Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

Reuters NewMedia, Inc.; Tuesday June 30 3:07 PM EDT
Patricia Reaney

Drug cocktails including the latest protease inhibitors can reduce the virus that causes AIDS to undetectable levels in patients but there is still a latent reservoir, or pool, of infected cells in every patient.

"I can never say never in biology," said Dr. Anthony Fauci of the U.S. National Institutes of Health, "but so long as we've looked it seems it is going to be very, very difficult to truly eliminate and eradicate this pool." Fauci and other scientists told the 12th World AIDS Conference that every patient, even those in successful therapy for three or more years, have the latent pool which is formed early in infection and remains despite the most effective treatment.

The virus can lurk in lymphatic cells anywhere in the body but are most likely to be found in lymph nodes, the spleen or the brain.

"It's a very small pool but it's a very important pool because we know that it is the engine that gets re-ignited without therapy," Fauci told a press conference.

"We need to deal with this reservoir and we need to deal with it creatively." Dr David Ho, of the Aaron Diamond AIDS Research Center in New York, in response to a question said U.S. President Bill Clinton's call last year for scientists to produce a vaccine within a decade was possible.

"It's a tall order, but it doesn't seem unreasonable."

But like Fauci and Dr Robert Siliciano, of Johns Hopkins University in Baltimore who presented similar research, Ho's main concern and the focus of his research is the latent reservoir.

Ho said that despite successful combination therapy the virus is lurking and reproducing, although to different degrees in patients. One theory is that the antiviral drugs may not be adequately delivered to the latent pool. "The challenge to eliminate HIV from an infected person remains," Ho said during his presentation earlier Tuesday.

Scientists are not sure if, or how quickly, the pool diminishes with long-term drug therapy and are looking at strategies to eliminate or control it, possibly by boosting the body's immune system.

Fauci admitted "it was sobering news about the reality of where we are" but stressed that combination therapy has dramatically changed the lives of many HIV patients.

The problem now is how to tackle those residual cells. Otherwise patients face 10 or more years on combination therapy or risk regression if they discontinue treatment.

Given the difficulty of taking the complicated assortment of pills every day and the build-up of toxicity, such long-term treatment may not be feasible for many patients.

The scientists noted that some patients have come off therapy with no ill effects and that there are long-term non-progressors who are infected but manage to bring the virus under control themselves.

Ho said it is "achievable naturally, although rarely."

He called for intensified treatment to get a true impression of how persistent the latent reservoir is.

"We have a lot to do," admitted Fauci.

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