Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
Newsday - February 2, 1999
Laurie Garrett - Staff Correspondent
Furthermore, treatment with Highly Active Antiretroviral Therapy, a combination of powerful anti-HIV drugs called HAART, fails to eliminate millions of viruses that hide inside specific populations of cells, including those in seminal fluids and the vagina.
Taken together, these findings support ongoing concern about the longterm efficacy of HAART treatment, and about the potential for further spread of the virus from apparently successfully treated patients.
Mathematician J. E. Mittler of Los Alamos National Laboratory used the latest available data on viral reproduction and the lifespans of cells in which HIV hides, reaching new conclusions about the true scale of the challenge for successful treatment. His calculations reveal that more viruses are made every day in infected people than previously thought, and that the five-day lifespan of latently infected cells is twice as long as was estimated in 1996.
"We are really pushing the limits of mathematical calculations here," Mittler said, noting that the most sophisticated computational capacities were employed in his analysis.
To obtain more biological evidence upon which to base their calculations, Bharat Ramratnam and Dr. David Ho of the Aaron Diamond AIDS Research Center in Manhattan carried out a dramatic experiment on four HIV patients. The volunteers, none of whom was on HAART, or triple-drug therapy , checked into the Rockefeller University Research Hospital in Manhattan. All of the blood was slowly removed from their bodies, the plasma was separated out, and the remaining blood was returned to their bodies.
Removing the plasma effectively eliminated about half of the viruses from their bloodstreams. The researchers then watched, and counted, seeing how rapidly the numbers of viruses in the patients' bloodstreams returned to high levels.
The answer was that in about two hours the virus populations swiftly returned to their previous levels, usually well in excess of a billion viruses. In contrast, Ramratnam said, antibodies against HIV fell dramatically in number during the treatment and a full day passed before they even began to be replenished.
When patients go on HAART, those viral populations in their bloodstream plummet, usually to below the technological limits of detection. But yesterday, Dr. Roger Pomerantz of Thomas Jefferson University in Philadelphia presented evidence that HIV in such patients hides in their semen and vaginas, where passage to sexual partners is possible.
Pomerantz expanded upon previous reports of sexual transmission of HIV from HAART patients, noting that genetic analysis of those hidden viruses reveals them to be what he called, "fossil archival viruses," or old microbes that have lingered, despite drug treatment. This suggests the terrible possibility that drug treatments cannot reach viruses hidden in genital areas, and therefore cannot slow the spread of HIV.
Offering further depressing news about HAART, researchers from the University of Alabama said that they have discovered that in two kinds of cell populations within the immune system, the virus inserts itself into human DNA, hiding from both antibodies and HAART drugs.
The size of those hidden populations, the researchers concluded, are stable, unchanged after an initial drop with HAART care. So, untreated, the patients had about 40 billion viruses in their bodies. With HAART they still have a lurking, lethal population of hundreds of millions of viruses, hidden inside their cells.
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