Newsday - July 1, 1998
Laurie Garrett - Staff Correspondent

Ho's decision to conduct the vaccine experiment comes in the wake of dismal news and real dangers involved with the standard treatment: Highly Active Anti-Retroviral Therapy, or HAART. This therapy involves a protease inhibitor and a combination of two older drugs.

The clinical trial, already approved by the Food and Drug Administration, will begin next week, said Ho, who is director of the Aaron Diamond AIDS Research Center in Manhattan. It will involve several HIV-positive men who have been on HAART for at least two years and have attained full suppression of HIV in their blood. The men will be vaccinated with a new French product developed by the Merieux Co. The vaccine is a canary pox product with components of four parts of HIV in it.

The hope is that once vaccinated these men will be able to mount an effective immune response against the up to 1 million viruses that are hidden throughout their bodies and are not detected in standard blood tests.

"We're ready to go with subjects who have had no detectable plasma HIV for over two years," Ho said.

The new intiative was revealed on a day that key AIDS researchers, including Ho, reported one set of grim statistics after another, all confirming HIV's ability to keep replicating, even when it appears indetectable in the blood.

Ho said yesterday that not only is HIV still present in patients having apparent success on the HAART treatment, but "we certainly have evidence of ongoing replication [of HIV], feeding back through the reservoir pool."

Even more striking, according to Ho, is analysis of the viruses that are growing and spreading in hidden reservoirs in the bodies of "successfully treated" patients. The analysis reveals "evolution of viral sequences, more and more with time" - meaning these strains are replicating and mutating.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has studied dozens of HIV patients who are on HAART. After as many as three years of seemingly successful therapy in which no viruses could be found in their blood, Fauci said in a speech, close analysis of hidden regions, such as tonsils and lymph nodes, reveals HIV "in every one of those individuals, and in each one we were able to isolate replication-competent virus . . . every one of them had virus in a latent pool."

Several other researchers - notably Dr. Robert Silicano of the Johns Hopkins School of Medicine in Baltimore - presented evidence that the size of this pool of lurking viral death is determined within days after a person becomes infected. And it stays the same size, no matter what drugs or cocktails of antivirals an individual takes.

"With what we have now [for treatment] I don't even think that [reservoir] is ever going to be eradicated," said a disheartened Silicano in an interview. "If only you had a way to eliminate these latently HIV-infected cells."

Canadian researcher Richard Paul Harrigan announced yesterday that he has invented a way to measure the presence of viral DNA in blood. Current tests only count HIV RNA, but when the virus hides, or goes latent, it converts itself into DNA and inserts into human genes. With his breakthrough test, Harrigan found that the half-life of this viral DNA is so long that it will take years to clear from the body on its own.

SUNY-Stony Brook's Dr. Roy Steigbigel said in an interview that he fears patients are getting an overly depressing picture of the situation.

"There's a lot of room for optimism here," Steigbigel insisted.

But the frustration of the AIDS community could be heard in the words of Manhattan patient Mark Harrington, who as a plenary speaker addressed the 13,000 people attending the conference.

"Let the experts mix and match tiny drug company studies . . . It's still guesswork," Harrington said. "We come to conference after conference to hear about product-driven studies conducted or heavily influenced by pharmaceutical sponsors . . . Researchers also urge us not to worry, promising a plethora of new drugs and new targets . . . Some of us don't have time to wait."
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