The Washington Blade - June 30, 2000
Lisa Keen

One of the leading optimists for the therapy, Dr. Franco Lori of the Research Institute for Genetic Human Therapy, told participants in a telephone conference call symposium last week that doctors still do not have enough information to recommend "structured treatment interruptions" (STIs) for any patient.

And a report in the July issue of Nature Medicine reports evidence that indicates the virus that "rebounds" once drug medications are stopped is apparently not the virus that is "hiding" in certain reservoirs of the body, as previously thought.

Lori noted that the prospects for "recently infected" patients (infected within just a few months) are better than for "chronically infected" patients, but he said that clinicians still don't have enough success cases to even suggest a "recipe" for when a patient might consider going off drugs. The best-case scenario for success on any such strategy, he emphasized, is likely to be "immune system control" of the virus, "not eradication."

Enthusiasm for therapy interruptions has been driven in part by a half-dozen highly publicized success cases around the world, beginning with the "Berlin patient," in which patients with HIV have stopped therapy and discovered that their bodies' immune systems were subsequently able to keep their viral loads down. But the data on such successes so far, said Lori, is still too little and anecdotal.

Steven Deeks of San Francisco Hospital's AIDS Program noted that "a lot of people" are stopping therapy in his clinic because of adverse side effects of the medications and concerns about the long-term toxicities associated with them.

Deeks also noted that "one theory" behind the interruption of medication for chronically infected patients is that, in the absence of the drugs, some of the viral mutations go away, making the medications more effective when resumed. But he warned that there have also been some serious side effects to stopping therapy -- including the loss of CD4 cells.

"Stopping drugs to allow the virus to shift," said Deeks, "remains quite risky, highly theoretical, and something that needs to be done only in a controlled clinical trial."

In the July issue of Nature Medicine, researchers, including Anthony Fauci at the National Institute of Allergy and Infectious Diseases and scientists at the University of Washington, report that the virus that re-emerges rapidly after drug therapy is significantly different from the virus hiding in certain cell reservoirs. The researchers said the findings could suggest that the rebounding virus could be coming from an as yet undiscovered hiding place in the body. In an editorial accompanying the article, researchers at the Aaron Diamond AIDS Research Center suggested the findings might also indicate that the virus in the known reservoirs mutates as it re-emerges. But the study, noted the commentary, adds another complication in the journey toward eradicating HIV from the body.

"In tackling the issue of HIV-1 eradication," noted the Diamond Center essay, "we should not be content with 'pounding away' at the virus using only existing anti-retroviral drugs. Instead, we must undertake studies to unravel the fundamental mechanism responsible for the residual viral replication in the presence of several specific inhibitors."

In brief ...

INTERNATIONAL AIDS CONFERENCE: The International AIDS Conference, a biennial confab of AIDS medical reports from around the world, begins in Durban, South Africa, next weekend. Organizers, with funding from the pharmaceutical development firm of Gilead Sciences, will provide copies of the abstracts as well as video and audio broadcasts of some presentations via a Webcast. Some will be available within eight hours of their presentation, while others will become available within about two months. People wishing to visit the Webcast can gain access at www.webcast.aids2000.com.

WORLD NUMBERS UPDATED: The United Nations Programme on HIV/AIDS released a report Tuesday with the latest numbers of cases of AIDS and reports of HIV infections around the world. The report shows that, as of the end of 1999, there were almost 19 million deaths due to AIDS and 34 million people living with either full-blown AIDS or HIV infection in the world. Of those living with HIV/AIDS, 900,000 are in North America. While less than 1 percent of the adult population in the United States is HIV-infected, in Botswana, the hardest hit nation in the world, almost 36 percent of the adult population is infected.

WEB HELP ON PILL-TAKING: People with HIV or AIDS who have questions about the complexities of their specific pill-taking regimens can consult a new interactive Web site at www.aidsmap.com. The site, run by the British HIV Association and other nonprofit groups, also provides recent articles on AIDS medical developments.

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