeter."

An editorial from the Journal notes that, prior to the arrival of successful drug combination therapy, 60 to 80 percent of patients with HIV developed the often-deadly pneumonia. With the use of trimethoprim-sulfamethoxazole, the number of patients developing pneumonia decreased dramatically. But with the burdensome pill-taking regimens required for most antiviral therapies, many patients are looking for safe ways to reduce their numbers of medications. The editors conclude that this study, and previous ones, suggests "it would seem reasonable to consider discontinuing" the preventive therapy in patients who have "sustained" their CD4 counts above 200.

"Exactly how this sustained period should be defined is still unclear," noted the editorial. It emphasized that not every patient who is able to keep his or her CD4 count above 200 will be safe without the preventive drug, especially patients with "persistently high viral loads or those with prior AIDS-defining illnesses.

In brief ...

PUMPING BACK UP: For men with HIV who have suffered wasting due to loss of normal hormone levels, two studies in the April 14 issue of the Journal of the American Medical Association suggest that a "moderate" weightlifting and exercise workout coupled with the use of synthetic hormones (anabolic steroids) "substantially increases" lean muscle tissue, muscle strength, and weight. Compared to men who were exercising but getting a placebo injection, the group getting the steroids also suffered less fatigue. Because such anabolic steroids have been known to cause serious side effects, a JAMA editorial accompanying the article urged caution.

MOUTH SORE STUDY: The National Institutes of Health is seeking people with HIV who suffer from mouth sores to test the efficacy of a new medicated paste applied directly to the sores. For more information, call 1-800-411-1222.
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