San Francisco Chronicle; Thursday, March 26, 1998
David Perlman, Chronicle Science Editor

In a detailed study of severely ill AIDS patients who have been treated at nine clinics across the country since 1994, a research team reported yesterday that by last June the new drug combinations had cut death rates among the patients by 70 percent and had curbed the rate of opportunistic infections by 73 percent.

This direct evidence of the power of the new drugs was coupled, however, with a warning from one of the world's leading AIDS researchers that inappropriate use of the newest drugs could cause the virus to develop dangerous resistance to the drugs, and that merely killing free-floating viruses in the bloodstream can still leave "reservoirs" of the virus hidden inside infected cells.

The report on the dramatic effect of the drugs is being published today in the New England Journal of Medicine by a team headed by Dr. Frank J. Palella Jr. of Northwestern University Medical School in Chicago. The nine AIDS clinics were located in major cities from Washington, D.C., to Oakland, and more than 1,250 patients were followed while under treatment.

In 1994, Palella and his colleagues noted, only one-quarter of the patients were being treated with more than one anti-viral drug, but by last year the vast majority were receiving two of the standard anti- virals plus one of the four new compounds known as protease inhibitors. The newest drugs, which first became widely available in 1996, have been shown to cut circulating virus levels in the blood of infected people to levels so low that they are virtually undetectable.

In a statistical look at the declining rates of death and illnesses, the researchers noted that the results of drug treatment were barely noticeable in 1995 and 1996. By the time the protease inhibitors were added to the combination therapy, deaths and illness dropped swiftly to the astonishing 70 percent level.

Until this report, the most optimistic national figures gathered by the Atlanta-based federal Centers for Disease Control and Prevention showed that death rates among adults aged 25 to 44 had fallen 26 percent by 1996 -- due to several factors, including increasingly successful AIDS prevention efforts and the early use of the protease inhibitors. Another CDC report showed that among all age groups, AIDS death rates had fallen by 12 percent during the same period.

In the more limited report from Palella's study, the most significant drop in death rates came from patients treated under private insurance, where the triple drug combinations, including the most effective protease inhibitors, is standard. Publicly funded clinics were least likely to use the new drugs, and also least likely to treat patients with more than one of the older anti-viral drugs, Palella said. The same was true of patients covered by Medicare or Medicaid, he said.

Since the protease inhibitors were introduced, AIDS specialists have been debating whether the treatment policy should be to "hit early and hit hard" with the new drugs once tests show patients have been infected, or whether it is better to wait until their immune systems show serious damage.

Dr. Jay A. Levy of the University of California at San Francisco, who was a pioneer in discovering the AIDS virus and determining its mechanism of infection, said there are dangers in using the protease inhibitors too soon.

Levy was a featured speaker in San Francisco yesterday at the city's 10th annual National AIDS Update Conference, where hundreds of community workers, nurses, doctors and volunteers gathered at the Bill Graham Civic Auditorium to compare effective strategies for prevention, AIDS services and treatment.

In his talk covering the latest developments in AIDS research, Levy acknowledged that the protease inhibitors have been remarkably effective in suppressing the virus and returning thousands of people with AIDS to healthy and productive lives.

But he warned that applying the new drug combinations too early in the course of the disease could suppress the normal ability of a patient's immune system to cope with the first stages of infection, which would allow strains of HIV to mutate and become drug resistant.

At the same time, he cautioned, although the new drug combinations can in fact swiftly reduce the "viral load" of AIDS patients to undetectable levels in their blood, the drugs still leave reservoirs of virus within infected cells, where they may lie undetected for long periods before transferring infection to other cells of the immune system.

980326
SC980303

Always watch for outdated information. This article first appeared in 1998. 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, 1998. 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. .