Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.
New View of How HIV Works
Newsday - January 12, 1995
Laurie Garrett. Staff Writer
Two billion viruses and a million opposing immune system cells are produced each day in the bodies of people infected with the AIDS virus, killing each other quickly as replacements rush in - a struggle that goes on for years. Eventually, the virus, having exhausted its opponent, wins, and the result is AIDS. This new view of the human immunodeficiency virus disease process - which supports the idea of a strong immune system, rather than a weak one, that's simply overwhelmed over time by killer viruses - is presented in two remarkably similar studies in today's edition of the British science journal, Nature. The studies show that every one of the immune system's CD-4 cells is replaced by new cells within 14 days, but that the virus counteracts this by replenishing its numbers within three days. The only glimmer of hope in this otherwise dismal picture is what scientist Dr. David Ho, director of the Aaron Diamond Research Center in New York, called "very promising" research results using a new drug made to block virus production. In one of the studies highlighted in Nature, Ho's team used the drug - dubbed ABT-538 and made by Abbott Pharmaceuticals - to deliberately alter the rate of virus production. Though clinical details on the drug obtained from a second set of studies will not be available until the end of January, Ho said the drug was "very potent and the effect is durable in some, but not all, patients. We're very high on this protease inhibitor [drug]." The durability of drug effects is a critical problem with all anti-HIV agents because the virus rapidly mutates around anything thrown its way. The other study in Nature - conducted by a University of Alabama team led by Dr. George Shaw - found that all of the viruses extracted from patient volunteers had mutated within 28 days to be resistant to nevirapine, the drug used in that study. Other experimental drugs, including ABT-538, were rendered useless by viral mutation on similar or somewhat longer timescales. "If ever you're going to be successful, you're going to have to have combinations of antivirals that are effective over extended periods of time," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "I am impressed by how rapidly the virus comes back to its former levels once it develops resistance." Fauci said the studies "clearly nail down the scientific rationale for wanting to treat someone as early as possible in the course of the disease with a combination of powerful drugs. If we had such drugs." Dr. Simon Wain-Hobson, of the Pasteur Institute in Paris, agrees. In an editorial in today's Nature, Wain-Hobson says the New York and Alabama studies show where resources should be directed. In sheer numbers, both the viruses and the immune system mount attacks equivalent to what's seen at the peak of viral infections such as measles or influenza. However, in these cases, numbers this high are produced only over a period of hours, at most days, when the patient is acutely ill. "What's different with HIV is that these numbers go on for years and years," Ho said.
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