San Francisco Examiner - Wednesday, Dec. 18, 1996
Lisa M. Krieger, Examiner Staff

In all six patients tested, "the virus reached levels that were below detection in both the plasma and lymphs at three months," Mills said in an interview. "There was a very rapid decrease, then a slower gradual decline."

"This doesn't mean that there was no virus hidden there," Mills said. "We don't know what is happening below the limit of detection, because we can't yet see it. . . . That would give people a completely false image. But it is incredibly exciting.

"Is the virus still there? I think the answer is yes. I am assuming it is."

The lymph glands - in this particular study, the tonsils - are major reservoirs of HIV infection, hiding 98 percent of the virus. Moreover, the lymph glands are part of the immune system. They are, in effect, where the disease happens.

So studies that examine HIV's presence - or in this case, virtual disappearance - in the lymphs give a truer picture of the disease process.

Until recently, scientists were limited to measuring the virus in blood plasma, where a mere 2 percent of HIV resides. All scientific assumptions about HIV pathogenesis have been based on what was seen in this fluid, which may not represent what is really going on.

The only way to see if the virus has been eradicated in these six patients is to stop therapy and see if it comes back, said Mills, whose visit was sponsored by the Conant Research Foundation. Mills and AIDS expert Dr. Marcus Conant spoke at a public forum Monday night.

Mills recounted how he had returned to his lab after a night of partying on England's Guy Fawkes Day to find a fax from Chiron Corp. detailing the results of his study.

Despite his fatigue, he knew from one glance that the combination of drugs - AZT, 3TC and the Abbott protease inhibitor ritonavir - had worked. He called Chiron scientists, then worked the rest of the night writing an interpretation of the data to present to his colleagues.

The discovery that this triple combination of drugs can so successfully suppress the virus in the lymph glands does not mean that every drug combination will work, Mills cautioned.

In fact, other combinations of drugs that have suppressed the virus in the plasma have been far less effective in the lymphs. In these treatments, "the lymph is still teeming with virus," Mills said.

"We have to get the answer to the question, which are best combinations?" he said.

"There is room now for guarded optimism," Mills said. "But we still have to exercise caution."

How to test a cure?

Twenty-one men infected with HIV have been able to stave off illness for the past year by gulping down triple-combination medicines.

Now, according to the Wall Street Journal, Dr. David Ho and his team of researchers at Aaron Diamond Research Center in New York are asking them to do the unthinkable: halt the regimen.

It is an audacious gamble. But Ho and others believe it is the only way to test whether the treatment approach, which has boosted the health of thousands of patients this year, could become an outright cure for AIDS if used early and intensively enough.

So far, though, none of the patients has agreed to stop treatment.

"Would you?" asks one test subject, identified only as Scott, a health care worker who refused researchers' request two weeks ago.

Many of the patients have gone a year without detectable virus levels in the blood. The Diamond researchers will continue following them, asking them periodically to go off therapy.

Other researchers say the researchers should pursue more realistic goals, such as discovering new targets in the virus for attack and testing which combinations of drugs work best. They note that no drug therapy has ever been able to vanquish any virus, let alone HIV.

But "the only way we'll find out is to do the experiment," Ho said. "Only with data can we move ahead."

Is it possible he is wrong? "Absolutely," he said. Then he added, "I don't think I am."

Free viral load test

A important new test is now free to HIV-positive patients who can't afford it.

The $150 test measures HIV levels in a patient's blood, revealing the degree of infection. Doctors treating patients with anti-viral drugs use the test to see if the treatment is working.

The deal, six months in the making, was negotiated between the San Francisco AIDS Foundation and test makers Chiron Corp. and Roche Molecular Systems. The San Francisco Health Department will conduct the testing at San Francisco General Hospital and neighborhood health clinics.

The companies will offer the test for free to indigent patients until the federal government starts paying for it. For information, call (415) 863-2437.

News briefs

*Health and Human Services Secretary Donna Shalala announced the award of $227.7 million to 49 metropolitan areas to provide care to Americans living with HIV and AIDS. The grants, issued under the Ryan White Comprehensive Care AIDS Resources Emergency Act, include $18.9 million to San Francisco, $3 million to Oakland and $1.2 million to San Jose.

*Groundbreaking is expected next month on a new San Francisco shelter for 25 chronically homeless men with mental, drug or HIV problems. The shelter, called A Man's Place, will be located at 399 Fremont St. in South of Market.

*Dr. David Baltimore, a Nobel laureate microbiologist at Massachusetts Institute of Technology, will lead an effort to revitalize the nation's drive to develop an AIDS vaccine, the National Institutes of Health says.
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