San Francisco Examiner - September 28, 2000
Ulysses Torassa, Examiner Medical Writer

The small study, published Thursday in the journal Nature, is considered a "proof of principle" that it may be possible to intervene early to help people stay well for long periods without drugs.

The idea is to mimic the immune systems of so-called long-term nonprogressors: that handful of individuals worldwide who have lived with HIV as long as two decades without getting sick.

Researchers at Massachusetts General Hospital followed eight people who had been put on highly active anti-retroviral therapy within six months of becoming infected.

In five cases, the subjects were able to later go off the often-toxic drugs, and their immune systems have been able to fend off the virus far better than expected. In the study, the subjects were followed from eight to 11 months after stopping drugs.

Researchers found that all eight patients had increased levels of immune cells that specifically fight off HIV.

"What we have is proof of principle - that at least under some circumstances we can induce the immune system to get the upper hand on the virus," said Bruce Walker, director of the Partners AIDS Research Center at Massachusetts General and senior author of the study.

The real challenge, he said, is to develop a therapy for people who have been infected for a long time.

Indeed, such efforts are under way, both in Walker's lab and elsewhere. Jay Levy of UCSF's AIDS Research Institute has been studying the use of the cancer-fighting drug interleukin-2, which is known to stimulate immune cells. He is also about to launch studies using particles of HIV injected into the system that would act like a vaccine, prodding the body to respond to the invading virus.

"I think the major impact of this story is that it indicates if we could get the immune system rallied to recognize the virus, then we could avoid using these (anti-retroviral) drugs," Levy said. "It's going to encourage a lot more people to look at the immune system," for answers to AIDS.

Walker said he believed the early drug therapy gave the body a chance to recognize the virus and gear up to fight it before it can overwhelm and begin to destroy the immune system, which eventually leads to full-blown AIDS.

It's one reason why Walker said it was important to diagnose HIV infection as quickly as possible. People who have picked up the virus recently usually experience flu-like symptoms weeks later.

There has been controversy of late over whether it is a good idea to put newly infected people on drugs right away. Many believe it could hurt the patient because the medications inevitably begin to fail, leaving them stranded with few options left.

The new study suggests early drug therapy may have a worthwhile effect, and it may not be necessary to continue it indefinitely. But the study is quite small, and the follow-up covers less than a year, so it is impossible to use it as a guide for day-to-day treatment - yet.

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