Miami Herald - Thursday, June 8, 1989
Rosemary Goudreau, Herald Staff Writer

NCI director Dr. Samuel Broder brought the first bit of excitement about progress in the treatment of AIDS since news of the anti-viral drug AZT was announced at the conference three years ago.

Broder even used the word "cure" -- the first top government official to talk that way in years.

The word came up during his discussion of an enzyme called reverse transcriptase, which the AIDS virus needs to replicate.

"Attacking the virus by this unique enzyme has given us a foundation stone on which we can build new therapies and combination therapies, hopefully ultimately developing a cure for HIV infection, and I use that term specifically."

By "cure," Broder said he meant that AIDS patients would regain a life expectancy equal to that of uninfected people of the same age.

Broder also said that researchers have genetically engineered a molecule that "definitely works in the labs" at neutralizing the ability of the virus to bind onto the white blood cell that masterminds the immune system, the T-4 lymphocyte. The virus hooks onto the blood cell at a site called the CD4 molecule.

"If I had said that to you when I spoke in Washington two years ago, many of you would have concluded that this was a science fiction approach, but we are on the verge of being able to adapt such molecules and administer them on an experimental basis to people who are HIV infected," said Broder, who used to head the NCI's laboratory for new drug development until his promotion a few months ago.

The cancer institute has been a leader in research of AIDS because one of the first infections identified in the syndrome was Kaposi's Sarcoma, a form of skin cancer.

Genetically engineered CD4 neutralizing antibodies also show a significant ability to reduce viral production in blood cells called macrophages, which are believed to harbor most of the virus and are the most difficult to penetrate, he said.

The bad news on the treatment front is that some patients taking AZT, the only drug proven to prolong life the lives of people with AIDS, are developing viral strains resistant to the drug. However, those people might respond to three anti-viral drugs -- called ddC, ddi and dda -- which are in preliminary stages of clinical trials in people.

Broder said researchers are about to begin a study with 200 patients in which they are alternately given ddC and AZT. In a small study of 25 patients switching between the two drugs, the longest survivor has broken the two-year mark and is showing a major drop in p24 antigen and a significant increase in T4 cell counts -- the two major measurements for marking progression of the disease.

An ongoing study of 40 patients getting treated with ddi shows a similar drop in the p24 antigen and rise in T4 cells. Broder said he could not compare ddi to the AZT-ddc treatment, but "we believe in it to a clinically significant degree. I wouldn't show you data if I was misleading you. We feel that this is a clinically relevant change and merits further study."

Reasons for the increasing survival rate of people with AIDS have to do with the use of AZT and the ability to better treat the infections that go with AIDS.

An update on AZT, presented by Dr. Margaret Fischl, head of AIDS research at the University of Miami School of Medicine, showed that 21 percent of AIDS patients on AZT were still alive at 30 months. The odds of survival increase even more when patients are given aerosol pentamidine to ward off pneumocystis carinii pneumonia, the major cause of death in people with the disease.

It is important to start AZT treatment as soon as a diagnosis of AIDS or AIDS-related complex is confirmed to get its maximum effects, she said.

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