Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.
Newsday - January 26, 1997
Laurie Garrett. Staff Correspondent
"I would be cautiously optimistic, but over the next two to three years we will be able to determine whether eradication [of HIV] is possible" in these children, Dr. Katherine Luzuriaga said in an interview yesterday at the fourth Conference on Retroviruses and Opportunistic Infections.
Luzuriaga's team of University of Massachusetts pediatricians and colleagues at the University of California at Los Angeles and the University of Connecticut Medical School treated six HIV-positive babies with three drugs: AZT, ddI and nevirapine. All target the same component of the human immunodeficiency virus, an enzyme called reverse transcriptase.
Initially, all six children, who were infected in utero, showed strongly positive results, as HIV seemed to disappear from their bodies. But after six months, the tenacious viruses resurged in four of the children. The scientists are now analyzing whether those viruses are mutant, drug-resistant strains.
The story is quite different for a set of twins born to an HIV-positive mother and adopted by a Massachusetts couple. After 28 months of treatment, they appear to be free of live AIDS viruses, Luzuriaga said.
One of the twins, a boy, had 400,000 HIVs measured in each droplet of his blood when he was 8 weeks old - meaning that billions of viruses were in his body. He was put on triple-combination therapy, and within four weeks his viral load dropped to below the limit of detection, which is less than 100 viruses per milliliter of blood.
After 16 months of treatment, HIV started to make a comeback, reaching 1,500 viruses per droplet of blood. So Luzuriaga took him off nevirapine and added a powerful protease inhibitor called ritonavir. The child's viral load plummeted, and he has been free of detectable live HIV ever since.
His twin sister was even more fortunate. Her initial therapy was completely effective and has remained so for 28 months.
Over 28 months of treatment the twins have suffered only the typical childhood ailments. They have received routine vaccinations and have acquired immunities to diseases such as measles. Their immune systems appear unaffected by their HIV infections, Luzuriaga said.
Viral particles and bits of viral DNA remain in the twins' bodies. Though the particles seem harmless, Luzuriaga is reluctant to declare the children HIV-free until all detectable viral fragments have cleared from their bodies. Still, she said, this study shows that "long-term control of HIV replication and potential eradication of infection may be feasible through early, potent combination therapy."
Additional optimistic reports came from researchers who studied the vaginal and seminal fluids of HIV-positive people undergoing antiviral drug treatment. Dr. Phalguni Gupta of the University of Pennsylvania headed a team that followed 34 gay Pittsburgh men for several years. The levels of HIV in the men's blood directly correlated with the amounts in their semen. When their blood HIV levels dropped below the limits of detection, the virus also disappeared from their semen.
Dr. John Lennox of Emory University in Atlanta found that the same was true of HIV levels in vaginal fluids.
But doctors warned that the findings did not mean that it might be safe for a person whose virus had seemingly disappeared to have unprotected sex.
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