United Press International - Wednesday, May 26, 1999
Ed Susman

In a series of articles in Thursday's issue of the New England Journal of Medicine, researchers say the virus continues to mutate even when it can't be detected in a patient's blood as long as three years.

Lingi Zhang, a researcher at the Aaron Diamond AIDS Research Center at Rockefeller University, New York, studied HIV recovered from eight patients whose blood level of the virus had remained undetectable from two to three years. But he was able to use molecular and genetic tools to find virus capable of replication in other body reservoirs, such as the lymph system.

Zhang suggested that it will take at least seven to 10 years of highly active antiretroviral therapy (HAART) to eliminate the reservoir, but he has doubts that is possible.

"It will be difficult to maintain treatment for such a long time, thus, we must find ways to facilitate a decrease in the size of the pool of latent virus."

In a second paper that analyzed the virus potential to mutate, Manchar Furtado of the department of pathology at Northwestern University Medical School, Chicago, said he was still able to detect replicating virus in patients who had undetectable viral blood levels for more than 20 months. Furtado also found virus in the patients lymph system.

"Our data suggest that even after two or more years of complete suppression of plasma (blood) levels of HIV, viral transcription continues....Our results suggest that this reservoir represents a serious impediment to the long-term goal of eradication of HIV," said Furtado.

"The eradication of HIV from the body is an elusive goal," said Dr. Franco Lori, co-director of the Research Institute for Genetic and Human Therapy (RIGHT) at Georgetown University, Washington, DC.

Lori, a co-author of a letter in the journal, describes the "Berlin patient", a man who maintains very low levels of HIV, despite abandoning treatment.

"The papers in the journal pretty much confirm that eradication is becoming more and more an elusive goal. We know the virus has quiescent -- sleeping cells -- and sometimes these cells wake up and produce more virus. These cells stay around for a long, long time," Lori said.

Julianna Lisziewicz (LIHZ-ee-eh-VITZ), co-director of RIGHT in Pavia, Italy, suggested a series of unique events may have allowed the Berlin patient to ward off the virus.

"He was treated very early in his infection, he went on and off treatment creating an intermittent treatment protocol, and he used the anticancer drug hydroxyurea in the treatment," Lisziewicz said. All three elements, she said, may have resulted in his ability to maintain health even though viable virus can still be found in his body.

Lori suggested that by stimulating an intact immune system early in HIV infection, this patient's body has learned to keep the virus in check -- much the way most people's immune systems keep herpes and other viruses in the body at bay.

Lori said he and other investigators are trying to replicate the Berlin patient protocol, working first with monkeys and a few human subjects. He cautioned both doctors and patients that the intermittent therapy is still just a theory and could be dangerous if attempted without further studies.

Despite the authors' suggestions that AIDS eradication may not be possible, Dr. Roger Pomerantz of the Jefferson Medical College of Thomas Jefferson University, Philadelphia, said scientists should not abandon the idea.

"Although the goal of a therapy capable of eradicating HIV in selected patients remains difficult to achieve, a review of the history of this epidemic still suggests reasons to remain quite optimistic about the future."
990526
UP990503

Always watch for outdated information. This article first appeared in 1999. 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, 1999. 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. .