United Press International; Saturday, June 27, 1998 10:53:00 PM
Ed Susman, UPI Science News

At a briefing prior to the 12th World AIDS Conference in Geneva, AMA officials unveiled a study showing immediate "cocktail" treatment suppressed the virus to undetectable levels 65 per cent of the time, as opposed to 30 per cent with incremental therapy.

Dr. Roy Gulick, assistant professor of medicine at Cornell University Medical College, New York, says his study may explain why fewer than expected AIDS patients do well on potent protease inhibitor drugs. Gulick says 65 percent of the 32 patients in his study who were started on a combination of the protease inhibitor Indinavir, and two nucleosideanalogs, AZT and 3TC, dropped the circulating virus to undetectable levels. The virus has remained undetectable in these 65 percent for two years or longer.

The story was different for patients who were given a protease inhibitor first and then had the nucleosides added; and for persons given the nucleosides first and then had the protease inhibitor added. Only 30 to 35percent of these 59 patients saw their virus dip into undetectable ranges.

When the first reports of the success of the combination were announced in 1996 at a Washington retrovirus meeting, researchers reported that 80 percent of patients had undetectable levels of the virus. Gulick explained that those studies were done with less sensitive tests. The new tests can detect as few as 50 copies of the virus as opposed to 500-copy detection levels in the older tests. While the study was done with specific drugs, Gulick says his work shows that "it appears sound to use potent drugs from different classes" in fighting AIDS.

Updated treatment recommendations, also announced at the briefing, call for AIDS treatment to begin with triple combination therapy containing one protease inhibitor and two nucleoside analogs. Dr. Charles Carpenter, professor of medicine at Brown University, who reported on the recommendations for colleagues at the International AIDS Society, says that by selecting drugs that have different modes of action,the virus can not build resistance one drug at a time. Carpenter says other drugs being developed may allow doctors to avoid giving protease inhibitors. The potent drugs seem to cause fat to move from normal areas and cause disfiguring lumps between the shoulders or protruding abdomens, and also cause worrisome increases in cholesterol levels.

Carpenter says studies find as many as 50 percent of patients develop these abnormalities after taking protease drugs for two years or longer. Gulick says only two or three patients in his study suffered these side- effects, but he admits his researchers were not looking for the unexpected developments. The abnormalities were first reported in February at a retrovirus meeting in Chicago.

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