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 - August 25, 1998
Laurie Garrett - Staff Correspondent
Patients taking a combination of antiviral drugs received powerful immune-system stimulators, agents that make them quite sick but that drive hidden HIV pools out into the open to be assaulted by the antiviral drug cocktails. In a total of five cases in two separate studies, patients appear to have cleared all viruses from their bodies, based on sophisticated tests.
"This does not imply, nor does it prove, that we have eradicated anything," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, Md., said in an interview.
Nevertheless, Fauci and Dr. Clifford Lane did obtain startling results from three of 13 patients in whom they tried the bold treatment strategy. The 13 were among 26 patients who appeared to be doing well on the standard anti-HIV drug combinations. All had eliminated viruses from their blood, so by standard tests they were "virus free."
But viruses lurked in hidden reservoirs in their bodies, and Lane and Fauci took a gamble, deliberately making 13 of them very sick. The idea was to fool the immune-system cells in which HIV hid, making those cells believe the body was under dangerous all-out attack from invading microbes. To do this, the patients were given infusions of a natural human chemical, called IL-2 or interleukin-2, which essentially puts out an emergency alert throughout the immune system. This brings on terrible headaches, high fevers and a variety of severe flu-like symptoms.
The result is that quiescent immune cells "wake up" to fight a non-existent enemy. The HIV inside of them are then flushed into the blood, where they are vulnerable to the anti-viral drug cocktails.
Three of the patients' results were so promising that culture analysis of more than 300 million white blood cells revealed no HIV. The other 10 continued to do well, but culturable viruses were found.
Calling the results promising, Fauci cautioned, "We don't know if this is clinically relevant."
The work is similar to that done by Dr. Joep Lange of the University of Amsterdam. Lange also gave his patients IL-2 and the standard anti-HIV drugs. He then went several steps further, as he described at yesterday's meeting at the Insititue of Human Virology here, giving all the patients five anti-HIV drugs at once. He also hospitalized the young men and infected them with lab-engineered monoclonal antibodies, immune-system agents that attack certain types of immune-system cells. The entire immune system goes on full-scale war alert.
In two of three patients treated in this manner so far, the results are hopeful. Later attempts to induce virus production in lab samples of these patients' cells proved impossible.
"There's still many things that are unclear," Lange said in an interview. "I don't think anyone can declare a patient cured."
The only way to know whether such radical treatments are eliminating HIV is to stop the treatment cold, Dr. Giuseppe Pantaleo of the Hospital Beaumont in Lausanne, Switzerland, said in an interview. If virus then returns, the therapy obviously failed.
Lane is going to follow Pantaleo's suggestion. Starting this fall, any patient who by any therapeutic means has held his or her viral blood load below five copies of HIV per milliliter of blood for more than six months may enroll in Lane's study. He will then stop their treatments cold, Fauci said.
It might work, said Ashley Haase of the University of Minnesota. His lab finds "even late-stage disease patients on combination therapy get some immune reconstitution," so their bodies might be able to fight off HIV without the drugs.
Or they may need more help. Pantaleo is giving such patients an HIV vaccine in addition to antiviral drugs. Dr. David Ho of the Aaron Diamond AIDS Research Center in Manhattan is also trying that.
A new strategy is urgently needed, Lange said, because the current drugs have dangerous side effects and may not perpetually hold down viruses. "It really brings back a sense of urgency," he said. "It's a window of opportunity we have with [combination therapy]. But it's going to slam shut again."
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