San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Tuesday, September 30, 1997 - Page A1
David Perlman, Chronicle Science Editor

The drugs, known as protease inhibitors, have been shown to wipe out the AIDS virus in some patients so completely that the load of virus in their blood becomes undetectable. Many patients near death have even remained free of symptoms as long as they take the new medications regularly in combination with some of the older AIDS medications.

The new study, which tracked 136 patients for at least six months at the San Francisco General Hospital AIDS clinic, shows that the the new drugs -- generally taken in combination with older AIDS medications such as AZT and 3TC -- failed for 53 percent of those patients.

On the other hand, those San Francisco clinic patients who entered treatment early -- well before such classic symptoms of viral infection as plummeting counts of immune system T cells and mounting burdens of AIDS virus in the blood -- fared much better.

Results of the study were reported yesterday by Dr. Steven Deeks of the University of California in San Francisco during a Toronto meeting on infectious diseases sponsored by the American Society of Microbiology.

"Our data supports the `hit hard, hit early' philosophy recommended by different panels of experts," Deeks said. "Treatment should begin before the patient's T cells drop to low levels."

In recent well-controlled clinical trials of the new drug combinations, failure rates have ranged from only 10 to 20 percent, Deeks noted.

But patients who are the first to volunteer for those studies typically are more sophisticated, better-educated and in the earlier stages of the disease than are the more typical AIDS patients treated at one of the nation's largest public clinics.

"This was a real-world study," Deeks said. "We were looking at patients who were not the ideal research patients typically found in a clinical trial but were the average patients seen by our physicians in a public health hospital."

According to Deeks, most of the drug failures his team observed occurred in patients who had tried many of the earlier AIDS medicines in the past, whose immune system T cells were badly depleted or who were most severely infected by HIV, the AIDS virus. Some also had trouble complying with the rigid pill-taking routines required with protease inhibitors and combination-drug therapies.

Still unknown, Deeks said, is just how long the four protease inhibitors now on the market will remain effective, even for those patients who begin using them in prescribed combination with other approved AIDS drugs and for those who start treatment early.

Ever since the first glowing results from short-term trials of the protease inhibitors were reported two years ago, AIDS experts have feared that sooner or later, the AIDS virus would become resistant to the drugs and patients who had begun to improve would relapse.

This is what appears to be happening -- particularly with patients who are most severely stricken. Failure of one of the new protease drugs appears to make the others ineffective, too.

That phenomenon, known as cross-resistance, was confirmed yesterday in another report by Deeks and his colleagues at the Toronto meeting.

A small study of 16 patients shows that in cases where one of the protease drugs had begun to fail, switching to another, more powerful drug in the same class appeared to offer only limited benefits. The patients had a short-lived response to the drugs, he said.

"In our clinic, we appear to be seeing the epidemic split in two," Deeks said. "About half of our patients will see a long-term, possibly permanent response to these drugs, while the other half may begin to exhibit disease progression again."

Paul Wisotsky, chairman of the San Francisco AIDS Foundation, who was infected by the AIDS virus more than a dozen years ago and who has been seriously affected by the disease for the past three years, typifies the study's results.

"I'm not exactly the protease inhibitor poster child," Wisotsky said as he discussed the Deeks study. "I've been on three of the four new drugs for the past two years, and my disease has seemed a little stabilized now and then. It's been a roller coaster, and I still have AIDS."

The Deeks report "confirms what all of us thought would eventually be happening," Wisotsky said. "It looks as though some people have gotten really great benefits from the drugs, while in some, they haven't worked at all and in others, they have worked for a little while and then failed. It means that we've got to have more options, we've got to have continued research, and we've got to have more new drugs available."
970930
SC970910

Always watch for outdated information. This article first appeared in 1997. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1997. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .