(CT) - SUNDAY, July 14, 1996 Edition: CHICAGOLAND FINAL Section: NEWS Page: 3 Word Count: 1,046
Jeremy Manier, Tribune Staff Writer.

A Chicagoan who has lived with HIV infection since 1984, Robert, 39, had entered the most dangerous stage of AIDS. "I was sick and getting sicker," he recalled.

His T-cell count--a vital indicator of the progression of AIDS--had reached a low of seven, compared to the normal range of 1,000 to 1,200 for the disease-fighting white blood cells.

Robert did not know then what would come of the new treatment he had started receiving just two weeks before. But now, after seven months on a regimen that includes indinavir, one of the revolutionary new drugs called protease inhibitors, Robert has gained back the weight he lost, is exercising for the first time in three years, and has resumed work as a wholesaler.

Even better, his T-cell count has returned to a minimum level necessary to sustain health--140 at the time of his last checkup two weeks ago.

Stories like Robert's have energized researchers and clinicians who met in Vancouver for the 11th international AIDS conference, which concluded Thursday. More than 15,000 medical professionals and AIDS activists from around the world attended the five-day event, the first of its kind in two years.

Although concerns over the protease drugs' price and staying power abound, recent results are adding to a growing consensus that combination therapies with protease inhibitors and older drugs now provide the best hope HIV patients have had.

"I'm realistic about it," Robert said. "If someone had told me five years ago that I'd still be alive today, I would have said no way. Now, I think I might be around for a while."

Such hope does not come easily to those familiar with the history of AIDS treatments. AZT, one of the first antiviral drugs used against HIV, never lived up to the hype that surrounded its introduction in 1986.

Like AZT, indinavir interferes with the virus' ability to replicate within T-cell genes. Indinavir and its chemical cousins attack an enzyme--protease--that helps the AIDS virus exploit T-cell DNA to make copies of itself.

On Thursday, Dr. Roy Gulick of New York University announced in Vancouver that 86 percent of patients taking a "cocktail" of indinavir, AZT and 3TC had undetectable levels of HIV for 48 weeks.

Only eight patients have been in Gulick's study for as long as 48 weeks, and no one knows how long the effects of the combination therapies will last. But Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the excitement about the new treatments is more than hype.

"I don't think it's fair to say that we don't know what this means, or we've been here before," Fauci said. "That's being too pessimistic because, taken in itself, this (treatment) is clearly better than anything we've ever seen."

Dr. Robert Murphy, director of the Northwestern University AIDS clinic, sounded even more encouraging. "The responses we're seeing now are absolutely incredible, compared to what was going on just six months ago," he said. "I mean, it's not two or three times better--it's ten or a hundred or a thousand times better."

Much of that praise arises from the fact that most patients taking the antiviral cocktails have not developed resistance to them. In medical terms, resistance refers to a point in drug therapy when a killer like HIV is no longer affected by chemicals.

For years, patients taking AZT alone went through a predictable pattern: good early results, followed by resistance and a long spiral toward death.

Experts now believe that protease therapies plummet HIV levels to a point where the virus can't mutate into resistant strains.

But keeping those levels low requires discipline: Robert must take 18 pills a day on a strict schedule. Even the slightest deviation could give his virus a chance to develop deadly mutations.

Some doctors have expressed concern that patients who fail to keep up the routine could pass on their resistant viruses to people now contracting HIV, making protease drugs ineffective.

Fortunately, according to Northwestern's Murphy, resistance to the new drugs may be hard to spread.

"It looks like even if you have the resistant mutation, as soon as you're off the drug the wild-type non-resistant virus comes back very quickly. So transmitting the resistant virus will be possible, but difficult."

But even if the combination therapies remain effective, their high price may place them out of many patients' reach.

All three protease inhibitors approved by the FDA since last December--Merck Pharmaceuticals' indinavir, Abbott Labs' ritonavir, and Hoffman-LaRoche's saquinavir--cost between $4,500 and $6,000 a year. Add to that the other drugs and tests that round out a typical treatment, and the total yearly bill may approach $20,000.

Robert knows how lucky he is to be free of that financial burden.

After finding out about the new drugs through the Internet last year, Robert fought for a place in an early study conducted by Merck, which continues to foot the bill for his indinavir.

"I could never afford to pay for these drugs on my own," Robert said.

Apart from resistance, doctors' main worry has been that HIV may still be hiding out in patients' lymph nodes and be undetectable. Preliminary data presented in Vancouver, however, indicated that levels of virus in the lymph nodes and blood plasma are about the same.

Such evidence contributes to Murphy's hope that the new drugs may transform AIDS into a chronic-yet-manageable disease, like diabetes.

"Diabetics don't have normal life spans, but they come close," Murphy pointed out. "They have complications along the way, but the ones who take care of themselves live pretty full lives. I think we're not far from that with AIDS."

Robert is leery of such predictions. He looks forward to celebrating his 40th birthday, but admits that he finds it hard to believe he's still around.

"It's scary, in a way," he said, grinning. "I'm suddenly faced with the fact I may have to start planning my life."

CAPTION: PHOTO: Robert, 39, was diagnosed with HIV in 1984. He is now taking an experimental drug mixture, with encouraging results. Tribune photo by Jose M. Osorio.

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