Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
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Newsday - May 27, 1998
Laurie Garrett - Staff Writer
While protease inhibitors, combined with other anti-HIV medicines, appear to obliterate the virus from a patient's bloodstream, HIV is quietly reproducing in hidden pockets of the immune system, according to Dr. William Paul, former director of the National Institutes of Health's Office of AIDS Research.
Theories currently guiding all HIV treatment in the United States constitute "an overly simplistic approach to HIV dynamics," write Paul, Tel Aviv University's Zvi Grossman and Mark Feinberg of the National Institute of Allergy and Infectious Diseases in today's Proceedings of the National Academy of Sciences. The dominant view among AIDS physicians and researchers is that the combination treatment kills off nearly all HIV, leaving only a tiny reservoir of virus strains hidden inside cells of the immune system. With time those cells will die, according to this theory. And then, it is argued, the patients will be free of HIV.
Paul and his colleagues, in contrast, say even when no viruses can be detected in blood of HIV patients, immune system cells hidden far from the circulatory system are manufacturing viruses.
"We argue those pools [of HIV-positive cells] are being continuously replenished. So you will have to be treated forever," Paul said in an interview. "No one is getting cured."
Earlier this year Paul stepped down as Office of AIDS Research director, returning to directing the Institute of Allergy and Infectious Disease's immunology division. As immunologists, Paul and his colleagues believe the drugs currently available cannot reach those infected immune system cells - and, therefore, cannot prevent production of lethal viruses.
Paul noted some of those virus-producing cells are capable of surviving more than two decades.
"This bodes extremely poorly for . . . [combination therapy] as something curative," Paul said. Given the toxicity of the drugs, it's unlikely anyone can tolerate taking them for more than a few years.
What sparked Paul's concern was a study by Simon Wain-Hobson and his colleagues at the Pasteur Institute in Paris. They analyzed spleens from men who died of AIDS, discovering tens of thousands of pockets of HIV-infected cells, deeply hidden in lymphatic tissue. Genetic analysis of those hidden pools showed that each one was filled with different HIV strains.
These hidden cells infected with HIV will begin mass-producing viruses as soon as they are exposed to something that triggers the immune system - a measles infection, the flu, a common cold. And then, Paul says, bursts of HIV emerge, infecting new, also hidden, cells. Thus, no matter how long a person is treated with anti-HIV drugs, there will always be new viruses.
Drs. George Shaw of the University of Alabama in Birmingham and David Ho of the Aaron Diamond AIDS Research Center in Manhattan could not be reached for comment. They are the primary proponents of the commonly held view that medication thoroughly suppresses the virus and that treatment will ultimately cleanse patients of all infection.
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