The Washington Blade - June 4, 1999
Lisa Keen

A letter to the editor in the May 27 New England Journal of Medicine suggests that a "more realistic alternative" is illustrated by the so-called "Berlin patient" -- a man who was given a combination of ddi-indinavir-hydroxurea very soon after infection (before he developed antibodies). The patient went off the therapy once and experienced a return of viral load. But the second time he went off the drugs -- after about six months on the combination -- he was able to do so without suffering the return of high viral loads.

According to the letter, from a group of highly respected researchers from several sites (including Johns Hopkins University, Massachusetts General Hospital, and Harvard University, among others), the man has now gone 19 months without treatment and has experienced no viral rebound. Instead, his CD4 counts have "increased to normal levels" and "viral control has been maintained."

In a separate press release, the lead author of the letter, Julianna Lisziewicz of the Research Institute for Genetic and Human Therapy in Washington, D.C., emphasized that the Berlin patient's success appears to be the result of three things: the use of a combination that includes the cancer drug hydroxyurea, starting the treatment early, and administering the treatment intermittently (or stop and go).

"These factors," she said, "may be keys to immune-based control of HIV, whereby the immune system can serve as the 'fourth drug' in" combination therapy that works at both controlling the virus and building the immune system's strength.

In this same press release, however, another author of the letter and a colleague of Lisziewicz's at the institute -- Franco Lori -- cautioned that the Berlin patient's "stop and go approach" must be confirmed in other patients.

"Intermittent, hydroxyurea-based combination therapy," he said, "should only be initiated in a controlled clinical trial setting -- as opposed to trying it on one's own -- or with one's private physician."

Another estimate on HIV elimination: 7-10 years

A second group of researchers published a report last month estimating how long it could take to "eliminate" HIV from the body, and this group's estimate is considerably more optimistic: seven to 10 years.

The first estimate last month came in the May issue of Nature Medicine. In that report, researchers from the National Institutes of Health and Johns Hopkins, Georgetown, Cornell, and Harvard universities scrutinized the decay rate of the AIDS virus in certain immune cells and concluded it would take at least 60 years for currently available drugs to eliminate the virus from the body.

In a study reported in the May 27 issue of the New England Journal of Medicine, another group of highly reputable researchers give the much more optimistic estimate. This second group includes David Ho and Martin Markowitz of New York's Aaron Diamond AIDS Research Center, as well as Alan Perelson of the Los Alamos National Laboratory and researchers from Germany. Their study concluded that HIV might be eliminated completely from the body in about seven to 10 years of "continuous, truly effective therapy."

Two problems, however, noted the Ho group, is that it will be "difficult to maintain treatment for such a long time" and that the "so-called highly active antiretroviral therapy [currently available] is actually not always active enough." The researchers noted, for instance, that "there is unrecognized residual replication of HIV-1 in some patients despite apparently effective combination therapy."

The Hopkins group measured the levels of HIV in the inactivated memory CD4 cells of 34 adults; the Diamond group measured the levels in eight patients.

In brief ...

DISCLOSING STATUS: A study of 147 people with HIV infection in Louisiana found that 76 percent told their sex partners about their HIV status. The study also found that those who consistently use condoms were almost three times more likely to tell their partners about their HIV status than those who did not consistently use condoms. The study, conducted at public clinics for treating sexually transmitted diseases in Louisiana with the help of the U.S. Centers for Disease Control and Prevention in Louisiana, appeared in the May issue of the journal Sexually Transmitted Diseases. Most of the participants were heterosexual; about 13 percent were men having sex with men.

INCREASES IN CANCER: Reports at last week's National AIDS Malignancy Conference indicate that the incidences of three forms of cancer -- Hodgkin's disease (lymph glands), testicular, and anal cancer -- have significantly increased among Gay and bisexual men with HIV in recent years. Summaries of the conference reports are available at www.medscape.com

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